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THAILAND - PROGRAMME REPORTS 


18February 2013

Trauma Program Week 2 Summary: By Matt Parazo and Sadie De Silva

What can you do with a Leatherman multi-tool? At home, you can screw in light fixtures into the wall, carve out pieces of wood, cut electrical tape, or extract a rusty nail. Well, what if you were a lone trauma medic, from a Burmese Ethnic Minority Group, in a remote jungle of Southeast Asia in the middle of a war zone with only a Leatherman multi-tool, stethoscope, saline drip bag, airway suction pump, and a chest tube? The answer came after Week 2 of an intense trauma training course.

But first, what makes a good trauma medic?

Resourcefulness: With only a hand saw, sutures, stethoscope, bandages, etc., the medics were taught different methods to reduce fractures, make splints, put in chest tubes, perform amputations and cricothyrotomies on individual patients or mass casualties. Many of these techniques were performed on animal cadavers during the “jungle operating room.”

Resilience: Frank Tyler, AAI Director, stressed the importance of working under pressure and dangerous conditions by repeatedly bringing up scenarios of explosions, gunfire, “Danger!,” and “your patient is dying!” Medics had to adapt to each of these situations while simultaneously considering their own safety and conducting primary surveys on critically injured patients.

Dedication to Learning and Teaching: After a long day of classes, the medics took to their notes and reviewed lecture material each night in order to prepare for the final exam at the end of the week. Learning the nuances of trauma translated from English was a challenge for many of the medics and translators alike. In addition to learning the material, many of the senior medics took the time to tutor the junior medics on important concepts. This was apparent when many of the medics sought Dr. Monica Kumar for further explanations and practice problems for solving Ketamine/Lidocaine dosages in children and adults. Those who understood the material willingly took the time to clarify the material for their peers.

Determination: After 2 weeks of instruction, it was time for the medics to demonstrate what they learned in the primary survey practical, though you could see the trepidation in their eyes. Medics were paired up before a proctor to perform a primary survey on a “patient” with multiple simulated wounds, displaying complex symptoms, in a dangerous setting. The medics worked tirelessly, trying to recall each minute detail before carrying out each sequence. “ I heard some of them saying the steps out loud during the practical,” observed Nikki Zingerle, AAI Emergency Nurse. One by one the medics waited anxiously to hear their scores. Frank beamed with pride as ALL of the medics had passed. “They did fantastic..I’m so excited because last week, less than 50% got it through the right sequence…Today 100% passed!” Dr. Larry Stock agreed, “this was the best group ever.”

Fearlessness: As in Week 1, medics continued to tell real trauma stories in their area reports. There were tales of traumatic landmine injuries, brain injury from a falling coconut and multiple gunshot wounds in conflict zones in the jungle. There was a tragic story in which 3 children playing with an unexploded mortar shell. When the medics had arrived in a 30min response time, they found 2 of the children dead but were able to stabilize one to be sent to a nearby field clinic for further treatment. Dr. Stock warned them that “just because there is ceasefire, doesn’t mean there won’t be injuries from war as in places like Bosnia and Cambodia.”

Assimilation of Learning Material: On day 8, Dr. Louis Berk and Dr. Jen Starling spent an entire day teaching the basics of orthopedics and various fractures that the medics could encounter in the field. With that information, it was time for the medics to apply what they learned in the “plaster splinting station.” They were shown various splinting techniques from a sugar tong splint to a short-leg posterior splint and had to recreate them shortly afterward. The medics were enthusiastic about this activity and persistent on placing the splints correctly. Dr. Starling stated that she was “surprised” at how quickly the group was learning the information in such a small amount of time.” When asked about which splint the medics had difficulty mastering, Dr. Berk answered,” the first one because once they started doing more splints, they became more efficient at it.”

During the closing ceremony, one of the original trauma medics offered some words of inspiration to the young men and women in the group. “In 1976 I started off with no formalized training and learned many of my skills from a book.” With only knowledge of traditional wound dressings and natural remedies, he found great pride in treating trauma patients in the middle of the war zone. However, he credits his collaboration with GHAP and AAI for his increased knowledge in trauma care and his ability to treat a wider patient base and make a bigger impact in his community. Still, he warned that learning about trauma is a lifelong process. “After you complete this course, you still must keep learning and reviewing the material and keep practicing together. You must save lives and save limbs - that is the motto of of the GHAP TMP.”

The medics were each handed a course completion certificate and a Leatherman multi-tool as the proud instructors looked on. Dr. Stock addressed the group:“This Leatherman tool has everything you need to perform each of the procedures you have learned in this course should you not have the appropriate medical equipment. You are now ready to save a life.”

To a trauma medic in the jungle, a Leatherman multi-tool can be used to save lives.


 

5 February 2013

Trauma Program Week 1 Summary:  By Taryn Colton and Ariel Becker

“I want to save my people…and their limbs.”

This quote from a Burmese ethnic minority medic gives an indication of what compelled this year’s participants to journey as long as five weeks to participate in the 2013 Trauma Management Program (TMP). This marks the 13th year since the courses inception and with the collaboration of Community Partners International/Global Health Access Program (GHAP), Access Aid International (AAI), medics from conflict areas in the Eastern Border areas of Burma are gaining access to training from professional international medical volunteers and other concerned citizens from all over the world. The ethnic areas of Eastern Burma are under extremely difficult circumstances in which there are low resources and no hospitals, doctors, or nurses. Thus, the program plays a vital role in educating village healthcare workers from ethnic minority groups in Burma in trauma care. Frank Tyler, AAI Director and TMP course manager stated “I am excited about the prospects of the medics that we are training now to possibly become part of a greater Burmese healthcare system in the future.” The goal of the program is that the experience shared in the course will not stop at the medics we teach and work with directly, but rather to have the skills and knowledge dispersed throughout Burma and bring health access to areas where it is lacking or non-existent. “Both the medics and trainers are learning and contributing to the success of this training” shared Dr. Larry Stock, GHAP trauma director emeritus and founder of the trauma management program, “the outcomes of this program translate into lives saved and reduced suffering.”

To put the courage and strength of these medics into perspective, we need to consider the hardships of the area in which they live. Burma, known as Myanmar, has been in a state of civil war for the past six decades. Throughout this war-affected area, access to proper healthcare has been extremely limited. These medics in training will have to face scarce resources and injured patients without the luxury of easy transportation, advanced care facilities, or even adequate equipment.

“Due to the conflict with the Burmese, some of the indigenous areas have been neglected for years or even decades,” emergency room physician and program trainer Dr. Charles Washington comments.  “In some areas there is active conflict, in some a large number of internally displaced persons, in many areas there is a lack of resources and little infrastructure. Without these medics and their trauma skills, the population would have to travel further to get care or be taken care of by people who do not have trauma experience.”

Despite all the challenges that these medics encounter, Dr. Loren Rauch, incoming trauma director of GHAP, comments that he is very impressed with the medics’ ability in “performing field amputations and delivering warm blood transfusions to trauma victims deep in the jungle far from any health facility.” Although there has recently been progress in instituting a peace agreement, Rauch shares “Eastern Burma is [still] one of the most heavily mined areas in the world. Even with the cessation of hostilities, landmine injuries will remain a problem for many years to come.”


This year’s week one staff consisted of four emergency room physicians, a surgeon, an experienced combat paramedic, an emergency room nurse and six other volunteers. Topics of week one included anatomy and physiology, major limb injury, wounds and antibiotics, and bleeding control, among others. Rauch notes, “This course has been refined over a decade by many health and training professionals before us. The curriculum synthesizes trauma life support training with combat and austere / wilderness medicine, adult learning principles, advanced medical procedures, and innovative low-tech teaching models.” With four different languages present in the room each day, communication is a constant challenge throughout the course, even with the use of interpreters. Thus, the use of innovative models and the belief in “show-not-tell” method is key to the effectiveness of the course. Models used in the course range from extremity models made of sugar cane, tissue, colored rope, and plastic bags to cricothyrotomy models made of plastic respiratory tubing, tissue, latex gloves, and tape. Use of these teaching tools throughout the course increases understanding and gives the medics a great opportunity to practice hands-on techniques prior to working on animal models and then real patients.


Thirty medics traveled through conflict areas of Eastern Burma to attend this year’s Trauma Management Program. For some, this was their first time participating in the Trauma program, while others had up to seven years experience with the course. Our insights into the trying situation in Burma and the importance of the course were further validated by conversations we had with participants in which we discussed their motivation for becoming medics.

“We would like to have more health workers in [our] area”, one male medic shared through an interpreter. “We would like to give health education in our community who does not have any education about health”. A female medic shared that she came to the training “because when we look at our community, we need more health workers. If we gain knowledge from this type of training, if we see an unconscious patient with an injury or wound, we know how to help them”.

Additionally, the medics shared with us detailed accounts of cases they encountered over the last 6 months. These stories were tragic, but also shed light on how the course has taught the medics to provide a meaningful response to injured patients in their areas. A 40 year-old senior medic, who has participated in the TMP 7 times, shared with us a story about a 16 year-old boy who was out fishing and stepped on a landmine. The landmine blast blew off the boy’s right foot. After being provided with initial first aid by villagers to control the bleeding, the boy was transported to the medic’s clinic. The medic and other workers at the clinic gave the boy a transfusion with warm blood and IV fluids. Following this, the medic performed a lower leg amputation on the boy using IV ketamine for pain control. The medic also started the boy on IV antibiotics Ampicillin and Gentamycin. The medic reported that the boy recovered well from the procedure and received a prosthetic from a rehabilitation center in another area. When asked about his greatest challenge, this medic stated that his clinic is very low on supplies and often finds themselves without basic tools such as sharp scissors and gloves to perform surgery. This often forces them to have to try and borrow supplies from other clinics, which slows the treatment process for patients unnecessarily.

“The first case left me saddened about the tragedies the medics face, inspired about the ability and successes of the Trauma medics, and worried about the future for the Trauma program,” Rauch commented. “We were all profoundly touched by this success story, this humble medic performing high level medical care in the jungle with few resources but incredible dedication and inspiring success. But I suddenly [realized] with concern that we almost had no Ketamine for pain and sedation to resupply the Trauma medics with this year. There were no funds for any medications or supplies to resupply the Trauma medics after this course. Without medications supplied by the Trauma program, the boy would have had this surgery awake if he had even survived his surgery without IV fluids, blood and antibiotic.”

Watching the medics selflessly sacrificing their time, energy, and safety, to help save their people has been inspiring. “Through a week of learning, laughing, trust building and hard work, I have witnessed the deep commitment that these amazing medics have shown to their profession and communities,” shared Sandy Adler Killen, an emergency room nurse on her first TMP training. While the mission to improve health care access in Burma has come a long way, it is clear that there is still much more that can be done. The medic’s story about the extreme lack of resources at his clinic shows that even the basic needs of the health facilities and workers in some Eastern Border areas of Burma are far from being met.

“Funding for the Trauma Management Program has come up short for the year 2013, ultimately limiting resources and other programmatic aspects required to effectively support the medics in the field for the entire year,” shared GHAP intern Julia Davis.

With these funding cuts, the ability to continue the Trauma program and provide adequate supplies and medications to the medics was severely jeopardized. Leaders of the trauma program make every effort to keep the course cost-effective, but there are still costs for equipment, supplies, medications, and administrative costs.

Stock expressed “We value all of our TMP donors. The TMP would benefit by a wider donor base and a major donor that would carry us through a 3-year cycle. Leaders from TMP and CPI are discussing strategies to secure the funding that would allow the program to continue to carry out the mission of saving lives.”
 

Though leaders, trainers, and supporters of the Trauma program donate thousands of dollars each year, the program would have the potential to achieve even more with increased financial donations.

“The program's funding should not be this precarious or uncertain… [The medics] do so much with so little formal education and so little resources, but even the few resources they need are endangered,” Rauch remarks. “The medic, the boy, the other medics, and patients all deserve more.”

 


Related Links:
Donate on the CPI website.

Donate on the AAI website.
(Please write in comment section that you want to support the "Trauma Program in Burma”)

Community Partner’s International site.



 

20 February 2012

AAI Prepares to Launch Medical Capacity Building Project

The population of eastern Burma, the Karen and Karenni, have remained in a state of chronic health emergency for almost 60 years due to the ongoing civil war. Those living amongst the fighting, as well as the refugees living in camps along the Thai border, have limited access to Burmese or Thai public health services.

Thanks to the dedication of Dr Cynthia Muang, the Mao Tao clinic was established in 1989 in the border town of Mae Sot, to provide free lifesaving medical services to the Karen and Karenni people both inside and outside of Burma. AAI has had an ongoing presence in Mae Sot and is currently exploring additional opportunities to develop an ongoing medical program that deploys doctors on a rotational basis to support the Mae Tao clinic.

The Mao Tao clinic is a collection of dilapidated buildings that provide services far and above that which you would expect. Over 110,000 patients received medical care in 2010, a patient load roughly equivalent to a major Australian regional hospital network. About 50 percent of patients travel from inside Burma, often delaying treatment due to the difficulty, danger and cost of reaching the hospital. Patients travel vast distances to the clinic, as it is famed as the best medical care available to this underserved population. The vast majority of cases presenting to the hospital are tragically preventable: malaria, malnutrition, diarrhoea, tuberculosis and HIV/AIDS.

In 2010, the clinic saw 32,000 outpatient cases, 2,800 deliveries, 7,500 surgical procedures, 10,700 admissions, 211 prosthetic limbs, 8,000 pairs of glasses dispensed and 6,000 dental procedures. Mae Tao also coordinates vaccination programmes and runs satellite clinics inside Burma. Staff are locally trained community health care workers, however most doctors are volunteers from abroad.

AAI volunteer, Doctor Jessica Holden recently returned from a volunteer placement at Mae Tao clinic. The quality of services was highly noted by Doctor Holden. "The care during labour and delivery was first rate, and I have learnt lessons on induction of labour to take home and implement in my current practise," said Doctor Holden.

The facilities are basic and routine procedures could often not be undertaken due to the lack of available doctors or locally trained staff. There is a desire for ongoing and regular training to build capacity so that so that all staff are trained to perform vital life-saving emergency procedures.

Regardless of the tumultuous political situation inside Burma, the need for healthcare will continue for as long as people live in the region. Investing in training and medical support now will improve the skills of health workers. Providing regular AAI doctors and other healthcare volunteers to the clinic will be a positive for the Mae Tao clinic and will not only benefit the population in the short term, but will also build capacity in the longer term.

Dr Jessica Holden and Midwife Unit Manager
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Morning Reproductive Health Care Worker Team

1 February 2012

GHAP/AAI Trauma Training Blog

In January, 2012, Australian Aid International (AAI) and Global Health Access Program (GHAP) brought medical professionals from around the world to Northern Thailand to help train Karen and Karenni Burmese Medics. This blog recounts their experiences. Health worker training includes the management of landmine injuries, penetrating and blunt trauma, shock, wound and infection care, and orthopedics. Material support includes surgical instruments, antibiotics, anesthetics and other supplies.

Click here to read the GHAP/AAI Training Blog


31 January 2012

AAI Delivers Vital Trauma Training

The Karen State in the eastern region of Burma has been in the midst of civil war for more than 60 years. Human rights violations are an everyday reality for many ethic minority groups. Rape, forced labor and intentional killings are a part of everyday life.

In early January 2012, leaders of the Karen National Union (KNU), Burma's oldest ethnic armed group, signed a provisional ceasefire agreement with the government. Talks continue and there is hope, although at this time fighting, landmines and illness continue to be an everyday reality.

For seven years, AAI together with partner groups Global Health Access Plan (GHAP) and the KarenDepartment of health and Welfare (KDHW) have been enabling medics working throughout Karen state in Burma to undergo intense trauma training. The training enables the rapid transfer of necessary lifesaving techniques that in turn save lives. The medics have been providing primary healthcare for over ten years in the conflict and rural areas of Burma, where access to healthcare is otherwise unavailable. Each district/village has access to a healthcare worker who works as a part of a larger network of medics (usually 3-4 per team). Together these medics deliver much-needed healthcare to undeserved populations. Each year, a small group of medics are chosen to attend the trauma training, and once completed they return to their villages as the trauma medic. These medics train other medics in there team which enables the transfer of skills.

This year a group of eleven doctors, nurses and one human rights lawyer, - travelling from Australia and America - met in Thailand to participate in trauma training of Karen and Karenni medics. Doctor Stock is a senior partner of the Emergency Department at AntelopeValleyHospital in California, a clinical professor at UCLA medical school and Global Medical Director on AAI's Advisory Board. Frank Tyler has been involved in the humanitarian industry for 20 years and holds a Masters of Public Health and Tropical Medicine, Bachelor of Health Science Nursing, Certificates in Aviation, Underwater Medicine Training and is currently an AAI Director.

Training facilitators prepare for medical demonstrations during the trauma training

This year, 34 medics attended the course. Some of the medics must travel hundreds of kilometers to the course; travelling by foot, boat and car through dangerous terrain and in some instances this can take as long as one month. Two female medics participated in the training and also joining for the first time were medics from the Karenni state. The trauma skills of the medics varied, ten medics had never attended the course before and for others this was their fifth trauma course. A great opportunity to revise old skills and learn new techniques.

The trauma training focuses on treatment and stabilization of traumatic injuries. The training started with a review of the situation on the ground throughout 2011. Cumulatively over the past year, there have been 115 traumas with approximately 34 landmine injuries and 28 gunshot wounds. One of the most amazing facts is that there is rarely a death following treatment by the medics, highlighting the importance of this lifesaving training. In 2011, there were three deaths (one landmine, one gunshot injury and one car accident). In Karen state most of the traumas occurred from landmines and gunshot wounds.

The medics shared stories on how supplies could not be kept near the village clinics due to the uncertainty of the Burmese military raiding the village. There were teams that had not received there supplies throughout the year due to the shipments being captured. All of the instructors learnt a lot during this time and had a small glance of the obstacles that these medics face everyday. 

One of the medics provided a raw account of what it is like to be a medic at times, "arriving on the scene after a day, I found my friend injured from a mine blast. I had to make the decision to amputate the limb. Initial examination showed me there was nothing that could be done to save the leg. I conducted the amputation and saved his life. I know I did the right thing but now everyday I think about what I did and I see him and see how sad he is. We do not speak much now and I dream about my decision; was it the right one? This happened nearly one year ago and to this day he complains of pain in the foot of the amputated leg. What can I do now?" It was explained to the medic that this is known as phantom limb pain and is often a side effect of amputation. Being able to explain that this occurs because of the amputation, allowed the medic to understand that this is not unusual and that he had not made an error.

Another medic explained their story of treating a gun shot wounded patient under a plastic cover makeshift shelter, with the Burmese military searching for them in the background and torrential rain pelting the shelter. These stories of bravery make it clear to see that the medics are an amazing group of people, dedicated to their job and saving lives.

Traumas often occur great distances from where the medics live. Data collected showed that the average response time to a trauma, can range from 1.5 hours to 2 days. And this is just to arrive at the treatment site.

The training focused on lifesaving treatments such as faciotomy, amputation, venous cutdown, fractures, splinting, anaesthesia and much more. The training consisted of both lectures and hands-on demonstration and application.

All of the medics were successful in passing the course exam and were presented with a certificate and a lapel pin to identify them as a trained trauma medic.

The medics are an amazing group of people who are skilled and well trained, doing amazing work in traumatic, dangerous areas. It is thanks to generous donors and supportive volunteers that GHAP and AAI, along with its partners, is able to deliver high quality training and resources to the dedicated trauma medics.


25 January 2012

AAI Provides Vital Clean Water Supply to Hway Ka Loke School on the Thai-Burma Border.

AAI acts fast to ensure the children of Hway Ka Loke school have constant access to clean drinking water after their wells dry up. Hway Ka Loke school (HKL) provides shelter, food, education and a safe, community environment for hundreds of ethnic Karen children who have been forced across the border from Burma.

With hundreds of students living at the school for most of the year, constant access to clean drinking water is essential for ensuring good health and hygiene practices. When the well ran dry, AAI was ready to step in and provide much needed assistance. AAI installed a pumping system, which feeds water from a nearby dam into the schools water access points via a storage tank and filtration system.

Further to the water pump project, AAI recently conducted a KAP (Knowledge, attitude, practice) hygiene survey with a selection of students and teachers at Hway Ka Loke learning centre. The survey identified and examined the current hygiene situation. The results of the survey identified the need for sinks. This led to the introduction of planning and design of sinks that would complement the existing situation at the school. The sinks were designed and produced by the local plumbing suppliers. Four high and four low sinks were attached to a lightweight frame, making them moveable. After the installation of the sinks, the children were quick to put into practice hygiene practices that they have been taught. It is now common practice for the 350 children to wash their hand prior to each meal and children are often seen wandering to the sinks at regular intervals throughout the day.

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The continued generosity of AAI's Australian and international community allows AAI to rapidly respond to the needs of local people in the field. The continued support from generous donors allows AAI to continue to deliver high quality assistance around the world. AAI would like to recognise all those who provide ongoing assistance and support to AAI; your generous contributions, both large and small, go into vital projects such as maintaining the Hway Ka Loke School's water supply. 


20 December 2011 

The Hway Ka Loke School Provides a Secure Community Environment for Hundreds of Burmese Children.

Hway Ka Loke school on the Thai-Burma border provides a safe and stable community based learning environment for refugee children forced across the border from Burma.

These children are forced to seek the security, shelter and education provided by the school for a range of reasons: Some children have been orphaned by the Junta’s ongoing brutal intervention in the ethnic border areas, for others their families cannot afford to support them and for most this is the only chance they’ll have of accessing education.

 
AAI's volunteer, Ryan Harvey, with AAI Operations Manager, Gordon Willcock, and a bunch of the Kids.

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A special meal for the kids after the wedding of two of the schools teachers.

When visiting Hway Ka Loke it soon becomes clear just how important the school is for all the children. The school provides the children with security and a community in which they can feel safe enough to just be kids.

AAI Programme Officer Sophie Wallace, a former volunteer at the school, commented that “while the children are the life of the school, it is the commitment of the teachers and their families which makes the school the wonderful place that it is.”

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Hway Ka Loke school children

AAI is supporting Hway Ka Loke school through our ‘Get Involved’ programme. The ‘Get Involved’ programme is providing monthly volunteers to assist with English language classes for the children.

After talking with various teachers at Hway Ka Loke and with Principal Jim, it is clear that the most important thing for any volunteer is to get involved with the school life and become a part of the community.

AAI would like to thank Principal Jim and Head English Teachers, William and Molly, for their amazing work and their warm welcome to me and all of AAI’s volunteers.


1 March 2011

Trauma Medics in Burma risk their lives every day to provide emergency healthcare to victims of Burma’s Junta’s ethnic cleansing

An undisclosed location on the Thai-Burma Boarder

I first meet Paw Char in this region three years ago. At that time, she was then a junior (18 year old) healthcare worker with the Karen Department of Health and Welfare (KDHW) waiting to undertake war trauma training so she could better assist victims of the Burmese Junta’s deadly program of terror on the Karen population. The Karen community, who play a deadly game of survival, live in daily fear for their lives and are slowly being squeezed into smaller areas of the free KarenState or as legal or illegal refugees in Thailand.

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Paw Char was a sweet unassuming young woman who was always smiling. She was wearing military fatigues and a camouflaged bandana. Paw Char was part of a group of medic trainees that would act as our escorts and carry supplies to the area where my two colleagues and I were to live in the jungle for seven days providing training in war trauma medicine to the Karen medics.

I remember Paw Char distinctly as I was amazed that a small, petite young woman – very innocent in appearance - was the guide for our group and that she could carry a backpack loaded with almost 20 kilograms of supplies. I can assure you that her appearance was deceptive. Paw Char had been witness to too many horrifying events at the hands of Burma’s campaign of terror for her years and would be far more mature than most of her age group from the developed world. Adolescents are forced to grow up quickly and take on adult responsibilities in areas like Eastern Burma.

It was still the early hours of the morning and the sun would not rise for another few hours. The thick jungle terrain was steep, wet and difficult to trek through.  The fact that Paw Char hiked with ease, under the heavy load and set a cracking pace, also added to my amazement.

Three years later I have returned to conduct our yearly training in war trauma medicine to Karen Medics. This is Paw Char’s third trauma course and I know her reasonably well by now. Paw Char is one of the hundreds of medics that provide healthcare within the KarenState in Burma where there are no doctors and no hospitals.

Decades of political instability, administrative challenges and economic isolation have steadily eroded Burma’s national infrastructure, public services and living standards.

The end of 2010 saw the expiry of the latest in a series of ultimatums laid down by the Burmese Junta to ethnic minority factions observing ceasefires. The Junta has been demanding that these “non-governmental armies” subordinate themselves to Burma's military command and act as border guard forces.  Last year, the Junta commenced preparations to launch a major military offencsive against one or more of these groups.

Burma’s border with Thailand is reported to be one of the most heavily mined areas in the world with approximately 1500 landmine casualties annually, accounting for 4% of all deaths. A staggering 1 in 1000 inhabitants each year die of landmine injuries. However, these estimates are likely to be conservative given the limited information made available by the Junta and these estimates do not include the significant burden experienced due to other war related injuries such as gunfire, grenades and rockets.

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Ethnic minorities within Burma such as the Karen and Shan number over 5 million, many of whom have been forced to live in isolation as Internally Displaced Persons (IDP’s) in a region that has been an active conflict zone for over 60 years.

Paw Char is part of a Karen healthcare team that is responsible for the delivery of primary and emergency healthcare to approx 2,000 villagers. She spends almost ten months per year hiking through the remote and steep jungle with the Karen resistance to deliver healthcare. At times, her work takes her into State Peace and Development Council (SPDC) controlled areas or to the front line where the SPDC attempt to eliminate the remaining pockets of resistance. As a medic, Paw Char earns a small amount of money but is mainly supported with food and accommodation by the villagers she assists. Paw Char takes with her whatever food she can carry, along with her medical supplies.

“People can’t go to hospitals or doctors here” she says to me through our interpreter. “Our medical care is all that they will ever receive and it is difficult when we have limited supplies or the patient’s sickness is complicated and I don’t know what the exact cause of the illness could be. We have to treat all the trauma victims on site in either their home or if possible they are carried back to our clinic where we have a few more supplies and a more senior medic may be there to help me. If the victims are lucky, we stop the bleeding and give them IV fluids and carrying them into Thailand where we may be able to get them to a hospital but it is very far and it is not often that we can do this. Therefore, I have to learn the skills well that you come here to teach me because it is up to me to try and save the patients lives. Everything you teach me will make me a better medic and I will be able to do operations, like amputations if I have to”.

I discover that Paw Char and her family escaped from their village before it was destroyed in 1997. They were forced to travel into Thailand and live as illegal refugees. As she grew older, Paw Char became discouraged with camp life in Thailand and wanted to do something to help her people. She left her family and was taken in by the KDHW to train as a medic. She has not seen her family for a number of years and is essentially homeless. When I ask her about where she lives she says, “ I don’t live in any one place. I spend the year travelling from one village to the next. We sleep with the local villagers and they provide us some food.” “What about your things - your clothes?” I asked. “I carry some things with me and the rest I leave at different villages. I pick my things up along the way and leave other items behind,” Paw Char tells me.

I am in awe of these medics and feel the swelling of a lump in my throat when they trust me enough and begin to tell me their life stories. A large majority of the population back home have no idea about what people like Paw Char must do everyday to survive. I feel privileged to have the chance to hear stories like this and to live with these amazing people for a short time.

Paw Char’s job as a medic puts her even in more danger then the rest of the Karen population. The SPDC are actively searching for any members of the Karen resistance. Her life has been in direct threat on many occasions as she has been seen by the SPDC in villages that she has been attending. She quickly assumes the status of one of the villagers daughters and pretends to be part of the village population. If she is caught, she could face torture, rape or possibly death. There are many reports of unspeakable acts that are carried out by the SPDC on suspected resistance members. I cannot begin to imagine that this innocent young woman is living under daily fear for her life in order to provide some level of medical care to her people - people that have been essentially forgotten by the vast majority of the world.

“What happens if they find your medical supplies” I ask, “We hide our supplies in the jungle before we approach the village. If we need medical supplies we ask the villagers to go and collect them” Paw Char explains casually.  I have so much admiration for her for making herself responsible for providing healthcare to a population which otherwise has little or no support.

As an international healthcare and disaster response practitioner, I have been in many situations around the world where I have had to provide life saving medical care in remote locations and even with all of my training and experience, I am very anxious on these occasions. In some instances, I may be lucky to have a physician with whom I can consult or there may the possibility to evacuate the patient to higher levels of medical care. I cannot begin to describe what it is like to be presented with a major trauma victim, such as a landmine injury, in the remote jungle and have to make an urgent decision to amputate a limb or provide other life saving surgical care with only rudimentary and limited supplies.

The KDHW, with our assistance, conduct war trauma training courses twice a year however, attendance is dependant on whether the medics can get to the safe area where the courses are conducted. Some medics must walk for up to a month to get to the training. Paw Char had to walk for five days to get to the training this year. Given that she walks for most of the year, to her, it is comparable to me walking down the street to the shops in my hometown in suburban Melbourne. When I asked her if the walk was difficult, she said “I walk everyday all year to reach people who need medical care. It is not anymore difficult than that” she says while looking at me with a smile for asking such a silly question.

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Paw Char was one of 15 either experienced or new trauma medics attending the course in her region this year. There where a further 25 new students who have been recently recruited to begin a year long training course to eventually become health workers – all bright eyed and eager young members of the Karen community. Interestingly, in this part of the Karen State half the medics are women. Other locations where we conduct the training most of the medics are male.

Of those new students who successfully pass their basic health worker training, only a handful will be successful to join the trauma medic teams in the future. All new students were keen to learn what the trauma medics do and sat in as attentive observers on the course.

They all eventually want to become trauma medics, even though trauma medics occupy the most dangerous positions within the KDHW. They work near or at the front lines and are regularly harassed by the Junta. Sometimes, they are shot at and live under constant fear of stepping on landmines.

The war trauma medical course has been designed and run by Dr Larry Stock who is a senior partner of the Emergency Department at AntelopeValleyHospital in California and a clinical professor at UCLA medical school. Larry is a long-term member of the Global Health Access Program (GHAP) which has been working on the Thai-Burma Border for the past 12 years. GHAP fund and support the KDHW to implement the trauma medical program. Larry is also the Australian Aid International (AAI) Global Medical Director and AAI has worked in partnership with the KDHW and GHAP for six years.

Among the many jobs that I do within AAI, I have also been the trauma course manager since 2004 and have worked with Larry to improve and develop the course so that it remains relevant to the Karen medics. To achieve this, we use training principles that are tailored to the student knowledge level, culture and environment. Larry developed the course to be implemented with limited resources and through the use of innovative medical materials that the medics can obtain locally.

Larry gives an enormous amount of time and personal resources to ensure the trauma program continues and improves every year. He is the leading light and the main motivator who ensures that victims of the Junta have the greatest possible medical care in the remote jungle environments.  As an experienced emergency physician, Larry knows the importance that advanced emergency medical skills can have on saving lives and is adamant that these jungle medics are taught the essential skills which many physicians themselves cannot perform.

Medical Training in the Jungle

The small camp where the training takes place is a bamboo village that has no services. There are no phones, shops or public transport. Training takes place in a bamboo style, open-air classroom with practical lessons conducted outside in the jungle environment.

The course packs in full days and nights of the suite of essential war trauma medical skills including diagnosis and management of trauma casualties with emphasis on resuscitation and stabilisation. The course focuses on the early and aggressive management of limb injuries including control of bleeding, wound care, fasciotomy, amputation, fracture and dislocation management. Other skills taught include surgical airway, tube thoracostomy, venous cut down, suturing, anaesthesia and analgesia, preoperative, operative and postoperative care, monitoring, hygiene, psychological care of the trauma patient and rehabilitation.

Recently, Paw Char used her trauma skills, taught in previous years, to help save the life of a villager shot through both upper things. “I did the necessary medical care by stopping the bleeding and giving IV fluids,” she said.

I have worked in emergency relief for 20 years and have been to most of the major natural disasters and areas of conflict and violence in complex emergencies during this time. I can undoubtable say that the Karen’s are the most deserving group I have ever witnessed; in no other relief situation have I felt this much admiration. They have an ever-present happy disposition and even though they live in desperate conditions; they are respectful, grateful, never ask for anything and are just thankful that we have given up our normal lives at home to come and assist them. I continuously hear them saying, “thank you for leaving your friends and family to come and help us. We know that your life is different when you are home and that you come here sometimes at great personal risk.”

On the day that we prepare to leave our jungle training camp, the students and village leaders hold a small ceremony for us. Certificates are awarded to the medics and the students convey speeches of thanks to the instructors and put on small musical performances dressed in tradition Karen clothes. How these young adults can bring out, from the jungle, perfectly cleaned and pressed clothes also amazes me - but how can I be any more amazed of these people that I am already in awe of?

I ask Paw Char what does she think about her future? She says, “I don’t think about it. There is no future for us.” I think about how most of the medics I see are young and single - it is because it is too dangerous a job and it requires far too much time away from home for a married person.

For more information visit Global Health Access Program


14 August 2010

AAI Delivers Medical Training on the Thai-Burma Border

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A training team from Access Aid International travelled to the Thai-Burma Border to deliver much needed medical training to Karen local health workers (medics). AAI has been implementing projects for refugee minority groups on the Thai-Burma Boarder for over seven years and considers these projects to be of critical importance.

AAI trains medics, many of which are female, to an advanced level and upon completion of the training medics are able to provide trauma care to victims of landmines and conflict. AAI trains local medics how to manage trauma casualties with an emphasis on resuscitation and stabilization including early and aggressive management of limb injuries including the control of bleeding, wound care, fasciotomy, amputation, fracture and dislocation management, splinting, and casting.

“It is a privilege to be able to provide such vital services to the Karen population. These medics risk their lives daily in order to assist victims of conflict and despite their hardships they maintain sincerity and integrity and it is truly humbling” commented Mr. Frank Tyler who has been involved in the provision of medical training for the past seven years on the Thai-Burma Border.

AAI is dedicated to providing high quality and much needed training to such a deserving and marginalised population.


10 February 2010

AAI & GHAP WAR TRAUMA MANAGEMENT TRAINING - THAI-BURMA BORDER PROGRAM 2010

Australian Aid international (AAI) provided another series of the War Trauma Management Training Courses (WTMTC), in partnership with the Karen Department of Health and Welfare (KDHW) and lead health organization on the Thai-Burma Border, Global Health Access Program (GHAP). AAI has been implementing projects for refugee minority groups on the Thai-Burma Boarder for over seven years and considers these projects of vital importance. This year the need could not be more urgent; the number of refugees fleeing into Thailand continues to rise as well as the number of war related trauma cases of populations within conflict areas of Burma .

Overview of the Situation:

Decades of political instability, administrative challenges and economic isolation have steadily eroded Burma 's national infrastructure, public services and living standards. Trade and economic sanctions has left Burma with high foreign debt and fiscal problems. In 2008, vast areas of Burma 's rice growing region were further impacted by Cyclone Nargis, in which AAI assisted with a disaster response program.

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Burma 's first national elections in two decades, is scheduled for this year. Therefore, the Junta are implementing another national citizenship check, which is triggering further border tensions. This is drawing military resources to the border region of Thailand in the east.The end of October 2009 saw the expiry of the latest in a series of ultimatums laid down by the Burmese Junta to ethnic minority factions observing ceasefires. The junta is demanding that these “non-governmental armies” subordinate themselves to Burma 's military command and control as border guard forces. This year, the Junta are beginning movements to launch a major military offensive, against one or more of these groups.

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The Junta is carrying out sporadic and swift operations against ceasefire and active insurgent groups during the run-up of this year's election in order to further fragment them and diminish the threat they could pose to the poll. It is likely that combined with ongoing military operations, continued fraud and rigged elections, the Junta will remain in control in the short and medium term.

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Burma's border with Thailand is reported to be one of the most heavily mined areas in the world, with approximately 1500 landmine casualties annually, accounting for 4% of deaths. A staggering 1 in 1000 inhabitants each year die of landmine injuries. However, these estimates are likely to be conservative given the limited information made available by the Junta, and does not include the significant burden experienced due to other war related injuries from gunfire, grenades and rockets.

Ethnic minorities' within Burma, such as the Karen and Shan number over 5 million, many of whom have been forced to live in isolation as Internally Displaced Persons (IDP's) in a region that has been an active conflict zone for over 60 years. Progress towards a satisfactory resolution to the conflict by the international community has not occurred and the IDP's live in daily fear for their lives.

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Response to the Challenges on the Ground:

The immediate challenge is to alleviate the economic and humanitarian crisis that is particularly acute in the eastern areas of the country. AAI, along with GHAP are addressing aspects of the humanitarian crisis through medical training to local healthcare workers (medics). The War Trauma Management Training Course (WTMTC) is aimed at training both new and experienced local healthcare workers to an advanced level of medical skills, where they are able to provide trauma care to the victims of the conflict.

GHAP commenced the WTMTC in 2000 to train local medical teams who could quickly get to the site of injured victims, resuscitate them and perform life saving procedures based on the premise that the victims have no access to advanced medical care by qualified doctors or from any other form of appropriate health facilities. Often the only chance these patients have is to be cared for is in the jungle and any medical procedures, including surgery are preformed while, at times, on the run from the Burmese Junta, who carry out appalling human rights violations and atrocities on these minority populations.

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The War Trauma Management Training (WTMT) program has been lead by veteran relief workers': Larry Stock MD (AAI's Global Medical Director) and Frank Tyler (AAI's Director of Operations), with the assistance of many other medical volunteers from around the world, who provide much needed training and support to medics working and living in the conflict region.

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GHAP's WTMT program has been extremely successful as they have been able to gather the only reliable mortality and morbidity data of its kind coming out of the conflict zones in Burma . This data has been released in a research paper - Trauma management training for community-based organizations in eastern Burma (GHAP 2009) - which describes the likelihood of survival for victims treated by trained medics from the WTMTC. The data gathered by GHAP indicates that of the victims who are alive when the trauma medics arrive, there is an 89 percent survival rate for land mine victims and an 88 percent survival rate for gun-shot victims.

_________________

The WTMTC involves the diagnosis and management of trauma casualties with emphasis on resuscitation and stabilization. The course focuses on the early and aggressive management of limb injuries including control of bleeding, wound care, fasciotomy, amputation, fracture and dislocation management, splinting, and casting. Other skills taught include: basic and advanced/surgical airway, tube thoracostomy, venous cut down, suturing, anaesthesia and analgesia, preoperative, operative and postoperative care, monitoring, hygiene, psychological care of the trauma patient, rehabilitation, nasogastric and urine catheter use and intravenous fluid therapy.

___________________

Part of the success of the course over the years is the continual assessment of the course content and ongoing course development to meet the changing needs of the student population. The content is adapted to teaching students with basic formal education through culturally appropriate teaching methods. Students gain the necessary skills and experience that instils in them the confidence to perform difficult life and limb saving procedures in the jungles of Burma.

Changing political pressures from both the Thai Government and the increase in the level of offensive operations conducted by the Burmese Junta has necessitated some major differences in how and where the WTMTC's are conducted. Due to reasons of operational security and because of fear of recriminations to the trauma medics by the Burmese Junta, specific details of the training courses locations are withheld from the general public. AAI can however, say that they were required to operate in areas that were of great risk to the AAI and GHAP training teams and also to the medics themselves. However, after undertaking detailed risk assessments and planning, AAI and GHAP's staff are prepared to accept a certain level of risk to ensure that this vital trauma training could continue and that local medics received the necessary skills to continue to assist their communities that are in such a desperate and dangerous situation.

__________________

It is sobering to meet and live with these medics who face, on a daily basis incredibly high risks to their personal safety in order to assist victims of this conflict. The medics that AAI had the pleasure of meeting and working with are some of the most polite and kind people that one could imagine. More then 50% of medics trained are females, many of whom have somehow managed to maintain innocence and inherent good nature and generosity, despite witnessing appalling atrocities in the course of their work. All have incredible stories of hardship and personal survival from a life lived while continually being hunted by the Burmese Junta. If captured they can be killed, raped, tortured, used as forced labour and for de-mining. For the AAI training team it was indeed an honour and a privilege to work with such an amazing group of people.

Summary:

AAI wishes to sincerely thank the KDHW and all of the staff that looked after the AAI training team so well and ensured that the courses could be implemented with great success again this year. Furthermore, our praise and recognition goes to the outstanding efforts of GHAP for continuing tremendous health programs on the Thai-Burma Border under such difficult conditions.

Most of all, AAI wishes to congratulate the heroic and dedicated medics who risk torture, imprisonment and death in order to attend this course and complete their daily tasks as trauma medics, in one of the most unrecognised and longest running conflict zones in the world.

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19 October, 2009

AAI Supplies Experienced English Language Teachers to Burmese Refugees in Mae Sot, Thailand .

AAI's Mae Sot teaching program is well under way. AAI signed a Memorandum of Understanding (MOU) with the Burmese Migrant Workers Education Committee (BMWEC). This body runs a significant education program for Burmese refugees located on the Border of Thailand and Burma in Mae Sot, Thailand . The signing of the MOU signified the commencement of AAI's partnership with BMWEC where AAI will be responsible for supplying high quality English language teachers for BMWEC's long standing education program.

Dedicated and skilled volunteer, Karen Doherty travelled to Mae Sot on 18 September, 2009 to commence AAI's English teaching program at Hsa Thoo Lei School . Karen is teaching from a set curriculum in place at Hsa Thoo Lei School . This curriculum will be carried forward with ongoing AAI volunteer support. While faced with challenges, Karen has had a fantastic experience immersing herself in the school atmosphere. With a little bit of creativity and the help of common teaching tools including songs and games, Karen has been able to deliver the curriculum in an effective and positive manner.

There is unfortunately an ever increasing demand for education for Burmese children. According to a recent study by BMWEC, it states that NGOs estimate there are around 2 million illegal Burmese migrants living in Thailand . Mae Sot is a hub for illegal workers, displaced families and homeless children that need to support themselves in any possible way. Most have ended up in Mae Sot with no money or education and even less prospect. These individuals remain exceptionally vulnerable due to the lack of available education, health care and legal aid.

At present, Has Thoo Lei School does their best to provide these children with a safe place to call home, to ensure they have a sense of belonging as many have nothing else and modest but regular meals. Hsa Thoo Lei School is home to over 650 students and 46 teachers. With only the most basic needs being met, it is education that is integral for encouraging children's healthy development and future possibilities. With their status unrecognized, each child's future remains filled with challenges and uncertainty however the provision of education helps to encourage hope and possibility.

AAI will continue to supply experienced and dedicated teaching volunteers to Mae Sot. AAI volunteers will carry on with the curriculum that is in place at Has Thoo Lei School and will work to provide these marginalised children with education, language skills and hope for the future.

A child from Hsa Thoo Lei School
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Children playing a game at Hsa Thoo Lei School

 If you believe that you have the requisite skills to volunteer please click here. 


23 March 2009

War Trauma Management Training Related Articles

Below are links to articles written about the War Trauma Management training AAI participated in February.

From the Human resources for health: Essential trauma management training: addressing service delivery needs in active conflict zones in eastern Myanmar © 2009 Richard et al; licensee BioMed Central Ltd.

From the San Francisco Chronicle: Backpack doctors risk Burma's wrath Written by Janet Wells, Chronicle Foreign Service, Sunday, March 22, 2009


9 February 2009

War Trauma Management Training

Australian Aid International recently participated in the Trauma Management Training Courses (TMTC) conducted in collaboration with the exiled Karen Department of Health and Welfare (KDHW) and lead health organization on the Thai-Burma Border, Global Health Access Program (GHAP). TMTC is now entering its ninth year of operations, and AAI is proud to continue its involvement in this vitally important and highly successful training program.

Burma's border with Thailand is reported to be one of the most heavily mined areas in the world, with approximately 1500 landmine casualties annually, accounting for 4% of deaths. A staggering 1 in 1000 inhabitants each year die of landmine injuries. However, these estimates are likely to be conservative given the limited information made available by the ruling Junta, and does not include the significant burden experienced due to other war related injuries due to gunfire, grenades and rockets.

Ethnic minorites within Burma , such as the Karen and Shan number over 500,000, many of whom have been forced to live in isolation as Internally Displaced Persons (IDP's) in a region that has been an active conflict zone for over 60 years. Progress towards a satisfactory resolution to the conflict by the international community has not occurred and the IDP's live in daily fear of their lives. The Burmese Junta shows no signs of altering the debilitating legacy of conflict, poverty and institutional failure that has been the status quo since the commencement of the conflict in the 1940's.

Karen medics opening a patients airway
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Dr Larry instructing amputations during an animal lab

GHAP commenced TMTC in 2000 to train medical teams who could quickly get to the site of injured victims, resuscitate them and perform life saving procedures based on the premise that the victims have no access to advanced medical care by qualified doctors or from appropriate health facilities. Often the only chance these patients have is to be cared for is in the jungle and any medical procedures including surgery is preformed while, at times, on the run from the Burmese Junta who carry out appalling human rights violations and atrocities on these minority populations.The immediate challenge is to alleviate the economic and humanitarian crisis that is particularly acute in the eastern areas of the country. AAI, along with GHAP are addressing aspects of the humanitarian crisis through medical training to mobile field medics. The Trauma Management Training Course (TMTC) is aimed at training both new and experienced mobile healthcare workers (medics) to an advanced level of medical knowledge where they are able to provide medical aid to the victims of the conflict.

The Trauma Management Training (TMT) program has been lead by the veteran relief worker and AAI's global medical director, Larry Stock MD. Dr Stock with the assistance of other medical volunteers from GHAP and AAI, provides much needed training and support to medics working and living in the conflict region. This year the TMTC was fortunate to have the International Committee of the Redcross (ICRC) partner on some of our courses. This partnership included ICRC providing two war surgeons to assist with training instruction, support staff, supplies and medical equipment for the KDHW to distribute to the trauma medical teams working inside the Karen and Shan States in Burma.

Placement of surgical airways, chest tubes and fasciotomy during an animal lab.
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Dr Larry instructing on the operations of a jungle surgery

GHAP's TMT program has been so successful that they have been able to gather the only reliable mortality and morbidity data of its kind coming out of the conflict zones in Burma . This data has now been released in a research paper Trauma management training for community-based organizations in eastern Burma (GHAP 2009) which describes the likelihood of survival for victims treated by trained medics on the TMTC. The recent data gathered by GHAP indicates that of the victims who are alive when the trauma medics arrive, there is an 89 percent survival rate for land mine victims and an 88 percent survival rate for gun-shot victims.

The TMTC involves the diagnosis and management of trauma casualties with emphasis on resuscitation and stabilization. The course focuses on the early and aggressive management of limb injuries including control of bleeding, wound care, fasciotomy, amputation, fracture and dislocation management, splinting, and casting. Other skills taught include: suturing, anaesthesia and analgesia, preoperative, operative and postoperative care, monitoring, hygiene, psychological care of the trauma patient, rehabilitation, basic and advanced/surgical airway, tube thoracostomy, venous cut down, nasogastric and urine catheter use and intravenous fluid therapy.

Part of the success of the course over the years is the continual assessment of the course contents and ongoing course development to meet the changing needs of the student population and is adapted to teaching students with basic formal education through cultural appropriate teaching methods. Students gain the necessary skills and experience that instils in them the confidence to perform difficult life and limb saving procedures in the jungles of Burma.

Frank inserting a chest tube during an animal lab
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Primary Survey Training with Karen Medics

Changing political pressures from both the Thai Government and the increase in the level of offensive operations conducted by the Burmese Junta has necessitated some major differences in how and where the TMTC's are conducted. Due to reasons of operational security and because of fear of recriminations to the trauma medics by the Burmese Junta, AAI have been required to withhold the location and specific details of the training courses. We can however, say that we were required to operate in areas that were of great risk to the AAI and GHAP training teams and also to the medics themselves. However, after undertaking detailed risk assessments and planning, AAI staff were prepared to accept a certain level of risk to ensure that this vital trauma training could continue and that medics received the necessary skills to continue to assist their communities that are in such a desperate and dangerous situation.

It is sobering to meet and live with these medics who face on a daily basis incredible high risks to their personal safety in order to assist victims of this conflict. The medics that I had the pleasure of meeting and working with were some of the most polite and kind people that one could imagine. More then 50% of medics trained this year were females, many of whom have somehow managed to maintain a childhood innocence about them despite witnessing appalling atrocities in the course of their work which most of us could not imagine. All have incredible stories of hardship and personal survival from a life lived while continually hunted by the Burmese Junta. If captured they can be killed, raped, torture or used as forced labour and for de-mining. For the AAI training team it was indeed an honour and a privilege to work with such an amazing group of people.

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AAI wishes to sincerely thank the KDHW and all the staff that looked after the AAI training team so well and ensured that the courses could be implemented so successfully again this year. Furthermore, our praise and recognition goes to the outstanding efforts of GHAP for continuing such tremendous health programs on the Thai-Burma Border under such difficult conditions. We also wish to acknowledge the assistance of the ICRC whose contribution will ensure that the TMTC will continue to evolve and improve.

Most of all, AAI wishes to congratulate the heroic and dedicated medics who risk torture, imprisonment and death in order to attend this course and complete their daily tasks as trauma medics in one of the most unrecognised and longest running conflict zones in the world.

Frank Tyler - AAI Director Of Operations


3 September 2008

AAI to supply English Language teachers to Burmese Refugee System in Thailand.

Marc Preston, AAI's CEO has recently signed a Memorandum of Understanding with the Burmese Migrant Workers Education Committee. This body operates an important schooling program for refugees on the Thai/Burma Border at Mae Sot Thailand.

The signing of this MOU marks the beginning of an important relationship between AAI and BMWEC where AAI will supply quality English Language teachers for BMWEC's long standing program.

The first AAI supplied volunteers will arrive in Mae Sot on the 18 th of September, and the plan is to continually supply appropriate volunteers to the program from that date onwards.

The emphasis for AAI's volunteers is on enthusiastic, mature, reliable volunteers who are willing to work in austere conditions. The program allows volunteers new to humanitarian work, or contemplating a career, with an opportunity to experience this important development initiative and view first hand the terrible predicament of Burmese refugees living in Thailand. If you believe you have the appropriate personality and availability then please consider volunteering your time.

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The pictures above depict volunteers teaching Burmese refugee children English Language skills in Mae Sot, Thailand


TRAUMA MANAGEMENT TRAINING COURSE - 2008

  AAI has again proudly assisted with the teaching of the Trauma Management Training Course (TMTC) that was conducted in consultation with the Karen Department of Health and Welfare (KDHW), and in partnership with the GHAP organisation. The aim of the TMTC was to train mobile health care workers (medics) to a level where they are able to respond to and care for victims of conflict related trauma.

AAI has again proudly assisted with the teaching of the Trauma Management Training Course (TMTC) that was conducted in consultation with the Karen Department of Health and Welfare (KDHW), and in partnership with the GHAP organisation. The aim of the TMTC was to train mobile health care workers (medics) to a level where they are able to respond to and care for victims of conflict related trauma.

The TMTC commenced in 2002 with the aim of training medical teams who could quickly get to the site of injured victims, resuscitate them and perform life saving procedures before transporting the patient to a referral clinic for further treatment and care. Since the inception of the course, medical professionals have conducted medical training through theoretical lessons, role-playing, practical workshops, simulation models and surgical labs.

Recent statistical analysis from the GHAP organisation and the KDHW indicates that of the victims who are alive when the trauma medics arrive, there is a 90 percent survival rate for land mine victims and an 82 percent survival rate for gun-shot victims.

In 2007, the United Nations Human Development Index (HDI), which measures achievements in terms of life expectancy, educational attainment, and adjusted real income, ranked Burma 132 out of 177 countries. The HDI is considered the leading measurement of a country's real wealth - the potential of its people. It was estimated that in 2006, the Burmese Junta allocated only 0.3 percent of the country's GDP to health services; compared to nine percent in Australia or 15 percent in the USA. The World Health Organisation places the health care system in Burma in the 190 th position out of 191 countries; a staggering predicament for a country that was once referred to as the 'rice bowl of Asia'.

Urgent change is required throughout the entire country, but particularly so amongst ethnic nationalities such as the Karens and Shans who have long been the victims of persecution from the Government's State Peace and Development Council (SPDC). Punitive measures, like the sanctions imposed by the USA, Japan, Australia and the EU, and intermittent talks instigated within the UN are likely to only bring about tokenistic reforms; meanwhile, immediate assistance is required in many socio-structural areas including health and education.

The Burmese Junta shows no signs of altering the debilitating legacy of conflict, poverty and institutional failure that have been the status quo for over half a century. The immediate challenge is to alleviate the economic and humanitarian crisis that is particularly acute in the eastern areas of the country.

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AAI, along with the GHAP organisation, are addressing one key aspect of the humanitarian crises through medical training for Karen medics. This years course commenced with a one day mental health training package where students discussed various mental illnesses, the effects of trauma and stress, recovering from traumatic experiences and coping mechanisms that they can employ themselves and pass on to their communities. The days training was a great success in helping the medics understand important mental health concepts that directly affect them, the patients that they treat and their families.

The second portion of the course consisted of a two day Train the Trainer (TT) package. Whilst over 20 trauma medics attended the course, they represent only a small portion of the entire trauma medic personnel in Karen. As a result, the many skills that they learn and revise during this course will need to be passed on to other medics who are still operating throughout eastern Burma.

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The TT package began with discussions of adult learning principles and moved into lesson planning and presentation. The students then participated in case study workshops and the development of their own procedure and lesson checklists.

The trauma portion of the course began with a night lesson and revision of anatomy and physiology; followed the next morning by primary and detailed surveys, bleeding control, shock analysis, fluid management and patient positioning. 

Each day of the course began and ended with a practical exercise where each of the students had to perform their basic skills on a casualty with unknown injuries.

An orthopeadic surgeon managed the two-day orthopaedic workshop. She introduced concepts such as dislocation and fracture reduction, injury splinting and casting. The students learnt not only the theory of how and why these procedures are performed, but also how they can achieve the best possible results in a jungle environment.

Other doctors instructed on compartment syndrome, major limb injury and salvaging requirements. The students were instructed through theoretical and practical lessons on suturing, fasciotomies, and amputations.

The theory of injury mechanism, wound management and antibiotics was presented to students to ensure they understood the latest research from around the world and from recent developments in conflict zone medicine. Students also revised patient and equipment preparation for both minor and major surgical procedures. By the end of the course, all of the students had performed damage control thoracotomies and laparotomies, fasciotomies and amputations, surgical airways and chest tubing on simulation models and during the surgical laboratories.

Our guest Public Health Professional and Dentist presented an introductory lesson on dentistry, including oral hygiene, anatomy and dental procedures. Two practical demonstrations were given of tooth removal, including the removal of a decayed tooth from one of the students!

The final portion of the course consisted of pain management, local anaesthesia and general anaesthesia. The students also participated in a group discussion on the best antibiotics to use in different medical situations.

The course has now been developed to an excellent level where students have both a thorough theoretical understanding of trauma medicine, but also real practical experience that has instilled in them the confidence to perform difficult life and limb saving procedures in the jungles of Burma. AAI wishes to thank all of the instructors from the many different countries who attended and instructed on the course. Most of all though, AAI congratulates the brave and dedicated medics who risk torture, imprisonment and death in order to attend this course and complete their daily tasks as trauma medics in one of the world's most unrecognised conflict zones.


31 March 2008

A Case Study of Human Security in Burma: A Checkerboard of Insecurity........By Dominic Bowen

This paper analyses the current human security situation in Burma. It is contended the majority of the population living within the borders of the Burmese State suffer from low levels of human security. To understand what a ‘low level’ of human security is, we must first consider what human security means. A discussion of the most important aspects of this concept, as it applies in practice within Burma, will be considered.

Click here to download the paper.


20 August 2006

AAI Sends A Training Team To Mae Sot Medical Course, 2006

During August, 2006, six AAI staff members travelled to Thailand to assist in the conduct of a medical trauma course in the Mae Sot, Thailand, near the Thai-Burma border.

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The course was convened by GHAP, the Global Health Access Program, which is a US based medical organisation committed to providing quality medical training and support to a network of Burmese medics who serve ethnic Karen Burmese refugees, in their struggle against the regime in Burma.

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The 23 Burmese students who attended the course, made a perilous journey, in a very hostile environment, in order to benefit from the training provided by the course. They were trained in surgical techniques and life saving procedures designed to allow them to assist Burmese people, many of whom suffer from gunshot and landmine injuries. The course covered extended care techniques often necessary when caring for the injured in these conflicts. These networks of medics often have to evacuate their wounded, by foot, across 100kms of hostile territory, to reach the only hospital care available to them, sometimes illegally crossing national boundaries to find care.

At the completion of this initial period of training, the students immediately went back to begin applying the techniques learned on the course, in very difficult circumstances.

AAI staff were happy to volunteer their time and expertise to assist the doctors from GHAP in this important work. Mae Sot is a town set at a border crossing point in the east of Thailand, with a rich mixture of culture from Thailand and Burma.

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The town hosts a large number of Burmese refugees, who have fled the violence perpetrated on them by the regime in Burma, aimed at pacifying the ethnic Karen people, who constitute 10% of Burma’s population. The Karen people are staunchly pro-democracy, and support the, currently detained, politician, Aung San Suu Kyi.

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The support of this course is another way AAI can serve their commitment to supporting those people, disadvantaged by circumstances and poverty, and in need of medical assistance.

Trauma Program Week 1 Summary:  By Taryn Colton and Ariel Becker

“I want to save my people…and their limbs.”

This quote from a Burmese ethnic minority medic gives an indication of what compelled this year’s participants to journey as long as five weeks to participate in the 2013 Trauma Management Program (TMP). This marks the 13th year since the courses inception and with the collaboration of Community Partners International/Global Health Access Program (GHAP), Access Aid International (AAI), medics from conflict areas in the Eastern Border areas of Burma are gaining access to training from professional international medical volunteers and other concerned citizens from all over the world. The ethnic areas of Eastern Burma are under extremely difficult circumstances in which there are low resources and no hospitals, doctors, or nurses. Thus, the program plays a vital role in educating village healthcare workers from ethnic minority groups in Burma in trauma care. Frank Tyler, AAI Director and TMP course manager stated “I am excited about the prospects of the medics that we are training now to possibly become part of a greater Burmese healthcare system in the future.” The goal of the program is that the experience shared in the course will not stop at the medics we teach and work with directly, but rather to have the skills and knowledge dispersed throughout Burma and bring health access to areas where it is lacking or non-existent. “Both the medics and trainers are learning and contributing to the success of this training” shared Dr. Larry Stock, GHAP trauma director emeritus and founder of the trauma management program, “the outcomes of this program translate into lives saved and reduced suffering.”

To put the courage and strength of these medics into perspective, we need to consider the hardships of the area in which they live. Burma, known as Myanmar, has been in a state of civil war for the past six decades. Throughout this war-affected area, access to proper healthcare has been extremely limited. These medics in training will have to face scarce resources and injured patients without the luxury of easy transportation, advanced care facilities, or even adequate equipment.

“Due to the conflict with the Burmese, some of the indigenous areas have been neglected for years or even decades,” emergency room physician and program trainer Dr. Charles Washington comments.  “In some areas there is active conflict, in some a large number of internally displaced persons, in many areas there is a lack of resources and little infrastructure. Without these medics and their trauma skills, the population would have to travel further to get care or be taken care of by people who do not have trauma experience.”

Despite all the challenges that these medics encounter, Dr. Loren Rauch, incoming trauma director of GHAP, comments that he is very impressed with the medics’ ability in “performing field amputations and delivering warm blood transfusions to trauma victims deep in the jungle far from any health facility.” Although there has recently been progress in instituting a peace agreement, Rauch shares “Eastern Burma is [still] one of the most heavily mined areas in the world. Even with the cessation of hostilities, landmine injuries will remain a problem for many years to come.”

This year’s week one staff consisted of four emergency room physicians, a surgeon, an experienced combat paramedic, an emergency room nurse and six other volunteers. Topics of week one included anatomy and physiology, major limb injury, wounds and antibiotics, and bleeding control, among others. Rauch notes, “This course has been refined over a decade by many health and training professionals before us. The curriculum synthesizes trauma life support training with combat and austere / wilderness medicine, adult learning principles, advanced medical procedures, and innovative low-tech teaching models.” With four different languages present in the room each day, communication is a constant challenge throughout the course, even with the use of interpreters. Thus, the use of innovative models and the belief in “show-not-tell” method is key to the effectiveness of the course. Models used in the course range from extremity models made of sugar cane, tissue, colored rope, and plastic bags to cricothyrotomy models made of plastic respiratory tubing, tissue, latex gloves, and tape. Use of these teaching tools throughout the course increases understanding and gives the medics a great opportunity to practice hands-on techniques prior to working on animal models and then real patients.

Thirty medics traveled through conflict areas of Eastern Burma to attend this year’s Trauma Management Program. For some, this was their first time participating in the Trauma program, while others had up to seven years experience with the course. Our insights into the trying situation in Burma and the importance of the course were further validated by conversations we had with participants in which we discussed their motivation for becoming medics.

“We would like to have more health workers in [our] area”, one male medic shared through an interpreter. “We would like to give health education in our community who does not have any education about health”. A female medic shared that she came to the training “because when we look at our community, we need more health workers. If we gain knowledge from this type of training, if we see an unconscious patient with an injury or wound, we know how to help them”.

Additionally, the medics shared with us detailed accounts of cases they encountered over the last 6 months. These stories were tragic, but also shed light on how the course has taught the medics to provide a meaningful response to injured patients in their areas. A 40 year-old senior medic, who has participated in the TMP 7 times, shared with us a story about a 16 year-old boy who was out fishing and stepped on a landmine. The landmine blast blew off the boy’s right foot. After being provided with initial first aid by villagers to control the bleeding, the boy was transported to the medic’s clinic. The medic and other workers at the clinic gave the boy a transfusion with warm blood and IV fluids. Following this, the medic performed a lower leg amputation on the boy using IV ketamine for pain control. The medic also started the boy on IV antibiotics Ampicillin and Gentamycin. The medic reported that the boy recovered well from the procedure and received a prosthetic from a rehabilitation center in another area. When asked about his greatest challenge, this medic stated that his clinic is very low on supplies and often finds themselves without basic tools such as sharp scissors and gloves to perform surgery. This often forces them to have to try and borrow supplies from other clinics, which slows the treatment process for patients unnecessarily.

“The first case left me saddened about the tragedies the medics face, inspired about the ability and successes of the Trauma medics, and worried about the future for the Trauma program,” Rauch commented. “We were all profoundly touched by this success story, this humble medic performing high level medical care in the jungle with few resources but incredible dedication and inspiring success. But I suddenly [realized] with concern that we almost had no Ketamine for pain and sedation to resupply the Trauma medics with this year. There were no funds for any medications or supplies to resupply the Trauma medics after this course. Without medications supplied by the Trauma program, the boy would have had this surgery awake if he had even survived his surgery without IV fluids, blood and antibiotic.”

Watching the medics selflessly sacrificing their time, energy, and safety, to help save their people has been inspiring. “Through a week of learning, laughing, trust building and hard work, I have witnessed the deep commitment that these amazing medics have shown to their profession and communities,” shared Sandy Adler Killen, an emergency room nurse on her first TMP training. While the mission to improve health care access in Burma has come a long way, it is clear that there is still much more that can be done. The medic’s story about the extreme lack of resources at his clinic shows that even the basic needs of the health facilities and workers in some Eastern Border areas of Burma are far from being met.

“Funding for the Trauma Management Program has come up short for the year 2013, ultimately limiting resources and other programmatic aspects required to effectively support the medics in the field for the entire year,” shared GHAP intern Julia Davis.

With these funding cuts, the ability to continue the Trauma program and provide adequate supplies and medications to the medics was severely jeopardized. Leaders of the trauma program make every effort to keep the course cost-effective, but there are still costs for equipment, supplies, medications, and administrative costs.

Stock expressed “We value all of our TMP donors. The TMP would benefit by a wider donor base and a major donor that would carry us through a 3-year cycle. Leaders from TMP and CPI are discussing strategies to secure the funding that would allow the program to continue to carry out the mission of saving lives.”
 

Though leaders, trainers, and supporters of the Trauma program donate thousands of dollars each year, the program would have the potential to achieve even more with increased financial donations.

“The program's funding should not be this precarious or uncertain… [The medics] do so much with so little formal education and so little resources, but even the few resources they need are endangered,” Rauch remarks. “The medic, the boy, the other medics, and patients all deserve more.”

Related Links:
Donate on the CPI website:
https://cpintl.secure.force.com/pmtx/cmpgn__Donations?id=70140000000O3ve
Donate on the AAI website:
http://aai.org.au/index.php/support-us/donate (Please write in comment section that you want to support the "Trauma Program in Burma”)

Community Partner’s International site: http://cpintl.org
Access Aid International sites: http://www.aai.org.au  Facebook page: http://www.facebook.com/AccessAidInternational


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