Y tế dân sự ở miền bắc việt nam từ năm 1954 đến năm 1975 tt

VIETNAM ACADEMY OF SOCIAL SCIENCES GRADUATE ACADEMY OF SOCIAL SCIENCES NGUYEN THI DUNG HUYEN CIVIL HEALTH CARE IN NORTHERN VIETNAM FROM 1954 UNTIL 1975 Specialty: History of Vietnam Code: 92 29 013 SUMMARY OF DOCTORAL THESIS ON HISTORY HA NOI - 2020 The Work is accomplished at: Graduate Academy of Social Sciences Scientific instructor: Associate Professor and Doctor Tran Duc Cuong Defender 1: Assoc Prof Dr Nguyen Dinh Le Defender 2: Assoc Prof Dr Nguyen Duy Binh Defender 3: Assoc Prof Dr Doan Ngoc Hai The thesis shall be defended in front of the Academic Thesis Council’s meeting at the Graduate Academy of Social Sciences At … hours… minutes, date … month … Year … The thesis can be learned about at the Library: INTRODUCTION The necessity of the thesis During the development process of each country and nation, health care is one of the significant sectors with not little influence on the social progress and sustainable development Upon such importance, during the near-modern period, all nations attach special importance to investments to build up their medical systems, especially the ones to serve for their people to develop human resources and meet needs for social development After the victory of the Winter – Spring strategic attack in 19531954 with the peak of Điện Biên Phủ Campaign, the French colonist had to sign Genève Convention to restore peace in Northern Vietnam (July 1954) The peace was restored and the North entered the period with socio-economic restoration and development Upon new requirements and tasks, the Health Sector has made efforts to set up and strengthen its system for organization, training, cultivation, and build-up of health officers & workers as well as has constantly moved toward the objective of considering the working masses as subjects for services With the health officer force supplemented from many different sources, the Civil Health Sector has built up a widely developed medical network with the strongest operation from the Central down to the local routes and made tremendous contributions to the health care activity for the people The period from 1954 until 1975 was the one in which many political and social fluctuations had taken place in Northern Vietnam During this period, Northern Vietnam enjoyed the peace at times but suffered from the war at other times, which requested for the Central Committee of the Communist Party, the Government, and the Health Sector itself to get sharp in making adjustments to their organization and activities in line with the situation and effectively & synchronously deploy their tasks to meet requirements in each period and condition Especially, during the period when the USA evoked the war to destroy and hit the North of Vietnam, the Health Sector switched all of its activities from the peaceful time to those in the wartime to fulfill the task of the entire people’s health care With the guideline of “considering the invalids as orders, disease beds as battlefields, outcomes as feats of arms”, the force of physicians and health workers had made many significant contributions to the activity of emergency and treatments to the wounded by the war or those affected by toxic chemicals Quite a few war hospitals, nursing houses, and medical stations, etc., in various routes had been restored and constructed to meet the people’s needs for medical checks-up & treatment and for combat services This period could be said to be the one in which the force of physicians and health officers was challenged and practiced in the war without hesitation to cope with difficulties or sacrifice They were truly “white blouse soldiers” who gained trust, love, and admiration from the people Therefore, it is essential to study the Civil Health in Northern Vietnam from 1954 until 1975 in order to clarify its position, roles, and contributions throughout the evolvement of the national history Rather many research works into the operation by the Health Sector in Northern Vietnam in this historical period full of fluctuations were announced at different levels such as: the history of the Health Sector in general, that of hospitals, research institutes, and training facilities for health officers, etc., some outstanding achievements had been presented while the Health Sector’s roles, restrictions, and assertion for their roles & positions in the activity for the people’s health care, disease treatment in the North, and implementation of the task as the rear to support for the great front line in the South Besides, there had been many research works with focus on the collaboration between military and civilian medicine The authors, however, just focused on analyzing the military Health Sector’s organization and operation systems Meanwhile, the Civil Health’s organization & operation ones had made so tremendous contributions to the health care and wound treatment activity for the people but it had not been focused to learn about much by scientists Thus, the research topic into the Civil Health’s organization and operation structure in Northern Vietnam from 1954 until 1975 needs studying to narrow a big gap in cultural – social researches in the North during the 1954 – 1975 period and simultaneously & honestly & fully reflect the Civil Health’s operation with great contributions to the social development During the current period, besides the gained achievements, there exist some shortcomings and weaknesses in terms of organization, operation, quality of health officers & workers, planning, allocation of the force, and management work of medical checks-up and treatment, etc., in Vietnam’s Health Sector Those restrictions are the social concerns which are barriers against the Civil Health’s development process Therefore, the successful research of the thesis shall contribute to further brightening both theoretical and practical issues in strategies for the medical development in general and the Civil Health in particular; thence, to make realistic contributions to the career of building up and developing Vietnam’s Health Sector in the current innovation and international integration period Originating from the above purposes and with a wish to learn about the Civil Health in the North more fully, holistically, and deeply from 1954 until 1975 to clearly realize its position, roles, importance, and great efforts for the task of build up and strengthen the rear in the North, the author chooses the thesis “Civil Health in Northern Vietnam from 1954 until 1975” as the research topic for the thesis on her speciality of Vietnam’s history Research purposes and tasks in the thesis 2.1 Research purposes Upon the research into the Civil Health in the North from 1954 until 1975, its organization and operation structure has been clarified in the thesis, thence, to withdraw achievements, restrictions, and some pieces of experience in the career to build up, defend the North, and fight for the Fatherland unity 2.2 Research tasks To realize the above-mentioned purposes, the tasks presented in the thesis are to: - Collect and systematize sources of documents related to the thesis’s topic; - Clarify the socio-economic situation in the North as well as the Party & State’s Policies for the Civil Health; - Analyze the organization structure in the Civil Health; - Analyze the process to build up and develop the health officer force for the Civil Health in the North; - Present activities by the Civil Health through such contents as: sanitation work for disease prevention; activity of medical checks-up and disease treatment; medicine production and supply, as well as international co-operation, etc., - And evaluate achievements, restrictions, and experience in the Civil Health in Northern Vietnam from 1954 until 1975 Research subjects and scopes 3.1 Research subjects Research subjects in the thesis mean the Civil Health’s organization and operation structure in Northern Vietnam from 1954 until 1975 3.2 Research scopes In terms of time: From 1954 when the peace was restored in the North until 1975 when the country was united; whereas in 1965, the usa expanded the war throughout the North and the Health Sector started to change its organization and operation to fit with the new context In terms of space: The space is limited within Northern Vietnam In terms of research contents: The author presents the process to build up and develop the Civil Health in some of the following contents as: its organization structure consists of medical organizations at the National and local routes; build up its officer forces; and activity by the Civil Health Methodologies, research methods, and sources of documents 4.1 Methodologies The thesis is based on the dialectical & historical materialism methods by Marxism – Leninism, Ho Chi Minh Ideology, and the Party’s viewpoints to learn about issues in the Civil Health in the relations with culture – society in the North, thence, to explain for historical phenomena, the Party and State’s objectives & policies, organization structure, and operation by the Health Sector to serve for the people during that period 4.2 Research methods To achieve the purposes, research methods of historical sciences like the historical one are used in the thesis when the author places the key research subject in the joint-development of the North’s socioeconomy; the logical method helps the author find out the relationship between the historical context and put-forward requirements to set up a relevant organization & operation structure for the Civil Health in each period In addition, the author makes strict combination with such other interdisplinary research methods as: synthesis document analysis, statistical, description, and expert methods 4.3 Sources of documents - To realize the thesis, the author has explored sources of original documents at Offices of Prime Minister, Ministry of Health, State Planning Committee, and Department of Experts, etc., under National Archives Center III; - Researched works on health: including books about the history of the Branch, history of hospitals, Research Institutes, and training facilities, etc., - Sources of documents in rural areas: the author has made surveys at such medical facilities as Hà Nội Medical University, Bạch Mai hospital, Việt Đức hospital, and National Institute of Hygiene and Epidemiology, etc., Contributions made by the thesis - To systematize and provide sources of new documents related to the Health Sector in general and the Civil Health in particular in the North during 1954 – 1975 period; - To provide an intensive research route which is the Health Sector in the panorama of economic, cultural, and social issues in the North during 1954-1975 period; - During the process to realize the thesis, the author had always placed the research in the context of the Resistance against the USA and country saving to review and evaluate influencers on the process to build up organization and operation for the Civil Health during 1954 – 1975 period; thence, to inherit, expand, and compare the Civil Health’s organization and operation structures during historical stages before and after the period; - To clarify the achievements and restrictions in the Civil Health in caring for the people’s health in particular and the career to build up the socialism in the North in general; - And to put forward some pieces of experience to plan for medical policies in the career of current innovation & development in Vietnam Thesis’s theoretical and practical meanings The outcomes from the thesis make contributions to supplementing knowledge on the actual sate of medical activity before 1954 and provide further information on the process to undertake Civil Health facilities in the North If the thesis is successfully made, it shall not only clarify the Civil Health’s organization structure with the National and local routes but it will also show the harmonious and strict collaboration between the routes in realizing the objective of the people’s health care Finally, the thesis is the historical research form of the Health Sector so it offers a significant meaning for the history, especially for the one of the Health Sector in Vietnam In terms of theoretical meanings: The research into the Civil Health’s organization & operation structure in the North during 1954 – 1975 period shall provide many lessons of experience during the process of further consolidation, construction, and uphold of the Health Sector’s roles for the people’s health care activity Thesis’s layout In addition to the Introduction, Conclusions, References, and Appendices, the contents in the thesis are presented in the chapters: Chapter 1: OVERVIEW ON THESIS TOPIC-RELATED RESEARCH SITUATION 1.1 Overview on the research situation Upon the works in which the medical activity in the North was mentioned, the works are divided into the following key groups of issues in the thesis: 1.1.1 The group of joint-research works in which the Health Sector in the North from 1954 until 1975 was mentioned There were many research works into health during this period like: History of Vietnam during 1965-1975 period by the collective authors such as: Cao Văn Lượng (the Editor), Văn Tạo, Trần Đức Cường, Đinh Thị Thu Cúc, Nguyễn Văn Nhật, and Trần Hữu Đính The work was published by the Social Science Publishing House in 2002; History of Vietnam by the collective authors such as Trần Đức Cường (the Editor), Nguyễn Hữu Đạo, and Lưu Thị Tuyết Vân It was published by the Social Science Publishing House, Hà Nội and firstly printed in 2014 & firstly republished in 2017; the 13th Episode of Vietnam’s History (1965-1975) by Nguyễn Văn Nhật (the Editor), Đỗ Thị Nguyệt Quang, Đinh Quang Hải, The Social Science Publishing House, Hà Nội It was firstly printed in 2014 & firstly republished in 2017; … in which many aspects of the Health Sector like numbers of health officers, facilities, and material facilities, etc., 1.1.2 The group of directly researched works on the medical activity in the North * The group of research works into history of military medicine: To research the Civil Health, the author has referred to some works on the history of military medicine to further compare and see the panorama of the medical activity during the period like: như: History of Vietnam People’s Military medicine, Episode II (1954-1968), Episode III (19691975) published by General Department of Logistics in May 1991; History of military medicine academy (1949-1999) (internal circulation) by People’s Army Publishing House, Hà Nội, in 1999; “History of National Military Hospital 108 (1951-2001) (internal circulation); General Department of Logistics of the National Military Hospital 108; People’s Army Publishing House; Hà Nội, 2001; etc., Roles of the military medicine sector toward soliders’ health care activity have been summarized When referring to those works, the thesis’s author can clearly understand the relationship between the military medicine and the civil medicine in the health care activity for the people * The group of works on history of military medicine: Besides the research works on the military medicine, there are also others on the civil medicine as: An overview on the 85 year history of Bạch Mai hospital; Medical Publishing House, Hà Nội, 1997; An overview on the history of Vietnam’s health care, Episode II (1954-1975) of Ministry of Health published by National Politics Publishing House; Hà Nội in 1999; Ten centuries of Vietnam’s health care by Doctor Nguyễn Minh San, published in 2012 by the People’s Intellectual Publishing House, etc., The development process has been reflected in the works and positions & importance of the health care sector with constant efforts by physicians & medical workers have been gradually asserted This has made contributions to the victory of the career to liberate the nation for the country reunification 1.2 Contents inherited in the thesis and issues that need focusing on for settlement in the thesis 1.2.1 Contents inherited in the thesis In terms of contents: The research outcomes from the above-mentioned works help the thesis inherit such following contents: the context in which civil medical facilities were set up with occupational & specialized activities by medical officers, physicians, and training activities & programs by the medical facilities, etc., especially with rather objective analysis and evaluation on positions, roles, and gained achievements by the health care sector in general and by the Civil Health care one in particular In terms of documentation: The thesis inherits the source of documentation on the establishment and development of Research Institutes, treatment facilities, and training facilities for medical officers from the National and local routes in the North during 1954 – 1975 period; provides documentation on numbers of physicians, health care workers, training facilities for medical officers; devices at treatment facilities; documentation on training work for medical officers, etc., Simultaneously, they suggest the author for sources of documentations to be used in the thesis through the main history & memoirs by physicians and health care workers who had ever worked at medical facilities during that historical period 1.2.2 Contents that need focusing on for settlement in the thesis Upon the purposes and requirements for the thesis, we have put forward issues that need addressing like: firstly, the situation in the North and the Party’s guidelines for the construction of the health care sector needed clarifying; secondly, the organization structure of the Civil Health care system in the North from 1954 until 1975 was systematically& holistically presented and analyzed; thirdly, the training activity for civil medical officer forces during that period was clarified to understand how it took place; fourthly, the activity of the civil medical system in the North was deeply learned about; and fifthly, some comments on achievements, restrictions, and experience for the career of building up & developing the health care sector in the current period are made * Training facilities for medical officers: were established to train occupational officers to operate the medical system from the National level to the local one, including University of Medicine and Pharmacy, Hải Phòng University of Medicine On 07th March 1956, the Decree number 238-BYT/NĐ to set up the Central Medical Officer School upon the unification of Vietnam Medical School and Vietnam School of Pharmacists was enacted by Ministry of Health * Production and distribution facilities in the National route are divided into: - In terms of medicine production and supply, this includes: Manufacturing Department (later it was changed into Major Pharmaceutical Department), Central Pharmaceutical Factory, and Institute of Medicinal Materials, etc., - Medical facilities consist of Medical Tool Workshop (later changed into the Fixing Workshop of medical devices) The workshop was established in 1961 By the year 1964, the Medical Tool Workshop was changed into the Fixing Workshop of medical devices 2.2.1.2 The local route - The provincial route: Medical Departments and Health Companies were in charge of provincial medical operation * Provincial treatment facilities consisted of regional, municipal, provincial, and specialized hospitals The provincial hospitals showed functions: disease prevention, treatment, officer training, and scientific & technical researches This was the highest treatment route of each province with many specialties; * Training facilities for medical officers: was divided into: Medical College with a scale of 300 students upward; the College trained about 100 students; this was a small scale ranging from 30 to 50 students Besides the establishment of Medical Colleges, medical intermediate and pre-intermediate schools were also set up in some provinces; * Provincial state-owned pharmaceutical and medical companies: they were responsible for supplying, producing, processing medicine, collecting, and purchasing medicine for provincial, suburban district, and grassroot treatment facilities; * Organization of specialized stations: consisted of sanitation stations for epidemic prevention, anti-tuberculosis, anti-malaria, antieyeball, and dermatological stations, etc., to meet the people’s needs to prevent and fight against diseases 10 - Suburban district, mountain district, and town route: they were in charge of doing the sanitation work for epidemic prevention and disease treatment to protect and enhance the people’s health within the scope of each suburban district and town - Communal route: The communal medical facilities consisted of: Communal medical stations and maternity homes; medical organizations of co-operatives 2.2.2 Training and build-up of medical officer forces 2.2.2.1 The medical and pharmaceutical higher education training program consisted of: full-time & in-service higher education training, and professional supplement * Full-time training programs: After 1954, the full-time higher education training program for medical officers was further conducted at the University of Medicine and Pharmacy - In-service training and supplemental programs were to improve skilled nurses and physicians to doctors and pharmacists Initially, classes were organized at the University of Medicine and Pharmacy and nurses, intermediate physicians & pharmacists joined in the programs but later, classes were opened at medical officer schools 2.2.2.2 The medical & pharmaceutical intermediate training program, consisted of: full-time and supplemental training - The full-time training program: was conducted at the University of Medicine with enrollment subjects who graduated from the 7th grade Besides being trained at the University of Medicine and Pharmacy, intermediate physicians were also trained at provincial medical officer schools and physician ones - The supplemental training program: it was formed to cultivate and enhance the quality of the medical officer force The enrollment subjects were nurses, dental nurses, pharmaceutical nurses, and midwives who had officially graduated in 1952 backward and constantly worked in the branch & the state payroll 2.3.2.3 The pre-intermediate training program: was conducted in communes and Internet-communes When joining in the pre-intermediate officer training classes, learners’ educational level must be from the 3rd grade upward and they would be trained from to months Communal midwives’ educational level must be from the 3rd grade, too 2.3 The Civil Health care activity in the North 2.3.1 Sanitation for disease prevention and fights 2.3.1.1.The implementation for the environmental sanitation: The movement of the environmental sanitation and the guidline to build up 11 and develop three sanitation works had been strongly conducted in the North, which made contributions to changing the people’s lifestyle and daily activities 2.3.1.2 The implementation of physical exercise and sport movement: To realize the call by the President Ho Chi Minh, the movement of doing exercises had become the masses’ movement It attracted the majority of the Northerners to join in The movement didn’t only develop in cities but also widely spread toward rural areas 2.3.1.3 Vaccination activity: many common vaccines were produced in large and sufficient quantities to meet local needs like those for smallpox, cholera, typhoid, diphtheria, rabies, BCG, Japanese encephalitis, measles, and Interferonogen… Thence, 80-90% of vaccination was reached at the grassroot medical network 2.3.2 Medical checks-up and disease treatment for the people 2.3.2.1 Checks-up, in-patient and out-patient treatment: The process of medical checks-up and disease treatment at treatment facilities was unified for right routes of treatment In 1961, Ministry of Health worked out a scheme for in-patient and out-patient treatments to minimize the activity for in-patient treatment So, the one for outpatient treatment the most fully showed the Health Sector’s guideline of combination between disease prevention and treatment put forward right at the beginning when the North was liberated 2.3.2.2 Combination of Oriental and Western medicine in the activities for checks-up and treatment: In 1957, Oriental Medicine Research Institute made researches into methods and established an inpatient area with 200 beds It became a facility to practice Oriental treatment methods The system of Oriental treatment facilities was also set up provinces and directly under cities like Oriental Medicine Hospital and Oriental Medicine subject Those in communes, towns, clinics, and Oriental Medicine co-operatives were set up and managed by Oriental medicine doctors Oriental medicine groups in hamlets and villages were undertaken by corresponding doctors or officers 2.3.3 Medicine production and distribution 2.3.3.1 Production operation: The production of medicine was made at the Central Preparation Workshop and the Central Medicine Warehouse By March 1963, Ministry of Health made a decision to set up the Pharmaceutical Factories and to undertake the medicine production 2.3.3.2 Distribution activity: It was conducted by grades: Central (1st grade), provincial & municipal pharmaceutical factories (2nd grade), drug stores in suburban districts (3rd grade), and people’s medicine cupboards at communcal medical stations There were facilities at the Central grade with the task of distributing medicine 12 They were the Central Medicine Warehouse (later changed into the State-owned pharmaceutical and medical Company) directly under Ministry of Health and Công ty dược phẩm Hà Nội Pharmaceutical Company directly under Ministry of Industry and Commerce 2.3.4 International operation 2.3.4.1 Supports to Laos’ revolution: Upon signed conventions for cultural and medical collaboration; protocols; documents; and Vietnam’s medical supporting plans for Laos, Vietnam fostered his aids with types of vaccines for disease prevention & medicine for disease treatment to Laos In addition, Vietnam dispatched many medical expert delegates on business in Laos in line with short-term or mobile antiepidemic programs The delegates realized their tasks of: conducting medical checks-up, disease treatments, and both internal & external emergency; organized for occupational training & cultivation to nurses and staffs at hospitals; and deal with sanitation for disease prevention within towns & surrounding areas, etc., 2.3.4.2 Full advantages of international supports: According to the signed articles, Socialist countries offered medical supports to Vietnam on the contents: Supports for material facilities, including: medical documents, mainly with medical & pharmaceutical journals, samples of medicine, formulas to process medicine, and those to prepare for cleansers, etc., In addition, countries also fostered their supports and aids to Vietnam with medicine and medical tools The work of expert was shown in aspects: dispatching medical experts to directly help Vietnam and accepting Vietnamese medical officers to their countries to learn and exchange experience * Sub-conclusions in chapter In 1954, the North was liberated but still confronted with many difficulties In the context of new requirements, the Party and State worked out several relevant policies and measures to set up, consolidate, and accomplish the organization so that the Health Sector would well fulfill their tasks of health care for the people The build-up and training for the medical officer force focused on the consolidation with quite a few training formats and programs Thanks to the supplemented source of officers, the Health Sector’s professional and occupational activities were taken consistently along the vertical route and this was reflected in such contents as: the realization of sanitation to prevent against diseases, conduct checks-up, treatments, medicine production, and distribution Besides the realization of occupational tasks, during the period, the Civil Health Sector’s international collaboration was also attached with special importance through the reception of aid sources from other Socialist countries and aided Laos 13 Chapter 3: SWITCH IN ORGANIZATION AND ACTIVITIES BY CIVIL HEALTH SECTOR IN NORTHERN VIETNAM FROM 1965 UNTIL 1975 3.1 The situation in the North and guidelines to switch Civil Health Sector’s organization & activities 3.1.1 The situation in the North When the strategy “special war” tended to fail, the American authority expanded the invasion war to the North to tie the Government of Vietnam’s Democratic Republic to stop aids to the South’s revolution With the spirit of “Nothing is more precious than independence and freedom”, the Northern army and people showed their high determination to defend vital objectives to smash the USA’s escalation In early 1968, successive victory in the South’s battlefield made the USA declare to stop bombing the entire North and sit for negotiations at Paris Conference Later, the North gradually switched to normal operation for economic development, boosted up his strength of national defence, and aided the South’s revolution By 1972, the USA re-bombed the North, however, with preparation in advance, the Northern army and people fought back the USA’s second destructive war in an active and confident manner The North’s resilent persistence and the USA’s failures in the South’s battlefield forced the USA to sign the Paris Conference The North quickly did things to restore the economy, heal the war injury, stabilize, develop the socio-economy, realize his tasks as the rear, and realize his international obligations with Laos and Cambodia’s Revolutions After Ho Chi Minh historic campaign on 30th April 1975, the South was liberated and the country was unified to enter into the period to build up the socialism 3.1.2 Guidelines to switch organization and activities In the context of new situation and tasks, the health care sector switched their thinking, organization, and activities to serve for production & fights Firstly, it was the guideline of “generalization and surgerization officers” to realize the slogan “teachers at the spot and medicine at the spot”, later, the Party and State attached special importance to switch the organization and activities with the following contents: “The medical work must be strictly attached with production and fights”; “the suburban district and communal routes must be consolidated while decentralizing the work of medical checks-up and treatment to actively fight against and win over the American enermy”; “the health care sector needs to firmly consolidate its organization to match with the context of the war”; “to serve for fights, punctually cure invalids, strive to lower the death rate, and simultaneously, work out measures to avoid injuries caused by bombs and bullets”, etc., 14 3.2 Switch in organization and build-up of civil medical officer force in the North 3.2.1 Switch in organization 3.2.1.1 To establish the organization system for ambulance: In February 1965, Ministry of Health enacted the Instruction number 12/BYTCT in which the ambulance organization was divided into routes, including: Route I: was set up where fights took place to offer first aids to wounded people; Route II meant communal, Inter-communal medical stations, and medical rooms at construction sites, and agroforestries with tasks of rehabilitation, anti-shocks, and treatment of emergency cases; Route III meant suburban district and Inter-district hospitals with tasks of rehabilitation, antishocks, and treatment of mainly war injuries; while Route IV meant provincial and municipal hospitals with tasks of treating complicated injuries that requested for high specialization If so, in the context of war, the health care sector quickly switched from the peace to the wartime to fulfill their tasks to serve for soldiers and people 3.1.2.2 Classification of treatment facilities by scales and professional natures: Besides standards for technical grades and scopes for responsibilities, treatment facilities also based on scales of patient beds to classify them into groups: The group of Central/National and modern hospitals with 500 patient beds upward; The group of National and modern hospitals with 500 patient beds downward; the one of regional hospitals with 300 patient beds downward, and the one of provincial hospitals with 300 patient beds downward, and the one of suburban district hospitals 3.1.2.3 Construction of hospitals and research & treatment facilities for war injuries, sequelae, and rehabilitation of labor functions: To minimize for treatment facilities, nursing homes were established Provincial and suburban district hospitals were facilitated with some more nursing beds to support treatment beds and simultaneously, to set up treatment groups for functional rehabilitation to aid patients after surgeries for sequelae removal without needs for practice They would be checked and instructed upon the out-patient regime 3.2.2 Expansion of training and build-up of medical officer force 3.2.2.1 Post-graduate training * Post-graduate training abroad: with the two programs: one was of the Ministry of Universities and the cultural exchange one with Socialist countries The subjects for training were officers working at the Central and local medical facilities Learners, after having finished post-graduate themes, would write and defend essays at training facilities & later, would be sent to Socialist countries to learn & defend their theses within 06 months 15 * Post-graduate training in the country: The subjects for postgraduate training were officers working at medical facilities In addition to training officer forces for Associate Doctoral degrees, training classes for specialist levels of I & II were also opened In 1972, the one for specialist level of II was organized full-time for years by Ministry of Health By 1974, Ministry of Health assigned the task to the University of Medicine to try organizing classes for the specialist level I full time with components: in-patient doctors and specialists of level I 3.2.2.2 Higher education/University training * Full-time University training: After the American Imperalist expanded the war to the North, with the guideline of “evacuation but still maintaining training and safe training”, the learning activity quickly got into principles at the evacuation places The syllabus was adjusted to get relevant by cutting down subjects with theories but enhancing those with practice * In-service and supplemental training programs: On 14th August 1967, Ministry of Health organized specialized University classes at Thanh Hóa, Thái Bình, and Việt Bắc Medical Schools In 1971 – 1972, the University of Pharmacy started to organize for specialized and function training systems for intermediate pharmacists However, the function training system was stopped later By 1974, because of actual requirements at the battlefield, some specialized classes on organization and biochemistry were re-opened by the schools while the specialized training program had been further remained during years later 3.2.2.3 Training for medical & pharmaceutical pre-intermediate and intermediate officers: In 1965, after pre-intermediate and intermediate training facilities were decentralized to localities, Ministry of Health intended to merge the two pre-intermediate and intermediate schools into the medical officer school of the locality The medical officer school was assigned with the task of training physicians; supplementing education and occupational activities to local medical officers; training nurses, midwives, and laboratory assistants, training, and supplementing Oriental medicine to Oriental medicine doctors, etc., 3.3 The Civil Health care sector’s activities in the North 3.3.1 The realization of People’s Aviation tasks during the wartime 3.3.1.1 The evacuation and protection work of material facilities: To realize the guideline for evacuation, medical facilities were dispersed into those with small scales to minimize damages when a war arose The 2nd facility of the hospital would be dispersed as its tasks were to both 16 serve and conduct medical checks-up & treatment to people who went for evacuation and strengthen medical forces for localities so that they would get ready to serve for emergency and wounded people in the war 3.3.1.2 Construction of medical groups for emergency: To quickly treat injuries when hostilities arose, medical groups for emergency were set up The emergency team of the route I was set up in hamlets, villages, and co-operatives while the emergency team of the route II was established at inner city medical stations, regional hospitals, infirmary zones, and specialized clinics The emergency team of the route III was set up at Central and Provincial hospitals 3.3.1.3 Facility of common medicine bags for emergency: On 6th April 1964, Ministry of Health enacted the Circular number 07BYT-TT quy định thành lập, bảo quản sử dụng túi thuốc cấp cứu thông thường Túi thuốc cấp cứu thông thường vệ sinh viên giữ, tác dụng chăm sóc sức khỏe nhân dân hồn cảnh có chiến tranh mà cịn có vai trị quan trọng hoạt động chăm sóc sức khỏe nhân dân thời bình Ngồi ra, cịn có túi thuốc cấp cứu y tá bác sĩ thường trực 3.3.1.4 The implementation of emergency and treatment: The emergency and treatment activities were taken by the hireachy principle with three periods: during the 1st period, emergency at the spot would be made at places where hostilities arose with the participation by mass organizations and health workers; during the 2nd period, supplementatl emergency and patient selection would be made to move them to the rear route; and during the 3rd period, patients would be moved to hospitals and treated until recovering from their diseases Layout of the emergency system for treatment Victims Temporary gathering station Emergency team Selected emergency station 3.3.2 Sanitation movement for disease and epidemic prevention 3.3.2.1 The sanitation movement for disease and epidemic prevention: The sanitation movement for disease and epidemic prevention continued being made with the slogan “three cleanliness and four elimination pieces” and it became a wide mass movement The sanitation work at schools and health protection for students were also boosted up There had been many achievements in industrial sanitation at factories, construction sites, and agroforestry 3.3.2.2 Vaccination work: In the context of the war, the vaccination was regarded as the top priviledged solution to limit the 17 spreading of diseases and epidemics Therefore, vaccination, technical training, and collaboration to organize or vaccines each time or last vaccination session were regularly organized in provinces The vaccination couldn’t be made during the daytime in areas with fierce hostilities so medical officers came over to the people’s houses in the evenings or accompanied them to the evacuation places to give them vaccination, thanks to which the rate of vaccination in many localities reached 80% 3.3.2.3 Prevention and fights against microbiological and chemical wars: the epidemic prevention & fight work against the germ warfare was conducted with supports by National Institute of Hygiene and Epidemiology as well as Institute of malaria and parasites Mobile anti-war teams directly conducted the prevention against epidemics and germ wars 3.3.3 Aids to the South’s battlefield 3.3.3.1 Aids of medical officers: During the first period, the number of medical officers moved to the South’s battlefield wasn’t high By 1965, medical officers were consolidated to the South’s battlefield They were divided into several groups The group of core officers was put into the construction of organization frame in areas, zones, and provinces Such specialized groups as surgery and medical ones were sent to specialized hospitals to support and treat patients 3.3.3.2 Aids of medicine and medical tools: Medicine aided to the South consisted of antibiotic types, antiseptic, bandages & cotton for emergency for wounded people, malaria, intestine, and respiratory diseases, etc., Hundreds of sets for middle and major surgeries, dozens of thousands of minor surgeries, and dozen thousands of syringes, razors, and scissors, etc., were aided There were enough necessary chemicals which were prepared and produced with measuring & testing tools, and portable pots, etc., The source of aided medicine to help the health care sector in the South was supplemented to mobile surgery teams, field battle clinics, and medicine preparing & production facilities 3.3.4 Reception of aids by Socialist countries According to the signed documents, Socialist countries boosted up their aids of necessary medicines, medical ingredients, and tools used to serve for the ambulance work such as Penicillin and Step Tomicine, etc., Aided medical machines and tools consisted of many surgical tools, general equipment, sets to operate corpses, foot pumps, electric knives, xray machines, anesthesia machines, and some separated tools like pincers, scissors, and knives, etc., in addition to 18 material aids, Socialist countries also sent many medical expert delegates to Vietnam for surveys and fieldworks Not only receiving experts to exchange occupational experience, many specialized doctors and post-graduates were also accepted for short-term training after having fulfilled majors on post-graduates in Vietnam *Sub-conclusions in chapter When the army and people in the North were actively emulating for labor and production to realize the first year plan (1961-1965), the American imperialist expanded the war to the North Requirements for the Health Sector to switch its organization and activities to fulfill the task of the people’s health care in the new context Accordingly, the health care sector took initiatives to adjust its organization and activities for relevancy to the new tasks With a guideline of “evacuation but still maintaining training and safe training”, the scale of the training work for medical officers and training format were expanded to create the medical officer force to be sufficient in terms of numbers and quality to meet the requirements in the new context Thanks to the timely and relevant adjustment to the context of the war, this helped the Civil Health Sector uphold its crucial roles in taking care of the people’s health, thence, to assert its great contributions to the joint-victory of the resistance against the USA to save the country Chapter4 COMMENTS AND EXPERIENCE 4.1 Achievements Firstly, to build up a widespread medical network with consistent operation from the Central to local routes After 1954, the Party and the Government of Vietnam’s Democratic Republic mobilized sources of expenses from within the country and simultaneously took full advantages of aid sources from Socialist countries which had built up their own widely developed medical networks The Health Sector didn’t only widely develop its medical network but also being able to establish a consistent organization system from the Central to local levels The rhythmetic collaboration among the routes helped the Civil Health Sector achieve many good outcomes in the sanitation work for disease prevention, checks-up, treatment, and medicine production Secondly, to build up the officer force with high professional grades and spirits for services Right after undertaking the task, the Health Sector attached special importance to training work for medical officers If, in 1954, 19 there were training facilities for medical officers only in the entire Northern Part, by 1975, the number increased to for University training and there were 28 medical schools The training program for medical officers was flexibly and relevantly conducted to the material facilities and learners’ time Besides the occupational & professional training work, the Health Sector also attached special importance to educating revolutionary morality to medical officers Thirdly, to combine modern and traditional medicine in checksup and treatment Right after the guideline to combine the Oriental and Western medicine, medical facilities from the Central to local routes all identified that the combination must be made for long term and holistically in all aspects, from theories to reality, from the Health Sector to the pharmaceutical one and gradually, the perception of “giving up medicine for the pharmacy” was gradually skipped Therefore, Ministry of Health and the Combination Board of Oriental and Western medicine were established & so were the provincial and municipal boards as well as those in suburban districts The task to combine them in communal routes became a vital task when there were Oriental forces in almost all communes They made medicine professionally and semi-professionally Fourthly, many medical achievements were applied to serve for the people’s health care Many medical achievements like the ones related to wells; twocompartment toilets; identification of nutritional values in common foods; build-up of sanitation standards and toxic gas; many research works on inflammatory pathology, etc., were applied by the Health Sector Especially, during the wartime, many achievements were applied to treat injuries caused by bombs and bullets to minimize wounds in various routes Fifthly, to well implement the work of the people’s health care With high determination in the medical systems from the Central to local routes, the work for social disease prevention and treatment was widely done upon improving methods as well as combining the in-patient and out-patient treatments, thence, the social disease-catching rate was cut down The Civil Health Sector had managed to make such abovementioned achievements thanks to: Firstly, thanks to the Party and Ministry of Health’s guideline for organization It was relevant to the actual context Secondly, thanks to the medical officer force who persistently strived to fulfill their obligations with a guideline of: “Medical work must serve for production, fights, and life & serve for 20 the people”; Thirdly, the Civil Health Sector in the North inherited, built up, and developed upon the infrastructure, and the medical officer forces at medical facilities were successfully undertaken; Fourthly, the sector gained supports and aids both in terms of infrastructure and occupation from Socialist countries 4.2 Restrictions Firstly, infrastructure remained lacking and poor: Many treatment facilities owned primitive and outdated medical devices & machines There was a severe shortage of treatment supporting machines The quality of patient beds, especially those at the suburban district level had remained low Specialties, especially like non-clinical ones: testing, radiographic, and pathological specialties had slowly developed yet having remained poor Secondly, the management work at medical facilities had remained poor with many shortcomings The reception work of patients at treatment facilities hadn't been strictly managed The management of prescriptions and stams had remained loose Many pharmacists sold medicine based on their feelings with respects for their relatives and acquaintances Thirdly, occupational activities by medical officers & workers had remained limited During the training process, students hadn't had many chances to practice much so the training quality had been limited Therefore, the quality of disease diagnosis by physicians and doctors at many treatment facilities had been much restricted Many physicians and doctors worked for the form’s sake and finished their working days without focusing on diagnosing diseases to work out treatment paradigm for patients Restrictions in the Civil Health Sector during this period originated from the following key reasons: Firstly, the Civil Health Sector was built up and developed in the context in which the country was divided while the economy – society encountered many difficulties Secondly, during 1954 – 1975 period, the North was in both peacetime and war time so the adjustment for organization and activities of the Civil Health Sector hadn't really got effective, especially when the USA expanded the war to hit and destroy the North Thirdly, leaders of the Civil Health Sector hadn't worked out holistic plans or planning yet 4.3 Some pieces of experience Firstly, the Party’s guidelines and the Health Sector’s guidelines should be firmly grasped: The Party and State’s guidelines and policies were all oriented toward the construction of the Health Sector of the people, because of the people, and for the people, thus, it had always been actively supported and responded by the people 21 Secondly, the route division for treatment had been well organized: The organization system of the Civil Health Sector was built up to realize the tasks of caring for the people’s health Thus, civil medical organizations needed establishing neatly and relevantly to assure for the consistency from the Central down to the local routes Thirdly, the build-up of medical officer forces with sufficient talents and morality had been made: To make the Health Sector uphold its roles to protect the people’s health, it was necessary to build up the medical officer forces as sufficient in numbers and occupational qualified All managers, occupational officers, and movement ones must clearly identify their responsibilities, uphold their positivity, and pioneered as examples to well fulfill all tasks in the peace and wartime alike Fourthly, the spirit of self-reliance had been upheld: The achievements by the Civil Health Sector in the North during 1954 – 1975 period had made significant contributions to the supports of the people’s health care work All of the achievements had originated from Vietnam’s actual and practical requirements, from his will of self-reliance, spirit to overcome difficulties and hardship of the Vietnamese medical officer forces Fifthly, the international collaboration to enhance the scientific and technical levels had been strengthened: the Health Sector had needed to expand the international collaboration not only with Socialist countries but with those with developed medical backgrounds as well The collaboration for researches, seminar organization, and officer training activities had been made to acquire advanced and progressive techniques & technologies to enhance the medical officer forces’ levels so that they would get qualified enough to accept the progressive technical transfers during the processes of vaccine production for the accomplishment and application in the conditions in Vietnam to reach the international standards *Sub-conclusions in chapter From 1954 until 1975, the Civil Health Sector had made many crucial achievements like the construction of the widespread medical network, close follow-up for production, fights, and the people’s lives; the construction of officer forces with high occupational and spirits for services The construction and development process, the Civil Health Sector in the North during the period had shown its positions, roles, and many vital contributions to the career of socialism build-up in the North as well as aiding to the great front in the South to unify the Fatherland Upon those contributions, the Civil Health care in the North during 1954 – 1975 period has brought about some essential lessons of experience to the career of the Health Sector’s construction and development in the current period 22 CONCLUSIONS When getting rid of the war, the North confronted with many difficulties and barriers for the process to recover and heal the war injury For the Health Sector, despite many joint-contributions to the victory of the resistance against the French colonist, however, because of the shortage and backward feature of material infrastructure, the shortage of medical officer forces which were weak at occupational activities, they had affected the medical activities after the peace was restored Upon the actual state and requirements for the Civil Health Sector’s construction and development, the Party and State worked out many guidelines and measures to build up the Civil Health Sector During the period (1954-1965), quite a few guidelines, policies, and measures had been put forward to mainly focus on such contents as: rearrangement and re-establishment of organization for Central & local medical facilities, and construction of rural medical organizations, etc., During the period (1965-1975), because activities by the Civil Health Sector were controlled by the war, the Party and State intended to switch the organization and activities to match with the historical requirements The system of people’s Health Sector in the North was established with the two routes: the Central and local ones The former one consisted of research institutes; training facilities; treatment facilities; medicine production, and distribution facilities whereas the latter one consisted of provincial, suburban district, and communal sub-routes At the provincial route, medical Departments and Medical companies were in charge of medical activities The suburban district route was under the provincial one It was the organization in charge of suburban district public health station The communal medical route was regarded as the grassroot one with crucial roles for the medical work in rural areas That decentralization was the vital factor which helped the medical activities consistently and strictly organized during the collaboration process to realize the task of the people’s health care When the USA expanded the war to the North, the Health Sector switched its organization and activities to serve for the production and fights In terms of organization, the Health Sector set up a system of emergency and ambulance with routes to actively cure the wounded In addition to establishing the ambulance system at the routes, the Health Sector also classified treatment facilities by scales and specialized natures In addition, the organization of the Civil Health Sector in the context of war had also been adjusted by establishing treatment institutes, building up research facilities to treat war injuries and sequelae, and rehabiliating labor functions The medical officer forces were built up with many different programs The post-graduate training program had commenced since the year 1970 with two systems: the post-graduate training one 23 abroad was offered with two ways: in line with the program of Ministry of Education and Training and the cultural collaboration one with Socialist countries The training program for medical officers with qualifications of Associate Doctor and Specialists II & I was conducted at University of Medicine and Pharmacy In addition, medical officers were trained by such programs as: higher education, pre-intermediate, and intermediate ones for medical officers at localities Thanks to the variety in the training formats, the Health Sector had managed to build up the medical officer forces rather sufficient in terms of numbers and quality to undertake the task of the people’s health care In each period, medical activities were differently shown but they all aimed at the joint-purpose of the people’s health care In the peacetime, sanitation for disease & epidemic prevention was mainly focused on and so were the medical checks-up, disease treatment for the people, medicine production & distribution, and international collaboration Each task was conducted in consistence upon the vertical route The Central route led the provincial one and in turns, the provincial route guided the suburban district one which guided the communal one, and the communal route guided the grassroot one When the USA expanded the war to the North, depending on new tasks, the activities by the Health Sector were shown in such aspects as organization of Aviation health care for the people in the wartime, the implementation of sanitation movement for patriotism, aids to the front in the South, collaboration between military & people medicine, and international collaboration So, the activities by the Civil Health Sector had always been close to tasks in each period to make relevant adjustments Thanks to the Civil Health Sector’s effective activities from 1954 until 1975, requirements for production, fights, the Northerns’ health protection in the wartime had been met while aids for the South had been still offered In addition to the gained achievements, during the operation process by the Civil Health Sector, there had remained such restrictions as: the shortage and weak material infrastructure, occupational levels of physicians, doctors, and nurses had been poor so they failed to meet practical requirements, the collaboration among the routes had caused many shortcomings; and the activities by medical facilities had still shown confusion and lack of professionalism, etc., Nevertheless, great roles and contributions by the Civil Health Sector in the North for the people’s health care work cannot be denied 24 ... needed clarifying; secondly, the organization structure of the Civil Health care system in the North from 1954 until 1975 was systematically& holistically presented and analyzed; thirdly, the training... Tuyết Vân It was published by the Social Science Publishing House, Hà Nội and firstly printed in 2014 & firstly republished in 2017; the 13th Episode of Vietnam’s History (1965 -1975) by Nguyễn... 85 year history of Bạch Mai hospital; Medical Publishing House, Hà Nội, 1997; An overview on the history of Vietnam’s health care, Episode II (1954- 1975) of Ministry of Health published by National