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When famine rewrites the population: the clinic plan must change

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Attribution: SCUK Alumna
PEN Type: Field Experience (Programme Delivery)
Main country: Cambodia
Other countries: Thailand
Project Themes: Operations & Field Leadership, Health – Medical, Health & Nutrition
Role: Field nurse
Mission brief: Brief was to help establish a Rehab Centre in Qui Nhan for war-wounded children
Audience: Frontline / Field, Programme / Project, Country or Regional Management
Geographic applicability: Global / broad applicability
Dates: 1978 → 1982
Advice Summary: Reality trumps everything, Adapt quickly, document clearly, and keep the clinical logic simple. Brief was to help establish a Rehab Centre in Qui Nhan for war-wounded children
Key words/phrases: lactating women, under-5, famine physiology, amenorrhoea, clinic redesign, under-12s, referral readiness
Operational snapshot
  • Scale: ‘42,000 displaced Khmer’ in scrubland
  • Presentation: torture survivors, famine, and ‘shocking incidence of mental illness’
  • Original programme brief: clinics for lactating women and under-5s
The clinical reality Our brief was to set up clinics for lactating women and under 5s. The reality was – no lactating women (extreme famine over 4 years saw to that.) Many children under 5 had died. Young women of 18 to 20 were pre pubertal, no menstrual periods due to famine damaged organs. What we did
  • Extended clinics to under-12s
  • Delivered intensive feeding plus first aid until the hospital was ready to receive referrals
Lessons learned
  • Validate assumptions immediately: famine doesn’t just reduce numbers — it changes physiology and demographics.
  • Design programmes with built-in flex: age bands, criteria, and triggers that can expand.
  • Be explicit about why you adapted — it protects clinical integrity and helps coordination.
What I’d tell my younger self Your ‘target group’ on paper may simply not exist in front of you. Adapt quickly, document clearly, and keep the clinical logic simple.