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Healthcare Sector in “Hanoi – Dien Bien Phu in the air” and lessons learned for provision of healthcare in national building and defence today

The epic story “Hanoi – Dien Bien Phu in the air” in December 1972 represents a symbol of revolutionary heroism and Vietnam’s will and intelligence in the war of resistance against American imperialists. Under the Party and State’s leadership and close coordination with ministries and branches at central and local levels, the Healthcare Sector brought into play its strength to overcome difficulties, together with people and military forces in the North made a vital contribution to defeating U.S. air raid, and left many lessons in the provision of healthcare in national building and defence today.

Realising Resolution of the 3rd National Party Congress to enable “… the north to advance rapidly, robustly and firmly to socialism while launching the people’s national democratic revolution to completely liberate the South,” the Healthcare Sector actively and proactively improved in every aspect and recorded vigorous developments. Its key task was to provide healthcare for the cause of building socialism in the north and the huge front line in the south. In the north, together with the foundation and development of the network of commune medical stations, the strengthening of disease prevention and control, and environmental sanitation, the system of central medical units was set up and developed. However, there remained a great deal of difficulty, particularly in facilities, staff, treatment equipment and technologies, and giving first aid to wounded soldiers, sick soldiers and victims in wartime as well as in medical catastrophes.

Bach Mai Hospital was heavily bombed on December 22nd, 1972 (file photo)

Since 1965, the American imperialists escalated their bombardment in the north with the aim of destroying Hanoi Capital, Hai Phong City, economic and defence capabilities, conducting interdiction of assistance for the south, and imposing pressure on us at Paris conference. In Hanoi alone, the enemy conducted 1,448 aircraft sorties to launch attacks of widespread destruction on our economic and defence capabilities, our people’s self-defence and combat capabilities, and densely-populated areas with a view to undermining the will to fight of military and Hanoi’s people. Important medical facilities, including major hospitals, 2 medical stations for tuberculosis treatment, 5 ward and district level drugstores, 3 subarea medical stations, 15 commune medical stations, 2 departments of public health and collective quarters, etc., were heavily destroyed. Their repeated, concentrated bombardment with various highly dangerous bombs and ammunition launched mostly at night-time and in cold weather made the settlement of the deadly aftermath of U.S. bomb campaign more difficult and complicated, requiring the Healthcare Sector to put a great deal of effort in evacuating and giving first aid to soldiers and people wounded by U.S. bombing.

In order to satisfy requirements in that situation, the northern soldiers and people in general and the Healthcare Sector in particular focused on shifting their operations from peacetime to wartime. The majority of medical facilities in Hanoi Capital was evacuated to the countryside to keep the strength intact, consolidate organisations, and develop methods to mobilise human and material resources in support of the tasks of defending the north and Hanoi Capital, and assisting the great frontline in the south. Right in October 1972, organisations of the Healthcare Sector and military medicine located within and without Hanoi Capital were carefully prepared for U.S. strategic bombing raid on the capital and its surrounding areas. The Ministry of Health instructed Hanoi Department of Health to closely cooperate with the Department of Military Medicine and some military medical facilities within and without Hanoi to devise plans for civil-military coordination in the spirit of allocating areas of responsibility to provide first aid and evacuate wounded soldiers and victims of war. The storming medical forces participating in giving first aid and evacuation of victims were mostly nurses from quarters and cooperatives, ambulance crews, members of the Red Cross; second-level mobile emergency teams of subarea and commune medical stations, hospitals, ward and district-level medical department, health services of agencies and enterprises, and military medicine; pupils and students of the Medical Secondary School and Medical University with 117 mobile ambulance teams transferred from second level to first level to provide support to victims on the scene. The bombing raid on Kham Thien street on 26th December alone, we mobilised 16 teams with 103 medical personnel at the local level and students to closely work with first-level medical forces to give first aid to and evacuate the wounded people. Quarters within the city provided emergency assistance among themselves and to surrounding areas. This method was applied to communes and between districts and communes in suburban areas. Second-level emergency teams were situated in several commune and subarea-level medical stations, and so forth. The evacuation of wounded soldiers and people was organised in a relatively scientific, appropriate and flexible manner. Search and rescue activities were carried out promptly and continually with close coordination between rudimentary and mechanised forces, assistance from adjacent localities, firm grasp of shelter and trench sketches, help of local people, and employment of man-made and natural indicators chosen as markers, and whistles to send out signals, making it easy for identification. Given its scientific organisation of forces, division of responsibility, willpower, intelligence, steadfast fighting spirit, proactiveness, and creativeness, the Healthcare Sector stood firm in giving first aid to wounded people when the enemy launched large-scale attacks. Some commune medical stations were able to categorise, select, deliver intensive care, transmit serum, and keep the majority of victims in their hospitals according to their areas of responsibility.

A unique feature of victims of the destructive war was high rates of patients. If the enemies attacked for numerous days, hospitals would become overloaded and incapable of receiving and curing victims. The wounded were adults, children, soldiers, militiamen, volunteer youth, and people, which made it difficult for the cure. Thus, it was necessary to stipulate areas of responsibility suitable for each level. The nature of wounds was complex. Most of the victims suffered several trauma and were seriously wounded, thus requiring triage to evacuate and manage shocks beforehand. While evacuating the wounded, special attention was paid to curing and evacuation techniques. In fact, initial evacuation was conducted massively without triage, or first aid before transporting by lorries. Victims of nighttime battles generally did not have commercial bills. First aid techniques for stopping the bleeding, fixing broken bones, etc., exposed a number of shortcomings in initial care and treatment. At that time, medical facilities performed over 600 operations in both surgery and internal medicine. Thousands of victims were on a drip feed, received blood transfusion, and so on. Medical staff had to work hard day and night for twelve consecutive days.

Nevertheless, given the utmost efforts made by the Healthcare Sector in general, the Capital in particular and by each cadre, doctor and medical worker, the victims enjoyed wholeheartedly, considerate treatment and cure. Hundreds of patients were opportunely dealt with within 6 or 8 hours since their hospitalisation, then the hospitals hurriedly made every necessary preparation for the next reception and treatment. The whole Healthcare Sector, from doctors to medical staff, from ordinary members of the Red Cross to passers-by, from first-level and second-level emergency groups to stretcher bearer teams, teams of bicycles, pedicaps and cars, medical stations, hospitals, etc., threw themselves wholeheartedly into their work for the sake of the wounded, sick soldiers and victims of war, and heightened revolutionary heroism, spirit, professional ethics, and intelligence to get over fierce challenges, successfully fulfill every mission, and satisfy the requirements of curing and treating the wounded soldiers, sick soldiers, wounded people, and victims of the 12-day U.S. bomb campaign.

What the Healthcare Sector did in the 1972 Air Defence Campaign displayed its spirit of “doctor as gentle mother” in war and left many invaluable lessons on medical support for the cause of national building and defence today.

First, it is imperative to strengthen the leadership and instruction of the Party, State, party executive committees and local authorities at all levels, and bring into play the role of the Fatherland Front, sociopolitical organisations and the whole society in protecting, looking after and improving the people’s health. Accordingly, apart from escalating propaganda and education with the aim of raising people’s awareness of the importance of medical support in peacetime, in case of medical emergencies and war to safeguard the Fatherland, authorities at all levels must mobilise every force, including medical forces and sociopolitical organisations, to participate in evacuation of wounded people. In particular, it is crucial to well execute civil-military coordination in first aid and treatment under the motto of “organising first aid, evacuation and treatment according to levels of care, areas and civil-military coordination.” This is Uncle Ho’s viewpoint on medical support, in which the civil-military coordination represents an effective solution in peacetime and wartime. Civil-military coordination also serves as the concretisation of the Party’s guidelines of all-people defence and aligning healthcare with national defence and vice versa with the aim of providing better health services for people, especially those living in border areas, on islands and in remote areas, and people being affected by disasters and storms in peacetime. At the same time, this measure helps to generate great, practical capabilities for national defence today. It is also the art of employing forces and exploiting the strength of civil-military coordination in each battlefield and campaign in the war to safeguard the Fatherland. Therefore, the concept of “area” in execution of medical support, treatment and evacuation of wounded soldiers, sick soldiers and people is in line with the theory of logistic support according to the Politburo’s Resolution 02-NQ/TW (Tenure VI) and Resolution 28-NQ/TW (Tenure X) on building provinces and cities under the direct leadership of the central government into firm defence zones, as well as the motto of “four on-premise factors” in dealing with emergency situations. In fact, in the years of U.S. destructive war in the north, treatment of wounded soldiers in the front line had been basically performed by the civil medical service before they were taken to military or civil hospitals, ensuring widespread, timely and effective first aid, and decreasing rates of mortality and disability.

Second, preparation must be made constantly, continually and right from peacetime. A matter of paramount importance in giving first aid to many wounded soldiers concurrently is to minimise the number of casualties, which relies on equipping the whole people with first aid techniques right from peacetime. Teams of surgeons and medical workers in charge of recuperation from operations must be ready to provide support for outpost lines of resistance or other units. District hospitals undertaking the third-level assignments should manage to perform on-premise operations and restrict themselves to moving the wounded to the fourth level to release the pressure in the urban areas. In actual fact, during the 12-day campaign in 1972, capital soldiers and people were successful not only in counter-attacking the air raids launched by the U.S. Air Force B-52s, but also in curing and evacuating the wounded people. Those results were attributed to the Healthcare Sector’s careful, thorough preparation. We are currently implementing the Politburo’s Resolution 28-NQ/TW (Tenure X) on building provinces and cities under the direct leadership of the central government into firm defence zones in the new situation. The Ministry of Health has instructed provincial and municipal departments of health to develop plans to provide medical support in the early years of war; carry out medical exercises in defence zones at province and district levels; accomplish plans to develop the medical reserve, self-defence force in healthcare service, and documents on local military geography; improve medical quality in recruitment; introduce military medicine training to curricular of universities of medicine and pharmacy; and so forth.

Third, continuing to consolidate mobile medical organisations, medical equipment and quality of technical training and competitions to ensure that medical organisations at all levels will be prepared to undertake their missions when mass casualties occur. It is necessary to strengthen cadres with a focus on development of surgery, especially the field surgeries in hospitals; and well realise the task of building medical reserve units according to the norms defined by Prime Minister’s Decision 137/2005/QĐ-TTg on 9 June 2005 and mobile medical teams as stipulated by the Government’s Decree 129/2014/NĐ-CP on assigning the Healthcare Sector mobilisation targets in cases of war and emergency situations. Attention should be paid to well practising preventive healthcare and maintaining readiness to perform tasks in every situation, including natural disasters, catastrophes, epidemics and pandemics, mass casualties caused by terrorist attacks, or enemy’s air raids by means of modernised, high-tech weapons.

Fourth, promoting the development of healthcare facilities from commune-level medical stations to central hospitals. During the implementation process, there is a need to explore flexible organisational models, suitable for conditions in each area with a view to providing better health services for people, especially those living in remote areas, border areas and on islands while developing medical techniques and field surgery to be ready to cope with natural disaster and catastrophes, and generate robust medical capabilities in defence zones to be prepared to handle medical emergency.

In the destructive war waged by American imperialists against Hanoi Capital in 1972, the Healthcare Sector put a great deal of effort in overcoming the deprivations and hardships to successfully fulfill the task of caring, protecting and improving the health of people and soldiers in all situations, making great contribution to the victory of the “Dien Bien Phu in the air.” Civil medicine and military medicine have been and will be side by side during their execution of the mission of curing, protecting and taking care of people and soldiers’ health in any circumstance. Civil-military medicine coordination represents the principle and foundation for developing objectives and missions of providing defence healthcare in the cause of national building and defence.

Associate Professor, People’s Doctor Nguyen Thi Kim Tien, Minister of Health

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