For the last five years, I have focused my professional time and interest on researching and writing the recent history of the Army Nurse Corps. As you may or may not know, my first volume concluded in approximately 1972 when the last Army nurse left Vietnam. And I thought that was a good place to start with the next volume so I did indeed do that and I traced the significant happenings all the way up to the year 2001, which of course is the hundredth anniversary of the Army Nurse Corps.

The Army Nurse Corps tale I am here to tell today begins on an exceedingly low note in the years following the conclusion of the Vietnam War. This unpopular conflict set half a world away in Southeast Asia was a watershed event. It had significant predominantly negative impact, not only on the nation, the Army, and the Army medical department, but also on the Army Nurse Corps. Some of the long-term effects incurred by the Army Nurse Corps were revealed in the deployments that occurred in the Vietnam War’s immediate aftermath. In the post-Vietnam era, particularly in the early days of the 1970s, the war weary American populous refused to countenance the notion of supporting overseas combat operations. Quite simply after the debacle of Vietnam, the nation was fed up. However at that time Americans did endorse foreign relief missions and when the call came in the 1970s and the early1980s to rally around the flag and participate in relief or humanitarian missions, the Army Nurse Corps officers responded quickly and with enthusiasm. They made worthwhile contributions to the disaster relief operations, predominantly in foreign locations despite less than ideal conditions.

During the 1970s, two relief missions took place in the Central American countries of Nicaragua and Guatemala. In December 1972, an earthquake shook the Nicaraguan capital city of Managua causing significant infrastructure damage and human casualties. In an answer to a call for assistance, the Army’s twenty-first evacuation hospital from Fort Hood, Texas set up one hundred beds in an area adjacent to the ruble of what was formally the Managua General Hospital. Approximately thirty Army Nurse Corps officers took part in the relief effort. The mission in Nicaragua was by and large successful although a number of minor setbacks surfaced. For one thing, the type of supplies conflicted with the mission requirements. While there were many pediatric and obstetrical cases, planners had included no pediatric or obstetrical supplies or equipment in the original supply issue. Most of those provisions were geared instead to the demands of combat medicine. Also the minimal care ward was unexpectedly inundated with individuals with supportive care needs like geriatric patients, the debilitated, the blind, and paraplegics. Caring for these patients called for adjustments in expectations, staffing, and equipment. Army nurses, renowned for their ability to cope, utilized field expedient majors to circumvent the deficits.

A few years later the Army again answered the call to provide assistance to earthquake victims, this time in Guatemala, where a massive tremor struck in February 1976. Within one day, the one hundred bed, forty seventh Field Hospital from Fort Sill, Oklahoma arrived and set up tents on a grove thirty-one miles from Guatemala City. Approximately twenty-six Army nurses cared for the earthquake casualties, whose traumas included fractured pelvises, various crushing injuries, and lacerations. A number of babies, including a set of twins were delivered at the hospital. A few of the newborns were premature, but all of the infants thrived. The older children on the pediatric ward had emotional and well physical wounds and would wake shrieking in the night in terror from nightmares. Frequent aftershocks also distressed the smaller tots. Reassurance and comfort played a large part in the treatment regime of these patients. Various operational snags surfaced. Supply deficits were again a major concern. Communication problems and cultural differences also emerged. Huge numbers of family members wishing to stay with hospitalized victims caused substantial discord. To deal with the crowds around the bedsides, hospital authorities asked Guatemalan soldiers to restrict entry into the hospital compound, an action that seemed absurd to the natives who were used to staying with their sick family members in their local hospitals.

While the humanitarian assistance operations of the 1970s seemed to be plagued by difficulties, there were paradoxically constructive. Not only did they provide comfort and relief to the recipients of nature’s raft, but they also instigated change and improvements in the Army and provided a sense of satisfaction for those who personally garnished the relief. Two major refugee resettlement operations took place in 1975 and 1980 respectively, during Operation New Life for displaced Vietnamese and the subsequent Cuban Relief Operation, Army nurses facilitated the integration of tens of thousands of immigrants in processing centers located on Guam, at Fort Chafee, Arkansas, Fort McCoy, Wisconsin, and Fort Indiantown Gap, Pennsylvania. Once again obsolete or inappropriate supplies created challenges. Nevertheless, greater efficiency characterized these missions.

A new humanitarian mission materialized in 1983 with the incursion of U.S. forces into Honduras. The objectives of Joint Task Force Bravo, as it was called, were to improve host nation readiness, counter Communist expansion, and demonstrate an American presence and interest in Central America. One of Army nurses’ many noteworthy activities in Honduras was their participation in Med Caps, Medical Civilian Assistance Programs. Lieutenant Colonel Cindy Gurney joined Task Force Bravo chief nurse in 1992 participated in a Med Cap at a nearby orphanage. She organized the children into a medical assembly line. First, a Honduran physician ascertained the child’s chief medical complaint. Then an Army physician assistant briefly assessed the problem and prescribed a treatment. Two pharmacy technicians dispensed appropriate drugs and Gurney administered de-worming medication to each child. A three-year old latched onto Gurney. She wrote, “When I couldn’t carry him, he hung on my pockets. I didn’t need to speak to him. He didn’t try to speak to me. We couldn’t understand each other except for the primitive understanding that passes when two souls touch and tickle and giggle together”. The assignment of Army Nurse Corps officers to Honduras continued for decades.
At the same time, Army nurses served an advisory role in El Salvador. Captain Nellie Olomon taught a five-month intensive care course to twenty-one El Salvador nurses. In that country, dangerous conditions prevailed so all were careful to observe personal safety precautions. Nevertheless on 21 November 1989, guerilla rebels attacked Olomon’s house and she sustained facial and chest gunshot wounds. Despite her injuries, she completed her assignment in El Salvador. Several years later, General Nancy Adams awarded the Purple Heart to Olomon in ceremonies held in the Pentagon.

In October 1983 after a decade of only non-combat missions, the United States initiated a combat operation to counteract a government takeover by a Soviet on the Caribbean island of Grenada. The military codenamed the mission Operation Urgent Fury. Fort Brag, North Carolina’s fifth MASH, Mobile Army Surgical Hospital, with its compliment of Army nurses began providing services on 5 November 1983 on Grenada. However, before becoming operational, the hospital encountered difficulties in assembling its staff. At the outset of the operation, the military field commander banned all military women, including Army nurses, from the island. He ordered that all female soldiers assigned to the invasion force remained sequestered on the nearby island of Barbados. Fortunately the unlawful ban was reversed shortly and all Army nurses, be they male or female, soon were able to participate in the campaign.

The first casualty treated was a young soldier suffering head and back trauma from a fall down a hill. After that the unit treated patients with minor injuries and illnesses such as lacerations, eye injuries, sunburn, and skin rashes. The hospital also received an eight-year old Grenadian boy injured while playing with a hand grenade. The child spent seven hours in the OR for the repair of a lacerated liver, bowel perforations, an open fracture of an ankle, and a fragment wound of the eye. Only one urinary catheter was available that came close to approximating a pediatric size and when it fell out of the child’s urethra, the nurses were compelled to soak the drainage tube in betadine and reinsert it. The only available ventilator had no IMV – intermittent manual ventilation and when not sedated, the boy fought the ventilator, attempting to breathe on his own. Still requiring ventilation, the child was evacuated to Naval Hospital Roosevelt Road’s Puerto Rico two days later. An Army Nurse Corps worker bagged the boy for the entire duration of the flight. The injured child did received state of the art care, but only because the staff could improvise.

While many aspects of the Army Nurse Corps participation in Operation Urgent Fury were troublesome, many other features were virtually flawless. Staff relationships were agreeable and productive. Major Grace Johnson wrote that she found the unit cohesive and responsive with “no pre-madonnas, no drunks, no doctors who thought they were God’s gift to women, and no slouches”.

The military launched Operation Just Cause, another combat mission in December 1989 in the Central American country of Panama. Its objectives were to safeguard U.S. citizens, foster Panamanian democracy, insure unimpeded passage of ships through the Panama Canal, and remove Dictator Noriega and end his massive cocaine trafficking business. In Panama, the Army used a new configuration for health service support. The forward surgical team - Fort Bragg’s first and fifth forward surgical teams with their compliments of OR and ICU nurses deployed and set up a facility on the tarmac of Howard Air Force Base, Panama. Over the course of the mission, the two forward surgical teams cared for three hundred forty-one casualties and performed seventy-three operations.

Lieutenant Colonel Susan McCall served as Operation Just Cause chief nurse. Her actions, in the dying casualties nursing unit, called the expectant area because these folks were expected to die, validated the age-old wisdom of including Army nurses in a combat operation. McCall encountered a young Navy Seal Corpsman on a litter in the area set aside for dying. Despite a bullet wound in one leg, he had continued to care for his team, but later suffered a gunshot wound to the head, which he promptly bandaged himself. The severity of his head wound, large enough to insert a hand with exposed brain tissue and his untimely arrival with the large number of casualties led the team to assign him to the expectant or the dying category. McCall sat down and talked to him. She described their conversation: “The patient was alert and awake. He had an IV going. I said to him, ‘So what’s your name?’ He said, ‘My name is Macho Camacho.’ I said, ‘Well Macho, where are you from?’ He said, ‘I am from Dallas.’ I said ‘Oh, do you know where you are?’ He said ‘Yep. I’m in hell.’ I said ‘No you are not in hell, you are at an airbase.’ He said, ‘Nope. I’m in hell. My head is on fire and you have to put some water on my head.’ The one attendant in the expectant area, a Navy Corpsman, asked McCall if he should administer morphine. Macho interrupted, ‘You can’t give me morphine. I have a head injury.’ Taken aback at his awareness McCall thought this kid is much too alert to be placed in the expectant category. She summoned a medical officer who concurred with her assessment and put Macho on the next evacuation flight out of Panama to Saint Antonio, Texas. McCall believed the young Navy Seal would die in route, but later she discovered that he had survived and was a patient at Audie Murphy Memorial VA Hospital in San Antonio. He suffered residual neurological deficits, partial vision loss and paralysis, but during rehabilitation volunteered at a nearby elementary school and read to students enhancing his own healing and providing a meaningful service to his community. Later he and his wife led support groups for families of service members deployed during Desert Storm.

During Desert Storm, participation by Reserve and National Guard nurses was unprecedented. The total Army concept was tested, tweaked, and proved pretty effective. Army nurses provided care in the Persian Gulf. They served in Europe caring for their usual peacetime patients as well as the casualties who were moving along the evacuation chain. Similarly, within the other overseas locations and the United States, Army nurses and civil service nurses provided care for both incoming causalities and regular beneficiaries. A total of forty-four hospital units were operational in the Persian Gulf and most were state of the art Dep Meds - deployable, medical, system facilities that replaced the outdated Vietnam-era Must - mobile unit surgical transportable equipment.

While in the desert, the nurses obviously cared for patients, but they also functioned as soldiers. The Army nurses assigned to the eighty-sixth evacuation Hospital home stationed at Fort Campbell, Kentucky helped to erect their hospital, set up beds, inflate air mattresses, and unload the shipping containers. They assembled shelf space. They created boxes and in this sandy environment, constantly cleaned and dusted. Operation Restore Hope followed Desert Storm and took place in Somalia, a nation situated on the horn of Africa. It began in 1992 as a humanitarian mission, but quickly devolved into a combat operation.

Three Army hospital units served in sequence in Somalia. One of these, the forty-sixth combat support hospital from Fort Devins, Massachusetts served during a guerilla offensive that was later chronicled in Mark Bowden’s book and the film Black Hawk Down. Numerous Army rangers incurred serious injuries during this operation and as you may already know, several died. Soon after the first wounded descended on the hospital, the EMT, Emergency Medical Treatment area had all of its tables occupied with incoming casualties and the wounds were just incredible. The hospital staff rose to the occasion. An Army nurse participant reminisced, “We utilized every person on the compound. Everyone pitched in and contributed in one way or another. We were familiar with how the system worked and were able to make it all come together. People were scared, but everyone did a wonderful job. Staff felt very proud of themselves to know that when the rubber met the road, they could do it.”

Beginning in 1992, many successive cohorts of Army nurses served in the former Republic of Ukaslovia. Imperious peacekeeping missions. Army Nurse Corps officers met extreme challenges in the Balkans. With a multi-national United Nations clientele from approximately thirty-three countries who spoke numerous languages, communication was often incomprehensible and difficult. To circumvent these predicaments, the nurses used flashcards, touching of body parts, hand signals, translators, and if all else failed, charades to communicate with the patients. Another issue included relearning the field expedient mindset to adapt available supplies to unanticipated needs.

With the extremely cold January 1993 weather, further improvisations became necessary. The thirty-degree below zero weather caused everything – medications, IV fluids, thermal pads, and even KY Jelly – to freeze. In the OR, the nurses thawed medication valves by placing them in their clothing close to their bodies. They put frozen water tubing in the overhead heating vents to obtain water. They focused high intensity spotlights on IV bags to heat them up. Captain Nell Debaringhill thought that this likely was one of the most unusual situations that ever happened in operating room nursing. She added that the attempts to deal with the subzero cold were a communal effort. All were creatively thinking of ways to deal with the extraordinary circumstances and improve patient care.

Like the operations in the Balkans, Operation Uphold Democracy took place in challenging environment. The objective in the 1994 mission to Haiti was to restore to office the democratically elected President Jean-Bertrand Aristide. Major Ellen Forester was one of a group of Army nurses was to receive orders to report to Fort Bragg and mobilize to Haiti with the 28th Combat Support Hospital. Upon their arrival in Port-ua Prince, local Haitians either cheered or jeered the nurses as they proceeded to two enormous vacant warehouses that would serve as their hospital and living quarters. Used as dumps in the past, the buildings were littered with animal and human waste. The nurses cleaned the buildings, and then everyone – physicians, nurses, and medics – helped to erect the hospital, a formidable effort in the one hundred degree temperatures. Within a few days, a mass cal was called after a grenade detonated in a crowd of demonstrating Haitians.
As head nurse of the EMT, Forester organized four trauma teams consisting of a physician, a nurse, and two medics and furnished them with supplies and equipment required to treat blast wounds such as chest tubes, nasal gastric tubes, and large IV equipment. Fortunately most of the injuries were minor, yet afterwards Forester was reassured about her team’s ability to provide quality trauma care. Nonetheless, no one was complacent. Forester and her staff fine-tuned their trauma sets, intensively trained on their field equipment and developed treatment protocols.

Later the nurses pondered the nature of their responsibilities. We cared for many indigents, many of whom had never had even the rudiments of medical care. How much could we do for them in the time we would be in Haiti? How could we help a severely mal-nourished baby? So many people needed so much help and our resources were limited. The Haitian on Haitian violence was frequently out of control. It was not uncommon for us to treat several patients with gunshot wounds, machete injuries, and stab wounds per day. When supplies ran short, as sometimes they did, we wondered how we would react if we had to make a choice between treating an injured American soldier or a Haitian. In the final analysis, we tried to provide the best nursing care we could.

Within the relatively short span of three decades, the Army Nurse Corps underwent a Renaissance. From the post-Vietnam War era to the heights of excellence achieved to this day in operation Iraqi Freedom, the Army Nurse Corps has constantly strived to reinvent and improve itself and by and large, it has succeeded. Along the way, a handful of themes have emerged such as the ongoing efforts to be fit and ready to mobilize quickly. The crusade to improve personnel configurations, facilities, and equipment. The propensity to employ field expedient skills. The power to cope with the stress of field nursing. The touches of humor and the ascendancy of soldierly skills.

This concise overview of the mobilizations that took place over the last few decades has illustrated the successful growth and commonality of these features. During times of good fortune on the one hand or when the physicians are in dire predicaments on the other hand, the Army Nurse Corps always meets the test of its time. It’s ranks inevitably age, retire, and pass on. But like a phoenix, the Army Nurse Corps always rises again and renews itself with each generation passing in review. I salute the Army Nurse Corps. Thank you!