Mae Sot, Mae Sariang, and Chiang Mai are clearly visible, and you can also see “Nu Po,” which is the refugee camp I went to in October, and Mae La camp, where I attended my first Karen wedding. GHAP also has fellows in Chiang Mai (working with the Shan people) and Sangklaburi (working with the Mon people).
(www.tbbc.org)
For almost two weeks in early Feburary, I was in Mae Sariang for Trauma Training. The whole experience was definitely the highlight of my work so far—to see the training come together after months of work, and also to see the medics learn and practice valuable skills so quickly.
Joining us from the US was the GHAP Trauma Team—a group of really energetic, interesting people. Dr. Larry Stock (emergency medicine) and Frank Tyler, RN (war surgery specialist) led the training, as they have for the past few years, joined by a general surgeon, a plastic surgeon, an emergency medicine resident, and two logistics helpers.
The GHAP Trauma Team
View from the training center
Group photo
There were 19 trainees—all male—and about half were old medics who have been coming to the training for at least a couple of years. But for those who were new to trauma, I was constantly amazed at how much they learned in such a short time. I’d probably describe the trauma curriculum as a quick procession from basic anatomy and biology to medical school to surgical residency—all in the span of just five days!
Day 1 reviewed anatomy and physiology, and transitioned to orthopedics and splinting in the afternoon. Day 2 was devoted to the MEGACODE, also known as primary and secondary survey of a trauma patient. Day 3 covered wounds, limb injuries, and amputations. Day 4 went over chest, abdomen, pelvis, head, neck, and spine injuries. And Day 5—practice on pigs and goats.
Throughout the training, the trainers also used innovative models for practice—sugar cane for an amputation, plastic tubing for practicing surgical airways. The medics even showed the trainers how they make bamboo splints (which are actually a lot more practical in the jungle than all of the plaster we gave them!).
Practicing amputation using a sugar cane model
Medics demonstrate using a bamboo splint
Surgical airway model kit (airway tube, "trachea", clamp, scalpel)
Practicing primary survey of a trauma patient
Medics practice splinting
For the final day, KDHW obtained 4 pigs and 2 goats for the lab. Because the trainers wanted to preserve the airways for surgical practice, we could not slit the animals’ throats. Which means the medics resorted to much more brutal ways of killing them (let’s just say, it wasn’t pretty). But the lab itself was fascinating. All of the medics practiced the key procedures—inserting a surgical airway into the trachea, putting in a chest tube for a pneumo- or hemo-thorax (accumulation of air or blood in the space between the lung and chest wall), fasciotomy (cutting fascia to relieve tension and therefore relieve loss of circulation to a limb), and amputation. The advanced medics learned how to skin graft as well. The medics did great—even the new ones—and will continue to practice with more experienced medics when they get to the field.
Medics work on a live pig under anesthesia
Using an amputation saw on a pig's leg
Inserting a chest tube
Teaching the surgical airway procedure to new medics
Demonstrating how to set up a jungle OR (operating room)
After learning and practicing a lot of the techniques all week, I also got to participate in the animal lab. With direction from the doctors, I got to put in a surgical airway and chest tube in a pig, and amputate a goat leg! So I guess, theoretically, I could save your life if you had a blocked airway. But I wouldn’t depend on it if I were you…
Me inserting a chest tube into a pig
I officially got blood on my feet
Me, inserting a surgical airway
It might seem a little crazy to you, and it certainly did to me at first, that these guys learn such complicated procedures in such a short amount of time and then go practice them almost immediately (with more advanced medics’ help). But, these kinds of programs are actually cropping up all over the world. Because—if you train a basic medic over and over again in a particular surgical procedure, who says that they can’t do it without medical school? Research has shown that training of non-physician clinicians can be effective, and should be used more frequently. Check out this article about “surgical task shifting” in sub-Saharan Africa: http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1000078
Pretty cool, huh?
And after talking to a few of these medics, a few of whom are in the KNLA (Karen National Liberation Army, the Karen National Union’s armed faction), I realized that they definitely need the training. I sat down with Gay Kaw Htoo, a 4 ½ foot medic who serves in the KNLA. After describing his quite dangerous lifestyle—constantly on the run from the SPDC, never seeing his family--he described to me several situations in which he had to attend to men in his brigade, who had been shot or stepped on a landmine only meters away from where he stood. Without his medical training, they wouldn’t have survived.
And yet still, he went on to describe how the KNLA lays landmines as well when they hear that the SPDC is coming to attack. Gay Kaw Htoo said that the KNLA knew where all of their landmines were planted, and removed them if the SPDC didn’t show up. But I couldn’t help but wonder about the continuous cycle of laying landmines on both sides of the battle…and what it’s actually accomplishing.
Gay Kaw Htoo, Trauma medic for 10 years
This could, actually, be the last year for the Trauma program. The 2010 elections in Burma are coming up in October, and there will undoubtedly be increased fighting surrounding the event. The government has not made it a secret that one of their primary aims is to defeat the ethnic insurgents once and for all—the Burmese army could certainly defeat the KNLA in the coming year. And the fighting is already beginning. Just at the end of training, one of the medics received word that the SPDC had attacked Tee Mu Ta Clinic (run by KDHW) and its surrounding villages in Karen State, burning them to the ground. Luckily, the clinic staff and villagers had escaped before the SPDC arrived, but are now hiding in the jungle without a reliable source of food, unable to return to their homes, and are much more vulnerable to malaria and other diseases. A brief report on these attacks is available here.
Following trauma training, a team of two mental health trainers held a 2-day training on medic self care and counseling techniques for patients with mental health problems. It was a very eye-opening experience for me, as I began to understand all that these men see and deal with on a daily basis. During one of the exercises, a medic, Ta Mla, who had never stopped smiling the whole training, told a story about his childhood. The SPDC attacked his village, dragged his father off into the woods to be killed, and kidnapped his brother and sister. Ta Mla remained hidden behind a tree, and unable to move for fear of being caught, watched horrified as the SPDC beat his brother and sister to death for 45 minutes.
Not surprisingly, the mental health trainers discovered that most of these men drink alcohol heavily, and recommended that next year we hold substance abuse training for an extra few days. As one of the trainers explained to me, it’s not only bad for their health, but think about it…if the SPDC attacks and you’re drunk, how equipped are you to run into the forest and hide, and take care of your family in the process? Scary to think about.
Medics practicing mental relaxation techniques
As for my involvement in the training, I taught a half day of TOT (Training of Trainers), which consisted of basic teaching methods that the medics can use when they go back to the field and teach first aid to village volunteers. Additionally, I gave a presentation on the landmine data that the trauma medics have collected for the past five years, originally given at the American Public Health Association conference. It was pretty cool to see the data brought full circle, and to show the medics how their work is helping to promote international advocacy for Burma issues.
I also got to spend some time with the medics after training and play some cane ball (a traditional sport of Burma...like hackey sack except with a plastic ball and a volleyball net) and soccer, which I unfortunately don’t have pictures of. I am happy to report, though, that when I got the wind knocked out of me during the soccer game, the medics were more than ready to start the ABC’s! (Airway, Breathing, Circulation—the first steps of assessing a trauma patient)
More updates:
-Mice invaded our house while we were gone for the holidays--eww. We set traps with peanut butter (their favorite according to Wikihow.com), but no luck! Our Burmese office manager said to use fish or chicken instead…gross! Who knew that mice have regional preferences? Fortunately, the rat poison did the trick, and the furry suckers seem to be gone.
-Our dog Gremlin had a puppy! All of her shenanigans in December apparently did the trick. My roommate wants to name it Gizmo, since apparently in the movie Gremlins, Gremlins turn into Gizmos or something like that.
Gremlin and Gizmo
-Chinese New Year was last week, with plenty of celebrations in Mae Sot. In addition to a dumpling-eating, Kung-Fu-watching celebration, I also followed the dragon around Mae Sot for a while (pictures below).
I also just returned from a hiking trip earlier this week, but updates/pictures on that next time!
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