Full understanding of medical operations in Vietnam requires some, appreciation of the nature of the country and of the war that has been waged there.

The Republic of Vietnam lies entirely within the Tropics. Saigon is halfway around the world from Washington, D.C. There is a 12-hour difference in time between the two cities. The nearest off-shore U.S. hospital is almost 1,000 miles away at Clark Air Force Base in the Philippines, The nearest logistical support base is about 1,800 miles away in Okinawa. The nearest complete hospital center is in Japan, some 2,700 miles distant. Patients being evacuated to the United States must travel, some 7,800 miles to reach Travis Air Force Base in California, or almost 9,000 miles to reach Andrews Air Force Base, near Washington, DC

Because of these distances, even with modern air transport, the need for self-sufficiency in the zone of operations is greater than that normally required within a combat zone, This fact is reflected by a higher ratio of combat, service support troops (including medical) to combat troops than is normally provided in more conventional situations, Vietnam is actually a combat zone combined with the advanced section of a communications zone. The distance of Vietnam from the logistical support base also has an adverse effect on the efficiency and morale of troops newly arrived in-country.

Since 1954 Vietnam has been divided like Korea. North of the 17th parallel and Ben Hai River lies Communist North Vietnam and south is the free Republic of Vietnam, South Vietnam has a typically tropical climate of two seasons: hot and dry and hot and rainy. South Vietnam's continuously high temperature and humidity, its, monsoon climate, and perennial dust-rain cycle have an obvious impact upon the, types of diseases to be expected and upon the provision of medical care.

The majority of tropical diseases, are both endemic and epidemic in South Vietnam. The high ambient temperature and humidity adversely affect the efficiency and health of US troops fighting in this area, and the medical personnel supporting them, These also make it difficult to preserve and maintain medical supplies and sophisticated medical equipment. South Vietnam's terrain, with its waterways and jungles, impedes patient evacuation and supply distribution, even without the interference of combat operations.

The Republic of Vietnam is less than half the size of California and long and narrow like that state. It stretches some 700 miles from north to south, and is only 125 miles at its widest, It occupies the eastern and southern part of the Indochinese Peninsula in Southeast Asia, and borders the South China Sea and the Gulf of Siam. Near neighbors to the west are Laos, Cambodia, and Thailand. Several good ports along the eastern shore form the bases for logistical support of combat forces deployed inland and, in turn, affect the disposition of medical installations, The peninsular nature of Vietnam facilitates the employment of US Navy hospital ships offshore in the South China Sea.

The conflict in Vietnam is a limited war as well as a counterinsurgency operation with the essential characteristics of both. Mere has been no ground or air confrontation between major powers, There has been no enemy aerial bombing of friendly troops, and artillery and rocket bombardment has been sporadic. The tour of duty in Vietnam is limited to 12 months and forces in Vietnam enjoy a relatively high priority for all US military resources.

The Republic of Vietnam is a sovereign nation, US forces are there at the invitation of the host government to help maintain this sovereignty. Economic, political, and sociological factors affect the conduct of military operations. Vietnam, like most developing nations, suffers a paucity of medical resources. Through various medical civil assistance programs, the Army Medical Department has helped achieve national objectives in all facets of stability operations. Similarly, medical advice provided to the medical department of the Republic of Vietnam Armed Forces, has played a vital role in increasing the department's competence, capability, and self-reliance.

Guerrilla and terrorist operations throughout the country, interspersed with sporadic organized unit assaults against cities and military bases, characterize enemy tactics. There is no defined main line of resistance. The battle has been for popular support and stability, rather than for terrain, per se. Casualties occur anywhere at, any time. There are no secure ground lines of communications outside of base areas.

The conflict has involved highly mobile,, small tactical units, and has not been a war of mass movement of major military formations. Search and destroy operations by small units from relatively secure base areas and for relatively short periods of, time have been characteristic. There has been a high reliance on organic Army air mobility for the conduct and support of these operations.

The Army Medical Department's deployments and procedures have reflected these tactical realities. Treatment facilities located in base areas receive casualties by air from operating combat elements. Because, there was no need to move frequently, it was practicable to construct send permanent medical facilities, thereby allowing the utilization of more sophisticated equipment and providing a general upgrading of the level of medical care.

At the beginning of 1965, the USMACV advisory effort was predominant, almost to the exclusion of all other US Army medical support functions, in Vietnam. There were some 20,000 US troops, in-country receiving medical support from two 100-bed hospitals (the US Navy Hospital in Saigon and the US Army's 8th Field Hospital in Nha Trang), plus some miscellaneous small medical detachments providing air evacuation and dispensary, laboratory, dental, and veterinary services.

The planning and implementing of medical support for the tactical and logistical buildup of Army forces in Vietnam have been challenging tasks. Many imponderables existed, mostly related to the nature of the country, the nature of the conflict, and the nature of the medical problems to be met. Estimates and plans based upon previous experience had to be modified to fit the unique situations in Vietnam as valid information was developed and a highly effective medical service created.