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When you may be the last resort

Year: 1997
Setting: Singapore
Position: Emergency medicine consultant

Yes, I will be ready in two hours. The representative of International SOS, a provider of medical assistance, international health care, security services and outsourced customer care, seems happy that I agreed to escort a patient from Bangkok to Hawaii as soon as possible. For this mission, his company has chartered a Challenger jet belonging to the Prime Minister of Malaysia, Mahathir Mohamed, and I look forward to the trip!

The patient I meet in the Thai capital has been transferred from Cambodia. He is a U.S. engineer who was drilling wells in a rural area on behalf of a non-governmental organization until he could no longer perform his duties because he was too tired. As soon as I arrive to the old airport, I proceed directly to the hospital where he is being cared for. It is an old building, poorly maintained. The patient is a very nice guy and we share common experiences in the oil industry.

Reviewing his chart I notice that his platelet count is too low for travelling safely. I immediately make a request to the attending physician for a transfusion but no blood is available. Without wasting time, I take the patient to the more modern Bumrungrad hospital, but unfortunately the situation is identical. There is a global shortage of blood in Thailand because people are afraid of contracting the HIV virus during their blood donation.

While waiting by the phone for a blood bank in Singapore to answer my request for a blood shipment, I go over the patient's file again and realize that his blood type is exactly the same as mine. In a matter of minutes I am in the hematology department, reviewing each disposable needle and plastic pack before my donation. Later on, the patient is transfused with a fresh concentration of my platelets. The medevac can resume and the rest of the trip runs smoothly. In Honolulu, a doctor from AIRescue takes over all the way to Houston, where the patient is diagnosed with acute leukemia.

The lesson for the doctor: Some circumstances may take you out of your comfort zone. Keeping the patient's best interest in mind can help you make tough choices.

Yann Meunier, MD, is the health promotion manager for the Stanford Prevention Research Center. He formerly practiced medicine in developed and developing countries throughout Europe, Africa and Asia. Each week, he will share some of his experiences with patients in remote corners of the world.

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