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.

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.

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 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.

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.

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.

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.

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.

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.

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


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

23 March 2009

War Trauma Management Training Related Articles

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

From the Human resoucrs 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.	Dr Larry instructing amputations during an animal lab

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.

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 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.	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	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.

Frank instructing a faciotomy during an animal lab

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
Director Of Operations
AAI

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. Click here to take you to our Jobs page to volunteer today.

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

1 April 2008

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.

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.

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.

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.

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.

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. 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.

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.