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A Scientific Visit to Hanoi
In June of this year I spent a week in North Vietnam where I met with North Vietnamese scientists and doctors and lectured on molecular biology. Like the other scientists 1,2 I know to have visited North Vietnam — a country that is startlingly poor by American standards and yet clean and healthy by any standards — I came away with the impression of a society in which a vigorous intellectual life outruns material capacities in a unique way. And, in the face of continuing military pressures, the Vietnamese scientists and medical people I met have a firm confidence in the importance of even fundamental research for building their future society.
I confess I traveled to Hanoi doubting the usefulness of just one or two lectures on molecular biology, a science whose discoveries are not related in any simple way to the practical problems facing an underdeveloped country, particularly a country at war. I shall not attempt to describe the physical damage there, except to quote Richard Gott’s summary 3 of his extensive survey published in the Guardian Weekly in February of this year:
Virtually all Vietnamese achievements since 1954 have been destroyed or rendered useless… the bombing of the North has done very great damage. Vietnam has not been bombed back into the Stone Age, but a promising underdeveloped country that was pushing its way through the middle of the nineteenth century has been forcibly smashed back into the eighteenth.
In fact, I found the Vietnamese to have a very lively interest in recent developments in basic science — even in molecular biology — and I was impressed by their serious efforts to develop their educational and medical programs. In attempting to convey this I should emphasize that my most vivid impressions are from direct conversations with the Vietnamese.
On a Wednesday morning at 7:30, I began a lecture to about a hundred Vietnamese students and professors in a bare room with a scratchy blackboard. My translator and I moved about a large wooden platform at the head of the room as we spoke. A microphone had been placed on the lectern, but neither of us used it. On our left, in the open doors, people who I later learned take care of the building watched, and on our right, below the open windows, oxcarts and bicycles moved by quietly. For the first few hours I reviewed a few of the basic aspects of molecular biology and described in some detail the repressor theory of Jacob and Monod. After outlining for them my own experiments, including the principal results, I paused before continuing with more recent developments in the field. At this point there was a barrage of questions. Mrs. An said:
“We are sorry, but we do not understand. You must tell us the precise logic you used in isolating the repressor.” From another member of the audience:
“Please tell us why you succeeded where others had failed. Explain to us what were the scientific and historical factors which led you to choose one alternative over the other at each stage.”
Still another questioner:
”What did it feel like to make this scientific discovery, what precisely was that experience?”
A moment earlier I had told them that the detailed methods we had used to isolate the repressors were primarily of historical interest because there now are easier ways of doing these things and besides, I had said, a detailed understanding of those methods is not absolutely necessary to understanding the overall results. They had already been listening for two hours, and I assumed they would only be bored by what seemed to me would be excessive detail. But now they were insisting that I supply them with precisely the details I had offered to omit. Moreover, they were probing for an understanding of one scientist’s view of the very enterprise of doing science. And so, for the next hour or so I described our experiments step-by-step, telling them what had been hard and what had been easy.
The questions they asked me that Wednesday afternoon initiated a conversation which continued through the early evening (eleven hours in all) and into two more sessions of several hours each. Several of the Vietnamese wanted to compare the results I had described with what they had heard elsewhere. For example, I was questioned about the work on histones of James Bonner (California); the suggestion of Eugene Bell (Massachusetts) that DNA fragments carry information to the cytoplasm; the arguments of Henry Harris (England) that gene control is effected in the cytoplasm; and the findings of a Hungarian horticulturist which they described to me. One Vietnamese wanted to know whether we may, with certainty, apply the results of experiments with bacteria to understanding the biochemistry of higher organisms, and another offered the argument that certain problems might be studied only in higher organisms. One of the biochemists had just heard on the BBC that Gobind Khorana, now in America, had synthesized a gene, and he wanted to know which gene, and what was the significance of that feat. One of the younger scientists, whom the others referred to as “our futurologist” made several guesses about possible developments in biology by the year 2000, and we discussed for a while their possible applications to man. I was asked about Barry Commoner’s arguments concerning DNA and information transfer, and about a description of S-RNA tertiary structure one of them had read in a Cold Spring Harbor Symposium volume.
The Vietnamese were also interested in the organization of American science. They asked for a description of the role of the Department Chairman in American universities, and inquired whether I thought that structure was the best arrangement. Someone asked whether there was a consensus on the question of the role of competition in science, and whether science is best done individually or in groups, cooperatively. My impression was that they were trying to plan their own scientific future, and they themselves did not have any set answers to any of these questions.
I had anticipated speaking to an interpreter who I imagined would translate line-for-line. However, rather than translating verbatim Mr. Dang Vien Thien listened to what I said, digested it, and then gave the lecture over again to the audience. Occassionally [sic] he would hesitate, ask me rapid questions to check his understanding, and then proceed. During discussion of my own work he sometimes anticipated my words, cut me off, and finished sentences himself. Mr. Thien, age thirty-five, was trained in Hanoi as a mechanical engineer and now works in the Science and Technology Information Department reading foreign engineering journals and then writing periodic reports, in Vietnamese, for technical workers. I asked Mr. Thien where he acquired the background in my field, totally unrelated to his, which enabled him to so readily understand what I was saying. His response: “I read.” One of the things he had just read was a Scientific American article on repressors which I had brought to Hanoi a few days before. The few Western scientific journals which the Vietnamese receive by mail usually arrive six months to a year late.
Throughout the conversations I was struck by the easy way questions and comments arose from among the eldest and youngest present, without a hint of embarrassment or intimidation. Apparently, my Vietnamese “class” was not wholly atypical — I visited a night school class in elementary physics for factory workers and watched as the audience readily offered answers and questions for the teacher, a woman, who I guessed was about thirty-five.
While I was lecturing on molecular biology one of my traveling companions, Dr. Bert Pfeiffer, a zoologist from Montana was meeting with another group of about 100 Vietnamese professors and students. He discussed some ecological effects of modem technology and chemical defoliation in South Vietnam. On another occasion he met with several Vietnamese doctors to tell them about modern techniques for defibrilation and for the use of artificial cardiac pacemakers. He learned that they were already completely conversant with these techniques and are in fact planning to begin this kind of work soon. He was told there is one defibrilation machine in Hanoi.
The night school class I visited is part of a supplementary education program which reportedly enrolls over a million people in North Vietnam. (The total population of North Vietnam is about 17 million.) These classes, which meet for 2 ½ hours twice a week provide education for those who entered the work force before completing secondary education. Upon completion of the course about half of those enrolled in the final year pass a national exam and enter a higher technical correspondence school.
The more typical primary and secondary education course begins at age seven and lasts in principle 10 years. As of now, the first degree, which lasts four years, is mandatory, and by 1972 the second degree, lasting another three years, will also be required. There are in addition 28 special secondary schools, one in each province, which teach advanced classes, particularly in mathematics. In 1967-68 there were reportedly 4 over three and a half million pupils enrolled in the primary and secondary schools.
There are 33 institutions of higher education in North Vietnam: the University of Hanoi, which enrolls about 5000 students, and 32 branches of the Polytechnical Institute scattered about the country, which in 1967-68 enrolled 62,000 pupils. Admission to one of these universities requires in part passing the baccalaureat,[sic] given throughout the country on the same day each year, a schedule which was reportedly maintained throughout the bombing of North Vietnam. There is only one baccalaureat for science and non-science students.
A few hundred Vietnamese students study abroad, mainly in China, Russia, and the Socialist countries of Eastern Europe. However, all teaching in the schools, universities, and medical schools is done by Vietnamese. Their textbooks are periodically rewritten in Vietnamese by professors who read what they can and select materials of interest to them. So far as I can tell, these are not merely expedients to solve the language problem — many students read scientific English and Russian, and in the physics class I referred to earlier, every word on the board was written in Vietnamese, English and Russian.
The French mathematician Laurent Schwartz recently studied North Vietnamese education in some detail, and concluded that the number of young Vietnamese graduating secondary school students who possess “good scientific training” is annually almost equal to the number produced at the corresponding stage in France 5. The magnitude of this achievement is partially revealed by these facts: in 1939-40 there were in all of Indo-China only 400,000 primary and secondary students and 630 graduate students, and at the end of French colonialism in 1945, 95% of the country was illiterate. 6 I visited one of Hanoi’s hospitals, the Viet-Duc. The equipment I saw there is gathered from many countries: a pH meter from Hungary, a balance from Germany, an electroencephalograph from Russia, a heart pump from America courtesy of the American Friends Service Committee. Although I was told the hospital had been equipped since 1954 mainly with German aid, I saw no foreign doctors, and I was told there have been none stationed there nor anywhere else in North Vietnam for over ten years. This is an example of what appears to be a general policy of the Vietnamese — what foreign aid they receive, in the civilian sphere at any rate, they control themselves. To me one of the most striking aspects of Hanoi, in strong contrast to other Asian cities I have seen, is the virtual absence of visible foreign influence there.
The hospital has 300 beds, immaculately attended by what appeared to be a large staff of doctors and nurses. The hospital specialized in surgery, including brain and heart surgery, with special attention given to tropical diseases of the stomach and liver. I looked in on an operation in progress, and in the basement I saw a research team performing experimental heart surgery on dogs using a manually operated lung pump.
The director of the hospital, Dr. Nguyen Trinh Co, who is also Vice Director of Hanoi Medical College, told me that there are four medical schools in North Vietnam, one in Hanoi, which graduate about 500 doctors a year. The course lasts six years following secondary school, and some students go abroad for advanced training. Dr. Co asked me for more information about the curriculum reform he heard had been instituted at Harvard Medical School.
Both at the hospital and at the Health Ministry the Vietnamese talked at length about their program to attack the health problems which faced the revolutionary government, problems greatly exacerbated the war. An early explicit decision was made to reject option of inviting friendly foreign governments to build modem hospitals where foreign specialists would practice and teach. Instead they concentrated on building a public health program, combining hygiene (sinking wells, sanitary latrines, persuading people to drink only with innoculations on a massive scale, sometimes using vaccines developed in North Vietnam. I was told the entire population is regularly vaccinated cholera, tetanus, typhoid, and tuberculosis. For TB innoculations [sic] the Vietnamese claim to have developed an effective dead strain of BCG which is easier to transport without refrigeration than is the live strain. Children are innoculated [sic] against small-pox and polio, using for the latter a modified Sabin vaccine which the Vietnamese claim is stable for a month without refrigeration. In addition to these preventive measures, dispensaries have been established in the villages and cooperatives, and there is reportedly at least one hospital staffed by physicians in every district. Many of these hospitals were destroyed by bombing raids and now exist underground. During the bombings the Vietnamese claim deaths were minimized by massive evacuations of the cities, efficient use of air-raid shelters, and rapid on-the-spot treatment — only the most gravely wounded were transported to the better equipped centers.
Throughout North Vietnam fractures are set with light splints of bamboo using a method apparently similar to that employed in China. 7 The Vietnamese also grow and use on a large scale suspensions of the bacterium Bacillus subtilis, which they claim helps prevent intestinal infections and is an excellent healer of burns and wounds.
The Vietnamese reject “academic” procedures which restrict the practice of medicine to specialists with several years’ training in medical schools. Instead, the country is covered by a network of assistant-physicians, midwives, nurses and sanitary officers. After a few years of experience, some of these sanitary officers become midwives or nurses, and with more experience, some of these ultimately become assistant-physicians. The exigencies of war demanded a large number of surgeons, and so all doctors are trained as surgeons. Even the para-medical people are often equipped to do certain types of simple surgery — for example, I was told that several thousand village workers can now perform the operation necessary to cure entro-pin, a frequent complication of trachoma
The North Vietnamese claim to have essentially eliminated the major diseases which ravage the peoples of Asia — typhus, typhoid, cholera, tuberculosis, smallpox, polio, dysentery — and to have lowered the infantile mortality rate to a level comparable to that in America. I cannot verify these claims, but the general health of the people of North Vietnam contrasts sharply with that of the residents of Vientiane or Saigon.
The Vietnamese anticipate that a major post-war medical problem will be treatment of various war-induced psychiatric disorders. They feel that the collective moral discipline engendered by direct participation in the war helps their people to avoid the anguish that will surface when the war ends. A second major problem will be treatment of those disfigured by napalm and by pellets from anti-personnel bombs. There are plans to establish a plastic-surgery center in every province and, I was told it is not impossible that they will ask for limited aid from specialists at that time.
The man most responsible for developing the health program of North Vietnam is Dr. Pham Ngoc Thach, 8 Minister of Health from 1958 until his death in 1968. In an interview 9 published in 1967, Dr. Thach described some of the obstacles to instituting these medical practices:
We have navigated against the stream in many respects. To make physicians trained in the old faculties leave their consulting rooms or hospitals and become interested in digging wells and installation of septic tanks, in a word, in the prevention of diseases, is contrary to their deep-rooted habits. Even a medical nurse of the old school would prefer giving an injection and dislike going to verify whether a septic tank is adequately built or not. To make an injection of antibiotic which cures almost miraculously is a gesture much more captivating than to lift up the lid of a septic tank. To practice complicated surgical operations with costly ultra-modern apparatus imported from abroad gives more prestige than to lecture on hygiene in villages, or to help village cadres complete their medical education. To have toiled many long years in the faculties and now to believe that medical art can be put into the hands of the masses is not any easy matter either.
Visiting the Oriental Medicine Institute in Hanoi one afternoon, I saw that the North Vietnamese take very seriously their accumulated knowledge of traditional medicine — the treatment of various ailments with vegetal extracts and acupuncture. Here the Vietnamese are gathering traditional formulae — cures for dysentery, rheumatism, arthritis, headache, shock, bone fractures — which have been passed on through the years by word-of-mouth and in books. The workers at the institute are analyzing these traditional remedies to determine which are most useful and, if possible, how they work in physiological terms. In the meantime, throughout North Vietnam, thousands of practitioners of the ancient art are working alongside Western-type doctors, learning modern methods as they practice and teach old ones.
The Vietnamese continually emphasized their view that, subject to their severe material limitations, the practices of traditional medicine should provide a strong impetus for research in North Vietnam. And, they said, research is necessary for maintaining and improving the quality of their education and for enabling them to continue to adapt to new requirements. Although the Vietnamese have a strong interest in learning about basic research done elsewhere, their own research, according to Dr. Thach,  will be tied to practical problems:
No doubt, a poor, industrially underdeveloped country has not the means that more highly developed countries possess, but shall we fold our arms in the domain of research? On the contrary, the less means a country has, the more it must develop technical and scientific research, so as to find out processes and methods appropriate to its national conditions. If we conceive research work as it is done in other places, if we only repeat and verify the works of scientists of other countries, we can only feel depressed by our powerlessness. We must carefully study what other people have done, strive to get the latest scientific knowledge, but we must also blaze our own trail. Only by boldly taking up practical problems of our country and endeavoring to solve them, can we make our work fruitful.
At the end of the long Wednesday I spent discussing molecular biology, and more generally, how they were able to discuss and learn about abstract intellectual matters in the midst of war. I thought of America: fewer students are going into science, those who do are often plagued by misgivings, and it is not uncommon to hear young scientists complain that they find it increasingly difficult, for reasons sometimes specified and sometimes vague, to continue doing science in our society.
Dr. Nguyen Tan gi Trong, a professor of biochemistry at Hanoi Medical School rose and answered my question. He said that despite the war’s destruction the Vietnamese are building a society and planning for the future which, he thought, requires knowing all these things.
- Chomsky, N., New York Review of Books,15,16, 1970.
- Schwartz, L., unpublished report
- Gott, R., Guardian Weekly, 102, number 9, Feb. 26, 1970.
- Some of these figures are taken from reference 2
- Schwartz, L., unpublished report.
- Schwartz, L., unpublished report.
- Penfield, W., Science, 141, 1153, 1963.
- Dr. Laurent Schwartz knew Dr. Thach and described him as “one of the most remarkable men I ever met.”  Le Monde, Nov. 25, 1967, gives this biography of Dr. Thach:
After having completed his medical studies in Hanoi, then in Paris, where he specialized in phthisiology (study of tuberculosis), Dr. Pham Ngoc Thach, a native of the Mekong Delta region (South Vietnam), settled in 1936 in Saigon where he practiced general medicine and phthisiology until 1945. Very early a member of the Communist party, he was one of the founders of the Vietminh in the South and directed the “resistance against the return o f the French expeditionary corps in Saigon, in September, 1945.
Transferred shortly afterward to the North, he formed a close relationship with Ho Chi Minh and became his personal physician. Prime Minister of Health of the Provisional government, in 1945, he was later Secretary General to the Presidential Council and carried out, between 1945 and 1954, numerous missions which took him from North to South and from South to North. In 1954, he returned permanently to the North and became Minister of Health in 1958.
- Is North Vietnamese Medicine Facing the Trials of War, Vietnamese Studies, Hanoi, 1970.