Seven miles south of the Demilitarized Zone and five miles inland from the South China Sea lies the village of Dong Ha, in the Province of Quang Tri, Republic of Vietnam. Strategically located at the crossroad of infamous Route 1, running north and south, and Route 9 to the west and Laos, Dong Ha was once a quiet hub of transportation for the surrounding rice-producing farm lands.
Now, as is true of many South Vietnamese Villages, Dong Ha shows the scars of years of war. Scattered about are the abandoned French-built observation towers and pillbox bunkers, replaced by South Vietnamese and American built military structures and machinery.
Thousands of refugees from in or about the DMZ and areas to the west, such as Khe Sanh, have taken up residence in new sprawling refugee centers and in villages such as Dong Ha. Some 85,000 refugees have been displaced to the eastern third of this province, and they now exist under the protection of U. S. bases. An uneasy peace prevails. Frequent mortar, rocket, and artillery attacks remind all that the enemy is never far away.
As in other areas of South Vietnam, American medical teams, in addition to treating servicemen casualties, have cared for the bulk of Vietnamese civilian diseases, either through American-advised (MILPHAP) and staffed provincial hospitals, through Med Cap teams, or as an ancillary service by primary American casualty receiving and sorting facilities.
One such facility, designated Delta Medical Company, of the 3rd Medical Battalion, 3rd Marine Division, until September of 1968, was the northernmost medical post. Situated on the perimeter of the Dong Ha Combat Base, the center was the prime facility for treatment and evacuation of casualties from the Northern I Corps tactical zone, until a larger and more secure facility was opened five miles south at Quang Tri Combat Base. Delta Med, although remaining open as a casualty receiving facility, focused its attention on the needs of the civilian population. Under direction of the then Commanding General of the 3rd Marine Division, Major General Raymond G. Davis, the temporary facility of the 3rd Marine Division Memorial Children’s Hospital was opened, with plans for a more permanent structure to be built near the provincial capital of Quang Tri, south of Dong Ha.
A Navy medical team, including a surgeon, orthopedic surgeon, pediatrician, anesthesiologist, and three general medical officers, and Medical Service Corps officers and corpsmen manned the facility, with security provided by Marines. Seabees tailored the construction and renovation to suit a pediatric patient population.
Local medical care was being provided by “Chinese doctors,” practitioners of Chinese traditional medicine, and poorly trained nurses and mid-wives. Only one civilian Vietnamese doctor practiced in the province, and he was based at the nearest civilian hospital ten miles away at Quang Tri City, the Provincial capital. This hospital, staffed by American MILPHAP physicians, was over-crowded with patients from its immediate area. Furthermore, inadequate transportation combined with military conditions denied access to the hospital to sick patients and to the bulk of the Province’s 303,000 population.
With its opening in September 1968, the Children’s Hospital was immediately flooded with acutely and chronically ill Vietnamese children. Adults received emergency care at the Children’s Hospital and were provided transportation to the provincial hospital or one of the Navy hospital ships lying offshore in the South China Sea.
Partially trained Vietnamese nurses were hired and began on the job training. Children were seen as outpatients in the converted “Triage” (sorting) area of the medical facility. Skin diseases ranked first in those illnesses seen, and first among these was scabies, a mite-borne chronic itching disease which, because of poor hygiene and sanitation, was usually complicated by a secondary infectious disease called impetigo.
As is true for children throughout the world, the second most common among outpatient diseases was upper respiratory illness. In South Vietnam these illnesses were aggravated by lack of primary care, which elsewhere in the world would be provided at home. Indeed, complications generating from inadequately treated simple diseases provided considerable morbidity and mortality. Draining ear infections were first treated by us—in some children after six to ten years of neglect. Chronic hearing loss, meningitis, and bone infections were resultant complications of such neglect.
Pneumonia, tuberculosis, parasitic diseases, anemia, traumatic problems, as well as cuts, bruises, and fractures were handled on an outpatient basis.
As a result of demand, inpatient bed capacity increased from 15 to 100 in a short time. The total number of admissions over an eight-month period totaled 813, of which 61% were medical and 39% were surgical in nature.
The majority of the surgical admissions were burn patients and paralleled a severe local refugee problem, that of extremely inadequate shelter and heating. Most of the infants and children burned were injured m accidents that occurred in their houses of grass, bamboo, or wood. Heating was provided by primitive heaters using expensive—often black market highly combustible fuel. Most of the accidents happened during the cold monsoon months, and owing to weather and transportation conditions, admission to the hospital was commonly delayed and the children were secondarily infected in the majority of cases. In spite of these handicaps, of the 75 burn cases admitted, only three deaths were recorded over an eight-month period. An additional 100 burn cases were treated in the outpatient clinic from January to May of 1969, but did not require admission.
Proven hostile wounds amounted to only ten patients. These were caused mainly by booby traps and nighttime VC-NVA raids on outlying villages. Amputees remained a major problem. Revisions of initial operations were performed and many children were sent south to DaNang and Saigon for brace and prosthetic therapy. As a result of U. S. training and funding, a new prosthetic center is being opened adjacent to the MILPHAP-advised provincial hospital at Quang Tri.
Cleft lip and palate repairs accounted for 34 patients. This defect carries a social stigma the world over, but to a worse degree in Vietnam. One of the first patients operated on, a 16-year-old girl, had carried a cloth over her facial defect for the better part of her life. Once repaired, she began a new life, her original defect, in every sense, being hardly visible.
Major orthopedic surgery, both elective and acute reconstructive cases was performed. Inadequately cared-for, simple fractures developed into major surgical challenges of a sort rarely seen in the Western world.
Among the medical admissions, bubonic and septic plague predominated. Of 145 cases treated, 95 were admitted, all in extremis. Plague, known to South Vietnam since 1906, has become a major epidemiologic problem since 1963 and has increased in severity with the ravages of war, to refugee overcrowding, and to poor sanitation. The initial vectors of the disease, the rats, were found dead in abundance in January of 1969, and soon after, a severe epidemic developed in the northern provinces, moving mainly along trade routes, such as highways 1 and 9 and major waterways. According to the World Health Organization, South Vietnam accounted for more than half the world’s cases of plague—780 out of 1,318 reported—for the second successive year in 1968. Early in 1969, Hue Provincial Hospital treated over 600 cases and the 3rd Marine Division Children’s Hospital treated 145 cases in children alone. The problem is considerably more severe than these figures would indicate since most cases are unrecorded throughout South Vietnam.
Additional medical admissions included severe pneumonia, malnutrition, and anemia from parasites, (hookworm and roundworms) severe diarrhea with dehydration, meningitis, malaria, amebiasis and typhoid fever. In spite of the severity of these diseases, therapy was unknown to most patients and they responded well to appropriate medications. Of the 813 admissions, 37 deaths occurred for a rate of only 4½%. During the same period 13,154 outpatient children were seen as part of the hospital’s primary function of preventive medicine. Many children with neurosurgical and eye problems were evacuated to one of the hospital ships—the USS Repose (AH-16) and the USS Sanctuary (AH-17)—for treatment not available at the Children’s Hospital.
The previously-mentioned Chinese doctors and locally-practicing “medicine men/pharmacists” were our major competitors. Most families consulted a local healer first, although in time we became the prime source of therapy. Herb mixtures, antibiotics, and steroid preparations with French language labels were readily available to the civilian. These were administered at home under unsterile conditions, in inadequate doses, usually for the wrong disease. This made diagnosis most difficult. It was also the prime factor for death in children with meningitis, as most children arrived at our hospital with irreversible changes already caused by partial or poor treatment.
Instead of, or in addition to our therapy, their own therapies of acupuncture, cupping, skin pinching, herbal remedies, scarification and cauterization were practiced. These were no major problem to us except to delay their arrival at the hospital. However, reluctance to give fluids or to eat or to bathe during an acute illness was a major factor contributing to morbidity due to secondary dehydration.
Most Vietnamese medical personnel, from physicians, nurses and mid-wives to Chinese doctors, practice various degrees of mixed Western and Oriental medicine. The popular belief common among Vietnamese, especially the Montagnards, is to attribute disease to the entry of evil spirits into the body. In many respects, the American doctor was a sorcerer who had more control over the evil spirits than others. Many patients entered with charms to the evil spirits hung about their necks, wrists, and ankles. Petitions were made at home to keep the evil spirits away.
Popular beliefs interfered with necessary diagnostic procedures, mainly blood tests. Believing that the blood holds the spirit and that he who draws it out therefore has control of the spirit, there was a common reluctance to allow blood drawing. The drawing of blood was usually done when the parent was not present, if possible; however, in most medical and surgical emergencies, we had to rely on anticipated results to prove our point of therapy.
Blood transfusions were accepted, especially in anemic children. Parents and friends would stand about watching the child “pink-up” and gain strength. In time, many asked for transfusions for their children when they were not clinically necessary.
A moribund newborn infant received an exchange transfusion. Nurses and interpreters watched the blood being removed and new blood injected in, in equal amounts. The procedure was lifesaving. Locally it was explained that we had removed the evil spirits and replaced them with “good” spirits.
Of what value were we? What did we leave behind? Beyond argument there was the immediate saving of lives. An example of this was the cruel statistic that untreated bubonic plague runs a mortality rate of between 60 and 90%, probably higher in infants and children. Of the 95 acutely ill patients admitted with plague, only four died, for a 5% mortality rate. For the Vietnamese civilian who knows well the consequences of his child entering with coma or seizures, to see his child made well was a miracle.
With the onset of the outpatient clinic, with referral from Med Cap Groups and outlying advisory teams, some degree of preventive medicine existed. Much work, however, is needed in this field, especially by South Vietnamese government agencies. Many government teams, annihilated during the Tet Offensive of 1968, are again beginning to function well. Our presence and wherewithal made this an easier task. The hospital is now staffed by the U. S. Army. Soon, teams from the Salvation Army will maintain a more permanent structure and base for developing South Vietnamese government medical teams in these refugee-populated areas.
In retrospect, the Vietnamese civilian and the American serviceman were worlds apart in culture and language. Most Vietnamese, especially the peasants not living in or near major cities, associated the American soldier with increased military activity and their constant forced movement from their sacred homes and land. There was little communication except through South Vietnamese government or military intermediaries or the few Americans who could speak the language adequately. For many, conditions changed little and an unfavorable eye was cast upon all efforts at pacification in many areas. The presence of this hospital and others like it in rural areas was the first link with the people, their culture, and their needs.
The Vietnamese came voluntarily, but with reluctance, many with superstitious fears. Medicine proved in many ways to be the universal weapon. Barriers that had existed for as long as the military machines were present in our area were at last broken down. The peasants observed the sincere willingness of the American personnel to provide the much-needed medical care. With some, it took repeated visits before trust was established, but results were soon apparent and communication and understanding followed.
One female interpreter, observing a medical officer’s distress over a Marine who died of wounds in spite of vigorous medical therapy, approached him and said, “Why are you so sad? He was not your brother.” This attitude reflects in many ways the setbacks we experienced in advising and teaching the Vietnamese nurses.
Unfortunately, many Oriental medical personnel associate treatment more as a profitable profession, less as a duty and sacrifice. Life and death exists on such basic terms that, for them, sacrifices without return are overtly absent. The nurses were stunned at the hours spent over a dying patient, and for them, little was learned or appreciated until they observed a life being saved as a result of diligent care. Slowly, at times painstakingly slowly, our efforts paid off, and for most of the impressionable young nurses there was a sense of pride in their work, unselfish sacrifices, and the assumption of responsibility.
At first, the female nurses were threatened and called harlots, but in time, local pride was generated around the presence of the hospital and the people who worked there.
Marine and Army fighting men were now routinely engaged in ferrying patients back and forth for medical care. Close relationships developed between Navy Corpsmen and the children. Parents, sensing this trust, followed suit.
What began as a memorial to the men of the 3rd Marine Division who died serving the people of South Vietnam, is now firmly established. As a fitting memorial, it could never be replaced or be more appropriate.
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Doctor Burkle graduated with honors from Saint Michael’s College and from the University of Vermont College of Medicine in 1965. He completed his internship and residency at the Yale-New Haven Medical Center. He was inducted into the Navy Medical Corps in 1968 through the Berry Program and assigned to the Third Marine Division, South Vietnam. He served as a medical officer at Delta Medical Company, 3rd Medical Battalion and then as the Pediatrician, 3rd Marine Division Memorial Children’s Hospital from its opening until July 1969. He served as a pediatrician at the Naval Hospital, Newport, Rhode Island, until discharge from the Navy in July 1970. Since that time he has been a Fellow in Adolescent Medicine at the Harvard Postgraduate School of Medicine.