Number crunching ...

One victim in 238 people.
Eight to ten million land mines.
More than one landmine per person.
The mines are being planted more quickly than they can be removed.
Peter Brophy is the Director of Finance & Administration for the Sydney Hospital. He has initiated a program involving thirty hospitals and twenty medical-supply companies in Australia that supplies medical equipment and surgical instruments to Cambodia and soon to Laos.  Commenting on how he became interested in the project and the region Brophy says, "Back In 1980-81 I worked for a Thai organization called Catholic Office of Emergency Relief and Refugees (COERR). I had the responsibility of going around to the refugee camps on the Thai border filing reports about the hospitals and health services. Then I went up to the northeast of Thailand for about nine months to work with a group of Thai nuns on a leprosy eradication program. They had an European agency called Peter Donders which was providing them with medication and a vehicle to travel around to small villages. Then I started a scheme back in Australia to raise money so that we could buy medicine in Bangkok to help supplement the program of overseas eradication with minor medications and first aid equipment.

"Three years ago I came back to this area and COERR asked me to go check on a hospital in RatnaKiree, Cambodia. The hospitals in Phnom Penh are the worst I've seen in all my experience in Southeast Asia. They are severely underprovisioned in medical expenses and medical surgical equipment. Luckily, I've had the opportunity to bring surplus medical supplies and equipment from Australia to donate to hospitals here.

"The availability of instrumentation in Australia fit the tremendous need in Cambodia, so I just married the two up. The New South Wales Department of Health came on board very quickly to support the project with some seed money. This enabled me to continue my work, but now I'm moved away from Department of Health funding to groups such as the Rotary Club so now community groups are providing the money to cover my airfare and overseas expenses. Making people aware of the program is just as important putting instruments in the hands of the surgeons themselves."

"I am particularly interested in supplying surgical instrumentation. I approach supply companies for disposal medical products such as dressings, surgical gloves, needles, syringes, intravenous give units, and intravenous giving sets. These are all scarce in the rural hospitals in northwestern Cambodia. And, in the operating theatres we provide general surgical instruments; ear, nose, and throat instruments; cranial surgical type instruments; and orthopedic instruments are very important.

"The surgeons with basic surgical training can recognize the instruments that are being provided so we don't need to supply any training, or technical support. The instruments are medically recognizable, and we make sure that the equipment is low-level technology and suitable to the hospital's ability to cope with it.

"In Australia health services are shifting from the major cities (Sydney, Melbourne, Brisbane, Adelaide) to the rural areas as the hospitals are downsized, and sometimes closed, so equipment becomes available.

"But, we just can't give out costly equipment to any hospital. Some do certain types of procedures, others don't. We first have to look at their needs, and talk to the surgeons. We don't impose what they think we need. We discuss the situation with them, and find out what they need and want. Then we go back to the hospital, issue the equipment, and hand it over to the doctors themselves.

"The deal I make with the people who supply me with their expensive equipment is that we insist that we distribute the equipment, and hand it over to the right people. We don't give it to a government ministry as the temptation to pilfer corruption is far too great. We think that by doing it this way we are being as fair and as objective as possible.

"We can usually cater to the needs of a hospital in a one-off donation, so that we don't have to go back and offer the same sort of aid for a number of years, so you can move on to other hospitals. The assessments are continuing and on-going. A lot of the hospitals I visited last year, I won't need to revisit again, but I will have noticed some others last year that I will check this time and I will do another run around with Australia embassy and probably look at another twelve hospitals.

"Having undertaken the review of hospitals I then gather the equipment, ship them in a container with the assistance of the Australian Department of Defense. When it arrives here, I receive it, break it open and give it out where it is most needed. No distinction is made between military and civilian hospitals. Ironically, the military hospitals are treating civilian casualties throughout the country, and the civilian hospitals are treating the worst of the military casualties."

Brophy says he very impressed by the level of organization and the infrastructure of the health services in Vietnam when he visited there, "The medical staff in Vietnam are extremely conscientious, and well-qualified, and they are very focused on providing quality medical service. The Vietnamese doctors are working for a ridiculously low wage as well - about US$40."

Asked about Laos, and the problems he forsees in delivering equipment there Brophy says, ""The country is landlocked, and one of the poorest countries in the world. It has a ridiculously low per capita income, and since it is of no strategic importance like Cambodia (which gets a lot of assistance) no one cares about it.

"Laotian authorities will be much more difficult to deal with. The Cambodian project is very streamlined because I am running it through the Australian embassy. Getting stuff cleared into Laos will be harder, and it will more expensive getting the equipment to rural areas, and this is my main interest. I want the medical supplies to get into more remote areas and not stay in the city hospitals in Vientiane.

"A major risk area is in the wards where they have maybe one set of dressing forceps, and one set of scissors to go through the entire ward and change all the dressings. So, it is not uncommon for a nurse to have to change dressings of as many as ten amputees on a ward in a given session with no change of instruments, and no sterilization. The risks are absolutely enormous.

"Infection control procedures are very poor, and this combined with the shortage of instruments provides for a higher rate of cross-infection and therefore a higher incidence of blood-borne diseases like AIDS. The AIDS rate is said to be twelve percent among the police and the military in Cambodia, and five percent among the civilian population.

"Unfortunately, many landmine victims have to have a second operation called a stump modification operation in order to fit their prosthesis. When their limbs are first amputated it is usually done in such haste, that the stump(s) just won't fit properly into the prosthesis.

"It is so sad to see these people go through so much trauma just surviving the land mine, getting their leg amputated, recovering, then going down to Phnom Penh to be fitted for their prosthesis, staying in one of the filthiest hospitals I know of, and then being told that they have to have another operation so that they can fit the artificial limb properly.

"It is extremely frustrating to see children and young adults - in many cases the major breadwinners of their families - incapacitated. Especially in a country where a reasonable standard of living is very difficult, and marginal at best. This puts people even further behind the eight-ball, and it makes life even more difficult for them.

"There isn't a lot of consciousness evident from the people who are planting the mines for the implications of their work. And, the problem is not going to go away, it will be with us for a hundred years."

For further info contact Peter Brophy c/o:
Tel: (02) 9382-7505
Fax: (02) 9382-7320

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