As usual during my time at MTC, the past two weeks have been busy and fulfilling. I spent my time with emergency care project planning, building relationships, and engaging in many discussions, both frivolous and profound. During these two weeks, I celebrated American Thanksgiving, finished my echocardiogram course curriculum, swam at a waterfall, saw people gain the ability to walk for the first time in years, participated in a conference to help coordinate with Myanmar's ethnic health organizations, celebrated a wedding, and of course ate delicious food. The remaining post will briefly describe some of these highlights and more that I experienced over the past 14 days since my last post.
ECHO Course:
This week I finished the echocardiogram course curriculum. The MTC Echocardiogram (ECHO) course is a collaboration between MTC and the Coastal Maine Global Health Fellowship, with support from Core Ultrasound. It is intended for MTC ECU and clinical staff including physician consultants and medics. The course is designed to provide a foundation in point-of-care (POC) ECHO knowledge and skills to assist in clinical decisions.
Part I of the course will cover basic ECHO views, the 5 E’s of ECHO, diagnosing pericardial effusions, normal size ratios (1:1:1 rule), and assessment of left ventricular systolic function by visualization and EPSS. Part II of the course is divided into three modules covering advanced ECHO techniques including cardiac tamponade diagnosis, right heart function, methods of evaluating right heart strain, valve pathology, diastology, and endocarditis.
Similar to other courses designed by the collaboration between MTC and CMGHF, such as the Basic Emergency Care Course, we strive for sustainable educational programming, including training future instructors and developing language-appropriate courses. We will hold the first session of the course tomorrow morning. Our first course will have four participants all of whom are Burmese physicians, including two radiologists who are skilled ultrasonagraphers but have not received formal echocardiogram training. Following the course completion we will hold a training of the trainer session to review general teaching theory, tips on presenting the ultrasound lectures, and suggestions how to to teach the hands on part of the course. Our second ECHO course will be primarily taught by the graduates of the first course, while I provide assistance as needed. This will allow our future ECHO courses to be taught in Burmese and encourage course sustainability as it will be taught by MTC staff. Additionally, we plan to record the Burmese language in-person lectures to help build a Burmese language virtual ultrasound curriculum. Now that the ECHO course curriculum is complete, I will begin putting together the remaining emergency ultrasound course covering FAST, RUSH, and lung ultrasound exams.
THET UK-EHO Health Partners Sharing and Learning Event
I was fortunate to participate in a two-day virtual conference organized by the Tropical Health and Education Trust (THET) that brought together members of Myanmar's Ethnic Health Organizations and partners in the United Kingdom. The event allowed participants to share their organization's current practices, achievements, future goals, and critical priorities to share knowledge and help determine areas where various UK partner organizations and Ethnic Health Organizations may collaborate. The event also highlighted the role healthcare workers are playing in defending freedom and democracy since the beginning of the Myanmar Military coup on February 1, 2021. Since this date, approximately 65-70% of Myanmar's doctors have joined the civil disobedience movement, over 870 health workers have been arrested, 1055 attacks and threats against health workers and infrastructure have been perpetrated, and 95 health workers have lost their lives. Despite this, all of the Burmese healthcare workers in this meeting and those I have met at MTC continue to work tirelessly to provide care and improve the health of their communities regardless of the challenging conditions.
The MTC campus was filled with many events over the past few weeks. Here are a few of the highlights:
I attended the opening ceremony of the MTC Bachelor of Nursing program. MTC already has a 6-month nurse aid training program and participates as a clinical training site for 12-month medic training programs. However, their commitment to developing long-term sustainable healthcare for the population they serve has led to the development of a 3-year bachelor of nursing program. Although the political situation within Myanmar is ever-changing, it is critical to support the long-term development of the Burmsese healthcare workforce despite the political instability within their home country. Short training programs designed to fill the immediate need for first aid and trauma care due to the tragic violence resulting from the Military Junta coup of 2021 are critical. However, at the same time, it is essential to think about the need for highly trained members of the healthcare profession to help lead the future of MTC and, in the future, the Burmese healthcare system. This program follows international nursing accreditation and will allow MTC staff and other Burmese refugees to advance their education while serving their communities.
World AIDS Day:
MTC participated in World AIDS Day, with many booths set up for the event. They had events focused on education regarding safe sex and sexually transmitted disease prevention, reducing the stigma of HIV, HIV treatment options, and more.
Prosthetic Manufacturing Training Program:
My favorite happening at MTC this past week was the prosthetic workshop and training. I had the opportunity to observe the event and learn a great deal about prosthetics. Three orthoprosthetists from Eqwal came for 10 days with the goals to provide care for amputated individuals, train healthcare professionals in manufacturing prosthetics, and establish the foundations for a prosthetic manufacturing workshop. At the end of the workshop over 20 patients were provided with prosthetics, many of them young men who recently sustained injuries fighting in the Myanmar revolution. Others incurred their injuries many years ago and have been living with either no prosthesis or a non-articular prosthesis (straight leg that does not allow people to walk). This event was the foundation of developing an in house prosthetic manufacturing center at MTC and as a result there were several patients were able to walk for the first time in over 20 years. All three of the Eqwal staff said they had never seen patients develop the ability to walk with a new prosthesis as quickly as the patients this week, just a small demonstration of the will and determination of the Burmese people I have met since my arrival.
Watching the joy and pride of the prosthesis recipients as they WALKED away at the end of the workshop carrying their old non-articular prostheses was one of the highlights of my time here thus far. Although already making incredible progress over the past few days, with continued physical therapy they will be able to walk without crutches or canes in the near future!
Prosthesis recipients from MTC-Eqwal Prosthetic Workshop
MTC staff manufacturing a prosthetic
American Thanksgiving:
To celebrate American Thanksgiving, I enjoyed a wonderful dinner at the Passport Restaurant, part of The Hospitality-Catering Training Centre (HCTC) in Mae Sot.
From the HCTC website, "In Northwest Thailand, on the border with Myanmar, the town of Mae Sot is home to a large Karen minority which is one of the most vulnerable populations in Thailand. In 2009, the IECD and its local partner, the Tak Border Child Assistance Foundation, opened the HCTC in order to help underprivileged young people by offering them a chance to access promising jobs in the hospitality-catering sector."
I went to dinner with Michael, an American who has been coming to Burma and the Thai-Burma border for over 25 years, initially working with mental health programs and currently a volunteer at the the Minmahaw School. The Minmahaw School is a local English immersive one-year boarding school for Burmses migrants and refugees, for more information see their website. Every moment, from our arrival at the restaurant through the end of the meal, was special, and the staff were both friendly and attentive.
Karen Wedding:
Last Saturday, I experienced my first Karen wedding, celebrating the marriage of a fellow MTC staff member. The Karen people are one of Burma's many ethnic groups who are indigenous to the Thailand-Burma border region but live throughout Burma. They have also been in armed resistance against the oppressive Myanmar Military since the end of World War II when the Karen people fought alongside the Allied Forces, and their continued battles are often sited as the longest running armed conflict in the world. For more information on the current state of the Karen peoples efforts and the overall state of the Myanmar revolution I recommend you look up news relating to the 1027 offensive. However, this was a day of joy. The wedding was held on a beautiful property 45 minutes outside Mae Sot. The event was filled with laughter, love, and traditional Karen dress. I have some lovely photos of the guests and event that would be nice to share, but out of the ever-present privacy concerns, I will instead share a photo that shows a glimpse of the environment of the wedding venue.
Sunday Adventure Day:
A group of my Burmese friends, the Eqwal prosthetic team, and I traveled around the hills surrounding Mae Sot for a day of pagodas, waterfalls, hot springs, and traditional Karen food. We even ate quail eggs cooked in the hot springs water, which I can safely say is the first time I had the opportunity to do that in my life. It was the perfect way to relax after a busy two weeks.
Waterfall swimming hole
We enjoyed a mid-afternoon snack of boiled quail eggs, cooked in the hot spring water.
Sunday Sunset
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