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December 11, 2019

Taking a crack at the brain: Neurosurgery in Myanmar

  • By Tar Yar, Kay Kay, Thi Thi Min, Min Thit (MNA)

(Continued from
yesterday)

Neurological surgeons operating on a patient at operation room in North Okkalapa General Hospital.

Since 2012, a team of neurosurgeons from the University of Medicine 2, Yangon, and the Henry Ford Hospital from Detroit, USA, led by Prof Jack Rock has been providing medical treatment every November under the programme of the Foundation for International Education in Neurological Surgery (FIENS).
FIENS was founded by a group of leading neurosurgeons in order to address the critical lack of trained neurosurgeons in developing countries. Since 1969, they have provided hands-on training and education to neurosurgeons around the world.
Prof Rock and his team of medical professionals impart their skills and knowledge by working side-by-side with neurosurgeons nurses here including surgery methods, ICU response, pre and post-surgery care, and proper maintenance of surgical equipment.
The following are excerpts from interviews with officials, medical practitioners and other people involved in this charitable programme.

Dr Kyi Soe
Medical Superintendent, North Okkalapa General Hospital
“I arrived at this hospital about three years ago but the neurological department was only formed over a year after I arrived on 7 May 2017. This hospital started as a 200-bed hospital in 2006 and its has about 37 departments. But there are still three departments we don’t have and we have to send our doctors to Thingangyun or Yangon General Hospital. We don’t have departments that focus on the digestive tract, urology or nephrology.”
“Before he became the head of the neurological department in this hospital, Dr U Win Myaing had to make preparations for 5 years. When I first got here, our emergency department was staffed with only a few assistant doctors but now it is staffed with special nurses. The main issue at North Okkalapa General Hospital is space. There isn’t much of it.”
“We have about 1,200 outpatients and 1,100 to 1,300 inpatients. The space complication means we discharge patients who have been treated and can recover at home. I wish to express my gratitude to the medical practitioners in this hospital who have to deal with a large workload with limited personnel.”

Professor Dr Jack Rock
Henry Ford Hospital
“I first arrived in Myanmar with Dr Merwyn Bagan, FIENS’ Chairman, on 13 February, 2013. I’ve been to many other countries as a volunteer neurosurgeon. My visit to Myanmar coincided with then President Obama and Foreign Secretary Hillary Clinton’s visits as well. I came here because I wanted to help.”
“My first visit here lasted 18 days. I performed surgery alongside doctors U Win Myaing and U Kyi Hlaing and the neurology students at Yangon General Hospital. Then in 2014, I performed surgery alongside other medical practitioners including biomedical engineers, emergency response doctors and otolaryngologists. We started to do the endoscopic pituitary surgeries alongside Dr Bhome Myint Tun at North Okkalapa General Hospital.”
“We started taking two resident from Myanmar back to the US for a two-month rotations starting from 2016. It was in that same year we introduced the technique of an awake surgery for brain tumours. It’s where the patient is awake during the surgical process. This is because we can minimize the risk of damaging critical parts of the brain that controls speech or motor skills.”
“An American lady donated US$ 30,000 to cover the expenses of Myanmar students coming with us on the two-month course. Then we received more donations and have now taken along eight students in total. We have also received numerous donations for researching people with head injuries. We’ve finished that research last year and submitted it to the largest research body and won an award. We also won an award for it at the annual Congress of Neurological Society.”
“I started teaching neurology students of North Okkalapa Hospital through Skype every fortnight starting from two years ago. They always have questions prepared for me.” “I have made a firm commitment to help revise the neurological curriculum into a more efficient and comprehensive form. We have a plan to call the medical engineers to America for a course on handling and maintaining medical equipment. And a similar plan for neurological nurses as well.”
“Some neurosurgeries aren’t too difficult. The patient will be good as new after two to three months. This is beneficial for everybody.”

Mr Andy Steiner
Biomedical Engineer
“I do repairs and preventive maintenance on the equipment. We do the best we can with limited resources but we try our best to make things better for people in Myanmar.”
“The Myanmar patients need us, our expertise and we teach as best we can to pass along better abilities for the people. We help the country by bringing our knowledge, our expertise and teach you so you can run your own hospital a little bit better.”
“My opinion of Myanmar is things are picking up. Things are going well. With future endeavours here, we can help you make a difference. The future is bright. We will help you move forward and make the opportunities for your country way, way better than without us.”
“I have helped your ministry provide the support and equipment support so that you can maintain your capital purchases, because that’s a lot of money that you spend on equipment. Without the maintenance or repairs, you would just end up buying more new equipment. So, the investment of the biomed tech would help provide longevity and lasting equipment for your hospitals.”
“The equipment, as we know, is the backbone of the operation. Our surgeons and neurosurgeons do the work but without the equipment, without the maintenance on the equipment, it’s a tough job. So, the future and abilities will be enhanced with our presence and I really hope we can do it for a long, long time.”
“Six years ago, when we first started coming, we spoke with the ministry (of health and sports) and they understood that the equipment needs to be maintained. Now, six years later, it’s amazing that everything is coming to fruition. I plan to train some engineers on how to be proactive in making the equipment last longer.”

Ms Tracy Enos
Head Nurse
“I have been to Myanmar since November 2014 and this is my sixth time here. I teach on the use of surgical equipment and apparatuses in the operating theatre. I also teach how to use new apparatuses and new surgical methods while working together with the doctor.”
“The people here are very receptive and cooperative. A big difference between nurses here and back in the US is we only need to inspect the surgical apparatuses and send them to the disinfection department but the nurses here have to do that themselves.”

Ms Tarsa Patrick
Head of Neurophysiological Monitoring
“I work with intraoperative neuromonitoring. This means I am a part of the surgical team and I assist in the surgery by monitoring the integrity of the nervous system, thereby protecting the patients and helping the surgeon. My main duty during surgery is to ensure nothing unneccesary takes place”
“Coming to Myanmar is my first time here and I am very humbled and honoured to be here. Everyone here has been very gracious and generous. I am also teaching people here and I am sure they will be able to help patients here like we do in the future.”

Mr Yosef Ben Dor
Infrascan Expert
“I am from Israel and this is my first time in Myanmar. I accompanied Dr Jack Rock here because I wanted to carefully explain the use and importance of this equipment (infrascan) in rural areas. You can easily teach general practitioners, nurses and emergency response personnel how to use this.”
“The infrascan only takes about a minute to scan someone’s head for signs of internal bleeding or clotting. It’s greatest asset is to help places far away from neurosurgeons or neurologists determine if a person is suffering from internal bleeding in their cranium.”

Ms Marianne Langlois
ICU Specialist, Boston Massachusetts
“I have worked with Dr Jack Rock for many years. I am currently working at a hospital in Boston after my time at Henry Ford Hospital. This is my second time in Myanmar. I teach first-aid emergency response to the nurses and students here. I also take care of patients before surgery begins.”
“I used to perform neurosurgery as well, but now I simply assist patients in critical conditions. Sometimes an operation may go well but the patient isn’t well cared for and doesn’t recover as well as they should. It’s nice working with the hardworking people here.”
(Translated by Pen Dali)

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