University of California Berkeley
Regional Oral History Office University of California
The Bancroft Library Berkeley, California
Aramco Medical Department Oral History Project
HEALTH AND DISEASE IN SAUDI ARABIA:
THE ARAMCO EXPERIENCE, 1940s- 1990s
VOLUME I
Interviews with
Richard Daggy
Armand P. Gelpi
Richard Handschin
Julius W. Taylor
Elinor Nichols
Dorothy McComb
Robert and Patricia Oertley
Ivor Morgan
Virginia Dooling
Richard Perrine
Ahmed Mustafa
Bernard J. Eggerman
Gordon Flom
Edited, and with an Introduction by
Armand P. Gelpi
Interviews Conducted by
Carole Hicke
in 1996 and 1997
Copyright 1998 by The Regents of the University of California
-f
Since 1954 the Regional Oral History Office has been interviewing leading
participants in or well-placed witnesses to major events in the development of
Northern California, the West, and the Nation. Oral history is a method of
collecting historical information through tape-recorded interviews between a
narrator with firsthand knowledge of historically significant events and a well-
informed interviewer, with the goal of preserving substantive additions to the
historical record. The tape recording is transcribed, lightly edited for
continuity and clarity, and reviewed by the interviewee. The corrected
manuscript is indexed, bound with photographs and illustrative materials, and
placed in The Bancroft Library at the University of California, Berkeley, and in
other research collections for scholarly use. Because it is primary material,
oral history is not intended to present the final, verified, or complete
narrative of events. It is a spoken account, offered by the interviewee in
response to questioning, and as such it is reflective, partisan, deeply involved,
and irreplaceable.
************************************
This manuscript is made available for research purposes. All
literary rights in the manuscript, including the right to publish,
are reserved to The Bancroft Library of the University of
California, Berkeley. No part of the manuscript may be quoted for
publication without the written permission of the Director of The
Bancroft Library of the University of California, Berkeley.
Requests for permission to quote for publication should be
addressed to the Regional Oral History Office, 486 Library,
University of California, Berkeley 94720, and should include
identification of the specific passages to be quoted, anticipated
use of the passages, and identification of the user.
It is recommended that this oral history be cited as follows:
To cite the volume: "Health and Disease in Saudi
Arabia: The Aramco Experience, 1940s- 1990s, " an oral
history conducted 1996-1997 by Carole Hicke, Regional
Oral History Office, The Bancroft Library, University
of California, Berkeley, 1998.
To cite an individual interview: [ex.] Interview with
Richard Daggy, an oral history conducted in 1996 by
Carole Hicke in "Health and Disease in Saudi Arabia:
The Aramco Experience, 1940s- 1990s, " Regional Oral
History Office, The Bancroft Library, University of
California, Berkeley, 1998.
Copy no.
Cataloging information
Health and Disease in Saudi Arabia: The Aramco Experience, 1940s- 1990s,
1998, 2 vols., xxiv, 799pp.
Recollections of fourteen medical professionals in Saudi Arabia who from
the 1940s through the 1990s participated in a unique program to mitigate
and solve not only the health problems of Aramco corporate employees and
their dependents but those of the local population as well. Eliminating
malaria; Harvard-Aramco Trachoma Project; Dhahran Health Center and
outreach clinics in oasis villages; other health and disease problems:
smallpox, Q fever, tuberculosis, sickle cell anemia, schistosomiasis,
ascaris pneumonia, cholera; maternal and child health program; nursing
staff; psychiatric care; surgical clinic; preventive medicine measures;
ob/gyn clinic; dental care; new hospital facilities.
Interviews with Richard Daggy (b. 1914), medical director; Armand P. Gelpi
(b. 1925), chief, medical services; Richard Handschin (1918-1997), medical
director; Julius William Taylor (b. 1922), medical director; Elinor Nichols
(b. 1927), wife of Roger Nichols, director, trachoma project; Dorothy
McComb (b. 1931), researcher, trachoma project; Robert Oertley (b. 1925),
director, preventive medicine, and wife Pat Oertley; Ivor Morgan (b. 1914),
chief, ob/gyn services; Virginia Dooling (b. 1934), nurse supervisor;
Richard Perrine (b. 1918), chief, internal medicine; Ahmed Mustafa (b.
1932), chief, internal medicine; Bernard J. Eggerman (b. 1927), chief,
dental services; Gordon Flom (b. 1927), coordinator, medical development
and construction. Written essay by John C. Snyder, dean, Harvard School of
Public Health.
Edited, and with Volume Introduction by Armand P. Gelpi.
Interviewed 1995 to 1997 by Carole Hicke, Regional Oral History
Office, The Bancroft Library, University of California, Berkeley.
ACKNOWLEDGEMENTS
The Bancroft Library, on behalf of future researchers, wishes to
thank the following individuals and organizations whose contributions have
made possible this oral history of the Aramco Medical Department. In
particular, we acknowledge the initiative, dedication, and countless hours
of work by Dr. Armand P. Gelpi, without whose efforts this project could
not have been done.
PATRON
Saudi Arabian Oil Company
DONORS
Paul Arnot
Elizabeth Arnot, in memory of Paul Arnot
Chevron (matching)
Richard Daggy
Carlton Dawson, in memory of Lewis V. Coleman
Lois and Gordon Flom
Dorothy McComb
Ivor I . Morgan
Richard P. Perrine
Peter and Ellen Speers
Julius W. Taylor
TABLE OF CONTENTS- -Health and Disease in Saudi Arabia: The Aramco
Experience, 1940s-1990s
INTRODUCTION by A. P. Gelpi i
VOLUME HISTORY xv
RICHARD H. DAGGY, PH.D., DR. P.H., PREVENTIVE MEDICINE IN SAUDI
ARABIA, 1947-1964 xviii
CONTENTS xix
INTRODUCTION by A. P. Gelpi xx
INTERVIEW HISTORY by Carole Hicke xxi
BIOGRAPHICAL INFORMATION xxii
I BACKGROUND AND EDUCATION 1
JI JOINING ARAMCO 2
Applying and Interviewing 2
Moving to Saudi Arabia 3
III ELIMINATING MALARIA IN SAUDI ARABIA 5
Identifying the Problem 5
Taking the Malaria Survey: A Ten-Year Study 6
Malaria Controls 8
Meeting the King 14
Other Preventive Medicine Programs 15
Smallpox 15
Looking for a Trachoma Vaccine 18
Public Health Program 18
IV WORK AFTER ARAMCO 23
Associate Dean, Harvard School of Public Health 23
University Associates 24
Some Statistics and Evident Changes 25
ARMAND P. GELPI, M.D., ARAMCO MEDICAL SERVICES: 1959-1969
CONTENTS 28
INTRODUCTION by A. P. Gelpi 30
INTERVIEW HISTORY 31
I BACKGROUND 33
Growing Up in Denver and California 33
Pre-med Training in the U.S. Navy, 1943-1945 34
Medical School 35
* Internship and Military Service During the Korean War 37
Residency in San Francisco and San Jose, 1952-1955 40
Practicing Medicine in the V.A. Health Care System 41
Private Medical Practice 42
II EMPLOYMENT WITH ARAMCO, 1959 43
Job Interview 43
The Move to Dhahran, Saudi Arabia 45
Aramco Health Care in Saudi Arabia Before 1959 46
Aramco s Dhahran Health Center 47
Community Clinics 50
More About Dhahran Health Center 50
III FACILITIES AND PATIENTS 52
Contract Facilities 52
Trips to Qatar in 1960 and 1968 54
Health Care at DHC and Other Aramco Facilities: Patients 57
Community Life 58
Aramco Medicine 58
Aramco Provides Medical Services to the Royal Family 62
The Persian Gulf Medical Society and Aramco s Medical
Department 64
IV HEALTH AND DISEASE IN SAUDI ARABIA 67
Smallpox 67
Malaria 68
Aramco s Health Care Program and the Saudi Government 70
More about Aramco and Malaria Control 72
Trachoma and Aramco s Trachoma Research Project 73
Q Fever in Saudi Arabia 75
Pulmonary Ascariasis 79
Cancer 82
Conference in Shiraz, Iran: G6PD Deficiency and Favism 85
Sickle Cell Trait and Sickle Cell Disease 90
Schistosomiasis 96
Pulmonary Tuberculosis 98
Hepatitis 99
V MEDICAL DEPARTMENT ADMINISTRATION 103
Reporting to Aramco Management 103
Hiring 104
District Visits and Medical Education 107
More on the Journal Club 109
VI RESIGNATION AND RETURN VISITS TO DHAHRAN 111
Leaving Aramco 111
Medical Research in Dhahran, 1974-1978 112
RICHARD HANDSCHIN, PREVENTIVE MEDICINE AND MEDICAL DIRECTOR:
1958-1968 114
CONTENTS 115
INTRODUCTION by A. P. Gelpi 116
INTERVIEW HISTORY 117
BIOGRAPHICAL INFORMATION 118
I BACKGROUND 119
II JOINING ARAMCO 121
Interview and Hiring 121
Moving to Saudi Arabia 122
III EPIDEMIOLOGIST 124
Annual Malaria Survey 124
Other Staff Members and Personnel 124
Tuberculosis and Smallpox 125
Personnel in Preventive Medicine 126
IV CHIEF OF PREVENTIVE MEDICINE 128
Responsibilities 128
Maternal and Child Health 129
Health Education Program 132
Trachoma Research 134
Malaria Research 134
Occupational Health Program 135
Statistical Data on the Impact of the Preventive
Medicine Program 136
V MEDICAL DIRECTOR, 1964-1968 139
Outpatient Clinics: Statistics on Patients 139
Developing Public and Private Medical Services 141
Relationships with Company Management 142
Hiring and Educating Staff 144
Dr. Ivan Alio 146
Lecturing at the American University of Beirut 148
More Statistical Data About Changes 149
Crucial Leadership of Dr. Richard Daggy 150
More Data on Patient Care 154
Need for Nursing Staff 156
VI OVERVIEW: GOALS AND ACCOMPLISHMENTS 157
JULIUS W. TAYLOR, SURGEON AND MEDICAL DIRECTOR: 1954-1978 162
CONTENTS 163
INTRODUCTION by A. P. Gelpi 164
INTERVIEW HISTORY 165
BIOGRAPHICAL INFORMATION 166
I BACKGROUND, EDUCATION, MILITARY SERVICE 167
II JOINING ARAMCO 170
Interview and Appointment 170
Moving to Dhahran, December 1954 171
IH DHAHRAN HEALTH CENTER 174
History 174
Patients and Cases 175
Concession Agreement 175
OB/GYN; Burns 177
Dental Service 177
Trauma 178
Staff Personnel 179
Smallpox 180
Medical Care Responsibilities: Dependents 182
Facilities and Living in Dhahran 183
The New Hospital 186
Developing Psychiatric Care 187
Accreditation 189
Medical Training 19A
IV CAREER DEVELOPMENT AND RESPONSIBILITIES 196
Chief Surgeon, 1961-1963: Hiring Staff and
Relationships with Management 196
First Open-Heart Surgery at Aramco 201
First Lung Removal 201
Evacuation Procedures 202
Contract HospitalsAnother Change 203
Attractions of Life with Aramco 20A
Chief of Staff, Clinical Services, 1963-1968 210
Dental Care 210
Administrative Matters 212
Medical Director, 1968-1978 212
More on Contract Hospitals 215
Medical Care for the King and Royal Family 218
Early Saudi Medical Practices 221
Preventive Medicine and Research 22A
Tapline Stations 228
Recruiting and Hiring Staff 229
Impact of Increasing Saudi Ownership Participtation 232
Emergency Preparedness 235
A Riot in Dhahran 237
V OVERVIEW 240
TRACHOMA PROJECT- -JOHN C. SNYDER 243
INTRODUCTION by A. P. Gelpi 24 A
The Harvard /Aramco Trachoma Project 245
ELINOR NICHOLS, ROGER NICHOLS AND THE TRACHOMA PROJECT: 1956-1982 249
CONTENTS 250
INTRODUCTION by A. P. Gelpi 251
INTERVIEW HISTORY 252
BIOGRAPHICAL INFORMATION 253
I JOINING ARAMCO 25 A
Roger Nichols s Education and Internship 25A
Looking for an Overseas Position: 1956 255
Moving to Saudi Arabia 256
II THE TRACHOMA PROJECT 258
Roger Nichols Gets Involved 258
Nichols Heads the Project 259
Background on Roger and Elinor 261
Trachoma Research: Isolating the Disease 266
The Next Objective: Developing a Vaccine 268
Nichols Gets A Case of Trachoma Himself 272
Other Medical Personnel 274
III POST-ARAMCO ACTIVITIES 276
Nichols Becomes Director of Boston s Museum of Science,
1982 276
Founding the University Associates for International
Health
Director, Museum of Science, 1982 283
V LIFE IN SAUDI ARABIA 284
Raising a Family 284
Curing Trachoma: A Moral Dilemma 284
Desert Explorations and Other Expeditions 286
Tom Barger 288
History and Archeology 290
Travels 291
DOROTHY McCOMB, TRACHOMA PROJECT: 1953-1976 292
CONTENTS 293
INTRODUCTION by A. P. Gelpi 294
INTERVIEW HISTORY 295
BIOGRAPHICAL INFORMATION 296
I TRACHOMA RESEARCH PROJECT 297
Starting Work with the Project 297
Dr. Snyder Undertakes the Reserach: Problems of Isolation 298
Relationship Between Harvard and Aramco 300
Village Surveys 302
Collecting Samples 304
Learning about Arab Culture and Undertaking Village Visits 306
Successful Isolations, then Vaccination 310
Ten-Year Follow-up Visits 312
Vaccines and Cures 315
Dr. Roger Nichols 317
Dr. Robert Oertley 319
Dr. Richard Daggy 320
Other Personnel 321
II WINDING UP THE TRACHOMA PROJECT 323
ROBERT AND PATRICIA OERTLEY, RAS TANURA, ABQAIQ, AND DHAHRAN
MEDICAL FACILITIES: 1956-1982 326
CONTENTS 327
INTRODUCTION by A. P. Gelpi 328
INTERVIEW HISTORY 329
BIOGRAPHICAL INFORMATION- -Patricia Oertley 330
BIOGRAPHICAL INFORMATION- -Robert Oertley 331
I BACKGROUND 332
Childhood on the Farm 332
Cornell College 334
Military Service 335
II BECOMING A DOCTOR 337
Medical School, University of Iowa 337
Internship 340
Work in the Belgian Congo: 1963 340
III ARAMCO: 1963-1982 343
Joining Aramco 343
Ras Tanura Clinic: Family Physician 344
Abqaiq Clinic: Medical Administrator 349
Epidemiology 356
Record-Keeping Procedures 362
Nursing Staff 363
Moving to Dhahran 365
Field Director, Trachoma Research Program 367
Director of Preventive Medicine 369
Camel Trip into the Desert 374
IV PAT OERTLEY 377
Background and Education 377
Early Work Experiences 379
Joining Aramco 383
Ras Tanura 383
Marriage and Move to Abqaiq 386
Dhahran 388
Dhahran Medical Facilities and Other Services 391
Adjusting to Cultural Differences 393
Leaving Saudi Arabia 398
Aramco Management Support 404
VOLUME II
IVOR MORGAN, OBSTETRICS /GYNECOLOGY: 1952-1967 406
CONTENTS 407
INTRODUCTION by A. P. Gelpi 408
INTERVIEW HISTORY 409
BIOGRAPHICAL INFORMATION 410
I BACKGROUND 411
Childhood, Education, and Early Career 411
II JOINING THE COMPANY 415
Description of Facilities 418
Change Within the Profession, a New Life 418
Accreditation and High Level of Service 419
Interpersonal Communication 420
Saudi Patients and Cases 421
III OBSTETRICAL /GYNECOLOGICAL PROBLEMS PECULIAR TO THE MIDDLE
EAST EXPERIENCE 1950s- 1960S 423
Some Anecdotal Material 423
Ruptured Pregnant Uterus 425
IV LIFE IN SAUDI ARABIA 428
Musings While on the Road Between Abqaiq, Dhahran, Ras
Tanura 428
More Anecdotes 429
V MORE ON THE OB/GYN CLINIC 432
Doctors Brown and Alexander 432
Abqaiq and Ras Tanura Clinics 433
Exploration Camps 435
Clinical Standards; Accreditation 438
"The Operation Must Go On" 442
Nursing Staff 443
A Trip to Dammam 445
Arab Patients 447
VI OVERVIEW 450
Aratnco s Medical Contributions to Saudi Arabia 450
Untold Story of the Bigger Picture: Aramco 453
VIRGINIA DOOLING, ARAMCO CLINIC NURSE, 1977-1981 456
CONTENTS 457
INTRODUCTION by A. P. Gelpi 458
INTERVIEW HISTORY 459
BIOGRAPHICAL INFORMATION 460
I JOINING ARAMCO: 1977 461
Reasons for Applying 461
Moving to Saudi Arabia 462
II ORIENTATION AND RESPONSIBILITIES 463
Dhahran Orientation 463
Assignment to Abqaiq: Assistant to Chief Nurse 463
Udhaliyah Camp: 1977-1981 466
Al-Hasa, Hofuf 467
Immunization Program 469
Health Education 469
Medical Disaster Plan 471
III LIFE IN SAUDI ARABIA 472
Multicultural Diversity 472
Multiple Births 475
Jubail: A Planned City 480
Travels 481
Lifestyle 481
RICHARD PERRINE, INTERNAL MEDICINE AT ABQAIQ AND DHAHRAN: 1960-1980 485
CONTENTS 486
INTRODUCTION by A. P. Gelpi 487
INTERVIEW HISTORY 488
CURRICULUM VITAE 489
BIOGRAPHICAL INFORMATION 491
I EDUCATION AND EARLY WORK EXPERIENCES 492
Childhood and Education 492
Internship and Residency 493
Practicing in Appalachia 493
II EARLY DAYS WITH ARAMCO 495
Joining the Company in 1960: How and Why 495
Lifestyle and Opportunity for Travel 496
Moving to Saudi Arabia 498
Abqaiq 499
III ARAMCO MEDICAL DEPARTMENT 500
Supervising Physician, Abqaiq Health Center: 1960-1963 500
The Clinic 500
Patients 503
Friends and Neighbors 504
Medical Facilities 506
Diseases and Diagnosis 506
Medical Conferences 508
Tuberculosis and Brucellosis 509
Teaching and Consulting 510
Chief, Medical Liaison Division, Dhahran Health
Center, 1964-1969 512
Liaison Responsibilities 512
Outside Hospitals 512
Handling Medical Records 515
Increasing Efficiency and Controlling Costs 516
Medical Personnel, Diseases, and Patients 519
Saudi Patients 522
Chief, Internal Medicine Service, 1969-1978 526
Appointment and Early Responsibilities 526
Growth in the 1970s 528
Research 530
Research Colleagues 534
General Public Patients 538
Further Education 540
Senior Internist, 1978-1980 541
AHMED MUSTAFA, INTERNAL MEDICINE: 1960-1984 543
CONTENTS 544
INTRODUCTION by A. P. Gelpi 545
INTERVIEW HISTORY 546
BIOGRAPHICAL INFORMATION 547
I BACKGROUND 550
Childhood in Egypt 550
Education 551
II ARAMCO-- EARLY DAYS 552
Joining the Company in 1960 552
Impressions of Dhahran 553
Outpatient Clinic 554
Senior Physician, Employee Clinics 555
Internal Medicine Service and Liaison Physician 558
Ascaris Pneumonia 560
Treating an Aramco Executive 561
Residency and Fellowship at Tufts Medical Service,
Boston City Hospital, 1971-1974 563
Back to Aramco Internal Medicine Department: New
Equipment 566
Hiring More Staff 569
Committees and Other Activities 570
III RETIREMENT AND REFLECTIONS 575
ODE TO DR. MUSTAFA 577
BERNARD J. EGGERMAN, DENTISTRY: 1958-1987 578
CONTENTS 579
INTRODUCTION by A. P. Gelpi 580
INTERVIEW HISTORY 581
BIOGRAPHICAL INFORMATION 582
I * BACKGROUND: CHILDHOOD AND EDUCATION 585
Family 585
Childhood and Education 587
Military Service and Early Work Experience 589
II HIGHER EDUCATION AND EARLY CAREER 594
University of Illinois 594
Working for Minerallac Electric 595
Hospital Work 597
Dental School, Northwestern University 598
Army Dentistry 599
Teaching at Northwestern 600
III ARAMCO 603
Joining the Company 603
Moving to Saudi Arabia: Starting the Tennis Club 605
Dhahran Health Center 610
Chief of Dental Services 611
History of Aramco s Dental Group 613
Training Dental Assistants 614
Dhahran Dental Clinic 618
The Contract Hospitals 621
Taking More Training at Northwestern; Adding Staff 627
Executive Management Help 630
Training Program with University of Kentucky 630
Preventive Dentistry 631
Life in Dhahran 633
Aramco s Medical Research 634
Trachoma and Tetanus 634
Sickle Cell Anemia 635
Community Activities 636
Hiring Dentists 637
Hospital Accreditation 639
More on Recruiting 640
Water Fluoridation and Diet Services 642
Leaving Aramco 643
GORDON FLOM, HOSPITAL ADMINISTRATION: 1969-1989 647
CONTENTS 648
INTRODUCTION by A. P. Gelpi 649
INTERVIEW HISTORY 650
BIOGRAPHICAL INFORMATION 651
I BACKGROUND 654
Education 654
Early Work Experiences: Hospital Administration 654
II ARAMCO 657
Joining the Company 657
Moving to Saudi Arabia: 1969 660
Administrator of Supporting Health Services 660
Management Grid 663
A Newly Created Job 664
Midwives and Nurses 665
First Impressions: Description of the Facilities 665
A Wedding 667
Outlying Clinics 668
Out-of-Kingdom Training for Saudis 669
Personnel and Staff 673
III COMPANY EXPANSION IN THE 1970S 675
Coordinator of Medical Development and Construction,
1975 675
Building New Hospital Facilities 676
King Faisal Specialty Hospital 680
Aramco Expansion and the New Hospital 680
New Facilities in Outlying Districts 683
Project Management Department 685
Equipment Purchases 686
Reporting 686
Cholera Epidemic 687
Health Education Fairs 688
Nationalization 688
Views of a Patient 690
Community Activities 692
TAPE GUIDE 696
APPENDIX
Curriculum Vitae, Armand P. Gelpi, M.D. 699
"Agriculture, Malaria and Human Evolution: A Study of
Genetic Polymorphisms in the Saudi Oasis Population,"
by Armand P. Gelpi, M.D., in Saudi Medical Journal Vol. 4
No. 3, July 1983 706
Biographical Data, Richard Handschin, M.D. 712
Curriculum Vitae, Julius W. Taylor, M.D. 717
Curriculum Vitae, Roger L. Nichols, M.D. 723
"Aramco-Harvard Search Proves Trachoma Vaccine," Sun & Flare
[Dhahran, Saudi Arabia], October 30, 1963 734
Letter from Roger Nichols to Sam Bell, July 17, 1957 736
Letter from Elinor Nichols to her parents, November 14, 1957 738
Curriculum Vitae, Dorothy Elizabeth McComb 741
"Trachoma Research Program," Chlamydial Research Publications,
1954-1981, published jointly by Aramco, Dhahran, Saudi Arabia,
and Harvard School of Public Health, Boston, Massachusetts 746
Robert Oertley, M.D., handwritten biographical information 772
"Vaginal retention of a term fetus following labor and expulsion
of the fetus from the uterus," by Ivor I. Morgan, M.D., in
American Journal of Obstetrics and Gynecology. Vol. 79, No. 6,
July 1960 773
Publications, Richard P. Perrine, M.D. 776
Resume, Gordon K. Flora 779
GLOSSARY 781
i
INDEX 791
INTRODUCTION
Early in 1995, this editor learned that The Bancroft Library at
the University of California, Berkeley, had produced a collection of
oral histories contributed by six retirees from the Arabian American Oil
Company (Aramco) . It told the story of developing and producing oil as
a joint effort by Americans and Saudis. What made this collection
unique is that its contributors played major roles in Aramco s
management during its developmental years, before the company was turned
over to the Saudi government as Saudi Aramco.
Now oil productionwhich is what Aramco did, and did well is one
thing. Exporting health carewhich it also didto what could well be
considered a developing country in the 1930s and beyond is quite
another. The scale on which this was done, the people who were key
participants, the consequences for all those employees and their
families associated with Aramco, and how Aramco s Medical Department
provided services to the non-Aramco population of Saudi Arabia s Eastern
Province seemed to be the ideal ingredients of an exciting story. Who
could best tell this tale? The people who contributed so much in
developing and extending Aramco s health care services.
Such a narrative required significant financial support.
Ultimately, it was possible to obtain a generous grant from the
donations committee of Saudi Aramco in Dhahran, Saudi Arabia, and after
engaging The Bancroft Library and those who were destined to be
contributors to this oral history collection, the project got underway.
But it wasn t until late 1995 and early 1996 that the interviews began.
Conservation of support funds was essential to bring the project along;
and with this in mind, my Bancroft Library historian, Carole Hicke, and
I decided to conduct interviews on a regional basis. It turned out that
there were important concentrations of former Aramco Medical Department
people in the New England, Puget Sound, and San Francisco Bay areas. We
planned to obtain interviews from fourteen key people. We came away
with twelve direct interviews, one telephone interview, and one written
contribution. As this is being written, editing is underway on the last
of the oral histories. And during the summer of 1997, we received a
financial supplement to our original grant from Saudi Aramco to bring
this project to its completion.
We feel fortunate to have had the cooperation and interest from
those -who made such vital contributions to Aramco s health care
programs. But most of all, we are grateful for their oral histories.
They tell of exotic diseases, hands-on care from dedicated doctors and
nurses, creative and imaginative corporate administration, health care
services which breached language and cultural barriers, lasting
friendships, and cutting-edge medical research. I feel privileged to
ii
have been a member of Aramco s health care team. Both Carole Hicke and
I feel even more fortunate to have been able to put this project
together for The Bancroft Library s Regional Oral History Office, for
Saudi Aramco, and for those readers who--we hopewill recognize the
scholarship with which we have tried to invest this work. We regret
only that circumstances of geography and limited finances prevented us
from obtaining and including interviews from others who made memorable
contributions to the Aramco and Saudi Aramco health care programs.
Aramco Health CareBeginnings and Evolution
It all began in 1936, with the arrival of T. C. Alexander, M.D.,
in Saudi Arabia. He was assigned to Dhahran as medical support for
drilling operations being conducted by the California-Arabian Standard
Oil Company (CASOC) . This company was formed by Standard Oil Company of
California (SOCAL), which ultimately became Chevron, Inc. Alexander s
clinic was the first in the region and the first in the field for an
American oil company operating in Saudi Arabia. This operation lacked a
hospital; so cases needing hospitalization were sent to Bahrain Island,
about twenty miles offshore. Among his other accomplishments, Dr.
Alexander started to train young Saudi men as nursing assistants. Some
of them were sent to Beirut for additional instruction as dental
hygienists and dental technicians. The main medical problems
confronting Alexander at this time were endemic communicable diseases
such as malaria, trachoma, smallpox, and tuberculosis.
In 1937, families from the U.S. began to arrive in Dhahran, as the
local workforce steadily expanded. During the World War II years, three
more physicians were recruited, and wards were added to the existing
clinics. On the night of October 19, 1940, both Dhahran and Bahrain
were bombed by Italian planes; and subsequently, families were evacuated
until the end of World War II.
In 1944, CASOC became the Arabian American Oil Company (Aramco),
and the company opened a refinery in Ras Tanura together with clinic/
dispensaries in both Ras Tanura and adjacent Rahima. These were for
American and European expatriates (Ras Tanura) and for Saudi employees
and their families (Rahima) .
American families began to return in 1945, and by 1948 Aramco was
operating clinics, infirmaries, a pharmacy, and hospitalswith a total
bed capacity of 205--scattered throughout the areas of oil production.
By this time Aramco s corporate structure included four owner companies:
SOCAL, Standard Oil of New Jersey later to become Exxon- -Texaco, and
Mobil. In 1949, Aramco began to add more hospital beds to its existing
clinic facilities. The epidemiology of malaria in the Eastern Province
was being explored and a malaria control program was underway.
iii
In 1955 a collaborative research project on trachoma was
established between Aramco s Medical Department and the Harvard School
of Public Health. And in 1956 a hospital/clinic complex, Dhahran Health
Center (DHC), was completed and opened as a secondary care facility for
major surgery, isolation, intensive medical care, sophisticated
laboratory and imaging services, field-wide medical administration, a
base for preventive medicine and public health outreach, and for
outpatient care. The same year, similarthough much smaller-
facilities were opened in both Ras Tanura and Abqaiq, and their older
units were closed. The Preventive Medicine Division at DHC started a
program of tuberculosis case finding and control, maternal-child health
clinics had been established, and health education projects were being
developed.
In 1957, Aramco s Medical Department hired its first industrial
hygienist, and by 1963 had its first occupational health physician.
Preventive and curative medicine had entered upon a unique partnership
whichtogether with its projects in medical researchwould become the
hallmark of Aramco s health care program.
Endemic Diseases
Despite the fact that Saudi Arabia was changing rapidly from a
developing country into a nation which would resemble the technocracies
of the West, the profile of disease was more representative of many
third-world countries during the 1960s. And while there was an
efflorescence of both private and government health care programs and
facilities within the Kingdom, information on health demographics was
lacking except as an extrapolation of epidemiologic data gathered by
Araraco. But at this time, Aramco had been collecting extensive data on
the incidence /prevalence of malaria and trachoma in the Eastern Province
and on schistosomiasis elsewhere in the Kingdom. Large-scale
epidemiologic investigations on conjunctivitis generally, and on
trachoma in particular, were launched in 1955 as the first stage in the
research project launched by the Aramco /Harvard collaborators.
Beginning in 1947, the Saudi government had developed a
cooperative malaria surveillance program with Aramco in the Eastern
Province. And control measures had started in 1948, primarily through
an extensive residual spraying campaign utilizing DDT. There was an
immediate and dramatic reduction in the incidence of malariaboth among
employees and among villagers in outlying oases which were being
monitored with annual malaria surveys. Resistance to DDT was
encountered in 1953, and Dieldrin was introduced for residual spraying
in 195*5 . By 1956, the Saudi government had taken the initiative for
malaria control in the Eastern Province. And this, together with the
more effective Dieldrin spraying, left malaria as a vanishing disease.
IV
A program of smallpox eradication had been undertaken in the late
1950s by the Saudi government, and this disease soon disappeared from
the Eastern Province. Tuberculosis remained an endemic problem. But
with effective case finding- -through x-ray screening and skin testing-
early treatment with an arsenal of effective drugs, and meticulous
outpatient followup, it appeared that Saudis could expect the same
satisfying results from modern treatment as Europeans or Americans.
Although Saudi Arabia s Eastern Province was not an endemic area
for schistosomiasis, the disease was rather common among Aramco
employeesmany of whom had come from the central and western regions of
the Kingdom. In contrast to infected patients from other populations in
the Middle East, the majority of Saudis seemed to have mild disease with
few symptoms. In 1965, a team from Aramco s Preventive Medicine
Division initiated a large-scale epidemiologic survey of sixty-seven
communities scattered throughout the Kingdom. Hundreds of individuals
were examined for evidence of diseaseemphasis being on identification
of schistosome eggs in the stool and/or urineand scores of water
sources were examined for evidence of the snail vectors which transmit
this infection. What emerged from this investigation was a monograph,
published as a limited, paperback edition in 1967. It remains unmatched
as the most extensive and complete study of its kind ever carried out in
Saudi Arabia. 1 It also remains relatively inaccessible, despite its
importance as a point of reference for the most widespread previous and
subsequent surveys. The most important results from this study were:
there are two schistosomal worms represented in the Kingdom. S. mansoni
is by far the most prevalent and is transmitted from many sources along
the watershed on the eastern side of the great mountain chain which
roughly parallels the coastline of the Red Sea. S. hematobium is
confined to the western watershed of the same range. The Eastern
Province is free of endemic disease and of snail vectors.
Another helminth infection of some importance was ascariasis.
Generally regarded as relatively asymptomatic, it can sometimes be
complicated by intestinal obstruction because of excessive numbers of
parasites in the gut. But in Saudi Arabia there was an additional
complication: seasonal pneumonitis due to pulmonary larval migration.
This was exclusively a disease of Saudis, characteristically occurring
each spring, usually several weeks after the brief, annual rainy season.
Transmission was seasonallimited to winter and spring because of the
intense daytime temperatures during the rest of the year, which
prevented survival of helminth ova.
1 Alio, Ivan. The Epidemiology of Schistosomiasis in Saudi Arabia
with an Emphasis on Geographic Distribution Patterns. Riyadh, Saudi
Arabia: University Press, 1967.
During the spring months there was also a recurring flu-like
illness--Q fever--among Americans and other expatriates living in Aramco
communities. This infection was presumably transmitted during the
lambing/kidding season by infectious aerosols from products of
conception within the herds of goats and sheep tended by the local
Bedouin. What wasn t appreciated at the time was that Q fever is one of
the most communicable of all infections the inhalation of just a few
organisms being enough to produce infection, sometimes illness. Which
is why the organism, Coxiella burnetti, has been considered a candidate
for biological warfare.
Trachoma was hyperendemic in the oases of Saudi Arabia s Eastern
Province, with prevalence as high as 90 percent in some communities.
The Harvard /Aramco research project was concerned with the clinical
aspects, the epidemiology, and the prevention of trachoma. Ultimately
epidemiological patterns emerged which indicated that trachoma was
essentially a family disease, and that it was most prevalent in the most
primitive and isolated oasis villages. Wherever trachoma was
encountered, prevalence and severity could be correlated with the level
of socioeconomic development and of sanitation. With prosperity and
improvements in hygiene, clinical trachoma was less evident, and other
indices of infection less apparent.
During the decade of the 1960s, the trachoma research program
became the centerpiece for Aramco 1 s research efforts as the disease
itself began to yield to the pressures of economic development and
social change. To speed up this favorable trend, a field trial of
immunization was carried out on almost 5,000 subjectswith both
disappointing and inconclusive results. But the thrust of the program
was to accumulate information on the epidemiology of the disease in
Saudi Arabia, which would be of help in developing control measures, not
only for the Kingdom, but for adjacent countries with endemic trachoma
having similar climatic and social conditions. It is therefore somewhat
ironic that in a 1976 comprehensive review of trachoma control in the
Eastern Mediterranean, which contained data from several Middle East
countries, there is not even one citation from the many publications by
the Harvard /Aramco group. And the project is not even mentioned in the
text. 1
Viral hepatitis was common in the Saudi population and was
associated with high mortality among pregnant and recently delivered
women. This phenomenon had been observed in Africa, other parts of the
Middle East, and in an earlier, widespread epidemic in India. Although
the specific viral agent could not be identified in the Saudi cases at
the time, there is good reason to believe this infection was due to the
1 Majcuk, J. Trachoma control in the Eastern Mediterranean region.
WHO Chronicle 30: 97-100, 1967.
vi
hepatitis E virusbased on more recent experience with infections due
to this agent and on the sere-epidemiology of hepatitis E.
There is more to the story of communicable disease: the interviews
in this series will mention some diseases included in this introduction.
But some merit comment here. Typhoid reached a peak in 1956, with
eighty-four cases reported in Aramco facilities for the year.
Thereafter, there was a steady decline. Bacterial dysentery (Shigella
infections) remained a significant endemic problem throughout the 1960s
and 1970s with rates up to 50 per 10,000 population. Poliomyelitis was
still present in the local population, and in 1973 there were ten
reported cases of paralytic disease reported from Aramco medical
facilities. The incidence of sexually transmitted disease increased
through the 1970s, with gonococcal infection most often reported.
Tetanus was an endemic problem in the Saudi population at all
ages, but mostly among the newborn. It seemed clear that neonatal
tetanus was due to infection through contamination of the umbilicus
shortly after birth. But among adults and children, the site of entry
for viable tetanus organisms was often inapparent. With the advent of
immunization programs --and thereby an emerging population of immune
mothersneonatal tetanus virtually disappeared among Aramco s Saudi
newborns, and became a vanishing infection among children and adults for
the same reasons.
Measles and chicken pox remained vexing problems among Aramco s
Saudi dependent children. And it was not until measles immunization
became as widely available in Saudi Arabia as it was in Europe and the
United States that the former disease began to decline significantly.
Diarrheal disease, primarily in infants and children, was always a
significant medical problem during the early years of Aramco s health
care program. Hospitalizations steadily increased from 1956 to 1966,
after which there was a steady decline through 197 A and beyond.
Mortality from diarrheal disease, which peaked in 1962--prior to a steep
rise in hospital admissions for this problemdeclined rapidly, but
ahead of the decline in morbidity. In most cases, the disease agent
could not be identified, but Shigella species accounted for most of the
bacterial isolates from stool samples.
Although there had been isolated reports of the disease cutaneous
leishmaniasis (Oriental sore, Baghdad boil) from the Arabian peninsula
before and during Aramco s early years, it was not until the 1970s that
this condition reached epidemic proportions. Beginning with six cases
in 1970, there was an explosive increase in the disease occurring among
Aramco s Saudi employees and dependents with a reported total of 542
vii
cases by the end of 1979. From the beginning, it was apparent that the
majority of patients were from the large al-Hasa oasis; of these, 73
percent were under the age of fifteen years, with both sexes equally
represented.
Reports of cutaneous leishmaniasis (CL) in widely separated areas
of the Kingdom began to appear in published reports from sources outside
of Aramco s Medical Department. For example, in a little more than a
two-year period, it was possible to collect data on 726 cases of the
disease referred to medical facilities in an area adjacent to Saudi
Arabia s capital, Riyadh. 2 The clinical features of these cases were
quite similar to those encountered among affected individuals reported
to Aramco from al-Hasa--including a predilection for the extremities and
the presence of multiple lesions in the same individual. In two key
publications which described CL in a colony of European expatriates
residing and working near Hofuf (al-Hasa oasis), both the clinical
features and epidemiological clues suggested that the organism was L.
tropica major, that P. papatasi (sandfly) was the vector, and that
certain desert rodents (Meriones libycus and Meriones crassus) were the
most likely natural hosts. 3i * Looking back on the Aramco experience with
CL, it appears that there was a distinct seasonal pattern to disease
outbreaks, with the largest proportion of cases presenting in the months
of December into March.
The central issue in the evolution of CL in Saudi Arabia during
the 1970s and 1980s appeared to be the ecology of this disease in
relation to the dramatic social change and economic development which
characterized this period. There were rapid population shifts,
accelerated suburban development, and vast building projects which
served to increase human contact with the sandfly vector. In addition,
or alternatively, these conditions may have created an enrichment
phenomenoneither by propagation of the CL parasites within the rodent
population, an increase in the rodent population, or both. It was
1 Aramco Medical Department: Epidemiological Bulletin 1-4, Jun-Jul,
1976; 1-7, Jan-Mar, 1980.
2 Morsy, T.A. Oriental Sore in Riyadh, Saudi Arabia. Castellania
3: 155-157, 1975.
3 Bienzle, U., Ebert, F., and Dietrich, M. Cutaneous leishmaniasis
in Eastern Saudi Arabia. Epidemiological and clinical features in a
non- immune population living in an endemic area. Tropenmed. Parasit.
29: 188-193, 1978.
4 Buttiker, W. , and Lous, D. J. Ecological studies in Hofuf,
eastern Saudi Arabia, in relation to dermal leishmaniasis. Tropenmed.
Parasit 30: 220-229, 1979.
viii
difficult to test these hypotheses under conditions of continuing
environmental change.
Another possibility is that widespread residual spraying for
malaria in townsites of the Eastern Province had earlier decimated the
sandfly population, thus interrupting transmission of CL. But residual
spraying was to a great extent abandoned and replaced by a larviciding
program in 1963 in the al-Hasa oasis, some eight years before the sharp
increase in the incidence of CL was observed. Publications on the
problem of cutaneous leishmaniasis in Saudi Arabia continue to appear
from various sources outside of Saudi Aramco s medical services.
It was during the late 1960s that several noninfectious diseases
attracted the attention of clinicians and researchers in Aramco s
Medical Department. It was known that the sickle cell trait was present
at a fairly high frequency within the oasis populations of the Eastern
Province. But sickle cell disease was not diagnosed nearly as often as
it should have been, simply because the disease was so mild in Saudis.
This was--and still is--in striking contrast to the character of the
disease in Africa and among African Americans. Studies on the
distribution, the unique clinical features, the genetics, and the
molecular biology of the condition in Saudis began with a collection of
patients encountered on routine visits or during hospitalization for
other, unrelated problems.
Ultimately these studies would involve a team of researchers from
Oxford, as well as Aramco clinicians and technical support in the
laboratories of Dhahran Health Center. Early revelations about the
expression of sickle cell disease in Saudis attracted the attention of
other workers in Saudi Arabia and elsewhere, leading to intense research
efforts, which still continue in the Kingdom. A byproduct of the
research on benign sickle cell disease in Saudis has been a greater
understanding of certain genetic f actorsother than the hemoglobin S
gene itselfwhich modify the expression of the disease, and
applications of this knowledge to develop new treatments for the more
severe, African-type disease.
Other genetic markers which affected red blood cells in Saudis,
particularly the oasis populations, are the thalassemias and glucose-6-
phosphate dehydrogenase (G6PD) deficiency. The Saudis have thalassemias
which suppress the production of both the alpha and beta hemoglobin
chains, producing a wide range of phenotypes with altered red cell
morphology, and a range of disease expression from the mildest anemia to
the more incapacitating, so-called thalassemia major. And of course
there is interaction with the sickle cell trait to produce genetic
admixture which also modifies the expression of sickle cell disease and
limits its severity.
ix
The type of G6PD deficiency encountered among Saudis is severe,
with almost complete absence of this red cell enzyme, which, among other
problems, can lead to abrupt and intense hemolysis in affected subjects
who ingest fava beans. The population genetics of this disorder have
been thoroughly worked out in Saudis, and this research has been
continued elsewhereagain, at other institutions in Saudi Arabia.
The unusual constellation of red cell genetic markers--G6PD
deficiency, the thalassemias, and hemoglobin S, together and separately
--are believed to confer considerable resistance to falciparum malaria,
and most likely have profoundly affected both the endemicity and
severity of this type of malaria in oasis populations. Finally, Saudis
--again, primarily within the oasis populationstend to lack the Duffy
blood group antigens, which function as receptors on the human red cell
for the Plasmodium vivax malarial parasite. Thus, the oasis Saudis have
a significant immunity against vivax malaria. The Duffy negative blood
group is an African genetic trait, shared to a lesser extent by Middle
East populations and Americans of African descent. This cluster of
genetic markers which confer resistance against two types of malaria is
unique to oasis Saudis and to native Africans.
Medical Miscellany
The usual cancers which characterize aging populations of the West
were less evident among the Saudis. In this group, lymphomas and
leukemias were the most common, followed by stomach cancer. And
typically, the lymphomas were of the non-Hodgkin 1 s type, often
presenting with abdominal disease, rather than with the peripheral or
mediastinal adenopathy usually associated with lymphomas among other
populations. It was difficult to distinguish abdominal lymphomas from
abdominal tuberculosisthe two so often presenting with similar signs
and symptoms. But by the mid- seventies, lung cancer was rapidly
overtaking leukemias and lymphomas in incidence, primarily among an
emerging, older, Saudi population.
What about degenerative diseases of middle age and beyond, which
seem to plague Western societies? Basically, Aramco s health care
program was involved with two rather distinct populations: a relatively
small number of American and European expatriates- -many with their young
families- -and a much larger group of primarily young Saudis. A
relatively small proportion of Saudi employees had families at that
time. The Americans and Europeans, as expected, experienced
hypertension, coronary artery disease, and three major cancers lung,
breast, and colon at about the same frequency and in the same age
stratification as might be observed in America or Europe. But by the
age of sixty, almost all of the expatriates had reached retirement and
were on their way back to points of origin. They had not even joined
the ranks of the "geriatric" population when they left Saudi Arabia.
Like retired military, most went on to other careers. And so prostate
cancer and stroke were uncommon.
The population of Western smokers was again what you might expect
--about 40 percentbefore that landmark announcement by the U.S.
Surgeon General in the 1960s. But Aramco s doctors were not seeing very
much tobacco smoking-related diseases chronic obstructive lung disease
and mouth cancers- -except for the emergence of lung cancer among aging
Saudis.
Now the question of alcoholism and its consequences. The Saudi
authorities strictly prohibit the importation and sale of alcoholic
beverages. And there is no question that consumption of alcohol by
Muslims is forbidden. Which left the issue of alcohol consumption by
non-Muslim foreigners somewhat ambiguous. As it turned out, Western
ingenuity and the Saudis kindly tolerance for Westerners made it
possible to produce and consume alcohol in privacy. Once again, this
was with the understanding that alcohol consumption would not take place
in Muslim company and would not be distributedeven as a gift to
Muslims .
Americans and others produced alcohol in the time-honored
tradition of fermentation, using yeast and some source of sugar, and
they went on to further refine and concentrate the product by a series
of distillations, which often resulted in a concentration of ethanol
approaching 95 percent. It would be safe to say that alcohol was
available in abundance to many people in Saudi Arabia s Eastern
Province.
Alcoholism, then, was a problem, but no more nor less than might
be expected in any expatriate community representing a slice of America.
Surprisingly, delirium tremens, acute alcoholic hallucinosis, alcoholic
neuropathy, liver disease, and cardiomyopathy were rare.
But Aramco s medical problems were by no means confined to exotic
diseases plus the usual degenerative diseases of Western society. As
originally conceived, Aramco s health care program would be primarily
concerned with employee health in an occupational setting. And in this
context, environmental health and industrial medicine were to be
important considerations.
As expected, in any large industrial undertaking- -either domestic
or foreign- -employees were exposed to a variety of hazards in the
workplace. And in an oil-producing area, with a subtropical-to-tropical
climate, there were health risks in oil exploration, production,
refining, storage, and transportation.
Surprisingly, heat exposure was less of a problem than
anticipated. To a large extent, heat exhaustion and heat stroke were
xi
prevented by attention to acclimatization, adequate water and salt
intake, early removal from exposure when symptoms or signs suggested
heat-related illness, and prompt supportive treatment for heat-related
casualties. Much of Aramco s administrative apparatus and its
personnel, community services, and medical care were housed in air-
conditioned environments. Americans and other Western expatriates
residing in Aramco communities were protected by residential air
conditioning. For those working both outside and in interior
environments in which air conditioning was lacking, every effort was
made to avoid dangerous exposure to high temperatures.
Despite an active safety program inaugurated early in Aramco s
history, there were a variety of job-related accidents and associated
trauma. Risky chemical exposures, such as those related directly to oil
production, were rare. As expected, poorly defined low back pain,
without a clear history of job-related, predisposing incident, was
fairly common. In later years, with increasing availability of auto
transportation, there were also more motor vehicle accidentswith
attendant trauma and occasional fatalities. In residential
environments, among Saudi dependents, there was a significant number of
burns from the use of gasoline-fueled stoves. Generally, this would
result from ignition of loose garments.
Deluxe Health Care: Psychiatric and Dental Services
It took a generation of employees and dependents some with
incipient, some with florid psychosis or neurosisbefore Aramco s
health care system began to deal with psychiatric illness by utilizing
professionals and facilities for psychiatric care at the Dhahran Health
Center. In its early years, psychiatric problems of any consequence
among expatriates were managed by referral to U.S. or European
facilities. Ultimately, and despite cultural barriers, it was
recognized that psychiatric disability was not uncommon among indigenous
peoples of the Middle East. And of course, Saudi Arabia was no
exception. As Aramco s Medical Department expanded in the 1970s, so did
the subspecialties of psychiatry and clinical psychology.
One of the brilliant chapters in the story of Aramco s health care
program is its history of dental care for expatriates and their
families, and eventually for the Saudi population under the wing of
Aramco s health care program. Ultimately, dental services included all
the subspecialties of surgery, restorative dentistry, endodontia,
periodontia, and orthodontia. Early on, dental care was incorporated
into the district outpatient services. Dental specialty services were
developed at Dhahran Health Center, and later as a large, free-standing
dental clinic adjacent to DHC with a full range of treatment and
preventive services.
xii
Dramatis Personae
Those who have contributed to this collection of oral histories
will tell stories which will deal with Aramco s health care program in
more detailhighlighting certain disease problems, medical research,
relationships with non-Aramco health care agencies and medical care
facilities, disease prevention, health care facility design and
construction, interaction with various parts of Aramco s administrative
elements, and personal experiences related to work and residence in
Saudi Arabia.
Three of the contributors to this series rose from the ranks to
become Aramco medical directors: Drs. Daggy, Handschin, and Taylor.
Three others rose to head Internal Medicine and the Medical Services
unit: Drs. Gelpi, Mustafa, and Perrine. Three others were intimately
involved in the trachoma research project sponsored by the Harvard
School of Public Health and supported by Aramco: Dr. John Snyder
(Harvard School of Public Health) , Elinor Nichols the widow of Roger
Nichols, field director of the project and Dorothy McComb, technologist
for the trachoma laboratory at Dhahran Health Center.
Dr. Bernard Eggerman, DOS, pioneered the development of Aramco s
comprehensive dental care program, integrating it with the medical
department s health care program. Virginia Dooling, RN, was key player
in the nursing serviceboth in hands-on nursing care and nursing
administration. Dr. Robert Oertley had several roles in Aramco s health
care operation: family practitioner, district medical director, and
epidemiologist. His wife, Pat, jointly contributed her experiences to
this collection. Dr. Ivor Morgan was Aramco s first obstetrician. Mr.
Gordon Flom was a prime mover in Aramco s medical facility renovations
and construction during the 1970s. Interestingly, there was almost
continuous interaction between our contributors both socially and
professionally during parts of three decades, spanning the mid-fifties
to the late seventies.
Besides anecdotal information on how they came to work in Aramco s
health care program, contributors elaborate on the many facets of health
careboth to Americans and to Saudis and their families and on life in
Saudi Arabia. We learn more about endemic malaria in the Eastern
Province and measures taken not only to control this disease but to
virtually eliminate it from oasis communities in which it was
holoendemic. There is more about trachoma: the disease, the village
surveys which mapped its epidemiology, about laboratory isolation of the
infectious agent, the use of a new screening technique fluorescent
antibody microscopy to identify and quantify the infectious agent in
scrapings from the inner eyelid surfaces, about the vaccine trial, and
about treatment and prevention.
Contributors elaborate on some of the clinical problems
encountered among American employees and their dependents, as well as
xiii
those which were more representative of the Saudi work force and Saudi
dependents. They repeatedly refer to the interaction between Aramco s
health care staff and the physicians and nursing staffs of those local
facilities outside of Aramco which were ultimately utilized for primary
care and routine hospitalization of Aramco employees and their
dependents .
They comment in some detail as to how the liaison between Aramco
and these "contract" facilities was established and sustained. And
contributors have much to say about relationships between the medical
staffs in Dhahran and the two districts: Ras Tanura and Abqaiq. There
is considerable commentary about the relationship between the Medical
Department, the company s Industrial Relations executives, and other
top-level management. There is talk about how Aramco s health care
program influenced the evolution of private and government health care
services in Saudi Arabia.
There is continual emphasis on professional standards,
accountability, quality assessment, periodic evaluation by the American
Joint Commission on Hospital Accreditation, and upon continuing medical
education. Contributors help us to understand how research on local
medical problems added to general medical knowledge as well as enabling
practitioners to use this knowledge in disease prevention and patient
care. There is material on hospital and facility construction brought
about by the rapid expansion of oil production, with corresponding
increases in the size of the work force and the numbers of dependents
eligible for health care.
We learn about the demographics of health and disease in eastern
Saudi Arabia, and how they were changed by Aramco s health care program.
We learn how Aramco s corporate structure affected administration in its
Medical Department. And we can trace a continuous thread of interaction
between preventive and curative services within Aramco s health care
program.
We can see how physicians, nurses, other technical staff, and
administrators were personally affected by their experiences with Saudis
and Saudi society, by life in Saudi Arabia, and by their new
understanding of Middle East cultures. And last of all, we learn
something about the destinies of those who left Aramco for other
professional pursuits back in the U.S.
It may seem strange that there is so little said about Aramco s
corporate change from its role as a creature of Mobil, Exxon, Texaco,
and Chevron to an oil company owned and operated by the Saudi
government. Officially, Aramco was nationalized on November 11, 1988.
But in fact, preparations had started in 1980, and there were gradual
changes in management structure throughout the company- -including the
Medical Department from that time until the corporate change became
xiv
official. The reason that little is made of this change by those
contributing to this oral history collection is simply that changing
Aramco s Medical Department to Saudi Aramco Medical Services
Organization (SAMSO) was gradual, smooth, and essentially uncomplicated.
In summary, this collection of oral histories is a record of
astonishing achievement in the provision of health care services to
employees and dependents of a major oil company operating in a harsh
environment and in a rapidly changing society and national economy. It
is the story of health services extended beyond employees and their
dependents, of health care provided to a needy general public before
government and entrepreneurial services were widely available. And it
is a story of major research efforts carried out on such diseases as
malaria, trachoma, sickle cell disease, and schistosomiasis . Here we
have an unparalleled, corporate accomplishment, not only in major
industry, but as a vast humanitarian effort in personalized health care,
disease prevention, health education, and biomedical research. No other
corporation has matched this joint endeavor of oil production and health
services either at home or abroad.
Acknowledgements
This collection would not have been possible without the splendid,
individual contributions from former members of Aramco and Saudi
Aramco s health care program. The essential financial support was
provided by Saudi Aramco s donations committee, both to get the project
underway (1995) and to keep it afloat (1997). Carole Hicke, oral
historian and colleague, from the Regional Oral History Office of The
Bancroft Library at the University of California, Berkeley, conducted
all of the interviews--more than forty hours worth of taped dialogue--
and collaborated with this editor/contributor to produce written, edited
transcripts, which form the bulk of this publication. My thanks goes
also to Willa Baum, director of the Regional Oral History Office, and to
Shannon Page, its office manager, and to other staff for their support
and interest. I am indebted to Saudi Aramco s Medical Services
Organization s Tarek M. Khattab, M.D., for some early historical
material about Aramco s Medical Department. This appeared in his essay,
"The Development of Medical Services in Saudi Aramco." And an
abbreviated version appeared in the August 25, 1993 issue of the Dhahran
publication The Arabian Sun. Last of all I want to thank Mr. Daniel
Blucker of Dhahran Health Center s medical library for a bibliography of
recent publications by SAMSO staff physicians and for photo-
illustrations of Aramco and Saudi Aramco health care facilities.
Armand P. Gelpi, M.D.
December 9, 1997
Sonoma, California
XV
VOLUME HISTORY
Aramco began producing oil in Saudi Arabia in 1938. Its name then
was California Arabian Standard Oil Company (Casoc), and it was owned by
Standard Oil Company of California (Socal) . King Abd al Aziz had
granted Socal the concession in 1933 to explore for and produce oil in
parts of Saudi Arabia, and the company finally encountered oil in
commercial quantities after five years of searching.
So began the annals of a unique corporate enterprise, unique
because of its size, its Arabian operations, and its close interaction
with the people of Saudi Arabia. Early leadership by company officers
such as Tom Barger and Cy Hardy fostered attitudes of pluralism and
respect for the Saudi culture. The Saudis, for their part, responded
with equal measure. Great efforts were made by the Americans to train
and promote Saudis, and great efforts were made by the Saudis to provide
for the needs of the oil company. Thus, cooperation became the keynote.
Aramco s interest in Arabia extended beyond the production of oil.
For example, the company used its resources to collect and preserve old
books and manuscripts concerning the history of the country. Railroads,
roads, electrification, natural gas recoveryall were added to the
company s accomplishments to the benefit of the local economy. Even
more singular, perhaps most remarkable of all, was the work of the
Aramco Medical Department in achieving unprecedented successes in the
research and treatment of local, tropical diseases, in local public
health programs, and in preventive medicine projects.
Why would a company owned by four giant American oil corporations
(Standard Oil, now Chevron, eventually brought in Mobil, Texaco, and
Exxon as owner /shareholders) provide crucial medical services to the
local economy of its offshore operations? Partly, it seems, because the
need, like the distant mountain to be climbed, "was there." Partly,
also, because the Americans and other expatriates were interested in
Saudi Arabia. And partly out of inevitability.
First there was the need for health care for the Americans. Paul
Arnot, who joined Aramco in 1938 as an engineer, recalled no company
clinic in existence. The nearest facility was at Bahrain. Clearly, it
was more efficient to establish a clinic in Dhahran.
As oil operations increased and numbers of employees rose, more
medical staff was hired, and services grew. Saudi employees were
covered, of course, but it became evident that their families needed
help also. As Frank Jungers, former chairman and CEO of Aramco,
explained, "We just tried to move in the direction of providing good
care and minimizing work force disruption."
xv i
New laboratory facilities were required, and this made possible
research into local tropical diseases, including a study of trachoma
jointly sponsored by Aramco and Harvard Medical School. Malaria was
prevalent, and local village people needed help; mosquito abatement
would clearly benefit both the people and the company. Further
expansion of oil production resulted in more employees and the need for
more and better medical facilities. Thus the growth of the Medical
Department, thoroughly documented in this volume of oral histories.
Its success was monumental. Take the preventive medicine program,
for example. Before the mosquito abatement effort was undertaken, a
quarter of the employees had at least one attack of malaria a year. By
1963, fewer than a dozen cases were acquired in the Eastern Province.
Further, in the 1940s and fifties, deaths from communicable diseases,
such a tuberculosis, pneumonia, smallpox, hepatitis, malaria, typhoid
and viruses, were common; in the 1960s, the death rate of employees from
these diseases dropped to zero. The maternal and child health program
was equally effective: in 1958, 250 of every 1,000 children died in
their first year of life. By 1966, the number was down to 30 of 1,000.
The oral histories in this volume encompass most of the post-World
War II decades, and continue through the building of new facilities
completed in the 1980s. By that time, company ownership had been vested
in the Saudis, who continued the work of the Medical Department.
An earlier volume of Aramco oral histories 1 contains interviews
with company management engineers, financial and legal officers,
geologists, and researchers, as well as top-level executives. A few
wives commented on life in Dhahran. Completed in 1995, this volume came
to the attention of Dr. Armand P. Gelpi, who was with Aramco in the
1960s. Dr. Gelpi was fervently interested in documenting the history of
the Medical Department, unequaled for its pioneering work on several
fronts: research in exotic diseases; establishment of local clinics; the
Harvard- funded study of trachoma; social and cultural interaction. Dr.
Gelpi, in consultation with staff at the Regional Oral History Office,
began planning the project and invited Saudi Aramco, as the company is
now named, to underwrite it. Company officers graciously agreed.
Dr. Gelpi located the interviewees and established contact with
them, smoothing the way for the interviews. He reviewed the
transcripts, wrote an introduction to each, and indexed them. His work
along the way has been indispensable, and we are inordinately grateful
to him for his interest and efforts. Many Saudis and expatriates from
other countries could have contributed significantly to this history,
American Perspectives of Aramco. the Saudi-Arabian Oil-Producing
Company. 1930s to 1980s. Regional Oral History Office, The Bancroft Library,
University of California, Berkeley, 1995.
xvii
but restraints of distance and travel put these out of our reach for the
present.
The Regional Oral History Office was established in 1954 to
augment through tape-recorded memoirs the Library s materials on the
history of California and the West. Copies of all interviews are
available for research use in The Bancroft Library and in the UCLA
Department of Special Collections. The office is under the direction of
Willa K. Baum, Division Head, and the administrative direction of
Charles B. Faulhaber, James D. Hart Director of The Bancroft Library,
University of California, Berkeley.
Carole Hicke, Interviewer /Editor
Regional Oral History Office
Berkeley, California
March 1998
xviii
Regional Oral History Office University of California
The Bancroft Library Berkeley, California
Aramco Medical Department Oral History Project
Richard H. Daggy, Ph.D., Dr. P.H.
PREVENTIVE MEDICINE IN SAUDI ARABIA, 1947-1964
An Interview Conducted by
Carole Hicke
in 1996
Copyright <D 1998 by The Regents of the University of California
Since 1954 the Regional Oral History Office has been interviewing leading
participants in or well-placed witnesses to major events in the development of
Northern California, the West, and the Nation. Oral history is a method of
collecting historical information through tape-recorded interviews between a
narrator with firsthand knowledge of historically significant events and a well-
informed interviewer, with the goal of preserving substantive additions to the
historical record. The tape recording is transcribed, lightly edited for
continuity and clarity, and reviewed by the interviewee. The corrected
manuscript is indexed, bound with photographs and illustrative materials, and
placed in The Bancroft Library at the University of California, Berkeley, and in
other research collections for scholarly use. Because it is primary material,
oral history is not intended to present the final, verified, or complete
narrative of events. It is a spoken account, offered by the interviewee in
response to questioning, and as such it is reflective, partisan, deeply involved,
and irreplaceable.
************************************
All uses of this manuscript are covered by a legal agreement
between The Regents of the University of California and Richard H.
Daggy dated April 21, 1996. The manuscript is thereby made
available for research purposes. All literary rights in the
manuscript, including the right to publish, are reserved to The
Bancroft Library of the University of California, Berkeley. No part
of the manuscript may be quoted for publication without the written
permission of the Director of The Bancroft Library of the University
of California, Berkeley.
Requests for permission to quote for publication should be
addressed to the Regional Oral History Office, 486 Library,
University of California, Berkeley 94720, and should include
identification of the specific passages to be quoted, anticipated
use of the passages, and identification of the user. The legal
agreement with Richard H. Daggy requires that he be notified of the
request and allowed thirty days in which to respond.
It is recommended that this oral history be cited as follows:
Interview with Richard Daggy, an oral
history conducted in 1996 by Carole Hicke
in "Health and Disease in Saudi Arabia:
The Aramco Experience, 1940s- 1990s, "
Regional Oral History Office, The Bancroft
Library, University of California,
Berkeley, 1998.
Copy no.
XIX
INTERVIEW WITH RICHARD DAGGY xviii
CONTENTS xix
INTRODUCTION by A. P. Gelpi, M.D. xx
INTERVIEW HISTORY by Carole Hicke xxi
BIOGRAPHICAL INFORMATION xxii
I BACKGROUND AND EDUCATION 1
II JOINING ARAMCO 2
Applying and Interviewing 2
Moving to Saudi Arabia 3
III ELIMINATING MALARIA IN SAUDI ARABIA 5
Identifying the Problem 5
Taking the Malaria Survey: A Ten-Year Study 6
Malaria Controls 8
Meeting the King 14
Other Preventive Medicine Programs 15
Smallpox 15
Looking for a Trachoma Vaccine 18
Public Health Program 18
IV WORK AFTER ARAMCO 23
Associate Dean, Harvard School of Public Health 23
University Associates 24
Some Statistics and Evident Changes 25
XX
INTRODUCTION to Richard Daggy, Ph.D.
One of the most important elements of Aramco s health care
programdating back to Aramco s early yearswas its medical
department s Division of Preventive Medicine. In terms of its scope of
activity and accomplishments, it was coequal with curative medicine, and
in this sense it filled a unique role in establishing standards for
sanitation, pest control, communicable disease prevention, and other
environmental safeguards for the company, its employees and dependents,
and the communities in which they resided. Dr. Daggy was one of
Aramco s medical pioneers, and in this role he rose to head Preventive
Medicine and eventually to guide the staff of the Medical Department as
its medical director. The importance of his studies on the epidemiology
of oasis malaria in Saudi Arabia and his efforts in establishing malaria
surveillance and control procedures for Aramco and the Kingdom cannot be
overstated .
Armand P. Gelpi, M.D.
December 9, 1997
Sonoma, California
XXI
INTERVIEW HISTORY- -Richard Daggy, Ph.D.
Dr. Richard Daggy joined Aramco in 1947 as medical entomologist.
Within two years he became superintendent of Preventive Medicine
Division, and from 1952-1960 he was chief of Preventive Medicine. From
1960-1964 he was Aramco s medical director. Daggy s work in eradicating
malaria has received the highest praise from other members of the
medical staff who were in Saudi Arabia. For example, Dr. Phil Gelpi
said: "I was able to see, in the eight-year period that I was in a full-
time position at Aramco [1959-1967], a very rapid decrease of malaria
infections in the Eastern Province. I don t think there is any question
that this is directly attributable to the Aramco program that was
initiated by Dr. Daggy and was eventually taken up by the Ministry of
Health." The importance of this program to Saudi Arabs cannot be
overstated.
Daggy began by taking a malaria survey in about fifteen villages
throughout the Eastern Province. Rounding up the children in each
villageand bribing them with fig newtons ! --Daggy and his cohorts took
blood samples and analyzed them for malaria parasites. In some places,
he found 90-95 percent were positive. He then undertook a program of
spraying in the villages, checking the effect every few weeks. Daggy
delineated the results of his ten-year study in a major article
published in The American Journal of Tropical Medicine and Hygiene in
1959.
Daggy was interviewed in his country home near New Boston, New
Hampshire on April 21, 1996. His son, Hormoz Soheili, prepared a
delicious lunch, which we ate on an outdoor balcony overlooking woods, a
stream, and a bird feeder with many visitors.
Daggy contributed further to the project by underwriting lodging
expenses for my trip to Boston to interview him and other members of the
Aramco Medical Department.
The transcript was reviewed by interviewer and editor; few changes
were made.
Carole Hicke
Project Director
January 1997
Regional Oral History Office
University of California, Berkeley
xxii
Curriculum Vitae
RICHARD HENRY DAGGY, Ph.D., Dr.P.H.
RETIRED
Born: August 23, 1914, St. Paul, Minnesota
Marital Status: Single
Citizen: U.S.A.
Academic Training:
Dates
1934
1938
1941
1952,
1958
1960
Institution
University of Minnesota
University of Minnesota
University of Minnesota
Harvard University
Harvard University
Columbia University-
Program in Executive
Management, School of
Business Administration
Degree
S.B. (with distinction)
S.M.
Ph.D.
M.P.H. (magna cum laude)
Dr.P.H.
Certificate
Positions Held;
Dates
1939-1941
1942-1944
1944-1945
1945-1947
1947-1949
1949-1952
1952-1960
Position
Instructor in Biology
Ensign to Lt. (H-Vs)
Entomologist
Associate Entomologist
Associate Professor of
Entomology
Medical Entomologist
Superintendent
Preventive Medicine
Coordinator & Assistant
to the Medical Director
Name of Institution or Agency
Bemidji State College,
Bemidji, Minnesota
USNR
Malaria Control Unit,
South Pacific-New
Hebrides
Naval Medical School,
Bethesda, Maryland
University of Minnesota
Arabian American Oil Co.
Dhahran, Saudi Arabia
Preventive Medicine Division
Arabian American Oil Co.
Arabian American Oil Co.
xxiii
Positions Held (Continued)
Dates
Position
1960-1964
1954-1952
1962-1964
1964-1966
1965-1966
1966-1973
1968-1970
1969 (Nov.)-
1970 (May)
1971-1972
1964-1982
Medical Director
Visiting Lecturer on
Entomology
Visiting Lecturer on
Tropical Public Health
Assistant Dean for Inter
national Programs, and
Lecturer on Tropical
Public Health
Acting Head, Department of
Public Health Practice
Associate Dean for Inter
national Programs,
Faculty Advisor for
International Students,
& Lecturer on Tropical
Public Health
Acting Head, Department of
Microbiology
Acting Dean, Faculty of
Public Health
Acting Dean, Faculty of
Public Health
Lecturer on Tropical
Name of Institution or Agency
Arabian American Oil Co.
Harvard School of Public Health
Harvard School of Public Health
Harvard School of Public Health
Harvard School of Public Health
Harvard School of Public Health
Harvard School of Public Health
Harvard School of Public Health
Harvard School of Public Health
Harvard School of Public Health
Public Health (retired June 1982)
Membership in Professional Societies:
American Association for the Advancement of Science
American Public Health Association (Fellow)
American Society of Tropical Medicine and Hygiene
Delta Omega (National Honorary Society in Public Health)
Entomological Society of America
Explorers Club
Massachusetts Public Health Association
Royal Society for Tropical Medicine and Hygiene (Fellow)
Sigma Xi (National Scientific Honorary Society)
Society for International Development
World Affairs Council (Boston)
xx iv
Other:
Member, Advisory Committee, Development Advisory Service, Center for
International Studies, Harvard University, 1965-
Associate Director, Aramco Trachoma Research Program, 1959-1964
Member, Program Area Committee on International Health, American
Public Health Association, 1967-
Liaison Officer, International Fellowship Programs, Association of
American Medical Colleges, 1968-
Member, Committee on Instruction, Harvard University, 1968-
Selected Publications:
Daggy, R.H., Muegge, A., and Riley, W.A.: A preliminary study of the anopheline
mosquito fauna of southeastern Minnesota and adjacent Wisconsin areas.
Pub. Hlth. Reps. 56: 883-895, 1941.
Daggy, R.Ek : Aedes scutellaris hebrideus Edwards: a probable vector of dengue in
the New Hebrides. War. Med., 6: 292-293, 1944.
Daggy, R.H.: The biology and seasonal cycle of Anopheles farauti on Espiritu Santo,
New Hebrides. Ann. Ent. Soc. Am., 38: 1-13, 1945.
Daggy, R.H.: New species and previously undescribed naiads of some Minnesota
mayflies (Ephemeroptera) . Ann. Ent. Soc. Am., 38: 373-396, 1945.
Daggy, R.H.: So You ve Had Malaria. USPHS, Office of Malaria Control in War Areas,
Atlanta, Georgia, 22 pp., 1945 (processed).
Daggy, R.H.: The Extended Malaria Control Program. USPHS, Office of Malaria Control
in War Areas, Atlanta, Georgia, 28 pp., 1945 (processed).
Daggy, R.H.: A pictorial key to adult anophelines of the United States. USPHS,
Office of Malaria Control in War Areas, Atlanta, Georgia, 1945 (processed).
Daggy, R.H.: Handbook of Residual Spray Operations. USPHS, Office of Malaria Control
in War Areas, Atlanta, Georgia, 45 pp., 1945 (processed).
Daggy, R.H., Hodson, A.C., and Granovsky, A. A. : Recommendations for using DDT.
Univ. Minn. Agric. Ext. Bull., 252 (16 pp.), 1946.
Daggy, R.H., and Page, R.C.: Aramco s preventive medicine program. The Medical
Bulletin, 16: 196-204, 1956. Standard Oil Co. (N.J.), New York, N.Y.
Daggy, R.H.: Oasis Malaria. Industry and Tropical Health, 111: 42-55, 1957.
Harvard School of Public Health, Boston.
Daggy, R.H.: Malariometric evidence for DDT resistance in Anopheles Stephens! in
oases of Eastern Saudi Arabia. Proc. 6th International Congresses, Tropical
Medicine and Malaria. Vol. VII, Div. B. Malaria, 317-324, 1958.
Daggy, R.H. : Malaria in Oases of Eastern Saudi Arabia. Am. J. Trop. Med. and Hyg.,
8: 223-291, 1959.
Snyder, J.C., Page, R.C., Murray, E.S., Daggy, R.H., Bell, S.D., Jr., Nichols, R.L.,
Haddad, N.A., Hanna, A.T., and McComb, D.E.: Observations on the etiology of
trachoma. Am. J. Ophth., 48: 325-329, 1959.
Daggy, R.H.: The administration of medical care and health services by Aramco in
Saudi ^Arabia. The Medical Bulletin, 64: 1-23, 1964. Standard Oil Co. (N.J.),
New York, N.Y.
I BACKGROUND AND EDUCATION
[Interview 1: April 21, 1996 ]////
Hicke:. I d like to start this morning by asking you when and where you
were born.
Daggy: St. Paul, Minnesota, August 23, 1914.
Hicke: And did you grow up in St. Paul?
Daggy: I did.
Hicke: Where did you go to school?
Daggy: I went to high school and the University of Minnesota.
Hicke: At the university, what was your major?
Daggy: My original major was zoology, biology. I m Bachelor of Science,
I took a Master of Science and Doctoral Philosophy degree in
medical entomology.
Hicke: You got the Doctor of Philosophy, and then you also got another
degree, I believe.
Daggy: At Harvard, yes, years later.
Hicke: What was that degree in?
Daggy: Practical public health.
This symbol (#//) indicates that a tape or tape segment has begun or
ended. A guide to the tapes follows the transcript.
II JOINING ARAMCO
Applying and Interviewing
Hicke: After you got your Doctor of Philosophy, you were doing various
things, but let me ask you when you first started to get
interested in Aramco.
Daggy: Oh, after the war, in 1947, I guess. I had returned to the
University of Minnesota to be on the staff, but I was not
particularly interested in agricultural entomology. I was
interested primarily in medical entomologymalaria control, that
kind of thing. I had explored various opportunities in South
America and Venezuela, and then I got a phone call from an old
malaria control buddy [whom I had known] in the South Pacific who
asked if I was interested in Aramco.
Hicke: Who was this, what was his name?
Daggy: Dr. [Robert] Page. He died some years ago.
Hicke: Can you tell me anything about him?
Daggy: No, he was at the Texas Company primarily.
Hicke: Texaco?
Daggy: Texaco, and then he later came to Arabia, much after I did.
Hicke: I believe that was 1948. Did they interview you?
Daggy: Yes, I sort of interviewed them. I wrote them and said I was a
little puzzled as to why malaria could be such a big problem in
Saudi Arabia. I thought it was nothing more than a sea of sand.
Hicke:
That was my first reaction when I heard about it too.
Daggy: Exactly. I was puzzled as to why a good, self-respecting malaria
mosquito could make its way in Saudi Arabia. They said that
they d like to interview me in New York. I agreed, but I felt it
was kind of a waste of time. Malaria and Saudi Arabia didn t seem
to go together very well. When I arrived, they put me up in New
York at the hotel, and I soon found out in talking to them that
there was indeed a malaria problem, and I was interested in it. I
had reason to think that I would have plenty of chances to go to
Venezuela, to South America, but I would never get a chance to go
to Arabia, I thought. This was a new area and a big opportunity
for me, and I found myself agreeing to go and signing up.
Hicke: As what?
Daggy: As entomologist.
Hicke: Do you recall who interviewed you in New York?
Daggy: Dr. Page was one of them; he was associate medical director of the
Texas Company at the time. The Texas Company did some of the
recruiting for Aramco at that time. I don t remember the name of
the medical director as such. This would have been 1946, maybe
47. Dr. Robert C. Page was the distinctive one; he later became
medical director of Aramco and a close friend of mine.
Moving to Saudi Arabia
Hicke: So then did you move to Saudi Arabia?
Daggy: Yes. I recall getting on a plane and flying to London. The
British had done some work on malaria control in Palestine and the
Middle East. So I stopped at the London School of Tropical
Medicine to see what I could find out about malaria in that part
of the world. Then I flew on from London and I very vividly
remember flying into Malta. In those days you put down overnight,
you didn t fly at night, and we put down in Malta for the night.
I can remember vividly in the next morning flying over the North
African desert battlefield, the Rommel area. And then I flew on
to Cairo, and joined the Aramco plane- -they had their own plane in
those days. I joined the Aramco flight in Cairo, took off across
the Red Sea, and once I got across the Arabian Peninsula I
thought: My God, what have I done? What have I done?
Hicke: Was this looking down on it or when you got out of the plane?
Daggy: No, looking down on the whole countryside. It was just all sand,
it looked like to me. When I got to the Dhahran airport- -the
Dhahran airport in those days was kind of a corrugated tin shack.
I can remember having to walk over a kind of sand dune to get into
the corrugated iron building, and again I thought: What have I
done, what have I done?
Hicke: What time of year was this?
Daggy: This was about June 7th, early June, 1947. The hot season had
just begun, and the shamal, the wind, was blowing. It was not
showing Saudi Arabia at its best. I was met by someone at the
plane and taken to accommodations in a dormitory.
Hicke: You lived in a dormitory?
Daggy: ~ Well, a dormitory room. I was very lucky; most of the people were
in shared quarters. We had eight menwhat we called an eight-man
bunkhouse, two to a room. But I had a private room, in sort of an
exclusive area, special bachelor guest house, that was it.
Hicke: How did you rate that?
Daggy: My position, I guess.
Hicke: I see. Was there an entomologist there before you?
Daggy: No, there had never been any entomologist.
Ill ELIMINATING MALARIA IN SAUDI ARABIA
Identifying the Problem
Hicke: Do you know whosomebody in management said this is a big
problem, we need an entomologist?
Daggy: Well, they recognized that Aramco had the problem, not in the
American population because that was in the Dhahran compound.
Apparently the King, Abd al- Aziz, the unifier of Saudi Arabia,
had heard or learned something about the marvels of DDT in malaria
control. And he asked Aramco to look into it.
Aramco also had some part of the problem, especially in
their Saudi Arab employees and their Saudi Arab dependents. But
not in the American community. The camp was located in a non-
mosquito zone in--
Hicke: It was in a dry area.
Daggy: In a dry area, no oases.
Hicke: I guess we should clarify this; as I understand it, the mosquitos
were mostly in the oases.
Daggy: The mosquito breeding was occurring in the oases. I should
probably break off for a moment here. Since before biblical
times, the Arabs on the coast had a series of artesian wells,
flowing wells, all up and down the coast. My idea of an oasis, of
course, was a little pool of water and three strategically placed
palm trees, and that was it.
t
Hicke: Mine too.
Daggy: To my surprise, 1 found that some of the areas around oases were
extremely large, fifteen and twenty villages, large towns and
maybe fifty to hundred thousand people, all up and down the coast.
People were concentrated in the villages and in the oases, and the
mosquitos were all concentrated, of course, in the springs and the
water-bearing areas. And of course, malaria had existed there
from time immemorial to the present.
Hicke: Did they understand that mosquitos were causing it?
Daggy: No, no, I don t think so. Some of them may have, but most of them
did not. The ordinary local farmer did not. The population was
primarily divided into two groups: The Bedouin, who lived out in
the desert, and the so-called "Sown," who were the farmers. They
raised dates and winter vegetables, alfalfa for their animals, and
so on. The Aramco towns were in the desert, and they were far
away from any mosquitos or malaria in that sense.
Hicke: Were the employees, some of them, still living in these villages
in the oases?
Daggy: Yes, some of them, and sometimes, especially in the malaria
season, they would come down with malaria. A headman or a foreman
would come down with malaria, and then the rest of them would not
have any direction. Some of the men would get it too, of course,
but it would be particularly difficult when the Saudi foremen or
Saudi headmen were down with malaria. There were some deaths
among the Saudi employees, but not very many. If they were going
to die, they died as children. The malaria was very, very intense
in these areas.
Hicke: So are you saying they developed some sort of resistance?
Daggy: Well, some immunity; there were relatively few deaths among the
adults. Among the children of employees, dependents, there was
probably a high death rate. For example, you would find that a
woman may have seven or eight children, and only one or two would
have survived, or even less. She would indicate that the fever
got them. That was probably not entirely malaria, but probably to
a large degree due to malaria. So it was having a greater impact
on the children than on the adults, and that was one of the keys
that we used to measure malaria in the area.
Takine the Malaria Survey; A Ten-Year Study
Hicke: Tell me what you started out doing. Well, first of all, where
were your offices?
Daggy: We had an office in one of these portable bunkhouses at first. My
first job was to begin to get out in the fields and take a malaria
survey. I found these pictures to show you. [points to picture]
This is the way we d round up kids in the village.
Hicke: You had some people helping you?
Daggy: We d round up kids in the local village square, and then bribe
them by giving them fig newtons for a drop of blood. We d stab
them, take a blood smear, and take the slides back to the
laboratory and examine them for malaria parasites. We did this in
quite a few villages. The first year we covered about thirteen,
fourteen villages, and then second year we went to a nearby oasis,
Hofuf oasis, and did that as well.
Hicke: f Do you have any idea how many samples you took?
Daggy: Oh, this was done over a ten-year period, so there would be
thousands .
Hicke: What s this? [points to pamphlet] Is this one of your writings?
Daggy: Yes, that s the ten-year study, the major study on malaria. 1
Hicke: Did you spend all your time taking these samples in the villages?
Daggy: No, no, this was seasonal. Usually in the fall for a few weeks,
during the worst part of the malaria season, we d take samples
from the children and calculate the percentage positive for
malaria parasites. Then we d calculate the percentage of
positives in that village and get a general estimate of the amount
of malaria in that village. Some places it would be 90, 95
percent of the children running around with these parasites, and
no telling how many would have been sick and probably died of
infection. But that was a benchmark against which we could
measure the amount of malaria in the area, and that would be also
a benchmark against which we could measure the success of our
control measures.
Richard H. Daggy, "Malaria in Oases of Eastern Saudi Arabia," The
American Journal of Tropical Medicine and Hygiene, Vol. 8, No. 2 (part 2),
March 1959, 223-291.
Malaria Controls
Hicke: When did you start instituting controls?
Daggy: We had to wait for supplies. After the war I worked for the
Public Health Service on a DDT spray program in the South.
Malaria was present in the South, in the southern states,
particularly in the negro shacks and so on, very poor people. We
sprayed the inside of the tar paper shacks against the malaria
mosquitos.
I should point out the theory behind this. DDT was a
wartime discovery. It had been touted as a malaria control
measure because of its long-lasting effects in houses. You d take
a house like this and spray the walls and the ceilings and all the
rooms in the house, and you d lay a thin coating of DDT. You
probably wouldn t even be able to see it on a white wall, for
example, but it would remain there for a varying length of time.
We found out that in Saudi Arabia, because of the dry climate and
so on, you put on the spray coating of DDT in the early fall and
it would last for almost a year until the next season, which was
quite different from in more humid climates where you had to
reapply the spray at different intervals. We found out that we
could spray once a year. I don t whether you want to get this yet
or not. So once we got all our equipment in--
Hicke: Is this your equipment in this picture?
Daggy: Yes, we had crews like this going.
Hicke: That was for the spraying.
Daggy: Yes, spraying the walls and the ceilings. They were mainly palm
thatch huts. You might as well pull these pictures out first to
get an idea of what the place is like. That gave us a base for
measuring malaria. The theory was: after the spray was put on,
the mosquitos would rest on the walls and the ceilings during the
day and then come out at night to feed. Screens were unknown,
obviously, and people slept outdoors very seldom, because there
was no protection against mosquitos as such.
The malaria mosquitos don t annoy; they re not like other
mosquitos, buzzing around and making a noise and biting. You
don t know that you re being bitten actually, it s a nonpainful
bite, for the most part. And then filled up with blood, the
mosquitos would find a stable or a barn or a house to rest on the
walls. In some places I remember, it was almost as if you took a
handful of wet raisins and threw them against the wall and they d
all stick to the wall. They d be hanging onto the wall.
That was the cause of their downfall, because they would
absorb the DDT through their feet and be killed, and if they
weren t killed the first night they would be killed on the second
or third or fourth or fifth. It usually takes about two weeks for
the malaria parasite to mature and to be passed on to another
person by a bite, so you had about two weeksten days to two
weeksto get at the mosquitos if you didn t get them the first
night. But usually they would be killed in the houses, and that
was the focus of the malaria attack.
Hicke: Did the people object to having you come in and spray?
Daggy: -/ Well, sometimes. These were mainly shacks, pretty much. As soon
as they saw it was a means to be safe, they didn t object.
Actually, they didn t have any right to object. The governor had
absolute power.
Hicke: Oh I see. You had the support of their local sheik or amir?
Daggy: For the most part they wouldn t object, although if they had a
particularly nice house they might. But they soon found out that
all the spiders and flies and scorpions and things like that would
be killed by the same DDT spray. Most of them didn t connect the
mosquito control with malaria control; they relished the idea of
having their house fly-free and tick-free and scorpion-free right
away, but I m sure most of them didn t connect the mosquito death
with the drop in malaria.
Hicke: Since the king had interested himself, did you have to report to
the government?
Daggy: No, they let us do the whole works ourselves. An agreement was
made whereby they were supposed to have put up the money for the
DDT supplies, because it was going out to a public health program
in the villages and not in the company towns. Sometimes they
would not pay up on time, or they couldn t pay their billsit was
quite a bit later that they had all the money but they came
around.
Hicke: Did you have other Americans working with you and some Saudis?
Daggy: 1 had one American assistant, that s probably who you saw in the
picture.
Hicke: What was his name, can you recall?
10
Daggy: Don Strait. Then we had some of these Arab boys that you saw here
in the picture. We had headmen who would be gang pushers,
foremen- -
Hicke: You had the headmen and then you had the people that sprayed?
Daggy: Yes, the spray workers and so on. Spray crew. And then during
the malaria survey season, we had some of our American laboratory
technicians, who would come out and do the village finger sticking
for us. They enjoyed the chance to get out into the villages. It
was a kind of holiday for them, in a sense. And of course it only
took a few days.
Hicke: After you sprayed most of the places in a village, then would you
go back?
Daggy: Then I would go back and count the mosquitos on the wall. I soon
found out that they had almost entirely disappeared. I had
regular checkpoints which I visited every few weeks in various
villages. I soon found out that at first, compared to how it had
been before spraying, with these raisins on the wall, there were
just absolutely none resting on the walls, for a time. And then a
very few would begin to reappear toward the end of summer, just
before it was time to spray again. So we would repeat the cycle.
We would repeat the cycle, both as far as blood checks and the DDT
spray program, once every year for most of the ten years. And the
malaria rate dropped precipitously down to a couple percent,
compared to 97 percent of the kids.
Hicke: Obviously the Saudi employees were much better off but also all
the local population.
Daggy: The local population was better off and the effect on the children
was impressive; there were almost no deathswell, we had no way
of knowing about what the deaths in the villages were.
Hicke: That must have been very rewarding for you.
Daggy: Yes.
Hicke: Can you tell me some of the villages you visited, are the names
within reach? They re in that book.
Daggy: Damman, al-Khobar, Jubail, Dhahran, Abqaiq, Ras Tanura, Thuqbah,
Qatif, Saihat, Safwa, Tarut . And so on down the list.
11
Hicke: That s a lot. How long do you think it took, probably, over this
period of ten years before you saw this amazing change?
Daggy: Well, there were a series of changes. Occasionally, we would have
a problemthe government would refuse to pay its bill, or just
couldn t. So the company thought they would just have to draw the
line somewhere. We were going up and treating all the villages in
the area, which was not a responsibility of Aramco as such, and if
they weren t going to pay for it, so be it. So every once in a
while when they would stop spraying DDT, the mosquitos would come
back in the houses and again rest on the walls and bite the people
and so on. And then the malaria rate would go up.
I should interject here that all the mosquitos weren t being
killed, obviously, only the ones that were resting on the walls of
_j the houses, and those were the ones that were most likely to be
infected with the malaria parasite, and those were the ones which
were most likely to transmit it. So for the others, it had to be,
for the most part, repeated each year.
Ultimately you probably would cut down on the total number
of mosquitos that were infected, but you wouldn t know that unless
you dissected them and found out whether they were infected or
not.
Hicke: Are you telling me you didn t know how many were infected?
Daggy: You could count the numbers of mosquitos, as such, but that
doesn t mean that they were all infected or any of them were
infected. But obviously in the beginning a large number of them
were or you wouldn t have had the drop in malaria, or the increase
in malaria that happened when we skipped the year. It would go up
and down, up and down, every fall.
Hicke: So it would start to rise again, as you said, just before you were
ready to spray?
Daggy: When the first DDT was put on, the malaria rate dropped
precipitously, down, down, down, down, down.
Hicke: Oh yes. [Looking at a chart] Started in 47, and then actually by
1949 it had dropped hugely.
Daggy: That was the major, major drop. When they stopped doing spraying,
stopped buying DDT, we had to skip on certain years, and it was
almost an alternate year for a time. And that gave us a good
chance to really explore what was going on, although we didn t
like the idea of skipping a year and losing all that time. But we
gradually were able to cut down, even on an alternate-year basis,
12
Hicke:
Daggy:
Hicke :
Daggy:
Hicke:
Daggy;
Hicke:
Daggy:
Hicke :
Daggy:
on the number of infected mosquitos over the year, even by the
alternate spraying and nonspraying. Then later they got with it
and got the supplies coming through on a routine basis; so you
could plan, that way. You must remember that the supplies of DDT
had to be ordered about nine months in advance, for ocean
shipment .
Where did it come from?
Oh, I think most of it came from the U.S.
Now I understand you used some other things besides DDT?
Yes. Then we began to see a peculiar thing that occurred. The
DDT seemed not to be as effective against the mosquitos as it once
was. In other words the mosquitos were developing a resistance to
the poison; and that was observed all over the world by about the
same time I reported it to the World Health Organization in the
annual international meeting in India at that time.
We proved by malarial metric evidence that DDT was losing
its killing power against mosquitos, and they were becoming
resistant to it. We started another insecticide, Dieldrin. That
lasted for a couple of years, and pretty much replaced DDT in this
as well. And then towards the end of this study, Dieldrin was
becoming less effective.
Towards the end of the ten years?
Yes. That s about the time I left Arabia and some of the other
people took over, and then some of the World Health Organization
people took over the spray program, and the Saudi Arab government
took over some of it as well,
come to Harvard.
That s about the time I left to
I think it was Elinor [Nichols] who told me about the fish that
you threw into the wells. I think that s pretty novel. Can you
tell me about that?
There was some type of small fish in all the wells and streams in
the oasis, little, tiny fish, Gambusia.
About an inch long?
Yes, little, tiny things. So we moved some of those. They were
in the wells, and the wells would carry the water and the fish out
to the streams and to the irrigation ditches and so on. And
sometimes of course, the fish wouldn t cross over into the
drainage ditches. If the water was coming out like this and then
13
being absorbed over here, sometimes there wouldn t be a direct
connection with the water. We spread a lot of fish in there.
Then there was another oasis farther inland near Riyadh
which did not have any of these fish whatsoever; we never
discovered any of them. We moved some of them from the Qatif area
into the Riyadh area, from the coastal area into the inland area,
and dumped some of them intothere were a number of enormous, big
wells that pumped water out into the irrigation fields. We dumped
some of those fish into those wells and distributed them that way;
and then we distributed some of them in the drainage ditches as
well. As far as I know they re still in there.
Hicke: That s what Elinor was telling me; she said she went back with you
to one of those wells near Riyadh once. And you asked some boys
J that were diving into the well if the fish were still there, and
they said yes. But how did you know these fish werewhat were
they doing, eating the mosquitos?
Daggy: Yes. There were a lot of these f ish Gambusia is one that we use
in this country a lot little, tiny fish that grow no bigger than
that, being full grown. They feed on mosquito larvae almost
entirely.
Hicke: That was known?
Daggy: That s known all over the world.
Hicke: I see.
Daggy: I had introduced some of those into the New Hebrides during
malaria control work with the navy.
Hicke: Brought them from someplace else?
Daggy: Yes, I think we brought them from Australia or New Zealand, but
they re worldwide.
Hicke: Are there any anecdotes or stories that you recall in your travels
out to the villages in Saudi Arabia?
Daggy: Most of the houses in those days were very poor, thatched huts.
Foreigners normally didn t get into these. But when I was
inspecting some of the work to see if they were doing proper spray
application on the walls and ceilings, I remember an old woman who
didn t want to be taken out of the house; so they put a big basket
over her head and left her alone in the back while they sprayed
the roof and ceiling.
1A
Hicke : Did she survive?
Daggy: Oh yes, she survived, she had her wits, but she d probably never
seen an American before.
Hicke: Yes, sure.
Daggy: There were so many stories; I was there from 19A6 to 196A.
Hicke: Okay, well let s just keep that in mind as we go along, and if you
think of any, we ll include them. About two years after you were
there [19A9], you became the superintendent of the Preventive
Medicine Division; so did you have things other than malaria to
worry about then?
Daggy: The original charge was to do malaria control spraying entirely,
and as I told you, the malaria was not a problem in the company
towns. It was a program entirely in the villages, and obviously
most of the villagers did not work for the company, so the general
public derived most of the benefits from the spray program. Some
of the employees who worked for the company benefited, then some
of their children and wives and dependents benefited, but it was
primarily a program for the villages and the oases. And as I told
you before, the Aramco camps were not put in the villages
primarily for this reason. Well probably, not only for that
reason alone.
Hicke: Anyway, they were free of malaria.
Daggy: They were free, most of them never heard of malaria, never came in
contact with it.
Meeting the KingM
Hicke: Did you ever have any meetings with the king or any kind of
relationship with members of the court?
Daggy: Yes, actually we did visit the king once. In the early 1950s when
we first started the malaria program, "Abd al- Aziz knew about the
program and invited us to come and spray the palaces. They just
had mud brick houses then. And so we went to Riyadh and brought
our spray crew in. At that time you had to have permission of the
king to travel to Riyadh and if you did, you had to wear Arab
dress of course. The king sent a whole outfit to me of the robes,
which I wore, and I was invited to the majlis.
15
The drill was that you dressed in the Arab dress, and the
king was seated a on a low dais, surrounded by a line of guards
with embroidered cloaks, and we sat there and we chatted a bit,
through the interpreter of course. Then the king started hearing
petitions; and in the majlis, any subject might come before the
king with a petition to be heard and it would be granted or not
granted. During this period, Crown Prince Saud came forward to
kiss his father s hand, and he sat right at our feet on the floor.
We were sitting at the king s right hand; I was on a low chair,
and the crown prince came and sat at my feet, although swordsmen
and others were sitting on the floor also. So then we chatted a
while more and the audience was complete.
After that we worked in the palace for seven or eight days
spraying the rooms, and at that time I learned my first lesson in
-f slavery. The slaves there in the court were fat, well dressed,
usually black, and rather sassy; they were drinking coffee, and
the free men had to wait until they were ready to have their walls
sprayed.
Most of the lower quarters were animal quarters, camel
stables and so forth. I remember one occasion in Hofuf the camel
herder said that the amir wanted to have the camel stables sprayed
with DDT for ticks. They were like bedbugs, they were all over
everything. If you came in and stamped your feet on the ground,
it would sound like the camels and it d bring the ticks right out
of the ground. But the main spraying in Riyadh was for flies,
because the king wanted to see the effect on flies; they didn t
really have malaria mosquitos.
I was also called to Jiddah one time when there was an
outbreak of malaria up and down the coast, and we did a survey
along the coast where the African mosquitos had transmitted a
different kind of malaria, and at that time we met Faisal, who was
then viceroy of the Hijaz, later King Faisal. He was interested
in our work and he came to see what we were doing. So all in all,
I met three kings, Abd al- Aziz, Saud, and Faisal.
Other Preventive Medicine Programs// //
Smallpox
Hicke: Besides malaria, I believe you started other preventive medicine
programs?
16
Daggy: It started out that the medical director asked me to begin
preparing for other preventive medicine activity, public health
activity.
Hicke: Who was the medical director then?
Daggy: Well, I had several: Dr. [T.C.] Alexander was the one who was the
first director I d reported to when I came out. He was succeeded
by Dr. Page. And then Dr. Page left and I succeeded him. Dr.
[Richard] Handschin, did you talk to him by any chance?
Hicke: Not yet, but I m going to.
Daggy: Dr. Handschin then succeeded me when I came to Harvard, and Dr.--
Hicke: [Julius] Taylor was in there?
Daggy: Dr. Taylor came thereafter.
Hicke: Okay, and I interrupted you when you were just telling me that the
medical director asked you to--
Daggy: Yes, so he suggested that malaria was only one of the many, many,
many problems. Tuberculosis and trachoma, oh gosh, we had
smallpox outbreaks and things like that. I can remember one of
the cases: There was a pilgrimage up into Iraq I think it was; a
group of Muslims would go every year for the pilgrimage. This was
a good place of course to spread smallpox. So these pilgrims came
home to one of the small villages up near Ras Tanura, and we
learned that there was a possible outbreak of smallpox in this
small village. This had been one of the villages where we had
done some of our malaria work, so we were known to them, for we
had just done malaria work.
Hicke: This was Ras Tanura?
Daggy: Well, near Ras Tanura: Safwa. Apparently one of the children had
come down with smallpox en route from a pilgrimage site in Iraq,
had died en route, and they brought the body back into Safwa. But
then we heard there had been some additional cases of smallpox in
the area, and this is only fifteen, twenty miles away. I couldn t
imagine that they wouldn t have asked for help from the government
or from somebody for a smallpox epidemic! The world would be on
fire if we had smallpox around here.
I was asked to go up and investigate, because I had previous
experience with malaria control group. So I went up and sure
enough, I found I d see women on doorsteps cradling pock-marked
babies. Terrible, and of course it was being spread all over the
17
place. I ll never forget these blistered, black-faced babies; it
was amazing. I said, Oh well, it ll be simple enough. We ll get
a smallpox film: One of these films that had been made for the
pan-American audiences. They were for backward countries for
health education tools. I had arranged for one of these to be
sent out by air, I guess, and said, We ll take this film up and
put a sheet up in the town square, show the film on smallpox
control, and then we ll have a chance to talk to them about it,
and so on. I had planned all this, and I thought there could be
no possible objection to this.
So someone said, You re going to talk to the Government
Relations Department, are you not? The Government Relations
Department was in charge of all government contacts. They said,
We re not sure that you ll be allowed to do that. And I said, Of
--J course I will. (I was naive then.) If people are dying of
smallpox, you do what you can to prevent it. They said, Well,
you d better see the local governor about this.
So we did, and he said, No, there will be no health
education films shown on smallpox. If God had not wanted smallpox
visited on the population, he would not have sent it to the
population. All these educational films were verboten; he didn t
want just any kinds of films. The amir enjoyed war pictures and
battleship pictures. No entertainment film and no educational
film, nothing of this sort. I said, Oh my God, I can t believe
this!
Then we showed him this picture I guess of a film made in
South America. These were some Walt Disney films that were made
some time ago, years and years ago. We took these films up and
showed them, finally got permission to show them on the screen in
the village. Later we sent up a vaccination team for smallpox
vaccination, and then they got the epidemic under control.
I started to say that the film was not a big success,
because what these people were looking at were woods and streams-
like in South Americathe rivers and all the green, green grass,
and green trees and crops and so on; and of course they lived in a
sand pit really, in the middle of the desert, in a desert village.
Hicke: They couldn t relate to that.
Daggy: They couldn t relate to the rushing streams and lakes and pools
and so on, green grass and green trees and things like that; they
were looking at the background rather than the lesson of the
story.
**
18
Hicke : Were those the only cases of smallpox you saw?
Daggy: Yes, that was the last outbreak that we saw.
Hicke: Bill Taylor said he saw some.
Daggy: Yes.
Looking for a Trachoma Vaccine
Hicke: What other kinds of preventive health things did you do?
Daggy: Well, we tried to develop a vaccine for trachoma.
Hicke: Yes, Elinor told me a lot about that, so did Dotty McComb.
Daggy: Dr. Snyder--you ve got a kind of deposition from Snyder, I think;
did you see him?
Hicke: He sent some materials but I haven t gotten it yet; he sent it to
Phil [Gelpi] . But I know he has a lot to offer about that too.
Let me just ask you what you had to do with that project. Tell me
what you knew about it, from your own viewpoint.
Daggy: Well, I had little to do with the trachoma project except to ease
the way. I was medical director at that time, chief of Preventive
Medicine anyway. All that was a Harvard research program.
Hicke: I m interested to know exactly how it got started. I guess it got
started with Dr. Snyder coming out?
Daggy: Yes. I had gone to the Harvard School of Public Health to take a
Master of Public Health, because by that time [1952], as I was
telling you, some of this kind of work was going above and beyond
the malaria control project.
Public Health Program
Daggy: They asked me to head up a preventive medicine program, a public
health program.
Hicke: Aramco did?
19
Daggy: Aramco did.
Hicke: They didn t have one before?
Daggy: No, Aramco Medical Department soon found out that as they were
treating patients, the more they were treating them, the more they
got. There was no preventive program, no vaccination program for
the dependents; in those days you could hardly get a Saudi
employee into the hospital. In the early days he d avoid the
hospital like the plague; hospital was the place to die, like the
old times in this country.
I asked that I go to the Harvard School of Public Health for
a six-month period and then perhaps come back for my next biannual
visit to finish it up. So I went and took courses in maternal and
- child health and epidemiology and statistics, tropical public
health, tropical medicine, sanitary engineering, and things like
that. Then at the end, I fully expected to come back at midterm.
Dr. Ted Allen had been at the Harvard School of Public
Health at the end of the war. He suggested that I go there to the
School of Public Health, and then the dean, Dean Simmons, had been
an army chief of preventive medicine during the war, and he had
become dean of the School of Public Health a year or two before.
He talked to Dr. Allen on a visit, saying that he thought it would
be insane for me to leave in midterm and pick up two years later.
Ted Allen asked whether I would be willing to stay. Yes, of
course I would be willing to stay; but if I m gone for three or
four months and ask to stay nine, they can probably do without me
for quite a long time! [laughter] So I said, "Well you can ask
but I don t think it will do any good." And then after he was
gone, I thought, My gosh, this isenough s enough. I m asking to
stay at the School of Public Health for the rest of the semester?
If they can do without me this long, they can do without me for
good.
But to my great surprise, they put me on the stateside
payroll and told me to stay; and then I took the master of public
health at that time. That led to all the other public health
activities, preventive medicine activities of the time. We added
a health educator to the group; we added sanitary engineers; I got
another entomologist, epidemiologist, maternal and child health
specialists. We established the nucleus of a public health
program, actually, and then we began working on programs in
a ddition to malaria.
Some of those were not only for the Saudi employees but were
for some other kinds of preventive problems within the general
populace, Americans as well as local. They had quite a few
20
problems with amoebic dysentery, for example, infectious
hepatitis, a number of things. We had food and restaurant
programs. We had sanitarians, and we developed a small public
health program: health education, environmental health and
sanitation, --to prevent diarrhea, malnutrition, skin infections-
special care of premature infants.
I might give you this, I ve got an extra copy of this:
prenatal care, proper feeding for children, there s maternal child
health specialists and so on. 1
Hicke: I think we re going to deposit some papers in the library at
Berkeley to go along with the oral history, so if you have a copy
of that or any other papers that eventually we could have, that
would be excellent. Was it a fairly unusual thing for an offshore
corporation to develop this kind of program?
Daggy: I think it was an entirely new thing. I don t know of a single
similar case that has occurred.
Hicke: Do you have any sense of why Aramco?
Daggy: Well, yes. I think they had a sense of responsibility to their
employees, not only to their American employees but also to their
Saudi employees. And the Saudi employees for the most part lived
in the nearby villages; or if they came from a farther distant
area, they lived in the [Aramco] camps. Sometimes even in the
camp they would have to be brought in against their will because
they were sick. The dependents were of course in the villages.
For a time they did not come in for any kind of treatment; so
there was a big backlog of treatment in one of the most
undeveloped parts of the world.
Gradually it improved, with health education, with maternal
and child health assistance, with care, with nursing. This was
primarily a male-dominated area. Then some of the female
dependents and kids came in. The Saudi employees, their wives and
children, if they came in to the hospital, got treatment; but it
was rough getting them in, in the beginning. Soon the flood was
on, and you couldn t keep them out, in a sense. I once told
management that if this kept up, they were going to have a huge
medical department attached to a little oil company. It was
growing by leaps and bounds. We had about 12,000 Saudi employees,
and each one had one or two wives and a set of children. That
Richard H. Daggy and R.C. Page, "Aramco s Preventive Medicine
Program," The Medical Bulletin, 16: 196-204, 1956. Standard Oil Co.
(N.J.), New York, N.Y.
21
quickly added up: in addition to 3,000 Americans, we had 12-15,000
Saudi employees and 12-15,000 Saudis wives and kids. It was
overwhelming.
So we started out trying to work with the World Health
Organization and trying to get the Saudi Arab government, who had
begun to take some interest in the hospitals and the clinics, to
organize some preventive medicine programs in the towns and
villages nearby. Aramco could draw people in; but once all the
nonemployee dependents, as well as the employee dependents,
started coming inanyone could come in for medical care--so once
we had gotten to the point where the knowledge that medical care
was something that the employees learned to appreciate, then their
wives and families came to appreciate it. And then not only their
wives and families came in but everyone else came in for medical
y care. So that s when we started trying to point out that the
Saudi Arab government must take responsibility at least for their
own people.
Hicke: The people who weren t Aramco. .
Daggy: Those who weren t Aramco and had no association with Aramco.
Hicke: Was there somebody in the Aramco management that you think was
particularly supportive?
Daggy: Oh yes. I think Tom Barger was. He was a geologist who came out
originally, way back before my time; he is long since dead. Many
of these older employees had a very strong appreciation for the
Arab and for their character and culture. They were truly
appreciative; they had been on exploration parties, of course with
Arab guides in the exploration of Saudi Arabia; and they had
appreciated the men of the desert, if you will. I learned to
respect them and appreciate them. Those early explorers had a lot
of respect for the Arab. They tried to do what they could for
them. There was a whole big program of worker educationschools,
even grade schools in the villages. There was only one high
school in the whole area when I first came. Since then there have
been high schools and colleges and universities that have gone
ahead.
So there was a whole development program in addition to the
medical program: educational program, road development, urban
industrial development; they tried to get people started in
various businesses and so on.
Hicke: I don t want to keep you too much longer, but let me ask you if
there are some things that we haven t covered, that we should talk
22
f
about. Maybe you could tell me a bit about people you worked
with, like you had mentioned Dr. Mitch Owens.
Daggy: Yes. He was a health educator, and I think you d be able to get
more information from Dick Handschin; he may know where he is
located.
Hicke: When did he arrive and how did you get him?
Daggy: After I came back from the Harvard School of Public Health the
first time, with my master s degree in health education, I felt we
needed a health educator, and we hired one.
Hicke: He was in charge of programs?
Daggy: Yes, this describes his activities.
Hicke: The Administration of Medical Care and Health Services by Aramco
in Saudi Arabia, by Richard H. Daggy. 1 Was there anybody else that
you recall particularly that worked on this program?
Daggy: The Maternal and Child Health nurse, MCH nurse, and again
Handschin will be able to tell you about her. I can t even
remember her name. This was about the time I left.
From The Medical Bulletin, 64:1-23, March 1964. Standard Oil Co.
(N.J.) New York, N.Y.
23
IV WORK AFTER ARAMCO
Associate Dean, Harvard School of Public Health
Hicke: Well then, I d like to hear how you decided to leave and how you
wound things up, turned over the preventive health program to
somebody else.
Daggy: Well, I should tell you, I didn t want to leave.
Hicke: I think that s not unusual; a lot of people I ve talked to didn t
want to leave.
Daggy: I was kind of forced into it. Dean Snyder had assumed that I was
going to come at age fifty, taking early retirement.
Hicke: Come to Boston where he was?
Daggy: Come to Boston, yes, and take a post in the School of Public
Health as associate dean. I finally agreed to it. Remember I
think I told you that--
Hicke: You didn t tell me on the tape though. We were just talking when
we were having lunch, so I m asking you to repeat that story on
the tape. What you started to tell me at lunch was that every
time you saw him, he had said that--
Daggy: Yes, shortly before my fiftieth birthday, Dr. Snyder was out in
the field, and he had asked when I was coming back. I said I
didn t know and I wanted to stay at least until I was age fifty
and eligible for early retirement. I had no real reason for
coming back, and I thought he was interested in helping me get
relocated if I ever decided to come back. I indicated that I was
not going to come back at the earliest until age fifty, so that I
could be eligible for early retirement.
24
Hicke:
Daggy:
I didn t know at the time that he was thinking of a post at
Harvard, I just thought he was thinking in terms of a responsible
school looking for assignments of its graduates, someplace. When
I learned that he was thinking in terms of my coming to Harvard, I
was very surprised. I said, Well, I guess coming back to Harvard
University is no mean place to begin. So I had asked for a leave
of absence and then I d been home just about that time on
vacation, and I talked to my father about it. My father said, You
aren t going to hold up everyone along the chain of command, are
you, waiting a year while you can make up your mind? I thought
that was a strong way of putting it, but he was right. Dr.
Handschin would have been waiting a year just for me to make up my
mind, and other people were there. I decided that was not the
thing to do, and that if I was going to go, I should go, and if I
was going to stay, I should stay. When I finally decided, I
thanked the administration for their willingness to give me a
year s leave of absence, but I said, No, I ve got to make up my
mind. So then I came back to pick up the post at Harvard.
This is 64.
I retired in December 64. So then I came back, but I continued
my association with the Harvard-Aramco trachoma research team and
my interest in Saudi Arabia up to the present.
University Associates
Hicke:
Daggy:
Weren t you part of the University Associates?
me about your part in that too.
Maybe you can tell
Oh yes. Well, Dr. [Roger] Nichols thought it would be helpful to
Saudi Arabia to have a kind of a consultant group. He suggested
faculty members: the dean of the faculty at American University
of Beirut and the head of the Department of Tropical Public Health
at Johns Hopkins University and himself and myself at Harvard.
That was after I had retired from Harvard, partially retired
anyway, not active anymore. We went out to review and to make
recommendations on the long-term study, long-term project for the
Ministry of Health.
I had just built this house, and a friend of mine was
staying in it who had also been in Saudi Arabia. He had a heart
attack while living in the house with a friend, and I had to come
home; I had the dog and the house and everything else to take care
of. So I came home about that time. I prepared some of the
reports, but the main work was with Dr. Nichols and Elinor, Dotty
25
McComb, and that group. They had some additional programs in
Qatar, I think, in the Arabian peninsula, in addition to Saudi
Arabia, consultant activities. But I did not participate; my time
was cut short because I had to get back to the house.
II
Hicke: So that s it for University Associates?
Daggy: Yes, pretty much. Elinor would have told you more about that.
Hicke: Yes, she did tell me a lot.
Some Statistics and Evident Changes
Hicke: Okay, anything else that we should cover?
Daggy: I guess I can t think of anything. I ll probably think of
something as soon as you go. For example, we had 10,000 employees
and 9,000 wives, 29,000 kids in Saudi Arabia at that time.
Hicke: That s pretty impressive!
Daggy: These are all in here, these figuresthe general health status in
1949, 59, 69, 79, 89. Thirty years ago 10 percent had
physical defects, and 11 percent were unfit for employment; 87
percent underweight. Serious disease, intestinal worms, trachoma,
dysentery, malaria, tuberculosis.
Hicke: What about worms, did you do anything about worms?
Daggy: We tried to improve sanitary food and water supplies, health
education, that kind of thing. Oh, the Ministry of Health
Cooperative project--! told you that we attempted to get the
Ministry of Health to stand on its own two feet with the help of
the World Health Organization.
Hicke: You must have gotten them interested, because I know they built a
huge hospital and a lot of small hospitals even in outlying areas,
so I think you must have been convincing.
Daggy: This was about the time I left.
Hicke: I think we ve covered most of what I wanted to ask; it s been a
very informative interview, and I thank you very much.
26
Daggy: Well, you re most welcome.
Transcriber: Lisa Vasquez
Final Typists: Carolyn Rice, Shana Chen
27
Regional Oral History Office University of California
The Bancroft Library Berkeley, California
Aramco Medical Department Oral History Project
Armand P. Gelpi, M.D.
ARAMCO MEDICAL SERVICES: 1959-1969
Interviews Conducted by
Carole Hicke
in 1995 and 1996
Copyright 1998 by The Regents of the University of California
Since 1954 the Regional Oral History Office has been interviewing leading
participants in or well-placed witnesses to major events in the development of
Northern California, the West, and the Nation. Oral history is a method of
collecting historical information through tape-recorded interviews between a
narrator with firsthand knowledge of historically significant events and a well-
informed interviewer, with the goal of preserving substantive additions to the
historical record. The tape recording is transcribed, lightly edited for
continuity and clarity, and reviewed by the interviewee. The corrected
manuscript is indexed, bound with photographs and illustrative materials, and
placed in The Bancroft Library at the University of California, Berkeley, and in
other research collections for scholarly use. Because it is primary material,
oral history is not intended to present the final, verified, or complete
narrative of events. It is a spoken account, offered by the interviewee in
response to questioning, and as such it is reflective, partisan, deeply involved,
and irreplaceable.
************************************
All uses of this manuscript are covered by a legal agreement between
The Regents of the University of California and Armand P. Gelpi
dated February 16, 1996. The manuscript is thereby made available
for research purposes. All literary rights in the manuscript,
including the right to publish, are reserved to The Bancroft Library
of the University of California, Berkeley. No part of the
manuscript may be quoted for publication without the written
permission of the Director of The Bancroft Library of the University
of California, Berkeley.
Requests for permission to quote for publication should be addressed
to the Regional Oral History Office, 486 Library, University of
California, Berkeley 94720, and should include identification of the
specific passages to be quoted, anticipated use of the passages, and
identification of the user. The legal agreement with Armand P.
Gelpi requires that he be notified of the request and allowed thirty
days in which to respond.
It is recommended that this oral history be cited as follows:
Interview with Armand P. Gelpi, an oral
history conducted in 1996 by Carole Hicke
in "Health and Disease in Saudi Arabia:
The Aramco Experience, 1940s- 1990s,"
Regional Oral History Office, The Bancroft
Library, University of California,
Berkeley, 1998.
Copy no.
Armand P. Gelpi.
Photograph by Elson- Alexandra, Los Angeles
28
TABLE OF CONTENTS --Armand P. Gelpi, M.D.
CONTENTS 28
INTRODUCTION by A. P. Gelpi 30
INTERVIEW HISTORY 31
I BACKGROUND 33
Growing Up in Denver and California 33
Pre-med Training in the U.S. Navy, 1943-1945 34
Medical School 35
Internship and Military Service During the Korean War 37
Residency in San Francisco and San Jose, 1952-1955 40
Practicing Medicine in the V.A. Health Care System 41
Private Medical Practice 42
II EMPLOYMENT WITH ARAMCO, 1959 43
Job Interview 43
The Move to Dhahran, Saudi Arabia 45
Aramco Health Care in Saudi Arabia Before 1959 46
Aramco s Dhahran Health Center 47
Community Clinics 50
More About Dhahran Health Center 50
III FACILITIES AND PATIENTS 52
Contract Facilities 52
Trips to Qatar in 1960 and 1968 54
Health Care at DHC and Other Aramco Facilities: Patients 57
Community Life 58
Aramco Medicine 58
Aramco Provides Medical Services to the Royal Family 62
The Persian Gulf Medical Society and Aramco s Medical
Department 64
IV HEALTH AND DISEASE IN SAUDI ARABIA 67
Smallpox 67
Malaria 68
Aramco s Health Care Program and the Saudi Government 70
More about Aramco and Malaria Control 72
Trachoma and Aramco s Trachoma Research Project 73
Q Fever in Saudi Arabia 75
Pulmonary Ascariasis 79
Cancer 82
Conference in Shiraz, Iran: G6PD Deficiency and Favism 85
Sickle Cell Trait and Sickle Cell Disease 90
Schistosomiasis 96
Pulmonary Tuberculosis 98
Hepatitis 99
29
V MEDICAL DEPARTMENT ADMINISTRATION 103
Reporting to Aramco Management 103
Hiring 104
District Visits and Medical Education 107
More on the Journal Club 109
VI RESIGNATION AND RETURN VISITS TO DHAHRAN 111
Leaving Aramco 111
Medical Research in Dhahran, 1974-1978 112
30
INTRODUCTION- -Armand P. Gelpi, M.D.
Dr. Gelpi joined Aramco from a California private medical practice
in 1959 as a board-certified internist. Assigned to the medical staff
at Dhahran Health Center, he took over the newly created Medical
Services Unit composed of Internal Medicine, General Practice, and
Pediatrics. During his eight years of service as a full-time Aramco
employee in Saudi Arabia, he balanced his clinical activities with
medical research and administration. The years with Aramco, in Dhahran,
were enriching for Gelpi and his familyso much so that his son, Peter,
went back for a few years of employment with Aramco before heading to
business school. For the Gelpi family, where tennis and water sports
left off there was prospecting for archaeologic artifacts and travel to
other Middle East countries.
\j
Resigning from Aramco in 1969, after a year s sabbatical at
Stanford, Dr. Gelpi returned annually to Dhahran, beginning in 1974, to
complete research projects begun earlier. From 1974 through 1978 he
conducted summer research, mentoring college students in laboratory
technique and field epidemiology, and provided locum tenens support for
Internal Medicine. His last visit was in 1981, for clinical service
only.
His stateside medical career has spanned employment as assistant
medical director at the Stanford Student Health Service, faculty at
Stanford Medical Center, part-time staff at Palo Alto and Menlo Park VA
medical centers, and more recently, staff physician in occupational
health at the National Aerospace Administration s research center in
Mountain View, California. He and his wife Lou now live in Sonoma,
California .
Armand P. Gelpi, M.D.
December 9, 1997
Sonoma, California
31-32
INTERVIEW HISTORY--A. P. [Phil] Gelpi, M.D.
Dr. Phil Gelpi joined Aramco in 1959 as an internist and spent ten
years with the company in Saudi Arabia. Soon becoming chief of
medicine, he supervised the internal medicine, pediatrics, and general
practice services. This gave him both medical and administrative
duties, which he describes in detail. He discusses the village clinics
in Abqaiq and Ras Tanura, and the arrangements with contract hospitals,
which he supervised as liaison officer for Medical Services. His
patients, both Arab and American; other members of the diverse medical
staff; and relations with company management and with Saudi government
officials.
Dividing his time among his various duties proved to be a
considerable challenge--Gelpi estimates 25 percent of his time went to
administration, 25 percent to clinical practice, 25 percent to teaching,
and 25 percent to research. He instituted a medical journal club that
met regularly to review articles and exchange information.
Discussing his cases and diseases being treated, Gelpi covers
smallpox, malaria, trachoma, Q fever, pulmonary ascariasis, cancer,
sickle cell disease, schistosomiasis, tuberculosis, and hepatitis.
Gelpi was interviewed at his home in Sonoma, California, on
December 3, 1995, and January 2 and February 5, 1996. He had prepared
extensively with notes and written essays on his work in Saudi Arabia.
Instead of correcting the draft transcript, he chose to rewrite most of
it, thus producing a somewhat formal document but one offering much
information in a clear and concise manner.
Carole Hicke
Project Director
January 1997
Regional Oral History Office
University of California, Berkeley
33
I BACKGROUND
[Interview 1: December 3, 1995]
f
Growing Up in Denver and California
Hicke: Let me start this morning by asking when and where you were born,
and where you grew up.
Gelpi: I was born in Denver, Colorado, in 1925, grew up in Denver, and
moved with my mother to California in 1939. My father remained in
Denver.
Hicke: And you went to school there?
Gelpi: I started high school in La Jolla, a town in southern California
just north of San Diego. My mother and I remained two years in La
Jolla and then moved to Beverly Hills.
Hicke: What particular subjects did you like in high school?
Gelpi: I was interested in science and math primarily; but I think I had
a fairly balanced high school education. I was particularly
interested in chemistry, and actually considered becoming a
chemist at one point during high school. This changed with the
advent of World War II, when the opportunity appeared to enlist in
an officers training program offered by the navy for college
students who would ultimately serve as lawyers, doctors, and
supply officers in the navy.
34
Pre-med Training in the U.S. Navy. 1943-1945
Hicke: So you joined the navy?
Gelpi: I joined in 1943 and was sent to the University of Texas for both
military training and undergraduate college education in the V-12
program (similar to the army s officer s training program, and
today s ROTC) . I completed almost four years of college,
compressed into six semesters, spanning two years.
Hicke: You got college credit?
Gelpi: I got full college credit; and then for a brief period I was
assigned to a navy hospital in Norman, Oklahoma, pending my
admission to medical school, which turned out to be the University
of California Medical School in San Francisco.
Hicke: What kind of courses were you taking in the V-12 program?
Gelpi: Well, there was a standard pre-med curriculum, which is heavy on
science, not so heavy on math, and relatively weak on liberal
arts, but it turned out that there were enough electives so that I
got a fairly balanced liberal arts program. We had additional
navy training designed for officer candidates, which included
naval history, naval rules and regulations, military drill, daily
morning calisthenics, and an intensive additional program of
physical education for an hour a day, five days a week. It is the
sort of exacting program you might expect at Annapolis, the Air
Force Academy, or West Point.
Hicke:
Let me back up a little bit. When did you decide you wanted to be
a physician?
Gelpi: By my senior year in high school I had just about decided to be a
physician. I knew that I was not only interested in the science
of medicine, but it appeared that medicine offered me an
opportunity to deal with people as well as with ideas and issues.
So I ultimately decided that going into medicine would meet all my
objectives, including science and the need also to have some kind
of personal contacts in my work.
Hicke: Did any person inspire you?
Gelpi: Not really. My father was a dentist; but I never for a moment
considered going into dentistry. I had some uncles on my father s
side who were doctors, but I had virtually no contact with them.
So they really didn t influence me. My mother was probably more
influential than anyone, simply because she was looking at
35
medicine as an avenue to a comfortable income, social status, and
other benefits which seem to be acceptable reasons for parents to
propel their children into medicine and other professions.
Hicke: So then when you joined the navy you specifically requested a pre-
med program?
Gelpi: There were specific undergraduate programs for pre-meds,
engineers, officers destined for the supply corps, naval law, and
for naval aviation. The V-12 program included special training
for all those students who were not destined to become line
officers (those who would be involved in the operation of naval
vessels and/or combat activities) or navy pilots. There were
probably several thousands of young men in the V-12 program,
several hundred of whom were assigned to the University of Texas
^,in Austin, which had one of the largest officer training programs
in the country. Of course, the idea was to quickly build a pool
of officer specialists to meet the expanding needs of the navy
beyond the customary supply of career officers from Annapolis. At
the time the program was initiated, no one could have foreseen how
long the war would last and how much attrition there would be
among officers on active duty. So the navy planned to continue
their specialist officers training programs indefinitely.
Hicke: And when you went to the navy hospital in Norman, what were you
doing there?
Gelpi: I was a hospital corpsman. Corpsmen fulfilled a role that today
is shared by people like nurses assistants, paramedics,
physicians assistants, and emergency medical technicians, who are
attached to fire departments. The navy still has a place for
corpsmen, and presumably their duties are roughly the same.
Medical School
Hicke: And then you wanted to go to the University of California?
Gelpi: All of us who were waiting for admission to medical school as
officer candidates and those civilians enrolled in conventional
pre-med programs were ultimately brought before a "Deans
Committee," which as the name might suggest was made up of a panel
of deans from a number of medical schools throughout the country.
This panel would have reviewed the candidates curricula and grade
point average, and then following a half -hour interview make a
decision about eligibility for medical school. And based partly
upon the choices among medical schools expressed by the applicant,
36
the academic standing of each applicant, and the availability of
first-year slots within the pool of medical schools accepting
officer candidates, the applicant might get his first choice. I
was accepted at the University of California; and this happened to
be, for various reasons, my first choice.
Hicke: At the University of California, would you be still in the navy?
Gelpi: Still in the navy. We remained on active duty until the spring of
1946, that is, several months after the war ended. Once relieved
from active duty status in the military, we were obligated to
remain in the naval reserve- -which most of us did for several
years.
Hicke: When did you begin work at the University of California?
Gelpi: I started in September of 1945, graduating in July of 1949. Our
first year of medical school was in Berkeley, and the following
clinical years in San Francisco.
Hicke: When did you get married?
Gelpi: I married in 1952, during the Korean War while serving with the
U.S. Marine Corps as a naval medical officer.
Hicke: What is your wife s maiden name?
Gelpi: Lucille Dachos.
Hicke: Okay, back to medical school. Were there any particularly
memorable experiences that you had?
Gelpi: Yes, there were. I found the first year of school to be extremely
tedious and more difficult than I had anticipated. I had sailed
through the arduous premedical program at the University of Texas
and was not used to working as hard as I had to in order to obtain
acceptable grades in the first year of medical school. It wasn t
until my second year that I really became enthusiastic about
school. The first summer- -that is, between my freshman and
sophomore years--! spent in Austin, Texas, at the University of
Texas getting some extra liberal arts credits.
Hicke: Do medical students get much in the way of liberal arts courses?
Gelpi: Most of us felt deprived, particularly if we were involved in
accelerated programs of the sort offered by the navy, in which
science was emphasized at the expense of the humanities. And I
think nothing much has really changed. There is a lot of pious
deliberation among medical educators about a broad education for
37
today s physicians, but I think they are just blowing smoke rings.
The schools don t want a change. And of course pre-med students
are furiously competitive, trying to pile on as much science as
they can, and get the best grades, knowing that this will make the
difference between acceptance and rejection from the schools of
their choice.
Hicke: Then did you continue any of your interest in the liberal arts?
Obviously you didn t have time to do much.
Gelpi: I had really been stimulated by a couple of teachers at the
University of Texas. One taught a class in modern English
literature; the other offered a course in philosophy. I m still
quite interested in modern English literature, particularly the
world of short stories. I enjoy poetry. But 1 am perhaps most
.interested in expository writing in the areas of history,
politics, international relations, and economics.
Internship and Military Service During the Korean War
Hicke: What happened in 1949?
Gelpi: I graduated from medical school and interned at the Santa Clara
County Hospital in San Jose, California.
Hicke: Does anything stand out from that period?
Gelpi: This was a plunge from formal training into the real world of
"hands-on" medicine, and this was quite an experience. In those
days we had what is termed a rotating internship, which took the
medical school graduate through month-long practical rotations in
general medicine, pediatrics, obstetrics, gynecology, surgery, and
so on. The idea was to lay the foundation of broad clinical
experience, either for the generalist or the specialist, by
exposure to all of the specialties.
Hicke: When you say "generalist," do you mean a general practitioner?
Gelpi: Yes. But in the forties and fifties, surgeons, pediatricians,
internists, and specialists in obstetrics and gynecology were to a
certain extent generalists because these specialists had--and many
still have--a broad range of interests and clinical skills. It s
really only recently that subspecialties have proliferated to such
a great extent.
Hicke: What were you heading for?
38
Gelpi: I was definitely heading for internal medicine. As I progressed
through medical school, I found that I was more and more attracted
to this specialty. It seemed to me that internal medicine offered
the greatest opportunity for developing diagnostic skills and for
pursuing medical research. But I enjoyed pediatrics a lot as a
medical student, and was encouraged by the department chairman at
UCSF to take postgraduate training in pediatrics. But my first
love was, and still is, internal medicine, and so I sought a
residency in internal medicine.
Hicke: Did you say you spent a year in internship?
Gelpi: I spent a year, and then was called to active duty in the navy,
spending two years in military service. This was to pay my debt
to the U.S. government for V-12 training during World War II. I
spent two years as a navy medical officer, partly with the navy in
San Diego and partly with the marine corps at Camp Pendleton,
California, and at the marine corps cold weather training camp in
the eastern Sierras. My service in San Diego with the navy was at
the navy reception center for recruits.
Hicke: So at the reception center you were examining...?
Gelpi: I was examining reservists who had been called to active duty,
mostly for assignment to sea duty on ships supporting military
activities in Korea. For reasons which are unclear to me even
today, I eventually became psychiatrist for the receiving center
in San Diego.
Hicke: What did that involve?
Gelpi: To some extent, it involved trying to work with people who found
themselves rather upset by the prospects of being sent overseas
and exposed to combat conditions. In addition, my job included
evaluating enlisted men who had declared themselves to be
homosexual or who were thought to be homosexual by others, in
order to obtain psychiatric documentation of their sexual
orientation. I was supposed to have a close liaison with the
naval secret service, which, among its other tasks, was tracking
down suspected homosexuals. Homosexuals were then and today
believed to undermine moraleparticularly in close quarters,
under crowded conditions existing on board ships.
Hicke: I wanted to go back to one thing. You said you were interested in
the detective aspects of internal medicine, and I suspect that has
something to do with your research in Saudi Arabia. Am I right?
Gelpi: Well, eventually it did.
39
Hicke: I don t want to get into that right now. I just want to find out
how this interest grew.
Gelpi: It matured in Saudi Arabia.
Hicke: Yes, but did you develop that in your reading? Do you remember
how that started out?
Gelpi: In most medical schools, the role models for medical students are
not clinicians in the sense of people engaged in direct patient
care, but people who really have a career devoted to research,
teaching, or both. So this influences some medical school
graduates; and it certainly affected me to a certain extent, and
probably was in part responsible for my later interest in
research. But I was really torn between a career in community
^medical practice and clinical investigation. When I went to Saudi
Arabia, I was fortunate enough to do both--I thought, fairly well.
Hicke: Then when you were up at the cold weather training establishment
in the Sierras, what were you doing?
Gelpi: I was there for three months with a cold weather training
battalion. The program was designed by the marine corps to
prepare personnel for the rigors of Korea in the wintertime. We
were camped in a place where temperatures would often drop to ten
or twenty degrees below zero in midwintercomparable to what
troops might experience in Korea during the winter months. There
were casualties, not unexpected among unseasoned marines in a cold
weather environment. As a physician, I was at this camp to deal
with the usual medical needs of military personnel, but also with
injuries due to dampness and cold. We had a couple of near
disasters, but no deaths nor serious cold-induced injuries during
my tour of duty.
Hicke: Did you also participate in training troops to avoid the effects
of cold?
Gelpi: Sure. The idea was to teach the troops how to obtain the maximum
benefits from protective clothing, how to avoid excessive
exposure, and what to do with damp clothing in rapidly changing
temperatures. We wanted to teach the men the dangers of imbibing
alcohol under cold weather conditions, how to avoid frost-bite to
areas of the body which were necessarily exposed to the elements,
and how to avoid hypothermia.
a
Hicke: I m not sure what year we re up to now.
Gelpi: This would have been the winter of 1951 and early 1952.
40
Hicke: And then what happened?
Gelpi: I was discharged from the marine corps--
Hicke: Oh, you were in the marine corps?
Gelpi: I was attached to the marine corps as a navy doctor, and I was
actually discharged from the navy after two years of service in
the spring of 1952.
Residency in San Francisco and San Jose, 1952-1955
Hicke: Then what did you do?
Gelpi: I was preparing for my first year of residency in medicine and had
been accepted to the University of California, where I had applied
while still in the navy. We (my wife and I) moved to San
Francisco. I had a year s residency training under the auspices
of UCSF, which included rotations in college health and
experimental oncology. My second year s residency was spent
entirely at San Francisco General Hospital on the University of
California medical service.
Hicke: Were you still heading toward internal medicine?
Gelpi: All of my residency training was in preparation for internal
medicine. My last year of residency training was at Santa Clara
County Hospital--now the Santa Clara Valley Medical Centeras
chief medical resident. Interestingly, I shared this spot with
Dr. Richard Perrine--six months rotation for each of us leading
to a long professional and social relationship.
Hicke: Did you have something to do with his going to Saudi Arabia?
Gelpi: Actually, I did. He was interested, and made some inquiries
shortly after my arrival. I don t know how strongly I encouraged
him to join Aramco, but my encouragement may have been important
in his decision.
Hicke: When did you finish at Santa Clara County Hospital?
Gelpi: I finished in 1955; and at that point, I was toying with the idea
of going into private practice with one of the other physicians in
the San Jose Area. But I had also been recruited by UCLA s
Department of International Health to carry out a research project
on elephantiasis in Tahiti.
Hicke: What happened to that?
Gelpi: We had just had our second child, and my wife developed two
consecutive kidney infections. The prospects of going to Tahiti,
where I might be the only doctor in the particular area in which I
would have to work and would be without the necessary follow-up
medical care for my wife, made the UCLA offer less attractive. We
had actually purchased our steamship tickets in preparation for
departure; but in the end I had to decline the faculty appointment
with UCLA and the research assignment in Tahiti.
Practicing Medicine in the V.A. Health Care System
Hicke: What did you do instead?
Gelpi: I had to make some quick decisions about employment; and since I
had declined offers from local physicians for association and/or
partnership, I had to decide either on solo medical practice or
employment with a large medical group, such as existed at that
time both in government and the private sector. I selected the
Veterans Administration, for reasons which are not clear today,
and took a staff position with the V.A. medical center in Fresno,
California as a full-time, hospital-based internist.
Hicke: What did this involve?
Gelpi: It consisted of practicing as an internist, which is what I had
been trained for, in a well-equipped hospital which had about 200
beds. I remained in Fresno for a little less than two years, and
then transferred to the V.A. Medical Center in San Francisco,
where I had been offered a fellowship in oncology and hematology--
cancer and blood diseases.
Hicke: Were you doing research?
Gelpi: Mostly research, but my appointment also included some clinical
responsibilities, which provided additional training and
experience in the diagnosis and treatment of certain cancers and
blood diseases. I held this position for a little more than a
year.
Hicke: What year was this?
Gelpi: This would have been the years 1957-58. At the conclusion of the
fellowship I decided for various reasons to go into community
practice. On the other hand, I had been appointed, during the
fellowship, as a career clinical investigator with the Veterans
Administration. There was a conflict between me and the chief of
the medical service at the V.A. hospital which would have made it
difficult to carry on independent research and contribute to the
teaching program in oncology and hematology at San Francisco s
V.A. hospital. I was thus leaving a hostile environment and
entering private practice.
Private Medical Practice
Hicke: Where did that take you?
Gelpi: I went to San Leandro, California, on the invitation of two older
doctors who were looking for an eager, young associate. The
relationship was satisfactory, up to a point, and that was when I
found out that one of my associates was an alcoholic. I was
obliged to think seriously about a new association, or solo
practice. Fortunately a couple of local colleagues were quite
interested in having me, which would have made it easy to withdraw
from the short-term association in which I was established.
II EMPLOYMENT WITH ARAMCO, 1959
Job Interview
Gelpi: But then something unusual happened. One day I was scanning the
"wanted" pages of the Journal of the American Medical Association
and came across a notice that the Arabian American Oil Company was
seeking an internist for its he alth care program in Saudi Arabia.
At the time, I thought that maybe this would be a chance to become
more involved in international health, which had been my early
intention when I was considering the position with UCLA, and to
continue to practice medicine in my specialty. So I responded
with a letter, which I believe was addressed to Aramco s New York
of f ice--Aramco s U.S. headquarters at the time. I didn t get a
letter back; I got a phone call advising me that the director of
Aramco s medical services in Saudi Arabia just happened to be in
the U.S.A., and that he would be coming to San Francisco to
interview me. Thus began a long and fruitful relationship with
Aramco and its health care program.
Hicke: Tell me who interviewed you and how that went.
Gelpi: The medical director at that time was Dr. Robert Pagelong since
retired. The interview seemed to go well, and a few days later I
got a summons from the New York office saying they were interested
in employing me and advising me to get my affairs in order for an
early departure to Saudi Arabia.
Hicke: Oh, a job offer that soon?
Gelpi: Yes.
Hicke: What had they told you about your prospective duties?
Gelpi: They sketched out some of the responsibilities of the job, with
the implication that I would be doing pretty much what 1 had been
doing in the United States, that I would be able to work within my
specialty, and that I would be assigned to the main Aramco medical
facility in Dhahran. There I would be joining a group of mostly
American-trained doctors working at Dhahran Health Center.
However, I knew little about the range of diseases I would
encounter; but I knew I would be responsible for the medical care
of American and European expatriates and their families as well as
Saudis and expatriates from other Arab countries. I anticipated
certain diseases which would be expected in developing countries;
but here, there was uncertainty because of the very limited
published information on health and disease in Saudi Arabia.
Hicke: Had you been able to do any reading about diseases of Saudi
Arabia?
Gelpi: I found one relevant article published in the late fifties in a
journal of military medicine--a survey of diseases encountered in
Saudi Arabia s Eastern Province by a physician attached to the
U.S. military mission [United States Military Advisory Group]
stationed at Dhahran s airfield. There must have been others, but
I didn t know of early publications which might have revealed the
types of medical problems indigenous to Saudi Arabia. I presumed
that this was a country with plenty of tropical and other exotic
diseases. I was not to be disappointed.
But just to be reassured, I insisted on a visit to Dhahran
prior to my acceptance of the job offer by Aramco. This was an
unprecedented request. Nevertheless, the company agreed, and I
made my way to New York at my own expense, then to Dhahran on a
company aircraft. This was in the summer of 1959. I spent
several days in Saudi Arabia, and was not only able to tour the
medical facilities which existed at the time in Dhahran, but also
those in the clinics and inpatient facilities at Ras Tanura and
Abqaiq--about seventy-five miles north and south of Dhahran,
respectively. Perhaps the decisive part of this visit was an
excursion with Dr. Richard Daggy--then head of Preventive Medicine
in Dhahran--to one of the large villages in the Qatif oasis.
There I saw what I had hoped forsigns of such disease as malaria
and trachoma which affect the populations of so many developing
countries .
I had a better idea of what I was going to face in Saudi
Arabia, and this convinced me that Dhahran and its environs would
be good places to practice medicine. I was even more encouraged
by the knowledge that I would have a highly sophisticated back-up
system in the form of laboratories and imaging facilities of a
quality typical of many U.S. medical centers at that time, that I
would have colleagues trained in other specialties to work with.
That I would be on a medical frontier diagnosing and treating
45
tropical diseasesnot as a missionary doctor, but as a well-
trained internistwas an opportunity.
Hicke: How long did you spend in Dhahran on that trip?
Gelpi: Less than a week. But this was enough to convince me to close my
medical practice in San Leandro and move with my family to Saudi
Arabia. This I did in August of 1959, arriving in Dhahran without
my family, which would follow in December of the same year.
The Move to Dhahran, Saudi Arabia
Hicke: , You ve written a nice description of arriving at the airport in
Dhahran in which you said, "It was in late summer that I stepped
off a DC 6B airliner on the tarmacmelting, it seemed at Dhahran
airport. Temperatures at that time of year were said to reach
120oF in the afternoon, and this seemed to be one of those
afternoons. The airport terminal was simply an open shed for the
Saudi customs officials, with a pile of baggage in the center."
But what was the trip like? Yb u had very young children, I
believe.
Gelpi: I had left Lucille, my wife, with a lot of extra responsibility in
disposing of our home and automobiles, getting our personal
effects packed and off to Saudi Arabia by boat, and arranging for
tickets, passports, luggage, and a minimum of personal effects for
her to take to Saudi Arabia for our temporary housing in Dhahran.
Hicke: Did you fly in the Aramco plane?
Gelpi: For many years Aramco had its own fleet of airplanes, a couple of
which were turbo-prop aircraft which in most respects would be
equivalent to the commercial aircraft of that era making
international flights. On my second trip to Dhahran, I took a
commercial flight from San Francisco to New York; and then, after
an overnight hotel stay, I boarded Aramco s plane bound for
Dhahran. There was another overnight stop in Amsterdam, possibly
a fuel stop at Beirut, and then on to Dhahran.
Aramco Health Care in Saudi Arabia Before 1959
Hicke: Let me ask you, before we get started on your own activities
there, what you can remember hearing about Aramco s medical
department before your arrival.
Gelpi: There was a little anecdotal information, most of which I probably
soon forgot. At the time, I was looking towards the future--
perhaps less interested in the past than I should have been. I m
sure I was given a brief historical summary at the time of my
interview in San Francisco, maybe more when I arrived in Dhahran.
Hicke: You indicated off the record that you thought Dr. [T. C.]
Alexander was important. Was he still there when you arrived?
Gelpi: I believe that he was just about to retire when I arrived on my
first visit. I may have met him then, or a couple of months
later, when I made the final move to Saudi Arabia. I was told
that he was one of the first physicians to be assigned to Saudi
Arabia by Aramco. Actually, during my brief contact with him we
did talk some, but I don t remember the details of our
conversation. It turns out that he was one of the pioneers of
Aramco health care.
Hicke: I ve heard that the medical department was originally staffed by
Indian physicians. Were there any still there when you arrived?
Gelpi: There were many Indian physicians on the medical staff. Aside
from the Americans, they represented a majority. But in addition,
there was a handful of Lebanese and Palestinian physicians. There
were no Saudis until later.
Hicke: I suppose that the Indians spoke English and that was an
advantage. Why else would they have been recruited, do you think?
Gelpi: I don t know exactly why they were recruited in preference to
other expatriates, besides Americans. All spoke English; most
were from the Indian province of Goa, and most were Christian.
The significance of this is not clear but may have to do with the
compatibility between Islam and ChristianityChristians, with
Jews, being regarded as "people of the Book." And certainly
during the early years of Aramco s Medical Department,
employability to a certain extent was determined by stated
religious preference. There certainly must have been other
factors which brought Indian doctors to Saudi Arabia and Aramco.
There has long been a drain of highly trained professionals from
India because of adverse economic and social conditions; and
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Indian physicians were well represented in places like Africa, and
more recently in the United States.
I really think that Indian doctors were hoping for economic
gains and that the logistics of recruiting and moving Indian
physicians with their families to Saudi Arabia was more cost-
effective than relying on a staff which might be almost entirely
American and European. In any case, as far as religious
considerations are concerned, Aramco s expatriate employees were
either Christian or Muslim.
Hicke: But the Indian doctors were looking for something special with
Aramco?
Gelpi: They were looking for a better life and the immediate opportunity
~f of. having their families accompany them to a new home.
Aramco s Dhahran Health Center
Hicke: Okay, let s talk a little bit about what changes your life when
you got to Dhahran.
Gelpi: I was assigned to a hospital with clinical services a lot similar
to what I would expect in a community comparable in size to many
small towns in America. The difference was: here we had two
populations the Saudis, and expatriates from America, Europe, the
Middle East, and India.
Hicke: They were in separate camps?
Gelpi: To a great extent, depending on a number of factors including
nationality, cultural preferences, professional qualifications,
and social standards set by the Saudi government. Later, when the
Saudis were moving up the corporate ladder into increasingly
responsible positions, cultural and other arbitrary barriers which
separated Saudis from other employees and their families either
disappeared or were at least lowered.
Hicke: Wasn t there a separation of management and employees, rather than
simply separation of Saudis and Americans?
Gelpi: In part there was; but there was also definite social separation
based on culture, tradition, and religion. To a certain extent
this was promoted by the Saudi government, and possibly encouraged
by religious authorities. And there may have been some merit to
this separation, at least at first. I think that most of us
welcomed the idea of mixing freely with our Saudi hosts, but this
was not to befor a while. It was only later, in the sixties and
seventies, that there was a social transformationfelt at all
levels of the company and in Aramco communities which brought
Saudis and Americans closer together.
Hicke: Possibly at first the Saudis would not welcome an intrusion of
another culture?
Gelpi: Then, and possibly even today, the Saudis tenaciously held onto
"family values" and cultural standards which had been in place for
many generations. In spite of this, they were experiencing an
extraordinary cultural challenge because of increasing contact
with Westerners involved in oil exploration and oil production.
What we were witnessing was a society being propelled rapidly into
the 20th century a change taking place in a matter of years,
rather than centuries. And this has had some profound and lasting
effects on Saudi society. In the early days, there was a strong
fundamentalist element among the Saudi Muslim population, which
was and still is closely linked to government. This
relationship strongly affected government domestic and foreign
policy and still does. To some extent this relationship imposed
constraints on an earlier, closer social relationship between
Saudis and Americans. But on the whole, I believe that the Saudis
responded warmly to their American guests, acted as gracious
hosts, and moved at a pretty good clip into a more integrated
society.
Hicke: What was your hospital facility like?
Gelpi: As I mentioned earlier, I believe that Dhahran Health Center had
about 200 beds. It was modern in every respect, with air
conditioning, laboratory and x-ray services, and an up-to-date
surgical suite. This was a pleasant surprise, although I had
known about this from earlier reconnaissance.
Hicke: How about the staff?
Gelpi: I quickly got to know the staff members with whom I would be most
intimately associated in my day-to-day professional work. To
begin with these were members of Dhahran s Internal Medicine
service.
Hicke: You were in the Internal Medicine service, or you were heading it?
Gelpi: I didn t start as chief of Internal Medicine. A Dr. Les McCoy was
the chief when I arrived. And there were two other colleagues
Dr. Bill Weidman and Dr. Larry Field. Dr. McCoy remained chief
for a few months, but was then assigned to the clinic and
infirmary in the community of Abqaiq--an hour s auto ride south of
Dhahran. In a sense, I was serving as Dr. McCoy s replacement.
Early the following year we were joined by a physician from Egypt
--the name escapes me--who was recruited specifically to run our
tuberculosis inpatient service. At the time we had quite a few
Saudis with tuberculosis who were housed in a separate ward, and a
larger number who were being managed as outpatients.
Hicke: I read in your notes that this was primarily abdominal
tuberculosis .
Gelpi: -^We had primarily pulmonary tuberculosis. But abdominal
tuberculosis was surprisingly common- -certainly more common than
in the United States.
Hicke: I ve never even heard of it.
Gelpi: We thought then, and believe now, that the Saudis contracted their
tuberculosis through the usual respiratory route but that the
disease affected the abdominal organsmostly small bowel and
lymph nodesmore prominently than the lungs. There is also the
possibility that they contracted tuberculosis from animal sources.
There is a type of tuberculosis which specifically affects cattle
but which can be transmitted to humans by milk or milk products.
Saudis had access to plenty of camel and goat s milk. But the
first cattle were not imported into the Eastern Province of Saudi
Arabia until the early sixties; so it is unlikely that the Saudis
we saw with abdominal tuberculosis had the bovine type.
The common occurrence of abdominal tuberculosis is by no means
restricted to Saudi Arabia; there have been many reports of this
disease from a number of developing countries in Africa and the
Middle East. There may be something unique about either the
transmission of tuberculosis or host response in third-world
populations. In any case, regardless of whether one is dealing
with human or bovine tuberculosis, it is difficult to tell unless
one has rather refined laboratory testsnot always available in
the usual bacteriology lab. It may still be only of academic
interest, for the treatment available then and now was pretty
effective for the treatment of both human and bovine tuberculosis.
Hicke: Could camels carry bovine tuberculosis?
Gelpi: That s an interesting possibility, which we never explored.
50
Community Clinics
Hicke: Let s go back to when you arrived; there were two other Aramco
clinics besides the ones in Dhahran, right?
Gelpi: Yes, Abqaiq and Ras Tanura.
Hicke: Tell me about staffing at these clinics.
Gelpi: Each clinic had a permanent staff, and each of them had its own
infirmary for brief hospitalizations . People were placed in the
infirmary for observation for relatively mild illnesses not
requiring either elaborate diagnostic facilities, major surgery,
or intensive medical care. On occasion, we even confined patients
with mild heart attacks in these infirmaries. This was before the
days of coronary care units, sophisticated cardiac monitoring, and
advanced cardiopulmonary resuscitation.
Hicke: For the most part, anyone with a major medical problem who had to
be hospitalized would be sent to Dhahran?
Gelpi: Anyone with a serious problem had to be sent to Dhahran. Those
with, say, a mild pneumonia requiring only bed rest and
antibiotics could remain in one of the district infirmaries.
More About Dhahran Health Center
Hicke: Going back to the hospital in Dhahran, [William L.] Bill Owen, the
former general counsel of Aramco, described to me that the first
hospital was built in the senior management camp, and then there
was another medical facility built in the Arab camp, and there was
a tunnel between the two, and then eventually a new hospital was
built in the Dhahran camp. What was left of all that when you got
there?
Gelpi: Bill Owen was talking about the wooden frame buildings which
originally served as hospitals and clinics for Aramco staff and
dependents: One was located on the north side of Dhahran, across
the highway which separated the northern residential area from the
main corporate headquarters and its adjacent residential compound.
The other was built on the south side to serve the needs of the
larger community of foreign expatriates and their families. The
northern facility served the Saudis.
Hicke: The north side was the...?
51
Gelpi: The Saudi camp. And the south side was the so-called senior staff
camp. Both were connected by a tunnel, under the highway
mentioned by Bill Owen. And of course medical staff and patients
could move back and forth through this tunnel. The frame building
on the senior staff side was eventually replaced by a much larger,
two-storied structure, which became the Dhahran Health Center
(DHC), intended for hospitalization of all staff and their
dependents. Ultimately, the remaining frame building on the other
side of the highway became a clinic for Saudi dependent women and
children.
Hicke: I see. The south wooden building was abandoned with the building
of the new hospital. So the new one was for employees?
Gelpi: The clinic facility incorporated into the health center served
~ Saudi males and foreign expatriates with their dependents. The
two clinics--A and B--incorporated into the DHC hospital/clinic
complex served Saudis and foreign expatriates respectively. The
old frame building on the north side became clinic C. I saw
patients in all three clinics.
52
III FACILITIES AND PATIENTS
Contract Facilities
Gelpi: When I arrived in Dhahran, all inpatients, with the exception of
those briefly confined in district infirmaries, were hospitalized
at DHC . Later on we developed what were called "contract
facilities" in Al Khobar--the closest Saudi community to Dhahran.
These facilities consisted of small hospitals and clinics managed
by independent contractors who were selected by Aramco to manage
an overflowing population of Saudis and their dependents requiring
primarily inpatient care. A liaison team was established by
Aramco to monitor the designated facilities in Al Khobar in order
to maintain health care standards comparable to those within the
Aramco compounds: Dhahran, Ras Tanura, and Abqaiq. Referrals from
these district facilities could often be re-routed to the contract
hospitals in Al Khobar, when formerly, all would have been
destined for hospitalization in Dhahran.
Hicke: Who ran the contract hospitals?
Gelpi: These were usually managed by physician/entrepreneurs--Egyptian or
Lebanesewho set up the facilities with Saudi partners, then
extended their services beyond the community in which they were
located to Aramco employees and dependents.
Hicke: How about the nearby U.S. Air Force base at the Dhahran airport?
Gelpi: This base was clearly separated both geographically and
functionally from Aramco, as was the nearby consulate. I believe
that the consular staff and their dependents received care from
doctors attached to the U.S. Air Force military mission
headquarters at the Dhahran airport. This mission was assigned as
an advisory group to the Saudis, and interaction between its
medical staff and Aramco "s was perhaps more social than
53
professional. Later on, I got the air force people involved in
one of my research projects, however.
Hicke: Did you inspect these contract facilities? How did that work?
Gelpi: Eventually I participated in Aramco s liaison operation,
monitoring quality of care at the contract hospitals and clinics.
But then I was essentially responsible for evaluating the quality
of general medical servicesnot surgical, OB, or pediatric.
Hicke: What did that involve?
Gelpi: It meant making weekly trips to Al Khobar to evaluate patient
care, to discuss patient management at times, on an individual
basis and to attempt to reconcile standards and objectives of the
contract facilities with those of Aramco s health care program.
Hicke: Did they contract with the Saudi government also?
Gelpi: No.
Hicke: It was only with Aramco?
Gelpi: Right. The Saudi government provided overlapping health care
services with their own "government" hospitals and clinics.
Hicke: So the contractors came specifically to set up...
Gelpi: Yes, but certainly under the auspices of the Saudi government and
with Saudi opposites as partners.
Hicke: You were assigned to the contract facilities?
Gelpi: This was strictly an arrangement between Aramco and the contract
facilities. I was merely an Aramco delegate.
Hicke: So you sent them all their patients, either Saudi or American
Aramco employees?
Gelpi: Not at all. As I mentioned earlier, they also served the
communities in which they were situated. And certainly in the
evolution of the contract facilities, people with no Aramco
affiliation were encouraged to patronize these facilities. There
had been a time when Aramco found itself in the difficult position
of providing health care usually under desperate circumstances
to anyone in need, regardless of his or her affiliation with
Aramco.
Serving the needs of the general public, particularly if
representatives of this "general public" were even distantly
related to the royal family, were influential local merchants or
were government functionaries, at times required delicate
negotiations between Aramco s Government Relations personnel,
prospective patients, and members of Aramco s medical staff. In
effect, Aramco s doctors were sometimes being pressured into
admitting people with no Aramco affiliation who might just as well
have received care in one of the government s own facilities or
one of our contract facilities as a non-Aramco patient.
Hicke: Was Jim Knight the head of Government Relations when you were
there?
Gelpi: Yes.
Hicke: So you had to work out...
Gelpi: These negotiations often involved a prospective patient who might
also have status in the local or central Saudi government- -usually
someone with an uncomplicated medical or surgical problem. It
would involve a representative from Government Relations. And it
would involve an Aramco doctor, who was being asked to make a
decision about health care on the basis of the patient s
preference balanced against the patient s need. In final
analysis, the doctor had to decide whether the patient should be
admitted to DHC or sent to one of the facilities in Al Khobar.
Hicke: Were there Saudi facilities available?
Gelpi: The only government hospitals and clinics were in the communities
of Hofuf and Dammam, which were relatively primitive, when I
arrived in Saudi Arabia.
Trips to Qatar in 1960 and 1968
Hicke: Now I d like to jump ahead to the trip to Qatar.
Gelpi: Within a few months following my arrival in Dhahran, the ruler of
Qatar requested medical assistance from Aramco, presumably through
the Saudi government, and indirectly through Aramco s Government
Relations. Specifically, he requested that an Aramco doctor be
sent to Doha, the capital, and then to his large villa nearby. I
was sent with an Arab interpreter, who also represented our
Government Relations. Upon our arrival we were greeted by the son
of a most influential merchant in Eastern Saudi Arabia, Abdullah
55
Darwish, who spirited us off in his car to the emir s villa. As I
remember, this villa looked like a desert fortress right out of a
B-grade forties movie about the French Foreign Legion. We
actually went through an archway flanked by armed guards in order
to get to the inside courtyard. The emir s medical problem turned
out to be fairly severe, insulin-dependent diabetes.
His condition was being managed at the time by a British
physician, who may have been on loan from the local oil company or
permanently attached to the emir and his family. In any case,
this doctor was not happy about my arrival, thinking that he had
become superfluous. But he managed, with the usual understated
British aplomb, to be civil under the circumstances, if not
cordial. After interviewing the patient through my interpreter,
examining him, and talking with the British doctor, I made a few
suggestions, which included this doctor as an essential element in
the treatment plan. And everybody seemed to be satisfied. By the
time I left, my British colleague and I had established a "first
name" relationship.
This was not my last trip to Qatar. I returned in 1968 with
an Aramco team to investigate an epidemic of mass poisoning.
Hicke: Let s talk about that trip.
Gelpi: As I recall, it was just another day during the autumn of 1968.
Aramco was notified about a sudden, mysterious epidemic in Doha,
which had resulted in a number of deaths and a torrent of
seriously ill patients flooding the city s clinics and hospitals
in a matter of hours. This was on the heels of the Arab-Israeli
war of 1967, and there was still a great deal of tension between
the Israelis and Arabs. These tensions extended to the countries
bordering the Persian Gulf, including Qatar. In Doha, rumors
floated about possible Israeli biological warfare or chemical
contamination of Doha s water supply. There was no end to
speculation by the time the Aramco representation arrived on the
scene.
On arrival, we were rushed to the central hospital, where in
the waiting areas there were scores of people being triaged for
admissionsome unconscious, some convulsing, some vomiting, many
seriously ill, people at various stages of illness from this
mysterious poisoning or infection. Ultimately our team was able
to establish that this illness was due to mass poisoning from
dieldrin, an insecticide which had been shipped as cargo in a
compartment adjacent to a large shipment of flour. Apparently,
the dieldrin had somehow been mixed with the flour during shipment
or distribution. In any case, the supply of contaminated flour
was sent to a specific bakery; and all of those who became ill had
56
purchased bread or flour to make bread from this bakery on the
same morning.
Hicke: They used dieldrin for mosquito abatement?
Gelpi: Yes. But we didn t know what the poison was until much later,
after the initial detective work linking the illness to bread,
flour, a single bakery, and ultimately to the revelation that the
dieldrin and flour had been packed side-by-side in the shipment.
There was a point in the investigation when I found myself in the
morgue of the central hospital with its administrator and chief of
medical staff; I was insisting that we autopsy some of the poison
victims in order to analyze stomach contents. By that time it was
clear that we were dealing not with some exotic infectionnone of
the patients were febrilebut with some sort of poisoning. With
^the help of the World Health Organization and its laboratories, we
were ultimately able to establish the nature of the poison. But
the first steps included sampling stomach contents of some of the
victims who were fatally poisoned.
Hicke: That s how you found out what it was?
Gelpi: Partly. The real detective work was done by team members from
Aramco s Preventive Medicine Division. Here we had an epidemic,
and my Preventive Medicine colleagues started looking for
something in common shared by all the victims. What they had in
common was: they had all eaten bread or used flour to bake their
own bread, which they ate on the morning of illness or the evening
before. The flour had come from one bakery, and its most recent
supply of flour had come from one shipment; and so the links of
the epidemiological chain came together.
Hicke: So you just treated the symptoms?
Gelpi: Since the illness was self-limited, the survivors recovered with
simple supportive treatment.
Hicke: Was the bakery still producing bread when you got there?
Gelpi: I assume that it was. I don t know if it was ever shut down, but
it was certainly incriminated as the outlet for contaminated flour
and bread. This was not the first nor the last of epidemics of
this kind. There have been additional epidemics of poisoning
caused by foodstuffs contaminated with dieldrin and other
insecticides.
57
Health Care at DHC and Other Aramco Facilities; Patients
Hicke: Can you tell me something about the patients you were treating?
Gelpi: I was expected to provide personal care primarily for American
patients. They were managed very much like they would be in a
typical U.S. group practice. Those of us on the Internal Medicine
service provided both personal and consultative services for these
people. Some patients insisted on an American physician for
primary care, and others were referred by other doctors general
practitioners or surgeons. Some were referred from the districts
--Ras Tanura or Abqaiq. The referrals were both Saudis and non-
Saudi expatriates and their dependents. Most of us internists had
a fairly large proportion of Americans as long-term, primary care
patients .
As the years went by, I tried to get away from my role as a
primary care physician for Americans and more into the role of
consultant, teacher, and researcher. In this regard, I was quite
happy to spend more time managing Saudi patients and consulting on
the more complicated medical problems, both among Americans and
Saudis. I was particularly interested in some of the endemic
communicable diseases found in Saudi Arabia s Eastern Province.
But that s another story.
Hicke: We ll get back to that later. What kinds of problems were you
seeing in American patients anything unusual?
Gelpi: The usual: overweight, high blood pressure, ulcers, coronary
disease, the flu. But by and large this was a pretty healthy
population. There were the expected, common surgical problems:
appendicitis, hernia, gallstones, fractures, and other sorts of
trauma. We were dealing primarily with a younger population of
adults, not the typical mix of younger and geriatric patients you
would expect to find in the U.S.
Hicke: How about depression due to living abroad?
Gelpi: I think that there were probably a lot of psychological problems
of which we were only dimly aware. Later, when Aramco expanded
its medical services to include psychiatrists and clinical
psychologists, these problems emerged simply because they were
easier to recognize and easier to treat with the help of skilled
professionals.
58
Community Life
Hicke: Where were you living?
Gelpi: We were living in Dhahran. Our first house was a small duplex.
We soon became friends with our next-door neighbors. Within about
six months we were offered a larger home, right across the street
from one of Aramco s guest f acilities--Steinecke Hall.
Hicke: Oh, yes. It must have been named for Max Steinecke.
Gelpi: Yes. We remained there for the balance of our time in Dhahran.
Hicke: Was it comfortable?
j
Gelpi: I thought so. I thought all of the facilities were satisfactory.
Ultimately, we got our own furniturereplacing temporary
furniture on loan from the companyconsisting mostly of new items
purchased during our annual leaves, either in Europe or the U.S.A.
Aramco Medicine
Hicke: Tell me how Aramco s Medical Department evolved.
Gelpi: Its evolution during my stay included Dr. McCoy s transfer to head
the Abqaiq facility, as I have mentioned. This was probably about
the time that Dr. Page lefteither for retirement, for assignment
in the New York office, or possibly to take on a position with
another organization. I m not really sure. But upon his
departure, Dr. Daggy took over as medical director for all of
Aramco s health care services in Saudi Arabia. And shortly after
his transfer from head of Preventive Medicine to the position of
medical director, a new division of health care was created within
Aramco s Medical Department- -the Medical Services Unit. This
included Internal Medicine, Dhahran s General Practice group, and
Pediatrics. In all, this represented about twenty doctors. I was
asked to provide administrative and clinical supervision of this
unit. I didn t welcome the administrative responsibility, but
enjoyed the prospects of clinical supervision with its load of
teaching and consultation. Aramco s medical management was trying
to consolidate the various fragments of health care into larger
administrative pieces, for a variety of reasons.
Hicke: Why did those other departments come under Internal Medicine?
59
Gelpi: Well, the combination of General Practice, Pediatrics, and
Internal Medicine, Surgical, and Laboratory Services was to become
the Division of Clinical Services for purposes of administrative
convenience. The Medical Services Unit was the largest block of
physicians under the clinical and administrative leadership of one
person. And it just happened that this one physician was an
internist. So I had the largest group of doctors; and it turned
out that I was able to do then what many people in group practice
and academic medicine today would envy: About 25 percent of my
time was devoted to administration, another 25 percent to direct
patient care, another 25 percent to consultation and teaching, and
finally, another 25 percent to research. This is what many
department chairs in medical schools would love to do and can
rarely achieve because of overriding administrative
responsibilities. My teaching role evolved slowly, but gradually
became of increasing importance.
Hicke : Whom were you teaching?
Gelpi: I decided that the DHC was too isolated from the districts--Ras
Tanura and Abqaiq. Therefore, I planned weekly visits,
alternating with each district, to see problem patients and to
build noon medical conferences around case presentations. One of
the district doctors would present a case to the assembled group;
I would play the guessing game about the diagnosis typical of
teaching hospital conferences in the States and conclude with an
extemporaneous review of what was then known about the disease in
question. The idea was to keep the doctors up to date on changing
concepts of medicine.
I also started a medical journal club, primarily for those
interested in internal medicine, but certainly open to those of
our doctors in general practice. Anyone wanting to attend could
come. This was an after-hours affair, usually at one of our
internist s homes in Dhahran, after dinner, sometimes accompanied
by refreshments. We would review journals from our library, going
over various topics discussed in these journals, in an effort to
educate the assembled group about new concepts and discoveries.
Early on, we structured these meetings around a single topic,
rather than reporting on multiple topics from several journals.
As an example, the topic for a forthcoming meeting might be
coronary artery disease, and one of our doctors would review all
the available material on this subject over a period of several
years from the journals available in the DHC medical library and
from those to which he might have a personal subscription. To the
best of my knowledge, the journal club is still going.
Hicke: Oh that s good. It seems like a very useful idea.
60
Gelpi: After the 67 Arab-Israeli war, the district visits were
interrupted for a while, possibly because of local tensions among
our medical staff generated by the war and its aftermath. But for
eight years of my stay in Dhahran, every weekwithout fail--I
would be on the road for a round trip between Dhahran and one or
the other district medical centers. Some of the problem patients
whom I saw on these visits were hospitalized in the infirmary
attached to the clinic, and it was often from these patients that
one was selected for the case presentation. This allowed us the
opportunity of going to the bedside, examining a patient briefly,
and then returning to the conference room to discuss physical
findings and the progress of the patient while confined in the
infirmary. Later in the day, 1 would see referrals on an
outpatient basis in the clinic, leaving before the dinner hour to
return to Dhahran.
^
I believe that this was a rather successful activity: It
promoted a more collegial relationship between the doctors in the
district and those at DHC, it eliminated some of the costly and
time-consuming trips for patients between the districts and
Dhahran for consultations with the internists at DHC, and it
fulfilled a teaching function for which it was intended. And of
course, I enjoyed the experience.
Hicke: How many hours a day did you work?
Gelpi: This is difficult to answer. We had an on-call system, so that
one of us was on twenty-four-hour call every third day. Later on
this would include the physician assigned to the tuberculosis
service. So a typical day might begin at seven in the morning and
last until five or six in the evening, depending on the burden of
inpatients assigned to each of us, and how many clinic patients
were to be seen. I had my extra administrative chores, impromptu
visits to my office by colleagues, a stack of electrocardiograms
to be read from DHC and the districts each morning, an occasional
urgent visit to our emergency room to see a patient for possible
admission, the responsibility of seeing maybe one or two patients
after-hours--sometimes in the middle of the nightduring my on-
call rotation, and finally, Wednesday afternoon grand rounds.
Every week, about three p.m. on Wednesdays, we internists
would assemble with those general practitioners assigned to the
wards and from our general clinics who could be spared for the
occasion; and as a group, we would visit all of the interesting or
complicated patients on the medical service. The doctor managing
each case would make a succinct case presentation at the bedside,
and one or more of our internists would make some suggestions for
management or further diagnostic testing. I believe that these
61
rounds served the patients well and provided an important learning
experience for the doctors.
Finally, in answer to your question, I believe that 1 was
working fifty- or sixty-hour weeks, despite which I managed to
have lunch at home almost every day, and seldom had my dinners
interrupted by emergencies. My living just a few blocks from DHC
made response for emergencies quick and easy. On free weekends,
my family and I were often at the beach, the community pool, or at
the tennis courts. In many ways I was closer to my family and to
community activities than my colleagues in the States.
Hicke: Let s review this: There were departments for surgical,
preventive, and medical services.
Gelpi: The Medical Services Unit included Pediatrics, Internal Medicine,
and General Practice. The Surgical Services Unit included
Surgery, Anesthesia, and possibly Diagnostic x-ray. The
laboratory services were included in a separate unit; we got our
first pathologist soon after I arrived. There was Preventive
Medicine as a separate entity, a division. And of course, there
was the Nursing Service as an independent group. Here it may be
important to point out that we are talking about subdivisions of
the Medical Department, not about separate departments of surgery,
medicine, and so on. The arbitrary namesdivisions, and units-
had administrative significance, which was not always clear.
Hicke: When did you take over as chief of the Medical Services?
Gelpi: Either late 1959 or early 1960.
Hicke: Whom did you report to?
Gelpi: I reported to Dr. Daggy, our medical director.
Hicke: Whom would he be reporting to?
Gelpi: He would report to one of a rotating group of junior vice-
presidents assigned from a large pool of management people in
Aramco s Department of Industrial Relations (IR). This department
was responsible for most of the corporate activities not directly
related to oil exploration and oil production; and it might seem
that as a natural consequence, the Medical Department would be
administratively tied to IR. In theory, this seemed to make
senseparticularly to engineers and businessmenbut in practice
it did not work well. It didn t work well because representatives
assigned to the Medical Department from IR had their eyes on a
bigger prize, which was top-of-the-company management. It didn t
work well because their individual rotations in the Medical
62
Department s "proving ground" were too brief for the medical
director to get to know them, and for them to get to know the
details and changing requirements of our organization. In any
case, these IR guys were involved on a day-to-day basis with the
medical director in making policy decisions which affected the
health and welfare of so many people, including Saudis and foreign
expatriates, people living in adjacent, non-Aramco communities--
the whole Eastern Province of Saudi Arabia.
Hicke: Do you recall any of the names of people in Industrial Relations?
Gelpi: The one I remember the best was a Mr. Deveney or Deveny. He and
his family became our personal friends. As my first close contact
with Industrial Relations people, I believe that he was the best
pf a long line of IR representatives who worked with Medical
Department management. Unfortunately, he was killed in a
commercial airline crash along with other Aramco people, either in
late 1960 or early 1961. There were many others, best known to
Dr. [Julius] Bill Taylor, who had more direct contact with them
than I.
Aramco Provides Medical Services to the Royal Family
Hicke: As we move along, if you think about anecdotes concerning these
local celebrities, let s include them. You told me about the trip
to Qatar. Were there others?
Gelpi: I believe it was in 1961 that I was summoned to Riyadh to see the
minister of agriculture--Khalid Sudairi, I believe. The Sudairi
family was closely tied to the Saud family by marriage. This
middle-aged man suddenly developed severe gastrointestinal
bleeding, thought to be due to esophageal varices (varicose veins
in the lower esophagus). The varices develop in the lower
esophagus and in the lining of the upper part of the stomach in
people who have chronic liver disease. Because of increased back
pressure through the portal vein which drains the liver, one or
more of these varices may rupture, resulting in catastrophic
bleeding. Which is what occurred in this patient, on this
occasion. I gather that a member of the royal family close to the
King had requested medical assistance through Aramco s Government
Relations .
When I arrived at his bedside in Riyadh, this patient was not
doing well. His doctors had placed a tube--Sensteken-Blakemore
tubewith balloons at one end, which could be inflated both in
the stomach and esophagus to control bleeding. But it was in the
63
wrong place. Both balloons were in the stomach; and they were not
controlling the bleeding but were distending his stomach. This
was the right equipment being used in the wrong way. By deflating
the balloons, withdrawing the tube to the proper location,
reinflating the balloons, and exerting traction on the upper end
of the tube, the bleeding was stopped. We were able to obtain on-
the-spot blood donations, and we had brought supplies for cross-
matching blood and transfusions with us from Dhahran. Thus we
were able to transfuse the patient in his bedroom- -which happened
to be in a guest villa, because he refused to be moved to a nearby
hospital. Our patient made an uneventful recovery, later went to
Boston for surgery to correct his portal hypertension in order to
prevent further bleeding, and went on to live out a normal life
span.
Before I returned to Dhahran, I was asked by a representative
from the King to attend other members of the royal family. I
believe I was asked to see one or more of his wives, and as I
recall, their problems were medically insignificant. I suspect
that they were bored and were looking for a little excitement by
an unexpected visit from an American physicianfor a change.
Hicke: What were your problems in examining them?
Gelpi: These patients insisted on remaining in bed for their
examinations, which considering the size of the beds made contact
between examiner and examinee awkward. All of this was observed
by ladies-in-waiting, who were in attendance.
Hicke: Were these English-speaking, or had they an interpreter?
Gelpi: I m certain that I had an interpreter on location, either from our
Government Relations or from the royal family.
Hicke: What was Riyadh like?
Gelpi: In those days the capital was a relatively primitive, small town.
Besides the royal palace within the royal compound, there was not
much around except for the older, mud-brick structures so typical
of towns and villages in the Middle East. It wasn t until a
decade later that Riyadh began to be transformed into what it is
todaya modern city, by all standards. Of course it had its old
mosques, which presumably are still standing, and a market, which
no doubt, has been vastly expanded.
Hicke: Was there a hospital there, or a clinic?
Gelpi: There was a government hospitalprimitive, like those in Hofuf
and in Dammam (another town in the Eastern Province, near
Dhahran) . I believe that there was also a private hospital,
primarily reservedwith its stafffor members of the royal
family. But it was not unusual for those who could afford it to
seek medical care abroad.
Hicke: I know that during the early years Aramco people were sent to
Bahrain for treatment. Were they still doing that?
Gelpi: Not when I arrived. Bahrain has government medical f acilities--at
the time, they were somewhat more sophisticated than government
facilities in Saudi Arabiaand also had then a small clinic and
hospital operated by the Bahrain Petroleum Company. It is only
fifteen minutes away from Dhahran by airplane.
The Persian Gulf Medical Society and Aramco s Medical Department
Gelpi: Not too long after I arrived in Dhahran, I became involved with an
organization then known as the Persian Gulf Medical Society-
later, for various reasons, to be called the Arabian Gulf Medical
Society. Its membership consisted of a heterogeneous group of
physicians, mostly representing the medical staffs of various oil
companies and missionary medical centers scattered along the
coast. So we had members from Saudi Arabia, the emirates on the
Gulf s southern coast, Qatar, Kuwait, Bahrain, and Iran.
Strangely, Iraq was not represented; perhaps because of its newly
installed totalitarian government with its aversion to things
Western.
Hicke: What was the purpose of the society?
Gelpi: To bring various physicians working under similar conditions
together in a common cause: What experiences could we share in
respect to the medical problems we were seeing? What were the
effects of environment and culture on these medical problems? I
believe that the underlying purpose of this society was very
worthwhile, and I believe that my participation in the society
added a lot to my enjoyment of life in Saudi Arabia.
Hicke: This was for an exchange of information?
Gelpi: - An exchange of information; and it later turned out to be a forum
for developing research projects related to patient care and the
diseases encountered in the Persian Gulf area. This forum was not
remarkable in terms of scope and financial support. But doctors
were beginning to look at local medical problems with an
inquisitive eye, to start recording medical data, and to organize
65
this data for presentation at the annual meetings of the society.
So their observations were reported formally at our meetings, and
these presentations provoked discussions among the membership and
its guests.
Within perhaps one or two years after my arrival in Dhahran, I
was elected president of the Persian Gulf Medical Society. It was
just about the same time that we had the society meeting in
Dhahran. I was chairman for this meeting, and Lucille and I were
totally involved in all of the social arrangements. The meeting
was a great success, not only because of the quality of the
presentations and the social events which followed them, but also
because of the presence of a couple of guest speakers from the
faculty of the American University of Beirut s medical school. At
the time, one of the guests--Dr. John Wilson--was chairman of the
department of surgery at the university. He later went on to
become the dean of Stanford s medical school; and we have been
close friends ever since.
Hicke : Let s continue with more about this medical society.
Gelpi: From then on, we had annual meetings in various placesBahrain,
Kuwait, and Abadan, Iran. Perhaps the real moving force behind
these meetings, at least while I was with Aramco, was the Persian
representation from the National Iranian Oil Company (NIOC).
Hicke: Who represented NIOC?
Gelpi: A Dr. Massoud Rouhani. Eventually, the Iranians began to think of
this as their own society, even though I was president of this
society. There are even thoseand I think that they would be
Saudis, Kuwaitis, Bahrainis, and others- -who would suggest that
the society had become an instrument of NIOC and Iran. Of course
this wasn t all bad, as far as I was concerned, because the NIOC
and its doctors were generous hosts, when the meetings were held
on Iranian soil. But inevitably, there was a problem.
The problem centered around the name of the society, not so
much its Iranian membership. The Gulf Arabs insisted that the
Persian Gulf was misnamed, that it should be called the Arabian
Gulfthis, despite the fact that in almost any world atlas it is
called the Persian Gulf. The sides were drawn, and I was
inadvertently on the wrong side: as president of the society and
an Aramco employee I tacitly represented the Arabs or so the
Iranians believed. And it was about this time that I was to turn
over the presidency to Dr. Rouhani. Soon I found myself in the
midst of an international controversy- -words had been exchanged
between the governments of Saudi Arabia and Iran about all this.
The Saudis insisted the name of the society be changed; the
66
Hicke:
Gelpi:
Iranians wanted the name to remain. I wanted to compromise, and
what I had in mind was two medical societies the Persian Gulf and
maybe the Arabian Medical Society. They could have joint
meetings.
So it was that on the veranda, overlooking the marina, next to
the St. George Hotel in Beirut, NIOC s Dr. Rouhani and I met to
work out the compromise. By that time our friendship had become
somewhat frayed, and I believe that both of us were looking for an
easy way out. What we decided was to have the two societies one,
the Gulf Medical Society, the other, still the Persian Gulf
Medical Society.
And did that work out?
It relieved tensions. And when I left Saudi Arabia they had
started to have meetings of the (Arabian) Gulf Medical Society.
Whether or not they included an Iranian representative, I don t
know.
67
IV HEALTH AND DISEASE IN SAUDI ARABIA
[Interview 2: January 3, 1996]
Smallpox
Hicke: Let s start this afternoon with smallpox. Can you tell me
something about the problems there, and what you were doing to
solve them?
Gelpi: When I arrived in Dhahran, I was aware that smallpox was endemic
in the Eastern Province. I was told that the governor of the
Eastern Province had launched a vaccination program to include all
of the Saudi residents under his jurisdictionwhich would also
include Aramco s Saudi workforce. How successful the vaccination
campaign would be was uncertain at the time; but within a few
years it was clear that smallpox had been eradicated in the
Eastern Province.
Hicke: Was there resistance among the Saudis to vaccinations?
Gelpi: Since this was essentially a government program, Aramco was only
secondarily involved, and, to answer your question, I m not aware
that its Saudi employees were resistant to vaccination. But
Aramco was also involved to the extent that some of its employees
and their dependents contracted the disease and were hospitalized
in Aramco facilities. I can recall that during my first year with
Aramco there were always two or three cases of smallpox confined
in isolation beds on our medical service at DEC. I have excellent
color slides of a number of these patients dating back to that
period. Within a couple of years smallpox had vanished from our
medical facilities, and, I presume, from nearby communities in the
Eastern Province. What the situation was in the rest of the
Kingdom is uncertain, because there were no reliable epidemiology
reports from any source reflecting patterns of communicable
disease in Saudi Arabia at the time.
68
Hicke: I read that they were doing surveys of the villages. Was that in
regard to smallpox?
Gelpi: No. The major surveys conducted by Aramco were related to malaria
control and the epidemiology of trachoma. Aramco was not looking
for smallpox in the Saudi villages. We saw smallpox when its
victims came to the hospital, and these were mostly Saudi
employees and their dependents.
Malaria
Hicke: Now, malaria is quite a long story; and I know you want to talk
about Richard Daggy s part in that.
Gelpi: Yes, why don t we talk about malaria. Perhaps the first major
disease that appeared with any frequency among the Saudis employed
by Aramco was malaria. This was apparent from the number of
Saudis hospitalized for this disease, and it prompted an
investigation of malaria, initiated by our Division of Preventive
Medicine. The prime mover here was Dr. Daggy, as head of
Preventive Medicine.
Hicke: What time period are we talking about here?
Gelpi: This would be the mid to late fifties. Daggy initiated annual
village surveys, which included most but not all of the villages
of the Qatif oasis north of Dhahran and the Al Hasa oasis, which
is about forty or fifty miles south of Abqaiq. These annual
surveys were carried out continuously during my employment with
Aramco.
A team from Preventive Medicine would go to each village and
take blood samples from a cross-section of its residents, which
included a high proportion of infants and children. The team
would survey about a dozen villages on an annual basis, and on the
basis of microscopic examination of each blood sample, determine
the types of malarial organisms infecting the population, perhaps
the duration and intensity of infectionbased on feeling enlarged
spleens in people examinedand also the proportion of people
infected.
There are four species of malaria which infect humans, three
of which were carried by mosquitoes in the Eastern Province. The
organism causing the most dangerous form of the disease,
Plasmodium falciparum, was present in the Eastern Province and
accounted for a high proportion of infections. Any one of the
69
four types may cause severe illness, but falciparum is clearly the
most dangerous because of the intensity of infectionthat is, the
large number of organisms often present in human infections.
Hicke: Well, I m going to ask you some questions, the answers to which
may seem obvious to you but might not to me or some reader.
Malaria comes from mosquitoes; so I suppose the malaria developed
in the oasis areas primarily. Well, would the oases be the normal
areas of civilization anyway?
Gelpi: The oases were heavily populated, and had been, as far as we know,
for millenia. And the reason for this is that there were natural
water sources which encouraged the development of agriculture.
Typical oasis agriculture centered around cultivation of the date
palm, but the soil and irrigation systems in these oases supported
cultivation of a variety of vegetables.
The water sources, while not necessarily stagnant, supported
the development of mosquitoes; and of course mosquito control
became a central element in malaria control. Mosquito abatement
was accomplished by means of a three-pronged attack: residual
spraying with insecticides, starting with DDT; spraying oil on
stagnant bodies of water to discourage the development of mosquito
larvae; and the introduction of larva-eating (larvacidal) fish,
minnow- like gambusia. There were some attempts at hydraulic
engineering to control flooding, irrigation sources, and to divert
irrigation away from densely populated areas.
Our main malaria carrier (vector) was, and is, a bug called
Anopheles stephensi. Fortunately this mosquito has a short flight
range, so that communities outside of the oases were less likely
to be affected by malaria. The control measures introduced by
Aramco were quite effective in largely eliminating A. stephensi
from the oases and surrounding areas.
Hicke: This sounds like it s part of a whole land-use issue--dif ferent
patterns of irrigation.
Gelpi: Maybe the key control measure was residual spraying. The oil
spraying and the use of larvicidal fish were perhaps of secondary
importance. Residential residual spraying was probably crucial.
Hicke: Was the spraying done by the government, the Saudi government?
Gelpi: It was a cooperative enterprise, which at least at first involved
Aramco. But Aramco was always intimately involved as an
interested bystander, because a large proportion of its workforce
came from the oases and town sites nearby. Later, there were
increasing numbers of employees from other parts of the Kingdom;
70
but initially, Aramco depended for much of its manpower on the
local Saudi population.
Hicke: Would the spraying programs have been developed by Aramco?
Gelpi: Yes, in consultation with an entomologist who was part of Aramco s
Preventive Medicine team.
Hicke: Do you have any idea about who started the residual spraying and
when?
Gelpi: I can t give the details. Either Dr. Richard Handschin or Dr.
Daggy would be the most reliable sources for this information.
And we do have some published material which may deal with this
issue.
Hicke: Is there anything more you can tell me about Dr. Daggy s work?
Gelpi: In 1959 he published a rather large monograph on malaria in the
Eastern Province, which was included as a supplement to its
monthly journal by the American Society of Tropical Medicine and
Hygiene. 1 I ll be including this in a bibliography to accompany
these oral histories. In effect, this publication describes the
conditions prevailing in the oases which led to endemic malaria,
the effects of malaria on the local populations, the control
measures applied, and the results of control measures in terms of
the declining frequency of infection among oasis inhabitants. The
publication says something about coordinated efforts between
Aramco and the Saudi government to develop malaria control and
eradication in the Eastern Province. And it describes the results
of control measures against the backdrop of annual village
surveys .
Aramco s Health Care Program and the Saudi Government
Hicke: What was Aramco s relationship with the Ministry of Health?
Gelpi: There was a longstanding relationship on the basis of referrals
from government medical facilitiesusually for urgent medical
care--in areas where Aramco s hospital and clinics were close
enough to make such referrals practical. Aramco had an open
Richard H. Daggy, "Malaria in Oases of Eastern Saudi Arabia,"
American Journal of Tropical Medicine and Hygiene. Vol. 8, No. 2, Part 2
(March 1959), 223-291.
71
policy which permitted its doctors to make discretionary decisions
about need, and, as you might expect, about how interesting or
educational such referrals might be as patients in our hospital.
In a sense, government and Aramco health care practices frequently
converged, based on proximity, subtle pressures through our
Government Relations staff, and the type of illness being
considered.
Hicke: Was this a formalized policy, do you know?
Gelpi: As I have implied, I don t believe it was ever formalized; rather,
it was a tacit understanding which gradually evolved between local
government functionaries and Aramco--an arrangement modified from
time to time, depending upon local needs, changes in Aramco
management, and upon the potential overuse of Aramco medical
facilities by non-Aramco patients. When our hospital was full,
this led to our discouraging hospitalization at DHC of people with
no Aramco affiliations, particularly at a time when we began to
encourage admissions to our contract facilities in Al Khobar.
Hicke: This must have created reporting and record-keeping difficulties.
How did this work?
Gelpi: I m certain there were difficulties in keeping medical records.
It was easy enough, in each designated contract facility to keep
records of admissions, discharges, and diagnoses. And at any one
time we had a rough idea of the sorts of medical problems which
were being managed, and an even better idea about actual numbers
of people coming from and returning to Aramco medical facilities.
I don t believe that this was duplicated in government clinics or
hospitals; and if it was, we really had no access to such records.
Often, patients would be transferred to DHC from a government
facility with virtually no information except personal
identification, a sentence about the nature of the illness, and a
statement that the government doctors couldn t handle the problem.
Hicke: Yes, that s what I was thinking about. And there s the problem of
whom to call if the patient has a further problem or complaint.
Gelpi: If the patient was referred to Aramco, he was usually sent to us
indirectly through our Government Relations. This triage system
acted to screen out people who were far removed from any
connection with Aramco, who had a minor medical or surgical
problem, and who were not intimidating in terms of their high
connections. And Government Relations people had to use great
discretion when caught between reluctant medical staff and
persuasive patient advocates. Sometimes the pressures were
extreme, as in the case of a very influential person in
government. And the intensity of these pressures, opposing the
72
diplomacy of Government Relations, determined the ebb and flow of
non-Aramco patients into our health care system.
More about Aramco and Malaria Control
Hicke: What was the status of malaria in the Eastern Province when you
left?
Gelpi: In the period of eight years, while employed by Aramco, I saw a
progressive decrease in the incidence of malaria. And I don t
think there is any question that this was directly attributable to
Aramco s program of control and year-by-year monitoring initiated
by Dr. Daggy, which was eventually picked up by the ministry of
health. That is to say, Aramco s Preventive Medicine people
provided essential information about the intensity and
distribution of malaria in the oases. The government ultimately
provided incentives and means for malaria control. I think I may
have arrived at a time when malaria had reached its second apogee
(the first was actually in the forties). And I left Aramco at a
time when there were relatively few cases. So we re talking about
a span of maybe a decade in which there were profound changes in
the endemicity of malaria.
Hicke: Were Americans getting something to combat malaria? I don t know
when it was developed, but I know now you take pills if you go
into an area where there is danger of infection.
Gelpi: Americans lived relatively close to the malarious area. But as
far as I know, with the possible exception of some daring campers
or passing travelers, foreign expatriates simply didn t get
malaria living in Dhahran or the districts. This was mainly
because the mosquito vector has such a short flight radius. In
summary, foreigners, including Americans, did not have to take
prophylactic medication because they were protected by distance.
Hicke: Is there anything else about malaria that you d like to mention?
Gelpi: I got interested in the malaria surveys because the village survey
seemed like a good vehicle for doing other kinds of research. In
other words, if you were using blood sampling in the surveys, you
could be testing the samples for other things besides malaria.
And that s where I came into the picture later onsampling for
the sickle cell trait, and for a genetic marker called red cell
G6PD, which we ll get into. So I went piggyback on the annual
malaria surveys for a couple of years. It was a wonderful way to
collect hundreds of blood specimens, and to process them in my
73
laboratory with the kinds of tests that were available to me. In
a way, this testing was relevant to malaria, because the disease
is closely associated with both the sickle cell trait and G6PD
deficiency. More about this later.
Hicke: So actually, the village surveys established a certain precedence.
Gelpi: Yes. I think they probably introduced the villagers to the idea
that strange people entering the village for what seemed to be no
particular therapeutic role were nevertheless providing services,
indirectly; and actually, once they got the idea that somehow this
might lead to improvements in their lives to less diseasethey
seemed to be quite willing to cooperate.
Hicke: They didn t mind being "stabbed"?
Gelpi: No, this was done with such skill that it was relatively painless.
Most of the subjects were infants and children, and the sampling
did not involve puncturing a vein for blood, but just a finger
stick or an earlobe stick with a sharp lancet to obtain a few
drops of blood. There really wasn t any trouble getting the
villager to cooperate.
Trachoma and Aramco s Trachoma Research Project
Hicke: Next on my list is trachoma, and I know that was a big project.
Gelpi: Ideally, the people that could best discuss trachoma are those who
were the active participants in the research project. Of all
those involved, Dr. Jack Snyder, representing the Harvard School
of Public Health, was the prime mover, and he would be the right
person to talk to. But as a physician...
Hicke: And we don t know if we re going to get to talk to him. Whom
would he have worked with at Aramco?
Gelpi: Dr. Roger Nichols, who represented the Harvard program in the
field, with headquarters in Dhahran. Another was Dottie McComb, a
full-time technologist sent to Dhahran on a more or less
indefinite basis to work in the laboratory and in the field with
Dr. Nichols on village surveys. These surveys were not done in
conjunction with the malaria project, but independently, to work
out the distribution of trachoma: which villages were involved,
how many people were affected, and so on. The Harvard /Aramco
trachoma project lasted almost twenty years, from the mid-fifties
until the mid-seventies.
74
Hicke: I have it as beginning in 1954. Do you know how it got started?
Gelpi: When I arrived in Dhahran I was not aware of the origins of the
trachoma project; nevertheless, it was in full swing. The
laboratory was on the second floor of Dhahran Health Center, and
the people engaged in the project were involved in a vigorous
program of village surveys to isolate the organism which causes
trachoma, to grow the organism in eggs, and to refine a new
technique for staining the organisms in eye scrapings. This
technique consisted of tagging antibodies against the trachoma
organism with a fluorescent dye, then putting the antibodies on
eye scrapings to combine with the trachoma organism so that the
trachoma would shine as brilliantly fluorescent particles under
the microscope. This is a very powerful tool, and more specific
than the usual methods for staining cells and tissues for viewing
under the microscope. And of course this makes it useful in doing
surveys on large numbers of people who are suspected of being
infected with the trachoma organism.
Hicke: It sounds like there must have been a sophisticated lab.
Gelpi: It was. And the people who were operating the laboratory were
using techniques which they had imported from the United States
for doing epidemiological studies to track down eye infections,
and for being able to decide whether these infections were due to
the trachoma organism or some other cause.
Hicke: Was Dr. Snyder actually on site?
Gelpi: He may have made site visits, but basically he was at the Harvard
end of the operation. There were comings and goings of people
from the Harvard School of Public Health who were interested in
various aspects of trachoma and in other eye infections. There
was a need to review progress, to keep the operation funded, to
establish and develop research priorities, to enter the results
into peer-reviewed publications for various journals, to interact
with Aramco management on behalf of the trachoma program, and to
interact with personnel in Aramco s Medical Department.
Hicke: But they weren t doing any of the actual lab work?
Gelpi: They may have, but it would have been correlativechecking
resultsand at least some of this would have been done back at
Harvard.
Hicke: This went on for how long, do you know?
Gelpi: From 1954 probably to 1973 or 1974. I m not exactly sure when the
trachoma project was officially terminated.
75
Hicke: Did it have anything to do with your work at all?
Gelpi: I had little to do with the trachoma project. The existence of
trachoma and malaria research sponsored by Aramco persuaded me
that other types of medical research might be welcomed. It seemed
to me that there were other problems waiting for research
projects, and that encouraged me to start looking.
Q Fever in Saudi Arabia
Gelpi: I m trying to think of the first possible investigation that
interested me. I guess that the place to start would be
mentioning a disease which really hadn t been either diagnosed or
defined before my arrival. It had probably existed for quite a
while. Every year there would be a minor epidemic of an
influenza-like illness among Americans and other foreign
expatriates living in Aramco residential facilities. This was
passed off as a type of flu that you might see in the U.S. The
Aramco epidemic would occur about the same time each spring.
I happened to have a couple of the victims sick enough to be
admitted to our hospitalas patients. Each had a pneumonia; and
besides x-ray evidence of the pneumonia, they had abnormal liver
function tests. This would be quite unusual for otherwise
uncomplicated viral pneumonia, which sometimes occurs with the
flu, or influenza. And this got me to thinking about similar
illnesses I had encountered in the United States, when I was
working at the VA hospital in Fresno. In that case I remember
some patients with pneumonia and abnormal liver function tests who
turned out to have Q fever. I won t go into a lot of detail,
except to say that Q fever is a disease caused by a microorganism
called Coxiella burnetti, bigger than a virus, smaller than
bacteria. It basically causes infections in domestic animals-
sheep, goats, and cattlewhich may secondarily be transmitted to
humans, causing an inapparent infection, but sometimes causing
disease which may be very severe.
It turned out that my two Aramco patients had Q fever. We
didn t make the diagnosis by isolating the organism- -which is a
risky thing to try in the laboratory but by finding specific
antibody against Coxiella in blood samples from our patients. The
precision of this test lies in comparing the level of antibody
early infection with that during recovery. If the antibody level
jumps up, this is attributed to Q fever infection. So presto, you
have a diagnosis!
76
It seems that this disease was endemic in Saudi Arabia. To
make a long story short, I was able to demonstrate infection in
goats and sheep. And I was able to show that a new dairy herd
(cattle), which had been sent to Hofuf from Denmark, was free of
infection shortly after arrival. The same herd was found to be
infected when retested a year later.
Hicke: How did humans become infected?
Gelpi: Certainly Americans and other expatriates with Q fever were not
getting it from close contact with Saudi livestock. But during
parturition- -the birth of lambs, kids, and calves- -great amounts
of infectious material are released into the environment, and
under conditions of periodic high winds, which occur starting in
the spring and continuing into the autumn, organisms are
presumably dispersed great distances. And of course the birth of
these animals typically occurs in the spring months in Saudi
Arabia.
There were reports that Americans working for Aramco and for
the American consulate in Riyadh were experiencing the same "flu."
But, rather than look for antibodies against Coxiella in blood
samples from this group, I used a test in which non- infectious
material from this organism is injected under the skin. And it
was possible to show that quite a few had Q fever infection. The
skin test is similar to that used to detect tuberculosis. The
survey was conducted by Dr. Ivan Alio, epidemiologist for our
Preventive Medicine Division.
I was also able to show that high proportion of Saudis had had
previous infection, most likely inapparent; that one could expect
positive skin tests in Americans who had lived in Saudi Arabia for
more than brief periods; and that the longer one had resided in
Aramco residential areas, the more likely one was to have become
infected.
Finally, I was able to investigate a population of airmen
attached to the U.S. military mission at the Dhahran airport with
the help of medical officers who were part of the mission. These
people were assigned for two years of duty in Saudi Arabia; so it
was possible to test new arrivals, and compare them to those who
had been around for a while. And of course those who had been
assigned the longest were more likely to show positive skin tests.
They may not have remembered being ill; but indeed, they had been
infected. So it became obvious that seasonal Q fever was pretty
widespread in Saudi Arabia s Eastern Province.
Hicke: Can you elaborate a bit on how you actually organized the
research, such as filling out forms, requesting permission...
77
Gelpi: I had to ask permission from every person upon whom we took a
blood sample or did a skin test, which required that I explain the
purpose of testing. In the case where I extended the testing to
animalsobtaining samples of blood and/or milk, looking for tell
tale antibodies--! had to explain what was going on to the owners.
I remember on one occasion in the desert asking a Bedouin herdsman
for permission to test his goats and sheep. He was amused, but
quite ready to let me do the tests on his animals, and then
invited me into his tent for tea and an introduction to his
family.
Hicke: How about camels?
Gelpi: That is an interesting question. I was not able to test camels
for a variety of reasons. But I did just about everything else,
still suspecting that camels were involved. I found a way to test
milk samples for antibodies, and I was able to use this on cow s
milk. Taking blood samples from cows is not easy; but I obtained
blood and milk samples from cows and goats and found that they
have antibodies in the milk.
Hicke: Were you doing this testing yourself?
Gelpi: I did the sampling, testingexcept those skin tests that I
mentionedand all the laboratory work by myself. But I sent some
serums away for special testing at laboratories in the United
States, and a few to our serology lab, operated by Preventive
Medicine, at Dhahran Health Center for tests on clinic and
hospital patients suspected of having Q fever.
Hicke: What kind of support did you get from Government Relations?
Gelpi: I told Government Relations what I was doing, insofar as it
affected people not directly connected with Aramco; and I
certainly cleared the work with our medical director. Beyond
that, I carried out the negotiations and other arrangements
myself. In fact, I went to the dairy owner in Hofuf in order to
sample his cattle, telling him exactly what I was doing and
getting his permission. It actually seemed that I was welcomed.
I was questioned, which was appropriate, but I was never turned
down.
Hicke: Did you take an interpreter?
Gelpi: Oh yes, I took along an interpreter. My Saudi hosts were
generous, interested, and helpful, and I really didn t have any
obstacles. My only obstacle was limits on my time and personal
effort I was able to put into this type of research.
78
Hicke: Did you develop any preventive procedures?
Gelpi: The whole idea, of course, was to provide effective treatment and
prevention. But the idea of controlling itinerant herders and
their animals didn t turn out to be very practical. What was
practical, however, was to recognize that some of the illness
passed off as the flu could be successfully treated with certain
antibiotics specific for Coxiella infections. Having a high index
of suspicion in patients with the combination of pneumonia and
abnormal liver function tests that an illness was Q fever would be
enough for the attending physician to start treating with the
appropriate antibiotic to shorten its duration.
Hicke: Would the patient have to be hospitalized?
Gelpi: Probably the vast majority of people who got this infection were
no sicker than those who might have stayed home with a fever for a
couple of days, thinking that they had the familiar flu. They
wouldn t go to the hospital. Some would be quite ill. This
disease can be potentially deadly in those individuals with a
heart valve defect. The Q fever bug can attach to the damaged
heart valve and cause severe complications, which can be fatal.
Hicke: Was Q fever still occurring when you left?
Gelpi: I have the sinking feeling that once I had stopped research on Q
fever nobody else picked it up. As far as I ve been able to tell,
since I left in 1968, I have seen no other publications on Q fever
in Saudi Arabia after my own. Q fever has been recognized in
other Middle East countries, notably Israel and Iran, but I have
seen nothing about the infection in Saudi Arabia. Among the
people with whom I was working in Araraco, and also among the
Saudis although engaged in all sorts of other medical research-
there has been no evidence of recognition or interest.
Hicke: You went back there in the seventies, and you did not hear
anything about it?
Gelpi: No, but I have no reason to believe that there isn t just as much
Q fever now as there was then. As long as there are herds of
sheep and goats wandering around in the desert, and as long as
these herds are near settled areas, such as the Aramco communities
and other towns in the Eastern Province, there is every reason to
believe that people are still getting infected.
Hicke: There s nothing that will prevent the animals from...
Gelpi: From acquiring and transmitting infection? I m not sure, but for
veterinary purposes, there may be a vaccine for this. But there
79
is no vaccine for humans, as far as I know. During the Desert
Shield/Desert Storm engagement, this issue was brought to the
attention of our military people, who were concerned about the
possibility of the Iraqi use of biological warfare agents against
our forces. I don t think that Coxiella would be an effective
agent, even though small doses cause infection. However, I don t
think the enemy was seriously considering it, for there are much
more dangerous and effective agents for use in biological warfare,
Pulmonary Ascariasis
Hicke: What else were you working on?
Gelpi: Another pervasive, even more interesting medical problem was what
we call pulmonary ascariasis. There is a parasitic worm, Ascaris
lumbricoides , which together with the pinworm accounts for most of
the human worm infections in the world, particularly in third
world countries. In Saudi Arabia, every year during the spring
months, we would see quite a few cases of pneumonia among Saudis.
The strange thing about this type of pneumonia was that it seemed
to change day by day, depending upon how often one takes x-rays,
which is unusual. Secondly, it was associated with a marked
increase in a certain type of blood cell called the eosinophil.
These two findings, that is, a changing x-ray picture of the lungs
together with an increase in the number of eosinophils in the
blood, made a distinct syndrome.
Hicke: So this is a kind of pneumonia?
Gelpi: Yes. Mild fever, with the main symptom a severe cough. The
patients didn t seem very ill, but they all had a severe,
constant, uncontrollable, dry cough. Some coughed so much that
they were exhausted from lack of sleep, and perhaps this symptom
alone led to a hospital visit. Getting an x-ray with a rather
alarming, extensive pneumonia would lead the admitting physician
to think that the patient was a lot sicker than he or she actually
was, and this would prompt admission. Once in the hospital, these
patients would be treated with various types of antibiotics,
without a clear diagnosis or notion of what was going on.
It occurred to me, in seeing some of these patients as a
consultant, that this might be a parasitic worm infection because
of the very high levels of eosinophils in the blood of every
patient. What type of worm infection could be common out here?
This was rather easy to determine, because our Preventive Medicine
people and laboratory service had carried out surveys, using stool
80
samples for microscopic exams. Of course, ascaris infection was a
fairly frequent finding.
The next question was: why would ascaris cause pneumonia, and
how would it cause pneumonia? Because this is an intestinal
parasite. The answer is clear. The infection starts with
ingestion of eggs from the adult worm under conditions of poor
sanitation. The eggs mature into larvae (minute, motile worms).
The larvae penetrate the wall of the intestine and actually
migrate through the intestinal veins into the liver, and
ultimately the lung. Here they migrate through the small
capillaries into the alveoli--the little air sacks and then up
the bronchial tubes to the esophagus, where they are carried into
the stomach, finally lodging in the small intestine to reach
maturity. The male and female worms copulate, eggs are produced,
which pass through the intestine into the stool, and the cycle
begins once again.
Hicke: It sounds like that "Journey Through the Bloodstream" movie!
Gelpi: It s really quite an incredible journey. Actually, during the
migration of these second stage larvae, as they move through the
lungs and bronchial tubes, they create intense inflammation,
leading to the severe cough and the characteristic widespread x-
ray changes in the lungs. When you look at typical x-rays, you
see what is called a "patchy" pneumonia, which in some wayswith
just a single x-raymight be difficult to distinguish from viral
and bacterial pneumonias.
By the time the larvae have completed their journey from
intestine through the liver and into the lungs, they have
stimulated the body to produce protective antibodies. The body
becomes aware of the invader and produces antibodies; but nothing
much happens until the larvae reach the lungs. And there they are
held up. For by this time the antibodies are attracted to the
larvae, and these larvae are releasing proteins called antigens-
unique to A. lumbricoides which combine with specific antibody to
form complexes which cause the intense inflammatory reaction which
results in a pneumonia which skips around in the lung a migrating
pneumonia.
Hicke: Tell me how you found all this out.
Gelpi: The best answer is serendipity. I think it was Louis Pasteur who
suggested that every time you have an accidental discovery, if it
does not prompt some sort of critical thinking or reasoning, your
efforts have been wasted. We were able to identify the typical
larvae in the sputum of several patients, which allowed me to
prove my point that the pneumonia was an allergic reaction to the
81
worms. We were able to markedly relieve the symptoms by injection
of what we call adrenocorticosteroid hormones --which don t cure
infections, but which powerfully suppress inflammation. An
example would be the use of a drug called prednisone, which is
used to treat people with severe asthma, who often have increased
blood levels of eosinophils, and who resemble our patients with
ascaris pneumonia in certain ways. This worked well in treating
patients who were quite ill, because the condition is self-
limited. Once the larvae get out of the lung and into the
intestine, all the symptoms subside.
Hicke: So prednisone reduces the inflammation?
Gelpi: Yes, by reducing the effects of the antigen-antibody reaction
which I described. This reaction is somewhat similar to what
happens when someone with hay fever gets pollen on their nasal
mucus membranes and in their eyes. There are antibodies in the
membranes which recognize the pollen proteins, and complex with
these antigens to produce a local, intense reaction, which we call
allergy. This results in the familiar symptoms of sneezing and
itching, inflamed eyes. This is similar to what goes on in the
lungs and bronchial tubes of people with ascaris pneumonia.
Hicke: Over what period of time did you work on this?
Gelpi: I worked on it for a couple of years, and then got out a couple of
publications on the problem. 1 I had reason to hope that this might
prompt people to be more aware of this condition throughout the
Kingdom. Subsequently, I have seen no more publications on this
disease from Saudi Arabia or elsewhere in the Middle East. But
there is also reason to believe that with time, and the great
improvement in the level of sanitation and public health, the
disease is disappearing on its own, and that special intervention
isn t necessary. But I d also be willing to bet that there are
many countries in the world which share the seasonal conditions
which prevail in Saudi Arabia and which promote this type of
infection.
There are probably many, many people who have a type of
pneumonia similar to what was occurring with the Saudis. What
made this a seasonal condition in Saudi Arabia is that the ascaris
eggs will not survive in high temperaturethe temperatures which
prevail on the Arabian peninsula from late spring into late
autumn. It was only with the winter rains that conditions became
optimal for transmission of ascaris infection, so that we would
see most of our patients in the months of March through May.
See Bibliography.
82
Hicke: Has this been found in other parts of the world?
Gelpi: It has been described elsewhere. Perhaps the earliest publication
on this problem came from Switzerland, of all places. The report
indicated that human waste was being used for fertilizer to grow
produce, and that some of the farmers were becoming infected with
ascaris . But as a seasonal medical problem, the first
publicationsmaybe the lasthave been from Saudi Arabia.
Hicke: When did you publish this information?
Gelpi: It was published from the mid to late sixties, and represents
another step in our understanding of human parasitic infections
and in our understanding that some types of pneumonia are really
not what they seem, but that they re due to worm infection.
Hicke: At Dhahran Health Center, they re still aware of your work?
Gelpi: I doubt it. I ve learned that published research is soon
forgotten, unless there is some reason for resurrecting somebody
else s research and applying the results. If researchers don t
recognize that earlier work is relevant, they re not going to read
a paper that was published twenty years ago, just out of
curiosity.
Hicke: I can understand that.
Gelpi: I suspect that the problem of pulmonary ascariasis has gone away.
The reason I believe this is because conditions in residential
areas where many of our Saudi workforce and their families lived
during the fifties and sixties have markedly improved in terms of
sanitation. You re not seeing the soil contamination with human
waste which was apparent then.
Hicke: That s what produces the worm?
Gelpi: That s what allows the worm eggs to get into the food chain, to
recycle the infection. So better plumbing has helped with a lot
of things.
Cancer
Hicke: What else were you working on?
Gelpi: One of the problems which interested me out there was cancer in
Saudis. We were dealing then with a relatively young population,
83
in which you wouldn t expect to see certain cancers which were
relatively common in the United Statesprostate, breast, colon,
and lung cancer. We simply weren t seeing much of this in Saudis.
The fact that we were seeing mostly young adults and children in
our hospital and clinics made comparisons with representative
populations in Europe and the United States and Canada unreliable.
Hicke: The Saudi population was younger because the life span was
shorter?
Gelpi: Most of our employees and their dependents were young. So we were
looking at a special group of people in a special environment.
And it turned out, interestingly enough, and not unexpectedly,
that the type of cancers we were seeing were different. It was my
colleague, Dr. Bill Taylor, who published the first paper on
cancer in Saudis, which appeared in the journal Cancer, in the
late fifties or early sixties. 1
He was finding the kinds of cancers that you might expect to
see in a relatively confined, middle-class, younger population in
a Western count ry--leukemias and lymphomas--rather than in a
population with a broader age representation. And I noticed that
a number of patients I was seeing in the hospital had what we call
abdominal lymphoma. They presented with abdominal pain, or
abdominal swelling, or both. And it was usually not clear what we
were dealing with until some had exploratory surgery and were
found to have lymphoma involving their intestine, the lining of
the abdominal cavity, or in the abdominal lymph nodes. This
seemed to be quite a bit different than the usual presentation of
lymphoma in Western countries in any age group. The organs
primarily affected were in the abdomen rather than in the chest,
or in the lymph glands (nodes) elsewhere in the body.
I had been used to seeing younger patients in the United
States with Hodgkin s disease (a type of lymphoma) and other types
of lymphoma, with swollen lymph nodes in the neck or armpit, or
maybe enlarged lymph nodes, detected by x-ray, in the mediastinum
--that space in the middle of the chest occupied by the heart,
trachea, great vessels, and esophagus.
But in Saudi Arabia we were seeing people roughly the same age
with lymphoma, seemingly confined to the abdomen- -more difficult
to diagnose. And the disease was particularly more difficult to
diagnose because of confusion with abdominal tuberculosis also
common among Saudis. So here you had two diseases with
overlapping manifestations one could be initially mistaken for
Julius W. Taylor, "Cancer in Saudi Arabia," Cancer. Vol. 16, 1963.
84
the other. The only way you could make the distinction, at times,
was by exploratory surgery, with biopsy of diseased tissue.
Hicke: How did all of this affect your making a diagnosis?
Gelpi: With a high index of suspicion, the diagnosis still had to be
confirmed either by finding tuberculosis organisms or by finding
in diseased tissues the typical cell pattern indicating that the
patient had lymphoma. The importance of this distinction, of
course, lay in choosing the right treatment. Because people with
tuberculosis could be treated effectively with the antimicrobial
agents available at the time. With lymphoma, the choice of
treatment was much different, and more complex. Many could have
been treated with x-ray, but we did not have therapeutic x-ray
available in Aramco medical facilities. We had only diagnostic x-
ray. So people with lymphoma would have to be referred out of
Kingdom. I m not sure that radiation therapy (x-ray, et cetera)
was available either in Riyadh or Jiddah at the time. We could
treat them with chemotherapy, but this was by no means always as
effective as x-ray.
Hicke: Do you have any idea why they were developing this type of cancer?
Gelpi: We know that a similar high incidence of lymphoma had been
reported from other third-world countries in North Africa and the
Middle East. In fact, someone coined the term "Middle East
lymphoma" to describe this disease. Some of the important work on
this problem, with resulting publications, was being carried out
elsewhere while I was investigating abdominal lymphoma in Saudi
Arabia.
The prevailing notion then was that multiple, recurring,
intestinal infections of various typesbeginning in infancyled
to a marked stimulation of those tissues responsible for the
immune response in the gut and in the lymphatic system associated
with the intestinal tract, with of course increased proliferation
of immuno- competent cells. Ultimately this growth would get out
of control, lose its self -regulating characteristics, and turn
into cancer. If you look hard at third-world countries, world
wide, this problem is probably there waiting to be discovered.
For it is not likely to be unique to Africa or the Middle East,
because lifelong recurrence of intestinal infections is a
universal problem in developing countries.
Hicke: What s happened to this research on abdominal lymphoma?
Gelpi: I think that the excitement generated by this and other exotic
diseases tends to die out. I also think that what the
identification of this disease, abdominal lymphoma, may have done
85
is to encourage trials of new sorts of treatment. And there is
evidence that the prognosis for patients with abdominal lymphoma
may be better than that for patients with the types of lymphoma
encountered in Western populations. But I don t believe that
there have been any major breakthroughs in this area over the last
twenty years.
Hicke: Is it a fairly high percentage of people who recover?
Gelpi: I can t tell you exactly; but the combinations of x-ray and
chemotherapy may be more effective than one would expect with
lymphoma, generally.
Hicke: Once again, were these mainly Saudis who were infected?
Gelpi: All were Saudis. This was not a problem among European or
American expatriates. It was strictly a problem endemic to Saudi
Arabia. And actually, I don t think we were seeing it among other
people from Middle East countries --Lebanon, Jordan, Syria, Egypt-
living in Saudi Arabia. But I wouldn t go beyond the presumptions
I had at the time the report on this problem from Saudi Arabia
reached publication.
Conference in Shiraz , Iran: G6PD Deficiency and Favism
Hicke: Meanwhile, you still had your regular duties?
Gelpi: Well, of course I was taking care of patients and doing a lot of
administrative chores. It was a period in my life of intense
activity.
Hicke: Yes, I can see that.
Gelpi: Another area of interest: in the early sixties I went to a medical
conference in Shiraz, Iran. And at this conference, the
pathologist at the university medical center in that city--Nemazee
Hospitalpresented a paper on red cell glucose-6-phosphate
dehydrogenase (G6PD) deficiency in the Iranian population living
in the city or nearby. G6PD is an enzyme which protects the red
cell membrane from oxidation. A deficiency of this enzyme leads
to interaction between red blood cells and a component of fava
beans--a major dietary item in the Middle East.
It seems that fava beans have a particular substance which
damages the red cell membrane, when the red cell is deficient in
G6PD, and results in rupture of the cell membrane. Many red cells
86
break down in this fashion, releasing their content of hemoglobin.
And this may lead to the rapid onset of anemia, release of a large
amount of free hemoglobin into the blood and ultimately into the
urine. The loss of red cells and the flood of hemoglobin passing
into the urine may result in severe anemia, kidney failure, and
death. Is it common? Favism, as it is sometimes called, is
widespread and well known among Mediterranean populations. But as
far as I know, favism and G6PD deficiency had not been previously
reported in the Middle East until this particular conference, at
which time it was discussed by the pathologist, Dr. James Bowman.
Hicke: Do you have any idea what year this was?
Gelpi: This would have probably been 1960 or 1961. Needless to say, it
took me a mere instant to at least consider the possibility that
if this condition was prevalent in central Iran, where people ate
fava beans, it may also be prevalent in the oases population of
eastern Saudi Arabia, where they also eat fava beans.
Hicke: Oh, they do?
Gelpi: The fava bean is a dietary staple. And the question then was, why
are we missing this condition?
Hicke: You didn t have it then?
Gelpi: It turned out that we did have it, and that we had been seeing
children with favism in our emergency room and on our hospital
pediatric service probably for as long as DHC had been open for
business. A parent would bring in a very pale, sick child, who
would be admitted to the hospital for severe anemia. Nobody was
asking the question, what did the child have to eat the day
before? I came back from the meeting in Shiraz with a messianic
message, which was: Let s start looking at our admissions,
particularly on the pediatric ward, to see if we are getting cases
of favism. The clue was, and is, the presence of hemoglobin in
the urine. Well, we were getting cases of favism, except the
diagnosis had been missed.
The next step was to go out and see how common G6PD deficiency
was, and where it was. In the oasis population? How might one
best survey the oasis population? As a supernumerary with the
annual malaria survey team, tag along I did, with my capillary
tubes for collecting minute blood samples and my lancets, and I
found that eastern Saudi Arabia has one of the highest
concentrations of G6PD-def icient people in the world.
Hicke: And nobody knew it before you arrived with your lancets?
87
Gelpi: No. In some villages I found that almost 40 percent of the male
population had the red cell defect, G6PD deficiency; which meant
that almost the same percentage were at risk from eating fava
beans .
Hicke: Because it s genetic?
Gelpi: Right. This defect is a sex-linked characteristic, which means
that the gene responsible is on the X chromosome. Thus males-
having only one X chromosomeare at risk from having the defect,
while the vast majority of females are only carriers. And these
carriers are not at risk, because they carry a normal gene on the
other sex chromosome. The rare female with a double dose of the
G6PD deficiency gene, that is, a defective gene on each X
chromosome, is at risk.
Hicke: So females would pass it on.
Gelpi: Yes, they pass it on to children of both sexes. And as far as the
G6PD-def icient males are concerned, they are not only at risk from
eating fava beans, but they are also at risk from certain
infectionswhich may trigger red cell damage in the presence of
the enzyme defect and from certain commonly used medications.
One in particular, primaquine, is known to bring about hemolysis
(breakdown of red blood cells) in G6PD-def icient red cells, and it
is commonly used to treat and prevent a certain type of malaria.
Hicke: Is it the same as quinine?
Gelpi: No. It s actually a synthetic which works somewhat like quinine.
So, given a situation in which you have a Saudi with vivax (one of
four malaria species) malaria and you decided to treat him with
primaquine, not knowing whether the individual is G6PD-def icient
or not, you have placed the patient at risk of a hemolytic
reaction to the drug. And for those Saudis who sometimes were
treated with primaquine and would subsequently become anemic, we
now had an explanation.
Hicke: Was this commonly known about primaquine?
Gelpi: Yes, it had been; the initial work with primaquine had been done
with G6PD-def icient Afro -Americans.
Hicke: So what did you do?
Gelpi: First of all, I was able to find out how prevalent the enzyme
defect was in the Saudi population, both within and outside of the
oases. Next it was possible to alert our medical staff to the
possibility that unexplained, severe anemia in Saudi children was
88
likely to be due to favism, not malaria or iron deficiency; and
that affected children should not again be exposed to fava beans.
Saudis should avoid certain medications, which in the presence of
G6PD deficiency might cause red cell destruction and acute
hemolytic anemia. Doctors should begin to think about the
possibility of G6PD deficiency as an explanation for otherwise
obscure anemias in adult Saudis, particularly if those individuals
were taking medications which interact with G6PD-def icient red
cells .
I believe that Aramco doctors began to appreciate the extent
of this problem. I m not so sure about doctors in other medical
facilities scattered throughout the Kingdom. Of course this
information was published and added to increasing knowledge about
the extent of G6PD deficiency in various populations throughout
the world. It s clear that the condition is common throughout the
Middle East.
Hicke: How do you go about alerting others through publications?
Gelpi: I believe that medical journals serve as the most important
conduit for transmitting this type of information to health care
professionals, including public health authorities. And since I
left Saudi Arabia, there have been many additional publications
describing G6PD deficiency in various parts of the Kingdom; so it
is clear that the extent of the problem is well known. I have to
assume that over the past thirty years most all of the health care
providers in Saudi Arabia have a fundamental understanding of G6PD
deficiency, favism, and drug-induced hemolytic anemias in G6PD-
def icient individuals.
Hicke: What actually happens when someone eats fava beans?
Gelpi: In a G6PD-def icient individual, red cell membranes are ruptured,
and a large proportion of red cells may be destroyed in just a few
hours. The large amount of hemoglobin released from the damaged
red cells, together with the red cell debris, may cause secondary
problems because of kidney damage. But the effects of the acute
anemia from the loss of normal circulating red blood cells can be
catastrophicparticularly for the elderly, who may have some
other debilitating conditions.
Hicke: How long does this last?
Gelpi: The anemia lasts until the bone marrow can replace the lost red
cells. If the victim is iron deficient to begin withas many
individuals in third world countries arerecovery may be delayed,
and it may be weeks before the red cells reach levels comparable
89
Hicke;
Gelpi:
Hicke:
to that which existed before the onset of the acute anemia. With
adequate iron stores, the lost red cells may be replaced in a
matter of days.
And why were you looking for G6PD deficiency in children?
Because they were more likely to be severely affected. The
effects of severe anemia would be more apparent. And iron
deficiency plus malnutrition as complicating factors would tend to
aggravate the symptoms and signs of red cell loss associated with
G6PD deficiency. And this would be more likely to tip the balance
in favor of hospitalization.
You talk about people known to have this deficiency,
some way to test for it?
Is there
Gelpi: I employed a simple test, which involved using only a drop of
blood collected in a fine, capillary tube. The test consists of
detecting red cell G6PD by a specific chemical reaction: a
positive reaction indicates the presence of the enzyme. There are
more sophisticated tests available, requiring larger amounts of
blood, which provide more quantitative information about the
enzyme rather than a measure of whether the enzyme is present or
absent. These tests also provide information about several types
of genetically distinct enzyme deficiency. For example, African
blacks and African Americans have a mild type of G6PD deficiency--
that is, they are partially enzyme deficient. In the Middle
Eastern type, there is complete absence of G6PD activity. Blacks
have what is called the B type of G6PD deficiency, whereas many
people with the Middle Eastern variantwhat we call G6PD
Mediterranean, or A-G6PD deficiency. Saudis have the A- variant.
A few carry the normal B+ variant. So I found that Saudis had the
more severe type of G6PD deficiency, which led to more severe
effects on their red cells when exposed to sensitizing drugs.
Hicke: Is there anything you can do to warn people that have G6PD
deficiency?
Gelpi: Both on an individual and family basis it was possible to provide
counseling. However, I have no idea what has been done throughout
the Kingdom in terms of health education about the prevalence and
risks from G6PD deficiency. I have to assume that there has been
some publicity, based on the number of publications which have
appeared in various biomedical journals over the past thirty
years. And there are investigators in Saudi Arabia who are still
doing surveys. I see the citations about this work in my reading.
Hicke: Maybe testing for it has become routine?
90
Gelpi: I think it probably is. The condition shouldn t be a stranger to
Saudi health care professionals any longer.
Sickle Cell Trait and Sickle Cell Disease
Hicke: What s next?
Gelpi: Well, we could jump ahead to sickle cell disease; but Dr. Richard
Perrine and a group from Oxford picked up where I left off,
carried out a lot of work, and published a number of papers on
sickle cell disease. However, just before my arrival in Saudi
Arabia, an anthropologist working for Aramco, in collaboration
with a British investigator who was an expert on the worldwide
distribution of human blood groups, carried out a survey for blood
groups and incidentally, the sickle cell trait--in the Eastern
Province of Saudi Arabia. Their important findings included the
observation that the sickle cell trait was quite common in the
oases populations. The work was published either in the Lancet or
the British Medical Journal; I don t remember which. But it was
an article which caught my attention soon after I arrived in Saudi
Arabia.
The sickle cell trait is common in Africa, and it is found in
about 8 percent of Afro-Americans. But there are places in
equatorial Africa where it occurs in more than 20 percent of the
population. This trait is a genetic marker, and in itself
harmless, except under most unusual circumstances, such as at high
altitudes. But sickle cell disease is another matter. Here we
have two genes affected- -one inherited from each parent. When
there are two genes for the sickle trait, the affected person has
sickle cell disease. And so the early village survey told me that
there might be not only a high proportion of oases inhabitants
with the trait, but also an alarming number with sickle cell
disease. But if that were so, where was this disease? We weren t
seeing it in our hospital or our clinics. The answer was there;
we just weren t paying attention.
Adult Saudis seen in our clinics for a variety of medical
problems, or hospitalized for, say, appendicitis, would be noted
to have a mild anemia. The anemia was usually ignored in favor of
dealing with another, more important medical problem. Bearing in
mind that blacks and Afro-Americans with sickle cell disease were
readily diagnosed, because the severity of their anemia and other
complications immediately called attention to the possibility of
sickle cell disease, we ought to be seeing patients with
91
comparable illness due to this disease. Why weren t we seeing
this? Were the sickest ones dying off in infancy?
One day I happened to see a Saudi, one of these people with an
unexplained, mild anemia who was referred for another medical
problem. On examination I found that he had an enlarged spleen.
Which prompted me to wonder if the enlarged spleen and the anemia
might be related. Well, of course this combination could be due
to malaria. But what about the possibility of sickle cell
disease? Upon testing he was found to have the disease.
But the medical literature at that time advised us that
African blacks and Afro-Americans had severe illness associated
with sickle cell disease, and that their spleens were affected in
such a way as to become smaller, almost to disappear. On the
other hand, every Saudi patient whom I saw with an enlarged spleen
was destined to be diagnosed eventually with sickle cell disease.
And most adult Saudis with unexplained anemia--later found to be
the result of sickle cells diseasewhen carefully examined, were
found to have enlarged spleens.
So here we had people with sickle cell disease which was
fundamentally different than the same disease among African blacks
and Afro-Americans. Most were without symptoms, and sickle cell
disease was an incidental diagnosis. But we had still only
scratched the surface; for some of these patients would appear in
our clinics and emergency room complaining of various aches and
pains. The pieces of the puzzle began to fit together.
It s well known that Afro-Americans and African blacks with
sickle cell disease have recurrent bouts of pain, sometimes very
severe, in joints and in the abdomen. And the cause of this is
the presence of deformed, sickle cells under conditions of low
oxygen tension in the small blood vessels. The deformed cells
become compacted and obstruct small arteries and veins, causing
bone and abdominal pain. So many of our Saudis with previously
unexplained pain began to fit into the picture. For often they
would be seen with this complaint, thought to have possible
appendicitis, peptic ulcer, or arthritis depending on the
location of their painand after some pain relief with
medication, they would be released, only to return again with
similar pain, perhaps at a different site. They were having the
same pain, in the same location, as blacks, only the pain was
almost invariably milder in comparison.
So the picture emerged of the typical Saudi with sickle cell
disease: a reasonably healthy young male with a hemoglobin around
11 or 12 grams/ 100 ml. --abnormal, because the usual level is
around 14 to 16 grams/100 ml. --an enlarged spleen, and an
92
occasional visit to our hospital or clinics because of joint or
abdominal pain. Whereas a young Afro-American, with presumably
the same disease, had a hemoglobin level of 7 to 8 grams/ 100 ml.,
was having disabling bouts of pain, felt miserable all the time
because of chronic anemia, and had a very limited life span
because of certain infections and other life-threatening
complications .
Hicke: They had a different kind of...?
Gelpi: They had a different kindor a different expressionof this
disease. We know now that there are at least two mutant genes
responsible for sickle cell disease. At the time we began
research on this condition in Saudi Arabia, I believedand so did
many other investigators that there was only the African type.
We now know that there is a type peculiar to the Middle East
genetically distinct which produces the same phenomenon of
sickling in the red cell, but to a lesser degree, resulting in
less severe symptoms. My original suspicion was that the sickle
cell gene was imported to Arabia from Africa, and that the mild
disease found in Saudis was due" to other, protective factors which
shielded sickle cells from becoming deformed. But we now believe
that an independent mutation occurred in the oases populations of
Eastern Arabia or some adjacent location perhaps thousands of
years ago. And we have also learned that in fact, the African
sickle cell trait is found in western Saudi Arabia, and that
homozygous individuals that is, people with both genes affected-
have severe disease.
I was wrong about the source of the sickle cell gene in
eastern Saudi Arabia; but I was right about the protective factors
which suppress sickling, and thus in part may be responsible for
ameliorating the expression of sickle cell disease in Saudis. One
of these factors is almost certainly fetal hemoglobin, or
hemoglobin F. Others may be the thalassemia traits common in
Saudis and G6PD deficiency.
But you also have a Darwinian explanation for the occurrence
of the sickle cell trait in the Saudi population. As a random
mutation, the sickle cell trait, like so many others, should
simply disappear or be represented in an extremely small
proportion of people, unless it confers some special advantage.
There is now a consensus that the sickle cell trait, together with
certain other genetic traits which affect red blood cells, makes
red cells more resistant to malarial parasites. Among these
traits is the hereditary absence of the Duffy blood group. The
sickle cell trait protects against falciparum malaria and the
Duffy negative status protects against vivax malaria. In fact,
the Duffy blood group antigen is the receptor for the vivax
93
parasite on the red cell. Back in the sixties, it was found that
most Afro-Americans were Duffy-negative, and that almost all
African blacks were Duffy-negative. But at that time we had no
idea about the significance of this except that the Duffy-negative
condition was a pretty reliable genetic marker for identifying
African gene flow to other populations, that is.
There are two Duffy gene types, A and B, expressed in various
combinationsAA, AB, BB, B-, A-, and 0- or absence of both genes.
Someone came up with the idea that the Duffy-negative state must
confer a selective advantage; but how? It was also well known at
the time that African blacks were mysteriously spared from vivax
malaria in endemic areas, although many suffered from falciparum
malaria. With just a little more serendipity it was established
that the absence of Duffy antigens on their red cells protected
Africans from vivax malaria.
Back to Saudi Arabia: it occurred to me that if sickle cell
disease was prevalent in Saudi Arabia, and if the sickling trait
came from Africa, which I believed it undoubtedly did, then there
must be another genetic market which would prove the point. Why
not look at the Duffy blood group genes in the Saudi population
and determine the degree of African admixture? It turned out that
between 70 and 80 percent of Saudis in the Eastern Province lacked
the two Duffy antigens.
So not only were they protected from falciparum malaria by the
presence of the sickle cell trait, perhaps somewhat by G6PD
def iciency for believe it or not, that is now believed to be a
protective factor but they were also protected from vivax malaria
by the absence of Duffy red cell antigens in a high proportion of
the population. Over many generations, the oases Arabs had
developed a unique pedigree composed of multiple genetic traits
which made their red blood cells resistant to two species of
malarial parasites.
Hicke: I ve read someplace that there were black slaves brought into
Saudi Arabia. That s obviously within recent history, speaking in
Darwinian terms.
Gelpi: Within the past 1,500 years let s say since the beginning of
Islam 1 there was a flourishing slave trade originating in East
African ports lasting well into the late 19th century. And there
may have been a trickle well into the 20th century.
was established by Mohammed (570?-632) and spread throughout
the Middle East. Within a century after Mohammed s death, an Arab Muslim
empire extended from Spain across central Asia to India.
Hicke: And was that a factor in all of this?
Gelpi: Here we have a convergence of historical and genetic evidence to
support the theory that there was a great deal of African
admixture into the populations of eastern Arabia. And I thought
that this was the explanation for the presence of the sickle cell
trait and sickle cell disease. But I concluded that the mild
expression of this disease had nothing to do with the possibility
of two different sickle cell genes, but that it was the result of
the interaction of other red cell genetic markers fetal
hemoglobin and the thalassemias--on the red cells containing
hemoglobin S (sickle cell hemoglobin). Yes, they tend to have
elevated levels of hemoglobin F, which is protective. And many
have associated thalassemia traits, which may also be protective.
But they also have a fundamentally unique type of sickle cell
hemoglobin.
Hicke: Which they did not get from blacks.
Gelpi: Which they did not get from blacks. But there is some of the
African type of sickle cell trait and disease in Arabia, notably
along the Red Sea. And we now know that the Saudi variant of the
sickle cell trait has spread to other populations in the Middle
East, probably fartherto Iran, India, Syria, possibly as far as
Greece. For we have known for years that there is a relatively
mild type of sickle cell disease in southern Turkey among the Eti-
Turks (immigrants from Syria), and in certain areas of Greece and
in India.
So the sickle gene has spread widely from the Middle East, as
it has from Africa. When I was working on the problem of the
trait and the disease in Dhahran, I exchanged correspondence with
some Israeli researchers interested in this problem within their
Arab population. And they indicated that yes, the sickle cell
trait was present, that the expression of sickle cell disease was
mild, and that Israelis even if native born did not have the
trait.
Beyond all this it was possible to show that having sickle
cell disease as a Saudi was compatible with a long life and
relative freedom from most of the complications associated with
this disease in America and in Africa.
When I finally left Saudi Arabia and Aramco employment, I
listed all the patients I had followed with sickle cell disease.
There were probably fifty or sixty. This was a good group to
follow for a longer period, for follow-up family studies. Dr.
Perrine and his colleagues from Oxford picked up where I left off,
extended the studies, acquired new patients with the disease,
95
amplified some of the testing which had been done before, and were
able to confirm that the Saudis had benign sickle cell disease,
and that a lot of the complications characteristic of the disease
in Africa and America were not occurring in Saudis. Much of this
work has been published, and Dr. Perrine knows a good deal more
about it than I do.
Hicke: You keep talking about malaria as a basic problem. Some of the
things that you detected were protecting against malaria. And
yet, when I first heard of malaria there, when you told me there
was malaria in Saudi Arabia, it seemed hard to believebecause
it s a desert. You don t think of water-based diseases there.
Gelpi: That s true. Most of Arabia is free of malaria because most of
the country is a desert. But the oases are rich, verdant areas
with an abundant water supply from the wells in the area. It s a
totally different environment.
Hicke: I guess what I m saying, then, is: would you notice considerable
difference between the Bedouins of the desert, for instance, and
the people who lived in the oases? You ve been talking mostly
about the oases.
Gelpi: As you might have guessed, evolutionary trends in geographically
separate populations are likely to be different. There would be
major genetic differences. And there are among Saudis. There are
very low frequencies of G6PD deficiency and sickle cell trait in
the Bedouin. I don t know about the Duffy blood groups, but I
imagine there would be similarities because of the African
admixture. But in any case, these populations have selected for
the presence or absence of these traits over many generations.
Hicke: Did you work with the Bedouin at all?
Gelpi: Actually, in many of the town sites in eastern Arabia there is
some representation of Bedouins. They are Sunni Muslim. They ve
been attracted to the oases for a variety of reasonsemployment ,
commerce, and so on. They ve become assimilated into village
life, but still maintain both their religious and cultural
identity, which distinguishes them from the Shi ite groupthe
predominant sect in the oases, particularly in the Qatif oasis
complex closer to Dhahran, as compared with Al Hasa oasis, which
is much farther to the south. But there, the red cell markers
which we have been discussing are much less prevalent among the
Sunni inhabitants, even though they have resided there for many
generations.
Hicke: There are religious differences, but also cultural?
96
Gelpi: The Shia and Sunni have different cultures--dif ferent attitudes
about employment, social status, different marriage customs, and
so on. But there are these genetic dif ferences--a matter of time
and cultural identity.
Hicke: And environment.
Gelpi: Yes.
Schistosomiasis
Hicke: I also wanted to ask about Schistosomiasis.
Gelpi: I d like to spend some time on it, if only to point out the
valuable work that was done on this problem by one of the Aramco
people. I won t go into the details of the disease except to say
that we saw evidence of Schistosomiasis in Arabs who came from
other regions of Saudi Arabia, not people who were indigenous to
the Eastern Province. The reason is that this disease is another
type of worm infection which involves the blood vessels of the
intestinal or urinary tract. Two different types of worm infect
the intestinal veins, one type affects the veins from the urinary
tract. That intestinal type, with which we are concerned, is
called Schistosoma mansoni.
The cycle of infection progresses as follows: there is a snail
vector and an alternation of generations between the worm which
infects humans and that which infects the snail. The snails carry
what we call the larval stage; the larva emerges from the snail as
a free- swimming form which infects man by penetrating the skin and
ultimately arriving in the venous system of the lower intestine,
where they mature to adult worms. Adult female worms release
eggs, which find their way into the membranes lining the
intestinal tract and are excreted in the stoolideally into
water. Here a new variant of the worm emerges again, as a free-
swimming form- -which seeks out the specific snail serving as
intermediate host to complete the cycle. A similar cycle of
events occurs with S. hematobium; but in this case, a different
species of fresh-water snail is involved; the larval form-
infectious for humans--ends up in the vascular system supplying
the lower urinary tractprimarily that of the urinary bladder.
And as you might imagine, the eggs are released into the urine and
find their way into water to hatch.
The complications from repeated infections of this type result
in scarring of the intestine or the bladder. But in the case of
97
S. mansoni, many of the eggs are carried downstream to the liver.
Almost all of the veins from the intestinal tract drain into the
liver, which acts as a huge metabolic factory, manufacturing by
products from the incoming load of proteins, carbohydrates, fats,
and vitamins. The complications which we saw from S. mansoni
infections indirectly resulted from scarring of the liver around
the entering veins, called portal veins. This scarring compressed
the tiny portal veins, increasing the pressure within the system.
Hicke: The scarring would be a building up of tissue which would...
Gelpi: Which would constrict the blood vessels. Therefore, it would
raise the pressure in the veins, which would be transmitted
throughout the portal system. The effects of this upon the veins
in the stomach and lower esophagus resulted in varices--very
fragile varicose veins-- just under the lining of the esophagus.
The varices would rupture; and so we would see people with the
complications of bleeding from the lower esophagus and upper
stomach. Otherwise, these victims were not too severely affected
by their disease.
Since schistosomiasis was not endemic in the Eastern Province,
we were not seeing the disease in locals. Dr. Ivan Alio, who was
an epidemiologist assigned to Aramco s Preventive Medicine
division, did a large survey in the early sixties which mapped the
epidemiology of the disease throughout Saudi Arabia. It turned
out that all of our cases were coming from western or central
Saudi Arabia. This was because the snail vectors, which were the
essential intermediate hosts, were not present in the fresh water
sources in the Eastern Province. I could digress and talk more
about the disease elsewhere in Saudi Arabia, but because of its
technical nature, I would prefer to defer it for editorial
commentary.
Hicke: What motivated Dr. Alio to go into this?
Gelpi: He and others were asking certain questions: does this disease
exist in the Eastern Province? Is there a risk to the local
population from imported schistosomiasis? How much is this risk?
And it was important to know the distribution of the disease
elsewhere in Saudi Arabia in order to anticipate the possibility
of schistosomiasis among Saudis from various parts of the Kingdom
already employed by Aramco, or applying for employment.
Knowing that the snail vector did not exist in the Eastern
Province answered the question concerning whether or not
schistosomiasis could be native to the Eastern Province, or could
be imported. And this is the way it turned out. Dr. Alio s
research, and its resulting publication, constitute a monumental
98
piece of epidemiologyprobably the best example of its kind-
showing the distribution of schistosomiasis in the Kingdom. It
was published as a soft-cover, limited edition from a printing
source in Riyadh; and there are not many copies in existence. But
I managed to abstract the results of the study from a copy in my
possession. This is a very important contribution.
Hicke: Is Alio s work still being used?
Gelpi: I have no idea what sort of control measures for schistosomiasis
have been developed in Saudi Arabia. But I know that there have
been additional publications on this disease in Saudi Arabia from
other sources.
Pulmonary Tuberculosis
Hicke: I have two more diseases to ask about: hepatitis and pulmonary
tuberculosis.
Gelpi: Tuberculosis, in many ways, was pretty much the same disease you
see in socio-economically deprived populations in the United
States. We were seeing tuberculosis in Saudi Arabia at a time
when the country was rapidly changing into a world-class
technocracy of the sort you might expect in Europe and elsewhere
in the West.
Much of the disease in Saudis was typical pulmonary (lung)
tuberculosis that you might see anywhere. But we were also seeing
abdominal tuberculosis, involving the same organs affected by
lymphoma, which I discussed earlier. But we also saw tuberculosis
involving the lymph glands of the neck- -proportionately more than
you would expect to see in the United States.
Treatment plans included the drugs which were then available
in the United States: streptomycin, para-aminosalicylic acid
(PAS), and isoniazid (INH). These drugs were widely used until
the seventies.
We now have additional, newer drugs, to combat resistant
strains of the tuberculosis organism. How the disease is being
managed in Saudi Arabia at this time, I have no idea. But the
original combination of streptomycin, PAS, and INH was very
effective for us in treating the disease in Saudis.
Hicke: Is tuberculosis dying out?
99
Gelpi: I believe that tuberculosis is disappearing in Saudi Arabia,
because I think that the standards of public health and access to
high quality health care have improved remarkably over the past
twenty or thirty years. But really, there s not much to add to
the tuberculosis story, except to emphasize the confusion between
abdominal tuberculosis and abdominal lymphoma which may make the
diagnosis so difficult.
Hepatitis
Gelpi: Getting on to hepatitis: I think I can summarize by saying that
the disease in Saudi Arabia, as it is in much of the world, is
caused by three main viruseshepatitis A, B, and C. At the time
when I was looking at the disease in Saudis, we were not able to
make these distinctions; and there is even another virus-
hepatitis E--and I ll touch on that a little later. We had not
yet divided the hepatitis virus family into four sub-types.
And it wasn t until the seventies that we really started to
make headway in identifying the different hepatitis viruses. But
at that time we knew how to distinguish viral hepatitis from
hepatitis due to other causes, such as drugs which damage the
liver. Given someone who was sick, jaundiced, who had abnormal
liver function tests, and who had someone else in the family with
hepatitis, it was not hard to make the diagnosis. But we didn t
actually isolate the virus for purposes of diagnosis because of
technical limitations, nor were we able to detect the virus
indirectly with blood tests which measure antibody against the
virus. And as yet, we were unable to make the distinction between
the virus sub-types.
So, we were seeing Saudis with acute liver disease, most
likely due to viral infection, and probably not due to drugsfor
none of the hepatitis victims were on long-term medications. Most
of these people had mild illness, and many did not need to be
admitted to the hospital. There were exceptions.
Women seemed to be more seriously affected by hepatitis, and
were often admitted to the hospital because of the severity of
illness. And those admitted were more likely to die than males of
the same age with the same disease. And of those women who died,
most were pregnant or had recently delivered a baby. Those who
were pregnant, and who succumbed, were likely to be in the third
trimester of pregnancy. The point was, given a young Saudi woman
with hepatitis who would soon give birth, there was a high
probability of a fatal outcome. Why? But the problem was even
100
more complicated. In pregnant women, hepatitis was associated
with a high rate of fetal loss, both spontaneous abortion and
miscarriage.
There wasn t any obvious explanation at the time; but there
were reports of fatal hepatitis during pregnancy coming from other
parts of the worlddeveloping countries an indication that the
problem was widespread. There were papers from Algeria and
elsewhere in Africa, from Iran, and from India indicating that
viral hepatitis in pregnancy was often fatal. Strangely, viral
hepatitis during pregnancy in Western countries, industrialized
societies, was not particularly risky. Why this difference?
There must be something about third-world social or cultural
conditions that makes the disease worse in pregnant women. What
could it be? Diet probably; the fatalities were due to
malnutrition. Wrong. All other things being the same, hepatitis
in Saudis, no matter how well-nourished the victims appeared, was
often fatal in pregnancy.
Hicke: Much more so than in Western societies?
Gelpi: Much more so. We now think we have an explanation- -not because of
the observations I made in Saudi Arabia, but because we have found
the culprithepatitis E viruswhich causes epidemics in
developing countries, but also causes sporadic cases of hepatitis.
And it has been consistently associated with high fatality among
pregnant women- -particularly those at term, those women who are
about to deliver or have just delivered their babies. This
infection is almost essentially water-borne. But we really don t
know why this virus is so dangerous during pregnancy. So I can
end up by saying that hepatitis A, B, and C is probably much the
same in both men and in women, regardless of pregnancy.
It has been suggested that a woman s immune response changes
during pregnancy. Not surprising, otherwise if it didn t change,
she would reject the fetus, regarding it as being a foreign body
in the uterus, but this doesn t happen very often. But we are
beginning to think that with immune tolerance of the fetus, there
may be tolerance for other, unrelated foreign material, such as
the hepatitis E virus.
Hicke: That s really amazing! Are there other instances of such
tolerance?
Gelpi: I can t tell you too much about it. Much of what I have told you
is speculation the sort of thing that medical scientists do when
they re seated around a conference table engaged in intellectual
browsing. We only know that the immune response in pregnancy is
different. And we think that the pregnant woman, with occasional
101
Hicke;
Gelpi:
Hicke:
Gelpi;
exceptionsobviously, there are spontaneous abortions, now and
thenidentifies the fetus as self, in spite of the fact that only
half of its genetic makeup is derived from its mother. But the
maternal immune system identifies this thing, this parasite, this
fetus, as self, rather than non-self. Even though the father s
genes are there, creating slight differences between the mother s
tissues and those of the fetus, the mother s immune system says,
"Hey, this is me."
But there may be alternative, totally opposite, explanations
for the effects of the hepatitis E virus on pregnancy and upon the
pregnant woman. Maybe this virus can run rampant and kill its
victim simply because of the large viral load causing large
numbers of sick and dying liver cells in the presence of a blunted
immune response. But maybe it s the other way around; the immune
response may be so vigorous that it is worse than the disease.
The damage that s done fighting the virus leaves the liver in
wreckage, which is obviously worse than simply contending with a
rapidly multiplying virus.
There are various reasons for believing the first hypothesis,
based upon what we know about hepatitis from other causes. With
other types of viral hepatitis, the virus may be fairly well
tolerated, despite the fact that the virus is proliferating and
destroying liver cells so well tolerated that it leads to chronic
infection which takes years to disable or kill its victim. That
summarizes the problem of viral hepatitis, as well as I can
express it.
But tell me exactly what you did, your part in all of this.
My part was to look at every Saudi woman with hepatitis in the
hospital. I asked to be called on all admissions in order to
document the severity of disease, to select certain tests which
would tell us the likelihood of survival or imminent demise, so
that we could evaluate the effects of supportive care and specific
medications on the course of the disease. We wanted to save these
people, if possible, by identifying those who were critically ill.
It seemed that the best test available for indicating an
unfavorable outcome was the prothrombin timea measure of one of
the components of the clotting cascade. If the prothrombin time
was abnormal (prolonged), this was almost certainly a death
warrant. All the women with significantly prolonged prothrombin
times died.
So they don t know if there s some remedy.
Based on what we know from multiple reports on the management of
fulminant (explosively severe) hepatitis from many sources in the
102
United States, Canada, and Europe, we have learned that
adrenocortical steroids don t work. Although at the time they
were first employed to treat potentially fatal hepatitis, they
seemed like rational choices to suppress an intense immune
response accompanied by marked inf lammation--if one believes that
the immune response is worse than the infection itself. Whether
or not supportive care- -intravenous nutrition and fluids,
primarilymakes much of a difference, it s hard to tell. In a
highly sophisticated, tertiary care medical center, many of these
patients would be candidates for liver transplants.
I don t know whether or not fatal hepatitis during pregnancy
is still a significant health care problem in Saudi Arabia. I
have no reason to think that much has changed, except that the
overall incidence of viral hepatitis has probably dropped to a
significant degree, and the incidence of fatal hepatitis has
dropped proportionately. But I went back after the first study of
hepatitis complicating pregnancy and began to look at the cases
that had accumulated over a period of five or six years following
completion of the original study and its publication. There was a
difference in mortality, with apparent improved survival in the
later group of patients with hepatitis. I have no explanation for
this. The patients may have been selected. Perhaps the strain of
virus had disappeared. Those who favor the theory that it was
socio-economic conditions and nutritional status which determined
the outcome would say, "See, living conditions are better; that s
why." But I don t think that s the explanation; it s too easy.
But that s the end of the hepatitis story.
103
V MEDICAL DEPARTMENT ADMINISTRATION
[Interview 3: February 5, 1996]
Reporting to Aramco Management
Hicke: Today we re going to talk about administration in the Medical
Department .
Gelpi: The Medical Department, now called Saudi Aramco Medical Services
Organization, or SAMSO, was more or less an independent entity
within the oil company administrative network. However, the
medical director consistently reported to a representative of
Industrial Relations, invariably an Aramco vice president. The
executive composition of Industrial Relations was continually
changing; so that the person to whom Aramco s medical director
reported was also changing. In the span of the medical director s
tenure, he might be dealing with three or four different IR
representatives .
Hicke: And these would be non-medical types.
Gelpi: They were definitely non-medical types, and all had to be
successively educated by our medical directors. This, I believe,
created a certain inertia in communications and interaction
between the Medical Department and the rest of the company. Of
all the dimensions of medical administration, this was the worst.
Internally, the organization of the Medical Department had a lot
to recommend it, and I had no quarrel with the organization of the
company outside of the Medical Department. The thread which bound
the Medical Department to the rest of Aramco had to be constantly
reinforced by repeated education sessions for each IR
representative .
Hicke: What kind of decisions would that person be expected to make?
104
Gelpi: There were three major areas of concern. The first was obviously
financial: how much it cost to run the Medical Department year
after year. The second had to do with how Aramco s Medical
Department was involved with outside agencies, both within and
outside of government --because as you already know, Aramco was not
only providing medical services for its employees and their
dependents, but also for many people who had nothing to do with
the company.
The third area involved the expansion of health care; for as
the working population of Saudis and their dependents increased,
so did the requirements for health care. And much of this care
was provided for routine and rather trivial medical problems-
immunization, maternal-child health, well-baby clinics, minor
injuries, health education, and so forth. So both Aramco
management and the medical director had to think about the
possibility of providing health care in some other way, rather
than simply expanding Aramco facilities and hiring more health
care providers.
Hicke: So you really had to keep close contact with Industrial Relations?
Gelpi: There were weekly meetingsmaybe more often, depending on
circumstanceswith the IR representative about matters of mutual
concern. And the agenda of some of these meetings filtered down
to medical department rank and file in the form of lower level
weekly meetings attended by division and unit heads, and
memoranda.
Hiring
Hicke: What about hiring?
Gelpi: To a great extent, hiring was an initiative of, and at the
discretion of, Medical Department administration. But it
obviously had to fit into budget requirements for any given year,
and had to meet the approval of company management. As personnel
requirements were constantly changing, so was the Medical
Department budget. Those changes involving the addition of key
personnel needed advance planning to fit budget requirements.
Hicke: So that determined what slots might open, but who actually did the
interviewing? I think you ve indicated that a few times people
would go back to the States to interview.
105
Gelpi: This would most likely happen in conjunction with a scheduled
visit to the States. Typically, a Medical Department division or
unit head--say the chief of Surgerywould arrange to interview
one or more candidates for the position of surgeon while he was on
vacation or attending a meeting in the U.S. Depending upon
qualifications and personal impression, one of the candidates
would be invited to join Aramco.
Hicke: Now tell me about your participation in this.
Gelpi: As you know, when I joined Aramco in 1959, I was assigned to the
Medical Services Unit at DHC. Once again, this unit consisted of
Internal Medicine, General Practice, and Pediatrics. Several
months later, I became chief of Internal Medicine and chief of the
Medical Services Unit. And at that time there were two or three
other internists, two pediatricians, and perhaps as many as ten or
fifteen general practitioners assigned to various clinics and
inpatient services.
At the same time there were two district clinics with attached
infirmaries, and each had its own medical director, both reporting
to the medical director at DHC. Each had his own medical staff a
small number of general practitioners, some lab technicians,
nurses, an x-ray technician, and custodial people. At DHC we had
a much larger number of doctors, including specialists, an
administrative unit, a large nursing service, rather comprehensive
laboratory and diagnostic x-ray services, and a rather large
division of preventive medicine involved in all sorts of public
health activities, both within and out of the company.
Representative division and unit heads all reported to the medical
director at DHC.
Hicke: How did the pay of doctors and nurses compare with that of
commensurate jobs in the States?
Gelpi: I can t say much about the nurses, but I would say that doctors
pay compared favorably with that of generalists, pediatricians,
and internists in the States. This, of course, was back in the
late fifties and early sixties. For general and orthopedic
surgeons, for ophthalmologists, for otolaryngologists, for
radiologists, and for pathologists, I think that the pay was
definitely less than what they might expect in the U.S. at the
time. So there had to be other attractions to bring people out
who were in these specialties.
Hicke: What were these other incentives?
Gelpi: For some it was the opportunity to pioneer in the health care of a
developing countryfor at that time, despite its oil riches,
106
Saudi Arabia was a developing country. Even though it sprang
ahead during the seventies and eighties, becoming a modern,
industrialized country, when I was there, we were really seeing
medical problems typical of underdeveloped countries in Asia,
South America, and Africa.
No doubt there were other attractions. Some people were
especially interested in Middle East cultures. There were
unprecedented opportunities for world travel, because of Aramco s
generous repatriation and vacation policies, as well as travel
allowances. Aramco medicine had its appeal for those who were
interested in combining medical research with clinical practice,
who wanted to see exotic diseases in an exotic place, who wanted
to be on the cutting edge of progress in international health.
And so there was something for everybody.
Hicke: Was this pretty well promotedthe opportunities for travel,
research, and so forthbefore the people were hired?
Gelpi: I don t know, really, what individual basis each of my colleagues
had for coming to work in Saudi Arabia. As you know, at the time
I was recruited I had the opportunity to make my decision on the
basis of a visit to Dhahran before I accepted employment. And
within a couple of days it was possible to make up my mind that
Aramco offered great opportunities for both research and clinical
experience. That was the selling point, as far as I was
concerned. The opportunities for travel and to learn a lot about
the Middle East and its cultures were both secondary incentives.
Hicke: Did you do any of the actual recruiting?
Gelpi: I did some recruiting. I recall one trip I took with Dr. Taylor.
We went to Egypt either in 1961 or 62, both to Cairo and to
Alexandria. We were looking for additions to my medical services
and his surgical services unit. I don t recall if we came up with
any really good candidates. Dr. Taylor may remember more about
the trip than I, because besides recruiting, we had some
interesting adventures. I don t think we found the doctors we
were looking for. I didn t participate in recruiting beyond this,
except for inquiries about suitable people when I was in Beirut on
other business. Beirut was an attractive source for recruiting
because of the American University of Beirut [AUB] medical center
and its medical training, and because of the professional quality
of both Palestinian and Lebanese doctors. We were definitely
looking for interested graduates from AUB.
Hicke: Do you recall any that you got?
107
Gelpi: Over the years we got quite a few good doctors. Many would come
and stay for a few years, make a little money, and then either
return to Beirut or go to the United States for postgraduate
training in various medical specialties. Some eventually recycled
back to Saudi Arabia; a few returned to Lebanon and other parts of
the Middle East. Many remained in the United States.
Hicke: Would some of your recruits have been Americans?
Gelpi: No. In Beirut, these were Lebanese, Palestinians, maybe a
sprinkling of Arabs from neighboring countries, but mostly
Lebanese .
District Visits and Medical Education
Hicke: Would you tell me a little more about the educational program that
you had for doctors when you went to visit the districts away from
Dhahran?
Gelpi: As I suggested during an earlier interview, I believed that there
were two activities which might stimulate interest and raise
educational standards among Aramco physiciansat least in my
group, the Medical Services Unit. Therefore, I started weekly
visits to the districts--Ras Tanura and Abqaiq. These were
industrial and residential community complexes, each with its own
clinic and infirmary. These visits consisted of a noon lecture to
the doctors, based on a preceding case presentation, and some
consultations on one or more infirmary patients. Usually, there
were one or two people in the infirmary with medical problems
needing bed rest, but not severe enough to warrant hospitalization
at DHC. I would finish by seeing patients in the clinic, referred
for various problems. Most were Saudis. And I would alternate my
visits: one week it would be Ras Tanura, the next Abqaiq. I did
this for the eight years I resided in Saudi Arabia. I really
can t recall whether or not the district visits were continued. I
know that when I returned, during the seventies on locum tenens
basis, I was not involved with district visits, nor was I aware
that they had continued in my absence.
I guess that the visits had some value, both for the doctors
and the patients in the districts. I think that it brought the
doctors closer to DHC in spirit. We came to understand one
another s problems better. We got an appreciationat least I
didfor some of the difficulties faced by doctors at a distance
from DHC. And so I think that in the long run, it was a
beneficial arrangement.
108
Hicke: What subjects might be included in your lectures to the doctors?
Gelpi: A typical district visit might include the case presentation, on
ward rounds, of a patient with, say, hepatitis. This patient
would be presented by one of the district physicians; and then it
was up to me to give an extemporaneous lecture on hepatitis, which
I would do as best as I could under the circumstances. I never
knew ahead of time what was wrong with the patient; and that was
part of the game. So the excitement was generated by the
possibility that the doctors had come up with a diagnosis or
disease I hadn t read about. For me there was the exhilaration of
trying to keep up to date, and to anticipate the kinds of patients
who were being presented. My lectures lasted about fifteen to
twenty minutes.
At these noon meetings we would talk about other issues
relating to the presentations. If hepatitis was the disease under
discussion, there would be questions and an exchange of views on
diagnosis and management. We d then finish lunch and return to
work. I would be seeing clinic patients for the remainder of the
afternoon; and at the end of the working day, I would jump into my
car, a taxi, or a busdepending upon availabilityand go back to
Dhahran.
Hicke: Who headed these clinics that you remember? There were a lot of
different people, but...
Gelpi: Medical directors were appointed specifically for the districts.
Hicke: Can you give me the names of some people?
Gelpi: There was Dr. Armbruster, who was director of the Ras Tanura
clinic /infirmary when I arrived in Dhahran, and there was Dr. Les
McCoy, who left the medical service at DHC shortly after my
arrival, as the director of the Abqaiq clinic /infirmary. Dr.
Armbruster s major interest was occupational medicine; Dr.
McCoy s, internal medicineactually, he had been trained as an
internist. Of course the medical directors in the districts
changed- -not year by year, but there were several changes while I
was employed by Aramco.
Hicke: The other thing I wanted to ask was if you had any anecdotes that
are particularly memorable.
Gelpi: It s hard to remember the little things. There are a few which I
have already talked about: the consultative visit to see the ruler
of Qatar, the trip to Riyadh to take care of the minister of
agriculture and immediate members of the royal family, and the
109
other trip to Qatar involving investigation of the poisoning
epidemic.
More on the Journal Club
Hicke: Now the journal club. We talked about it before, but I wonder if
you could elaborate a bit more.
Gelpi: Our medical journal club developed along traditional lines, and
resembled those that have existed for generations of physicians
who have been involved in academic medicine, particularly in the
United States. A journal club consists of a group of physicians
who meet regularly, in an informal setting, to discuss the
contents of various medical journals reviewing articles of
particular interest, exchanging information and opinions about the
topics covered, and passing judgment on the quality of research
and the merits of its publication.
Another way to do thisperhaps more profitably for a small
group meeting at infrequent intervals is to have one of the
doctors pick a favorite topic and go into it in detail, using
articles from various journals to highlight a particular point he
or she wishes to convey to the group. To just go through a
journal by listing its table of contents and commenting briefly
about each article doesn t seem to be a useful educational tool.
Anyway, that s how we started our journal club meetings and
discussions built around specific topics. As far as I know, the
journal club established at DHC was still going long after I left.
I m pretty sure that when I made my last visit to Dhahran in 1981,
it was still going.
Hicke: Who was part of the club?
Gelpi: When we started there were three internists and a few interested
general practitioners (GPs). Then more people began to be
interested more GPs and doctors from the districts. The
pediatricians were not interested, because the topics were not
related to their training or experience in managing diseases of
childhood and infancy. And certainly, the surgical staff was not
particularly interested, for similar reasons. Some of the medical
directors in the districts became interested. So we began to have
quite a following. By the time I last visited, in 1981, the
medical department had expanded considerably, and I presume there
were many more internists and GPs in attendance.
110
Hicke: I think you said the journal club met monthly, as most journals
are published monthly. And who would set the agenda?
Gelpi: When I was there, I would set the agenda. Then when I left, it
was set by my successors.
Ill
VI RESIGNATION AND RETURN VISITS TO DHAHRAN
Leaving Aramco
Hicke: Tell me about your decision to leave.
Gelpi: There are several reasons for this decision. I left Dhahran on a
combined vacation/ sabbatical leave in the summer of 1967. I had
planned to work in the Department of Physiology at Stanford to
improve my laboratory skills in immunology, so that I could return
to Arabia and work on the immunology of ascaris infections. When
my family and I were in the United States, I began to consider the
long-term question of indefinite employment with Aramco versus the
option of putting down roots and pursuing a medical career in the
States. We were concerned about moving our children from a
protected educational environment in a family setting in Saudi
Arabia to schools in the U.S. or elsewhere. This meant a change
in primary education for our three children, from grades 1-9 in
Saudi Arabia, to high school in the U.S., Beirut, or Europe.
Finally, there was the question of whether medicine and health
care would continue to be as challenging for me in Saudi Arabia as
it had been when I arrived.
In the eight years I had been in Saudi Arabia, I was seeing a
rapid evolution of health care and a distinct change in the
spectrum of medical problems. We were seeing older patients with
Western diseases. Most of the exotic diseases were being
eliminated, or had been eliminated.
Hicke: Your successes were eliminating some of the challenges?
Gelpi: Yes. So I was considering all these questions during my
sabbatical year. In time, I decided that I would have to put down
roots sometime. So after eight years of living abroad, it was
time I settled in one place. Palo Alto, with its proximity to two
major university medical centers, seemed to be the ideal place to
112
begin a new career. I knew that the transition from grade school
to high school, no matter whether it began in Dhahran or the
States, would be traumatic. But in Dhahran, it would be worse,
because there would be geographical separation of our children
from us and from one another.
Hicke: Highschoolers have to go to boarding school, don t they?
Gelpi: Right. We had not reached this point with our children yet. In
any case, it looked like a new career in the States would not be
as exciting as that with Aramco. But there was another question:
whether or not I could spend more time on research while working
for Aramco, or would be consigned to less stimulating clinical
activities. So we decided to return, as a family, to the U.S. We
had found that there were many attractive features to life in the
Bay Area at the time. And perhaps the time had come to leave
Aramco and Saudi Arabia; and so we did.
Meanwhile, all of our personal effects had been put in storage
in Dhahran. And the prospect of moving them backeither to our
home in Dhahran, or a new home in Palo Alto--was not very
attractive. But this may have been the decisive consideration:
for in a sense, we had already moved out of Dhahran and Saudi
Arabia. To have returned meant unpacking over 100 boxes and a
move to another house in Dhahran. I felt an obligation to return
to Dhahran alone, leaving my family in a newly purchased home in
Palo Alto, in order to work until a replacement could be found for
me. Several months later, just short of 1969, I returned to the
States. I took a job with the Office of Economic Opportunities as
medical director of a new clinic for disadvantaged residents of
East Palo Alto. And of course, that is another story.
Hicke: Yes. Well, you did a lot.
Gelpi: But this was not the end of my relationship with Aramco. Because
in 1974 I began a series of five summer visits (1974-1978) to
continue some of the research I had begun earlier, and also to
provide vacation relief for physicians in internal medicine.
Medical Research in Dhahran. 1974-1978
Hicke: Tell me about this in more detail.
Gelpi: I was doing work on red cell genetic markers, which included
sickle cell trait, G6PD deficiency, blood groups, but was also
113
doing the reviews which would lead to an additional publication on
hepatitis in pregnancy.
Hicke: What was the time period on that?
Gelpi: I spent four to six weeks each summer in Dhahran for five
consecutive years. On occasion, I was able to employ a college
student, whose parents were living in Dhahran, to work with me
during the summer months. I would show them how to do the
laboratory work, and hire them on as laboratory assistants. This
slowed me down, but I think that it was worthwhile for the
students. And it eventually allowed me the extra time to devote
to clinical activities.
Hicke: Were these medical students?
Gelpi: Some were pre-med, some were interested in biomedical research,
and some were simply liberal arts majors.
Hicke: What resulted from these follow-up studies?
Gelpi: I completed the research, and this led to about a total of eight
to ten publications. I finished the investigations on red cell
genetic markers; and I finished the work on hepatitis complicating
pregnancy, for publication. That wound up my research activities
in Saudi Arabia. But I made a final visit in 1981, as a
substitute for another physician on leave.
Hicke: How long was that for?
Gelpi: I was in Dhahran for a month. My oldest son was working for
Aramco and living in Dhahran at the time; so we got to see each
other rather often.
Hicke: I wonder how he got interested in that! [laughs]
Gelpi: Well, that s another long story.
Hicke: All right. We ll stop here, and you can fill in any details when
we do the transcript. Thank you very much.
Transcribed by Lisa Vasquez
Final Typed by Shana Chen and Shannon Page
114
Regional Oral History Office University of California
The Bancroft Library Berkeley, California
Aramco Medical Department Oral History Project
Richard Handschin
PREVENTIVE MEDICINE AND MEDICAL DIRECTOR: 1958-1968
An Interview Conducted by
Carole Hicke
in 1996
Copyright C 1998 by The Regents of the University of California
Since 1954 the Regional Oral History Office has been interviewing leading
participants in or well-placed witnesses to major events in the development of
Northern California, the West, and the Nation. Oral history is a method of
collecting historical information through tape-recorded interviews between a
narrator with firsthand knowledge of historically significant events and a well-
informed interviewer, with the goal of preserving substantive additions to the
historical record. The tape recording is transcribed, lightly edited for
continuity and clarity, and reviewed by the interviewee. The corrected
manuscript is indexed, bound with photographs and illustrative materials, and
placed in The Bancroft Library at the University of California, Berkeley, and in
other research collections for scholarly use. Because it is primary material,
oral history is not intended to present the final, verified, or complete
narrative of events. It is a spoken account, offered by the interviewee in
response to questioning, and as such it is reflective, partisan, deeply involved,
and irreplaceable.
************************************
All uses of this manuscript are covered by a legal agreement between
The Regents of the University of .California and Richard Handschin
dated November 7, 1996. The manuscript is thereby made available
for research purposes. All literary rights in the manuscript,
including the right to publish, are reserved to The Bancroft Library
of the University of California, Berkeley. No part of the
manuscript may be quoted for publication without the written
permission of the Director of The Bancroft Library of the University
of California, Berkeley.
Requests for permission to quote for publication should be addressed
to the Regional Oral History Office, 486 Library, University of
California, Berkeley 94720, and should include identification of the
specific passages to be quoted, anticipated use of the passages, and
identification of the user. The legal agreement with Richard
Handschin requires that he be notified of the request and allowed
thirty days in which to respond.
It is recommended that this oral history be cited as follows:
Interview with Richard Handschin, an oral
history conducted in 1996 by Carole Hicke
in "Health and Disease in Saudi Arabia:
The Aramco Experience, 1940s- 1990s, "
Regional Oral History Office, The Bancroft
Library, University of California,
Berkeley, 1998.
Copy no.
Richard Handschin, November 1997,
115
TABLE OF CONTENTS- -Richard Handschin
CONTENTS 115
INTRODUCTION by A. P. Gelpi, M.D. 116
INTERVIEW HISTORY 117
BIOGRAPHICAL INFORMATION 118
I BACKGROUND 119
II JOINING ARAMCO 121
Interview and Hiring 121
Moving to Saudi Arabia 122
III EPIDEMIOLOGIST 124
Annual Malaria Survey 124
Other Staff Members and Personnel 124
Tuberculosis and Smallpox 125
Personnel in Preventive Medicine 126
IV CHIEF OF PREVENTIVE MEDICINE 128
Responsibilities 128
Maternal and Child Health 129
Health Education Program 132
Trachoma Research 134
Malaria Research 134
Occupational Health Program 135
Statistical Data on the Impact of the Preventive
Medicine Program 136
V MEDICAL DIRECTOR, 1964-1968 139
Outpatient Clinics: Statistics on Patients 139
Developing Public and Private Medical Services 141
Relationships with Company Management 142
Hiring and Educating Staff 144
Dr. Ivan Alio 146
Lecturing at the American University of Beirut 148
More Statistical Data About Changes 149
Crucial Leadership of Dr. Richard Daggy 150
More Data on Patient Care 154
Need for Nursing Staff 156
VI OVERVIEW: GOALS AND ACCOMPLISHMENTS 157
116
INTRODUCTION- -Richard Handschin, M.D.
Dr. Handschin obtained his M.D. degree at the University of
Rochester (Rochester, New York). His postgraduate training included a
residency in public health and a masters program at the School of Public
Health, University of California, Berkeley, where he obtained his M.P.H.
He joined Aramco s Medical Department in 1958, on the staff of the
Preventive Medicine Division. He was instrumental in developing the
division s strong health education, maternal-child health, and
occupational health programs. He did much to integrate preventive and
clinical services, both as head of Preventive Medicine, and subsequently
as medical director.
Handschin was a pioneer in developing Aramco s remarkable public
health outreach activities a model for corporations abroad, and for
developing countries. Because of special family needs, he retired early
from Aramco (1968) and went on to join Seattle, Washington s, Group
Health Cooperative (HMO) as research director. At the time of this
interview, he was ailing with chronic obstructive lung disease, from
which he died on April 25, 1997.
Armand P. Gelpi, M.D.
December 9, 1997
Sonoma, California
117
INTERVIEW HISTORY- -Richard Handschin
Richard Handschin served the Aramco Medical Department from 1958-
1968. Joining the company as epidemiologist, he was promoted the
following year to chief, Preventive Medicine. In 1964 he was appointed
medical director and remained in the position until he left Saudi Arabia
in 1968.
Born in 1918 in Champaign, Illinois, Handschin grew up there and
took his B.A. in Economics at the University of Illinois in 1942. He
served in the U.S. Army 1942-46, then took pre-med training in
California and obtained the M.D. from the University of Rochester in
1953. Four years later he received a degree in Public Health
Administration at the University of California. He was eminently
qualified to contribute to and later to direct the Aramco Medical
Department.
Handschin has the highest praise for the medical director who
hired him, Dr. Richard Daggy. Handschin speaks warmly of Daggy s
creative and persevering efforts in .preventive medicine on behalf of the
Saudis, whether company employees, their dependents, or villagers in the
Eastern Province.
The discussion in Handschin s oral history covers diseases treated
and research undertaken, other staff members and personnel, and
reporting procedures. His recollections are most valuable, however, for
the statistical data and careful notes he brought to the interview.
Using the outline sent by the interviewer, he describes his work in
detail, but most importantly, he offers statistics on the enormous
difference made by the work of the medical department, both in patient
care and in preventive medicine. His notes and data cover mainly the
years he was there--1958-1968--but in just these ten years, the progress
in public health was impressive.
Richard Handschin died April 25, 1997. He did not have the
opportunity to review the transcript of the oral history, which was
recorded on November 9, 1996, in Seattle, Washington. The transcript
was reviewed by the interviewer and by Dr. A. P. Gelpi.
Carole Hicke
Interviewer /Editor
June 11, 1997
Regional Oral History Office
University of California
Berkeley, California
118
Regional Oral History Office University of California
Room 486 The Bancroft Library Berkeley, California 94720
BIOGRAPHICAL INFORMATION
(Please write clearly. Use black ink.)
Your full name Richard Handschin
Date of birth October 17, 1918 Birthplace Champaign, IL
Father s full name Walter Fredrich Handschin
Occupation Professor of Agriculture Birthplace Calumetville, WI
Mother s full name Edith Knott Handschin
Occupation Teacher Birthplace Mt. Clare, IL
Your spouse Ula Steffani Handschin
Occupation Secretary Birthplace Maitland, CO
Your children Linda (46), David (43), Daniel (41), Lori (38), Rik (36)
Where did you grow up? Urbana, IL
Present community Bellevue, WA
Education U of IL (B.A. 1942); U. of Rochester (M.D. 1953);
D.C. Berkeley (M.P.H. 1957)
Occupation ( s ) Economic research & teaching (7 yrs.); preventive medicine
(7 yrs.); Medical Director (4 -yrs.); Research Director (15 yrs.)
Areas of expertise Analysis, planning and monitoring for health care
organizations (until 1983)
Other interests or activities The 19-mpmher Puget Sound Handschin clan
(including spouses) all live within 15 minutes. They are my major
interest.
Organizations in which you are active Silver Glen Cooperative a senior
housing cooperative where I, my wife and son live among 180 active
senior co-op members"!
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119
1 BACKGROUND
T f\
[The accompanving resume was furnished CURRICULUM VITAS
by Dr. Handschin] HICHARD HANDSCHN. M.D., M.P.H
P:;R5C K IAL DATA
?om: October 17, 1918, ChamDairn, Illinois
Married, ^ children, apes R throuch 18
and Uniformed Service;
19U" - Combat Medic, U.S. Army, Pacific Theater.
l^ i" to date - U.S. Public -lth Service Commissioned Reserve Corps.
AcMve Dutv, 1^5^-^. Inactive Reserve, 19^ to date. Current rrade: Surgeon.
19U? - 3.;. in Liberal 4rts (-Jcononics) , University of Illinois,
19U? I- 19^. - Graduate stuHent in Economics, University of Illinois, Urbana
- M.D., University of Rochester, ^ew York
.19^ . Rotating Intern, U.S.P.K.S. Hospital, Seattle, Washington
tll96 - Preventive Medicine Residency, Seattle-Kin? County Health Departmer.
19^ .! y P H. (Public Health Administration), University of California, Bj*-l<v
19?2 - Executive Proera-m in Business Administration, Columbia Universitv (< weeks)
19f3 - In-company Managerial Grid Seminar, Saudi Arabia (1 week
PUrLIC K.-1ALTH LX? ?~1~*:Z 2
. . Research Technician, California State Disability Insurance Proeram
Sacranento (2^ vears). Workload and cost estimation.
1952 (summer) - Research Technician, California State Department of Health
Nutrition Study, San Mateo, P months). Project coordination.
19^5-1956 - OverlaTOino anointments as Director of Communicable Disease
Control and Epidemiology (0 months) and District Health Officer (?1 months)
Seattle-Kine Co^ontv Health Department.
19 ^-l?^ - District Health Officer, Seattle-Kin? Countv Health Deoartment
(Q months). Suburban and rural area, ?0 nurses and sanitarians.
19 C B-1959 - Spidemioloeist, Arabian American Oil Company, Dhahran, Saudi
Arabia (20 months). Communicable disease investigation and control.
1959-196U - Chief, Preventive Medicine, Arabian American Oil Company,
Dhahran, Saudi Arabia (5 years). Direction of preventive i^ustrial and
community public health services for 12,000 employees and 60,000 dependents.
Administered 3 physicians and 80 other professional and technical personnel,
responsible for $700,000 annual total expenditures.
120
HEALTH SERVICES ADMINISTRATION EXPERIENCE
1Q64-19--8 - Medical Director, Arabian American Oil Company, Dhahran, Saudi
Arai-ia (4 yo^-s). Direction of comprehensive health care system serving
~l,GuO persons in 50,000 square mile area. 1*50,000 outpatient visits and
100,000 days of hospitalization annually in 5 hospitals totaling 450 beds
(3 of hospitals accredited by JCAH). 80 full-time physicians and dentists,
950 total health service employees. $14 million total annual expenditures.
(For further details see attached publication). Frequent advisory and ad
ministration contacts with other private and povernment health services in
Saudi Arabia and with World Health Organization.
1/6/69 - Research Director for Group Health Cooperative of Puget Sound
T"VCHI v :- A D ACAD-ffIC EXF ^I^C^
104? - Research 4ssi?tant in Economics, Universitv of Illinois, Urbana
(Q months).
T.9U< - Teaching Assistant in economics, University of Illinois, Urbana
(1 ser-.est=r). Taupht- 2 upoer class courses in Economics.
1Q55-195-? - Clinical Associate in Preventive Medicine, University of
Washington, Seattle (1 academic year). Tausht course in public health
aspects of ccrraur.i cable disease to student nurses.
lc^o_l^--7 _ Lecturer in Public Health and Lecturer in ipidemioloev, American
Universitv in Beirut, School of Public Health. Occasional lecture or
se-jLnar with public health or medical students.
1 = - Instructor, Aramco In-comoanv Managerial Grid Seminar. 3 week-lonp
c- -- v.tratod courses in advanced management techniques to ISO members of
>-. - arri uoT>er level Aramco ^an
preventive-Curative Sei"/ice? in Aramco" , TO. ?5- 7 0, Industry
ar.^ Tropical Health; VI, Inrtust^al Council r or Protncal Health, Harvard
"School of P-ablic Health, Boston, 1? 7.
OTH7R FRCFESSIOKAL O
Current Iv licensed to practice medicine in Washineton and California.
Certified in Public Health, American Board o^ Preventive Medicine - 19<
PRQg-:SSTCI-UL SOCIETY MiyBZ^SHIPS (M) OR FELLOWSHIPS (F)
American Public Health Assn. - Medical Care Section (F): American College
of Preventive Medicine (F); Royal Society of Tropical Medicine and Rveiene (F);
King County Medical Society (M), Washington State Medical Association (M);
American Medical Association (K); Zeta Chapter, Delta Omepa Honorary Public
Health Society (M); American School Health Association (M); American Society
of Tropical Medicine and Hygiene (M) ; Royal Society for Promotion of Health (M);
Association of Military Surgeons of the U.S. (M); American Association of
Public Health Physicians (M).
121
II JOINING ARAMCO
Interview and Hiring
[Date of Interview: November 7, 1996] ////
Hicke: We have your background and so I m going to start this morning
by asking how you happened to hear about Aramco and how you
first joined the company.
Handschin: Well, I saw an ad in the American Journal of Public Health for
an epidemiologist. I d always had an interest in Saudi Arabia,
dating way back to my exposure in National Geographic magazines
as a youngster. I had just completed training in public health
at the University of California, Berkeley, and I wrote and got
a job description of this job. It was an exceptionally and
precisely descriptive job description. I had just been
drafting some job descriptions for the Seattle-King County
Health Department, so I knew the difficulty of writing good job
descriptions .
Hicke: Yes, it is an art.
Handschin: And this was a superb description. And then I noted that it
had been drafted by R.H.D., which stood for Richard Daggy. If
someone were to be hired, they would work under him directly.
I thought, "Oh, that would be a wonderful opportunity."
Hicke: You had heard of him?
Handschin: No, never had heard of him. So, that s how I heard about it.
Hicke: And this was 1958?
Handschin: This was 1958. Then I made arrangements to travel--
122
Hicke: You sent an application; and were you interviewed for the job?
Handschin: Yes, I was interviewed, but I don t remember the details. Much
of what I have been able to recount now comes from notes that I
had used for speeches.
Hicke: Well, you don t think about those things for decades and so
it s hard to retrieve them.
Handschin: I was interviewed, but I don t recall the details. Then the
decision. We had four children at the time, the fourth child
was just about to arrive, and my wife had been enthusiastic but
she also had her fingers crossed. We were told at the tail-end
that there would be up to an eighteen-month separation. It
turned out that I left in April and my wife was able to join me
in October of 1958--so eighteen months shrunk to around six
months instead. But that was still far too long.
Hicke: Meanwhile she had the baby.
Handschin: Born on the third of March, and I left on 30 April.
Moving to Saudi Arabia
Hicke: What were your first impressions when you got off the plane?
Handschin: At that time there was not really a terminal. There was an
open quonset hut there when we got off the plane. The terminal
was, I believe, under construction at the time. Dick Daggy met
me. When he did, we were all standing underneath this quonset
hut with the wind blowing through, and he pointed out that the
chairman of the board was standing right next to us--and he was
dressed quite casually.
Hicke: Who was the chairman?
Handschin: I m blanking- -
Hicke : Okay .
Handschin: Anyway, Dick Daggy himself--! was surprisedwas wearing a
nice, button-down shirt. I thought, "Oh, this is a nice
mixture here of casualness and yet people who were savvy and on
board."
123
Then Dick arranged really an excellent orientation for
me. I visited not only all of the Aramco medical facilities,
but I spent a long time talking with the Dhahran people. I
also was introduced to the two local hospitals, and spent a
fair amount of time there. At those hospitals, they spent a
lot of time showing me around the two largest oases from which
populations many of the of the employees were derived and where
most of their families were living.
Hicke: That would be Qatif?
Handschin: That s right. And the Al-Hasa oasis near Hofuf. Some of the
people commuted back and forth to there, but some of them
actually only went home on weekends.
Then he gave me stacks of material that he had gathered- -
statistical data and reports for review. I think that it was
at the executive committee meetings of the Medical Department
where I got to learn a good deal of the inner functions of the
government. Everyone had excellent orientation.
124
III EPIDEMIOLOGIST, 1958-1959
Annual Malaria Survey
Hicke: Did they want you to learn any Arabic?
Handschin: I took some Arabic courses, but I never really became very
f luent--partly because I myself wasn t really involved directly
in patient care, although I did participate in the annual
malaria survey, in which we went into the villages and examined
all children of the village. All of the children would be
brought in, and we would examine them for the enlargement of
their spleen, which is an indication of infection with malaria.
I participated in that, and I learned enough Arabic to be
able to give instructions to the parent or the child while I
was examining them. Of those that had the enlarged spleens, we
took some blood specimens. In this manner we kept the tally of
what was going in the way of malaria. These young children,
who were completely susceptible, were kind of our sentinels to
tell us what was going on in the way of malaria transmission in
individual villages.
So, it was really a great experience. I was on cloud
nine. My children and my wife were not there; I was able to
put in many hours a day and many days of the week absorbing all
of this, and it was really quite exhilarating.
Other Staff Members and Personnel
Hicke:
Yes. Who else was there at the time that you recall meeting?
125
Handschin: At the time, Dr. Page was the medical director, Daggy was chief
of Preventive Medicine. I spent some considerable time with
Roger Nichols. Roger was the physician in charge of trachoma
research in Saudi Arabia. Over the years, I developed a very
close relationship with Roger.
Hicke: I talked to Elinor also when I was in Massachusetts.
Handschin: Oh, great, great family.
Those were people whom I had closest relationships with
initially at that time. Then I got started as an
epidemiologist there, which is what I d been hired for. The
first responsibilities I had were to review the disease-
reporting system that had been installed, to critique it and
analyze the data; to follow up on some data that we had,
looking for sources and methods of infection, and start to
draw, tentatively, some control mechanisms.
Tuberculosis and Smallpox
Hicke: Were there any particular diseases you were concentrating on?
Handschin: Malaria had been addressed fairly well, and I can comment on
that later. But one of the diseases that had not been well
addressed was tuberculosis. I tried to search out as much
information as I could on the occurrence of that. Early on we
started planning a 100-percent survey chest x-ray of all
employees, which had never been donepartly because of the
expense .
In doing that, I had the good fortune to work with the
physician here in Seattle-King County, who had been a leader in
mini-chest x-rays. They were small films that were only
seventy millimeters, twice the size of a thirty-five millimeter
film. And this man had interpreted over a million of these in
the Pacific Northwest and Alaska and was able to do it at a
high rate of speed and with a high degree of accuracy. Working
with himand I actually brought him out to Saudi Arabiawe
developed a program in which all persons were x-rayed. Close to
99 percent of our employees were x-rayed over a period of time,
and at the same time, smallpox vaccinated. So this was one of
the first major undertakings that we got off. We were able to
do that by the end of 59, and it worked out fairly well.
Hicke: It wasn t all in Dhahran?
126
Handschin: Oh no. We had to go to all of the major installations in order
to accomplish that.
Hicke: And did they bring in the people from the exploration camps?
Handschin: The people from the exploration camps rotate anyway, so we were
able to pick them up on their rotation. It was a considerable
effort, and loaded the bases, then, for really being able to
identify the infected persons and start up an excellent
program. Subsequently we started developing a manual on how to
continue to care for those had been identified, because they
were being cared for on an out-patient basis. Many of them
were able to work and, at the same time, be non-infectious by
having them on adequate antibiotic therapy.
Hicke: What about the families of the infected?
Handschin: The families of those people were also brought in for screening
to see if there d been propagation of the disease within the
household; and they were placed under care too.
Hicke: And also they were vaccinated for smallpox?
Handschin: That had been a separate program. We didn t have a program of
x-raying these people; we didn t x-ray them with the mini unit.
We brought them in individually and they were x-rayed with a
large film. I m not quite sure when we instituted a program
for routine smallpox vaccination, but I don t think it was at
that time, because they hadn t really started to work with the
major clinics on how to address some of the more significant
health problems particularly with dependents.
Personnel in Preventive Medicine
Hicke: If I interrupt you with a question that you re going to talk
about later on, you can just say so. But there are some things
that I don t want to pass up, like when you say, "We were doing
this." Who was the "we"? Was somebody working with you? Did
you have nurses or some other kind of staff?
Handschin: We ll talk about that later too, on how we organized. In large
measure, the people in Preventive Medicine were staff people
who did organizational work, developed programs, and assisted
in their implementation, but they didn t actually direct them--
with some exceptions. Initially, for example, I myself had a
highly capable Indian clerk--the best secretary I ve ever had.
127
I had an Indian clerk and the part-time services of a Lebanese
lab technician, who was quite fluent in Arabic. I used him if
and when I needed to.
At that time, there were about seventy people in
Preventive Medicine. That included sanitary engineers, a lot
of sanitary technicians, health education people in particular.
Then we had entomologists doing insect control and mosquito
control, assisting and advising the Ministry of Health on
control. All these things were going on. I never acted with
those people and was a member of their team, but they were
doing their thing and I was working predominantly at that time
in communicable disease.
Hicke: Was most of this set up by Doctor Daggy?
Handschin: Yes. Great guy. Did--?
Hicke: I did; I talked to him also.
Handschin: Oh, did you? Wonderful guy. How was his health at the time?
Hicke: He had had a stroke a year before I think, but he was doing
quite well.
Handschin: Is that right? Great admiration I have for that guy.
Hicke: Everybody seems to think he is a wonderful person.
Handschin: Yes, highly admirable man.
I didn t really see very many patients, although I asked
to see some patients as people who were being diagnosed with
particular diseases that I had interest in or that I knew very
little about. I asked the clinicians to give me a call and I d
come down and watch them as they examined or as they continued
to care for patients, kind of get a feel and ask questions as
to how the disease might have been propagated or acquired and
how it affected other people in the family and so forth. I had
very little contact, really, in the main, with patients at that
time.
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128
IV CHIEF OF PREVENTIVE MEDICINE, 1959- 196A
Responsibilities
Handschin: After I d been there--! forget--it was about fifteen months or
so, about a year and a half, Dick Daggy was suddenly advanced
to medical director, even though he was not a physician, but he
was a very skilled person in dealing with people, far more
skilled than I, in fact. So Dick advanced and he kind of
sucked me up with him. [laughter] I became the chief of
Preventive Medicine at that time, with the responsibility of
doing some overall planning and operating of an environmental
health program, being aware of, assisting, and directing the
sanitary engineering, insect and rodent control. We had a
small public health laboratory that did work related to disease
transmission.
Hicke: Such as?
Handschin: We did, for instance, some of the TB [tuberculosis] work. We
did the work on tuberculosis cultures and so forth. We did a
lot of work on malaria specimens. We did some work on samples
of milk and water specimens.
Hicke: Was this separate from the rest of the laboratory?
Handschin: Yes, it was. It was a separate establishment.
Dick had already recruited by that time an industrial
hygienist to work with toxic substances, of which there are a
number in an oil industry. And one of the most interesting and
fruitful interactions was with our health education unit. We
also invited a lot of staff services in planning and evaluating
programs that the Medical Department carried out in prevention.
In other words, many of these programs were carried out by the
129
clinicians and the nurses who were delivering care. We
developed programs that incorporated the preventive aspect, and
they became responsible for carrying those out. We had to do a
lot of training.
Hicke: Training the staff or the doctors?
Handschin: Training the people who were going to be delivering it, because
they had not been trained necessarily with an emphasis on
preventive aspects.
Hicke: I suppose the idea is you ve got the patient here, you should
take advantage of it.
Handschin: That s right. And many of them were having to come in from Al-
Hasa--more than forty miles away. So as long as they were
there, make the best of it.
Maternal and Child Health
Handschin: Much of that effort came from a maternal and child health
physician whom we recruited, Hazel Blair. She d previously
worked in Iran and Alaska. We also did recruit a public health
nurse consultant, who had experience also in Iran, Egypt, South
America, and China working with the World Health Organization
and other organizations. These people initiated an
investigation as to what could be the problems in maternal and
child health. It was obvious that there were lots of problems.
Hicke: Do I assume that if you have the names of these people, you
will pass them along?
Handschin: The names?
Hicke: Yes, like the public health consultant. In other words,
instead of me stopping to ask if you know the person s name,
you tell me the name.
Handschin: Oh, well, one of the names is Hazel Blair.
Hicke: Yes, she was a doctor.
Handschin: A doctor. And the nurse was Ms. Pitcherella. Pitcherspelled
even with a "T" I thinkand "ella." Pitcherella. "J" was her
initial. J. Pitcherella. Jeanette, actually, come to think of
it. We always called her "J"; she became our babysitter, and
130
Hicke:
Handschin:
Hicke:
Handschin:
Hicke:
Handschin:
she subsequently went to work in Alaska with an Eskimo group
after she left Aramco, and would come down here and visit us.
I saw her in about 93. Yes, in 93, I went to back to my
University of Rochester for the fortieth-year reunion of my
class. I graduated in 53, went back in 93. We made a
special trip to go down and visit her in New Jersey and boy, we
were glad to do so. She was in fair health then, but two
months later she was dead.
These were really skilled people. They used English-
speaking Saudi girls in addition. We had a few senior staff
Saudis, who were upper echelon people, who lived in senior
staff camp amongst Americans and whose daughters attended
senior staff schools and were fluent in both English and
Arabic. We used several of those girls to assist in these
investigative efforts.
They went along when you would go out to the villages, is that
what you re talking about?
Yes, yes. They assisted us with visits to homes, talking with
parents in particular, revealing the foodstuffs and their
availability; the methods of growing those foodstuffs; how they
were marketed; how foods were prepared; what foods were
acceptable and what foods weren t; and actual nutritional
analysis of some of those foods.
You went into all that?
This was the basis that took some time to discover, because
malnutrition was a major problem. It took some time to
discover what was going on, what were the resources to combat
it, and what were the cultural views about the feeding of
children. There was a malnutrition problem principally in the
first few years of life
I have to interrupt you again.
Aramco dependents?
Are we talking now mainly about
Yes we are, yes we are. We talked about how conception
occurred, what people felt about pregnancy, how they acted
during pregnancy, about delivery, and about childcare. There
was actually a lot of frank malnutrition, including
quashiorkor, a classical disease of protein deficiency in which
female infants were never breast-fed. The male infant wasn t
always taken off the breast when the second child or the
subsequent child was born, particularly if the second child was
a girl. And the woman might not increase her food intake.
These youngsters suffered frank malnutrition as a result.
131
Hicke: I ve seen some slides of a couple of those kids. Awful!
Handschin: One thing that came from these studies was the real cause of
the problem. Adequate amounts of suitable foods were available
to most families; there an was adequate amount of protein,
either from meat or fish or from cheeses or from lentils. But
it was not considered appropriate to feed these to children
until they were three or four years old. And so as a result,
we found later even if you encouraged people to use these foods
and feed a child who was six months, ten, twelve, fifteen
months, feed these foods, if the child once rejected it, the
mother would say, "I told you so!" And so it took an awful lot
of convincing the people that this was a desirable thing to
feed these infants foods, particularly protein foods
sufficiently. It was actually malnutrition in the midst of
plenty.
Hicke: That s amazing.
Handschin: And it was all based upon cultural beliefs that these were not
good foods for children.
II
Handschin: Although actual frank starvation was probably pretty much--
Hicke: Are you saying "frank"?
Handschin: Yes, meaning true. The problem is that you can t sometimes
tell the difference between starvation per se or malnutrition.
Why did some people die? It was usually malnutrition with
superimposed diarrhea on top of it. They were really very
vulnerable to any infection because of the malnutrition,
including pneumonia. It was an admixture. Incidentally, it s
not so unique to Saudi Arabia. I find that I had two uncles in
1875 who probably died of malnutrition in Wisconsinpeople
trying to make a living on cut-over land that was inappropriate
for farming purposes at the time, and unable to keep their kids
healthy. As one uncle said, they probably really starved to
death. He said that they were just were skin and bones when
they were sick. It s exactly what was happening in Saudi
Arabia.
Hicke: Except that they had the food available in Saudi Arabia- -didn t
know how to get it to the kids.
Handschin: What was lacking was suitable child-rearing techniques.
Hicke: Yes. Interesting. That s an amazing story.
132
Handschin: There was a really massive gathering of data by these people,
then some testing of hypotheses, and then the beginning of
training of some nurses and some physicians to start to teach
what should be given to people whom they were seeing now as
patients, what should be done.
Several different approaches were tried, and they didn t
all work. Then ultimately, a fairly well-designed program was
beginning to gel during my days, and it was mainly addressing
malnutrition more than anything else. That was the basic thing
that was causing the highest infant mortality rate.
Hicke: Is this the maternal and child care program we re talking
about?
Handschin: This is the maternal and child health program.
Hicke: That is interesting, because I would have thought that just
from the name of it that it was teaching mothers how to take
care of their babies and that sort of thing. But it was
considerably more than that.
Handschin: Well, this s_ taking care of their babies.
Hicke: Well, yes, that s truebut not just changing diapers and so
forth.
Health Education Program
Handschin: Associated with that, I d like to say some things about the
health education program.
Hicke: Yes, I wanted to ask you about that.
Handschin: It was principally under the direction of Mitchell Owens, a
very fine health educator who devised most of this. He did a
whole variety of things; I can t remember all the things he
did, but let me cite some of them. First of all, hewith the
assistance of crews that were brought from the U.S. --did a
series of color movies on trachoma, on malaria, on community
sanitation, on personal hygiene. These also were shown on
television. They had the television station there that had
allegedly as many as three hundred thousand viewers, but I
don t believe that. But there were an amazing number of people
who did have access to television.
133
These were also shown in the public schools. Aramco had
a program of building public schools, and in the end I think
they built seventy public schools. In those public schools,
and in others, we had a program in which our health education
people went into those schools. They were fluent in Arabic.
They were Middle Eastern, predominantly Jordanian and Lebanese.
They carried these movies into the schools; they carried a
great number of pamphlets into the schools. Later, September
of 1960, into girls schoolsno girls schools before that.
We even developed a curriculum for the teachers--to
assist the teachers in this, including books that were
specially designed and produced addressing the problems of
health in Saudi Arabia. These books were then produced and
given to the students at a particular level, I can t remember
which. I think it was the equivalent of the sixth grade when
the youngsters would leave that elementary school. They could
keep this and take it home. It was a nicely bound, hardcover
book with illustrations, and with illustrations that were
specifically designed to be compatible with Saudi lifestyles in
a just beautifully done pie-ce of work.
Hicke: Was that done at Aramco?
Handschin: It was done by Mitchell Owens and his people. The graphics and
so forth were farmed out. It was very well done. In addition
then, they conducted family health classes. These were done
out in the villages. There they used some of the Saudi girls
who were from senior staff families. There was a weekly TV
program on health; I think it was about fifteen minutes. It
was pretty popular, with an opportunity to write inthat was
before the days of call in--to suggest questions or what you
didn t understand and so forth.
Hicke: This was Mitchell again?
Handschin: This was all Mitchell, but he had a lot of skillful people- -
including a number of American wives who had particular skills,
some of whom had worked in television and so forth. So they
were very useful too. Actually, the attempt was to really
develop a willingness among Saudis to both accept and then to
maintain health care, to utilize it, to recognize when they
should utilize it, to understand that health care also involved
washing your hands and a variety of lifestyle changes, and try
to get them to maintain the things they learned from health
care.
Hicke: Let me interrupt again. Change is difficult for people.
134
Handschin: Oh yes.
Hicke: How did they manage to persuade these people to change their
lifestyle?
Handschin: Well, we ll talk about that some later on, when I discuss
directing the Medical Department; we ll talk about how they had
to do that for women who were coming in.
Hicke: Okay. That would be fine.
Trachoma Research
Handschin: There are a couple of other things as well while I was an
epidemiologist. You had asked something about description of
research carried out while I was the chief of Preventive
Medicine. I might just take this time to talk about the
trachoma research, which regularly was not directly under my
purview as I was chief of Preventive Medicine; but subsequently
when I was medical director, Roger reported to me.
Aramco donated over a million dollars for trachoma
research, which was started in 1954 under Dr. Snyder--John
Snyder, J.C. Snyder--who was dean of the Harvard School of
Public Health. Much of the research was carried on in Saudi
Arabia, but elsewhere too; they traveled to observe trachoma
elsewhere. And quite a bit of work was done in Boston in the
laboratory there for over ten years, including isolating the
organism; developing tests to type the organism and identify
it; and some attempt at developing a vaccine, which did not
prove successful. Ninety-five percent of Saudi Arab employees
showed evidence that they d been infected with trachoma, and
although many recovered without major difficulties, it was at
that time the leading cause of blindness in the world. So
there was considerable effort in trying to do something about
it.
Malaria Research
Handschin: Another aspect of research that was going on was the malaria
survey, which I indicated was done annually in a variety of
different villages; and then I already mentioned we examined
all the children in the village, particularly those who were
135
under two or three years of age, who were likely to be able to
tell us [through the examination] what has happened in the last
year or two by the fact of whether they were infected or not.
We shared all this information with the Ministry of Health. We
did a lot of research work on the resistance of mosquitoes to
insecticides. And as a matter of fact, at that time there was
a resistance developing, and we assisted the Ministry in
identifying the one particular insecticide that was no longer
being satisfactory in suppressing the mosquitoes, and assisted
in choosing some others. Research was being applied almost
immediately in continuation of malaria control. Malaria was
not really eradicated, but it was very effectively being
controlled during this particular period in time. I ll talk a
little more about that when I talk about the impact of
preventive medicine on overpopulation.
Occupational Health Program
Handschin: We did at that time also hire an occupational health physician.
He principally worked along with an industrial hygienist on
some of the noncommunicable disease exposures that our people
had. Heat exposure was a big problem in Saudi Arabia.
Hicke: I can believe it.
Handschin: Particularly, for example, working offshore. We had drilling
rigs that were located offshore. The humidity was tremendous.
Those people worked forty- five minutes, and then they had a
fifteen minute break in a cooler atmosphere. Changes in this
patternwhen breaks should be given, and how frequently- -were
developed on the basis of some recommendations that came from
our occupational health physician.
Hicke: Do you recall his name?
Handschin: Paul Mossman.
We also had problems on noise exposure, because a lot of
activities are in noisy refineries. So we had a hearing
conservation program, in which people were tested in certain
strategic areas where it was likely that they would have
diminution of hearing. Altering the work situation to provide
baffles for sound or to obtain a variety of ways of
ameliorating the risk was done through this program.
136
We had a lot of problems with back injuries, so we were
trying to teach people how to lift and also how to organize
work so that the back injuries were not likely to become a
consequence. So our occupational health people had a lot of
work to address, and it was one of the areas in which I gave
very little supervision; these people were professionals in
their own right, and mostly what they needed from me was
assistance in equipment or assistance in arranging contacts and
so forth. They were very good independent workers.
Statistical Data on the Impact of the Preventive Medicine
Program
Handschin: You asked on the outline at the end of the chief of Preventive
Medicine section something about the impact of preventive
medicine programs on the local population. Let me cite some
data that I gathered out of looking at some notes.
Hicke: Oh, that would be great.
Handschin: Formerly, there had been thousands of malaria cases treated
annually. For example, in 1947 there were 12,000 visits to
clinics by employees for malariaand a total of 30,000 visits
altogetherbut 12,000 of them were among the employees.
Hicke: That s impressive.
Handschin: Ninety to ninety-five percent of children had malaria. One
quarter of the employees had at least one attack a year. Now
by 1963, there were less than a dozen cases of malaria acquired
in the Eastern Province among our employees. That s a marked
difference: from one quarter of the employees having at least
attack a year down to a dozen cases a year, which had been
acquired in the Eastern Province.
We had a program, starting in 1958, in which Saudi women
were selectively interviewed as they were coming through clinic
at the time of Ramadan. Ramadan, the fast and feast month of
the year, is well remembered by people, so that they always
knew events as what had happened before or after the last
Ramadan. So at Ramadan each year, we interviewed women as to:
"Have you given birth to a child since Ramadan?" "Is that
child surviving?" "When did that child die?" From this type
of interviewingit s very simple, two or three or four
questions is all it took- -we were able to find out that in 1958
one out of four children died within the first year of life.
137
From one Ramadan to the next, one of out four children in
their first year of life died: 250 out of 1,000. That was
1958. By 1966, which was only eight years later, it was down
to 30 out of 1,000 instead of 250 out of 1,000. At that time,
the infant death rate in the U.S., death in the first year of
life, was twenty-one; and by 1966 in this group of Saudi women
who had been exposed, we were down to thirty.
Hicke: Are you going to tell me what that s attributable to?
Handschin: It was attributable to the MCH [maternal and child health]
program that Hazel Blair headed up.
Hicke: Mainly overcoming that malnutrition?
Handschin: Malnutrition and other aspects of child care too.
During the seven-year period from 1960 to 1967, there
were no employee deaths due to tuberculosis, pneumonia,
malaria, smallpox, infectious hepatitis, typhoid, or any
viruses. These were all diseases which in the early days were
causes of death. And that was a seven-year period in which
among those one, two, three, four, five, six, seven diseases
which had been common causes of death in the forties and
fifties among our employees. There were none in that period.
Hicke: What a story!
Handschin: In the 1940-50 period, all of these were prominent causes of
death. Comparing 1960-67 with the 1940-49 period, there was a
98 percent reduction in the communicable disease deaths, and a
53 percent reduction in accidental death. I mean, these are
rates per thousand. Part of this related to other things, such
as company housing, which was not just housing for bachelors or
in bachelor-type quarters, but also in town sites adjacent to
the major installations. These were little villages which the
company built. All of these had running water in each house;
running water is a great godsend. Soap and water can do a
great deal in controlling disease. It doesn t even have to be
high-quality water; it can be just water, because it gets used.
All these had excellent sewage disposal; they had fly control;
they had vermin control. All of these were developed by our
preventive medicine group, who worked with those town sites to
make sure that they had-- Well, that gives you some idea of
the impact that was going on. Maybe I ll have some more later.
Hicke: When I talked to Bill Taylor and I told him that I was going to
be interviewing you, he said during your time there was a
138
spectacular change in public health. You just indicated that,
It really was an incredible improvement.
Handschin: Yes, it certainly was. Well, let s go onward.
139
V MEDICAL DIRECTOR, 1964-1968
Outpatient Clinics: Statistics on Patients
Hicke: In 1964, you became medical director.
Handschin: [reading outline] "Developing procedures for outpatient
clinics."
Hicke: I understand that was one of the things that you did.
Handschin: A large part of this was related to maternal and child health.
Let me give you some figures, then. During that time when I
became medical director, we were caring for about 69,000
people. Thirteen thousand of them were employees. That
constituted 19 percent of our people for whom we were
responsible. Wives accounted for an additional 16 percent.
Children accounted for 59 percent of the people we were
responsible for. And the Saudi Arab parents, for whom we
became responsible, accounted for 6 percent of the people that
we had to care for.
Hicke: Employees parents?
Handschin: Saudi Arab employees parents.
About 92 percent of our population that we were covering
were Saudi Arabs, 6 percent were American at that time, and 2
percent were of every other nationality. That 2 percent was
low because they didn t have their families; they weren t
permitted and we didn t care for them. In 1968, which was
towards the end of my tenure, one out of thirteen people in
Aramco worked in the Medical Department.
Hicke: One out of thirteen?
140
Handschin: That would be about 7 percent, something like that and we used
6 percent of the company s total operating cost. And about 12
percent of our Medical Department costs were for prevention:
about a million dollars a year was being spent on prevention at
that time.
The principal cause of severe, serious illness in
children was the malnutrition-diarrhea complex. It was the
biggest single health problem. And it was through the
developed procedures that Hazel Blair and Jeanette Pitcherella
spent so much time writing procedures for outpatient clinics.
They d plan these preventive aspects, then they d teach them to
the people who were going to utilize the techniques. There
were other things that were being done in addition to
preventing malnutrition. For instance, we had problems with
tetanus in the newbornchildren being born and the umbilical
cord wasn t handled properly. Most of these people were being
delivered by midwives in the village. But they weren t really
midwives; they weren t trained midwives.
Hicke: Just an older woman?
Handschin: They were casual cronies who did this. And we had a lot of
trouble with tetanus in younger children. So one program for
the prevention of this was to immunize women, even before they
became pregnant, you see. And their antibodies went through
the placenta and protected the child. We also developed
because of considerable need a program of giving BCG, which is
a tuberculosis vaccine, to newborn infants.
In the clinics we developed some day-care units in the
clinic, right adjacent to where the curative medicine was being
practiced. The mother could be sent by the doctor or nurse to
stay in that unit for eight hours to receive education that
seemed to be appropriate for her particular problem. For
instance, the mothers would prepare the food for the child
there, and they would feed the child under the tutelage of the
nurse. And not only once, but repetitively, so that in an
eight-hour time period, they would feed the child maybe three
or four times. Each time, that activity would be critiqued. A
lot of this was group instruction. There d be ten or twelve or
fifteen mothers there in that particular room, and there "d be
an interaction in that group maybe not with neighbors, but
with people they could talk quite freely to because they were
the same clans.
141
Handschin: During those all-day sessions they also got new information. I
have emphasized food preparation, but there was also emphasis
on skin care- -because you had a lot of problems with skin
infections also upon the whole care of an ill child: how to
respond to minor ones and those that required more care.
Hicke: When to see the doctor.
Handschin: Yes, that s right.
Hicke: That s the hard one.
Handschin: But in our case it often was when to see the nurse, too. We
trained nurses for screening. We had no Saudi Arab females
available. We used predominantly Middle Eastern female nurses,
Indians doing the more clinical, the more routine aspects of
care. But most of these people active in the actual on-the-job
training were Palestinian, Jordanian, some Egyptian. We had an
English gal who spoke Arabic pretty well too. These were all
trained in Aramco by our MCH nurse and our MCH physician, which
was really a major thing to do that.
Developing Public and Private Medical Services
Handschin: Another aspect that we really had to do as a medical department
was assisting in the development of public and private medical
services in Aramco--non-Aramco services and to some extent
allocating some medical service to the general public where it
wasn t possible for the public to get that kind of service. We
helped establish the first hospital in al-Khobar--a town of
about 35,000. I m suddenly blanking on the name of it. It was
a private hospital. Al-Sharq was the second hospital in this
same area. But when this first one was established, we
provided initially 90 percent of their patients. They were
Saudi employees and Saudi dependents, principally Saudi
dependents, I should say. They had on their staff twelve well-
trained, non-American physicians, some of whom had been trained
in America. It was a large, well-run hospital. They had, for
instance, a center for preemies that was the equivalent of what
was available in many parts of America.
Hicke: That s wonderful.
Handschin: We had assisted in the establishment of the second hospital;
about 85 percent of its patients were Aramco.
142
Hicke: These are contract hospitals, right?
Handschin: These are the contract hospitals. In both of these hospitals,
Aramco supervised and audited their care. We had Dick Perrine,
who was in charge of this, the liaison physician. Almost every
aspect of their medical and nursing care was audited and
reviewed to see how it was going. The general public was free
to use these; initially, of course, it was only the more
affluent ones and expatriate personnel. There were many
expatriates in the area who were attracted because of the
opportunity for economic endeavor supporting Aramco, selling
things to Aramco.
Hicke: Are you talking about American expatriates or all kinds?
Handschin: Not necessarily. There were Indians, English, Germans, French,
Americans and so forth, a great variety. These hospitals
provided a resource for that group of people too, including
those who had brought their families along.
In addition, between 1963 and 1966, a four-year period of
time there, we paid about a $135,000 a year to a team of
consultants from the World Health Organization to assist the
government in developing the health services for about 360,000
people in the population who were not Aramco employees and who
needed care--in particular, to work on one hospital which had
been sitting idle for five years unutilized, and to get that
going; and they did. They were able to get that hospital open;
and although the care was far from what we would like, it was
there.
In the year before we started that program with WHO
advising and expediting, the year before that we provided $1.1
million in care to the general public in 62. In 66, four or
five years later, $400,000 only--a significant reduction. Of
course, we had expended $400,000 providing the advisory
assistance for that. Later, Aramco expended at least $700,000
in total to the World Health Organization. I have no data, but
I know that there was continued progress.
Relationships with Company Management
Handschin: You want some things about my relationship with company
officers and reporting procedures. I reported as medical
director to the vice president of Industrial Relations.
Sometimes they had a slightly different title than that, but
143
basically that was it. In some instances, I used to relieve
Dick Daggy when he was on long vacation. I served under several
different vice presidents of Industrial Relations, including
two who ultimately became presidents of the company; so they
were quality people.
Hicke: Who were some of these people?
Handschin: [Bob] Brougham was one, and Listen Hills another. I guess that
what had happened was that Dick Daggy had established a
remarkably good relationship with company managementbecause I
just fell into it and found that our relationship was always
one of cordiality. I was at ease. I was usually able to get
what I wanted. I found that the transmission of information
upward to them about our needs, our successes, or our failures
was really an enjoyable activity. I enjoyed that aspect of my
work more than maybe many others. I also enjoyed defending the
department against some budget cuts, and I think I was largely
successful in those interactions.
For instance, I felt that I was given a lot of respect,
and I had a lot of respect for these people. All that had been
prepared by the type of interaction that Dick Daggy had
established. I just lucked out.
Hicke: Well, I m sure you had some input also. That sounds like a
very good working relationship and one of the reasons you were
able to do so much for them.
Handschin: And there was a keen understanding of what we were doing in the
way of preventive care at the highest level, including Tom
Barger, who was at that time the chief executive officer.
Barger had a thorough understanding. Barger would come down
and go with people like Dick Perrine and me. I remember one
time the three of us went to visit because he was interested in
these private hospitals, the contract hospitals. He came down
and said, "Let s go visit." It was really unannounced. He
said, "I just thought of it today," and very informally came
down. Perrine was there, and the three of us hopped into Dick
Perrine s little Volkswagen.
And Barger was a tall man too. We had called ahead to
tell them that we were coming. The first hospital we were
visiting was headed by a Palestinian, who had spent a lot of
time in the U.S., incidentally. He was a physician. And he
was very surprised to see the chief executive officer crawl out
of the back end of a Volkswagen! [laughs]
Hicke:
Handschin:
Hicke:
Handschin:
The two of you unfolding yourselves!
It illustrates how things got done.
That s a good anecdote.
It was really a very egalitarian community; people had very
little pretense. Barger especially was a very admirable man,
very admirable.
I
Yes, I understand from what I ve heard about him that he
certainly was responsible for much of the interest in the Saudi
culture.
He was. He was a student of the Arab people and the Arab
culture, and an appreciator of that. As a result, he was
admired by the Arabs, who recognized the empathy he had.
Hiring and Educating Staff
Handschin: [reading] "Talk about recruiting and hiring." I did very
little of this, actually. Largely the recruiting and the
hiring of staff were done by people directly under me. They
had the savvy to know what kind of people they wanted. They
reviewed them with me, but I did very little. When I was chief
of Preventive Medicine I did do some hiring. I helped hire
Hazel Blair and Jeanette Pitcherella. I hired the
epidemiologist, Ivan Alio. I recruited him directly. I was
responsible for the recruitment of Gordon Flora. I don t think
I ve ever met him. But I was working with some people from
Booze, Allen, Hamilton who had provided a variety of names, and
I recognized that this man probably had the most suitable
background among the many candidates. But I ve never met him,
that I recall. I say that, maybe incorrectly, because I find
that I ve often forgotten people whom I ve actually met.
[reading outline] Let s see what else I have. I m about
ready to move to the second page here. "Ongoing education of
staff." Well, one thing, of course, I ve already described
something about the re-education we had to do among clinical
people who were predominantly curative in their viewpoint.
That involved a lot of education, of "Hey, it s really
important that you report communicable disease." But it s also
much more elaborate than such things as that. It s "In your
preventive practices, you are going to be held responsible."
Hicke: This was a new approach, right?
145
Handschin: That was a new approach. It was not accepted by everyone.
There was quite a difficulty. We didn t win all the battles,
but we were most successful probably in the area of
tuberculosis control, where we had a tuberculosis control
physician who really believed in prevention. Another area was
the whole area of maternal and child health. We did pretty
well there, in the long run. Then, ongoing education of staff:
we had a whole program at Aramco--! forget its titleit was
management and professional development, in which we had a plan
for every key person as to what they might benefit from in the
way of additional training, and when it might be. That
training could be on the job training, for instance, to rotate
them through different assignments. I was medical directoras
vacation relief --for two months or two and a half months, I
would be assigned to Ras Tanura and would run the Ras Tanura
medical center or Abqaiq.
So similarly, we did this for everybody. This could be
on the job training or it could be educational leave, or it
could be sending somebody to a year at school, which we did,
for a master s in public health. David Weeks, who became chief
of Preventive Medicinewe sent him off for a year of public
health training at Harvard. I was sent for training in
executive management at Columbia University s campus at Arden
House in urban New York six weeks of rubbing shoulders with
executives from IBM and a variety of other people. There was a
whole program, and this was reviewed annually, not only with
the personnel department to make sure that you had this but
you had to review it also with your boss, all the key people
underneath you, and so it went. Then if we felt that people
were weak at particular management skills, then we gave them a
short course that might be available in the field or actually
have them spend some time substituting for somebody. So you
got an idea of what it was: "Hey, you re just objecting to all
this; somebody is going to be gone a month, why don t you fill
in?"
Hicke: See how it looks from the other side.
Handschin: So, I spent a lot of time on some of these programs, assisting
and advising on how surgeons should be upgraded, the new Saudi
surgeons we had brought on.
You asked about Tapline outposts. We didn t figure that
much with Tapline. We backed them up occasionally on medical
care. They had pretty much their own outlet. We brought some
of their medical people down and gave them some indoctrination
in some of the things that we had learned, but they were people
146
that had been trained at American University in Beirut largely,
They were pretty capable on their own.
Dr. Ivan Alio
Hicke:
Handschin:
How about the U.S. military?
with them?
Did you have much interaction
Hicke:
Handschin:
I didn t have any, although I recruited my successor as
epidemiologist, Ivan Alio, there. Most interesting guy. He
was a Macedonian, and when part of Macedonia was taken over by
Greece, his father moved to Sophia. And so he, who had spoken
Macedonian as a child, grew up in Sophia, Bulgaria, spoke
Bulgarian. But he took French too, because his father had been
educated in a French medical school; so he took French and
ultimately he was going to go off to France. Just about that
time, the war came and Bulgaria was on the other side; so he
went off to Germany and went to medical school in Germany and
learned German.
So a Greek-Macedonian-Bulgarian-French-German-speaking
Ivan went through medical school.
And eventually he must have learned English.
Well, not yet.
Then he went back to Bulgaria. But he didn t like it; it
was after the war was over and he didn t like it. He made
plans to get out, and he was able to go on leave to Prague, and
he got into Prague just as it was falling to the Russians after
the war. He skipped out of there in a hurry and he got to
Italy.
In Italy he was in a refugee camp, and he served in this
refugee camp as a physician. He started to learn Italian,
quite a bit of Italian. He was there for a long period of
time, and he wanted to get to America. So he started doing
research in what kind of things could he become skilled in to
emigrate . He found out the list of things that were in demand
in the Americas, and one of them was a skill in, as I recall,
textiles--re-dyeing of textiles and production of textile
products. So he did research in Italian in the local libraries
that were available on this, and he was able to pass the test
proving that he would be competent to assist in the development
of some kind of textiles. And as a result, he had an
147
opportunity to go to either Peru or Bolivia. I forget which.
I think it was Peru, but I m not certain. When he found that
out, he started studying Spanish. He said that he got off the
plane in Peru, Ecuador, Bolivia--! forget whichand he said by
the first night he had a date with a girl, and he could carry
on a conversation in Spanish that was passable.
Subsequently he migrated to Venezuela, where he served
under a world-famous malariologist. He trained under and
served under this fellow on malaria control in the upper
reaches of Venezuela, a really primitive area. But his mentor
told him if he really wanted to get ahead, then he ought to
train in the United States and encouraged him to make an
application to the school that he had attended: Johns Hopkins
[University]. And lo and behold, he was accepted at Hopkins,
even though he wasn t fluent yet in English. But he had
started.
He was accepted and went to Johns Hopkins and learned
English. He met a girl there who became his wife. She was
employed at Hopkins, in clerical or secretarial, and she did a
lot of tutoring. He went through and got a Master of Public
Health at Hopkins.
Hicke: What an amazing story!
Handschin: Then, in order to expedite his American citizenship, he joined
the [U.S.] Army and served in Korea, where he was an advisor in
preventive medicine to the Korean armed forces. And he learned
a good deal of Korean! He just had this innate facility for
learning a language very rapidly. I think he was in Korea two
or three years, then came back and was about ready to be
discharged when he saw our ad for an epidemiologist. I
interviewed him at Fort Leonard Wood in Missouri on a vacation.
So that was one person that I was actually responsible for
recruiting. I brought him out to Saudi Arabia. He was an avid
student of Arabic, and it wasn t long before he was quite
capable in Arabic.
He was also in the military reserve; the military was
using him to provide information about health conditions in
Saudi Arabia. He did an enormous amount of traveling in Saudi
Arabia for the benefit of Aramco and for the benefit of the
American military, describing living conditions and health
conditions, occurrence of disease, and availability of medical
f acilities describing the health infrastructure of the country
for us and for the American military. So that s the only
instance I can talk of in which I know of direct interaction
with the military.
148
Hicke: Oh, but that was a wonderful little history of Dr. Alio!
Handschin: Oh, he was a very interesting guy. He had some rough edges,
but he was a guy who was most intriguing to listen to. Later
he went back and visited in his old country, and brought out a
priceless icon from Bulgaria that had been in his family for
several generations. His mother was still there. But he had
covered his tracks well. He had arranged that everything was
in order as he left there, and he left nobody dangling up in
the air.
Hicke: That was wonderful.
I*
Hicke: You were just going to tell me what happened to him later.
Handschin: After he left Aramco Ivan Alio became medical director for the
Peace Corps, a position which he held through at least six or
eight years. He was the medical director for the Peace Corps
and was, once again, active traveling. He was a most
inquisitive and acquisitive guy: he wanted to know things and
facts.
Hicke: I m glad to hear so much about him.
Lecturing at the American University of Beirut
Handschin: You ask about lectures at AUB. Actually, I made very few.
Principally they consisted of descriptions of Aramco s
programs; descriptions of the health conditions observed in
Saudi Arabia; descriptions of our nurses, many of whom had been
trained at AUB; sanitary technicians, how those people were
being used in Saudi Arabia; what they had learned at AUB that
was of help and things they had to learn additionally that
hadn t been provided at AUB; and how physicianswe used an
awful lot of American University of Beirut physicianshow they
had been utilized and how they had opportunities for
advancement and so forth. So those lectures at AUB were
principally in the School of Public Health, although I think I
gave one or two to the School of Medicine. But I was not on
the School of Medicine Faculty; I was on as a lecturer in the
School of Public Health.
149
More Statistical Data About Changes
Handschin:
Hicke:
Handschin:
Hicke:
Handschin:
Hicke:
Handschin:
Hicke :
Handschin:
[reading] "Something about changes that I observed during my
time in Arabia. "
Enormous, for one thing- -
Yes.
--the changes that you effected while you were there,
other things.
But--
In 1952, six years before my time, there were three non-Aramco
physicians in the Eastern Province, at a population then
probably close to 300,000. In 1967, fifteen years later, there
were ninety-two employed by the Saudi Arab government. In
fifteen years they d gone from three to ninety-two. By that
time, they were located in twenty-four different towns, and
there were at least nine different specialties that were
represented among those things.
Nearly all of those Saudi Arab government physicians also
were practicing part-time as private physicians. That s what
attracted them: most of their income was in the private
practice. So half-time, half-time. Or, a full-time position
with the government- -which was about a six-hour day--and then
six hours of practice in the evening in their private clinic.
Some of these were at the contract hospitals, right?
Some--well, no. We ll go on to those.
Okay, go ahead.
Then in addition to those ninety-two who were employed by the
government, there were sixty who were solely in private
practice. They were located in only six towns, the larger
towns, including al-Khobar, as an example. There were also at
least nine specialities represented. So you add these up--
you re talking about the non-Aramco physicians: 152, fifteen
years later from the time there were only three.
And if you add in the Aramco physicians, there was a
total of sixty-five doctors per thousand in Eastern Province.
Compare that to Alaska: at that time, there were seventy-one
per hundred thousand. So sixty-five in Saudi Arabia, seventy-
one in Alaska. Seventy-four in Mississippi in 1965. I m not
talking about the quality necessarily of all these physicians
150
or how they practice, but obviously an enormous explosion in
fifteen years. You might talk about evolution; actually, it
was almost revolution. And this continued on after that time.
So those are some examples of the changes.
I ve got some more statistics, but I m going to run into
them later.
Hicke : Do you want to say something about why and how this enormous
explosion took place?
Handschin: We were giving a good deal of advice to the Ministry of Health
in trying to get them to hire more physicians, more nurses in
particular. But mostly it was economic opportunity that
attracted doctors. There was money to be made, and that s why
these people flocked into take advantage of it. It was the
arrival of all these expatriates in particular: a large number
of Palestinians, Indians, and others who came there had been
accustomed to good health care.
Hicke: You were talking about the supply; now you re talking about the
demand side.
Handschin: So the demand side was there. And these people had money and
they could pay for the care; many of them had wives and
children, and they did pay for that care.
Crucial Leadership of Dr. Richard Daggy
Handschin: One thing I want to talk about is something about the
leadership by Dick Daggy, first as chief of Preventive Medicine
and then as medical director. He s the guy who recruited me as
an epidemiologist. He assisted in the recruitment of
industrial hygienist, maternal and child health physician, and
the nurse consultant. I actually recruited the occupational
health physician. He established the first disease reporting
system. It wasn t perfect. He did a lot of special studies of
particular disease.
He was the person who instituted malarial control. He is
the author of the definitive study of malaria in oases, a
published document. There were many springs in the oases,
from some of which water then flowed down canals. He
introduced a particular kind of fish that would eat the
Anopheles mosquitoes larvae as a malaria control mechanism.
He turned that malaria control pretty well over to the
151
government by "54. I think he was hired in
he did an enormous job of malaria control.
48. In six years,
He s the one who devised the idea that all these
preventive medicine people that he was bringing in should be
staff advisors to line operators. They should do the studying,
the planning; they should help expedite; they should evaluate;
but they should not directly operate most of the preventive
programs that were related to clinical care. Instead, the
curative doctors and nurses were made responsible for the
preventive programs in their own clinics, and they had to be
given in-service training that people had recognized as
necessary for preventive aspects. And not all clinicians
really relished this new role.
Hicke: Yes. And this was all devised by Dick Daggy?
Handschin: It is a tribute to Daggy.
During 61 to 66 there was increasing recognition that
one clinic should serve to provide both the preventive and the
curative care. In one sitenot a separate site. And then to
make every clinic visit an opportunity to review what
preventive means there might be, and how to address themand
how to dispense a pound of prevention with a pound of cure. So
there was widespread recognition that this was the way to go.
Daggy s concept was resisted by a certain segment of people who
were in curative medicine at the time. But ultimately the
people who started seeing it pay off fell in and found out
"Hey, this makes sense." That, I think, was his creation; all
I did was fit into the traces when he fell out and try to jog
along the same sort of way.
There was really a very heavy emphasis upon primary
prevention: preventing from occurring if possible. Then the
second step: early diagnosis. If it has occurred, let s find
it and do something about it, actually to treat it, and if at
all possible, in an outpatient settingwhere the patient is
still standing. We provided 450,00 clinic visits a year; 50
percent of our medical care costs were outpatient care. We
attempted to provide those outpatient physicians not only
suitable time to see the patients, but suitable supporting
personnel, the lab, an x-ray, the requirements that they
needed.
Principally this kind of care was under the direction of
general practitioners, but we provided suitable speciality care
to try and keep people out of a hospital. Because hospitalized
patients, in addition to their medical care had all the expense
152
of room and board: the equivalent of being in a first-class
hotel, the expense part. So it was an emphasis also in Aramco
--and this again came from Daggy--on using the lowest level of
skill which can competently do the job. And if that lower
level of skill is inadequate, we give them specialized training
or on-the-job training to upgrade it to a particular level that
we were comfortable with. Forty percent of outpatient visits
were attended solely by an appropriately trained nurse. Forty
percent. Nurses outnumbered doctors in the clinic four or five
to one, and they provided 75 percent of the care, mostly under
M.D. or under nursing supervision. So an enormous amount of
care was being done by nurses.
Hicke: Weren t you ahead of this trend in that?
Handschin: Oh, much, much more so. Way ahead. Ahead of what we were
doing in the United States too. And again, these are Daggy s
ideas that I believed in, and others did too. But he was the
leading proponent and he was the guy who sold it to management.
Management liked it too, because an estimated 20 to 30 percent
of our care was preventive care that was being delivered by
these nurses. Nurses were closer socioeconomically to the
patient than the physicians were. They could relate better to
the patients. And most particularly the nurses that we were
hiring cost from one-fifth to one-tenth what physicians cost.
Now how did the GPs interact in these large clinics that
were working with the dependent? GPs worked two days a week in
a screening modality in which they were working with several
nurses at their elbows. They quickly screened patients, and
determined what should be done for them that day--to whom they
should be referred. They would see maybe a hundred patients in
eight hours doing that. But they had only to say, "Nurse, do
this for this patient." And many of those patients got
referred to another doctor that day, immediately sometimes.
This was triage; this was sorting to determine what are
the skills that we have that should be applied to this
particular case, and then the doctor and the nurse jointly
making that decision. So that was a screening program. It
wasn t much fun, and some guys disliked it. They would spend
one to four minutes, maybe, with a patient, and then get them
into the hands of a nurse who was going to do something for the
patient. But then the other three days of the week, the
general practitioner went back to being an attending physician.
He then would see maybe fifteen patients, maybe twenty, but
fifteen commonly, and give them a more complete workup. For
every ten general practitioners working in a clinic, we had a
senior physician who just floated around and helped. He was a
153
Hicke:
Handschin:
clinical leader, chosen because of his capability, assistance
in diagnosing, assistance in handling and treatment, and so
forth. He was in charge of the clinic, but his job was
principally to serve as a consultant to these other people. He
himself might see a few patients that daythe more complicated
ones. But in the main, that s his focus. Again the idea being
using the lowest level of skill that can competently do the
job.
In fact, those clinics in the main handled about 98
percent of the outpatient care of dependents. Only about 2
percent at most ever were referred to specialists for
outpatient care, although we had about twenty specialists
available that we could send them to. So it was that the
general practitioner became a specialist in common diseases and
af f lictions--in their prevention, and in their treatment. They
really knew about a variety of things that they were seeing
most commonly.
The Preventive Medicine staff became responsible for
developing overall objectives and methods in disease prevention
and control. We developed manuals for tuberculosis control:
they gave some guidance as to what specific therapies were to
be used, what specific screening programs were to go on, how
you followed up on all contacts, how you got people to come
back in when they were supposed to come back in at certain
intervals, and how you related to the supervisors of these
employees. All this was spelled out in considerable detail.
And we had that not only for tuberculosis control, we had
manuals for maternal and child health programs too, so that
there was agreement between the clinic and the information that
we were providing to employees through our health education
program.
Aramco had a series of schools industrial training
schools. Remember, when we first started operating there, 98
percent of these people had not even attended an elementary
school. There was illiteracy. We began a big literacy
program. We ended up training many, many people to read and to
write. In that process, we put health education into that; so
we did that too. As long as you were learning to read, you
could learn to read about diseases or conditions of the
country, in the home and the village.
Did you write these manuals? Or your staff?
The staff. I assisted in critiquing many of them. We had
similar manuals, for instance, for hearing conservation, and we
had to have certain standardized approaches for immunization:
154
Hicke:
what immunizations should be provided; when they should be
provided. Not left to the judgment of the individual
physicians. He could countermand it if he had reason to.
Also, how do you teach cleanliness, which was an important
thing to do? How do you teach infant feeding? How do you
teach care of skin? and so forth.
All of these were things that the Preventive Medicine
staff spent time developing: working with the clinicians,
getting their ideas; finding out what was feasible and what
wasn t feasible; what would have been desirable but couldn t be
achieved because it was too boring or it was too demanding; and
so forth.
Amazing.
More Data on Patient Care
Handschin: I ve got some other things that I ve looked up.
Hicke: Good.
Handschin: In 1957, 40 percent of dependent infants who were hospitalized
in Aramco facilities died within twenty-four hours. Sixty
percent died before they were discharged. That was in 1957.
In 1967, ten years later, less than 10 percent died. This came
about by getting people in earlier, recognizing problems and
dealing with them on an outpatient basis. Between 1962 and
1967, we saw the deaths among dependent children due to
pneumonia, diarrhea, and malnutrition decreased by two thirds
in a five-year period of time. Deaths among children decreased
by two thirds.
Hicke: That s amazing.
Handschin: I don t think we introduced any marvelous new medications or
any great new procedures.
Hicke: No new drug discovery?
Handschin: It was better information on feeding, on earlier seeking of
care, telling people whom to seek out, and then finding out
more effective outpatient care.
Hicke: Can I just interrupt to ask you: did you feel this happening?
155
Handschin: Oh, definitely so.
Hicke: You could see it happening? It must have been very exciting.
Handschin: Yes, yes. That s what finally turned some people around who at
first thumbed their nose at this idea. When they began to see
the results, they would buy in. For instance, the big change
in tetanus: I don t remember the fifties, but the frequency in
which we were seeing tetanus in the newborn was just dropping.
It could be attributed to a program we developed.
Hicke: Very rewarding, it must have been.
Handschin: It was.
Between 1961 and 1965, the clinic visits per hundred
wives or children went up 24 percent; and that s within a six-
year period. But hospital days per hundred outpatient visits
went down by 24 percent. In other words, the most expensive
and often the most futile type of care--hospital care--was
significantly reduced; so that in a sense we began to look upon
hospitalization as a failure of medical care. People shouldn t
be hospitalized. They were hospitalized because they didn t
receive suitable medical care, including preventive care,
before then. They didn t have the proper information in order
to be able to do the sort of things they were told to do. And
that idea gained weight even in this country. It s just
recently that you find that hospitals now, instead of being
considered sort of the quintessence of care, there s now been a
great recognition in this country that many of these things
should not be done in the hospital; they should be done on
outpatients, or patients not even admitted to the hospital but
brought in as outpatients only.
Hicke: You were pioneering a philosophy of medicine, in a sense.
Handschin: Yes, yes, we were.
Hicke: That s really fascinating.
Handschin: In 1966 Aramco treated 300 cases of malaria, and only a few of
those were our own people. Most of those were general public.
Compared with 30,000 twenty years before. See, another example
of how things changed.
In 1952 there were fifteen non-Aramco hospital beds. By
1967, which was fifteen years later, there were six private
hospitals with 350 beds. In fifteen years, it s gone from
fifteen beds to three hundred and fifty. Two hundred and fifty
156
of those beds were in two hospitals that Aramco supported by
providing most of the inpatient load. But we also aided
government in addition to these private hospitals, and they had
680 beds in maybe eight government hospitals. You add all
those up and you came to 3.3 beds per thousand population
achieved by 1967. That compared to about five beds per
thousand in the U.S. at the time.
Need for Nursing Staff
Handschin: The major problems in the government hospitals at that time
were a critical shortage of nurses and of able administrators.
Often the administration was left in the hands of doctors, and
doctors aren t necessarily good administrators.
Hicke: I think Bill Taylor told me that Aramco had the first health
administrators in the Middle East.
Handschin: Yes. The biggest criticism that I could make of non-Aramco
care was the shortage of nurses. What that country really
needed was nurses--not doctorsmore than anything else.
Hicke: But there was a resistance, I think, to training women as
nurses .
Handschin: Oh yes, big resistance, yes. Probably in the long run the most
significant long term health event in the country was the
establishment of schools for girls in 1960. By 1967, seven
years later, there were already 25,000 girls enrolled. Before
that, nothing, nothing. Generally speaking, about 75 percent
of medical care in the U.S. is delivered by women- -nurses,
doctors, and so forthbetween 70 and 75 percent. Now even 50
percent of physicians, the younger graduates, are female.
So literate mothers, ultimately, are really a key to
having good health- -mothers who establish the family living
patterns and mold those--"Wash your hands before you come to
the table"--all these principles of good health and disease
control. This evolves from parent education, particularly of
the women who are the guardians of the next generation and
establish what s going to happen. That had not happened by the
time I left. These were kids in grade school,
course later, there must be higher education.
And then of
157
VI OVERVIEW: GOALS AND ACCOMPLISHMENTS
Handschin: I m going back down to one last thing on your outline. I m
going to spend a little bit of time talking about my own
experience as medical director and some of my reactions to
that, with my objectives and accomplishments.
One major objective I had was that you try to create and
then maintain a climate within the department that would be
conducive to delivering both suitable care effectively and
efficiently by a variety of professionals who themselves did
most of the planning and who themselves delivered most of those
services, who in large measure, by the kind of professional
training they had, were accustomed to self-policing of
reviewing quality of care, of being aware of other instances of
poor care that they might encounter.
In some respects, little of my time was needed to
maintain this aspect. It was mainly keeping people congenial,
making certain they were following up on quality control,
making certain they were aware that there were limits to
wasteful use of certain services, and also there was waste when
you failed to use other kinds of services that would be
beneficial. In the main, this was a professional organization
in which the professionals were running it. It wasn t quite as
bad as whatwho was it?--Hutchins, president at one time of
[University of] Chicago, who said something about: "A
university is a group of professional educators, all of whom
have only in common a public utility system."
We had a lot of interaction, but mainly these people
provided many of the ideas. I did spend a lot of time on that.
I had a lot of difficulty and a lot of time consumed in finding
people who were interested in change within that group- -who
were motivatedand finding those professionals who were
willing to undertake some kind of creative administrative
158
change that would be needed to increase efficiency or
effectiveness .
At best, I think that where I was most successful was in
identifying some of the more accomplished professionals and
helping them do their kind of job better- -people who were doing
an excellent job- -help them do even better and help them
because they were doing things that we wanted other people to
do. So help them propagate their ideas, abet them, and assist
them. In other words, I was getting the good people who were
already doing good things to help others do the same thing
better. A major portion of my time was really in assisting
good people to do things better than they had been. I had
ideas that there ought to be change, and these people were
suggesting there were changes; so I was seeking allies who
agreed with that and then working with them.
Hicke: It sounds like politics.
Handschin: It was. And I wasn t always, by any means, successful.
The second major objective I had was, of necessity in an
industrial organization, to transmit and to explain company
management s objectives, the company s interest, and the
company s policies. To transmit this I went to communication
meetings at least twice a week with top management, in which I
was exposed to things that should be transmitted downward.
This I did quite faithfully to maybe eight or ten division
heads that I had at the time. And I thought we did a good job
of that, a good first step. But I was often dismayed at the
trickle. The flow stopped at a trickle. And I admitted to
management that I was having trouble devising ways to enhance
its percolation in greater amounts downward.
I found that the Medical Department was not unique in
this; they were having problems like that throughout the
organizationof getting the information spread. There were a
variety of programs. They brought in a program called the
Managerial Grid. In fact, I participated in it. It was run by
some psychologists out of Texas, who had a very good program of
getting people to open up and learn how to recognize the skills
of the people they were working with, how to become team
members. Very effective program, although it was frustrating
to me. It wasn t much help to find out that other people were
having the same problem. Important things were not getting to
the proper people always.
Hicke: Do you have an example of something like that?
159
Handschin:
Hicke:
Handschin:
Hicke:
Handschin:
Not readily. [pauses] The company often had tosometimes
with advice from the government --make some decisions that were
not popular. And to be able to share those decisions explain
them, and explain the rationale for making them was one of the
duties I was expected to perform. I tried to do it. I enjoyed
doing it. Occasionally, we had meetings in which I would
address fifty or sixty top people. But mostly I dealt with
someplace between eight and twelve people. It was kind of
disconcerting to find that not everybody was quite that
interested in doing this. It was an annoyance, and something I
hadn t bargained for.
And maybe one final objective that I had was almost the
opposite, and that was to transmit to management and to others
in the company some things about the needs of the medical
department: the capabilities, the problems the medical
department was having, sometimes the successes and failures of
the medical department, the people within the department, and
the programs. I found this to be one of the most enjoyable
things I had to do.
It sounds as if you increased communications.
Yes. I felt it was useful. It made me feel highly creative.
I ve always spent a lot of time trying to be able to articulate
to people in a way they would understand why we were doing some
of the things we were doing in the medical department,
particularly each year.
You had a lot of successes to report,
things about doing that.
That s one of the nice
We did, we did. I was willing to really strive towards some of
these. I was willing to do that, because not all clinical
people would really like to spend a lot of time digging out the
data on how we are controlling costs, for example, which was
often an incessant question that came from management. How
efficiently were we operating? Or why we were failing to be
effective in training Saudi nurses? I wanted to lead a
creative team, and I was really strongly motivated to do that;
but I didn t think I was as effective in leading a team as I
would have liked to have been.
I left Aramco because I had a son who was mildly
retarded, born in Saudi Arabia. By the time he moved out of
kindergarten and the first grade, he was obviously uneducable
in that particular setting. He was not at an age where we
could board him, so we moved back here at that time. That was
a big disappointment, because I had all kinds of aspirations.
160
We had a group from Booze, Allen, Hamilton consultants out. I
had a lot of aspirations to become a more successful person, to
develop better leadership skills; and I never exercised them to
the extent I hoped for. But I had a lot of fun.
I learned a lot of things; I saw a lot of things. And
surprisingly, some of the things I d left there, I came here to
do, and started work here in a large cooperative that was
caring for about 100,000 people. I started beating the drum
for nurse midwives. Oh God! Our obstetricians here went up in
smoke. What? Ultimately, it was our consumers who demanded
more nurse midwives, and they got them.
Hicke: So you did some pioneering here as well.
Handschin: I did some things that they wouldn t believe in until I cited
some data. And then interestingly, I used some of that data
that I was acquiring here working with Group Health of Puget
Sound, which was a leader many times in using physician
assistants, as they were being trained. I used a lot of this
data when I then went back with Roger Nichols as a consultant
to the Ministry of Health.
Hicke: Oh, were you part of that corporation?
Handschin: Yes, that s right. I provided a lot of information to Roger:
staffing, and so forth. There was a melding of what I had
learned in Saudi Arabia with what I was learning from Group
Health here. So there was some continuation. But I m just
amazed at how--if I hadn t had some notes from speeches I had
to give there were vast areas of what we were doing out there
which my unprompted memory would not have brought back.
Hicke: I really appreciate your doing the research and bringing the
notes. You ve got it all organized so beautifully. But also,
you ve told me so much that I haven t heard anywhere, which is
surprising because I ve talked to a lot of people.
Handschin: If Dick Daggy were in his old health, I don t think anybody
could talk more. He had an enormous fund of knowledge that he
acquired, well thought-out. He had winnowed and sifted to find
out what were the essential things. He was the architect of
that system that I felt was kind of unique. We at least spent
some time interacting with other oil companies and their
programs . We were asked to come and talk about what we were
doing with Kuwait Oil, which I think of immediately, and with
the oil company in Bahrain. We spent a lesser amount of time
with the Iranians, although we attended clinical meetings of
the so-called Persian Gulf Medical Association, which was
161
Hicke:
Handschin:
Hicke:
principally people in the countries surrounding the Persian
Gulf who were affiliated with oil companiesmostly physicians,
though some weren t. There had never been any missionaries
operating in Saudi Arabia; there hadn t been missionaries in
Bahrain and the principalities along the Persian Gulf. But
there had been no other Western practitioners of medicine,
really. The first Saudi who graduated from medical school was
in 1948. And shortly thereafter, there were about five or six.
Unfortunately, most of those people had entered medical school
directly out of high school.
And they were weak in math and science. Most of them
didn t stay in the practice of medicine for long. That was the
early history in the fifties. There were some outstanding
Saudi physicians, including one that we helped to get a
master s degree in public health at Harvard.
Who was that?
Dr. Zowawei. Omar Zowawei. He had a charming wife. We
entertained them and they entertained us openly several times.
That s a good note to stop on and I really appreciate, as I
said, all you ve done. Thanks for a big contribution.
Transcriber: Lisa M. Vasquez
Final Typist: Caroline Sears
162
Regional Oral History Office University of California
The Bancroft Library Berkeley, California
Aramco Medical Department Oral History Project
Julius W. Taylor
SURGEON AND MEDICAL DIRECTOR: 1954-1978
An Interview Conducted by
Carole Hicke
in 1996
Copyright O 1998 by The Regents of the University of California
Since 1954 the Regional Oral History Office has been interviewing leading
participants in or well-placed witnesses to major events in the development of
Northern California, the West, and the Nation. Oral history is a method of
collecting historical information through tape-recorded interviews between a
narrator with firsthand knowledge of historically significant events and a well-
informed interviewer, with the goal of preserving substantive additions to the
historical record. The tape recording is transcribed, lightly edited for
continuity and clarity, and reviewed by the interviewee. The corrected
manuscript is indexed, bound with photographs and illustrative materials, and
placed in The Bancroft Library at the University of California, Berkeley, and in
other research collections for scholarly use. Because it is primary material,
oral history is not intended to present the final, verified, or complete
narrative of events. It is a spoken account, offered by the interviewee in
response to questioning, and as such it is reflective, partisan, deeply involved,
and irreplaceable.
************************************
All uses of this manuscript are covered by a legal agreement between
The Regents of the University of California and Julius W. Taylor
dated April 18, 1996. The manuscript is thereby made available for
research purposes. All literary rights in the manuscript, including
the right to publish, are reserved to The Bancroft Library of the
University of California, Berkeley. No part of the manuscript may
be quoted for publication without the written permission of the
Director of The Bancroft Library of the University of California,
Berkeley.
Requests for permission to quote for publication should be addressed
to the Regional Oral History Office, 486 Library, University of
California, Berkeley 94720, and should include identification of the
specific passages to be quoted, anticipated use of the passages, and
identification of the user. The legal agreement with Julius W.
Taylor requires that he be notified of the request and allowed
thirty days in which to respond.
It is recommended that this oral history be cited as follows:
Interview with Julius W. Taylor, an oral
history conducted in 1996 by Carole Hicke
in "Health and Disease in Saudi Arabia:
The Aramco Experience, 1940s- 1990s, "
Regional Oral History Office, The Bancroft
Library, University of California,
Berkeley, 1998.
Copy no.
Julius W. Taylor, July 1998.
163
TABLE OF CONTENTS- -Julius W. Taylor, M.D.
INTRODUCTION by A. P. Gelpi 164
INTERVIEW HISTORY 165
BIOGRAPHICAL INFORMATION 166
I BACKGROUND, EDUCATION, MILITARY SERVICE 167
II JOINING ARAMCO 170
Interview and Appointment 170
Moving to Dhahran, December 1954 171
III DHAHRAN HEALTH CENTER 174
History 174
Patients and Cases 175
Concession Agreement 175
OB/GYN; Burns 177
Dental Service 177
Trauma 178
Staff Personnel 179
Smallpox 180
Medical Care Responsibilities: Dependents 182
Facilities and Living in Dhahran 183
The New Hospital 186
Developing Psychiatric Care 187
Accreditation 189
Medical Training 194
IV CAREER DEVELOPMENT AND RESPONSIBILITIES 196
Chief Surgeon, 1961-1963: Hiring Staff and
Relationships with Management 196
First Open-Heart Surgery at Aramco 201
First Lung Removal 201
Evacuation Procedures 202
Contract HospitalsAnother Change 203
Attractions of Life with Aramco 204
Chief of Staff, Clinical Services, 1963-1968 210
Dental Care 210
Administrative Matters 212
Medical Director, 1968-1978 212
More on Contract Hospitals 215
Medical Care for the King and Royal Family 218
Early Saudi Medical Practices 221
Preventive Medicine and Research 224
Tapline Stations 228
Recruiting and Hiring Staff 229
Impact of Increasing Saudi Ownership Participtation 232
Emergency Preparedness 235
A Riot in Dhahran 237
V OVERVIEW 240
164
INTRODUCTION--Julius W. Taylor, M.D.
Dr. Taylor came to Dhahran, Saudi Arabia, in 1954, fresh out of a
surgical residency training program at Kingsbridge VA hospital in New
York. In Aramco s Medical Department he served as a general surgeon,
then successively as chief of Surgical Services, chief of Clinical
Services, and finally, as medical director. Not only is Dr. Taylor a
talented surgeon, but he demonstrated, early on, a gift for organization
and leadership, most effectively demonstrated during his years as
medical director. But Taylor lost neither his interest in surgery nor
his surgical touch as he moved up through administrative ranks. Among
his other accomplishments, he published the first paper on the
epidemiology of cancer in Saudi Arabia.
Bill and his wife, Lois, were very active in Dhahran community
affairs, in tennis, and in gracious entertaining. They finally left
Aramco in 1978, settling in New England, where Bill ultimately took on
leadership of Boston University s Student Health Service as its medical
director.
Armand P. Gelpi, M.D.
December 9, 1997
Sonoma, California
165
INTERVIEW HISTORY--Julius W. Taylor, M.D.
Dr. Julius W. [Bill] Taylor was with Aramco from 1954 to 1978,
serving as assistant chief surgeon, chief surgeon, chief of staff,
Clinical Services, and for his last ten years, as medical director. His
recollections thus cover twenty-four years at Dhahran Health Center-
years that were crucial in the growth of health care in Saudi Arabia and
in preventive medicine and other public health programs fostered by the
company .
Taylor s recollections cover a broad area concerning the Aramco
medical department. He discusses patients and diseases, research
undertaken, medical response to trauma, hospital administration and
accreditation, outreach efforts, contract hospitals, and life as the
Aramcons lived and enjoyed it in Saudi Arabia. Reporting to oil company
management presented an unusual situation for a surgeon and hospital
directorand that was only one of the many unique aspects of Taylor s
career. The anecdotes he recalls illustrate the interest of life in
Dhahran and demonstrate his enthusiasm for his work. He proved to be a
fascinating story-teller and an informative narrator.
Taylor was interviewed on April 18, 1996 in his office at Boston
University Student Health Services where he has been director since
1988. The transcript was lightly edited by the interviewer, then
reviewed carefully by Taylor. He made many corrections which helped
clarify and explain the information, and added useful and enlightening
comments .
Carole Hicke
Project Director
January 1997
Regional Oral History Office
University of California, Berkeley
166
Regional Oral History Office
Room 486 The Bancroft Library
University of California
Berkeley, California 94720
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167
I BACKGROUND, EDUCATION, MILITARY SERVICE
[Date of Interview: April 18, 1996] II 1
Hicke: Let me start by asking you when and where you were born.
Taylor: I was born in Holtville, California.
Hicke: What was the date, please?
Taylor: 12/12/22.
Hicke: And did you grow up there?
Taylor: I grew up there for eight years. My father was a truck fanner, so
we ran a little farm down there in southern California. I was
there for eight years; he was there for a little longer. After
that, we moved back to Kentucky, where my family was originally
from. We re from Kentucky, basically.
Hicke: Where in Kentucky did you live?
Taylor: We moved to Louisville.
Hicke: Now, let me ask you how you got interested in becoming a doctor.
Taylor: That s very simple. My mother was what we would now call a
medical assistant. She worked in a doctor s office in Holtville
and Louisville. There was a doctor that she worked with for
several years. And so as a result of that, she was convinced that
my brother or I should become a doctor. As long as I could
remember, she was saying that: "When you grow up, you should be a
doctor." When I was little, that didn t mean much to me; but
later on, people would say, "Well, you re going to be a doctor?"
This symbol (##) indicates that a tape or a segment of a tape has
begun or ended. A guide to the tapes follows the transcript.
168
and that s how it happened. So I just took the doctor s track and
stayed on it. It was my mother s strong influence that resulted
in that.
Hicke: How did you pick your university and medical school?
Taylor: It was interesting because when I was in pre-med and the--
Hicke: Where was that?
Taylor: I went to DePauw [University] initially, but I had to leave there
because my father got sick. As I finished up pre-med at the
University of Louisville, World War II broke out; we were just
automatically enlisted and designated to go to the University of
Louisville. They called it ASTP, which is the Army Specialized
Training Programalso quaintly known as "all safe till peace"
unit.
Under that program, medical school was sped up then: you only
went three years, as there was no summer vacation; you just went
right around the year. I think you had a couple days for
Christmas and the holidays, and that was it. We got through
medical school in three years instead of four. I graduated from
the University of Louisville Medical School in 1946.
Hicke: Did you have to go overseas?
Taylor: I had an internship in New York, and in that little interim there
somewhere, the war in Europe ended. So while I was in the
internship, I was still retained in the active reserve, which
meant that I was still at their beck and call. When we finished
the internship in 1947, I went into the military on active duty
for two years.
Hicke: Where were you?
Taylor: First, I was in San Antonio, Texas. Then I was transferred to
Belleview, Illinois, which was Scott Air Force Base, completing
two years of active duty.
Hicke: Were you in the air force?
Taylor: At Scott Air Force Base, I was in the air force. As a matter of
fact, the air force used to be part of the army. And then they
split, so the air force became an independent arm of the military;
so I transferred into the air force. I was in the air force for
the last year of my active duty.
Hicke: And what did you do when you got out of there?
169
Taylor: I went into a surgical residency then, back in New York at the
Kingsbridge Veterans Hospital. I spent four years there, from
1950 to 1954.
170
II JOINING ARAMCO
Interview and Appointment
Hicke: Now, how did you happen onto Aramco?
Taylor: An interesting thing happened: a predecessor of mine at the
Kingsbridge Veterans Hospital, a fellow named Dr. Johnson, had
gone over to Aramco and done one tour, and was coming back.
Hicke: What was his first name?
Taylor: I don t remember.
Hicke: He must have been there very early.
Taylor: He had a tour of surgery there for two years. He came back, just
passing throughhe was on his way to Philadelphiasinging the
praises of Aramco, what a wonderful time he had, and how much
exciting surgery he did, what an exciting adventure it was, and so
forth, so on. After I talked to him, I decided I really wanted to
do this. He said, "Well, my job is open." He called up Aramco
at that time, one of the bases was in New York and I talked to a
doctor named Ted Allen, who was the medical director in the
States. We talked, and subsequently I was employed for that job.
That s how that happened.
The residency was hard work; I d been there four years. I
thought, "Well, I m going to do this. It s going to be fun." And
I d gotten married just at the time my residency started, so we
were going to take a little world trip and have some fun after
that, and just enjoy ourselves, at least for one two-year
contract. So that s how it started.
Hicke: And you figured on two years?
Taylor: Two years. At most. [laughter] That didn t work out that way.
171
Moving to Dhahran, December 1954
Hicke: Tell me what your impressions were of Dhahran and the health
center when you got there. This was 55 that you moved there?
Taylor: No, "54. 1 was supposed to finish my residency through December.
Aramco said, "Oh, no. We need you badly. We ve lost a surgeon.
And we have to have you right away." In fact, they became very
adamant about it: "You must go now." So I actually left the
States on December 11. I left my training programthe people
running it at the hospital were unhappy because they had to cover
me for that. And that was not easy, since that included
Christmas, and people wanted off for Christmas. But I ll never
forget the New York office; Ted Allen, in particular, said
something like, "Either go now, or you re not going to get the
job." So I finally got everything together, climbed aboard the
Flying Camel, one of Aramco s transcontinental airliners, and
began what turned out to be a lifetime overseas adventure.
When I got there, I was appalled when I found out they didn t
know I was coming. I thought, "This place isn t as well organized
as I thought." Because I m standing in the airport building
which, at that time, was a World War II quonset hut. It was wide
open; it was noisy; there was nothing. And when you first went
in, you thought, "This must not be it." [laughter]
Hicke: Wrong place.
Taylor: So I was just kind of standing around, and I remember a woman,
whose name was Johnnie Rusher, came up and said, "Are you our new
employee?" I said, "Yes." She said, "What s your name?" I told
her. She said, "Well, you re not on my new arrivals list."
"Well, by chance," she says, "The chief surgeon is a fellow named
Lonas, Hal Lonas. Hal happens to be here meeting his children who
are coming home for Christmas." So she took me over and
introduced me to Hal Lonas; and he said, "What are you doing here
now? I said, "Well, Ted Allen told me the surgery cases were
backed up and I was needed desperately." He said, "Well, we re
very slack now. We re slow. It s Christmastime. I can t imagine
you came here and missed Christmas at home." And I said, "I can t
imagine it either." [laughter]
Hicke: So you would say there was maybe a lack of communication--
Taylor: Definitely.
Hicke: --between New York and Dhahran?
172
Taylor: Well, Lonas, who was my chief, mentioned that he knew they were
interviewing me. But he said, "I haven t gotten any information
that you were hired or that you were coming." In those days,
communications were obviously not as quick and accurate as they
are today. So there was frequently a lapse in the communication,
Sometimes this was funny; sometimes not so amusing.
Hicke: Are we talking about technological lapse or a lapse in a--?
Taylor: Technological, because mail in those days, even air mail, special
delivery, whatever you did, would take two or three weeks to get
from New York to the field.
Hicke: There was no telex?
Taylor: Yes, but only for important messages. Even telephoning was very
difficult. It wasn t until the seventies that you could finally
pick up a phone and call the States. And even today, if you pick
up a phone and try to call Aramco, you ll run into a little
trouble, but not like those days. Sometimes the message simply
did not get through. The next time I saw Ted Allen, I said, "What
was all that about?" He said, "Well, I had to get you out there,
and I wanted to get that done." I told him, "They didn t happen
to know I was coming." And he said, "Well, they should have."
In those days, your wife couldn t go with you when you went.
Aramco had learned that when husbands and wives came together, all
too often they said, My god, what have we done? And they would up
and leave, and for good cause. In those days, it could be rugged
going; it was a far cry from Stateside living conditions. So
wives would come, and after a short time, they would say, "This is
crazy. I m leaving." So Aramco decided that the best way was to
bring in the employee, let him get settled, and then bring out the
wife at least into more reasonable circumstances.
It s hard to describe the emotional reaction, because it was
departure from a Stateside routine into a strikingly different
existence in Saudi Arabia. A far cry from the U.S., Europe, or
even the Orient. It was simply too much for many new arrivals,
and they would turn around and go home. This expatriate life
demanded rugged people, both in body and soul.
Later on, as I went along, I met a newly hired woman doctor.
She too was welcomed at the little quonset hut. She walked down
the steps, and I was there to meet her. She looked around and she
said, "This is it?" I said, "Well, this is the airport." She
said, "You re kidding." She went over to the counter, and she
said, "Don t even put my bags through." She never left the
173
airport. She got back on the same plane and took off for India.
That was our shortest hire of all time!
Hicke: You wonder what she was expecting.
Taylor: It was a hot day. When you walked down those metal steps, your
feet would burn. When she stepped out, it was probably 110
degrees F--and it was very hot. Between that, a little sandstorm,
this hut, and the customs people one had to go through, it was too
much for her. And in retrospect, she probably did the right
thing, when she quickly decided it wasn t for her.
So when you got out there, you have this delay with your wife
coming. Aramco finally shortened it to six months. When your
wife arrived, you had to caretake houses, because you couldn t get
your permanent assignment. We moved six times before we got into
our house. That gets to be a drag when you keep moving around.
You might get a good house, you might get a lousy place, you know.
So that was an indoctrination in itself. In fact, I ve always
wondered if my wife stayed because of the adventure and travel or
because of the challenge. She s a New Englander, and she liked
the New England area, and this is just about as far away from that
as you can get. Anyway much to my surprise, she stayed and
stayed.
174
III DHAHRAN HEALTH CENTER
History
Hicke:
Taylor:
Hicke:
Taylor:
Tell me about the Dhahran Health Center,
when you got there?
What was going on there
Well, the health center was in a state of early development and in
the early stages of providing comprehensive care.
Can you tell me about Dr. T.C. Alexander?
Dr. T.C. Alexander was the pioneer doctor of Aramco medicine. He
was the first doctor. When he started, he had a nurse and a first
aid station in a little building. He continued on several years
after I arrived. As I heard it, he was with the American oil
group. In fact, he was sort of a legend, because he was
originally in Bahrain, and when oil was brought in at a wildcat
drilling site in Dammam, he came to Dammam and set up a medical
station. Dr. Alexander was legendary and people came from far and
wide to see him. After it was established that there really was
major oil in the area, he moved to the Dhahran compound. They had
this very small, almost like a first aid station. He was a well-
trained general practitioner, so he did a lot of things: he did
surgery--f ixed hernias, did appendectomies under spinal or local,
which was pretty rugged stuff. In those days, there was a good
British hospital in Bahrain run by Dr. Snow. It was my
understanding--! wasn t there then, obviouslyif anybody got too
sick for Dr. Alexander to manage, they d take them over to Bahrain
and treat them over there.
They went from a tent, actually, as I understand it, into
this little building. Around that building they built their first
small hospital. It was rustic; it was like World War II. You
have to remember this is right after World War II, and a lot of
these people that were there were veterans of World War II. Hal
Lonas was a commander in the navy as a surgeon. He was the chief
175
surgeon, and there was a chief of medicine, a fellow named Curtis,
and several others. Dr. Robert Page, at that time, was the
medical director. When I arrived there was a Dutch surgeon, Peter
Van Dooren, an Indian surgeon, and an Arab surgeon, Dr. Fyak Abdi,
who later became chief surgeon.
The thing about the hospital which remained true throughout
was that the hospital care evolved slowly but surely along the
lines of current American medical care. There was never a clear-
cut policy as to who decided what level of medical work would be
done. So the medical work that was done there was like in a field
hospital in the military. We operated, and we did all kinds of
traumatic work as well as medical work. Today you d say that was
primitive, but in those days, it was consistent with a good
military hospital.
We had all the modern drugs we needed. We had good operating
rooms and good supporting services. Good x-ray and lab
facilities. In general, the hospital worked at that level, which
was quite good. Excellent records were kept on all patients, both
inpatients and outpatients. The people there were well trained:
most of the top professionals were board certified. Dr. Lonas was
a board-certified surgeon. Dr. Robert Page, as a matter of fact,
was a board-certified internist. Fred Howard, M.D. was chief of
Pediatrics. Dr. Curtis was chief of Medicine. There were two
G.P.s who headed up the OB-Gyn section: Dr. Robert Brown and Dr.
Ivor Morganin fact Dr. Brown delivered my son, Scott, in 1955,
Dr. Morgan my daughter, Sandra, in 1958.
Patients and Cases
Concession Agreement
Hicke: Who were the patients, besides Aramco employees?
Taylor: The patients were the same from the beginning. Gelpi was looking
for the original medical agreement with the government. I read it
once in some book.
Hicke: Oh you did? I ve inquired myself, and was told that nothing was
written down.
Taylor: I m just recalling this from long ago. It was a one-sentence
agreement; and it said in the concession agreement that "Aramco
176
would provide medical services to all employees and their
dependents in that area." That s all it said.
Hicke: They put it in the original concession?
Taylor: That was in the original concession. You ve got to remember, when
that concession was written, in 1936, there were only about fifty
Americans there, and very few Arab employees. There were very few
dependents at that time. This was a pretty barren area in those
days. Most of the Arab employees migrated there. They didn t
start there, so their families were not around. I think I read
somewhere the original total responsibility was something like 300
people. There were about fifty Aramco guys; the nurse was there;
very few women, two or three women as employees; and originally,
there were maybe only sixty-seventy Arab employees. Because at
first, they were just exploring, and the first well, Dammam No. 7,
was a small producer. So that original concession agreement was
very simple. Nobody ever anticipated at that time what the
medical program would eventually amount to. In 1968 there was a
direct medical responsibility for 40,000 employees and 160,000
dependents and an indirect responsibility for major illnesses of
the 2 million people in Eastern Saudi Arabia. The president told
me one day, "We do more medical business here than we do oil
business!" [laughter]
Hicke: Who was the president?
Taylor: Well, there were several presidents during my twenty-five years.
[Added later] There was one thing they had in common: The Aramco
medical repsonsibility was low on their list of concerns. From my
viewpoint an Aramco president wanted good, middle-of-the-road
medical care. This meant we should be able to manage all run-of-
the-mill medical problems as well as a small-town hospital in the
States. I agreed with this level of care. What we did we did
well, but we were not a Mayo Clinicthis meant that everyone
dependent on us ran a certain medical risk by working in Saudi
Arabia. We did not have surgical or medical specialists. [end of
insert]
Hicke: Did you know Tom Barger?
Taylor: Fred Davies was president when I first went there. He was one of
the original guys, as was Tom Barger, by the way. Fred Davies was
the president when I got there, and after him came Barger. I knew
Tom Barger quite well and took care of him and his family many
times. Originally, it was a small MASH-type outfit; later this
hospital was built. As a hospital, it had three wards on it:
medicine, surgery, and OB/GYN. It had two well-equipped operating
rooms; it had an x-ray unit in it. And the surgical equipment was
177
all good; it was modern and geared for the level of care we
intended to deliver--"we" being somebody else who decided what we
were going to deliver.
OB/GYN; Burns
Taylor: At that time, there were very few women, so obviously very little
American OB/GYN work was done in the early years. That was a
minor little side. But there were Arab women who came in there
for deliveries, so we did have the OB/GYN ward. Of interest, Arab
husbands frequently insisted on being present for pelvic exams.
One ward was set aside for burns, because there were many
burns. They used a British stove called a Primus stove, and that
stove was dangerous. The clothes of the Arab people were long
flowing dresses and robes. It was all too common for the stove to
explode when it was being pumped up for use, and these robes would
catch on fire.
Hicke: Is it a cooking stove?
Taylor: Well, it s one of those things you pump up and get the pressure on
the gas. You cooked on it and used it for heat as well. Thinking
back, I think most of the fires occurred when they were lighting
it. Because you d pump it up, and then I don t know what went
wrong, because it would puff out with a flame and catch them on
fire while they were trying to light it, causing severe, extensive
burns. These patients frequently died, and if not, were on the
burn ward for months for treatment and skin grafting.
Dental Service
Taylor: Early on, we had a dentist. Initially he did fillings and
extractions.
Hicke: Did he have the necessary dental equipment?
Taylor: Yes. He had a small office with what we would think of now as
essential equipment. He drilled out cavities and put in fillings,
pulled teeth, fixed broken teeth, and that sort of thing. He was
a very good general dentist. The dental service grew rapidly and
later expanded into the biggest dental unit in the Middle East.
Still is today.
178
Hicke: That was while you were there.
Taylor: Yes. I think they were building up to fifty dentists, covering
every phase of dentistry. We had all the subspecialties. It was
kind of interesting, because dental was easier to recruit for.
Bernie Eggerman became the chief. He was an enthusiastic,
dedicated, and well-connected pusher, and so he got a lot things
done for dental, which was very good for everyone. They
eventually offered quality dental care to all Aramco workers and
their families.
Trauma
Taylor: The biggest problem in those days was trauma, because Arabs loved
big American cars, and the roads were absolutely hopeless: no
lights, no lines, no signs. It was just a strip of asphalt
through the desert, through the easiest way they could go, and
often drivers would simply cut across the desert; so they d go
over hills, around curves at break neck speeds, and it was
extremely dangerous. The Arabs were not unlike the rest of us--
loved to drive fast.
The other interesting thing worth noting was that the Arabs,
like earlier days in the U.S., would hitchhike all the time. It
was almost an obligation for the Arab, if he saw somebody waiting
along the road, to pick him up. So the cars were usually full of
people; when they d collide, as they often did, there d be a
helluva wreck, usually with multiple major casualties.
Literally, it was not unusual to have our ambulances bring in
ten or twelve mangled people all at once. In the early years, up
to 1965, Aramco had the only ambulances, and they would range long
distances to help the injured.
Hicke: Can you describe an example?
Taylor: The worst accident I ever managed in heading up our ER [emergency
room] happened to a big bus full of people coming back from the
Had j . They had pulled off the side of the road, but not far
enough; Half of the bus remained on the road. I don t know what
was wrong with the bus; it had stopped, so all the people were
sitting there. This huge truck came along with a big grading
blade which was up, and that blade went along and just literally
sheaved off the outer half of the truck. I ve forgotten how many
got killed. I think about twenty. However, there were another
thirty badly injured people screaming in the night pretty far from
179
Hicke:
Taylor;
Hicke:
Taylor:
this hospital. So by the time they were gotten to the ER, another
five or six had died. That was the worst accident, as far as road
accidents were concerned.
Such accidents were frequent,
major trauma on the highways.
Mostly Arabs?
Very few days passed without
Mostly Arabs. Occasionally, an American. Americans were wary:
they wouldn t drive at night if they could possibly help it; they
realized that these roads were dangerous. Arabs didn t think of
them as being dangerous. So it was mostly Arabs who got smashed
up in these automobile accidents. It s still true today. They ve
never done much to improve the road; at least when I left, there
were still no lines, no signs, no curves. I think they finally
got stop lights in some places, but out on the highways, it was
every man for himself. And there were no speed limits; they d go
like the blazes, you know. And so it was a setup for trouble.
That s where we got our most demanding medical work. I never
ceased to have a little chill when called. In a "big crunch" the
emergency room patients would be all over the place, sometimes on
the floor or on the gurneys, sometimes stacked up on the ambulance
platform.
Did you call on every doctor available?
No. We d just call in the surgeons.
Staff Personnel
Taylor: When I first got to Aramco, there were six surgeons. Three were
trained as board surgeons; the other three, who had become
surgeons had become skilled in the hard school of experience. We
all became trauma experts.
Hicke: Were these all Americans?
Taylor: Oh no. In fact, Dr. Lonas and I were the only two Americans at
that time. There was one Saudi, Fyak Abdi; one Dutch surgeon,
Peter Van Dooren; and one Indian surgeon, Cecil Smith from Bombay.
Later we added a surgeon from Beirut whose name was Dr. Mikhail.
He was an unusually brilliant and talented surgeon. That made up
the surgical staff during my first tour of duty. Dr. Lonas was
the chief, I was the assistant chief, and all of us worked
together as a team. These surgeons were fearless and hard
180
working. Two of us were on call every third night and since very
few nights went by without surgery, we were in the hospital eighty
to 100 hours per week.
ta
Taylor: One of the things that was interesting about the surgical theater
was that the anesthesia was always given by a nurse anesthetist.
Our statistics on anesthesia were surprisingly good. These nurse
anesthetists were there for many years. They were very cautious;
anesthesia was very light. These four American nurses did a
remarkable job over all the years I was there.
Hicke: So they could probably administer but not handle emergencies?
Taylor: On the contrary, they were super with emergencies. They stuck to
very simple anesthesia. The anesthesia they did was very safe and
it worked. There were four anesthesia nurses available most of
the time. If there was big troublewhy , we d get as many of them
as we needed, usually two or three of them. Usually, we d run two
O.R.s [operating rooms] at once, so there d be one anesthesia
person in each one. That was the surgical part. If you have
watched the MASH programs, there was a striking similarity to the
Aramco surgical world.
It should be understood that at the same time we were
providing a full range of medical care. There was a medical ward,
pediatrics, and OB/GYN. However, of special interest, there was
no psychiatry service in the early years. There was no need.
Americans were sent home. Arabs didn t go psycho.
About five years after my arrival, a new hospital was built.
The medical business was increasing rapidly and more sophisticated
demands were being made by the patients. The old equipment, the
sandy O.R.s, the one-room lab, and waiting out in the sun to be
seenthese were some of the problems that had to go.
Hicke: And this was nearby, across the road?
Taylor: The hospital was built on the main access road so that Arabs had
quick and easy access--95 percent of the patients were Arabs.
Smallpox
Taylor: One interesting fact: when I first got there in 1954, they were
having what was probably the last smallpox epidemic in history.
181
They had a little isolation building that they used. I was called
to see one of the smallpox patients who had some kind of surgical
problem, which turned out to be appendicitis. I went over there
and took care of it. There were about ten patients in there with
smallpox. As far as I know, I never saw case of smallpox after
that in my life. Even though we were all vaccinated against
smallpox, everyone taking care of these patients was very nervous.
It s one thing to be vaccinated; it s another thing to be exposed
and hope the vaccine works. It did.
Hicke: These were Arabs?
Taylor: These were Arabs. And this kicked off, with Aramco s help, a
nationwide effort to vaccinate everybody for smallpox. Up until
now the vaccination program had been spotty. Arabs didn t like
being vaccinated. But now a royal decree came down from Riyadh,
and nationwide vaccination was carried out.
Hicke: Which had not been done before?
Taylor: Well, some of them were vaccinated, but now all Saudis were
vacinated by royal decree.
Hicke: The youth had had some vaccinations?
Taylor: A lot of them had been vaccinated, but many had not. Some of
people came from Yemen, which is south of Saudi Arabia, and had
not been vaccinated. We hoped that was the end of that. One
thing--! don t believe it s known to this day whether everyone is
vaccinated for smallpox there or not. As you know, smallpox
vaccination has been discontinued worldwide, because everybody
thinks it s finished, you know, there won t be any more smallpox.
But I often think to myself, maybebecause there must be areas in
that part of the world they ve never heard of a vaccine for
smallpox. To believe that smallpox is really eradicated is highly
optimistic. Since the Western world will soon have no immunity,
an epidemic would be catastrophic.
So I think it s a little optimistic to think that it s gone
forever; but so far, so good. And there haven t been any cases
for a long time. So maybe it is finished. I hope it is. But
that was an interesting thing to start with, a little smallpox
epidemic; most medical people have never seen a case of smallpox.
To be in on the last of the smallpox epidemics was a very
interesting and exciting way to begin this fabulous adventure.
Hicke: How did they deal with this?
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Taylor: The Arabs never fully understood the potential of a smallpox
epidemic; very few even knew it happened. One must remember there
was no dissemination of news about such things. However, the
Arabs living in the Eastern Province knew about the Aramco Medical
Center and would come long distances to be treated. No Arab was
ever turned away, nor was anyone else who needed the services.
However, once we had done all we could, then they had to leave our
system.
Medical Care Responsibilities: Dependents
Hicke: It also raises the question of who you were responsible for.
Taylor: We got that clear, eventually, because what it boiled down to was
very clear-cut: First we were responsible for all Aramco employees
and all their dependents. This included all employees; at times,
there would be as any as twenty different nationalities working.
We can take a second to discuss the dependent situation,
because there was a long- running argument about that for many
years. What Aramco regarded as a dependent was a wife--or wives,
because many Arab employees had more than one wife and the
employees children. Well, at one time, the average number of
children was something like twelve. Average. So there were many
families with eighteen, twenty, twenty-four kids. The number who
had four wives was small; I think at one time it was like 10 or 12
percent of the employees had four wives. On the other end, there
was 10 or 12 or 15 percent who had no wives: they weren t married
at all. The biggest number of married Arabs had two wives; three
wives was next; and then four wives was the least. This created a
large dependent population of approximately 600,000. We provided
quality care for all of them.
Now, what the Arab thought were his dependents were all the
people who lived in what he called his villa; this often included
more categories. Then Aramco had bargained for brothers and
sisters and their children. Aramco decided the best plan was to
just take care of all of them. So if an employee would come in
with a boy, we d take care of him. We learned our lesson: I
persuaded Aramco management that we would just take care of all of
them. We would have lost far more in our rapport than we d ever
save in money. The actual cost add-on was negligible anyway.
The second part of our obligationwhich was clearly
understoodwas we would provide medical care to anybody who
needed medical care that was not available outside of our
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Hicke:
Taylor:
facility. And in the early years, that was everybody, because the
local facilities were very, very spartan and meager. They had few
specialists and inadequate equipment. So if a general public
patient was diagnosed with appendicitis and he went to the local
hospital, they would send him up to us.
On our side, we had complete backing of the government; if it
was somebody that we couldn t do anything for- -even if they were
dying, like an advanced cancer casewe wouldn t take them. They
had to go home, because there was nothing we could do for them.
So we were very firm about only taking general public patients who
were people that we could do something for medically. Once we had
done what we could, such as take out an appendix, we d send that
patient home in a couple of days or send him back down to the
local hospital, because the local hospitals did have beds and they
did have facilities, but their doctor supply was limited. As far
as I know, that level of responsibility still holds; so that even
now, if somebody comes in who s not eligible and they have
something that the local facilities can t handle, SAMSO [Saudi
Aramco Medical Services Organization] will take care of it.
Who established those guidelines? Do you know?
I was the one who finally crystallized those guidelines, along
with Aramco management. In a sense, and rightfully so, the
administration out there and the parent companies thought of the
medical system as a necessary evil. We had to have it for almost
everyone. Once you have something for the Americans, you
certainly won t deny the same level of care to the Saudis. It s
also very difficult to say, "Well, we re going to have a good
medical facility, but only for the employees, or only employees
and their dependents, only employees and their real dependents."
In other words, trying to delineate such fine lines was
politically ill-advised. In looking back, any other decision
would have been stupid.
Facilities and Living in Dhahran
Hicke: That s really interesting, because I think that happened in other
than medical areas too, like electricity and water and air
conditioning.
Taylor: Well, the AC, the air conditioning, was always a bone of great
contention. It used to be amusing, because they used to call the
Arabs who were inside the compound "AC Arabs," and that was a
derogatory term. I heard guys say, "Oh, you re one of those AC
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Hicke:
Taylor:
Arabs"--like you were a bad guy, you know. Health bears on it to
some extent, because there was always an intense effort early in
the early years for the Arabs who wanted to come into the compound
and live inside the compound. At the same time, there was an
intelligent and logical resistance to this, because there was such
a difference in the social structures that this integration was
very difficult. It wasn t easily done, and created major societal
problems.
One day, an unusual Aramcon named A.C. Hill came in with what
he thought was a solution. He was an American guy. He said,
"I ve got a better idea. We ll build good housing for these guys
out in the communities. We ll put in AC, we ll put in running
water, we ll put in toilets." And they did. That solved one of
the most difficult problems of all, because the interesting part
of it was the Arabs actually had more difficulty living inside the
camp than the Americans had with the Arabs. The Americans would
come in, living their way of life; and a lot of our customs were
not acceptable to the Saudis. As their children grew up, they
were subjected to the peer influence of our young crowd. And they
didn t like that. The schism between the Americans and the Arabs
was too wide and there was no meeting of the ways; it caused
endless animosity.
So when we offered this solution, they thought it was great.
In fact, as of today, the executive Arab compound is much better
than the American compound- -beautiful. We built it right outside,
just across the road from the hospital. They didn t have to, but
they wanted to: because these were better houses. There were the
same kind of people living around them; and they had their own
community; and they had all the amenities they could have inside
the camp. That was a great solution. Up until then, it was
becoming more and more of a very sore point, because the Arabs
were saying, "Look, you Americans are living in there. You ve
got--." AC was their main complaint. "We re out there in the
heat!" So remedial steps were taken, and the problem was solved
by A.C. Hill.
Did you see a lot of problems caused by heat in the Americans?
No, oddly enough, because the only time we had problems was when
the Americans would overdo it. They used to run a marathon, you
know, as a sporting event. So Americans would runI ve forgotten
how far they ranbut it was like twenty miles, and they d get
heat exhaustion. But you have to remember that the heat was only
serious between July 1 and November 1. Up until then, it s like
southern Florida; so in the winter, it was cool and the weather
was generally good. So the hot weather was really mostly July,
185
August, and September and then it was really hot.
over 100 degrees, sometimes 120 degrees.
Almost always
Hicke:
Taylor:
Hicke:
Taylor:
Hicke:
Taylor:
Hicke:
Taylor:
The other thing that had a big influence on the reaction to
the weather was that it was right on the Gulf. When the winds
blew in off of the Gulf, it was very, very humid, and it was so
humid that the AC couldn t handle it. So the temperature inside
the houses would go up into the eighties. That doesn t sound like
much, but somehow or another everybody thought it was too much.
The humidity certainly added to the discomfort.
The humidity was bad, the heat was up, and people would get
irritable and everybody was in a bad mood when that would happen.
Most of the time, the winds were from the north; shamal is
the word for the north wind. When the shamals were on, they d
blow dust and sand all over the place; there d be dust storms,
sand storms. But most of the time they were blowing out into the
Gulf, so you didn t have this intense combination of heat and
humidity. But the shamals I Sometimes they d last two or three
weeks; these shamals were wicked. The sand would come through the
doors, in the windows. You d have to clean up everyday. Where I
lived initially, I wasn t too concerned about it: the sand would
get to be an inch or two high in my room. My roommates, who were
meticulous, would come in and say, "What the blazes is going on
here?" One guy got so upset about it, he d come in with his own
vacuum and he d vacuum my room! I found this amusing; he did not.
So the sand storms were very
Can you vacuum up the sand?
Yes. Then you d pour it outside,
interesting.
Could it come into the hospital?
Oh, it came everywhere. It did. Of course, the hospital had a
little better AC--the new hospital. The old hospital? Well, when
the sand storms were on, you knew they were on. We used to keep
the blinds down, everything, to keep the damn sand out. But you
couldn t keep it out; it was very fine; and of course when you
opened a door, it would blow in. In the hospital, we had big
vacuums. You know, we d run around with those damn things and try
to suck it all up. When the shamals were on, the sand was there.
The operating room?
The operating rooms were super insulated with double doors, triple
doors, whatever--! ve forgotten. It would be stretching it to say
186
that it was a problem. There would be a little in there because
people walk through, but we finally said, "Oh well. Sand never
hurt anybody."
Hicke: Clean sand!
Taylor: But those shamals were something to remember. It was sort of
equivalent to a severe snow storm here. Everybody would get
house-bound and irritable. I think the longest one ever lasted
about a month, and it just wouldn t stop. Everybody got so
touchy, you could barely speak to anybody, because the damn sand
was everywhere.
The New Hospital
Hicke:
Taylor;
Hicke:
Taylor:
Hicke:
You haven t told me about the new building,
something else.
We got off onto
The new building--in those dayswas very modern and very
attractive, as they go there, although Aramco was always against
anything architecturally attractive; it was practical. In fact, I
initiated another new hospital just before I left. It was
amazing, because we had two plans: one of them was an
architecturally beautiful building, very nice, designed by some
big architect from the States; it looked wonderful.
The other was one of these deals where they rebuild around
the old building. And that s what they finally did. I ll never
forget that, because I was on the board of directors at the end,
and we were arguing over this building. The amazing thing was
their approach to it: "Well, you re going to have this beautiful
hospital sitting there right in front of everybody, and we ve got
these old ugly buildings. If we have this beautiful hospital
sitting here, we re going to have to redo these buildings, and
that ll cost us a lot of money." So they turned it down. We
built around the old hospital.
You were on the Aramco Board of Directors?
Just at the end. I finally got on the bottom rung.
What were the problems of moving from the old hospital into the
new one?
Taylor: Well, we kept the old hospital: we kept using it.
went on, that became a health educational center.
As the years
We did all
187
kinds of things over there in the old building: we ran a huge
pregnancy program there for pregnant women, teaching them how to
feed their babies; we had movies on how to change diapers, what a
good diet for the baby was. That was one big part of it; that
went on every day. Our industrial medicine was over there, and
our own public health unit was over there, which was a big
operation for us, for everybody. So we kept using the old
building for very important functions which were not clinical
medicine.
Then part of the time we used it for a place where we put
people who were in medical trouble and couldn t go home. It was
like a holding station. Those would be advanced cancer cases,
some burns that we were working on that were going to take months
to do. I think the OB/GYN delivery unit was the last one to move
from there to the new hospital. So eventually, the new hospital
was basically to take care of, all current, ongoing illnesses,
primarily clinical, and the old building was for preventive
medicine, public health, occupational and health education.
Developing Psychiatric Care
Taylor: The other major area we finally developed there was the first
psych ward. That always amuses me because when we were first
there, we had no psychiatrists, we had no psych ward; we had
essentially very little business and very little interest in it.
But as the years went by, we changed that. When I left, we had a
regular psych ward full of people, and I think it s sort of a
measure of the impact of the times. We had two Arab psychiatrists
and a large inpatient and outpatient service.
Hicke: Since we re talking about that, why don t you tell me how that
developed?
Taylor: Well, it just evolved. It s a sad commentary on the Western
world, I think, because most of our early psych patients were Arab
employees. They came under the same pressures as everybody else:
advancement, promotion, failure to advance, disappointments in the
work sitethings of this sort, and inability to keep up with the
changing times and changing customs that were happening all around
them. And so they had emotional problems. Originally, we had an
American psychiatrist for the Americans. But he would also take
care of the Arabs, most of whom spoke good English. As that crowd
got larger with the increasing pressures of advancement, we
finally got an Arab psychiatrist, because we had not only the
188
employees but their dependents who came inbecause they too were
undergoing major changes in their social structure.
I think the reason that the Arab people, in general, had very
little emotional trouble is because their societal lines are black
and white. They re very clear cut: if you do this, you re on the
right side; if you do that, you re on the wrong side. Whereas in
our society, not only are they blurred, I think they re probably
almost gone: you get to the point where you think, "What can
anybody do that anybody s going to do anything about?" But not
there. If you do this, you re going to get that, so that they
know from the youth on up what s right and what s wrong much more
clearly, and so they have less trouble coping with that problem as
time goes by. So there was not nearly as much need for
psychiatric situations. Plus you have to remember in those days,
there were no schools; they didn t go to school--
Hicke: The Arabs?
Taylor: The Arabs. I m pretty sure it was into the seventies before there
were any girls schools. First they had boys schools; and then
eventually they had girls schools. But even in the schools, the
pressures were not severe; schools were 50 percent religioushalf
the day they taught the Koran, and the other half, they would
teach various and sundry subjects that were germane to what they
were doing there. They didn t have a feeling of pressure; they
weren t trying to get into college. So the kids didn t have the
pressure that our society puts on them.
So the emotional problems were very minimal, comparatively
speaking. I think, rightly, now there are more, for very obvious
reasons. But you still have clear-cut lines of right and wrong,
so there s not as much consternation in the minds of the young
people as to what is acceptable. I think there is less of that
kind of underlying background to cause them to get into emotional
dilemmas. Once they got into the company, and they were trying to
move up, then they got into emotional dilemmas-- just as we do.
Hicke: That s interesting that the work pressure is stronger than say,
inter-sexual relationships and things like that.
Taylor: Oh, that was clear cut. That s why it didn t create problems.
There weren t any inter-sexual problems, at least not that I was
aware of: that was a clear-cut code. And it worked; it was there.
They didn t drink, smoke, and do drugs, which create a lot of our
problems in the rest of the world. The problems which loom so
large here around illegal drugs don t exist there.
189
Accreditation
Hicke: Let me just mention a couple of things. In 1957, the health
center was accredited.
Taylor: Right. That was in the new hospital. Obviously, I was there
then. It was in the new hospital, because I ran that
accreditation for the first time. There was probably a
misconception in a way about accreditation, because accreditation,
oddly enough, has very little to do with the quality of medical
care; whereas it has a lot to do with the safety of the building,
the environment of the building, the prevention of cross
contamination amongst patients. It has a lot to do with the
record keeping; they usually come in and pull twenty surgicals,
twenty medicals at random, and then they ll go through them to see
if the record is done right with physical examination and progress
notes, nurse notes, et cetera. The format of the record was
important, but the attention to actual climical management was not
criticized.
They don t get into "Well, here s a guy with TB of the
kidney. What did you do for him?" They don t get into that.
What they do is they say, "Okay. Here s a guy with TB of the
kidney. You took his history and physical [examination]; you
established the diagnosis; you kept progress notes on him. The
record is a good record." We had opened up some extra isolation
places, and that air-conditioning was not isolated from the rest
of the hospital; so they said, "We will not approve until that s
corrected." As a matter of fact, I will take the blame for that,
because we hadn t thought about this cross contamination in the
air-conditioning when these new places were opened. So we closed
them down and fixed the problem, and we were approved. But that s
the kind of thing they were more interested in--fire hazards,
smoke detectors, hoses, all these things; they d pull them out; do
they work? The accrediting is very concerned about the physical
plant. For example, we had to have an emergency generator.
They d go around and flip it on. And it if it doesn t work, you
don t get approved.
Secondly, they are concerned about the quality of the chart
itself, but not about the medical care. That s a big
misconception. Because people say, "Mass General [Massachusetts
General Hospital] is accredited. It must have great medical
care." That s not true. What it means is "Mass General is a
great medical plant. It has a great facility." Now, at the same
time, if you do keep your records well and you do have everything
in, it does promote good medical care, obviously. But nobody
comes around and says, "Hey! This surgeon isn t seeing his
190
patients post-op. How come?" That didn t happen. That doesn t
happen today, either.
Hicke: How did you go about getting the accreditation?
Taylor: I had been in accreditations back here to begin with, so I knew
what they were about. And they send you exactly what you have to
do.
Hicke: Do you request it?
Taylor: Oh yes, you have to request it, and you have to pay for it.
They d bring a whole team over. Originally, it was four;
eventually, it got to be ten.
**
Taylor: In general, in the intervening times, we kept things up to
accreditation levels, because once you were accredited and you re
claiming that you were accredited, you should function at that
level; and we did. Accreditation is an ongoing process, and once
achieved, no one wants to lose it.
Hicke: How often did you have to get inspected?
Taylor: I think it was a two-year interval, unless you were on probation;
if you were on probation, it could be as short as six months.
They d say, "Okay"--like this air-conditioning thing that was
found in June--"we ll be back in January to confirm that this is
approved and then you ll get your reaccreditation. " So I think it
was two-year intervals, and then if there was anything amiss,
they d tell you what it was and give you so long to fix it. If
you didn t fix it, then you lost your accreditation.
Those were always stressful, because everybody had to run
around and make sure everything was up to snuff--that all the
physical plant operations were right, and that all of the records
were complete. The records, in general, were well maintained.
Now, the records were what separated us from the rest of the
medical centers in the Mideast, because record-keeping in most of
the world is a very marginal effort. As the years have gone by,
precise record-keeping has become increasingly important.
Hicke: You re talking about medical records?
Taylor: Medical only. So if you go into--as I did--go into a hospital,
oh, we ll say in Iraqwhere we wentyou would be very hard
pressed to figure out what s happening to the patient by looking
at the record. So that s a bad thing. England is very good at
191
records; they re the only country that has decent records. Ditto
for Canada. The rest of the world just doesn t think that the
records are that critical, and doctors are somewhat negligent
about maintaining records. They don t like to do paperwork, and
they just ignore it if they can. The nurse s notes also count,
because you want to know what happened, and often the mandatory
notes by nurses tell the real story.
So we kept very good recordsnot only there, but in the
outpatient clinic. At one point in time, we were regarded as the
largest, well-organized outpatient clinic in the world. That
meant just what I m saying: when people came, you knew you could
review their record and see what happened. We were seeing over
two thousand people a day in these clinics. It was a big step,
because we had far-flung clinics all over that Eastern Province,
as the area was called. We saw all these people I was talking
about, plus the local people who would come into those clinics.
And each and every one of them was identified and had a record-
retrievable, and kept in proper sequence, filed properly. It was
all part of the system.
Hicke: And no computer!
Taylor: No computer in those days, but excellent handwritten records were
always available. Whereas if you go into many non-American areas
and you say, "So this patient was here last month; let s see what
happened," there s no way you ll find out. You might ask him, and
he might not know. That s one of the criteria of accreditation,
record-keeping, that separates good American medicine from others,
in that you know what has happened to people and you can maintain
some continuity. TB is a big problem: you have to know what drugs
they re on, how much they re getting, how long they ve been on
them, and whether they actually are- -this kind of thing.
Otherwise it s very difficult to do your job right. We did do
that very well in Aramco.
We were a very organized system. In other words, the doctors
were all employed by us; all the doctors had to work to a certain
standard; we were constantly doing peer review on everybody; there
were no outside doctors who came in on an occasional visit basis--
none of that. It was all a very controlled system. So we even
got high marks on that. If you go down to our hospital here,
there ll be guys who come in and see a patient once a month, and
they may or may not fill out the records, and the poor records
people are chasing them all the time: "Please fill out these
records." And they may be three to six months old or may never
get filled out. We didn t have any of that. That was one of the
key things, and that, we did well.
192
They were big on the lab. We had a very good lab. Good
blood bank; the only blood bank in Arabia at that time.
Hicke: Did you collect it yourself?
Taylor: We had a whole blood bank system, where we d collect the blood and
have blood on tap for operations and major bleeding problems. It
wasn t easy. There was great resistance to donating blood, as
there is in most countries. They didn t like to donate blood. It
was understandable. They just couldn t visualize why we thought
they should give their blood to somebody, particularly somebody
else who wasn t related or close to them. In fact, most of the
blood was donated by Americans who were conditioned from World War
II about giving blood.
Hicke: Did the government give any help on that?
Taylor: Not on that. They had their own problems, which were worse than
ours: trying to get it in their own hospitals. It was just
practically impossible to force anybody to give blood. It s just
an impossibility. There was a long, historical background in that
society that being bled was not a healthy thing. It was very hard
to overcome. But we did have a reliable blood bank, and we had
very up-to-date cross-matching techniques; we didn t give the
wrong blood to the wrong people. So the lab, the blood bank, the
x-ray unitwhich was very modernthey were all good. In other
words, the supporting services to the clinical medicine were
strong. That s what makes good medicine.
We tried to keep up in these areas, although I remember when
we wanted a CAT scan operation, that was hard to get. Whenever we
went up to management with a major expense item, which I would
usually present, it was often amazing to me how difficult it was
to sell it. They ve done it since I left; but when I was there, I
was still trying to get this CAT scan in. I must have been
ineffective.
Hicke: How much did they cost?
Taylor: At that time, that unit was going to cost $600,000. Back in the
late sixties-early seventies, Aramco management would think, "Gee,
that s a lot of money," you know. And their question was, "Do you
really need it? What can you do with that that you can t do now?
How much good is it going to be?" And in the old days of CAT
scanning, when it was still a little bit dubious --"What can the
damn thing do?"--you could be hard pressed, as I was, to prove to
them that you had to have this sort of thing.
193
It was interesting, because we had the same sort of thing
when it came to computerizing. In my last years out there, there
was a big push on to computerize the hospital. We partially
computerized it. This was my decision right along. Being
computerized has obvious advantages to it. The big problem with
us was when it would go down. For example, they wanted to put all
the drug system on computer, which they do in many hospitals now.
If you re on a ward, the computer will say, "Send up six shots of
penicillin to ward six for these numbered patients, and each one
of them gets the shot at four o clock this afternoon." And that
comes up on a tray and the nurse gives them. So it s all done by
computer; you ordered it by computer, it comes back by computer.
Well, I wouldn t do that.
The other thing they wanted to do, which fascinated me, was
to put in a computerized delivery system: it s like a little train
that fits in the walls and that would take drugs, food, messages
to various destinations. They have that in many places. In the
pharmacy they just put them on in the proper sequence, and then
they would go around to the various wards and they would get
offloaded. Well, that s great until it breaks down. Because in
this case we have two things to break down: the train itself and
the computer. And we were already having trouble in other parts
of the company with the computers. When they d break down, it was
a helluva job to get them fixed. When the King Faisal Hospital
went on with computers, they finally had to hire a twenty-four
hour team from Japan to maintain the computer. Sony. Because if
it once goes down, the hospitallike the King Faisal Hospital
which I consulted on to get it in operationif a computer goes
down, the system fails, chaos reigns. So if the drug system goes
down, there s nobody to get the drugs from the pharmacy to the
ward, the food from the kitchen to the patients, et cetera; the
hospital doesn t function.
It becomes chaoticwhich they found out the hard way. The
lab was on the computer, and the lab computer goes down. The
whole system breaks apart, because you order by computer; once you
can t order by computer, and you have to go back to the old
handwritten delivery system, why, you have a serious problem. As
a result, in Aramco we only computerized in a modest degree. And
I m sure since I left, they ve probably updated that and have a
fully computerized system by now.
Hicke: It s probably much more reliable by now.
Taylor: It s more reliable, as they now have what we call a mainframe
system, because Aramco is totally computerized. They have a home
team out there, employees who are computer experts, so they can
come down and keep the computers running. And they have the parts
19A
Hicke:
Taylor:
in store and this kind of support, which we didn t have
originally. We had to fly them in. So that was a problem. But
now, I think--! haven t been backbut I suspect it s fully
computerized at this point in time it should be. They ve got the
money and they should do it. That s how that evolved.
Well, we were just on accreditation business,
that?
Can you finish
Accreditation became a way of life. The funny thing about
accreditation is that once you re accredited, it s very
uncomfortable to back out of accreditation. And occasionally, you
think, "What good is accreditation? I mean, we know we re running
a good outfit." The good, I guess, is, like every year when we d
get accredited, it would come out in the local paper that we were
re-accredited, and everybody would breathe easier thinking, "Well,
we have a great medical system because we ve been reaccredited by
the joint commission." It had a good public relations impact.
The problem was the part that people failed to realize a
hospital may be accredited, but it may not be doing good medicine.
That s what people don t know, because they automatically think,
"If it s accredited, it must be doing great medicine. It must be
medically up to certain standards." That s true. I m not against
it, because it certainly is an incentive to do medicine right. In
other words, it s better to be accredited and at least kept to
that level, than not to be accredited and work at some lower
level. So we kept doing it, and they are still getting accredited
as far as I know. It became an established thing, and as far as I
know, it still is. Being accredited is definitely a positive
factor in having a medical system.
Medical Training
Hicke:
Taylor:
Let me ask you a little about teaching duties,
had some teaching duties all along?
You indicated you
Hicke:
Yes. We became accredited by the Royal College of Surgeons, which
is somewhat equivalent to the American Board of Surgeons in the
U.S. After this, surgeons who worked in the Aramco surgical
system could get a year of credit towards being a fellow in the
British College of Surgeons.
When was this?
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Taylor: This was in 1961. That was a representative from the Royal
College, Dr. H. Wells, who was there to accredit us. He came down
and went over our system, came in and watched us operate, and
actually operated with us. He spent, I think, a couple of weeks
there to approve us, our training; and we were approved, so that
people who worked with us could get time credit for becoming a
member of the Royal Academy of Surgeons. And several did become
members. They had to go to Englandusually London. We were good
for the first two years, but after that they had, at some point in
time, to go up and do two more years sometimes more than that to
finally get to be a Royal College-accredited surgeon. This was
good for us, because it kept us on our toes. Every two years we
had to get reaccredited by the R.C. of S.
When they developed a medical school in Riyadh, some of the
students would come over and work with us as interns. That was
probably around 1970, I would guess, thinking back. So we trained
those people. And then we trained our own people, extensively.
We had training for lab, x-ray, all kinds of technical support.
When we got new doctors in, we trained them. When we hired a new
doctor, they had to go through a year of training; they had to go
through their first year being closely under a supervisor who was
making sure that they did things "our way," so to speak. There
was no medical school in our area then. There may be now. In
fact, it was in the wind when I left, that there d be a medical
school in Damman. So if that s there, I m sure that they will use
the SAMSO hospital as a training center. But that was after my
time, so I don t know. When I was there, we did the necessary
training to guarantee quality of care.
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IV CAREER DEVELOPMENT AND RESPONSIBILITIES
Chief Surgeon, 1961-1963; Hiring Staff and Relationships With
Management
Hicke: Okay, let s go back to your career a little bit. You became chief
surgeon in 61? What kinds of responsibilities did that mean?
Taylor: Before that, I was the assistant chief surgeon [1953-1961]. Dr.
Lonas resigned, and then I became the chief surgeon. As the chief
surgeon, you were over all the surgical services, not just general
surgery. OB/GYN, orthopedics, urology, whatever surgical activity
was done was under the chief surgeon. This was an interesting
little phase of development, because Aramco management was slow to
accept progress in these areas. This was very disconcerting,
because one of the things that has always amazed me in lifeit
shouldn t, but it doeswas how some of my most intelligent
friends have a paucity of knowledge about medical people and what
they can do. And a lot of people would say to me, "Well, you re a
surgeon." And you were considered to be competent in all fields
of surgery.
But American management, coming from the old daysWorld War
II, when the surgeon is out there doing all kinds of stuff --had
this vision of the general surgeon being able to do all these
things. As a matter of fact, we were occasionally doing things
that were beyond our scope. I used to do severe head injuries,
and operate on brains and skulls that were caved in and things
like this. This was very complicated surgery. We did a pretty
good job under the circumstances, but as far as doing it as well
as a neurosurgeon that didn t happen. For unknown reasons,
management was extremely resistant to appropriate progress in the
Medical Department. This was penny-wise, pound-foolish management
by Aramco and should have been changed long before it was.
Hicke: Did you feel you wanted to hire different specialists?
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Taylor: The first specialist we finally got was an orthopedic surgeon, Dr.
Charles Thomas. I d been there long enough that I usually knew
the top level managers. Every president after Hardy was a good
friend of mine. We were good friends; and I d say to them, "I
cannot understand your approach to this when you may get hit in a
car next week, or your wife, or your kids, and have bones broken,
and we ll have guys down there fixing them, including me, who
aren t nearly as good as an orthopedic surgeon." It was just
beyond me, because, between us, there was never a true money
problem. What a joke Aramco didn t have enough money to hire a
good medical staff!
Later we did have a chest surgeon who was a general surgeon
and specialized in chest. But it was just like pulling teeth.
You d go up time after time, and some of these upper-echelon
managers who were resistant to this would say, "Well, we ve gotten
along without them. Were there any major problems because we
didn t have them?" Well, the true answer was "Yes"! [laughter]
But luckily, I guess, for everybody, it wasn t very often. So
that was one of my most difficult tasks, one of the most difficult
to accomplish.
Hicke: Not all of them, but most of the presidents and CEO s felt the
same way?
Taylor: Well they seemed to.
They don t think about it until they re sitting at the table
and I say, "I want to hire an orthopedic surgeon. He s going to
cost so much money. We need him."
And they d say, "Well, how come we need him now?" And then,
"We never had one up until now, you know."
"Well, the world is changing."
There was a day, back in World War II, at Mass General, when
orthopedic surgery was done by general surgeons. They weren t
really specialized as orthopedic surgeons. But that went by; we
didn t go by with it very easily. I think it was one of these
decisions where they saw it as sort of a major change and were
just resistant to the decision. And after I d leave, they d
probably say, "Well, old Taylor is up here pushing to get this.
We ll put that off for a while and see how things go." And it
gets turned down again.
When I left, we finally had gotten a good orthopedic surgeon.
We had a good chest surgeon. And that was their attitude: "We re
getting along okay. What s the problem?" There were a couple of
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bad accidents amongst what we called in those days the senior
staff, and that helped push that along. Because I made no bones
about it: if we don t have the right guy, we are going to have
major setbacks in the specialty fields, much to the sorrow of
those involved.
It was a bad decision on their part, as far as I m concerned.
Now they might say, "We saved three million dollars over the years
by not doing it." But they really didn t: they had general
surgeons doing it, who weren t as good, and they wouldn t have
paid the specialists any more than the general surgeons. Now for
neurosurgery, for example, they said, "How many neurosurgical
problems would this guy see? Would he be fully employed? Would
he be working?" "Well," I said, "I don t know about that. But
let s look at it generally. Suppose there s one that comes up
tomorrow: a guy comes in with his head mashed in, and we can save
his life and return him to normal. And that may be his only big
case of the week. Maybe you only do fifty of those a year. No,
he s not working on a big case every day." That was an
interesting decision on Aramco management s part. This slowed
down the progress that should have been made.
Hicke: Quantity is not really the issue, is what you re saying?
Taylor: That was hard to do, and that remained hard to do throughout my
entire time there. It was hard to keep the system moving with the
times, which I could never understand. I just couldn t understand
it. Bob Brougham was one of my real solid friends; I finally
convinced him. I said to him, "I ll tell you something
interesting. The thing that people will remember and appreciate
most about Aramco is the health care. The money is okay, but when
somebody comes in really sick or really hurtthey have something
wrong with them- -and they get good medical care, they remember
that. I think if you take a poll of all the Arab employees and
say, What about Aramco do you like best? 1 you d get 99 percent
saying the medical services. And not only that, but we take care
of all these other Arabs, including the royal family who come to
us all the time. Now what better way to befriend the country?"
I said, "I just can t believe that they don t think it s a
great benefit to them, and that Aramco is a good citizen because
they re providing these kinds of services. If you eliminate
medical services, I think there d be a very unpleasant reaction to
that." Management often would say, "Let s tone down the medical
services." As I was telling you originally, they used to accuse
me: "You re building a medical empire!" Which I was, because it
should have been done. I told Brougham, I said, "It s easy to
afford it. It s a worthwhile goal. Because the way we re doing
is too slow and cost-conservative. We re not out here building a
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Mayo Clinic. But we want to be working at a certain quality
level, and we sometimes do not measure up to the quality Aramco
should provide."
So you were mentioning in there [in the outline], "What was
the relationship between the Aramco administration and medical?"
It was not what it should be. Aramco was not concerned enough
about providing the proper quality of care.
Then on top of that, of course, the Aramco administration was
always caught between the parent companies and the field. The
parent companies were surprisingly resistant--"It s a business.
The bottom line is what counts. Whatever is going to cost a lot
of money, we re going to be against, unless it is in concrete that
it must be there." So, our people were a little reluctant to
bring up, say, the CAT scanner for a million bucks or whatever it
was, because some guy from the parent company was going to say,
"What the hell do you guys need a CAT scanner for out there in the
desert?" After all, the chances of them needing it for the few
days they were in the fieldthat was another resistance factor
that weighed heavily on management. In general, most of them
would hate to go to the parent company gunners who came out once
or twice a year and say, "We need this for medical." Because it
was just another request for something else, and the parent
company guys disliked additional requests for expensive "luxuries"
in the field, even though Aramco literally carried them when oil
financial pressures had the stateside companies in the red.
Hicke: But, you know, I think you really had a major influence here,
because not only did you have this marvelous health center in
Saudi Arabia, I don t think there are very many oil companies that
have this kind of offshore medical facility.
Taylor: Not of that scope. This was and still is, as a matter of fact,
as far as I knowthe largest American overseas group in the
world. At their peak, there were approximately 8,000 Americans.
Now I think there are about 4,000. They were guaranteed, and it
was written in their agreement, that we d provide good medical
care. And somebody would say, "What is good medical care?" We
would never say Mass. General; we would say it s as good as the
average small- town hospital. That was our goal, and I think we
met that goal.
I told people, including the doctors that I hired: "You are
taking a certain risk, medically, when you go to Saudi Arabia. If
you get into an automobile accident and get major injuries, your
chances of doing well are certainly not as good as they are where
there s a neurosurgeon. " You d think anybody would recognize
that, but--. I had people turn down employment over there because
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of medical, particularly if they had any kids or somebody with
major medical problems. We had no facilities for the disabled
like deaf, partially blind, autistic, or some of these things that
need ongoing, persistent care. In fact, we would turn down
employees who had those kinds of problems, because we knew they
wouldn t be able to get along properly without that out there.
We never aspired to be a Mass. General; that was too much for
us. We had a rule, which I suspect is still there, a regulation,
that any employeeother than the Saudiscould be returned to his
country of origin for medical care if it was necessary. And of
course, the employees knew this. Now, the question that would
come up was: "What is necessary and what is not necessary?"
Medical management made that decision. Let s say that an employee
had multiple sclerosis, for example; this was one of many such
problems. He would say, "Well, I have to go home to have this
treated." We would usually arrange to have that done in
connection with a vacation, assuming it s not an acute episode at
the moment. Chronic problems that could be handled in connection
with vacation were usually done that way.
Then we would get the results back, after a workup at some
multiple sclerosis center; we usually went to the New York
Neurological Center. They would send back a whole program for
this employee, which we could follow. Now if we couldn t follow
it, if it was too complex for us, then we d have to say to that
person, "Well, you can t stay here, because we re not going to
send you home every month to get this thing taken care of. We
can t be certain your medical problem will get the care you need,
so you will have to return to the U.S.A."
Now let s say somebody turned up with a cancer of the breast,
and they needed not only surgery, which we could do there, but
they needed x-ray therapy and chemotherapy following the surgery.
Then, we d usually give that patient the choice: you can either
have us do part of it and then get additional care in your country
or return home and have the entire problem taken care of. Usually
patients chose to go home.
I*
Hicke: We ve just been talking about your period as chief surgeon from
61 to "63. Was there anything particularly memorable that
happened in those two years?
201
First Open-Heart Surgery at Ar amc o
Taylor: Well, I did the first open-heart surgery there, which was
interesting, as much less major surgery had been the rule. Arabs
had to make do with what we could provide. Neither Aramco nor the
government would send them out of the country, as this was their
country. Consequently, in some instances we were doing procedures
that were a little beyond what we were set up to do. I decided
that since there were some serious heart cases around and these
patients had serious trouble and were going to die if they didn t
have something done, we would see how that went. So I did the
first mitral valvotomy, which is a simple, open-heart procedure.
It went okay, but it was a major challenge.
One, you need a lot of blood for these procedures and we
didn t have a lot of blood. To set up six pints of blood for a
procedure was a big deal with us, because it was just hard to get.
Secondly, the surgery is simple, but the support that s required
to go with big surgery is essential to success. You have to have
the right anesthesia. Looking further, you have to have the right
equipment to go with open-heart surgery. Further, you must have
the right technical people around. We didn t have that. Then
what you have to decide is, "Well, is this patient better off
taking the risk going with us, or is he better off just going as
long as he can without anything?" A very difficult call to make.
Temporarily, we decided against major heart and vascular surgery.
We really couldn t do it right.
Luckily, the thing got turned around and we could get the
Saudi Arabs out for highly specialized procedures. So we didn t
have to worry about it anymore. We quit doing surgery which was
too big for us. Secondly, the King Faisal Hospital was completed,
plus great strides were made in the medical care that the Saudis
delivered in other parts of the country, and so they began doing
these complicated procedures under Saudi auspices, and it s my
understanding they now do them properly.
Hicke: This was in the seventies?
Taylor: Yes.
First Lung Removal
Taylor: I also did the first pneumonectomy, the first lung removal, which
was another thing that hadn t been done.
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Hicke: Tell me about that.
Taylor: This was a patient with his left lung destroyed by TB.
Tuberculosis now rarely requires major lung surgery, but it did
then. If diseased lung tissue was not removed, the disease would
continue to spread and kill the patient.
There was a lot of TB in Arabia; and even today, I think that
TB is the most difficult medical problem Saudi Arabia has to cope
with. When Aramco was in the early years, malaria was the major
medical problem, but the Preventive Medicine Department under Dick
Daggy eliminated malaria in the Eastern Provincea major medical
triumph, quite possibly the most important accomplishment of the
Aramco Medical Department.
Dr. Daggy probably did more for Arabia healthwise than
anybody else, even though he s not a [medical] doctor. He s a
Ph.D. and he later become medical director. But that [eliminating
malaria) was a major accomplishment.
Evacuation Procedures
Taylor: In the medical business in the seventies, we were trying to
delineate how far we should go. With the Americans, if a guy had
medical problems beyond our scope, except for acute emergency,
we d send him back to the States. I had identified centers for
their specialty expertise; so if a patient had a cancer, we might
send him to M.D. Anderson in Texas, one of the highly specialized
cancer centers. Or we might send him to Mass General here in
Boston. Heart problems would be sent to the Cleveland Clinic,
which was the original coronary bypass center. And so on and so
forth. Of course, air transportation became much better: it used
to take us three days to get by air from there to here; later on,
when we had our own plane, we could fly a patient back in less
than twenty-four hours.
Another thing that we did that was kind of interesting: we
coordinated with KLM [airlines] and we designed and implemented a
hospital evacuation setup in KLM jets, which took up eight first-
class passenger seats. We had this unit, which they kept, and
they evacuated people all over the world with our unit. But
whenever we needed it, they would come and pick up a patient.
This area in the plane was converted to something like a small
intensive care unit: we had IVs, EKGs, and oxygen and all kinds of
equipment in it; a medical bed that fit over the first-class
seats; and an area for nurses. It was a highly specialized unit
203
which we developed and improved to evacuate patients over long
distances to world medical centers.
We used KLM on many occasions to get acutely ill patients
back to the U.S., usually to New York City. That was the nearest
place that had multiple major medical centers. We used
Presbyterian Hospital, particularly for neurosurgical problems and
major orthopedic problems and things of that sort. That was very
useful to us for quite a while and obviously a must for patients
who needed highly specialized care.
Then when we got our own jet planes, we d use them. But they
weren t as good as KLM, because they were small; these were
Gulf streams with limited space. But you could certainly transport
a patient quickly, as we had to wait for KLM. In those days,
these evacuation units were on the big jets, these were on DC-8 s,
plus a part of the agreement was they would come at our request.
Because if you had to wait for a scheduled flight in the early
days, that might be two days later, and that might be too late.
So that was our method of evacuation for the intervening years and
saved several lives.
Contract HospitalsAnother Change
Taylor: So that s how things changed. Now the major reason for that was
interesting, because at one time we used the local hospitals for a
lot of our patients, mostly on a postoperative basis. For
example, we d do a hysterectomy, and then after we d done the
hysterectomy, we d send them downtown to the local hospital. This
wasn t a good relations concept; they didn t like that, because it
was an obvious economic decision. The reason was that keeping a
bed down there was about fifty dollars a day, and a bed at our
place was about three hundred dollars a day. That concept was
quickly abandoned for obvious reasons.
Hicke: When you say downtown-
Taylor: That was in Al-Khobar. There were two hospitals down there, run
by local people. Joseph Yamine was one of them, director of the
Asharq Hospital. Moh d Ali Ahmed was the other Lebanese running
the Asalama Hospital. They provided a service which was expensive
but good; so that the local people, many of whom had the money,
had a place to go. They had good doctors down there, oddly
enough, because they paid wellbetter than Aramco. They were
from the Middle East and did good work.
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Hicke: We re talking about the seventies?
Taylor: Yes. Late sixties, seventieswhen government health care was
still in the developmental phase; they hadn t really gotten into
local medicine yet. We would use them as part of our system.
Sometimes it was odd, because speaking of specialists, for
example, they had an outstanding ear, nose, and throat specialist.
So we would send our own patients down there; Americans would go
down there if they had something like a ruptured ear drum that had
to be fixed. We would use them a little bit, but others living
locally would use them a lot.
When the Aramco philosophy changed about what our
responsibility really should be, we decided it should be more
inclusive than what we had been doingwe no longer sent Aramco
patients to Al-Khobar hospitals. This required an increase in our
capacity. We took them all in, and that increased the budget
significantly. I was not necessarily pushing this concept so
much, but management did, because they were getting too much heat
on "we go here" and "they go there"; that was beginning to be a
major relations problem; so this major shift in hospital policy
occurred. And as a result, the budget went up--way up.
Attractions of Life With Aramco
Hicke: Before we continue, tell me what you were just telling me off tape
about why you stayed so long. Do you want to put that on tape?
Taylor: Well, I don t mind. Number one, I had the right personality for
Arabia: I m adventuresome; I like excitement; I like to do things;
I like to meet exciting people. For example, I took care of the
whole Kennedy family, starting with Ted Kennedy, for a week. We
had all kinds of unusual surgery. At one point, Secretary Vance
was there, Cyrus Vance. Another time we had to bring in the
secretary of State under Eisenhower, Dulles, for a medical reason,
as explained below.
Just a quick vignette: we had an employee who accidentally
killed an Arab. It was a sad situation, because he was driving
through Al-Khobar very slowly and carefully, and an older, blind
Arab citizen just walked right out in front of his car. He d
barely hit him, but he hit him just enough to knock the man over;
so the man fell, hit his head, and died. The rule was, under
these circumstances, that the American system had to make a
decision: they could either deport that person immediately, so
that the employee did not get into the Arab judicial systembut
205
it had to be done before midnight. So the involved person had
that choice, along with Aramco. If the employee decided to take
his chances in the local court, he could. But whatever the
decision was, that was it. The local people, and I think with
justification, would say, "You come to the local court, you must
accept the ruling of the local court." This employee, thinking he
would win, chose the local court and lost.
So they put him in prison. Nobody ever knew for how long.
And going to prison in Saudi Arabia is a dangerous thing to do.
So he got very sick, and to make a long story short, if he stayed
in prison, he was going to die. There was no question about it.
He was dying. So I told Aramco, "If that employee remains in
jail, he s going to die." We were seeing him regularly and he d
gotten very bad liver trouble and was deteriorating. So Aramco
wanted him out. And so did the royal family; they didn t want
some American dying in jail under these circumstances.
But the local governor, Amir Ibn Jaluwi, was a very tough
person. I knew him well. Once Amir Ibn Jaluwi, who was almost
the original king, made such a decision, nothing could make him
change it. Aramco got John Foster Dulles to come to Saudi Arabia
to see the king. The king had to get Dulles and Ibn Jaluwi
together; and when they got together, there was a major conflict,
because Ibn Jaluwi didn t take anything from anybody, including
the king. Eventually, some major concessions were made to Ibn
Jaluwi that he wanted, and the patient was released. We flew him
out. And he survived. I wasn t sure that he was going to make
it, even if he did get out. But it just shows you how stringent
it was and how difficult it was if you took your chances like
that. Very few people ever did that, for obvious reasons.
Hicke: After that, I can believe it.
We were starting to talk about your becoming chief of staff,
but I wanted you to tell me why you chose to stay.
Taylor: Those were the kinds of things that kept me around. I enjoyed
those kinds of things. As a matter of fact, as I was saying
earlier, when you become an expatriate, you really became an
expatriate; so all your friends, all your activities, were
associated with Aramco. You are separted from U.S. living, and
it s a whole new way of life.
I was athletically inclined, and Aramco provided that. They
had all kinds of sports events; they had everything you could
think of. I was a tennis player of some skill, and I was the
Middle East tennis champion for several years. My wife also
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played well. We were number one, both of us, in the Middle East.
That was a big attraction for us.
Hicke: I recently interviewed Richard Perrine, and he told me to ask you
about playing tennis at lunch. For some reason, he said you d
drag him out there and play tennis at lunch.
Taylor: Well, I was number one; and in those days, I was heat resistant.
Dick was a very good tennis player, and he would challenge me. If
you were challenged, you had the choice of time and place. And so
whenever I thought it was going to be tough to win, I d say,
"We re going to play at noon!" Everybody else wanted to play
either early or late, but I thought Dick was good enough, so it
had be at noon: "Dick, I ll meet you at twelve o clock down at the
courts . "
So I had a great time out there. I ll tell you something: if
I had it to do over again, I d do it. When I talk to some of my
friends that were here, surgeons, they ve had a boring life, as
far as I m concerned. One thing I will say about Arabia, which I
consider to be very important: it was never boring.
Hicke: That could be the good news and the bad news.
Taylor: In any event, it was an exciting life, and we met many interesting
people. We traveled all over the world, which we enjoyed. Our
children were born there and grew up there. Both of them were
very prominent in the local scene as kids.
I think that the big dilemma with people was when to leave.
Aramco, as I said before, had a backloaded system, and there were
significant financial benefits for those who stayed.
Hicke: You did say that, but you didn t tell me on tape.
Taylor: Originallywhich was common everywhere- -with regard to things
like your retirement, you had to stay so long. Originally you had
to stay twenty-five years to get a retirement. If you didn t stay
for twenty-five years, you didn t get any retirement. So
obviously, people were very determined to stay twenty-five years.
The employee who killed the Arab, had he left, he would have had
to sacrifice his retirement. And he d been there eighteen years
or something like that.
Hicke: So that explains it.
Taylor: So that was why he was so determined to do it. It wasn t that he
was obstinate; he just hated to give up a life s work, his
retirement. Then later, it became modified as it has in the
207
States. Now it s portable: you can retire anytime, and you can
take along whatever you ve got put aside thus far.
But originally, they kept backloading, so that the longer you
stayedand the magic number was twenty-five when I left in
twenty- five years, you got all Aramco had to offer. And in a
sense, you didn t get much more after that; you kept it, but it
didn t keep going upwhich they did on purpose because at that
time, they wanted you to leave. [laughter]
Hicke: Why was that?
Taylor: It was a very interesting thing: originaly at the age of sixty,
you had to leave and I mean had to leave. They had it so
arranged that nobody if they could possibly avoid it, and that
was most of the time could be in Arabia sixty plus one days. So
you had to leave when you were sixty, on your birthday, or before.
You could leave or retire before. But they just had this funny
rule that sixty is it. Sometimes the guy would leave, and his
wife and kids would still be there packing up! [laughter] I
always thought, "Boy, talk about holding the line!"
Hicke: Why? Why did they have this?
Taylor: The reason was many people didn t want to leave, you see. The
employees were always trying to figure out some way to stay a
little longer and hang around. A lot of people thought that was
their world and their life, and so they hated to leave. In fact,
some of them actually retired in Saudi Arabia- -but not many; I
think maybe five out of the whole crowd. But people just kind of
hated to go. So they finally made a rule: on your sixtieth
birthday, you re either leaving that day or before, and that s it
--and there are no more arguments. One of the guys said, "July
the sixth is my sixtieth. I gotta be out here on July the
fourth." So that s the way that works. As a matter of fact,
Perrine, the guy you talked to, was the first employee in Aramco
history, after the law changed, who stayed after sixty. It caused
a furor. He wouldn t go, and because of the new law he stayed on
for two years .
Hicke: He didn t want to go, either; I recall he wanted to finish up his
research and publications.
Taylor: It s crazy. You wonder, "Why would anybody want to stay in this
crazy world?" It was something. But it was an exciting life.
There was a social life out there you couldn t believe. And the
social life was fast and furious inside this little compound. The
travel that went with it was exciting: every long weekend, people
would fly to Bombay, or fly to Cairo, or fly to Beirut. We called
208
them the DOGS, which was the group that went places, the travel
group. If you wanted to go with them, you could go somewhere
every long weekend. Many people would go out six times a year.
They d go to Bombay one time, Cairo. Beirut was the favorite
place. The Aramco playground.
Beirut was called the Aramco playground for good reason. It
was some playground! We used to love it, because a lot of the
women who worked in the shows, particularly in Paris, would come
down there and be in the- -they had a famous gambling place- -the
Lebanese casino. They had the marvelous shows. But those girls
didn t seem to have something to do all the time, so they were
downtown a lot and certainly improved the scenery in Beirut.
Hicke: That s why it s known as the Paris of the Middle East.
Taylor: That s right. It had a charm about it that you had to like. Not
only lovely ladies, but high-style clothes, marvelous clubs,
swimming in the Med, skiing in the Cedars--a sophisticated
society.
However, some employees could not adjust to desert life. We
had one doctor come out, I ll never forget, who was a New Yorker.
He loved New York and he went to the clubs. And he was a chess
player. He loved playing in the chess club tournaments. He came
to me one day; he said, "I ve got to go home next month in
December." I said, "Why is that?" He said, "The chess tournament
is on. I play every year." I said, "But you ve only been here
six months. You can t go home." He said, "I have to go! I m.
going!" I said, "Oh? Well, if you go, I think you ll have a lot
of time to play, because you won t be coming back." We had a big
fight about it. Actually, he could have played in Dhahran; we had
two "master" chess players.
As a matter of fact, I finally arranged it so that he could
go. And he did go. But I told him, "Don t do it againbecause
this is the only time." But he couldn t stand it out there. He
quit. It was just not enough for him, you know. He just couldn t
enjoy himself. It was a place which appealed to me; it didn t
appeal to him. You had to like it. A lot of people stayed, many
left. Interestingly enough, the compensation for doctors was
never quite good enough, never irresistable. They put us in a
category with the engineers, pay-wise. But the category for other
groups like nurses, teachers, techs--was almost always
comparatively much better an incentive to stay: "Whatever you re
making now, we ll double it." That was the standard criteria. So
we d get a nurse who was making, let s say in those days, $20,000
a year here in the U.S., and she d get $40,000 with Aramco.
209
Hicke: Why wouldn t they do that for doctors?
Taylor: They thought engineers were top guys. They were all engineers.
They were going to put doctors in with engineers; the truth of the
matter was, in those days, doctors were in a higher income level
than engineers back here. But that was another thing we could
never get together on either. As a result, Aramco had great
difficulty in recruiting and keeping high-quality physicians.
Hicke: They didn t quite figure that out.
Taylor: However, Aramco had many redeeming factors. We used to call
Aramco "Mother Aramco." One of our top employees went to India
and got acute amebiasis and almost died. We got our plane out,
flew over to some little place in India, picked this employee up
in our little Convair, and flew him back to Arabia and took care
of him. He was over there on a vacation. So Aramco would do
whatever it took to take care of its people. It was a
paternalistic attitude that a lot of people liked.
I was just having a good time. Then I d come home and talk
to my friends; and I d think, "These guys are having a boring
life." So I wouldn t quit. My wife regretted it, because I did
pass up a couple of nice opportunities. But that s why I stayed
all that time.
It would almost appear that Aramco had a sixth sense about
this, because every time I d pretty much made up my mind to leave
--I had a great offer from Stanford, out in Palo Alto. Somehow,
you think somebody d let them in on it, because I came back and
they said, "We know you re thinking about leaving. But we ve got
some nice things to talk to you about. You know that house you ve
always wanted that Frank Jungers--he" s the presidentused to live
in? Well, we think we can get that for you. It has a pool in it,
and we ll fix that up for you. Of course, it s time for your
raise, but you ve done such a great job, you re going to get a lot
more than usual."
One year they sent me to the tennis tournament in France on
the Riviera. They said, "It ll be good publicity for Aramco." I
said, "Absolutely!" So my wife and I and two other people went
from Aramco, and played in the French Riviera tournament. They
did little things like that, and I thought, "Why should I ever
leave?" So then I d go in for another two years.
Hicke: So you signed up in two-year increments?
Taylor: Yes, the contracts were for two years.
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Hicke: They d make an offer you just couldn t resist.
Taylor: Yes, an offer I couldn t resist. It was exciting, I must say,
I still say, there are no other opportunities like this.
and
My wife, if she were here, she d probably say we stayed too
long. In the later years there, my kids were in college, and then
they didn t want to come anymore, because to them it was boring.
And a lot of our friends had left, retired and gone. Our little
social group was breaking up. Even I got so I thought, "Well,
it s certainly lost a lot of its luster; the same old crowd isn t
around; not having as much fun anymore."
So finally I quit at twenty-five [years of service] . Even
then, it was hard to do. I always said, "That letter I had to
carry up the hill (to say that I was leaving) was the heaviest
letter I ever carried." Because I really left reluctantly, and at
considerable cost to me financially. I left at fifty-five. If I
had stayed until sixty, it would ve amounted to considerably more
income at the end. But in looking back, we had done it there was
no doubt about it. When you say, "There s no place left on earth
I want to go, my kids are back in the States, and my wife is fed
up with the place," you ve got to start taking it seriously
whether you want to stay or not. So that s why we finally packed
it up and left for good.
Chief of Staff. Clinical Services. 1963-1968 ##
Hicke:
Taylor:
Going back to 1963, they persuaded you again to stay, and you were
chief of staff from 1963-1968. What were your responsibilities?
Chief of staff was the job where I was responsible for all of
clinical medicine. I was over not only surgery, but the medical
department, the OB/GYN department, the dental.
Dental Care
Hicke: Can you tell me more about the dental service?
Taylor: Dental is worth touching on for a moment, because the dental
service was something that they definitely did do right. The
dental caught the fancy of management more than the medical.
211
Hicke: They needed it?
Taylor: I think it was mostly because all their kids needed their teeth
straightened. Anyway, we had a beautiful, big dental clinic
there. As I told you, it went from one dentist when I first went
there, to fifty dentists when I left. So in Ras Tanura and
Abqaiq, there were two or three dentists in each place. The big
center was in Dhahran. We had orthodontia, endodontia, oral
surgery- -we had complete coverage. They were highly
subspecialized, so they provided a superb dental service.
In the end, when we rebuilt the hospital we built a new
dental clinic that must have been the best dental clinic outside
the United States in the world. If you went in there, it was
absolutely astounding. And this was all due to [Bernard] Bernie
Eggerman, because Eggerman was a superb dentist, and he had
imagination; he had creativity. He created this clinic; it was
round, with offices coming off of the center, administration was
in the middle, and everything related to dental service you could
think of was in there.
Hicke:
Taylor:
Originally, we would only provide Saudis with emergency
dental work. But then as the years went by, we kept giving them
more and more of the dental work, and that enlarged the system.
The dental educators taught preventive dentistry to the Arabs, as
far as how to take care of their teeth. So that was part of their
job, and the dental work grew and grew.
But I have to give 95 percent of the credit to Eggerman, and
the other 5 was me driving it through management. I have to give
him credit, because not only could he visualize it, but he could
convey this to other people as a really great idea. So that s why
the dental program was good. He was there; he was the kingpin of
it--as versus the medical, where people were moving around more
and not concentrating on one area.
So you had Outpatient Service, Medicine, OB/GYN, Surgery,
Pediatrics, Radiology, Laboratory.
Yes. They all came under chief of staff. As I told you, the
outpatient load was huge. That was a big system, so that in
itself was a major undertaking. Not as glamorous as inpatient
work, but very demanding because of its size and being spread over
such a large area.
212
Administrative Matters
/
Hicke: How much of your time did you spend on administration?
Taylor: I would say, in that job, about 50 percent, which wasn t what my
bosses would have liked. It was funny, because I turned the job
down once because they said, "No more surgery." Well, in those
days, I was thinking, "I m not going to stay here forever. I m
going to go back and do surgery, so I m not going to quit doing
surgery." So I turned the job down. The guy who got the job, we
didn t get along too well, and I said, "That s not going to happen
again." He left. They offered me the job again and said, "No
surgery." And I said, "Well, I ll keep it to an absolute
minimum," and I took the job.
Hicke: Who would you be reporting to in management?
Taylor: As chief of staff, I reported to the medical director. The
medical director was over everything medical.
Hicke: And who was the medical director?
Taylor: Well, the medical directors were: Robert Page; then Dick Daggy;
then Dick Handschin after Dick Daggy.
Hicke: I hope to talk to him, too.
Taylor: Dick Handschin became the director after Dick Daggy, and I was his
backup, chief of clinical medicine; I was also the assistant
medical director. I was right behind him. He had to leave for
personal reasons, reluctantly. This was unfortunate for him and
for Aramco; he was a dedicated, competent director.
Medical Director. 1968-1978
Taylor: This is a funny little story you ll get a kick out of. When he
left, I had just automatically assumed that I was going to step
right into that job. They called me up and they said, "Come on
up. We re going to have a meeting about the medical director."
And in my naivete, I completely expected for them to say, "And Dr,
Taylor, you will be it." So I get up there, and they start to
talk about it: "Who will we make medical director? Should we
bring in somebody from the outside?" Out there it was very
fashionable to bring in someone from the U.S., not infrequently
someone that was no longer needed in a parent company.
213
At that time, Bob Brougham was president. I happened to be
sitting next to him, because I thought he was going to say to me,
"And Dr. Taylor, you re the next medical director."
So this selection concept was going on--"Maybe we should take
this guy in; maybe we should get a lay administrator"- -and that
went on for about half an hour. I got out a piece of paper and I
wrote a little note to Brougham, who was sitting there: "If I m
not medical director when I walk out this door, you can get
somebody for my job as well as medical director." I meant it. I
handed it to him. He looked at it and said, "This meeting is
temporarily discontinued. Everybody except Taylor leave," so
about six guys got up and left.
He said, "Why do you want to be medical director?" I said,
"Are you kidding? Do you think I ve been out here all this time
and I don t want to be director? I ve been in this system for--"
whatever it was--"f if teen years." He said, "But I thought you
wanted to be in medicine and all that." I said, "I do, and I will
still continue to do about as much as I m doing as medical
director." He said, "You can t do that. The job is not like
that." I said, "Take it or leave it." I meant it. And he said,
"You re the medical director." He called everybody back in: "I
just made a decision. Dr. Taylor will be the next medical
director." So that s how I became medical director by popular
choice.
My boss was a guy named George Larsen. We were walking away,
and he said, "What happened in there?" I said, "George, you ll
never know." But I would "ve left, because it was one of those
face-saving things, you know. Everybody, including me, thought I
was going to be the medical director. For them to start talking
about people that had absolutely no ability to do this job was
more than even I could stand. As easygoing as I am, I wasn t
going to take that one.
Hicke: They clearly thought you didn t want it.
Taylor: Well, later I said to Brougham, "Bob"--Bob was a guy I knew; he d
came up from Down Under; he wasn t originally destined to be, but
he was a goer--"a guy like you should understand that a guy like
me is not going to let that happen. It just can t happen."
Because he said again, "What did you want to do that for? You
have to fool around with all these kinds of problems that have
nothing to do with medicine." I said, "That s okay. I ll accept
that" because it was financially very rewarding, and I was always
happy about that. So that s how that happened. I became the
medical director.
214
Just to finish up that part of it, I was medical director for
approximately ten years. Other guys were moving up. I ve
forgotten which president was in. I said, "It s time for me to be
on the board. I ve been here long enough to be on the board and
I ve got one of the biggest budgets in town." In fact, I had the
second biggest budget in the company. They wouldn t call me a
vice president; that was too much for them. They said, "No, we
can t make you a vice president. We re going to make you the
executive director of the Aramco Medical Department," I think
that s what it turned out to be. There were fourteen men on the
board, as I remember, and I was the fourteenth.
Hicke: Everybody else was operations?
Taylor: They were, right, as a matter of fact. They only did it because I
was insistent and a good friend to most of them. There was no
administrative reason, in a way, but at the same time I was over a
larger budget and had far more employees than several other vice
presidents .
Hicke: Well, were there budgetary considerations?
Taylor: Not really, because they didn t think in terms of money. It was
more important to know where they were going to drill another wild
cat well out in the desert than whether the hospital opened or
closed. We didn t really have anything to do with the real oil
business, so I could see their point. But that wasn t good enough
for me. The thing I liked about it most one of the reasons I was
so persistent--was one had access to the airplane. If nobody else
was using the plane, you could take the plane. So finally
Brougham said, "We ll just give you the plane." [laughter] I d
come up there to ask that pretty often, "I d like to have the
Gulfstream this week. Is anybody taking it?" Brougham finally
said, "You re overdoing it." I guess one time while I was gone,
some important Arab wanted to go somewhere in the damn plane.
"Where s the plane?" Well, anyway, in those last few years, I did
have fun.
Hicke: Where did you go?
Taylor: Well, that time I was in Rawalpindi, which was the capital of
Pakistan. Then I flew to Bombay; I flew up to Iraq sometimes. We
went up to Iraq to look at the hospital when we were thinking
about hiring Iraqi nurses. It was a long weekend so we went on to
Beirut; that was our favorite place to go. That s what happened
toward the end of my career out there; however, I felt that I
deserved the post, given the size and scope of the Medical
Department and what we accomplished for Saudi Arabia and Aramco.
215
More on Contract Hospitals
Hicke: Okay, let s go back. I want to ask you a little more about the
contract hospitals. You alluded to them before, but I d like to
ask you to describe these in full.
Taylor: Those were the Asharq and the Asalama Hospitals. They were both
underwritten, in a sense, by Aramco--in the sense that we
guaranteed them so many beds. So they got a steady income from
us, and then we sent certain patients to them. That made good
sense, because when those were started, not only did they take
care of our patients, but they definitely provided a higher level
of medical service to everybody in that area. There were a lot of
people in that area who couldn t use Aramco, like Lockheed, the
military, all kinds of other American companies. They all used
those contract hospitals. Indirectly, we convinced the managers
of those hospitals that they had to have good staff and maintain a
good reputation.
We gave them a lot of support. For example, we would provide
blood for them if they needed it. We d provide advanced
laboratory services, advanced x-ray services; in other words,
their patients--all of their patients could come up and use our
support facilities. They didn t overdo that, because we would
charge them, you see, so they wouldn t send anybody up that didn t
need say, a GI series or something like this. So we worked in
coordination with them to assure a reasonably high quality of care
for our patients and their local clientele.
That did three good things: one, it provided a much better
level of care to the local area; two, we shifted a lot of our
inpatient load off to them, which was quite acceptable; and three,
it took away the onus on us to provide medical care for everybody,
because they did a large part of the outside work we were
originally doing before. It was a very desirable concept at that
time; the managers did a good job and made a good profit. They
were responsible to me. We were down there all the time, seeing
our patients; and if the care was inappropriate for our patients,
and we didn t think it should have been, we d definitely have a
meeting about that. So we helped them provide good medical care
for the benefit of all concerned.
Hicke: When did you get this started?
Taylor: Good question. It was well after I became chief of Clinical
Services, so it must have been around 1963, somewhere in there.
Hicke: And can you tell me what it took to get this going?
216
Taylor: The original hospital was the Asharq Hospital managed by Dr. Joe
Yamine and Dr. Afif Wahab, both Lebanese doctors who came to Al-
Khobar to open a private hospial. I knew Joe pretty well. He did
not do medicine himself but did want to run a good hospital and
provide an appropriate quality of care. Dr. Yamine of the Asharq
Hospital was the first partner. And then Ali Ahmed, who was
previously an engineer with Aramco, saw this as a money-making
proposition. So he got the second hospital going. That was good
because they competed, and that kept them both at good levels.
Another thing was that they employed Arab nationalities.
Almost all of their doctors were of Arab origin. Many of them
were Beirut citizens, several Palestinians, and Egyptians. In
those days, that was good. There was a solidarity behind that
group of people, and they were all very pro-Arab, and so it was
very well received. In the interval before the government really
got their system going, they were a great fill-in, to fill in that
gap. If you have a big company like Lockheed, they have to be
able to say with some assurance that there s pretty good medical
care around. Otherwise, people are very nervous about living out
there.
Hicke: What were they doing before?
Taylor: Lockheed?
Hicke: Yes.
Taylor: They just got started then.
Hicke: But Bechtel had been there.
Taylor: Bechtel used us. Bechtel and Aramco were very close. Steve
Bechtel, who was a patient of mine, had a very close organization.
They re still doing things out there in a big way. Fluor also had
a deal with us that we d provide medical care. However, with
Bechtel and Fluor combined, they only made a few medical visits
per year.
Hicke: How large were these contract hospitals?
Taylor: I think each one had 110 beds, plus all the outpatient services;
in other words, they had a big outpatient unit and they d see
anybody. But they were pay as you go. You paid as you came
through the door, unless you were Aramco; in this case we paid.
Each one of them had an operating room, they had straightforward
x-ray equipment, and they had modest labs. But each one of those
was done well. What they did at their level was done well. And
they too, under our insistencecertainly for our patients--had to
217
Hicke:
Taylor:
Hicke:
Taylor:
Hicke:
Taylor:
Hicke:
Taylor:
keep good records so we d know what was going on.
good medical care.
How often would you go to visit these hospitals?
They delivered
Probably on average every two weeks we d do an inspection, where
we d go down to see how things were. I knew both of these
managers well, and I made sure they understood in a nice way that
the standards had to be there, because all we needed was have some
unfortunate medical results and there d be big trouble with the
whole conceptwhich they recognized in the end, would be big
trouble for them.
These were for-profit hospitals?
Oh yes.
And were they profitable?
Absolutely. That was a big conflict. It s just like today: it s
very hard now for a hospital to be profitable. You have to cut
corners; you have to watch out not to cut the wrong corners. But
that was why we were going down there all the time to inspect
them. Even then, it wasn t all we would like, but it was close
enough to work. They were always short-staffed; it was hard to
keep staff; it was difficult to run a decent hospital in that
area.
Did they have enough electricity and water and all those things?
Yes, they did. That was a side effect of Aramco, because we kept
Al-Khobar, where there were a lot of employees living, hooked into
the water system. The telephone system looked like a spider web;
there were about eight million telephone lines, because every
telephone had a single wire coming from the base unit to that
telephone. So you look at these telephone poles, and you could
almost tell the state of progress of the country. Originally,
there d be about five lines; and when we left, there were about
five thousand lines on this same telephone pole.
Phones were a luxury. You had to wait a year to get a phone.
The local Americans who worked down there, that could drive them
crazy. So that was one of the drawbacks. Anytime those companies
had a serious problem medically, we d take care of it. You also
had a big military base there for a while, 25,000 airmen, and we
were very closely associated with them medically. They had a
hospitalit was a nice buildingbut they didn t have any
surgeons. The guys who d cycle through there were young M.D.s
right out of school, you know. So we helped out a lot. Luckily
218
they were a healthy bunch of guys. Usually an accident or
something would be their major medical concerns.
Hicke: There weren t any dependents?
Taylor: Very few. Some of the very high-ranking officers had family, but
there probably weren t more than twenty dependents in the whole
place. In the American Consulate, you had just another small
group of Americans.
Hicke: Where was that?
Taylor: The consulate was between us and the air base, about five miles
away. We needed them and they needed us, and we worked very
closely together. We d take care of any major medical problems
they had, but there was only the consul general and his wife and
occasionally his family and the marines who took care of the
consulate .
Medical Care for the King and Royal Family
Taylor: The other group we took care of was the royal family. We had a
steady flow of those people. King Saud ibn Abd al Aziz was the
ruler when we got therehe used us a lot. He had great faith in
us, and he d come over for all kinds of medical problems. We saw
him a lot; I personally saw him many times. Any of the royal
family, which was big, could come, but they didn t like to come
because they wanted to go out--just to go out. So they d use
London, and they still do. If it was an emergency, they d come
and see us. It mainly depended on the level of their closeness to
the king, too, because the extent of the royal family is unknown.
I don t know how many there are that can legitimately claim to be
part of the royal family, but it numbers in the thousands. Once
they came and were approved by our Government Relations people, we
took care of them- -whatever level they were. It didn t matter to
us.
But when the king came, that was always a big occasion,
because he d come in an take up about half a ward. Phil Gelpi was
his main physician. Did he ever tell you about that?
Hicke: Yes, he told me a little bit about that.
Taylor: Oh, those were trying days. Phil and I were responsible for the
king s care, but were not fully appreciated by the king or Aramco.
219
Hicke: Wasn t he the one who was eventually deposed?
Taylor: Yes.
Taking care of King Saud ibn Abd al Aziz was an adventure of
its own. We went over two or three times, and we d go into the
palace. First time, it was like two in the morning. Our Government
Relations guy just called up and said, "Come down and get on the
airplane." I said, "Just a minute." At that time I m thinking I m a
wheel, you know, and I said, "What do you mean come down? What for?"
He said, "We re not discussing it. Just come down."
Taylor: So I got Phil Gelpi, who was the chief of Medicine, and the two of
us went down and got in this plane; we still didn t know what it
was all about. It was like cloak-and-dagger stuff. We got over
there; it was about three in the morning, dark. We got out and
there were three big, black Cadillacs lined up; so we got in one
of them with a guy named Ron Metz, who was our contact in Riyadh.
He was acting like it was top secret, confidential, you know.
Another guy that was there was Sheikh Bed Ibn Salim, who was the
king s top confidant. So we rushed over and here s the king lying
in this truly king-size bed. We were duly impressed. [laughter]
The bed, I swear to God, was almost as big as this room. We came
in; we couldn t even get close to him to examine him, he was in
the middle of this bed.
He s looking sad, because he s been throwing up this blood--
and there was lots of it. So we immediately began looking sad,
because we knew that we had a real problem on our hands. Sheikh
Eed was a very tough Arab; he said, "This is not going to happen,
you know. You guys do whatever." So then when we started telling
him what had to be done, the king kept saying, "No. No!" He was
not going to do this, not going to do that, couldn t take any
blood; he was not what you call the ideal patient, to say the
least.
So finally we said to Ron Metz, "You tell Sheikh Eed, who s
siding with the king on everything, that if he wants the king to
be around here tomorrow, he d better do what we say; he d better
do it now!" I got tough. I said, "If anything goes wrong here,
you make it clear to him it s his responsibility and he s the one
who s going to be held responsible." Sheikh Eed didn t like that;
nobody talked to him like that. I said, "That s the way it s got
to be." And I said, "Ron, you re representing Aramco. You better
make sure it gets done, or else you 11 be in the hot seat."
220
Hicke:
Taylor:
Hicke:
Finally--! ve forgotten how long it was; too long for us--he
finally agreed. We got him on the plane with all these people.
Every time a plane takes off, everybody tries to get on it. So we
were out there fighting them off. We flew back over [to Dhahran]
and got him into Aramco, and finally got him medically stabilized.
But we had all kinds of consultants from all over the world,
mostly from the U.S., and they were looking at him. It was some
deal. He didn t want to leave; he wanted to get it settled right
there. In the long run, Dr. Francis Moore, chief surgeon of
Brigham Hospital in Boston, who s a good friend of mine, came over
and took over.
There was a funny vignette: I sent for Franny Moore, and this
guy shows up from Germany! I thought, "Well, what s Franny Moore
doing in Germany?" I went down. There was a guy whose name was
Franny Moore. It wasn t Franny Moore from the U.S. [laughter]
In the communications system, somebody found a Dr. Mohr in
Germany, who was big in tropical medicine. But that wasn t what
this problem was. So I went down and he was there, and I said,
"Why are you here?" He said, "They sent for me. I m here to save
the king." "Oh," I said, "well, that s good to hear. I hate to
say this, but you re not the Franny Moore we sent for." "What?"
he replied. Oh, he was indignant. And he hung around the whole
time .
Trying to save the king?
It turns out he was a world authority on tropical medicine, but
that wasn t the king s problem. And then when Dr. Francis Moore
finally showed up, we introduced them. They had a great time
together. They stayed up into the wee hours talking together.
That s only the abbreviated scene, but that was a frenetic
occurrence, I ll tell you! Then under Dr. Moore s direction, it
was decided to move King Ibn Saud to the Brigham Hospital in
Boston.
I ll never forget: they got a TWA 747 ready. But the king
did not want to seem like he was sick. So we put him in a big
chair in his hospital room. We brought up a huge trailer and put
the chair on it and they wheeled him out. Then we lifted him up
into a truck with a forklift and put him up in this truck in his
Aramco-made throne, and he was sitting in this truck like this,
[indicates position] He waved to his citizens as he was taken
down to the TWA jet for Boston.
You indicate he was leaning back, with his head back, barely
surviving.
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Taylor: Yes, but he had so many clothes on no one could really see how he
was. I ll never forget it as long as I live. We got down to the
plane, and they had another forklift down there, and they lifted
this whole platform with lights up to the plane door. Then the
problem was getting some people to get him out of that damn chair
in through the plane door. The rest of us were climbing up the
steps, and we had to haul him out of that chair. He was trying to
walk, you know, like there was nothing wrong with him, all these
people were cheering, and he made one last feeble wave to the
crowd.
We finally got him through the door, whereupon he promptly
fell into the bed we had arranged for him. And then all these
people got on I was telling you aboutthey filled up the plane.
I didn t go with him; I wish I had. They took off for Boston. I
could have gone. I missed that one. I don t know what I was
thinking about, because that was a spectacular trip. Franny Moore
went with them, and he wrote a paper about it. He wrote it up.
It was certainly one of the most spectacular medical
evacuations in all history, I ll tell you that. They got there
and they rebuilt the king. I ll give him credit that he came to
the right place. He had many little things wrong with him as well
as major things: he had a hernia; he had problems with his eyes-
he couldn t see very well. So that was that. It was quite a
scene. He was finally in decent medical condition and returned to
Saudi Arabia.
He finally stepped down because of ill health and King Faisal
ascended to the throne.
Early Saudi Medical Practices
Hicke : We have about an hour to cover your last years and there s a lot
to cover therebut I also wanted to ask you if you could tell me
a little bit about the Saudi medical practices as they were before
the advent of Aramco, so we can see how things have changed.
Taylor: There were two major phases. When we first got there, they were
still in an era where there was something like a local medical
person in the community, who really wasn t a doctor, but somebody
who was interested in and carried out medical activities. When we
first got there, one thing that the Arabs did learn fairly quickly
and easily that antibiotics are good. So when anybody had an
infection, the local people would give them antibiotics.
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Before that there were mostly what you and I would say was on
very practical first-aid basis. They did still have some outdated
practices: for example, one thing they used was cautery. The
objective of cautery, which is not quite as bad as it sounds, if
someone was having pain, the local medic would cauterize some part
of the body with a little cautery coin, almost like a nickel.
This would burn the area and leave a scar. We got so we could
diagnose abdominal TB because they d have these little burn marks
on their abdomen, and that was always because they had abdominal
TB. TB would hurt, they d apply the cautery and relieve the pain,
an ancient but effective remedy.
I m trying to think of other things. Until the advent of
antibiotics, it was pretty low levelfirst aid and splints. In
fact, they used to harden splints with camel dung, which is very
interesting; they d take soft camel dung and put a splint on a
broken leg, and wrap it in muslin. That would harden and hold it
in place. It worked surprisingly well.
Hicke: What about herbal medicines?
Taylor: They used herbal medicines and things like bark. I remember they
used the bark of some tree for something. Anyhow, according to
them, it worked; so who were we to argue?
When Aramco and these local hospitals had gotten there in
1962, 63--then they suddenly went into the next phase of medical
practice. They began to get in real doctors, who had been to
medical school and trained. Some of them were very competent.
Mostly, they would come from Cairothe University of Alexandria
and the American University of Cairo. Some of them were
Egyptians; some Palestinians came down; doctors from Beirut came
down.
And then Saudi Arabia started training doctors. They started
their medical school, which I think was around 1970 in Riyadh; I m
just guessing, but it was somewhere in that era. But of course,
they had four years of medical school before they graduated. They
eventually began graduating doctors, and then they came into our
system and went all over the country. We had two forms. In the
government hospitals, the doctors were paid by the government.
And the pay was not exceptional, I ll say that, to say the least.
A lot of the doctors had an obligatory time to put in, and they
would assign them to various parts of the country; so they got to
stay in that area until they d finish their time, which would be
two to four years.
Hicke: It s in response to the education benefits?
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Taylor: Yes, as a reward for being trained and being paid for, they had to
put in their time taking care of the population. After that, most
of them would try to get into a situation where they could make
money at the same timenot unlike we do here. They d concentrate
in the populated areas, in particular in the populated areas where
people had the money to pay. Other than these two hospitals in
Khobar that I was telling you about, there was one over in Jiddah
--there were some Americans working over there as well as local
peopleand then in Riyadh, there was a private hospital, but it
was hard-pressed to get doctors and keep up.
Then the Arab government had one of its meetings and said,
"What do we need to do? Shall we build a railroad or shipping
fleet?" They decided to build the King Faisal Hospital as a grand
and rewarding project. And they did. They built the fabulous
King Faisal Hospital, which was extremely well done. It s a
handsome building. They decided to make it the most modern
hospital in the worldnot just in Arabia, not just in the Middle
East, but in the world. They put everything in that hospital that
you could think of in the way of monitors, computer systems and
equipment. They had all kinds of modern x-ray equipment, as
modern as you could get in those days. I ll never forget: they
treated burns there, and they had a sand bed they put them on, so
they wouldn t irritate the skin. The very latest thing in
hospitals .
We collaborated. It was managed by Hospital Corporation of
America, which was in Nashville, Tennessee. Their approach was to
get well-known chiefs of services, more or less, from the United
States to come and run these big services. I remember they had
the retired chief of surgery from the University of Oregon, for
example. And they had another retired medical chief from
Vanderbilt. So they would look around, and with some success,
they would get very high-level people to come and monitor and
manage their respective services at the King Faisal Hospital.
Originally and still is, as far as I know it was open to
anybody. Anybody. If they came from China, they could come
there. It was a big hospital: I think it was 300 beds. When I
left, they were planning another 100 beds and it is now up to 500
beds. It s extensive; it takes up several blocks. They had their
own nursing school there, but they imported most of the nurses.
Arab women were slow to get into nursing; it was not regarded as a
high-level profession by Arab families still isn t so nobody
encouraged their daughters to become nurses. Nurses were imported
from India, Philippines, and so forth- -from outside the country to
do the nursing; large numbers were required the man the twenty-
four-hour shifts. They had x-ray therapy and cancer therapy
before Aramco. Now Aramco s gone into that, but we didn t have it
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then. They were the only center in that area that did that kind
of advanced treatment for cancer. So that s what happened as far
as medical progress was concerned in Saudi Arabia.
How did we help? For example, we set up an entire pay scale
for the staff. We set up a benefits plan, a contract schedule-
how long they should come for, how much vacation. That made it
easy for them from that viewpoint. We met with their management
team on numerous occasions to assist. 1 went into the OR
[operating room] and looked at things and told them how I thought
they should equip these areas, arranging OR location more
satisfactorily and so on. We had a little bit to do with the
actual construction in certain areas of the hospital.
Then, a big company from California, which you may know, came
into the Arabian Hospital system. They took over hospitals on the
west coast, of which there were three: one down south of Jiddah,
one in Jiddah, and one up in Yanbu. These were three hospitals
which were originally built as military hospitals, but they took
them over and converted them into good hospitals. So there was a
little chain over on the west coast that took care of that area,
and they were quite good.
There were a few private doctors around, like a couple of
Americans in Jiddah and Riyadh, but you had to be a certain
personality type to do that. It was one thing to live in Aramco
inside the compound; it was another thing to live in Arabia
outside the compound: two entirely different worlds.
Preventive Medicine and Research
Hicke: Now during your time as medical director, what were some of the
most important things that happened?
Taylor: Well, as I said before, in the clinics, we were training people
clinically, mostly with hands-on: we d walk around the wards and
I d make rounds; we d have four or five doctors and four or five
students, just like they do here. In the training arena, like in
the OR, if a new surgeon came--I remember when a new Saudi surgeon
came, he had to operate with one of our senior surgeons for a
year, in the big cases, until we approved him. They do that here;
that s standard practice. So as far as clinical medicine was
concerned, it was a routine very similar, as I said before, to
what we do here.
225
However, we made some big strides in training clinicians.
Public health and preventive medicine was done by Robert Oertley.
He was a man of the Arabs: he loved to go out and stay with the
Arabs. He d stay out in their camps with them and travel on the
desert. He spent a lot of time out there, and really knew what
their problems were.
One of the things that we did was the trachoma research
project. That was set up with Dean [John] Snyder of Harvard. I
don t know whether you re ever going to see him or not. Further,
the Aramco part of the research was headed up by Roger Nichols.
Hicke: Dr. Snyder sent us part of the memoir he s writing.
Taylor: In a nutshell, what they were trying to do was to develop a
vaccine against trachoma, because trachoma was making a lot of
Arabs blind. It s the leading cause of blindness in the world-
trachoma. What Harvard hoped to do was to make a vaccine that
they d give youngsters and prevent them from getting trachoma. So
we spent a lot of time and money working with Harvardin fact, I
think that research is still going on. Roger Nichols spent all of
his time on this trachoma project. Unfortunately, it was very,
very hard to make a vaccine against trachoma, because it behaves
like a cold virus. Even though you can give a trachoma antigen,
the antibodies resistance buildup only lasts for a little while--
maybe six months and then it disappears, like a cold. And then
if you re exposed to the trachoma organism again, you get
reinfected. Nonetheless, they worked long and hard at it, but
even today, I would doubt that they ll ever succeed, because of
the short life of the antibodies.
The other thing they found out which was very interesting:
the people in all those houses I told you about that we built, the
people in those houses never got trachoma. What they found out in
this research project was that there was a direct relationship
between the availability of water and the incidences of trachoma.
The more water you have to wash with and keep clean with, the less
trachoma you have. One time I seriously proposed that instead of
spending all this money on the trachoma research, we should put
water systems into these areas and we d knock out trachoma. That
happened, but by accident, not planning.
We did a lot of work on TB, which was equally difficult and
not very rewarding. We tried to educate them and we treated the
local TB cases. But TB had a stigma. Even though they knew they
had TB, they wouldn t come in. It has a stigma here [in the
U.S.], by the way. It s stigmatized because TB is regarded as a
disease that goes along with poverty; and as a matter of fact, it
is more common in people and areas where the hygienic levels are
226
low. So we couldn t make much headway there. It was hard to
educate them and it was hard to treat them. They d often come in
very late; and sometimes it was too late. We worked hard at TB,
but we finally got so that we treated it the best we could and
that was it.
One time we had a cholera epidemic, which we played a big
part in, which Oertley headed up for Aramco. I think we helped
immunize something like 200,000 Arabs with a cholera vaccine that
we had flown in. That was a big effort. After that, we kept kind
of an ongoing cholera vaccine presence: if any cholera showed up
anywhere, we d move into the area and vaccinate the contacts.
Since then, the cholera vaccine has lost its support; it hasn t
worked very well and is rarely recommended.
But all the Arab employees were vaccinated with the standard
vaccinations of that era. This included tetanus, diphtheria,
measles, mumps, and German measles--all the routine vaccines.
Once or twice when we thought we had a typhoid outbreak, we
vaccinated the involved people. So we had a public health program
that would protect everybody that we could.
We did those kinds of programs. Then another interesting
thing that we did which is worth notingand you ll get more of
this probably, so I won t take too longoriginally , when we first
went, they used nightsoil, which is human excreta to fertilize all
the local produce f ields--tomatoes, lettuce.
It was very difficult to persuade the Arabs to switch to
chemical fertilizer, because they d been doing this other for
centuries, literally. But the nightsoil caused everybody to have
worms. So that ascaris, big worms, were very common. It was one
of our common operations, where we d explore usually older kids--
and I won t discuss it because it ll ruin your lunch--and take out
literally pans full of worms. We used to call it the spaghetti
lunch. These worms would frequently cause intestinal obstruction.
In order to sell chemical/urea fertilizer, Aramco would go
out to a farmer and say--Aramco had contracts with certain local
farmers to use their produce, but the agreement was that they had
to grow it like Aramco said, no nightsoil. But they were still
using this nightsoil, because they would also sell this produce
elsewhere. So Aramco went out and actually marked off certain
areas in each farm and fertilized that area with urea fertilizer.
And they had to put guards out there, because the funny part about
it was that the farmers would come and in spite of all the
positive evidence, they d want to do their thing. So they had
that part marked off and fenced off. Then Aramco proved without
227
any shadow of a doubt how superior the synthetic fertilizer was to
nightsoil.
After that, they went to the four-crop season, which they
couldn t do before. They would raise four crops of tomatoes, four
crops of lettuce. So they greatly increased the produce volume.
That was an indirect health measure, but in due time, it greatly
reduced the number of patients who came in with worms and other
types of intestinal parasites that they got from this human
fertilizer. So it was a huge step in the right direction.
Hicke: I see all along here this theme of preventive medicine, which was
a crucial factor.
Taylor: Well, I never was as big as I should have been on preventive
medicine. But there s no doubt about it: if I were going to write
a thesis on preventive medicine, I d go there, because it s
demonstrated how much good it did. In addition, we cleaned up
their water supplies; we put in sewers. When we were putting in
these new Arab housing units, they had sewers. And then we let
the other people hook into the sewers. Before that, they d just
go out to the streams, you know, and that was it. Still do,
probably in many parts, but that contaminated everything, because
their stool would drain into these waterways which people were
drinking from. It was a vicious circle.
That was never fully accomplished; when I left, they were
still trying to get the sewer into Hofuf, because the people
resisted it. People didn t know: "Why do we have to have that?"
So those were some of the major health efforts. If you get to
Oertley, if you want, he ll clarify all these efforts.
And we did a lot of preventive dental, which helped their
teeth. We put fluoride on their teeth and gave them lessons in
how to take care of their teeth.
At one point, we brought in the pill for birth control.
There was a lot of controversy about that even amongst our own
people.
Hicke: Americans or Arabs?
Taylor: Birth control pill for the Arabs. Oh, the Americans were already
doing it. Well, the Arabs found out about this and learned what
was going on. So the Arab women who came to these classes said,
"We want to take the pill." Because it wasn t uncommon for one
woman to have ten, twelve pregnancies. It was easy to understand
why they d want the pill. That was very interesting, because we
Hicke:
Taylor;
Hicke:
228
started giving them pills with no advertising because we
anticipated religious resistance.
The local Qadhi, who were the religious leaders, found out
about it. They came up and said, "You can t do that. That s
against the Koran." Well, it isn t written in the Koran. But
anyway, they objected, so we stopped. Now this will give you an
indication of the power of the women in Arabia. These women
raised so much trouble about that, that the religious leaders
reversed themselves and allowed the women to have the pill. We
were trying to change the society about excessive pregnancies,
because for one women to have twelve, fourteen pregnancies is just
not a healthy thing. Overpopulation is not a problem there, but
at the same time, to have one man with three wives and thirty
childrenthat doesn t make sense somehow. But the Qadhi didn t
like it, and they yielded reluctantly. The only reason they
yielded was because these women were unified in their attitude and
demanding the pill. When I left, anyway, we would still give
anybody the pill. And I think that at one time, we had at least
2,000 women on the pill. In looking back, that was one of the
major changes the Aramco Medical Department created in their
medical activities.
That was quite a significant impact, I would say.
I think that s about it. I m trying to think of any other
changes. There probably are some things that I ve forgotten
about, but those were certainly some of the more major thrusts in
our preventive medicine that did make a big impact on the country.
I told Brougham one time, I said, "When Aramco is history and long
forgotten, the thing they may remember is the medical
contribution, because the accomplishments that were made by the
Aramco Medical Department did such a lot of good for Saudi Arabs."
Well, they won t forget it, because we ve got it documented here-
right here and now.
Taylor: Okay.
Tapline Stations
Hicke:
Taylor:
Let me ask you a couple more things,
with the Tapline pump stations?
Did you have anything to do
Very little. As a matter of fact, Tapline had its own medical
department, its own medical director.
229
Hicke: Even after they were acquired by Aramco?
Taylor: Oh yes. Tapline was always separate. They were like a
subdivision of Aramco from the beginning. But they had their
headquarters in Beirut. The Tapline offices were in Beirut, and
I ve forgotten the medical director s namehe s dead now. They
used to take care of the office and personnelof which there were
several hundredin Beirut. They also took care of these little
Tapline stations all up and down the desert pipeline--! think it
was 1,200 miles of 36-inch pipe carrying oil to the Mediterranean
--a long line of these little pump stations. At each pump
station, there were two or three people. They had two
developments along the line, which were full of Americans. They
used air transportation: you either fly a doctor in, or you fly
the patient out. They used basically the American University of
Beirut Hospital, which was a highly regarded medical center, the
best in the Middle East.
Taylor: It was staffed and run by Americans and was directly connected
with the Columbia-Presbyterian Hospital in New York City. Tapline
would bring its sick patients to that hospital, where they
received excellent medical care.
At first we set a dividing line: if the patients were south
of a certain level, they d come to us. In the end, I think they
all went up there because they had such good flights up there and
back. And they were small numbers: I think we re talking in the
hundreds, the people that were on that line that had to be taken
care of.
Recruiting and Hiring Staff
Hicke: Now what about recruiting and hiring people nurses, doctors,
whatever?
Taylor: All the supervisory posts were held by Americans.
Hicke: That was the policy?
Taylor: That was the policy. Right on down to top supervisors. But after
you got below that and got into big numbers, we would employ
foreign medical personnel. So at one time, we had nurses, for
example, from England, Holland, Iraq, the Philippines. Most of
our nurses were from India the largest number. The Indian nurses
230
were extremely good, because they were trained in a big British
nurse training center over in the southeast of India. I ve
forgotten the name of the area, but that s where they were trained
and almost all of them came from that area. The male Indian
nurses were the supervisors, and they were very good. Almost all
of our wards had a male supervisor except the female ward. The
other Western country nurses were always small in number and were
under our American supervisors. And they would be supervising
smaller segments throughout the medical system.
The doctors: we always had an overriding policy that if a
good Saudi Arab doctor applied, he had to be taken and he had to
be given a position. So towards the end, we began having more and
more of them. But oddly enough, they weren t too eager to work
for Aramco. Before Saudi medical schools started pouring them
out, there weren t many, and the ones that usually made it went to
the University of Beirut. They went to medical school there. In
my time, we had something like four Saudi doctors.
For the rest, we had a mix: we had Egyptians, Palestinians--
and they were good. Then we had Indian doctors, quite a number of
them. And then others, occasionally, like Peter Van Dooren, who
was Dutch. For a while there were Dutch medical personnel
available. So we had Dutch nurses and Dutch doctors. And they
were quite good. But in all circumstances, all medical personnel
were under the American system, and the Americans always were the
top-level guys throughout the system.
Hicke: Did the pay and benefits improve any as time went by?
Taylor: Well, they kept going up. For example: when I hired the
orthopedic surgeon, I hired him for--I remember pretty clearly--!
hired him for $170,000 a year. He was making over $200,000 at the
time, and the only reason he came was for the fun of it. So he
didn t stay all that long. Chuck Thomas was his name; he was very
good. In fact, he lives right near you somewhere. I know he
lives near Portland, Oregon. I kept telling the people in the
company: "You should pay doctors much more than you do, so that
you get good ones and they stay here." Although oddly enough, the
funny thing about it was, doctors would come and they would either
like it and stay for a long while, or they would quit quickly- -
within weeks. Lots of them would make one contract, which was two
years, and leave.
But the old die-hards like myself, Phil Gelpi--! think he was
nine years; Perrine was much more--I think he was fifteen, sixteen
years. There were a lot of doctors who were up in the double-
digit range. They just liked the life. They were like me: they
had a good time; they enjoyed the atmosphere and the life there.
231
You had to like that. Phil Gelpi was interested in sickle cell
diseasehe did a lot of work on that, and there was a lot of
sickle cell disease there; we gave him the time and the money to
do his research. Perrine, he just liked it. He was a very, very
fine doctor, Perrine--a very smart guy. So certain guys liked it,
and they would stay. They weren t really interested in getting
wealthy. Many of them, like Gelpi, could definitely have had a
very fine practice at home; but he just never wanted to be in
private practice. Neither did I. I was never in private practice
very long. So it was a type that you got who weren t quite as
interested in financial advantages. But in the long haul, by the
time I stayed that long and built up those benefits and
everything, it worked out pretty well.
In fact, I d be remiss in criticizing it too severely. When
I went, I started at $15,000 a year, but I came out of a system
where as a resident, I was making $2,000 a year. So I thought
this was great. It took a long time for that to build up, in sort
of standard increments. With each promotion, each time they
thought I was going to leave, it would build up much faster.
They did that with other people, too, as well as myself.
Aramco did have one intelligent philosophy: if they got an
employee that they felt was really good and good for them, they d
go out of their way to do things to keep them. That wasn t just
doctors; that was engineers and administrative guys all kinds of
different, talented guys. As a result, the middle and upper
management Aramco employees were very good at their jobs.
Hicke: But still, comparably speaking, the pay was not great?
Taylor: Well, you see, doctors pay, oddly enough, hasn t gone up much in
recent years. There s been a cap on it here--I was just reviewing
that so that you can get a good general practitioner for $120,000
a year, which in doctors language is the bottom. A cardiac
surgeon? He may make $500,000 a year a good cardiac [surgeon].
Neurosurgeons make the most: $700,000 a year. These are averages.
So if they were going to hire a neurosurgeon and had to pay
$700,000, they d say, "Hell, we ll buy a private airplane and fly
them all back, because we ll save money." So they probably
wouldn t be willing to ante up for such highly specialized and
expensive employees.
Now they have very few American doctors left, because of the
Saudi takeover, which was a well-disciplined change, by the way.
However, one of the major aspects of the change was to replace
Americans with Saudis.
232
Impact of Increasing Saudi Ownership Participation
Hicke: I want to ask you a little bit about that and its impact on the
Medical Department.
Taylor: Ever since that happened, they ve been weaving in more and more
Saudis and Arabs. Although oddly enough, I remember I noticed an
ad the other day in the paper that Aramco was looking for medical
personneldoctors, nurses, and so forth. I thought, "Well, I
could always go back." So they are still looking. I will say one
thing: the Arabs hold American medical practice in very high
esteem. They always thought and I think they still dothat it s
the best in the world. They d go up to London and they d get
super specialist private doctors up there. But they went to
London because they got very special attention there. So they
always had the policy of bringing in American medical personnel.
In my opinion, they are right: the English do first-class
medicine, but not as good as in the States.
After I left, one of the Saudis that I had been promoting
Adnan Habbal became medical director. 1 think he had a stormy
reign as director, because he liked great loyalty, which everybody
does, but I think his demands in that area were a little stronger
than usual. So anyway, he took over. Then a lot of divisionary
problems came up where people would disagree about what we should
do next towards making things better- -which way to go internally
within the medical department.
Another thing about the Arabs, which in a sense is good:
they re very fatalistic, and I mean truly f atalistic not just
mouthing it. One thing that always used to amaze me: when they
had these big wrecks I was telling you about, their relatives
would come in, and the dead bodies would be laid in the back hall.
They d go down the line until they found their relative, wrap them
up in a white cloth and take them away. There was never anything
like "Well, what happened here?" or "Whose fault was this?" or
"What did you guys do for him?" There was never anything like
that; it was amazing. We d lay them over there, and out they d
go. They d put them over their shoulder, or two of them would
carry the body out and put it in a vehicle of some kind. Gone.
So there was essentially very few medical legal problems, which is
very interesting, because that s one of the big banes of a
doctor s existence back here. There s nothing I hate worse than
to get a subpoena or have one of my guys get a subpoena. We know
we re going in for a long, drawn-out, miserable affair. Well,
there was none of that there. That was one of the attractions
about being there. They appreciated the medical care they got and
assumed those providing the care did the best they could.
233
Hicke:
Taylor:
On the other hand, it wasn t completely free of oversight by
the local system. For example, one time a guy died in our system
whose father was the employee. The son had a brain tumor. None
of us were neurosurgeons, but that was in the days when Saudis
couldn t go anywhere; we had to handle it. So we decided to
delineate this tumor and find out how big is it, if it s operable
or not. We did a cerebral angiogram, a blood vessel picture of
his brain, and after that angiogram, he died. So the fellow, who
was named Michael Jura j , who was a crack surgeon, was called down
to the local court by the Qadhi and had to explain that. And
Aramco said, "Not to worry. We re right behind you."
Well, I atended the Qadhi s questioning session and the Qadhi
said, "Juraj, you better have a good explanation for this." The
problem was, as I told you before, once you get in their court and
are playing by their rules, if you turned up on the short end of a
judgment, you might be subject to their very dangerous sentences.
That could be very unpleasant, to say the least. Juraj was taking
it all sort of matter of factly, until he suddenly realized that
if they decided that he did something wrong, it could be a serious
problem. The Qadhi ended up saying, "I m letting this go by,
because I think everybody was trying to do their best. But," he
said, "in the future, if any doctors like you, Dr. Juraj, are
doing things that you re not fully trained to do, there s going to
be a bad problem." Well, that cooled things.
So those things we had been doing, which were a little on the
margin, you knowlike thatwe quit doing them. That s all.
Nobody was going do them and run a risk like that. So that s the
way the interactions would happen. But that was about the only
time that there was a big problem with something like that. That
shook up everybody, because Juraj was trying to do the best thing
for this boy. He was trying to help him if he could. We all
expected that to go through the court in our favor. But it didn t
--and we ended up with this warning. So that created an internal
resistance on the part of the doctors: "We re not going to do this
because of that," you see. They would quit doing things that were
a bit out of reach, in a sense. "Should we really do this or not?
Suppose it doesn t work out right?" Sometimes that resulted in
lack of treatment where there should have been treatment.
Tell me a little bit about the impact of the increasing Saudi
participation in ownership.
Well, luckily, I was not there for the big impact. When I left,
it was still under American directorship. John Kelberer was still
the president. We didn t feel the impact. And it s my
understanding, from talking to people who were still there, that
it was a subtle thing. But the major impact was, as I look back
234
on it, when the Americans were in charge, it was like "Well, we re
all in this together, and we re going to make sure everybody does
well here in all areas legal, sickness, whatever the major
problems that might arise, were. We will make sure that you get
what you are entitled to."
But I think the Saudis are more independently minded; they re
more concerned about how they re doing individually, versus the
company. As a result, I think everybody feels significantly more
nervous about if they go in and say, "Oh, I think my kid s got
some serious problem." In the old days, that patient would be
hurried back to New York, let s say, to see what it was; I think
that that isn t quite as easy as it used to be. And that s
understandable, because they don t ship the Saudis out to New
York, you see; and you can understand how some Saudi manager who
has to approve it would say, "I don t know about this. Why should
we do this? We don t do it over here [for the Saudis]; why should
we do it for foreigners?" I m sure that s happened, but to what
extent is not clear.
I think that otherwise it s been very subtle. But I think
that people don t feel quite as secure about everything. When I
was there, we thought, "No matter what happens, Aramco will take
care of us." No matter what. Even if it s in India, or something
like this. Because the Americans had this intense loyalty. It
was interesting: when the Americans were there, they had this
idea: "We re all out here together and we re in this strange
environment. We re out here on our own, in a sense; and certainly
we are going to take care of each other." And that s like when
I d say, We ve got to go there"--we d go to Beirut or India, pick
up employeesnobody would ever say no. Before the Saudis took
over, this was policy.
Now I don t think that prevails. With us, it was almost a
calling.
Hicke: You had a colony of expatriates, including the management, which
they don t really have now with Saudi ownership.
Taylor: Yes, that s right. It s divided off now, and of course those
people naturally are as anxious to have their people do as well as
the Americans. This is fully understandable. Not that, I think,
the Americans asked for anything more, but they just expected more
in the way of "I m over here. I m working for Aramco overseas."
And another thing about the Americans : they also acted like they
were working for the U.S. government. They used to say, "Well, if
it weren t for us getting out this oil, the United States wouldn t
have enough oil. The government would be in a serious problem."
We were always very friendly with the military. We d go down to
235
the U.S. base, and they d come up to Aramco. There was a very
strong interplay with this big base, which eventually was cut down
to a small base, from 2,500 to 500 personnel. I think it s still
a small base as far as I know, and probably still uses the Aramco
Medical Department.
Hicke: I don t even know if it s still in existence.
Taylor: I think so, because I think they still train the fighter pilots.
So anyway, there was not only allegiance to Aramco, but also sort
of an allegiance almost like we were a military support team. We
were often compared to a big military base because of the
compound, security, and all these kinds of things going on. That
was a similarity there that kind of came through to people. A lot
of these people, as I said initially, were ex-military personnel.
Whenever there was a military holiday or anything, we all got into
that, because I d say 75 percent of us, including myself, were
veterans or had been in military roles one way or the other.
Further in the years we expected them to take care of Aramco in
case of riots or attacks on the Americans.
Emergency Preparedness
Taylor: One last thing I m going to tell you which is sort of a funny
thing. You ll get a kick out of it. In Aramco, while I was
there, there was always this fear. The Communists were in full
bloom in those days. Iran was there. And Iraq was there. And
there was always this fear, which the Americans generated, that
some of these potential enemies might come down there and try to
take over this big oil well. That was, in a sense, a well-founded
fear. (Recently borne out by the Kuwait war, the kind of thing we
worried about . )
At the same time, the American government made it clear and
we thought everybody knew: "Anybody who lays a hand on that oil or
attacks the Americans is going to have a war on their hands the
next morning." So what we always worried about was before they
can get into gear, our place might be blown away. Now this is a
fact: we kept a convoy of Kenworth trucks. These were huge,
eighteen-wheelers. We kept this convoy set up for evacuation. It
was unbelievable. I was on that committee. And they had desert
tires on them that were literally six feet across like this.
Those trucks could go anywhere in the desert. They used them on
the exploration teams, and they never got bogged down in the sand,
essential for forward motion.
236
Hicke:
Taylor:
I first got into it when I became chief of clinical medicine.
Part of my job was the convoy. Those trucks had to be set up
medically to take care of all these people that were going to be
hauled across the Arabian peninsula from the east coast to the
west coast. They were going to go Jiddah. At Jiddah, they had a
ship standing by all the time. Everyone was going to get on this
ship and go over to Ethiopia. I actually made this trek once,
just to see what it was like. They were going to get on this ship
over in the Red Sea at Jiddah; they were going to go across the
Red Sea; and they were going to Ethiopia- -near Addis Ababa in
Ethiopia.
They had taken over what had previously been an Italian
military facility. It had been evacuated. The Italians were
moved out and so Aramco paid for itwhatever they had to do when
they got it- -and they kept this facility ready. In that facility
there was a small hospital. We had to go over there and change
the drugs out whenever they get outdated; we had to make sure
everything was up to snuff; the I.V.s had to be ready. It was
fantastic. The idea of taking care of a large contingent of
Aramco men, women, and children there in Ethiopia always
fascinated me.
I don t know how long that went on, but many years. An
employee named Bill Otto was in charge of it, an ex-navy officer;
he took it very seriously. You did not ridicule this plan,
neither to Otto or to Aramco. This was a serious back-up plan.
We had to inspect these trucks standing by, go through them, take
out the old drugs, put in the new drugs, check the foodthey had
all kinds of long-lasting food in there. They d take them out
every so often and drive them around, make sure that they would
still run. They had supply trucks, gas tankers, and everything
else a mechanical truck that could fix them if they broke down.
Later these were used to help transport the Saudi Army up to the
67 War.
I said to myself one day, "If anybody ever attacks us, and
they see this caravan cruising across the desert, I think they ll
be able to find a way to locate it." I told Bill Otto one day he
and I got to be sort of friends--! said, "Bill, I don t understand
you. Sometimes I think you really believe this stuff." Oh, he
went through the ceiling. He said, "I ll remember that. I ll
remember that. By God, when that caravan leaves, you re not going
to be on it!" [laughter]
You lost your place!
Can you believe for years we kept that thing in there for
evacuation? And even to this day I think, "Could that have
237
possibly have been?" A lot of these people would ve gotten sick.
We had all kinds of stuff in the caravan--!. V.s and everything
else, but that trek across that desert would take two or three
days, at best. And if you did that in the middle of summer--wow!
--you d endanger more people going across 1,000 miles of sand than
they d ever kill with bombs. But we did that faithfully, all the
time. He d call a red alert like the damn movie. Red alert. We
had a red alert meeting. I d say, Oh, one of those! I couldn t
help but laugh occasionally. "Taylor, how many patients can you
get in that Kenworth?" Because we had to evacuate the hospital.
I said, "Fellas, is this for real?" Those guys used to sit
there and monitor the northern airwaves. Every once in a while,
somebody would fly through that zone. I remember one time some
Russian military planes flew through the northern part of Iraq,
down over Iraq. Iraq didn t even know it; but we knew it. We got
all excited, alerted the U.S. Air Force, and for a few hours we
really were on red alert.
Hicke: Bill was going to start up the trucks?
A Riot in Dhahran
Taylor: I tell you, that was some deal. And then, of course, once we had
a riot. The hospital sat right on the road, and we were looking
out the window, and these guys were getting carried away. So I
call up Brougham at the time. And I said, "Bob, these guys really
look pretty serious about it." "Oh, no. We ve gotten clearance.
Ibn Jaluwi said not to worry; they re just going to agitate out
there, do a little chanting and beating the drums, and we re not
supposed to get into it. Just don t worry about it." I said,
"But I m looking out the window, and I don t think these rioters
have gotten the word." I was looking, right? I said, "Are you
looking out the window?" He had a window that faced out. "Do you
see these guys down here tearing this fence down? When they tear
this fence down, do you think they re going to stay on their side
of the fence?" He said, "You know, Taylor, you ve got a point."
So I said, "A point? Man, these guys are going to be in here."
And sure enough, within minutes, they came storming through.
The first place they hit was the hospital. I told Flynn, who
was my chief administrator, "You go down and lock all the doors so
they can t come through here." He said, "Okay." So he ran
around, got a couple of other guys, and they locked all the doors.
I went down. They came marching through; they tore up the place
but didn t hurt anybody. They tore up the whole compound. It was
238
Hicke:
Taylor:
a wild day. And they were wild, partially out of control. So
they were running around and all the Americans were suddenly
scared to death. All of us were moving to the back of the
compound, and actually getting fortified.
So, anyway, I go downstairs and all of a sudden all these
guys, these rioters are running right through the hall. They were
coming in this side and going out that end. I m standing there,
"How in the hell are these guys getting in?" I thought we had all
the doors locked. It turned out we locked the doors from the
inside--but not the outside. They could get in but then they
couldn t get out. This didn t seem like a good way to go, so we
opened up the doors and the rioters ran up into the compound.
Oh no!
The only trouble they were having was getting out at the other
end. "Open the back door, so they can get out!" [laughter] I
never let Flynn forget that. I said, "You locked us in and you
let them in. Great move." That was a very frightening situation
for a few hours .
It was interesting because anybody who wanted to leave, could
leave. And a lot of doctors and their families wanted to leave.
Hicke: During the riot?
Taylor: Yes, because of this riot. But then old Ibn Jaluwi--! told you he
was a very tough old soldiersent over his personal white army.
The regular army dressed in khakis and they looked like soldiers;
but his men are dressed in long, white, flowing robes. They used
to wear these white turbans and white outfits and a black belt.
They carry big swords and, of course, guns, and don t hesitate to
use them.
Brougham, meanwhile, is calling up Ibn Jaluwi and saying,
"Your Highness, Ibn Jaluwi, it doesn t look as calm as we thought.
These guys are coming through the fence." Ibn Jaluwi said, "What?
They re not supposed to do that. You tell them I said to get
back, leave the compound!" Brougham said, "It s hard for me to
get through to them. They re not listening." He s telling me
this story later, and it was humorous later, but not at the
moment .
So Ibn Jaluwi said, "Well! We ll take care of that." He
sends his personal army. It took them about an hour to get there,
that seemed much longer. But when they showed up, the rioters
were suddenly the endangered species. Oh, these guys were
swinging these swords and they got a few of the rioters, major
239
cutting injuries. In fact, we ended up taking care of them in the
hospital. They killed two rioters, one of whom was the leader.
240
V OVERVIEW
Hicke: Could you give us an overview of Aramco s impact?
Taylor: Just in summary, I think that the overall impact of the medical
was extremely beneficial, and set a basic standard of care that
they built on. I think it did then and has continued to provide
good medical care. I think it was one of the best things that
Araraco did, as far as doing something good for the country, being
a good citizen or whatever you want to think of as a good company
--which Aramco definitely wanted to do. They wanted to present
themselves as a good citizen and somebody who was interested in
the country and its development. So we were a part of that and I
think we did our share.
I think we did more than our share, and I think it worked out
to their benefit, helping them get going as we did in several
different areas. Our major influence was in the Eastern Province.
All in all, 1 think the whole thing was good. I will say this: I
truly don t think that there was any particular emphasis on doing
good for the Americans and not doing just as much for the Saudis.
And I ll tell you something: there were a lot of nice Saudi people
who truly appreciated the Medical Department. They were so
grateful, this was half of their world. When you did something,
particularly when they weren t entitled, God, they were so
thankful they d make you cry, because they had nothing else to do
and no place else to go. That part was always very gratifying to
the people who were working in the medical department .
And of course we had a lot of Arab doctors; they were more
intent on taking care of those people. So there was not a real
double standard, except for the evacuation part, which was
something that was policy. I don t think there was any way to get
out of that; in my opinion, the Saudi government should have
approved medical evacuation of Saudis. I think the basic idea
was: "If you get sick out here, we will return you, unless it s
impossible, to your original site, and you can get the medical
care that you d get there." So that s what we did. I think it
241
was pretty reasonable for everybody. From the professional
viewpoint, I think we did a top-notch job, and I think we
delivered wonderful service to all those who used the service of
the Aramco Medical Department.
I think Aramco should have spent a little more money and been
more into keeping up with American medical standards, but they d
tell me: "We spend too much money on you guys!" So it probably
worked out to a draw. I think they probably did it about right,
at least in their mind; they weren t oblivious to that fact that
it was a good PR move. That s about what happened; that s what it
was like.
[Following material was added later] One thing I d like to
add to this discussion is the separation of the clinical from the
preventive health/public medicine contribution. On the clinical
side, we accomplished the most by introducing therapy not
previously available. The major areas were proper treatment of
malaria, TB, and intestinal parasites. We certainly cured many of
these patients, returning them to normal life. At the same time
we introduced mosquito control, prevention of spreading TB, and
artificial fertilizer. These public health measures had an impact
on large numbers of Saudis and were adopted by other countries in
the Middle East, and certainly today continue to prevent large-
scale illness.
On the practical level, sewers, in-house water and toilets,
and public health hygiene training represented another huge step
in the progress of fighting disease in Saudi Arabia.
Another measure that resulted in much better health was our
massive immunization program for employees and dependents. This
prevented many illnesses that had been a way of life before.
Finally, our insistence on the "American way" in ethics-
equal medical care for all we cared for, appropriate training of
medical personnel with no exceptions no matter what nationality,
including Saudis, proper record-keeping--all resulted in a level
of care that had never prevailed before. I hope this type of
ethical thinking continues on, as it is the mark of true medical
progress, not only in the Middle East and Saudi Arabia but
throughout the world. [End insert]
Hicke: That s great. I just had one more question.
corporate offshore medical operation-
Taylor: Oh yes.
Hicke: --to compare to this?
Do you know of other
242
Taylor: Oh, to compare to that? No. But there are several, like Esso has
a big one down in Barranquilla, where they have a big oil
situation. I was in that once. I was in there because we had a
patient that I took in there when I was in the merchant marine.
We had a sick man and we took him in there, and it was the oil
company hospital. I had the feeling that they used the hospital,
and therefore they kept it up to good standards, but I didn t have
the feeling that they really owned it. I think they just had a
lot of influence on the level of care that was rendered there.
Now the British had a hospital in Kuwait, and they had a
hospital in Bahrain, but it was a matter of not just oil but of
colonialism. It was there not entirely for oil. And so to my
knowledge, there was never anything like this. Indonesia: I know
they had a hospital there, but I was never there, so I never knew
how it worked. It made a big difference where we were in total
control, and we demanded JCHA quality versus being in a hospital
where the government or other outfit was in control and didn t
demand that level of care. So I thinkand I m pretty sure I m
right that probably the best quality medicine outside of the
United States for expatriates was there in Saudi Arabia. I don t
want people to think that, as some people used to think, "Well, my
God, you had the Mayo Clinic." We didn t have the Mayo Clinic out
there. But at the level we were working for, we did good work
very commendable, as far as I m concerned. I think it was about
right for the situation: because if you went there, you had to
have a spirit of adventure; you couldn t expect the Mayo Clinic
out there, I ll tell you that So that s the way it worked.
Hicke: You summed it up very well a while back when you said that if you
had it to do all over again, you would.
Taylor: I would. When you talk to these other medical physicians, ask
them. I d like to know. Now, Gelpi, he was there nine years and
I know he enjoyed it, but I think he would say, "No, I stayed long
enough." Perrine would ve stayed even longer, but he finally wore
down under the pressure and left. And Dick Handschin--whom you re
going to seeleft under duress; he wouldn t have left except for
this personal problem he had with one of his children. So there
were mixed reactions. Bill Weidman, who stayed until he retired,
loved it out there. He followed me; he was the chief of clinical
medicine. It depended very much on your personality. You had to
have a certain rugged, individualistic character to enjoy that
there, because many times it was not physically pleasant. But all
in all, it was a great adventure.
Hicke: I d like to thank you very much for spending this time recording
your recollections of your career with Aramco.
243
Regional Oral History Office University of California
The Bancroft Library Berkeley, California
Aramco Medical Department Oral History Project
John C. Snyder
TRACHOMA PROJECT
A Written Account
244
INTRODUCTION by A. P. Gelpi
This is the story of the trachoma project in Saudi Arabiajointly
sponsored and supported by the Arabian American Oil Co. (Aramco) and the
Harvard School of Public Healthas seen through the eyes of one of its
prime movers, Dr. John C. Snyder. As chairman of the department of
microbiology at Harvard s School of Public Health, Dr. Snyder helped
launch the project and set its goals. Becoming the dean of the faculty
at the HSPH, he remained a guiding light for much of the project s
twenty-year life span.
A. P. Gelpi
September, 1996
Sonoma, California
EDITOR S NOTE
Dr. Snyder declined to be interviewed for this oral history
project, but kindly submitted the following written history of Aramco s
and Harvard s trachoma project.
Carole Hicke
245
The Harvard/Aramco Trachoma Project
[The following is quoted from Dr. Snyder s papers, and Dr. Snyder
retains copyright.]
In the fall of 1953 Dean Simmons of the Harvard School of Public
Health (HSPH) was invited to speak at the annual meeting of the Persian
Gulf Medical Society. That year Aramco was the host for the sessions, in
Dhahran, Saudi Arabia, where the new hospital and laboratory facilities
were nearing completion. Dean Simmons was invited to give three separate
speeches touching on matters of concern to the members of the organization.
The meetings were scheduled to begin in the last week of November. The
Simmonses were to be transported in Aramco aircraft, with stops in the
Azores, Holland, Rome, and Beirut en route.
Very shortly before the date of departure, Dean Simmons developed an
illness that prevented his travel at that time, particularly because he had
already entered into firm commitment to undertake an extensive tour of
Asian countries early in 1954 to search for institutions where "Bridges of
Health" could be developed between the school (HSPH) and interested
organizations, whether academic or industrial. [Under Dean Simmons s aegis
an organization entitled "The Industrial Council for Tropical Health" had
been formed in 1950, with its first meeting in Boston, as guests of the
HSPH. Simmons s role in that organization and his plans for the future
undoubtedly led to his invitation to address the Persian Gulf Medical
Society. ]
On the late afternoon of Wednesday, the day before Thanksgiving,
1953, I was about to take my wife and our three small children to New
Hampshire for a short holiday. The telephone rang about 5:30 p.m. to tell
me that Mrs. Snyder and I were invited by Aramco to substitute for the
Simmonses if we could leave the following Tuesday for Dhahran to give the
three talks on the subjects already assigned to Dean Simmons. A prompt
response was essential. Our weekend in New Hampshire was cancelled--
against the wishes of the children, to be sure!
It was necessary for me to arrange coverage of my academic duties
during my absence, and for Ginty [spouse] to obtain permission from Milton
Academy to find substitutes who would take charge of her activities as
teacher of seventh grade classes in geography and mathematics. Milton
Academy saw the importance of a visit to the Middle East for their
geography teacher, and by the end of thirty-six hours we had persuaded a
very reliable person to live in our house to look after our children.
246
Passports, visas, immunization, documents required by Saudi Arabia,
indoctrination in Aramco s procedures, etc., were attended to in the New
York office of Aramco by the medical staff. Seven days after the
invitation was received we were at the New York airport embarking for the
journey in Aramco s propeller plane, a DC6, on its scheduled trip to
Dhahran. I had the titles of the three speeches, but no notes from Dean
Simmons s secretary as to his plans for the material to be covered. My
small portable typewriter was busy during several of the long stretches of
smooth air en route. Ginty studied all the documents about Saudi Arabia
and Aramco that were provided by the New York office. An overnight stop in
Holland kept us from excessive fatigue. Arrival at the Dhahran airport
occurred late in the afternoon on the day before the opening session of the
Persian Gulf meetings.
In addition to the formal papers, the sessions included brisk
discussions by the members of the Societyall of whom were either
physicians or surgeons or professionals in fields allied to medicine and
public health. A few guests were included in the audiences, mostly those
involved in administrative affairs of the several different industries
operating in the Middle East. We were all shown the new Dhahran Health
Center, especially its medical and laboratory facilities that were nearing
completion.
During the tour of the center I became especially interested in the
empty space described as the "future laboratories for activities of the
Medical Department." Answers by the tour guides were vague when I asked
what was expected to be studied in that space. The vagueness was dispelled
later when I had a chance to talk alone with the chairman of the Aramco
board, Fred Davies, who had attended some of the medical meetings. He
asked for suggestions: what would be the optimum use of their new
laboratory space? That was an easy question. Having spent nearly two
years in Egypt, with visits to Iran, Turkey, and several North African
cities, I replied that some of the local health problems should have high
priority. One of the speakers at the meetings had described trachoma as a
serious problem in the Middle East, causing poor vision especially among
local inhabitants serving as employees. I told Mr. Davies that research on
trachoma might be a possible joint undertaking by Aramco and Harvard. I
promised to send specific details after I had returned to Boston for a
conference with Dean Simmons and my colleagues in the microbiology
department .
Our research at the HSPH had revealed important properties of
microorganisms that could only multiply inside living cells. [Therefore,]
we felt confident that some of the procedures and techniques we had
developed for typhus and other rickettsial diseases could readily be
adapted to studies of trachoma infections in Saudi Arab employees of
Aramco. Furthermore, the procedures would be valuable in several of the
Middle Eastern countries elsewhere as well.
247
At that time the organisms causing trachoma had not been grown in
laboratory studies nor were they accurately identified. Candidate
microbes, however, could be observed inside the conjunctival cells [cells
covering the eyeball and inside the eyelids] of patients. After several
conferences, I prepared a proposal for Dr. Robert Clinton Page, the medical
director of Aramco, and Dr. Richard H. Daggy, the assistant medical
director, outlining a joint research program financed by Aramco with
activities in Dhahran and our laboratories at the HSPH. Meetings with them
and with officials of the four parents organizations of Aramco were
undertaken in New York, followed by long sessions with Aramco s lawyer,
John Noble, and with the staff of Harvard s Office for Research Contracts.
It became clear that there would be no possibility of an outright grant
from Aramco (or from the Saudi government) for research, but that a
detailed contract might suffice.
This was one of the earliest of contracts between Harvard and an
industrial organization. There were no guidelines for the process.
Despite several issues that threatened to sidetrack the proposals, John
Noble and I managed to devise safeguards to assure uncensored publication
of research results and to indicate Harvard s respect for Saudi Arabia s
identity as well as its role as the major donor of the funds.
Obtaining approval of the contract document was less arduous than
Noble had anticipated, in large part because several of the medical
officials of the four parent companies of Aramco had participated in the
1950 and 1954 meetings of the Industrial Council for Tropical Health at
HSPH. Trachoma as a major cause of impaired vision in the Middle East had
been stressed by industrial delegates to those meetings, and reinforced by
the presentation of Dr. Phillips Thygeson, the American ophthalmologist who
was recognized as one of the ablest of the experts in clinical diagnosis of
trachoma. 1 From early January until mid-May of 1954, my assignment was
"Acting Dean of Faculty" [while Dean Simmons visited several countries in
Asia searching for cooperative arrangements for the "Bridges of Health" he
had proposed for the HSPH] , and therefore I was able to facilitate progress
toward completion of the Harvard-Aramco contract.
Dean Simmons died in July, 1954. The president and governing boards
of Harvard appointed me to succeed him as dean of the faculty, effective
October 15. My new responsibilities for the HSPH reduced the amount of
time and effort I could devote to the studies in Arabia, but over the
succeeding years I made eleven trips to Dhahran--the longest being six
weeks in the summer of 1958.
1 Industry and Tropical Health. New York, 1951, Robert Kelly
Publishing Co.; Industry and Tropical Health II. Cambridge, 1955, Harvard
School of Public Health, Libr. Congress #52-34882.
248
Both parties signed the contract, to begin on October 1st, 1954, and
to extend for five years. During the first few months, selection of
equipment of the Dhahran laboratories and personnel to undertake the field
studies occupied the team in charge of the project.
John C. Snyder, March 30, 1996
249
Regional Oral History Office
The Bancroft Library
University of California
Berkeley, California
Aramco Medical Department Oral History Project
Elinor P. Nichols
ROGER NICHOLS AND THE TRACHOMA PROJECT: 1956-1982
An Interview Conducted by
Carole Hicke
in 1996
Copyright C 1998 by The Regents of the University of California
Since 1954 the Regional Oral History Office has been interviewing leading
participants in or well-placed witnesses to major events in the development of
Northern California, the West, and the Nation. Oral history is a method of
collecting historical information through tape-recorded interviews between a
narrator with firsthand knowledge of historically significant events and a well-
informed interviewer, with the goal of preserving substantive additions to the
historical record. The tape recording is transcribed, lightly edited for
continuity and clarity, and reviewed by the interviewee. The corrected
manuscript is indexed, bound with photographs and illustrative materials, and
placed in The Bancroft Library at the University of California, Berkeley, and in
other research collections for scholarly use. Because it is primary material,
oral history is not intended to present the final, verified, or complete
narrative of events. It is a spoken account, offered by the interviewee in
response to questioning, and as such it is reflective, partisan, deeply involved,
and irreplaceable.
**** *************** ******** *********
All uses of this manuscript are covered by a legal agreement between
The Regents of the University of California and Elinor Nichols dated
April 19, 1996. The manuscript is thereby made available for
research purposes. All literary rights in the manuscript, including
the right to publish, are reserved to The Bancroft Library of the
University of California, Berkeley. No part of the manuscript may
be quoted for publication without the written permission of the
Director of The Bancroft Library of the University of California,
Berkeley.
Requests for permission to quote for publication should be addressed
to the Regional Oral History Office, 486 Library, University of
California, Berkeley 94720, and should include identification of the
specific passages to be quoted, anticipated use of the passages, and
identification of the user. The legal agreement with Elinor Nichols
requires that she be notified of the request and allowed thirty days
in which to respond.
It is recommended that this oral history be cited as follows:
Interview with Elinor Nichols, an oral
history conducted in 1996 by Carole Hicke
in "Health and Disease in Saudi Arabia:
The Aramco Experience, 1940s- 1990s,"
Regional Oral History Office, The Bancroft
Library, University of California,
Berkeley, 1998.
Copy no.
Dr. Roger Nichols and Elinor P. Nichols, Museum of Science,
1986.
250
TABLE OF CONTENTS- -Elinor Nichols
INTRODUCTION by A. P. Gelpi 251
INTERVIEW HISTORY 252
BIOGRAPHICAL INFORMATION 253
I JOINING ARAMCO 254
Roger Nichols s Education and Internship 254
Looking for an Overseas Position: 1956 255
Moving to Saudi Arabia 256
II THE TRACHOMA PROJECT
Roger Nichols Gets Involved
Nichols Heads the Project 259
Background on Roger and Elinor 261
Trachoma Research: Isolating the Infectious Agent 266
The Next Objective: Developing a Vaccine 268
Nichols Gets A Case of Trachoma Himself 272
Other Medical Personnel 274
III POST-ARAMCO ACTIVITIES 276
Nichols Becomes Director of Boston s Museum of Science,
1982 276
Founding the University Associates for International
Health
Director, Museum of Science, 1982 283
V LIFE IN SAUDI ARABIA 284
Raising a Family 284
Curing Trachoma: A Moral Dilemma 284
Desert Explorations and Other Expeditions 286
Tom Barger
History and Archeology
Travels 291
251
INTRODUCTION- -Elinor Nichols
Dr. Roger Nichols joined Aramco s medical staff in Saudi Arabia in
1956 following two years of residency training in internal medicine, and
in 1957 he was appointed by Harvard s School of Public Health (HSPH) to
be field director of a research project on trachoma, which was jointly
sponsored and supported by Harvard and Aramco. He held this position
until 1970, at which time he took over as director of the project and
head of the Department of Microbiology at HSPH. The trachoma project
ended in 1975, and Nichols turned to full-time teaching and research at
Harvard, where he remained until 1977. At this time he was selected to
be the director of Boston s Museum of Science, a position he held until
his untimely death in 1987. The trachoma project and Dr. Nichols"
contribution to this effort is one of Aramco s notable contributions to
its host country, Saudi Arabia, and to international health.
Elinor Nichols was not only wife, mother of their three children,
and companion, but contributed personally to the trachoma project in
field studies. It is largely from her recollections that it was
possible to build a history of Roger Nichols. For this is also Elinor s
story. It is inextricably part of a larger mosaic of love, marriage,
life of a medical student, a young doctor and his wife trying to make
ends meet, academia, association with Aramco, life in Saudi Arabia, the
trachoma project, personalities from the Harvard School of Public
Health, and the resumption of new careers in New England at the twilight
of the twenty-year Harvard /Aramco trachoma project. Elinor has given
the reader a firsthand glimpse into the exciting role of an expatriate
exploring the mysteries of the Middle East and participating in a joint
venture in which industry and the university become partners in
researching an eye disease which was, and may still be, the world s
leading cause of blindness.
Dr. Nichols and I were colleagues and friends. I remember him
best as one of the most dedicated researchers I have ever known, a man
whose enthusiasm for the trachoma project, Saudi Arabia, its people, and
the field of microbiology was as contagious as trachoma itself.
Armand P. Gelpi, M.D.
December 9, 1997
Sonoma, California
251a
ASTC NEW5LTTTBI
1988 J
Nichols Death a Blow to Science Museum Community
Roger Loyd Nichols
Roger Loyd Nichols, M.D., president
and third director of the Museum of Sci
ence, Boston, died suddenly on Decem
ber 10 of an apparent heart attack. He
was 61.
"Roger Nichol s untimely death is a
tragedy," said Bradford Washburn, who
directed the museum from 1939 to 1981
"He was a hrilii.ini star in the public ed
ucation arena."
Dr. Nichols joined the science mu
seum community in 1982, when he left
the Harvard School of Public Health
where he had served as department
chairman for seven years, to direct the
Museum of Science, Boston.
Although Dr. Nichols was a member
of the science museum community for
less than six years, his leadership and
accomplishments quickly gained inter
national recognition, and he proved lo
be an eloquent spokesman for the im
portance of science literacy and informal
science education, serving as an advo
cate on Capitol Hill and elsewhere. As
chairman of the ASTC Legislative Com
mittee for four years. Roger urged ASTC,
to publish a science museum advcKacy
manual (published in 1986) that would
help guide science museums in their el-
forts to have an influence on legislation.
Senator Edward Kennedy said, "Roger
Nichols was warm, sincere and humor
ous He was dedicated to improving sci
ence education in our country and
succeeded at this task. He will be greatly
missed as the task continues, but greatly
remembered for moving us up the
mountain."
Under Dr. Nichols 1 dynamic leader
ship, American museums formed several
collaboratives, pooling talents and re-
Sources iii iucli jica.s as exhibits dcaig;i
and preparation, film networking, and
educational programming. Although the
idea of forming collaboratives had been
around for a number of years, "Roger
made science museum collaboratives re
spectable, indeed, popular," said Joel
Bloom, president of the Franklin Insti
tute Science Museum.
Dr. Nichols was responsible for the
opening of a new wing at the museum
that grcn;!y expanded exhibits and ed
ucational programming and winch
houses a J14-million Omnimax theater
Most members of the science museum
community are familiar with these ac
complishments, but may not be aware
of his achievements in the medical field
A 1953 graduate of the I mveisitv of
Iowa Medical Sch(x>l, Dr Nichols wa- a
research s|xxialist and author in the- lield
of microbiology I )e spent more than 20
years of his career in field research in
Third World countries, including Kenya.
Uganda, Ethiopia, Haiti, Saudi Arabia, and
Iran. He also helped plan and implement
a new medical school in the Eastern
Province of Saudi Arabia, and helped to
stan up a large general hospital in Doha
Qatar in the Arabian Gulf.
He is survived by his wife Elinor (Po-
tee) and three children: Quaife, a mem
ber of the Peace Corps in Swaziland;
Kathleen, an attorney who lives in Izmir.
Turkey, ;-i,-j Wendy, an instructor a; I o-
lytechnic Institute in Jsatown, State of
Bahrain, Arabian Gulf. He is also sur
vived by a brother, Frank, in Davenport,
Iowa.
251b
Roger Loyd Nichols
V 29, 2926 - December 10, 19S7
"People just don t dream
big enough."
"Don t get into the thick of
thin things."
"In most of life, what matters
is not how smart you are but
how much glue there is
between the seat of your
pants and the
seat of your chair ."
"O Lord God, when Thou givest
to Thy servants to endeavor any
great matter, grant us also to
know that it is not the beginning
but the continuing of the same
unto the end, until it be thoroughly
finished, which yieldest the true glory. "
Sir Francis Drake
"You gave the best you had,
and that is all that I will
ever ask of you.
Good job.
Well done."
252
INTERVIEW HISTORY- -Elinor Nichols
Elinor Nichols for nearly twenty-five years participating fully in
the life and activities of her late husband, Dr. Roger Nichols. She was
interviewed to record her knowledge of her husband s work, as well as
for her own informed views on the people and country.
Dr. Nichols joined Aramco in 1956, shortly taking over
responsibility for the Trachoma Research Program. Trachoma was then the
leading cause of blindness in the world, and Aramco management had
decided that research on the disease would be a way of helping the Arab
people that would benefit them greatly. Although he did serve as
director of the Medical Research Division 1963-1970, and was thus
involved in other administrative duties, Dr. Nichols s work is most
warmly remembered as head of the trachoma investigation. The Nichols
left Saudi Arabia in 1970, and Dr. Nichols continued to work on the
project as director and principal investigator at Harvard. He was
director of Boston s Museum of Science when he died in 1987.
Elinor Nichols describes something of her husband s background,
providing an interpretation of his character and successful career. Her
portrayal of their travels into the desert and to other countries tells
much about the life of the expatriates in Saudi Arabia.
Elinor Nichols was interviewed on April 19, 1996, at the Harvard
Club in Boston, Massachusetts. She brought along some copies of her
husband s correspondence, which will be deposited with the oral history.
She also donated to the library a book edited by Dr. Nichols, Trachoma
and Related Disorders, 1970, which publishes the Proceedings of a
symposium held 17-20 August 1970. She talked enthusiastically and
warmly about her husband s work and their life together. Reviewing the
draft transcript, which had been lightly edited by me, she made few
changes .
Carole Hicke
Project Director
January 1997
Regional Oral History Office
University of California, Berkeley
253
Regional Oral History Office University of California
Room 486 The Bancroft Library Berkeley, California 94720
BIOGRAPHICAL INFORMATION
Your full name
(Please write clearly. Use black ink.)
J* SP.J- Xl.
Date of birth
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254
I JOINING ARAMCO
Roger Nichols s Education and Internship
[Date of Interview: April 19, 1996] II 1
Hicke: Let me ask you how you and Dr. Nichols got to Saudi Arabia.
Nichols: That s a good place to start at the beginning. Roger went to
medical school at the University of Iowa, choosing that because
Case Western Reserve in Cleveland, which accepted him, was
considerably more expensive. He had grown up in Iowa, so he was
an Iowa resident, and of course, residents do receive much less
expensive educations; so rather reluctantly he chose to go to the
University of Iowa. And we got married the summer before that,
which was 1949. I went to graduate school in psychiatric social
work for the first two years of that, and he had, of course, the
four years of medicine. He finished that and graduated in "53;
by that time, in June of 53, we had our first child, Kathleen,
born in January of "53. Unfortunately, she was born the night
before his national board exams; so he was up all night studying,
and I didn t really have a great deal of time to encourage him
through this new baby arrival process. He came in once; he
patted me on the head and said, "Breathe fast and I ve got to go
study." I ll never forget that.
But he was looking for a residency, an internship, and the
Chief of Medicine at the University of Iowa--he had graduated
from the Harvard Medical School, herewrote to Harvard and said,
"This is the brightest, most energetic young man I ve ever met in
my life," and said, "Please consider him for an internship, a
This symbol (##) indicates that a tape or a segment of a tape has begun
or ended. A guide to the tapes follows the transcripts.
255
residency." So that brought us to the Harvard area in the summer
of 1953. At that time, Boston City Hospital was owned and run by
three teaching hospitals: Harvard, Tufts, and Boston University.
Roger was brought into a rotating internship under the Harvard
service at Boston City Hospital, which was excellent medicine,
because nothing was as good as the City Hospital; he received the
widest breadth, as you know, of good clinical cases. So we were
here from 53 until 56.
Looking for an Overseas Position; 1956
Nichols: He was two years into his three-year residency in internal
medicine: the first year is rotating internship. Well, we had
borrowed, I think, the staggering sum of about $3,000 from his
parents, who were retired farmers from Iowa living in Florida.
We d never borrowed before, and it really bothered us. His
internship and residency salary in the early fifties was $3,000 a
year. So we were living pretty much hand-to-mouth; and now by
that time, we had two children, two little girls.
Hicke: What s your second daughter s name?
Nichols: Wendy. She was born in November of 54. So we sat around and
said, "Well, we ve got to pay Dad Nichols back somehow, so let s
take out a year or two and go overseas to some interesting spot,"
where, as a clinician, he could earn enough money in one or two
years to pay his parents back. My parents, who were missionaries
in India, were back in the countrythat was the summer of 1956
and we were taking care of some friends house. That s another
story. So we were living free, in return for taking care of this
huge house, which was great fun. Kooky people, but I loved their
house .
We looked up places all over the world; and my father typed
thirty-seven letters, which went out to companies all over the
world, looking for a medical position. Only two of them
responded with something that was feasible. Everybody else wrote
backVenezuela, Tripoli, you name itthey all wrote back and
said, "We only hire local physicians. We have no positions for
American physicians."
But the Gold Coast in Africa: the Lever Brothers soap people
had a tent city on the Gold Coast, and they were offering fairly
good salaries for American doctors. The only other company that
responded positively was Aramco, the Arabian-American Oil
Company, with headquarters in New York. They were offering
256
Hicke:
Nichols :
Hicke:
Nichols :
American physicians jobs, and I think the salary was $25,000 or
somethingit was a fairly good salary compared to $3,000. And
those contracts were always for two years; so we thought,
Perfect. That s why we moved out of his residency program,
thinking, for two years. We d pay off Dad; come back; and then
go back into the Harvard service to finish the residency. We
sent in all the material they wanted and he went down to New
York. You asked [in the outline] with whom he interviewed. He
interviewed with Robert Page, Dr. Robert Page. I noticed in Jack
Snyder s letter or summary that actually Page, in 54--you ll see
this here, 54, now, this is 56--but in 54, he was medical
director. So I don t know at what point he came back to New York
to take over the top position of hiring physicians. Roger went
down there, and was interviewed by Bob Page.
He was a very early doctor in Aramco.
Yes, he was, and you may know more about his background than I
do.
Anything you can tell me about him--
I can t. I don t know anything about him, but I think you ll
find that Dick Daggy does, because at that time, in 54, Dick
Daggy was associate medical director in Aramco. Page and Daggy
worked together, which I did not know until Jack Snyder s summary
came out .
Moving to Saudi Arabia
Nichols: So they hired him. The first letter I ve xeroxed for you is
December 8, 1956. Roger left at the end of the summer, maybe in
November of 56. Now, housing was tight in Saudi Arabia; so we
were told from the very beginning that no family could come for
the first year. I think it was partly because it was too
expensive to fly families over, and then have a guy look around
and say, "This is horrible. I m not going to stay here." And a
lot of the doctors did. They d go over there; they d look around
and they just hated it, and they simply got back on the next
plane. One guy actually stepped off the plane into the desert,
looked around, and said, "This is it," and he got right back on
the plane and came back. So you can see why they had to protect
their own finances a bit.
That left the two little girls and me in this big house in
Belmont [Massachusetts] for a year. And Roger went overnothing
257
to do with trachomahe went over there as a general physician.
He was in Abqaiq, as I remember, five months and I think you ll
find the actual dates in here. He was just a clinician, taking
care of patients.
Trachoma Team, Dhahran, 1965? Left to right: Dr. Sam Bell, Dr. Nadime Haddad,
Dean John C. Snyder, Dr. Roger L. Nichols, unidentified, and Dorothy McComb.
258
II THE TRACHOMA PROJECT
Roger Nichols Gets Involved
Nichols: I think five months after he was there, Sam Bell, who was sent
out by Jack Snyder, who at this point was dean of the School of
Public Health, but also the head of the Department of
Microbiology at Harvardso this was probably early 57--they
sent Sam Bell out, because they had had to fire an Italian who
was in charge of the trachoma program. So you have to read in
here [ Snyder s paper] when the trachoma program was started, why
it was started and how it was startedwhich Snyder is giving
you, which you just have to have. Very interesting.
So they f ired--Dottie should have told you the name, or
maybe not
Hicke: She did. It was Mario Tarizzo.
Nichols: They sent Sam Bell out, Harvard finding its own. And Sam
evidently came to Roger and said, "We need somebody to take
over." They weren t offering a directorship, but sort of a part-
time position to run the research program. So he was going back
and forth between Abqaiq and Dhahran. And these letters, which I
have not read in entirety, will tell you when he actually moved
over to become head of the department of the trachoma research
lab. Now, my memory is, Carole, and this could be entirely
wrongand I hope Dottie could help you or Dick could help you
but Aramco, at Jack s suggestion that trachoma was the number one
health problem in Saudi Arabia, when they were looking for
something to do with lab space they had just built, and how can
we help the Arabs the most it was Jack Snyder who said,
"Trachoma is the leading cause of blindness in the world." In
Arabia, at that time, about 98 percent of the people had had it.
So this was a health hazard of enormous concern. I thought that
I remembered Aramco gave Harvard $5 million over a twenty-year
259
period to do research, and that must have started in 54 or 55.
But you ll have to find out more from Snyder. I m sure it was $5
million.
Hicke: I haven t heard what Aramco s contribution was.
Nichols: I m sure somebody in Aramco has a record of this.
Hicke: Right.
Nichols: So it was a twenty-year project, and we got intohe, Roger, got
into it- -I say we because we were very much involved in all of
this.
Nichols Heads the Project
Hicke: And Aramco also gave his time? The company underwrote his work?
Nichols: Well, they finally put him in charge of the whole research
project- -we had the best of worlds: we were with Harvard, which
Roger loved, doing research; and being paid oil company salaries;
and living in Aramco, which is a country club: you know, twelve
tennis courts, swimming pools, good schools. So we felt very
fortunate, because I don t think he would have stayed out there
as a physician. It would have been very difficult to stay out
there, because there were some problems and difficult people to
work with, and the desert; and he was lonely and so forth.
Once he changed over to Harvard, it suddenly became a much
more exciting intellectual exercise for Roger Nichols, who,
incidentally, I have to tell you was a brilliant man. He had an
enormous amount of integrity, and an enormous amount of optimism
and energy; and a combination of these four qualities is really
something to see. He was a farm boy who grew up in Iowa. His
parents were high school graduates, and that s alland nice
people, good hearted, didn t speak good grammatical English.
He was driven by what he used to say was a real burr
underneath his saddle; he was so bored with growing up- -he was so
smart and so bored. And he always complained to our children
that they didn t have a burr under their saddles, because life
was much easier for them. Whereas they were Iowa farmers who
were poor, and they were hungry, and they worked hard from dawn
to dark.
Dr. Roger L. Nichols examining child s eyes for Trachoma, Saudi Arabia,
approximately 1963.
260
And his mother had a driving force behind her, which always
puzzled me, because she seemed such a simple woman; but she d
back the two horses and the tractor up to the back of the
farmhouse when Dad Nichols was taking a nap after lunch, go in
and wake him up and say, "There s no time to sleep. Get back
out." She was the same with Roger, you see.
Hicke: That s interesting. You could grow up so bored that you would
just turn off of everything.
Nichols: Right! She probably made that difference, though. It was very
tough for him, because when he was in fourth, fifth, and sixth
grades, she wanted him to compete with all those grade students
in the entire state of Iowa. She would get him up at four in the
morning to practice his spelling for the bee, his arithmetic.
And I always kind of resented that, in a way, because it gave him
ulcers, migraine headaches; his stomach was twisted. But she did
drive him; and because of that, really in the long term, he was a
truly driven man himself. He really wanted to get a lot done and
make a difference in the world. And he really did. But he was
driven.
And with that goes some very painful things that are very
hard to deal with, both for him and those who are around him. He
always said to me, "I know I m hard to live with." And I always
lied and said, "No, you re not." [laughter] But I mean, I knew
enough having my own psychiatric social work and medical social
work background and so forth. I knew his parents well, and I
lived with him. So I knew from whence this came. And I think,
even fairly young, I understood that it had its dark side, but
that it made Rogerin a waythe great person that he was. He
was an A type; and the A types always die young, as you probably
know, because they drive themselves too much and so forth.
Hicke: There is that too.
Nichols: Yes. Okay, where are we?
Hicke: Well, we re only six months into his work in Saudi Arabia!
Nichols: Okay, so he s out there and sort of asks my permission--. We
were quite a team. We always felt I had- -and I think he was
right a better sense of people, and I feelmost women do I
feel closer to people. And he always sort of trusted me to read
the people around him and to pass on any knowledge because, like
most men, he was progress and program oriented. He was good
with people, and people who worked with him followed him and
adored him, but he never read a novel. He didn t have time for
fiction. We were a real team, I think, because we could give
261
balance to each other; he was much brighter than I was, but I had
enough intelligence and education to go along with him.
So that year I was home with the two little girls, and it
had some problems. He was lonely and he was thinking of coming
home, until he got this trachoma project going. My parents were
back for part of that year, and that helped a great deal. My
parents and I, with the two children, left for Arabia via India
in September of 1957, because that was the full year and I wanted
some time in India. I had left in 1944 at the end of high
school, and had gone to Oberlin College for four years, and then
met Roger in a very interesting--! 11 stop briefly to tell you
that, not that you need it.
Hicke: Yes, please do.
Background on Roger and Elinor
Nichols: During our junior year, he was at college at Cornell College in
Iowa, though he d been to Columbia in the V 12 program, and he d
been to--he always said he went to five of the best colleges in
the country, because of V 12 and moving around. So during our
junior and senior years, I was at Oberlin in Ohio; he was at a
little Methodist college called Cornell in Mt. Vernon, Iowa.
Many years ago, before thatwe re talking now 27--people
by the name of the Baldwins, again this is kind of an aside, had
been missionaries for thirty- five years in Burma. They came back
to this country, having been very impressed by how people of
different religions and different races lived and worked together
in Burma. There weren t many conflicts; so they thought, "Well,
the way to get the world on track is to come back to America and
we ll set up summer camps which will be experiments in
international living." And they had one in Glen Falls, Finger
Lakes; they had one outside of Denver, up in Golden, [Colorado],
up in the Rockies just outside of Denver. They actually ended up
with one in Japan; they had one in Denmark; they had one in
France. My brother had gone to this in 1946. My brother was a
doctor; he graduated from Case Western in 1948. He told me what
a great experience it was.
So I hitchhiked from Oberlin to Colorado. In those days you
weren t supposed to hitchhike, but we all did it. I nearly got
thrown out of Oberlin because I hitchhiked once with another
girl, and it was illegal, and the dean of women was terribly
upset. She said, "Your parents are in India. We re your
262
parents; and you can t do this." And I said, "Well, gee, I have
no place to go and I wanted to see Niagara Falls;" so my friend
and I hitchhiked to Niagara Falls.
Anyway, so I hitchhiked out to Denver, and Roger came out on
his red Indian motorbike, which in those days, was the biggest
motorcycle on the marketBig Red, they called it. This camp was
in an old Boy Scout camp with a swimming pool and dormitories.
There were fifty international students and there were fifty
American students. And we spent six weeks together, going out on
so-called deputations in small groups of three to four. We
worked in prison camps; we worked with the migrants; we all had
different jobs; we worked in the Methodist Youth Camp; I don t
even remember the whole list. We d spend four days out there,
working in small, carefully chosen groups.
Then we d come back for three days and sit around and talk.
What were the problems? What was the antagonism we felt? And it
was like a cell group terribly artificial in a waybut
wonderful for young people. All the girls lived in one
dormitory, and all the boys lived in another. We went swimming
and so forth. But it was artificial; and only the Americans
learned from it, I think, because the ones from all over the
world were already in a country, which for them was a foreign
country. And I have to believe that they sort of tried to make
their way carefully lest they irritate their host country.
But the first night, Carole, we sat around this huge circle
with a big fire in the middle. I was very shy; my father was a
brilliant preacher and a brilliant storyteller and a brilliant
speaker, so I grew up cute but very quiet. So we sat around the
circle and they announced that everybody had to stand up and they
had to give their name, where you re from, and where you re in
college. And I just died. I mean, it started over here; I m
here; and Roger is over there. And they started to come around,
and I quickly thought, "Well, what in the world can I say?" So I
stood up and I said, "My name is Elinor Potee. I am at Oberlin
College, a junior-senior. And I was born and brought up in the
jungles of Central India." And I sat down. I thought, "Oh thank
goodness. I hope nobody speaks to me again."
Well, it went around; everybody stood up. And then, right
across from me, this tall, thin, butch-haircut guy stood up,
looked me right in the eye across the fire and said, "My name is
Roger Nichols and I m at Cornell College, junior-senior; and I
grew up in the jungles of tall corn in Iowa," and he sat down.
And I was mortified! At least one person is really making fun of
me. But it was an interesting thing that happened that first
night.
263
Hicke: He wanted to communicate with you.
Nichols: Well, as it turns out, he was so popular all summer because of
his red Indian motorcycleevery girl in town fell in love with
him. But, the Baldwins put the two of us together- -why, I will
never knowin two of the six deputations that went out. So we
actually had some time to work together. I learned a lot about
him. This boy, at that point, was the head of all the Methodist
youth in the state of Iowa. He was very good with groups of
people. I fell madly in love with him; and that summer really
destroyed me, because he was so busy with all these other girls.
Why he had picked me out across the circle and then spent the
summer ignoring me, I guess I ll never know, so. So that was my
first agonizing experience with unrequited love.
He went back to college, and I went back to college. It
ruined my senior year. I mean, I just broke off dates with
people: I had one boy that I had dated all through high school in
India and had dated through college, and would ve married him.
His name was also Roger, Roger Evans, who became a surgeon. I
broke up everything and just cried every day, and waited for a
letter.
I finally got a couple of little letters from Roger. I
believed, because of my background with letter writing, that we
could develop a relationship through letters. And he, who d
never written a letter in his life, practically speaking, just
said, "That is absolutely impossible," and so he didn t want to
continue this. In the spring, I wrote to him and said, "I have
four guys wanting to take me to the junior-senior prom. And I m
just telling you. I m coming out of my isolation and I m going
to the junior-senior prom." I just couldn t live like this any
longer. Well, he didn t even call me; he got on the road within
an hour of the time he got my letter, hitchhiked thirteen hours
from Cornell to Oberlin, and turned up at the dorm door, knocked
on the door and said, "I want to see Elinor Potee." And they
said, "Well, she s dressing for the prom." I came downstairs,
and here are my four other suitors. [laughter] Interesting. Of
course, to have him there, the implications of that were clear.
So he and I went. I don t know how I got out of all of this.
But then we decided we didn t really know each other very
well, so after we both graduated, he came to Oberlin for a year
to take a pre-med course. He d been a history /math major at
Cornell, and his mother had always said, "Oh, you have such
wonderful hands; you d make such a good surgeon." And that so
turned him off, he just wasn t considering medicine. But at that
point, he felt, "Well, if I marry this girl, I would go into
medicinebecause that s really what I ve always wanted to do."
264
So we had an extra year on a campus together, which was helpful
for both of us to get to know each other. But if I may throw in
a tiny story--?
Hicke: I m always interested in stories.
Nichols: We were walking along a road in Oberlin one day. We stopped in
the middle of it. And he said to me, "You know, I have to tell
you: I have a real problem. I really hate your name." And I
laughed. I thought it was a lovely name, Elinor. I looked at
him with horror and said, "Why do you hate my name?" He said,
"Well, there was this girl on a neighboring farm where Frank and
I"--his brother--"were growing up in the thirties. She was
horrible: she had buck teeth; her nose was always running; and
she had dirty and stringy hair. She followed us, and she was
always sneaking around and watching us skinny dip in the creek.
And we hated her, we just hated her. And that was Elinor!" And
I said, "Well, that s a good enough reason for hating a name!"
So we decided right there: 1 said, "What do you want to call me?"
He said, "You re little and you re petite and Sue is a nice name.
So I ll call you Sue." So I said, "Fine. That s fine." So that
was the Oberlin year. I graduated in 1948.
The summer of 48, he was in Iowa helping his parents build
a house in town- -they d left their farm- -and he cut off his thumb
in the big saw by mistake. He couldn t do any work for a while.
So again, without telling me--I was in Cleveland with my parents
who were back here, so we were living in an apartmenthe
hitchhiked to Cleveland to see me, because he couldn t work for a
while and he was in lots of pain.
He knocked on the door of my parents apartment in
Cleveland; and I was downtown at a Methodist youth convention for
12,000 young people. We weren t Methodist, but for some reason I
was down there. And he knocked on the door. My mother knew that
I was terribly in love with this young man and at that point he
wasn t all that interested in me; and she couldn t believe it.
Since first grade I d had little boyfriends, and she was really
quite upset about it. So she was home alone and he identified
himself; she invited him in and they sat there on the sofa. My
mother was tiny, and she was sitting there, looking at him. She
said to him, "Roger, I understand you don t like my daughter s
name. I m just curious." He didn t even know that I d told her
the story. He said, "Well, let me tell you the background on
that if Elinor hasn t." So he said, "When Frank and I were
growing up, there were two girls"--he d never said this to me--
"there were two girls, in the farm area, and we really despised
both of them. One of them had buck teeth, the other one was
always dirty, had a runny nose. And they sort of took turns
265
spying on us; they just tormented us as we were little boys
growing up. We hated them, we just hated them!" My mother was
listening very quietly. And then he said, "One girl s name was
Elinor and the other girl s name was Esther." Well, my mother
pulled herself up to her full five feet two inches, and she said,
"My name is Esther."
Hicke: Oh no!
Nichols: It was tragic that the man I eventually would marry, having had
only two girls in his background whom he really hated, and to
have them--tell me, Carole, if that wasn t a connecting
coincidence, well! As he always told that story at the parties,
he said the relationship with Mrs. Potee went downhill from then
on, which was not true. But the chances of that happening--.
But he d never told me the story about Esther. He didn t know my
mother s name was Esther. He never mentioned the second girl.
That did sort of make it hard for my mother to recognize him as a
viable suitor. [laughter] But anyway, we worked a lot of things
out during that last year, and we got married, as I told you, in
August of 1949--both having been accepted at graduate schools in
the University of Iowa.
So, then you know why we went to Saudi Arabia. I went out
in September of 1957. I went to India and spent six weeks with
my parents, which was nice, because I hadn t been back since
1944, and this was now 57. Growing up in India, I learned to
speak Hindustani before I learned English. For years, I dreamed
in Hindustani. And I really didn t want to leave India when I
left in 1944, anyway, because it was a magical childhood in the
jungle. You know, we were in the Seoni Hills: if you ve ever
read any of the Jungle Books, Mowgli stories with the Rock;
Council Rock is laid right in the Seoni Hills. We had pet
mongoose, "mongeese," Rikki Tikki Tavi. We had pet pythons. The
black panther Badura was there. Everything was there; it was all
part of my childhood. So it was a magical childhood.
Then after six weeks with my parents and I think one of the
letters here describes going back to Arabia--. And by that time,
they d found a house; and so I got there, I think, in November of
57. Now, I m going to stop talking, because that s up to the
time that I m now with Roger in Arabia.
266
Trachoma Research; Isolating the Infectious Agent
Hicke: Okay. I want to ask two things: what were your first impressions
of Dhahran? And the second is what was Roger doing?
Nichols: At that point, he was running the trachoma lab, as I remember.
Hicke: What was his day-to-day routine?
Nichols: Well, I was hoping Dottie would tell you more of that. There may
be more in the letters as I send them to you. But when they went
to Saudi Arabia, they didn t know what trachoma was. They really
didn t know. They had never isolated it as a disease: they
didn t know how it was carried; they didn t know whether it was a
bacteria; they didn t know whether it was a virus. So there was
some basic research that had to be done.
The first year Roger was in charge of trachoma--f irst year-
he and his lab technicians collected 10,000 flies, and they had a
special name for them. When you go to Arabia, there s this tiny
little fly which is in everybody s eyes, because the fly lives
exclusively on the mucous in your nose and the tears. When the
babies are born, immediately flies are around those eyes; and
they are so covered that the mothers don t even bother to do this
[brush them away]. In fact, Roger would examine the babies eyes
at three months, because many of them had trachoma by that time-
three months. He found dead flies in the eye; I mean, they re
everywhere. So naturally, they assumed that flies must be what
was carrying whatever this disease was. Well, they found
absolutely no evidence; it was not being carried by flies.
Then they had to figure out what the disease was. So they
went out into the villages and there is some in here and I ll
send you more about which villages they went to, and I ve got
some pictures of them working in the villages, which I will get
developed and slides for you--and they would scrape the
children s eyes it s inconceivable now--scrape their eyes and
you have to grow what was in the eyes in something. Now, in
those days, there were no chickens in Saudi Arabia. The best way
to grow living tissue is in fertile chickens eggs. And now here
we are in a country where there are no farms and no chickens for
all practical purposes. So Roger was telegraphing and radioing
Harvard to get huge boxes of fertile chickens eggs and send them
out to the laboratory. Well, it was very odd, Carole. Not a
single box ever got there. A whole bunch of boxes got to Cairo,
and somebody, by mistakein the middle of the summer- -unloaded
them from the refrigerated area, left them on the tarmac where
the sun was 150 degrees, and they fried. So then he said, "Well
267
then, we can t do it that way."
about the chicken eggs?
Didn t Dottie mention this,
Hicke: No. She told me they were using chicken eggs, but she didn t
tell me anything about that. That s why it s good to get stories
from different people.
Nichols: So then we tried to send them through the Hague--Aramco had an
office in the Hagueand something went wrong with that. Now
this is anecdotal--! don t have anything in writing that I have
found, but it s going to be in some of my letters. What I find
in my letters and send to you will be more accurate than what I
tell you right now, because I wrote the week it happened. And so
anything you find in my letters will be more accurate
statistically, Carole, because this is a long time later.
So, darned if those huge boxes of fertile chicken eggs
didn t get unloaded by mistake in the middle of the winter and
left on the tarmac. He could not get huge supplies of chicken
eggs in. So then they started to fly in human tissue, vials of
living tissue. And that was very expensive. They also brought
in sterile mice, which had to be flown in, which had to be dealt
with. Maybe that was when they started working on the vaccine.
Yes, I think the mice came later. But while they were trying to
grow whatever trachoma was in the very expensive vials of living
human tissue, one of the graduates of the Harvard School of
Public Health-
Nichols: --who was a Chinese, and I cannot remember his name-- [This was a
Dr. Tang. There was also someone at Aramco named Bob Chang- -he
was from Harvard. ]- -working in China, using eggs, isolated
trachoma. When that hit the world s press, in the medical world,
it was a terrific boon. Because now that we knew what it was,
and it s a veryand I can t explain it to you though I ve heard
Roger explain it many, many times and I m sure it s in the
material that you can get.
Hicke: Yes. I think it s in the papers that were published here.
Nichols: Okay. It s an adenovirus: it s partly virus and partly bacteria;
and each of them behaves opposite from the way they re supposed
to behave. In fact, syphilis and a lot of these things are
related to trachoma, and they found all of that out.
Unfortunately, that Chinese doctor who was so brilliant was
picked up by the Communists and put out on a work gang and died
out there, even though he made this major contribution when he
did.
268
Hicke: Dottie told me some parts of this, but you re giving me something
different, actually.
So this was a major breakthrough.
Nichols: Without that, you couldn t develop a vaccine.
Hicke: And then you didn t need the eggs anymore.
Nichols: No, no. And at that point, farming was coming in Arabia and we
could get chickens eggs. After that first year of 10,000 flies,
and then they tried the chickens eggs--and I cannot tell you how
long they tried to get chicken eggs out there. Again, I think it
will be in some of my letters. I ll never forget him saying.
"Those flies--10,000; chicken eggs on the tarmac at Cairo!" It
was frustrating. And obviously, he, Roger Nichols, would love to
have been the one. If they could ve gotten chicken eggs in, he
would have done it. But fortunately for them and Harvard, it was
a Harvard graduate who was in some village or some laboratory in
China.
The Next Objective; Developing a Vaccine
Nichols: The next big project for Harvardand I think they must have
gotten more money at that point from Aramco--was to develop a
vaccine. Once they d found what the disease was, they started
working on vaccines; that gave them something big to work on.
The first thing they had to find out: is it just one trachoma,
or, like the flu virus, were there 150-250 strains? If there are
150 or 250, it s going to be very difficult to come up with a
vaccination. You can t do it: you can t put more than four or
five into one vaccine, evidently. So they started scraping eyes
and growing this stuff. I have his definitive book at home--I
have two copies; I should have brought one in for youwhich is
the publications of all the papers, at that time, on trachoma.
If you think you need the book 1 for the articles, I will
send you a copy of it. It probably ought to go in the file in
Berkeley.
Roger L. Nichols, ed., Trachoma and Related Disorders, Proceedings of a
Symposium held in Boston, Massachusetts, 17-20 August 1970, Excerpta Medica,
1971.
269
Hicke: We should deposit it with the oral history volume, yes.
Nichols: I think, as I remember, they isolated four major types of
trachoma. Roger flew to Australia, where the Maoris live. Oh,
let me go back a little bit. Trachoma only exists in countries
where the standard of personal hygiene is low. If you don t have
running water and you don t have towels and you don t have soap,
and you re all living close together, then trachoma is rampant.
The Indian villages in this country, in the Bible Belt in
America, have quite a bit of trachoma. The primitive tribes in
Australia, also. He flew to the Masai reservation in Africa. In
all of these places he was collecting; and I m sure in that book
it ll list all the places that Roger went, personally, to
collect, scrape eyes, and bring this stuff back and grow the
adenovirus to find out if there was a difference between each
thing, because that was crucial. Once they got their four
strains, what I cannot tell you is, did they try to mix these
strains into vaccines? I don t know how this, and Dottie s got
to be able to tell you, because she was his prime investigator on
this, or prime hands-on worker- -very good lab technician.
They did come up with four vaccines, and they tested all of
them on--I can t tell you again on how many children. And all of
them had a bad side effect that just scared Roger. One of them
caused big boils; and you know, the last thing you want in a
country where hygiene is low is a boil on a three-month old baby.
None of them [vaccine protection] lasted more than six months, as
I remember, which is like the cholera vaccine. We had a friend
in the team die from cholera because, even though they d taken
the vaccine, they went back to Egypt several months after they d
had it. So, it was a very, very tricky vaccine. They worked and
worked on it; they would go out two or three days a week, load up
the Land Rovers at dawn with all of the equipment --and I will
send you pictures of this go out to various villages.
Now, it was difficult, Carole, because they didn t want to
treat all these people. I mean, it s easy to treat trachoma: you
give them sulfa drugs and they get well. But the reinfection
rate if the patient remains in the same situation is 100 percent.
All of the Arabs in those days were sleeping on a mat on the
floor; they were all sleeping together. A mother wears this aba,
and she wipes her eyes and she wipes Fatima s eyes and Mohammed s
eyes. They have no running water, no towels, and no soap,
washing in a ditch going through the village. So even if you got
trachoma and you were treated for it, if you go back into the
same village, you re going to get it again in six weeks. They
had to come up with a vaccinelike Roger used to say, "We need a
vaccine against syphilis all over the world. Every two-year-old
in the world should be given a syphilis vaccine." Well, we don t
270
have one; so then, every ten years--. These are tough diseases,
because the reinfection rate is so high if your contacts
continue. Roger and Harvard felt that none of the vaccines could
go on the market because they just weren t good enough; so they
continued for many, many years to work on a vaccine.
I will break the chronology with another story which you may
find interesting. Somewhere in my letters, I will find the date.
We flew to Asmara, in Africa, early on- -we must have gone over
there in 58- -to see what the Italians were doing, because if
Harvard s doing research on a particular disease, it s important
to know what all the other laboratories all over the world are
doing. So Roger went to Lister Institute in London, and he had a
lot of work to do with them. They were working on trachoma, too.
We went together to Asmara. The Italians were working on
vaccines by this time, so it had to have been after the isolation
of the disease. Roger was not terribly impressed: he thought
some of their methods looked pretty haphazard.
Well, somewhere in the sixtieswe went to a lot of parties
out there, because that s what everybody did for fun--and this
tall doctor, an Arab, came up to me--I can t remember his name;
it ll come in one of my letters and he was very arrogant. We
all knew him very well. He said, "Well! You Harvard types think
you re so smart. Let me tell you what s happening: the Italians
have come up with a vaccine. The King is going to buy all the
vaccine they have, and we are going to vaccinate every single
person in Saudi Arabia for $4 million [or something], and we re
going to wipe out trachoma in Saudi Arabia." So I said, "Gee,
that s marvelous, doctor. That s really wonderful. Poor
Harvard." You know, we sort of laughed and he stalked away.
When we got home that night, I said to Roger, "I d like to
tell you what I heard at this party." So I told him; and of
course, he was horrified. Now the question was: how to get over
to Riyadh and talk to all the medical people over there,
including the King--I bet it was King Faisal at the time; I wrote
this all to my parents; I haven t touched these letters and how
to do it without antagonizing everybody. Finally, he got in
touch with them. He said, "You know, I feel bad. I haven t kept
you all current with what Harvard is doing. I d like to come
over, you pick the day, I ll bring all of our material with me,
and spend a day with all of your medical people, the Ministry of
Health and the Ministry of Education and so forth. And I ll just
tell you where we are."
And he did it brilliantly, I guess. He went over there with
all of his documents, all of the information about their
vaccines didn t mention the Italians where they were, what the
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Hicke:
Nichols
problems were with each of the vaccines. He may have mentioned:
"Other labs are working on this, and we are nowhere close to
having a vaccine that I feel is safe enough to announce to the
world." Then everybody listened very carefully, and after a full
day of this, he closed up his book, and everybody thanked him.
He came back, and we never heard anything more.
But the chances of my being at a party where this man was--
because it was a big secret: nobody was going to know about it;
the King was going to do this, sort of, without saying anything.
But the Italians were going to make a huge amount of money. This
is another one of those serendipitous things that happen in life,
which you look back on in life and say, "Boy, I m glad he picked
me out." Because if he had said it to anybody else, it wouldn t
have gone back to Roger.
And Roger s trip over there, then, made them realize--
Oh, yes, absolutely. Roger didn t say a thing about the
Italians. They d made a terrible vaccine! It was absolutely
worthless, because they had changed all of their data. It was
all dishonest: it was bad data and we found that out when we went
out to Asmara. They didn t follow it up; they wrote up what they
wanted it to say, and they had no provable lab background to show
that this was true. So Roger knew that they couldn t have a
vaccine .
Hicke: It was out-and-out fraud?
Nichols: It was out-and-out fraud. They were just going to sell the whole
thing. Also, what Roger said to me was, "Okay, the vaccine was
no good. But if they would have vaccinated every single person
in Saudi Arabia except one grandmother in the back of the Bedouin
tent whom everybody forgot or she didn t want a shot, and she had
trachoma, it takes just one person to start it right back through
the entire Kingdom."
And it s the same thing with syphilis. If you vaccinate the
entire worldand they don t have a vaccine against syphilis and
there s one person, anywhere in the world, who still carries
syphilis, it will start again, because of the way syphilis is
carried. So it was interesting; actually, syphilis and trachoma
are very close. But, you know, be a little careful, because I
don t know the medical part of this and Phil Gelpi may know it.
Hicke: That is interesting. You really saved the day.
Nichols: Well, he saved the Kingdom from a very foolish, expensive
mistake. But it wouldn t have hurt anybody, probably.
272
Hicke: You said he had found some very bad side effects from the
vaccines he was working on. So maybe side effects might have
been a problem.
Nichols: I don t know. Once it was done, we just kind of held our breath
waiting to see if anything would happen. We didn t talk about it
in Aramco. Dottie may not even know this. It was an
embarrassment for the Italian laboratory, I m sure of that. So
that was the end of that. Now, as Roger always said, "We still
don t have a vaccine." With the easy diseases, you get vaccines
fairly quickly; but it took sixty years for the polio vaccine
(Salk) to be developed. And trachoma and syphilis and related
diseases are so tough that although they started this whole
program in 58- 59, the world still does not have a vaccine. And
the world s major labs are still trying to find it. You raise
the standard of living and it is wiped out, by definition of it
being a disease of low hygiene.
To develop these vaccines, they were using donkeys at the
Hobby Farm, which is where the horses were in Aramco. Our
daughter had a horse there. They were putting live trachoma into
the donkeys, and taking the blood out, using what was in the
blood to try to make a vaccine, which is how you really make
vaccines. You take a little bit of a disease and you put it into
a vaccine: your body builds up antibodies; when a disease really
hits you, then you ve got these cute little antibodies running
around, saying, "That s mine. Let me have it." And that s what
they were doing with donkeys, putting it in and taking the blood,
using that to try to make a vaccine.
Nichols Gets A Case of Trachoma Himself
Nichols: Well, on one of his trips it was about March of 65--the donkey
didn t like having blood drawn, and they had four- five people
holding him, but he kickedand a vial of pure, virulent trachoma
splashed up into Roger s eyes. These are what are known as
"laboratory infections." Of course, they washed it off. But he
came down with a terrible case of trachoma and we all had to be
careful. We couldn t use his towels, we had to use a different
bathroom, we had to sleep separately, we didn t touch him, and he
became an outcast in the family. But it s easy to treat it: you
take sulfa.
The problem was that we were leaving two weeks later for
Kathmandu; he and two other doctors were going to trek across the
Himalayas into base camp at Everest. Now, sulfa is a very bad
273
drug: you have to drink about eight glasses of water a day to
keep washing it through your kidneys, otherwise your kidneys
seize up and you have real problems. He was going to trek 8,000
feet up, 8,000 feet down for three weeks from Kathmandu, and
there was no way he could carry enough water to drink eight
glasses. I mean, it was a terrible problem. But it was a
wonderful trip; it had taken us weeks to get permission from the
Nepali government.
So we went over anyway. I went over early with the two
girls in 65, because I speak the language, though I didn t
realize that all the Nepalis also speak Hindustani. So I found
the sherpas, two sherpanis--four of themand got all of the
equipment bought using my Hindi. And then three doctors came
over: they had three weeks; that s all they had, so they had to
really set right off; the three of them.
Hicke: He went?
Nichols: Yes, he did. He took his chances. He took sulfa, drank as much
water as he could. He just couldn t bear to give up the trip,
and somehow, I can t remember the sequence, but he didn t do the
damage that he might have .
Hicke: Did you have your nails chewed down to your elbows?
Nichols: Oh, beside myself! I kept saying, "Roger, how can you? You re
so intelligent. You know more than anybody in the world about
trachoma, and you re telling me you can take--?!" But he said,
"Well, don t worry about it, Sue. I know what I m doing." I
didn t argue with Roger. He was so much wiser than I was, and he
was a medical man, and I just had to trust him. So he had a
wonderful trip. It worked out.
Hicke: Happy ending.
Nichols: Yes, it was a happy ending. When they got back to base camp,
they found some others who were planning an assault on Mt.
Everest. This was 65, before a lot of people had climbed
Everest. Roger was a very good mountain climber. The leader
asked Roger to go up Mt. Everest with them. He wanted to go so
badly, because they had all the equipment. But these three
doctors had a date to get back to Aramco, and they just felt so
strongly about being back on duty; so they didn t go, and they
flew back out in [Sir Edmund] Hillary s plane, which came in at
the same time Hillary came out. The military commander of the
Indian team got to the top, and so he wrote a postcard, sent it
in by runner; he was three weeks running, literally running all
the way from base camp to Kathmandu with this postcard; [he] gave
274
Hicke:
Nichols:
him money and told the guy, "Put a stamp on it." Because Roger
had left his card and it [the postcard] said--I still have it
someplace--"Dear Dr. Nichols: We made it to the top. You should
have been there with us." But it was so sweet because they did
make it to the top and they remembered that he d liked to have
gone. It was all crinkled and wet; you could barely read it.
But this guy had strapped it to his body and run. I mean, we re
talking literally 8,000 feet up and 8,000 feet down. You re
going across the Himalayas, higher and higher. So I thought that
was really quite amazing.
And they made it back down, too, I take it.
Yes, yes. It was a regular assault, so they made it.
Other Medical Personnel
Hicke: Okay, well how about some of the other people that he worked
with; can you tell me a little bit about them?
Nichols: Jack Snyder--he lists in here how many times he came out. I
think they came out almost every year. Roger went back to Boston
a lot. Again, this will be in the letters. I can t remember if
he came back because it was easier to do a lot of the lab work at
Harvard, which had better labs and better equipment than Aramco,
as I remember. One time, I noticed in one of the letters, he
went back for three months. But he would fly back, I think,
three or four times a year, bringing vaccines back and refining
the process and so forth. So Jack Snyder, who was dean of the
School of Public Health at this point and still head of the
Microbiology Department, kept in close touch with all of us.
Sam Bell, who has died, was with Harvard; he must have been
on the research team. He was at the School of Public Health. He
flew out. He was the one who originally came out to interview
Roger.
Ed Murray, who has also died, was a brilliant physician.
Somebody ought to have information about him. He had been in
Turkey on horses, and he had ended up, by mistake, in China and
was put under house arrest. He had a history, and I don t know
whether Ed Murray s history has ever been written up, but he was
a fabulously interesting person. In fact, after a year or two of
being kept in house arrest in some little village, I guess he
wrote to--
275
Hicke: A year?
Nichols: Oh yes, it was incrediblevery tough story. He wrote to
somebody high up in China and said, "I am going to write to
President Roosevelt and suggest that he write to you and arrange
for my release." Somehow, this made them think, "Oh, this guy
really knows the top man, so we better do something," so they let
him out. Ed Murray had been with Harvard for quite some time, I
suspect; but he had, like Jack Snyder did, a terrific background
of work in Egypt, Turkey, and China. They worked on some of the
diseases. Jack Snyder is working on his autobiography. You got
his CV?
Hicke: Yes.
Nichols:
For us, he has been terribly significant, because he s really
been Roger s mentor from the beginning. He was the one who knew
about Roger being in Saudi Arabia, even though I don t think
Roger had worked with him at the School of Public Health; and he
sent Sam Bell out to ask Roger if he would do it. So he got us
into trachoma. In 1970, he was head of Microbiology, and though
he says this is not true, he s the one who recommended that Roger
be brought back from Aramco to become full professor and head of
the department of Microbiology at Harvard School of Public Health
to continue the trachoma research.
276
III POST-ARAMCO ACTIVITIES
Nichols Becomes Director of Boston s Museum of Science, 1982
Nichols: In 1982, the director of the Museum of Science, Brad Washburn,
had retired after forty-nine years. They had one director for a
year, and they had to fire him, worked for nine months. Then
there was an interim director for a year. Brad went to the
search committee and said, "You know. I wasn t a scientist"--he
was a mountain climber and a cartographer--"Why don t you guys go
looking for a real scientist? Why don t you go looking for a
doctor, somebody who really knows some science?" And the search
committee said, "Well, you re so blankety-blank smart, Brad, you
find us a doctor." So Brad Washburn called Jack Snyder and said,
"The position for director of the Museum of Science is open. Do
you have any suggestions?" And Jack Snyder said- -third time:
"The smartest, most intelligent, energetic man I ve ever known in
my life, who s a doctor, is Dr. Roger Nichols."
Hicke: Never changed his mind.
Nichols: You see, that year was very interesting. Roger was a magnificent
teacher, Carole, absolutely stunning. He would get a standing
ovation after every class. He was just incredible. I sat in on
quite a few of his classes and helped him with his slides. That
year, 1982, he was the first professor at the School of Public
Health who had ever received a Best Teacher of the Year award
from the students. And the same year, he was given the Best
Teacher award by the faculty.
So when Jack Snyder said that, Brad Washburn said, "Get in
touch with Roger Nichols." They got in touch with Roger.
277
Founding the University Associates for International Health
Nichols:
Hicke:
Nichols :
Hicke:
Nichols :
When we came back from Saudi Arabia- -our work with Saudi Arabia
after we left was actually an interesting continuation of Roger s
time out there. We started an organization called University
Associates for International Health. We started it in 71, when
the government of Saudi Arabia decided to go to American
University of Beirut School of Public Health to see if that
university would combine with the government of Saudi Arabia and
study the country. They d pay anything they wanted. It was such
a huge task that the American University of Beirut said, "We
can t touch it."
Then they went to Johns Hopkins [University] , to the School
of Public Health, and said, "Please help us with this Kingdom
problem." And they said, "Can t touch it. We don t have enough
faculty. We can t touch it." They went to Harvard School of
Public Health. Now this was after Dean Snyder, who resigned in
71, soon after we got back, which was most unfortunate. He and
President Pusey at Harvard both resigned in September of 71, and
we came back in September of 70. That was a time of the student
uprising, and they were taking over the campus. Both deans had
been there about eighteen years the president of Harvard and
Dean Snyder--and they just said, "This is a younger age. We
don t want to handle this. We ve done a lot." So they both
stepped out, which was very difficult for my Roger. [Comment
about new dean of the School of Public Health not transcribed.]
That s probably already in the public record.
It may very well be.
mention it to you.
And I don t even know whether I should
Well, Dorothy mentioned it.
Roger was so upset, he went to John Dunlap, who was dean of
Harvard College at that time. John s a lawyer, and John said,
"Well, it s an easy solution, Roger. Get a couple of faculty
from Johns Hopkins, you and Dick Daggy, as the ones from Harvard,
and a couple guys from the American University in Beirut. Put
together a corporation. Go back to the King and say, Okay.
It s such a big job, no one school can do it. 1 Don t even talk
about the reasons. But we are now a nonprofit corporation: we
have six top physicians from these universities. Isn t that
better than just one? We can do it. "
278
So that s what Roger and I did.
Associates for International Health.
We incorporated University
I think it was in 73.
Well, that s a long story, but I ll go through it quickly.
Hicke: No, we have plenty of time.
Nichols: We took a team of fifteen out to Saudi Arabia for sixteen weeks.
We lived in a hotel in Riyadh. We flew all over the country, and
studied all of the health problems and came up with awhich I
still have a huge report. It took us six weeks to write it: a
twenty-year project for Saudi Arabia, run by University
Associates. It was a $27 million project. The first thing was a
survey of all the villages, what the diseases were. And then
there was a plan for training manpower: you had to have nurses,
dentists, paramedicals , and doctors. There was one medical
school in Riyadh at that point.
It was a marvelous project, Carole. The Report Plan was
done in Arabic, and in English. We carried it all out to the
minister of Health out there, and the King, and they were so
excited about it. And then King Faisal was shot. King Faisal
was our king; he was the one Roger had been working with. The
minute King Faisal was shot, Roger must have known we were in
trouble. They changed everything, because everybody coming in
charge wants to have his own men working with him.
The new minister of health had come from agriculture, and
he d been trained in England. He wasn t a physician; he was a
Ph.D. in agriculture; and now he s minister of health. So here
they have all of our material, and we re waiting to hear. In
fact, we were within a week of signing a twenty-year, $27 million
contract to do everything tell them where, when to build
hospitals, new medical schools, and everything. It was really
exciting. And the King was shot.
The minister finally telexed us and said sort of, "Don t
call us. We ll call you." That was a real heartbreak for us,
because we knew that this group could do it. I mean, we had just
terrific people working with it. At the same time, Roger was out
there negotiating this contract, the minister of Higher Education
heard that he was there. He made quite a name for himself with
Aramco, because he was working on trachoma; he was going over to
Riyadh; he treated the old king for trachoma. And so he was well
known and well respected outside the Aramco circles, because he
was articulate; he just came across well. He was out in the
villages; he knew all the sheiks, up and down the country; we
were out with the Bedouins. He was just known by a lot of
people.
279
The minister of higher education had been a Bedouin. He
didn t speak any English and he worked with translators. So he
said to Roger, "I want to build another medical school. And I
want you to help me."
Roger said, "Your Excellency, I cannot help you."
He said, "What do you mean you can t help me?"
He said, "You don t need another medical school. This is a
country of 3 million people [in those days]. You ve got a good
one in Riyadh; that s all you need. You don t need brain
surgeons . "
So he said, "Well, explain to me what I really need."
So Roger said, "What you needand I would be happy to help
you with what I can do; my interest is in the people of Saudi
Arabiayou need a health sciences university. You need one that
turns out doctors, nurses, paramedicals, and dentists. And they
should be staggered in such a way that all of them come out of
school at the same time, and then you ve got a primary care
health team."
And the minister said, "Well, that makes good sense." And
so he gave us a contract to study the situation and prepare a
proposal. Then we worked on something else again. We took
another team of ten people out there for six weeks to work on how
we could do this. Then we started--
Nichols: --the University in Damman. Now, this is not part of Aramco, but
because of our Aramco background it was easier to do. Roger and
I were the only staff. Roger was working full-time at Harvard,
but at five o clock he would come to our offices near the
children s inn. The first job given to us by the chosen dean, who
was Dean Al Turki, was to place nine Saudi physicians in American
internship and residency programs. These physicians would be on
contract to be the professors at this university eventually.
They d all gone to school in France, or they d gone to school in
Germany, or in Ecuador or somewhere; but the Saudis really wanted
an American graduate training for these people. Mind you, we
didn t get any money up front. The Saudis were very slow about
giving us any contract money for a variety of reasons. They just
didn t think money was important when they had so much of it. So
Roger, of course, was a volunteer, and I was a volunteer, too.
280
The first job he gave us was to find internship and
residency programs for these nine physicians. Well, every
afternoon at five I would go over to Harvard, having gone to the
library and gotten the names of the heads of departments of every
residency in America. The Harvard Library has a list of the
heads of every teaching hospital in the country. And then Roger
would just start dialing through them, and explaining who he was
and what he was looking for. To sweeten the pot, he went to Dean
Al Turki and said, "Look, Dr. Al Turki, by the time you come to
me, all of these positions are filled. May I make a suggestion?
Would you be willing to offer a $5,000 yearly gift to the
department of the host university? That would help them, because
their English was bad and that ll help them make the adjustment
to the extra time that we want your young men to be given."
What Roger would say to the host universities was, "I can
guarantee you, 100 percent, that every one of these young men
will go back to Saudi Arabia." That was very attractive to the
departments, because the Indians come over and they never go
back. They end up doing very well here, and they re good
doctors, but they never go back to practicing in their own
country. And it upsets Americans because they like to feel
they re training third world country doctors who will go back and
help their own countries. Well, these guys were all on contract:
they were going back; and they didn t even want to stay. So that
was a promise; "and we ll give you $5,000 a year, and the
university in Saudi Arabia will pay for their housing. Really,
you re doing this government which needs help so badly a
tremendous favor." Within six weeks and we worked for six weeks
on this, every afternoonhe got all nine of them into top notch
residencies, ob and surgery. That was a good way to start,
because it gave Dean Al Turki the feeling that Roger and I could
do something. They all began to realize very soonthe Arabs
that we wanted to help them with their medical training programs.
I loved Arabia. We just had a marvelous time out there.
I d be there still if he hadn t been offered the chairmanship of
the department and a full professorship. He had an endowed chair
at Harvard; as he said, "How can you turn down an endowed chair?"
And he was right. I was wrong. I often was. Roger could look
ahead. Saudi Arabia was an interesting place to liveall the
things we did out there, traveled all over the world. We really
had a very interesting time. Having grown up in India, Carole,
it was very easy for me to be an expatriate, and to be a very
happy and enthusiastic expatriate. I live overseas very
comfortably. I may be an American, and now I ve made my peace
with living here, but having grown up overseas whereas Roger
grew up on a farm. So I think it was a bigger jump for him, but
he learned to love it.
281
Anyway, after we got all of them into it, then we started
looking forand I won t keep on with this--a staff. We had to
put a full-time staff of six of our own people out there as
hospital architect, hospital planner, and so forth, educating.
We did that, and they were out there for two years.
Hicke: This was in Dammam where you had the hospital?
Nichols: Well, nothing was created, you see. We were creating a medical
school and all we started with was an abandoned building, which
had goats, sheep, and camels living in it because it was on the
edge of this small village, which is now a big town. The
government took it, swept everybody out, and then my job- -I was
head of recruitmentwas to find faculty.
They were going to do this on the English system. You come
out of high school and you have six years of medical school.
There s no college. The first two years are the basic science.
So the first year, I went to the Harvard library, got the names
of every chemistry department in the country, every physics
department in the country, and so forth, and wrote to all the
departments. I advertised in all the journals, Journal of
Chemical whatever. They would put these things up on the
bulletin board. The first year we had to hire faculty for
chemistry, physics, anatomy--no I don t think so--and biology.
Worse than this, it wasn t just one medical school. We had
to have two separate medical schools: the boys had to be in a
separate building taught by men; and the girls- -and they wanted
to bring girls into ithad to be in a separate building taught
by women. And if you think it was hard to find men to go out to
Saudi Arabia for two years, finding women who wanted to go out
there, knowing the customs were dif ferent it was tough.
Fortunately, or unfortunately for all of them, I loved Saudi
Arabia. So I was the best ambassador they could possibly have.
It might not have been very straightforward. I mean I didn t
mean it to be deceptive, because we were living in Aramco. We
had tennis courts and swimming pools. They were going to be out
there in a small town, with an apartment and not much in the way
of facilities. And we told them that.
So the first year we got a faculty for both girls and boys.
The next year we had to add the second year of pre-med. And then
we went right on up through the six years, bringing in
physiologists and anatomists and everything like this, flying
back and forth. That was very exciting.
Hicke: A major project.
282
Nichols: It was wonderful. Four times a year we would fly to Houston,
Roger and I, because the university rented a whole floor; and
that s where they wanted to hold their interviews. Roger made
them come over and interview all of their prospective staff.
There was no way we were going to be held responsible; because if
they made a mistake and somebody was really a mess, our feet
would have been held in the fire. So the dean came over, and the
vice dean, and Roger sat there in this room. I d bring eighty
people in from the entire country, gave them half hour slots,
took Polaroid pictures so that at the end of every day, every
week you could sit down and say, "These are the four for
surgery"--you wouldn t remember who they were unless you had a
picture.
The dean and vice dean would find somebody charming, and
they d want to choose him; and then Roger would say, "Well, now
let s look at their background." Then Roger would come out to
me, and say, "Give me any little dirt that you have." Out in the
main lobby we picked up a lot of information. I could tell who
was absolutely kooky very quickly. So with one guy--I ll never
forget--whom the dean wanted to hire so very badly, I said, "Your
Excellency, this man is mad. He s absolutely kooky." "No, he
isn t." So I gave him the clues, and he didn t see it, because
these were Americans or Canadians, and the cultural difference
was too big.
We were on that contract for ten years. We got the school
up and running for six years, and then they had to have a
teaching hospital. There was a new hospital that had never been
staffed. The government gave it to the King Faisal University.
And I was still in charge of worldwide recruitmentworldwide
recruitment, because the salaries were so low that we could only
send American heads of nursing over. We had to go to the
Philippines, Cairo, the Sudan, and India to get cheaper people--
who were not very goodbut they wouldn t raise the salaries for
us. We got the teaching hospital up and running. It was
wonderful.
Then when Roger became director of the Museum of Science in
82, he couldn t fly out there every five weeks, which is what
he d been doing with Harvard- -flying out there every five weeks.
In Saudi Arabia, they don t want to deal with anybody but the top
man; they wouldn t even talk to anybody below Roger. So he had
to conduct all negotiations and all discussions of problems. Now
that just wasn t possible, because the museum was a very
challenging job. We just simply closed up the contract. They
were well on their way. We were just about at that time to start
a big CDC [Centers for Disease Control, the federal government
laboratory in Atlanta] --Kuwait had asked us and were going to
283
give us the money to start a CDC type major laboratory for the
whole Middle East in Kuwait. We just had to write to them and
say we couldn t do it. And they never did it. Then all of the
Trucial Coast little kingdoms, oil kingdoms, down the Gold
Coastasked Roger to set up a training program, continuing
education for all of their physicians: their Indian physicians,
their Bahrain! physicians. That would have been another
contract, but there comes a time when you simply have to pull out
of something when you can t do it.
Director, Museum of Science, 1982
Nichols: When he became head of the museum, I lost the best job I had.
Well, there was no contest. I just went in every day as a
volunteer at the museum. But it was the time to do it. What we
did at the museum was so spectacular, and it was just at the
right time in his career, because he brought the museum from
850,000 people a year coming in to 1.6 million. He brought in
these huge blockbuster exhibits. If he had lived, he would have
made it the best museum in the world, I m absolutely sure of it.
Roger did a lot of outreach programs that everybody said
couldn t be done. Girls don t go into scienceyou know, at that
time, 6 percent of the women were going into science, in 83 and
he said, "We re going to bring Girl Scouts in for camp-outs in
the museum; we re going to give them science taught by women;
we re going to let them stay overnight; we re going to give them
badges that give them free access for the whole year." The first
year we had 3,000 girls; we re now up to 25,000 girls. And
there s a backlog. The girls love it, and it makes a difference,
because they see that science is fun, you can go into science and
be a teacher and the women teachers are marvelous. He had a lot
of very brilliant ideas that everybody in the museum said
couldn t be done; so he just went ahead and did them. Okay, back
to Aramco.
284
IV LIFE IN SAUDI ARABIA
Raising a Family
Hicke: Let me ask you a little about life in Arabia, your own life.
Nichols: Life in Arabia. Well, I found it very interesting and very
absorbing. Roger was out in the field three days a week,
scraping eyes. I went out with him quite often. Our son was
born in 61. We actually came back 1960 to 61, and lived in
Belmont, because he wanted to finish his residency in internal
medicine, and so we did that. And that was nice, and he did his
boards. Then we went back. Aramco kept us on salary, which was
very helpful. When you have two small childrenthe girls were
two and four when we went out there- -you re busy at home pretty
much with the kids. Eventuallythere s a little bit in here
about it--I was head of the Girl Scouts for many years, and
marched them out in the desert and had a marvelous time. Got
involved with Sunday school teaching and Bible school in the
summers. I just loved it, Carole. We took the kids swimming
every day. Roger and I were in the desertsometimes with the
childrena lot. I even got to drive in Arabia, because we just
wrapped my head in a red and white gutra. We had Land Rovers all
the time, and nobody knows: if you meet a Bedouin, they don t
know if it s a woman or a man. So we got way out in the desert,
no roads, compass, and Roger would say, "You want to drive?"
That was exciting and sort of daring.
Curing Trachoma; A Moral Dilemma
Nichols: I went with him on a lot of trips to the villages, where he was
scraping eyes. But I started to tell you earlier on: the one
thing that was sort of difficult was that if they treated all
285
Hicke:
Nichols:
Hicke:
Nichols :
Hicke:
Nichols :
these people with trachoma, then they were no longer useful to
develop the vaccine. So we had a problem. You sort of had a
moral problem here: are you going to treat all of these people
who have trachoma, or are you going to use them to get a vaccine?
And I m sure that he must have treatedhe must have--I cannot
believe that through all those years, that they weren t also
treating people. But the only way to do a study and to follow
children is to go back out regularly and scrape the eyes and see
what s going on. So I think there was sort of a moral dilemma
there. And you d have to ask Dottie, because I honestly don t
know how they resolved that. Because we had to have real
trachoma going on. Obviously, they d never let people go blind
from it; they would treat it before it got too far advanced.
You also said the reinfection rate was so high that treatment was
really not effective.
Oh, that s right. They would get it right away again, which was
almost worse for you when you repeat it. And some people got
trachoma, didn t go blind, and got over it on their own. I don t
think they ever found out what there was in anybody s body that
gave you a spontaneous recovery from it. But in those days, it
was what?--6 million people in the world were blind from it?
Again, the statistics must be somewhere, but it was a leading
cause of blindness in the world. When we went out there, Carole,
there were three major health problems in the world: trachoma;
malaria; and tuberculosis.
You had them all.
Well, yes, but those were considered by the World Health
Organization as the three most worrisome. And they were all
being worked on, of course. But I didn t know until we went out
there that trachoma was so prevalent and that it was such a worry
socially. Because if you re blind in a country, you can t work;
and an awful lot of people were blind in Saudi Arabia. It
[trachoma] hit them by the time they were three months old--if
not earlier, you see. But again, if you raise the standard of
livinggive them soap and water then it just goes. It goes of
its own accord. It s almost faster to raise the standard of
living, but it really isn t; it s not that easy to raise a
standard of living.
No.
That s very difficult,
wealth.
But Arabia has done that with their oil
Hicke:
286
Well, they have plenty of money there, so that made it easier for
Saudi Arabia. But there are other places in the world-
Nichols: Oh, sure. Bangladesh and Pakistan.
So it was a good life, I thought. As a family, it was a
safe place to live. We played a lot of tennis. We had swimming
pools, little theater, good school systems. The kids had to go
away to school after the ninth grade, but we sent Wendy, the
second daughter, to the same missionary school I d gone to in
South India. She had four years there, which was great. Our
first daughter went to Northfield, Mount Herman, in
Massachusetts, and hated it. So we let her go--it was a good
school, but she was so homesickwe let her go to India for a
year. Great place to raise a family: partly it was great for us
as a family because we were so active. We were in the desert
with the Bedouins; we were following the tribes as they went from
grazing area to grazing area. Roger was well known and welcome,
and so we had some wonderful experiences sleeping under the
stars with the Bedouins, with camels tethered right above us,
with the babies and so forth; rode camels.
Desert Explorations and Other Expeditions
Nichols: And then as you ll read in this, Dr. Barger, Tom Barger, the
president, told him about some ancient fortress that was out
there, a small one. Then we went out and started looking for
some big ones, and we found ones that nobody had ever documented
before, and climbed them. Found wells that went down 180 feet
from the top of the jebel, down through the jebel, all the way
down to ground water, which was way down there. Nobody knows how
old they are; at least we didn t at the time we were there. But
clearly, people withdrew to there, because they had a huge entry
hole that they would cover with a big capstone. They had the
water; and they had enough food, I guess, to be besieged. Or how
would you besiege them? They had to have lost all their sheep or
whatever else was down below. Nobody knows who lived there. All
the Bedouins would tell Roger they d say, waajid atiig, which
means very old. But I m sure archeologists now know this. They
must know; they must have figured out. I have a huge grinding
stone in my living room, a great big thing made out of sandstone,
which we found on the top of one.
We did a lot of desert exploring. Roger was brave and he
liked to do things. He was an adventuresome guy. We drove twice
by Land Rover, as a family, from Dhahran across twenty-seven
287
countries to London and back, which when we did it, had never
been done before. We carried tents and had some very exciting
experiences doing that. It was a good life; it was an exciting
way for the three children to grow up. We sailed in the
Mediterranean for three weeks by ourselves during the melteme,
which is the big storms that go on day and night. The Greeks
wouldn t leave port in the morning, but Roger Nichols always had
us up and out in force-eight winds, you know! He was an exciting
person to live with, because he loved adventure, and we did
things that many other people didn t do.
We had a boat for waterskiing; we used to water ski at night
with the dolphins beside us, with fluorescence all around us.
And we d have people come way down the Half Moon Bay of the
Persian Gulf, to the top of sand dunes; and we d have lobster
picnics. We just did things. For an Iowa farm boy, how he came
up with all these--! He had all the ideas and I did most of the
execution, which was fine.
Hicke: I think he was fortunate to have you.
Nichols: I often said, "That s the stupidest idea I ever heard of in my
life." But I was always wrong. And we did do it. I mean, you
know, traveling with three young children from Dhahran in July
all the way to London and back. That was tough: you have to
carry your own food and water; you worry about sickness; you
worry about boredom; you re putting up tents every night in the
desert. But it was marvelous. Having grown up in India, this
was relatively easy for me to do, once I got over being kind of a
placid cow who says, "We can t do it." And he would say, "Yes of
course we can do it. You ll love it." And I always did. I m
sure I loved it more than anybody else once I got over that
feeling of "Oh, dear! Here we go again!" [laughter]
But he was so interesting. And I felt safe with him; in
fact, I would have gone anywhere in the world with that man. He
was a good sailor, and we got into some terribly difficult
situations back here after 1970, when he used to charter small
sailing boats with a crew that had never sailed before, big
storms where nobody else was going out. But I knew Roger knew
what he was doing. Even though I was seasick and scared
spitless, I knew that we were all right, because he was the kind
of man you could have followed to the end of the world: he just
didn t make mistakes.
I started learning that when we were on the motorcycle the
summer of 47, when we went screaming down from Golden in the
rain to a meeting in Denver--three-hour trip downand I sat
behind him on this motorcycle. He was going much too fast; and
288
he just said, "Hang on. And if we skid, think, and throw
yourself toward the mountain. Because if you throw yourself one
way and I throw myself the other way, we are dead." So we came
around a corner, Carole, just as a car skidded on gravel, in the
dirt, and right in front of us, went shrieking out into space.
We hit the same skid mark, and, you know, I held onto him, and we
both threw ourselves towards the mountains, skidded right up- -and
he was trying to control the motorcycle right up to the edge of
the cliff, which fell straight down 3,000 feet, and here was this
car, you know. From that very beginning, I must have realized.
Hicke: You knew what you were getting into!
Nichols: Well, you don t really know; but I had this feeling of
overwhelming trust, that this man was so competent and so capable,
which is nice. But on the other hand, I also would watch when we
were sailing and often said, "Hey!" and he d look up, and we were
heading straight for a huge buoy or for another boat. Because I
was so nervous all the time, 1 was very alert. So again, there
was a teamwork there. It was useful, because I was a scaredy cat
and he was bold and brave; together we kind of kept going. We had
many situations where, without the two of us working together, it
would have been the end. That s allsimple as that. [laughter]
It was a good combination, in many ways. I was scared; and he was
kind of irritated because I was such a scaredy cat.
Hicke: A little caution, as you pointed out, is useful at times.
Tom Barger
Hicke: Let me ask you about Tom Barger, since I can t talk to him.
Nichols: He was absolutely the most marvelous man. I have the Aramco
World which is devoted entirely to Tom Barger. Now, I presume
they left in 68 or 69, and they did a whole Aramco World [on
him] . You see it in the Aramco magazines that come out every
month or every two months. You should get a copy of that,
because that gives his whole story. He went out there as a
geologist. It obviously should be a part [of the history], and
it might be a part of the medical--! don t know. He was a
fabulous president.
Hicke: I sense that the kind of support and interest in the Saudi
Arabian country and culture was part of why Aramco did this
really unique-
Nichols: The trachoma research--
289
Hicke: The trachoma, the whole- -
Nichols: Oh, absolutely! The real people, Carole, who worked out there,
learned to love the Arabs. Tom Barger went out there as a young
geologist; he was in the desert all the time; he spoke Arabic
well: he really understood the Arabs and he loved them, and they
loved and respected him. It is people like that who held Aramco
as a strong force out there. There were a few people who came
along who were only interested in making money. They would be in
charge, but they didn t have the same ability to carry the
country with them. Barger was absolutely spectacular. He had a
marvelous wife, six children. We just adored Tom Barger. If you
don t have it, I will either xerox my copy or loan my copy to
you, of his entire life story.
Hicke: I think we can get that.
Nichols: Okay.
Hicke: But it would be helpful if you would tell me which issue it is.
Nichols: I can go back and look it up. I have all of the Aramco Worlds.
he left in either 68 or 69, so it was one of the issues there.
I will go and double check. He was entirely supportive of
Roger s trachoma program.
The first time I got out there in 57, there was a big party
held honoring Jack Snyder, and I didn t know anything about
anybody. I sat at a table on a big lawn with two other people.
Right across from me was this awfully nice-looking young man. He
was telling about being a geologist and these fabulous stories
about the desert and following this one guide who got them out of
all sorts of trouble, because he was a Beduoin who knew where
they were. Just wonderful stories.
When we got home, Roger said, "Well, did you have
interesting people at the table?" And I said, "Oh! There was
this one man--." At the end of the conversation at dessert, I
had said, "What do you do now?" And he said, "Well, I just sort
of sit behind a desk." I said, "Gee, that can t be very
interesting. That s not nearly as interesting--" I didn t know!
I didn t even really get his name. So I said, "This man was so
interesting. He says he sits behind a desk, but it used to be
that he was out following this Bedouin and exploring for oil."
And he said, "What was his name?" And I said, "Oh, dear.
Berger? Buckley? Bucker? Barger? Tom Barger?" And Roger
said, "Oh. He s president of Aramco." I said, "You re kidding.
No wonder he sits behind a desk!" But Roger said, "Well, at
least you didn t butter up to him." I said, "Well, I was just so
290
stupid I didn t know who he was." [laughter]
modest. Oh, they were a wonderful family.
But he was so
We went on several, long desert trips with them. He knew
the desert very, very well, and had done a lot of exploring long
before. Now we were out there discovering ancient cities that
had been buried for centuries, one of them called Tha j . I always
loved archeology, so we were digging and picking up arrowheads,
and bringing in stones, you know, all sorts of things, because
I m an avid rock collector. We were finding marvelous things.
History and Archeology
Hicke: Are the Saudis doing some archeology now?
Nichols: Oh, yes. They have a whole department. They have a marvelous
archeology museum in Riyadh, I think. I ve not seen it. Have
you ever heard of the Nabateans? Petra?
Hicke: Yes.
Nichols: Okay, well Petra was their main city; but in Saudi Arabia, it was
Madain Saleh. The Nabateans ruled the trade routes from 300 B.C.
to 100 A.D. All of the Queen of Sheba-type spices were coming up
there; before the Romans came in and began to travel the Red Sea
by ship, all of the huge, long camel caravans carrying all these
spices and gold and whatever was coming from India and China were
coming right up that coastline. Both Petra and Madain Saleh were
stopping places for food and water. They were stocked, they were
helping; and they were charging huge taxes and so forth. That s
how they were making their living.
Well, when we went to Madain Saleh, the Christmas of 1969--
the Bargers had been there, but I don t know how many other
Americans had ever been there. It was just an open ruin with
these tombs in this rose-colored mountain. We d read about it
for years. As a family, we drove there Christmas Eve and spent
Christmas there. I brought back some basalt, volcanic basalt--
and there re no volcanoes there, so I don t know where they would
have been brought from- -grinding stones. The village is all
gone, but these rose tombs are there and all of this huge jebel.
Just gorgeous. But now, you can t get anywhere near it. I don t
know whether they ve got it fenced off, but it s just too easy
for people to come in and take things. They do have an
archeology department. They do recognize that they ve got some
terribly interesting history there. Excellent archeology. So,
they re protecting it and they should.
291
Travels
Hicke: You traveled to other places, I assume, outside of Arabia.
Nichols: Oh, yes. We went to Africa, India. I went to India every year
for many, many years. Back and forth through Europe. We never
got around to the Far East, partly because we just were so
interested in the Middle East. We both liked the Middle East so
well. Every year they give you a short vacation, and every two
years you got a long vacation. It seems to me the long vacation
was- -could it have been three months?
Hicke: Yes, I think that s what I ve heard from others.
Nichols: You had to leave the country. They handed you the money and
said, "You have to leave the country." Because they wanted
people to get out and get a fresh view. So we could buy both of
the Land Rovers we had. They handed us $6,000, and we could take
one Land Rover up to London; buy a new Land Rover; and bring the
relatives back. We didn t use the money for air tickets by and
large because we wanted to be out exploring.
I was very lucky, Carole. There were other people out
there, but not many as adventuresome, interested, or capable as
Roger. We were the first ones, as far as I know, to make that
drive. And then other people were doing it.
Hicke: You must have gone through Lebanon and Syria?
Nichols: Oh yes.
Hicke: And Anatolia?
Nichols: Absolutely. In fact, we loved Turkey best of all. We went
around the whole edge of Turkey and we went through the center
twice. Our oldest daughter Kathy, who s a lawyer, was out there
when Roger died in 87. She and her husband were out there; he
was an engineer with the Corps of Engineers.
Hicke: Well, I think we ve covered most of what I wanted to ask you.
This has been a wonderful view of your husband s life and your
view of Saudi Arabia and Aramco. Thank you.
Transcriber: Lisa M. Vasquez
Final Typist: Shana Chen
292
Regional Oral History Office University of California
The Bancroft Library Berkeley, California
Aramco Medical Department Oral History Project
Dorothy McComb
TRACHOMA PROJECT: 1953-1976
An Interview Conducted by
Carole Hicke
in 1996
Copyright 1998 by The Regents of the University of California
Since 1954 the Regional Oral History Office has been interviewing leading
participants in or well-placed witnesses to major events in the development of
Northern California, the West, and the Nation. Oral history is a method of
collecting historical information through tape-recorded interviews between a
narrator with firsthand knowledge of historically significant events and a well-
informed interviewer, with the goal of preserving substantive additions to the
historical record. The tape recording is transcribed, lightly edited for
continuity and clarity, and reviewed by the interviewee. The corrected
manuscript is indexed, bound with photographs and illustrative materials, and
placed in The Bancroft Library at the University of California, Berkeley, and in
other research collections for scholarly use. Because it is primary material,
oral history is not intended to present the final, verified, or complete
narrative of events. It is a spoken account, offered by the interviewee in
response to questioning, and as such it is reflective, partisan, deeply involved,
and irreplaceable.
************************************
All uses of this manuscript are covered by a legal agreement between
The Regents of the University of California and Dorothy McComb dated
April 19, 1996. The manuscript is thereby made available for
research purposes. All literary rights in the manuscript, including
the right to publish, are reserved to The Bancroft Library of the
University of California, Berkeley. No part of the manuscript may
be quoted for publication without the written permission of the
Director of The Bancroft Library of the University of California,
Berkeley.
Requests for permission to quote for publication should be addressed
to the Regional Oral History Office, 486 Library, University of
California, Berkeley 94720, and should include identification of the
specific passages to be quoted, anticipated use of the passages, and
identification of the user. The legal agreement with Dorothy McComb
requires that she be notified of the request and allowed thirty days
in which to respond.
It is recommended that this oral history be cited as follows:
Interview with Dorothy McComb, an oral
history conducted in 1996 by Carole Hicke
in "Health and Disease in Saudi Arabia:
The Aramco Experience, 1940s- 1990s, "
Regional Oral History Office, The Bancroft
Library, University of California,
Berkeley, 1998.
Copy no.
Dorothy E. McComb, 1996,
293
TABLE OF CONTENTS- -Dorothy Elizabeth McComb
INTRODUCTION by A. P. Gelpi 294
INTERVIEW HISTORY 295
BIOGRAPHICAL INFORMATION 296
I TRACHOMA RESEARCH PROJECT 297
Starting Work with the Project 297
Dr. Snyder Undertakes the Reserach: Problems of Isolation 298
Relationship Between Harvard and Aramco 300
Village Surveys 302
Collecting Samples 304
Learning about Arab Culture and Undertaking Village Visits 306
Successful Isolations, then Vaccination 310
Ten-Year Follow-up Visits 312
Vaccines and Cures 315
Dr. Roger Nichols 317
Dr. Robert Oertley 319
Dr. Richard Daggy 320
Other Personnel 321
II WINDING UP THE TRACHOMA PROJECT 323
294
INTRODUCTION- -Dorothy McComb
Dottie McComb was part of the trachoma projecta joint project
involving the Harvard School of Public Health and Aramco s Medical
Department. It remains one of the crown jewels of Aramco s health care
efforts during the fifties and into the mid-seventies. This was a
project which began with clinical observations on eye disease among the
inhabitants of the Eastern Province- -many of them Aramco s employees and
dependents and moved from the field into the laboratory. And in the
laboratory, it could be determined that among the multiple causes of eye
infection, it was the trachoma organism which was responsible for the
most serious and the most widespread eye disease. Using the new
technique of fluorescent staining to identify the trachoma organism in
eye scrapings, it was possible to carry out epidemiological surveys at a
pace, and with discrimination, heretofore not possible. Ms. McComb
played a prominent role in both the field work on trachoma and related
studies carried out back at Harvard s School of Public Health. Her
technical expertise in the field and in the laboratory made her an
invaluable colleague another true pioneer of Aramco medicine.
Armand P. Gelpi, M.D.
December 9, 1997
Sonoma, California
295
INTERVIEW HISTORY- -Dorothy McComb
In 1953 Dorothy McComb was hired as a researcher by the Harvard
School of Public Health, thus beginning an association with the
Aramco/ Harvard Trachoma Project that lasted nearly twenty years. She
was therefore in a position to describe in detail the initiation of the
project, the state of scientific knowledge about trachoma at that time,
the village surveys undertaken, the search for a vaccine, and the
results obtained. She discusses the challenges the teams faced in the
Arab villages as well as the difficulties the investigators found in
isolation of the microorganism. Experimental vaccination in the early
1960s was followed by samplings in 1972 to check responses. McComb also
describes other personnel involved, such as the late Dr. Roger Nichols,
who headed the field program, Ali Abdul Rahman, lab technician, Dr.
Robert Oertley, Richard Daggy, and other members of the research team.
McComb was interviewed on April 19, 1996, at the Harvard Club in
Boston, Massachusetts. She brought along notes from journal that she
had kept during the investigation. She revised the draft transcript
extensively, to the extent that most of it was completed as her written
document. The result is a precise and knowledgeable description of the
trachoma research in Saudi Arabia.
Carole Hicke
Project Director
January 1997
Regional Oral History Office
University of California, Berkeley
296
Regional Oral History Office
Room 486 The Bancroft Library
University of California
Berkeley, California 94720
BIOGRAPHICAL INFORMATION
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297
I TRACHOMA RESEARCH PROJECT
[Interview 1: April 19, 1996]** 1
Starting Work with the Project
Hicke: Please tell me how you got started and involved with this trachoma
project. That was the major thrust of what you did, right?
McComb: I graduated from Simmons College in 1953 with a bachelor of
science degree in biology. In those days the job market was in
our favor, lots of jobs. Simmons College is located about three
long blocks from Harvard Medical School and the Harvard School of
Public Health. I headed for job interviews at both places. At
that time, John C. Snyder, M.D. was chairman of the Department of
Microbiology at the Harvard School of Public Health.
Dr. Snyder and Edward Murrayboth of them physicians, and
both of them doing research- -had been involved in epidemic typhus
outbreaks in Egypt during World War II. After the war they came
to the Harvard School of Public Health. I interviewed with and
was hired by Robert Shih-man Chang, M.D. Bob was in the process
of trying to develop some serologic tests for leptospirosis, a
disease that affects both humans and dogs; at that time he was
working with leptospira cultures that had been isolated in dogs.
He was a wonderful teacher--! mean, how lucky can you be? When
you made mistakeswhich I don t remember making that manyit was
a learning process. He never condemned you for something that you
had done. In 1953, the research focus in the department was
primarily on rickettsial diseases. That s where Ed Murray s
expertise was, as well as Jack Snyder "s.
This symbol (##) indicates that a tape or a segment of a tape has
begun or ended. A guide to the tapes follows the transcripts.
298
We had a laboratory with access limited to people who were
vaccinated. These microorganisms were highly infectious for
people who were not immune. The infectious areas were secure
behind an iron door, which quite literally was about three inches
thick, and we all had keys to get in. That s where the laboratory
cubicles were located.
And since I m telling anecdotal things, we had an episode
where a man who wandered in off the streetthis was some years
latersomehow managed to get up to the second floor of the
building, walked across the corridor and then downstairs to the
basement of our department. There he encountered a technologist
who was working in mycology (fungi). The technologist recognized
this man was definitely in a restricted area. She called Ed
Murray, who by this time was acting head of the department,
because Jack Snyder was already dean of the school as well as
still being head of the Department of Microbiology. She sent this
man up one flight, then called and told Ed Murray what she d done.
Ed Murray was coming down the corridor from his office, and there
was no way this fellow could get by him. So, in a very nice way,
he explained to the man that he d gotten back into an area that
was restricted because of the kinds of work we were doing and he
promptly took him down to his office and told him that he would
have to vaccinate him against epidemic typhus!
Now I have to put a little footnote in here, because this
fellow was up to no good (claimed he was looking for personnel).
We did have some thefts in the past. Ed Murray couldn t wait to
tell us the whole story after he d gotten through vaccinating this
fellow. He said the beads of perspiration just came out all over
his brow, and you knew he would walk out that door and tell his
buddies to stay away from that building, because this is what they
would do to you.
Dr. Snyder Undertakes the Research; Problems of Isolation
McComb: Working in microbiology was really very interesting because you
learned about other research than your own. In 1954 Jack Snyder
made a trip to Saudi Arabia to do a presentation for the Persian
Gulf Medical group; from that evolved the question of looking at
doing some research on trachoma in the Kingdom. Saudi Arabia was
probably one of the areas in the world where the eye disease was
the worst. In 1954 the microorganism had not been isolated.
Related microorganisms like lymphogranuloma venereum and
psittacosis had all been isolated, but not trachoma.
299
Hicke: Maybe you should explain isolation, because I read that paper you
sent, it s all on isolation, but I don t quite understand what
that means.
McComb : A suitable medium is required to culture microorganismsbacteria
or viruses--f rom infected tissue. In the case of polio virus,
isolation was done in monkey kidney cells grown in glass test
tubes. The virus killed the cells. When samples were transferred
to fresh monkey kidney cells, those cells became infected. That
is called isolation. Further work was required to determine how
many types of polio there were.
Hicke: It s different from identifying?
McComb: Oh yes. The identification is a separate process. Now you have
to know what you re looking for before you choose the type of
medium you re going to use. In hospital laboratories they will
have solid media on petri plates, and they can take a little wire
and touch the inside of your mouth and swish it around, and they
will probably get ten or fifteen different kinds of bacterial
colonies that will grow on that particular medium. For viruses,
it is sometimes more difficult. The microorganism causing
trachoma was called a virus initially; it is not. However, since
trachoma infects the human conjunctiva, Bob Chang established a
culture of conjunctiva cells from humans to attempt the isolation
of the trachoma microorganism.
Hicke: Isolation then means actually being able to grow this, not just
identifying it, but being able to get it to reproduce.
McComb: Yes. They knew what it looked like, interestingly enough. By
taking a scraping from an infected conjunctiva, smearing it on a
glass slide, and staining it with giemsa stain (common laboratory
stain), the inclusions inside of the cells could be seen.
Hicke: But they couldn t figure out what was causing it to grow?
McComb: They didn t know how to isolate it. In the populations where the
disease was the worst, other microorganisms in the eye
contaminated the culture medium used to attempt isolations.
In the summer of 1955, Bob Chang, the one who developed a
human conjunctival strain of cells, took these cells to Saudi
Arabia to attempt isolation of trachoma. The paradox is it worked
and it didn t work! No isolations of trachoma were made.
But... the first isolations of coxsackie viruses and adenoviruses
were made and identified.
300
In 1957, Dr. Tang, who was working in Peking, China, did
something for which all of us thanked him. He simply took
streptomycin and mixed it with the sample taken from a patient
with active trachoma. Giving the streptomycin time to eliminate
bacterial contaminants he then inoculated that mixture into the
yolk sac of an embryonated egg. His work was published in the
Chinese Medical Journal in 1957. In very early May of 1958 our
laboratory learned what he had done. It was just like an eruption
for all of the laboratories who had been working unsuccessfully in
this area. Now we had a means to begin the process of learning
something about this microorganism. But, I m ahead of the story.
Hicke: Right, we re still in 54 or maybe even 53.
Relationship Between Harvard and Aramco
[Following sections were mostly written during narrator s review]
Hicke: Can you explain exactly the connection between the Harvard School
of Public Health and Aramco? As you said, it started with Dr.
Snyder, he was by this time dean of the Harvard School of Public
Health as well as head of the Department of Microbiology. He went
out to give a lecture in Dhahran to Aramco executives and
physicians from the region.
McComb: Aramco (Arabian American Oil Company) had recently completed a new
hospital. In the construction of the Dhahran Health Center the
company obviously were thinking in terms of some research. That s
why they included research laboratory space on the second floor.
The Persian Gulf Medical Group, some of whom had been to Harvard
for scientific meetings, were not unknown to Jack Snyder. I think
the person originally to have gone to make the presentation was
Dr. Simmons. He was dean of the school at that time. Dr. Simmons
died suddenly, and Jack was asked to be the pinch hitter. In
addition, Jack Snyder was unaware of what kind of presentation
Simmons was going to make. He sort of had to go out there almost
cold turkey. But while he was out there, I believe the question
came up as to initiating a research program of some kind. I also
think Snyder felt that the research definitely had to be something
that dealt with the local population.
It was Dr. Snyder s suggestion to Aramco to support research
on the eye disease trachoma. Approximately 400 million people in
underdeveloped countries around the world were infected with the
eye disease trachoma (Chlamydia trachomatis) , many showing signs
of serious sequelae. After his visit to Saudi Arabia and Aramco
301
in 1954, a joint program was announced to begin research to
isolate the causative microorganism, the program to be funded by
Aramco and the principal investigators to come from the School of
Public Health.
In the summer of 1955 a team from the Department of
Microbiology at the Harvard School of Public Health left for
Dhahran, Saudi Arabia, headquarters of the Arabian American Oil
Company. In the group were: John C. Snyder, M.D., Edward S.
Murray, M.D., Robert Shih-man Chang, M.D., and Samuel D. Bell,
Jr., M.D. They were joined by Mario Tarizzo, M.D., an Aramco
employee.
All of the equipment, solutions, and materials needed for
the initial study were brought from Boston. In addition, Bob
Chang s wife, Yinette, joined the group, as she had particular
expertise in cell culture. In anticipation of this trip, Bob
Chang had developed a line of normal human conjunctival cells
which were to be tried for the isolation from the eyes of Saudis
with the disease.
Yinette had the task of setting up the laboratory in the new
space on the second floor of Aramco Health Center. The facilities
included the "kitchen," a room for washing glassware, an autoclave
for sterilizing glassware, equipment and media, and a small
storeroom for supplies. Immediately adjacent off a central
corridor were the lab areas consisting of five rooms with benches,
drawers, cabinets, hoods for cell culture and a large -60F Revco
freezer for storage of clinical specimens.
So in 1955, Jack Snyder, Sam Bell, Bob Chang, and Ed Murray
went out to Saudi Arabia to do an initial survey of trachoma in
the villages. It was not going to be a big survey, but they
needed to get a look at the people in a few villages in different
parts of the Eastern Province of Saudi Arabia. The laboratory was
located in the Aramco Health Center in Dhahran. It was a fairly
well-planned laboratory, in terms of space, and newly built.
They obviously needed a medium in which to collect the
samples. For years Snyder and his colleagues worked with the
rickettsial microorganisms, including Rocky Mountain spotted
fever. The medium of choice was a solution which had phosphate
and glucose in it. They just had to assume this might also work
for attempting the isolations of trachoma. Using tiny vials
containing the solution, they would take a little scraping from
the child s conjunctiva and twist it in the solution. A
sequential number would be assigned and each vial placed in a
portable icebox. Samples returned to the laboratory would be
frozen under dry ice and alcohol (approximately -60F) and then
302
stored in a -60F freezer. To protect the samples they would be
brought back to Boston under dry ice for testing.
While in Saudi Arabia Bob Chang was also trying out his cell
line of conjunctival cells in attempts to isolate trachoma. While
this approach failed, isolation of two groups of viral agents were
successful--adenoviruses and coxsackie virus. The laboratory
results showed the potential for many infections of the eye in the
Saudi population. These early results came to bear on a growing
understanding of the disease process in the eyes of children--!. e.
isolations of infectious agents, the clinical appearance of the
eye, and epidemiologic factors. Trachoma in the Eastern Province
of Saudi Arabia was severe, with vision impairment early in life.
Village Surveys
McComb: At the end of our twenty years of work in Saudi Arabia, in the
village of al-Mallahah, we did a survey of all the people from the
youngest to the oldest. Twenty percent were blind in one or both
eyes .
Hicke: How many would the total be that you surveyed?
McComb: About 500. Now we re talking economically blind, in other words
they might be able to see shadows, but for the purposes of the
study they were blind.
I probably should mention at this point that when we got
further into our vaccine studies, we were looking at three
different types of villages and settlements. The village al-
Mallahah was very small, but it was a community in and of itself.
It was right next door to another village, yet there was not much
intermarrying. The young girls married very early, anywhere from
eleven, twelve, thirteen, fourteen years of age. Sometimes that
was done with the stipulation that they not have intercourse until
they got to be fourteen. This was something parents worked out.
Al-Mallahah and others were considered the primitive
villages. No running water, and only a central latrine. To be
sure, they boiled water that they used to cook with or to make
tea, and they did very well trying to keep the children from
having flies. But the flies were everywhere, on the eyelids of
the kids; and the kids got so used to it they didn t pay any
attention.
Hicke: Was the water brackish too?
303
McComb: No, the water was pretty good; they had some deep wells. When the
mothers would see the children with discharge from their eyes they
would just wipe the eyes with their abba or outer garment. So the
transfer almost certainly was done a lot by just clothing, from
one child to another. Then once the eyes had been infected, the
condition of the eyes got worse and then would subside. Cycles of
active disease occurred periodically.
Hicke: You mean an individual would go through cycles?
McComb: Yes, you ll see. I ll show you some examples later of how the
disease was scored; there was scarring of the conjunctiva,
infiltration of the cornea--i.e. observation of blood vessels
penetrating the corneal area. For those who had experienced this
over a period of thirty years, many of them had a clouded cornea,
and often they would be totally blind in that eye. It was a
disease process that was set in motion early in life. When
analysis of the data began we found that most of the children were
infected by the time they were three months old.
We finally categorized the Saudi villages into three types
based on the types of living conditions. So you have what I would
call the primitive village, such as Al-Mallahah. Then, on the
other extreme, what Aramco called its "town sites." Aramco was
already ahead of the public health game, because they realized
that many of their Saudi employees were coming from these kinds of
primitive villages in the Eastern Province. What the company
chose to do was to give their employees the opportunity to live in
a brand new home, which they would build at new sites. But they
didn t want to build them to the old-style communities. They
wanted to build it in a new area. There were two of these "town
sites" where we examined children for trachoma: one was in Ras
Tanura, which was fifty miles north of Dhahran (the location of
our laboratory), and the second in Abqaiq, fifty miles south of
Dhahran. These "town sites" were all new housing with running
water and toilets.
The third type of housing was a mixture of old and new.
Qatif, which was a large city by Saudi standards, was located
right on the Persian Gulf, or as the Saudis preferred to call it,
the Arabian Gulf. If a family wished to build a new house in one
of those places, the company would agree to it, and I m sure there
were some stipulations on the site.
Hicke: Do you mean a non-Aramco Arab?
McComb: No, sorry, it would be an Aramco employee who chose to stay where
the rest of his family was, i.e. other relatives, rather than
304
Hicke:
Me Comb :
building a house a distance away. So if we jump ahead of the
story to describe the actual effects of the vaccine program, which
we eventually initiated there and did a ten-year follow-up, you
could tell easily which children had grown up in a town-site home.
The children appeared to be taller, their health was better, the
disease was milder, and the sequelae less serious.
That could have been only one generation at most.
Correct, but they had a safe source of water inside the house, and
the clothes could be washed more often. It s the same population
of people, but suddenly they re living in very different
circumstances.
Collecting Samples
McComb :
Hicke:
McComb ;
Hicke:
McComb ;
Getting back to the beginning of the story then: when Bob Chang
knew that he d isolated viruses we were able to type them. The
adenoviruses were very new, they d only been described very
recently in the scientific literature. In fact it was apparently
a very common infection in the U.S. military, when young recruits
came in for training. Proximity of beds in barracks contributed
to the spread of the adenovirus as a respiratory infection. They
were just beginning to identify them by type (over twenty types of
adenovirus have been identified). Some types are more prevalent
and more severe than others, so there s an importance in typing
the virus once isolated. Most of the strains being isolated in
the U.S. military were types 3, 4, and 7. Isolations of
adenovirus were an unexpected outcome of attempts to isolate
trachoma. However, it graphically showed the spectrum of eye
disease in the Saudi population.
That did not cause blindness?
No, not as far as we know. Certainly not in this population. It
made you think a bit, because the very technique you hope to use
to isolate the trachoma microorganism (in cell culture) obviously
didn t work. At that point we had to backtrack. By the time the
Chinese Medical Journal article was published in 1957 detailing
the first isolation of the trachoma agent, our laboratory probably
had 500 samples frozen down in a Revco freezer in Boston.
When was this survey that you told me about?
The first team went out in the summer of 1955.
samples and brought them all back to Boston.
They collected
305
Hicke: Is this the same survey as the one you told me about in the small
towns?
McComb: No, that came later, that s actually several years later. We
needed to know a lot more before then. With the information from
the Chinese Medical Journal, we literally walked across the hall
of our Boston laboratory, took these 1955 specimens out of the
freezer, did just what the Chinese did, and isolated the trachoma
organism from five children. The method the Chinese used was the
treatment of the patient s sample with streptomycin, followed by
the inoculation of the mixture into the yolk sac of embryonated
eggs. The use of streptomycin largely controlled the death of the
embryos from bacterial contaminants. The technique is as follows:
candle the eggs to check for a live embryo. When the embryo is
about seven days old, a tincture of iodine is used to sterilize
the top of the egg. Then using a syringe and needle, the sample
is inoculated into the yolk sac. The top of the egg is sealed
with a mix of paraffin and beeswax. The eggs are placed in a 37"C
incubator. Eggs are candled beginning on the fourth day. If the
embryo is dead then you just discard the egg. All others are
candled daily thereafter.
Hicke: The ones that live.
McComb: Yes. What happens is the infection from the trachoma organism
will eventually kill the egg. When that happens you remove the
yolk sac membrane in a sterile fashion and homogenize it in a
glass vial containing a special solution. We used to do that with
glass beads to break apart the yolk sac membrane. We might only
inoculate two or three eggs for each sample from one person.
Confirmation of the presence of tiny spherical elementary bodies
was done by staining their smears on a glass slide of the
harvested yolk sac, which was then examined with a microscope
under high power magnification.
This was the first part of the process, but it worked very
well in terms of being able now to isolate and to grow the
microorganism. It also meant that we could then grow it in large
volumes, if we wanted to. There was much work put in initially on
just getting information on the growth of the organism. Obviously
the intent was to hopefully make a vaccine at some point, to
protect people against the infection to begin with. So I m going
to jump ahead a bit, because you need to know that the vaccine
didn t work.
Hicke: Okay, here s the end of the story already.
306
Learning about Arab Culture and Undertaking Village Visits
McComb: But there was a long period in between, a long period in between.
Part of it was getting to know a lot about the Arab culture and
what worked best, and we had very good help from Aramco in terms
of support. We had three male Saudi nurses who worked with our
group. This is on the vaccine part of the program. We had
bilingual clerks who were loaned to us because we needed to keep
our records accurate. When we went back to see a family, we
wanted to make sure that that was in fact the family that we saw
two months before, or two weeks before. We always took a
bilingual interpreter (English/Arabic) with us on village visits.
He was critical, because we needed to get accurate family
information to avoid the similarity of names between families in
one village. These individual records were large (18"xl5" on
linen paper for durability), preprinted on two sides for multiple
categories of data to be collected.
That was one reason that I initiated a log book the very
first time we started out on the vaccine program, because there
were many important events that could not be recorded on the
individual patient record. If something happened in the course of
the day s outing that we needed to know or that might affect our
results, the log book was the place to record the information.
Hicke: Can you give me an example?
McComb: Sure. We went down to Abqaiq, one of the Aramco town-site
villages fifty miles south of Dhahran. We assigned each child a
distinct IBM number. There were blocks of numbers for each
village to avoid any mixings. Everybody knew we were coming. By
announcing we were coming back for a visit, the children and
parents would be lined up waiting for us when we arrived.
Hicke: They didn t object to this?
McComb: Oh no, they were really very good. Very, very good. In fact when
we went back for a ten-year follow-up, there were women who
brought with them the IBM numbered tag that we had assigned to
that child on the first day. It was a linen tag which we tied
around the wrist of the child. It had the IBM number stamped on
it for easy reading. If the family showed up with the numbered
tag we would still ask them all of the family information to make
certain we had the right child. Most often we were working
outside of any building; in the primitive villages, there was no
place big enough for us to work inside.
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307
In Abqaiq Town-site we were working inside the health
center. A woman came through the line with a child. She didn t
have the child s record in hand. We went through the stack of
patient records kept in IBM number order. The clerk who was
checking the patients in would pull the sheet out and that would
go with the patient through the examining stations. After a
thorough search we still couldn t find the record. We d never
lost a record before, and there was some consternation in our
group! We decided that what we would do was to inoculate the
child with a placebo--we always carried sterile saline with us--
because we couldn t take the time to figure it out and we didn t
understand it. Much to our surprise when the child s garment was
raised there was the patch of iodine indicating the child had been
vaccinated! Turns out, they d already been through the line.
Somehow the mother had gotten confused and thought there was more
to it and got back in line. The IBM sheet for the child was
already in the "out pile"!
Hicke: Oh dear. It s a good thing you used a placebo.
McComb : The placebo did not need to be given. The mother and all of our
team got a good laugh. But it just shows you the stress of it,
you know, because there would be a lot of people who would stand
in line for a long time, and we d just take them in the order in
which they came.
Hicke: I suppose that s one of the things you had to look out for then.
McComb: The village women had tasks to do. We were working in Anik, which
is an interesting village. It was different in that it was
primarily a Bedouin village. The men and the flocks of sheep
would be out grazing in the springtime. There would be some
people in the village, mostly women and children. We d gone to
that village one day with much to do. Partway through the process
you could tell that the women were getting tired of standing. I
didn t know enough Arabic then but we had translators with us and-
-my answer to most problems is humor. One of our translators was
telling me how the women were getting tired, because they were
holding the children, the youngest ones that they were bringing.
Then I said okay, so you tell her I m going to take the baby. I
just dropped what I was doing and I walked over and I took the
baby and said I d take it home with me if she didn t want it.
Much hilarity! They re wonderful people. They all just chattered
and laughed. It was necessary to release the tension somehow,
because otherwise we were not going to get through the day. I
really meant that, the people in the village were just wonderful,
they were easy to work with, they just didn t have many problems.
Except one time in 1972 when we were going back to look at some of
308
our vaccines in the village of Al-Mallahah. Only this time the
physician Bob Oertley was the person on site.
I*
McComb: It was getting late, and by that I mean dusk. We were working
with a darkened van that had a slit lamp in it for examination of
the eyes. The routine was that you checked the people in, you did
the preliminary exams of the eye, and then the child went into the
van and had a slit lamp exam which provides a very precise
measurement of the clinical status. Henry Allen, MD., an
opthalmologist with the Massachusetts Eye and Ear Infirmary, came
to Saudi Arabia to do the exam with us the whole month of
November. While the work is strenuous, it also must be precise.
In the waning light the teenage boys, probably around age eleven
or twelve were just trying to figure out how they could steal the
sponges off our working table, running around and creating havoc.
Here we were trying to finish up and probably didn t have more
than fifteen or twenty minutes of work left, but we needed light
to be able to see, and it was just getting too dark. So finally,
Bob Oertley and I had cleared the last of the people through the
early stations, but they still had to go through the rest of the
slit exam.
I said, "Bob, we ve got to do something." Now this is a
village where there was nothing but dirt roads and gullies on the
side of the road. I said, "I ll tell you what; let s go across
the road over there. We ll get away from the group that s still
trying to work here. I think we ought to teach these people how
to sing "Three Blind Mice." Now that may sound funny to you, but
as soon as Bob and I moved over there, just like the Pied Piper,
all of these big kids followed us. And so we started; we taught
them the first verse of "Three Blind Mice." They knew some words
of English, but they didn t know English very well. They picked
up this song quickly after we taught them and went through it a
few times. Then we sang it as a round. By this time we were
joined by a couple more of our staff so we had somebody to lead
each of the three rounds. Every visit thereafter to that village,
they wanted us to sing "Three Blind Mice!"
Hicke: I bet they couldn t make any sense out of the words- -nobody can
anyway.
McComb: No, but I bet they probably could get somebody to tell them. They
knew what mice were; they could probably get somebody to tell them
what the full story was .
In that phase of the trachoma program we were revisiting
several villages. With us was a female Saudi physician who was
309
studying medicine in Aberdeen, Scotland. Each student is required
to do what is called a clerkship. Her name was Tahiya bin Hemd.
Hicke: What year are we in now?
McComb: This is the fall of 1972. Tahiya wanted to come back to Arabia to
do her clerkship. Somehow she d heard about our group and written
to Bob Oertley. His response was "by all means." And so she was
there that November while we were doing all these follow-up
studies. She had been blinded in one eye from measles when she
was a child. She d been fitted for a glass eye, but at the time
she still had the eye covered with an eye patch. The women in the
village are of course veiled. It s really more a veil that they
pull over their face rather than a face mask. The Bedouins are
the ones that wear the face masks with the eye slits.
Tahiya worked with me as we got the records in the lab ready
to go out to the villages on the follow-up to the vaccinations.
She didn t veil. Nobody said boo to her about that, certainly not
any of us. But I wondered what s going to happen when she goes
out to the village with us. Well, she didn t veil, and those kids
and those women all knew that she was a Saudi. The interesting
thing is that they absolutely accepted her. So there were
barriers being broken in this period, and it was during that time
I witnessed young Saudi women who were university educated who
were working for the oil company Aramco. The women were picked up
by company automobile. They wore a veil while they were going
from their home in the Aramco compound to the hospital, but then
would work in areas where they would not be in the presence of
male Saudis. One of these young women was a petroleum engineer!
And of course there are many young Saudi women working now; some
of the barriers for women are pretty much down.
Hicke: The women never worked with the men in Aramco, is that what you re
saying?
McComb: Well, I think they do now.
Hicke: But at that time--you re talking about the "70s.
McComb: Yes. Most of the older Saudi men in the communities of course
would frown upon it; but we also found that taking Polaroid
pictures under some conditions was possible. We thought of doing
that as a way of identifying our patients. But actually there was
a prohibition of photographing the Arabs. I think it was pretty
much respected. Once we d gotten to know the people in the
villages limited photography was possible. For instance, if we
were in somebody s house and they knew we had a Polaroid camera,
they didn t mind us taking pictures of their family; they just
310
Hicke:
Me Comb :
didn t want their neighbors to know. But if you d gone separately
to the neighbors, they would have agreed as well.
But as a matter of policy you couldn t do it in an official way.
Correct.
Successful Isolations, then Vaccination
McComb : So, if we go back to the beginning of the story then, once that
initial survey was done in Saudi Arabia they had a pretty good
idea of: A) how bad the disease was, and B) what we were up
against in attempting to isolate the microorganism causing the
disease trachoma. That barrier was crossed when the Chinese
published their data; and from that moment on, we actually just
rolled right through all of those frozen samples stored in Boston.
Clinical samples from the conjunctiva were inoculated into the
yolk sac membrane of embryonated eggs. Once the organism was
isolated it was noted on the record for the patient. It was
assigned a number. The designation SA was used for Saudi Arabia
and a sequential number added to indicate the sequence of
isolations from individuals. So, SA-5 was the fifth isolation
made.
Hicke: Now what did this mean?
McComb: When you see this microorganism inside a cell, it s called an
inclusion as it s more or less encapsulated. Inside that capsule
are just hundreds of these tiny little spherical bodies. When the
cell ruptures, which it does, these elementary bodies, as they are
called, go looking for more cells to infect. Large amounts of
infected yolk sac membranes could be prepared from sequential
passages in embryonated eggs.
What we had to do eventually was to have to develop all of
the reagents that we needed to do our own work. Now you can go
out and buy some of these from pharmaceutical companies, but at
that time we had to make our own. You took a sample of a person s
conjunctiva and smeared it on a glass slide and then stained it
with an immuno- fluorescent stain, i.e. antibody to the trachoma
microorganism which is tagged with fluorescein. The tagged
antibody would then latch onto the organism inside the cell. By
looking at the slide under a dark field microscope, if there are
trachoma inclusions present in the conjunctival cells, they will
f luoresce.
311
And so that s what we laboriously did for all of these kids
who had been vaccinated with an experimental vaccine. We had the
conjunctival scraping we took before they were vaccinated, and
several times afterward. To simplify the task each conjunctival
scraping smeared on a glass slide was circled with a glass marking
pencil that had a sharp point on it. After exposure to an
immunof luorescent stain, the cells were scanned under the
microscope. The number of inclusions were counted and estimate of
the number of conjunctival cells made. This was the only crude
quantitative way to estimate the level of the microbiologic
infection.
Hicke: I think I missed something; first you surveyed them and took
samples, but when and with what did you vaccinate them?
McComb: A large amount of the microorganism was grown in our Boston
laboratory using the yolk sac of embryonated eggs. This was
partially purified. Two types of vaccines were prepared, one a
fluid vaccine and one containing an adjuvant. The adjuvant is
supposed to enhance the effect of the vaccine.
Hicke: So then you went back and vaccinated them, then you took samples
again to see if the vaccine was okay?
McComb: Yes. Parke-Davis Pharmaceutical company took our vaccine
preparation, added the adjuvant and packed it into syringes all
ready to use. That process was done outside our laboratory. The
vaccinations in Saudi Arabia took a pretty good-sized team; there
were around ten of us who were involved on any given excursion to
a village. Each type of vaccine had a placebo control, so the
adjuvant was labeled A and B. Nobody knew whether A was the
vaccine and B was the placebo or vice versa, and on the fluid
vaccine, same thing. Each vaccine code was marked in the patient
record .
Hicke: Did you do half and half, or how was that?
McComb: I don t now remember how the team physicians decided.
Hicke: And then how long does it take for you to study the results?
First of all, when did you go back and vaccinate?
McComb: 1 think it had to have been some time in the early sixties, I
could probably tell that from the records.
Hicke: That s your log? You still have it?
McComb: It was April 1962.
312
Ten-Year Follow-up Visits
Hicke: And then, when did you go back to take more samples?
McComb: We did a ten-year follow-up in 1972. That s when Tahiya, the
Saudi medical student, was with us. We added one more component
to it, to do an eye vision test. And I ll show you the thing that
we used; it was something that Henry Allen, M.D. had developed for
use in countries where literacy and language was a problem.
Henry Allen was an opthalmologist and the kind of person who
donated his time; he made these kind of trips to South America.
Great guy. He was Chief of Opthalmology at the Massachusetts Eye
and Ear Infirmary. The MEEI is physically attached to the
Massachusetts General Hospital in Boston but they are two separate
institutions. How he would charm the kids. He was bald, really
bald! I think he must have shaved it. He taught the kids about
doing mumbletypeg, you know, where you tip an open jackknife so it
goes blade first into the ground. He also created a mouse out of
cloth and he would make it crawl right up his arm! You knew very
well he had worked a lot with kids. Sometimes you just need to
get the attention of kids, and to do that a gimmick helps. He was
a wonderful person. He did all of the eye examinations for the
ten-year follow-up.
We were there for a month in November of 1972. I d gone out
a little bit early to get things organized. When the field work
was completed, he and I flew out together to Boston. The work was
very intense as we were working outdoors in the villages almost
everyday. You don t think about it; but you love what you re
doing, it s so very important.
Hicke: Well, that s good. That s the way it should be; but it doesn t
always turn out that way.
McComb: One of the problems we faced was taking blood samples to test for
antibody titers to trachoma by taking finger pricks.
Hicke: Finger pricks?
McComb: Yes, using tiny capillary tubes. The blood was expelled into a
small pointed plastic tube containing a diluent. Once the red
cells settled out of the supernatant, the serum could be tested
for antibody to trachoma. The other thing that we wanted to look
at was whether there was antibody in the eye secretions.
Initially in the field work in Saudi Arabia the eye secretions
were collected. With a small strip of filter paper placed in a
sterile glass vial and eluted with a small volume of buffered
313
saline. Later in the course of research on owl monkeys small
sponges were used.
Hicke: What would be the significance of that?
McComb: To learn whether the disease has actually prompted a local
response from the immune system.
To obtain the eye secretions, you pulled the lower lid down
just a little bit and put the end of the filter strip in. The
strip would fill up immediately. Then the strip containing a
measured amount of fluid was put into a glass vial. In the vial
we combined the two strips, one from each eye. To detect antibody
to trachoma, serial dilutions of the eye secretion were exposed to
both yolk sac infected with trachoma and normal yolk sac side by
side on a glass slide. If antibody is present, the antibody
sticks to the microorganism on the slide. Rinsing the slide and
layering with anti-globulin containing fluorescein the result can
be read under a fluorescent microscope. In retrospect it was a
very tedious process in order to get a yes or no answer as to
whether antibody was present locally in the eye. There was!
Today the disease (the microorganism) is called Chlamydia
trachoma tis . In this country, it s a sexually transmitted
disease, often causing pneumonia in newborns whose mothers are
infected. In Saudi Arabia the transmission is eye to eye.
Hicke: You re now talking about the work you did at Harvard, right?
McComb: Yes, much of the early work was done in Saudi Arabia between 1955
and 1972. Remaining activities in the Saudi Arabia laboratory
were not concluded until 1976 when I went out to close it up. One
of our unusual tasks in Saudi Arabia was to make our own dry ice.
By taking C0 2 (carbon dioxide) and compressing it, the solid dry
ice mixed with alcohol could be used to freeze samples for storage
at minus sixty degrees.
Hicke: So for some of these processes you had to innovate, because you
were in Saudi Arabia and they didn t have them; but also there
were some things you had to innovate at Harvard because they
hadn t been invented?
McComb: Absolutely.
Hicke: Can you give me some other examples that I might be able to
understand?
McComb: Well, I m trying to think. In our isolation method, we eventually
got it to grow the trachoma organism in cell culture, but it was
314
Hicke:
Me Comb ;
Hicke:
McComb :
Hicke:
McComb :
with great difficulty. We had to centrifuge the material onto the
cells. But as far as getting us from the patient with the disease
through the process to test an experimental vaccine this really
took time. It was a fair amount of work from 1955 until the
spring of 1962, when vaccinations were begun. We needed to know a
lot of things. We needed to know how many different serotypes of
microorganism there were in order to know what to include in a
vaccine. Two serotypes 1 and 2 were combined for vaccination.
Those decisions had to be made by the physicians who were in
charge of the program. When it became clear from the follow-up
studies in the Saudi children that the vaccine really had not been
effective, then we were at the point with, well what do you do
next? What you really do is what Aramco had already started to
do, i.e. change the environment and personal habits. When I went
back to the Saudi study village of Al-Mallahah in 1976, and closed
the laboratory, the narrow streets had already been paved.
Oh, this little town. [looking at photo]
It s hard to move people from a village that they ve lived in for
generations so they can experience a cleaner environment for the
health of themselves and their children. But the Saudi government
was already building brand new schools all over the Eastern
Province, first for boys, then for girls. Times were changing.
When I left Harvard in 1977 I went to work for an organization
that was helping the governments in the Persian Gulf area to do
much needed health planning, both of services and facilities.
What was the name of that organization?
A non-profit organization; University Associates for International
Health. It was made up of faculty from AUB (American University
in Beirut), Harvard, and Johns Hopkins. It was great because I
had a lot of experience in the Middle East and they needed help in
health planning. Many of the plans that were recommended are now
in place.
And as part of this group you did follow up on trachoma?
back in 1976.
You went
No, the program ended in Saudi Arabia in 1976 when I went out to
close the laboratory.
315
Vaccines and Cures
Hicke: Let me ask you a couple of basic questions. You were looking for
a vaccine. Is there such a thing as a cure? You weren t looking
for a cure?
McComb: Antibiotics can be used, but the difficulty is treating that kind
of massive disease with an antibiotic, since reinfection was
common. It s not as though you treat once and that s it.
It s like smallpox; everybody knew that the way to eradicate
smallpox was: A) to vaccinate, and B) to find the last cases and
isolate them. And that took years. There were people at the
School of Public Health at Harvard who were involved in the
smallpox eradication program through the World Health
Organization. One of the biggest problems in India was getting
Indira Gandhi to give permission to track cases of smallpox. With
cooperation from government, tracking active cases was easier
because the evidence showed clearly on the skin. The last case
was tracked down in Africa. Finally smallpox had been eradicated,
and the scientific community has been debating getting rid of what
stocks of vaccine and live virus are frozen away in laboratories,
lest somebody do something dreadful and start epidemics all over
again.
Hicke: Dr. Taylor was telling me that he wasn t convinced that there
isn t still some smallpox around; he saw some cases of it when he
was in Saudi Arabia.
McComb: I saw a case my first trip out there, in 1956.
Hicke: He said they got it very young, too.
McComb: Yes, this child was about eleven. He was dead. Smallpox is
unique in that it is only passed through humans; as far as they
know it does not have any animal reservoir. So therefore, if
you ve been exposed to it, you will get it. The epidemiologists
really tracked down all of these cases. It was amazing.
Hicke: Let me go back to--
McComb: Arabia, yes.
Aramco was hiring locally from the Eastern Province of
Arabia. They had a large Saudi employee group. All employees had
access to all of the health care services that Aramco was
providing. Part of the support from Aramco was to provide one of
their Saudi employees to man the "kitchen." That was how Ali
316
Abdul Rahman came to be "Our Man Friday." What a perfect choice
he was, with a wonderful sense of humor. He remained with the
program until its closure in 1976.
Ali Abdul Rahman, now our chief cook and bottle washer, was
trained by Bob Chang s wife, Yinette. She was working for John
Enders at the time at Children s Hospital in Boston. He was a
physician and scientist who contributed to the development of the
polio vaccine. With Dr. Enders s concurrence, Yinette went out to
Saudi Arabia with her husband that summer of 1955. It was she who
trained Ali in the laboratory to wash glassware and to sterilize
media and equipment.
Hicke: As a technician, more or less?
McComb: Yes, he was wonderful. He was about seventeen years old at the
time. Aramco had taught him English, reading and writing in
Arabic, and math. When Aramco went into this training program,
they did a really good job for their Saudi employees. Ali was
quite fluent in English, and he was one of these very happy souls
who would do anything. He dearly wanted to learn to drive an
automobile and would press Roger Nichols from time to time to take
the company car. Roger sort of kept putting him off. Finally
Roger and Elinor, his wife, went on long leave for three months.
However, I was still working in the lab in the Dhahran Health
Center. But with the kind of work I was doing, I wouldn t need
Ali full time. So Roger gave permission for Ali to go and learn
how to drive. It was maybe two or three months after that, after
Roger had been back, and we were getting ready to go out on a
field trip that he told Ali to take the car up to the company
garage and get the oil checked.
He hadn t been driving by himself for very long and he must
have been a little nervous. However, the company had their
maintenance garages right within the compound, so he took the car
up to the light car garage. Well, he somehow missed the area
where the car was to be driven over a pit. Instead he hit a fire
hydrant! Guess where all the water went. The people who were
working down in the pits all came piling out.
Hicke: They got a nice cool shower. [laughter]
McComb: While the workers got that situation handled, Ali ran all the way
down from the light car garage to the hospital to tell Roger. He
was beside himself. He thought something dreadful was going to
happen to him. Short of a mild reprimand, it was a good
experience for him.
Hicke: A learning experience.
317
McComb: He eventually did drive the car sometimes out to the villages, but
he never forgot the first time he drove alone.
Aramco was well run and the environment was such that you
had all the support services you needed. That included special
things that we might need from the company to support the research
and field work.
II
Dr. Roger Nichols
Hicke: Where did Dr. Nichols fit in?
McComb: That s another interesting story. When we first began work in
Arabia, Aramco already had an Italian physician, Mario Tarizzo,
who was working with the company. I guess he had some research
experience. However, I believe it became very apparent to Dr.
Snyder that here Tarizzo was not going to be suitable. Dr. Snyder
was looking for someone with more research experience to head up
the program and be based in Saudi Arabia. I suspect he talked to
many people in the Boston area who might know of such a person.
It turns out Roger Nichols was at that time in Saudi Arabia. He d
been assigned to the Health Center in Abqaiq. Aramco had health
centers both in Ras Tanura, fifty miles north of Dhahran, and in
Abqaiq, fifty miles south of Dhahran. Elinor and the children
were still in the U.S., because at that time you couldn t bring
your family with you right away. Roger went out to Abqaiq as an
internist. However, he d had significant experience in Boston at
Boston City Hospital. So he was well known.
I returned to Boston from Arabia in September 1956. Then
Sam Bell and I went back out in February of 1957 with the initial
purpose to interview Roger Nichols. Aramco had a couple of types
of facilities for visitors. My first year I lived in Steinecke
Hall, a large guest house, where the staff were all Indians from
Goa. I was the only woman there, so I got lots of attention.
Many of the men staying in Steinecke were only engineers on
assignment to Aramco from the Hague, Netherlands. My third year
out I actually lived in what they called a boracity, which was a
square house with four bedrooms and a communal living room and
kitchen. That second year in 1957 Sam Bell and I both stayed in
Steinecke Hall.
Roger came up from Abqaiq and we met with him. I didn t
read the communication that went to Boston but obviously it was
318
"You better hire this guy." He was exceptional both in his focus
as a physician and somebody who was interested in research. And
so that first year, he spent only half time with our program. The
other half he was head of the pathology laboratories in the
Dhahran Health Center, which were on the same floor as the
Trachoma Research Laboratory. I forget when he became full-time
on the trachoma project, but it wasn t too long after that.
Hicke: What was his actual job with the trachoma project?
McComb: With Aramco he was head of the Trachoma Research field program.
Much of that involved discussions with him back in Boston. In the
early stages of the research his contribution to the planning was
essential. Communication between Arabia and Boston was done by
large, flat, transcription tape belts, which could be mailed in
large envelopes by Aramco courier planes to New York and thence to
Boston. The tapes were then transcribed in Boston.
Hicke: Telex or something?
McComb: No, no- -the tape was big enough that you could get a half hour or
an hour of dictation on it.
Hicke: And then you mailed the tape?
McComb: Yes, we would mail the tape back, and the secretaries in Boston
would transcribe it. Then we would get a copy. You don t think
about things like that; in Arabia we were using photocopy
equipment that was made in Japan, with paper that dehydrated in
four to five years. Then it just eventually crumbled.
Hicke: I remember that. Very early time.
McComb: With communications you had to do the best you could outside of
picking up the phone and calling Boston.
Hicke: Which you probably couldn t do either until later.
McComb: Well, we could have, but the point was to keep them informed of
what was going on and vice versa. So we shared information on a
frequent and regular basis.
Dhahran, Saudi Arabia was a great place to be. I had the
opportunity to take evening classes in Arabic sponsored by the
company. Aramco of course had many recreational facilities. That
included a movie theater, bowling alleys, tennis courts, and
baseball diamonds. Most of us who were on the research team loved
to explore the desert, and Land Rovers were the way to go. There
were many opportunities to get out and see places. Aramco
319
required you to sign out at the main gate, and you had to sign in
on return when traveling outside the company areas in the desert.
The reason was in the event anybody got lost. You were required
to state where you were going, what direction, and expected time
of return. In the event they had to send out airplanes to look
for you, they wanted to know in which direction to search. There
was wonderful swimming- -the Arabian Gulf was close by with warm
water --and water skiing was popular.
Dr. Robert Oertley
McComb: So there were many opportunities to explore the Eastern Province,
which we did. After Roger had left, a group of us in three Land
Rovers went into the desert on a five-day Moslem holiday. Bob
Oertley and his wife, the head of the Aramco exploration and his
family, and one of the Aramco schoolteachers, and I made up the
group. We headed south to the edge of Rub al Khali, the Empty
Quarter, in an area of sand dunes. It s in areas like that where
you find stone-age arrowheads just lying on the surface. I should
have brought some to show you. I found many on that trip. It s
relatively easy to find the arrowheads. With the shifting dunes,
granular flat patches would be covered and uncovered. In these
gravel plains you would find not only arrowheads but also stone
axes .
People tell me when they first went out to the Arabian
desert, particularly those who were associated with the oil
exploration crews, they would pick up the arrowheads by the
bucketful, literally. The area was largely uninhabited. If you
were to look at a map of Saudi Arabia, the areas where there s
water are where people live.
The types of local Arab housing found on the west coast of
Arabia I didn t see until I was with University Associates. At
that time I was traveling with a team to interview some of the
health people who were working in those areas. The style of house
is very different in the Western Province from what it is in the
Eastern Province. Rainfall in the Kingdom is only about two
inches a year. There are deep wells from which water is pumped to
the surface. There is a period in the spring when sandstorms,
some severe, are quite common.
320
Dr. Richard Daggy
McComb: Have you already talked to Dick Daggy?
Hicke: No, I am going to see him Sunday.
McComb: Well, I m going to tell you a story on Dick Daggy. Dick was part
of the group (including myself) that went out to Saudi Arabia in
July 1973 with University Associates to participate in long term
health planning for the Saudi Ministry of Health. He had
previously been an entomologist and medical director with Aramco.
He was the one who was instrumental in eradicating malaria in the
Eastern Province of Arabia. When he joined the University
Associates group, we visited a very big ain (Arabic for a large
water well). While he was still with Aramco, he had gone to this
ain located in Al Kharj , and seeded this well with tiny fish that
would eat the malaria larvae. You ve heard about seeding the
clouds for rain; so he was seeding the ain to combat malaria. The
edge across the top of the ain was about 150 feet, while the
distance to the water surface was about 30 feet. What Dick had
done many years before was to throw a whole lot of these fish in
the ain. Eventually the fish got into the irrigation ditches that
were on the surface of the ground above the well. He was
interested to see whether those fish were still there and alive,
since he never came back to see after the seeding many years
before .
A big group of young boys were diving from the top into this
ain. He went up to them, still remembering enough Arabic to ask
them whether the little fish were in the pond. "Aiwa, aiwa."
Yes, yes. And so we walked farther along to the little canals
that come out, and sure enough the fish were there. Malaria was a
big problem in Arabia, not just trachoma. You don t get good work
out of people until you find that they re healthy. So I think
Phil Gelpi s idea of doing this monograph detailing Aramco "s
experience in health care in the Eastern Province of Arabia is an
important document. At the time of this visit to Al Kharj there
was still malaria in the Western Province of Arabia in July 1973.
We went to a place in the Asir or Western Province. To get there
we drove over mountains in jeeps on dirt roads. When we got down
to the coastal plain there, here was a brand new hospital which
the government had built. Their well was full of dead things, and
most of the staff had malaria. Then you realized that until the
country solves some of their public health problems, they were not
going to have a healthy population. Many of the people who lived
in the cities, people of means, were doing pretty well, but in the
outlying areas this was not true.
321
Other Personnel
Hicke: Who else did you work with in Aramco? You said you got wonderful
support from Aramco, anybody in particular?
McComb : In the medical department Nadim Haddad was our opthalmologist .
Nadim was Palestinian Christian Arab. He and his family were
among the group that lost their land in the 1948 war with Israel.
Later, as part of work with University Associates, Ahmed Dajani,
M.D., a Palestinian Moslem, added much to the development of a
health plan for the kingdom. He too lost land in the 1948 war.
You realize how peoples lives just get shattered. But each one
of them moved on to other things; it s amazing. It was a
privilege to work with such wonderful people.
Arthur Bobb, M.D., was another Aramco opthalmologist who
worked with the trachoma team after Nadim Haddad left. Three
Saudi male nurses were a key part of the experimental trachoma
vaccine program team. They were Mehedi Hassan, Ibrahim Ali, and
Abdulla Abdul Aziz. We needed bilingual Saudi clerks to do our
record-keeping during field trips. We required people who were
bilingual but spoke English well enough so that it would not be
difficult for us to communicate. Roger Nichols was interviewing
several people as possible clerks.
Hicke: He was interviewing for a clerk?
McComb: Yes, right. We were stunned when one young man told us during the
interview that the world wasn t round, that when you got to Mecca,
you were going to fall off the world. You know you had to be so
careful, I mean none of us cracked a smile, but we didn t select
him!
Hicke: You think that was a religious concept maybe rather than a lack of
knowledge?
McComb: I don t. On second thought, maybe a little bit of both. How far
such ideas existed in the general population--! don t think far, I
really don t. There were many people who knew we came from the
United States and they knew we didn t fall off the earth when we
went home !
Hicke: There are some people in the United States that believe the world
is flat, I guess, too.
McComb: But even Ali, our lab technician, told me once he d been working
in the Health Center, I guess helping out somewhere in the
emergency room on the night shift. He described to me one
322
experience where he claims he saw a djinn (a ghost). But he was
not superstitious, not really. Wonderful sense of humor, though!
He would play jokes on me. I liked lemon in my tea. Some
days Ali would make the tea by boiling the water in a cylinder
with a gas bunsen burner. Then somehow he conned Roger Nichols or
vice versa (I never quite got the story) to spike my tea with
something that was very tart. It was like lemon juice only
sharper. This went on I guess for about a week. I kept saying
something about this, "This tastes very sharp." Ali was very
good, I mean he never squealed on the culprit, Roger Nichols.
Hicke: He never let on?
McComb: And finally, finally, I said, something is going on here and I
want to know what. We had a little, tiny room where we did our
staining of slides. It had a sink in it and all of our stains up
in the cabinets. I cornered Ali in there one day and I said, "Now
Ali, you ve got to tell me what s going on." "Ah, no, no, Miss
Dorothy, ah no, no." Well, he didn t lie very well, but he didn t
tell me who was doing it eithe r. Roger finally fessed up.
The other thing we did in the lab was to have a chess game.
The chess game was set up on the lab bench used as a desk. It
might take us a week to play a game. Moves were made as time
permitted. It was sort of a nice challenge. Roger and I would
play.
We really got a great deal of support from all levels of
Araraco; even from the medical director and his staff and other
departments such as Government Relations. The latter were
critical in setting up working relations in the villages. We also
set up visits to the Aramco women s clinic for the Saudi women and
children. Aramco provided a separate building for them, because
many of them came in with two or three or four children at a time.
Their families were large. Sometimes they would have ten, eleven,
or twelve children. I told Phil Gelpi that those women and
children had better records of vaccination than the senior staff
clinic in the main facility, because they had nurses that made
sure each child s vaccinations were complete. If Nuha came in and
this time she had three children, only one of them might have been
in the last time. So the nurse would pull the records on all the
kids, because you couldn t tell how often they would come in. If
they needed a vaccination, they got it. Oftentimes their records
were in much better shape than some of the American families.
323
II WINDING UP THE TRACHOMA PROJECT
Hicke: Well, there s probably more to say but before we go too far, tell
me how you decided to wind it up. You actually found no
conclusions other than that better living conditions helped the
threat of trachoma?
McCorab: Well, a lot of things were happening in Saudi Arabia and Harvard
at that time. Roger came back to Harvard to become the head of
the Department of Microbiology in 1970.
Hicke: Did somebody take his place?
McComb: Yes, Bob Oertley did, also a very good person, but he was only
half time with the trachoma program. However, he could divide his
time so that the vaccine program follow up that we did in 1972 was
with him. Just remember "Three Blind Mice," that was Bob Oertley.
Hicke: Yes, that s right.
McComb: Lot of things happening in Harvard. Derek Bok by this time was
president of Harvard. Jack Snyder left as dean, and I don t
remember what year that was--it was right around that time. And
the usual way is you pull together a search committee. Roger
Nichols was on that search committee. It s too bad that Roger
isn t here because I don t know all of the details, but I do know
that that search committee made a recommendation to President Bok
as to who the new dean of the school should be. That was not who
Bok hired. And the physician that he brought in was the beginning
of about thirteen years of chaos in the school. It was one of the
reasons I left the School of Public Health in 1977.
By 1977, part of the expertise of the trachoma team was that
we needed to share new laboratory procedures with others. Much of
this knowledge was new enough that before I left, we had set up a
training session for senior research personnel in other labs to
learn our techniques. I wrote a manual to be used in the week-
long exercise. We wanted them to go away with something that they
324
could refer to. They came from all over the U.S.; we had about
fifteen or sixteen people. They were senior investigators. We
set up both lectures and laboratory sessions and already had
samples for them to do the tests. We sent them away with a
"doggie bag" which had standard reagents which they could use as
positive controls for making their own reagents.
The situation in the School of Public Health was sad in many
ways, but you can t control the world. Within the School of
Public Health itself, many of the junior faculty left the people
with the most promise. Eventually two-thirds of the senior
faculty voted for the new dean to be dismissed. And at that
point, President Derek Bok came across the river; because we were
in Bostonthe School of Public Health, the Medical School and the
Dental School were all right in the same area in Boston- -and the
rest of the university in Cambridge. And he really told the
faculty that they had no right to say that.
Hicke: He didn t care that they all left or were leaving?
McComb: I don t really know how President Bok felt about the faculty loss.
I asked Elinor Nichols about this just recently, because it had
bothered me. The dean was not a leader. In fact, he actually was
caught telling lies about some events. Apparently Bok actually
admitted at some point to Roger that he had made a mistake. It
was the first appointment he made after becoming president of
Harvard. About two-thirds of the new department chairs that the
new dean brought on board eventually left. I don t know if
President Bok had any sense of what public health really was.
It s a very broad spectrum of discipline: everything from teaching
health, biostatistics, tropical public health, nutrition,
microbiology everything you could tap into to do this kind of a
project in Saudi Arabia. You needed to have a statistician who
could look at the data; you needed many different kinds of
people- -those who knew a lot about women s and children s health,
and so forth. If you don t get the best people in place, then
you re in trouble. Anyhow, that was a sad time for all of us. It
really was.
Hicke: And that was one of the reasons you wound up the trachoma project?
McComb: Well, the other thing I didn t mention to you, which is actually
important, is that we applied for an NIH [National Institutes of
Health] grant on trachoma and related diseases, and we were
awarded one. I think it lasted ten years. This award allowed us
to look not only at trachoma but the related diseases, such as
inclusion conjunctivitis of the newborn and mammals that had
similar infections. These microorganism vary from the one that we
were isolating from humans in Saudi Arabia, but the course inside
325
the cells is exactly the same. We were looking at the broad
spectrum of this group of microorganisms and its application to
infections in human. This involved a lot of staff in the Boston
lab, some of whom had also gone to Saudi Arabia as technologists.
In fact, I did have a list for you because I had been in contact
with many of the people who worked on it long after they had left
Harvard. Most of these I had trained when they were in the Boston
lab. Many of them went on to other careers in the health field.
There was Sandra Labas, now a vice president of Beth Israel
Hospital in Boston. She went on to get her Master of Public
Health degree in Texas. We found people who actually were excited
about what they were doing and wanted to learn more.
Judy Whittum Hudson went on to get her Ph.D., and she s now
associate professor at John Hopkins University and she s doing
research on chlamydia.
Joan Barenf anger, who also did part of the work for her
Ph.D. degree in Saudi Arabia, went on to get her M.D. and she s
now a pathologist in Illinois.
And Pamela Scott, who worked only in the Boston laboratory
is now a surgeon.
Michael O Leary worked with Ed Murray on guinea pig
inclusion conjunctivitis. So he wasn t actually on the program in
Arabia but he was working on some of the materials that came back.
He s an M.D. and a urologist.
Connie Pozniak was somebody that I trained. She did not go
to Saudi Arabia but she worked on the Saudi material in Boston.
She s now a veterinarian in Virginia, in Virginia Beach.
And lastly, Sara Murphy, who actually went on to be a
physician s assistant.
Hicke: Is there anything we ve missed now?
McComb: No, except I thought maybe you might like to see something that
you don t need to include for this history, but which are samples
of the documents and records used in the Aramco- sponsored Trachoma
Research Program.
Hicke: Thanks, I d like to, and many thanks for taking the time to record
your recollections.
Transcriber: George Chen
Final Typist: Shana Chen
326
Regional Oral History Office University of California
The Bancroft Library Berkeley, California
Aramco Medical Department Oral History Project
Robert and Patricia Oertley
RAS TANURA, ABQAIQ, AND DHAHRAN MEDICAL FACILITIES:
1956-1982
Interviews Conducted by
Carole Hicke
in 1996
Copyright c 1998 by The Regents of the University of California
Since 1954 the Regional Oral History Office has been interviewing leading
participants in or well-placed witnesses to major events in the development of
Northern California, the West, and the Nation. Oral history is a method of
collecting historical information through tape-recorded interviews between a
narrator with firsthand knowledge of historically significant events and a well-
informed interviewer, with the goal of preserving substantive additions to the
historical record. The tape recording is transcribed, lightly edited for
continuity and clarity, and reviewed by the interviewee. The corrected
manuscript is indexed, bound with photographs and illustrative materials, and
placed in The Bancroft Library at the University of California, Berkeley, and in
other research collections for scholarly use. Because it is primary material,
oral history is not intended to present the final, verified, or complete
narrative of events. It is a spoken account, offered by the interviewee in
response to questioning, and as such it is reflective, partisan, deeply involved,
and irreplaceable.
************************************
All uses of this manuscript are covered by a legal agreement between
The Regents of the University of California and Robert and Patricia
Oertley dated August 18, 1996. The manuscript is thereby made
available for research purposes. All literary rights in the
manuscript, including the right to publish, are reserved to The
Bancroft Library of the University of California, Berkeley. No part
of the manuscript may be quoted for publication without the written
permission of the Director of The Bancroft Library of the University
of California, Berkeley.
Requests for permission to quote for publication should be addressed
to the Regional Oral History Office, 486 Library, University of
California, Berkeley 94720, and should include identification of the
specific passages to be quoted, anticipated use of the passages, and
identification of the user. The legal agreement with Robert and
Patricia Oertley requires that they be notified of the request and
allowed thirty days in which to respond.
It is recommended that this oral history be cited as follows:
Interview with Robert and Patricia
Oertley, an oral history conducted in 1996
by Carole Hicke in "Health and Disease in
Saudi Arabia: The Aramco Experience,
1940s- 1990s," Regional Oral History
Office, The Bancroft Library, University
of California, Berkeley, 1998.
Copy no.
Robert and Patricia Oertley.
327
TABLE OF CONTENTS- -Robert and Patricia Oertley
INTRODUCTION by A. P. Gelpi 328
INTERVIEW HISTORY 329
BIOGRAPHICAL INFORMATION- -Patricia Oertley 330
BIOGRAPHICAL INFORMATION- -Robert Oertley 331
I BACKGROUND 332
Childhood on the Farm 332
Cornell College 334
Military Service 335
II BECOMING A DOCTOR 337
Medical School, University of Iowa 337
Internship 340
Work in the Belgian Congo: 1963 340
III ARAMCO: 1963-1982 343
Joining Aramco 343
Ras Tanura Clinic: Family Physician 344
Abqaiq Clinic: Medical Administrator 349
Epidemiology 356
Record-Keeping Procedures 362
Nursing Staff 363
Moving to Dhahran 365
Field Director, Trachoma Research Program 367
Director of Preventive Medicine 369
Camel Trip into the Desert 374
IV PAT OERTLEY 377
Background and Education 377
Early Work Experiences 379
Joining Aramco 383
Ras Tanura 383
Marriage and Move to Abqaiq 386
Dhahran 388
Dhahran Medical Facilities and Other Services 391
Adjusting to Cultural Differences 393
Leaving Saudi Arabia 398
Aramco Management Support 404
328
INTRODUCTION- -Robert and Patricia Oertley
Pat and Bob Oertley jointly participated in this interview. Both
had much to contribute about Aramco s Medical Department, Aramco
society, Saudi Arabia, and each of their respective roles: Bob, as an
Aramco physician; Pat, as one of Aramco s school teachers. And both had
worked abroad prior to employment with Aramco. Dr. Oertley joined
Aramco in 1963; Pat was already therein Ras Tanura. And they had yet
to meet.
Trained in general practice, Oertley was first assigned to the
clinic /infirmary in Ras Tanura. Bob and Pat first met in 1966; within
the year, they were married. And both ended up working in Abqaiq before
settling in Dhahran. Then, successively, Bob became director of the
Abqaiq clinic/infirmary, head of Preventive Medicine, and finally, field
director of the joint Harvard /Aramco trachoma project during the
seventies .
Bob had a nose for epidemiology, which comes through during this
interview, making him ideal for his assignments, both to Preventive
Medicine and to the trachoma project. He and Pat left Dhahran and
Aramco in 1976 to find a new home in central Oregon.
Arraand P. Gelpi, M.D.
December 9, 1997
Sonoma, California
329
INTERVIEW HISTORY--Patricia and Robert Oertley
When Robert Oertley joined Araraco as a family physician in 1963,
they assigned him to Ras Tanura. There he met Pat, who was teaching
school. They were married in Beirut in 1966. Pat ended her official
teaching job at that point, but she taught art as a "casual" employee in
Abqaiq. Bob was soon assigned to Abqaiq, then to Dhahran. Along the
way he acted as field director for the trachoma project, director of
Preventive Medicine, and director of Tapline medical services.
The two were interviewed in their home in Sun River, Oregon, on
August 18 and 19, 1996. They gave excellent descriptions of life in
Saudi Arabia, especially in the outlying clinics. They reviewed the
transcript and added some information.
Carole Hicke
Project Director
January 1997
Regional Oral History Office
University of California, Berkeley
330
Regional Oral History Office
Room 486 The Bancroft Library
University of California
Berkeley, California 94720
Your full name
BIOGRAPHICAL INFORMATION
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Date of birth L
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Areas of expertise L V "XL- - i
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Other interests or activities
Organizations in which you are active
331
Regional Oral History Office University of California
Room 486 The Bancroft Library Berkeley, California 94720
BIOGRAPHICAL INFORMATION
(Please write clearly. Use black ink.)
Your full name RpS&RT E. D - ftf L ^- ^ _
1 C ^
Date of birth 23 MAY I^S Birthplace PfriA C a v/ 1 t- L ^ Ilt-t^C
Father s full name FLQrD Q 6, A/ :
Occupation P/\RA1)A V; ^ |3fC L/LTtJ R> Birthplace \A C^H- i P
Mother s full name L U LA ^1-EAA/^ g, ^RAY _
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Your spouse PAT R 1C ( A >V A h\ - L u. E g g) O ^ K T L
Occupation T^- A C rt C^ _ Birthplace
Your children Hfcfp/ C ^TLY ^Aig-A; Qg-^T^JLV ^HE^A^P V
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Where did you grow up? Pec ft i-\ c. \;TA S ^flc;A. ~T / XCu, 4.
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Occupation(s) f^\ -P "^ A: J> CT 6 R 1 f^l P^ /iY i C/./1 ^ / <;
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Other interests or activities UJ 06 -PUJO RK ( /VJ<Jk / j? -A -^ ( A/ ;
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Organizations in which you are active f\J C .A/ 1=^ __
332
I BACKGROUND
[Interview 1: August 18, 1996] ##
Childhood on the Farm
Hicke: Will you start by telling me when and where you were born?
Oertley: I was born in Princeville, Illinois, on May 22, 1925.
Hicke: And did you grow up in Illinois?
Oertley: No. My mother and dad moved to Iowa while I was still a baby.
In fact my dad preceded my mother s and my travel. He took
the livestock to Iowa and accompanied them on a freight train,
and then sent for my mother and me. We didn t go on a freight
train. I d see these trains later as I was growing up, the
same train for years.
Hicke: Was it the Rock Island Rocket?
Oertley: No. It was the Chicago Northwestern. By the time it got off
to Iowa it had become another line, and I can t remember that
name. But he sent for us and we arrived there by train. I
don t remember any of this; I was still a baby.
Hicke: Yes. What kind of livestock did he bring?
Oertley: Cattle and hogs, mostly cattle, and I think a couple of
horses. This entailed the actual cars that contained these
animals to be switched to other lines. Of course I don t
remember any of this but it s been told to me. But we--my
This symbol (##) indicates that a tape or a segment of a tape has
begun or ended. A guide to the tapes follows the transcripts.
333
mother and Ifollowed later as soon as dad had the place
settled in. He had a cousin, his mother s sister, who had
married into the Hartsock family and they already hadit was
H-A-R-T-S-0-C-K a farm across the road from us: one was two
hundred and forty and one was two hundred acres, I guess.
They were already Iowa residents for some time. At any rate,
my father decided that the farm that the Oertleys had in Iowa
should be farmed by the descendants thereof, and that s how it
happened.
Hicke : Whereabouts was this?
Oertley: In Pocahontas County, five miles from a place called Havelock.
Hicke: And did you then grow up on a farm?
Oertley: Oh yes, and went to a country school a mile west of us.
Walked to school. My father had a Klondike, which is a kind
of chariot wagon, covered with a roof and rein slot under the
windshield for the reins for the horse that s R-E-I-N, not R-
A-I-N. The school rarely had more than a dozen youngsters at
one time. It wasn t limited; it was just that there were not
anymore than that to attend. It was always a female teacher
who covered all the grades that there were.
Outhouses you held up one finger for one activity and
two fingers for the other, because this meant that you were
going to be a little longer. [chuckles] The directorship of
the school rotated among the farmers whose families used it,
and the director then housed the teacher during that year or
years that she taught all grades that there were. I remember
that the year my father was director I got more rides to
school than before.
Hicke: The teacher lived with you?
Oertley: Yes, there being no other accommodations, the teacher always
lived in the home of the current director. It was a dirt road
and it was a mire of mud in the spring rains, almost
impossible to negotiate with a motor vehicle horse-drawn
buggy being the only suitable recourse when the road was muddy
gumbo.
Hicke: So you usually had to walk.
Oertley: Yes, you had to walk or get a buggy ride. We did have a
buggy.
Hicke:
You had chores to do after school?
334
Oertley: Oh yes. They weren t heavy while we were living on that farm.
It was mostly a matter of feeding the chickens, gathering the
eggs, and taking care of the younger livestock, making sure
they were watered and corn or oats or hay was in their feed
boxes .
Hicke: You had to get up pretty early, though.
Oertley: Oh yes. I can t remember the hour. It wasn t that
significant to me as an hour at that time; it was a matter
that it was time to be up, and in winter, we were always up
long before daylight.
Hicke: Where did you go to high school?
Oertley: We moved to another farm when I was in sixth grade and it was
closer to the town of Havelock. In fact, instead of being six
miles away, it was merely a mile and a half. I could walk to
school, but a bus came by. It seemed like that was a real
advancement as far as I was concerned. Boy, things were
looking up.
Hicke: What kinds of things did you enjoy in high school?
Oertley: I never enjoyed team sports. In country school we didn t have
that kind of exposure. By the time I was in the town school I
was entering high school, practically. I enjoyed the spell
downs. I usually got to the County Bee level, but never won
in the final endeavor. [chuckle] But I tried hard. We had a
lot of winter snow and I loved the sports attending thereto:
the sleds down the hill and all that sort of thing, and even
clamp-on ice skates on the frozen puddles and things of this
sort. I can t think of anything else that pertains there.
Cornell College
Hicke:
Oertley:
Eventually you started thinking about becoming a doctor,
that in high school or was that later?
Was
Actually, it was in college that I thought of that. I always
liked math and the engineering kinds of subjects, and I loved
to watch my father fix things --things on the farm were always
breaking down. I enjoyed that and I decided by the graduation
from my high school that I was going to be an engineer of some
sort. I didn t really even know all that engineers aspired to
or were capable of, but it seemed like the thing that I wanted
335
to get into, something that worked by mechanics and where you
did things with your hands. So I went away to Cornell College
in Mt. Vernon, Iowa with the idea of becoming an engineer in
the long run. I took all the science subjects that I could.
But it turned out that with my first exposure to biology, I
began to be interested in perhaps being a doctor. But I
didn t tell anybody. It really wasn t appropriate, I felt,
for me to be thinking in that direction, but maybe, you know.
Well, I went on with that idea and I got all the biology
and organic chemistry courses that were available to me at
Cornell, and by the time I did mention it to my parents- -
"Rather than engineering, I think I d like to study medicine"
--they gave me encouragement. Once it was disclosed, it
became easier to proceed with a little more aggression in that
direction.
Hicke: You were afraid that they would--
Oertley: I felt that they would support me in anything, but I knew it
was going to be expensive. Although I only had one sibling (a
sister, Virginia, four years younger than I), farms weren t
all that profitable then in the days I was growing up. It was
during the Depression, and we had realized that it was
probably going to cost some money, so I mentioned it only sort
of late in the game. I knew I had first to successfully
complete four years of pre-med college with an appropriate
science or biology major.
It worked fine. My folks were very encouraging, in
retrospect, and I didn t have to be concerned about it. In
fact, they were very happy. Dad, even before I got the M.D.,
would always introduce me as: "Oh, this is Bob. He s my son.
He s going to be a doctor." [chuckles] It began to be
embarrassing. He was taking more pride in this, almost, than
I was... and I had it yet to accomplish!
Military Service
Hicke: By the time you graduated from Cornell, you had come to this
conclusion?
Oertley: I didn t graduate from Cornell. The army came along. In my
junior year I was off to the army to Camp Roberts, California,
Fort Benning, Georgia, Fort Meade, Maryland, and 473 Infantry
Regiment in Italy. The decision, the real decision, to become
336
a doctor sprang, I think, solidly, when I was in Italy in the
infantry and I woke up in a field hospital in northern Italy.
Obviously, not mortally wounded, but I did lose my hearing;
retrospectively, it s been very apparent that that s when it
started. I had tinnitus, the ringing in the ears, thereafter.
Under some shell explosion, I had minor, superficial wounds,
but strong tinnitus thereafter and reduced hearing.
Within weeks after getting out of the field hospital and
rejoining my infantry battalion, the war was over in Europe,
and I was among the first to be transferred back to the
States, because I was young, and I was to be retrained for war
in the Pacific theater. But on my way across the Atlantic,
getting to the States, the newspaper aboard this troop ship
told about "atomic [AT-omic] bomb drops on Japan." I didn t
know how to pronounce atomic: the word was atom and atom-ic,
so--. [chuckles]
By the time we landed, I thought, "My goodness, the war
is going to be over and I m going to be able to get back to
school." At this time I was a staff sergeant. But the army
decided that I should be staying on and retraining other
troops. And I had a very hard time talking my superiors into
ultimately letting me out. Time was wasting and I was not
getting back to school like I d like; I was working for a
master sergeant, processing other people s orders. I kept
imploring him to put mine forward, and he wouldn t. He said,
"You ve got it made. You ve got it made. Your future s
secure." And I said, "In the army? Who wants to be secure in
the army?" [laughter] But he didn t consider that patriotic
talk, almost, you know.
So finally one night, I typed up my own orders and put
them on his desk. And I said, "Please. Please sign these.
Time s wasting. I could be back in school." And he said, "So
you re really convinced; I ll sign it." Then I had to go
through the physical. In the physicalthis was the joke part
of it- -he then pointed out to me, "Oh, but you ve got a
tremendous hearing loss. You ought to make the army your
career. You re not going to make it out in the real world."
Again, the argument went on.
Hicke: He wanted you.
Oertley: Well, he was a lazy kind of fellow, and I was doing a lot of
his work. He was off playing golf or whatever. I was his
captive. But I finally succeeded and was honorably
discharged, and was free to re-enroll in Cornell College to
complete my pre-med education.
337
II BECOMING A DOCTOR
Medical School, University of Iowa
Hicke: Back to Cornell?
Oertley: Yes. And then I attended year roundclasses in summer school
as well. After two years, then, I applied to medical school
at the University of Iowa and was accepted upon their receipt
of my transcript of credits. Medical school went very well.
Hicke: What year did you graduate?
Oertley: It was in 1951 from State University of Iowa College of
Medicine, by combined course; I entered without my B.A.
Hicke: How did you do that?
Oertley: Actually my science professors (and particularly Dr. Frank
Brooks, Head of the Biological Science Department) at Cornell
College were sufficiently convinced of my ultimate aspirations
that they provided great guidance in appropriate course
selection at Cornell College, so that by the end of my third
year, I not only had completed all of the required
undergraduate courses with high grade points, but their
support in recommending me as a student prepared to undertake
the medical curriculum for an M.D. [pause]
Hicke: Let s just go back over that again. You submitted your
application to the University of Iowa and you didn t need a
B.A.
Oertley: Yes, the University of Iowa Medical School at Iowa City.
Hicke: Did you specialize in anything?
338
Oertley: No, it was a straightforward, four-year course in the college
of medicine; it was for an M.D., with or without the B.A.; it
was a four-year course. It went well. I enjoyed it
immensely. The classes were tough. We had one classmate who
committed suicide in our first year.
Hicke: Oh dear.
Oertley: His parents were both doctors and we (his classmates) didn t
know his parents. We had a feeling that they were perhaps
unduly pressuring him into a direction he didn t want to go,
and he didn t know how to get out of it any other way. This
isn t necessary in this bio certainly, but it was something
that caused us all a bit of a shudder. He was somebody who we
knew quite well, and three-quarters of the way through his
freshman year, he committed suicide.
Hicke: Did it make you think more seriously about whether you wanted
to be a doctor?
Oertley: No, no. It didn t cause me or anyone else to consider a
course change. I think we all assumed that since his parents
were physicians, he might have entered medical school not by
his own volition. Now he was feeling the strain was too much
and didn t know any acceptable way out. At least we (his
classmates) ascribed it to that. No investigation was ever
undertaken that I know of. Nonetheless it was sobering. That
was all.
Medical school was tense. We all felt it. There was a
fraternal spirit among us all, including the six women who
were in the class. There were eighty-four males and six
women. The orals were the tough part. Anatomy dissection
initially was a little bit more gruesomeit was something you
had to get used to: dissecting a human body and literally
isolating the nerves, following them on down, and not cutting
into something else. And constantly the instructors coming
around saying: "Show me the cranial vestibular nerve on your
cadaver." "Yes, sir," you know. And then we d nervously
"tease" this delicate strand of neural tissue free from its
neighboring tissue. "All right, give me its origin and tell
me where it s going and its specific function." It was tense,
because of the mass of information you were trying to master,
and anxiety about which question would be forthcoming next.
I didn t enter a fraternity, because by this time I was
already married to a girl from Cornell College, Jean Beaumont.
So I wasn t living in a fraternity house, but I began to feel
almost like I should be there: they re studying together;
339
they re burning midnight oil and going over the
upperclassmen s notes from the years before and other similar
study advantages. But I got along all right, even though the
exams were strenuous and nerve-racking. But it began
gradually to fall into place and became easier. And as each
year went by, I felt more and more secure, and more satisfied
with the decision I d made, and particularly when we began to
see patients in the last half of the junior year in the
university hospitals. In the final two years, we were charged
with increasing responsibility for care to hospitalized
patients. We were responsible for doing the admission
histories and the admission physical exams on new patients,
and writing our findings in the actual chart of the patient.
Now we were getting our hands and minds in direct contact with
live patients.
That direct professional contact with ill patients was
exciting, and the onus was on each of us not to miss any
significant detail in their medical history, nor any
aberration from normal health in our physical examination.
And we were to write in the patient s hospital chart a
complete description of our f indings--f rom head to toe. Then
to order in the chart what we felt to be necessary in the way
of lab work, what x-rays if indicated, and plot a course for
managing the patient care. You can imagine the anxiety we
felt--that we might miss some significant symptom or sign that
would give a clue as to the diagnosis of an alternate or
secondary health problem which, if not managed properly, might
jeopardize the patient s recovery.
Also, we were aware when we had passed the tough
milestones. They weren t spelled out in any way, but you knew
now that you were being accepted by the instructors. At first
they were doing a weeding-out process. Nobody really said
anything about it, but you were aware by their responses to
your questions, or how your responses to their questions were
received. They might even go so far as to say: "Now I
wouldn t quite put it that way. Here s the way you really
ought to look at that." The oral exam became an instructive
device rather than a destructive device.
With the exception of three- -the one suicide and the two
people who dropped out of their own volitionwe all made it;
nobody was actually kicked out. Those three lost were
expected almost, by the rest of us. We could sort of tell
that they just weren t cutting the mark; it s probably
apparent to students in all vocational aspirations. Any rate,
eighty-six of the original ninety aspirants made it.
340
Internship
Hicke: You graduated. And then what did you do?
Oertley: I must add that during medical school, it turned out that I
undertook medical R.O.T.C. also. Without going into excessive
detail about that, we spent a summerthose of us who were in
that programat Denver, at the Fitzsimmons military hospital
out there. I d never before been west of the state of Iowa,
and I concluded that I would choose a Denver hospital in which
to do my internship, and I selected St. Luke s Hospital in
Denver.
The internship was marvelous. At this internship, one of
the other ten interns was Lyle Olson, who was a graduate of
Wisconsin University. I had particularly liked the pediatric
portion of the internship, so I decided I was going into a
pediatric residency. But Lyle had decided that he and I
should practice together, and he wasn t about to go on in a
residency toward a specialty. He implored me, saying: "Come
on to Wisconsin with me. You can always take a residency
later and specialize if you want to, but I know a place that
we can go." So with a little more encouragement from him, I
did, and we went to practice in a county seat town in
Wisconsin: Darlington. It was a very successful family
practice. Indeed, after completing two years, we took on a
third partner, another new graduate from the University of
Wisconsin, Fred Ruf. It was a very gratifying practice in a
very warmly receptive community. We enjoyed the rotation of
nights and weekends on callevery third night and every third
weekend on call was much less exhausting and our community of
patients seemed to like our trio of practitioners.
Work in the Belgian Congo; 1963
Oertley: Then I learned about a need. The Belgian Congo was in an
uproar: the natives were restless, as it were, and a number of
Belgians were going back to Europe. Among them were many of
the professionals, including doctors. This appeared in a
medical journal and also in one of my church journals, at the
same time, that they needed doctors. So I figured, gee,
getting that info from two different directions, maybe I ought
to respond, and it might be quite exciting. Also, at that
time, my marriage was breaking up. Without addressing it
341
further, it was about to dissolve, although we had four
daughters .
I took a six month leave from my partners and I went to
the [Belgian] Congo. It was a very exciting practice. Dr.
John Zook needed help. Dr. Zook s father was a missionary in
the Congo and John was born there got his higher education in
U.S. A and returned to the Congo as a missionary doctor. He
had been born to missionary parents in central Africa.
Hicke: What did you do? Did you see the patients there?
Oertley: There was a small hospital, with x-ray and an operating room,
which was used for minor surgery, compound fractures,
Caesarean sections, and so forth. We held clinic hours for
outpatient care, seeing patients; we were doing various kinds
of surgery, setting bones, doing regular general practice, but
we were also treating malaria and smallpox, of all things. I
mean handling smallpox, because they just hadn t been
immunized and I d never seen a case of smallpox. Not even in
medical school. Things like that are kind of exciting in
their own way. That was a six-months tenure, and during that
time I had thewhat should I say?--the gall or the nerve to
write Dr. [Albert] Schweitzer in Lambarene [Gabon], because
they are contiguous countries, the Belgian Congo and Gabon
(both countries sit astride the equator), and I asked if I
might, on my way out of Africa, stop by there and see their
operation. I got an affirmative answer from him, and I did go
there, spending about ten days in Lambarene on the way out of
Africa. Dr. Schweitzer died within the next year; so in
retrospect, I am thankful that I availed myself of that
opportunity to meet that remarkable personage.
I got a chance to compare their operation with the one I
had just come from, and they were different. They had a
number of doctors who were coming and itinerating there. I
didn t know that that s what they were doing, that they were
coming out of various churches, working there for a week or a
year or whatever. My stay there was merely observing for that
week.
I remember one funny thing. I was housed in a sort of
barracks-like situation for the time I was there. This was
right on the equator. There was a huge spider on the wall
above me, and I was sure this thing was going to- -while I was
asleepdrop down and perhaps bite me. Was it venomous? I
got up to kill it and I thought, No, "Reverence for All
342
Life" --that s what Dr. Schweitzer stood for. I thought, If
they find this flattened gooey, big spider smashed on the wall
tomorrow morning, I m out of here. [laughter] And so I let
him live. He didn t bite me.
Hicke: Did you move him out?
Oertley: No, but I did my best to encourage him to leave. I finally
decided, "I m really risking more than if I just go back to
bed."
Hicke: I guess that s called "When in Rome, do as they tell you to
do."
Oertley: But enough of that.
343
III ARAMCO: 1963-1982
Joining Aramco
Hicke: So you went back to the States then?
Oertley: Yes. Another good friend, Dr. Roger Nichols, stopped to see
me first, on his way to Arabia, and then he cabled me: "As
long as you ve uprooted once and as long as your marriage is
null and you ve got your kids in schools and so forth, why
don t you come out to Arabia and put in a little stint?
Because it s exciting medicine." This was about a year or so
after getting back from the Congo. So I told both my partners
to take vacations, that I was going to leave again. They were
getting used to this. [laughter] It made it easier for me,
because there was a group practice established and they could
continue on; also, I wasn t leaving specific patients behind.
I had a lot of encouragement from the community. They were
nice about it. They thought it was exciting. But I never got
back to Wisconsin again. [pause]
Hicke: This was 1963? Didn t you say you went out there then?
Oertley: Yes, about that.
Hicke: How did you get hired?
Oertley: Let me think here now.
Hicke: Somebody must have interviewed you.
Oertley: To get to Arabia with the Arabian American Oil Company
(Aramco), you could just submit an application to the Aramco
office in New York, and their only stipulation was, as far as
even looking at your application for work, that you had to be
willing to go for two years.
344
P. Oertley: I think Roger interceded. It was Roger s idea. I think Roger
got in touch with them. They didn t even send an application;
they said something like, "Come to New York for an interview."
I think it was just about that simple.
Oertley: At any rate, I went. As I say, there was this two-year
stipulation; this wasn t going to be just a couple of weeks or
a three-month tour or anything of this sort. So, I had both
my partners take vacations and gave Aramco a time that I would
be available at that point in the future. I went overseas
and, shortly after getting there, I met Pat. Pat was already
there, working with the--
P. Oertley: And the rest is history.
Hicke: [laughter] Well, that s what we re here for. But first of
all, when you got to Dhahran, what was it like?
Oertley: Well, it was hot and dry, and there was the shamal in the
summertime, which blew the wind from the north. Dust would
sometimes make the day gray, but hot nonetheless. The people
who were there were very interestingthe Americans who were
out there working and the people of other nationalities.
There were Europeans there too, and then of course the Saudis.
Hicke: Do you recall any particular people?
Oertley: I ll bring that up later.
Hicke: Well, as we go along, if people come into it, you can tell me
about them. What did they put you to doing when you got
there?
Ras Tanura Clinic: Family Physician
Oertley: I went to Ras Tanura. You ve probably run across that
already.
Hicke: I have, that one. But I appreciate all this spelling help, a
lot of them I haven t.
Oertley: I was the American physician for the American community
essentially. That s what I was hired for at Ras Tanura.
There was already an American chief of that clinic. Dr. Bob
Armbruster, wasn t it?
345
P. Oertley: Yes.
Oertley: Dr. Armbruster.
Hicke: So it was a clinic.
Oertley: It was a clinic.
Hicke: Primarily for Americans?
Oertley: No, it was for the entire work force and their family members.
The Saudis often had large families.
I was working there essentially as the American physician
for the American community, but you were on call, and on your
turn on call, you were seeing everybody on those nights. I
became intrigued: I found the work was of good quality. The
people who had started the Medical Department had done a good
job of establishing good controls, good medical demeanor, and
it was very satisfying work.
Hicke: What would a typical day be like?
P. Oertley: First you caught the bus, and there was the bus driver who
sometimes wouldn t stop for people because he was late.
[laughter]
Hicke: Oh, dear.
Oertley: That s true. It made the route through the community, out to
the refinery, out to--Ras means "cape," and there was a long
peninsula. This was where the oil that was collected in
Aramco came by pipeline to be processed. It went out this
long cape, which was a skinny cape, literally, to where the
pipelines connected with ships.
Hicke: Oh, it went right out to the ships.
Oertley: Yes. Pat and I met there.
Hicke: At Ras Tanura?
Oertley: Yes. Pat introduced me to walking the beach and observing the
fish and wildlife of the waters there. I got more and more
interested in Pat and less interested in the water,
[laughter]
P. Oertley: That s very precious!
346
Hicke:
P. Oertley:
Hicke:
Oertley:
P. Oertley:
Oertley:
P. Oertley;
Oertley:
Hicke:
Oertley:
How flattering!
Yes.
Well, anyway, assuming the bus picked you up and took you to
the clinic, what was the clinic like?
It was a very well-designed structure. It turned out there
was one in each of the three districts. The two smaller
districts, Ras Tanura and Abqaiq, had smaller clinics. They
had beds for about ten to eleven, twelve people only as far as
overnight. Otherwise, they d go to the main hospital, which
had two hundred beds, in Dhahran.
We were taking care of the Saudis who were in the
immediate area and had moved there to work at this refining
complex, and the American community. We had other Arab
physicians in this clinic. I think there were eight or nine.
Indians as well.
And Indians, yes, from India. They had an American director
who left there shortly thereafter, Armbruster.
And then you were the director.
Yes, I replaced Dr. Armbruster.
This group of physicians was very carefully screened and
chosen. Most of them were Indian, Egyptian, Jordanian, and
Lebanese. That covers it.
What kinds of cases were you seeing? What illnesses?
Well, the routine kind of things for general practice: the
tummy upsets, the fractures. It wasn t as exotic as one might
expect. There were certainly oil company accidents that were
different. Even they weren t that strange, but injuries that
would occur in any processing plant: having a finger ripped
off or another kind of injury or a rollover in a vehicle and
that kind of thing. It was essentially an American community
in each of the three districts, but there were European
laborers who didn t have family members with them, who also
lived in bachelor housing.
Hicke:
How about the Arab women?
pregnancies?
Were they coming in with
347
Oertley: Oh, definitely. See, any Saudi who worked for the company was
eligible to bring his wife or wives into the clinic. He could
have up to four, and as many children as they could produce.
So that was really an extended family. That was the really
exciting part of it in the long run. The rest of it was
medicine as I d seen it elsewhere, it was just in a different
climate. But the Saudis who worked for the company got their
total care and total family care. It didn t cost them
anything. There was no money exchanged at all at any of the
clinics .
Hicke: Were they having different kinds of illnesses?
Oertley: Yes. Because we were living in the tropics, certainly, and
two kinds of malaria were endemic: Falciparum and Vivax. But
then there were all kinds of local nostrums being used from
classical days and available from street vendors who were
simple merchants without any trainingwho had acquired from
equally uneducated suppliers the nostrums that they purveyed.
Hicke: Oh, that s interesting. Can you tell me about any of them?
Oertley: Sometimes you didn t know why this person was ill, and it may
have been even an imaginary illness that started it, but now
they had taken some medications obtained from street vendors,
and now they really had an illness. 1 Very interesting kinds
of interconnecting problems that Aramco clinics had to sort
out.
Hicke: So diagnosis was a problem?
Oertley: Yes, but this added interest.
Hicke: Did you eventually find out you had to ask them what they d
been taking?
Oertley: Oh, always you had to. Of course, you had to do this through
an interpreter. At least I, as an American whose only
language was English, did. We had Arab-speaking physicians
who had graduated from schools in Lebanon, and they were very
good physicians. They were well chosen, selected, and signed
up in Lebanon. They were selected for being top of the class
and also the fact that they could speak very good English.
That perhaps was almost as important.
Patients illnesses became compounded by having taken some exotic
concoction as therapy.
348
When I first arrived in Arabia I was assigned to the
American /European clinic in Ras Tanura where I would be seeing
American patients the American workers and their families.
But when my nights on call came, I was seeing the same gamut
as everybody else, but with a nurse interpreter, who was
usually a male or female nurse of Lebanese or Egyptian origin
who d been educated and trained at AUB, American University of
Beirut. I found that stimulating and exciting, albeit
different, because it took a little longer to get all the
information you needed. The examination of somebody with a
stethoscope was the thing and all that, going over them, but
you need more than that in medicine.
Hicke: What kinds of things did you find they were doing at home?
Would they be like herbal medicines?
Oertley: Well, I ll give you a couple of good examples. A baby was
brought in; it was terribly anemic. Looking at the blood
cells under the microscope, the red blood cells were stippled,
which indicates a very specific problem: lead poisoning causes
deposits of lead to accrue in the red blood cells, just the
red blood cells. They are otherwise without a nucleus, so all
you have is this nice, red disk, and it was stippled. You
don t need a special dye even to see it. So this one baby
came in grossly ill, pale, anemic, skinny, definitely failing.
This wasn t at Ras Tanura, I should say.
Hicke: Well, since we re talking about this, please continue.
Oertley: It happened to be on a night that I was on call. Going over
this child, the stippling tipped us to the fact that this had
to be lead poisoning or something very similar to it. So I
tried to find out where the kid got his lead. I mean, after
all, it was a nursing baby. It turned out the mother had
cracked nipples earlier on, and she d gone to a local nostrum
dealer. She gave her complaint to himand he was not a
certified druggist or anything of that sortand he gave her
this paste, which she was to put on her nipples as a healing
ointment .
Aramco had good labs. I mean, they really had them for
all kinds of things in the oil industry. We took this sample
to them for analysis. First, we stopped her from using that;
we weren t quite sure that this was the cause, but this had to
be integral somehow. The lab reported it was a lead paste.
And this kid had lead poisoning, and he was failing. It took
some time to leech out the lead that he had already consumed.
He did survive, but he was in the hospital for a while. We
got him on formula just because it was the only way we could
349
keep him in the hospital. He did survive, but he came very
close to--I m not sure, even to this day, that as he matured,
that he might not have had problems. You can t leech it all
out, and some of this is deposited in cerebral tissue and so
forth. Nonetheless, there were things like that that
occurred.
Hicke: That s an interesting example.
Oertley: Then, on the basis of this, I went to the Eastern Province
director of health, who was Dr. Shishakli, to tell him about
it, and was able to get the husband to give us the ointment
canister. He had actually gone home and thrown it way. But I
told him, "We need it, because we need to inform others."
Hicke: Is this for Aramco or is this the government?
Oertley: No, no, this is the government in the local village. He got
hold of the man who had sold this ointment to the woman and
put him in jail. When I d go in and talk to him for a little
while, "Now, you know, this isn t going to change very much.
What you really have to do is make sure that this druggist
knows now that this can be dangerous, and he ought to be more
selective in what kinds of things he uses for unguents. There
are probably others out there. What you really ought to be
doing is making sure that they know too." So then he would
proceed with this. He got to be very good, as a matter of
fact. We had a good relationship, and we did get the guy out
of jail and, likewise, properly informed about dispensing,
utilizing a couple of our Lebanese, Arabic-speaking physicians
for that objective.
Abqaiq Clinic; Medical Administrator
Oertley: Incidentally, similarly interesting things were happening all
the time. Another interesting affair happened when I was
assigned as director of Abqaiq Clinic in Hofuf , an Arab town
to the south of Dhahran.
P. Oertley: You received a call from a nurse in Hofuf, and she said that a
lot of people were coming in--
Oertley: --sick. All had similar stories--
P. Oertley: All happened at once, and there were lots.
350
Oertley: So I went down. They bake bread, first of all, by just making
big, flat patties, thin as a pancake, about ten to twelve
inches in diameter and then putting them in a hot oven, which
is actually a barrel which had been salvaged someplace. It
had a gas burner attached to it, the hot flame inside the
drum. Then they slap these patties of bread up on the inside
wall of the hot barrel, and then with a metal tong reach in a
minute or so later and peel them off. They were large, round,
brown and white. They were very good; I loved them. But it
turned out on this instance that I went there and found that
the man that was making the bread was also ill.
P. Oertley: That s the only thing they had in common.
Oertley: Yes, right. Also some of the ill persons remembered that the
bread they d eaten had an odd taste.
P. Oertley: And one of the families had some bread, and you smelled it.
Oertley: And you could smell an odor like fuel oil or kerosene in this.
It was the flour! The flour was soiled with kerosene. You
could see it; it was caking the flour on the one side where it
had been spilled, and we could see it when we reached the
first bakery; and then we went checking up. It turned out
that the baker himself was ill from eating his own bread.
It turned out that as we investigated all this, the flour
was American flour; it had come in on a ship and had been
transhipped from the Persian Gulf onto a smaller ship to be
brought in to the Gulf where it was offloaded at Ras Tanura.
The flour was caked in there. You could smell the kerosene;
it was literally kerosene. How it avoided the kerosene itself
causing the conflagration in the ovens was beyond me, because
it was an open fire in the thing. And some of it apparently
did.
What happened as a result of this, I felt very guilty.
The police were following me around, basically. They knew
what I was doing. I ve forgotten whether I reported to them
or whether somebody said, "The American Aramco doctor is
here." They also knew that people were ill. They had already
hauled this baker off to jail, who was really innocent except
he used these soiled flour bags. He should have been a little
more suspicious. And he was sick, also.
The upshot of it all was that we got him out of jail, but
then suddenly they were looking for the American supplier of
the flour. And now I m in the position of having to defend
the fact that the flour wasn t made with the kerosene: it was
351
somewhere in shipment that it got this way. It turned out
that it was a ship that had come in, transloaded this onto
part of its cargo, and was also carrying barrels of kerosene.
Somehow on shipboard, I ve forgotten how, the two got mixed,
but nobody was really culpable except those who didn t know
how to load a ship and needed to recognize that these things
must be separate.
So then I went in and talked to the local Eastern
Province director of health, Dr. Shishakli. We sat down and
had coffee and went all over this: "Now, the way to do this
isn t to put the baker in jail; that doesn t solve your
problem, particularly when he s already sick from the same
thing." He was a very intelligent man and we got along very
nicely through the years. He was very tractable. He was glad
that--
II
P.Oertley: They had gone you, your investigators, and the police
following youhad gone to the warehouse, because the baker
told you where he had bought the flour. So he d bought his
flour from there. Eventually, this story became sort of
important, and it was reported to the World Health
Organization; and it all had to do with the fact that there
should be some control over the storage of edibles--
Oertley: --comestibles, yes--
P. Oertley: --yes, I m looking for that word--comestibles?--foodstuf f s ,
anyway, on international freight; because in this case, the
boat was on its way to Pakistan. There was that in it too.
Hicke: So that was a significant bit of investigation you did.
P. Oertley: That s right.
Oertley: It was fun. You didn t know you were even doing any
investigation. You get out here and you find that the baker
is sick. The mothers came in with the families who were ill,
and they brought the bread that didn t smell good. Then it
was a matter of going out to this area- -where is the baker
where you got it from? And he wasn t working; he was sick.
He d eaten his own bread. [chuckles]
P. Oertley: And we were in Abqaiq at the time, which was another of the
districts, the one more inland, which is where all the
roughnecks were. By roughnecks, that s a term that people in
there--
352
Hicke: There s an oil rig there.
P. Oertley: It was not a rough community, but it was less polished than
the other two, where you had more engineers or petroleum
geologists or whatever in those other areas. Well, in Abqaiq
about the time this is going on, the interesting thing about
it was if you went to a party, one group would say, "Hey, this
is what happened to us today." I remember the one where even
the host was absent, because there are islands in the Gulf
that are under dispute between Iran and Saudi Arabia, and at
that point, I guess a couple of the Aramco boats had been out
in the area and they d been boarded or taken over. So they
had Aramcons held by Iranians on some of the islands.
There were groups going to Abqaiq to help with this
business of going to Hofuf to help with the investigation that
Bob was involved in; and then there were others that had to go
out into the Gulf and do political and diplomatic stuff to get
the men out of jail.
Oertley: It was great fun living over there.
P. Oertley: That was exciting. That didn t happen every day.
Oertley: Those were events that became epochal.
P. Oertley: And they talk now about the fact that some of the islands in
the Gulf are under dispute with Iran. And on television the
other night I heard that they sent five thousand- -which is a
huge number of planes--the U.S. sent five thousand planes over
into that area to beef up the force because of this threat. I
was thinking this threat s been going on probably forthey ve
had those islands under contention for centuries.
Hicke: They are not going to solve that problem right away.
You have some other good stories. Do you want to
discourse on those?
P. Oertley: Fahad Matlaq?
[discussion of spelling of the name]
Oertley: You can spell it almost any way you want with the vowels.
Actually, in Arabic they write with all consonants and the
vowels are simply a, i, and u, and that means a little mark
over the consonant that is followed by that sound.
353
Hicke: Oh, that explains why there are so many different ways to
spell some of these things.
Oertley: Yes, exactly.
Hicke: Okay, so who was Fahad Matlaq?
Oertley: Fahad Matlaq. I have to back up.
P. Oertley: We re still living in Abqaiq.
Hicke: We never actually moved you, but we re getting good stories.
We never actually moved you from Ras Tanura to Abqaiq.
P. Oertley: You were only in Ras Tanura until 66, only three years.
Because then we got married and you moved.
Oertley: I ve moved to Abqaiq and then later to Dhahran.
P. Oertley: So the business about the bread that was at Abqaiq. This also
is Abqaiq.
Oertley: No, Pat. We were in Dhahran. Fahad Matlaq drove all the way
from Rafha, the third station northwest along Tapline [Trans
Arabian Pipeline]. What s the first station on Tapline? I
can t think of it. Hang on a moment. [tape pauses]
[This material inserted from written document.]
Oertley: Within the perimeter of the tether of his favorite Arab horse,
which was staked out to graze, Fahad one morning found the
stomped-to-death carcass of a feral fox. Because the horse
had evidence of bite wounds on its hocks, Fahad feared that a
fox so brazen as to enter the perimeter of the horse s tether
might have been rabid. He thus concluded to observe his horse
carefully for the next week.
Sure enough, within a few days the horse was stumbling
and behaving erratically; but most importantly, it was also
refusing to eat or drink. With the help of a friend he got
the animal down, and with its forelegs and its hindlegs
securely tied together, Fahad made a desperate effort to rule
out any foreign body that might be lodged on the animal s
gullet. He found none, but this effort caused the animal to
thrash about, and during one swing of the horse s head, the
animal s incisors laid open Fahad s scalp. The animal died
(choking to death) within the hour, by Fahad s description.
354
With the help of his friend, Fahad decapitated the
animal, loaded the horse s head into his pick-up truck, and
started the 150-kilometer desert trip to the hospital/health
center in Dhahran. I was awakened and called to the emergency
room to attend this man and told: "And please, take care of
this horse s head!" To conclude the narrative based on
Fahad s story, I hastily started Fahad on a course of rabies
antiserum, while the pathologist and l--gowned up, doubly
masked and doubly glovedbegan the impossible task of opening
the dense horse skull using a Stryker Cast Cutter and all
kinds of adjunctive tools (ruining several!) to get that brain
out intact.
Finally succeeding, I placed that equine brain in a
canister of liquid nitrogen; then through the personnel
office, learned that there was an Aramco employee whom Aramco
was sending to the States on a business assignment that day.
I then cabled CDC (Centers for Disease Control) in Atlanta to
please have somebody meet that plane at Kennedy and help our
horse brain courier get through customs, and for CDC to please
carry on from there with the lab work to determine whether the
horse had been truly rabid or not.
The old fashioned name for rabies is "hydrophobia." But
the symptoms are not fear of water but spasms of choking when
swallowing anything, even their own saliva, thus drooling from
the mouth and refusing to eat is a pathognomonic symptom.
Within hours I had a response cable that they, even
though they were our highest authority in USA disease control,
would not be able to clear that specimen through U.S. Customs.
However, someone from CDC would meet the flight, and would see
to getting it trans-shipped to the Pasteur Institute in Paris
for us. I was worried lest the same situation would occur in
Europe, but it was accepted by the Pasteur Institute; and
within thirty-six hours we had a reply something like this
(forgive my French): "Le cerveau du cheval a iimuno-
fluorescence positif le rage"--thus confirming our worst
fears. Of course, we had already started a course of rabies
antiserum injections into Fahad; thus we continued the full
course. Fahad remained well despite a tooth-inflicted,
saliva-contaminated scalp laceration by an animal dying of
rabies.
Indeed, albeit living 150 kilometers away, he maintained
contact from time to time, and years later when I was in the
final preparation of retiring from Aramco and departing
Arabia, I received a very nice phone call from Fahad, saying,
albeit in Arabic, "Greetings Doctor Oertley. I am Fahad
355
Hicke:
P. Oertley:
Oertley :
Hicke:
Oertley:
P. Oertley:
Hicke:
P. Oertley:
Oertley:
Hicke:
Oertley:
Hicke:
P. Oertley:
Hicke:
P. Oertley:
Matlaq-- horse bite! 1 And I want to thank you again for your
treatment, and pray that Allah (God) watch over you and your
family as you leave our country and return to your own."
[End of inserted material)
Okay, that s
a sequel.
the story of Fahad Matlaq. But there s a bit of
Fahad showed up at Bob s office in the clinic one day carrying
a bag of fugah. That s the name of this thing that appears in
the desert in the rainy season, in the soil, which is very
similar to a truffle. They re considered delicacies. So he
had a huge bag of them, and we didn t know what to do with
them. They re quite sandy. I asked around, found out; we ate
them and they were delicious.
They really were.
Did you ever see any again?
No. I didn t.
I don t remember.
Fugah is kind of like fungi, isn t it?
Yes.
It is.
They re mushrooms?
I ve never thought about it that way. I m going to look it up
in the Arabic dictionary just to see how it s spelled.
Tell me how you found out what to do with it.
I asked all my friends and somebody knew, probably someone
who d been there long enough and who had people do the same
thing to them that Fahad did to us, which was simply
presenting us with this little treasure.
But you never saw it in the market?
No, no. They weren t in the market; probably they were scarce
and maybe too hard to collect; and if you did collect them,
you d bring them as a gift or eat them.
356
Oertley: Probably a very narrow season, also, when you consider their
hot desert out there, they have a kind of a rainy season,
briefly. And it isn t everywhere and it isn t every year.
Epidemiology
Hicke: One thing we haven t much discussed was that you were, as you
said off -tape, starting to get more and more knowledgeable
about epidemiology. Tell me how that evolved.
Oertley: When there is in an area an unexplainable high incidence of a
particular illnesswhether it s malaria or food poisoning
from people harvesting fungi offseason or whateverthis is
considered a kind of epidemic for which there must be some way
to reverse the epidemic. Some epidemics, it s difficult. An
epidemic of smallpox is fairly easy if you can get to the
unexposed and vaccinate them before it gets to them. That s
what epidemiology is. Well, just stepping on a nail: you give
the guy a shot of tetanus; the same program is being enacted.
With malaria, you move out and destroy the mosquito breeding
ponds, cover them with oil or something of this sort so that
they can t breed. A mosquito doesn t have malaria de novo; it
gets its malaria by biting a person who has malaria. It gets
its organism and then bites somebody else.
Hicke: Did you have to deal with malaria?
Oertley: Yes, we had two varieties there.
Hicke: Oh yes, I think you mentioned that.
Oertley: They were both in Arabia, and the thing is, you can t do much
about immunizing the people against malaria. You couldn t
then, at any rate. I think now there s- -well, I don t even
want to talk about it because I m not sure; they are coming up
with other things you can do. But there, you either have to
get rid of the mosquito--and of course, that s a matter of
finding out where they re breeding and pouring oil on the
surfaces, kerosene, that sort of thing. This is done in all
of the underdeveloped countries of the world where people are
always going around looking for larvae of mosquitoes. The
potential for malaria is there, particularly if even some
transient person goes through in an incubating stage with
malaria, now the mosquitoes have it, and now it can spread.
The mosquitoes don t have malaria.
357
Hicke: Yes, they carry it. So it sounds to me like you were not only
treating patients, but you were going much further and trying
to eliminate or contain the disease.
Oertley: That s what epidemiology is. Epidemiology is trying to
anticipate, prevent, what can happen. For instance, rabies
had never been reported in Arabia before. And I didn t know
that it was there. So we had doubts when we were sending this
brain off. Well, although he s got this scalp laceration and
it s saliva-contaminated from the horse; when you get a dog
bite from a rabid dog, if it s been saliva-contaminated, now
this person s infected. Nobody lives with rabies.
Hicke: So did you go back and try to do something about the rabies
that you found?
Oertley: Well, definitely, we announced to the minister of health that
there is rabies on the northern frontier, and that was out of
our bailiwick. He had come three hundred kilometers to
Aramco--with his perspicacity, let s put it.
Hicke: He was a Tapline employee?
Oertley: A Tapline employee.
Hicke: So you didn t have to do anything about it because--
Oertley: Oh, no, no, no, we took care of Tapline. I was also later on
even medical director at Tapline from Dhahran. I didn t have
to go up to Tapline to do that.
Hicke: So you supervised--
Oertley: So I went up and visited their clinics along the line
periodically and discussed problems. They were small clinics.
They had probably four or five doctors and a dozen nurses in
each one of these.
Hicke: Were they established at the same time that the pipeline was
being built?
Oertley: No. Well, yes, but they didn t become really sophisticated
until later on. They were sort of quick walk-in clinics and
it was meant for the people who were doing the work on the
line, and that was about it.
P. Oertley: Like an emergency room.
Oertley: Exactly, like an emergency room.
358
Hicke:
P. Oertley:
Oertley:
P. Oertley:
Oertley :
Hicke:
P. Oertley:
Oertley:
P. Oertley:
Oertley:
P. Oertley:
Oertley:
Hicke:
Oh yes.
But then they had beds,
really.
They were like little hospitals,
They ultimately had an eight- to ten-bed hospital complex.
Tapline was a rarefied atmosphere. You don t see anything for
three hundred kilometers, except the pipeline, while you re
driving along the desert; and then suddenly there s this
station that is only there because Aramco needed a pump
station at that point where part of the oil is taken out and
serves as fuel for the pump, and then that drives the rest of
it through. It s like the heart.
Mainly towards the end there, they did a lot of deliveries,
wasn t that it?
Oh yes.
Babies, you re talking about?
Yes.
That s because when that station developed, there was also
water. They drilled for water, so there was a well, a water
source for the people that manned the station. And this
caused then migratory Arabs to make sure they headed toward
this spot on their migration north and south annually with
their flocks. So then, as always in Arabia, those non-company
related families of Arabs began to colonize around these
places because there was water. Grocery stores evolved for
the company employees and then they expanded out. A local
entrepreneur would set up one also. These became towns.
It was understood that you gave treatment to anyone who came
in.
Exactly. You didn t refuse treatment to anybody.
So, that could be Bedouin.
But you can understand how could you refuse treatment, in an
environment like that? Management wasn t going to in any way
offend the native community by refusing to care for anybody.
Maybe nobody knows, but do you suppose those little
communities are still there even after Tapline closed?
Oertley:
Oh yes, actually.
359
P. Oertley: Tapline is closed down, but they can start it up whenever need
be.
Hicke: It s still potentially operational, as I understand it.
P. Oertley: There s a word for it, like mothballing.
Hicke: Yes.
P. Oertley: They re mothballed.
Oertley: And wells are still there. The pipeline is still carrying
oil.
P. Oertley: One of the stations, Quaisuma, was reopened and it was made-
Frank [Jungers] would know all this it was made large and is
large. They even have a school going there again. But I
don 1 t know why.
Oertley: Yes, I don t know why either now.
P. Oertley: It s bigger now than it ever was.
Hicke: So getting back to what you were doing, that was one of the
things you did: supervise these clinics. Did you have any
particular incidents or challenges that you recall?
Traveling?
P. Oertley: What about the airplane? [laughter]
Hicke: You had to fly on the airplane?
P. Oertley: Always. That s the way they got up and down the line.
Hicke: Yes, you said it was three hundred kilometers.
Oertley: There wasn t a paved road; it was sand. And three hundred
kilometers, even in a Land Rover-- [pause]
Hicke: Okay, well let s get back to Abqaiq.
Oertley: When we got moved to Abqaiq, it evolved that a lot of our
patients who were Aramco employees lived in Hofuf , which was
fifty, sixty kilometers southagain, on a sandy road. Some
of the people who lived in Hofuf worked for the company very
definitely; and they traversed this distance. In fact, the
company even had a bus that went down, picked them up, and
took them back. Then they would stay in temporary housing for
the week and on the weekend go home. The weekend, of course,
360
is different from Saturday-Sunday.
Because Friday was mosque day.
It was Thursday-Friday.
Hicke: So they wanted medical treatment closer to home for their
families as well as themselves.
Oertley: Yes. And Aramco responded favorably. I went to the weekly
meeting in Dhahran--the weekly meeting of managers and by
that time, being medical manager of the thing, I felt the onus
was on me to at least express this. I felt Aramco would
respond favorably. What we had done, we had started to send a
little team of Arabic-speaking doctors and nurses down, and
sort of rotating them into a less-than-adequate environment.
It was in an old kind of a school building that was masonry
but it lacked some things. We couldn t do deliveries there
and that s one of the things that you really needed to do.
For the Saudi, with many children, a proper delivery room was
necessary.
Aramco management quickly accepted this. They asked:
"Well, how big do you have to have it?" and "Do you have to
have your own well?" We did our own research on that aspect
of it, because I had that preventive medicine--we had people
there who could do those things.
Hicke: Did you have to sink a well?
Oertley: I don t remember whether we did. But since it was an Aramco
building with Aramco manpower within, they must have drilled a
well.
Hicke: It wasn t part of your work; I guess you had somebody who
dealt with that.
Oertley: I think ultimately Aramco probably made that decision itself:
If we re going to do it, we re going to put in our own water,
et cetera. That s usually the way they did things, not to
depend on whatever the city water is or anything of that sort.
But then it would be our fault if we didn t take full care.
So that would have been a simple matter for Aramco: they
drilled wells all over the place anyway. Not only oil wells,
but water wells. That s a good question. I m not absolutely
certain, but I m sure that we had our own source.
Hicke: What did you build? Did you build it?
P. Oertley: Ultimately. But at first you--
361
Oertley: Yes, we used an existing facility there for at least a couple
of years; and that s the one I remember.
P. Oertley: You redid that, and that was sort of revolutionary, because no
one had retrofitted another building for a clinic in Aramco s
history or the local history either.
Hicke: So it was sort of flying by the seat of your pants, I guess?
Oertley: Yes.
P. Oertley: You had input from--
Oertley: From Haynes, Lundberg & Waehler in New York.
P. Oertley: Architectural firm in New York.
Oertley: Yes. They had already been out with Aramco on other building
projects, office buildings and so forth that they were doing.
P. Oertley: And then later when you really built the clinic rather than
just rebuilding the other, they did that too. So they rebuilt
the building for a clinic.
Hicke: So you had to order more equipment and outfit this clinic?
Oertley: Yes, well, the equipment was an easy thing, because
replacement equipment, you know, we could even do that by
saying, This thing is still good, but we could use it down
there until a replacement examining table can be shipped from
the states.
Hicke: Oh, I see: you shifted it.
Oertley: Yes, to where we needed service more, and then we could get a
new one for here like any situation. It didn t turn out to be
second class down there; it turned out--once we got the ball
rollingthere was a very nice clinic established in Hofuf.
We had no Americans on the staff down there, because it
required Arabic-speaking persons; and it was just a matter of
going down once a week, seeing how things were going. It was
only fifty kilometers, sixty kilometers down there from
Abqaiq--about thirty-five or forty miles.
It became totally as active as each of the other three--
Abqaiq, Ras Tanura, and Dhahran--the outpatient clinic part of
it. Moreover, we had probably more deliveries down there than
the others, because this became a situation where we weren t
quite sure of the identity of some of the women who came in.
362
You don t see the whole family at any one point, and somebody
could bring in his brother s wife who s having a baby. We
didn t do fingerprints or anything of this sort. We just sort
of knew that this could happen down there and nobody worried
about it. Again, Aramco didn t expect us to deny service to
anyone. For example of that, along Tapline, the medical
clinics denied no one for service. And these clinics were
along the north border of Arabia, and even Iraqi patients were
often treated at Tapline clinics. Always, car accident
victims of whatever origin were always cared for.
Record-Keeping Procedures
Hicke: Well, it brings up another question: what kind of record-
keeping procedures did you have in all these clinics?
Oertley: Oh, they were excellent records. A record was established for
each patient and their lineage of children as they were born:
the mother and the employee, who would be named. He could of
course have four wives, but they were Wife Number One or Two
or Three or Four. And if he divorced one, then you had a
little confusion for a little while. We didn t worry a lot
about that except for the fact that you needed to know whether
this was that patient or not.
Hicke: Sure.
Oertley: I mean, it wasn t a matter of denying them care; it was a
matter of: "Is this the same one that we saw for
schistosomiasis just a year ago?" It was a matter of getting
the identities as correctly as you could for continuity of
individual medical histories.
One funny story, I have it in here incidentally. You can
take this [gives paper]. I made it for you, anyway. The
Saudis began to be birth control conscious. They sort of
recognized that they could never be as wealthy as they d like
to be if they kept on having kids, because it was sort of a
gradual growth of awareness. At one point it was pride in
having a retinue. But now, when more modern things are
available, how do you provide for all of the families all the
children.
Hicke: Difficult.
363
Oertley: So birth control became important, and they got around to
wanting not just medication but a diaphragm. A woman was in
the clinic, and the gynecologist who was fitting her for her
diaphragm was called to a woman with a bleeding uterus or
something, away from this process. And you know what an ugly
instrument the vaginal speculum is. You ve seen them, I m
sure, not just felt them- -this alligator jaw thing, which
holds the walls of the vagina open for visualization of the
uterine cervix (mouth of the womb).
The gynecologist was called away and the nurse had come
by, and was busy in this little clinic. She asked the patient
if the doctor had seen her and didn t bother to check anywhere
else while he was away taking care of a bleeding patient in
the emergency room, I don t know what. At any rate, she was
told to dress and that she could go. And of course, there s
no billing or anything, so they go. There s no final checkout
except there s a note put in the chart; that s the end of it.
Her husband brought her back to the clinic that night. He was
irate .
Oertley: Literally in a rage, he said, "I don t care how effective this
instrument of the devil is, but get it out! By all means, get
that thing out of there!" And the thing was, with the vaginal
speculum, once you screw this little thing open, it stays
open. You can t pull it out. He didn t know where to release
it. Of course, she s waddling all the way like this when
she s coming in! [laughter]
Hicke: Oh, heavens!
Oertley: I didn t see it, but the story spread through the whole
medical group the next day. All four stations knew about it,
and everybody was chagrined but laughing.
Hicke: Yes, that s a great story.
Nursing Staff
Hicke: I d been meaning to ask you: what about nursing help? What
did you have in the way of nurses in these village clinics?
Oertley: We had nurses that were trained in Lebanon, particularly
because of the language. We really needed that sort of thing
364
for the management of patients. We had American nurses of
course, not a lot of them, but it became essential. I mean it
was essential from the word go. We were searching for nurses
who were trained in Lebanon, who were Arabic-speaking. They
were all of good quality. They were trained at American
University of Beirut.
Hicke: Was there a big turnover?
Oertley: No, I think they were pretty stable.
P. Oertley: The wages were good for them. They had more of an
opportunity, 1 think, in Arabia than they did elsewhere.
Oertley: They had opportunities for further training. Aramco was very
generous with giving employees an opportunity: "Oh, you d like
to advance and go into this," and they d ship them off, let
them go towhat was the place in Egypt? A lot of them
trained there, but I can t think of the name.
P. Oertley: I can t either. I remember towards the end of your stay
there, you had some Irish nursesEnglish and Irish nurses.
The company was hiring a lot of English people. One of your
Irish nurses was at the Hofuf clinic. She was the one that
was bitten by the spider that was like a brown recluse. It
has a horrible bite, which I saw pictures of.
Hicke: She lived through that, I guess?
Oertley: Oh yes.
Hicke: Uncomfortably, obviously.
Oertley: Well, it caused an increasingly large necrotic 1 area. It just
killed the tissue there; it all had to regrow and there was a
big scar and all that sort of thing, you know.
P. Oertley: That s why I remembered he had Irish nurses. [laughter]
Hicke: Well, whatever works. You lived in Dhahran, eventually,
right?
Oertley: Yes.
Necrosis means death of affected tissue,
365
Moving to Dhahran
Hicke: How did it happen that you moved from Hofuf to Dhahran?
Oertley: I never lived in Hofuf. I worked out of Abqaiq down in Hofuf.
I would go back and forth, but we didn t live in Hofuf.
Hicke: Okay. But then eventually you moved from Abqaiq to Dhahran.
Oertley: We did move to Dhahran.
P. Oertley: You only lived in Abqaiq for a year and a half. I lived there
three years. This is the story I like to tell, because he was
transferred; but a lot of people were being transferred into
Dhahran. Housing was at a premium, and there were certain
requirements for certain kinds of houses. If you had this
length of service with the company, you had adequate housing
points, this many children, and all of that. So you waited
your turn in a situation like that, unless you wanted to go
into housing that you weren t really happy with.
So there we were, waiting. It took a year and a half.
He d commute back and forth from Dhahran where he was now
working and living in Steinecke Hall, which was where they put
people in his situation, and also guests of the company. He
lived there; it s sort of like a little motel without the
parking places. So he went back and forth on weekends, and--
tell the story about this Easter weekend.
Oertley: This was funny because it relates to Easter. In Abqaiq one
morning--! was in the church choir that we had--it was the
Easter Sunday weekend for the rest of the world. Of course,
as far as Aramco went, they didn t observe Easter as a holiday
per se. Friday was church day. 1 That was no work as far as
regular work; the offices didn t open. Things that had to be
done were done, but the routine work could be set aside for a
weekend acknowledging the Saudi holy day, Friday, mosque day.
So it was Easter FridayGood Friday, it was a holiday.
The services were held in the hall--the cafeteria or
recreational building that we had in each district. You
didn t have a church. But that was where we had plays and so
forth; it had an auditorium, it had almost a basketball court
Friday is Mosque Day in the Muslim world, so we as Christians
observed our weekly religious services on Friday. Sunday was the second
day of the work week.
366
kind of thing. So church services were held. We had pastors,
probably one in each district, and then they d rotate if they
were Catholic or Protestant.
I was in the choir and we had an Easter anthem. Pat and
I lived right across the street from the District s Great
Hall--this community gathering spot, across the corner from
our Aramco house. Pat hadn t gone to this service. I was
heading out to go to Dhahran for that day as I had been doing
for the last week for a particular reason: covering for
someone, I don t remember who. 1 called a company taxi to be
waiting for me. He was coming, I think it was every Friday,
he came out .
But at any rate, I finished the anthem and dashed out to
get the taxi. Oh no! Before I had done that, I had to call a
patrol taxi to tell them to come, but don t expect me to be
right on time because I ll try to be out there at such and
such a time. But don t honk your horn; I remember telling him
that.
But at any rate-- [chuckles] --I came out of the common
building, our recreation hall, where we held the church
services, because we didn t build Christian churches in the
Kingdom. (We weren t permitted to build Christian edifices in
Arabia, the home of Islam s two holiest holy cities, Mecca and
Medina) . I went to the taxi and I approached him from this
side, of course, because he s sort of watching the house and
I m coming from the opposite side of the street. I tapped on
that window. "Ah, doctor!" he says. So then he lets me in
and we start off; it s a routine trip that I ve been doing to
Dhahran for the last month for some reason, I don t remember
why at this point in time.
I was aware, as we were driving along, he kept massaging
the steering wheel, holding it in one hand. He was agitated
about something and I couldn t figure out what it was, but I
didn t worry. Finally, he asked me: "Why were you not at home
today?" You know, he had a feeling that I had been out,
coming from somebody else s house. [laughter] I could never
have explained it satisfactorily that I was singing in an
Easter, (thus Christian) choir service and my wife was still
in bed. Oh, first he asked me why I didn t want him to blow
the horn. "Well, I didn t want you to wake up my wife," I
said. Now this man [laughter] went, "Aaahhh," with a knowing
nod and a bit of a sly grin. And since he d been watching for
me to emerge from our house, he d not seen me emerge from the
public building across the street.
367
P. Oertley:
Hicke:
P. Oertley:
So then he keeps massaging the steering wheel as he s
going along, and he has more questions but he doesn t know how
to phrase them. Finally [laughter] he gave a sort of knowing
wink and dropped the subject. I m sure he firmly concluded
that I d been philanderingand worse, probably spread his
tale among fellow taxi drivers. Who knowsmaybe they even
watched our neighborhood to determine where the other party
lived. If so, they wasted a lot of time.
Isn t that great?
That s a great story!
People are the same all over. [pause]
Field Director, Trachoma Research Program
Hicke: You were just talking off -tape about the things that happened
on these village visits.
Oertley: Yes, these trachoma field trips. People responded
surprisingly well, mostly because it was sort of like the
circus coming to town. We spread our stuff out, all the gear
--there wasn t much, but vials and bottles and things. We d
collect specimens. We had this one instance that Dottie
mentions [in her oral history), Dottie McComb, regarding the
singing. I d forgotten the "Three Blind Mice." It was a way
of getting them all kind of involved in a fun thing, actually
singing in rounds. We would do it in rounds among us and get
them to go with us. It wasn t pronounced correctly, but it
was close, and it was kind of fun; they really got a kick out
of it. I was surprised, because we had nothing from our
experience with them to enable us to realize that they might
like to join in something like that.
Now, they did like music and they did like particular
kinds of folk dancing that they d do. But this didn t involve
that: this was singing a song that made no sense to them. But
it wasn t that hard to sort of mimic the song; it came out
distorted but fine.
Hicke: And you were saying that the villagers really didn t give you
a hard time, although you were inflicting some discomfort.
368
Oertley:
Hicke:
Oertley:
Hicke:
Oertley:
Hicke:
Oertley:
P. Oertley:
Oertley:
P. Oertley:
Oertley:
P. Oertley:
Oertley:
Hicke:
Oh, yes. Exactly. Definitely. It was amazing to me. Roger
had the program well established before I ever reached Arabia.
Roger Nichols.
You are referring to the trachoma project.
He was doing this with the Harvard School of Public Health.
He was an Aramcon, but he--. Have you seen his book, by
chance? You know he put together a book on trachoma.
Elinor [Nichols] sent me some excerpts from it and also she
told me about his part.
Okay, good. I have a copy upstairs, but it s not something
that even I want to read through. Technically, it s all that
you ever wanted to know about trachoma at that state of the
art.
So he just got you involved as soon as you got there?
No. He would plan these sorties on weekends; and he needed me
for extra help and because I was an M.D.; this was something
that wouldn t take long to impress on me what things could be
done without a lot of extra explanation. So 1 went out with
him and enjoyed it very much.
And the way you actually got involved was he had decided to go
back-
That s true.
--and take the head of the department of biology whatever at
Harvard-
Microbiology,
--and he asked you if you would take the program over.
It was a matter of only continuing what he was doing,
following up in the various villages, scraping the underside
of the upper lid of people, looking for the organism and
comparing that to their lifestyle and what they were doing.
He did determine that the trachoma organism was harbored in
the vagina of the women, and the kids were infected at birth.
Sliding through the birth canal would inoculate the child s
conjunctivae, the lid. It wasn t a matter of direct
acquisition. It was probably extended by the use of kohl--
Oh, yes. Eye shadow.
V *.
369
Oertley: Eye shadow. Because now they would use the same instrument to
apply this on this person and that one. A little more here
and, you know.
Hicke: So you continued that, then.
Oertley: I continued it for a time, not for very long. He had some
villages he still wanted to have followed up, but he left.
And Dottie was there also, so she was really the one who held
it together, because I was continuing with my work with
Aramco; and this wasn t Aramco work per se. It was approved
by Aramco for Roger to do this.
P. Oertley: They funded it. I also think that they did a lot of things
like that, altruistic things as we all do, because they got
credit. It sounded very good.
Hicke: With the Saudi government?
Oertley: Yes, definitely. We re doing something else besides taking
oil. It provided employment to a lot of Saudis, the oil
company. The Saudis didn t lose by us being there. Indeed
wherever we traveled in our four-wheel-drive vehicles,
exploring the desert, the Bedouins we encountered in their
tents were always friendly and happy that we stopped to visit
with them. Not only were there no road signs, there were no
consistently defined roads; they truly were tracks in the
sand, and they would disappear in wind storms.
Director of Preventive Medicine
Hicke:
Oertley:
P. Oertley:
Hicke:
I wanted to ask you about moving to Dhahran now. You must
have moved because you changed jobs or were promoted.
Yes, I guess that was it.
You went from being head of what was going on in Abqaiq and
also working on trachoma. You went into Dhahran when they
were expanding in every way because this was the beginning of
the seventies. The Medical Department was expanding, and you
were at that point going to head up a unit that they had never
had. They hadn t called it that before: it was the
Epidemiology Unit.
They just formed a new department?
370
P. Oertley: Yes, everything was expanding. And because of the workload of
this, that, and the other, they were separating things. That
was it. And you were also doing ambulatory medicine. I
remember you had two or three jobs, and the one you liked the
most was epidemiology.
Oertley: Well, epidemiology was thrown in by virtue of the fact that we
had malaria, two varieties; we had schistosomiasis there among
the Saudis. And these things were endemic, endemic meaning
they were there .for a long time and just
Hicke: Permanent.
Oertley: Yes, exactly. I would go to management when we would need
some additional people for various kinds of operations that we
were undertaking. Aramco was very, very compliant in this
respect. They recognized that the Medical Department was
their
P. Oertley: P.R.
Oertley: Yes, a public relations thing, and also a real asset to the
communities there. The government knew it. This was an
altruistic involvement. I would have expected that the people
who were searching, drilling, producing, refining, and
shipping oil would have been hard pressed to see the need for
the expense of what we were doing, but they were most
responsive.
P. Oertley: Well, you proved it to them. I remember when you could show
them charts of the decrease in clinic visits as a result of
education programs for the women, the babies, that sort of
stuff, and the malaria.
Oertley: They did respond and they did understand; and they also knew
that to maintain goodwill in the Kingdom, this was enhancing
that process, because the Saudis could have said, "Well,
you re draining off a lot of oil from usall those barrels
and barrels." But they knew they were getting a benefit that
had no relation to the oil production. And we reported to
them. I d sit in, in my role in preventive medicine--!
actually hired a Preventive Medicine director at their weekly
meetings. Just sit in, number one, to listen to what s going
on, what are they doing here, what s the prospect of some
clinical problem out in here just this listening, hoping to
anticipate a problem or presenting a request: "We really feel
we have to do thus and so."
Hicke:
These are management meetings?
371
Oertley :
Hicke:
Oertley:
Hicke:
Oertley:
P. Oertley;
Oertley:
Hicke:
P. Oertley;
Oertley:
P. Oertley;
Hicke:
P. Oertley;
Yes. That s a management meeting. They were always
responsive and more compliant than I expected them to be.
They were interested in the area and its people, and anything
that enhanced goodwill. I make it sound like it s commercial,
but it s not, really. I think they had a real feel for the
people; I think those were people out there for a while who
really liked the Arabs.
So you attribute this to--
- -humanity I think as much as anything.
But it sounds as if the early managers formed some sort of
corporate culture that was passed down. Is that right?
I don t really know.
I ll look into that. I think that s the way it was.
Yes, I do too. I came in late, and as far as I m concerned,
that attitude was not just, prevalent , but evident. And the
very fact that I began to attend the weekly management
meetingalthough I had nothing to do with oil, nothing to do
with its processing or transport or anything--! d sit in and
listen; and then I d occasionally tell the manager about the
little report or request I d like to put in before this
meeting s over. It developed to the point where finally
they d say, Okay, doc, you got anything for us today? you
know. It was always in good humor. There was no feeling of,
Oh, okay, now what are you going to lay on us? It wasn t that
kind of thing. Oh, they did that sometimes as a joke.
You reported to Industrial Relations, is that right?
that work?
How did
It changed. It changed at various times: for instance, in Ras
Tanura and in Abqaiq, you reported to the district manager.
Yes, that s where I was.
He was the head of the whole thing.
This is not a medical person, this is the company district
manager?
Yes. Then when you got to Dhahran, it was levels and levels
and levels. The person in that case, you reported to the
equivalent of Bill Taylor, who then reported to--
372
Hicke: The medical director?
P. Oertley: Yes. He was Bill s medical director, who then reported to
Industrial Relations.
Oertley: But in each district, in Ras Tanura, I ended up going to that
district management meeting. Dhahran meetings, as I can
recall, they were all managers.
Hicke: Are we talking about the medical clinic now or are you talking
about the whole company?
Oertley: I m talking about Aramco and this matter of reporting to them.
There was an openness. You could go in and present anything.
There was a meeting, I think it was on Sunday, Friday being
mosque day, as I ve said. My attendance started when I felt
that we in medicine had something currently significant that
management needed to know regarding health affairs, whether it
was limited to the American community or some health problem
involving the wider area, and especially in those instances
where I d travel to Riyadh (Riyadh is the capital city) to
discuss a health problem with the Minister of Health. I began
to attend, and I learned what they were talking about by first
having something to present; and then thereafter, I would go
and give a followup on whatever we had done. "You remember
the program that we started on such and such? Well here s
what s happening. And I think we ll see that it was a
worthwhile effort."
Then it was a matter of somebody saying at a party, "Hey,
you haven t been to a meeting lately." "Well, I haven t had
anything to present," I say. "Well, you used to come and at
least listen to what we were doing," they d reply. I said,
"Well, okay, I ll be in next week." Then I d go for a few
weeks again. But it would happen always that something would
interrupt again for a little bit. I didn t make a regular
report at the weekly meeting by any means, but neither did
every other manager. They d go around the table: "Anything
from you in this area?" Nobody ever frowned on Medical s
appearance in there. I think they knew the Arabs appreciated
our being there. They recognized a difference in their
health, all of those who had association with the company.
And more than that, we began really to interact with the
Ministry of Health and going in to Riyadh or at least as far
as Dammam. That was where I d see Dr. Shishakli.
Hicke: It was the local seat of government?
373
Oertley: Yes, Daramam was the governmental center for the Eastern
Province. [pause]
Hicke: You were just talking about how you sort of evolved into
preventive medicine by going back to the States--
Oertley: --and realizing that there were things that we could do to
even reduce our workload, which was economically justified.
P. Oertley: And taking workshops and seminars at CDC (the Center for
Disease Control in Atlanta) . They had these things to educate
people from countries where they ll have the opportunity- -
[Interview 2: August 19, 1996 ]
Oertley: --to stop at CDC whenever I was back in the States to discuss
with somebody a particular problem, and on occasion, bring one
or another of them out to Arabia at Aramco expense. Having
them come out and be on site helped immensely in more rapidly
developing a solution for any particular problem. Aramco
management was truly never stingy about this. In fact, I d
make a point of always reporting back to them what results had
emerged, because I felt that would improve my chances the next
time I needed that kind of help. [pause]
Hicke: You were just saying you went out as a GP.
Oertley: Yes, general practitioner, delivering babies, setting bones--
the various things that you do there. All of this, the
necessity for doing more than treating those who get to you
meant to go out and look for sources where this was evolving
and stem it way back. It turns out that it saves more time,
saves people from illness, saves money in the long run.
But management, I felt, was always very responsive in
Aramco. They knew we were guests in this foreign country and
we were benefiting, and we were also helping Saudis to become
affluent. Keeping them healthy was part of the game; it
improved the relations between the two countries, the working
components from each. It was never a problem. I always felt
warmly toward management in that regard; they listened and
they responded. Oh, sometimes they teased: "Oh, Oertley.
What are you going to ask for today?" This kind of thing.
But I was always happy when I could say, "No, I m going to
report the good news about what we did last month." [pause]
37A
Camel Trip into the Desert
Hicke: Tell me about your trip out into the desert with Mohammad.
Oertley: Okay. Mohammad Said al Ali was a graduate of the University
of Ohio or Ohio University, I don t know which it was, but a
native of Arabia. He was in the hierarchy of the company; I
don t remember what he did, really.
P. Oertley: Industrial Relations.
Oertley: Thank you. At any rate, he and a dentist helped me back--
P. Oertley: Carl Koenig, an American dentist in the Medical Department.
Oertley: Yes, Carl Koenig. We talked together one time at some social
event about the fact that we d all like to take a camel trip.
Mohammad would say, "You haven t ever ridden a camel, either."
So we took our Land Rover and went out into the desert, the
three of us, equipped with gear for camping for a few days,
including three five-gallon jerry cans of drinking water. We
went to an Arab camp and asked if they knew anyone we could
hire to make a short, few days trip on the desert. It turned
out that we did get a referral. This fellow, though, had to
find someone who would now rent us the camels; he didn t have
any. We ultimately got ourselves going and we had brought a
lot of water with us--jerry cans of water in our Land Rover--
but now we had to carry this on a camel s back, and some of
the camels were a little reluctant to have all that weight.
You can find water in the desert, but we were not about to go
quite the hard way.
This was ultimately accomplished and we started off. We
did get a man to serve as guide. It was actually the first
man we ran into; he found the camels for us. Then he said,
"Where do you want to go?" "Well, anyplace. Just take us
where you d like to take us," we said. And this left him sort
of puzzled. As we proceeded, though, he began to commiserate
to Ali Mohammad. He was singing a kind of sad song, and
Mohammad recognized that this was kind of weird. He asked
him: "Why are you singing that?" "Well, I don t know what
we re going to do if I run into some other nomads. They re
going to wonder what I m doing," he said. This was
unconventional; he didn t put it in those obvious words.
Now he began to really feel the onus on him; he wasn t
concerned about our safety or anything, but now he was
concerned about his image with this group of people. We had
v :
375
no purpose; we weren t going any particular placewe had no
destination. He had a way of even massaging the rope. You
don t use a bridle to drive a camel. It s just a halter kind
of thing, one rope and it s in your hands; you direct the
camel with a bamboo switch. When you want him to turn left,
you swish the bamboo by his right ear, and the camel would
turn to the left. Sometimes if he didn t want to go, he just
turned his head and continued straight ahead. And then you
sort of whack him on the neck. These things we learned and
had a good time with.
The foregoing dissertation on direction control is
important to this little event, because one night it rained.
It rained hard. Even the desert doesn t soak up the water
fast. The low spots become ponds suddenly, and it takes a few
days for it to soak in and/or evaporate. It depends on the
permeability of underlying strata. Suddenly, as we were
proceeding after this rainy night, we saw this water ahead on
the desert. Our guide Fahad was veering off to the right. My
friend the dentist, Carl Koenig, followed. But I thought, Oh,
I don t want to. This camel wants to go to the water. And
indeed, he hadn t drunk since we left. I ended letting him go
his way, without exerting any control.
Now our Arab guide that we had hired started yelling at
me: "No, no, no! Left! Left! Tahena I Come this way." At
any rate, I thought, Well, I m going to let this camel drink.
I m not about to deny him water. But our guide knew very well
what he was talking about, because the camel, when he realized
that I wasn t going to redirect him, went straight to the
water s edge, but proceeded into the water deeper and deeper.
I thought, Well, you don t have to get in this deep to drink.
By this time the guide Mohammad had jumped off his camel
and came running toward me through the water. The camel was
down on his front knees that s the way they get down. They
go down front first and then the back, and you almost fall off
both ways. At that time I realized, He s not interested in
drinking. And at this point, he starts to roll over and
unload his back and the saddle. Camels saddles aren t like
horse saddles; they re made of wood and very crude things. My
gear was soaked. At least I had jumped free rather than get
mashed under the camel. I was soaked. Mohammad, our hired
guide, was chastising me most harshly and soundly, as he
dismounted and ran to my aid, as my camel literally rolled
completely over in the water with my gear lashed to his back.
Our guide expertly got my camel on his feet again, and
then he laughed uproariously about this dumb American who
376
Hicke:
Oertley:
Hicke:
P. Oertley:
Oertley:
couldn t control his camel. I m glad it happened, because
ever after, when I took my kids out on the desert and we would
stop well out in front of a Bedu tent to show them a family
living in the desert, I would introduce myself as a friend of
the guide. I would announce this to the people coming toward
the Land Rover, and we parked by established protocol, about
thirty to forty yards out in front of the place and made sure
that there were men present before we approached the tent and
all this kind of thing. In order to break the ice more
quickly, I d just tell them that I rode a camel with Nasir--or
whatever his name was, I ve forgotten. And they d respond:
"Ah!!" This had gotten all around.
"You re the one! Come on in. Come on in, crazy American
who lets his camel get down in the water and roll over with
him still aboard." [chuckles]
It was well worth it.
Oh, it was. It paved the way for many lively desert trips.
As they say, you dined out on that for years at dinner
parties, [laughter]
What a nice expression.
Enough of that.
377
IV PAT OERTLEY
Background and Education
Hicke: Now let s talk to Pat for a while, and let s start with when
and where you were born.
P. Oertley: I was born in Pensacola, Florida, on October 9, 1927.
Hicke: Did you grow up in Florida? In Pensacola?
P. Oertley: No, in Tampa.
Hicke: In Tampa, okay. Stayed there through grade school?
P. Oertley: Through high school. And then I went to college in South
Bend, Indiana at St. Mary s of Notre Dame.
Hicke: How did you pick that?
P. Oertley: Let s see. There was an aunt of one of the nuns at the high
school, who came and talked to us. That was the school that
she was talking about. I liked it because it sounded far
away, so I thought, "Oh, great." So I went and really enjoyed
it.
Hicke: You re a professional artist. When did that get started?
P. Oertley: I began lessons in high school, private lessons.
Hicke: Painting?
P. Oertley: Yes. Oil painting.
Hicke: What kinds of things were you doing?
378
P. Oertley:
Hicke:
P. Oertley:
Hicke:
P. Oertley:
Hicke:
P. Oertley:
Hicke:
P. Oertley:
Hicke:
P. Oertley:
Hicke:
P. Oertley:
Hicke:
P. Oertley:
Just learning, of course. As I recall, we were copying
pictures, which is very good training.
Masterpieces?
Anything. We could choose it. I remember the head of a
little girl with berries, red cherries I guess they were.
Then what did you do when you were in college? What did you
major in?
I majored in art. I had a minor in theology and also in
textiles. I really enjoyed going to college and high school,
I loved going to school.
What kind of extracurricular activities, high school and
college?
Dating. [laughter]
Dances?
Dancing, yes. You know, typical. I don t remember being in
any clubs. It was a small school, for one thing, and there
weren t a large number.
High school or college?
College. I don t remember a large number of clubs,
seemed very full and very satisfying.
What was your goal?
It just
I don t think I ever thought of it. So of course, when I got
out: what do you do with art? Then I went and got a master s
in art in New York, and really enjoyed that.
Where?
At Columbia [University]. And I think part of the enjoyment
of the thing was the fact that I was dating a reporter from
the New York Times. He had a lot of entree into things that I
wouldn t have had the chance to attend: he got tickets to art
openings, and I remember being in the presence ofnot
meetingpeople like Franz Kline. He did black and white
abstractions or nonobjective art. I hadn t been exposed to
any of that in college, so it was quite an awakening.
379
There were others too that were on their way up and now
are famous. I went to a lot of events. I remember I went to a
prize fight once with him--the only one I ve ever been to--and
the man s name was Tony Zale, not a well-known name in prize
fighting.
Hicke: What years are we in now? When did you graduate?
P. Oertley: I graduated in 49.
Hicke: This is from Notre Dame?
P. Oertley: Yes. And then I got my master s in 50--did it in one year.
Then I tried to get a job and couldn t because, you know, what
are you prepared for? So my father suggested I go back to
school and take education. You can always get a job in
education. So I went back to Tampa and I got in another
year s work just picking up education courses.
Hicke: Which university?
P. Oertley: University of Tampa, which had a beautiful setting because
it s right on the river. It was in the beginning a very large
hotel set in Moorish style. That was in the twenties I guess.
Like I said, it was just a beautiful setting. Enjoyed that.
The courses were sort of uninteresting, but anything can be
interesting if you could just sit there and listen. There was
some aspect of it that can be worthwhile, but I don t think
any of those courses helped me to know how to teach.
So I did that for a year; I picked up all of the
necessary requirements, got a certificate.
Hicke: Elementary?
P. Oertley: Yes, and teaching art from kindergarten through twelfth; so I
had two certificates.
Early Work Experiences
P. Oertley: The job that I took after that was on Lake Okeechobee in Belle
Glade. That was on the edge of Lake Okeechobee. You may not
be aware of it, but it s a very commercial area- -sugarcane,
commercial fishing. It s rural but rural with a difference.
They had a lot of immigrant workers. In those days they were
white.
380
Hicke:
P. Oertley:
Oertley:
Hicke:
P. Oertley:
Hicke:
P. Oertley:
This is Florida still?
Yes. So the first year I taught was there. Most of the
children didn t have shoes. I remember having to teach a
health unityou know, be sure to brush your teeth every
morning. They didn t have toothbrushes. And for Christmas,
one little boy gave me a pink towel. He lived where they
didn t even have water. That was the first year, which was
certainly very interesting. I know I had something like
forty-one children.
Then I read an article in Glamour magazine about
opportunities for teaching outside the United States with the
International School Service in Washington. I wrote to them.
They made up a file. It was somehow, and I m not sure how,
connected with the U.S. government. I ve heard since then it
was a CIA kind of thing and that was the opportunity to put
people in different countries. Well, nobody ever approached
me on being a spy. [laughter] I would ve been a good one!
Anyway- -
She would have.
Did
you have to send in your grades to the CIA?
You know, it was the usual thing. They built up a file. Then
they told me three or four different countries where there
were openings. And the one that appealed to me most was
Venezuela, because it was Caracas, the big city. I went there
the first year. That was a marvelous year because of the fact
that I was right in the middle of the city--a lot going on.
There were a lot of single people there, all different
nationalities. I lived with another teacher from the school
in an apartment building which was in a small area right in
the city, but it was known for its nightlife so it was
exciting to be there.
Who were you teaching?
These were children in a private school. The school was
subsidized by the oil companies who were there; so if their
employees were there in the city and they wanted to send them
to the American school, they did that, with help for the
tuition. But at the same time there were also lots of
Venezuelan children whose parents, of course, wanted them to
be fluent in English. Those little children came to school in
chauff cured cars and they wore diamond earrings. So it was a
neat mixture.
381
I got to see a lot of Venezuela. We spent a lot of time
on the weekends at the beach, little groups of us. There
would be places where there were hammocks and little
outhouses. In the morning, the little boys would be waiting
at the edge of the water with baskets, covered with wet
seaweed and there were raw oysters in there.
Hicke: Nice!
P. Oertley: In those days, you ate raw oysters. Probably shouldn t, but--
Oertley: Well, you re here to tell it.
Hicke: Yes, right.
P. Oertley: The next year I went to Chile. Again, I heard that opening
was with International School Service. That was in a copper
mine in Chuquicamata. That s in northern Chile, at about
9,500 feet. At that time, it was the second largest open pit
copper mine in the world. It was Chile Exploration Company,
which was a subsidiary of Anaconda.
That was a very small setting. The children at that
school were children of that company only. It was a little
company town. It was barren; there were very few trees,
because this was the Anaconda desert--rocky . I was there a
year and a half. We didn t have any rain that whole time, but
we had snow once .
The interesting part of being there: the employees were
mostly from Canada, some from the U.S., a few Europeans.
There was always a good social life in situations like that.
On the weekends, we d go fishing in the rivers which they had
stocked with trout glorious settings, huge, gorgeous
mountains and the Indians, with their flocks of llamas,
guanacos, and things of that sort. The little boys hunted
with a slingshot; they hunted birds with a slingshot for food.
We saw that frequently.
The teaching I did there was mostly combinations of
grades. I think I started with the fifth and the sixth.
There might be ten children, so it was more like a little
family. And of course you did everything. The principal,
who d been there I think since they opened the place, decided
I was the one to do the art for the school because of my
background. She did the music. So we put on plays; that was
a lot of fun. I remember I always made sure that I had the
scenery against the back of the piano so she was hidden- -and
also then she couldn t interfere with my directing. As the
382
principal, she did tend to want to be the head cheese; but I
put her back there with the music. [laughter] It worked out.
Then I came back for a few months. I went to the
University of Miami and took some more classes for some
reason. I don t remember why. But the University of Miami is
a very nice place, and of course it s right in Coral Gables.
The setting is, as you would expect in Florida, very tropical,
and the beaches were close by. They had apartments instead of
dormitories .
And then the next fall I went off to Peru for teaching
with the International Petroleum Company, which is a
subsidiary of Standard Oil of New Jersey, otherwise known as
ESSO. I was there four years. That was a glorious setting
because it was right on the Pacific Ocean, at Talara. Talara,
Peru is in the northern part of the country. Close to it along
the coast, they had whaling stations. They probably don t
now, but in those days they did. They had tuna boats, all
sorts of things going on. It s a rocky coast filled with sea
life; because of the Humboldt Current we get an upswelling of,
oh, plankton and all the rest of things that attract the
smaller fish, which attract the larger fish, and the birds.
The setting for the company s town was right on the
ocean. We were just right there; it was like a resort. So it
was a glorious place to be. I walked along the beach a lot.
One of the things I remember most was coming across two giant
squid.
fj
P. Oertley: Once while walking along a beach, I came across two giant
squid which were maybe three feet long. They were in a
shallow tide pool, which is not their natural habitat. So I
decided that they needed to be out. It appeared to me that
perhaps they were trapped there, because they didn t go away
when I came ; and I knew they knew I was there because they
watched me with their eyes, which are quite large.
So I got behind them. They have a deltoid shape, almost
shaped like an arrow, which gave me the opportunity to grab
them along the edge of that shape and pull them into the
deeper water. I pulled the first one in. Then I pulled the
other in. When I got back to the shore and turned around,
they were both gone. So it must have enabled them to get back
to deeper water, which is where they belong. That was really
thrilling.
383
Hicke:
Yes, I can see how it would be,
Joining Aramco
P. Oertley: I d been there four years. I went into the principal s
office. His name was Russ. I asked him to put my file in
circulation for a transfer, and preferably the transfer would
be to Aruba, an island in the Caribbean which I had visited
going back and forth to the U.S. It had gorgeous beaches. He
said, "But you re a woman." I reminded him that first of all,
I was an employee and all employees had the privilege of
requesting that their files be circulated for transfers.
He came back, oh, maybe six and a half weeks later or so,
and was surprised. He told me that I was to report to Arabia
in September. But I had been to Arabia before, visiting a
friend.
Hicke: You visited a friend in Dhahran?
P. Oertley: Yes.
Hicke: So you actually had been to Dhahran?
P. Oertley: Yes, I had been there. As I recall, I even had dinner one
night in the company of the principal. I can remember he
would ask me if I wanted to work there.
Hicke: Maybe they were laying in wait for you!
P. Oertley: So it s quite possible that the file came through and they
said, "We ll take her." Whatever. So I went.
Ras Tanura
P. Oertley:
Hicke:
The first place I went was to Ras Tanura, which is right on
the beach. I lived in what they called the dorm, but it was a
combination dorm/ apartment kind of thing with common living
quarterskitchen, living room, and all thatbut private
bedrooms .
Did you actually cook in the dorm?
384
P. Oertley: Not much. There was a cafeteria. And there were a lot of
single people there. The school, at the time, was also right
on the beach. Ras Tanura is a beautiful place. The school, I
don t remember the size of it, but it was certainly larger
than the one in Chile and the one in Venezuela. There was an
American principal. Most of the students were American, but
there were a lot of Europeans. When I first went there, there
weren t any Saudis in the schools, because the schools were
founded on an American curriculum for the dependents of
foreign workers because there was nowhere else for them to go.
Through the years that changed.
In Aramco there were levels of occupations, and those
levels had numbers attached to them. There were some numbers
higher than others, and those were all executive or what they
called senior staff. Anyone from another country was
automatically in the senior staff; anyone in senior staff was
allowed to live in the community that was built. There were
good reasons for that, because in the beginning there was
nowhere to live. Everything that evolved was brought in. The
local towns evolved, but these were all usually poor
structures. They had no schools. They had no medical
facilities.
The local people who lived there and worked for the
company were trained. They were usually given schooling.
Many of them started at the age of fourteen or fifteen. But
that s one of the reasons for the company s policy of "the
camp." We called it "the camp."
Hicke: Ras Tanura?
P. Oertley: Ras Tanura--the camp being reserved for foreigners. You know,
someone looking at it from afar would say, "Oh, those are the
Americans, dividing themselves or separating themselves from
the from the native population." But it grew up like that.
Eventually, it changed, in that as the Saudis became more
educated, they attained job levels in that staff level and on
up. And at that point, they too moved in--if they wanted to.
Frequently they did want to, because the housing was better
than what was available to them locally. But later on that
changed too, because the company provided the money for the
people to build their homes. In the beginning, this was free.
They just gave them the money: You build your home; here s the
money to do it. That s all sort of beside the point, except
that it does explain the school system and the living system.
Hicke: How many children were in your class?
385
P. Oertley: Oh, they weren t large, maybe twenty. That breakdown would be
mostly Americans, with some Europeans and Indians. I forgot
them. They were always children of the Indian doctors. Later
onbecause I taught in three different districts later on
the makeup of the class would be different. There would be
probably fewer Americans; certainly some Saudis; maybe
Pakistanis; Jordanians, certainly; some Indians; and some
Europeans. So that was a nice mixture.
Hicke: When did you go to Arabia?
P. Oertley: I went in 59. At that time, it was a pleasant shock to me to
realize that everything I wanted in the way of teaching, or
most of it, was there; and anything I needed that wasn t
there, I could order it. The money was really no problem
which is not the case in most teaching situations.
Hicke: You had all the supplies you wanted?
P. Oertley: Oh yes a well-stocked library. In many cases, you had to
wait for the supplies to come in. But being right there on
the water, and also being close to the desert, that gave
everybody including the children and their parents the
opportunity for learning about the sea, learning about the
ocean, learning about what was available in the way of plant
life and animal life in the desert. And then of course
there s this contact with the Bedouins. Near where we were,
the company had provided an area so that we could have a yacht
club; that s what everybody did every weekend. We learned a
lot about sea life there.
I remember when we first went to the beach in front of
where I lived; there were times of the year, in times of the
moon s cycle, when you could depend on going out and watching
the olive snails do their thing, which was amazing. It was a
circle, one right after the other; so obviously it had
something to do with mating. They have two antennae; they re
siphons, really. Well, no, just one siphon that sticks up,
but it looks like two little antennae. That was always up
when they were on the surface of the sand; as they went under
the sand and they do that if you approach- -everything would
disappear except that little siphon.
Hicke: A submarine.
P. Oertley: They had what is known as the Hobby Farm. That was an area in
an oasis-type setting where they had horses. Lots of people
had their horses there. The children, many of them, learned
to ride in that setting. There were very few aspects of life
386
there that were unpleasant. It got hot, but everything was
air-conditioned. And there were company buses free of
coursewhich took you to the other districts of Dhahran,
Abqaiq, and also to the local towns. Life was very agreeable,
Marriage and Move to Abqaiq
P. Oertley: Bob and I met and were married in Beirut in 66. We went
there on the company plane. I remember it was a medical
seminar that all the doctors were going to. So Bob said,
"Well, I m going to get married. Can Pat go with me?" So
that s the way it happened.
Hicke: Oh, great! So it was a business trip?
P. Oertley: Yes, so we got there. That was in 66. By then I had my own
apartment so he just moved in. Then we got better housinga
house on the beach. Four months later, he was transferred to
Abqaiq, which was sort of like being transferred to Calcutta,
you know the hell hole of--. At least that s the way I looked
at it from being there on the beach in Ras Tanura.
We went to Abqaiq, which had its own attractions. You
were more in the desert.
Hicke: That s south of Dhahran?
Oertley: Southwest.
P. Oertley: It was more in the desert and it was, of the three places, the
least desirable place to live. I think Aramco recognized
that, and they went out of their way to bend all the rules in
every way possible for anybody who lived there. So that was
nice. I can t remember anything that we did that would have
been bending the rules, but there was an atmosphere about it.
Hicke: You had to stop teaching school, right? You had to quit?
P. Oertley: I had to quit teaching on that basis as a contract employee.
I could be rehired the next day as a what they called a
casual, but that meant less salary, and they did that, as it
was explained to me, because as a contract person we had
received extra pay for the fact that we were in a foreign
country. We were also included in benefits of the yearly
transfer back and forth. Actually, it was two years when I
first went, but they changed it later to the annual vacation.
> :
387
Hicke:
P. Oertley:
When I married Bob I didn t get a certain amount of money that
could have covered their cost of some of those things. And I
was on an hourly basis, so the pay was less.
But, shortly after we were married, I remember they
wanted me to substitute for the art teacher; all that time I
was qualified to teach art, there was never an opening. She
went on vacation and I took her job in Ras Tanura doing that.
Then Bob was transferred so we went to Abqaiq.
Abqaiq didn t have an art teacher. So that was the first
time I had a whole program to myself; and that was
kindergarten through ninth, oh, everything. I remember that
since the woman before me had really no training, it was just
starting from the ground, working a program with the little
ones that hopefully would build each year in certain skills
that they would learn at one level. Drawing with kindergarten
children should be different from drawing with eighth graders;
but if the eighth graders don t have any skills, you have to
take that into consideration and go backwards.
I started out trying to have all the lower grades
established in certain skills and then carry it through. That
was a challenge, but again, money was no object. If I wanted
to have a program in weaving or a program for clay, I could
make out the list and give it to them. They would order it.
The only problem was time involved in waiting for it.
Plan ahead.
Plan ahead. That was a lot of fun. Oh, but then, like I told
you before, although we were there technically three years,
Bob was really only there a year and a half before he was
transferred to Dhahran; so he spent most of his time in
Dhahran and then he was home on the weekends in Abqaiq. We
went out to the desert a lot. That was fun.
The atmosphere of the place was different. For instance,
bowling was big, whereas in Ras Tanura people sailed; they
golfed. There was more of an academic atmosphere in Ras
Tanura because many of the employees were engineers. When I
got to Abqaiq, it was obvious from the children that perhaps
they didn t do much reading at home. That was because, I
felt, the educational backgrounds of some of the parents were
shorter than the ones in Ras Tanura. And I mention that
because it s an important factor in teachingvery important.
You have to know that you can depend on the parents
cooperation and also their understanding of homework and what
you do in class.
388
Hicke: Ras Tanura was a refinery. Abqaiq was an oil--?
P. Oertley: It was the producing part, which meant that you had a lot of
people there who went out and worked out on the wells. I m
not quite too sure on the aspects of production, but that s
really what they did; they produced. They were the ones that
got dirty, more so than the ones in Dhahran. Now, certainly
some of them went out far afield and there were technical
things that had required a great deal of education, but there
were fewer of them there.
Dhahran
P. Oertley: When Bob was transferred, we had to wait out a year and a half
for housing to develop in Dhahran. Everybody was on a
numbered scale according to the number of children you had,
your job points. Housing was available to you according to
your housing points. That was a big bone of contention for a
lot of women who had left the United States and left a home
that they owned, was in a nice neighborhood, and so forth.
For some of them, to go over to Arabia and not get the same
quality housing that they were used to right off the bat was
traumatic. Also, I m sure, it was exacerbated by the fact
that they couldn t work unless they could get one of these
jobs in teaching. They didn t even have nursing jobs for the
substitutes at the very beginning. Later on they did; but it
was only teaching or nursing. They weren t in the offices
yet. They came to that later, but mostly they were not in the
offices .
Supposing they had been used to working in some field and
there was not going to be an opening for them, that was the
real blow. They became housewives: they lost status; and then
they didn t have their housing, which is also a status feature
for many women. I could see that. But I was always
different, because I didn t come from a background like that;
my adult life was never like that. So, that was really a
factor in this business of moving to Dhahran. Because it was
the early seventies, the oil embargo had come in; that meant
more money into the Kingdom, and they were hiring. They had
lots of people coming in. It was a year and a half after Bob
was transferred before we got a house; so we moved.
I decided that was a good time to retire from teaching.
But there was an opening for the art job. Oh! No, I didn t
retire right away, because they wanted me to commute twice a
V -
389
week back to Abqaiq and do the teaching there. They would just
redo their schedules so that I could have all the art classes
on Tuesdays and Thursdays. Then they would fit all their
other things in around that,
again, that was sort of fun.
back and forth. When I went
everybody in those two days.
I did that for a while, and
You know, they had a taxi go
I d stay overnight and teach
That was it. They had the days
backed so that I could come, stay overnight in their
guesthouse, teach the next day, and then go back. I did that
for a couple of years, I think.
Hicke: They must have thought that was a valuable program.
P. Oertley: They didn t have to look around for somebody else. It was
already established. I knew the situation. I also liked the
principal very much.
Hicke: Who was that?
P. Oertley: His name was Bill Dickerson. He was one who was interested in
traveling a great deal. In Aramco, in the three different
districts, they had what they called the Aramco Natural
History Society or something. It was an organization that
employees had formed to make it easier for them to travel to
different places, because every time there was a long weekend,
people would go. In a situation like that you could go to
Egypt, you could go to Syria, you could go to Afghanistan-
just all over. And we did.
Well, in Abqaiq Bill Dickerson, the principal, was the
big cheese in the Natural History Association; and he led some
fantastic trips. One of the trips he led was to Oman.
[speaking to R. Oertley] And you didn t get to go for some
reason. I guess you couldn t get the time off, but I went.
That was really one of the most interesting times in all the
trips we took, although it was only three days. As with the
travel agent, one who knows their stuffwhich Bill did by
this timeeverything was organized right down to the minutes
if you wanted it and he had it really organized. Frequently
the first thing you did on all of these things was to make
sure there was enough gear on the airplane.
So we moved to Dhahran and I did that commuting. At one
point, my mother died. I went home because my mother was
dying. It may have been when my father diedthey died about
a year and a half between each other- -but at one point I
decided, "Well, this is a good time to quit." So I quit. By
this time Bill Dickerson was the principal of the Dhahran
390
Hicke:
P. Oertley:
Hicke:
P. Oertley:
Oertley:
P. Oertley:
Oertley:
P. Oertley:
Hicke:
P. Oertley:
school. He called me, wanting me to do the art teaching
there. I went for three days and I decided that I didn t want
to do it anymore. In all this, I didn t have any time for my
own work; so I quit and haven t looked back. I ve just been
doing my own work since.
I m wondering: as we go along, do you have any observations
about the growth of the medical facilities and the other
people that were involved. Did you know the Gelpis and the
Taylors and Nichols?
Most of them were in Dhahran. Since we were first in Ras
Tanura and then in Abqaiq, we would see them at parties.
Social life was very important throughout all of the
districts lots of socializing. We d see them at parties.
But Bob and I don t play tennis; we don t play golf; and we
don t sail. Well, actually he did sail when we were in Ras
Tanura. We re not big organized-recreational people, and most
of the things that we do are in very small groups. For
instance, we would tend to be going out into the desert for
overnight camping trips, and none of those people did that.
It s really interesting: it seems like most of the people in
the Medical Department played tennis.
[laughter] This is a new trend we re finding here.
Let s take that back, because Roger Nichols was a great going-
out-in-the desert person. Actually, that s rare; he was a
rare one.
Bob, wouldn t you say that s true?
[at some distance] I wasn t listening to that.
Most of the people in the Medical Department played tennis?
Oh, yes.
Not golf. Tennis. So, curious.
Did you go with the Nichols on any of these trips out in the
desert?
Oh, yes. It was fun. Roger and Elinor were marvelous to be
with. Roger always had things well planned. Elinor is a very
good cook. She s also a good planner in a lot of other
aspects of it. But I m just thinking of some of the meals
that we had.
391
Hicke: On the camping trips?
P. Oertley: Yes. And at their home, too. I m trying to remember if Roger
played tennis.
Oertley: Oh, yes!
P. Oertley: Yes, they played tennis.
Oertley: Yes, Roger was an avid tennis player.
P. Oertley: You must remember this is corporate life, too.
Dhahran Medical Facilities and Other Services
Hicke: Oh, yes, sure. Did you yourself use the medical facilities?
P. Oertley: Oh, sure. Yes.
Hicke: Just looking at it from a patient s--
P. Oertley: From a patient point of view? Oh, I thought it was great.
Let s see. My feeling was that 1 was happy with the services
I got, whether it was in the hospital, in the clinic, or in
the dental office. I thought they were well set up. I always
felt that the treatment I received must have been good because
it worked, [chuckles]
We never had long waiting lines. There was that. You
could request the doctor that you wanted to see. It wasn t
always that way: if you went in saying, "I have a terrible
cold; I want to see somebody," well, you took whoever was on
call. It was obvious in the beginning that Americans wanted
to see Americans, but I think as time wore on that they
realized that the other nationality doctors were trained.
I had each eyeball operated on, not at the same time. In
that case--
Hicke: In Dhahran?
P. Oertley: In Dhahran. Two different doctors operated on me. They were
both Americans. But I also had other surgery, and that was
performed by a Jordanian. Many Jordanians are Palestinians
who need a passport and they can always get a Jordanian
392
Hicke:
passport. But they consider themselves Palestinians. And he
was a lovely man.
Okay. I m going to change this.
P. Oertley: What a shock it was for returning Americans to discover that
health care in the U.S. was a bit dif ferent--it s run like a
business. It s hard for people coming back from a situation
like that to realize that a clinic is not available at their
beck and call as it was there.
Hicke:
I expect in that case, and in other cases too, that services
weren t available.
P. Oertley: That s right.
Hicke:
Another aspect of life there that was interesting from a
woman s--man s toopoint of view was that the other services
that they offered us were plentiful. Grocery stores: in the
beginning, there were no places to buy anything, so they had
to build grocery stores. That s the fascinating thing about
the history of the company, how they had to become experts in
all these other things, not just oil. They had to hire people
to do this, to build a this, that, and the other. They needed
a place for the women to shop once the families came over, and
they built grocery stores.
When I first arrived in Ras Tanura, as I remember it, it
was a fairly small store but certainly adequate. The only
thing that you had to remember was that you couldn t always
find what you wanted because of, again, this business of
ordering and waiting for it. Also, you went to buy flour; you
didn t go to buy Gold Medal flour. And you went to buy frozen
peas, not frozen tiny deluxe. You just hoped for that, but
you had to be flexible.
Some of the stories of the early times, from a cooking
standpoint, were really interesting. We all became experts at
debugging flour, substituting various things for things that
they didn t have, and sharing stuff for birthday cakes and
that sort of thing. But by the time we left, we had
supermarkets. We also had something called a pork store.
Just to get it in the record, you stayed until 82. Is that
right?
P. Oertley: January of 82 we left.
393
They had what was known as the pork store, which was a
set-aside room in the supermarket that non-Moslems could enter
to buy their pork products. It was well documented what you
bought, because they recognized the opportunity for people to
buy huge amounts and give them away or sell them, which I m
sure some would do. So we had pork store. But I understand
they don t have that now. I don t know.
Before, when I first went there, what was available was
on the counter along with everything else. And they did have
bacon and pork products. But that was because the people
using those stores in the beginning were always non-Moslems.
It was only after this [Moslem] trained personnel became
higher up in the company and then they were allowed all the
other privileges, you might say, of the higher ups, could they
come into the stores; and here they are confronted with pork
which of course they re forbidden to eat. That s when that
was taken out of the general store area and we had our own
little pork store.
Adjusting to Cultural Differences
Hicke: What about liquor? You couldn t buy any wine.
P. Oertley: No, you couldn t buy any. People did make some. We made
wine. I will admit that about the first month we were in
Dhahran, someone offered us a case of scotch or gin, and we
bought a case of scotch and a case of gin. Someone had
smuggled it in somehow. Friends somehow knew that it was
there, and so they were asking their friends if they wanted
some. So we had a case of scotch and a case of gin, and that
lasted us the whole time, because we didn t drink that in the
house. We drank my wine. Now, when guests came in, if they
wanted gin or scotch, we could offer it to them- -which is very
nice. Tanqueray gin, and black-label scotch- -Johnny Walker.
The wine I made was of raisins. I also sometimes used
frozen blueberries. There was a simple formula: so many boxes
of raisins or bags of frozen blueberries, so much sugar, so
much yeast, and so much water. You dumped it all together. I
used an old acid jar, which was a big, five-gallon glass jar
that had a small top.
Hicke: Like an amphora shape?
P. Oertley: Yes.
394
Oertley: Exactly.
P. Oertley: Except it had a straight bottom. And when I poured all that
stuff in it, then I just put aluminum foil over the top, and
poked a hole in it. That was our wine.
That was not the appropriate way to make wine. You re
supposed to have airlock and all the other, but it worked.
The wine was delicious. It tasted a little bit like sherry.
We never had enough left over so that I could set some bottles
aside and let it age.
Hicke: [laughter] Any other things that you particularly missed?
P. Oertley: I always felt like I wasn t missing much of anything. I felt
that the bonuses were so much greater than any small thing I
might miss. We had a very good life over there. Some women,
especially the ones who came in later, would complain about so
many things. I think it must be because many of those women
were the ones who had been raised to think they should have a
job right away when they got out of college; they should be
able to do many, many things because they were women.
You had to forget that you were a woman. You had to
forget that you were a woman in the fact that if you wanted to
live a life there that was satisfying and productive, you just
had to figure out how to do it. It was all there. There were
some things you were not allowed to do. One was you were not
allowed to drive a car outside of camp. You didn t need to;
there were taxis, there were buses, and men with cars--your
husband or your friends or whatever to drive you around.
Now, some women took that as a personal affront to their
God-given right to drive a car anywhere they wanted to. I
never felt that. Actually, I never had a car until we came
here. All the time I was a young adult, I wasn t in a place
where I needed a car. I don t think I learned to drive until
I was twenty-one. Not being able to drive outside was the
biggest sore point with many women, and I ve never really
understood it because you didn t need that; you could do
everything you wanted to do with a taxi, with a bus, or with
your husband or with your boyfriend. For me, that wasn t a
lack of freedom.
Some of the women felt that the fact that they couldn t
wear what they wanted was a personal affront to their freedom.
I never felt that, because I think I was raised to know that
you dress according to situation. I mean, even now you dress
according to the situation: I guess the best description of
- V
395
Hicke:
knowing what to wear, what not to wear, was when not wearing a
bra, burning the bras, was popular. At that time, the company
was expanding some and they brought in a lot of European
secretaries, mostly from England. Well, I m exaggerating of
course, but by the time you saw them, it was a t-shirt with no
bra and a very short skirt. That s in a traditional setting
where women are completely covered; it s nonsensical. It s
not only bad taste, it s asking for it, reallyat least
that s the interpretation the young male would have.
So, as far as I was concerned, I was happy to wear long
pants, which is what I wore, and long-sleeved shirts. It made
so much sense in the hot weather. We could go into the local
towns and buy Indian outfits; that s real thin cotton, they re
colorful, and they re batik or they re tie-dyed. I had quite
a colorful wardrobe. I liked that. And I always felt too
that I was, as a woman, really safe around Saudis, because
that s the way they were trained. So none of that ever
bothered me.
When people ask me today, "Oh, what was it like to be a
woman in Arabia?" it gets a little tedious trying to explain
it to them; many people don t understand. I think it s simply
because you have a different mindsetor I had a different
mindset and it s that business of, in some cultures you don t
do this, in other cultures you can t do that. It s like going
to Italy and women wearing shorts and sleeveless shirts in the
cathedrals. They ask you not do it; and yet some do. And I
often wonder: didn t they have any home training? Didn t
anyone ever say, well, that s just not done here.
If you go to a Japanese home where they take their shoes off,
you take your shoes off when you go in.
P. Oertley: Okay, it s that same mindset. Some didn t get it.
At
I liked the interactions that I had with the Saudis,
one point, I was in a group who used to go out into the
villages once a week for socializing with the Saudi women. I
don t know how this got started, but I think it was the wife
of the head of Industrial Relations.
Hicke: Who was that?
P. Oertley: I can t remember offhand. I can see her face, but I can t
remember her name. I think she started it and she asked a
group of us if we d like to go. Somehow, her husband, through
one of his employees, had arranged for us to go to a Saudi
home. The women were expecting us. We just simply spent a
396
Hicke:
P. Oertley:
Hicke ;
few hours there as the Saudi women do when they go visit other
Saudi women. They lay out a table that you wouldn t believe.
It s tea and it s soft drinks --lemonade, iced tea, fruit
drinks, all sorts of things to drink- -nothing alcoholic, of
course. Then the table is spread with sweet stuffs and other
stuffs like hummus, babaganoush, and stuffed squash--all the
Arab dishes. It was a feast.
We d usually go early in the morning- -we 11, ten o clock- -
and come home a little after lunch, stuffed. They wore their
finest; we saw them, of course, without the black abba on and
no veil. Many of them were beautiful young women. Then we
reciprocated: they would also come to our house.
Did you have to have an interpreter to talk?
Well, most of us had taken Arabic enough so that we could do
some talking. There were usually, as I recall, one or two of
the Palestinian women who went with us. They were fluent in
both languages. With the Saudi women, most of them weren t
educated and when you tried talking in another language to
someone whose language that is but who is fairly uneducated,
they don t slow down. They don t realize the difficulties
that you re having with trying to speak their language. It
was not always easy, and not always successful, but it was a
great contact.
Then, they would also come to our houses. We didn t have
the tables spread as well as they did. We were supposed to
make sure that it was at a time when there weren t any men
around. They arrived, always driven in a car by a driver; all
families have drivers or brothers or somebody who s supposed
to do this because the women of higher economic status were
attended to in this manner, if they have any money at all--and
most of them at that level had very nice houses.
So they would come and they were driven in cars, usually
two or three women in a car, all draped in black. They d come
in and throw off this black stuff. Gosh, there was one woman
who was so beautiful, and she wore a hot pants outfit. Many
of these outfits were European and expensive. I can remember
thinking: "Oh! What they would give for her in Hollywood."
But they wanted to talk about clothes, lipstick, you know,
stuff like that. You could talk about family and stuff, but
they were really interested in what they saw of American life
on television.
Did you have to refute some of that, tell them that isn t
exactly how we live?
397
P. Oertley: Sort of. They never really came out with questions on a basis
like that. They d ask about movie stars. They d want to talk
about clothing or where they had things made, things of that
nature. You didn t have an intellectual conversation or
something meatycertainly because none of us had that
facility in the language, so it was impossible.
Hicke: What kind of education had they had?
P. Oertley: Not much. Some of them had been a little way into high
school. I remember the one with the hot pants outfit said she
was taking private lessons in something; but she told us it
was from a man, and I just couldn t imagine how that could be.
But maybe it was.
We did that, off and on, over a couple of years, I think.
They enjoyed it; we enjoyed it. They always thought it was
funny when they came into a house that had Arabic stuffyou
know, that half moon shape over the door there [points to her
own doorway] which I think originally had been over a gate
somewhere. They thought our interest in their carved wood
Arab chest, things of that sort, they always thought that was
funny .
Hicke: They had it in their houses, didn t they? Or did they? Rugs?
P. Oertley: Well, not really. Rugs, yes; but rugs are different. Rugs
cost money and rugs are accepted in Western decor as well.
But most of the houses had what you could buy in the local
stores; it was usually European. There might have been a lot
of plastic on it, as well, some in very good taste, some not.
But it was what was available locally. Towards the end too,
they were getting married in white dresses.
In one of the first teas we went to- -we called them teas,
but it was in the morning- -they got in a group of women to
dance for us and play musical instruments like they do at a
wedding. That was really interesting. Many of the Saudi
women there wore the outfits that they d wear at a wedding,
and they danced. And then they wanted us to dance with them,
stuff like that.
Oertley: I rode a bicycle back and forth to work at the hospital. I
knew Pat was hosting this women s group one time. When I got
home, Pat said, "You re just five minutes too late. You
should have been here just a little bit earlier today. They
were really dressed to the hilt today." All of the drivers
had come for them, knowing that this was the time that men
come home and the women should be gone.
398
Hicke: You would have been kept out of the house, if you had come
home, wouldn t you?
Oertley: Of course. She wasn t chastising me for being late; it was a
matter of "You should have been here, but you couldn t."
Hicke: Would they allow you to take pictures of them?
P. Oertley: I don t think that ever occurred to us. Perhaps they would
have, I don t know.
Hicke: Interesting.
What about dishes? Did they have something special in
the way of china?
P. Oertley: Oh! China. Again, that was locally purchased and probably
European. They didn t have a history of locally made clay or
glass. There were some potters, but that was very
utilitarian. The pots had been made originally to hold water
and oil, things of that sort.
Hicke: Did they use the copper coffee pots and things like that that
are so beautiful?
P. Oertley: They use those on the desert.
Hicke: And the trays?
P. Oertley: On the desert mostly.
I think now it s different. I think they ve reawakened
the Arab pride and they too would want to use the motifs like
we used in our homes. They probably recognized the worth of
it simply because we began collecting these things and using
them. Now there are museums in the country that show these
things off, and some of them are very beautiful. The museum
in Riyadh is especially well done.
Leaving Saudi Arabia
Hicke:
Before it gets too late, let me ask about why you decided to
leave Arabia.
P. Oertley: Oh, I felt Bob was working too hard. And I thought his temper
was getting short.
399
Hicke: [chuckles]
P. Oertley: You know, you re going to retire at some point, so why not
now? So we did. It was a good time.
Hicke: And this was 1982.
P. Oertley: Yes. January.
Hicke: So what did you decide to do?
P. Oertley: Well, we already had the house built, so we knew we were
coming here.
Hicke: Tell me about that. Go back to how you found it.
P. Oertley: [speaking to R. Oertley] In 76, you were going to a rabies
conference in Portland, Oregon. We decided that it was time
for us to look around in the northwest. So we drove down the
Pacific Coast. I wanted to see Coos Bay, because it was on
the water, and I liked the sound of the name. We stopped at
Coos Bay. It was like twenty-five years in the past. It was
not attractive; besides that, they had all of this yellow
pollution in the water from the mills. So we kept on going.
Bob wanted to see Klamath Falls, because in the army, he
had a buddy who told him about geothermal energy that they
were using in Klamath Falls. We got there, and again, it was
like twenty-five years agoalmost a time warp for both of
those places. We stayed overnight somewhere. Then we drove
up through south of here and it was very attractive.
Actually, this was in February. We stopped at Sun River to
stay overnight, because we had some friends who had places
here: for instance, the Jungers had a place here; and the
company pilot, whose name I don t remember, Lundquist or
Lundgren or something like. They had a place. And she
especially had shown me pictures of this, that, and the other.
We knew that there was a nice lodge, so we stayed overnight at
the lodge and had dinner. It was great.
On the way out, we passed a sign that said "Sales
Pavilion." Bob said, "Well, why don t we just stop?" So we
stopped. A woman took us all around; she took us up here and
she showed us this lot, so we bought it.
Hicke: Right then and there?
P. Oertley: Yes. Yes, right then and there.
400
Hicke: Good for you.
Oertley: Incidentally, the whole ring here was bare of houses.
P. Oertley: This was the end; and now we re in the middle. There was
nothing north of us. She had a plane. After we did this, she
took us up in her plane and all over. You could see the roofs
and the trees and the snow. It was really beautiful. That
was in 76. In 79, I guess, we decided to start building.
And all this was from a distance. Bob came back at one point
to see how things were going. Good thing he did, because they
didn t have the windows up there [pointing to windows], so we
had to remind them that they should have put windows up there.
We made some changes and we put in some skylights. That was
necessary. We moved in March of "82.
Hicke: And did you retire pretty much completely from practicing
medicine?
Oertley: Completely. I ve not done anything medically since--
P. Oertley: You did some consulting.
Oertley: Well, yes, but I mean the hands-on kind of playing doctor.
P. Oertley: But you did some consulting and you were invited back to
Arabia for a conference with the Saudi government. It was
concerned with your public health program.
Oertley: The last couple of years that I was there--! mean when we were
living there--! began to go in to see the Minister of Health,
because there were certain things that needed to be done in
the matter of malaria control and Schistosomiasis and things
of this sort. We would treat patients until you re blue in
the face, but if you aren t doing something to prevent some of
these things-- I even had somebody come over from CDC, Center
for Disease Control, to accompany me one time.
Later on the Minister of Health took all this seriously.
I even encouraged him to go to meetings outside the country:
"Go to something in Egypt sometime, or London. Your
government can afford it." I know he did. But I was invited
back at one point to deliver a paper on something relevant to
our health at a meeting. I said, "Well, look, I can t do it
in Arabic." They said, "No, no, no. We will have
translators. So please come." I went and it was great. It
was marvelous, because it was sort of like having planted a
seed that you didn t know if it would grow or not. And it had
401
grown. And he wanted me to know that this was growing and he
didn t just sit on his haunches and think about it.
Hicke: So you were responsible for that development.
Oertley: Yes. It was nice that the seed had fallen on fertile ground.
Hicke: Yes, that s true. This was 1988, I think you said, that you
went back.
Oertley: Yes, something like that.
Hicke: [to P. Oertley] And did you go back with him?
P. Oertley: Yes! That was marvelous. I like to explore on my own.
Although there were other women in this group of us that went,
all of the women were there for work except me and the wife of
another physician. I was real happy that they were in one
place and we were in another [chuckling] because I could go
and do my thing.
So I would go out in the morning and get a taxi. I knew
that we were going to be in Riyadh and that I would have to
dress very appropriately, so I had a long trench coat and
fairly long skirt. But I didn t cover my head. I would go
out in the morning and get a taxi. I knew where I wanted to
go. I thought of the old souk. I had my camera with me, but
I knew too that it was more difficult to take pictures there
than it would have been, say, at Dhahran or Abqaiq, because
they were used to Americans there. So it was a very small
camera and I just sort of surreptitiously took a shot here and
there. But I had a marvelous time until they moved Bob and me
from where we were to where everybody else was. That sort of
curtailed my ability to move around.
Hicke: Cramped your style! Well, I think we re just about coming up
on the end. Is there anything more that you want to include,
either of you?
Oertley: No, I think not.
P. Oertley: I will say this: I think we both had culture shock when we
came back here culture shock in that it was very difficult to
find anyone to talk with who had a world view. Even now, at
times, it s amazing how many people can t see beyond the
shores of the United States. I think it s a real mistake,
because we re all bound up in it; what happens elsewhere does
affect us.
402
ff
P. Oertley: I wanted to say that I think it is a mistake for people not to
realize that what happens elsewhere in the world affects us,
and vice-versa. But many of the people that we talk with
still don t recognize that. I know that we were very aware of
it, because we had lived outside of the United States. So
often, even those who do just a little traveling don t
recognize that.
I think it s changing a bit, certainly, because more and
more people are getting outside of what they know. You can t
stay in the same place forever and think it s going to be like
that forever. It s not. We need to recognize that although
we are all the same, we are still all different, and you have
to respect the differences. Part of the problem, I m sure,
with what s going on in the Middle East is what s always been
the problem with this business of respecting differences
between two different tribes, two different cultures, or two
different religions, whatever it is.
That s what was this "culture shock" for us when we came
back. We were somewhat aware of that before, because when we
went home, on vacation- -
Oertley: This was our rehab.
P. Oertley: --here, to the United States, frequently the families were
very happy to see us. For about thirty minutes they want to
hear about your life.
Hicke: [laughter]
P. Oertley: So we knew there was not a big interest in the Middle East.
Oertley: But you know, I don t think people can be blamed for those
attitudes. The traveling is what changed it. We are pleased
with where we ve been and intrigued by the world out there,
outside of America. Sometimes you get involved in a
conversation with someone, and not necessarily about travel,
but their attitude about particular peoples or cultures or
places. You sort of--
P. Oertley: You recognize a dead end.
Oertley: Yes. And you realize that I don t really want to discuss this
with this person because I m not going to change his mind, and
he won t change mine. It s better to change to subject.
V V
403
Hicke: Yes. We can agree on the weather or whatever.
Oertley: For instance, it s very pleasant to communicate with you.
You re open and like a sponge, soaking it up naturally and
taking in the attitudes that we have. I can see it.
P. Oertley: Oh! There s one very important thing I forgot to mention. As
a single woman going to Arabia, when I was first there I
recognized that most of the people in power that I had to deal
with were men; and they did not recognize women in the company
same as men in the company. That changed, fast.
Another thing changed fast too, and I remember this
vividly. We talked about those olive snails during the full
moon or whatever it was, when they did their mating ritual of
going in circles; you never saw tar in the water or on the
sand at that time. Later, the tar began to come in; it was
polluting the beaches. I could see the difference in the fact
that I didn t see those snails there any more. We were at a
cocktail party one night. I remember sitting with whose-name-
I-won t-mention. And I can remember saying to him, "You know,
that tar and the oil that comes up on the beaches of Ras
Tanura is terrible. It s really a problem." He replied, "Oh,
it s no problem." And this was a man who really could have
done something about it. So that was his attitude: no
problem, not going to do anything about it. That changed fast
too because of the fact that worldwide it became such a
problem in the business of debunking the--
Oertley: De-ballasting the ships. They can t cross back empty. They
load their ships with seawater because they are not seaworthy
unless they have proper ballasting. But then they d get into
the Gulf and de-ballast. And now here were these globs of oil
which were--
Hicke: That came out with the seawater they dumped. Interesting.
P. Oertley: I remember that conversation to this day. I kept telling him
how the sea life in the region was becoming affected. You
could see on the coral--that whole area s just filled with
coral--you could see the deposits on the coral reefs. I was
telling him about it. He didn t exactly say, "You don t know
what you re talking about. You re only a woman."
Hicke: [laughing] But you felt it.
P. Oertley: Yes. And it changed. It finally changed. He was still there
at the time. I often wondered how it came about, but it
changed; that was the important thing.
404
Hicke:
P. Oertley:
Hicke:
P. Gertley;
Oertley:
P. Oertley:
Hicke:
P. Oertley:
Hicke:
P. Oertley:
Hicke:
Oertley:
P. Oertley:
How did the status of women change? Because they hired some
women?
The status of women changed because the men that they hired
changed, and their wives were influential. It was somewhat a
generational evolution.
It was happening everywhere.
Yes.
The Saudi men were also going abroad a great deal. They began
to bring back things or take their wives with them. Once that
happened, the exposure is like an ignition. The thing now is
started. He also wants his wife to be more like those he
finds outside the area. After all, she is his wife and--
--the mother of his children and all of that,
did change, nicely.
Those things
[To R. Oertley] So you re talking about the status of Saudi
women, but you [P. Oertley] were talking about the status of
women in the company, weren t you? At first?
At first.
So both situations changed.
As they did everywhere else in the world.
Well, let me just ask you: this is probably a silly question
in view of all we ve discussed, but if you had it to do all
over again, would you go to Aramco?
Oh, sure.
Of course.
Aramco Management Support
Hicke: Maybe you can tell me something about why, and why you
Aramcons are unusual.
Oertley: I was impressed by the fact that Aramco was aware of
standards, for instance, in medical care. They knew what they
needed, that it took medical people to bring in the ideas of
A05
"Well, this is what needs to be done." And one of the things
that I enjoyed immensely was the weekly management meeting. I
began to go early on to them, on Friday I think it was. At
this point, I can t remember precisely. I just sat and
listened there because I was intrigued by what they were
doing. It was only an hour or so long. Because I was clinic
manager I was invited; but I didn t have to come. They needed
a little input on the health side of things for whatever they
were doing. I never encountered any objection to anything
that I might want to put in with; and I thought, boy, these
fellows aren t just oil-oriented. I mean, even this matter
that we talked about, the de-ballasting of the ships. That
wasn t anything in health, but they were discussing those
kinds of things. From time to time, some of the people would
bring these kinds of things up because it was becoming kind of
an issue in other realms.
I was so impressed by the quality of men, the officers.
They had selected among themselves the right ones to be making
the decisions. They listened to anybody about everything,
even if it wasn t "How many barrels of oil should we upgrade
to?" and so forth; it had to do with our presence in that
country as much as anything else. Because they were depending
even on Saudis help in that area.
I could make a suggestion or at least highlight a problem
and there was interest. They d say, "Well, next week s
sessioncan you come back with some potential answers to
that? Are there answers? Is there anything we can do that s
within limits of our means?"--not just some fly-by-night
scheme .
Hicke:
Oertley:
I was impressed by the intelligence of Aramco management
in a broader sphere than just producing and delivering oil.
They were very interested in not despoiling Saudi Arabia or
the Gulf. At the same time, they were interested when I would
tell them about even an epidemic of whatever was going on, and
that we were stemming it. They d ask: "How does that arrive
here? Where does it come from?" If I didn t volunteer on the
weekly meeting, they d urge: "Okay, doc, tell us what s new in
medicine?" It was marvelous.
I think that s a good note to end on, so I d like to thank you
both very, very much for the great interviews.
Well, we thank you.
Transcriber: Lisa Vasquez
Final Typist: Shana Chen
1691 8.=,
U.C.BERKELEY LIBRARIES
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