North Viet Nam's Rx

Hanoi recently invited a quartet of American physicians--Drs. Morris Simon, Peter Wolff and Pierce Gardner of Harvard Medical School and George Roth of San Francisco--to inspect North Viet Nam's health-care system. The four spent a week touring rural and urban facilities. They said that they were able to see nearly everything they wished, though their hosts were obviously interested in showing off their best facilities. Interviewed by TIME last week, the doctors offered this appraisal:

Many countries have met the medical challenges of war; North Viet Nam seems to have surmounted them. Despite a blockade and almost daily bombings, the North Vietnamese have one of the best and most extensive healthcare systems on the Asian mainland. Building on what the French left behind 16 years ago, the country has increased its total number of hospitals and infirmaries from 42 to 200, its corps of doctors from 100 to more than 2,000, one for every 1,700 people. (The U.S. has one for approximately every 600.) Hanoi has also made medical care more widely available than in any other Southeast Asian nation, including South Viet Nam.

Five Tiers. The key to the system is organization. Nearly every citizen has health insurance contracted for through an agricultural, labor or other group. Members are entitled to regular care from a medical structure that is neatly divided into five tiers. At the lowest level are the agricultural and industrial cooperatives, in which teams consisting of two nurses and a midwife educate workers in personal hygiene, perform minor medical procedures and provide pre-and postnatal care. Above these are some 6,000 health stations, financed by individual villages and staffed by assistant physicians who have from two to four years of training.

On the third level are district hospitals capable of performing appendectomies, amputations and other operations of comparable complexity. These, in turn, pass more complicated cases up to any of 26 provincial hospitals; each of these institutions has between 300 and 500 beds, and graduates 70 to 80 assistant physicians a year. At the top are the "center hospitals" of Hanoi and Haiphong, legacies of the French occupation that Gardner found "clearly recognizable as university hospitals by any standard."

Though these institutions are old, the care they provide is relatively up-to-date. Few have modern laboratory equipment or physical-rehabilitation programs, but all have doctors who read U.S., European and East bloc medical journals and stay abreast of current medical developments. They not only manage to provide a complete range of medical services but also carry on clinical research on cancer of the liver, which is prevalent in North Viet Nam.

Outhouse Poetry. Like their Chinese counterparts, North Vietnamese authorities stress prevention of disease through sanitation. Several local physicians told Roth, "I have failed unless I keep my patients from getting ill." Most North Vietnamese make a fetish of cleanliness. Public-health teams even inspect every family's outhouse, awarding pink slips to those that pass inspection, green to those that fail. According to Gardner, families get special red slips if their outhouses are "clean enough to write poetry in."

Of necessity, the country's doctors have been concentrating on improving the treatment of war injuries, particularly burns caused by white phosphorus from bombs. Most civilians are trained in basic first aid; Simon saw children of five or six with first-aid kits strapped to their belts. Minor shrapnel and burn cases are cared for at local clinics; serious ones are sent to the large hospitals.

The four U.S. doctors were present at St. Paul's Hospital in Hanoi when French Diplomat Pierre Susini, who later died, was brought in with burns suffered in a U.S. raid on the city. "They were doing a remarkable job on him," Wolff said. "I considered that he was in excellent hands."

Despite its progress, North Viet Nam has not become a medical Utopia. Parasitic and infectious diseases, for instance, remain major problems. However, the visitors were told that some ailments have been brought under control. Cholera, trachoma, venereal disease and leprosy have become relatively rare. Polio, which still occurs in South Viet Nam, has been all but eliminated in the North. Even more impressive has been the decline in infant mortality. The infant death rate now stands at 26 per 1,000 births, a figure that seems high by Western standards but represents tremendous progress for the North Vietnamese. When the French left in 1954, it was 400.

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