TRAINING COLLABORATION COMMUNITY HEALTH
Mae Tao Clinic is viewed as an excellent training facility as it offers skilled trainers, including Burmese doctors, senior medics, and international professionals. Due to the Clinic’s high patient load, it also offers extensive practical training. Although travel from inside Burma to the Clinic is expensive and difficult, involving passage through areas of conflict and the passing of security checkpoints both in Burma and Thailand, participants come from all over Burma to attend trainings at MTC.
Health workers, doctors, or medical students arriving on the border in 1989, no matter their specialty, were all responding to the same emergency – Malaria. Residents in student camps with some type of clinic facility were the lucky ones. For the rest, illness meant long periods of travel, often on foot and by boat to seek medical care; there were simply not enough medical facilities to attend to the continual flow of new arrivals to the border. Eventually, each camp established its own health care facility, but staffed with only a few doctors and senior medics it was not enough. After about a year on the border, the health workers of the different camps began to discuss providing coordinated medical trainings, which led to the first formal medical trainings in the student camps.
At this point MTC was focused on offering referral services to patients, with Dr. Cynthia providing informal medical ‘discussions’ in the evenings as a means of training, with visiting doctors helping when they were there. Dr. Cynthia recalls, “We didn’t have manuals, textbooks, or a curriculum. We just started with the basics, physiology…malaria.” These informal trainings went on for over a year. After a couple years on the border, with acute treatment fairly well established, it was identified that lacking not only at the clinic, but all along the border were maternal and child health care services. As the students started to marry and have children, these services became essential.
Dr. Cynthia met with Women’s Education for Advancement and Education (WEAVE) to discuss the need for maternal and child health care training, which resulted in a 6-week programme. This training, the first formal training conducted by Dr. Cynthia, was conducted in 1991 inside Burma as it was identified that the services were most desperately needed in the IDP areas. The training focused on maternal health, especially safe motherhood and family planning. After this first training, some of the trainees who had come from different villages along the border decided to return to MTC, where a more comprehensive maternal and child health care training would be conducted. The training was run in 1992 and 1993 with a 3-month theory and a 3-month practical portion. Most of the participants of these first two years had previous health care training and so this acted as a specialised upgrade training. By 1994 this was no longer sufficient; there was a great demand for more basic health care workers, and so the me was expanded to 4-month theoretical, 4-month practical segments, covering basic health care so that individuals without any previous training could join the programme. The increases still were not providing adequate training for these new participants however, so the first 10-month Primary Health Care Training was offered in 1995/1996. This training was conducted for five consecutive years, with trainees from other ethnic groups and various camps along the border joining in.
In 2001, Burma Medical Association and the National Health Education Committee held a joint conference where the decision was made to begin coordinating the training programmes offered on the border, and to develop standardised curriculums for these programmes. It was concluded that all health organisations should be providing two levels of training: a 6-month Community Health Worker (CHW) Training, and a 2-year Health Assistant (HA) Training. MTC, BMA, BPHWT and NHEC began collaboration to develop standardised training curriculums. A commitment was made to ongoing Laboratory Training, as well as to standardise a Traditional Birth Attendant (TBA) training curriculum.
The growth and development of training programmes continued in this fashion – an organic response to the continually changing needs of the growing population on the border. The MTC Training Programme has grown to include trainings in: Prosthetics, Eye Care, Dental, and Comprehensive Reproductive Health, as well as an Internship Programme for previously trained health care workers to come for upgrade training. There are frequent short workshops available on topics such as: Leadership Training, Gender-based Violence, Community Management, Human Rights, and Environmental Health.
MTC is viewed as an excellent training facility as it offers skilled trainers, including Burmese doctors, senior medics, and international professionals. Due to the clinic’s high patient load, it also offers extensive practical training. Although travel from inside Burma to the clinic is expensive and difficult, involving passage through areas of conflict and the passing of security checkpoints both in Burma and Thailand, participants come from all over Burma to attend trainings at MTC. The Thai Ministry of Health also recognises the strength of the training and has MTC health workers assist in the TBA trainings offered by the MoH. MTC is only able to support a small portion of travel cost for participants, but does provide full support for food, shelter, training materials including stationery, and a small stipend for pocket money. Although the clinic always finds a way to support the trainees, there are always challenges; it is often difficult to find training space, teaching materials, and knowledgeable, skilled trainers that are able to commit the time needed. Fortunately, participants from large NGOs are frequently sponsored through their own organisations, relieving MTC of the financial burden in these instances.
Although the trainings are incredibly beneficial to the populations living both inside Burma and along its many borders, the fact that such a diverse group of individuals come to MTC for the trainings also poses one of the biggest challenges – that is to say, training a group of individuals from various social, cultural and political backgrounds, with different education and skill levels. A further problem is student retention, which can be as challenging as staff retention; although it is required that participants of the training programme have not applied for resettlement before beginning the training, this is not always the only problem and some students end up leaving the programme due to other obligations.