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Medical Assistance to Vietnamese Civilians

     U.S. civilian medical aid programs began in the early years of support in Vietnam. As the U.S. military commitment grew throughout the 1960's, new and expanded programs were developed. Through such efforts as PHAP (Provincial Health Assistance Program), MILPHAP (Military Provincial Health Assistance Program), MEDCAP (Medical Civic Action Program), and CWCP (Civilian War Casualty Program), medical aid in increasing amounts and effectiveness was given to the people of Vietnam.

Provincial Health Assistance Program

     The Agency for International Development initiated a program in the early 1960's to supplement the health services of the Vietnamese. A major objective of PHAP was to improve the training of' Vietnamese physicians, nurses, and medical technicians. Others were to expand and improve Vietnamese hospitals and dispensaries and to eradicate malaria.
     Under the auspices of AID, surgical teams of U.S. civilian physicians, nurses, and technicians were, sent to Vietnamese provincial hospitals. The first of these teams arrived at the provincial hospital in Can Tho in the summer of 1962; shortly thereafter, teams were assigned to the hospitals at Nha Trang and Da Nang. Surgical units, consisting of two operating rooms, a central supply area, and a four-bed recovery ward, were constructed adjacent to the provincial hospital where the team was assigned.
     Despite the valiant efforts of the U.S. teams, augmented by those, from New Zealand, South Korea, the Philippines, and other nations of the Free World, the broad and ambitious aims of PHAP could not be realized. The task of substantially improving health care in an, underdeveloped nation was difficult enough. Compounded by civil strife and guerrilla warfare, it became impossible.

Military Provincial Health Assistance Program

     The increase in military medical resources which accompanied the buildup of U.S. combat troops in 1965 permitted an expansion of the effort to improve the health of Vietnamese civilians. In conjunction

with the buildup, the Secretary of Defense directed the services to prepare a program to aid the civilian health effort in Vietnam. The new program, which initially employed Army military medical teams in direct aid to civilians, was MILPHAP. It was developed jointly by AID and USMACV.
     The first MILPHAP teams went into operation in Vietnam in November 1965. Each team was composed of three physicians, one medical administrative officer, and 12 enlisted technicians. A MILPHAP team was assigned to a Vietnamese provincial hospital where its work was under the supervision of the provincial chief of medicine. By early 1966, six teams were functioning in provincial centers and the decision was made to add 15 teams to the program. The number increased to eight Army, seven Navy, and seven Air Force MILPHAP teams by May 1968. At the end of 1970, teams were assigned to 25 of the 44 provinces.
Sent to both provincial hospitals and district dispensaries, the units provided continuity in medical care at permanent civilian medical facilities. By augmenting or, in some cases, replacing the Vietnamese medical staff, MILPHAP teams, assisted in clinical, medical, and surgical care. They provided a permanent source of support for local public, health programs. With the co-operation of the chiefs of medicine in the provinces, the teams established a program of evacuation for patients to those Vietnamese and American medical installations which had a greater capacity for extended treatment.
     The MILPHAP teams were reorganized in 1969 to make them more responsive to the requirements of the varying sizes of the medical installations to which they are assigned. The reorganization provided more surgeons and nurses with levels of skill appropriate to the medical facility

in which they served. By the end of 1970, the program supported a total of 30 Vietnamese Ministry of Health hospitals, in addition to its work in district and smaller Vietnamese medical installations.
     A major objective of MILPHAP was to improve the medical skills of the Vietnamese. In 1970 alone, for example, more than 700 Vietnamese nurses received training in hospitals supported by MILPHAP teams. Through this type of training, the program advanced toward its primary goal, the development of an independent, self-sustaining health service program in Vietnam.
     A medical policy co-ordinating committee was established in 1965 to plan and co-ordinate the growing number of medical programs involving aid to Vietnamese civilians. Headed jointly by the Assistant Director for Public Health, AID, and by the Surgeon, USMACV, the committee also included the surgeons of the USMACV component commands. Efforts to eliminate duplication in the administration of civilian health programs between AID and USMACV resulted in the establishment of joint USMACV-AID working committees in 1968. The committees formulated joint plans for hospital construction, medical supply, medical education and training, preventive medicine, and public health. By including military and civilian Vietnamese medical officials as members of the committees, policy makers laid a basis for the future assumption of responsibility for these programs by the Vietnamese themselves.

Medical Civic Action Program

     The, best known of the various programs in Vietnam, for medical civil assistance, was MEDCAP. Developed from a joint proposal by the American Embassy, Saigon, and USMACV made in 1962, MEDCAP began operation under the auspices of the Department of the Army in January 1963.
     The primary objective of MEDCAP was to provide increased outpatient care, for Vietnamese civilians living in rural areas. American and Vietnamese military medical personnel were used in the program, a major goal of which was to increase mutual respect and co-operation between the military forces and the civilian population.
     Originally, medical assistance was provided by U.S. military advisory teams and Special Forces personnel; as the program grew, regular American military units participated. Initial MEDCAP organization comprised some 127 U.S. Army medical personnel, working in three teams. Later, medical personnel came from all the U.S. military services in Vietnam, although the Army continued to administer the program and support it logistically.
     Although some improvisation was necessary due to local needs and conditions, the MEDCAP teams normally traveled to hamlets and vil-

lages with their ARVN counterparts and established temporary health stations, of dispensary size, to provide medical care for the inhabitants. Through the operation of these teams, Vietnamese medical personnel were also trained in medical techniques.
     In contrast to MILPHAP, the MEDCAP team was a mobile unit which visited a village for a short period of time, treating civilians only on an outpatient basis. Although each team was supervised by a medical officer, the enlisted medical personnel provided most of the direct effort. MEDCAP can properly be regarded as complementing the more permanent operation of the MILPHAP team. While the latter might operate a surgical facility in a provincial hospital, or assist in the renovation of local medical facilities, the former team worked on a "one-day visit" basis in areas where more permanent medical aid was impractical.
     The buildup, of U.S. forces in Vietnam beginning in 1965 afforded the opportunity both to expand and to extend MEDCAP. Direct participation in the program by American and Free World military units of battalion size and larger became known as MEDCAP II; the original program which continued was then called MEDCAP I. Even in the expanded effort, however, U.S. personnel were directed, unless it was impractical, to conduct their medical civic action effort through a member of the RVNAF medical service or the Vietnamese civilian government medical authorities. MEDCAP retained the objective of eventually enabling the Vietnamese to assume the complete burden of medical care for their own people.
     To support the expanded effort, a new supply system was developed for MEDCAP in July 1967. Previously, medical supplies had been furnished through the RVNAF medical depot system, but difficulties of distance and co-ordination made this means of supply increasingly unwieldy. Under new procedures, MEDCAP units were authorized to requisition material directly through the regular U.S. Army supply channels. Supply levels were also increased in recognition of the larger number of MEDCAP projects.
     The extent of the MEDCAP program in Vietnam was remarkable. Both American and Free World forces participated in it, often, on a volunteer basis. On many occasions, U.S. medical personnel devoted their free time to MEDCAP activities. In the later years of the program, when time and circumstances allowed, more extensive treatment than outpatient care was given. From 1 December 1967 to 31 March 1968, a monthly average, of 188,441 civilians received outpatient treatment from personnel of the program. A monthly average of 17,686 Vietnamese were immunized in the same period. By 1970, the MEDCAP II program alone treated an average of 150,000 to 225,000 outpatients per month.
     Both U.S. dental and veterinary military personnel participated in the MEDCAP program with equally gratifying results. The dental con-

tribution to the program is often termed "DENTCAP." An attempt to alleviate the dental defects of the Vietnamese people was made by dental officers and enlisted technicians. During the 1967--68 period previously mentioned, dental treatments under the program averaged approximately 15,000 per month.
In a country as predominantly rural and agricultural as Vietnam, veterinary activities were of great importance in any medical civic action program. U.S. Army veterinary personnel provided much aid in swine husbandry and animal disease control as early as 1966. Sometimes called VETCAP, veterinary participation in MEDCAP increased in the following years. Treatment of sick and wounded animals, cattle vaccination, and guidance in the care and feeding of swine and cattle were all part of VETCAP activities. A rabies control project was also undertaken. During 1967 alone, a total of 21,391 animals in civilian communities were immunized against rabies, and 2,254 farm animals were treated for various diseases.

Civilian War Casualty Program

     The success of MILPHAP and MEDCAP only partially met the medical needs of the Vietnamese people. As the tempo of the war increased in 1967, the growing problem of civilian war casualties called for new efforts. Estimates of 50,000 such casualties a year indicated that existing Vietnamese medical resources would be overwhelmed in providing care for these victims.
     After some discussion, U.S. Government officials assigned to the Department of Defense the mission of providing additional care for Vietnamese civilian casualties. The U.S. Army was directed to begin a program to this end, and in, April 1967, a detailed plan drawn up by USMACV was approved by the Secretary of Defense. The CWCP was provided with the resources necessary to construct additional hospitals in Vietnam to care for civilian casualties.
     A temporary allocation of 300 beds in U.S. Army hospitals in Vietnam was made, with this number increased to 400 in December 1967. Three Army hospitals, the 27th Surgical at Chu Lai, the 95th Evacuation at Da Nang, and the 29th Evacuation at Can Tho, with a total bed capacity of 1,100, were then designated as CWCP hospitals. American military medical personnel were assigned to the program, and plans were made for additional hospital construction.
     The original intent of CWCP was that medical installations assigned to the program would remain separate from the U.S. military hospital system in Vietnam. Because of the reluctance of Vietnamese civilians to leave their home areas for treatment in distant hospitals, and because of the increase in civilian casualties during the Tet Offensive in early 1968, the program was modified. Treatment of Vietnamese civilians in U.S.

military hospitals had been authorized on a limited basis since the buildup of American forces and installations in the country. During the period of the Tet hostilities, a civilian patient load higher than normal was assumed by all U.S. military hospitals. This system of "joint occupancy" by American military and Vietnamese civilian patients was found to be the more practical alternative to a separate CWCP hospital system.
     Under this system, Vietnamese civilians more, readily accepted extended treatment at a, location near their home areas. Additionally, administrative and evacuation procedures were simplified under the system and construction requirements were lessened. Acting on the direction of the Secretary of Defense, USMACV incorporated the previously designated CWCP hospitals into the U.S. military hospital system in April 1968. Vietnamese civilian patients were authorized treatment at all military hospitals on a space available basis. As the number of American forces was reduced during 1970, a requirement to maintain 600 beds in US, Army hospitals for CWCP was established. Provision for periodic re-evaluation of the facilities needed for the program were included in this requirement.

     In late 1968, USMACV and AID jointly proposed that Vietnamese military and civilian hospitals be merged. The proposal called for the merger of RVNAF sector hospitals with the civilian provincial hospitals in areas where the move would improve medical service. In a three-stage implementation of the plan following its adoption, 13 hospitals were chosen for immediate merger, 12 more needing minor reorganization and rehabilitation were added thereafter, and certain Vietnamese Government buildings were converted to hospital use. The entire program integrated the hospital systems in 26 of the 44 provinces. The consolidation enabled the Vietnamese people and their armed forces to receive the maximum care available from their medical resources.
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