BEC Training, a 1st Birthday Party, Operation 1027, and a Sunset Commute

Updated: Mar 12

It has been a busy yet rewarding couple of weeks. Yesterday was the final day of our inaugural 7-day MTC Emergency Care Unit Basic Emergency Care course (MTC ECU BEC), with 14 participants (a combination of doctors, medics, nurses) graduating the course. As mentioned in prior blog posts, this course is based on the open-access WHO Basic Emergency Care course: Approach to the Acutely Ill and Injured (a course I have experience facilitating in several countries). Modified to fit the unique context of Mae Tao Clinic.

Training Center for TOT and BEC course

MTC BEC TOT

This phase of ECU curriculum implementation began two weeks ago when we completed a two-day BEC training of the trainer (TOT) course to prepare a group of Burmese physicians to facilitate the MTC BEC course. The TOT course introduces future facilitators to the topics taught in BEC, explores teaching/learning theories, and focuses on improving teaching skills in the lecture setting and when leading small groups. The TOT also explores the challenges of teaching clinical skills and provides skills-teaching techniques. Although it can be advantageous to have future facilitators complete a BEC course before the TOT, this was not the best course of action given our unique situation. Due to the ongoing military coup and associated violence in Myanmar, MTC currently has a group of Burmese physicians assisting the hospital. Given this situation, Dr. Phillip (a Burmese emergency medicine-trained doctor and leader of the ECU project) and I acted as lead trainers for the TOT. Four of our TOT course graduates served as provisional trainers during the subsequent BEC course, including an orthopedic surgeon, an anesthesiologist, an OBG/GYN, and an internal medicine doctor.

This pathway enhanced the learning of our participants by allowing our lectures and small groups to be conducted primarily in their native language, Burmese, with some English phrases and medical terminology. Our facilitators are an extremely talented group, and their leadership and energy allowed the BEC course to succeed. The response to our two-day TOT course was overwhelming, with some participants reporting they had yet to experience lectures with the interactive and animated teaching style designed to engage students in active learning. Our facilitators then expertly incorporated these lecture teaching skills into our BEC course with a positive response from the BEC students.

MTC BEC

The core of the BEC course emphasizes a systematic method for evaluating and managing patients with acute illnesses and injuries utilizing the ABCDE approach. It focuses on various forms of active learning and repetition to build comfort with this algorithmic approach. Also, it teaches medical history taking using the SAMPLE mnemonic and organizing succinct patient hand-offs with the SBAR mnemonic. The course provides small group case scenarios and clinical skills associated with four primary modules: difficulty in breathing, shock, altered mental status, and trauma. Despite seven full days of active learning (including a Saturday), the participants were highly engaged, interactive, and excited about becoming the pioneers of emergency care at MTC.

Additionally, all lectures were recorded to help with the development of an online/in-person hybrid Basic Emergency Care course that will be available fully in Burmese to help expand emergency care skills and knowledge throughout Myanmar when it is not feasible to gather large groups for a 7 day course, this will allow for distance learning for emergency care theory followed by shorter in person skills course.

BEC Skills:

*** Denotes change for MTC BEC course

Shock Lecture

Oropharyngeal Airway (OPA) insertion

Tourniquet application (both commercial and homemade)

Fracture immobilization

Demonstrating the Hagen-Poiseuille law with regards to IV fluid dynamics during a MTC specific BEC course team “race” to empty their respective syringes. In simple terms, a “wider and shorter” IV canula will infuse fluid faster than “thinner and longer” canula.

Channeling my brother Ian's IT skills: technology used to record lectures

BEC course graduation ceremony

MTC Advanced Emergency Care Certificate Course:

The BEC course will act as the first component and foundation of the MTC Advanced Emergency care curriculum, which will also include the following:

Emergency ultrasound course (FAST, RUSH, basic ECHO, Lung)
Advanced airway course (enhanced training and simulation on skills taught in BEC, with additional training on Laryngeal mask airways (LMA))
Emergency ECG interpretation course
Advanced emergency medication administration
Basic Life Support/AED

The details of this curriculum are still being developed, with plans for evaluation by a committee of local and international emergency medicine physicians.

ECHO course:

Now that the first MTC BEC course is complete, over the next several weeks I will be focusing on developing an echocardiogram course for the MTC medics and several Burmese radiologists who are experts in other forms of ultrasound but have yet to have dedicated ECHO training. This course was requested due to the frequent need for ECHO evaluation and patients frequently presenting with severe cardiac abnormality on ECHo as displayed in previous blog posts and below. Core Ultrasound (https://coreultrasound.com/), an incredible resource for ultrasound education, has offered to provide free access to the MTC team to Core Ultrasound's educational resources. This will be critical in the ECHO course development and the emergency ultrasound course mentioned above. The course will be a combination of lectures, at home video and US question bank assignments through Core Ultrasound, and in person ultrasound scanning of cases at MTC.

One of many cases that inspired the ECHO course development:

Another abnormal ECHO obtained during my time at MTC, a patient in their 40s with likely alcohol induced dilated cardiomyopathy presenting in hypoxic respiratory failure due to volume overload and heart failure exacerbation. Patient significantly improved with diuresis during his hospitalization at MTC and was able to be discharged home.

ECU Roof:

The ECU building roof is complete; the construction team has moved on to additional remodeling.

Beautiful new roof!

Other Musings from Mae Sot:

In non-medical updates, last weekend, I was fortunate to spend an entire day celebrating the one-year birthday of the son of one of my friends/colleagues. As they are Buddhists, the festivities began at their home for a 7 am blessing and reception by three monks, followed by breakfast and gathering of countless friends and family, most of whom have been forced to leave their homes due to the 2021 military coup in Myanmar. I had an inspiring conversation with a group of Burmese university students about their experience of suspending their lives to support the civil disobedience movement to counter the violent Myanmar military coup and rule. Most who I was speaking to were in law school or medical school when the coup began. We discussed their desire for freedom and democracy in their home country, the challenges they have faced, including the violence they have witnessed, the mental toll of peaceful protest and armed rebellion, the hope and confidence they have in their movement's ultimate success, and what they are doing to try and prepare themselves to rebuild their country when that success is achieved. These are heavy and thought-provoking conversations to have with anyone with details and depths that cannot be explored fully in the venue of a blog post. It is hard to imagine having those kinds of thoughts and stress when their most significant concern should be studying for exams. Unfortunately, they are not alone in their challenges, as nearly all of the people I have become close with have had similar paths. What has stood out the most to me during my time here, is despite the unimaginable hardships nearly everyone I met has been through, their warmth, kindness, and positive energy shine through with a conviction to forge the future they envision.

Despite these challenges, today was a day for celebrating life. Although many expressed conflicted feelings about having fun while there is escalating violence in their home country, everyone agreed that moments such as this must be celebrated. The revolution is as much a mental defiance of oppressive rule as it is physical. These are the moments they are fighting for, the reason they are striving for freedom so that children such as the one whose birthday we are attending will have a future in Myanmar. The party and reception lasted all day, with more friends coming for lunch and socializing. The day ended with an intimate dinner with family and close friends at a restaurant serving traditional Karen food and, of course, birthday cake.

***Although I would like to highlight more details about the specific people I have met and interacted with due to the dangers to them and their families who remain in Myanmar, I will continue only to write generalities about the people I meet personally and professionally.***

Operation 1027:

If you are interested in following the revolution in Myanmar here are a few articles. Recently, an alliance of ethnic armed groups began the 1027 offensive (named after the date it began October 27th). Although it has taken years of buildup to this moment by many different groups opposing the Myanmar Military Junta's oppressive rule, this most recent offensive has acted as a catalyst that some observers believe will lead to the downfall of the military government. The road to revolutionary success remains long, but there is a growing sense that the junta does not have a long term path forward.