frostfire is offline
Join Date: Nov 2004
Location: land of Airborne and Special Operations
Richard H. Carmona, M.D., M.P.H, FACS, R.N., SF Medic
For those who served in Vietnam, have you ever met him or worked with him?
Would you tell me more aout him?
He is a definite role model for anyone who's aspired to be involved both in SF and healthcare. I almost made my mind to fly to Arizona and interview him. We need to get him on this board since preparedness, especially for the mass-casualties terrorism type, was one of his focus when he served as the Surgeon General.
I've been reading everything I could find about this marvelous gentlement who came from a poor, homeless environment, highschool dropout, started off with the US Army Special Forces (two Purple Hearts and a Bronze Star), and all the way (surgeon, nurse, police officer, hospital CEO, swat medic) to US Surgeon General. Turned out an SF neighbor sparked that extraordinary journey when he told him to go back to school and later to join SF.
Here's one of his medical dealings with the Montagnards in Vietnam
I learned this lesson more than 30 years ago, as a young Special Forces medic in Vietnam. I was a medic and a weapons specialist on a 12-man A-Team.
I learned firsthand then that how I communicated with a patient and her family could have direct effects on their outcomes.
These lessons that I learned in a very remote area, working with the Montagnard villagers, were lessons I have never forgotten. Montagnards in Vietnam are more or less analogous to American Indians here hundreds of years ago. They are wonderful people of great character and dignity, and their language at that point was only spoken. The reality was that they had no context to understand some of the messages that we wanted to give them about health.
This A-Team that I was a part of had a wonderful relationship with the Montagnards, and at one point in time when we were standing down for a couple days from combat operations, we went into the Montagnard village and did what was called a MEDCAP.
This was very early in my career; I was just shy of my 20th birthday. By that point in my life, I had taken care of gunshot wounds already, I had taken care of parasitic diseases, I had set up a sanitation system for the village, and I didn't realize at the time how important those lessons would be to me years later. In fact, more important to me today than they were back then, because I now work with very diverse populations and the unique needs of those populations.
In any case, we went into the village to do a Medical Civil Action Program, what we called a MEDCAP. When you go into the village as Americans, you just want to run sick call.
You want to line everybody up and start diagnosing and treating their medical complaints.
Well, the Montagnard village leaders didn't want us meeting anybody or touching anybody until they knew who we were. So we had to sit for a while with the village chief and his family and get to know each other. We talked through an interpreter…the Montagnard interpreter. We had learned a little Montagnard, but not enough to fully converse.
The Montagnard interpreter would field questions from the village chief. The questions were largely, "Who are you?, Where are you from?, Are you married?, Do you have children?, What's your value system?" They wanted to know who we were.
Today, Americans are still on a fast track all the time. But that's not necessarily the best way to understand what is really happening with someone, within their culture. I sat down and learned that lesson. I had to share food with the village chief, which I did. To this day I'm not sure what I was eating, but I smiled.
And that wasn't all. We were in these thatched huts. They were on stilts, so that when the monsoons came, the water would run below and the houses wouldn't get washed away.
But underneath the chief's house; buried into the ground; connected with long, thin pieces of bamboo was this ceremonial wine that fermented through generation after generation.
So we sat in the middle of the house, and the bamboo straw came up, and we sat in a circle with the healer and the village chief, and we had to sip this stuff. Well, as soon as we smelled it, it was enough to just knock us out. And I wasn't a drinker. I had learned from my parents' bad habits, so I just pretended like I sipped it. And we sat there for what seemed like an extraordinarily long period of time drinking this stuff.
And when it was all over, the village healer started to bring some people in, because we had offered to look at them for conditions that the healer was not able to treat. And the first person who came up was the granddaughter of the village chief. I don't know how old she was, maybe 7 or 8. Mind you, in their language, they don't have words for time or days or years. It's sunrise, sundown. Passage of time is related to the crops and the cattle.
So when I saw her walking toward me, I thought, "I'm going to look brilliant." Her arm was covered with scabs, and I immediately recognized it as impetigo. Even as a 19yearold Special Forces medic, I was thinking that I was going to look pretty good with this diagnosis and treatment.
For those of you who have been around for a while and are practitioners, you remember that we used to have these big green buckets of Phisohex. They weighed about 10 pounds.
So I put some of this Phisohex in a bottle that the villagers had. They didn't have running water, so we said, "Go down to the river, wash with this, don't pick at the scabs, let them fall off. Oh, and by the way, take these."
Back in 1969/1970 we only had two antibiotics penicillin and streptomycin. So I gave them a little bottle of the PenVK and said, "Take one of these four times a day." There were 28 pills in the bottle, and I said, "I'll be back in a week or 10 days, and I'll check up on you when we come through the village."
So I went away, and then came back in about a week. We went through the whole ceremonial thing again with the food and wine and talking. Then the little girl was introduced as the first patient. She looked wonderful. The scabs were coming off her arm.
The village chief thanked me. They brought me some things. I got a Montagnard bracelet, a Montagnard ring, they gave me a crossbow, and made me an honorary member of the family. The village chief thanked me for all I was doing for his people. And then he showed me a little box and said, "And we thank you for this gift that you have given us."
He opened the box, and there was a necklace of 28 Pen VK pills.
Then the interpreter told me that now when people are ill, they wear the necklace so that it will ward of the disease.
The thing is that I thought I was a pretty good communicator. Obviously I wasn't, and I learned a lot that day. More than 30 years later I still think of that and what an invaluable lesson I leaned about never assuming that someone understands what you're talking about.
The Montagnard villagers had no idea what questions to ask me about the pills. This was the first time that they had ever seen a pill. To them, it looked like a bead. A medicine bead.
So they treated the vial of pills as a bottle of beads. And to take it four times a day, there was really nothing in the language to say that.
I wish I could have anticipated the misunderstanding. As a relative stranger to their culture and their way of life, I didn't even consider that the Montagnard people would see a pill as anything other than a pill.
"we also rejoice in our sufferings, because we know that suffering produces perseverance; perseverance, character; and character, hope" Rom. 5:3-4
"So we can suffer, and in suffering we know who we are" David Goggins
"Aide-toi, Dieu t'aidera " Jehanne, la Pucelle
Der, der Geld verliert, verliert einiges;
Der, der einen Freund verliert, verliert viel mehr;
Der, der das Vertrauen verliert, verliert alles.
Last edited by frostfire; 04-22-2007 at 00:37.