Military Medicine to Win Hearts and Minds: Aid to Civilians in the Vietnam War (review)

This is the first historical overview of medical aid programs for civilians conducted by the United States Military during the Vietnam conflict. The author, a retired general surgeon who served as an Army medical officer in Vietnam, now teaches medical history at George Mason University, American University, and the Uniformed Services University of the Health Sciences.

Despite the scope of the programs—more than forty million contacts between U.S. military health-care providers and Vietnamese civilians between 1961 and 1973—this subject has not been addressed in either the primary or the secondary literature. To his credit, Robert Wilensky deftly navigates the complicated sources of governmental data, which include the acronymic jungle of agency labels—confusing even to those who have dealt with the programs firsthand. He examines the motivations for the various programs, their planning and implementation, and their evaluation by both medical and command criteria in order to assess their impact in providing medical care and contributing to the war effort. The product is more a case study of the use of medical aid to civilians as an instrument of policy in wartime than a history of the various aid programs and where they fit in the overall context of the Vietnam conflict.

In the introductory chapters Wilensky discusses previous instances of care for foreign civilians by the United States (in Cuba and the Philippines after the Spanish-American War)—but, strangely, he begins with descriptions of the founding of the U.S. Public Health Service and hospitals and the care of freedmen by Union Army medical personnel during the Civil War. He goes on to discuss the formal and informal aid programs in Vietnam; the coverage of the informal programs is necessarily anecdotal and somewhat misleading, however, because the anecdotes chosen do not display a full understanding of the role of the Special Forces ("Green Berets").

The coverage of the formal programs in chapter 4 is the strongest part of the book, providing significant insight into the Medical Civic Action programs. MEDCAP was a joint Vietnamese/U.S. program that became MEDCAP I, which was carried out by the Armed Forces of Vietnam (ARVN), and later MEDCAP II, which was carried out under command direction by U.S. forces from 1965 until their total withdrawal. This last program, in which the author was involved, is the target of his strongest criticism—and as one who was there as well, I agree that the outpatient care provided intermittently across linguistic, cultural, and security barriers with inconsistent follow-up and referral had little impact on the overall health of the populace.

The chapters devoted to medical evaluation (chapter 5) and evaluation of the programs as instruments of U.S. policy (chapter 6) are less successful: here the author offers opinions without supporting information. The extreme difficulty of measuring the impact of any program on the allegiance of the populace in a guerrilla war, the lack of applicable standards, and the depth of confusion regarding program aims and goals within both the United States and the government of South Vietnam is compounded by the author's attempt to pigeonhole these counterinsurgency programs as either "medical" or "policy." Such operations can be understood only in political, cultural, strategic, and tactical context, and in South Vietnam these elements changed rapidly. The result was that programs were developed to address one set of conditions but were often overtaken by events prior to their implementation. The author acknowledges the importance of these factors but does not fully address them. Of particular importance is the posture of the Kennedy administration, beginning in 1962 with its emphasis on using military civic action to assist emerging nations, its infatuation with the Peace Corps and the U.S. Army Special Forces (it was President Kennedy who both approved the Green Berets and labeled them), and...