To the Editor.— Medical assistance to South Vietnam followed in the wake of our increasing participation in military and political affairs of that country. The initial program implemented existing physical facilities and provided physicians for direct patient care. The efforts were modest, improvised, and limited. Vociferous and often inflated claims of war-related human suffering gave impetus to the program, and we rapidly found ourselves involved in a large-scale health effort in an environment for which there is no parallel in the West. We viewed isolated problems through glasses shaped by Western experience, and applied Western solutions outside their demographic, social, and political settings, more often than not aiming at an optimum, when only improvements were realistically feasible. In consequence, much of our effort has been misdirected, and the need for a fundamental change in our approach to health conditions in Vietnam has become obvious. Chamberlain's article (214:1687, 1970) and