AUSTRALIAN CIVILIAN NURSES AS VIETNAM VETERANS.
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As a result of exposure to various elements of the war in Vietnam, many nurses who served there are now ill or ailing and the civilian nurses are getting no compensation for their disabilities. This has led to the formation of the CN-ASTV(Civilian Nurses - Australian Surgical Teams, Vietnam 1964-1972).
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On 7 December 1998, results of the morbidity study of female Vietnam veterans were released by the Minister for Veterans' Affairs (Bruce Scott). The study reported 16 conditions with a statistically higher occurrence than in the general community. It further reported that the number of female veterans who never married greatly exceeds expectations, which could signify that their Vietnam experience had greatly affected their ability to form relationships. For those women who did marry and have children, many report congenital defects in these children. The nurses and other female personnel on the civilian surgical teams were included in this study, but were listed, along with others, as not being eligible for benefits under the Veterans' Entitlement Act.
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Maureen McLeod Spicer:
Civilian Nurse who served at Bien Hoa in 1966
"I felt that I had a responsibility, aged 22, to go and look after the civilians. I was at that age when you feel you can change the world, you know, I was going up there to "save them all". Mind you, you come a thud once you get there! Unless you've been in a war zone you don't really have an appreciation of how difficult it is to achieve anything. There's no infrastructure. At every twist and turn there are these obstructions: supplies don't arrive, the water supply stops for a day, the power goes off three times in a day - and that's just when you think you're getting somewhere."

Von Clinch:
Civilian nurse, also served at Bien Hoa Hospital in 1966.

"At one stage we had 40 patients in the 5-bed wardSr ClinchWe had relatives sleeping under the bed, 2 or 3 patients on the bed, an army stretcher on top of each bed (supported by the bed head and the foot plate) with patients in it. There were army stretchers spread over the floor with patients in them. If you had to run down to the other end of the ward to change the blood or put up another flask of saline, you'd almost break your ankles on the stretchers. But you got to the stage of just accepting it."

Sr Clinch in the "5-bed Ward". Note the stretcher
suspended above the bed at the end of the ward.

 

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By October 1964 Australian civilian teams were located in existing provincial hospitals in Long Xuyen (capital of An Giang Province in the Mekong River Delta region and situated 100 miles south west of Saigon). Another Australian civilian nursing team established itself in the hospital at Bien Hoa (capital of the Bien Hoa Province some 20 miles north east of Saigon) and started work in January 1966. In November 1966 another Australian team was located at Vung Tau (an autonomous city situated next to the Phuoc Tuy Province, where the Australian Task Force was based, and about 80 miles south east of Saigon).

By 1967, out of the 859 Vietnamese doctors in South Vietnam, 701 were serving in the armed forces, held administrative posts, were teaching or had retired from practice. The remaining 158 were spread thinly over a total population of some 16,000,000 people . As civilian casualties continued to rise, so too did the workload on an already decrepit civilian hospital network.

In October 1968 yet another Australian team was established in Ba Ria (the capital of the Phuoc Tuy Province situated about 15 miles inland from Vung Tau). The last of the Ba Ria teams ceased in April 1969 when the area was considered to be unsafe.


 
NEW THESIS:
"Breaking the Silence:
The Experience of the Civilian Nurses in Vietnam"Dr Angell
By Dorothy Angell, PhD, DipAppSc(Nurs), MEd, Manc.
Inquiries:La Trobe University Library
Melbourne, Australia
Working conditions:
Von Clinch reports: "It was absolutely filthy! You couldn't have imagined it in your worst dreams. We went to the so-called theatre suite where there were two theatres and what we called our Intensive Care Ward - really just a room with 5 beds in it. There was a little slop hopper through a doorway, and a sink. We walked to the slop hopper and found faeces caked at least an inch (2.5cms) thick! I tried to shovel it off but it was so hard I had to bang the spade down as though it was a chisel, to get this filth off. Unbelievable!"

Sr McLeodMaureen McLeod: "There was nothing that prepared us for the filth of that hospital. And the smell - the smell will never leave me! They didn't tell us about how, when it rained (the Monsoon season), when we walked through the water in the hospital compound all the dirty bandages and dressings would be floating past you in the water. Horrendous."

Sr McLeod nursing patients on the floor
Bien Hoa hospital, Vietnam.

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Dot Angellserved in the Civilian Team at Bien Hoa hospital from December 1966 to March 1967. Extracts from some of her letters home follow:
4.1.67 "Since the beginning of January we have performed 116 operations, and when you consider that for most of that time only one theatre has been in working order it is absolutely phenomenal. The work is hard because beside nursing, one has to be general slushy and mop and scrub to try and keep the place reasonably clean..."
16.1.67 "We suffer from a gross lack of medical supplies. It seems the Australian government do not know us, and our whole life is spent scrounging from the Americans. This is very hard for us girls as we are used as the weapons, and one finds it very hard being terribly sociable at a party when you have been on your feet for 16 hours..."
7.2.67 "Food is scarce up here and most of us girls are literally starving, trying to give the boys enough to eat."
Dot arrived back in Australia showing many symptoms of post traumatic shock syndrome but received no official counselling or help of any kind. To this day she is also suffering some of the physical and mental symptoms listed below.


Recognized Conditions amongst civilian nurses:
By the year 2000 several of the civilian nurses have already died from some of the recognized Vietnam related conditions (cancer, brain haemorrhage etc.) and today many surviving members now suffer from non-Hodgkins Lymphoma, Auto immune disease (thyroid), other immune system disorders, multiple sclerosis, various cancers, Post Traumatic Stress Disorder and other anxiety disorders.

Trauma - feeling threatened:
McLeod: "We were just 5 Australian nurses and 40,000 Americans in Bien Hoa at the Air Base. There were 2 female Red Cross workers and that was it apart from some American nurses. Western women were definitely in the minority and there was all this testosterone out there. There was a lot of drug taking amongst the military, so our personal safety was a factor. At times I felt we were more in jeopardy from the American military than from the Viet Cong. That fear was borne out one day when we were walking back from the hospital - I felt really threatened. We were in a lot of danger, a lot of danger, but we were rescued by a Vietnamese shop owner."

Clinch: "One night the surgeon and I were just about to leave the ward to go back to the house when we heard this army truck pull up. We thought: Here's trouble and we heard the clump of heavy boots. These Vietnamese Army troops came in and dumped about 6 or 8 stretches on the floor, and one of the wounded soldiers died just as they put him down. The troops immediately raised their guns at us, because one of their men had died. The fact that we hadn't had time to do anything for him didn't matter to them. We eventually convinced them, after a lot of arguing, that they shouldn't shoot us because if they did we wouldn't be able to look after the others. My hair stood on end that night. We found out later that their behaviour stemmed from the fact that if one of the South Vietnamese troops died in a civilian hospital, their wife didn't get the pension."

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Trauma - the horror.
McLeod: "We were nursing this burns patient in the theatre, because it was the coolest place. We nursed her on the floor. We had a couple of IVs going and she was bandaged literally from head to toe because of these burns. Suddenly the ammunition depot went up. The instruments were blown off the trolleys, the shutters at the windows were blown in, patients were blown out of their beds and we were blown off our feet. I can remember very clearly the feeling of my brain shifting in my skull... We were sitting amongst all this debris and the other nurse started to cry and I started to laugh, and she's saying to me, Maureen, this isn't any laughing matter! and I'm saying, I know, I know! My knees were knocking, and I was fascinated, and I'm laughing, watching these knees knock."

Maureen McLeod Spicer was also present when a motorcyclist was hit by a convoy truck. He was knocked off his cycle, which fell on him. Just as Maureen and her companions reached him in order to help him, the petrol tank exploded and the cyclist burst into flame. Maureen and the medicos were unable to shift the cycle and had to stand by watching helplessly while the man burned to death. "I can still hear the screams," she says, "The screaming, screaming, screaming, and then it finally stopped. I still experience flashback of this incident. I smell burning flesh, then I want to be sick."
 

Civilian nurses' preparation to go to Vietnam:
McLeod: "I don't think we were prepared at all. We got a hand-out, written by someone who had gone up there prior to the first team going. What they gave us on the area and its people you could have got out of any text book, but it didn't prepare you for the cultural differences. I think that if we'd had people from, say, the Buddhist community to speak to us about what their health beliefs are, that would have prepared us much better. We went in with all our Western ideas about health and illness and how you approach it. Just by having those understandings I think we might have been more sympathetic towards them. We still would have done the same, but perhaps we would have gone about it in a different way."
 
 

Read about the nurses
Who served at Long Xuyen
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Australian teams of civilian nurses and doctors served in Vietnam for 16 years commencing 1964.
As a result the health of many of them has been permanently affected, both physically and mentally. A group of them calling itself Civilian Nurses - Australian Surgical Teams Vietnam (CN-ASTV) is campaigning for recognition as war casualties. At the moment the victims are getting no help from the Australian government or the military, they received no post trauma counselling or any other form of support on their return.
 

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The following  paraphrases a presentation prepared for the Australian Department of Veterans' Affairs in an attempt to bring the situation to the government's notice. The original presentation was written by Dorothy Angell but it has been edited under her supervision for the Internet.
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Background: Australian Civilian Medical Aid to South Vietnam:
Vietnam (then known as the Republic of Vietnam - RVN), a regular member of the Colombo Plan, had been getting civilian aid from Australia since 1954. In addition to this, as a Protocol State under the SEATO alliance, the Republic was also entitled to benefit under Australia's SEATO Aid program.

By the 1960s, partly due to the French withdrawal, civilian medical services in South Vietnam were in a state of crisis. There were disastrous side effects from the war too: increasingly large numbers of both civilian and military casualties, and a severe shortfall in the number of local medical graduates because of army conscription. Tuberculosis, intestinal parasites, leprosy and malaria, had always been major problems in Vietnam, but now within the overcrowding and squalid conditions there was an outbreak of plague in 1961. Cholera was on the rise and the United States Agency for International Development (USAID) predicted the possibility of a widespread epidemic.

The RVN Government asked USAID for medical teams to deal with the rising health problems and it was decided to provide surgical teams to work at selected provincial hospitals.

In 1962 USAID relayed the RVN request for more medical support to the Australian Government. This request was endorsed and the Department of External Affairs approached a number of Australia's teaching hospitals to provide surgical services and medical care to the South Vietnamese population under the USAID program.

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A run-down system:
Most of the Republic's provincial hospitals were built by the French between 1925 and 1935 and had no surgical facilities of any worth. In preparation for the proposed program USAID started constructing standard surgical suites that consisted of two operating theatres, a 5-6 bed recovery ward and a central supply unit. By the end of 1963, twenty-six of the 38 provincial hospitals had been equipped with these and were ready for 'modern' surgery.
 

Aid arrives in '63:
The first foreign medical assistance arrived from USAID in 1963 with 3 American surgical teams. Other teams came from the United Kingdom, Switzerland, Spain, Iran, the Philippines, South Korea and Taiwan, while a German Hospital ship, the Helgoland, was moored in the Saigon river.


1,500,000 Refugees !
Added to this chaos a ragged tide of around 1,500,000 refugees straggled in from North Vietnam to find a dubious security in Saigon. Children at warDestruction of villages, the uncontrolled movement of groups of people, the squalor of the makeshift refugee camps: these broke down the barriers to the spread of disease. The plague outbreak that began in 1961, had spread to 24 of the 41 provinces of South Vietnam by 1967.

Loss of crops and the difficulty of food distribution, with railways blown up and roads unsafe, caused under-nutrition, especially amongst children.
 


What were the Aims of these Civilian Australian Surgical Teams?

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The Bien Hoa Experience

It was to Bien Hoa, approximately 25 miles north east of Saigon, that the first Alfred Hospital team travelled in January 1966. The Alfred Hospital is a large teaching hospital located
in Melbourne, Victoria. The mission was the same as for Long Xuyen, but initially, due to the acute trauma workload in Bien Hoa, the outcomes were to be very different and
it took until 1969 to set up any formalized reaching programs.

Dr Peter Ryan's report on the conditions in Bien Hoa (Nov. 23, 1965) stated that Bien Hoa was
much busier than Long Xuyen because of large troop concentrations in the vicinity
and that it was noisier and dirtier. He described "shanty like suburbs" due to an influx
of refugees from the north. Numerous small shops and bars arrived to cater for the
soldiers and he said that the road to Bien Hoa reminded him of Route One
in South Korea.

The name Bien Hoa means "the land of peaceful frontiers". What a misnomer this had become!

Alistair Brass, Editor of the Australian Medical Journal, described Bien Hoa in
early 1967 as "...frontline surgery under frontline conditions."

Civilian doctors and nurses in Bien Hoa did not stop to think who had fired the bullet
or thrown the grenade, who had set the booby trap or released the napalm. All that mattered was the burned or mutilated flesh, the devastation of families and the terrible degradation of the war.

The working milieu for civilian teams at all of the provincial hospitals in South Vietnam
was peopled with children too starved for revival; teenagers whose lungs were
honeycombed with tuberculosis; emaciated young women ravaged by constant child bearing,
hard labour and malnutrition; the elderly and infirm plus Vietnamese military
and paramilitary personnel - friend or foe.

It was not up to doctors and nurses on these teams to accuse, label or lay blame - nor did they.
Their job was to diagnose, operate, care for, comfort and treat; to inject and transfuse, 
and leave it to others to ask the questions.

The teams offered help to everyone who came through the gates of these hospitals.


 
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 The CN-ASTV Group (Civilian Nurses, Australian Surgical Teams, Vietnam 1964-1972) has again submitted the case on behalf of the Civilian Surgical teams, making the following recommendation:
1.    That the Senate Foreign Affairs, Defense and Trade Legislation Committee of Inquiry into the Veterans' Affairs Legislation Amendment action the recommendation of the Review committee in regard to the Civilian Surgical and Medical Teams service in Vietnam.

2. That the Minister of Veterans' Affairs, under 5R of the Veterans' Entitlement Act 1986, be required to give notice of the Civilian Surgical and Medical Teams service, in Vietnam, eligibility for qualifying service under the Act.

"It is recommended that Australian Civilian Surgical and Medical Teams operating in Vietnam during the Vietnam War be deemed as performing qualifying service for repatriation benefits." This recommendation was made to the Australian government in February 2000 by Major General Bob Mohr RFD ED RL, Chairperson of the committee reviewing Service Entitlement Anomalies in Respect of South-East Asian Service 1955-75.

Up until the present date, civilian nurses who served in Australian Surgical Teams during the Vietnam war qualify for NO BENEFITS as veterans of that war.

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Further reading:
The words of the following scholars have been paraphrased in the above article with the aim of turning an academic work into an Internet page. This was done by the editor, not by the writer of the original article (which was produced for a purpose other than an Internet page). The Editor apologizes if any offense is caused but urges the readers of this Page to refer to the following sources for additional information:
 References
Angell, D. (2000) Australian Civilian Surgical Teams Vietnam 1964 - 1973 (Unpublished submission)
Angell, D. (1999) Breaking the Silence:  The Experience of the Civilian Nurses in Vietnam. Thesis for PhD, LaTrobe University, Melbourne.
Brass, A. (1967a) Foreign Medical Aid to South Vietnam.The New England Journal of Medicine, 277: 789-793.
Brass, A. (1967b) Medicine in South Vietnam Today. Sydney, Australasian Medical Publishing Co. Ltd.
Brass, A. (1968) Bleeding Earth- a doctor looks at Vietnam. Melbourne, William Heinemann Ltd.
Crowe, A. (1999) The Battle After the War: The story of Australia's Vietnam Veterans, St. Leonards, NSW, Allen & Unwin.
Evans, B. (1968) Caduceus in Saigon. Melbourne, Hutchinson Publishing Group.
Grove, G. (1967) Background to the Australian Surgical Teams in South Vietnam. The Medical Journal of Australia, 2:331
King, K. (1967) Orthopaedic Aspects of Surgical Work in South Vietnam. The Medical Journal of Australia, 2:331.
Large, P. (1967) Trauma, Accident and War. The Medical Journal of Australia, 2:331
Macleish D.G.(1967)Surgery of Indigenous Disease. The Medical Journal of Australia, 2:331
O'Keefe, B. (1994) Medicine at War. St Leonards, NSW, Allen & Unwin in association with the Australian War Memorial.
Santamaria, J. (1967) The Wider View. The Medical Journal of Australia, 2:331.
Snell, J. (1967) Plastic Surgery in Vietnam. The Medical Journal of Australia,2:331.
Terry, S.(1966) House of Love. Melbourne, Lansdowne Press Pty. Ltd.
The Alfred Heritage Committee (1999) Faces and Places VolumeII.Box Hill, Victoria, Jenkin Buxton Printers.

A.H.A- Alfred Hospital Archival Box 8- Surgical teams South Vietnam.
( Contents of the box were not catalogued, numbering system evolved by the author)

1. Australian Surgical Teams in Vietnam- Background Paper from Dept. External Affairs.
2. External Aid Bulletin No. 15 Dec.1968, Dept. External Affairs.
3. Vietnam- Issued under the authority of the Minister for External Affairs, Nov. 1965
4. Report to Department of External Affairs- Professor Sydney Sunderland.
5. Feasibility study of Bien Hoa re: site for 2nd Australian team  7.6.65 Report of visit to Bien Hoa  23.11.65
6. DDMS Technical Weekend 18-19 Sept.'65- Care of Civilian Population Vietnam.
7. Epidemiological situation in Vietnam  23.1.68
8. Dept. External Affairs- Administrative Arrangements and Guidance Notes,
    Australian Surgical Teams, Vietnam Nov.1968
9. Team Reports
10 Slaughter, J (1997) Casual Recollections from a Distance. Unpublished paper

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  THE LONG XUYEN EXPERIENCE.
(Australian Civilian Surgical Teams in Vietnam)
See also Pat Deal's report.

Jan Rayner Mills
...was the first Nurse Educator to go to Vietnam for the Australian Government. The position was to act as advisor to the Vietnamese nurse instructors at the Long Xuyen Hospital in An Giang Province in the Mekong Delta. She arrived at Long Xuyen in the first week of September 1967 to join the team from Prince Henry's Hospital (Melbourne). This was about 6 weeks before that team's departure for home. They were then replaced by a NSW team. "As to what team I actually belonged to - I was just a member of the SEATO Civilian Surgical Teams. As to any orientation or post briefing - there was absolutely none."
 

Map The only orientation, she said, was a briefing by a colonel at the Australian Air Force base at Bien Hoa on her first weekend in Vietnam who informed the new arrivals that they had now "entered a theatre of war"

Jan spent just over 12 months in South Vietnam, mostly at Long Xuyen, leaving at the end of September 1968. "It was a challenging year," she says, and it included the Tet Offensive. "The horrific injuries to children in particular are memories I will never forget." In the midst of all this Rayner-Mills's mother died unexpectedly and she had to rush home and then back again to complete her year. 

When the Tet Offensive occurred, Rayner-Mills had gone with an American US Aid nursing advisor, also based in the Delta, to see the Australian Surgical team at Vung Tau. This was while they were en route to a planned meeting with the Ministry of Health of Vietnam in Saigon on the Monday. "The Tet Offensive occurred on the first night we were in Vung Tau. I was sent out to the Australian Army base to the Field Hospital with the Australian Surgical Team members. Here the continual Medivac choppers arriving with dead and injured Australian soldiers was a memory that is also unforgettable." Her American friend had flown back to Can Tho in the Delta and subsequently spent 8 hours under a truck sheltering from mortar fire. "I don't think Lois had any orientation either for coming to a war torn country and she, too, was a civilian nurse with no military experience." 

After the Tet Offensive:
After the Tet Offensive, life was never quite the same. Rayner Mills recalls even stricter curfews with guards everywhere - even on the verandah outside the classrooms. Machine guns were stacked inside the classroom itself, and hand grenades were hanging off the door knobs while the students were receiving lessons. Before TetThere were guns in the Operating Theatre while surgery was in progress. "What would Work Cover and the OH&S Regulations say to that?" she asks ironically.

Long Xuyen was, she says, an unusual place. There were only about 60 American military and a few US Aid workers, plus the Australian Surgical Team. A South Vietnam Division (with their own military hospital) was based in the town. "It was known that R&R (Rest and Recreation) was available to the Vietcong in the Long Xuyen area - and it was impossible to know who was who."
 

Jan Rayner Mills (L) with Vietnamese nurse teachers
before the Tet Offensive
An Giang Province was the home of the Hoa Hoa Sect, a breakaway form of Buddhism which previously supported and fought with the Vietcong. This combination largely ended when the Vietcong assassinated the founder of the Hoa Hoa religion. The Hoa Hoa sect remains a difficult issue for the current Vietnamese government.

(Below) The nursing school after Tet
After TetHealth problems amongst the Civilian Teams:
"The SEATO Surgical Teams faced similar health environmental factors to the troops," Jan Rayner Mills points out, "We rode in army convoys and military aircraft as well as the more chancy Air America. A number of us have incredible hair raising memories of some of those rides we took on as part of our jobs. Unfortunately a number of the SEATO team have had severe health effects from their role in Vietnam and to deny them compensation is unjustified." Rayner Mills stresses that, in discussion with a number of SEATO team members who have been affected by their experience, she finds that many have had humiliating experiences with bureaucrats who further make life difficult for them. She concludes: "Members of SEATO Civilian Surgical Teams made a generous commitment for Australia and, if they have been affected by their experience in Vietnam, then they should receive the same benefits as their Australian armed forces colleagues."

Contributed by Jan (Rayner) Mills
©May 2001

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Patricia Gertrude Deal
Long Xuyen Hospital
Vietnam
October 1968-February 1969
Member of SEATO Medical and Surgical Team
See also Jan Mills report.

The NSW medical team in Long Xuyen in 1968 was due to complete its tour in October 1968. The next team from Western Australia that was to take over was not due until February 1969 because the Department of Foreign Affairs had apparently made an error in dates. Neither team either wanted to extend, or could be ready earlier, so there was a need for an interim team to cover that period.

The NSW Department of Health called for volunteers. The Commanding Officer of my army reserve hospital, Col. Keith Harris, applied and became the senior doctor for this tour. I became the senior nurse, even though I did not work for the Department of Health. Members of this team worked with the Vietnamese staff of the hospital. We covered three wards: Children's, Medical and Surgical, plus Operating Theatre, X-ray, Pathology and Outpatients' Clinic.

There were 3 nurses in the team. Two worked in the Operating Theatre and I covered the needs of all the wards. our main casualties were from trauma associated with the fighting that was going on around us in the Delta. Gunshot wounds, napalm burns, head injuries and fractures were the most common on the operating lists. the lists did not start until well into the day because most casualties had to be brought into hospital by any means of transport. Most were in very unstable conditions by the time they reached us and a large number required stabilization before we could operate. This is turn meant that operations were continuing well into the night.
 
Pat Deal
A nurse with a gun?
Pat learning to use M16 rifle to protect herself
in time of crisis.
"We all had positions to take up and
had posts to go to if evacuation was required."
The medical ward had a variety of cases; tuberculosis (one of the spine), heart conditions, leprosy, a case of rabies and various neurological conditions. The Children's ward contained mainly burns victims and victims of dehydration from diarrhoea.

I worked alongside the Vietnamese nurses dressing wounds, attending to intravenous solutions and medications. We also admitted the elective surgical patients because the surgeon was always too busy operating. The patients' families always sent a family member to obtain food and to carry out the basic nursing needs of the patient. When necessary I assisted in the operating theatre.

On 2 occasions the paediatrician, physician and I went into the distant villages to conduct clinics.


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