A Surgeon’s Vietnam Story
As a younger boy rising up in Montgomery, Alabama, through the late Forties and Nineteen Fifties, Dr. Sheldon Kushner, a 26-year-old U.S. Air Drive captain, by no means envisioned that he could be a trauma surgeon for civilians in South Vietnam’s Mekong Delta, an expertise that modified his life. He noticed the horrors of struggle however believes his tour of obligation in Vietnam made him a greater physician when he returned to america.
The struggle was heating up through the time Kushner was in faculty after which medical faculty on the College of Alabama. Beneath the Berry Plan, a Protection Division program allowing college students to finish medical faculty and residency earlier than serving their army obligation on lively obligation, he was scheduled to enter the Air Drive following his internship. After finishing primary coaching at Sheppard Air Drive Base in Texas, he was stationed at Vandenberg Air Drive Base in California, serving as a common medical officer. Whereas there, Kushner realized he could be going to Vietnam.
In March 1968, Kushner arrived at Tan Son Nhut Air Drive Base close to Saigon. He was loaned out to the Military and despatched to Vinh Lengthy province on the Mekong River to serve on a workforce collaborating within the Navy Provincial Well being Help Program, or MILPHAP, created to enhance the well being of Vietnamese civilians.
A contemporary nationwide well being care system didn’t exist within the Sixties in South Vietnam, so the U.S. authorities stepped in and funded a range well being care packages through the struggle. MILPHAP was a type of packages. The others included the Medical Civic Motion Program (MEDCAP), with docs who visited villages; a Dental Civic Motion Program (DENTCAP), offering dental remedy to the Vietnamese; the Veterinarian Civic Motion Program (VETCAP), with U.S. Military veterinary personnel treating sick and wounded animals, vaccinating cattle and offering recommendation on feeding and caring for livestock; and the Civilian Struggle Casualty Program (CWCP), which cared for Vietnamese with war-related accidents.
MILPHAP was a hospital-based program established in 1965 to coach native docs and ship extra refined care. It was created by U.S. Navy Help Command, Vietnam, the group in control of American fight forces, and AID, the Company for Worldwide Improvement, to enhance the well being of Vietnamese civilians. The primary MILPHAP workforce was arrange in November 1965. By Could 1968, there have been eight Military, seven Navy and 7 Air Drive groups. By 1970, groups existed in 25 of Vietnam’s 44 provinces.
The objective was to develop an impartial, self-sustaining well being service program in South Vietnam. Extra particularly, MILPHAP’s mission was to supply medical care and well being providers to Vietnamese civilians, develop the surgical abilities of the Vietnamese docs and practice hospital employees employees.
The Vinh Lengthy hospital had just one Vietnamese physician, Basci Gian, who rejected any coaching supplied by People and sometimes engaged in what Kushner and his colleagues thought of unethical and substandard medical practices. As with our army position in South Vietnam, the position of MILPHAP was anticipated to be short-term. It was assumed that ultimately the South Vietnamese could be solely answerable for these packages. That by no means occurred.
The Vinh Lengthy MILPHAP workforce, Unit 558, consisted of three docs, together with Kushner, two civilian nurses who had been in Vietnam for an 18-month coaching program, 15 Military medics, Military Particular Forces troopers, Air Drive ahead air patrol pilots and CIA operatives who suggested the Vietnamese in covert actions.
Serving with Kushner was Fred Seaman, a pediatrician in his late 20s. He served as commander of the MILPHAP workforce and supplied care to the Vietnamese kids who had been sick or recovering from operations, however often didn’t carry out surgical procedure. The opposite physician was James Gordon “Mac” McComb, additionally in his late 20s. He and Kushner carried out many of the surgical procedures. The entire workforce shared within the care of sufferers after surgical procedure.
One of many nurses, Marcella O’Connor, oversaw the working room. She saved up with provides and tools, ordering no matter was wanted, and taught the Vietnamese methods to sterilize medical devices and bundle and retailer tools. The opposite nurse, Jackie Ventura, took care of post-operative kids and different sick children within the pediatric unit and labored carefully with Seaman.
The medics assisted in surgical procedure, sutured small lacerations, eliminated lifeless or contaminated tissue from wounds, irrigated post-op wounds, set damaged bones in casts and altered dressings when wanted.
Medic Invoice Grover had a selected expertise. It appeared that regardless of the medical workforce wanted he might get. Grover as soon as informed Kushner: “Doc, when you are over right here, if there’s something you want, simply inform me; I’ll get it for you, however by no means ask me the place I obtained it or to take it again.”
One evening on the best way again to the compound, Kushner complained, “Simply as soon as I’d wish to have a T-bone steak.” A number of nights later, the physician discovered 200 T-bone steaks in his room! Extra crucially, Grover was in a position to spherical up medical provides that had been scarce in locations like Vinh Lengthy, communities on the far finish of an extended provide chain. “If it weren’t for Grover, lots of people would have died,” Kushner acknowledged.
Different invaluable assist got here from a husband and spouse workforce—Ong Thoai, known as Charlie Brown, an X-ray technician for the hospital, and his spouse, Ba (Mrs.) Houng, the pinnacle nurse. Ba Huong was in control of the male post-op surgical unit and labored carefully with Kushner, in control of male surgical procedure. Her husband assisted in surgical procedure, did minor procedures, carried out solid work and helped with no matter else needed to be achieved. McComb, who was in control of feminine surgical procedure, labored carefully with Ba Tam, the pinnacle nurse on the feminine post-op unit. Different personnel included three Vietnamese translators, two girls and one man, who helped the American docs perceive their sufferers’ wants.
The American compound, the place the MILPHAP workforce lived, was within the metropolis of Vinh Lengthy, the provincial capital, whose inhabitants was about 40,000. The compound was a transformed outdated lodge constructed throughout France’s colonial rule of Vietnam. There have been American guards posted always all through the compound, which housed about 160 folks. They shared this duty with Vietnamese guards.
“We lived in a really harmful space,” Kushner defined. “Nothing was fully safe, which is why we needed to have guards.” The People nervous about folks on bikes who would trip previous the MILPHAP compound and throw explosives on the guards. There have been a number of such incidents throughout Kushner’s tour of obligation.
Kushner’s every day routine started after breakfast, at round 6:30 a.m., when he arrived on the Vinh Lengthy metropolis hospital, a 400-bed facility constructed by the French in the course of the downtown space. There have been three working rooms. Every might accommodate about three sufferers at a time. Seabees, the Navy’s building items, had constructed these services earlier than Kushner arrived in Vietnam. The hospital beds consisted of straw mats typically put collectively so 4 or 5 sufferers might relaxation after surgical procedure. Crowded circumstances had been the norm.
On most days, there have been 30 to 40 sufferers within the hospital needing care. Kushner labored 14-hour days, six and a half days every week, performing about six surgical procedures a day. Lots of his sufferers had been native civilians with accidents from bombings, small-arms fireplace, rockets, mortars, land mine explosions, booby lure explosions and napalm burns. The munitions had been deployed by Viet Cong guerrillas, the People and the South Vietnamese. There have been no North Vietnamese troopers within the province, solely Viet Cong.
Kushner, who wrote typically to his spouse, described the scene in an Aug. 26, 1968, letter: “I walked into the hospital this morning and located 41 new struggle casualties. The place within the hell do you begin? I did 5 main instances, Fred Seaman did 2 and we nonetheless have many left. This was all the results of a mortar assault final evening. Would you consider that I did a saphenous vein graft to restore a minimize axillary artery? I don’t know if it can work, however I attempted. Solely time will inform.”
Different wounds had been to be anticipated amongst folks dwelling alongside waterways or in cities surrounded by rural countryside and filth roads. A affected person would possibly arrive with a crushed leg, a head wound from a truck tire or toddler progress points. The medical workforce would additionally see sufferers with burns that resulted from jet gasoline looted from a close-by base and used as family gasoline.
Kushner found that his internship on the College of Alabama Medical Faculty had supplied solely minimal preparation for work as a trauma surgeon. Not one of the docs had in depth expertise with surgical procedure, but they had been anticipated to function on abdomens, brains, blood vessels and extra. Additionally they did many pores and skin grafts due to napalm burns.
Every introduced his personal medical experiences to the circumstances that existed in Vinh Lengthy, and collectively the docs devised “medical protocols” they believed would work greatest for his or her sufferers as they tried to avoid wasting lives and limbs beneath nearly not possible circumstances, far totally different from these in American hospitals and clinics. For instance, Kushner and McComb selected to not do thoracotomies (opening the chest) as a result of they didn’t have the tools. Such surgical procedure was extraordinarily harmful for the affected person when the docs didn’t have respirators or chest suction gadgets at their disposal.
Given their unfamiliarity with wounds and accidents not often or by no means seen in medical faculty, the three American docs must make powerful choices on which civilians could possibly be helped. This follow was additionally utilized in different hospital and fight areas in Vietnam and meant separating sufferers into three teams: those that might survive with out instant remedy; those that might survive if their wounds had been handled instantly; and sadly, those that had been so severely injured that they’d more than likely die regardless of remedy.
The triage circumstances additionally affected staffing choices. “Medical assignments had been free,” Kushner stated. “You set folks the place they had been wanted while you got here in that day.”
Lack of medical provides was one other major problem. Kushner and his workforce had solely ether for anesthesia, and there have been no muscle relaxants, which made surgical procedure harder as a result of the docs needed to battle stiff muscle mass. Antibiotics had been restricted to penicillin and chloromycetin, enough for treating infections. The medical workforce didn’t have entry to a blood financial institution. Generally blood could possibly be obtained from a affected person’s relative, however the workforce quickly found that the Vietnamese inhabitants felt uncomfortable about blood transfusions, an unfamiliar process of their tradition.
When blood was accessible, the workforce had no technique of figuring out the sort and cross-matching it, so Kushner and his workforce needed to improvise. They found that if the donor’s blood didn’t clump when combined with the affected person’s blood the donor blood was typically secure to make use of. They’d no entry to blood substitutes, equivalent to plasma, and there was at all times a necessity for intravenous fluids.
At occasions the hospital would obtain ineffective provides that simply piled up exterior, equivalent to dextrose, used to extend blood sugar in folks with diabetes or hypoglycemia. Few sufferers handled within the Vinh Lengthy trauma hospital would have these circumstances.
Though the medical workforce did have the usual working instruments, Kushner stated they had been, at greatest, merely “enough.”
Their three-patient working room typically ran at full capability, so the docs and employees regularly labored in unsanitary circumstances. As a result of Kushner’s data of varied surgical procedures was restricted, he used audiotapes made on the College of Alabama Medical Faculty and medical books to get details about unfamiliar procedures. Tom Graue, one of many medics, helped Kushner on one event, when “we needed to take away a bullet from a girl’s mind, and whereas he learn the textbook, telling me methods to do it, the operation went properly.” It was unavoidably “on-the-job coaching.”
The overwhelming variety of surgical procedures, about 200 a month, took its toll on Kushner, each bodily and psychologically.
He recollects being sick more often than not with gastroenteritis, viruses or colds. He misplaced 20 kilos throughout his yr in Vietnam. The meals he ate was not superb or nourishing, and he had bother sleeping. He typically heard rockets and mortars from his compound at evening. As soon as Kushner and others within the compound needed to vacate the premises due to an assault.
After three months in Vinh Lengthy, Kushner wrote dwelling in a letter dated Could 13, 1968: “I’m doing 2 to three to 4 main op instances a day and lots of, many minor procedures. This afternoon, they introduced in 14 9-year outdated children, whose faculty was blown up. 7 had been lifeless and one died shortly. A sadder sight I don’t consider I’ve ever seen. I simply want I knew extra and that I might do extra for these children.”
Writing to his spouse on Aug. 26, 1968, Kushner shared his frustration by saying: “As we speak was hell and once more I spent all day within the working room and I simply surprise what number of extra individuals are going to be injured right here. I see this every single day and I nonetheless can’t consider it.” Kushner did a lot surgical procedure on gunshot wounds, accidents beforehand unfamiliar to him, that he might inform simply trying on the wound what kind of weapon was used.
Regardless of the tough circumstances, minimal provides, lack of assist and native customs, Kushner and his colleagues served sufferers to one of the best of their skills. Kushner’s letters to his spouse reveal deep issues in regards to the devastating results the struggle had on the civilians in Vinh Lengthy and his means to assist his sufferers. It was irritating to be able the place he needed to carry out surgical procedures that had been typically unfamiliar to the MILPHAP workforce and work with locals who had been skeptical of recent medical procedures, both as a result of they didn’t perceive them or had by no means skilled them.
He and his workforce relied on tenacity, ingenuity and creativity to assist their sufferers survive. Kushner attributed such qualities to his internship expertise in Birmingham, Alabama, which supplied him with the medical data to confidently reply to conditions he confronted in Vietnam, but there remained the actual problem of not figuring out sufficient and desirous to do extra for his sufferers.
Practising drugs in an underdeveloped nation throughout wartime additionally uncovered the docs to medical issues not seen in america. About six months into his tour, on Sept. 10, 1968, Kushner was despatched to take a look at a doable epidemic of smallpox in a distant Vietnamese village, removed from Vinh Lengthy, that had been hit by the Viet Cong on Sept. 9. He was taken there by helicopter and observed an airfield near the border with Laos. When he requested why the airfield was there, Kushner was informed that it was to guard our army presence in Laos, the place formally there have been no U.S. troops. After his investigation, he concluded that the village didn’t have any instances of smallpox.
One other uncommon incident occurred on Nov. 12, 1968. Whereas on the compound, Kushner acquired a observe from one of many nurses on the hospital. It acknowledged: “Expensive Dr. Kushner, we obtain a 13-year outdated feminine who was injured rectum by water buffalo right here at 16.00 … Will you please come?” Kushner rushed to the hospital to care for the issue, regardless that he had completed work that day.
One specific case involving a 7-year-old boy named Loc was particularly memorable and tragic. On July 1, 1968, Loc’s mom carried him into the hospital. The boy’s legs had been mangled and gasoline gangrene was seen. Kushner carried out two above-knee amputations. With surgical procedure and antibiotics, Loc survived.
The physician recalled: “I grew to become very connected to this teen and taught him some English and skim to him once I might discover time. My mom despatched him toys that at all times introduced a smile to his face. The Navy Seabees constructed him a wheelchair. We had been in a position to receive synthetic legs for Loc, and with the assistance of crutches, he was in a position to stroll. After he was launched, Loc’s mom introduced him to the hospital to see me sometimes.”
As a result of he solely labored a half day on Sundays, these afternoons had been spent stress-free. Kushner would typically play tennis on a courtroom not removed from the hospital. Generally he learn Stars and Stripes, The Montgomery Advertiser (despatched by his father) or The New Yorker journal. He additionally loved speaking with colleagues on the compound, which had a bar that was a gathering place the place they performed card video games and once in a while noticed films.
In March 1969, Kushner’s tour in Vietnam was over. After a 30-day go away in Alabama visiting his spouse, mother and father and associates, he was assigned to Patrick Air Drive Base on Florida’s Atlantic coast, the place he completed his army service. He served as a common medical officer and lived close to the bottom in an residence together with his spouse.
Wanting again on his service in Vinh Lengthy, Kushner, after all, regrets that he couldn’t save each affected person. Even so, the expertise had rewards. Regardless of the MILPHAP workforce’s restricted coaching and assets, “we did quite a lot of surgical procedure and saved lots of people’s lives,” Kushner stated. “We crammed a terrific humanitarian want.” V
This text on Dr. Sheldon Kushner was tailored 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 historical past and has taught on the college degree. She lives in Sebastian, Florida, and has written, as a information correspondent, a number of articles about veterans.
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This text appeared within the February 2021 concern of Vietnam journal. For extra tales from Vietnam journal, subscribe right here and visit us on Facebook: