The SAMU in the service of
medical emergencies
Annik Bianchini, France
The organization of medical emergencies in France
is based on a co-ordinated network of aid. Permanent medical attention and treatment given
on the spot where the accident occurred, provide patients with greater physical and moral
support and direct them to appropriate aftercare.
At the command post of SAMU-Service d'Aide
Medicalise d' Urgence-there is a permanent staff of four to answer the telephone 24 hours
a day when people dial 15. This two-figure number which is free and the same throughout
France, has operated in Paris since summer 1989. It is available to the public as well as
to those involved in health care and makes it possible to obtain immediate access to
emergency medical care. In a few seconds, the permanent staffs have to be able to evaluate
how serious the phone call is, from an attack of asthma to a road-traffic accident and
from a panic attack to a suspected heart attack. Once this case has been determined and
located, the call is transferred to the controlling doctor. After a short and precise
conversation, the latter sets in motion the appropriate medical measures to be taken for
each individual patient.
In France, the hospital is the pivot of medical
emergencies. The SAMU doctor is the archtype of the public service by physician. He has
chosen to spend nights and weekends in the service of the hospital. Moreover, in France,
it has been decided to send the doctors out. Before reaching the hospital, the patients
have already been treated. Some of them are directly taken to the intensive care unit or
to an operating theater. Medical skills are brought to the patient so as to transfer him,
in the best possible conditions, to the technical center best suited to take care of him,
even if it is not the nearest hospital. Other countries, the United states in particular,
have a completely different health system. The patients are taken to hospital as quickly
as possible. Paramedics or health technicians with first aid training first take them care
of and they arrive without any warning and without anybody having already started to treat
them.
A medically equipped intensive care ambulance: To
treat casualties on the very spot where their emergency occurred and while they are being
transported, the SAMU snds a SMUR, emergency and intensive care mobile service- ambulance.
Each of them contains a mobile hospital unit fitted with important equipment just like in
an emergency and intensive care hospital unit. A team consists of an ambulance man, a real
expert at the wheel able to cope with the most difficult driving conditions. Next to him
there is a doctor, specialized in medical emergencies, accompanied by an intern. On
average, between the phone call and the arrival of the SMUR, it taken ten minutes. If
there is less of an emergency, an ambulance without any medical equipment is enough to
take the patient to the emergency unit of the best-suited hospital, but, in many cases,
the intervention of a medical practitioner will solve the problem. In the mean time, the
controlling doctor will reassure the patient and give him initial advice over the phone.
The SAMU 75, which was created in 1972 at the
Necker hospital, is part of the French and Paris state-owned hospital organization called
Assistance Publique de Paris which shares its funding with the ministry of health and the
general council. "588,000 calls are received by the Paris SAMU every year," Dr.
Daniel Janniere, the deputy medical director of the Paris SAMU points out. "80% of
the emergencies are dealth with by state-owned hospitals". To cope, with emergencies,
the SAMU is able to use a medical helicopter, which is subsidized by the Regional Council.
Throughout France, there is a center for receiving and regulating phone calls by
departement, for an administrative entity of about 500,000 inhabitants. There are
road-traffic accidents and heart attacks but also household injuries and serious
industrial injuries. 24 helicopters belonging to private companies are ready to intervene
at any time. They come in addition to the helicopters of the police force and the civil
defense corps specialized in bringing aid to people in danger.
French know-how exports well: The SAMUs team have
all the necessary equipment to keep informed and to communicate via a vast network
including radio, an independent switchboard to that of the hospital and special lines,
fire brigade, police, hospitals, emergency medical services, SOS me'decines, etc. SOS
me'decins is the largest private emergency doctors' service in the world. They can be
found in all towns of more than 100,000 inhabitants. "It can be said that 70% of the
calls made at the request of the SAMU are addressed to SOS Me'decines", Dr. Pierre
Maurice, vice president of the SOS,France points out.
French know-how in the area of medical emergencies
exports well. It is based on long experience in the field, enriched by partnerships with
several foreign groups. With the support of the ministry of Foreign Affairs, French SAMU
team take part in humanitarian actions in numerous regions struck by catastrophe. French
doctors are also involved in training and research, on an international scale, and act as
consultants in about twenty countries. "Especially in South America and in
China," Dr. Janierre goes on, "where numerous SAMUs already exist". So much
the better as solidarity is a treasure which is not locked away.
Germany: Where does the wall
stand?
-Klaus V. Dohnanyi, Germany
In 1990, one thing was obvious: the products, the
prices, quality and management of the old Federal Republic, and of the West in general,
were so superior to those of the East that, without additional protection, the dilapidated
economic structure of the East would collapse within a few weeks. Incredibly, however, the
"market" economists underestimated the power of the market. And this
underestimation of the consequences of the superiority of the West led to a crucial error
in the strategy used to rebuild the East: market forces and competition not only build
things up-they can also destroy inferior economic systems in open competition. In the
former GDR, this meant that, until at least 1995, when separate statistics were still kept
for East and West-the eastern German "output gap" in international terms, one
would speak of a trade deficit, amounted to more than DM200 billion each year. Even today,
it will not be much lower.
It might have been possible to grant local
suppliers, for example, more substantial advantages when building infrastructure; if
necessary, the existing rules on tender procedures could have been suspended. But such
proposals were immediately rejected; they were disparaged as "market economy with
contraceptives" (Lambsdorff).
The one-sided trust placed in market forces led to
a further mis-judgement with serious consequences: in general, the rebuilding of the
economy was supported in the form of depreciation allowances for investment in the East
and not in the form of a preferential tax arrangement for the "new" Lander
themselves, as the FDP had proposed in 1990. The opponents of a low-tax area feared the
sort of discredited developments associated with the subsidies for former West Berlin.
Today, however, we know that the high depreciation allowances not only favored a formation
of western, rather than eastern, capital, but also resulted in the building of excessively
capital-intensive production sites. These in turn only had a minor impact on employment,
but often resulted in misplaced investment, office buildings, for example, and expensive
over-capacities.
When in 1993 the Federation of German Industries
again cried out for a tax preference for value-added by the manufacturing sector in
eastern Germany, Bonn refused to listen, placing its trust in market forces. Ultimately,
this meant that the Federal Government quite simply failed to utilize its right,
reconfirmed in the Maastricht Treaty, to give the east every sort of state aid
"insofar as such aid is required in order to compensate for the economic
disadvantages caused by… division " (at the time Article 92(2)c of the EC
Treaty).
And so the industrial recovery became slower and
thus more and more expensive. In fact, roughly three-quarters of the annual transfer
payments of approx. DM 150 billion end up being used for consumption and social security;
only one-quarter or so goes into investment. And since, when it came to financing the
rebuilding, the politicians did not dare to take the route which economic logic would
normally dictate, that is increased consumption taxes, value-added tax-here, the political
parties blocked one another), the Federal Government's policy ultimately resulted in the
explosion of debt whose consequences are now placing such a burden on the whole of Germany
in the form of "austerity program".
So whilst it was the GDR policies which dealt the
decisive blows after 1945 to what had once been such a strong economy, after 1989 it was
an over simplified trust in market forces which impeded a more successful recovery of
eastern German Industry and the labor market there. But when making such criticisms, it is
necessary to remind oneself of two things:; Chancellor Kohl recognized and seized, on an
historic scale, the chance to reunify Eastern and Western Europe. And when it came to the
major decisions, his government opted for whar was clearly the right course.
Today the high level of unemployment in the east
marks a German landscape which is deeply divided, both morally and socially. Even ten
years on, internal unity has still not been achieved, and we will have to keep working at
it for many years. This also has serious political consequences.
In the east, the PDS, which is the successor of the
SED, the GDRs communist party, has not only come up closely behind the SPD in the Lander
parliaments: it actually threatens to relegate the SPD to the status of a third force. But
the PDS would never have been established if the western political parties had been as
lenient to SED members as they were to the Nazi party members after 1945. Some talented
individuals in business, science and society were thus unnecessarily driven into the PDS.
At heart, this PDS is still opposed to market economy; like all Marxist parties, it fails
to understand that a country's social strengths need to be underpinned by an efficient
competition driven economy.
Democracy and the market economy are not so firmly
established in the east. And, as the Kosovo war has shown, there are also substantial
differences in the way global political developments are assessed in the east and the
west.
Nevertheless, all those who speak of a fixed
"mental wall"'' in the heads of the people in the east are wrong. Less than half
of all western Germans have been even once to the new Lander during these ten years,
whereas the east is now familiar with the west. So where does the wall stand?/ The rift
keeping the two parts of the country apart is a social division. It is easy to claim that
the east Germans "hold their hands out"' and have a "free rider"
mentality. No where else in Germany are the workers as flexible and hard working as in the
east. But they do need to be shown where the opportunities lie. Actually seizing these
opportunities themselves is something foreign to many of them. But if the east had a
supply of jobs, a proper infrastructure and thus a self-confidence like that to be found,
for example, in the Ruhr district, another area hard hit by unemployment, the east would
be extremely successful, and the political perspectives would also be closer together. In
fact, in those places where more progress has been made on industrial reconstruction in
the east, the rifts in society have largely been healed. (Text IN-Press, courtesy: Embassy
of Germany, Kathmandu).
-26 March: On the eve of national day of
Bangladesh-
International Mother Language Day: 21 February
-Prof. Kabir Chowdhary, Dhaka
UNESCOs declaration of 21 February as the
International Mother Language Day has brought fresh glory and prestige to B'desh, which is
making significant strides towards peace, progress and prosperity at home and discharging
international obligations abroad. After 1952, the people of B'desh have been observing
year the 21 February as their glorious and unforgettable Language Martyrs day. What
happened on 21 February 1952 is widely known.
The language of the people of eastern wing of
Pakistan, and they were the majority, was Bangla. It had a rich tradition of literature of
over a thousand years. The Bengalese also had a highly developed culture that had little
in common with the culture of the people of the western wing of Pakistan. The Bengalese
love for and the attachment to their language and culture was great and when in 1952 the
arrogant rulers of Pakistan declared that Urdu and Urdu alone would be the state language
of Pakistan, they sowed the seed of its future disintegration.
The people of the then east Pakistan, particularly
the students, rose in angry protest against the vicious undemocratic designs of the
government. The reaction was strong and spontaneous. The government decided to quell the
protests by brute force. The police opened fire on 21 February 1952 on unarmed peaceful
protesters, most of whom were students, resulting in the death, among others, of Rafiq,
Barkat, Jabbar and Salam. As the news of those deaths spread, the entire people of the
eastern wing felt greatly involved emotionally. Those who lost their lives to uphold the
prstige and defend the rights of their mother-language became hallowed martyrs.
21 February became a symbol and attained mythic
properties. It nourished the concepts of democracy and secularism. It also contributed
significantly to the flowering of Bengalee nationalism. It led to the dawning of the
realization in the minds of the Bangalees that they constituted a separate nation and
their destiny lay not with Pakistan but elsewhere as an independent country.
At the initiatives of the UN and various organs, a
number of specific days have been declared over the years as international days for
observance by the people of the whole world. International Mother Language Day is
particularly significant in the sense that it has a cultural importance. From now on, 21
February-so long observed in B'desh as the Bangla Language Martyrs' Day-will be observed
here simultaneously as the Bangla Language Martyrs' day and the International Mother
Language day.
He declaration made by the UNESCO in November 1999
designating 21 February as the International Mother Language Day has placed B'desh on the
cultural map of the world with a highly positive image for it was Bangladesh and the
language movement launched by her people that reached a climatic point on 21 February 1952
will be referred by the people's of the world while they would be observing their language
day. We shall love, cherish and promote Bangla, our own mother language, but we shall not
indulge in any kind of chauvinism.
Long live 21 February-the International Mother
Language Day.
(Text courtesy: B'desh embassy in Kathmandu.
Excerpts only-chief editor). |
