SOS in Cambodia

For tourists who visit the famed temples of Cambodia, the remains of millennia-old Khmer architecture can take their breath away. For one British visitor with longtime asthma, however, the humid climate and deteriorated buildings contributed to a more serious pulmonary problem: a collapsed lung. Fortunately, Anne Fine, a registered nurse from South Africa, was able to provide appropriate healthcare. She does so in a country where hospitals are primitive and trained professionals are few.

"He came to us 15 days after he blew a pneumothorax," says Fine, branch manager of International SOS's clinic in Phnom Penh, Cambodia. After days of misdiagnosis, the young man entered a hospital in Phnom Penh. "When we first heard about him, they had cut open his chest without benefit of local anesthesia. He leaped off the operating table and ran out of the hospital." By the time his girlfriend brought him to the clinic, 60% of his lung had collapsed. Fine and the medical staff successfully stabilized the patient, and he was able to continue his travels.

Fine's clinic is part of International SOS's worldwide healthcare delivery system. With 2,500 staff members, SOS is the world's largest medical assistance company and a leading provider of medical services to remote sites. In Cambodia, Fine's 31-person clinic focuses on providing 24-hour medical and dental services. Patients include tourists, embassy staff, and individuals working for international and local companies.

Each month, 800 to 900 patients pass through the doors of Fine's clinic. She sees conditions such as MIs, CVAs, URIs, asthma, TB, dehydration, gunshot wounds, MVAs, monkey bites, snake bites, even hemorrhagic fevers. She says, "The excitement of the job is not knowing what is going to happen day to day."

Fine, who oversees the clinic's operations and finances, assists in emergency care and is responsible for ensuring good medical care despite the challenges of working in a country whose economy has been devastated by internal warfare.

Fine says that when an emergency case comes in, the scene often is like one from the television program ER. "The Cambodians are very dramatic," she says with a laugh. "Doors fly open and a thousand people come in carrying the patient. If it's a tourist, there will be flustered tour group members in attendance." Often, the clinic has to undo the damage done by local medical care: poorly set bones, improper casting, polypharmacy, misdiagnosis, and inappropriate management, such as improper wound cleaning.

If necessary, evacuation will be via a dedicated air ambulance that comes from SOS headquarters in Singapore or via commercial carrier with a medical escort. If it is a private medevac flight that arrives at night, the airport will need to be re-opened. Patients are evacuated to hospitals in Bangkok or Singapore.

One of Fine's biggest challenges is the lack of supplies and trained personnel in Cambodia. This is largely due to the Khmer Rouge, which is estimated to have been responsible for the deaths of up to 25% of the population during the late 1970s. The educated, including doctors and nurses, were among the first to be murdered. And during this period, the economy was virtually decimated. "There is so much poverty here, you can't walk out without beggars approaching you," Fine says with a sigh. "Since the average monthly wage is about $20, corruption is everywhere. It's the survival mode, but it's hard to take."

Since the Khmer Rouge forbade education, some Cambodian staffers lack basic skills. This needs to be made up by extra training. "Yet the Cambodians are learning quickly. We have a great staff." Fine adds, "I come from a medical environment where everyone is a well-oiled machine, functioning independently. Here, things are done collectively."

She says she loves the responsibility she has been given to make the clinic work within a budget and to develop both the clinic and its staff. "How I achieve this is largely up to me and the team. SOS is very supportive, and they encourage innovative ideas."

Fine's medical experience to date is well suited to her demanding position. She has spent a lifetime treating victims of violence and trauma. She grew up in South Africa, and after training as a nurse abroad, returned to her home country to serve as a paramedic with the emergency helicopter service in Johannesburg. Fine counts this as her biggest challenge to date, including her current position. As apartheid was ending in South Africa, the helicopter service became the world's busiest rescue service. "It was not uncommon to be called out eight to 10 times a day," she said. Each call was a patient requiring life-saving treatment on the roadside, with victims frequently burned or shot and in need of major resuscitation.

"I was reluctant to leave in case I would miss a good call – we were all like that."

When she was approached to manage the clinic in Cambodia in April 2000, Fine decided it was a great opportunity to further her skills.

While she has good friends in Cambodia, Fine admits Phnom Penh can be a lonely place. "I spend a lot of time on my own, studying (for a Bachelor of Commerce degree from the University of South Africa)." Still, the move has clearly helped her grow professionally and personally. Her entire life outlook has changed. She recalled that while on the paramedic team in Johannesburg she was very emotional and needed constant companionship. "Now my life is more balanced. I am able to enjoy it without always seeing a trauma scenario in my head. Even in this culture where poverty and violence have been the norm, I see many wonderful, caring, and genuine people. They have shown me that kindness and family values are still possible."

International SOS For more than 20 years, International SOS has provided worldwide medical, personal, and travel assistance to thousands of multinational organizations, corporate travelers, and expatriates. It is the world's largest medical assistance company, providing global emergency assistance, medical services (e.g., medical and logistical support and medical audits), healthcare management, and security services. It also operates international clinics in Kazakhstan, People's Republic of China, Vietnam, Myanmar, Indonesia, the Federal Republic of Nigeria, the Congo, Australia, Russia, Cambodia, and Azerbaijan. If you would like more information about International SOS and its services, visit their website.

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