History

CHAPTER 9

Conclusion

An Army medical role in disaster relief emerged from a particular historical context. It followed three developments: the rise of an urban, interdependent nation in which traditional local sources of assistance were sometimes insufficient; the acceptance by the federal government of responsibility to augment those sources when necessary; and the development of the medical knowledge and skills to render effective care. Even then, Americans preferred to leave health care to the private sector and disaster relief to local and voluntary agencies, so Army medical participation was always limited to instances when "the overruling demands of humanity" required it. When a network, of voluntary, municipal, state, and federal agencies which furnished and coordinated disaster assistance matured after 1950, such occasions occurred less frequently and the Army further reduced its efforts. It did not end them, however, for a few disasters overwhelmed established relief institutions and prompted Army aid.

Though the Army assumed a medical role partly by default and reduced its involvement when other relief agencies were created, its participation proved beneficial to civilians and soldiers alike. In the first years of the twentieth century, Reed, Gorgas, and other military surgeons were among the most talented health care professionals in the country. Employing and expanding the latest medical discoveries and techniques, they saved lives in Cuba, the Philippines, and several domestic disasters. As medical practice advanced, their less-heralded successors rendered valuable assistance in many later crises. The history of their efforts revealed the ability of Army medical personnel to furnish `rapid and effective aid to civilians in emergencies.

This history also suggested that the Army itself benefited from disaster relief operations. Civilian emergencies provided more realistic experience in the care of mass casualties than most training exercises, and participating units learned a great deal about operating in an environment that resembled combat. Moreover, the personnel felt a sense of accomplishment that came from helping people in need and using the skills they had worked to develop. Successful disaster relief missions, in sum, improved technical

175

skills while they increased morale and esprit. They thereby strengthened the Army Medical Department as well as aided civilians.

Not every Army medical relief operation was totally successful, and all of them encountered various difficulties. Failures in planning and execution plagued many missions. Not until the 1960`s did the Army send survey teams to estimate the medical needs in a stricken area, and even in the 1970`s a few critics contended the teams did not accurately assess the medical situation. On a few occasions, the wrong kind of health care facility was dispatched. In other instances, medical units arrived at the site with inappropriate personnel or insufficient equipment for the types of casualties they encountered. Other minor problems sometimes hindered operations: sloppy packing or unloading of equipment, poor coordination between hospital and professional staffs unused to working together, minor maintenance failures, to name a few. Such failings could have occurred in any mission.

Problems also arose out of the special character of disaster assistance missions. Relations between the military unit and host community sometimes generated difficulties. Medical personnel in domestic disaster missions had to be careful not to provoke civilian hostility. After the San Francisco earthquake, for example, civil-military tensions developed because some residents resented what they considered arbitrary military intrusion into their affairs. The Army had to respect their feelings but could not totally give way to their complaints. Medical officers had to maintain strict sanitary measures even if a few San Franciscans objected. Wisely, the relief force also moved to reduce tensions by first restricting and then quickly withdrawing its services. On other occasions, officials were too solicitous of civilian attitudes. During Mississippi flood relief in the decades around 1900, Army officials may have too readily accommodated their plans to the white racial attitudes prevailing in the delta.

Relations with civilians, especially knowing when to conform to and when to confront their cultural attitudes, became more troublesome, in operations abroad. In Cuba and the Philippines after the Spanish-American War, and in other missions as well, American medical personnel were not always sufficiently responsive to local beliefs and practices. Their insensitivity sometimes undermined medical goals, though they rightly felt they could not abandon basic principles of scientific medicine. Military doctors had to respect the local culture, abide by its practices when possible, but still provide modern health care. Theirs was not an easy task.

In addition to the potential conflict between local custom and modern medicine, political differences sometimes complicated relations with foreign civilians. In all relief operations abroad, participants found they

176

served as diplomats as well as doctors. In a few- those in Japan in 1923, Chile and Yugoslavia in the 1960`s- Army medical personnel encountered extremely tense political situations. Commanders exercised strict control during these and other operations, and their units proved successful ambassadors. In, fact, medical personnel appeared to cope with political tensions better than with the more insidious cultural conflicts.

Operational difficulties and civil-military tensions were present throughout the history of Army medical aid. A third problem developed only after the establishment of a disaster bureaucracy. In the late nineteenth century there had been too little assistance, but by the mid-twentieth century, there was sometimes too much aid from too many groups. An abundance of help but a dearth of coordination complicated a few domestic missions during the interwar years and a number of foreign operations after World War II. Working as part of an increasingly bureaucratized system of relief, medical personnel could do little to eliminate the inefficiencies, since responsibility for planning and coordinating relief resided with civilian agencies. But they had to be aware of the difficulties and dangers involved.

Though all three types of problems bedeviled assistance operations they never overshadowed the success of Army medical relief. Army medical personnel employed their special talents and resources to succor countless victims of nature`s wrath who might not otherwise have received help. Though the historical conditions changed and the phase of extensive Army Medical Department assistance quickly passed, emergencies continued to arise that necessitated use of its expertise and manpower. The people it aided on those occasions probably cared little about operational difficulties, civil-military tensions, or the complications of the relief bureaucracy. Their personal suffering was eased, and that was enough.