In 1965, the United States was looking for partners to form a coalition to prevent South Vietnam being overrun by the communist North. Communism was spreading south from “Red China”, Laos had fallen, and the “domino theory” predicted that South Vietnam would be the next to fall. The French, who had been the colonial power since 1861, were defeated at the Battle of Dien Bien Phu in 1954. Vietnam had been divided into the communist North and the anticommunist South by the Geneva Accords. During the Korean War (1950- 53) the US had been backed by United Nations troops, with which the UK troops took part. Our Prime Minister of the day, Harold Wilson was asked for military help by President Lyndon Johnson, but he turned down the request. However there was a proposal on the table, drawn up by Dr Tony Brown, who was working in Saigon, for a British Medical Team to be sent to Vietnam. A request had come from the Vietnamese Ministry of Health for a team to work at Bien Vien Nhi Dong, the Children’s Hospital in Saigon. Dr Philip Evans, Consultant Paediatrician at Great Ormond Street Hospital (GOSH), and civilian consultant to the army, was asked to undertake a preliminary visit while in the Far East. He agreed to lead the team, and to help recruit for the first year. He turned to his colleagues at GOSH to find people, and I was sent for by Dr Robert Cope, or Uncle Bob as he was known to us, and thought I was to be told about my next rotation to Barnet or Brighton, but was asked if I would go to Saigon. Having worked at GOSH for a year, and enjoyed working with the children, the decision to go was not difficult.
Arrival in Saigon
The team of four doctors and six nurses arrived in Saigon in August 1966. The four doctors were: Philip Evans, our leader, John Partridge, who had been Resident Assistant Surgeon at GOS, from Barnstaple, Ronald Young our pathologist, and myself. A pathologist was included because there had been a specific request to develop some micro methods for blood tests for children. Five of the nurses, who were all very experienced, had worked as sisters at GOS. We were looked after by the British Embassy, who had found a house for each of the doctors, and a large house for the nurses to live together. The embassy had kindly brought out a long wheel based Land Rover to get the nurses to and from the hospital. It had been designed for the English winter, and my very first task was to improve the ventilation by taking out the glass in the rear windows, and then fitting two doors to make it child proof!
Nhi Dong
At Nhi Dong we found, a modern concrete building, overcrowded, in a poor state of repair. The Vietnamese hospital doctors and nurses were very unsure of what to do with us, but after a few days we were allocated an office where we could put things, and began to find our way around. My next task was to get one of the loos working which could be reserved for our sisters. I recall a certain sense of achievement having found a new ball cock! Some of the wards were very grim and in need of a lick of paint, so we set to and improved some of the wards considerably, and were asked to improve others! We were then given a few clinical tasks, and had the problems of getting started in a strange environment. The doctors had all been trained by the French, the notes were in French, but the children and their parents spoke only Vietnamese. I recall going to French evening classes for two hours, five nights a week, to improve mine. We were allocated two operating days a week, and some surgical beds. We volunteered to do some emergency cover, to avoid the children having to be transferred to an adult hospital, but there was a curfew, so nighttime work was difficult. The operating theatres were designed for air- conditioning, which did not work. The theatre superintendent, a local male nurse, did not relish the longer working hours that we created, but other theatre nurses were very helpful and friendly. There were two locally trained nurse anaesthetists who were fairly competent but were bullied by the local surgeons. The equipment was pretty basic with two old Boyle’s machines. The oxygen was piped, but very dependent on the man outside to change the large cylinder when it needed changing, and there were no alarms. There was no nitrous oxide. There was ether, trilene and I brought some halothane, laryngoscopes, endotracheal tubes etc. The Overseas Development Ministry told me to order and send out everything I would need for the next year, quite a task when I did not know what I would find when I got there. I took advice and went to see John Farman in Cambridge, who had worked in Nigeria and written the book on the EMO, and Tom Boulton who was writing about “Anaesthesia in Difficult Locations” at the time. I recall being advised to take out Brevedil (Suxamethonium bromide) which came in a powder form and did not need refrigeration.
Clinical work
We found the surgery was very varied, with trauma, abscesses, and congenital abnormalities, hare lip and cleft palate. John Partridge had been well trained in paediatric surgery and would tackle anything slowly and cautiously, and we saw some very sick children with typhoid perforations, and had to tackle some difficult lips and palates in older children. I also worked with the Vietnamese surgeons, Professor Tran Ngoc Nihn, known as ‘Big Ninh’, who was a French trained surgeon, and had recently been Minister of Education. He was a competent and ambitious surgeon, and announced soon after I had arrived that he had some interesting cases of children with fixed temporo-mandibular joints. Fortunately I had been trained by Dr James Smith in Plymouth, who made sure we were all skilled in blind nasal intubation.
We did see children injured by the war, but not as many as we had expected; we saw some burns, but very few were from napalm. Visiting journalists tended not to believe us when we told them this. Apart from the Embassy, we were the British presence in Saigon, and we had many visitors, from Vietnamese politicians, British MP’s, journalists and other foreign health workers. I recall one American physician saying he had never seen a case of tetanus, and quietly opening the door, and saying “you have now seen six.”
Much of the time, the two local nurse anaesthetists did not need supervision, and I found myself working on the wards as a registrar to Philip Evans. Betty Partridge, John’s wife was a trained paediatrician, and we set up a 1 in 3 rota for the wards. Here we encountered the infectious diseases, diarrhoea and dehydration, malnutrition and tetanus. We had antibiotics, but IV fluids were in short supply, and we needed 1/5 N Saline (Dextrose saline) and 1⁄2 N Saline with Dextrose. This involved a trip to Hong Kong, and the fluids were delivered to Saigon, courtesy of the RAF. Obtaining blood from the local people was difficult, but we were able to get some blood from the US military hospital, which had come from the States.
The children were cared for at the bedside by their relatives, often the grandmother, who would spend hours or days by the cot, and it was they who did all the feeding, washing and changing. The nurses did the technical tasks, the medication and all the IV lines. It was not easy for our nurses to fit into this pattern, but they did and helped with the nurse training. They became good at the Vietnamese, which being a tonal language is difficult. We encountered French customs in the hospital, and passing the Medicine Chief, Professor Phan Dihn Tuan on the stairs in the morning required a handshake, a “Bon Jour,” and another handshake before one could get on one’s way.
Teaching
We had the privilege of teaching medical students of the Saigon Medical School, who came to Nhi Dong for their paediatric time; they were very keen to learn, and clustered around our team leader, who was an excellent teacher. After a while I met with Vietnamese physician anaesthetists from other hospitals, who told me of the difficulties of teaching the local nurse anaesthetists, as their teachers had been called up into the army. I was invited to help with the teaching at Cho Ray, an adult hospital in Cholon, the Chinese part of the city. This was a considerable challenge, because of language difficulties. It consisted of teaching sessions during the lunch hour, which extended from 12 noon till 3 p.m. I managed to spend some time with them in the theatres, and at the end of the time was asked to help with the exams which were practical as well as written. At the end of one course, the British Ambassador was invited to present the prizes.
Travel to other hospitals
The British Government had supplied EMO draw-over apparatus, complete with Oxford Miniature vaporizer (OMV) and Oxford inflating bellows (OIB) in a wooden box, to all the 44 district hospitals in South Vietnam. Some of this equipment had yet to be delivered and gave me an excuse to take it to various hospitals, and demonstrate its use. Because of the security situation and the travel difficulties, this involved being away for a few days each time, but a wonderful opportunity to see the countryside, and to see what others were doing in Vietnam. In Qui Nhon, the UK Save the Children Fund had a team working in a rehabilitation centre, and a New Zealand civilian medical team was working in the district hospital. An Australian medical team was based at Bien Hoa, and I was able to swap jobs for a week, and see how the Australians were working; they were much closer to the action.
Achievements at Nhi Dong
In the first year the British Medical Team had established itself at Nhi Dong, and had maintained good relations with our local hosts, the staff of Nhi Dong. We felt we had contributed to the welfare of the children, and helped with the teaching of young doctors, medical students and nurses. The team members mostly stayed for one year.
Life during the war
In Saigon itself, in spite of a bloody war, life went on, the children went to their schools on their bicycles, the market was always crowded, the young fell in love and got married, and the next generation arrived. But in the countryside a terrible war was being fought, there were 500,000 US and 100,000 Allied troops in the country, with the Americans losing around 300 people a week, and untold numbers of Vietnamese dying on both sides.
Second sojourn in Saigon
After 16 months, I returned to the UK for leave and went back to Saigon to work for USAID (Public Health) as the Free World and Voluntary Agencies Liaison Officer; the position previously held by Tony Brown. This involved supporting the various foreign medical teams. These came from various countries, the Swiss, the Iranians, the Australians having three teams, and the New Zealanders two. The Spanish sent a military medical team and the West Germans sent a hospital ship, manned by the Red Cross. At the time of the Tet offensive in February 1968, all the US offices closed for about a week so I returned to work at Nhi Dong with the British team who were busy, while the fighting was going on around the hospital. I had been replaced by Catherine Ryan (1967), and she was succeeded by David Gray (1969).
Further work of the British Medical Team
The team expanded after the Tet offensive, and completed the five-year agreement signed with the Ministry of Health, but it contracted towards the end, as the political situation was deteriorating, ending in 1971. Saigon fell to the communist North in 1975, and was renamed Ho Chi Minh City.
