Emergency Medicine on the Thai-Myanmar border (L.A. Times)


Dr. Larry Stock, director of CPI's Trauma Management Program, assessing a young boy at a clinic on the northeastern border of Myanmar. Families like this often travel for days through rugged jungle to reach medical care in conflict-affected eastern Myanmar. Local medics trained by CPI are often the only medical care available.

Below: Los Angeles Times profile of Dr. Larry Stock

Twice a year Dr. Larry Stock, vice chairman of the Emergency Department at Antelope Valley Hospital in southern California and a clinical professor at UCLA medical school, travels to Thai-Myanmar border to train local medics in the life-saving trauma skills critically needed in eastern Burma — a region with little to no health infrastructure and tens of thousands of people suffering devastating conflict-affected displacement and ill health.

In January 2012, 34 medics travelled long distances by foot, boat and car to get to the training site. This small group was chosen to represent a much larger network of medics who remained in their assigned regions inside Myanmar. Once the training course was completed, the medics returned to their villages to train other medics in their teams, building both community-based leadership and skills.

As part of the course medics talked about the challenges of their work and lives with CPI and our longtime Trauma Management Program training partner Access Aid International:

"Arriving on the scene after a day, I found my friend injured from a landmine 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?"

This medic learned about phantom limb pain — that it is often a side effect of amputation, and that he had not made an error.

Another medic shared the difficulties of working in an active conflict zone: how he and his trauma team treated a patient with a gun shot wound under a plastic cover makeshift shelter, with the Burmese military searching for them in the background and torrential rain pelting the shelter. Other medics talked about severe supply shortages due to villages being raided or shipments on route being captured.

These stories make it clear that the life of a medic is one requiring dedication to their job and and their communities, even at the expense of their own personal safety. As Dr. Stock says, "They are everyday heroes."

CPI's trauma training course focuses on treatment and stabilization of traumatic injuries, with a mobile team approach. Traumas often occur great distances from where the medics live, with average response times ranging from 1.5 hours to 2 days — and this is just to arrive at the treatment site. The medics then must arrange transport of seriously injured patients to higher level care that can mean further weeks of travel through dangerous terrain. As grim as it sounds, there is rarely a death following treatment by the medics, highlighting the effectiveness of this lifesaving training.

Dr. Stock developed the trauma management training course almost ten years ago with colleague Dr. Richard Hahn in response to the needs and vision of CPI's local partner, the Karen Department of Health and Welfare. Read about the challenges of caring for the injured and sick in the U.S. vs. on the Thailand-Myanmar border in the Los Angeles Times profile, below.