Development of

Emergency Medicine

in Myanmar

Dr Zaw Wai Soe MBBS, MMedSc(Ortho), FRCS(Glasgow),

DrMedSc(Ortho) Dip in Med Education

Professor of Orthopaedics & Traumatology University of Medicine I Yangon

Yangon General Hospital & Yangon Orthopaedic Hospital

14 States and Regions 67 Districts

330 Townships 64 Sub-townships

2891 Wards 13698 Village tracts

64817 Villages

Myanmar is the largest country

in mainland South-East Asia

Shwedagon Pagoda Population

59.13millions

Growth Rate 1.29

70% in Rural Areas

135 National groups

100 Languages

90 % Buddhists

0~14 32%

15~59 59%

60~>60 9%

98.89M/100F

Adult literacy rate 94.1% IMR(R) 30 IMR(U) 28.2 MMR(R) 1.57 MMR(U) 1.23

Life Expectancy Urban Male 65.1 Female 70.5 Rural Male 63.9 Female 67.4

Mandalay

Inlay Lake

Total No. of doctors 26435 Total No. of Nurses 25644 Total No. of MW+LHV 22900

Royal Boat

Public Hospitals 924

Per Capita (public) Health Expenditure (2009-2010)

1082.4 (Kyats)

[1.35 (US $)]

(880 Kyats = 1 USD $)

Medical University and Number of Students

1. University of Medicine (1), Yangon 4327 2. University of Medicine, Mandalay 3956 3. University of Medicine (2), Yangon 3706 4. University of Medicine, Magway 3141

Health in Myanmar 2009

Morbidity

Mortality

Year 2007 2008

Reporting Status 96 % 97 %

Cases/Deaths of Transport Injury 37644 / 1085 43917 / 1316

Cases/Deaths of Occupational Injury 39845 / 302 46096 / 358

Cases/Deaths of Poisoning 2435 / 196 2538 / 243

Cases/Deaths of Fall from Height 10617 / 394 10196 / 355

Cases/Deaths of Burns / scalds 14571 / 148 15544 /138

Cases/Deaths of Drowning 2599 / 1484 13083 / 7625

Cases/Deaths of Suicide 1275 / 557 1518 / 564

Cases/Deaths of Assaults 24826 / 405 28569 / 467

HMIS Reports for 2007 & 2008

Cyclone Nargis

• Formed 27/4/2008

• Dissipate 3/5/2008

• Winds 135 mph (215 km/h)

• Tides 12 to14 foot high storm surge

Cyclone Nargis

2/5/2008 3:00pm

3/5/2008 9:00am

Winds 135mph (215 km/h)

Tides 12~20 foot high storm surge

• Started at 11pm • Ended at 7am

In Yangon

The Official said 150,000 Deaths 57,000 Missing 100,000 Injured.

Dr James Han Boon Kong ( RACS )

Primary Trauma Care in Myanmar

ROYAL AUSTRALASIAN COLLEGE OF SURGEONS

• Mrs Daliah Moss • Dr Georgina Phillips • Dr Sydney Chung • Dr Anthony Ho • Dr Antony Chenhall • Dr James HB Kong • Dr Lee Tsun Woon • Dr Eric Vreede • Dr Wong Tai Wai • Dr Stephen Swallow • Dr Michael Holland • Dr Hadyn Perndt • Dr Max Esser • Dr Kou Sio Kei

RACS & ACEM

PTC Training

Since March 2009 • Supervisors 14 • Instructors 189 • Providers 861

2011 - 2012 Changes in Myanmar:

The Lady was out…

She was elected !

The doors of Myanmar began to open.

SEA Games (11 ~ 22 December, 2013)

• 11 countries • 10,000 Athletes & Officials • 40,000 Supporters & Spectators • 17 events in NayPyiTaw • 14 events in Yangon • 1 in Chaungthar

We are Preparing for medical care in SEA game

• Minor illness • Minor injury • Major illness • Major injury • Outbreak • Disaster

The last SEA game in Myanmar was in 1969.

RACS SURGEONS INTERNATIONAL AWARD

(13~26 November 2011) Jointly funded by ACEM

I would like to find the way to develop the

A&E services in Myanmar by looking and

learning during my visit to Australia.

1500 bedded YangonGeneral

Hospital

1896

Entry to ED, YGH

ACLS room

Trauma receiving area

Emergency X-rays

In Myanmar…

– YGH is the only center that has an “A&E”.

– There is no AMBULANCE SYSTEM.

– There is no EMERGENCY MEDICINE

training.

Back from Australia

I wrote a report of my visit to Minister of Health.

I went and met him in Nay Pyi Taw, the new capital.

I advocated him about the importance of the development of A&E in our health care system.

2 weeks after

He accepted and received the courtesy call of the PTC international faculties;- Dr James HB Kong, Dr Georgina Phillips, Dr T W Lee and myself at the Ministry of Health on 9 December, 2011.

Courtesy Call in MOH 9 December 2011

To develop Emergency Medicine specialty & service in Myanmar

To organize National Level Workshop on Emergency Medicine Development in Myanmar

Deputy Minister of Health, President - MMA, International Faculties, DGs, Rectors of UM, MS of Teaching Hospitals, Professor & Head of

Departments , Directors from DOH and DMS

DEPUTY MINISTER OF

HEALTH

PRESIDENT OF

MYANMAR MEDICAL ASSOCIATION

Professor David AK Watters Dr Tai Wai Wong Professor Peter Cameron Dr James HB Kong

Myanmar – the future

• A plan to upskill existing specialists (surgeons, anaesthetists or physicians)

• A specialist training program for doctors (eg Masters in Emergency Medicine)

• A diploma or certificate for Rural Family Physicians • A trauma system embedded in the curriculum? • Align training with International standards • Better reception and initial treatment of all

emergencies presenting to hospital, including women and children

Progress

• Recommendations and Proposals were send to MOH (30/1/2012)

• Agenda of EC meeting in Ministry (23/3/2012) • EM Development Committee (29/3/2012) • Discussion in Postgraduate Training Meeting

(30/3/2012) • Letter of Intent between Department of Medical

Science / Department of Health and RACS/ACEM/IFEM

Letter of Intent

Emergency Medicine Development in Myanmar

Phase I Diploma Course & EM Departments in Major Cities Phase II Masters in EM EM Department in State & Division Phase III EM Department in Universities Local MMedSc (EM) Dip of EM Nursing EMT & Paramedics School

PHASE I

Diploma of EM for Junior Specialist Board of Study (2/4/2012) Curriculum (23/4/2012) From 1/6/2012 to 12/2013

Diploma in EM

• MMedSc in Medicine / Surgery / Paediatrics /Anaesthesia / Ortho

• 45 and <45 • 4 May 2012 last date • 8 May 2012 Interview • Selected 18 Candidates • 2~8 June 2012 Myanmar Emergency Medicine

Introductory Course (MEMIC) • 2 months Clinical Rotations in each Specialty

Emergency

HE Professor Dr Pe Thet Khin

AusAID & First Secretary Shaanti Sekhon

International Faculties and Students

Myanmar Emergency Medicine Introductory Course (MEMIC)

HE Ms Bronte Moules

ASSET Course, 7~11 September 2012

Plan

• ATLS 13 – 20 /11/2012 • ELSi 2/2013 • EM visit to Hong Kong & US ED 13 – 21 /4/2013 • MIMMS 6/2013 • APLS – Burn 7/2013 • Toxicology 9/2013 • Examination 10/2013

Bagan

Thank you very much for your help to Myanmar People.