NEGOTIATIONS between France and the Cambodian Red Cross (CRC) over Paris' imminent

donation of two state-of-the-art ambulances have seemingly hit a snag over who will

control them.

The 300,000 franc ($100,000) vehicles - designed to allow medics to work upright

on patients being evacuated to hospitals - are seen by both sides as critical to

boosting Phnom Penh's capacity to respond rapidly to medical emergencies.

The ambulances are due to be transferred to CRC in June via the French Red Cross.

But, contrary to Cambodian expectations, French aid officials insist that they be

stationed at and placed "under the authority" of the Paris-subsidized Calmette

hospital, because of fears the CRC will use them for non-emergency purposes.

"These ambulances have been bought by France," said Dr Jean-Pierre Alluard,

head of the French Cooperation delegation at Calmette. "The French authorities

want to guarantee that these will be used only for the evacuation of patients."

Since Calmette, in cases of medical emergencies, is "the first choice"

among metropolitan Phnom Penh's hospitals with its operating theater, it would be

"perfectly normal" that the ambulances be based there, he added.

Cambodian Red Cross officials plainly disagree. They maintain that basing the vehicles

at their headquarters is linked to the plans of the CRC and its counterparts from

other donor countries to turn their HQ into a 24-hour emergency communications and

first-aid team dispatch center.

"For us, we would prefer to base these teams and ambulances at national HQ and

not at Calmette, otherwise it would be very difficult for us to manage our [future]

ambulance services," said Pum Chantinie, CRC's program director.

At Post press time, the matter was reportedly going to be discussed by the concerned

parties during a meeting scheduled for May 14 at the French Embassy.

In the wake of the Mar 30 grenade attack on an anti-governmental rally that left

up to 19 dead and scores wounded, public health experts from inter- and non-governmental

organizations have been pondering the urgency of bolstering Phnom Penh's preparedness

to handle medical emergencies.

The general prognosis is that a medical calamity on the scale of Mar 30 will probably

strike Phnom Penh again unless the city is equipped to respond rapidly and effectively

to future contingencies.

"Mar 30 has shown that the response to such an emergency is not adequate and

not organized well enough," says Dr Georg Petersen, resident representative

of the World Health Organization (WHO). "Phnom Penh has needed better planning

and emergency-preparedness for a long time, so Mar 30 put this question back on the

front page."

By his reading, municipal hospitals and health services should not only anticipate

handling the humanitarian fallout of more political bloodletting expected to occur

in the run-up to nationwide elections.

Other potential man-made disasters - a factory fire through arson, for example, or

an air crash through pilot error - will become more real threats as the Cambodian

capital swells with tourist and investment dollars and safety standards are overlooked.

"As the 1998 general election gets closer, of course there might be more and

more wounded people from acts of terror and intimidation," Petersen notes. "But

what I am really concerned about is that Phnom Penh is starting to get a lot of large

textile factories and hotels, and there is greater traffic in the city and at Pochentong

airport."

Although public health experts have commended the way municipal hospitals dealt with

the Mar 30 crisis, it is widely recognized that many victims bled to death because

of a breakdown of communications and transportation. As a result, say the experts,

no qualified medical workers arrived at the scene of the disaster in time to administer

first aid and triage-out victims, and there were not enough ambulances to evacuate

the seriously wounded.

"The immediate capacity to respond on the ground was not there," was the

way Dr Julian Lob-Levyt of WHO summed it up.

WHO is now working with the Ministry of Health (MOH) to assemble first-aid kits designed

to be used quickly on as many as five patients in the event of a future emergency,

he noted.

According to a French doctor stationed at Calmette hospital, on Mar 30 the lack of

a proper triage system translated into metropolitan hospitals being overwhelmed by

victims of the attack. Precious time was reportedly wasted sorting out those with

minor injuries from the seriously wounded.

"We were compelled to undertake triage at Calmette, although this should have

been done at the site of the attack," said Dr Christian Rathat.

As part of the ambulance package destined to the Cambodian Red Cross, a team of first-aid

and triage instructors is due to arrive from France in June to give a two-week crash

course to CRC recruits, he added.

On the NGO front, foreign and local organizations working in the medical field are

now pooling their reportedly limited resources to help MOH better coordinate its

emergency preparedness.

According to Stephane Rousseau, Executive Director of MEDICAM, a survey was carried

out among the members of the consortium to gauge their readiness to respond in the

event of a future emergency.

"We took an inventory of their human and material resources," he said.

"Most NGOs are willing to assist in emergencies, but the main problem is that

they lack resources."

Rousseau explained that, since the UNTAC period, NGOs and other humanitarian agencies

have switched their operations in Cambodia from being emergency-oriented to being

geared towards long-term rehabilitation and development.

"We are not at all thinking of setting up a parallel [apparatus]," he added.

"We want to integrate whatever response system that we can set up within the

governmental response system."