Jim Cousins '75, M.D., was sitting in his emergency room office at Chestnut Hill Hospital at the end of another 12-hour shift--12 hours that usually ended up being more like 14 or 16. As usual, he was plowing through his endless stack of insurance paperwork. As usual, doubts were creeping into his mind.

Things were not so good in Philadelphia. Cousins was operating in a war zone; gunshot wounds, stabbings and beatings were all too common, and the number of uninsured people using the emergency room for primary care reflected growing problems with how medical care was being delivered in America.

As his shifts grew longer, the piles of insurance forms grew out of control. In eight years of work, Cousins had missed too much of his two oldest kids' growing up. And his medical school bills (which he'd put on credit cards as an impoverished resident) looked like they would never be paid off.

Moreover, Cousins's car had been stolen three times, he had been robbed, his son Tim was mugged just before he left for boarding school in Switzerland, and his wife, Catherine, had been a carjacking victim.

Then came the call: go to Cambodia to start a hospital. It sounded like a refuge, an oasis, a place in a far-off land where things couldn't be any worse, a place where he could start fresh and where he and his family would be safe.

Safer, anyway, than in Philadephia. A month later Cousins and his family were on a plane to Southeast Asia.

It wasn't long after the latest coup, and just before new elections, that Jim, Catherine and their youngest son, Jerome, landed in Phnom Penh. They disembarked at Pochentong airport, which the year before had been looted after personal armies of several competing "prime ministers" fought in the streets. The Cousinses emerged into the sweltering air and were thronged by street kids and beggars.

For several years, Cambodia had endured the awkward arrangement of having two prime ministers--Prince Norodom Ranariddh and Hun Sen, enemies who ruled together in a sort of truce since the 1993 election. But by 1997, the standoff had run its course, and the two fought openly for control of the city. Oddly, when the fighting was over, there emerged not one but three prime ministers, at least on paper. Except that one was in exile and the other was demure. In reality, Hun Sen was the new leader.



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Sidebar: At Sea on the Rambo Express
Sidebar: Next Generation Finds Beauty and Sadness

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