As a young boy growing up in Montgomery, Alabama, during the late 1940s and 1950s, Dr. Sheldon Kushner, a 26-year-old U.S. Air Force captain, never envisioned that he would be a trauma surgeon for civilians in South Vietnam’s Mekong Delta, an experience that changed his life. He saw the horrors of war but believes his tour of duty in Vietnam made him a better doctor when he returned to the United States.
The war was heating up during the time Kushner was in college and then medical school at the University of Alabama. Under the Berry Plan, a Defense Department program permitting students to complete medical school and residency before serving their military obligation on active duty, he was scheduled to enter the Air Force following his internship. After completing basic training at Sheppard Air Force Base in Texas, he was stationed at Vandenberg Air Force Base in California, serving as a general medical officer. While there, Kushner learned he would be going to Vietnam.
In March 1968, Kushner arrived at Tan Son Nhut Air Force Base near Saigon. He was loaned out to the Army and sent to Vinh Long province on the Mekong River to serve on a team participating in the Military Provincial Health Assistance Program, or MILPHAP, created to improve the health of Vietnamese civilians.
A modern nationwide health care system did not exist in the 1960s in South Vietnam, so the U.S. government stepped in and funded a variety health care programs during the war. MILPHAP was one of those programs. The others included the Medical Civic Action Program (MEDCAP), with doctors who visited villages; a Dental Civic Action Program (DENTCAP), providing dental treatment to the Vietnamese; the Veterinarian Civic Action Program (VETCAP), with U.S. Army veterinary personnel treating sick and wounded animals, vaccinating cattle and providing advice on feeding and caring for livestock; and the Civilian War Casualty Program (CWCP), which cared for Vietnamese with war-related injuries.
MILPHAP was a hospital-based program established in 1965 to train local doctors and deliver more sophisticated care. It was created by U.S. Military Assistance Command, Vietnam, the organization in charge of American combat forces, and AID, the Agency for International Development, to improve the health of Vietnamese civilians. The first MILPHAP team was set up in November 1965. By May 1968, there were eight Army, seven Navy and seven Air Force teams. By 1970, teams existed in 25 of Vietnam’s 44 provinces.
The goal was to develop an independent, self-sustaining health service program in South Vietnam. More specifically, MILPHAP’s mission was to provide medical care and health services to Vietnamese civilians, develop the surgical skills of the Vietnamese doctors and train hospital staff workers.
The Vinh Long hospital had only one Vietnamese doctor, Basci Gian, who rejected any training offered by Americans and often engaged in what Kushner and his colleagues considered unethical and substandard medical practices. As with our military role in South Vietnam, the role of MILPHAP was expected to be temporary. It was assumed that eventually the South Vietnamese would be solely responsible for these programs. That never happened.
The Vinh Long MILPHAP team, Unit 558, consisted of three doctors, including Kushner, two civilian nurses who were in Vietnam for an 18-month training program, 15 Army medics, Army Special Forces soldiers, Air Force forward air patrol pilots and CIA operatives who advised the Vietnamese in covert activities.
Serving with Kushner was Fred Seaman, a pediatrician in his late 20s. He served as commander of the MILPHAP team and provided care to the Vietnamese children who were sick or recovering from operations, but usually didn’t perform surgery. The other doctor was James Gordon “Mac” McComb, also in his late 20s. He and Kushner performed most of the surgeries. The whole team shared in the care of patients after surgery.
One of the nurses, Marcella O’Connor, oversaw the operating room. She kept up with supplies and equipment, ordering whatever was needed, and taught the Vietnamese how to sterilize medical instruments and package and store equipment. The other nurse, Jackie Ventura, took care of post-operative children and other sick kids in the pediatric unit and worked closely with Seaman.
The medics assisted in surgery, sutured small lacerations, removed dead or infected tissue from wounds, irrigated post-op wounds, set broken bones in casts and changed dressings when needed.
Medic Bill Grover had a particular talent. It seemed that whatever the medical team needed he could get. Grover once told Kushner: “Doc, while you are over here, if there’s anything you need, just tell me; I’ll get it for you, but never ask me where I got it or to take it back.”
One night on the way back to the compound, Kushner complained, “Just once I’d like to have a T-bone steak.” A few nights later, the doctor found 200 T-bone steaks in his room! More crucially, Grover was able to round up medical supplies that were scarce in places like Vinh Long, communities at the far end of a long supply chain. “If it were not for Grover, a lot of people would have died,” Kushner acknowledged.
Other invaluable help came from a husband and wife team—Ong Thoai, called Charlie Brown, an X-ray technician for the hospital, and his wife, Ba (Mrs.) Houng, the head nurse. Ba Huong was in charge of the male post-op surgical unit and worked closely with Kushner, in charge of male surgery. Her husband assisted in surgery, did minor procedures, performed cast work and helped with whatever else had to be done. McComb, who was in charge of female surgery, worked closely with Ba Tam, the head nurse on the female post-op unit. Other personnel included three Vietnamese translators, two women and one man, who helped the American doctors understand their patients’ needs.
The American compound, where the MILPHAP team lived, was in the city of Vinh Long, the provincial capital, whose population was about 40,000. The compound was a converted old hotel built during France’s colonial rule of Vietnam. There were American guards posted at all times throughout the compound, which housed about 160 people. They shared this responsibility with Vietnamese guards.
“We lived in a very dangerous area,” Kushner explained. “Nothing was completely secure, which is why we had to have guards.” The Americans worried about people on motorcycles who would ride past the MILPHAP compound and throw explosives at the guards. There were several such incidents during Kushner’s tour of duty.
Kushner’s daily routine began after breakfast, at around 6:30 a.m., when he arrived at the Vinh Long city hospital, a 400-bed facility built by the French in the middle of the downtown area. There were three operating rooms. Each could accommodate about three patients at a time. Seabees, the Navy’s construction units, had built those facilities before Kushner arrived in Vietnam. The hospital beds consisted of straw mats often put together so four or five patients could rest after surgery. Crowded conditions were the norm.
On most days, there were 30 to 40 patients in the hospital needing care. Kushner worked 14-hour days, six and a half days a week, performing about six surgical procedures a day. Many of his patients were local civilians with injuries from bombings, small-arms fire, rockets, mortars, land mine explosions, booby trap explosions and napalm burns. The munitions had been deployed by Viet Cong guerrillas, the Americans and the South Vietnamese. There were no North Vietnamese soldiers in the province, only Viet Cong.
Kushner, who wrote often to his wife, described the scene in an Aug. 26, 1968, letter: “I walked into the hospital this morning and found 41 new war casualties. Where in the hell do you start? I did 5 major cases, Fred Seaman did 2 and we still have many left. This was all the result of a mortar attack last night. Would you believe that I did a saphenous vein graft to repair a cut axillary artery? I don’t know if it will work, but I tried. Only time will tell.”
Other wounds were to be expected among people living along waterways or in towns surrounded by rural countryside and dirt roads. A patient might arrive with a crushed leg, a head wound from a truck tire or infant growth issues. The medical team would also see patients with burns that resulted from jet fuel looted from a nearby base and used as household fuel.
Kushner discovered that his internship at the University of Alabama Medical School had provided only minimal preparation for work as a trauma surgeon. None of the doctors had extensive experience with surgery, yet they were expected to operate on abdomens, brains, blood vessels and more. They also did many skin grafts because of napalm burns.
Each brought his own medical experiences to the circumstances that existed in Vinh Long, and together the doctors devised “medical protocols” they believed would work best for their patients as they tried to save lives and limbs under almost impossible conditions, far different from those in American hospitals and clinics. For example, Kushner and McComb chose not to do thoracotomies (opening the chest) because they did not have the equipment. Such surgery was extremely dangerous for the patient when the doctors did not have respirators or chest suction devices at their disposal.
Given their unfamiliarity with wounds and injuries rarely or never seen in medical school, the three American doctors would have to make tough decisions on which civilians could be helped. This practice was also applied in other hospital and combat areas in Vietnam and meant separating patients into three groups: those who could survive without immediate treatment; those who could survive if their wounds were treated immediately; and sadly, those who were so severely injured that they would most likely die despite treatment.
The triage conditions also affected staffing decisions. “Medical assignments were loose,” Kushner said. “You put people where they were needed when you came in that day.”
Lack of medical supplies was another serious problem. Kushner and his team had only ether for anesthesia, and there were no muscle relaxants, which made surgery more difficult because the doctors had to fight stiff muscles. Antibiotics were limited to penicillin and chloromycetin, adequate for treating infections. The medical team did not have access to a blood bank. Sometimes blood could be obtained from a patient’s relative, but the team soon discovered that the Vietnamese population felt uncomfortable about blood transfusions, an unfamiliar procedure in their culture.
When blood was available, the team had no means of determining the type and cross-matching it, so Kushner and his team had to improvise. They discovered that if the donor’s blood did not clump when mixed with the patient’s blood the donor blood was generally safe to use. They had no access to blood substitutes, such as plasma, and there was always a need for intravenous fluids.
At times the hospital would receive useless supplies that just piled up outside, such as dextrose, used to increase blood sugar in people with diabetes or hypoglycemia. Few patients treated in the Vinh Long trauma hospital would have those conditions.
Although the medical team did have the standard operating tools, Kushner said they were, at best, merely “adequate.”
Their three-patient operating room often ran at full capacity, so the doctors and staff frequently worked in unsanitary conditions. Because Kushner’s knowledge of various surgical procedures was limited, he used audiotapes made at the University of Alabama Medical School and medical books to get information about unfamiliar procedures. Tom Graue, one of the medics, helped Kushner on one occasion, when “we had to remove a bullet from a woman’s brain, and while he read the textbook, telling me how to do it, the operation went well.” It was unavoidably “on-the-job training.”
The overwhelming number of surgical procedures, about 200 a month, took its toll on Kushner, both physically and psychologically.
He recalls being sick most of the time with gastroenteritis, viruses or colds. He lost 20 pounds during his year in Vietnam. The food he ate was not very good or nourishing, and he had trouble sleeping. He often heard rockets and mortars from his compound at night. Once Kushner and others in the compound had to vacate the premises because of an attack.
After three months in Vinh Long, Kushner wrote home in a letter dated May 13, 1968: “I am doing 2 to 3 to 4 major op cases a day and many, many minor procedures. This afternoon, they brought in 14 9-year old kids, whose school was blown up. 7 were dead and one died shortly. A sadder sight I don’t believe I have ever seen. I just wish I knew more and that I could do more for these kids.”
Writing to his wife on Aug. 26, 1968, Kushner shared his frustration by saying: “Today was hell and again I spent all day in the operating room and I just wonder how many more people are going to be injured here. I see this every day and I still can’t believe it.” Kushner did so much surgery on gunshot wounds, injuries previously unfamiliar to him, that he could tell just looking at the wound what type of weapon was used.
Despite the rough conditions, minimal supplies, lack of help and local customs, Kushner and his colleagues served patients to the best of their abilities. Kushner’s letters to his wife reveal deep concerns about the devastating effects the war had on the civilians in Vinh Long and his ability to help his patients. It was frustrating to be in a position where he had to perform surgeries that were often unfamiliar to the MILPHAP team and work with locals who were skeptical of modern medical procedures, either because they didn’t understand them or had never experienced them.
He and his team relied on tenacity, ingenuity and creativity to help their patients survive. Kushner attributed such qualities to his internship experience in Birmingham, Alabama, which provided him with the medical knowledge to confidently respond to situations he faced in Vietnam, yet there remained the real challenge of not knowing enough and wanting to do more for his patients.
Practicing medicine in an underdeveloped country during wartime also exposed the doctors to medical problems not seen in the United States. About six months into his tour, on Sept. 10, 1968, Kushner was sent to check out a possible epidemic of smallpox in a remote Vietnamese village, far from Vinh Long, that had been hit by the Viet Cong on Sept. 9. He was taken there by helicopter and noticed an airfield close to the border with Laos. When he asked why the airfield was there, Kushner was told that it was to protect our military presence in Laos, where officially there were no U.S. troops. After his investigation, he concluded that the village didn’t have any cases of smallpox.
Another unusual incident occurred on Nov. 12, 1968. While at the compound, Kushner received a note from one of the nurses at the hospital. It stated: “Dear Dr. Kushner, we receive a 13-year old female who was injured rectum by water buffalo here at 16.00 … Will you please come?” Kushner rushed to the hospital to take care of the problem, even though he had finished work that day.
One particular case involving a 7-year-old boy named Loc was especially memorable and tragic. On July 1, 1968, Loc’s mother carried him into the hospital. The boy’s legs were mangled and gas gangrene was visible. Kushner performed two above-knee amputations. With surgery and antibiotics, Loc survived.
The doctor recalled: “I became very attached to this youngster and taught him some English and read to him when I could find time. My mother sent him toys that always brought a smile to his face. The Navy Seabees built him a wheelchair. We were able to obtain artificial legs for Loc, and with the help of crutches, he was able to walk. After he was released, Loc’s mother brought him to the hospital to see me from time to time.”
Because he only worked a half day on Sundays, those afternoons were spent relaxing. Kushner would often play tennis on a court not far from the hospital. Sometimes he read Stars and Stripes, The Montgomery Advertiser (sent by his father) or The New Yorker magazine. He also enjoyed talking with colleagues at the compound, which had a bar that was a gathering place where they played card games and on occasion saw movies.
In March 1969, Kushner’s tour in Vietnam was over. After a 30-day leave in Alabama visiting his wife, parents and friends, he was assigned to Patrick Air Force Base on Florida’s Atlantic coast, where he finished his military service. He served as a general medical officer and lived near the base in an apartment with his wife.
Looking back on his service in Vinh Long, Kushner, of course, regrets that he could not save every patient. Even so, the experience had rewards. In spite of the MILPHAP team’s limited training and resources, “we did a lot of surgery and saved a lot of people’s lives,” Kushner said. “We filled a great humanitarian need.” V
This article on Dr. Sheldon Kushner was adapted from Trauma and Tenacity in Vietnam: A Surgeon’s Story by Mary Jane Ingui, Ph.D., 2017.
Mary Jane Ingui has a doctorate in American history and has taught at the university level. She lives in Sebastian, Florida, and has written, as a news correspondent, several articles about veterans.
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This article appeared in the February 2021 issue of Vietnam magazine. For more stories from Vietnam magazine, subscribe here and visit us on Facebook: