Celebrating 20 Years of Training Backpack Emergency Medics in Eastern Myanmar

For the 20th successive year, in late January, 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 injuries and emergency medical illnesses. The Karen Department of Health and Welfare (KDHW) organized the six-day workshop 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 the conflict, and they regularly dealt 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, emergency needs in these communities are 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.

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 in a ‘jungle operating theater’ context.

The attending medics reported attending at least 154 patients between January and June 2018. They treated a diverse range of injuries, including the following cases:

• ​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 the hospital.
• A 24-year-old man sustained a self-inflicted 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 antihypertensive medication. She refused the referral.
• A 35-year-old man had a seizure, fell into a fire, and sustained third-degree burns to his whole face, right arm, and chest. He was treated with dressing changes and antibiotics. He refused a referral.

More recently, the focus of the workshops has expanded to encompass broader 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, a Professor of Emergency Medicine at the University of New Mexico. It was 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.