HOW THE VIETNAMESE SAVE THE WOUNDED AND BURNED
In its issue of November 25, the Paris daily Le Monde featured on its front page an interview of unusual interest, describing how the Vietnamese people have organized their medical services to meet the gigantic problem which they faced as the target of American military night.
The interview was granted by the North Vietnamese minister of health, Dr. Pham Ngoc Thach, to Dr. Escoffier- Lambiotte during a trip to Europe to testify before the second session of the In-
VIETNAMESE freedom fighters defending their land against the aggression of the mightiest military power on earth. They have written one of the most heroic pages in human history. Equally heroic are the determined workers and peasants who have kept up production in face of the napaln, ternational War Crimes Tribunal at Copenhagen.
Dr. Escoffier-Lambiotte asked Dr. Thach about the losses being suffered.
"The losses," replied Dr. Thach, "are actually quite low and this is because of a tight, disciplined organization that is universally accepted, because it is based on a moral ideal profoundly rooted in the people. They know that they are defending their land, their factories, their jobs, their freedom and
high explosives and fiendish antipersonnel devices dumped on them by U.S. planes. One of the most moving chapters written by the people of this small land is their success in maintaining and expanding medical services into a vast network active throughout the entire countryside.
their lives, and it is easy to understand, in view of this powerful motivation, why this life-saving discipline is rigorously followed.
"The directives given out arise from continuous research and experience which is ceaselessly renewed and ceaselessly adapted. At present ninety percent of the wounded or killed, which we have suffered, were outside of their shelters. The policy of constructing trenches and individual shelters is efficacious, unanimously followed and applied.
"The same holds true for the evacuation of the cities. The first raid on Hanoi in October left 200 victims, killed and wounded, by fragmentation bombs in many instances. In the last raids of the series we had practically no losses. In the meantime we had proceeded to evacuate all the populous quarters, sending the people to the village cooperatives; the city dwellers were welcomed there by the officials who organized lodging and activities for them. Rescue workers acconpanied the evacuated populations."
Dr. Thach explained how the medical services are organized:
"Kach village, each factory, each community, has a health network composed of a health officer, a nurse and a mid-~ wife. Each village infirmary has an underground operating room and equipment enabling them to handle ordinary surgical cases (fractures, flesh wounds, etc.) and in addition countering such things as shock among those who are gravely wounded.
"We don't have sufficient reserves of blood in all these scattered infirnm~ aries; so we battle against losses of liquid through transfusions of serum and electrolytic adjustments, and we likewise employ with success the methods of traditional medicine, utilizing extracts from local herbs.
"We evacuate to the better equipped centers only the gravely wounded who require considerable care. In Quang-—Binh, for instance, where we suffered relatively high losses, eighty-three percent of the wounded were taken care of on the spot and only seventeen percent had to be evacuated to the district hospitals. In these cases transportation is handled by two men bearing a stretcher."
Asked about the danger
of epidenics, Dr. Thach said that this had been successfully overcome through massive use of vaccines and careful general hygiene and sanitation.
Hasn't this required large amounts of vaccines? Who furnishes them?
"No one. We manufacture them ourselves and our reserves are sufficient.
"During the first two years of the war in 1965-66, we produced more than 100 million doses of vaccines....Our centers for manufacturing these obviously could not remain in the cities; we moved all of them and completely reconstructed them in the heart of the forests where they are operating at full capacity. In addition we have worked out new techniques adapted to our particular situation; thus in the case of Sabin vaccine against polio, yours can be kept only under refrigeration. Ours must be transported on foot from village to village; it can be kept for a month at ordinary temperatures.
The interviewer wondered if this required unusual help by doctors and technicians from abroad in view of the flood of new problems.
"Up to now we have not had a single foreign practitioner. It is possible that we will eventually accept such aid, but it will only be symbolic.
"In 1955 we had one doctor for every 150,000 inhabitants and one health officer for every 100,000 inhabitants. In 1965, we had one doctor for every 8,000 inhabitants and one health officer at least for every 2,000 inhabitants.
"We followed a policy of intensive formation of doctors in all the provinces; this year we now have several medical schools installed in the provinces in the heart of the forests, with all their research equipment, training materials and libraries. In six years, every province will have its school. Today, one-fourth of our doctors are women and we estimate that in six years women will constitute eighty percent of the medical corps.
"The health officers likewise are mainly women. They complete a short threeyear course, but each year they go on to a new level of skill. Thus in 1965 we made a fantastic effort to prepare them for surgery. The plan to improve the level of surgery started in August 1964, at the time of the first bombings. At the end of 1965 everything was ready, men and materials, to face the daily problems.
"The health officers are able to handle simple surgery (fractures and flesh wounds) and shock, and we have simplified and codified a certain number of techniques which are satisfactory and correspond to our particular needs.
"Thus for fractures, we utilize an old method of traditional medicine which uses splints of bamboo that maintain conmplete mobility of the joints. We have also found that the bacillus subtilis constitutes a remarkable preventive treatment for infection and an excellent healing
agent for burns and wounds. We manufacture it on a massive base and utilize it systematically.
"Our results are satisfactory, since the mortality rate for wounds among civilians due to bombings is lower than that among the American troops during the Korean war."
The interviewer observed in a footnote that bacillus subtilis is used in the West mainly against intestinal infections and as a complement in the use of antibiotics. "The results obtained in Vietnam," he added, "are extremely interesting and merit wider research and study here.
The Parisian doctor asked the following question: "The prodigious organization of the American military medical services has been described many times. Based on speed and mobility, the helicopter, the portable hospital installed in a few hours, almost immediate evacuation to the rear, it has meant a very low nortality rate. You lack technical means of this kind. On the military level what is your organization like?"
"Our methods," replied Dr. Thach, "are diametrically different. We answer the American mobility with our organizational stability and Vietnamese rigidity.
"In place of taking the wounded to the doctor, we take the doctor to the wounded. We have one nurse for fifteen men, and when it is necessary to transport casualties we do it with the help of stretchers carried by men to the underground hospitals.
"Moreover, we have many more civilians wounded than soldiers. In two years our health service developed ten times more than during the ten preceding years of peace and it is at present infinitely more developed than the military medical service. The results obtained through this organization are good and I can cite by way of example that in one of the provinces that has been the hardest hit by air raids, Quang-Binh, in two years we have had only four cases of tetanus. The percentage of infections among civilians as well as soldiers is in general very low.
Concerning burns from napalm and poisoning from chemicals used by the U.S. forces, Dr. Thach had this to say:
"In the provinces near the border, five to ten percent of our wounded are from napalm burns. You know that these burns leave frightful keloidal scars, a great deal like those observed after the explosion at Hiroshima. Napalm is dropped by plane in ‘jet containers' and is utilized in bombing our towns.
"The same holds, with less frequency, for phosphorous and magnesium, the latter sent by shellfire from the marine artillery and those who have gone beyond the seventeenth parallel. We treat these burns with the classical methods -- struggle against shock, dehydration, electrolytic imbalance, occluding dressings, antibiotics, and systematic use of bacillus subtilis. We have neither a blood bank nor a skin bank."
The chemical war conducted by the U.S. has likewise faced the Vietnamese with problems. Casualties, particularly from the defoliant chemicals, are treated with both modern and traditional methods.
The final question was as follows: "Doesn't this people, which sees death every day, burns or mutilations, whose towns, villages, factories and roads are razed or destroyed, which has seen so many years of horror and grief from the war, doesn't this people want peace at any price?"
Here was Dr. Thach's answer: "'Peace' should not be an empty word. For us it can only be a synonym for independence and freedom. The desire for peace is immense, but our people are ready to go to the end. Almost all of our fishing industry has been destroyed, but as against this our agricultural productivity is higher than ever; we have more than 1,000 cooperatives producing close to five tons of cereals a hectare and in which seventy percent of the labor has been taken over by the women. Our survival is assured; and the difference between survival and life is the freedom for which we are struggling and without which peace could have no meaning.
"Principles have become a tradition among us, and peace is a question of principle.
"No discussion with the Americans is possible until the bombings and all the acts of war against the DRV LDemocratic Republic of Vietnam] are halted unconditionally. If this is done, then a discussion could be envisaged."