My experience with Project Hope began on a bright, sunny September day in San Francisco Bay in l960. The Hope Ship was in the final stages of preparation for sailing out the Golden Gate for Indonesia and what was to become an historic program of people-to-people health care and education.

Today we are celebrating the thirtieth anniversary of the inception of Project Hope, the birth of which was the conception and inspiration of our founder, Dr. William Walsh. Dr. Walsh and all of the thousands of Hope participants made a reality of the dream of President Eisenhower who made People-to-People aid one of his key foreign policy goals. The Peace Corps and numerous other movements have followed Project Hope and, altogether, Americans have made a laudable contribution to the relief of those in want around the globe.

I have been asked to speak briefly in a mood of reminiscence about the earliest days of the Hope Mission to the world beginning in Indonesia and the Project as I have found it in Grenada now 28 years later. I am really speaking to honor the thousands of American health workers who have put their shoulders to the wheel for Project Hope.

Prior to the l960 departure from San Francisco, doctors and their families of the Bay Area were invited to visit and inspect the ship. I was introduced to Dottie Aeschliman, Assistant Chief of Nurses on the ship, and impulsively asked her if they needed a general surgeon. She arranged for me to meet Dr. Paul Spangler, Chief Medical Officer, who happened to be in his cabin. It turned out that we hit if off from the very beginning and that we both had the Massachusetts General Hospital in our backgrounds. He told me that there were thousands of applications on the Washington desk but that the ship would be sailing in the next few days and the medical roster was not at all complete. Naturally I said I would go if my family approved. My wife and four children seemed to be enthusiastic about the prospect. Some of my professional colleagues thought I’d taken leave of my sanity to go for several months on such short notice. Legions of Hopies and their families have made substantial financial sacrifices to go on Hope missions but I am sure that the vast majority of them felt the rewards in job satisfaction from serving with Hope far outweighed the financial considerations.

Our enthusiasm for the voyage grew in the next few days as we met with Dr. Walsh in the few days that remained before the Hope sailed out the Golden Gate. My San Mateo colleagues, Dr. Richard Thompson, Anesthesiologist, and Dr. Phillip Myers, Obstetrician-Gynecologist volunteered promptly to fill the yawning gaps in their specialties.

Further on in the first voyage our own San Mateo County rallied to the cause when the Doctors Goble, the Doctors Kohn and Doctors Weisskopf, Benner, and Ellis also went out to serve in Indonesia and in Viet Nam.

We had just three weeks after the ship sailed to put our affairs and practices on hold. Just 28 years ago today we three, joined by Jack Tetirick, General Surgeon from Columbus, Ohio, and Buzz Kramer, Otolaryngologist from Oakland, California, took off by Pan Am jet for Djakarta. We flew via Honolulu, Manila, Saigon, and Singapore. Even at that early date I remember the machine gun emplacements around the Saigon Airport portending the coming of our war in Viet Nam. It took 30 hours for us to reach Djakarta.

None of us will forget the twilit evening of our arrival at Djakarta. The last rays of the sun bathed a vast oriental city with a hazy overcast of smoke from the evening cooking fires spiked with other aromatic essences of spices and so forth. Dr. Mark Beaubien met us at the airport and extracted us patiently from the emmigration formalities. After a colorful drive through the crowded city we arrived at the port of Tandjung Priok where the Hope Ship had just arrived. Thus we were on station ready for work.

There was no delay. Bright and early the next morning, as I recall, we visited the University of Indonesia Medical School and the Rumah Sakit Umum Pusat, the general hospital. Here we were greeted warmly by Dr. Soekarjo, the Dean, and many of his staff. The Hope doctors accompanied their counterparts to the various services of the hospital and Dr. Tetirick and I were deeply impressed by the gravity of surgical illness we saw there. Dr. Tetirick was struck by the plight of a little girl named Yuyu whose abdomen was vastly distended by her diseased spleen. I saw a sickly little fellow playing on the floor behind his hospital crib. There was a tumor mass on the side of his neck reaching from the ear to the collar bone, the size of a melon. Clinically, the tumor was a malignant lymphoma. Little Sana was such a pitiable sight that I felt compelled to take him to the ship and to do an open biopsy and, if possible, an excision of the tumor.

In a day or two the Hope nurses and technicians had everything in readiness for the first surgery. Little Sana was the leadoff batter and I assisted Dr. Soekarjo in the biopsy. When the diagnosis of lymphoma was confirmed by our Pathologist, Dr. Dennis, I went ahead with the necessary radical neck dissection. The operation took over six hours and the ambient temperature in the operating room was in the 90 degree Fahrenheit range with humidity to match. Everyone in the operating room (“Kammer Operasi”) literally melted but the operation went very well and the tumor was completely excised with preservation of all of the vital structures in the neck. I only weigh l40 pounds and I lost seven of them in perspiration. Sana became the ship’s first mascot and when the ship sailed for Surabaja in two weeks he was discharged from the hospital to his family with a cheerful ceremony on deck conducted by our masterful captain, Jack Windas.

A word of appreciation of Captain Windas. We all found him to be a man of enormous dedication to the Hope and possessed of a fund of idealism beyond measure. He was a learned man who could quote the pertinent lines from Shakespeare to fit virtually any occasion. His enterprise and labor made much of the success of the first voyage possible. Others in his ship’s crew too numerous to mention did their parts. I do especially remember Bud McGorian, head of the food services, for his excellent cuisine said to have costed only $l.87 per person per meal. Leo Haney was the master maintenance man who found, among other things, that the exhaust fans from the operating room were reversed so that the heat of the deck was sucked into the surgery instead of being sucked out. When that was remedied, the air conditioning in the OR became effective to the great relief of all.

Dr. Tetirick removed the huge spleen of little Yuyu on the day when President Soekarno visited the ship (arriving at dockside by helicopter). As Jack operated, President Soekarno sat in the lecture hall and observed the operation via closed circuit television. I gave a layman’s play by play account of the operation to the President. The hall was crowded with medical students and the entire program was quite impressive.

The fact that we were able to conduct surgery in the first Djakarta days was an immense tribute to Chief Surgical Nurse Mavis Pate and her crew who literally had to sew operating linen from bedsheets until the ship’s surgical supplies could be found in the hold of the ship. No amount of eloquent words can give a true measure of the contribution to the success of the surgical program of these heroic and indefatigable ladies. I wish time permitted me to name and honor our teammates in all departments in those early days.

Honors also by the ship load for Chief Nurse Claire O’Neil and for Dottie Aeshliman whom we were also destined to meet again in Riyadh. A thousand cheers for all of our inspired and inspiring shipmates!

The Indonesian doctors and their wives of the local Hope Committees provided us with the finest hospitality in the few evenings and weekends when some of us could get off the ship for a few hours. There were banquets and cultural entertainments beyond description. We came to appreciate the cuisine of the country and the classical dance and music were enthralling. We became good friends of a number of the doctors in each city. After 28 years I still recall such men as Lium sze Swie of the University in Djakarta and Dr. Basoeki, a fine Neurosurgeon from the University at Surabaja, both of whom came on to Bali to help us.

After the test of fire in the first two weeks in Djakarta, the great white ship dutifully set sail for the port of Surabaja on the northeast coast of Java. The seachange did everyone a lot of good. We marveled at the sinister poisonous sea snakes swimming on the surface of the placid sea. Numerous coastwise tramp steamers and exotic Macassar schooners adorned the passage.

Upon arrival in Surabaja we again entered on the process of meeting our counterparts both on the ship and in the general hospital. The same collegial atmosphere developed here as we came to know it in Djakarta. Despite occasional signs of grafitti indicating that we were not universally welcome, we always found that the patients and medical personnel ashore gave every evidence of their appreciation. Many warm friendships were established. All of the ship’s company proved to be just the kind of good will ambassadors that success of the project required.

Members in all departments gave unstintingly of their expertise to their counterparts. The essence of the approach we found most pleasing to our professional hosts and hostesses was to emphasize again and again how much we were learning from them; we didn’t pose as great American know-it-alls (which, of course, we weren’t). All of us surgeons urged the Indonesian surgeons to do operations with our assistance but it became apparent quite soon that they wanted us to do all of the surgery. Perhaps they were bashful about their skills but I rather think they really wanted to know how we do it since, of course, they already knew how THEY did it. There were everywhere only a very few surgeons trained by western standards in Holland so they really did welcome our coming to help them handle the vast sea of surgical need.

Patients and our colleagues are our best teachers. We did indeed learn a great deal of surgery in Indonesia. There was the case of the l9 year old Surabaja lad who was perfectly healthy EXCEPT for the fact that he had one greatly swollen and overgrown leg with massive varicose veins. A stethoscope on his affected groin revealed a loud, roaring murmur and the examining hand confirmed by the course thrill that he had a large arteriovenous aneurysm. The overgrowth of the leg resulted from the disproportionate flow of nourishing arterial blood that poured through the abnormal passage from the femoral artery to its vein. His history was that, as a five year old child seeking cover from gunfire and shrapnel during the fighting in l945 between the reoccupying Dutch army and the Indonesian freedom fighters, he was wounded in the groin vessels. The problem here is that the blood pressure in the right side of the heart rises and heart failure ultimately claims the life of the victim. Surgical repair of the injured artery resulted in return to a normal circulatory state. In years of vascular surgical experience I had never seen such a gross deformity from chronic arteriovenous fistula.

It seemed as though every patient who had an abdominal operation had innumerable worms palpable through the intestinal wall. This brings to mind the prevalence of anemia in the population. Our patients were walking around and normally active with only two thirds of their normal red blood cells. At first we worried that their anemia might make the patients unfit for surgery because it has long been held that wounds don’t heal well in the presence of profound anemia. Probably the intestinal worms contributed largely to the anemia. Naturally some of the patients needed blood transfusions although we took special pains to conserve blood by meticulous technique. In fact, we adopted the policy of taking only 250 cc. of blood from donors instead of the usual 500 cc that our domestic blood banks take from our donors. To our great satisfaction we learned that wounds can heal perfectly normally in patients who have less than ten grams of hemoglobin per l00 cc of blood. This is a valuable lesson, especially in these days when fear of hepatitis B or AIDS has inspired a much more conservative attitude among physicians in the matter of giving transfusions of questionable necessity.

Another revelation to me and others was the fact that our patients required very little in the way of opiates for relief of operative pain. I remember one elderly man who had a painful cancer of the floor of the mouth. The tumor invaded the jawbone. The only possibility of cure was to do a very radical removal of the jaw, part of the tongue all in continuity with a radical neck dissection. We accomplished the operation uneventfully. The next day on rounds the patient got out of bed to greet me and, tracheostomy and all, embraced me. That man never took a single pain shot for what had to be a very painful ordeal. The mysterious orient! Perhaps this helps to explain the marvels attributed to acupuncture in the hardy oriental patient.

One day we journeyed from Surabaja into the mountains to Kediri where there was a Baptist missionary hospital. We did thyroid and colon cancer surgery there. I’ll always remember the colon case because I only had six arterial clamps for the entire procedure. It showed me how much can be done with a few basic instruments. The wonderful southern fried chicken dinner those wonderful people gave us was unforgettable.

After a month in Surabaja where we left a thousand medical books we sailed on to Bali. The capitol of Bali is Denpasar but there was no harbor there so we anchored in one of the most beautiful bays one can imagine about 60 KM from the city. We all operated in the small general hospital in Denpasar and also brought patients out to the ship. The two million people of Bali were being cared for by only eleven doctors! Dr. Djelantic, son of a prince, was the dedicated chief medical officer. We all pitched in to help reduce the backlog of medical and surgical cases.

One day I thought I had persuaded Dr. Lium Jze Swie to do an hemmorrhoidectomy with my assistance in the Denpasar Hospital. The patient had suffered for years with bleeding hemorrhoids. While we were scrubbing our hands with ivory soap for the surgery, Dr. Lium said, “The Prince wants the Hope doctor to do the operation”. So, by the light of a flickering goose-neck lamp, Dr. Thompson gave a spinal anesthetic and I did the surgery. This wonderful man, true to tradition, took no postoperative pain medication. It turned out that the patient was the Rajah of Ubud, the highest ranking personage on the island, a greatly venerated religious leader. We signed his guest register in the palace, a register which included many famous names including that of Eleanor Roosevelt. To our astonishment and gratification, only five days after the operation, Tjokorde Egi Agung Sukawati, the Rajah, gave a banquet in a marvelous bamboo pavilion in the palace garden for the entire complement of ship’s officers and the medical personnel. The National Geographic photographers should have been there. As the sun set we feasted on Balinese culinary delights featuring roast suckling pig. As the darkness came we strolled down a forest path to a towering temple gate illuminated by cocoanut oil lamps on each step of the pyramid. Little boys scampered up and down the steps keeping the lamps alight. There was a small stage in front of the entrance to the temple gate and we took seats for what was to be the most elegant and dramatic dance concert of our entire trip. The dark quiet of the forest rang with the musical bells of not one but two gamelan orchestras. The mood of the occasion was perfect for what was to follow. A succession of little Balinese dancers with their sinuous bodily movements and exquisite hand and arm expression all by flickering lamplight cast a truly indescribable (by me) spell over the entire gathering. During all of this our noble host sat on a throne-like chair. I couldn’t help noticing that he sat a little off center and no one knew better than I why that was.

As if that weren’t enough, after the concert and our expressions of profound gratitude to our host and to the artists, we drove in the jeeps back to the ship. As we came over the brow of a hill we entered a magical valley entirely alight with an unearthly glow. We couldn’t figure out what was happening until we realized that we were looking at billions of fireflies. It turns out, as I learned from an article in Scientific American a few years later, that that valley is one of a handful of sites in the entire world where this firefly phenomenon occurs. We thought it was entirely in character for the Rajah to cap the evening with such magic!

Finally, in December, the time came for Myers, Thompson, and Ratcliffe to depart for home. Our last memory was of the ship anchored in the great bay at the foot of the sacred mountain, Gunung Agung. That very mountain, a volcano, erupted two years later and some thousands of Balinese lost their lives.

Now the scene changes to twenty-five years later in the clinical laboratory of the King Faisal Specialist Hospital and Research Center in Riyadh, Saudi Arabia where Sherrel Bradford now Roshdy was working in her usual conscientious and sturdy way in the Cytology Service. My wife, Joanne and I, had gone to Saudi Arabia in l975 for what was to have been a two year adventure in the remote southern mountains of that fabulous country. In l977 we were invited to work at the King Faisal in Riyadh and finally we stayed in Saudi Arabia nearly eleven years. We became well acquainted with Sherrel and we all played a lot of tennis. Incidentally there were other Hopies there; Phil Weaver in Radiology, and Dottie Aeschliman, Grace Tucker and Marcella O’Connor in Nursing. Sherrel told me about the Hope Project in Grenada. Since Joanne and I were planning to leave the King Faisal Hospital in early l986, I wrote to Dr. Walsh to see if they needed a surgeon. His reply was affirmative and so Joanne and I flew to St. George’s on l May l986 for a two month stint. I also worked the months of February and June-July of the following year.

Since l985 there have been some l50 Hopies working in Grenada. There were approximately 30 surgeons of various disciplines. Dr. Rick Murphy and wife Beth served an entire year and others like myself rotated from one to four months. The spectrum of workers was indeed broad and included Nurse Tutors, Sanitarians and waste management people, psychiatric nurses, cytologists, environmental health consultants, health economists, the late Pete Neal in material management, biomedical engineering, information management and computer service, and so on. I think nearly every branch of medicine was represented in depth. The project directors were Dr. John Wilhelm and Bob Burastero.

In surgery we are indebted to the stellar service of members of the profession from the University of the West Indies in Barbados, Jamaica and Trinidad-Tobago. I had the privilege of working closely during my rotations with Dr. Selwyn Ferdinand, Dr. Jerry Thorne and Professor Clark of Bridgetown, Barbados. On alternate weeks we had visits by a fine group of orthopedists from Trinidad. I can say that I gained enormous respect for the dedication and proficiency of all of the UWI people with whom I worked. I am sure that the model of the medical education of the University of the West Indies is inspirational and the graduates of those campuses will ultimately provide state of the art medical care to all of the islands of the West Indies.

I am also glad to report that there are women coming up the ladder in Medicine in Grenada. Theresa Simon and Lydia Gilbert were our internes and they are marvelously hard-working, intensely dedicated and promising physicians. Theresa probably will go on in OB-GYN and Lydia is headed for Pediatrics. These two young women and several other internes had attended medical school in Havana during the time of the Cuban presence prior to our “intervention”. Their preparation seems to have been better than might have been expected. They certainly possessed the ideal spirit and philosophy for a career in Medicine.

HOPE is funded vis-a-vis general surgeons until the end of this year and I was gladdened to hear from Dr. Wilhelm this week that Dr. Weithers of Guyana and London will have arrived on l October last to take a contract with the Ministry of Health as a permanent staff surgeon. The Ministry is seeking another surgeon because it is a lonely feeling to be the lone surgeon as I was for three weeks last year on an island of some l00000 people!

It isn’t easy for the little islands of the Caribbean to round out their roster of health professionals. Their budgets are strained in many directions and medical care until recently hasn’t been one of the luxuries they could afford. There is still much work to be done in building the infrastructure of health care. Many people have given little bits of help to tide them over the lean times but the foundations built by the full-time nurses and other health professionals and educators of Project Hope in the past four years will leave a lasting inspiration and benefit to the Grenadan people. Ideally the people of the islands want to take care of their own and HOPE has been there to work itself out of a job. We shall all follow the progress of those fine people with great interest and hope.

As one who saw the inception of PROJECT HOPE in l960 and another surgical mission 26 years later, I was struck by the change in the approach and philosophy of the program. In l960 teaching and hands on surgical care had at least equal thrust. Now, with the exception of the open heart efforts in Poland and in China together with the much less elaborate Grenada experience soon to end, the main thrust of the world outreach is directed toward education of nurses and health technicians. Although the surgery of the early years certainly was extremely satisfying and stimulating, the work done could not be more than a drop in the ocean of need. So I think the best impact of HOPE in the world can be realized by the more fundamental approach as at present. The legacy HOPE forces leave in the world should be of a more lasting nature under the present practice. Personally, I do hope that other opportunities for hands on medical and surgical work will materialize, for I would like to go out on station again someday. Perhaps the established clinical facilities of the good ship HOPE herself were necessary for the kind of work we all did back in the early days.

Finally, I would like to address a point that has raised considerable furore here in the United States and elsewhere as well. I would like to say a word in defense of our intervention in Grenada. At first we thought our quick fix down there was more of an easy political victory for the Administration. But when Joanne and I were on site in Grenada and when we talked to many people in all walks of life, we were convinced that the military threat to the peaceful peoples of the Caribbean islands was very real. We heard shocking stories from the citizens of suppression of civil rights and the warehousing of preposterous stores of heavy armaments which could have no conceivable use in a small island. A climate of terror prevailed. We lost l9 young American soldiers in the fighting so the price of our so-called easy victory was dear. That we were right to intervene is attested to by the testimony of everyone we met. Democracy has a fair chance of success in Grenada.

In conclusion, I wish Project Hope an even more illustrious future and I thank the Program Committee for this opportunity to express my appreciation for the life enrichment that Hope has given me.

John W. Ratcliffe, MD, FACS
72 Yankee Point Drive
Carmel, CA 93923.