With Healing Hands: The Untold Story of Australian Civilian Surgical Teams in Vietnam
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With Healing Hands: The Untold Story of Australian Civilian Surgical Teams in Vietnam
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| ISBN-13: | 9781741761016 |
|---|---|
| Publisher: | Allen & Unwin Pty., Limited |
| Publication date: | 10/01/2009 |
| Sold by: | Barnes & Noble |
| Format: | eBook |
| Pages: | 288 |
| File size: | 4 MB |
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With Healing Hands
The Untold Story of the Australian Civilian Surgical Teams in Vietnam
By Gary McKay, Elizabeth Stewart
Allen & Unwin
Copyright © 2009 Australian War Memorial and Gary McKayAll rights reserved.
ISBN: 978-1-74176-101-6
CHAPTER 1
The teams
Australia sent its first civilian surgical team to the Republic of Vietnam (South Vietnam) in 1964. Prior to that, the country had been receiving civilian aid from Australia as a member of the Colombo Plan, but as a member of SEATO, South Vietnam was entitled to further aid under Australia's SEATO aid program. The country desperately needed medical assistance. South Vietnam had a population of about 16 million, and of the country's approximately 850 doctors, only 158 were available to care for the civilian population. The rest had been conscripted into the army.
Given the dire lack of medical care for its people, the government of South Vietnam appealed to the United States Agency for International Development (USAID) for medical teams. USAID was the body that arranged and distributed all American and allied civilian aid to South Vietnam, eventually including the Australian surgical teams. After some discussion, it was decided to ask various nations to send civilian surgical teams to work at provincial hospitals throughout South Vietnam. To accommodate the teams, USAID began building new surgical suites and improving existing buildings in many of the country's French-built hospitals. By the end of 1963, twenty-six of thirty-eight provincial hospitals had been equipped for modern surgery. Despite the improvements, Australian surgical team members were to find conditions very different from those they were used to at home.
The first three American surgical teams arrived in South Vietnam in January 1963 and were based in the towns of Da Nang, Nha Trang and Can Tho. A New Zealand team arrived a short time later, operating out of Qui Nhon. Teams were also sent from South Korea, the Philippines, the United Kingdom, China, Switzerland, Iran, Spain, France and Cuba, and a German hospital ship, the Helgoland, was moored in the Saigon River. In addition, around 770 doctors, male nurses and technicians from the United States armed forces were organised into Military Provincial Hospital Assistance Program teams, which served as advisers in district dispensaries and lived and worked with groups attached to the South Vietnamese Army.
In 1962, after USAID relayed the South Vietnamese request for medical support to the Australian government, the Department of External Affairs (DEA) sent a leading Melbourne neurologist, Dr John Game, to South Vietnam to assess what was needed. In his report, Dr Game said 'the request for surgical teams appears to be based on a sound concept and offers a means ... to give immediate aid, the benefits of which will extend through the whole country'. Furthermore, it would be 'a form of aid which would be at once visible to the local populace and the world', but not one that would involve Australia in a continuous commitment. He recommended that a surgical team (only one in the first instance) be sent to the town of Nha Trang, on the central coast. Although the location of the first team was later changed to Long Xuyen, in the Mekong delta, Dr Game's second recommendation, that the team be raised from one of the major teaching hospitals, was adopted.
Despite Dr Game's comprehensive report and the Australian government's support for the scheme, it was another two years before the first Australian civilian surgical team was sent to Vietnam. The aims of the teams were threefold: to provide a quality general surgical and medical service for the South Vietnamese population; to teach the Vietnamese medical staff (mainly by example); and, as Dr Game had foreseen, to serve as evidence of Australia's support and concern for the people of South Vietnam. Although these aims appeared straightforward, they were to prove ambiguous and difficult to implement, and many team members later questioned why the teams were sent at all.
Team composition
The first Australian surgical team, from the Royal Melbourne Hospital, arrived in Long Xuyen, the capital of An Giang province in the Mekong delta, in October 1964. It served as something of a template for later teams, coming as it did from a major teaching hospital and comprising experienced doctors, nurses and other personnel hand picked for the job. As time went on, and the number of medical staff wanting to join the teams declined, the DEA sought teams from Repatriation hospitals across the country. When this pool too proved inadequate, composite teams were formed from hospitals around Australia. These, however, sometimes lacked the close bonds and unity of purpose of the earlier, single-hospital-based teams.
As it became harder to recruit people, less experienced and younger men and women were chosen. Some older team members felt that these people adapted less successfully to conditions in Vietnam, and that their inexperience led to team disunity. John Game's original view had been that the first team to go must be made up of experienced, mature staff: at minimum, a surgeon 'with experience and judgement' (preferably an outpatient surgeon of a teaching hospital), a more junior doctor or experienced general practitioner, an anaesthetist, a theatre sister, a ward sister, a laboratory technician and a radiographer. His preference was for team members who had already worked together, presumably because this would help with team cohesion. The theatre sister, he noted, 'should be a resourceful woman, physically robust and with experience'. Terms of service, Game thought, should be three months for the senior surgeon and twelve months for the junior. Team members should be replaced one at a time, to help maintain continuity and local knowledge.
Practical experience in Vietnam and difficulties with recruiting ensured that many of Dr Game's recommendations were eventually laid aside. As the volume of work grew, it became clear that many more staff would be needed. By 1967 it was recommended that teams should have at least ten members, with, in addition, a paediatrician, an administrative officer and extra nursing sisters. Later on, teams of sixteen or more were not uncommon. Length of service also varied from Dr Game's recommendations. One constant problem was the amount of time senior surgeons could take away from their work. Many had heavy responsibilities at their home hospitals, as they were often leading specialists in their field, or had private practices that could not be left for long periods. Three to four months was the longest that most could afford to be away. Still, a significant number felt they had more to contribute after their first tour and returned to South Vietnam a second or even third time. Junior surgeons also faced difficulty in getting away. An absence of several months could make a significant difference to the progress of their career. On the other hand, some applied because they thought experience gained in Vietnam would benefit their careers.
Nursing and other medical staff often joined the teams for six months. Most felt this was enough time to feel they had achieved something, but by the end of it they had had enough of the difficult conditions and pressures of the work in Vietnam. A small number of teams were sent for one year but that was uncommon, since it soon became clear that twelve-month tours led to high rates of burnout, illness and exhaustion.
Two of the most important team roles were those of the leader and the administrator. In a 1965 report on team progress in Long Xuyen, it was emphasised that 'good leadership, of vital importance in the functioning of armed forces, is perhaps more important in small civilian teams isolated in a foreign community, where the cultivation and maintenance of good relations between the team and the host civilian population poses further demands on team members'. The team leader, usually the senior surgeon, was responsible for looking after other team members, settling disputes and ensuring that their mental and physical needs were met. A good leader united his team; a poor one could damage morale and lower work standards.
The administrator's job, as outlined in 1967, was to relieve the leader of most of the daily non-medical chores, but the lack of a clear duty statement was frustrating for some who took up this role. Bill Townsend, who was team administrator in Vung Tau in 1968–69, remembers attending a DEA briefing where he was given a letter outlining his duties and told that 'the success of the mission depends upon you'. In fact, the letter gave him only the most basic guidance and he had to learn most of the job on the run, finding ways to maintain supplies, organise pay, arrange maintenance and repairs both at the hospitals and the team members' housing, look after team vehicles, and ensure the smooth running of the team.
Administration and conditions
Australian surgical teams were administered by the DEA. The Department organised team members' travel arrangements, vaccinations, pay and briefings. In Saigon, the capital of South Vietnam, teams were officially under the auspices of the Australian embassy but in fact had little contact with it. Teams were usually met in Saigon by embassy staff, and occasionally briefed by them, but after that formal contact was mainly limited to meetings between the team administrator and the embassy's Counsellor for Aid, though team members sometimes attended official embassy functions.
In 1967 the DEA decided to rely on the Vietnamese for all the teams' supplies and equipment. This did not work out well. Team members often carried basic medicines and equipment to Vietnam in their luggage, but ongoing supplies were always a problem. When the first teams arrived at the four provincial hospitals to which Australian teams were sent, they found that medical supplies and equipment were almost nonexistent. The team in Vung Tau had to spend two weeks cleaning the hospital and installing basic equipment before they could even begin to deliver medical services. Teams in Bien Hoa, Long Xuyen and Ba Ria had similar problems. Generally, they relied on USAID and American and Australian military hospitals to provide them with the necessary supplies. This was not a perfect arrangement and took valuable time away from their primary work, but it was unavoidable. Later teams, which had administrators, were spared much of the scrounging for supplies that their predecessors were forced to do, but even so, shortages of such basic items as blood supplies continued.
Before leaving for Vietnam, all team members were given medical examinations by the Department of Health and were vaccinated against smallpox, plague, cholera and typhoid. Throughout the tour they took antimalarial pills. The Vietnamese Ministry of Health housed the teams, usually in a single building, but in Vung Tau in two buildings. Teams were provided with Vietnamese staff to do their laundry, cleaning and cooking; their food came from the local markets. It was part of the team administrator's job to run the team house, pay local staff and, most importantly, make sure 'that the beer supplies were kept going too'.
Team members were paid according to their status. The leaders received the highest salary, plus an allowance for their extra responsibilities. All team members were given a daily allowance of $6.25 to cover extra expenses. Because their food and accommodation were paid for, this was usually found to be enough.
Many team members found conditions in South Vietnam difficult and exhausting, especially if their tour of duty was long. Leave was deemed essential, and most leaders made provision for each member to have a weekend away every few weeks. Those on six-month contracts got one week's leave; those in Vietnam for a year were given three weeks off. During longer breaks, many took the opportunity to explore neighbouring countries, and Cambodia and Thailand were popular destinations. On shorter breaks, members sometimes travelled in small groups to other towns in South Vietnam, especially Da Nang, Nha Trang, and Dalat, in the mountains. For weekend trips many went to the seaside resort town of Vung Tau, visiting their local counterparts and enjoying the beach. Vung Tau teams in turn visited Bien Hoa and Long Xuyen, which was set in a relatively quiet and peaceful location on the Bassac River.
Preparation
Surgical teams were formed in various ways. Early teams were often hand picked by senior surgeons in the teaching hospitals. Dr Mervyn Smith, who took the first Royal Adelaide Hospital team to Bien Hoa in 1967, was a persuasive recruiter. He approached a number of the hospital's experienced doctors, nurses and other medical specialists and eventually assembled a team of twelve, most of whom signed up for a six-month tour. Dr Smith was exceptionally well liked, and his care in choosing his team was rewarded with a tightly knit, harmonious group of men and women who worked and lived together without major problems.
Even where teams were not hand picked, they generally bonded into happy working units. Often vacancies were advertised on hospital noticeboards, and applicants were interviewed either by the team leader or senior hospital staff. Janet Brewster's (née Glasson) selection was typical. She was working as a nurse at the Royal Prince Alfred Hospital in Sydney and had read some of the letters sent back from a Prince Alfred team in Long Xuyen. They inspired her to apply when positions on a New South Wales state team were advertised:
I was only twenty-four at the time and they wanted them twenty-five plus. I very brazenly went to this interview thinking 'Oh, well.' There were people lined up everywhere for interviews. There was a panel of six, I think. And then I got notification to say I was chosen ... It was [because] I had all the qualifications [and] because I had been to a boarding school and they knew I wouldn't get homesick.
New recruits often had very little time to prepare themselves for the adventure ahead. In some cases nurses had only a few weeks to obtain passports, get vaccinated, buy and pack the necessary supplies and clothing, and farewell their families. Surgeons usually had a slightly longer lead time, as it was a complicated business leaving a practice or senior hospital position, even for three months.
Few team members were briefed by the DEA before they left. Those who were — they were flown to Canberra for the purpose — received advice on issues like what clothing to take and how to be good representatives of Australia. Very few people received useful advice on how to cope with living in a war zone, what safety precautions to take, or what Vietnamese customs they needed to be aware of to avoid giving offence to their hosts. A few team members were offered, and took up, the opportunity to learn basic Vietnamese, but most were told not to bother: rudimentary French would do. This did not prove to be the case.
Every former team member interviewed for this book was critical of the lack of preparation he or she had been given for work in Vietnam. The early teams, being the pioneers, were forced to learn on the spot. However, they were never asked to formally brief later teams, who would have benefited greatly from their experience. Information was sometimes passed informally from those who had returned from Vietnam to those preparing to go, but this process was ad hoc and relatively uncommon.
Dr Peter Last, a paediatrician and anaesthetist in Bien Hoa in 1967, wrote a detailed report towards the end of his tour with the aim of improving conditions for later teams. About departmental briefings he wrote:
No attempt whatever was made to prepare us for the considerable difficulties and frustrations of the Asian temperament and Vietnamese customs. Only after many weeks did we discover that these people must not be beckoned to with one finger, spoken to in a loud voice, touched upon the back, or pointed to ... If this sort of information is not known to the Department, it certainly should be, and it should be promulgated before members leave.
Peter Last's was not the only report written during or after a tour by a team member determined to make things easier for his successors, yet it seems that such information was rarely, if ever, passed on.
Sometimes, when team members did receive briefings or written notes, they were inaccurate. John Morriss remembers being reminded by his team leader about 'the construction of deep trench latrines and the use of duckboards in tented camps in the tropics'. Expecting primitive accommodation, he was pleasantly surprised to find that the team house in Long Xuyen 'was in a French colonial villa with eleven bedrooms and seven bathrooms'. The advice given to Kay Dabovich, a nurse in Long Xuyen in 1969, included not wearing shorts or other revealing clothing in public and preferably not wearing trousers; apart from that, she recalls, 'we were not given much information at all'. Dot Angell, who served with the Alfred Hospital team in Bien Hoa in 1967, was very blunt about their poor preparation:
The preparation that we had was nothing. It was like a tour guide to sunny Vietnam. We had no idea what the living and working conditions would be like ... And [there was] no discussion about what it would be like to be a woman in a war zone.
(Continues...)
Excerpted from With Healing Hands by Gary McKay, Elizabeth Stewart. Copyright © 2009 Australian War Memorial and Gary McKay. Excerpted by permission of Allen & Unwin.
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Table of Contents
Contents
Foreword,Preface,
Introduction,
1 The teams,
2 First in: Long Xuyen,
3 In the firing line: Bien Hoa 1966–68,
4 Battling on and backing up: Bien Hoa 1969–72,
5 Life in Phuoc Tuy: Vung Tau and Ba Ria,
6 Mixing it: interaction with the allies,
7 Staying sane,
8 Coming home,
Epilogue,
Appendix A: Dates of service of Australian civilian surgical teams in Vietnam,
Appendix B: Members of Australian civilian surgical teams in Vietnam,
Notes,
Bibliography,