Escalating Violence in Myanmar:
The past couple weeks, on several occasions, I awoke to the distant sound of artillery shelling and explosives from the ongoing battles between the Karen National Liberation Army (KNLA) plus their resistance allies against the Tatmadaw (the Myanmar Military) forces. Although my friends, colleagues, and I are safe, as we are on the Thai side of the border, not everyone is as fortunate. All of my colleagues have family members still in Myanmar, and hearing these explosives is a visceral reminder of the tragic situation faced by those within Myanmar and the atrocities experienced by people who are fighting for their freedom.
As I have covered in previous blog posts, Myanmar has a long history of authoritarian military rule. It is also the home to what is considered the longest active armed conflict in the world, with ethnic armed organizations (EAOs) in multiple states engaged in armed resistance since shortly after the end of World War II when Burma achieved independence. In response to the National League for Democracy’s (NLD) major victory in the 2021 elections, after a period of pseudo-democratization during the 2010s, the Tatmadaw executed a coup to regain complete government control. This coup sparked significant protests and led to national resistance, with many refusing to return to authoritarian military rule, instead fighting for freedom and democracy.
As the civil war enters its third year, the Tatmadaw has lost control of significant territory and has sustained increasing losses, especially since the onset of Operation 1027 last October, despite having better financial backing and weapon superiority. In response to battlefield losses and dwindling military support and recruitment, the military recently announced they would enforce a conscription law to help fill their ranks. Many people I am close with, as well as international observers of the Myanmar conflict, believe this will ultimately lead to more internally displaced people (IDPs) and refugees fleeing to neighboring countries. There has already been an increase in refugees along the Myanmar-Thai border. This Al Jazeera article discusses the mandatory military service announcement and has several videos about the civil war.Â
Of course, increased battles lead to increased war casualties and patients. This increase in war-related injuries, combined with the further destabilization of Myanmar governmental services, highlights the importance of our collaboration with ethnic health organizations, such as the Civil Health And Development Network (CHDN) Karenni State, and our research to better understand gaps in healthcare services to help design programming to expand emergency care services within Myanmar.
The following quote and photograph is from the United Nations (UN) Office for the Coordination of Humanitarian Affairs (OCHA) website...
"Three years on from the military takeover, the humanitarian landscape for 2024 is grim with a third of the population – 18.6 million people – now estimated to be in humanitarian need. Children are bearing the brunt of the crisis with 6 million children in need as a result of displacement, interrupted health-care and education, food insecurity and malnutrition, and protection risks including forced recruitment and mental distress."
*A note about the below photograph
I have not posted many pictures of my friends or co-workers due to concern for their privacy and safety. When I have posted pictures the faces have been obscured. Many people I interact with are fearful of retaliation to themselves or their families' from the Myanmar military should their whereabouts be known due to their involvement in the Civil Disobedience Movement and resistance. However, photographs are important as they help readers/viewers relate to the stories they read. Below is a photo that was published on the OCHA Myanmar website of an internally displaced family in Karenni State, the location of our emergency care assessment pilot project. I did not take the photo but it represents the many people and families I interact with on a daily basis, as well as the human impact this conflict is having.
An internally displaced family in Karenni (Kayah) State, eastern Myanmar (near the border with Thailand).
UN/S. Modola (https://www.unocha.org/myanmar)
Click the image below to download the 2024 OCHA Humanitarian Needs and Response Plan for Myanmar
Emergency Care Research Update:
During the past week, we have been working on several of our upcoming emergency care research projects. We traveled north to Mae Sariang to have a second meeting with members of the Civil Health And Development Network (CHDN) Karenni State to finalize the healthcare facilities that will be included in our Emergency Care Assessment pilot project. The Coastal Maine Global Health Fellowship supported this initial trip while we finalize our grant applications to fund the research project.Â
This project will utilize the modified WHO Emergency Care Unit Assessment Tool to understand the current emergency care capacity in a district in southeast Karenni. We will then present the research results to our partners: CHDN and the Ethnic Health System Strengthening Group (EHSSG). Together, we will use the research results to create intervention proposals to address the gaps in emergency care. We will then contact donors as well as local and international organizations to discuss collaboration on our interventions. Additionally, we will use our pilot project as a feasibility study to apply for a more significant grant to support expanding the emergency care assessment to the rest of the Karenni state and other states along the Myanmar-Thai border.
Mae Sariang sunset
Emergency Care Protocols:
As discussed in last week's blog post, we have been working on our emergency care protocols, a process that is being led by Dr. Tiah Ling and includes input and review by MTC clinical staff, administration, the our ECU working group. For those unfamiliar with medical protocols, they are treatment algorithms (or pathways) that can be used as a reference tool for clinical staff. They should be evidence-based, context-appropriate (i.e., to the training level of staff, only include medications and treatments available at your facility), aesthetically easy to follow, and include enough information to guide the clinical team without being too verbose. Protocols are not an all-encompassing review of their subject matter but a concise reference tool that staff can study beforehand or use in real time. Below is a sample draft of our anaphylaxis protocol. Before looking at the anaphylaxis protocol I have embedded a short video with a general overview of anaphylaxis/anaphylactic shock.
MTC ECU Anaphylaxis Protocol (DRAFT)
Sunday Lunch and Pancakes
Last Sunday I enjoyed a delicious homemade lunch of coconut rice, chicken curry, and fresh mango at the home of my good friends who are also both doctors. Lunch was followed by a large stack of Hello Kitty pancakes for desert.
New MTC Main Entrance Road
As Mentioned in last week's post, MTC constructed a new main entrance road with increased width and drainage. Below is a photograph of the completed road.
