Frontline accounts
Stanford faculty and alumni recount their experiences
By MITZI BAKER
River of blood
Augustus White, MD, PhD, professor of orthopedic surgery at Harvard Medical School, Stanford medical school class of 1961. White served for a year in Vietnam in the 85th Evacuation Hospital, which also functioned as a Mobile Army Surgical Hospital — a MASH unit. He arrived in August 1966 and remained a year.
Two weeks out of my residency, I was in Fort Sam Houston, San Antonio, Texas, learning how to salute and how to debride wounds, which is making judgments about which tissues have a chance to survive and which are damaged enough that they should be cut out. This is what you do after you clean out all of the obvious sand, dirt, bolts, screws, rocks, animal feces, whatever may be in a battle wound.
I think people have no full concept of the realities of the battlefield, what really goes on, what it is to observe directly someone under the various conditions of mutilation that exist. There is no good way to observe a war. And I will tell you, the view of a military surgeon is not one either. I think all world leaders ought to spend a day with a military surgeon. This would bring them a whole lot closer to understanding what their decisions mean.
It’s very easy to look at charts and graphs and reports and make decisions about war. But I think sitting there with a military surgeon by a river of blood as it flows by would give a more realistic view. If there is a war anywhere in the world, all world leaders, one at a time, should be brought to the hospital to spend at least one day shadowing a military surgeon and then hopefully we would run out of wars for the leaders to observe.
Isolated in Vietnam
Norman Rich, MD, professor of surgery at the Uniformed Services University School of Medicine, Stanford medical school class of 1960. After joining the Army and completing his surgical residency at Letterman Hospital in the Presidio in San Francisco, Rich went to Vietnam in the fall of 1965. He was stationed at a remote enclave called An Khe, in the central highlands of Vietnam, as chief of surgery in a small MASH unit, where he served for nearly a year.
War is hell; there is no way around it.
We were in the first inland enclave; it was a big circle and the idea was that the circle would expand and win over the hearts and souls of the local people. That never really happened.
We were really an island; we were literally cut off. Almost once a month we were hit by the enemy forces, where we would have mortars come in and bullets flying around. We were all armed and there were a number of times when we had to defend ourselves. We were very fortunate that we never had any wounded or any deaths of our doctors.
One unique aspect of my time there was that we had around 242 punji stick wounds. Punji sticks were sharpened pieces of bamboo stuck in the ground — very simple, very inexpensive booby trap. The irony was that this was at a time when new developments like the M16 and the AK47, which are very effective military rifles, were being used and here were these primitive devices that have been in use for 2,500 years. They would put our soldiers out of the line of fire for 10 days or two weeks and if the punji sticks went into the knee or ankle joints, the soldier would have to be evacuated out of the country — from such a primitive weapon.
Tent of the damned
Sheri Fink, MD, PhD, Stanford medical school class of 1999. Just after her medical school graduation, Fink was in Bosnia-Herzegovina researching what became her book War Hospital, and war broke out in neighboring Kosovo, leading to a massive refugee outflow. The group Physicians for Human Rights asked her to go to the Kosovo/Macedonia border to document human rights violations. The physicians there recruited her to triage patients at a medical tent in the cold, muddy no-man’s land between the nations. She remained until Macedonia opened its border a week later.
We were treating people with acute illnesses, heart attacks, war injuries and seizures. However, volunteer medics from among the refugees also brought us people who were elderly, had mental health issues, were developmentally disabled, or had difficulty ambulating and were separated from their wheelchairs. The Macedonian soldiers wouldn’t let their family members accompany them to our area, so they were all alone with no one to assist them. We set up a separate tent for these people with these chronic problems. We let ourselves be very busy with the acute problems and very few people had the goodwill to go in and remember to bring food to these people, to change their clothes, to help them use the bathroom. Some of them died. We came to call it the tent of the damned. It was just awful.
Now I’ve seen it again and again in disasters and refugee situations. The most vulnerable people get neglected. Carrying a child out of the floodwater — that will get you in front of the cameras. Promoting the health and dignity of people with chronic problems isn’t glamorous like that, but it’s one of the most crucial services we can provide in emergencies.
Cut off from care
Sherry Wren, MD, associate professor of surgery at Stanford and chief of general surgery for the Veterans Affairs Palo Alto Health Care System. Wren volunteered with Doctors Without Borders/Médecins Sans Frontières, which sent her to a hospital in the Ivory Coast city of Bouaké. She served for six weeks.
The country has suffered from a prolonged civil war since 2002. The country is basically split in two, north and south, largely based on religious and tribal differences. In the northern part, there is no civil infrastructure: no government, police, banks, post office or any other kind of civil service. Bouaké is the second largest city in the country, with about half a million people and is located in the rebel zone. Immediately after the start of the conflict the hospital had nobody to run or staff it fully. MSF came into the city in 2002 and took over the management of the hospital, which now provides health care for the entire rebel area of the country.
In the conflict zone, if you can’t get some type of transportation to the hospital, you die. Transportation can be everything from walking, bicycle or bus. We would see people come in days after gunshot wounds. Here, in the US, a gunshot wound would be taken care of in under an hour. Yet we were seeing people days later if they were still alive. You compare that to the States — and even though we have underinsured and noninsured people, there is nobody in this country who cannot get health care if it’s really needed. And on top of it, an ambulance will pick you up at any point in time.
Close call in East Timor
Latha Palaniappan, MD, adjunct clinical assistant professor at the Stanford Prevention Research Center and attending physician for the preventive cardiology clinic. In 1999, after her residency at the University of California-San Francisco, Palaniappan served with her husband with Doctors Without Borders/Médecins Sans Frontières in East Timor, which was suffering the fallout of a civil war. They remained for six months, until the provisional authority took over and elections were set.
The clinic was a tent set up in the middle of the city’s central soccer stadium, surrounded by refugees. The line of patients seemed and was endless. Once, a moving size truck pulled up to the clinic with about 40 people riding in the back. There was blood everywhere in the back of the truck, and people were screaming in pain. I thought they had been victims of a roadside siege, beaten up and thrown in the back of the truck. My heart was pounding as I grabbed my small bag of dressings and climbed in the back to see what I could do. I assessed the first few people, and saw ghastly lacerations, open bone fractures, along with my first traumatic hemothorax. I did not have any surgical instruments, so I asked the truck driver in my broken Tetum [the local language] to drive the truck, with me and the people in the back, to the French army hospital, which was about a mile away.
It was only as I was dressing some of the superficial wounds in the back of the truck that I inquired about how everyone was injured. I found out that the brakes on the truck did not work well, and the truck had recently rolled into a ditch with all the people inside. I was dumbstruck that I had put all of these people as well as myself into another potentially dangerous situation as we drove with the faulty brakes to the hospital. With some prayers, a few tries, and lots of good luck the truck stopped safely and the patients and I made it into the hospital. From this experience, I learned a lesson that in an emergency, make sure you are safe enough to practice medicine, before jumping into a dangerous situation headfirst.
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