Below is chapter six in its entirety from a 1966 book entitled Vietnam North: A First-Hand Report by prominent Australian journalist Wilfred Burchett. In it he wrote about the ingenuity of Vietnamese medical professionals in successfully confronting difficult medical and surgical issues created by another war that included bombs and resulting injuries for those lucky enough to survive.
Based on my own nearly two and half decades of experience, it has always seemed to me as if the idiom “Necessity is the mother of invention” could have been invented by the Vietnamese. While 1966 was a time of war, embargo, deprivation, and suffering, 2020 is one of unprecedented economic well-being and access to knowledge, experience, and resources. Just imagine what Viet Nam can accomplish in the future.
NOTE: Parts of above paragraphs were excerpted from a draft article about COVID-19 and the success of the Vietnamese government and people in dealing with it to date.
I referred to this chapter in a 21 March 2020 article for VNExpress International entitled During the Covid-19 pandemic, do as the Vietnamese do.
Follow this link to see a documentary by Australian journalist Wilfred Burchett filmed in the Democratic Republic of Viet Nam (“North Vietnam”) in 1966.
Shalom (שלום), MAA
MEDICINE OLD AND NEW
How does a backward country like Vietnam face up to the medical and surgical problems imposed by half a million or so tons of bombs a year? And the constant threats of “worse to come?”
Health Minister Dr. Pham Ngoc Thach was the obvious person to turn to for the answer. Dr. Thach, a small, stocky man, with a bronzed face and balding head and fairly radiating his inexhaustible energy, originates from the imperial family of Annam. A cousin of former Emperor Bao Dai, he threw in his lot with the Vietminh revolutionaries at an early age. After the August 1945 uprising, Pham Ngoc Thach headed the Vietminh administration set up in the Nam-Bo (Cochin-China), and when the resistance war started against the French, he left for the jungle to organize a medical service which he continued to direct and expand, setting up pharmaceutical plants in the jungle, until the war ended. (A cousin, Dr. Ho Thu, performs a similar service in the Liberation Front zones of South Vietnam today.)
A brilliant medical scientist, Dr. Thach is known among his western colleagues for his original research work on TB. He is the architect of Vietnam’s health services today, having built them up brick by brick mainly from the medical schools he established in the jungle during the resistance, but also reinforced by a number of brilliant French-trained Vietnamese doctors and surgeons who gave up their often lucrative practices in Paris to serve their ‘own people. Because the hard resistance years forced Dr. Thach to rely largely on medicinal plants and traditional medicine, he is an ardent advocate of a harmonious development of both traditional and western medicine. It is almost useless to try and Bud him in his ministry and the likeliest place of all is in the Hanoi TB hospital and research center. To my first and main question, he replied as follows:
“The American attacks did not catch us by surprise. Thanks to our medical organization, which goes all the way down to the agricultural cooperatives, wounded have been treated on time, and almost on the spot. In fact, all the villages in the plains have medical and maternity clinics and almost all the cooperatives have a public health organization. Seventy per cent of the villages in the highlands (where the tribal minorities live) also have their medical and maternity clinics. In peacetime, these organizations take care of the public health campaigns, vaccinations against smallpox, cholera, paratyphoid, diphtheria, tetanus, whooping cough and poliomyelitis. They render first aid to the sick and send urgent surgical or obstetrical cases to their district hospital. Over 90 per cent of mothers give birth in the village maternity clinics.
“Our medical service, in other words, is solidly established at village level. So it’s natural in wartime that these clinics give first aid to the wounded and treat shock cases on the spot while waiting to evacuate patients to the district hospital. For months past, in view of the savage and indiscriminate American bombings, the district surgeons often operate in the village clinics, avoiding what, after a bombing raid, are often difficult transport conditions for the patient.”
“Can you have sufficient stocks of plasma or blood widely dispersed enough to treat shock and loss of blood immediately, in view of the fairly haphazard nature of the bombings?” I asked.
In answer, Dr. Thach invited me to accompany him to an improvised “operating theater” in the basement of one of the hospital buildings. On a table, two dogs lay on their sides, facing each other. A tube, through which blood was pulsing, led from one to the other, heartbeats, blood pressure and respiration automatically recorded by needles on slowly-revolving graphs. “We are still trying to discover exactly what happens to the nervous system in the case of shock of varying degrees,” explained Dr. Thach. “In this experiment one of the dogs is getting blood supply fed to the brain through direct transfusion from the other, while the rest of the system is severed. This is a theoretical study.” We passed into another laboratory, where a third dog was tied down to the “operating table,” and as we watched half the blood was drained out of the body, flickering needles recording what was very close to death – one of the conditions of extreme shock due to loss of blood. The dog’s eyes closed and he seemed perfectly inert. Nurses then gave a large intravenous injection and at the same time a solution was slowly fed in through a tube in the dog’s mouth. Within seconds, the recording needles, which had started to draw the straight line of clinical death, started flickering again and soon were describing definite rhythmic zig-zags as the heart and respiratory system started to work again. Within seconds the dog’s eyes had opened and his body was pulsing away fairly normally.
“That’s the practical application of what we have learned from our theoretical studies,” Dr. Thach explained. “It is difficult for us to have stocks of plasma available everywhere for immediate emergency use. And at village level it is not always possible to make transfusions. But we have developed this method of intravenous injections of a solution that we call NTG, combined with an isotonic solution of a glucose type of serum administered orally. With this method we have been able to save very severe shock cases without resorting to blood transfusions or the use of blood serum. Apart from shock cases through loss of blood, we are also doing a good deal of research on the actual effects of shock from blast. We have many such cases now, especially among children, due to the great explosive power of the bombs the Americans are using.”
I asked what other research was being done, directly related to the war situation. He took me into a third laboratory where an experiment was being carried out on guinea pigs for testing lime-water as an antidote for phosphorous bombs. “This method is about perfected,” Dr. Thach said. “It is simple and efficient, can be applied by anyone and anywhere.”
The small body, tied down to the “operating table,” quivered slightly as the drops of colorless liquid splashed on its back. Within 40 seconds bluish white smoke started rising from the soaked skin and within a few more seconds there were anguished squeals as the smoke burst into flame, long brilliant sparks leaping between the smoke spirals. A masked, white-gowned figure poured on another liquid which extinguished the flames but did not stop the squeals, then deftly wrapped the whole body in liquid-soaked gauze and it was carried away, stiff squealing, its place on the “operating table” taken by another small, quivering body. Again some splashes of innocent-looking liquid, white smoke and squeals as the smoke bunt into names on the bare body. But this time the squeals trailed away as liquid from another bottle was poured on, and ended completely as the little body was wrapped in gauze saturated with the same liquid. Within seconds the bandaged guinea-pig was nibbling contentedly some greens.
“White phosphorous,” explained Dr. Thach, “we have to find means of countering it that can be available in every village and can be applied by the peasants themselves. The classic method is copper sulphate but it’s very expensive and can’t be made available on a mass scale. That was used in the first experiment. In the second, ordinary lime water, available in every Vietnamese village was used. As you saw, it is more effective. The pain stops immediately and the burs heal much quicker. It’s a question of getting the mixture absolutely right.” I remarked that I had not heard the Americans were using phosphorous bombs in the North. “They are using them in the South,” replied Dr. Thach, “and we must reckon on them using them against our villages as Johnson escalates the war. We must prepare for the worst.”
“We are also studying a simple and practical mask in case the Americans start using gas or other toxic products.” When I asked for details, he smiled and said: “This is on our secret list. If the Americans knew what principles we were working on they would try and counter its efficacy.”
Later, on Dr. Thach’s advice, I visited the splendidly equipped biological research laboratories and saw white mice being injected by various types of toxic chemicals that the Americans have been using in South Vietnam, samples of which have found their way to the North. After a minute dose of one of the agents, the legs stiffened, the mouse started to stagger and then fell. “It has the same effect on pigs and buffalo,” the researcher explained, “and also on small children and aged, weak people.” The mice that died were passed over to a dissector who carefully removed minuscule livers, spleens and kidneys and took blood samples which were passed on back for laboratory tests. “We can’t take any chances,” the head of the laboratory said. “Today it’s in the South and tomorrow it may be here.” And obviously any discoveries as to antidotes could be passed over Radio Hanoi to the South in the form of a scientific commentary!
Returning to my talk with Dr. Thach, he explained that against certain of the chemicals being air-sprayed in the South under the general name of “defoliants,” the resulting irritations and inflammations could be cured by extracts of certain medical plants. “We don’t always know the reason why but we try to find out. In our situation, it’s not for us to try and find complicated, highly specialized methods of treatment, but to find simple and effective treatments within the grasp of our local public health services. People’s war imposes on our researchers an effort to find simple remedies, that everyone can use. But the discovery of such remedies requires knowledge of modern, scientific data combined with most detailed laboratory research work and repeated clinical tests, before their popularization.”
Certain of these plant extracts, according to Dr. Thach, in clinical tests had proved effective against staphylococci resistant to other antibiotics.
Four-fifths of the patients from the TB hospital and the same proportion of medical personnel had been evacuated to the countryside and this was true of all the other hospitals and medical research centers that I visited. A great deal of expensive laboratory equipment had been removed and mothballed in safe places, until the end of the war. I asked Dr. Thach to what extent the evacuation, mothballing of research equipment and what obviously must have been a large-scale mobilization of medical personnel for the various fronts, would affect normal medical research.
“We will continue research with less sophisticated equipment,” Dr. Thach explained, “and we will continue our peace- time public health campaigns. The war will push us to go much faster in this. For two years now, after clinical and successful held tests, we have developed our own subcutaneous injections for cholera, typhoid fever, diphtheria and tetanus. Cholera and smallpox have been wiped out since 1957. The chronic cholera epidemic, which made its appearance in South Vietnam two years ago, did not spread to the North, thanks to our public health campaigns. Typhoid fever and diphtheria have been practically wiped out in those regions where 90 per cent of the population have had subcutaneous injections. An epidemic of infantile paralysis five years ago disappeared, thanks to the Sabin vaccine which our institute of epidemiology continues to produce despite the wartime difficulties. (Later I was to watch the production of this vaccine and control tests on live monkeys.) Serious intestinal diseases caused by insanitary conditions have practically disappeared thanks to the vigor of the public health campaign waged since the American attacks.” And, he could have added thanks to his own insistence on the closed double-toilet system, individual wells and other sanitary improvements, referred to elsewhere. “We are also studying the problem of virulent malaria (with which the Americans are having great trouble in the central highlands of South Vietnam) and a solution to this problem, of worldwide importance, will be found. An attempt to use vaccination against helminthiasis is also being tackled.”
Then Dr. Thach dealt with a subject very close to his heart – the treatment of tuberculosis with the use of killed BCG vaccine (as opposed to the live vaccine normally used) together with the bacillus subtilis, which he did much to develop and on which he has been invited to present papers at many international conferences on TB.
“Vaccination against TB with killed BCG, studied clinically and experimentally in North Vietnam for almost eight years, because of the ease with which it can be administered and its all-round effectiveness, has greatly contributed to lowering mortality from this disease. In one district of Hanoi, with a population of 100,000, and which has been followed since 1960, the TB mortality rate, as revealed by radio-photography, has fallen from 20.6 per thousand in 1960 to 4.3 per thousand in 1964, that is a reduction of almost 80 per cent in four years. This, despite material conditions which are still difficult.
“The bacillus subtilis,” continued Dr. Thach, “which has been known to us since 1952 through the work of Henri and Albot, has been used in big therapeutic doses through numerous injections. Employed alive, either via the lungs, by subcutaneous or even intravenous injections, this bacillus has given surprising results not only for pulmonary and other varieties of TB, but also for leprosy and whooping cough. Administered by nasal inhalations it enables the prevention of epidemics of whooping cough and measles. Our doctors also employed it during the past year with encouraging results in treating tetanus and Japanese encephalitis, as well as in the treatment of infected wounds and burns.”
The conversation then turned to the use of various medicinal plants, the effects of which were known but in many cases not the reasons why, Dr. Thach advised me to visit another laboratory where “family planning” experiments were being carried out on white rabbits.
A group of cheerful white-gowned young women met me and escorted me to the rabbit house. Here an experiment was in progress, in which a precisely-measured amount of bluish liquid, fed in through a tube in the rabbit’s nose, within a few minutes resulted in an artificial miscarriage, or abortion. They repeated the procedure on several other members of the rabbit colony and showed me charts with dosages and weights and ages of rabbits, the various times it took for satisfactory abortion, according to dosages and so on. The liquid came from a plant, similar to indigo, and was in fact used by the Meo tribes people to dye their homespun cloth and to produce abortions. The rabbits showed no ill effects even after prolonged observation, they said, nor did the young Meo tribeswomen. But further investigation would be made before the plant juice would be judged an acceptable “family planning” agent.
In this connection, Dr. Thach explained that it had been known for a long time that certain old women among most of the mountain tribes people had secret contraceptive concoctions, or at least those which produced abortions. The morals of young people before marriage are, or used to be, notoriously lax but babies born to unwed girls reduced considerably their material value as brides. So the old women who kept the secret of “the pill” were in great demand. But the strictest secrecy was maintained, perhaps at first because of tribal rivalries over such matters, but later because the French Catholic missionaries who established themselves all over the country regarded such practices as outright handiwork of the devil. Punishments were severe if the practitioners were discovered. So the secrets remained in the hands of a few old women and were passed on from family to family. Dr. Thach and his researchers set to work to pry out these secrets, once family planning became an official project.
“ft required prolonged political and ideological work,” said Dr. Thach, “the tribes people never yield their secrets easily, especially the older people. It took a long time to gain their confidence, but in the end they began to yield. Now we have some really exciting perspectives.” And he went on to describe the effects of one plant which produces temporary sterility after swallowing one single dose and fertility again by a single dose of an antidote, also from a local plant. If the antidote is not taken, sterility remains for all time. The plants have already been found, the juices extracted and they are at present undergoing laboratory tests, whereas the indigo-type abortion-provoker has already passed laboratory and clinical tests. The potentials of the sterility-fertility philter are obviously overwhelming. Dr. Thach is very cautious in professional conversations about the potentials, but is also excited about the prospects of his country capturing a world market in what could be the most popular medicament of our time. “One of the roles of advanced medical science,” he said, “is to explain scientifically the almost miraculous properties of many of the medicinal plants. There are certain leaves, for instance, used by the tribes people that reduce fractures and help the bones set in a fraction of the time of our most advanced methods. Our doctors are studying plants that are very effective against arteriosclerosis, others against malaria and a wide variety of intestinal diseases.”
Life expectancy had doubled during the previous decade from 30 to 60 years, the adult death rate having dropped from 20 per thousand in 1955 to six per thousand in 1964, infant mortality in the same period having dropped from 300 to 28 per thousand. “Our people live much longer and die much older and this means we have to do lots or experimental and clinical research in diseases like arteriosclerosis, chronic bronchitis and cancer with which we had little to do in the past,” Dr. Thach explained. “We do not let the war interfere with such research. As far as surgery is concerned we gained some world attention with liver operations and now for the past few years we have been successfully carrying out throat cancer operations.”
Referring again to the importance he and his colleagues in the Health Ministry attach to the study of medicinal plants and traditional medicine, Dr. Thach said: “Clinical results obtained from many of these medicines pose theoretical problems for which our doctors, chemists and biologists must find the answers in their laboratories. In this way medical research, medical observation and experimental medicine are closely linked. The problems are numerous and complicated but if we combine modern knowledge and practice with the experience of traditional medicine, we hope, bit by bit, to find the answer to problems that baffle us now. To have the most simple and efficient treatments within the grasp of all, requires a very high level of modern science.”
At the pilot hamlet of Quang An, mentioned in an earlier chapter, I noticed that 110 medicinal plants growing in the vicinity had been listed; samples of most of them had been planted in the small garden of the local clinic. And in the local pharmacy, alongside one cabinet for modern medicine such as streptomycin and other antibiotics, there was another cabinet for traditional medicines, some of them little packets of powdered roots or crumbled leaves. All medicine, western and traditional, was sold only by prescription. The local health officer assured me that 85 per cent of patients were cured by traditional medicine. The pharmacy was run by the agricultural cooperative. In the same courtyard as the general clinic was also the maternity clinic where 48 babies were scheduled for delivery during 1966.
At Hanoi’s University Surgical Hospital, the director, Professor Tung, took me to see a strikingly handsome young lad, 17 years of age, who had recently been brought to Hanoi from Vinh for a bone graft. He was a third-cycle student, a member of the school’s self-defense unit. Planes came to attack an anti-aircraft battery near his school. He had rushed out, pointed his light machine gun at a diving plane and started firing. “Then there was a tremendous explosion,” he said, “and next thing I was rolling down a small ravine and my leg was covered with blood.” Professor Tung, one of North Vietnam’s finest surgeons, who acted as interpreter, explained that this was a rare case, brought to Hanoi for treatment. “He was a brilliant pupil,” he said, “and showed such great courage that it was thought exceptional efforts should be made to save his leg. He lay for two months in a district hospital, but it became evident that only a bone graft of the type we do here could save the leg. We have started work, and will save it. We are using a bit of young calf bone, very suitable for such a case. His leg will be permanently stiff because of the knee injury.”
“What do you think about that?” I asked the lad. “I would willingly give my leg or my life for my country,” he said so spontaneously and with such a warm smile that it was clear the words came straight from his heart. The point Professor Tung wanted to make was that it was very rare that surgical cases were brought to Hanoi.
“Almost all operations are carried out in the district hospitals,” he said. “It is very rare that patients are brought to provincial hospitals and even rarer to Hanoi. Of the many thousands wounded since the Americans started their bombings, only 31 have come to this hospital, and ours is the chief surgical hospital in Hanoi. The Ministry has made an enormous effort to adapt the district hospitals to our war needs and to train more of our doctors in war surgery. At the present time, we have over 200 district hospitals able to cope with their foreseeable problems.”
At the Gia Lam district hospital, which had been moved out of its almost new three story building in the Hanoi outskirts into a centuries-old Buddhist pagoda, I found that the 100 beds were served by 90 medical personnel, including nine doctors of whom two were surgeons, and ten assistant-doctors (with two years of medical training). The hospital served 33 villages, each of which had a small four-to-five-bed clinic with a qualified nursing sister in charge, and 147 agricultural cooperatives. In the nine months since it had been evacuated to the pagoda, 150 operations had been performed, many of them by the aid of the six-volt bicycle lamp, referred to earlier. Eight of the operations had been for appendicitis and 30 Caesareans.
“In the case of intensified bombardments of the Hanoi area, could you cope?” I asked the doctor in charge.
“There are also two stand-by field hospitals in this district, each with 200 beds,” he replied. “With their help, and the local village clinics, we think we can cope.” He showed me emergency surgical kits, packed in small leather suitcases, used by mobile teams. The air pump for administering ether was a football bladder, but the surgical kits, made in Germany, looked very efficient. The hospital sterilizer was made from a sand-packed, cut-down petrol drum and could be heated by charcoal or wood. I noticed another modern one, gleaming under its wrappings, standing by for the day when electricity was available. A vacuum pump for extraction of liquids, I noted, was adapted from an ordinary bicycle pump. A cabinet, in which certain medicines had to be maintained at set temperatures, was heated by a petrol lamp. “Improvisation is part of ministerial policy,” explained my guide. “We want all our hospital staffs to think in these terms and get used to producing first-class results with the minimum of modern equipment.”
On the walls of the pagoda, I noticed a life-size scientific drawing in chalk of certain anatomical aspects in the technique of family planning-free lessons for any patients who cared to glance. The scores of lacquered Buddhas looked on with benign indifference. In any case, the educational wall drawings will lose their importance if Dr. Thach wins out with his sterility-fertility elixir.
Before I completed the check-up on the medical system, I asked Minister Thach what happened with wounded captured pilots.
“The Americans have once again demonstrated their desire for peace by their savage bombardments of Nam Dinh city,” he replied, “by the use of their B”52’s against Quang Binh province and their escalation of attacks against the suburbs of Hanoi and Haiphong. The list of our children, men and women, the sick, lepers, TB patients, that they have killed is a long one. Also the list of schools, hospitals, homes and roads that they’ve destroyed. They are criminals and deserve to be punished as such. Nevertheless, if they are captured wounded, we treat them with exactly the same care that we give to our own patients.”