From Kuwait to the Khyber Pass



Report of a Traveling Visiting Professorship to

Kuwait, Cairo, and Throughout Pakistan

March, 1995









Glenn W. Geelhoed

MD, MA, DTMH, MPH, MA, FACS



Professor of Surgery

Professor of International Medical Education

George Washington University Medical Center

Office of the Dean, Ross Hall 103

901 23rd Street, NW, Washington, D. C. 20037

Phone 202/994-4428, Fax 202/994-0926

Email gwg @ gwis 2, circ, gwu.edu









"And you think that Clinton has power?"

This was the walk away punchline delivered disdainfully over the shoulder by a Malik in Baluchistan to a colleague I met in Pakistan. It was the object lesson of a very short story emphasizing ancient and entrenched power politics in an area of the world where modernity is a recent intruder, and only tolerated when useful for advantage to be taken over traditional and ever changing hostilities. The story illustrates some of the feudal actions that I had found myself between in the remote strategic passes along the spine of the Asian land mass pushed up by the collision of the subcontinent long eons ago. The violence of that collision has persisted in the contact of cultures at this crossroads, where peoples of different culture, religion, politics, economy and technology watch each other warily through fear and fascination. In this area of the world, I had adopted the policy in introduction to new peoples to ask myself the framework question--not so much, what language do you speak? or, what religion are you? or, where do you originate?--as the much more fundamental query,, in which era or millennium are you living?

The story is a chilling example of the presumptions that may occur when "democracies" are negotiating with "nation-states"--and miss each other by centuries. The story was confirmed for me by two witnesses of the event. The fellow to whom I was introduced was a close friend of my Pakistani colleague, and they had been discussing the role of the United States and its leadership as the sole remaining super power. Pakistan is quite self-conscious of its role either presumed or potential as the "Asian hinge" between the Middle East and its rising tide of Islamic Fundamentalism and two very large neighbors to the east. With the disappearance of the Soviet Union, the vacuum in the power balance will be filled by the next generation's super power for which there are two likely candidates, the second of which is most feared by Pakistan. To the north and to the east are two very foreign powers, each a billion strong, with the bomb. China has nuclear weapons and a very cumbersome peasant economy. Pakistan is more fearful of its partitioned neighbor India, which has faster growth in both population and economy as well as technology and also has nuclear capability. To foreswear the "Islamic bomb" and to buffer its Muslim neighbors to the west without getting absorbed into their Fundamentalism, Pakistan is attempting to play "the American card". This scenario in a global geopolitical struggle immediately had affected my tour of Pakistan (the First Lady and First Daughter of the US arrived in Islamabad a day after I had and two weeks before Benazir Bhutto left for a State visit to Washington to argue the "Pressler Amendment" among other strategic issues), yet, among the shadows of theoretic global threats lurked the reality of immediate danger in the passes from Khyber to Karachi. I will tell of two of these dangers that confronted me during my tour of Pakistan, but fit it into the context of a much more dramatic confrontation of modernity with power politics of the feudal baseline with which each Pakistani is much more familiar.

The conversation about the power emanating from Washington half a world away took place in Baluchistan, where the Malik is the supreme authority in his local region. He had overheard parts of a discussion while green tea was being poured to "cut the grease" after the fatty lamb lunch, the main meal of the day. The enclosure around the court yard sprouted the traditional watchtower with parapets and rifleslits three stories up with a guard stationed above. The Malik took offense at the suggestion that there were modern leaders with power superior to his own absolute sway over the people in his local chieftainship. The Malik sneered, "Clinton cannot even hurt anybody if he wanted to--do you want to see power?" With one little finger, the Malik beckoned to the guard standing at the top of the parapet three stories up. At first confused, the message then became unmistakable when the Malik beckoned again--he wanted the man to jump. He did. Disdainfully, the Malik did not even go over to see the body, but walked in the opposite direction after this dramatic adjournment of the luncheon. His point had been made emphatically, perhaps, "all politics is local." It should not be surprising that whole provinces vote a single way in Pakistani politics, since the Malik can surely decree the vote to be cast if he can order someone to jump to his death. I experienced local power first hand, but, fortunately, with less decisive outcome.



The Itinerary

My travels on this visiting professorship involved three nations, Kuwait, Egypt and Pakistan. I had been to Kuwait and to Cairo three times each already earlier this year, but had not been to Pakistan since my first and only prior visit as James IV Surgical Scholar in 1986. Since that time, I had been eager to return to Pakistan, and particularly to see two goals of longheld ambitions since I became acquainted with the stories of Rudyard Kipling. Since my home address is on Kipling Road and Rudyard's father was city manager of Lahore on the Grand Trunk route through the Punjab, I had wanted to follow the "yellow brick road", the string of the necklace of empire. I also wanted to see the "roof of the world" and its remote and beckoning valleys along the Chinese/Pakistani border and the forbidden and disputed Kashmir. It was suggested to me that this might not be the best time to visit Pakistan, since the epidemic of urban assassinations that have afflicted Karachi for some time had just specifically targeted American diplomats with two of them killed a week before my departure in the public streets of Karachi. The Pakistani citizens were somewhat chagrined that there was a virtual invasion of Karachi by FBI, CIA, and other American operatives to investigate just two of the forty or more murders that occur in a given day in Pakistan's biggest port city, another indication that Americans have an inflated estimation of the value of life, so long as the life being considered is that of an American. If danger and instability were major deterrents to my global wanderings, I would not have come this far or further, and I could sympathize with the Pakistani view of the western perspective of the relative value of life lost. Kuwait, with a stormy recent history of conquest, occupation, destruction and liberation with a renewed Iraqi threat as recently as October 1994 during my last visit was the first stop, and Cairo, in which Islamic extremists have been targeting tourists, was the next stop. And that was just before pushing on to Karachi, so, watch your step, but come on along!



Kuwait

My first planned trip to Kuwait in 1989 was aborted by the arrival of Suddam Hussein just before I would have been there. Shortly thereafter, this small Gulf nation and its very large per capita oil revenue wealth became very well known to the West and visited by a half million armed representatives of that Western world. Over the subsequent visits following liberation, the word of the wag on the street has been that Kuwait "has gone from the nineteenth province of Iraq to the fifty-first state of the USA." It remains one of the few nations on earth where pro-American graffiti are spray painted on the walls, quite possibly reason enough for "historic preservation" of those walls!

I had been to Kuwait several times in that interval in lecturing in Kuwait University's medical faculty and several affiliated hospitals, and had been asked to help with the Kuwait Medical Association revival last October. I was included in the planning of a conference on cytokines, trace elements, tumor markers and a variety of trophic factors in current research in surgery and biology. As part of the faculty and the planning committee, I was invited with first class Kuwait Air passage and a five star Sheraton Kuwait stay with very elaborate hospitality on the part of the Kuwait University medical faculty. This involved elaborate ceremonial openings and closings, and I was present for the former graced by the presence of the health ministry officials and the el Sabah ruling family, but had already left by the closing ceremony. I hope I did not appear ungracious by skipping out on several of the receptions which I would have genuinely enjoyed, such as the dhow cruise on the Gulf, but I had made a prior commitment to make a quick trip to Cairo in the brief interval before going on to Karachi.

Last October I was introduced as someone who had come from the George Washington, and in my acknowledgement of the introduction, I pointed out that it was not the important one floating just off the harbor within plain view. As opposed to George Washington University, the carrier in the Gulf is the mightest war machine ever constructed showing the flag in support of both the extensive ground troops that had been flown into Kuwait the same week as my appearance there as well as lifting the morale of the Kuwaitis and an understandable fear factor for the Iraqis. At that time, I had been taken on a tour of the "oil lakes" and had seen some of the destruction of the military and petroleum machinery of Kuwait in sabotage by retreating Iraqis. On this trip, I had seen a much more specific kind of destruction, and one that would not make military sense, unless the strategy were somewhat more complex than the destruction of both the means of defense and means of production in wealth generation.

Following my lectures and multiple panels and receptions, I had ducked out to take a brief tour of the city to a couple of places I had not previously been. One is the National Museum. Kuwaitis, perhaps overdoing the German habit of a major "denkmal" to monumentalize the horror of war in every German city destroyed during World War II, have left quite colossal ruins just the way the Iraqis left them in scorching the earth behind their retreat. A number of these include the el Sabah family's antique rug collection which was burned, and perhaps the most poignant, the planetarium with Dr. Zeiss' last sophisticated exquisite multimillion dollar machine in a stark charred ruin.

Nearly every hotel here including the Sheraton Kuwait five-star opulent lobby contains a very large poster of the condition from which this now reconstructed elegance was raised up from the ashes following Iraqi occupation. Bomb bursts are carefully preserved in the cratered Kuwaiti towers, landmark of the city where my final reception and dinner with the group was held. The random destruction of much valuable historic and cultural resources would not make sense, unless the very specific military target was whatever made the Kuwaiti culture distinctive, so that it could be absorbed back into the Iraq which still claims it to be its separated nineteenth province. If its culture is the target, then the strategy of blowing up historic sites makes sense. I believe the Kuwaitis understand that too, since the city gates of old Kuwait were the first things restored during reconstruction.

In the very opulent receptions for the faculty from all around the world, I had the chance to meet quite a few new acquaintances from many areas on earth that I would not otherwise have access to, such as Iran, several disassembled parts of the former Soviet Union, and scores of MDs and PhDs from India and Africas "guest workers" throughout the Middle East. The Kuwaitis themselves, although proud of their rapid reconstruction and the new plateau which this interruption allows them to use as a revolutionary baseline for next advances, have somewhat softened from their firm resolve and principled stand made necessary by foreign occupation. Psychology is probably even more fascinating than the toxicology of Kuwait, about which quite a number of presentations dealt with the high levels of petroleum byproducts that fell out of the sky during the "black rain" with trace elements contamination of the entire Mid-East region in its soil and water supply. The psychologic damage comes from two rapid reversals in circumstances. A group of previously pampered nouveau riche people achieved a strong identity not simply based in the notion of wealth. Their identity caused them to suffer during occupation, and many were killed or tortured. That made a purposefulness to the lives of those who remained to serve. Women who had never in their lives lifted a finger except to scold or direct their domestics were scrubbing floors and doing dishes and felt proud of their contribution to the society. The underground physicians who were helping maintain support for those who were injured gave them a strong sense of identity and purpose during the occupation. With liberation and the exhilaration of early reconstruction, this sense of purpose persisted for a short time, but now with regression to the affluence in even greater degree, much of that spirit has been lost and materialism regained ascendancy.

One of the assistants in the department of surgery of the faculty of medicine has a relative whose job it is to officiate at Islamic ceremonies during burial services. He has made the habit of noting the gender, age, and something of the circumstances of the deaths that have been occurring. He had done this before the occupation, during it, and since liberation. He has noted that the number of cardiac sudden deaths has increased dramatically and the age at death has dropped very remarkably by more than a decade since the occupation was lifted. The death rate was very low except for those deaths related to direct injury during occupation, possibly less than half the incidence that it was before, but that death rate has now surpassed by almost two-fold the previous death rate, that is, a four-fold increase over that seen during occupation, and for reason of sudden cardiac deaths among young men. This might be an interesting epidemiologic approach to a study of meaningfulness and despair in an affluent society.

Cairo, Egypt

I was unable to shuffle my Kuwaiti Airways ticket sent in advance, so I bought new round trip passage on Kuwait Airways from Kuwait to Cairo for the very brief stay in the Nile Hilton. I had dinner with Sharif Canaan and his wife at the Semiramis and told them stories of my recent expedition to the Amazon which they were very interested in since their daughter is doing an ecology project at the French school for which I supplied her some firsthand original photographs!

The invitation I had been extended in January was for the Keynote Lecturer of the Inaugural Pan-Arab Congress of Chemotherapy. Professor Sabbour who is the clear leader of the academic and clinical community with respect to antimicrobial therapy was my host and in a very flattering introduction and moderated discussion, led the very large assembly in Cairo in questions and answers on the subject of intra-abdominal sepsis and modern monotherapy for hospitalized in-patients.

I looked down from my top floor room in the Nile Hilton at Tahrir Square ("Independence") on one side of the Nile bank and the classic Egyptian Museum. This square appears to be a small clearing on the busy banks of the only oasis strip in the vast desert of the Egyptian sands. Egypt, as has been known from Herodotus down is called the "gift of the Nile" and that is apparent even in the heart of this busy metropolis of close to fourteen million people. Development proceeds one pipe length from the Nile banks and then abruptly stops with desert sandstone immediately apparent at the margin of this lifeline. When I had lectured in Cairo in January at NIH, it was apparent that the hospital was at the end of this line, and it had been developed by carving directly into the sand only a couple of miles east of the Nile, with sand swept desert as far as the eye could see stretching to the Sinai on the other side of the hospital's windows. I toured Heliopolis, formerly a city in its own right downstream from Cairo, but now engulfed by the ameboid megapolis as it grows on down to the Delta. I had been invited at some point in the future to explore upper Egypt, and in the last several trips had taken excursions to the Delta or Hurghada, but on this occasion caught the Kuwait Airways flight in Heliopolis for Kuwait enroute to Karachi.



Pakistan

My layover in the relative luxury of the tented oasis in the sparkling Kuwait Air terminal in Kuwait City began the midnight flight another time zone or two east to arrive in Karachi just before dawn. Karachi Civil Airport is named Quaid-e-Azan in reference to Jinnah, founder of Pakistan at its partition in the British dissolution of the Raj. The new nation of Muslims was named "the Land of the Pure" (equals "Pakistan") and Jinnah had called himself Quaid-e-Azan ("father of the nation"). This is exactly the same situation as had developed in Turkey when the modern state of Turkey was created by Mustafa Kemal, the young Turk who became "father of the Turks" (equals "Attaturk"). Turkey, like Pakistan, is an Islamic society with the presumed creation of a secular modern state, and the remove of its capital from its largest city to an interior new capital city--Constantinople, renamed Istanbul, in the instance of the Turks to Ankara, and Karachi, in the instance of the Pakistanis, to Islamabad. The airports in each of the largest cities in each nation remain named after the founder of the new modern state in the stylized new names: Ataturk for the former and Quaid-e-Azan for the latter.

My arrival in Pakistan was greeted by Dr. Shujjadin Shaikh or "Shuja" who had been my frequent correspondent and fax-mate throughout the planning stage, and would accompany me from arrival to departure. We have many good things in common, such as that he was quite surprised to hear that I was a bit of an Africanist, since he had grown up from childhood on in Nigeria, had gone to school in Kaduna, and his father had practiced medicine throughout many parts of West and East Africa during the era just preceding full de-colonization. I checked in briefly to a hotel near the airport in order that I could consolidate the baggage and books that I had accrued along the way to travel the rest of Pakistan with the more portable carryon luggage. We would have a week of "road work" and air junkets among the major cities of Pakistan which I had visited previously in all instances except that of Peshawar. For that reason, I was most interested in what I could see and learn in that capital of the North West Frontier Province.

Islamabad

Iran was given full credit for sending bad weather across Baluchistan to the Arabian Sea causing rain squalls and a lot of turbulence in our flight two hours on a fully loaded 747 from Quaid-e-Azan to Islamabad. We were all hoping for clearance of the weather pattern, since very big things were dependant upon clear weather, with reservations starting in the morning for a weather-sensitive "Air Safari". I had been booked for this by Shuja and it was the pivotal point around the "window" of my Pakistani visit. Once a week Pakistani International Airways runs a four hour flight around what it modestly calls the "seven tallest peaks in the region" which just happen to be the highest peaks on earth. This air tour around the "roof of the world" would give me a very good idea of the trekking that I had long ago planned for this area, and I wanted to see the famous Hunza and Swat Valleys in the Karakorum as well as the world class mountains of the Hindu Kush. In this area the Karakorum Highway literally crosses glaciers on its route up into China in Sianking Province, a route that I had wished to trek following the old silk road. The Karakorum Highway has only recently been completed, and at a cost of hundreds of lives for very few kilometers, being the highest highway built on earth. There are signs along the road that would forewarn travellers that the altitude is such as to induce pulmonary edema and cerebral edema which would both cause loss of judgement as to whether one should be travelling any further along this high altitude road! At right angles to the Hindu Kush stands the massive wall of the Himalayan Massif which contains K-2, the tallest mountain in Pakistan and the second tallest in the world, near its neighbor Mt. Everest which has it beat by very little altitude to take top honors. Because of the hopes that were pinned to the Air Safari in not only the orientation on this occasion to the mountain fastness of Pakistan but plans for future trekking, all eyes were looking up and hoping for a break in the weather.

On the 747 that arrived in Islamabad, Shuja recognized a prominent young friend named Moin-Ul-Atique. He is a world class cricketeer who has represented Pakistan often in the final test matches. Moin-Ul-Atique had come to Islamabad for his first visit with his new (arranged) bride Kishwer Naz. The fastest bowler on the Pakistani cricket squad had backed out of next weeks' cricket matches alleging back problems. He was taking advantage of this specious layover to get married in much the same way that Moin-Ul-Atique had, since Moin was half of the couple that had brought the cricket team all together previously for their wedding. They had invited me to attend, saying that it would be a classic Pakistani affair and would last three days in celebration, and would still be going on if and when I return from Peshawar.

We had rented a car and driver at the Pearl Continental and had driven up the picturesque hills behind the new planned capital city of Islamabad. In these hills wandered boar (presumably safe from any form of Pakistani poaching) and even snow leopards which had occasionally been pushed down from the high mountains to these rocky foothills. There is a restaurant on the top of one of these small mountains called Daman-e-Koh ("in the heart of the hills"). Over our Chinese-style dinner, (befitting our proximity to the Pak-Chinese border on the silk route) we could look down upon the Shah Faisal Mosque, a gift from the former Saudi king to the people of Pakistan and the centerpiece of their new capital.

Over dinner, I talked with the newlyweds about their shyness and embarrassment at first meeting each other after their wedding had already been arranged. I asked about the ceremonies themselves, which I had heard about with respect to previous Pakistani friends of mine "of good family" (a replacement for the buzzwords of the British-outlawed caste system), and they described for me as participants a couple of weeks earlier and as observers during this trip what the current status of matrimonial rituals in Pakistan might represent. As we were driving down from the hills through a part of Islamabad, I saw an illumined sign over what could be called a stripmall shopping center. At the top of a multipurpose building the sign said in English "Marriage Hall, Fast Food, Fun House". I pointed this out to them and said, "You didn't have to go through the whole ritual ceremony, since right here you could have had 'one stop shopping'"!

And now for the bad news: through the night the wind was howling a gale, and the pelting downpour continued through the morning. By nine AM, airport take-off time for my air safari, it was cancelled, and it was unlikely that such a flight would be flown this month.

Beyond filling in postcards during the rainy morning, I learned a bit about Pakistani history and saw it architecturalized in its new capital city. There is a political party here called the MQM (Muhajeed Qom Movement). MQM represents the individuals who had migrated into this relatively vacant area of Pakistan from India during the partition. There was a small village "Pindi" in this area when Pakistan was created out of the partition of India in 1947. A dam was erected on the river to back up a reservoir (Lake Rawal) when it was obvious in capitals around the world (Lagos, Nigeria, Melbourne, Australia, Rio, Brazil, Bombay, India--and Karachi, Pakistan) that the busy large port city was probably not the best site for a capital, new capitals were planned (Brasilia, Canberra, New Delhi, and Islamabad). Down in the rural parts of adjacent Sindh Province further down the Indus River and in the great desert areas adjacent to it, the Pakistani Peoples' Party (PPP) is the rural provincial party of Benazir Bhutto's support. The previous president, Zia al Huq (whose wife, coincidently, I had seen as a thyroid patient in Washington, D.C.) came from the Islamic party, and the Baluchistani feudal maliks had brokered power with association with whichever party can serve them best. When it came time to re-site the capital, there was enough power in the newly arrived MQM Pakistani immigrants from India to have the plans drawn up and completed for a new capital city dedicated to Allah in Islamabad ("the city of Islam") adjacent to the older city of Rawalpindi.

Since we would be leaving in the afternoon via the GT--the Grand Trunk route--I had a full morning to tour the new capital, Islamabad. From a small park on the hill overlooking the city with a model of the city plan, one can look over Rawalpindi from one side of the hill and its distant Lake Rawal and Islamabad on the other side nestled against the small mountains from which I had looked out the night before. The dominant features of the urban cityscape are the Shah Faisal Mosque and the Saudi-Pak tower. In going down the broad boulevards and parade grounds of Islamabad, the tanks and military equipment were being cleared out from the display on Pakistani national day the previous day as the town put in another festive order for the arrival of the U.S. First Lady the following day. I went to the Shah Faisal Mosque and stopped first at the shrine in front of it which marks the tomb of Zia al Huq. After ten years rule of a somewhat strong-headed Pakistan going its own way, Zia al Huq joined nine of his generals in boarding a plane which at the last moment invited the U.S. Ambassador on board. This flight was brought down by a surface-to-air missile, ironically of U.S. manufacture. There is not a Pakistani I met who did not know for certain that this was a "CIA hit" quite willingly disposing of a U.S. ambassador figured as ineffectual since he was unable to restrain an independent-minded military president and his top generals. Ironically the stinger missile used to take down the president of Pakistan and the U.S. Ambassador with the plane was supplied by the U.S. for resistance to the overthrow of the Afghan government by the Russian occupation. Zia al Huq--as is common with many men who command considerable power during life--is far more revered in death than he was during his administration as a military dictator.

Zia al Huq also had one defining moment of his presidency, and that is the hanging of his predecessor in office, Ali Bhutto, father of Benazir Bhutto, currently Prime Minister. Daughter Benazir is in a very tenuous position. The outsiders that had immigrated from India that formed the MQM had been an urban party of middle class, moderately educated and quite capable people. The power base for Benazir Bhutto is that of the rural Sindh Province, and she has very little support in Sindh's biggest city, Karachi. The apportionment of the votes is certainly not one man/one vote, and the entire feudal areas of rural provinces vote according to the Malik who can deliver them, since there are only aristocrats and very poor peasantry but no middle class in such regions where development of human potential is not a strong priority. This theme, as noted at the outset, has been a recurring one as I learned of the political realities of present day Pakistan.

Plans were drawn up for the new capital of Islamabad in 1959 when it was selected as the new capital site. Only three years later it sprang into life with shopping centers, broad boulevards and the somewhat sterile new, upscale appearance of most new capitals which do not feel as comfortable as a well broken-in town to live in. I saw the parliament, the supreme court, foreign ministry and all embassies, some in construction such as the opulent one from France. Some of the architecture here is reminiscent of Saudi Arabia in which highly imaginative designs are employed in a very sterile landscape with the form rather than the function of the building appearing to be the monument to be created.

I looked over Rawal Dam and Rawal Lake. There are large notices by which one is warned that it is illegal to take a photograph of the spillways of the dam, presumably as a saboteur's way of flooding out the city if this intelligence were in the wrong hands. There were scores of people who were apparently illiterate in Urdu and English, since it was the holy day Friday in which families were picnicking along the photogenic park despite the occasional threat of rain, leftover from the storm that had rained out my air safari. We reassembled back at the Pearl Continental and hired a taxi with a Pushtan driver with a tuberculous cough. This was much more noticeable during the drive when the downpour required us to keep the windows rolled up. We weaved around the colorfully decorated buses flapping black flags from every handhold to ward off the evil eye. We went at breakneck speed through the potholes and puddles of the Grand Trunk Road dodging around herds of sheep and spraying bicycles whose drivers were balancing large loads.

The Grand Trunk Road is perhaps a bit less grand than it was in the days of the Mogul emperors when it was also the only road. We stopped at Fort Attock, the resting place where the entire army of the mogul emperor could stay while boats ferried them in small contingents across the River Kabul. The River Kabul comes down from Afghanistan where it gives name to the city on its banks that is Afghanistan's capital. At this point it forms the border between the North West Frontier Province and Punjab. It is later joined by the Swat River down from the Hindu Kush's high Swat Valley and together they form the Indus River, not only the main stream of Pakistan but also the cradle of civilization, even older that the Nile, but less well known. Also somewhat less well known is that Fort Attock once used by the Mogul emperors is still used for similar purposes, since its dungeons now are used, it is said, for the largest collection of political prisoners in the nation.

We took the modern bridge across the Kabul River as opposed to fording the river on elephants, the vehicles of the Moguls. From Kabul to Calcutta, the Grand Trunk Route under Akhbar the Great spanned an empire as far flung as it could be, given elephant transportation speed for an army's logistic supply.

Peshawar

"The North West Frontier Province" is a suggestion as to status of this political entity--it is the wild, wild west. There are mixes of peoples here who use different languages, different customs, and a common interest in white powder which has currency value in this and other parts of the contentious world. This is a narrow chokepoint along the Grand Trunk and has seen the ebb and flow of many civilizations from Bactrian, Alexandrian, Roman, Ottoman; even the British came to a halt at the pass above Peshawar. The Khyber Rifles post was where Winston Churchill was stationed and also Lord Lugar who had previously distinguished himself in Kaduna, Burma, India; these leaders and other faithful international servants of Victoria came to a halt against the wall of the mountains and the mountain men. The warlike Afghanis didn't hold together even under the Mogul empire, but broke off independently in a group of feudal systems that persist to the present.

For a foreigner, particularly an American, to get into the Khyber Pass requires a permit. One does not apply to any national government for such a permit, but seeks it from the Malik, a local chieftain, through whose terrain one is passing. Through extraordinary effort, I had been told, my wish to enter the Khyber Pass would be accommodated, if I truly knew what I was attempting to get into. The Malik's permit was granted after one of Shuja's associates, in local custome had approached him for the permit, and achieved in addition an invitation to a special luncheon for me on the outskirts of Kabul Province, and possibly even an escort to assure safe passage. This was especially necessary because of security problems that were at all times an issue, but particularly at present. But, if I really wanted to . . . it might be available for me if I understood the risk associated with such an excursion.

We only checked in at the Pearl Continental, Peshawar, and had not gone up to the room past the sign in the lobby that states "all guests should be notified that it is official hotel policy that automatic weapons should be left at reception and no personal bodyguards should be permitted above the first floor." We hired a car and driver and drove off during the sunset prayer call. We went directly to the Mohabat Khan Vizir mosque as the faithful were coming to prayer, and admired the 1757 mosque against the backdrop of the setting sun.

I learned about the pivotal point of Peshawar on the Grand Trunk Route here below the Khyber Pass. Travellers had stayed the night in the inns along the bazaars and would tell stories of what they had seen in their travels up and down the vast Grand Trunk Route. This Qissa Khallil ("story teller's bazaar") would enthrall the visitors and also give news to some of the travellers of the dangers that lay ahead. They would tell of the group of people called Kafir (the same word in many languages means "unbeliever") who called themselves "Kalash". These were direct descendants of Alexandrian armies. They were a colorful people, though they never bathed, and had blue eyes. "One glance at a Kafir woman and a true believer would loose his soul" was the warning passed along and which added to the intrigue. These people used cowry shells as currency. They had beaded and decorated clothes, primitive implements and different language and different culture, building their houses on the slopes of the feeder streams running down to the Indus River from Baluchistan. They are still there, although in diminished numbers.

In the high valleys of the Hindu Kush, opium is grown in small plantations. There are times of the year when the children are not allowed out into the fields, because a white mist that is heavier than air hangs over the poppy fields that would get them hooked at an early age through the inhalation route. Later the alkaloids of the poppy are stored in the pod stage from which the brown resinous gum is collected for further processing into white powder. That this area was known as the White Powder Province was a name passed along from ancient to present times. A BBC documentary "Traffic" on the drug cartel across world borders was filmed here in the North West Frontier Province. The trading that occurs in the storyteller's bazaar and in other sites in Peshawar is not all innocent trade, but more recently the pot has been simmering from a lot of stirring up of pocketed populations that had been isolated, such as that which had taken place during the Russian occupation of Afghanistan. These political changes have freed up a lot of trade items that would not ordinarily have escaped from the country. Many things in the markets of the NWFP seem to have "fallen off a truck" in transit, sometimes including the truck itself. There is a very large central square in Peshawar known simply as the "money changers' market". Why so much foreign currency would be present in such a remote outpost would be difficult to understand for the naive; I had walked through this market on several different occasions, sometimes in a crowd of over 10,000, and I represented the single European face, but not the only presence of U.S. currency.

I did my major shopping in Qissa Khallil. I visited a small cubbyhole in the market where a hospitable merchant, a Pakistani, he informed me, to distinguish himself from the Afghani who outnumbered him, showed me his brass wares, his antiques, and then in this little hole in the wall shop autographed pictures of the famous folk that had stopped by. The autographed pictures included one of George Bush, several actors, a few authors. When they had appeared there, I am uncertain, since I was apparently alone as a foreigner each of the times that I had gone through Qissa Khallil, but then, autographed portraits are perhaps an exchangeable good as well. I entered one small shop and admired some antique musical instruments and flintlock weapons. One of the people showed me a bag of coins. Most of them were silver, some European, and many several hundred years old. However, some appeared to be even older. One was gold. After isolating that for a period of time and looking at other things, I asked again about the gold coin which weighed 8 grams. Through interpreters, the shopkeeper stated that it was gold so he would need a price of $200. I had recognized it as something of value greater than the gold it was purported to represent. Shuja and the others had said "lets take it to Big Brother", a reference to the fact that a Pakistani does not necessarily trust an Afghani to be telling him the truth. Wrapped in a small piece of newspaper, the coin was whisked away to a shop from which the message returned that Big Brother had seen and evaluated it, and yes, it was genuine gold of high quality. That was not my principle concern, so I had again asked if it could be authenticated as to the coinage it was said to be. It was represented as a very old coin, probably Bactrian. This would place it before the Macedonian era and possibly 3,500 years ago, around the earliest of minted gold coins. After this was further authenticated, I had offered the $100 U.S. bill in my pocket, which after some further haggling was accepted. I had paid essentially the Zurich gold price on the spot market for the raw material and bought the history free. This was later confirmed in the National Museum in Karachi in the numismatic display, in which the curator compared the single gold coin he had from the Bactrian era and mine, stating that he would very much like to exchange the one I had purchased from the Afghani.

I went on to what was purported to be the oldest carpet shop in Pakistan, since 1880 under the continuous management of a single family whose fifth generation was attending me. Several rugs were shown to me, most of them quite modern with chemical colors before they recognized that I was interested in antiques and showed me quite old beautiful rugs with vegetable dyes. The prize specimen was a Turkoman Anhura tribal rug a century old. In addition, a Noakhali from the Baluchistani border of Iran and Afghanistan was shown and a third was a Buhara rug, all around eighty years old. I am not a shopper under most circumstances, but I do enjoy learning a bit about culture as I poke along, and I picked up history by the centuries and millennia in poking around through the Qissa Khallil.

We became very late for a rendez-vous in which it was insisted that I have a highly authentic Afghani dinner including chaplikabob, which is a meat cake and sesame and other seeds in a patty grilled on a heated iron dome which we had seen and smelled all through the market in Qissa Khallil. I would get my chance to have a highly authentic Afghani dinner, it was pointed out, on the outskirts of Kabul Province through the invitation of the Malik. Are you ready?



The Khyber Pass!

The Pakistani of the Khyber Pass are said to live by a code that is most hospitable and least forgiving; blood for blood and an eye for an eye. The Pathan are the most Orthodox in Islamic religion, dress, and culture, and they predominate in the Khyber. I had been very lucky to get the permit from the Malik, but even my permit is no good at the border if closed, and rumors were that the because of the drug crackdown the day before yesterday the border had been closed. It was possible that they could reopen it at ten o'clock, but they were also certain that the first person into the Pass should not be a foreigner, especially one who might command a very heavy ransom if kidnapped. We leisured over breakfast.

We talked about the delicate political balance that Benazir Bhutto is playing on the high wire act. For example, Bangladesh (formerly East Pakistan during the post-partition era before it broke off in independence) is like Sindh rural province--a land of very rich land owners and poor peasants with no middle class, the class which is what the urban MQM represents in Pakistan today. There remain in Bangladesh one "lakh" (that is a Pakistani term for 100,000) Pakistanis who are Urdu-speaking, and if they were repatriated, they would wipe out the delicate political advantage that the rural Sindh landlords have which has kept Benazir Bhutto in power by a gerrymander that makes it possible to have a minority government officially enshrined. The government is playing a game to presume that the Pakistanis in Bangladesh are not seen and therefore do not exist, to avoid the refugee backlash, also complaining that it has refugees enough at present from the flood of Afghani who have been in Pakistan since the Russian invasion of Afghanistan. The invasion had made Pakistan a "frontier nation" bordering on and containing a Russian communist threat, so Pakistan became the second largest U. S. aid recipient to hold back the last domino. That threat has come and gone with the U.S.S.R., yet few Afghanis are showing any enthusiasm for repatriation, since they too are enjoying the largess of the U.S.-stimulated consumer economy within Pakistan. Benazir Bhutto must pull some form of rabbit out of the hat from the U.S. to which she is firmly allied and well-accommodated, since her days as a Radcliffe graduate. She was married in a traditional arranged Pakistani style to the only other large influential family and an extremely wealthy landlord of rural Sindh Province, a fellow whose wealth and position in the feudal privileged society has not caused him to doubt his privilege to beat the head of state. Benazir's marriage as well as her parentage may not be happy ones but quite politically necessary.

The delicate balance of this political unsteady state is recited to explain what happened next, which, under the pressures of the moment, I would be fated to concentrate on the foreground, ignoring the background at the time of the action. I will tell the story the way it happened to me and explain it later at the time that I learned the explanation.

With our rented car and driver (he even pulled out a uniform cap to identify himself more clearly as such) we went down Jumad Road which is what this border piece of the Great Trunk Road is named before it becomes Khyber Pass once passing through the Khyber Gate and leaving the last protection of the Khyber Rifles whose fortress is just to the right of the no man's land side of the Khyber Gate. In going down Jumad Road, shops are seen lining the road behind rubble strewn scrap piles between the road and the open shop fronts. Inside are metal working fires and people who look for all the world like village blacksmiths who are very skilled artisans in a major cottage industry here at the border of NWFP. These are highly skilled gunsmiths. If you so much as carried a picture of a weapon you would like to have produced, they can make it for you while you wait. No such picture or description is needed to produce an AK-47, which any one of these gunsmiths can do from memory and force of habit, since Kalashnikovs are produced in large numbers and good operating order while you wait.

At a distance, all that one can recognize about a figure coming toward or going away from the observer is a shrouded cloaked upright figure about human adult size. If it is a woman, that is all you will see, since the chador completely occludes the observer's vision, and most of the woman's as well, to the point that you do not know in which direction she is facing. However, the man is recognized much sooner, since he has one item of wearing apparel that is indispensable. Slung across his back or carried portarms is a fully automatic AK-47 with loaded clip inserted. This is the "Kalashnikov Kulture", an intrinsic part of the Khyber code. I had been forewarned not to touch or carry any of the arms or suspicious merchandise that could be drugs, since special agents would be following. A small stone pylon in the roadway marked thirty-two kilometers to Torkham which is the Afghani border, which meant there were more than thirty kilometers of free fire zone from the Khyber Gate through the Pass to reach Afghanistan. Our timing was very fortunate, since we arrived simultaneous with the escort.

When told that I might be met by an escort at the Khyber Gate, I had visions of a uniformed police officer wearing a sidearm. In the tradition of Hemingway and the African white hunters who had advised "take enough gun", a police guard of this description would be carrying a knife to a gun fight. A Toyota pickup truck rolled up to the gate in front of us and another one closed behind. On the flatbed of each pickup truck was a swivel mounted .50 caliber machine gun beltfed by two of the eight men in the back of each truck, each also branishing automatic rifles. The driver stayed very close indeed to the escort as we threaded our way up the hairpin switchbacks of the Khyber Pass.

All along the way, groups of men could be seen squatting in pairs or small groups with their rifles swung at the ready, and most appeared quite agitated as though passing along bad news. At one point we passed a pickup truck very similar to those driven by the escort, and apparently in this "labor intensive society" no jack had been found inside the truck. On my previous trip to Pakistan on my drive up the mountains to Kashmir Point in Muree I had seen a similar scene, and used it for pictorial definition of what a labor intensive society represented; six men were holding up the side of the pickup truck while a seventh changed the tire. The identical process was going on in the gravel roadbed of the Khyber Pass with one notable distinction in this group of seven--not one of the men had unslung his Kalashnikov or laid it aside while going about this extra manual labor.

I am a fairly accomplished "furtive photographer". I have shot quite a lot of film from the hip and have recorded in my photojournalism the headquarters of the Khyber Rifles despite the notice that it is off limits and quite a few of the passersby who were--to coin a cruel phrase--"armed but not legged". There were quite a few amputees, and from the age of the victims I would assume that it was not from occlusive vascular disease.

Something was very wrong as we progressed up the switchbacks and what it was I was unsure since the snatches of information were in Urdu or Pathan; but the driver became very tense. At one point the trailing pickup truck turned back and later the escort ahead of us withdrew. In the confusion of much shouting in many different languages, I heard one snatch of two English words "permit revoked"!

When a group of very irritated Pathan ran toward the vehicle waving their assault weapons, the alarmed driver did what I would have to applaud as the most perfect dogleg 1800 turn I had ever witnessed or been the beneficiary of, which I would have to say is high praise from someone thrown to the floor in the rapid sequence of sliding down switchback turns at high speed. There was no time for questioning and only a few clandestine exposures of film helped to piece together the sequence of events as we screeched to a halt at the Khyber Gate under the fortress of the Khyber Rifles. There, through Urdu to English translation I heard the plot and counter reaction, which is just as well that it was carried out without time for explanation during its process.

My permit for the Khyber Pass had been revoked while I was in transit through it, because it had been issued by the Malik whose invitation to the Afghani luncheon was our destination. Benazir Bhutto needed some earnest to reflect her sincerity that she was doing all that could be done to control drug crime and traffic through the Pass to announce that something positive was being done at the arrival of Hillary Clinton and entourage. The positive step that Benazir Bhutto had taken had a direct effect upon me in that she jailed the Khyber kingpins, one of the most prominent being the Malik who had issued my invitation and permit!

One of the phrases that had been heard in Urdu when the escort had withdrawn was "Allah has delivered into our hands a princely hostage to ransom for our Malik! We have few enough foreigners here and an American at that! This will serve the double purpose of being an embarrassment to the First Lady of the Great Satan and teach the foreigners to respect Islam." It was at that point that the driver might have worried that he was going to lose a tip. But the next snatch of threat that he heard in Pathan was worse "We need the American, but not the driver, and I want the car!" It was at that point that he executed the aboutface that accomplished the return of car, driver and passenger to the far side of the Khyber Gate. Not all good stories have a happy ending, but I am very happy with the ending of this good story!

We toured around the smugglers' market in the Khyber fully loaded with nearly every form of consumer goods one could wish. Some were marked "in transit from Russia via Kabul, Afghanistan". Some were still in containers with the U.S.A.I.D. handshake. We spent some time in a soap store, since the fragrance inside was far better than the odor of the open latrine outside. It seems that Afghanistan's home port is Karachi, which happens to be in a different nation, and that all these goods "fell off a truck in transit". Vehicles reaching the border are untraceable, so there is a thriving "second market" in this profitable line as well.

The biggest hit of my visit to the Khyber was made in a typical Afghani restaurant, to which I repaired in lieu of the Afghani lunch I would have had on the border of Kabul Province. One walks under fresh dripping lamb carcasses with the prized bi-lobed fat tail marking the special breed most favored here. There is a charcoal pit in the front of the restaurant, and upon entering it, the first thing noted is that they are all men within the restaurant. A few can sit in chairs at tables in the middle of the restaurant, but most sit on an elevated platform that furnishes a rug-covered floor around a central plate of flat bread with a bed of rice and skewers alternating little cubes of meat from the lamb and thick fat from the tail. It is a very greasy kind of luncheon, and one of the principle purposes of the flat bread is to wipe one's hands of the fat that accumulates after handling the skewered shishkabobs. Hot green tea is an essential chaser to "clear the grease". This is a high calorie meal in the middle of the day, yet it seems to cause little damage. Despite this "all you can eat" feast, nearly all Pakistanis seen were quite thin, indicating how much energy they have to put out in climbing up and over the mountains on a regular basis. Some of them are actually Khyber commuters in shifting things from one side of the border to the other, always in the direction of profit. Second, there is very little damage in the terms of how many rupees were laid out for this four course dinner for three cost 129 rupees or less than $4.00.

On the way out, I took a turn with the cleaver in chopping up lamb carcasses at the grills, making quite a hit among the Afghani patrons and food servers who all wanted to pose with me at the chopping block. It is just as well they did not learn that I was a board certified surgeon yielding the cleaver! Upon return back to Peshawar, I had gone with the driver who had relaxed a great deal, and we went through the busy market on a return to Qissa Khallil riding through stacks of fresh fruit, red-tinted sheep herded through the gold market on their way toward a special sacrifice, jostled by horse carts, pedestrians, shishkabob cooks, dollar changers, spice marketeers, and ever-present powder packets.

On return to the Pearl Continental to shower, I had a visitor. Wadir Safi is the eldest brother of my senior medical student Elam Safi who had asked that I carry a package back to Peshawar for his mother. Wadir Safi had been the attorney general for a prior Afghani government before they were overthrown in the current revolutionary upheaval since Russian withdrawal from Afghanistan. He had been a principle in the united factions all fighting the Russians, but then they fell to fighting among themselves when the Russians were gone. There are major parties at odds currently, Moussad, Talimar (presently a consortium supported by the U.N.) and several other minor parties, which I cannot keep straight, although Wadir Safi tried to help enlighten me, although both he and I are on the outside looking in.

I had brought a package from Elam Safi whose struggle through college and medical school had brought him to graduation this month. For his senior elective period I had arranged that he return on an international elective to Afghanistan where he had not been since age sixteen when he had last seen his mother. He had asked that I carry a package back for his family, and I had done so, stopped at several customs agents, in Kuwait and in Cairo, who wanted to search the contents. Of all things, the contents consisted of a large box of Mary Kay cosmetics! I may be one of the first people in history to bring a form of white powder into Peshawar! I was relieved to have turned over this package to Elam Safi's brother, who then wished me well and hoped for a reunion some day when we could all meet in Afghanistan if there should be a shift in the political climate.

After several of these adventures you might think it is time for me to get to work! I did so, in a presentation in Peshawar in a major conference room next to the grand ballroom where a political figure had also arrived to give a speech. Here the hotel had broken down its usual policy restricting heavy automatic weapons which were now lavishly distributed throughout the hotel. I had told my host that I usually do not say anything so inflammatory as to require that kind of heavy security. The lecture went well and the question and answer reception afterwards were also stimulating, with one further big worry. Just before the lecture began, the power failed throughout the hotel. We were now plunged into darkness with the awareness that there might be fifty automatic weapons within fifty meters, no illumination except for an occasional cigarette lighter, and, of course, no slides projected. However, the emergency generator kicked on and the rest of the evening's performance and activities were uneventful. Additionally, I picked up several suggestions for mountaineering in the Hunza and peaks and valleys in the NWFP for later return on trek.

Rawalpindi

In the morning, we had packed out from Peshawar down the Grand Trunk Route by road driven by an incessant horn-blowing driver until we came to the historic sites where the Swat and Kabul Rivers join to form the Indus River. There the Mogul emperors whose armies were made of conscripts picked up along the way who had to forge a fighting force out of this very disparate group of men. So on the banks of the Indus River at its origin a Hindu temple was built adjacent to a Muslim mosque. Both of them are in disrepair, since I doubt that the Pakistani government would do anything to keep a Hindu temple from falling apart, despite its historic nature.

The Indus River has determined a good deal of the civilizations downstream that it has nurtured on its banks, and has brought them up to let them down again when it has changed course remarkably over history as empires rose and fell because of it and its fickle course. For instance, Lahore Fort was built on the banks of the Indus River which is now six kilometers away, and when I had toured India I had discovered a completely abandoned Mogul empire capital city left high and dry by the retreating Indus.

We drove the Grand Trunk Road passing an abandoned airbase which had been very active in the 1950s. It was from this airfield that the U2 flown by Gary Powers took off to fly over Russia on an intelligence gathering information flight when shot down over Russia in the Eisenhouer administration. As we drove, we noticed that the Grand Trunk Road is only now being made into a duel highway some three hundred fifty years after the time of the Moguls. We passed through a village with an open air roadside cattle market where once per week water buffalo, camels and cattle are sold and traded. The village name is "Jhan Girsheh" and we made it through just as the entire herd was brought in and put up for sale. The camels are useful in the "Ther" Desert in Sindh Province, part of the rural power base of the Bhutto government in power at present. We arrived in Rawalpindi and checked into the hotel. Over a Chinese lunch I heard more stories of the Karakorum in this part of the Hindu Kush.

The highest point in Pakistan is K-2 which is 8,617 meters, but there are mountain passes at 7,000 meters including one called "Siachen" which has the distinction of being the site of the highest altitude warfare on earth where troops have often developed nosebleeds and frostbite and are changed every month from this duty station. This is on the border between Pakistan and India, and is a quite separate dispute from that of the Kashmir partition.

My Rawalpindi lecture lasted fifty minutes, and the discussion continued for a hundred ten minutes! The group represented the military medical school and several of the sophisticated hospitals in the Rawalpindi area, and some of the attendees stated they recognized me from my previous lectures in 1986 in these institutions. With multiple invitations to come and visit their centers or to return for a longer period of time, the discussion was finally broken up by a downpour that somewhat dampened the outdoor dinner garden party under a tent roof. The Iranians had to take a good deal of abuse for sending this airmass over Pakistan throughout the week, and I noted on the news that this had dampened the U.S. First Lady's visit in some of the more secure areas I had visited a day ahead of her. I do not believe she made a similar request to transit the Khyber Pass!

Lahore

A pre-dawn checkout brought us to the airport for two attempts at take-off before we actually flew after reboarding. The all night downpour had left standing water on the runway giving too low a coefficient of friction for air traffic control to permit rollout and so we were off-loaded after the first two attempts at boarding and taxiing. We sat in the waiting lounge next to CNN equipment and reporters fretting about not getting to Lahore to film Hillary Clinton's dampened and modified itinerary there. When we finally did fly into Lahore, I had a very rapid tour, going directly to Old Town to visit the Wazir Khan's Mosque and market. The market is a colorful place even in a downpour. Vendors are sitting unconcertedly in the open with stacks of fresh fruits and vegetables in what would be considered a public health officer's worst dream. The vendors are sitting in mud and manure, being splashed with each by every passing horsecart, diesel fuming from colorfully decorated bus flinging human excreta from adults or children. As the citizens of the subcontinent would say, "it is the failure of the rains not their presence that would be a real disaster", and they go about their business as though it isn't happening.

I then saw the Lahore Fort, again, since I had toured it during the middle of the month of Ramazan (the Urdu spelling of Ramadan) in the very hot month of June. Now, as they tore down the garlands of flowers that had decorated the tables and lamps of the open-air dinner party for Mrs. Clinton that had been rained out, I toured around the carved marble and judgement seat of the Emperor's Doualte. He was the jury, judge and executioner, and there was not a lot of "down time" in the judicial system. After the case was made before the Mogul Emperor, a trained elephant would be called upon to put his foot on the head of the accused on the marble step of the Doualte and a signal passed from emperor to elephant decreeing the guilt or innocence of the accused. If judged guilty by the emperor, the elephant read the signal and crushed his weight down. The recidivism rate was quite low!

The emperor of the Moguls called Akhbar ("the Great") had built many things including this fortress on what was then the banks of the Indus River. Through the imperial lineage, several other notable emperors had modified it to still grander elegance, including Akhbar's grandson Shah Jahan. Shah Jahan is perhaps best known for his love for Mumtaz, his wife, expressed in the Taj Mahal. But here is the Sheesh Mahal in the Lahore Fort, "the hall of mirrors", in which the convex mirrors set into mosaic patterns reflect a candle beam carried into Mumtaz' chambers like a star-filled heaven above. In the opulent marble carvings, semi-precious stone inlays and other detail work resemble the Taj Mahal, and were done by the same artisans. The fragrant garden for his bride to stroll, Shalimar, is nearby.

On my prior visit I had tried to walk across the open courtyard of the Royal Mosque, one of the world's largest. At that time I had learned that there was one momentous occasion when forty-seven Muslim heads of state had prayed here simultaneously, being thought of as the high water mark of Islamic political power and influence in the world. During that time of high Ramazan in hot June, it was difficult to walk in bare feet across the baking hot tiles of the court yard. This time, the problem was quite reversed, since we had to slosh across ankle deep water from the continuing rains. Across from the Royal Mosque is the Sikh Temple with a gilded dome looking like a copy of Amritsar. There is considerable bad blood between the Sikhs and Muslims, and a large banner is strung out in front of the Sikh Temple inviting the attention of Hillary Clinton to the suppression of the Sikhs. To complete my Rudyard Kipling collection, I stopped in front of some of the great old British architecture of the Raj and took a picture of "Kim's Gun". I then rushed back to deliver the lecture to the faculty and staff of the Lahore area medical schools before packing on to the flight to Karachi for midnight arrival.

Karachi

I spent Wednesday and Thursday touring Karachi's hospitals, giving lectures, making interviews for the medical press, admiring the very heavily endowed transplantation unit and its forthcoming new hospital (the largest charitable gift in Pakistani history from the industrial Dewan family). I picked up a good story from the nephrologist and immunology researcher from the transplantation unit. Several animals were donated to him for use in transplantation, since the first clinical human cadaver transplant had just been done that week with a donor kidney that was flown in from the Netherlands. All previous kidneys have been from living related donors, despite mulima (Islamic clerics') clearance to perform cadaver kidney grafts, the culture has been slow to catch up. With this experimental laboratory, dogs, cats and other animals were kept in cages and runs on the roof of the hospital, and the professor was donated a prize large animal for research--a large wild boar. When this was shipped to him airfreight, he went to the airport in his long white coat and all his laboratory personnel to help arrange its transfer to the hospital. He was arrested. It was only after both the police and the Muslim clerics were called to the airport and accompanied him to the hospital and saw the animal placed in the laboratory runs, that they could be persuaded not to carry him off to jail for the suspicious use of a very non-Muslim animal in his possession!

I was also told of the very high security on the streets of Karachi during the Dubai camel races. Agents have been known to kidnap kids of three or four years of age off the Karachi streets, and put them on the racing camels. The kids scream in terror, which excites the camels to greater speed. Half the kids fall off and some of them are crushed. After a BBC special reported this child abuse, Pakistani government special agents patrol the streets for child snatchers to furnish to the camel races of Dubai.

At least one group of citizens was delighted with Hillary Clinton's arrival in Pakistan. They had a gravel road up to the top of one of the small hills that for a distance of some fifteen kilometers was quite dirty and risky for the children living along that road. Because it was thought to be a good perspective from which Hillary could view the town, a trip up the road was planned for fifteen kilometers from the base, and that was paved overnight. For reasons of security and weather, the visit was cancelled, but the citizens are quite grateful to Hillary Clinton for paving their road.

Two of the physicians who were functioning as medical reporters have written to me immediately upon the completion of their three hour interviews with remarkably similar letters. "Your philosophy and influence has so changed my life that I want to follow you wherever you go and learn from you further. Consequently, if you will just sign the attached paper which will accept me into your program and arrange the immigration, I am ready to go at a moment's notice to live with you in America." If only I were running a dating service! Pakistani marriages are also arranged on such economic advantages.

Friday is the holy day and traffic nearly vanishes. I came down to the lobby of the hotel and suggested that it would be a good day to look around Karachi. The general response was "are you crazy?" Apparently, it was thought, I had not read any news nor did I understand where I was, since I would require an armed and uniformed escort to go only to those places permitted and certainly not to the majority of the areas of the city that were too dangerous even for the police. I suggested just a scenic view such as out into the Arabian Sea on a sailing Dhow. This might have been somewhat dicier still, since it would put me out into the smugglers' port, and under the guns of the navy base where I might be thought of as a photographer acting as espionage agent. With cameras under wraps, and three Urdu-only speaking accomplices, we sailed out into the Karachi Harbor and then out past the mangrove islands into the Arabian Sea. We anchored on a gravel bar and there caught and roasted crabs and a small fish called "muchli", cracking the cacaro (the crabs) with my teeth. If you were thinking that the hazards of running the Khyber Pass through heavily armed hostiles was a danger to my health, I, with a degree in tropical medicine, knew at the time that I was running a more severe risk in this little afternoon outing. And I did.

We completed tje luncheon and took a tour of Manora, a long sandy strip down in front of the Karachi Harbor and site of the naval academy as well as a beach. It being Friday (equivalent to our Sunday afternoon) the beach was crowded with lots of families coming down to the water's edge. The difference is that everyone there was shrouded from head to toe in the hot sun walking along the lapping Arabian Sea. At least the skin cancer rate should be acceptably low given the epidemiology of this cultural barrier to sun exposure!

With respect to exposure I now can report the hazard that I had carried home with me. Flying out the following day through eleven time zones and twenty-nine hours off my reset watch, I arrived in Washington to give a paper for a class in my PhD program and retired early, a little ill and weary. And now I can report the name of the unwanted souvenir which I had brought back--vibrio cholera! I do not recommend this as part of the training regimen of anyone anticipating running the Boston Marathon four days later. I tried very hard to rehydrate especially with potassium salts and went to Boston despite my debility determined to give it a try. I am happy to report three outcomes: 1) I survived, despite being much lighter than usual at the start of the race; 2) I finished, although I might have to confess that I did not enjoy the final miles that much; 3) I qualified for next year's running of the 100th Boston Marathon. It is better to be resilient and lucky than smart and secure!