For the week of June 13 - June 19, 2001

Photos courtesy Susie Werner

Called to serve 
a world away

Valley nurse devotes time 
to Cambodian children

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By DANA DUGAN
Express Staff Writer

For some people, Cambodia is the killing fields country. For Susie Werner, it’s a country of beautiful children.

Susie Werner feeds children in a Cambodia orphanage.

A Wood River Valley resident and nurse, Werner returned to Idaho in March after spending nine months in Cambodia working at the Angkor Hospital for Children in Siem Reap.

Werner admitted her previous experience working in Third World countries was "absolutely zero," but said that was part of the challenge.

Home of the Angkor Wat Temple, Siem Reap is the third largest town in Cambodia and a center for tourists and international organizations. The temple is considered among the world’s most magnificent historical monuments

Since the hospital opened in 1999, more than 43,000 children have been treated and over 1,200 surgeries have been performed by an international group of doctors and nurses, including Cambodian health care professionals in training.

The hospital owes its origins to Japanese artist Kenro Izu, who, while photographing the temple, was moved by the many children begging outside. Many were disfigured by land mines and in desperate need of medical care.

The sale of 65 expensive platinum photographs raised money for the hospital. The series, "Light Over Ancient Angkor," has been exhibited at major museums around the world, including the National Gallery in Washington, D.C., and the Cleveland Museum of Art.

Along with that gift, Izu organized Friends Without a Border, a multinational charity based in New York and Tokyo, to fund the hospital’s construction and bring health care to this blighted and remote part of Asia.

Beginning at 6 a.m. each day, those in need gather on the outdoor patio to await the free care. Between 100 and 150 children are treated daily in the outpatient ward. The most common cases are upper respiratory tract infections, ear infections, diarrhea, dysentery and intestinal worms.

The hospital also maintains a 35-bed inpatient ward, of which 10 beds are reserved for intensive care of children whose ailments include TB, malaria, dengue fever, uro-genital disease, injuries caused by land mines, typhoid fever and hernia. The hospital has a three-bed emergency room.

For children who are less severely injured but need to stay overnight, there’s a low acuity ward. Many families simply spend the night on the patio, since no one travels at night.

During 30 years of civil war and foreign occupation, many of Cambodia’s medical professionals were either among the estimated 2 million murdered under the Khmer Rouge regime or they fled to the West. As a result, trained health professionals are very rare. Low salaries compound the problem.

"You can be a tour guide, and make $20 a day," Werner said. "Government doctors make $20 monthly."

On top of that, 60 percent of the country’s population is under 18 years old, and most have little education. The practice of going to a hospital does not come easily to Cambodians.

"They will try to do something themselves," Werner said. "If that doesn’t help, they go to a traditional healer--most of them were wiped out too-- and then they’ll go to the market and try to buy something. And then they might go to the clinic and the last resort is always the hospital. When they come to the door they are in extremis."

Werner went to Cambodia to help rectify that situation. She had never been to Asia. She had, however, traveled all over the United States as a nurse and thought she was professionally equipped for the venture.

"I’ve done critical care, research, emergency room, pediatrics, public health. But it’s not just TB in the lungs, it’s TB of the bones, of the stomach, and they’re all malnourished."

There’s virtually no blood supply, because Cambodians don’t believe in giving blood, she said. Backpackers and other tourists give most of the blood.

The major financial and equipment donors are from Japan. The hospital first received one defibrillator, then a couple of monitors and finally a portable X-ray machine. But its needs are still many. Werner pointed out that even if the hospital had all the machines administrators would like, servicing them would still be a problem.

Since administrators knew they would need to depend on foreign staff for the first several years, they decided the first language at the hospital would be English. However, Cambodia medical and nursing school is taught in French, (Cambodia’s second language). Post-graduation there’s a shift to English.

"They’re so bright," Werner said. "Can you imagine growing up in one language, learning another for school and then another to practice in? Their motivation is phenomenal."

The privately funded hospital pays nurses $120 a month, enough to eventually build a house as one nurse did, much to the amazement and pride of her family.

"Most of the nurses and doctors run clinics out of their homes, at what level, and with what equipment and with what proficiency is another story," Werner said.

Among the young patients at the AHC, the boy on the left stepped on a land mine while playing and the boy on the right has typhoid fever.

Werner fell in love with the children. She has many photos of patients she knew and cared for there. They are maimed, diseased, too skinny to be believed but they are smiling. She exults even today at the success stories--how one child wouldn’t look at anyone in the eye, and there is a later picture of him smiling right into the camera; a deaf girl who drew pictures and played games with the nurses; a 2-year-old who couldn’t walk when he arrived and now runs. Her favorite was a boy who had a huge leukemia tumor on his neck. "It stank," Werner said, but they treated it and eventually were able to at least shrink, though not eradicate, the tumor. The boy was sent home to an uncertain future.

His tawny face glows in a photo taken before he left the hospital. So did Werner’s as she looked fondly at the photo.

And then there were the infants. There are five orphanages filled with children and babies in Siem Reap. The nurses realized they had an opportunity to do more than just tend to the children in the hospital and teach the Cambodians.

"The expat nurses got into this project with the orphanage. They stop in and see how the kids are looking and if they need to refer them to hospital."

There are so many children that two of the orphanages just care for babies. But they are severely shorthanded. For instance at one of the baby orphanages there are only two caretakers for 60 kids. When they receive donated clothes and toys, Werner said, the caretakers often sell them to buy food. The allotment for food was under five dollars a day for all the kids.

Because of the expat nurses’ devotion on their own time, Friends without a Border and the hospital in Angkor recognized the needs of the orphanages and adopted the project as part of their outreach program.

The hospital staff is comprised of eight expatriate nurses and four expatriate doctors, eight Cambodian doctors and 40 Cambodian nurses.

"We were teaching a lot to them. As much as they worked, they had lots of classes. And nurses from outlying health centers came for classes but they didn’t speak any English."

The big push, she said, was educating the Khmers. Izu’s goal is to train enough Cambodians to take over in 10 years. Werner calls him the nicest man in the world.

"To start from scratch by an artist--it has made great gains. But it’s amazing what you have to go back to when you don’t have the machines that Americans are used to now."

Instead of high-tech equipment, they relied on non-technical things such as a patient’s history, diet and family. It took Werner three months to accommodate an Asian thought line.

"They don’t plan ahead. It’s a very here and now. For a while I thought it was because they suffered so much, and I think it’s a cultural thing. Buddhism is be here now--that adds to it."

But, she said that didn’t hinder their ability to learn.

Outside the hospital walls a vegetable garden grows next to an outdoor kitchen where mothers cook for their children.

"There’s a lot of B1 deficiency and malnutrition. We’re trying to get them to eat green vegetables and not just polished rice," Werner said.

A rehabilitative play-village was built next to the gardens with funds raised in the Wood River Valley by Barbi Reed, owner of the Anne Reed Gallery in Ketchum. Santa Fe architect Rufo Di Carpegna, who owns land in the valley, designed it pro bono.

It was Reed, a member of the hospital’s board, who initially steered Werner towards Angkor.

"When I was at the hospital for its opening, my thoughts somehow focused in Susie," Reed said. "I spoke with her on my return and to my surprise found out that she was hoping to find a position in a Third World country. The match was perfect."

During the past two years, the expatriate hospital staff has included English, Sri Lankan, Australian, Greek, Japanese and, until recently, American workers. The Americans, though unknown to each other, were all from Idaho.

The hospital rents guest houses for the staff that come with a cook and maid. The staff ride bikes to work and back daily. Parties and dancing, and trips to remote areas to help others, were all part of Werner's life for nine months.

Though she’s returned to the states for now, her life has changed. She is a medical advisor on the board of directors of Friends Without a Border. She’ll be devoting herself to help raise both awareness and more money for the Angkor Hospital for Children. In the meantime, the tireless Werner is off to Alaska to do relief work in the bush for the summer.

However, Werner acknowledged, "It was so hard for me to leave--there’s so much to do."

The Idaho Mountain Express is distributed free to residents and guests throughout the Sun Valley, Idaho resort area community. Subscribers to the Idaho Mountain Express will read these stories and others in this week's issue.