Old Asia Hands : May 2013

A preview chapter of my forthcoming book

The Mekong Delta family of Vo Van Trac says his mental and physical deformities are the result of exposure to Agent Orange. He howls like an animal and has only left home once in 26 years. Vo and his parents all have tested for high levels of dioxin. (Fredericksen, 1994)

“Planes would first come and bomb the area to scatter the guerillas, followed by the spray planes. We didn’t pay much attention but some villagers vomited and were bothered with bloodshot eyes. If you had a plastic bag, you could put it over your head. You could shampoo your hair with beer, or urine would also neutralize the chemical. At night you could hear the trees falling.” Dang Suong

One of the most complicated and tragic ironies of the Vietnam War was the use of a chemical cocktail with the sinister sounding name of Agent Orange. This was no breakfast drink chocked full of Vitamin-C. It was a liquid defoliant spiked with the cancer-causing compound dioxin. According the Veterans Administration, from 1962 to 1971, 19-million gallons of herbicides were applied across South Vietnam. Agent Orange was the most common blend of the plant killers, sprayed by air or by ground troops. Dr. Arnold Schecter, a professor of Preventive Medicine for State University of New York, and a dioxin authority, thought there were possibly millions of Vietnamese suffering serious health problems. There were very real concerns that traces of the chemical had entered the gene pool and birth defects could be passed down to future generations.

The strategy behind using Agent Orange made sense. Deprive the enemy of hiding places by applying the toxic mix to trees and underbrush. The leaves would drop and communist hiding places and infiltration routes would be exposed. Allied and Vietnamese lives would be saved by making the Viet Cong and North Vietnamese work harder to secretly move men, provisions and munitions. Agent Orange was extraordinarily efficient. It performed as advertised, and then some. The post-war years coughed up the human cost of Agent Orange, hundreds of thousands of civilians and soldiers, on both sides of the conflict, suspected that exposure to the defoliant was making them very ill. For American vets, troubling questions were raised to the Veterans Administration, but many of the important answers remained in Vietnam, where the population is as paranoid of Agent Orange as Japanese were of nuclear fallout.

A wartime photo of roadside defoliation that has killed trees and shrubs near Nha Trang. (Fredericksen, 1970)

By the 1990s, the intense interest in Agent Orange’s lingering impact had shifted to the civilian toll in Vietnam. One study purported to show that people who lived in South Vietnam, where the chemicals were sprayed, had the highest dioxin levels in the world. In contrast, the population living in North Vietnam, where Agent Orange was not used, had some of the lowest dioxin levels in the world. There were hearings in Congress, journalistic exposé’s, academic and health studies, and industry inquiries. In 1994, America’s most respected network investigative unit was preparing its examine the controversy for CBS News. 60 Minutes, with reporter Ed Bradley, was planning to accompany Elmo Zumwalt to Vietnam. He’s the retired Admiral who ordered the spraying, and whose son died of cancer that may have been caused by Agent Orange exposure. Zumwalt also thought it was the cause of brain damage to his grandson. The retired Admiral would be traveling with the prominent American scientist Arnold Schecter. The show’s “Blue sheet,” which is a one-page prospectus, was a shocking summary. “Imagine an area where the infant mortality rate is about 5 times the national average, birth defects are 6 times higher…and in the last few years, 16 sets of Siamese twins have been born.” It was sure to be a high-impact, emotional story. 60 Minutes came to me to help set up what would be a difficult journey into some of Vietnam’s near-inaccessible topography.

I recommended to the producers that I go in solo first, to advance the trip. My plan was to penetrate deep into the countryside where Agent Orange had been widely used, seek out witnesses who remember the spraying, find patients with suspected dioxin-related maladies, visit hospitals, photograph birth defects and identify English-speaking experts who might be interviewed. It was always a luxury to work with the documentary units, because they had no daily deadlines to meet. So I was elated to join the production, but also apprehensive about the evidence, and alleged victims, I was about to encounter.

Millions of people transited through, lived in, or nearby, the mangrove forests, jungles and wooded areas that were saturated with Agent Orange during the war. Low-flying planes were deployed to carpet-spray targeted areas. During my final weeks in Vietnam as a Marine, early in 1970, I served on a mountain island that had been made safer through defoliation. The coastal areas of Hon Tre Island, in the Bay of Nha Trang, had been cleared of dense foliage. Also, the trees and brush along the main road had been killed, to reduce the chance of an ambush on vehicular traffic. At my unit on the summit of Hon Tre, the American Forces Vietnam Network, it was common knowledge that Agent Orange was a weapon used against the enemy. When an odd chemical smell was noticed as a group of us emerged from the mess hall one day, these were the comments, “What stinks?” asked one of my colleagues. Someone blurted out, “Agent Orange.” We just assumed it to be true. But it wasn’t controversial at that time, and we understood it was a tactic that worked to our advantage.

The use of herbicides was considered just as important as a good perimeter, with barbed wire, lights and night patrols.
U.S. military unit on Hon Tre Island, Vietnam. (Fredericksen, 1970)

The ground war was concentrated across South Vietnam, so that’s where the spraying was focused. For the civilians who lived in these areas, their biggest concerns were surviving day-to-day combat, Viet Cong retribution and bombing raids. Agent Orange did not present an immediate danger and was something they could deal with. Most Americans served just one year and went home. But long term, the local Vietnamese were easily the demographic most at-risk. They were permanent residents; many had sustained repeated applications and were still there, more than 20 years later. Some villages that relied on farming had to be evacuated because nothing would grow. When the war ended, the hardest hit areas were re-populated as the landscape recovered and plant life could survive again. Gradually, by the mid 90s, there was a feeling that we could learn a lot about the Agent Orange menace from research inside Vietnam, which could serve as a living laboratory. New findings could be incorporated into updated diagnosis and treatment, for patients in both Vietnam and the United States.

Bien Hoa Airbase and Da Nang were ground zero for American handlers of the herbicide. It came in 55-gallon drums and was labeled with an orange stripe. The men who processed the material, conducted ground spraying, or loaded planes for aerial spraying, were at the highest risk of contracting complications, along with anyone underneath the dioxin mist as it settled over the entire landscape, like a light rain. Veteran Dave Trotter said, “I would sit high on a hill, it was so beautiful, there were so many colors of green.” He told The Nation in 1993, “The planes would circle back and forth, spraying the troops, the foliage, the water supply, everything…within 48-hours it would look like a wasteland.”

In July of ’94, I departed on my final major assignment for 60 Minutes, with $2,500 cash for expenses. I was not a reporter this time, rather a researcher, and traveled with the most basic gear: a notebook and a still-camera. Two weeks later, I submitted my findings, describing the miserable places I’d been, along with the most pathetic and hideous photographs I’ve ever had to take. A summery of my report follows.

An overflowing wing of women with gestational diseases at Tu Du Hospital, a key facility for treatment of suspected Agent Orange-related conditions. "A miscarriage, still birth or birth defect almost every day," according to the hospital director. (Fredericksen, 1994)

A medical student who worked her way up to director of Tu Du Hospital in Ho Chi Minh City. Dr. Nguyen Thi Ngoc Phuong was here before, during, and after the war years of heavy herbicidal application over South Vietnam.
(Fredericksen, 1994)

Tu Du Obstetrical and Gynecological Hospital

Dr. Nguyen Thi Ngoc Phuong, dressed in a clinical white coat, was the hospital director and served as my guide. She has seen it all, since arriving as a medical student in 1962, long before Agent Orange was introduced into the environment. Dr. Phuong took me along the external hallways, which are open to the outside. Walking past a darkened corridor of the hospital, three young women in hospital gowns peek at me from the door to their room. They smile and I snap their picture. “They are waiting for abortions,” Dr. Phuong says, along with 72 other women. The ward is over-capacity, for patients with Molar pregnancy complications, including cases involving tumors growing inside the womb. Some of these problem conditions result in placental cell cancers. According to Dr. Phuong, Vietnam’s rate of Choriocarcinoma, “is the highest in the world.” She told me there are birth defects and stillbirths almost every day at Tu Du. For 1993; there were nearly a thousand.

The "Collection Room" at Tu Du Hospital has dozens of horrifying specimens in sample jars that line the walls, including Siamese twins/triplets. "We had to stop collecting them...just cannot hold them all." (Fredericksen, 1994)

Collection Room

Tu Du’s Collection Room is a chamber of horrors. Wall-to-wall shelves with formaldehyde jars containing specimens of dreadful birth defects. There were Siamese twins and at least one case of conjoined triplets. The hospital director said Tu Du averages about 10 Siamese twins per year, but they almost always die, hours or days after birth. Five twins had been separated in recent years, two died, two live outside of Saigon, and one set remains at Tu Du. In my report, I questioned if showing the Collection Room might be too graphic for our television audience. It’s a terrible thing to say, but the assemblage of preserved fetus jars could accurately be described as monsters. Had they survived, life would have been unbearable. One sample appeared more alien than human, with extra arms and legs hanging from the chest and a grotesque square jaw, like a heavyweight boxer’s chin, attached to an infant’s face. Another container was almost too difficult to look at, multiple heads fused together in an oversized mass, with one squeezed face looking back at me. An official said they had to stop collecting the malformations 3 years earlier, because they simply couldn’t store them all. Two jars were on loan to the “War Crimes Museum” in Saigon, which is open to the public and tells the Agent Orange story from the communist perspective.

Viet (in bed) is a Siamese twin, separated from his brother, Duc, in 1988. Viet came out on the losing end; he is described as being in a "vegetative" state. His mother worked in farm fields sprayed by Agent Orange. (Fredericksen, 1994)

Duc (right) is the Siamese twin of Viet. They live in Peace Village at Tu Du Hospital. He wanted to become a doctor when I met him in 1994. (Fredericksen, 1994)

Peace Village

Located on the second floor of the hospital is Peace Village. It is one of four branches in southern Vietnam, funded by Peace Village International of Germany. This wonderful charity provides residential care is for severely handicapped children up to the age of 15. Some of the deformities were linked to Agent Orange and some were not. I saw many of the 36 kids who were staying at the Saigon village, and most of them behaved as typical children. They were either without arms, legs, had twisted limbs, wore braces or were confined to a wheel chair, but still smiling, goofing off and doing the best they could. The non-profit organization had taken 10 groups of kids to Germany for specialized care. This is where I met two celebrated 13-year old brothers, Duc and Viet, Siamese twins who were successfully separated. Duc lost a leg in the surgery but was bright, energetic and attended sixth grade at an outside school. He wanted to become a doctor. Duc’s brother was a sad contrast, described as a “vegetable.” The bed-ridden teenager was conscious but didn’t understand anything or recognize anyone. His only leg extends out from his body at a 90-degree angle. The boys’ mother works in the hospital laundry and flatly says Agent Orange is responsible. She was pregnant and worked in the fields of Kontum Province that had been sprayed. She tested positive for dioxin in fatty tissue.

Phuc, abandoned, but not forgotten, is loved at Peace Village. (Fredericksen, 1994)

I photographed a cute little 4-year old boy named Phuc, scooting around on his stubby legs in a special chair on wheels. His calves never developed, he has only one arm and no tongue, but was scheduled for treatment in Germany. Phuc was abandoned by his parents from Tay Ninh, not far from the Ho Chi Minh Trail, and one of the top 3 Agent Orange provinces.

Dr. Dang Suong, Health Director of Ben Tre Province (center), was directly sprayed with defoliants and said he "could hear the trees dropping at night." (Fredericksen, 1994)

Ben Tre Province

One of my target families resided deep into Ben Tre Province, at a tranquil hamlet in the Mekong Delta that was ground zero for multiple aerosol applications. The safari-like adventure got slower by the mile: leaving Saigon by car, catching a ferry to Ben Tre, a small taxi boat down progressively tapering waterways, and finally an hour by foot along a muddy trail. Dr. Dang Suong, the gray-haired provincial Health Director, gave me historic eyewitness accounts as we approached Thuan Dien Village. He was a military doctor during the war and was sprayed directly. Dr. Suong understood why the Americans defoliated the province. It was strategically important, and the VC would plan and launch attacks from the jungles. “After the initial bombing, the guerillas would come out and shoot, as planes applied Agent Orange. One was shot down in this area.” An odd thing that Suong remembered was what the chemical spray did to bananas. “They would swell up the size of your arm,” he told me, while gripping his forearm. The villagers were thankful and happily ate them. While the Health Director was not angry with the U.S., he did feel that America should provide help on the Agent Orange issue.

The home and family of Vo Van Trac (see first photo at top) in Ben Tre Province. I was told that some families let their deformed children die. (Fredericksen, 1994)

We approached a simple open-air home, and were greeted by the family and neighbors of Vo Van Trac. He was vocalizing in a howling, animal-like sound while lying on a bamboo bed in the house he was born in 26 years earlier. He hadn’t left except for a 2-week trip for medical care. There is no electricity, chickens run about and the young man simply urinates through the bamboo slats onto the ground below. And this, we are told, is a “well to do family.” During my visit, Vo had a seizure and arched his back so severely that I worried bones could be fractured. His physical and mental illness was attributed to dioxin, a by-product pollutant in the defoliant that was applied repeatedly between 1968 until 1972. Vo was born in 1969. Blood tests on the family show high dioxin levels in Vo and his parents, but his siblings, born before and after the Agent Orange era, are normal. Vo’s mother and grandmother said the chemicals turned the trees and ground white. It got into the house, onto hanging clothes, into food and water. Coconuts dropped to the ground and cracked open. Despite the primitive conditions, Vo is loved and well cared for by his family. He cannot talk, but was aware enough that he would only eat from his mother.

After 20 years, the lush vegetation returned and the area had been re-forested, but the trees were not as tall as before. I'm told that birth defects are common around Ben Tre and that some parents had allowed their abnormal children to die. They worried what the neighbors would say about their former lives. As Buddhists, there are superstitions that having children like this is a punishment for misdeeds in a previous life. As of 1994, Dr. Suong's health was okay.

"American Grass" in Song Be Province. (Fredericksen, 1994)

American Grass

I was able to photograph a patch of “American Grass” in Song Be Province, less than an hour from Saigon. It was the first thing to grow on sprayed land, so Vietnamese named it American Grass. It would grow taller than a man. An unintended consequence, since Agent Orange was intended to destroy ground cover that the VC would hide in, but the first thing to grow back was American Grass, which provided a substitute hiding place. But that was long ago. By the ‘90s, the landscape had largely recovered and the vegetation looked normal. Without a guide, you wouldn’t know if you were in a sprayed area or not. Studies would be needed to determine the extent of any residual health danger.

Song Be Peace Village

Located in Song Be Province, this Peace Village provides care for 25 kids under the age of 15. A one hour drive from Ho Chi Minh City, Song Be was one of the top three provinces exposed to Agent Orange.
(Fredericksen, 1994)

Bui's father was in the North Vietnamese Army and fought along the heavily sprayed Ho Chi Minh Trail.
(Fredericksen, 1994)

This former NVA soldier and his wife brought their 2-year old son here for an appraisal. Bui Duc Hung was a darling child with a single finger where hands should be, and partially developed feet with a single toe. He was able to walk with a hobbled gait. His dad fought in the central highlands and camped in areas contaminated. The parents blame the deformities, and the father’s own ill health, on Agent Orange. An older son is normal.

I was told that Nguyen Thi Cam Van was a good prospect for surgical correction.
(Fredericksen, 1994)

Another family I brought to the attention of 60 Minutes was the unusual case of 6-year old Nguyen Thi Cam Van. I went to her hamlet in Tan Uyen District of Song Be Province. This was the former Viet Cong military zone D, a jungle hideout that was drenched with the toxic chemical. The little girl is normal in every way, except for a monster left hand. The thumb curls up and the index finger juts in the opposite direction and is about 4 times normal size. Her father is a farmer and both parents were exposed to the defoliant. They had applied for her to receive surgery in Germany. The family had never heard of Agent Orange, but the grandmother told me that when she worked in the field and saw planes, she would think, “Oh no, they’re going to kill the trees again.” While Nguyen’s two brothers have no defects, the parents reported seeing other kids with deformities along the road. Again at Song Be Province, the doctors who hosted my visit, suspected Agent Orange for a range of maladies, like the 12 percent of pregnancies resulting in miscarriages, or molar pregnancies, and high rates of congenital defects, including Siamese twins.

I was invited into a surgical suite to observe a delicate operation, probably not related to Agent Orange.
(Fredericksen, 1994)

Ho Chi Minh City Cancer Center

For someone accustomed to the most modern medical system in the world, my visit to southern Vietnam’s sole oncology center was a spooky experience. I came here to question doctors about any links between Agent Orange and cancer. As part of my tour, Medical Center Director Dr. Nguyen Chan Hung asked me if I’d like to see an operation in progress. The patient was a 16-year old girl with a fist-size tumor between her heart and lungs. I had to wear a crisp hospital gown over my street clothes, along with a mask and head cover. The procedure was already under way when I was escorted through the swinging doors of the operating room. The anesthetized patient was draped and turned over on her side. The surgeon had already opened a large entrance into the chest cavity from one side of her back. Dr. Hung walked me over the operating table so I could look down into the gaping hole. He pointed out the tumor they were about to remove, next to the young girl’s beating heart. I was choked with emotion and felt privileged to have witnessed such a sight.

I also watched an older women receive radiation treatment. The antique equipment, circa 1960s, was made in the U.S.A. I sent a snap shot to 60 Minutes with this notation, “Overall, a frightening place.” Even though the 30-year old hospital would not meet western standards, this Ho Chi Minh City facility was performing medical miracles every day. Two years before I met Dr. Hung, he’d toured cancer centers in the United States. His salary in Saigon was $40 a month, not bad by Vietnam standards. In 1994, the Ho Chi Minh Cancer Center had 700 beds, but 1,000 in-patients. The outdoor courtyard was packed with patients, family and visitors who came from all over southern Vietnam and lived at the hospital with their loved ones.

Dr. Nguyen Chan Hung, oncologist, head of the Cancer Center and Dean of Dept. of Oncology at HCMC School of Medicine. Average cost of major cancer surgery was $50. (Fredeericksen, 1994)

When it came to pinning down a definitive connection between Agent Orange and cancer, the specialists gave surprising, but honest, opinions. Dr. Hung told me, “Now, there is no solid association…we are conducting research to have a clear idea.” The Cancer Center’s radiology chief Dr. Cung Thi Tuyet Anh said, “Many factors can create cancer. We have a positive impression (of a link) but need more study to confirm.” The Cancer Center was launching an investigation into soft tissue sarcoma and non-Hodgkin’s lymphoma, two cancers that occur in high frequency in sprayed areas.

Dr. Pham Hoang Phiet is an immunologist studying links between Agent Orange and various health issues.
(Fredericksen, 1994)

At the University of Medicine and Pharmacy in Saigon, blood samples awaiting dioxin tests were kept a basic refrigerator/freezer that you’d find in a typical western kitchen. This is where Dr. Pham Hoang Phiet was trying to prove that Agent Orange exposure damaged the immune system, leading to a weak defense against Hepatitis-B, which often results in liver cancer. Dr. Phiet said blood donors in the general population test positive for Hepatitis 10-20 percent of the time, an incredibly high rate. But he explained that Vietnamese have a reluctance to be tested. They are not always willing to undergo the blood test because of the volume needed, about 100 milliliters. Not a lot for you and me, about half a glass, but the Vietnamese are sometimes afraid to give more than a finger prick. Similarly, a biopsy of the fat tissue, where dioxin resides long term, required a sample of about 10 grams, usually taken in association with surgery. In view of these factors, and the cost, testing of the population was insufficient. Doctors had to embellish their presumptions with exposure histories, and that was not a precise science either.

The War Crimes Museum in Ho Chi Minh City presents the Agent Orange exhibit as an atrocity, much like the My Lai massacre and napalm. (Fredericksen, 1994)

Summary

Throughout my stops in Vietnam, I kept hearing about incomplete statistics, or none at all, studies with poor protocol, and the need for western research assistance. Records were so incomplete that the Cancer Center could not come up with a basic cancer rate. It all demonstrated the need for organization and U.S.-Vietnam cooperation on this shared public health menace. Anecdotal, circumstantial and statistical evidence pointed to a connection, but that was not definitive. The immunologist, Dr. Phiet, said, “The link is not yet scientific truth, only statistics show it.” “In conclusion,” I reported to 60 Minutes, “I probably do not have the convincing evidence you’d like…to find Agent Orange guilty in the plague of Vietnam’s many post-war human maladies.” It was simply not possible to conclude 100 percent that the dioxin brew is, or is not, responsible. The terrible conditions I saw, occur naturally in every country around the world. Also, most Vietnamese exposed to the noxious concoction appear to be leading normal lives. Then, I suggested a theme for the 60 Minutes documentary, “The pool of circumstantial evidence is persuasive, and here for you to present a compelling and gripping case, supporting the need for a long overdue joint investigation into one of the war’s most haunting mysteries.” I sent my report to 60 Minutes in New York on July 25^th, 1994.

60 Minutes Reaction

Two weeks after forwarding my findings, 60 Minutes was moving forward. An advance team was planning to enter Vietnam in early September to film the Zumwalt visit. I had booked hotel rooms in Hanoi and Saigon. Meanwhile, the Associate Producer had a special request for Vietnam’s “10-80 Committee,” the country’s top expert leadership on the Agent Orange question. “We need to find at least four sprayed villages which starkly illustrate the problem of childhood malformations...and a much higher than normal rate of birth defects. Without such evidence, it will be quite difficult for us to present the argument in favor of embarking on a comprehensive and costly scientific research project.” CBS was looking for some measure of evidence.

Four days later, an unexpected fax was waiting on my desk in Bangkok. “Bad news. The Agent Orange story is OFF.” Producer John Hamlin wrote that Don Hewitt, the show’s Executive Producer, felt that Ed Bradley should be in Rawanda and Haiti doing news stories, “instead of going to Vietnam to rehash an old story. (We) are not happy but that’s the business. Cancel all arrangements.” This was distressing news that would devastate all the Vietnamese who were looking forward to our visit, and the impact 60 Minutes would have on raising awareness on the issue. There were other complications too. In a phone call to 60 Minutes, I was told that the timing was difficult. They were “crashing” shows to get on the air for 60 Minutes season premier. They’d tried, unsuccessfully, to get Gen. Zumwalt to reschedule his trip. I suggested just sending in a camera crew and following up later, but Hewitt had changed his mind and considered it “old news.” No one was more crushed than Ed Bradley, who was “dying to go back” to Vietnam. I suspected another excuse was also at play. 60 Minutes wanted undeniable confirmation that Agent Orange was a serious medical villain in Vietnam, and it did not exist, at that time. Nearly 20 years after the war, Vietnam did not have the means, or the expertise, to pull it off alone. That’s why a bilateral research program was necessary. In the following days, I informed the Vietnamese that the trip was postponed and that we hoped to reschedule it later. It never happened.

Adm. Zumwalt continued with his planned visit to Vietnam, and in an interview with the Associated Press said he had no regrets about ordering the use of Agent Orange when he was Commander of Naval Operations in Vietnam from 1968-70. “I would use it again, because we reduced our war casualties. A tremendous number of lives were saved as a result. It’s one of those terrible things you have to do in war.” Zumwalt even said, “My son believed he got 20 years additional life because of Agent Orange. Otherwise he could have become a casualty.” The Adm. returned home and worked with U.S. veterans groups to press for medical care and compensation for sick servicemen and women exposed to the herbicide.

In the decades since the Vietnam War, the Veterans Administration has expanded its list of diseases related to Agent Orange exposure. New medical conditions have been approved for health benefits and disability compensation to qualifying veterans. Diseases that the VA now recognizes, include certain nervous disorders and skin conditions, various cancers including prostate, Hodgkin’s disease, some liver and heart problems and birth defects in the offspring of exposed veterans. Furthermore, a unit of soldiers that served along the Korean DMZ between 1968-71, is now presumed to have been exposed to herbicides. Also, in the intervening years, the U.S. has spent millions of dollars helping the Vietnamese eradicate “hot spots” of Agent Orange contamination. As more information emerges on the long-term consequences, there is agreement that dioxin is a toxic and dangerous chemical. For years to come, enemies that used to fight against each other, now face a common adversary, Agent Orange, and the fear that they could be the next “casualty” of the Vietnam War.

Every spring in Washington D.C., there is a special ceremony at the Vietnam Veterans Memorial. It honors those who died during the previous year from war-related experiences. They didn’t meet the criteria to be included on the granite wall, but their names are read aloud and entered into a special Honor Roll Book. These indirect war casualties include victims of emotional wounds and Agent Orange.