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In the spring of 1965 I was 27 years old, single and on the last leg of my internship. I was also emotionally drained. Six uninterrupted years on a treadmill of demanding medical studies had left me desperate to slow down. When my induction notice arrived, I initially felt only reflex embarrassment. Couldn't I have avoided the draft? Shouldn't I have? But then I felt relief.
Why am I running? Because the Vietnamese youngster in my arms still breathes? Because I can't abide his dying in his father's arms waiting his turn to see me at the outpatient clinic at the benh-vien (hospital)? Later I will hear of the murmurs. Who had ever seen a doctor running? Who had even heard of a doctor carrying his patient to the in-patient ward, let alone as the entire hospital was shutting down for the noon siesta? Nobody really expected the boy to live anyway. He had rabies. By midafternoon the boy is dead, the clinic up and operating again, and I am feeling disoriented.
In August 1965 I was at the Medical Field Service School at Fort Sam Houston, Texas, training in the basics of military medicine. It was there that I learned of an extraordinary program, sponsored by the State Department, by which selected doctors–volunteers–would be placed on loan to the Vietnamese Public Health Service. Called the Military Provincial Hospital Augmentation Program (MILPHAP), it would entail small medical teams, from all three branches of the armed forces, sent to beef up civilian facilities. Although it was to be classified as 'counterinsurgency, I immediately related to it in personal terms. As a preschooler, I had accompanied my father on his house calls in rural Connecticut. Standing solemnly by the bedside as dressings were changed and words exchanged, then sharing refreshments in the kitchen, whenever I had imagined myself as a doctor, it was always as a doctor like my father, on the road, seeing people where they lived, a doctor sitting down to eat with his patients. I volunteered.
The Vietnamese boy stands motionless, unresponsive, his gaze vacant. His arm remains extended just as I'd left it. Catatonic stupor. The family who'd brought him in describes its onset, which followed a bombardment of their village. Post-traumatic catatonic stupor, then. He's admitted. Blood tests show falciparum malaria, and he is given chloroquine. He recovers fully. It was cerebral malaria the whole time.
On June 20, 1966, after a 26-hour flight crammed alongside other physicians on rows of canvas jump seats in a two-window C-141, I arrived in Saigon and then received an eight-day briefing in Cholon. Among the handouts was a copy of Standing Orders, Rogers Rangers, 1759. Order Number 1: Don't forget nothing. Number 15: Don't sleep beyond dawn. Dawn's when the French and Indians attack.
My medical school alumni association and friends send supplies, such as griseofulvin to cure the disfiguring ringworm that is rendering local girls unmarriageable.
Two other physicians and I, along with two sergeants and six medical technicians, made up our team, and with our administrative officer, Lieutenant Henry Brown, who coordinated everything, we officially became the 734th Medical Detachment. Our assignment was Public Health Region II, in the region where South Vietnam bends left like a comma–the Central Highlands province of Darlac, peopled by the Nguoi Thuong, or People of the Plateau, called Montagnards by the French.
I can't seem to reassure the distraught father that his son, sick with pneumonia, will recover. He is simply inconsolable. Only later do I find out that an army truck struck and killed his other son on their way to the hospital.
We landed in Ban Me Thuot, a sprawling city of 50,000, home to the Rhade tribe and, since sometime after 1954, to the many North Vietnamese refugees who had fled communism and were resettled here. These two racially and ethnically distinct peoples now lived side by side in uneasy accommodation. A recent Montagnard rebellion, aiming to drive out all outsiders, had begun here in Ban Me Thuot in 1964, and the leaders, under the banner of FULRO (a French acronym for United Front for Liberation of Oppressed Races), still armed, were close by in Cambodia. Like our Vietnamese colleagues and patients, we too were a racially mixed bunch. Our radio call name was Sport Grant.
How long does the spirit of the deceased haunt the hospital before it becomes safe for others to go there? What are the natural medicines used? What are the values and attitudes on pain, age, infirmity and death? Why does the Montagnard vocabulary seem so sparse in terms denoting subjective symptoms? I discuss these questions with Y Tang Rulick, director of the Lac Thien District Dispensary, who is seeking to record this sort of information and publish it. In my October report to the public health director, I recommend that funds be provided for his efforts.
We were welcomed by Bac Si (Doctor) Ton That Niem, who was public health director of II Corps and acting head of Public Health Services of Darlac province as well as medical director of the civilian hospital in Ban Me Thuot; the U.S. Agency for International Development (USAID) representative; and a sister from the Benedictine convent. We would be directly responsible to Dr. Niem. We rode the 15 kilometers from the airfield in Land Rovers. It was monsoon season, but the sun was out. I was rested, confident and eager to begin.
I disqualify myself. The authorities simply have to find someone else to determine whether or not their prisoner is malingering. A VC suspect, he apparently had a seizure during an interrogation. They need to know, because if he's not malingering they probably won't execute him.
We were nominally advisers (all of us wore the MACV patch), so our room and board were courtesy of the MACV Advisory Team 33 headquarters, placing us just walking distance from the civilian hospital. Four bilingual youths–Zwi, Chin and the Nguyen brothers Hoan and Din–were our interpreters, courtesy of USAID.
The desperate mother continues trying to force her infant to swallow the adult-size pills. She is using a spoon and water. But the child is already dead, drowned from the water forced down its lungs.
The sprawling provincial hospital, made up of single-story structures and interconnecting pavilions in the French colonial tradition, included a pay ward, charity wards, surgical suite and ward, midwife/obstetrical unit, outpatient clinic with injection room, laboratory (urinalyses, blood chemistry, hematology, bacteriology, parasitology, X-ray services), pharmacy and offices. The hospital was chronically short of medicines and other supplies. No medications were dispensed on weekends. During times of severe shortage, patients picked up and went home. One civilian doctor and a visiting military surgeon were the only physicians overseeing all clinical care. Dr. Wheeler of MACV Team 33 and Dr. Paulk of the 155th Aviation Company had been volunteering their time at the Montagnard charity ward. Dr. Stanley Banach and Sergeant Strickland were assigned to the pay ward, along with Pfcs Aragon and Rodriguez. They would be working with a Vietnamese nurse and H'Nhe, the Rhade nurse.
I drive my jeep to the airstrip on the outskirts of town. There, in the hangar, are the Montagnard tribesman and his sick daughter, just as the pilot had said. I confirm she is the patient who'd been discharged four days ago from the hospital Montagnard charity ward due to continued lack of medicines (and they had no money to buy the medicine in town themselves as directed). The child's condition, deteriorating from lack of adequate food and water, is now certain to deteriorate further because, unknown to her father, planes from the 155th simply don't go to Quang Duc, from whence they'd come several weeks earlier. I drive the girl and her father back to the hospital and place her in the pay ward this time, as some GIs have offered to pay for her care. The medicines she needs are available at the pay ward and in stock in the hospital pharmacy.
Dr. William Baxley and Pfc Davis were assigned surgical responsibilities, in support of the part-time Vietnamese military surgeon, Captain Lam. Privates Guingrich and Melberg were assigned to the laboratory. My assignment, along with Sergeant Sanders and Pfc Harris, was the outpatient clinic of the benh-vien.
The young man lies unconscious, a reported overdose. When I find that no matter how I raise his flaccid arm and drop it, it never hits his nose, I seek more information. This apparent collapse followed an angry confrontation with his uncle (who is now standing in the gathered crowd). I gravely examine the patient's deep tendon reflexes with my little doctor's hammer and then solemnly announce (Hoan interpreting) that he would wake up in 20 minutes. We all step back. Don't you think he took the phenobarbital? Hoan whispers. We'll see in 20 minutes, I reply. Five minutes later the lad sits up, acts groggy and leaves in the care of his now attentive and apologetic uncle.
With Sergeant Sanders and Pfc Harris, I took up my position in the clinic, joining Dr. Lang, her technician Ba Lung and Co Nam, who gave the injections. We discreetly stood by, observed them and waited. It seemed days before I was invited to speak or contribute. Eventually, I was asked my opinion about a difficult case. Afterward I asked if they'd like us to move the never-used examining table closer to the window for better light. They nodded. Then I asked if we might put up a second examining table with a screen, then additional tables. Finally, we just went ahead and scrubbed down the entire examining room, eliminating all the small flies and worms from behind the long-stationary furniture. In the waiting area, we set up educational posters that explained fundamentals of hygiene and sanitation. Thus we made a workstation for ourselves.
Hoan helps us with the cleaning. You don't have to do this, I tell him. You are the interpreter. And you are a doctor, he points out. We next convert a small, adjoining room with running water into an outpatient laboratory. There, we are also able to wash and apply ointment to diseased skin, sponge patients burning with fever, give enemas for constipation and set up intravenous fluids. We give ear irrigations, foot soaks and tapeworm purges. We apply skin creams.
Work with your counterparts, we were told. Do not attempt to take charge or to make changes. Avoid giving the impression that you know better. The ultimate goal of the MILPHAP mission was clear. We were there to win the hearts and minds of the people to their government, not to ours.
Captain Lam, the South Vietnamese army doctor and surgeon, has personally come to the outpatient clinic from the adjacent military hospital in response to my hurried note requesting a consultation (a woman with advanced cancer; can you operate?). After shaking hands with me and greeting me in French, he turns to my interpreter and commences a stunning, two-minute verbal outburst. I stand, in shock. I understand nothing he says, but his rage is unmistakable. In the startled waiting area, all stare in embarrassed silence. Abruptly Doctor Lam finishes, turns and marches out before any translation is rendered. Hoan sits. Ong noi gi? (What did he say?), I whisper, preferring to use the few Vietnamese phrases I am picking up. A trembling Hoan explains. Doctor Lam, it seems, read my note as simply a slur about his medical qualifications. Now my mouth drops open like everyone else's.
The usual military activities were the occasional mortaring around the outskirts of Ban Me Thuot or attempts to ambush convoys that left for Qui Nhon and Pleiku. I went about in civilian clothes when the clinic was closed, to emphasize the noncombatant nature of my presence and intentions.
I think Co Nam likes me because I shoo away the crazy Chinese opium smoker who brings along his collection of obscene pictures and looks at them and displays an erection when it comes his turn for his injection.
It quickly became obvious that the most ubiquitous medical problem on the wards was malaria-related. It was also clear that patients came only when the illness was far advanced, and commonly discontinued treatment at the early signs of improvement. Despite being the minority group, the Vietnamese made up a sizable portion of the patients who appeared for treatment and often displaced Montagnard patients to get a hospital bed. We sent for medical texts to educate us.
The boys take some mops and pails and wash down the small two-bed room adjacent to the pay ward. When they leave, the patients on the ward ask that the equipment be left behind. Next morning the pay ward is spanking clean.
Eventually, all of us doctors made excursions to places such as the Chieu Hoi, or Open Arms, refugee center (for VC defectors), district dispensaries and village and hamlet aid stations (e.g., with mobile immunization teams). It helped when we used loudspeakers and played Rhade music to encourage reluctant or distrusting villagers to come forward.
Meanwhile, we also found time to provide medical services for the workers and for the hundreds being cared for at the nearby leper colony. We provided house calls on an as-needed basis to the province chief, USAID staff, General Minh of the ARVN 23rd Division and missionaries whose own medical doctor had been kidnapped by the VC several years earlier.
The rhythmic beating of the gongs from across the long house is hypnotic, and the effect of the obligatory cup of nampay (rice wine), sipped moments earlier from one of the large communal jars, is starting to take over. I know I promised the Special Forces captain I'd be alert and sober when I returned to camp after dark. But gradually another feeling dominates: This is OK. This is what I came out here to do. I let myself forget the sick people waiting, the sick child waiting. I pass out.
MILPHAP also ran medical civilian aid patrols (MEDCAPs) and staffed the bungalow dispensary for the 250 American advisers of MACV Team 33 in Dr. Wheeler's absence.
I note the customary practice of stimulant injections. Usually it is young men complaining of nocturnal emissions and asking for intra-muscular camphor, as if an out-of-balance life force must be chemically restored. I'm troubled, however, by the practice of injections of nikethamide, a powerful cerebral stimulant, as the sole treatment for typhoid fever, for high fever in a newborn or for suspected cholera. After observing more than a few deaths, I include these observations in my first monthly report to Doctor Niem, along with my assessment that this is inappropriate. An emergency senior staff meeting is quickly called. Doctor Lam, who is visiting, begins. It is wrong to criticize one's medical colleagues, he announces. The rest of the Vietnamese staff concur, explaining that this can hurt feelings. Doctor Stan Banach, our MILPHAP Team CO, speaks bluntly: If a doctor can't criticize another doctor, then who can? In the end, both Doctor Niem and his administrative officer, Ong Cho, are sorry they called the meeting. Doctor Lang still doesn't greet me, and Ba Lung still sends patients directly to the inpatient ward to be admitted without a diagnosis or doctor's input. Only now they move into another room altogether to work. Patients arriving at the outpatient reception now ask for the bac si my–the American doctor.
Unlike my abrupt exposure to the complexity of ethnic Vietnamese identity, my introduction to the complexity of hospital (and other) politics was slow. Even slower was my introduction to the complexity of the local approaches to illness. Practiced side by side with Western medicine were a variety of other approaches. There was the Sino-Vietnamese practice, the Chinese medicine (whereby, for example, a Western-educated professional would seek hot suction cups along with antibiotic treatment). There were the Vietnamese sorcerers who knew how to make the amulets and intone the formulas against evil spirits. Finally, there was the Montagnard way, centering on animal sacrifice with ritual prayers (e.g., a Rhade would sacrifice an animal and chant prayers while accepting aspirin to bring down a fever). The important point was that all of the other methods were pretty nontoxic, except some of the so-called Chinese medicines prepared in pharmacies in Cholon, Saigon and Tan An.
I am sitting in the mess hall of the Special Forces Camp with the Green Berets. There are many loaded shotguns. Outside, two fully armed companies of strikers wait, like us, for the outcome of the negotiations. The Vietnamese officers have been tied up in another location. I conceal a knife in my boot. It is the knife my father brought back from the Pacific years before. I think the mutiny is over food.
The missionaries from the Christian Alliance Mission educated me about the particularly toxic aphrodisiacs that young Rhade men preferred when looking to seduce Christian Rhade girls. A brand sold locally was called Japanese chewing gum. The unsuspecting girl, after a young man slipped her the drug, could end up quite delirious and crazed.
They take me to the stream where the Montagnard man lies among the reeds, partly submerged. I learn he is 23 years old, already a distinguished veteran soldier in the special forces, a company commander. His father is French. He gets to his feet. He has a knife. Downstream the women and girls doing laundry pause and watch, apprehensive. Now he is singing a Rhade lament, praying, then boxing an unseen foe. When he finally quiets, he lets others take away his weapon. In custody, he will be taken to Saigon and given psychiatric care.
Most of the medications available through the Ministry of Health channels were of Asian manufacture and in short supply. MILPHAP, of course, was enjoined from going outside these channels for supplies, as that would undermine the political objective of the mission.
We pick up needles, gauze and Zephranin from the 155th Aviation Company and buy Dial soap at the MACV PX. We then pass them on to Doctor Lang and Ba Lung.
Most intestinal parasites (hookworm, ascariasis, pinworm) were curable, as was scabies. Tuberculosis (nearly everyone over 15 tested positive) and leprosy (estimated at 5,000 cases) were not.
I ask relatives of a patient to buy a liter of dextrose and water in town for an intravenous. They pay twice the rate, get half a liter and add two vials of medicine a friend once used for another illness. They have injected two vials before I discover this. It is sodothiol and isn't in any of our books.
There were no latrines for the families living with the patients. They defecated outside the windows. Behind the surgery ward was a black, foul-smelling, fly-infested streamlet with pooled feces, urine and infected waste.
Lieutenant Colonel Monroe of the advisory team, our counterpart to General Humphries, assures us that things have improved significantly since our arrival. By October 1966 MILPHAP is running three of the four hospital wards and is responsible for all minor surgery. In an average month there might be 130 inpatients, 275 outpatient visits, 10 emergency surgeries and 375 elective surgeries.
Malaria, skin diseases, anemia and diarrhea were treatable.
I save food from the officers' mess (hot dogs, vegetables, etc.) and bring it to a hospitalized Montagnard with nutritional deficiencies and to a young girl low on any red blood cells. The hungry family, visitors and other patients gather about me.
Typhoid fever was treatable if caught early, at least before intestinal perforation.
Doctor Lam asks Bill Baxley to assist in an operation. Bill scrubs in on the removal of a bladder stone from a Montagnard girl. The girl's father visits her in recovery. Bill shows him the large stone and the man begins crying.
An unprecedented epidemic of violent illness and death appeared unstoppable. Lac Thien was hit first, with 26 deaths among the Montagnards. No one knew the cause.
The MILPHAP officers are at the town hall with 60 dignitaries to attend a party the province chief is holding for Lt. Col. Ireland, deputy adviser to the ARVN 23rd Division, headquartered nearby. All the RVN province administrators are there, plus the senior advisory staff of the MACV 33rd Advisory Team, plus USAID representatives. Montagnard and Vietnamese boys and girls provide the entertainment, singing folk songs. I sit with Doctor Niem. He asks how I spend my leisure time, and I reply, Reading and writing. That probably won't be enough, he reflects. I know the people are slow to action and temporize, I reply. The evening ends early when a messenger announces that an outpost by a refugee camp 20 kilometers away is under mortar attack.
Cholera and plague were curable if treated early. Advanced goiter and cleft palate were correctable with surgery.
We are now informed the hospital is again out of penicillin, chloramphenicol, erythromycin, tetracycline and intravenous solutions. I see them stocked on the shelves of the hospital pharmacy.
People died of diphtheria and tetanus because of delayed treatment. Abscesses and burns were treatable. I treated 50 patients one busy day.
Major Hereford of G-4 speaks up at a sector meeting to denounce MILPHAP. He declares we'd better start doing some work or he'll see us out of Ban Me Thuot.
Epilepsy, eczema, asthma and congestive heart failure were treatable when we received supplies mailed us from sympathetic friends in the United States.
My interpreter signals that my patient is VC, having noticed something about the sandals he is wearing. Like the other VC he has pointed out, this one is undernourished, tired and worried sick about his children.
If the pharmacy didn't have a specific medicine, the technician selected another they did have and dispensed it in the dose indicated for the original.
The crazy Chinese opium smoker is no longer allowed in the clinic. Now he is standing outside my window and tossing in fruit, corn and cinnamon apples. Like other lecherous men he is called ba muoui lam, which means 35. It seems there is a Chinese game with 40 pieces, each representing an animal. Piece number 35, ba muoui lam, is old goat.
Nutritional edema, nephrosis and meningitis could be treatable. Advanced trachoma and glaucoma were not, nor was blackwater fever, a complication of malaria.
Cases of vivax malaria begin appearing. Not uncommonly this follows heavy fighting in the Mekong Delta 200 miles to the southwest. Sector is interested. Malaria in the Central Highlands is always the falciparum type.
Cases of malaria refractory to chloroquine might be treatable with the new anti-malarial drug recently investigated at the 3rd Field Hospital.
Hoan, 21 years old and a former law student, is doodling. He draws a cross section of the spinal cord and correctly labels the neuron tracts. I am speechless. What else can you do? I ask. He gets a guitar and sings Streets of Laredo. We sing Red River Valley together.
Available statistics estimated that 50 percent of the children born didn't live to age 5.
I am awakened in my bunk by the duty sergeant, who is pale and shaking and wants to talk. He tells me that earlier that night an intoxicated trooper had entered MACV detachment HQ and lined up the men on duty against the wall at gunpoint, saying, I could kill you all. When he backed out the door, the men on duty immediately locked the door, turned out the lights and took cover behind their desks with their weapons. When the trooper returned, forcing the door and breaking the lock, the sergeant raised his rifle and fired at him point blank. It misfired. The trooper, hearing the click, fled. MPs later found him and took him into custody.
Average life expectancy was less than 40.
I am advised that people have been wondering why I wear socks with my sandals in the manner of the lepers.
USAID provided powdered milk, wheat and protein supplements for exclusive use on the Montagnard charity ward.
A visiting World Health Organization representative, a French doctor who has lived in Vietnam most of his life, explains that Chinese medicine makes extensive use of arsenic, lead and mercury.
The 33rd Advisory Team sponsored renovation projects such as shelters for families, shelters for cookouts, and sanitary facilities. MILPHAP built examining tables, cabinets and screens and gave them to the hospital.
The books arrive. The text on oral surgery is especially welcome to Doctor Baxley. There are no books on parasitology. There are texts on administration and group psychiatry.
On election day, September 11, 1966, the MILPHAP team was confined to the MACV compound. Many candidates were Rhade. FULRO was on the ballot. The VC blasted three bridges along the major highways leading from town, felled large trees across the roads and ambushed an engineer group sent to clear the way.
One of the interpreters, Zwi, brings his sister the Nivoquine tablets she requests and then, later, she commits suicide with them. He is devastated. He blames himself. Another interpreter passes him in the market and asks what he is doing there. Zwi, covered with dirt and mud, replies, I'm looking for my sister, but I can't find her.
We were warned by State Department notice to stop soliciting and using supplies from outside channels.
The Vietnamese public health minister and Mrs. Keyes from the State Department (USAID) tour the hospital. When he sees all the vials of camphor on the pharmacy shelves, he takes them down and smashes them on the floor.
The mystery of the epidemic of violent illness and deaths among the Montagnards was traced to methyl alcohol poisoning from stills in Ban Me Thuot. Because of ongoing use of the alcohol in ceremonies that were being performed with sacrifices over their sick and dying, the number of people who became ill kept rising.
The night technician does not want us to use the small room adjacent to our clinic workstation anymore. He had been accustomed to using the room as a dormitory and prefers it to the hospital dormitory. He asks that we move out.
By July 1967, my part in the MILPHAP mission was over and my former life was back on track. I was again in New Haven, out of the Army, newly married and back in medical training, now specializing in psychiatry. A bout with dysentery in Vietnam just prior to taking my R&R in Hong Kong turned out to be the reason why all the handsome and stylish hand-tailored suits and shirts I had purchased there didn't fit me at all in New Haven. I wasn't aware that I'd lost so much weight. I didn't think one could change that much in so short a time.
The article was written by Dr. Lawrence Climo and originally published in the April 2003 issue of Vietnam Magazine. Dr. Lawrence Climo practices psychiatry in Andover, Mass. He wrote this account of his wartime experiences at the urging of his daughters.
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