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Health Policy Advisory Center No. 31 May 1971 HEALTH / PAC BULLETIN AMERICA IN VIETNAM: DEMOCRACY FOR DEAD PEOPLE The South Vietnamese people are not only suffering the quick death of bombs, bullets, and burns. They are also dying the slow but certain death that comes from starvation, disease and dislocation. These are not accidents of warfare, the tragic but unintentional by products - of heavy com- bat. Rather they are deliberate, calculated and, in fact, central elements of American strategy. As in any successful guerilla struggle, the enemy in Vietnam " swims like a fish in the waters " of the Vietnamese people, especially in the rural country- side. If it cannot catch the fish that swim in the waters then, the United States has concluded, it must dry up those waters to catch the fish. - So it has offered the South Vietnamese two choices: move to " secure " areas un- der American control, or be annihilated. The same choice was offered the Amer- ican Indian; and the same devices were used to insure that both choices meant destruction. Take away the buffalo; take away the rice. Move to a reservation; move to a refugee camp. Use infected blankets; eat herbicides. If firepower doesn't work; your culture will be de- stroyed instead; your hearts and minds will be won. To ask about the effect of the war on the health of the South Vietnamese is to dis- cover that the people of Vietnam now face the same grim prospect that faced the American Indian. Under mounting in- ternal pressure the United States may move to complete the task swiftly or it may continue to turn the tools of destruc- tion over to Saigon. In either case, the United States is on the brink of destroying the very fabric of life as it has been known in South Vietnam and the ecological ma- trix which has made that life possible. Civilian Casualties Roughly one million South Vietnamese have been killed since 1961. Three- quarters of them were civilians. In the past year, only 46,000 were killed because of the diversion of bombers to Laos and Cambodia. Counting the dead and wound- ed, casualties include four million Viet- namese, close to one quarter of the coun- try's total population of 17.5 million per- sons. 60 percent of the civilian war injuries involve children under sixteen years (10, 15, 19). Bombs and fire power are responsible for about four fifths - of all the casualties. Since 1965, the United States has dropped 5.7 million tons of bombs on Vietnam- twice the combined tonnage of World War II and Korea. This amounts to 86 tons of bombardment for every square mile in South Vietnam and 650 pounds apiece for every man, woman and child (16). Included in this arsenal are a complex array of anti personnel - weapons with af- fectionate names (lazy dog, pineapple and guava bombs, rockeye, beehive) and incendiary bombs (napalm, gasoline, white phosphorus). These weapons are directed against victims almost at ran- dom; they accomplish military objectives whether they hit belligerents or civilians. Aviation Week describes the strategy CONTENTS 1 Vietnam Devastation 9 Vietnam Veterans 16 Anti War Activities and its effects: " Most of the victims of anti personnel - bombs are not killed, rather they are maimed. The pellets [or napalm, as the case may be] are designed to cause irregular and hard - to - cure wounds. This serves two functions. First, it means that instead of a single man dead and withdrawn from military pro- duction, six to ten people (as well as fa- cilities and supplies) must care for him. Second, the sufferings of a badly wound- ed victim tend to have a greater demoral- izing effect on the remaining population than the dead. Thus such weapons'build a deterrent capability into conventional ordinance.'That is, they have a'separate and distinguishable psychological impact ... apart from the actual destruction they caused.'" (5). The lack of concern for civilian welfare in Vietnam policy is illustrated in a recent Defense Department admission that, " it has never made a study, nor has it asked any outside agency, to make a study of the number of noncombatants wounded or killed by American military operations in the Vietnam war. " 20 (). Destroying the Forests When 650 pounds of bombs for every member of the population weren't enough to bring submission or annihilation, the warmakers sought more subtle tech- snuibqtulees .t hUen ftoercthunniaqtueel,y thhoew emvoerre, ptehrev emrosree, pervasive and incalculable the damage. The art of defoliation - by bulldozer and herbicide has been perfected in Viet- nam. Vast stretches of vegetation have been destroyed under the guise of deny- ing cover, food and sanctuary to fighters of the National Liberation Front (NLF). Using giant tractors with plows, the United States has cleared 1000-2000 yard strips along most transportation routes. In addi- tion, half a million acres of forest had been bulldozed by 1969. In the words of one commanding officer, " The B 52 - is the battle - ax of this war, and our plow is the scalpel " (21). If the plow is the scalpel, then herbi- cides must be the sabres. Since 1961, when the defoliation program began, the US has sprayed over six and a half million acres or one in every six acres in South Vietnam (21). The little that is known about the effects of herbicides is due largely to a study undertaken in South Vietnam by the Her- bicide Assessment Commission of the American Association for the Advance- ment of Science. The Commission had to conduct the study without benefit of vital data possessed by the Department of De- fense - the number of defoliation missions flown; where they were flown; and which defolients were used. Furthermore, most of the knowledge about herbicides is limited to its effects on the more tradi- tional aspects of ecology; little is known about its long term - effects on the human body or psyche. However it is obvious that massive destruction and alteration of the non human - ecological systems bring about enormous transformations in the systems of human life - be they physio- logical, economic or cultural. In the awe- some rhetoric of Maxwell Taylor, " Here [in Vietnam] we have going a labora- tory. " The Vietnamese have been exposed to three types of herbicide: Agents Orange, Blue and White. Agent Orange has been used most extensively. It consists of 2,4 - D and 2,4,5 - T and is especially effective on broad leaf and crops soft stemmed - plants (bushes and crops); scientists now fear that it may cause birth defects. Agent Blue is dimethyl arsenic acid, more frequently called cacodylic acid. It is effective on plants with narrow - bladed leaves, and thus it is used on elephant grass and rice. In many cases, as Agent Blue breaks down in the soil, its toxicity increases enormously. Agent White is a mixture of picloram and 2,4 - D. It is used against forest vegeta- tion. Thus far, it has remained in the soil with such persistence that no one knows how long it will continue to contaminate the land. A single spraying of herbicide kills one Published by the Health Policy Advisory Center, Inc., 17 Murray Street, New York, N. Y. 1007. Telephone 212 () 267-8890. The Health - PAC BULLETIN is published monthly, except during the months of July and August when it is published bi monthly - . Yearly subscriptions: $ 5 students. $ 7 others. Application to mail at second class postage is pending at New York, N. Y. Subscriptions, changes - of - address, and other correspondence should be mailed to the above address. Staff: Constance Bloomfield, Robb Burlage, Barbara Ehrenreich, John Ehren. reich, Oliver Fein, M.D., Marsha Handelman, Ken Kimerling, Ronda Kotelchuck, Howard Levy, M.D, Susan Reverby and Michael Smukler. 1971. 2 out of every eight to ten trees; the rest lose their leaves for several months be- Some of the ecological effects of the use of herbicides are not so obvious as fore recovering. In areas sprayed more the numbers of acres sprayed or trees that once, 50 to 80 percent of the trees are killed. Agent White is extremely persist- killed. Out of a total of 26.5 million acres ent in the soil; less than four percent of it of forest, over five and a half million acres vanished from a test plot after a year. have been sprayed at least once and Agent Orange breaks down over a period large tracts have been sprayed repeat- of several weeks, but one of the elements edly (1, 4). it breaks into destroys plant growth regu- While only a small part of Vietnam's lators, thereby becoming a growth herbicide forests are mangrove, mangroves are the itself. Agent Blue is metabolized by micro- ecological foundation for areas such as flora in the soil and demethylation, a com- the Mekong Delta. Here they line the mon metabolic reaction, increases its tox- rivers and estuaries of the coast, building icity 50 fold -. In the absence of air (such as and maintaining the shoreline. Tens of at the bottom of a rice paddy) these re- thousands of Vietnamese live among the actions can convert Agent Blue to arsenic mangrove forests. These trees serve as a poison (9, 13). source of firewood and charcoal as well The Defense Department's glib reassur- as providing cover and food for various ances of refoliation do not take account birds, fish and crustaceans, important of serious intervening processes. If South sources of protein in the Vietnamese diet. Vietnam can be transformed into a pro- The mangrove is wiped out by a single ductive land once again, it is doubtful that spraying of herbicide. Nearly half of the it will ever resemble its former self, even . mangrove stands in South Vietnam (346, - in ecological aspects. For instance, the 000 acres) have been destroyed. No re- 500 to 750 pound - bombs carried by B 52's - growth has been observed for up to six leave craters as deep as 30 feet and wide years after a single spraying. It is esti- mated that the mangroves will take as 45 feet. 848,000 of these holes were made in 1967 and over two and a half twenty years to grow back, if they do so million in 1968. As one Vietnamese put it, at all () 3. " The United States is making our country Ninety percent of South Vietnam's fores- look like the surface of the moon. " (17). tation is hardwood. 35 percent, of the 14 Many tropical soils are subject to later- million acres of dense forest have been ization, a process of hardening into a sprayed at least once, resulting in the de- brick - like substance. Laterization occurs struction of 6.5 million board feet of sale- when soils of susceptible chemical com- able timber. Based on current demand for position are depleted of organic matter, timber, this is equivalent to South Viet- leached of soluable materials by water nam's needs for the next 31 years 7 (). runoff, and baked by the sun. This pro- On Bombing Hospitals " Fixed establishments and mobile medical units of the Medical Service may on no circumstances be attacked, but shall at all times be respected and pro- tected by the parties to the conflict. " Article 19, Geneva Convention, Aug. 12, 1949. " The purpose of the strikes into the sanctuaries is not to go into Cambodia, but to take and reduce these supply depots, THE HOSPITAL COMPLEXES. * " I (emphasis added) Spiro Agnew, May 3, 1970, on " Face the Nation. " Because of the Cambodia operation the North Vietnamese and NLF would have " no medical facilities left to treat the wounded. " Typhoon, publication, U.S. Department of the Army, June - July, 1970. Description of the effects on the North Vietnamese and NLF troops when two hospitals in the Que Son mountains, 21 miles south of Da Nang, were attacked and overcome: " The two hospital finds could seriously hurt the NFL units and VC operating in the Que Son area by almost eliminating any chance of intensive medical care. " Observer, published by U.S. Military Assistance Command, Vietnam, Sept. 18, 1970. 3 If South Vietnam approximates the size of New England, the area sprayed is larger than Vermont and the area bulldozed is about the size of Rhode Island. cess is irreversible, except in the context of geological time. Scientists estimate 30- 50% of the soils of South Vietnam are laterizable (9). Defoliation also disrupts symbiotic relationships among forest plants which produce necessary plant vitamins and nutrients. Many leaf stored - nutrients and primary minerals are lost through water runoff. Defoliated areas are subject to erosion. Severe floods were reported in several northern provinces last autumn. Insect, bird and bat popula- tions, among other animals are declining, and with them their important pollinizing function. Many plant species, normally held in check by lack of light, quickly colonize defoliated areas, competing with larger and more valuable plants for space and nutrients. Thus large growths of bamboo have appeared in the hardwood forests; these hinder or prevent reforestation and are nearly impossible to eradicate. Only the most dramatic effects of these herbicides on people are known. Scien- tists are finding that Agent Orange, long considered the safest of the three, is prob- ably the most insidious. In direct contact, one of its components, 2,4,5 - T causes irri- tation of the eyes, nose and skin, swelling, vomiting and diarrhea, and eventually malaise and asthenia (general weak- ness) requiring several months of bed- rest. Laboratory tests also show that 2,4,5 - T may cause gastrointestinal or uri- nary tract changes. Many of these go un- noticed, revealing themselves only in later complications or early death (9). The most shocking discovery about 2,4,5 - T, however, is that it produces birth defects. In early 1970 Bionetics Research Laboratories, Inc. reported that offspring of laboratory animals fed 2,4,5 - T showed nearly 80 percent fetal mortality; of the offspring that lived, nearly 100 percent suffered birth defects. 2,4 - D, the other com- 4 ponent of Agent Orange was said to " re- quire further study. " (13). Reliable statistics on still births and birth defects in Vietnam are difficult to ob- tain because many of the most heavily sprayed provinces are rural; medical fa- cilities are few; and most deliveries take place at home. In the summer of 1969, Saigon newspapers disclosed a sharp rise in plant defects and linked them to the use of defoliants. The AAAS team found that Tay Ninh City Provincial Hospital showed a stillbirth rate of 64 per thou- sand, well above the country - wide aver- age of 31.2 per thousand. The Saigon Childrens'Hospital also reported a " dis- proportionate rise " in two birth defects, pure cleft palate and spina bifida (a spinal deformity frequently resulting in paralysis) in 1967 and 1968. These in- creases occurred during the period of heaviest defoliation. Available data is far from conclusive, however, and scientists are reluctant to attribute these defects solely to defoliants (9). In December, 1970, three days before the Herbicide Assessment Commission was to present its report to the AAAS, the White House announced that herbicide use would be phased out of Vietnam. But what this announcement actually means for the people of South Vietnam is ques- tionable. The use of Agent Orange was supposed to be terminated in April, 1970, but was still being used as late as October. Furthermore, there are rumors that the defoliation program is merely be- ing " Vietnamized, " and that American G 123 - aircraft used for spraying are being painted over with South Vietnamese insignia. Destroying the Crops The United States has been conducting massive crop destruction missions in South Vietnam since 1962. Under the euphemism " resource denial program " Agent Blue has destroyed 688,000 acres of crop land (nine percent of South Viet- " Troops have found rice to be one of the most maddenly indestructible substances on earth. " Charles Mohr, New York Times Taking It All Over There In 1960, Parke, Davis was near the top of the pharmaceutical world. Its success was built upon the antibiotic Chloromycetin (chloramphenicol) which brought in sales of $ 80 million a year. By the late 1960's Parke, Davis'patent on chloramphenicol expired and smaller drug houses rushed into market this money maker. At the same time, the Food and Drug Administration (FDA), act- ing on convincing data which it had allowed to accumulate for nearly a decade, strongly advised doctors to restrict the drugs's use. Chloramphenicol was found to be causing aplastic anemia, a disease which may result in death. Since this blood and bone marrow - affliction can result from short as well as long - term therapy with the drug, chloramphenicol " must not be used when less potentially dangerous agents will be effective... must not be used in the treatment of trivial infections. " (FDA) It is now considered the'drug of choice'for only one disease typhoid - fever. Consequently Parke, Davis'sales of Chloromycetin plummeted to $ 30 million in 1969. Parke, Davis makes a good part of that $ 30 million by pushing the drug in Europe, Asia and Latin America where regulations aren't as strict. In Italy, Parke, Davis tells doctors that " the fact that therapy with Chloromycetin is remarkably without secondary reactions is very significant. The preparation has been tolerated well by both adults and infants. In the few cases in which reactions occur, these are generally limited to slight nausea or diarrhea andt heir severity rarely requires suspension of treatment. " In Japan, Parke, Davis calls Chloromycetin " a remarkably ideal antibiotic. " The State Department's Agency for International Development buys the drug from Parke, Davis and gives it away to the South Vietnamese Government's Civilian Health Ministry for unrestricted use. The Defense Department gener- ously gives the drug gratis to the South Vietnamese Armed Forces. While the United States is helping push Chloromycetin in Vietnam, the Defense Medical Materials Board advises United States military hospitals to exclude it from their formulary. Its use for American servicemen is restricted to diseases which are " extremely serious and not responsive to safer antibiotics. " nam's agricultural land) (23). The stated goal of this program is to starve the Na- tional Liberation Front into defeat or death. Short of this the United States hopes that scarce food supplies will strain relations between the guerillas and the peasants. Since 1962, 344 million pounds of milled rice have been destroyed, enough to feed 860,000 people a year (five percent of the population) (23). Up until 1964, rice had been South Vietnam's second largest export; in that year 49 million metric tons were exported. In 1965, three years after crop destruction was initiated, South Viet- nam had to import 240,000 tons of rice (11). Several recent studies by and for the United States Army reveal that food de- struction has had little effect on National Liberation Front forces. Civilians, on the other hand, have suffered badly. It is es- timated that between ten and one hundred civilians must be denied food in order to deny food to one guerilla. In other words, of the 860,000 annual diets destroyed be- tween 1962 and 1969, between 774,000 and 851,000 were destined for civilian stomachs. Moreover, it is reasonable to assume that the brunt of this burden is borne by the unborn, infants, the aged, pregnant women, and the sick (23). Accidental spraying and the spreading of herbicides by wind and rainfall have caused extensive damage to crops of bananas, beans, water spinach, papaya, jack fruit, milk fruit, coconut, mustard cab- bage, and watermelon. Nearly 100,000 acres of rubber trees have been acci- dently defoliated. Crop destruction hasn't been a very successful tactic in terms of its stated goals: it has failed to " starve out the enemy; " it has devastated the national economy and where farmers have en- dured, it may have even strengthened their bond to the NLF. According to the AAAS Commission Report, many peas- ants interviewed felt that the United States is deliberately trying to destroy the rural economy in order to make the farmers de- pendent on the United States. But the ef- 5 fectiveness of defoliation in uprooting the rural population casts serious doubt on its goals. Dislocating the People The most direct effect of all these tac- tics, massive bombing, defoliation, and crop destruction, aside from the immedi- ate death, destruction and suffering they inflict has been the massive dislocation of the population. In April 1971, Edward Kennedy's Senate Subcommittee on Refu- gees conservatively estimated that five million South Vietnamese were refugees (16). This is nearly one third - of the popu- lation. Furthermore, since a refugee is only considered as such until he becomes resettled in a new environment, it is rea- sonable to assume that from the begin- ning of the war as many as half of the people of South Vietnam may have been forced to leave their homes to make way for the military. Refugees are settled in camps or find their way to urban slums. Saigon has grown from 250,000 to over three million in ten years. Needless to say, the vast majority of refugees face joblessness and destitution in their new homes. Refugee camps are squalid and crowded, many having no water or sanitary facilities of any kind. Daily food allowances are often below subsistence. A military man clarified the intent of this forced " urbanization " or " moderniza- Bringing It Chemical warfare is not only being waged in Vietnam. The men and women who work in our factories and plants are also the victims in this sometimes explosive, but more often quiet and insidious war. According to the Surgeon General " every 20 minutes a new and potentially toxic, chemical is being introduced into industry. " The number of chemicals being used is an estimated 450,000, yet the dangerous properties are known for only 12,000 of these. The American Conference of Governmental Industrial Hygienists sets the maximum exposure to chemical substances considered safe for an eight hour work period. These maximums are called the Threshold Limit Values or TLVs. The TLVs have been estimated for only some 450-500 substances; and even these are rarely enforced. The dangers, especially the long term dangers, are just now being studied. The Oil, Chemical and Atomic Workers (OCAW) union held a series of nation - wide hearings over a three year period on industrial hazards. Nearly 11 million people who work in the war related - industries experience hazards such as these: OE Dow Chemical Company is famous for napalm and herbicides. Its Midland Michigan plant which produced the herbicide " 2,4,5, T " was closed down when its workers were overexposed to the product. The workers expressed com- plaints similar to those of the Vietnamese people sprayed with the chemical: skin irritation, swelling, malaise, and general weakness leading to an inability to work and requiring prolonged bedrest. Factory workers are not the only people in this country who are exposed. Studies are being done on the children of migrant workers to determine if the higher retardation rates found among them is related to the chemicals used in the fields. Thus in recent negotiations, the United Farm Workers have won agreements which specifically prohibit the use of 2,4, D. 2,4,5, T, DDT, DDD, aldrin, dieldrin and endrin. The first two are used in Vietnam; there " 2,4,5, T " has been shown to cause birth defects. OE Uniroyal Company maintains a small plant in Edmonton, Alberta, which manufactures insecticides and herbicides, among them the " 2,4,5, T ". Every day workers are exposed to the chorophenols in the herbicide. They have been unable to wash the smell of the chemicals from their skin. No one is certain what the long term effects of exposure to these chemicals might be. OE In 1969, Montrose Chemical in New Jersey had a $ 1.11 millon contract to produce chemicals for tear gas. That year, a worker testified at the OCAW hearings that a blower situated 20 feet from his workplace was " shooting " the stuff at him: 6 tion, " as it has been called. " There have been three choices open to the peasantry. One, to stay where they are; two, to move into areas controlled by us; three, to move off into the interior towards the Vietcong. ... Our operations have been designed to make the first choice impossible, the second attractive, and to reduce the like- lihood of anyone choosing the third to zero " (9). The U.S. claims that the crop destruc- tion program is also being phased out. The question is whether it, too, has simply been Vietnamized. Disease in Vietnam Life expectancy in Vietnam is approxi- mately 35 years. Infant mortality is esti- mated to be 255 per 1000 live births and half of the children born die by the age of five (24). The crowded and unsanitary conditions of South Vietnam's refugee camps, urban slums, and devastated rural areas provide hospitable environments for disease. In 1961, only about half a dozen cases of bubonic plague were reported in South Vietnam. By 1967, the number had risen to 5500, of which 350 died. Pneumonic plague, which is even more serious, is also reappearing after an absence of thirty years (13). Cholera has increased 100 percent and is more prevalent in South Vietnam than anywhere else in the world. Malaria has become epidemic, due no doubt in part to the millions of bomb created - craters which All Back Home "... So I go to work, and as I said many times, I'm fresh. I relieve another fireman and the guy is getting dizzier and dizzier. So we start complaining. We go down there. So they done us a big favor; they extended the stack four feet, thinking this is something, and yet, when it's a windy day, it still comes down. " @ The men who worked within the Army's Rocky Mountain Arsenal were studied. Some of them were producing nerve gas, while others made insecti- cides for Shell Chemical Company, which maintains its plant within the Arsenal. Examinations of the men exposed to both the insecticides and nerve gases have revealed " soft " neurological symptoms such as coordination deficiency, memory difficulty, inability to maintain alertness and visual focus and in- creased irritability. There was also some evidence which indicated that they have above average suicide and divorce rates. The Oil, Atomic and Chemical Workers have stated in a report, " Hazards in the Industrial Enviornment ", that the hazards of the Rocky Mountain Arsenal spread beyond the complex itself. " Water wastes from the plant have killed thousands of ducks and other wildlife. When an attempt was made to pump the liquid wastes into a well 2 miles deep, Denver was hit by its first earth- quake in eight years. More than 1500 earthquakes were subsequently recorded during the next five years. A study by the Colorado School of Mines held the huge underground shaft responsible. Today the workers speak of chlorine and other gases being vented straight into the atmosphere without any treatment. " The exposure in these plants is most often a cumulative one. Respiratory and other ailments build up slowly; often the damage to the lungs and other organs does not show up until irreparable harm has been done, many years later. One man put it this way: " We don't have a line [pipe] break every day, but you breathe these fumes every day. What happens to these people after a period of time, say in fifteen years, of working there? " The dangers in these war products plants are tremendous, but no greater than in many other American industries. Everyone from lipstick makers to dry cleaners faces this daily barrage of chemicals. Every day workers, their families and the whole country are exposed to lethal dangers. The damage to our health and life as a nation is only now being revealed. As a worker said: " We need to do something soon so at least our families can live and our minds will function. " - Susan Reverby 7 The only insurmountable health problem in Vietnam is the presence of Americans. are filled with stagnant water much of the year. Tuberculosis, smallpox, influ- enza and polio are on the increase. The suicide rate has risen tenfold in two years (6). Malnutrition has become a serious med- ical problem in South Vietnam, and with it are appearing the expected incidences of beri beri -, kwashiorkor, and anemia. Weakened by lack of food, the population becomes even more susceptible to other diseases. Even less direct effects on health must be considered in an evaluation of the im- pact of the war. The increased risk of disease may last long after a return to normality. For instance, a study of World War II prisoners - of - war many years after their release showed twice the expected rates of death from heart disease and ac- cidents; twice the average rate of gastro- intestinal diseses; and nine times the ex- pected death rate from pulmonary tuber- culosis. Since many of these diseases appeared to be unrelated to the original confinement, researchers could only con- clude that they were the long delayed - effects of stress (2). South Vietnam's only weapon against death, injury and disease caused by the war is its medical system. The Saigon government spends only two percent of its budget on health. 60 percent of this goes to the military. There are only 800 qualified physicians in Vietnam. Of these, 500 are in the military. About half of the remaining 300 have private practices in Saigon, leaving a mere 150 doctors to treat the rural population and to handle the half million casualties which occur each year. This leaves a ratio of one doc- tor to 100,000 people outside of Saigon. More South Vietnamese doctors are re- ported to be living in France than in South Vietnam itself (6, 24). South Vietnam's two medical schools were the only answer to this shortage. The Saigon medical faculty graduated 50 doctors a year and Hue produced another 25. However, the Saigon school was closed in 1970 due to student uprisings and Hue's university was destroyed dur ing the Tet offensive of 1968. The South Vietnamese public health system is built on the remains of the 8 archaic French system. It relies on a net- work of provincial hospitals and village dispensary - clinics. Most of the 60 provin- cial hospitals were built around the turn of the century. 90 percent have no running water; few have power; virtually none have waste disposal facilities. Most hos- pitals have two to three patients per bed (24). The U.S. boasts that it has opened up its military hospitals for civilian casualties. These hospitals treat about 10,000 cases a year - less than 2 percent of total casual- ties. The U.S. also sends medical and pub- lic health aid through a $ 50 million a year program. (see box, p. 5) Little of this aid reaches the hospitals, however, after passing through a hierarchy of corrupt officials. A Harbinger of Future Warfare With the opposition to the war again building, the heat is once more on Presi- dent Nixon to cut the finanical and human cost dramatically, or get out of Vietnam. His tenaciousness, like that of his prede- cessor, stems from a sense that Vietnam is a harbinger of American wars to come. So it is more important than ever that the United States develop a viable stra- tegy for counterinsurgent warfare - one that can crush revolt abroad while re- maining marketable at home. That is what the United States has been doing. Aerial bombardment, incendiary and anti personnel - bombs, and chemical and biological warfare - all perfected in Vietnam - have two important elements in common. They are cheap to manufac- ture and they can be deployed with min- imal use of or danger to American troops. That these weapons rain nearly total destruction upon people whose democ- racy the U.S. came to save and whose hearts and minds it found it had to win is no accident. If it could not win their hearts and minds, if indeed these people were not friends, then they would have to be sacrificed to the American goal of winning or at least saving face. Whether this policy was declared or undeclared, the facts can lead to no other conclusion. And now Nixon says the troops are leaving Vietnam. Whether they are with- drawn, partially or wholly, by December " Here (in Vietnam) we have going a laboratory. " Maxwell Taylor 31, by November elections, or according to some unknown timetable is quickly be- coming irrelevant to the Vietnamese peo- ple. To them the only relevant question is, " What is the U.S. leaving behind in Vietnam? " - Ronda Kotelchuck References 1. Aaronson, Terri, " A Tour of Vietnam, " Environment, Vol. 13, No. 2, Mar. 1971. 2. Alland, Alexander, War " and Disease: An Anthro- pological Perspective, " Bulletin of Atomic Scientists, June, 1968, pp. 28-32. 3. American Association for the Advancement of Science, " Summary of Presentations by the Herbicide Assessment Commission. " Dec. 29, 1970, Chicago. 4. American Association for the Advancement of Science, Herbicide Assessment Assessment Commission, Back- " ground Material Relevant to Presentations of the 1970 Annual Meeting of AAAS, " January 14, 1971. 5. Aviation Week, Vietnam Spurs Navy Weapons Ad- vances, " Mar. 21, 1966. 6. Bodenheimer, Tom and George Roth, Health " and Death in Vietnam, " in Barry Weisberg, Ecocide in I16n3d-o16c8h.i na, San Francisco, Canfield Press, 1970, pp. 7... Boffey, Philip H., Herbicides " in Vietnam: AAAS S1t71u,d yN oF.i n39d6s6 WJiadn.e s8p,r e1a9d71 ,D epvpa.s t43a-t4i7o.n , " Science, Vol. 8. Chomsky, Noam, American Power and the New Mandarins, Pantheon Books, New York, 1967, 9. Kahn, Peter and Salome Walsh, Defoliation " : The Ecology of the War in Vietnam, " April, 1971, to be published. 10. Lumsden, M., The Vietnamese People and the Impact of the War, Denmark, Institute for Peace and Con- flict Research, 1969. 11. Mayer, Jean, " Starvation as a Weapon, " in Barry Weisberg, Ecocide in Indochina, San Francisco, Can- field Press, 1970. 12. National Action Research / on the Military Industrial " Complex, " Weapons for Counterinsurgency,'Phila- delphia, Pa., 1970. 13. Neilands, J.B., " Vietnam: Progress of the Chemical War, " Asian Survey, March, 1970, reprinted in Not Since the Romans Salted the Earth, Ithaca, N.Y., Glad Day Press. 14. New York Times, October 24, 1970. 15. New York Times, March 15, 1971. 16. New York Times, April 21, 1971. 17. Orians, Gordon H. and Pfieffer, E. W., " Ecological Effects of the War In Vietnam, " Science, May 1, 1970, reprinted in Not Since the Romans Salted the Earth, Ithaca, N.Y., Glad Day Press. 18. Physicians for Social Responsibility, Indochina " Fact Sheet, " March 1971. 19. Subcommittee to Investigate Problems Connected With Refugees and Escapees, Senate Committee on the Judiciary, " Civilian_Casualty Civilian_Casualty Social Welfare and Refugee Problems in South Vietnam, " Washington, D.C. GPO, 1969. 20. Washington Post, March 15, 1971. 21. Westing, Arthur H., " Ecocide in Indochina, " Natural History, Vol. 80, No. 3, pp. 56-61. 22. Westing, Arthur H., " Poisoning Plants for Peace, " Friends Journal, April 1, 1970, reprinted in Not Since thePr esRs.o mans Salted the Earth, Ithaca, N.Y., Glad Day 23. Westing, Arthur H., " U.S. Food Destruction Program in South Vietnam, " Vermont Freeman, Vol. 3, No. 8, pp. 9-10. 24. Vastyan, E.A., " Civilian War Casualties and Medical Care in South Vietnam, " Annals of Internal Med- icine, Vol. 74, pp. 611-624, April, 1971. WHERE HAVE ALL THE YOUNG MEN GONE? Over 2 million Americans have been stationed in Vietnam since 1961. Of that number, 44,332 have been killed and 297, - 576 have been wounded (January, 1961 to April, 1971). In terms of American lives lost, the Vietnam " conflict " recently be- came the third most costly war ever en- gaged in by the United States, topped only by the Civil War and World War II. One may take some solace, however, in the fact that GI's are dying at lower rates than ever before; only 21.9 men per thou- sand have died in Vietnam as compared with 43.2 per thousand in Korea and 51.9 per thousand in World War II. Nature of Casualties Thanks to the miracles of modern mili- tary medicine, wounded men are surviv- ing at higher rates than ever before. 81 percent of the Vietnam wounded survive; this compares with 74 percent for Korea and 71 percent for World War II. Men who would have bled to death on the field in previous wars, are evacuated by helicop- ter to field hospital units, sometimes only 20 minutes after being hit. The care in these units is good. " In Nam, if they take you off the choppers alive, or just a little dead, it may hurt a lot, but you'll live. " (365 Days, Ronald J. Glasser, M.D., Braziller Publishers, 1971) Approximately 93 percent of the men who recover from their wounds are sent into battle again or remain on active duty 9 " Vietnam combat veterans tend to see their experience as an exercise in survival rather than a defense of national values. " V.A. Description of Viet Vets in some other capacity until being dis- charged. The other seven percent are kept in military hospitals (most of them in the United States), until the military decides it has done all it can, has no further use for them, and discharges them, most often to a Veterans Administration VA () Hos- pital. This group of men (approximately 167,350), shows that the Vietnam War has been the worst crippler ever experienced. 54 percent of the men separated from the Army due to disability have suffered amputation or paralysis of extremities, compared with 28 percent for Korea, and 21 percent for World War II. 12.4 percent of the men receiving disability compensa- tion from the VA are totally disabled; this compares with 6.7 percent for Korea and 4.4 for World War II. Vietnam is an ugly and devastating war in every respect in- cluding the way it injures its fighters. It is in the nature of this war to be a crippler: higher firepower combined with guerilla mines and ambushes produce awesome and terrifying results. A Claymore mine sends out 200 to 400 ball bearings at 1000 feet per second. " In Korea and World War II, much of the fighting was done from the protection of trenches and bunkers... Thus, a mortar or rocket shell exploding near a soldier in Korea might have injured only one limb- but in Vietnam it may spray fragments into several areas of his body... [For instance, a] soldier recently hit by a rock- et blast had his lower right arm blown off, was hit by 33 fragments in his other arm, in his chest and abdomen and in both legs, and was burned over 60 percent of his body... At 100 yards you can almost catch the burp gun shell with a pitcher's mitt, but at the same range an AK - 47 can kill a bullmoose. " (Hearings, Senate Sub- committee on Veterans'Affairs, Nov. 21, 25: Dec. 15, 16, 1969) Degrees of a man's disability are cal- culated from a thick government publica- 10 tion, Schedule for Rating Disabilities. This book lists every conceivable injury to, loss or destruction of every part of the ana- tomy percentages - for fingers, eyebrows, ears, legs, arms, gut and brain. This book has been in use since 1945 and with re- visions, it forms the basis for determining how much a veteran's wound is worth. 100 percent disability is generally the complete loss of a sense or a limb. 100 per- cent disability = $ month 459 / ; 50 percent disability = $ 135; 10 percent = $ 25, etc. The most a wounded man can get for his injuries if they are multiple and he is a paraplegic is 784 $ per month. Blindness is running three times the World War II rate. 20 percent of the wounded have " multiple wounds, " (mean- ing many injuries without a single pre- dominant location); this compares with 2 percent in Korea; 3 percent in World War II. The statistics go on and on like reckon- ings in Hell. They all show that more Viet Vets are returning with less. To compound the crime, they are also returning to less. Less glory, for sure. Less medical care. They do have more unemployment how- ever. They also have more of their lives before them, since they are younger than the victims of any other war. VA Medical System The Veterans Administration is that agency charged with providing service and compensation to the survivors of America's armed forces. By mid 1969 - the veteran population was 26,925,000 men and women. When their dependents, pa- rents and widows (in the case of deceased vets) are added to that figure, the signifi- cance of the Veterans Administration be- comes apparent; 48 percent of the popula- tion is potentially eligible for some sort of VA benefit or service. VA benefits and services range from providing burial flags and tombstones to life insurance. Somewhere in between those extremes rests the VA medical sys- tem. The VA claims that it runs the largest medical system in the world (166 hos- pitals, containing 105,000 beds; 202 out- patient clinics; 16 domicilary units with 13,523 beds; 6 restoration centers; 63 nurs- ing homes with 4,000 beds); it is becom- ing apparent that the VA also provides some of the worst care this nation can come up with. The crisis in care which has come home to almost every medical facility and pro- gram in the country has also come home to the VA. The problems that plague the American health care system as a whole are repeated and intensified in the VA. Nothing was too good for the World War II and Korean veteran, but the momen- tum the VA gained during that period has long since dissipated. During the 40's and 50's, general medical care in the VA was considered to be better than in the hos- pital system at large. Now the VA ranks with the average public hospital in gen- eral medicine; in psychiatry the VA is thought to be worse than the average pub- lic hospital! In the fall of 1969, the Senate Subcom- mittee on Veterans Affairs led by Senator Cranston of California, held a series of hearings on " Oversight of Medical Care of Veterans Wounded in Vietnam. " Pa- tients, doctors and medical directors from around the country paraded before the Subcommittee citing horror story after horror story. National press followed suit with first hand investigations of VA hos- pital conditions (notably Life, May 1970). of a lack of trained staff. In all, $ 20 mil- lion worth of VA facilities go unused be- cause of personnel shortages. Turn of the century hospital buildings. are seriously dilapidated, with peeling, chipping paint on the walls, leaky roofs, broken windows, and filthy floors. Rats, mice and cockroaches are not uncommon. " I suddenly awoke to find a rat on my hand. I can't move my hand, so I tried to jerk my shoulders. I screamed and the rat " At times the conditions of the rooms are disgraceful... we killed Health Care A Disgrace The VA health system has been ex- posed as unprepared, incompetent, Land to some extent uninterested - in providing top quality care to the Viet Vet. As an in- dication of this, although the V.A. has been paying " wartime benefits " since August, 1964, it has never developed a plan to deal with the increased demands placed on its personnel or facilities by the war. In the system as a whole, there is a ter- rible shortage of personnel; physical con- ditions are bad and priorities are skewed. The hospitals (which treated 776,314 vets in 1969; 14 percent of whom were Vietnam Vets) are terribly overcrowded and dis- gracefully understaffed. Like the munici- pal hospitals, the VA hospitals are running enormous yearly deficits. In California alone, VA hospital directors revealed a deficit of $ 5.6 million for fiscal 1970. Equip- ment purchased in the 40's is now obso- lete, faulty and sometimes dangerous. A huge backlog of repairs on poorly - main- tained equipment and facilities exists. World War II huts are still being used by at least two VA hospitals, while the new Miami VA hospital is half empty because " I had been wounded 14 mice in one room alone. " Patient, Bronx V.A. Hospital jumped slowly off my bed.... Nobody has done anything to this day, so some of the amputees who are not totally disabled have taken to setting traps, to protect us. If you're a nervous system injury you can't feel anything, and you could get bitten in the night and not know it. " (Life) Nationwide the VA hospital staff short- age was reported last year to be between 9000 and 10,000. In 1970, the VA medical staff was smaller than it had been in 1966, although the patient load increased 300 percent in the same period. There are one and a half staff members for every patient in VA facilities. Public municipal hospitals have nearly three, and university teach- ing hospitals have upwards of four and a half staff members for every patient. " A Vietnam veteran stricken with encepha- litis could not be adequately cared for because of lack of personnel. His mother actually found it necessary to remove se- cretions from the tracheostomy opening to keep her son alive. " (Chief Medical Resi- dent, Wadsworth, California, VA hospital) a year before I got a wheelchair of my own. " Max Cleland, Viet Vet, Hearings Staff Shortages The shortage of nursing and support staff exacerbates the miserable physical conditions in many VA hospitals and adds to the humiliation of injured veterans. Ac- cording to a Viet Vet in the Bronx VA: 11 " Bed linen is changed only once or twice a week, no matter how dirty it gets. At times the urine bags overflow and often wheelchair patients clean it up and change the bags.... The call light can be on for hours at a time before someone happens to wander in. The commodes are rarely flushed and the sinks are usually dirty. I have seen many people lying on litters for about three or four hours at a time just to get an enema or shower ". (Hearings) 29 percent of the disabled Vietnam vet- erans end up in psychiatric wards; there, staff shortages are felt most cruelly. Dr. Louis West (Brentwood, California, VA Hospital) says his hospital is functioning " mostly still at, or below, the level of 20 to 25 years ago. " Because of staff short- ages drug " therapy " is relied on almost entirely. The patient becomes " a man in a chemical cacoon... stiffly shuffling along... with an invisible barrier be- tween him and the rest of the world... What is not realized is that we can, and are, chemically lobotomizing thousands of patients; and if you keep it up indefinitely, you might as well have done it surgically in the first place. " (Hearings) Dr. Ernest Bors, former head of the Spinal Cord Injury Center at the Long Beach, California VA hospital, estimated that the Center needs twice its current number of nurses and therapists. He con- trasted the 1940's, the " honeymoon time ". - when there were enough staff to give patients physical therapy two or three times daily, and to spend hours doing bedside nursing, providing the " sweet- heart or mother image -with " today, when " nurses are too swamped to spend much time talkin gto patients. " (Washing- ton Post, Dec. 25, 1969) Registered Nurses working for the VA are paid at levels comparable to salaries outside the system. However they are not offered any of the benefits available to nurses who choose to work in other hos- pitals e.g. (, additional pay for night work, transportation, subsidized housing). As a result one can find six RN's for every 34 patients at Bellevue Hospital in New York City, but only two RN's for 42 patients during the day and one for 42 patients at Undeclared Victims The Vietnam War is wounding a lot of men who are rarely seen by the Veterans Administration medical system. These are the GI's who return home hooked on drugs or seriously rattled by the psychological horrors they have experienced in Vietnam. To some extent one can be thankful that few of these men are subjected to treatment by the VA. On the other hand, these casualties only add further testimony to the fact that this country is incapable or unwilling to take responsibility for the effects of this war, even on its warriors. Last year, Congress was disturbed by marijuana use in Vietnam. This year the concern is considerably more serious. The U.S. Command has " indicated that 10 to 15 percent of the American troops in Vietnam - about 30,000 to 45,000 men - are using heroin which is between 94 and 97 percent pure. " (New York Post, April 19, 1971). What the military is doing about drugs is unclear. Until last fall, addicted GI's were given honorable less - than - discharges. As a consequence they were deprived of all VA benefits and services and severely hampered in finding employment. Although the military says it has dropped this practice, there are indications that an addict can only avoid such a fate by turning himself in. The VA has only started to steel itself for the addicted Viet Vet. Experts have been sent to study the Lexington, Kentucky drug treatment center known - nationwide as a remarkably unsuccessful facility. Five drug abuse centers have been funded; and thirty are planned. Representative Shirley Chisolm's staff has looked into the program and says it's " a late effort, and of poor quality. There is no sophistication and you can't have stodgy old doctors deal- ing with drug addicts. " The military and the VA have even more disregard for the psychological abuses suffered by veterans of this war. Most of the psychiatric patients han- dled by the VA are either brain injured - or actively psychotic. The undramatic neurotic who keeps ending up in the stockade will frequently be given a bad conduct discharge. He will be unable to get any VA benefits, even when it is acknowledged that the service activated his neurosis. He is dismissed as hav- 12 night next door - in the Manhattan VA. Nurses'Aides have even less reason to work for the VA than RN's. Nurses'Aides are paid at Civil Service rates, which start at $ 1500 less than pay levels outside the VA. Physicians earn 20 to 25 percent less than they would if they were working in university hospitals. Many doctors are part time and those who are full time - fre- quently work on the side. Some physi- cians have used the VA as an opportunity for hanky panky - . A directive issued last year by Marc Musser, M.D., Medical Di- rector of the VA, chastized doctors for " transferring VA patients to non federal - and university hospitals for the purpose of collecting commercial health insurance, " and " rendering services to Medicare and Medicaid patients, as prohibited by cur- rent regulations. " (U.S. Medicine, March 15, 1970) Despite the fact that the VA has taken advantage of affiliations with medical schools and roughly one half of the physi- cians in the country receive part of their training in VA hospitals, the VA has taken no initiative to supplement its staff with any of the hundreds of doctors who fulfill their military obligations as in the Public Health Service. According to Sen- ator Cranston, " The VA has not been given the same national priority as the PHS by the Defense Department, " and doctors who have been trained by the VA have not been allowed to meet their mili- tary obligations there. The VA system, in an attempt to stretch the dollar and create an illusion of effi- ciency, has cut back on its inpatient facil- ities. Since 1965, the number of beds has dropped by 20 percent. The shift from in- patient to outpatient care is considered by some to be a progressive step. But this is only true when the patient is not being sacrificed to staff shortages and not being cleared out to make room for someone or something else. A social worker at the Manhattan VA Hospital described the problems of prema- turely discharging patients: " When a pa- tient who has received his maximum hos- pital benefits is discharged from our hos- pital, he will not necessarily receive the of an Undeclared War ing a " personality disorder, " which is considered the " same as near sighted- - ness, a built in character trait. " (Spokesman, Disabled American Veterans) Although the VA and military may say that any man who feels guilt, resent- ment, anger or hostility about his experiences in Vietnam has a " personality dis- order. " there are many quite sensible veterans and doctors who claim that " significant numbers of Vietnam veterans are very disturbed by their expe- riences. " (The " Vietnam Veteran and Psychoanalytic Community, " Dr. Chaim Shatan) While a spokesman for the VA says that, " If he can adjust to leaving home and going to war he certainly can adjust to coming back, " Vietnam veterans are stating their case more eloquently: " When we go into boot camp they take our identity away... And I guess in the Army, Vietnam tears you down to nothing and builds you up. But it's gonna take a complete tearing down again [to make] you a person. " (Hearings) Since it is impossible for the military or the VA to recognize that this war has had unique reprecussions on its soldiers, vets have had to find their own alternatives. One method, rap sessions, is advocated by Drs. Robert Lifton and Chaim Shatan. These are conducted under the auspices of Vietnam Veterans Against the War. Vets talk about their feelings of guilt, persecution by society, and alienation. " You paid a high price for trusting other people in Nam. Every- time you acted human you got screwed. I hope I can learn to love as much as I hated - and I sure hated, man. Love's a pretty heavy word. " (The Vietnam Veteran and the Psychoanalytic Community ") There are other ways to handle the anger. One is withdrawal: " I worked at night because I couldn't stand looking at those 9 to - - 5 people who sent me to Vietnam. " (Hearings) Yet another alternative is political action like the Vet- erans'March to Valley Forge last summer and speakouts such as the Winter Soldier Investigation. Or as the hundreds of veterans who camped in Washing- ton in April did, the Viet Vet can use his medals to jam the wheels of the war machine. 13 care he needs at home or in a community nursing home... we have many patients with the diagnosis'organic brain syn- drome'who cannot live or stay alone dur- ing the day in the community. Nursing homes do not want them because they present'management problems.'The VA psychiatric hospitals do not accept our referrals because these patients are ' chronic.'The New York State hospitals have recently closed admision to such pa- tients for different reasons. "'(Medical World News, July August - , 1970) Why The Vet Gets Sacrificed How can a nation which can afford a decade - long undeclared war, not afford to take care of its undeclared heros? One could say that the Viet Vet is caught be- tween a War in Vietnam, Battle on Infla- tion, and Skirmish between the Genera- tions. Unlike other federal agencies, and fre- quently in repudiation of its own hospital administrators, the central office of the Veterans Administration is not crying that it's short on money. According to its Pub- lic Information office, the VA has only to ask, and the Congress gives it what it needs and more. [When the Senate Sub- committee on Veterans'Affairs scraped together an extra 105 $ million last year to help the VA fix up its facilities and hire ne wstax, much to its chagrin the VA only used the money to absorb inflationary costs.] The VA's annual budget is bigger than ever - but that isn't saying much; it still only amounts to what the United new staff, much to its chagrin the VA only States pays for one month of war in Viet- nam (approximately $ 1.9 billion). The VA isn't pleading for more money, or even acting like it's a problem, because it toes the Administration's fiscal line. And Nixon seems to think that it is worse for the crisis economy to spend money at home, than it is to spend it in Indochina. Furthermore, a larger VA budget would be a confession that the light at the end of the tunnel was just a mirage. Nixon, and Johnson before him, haven't wanted to " admit to the effects and horrors and dur- ation of the war. [More money for the VA] would be a political admission on the most important issue in the country. " (Subcom- mittee staffer) The VA works in close conjunction with and is strongly influenced by the tradi- tional veterans'organizations - VFW, American Legion, etc. One could call it a symbiotic relationship. For instance, the VA pays for their offices in Washington and they sing the praises of the VA. When the American Legion whitewashed condi- tions in VA hospitals, an official at the Bronx VA, to whose defense the Legion V. A. Glossary Rap Session: "... an informal interaction process to encourage open expres- sion of feelings and attitudes... characterized by a willingness to listen to and understand why different views are held. Its objective is to increase awareness and understanding even when resolution of differences may not be possible. .. It is recommended that ward rap sessions'be held including veterans of all ages and staff to discuss pertinent matters and thereby improve mutual regard and acceptance. " The'Now'Phenomenon: " * * * the young veteran frequently has a conviction that institutions are not going to change on their own and that he is powerless to change them. As a consequence, he feels less interest in long range plan- ning for the future and greater interest in short term satisfactions, the'now ' phenomenon... There is a strong tendency to identify problems as due to the inadequacies of institutions and society rather than inadequaices within himself. " Turned off: " * * . (A) characteristic common to the young veteran is the ex- pectation that authority whatever its form, will not be responsive to his intense need to be treated as an individual with a right to a voice in things that affect him... There is a built - in readiness to react by direct confrontation, by physical withdrawal or by reduced psychological involvement. The latter response is often referred to as being turned ' off. It exists in varying degrees in young veterans and young people... It is manifested in degrees of bitterness, distrust, and suspicion of those in positions of authority and responsibility. " -Marc Musser, M.D., Chief Medical Director of VA 14 had rushed, was puzzled: " I can't under- stand why they would be a hundred per- cent behind the Veterans Administration instead of a hundred percent behind the " veterans. (Catholic World, January, 1971). One answer to his puzzlement might be, as a Senate Subcommittee staffer put it: " To them, the Viet Vet is some kind of freaky pot smoking - , peace creep, who didn't want to go over there in the first place. " The VA's reaction to the Vietnam vet- eran has ranged from passive resistance, to distrust and fear, to outright repression. The Vietnam veteran does not respond to American society with the same kind of enthusiasm that earlier veterans did; nor is his experience in war marked with the same kind of patriotism which character- ized earlier veterans. " When you're in Vietnam the rationale for being there changes. You learn how the Vietnamese people hate Americans....... [I learned] that our involvement was a mistake. It's never too late... to realize a mistake, but it takes more guts than America has. " (Former Marine, NBC News Special). The VA complains that young vets are " embittered, unsettled, generally distrust- ful and [they show an] inability to find meaning in the future. " (Chief Medical Director's Letter, Dec. 22, 1970 to all VA Hospital Directors) According to the VA, these attitudes are due to immaturity, adolescent adjustment problems and the " increasingly crowded, automated, and technological society. " The veteran has more trouble dismissing his feelings. " I think any other war would have been worth my foot. But not this one. One day, someone has got to explain to me why I was there. Thousands of men have been wounded. They'll never be the same. They don't want to live with their parents all their lives. They want to be a whole man again. " (Hearings) The VA also has an easy answer for why, " These young men do not appear to be'oriented goal -. '.. * often there is a surprising lack of drive to better prepare himself vocationally or motivation for per- sonal change and growth. Instead, there is a strong tendency to identify problems as due to the inadequacies of institutions and society rather than inadequacies within himself. " (Chief Medical Director's Letter) However the institutions of this society are remarkably inadequate to and unre- warding of the veteran's motivation. Last September, the total number of unem- ployed Vietnam veterans was 218,000. Now it is estimated at 320,000. In the year between September, 1969 and September, 1970, the unemployment rate rose from " There is no more dif- ference between vets of other wars and Vietnam vets than the difference between me and my children. " Central V.A. Spokesman 2.1 percent to 6.5 percent. For vets under age 24 the unemployment rate is 12 per- cent. For black vets (without high school degrees), the unemployment rate ranges from 18-25 percent. For disabled vets the rate is 20-25 percent. Last year, only 9 per- cent of the black vets and 12 percent of the white vets went to college on the GI Bill; but then the GI Bill has been paying roughly the same benefits it did to Korean vets: $ 175 per month for tuition, books, and living expenses. VA Attempts to Respond Apparently, these " miscommunications and misunderstandings between younger veterans and the hospitals, " have started to cause some concern in the higher levels of the VA; a Vietnam Era Veterans Committee was established last year to look into the problems of younger veterans; and the VA's Chief Medical Di- rector sent a letter to all hospital directors with recommendations for change. Hospital directors were reminded that, " There is the very human tendency to re- spond with disapproval to those whose values, modes of behavior and style of dress differ from our own. It is not neces- sary to embrace such values but it is necessary to respect the right of the young veteran to have them.'" However the Veterans Administration's found new - concern for the problems of the young goes beyond a desire to bring the generations together again. The VA also fears that their patients will disrupt the VA medical system. " When he [the vet- eran] is not consulted he does not count- and this is unacceptable to him. He is quite prepared to refuse to comply and to risk the consequences for doing so. " The central VA has warned the hospital administrators that, " It is important that 15 the distinction be clearly understood be- tween the deep urge to be treated as an individual, which typifies most young vet- erans, and the destructive disregard by a small segment of society for all but their own wishes and aspirations... It should be noted that older veterans, perhaps in- fluenced by younger colleagues...... are becoming less compliant. " (Chief Medical Director's Letter) While the VA hospital system is ripe for some sort of patient role in policy making the VA has responded to assertiveness on the part of younger vets with an authori- tarianism that would do the military proud. When 70 veterans in the Manhat- tan V.A. circulated an anti war - petition last May, the V.A. threatened to discharge any patient partcipating in political ac- tivity. The chief of medical staff at the hospital issued a statement declaring that " For reasons of optimal medical care and treatment, the patients in the Hospital should not be asked or petitioned in any way to partcipate in controversial activ- ities, including the signing of petitions and demonstrations. It is not the purpose of this directive to suppress discussion of po- litical affairs among the patients or em- ployees. " Soon after, no visitors except relatives were allowed to see the patients; relatives were required to show identifica- tion. An old regulation which prohibited patients from freely visiting other wards was revived for for so called - " medical reasons. " Several months after this startling act of repression, the VA continued to rub salt in the wounds of veterans by publishing a Descriptive Profile of the Young Veteran which said that, " there is a decreased feel- ing of social responsibility. This appears related to pessimism that institutions can- not be changed to make them more re- sponsive. " " Many young Americans who have been sent to Vietnam to defend South Viet- nam's political and social order have de- cided that it's not worth defending. Many of them come home with broken bodies, minds, and some say, souls. They return to a system of medical care which is part and parcel of the political and social order which sent them into this brutal, ignoble and shameful war. Many vets feel feel it too is not worth defending. - Constance Bloomfield and Marsha Handelman HEALTH WORKERS WORK FOR PEACE 16 The war in South East Asia has once again become a burning public issue. Adding fuel to the fire are a disastrous military and political defeat in Laos; the possibly imminent collapse of Cambodia's military dictatorship; the demoralization, if not out- right mutiny, of American ground troops in Vietnam; and national distress over the courtmartial conviction of Lt. William Cal- ley. Dissension against the war is spreading with new force throughout the medical community. Fanning the flames was the February 22 announcement by the Depart- ment of Defense that after a two and a half year moratorium on the doctor draft 1,608 physicians, and osteopaths will be in- ducted into the Army, Navy, and Air Force beginning in July. Reinstatement of the doctor draft im- mediately affects interns and residents. Since these are the doctors who staff most of the hospitals serving poor communities, the effect of diverting them from duty in civilian hospitals to duty on military bases will be the denial of medical care to poor people across the country. Already in Los Angeles, Philadelphia, New York City and elsewhere, angry voices are declaring that the draft callup means death and suffer- ing to communities whose medical needs are scarcely being met now. In New York City it is estimated that as many as 200 interns and residents will be forced to leave their hospital assignments to fulfill two years'military service. So far, 57 interns and residents in New York City municipal hospitals have received their induction notices, and it is certain that many more will be called within the next two months. At chronically understaffed City hos- pitals, such as Lincoln and Kings County, the loss of ten or more interns and resi- dents will have a crippling effect on the delivery of health care to thousands of men, women and children. Opposition to Doctor Draft In response, house staff organizations, both formal and ad hoc, are mobilizing op- position to the draft callup. At the Uni- versity of Southern California Medical Center in Los Angeles, the Residents - In- terns Association is rallying doctors and community residents to fight the expected 10 to 20 percent reduction in County med- ical services which will result from the callup. The Association complains that " military needs are being given priority over civilian needs. " Together with the Community Services Division of the Stu- dent Association of California State Col- lege at Dominguez Hills, the Residents- Interns Association is protesting the doc- tor callup as well as the deterioration of health services over the past two years in Los Angeles'poor communities. Also, in Los Angeles, a small group of doctors calling itself the National Union of Concerned Health Workers (NUCHW) has issued " A Call to Action. " " The effect of the mass induction of physicians... is all but too predictable. The poor.. * peo- ple of this country who serve and die in disproportionate numbers in Indo China - again must reliquish their right to health care at home in order that the war effort may continue. " The call encourages doctors to apply as conscientious objectors, while, at the same time, lobbying and publicizing the need for the implementation of a National Health Corps for doctors who would prefer to serve the medical needs of the poor communities rather than the military's. NUCHW accuses President Nixon of al- lowing the Emergency Health Personnel Act of 1970, which would establish a National Health Corps, to " quietly slip into obscurity. " Similar initiatives have also been undertaken in Los Angeles, San Fran- cisco and New York City. On 29 March, 500 health workers rallied at the U.S.C. medical center in Los Angeles to protest government priorities which favor the pur- suit of an immoral war instead of satisfy- ing the public's health needs. Plans are underway for rallies at other California medical centers. NUCHW together with community groups, also plans to initiate a lawsuit on behalf of Los Angeles County poor pa- tients, many of whom are black and brown. The suit seeks an end to the doctor draft on the grounds that the conscription of doctors deprives poor people of essen- tial medical services. Finally, the Los Angeles chapter of the Medical Committee for Human Rights (MCHR) sponsored a talk by Madeline Duckles, an organizer for the Committee of Responsibility. Ms. Duckles has tray- eled to North Vietnam visiting schools, hospitals and clinics. There she met with North Vietnamese government leaders and representatives of the Provisional Revolutionary Government of South Viet- nam. Her sponsorship by Los Angeles MCHR represents an important departure in that it suggests the need to build an American peace movement which acts in solidarity with the people of Vietnam. " The poor must again relinquish their right to health care at home in order that the war effort may continue. " National Union of Concerned Health Workers Pledge to Resist In New York City, the most militant statement of opposition to the doctor draft and the war in Southeast Asia has been issued by the draft eligible - members of the Lincoln Hospital Pediatric Collective. Their April 6 announcement reads in part: " The health care crisis has reached be- yond emergency proportions. ".. We therefore will resist any attempt to take doctors out of the hospitals and will ac- tively support any doctor who refuses to be drafted from his duties. " This pledge is presently circulating to all house staff in New York City. Pressure 17 is being exerted upon hospital administra- tors and chiefs of departments in volun- tary and municipal hospitals to support draft resisters. They are being asked to guarantee jobs for doctors regardless of their draft status including those who may be prosecuted for refusing induction into the Armed Forces. The Administrator of Lincoln Hospital, Dr. Antero LaCot, has already offered his endorsement and sup- port. Dr. LaCot drafted a letter indicating his opposition to the war, and detailing the disasterous consequences of the doctor draft on patient care at Lincoln Hospital. The position of the Lincoln Hospital re- sisters has drawn strong support from community and worker organizations, such as the Health Revolutionary Unity Movement (HRUM). The Committee of Interns and Residents (CIR) of New York City has directed the following demands to Dr. Joseph English, President of the Health and Hospital Cor- portation (the administrative body that runs all 18 municipal hospitals in New York City): () 1 that " the Corporation continue to employ physician [draft re- sisters] as long as they are able and willing to work and serve at the City Hos- pitals " and (2) that " employment should be continued, irrespective of adverse pub- lic comments on their decisions. indict- ments, prosecutions, or the like. " Thus far, the Corporation has been silent. Individual members of the Corpora- tion, speaking unofficially, have indicated their endorsement, but formal support by the Corporation is still being awaited. In the meantime, demands for support for resisting doctors will be pressed upon city, state and federal officials. Doctors at New York City's Montefiore Hospital have organized yet another ad hoc group, this one calling itself House Staff Committee Against the Doctor Draft. On April 7, the Committee organized a citywide meeting of house staff who are faced with the draft. The objectives of the meeting were to protest " curtailment of health services that the draft call would create, " and to assist doctors in finding alternatives to the draft. Billions For Death Health and war are incompatible. This is being substantiated by recent threats of cutbacks in basic health services. Although it is difficult to correlate the dollars spent for one more bomber with the loss of one more hospital, budget cutbacks are clearly related to the costs of war. In the national budget, the Nixon Administration wants to trim $ 350 million from Medicare by reducing the number of free days of hospital care from 59 to 14. This leaves the elderly, particularly the chronically ill, footing one eighth - of the hospital bill from the 16th to the 60th day: an amount which may go as high as $ 800 per hospitalization. In addition, the administration wants to close eight Public Health Service hospitals and 30 Public Health Service clinics most of which serve poor communities (see March, 1971 BULLETIN). The President's January budget also cuts direct loans for nursing students in half. @ In New York State, Governor Rockefeller has reduced Medicaid eligibility for families of four from 5000 $ to 4500 $. This will drop 300,000 to 500,000 low income families from all health insurance coverage. In addition, Rockefeller has stopped Medicaid coverage for abortions. @ In New York City, the Health Hospitals Corporation (the quasi public - agency which runs the 18 municipal hospitals in the City) is threatening to close eight hospitals, lay off 20,000 employees including 2.000 doctors. The result will be the displacement of 80,000 inpatients, the discontinuation of over three million clinic visits, the cessation of all home care and specialized ser- vices in the remaining hospitals. In spite of the cuts, each year's budget is larger than the year before and requires more taxes. Yet the more the taxpayer pays, the less he gets back. The war lies at the root of this problem. As Governor Patrick J. Lucey of Wisconsin said to the Joint Economic Com- mission, " As long as we spend over $ 75 billion a year for defense, there will never be enough money to cope with local and state problems. " Many econ- omists agree. They say that there can be no improvement in human services, pollution control, urban development, mass transit, and health services when defense is the top priority. 18 During the meeting, the point was made over and over again that solutions must be sought which do more than merely exempt individual doctors from military service. The health needs of poor patients and the very survival of the people of Vietnam demands that draft eligible - doc- tors, together with the rest of the peace movement, enlist broad support both in- side and outside the medical community for an end to the war. It was insisted that the hallmark of success is political effec- tiveness and not merely the assuagement of individual doctors'consciences. A resolution which was passed at the first National House Staff Conference held March 18-20 in St. Louis indicates that these feelings are wide spread. The Con- ference's Task Force on Ethical Issues in Medicine stated that: " Violence is a disease of humanity. War is a symptom of that disease. It is within the ethical responsibilty of physicans and health professonals to do all within their power to eradicate this most life threaten- - ing of all human ills. Specifically, to care for the wounded without trying to prevent the cause of their wounds is no different from treating infection without trying to prevent its spread. Physicians must do both. The war in Southeast Asia has con- sumed the lives of hundreds of thousands of people.... It is entirely consistent with the ethical principles set forth here that all physicians must oppose this war and do all in our power to bring the killing of all people to an end. " But, for many at the Conference, a gen- eral statement which did not even call for an end to the War, was inadequate. There- fore another resolution was drawn up de- claring that " We strongly oppose all wars, especially the war in Southeast Asia and ... we insist upon the immediate cessation of this war. " This resolution was passed in a late evening meeting by a vote of 68 to 27. But the conservatives balked and threatened to walk out of the Conference. The next morning the beefed- up resolution was reconsidered and tabled in order to preserve unity. In Philadelphia, the Health Information Pennies For Health A brief review of the President's Budget for fiscal year 1972 (July 1, 1971 through June 30, 1972) discloses: --@ $ 77.5 billion will go to defense. This is a 1.5 $ billion increase over last year. OE This does not include Veterans benefits, space research, and other hidden defense expenditures. Arthur Burns, the President's closest economic advisor calculates that defense expenditures actually come to at least $ 106 billion. Hi The President's contention that defense expenditures have decreased to 32 percent of the total budget (the lowest proportion since 1950-51 is " budget juggling ". In fact, if Social Security payments are subtracted from the budget as they used to be (because they are fixed liabilities not subject to shifting pri- orities), then the percentage of defense expenditures soars to 63 percent. OE Health including the Medicaid and Medicare reserves gamers 9 percent of the total budget. Over the last year, private expenditure for health increased by 13.8 percent while public expenditures increased only 9.7 percent. This reverses the trend toward increased government expenditure for health for the first time since Medicare and Medicaid were passed in 1966. The President's economists confidently predict we are over the hump. They say the cost of the Vietnam War peaked in fiscal year 1969 at $ 30 billion. Since then it has been steadily decreasing, as the reasoning goes, so that the present fiscal year will cost only $ 12 billion; next year they predict it will be below $ 10 billion. But this ignores the cumulative cost of the Vietnam War. Robert Eisner, econ- omist at Northwestern University, tallies the direct costs of the war at $ 113 billion. Making the unlikely assumption of full employment, Eisner adds the indirect cost of 82.5 $ billion for production lost because young men went into the armed forces or stayed in school to avoid the draft. $ 23.1 billion more can be added for production that will never be realized because of the dead and wounded. Add to this University of Utah economist James Clayton's estimate that pensions for Vietnam Veterans will amount to 220 $ billion over time. Thus, the total cost of the war amounts to half a trillon dollars, money which could have gone for health and other human services. _Oliver Fein 19 " All physicians must oppose this war and do everything in their power to bring the killing of all people to an end. " National Conference of House Staff Project (a research and community action group) is working to rally opposition to the doctor draft among eligible doctors. Other physicians who are not draft eligible - are planning to purchase an advertise- ment in a Philadelphia newspaper pro- posing that the medical community_sup- community_sup- port the People's Peace Treaty. Once again, this action indicates a growing awareness within the medical community of the need to offer support directly to the people of Vietnam. In the Midwest, Chicago is the hub of peace related - activities. There the Mid- west Committee for Draft Counseling, a branch of the Central Committee for Con- scientious Objectors, has published an ex- cellent pamphlet dealing specifically with the doctor draft. It is simply entitled, " The Doctor Draft, " and is being distributed na- tionwide. It offers concrete alternatives for doctors confronted with the draft. Aid to the People of Vietnam More daring and direct are the efforts of a group of Chicago - based scientists who are members of Science For The Peo- ple. This organization has begun several long range - projects to provide technical assistance to the people of Vietnam. Re- quests emanating from the government of North Vietnam and the Provisional Revo- lutionary Government of South Vietnam (PRG), sparked these projects. Science For The People is investigating ways to recover defoliated land and land where the soil structure has been de- stroyed by bomb craters (see p. 3). The group also hopes to provide the Viet- namese with information concerning in- tegrated circuits, computer technology and micro chemical - techniques. More immediately the Vietnamese have asked sympathetic American scientists to 20 search for a method of locating small plastic pellets in the human body. These transparent pellets are now being used in American anti personnel - bombs and can- not be detected by X rays -. In addition, the scientists hope to send new equipment and spare parts for equipment which the North Vietnames have. Science For The People suggests that its program " will reaffirm that the people [of the U.S. and Vietnam] are not at war and that they wish to cooperate in... using science not for oppression but rather for liberation and the betterment of life. " Scientists at the University of Chicago are also planning a " National Day of Sci- ence for Vietnam " to be held on campuses across the country on May 14. The pur- pose is to implement the People's Peace Treaty by () 1 " provid [ing] material aid for the Vietnamese in problems of recon- struction and development; " and (2) " dissociat [ing] us from the war " while ex- pressing " our solidarity with the struggle of the Vietnamese. " The work begun by Science For The People is being complemented by small groups of health workers in New York, Philadelphia, Washington, D.C. and else- where, who are informally collecting money to purchase medical supplies, books and periodicals which will be for- warded to North Vietnam and the PRG. April 24 Throughout the nation, medical schools and hospitals sent large contingents of health workers to the April 24 mass rallies in Washington, D.C. and San Francisco. This year's demonstrations involved larg- er numbers of non professional - hospital employees than any previous peace rally. This was largely due to the intensive na- tionwide organizing done by the Drug and Hospital Workers Union (1199). The large " We wish to use science, not for the oppression but rather for the liberation and better- ment of all people. " Science for the People turnout of hospital employees was paral- leled by the unprecedented participation of rank - and - file members of unions repre- senting a cross section - of the nation's in- dustrial and service workers. Locally anti war - opposition of hospital employees is continuing after the mass rallies. In New York City, Philadelphia and Chicago, success has been attained in rallying support for the Vietnamese peo- ple through the use of the People's Peace Treaty together with a film (Health " War ") depicting the development of the PRG's health care system under wartime conditions. Workers, most of whom are women, have spontaneously organized hospital - based committees in response to the films and the People's Peace Treaty, to collect medical materials for the people of Vietnam. This year's annual MCHR Convention held in Philadelphia April 16-18, brought anti war - activities within the medical com- munity all together. The convention sign- ed the People's Peace Treaty. Further, it pledged to implement the treaty " through such programs as draft resistance for health workers and organizing, in the name of the treaty, within the military and in hospital and medical schools through- out the country. " The convention endorsed independent committees striving to pro- vide needed medical supplies for the peo- ple of Vietnam. Medical Activism in the Military More concretely MCHR endorsed plans to initiate a military chapter of MCHR. It is anticipated that MCHR will dispatch a full time - organizer to San Antonio, Texas, to greet the new doctor and osteopath re- cruits as they start " basic training, " in July at Fort Sam Houston. The organizer will also recruit military corpsmen and nurses, to join the military chapter of MCHR. Perhaps prophetic of medical activism within the military Jan Varner, a Navy nurses to join the military chapter of nurse spoke in uniform at the April 10 Women's March on the Pentagon. She condemned Commander - in - Chief Nixon's drastic limitation of abortion services for women in the armed forces and wives of servicemen. She compared Nixon's lack of concern for the well being - and health of American military personnel with his disregard for the health and lives of the Vietnamese people. Military men and women can be courtmartialed for partici- pating in uniform, at anti war - rallies. To be sure, the Pentagon may succeed in drafting its 1,608 physicians and osteo- paths. But, despite the fact that they will take the proverbial step forward into the Armed Services, their induction does not promise an end to their anti war - activi- ties. As long as the contradiction between healing and killing persists, medical work- ers will continue to stand in opposition to the militaristic policies of the American government. Opposition will continue lo- cally at medical institutions throughout the nation. Perhaps, anti war - opposition on the part of medical workers will soon seem as commonplace at Fort Dix and Fort Bragg as it now does at the University of Southern California and University of Chicago. - Howard Levy HEALTH / PAC Occasional Paper CONEY ISLAND HOSPITAL A CASE STUDY IN THE POLITICS OF HEALTH This 16 page HEALTH / PAC report documents the politics and de- cision making of a New York City municipal hospital. It is a case study of Coney Island Hospital - who controls it, how they control it, and the power of the present leadership. The report concludes with concise recommendations for improved health care delivery. Though focussed on a New York City hospital, the power analysis is applic- able throughout the country. The Coney Island Hospital Report is available from HEALTH / PAC for 50 cents 21 Anti - War Resources Information on anti war - activities can be obtained from the following sources: To send medical supplies, periodicals, books directly to Vietnam Medical Aid Committee for Vietnam PO Box 100 36 Wellington Street London, W.C. 2, England General information on medical aid for Vietnam Don Goldmacher 442 Pacific Street Brooklyn, New York (212) 596-1446 Military Chapter of the Medical Committee for Human Rights (MCHR) Jerry Kroe 4733 South Woodlawn Chicago, Illinois (312) 924-3682 Howard Levy Henry / Kahn c o / Health - PAC 17 Murray Street NYC 10007 (212) 267-899 or (212) 866-4865 Technical assistance to the people of Vietnam Science for the People c o / Dick Levin Biology Department University of Chicago Chicago, Illinois 60637 National Day of Science for Vietnam Conferences (May 14th) Larry Lambert Box 89, Ryerson Laboratory 1100 E. 58th Street Chicago, Illinois 60637 ' G.I. and medical draft counseling (con- tacts for local chapters throughout the country) Medical Committee for Human Rights 137A West 14th St. NYC (212) 924-0894 Literature and speakers on chemical- biological warfare Physicians for Social Responsibility Box 8804 JFK Station Boston, Massachusetts, 02114 (617) 742-7380 New University Conference (NUC) 622 West Diversey Parkway # 403A Chicago, Illinois 60614 (312) 929-3070 Literature and contacts on resistance to the " doctor draft " Bill Chodoff Box 66 Lincoln Hospital 333 Southern Boulevard Bronx, New York (212) 927-5346 National Union of Concerned Health Workers Joel Duvinsky / Melvin Levy, Co chairmen - c o / Chagi 1927 Carmen Drive Los Angeles, California 90002 House Staff Committee Against the Doctor Draft Stanley Fisch Steven / McLoy, Co chairmen - 3529 Kingsland Avenue Bronx, New York 10469 (212) 920-5233 (days) 798-4097 (nights) Central Committee for Conscientious Objectors (CCCO) 2016 Walnut Street Philadelphia, Pennsylvania 19103 (215) 568-7971 (midwest) 711 Dearborn Street Chicago, Illinois 60605 (312) 427-3350 (west coast) 437 Market Street San Francisco, California 94105 (415) 397-6917 Residents - Interns Association L.A. County - U.S.C. Medical Center 1200 North State Street Los Angeles, California 90033 (213) 225-3115 Womens health and anti war - organizing projects Barbara Maggiani 12 Whittier Street Scarsdale, New York 10530 (914) 761-3308 (home) (212) 255-1075 (after 4 PM) 22