OUR FIRST CUSTOMER
Emergency's surgical team makes its Cambodia debut.
BATTAMBANG - "Ah Christ," says Dr Gino Strada, peering at the underside
of the soldier's left leg, "look at this shit." The limb is pock-marked
to the bone with shrapnel up to the buttock, awash with pus mixed with the purple
of old iodine.
"Can you move your foot?" asks the veteran of more than 32,000 war surgeries
around the world, who says his business is not for amateurs. "Hmm. That leg
worries me," he says to no one in particular.
The semi-delirious soldier creases his eyes shut. One wonders whether the pain may
somehow dull for him the cloying stench in Emergency Hospital's new pre-op room.
Strada takes off a gauze bandage lying on the man's right leg and again mutters "ahh
The soldier's leg ends mid-shin, but not as the red-raw meat joint of a recent wound.
This former KR fighter trod on a mine 10 days ago in Pailin and suffered botched
field surgery before being dumped outside Emergency on July 25. This soldier must
bear the insult as well as the amputation. He is the Italian-based NGO's first surgical
patient in Cambodia, and today is 'opening day'.
A few inches below his knee the end of his leg has swollen to four times normal size.
The burnt-black skin is taut and torn in places like paper. His flesh - but it's
not flesh, it's the consistency of ripe Camembert cheese - is dirty yellow, slopping
on the table in dripping ribbons. The nicotine-brown stick protruding from the fetid
mess is a bone? Surely a bone, from which the very marrow laps out in little waves
of creamy stinking sepsis when the leg is gently moved.
"He has 60% to 70% chance," Strada says. "Of living?" he's later
asked. "Of dying," he answers,
Emergency is a $1.2 million hospital for victims of war, set up in Battambang town
by a Milan-based team - or, perhaps more accurately, a "family" - of savvy
medics who are contemptuous of the politics that swirl around what they do.
"From the moment you're wounded you're not a soldier anymore," says Strada.
It's Emer-gency's raison d'être and Strada "doesn't give a shit" if
it's taken as a spit in the face of any international organization that has decided
that it's too politically difficult to help wounded men because they happen to be
If anyone wants an ideological debate about Emergency's policy of helping war victims
- women, kids, soldiers, anyone and everyone regardless of politics or what army
they may belong to - take it up with Gino Strada. He is a humanitarian surgeon and
he helps wounded people. End of debate.
"We maintain absolute neutrality here. We don't ask if you're from this party
or that party or that guerrilla group.
"We have strict humanitarian principles and don't want any interference."
Strada is severe about the politics of international aid and wastage of money. Few
are immune: he bought a single Fiat share so he could embarrass Fiat boss Gianni
Agnelli as a liar at a shareholders' meeting for the company's part in making landmines
"and he didn't sue me".
Emergency gets its money in Italy from more than 30,000 private donors, and it dovetails
with Strada's heavy involvement in the 'Ban the Landmines" campaign. Ask how
much Emergency spends and where and Strada will tell you to the cent, "we're
completely transparent... not like some [organizations]". The running costs
are about $30,000 a month and "that's not high compared to the standards we
Cambodia has just about used up the money in Emergency's coffers. "Obviously
we're going to have to look for international donors, but I'm sure sooner or later
some big cheese will realize this hospital is quite different from the rest,"
he says. "The future of aid is like this. Small, specialized services."
What about the notion of sustainability? "Sustainability?" Strada snorts.
"Sure we could send our nurses to give out tablets within the national health
system." "And we'd still be doing that 75 years later," says Kate
Rowlands, the administrative head who has been at Strada's side for many of his 32,000
"Look," says Strada. "NGOs can give out drugs like penicillin that'll
be used to treat heart failure or are out of date or will be sold in the local markets.
What do you gain? If you limit yourself to support local structures that doesn't
change the system... it doesn't work.
"Some NGOs have been here for five years. Why are there still bloody gauzes
on the floor? Why are there still thousands of flies around the patients? Huh? Why?"
Strada set up Emergency in 1990 and has built pristine, superbly-run and low-tech
trauma hospitals in Kurdistan, Rwanda, Chechnya, Iraq and now Cambodia among other
places. The idea is to introduce standards and capacity for trauma care and eventually
hand everything over to the state. Strada says it may take five years for Emergency
to work itself out of a job here.
Strada's argument is that no-one else is doing this, or at least not properly. Emergency
is for war victims rather than war wounded: "If a boy breaks his leg and because
of conflict there are no medics or if there are other kinds of complications, he's
a war victim," Strada says.
Strada reckons Emergency Cambodia will treat perhaps 100 or more patients each month,
including those referred from other hospitals for rehabilitation or urgent surgery.
Patients will be in and out within two weeks. Emergency employs an international
surgical and nursing team of 10 and 126 Khmer staff. Twenty-five local staff are
mine or war victims.
In Iraq, he says, Emergency instilled in local medics a "totally different"
attitude, that of respect for patients and "total dedication". The same
will happen here - professionality and kindness, and in a dignified way, he says
- "and if that's the only bloody message then that's enough," he says.
Emergency may be low-tech, but it's performed by committed experienced experts and
balanced by a concept they deem as more important than expensive machinery: one-to-one
Emergency is finishing off the hospital grounds now. There are tropical flowering
bushes and trees being planted; Buddha and Angkorian statues as decorations; a children's
playground out the back. There's an open patients' cafeteria so "they can get
out and about," nurse Susanne Elofsson says. "It's about all-round care.
"We want them to be at peace in their hearts and minds, not just their bodies,"
Similarly, patients see hospital staff who are amputees themselves working and talking
and joking. "It gives them hope," says Elofsson "that they can work
one day in society... that they will be useful on the outside."
Photographer Tim Page, who took pictures of Strada's first Cambodian operation of
the injured Pailin soldier, came out of the operating theater moved at the way Elofsson
"just smoothed the guy's hair and head during the operation."
And later, when the man awoke from anesthesia, how he grimaced and clutched at his
new above-knee stump while Elofsson, Page says, gently lowered his leg and whispered
Strada's first patient is still a couple of days away from safety, but getting through
this operation gives some unspoken satisfaction to the Emergency team. "He smiled
this morning," Rowlands says of the Pailin soldier. "That was nice."