WCI #188: Dr. Rick Hodes, a Life Dedicated to Service

This is the White Coat Investor Podcast where we help those who wear the white coat get a fair shake on Wall Street. We've been helping doctors and other high income professionals stop doing dumb things with their money since 2011. Here's your host, Dr. Jim Dalle. This is White Coat Investor podcast 188. Rick a life dedicated to service. Thanks for what you do. Life's not easy these days. I saw a COVID patient the other day in the ER who was not that sick, could actually go home. Shot a chest X ray. It looked pretty good and his oxygen looked good and so I was going to let him go home and we got his wife on the phone and we were all talking together and. And she threatened to sue me if anything bad happened to him. You know, what a great job we have that people are constantly threatening just to sue us in case anything bad happens, even if our actions were completely reasonable. So I actually got him a pulse oximeter, sent him home with that, told him to drink a bunch of water because he was a little dehydrated and called him the next day to make sure he was doing okay. And he said, yeah, you know, I really was very dehydrated and just needed to do that. I'm feeling much, much better today. So obviously he's not going to sue me. But you know, it's tough having a job where you have that liability hanging over your head all the time where people just walk up and threaten to sue you for millions of dollars for killing their spouse.

So.

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My pleasure. Thank you.

Now tell Us briefly about your upbringing and how it affected your views on life, medicine and the way you live your life financially.

Okay, I live in. I'm from Syosset, a town in Long island. Went to public school, came from a middle class family. My father had an insurance business, went to Middlebury College in Vermont, got a degree in geography. I lived in Alaska for several years. I like to wander around. You'll get that picture. And thought about my life and then I thought, the best thing I can do with my life is go to medical school. So I did pre med at the University of Alaska, went to medical school at University of Rochester, moved down to Baltimore and trained in internal medicine at what's now called Hopkins Bayview. And I also somehow along the way got interested in global health. And I knew that that's what I wanted to do with my career, even though there was no role models and I didn't have a lot of opportunities. So I made them for myself. As a medical student, I spent a summer in Bangladesh and a winter in South India. As a resident, I would take my vacation and work in refugee camps in Africa. And then I thought, well, I'm going to spend one year teaching in Africa after residency. So I had no money and I applied to a bunch of different things and I got offered a Fulbright fellowship to be a professor lecturer in medicine at Atisabe University. And they were going to pay me. So I said, okay, you want to pay me, I will go. So I went to Addis Abba University and I taught there for two and a half years. I taught internal medicine. It was completely different spectrum of medicine. Here I am coming from Baltimore and there we had people dying of rheumatic heart disease, people dying because they couldn't get their valves replaced, things like that. So it was a major challenge for me and I was able to intervene and help send a bunch of people to America for surgery. And then I left to try to take a job with the World Health Organization, but that fell through because of a revolution in Burma. So I ended up back in the States and I got a job working in a practice. But I really wanted to go back overseas. Israel and Ethiopia re established diplomatic relations in 1991, 1987. Sorry. And Ethiopian Jews heard about this and they started coming to the capital, Addis Ababa. So they had a major health problem. I contacted the American Jewish Joint Distribution Committee, which is an organization on the ground there. And they hired me to go back to Ethiopia. Ethiopia in 1990, to be the doctor for the Ethiopian immigrants to Israel. So in 1990, I went back to Ethiopia to be the doctor for the Ethiopian immigrants to Israel. There was about 25,000 Ethiopian Jews who were stuck on the ground. So I became their doctor. And somebody had been there for a couple of months before and helped start a medical program. I took over after that and polished it and we had a clinic that was going 12 hours a day, seven days a week. We had a nutrition program, we immunized people and started a program for TB. I ended up diagnosing 3.5% of the population with active tuberculosis. Dr. Jack Adler from New York came in who was head of New York TB for New York City. We started them on a six month, 62 dose TB regimen and they did very, very well. And it was my first big time introduction to tuberculosis. And tuberculosis has in one way or another taken over my life since then. So I've been a doctor in Ethiopia now for 33 years. And even though I stepped out because of COVID I can't wait to go back. And I've really spent my whole entire career in Ethiopia.

You know, it's interesting, we actually went to Alaska the same year I was born on vacation while my parents were living in Anchorage and they brought me home from the hospital and we went to Alaska in 1975, same year you went to Fairbanks to do your pre med work. So we have that connection. But when I was growing up in the 80s, the only thing I knew about Ethiopia was that everybody there was starving. Right. This was the example that your parents would give you if you don't eat your potatoes. You know there's kids starving in Ethiopia. Prior to going there to teach, you went as a relief worker there in 1984. And really the height of the famine. How did that experience impact your life and career plans?

Oh my gosh, tremendous. So what happened was Haile Selassie was the leader of Ethiopia and he was overthrown in about 1974. He was taken over by Mengistu Hailemarim, who was a dictator in every sense of that word. He also, Haile Selassie had what we would call a capitalist economy. Mengistu changed it to a socialist communist economy, completely ran it into the ground. So While there was 10 to 12% economic growth in the final years of Haile Selassie, it just went downhill from there. And it was a disaster in many ways. So number one, you have a lot of economic issues. Number two, you had the bad luck and partly bad policies causing the famine. And so in the late 80s, in no, I'm sorry. In 84, there was this tremendous famine, and the whole world heard about that. So I went and I was in charge of. I was working with another one of the Jewish organizations, and I was in charge of the health care in one one of the camps. So we had a cholera epidemic. We had meningitis. We had a lot of starvation. We were rehabilitating these people nutritionally. And of course, if you're starving and you're in an environment like Ethiopia, you're wide open to infectious disease. So there's a lot of consequences. So it was a very important experience for me, and I learned so much trying to work with these people and keep them alive. And Ethiopians are wonderful people. They're just. I love them. But it was my first introduction to sort of mass casualty medicine. Fast forward. Years later, when there was the problems in Rwanda and Zaire, I flew to Gomezaire and was in charge of the healthcare of 25% of Kibumba refugee camp. So what I learned in Ethiopia in round one became big time in round two because the camp had 200,000 people. So my team was in charge of 50,000 people. We had a cholera epidemic, which is a massive, massive watery diarrhea. Then we had meningococcal meningitis epidemic. And we were able to handle this in quite a nice and creative way. One of the tricks for cholera, for example, that I introduced, and I had learned this in the first Ethiopian cholera epidemic, was peritoneal hydration. So when somebody is severely dehydrated, instead of fishing for vein, you can just go into the peritoneum, and you go in an inch or two below the umbilicus after the bifurcation of the aorta. And then you make a Z track in. You put in a needle and you fill them up with lactated ringers. And an adult, you can put seven or eight liters. Liters in. Even in a kid, you can put in about 10% of their body weight and rehydrate them, and it works marvelously. I've done it hundreds of times.

And so just like the opposite of paracentesis, huh?

No, exactly. It's the opposite of paracentesis.

Awesome. So, I mean, you went to medical school in Rochester. You trained internal medicine in the Johns Hopkins system. You clearly had this overseas medicine interest right at the beginning. But this is really interesting. You came out of training, you went to Ethiopia as medical school faculty and started giving lectures. What can you tell us more about that experience? What was that like to just go to another country and start Teaching medicine there. I mean, you said you had a scholarship. I assume that probably paid some basic living expenses, but I'm sure you weren't making any significant amount of money doing that. Tell us about that experience, what that was like.

So I got this idea that I could apply for a Fulbright fellowship. And I applied for the Fulbright, and the Fulbright people said, doctors don't apply for this. And I said, is there a problem with that? And they said, no. And they said, there's two types of Fulbrights and you can apply for both. One is a research Fulbright and one is a Professor Fulbright. And I said, what's the difference? And they said, well, Professor Fulbright pays more, and you're talking about maybe 25, $30,000 a year. They said, but you need three years teaching experience. So I thought fast, here I am, you know, right at the end of my residency and said, oh, I've been teaching medical students for three years.

Perfect, perfect.

And they said, oh, okay. And residents, obviously, when you're a senior resident, you're teaching the younger ones. So I got a Fulbright fellowship. I arrived at Addis Abe University, was assigned to the faculty of medicine. And I said, what area do you need help in? And they said, cardiology. So I said, okay. I said, I'm. I'm. I'm the closest thing you have to a cardiologist. And so cardiology in America, as we know, is largely ischemic heart disease. And cardiology, especially back then, was more rheumatic heart disease. I actually published a series of 100 or 200 consecutive cases in my outpatient clinic, and it was 55% rheumatic and 3% ischemic. So I would see more rheumatic heart disease in one day than I saw in all my residency. So I got very good at listening to hearts. I would make the diagnosis by putting them in different positions, listening for the murmur of mitral stenosis, sitting them forward to hear the murmur of aortic regurgitation. People would come in with these complex congenital lesions. If they came in, for example, with hypoxia, the question is, do they have Eisenmengers or do they have uncorrected tetralogy? And they're 12 years old, and if they're lucky, they're going to have uncorrected tetralogy. And by then I had written enough letters to doctors in America that they started accepting my patients for free. I was able to send some patients to America for heart surgery. I mean, I had one kid, literally, who was carried by piggyback to my Office. And I stood outside my office. I mean, somebody knocked on the door, opened up the door, and it was an older brother carrying. And his brother was piggyback. And I said, put your brother down. And he said, okay. And his brother stood, and I said, let's walk into my office. And he picked him up again. And he was so, so hypoxic. He couldn't take more than three steps. So his brother carried him everywhere by piggyback. I got him accepted to for surgery at Stony Brook. Back then, they were doing tetralogy surgeries in two stages. They were putting in a shunt for stage one, then a year later, doing the final correction. So we flew him to America, plugged him into the Stony Brook system. This guy is now a soccer coach in Ethiopia.

Awesome.

And all that was done for free. I just had to raise money for his airfare.

So I'm curious. When you send these letters and ask docs, will you take care of this patient for free? And I assume you got to ask the hospital, too, because the operation care has to be given somewhere. What was your hit rate? I mean, what percentage of the time did they say, yes, we'll do this for free?

So. So you actually need five things. I mean, you need a passport, you need a visa, you need a place to stay. You need free surgery, you need free anesthesia. Now I'm doing spines. So you need spine implants. And it all has to come together. If you only get one or two or three, it's not enough. So the hit rate, the success rate, 15%. Like that. It's low. It's like, what's the best? The best batter is never going to hit 75%, right? I mean, so you plant a lot of seeds, and you see what grows, and you see what happens. But sometimes you get these offers, or sometimes people just like one of my Greek. There's a small Greek community in Ethiopia, and I had this kid with tetralogy, and he said, rick, can we send him to Greece? And I said, yeah, why not? This is a kid from Mother Teresa's Mission. And he said, let me call Greece. And so he calls Greece, got this kid accepted for heart surgery, and he flew the kid to Greece. The guy had successful heart surgery, stayed for six months in Greece, came back speaking Greek because he's a little kid, and rejoined his family.

Huh. Pretty awesome. You know, it makes me wonder. I hear about you doing this a few years ago, and then I know I talked to all these doctors coming out of. Coming out of their training owing 200 300, $400,000 in student loans. How can these doctors do something similar? Go to Ethiopia or wherever on a, on a Fulbright Fellowship, $30,000 a year and still do this? Can this still be done today, do you think so?

It's tough, you know, like my first year of medical school at University of Rochester in 1978, tuition was $4,500. My last year it was $9,500 and I got a $5,000 scholarship. These days, you know, if you're coming out and you owe $300,000, that's. It's very tough to, to take a low income job or a no income job for a long period of time. So there has to be a different model. People who have a skill like eye surgery, arthroscopy, things like that can come and do a procedure and teach how to do the procedure. That's the best way to do it, to transfer the knowledge to partners on the other side of the globe. But it has to be done in a very careful and planned way. I mean, like, there's lots of this crazy stuff that goes on, people showing up with great intentions, but without a partner on the other side or without a lot of planning, it doesn't work out. Like one of my partners right now, a wonderful guy named Ted Bellinger, who's in Dallas, is a wonderful spine surgeon, deformity surgeon, came to Ethiopia, had an arrangement with one of the hospitals, arrived with his team, all ready to do spine surgery. They hadn't set up any patients, and the first two days they just waited to see if any spine patients would show up. Finally somebody knew of me and called me and said, rick, do you have any spine patients? And I said, do I have spine patients? Like, I have 100, how many do you want? And they said, we have a surgeon here right now. So I spoke to him. I find out the type of patients he wanted. Not too difficult to start off, sent him a bunch, and then for the rest of the second half of his trip, was very successful, but only because I stepped in. Now he cut out that hospital and the relationship is between he and me, and I'm the one who sends him his patients. Let me just say something about spines, because it's completely changed my life. So I was taking care of the Ethiopian immigrants to Israel, and at the same time I was volunteering at Mother Teresa's mission. So I'm a Jewish doctor from Long island and I was taking care of, working with the Catholic nuns, taking care of Ethiopian Orthodox Christians and Muslims. It was the whole World working together. It was just beautiful. And we all, we work together, we love each other. It's fantastic. In 1999, I got an admission one day of two abandoned orphans and they had TB of the spine. We all know that TB is a lung disease. TB also causes spinal deformities and it causes a symmetrical V shape to the spine. While scoliosis is obviously an S, when you look at a patient straight on, you'll see an S in their spine. TB's have straight spines. When you look from the front or from the back, but from the side, it causes a tremendous V. And so of these boys, one of them had a 90 degree angle and one of them had 120 degree angle. I knew one of them was quite young, he's like six or seven. The other one was early puberty. And I knew if you have multi vertebral TB and you're in puberty, you're in your growth spurt, you're likely to become paralyzed. There's likely to become spinal cord involvement. And I didn't want him to be. He was just starting to become myelopathic and was hyperreflexic. So I wanted to help these guys, but I couldn't get them free surgery. I had no connections in the spine world, and it's even now very difficult to get free spine surgery outside Ethiopia. So I was walking around and I got this brilliant idea one day that I could adopt them, add them to my American health insurance and get them surgery in the United States. Now the problem is when you adopt an abandoned orphan who has no known relatives, they become yours for life. So on one hand I could get them surgery, on the other hand, we'd have to spend the rest of our lives together like this. Not a joke. And did I want that much permanence in my life? So I said, like, wait a minute, think, you know, I said to myself, rick, think about this. So I'm walking along one day and I looked up at the sky and I said to the Almighty, what do you want me to do? Like, in a bit of an obnoxious tone, actually. But three days later. And I'm not like one who gets messages from God, but three days later, it's like I got a fax sent to my brain and the answer was there. And it said, I'm offering you a chance to help these boys. Don't say no. So I said, okay. And again, like, nothing in Ethiopia is easy. But I went ahead, I adopted them. I added my them to my health insurance. I brought them down to Texas Scottish Rite Hospital in Dallas, and they had successful surgery of those two. One of them is now in pharmacy school in Atlanta, and the other one is a businessman in Ethiopia. Another kid came along and he had a bad back. And I adopted him and added him to my insurance and got him surgery the same way. Now, serial adoption is probably not the answer to spinal deformity. So I had to come up with a better solution. Now, the better solution has a very unusual name. His name is Ohena Boachiaji. Dr. Boachi, as he's known, is in my opinion. I don't want to insult any of your fine listeners, but I think he's the best spine surgeon in the world. He's in a great American success story. At 18 years old, he flew to Ghana. He flew from Ghana to Brooklyn with $20 in his pocket, worked his way through Brooklyn College, Columbia University Medical School. He was aoa. I was not aoa. He did his orthopedic training at special surgery. He did his spine training in Minnesota, which at the time had the best deformity program in the United States. He became a super surgeon. Was on the west, he was in Minneapolis, he was on the West Coast. Then he went. He was chief at Special Surgery for years. He made money that way. He moved back to Ghana and opened up his own hospital, which is called Focus F O C O S Foundation for Orthopedics and Complex Spine. And he does fantastic surgery there now. I did a neurosurgery presentation at Mount Sinai Hospital some years ago, and the chief of neurosurgery said to me, rick, the surgery that you're doing in Ghana, we can't do here at Mount Sinai. That's how complicated it is. And so working with Dr. Bwuachi, we first met in 2005 and. And we decided. We spent a day together and we decided we could work together. But he also needed money because he said he and his team work for free. But they have still still have to pay their Ghanaian staff and they have to pay the Ghanaian hospital system. At the time, they were not. They didn't have their own hospital. They. They were working at a government hospital called Korlibu. So I raised some money. In the spring of 2006, we sent five kids to Ghana for spine surgery. It was a learning curve for all of us. So we sent one staff. The one staff was not enough. We literally found out. So what happens in the Ghana hospitals is at night, the nurses. 10 o' clock at night, the nurses sit down, they put a blanket over their head and they go to sleep. And so we have to take care of the nursing care of our patients. That's crazy. And so later on, we sent more staff. And then later on, Dr. Boatschi opened up his own hospital so that now it's a real hospital and we don't have to provide the nursing care. In fact, because I also take care of kids who met rheumatic and congenital heart disease and have a partnership with the Hindu hospital in India. And so when I send patients to them the first time, I specifically sent a nurse so that she would assess somebody I like and trust very much so that she could assess the nursing care. She came back and she said, Dr. Rick, the Indian nurses are great. They work all the time. They don't sleep for one second at night. She said, you don't need me. You just need a translator. So I opened up my spine practice in 2006, and that year I got 20 new spine patients, and we did 11 surgeries. I'm the only doctor practicing spinal deformity care in the country that I know of, and we are now getting about 500 new deformities a year. And so I now have, really, the largest collection of the worst spinal deformities in the world. We had a paper in the European Spine Journal last year with nomenclature for three new deformities. We have an alpha, we have a gamma, and we have an omega spine based on these new shapes that we're discovering that we can't put words to. So we're using Greek letters. I'm raising money. We're sending people to Ghana for spine surgery. And in Ghana, we're putting them into ambulatory traction, Halogravity traction, invented at Scottish Rite in Dallas. They drill four holes in the skull, they put a halo around. They stretch them 23 hours a day when they sit, when they stand, and when they lie down. And then they go ahead and they operate after, say, two, four, six months, and they still have to do major surgery, including removal of vertebra, which is called the vcr. That's a very big deal. But they're doing all of that. We're getting very nice results. And then I also have teams coming into Ethiopia to operate inside the country. That's a lot cheaper. And we're also training Ethiopian doctors because our ultimate goal is to put ourselves out of business and be the advisors and have our fine Ethiopian doctors doing all of this themselves.

It's pretty remarkable what you've been able to accomplish over the years there. And at the rate you're moving. I'm sure you'll be able to accomplish that goal and get yourself fired eventually. Here.

Yeah, I have the support of my organization, the American Jewish Joint Distribution Committee. They are sponsoring us. We have to raise all of our money to fund the project. And I work on that. I'm probably in the States about, on a normal year, 20% of the year. And I'm visiting family and doing fundraising.

Let's talk just for a minute about that fundraising. It sounds like you do a fair amount of it. @rick hodes.org which is your website, it lists the following dollar amounts. A hundred bucks for an MRI, $500 for pre surgical tests, $1000 for two weeks attraction, $10,000 for a set of spine rods and screws, 1900 for a full cancer treatment, 10,800 for a full heart surgery, and 29,800 for a full spine surgery. Some of these are pretty big ticket items per patient. How do you raise the funds for this cause?

Yeah, we don't charge our patients anything. Occasionally they will have a relative in the States who will raise money. Recently I had a patient from Eritrea who needed spine surgery. And I contacted the relatives in the States. They raised the money through the Eritrean community in America. And we sent. But I have a website. People contact me. Some people send me $20 a month, some people send me $100 a month, some people give me $50,000. We put all the money into our project and that's what we want to keep on doing.

Awesome.

The thing is, like $28,000 does seem like a lot of money for a surgery. That same surgery in America could be a million dollars. I mean, if you're putting somebody into traction in the hospital for three, four months and then you're operating, that runs into millions. I mean, for example, I know of a case of a specific patient in New York City who had very good insurance, who had traction and surgery. His medical bill was $1.5 million.

So in that respect, it's an incredible value.

So it's incredible value.

We ought to be sending this guy to Ghana to have it done.

Absolutely. And in fact, like, I've spoken to the Ghanaian doctors and I said, get yourself accredited as an American hospital and you're going to get people coming over from America. And now they've become an international resource. So people through my website, contact me. And Dr. Bwatche has patients coming from the Philippines, from Rwanda, from all over the place. One of my dear friends is a doctor in South Sudan and she brought me A patient, I brought the kid to Ghana. He had surgery, and now we're trying to get him back to South Sudan. And so one of the things I was working on this morning was getting my son, the businessman in Addis, a visa for South Sudan so that he could fly to Ghana, pick up this kid, and bring him back. He's somewhat paralyzed now. We expect him to get better. We find that many of the paralysis do get better over time, but it takes time.

Now, you can also donate frequent flyer miles to the cause. It helps transport patients from Ethiopia to Ghana or India. How does that work exactly?

Yeah, so that actually is possible. People contact me, and we do it the way. It's not a formal program, but we do it by private arrangement. And we've had. Have had patients say, I have 50,000. I have 100,000 miles. Can you use them? And depending on the airline and so on, we can work out a way of using that to pay for our patients to go to Ghana for surgery or to go to India for heart surgery.

Awesome. So if you'd like to donate to this cause, it's really easy. If you go to rickhodes.org, you can just follow the links, and it's relatively easy to donate money or even donate extra miles that you have to this cause. Now I want to turn the page back a little bit to this interesting chapter in Your Life in 1991, where you participated in Operation Solomon, which I will bet most of my listeners have never heard of. This was essentially a covert Israeli military operation to airlift Ethiopian Jews to Israel over 36 hours. In 1991, they airlifted 14,000, 325 Ethiopian Jews in 36 hours. And it includes a record that is almost unbelievable. 1088 people on a single plane, which was made possible because nobody brought any luggage and everybody was so thin. What was that like to be part of that incredible 36 hours?

I could take another hour of your podcast to talk about this. I was hired to be the doctor for the Ethiopian immigrants to Israel. And we had all of these people who needed to get to Israel. There were secret negotiations between the Israelis and the Ethiopians to try to get people out. And the Ethiopians at first said 1,000 people a month could go. So I was hired at the beginning of this. And so it seemed like there were 25,000 people. It was going to take a while. Meanwhile, In May of 1991, Mengistu Hailemattium, the dictator of the country, fled. There were about 15,000 Ethiopian Jews still left in Ethiopia. At the time, the Ethiopians contacted through George Bush Senior contacted the Ethiopian government again and got permission for Operation Solomon. So I was walking across the lobby of the Hilton Hotel. Let me back up, because the story gets better. I had a woman who had come in from Sudan. She was pregnant, and she had malaria. Now, malaria in pregnancy is a terrible situation because the placenta becomes like a magnet for the malaria parasite. And it's very easy to lose the mom, and it's very easy to lose the fetus. So this becomes like a medical emergency, and you often have to give. They hemolyze, and you need to give them blood transfusions. So I needed to get. I needed to give her a blood transfusion. Her husband, who was with her, weighed less than 50 kilos, so he didn't weigh enough to give the. To give the blood. I myself needed to. I said, okay, I'll give you one unit, but we have to find somebody else. I went to a shoeshine boy, and I said, how much do you make in one month? He said, $5. I said, great. I said, I'm going to pay you $20. I need. I want you to donate blood with me. He said, great, let's go. He went down to the blood bank. He looked, and Ethiopians, culturally, don't like donating blood. And it's a perfectly hygienic place. It's done very well. I have no hesitation. But he just said, there's no way I'm donating blood. And I said, there's a pregnant woman who can die. You can save her life. He said, I don't care. So then I needed to find a blood donor. So I said, okay, people. We knew that Operation Solomon was going to be the next day. This is like, we who had inside information knew all of this. So I went to the Hilton Hotel, and I knew there must be Israelis around. So I was slowly walking around, just listening for Hebrew, and there were four guys speaking Hebrew. So I said, shalom. My name is Dr. Rick Hodes. I'm medical director of the American Jewish Joint Distribution Committee. I need somebody to donate blood with me right now. And they looked at me, didn't say a word. And like, 30 seconds passed, and I said, okay, shalom. My name is Dr. Rick Hodes, medical director, the American Jewish Joint. I repeated myself. One of them looked at me, and he said, I can't donate blood. And I said, why not? He said, tomorrow's going to be a very busy day. I don't want to be tired and using more profane language. Than this. I said, doesn't anyone give a damn? I said, there's a pregnant woman who can die and you're worried about being tired. And I turned around and I walked out. This guy got up and he ran after me and he grabbed me and he said, doctor, let's go. And I said, what made you change your mind? He said, I have a pregnant wife. And so we donated blood together. It turns out he was the lead correspondent for one of the Israeli newspapers. So he wrote about all of this. I had no idea who the guy was. He later became Israeli ambassador to Mauritania. So he wrote about this. The next day, we called together a group called the Committee. The committee was the 15 most educated people in this population of 15,000. Now, educated means maybe they had a high school education. We said to them, go to every single house of all the Jewish people. Tell them, drop everything and come immediately to the Israeli embassy. Bring only your family and any medical records you might have. Because people had kept their X rays themselves sometimes, and that's it. And they went out to spread the word. My job was getting people out of the hospital. Now, all of this had been worked out on our computer system. So each person had five people he needed to tell. Each of them had five people that they needed to tell and so on, so we could get a message out inside the Jewish community and keep it there, at least for a while. They went out to spread the word. My job was getting people out of the hospital. So I drove across the city to the leprosy hospital. And I had a boy who was 10 years old, very malnourished, who had both tuberculosis and leprosy. They wouldn't let him go. I waited till they turned around. I picked him up over my. Put him over my shoulder and I started running to put him in my car and drive away, literally kidnapping this kid from the hospital. And Ethiopians were running after me. And, you know, Ethiopians are good runners. But I got him into my car, covered him with newspaper which I had prepared, and we drove out and delivered him to my office. Then there was actually something miraculous that took place. I went to another hospital. There was a kid with meningitis. And I said to the mom, I speak Amharic, the Ethiopian language. And I said, you and your kid can go to Israel. Let's go right now. She said, this is. This is 10 in the morning. She said, no, I have to be here at three o'clock in the afternoon. My brother's going to meet me. So I just lied and I Said, you brother's waiting for you at the embassy. And he said. She said, no, I'm not going. So I went to the Israeli embassy, not knowing what I was going to do. I walked in. There's a crowd of people walking in. It's like people going into Yankee Stadium. I mean, just thousands of people, because the word was out. And a lot of strangers were there as well, trying to get in. Somebody tapped me on the shoulder and said, doctor, you need to help me. My sister is here. My sister's in the hospital. Her kid has meningitis. What do you want me to do? And I said, oh, my gosh, you were sent by the Almighty. Let's go. We got in my car, took him to the hospital, and she left. So at the end of the day, I had 12 people I had gotten out of the hospital. We put them on mattresses, and my head nurse came to me. She said, Dr. Rick, you need to eat. And they need to eat. I said, do we have any food? And she said, we have the kita. Now, it's interesting. This is May of 1991. I worked for a Jewish organization, and we had sent in a large quantity of matzah, which Jews eat on Passover, except that it took some time to clear, and it wasn't cleared until a week after Passover. So we had this in a packing crate in our front yard. So we opened up our container, and everybody got a whole bunch of matzah. Mr. SlimFast had donated thousands of packets of SlimFast to us. And so we gave them Slim Fast to eat. We gave them matzah to eat. And I sat there and I wrote my medical summary, and I thought, isn't this appropriate? I said, you know, when the Jews were in, during the exodus in Egypt, we ate Passover, we ate matzah in the desert, and they're in the middle of their exodus, and they're eating matzah on their mattresses here. So at the end of the day, 14,000 something people flew to Israel, 39 flights. The 747 that took off with, like, I don't know, 1079 people landed with 1080 people because one baby was born on the plane.

Yeah, it's pretty awesome.

Yeah.

Now, this is a financial podcast. I have to at least ask some financial questions along the way. Now, while doing all this international work, none of which, I presume, pays well, if at all, have you been able to save anything up for retirement at all? Along the way?

I have been able to save for retirement, and I have some Investments. And I have a retirement plan because I work for jdc. So they, I have their. Not their new retirement plan. I have the better old retirement plan. So I do have some, some potential to retire. And I'm also paying into Social Security.

Okay. Now, many physicians I run into feel burned out on medicine. They want to save up money and get out of medicine as soon as possible. They want to fire is what the acronym is in the community. Financial independence, retire early. This sort of thing was clearly never in your plan. How have you been able to sustain your passion for medicine and service over so many decades? And what advice do you have for doctors who feel they're losing that passion?

You know, I have a monthly zoom call with people that I was residents with, and I'm very much in touch with some of my classmates. So I know the stresses and the problems of being a doctor in America right now. And doctors are losing control. We have managers telling us the number of patients we should see and bean counters and so on. And I certainly sympathize with the situation that many American doctors find themselves in. What motivates me is the fact that I know that I'm personally making a difference. And if I don't go to work, somebody's going to die. If I don't do this, it keeps me going. And somebody wrote something. One of my patients wrote something a few weeks ago for my website. And she said this is just this amazing thing that she came up with. She said, you can't change the world, but you can change one person's world. And so when you change enough one person's world, you're changing a lot of worlds. So that's what I try to do. But I understand the problem. And I understand if you're too pressured and you don't have balance in your life, then life becomes terrible. So we have to somehow work to restore balance. And what I do, at least not like I take real vacations, but I at least leave the country and I'll. I have lots of frequent flyer miles, so I'll fly somewhere and work from somewhere else for a week and take half day off every day, every day and just walk around Bombay or Bangkok or Angkor Wat or something like that just to have a change of scenery.

Now, some people have criticized international aid programs as doing more harm than good. I looked and found a quote from a New Yorker, William East Easterly, who is a professor of economics at NYU and the co director of their Development Research Institution, who said, we've already spent as official donors 600 billion in aid to Africa over the past 45 years. And after all that, children are still not getting the 12 cent medicines to fight malaria. So there were still between 1 million and 3 million deaths from malaria last year. So aid would be a great thing if it worked. But the sad tragedy is that, and this is really one of the scandals of our generation, money meant for the most desperate people in the world is simply not reaching them. 600 billion in aid in Africa over the past 45 years. And over that time period there's basically been zero rise in living standards. Now personally, I've had a few international medical experiences where I felt I wasn't accomplishing much long term good anyway and maybe even doing harm. What do you think is the key to effectively aiding others in less developed countries without doing harm to them on an individual or a community level?

This is a great question. Thank you for asking this because you see so much nonsense going on. I mean, you see for example, NGOs that spend thousands of dollars for the nicest cars. Like a so called Christian NGO spending $3000 for their sound system in the car so that they have the best stereo sound system. Like my car doesn't have a radio. Or a British group who thinks that they're doing wonderful things by shipping an old CAT scan to Ethiopia. It ends up in the hospital, it does 12 CAT scans, it dies and that's it. So like all this money that they sent to send the CAT scan, you know, went into, into doing 12 CAT scans and that's it. While maybe if they had invested in handheld ultrasounds, they could have gotten a lot, lot more bang for their buck. So you need to ask yourself, is this needed, is it effective and is it sustainable? And if it's not, like for example, somebody wanted me to send a C arm to one of the hospitals, but the hospital had no interest in the C arm. Like it was the outside doctor who was saying these people need a C arm because he wanted, he knew that, you know, to do good orthopedic surgery they should have a C arm. But they had no interest in the C arm. They weren't asking for me for the C arm at all. And I just said no. I just don't think at this point that it's a good way to spend money. Now In Ethiopia, in 1984, the gross national income was $210 per person per year. Now it's up to 850. So we are actually on the upward trend and development is going in the right direction. Part of it is because we have a change in government and we have much more of a capitalist system than we did when the communists were running it. And communism, we all know, is not, is not a good economic policy. So you need economic development, you need education. So if you educate a bright and motivated person, that person's going to take off a lot. And so one of the things that I like to do is send people to school and there's programs to do that. And another thing that I like to do is help individuals not become handicapped. And that has to do with the spinal deformities. Now, you know, $26,000 or something for a spine surgery, that's a lot of money, you know, compared to, for example, that a cataract surgery is some small percentage of that. On the other hand, as we know, there's 3% of Americans with spinal deformities. And in Ethiopia we have old polio. 5% of my patients have neurofibromatosis. 1/3 of my patients have TB of the spine. So there's lots of other reasons that Ethiopians have spinal deformities. And I don't think that we can just forget them.

Thank you for sharing that. Now there'll probably be 30 to 40,000 people that listen to this podcast. Most of them are doctors, but doctors and other high income professionals, you now have their ear. What should they know that we haven't already talked about in this podcast?

Well, they've heard a lot. I mean, they've heard how I'm working to bring the world together, that, you know, I'm working in an international, inter religious, interfaith, inter ethnic environment to make the world a better place. And that for not a lot of money, we can help a lot of people. If they would like to contact me, if they would like to read more about our work on the website, if they're interested in doing a difficult case, or maybe not so difficult case in America, I have lots of potentials. If there's a spine surgeon out there, I can send you very, very interesting patients. I have a kid right now, for example. I just have to tell you about this because this is so amazing. This guy has, he could look up, he could look down, but he couldn't look horizontally to the right or to the left. And he had a severe scoliosis. So there's like 60 people in the world who have horizontal gaze palsy with progressive scoliosis. It's a robo3 gene. But the very, very amazing thing is his brain has no decussation. So the right side of his brain controls the right side of his body. The left side of his brain controls the left side of his body. Like, I had no idea that that ever occurred. And in this small number of people, it actually does. Now, it's interesting, in albinos, it's the opposite. Albinos over decussate. And it's not 50 50, but we have a lot of very interesting stuff that we're able to offer people if they might be interested. The other thing is that I do academic talks and I give pediatric grand rounds, medical grand rounds, neurosurgery grand rounds. If anyone is interested, they can contact me. And I'm happy to work that out. And now that we're all used to zooming, I don't have to fly into Salt Lake City. I can. I can zoom in in a second. So thank you so much.

What's the best way for them to contact you if they're interested in reaching out to helping what you're doing, or to reach you for a grand rounds or something like that? What's the best way to contact you?

Just through my website is fine.

Rickhodes.org awesome. Well, Rick, you are an inspiration to us all. I tell my readers all the time, thanks for what they're doing, but thank you for what you do. You have made a dramatic difference in the lives of hundreds and hundreds of patients.

Thank you very much. You know, I have this sign that I keep over my desk. It's from one old rabbi, but it says, stop thinking about what you need and think about what you're needed for.

Awesome. That's good advice.

That's the thought that I start every day with. So I want to thank you and wish you all blessings for a good year and a good life.

Thank you very much. Wasn't that great? It's really inspiring to talk to people like Rick. You know, he mentioned that he'd been introduced at a conference in New York City as Rick is the doctor that I wrote that I wanted to be in my medical school admissions essay. And I think that's a lot of. There's a lot of truth to that. I mean, we all wrote in our essays that we really love science and just really want to help people. And you look at somebody like Rick and he's actually doing it. You know, he's right. $30,000 is a lot of money, but it changes a life. It takes him from having no life to having an incredible life. And it's a bargain. You know, it's a million and a half bucks if we do it In New York City, it's 30 grand if we do it in Ghana. So I'm pretty inspired by that. You know, in between the time I recorded that interview and now that I'm recording the end of this podcast, I texted Katie and said, can we don't seem to donate some money to this guy. And, and she said we could. So here's what we're going to do. We're going to match every dollar you donate@rickhodes.org now this is a great organization, right? This is run through the American Jewish Joint Distribution Center. If you look this up on Nav on Charity Navigator, you will see that it gets a very high rating. They get a four star rating and they get 92% financial score and 100% transparency score. So that's pretty good for a charity. This is a good charity to donate to. They're obviously doing some fantastic work. You got somebody like Rick Hodes directing it down there. I mean, it's wonderful. So we're going to match every dollar you donate. So if you will go to rickhodes.org and donate some money this holiday season, shoot us an email as well, tell us how much you donated it and we will donate that amount as well. We're going to donate a minimum of ten grand. We will match your donations up to as high as, let's say 50 grand. You guys donate 50 grand, I'll donate 50 grand to rickhodes.org and get some of these, you know, some of these people fixed so they can have a real life. Awesome stuff. And you know, as I sort out what I'm going to do with my life, just like you guys do, I hope that I can have as much impact as somebody like Rick has had. The White Coat investor is proud to introduce our no Hype Real estate investing course which will provide the framework for developing further knowledge and experience. Experience as you progress in your real estate investing career. We call it an introductory course because there's always more to learn. But this is no short, superficial course. There are over 200 lectures and videos adding up to more than 27 hours of content by over 15 different instructors. We think it just might be the best real estate course on the planet. Continue your wealth building journey today with the no Hype Real estate Investing course@whitecoatinvestor.com courses. You can do this and the White Coat investor can help. Don't forget about WCICON21. That registration is going all the way through the event, but if you sign up before January 5th, you get the swag bag, which is going to be awesome. We're going to mail it out to you. It's got books, conference, t shirt, etc. Also the zero to freedom course. You only have a few more days to get the 300 off that. Also, if you sign up through our links, we'll give you our WCICON 18 online course. This is WC icon Park City. And we'll also give you a signed copy of the White Coat Investors Financial Boot Camp, so check that out. You can check out the conference whitecoatinvestor.com conference. You can check out the Zero to Freedom course for direct real estate investing at whitecoatinvestor.com rental thanks. For those of you who are leaving us a five star review and telling your friends about our podcast, our latest review comes from Omega CRNA left this review on Halloween saying worth your time. I've been following the blog since 2012 and credit much of my knowledge in financial literacy to the White Coat Investor. It's focused on helping us get a fair shake on Wall street by empowering us with the knowledge has expanded greatly since you launched the podcast. Great job Jim. Keep up the good work and congratulations on growing your business while helping others succeed in theirs. Five stars. Thanks for that review. Those reviews actually do help get the word out about this message to your peers. Head up, shoulders back. You've got this and we can help. We'll see you next time on the White Coat Investor Podcast. Stay safe out there.

My dad, your host, Dr. Dahl, is a practicing emergency physician, blogger, author and podcaster. He is not a licensed accountant, attorney or financial advisor. So this podcast is for your entertainment and information only and should not be considered official personalized financial advice.