Our medical mission in Myanmar
November 13, 2019
Editor’s Note: Matthew Park, MSN, CRNA, had the opportunity to serve on a two-week medical mission with Rotaplast International in Myanmar (formerly Burma), and wrote this account of his experiences.
Our multidisciplinary team arrived first at the city of Yangon, which is Myanmar’s commercial hub and home to markets, parks, lakes, and the majestic gilded Shwedagon Pagoda, one of hundreds of pagodas throughout the country.
From Yangon, we embarked on a five-hour bus ride to the city of Naypyidaw (officially Nay Pyi Taw, which translates in English to “Abode of the King”). Naypyidaw is also referred to as “Ghost City” by the local people due to the fact that although the city area is roughly four times the size of London, the population is less than a million. Naypyidaw is a new, planned city that was built starting in 2002 and replaced Yangon as the capital in 2006. Our clinical home was Nay Pyi Taw General Hospital.
The main goal of our medical mission was to provide surgical intervention for patients, mainly children, who are unable to receive treatment for cleft lip and palate due to insufficient financial resources or because their clinical problems are too complicated for the surgeons in the area. We also provided care for adult patients with moderate to severe wounds or burn scars. Over 10 days, we evaluated 122 patients and operated on 77, including 63 cleft palate cases and 14 burn contracture release cases.
Thwe-phoo-wai
One of the patients I remember best is a little boy named Thwe-phoo-wai, then 18 months old, with severe unilateral cleft lip and palate. His mother traveled many miles with her child from a northern region of Myanmar, desperate to find care for her son because of the ridicule by people intheir village and the scornful treatment she suffered from her family members for bearing a child with a defect.
The mother wept as she told us her story and described her child’s difficulty with feeding. We planned for surgery the next day. By Rotaplast standards, Thwe-phoo-wai was a good candidate for surgery with hemoglobin greater than 10 mg/dL, weight above 10 kilograms,and age above 12 months. However, many cleft lip and palate cases can be difficult airways, and we knew we would have limited equipment and resources – no fiberoptic bronchoscope though we did have a McGrath video laryngoscope available.
The next day, I held the little boy in my arms as we walked into the OR with the Rotaplast nurse. We were greeted by Dr. David Morwood, a plastic surgeon volunteer from Monterey, California, and the local Myanmar RN who would function as the surgical technician. With our small, portable OBA-1 anesthesia machine, we mask-induced the weeping toddler with sevoflurane. He struggled but eventually surrendered to the anesthetic, and I was able to ventilate effectively.
After making sure the patient had 1 MAC of sevoflurane onboard, we started an IV and administered propofol. Moments later, I performed a direct laryngoscopy with a Miller 1 blade and saw a Mallampati II view. However, I was unable to pass the 4.0 mm cuffed tube through the tiny vocal cords, and had no smaller tube available!
We had four people on our anesthesia team to staff three operating rooms, with one person always available as the “float”. Luckily, the float person quickly retrieved a 3.5 mm tube that had just finished being cleaned from a previous case while I maintained adequate mask ventilation with sevoflurane. I was able to gently slide the 3.5 tube through the narrow vocal cords. Once we confirmed tube placement, I allowed Thwe-phoo-wai to resume spontaneous breathing and we prepared for the start of surgery.
The operation lasted about 3 hours due to the severity of the cleft and the time it took to repair the floor of the nasal cavity. Even with the challenges in the OR, Thwe-phoo-wai did well. The most memorable moment was seeing his mother’s expression as she was reunited with her toddler after the surgery. She wept tears of joy and was so grateful for the results of the treatment. We were all deeply moved to see the happiness of a struggling mother fighting to give her son a better life.
The need to reuse endotracheal tubes is just one example of how different it can be to deliver anesthesia care in a developing country. We hand-washed and scrubbed each tube with warm soapy water, then soaked them in a solution of dilute bleach before a final rinse. Since people sometimes threw tubes in the trash by accident – as we do routinely in the U.S. – we had only a limited supply left by the end of our visit.
The mission of Rotaplast
In addition to direct clinical care, our team educated families and the local community about cleft lip and palate conditions, and about how to prevent them through diet and supplement intake with Vitamin B and folic acid during pregnancy. We also worked to build capacity among the local healthcare providers by providing training and technical support in the management of these complex cases.
Rotaplast International, founded by members of the Rotary Club in San Francisco, helps children and families worldwide with plastic surgery to correct cleft lip and palate defects, burn scarring, and other deformities. The nonprofit organization facilitates global surgical mission programs in developing low- and middle-income countries. In 1992, Rotaplast team members performed their first medical mission in La Serena, Chile to provide surgery for children with cleft lip and palate anomalies.
Today, Rotaplast teams work in 26 countries around the globe: Vietnam, Colombia, Chile, Argentina, Mexico, Venezuela, Bolivia, Peru, Guatemala, Ecuador, El Salvador, Romania, China, Ethiopia, India, Nepal, Brazil, Bangladesh, Mali, Togo, Liberia, Dominican Republic, Egypt, Tanzania, Myanmar and the Philippines.
Rotaplast relies on the generosity of a community of stakeholders. Medical and non-medical volunteers donate their time and experience to perform countless surgeries. In addition, Rotaplast relies on financial support from private donors, as well as donations of medical supplies, devices, and equipment from hospitals and
corporations.
My first medical mission in Myanmar was the experience of a lifetime. Providing anesthesia and peri-operative care in a low-resource environment
enhanced my clinical skills without all the fancy tools that I’ve come to rely on
in the U.S. Most importantly, participating in this medical mission has made me more passionate about my chosen vocation, and I can highly recommend the experience to any clinicians who are willing to volunteer their expertise and time.
Original post: https://www.uclahealth.org/anes/our-medical-mission-in-myanmar