The people at Orbis asked me again to go to Outer Mongolia in 2004. I agreed and decided to do a side trip to China. The plane trip was arduous. It took me almost 24 hours. I flew to Tokyo, then Beijing and then on to Ulan Bator, which is the capital city of Outer Mongolia. More than half the population lives in the city. Every time there is a drought or some other natural disaster, the people stop being herders and come to the city. The interesting thing is that for every person in the country, there are seven animals. The city was falling down and what buildings there were of typical Russian design and construction.
Normally, we get a free day on our arrival to get over jet lag. Our group did not. I started seeing patients the next morning. It seems everybody I saw had optic atrophy. Some of these patients had X-rays and a few had a CT. There was only one CT in the entire country. I’m not sure they knew what to do with it.
I saw one lady with optic atrophy and I was shown her CT that was read as normal. She had a huge pituitary tumor that even I could see. I had some free time late one afternoon, so I went to a museum where there was a dinosaur collection. Most of the dinosaurs that we have in museums in the world today were excavated from the Flaming Cliffs. We excavated them and took the best of them back during the '20s and '30s, and they are on display at the Natural History Museum in New York.
In the museum in Ulan Bator, there was one very small example and it was poorly displayed. Perhaps it was the right thing to do by bringing them to the U.S., where somebody would do a good job of preserving them.
It isn’t that we left them any dinosaur bones, since some are still being found to this day. They don’t have the money to spend, which was obvious in the condition of the rest of the museum.
Looking for Golf Course
One afternoon, I was free, so I rented a driver and a car to take me to the one and only golf course. It was a long drive and I thought he was lost and I was just taking a nice ride. We finally arrived. The course was brown and not green. There were no flags to identify the holes, if there were any holes. Their idea of a caddie was to rent a small Mongolian pony to carry your bag.
Unfortunately, there were no bag tags to bring home for our collection. They did have overnight accommodations. They had Gerds. These are round tents on a platform that they take with them when they move their herds to a new grazing area. The caddie house was about the size of a small outhouse.
I did some shopping at the only department store and was able to get cashmere sweaters for all.
The Orbis surgical plane did not come for this trip, so all the surgery was done at the local hospital. It was very difficult for the retinal and corneal surgeons. The equipment was primitive.
The last night there, we were taken way out of town where a resort had been built. It was set off by itself and was quite lovely by any standards. The next morning, I got the very early plane to Beijing. I was amazed at the changes. There were now five ring roads around the city. I saw cars all over and no bicycles.
I had a room at a Holiday Inn. It was magnificent and adorned in marble and as modern as any grand hotel in the States. This place even came with a concierge. I then decided to make the most of my day and went to revisit the Forbidden City. This time, I did not want a guide. I knew the buildings I wanted to see. Typically, the guide rushes you past these and runs you down the meridian line through the center.
I then went back to the hotel and asked the concierge to get me a cab to take me to a golf course so that I can get a bag tag. He arranged it. However, it turned out to be a driving range. I came back and discussed the matter with him. He was very apologetic. He got another driver, and I explained to him where the two golf clubs were. He wanted to be sure, so he gave me one of his cell phones and set it up so I would get him by just pushing a button.
I found the golf clubs -- they were right next to each other -- and they were green and beautiful. One of the clubhouses was all marble. They had all the amenities except bag tags. I settled for golf shirts for everyone. They were so modern that they had sold off the peripheral property to sell condos to their members like some clubs do today in the States.
That evening, I had Dr. Lao and her helper to dinner. It was marvelous seeing her again. We even used my cell phone so she could talk to Sally. The next day, I went to the hospital to give my talk and get my honorary degree.
The following day, I went on my quest for a porcelain statue that Sara and I wanted. For years, I received a catalog from a London art dealer. One particular object interested us. It was very famous and had been smuggled out of China years ago. The dealer was asking $4 million. It was a tang camel with four musicians seated on it. I took myself down to Liulichang Street, which was the street of the artists. We visited it during our first trip in 1979.
I got a cab and arrived at a very broken-down street. I went into the first shop, which was the one that had great statues during our last trip. He had large ceramic vessels in the shape of a tang dog or a Panda. We wanted to have them for our patio, but shipping was a problem. This time, I went into the shop and saw nothing I wanted. It had turned into a cheap curio shop.
I saw a young man who seemed to be in charge and went over to him. I showed him the picture of the item I wanted. He wasn’t interested. He told me that the only thing he had was what I saw.
He just started to go away and I remembered something from our first trip. I told him about an older man who had owned the shop and told us about a son who was in an Ivy League school. I asked him about the old man and was he that son. His face brightened up. He said his father had died and the son that went to the States was his older brother.
All of a sudden, we were like lost relatives. The next thing he did was to ask to see my picture again. He said he would try to get a copy for me. He was good to his word. It arrived at the house a few months later in perfect condition. It stands in front of the fireplace in our living room to this day. It’s that Walsh charm again.
The next morning, I was up at the crack of dawn again in order to catch the early plane to Tokyo so I could make my connection to the States. I was able to make it and spent my two hours in the duty-free store, which was filled with electronic gadgets. I didn’t buy any since the prices were outrageous and at least one of them I had priced at Radio Shack in Stamford.
I got on my plane and it was a tourist seat, but at least it was on an aisle. As I mentioned before, we were not allowed to pay for an upgrade. As soon as we took off, the Japanese gentleman in the seat in front of me put his seat all the way back. I didn’t say anything since he was within his rights, but he could have left me some room.
After a few hours of a 14-hour flight, I had to go to the bathroom. It was difficult to get up with his seat way back and the arm of an aisle seat which did not go up. As I struggled to get up, I had to pull on the top of his seat. It woke him up and he complained to me. I explained to him the problem I had getting up. His answer was that all of us Americans always want our own way.
I explained to him we didn’t always get what we wanted. I told him we did not want Pearl Harbor, but we didn’t mind Hiroshima and Nagasaki. He did not seem to like my sympathetic explanation. God put these type of people on Earth to amuse me. I tried my best Walsh charm, but I was never good at languages.
Good Samaritan
The rest of the trip seemed to go smoothly until about two hours out of Kennedy. There was a call for a doctor. I know better than rise to that call since I found out the Good Samaritan rule does not work for doctors. I don’t put MD on my passport or on my plane reservation since it never gets me anything. This time, though, they found me.
I think it must have been all the medical papers I had to fill out in Tokyo because of some epidemic that was going around. I also had learned a few years ago that if you are on most European airlines and don’t step up, you can go to jail. I didn’t know about Northwest Orient airline.
I went to see this huge man in business class. He was in respiratory distress and in obvious failure. They had a stethoscope and I listened to his chest. Even I knew he was in failure. I had no Lazics and no leeches to get rid of some of his blood volume. I remembered something I had learned when I was an intern.
In those days, we gave these people an IV of Mannitol. However, it took perhaps an hour to work. In the meantime, we cut down the blood volume to his heart by pooling the blood into his limbs. I used the cuff from the blood-pressure instrument they had on board and then I used my tie for another limb and got another tie from the pilot.
The patient made it to Kennedy. Then the kids from the local emergency group came on board with their belts filled with all sorts of instruments while they were talking wildly on their cell phones. While they were putting the electrodes for the EKG on the man, I stepped aside. There were some comments that they made as they took off the ties. I did not try to explain and did not ask for my tie back.
I finally got off the plane and got my luggage. Sara, Sally and a cold can of Tab awaited me. I was full of stories, but I was glad to get home and get a bath. However, I always enjoyed these trips and liked to see how the rest of the world solved their medical problems.
2004 Egypt and Ethiopia
I had another call from Orbis and this time it was Ethiopia, where they wanted me to go. Orbis had a long relationship with that country, and I agreed to go but I decided to take a side trip to Egypt.
Sara got me books and maps so I could plan my trip and get the most out of my time. Sally suggested I start to do some walking around our compound to get use to walking more. I agreed. The first day, I went no more than 50 yards before I took a bad fall. I struck my head very hard and broke three ribs. I wasn’t unconscious, but I barely got back to the condo. That was the end of my walking.
I finally was ready to go on my trip, but I still had very painful ribs. When I made it to Cairo, I walked around like I was a priest. I had to keep my head down most of the time since the ground was always irregular and I did not want to fall again.
I had a great room opposite the great pyramids. I had a guide and took in all the sights, including the museum where they had Tutankhamun (King Tut). I did a little shopping for all the women and took a lot of pictures.
A Room on the Nile
After a few days, I went to Luxor and the Valley of the Kings. I had a great room overlooking the Nile. I loved sitting on my balcony looking at the felucca sailing by. The next day, I flew to Aswan and again had a room over the Nile. I could see an island across from me that was called Kitchener’s Island. The island was given to Lord Horatio Kitchener as a gift for his services, which included securing control of the Sudan for the British in 1898.
I went out and rented a boat at the dock for a tour. This included a trip around the island and a run to go see the Elephant Rock. It looked like the rear end of a huge elephant. The next morning, I got up early and we flew to Abu Simbel. There was nothing at the airport. My reservation for the bus trip was fouled up, so I just slipped on the bus.
I got to see the temples and saw it all. I decided to arrive back at the bus early so I would have transportation back to the plane that I had to catch if I was going to make my connection to Ethiopia. When the guide was counting heads before the bus left, she was obviously puzzled. Guides usually lose someone but do not usually have extra passengers particularly out in the middle of nowhere. I made the plane to Ethiopia.
As we were approaching Addis Ababa, the capital city of Ethiopia, the plane put up a screen showing the distance and height above the ground. I suddenly felt the plane hit something and I thought I was crashing because the screen showed 9,000 feet. It turned out they did not tell us that was the ground because the city is on a plateau.
I was met and taken to another hotel. It seems this was a religious holiday and we could not go to our Hilton until Monday. They put us up in a government hotel that was very nice. It seems that people were getting married all over the property, so it was very colorful. There were very colorful dresses and lots of music.
Since I arrived earlier than everybody else, they put the driver and car at my disposal for the afternoon. There is nothing to see in the town unless you enjoy seeing one vista after the other of poverty.
We decided to go and see the Cathedral of St. George. We went to go inside but it was locked. My driver said not to worry. He knocked on the door and a small window-like opening was opened. I was asked for some money. We pushed it through the small window and we were let in. The priest gave us a grand tour that was quite interesting. It turned out he was the bishop. We began talking, and the next thing he invites me to his wedding the next Saturday. It was a long affair, he told me. It was to start at 4 a.m. and last six hours. Later, when I got home, I teased Sally when I told her I would have never married her if that were our time frame.
The next morning, our group got up early and checked in at the Hilton. They then took us to the Menlick 2 Hospital, which was a series of one-story tin huts for an Eye and Ear Hospital.
The last time Orbis came there, they were given 4 Zeiss operating microscopes and had them set up as ceiling mounted. None of them was now working a year later. We had a man with us who was a genius at fixing them. The real tragedy was that one of them only needed to change the bulb. I even have a picture of them carrying parts of another microscope in pieces on their back. I don’t think that did much for the calibration.
I have another picture of a post-op patient going from the OR to another building on a stretcher and covered by an umbrella.
I did not want to do any touring of the town, and resting my ribs was still a problem. Saturday, I got a car and driver from the hotel. You could not trust getting them in town. You very likely would not come back. I went to the bishop's wedding that was in full swing. It was very colorful, but I did not take pictures since nobody else was.
Ethiopian Lions
I then went to the zoo to see the special lions that are only in Ethiopia. The zoo was not much else. It cost me a dollar to get in. I could see the lions in cages across a very small moat. The guard said that I could cross over to get in front of the cages if I gave him a dollar. I did.
Considering the security problem in town, I did not go to the big market to do any souvenir shopping. My American host told me I would do as well at the hotel, and that was what I did.
That evening, they took us out to a great Ethiopian café with singing and dancing. We all got into the act that was what you were supposed to do. I even have a video of me singing and dancing.
They wanted me to return but did not offer me a long-time contract. I got my plane home the next morning early and flew into Cairo to make my connection for the States. They put us in a transit lounge and took our passports.
This made me very nervous. Then the man with our passports said he would meet us at the next building, where we were to get our plane. I told him I wanted back my passport, and he said I would get it later. I explained to him that I go where that passport goes. We had words, but I finally attached myself to him and we went on our way together to my plane. After that, no more problems and an uneventful trip home. If I have learned anything from my travels, it is how you feel as you pass U.S. customs and you are on American soil. It is not relief, but how you love your country that is not something you normally think about.
My last trip: Oman in 2008
This trip was very different than any of my others. It started with Yale’s idea of who it is. Yale considers itself an international university rather than a great American university. It already believes it is the best one in this country. Yale has this motto: God, country and Yale, not necessarily in that order.
This concept is not new and goes back centuries. Yale is more than 300 years old. One day in 2008, we all received an e-mail exhorting us to look at opportunities for Yale beyond the USA. We discussed this at a faculty meeting in early May. I suggested that I might be able to do something in the Gulf States. My chairman thought it was just a senile man’s ravings. It wasn’t, but I was used to him just blowing me off.
The next week, I was off to Walter Reed and had my usual lunch with a few friends. One of them was John Countryman, an old friend from Xavier who had retired as ambassador to Oman. I asked him if he kept in touch with them and he said yes.
His friend was the second man in the country. He held no specific post, but he held the power after the Sultan. His name was Zawahiri. This is probably not the correct spelling but it was a well-known name. It seems that was the name of the second in command to Osama Bin Laden. I felt this was not a good omen so far. It turned out that is a very common name in that part of the world.
First, here is a little background. The present country and the Arab Emirates, Qatar and Kuwait were all pirates at one time and were taken over by England in 1851. They divided all that area up about 1971.
Many of the Sultans and others still go to Sandhurst for school. The head of Kuwait, Abu Dhabi and Oman all went there. Oman was a very backward country in 1971. A few years before that, Saudi Arabia was going to war to take over the oil fields in Kuwait. The Sultan of Oman gathered 7,000 men on camels and with only rifles to go and stop them.
This was a scene before the First World War. However, Britain took issue with that and told Saudi Arabia to back off and nothing happened. At that time, there were 12 telephones in Oman, 25 miles of roads, no hospitals and no schools. He even locked up the city gates in the evening and, when women went out at night, they carried lanterns.
After his son came back from Sandhurst and two years in the British Army, he and the British arrived at the palace one day and explained to the Sultan his options. He could get on a waiting British Air Force plane and stay at the Brevort Hotel in London or stay there and stay under six feet of sand. He elected London, and ''Sonny'' is still Sultan today.
Nowadays, there are several good hospitals in the capital, thousands of cell phones and paved roads. The most important idea is universal education. Everybody, including women, go to college. If the father says he does not want his daughters educated, someone from the government comes by and talks to him about it.
The Empty Quarter
John told another story about the mentality of these people. He and a group were driving in the area that is called the Empty Quarter, which is part Oman and part Saudi Arabia. They stopped for tea and set up their tent. As they were sitting there, an Arab with two camels, two women and a herd of goats came over the dune. As hospitality requires they are invited over for tea.
John noticed that the women had their skirts pulled up to their knees and they had no veils. With my curiosity, I would have immediately asked why, but John was a diplomat. After a while, he asked about the skirts and no veil and hoped that he would not offend the man.
The man was not offended and told him that if they did not tie up their skirts, they could not walk over the dunes and if they had veils they might miss some of the goats. He was a Muslim but was also pragmatic. This was what this Sultan had done in the country after deposing his father.
Now back to my trip. John sent an address of his friend. This friend kept an address in Georgetown. I wrote him at that address asking that he and I get together sometime at the Cosmos Club and discuss mutual interests between Yale Ophthalmology and their medical program. I called his secretary to be sure I addressed him properly. It seems he trained at Harvard Medical School and did a residency in Ob Gyn.
As soon as daddy died, he scrapped medicine and now runs 70 corporations, including the Bank of Oman. I always said an Ivy League education was a good way to get up in the world. His secretary said since 9/11, he would not meet me in New York and he only comes to his place in Georgetown for two weeks a year.
It seemed that my idea was a loser. In three weeks, I got a letter from the head of the Medical Societies and its Commissioner of Health, inviting me to come for a week first class, all expenses paid and an honorarium.
I received a copy of my letter to Zawahiri, which he sent to the Minister of Health. He did not send him a letter, but just a few scratches telling him to do it. I was impressed with his influence. I decided to not go until the early fall so I could prepare a formal program.
I put together a large folder of information about coming to learn in the U.S., something about our program and Yale University. I even got letters from the school president, the dean of the medical school and from my chairman.
Just before I left, they changed my date by a week and, as a result, I did not get the direct flight to Abu Dhabi. I had to go through Amsterdam. I also had the worst flu I have ever had, so I was dragging it all week while I was there.
I arrived at Muscat, which is the capital, and was met and taken to a very luxurious hotel overlooking the Gulf of Oman. The next day, I met the working group about ideas. At this time, they did not have a residency program.
They immediately presented me with a magnificent ceremonial knife in silver in a presentation box. I was given the grand tour of the hospitals for the next few days. The hospitals were modern, had all the toys and good technicians to work them. Their problem was a shortage of medical doctors.
They had one retinal specialist who was from India. He toured around with me one morning. After an hour, he told me he was coming to the States in a month and asked if he could call me to go to dinner. I said yes and asked him where he was going to stay. He said he was going to Greenwich, Connecticut, and staying with his sister.
It turned out his sister was Indra Nooyi, the CEO of Pepsi. In addition, I found out she is a graduate of Yale business school and she was on the university board. You never know whom you are talking with.
All the homes in Oman are almost a two-story design by law. If you do anything to the house, you need government permission. Another doctor took me for a drive to see her home and the university. She said she had her second child and wanted to just add on a room and it took one year to get permission. This all came about when this Sultan hired a group of Italian architects to build the capital. When they got finished, it looked like Disneyland, and the Sultan tore the entire city down and built what you see today to almost one design.
The third day I was there, I was scheduled to see the Minister of Health. However, he was out of town visiting the hinterlands with the Sultan, who was very good about keeping in touch with his people. Instead, I had a visit with his deputy, who must have been well-educated in Britain.
His English was better than mine. He was also a diplomat and was not a physician. Now my CV begins with finishing my college at Fordham. This man did his homework besides the CV I had previously sent. He said that the Sultan and I have something in common. He said that the Sultan went to a military academy in England by the name of Sandhurst.
I knew he meant West Point and I didn’t know how well that would go over. I said that Ambassador John Countryman and I went to Xavier, a military prep school. He smiled at my comeback but said nothing. We both understood. This man was no dummy. He checked on me to be sure who I was rather than somebody running a scam.
The next day, I had a final meeting with the group and they gave me a very generous check. They gave me a driver to take it to the bank to get local cash. I then was driven into town in order to change it into dollars.
Oman's money was not internationally traded. I went to the exchange place and got it in dollars. I was so busy counting that I left my passport.
I went down a few doors to the suk and decided to get some souvenirs. I did not take long, which was fortunate. As I came out, a man approached me and said he had my passport. I was lucky because he was closing for the afternoon.
I walked around the waterfront just to take a look. I saw two huge four- or five-story cruise boats in the harbor. I asked someone what line they were. He told me they were both yachts of the Sultan. I understand that my friend Zawahiri had one like that.
The U.S. is all over that part of the world with multiple universities in Kuwait and Abu Dhabi like Georgetown, Harvard, Cornell, West Virginia, Sorbonne and Isiad to name a few. Yale is johnny-come-lately. However, none is in Oman. I think the reason is that they want to develop their own system rather than be dominated by outsiders like Saudi Arabia.
After over 50 years, Saudi Arabia still only has about 35 percent Saudis. I agree with the Omanis and some ideas how we could do it for them. I would have to do some tall-talking to Yale.
Abu Dhabi Do
I got the early plane to Abu Dhabi and checked into a hotel. I was going to the gold suk, which was a building with about a hundred gold jewelry stores. I did my shopping and did not bother to look around the town.
The town is a must-miss. There are lots of tall buildings, but very grubby-looking down on the streets. I slept at the hotel, but I had to check out by 11 a.m. I was supposed to have a late checkout. The hotel did not honor it and was not very pleasant. I therefore sat in the lobby till my limo was coming to take me to the airport for a midnight flight home.
I considered getting a driver to go and see Dubai about 90 miles away. The best I could do was $500. I had spent a lot on jewelry and besides I didn’t think it was worth it even with my honorarium in my pocket. I wrote cards for an hour and gave the money to the concierge to get stamps. I also gave him a good tip. He pocketed everything. Nobody got a card.
There is another interesting thing about Oman. The end of the peninsula that covers Abu Dhabi and Dubai is right at the choke point of the Strait of Hormuz. However, when the British divided up all that area, the very tip belongs to Oman. Despite of all the news about the U.S., Kuwait or Qatar, you never hear about anything going on in Oman. Dick Chaney supposedly visited the Sultan a few times a year to go fishing. But, really, who would go that far just to go fishing?
I can’t believe we don’t have all sorts of eyes and ears on that little strip of land.
Since I have been home, nothing is happening. I had two articles published in Oman's medical journal and I was put on its international advisory board.