February 8, 2017

Other Health Services

Physiotherapy

In 2016, an average of 50 patients a month were managed, which increased to 96 patients in 2017. Early 2018, the physiotherapy activities were moved to a designated department within Mae Tao Clinic. Highly immobile patients are still managed in the in-patient department, but others can now come to the appointed area for management and care.

 

History of the Physiotherapy department

Until 2014, Mae Tao Clinic did not have physiotherapy services. In March that year, Roslyn Finch, a physiotherapist, began working at Mae Tao Clinic through Australian Volunteers International (AVI). She helped to develop staff’s capacity to manage the exercise and rehabilitation needs of patients. The capacity building was both theoretical, with building understanding of the scope of practice of physiotherapy, and practical. She helped developing patient and staff education materials in the areas of safe feeding and back pain before, during and after labour. With her help, MTC could adapt best practice principles to the resource poor environment of Mae Tao Clinic, including low patient to staff ratios.

In 2015, the clinic’s first Allied Health Assistant was appointed to be trained by the physiotherapist. This enabled on-going support for clinic staff to help them manage mobility and exercise care for patients. The successful introduction of a system for pressure care management in the medical in-patient department saw a reduction in the prevalence of new pressure sores at the end of 2015. Other elements of training are exercise and pain management for antenatal and postnatal care and for women in labour; safe feeding practices, patient mobility, stroke care, management of development delay in children, back care for patients and health workers, patient handling and amputee care.

A patient who could not sit or stand at first now can walk with walking assist device

In 2016, a new assistant joined the physiotherapy team. An average of 50 patients a month were managed, which increased to 96 patients in 2017. MTC staff received training of the trainer on physiotherapy issues. The physiotherapy team also assisted with training of the first intake of nursing students at MTC.

Early 2018, the physiotherapy activities were moved to a designated department within Mae Tao Clinic. Highly immobile patients are still managed in the in-patient department, but others can now come to the appointed area for management and care.

 

Challenges

Training materials at the physiotherapy department

While allocated budget for the physiotherapy department is limited, the caseload of new patients has been growing. Physiotherapy patients usually stay in the clinic long-term for rehabilitation and their caregivers are often absent. This results in increasing workload for physiotherapy staff and the medics from inpatient departments. In addition, physiotherapy staff are occasionally but inevitably engaged in assisting patients after discharge — looking for accommodation or transportation, as some patients with mobility difficulties cannot return to their previous housing situation.

Physiotherapy department also finds it hard to provide essential equipment for rehabilitation or wheelchairs to patients due to insufficient funding.

Staff

Currently, 2 staff are providing physical therapy to an average of 96 patients per month.

(Last Update: 18 May 2018)


Aucupuncture

Even though it’s one of our newest departments, the Acupuncture staff treat around 30-50 patients every day.

 

Most of patients that receive treatment in the acupuncture department feel as though they benefit from the treatment and leave feeling more comfortable and in much less pain.

Most of the patients that visit the acupuncture department are chronic cases and need to stay at clinic for long periods of time due to their ongoing needs. There is adequate staff within the department, however it does always need more training in technical skills related to acupuncture. As with most other departments at MTC the acupuncture department has serious space limitations as well.
 
History

The Acupuncture Department was inaugurated with some scepticism in January 2010, getting its own place between the Dental and the Eye Department. As acupuncture is more or less unknown and rarely practiced in Thailand, the degree of acceptance by the patients had to be tested.

The idea of acupuncture at MTC was launched during the multiple visits of Mrs. Harmony Wagner from Canada. Her organisation NATSTA, sponsored acupuncture training, but due to a lack of time, could not achieve the launch of the department. Mrs. Wagner taught the staff the basic techniques, as well as a form of massage call Tuina, which helps a lot in our daily routine. Later the NGO “Help Without Frontiers”, which is based in Italy and runs projects in Mae Sot, helped the department with the necessary resources to launch the department. They have become reliable friends and help us grow as an organisation. Dr Ulrich Huehne came to MTC at the end of 2009 and helped set-up the department by teaching acupuncture techniques he previously learned in China. This 74 year old man, originally from Poland, spent every day at the clinic teaching the staff all he knew, including English. The acupuncture staff are extremely grateful for the time, the kindness and friendship he shared with them and it was with great sadness that Dr Ulrich passed away on December 30, 2010 at Mae Sot Hospital.

There is a growing international interest in the departments’ work. For three weeks we hosted one Australian and one American acupuncturist. As acupuncture is not a fixed entity, those who practice it develop a different system in their daily work, which is interesting for local staff to observe and learn from.

Successes and Treatments

The successful stories of the acupuncture department transcend the border, attracting new beneficiaries from Burma who were eager to undergo treatment for various ailments. We are now treating around 50 patients per day, a high number for an inexperienced staff. Therefore, we’ve developed intensive trainings sessions at the clinic, which include a lot of hands-on practice. We invited other departments to send their “incurable” cases to the department, which means many hopeless cases gather at the department.

The department is proud of its great success, especially with patients suffering from chronic, long term problems, where traditional Western medicine has not been able to help them. The acupuncture department provides a relaxed atmosphere for the patients, with cosy music, positive conversation, good understanding amongst the staff, and a joke here and there. Many patients feel so happy and safe at the department that they often come back to visit even after they no longer require treatment.

As well as ‘traditional’ acupuncture methods, the department was donated a  soft laser which is primarily used on infants and patients who are afraid of needles. But its true success can be seen in its use treating non-healing wounds. Although our laser has only one beam and is constructed for the treatment of acupuncture points, the departments’ staff was asked to treat two patients at the surgical inpatient department. Both were close to amputation of a foot and a lower leg. With amazing success, the acupuncture department treated them for about three weeks.  They were able to close their wounds, which needed about one and a half hours of treatment per patient each day. The department is now seeking a laser that is constructed specifically for these larger wounds, as there is a constant demand for this kind of treatment.

The acupuncture department has also collaborated with Backpack Health Worker Teams, who perform their difficult jobs inside the Burmese jungle and return with their teams every six months for a refresher course. The department introduced acupuncture to them, focusing on the major health problems the teams face. Their response has been very positive, and they enjoyed learning something entirely new.

Prosthetics

 

With an estimated 70% of the Burma – Thailand border landmined, and mines continuing to be laid with no humanitarian mine clearance programmes extant in Burma, our Prosthetics department is kept busy providing over 200 new and replacement limbs every year.

 

The founder of the prosthetics workshop at MTC is himself  survivor of a landmine injury, he has experienced the psychological wounds of this physical injury. He explains: “In our culture, the man is the leader of the family and is more responsible for taking care of the family”. Many landmine survivors suffer humiliation and shame when their injury makes them dependent on the loved ones they are supposed to provide for and protect. “I have seen that most [landmine survivor] patients have little confidence in themselves after they get their prosthetic, including me,” he says.  “They got injured not only physically but mentally…some don’t even listen when they are told how to take care of themselves after their amputation. I understand how they feel, because I was also feeling the same way a long time ago.”

History and Services

The prosthetic workshop was started at the Clinic in 2000. The department has grown every year – from a simple workshop into a more sophisticated production facility. Initially, lamination was the primary method of making artificial limbs. By 2005, with the support of Clear Path International the monolimb was introduced. Light and partly vacuum formed, this technical improvement made faster production possible, and consequently easier delivery to IDP areas.

In 2004 the ICRC began supporting the referral programme of landmine triage cases to Mae Sot Hospital. After amputation, patients return to MTC to begin their long rehabilitation journey. Amputees receive food, housing, physical therapy to help them learn to walk again and psychological help from our counselling centre.

Since 2003 the local government of the Autonomous Province of Bolzano, Italy, has provided a significant portion of the funding needed for the materials, machines and buildings necessary to produce prosthetic limbs at the Clinic. Today the shop staff of produce over 200 new and replacement limbs annually, utilising both lamination and monolimb methods. Most of the prosthetics workshops’ clients came from inside Burma, with some even coming all the way from central Burma, from towns such as Myin Chan in the Mandalay Division. 80% of the beneficiaries are landmine survivors, although some are the victims of car accidents, congenital issues, gunshot wounds and so on. The majority of the prosthetics patients require lower limbs; when a patient needs an upper limb, a sponsor is sought to purchase and deliver the materials for an artificial arm.

In addition to the successes, the program faces hurdles that are beyond the Clinic’s control. The supply of artificial feet, ordered from Cambodia by Handicap International, often cannot keep up with the demand. It is difficult to find local people willing and able to give physical therapy and limb massage to patients, and, with such a small staff, the shop acutely feels the loss of experience and knowledge when a technician resettles overseas. Fortunately however, the programmes financial future seems secure, as an Italian community organisation has guaranteed the Clinic’s prosthetics programme long-term support. Eventually the clinic hopes to produce artificial feet in-house to reduce the reliance on supply from the outside.

The legacy of MTC’s programme will not only be the landmine survivors it has served, but the many technicians that have graduated from the programmes prosthetics workshop training. Some from ethnic minorities have returned to their communities inside Burma to apply what they learned in Mae Sot, bringing hope to landmine survivors who are unable to make the arduous trek to the border.

Though the prosthetic limbs are an imperfect replacement for what was physically lost, they are pivotal to recovering a wholeness of being.