Ambulance staff take away a victim of a building collapse in November 2001. Thirteen people died.
At 9:45 in the morning of July 25, an emergency call came in to Chey Vathana, one
of Phnom Penh's three ambulance dispatchers. A car had hit a horse-cart in Kandal
province, killing one passenger. The other, the 33-year old wife of the dead man,
suffered three serious injuries: a broken skull, a broken collarbone, and a gash
on one of her legs.
A 2001 Toyota LandCruiser outfitted with some of the most advanced medical equipment
in the country sped off to meet the patient at a crossing point on the Phnom Penh
side of the Tonle Bassac river. Kong Savy, the ambulance driver, got the rig up to
its maximum speed of 60 kilometers an hour to pick up the patient. A combination
of bad roads and daredevil drivers limit the speed the ambulance can reach.
After a 40-minute drive, San Sethy, lead medical officer in the crew, and Dou Sophorn,
the team's first aid specialist, were able to attend to the patient and prepare her
for the 40-minute trip to Calmette Hospital.
"I think she'll survive," says Sophorn.
That was just the start of a long day for Sophorn and his team. They had clocked
on to their 24-hour shift at 7:30 that morning, and expected to see more problems
on the roads. Traffic accidents make up the majority of the ambulance crews' cases.
"There are more traffic accidents than any other," says Dr Svay Kamol,
the ambulance service's project manager.
Kamol, Sophorn, Vathana, Savy and Sethy are five members of the country's sole rapid-response
ambulance crew. There are 23 members in Phnom Penh's emergency ambulance service:
six three-member ambulance crews, three dispatchers, and a logistics director.
Dr Svay Kamol covers the body of a garment worker shot on June 13, as riot police look on.
Alcohol sometimes poses a problem for rescuers.
"I don't like drunk victims who throw up on me," says Sophorn. "It's
hard, but I keep doing my job."
The other major calls the ambulance service gets are for street fights and fires.
"Sometimes we go out with the firefighters, but that rarely happens," says
Kamol.
The control center, complete with the dispatchers and Kamol's office, is at Calmette
Hospital, but ambulances also operate out of Preah Sihanouk Hospital. Each crew works
a 24-hour shift followed by two days off before coming back on duty. Exhausting?
Not for some.
"I don't get tired because I am happy with my work," says medical officer
Sethy.
The Cambodian Red Cross (CRC), in partnership with the French Red Cross, started
the ambulance service in 1996. The ambulances were donated by the Japanese government.
With a two-meter long patient bed-smaller than normal-the trucks are not ideal.
Also, their age means they should be coming up for retirement. In Singapore, where
Kamol trained as a paramedic, ambulances are taken out of service after 40,000 kilometers.
Dr Svay Kamol of the ambulance rapid-response team: 'If my crew can work 24 hours, so can I.'
"Here, we've had them for two years, they've gone 100,000 kilometers, and we're
keeping them," Kamol says.
He is concerned the ambulances will not survive into next year, but is not comfortable
asking the Japanese Embassy for another ambulance.
"They've already given us trucks," he says.
Including salaries, gasoline, spare parts, maintenance, medicine and equipment, Kamol
says the capital's ambulance service costs about $40,000 a year. Sixty percent comes
from CRC, and the rest from its French counterpart.
Salaries range from $200 per month for Kamol to $60 per month for dispatchers and
first-aid specialists. Despite the low costs, funding from the European Union was
stopped in 2002, and that from the French Red Cross has been reduced. The EU's money
used to provide for four ambulances, two each at Calmette and Preah Sihanouk hospitals.
Now each hospital has just one.
The costs do not include uniforms. On the left breast pocket of all ambulance service
uniforms is the green and white logo of the Mohosot Import/Export Company, Ltd.
"We are so poor, a local company sponsors our uniforms," says Kamol.
Even with uniforms that serve as advertisements and two ambulances that may not survive
the year, Kamol says this is the only ambulance service with life-saving capabilities.
Inside the creaky back doors of the truck are an oxygen tank and IV stand, and a
black gym bag filled with medicines, syringes and other tools.
There are no defibrillators or other electronic equipment. But, says Kamol, it could
be worse: the ambulances run by the Ministry of Health and private clinics don't
even have the gym bag.
The team gets about 10 calls per day, with calls divided between the Calmette and
Sihanouk ambulances. Problems arise when there are more than two calls at any one
time.
"Sometimes there are too many cases, and we can't help all the victims,"
says Sethy.
When that happens, the priority is to attend to the first two calls that the dispatcher
receives.
Driver Kong Savy of the rapid-response team.
"But if the one who calls first is farther away, we go to the closer one,"
Kamol says.
The creaking, worn-out ambulances and the decrease in funding have not stopped Kamol
from thinking big. He is currently preparing grant proposals for the US, British
and Australian embassies, and is drawing up plans for ambulance crews to be placed
in five hospitals around the capital.
"If they increase us to five stations, the people of Phnom Penh will be much
safer," he says.
It will also allow more people to get the feeling that Sethy gets when he does his
job.
"I feel like I'm a god because I can help people," says the lead medical
officer.
Along with the ten calls per day, the ambulance service has to deal with the scourge
of emergency services across the world-prank calls. There are usually between 15
and 20 a month, but the dispatchers are getting better at spotting them.
"Sometimes the people laugh when they call, and sometimes you can tell from
the sounds of the street," says Vathana.
But deciding between three calls is not the most gut-wrenching part of the job. Although
the crews are supposed to drop off patients at the nearest of Phnom Penh's nine public
hospitals, doctors can refuse patients if they have no relatives with them or look
like they cannot pay. There have been times when ambulance crews have had to drive
to several hospitals just to get a patient attention.
"I just have to beg the doctors to accept the victim," says Sethy.
The rules of the International Committee of the Red Cross prohibit weapons in ambulances.
That is not as easy as it sounds here, although there have been fewer weapons recently.
A 'no weapons' sticker-an AK-47 with a red slash through it-is on all ambulance windows.
If a patient refuses to give up his weapon, the ambulance crew can refuse the patient
help.
"If the patient won't give up the gun, the ambulance won't go," says Kamol.
Ambulance crews are also given the choice to leave a dangerous scene. Kamol, who
has headed the program for five years, remembers having to go out and pick up the
truck when the crew abandoned it in panic.
In the coming days, the teams have prepared for a higher call volume. A heightened
alert goes into effect around national festivals and elections. Savy, the ambulance
driver, says the crews have to be prepared for anything in the aftermath of Sunday's
election.
"We have to be well prepared for the day. Many cases may happen," he says.
Kamol is also putting in longer hours. He normally works an eight-hour day, but starting
July 25, he will be working from 7 am until midnight. At midnight, he will decide
whether he has time to sleep: "If my crew can work 24 hours, so can I."
