Vietnam Health Issues Readings

America's involvement in Vietnam lasted from 1957 until 1975. In 1954, the French were defeated and the former colony of French Indochina was divided into Communist North Vietnam and (non-Communist) South Vietnam. In 1957, the Vietcong began a rebellion against the South Vietnam government of President Diem, whom the US supported with equipment and advisors. In 1963, the government was overthrown, Diem was killed, and a new government was formed. In August of 1964, Congress passed the Tonkin Gulf Resolution giving the President the power to take "all necessary measures" to "prevent further (Communist) aggression." Between 1965 and 1969, US troop strength rose from 60,000 to over 543,000 in country. Despite the US's superior firepower against the guerilla forces of the enemy, the two sides fought to a highly destructive draw.

In the US, increased casualties and higher taxes to support the war lead to great public dissatisfaction and a growing anti-war movement. In January 1968, the Tet Offensive began a new phase with savage attacks on the cities of South Vietnam. In May of 1968, the US began peace negotiations, which eventually broke down. However, a change in US policy led to the greater emphasis on training and supplying South Vietnamese troops and US withdrawal began in July 1968. TV coverage brought the war directly to America's living rooms in a way never before experienced. Antiwar demonstrations intensified as did concern over war crimes and the environmental impact of Agent Orange.

Fighting again intensified in 1972, leading to heavy losses on both sides but this also led to renewed peace efforts. A cease-fire was signed in January 1973 providing for the withdrawal of all troops and return of all prisoners within 60 days. The last US ground troops left Vietnam in March 1973, after which the peace talks once again broke down. Fighting resumed and South Vietnam eventually surrendered to the forces of North Vietnam in April 1975.

Approximately 2,700,000 American men and women served in Vietnam. It was the first war in which the US failed to meet its objectives. It was also the first time America failed to welcome its veterans back as heroes. Many veterans were attacked personally by their fellow countrymen, who opposed the war. This situation magnified the stress associated with their combat experiences. Also contributing to the stress many veterans experienced was the lack of unit cohesiveness as many were sent to Vietnam as individuals and left when their year's tour was completed. They often traveled to and from Vietnam by air, being an active combatant one day and a veteran returning to a hostile civilian environment the next. They reported being spat upon as they disembarked at the airport and being uncomfortable wearing their uniform in public.

In addition to the risks inherent to combat, troops experience many environmental hazards. Pesticide and herbicide spraying was commonplace. In addition, Vietnam is a tropical country with high temperatures, high humidity and a monsoon climate. Many troops were unable to get dry for days, opportunities for bathing were infrequent, and skin hygiene was poor. Bacterial and fungal infections of the feet were a major cause of temporary disability. Skin disease was a leading cause of outpatient visits and hospitalization. Throughout the war, disease accounted for 70.6% of all admissions with the remaining approximately equally divided between battle casualties (15.6%) and nonbattle injury (13.8%). The good survival rates seen were attributed to rapid evacuation, the ready availability of whole blood and well-established semi-permanent hospitals. Tropical diseases were frequent. Malaria was the most important. Over 40,000 cases of Malaria were reported in Army troops alone between 1965 and 70 with 78 deaths. However, this was less than had been seen in earlier wars because of the effectiveness of weekly chloroquin-premaquin prophylaxis against vivax malaria. (Prophylaxis was much less effective against falciparum but the institution of dapsone prophylaxis cut those cases in half.) Diarrheal diseases were also common and cholera was epidemic in Vietnam but not a single case of cholera was seen in the highly immunized, well nourished US troops. Meliodosis was a relatively rare disease caused by Pseudomonas pseudomallei but well publicized after 8 of the 29 cases diagnosed in 1966 died. It was also publicized after the war by Dow Chemical, which erroneously hypothesized that the symptoms of Vietnam veterans after the war were due not to Agent Orange, but to Meliodosis. Neuropsychiatric casualties paralleled those in the US until 1970 when rates rose rather precipitously. This was attributed to the lessened American presence, the news of lack of support on the home front, and a growing substance abuse problem because of the ready availability of a variety of cheap drugs.

Following the war, veterans experienced many readjustment problems and adverse health effects, many of the latter attributed to Agent Orange. The Vet Center program was established to deal with the readjustment problems in an environment acceptable to the anti-establishment veterans. After years of debate, Congress directed the National Academy of Sciences to conduct a comprehensive review and evaluation of the available scientific and medical literature on Agent Orange and the other herbicides used in Vietnam. As a result of the first two reviews, published in 1994 and 1996, VA now recognizes eight conditions which are presumed to be related to service in Vietnam for the purposes of establishing service-connection: soft tissue sarcoma, non-Hodgkins lymphoma, Hodgkin's disease, chloracne, porphyria cutanea tarda, respiratory cancers, multiple myeloma, prostate cancer, acute periperal neuropathy, and spina bifida in offspring.

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