Due to the dangerous nature of the border situation in Burma, the Surgery and Trauma Department is regularly faced with serious injuries including gun shot wounds, landmine injuries and severe burns, as well as work-related injuries and chronic conditions such as heamorrhoids and prostate problems.
The challenges of the surgery department are great in that the displaced and oppressed peoples of Burma are often more susceptible to traumatic injuries such as landmine injuries, work accidents, motor vehicle accidents, and burns due to being exposed to and involved in conflict situations, occupational hazards and unsafe work environments. We are also seeing an increase in chronic conditions such as diabetes, haemorrhoids, and prostate gland problems visiting the department.
Burns are a very common type of trauma treated at the clinic. Some of the most preventable traumas are the accidental burns of children. Called fire-pit burns, children come in with major burns to the feet and legs, as a result of running through the ash of fires thought to have gone out. Fires are often built under stilt houses as a way to ward off mosquitoes during the night, so if children are up in the morning before their parents, or the parents are already working and cannot tend to the children, the results can be devastating. The clinic is never without one of these fire-pit burn cases.
Other common treatments include hernia operations, hydrocele, vasectomy, skin grafts after burns or cellulitis, amputation, bladder stone removal, and penile repair after infection resulting from penile enhancement (coconut oil is injected into the penis to increase size and rigidity).
It is common for many to assume that the trauma department was the first program in Mae Tao Clinic, however, this is not the case. While the original intention behind establishing the clinic was to provide referral and recovery services, there was still a need for Dr. Cynthia and her team to take care of burns, abscesses, and minor work injuries. Today, one might be more likely to encounter complex operations such as hernia surgery, bladder stone removal or a vasectomy. Initially, the staff tended to skin infections such as cellulitis, as well as abscesses, some burns, and minor work injuries like lacerations and nail punctures. Originally there was one room with two beds – one for medical patients and one for dressing (trauma) patients. The current Surgery Department continues to treat trauma cases, but has transformed into a surgery and recovery department with an increased focus on medical cases. The medics note that the changing functions of the department are not just a matter of a bigger caseload, but also a question of seeing a broader and more complex range of ailments.
Starting in 1999, Norwegian trained medics (Trauma Care Foundation) trained local medics over the course of three years; these local medics were working in the jungle, doing conflict casualty management. This intensive training made more services available and upgraded surgical procedures. Naturally, the team of health workers who received training was very eager to upgrade the surgical facility.
In 2001 the dressing services moved to a separate building with more space for tending to traumas, and the trainings facilitated changes from 2002 when the number of surgeries began to increase. Surgical procedures were introduced in 2002, under the instruction and supervision of international volunteer doctors. Department Manager Saw Law Kwa recalls how he first observed and assisted the visiting doctor, but after about 15 patients the roles changed and he was performing his first hernia operation.
The first surgical space was small and dark, with the staff quarters later added on the floor above it. The medics living above were always careful to walk quietly so as not to disturb operations going on below. A new operating theatre was built in 2004, offering a much larger and brighter air-conditioned space with improved equipment, allowing staff to more comfortably perform a variety of surgeries.
For severe cases that cannot be treated at MTC, patients are referred to Mae Sot Hospital. The most common referral cases are severe fractures (open or closed), abdominal injuries, head injuries, landmine injuries, and severe burns. After being treated at the hospital, patients return to MTC for post-operative care. If the patient has the ability to walk they will stay in the Patient House at the back of the clinic property; if not, they will stay in the Trauma and Surgery Department. These patients receive daily dressing changes, and rehabilitation support for as long as necessary, which could be anywhere from one to six months, or even longer if there are post-operative complications. Patients with severe fractures usually require the longest rehabilitation time.
Law Kwa would like to reduce the need for patient referrals to Mae Sot Hospital, saving the Clinic money and patients undue stress. Currently, the clinic is fortunate to have volunteer doctors that come for short-term visits and perform very specialised services, such as talipes surgeries, but the department would like a more sustainable solution and to be able to further develop the skills of the staff. Adding new procedures to the list already performed by the department would, however, require a great amount of training in new skills and knowledge, and most importantly, regular ongoing support from trained professionals. Because it is difficult for international doctors to visit for extended periods of time, and the clinic cannot offer financial support to volunteers, the likelihood of this seems distant, but the staff continue to hope.
The surgical department shares the challenge of psychosocial issues with the Inpatient Departments and the Counselling Centre. The department takes a pragmatic approach, which revolves around patient education. First, they try to learn as much about the patient as possible in order to gain an understanding of the broader circumstances faced by the patient. They then educate the patient through confidential conversations, supplemented by educational pamphlets in Burmese language. Educating the patient yields multiple returns – the medics report that patients tend to talk to other patients about their experience at the Clinic once they have returned home, thereby acting as conduits of knowledge in their communities. The medics even educate patients about the health implications of smoking, drinking and risky sexual behaviours. While the medics feel it is an integral part of their job to manage the psychosocial issues, they also appreciate the need for more extensive support for the patient and work to ensure appropriate referrals.
Around 30 local medics staff the Surgery Department seeing approximately 90 patients per day on average. Just like their patients, the medics themselves suffer from psychosocial problems as well. When patients tell medics about their experiences whilst seeking health care in Burma, they feel disappointed and sometimes hopeless for the future of their homeland. The patients’ stories relating the cause of their visit to the Clinic lead to mental and emotional challenges for the medics who deal with victims of trauma on a daily basis. There are also many positives associated with this type of work as well however; when asked what was the most satisfying part of their job, the medics said it was the satisfaction derived from treating a patient successfully and helping them get back to their families and jobs.
One Patient’s Story
Law Kwa explains that they often have patients who want to continue staying at the clinic after their treatment is finished. This is understandable, as the clinic provides a safe environment, with free shelter and food; a much easier existence than what many will have to face after leaving the clinic. Unfortunately the clinic cannot allow these patients to stay; they must make space for the many patients coming in after them. There are exceptions to every rule though. Law Kwa recalls the story of Khun Myo Myat, a previous patient who is now a staff member in the department. At the end of 2006, Khun Myo Myat had an accident while working at a construction site in Bangkok. He fell from a tower, severely fracturing a leg and his jawbone. Not long after this, he was arrested by police, and sent back to the border crossing in Mae Sot. Khun Myo Myat was still suffering from his injuries and did not know what to do; he certainly didn’t want to cross the border back into Burma. Luckily, a kind stranger at the border brought Khun Myo Myat to the clinic. When he first arrived at the clinic he could not speak to anyone, and was thus unable to explain his story. Regardless, the staff tended to his wounds and waited for his jaw to heal. Once the wounds had healed, about four months later, Khun Myo Myat was faced with the decision of what to do and where to go. He had left Burma nearly 20 years earlier, his parents were dead, and he didn’t know where his sister was; he didn’t know where to go. The department staff spoke with Dr. Cynthia, and it was decided that Khun Myo Myat could stay on as a cleaner in the surgical department. When asked why Khun Myo Myat was an exception to the rule, Law Kwa responds, “He is from Shan state….a long distance to travel. We can also say that he is lucky.”