CHAPTER XI
Laboratory Support
Evolution of the System
The development of the medical laboratory system in Vietnam derived fromknowledge and experience from the Far East Medical Research Unit attached to the406th Medical General Laboratory in Japan, the U.S. Army Medical Research Unit(Malaya), the U.S. Component of the SEATO Medical Laboratory in Bangkok, and theField Medical Laboratory Project, USARMDC. The system was based on a concept ofthe laboratory as a component of medical service, with a specific function ofgenerating medical technical information for the purpose of patient care,disease prevention, advice to the command, and forensic activity.
The first medical laboratory unit in Vietnam, a mobile detachment of the406th Medical General Laboratory, began operations as laboratory augmentation ofthe 8th Field Hospital in Nha Trang in 1962.
In late 1965, the 528th and 946th Mobile Laboratories of the 9th MedicalLaboratory arrived in Vietnam and were placed under operational control of the406th Mobile Laboratory. These units were to support the 85th and 93d EvacuationHospitals. Within 6 months, the headquarters and base section of the 9th MedicalLaboratory arrived and assumed control over these units. In August 1967, the406th Mobile Laboratory was placed under operational control of the 9th MedicalLaboratory.
In January 1968, the 74th Medical Laboratory was activated and organized toreplace the 406th Medical Laboratory (Mobile) and was placed under operationalcontrol of the 9th Medical Laboratory. By September 1968, the 946th and 528thMedical Laboratories (Mobile) were inactivated and their personnel assigned tothe 9th Medical Laboratory. These two mobile laboratories, or mobile sections ofthe 9th Medical Laboratory, continued operations in Long Binh and Qui Nhon.
The 9th Medical Laboratory
From May to December 1966, the 9th Medical Laboratory was assigned to the44th Medical Brigade under the 1st Logistical Command. The equipment wasantique, and efforts to obtain new equipment and supplies were unrewarding.Building facilities, located 15 feet from a dirt
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highway, were inappropriate and inadequate. As a result, little productivework was accomplished considering the high potential of the personnel. InDecember 1966, the laboratory moved from the small dusty store to a newerbuilding, a Vietnamese constructed barracks. Although the building was larger,the site was less favorable.
In June 1967, authorities decided to construct new facilities for the centrallaboratories at Long Binh for the purpose of establishing more appropriatebuildings, bringing the 9th Medical Laboratory and the 20th Preventive MedicineUnit together for more co-ordinated function, bringing the 9th MedicalLaboratory in close support of major hospitals at Long Binh to free a mobilelaboratory for service elsewhere, and bringing the 9th Medical Laboratory inclose range of its supply and personnel support units. It was not until December1968, however, that the laboratory moved into its new fixed facilities, but notbefore it had been exposed to hostile fire and isolated twice earlier that year.
The 44th Medical Brigade was transferred from 1st Logistical Command to theSurgeon, USARV, in 1967. After this transfer, a set of equipment and supplies,developed by a USAMRDC contract, was ordered from manufacturers in sufficientquantities to provide for all medical laboratory services within the 44thMedical Brigade.
In his role as USARV pathology consultant, Colonel Baker recommendedassignments of all medical laboratory personnel within the 44th Medical Brigade,after their initial 2-week period of special training in the base laboratory inSaigon. (Chart 14)
Innovations
An innovation in staffing that produced outstanding results in 1968 was theassignment of an internist to the laboratory staff to head an infectiousdiseases department. In the 6-month period after the internist arrived, theoutput of diagnostic information in febrile cases more than doubled. In 1968,29,160 diagnostic serology procedures were performed.
Veterinary laboratory officers played an important role in Vietnam. Theytested ice for chlorination potability and developed serologic methods fordiagnosis of melioidosis, leptospirosis, scrub typhus, and murine typhus.
The thrust of medical zoology in the laboratory system was for qualitycontrol, mainly in laboratory diagnosis of malaria and amebiasis. The malariasmears reviewed by the laboratory increased each year, from 1965 to 1969, asfollows: 1965, 300; 1966, 1,199; 1967, 3,312; and 1968, 8,176. This review forquality of smear, staining, and identification of parasites was returned to eachunit submitting smears, so that any deficient technique could be recognized.Where needed, special visits by central laboratory personnel were made.Similarly, materials
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CHART 14-A FIELD MEDICAL LABORATORY SYSTEM IN VIETNAM
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Veterinary Food Inspector Checking Ice forChlorination and Potability, Long Binh, Vietnam
were provided to hospital laboratories to make trichrome stains of all stoolspecimens considered positive for amebic dysentery. Some specimens weresubmitted for review and diagnosis confirmed. The procedure for confirmation wascause for greater care on the part of technicians in field units.
Problems Surmounted
Under supervision of the base laboratory, advanced laboratory procedures wereestablished for hospitals carrying major surgical loads where advancedintensive postoperative care was practiced. Because hospital facilities werewidely scattered, with restricted land communication between them and a baselaboratory and with a strictly limited number of laboratory personnel available,it was imperative that the chemistry procedures provided be essential forclinical decisions and be performed competently in forward areas.
By late 1967, surgeons recognized that advanced laboratory methodologyprovided information on the condition of their patients which challenged theirknowledge and prior experience. Similarly, the opportunity for Army physiciansto establish definitive etiological diagnoses on
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eight febrile diseases, being encountered for the first time in theircareers, was not only a benefit to the patients but also a positive factor inprofessional morale.
The base laboratory maintained a courier system for specimens and reportsbetween dispensaries, some clearing companies, all hospitals, and the 9thMedical Laboratory. Despite its imperfections, the courier system operated byvirtue of the determination of the couriers. After 1968, couriers were helped inpart by access to the Otter aircraft assigned to the 44th Medical Brigade.
An automatic data processing system was established to retrieve diseaseinformation by place and time. By late 1968, weekly summaries of etiologicaldiagnostic findings in febrile disease were prepared by computer and distributedto all hospitals, preventive medicine units, and division surgeons. Thesummaries gave the patient's name, identification number, and unit, informationwhich was necessary since patients often remained only a short time infacilities where the working diagnosis and treatment were initiated. Routinelaboratory reports were often returned to the hospital after discharge ofpatients and went into their records without notice of the attending physician.The weekly summary was an attention-catching mechanism that allowed thephysicians to review cases with specific findings for educational benefits ondiseases occurring in Vietnam. This information served also for the purposes ofdisease prevention and advice for continuing military operations.
By 1968, the medical laboratory system had largely matured. It providedadvanced technology where it was needed with a limited number of skilled personsstrategically placed. Many persons with special skills were regularly calledupon to assist in solving unusual problems. Each area pathologist was eitherassigned to, or closely associated with, the 9th Medical Laboratory.
The greatest need for pathologists was in supervising clinical pathology, inmanaging the flow of work within the laboratory, and at times even inmaintaining advanced equipment. However, the most important role of thepathologist was in his relation with clinicians in understanding the nature ofillness and trauma and in assuring that the most appropriate specimens reachedthe laboratories. A pathologist in the base laboratory was assigned the task ofsupervising clinical pathology throughout the 44th Medical Brigade laboratoriesto assure standardization of methodology.
Anatomic pathology required fewer pathologists. The greatest and mostessential workload in anatomic pathology was the forensic cases. A largeworkload of interest to the pathologists was the surgical pathology on biopsiessubmitted by volunteer surgical teams working with the indigenous population.Since provision was made for frozen sections in
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the larger military hospitals, the processing of paraffin sections and theirreading was centralized in Saigon.
The medical laboratory service in Vietnam finally reached a high level ofquality service after several years. By 1970, as a result of co-ordinationbetween the medical laboratory system and preventive medicine, a level ofeffectiveness comparable to that in World War II had been achieved. The primaryfailure had been an inordinate delay in bringing about a close co-ordinationbetween the medical laboratory system and the preventive medicine units. Sinceboth activities were an integral part of the laboratory system, this had notbeen a problem in World War II.
