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hotline International SOS Worldwide Journal 20 ANNIVERSARY OF INTERNATIONAL SOS TH 1985-2005 Contents 04 A PASSION FOR QUALITY CARE AND SERVICE International SOS founders, Dr Pascal ELCOME to this special edition of W Hotline. To mark the 20th anniversary of International SOS, this Rey-Herme and Arnaud Vaissié, talk about the genesis of the company and the changes they have seen over 20 years. 07 A DOUBLE SUCCESS Dr Rey-Herme remembers a day in 1985, issue is devoted to a review of just some which stretched International SOS resources to the limit. of the milestones in the company’s 08 A 20-YEAR PARTNERSHIP history. It looks back at a few of the more A focus on BP, with whom International SOS has been working for 20 years to dramatic events from the past 20 years. provide a duty of care to its employees, their families and local communities throughout the world. There are memories of International SOS 10 HOSPITALS IN THE AIR in the early days, of individual clients and A look at the vital work played by International SOS’s global ﬂeet of members, and recollections from air ambulances around the world. International SOS people who have played a key role in the company’s development. It also highlights more recent initiatives, which today support the delivery of services to the millions of clients and members that International SOS is proud to serve around the world. 2 INTERNATIONAL SOS 18 04 08 10 12 PIONEERING A NEW 22 THE WORLD AT YOUR FINGERTIPS 34 WIDENING THE NET SERVICE CULTURE A close-up of how International SOS’s A spotlight on SPIN - the tool for Personal memories from Dr Inggriani clients can harness the power of accessing International SOS’s 24-hour Gandha of the opening of the very ﬁrst technology to provide a global duty network of medical and other providers. International SOS clinic. of care. 35 SAFETY IN THE SKIES 14 ALL HANDS ON DECK 24 A VITAL 20 HOURS The story of how one Lufthansa passenger Recollections of the early days at International SOS medic Patrick Deroose received vital medical care on a long- International SOS’s ﬁrst alarm center, recalls a mass medical evacuation from Bali. distance ﬂight. and the rapid response they provide today. 26 ANYWHERE IN THE WORLD 36 SUPPORTING PATIENTS How International SOS is delivering IN A NEW WAY 17 STRAIGHT FROM THE TOP healthcare services in some of the A look at the new service provided to How International SOS’s most senior remotest regions on earth. patients who need to take prescribed medical team is involved in delivering medication long term. front-line care. 30 A CHANGE OF GEAR IN OCCUPATIONAL HEALTH 38 ADDING VALUE 18 EVERYBODY OUT A conversation with Dr David Cook about How International SOS’s logistics The dramatic events that unfolded during the importance of occupational health expertise is helping clients to deliver Indonesia’s civil unrest in 1998. services and how they have changed over premium services to their customers. the years. 21 MORE THAN AN 39 KNOWLEDGE IS POWER EMERGENCY SERVICE 32 WHERE OTHERS FEAR TO TREAD Innovations in technology mean that How one International SOS doctor views An insight into the work undertaken by patients can now be monitored in real the importance of membership. International SOS for governments and time, irrespective of where they are in NGO’s in some of the world’s hotspots. the world. Designed by Andrew Kellard Associates +44 (0) 1483 549095. 26 38 HOTLINE - ANNIVERSARY EDITION 3 INTRODUCTION 4 INTERNATIONAL SOS A passion for quality care and service Since they founded the company in 1985, Dr Pascal Rey-Herme and his childhood friend Arnaud Vaissié have seen the company rise from humble beginnings to become the world’s leading provider of medical assistance, international healthcare and security services. How did the company begin? open-pit coal mine in Kalimantan, Borneo, and Pascal: I was working in Jakarta as Medical our remote site services began. Today we run over Attaché for the French Embassy and observed how 200 such operations, with hospitals and clinics, medical care in Asia was very much based around taking care of tens of thousands of people the hospital. I felt that there was a big opportunity including both employees and the local population. to bring in a European model of ‘pre-hospital care’, including a medical rescue service. Arnaud was Arnaud: We were very small at ﬁrst, with just two based in San Francisco at the time and I persuaded small clinics in Singapore and Indonesia, and 14 him to join me in setting up this new venture. staff. But we saw tremendous growth from day one. Although at ﬁrst we only had small pieces of Arnaud: I was told that you should never go into business, they were with large clients such as BP, business with your friends – but we’ve proved that Schlumberger and Alstom, with the potential to it can work! We gave each other support and grow. I’m delighted to say that all our clients from fortunately our styles are complementary. our early days are still with us today, as are many Naturally we have our differences but when it of our original employees. comes to the major decisions, we have always been in agreement. Essentially our early vision Pascal: Our first plane was a small Beechcraft was the same as it is now – to offer complete that we had to convert ourselves by ripping out healthcare solutions to organizations and seats. On one of our first evacuations out of institutions – ﬁrstly in Asia and now globally. And Dacca, we had to stop in Rangoon without from day one we have both been passionately permission and were promptly arrested! Our nurse committed to quality service – something that will was actually on her first ever flight and must have never change. wondered what she was getting into. We now have a fleet of ten state-of-the-art air ambulances, and How did the business develop in the at any point in time at least one of our planes will early days? be in the air. Pascal: We started with medical evacuations and clinic services, with most of our patients being Arnaud: Having clinics wasn’t part of our original expatriates working in Indonesia and Vietnam. idea, but we soon realized that this gave us a base However, as many of these people were working in to employ and train specialists, which is now one remote locations and employing large local of our core strengths. Now we have 24 clinics populations, it was a natural progression to move around the world, but they all stay true to the initial into broader healthcare consulting services. Then concept of 24/7 pre-hospital and emergency Rio Tinto told us it was building an enormous services. HOTLINE - ANNIVERSARY EDITION 5 INTRODUCTION Tell us about some other key milestones Arnaud: In many cases we’ve simply been responding to client demand. Security services are a good example of this natural evolution. During the 1998 crisis in Indonesia we had to carry out a large-scale evacuation of foreigners from Jakarta. At that time we weren’t openly offering specific security services but having proved our capabilities we have integrated this into our portfolio. By bringing in security specialists we utilize our existing global infrastructure, and the majority of our clients now use both security and medical services. We are always looking to improve existing services and grow new ones – in fact 40% of our existing business is with services developed in the past five years. We also encourage our operating units to be innovative. Our Australian ofﬁce developed a patient compliance service with Roche, offering support to patients on long-term therapies, and this has been so successful that we’ve now rolled it out worldwide. Arnaud and Pascal relaxing on the Great Wall year, this speeds up our service and radically Pascal: Our online services really proved having obtained the right to open an improves the quality of our decision-making. their value during the SARS epidemic, International SOS clinic in Beijing in 1989 where there was a huge need for accurate, Pascal: It also allows us to stay true to our practical information on a daily basis. Our initial ideas – where a customer will always general attitude is: “if it needs to be done, reach a trained professional who can we’ll find a way to do it”. This was amply understand his or her situation and quickly demonstrated during the recent SARS pass the caller onto a medical or security epidemic. We were told that we couldn’t professional. evacuate patients due to the risk of infection, so our team lead by Dr Roger Farrow, Arnaud: To achieve the global reach that our quickly developed a Portable Medical clients demand, we have had to expand Isolation Unit (PMIU). quickly, and acquisitions have played a big part in achieving this. Of course the biggest What are the main challenges now single addition was the purchase of that the company has grown so large? International SOS Assistance in 1998, which Pascal: We have to sustain the same culture Laurent Sabourin speaking at the inaugural meant we became a global rather than a and values that have driven us from the start: ceremony of the ofﬁce in Taipei predominantly Asian company, with a far a medical heritage and a passion for patient bigger US presence. care. Now that there are over 4000 people, we have to work harder to achieve this, and What about the future? recruitment and training have a very big role Pascal: My main aim is to ensure that we to play to ensure we maintain quality control. continue to offer the highest quality service Arnaud: Logistics is a key development area, “40% of our to our clients. To achieve this we need to attract a new generation of dedicated as we serve more and more clients and professionals. Arnaud and I were 30 when individuals, and IT plays a central role. We have recently invested millions of dollars and existing business we started the business and we want to bring in talented 30 year olds to keep driving the thousands of man-hours into a new global case management system called Magellan. is with services organization forward. This means that anyone dealing with a patient’s case from an alarm center will see developed in the Arnaud: Innovation is the key: providing unique new services and as Pascal said, the same details in real time, enabling us to attracting the best talent in the world. I create virtual coordinating teams with doctors from around the world. When you past ﬁve years” spend a lot of time interviewing, and see this as my number one responsibility – to ensure consider that we handle over 600,000 cases a ARNAUD VAISSIÉ we all get the very best people to join us. s 6 INTERNATIONAL SOS FIRST EVACUATION A challenging ﬂight Unfortunately the landing ﬁeld at the mission was too short for the HS 748, so we arranged for a light aircraft belonging to the missionaries to meet our incoming team at Banjarmasin and take them and whatever equipment they could ﬁt into the small aircraft on to the mission. From Jakarta we contacted the Indonesian authorities to get landing clearances at Banjarmasin airport at sunrise (the airport had no facilities for night-time take-offs or landings). The pediatrician, the mother and her premature baby were squeezed into the light aircraft and taken to Banjarmasin, then transferred to the HS 748. The head of immigration was waiting at the aircraft with the necessary travel documents, and the A double mother and baby were rushed to Singapore. Weighing just 1.9kg, the baby was taken straight to hospital where I’m pleased to say both mother and baby recovered well from success their ordeal. Another emergency At the same time as we were harnessing our resources to save the baby, another request came in, this time from Malaysia. An American oil worker had been transferred from an offshore platform to his company clinic in Kerteh. Suffering from a heart We asked Dr Pascal Rey-Herme to tell us about some condition, he needed urgent transfer to hospital in Singapore. As the HS 748 was of the ﬁrst medical evacuations he was involved with already being used to transport the baby, the for International SOS. Here he remembers one only aircraft available to us was a much smaller plane called a Queen Air. afternoon in 1985 when his team received two With our Singapore escort team already ﬂying to Indonesia to care for the baby, I went simultaneous calls for help. on the journey to Kerteh to escort the patient to Singapore. On arrival I discovered that he was 1.95m tall and weighed over 140 kg. (These days it’s standard procedure to check Vital help and support A JAKARTA-BASED church which ran a small remote mission in Kalimantan, Indonesia, heard that the wife of a foreigner Through the night an obstetrician and pediatrician in Singapore gave vital help and this type of information before a ﬂight.) With considerable difﬁculty we got the patient, the pilot and me on board. We then ﬂew back to working in the area had arrived at the support to the mission’s health officer by Singapore where we landed at the same time mission’s medical center in premature labor. phone while the baby was delivered and then as the baby. I will always remember one of At that time, the only way to communicate resuscitated. At the same time, we were our Singaporean nurses exclaiming at the with the mission was by radio. We already assembling a pediatric team from Singapore time: “So, you put the big patient in the small had an arrangement with Singapore Radio and equipping an HS 748 aircraft to fly out plane and the small patient in the big plane!” (which supported shipping ﬂeets in that part to Kalimantan as soon as possible. After carefully extracting the patient from of the world) whereby we could patch our Our team in Jakarta managed to contact the small plane, we transferred him safely to telephone with their radio. In this way, we the head of immigration in Banjarmasin at hospital. Facing many challenges, we had were able to establish a radio link with the home that night to convince him to issue a successfully completed two evacuations at the mission. travel document for the new-born baby. same time. s HOTLINE - ANNIVERSARY EDITION 7 FIRST CLIENT A 20-year the managers who was using our clinic. He was invited to visit the site, undertake a partnership survey and set up protocols for malaria. He also arranged an evacuation service using our clinics and alarm centers in Jakarta and Singapore. “The relationship with BP is ongoing. I think the reason why we’ve been successful is because we have common goals: we were able to provide them with locally based International SOS has been working with BP for 20 services. Local knowledge is so important. If you break your leg in Singapore, there’s no years. Sandy Johnson who joined the company in 1985 big problem because medical services are available. If on the other hand, you’re with a recalls that right from the start, she saw the geo-thermal crew in Sumatra and you break your leg, it’s a completely different situation. importance of combining international standards with It’s not possible to undertake night ﬂights on helicopters. We had to develop detailed plans local knowledge and experience. for BP to evacuate people by road ambulance to a point where the aeromedical evacuations could be done by ﬁxed wing. “Over the years we’ve maintained an unwavering, uncompromising commitment to “I WAS BASED in Singapore in 1985 and met two charming French gentlemen through a friend of mine who was a nurse and PARTNERING WITH BP quality. I’ve always been absolutely sure that we would get the job done. Arnaud and Pascal lead from the front and there is had done medical evacuation work for them. accountability through every layer of the They were looking for somebody to “Our relationship with International SOS organization. I call the company a diamond – communicate with American and Western has been successful because they it has many facets, with a core integrity.” clients operating in Singapore and Jakarta. understand our business needs and our Having grown up in Texas and with the oil culture. International SOS teams can Assistance in partnership industry, I was very aware of the importance work seamlessly with our staff in the International SOS has been working with BP of medical evacuations and was fascinated by ﬁeld and provide specialist skills, advice for 20 years, helping to ensure the well-being the work that Pascal and Arnaud were doing. and experience where needed. of employees, their families and local “I joined as Director of Marketing in July International SOS has the global reach communities throughout the world. 1985. At that time there were many European we need combined with vital local As one of the world’s major energy and North American companies operating in knowledge. Its network of alarm centers companies, BP is committed to meeting its Indonesia who were drilling for oil and gas in and family-based clinics is a very useful corporate responsibilities to the environment, the area, as well as organizations providing resource for BP worldwide.” to its people, and to the communities in support services to them. It was natural for us Dr Alison Martin, Health Director, which it operates. It’s an ethos that to work with these companies because they Exploration & Production, BP International SOS readily understands and the had a speciﬁc need we could help them with. two companies have worked closely together “We also worked extensively with “The security of our employees across the at a global and local level. embassies, insurance companies and private globe is of paramount importance. In citizens who were looking for real-time local, order to assure ourselves of our ability to Work on projects medical support. Unlike the European relocate any of them in times of crisis, International SOS’s relationship with BP assistance companies at the time, who had no we have contracted on a long-term basis started in 1985, when Dr Pascal Rey-Herme physical presence in Asia, we had people on with International SOS to take advantage was asked to assist with a malaria outbreak at the ground and had developed very strong of their expertise and capability to effect one of BP’s remote sites. International SOS’s relationships with doctors and hospitals in the such emergency relocations, and have involvement with BP’s anti-malaria programs region. tested that capability in a real situation still continues today. “Our ﬁrst client was BP. They had with great success.” Since then International SOS has been operations in Sumatra and at the time had a Nigel Carpenter, Deputy Head, Group involved with many of BP’s largest projects. problem with malaria on one of their remote Security, BP International SOS is often there right from sites. Pascal heard about this through one of the start – delivering primary and emergency 8 INTERNATIONAL SOS FIRST CLIENT Security services Four years ago, the Global Membership Agreement was broadened to include security assistance services, which International SOS provides to BP on the same partnership basis. Again, International SOS teams are organized to align with BP’s own security divisions. 24-hour security advice and evacuation assistance is available to BP employees abroad, and International SOS experts work on BP’s projects providing advice and support on security and risk management. In just one example, an International SOS team provided security consultancy to BP’s contractors and sub-contractors in Baku, Azerbaijan. Having carried out a detailed gap analysis of current procedures and systems, they made recommendations for effective security risk management and contingency plans that met BP’s standards and requirements. In Kuwait, International SOS was responsible for the evacuation of 65 BP employees just before war broke out in Iraq in February 2003. Medical services support International SOS’s medical services support Picture courtesy of BP some of the largest energy and exploration projects in the world today. International SOS is currently providing a full suite of project-based medical services to a number of BP projects across the globe including the: care services to workers on site. As each Namconson Liqueﬁed Natural Gas (LNG) project develops, employees’ families join project in Vietnam, Tangguh LNG project in them and local people are hired. So the Papua region of Indonesia, various BP International SOS broadens its service to projects in the Caspian region and new include the full spectrum of healthcare in the ASSESSING THE HEALTH OF ventures in Russia, including Sakhalin Island community, including family and in far east Russia. THE LOCAL COMMUNITY IN occupational health services. TANGGUH, INDONESIA Growth and evolution Global agreement The partnership between BP and In 1999, after a number of highly successful Among the many projects International International SOS has grown from the close projects, BP and International SOS SOS has been involved in, is one for BP involvement of one doctor to the fully recognized that a more strategic approach was in Tangguh - the development of a structured corporate response service it is needed. They developed a Global large liquefied natural gas (LNG) today. Martin Dennett is Business Membership Agreement which put in place facility. Development Director for Energy, Mining consistent mechanisms for looking after the As part of BP’s environmental and Infrastructure at International SOS: “By health of all BP’s personnel when they were impact assessment, International SOS aligning ourselves closely with BP’s outside their home countries. developed and carried out a baseline business, we can deliver comprehensive The agreement means that International health survey in the local area, Bintuni solutions to help provide a duty of care to its SOS can work closely with BP in a consistent Bay. This work assessed the state of employees and their families. BP takes its and structured way. International SOS’s health of the community, so that BP corporate responsibilities seriously, and in medical teams are aligned with BP’s own could review the potential impact on partnership with them we can help to ensure medical divisions, and its global network of the health of its employees and the that medical and security risks to employees, alarm centers and clinics are accessible to BP project overall. their families and local communities are employees when they’re working abroad. managed effectively.” s HOTLINE - ANNIVERSARY EDITION 9 Hospitals in the International SOS’s air ambulances are a vital three dedicated aircraft, we make over 100 medical transports a month between our link in providing ‘bed-to-bed’ care for patients. resources based in South Africa, Botswana and Namibia. We have been as far aﬁeld as the Maldives, Ascension Islands, Canary Islands and Diego Garcia. Overall, more than A SIX-YEAR-OLD child was lying in a hospital bed in Abidjan in the Ivory Coast following a snake bite. International the rest of Africa,” explains Dr Fraser Lamond, Regional Medical Director Southern Africa. “Logistically our jet air ambulances two thirds of all the patients brought into South Africa for medical care are handled by International SOS.” SOS doctors in Johannesburg were can access anyone up to ﬁfteen degrees north monitoring his condition, but one vital piece of the equator. We are also supported by our A growing ﬂeet worldwide of information was missing: what kind of air ambulances based in Europe which can From the early days it was a real challenge snake had bitten him? They decided it was also overlap this area into sub-Saharan Africa getting quick access to suitable aircraft for too risky to wait. thereby allowing us to efﬁciently cover the the medical teams operating out of Jakarta It was June 2000 and the newly entire continent.” and Singapore. This prompted the company to commissioned Falcon 10 air ambulance was And the demand for evacuations to South think seriously about investing in its own jets. about to make its ﬁrst medical evacuation. Africa has spiraled in recent years: “With Since the Falcon 200’s maiden air Within hours the boy had been picked up and ambulance ﬂight from Singapore in 1997, ﬂown, with the unidentiﬁed snake in tow, to a International SOS has expanded its ﬂeet to modern hospital in Johannesburg, where he ten, making it one of the world’s largest air was placed in intensive care. ambulance service providers. With bases in It turned out that the bite came from the Germany, Russia, South Africa, Namibia, potentially deadly West African Carpet Viper Botswana, Singapore, China and Papua New and would probably have proved fatal in this Guinea. The speed and range of the aircraft child. The boy was given the appropriate enables International SOS to reach patients serum but also needed to be on a ventilator. virtually anywhere in the world. There are a He made a full recovery and was able to variety of aircraft including Learjet, Falcon, return home a few weeks later. Hawker and even turbo props that can land in “With its high quality of medical facilities, particularly difﬁcult terrain where there may South Africa – and Johannesburg in particular be no proper airstrip. – is very strategically placed in relation to The aircraft are quite literally ‘intensive 10 INTERNATIONAL SOS AIR AMBULANCES air MAKING A DIFFERENCE ”FROM the moment we arrive on the scene, we’ve upgraded the quality of care”, says woman in Mozambique with 60% burns. We had a very bumpy ride due to bad weather Dr Tyrone Richards, Deputy Medical Director, and we had to use a tube to get oxygen into care units in the sky’, carrying everything International SOS, South Africa. “Medical her lungs. necessary to cope with a medical emergency, facilities are virtually non-existent in many “On landing in Johannesburg we rushed her including resuscitation equipment, oxygen, parts of Africa, so we can offer real hope for to a preferred hospital. It was touch and go infusion pumps and a full range of drugs, the patient. but fortunately she pulled through and three ﬂuid and supplies. “Each day is a new adventure; you never months later was back home, working again. “All our medical staff is fully trained in know where you may end up. One of our most It’s so satisfying to know that you’ve made a aviation and emergency medicine and has dramatic rescues involved a ﬁfty-year-old difference.” extensive medical evacuation experience,” says Dr Arnaud Derossi, International SOS’s Regional Aviation Medical Director for the alarm centers manage all the logistical helicopters, and communication with staff at EMEA region. “They can manage adults, aspects of an evacuation. The nerve centers clinics and hospitals to prepare them for the neonatal and pediatric cases, with the most are the four regional aviation units in patient’s arrival. common conditions being cardiac conditions, Frankfurt, Johannesburg, Singapore and traumas, infectious disease, head and spinal Philadelphia. Bed-to-bed care injuries. Dr Derossi explains some of the key “It’s capability, continuity and quality of care “Medical missions need to be ﬂown by challenges in creating an integrated support that distinguishes our service,” Dr Fraser pilots who are expert in air ambulance structure: “Access and landing permits are Lamond tells us. “We offer a high standard of processes and knowledgeable about the critical to the success of a mission and our medical care and attention throughout the medical team’s requirements. They also need centers can obtain landing clearances and transportation process. And every detail to have the experience of dealing with the coordinate the complex set of activities counts: we deliver a safe reliable service to logistics of ﬂying in and out of remote sites required at destination airports”. those who need it. where conditions may be rudimentary. And when every minute can literally mean “The integrated nature of International “Although the vast majority of ﬂights are the difference between life and death, local SOS’s local, regional and international on our own jets, we also have access where knowledge and contacts can help get you network means that from the very ﬁrst call, necessary to a range of other aircraft through customs and immigration quickly. we can manage just about any logistical including executive jets, helicopters and even “We recently evacuated a seriously ill patient challenge and deliver medically appropriate military aircraft or wide-body aircrafts.” from Tajikistan to London, which required services and support. clearance across seven different countries’ air There are many decisions to make during Sophisticated logistics space.” an emergency: ﬁnding the quickest and best Whilst the pilots and paramedics on board are The coordination activities also involve the transportation should not have to be among at the sharp end, the aviation specialists in the utilization of ground ambulances and them.” s HOTLINE - ANNIVERSARY EDITION 11 FIRST CLINIC Pioneering to work at the clinic. “What Dr Rey-Herme emphasized right from the start was that the patient was at the center of any decision that was made”, says Dr Inge. For her, this was perhaps the most important aspect of the clinic at that time. “We were teaching our doctors to see their a new service culture patients as customers. This was a very different ethos for clinical services in Jarkarta – and is still the foundation of every International SOS clinic today.” Dr Inggriani Gandha joined AEA Growth and change As the years passed, the number of clients International, now International SOS, in and members visiting the clinic grew steadily. “At the ﬁrst clinic we saw around 1985. She was part of the team that 900 expatriate patients and the numbers just went up. By 1991 we needed new premises opened the ﬁrst clinic in Jakarta. to accommodate our growing client base and we opened our second clinic – where we’re still based today.” Increasingly the client base grew to R INGGRIANI Gandha (known locally As well as delivering primary healthcare include local people as well as expatriates D as Dr Inge) trained as a doctor in Indonesia. She spent 11 years in Germany, services to expatriates and their families, the clinic pioneered emergency care to patients and eventually the balance tipped. “These days we see around 6,500-7,000 patients studying in Aachen and specializing in before they were evacuated, often to hospitals every month”, says Dr Inge, “With around gynecology. In 1983, she returned to in Singapore. “We have always been strong 60% of them coming from the local Indonesia and joined AEA International (now on our emergency response capabilities. Back population”. International SOS). In 1985 she was part of when we ﬁrst started, the type of service we the team that opened the ﬁrst clinic, in offered was virtually unheard of in The clinic today Jakarta. Indonesia.” Today’s busy clinic has around 300 staff, including 40 doctors on site. “We see patients First beginnings Changing the culture of all ages, and many of the children at the “We set up the ﬁrst clinic in 1985 in Jakarta As well as pioneering new services, the International School in Jakarta come to us”, because we needed a place where patients clinic was forging a new, more service- says Dr Inge. The range of services has could be stabilized before being evacuated”, oriented culture among healthcare expanded over time to include a dental Dr Inge explains. “At that time, there were professionals. Dr Pascal Rey-Herme practice, a pediatric practice, a diabetic clinic, 24-hour clinics in the city, but they were recruited and trained a team of local doctors a well-woman clinic and a weight-control staffed by operations people who would ring a doctor only if they decided it was necessary. With around 31,000 doctors and a population of 180 million in Indonesia, getting to see a doctor could be difﬁcult. Ours was the ﬁrst clinic to offer direct access to a full clinical team, around the clock.” Establishing services Opening the new clinic was fraught with practical difﬁculties and challenges. “We struggled even to get a telephone line installed,” she remembers. After just a few months, and with a small medical and operations team in place, the clinic opened its doors. “In the early days, a large proportion of our clients were international oil and mining companies”, says Dr Inge. “They came to us because they knew their people would get access to international standards and procedures they recognized.” 12 INTERNATIONAL SOS FIRST CLINIC INTERNATIONAL SOS clinics operate in countries where medical care of an international standard is unavailable, or where cultural and language barriers make it difﬁcult to receive appropriate care. Each clinic offers primary care, diagnostic care and 24/7 emergency care. Services include family practice consultations, pediatrics, ophthalmology Reception of the International SOS clinic in Jakarta and occupational health programs. Clinics are well equipped with the facilities needed to stabilize a critically ill or injured clinic. “We also do a lot of medical check-ups healthcare services on every continent. She person before evacuation. Many clinics for companies as part of their employee speaks six different languages and have international-standard pharmacies, healthcare programs. Of course the percentage understands cultural differences in the laboratory services and diagnostic services. of emergency cases is small – but we provide delivery of healthcare around the world. Many are also equipped to offer x-ray and dedicated intensive care,” she says. “My time in Germany was instructive in ultrasound tests, dentistry, physical “Our clients today still value international terms of getting experience of international therapy and counseling. medical training and standards. While standards”, she says. “I’ve learned about the There are 24 International SOS clinics English language capabilities are critical, the differences in emphasis and expectation in worldwide in the following locations: spectrum of nationalities among our staff is different countries. And of course sometimes wide, including Australian, South African, you have to adjust your approach to your Angola: Gamek American, Malaysian, Philippine, French, environment. But international standards of Ilha German and British.” medical care are essentially the same Azerbaijan: Baku everywhere – and that’s what we are here to Cambodia: Phnom Penh International standards provide. Whether you’re in Moscow or During her career, Dr Inge has traveled Beijing, the standard of care you’ll receive is Chad: N’Djamena extensively and gained experience of the same.” s China: Beijing Nanjing Shekou Tianjin “Dr Rey-Herme Indonesia: Jakarta (2) Bali emphasized right Kazakhstan: Almaty Atyrau from the start that Mongolia: Ulaanbaatar Myanmar: Yangon the patient was at Nigeria: Lagos Port Harcourt the center of Warri Russia: Moscow any decision that Vietnam: Yuzhno-Sakhalin Hanoi was made” Ho Chi Minh City Vung Tau DR INGE, INTERNATIONAL SOS HOTLINE - ANNIVERSARY EDITION 13 hands on alarm center Allﬁrst International SOSdeck at the Dr Roger Farrow has been with International SOS since 1987. He ﬁrst started on a locum basis when he was Commanding Ofﬁcer at the New Zealand Military Hospital in Singapore and is now Chairman of the Corporate Assistance Department. F OR 18 YEARS, Dr Farrow has been closely involved with the development of the International SOS alarm center network. mobile phone. It was huge, and the networks weren’t great, but even then we were leading edge in terms of telecoms and technology.” they are today, but we were doing frequent medical evacuations so the level of expertise was high and the process very efficient. We Here he looks back at the early days, at what learnt right from the start about the has changed – and what has stayed the same. Early days importance of harnessing the “Back when we ﬁrst started, it was all Sharing and swapping apartments and complementary skills of both expatriate and hands on deck”, he says. “Arnaud [Vaissié] traveling between Jakarta and Singapore, Dr national staff – just as we continue to do and Pascal [Rey-Herme] were involved with Farrow and Dr Rey-Herme were on constant globally today. This mix of expertise has every case, with Pascal and I always on call call at the Singapore and Jakarta alarm been a key element in the company’s to give medical assistance to clients and centers when in 1989 the Hong Kong alarm success.” undertake medical evacuations. This was in center opened and additional medical staff Zaleha Hassan also worked at the the days before mobile phones, when we came on board. “There were a lot of mining Singapore alarm center in the early days. each carried pagers and bags of 10-cent coins and infrastructure companies in Asia, and a “Back then we did everything ourselves”, she ready to rush to the nearest public phone. I large population of expatriates and families. remembers. “We rushed to embassies to apply remember sharing our very ﬁrst Ericsson Medical facilities were certainly not what for visas, picked up medication, ﬁlled up 14 INTERNATIONAL SOS FIRST ALARM CENTER oxygen tanks locally, and went to the airport to check in patients ahead of repatriation.” “The soul of the sophisticated medical equipment available today, we had to take the utmost care to monitor the patient to make sure he remained Pioneering evacuations Modern aviation has made the medical company, its stable through each stage of the ﬂight.” On another occasion, a Singaporean boy transportation of patients faster and less stressful. Roger Farrow continues: “I humanity and had to be ﬂown back urgently from Kota Kinabalu, where the airport was already remember in 1988 we completed a pioneering evacuation of an extremely sick compassion, have closed. Dr Pascal Rey-Herme asked Lisa Tan, who was the only Malaysian in the company patient by air ambulance from Singapore to a at that time, to talk to the Malaysian hospital in London. This was before the advent of the non-stop long haul 747 400 been preserved” authorities to convince them to open the airport especially for the mercy ﬂight. The aircraft and when there were few air ROGER FARROW, INTERNATIONAL SOS airport authorities readily agreed to do so ambulance aircraft available. We used a Lear once the urgency of the situation was 36 to make the transcontinental ﬂight, explained. stopping at Madras, Abu Dhabi and then Lanaka in Cyprus before ﬁnally landing at Soul of the company Heathrow. Stopping in the middle of the The years since have seen the rapid growth night, while the aircraft was being refueled of International SOS, with hundreds of new needed careful planning. With little of the staff joining and new alarm centers and clinics opening throughout the world. This might have meant a lot of change – particularly for longer-serving members of the team. Dr Farrow doesn’t agree. “Yes, SERVING INTERNATIONAL SOS’S today’s alarm centers are incredibly efﬁcient JAPANESE CLIENTS AND MEMBERS operations, with systems and technology that we wouldn’t have recognized even 10 years ago. But the heart of what we do is the same. INTERNATIONAL SOS delivers services Jakarta, Hong Kong and Brisbane to audit our The soul of the company, its humanity and speciﬁcally designed and tailored for its operations. We were able to demonstrate our compassion, have been preserved. Japanese clients and members. consistency of approach. More importantly, “I always liken Pascal and Arnaud to the Lisa Tan joined International SOS in 1988. we demonstrated our understanding of Asia queen bee in a bee hive. Just as the queen She spent two years setting up and and the Japanese market, and showed bee affects and directs the behavior of the upgrading International SOS's alarm center intimate local and cultural knowledge. The whole hive, so in the same way Pascal and operations in Seoul and Hong Kong. In 1991 key win for us was our geographically Arnaud’s strong medical and personal ethics she returned to the Singapore alarm center balanced network, which met the and their passion for excellence have shaped as Operations Manager. She remembers how expectations and requirements of Tokio this company and the people who work in it. the International SOS Japanese Desk first Marine in Asia Paciﬁc at that time. Today, we I’ve been strongly inﬂuenced by them both came about. provide services to Tokio Marine on a global since the day I ﬁrst met them. And in turn "Our Japanese clients and members have basis. those longer serving members of the always been important to us. They were the "In 1993, we set up the Japanese desk at company are passing onto those who joined first clients in Asia willing to invest in our the Singapore alarm center, dealing later, the same values and standards. services despite medical assistance being exclusively with assistance to our Japanese almost unknown in this region in the late clients and members. This was the start of A hands-on approach 1980's", she explains. "Both AIU Insurance the fully-ﬂedged Japanese service department “What is so important and so unusual for a Company and former Mitsui Marine & Fire that has continued till this day in Tokyo, large company like ours, is that Pascal and Insurance Company, now known as Mitsui serving more than 90% of Japanese non-life Arnaud are still directly involved in medical Sumitomo Insurance Company, were the first insurers and all our global members from and operational decision making. There is no Japanese insurance companies to show a Japan. serious medical case which senior keen interest in including medical services "International SOS has always believed in management are unaware of. What we all to give added value to their insurance the importance of providing services to value – and the reason so many of us stay products. Both companies have grown to customers in their own language and in with International SOS – is the opportunity become key clients and our business accordance with their own customs and to work for a compassionate, medically partners in many ways. traditions, even when they're overseas. The driven, ethical company. "In 1992 we reached another milestone attention to detail and commitment we “In another 20 years we’ll probably look when Tokio Marine chose us as their demonstrated to our Japanese clients in the back at 2005 and say that what we’re doing appointed assistance company for Asia early days is still fundamental to the service now was pioneering. It’s all a question of Paciﬁc. Before choosing International SOS, we offer today, even though we have grown perspective. But it is extraordinary to see Tokio Marine sent teams to Singapore, such a lot in the past 20 years." just how far we’ve come in such a relatively short time.” s HOTLINE - ANNIVERSARY EDITION 15 FIRST ALARM CENTER A TYPICAL CASE FOR THE ALARM CENTER TEAM Patient calls International SOS An Australian lady, Sue Williams, lives in Inner and speaks to Mongolia, China, with her husband, who is Operations Coordinator working on an Australian aid project. At home one day she falls and hits her head. As well as a bump to her head she receives a black eye, but chooses not to visit the local doctor. Over the Patient speaks to Intl. SOS doctor course of the next few weeks she suffers frequent fatigue, nausea and vertigo. Finally after ten weeks, when her condition worsens and she experiences debilitating earache, headache and dizziness, she calls the International SOS alarm Doctor calls Beijing AC center in Sydney. Expert response After talking at length with Mrs Williams, an Beijing AC recommends International SOS doctor determines that she admittance needs neurological investigations and treatment. to hospital in Hong Kong He contacts his medical colleagues at the Beijing alarm center to discuss suitable medical facilities. Having completed their research, they identify Hong Kong as the nearest center of excellence in this ﬁeld. Because of her medical condition, the Intl. SOS doctor calls International SOS Intl. SOS arranges International SOS doctor recommends that she patient to make calls insurers ﬂight and escort travels on commercial ﬂights from Yinchuan to recommendation Hong Kong with a medical escort. This recommendation and a quotation is provided to, and approved by, Mrs Williams’ insurer. The International SOS alarm centers in Beijing Intl. SOS stays in and Hong Kong work together to arrange all contact with Intl. SOS stays in logistical aspects of the transportation, including insurers contact with her medical escort and Mrs Williams’ admission patient to hospital in Hong Kong. Throughout, International SOS staff keep in constant contact with Mrs Williams to keep her fully informed and reassured. They also maintain communications with the underwriter. Patient discharged On being discharged from hospital, Mrs from hospital and Williams asks International SOS for help to make contacts Intl. SOS her hotel arrangements before ﬂying back home to Inner Mongolia. International SOS not only arranges and pays for the hotel, but also arranges taxis within Hong Kong. Intl. SOS arranges A safe conclusion hotel and taxis On her safe return, Mrs Williams contacted International SOS to express her gratitude for the service provided. “I wish to commend all the staff I had contact with, from my initial telephone contact in Patient arrives Sydney, to the staff in Beijing and Hong Kong. home safe Everyone was concerned and professional. I and well cannot praise your organization too much.” 16 INTERNATIONAL SOS CORPORATE ASSISTANCE DEPARTMENT Straight from the top Dr Neil Nerwich is Deputy Group Medical Director and Regional Medical Director for International SOS, EMEA. When we spoke to him about the approach to medical and operational decision making, and the role of the Corporate Assistance Department (CAD), he echoed many of Dr Roger Farrow’s comments. “O UR OVERRIDING aim is to consistently provide medical duty of care at the very highest levels”, he says. “The • the condition of a patient deteriorates while they are being evacuated • a major medical or security incident International SOS service delivery model requires a crisis response puts the best people with the right expertise at the front end. That’s why we have full-time “Ever since the company started, senior medical teams – not medical consultants – on medical staffs have provided round-the-clock duty in all our alarm centers. They provide support to members of assistance teams,” real-time medical advice, direction and explains Dr Nerwich. “But as the reassurance to our members and patients. organization grew, we realized we needed a Their skill is to listen to what’s being said, more formalized approach, and in 2000 the assess and interpret in the context of the Corporate Assistance Department was individual’s situation, and then to respond formed. The Department ensures there is appropriately.” total transparency and that any element of “The decisions taken will depend as much medical or security risk is dealt with on the condition of the patient as on the proactively. This is particularly important in a implications posed by the local environment. crisis situation.” In consultation with our other medical teams In response to the most recent Bali around the world who are experts in their bombing in October 2005, Dr Philippe region, we decide on the best local solution, Barrault, a fellow CAD member, poignantly or alternatively evacuate them if local commented that International SOS had resources are insufﬁcient. learned so many lessons from previous “And when a situation is particularly bombings that this time the decision was challenging, all our staff know they have the taken to proactively launch mercy medical Corporate Assistance Department to call on.” “Ever since the evacuation ﬂights. “One of the lessons was to mobilize as quickly as possible,” says Dr Expert advice and opinion The Corporate Assistance Department company started, Barrault. “As soon as we realized that help was needed, our largest air ambulance left (CAD) comprises a global roster of senior medical directors with the knowledge and senior medical Singapore in the early hours of Sunday morning.” experience to deal with the most complex or “Our processes ensure that clinical need is challenging cases. On call 24 hours a day, seven days a week, they make decisions on a staffs have provided put ﬁrst,” continues Dr Nerwich. “Patients are in direct communication with medical real-time basis in the best interests of the patient and the client. A strict set of round-the-clock staff right from the outset, so their access to a doctor is in real time. The ethos of operating procedures ensures that they are always contacted in scenarios where: support to members International SOS comes from the very top. Through the Corporate Assistance Department we make sure that our collective • there is a complex case involving evacuation across continents or where of assistance teams” experience is applied where it matters most – responding to our members when they need technical difﬁculties need to be resolved DR NERWICH, INTERNATIONAL SOS our help.” s HOTLINE - ANNIVERSARY EDITION 17 Indonesians demanding the resignation of President Suharto SECURITY EVACUATIONS Out Everybody International SOS evacuated 4000 members from Indonesia during the civil unrest that followed President Suharto’s resignation in May 1998. Jim Williams was at the center of the drama. B Y EARLY 1998, President “It was absolute mayhem. I remember Suharto’s thirty-year grip on power hearing of people driving their cars to the in Indonesia was loosening. With airport and abandoning them or selling them the economy in crisis, on the spot”, recalls Jim Williams, who was in demonstrations, violent clashes and riots charge of International SOS’s Indonesian erupted on the streets. By May 21st the pressure on the leader had grown to such an extent that he was forced to step down. Appointing his Vice President as successor did little to stop the strife. Not surprisingly expatriates, as well as local citizens, were desperate to leave the country, but it was virtually impossible to get a ﬂight on a commercial airline from Jakarta or other airports. The situation was considered so dangerous that the US government advised all its citizens to leave the country as soon as possible. HOTLINE - ANNIVERSARY EDITION 19 SECURITY EVACUATIONS operations at this time. “Once the phones started ringing they never stopped, so we immediately set up a crisis center in our alarm center and mobilized all our team. People expected International SOS to be able to help them and we were determined to justify this faith.” A triumph of logistics Within the ﬁrst few hours, we established a plan of action that was on the scale of setting up an airline. One room was set up speciﬁcally to track the 15-20 aircraft that International SOS could call on to make evacuations. All employees helped out no matter what their normal jobs were. Every detail for each passenger’s ﬂight needed to be covered. Our staff had to do everything from schedule the aircraft and crews to assign passenger seats, deal with immigration paperwork and help them pay the ourselves. This enabled our members to go exit tax. “At the airport most people were through the system in a fraction of the time,” waiting eight hours in a government line to explained Jim. The Singapore operations pay the exit tax. We took the situation into our provided all of the reception services. They own hands and agreed to a new procedure were tasked with arranging ground with ofﬁcials to help with the paperwork transportation, travel arrangements and hotels for the members we evacuated. Organizing the evacuation of so many TOWARDS RISK MANAGEMENT people in such a short time was an enormous logistical operation. In spite of this we “INTERNATIONAL SOS is no longer just and other hostile regions. managed to launch several medical helping organizations respond to events,” “It’s all about knowing the risks you evacuations with our own air ambulance. One says Richard Culver, Senior Director, Security face, managing those risks and making of these was a neonatal case. Services, EMEA/CIS. “In an uncertain world, informed decisions. In 2004 a construction During an intense three-day period, over we’re increasingly being asked to look at client needed to establish business four thousand people were successfully the complete security infrastructure to help operations in Afghanistan. We embedded a airlifted out of the country. “Overall many of reduce the risks of terrorism or crime. We security consultant with their project team, us in Jakarta and Singapore didn’t sleep for 56 also help clients manage the consequence and as an integral part of the client hours. When members are in trouble, they of crisis, not just the incidents themselves, structure assisted in the management and immediately call International SOS. Our job is through the provision of holistic crisis reduction of risk to enable the business. We to help them, whatever their needs.” s management services.” supervised security provider selection, and “We can evaluate site security, travel deployed with the client advance party to policies and the quality of security ﬁrms used. We can also provide a full-time or ensure that their security management in- country was up to the standards required. “I remember seconded security manager to oversee all a client’s activities and prepare crisis That client is still successfully operating in Afghanistan, and our hearing of people management and emergency evacuation plans. plans and procedures have assisted in the driving their cars to Clients can access our comprehensive prevention of death web services, giving security updates and other useful information. They can also call and injury to their staff on a number of the airport and into our alarm centers 24/7 and receive immediate advice and assistance from our occasions.” abandoning them on-call security specialists. “Our security specialists typically have a military Richard Culver, Security Services, or selling them on background with further experience in EMEA/CIS consulting and corporate security. They’re all accustomed to working in war zones the spot” JIM WILLIAMS, INTERNATIONAL SOS 20 INTERNATIONAL SOS MEMBERSHIP More than an emergency service Dr Rene de Jongh has worked for International SOS since 1992. He’s a passionate believer in the importance of membership – and he’s at the end of the phone when members call for help. S INCE he started working for International SOS back in 1992, Regional Medical Director for Assistance, got her examined at the nearest International SOS clinic. She had in fact a significant previously undiagnosed neurological International SOS in an emergency. “I’m not interested in just sticking to the bare facts,” says Rene. “I want to give people proper, Dr Rene de Jongh has seen the benefits of problem, so we arranged to evacuate her by detailed advice on how to manage membership time and time again. “People commercial flight to London so that she themselves while they’re traveling. If aren't always clear what membership really could immediately receive the care she someone is a diabetic planning a trip to gives them,” he says. “I think the value of needed to make a recovery.” China, they’ll want to know where they can membership is two-fold: Members have buy needles, where they can keep their access to myself or any of my physician Managing risk insulin cold during flights, and whether they colleagues day or night should they have a Of course membership isn’t just there for can get their needles through customs. We medical concern, and as medical emergencies. Members have access to travel give them the whole nine yards.” professionals, we have the opportunity to get and security advice to help keep themselves to know a little more about them. Knowing and their families safe while abroad. “It’s Clinical need our members' background and situation human nature to get excited when you’re For Rene, membership is about much more helps us to deal more effectively with issues going on a trip. People tend not to think than just a fast service. “The first person or emergencies when they arise. What’s about what might go wrong,” says Rene. “I you’ll speak to when you call is a trained more, membership ensures that don’t want to take the fun out of traveling; I customer service executive. The second will administration and payment is already just want to help people manage the risks.” be a medical professional who will already sorted. When you’re dealing with someone One International SOS member was have an idea of who you are, what your who’s had a serious accident, the last thing starting a mine site survey trip to Africa and problem is, and at least a partial solution you want to talk about is who’s going to foot called Rene on the suggestion of a already in place.” the bill.” colleague. He outlined his plans and the This reflects a principle that attracted Sometimes International SOS helps vaccinations he’d been given on the advice Rene to International SOS in the first place. members with problems that they didn’t even of his GP. It soon became clear that he “The service we give our members when know they had. “I remember one lady who would pass through countries where it is a they travel is unique,” he says. “Every had been a member for some time,” says requirement to have been vaccinated against decision is based first and foremost on Rene. “I was delighted to get a call from her yellow fever. “If you’re not covered, quite clinical need – even before they’ve stepped telling me that she and her husband were apart from the risk of the disease to you off the plane.” s expecting a baby – I knew they’d wanted a personally, you may either be deported or be family. But during our conversation, she told given a jab there and then at the airport, Dr de Jongh is a New Zealand citizen who me she’d been experiencing nasty headaches. which won’t always be safe,” explains Rene. joined International SOS in 1992 and is now She presumed these were a normal symptom During their phone conversation Rene Area Medical Director for SOS’s operations of her condition and had been suffering advised his client to re-route in order to have in the South Asia Region. His specialty is in bravely because she didn’t want to take any the yellow fever vaccination, take time to hospital-based emergency and intensive care painkillers. As she was talking I realized that develop immunity and collect documented medicine. He is also qualified in pre- these headaches weren’t just another side proof to take with him. hospital emergency care, advanced cardiac, effect of pregnancy. They sounded much Getting this kind of advice reduces the pediatric and trauma life support and was more serious. Speed was important, so we likelihood of ever having to call on awarded a MSc in Travel Medicine. HOTLINE - ANNIVERSARY EDITION 21 ONLINE pages each, available in English, French, The world at your Spanish, Japanese and Chinese. You can ﬁnd out all you need to know about health, security, climate, culture and customs. And information is constantly updated 24/7 to ﬁngertips keep users fully informed.” Towards full interactivity Customers are always searching for ways to help manage risk more effectively: “The idea for our ‘Traveler Locator Service’ came following a client discussion shortly after 9/11. Tragically, the company had had employees on one of the hijacked planes, and Hi-tech online solutions help mitigate the risks of wanted a system that could track every traveling member of staff anywhere in the international travel. world. “Traveler Locator takes data from travel management systems and travel agencies to give an instant snapshot of the movements of O NE OF THE downsides of living in the ‘Information Age’ is data overload. This is particularly true for international International SOS’s website and associated online services the only places you would ever need to look,” says Tim Daniel, Chief employees. You can track individuals by region, by country, by ﬂight number or hotel booking. It also lets you assess the risks companies with hundreds or thousands of Operating Ofﬁcer, International SOS Online. facing these people and gives automatic employees traveling or working abroad. From humble beginnings in 1997, the main medical and security alerts if they’re likely to With so many sources of information, it’s International SOS members’ website has face dangers or hazards. virtually impossible to access the specific developed into a comprehensive guide to “The service is web-based and accessible details they need to help keep staff safe and traveling and working around the world, as from anywhere in the world, yet also highly secure. Tim explains: “We now have more than two secure with restricted users. As you would “The aim from the start was to make hundred country guides of around 25-30 expect, the amount of data processed is 22 INTERNATIONAL SOS ONLINE enormous, with 120,000 travel itineraries management, it asked International SOS to entered every day.” create a dedicated portal. This contains action Over the past few years a number of other plans and procedures, relevant local online services have emerged, such as information such as ﬁre, police and ‘Automated Travel Advisories and ‘Travel ambulance services, and details on all Ready’. These help travelers prepare for the employees, including scanned copies of next trip, giving up-to-date information on passports. destinations through email alerts, making sure If there is a crisis, management can act they have the right vaccinations and even quickly, contact all relevant parties and make letting them know the status of visa evacuations or close facilities. There are even applications. detailed maps helping to locate expatriate workers. Customized services Renault in France has chosen to provide a As with many International SOS offerings, similar service to its employees and decided the client is often the trigger for to incorporate a customized medical section improvements. For example, when IKEA into the site. Daniel Mahé, General Manager wanted to improve its global crisis of the International Mobility Department succinctly summarises the beneﬁts: “This is an additional risk prevention tool for our company. This new online tool contributes to “This new online tool contributes to our our employees’ awareness of the importance of maintaining their health and of the services employees’ awareness of the importance of our company provides in this ﬁeld.” “The future of online services is all about maintaining their health and of the services getting the right information to the right people in real time,” says Tim, “Whether it’s epidemics, natural disasters or political our company provides in this ﬁeld” unrest, the use of email alerts, websites and portals will give clients the tools they need to DANIEL MAHÉ, RENAULT take important decisions and mitigate risk.” s HOTLINE - ANNIVERSARY EDITION 23 A vital 20 hours Memories of the ﬁrst International SOS mass evacuation. Combining resources P ATRICK Deroose is General Manager at International SOS’s Corporate Assistance Department. A trained nurse, he has been seriously, and several people were killed. Local services arrived at the scene as quickly as possible and took the injured passengers to The operations team at Singapore quickly put together a plan that combined the resources of with International SOS since 1993. the local hospital. three International SOS alarm centers: Soon after he joined, Patrick was part of a As soon as they were informed of what Singapore, Jakarta and Bali. The Singapore team sent to care for the victims of a serious had happened, the French insurance company and Bali teams would triage the patients (that road accident on Bali. Here he remembers contacted International SOS and the is, determine their injuries in order to decide how events unfolded. Singapore alarm center was immediately the order and urgency of treatment) ready for “A couple of weeks after I started work alerted. repatriation. The Jakarta team would provide with International SOS there was a terrible Knowing that local medical facilities the necessary equipment and personnel for crash on Bali. A group of elderly French and would not be sufﬁcient to deal with the the aircraft. Belgian tourists were traveling in a situation, our mandate was to bring the One of our Bali-based doctors was mountainous area when their coach tumbled patients to major trauma centers in Singapore immediately sent to the hospital in Bali to into a ravine. for treatment and repatriation. assess the situation. Understandably, Many of the passengers were injured, some conditions at the busy emergency room of 24 INTERNATIONAL SOS FIRST MASS EVACUATION “20 hours from the time of the ﬁrst call, the patients had arrived safely in hospital in Singapore” this Government hospital were crowded, with to us. We quickly organized for the least Ofﬂoading the patients in Singapore was staff struggling to cope. The doctor carefully injured patients to go ﬁrst, with the most easier because there were 14 ambulances and sensitively explained the plan that critical patients following last so that they waiting to transport them to the casualty International SOS had put in place. would spend as little time as possible out of departments of Singapore General Hospital, Meanwhile a medical team was sent from hospital. the National University Hospital and other Singapore to Bali, comprising myself, Dr Meanwhile, our logistics team were sorting private hospitals in the city. Allocations were Roger Farrow and Dr Peter Heron. With the out passports and the necessary papers in made by the Singapore alarm center to ensure necessary language capabilities between us, collaboration with the insurance company and that each patient received the treatment they we took with us the medical equipment we the relevant consul on Bali. needed. would need, including 15 stretchers. 20 hours from the time of the ﬁrst call to Safe arrival in Singapore International SOS, the patients had arrived Directing triage The patients were ﬂown out of Bali on a safely in hospital in Singapore where the 15 One of our Bali team met us at the airport Fokker aircraft, which had been prepared by most seriously injured remained until being and took us to the hospital. Dr Farrow the Jakarta team, including medical staff, repatriated for treatment or rehabilitation. directed the triage and we prepared the monitoring equipment and enough food and Out of the ﬁve people with more minor patients for transport out of Bali to drink for the patients. injuries, three went home and the two others Singapore. 15 were seriously injured and Once the aircraft was loaded, we called the stayed in Singapore to be with their loved another ﬁve had more minor injuries. Singapore alarm center with our arrival time ones who were being treated in hospital. All A lack of ground transport in Bali meant so that ambulances would be waiting on the the uninjured were ﬂown home within 24 that there were only ﬁve ambulances available tarmac at Singapore airport. hours.” s HOTLINE - ANNIVERSARY EDITION 25 Any REMOTE SITE SERVICES where IN THE WORLD Taking healthcare to some of the world’s most remote regions. O RGANIZATIONS working in oil, gas, day healthcare, as well as provide preventative mining and construction operate in treatment for malaria and other tropical diseases. some of the harshest, hostile and most “What began with just one doctor in a single inaccessible environments, with clinic has now grown into a complete medical employees carrying out dangerous work, often in infrastructure operation incorporating a small extreme weather conditions. Whole communities hospital, outpatient and emergency facilities, and can spring up around these sites, and keeping satellite clinics with occupational health employees and their families healthy is a major programs and award winning public health challenge. programs,” explained Dr Myles Neri, Group International SOS first became involved in Medical Director for International SOS’s Global this field in 1988, when a French airport Medical Services. construction company was commissioned by the Indonesian government to build Jakarta’s new A natural development international airport. The company was eager to Fast forward to 2005 and International SOS now offer a high standard of care to their construction manages around 200 remote sites across five teams at a site that was three hours’ drive from the city. After consultation, Dr Pascal Rey-Herme recommended creating a field clinic offering the same emergency and primary care services as his city center operation. The doctor not only designed and equipped the clinic, he also supplied and supervised local medical staff. Some time later a senior mining company executive asked International SOS whether it could help develop medical services for a huge coal mine that was being built in Kalimantan in Borneo. With the mine employing 300 expatriates and 2000 local Indonesian workers and their families, the company needed to be able to make medical evacuations and manage day-to- HOTLINE - ANNIVERSARY EDITION 27 REMOTE SITE SERVICES “The occupational health program aims at prevention, detection and surveillance of occupational illnesses and injuries on the site” DR DAVE KNIGHT, INTERNATIONAL SOS continents, from the new tarsand oil fields in Canada to gold mines in Papua New Guinea; from pipelines in Chad and Cameroon to petrochemical plants in China. Dr Neri continues: “Companies take their duty of care towards employees very seriously, and they’re looking to achieve a high standard of medical service for all their operations. These facilities may range from a simple first aid station to 120-bed fully managed hospitals.” Over the years, International SOS has developed its services to encompass the full spectrum of health care specialist services from primary and emergency care to occupational and public healthcare. And having gained an intimate understanding of remote site medical needs, it also offers expert consulting advice and guidance to its clients. Dr Neri continues: “Our first step typically involves a site survey, looking at everything from local living and working conditions to the availability of medical care and accessibility of emergency transport. From here we work with the client, the local health authorities and local resources to define the appropriate scale of medical services.” The oil and gas fields on the island of Sakhalin, off the easternmost coast of Russia, present a different challenge altogether. There are 16 field sites scattered around the island, where the severe winters can last for up to 7 months. International SOS provides doctors and paramedical staff for all these sites and has nine permanent clinics on the larger work sites, plus a doctor, medic and health and safety adviser 28 INTERNATIONAL SOS Water sampling as part of a malaria control program Large, remote sites of occupational illnesses and injuries on the site. The dual aim is workers’ health protection as well as health promotion.” not only create their In recent times governments and aid agencies have called upon International SOS own communities, to provide similar services to them in areas of reconstruction, following conflict they also impact (Iraq/Afghanistan) or devastation (Aceh/Pakistan). The emphasis is on rapid deployment, quality medical services, upon the wider medical evacuation capacity and local staffing, training and development. local population. Companies, governments and aid organizations will continue to operate in remote areas, to respectively extract raw material and energy, develop the infrastructure or to help the local population. And in extreme heat or arctic cold, in deserts or offshore, International SOS will be there with them, helping keep the workforce – and their families – healthy. s on the huge offshore platform that supports HAIR-RAISING SURGERY a crew of 132 people. DR Patrick O’Neill, who worked as Chief into the site clinic, where visiting plastic Helping the wider community Medical Ofﬁcer at the Kaltim Prima coal mine surgeons involved in a company public health Large, remote sites not only create their own in Indonesia when International SOS ﬁrst set surgical program for cleft lip repair, were on communities, they also impact upon the up its on-site operation, remembers the many hand to sew it back on. After a difﬁcult wider local population. International SOS is challenges of those early days. period of readjustment the orang-utan was active in helping clients build health In addition to carrying emergency ﬁnally released back into the wild with both capacity with their neighbouring operations out in remote jungle clinics, and hands fully intact. communities by providing programs to riding 90 minutes by boat to transport monitor, treat and prevent diseases, improve patients to the nearest local hospital (before sanitation and manage and counter sexually a hospital was built on site), he also had to transmitted diseases (including HIV), TB handle patients of a hairier variety! and malaria. One day an orang-utan managed to ﬁnd Dr Dave Knight, International SOS its way into the site and severed its thumb in Medical Director at Batu Hijau, Indonesia a conveyor belt. The unfortunate animal was told us: “The occupational health program sedated with tranquillizers and then taken aims at prevention, detection and surveillance HOTLINE - ANNIVERSARY EDITION 29 ’D SPENT YEARS delivering general “I medical services on remote sites around the world”, he says. “And it was clear that what was increasingly critical was occupational health. Where there are employees, it’s not just a question of delivering primary healthcare. You need to ensure that there’s an appropriate fit between employer work and employee – that the job doesn’t cause ill health, and that ill health doesn’t affect the health and safety of anyone in the workplace.” David was given the remit to develop occupational health services globally for International SOS, working in the UK and supporting its network of occupational health professionals at its regional centers worldwide. David, what does occupational health mean? There are two types of occupational health. There are occupational health services in first-world countries like the UK and US. These countries benefit from a good medical infrastructure, resources, training and research, and full health and safety legislation that is enforced. Here occupational health focuses on prevention of work-related ill-health, promotion of wellness and on managing health and safety programs in the workplace. Then there’s occupational health in A change of gear emerging countries where there is little medical infrastructure, where medical training can be variable and resources scarce. Classic industrial diseases – like lead poisoning, dust induced lung diseases and in occupational hearing loss – may prevail and public health problems are far more prevalent, for example HIV, tuberculosis, under-vaccination, and so on. Services are often delivered at remote health sites and include employment screening and health and safety management, with disease management an inevitable component. What occupational services does International SOS offer? Dr David Cook was originally Chief Medical Ofﬁcer International SOS offers services across the whole occupational health spectrum. We’re in Burma for International SOS between 1996 and second to none in terms of resources – medical, intellectual, transport, 1997, working in Jakarta, Singapore and Papua communications, and security. Remote sites are usually in emerging New Guinea. After 10 years working abroad he countries, where International SOS delivers returned to the UK to pursue occupational health occupational health services along with general medical services in places where as his specialty in 2003. employees don’t have ready access to a GP or a local A&E. We also develop comprehensive occupational health programs 30 INTERNATIONAL SOS OCCUPATIONAL HEALTH designed to suit a particular company’s Can clients access GO-Care? – a quality system and a quality service. We needs. We can deliver fully managed A very important component of GO-Care is call it quality, quality, quality. That was our occupational health services on behalf of the online statistics and reports that it can mantra back in the 1990s and it hasn’t clients. generate. As GO-Care is web-based, some of changed today. We are the only company in the world our clients can access it to generate and that can offer consistent levels of care – download their own reports. So it’s a tailored What new developments are there in globally. And that’s a capability that’s service, with tailored data recording and occupational health? becoming increasingly important for many reporting. And employees with some of our International SOS is continuing to develop of our clients. clients can download their own paperwork new occupational health services. At the (while individual medical records remain moment, we’re working on an evidence- How has occupational health confidential). based service to manage sickness absence changed over the years? GO-Care is all about quality management for our clients in Europe. Believe it or not, Occupational health has always been in place. More recently the emphasis has changed towards preventative medicine and public health, not just general medical health. Companies recognize that LOOKING AFTER THE WELL-BEING occupational health directly affects safety and productivity. OF WORKERS AT TOYOTA AUSTRALIA We are also moving towards evidence- based occupational health. Companies are TOYOTA Motor Corporation is one of return to work after ill health, including keen to meet their corporate responsibilities, Australia’s leading car manufacturers. It has primary ﬁrst aid, diagnosis, support, to improve the health, safety and over 4,500 employees in Australia, spread treatment planning, active support and environment of local employees and to make over six locations with 90% based at its two advice. Staff assess and advise on a wide a positive contribution to communities. main sites in Port Melbourne and Altona. range of health issues, and provide stability and familiarity for workers visiting the What is evidence-based Objectives for Toyota Australia centers. occupational health? Toyota’s key objective is to ensure that ‘every We also carry out pre-employment and It’s about developing management and employee is treated as an elite athlete and employment assessments, monitoring, reporting systems that enable organizations the best treatment possible is rapidly sourced reporting and education. Recent health to manage risk proactively and coherently. so that they can be returned to their education initiatives have included healthy Specific initiatives can be designed to workplace as soon as possible.’ eating and keeping hearts healthy. combat particular issues that are identified Back in 2003, with concerns about costs To raise awareness of healthy practices in based on evidence. It’s also about spiraling, its own health services not widely the workplace, we are working closely with implementing coordinated systems and used, and work injuries (particularly Toyota Australia to identify workplace processes to ensure that employees are musculoskeletal injuries) increasing, Toyota concerns and put in programs to minimize treated consistently, wherever they work. Australia needed a more proactive approach risk of injury.” International SOS delivers a thoroughly to managing the health of its employees. It researched, evidence-based medically driven wanted its Health Centers to be the ﬁrst port Measuring progress service, comprehensively thought through of call for any employee with a health International SOS carries out detailed and comprehensively delivered. concern, whether work-related or not. monthly reporting against key performance Toyota Australia needed an expert partner indicators agreed with Toyota Australia. Data How is evidence generated? who understood its business and had the is used to target healthcare and education Data reporting and measurement is critical capability to deliver a full range of healthcare initiatives. Key measures this year include a to effective occupational health services. It asked International SOS to work in fall in the number of musculoskeletal injuries, management. partnership with its occupational health and and a reduction in the cost of third-party At International SOS we have developed safety team to design, deliver and monitor a medical providers. our own occupational health tool called GO- comprehensive occupational health Paul Furtado is Health Support Advisor on Care (Global Occupational Care). Its management program. Toyota Australia’s Occupational Health and backbone is a bespoke piece of software, Safety Team. “The Toyota/International SOS which is fully integrated with the other How International SOS has helped relationship is now over 12 months old. In International SOS systems. We use GO-Care Philippe Arnaud, Group General Manager this time a strong relationship has been to manage a complete suite of occupational GMS Development explains International established and quality health outcomes are health services for our clients. SOS’s approach: “We have delivered a fully being delivered. These include comprehensive fit-for- integrated occupational health program in Toyota looks forward to continuing to work programs and vaccination programs. partnership with Toyota Australia. work with International SOS in the important We also use GO-Care to manage and Our medical teams run Health Centers at area of employee health to ensure that we support our occupational health consulting Toyota Australia’s two main sites. They offer a retain our competitive advantage both locally services and our occupational health staff full range of services to promote employees’ and globally.” on-site. HOTLINE - ANNIVERSARY EDITION 31 OCCUPATIONAL HEALTH £13.2 billion is lost annually in the UK through sickness. There is plenty of evidence that employed people who stay in work are healthier, get better faster and to a greater degree if sick or injured, compared to those who are unemployed or stay out of the workplace too long. As I always say, work is good for you! Is that something that companies in other parts of the world would benefit from? When we develop a service in one region, we always look for opportunities to apply it in other regions where appropriate. Our network of occupational health practitioners regularly meet to share interesting cases and learning – and to cross-fertilize ideas. This exchange is crucial for delivering international-standard services to our clients. s NEW GLOBAL PUBLIC HEALTH CHALLENGES AS anxieties increase over the spread of the avian inﬂuenza virus, International SOS’s most senior medical staff has been working over the last 18 months to thoroughly research the implications of a Where others potential inﬂuenza pandemic and to develop pandemic preparedness plans. The concern is that if the current virus Non-governmental organizations (NGO’s) often arrive mutates and gains the ability to spread easily from person to person, it may in a country when everyone else is leaving. So who can emerge as the cause of the next they turn to in time of need? inﬂuenza pandemic. Dr Doug Quarry, Medical Director, International SOS Online, is a member of the International SOS Avian Flu and Pandemic Preparedness team. “As well as N ON-GOVERNMENTAL organizations (NGO’s) often arrive in a country when everyone else is leaving. So who can they turn monitoring the situation 24/7 and to in time of need? making the latest information available Whenever there is a war, famine or through our dedicated website, we environmental disaster, most people’s ﬁrst wanted to give our members practical reaction is to get out of the area as quickly as guidance so that they could put possible. But for organizations like the UN, contingency plans into place for their Red Cross, WHO, Oxfam, Save the Children businesses,” he says. and Medecin sans Frontières, this is typically “After extensive research, we have where their work is just beginning. developed nine chapters of protocols Like any large international concern, NGO’s and over 120 pages of information to and indeed government agencies also need to ensure employers have the key safeguard the health of their employees. documentation they need to develop a Emmanuel Chevron, head of Sales and company- and employer-speciﬁc Marketing in International SOS’s Geneva ofﬁce Banda Aceh – chaos and destruction caused Pandemic Preparedness Plan.” explains: “With the ever-present threats by the Tsunami surrounding them, our clients need to be able to 32 INTERNATIONAL SOS GOVERNMENTS & NGO AGAINST ALL ODDS DR Jean-Bernard Carbonnel, who has been landing permit 2 hours before arrival in with International SOS since 1992, recalls an Kinshasa. urgent medical case that he coordinated for On reaching Geneva a large ambulance the Red Cross: was waiting to take the patient to the “In March 2002 we received a call in our intensive care unit in the Cantonal Hospital, Geneva alarm center about a four year old where a successful operation was followed girl with severe hepatitis in Kinshasa, by a full recovery. This project was a triumph Democratic Republic of Congo. She was the of logistics, with our team arranging visas, daughter of a Red Cross delegate in the landing clearance, ambulances and hospital country and needed an urgent liver facilities.” transplant. We decided that the best place to get a quick operation was Geneva, despite it being 11 hours away, and commissioned a long distance jet. We took a chance in sending the plane immediately and only received a fear to tread get medical assistance at a moment’s notice, employees are essentially no different to those out over 100 evacuations. anywhere in the world. Thanks to our global of a commercial corporation.” Mike Penrose was also seconded to the coverage, we have been able to help a number Having previously worked in a number of WHO for six weeks to help set up disaster aid: of government bodies provide high levels of NGO’s in war and disaster zones around the “In an environment with so much suffering and primary medical care to employees in different world, Mike is only too aware of the dangers. a totally traumatized population, it’s very parts of the world.” Indeed, he was once kidnapped by Chechen difﬁcult to coordinate the aid effort. rebels for two months. “When planning their International SOS’s experience in similar Security climbs up the agenda security, NGO’s must be very conscious about situations helped us put together appropriate With the breakdown of former political how they are perceived. Surrounding yourself strategies and assist the Indonesian Ministry of structures and the rise in religious with bodyguards may be counter-productive Health to re-establish its own structure.” s fundamentalism, security is also an issue. and only serve to alienate local groups; it’s NGO’s are not always seen as neutral more important to project an image of absolute organizations and may get labeled as ‘tools of neutrality.” the west’, leaving them increasingly vulnerable. TSUNAMI AID APPEAL Security has consequently become a far higher Tsunami: helping when disaster strikes priority and a number are turning to With its global infrastructure and experienced THANKS to the generosity of customers International SOS for advice on protecting staff staff, International SOS can offer much-needed and staff, International SOS has been able and facilities and minimizing the risk of advice and on-the-ground support to both to raise over $330,000 dollars to help terrorism, kidnapping and crime. governments and NGO’s. Following the 2004 victims of the disaster in Banda Aceh. “Where NGO’s may once have been seen as Tsunami that devastated Sri Lanka, Indonesia, These funds are being used to sponsor 80 a group of well-meaning amateurs they are now Thailand, Maldives and Malaysia, it gave young Indonesians from Aceh over the large, established, professional organizations valuable logistical aid to the UN and AUSAID next four years to become nurses, so that with full time staff,” explains Mike Penrose, (the development wing of the Australian they can actively participate in the Regional Security Manager, International SOS. Government), providing a team of 20 medics rebuilding of their community. “The security and medical needs of their on the ground in North Sumatra, and carrying HOTLINE - ANNIVERSARY EDITION 33 GLOBAL ASSISTANCE NETWORK Widening the net Thierry Watrin, Corporate Director, Global automatically. It is also integrated with our case management system, to ensure that the Assistance Network, joined International process of dealing with each individual case is as smooth and efﬁcient as possible. SOS in 1998. He has been responsible for For a small number of our largest clients, we’ve developed tailor-made provider developing the global network of medical networks, available via the Internet. In particular, we can make details of key and other providers that International SOS providers available to members through our online country guides. can call on anywhere and at any time. Into the future The Global Assistance Network, which now “W HEN I joined International SOS there was already a strong network of providers established in Asia, with more tool used daily by our GAN managers and coordinating doctors for managing the quality of service delivered by our worldwide includes a team of more than 40 dedicated personnel based in all our alarm centers, is set to develop – not only with the numbers of informal networks in place in other regions. network, from assessing and credentialing providers and preferred providers growing, but Years previously, the company had providers, to ensuring smooth payment and with the depth and quality of information sometimes relied on the co-operation and administration when help is needed. continuing to improve. Key areas, like China, resources of our correspondents to record When someone from International SOS are expanding quickly, and new parts of SPIN, information about medical providers in visits a provider, they use SPIN to record for example a whole new function for provider different parts of the world. All cases were details about its organization and services. credentials, is being released. handwritten or typewritten, and to search for This helps us make the right choices on Thanks to the energy and dedication of the individual cases required a trawl through behalf of our clients and means we can Global Assistance Network team, we have stacks of physical ﬁles. develop a set of preferred providers. SPIN managed to formalize our network rapidly The big change came when an important also holds comprehensive records about while continuing to meet the urgent needs we client, the insurance company Tokio Marine, providers, including licenses to practice, deal with every day. asked us to establish a cashless network of medical qualiﬁcations, terms and conditions, The network is the backbone of medical providers for its clients worldwide. and site audits. International SOS and a vital part of the way Timothy Yee and Dr Doug Quarry at our we deliver services to our clients. There is still Singapore alarm center established a system Widening access much to do, but the last three years have seen to document assessments and details of As a web-based tool, SPIN is accessible a lot of progress in our development of such medical providers onto a database and to set worldwide and updates are available an unique resource.” s up guarantees of payment with providers as part of our service. This was the genesis of the vast Global Assistance Network (GAN) that we have today. The other strong building block was to develop a whole team of Global Assistance Network managers able to develop our network anywhere we have a case. About SPIN Launched in November 2002, the Service Provider Information Network – or SPIN – is the key means of accessing our Global Assistance Network and spans every country in the world. SPIN is a powerful on-line database and search tool that pinpoints a particular provider according to the criteria that our staff choose, for example by location, medical specialty or type of agreement. But it’s much more than that. SPIN is a 34 INTERNATIONAL SOS IN-FLIGHT SERVICES Safety in the skies emergency medical treatment procedures, When a Lufthansa passenger suffered a heart attack which includes simulation exercises. on a long distance ﬂight, he was in the safe hands – Serving the aviation industry of a doctor hundreds of miles away. “The development of our services to the aviation industry can be traced back to the 1980’s, when we provided medical assistance to members of SIA’s frequent ﬂyer program, I N FEBRUARY 2003 a middle-aged man suffered a myocardial infarction whilst his Lufthansa ﬂight was passing over Siberia. procedures. Our doctors will calm everyone down and help the captain decide whether a diversion is necessary.” Priority Passenger Services (PPS),” Kasey Khaw, Regional Director, Global Accounts Asia, explains. “The airline was impressed This was cause for serious concern. International SOS offers in-ﬂight services with International SOS’s ability to provide Fortunately the pilot was able to contact a to Lufthansa, Singapore Airlines (SIA) and a remote medical care and assistance. We had German-speaking International SOS doctor number of other carriers, as well as successfully carried out some medical by satellite phone at the Frankfurt alarm supporting several ﬂeets of private jets for evacuations for individual customers whilst center. The doctor assessed the patient’s multinational corporations.Training is on business and personal trips. Offering in- symptoms and concluded that it was provided for the airline ﬂight crew in ﬂight services was just a natural progression, imperative to get him to a hospital as soon as where we combined our on-board medical possible. Having checked the database, he experience with our geographical knowledge conﬁrmed that the nearest appropriate facilities were in Almaty. The pilot agreed to “It’s the closest of appropriate medical providers and facilities. Our in-ﬂight medical assistance land at the local airport and the patient was rushed in for emergency treatment. thing to having a teams are all aero-medical specialists trained in aviation medicine.” “In-ﬂight medical assistance is a highly Today, International SOS is also working specialized service requiring an in-depth knowledge of emergency treatment and an doctor next to you” with airlines’ medical departments to help reduce the risk of medical incidents by understanding of how patients react when at MR YAP KIM WAH, SIA SENIOR providing pre-ﬂight screening for both 35,000 feet,” says Dr Michael Weinlich, VICE-PRESIDENT MARKETING passengers and crew. Whilst you’ll never be Medical Director International SOS Germany. able to guarantee that there’s a doctor on “You have to know the nature of on-board SERVICES, TALKING ABOUT THE every ﬂight, a ‘virtual’ medical team is the conditions and be familiar with ﬂight TELE-MEDICAL SERVICE next best thing. s HOTLINE - ANNIVERSARY EDITION 35 PATIENT SUPPORT Supporting patients in a new way With help from International SOS nurses and specialists, patients on prescribed medication are beneﬁting from a new service provided by International SOS. T HE PROBLEM of non-compliance has been plaguing the healthcare sector for years. In some cases as many as 80% of the treatment and make necessary behavioral changes. have. We talk to them about their lifestyle and for certain treatments, the importance of a healthy diet. Many people expect a quick ﬁx, patients fail to ﬁnish their course of treatment Holding their hands so we also have to manage their expectations or take their medication correctly. This can “We’re there to provide ongoing support to the and educate them on the long term nature of have very serious consequences for the patient, holding their hands through the the beneﬁts.” patient’s health, as well as costing the health journey,” says Ben Connor, International SOS Patients enrol voluntarily, usually after service the time and expense of re-admissions Operations Manager, Pharma Services. “Our hearing about the program from their doctor and further treatment. aim is to give patients a better understanding or pharmacist. International SOS will then There are many reasons why so many of the medication and what effects it may work to a contact plan, calling at critical patients seem unable to follow dosage regimes or make lifestyle changes. For some it’s simply a matter of poor motivation, whilst others don’t really believe they’re ill, Reasons given by patients for ceasing antidepressant therapy especially when the symptoms are hidden, such as with high cholesterol. While poor 60 compliance is often attributed to simple 50 forgetfulness, in fact, the majority of patients 40 can articulate their reasons for ceasing 30 therapy. In a bold move, doctors, pharmacists, 20 health managers and the pharmaceutical 10 0 industry have joined forces to combat non- r ts ce s y gs ns tte ug ac compliance, with the additional help of en ru en tio ﬁc Dr Be Ev tD nd uc Ef th International SOS. ng pe rse str ou of wi eli De ith In ve ck e Fe The Patient Support program offers patients Ad W GP bl of La rta ve ar fo on speciﬁc medications a support network of Fe ol tS m co us healthcare professionals who can guide them Un M through the weeks and months of their therapy. Primarily telephone-based, they Ref: K. Demyttenaere et al. Compliance with antidepressants in a Primary Care Setting, 1: receive a combination of information and Beyond Lack of Efﬁcacy and Adverse Events; J Clin Psychiatry 2001; 62 encouragement, helping them to understand 36 INTERNATIONAL SOS PATIENT SUPPORT “Non-compliance with prescribed medication continues to be a signiﬁcant and widespread problem. The idea of providing proactive telephone support to patients is looking increasingly promising. We support the development and evaluation of these schemes to establish what works and what doesn’t, for the beneﬁt of patients.” Geraldine Mynors, project manager for Medicines Partnership points, during a prescribed period. This can patients, echoes Ben’s sentiments “We get so approach: the patient improves his or her vary between three and six months depending much positive feedback from patients. One condition; the health service saves time and on the therapy. woman recently told me she had just got out money; and the pharmaceutical company The level of attention is a vital factor, of her wheelchair and hung the washing up for beneﬁts from longer treatment regimes, according to Maggie Butler, a registered the ﬁrst time in fourteen years, after helping them establish their therapies. nurse who works on one of the programs: successfully losing weight. Whilst another One client reported that the average “Doctors just don’t have the time to talk to improved her health and became pregnant, and treatment duration has subsequently more than patients at length, and sometimes it can take rang to tell me that I had changed her life.” doubled, with patient satisfaction with the days to simply get an appointment. We’re on program running at over 85%. Importantly, the the other end of the phone any time they want Win-win concept has the blessing of health to call us.” Patient Support is proving increasingly organizations who realize the beneﬁts of a popular, with International SOS working with healthier population. Indeed the UK Highly rewarding pharmaceutical companies across Europe, Department of Health is so concerned with Patient support is relevant for a wide range of Asia and Australasia. It’s essentially a win-win non-compliance that in 2002 it set up The longer term or chronic conditions such as Medicines Partnership, a task force aimed at cardiovascular conditions, diabetes, high helping patients get the maximum beneﬁt cholesterol, multiple sclerosis, osteoporosis, . obesity, rheumatoid arthritis and HIV Ben “This is the most from their medicines and therapies. Patient Support is an intrinsic Connor continues: “We have nurses, exercise physiologists, nutritionists and a range of rewarding job I’ve element of this initiative other specialists who have developed an in- The last word goes to Ray Rowden1, an depth understanding of the various treatments we support. Most importantly, we can give ever had, knowing adviser to the UK Health Service, who believes we need: “...to create a generation of patients all the time they need, whether they’re concerned about side effects or merely want that I can make a patients who are empowered to take action, with the health professional caring for them. some encouragement. In over twenty years of working, this is the most rewarding job I’ve real difference to Patients will receive the support to take more control of their own health and treatment and ever had, knowing that I can make a real to make more appropriate use of health and difference to people’s lives.” And International SOS nurse Maggie people’s lives” social services.” s Butler, who provides support to obese BEN CONNOR, INTERNATIONAL SOS 1. Rowden R. The Expert Patient, Pharmaceutical Field, April 2002. HOTLINE - ANNIVERSARY EDITION 37 SPECIALTY SERVICES technological infrastructure gives our team the ability to search for solutions quickly.” Personal service ‘Concierge’ services are being offered to customers across a number of industries as a way of adding value to the core product or service. Just one call will put you in touch with a dedicated team of personal assistants, who can sort out birthday presents for a loved one, ﬁnd you tickets for the latest top show or even get you prices for a private helicopter! “A number of card issuers ask us to deliver concierge services for them because they know they can trust us with their most valuable customers,” says John, “At our Sydney alarm center we offer seven different languages 24/7, and people who have the right answers at their ﬁngertips.” Adding value Since International SOS ﬁrst started managing such services for Visa’s premium customers in Asia-Paciﬁc in 1997, they have added a range of other offerings including domestic tradesmen (for home insurance customers) and emergency medical assistance International SOS is using its remote servicing skills to mobile phone users. Expectations are high, says John: “Our and logistics expertise to help clients deliver premium clients want comprehensive feedback on who is making the calls and how quickly and services to their customers. effectively their customers are dealt with. Our management information systems - initially developed to manage complex medical cases E VERY DAY a team of skilled car mechanics arrives at International SOS’s alarm center in Sydney. But they’re not premium services to help clients around the world differentiate themselves from the competition. “One of our core competencies - are able to give the kind of detailed reports they’re looking for. But above all, they have the conﬁdence of knowing that International wearing overalls and they won’t be getting is highly skilled and trained specialists who SOS is always fully committed to keeping the their hands dirty. Their job is to take calls are determined to solve any caller’s problem.” customer happy - no matter what they’re from worried motorists, talk them through John Jessup continues: “Our sophisticated demanding.” s their concerns and if necessary arrange to send a breakdown vehicle. This is part of a specialized service “SUBARU has entrusted International SOS to technicians as operators who have a real provided for drivers of new Saabs, Ferraris, provide Premium Assistance Service to our understanding of the customer’s needs Maseratis, Alfa Romeos, VW’s and other top customers across Australia since February 2002. together with a focused account marques. “Because the mechanics really Customer interaction and high quality management team. understand the cars, one in three calls gets service is a vital part of our business, and we Subaru’s philosophy is based on doing the resolved without having to send out a have found International SOS to be a highly common things uncommonly well and breakdown truck,” explains John Jessup, valuable and professional partner. From a ﬂat International SOS is a key part of that Managing Director, International SOS, tyre to an accident, International SOS strategy.” Australasia. “With our expertise, we can provides assistance and peace of mind. handle calls on behalf of our clients and help They understand our business, our culture Derek Ashby offer something extra to their customers.” and our customers. They have proven to be Subaru National After-Sales Manager ‘Auto Assist’ is just one of a number of ﬂexible and provide skilled automotive Subaru Australia ways in which International SOS is providing 38 INTERNATIONAL SOS GLOBAL SYSTEMS W Knowledge is HEN International SOS members get sick or injured, they may well have to be passed through more than one medical power facility and possibly be evacuated across hundreds or even thousands of miles. In such situations it’s vital to keep a constant watch on the patient’s progress and have a full medical history to hand. A fully integrated system International SOS’s new global ‘case management’ system (codenamed Magellan) which is currently being rolled out to all of its 28 alarm centers, provides full, regularly updated details for doctors monitoring cases around the world. Advanced technology lets International SOS globally “If a patient is moving between time zones, then doctors in different alarm centers monitor a patient’s condition in real time. will all view the same information on screen, letting them discuss the case more efficiently. All details are entered directly on to the paper-free system which already contains the patient’s medical history,” explains Mark Crawford, Global Systems Development Director. “This innovative technology is fully integrated with virtually all our other systems across the organization, helping us to reduce administration and speed up data entry, giving the doctors more time to focus on the patient’s needs.” And with the digital age well and truly upon us, information such as x-rays and scans can be attached and viewed from any of the centers, greatly aiding the decision- making process. Invisible life support So, when a patient calls from Nigeria with chest pains, the coordinating doctor, taking the call from International SOS’s alarm center in Paris, is immediately able to access the man’s details, arrange transport to the nearest approved hospital and automatically generate a Letter of Guarantee to cover any medical expenses. When the patient is evacuated to South Africa, the case can be simply and seamlessly taken up by the alarm center in Johannesburg. “This whole system has been two years in the making, involving millions of dollars of investment and a tremendous effort by a team of over 100 people. It is an invisible life support system for our members. Our doctors are delighted with this new development as it helps them deliver a better quality of care.” Mark continues: “This software effectively lets us watch over a patient twenty-four hours a day from anywhere in the world.” s Hotline, International SOS, Landmark House, Hammersmith Bridge Road, London, W6 9DP, United Kingdom Phone: +44 20 8762 8000 Fax: +44 20 8762 8400
"20TH ANNIVERSARY OF INTERNATIONAL SOS"