Second Batch Basic Emergency Care Course
Next week, we will conduct our second modified WHO Basic Emergency Care (BEC) course. We plan to have 12 participants (8 medics and 4 nurse aids). Four of our first batch of BEC graduates who performed exceptionally well in the course and also completed the BEC training of the trainer (TOT) course will act as provisional facilitators alongside our cohort of four full facilitators. These four provisional facilitators include two doctors, one senior medic, and one nurse aide. Additionally, one pediatric physician specialist who underwent an expanded BEC TOT will join as the fifth provisional facilitator. Expanding our trained facilitator group aligns with our sustainability goal of utilizing TOT programming to work with the long-term MTC staff, including senior medics and nurse aids, to ultimately be the leaders of future MTC BEC courses. We are planning a third BEC course in February, with a second BEC TOT course in March.
BEC course documents ready for the next course! Includes participant workbooks, and facilitator guides. We also have translated into Burmese the pre- and post-course surveys, knowledge assessments, and course evaluations.
ECU Design
We have had many meetings of the past few weeks to finalize our ECU building design. The architect of the current Mae Tao Clinic, Jan Glasmeier, who is in Mae Sot with a team building a school, met with our ECU planning team and the MTC engineer team today to review the latest design as we work to finalize a sustainable building use plan moving forward.
Interesting Ultrasounds
Per usual, the pathology managed at MTC is wide ranging and often more progressed than typically seen at my home institution given the many barriers to care faced by MTC's patient population. These include financial, physical distance, legal status, traversing active armed conflict-zones, and health literacy, among many others.
One patient (40s yo female) seen recently presented with abdominal pain, and intermittent fevers for several months. On abdominal ultrasound the following image was obtained...
This is consistent with a large liver abscess. Plan is for one of the senior medics to use ultrasound to guide a needle aspiration and drainage of the abscess. This will provide source control of the infection and allow us to send the sample for culture and ensure the correct antibiotics are used to treat the infection. Prior to drainage we are obtaining blood counts, including platelets, to minimize the risk of associated bleeding given the significant blood supply to the liver.
The following video is a general overview of what an abscess is and how they form.
If you want a more in depth review of liver abscesses specifically and want to pretend you are studying for a medical school exam, then watch this video about types of liver abscess and treatment.
Another patient (50s yo male) presented with shortness of breath, intermittent left sided chest discomfort, fevers, and mild weight loss for several months. He does smoke cigarettes and drinks alcohol regularly. Denies significant medical history but it was not clear how often he seeks medical care. He was not in acute distress and initially presented to the outpatient ward. The differential diagnosis for these presenting symptoms is broad including tuberculosis, pneumonia, lung abscess, malignancy, interstitial lung disease, pulmonary hypertension, and HIV to name a few. An X-ray was obtained that showed the following...
This x-ray demonstrates a LARGE opacity in the left hemithorax (the big asymmetric white thing on the patient's left side, which is the right side of the image) where the left lung should be. We performed an ultrasound and found the following...
This ultrasound image shows a large fluid collection. He had no rib tenderness or reported trauma so it was unlikely to be due to blood. With the infectious symptoms he reported there was concern for tuberculosis, empyema (purulent fluid in the pleural space), or fluid/infection due to obstruction from a malignancy. He underwent thoracentesis with drainage of over 850 mL of purulent fluid consistent with an empyema. The procedure was successful and a sample was sent for culture and tuberculosis analysis. We plan on obtaining another chest x-ray to better evaluate the lung after removal of the empyema to help determine the cause of the empyema, as CT scan is not currently an option for this patient due to cost.
Visits from my United States based Friends and Colleagues
Dr. Ramu Kharel
In December, a very close friend and mentor, Dr. Ramu Kharel, visited Mae Sot on his way home from inaugurating Nepal's first poison control center, just one of his many global health projects. During his visit, I introduced him to the clinic and staff, rounded on patients in the inpatient ward, met with the Singapore Health team regarding ECU planning, and enjoyed several outings with my MTC friends. We also discussed ways of collaborating on future emergency care projects, including developing communication between MTC staff and the staff at Bayalpata Hospital located in the Achham district in rural far western Nepal. Ramu and I have both collaborated with the Bayalpata team in the past, and although these two hospitals are located in different countries and each faces the unique challenges of their respective contexts, they share many similarities and difficulties that hospitals affiliated with large academic institutions cannot relate to. If you would like to learn more about Dr. Kharel's global health efforts, visit his non-profit HAPSA Nepal or follow his social media! (tiktok and instagram)
"Uncle" Ramu with the son of one of my closest friends from MTC, we all enjoyed a beautiful sunset at a reservoir just outside of Mae Sot and then had dinner together nearby
Dr. Giovanna DeLuca
I was also fortunate to have two other really close friends and colleagues visit MTC this January. Dr. Giovanna DeLuca is a global emergency medicine fellow at Brown University, and I have worked on multiple previous global health projects with her. During her visit, she joined ECU planning meetings and taught ultrasound during inpatient ward rounds. We also held planning meetings regarding our upcoming emergency care research collaborations with the Ethnic Health System Strengthening Group (EHSSG) and the Civil Health and Development Network Karenni State (CHDN). We are currently in the protocol design and IRB preparation phase of our research, so stay tuned as I will explain more about these projects in the coming blog posts.
Dr. Craig Biebel
My final visitor was Dr. Craig Biebel, who is in the final month of his family medicine residency at Beaumont Hospital, Troy, Michigan. He will start a combined hospitalist/outpatient attending position at a critical access hospital in rural Maine this March. In addition to rounding in the inpatient ward, he joined ECU planning meetings and will be consulting on our upcoming ECU protocols.
Below are several photos from their visit.
Dr. DeLuca teaching bedside ultrasound
Lunchtime at the clinic
Dr. Biebel evaluating a patient in the respiratory isolation unit
Karen New Year
The Karen New Year celebration was held on January 11th during Gia and Craig's visit. So we donned traditional Karen outfits and joined my good friend and Burmese Emergency Medicine doctor at 7:30 am to head to the festivities. During the celebration, we watched Karen dances and songs, ate delicious food, and welcomed the New Year alongside MTC staff and other members of the local Karen community.
I have some really wonderful photos of the celebration and friends we were with, however, as mentioned before in this blog to ensure everyone's safety I will not be posting any names or pictures of any Burmese friends or colleagues. Below is a photo from the New Year Celebration.
Mae Moei National Park
Last week I also visited the Mae Moei National Park which is located about 2 hours north of Mae Sot. The picture below was taken at a small restaurant and shop within the park.
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