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For Humanity Exhibition Launch – Air Vice-Marshal Tracy Smart AM and Dr James Villiers

Launch of For Humanity: Medicine in War and Peacekeeping Since 1945.

Conflicts:
Vietnam War (1962-73), Dutch East Indies (Indonesia) (1947-1951), UN Military Observer Group in India and Pakistan (1948-1985), Malayan Emergency (1948-60), UN Commission on Korea (1950), Korean War (1950-53), UN Observer group in Lebanon (1958), The Congo (1960-1964), Yemen Observer Mission (1963-1964), Indonesian Confrontation (1963-66), Cyprus (1964-2017), India-Pakistan Observation Mission (1965-1966), Rhodesia (1979-1980), Sinai, Egypt (1982-86, 93-), Namibia (1989-90), Uganda (1982-1984), Iraq-Iran Military Observers (1988-1991), UN Mine Clearance Training Team, Peshawar, Pakistan (1989-1993), First Gulf War (1990-91), Cambodia (1991-93), Croatia, Bosnia-Herzegovina and Macedonia (1992), Somalia (1992-94), Rwanda (1994), Haiti (1994-95), Mozambique (1994-2002), Guatemala (1997), Bougainville, Papua New Guinea (1997-2003), East Timor (1999-2005, 2009), Solomon Islands (2000-2003), Sierra Leone (2000-2003), Ethiopia and Eritrea (2001-2013), Afghanistan (2001-), Iraq (2003-2009), Sudan (2005-2011), South Sudan (2011-), Syria (2014-)
Services:
Army, Air Force, Navy, Nursing services, Peacekeeping operations

Launch ofFor Humanity: Medicine in War and Peacekeeping Since 1945 featuring guest speakers Dr James Villiers and Air Vice-Marshal Tracy Smart AM. Recorded April 2018.


Transcript

Voiceover: Welcome to the Shrine of Remembrance podcast series, recorded live at our public talks and events. Today’s release is the exhibition launch of For Humanity: Medicine in War and Peacekeeping Since 1945, with guest speakers Dr James Villiers and Commander Joint Health, Air Vice-Marshal Tracy Smart AO. For Humanity is open in the Galleries of Remembrance Post-’45 section daily, from 10am to 5pm, with last entry at 4:30. It will be on display until March 2019.

Dean Lee: The Shrine Trustees are very pleased to present For Humanity: Medicine in War and Peacekeeping Since 1945. This exhibition explores the circumstances and experiences of Victorian doctors, nurses, medical professionals and their patients in the Korean, Vietnam and Middle East Wars, and in peacekeeping operations in Rwanda and elsewhere around our world. Stories of extraordinary people who have provided skilled care and compassion to treat wounds and disease in some of the most difficult conditions imaginable.

It is now my pleasure to introduce the first guest speaker for this morning’s presentation, Dr James Villiers. James was born and trained as a doctor in England before joining the Royal Australian Navy. He served in the Korean War, as Medical Officer on HMAS Warramunga, later becoming an anaesthetist at Royal Melbourne Hospital. James served with two civilian surgical teams sent by Victorian hospitals to Vietnam, before returning to Vietnam a third time as a Reservist in the Navy, where he was an anaesthetist at the Australian Task Force Hospital in Vung Tau, between 1970 and 1971. Please join me in welcoming James.

Dr James Villiers: Thank you very much for that introduction. I’ve been asked to talk about the role of civilian surgical teams in Vietnam. First of all, I think to explain the origin I have to go back and renew a bit of history. As my generation will remember, Vietnam was actually a French possession. It was only after the insurrection and the Battle of Dien Bien Phu that the defeated French in actual fact had to return and hand over North Vietnam to the Viet Minh. South Vietnam however remained independent. Now in 1962, an appeal was made by Vietnam for medical aid.

The French had supplied a very adequate colonial medical service while they were there in Vietnam but unfortunately they had made very little attempt to create a structure that would last after them, so that there were very few trained Vietnamese doctors. I think there was a total of about eight hundred for the population of 16 million in Vietnam, but eight hundred of those were in the Vietnamese Army. So that left about two hundred to care for the remainder of the population, which meant that the average Vietnamese would live and die without having any recourse to medical assistance. As a result of that, there was a lot of, shall we say, improvised medicine, so that all the people who came initially to our hospital bore the marks of cupping, by which you put a vacuum on the patient’s spot where they’re complaining of pain, light a little taper under it, it evacuates the air and when they take that off it leaves a nice bruise there, so that the pain that they were complaining of is nothing like the one that they’re left with.

In 1962, an appeal was made by the South Vietnamese to use aid, and to involve Australia particularly at that time. We had a neurologist, Dr John Game, who was travelling around South East Asia, and he was asked to look into what sort of aid Australia could furnish. Now at about that time the US department dealing with medical aid had produced a plan and in fact gone ahead with that plan to produce 28 surgical suites to be attached to various civilian hospitals, that is hospitals that were dealing entirely with civilians. The Army were looked after by their own chain of army hospitals. Now these civilian hospitals were very undermanned by the Vietnamese and Australia finally decided—the Department of External Affairs—that they would provide a surgical team to go to one of these hospitals in Long Xuyên to commence a period when they would undertake a lot of the work that the civilian doctors were trying to undertake, but that they would run not independently, not usurping the Vietnamese, but as part of the Vietnamese hospital.

That’s the general picture. Now at that time, Vietnam was not well known in Australia. It’s hard to imagine under the subsequent history and the Australian military involvement that most people didn’t know where Vietnam was. And I remember being asked by a highly educated Australian if Laos was the capital of South Vietnam. Now my first involvement with any of this was when I was at the Royal Melbourne Hospital performing my duties as an honorary anaesthetist there for an orthopaedic session. The senior honorary anaesthetist approached me this particular afternoon in the corridors, and he himself had served with some distinction, having parachuted in on D-Day, into France. Presumably this is why he was singled out as part of the recruitment of a team. He approached me and said, ‘We are sending a surgical team to Vietnam, would you be interested in going as anaesthetist?’ Having been in the Navy and some experience of these situations I immediately said ‘yes.’ He said—which gave me to hesitate—that the team would be departing in about two weeks’ time. Well, my first action on that when I recovered was to ring my wife up and say:

Would you like to go out to dinner, to our favourite Italian restaurant? Can you organise a babysitter in time?

Anyway, she having some experience as a naval wife managed to come to terms with my imminent departure.

Now it’s very hard at this time. The Department of External Affairs were dealing with all this through the Embassy in Saigon, but in the absence of emails and all the modern communications that we have today it was very difficult, and I was trying to find out what I might expect in the way of anaesthetic equipment, and all I could be told was that the Americans would provide everything. Well, having some experience in the forces, I looked upon this with some degree of doubt, and I wanted to make sure that I had an independent means of sending people to sleep. And I knew from my experience in England that there was a portable anaesthetic machine called an EMO, for Epstein MacIntosh (Oxford) Inhaler, that was readily portable and although it used ether it was capable of producing accurate concentrations of ether. I knew that the Navy had one in storage, so I got onto the Director General of Naval Service who was Admiral Coplans at that time, and told him the story and asked would he be agreeable to me taking that on my personal chit, on loan and he very kindly agreed to that. 

When I got it, I found out that it was missing a necessary attachment, and I don’t want to get too technical about anaesthesia, but modern anaesthesia consisted of using muscle relaxants to paralyse the patient and then ventilating them with a bellows, and this attachment was entirely missing. So I got together with a friend of mine at Commonwealth Industrial Gases and between us we improvised an equipment which would attach to the EMO and we could provide ventilation, keep a patient asleep, and use relaxants, in other words, use modern anaesthesia. That is the one that is contained in a replica which I donated to the Society of Anaesthetists Museum, and it’s reposing up in the museum here complete with the QANTAS bag in which I carried it. And that was in fact to provide the pattern for all the anaesthetics of Australian surgical teams, more were made available. The Department of External Affairs gave another one to the Navy and obtained more for the various Australian surgical teams. 

We took off in seven weeks—a small party consisting of a surgeon, a medical registrar, two theatre nurses, and a ward sister, and a radiographer. We eventually landed in Saigon and after a week of being entertained by the authorities in Saigon we were taken down to this, I might say, very primitive civilian hospital, where we were told we would proceed with due warning as soon as we became accustomed to the place. Unfortunately, we were presented that very afternoon with a small boy of five years old. Now five-year-old children were never operated on in Vietnam, it was thought that they would not survive. This small boy had already been treated with the—well this was a slight advance on the cupping—where you produce a small puddle of oil and you ignite that, and that left him with a severe burn of his abdomen. I was asked to anaesthetise this small boy. Fortunately, it turned out that he did have an appendix, and he survived the operation without any incident.

From there we proceeded to do very many major operations from ninety-year-olds to neonates. The work of the team became known far and wide, and we had a lot of patients who presented for us to operate on during that time. They then decided, External Affairs, that another Australian surgical team should be sent to Vietnam and this was sent to Biên Hòa, which is very different. We were some eighty kilometres from Saigon in the heart of the Mekong Delta at Long Xuyên, but this Biên Hòa was a very different area and only about twenty miles from Saigon. Now I don’t want to dwell on the work of the surgical teams because this is all very well documented and whatever, but I just want to get on what we tried to achieve. That was to leave something behind us, because we could all see the day would eventually come when we would have to leave Vietnam, to the Vietnamese. And I might say that we achieved a considerable amount of success with that. 

I was in the fortunate position because in due course, having given anaesthetics to the senior surgeon at the Alfred Hospital, who was to head one of the teams from the Alfred Hospital to Biên Hòa, (he) automatically assumed I would go as his anaesthetist. So, I ended up back in Vietnam again as anaesthetist, but this time at Biên Hòa. But it did give me the opportunity two years later to come back to Long Xuyên and find that my anaesthetist nurse there was very ably giving all the anaesthetics at Long Xuyên, so I felt that our aim had succeeded. Again when I went back for a third time, but this time with the Australian 1st Field Hospital under very different circumstances, with all mod cons in the way of anaesthetics and so on, but it gave me an opportunity again to go back to Long Xuyên. By this time surgical teams had left Long Xuyên and it was a completely functioning entity, run by the Vietnamese who were entirely responsible for the medicine, the surgery and the anaesthesia, so I felt that our presence had been justified. 

Ladies and Gentlemen, thank you very much.

Dean Lee: Ladies and Gentlemen, please join me in giving another round of thanks to Dr James Villiers.

It’s now my very great pleasure to welcome Air Vice-Marshal Tracy Smart AM, Commander of Joint Health, to officially launch the exhibition. Now Tracy’s bio went for about two and a half pages. I spoke to her before and she said:

Oh no, it’s ok, I joined the Royal Australian Air Force in 1985 and I finished my university studies, then I did a couple of deployments and that’s it.

But I’m afraid that won’t do, so I will go through some of the background.

Tracy joined the RAAF in 1985 and completed her medical studies at Flinders University in South Australia in 1987, subsequently commencing full time duty with the Royal Australian Air Force in 1989. She joined peacekeeping forces in Rwanda, Timor Leste, and in 2003 deployed as Senior Australian Defence Force Health Officer and Deputy Validating Flight Surgeon in support of Coalition operations in Iraq and Afghanistan. In 2004 Tracy became Officer Commanding of Health Services Wing, overseeing all Air Force Health units and dispatched teams in response to a number of natural disasters. In November of 2015, Tracy was promoted to Air Vice-Marshal, and assumed the positions of Commander Joint Health and Surgeon General of the ADF on 3rd December 2015.

Tracy is a fellow of the Royal Australasian College of Medical Administrators, the Australasian College of Aerospace Medicine, the Aerospace Medicine Association of the US, the Centre for Defence and Strategic Studies, and an Academician of the International Academy of Aviation and Space Medicine. Quite an impressive sort of background, so I couldn’t let it go, I’m sorry Tracy. Please join me now in welcoming Air Vice-Marshal Tracy Smart.

Air Vice-Marshall Tracy Smart AM: Distinguished guests, Ladies and Gentlemen. It is indeed a pleasure to be here today, as a leader of ADF Health Services, as Surgeon General, to open this important exhibition, even though I’m not a Victorian, I’m a South Australian, sorry about that. But it is a hard act to follow our previous speaker, but interestingly enough, many of the themes that he brought out are really very typical of what we do as military health providers, and I think you’ll see as we go along, demonstrate many of the themes that I wanted to talk about here today.

First of all, what do we do as health providers? Well, we fix people. We tend to their wounds. Well, we do a lot more than that actually, because of course I work for an organisation that puts people, as we’ve heard, in very high risk and dangerous situations. And in fact, because of our very important mission to defend Australia and its national interests, we deliberately put people in harm’s way, and that’s an unfortunate fact. So military health service is just one mechanism to mitigate the risks that our people face, and we do this by making sure for a start that our people are fit and healthy to go to the fight. We provide them with protective mechanisms from both injury and wounding and disease when they’re deployed. Then we provide treatment services for those who become wounded, injured and ill on operations or back home in Australia. When they’re deployed overseas and they’re injured, we bring them back home for definitive health care, and then we look at how we can help them recover, to get back to full fitness, to go through the cycle again, or if that’s not likely to be possible, how we can best transition them to their next life, after defence, in the civilian world. 

We talk about health as being a key combat enabler, we’re part of those things that get our forces into the field, but we’re also essential in providing or meeting ADF’s duty of care requirements for our people. This exhibition really covers that entire continuum, but it focuses on the literal cutting edge, which is how we deliver health care on the front lines in times of strife. Both so that we can maximise the value of our fighting force, but also, so that our troops will fight knowing that if they do become injured, or wounded, that we’re there to pick up the pieces, to look after them, and to get them home.

So we’ve got an important job to do, but sometimes military health isn’t really understood that well, and there’s maybe some contradictory aspects to it. The first part, or the first reason it’s a bit controversial—not controversial but overlooked perhaps—is because as military medical providers we’re non-combatants. So we’re non-combatants in a war-fighting organisation, and we’re covered by various Geneva Convention protocols et cetera, and sometimes therefore we’re thought of as, well, we’re not the real fighting force, therefore we’re the softer side of the military. Yet the courage and the bravery and the sacrifice that our people have been through often at the very front lines is as impressive as any front-line soldier. 

Military personnel are decorated war heroes. Many of you would know of course that our first VC, Victoria Cross winner, was a doctor: then Lieutenant, later Major General Sir Neville Howse. He was in the Boer War in 1900 when he spotted the trumpeter of his unit being wounded, shot, so he rode his horse—those were the days—rode his horse through a hail of bullets. His horse got shot, but he managed to get to the wounded trumpeter. He dressed the man’s wounds. Because his horse was no longer there for transportation, he hoisted the wounded soldier over his back, took him back to safety and then operated on him for a perforated bladder. Not a bad day’s work.

Of course there’s more modern examples and you’ll see this in the exhibition. My colleague, then Captain Carol Vaughan-Evans in Rwanda, who with her medics and other health personnel were at the centre of the Kibeho internally displaced persons massacre in 1995. Carol was my next-door neighbour on that deployment, and I vividly remember her coming back after that experience and downloading. It was amazing bravery that our people showed, our health providers and also our other soldiers who were down there, as they worked out in the open, no cover, to save civilians, and a lot of them were women and children. And for her bravery and focusing on that humanitarian mission, she was awarded the Medal of Gallantry, but all of our people down there were incredibly brave.

Health personnel also are military leaders, not just leaders of health effects, but actually leaders of soldiers, sailors, and airmen. A great example of course is Edward ‘Weary’ Dunlop, who was a prisoner of war in World War Two as many of you will know, but he took over the command of a group of prisoners working on the infamous Burma-Thailand Railway. That was obviously a terrible period of time, over 2,700 people died, many others had ongoing problems, both physical and mental after that, but Weary’s men fared much better than most of the rest. His ingenuity and self-sacrifice saved lives. He didn’t have a lot of medicine, didn’t have much equipment, but he continually went in to bat, to get more supplies, to get more humane conditions for the men under his command.

Of course, many military health personnel have made the ultimate sacrifice while selflessly serving humanity. There’s no better example, the familiar tale, but I think it’s always worth remembering, of the twenty-two nurses who, after being reluctantly evacuated from Singapore, their ship was bombed and it sank in the Indonesian straits near Banka Island. They washed ashore on Radji Beach but instead of running for cover they stayed on the beach to tend to the wounded and then tried to surrender to the enemy. Unfortunately, the enemy didn’t accept their surrender, and they were ordered back into the sea as the Japanese raised their weapons. As they began their fateful walk their leader, Matron Irene Drummond, calmly said, ‘Chin up, girls, I’m proud of you all, and I love you all.’ And they were gunned down as they walked side by side into the surf. Vivian Bullwinkel, who many of you will know, survived, she was the only survivor of that, and she said that:

There were no protests, the Sisters died bravely, as they had served.

ADF personnel continue to risk their lives. An example on peacekeeping missions is Major Susan Phelps. She was an army doctor who actually joined up at about the same time I did. She was in the Western Sahara on a UN mission in 1993. She would fly out from her base to do clinics for both local people and also for the UN soldiers that were out there, but as she was going out there her aircraft crashed and killed everybody on board. She was the first Australian woman to die while serving overseas since the Second World War.

More recently, and personally for me, of course, we lost nine health personnel in the Shark 02 Sea King accident on the island of Nias in 2005, in Indonesia once again. Our people that were there of course rendering assistance after an earthquake, and three of these nine health personnel were Air Force members: Squadron Leader Paul McCarthy, a doctor; Flight Lieutenant Lynne Rowbottom, a nurse; and Sergeant Wendy Jones, who was a medical assistant. And these were my people, they were under my command. I had sent them into harm’s way and they didn’t come back. So, it’s very real, it’s still happening, we’re still putting people—medical practitioners are still heading out to danger.

The second contradiction, I guess, of military health, and this has been said to me sometimes quite vividly in the past, is how can you be a healer and a doctor and dedicated to look after people but be part of a war machine, an organisation that kills people and causes mass destruction? But of course, the reality is, in those sort of circumstances, our skills are needed more than anywhere else. You know, not only does this give us the satisfaction of helping individual people, but often it contributes to a greater good well beyond the actual battlefield itself. Because when war fighters use increasing technology and innovation to find better ways to get a strategic edge and sometimes to kill people, we are given more problems to solve on the battlefront from a medical point of view, and therefore we as medicos, as is nicely illustrated, have to find innovative ways to help people with limited resources very often. It’s innovation born from necessity as we say. How can we use these resources? How can I fix a piece of equipment where there’s a bit missing to make it work? And through these innovations we’ve actually produced a lot of medical advancements that we now take for granted in the civilian world.

There’s a long, long list, and I won’t go through it all you’ll be pleased to know, but it’s led to clinical, technical, organisational changes and in some ways a whole different way of doing medicine. Examples are in the trauma space, very obviously, trauma management, controlling haemorrhage, and also of course trauma surgery itself became a specialty out of the Vietnam War. Human-to-human blood transfusion first happened because of necessity in war. Surgical specialties like orthopaedics, neurosurgery and plastic surgery were greatly enhanced from World War One onwards, and particularly because of the horrific injuries that we saw as we developed more and more weapons of mass destruction, if you like. This was taken to a new level of course in World War Two, one of our Kiwi brethren, Archibald McIndoe, who had a Guinea Pig Club, and this was an RAF air crew who were burnt and otherwise severely injured while flying, and they volunteered to have experimental surgery done on them, which has then reaped benefits for mankind.

Of course we know, though, as many casualties sometimes occur from infectious disease as they do from actual bombs and bullets. A great example is malaria. It’s one disease, but it’s stopped the army on three occasions, in World War One, World War Two and Vietnam, and nearly did so in Timor as well. The advancements in terms of malaria prophylaxis and treatment have actually developed from that, and they’re benefits that have come from Western militaries, but actually benefit the Third World where most of the malaria still resides. We shouldn’t forget that a lot of this has actually come from our own people. The ADF Malaria and Infectious Disease Institute, as it’s now named, it was born out of war, but it still does work in islands around the Pacific to control malaria and understand how the disease is in that region. And of course, prevention of disease, things like better sanitation, preventative health, public health and of course more sanitised nursing techniques pioneered by Florence Nightingale.

The other area is pre-hospital care. We wouldn’t have ambulances today operating if we didn’t have to move casualties from the battlefield. We wouldn’t have paramedics, we wouldn’t have pre-hospital care, or it wouldn’t be as developed if it hadn’t been for the military, and of course aeromedical retrieval, which is an area that I am interested in being in the Air Force, it was pioneered in war and as airplanes got more advanced, as situations got more dire, so too that developed alongside of it. Particularly, another Australian example, World War Two, trying to evacuate soldiers across the mountains of PNG, being able to fly in there, evacuate them back to Port Moresby and then back to home made a huge difference in survival rates. Then of course the Korean War came along: helicopters. We’ve all watched M.A.S.H, we know what a big role helicopters played, and the role, particularly in a big country like Australia, in our rural and remote areas.

In more recent wars we’ve learnt a lot of other lessons, technology lessons, but also things like mental health. We’ve learnt a lot about the mental health burden that’s come from the long wars we’ve been involved in, including PTSD, and as a result we have developed mental health services, our ministers commonly say, really the best mental health services in Australia are in Defence. And that’s come out of war, and we’re now sharing that with first responder communities. Rehabilitation is another example of that, and there’s some good examples in the exhibition where you’ll see some of the innovative rehabilitation that’s coming now, things like art for wounded veterans, or injured veterans. We’re also continuing to do technical innovation. We’ve just finished a project with the Australian Blood Service to develop better ways to freeze and transport blood. Now we’re now able to use this on operations, solving a lot of logistics issues, but there are a lot of opportunities to use that again in rural and remote Australia that could benefit a lot of people. We’re still seeing innovations in things like telehealth, telemedicine. That’s emerging out of the military requirements, and for example we’ve now done telepsychiatry, we’ve had a psychiatrist do consultations with people in the Middle East from back in Sydney. So, these developments are happening all the time.

Military medicine is important. There is a good reason why we as healers are in this organisation, and it’s all about doing good. It allows us to do good in an individual scale, as I said, or on a grand scale, sometimes with long-term effects, and that was well illustrated in our previous speaker. It’s the legacy we leave behind as well. I look back from our time in Rwanda and those terrible times, and I was down at Kibeho camp a couple of days after that massacre. It was a terrible time, but Rwanda now is thriving. It’s one of the most advanced countries in Africa, and so I saw they’re at the Commonwealth Games. I’m not quite sure how a Belgian colony is part of the Commonwealth Games, but they are, and they are thriving. And I look back and think, well we contributed to that. We have contributed to the greater good, and there’s no better feeling than that.

But of course the individual personal level is still important, and that is that we’re there when people need us most, in the most dire circumstances. We’re there to save lives, both of our troops and civilian populations, either in war or natural disasters, but sometimes it’s just about being there to hold the hand of a dying person. Or, you know one case I particularly remember, just giving someone a dignified death in a very tumultuous and chaotic situation. They’re the things t