Saigon Medical School, An experiment In International Medical Education, An Account of the American Medical Association’s Medical Education Project In South Vietnam, 1966-1975
By C. H. William Ruhe, M.D., Norman Hoover, M.D. and Ira Singer, Ph. D.
(American Medical Association ,1988).
Medical Education
Following the Geneva Convention of 1954, many of the medical faculty from Hanoi chose to move to Saigon in order to reestablish the faculty of Medicine under the national University. The movement coincided with the shift of millions of people from one side of the border to the other, mostly from north to south. Another Faculty of Medicine was created at the University of Hue in 1964. Both medical schools were under the Ministry of Education. The Hue school was essentially without tradition: the organizers established the curriculum and teaching methods according to their individual experiences. On the other hand, the Saigon school was an extension of the original Indochinese University in Hanoi and was organized according to French medical education and tradition….
A third medical school, part of the private Minh Duc University in Saigon, began in 1971 and admitted 50 students per class.
Administration
The administrative head of the Faculty of Medicine was the Dean, elected from the Vietnamese members of the Faculty Council by that council, with the lection confirmed by the Minister of Education, after nomination by the Rector of the University…The executive body of the Faculty was the Faculty Council, comprised of all department heads and professeurs titulaires and delegue;..
Not long after the AMA project began, Dr De (Giao su Tran Quang De) went to France, as he did customarily for long periods each year. Later that year, Dr. Tri (DR Le Minh Tri, MD,PhD, Chair man of the Department of Otolaryngology) by then Minister of Education, declared Dr. De’s absence to be de facto resignation, and he was replaced as rector by Tran Anh, MD who also continued to serve as chairman of the Department of Anatomy. Like Dr. De, Dr. Anh held the French agrege, but he was much more supportive of the American presence in the medical school. He and Dr. Tri were both members of the faculty committee appointed to administer the school after Pham Bieu Tam, MD, had been deposed as Dean (Although he continued to serve as Chairman of Surgery, Department "B," at Binh Dan Hospital). Dr. Tri and Dr. Anh were both assassinated within the year in separate, unrelated incidents.
Changes of this nature in the administrative leadership were very disturbing to Vietnamese and Americans alike. There was a pervasive air of mystery and intrigue in almost everything that happened. There was a constant threat from the Viet Cong and the North Vietnamese, which erupted in the Tet Offensive of 1968 when the Cholon section of Saigon (where the medical school was located) was overrun. But even during periods of relative calm in the war itself, there was an underlying political turmoil that may or may not have been related to the war. Agitation and violence were never far from the surface.
The Medical School Building
The basic sciences complex of the Faculties of Medicine and Dentistry was located in the Cholon section of Saigon on a 15-acre tract of land. Construction was begun in the spring of 1963 and completed in the fall of 1966, at a total cost of $2,700,000 (U.S.), of which the U.S. and half by the Republic of Viet Nam paid approximately half. Original plans called for the construction of a teaching hospital on adjacent land, but those plans were not fulfilled.
The complex included four main buildings connected by a broad, two-story passageway. The two major structures, North Building and South Building, were four stories high. Between them were two smaller buildings, one containing the library and the cafeteria, the other a 450-seat auditorium. The North Building included the departments of gross anatomy, physiology and pharmacology, and animal surgery, and the animal vivarium, central administrative offices, and two 200-seat classrooms. The South Building included the departments of histology and embryology, pathology and biochemistry, and microbiology. On the ground floor were the Dental Outpatient Clinic and Dental Technical Laboratories and another 200-seat classroom. The South Building also included the administrative offices of the American Dental Association, AMA, and USAID.
The construction of the medical school building was a landmark in the development of the Faculties of Medicine and Dentistry of the University of Saigon. Contrasted with what they had previously, it was a major step forward and compared favorably with medical and dental schools in other underdeveloped countries. The cafeteria and library were major advances both physically and philosophically. Although the space was somewhat limited, particularly for research, and power failures often interrupted the elevator service and the air conditioning, the medical school building was probably the strongest single asset of the school. It was a showplace in which the faculty had justifiable pride.
The Teaching Hospitals
The clinical instruction of medical students was carried out at eight different hospitals in the Saigon area. When the AMA project began, Cho Ray Hospital was probably the major teaching hospital, with full clerkships in internal medicine and general surgery. General surgery was also taught at Binh Dan Hospital, as well as urology, orthopedic surgery, ophthalmology, and dermatology. Pediatrics and pediatric surgery were taught at Nhi Dong Hospital. Obstetrics and gynecology were taught at Hung Vuong and Tu DU Hospitals. Nguyen Van Hoc Hospital was being constructed as general teaching hospital for clerkships in internal medicine, surgery, pediatrics, and obstetrics.
Only one hospital, Binh Dan, was under the control of the Ministry of Education and the medical school; all members of the professional staff were members of the faculty. All other hospitals were under the Ministry of Health and there was no relationship between staff membership and faculty appointment.
Pediatrics and Dr. Eiochenwald
At the time of Dr. Eichenwald’s visit, a British medical team had been at the Nhi Dong Hospital for more than a year. The hospital, built in 1958, was the chief site of the activites fo the Department of Pediatrics. Dr. Eichenwald met with the British team and learned that this group under Dr. Duncan Macauley was engaged chiefly in service activities and did not participate in the teaching responsibilities of the department. In his end-of-tour report, Dr. Eichenwald was less than enthusiastic about the activities and credentials of the Vietnamese faculty and of the facilities provided for them at Nhi Dong Hospital. His report cited the department as a dismal situation with the medical students as perhaps the only redeeming feature. He felt that the students were intellectually the equal of students in the top half of any medical school class in the U.S., That they were willing to learn, and would work very hard to become physicians. He believed, however, that they were discouraged, disillusioned, and bitter about the quality of the educational program offered. "It goes without saying," he wrote, "that with the present state of disorganization at Nhi Dong Hospital, the place provides neither the atmosphere, the professional staff, nor the facilities to carry out even a barely minimal teaching program in pediatrics."
Epilogue
The Vietnam medical education project ended when the government of South Vietnam fell to the invading armed forces of North Vietnam in April 1975. The project began officially with the signing of contract AID-Fe-260, which was in effect from September 11, 1966 until March 31st, 1970. The support program was operative for almost nine years at a cost to the U.S. government of almost nine million dollars with additional undetermined costs borne by the AMA, nineteen American medical schools and many individuals…
Was all of this wasted, or will there be some lasting benefit to the people of Vietnam? Ten years later it is very difficult to answer that question. Piecemeal reports are available from members of the faculty of medicine who have left Saigon during the intervening period. Some key individuals from the medical school have come to this country during the past few years.
At a meeting of faculty and students on May 1st, 1975 a North Vietnamese official of the Communist Committee assigned to operate the school: "The Americans are not very good at fighting a war, but they do know how to build a good medical school."
There was initially considerable persecution of the existing faculty. Some were sent to indoctrination camps. Others were assigned to work details in the fields. Two department chairmen have never been permitted to return to the faculty because of previous political activities. Children of the faculty have been discriminated against, especially for entrance to Universities…
In summary, it appears that some beneficial results from the American presence remain in Vietnamese medical education and in the delivery of healthcare. However many of the major gains made during the nine years of the AMA project have been lost or are being gradually dissipated because of the loss of trained faculty and the lack of support in supplies, equipment, and books/journals. Only time will tell whether some of the benefits will endure permanently.
References:
VIET WIKIPIDIA: Lịch sử Trường Đại học Y khoa đầu tiên ở Việt Nam
JAMA: 1989;261(18):2717-2718. doi:10.1001/jama.1989.03420180143050
http://jama.ama-assn.org/content/261/18/2717.2.full.pdf+html
BOOK: Saigon Medical School, An experiment In International Medical Education,
An Account of the American Medical Association’s Medical Education Project - 266 pp, gratis (limited number of copies available from Department of Book and Pamphlet Fulfillment, American Medical Association ), Chicago, American Medical Association, 1988.
By C. H. William Ruhe, M.D., Norman Hoover, M.D. and Ira Singer, Ph. D.
(American Medical Association ,1988).
Medical Education
Following the Geneva Convention of 1954, many of the medical faculty from Hanoi chose to move to Saigon in order to reestablish the faculty of Medicine under the national University. The movement coincided with the shift of millions of people from one side of the border to the other, mostly from north to south. Another Faculty of Medicine was created at the University of Hue in 1964. Both medical schools were under the Ministry of Education. The Hue school was essentially without tradition: the organizers established the curriculum and teaching methods according to their individual experiences. On the other hand, the Saigon school was an extension of the original Indochinese University in Hanoi and was organized according to French medical education and tradition….
A third medical school, part of the private Minh Duc University in Saigon, began in 1971 and admitted 50 students per class.
Administration
The administrative head of the Faculty of Medicine was the Dean, elected from the Vietnamese members of the Faculty Council by that council, with the lection confirmed by the Minister of Education, after nomination by the Rector of the University…The executive body of the Faculty was the Faculty Council, comprised of all department heads and professeurs titulaires and delegue;..
Not long after the AMA project began, Dr De (Giao su Tran Quang De) went to France, as he did customarily for long periods each year. Later that year, Dr. Tri (DR Le Minh Tri, MD,PhD, Chair man of the Department of Otolaryngology) by then Minister of Education, declared Dr. De’s absence to be de facto resignation, and he was replaced as rector by Tran Anh, MD who also continued to serve as chairman of the Department of Anatomy. Like Dr. De, Dr. Anh held the French agrege, but he was much more supportive of the American presence in the medical school. He and Dr. Tri were both members of the faculty committee appointed to administer the school after Pham Bieu Tam, MD, had been deposed as Dean (Although he continued to serve as Chairman of Surgery, Department "B," at Binh Dan Hospital). Dr. Tri and Dr. Anh were both assassinated within the year in separate, unrelated incidents.
Changes of this nature in the administrative leadership were very disturbing to Vietnamese and Americans alike. There was a pervasive air of mystery and intrigue in almost everything that happened. There was a constant threat from the Viet Cong and the North Vietnamese, which erupted in the Tet Offensive of 1968 when the Cholon section of Saigon (where the medical school was located) was overrun. But even during periods of relative calm in the war itself, there was an underlying political turmoil that may or may not have been related to the war. Agitation and violence were never far from the surface.
The Medical School Building
The basic sciences complex of the Faculties of Medicine and Dentistry was located in the Cholon section of Saigon on a 15-acre tract of land. Construction was begun in the spring of 1963 and completed in the fall of 1966, at a total cost of $2,700,000 (U.S.), of which the U.S. and half by the Republic of Viet Nam paid approximately half. Original plans called for the construction of a teaching hospital on adjacent land, but those plans were not fulfilled.
The complex included four main buildings connected by a broad, two-story passageway. The two major structures, North Building and South Building, were four stories high. Between them were two smaller buildings, one containing the library and the cafeteria, the other a 450-seat auditorium. The North Building included the departments of gross anatomy, physiology and pharmacology, and animal surgery, and the animal vivarium, central administrative offices, and two 200-seat classrooms. The South Building included the departments of histology and embryology, pathology and biochemistry, and microbiology. On the ground floor were the Dental Outpatient Clinic and Dental Technical Laboratories and another 200-seat classroom. The South Building also included the administrative offices of the American Dental Association, AMA, and USAID.
The construction of the medical school building was a landmark in the development of the Faculties of Medicine and Dentistry of the University of Saigon. Contrasted with what they had previously, it was a major step forward and compared favorably with medical and dental schools in other underdeveloped countries. The cafeteria and library were major advances both physically and philosophically. Although the space was somewhat limited, particularly for research, and power failures often interrupted the elevator service and the air conditioning, the medical school building was probably the strongest single asset of the school. It was a showplace in which the faculty had justifiable pride.
The Teaching Hospitals
The clinical instruction of medical students was carried out at eight different hospitals in the Saigon area. When the AMA project began, Cho Ray Hospital was probably the major teaching hospital, with full clerkships in internal medicine and general surgery. General surgery was also taught at Binh Dan Hospital, as well as urology, orthopedic surgery, ophthalmology, and dermatology. Pediatrics and pediatric surgery were taught at Nhi Dong Hospital. Obstetrics and gynecology were taught at Hung Vuong and Tu DU Hospitals. Nguyen Van Hoc Hospital was being constructed as general teaching hospital for clerkships in internal medicine, surgery, pediatrics, and obstetrics.
Only one hospital, Binh Dan, was under the control of the Ministry of Education and the medical school; all members of the professional staff were members of the faculty. All other hospitals were under the Ministry of Health and there was no relationship between staff membership and faculty appointment.
Pediatrics and Dr. Eiochenwald
At the time of Dr. Eichenwald’s visit, a British medical team had been at the Nhi Dong Hospital for more than a year. The hospital, built in 1958, was the chief site of the activites fo the Department of Pediatrics. Dr. Eichenwald met with the British team and learned that this group under Dr. Duncan Macauley was engaged chiefly in service activities and did not participate in the teaching responsibilities of the department. In his end-of-tour report, Dr. Eichenwald was less than enthusiastic about the activities and credentials of the Vietnamese faculty and of the facilities provided for them at Nhi Dong Hospital. His report cited the department as a dismal situation with the medical students as perhaps the only redeeming feature. He felt that the students were intellectually the equal of students in the top half of any medical school class in the U.S., That they were willing to learn, and would work very hard to become physicians. He believed, however, that they were discouraged, disillusioned, and bitter about the quality of the educational program offered. "It goes without saying," he wrote, "that with the present state of disorganization at Nhi Dong Hospital, the place provides neither the atmosphere, the professional staff, nor the facilities to carry out even a barely minimal teaching program in pediatrics."
Epilogue
The Vietnam medical education project ended when the government of South Vietnam fell to the invading armed forces of North Vietnam in April 1975. The project began officially with the signing of contract AID-Fe-260, which was in effect from September 11, 1966 until March 31st, 1970. The support program was operative for almost nine years at a cost to the U.S. government of almost nine million dollars with additional undetermined costs borne by the AMA, nineteen American medical schools and many individuals…
Was all of this wasted, or will there be some lasting benefit to the people of Vietnam? Ten years later it is very difficult to answer that question. Piecemeal reports are available from members of the faculty of medicine who have left Saigon during the intervening period. Some key individuals from the medical school have come to this country during the past few years.
At a meeting of faculty and students on May 1st, 1975 a North Vietnamese official of the Communist Committee assigned to operate the school: "The Americans are not very good at fighting a war, but they do know how to build a good medical school."
There was initially considerable persecution of the existing faculty. Some were sent to indoctrination camps. Others were assigned to work details in the fields. Two department chairmen have never been permitted to return to the faculty because of previous political activities. Children of the faculty have been discriminated against, especially for entrance to Universities…
In summary, it appears that some beneficial results from the American presence remain in Vietnamese medical education and in the delivery of healthcare. However many of the major gains made during the nine years of the AMA project have been lost or are being gradually dissipated because of the loss of trained faculty and the lack of support in supplies, equipment, and books/journals. Only time will tell whether some of the benefits will endure permanently.
References:
VIET WIKIPIDIA: Lịch sử Trường Đại học Y khoa đầu tiên ở Việt Nam
JAMA: 1989;261(18):2717-2718. doi:10.1001/jama.1989.03420180143050
http://jama.ama-assn.org/content/261/18/2717.2.full.pdf+html
BOOK: Saigon Medical School, An experiment In International Medical Education,
An Account of the American Medical Association’s Medical Education Project - 266 pp, gratis (limited number of copies available from Department of Book and Pamphlet Fulfillment, American Medical Association ), Chicago, American Medical Association, 1988.
