February 8, 2017

Surgery and Trauma

Numerous people from Burma have been crossing the Thai-Burma border in search of security and job opportunities. It is believed that around 300,000 migrant workers reside in Mae Tao Clinic’s coverage area, along the border in Thailand. These migrant people often lack official work permits for Thailand, which deprives them of access to healthcare, protection and education. The Surgical In-Patent Department is regularly faced with injuries including crash injury, severe burn wounds, dog bites, as well as work-related injuries and chronic conditions such as haemorrhoids and prostate problems.

 

 

History

While the original intention behind establishing Mae Tao 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, on the old Mae Tao Clinic compound, there was one room with two beds – one for medical patients and one for dressing (trauma) patients. A new operating theatre was built in 2004 in old Mae Tao Clinic compound, offering a much larger and brighter air-conditioned space with improved equipment. Nevertheless, the space at the old MTC was still limited. Moving to the new MTC compound in 2016 allowed Surgical IPD staff to more comfortably perform a variety of surgeries.

The current Surgical Department on the new Mae Tao Clinic premises continues to treat trauma cases, but has transformed into a surgery and recovery department with an increased focus on medical cases. The Surgical Department consists of In-Patient and Out-Patient wards and 25 beds. 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.

Treatments

The challenges of the surgery department are great in that the displaced and migrated peoples of Burma are often more susceptible to traumatic injuries such as work accidents, motor vehicle accidents, and burns due to being exposed to occupational hazards and unsafe work environments. As the condition of road both in Thailand and Burma has improved, mobility of persons and crash injuries have also increased.

Other common treatments include hernia operations, hydrocele, vasectomy, skin grafts after burns or cellulitis, amputation, bladder stone removal, and complication after penile injection.

The workload of the Surgical Department has been increasing since its establishment. We expect the number of patients will increase until sufficient health facilities are set up and function properly in eastern Burma.

Patient Referrals

For severe cases that cannot be treated at MTC, patients are referred to the advanced hospital, e.g. Mae Sot General Hospital, or our partner organisations. The most common referral cases are severe fractures (open or closed), abdominal injuries, head injuries and severe burns. After being treated at the hospital, patients return to MTC for post-operative care. 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.

Mae Tao Clinic aims on reducing the need for patient referrals to the advanced level hospital or other facilities, saving the clinic costs for other cases and patients undue stress. Currently, the clinic is fortunate to have volunteer doctors that come for short-term visits and perform very specialised services, but the department would like a more sustainable solution and to be able to further develop the skills of the staff.

MTC continuous to train its staff as part of the strategic plan to assure the quality of health care provided. Training to existing staff consists of continuous medical education (CME), through bi-weekly 2-hour seminars on surgery-related topics. Throughout 2017, 39 clinical topics and 88 different sessions (e.g. wound care; standard of antiseptic and disinfection use in the hospital; lower back pain; sciatica) were organised. The clinical consultant and senior staffs (medics) from MTC serve as CME trainers.

Inter-departmental Collaboration

The surgical department shares the challenge of psychosocial issues with the Medical Inpatient Departments. 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. 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.

Staff

Around 20 health staff at the Surgery Department (IPD + OPD) consult approximately 8,500 to 9,000 patients per year. 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 say it was the satisfaction derived from treating a patient successfully and helping them get back to their families and jobs.

Meet Our Patients here: http://maetaoclinic.org/our-services/our-patients/

(Last update: 22 March 2018)