From the frontline 

Editorial Advisory Panel Member, Alvaro Pemartin, works as a Remote Site Officer for International SOS - a challenging, yet immensely rewarding role.

Although our small world is growing smaller thanks to improvements in communication and transport, there are some places that are still far away - places where essential services like electricity or running water are difficult to find and where delivering medical care can be a real challenge.

International SOS faces this challenge every day, providing primary and emergency care, medical assistance and evacuation.

In the early 1980s, Dr Pascal Rey-Herme, a French doctor working for an Embassy in Jakarta, noted the difficulties finding high-quality medical care faced by expatriates working for private companies and international organisations. Together with Arnaud Vaissie, in 1985, he founded AEA International, providing international standards of medical care and emergency medical assistance in south-east Asia. In 1998, AEA International acquired International SOS and adopted its current name.

Currently the company has facilities in more than 70 countries, with 27 alarm centres, staffed by doctors and nurses, multilingual co-ordinators, security experts, and air and ground logistics personnel. The organisation also has 32 clinics, primary, emergency and diagnostic care and pharmacies; and air ambulances in Germany, Nigeria, South Africa, Namibia, China and Papua New Guinea, staffed with 2,500 full-time doctors, nurses, medics and aero-medical specialists. International SOS delivers: Pre-trip medical information; medical check-ups and vaccination programmes; medical staffing; medical supply chain services; medical training; medical consulting; and occupational health.

The company supports workers and expatriates with pre-trip medical and security preparation, provides medical and security assistance abroad and help in emergency cases, evacuates or assures the best level of care in the remote site while assisting the family and response to security crises.

What is it like to work for International SOS? Remote medicine is as fascinating as it sounds. It is about taking care of those who work in places like an isolated offshore rig in the middle of the Northern Sea, or a mine in a western African jungle. You live incredible experiences and meet exciting people. And your medical knowledge and skills are tested on a regular basis, whether confronting a broken ankle or malaria infection, through to a common cold or a severe hypothermia. You are a mix of a general practitioner, emergency physician and an occupational doctor. There is no time to get bored and plenty to learn.

_{The emergency dayshift}

"When amateurs mess with tactics, professionals discuss logistics," the old military adage goes and this can be easily adapted to the concept of remote medicine. Access to the most basic, and sometimes critical, resources or equipment is a challenge, if not an outright nightmare. How and where to obtain fresh water, communication, electricity or essential drugs supplies are the first problems. The simple delivery of a vaccine is not only a medical issue, but the sum of the efforts of a host of managers, logisticians and even lawyers.

And it is certainly international. You may find yourself taking care of a Brazilian worker with a Guinean supervisor supported by a Portuguese nurse and an Italian security chief, while the South African health and safety officer contacts the Senegalese officer for a medical evacuation to a French dispatcher.

From your own medical judgement, combined with your colleagues' experience in the Paris or Sydney assistance centres, that Brazilian worker appears to be suffering from malaria, although the quick test you have performed shows negative?And when all concur to decide on a medical evacuation, the tropical rains prevent the helicopter from taking off.

While you care for your patient whose condition is deteriorating, for another night alone in the jungle, the whole support team is working to back you up.

Remote medicine is not rocket science and never will be (you may think jealously of your comrades in their properly-staffed emergency departments, supported by plenty of diagnostic tests), but the company has made working in these challenging environments a more secure place for all, including remote doctors.

The sun rises, the helicopter arrives and brings your patient to the hospital where the miner receives further treatment and diagnosis - yes, it was malaria!

You celebrate the good news with a mango just plucked from a tree while enjoying the magical view of a dawn in the middle of western Africa, feeling sorry for your comrades at their urban hospitals?

This article was first published in Crisis Response Journal, Vol 8 Issue 1, 2012