Celebrating 20 Years Training Backpack Emergency Medics in Eastern Myanmar

Medics practice applying an orthopedic cast to a fellow trainee. Photo courtesy of Charles Washington

In late January, for the 20th successive year, a group of emergency medics from Kayin State, Myanmar, gathered on the Thailand-Myanmar border to learn how to manage patients with major and minor traumatic injury and emergency medical illnesses. The six-day workshop was organized by the Karen Department of Health and Welfare (KDHW) with support from Community Partners International (CPI).

The 25 medics who attended the 2019 workshop operate from 14 clinics in remote and conflict-affected areas of Kayin State, and provide the first line of emergency medical care to their surrounding communities. Twenty years ago, when these workshops began, eastern Myanmar was in the grip of a decades-long civil war. KDHW’s emergency medic teams were a lifeline for communities caught in conflict and they dealt regularly with gunshot wounds and landmine injuries. The communities these medics serve are dispersed widely across rugged terrain and are frequently hard-to-reach. Medics often need to travel long distances by foot on jungle pathways and by boat to provide care.

​In recent years, with a ceasefire in place and peace negotiations ongoing, the profile of emergency needs in these communities is changing. Gunshot and landmine injuries continue to occur but less frequently, and development has brought other risks. Field medics are seeing an increased number of patients injured in road accidents, as well as burns, animal attacks, lacerations and broken bones.

Lead trainer Dr. Charles Washington works on anatomy with medics. Photo courtesy of Charles Washington

As in previous years, the 2019 workshop focused on core emergency medicine topics including emergency case assessment, mass casualty management, shock, bleeding and wound management, pain relief, fractures and dislocations, splinting, amputation, and rehabilitation. Medics also had an opportunity to practice surgical techniques to be used in a ‘jungle operating theater’ context.

Medics practice wound suturing using improved 'limbs'. Photo courtesy of Charles Washington

The attending medics reported that they attended to at least 154 patients between January and June 2018. They treated diverse range of injuries including the following cases:
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• A 29-year-old man suffered a right lower leg injury from a landmine. He had a below-the-knee amputation and a prosthesis.
• A 40-year-old man suffered a landmine injury to the face. He lost his right eye. He was treated with antibiotics, painkillers and IV fluids.
• A 32-year-old man was stabbed in the chest. He received antibiotics, IV fluids and painkillers but died before he could be transported to hospital.
• A 24-year-old man sustained a self-inflected gunshot wound to his left leg. He received antibiotics, a drain and IV fluids.
• A 46-year-old woman sustained a bear bite to her right thigh. The wound was cleaned and she received painkillers and antibiotics.
• A 49-year-old man was accidentally shot in his right thigh by his friend while climbing a tree. He was referred to hospital.
• A 14-year-old boy fell 30 feet from a coconut tree, sustaining fractures to his wrist and femur, and cuts to his face. He was given a local anesthetic and the fractures were set and splinted.
• A 58-year-old woman collapsed while cooking. She received aspirin and anti-hypertensive medication. She refused referral.
• A 35-year old-man had a seizure and fell into a fire burning and sustained third degree burns to his whole face, right arm and chest. He was treated with dressing changes and antibiotics. He refused referral.

Medics practice IV insertion. Photo courtesy of Charles Washington

More recently, the focus of the workshops has expanded to encompass wider community needs encountered by emergency medics. This year’s workshop addressed additional topics including pregnancy and basic emergency obstetric care, pediatrics, regional anesthesia, skin infections, chest and abdominal pain, diarrhea, shortness of breath, drug and alcohol addiction, and altered mental states.

The workshop was led by Dr. Charles Washington, an Emergency Medicine physician based in Boise, Idaho, and Dr. Cameron Crandall, Professor of Emergency Medicine at the University of New Mexico, supported by a team of volunteers from the US working in emergency medicine. Training sessions were co-taught with senior medics from the Karen Department of Health and Welfare, reflecting the success of the ‘Training of Trainers’ model that has been incorporated in these workshops for the past seven years.

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