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Full text of "Health and disease in Saudi Arabia : oral history transcript : the Aramco experience, 1940s-1990s / 1998"

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"! 



118a 



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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. 




o 

CO 

o 

C 
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a 



cd 

u 

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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 



BIOGRAPHICAL INFORMATION 
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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? 



182 



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 



183 



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 



184 



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? 



195 

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. 



196 



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? 



197 



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 



198 

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 



199 



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 



200 



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. 



202 



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. 



204 



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 



206 



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 



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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 litt