Derek Goodisson / Consultant Maxillofacial and Head and Neck surgeon / New Zealand
The World Health organisation rates Myanmar’s health system as the worst in the world, with respect to access and equity of care. In January 2012, Derek Goodisson, fellow New Zealand surgeon Rajan Patel and anaesthetist Gavin King joined Singapore plastics surgeon TC Lim and his anaesthetist for a week long surgical mission to Yangon (formerly Rangoon).
Our mission followed recent visits by William Hague, the British Foreign Minister, and Hillary Clinton in the months after the announcement of elections in Myanmar. These were to be the first since the annulled elections of 1990 when Ang Sun Suu Kyi was placed in house arrest.
For me, this was my second surgical mission, and the changes in Myanmar were dramatic. It also was an opportunity for Gavin King and I to see a little of the country. The mission had been announced to the public six weeks in advance throughout the Yangon region. We were told later that hundreds had turned up, often travelling days hoping that they would be chosen for the clinic, and take a step closer to receiving the surgery they needed.
The Clinic
Our first day was an outpatient clinic, assessing those able to get through the initial screening process for the next three days of surgery. Perhaps 15 of the 30 of so of those assessed would be operated on. The spectrum of craniofacial deformity was extreme: from congenital facial deformity and severe post-traumatic disfigurement, to neglected benign and malignant pathology.
In stark contrast to these cases, we were also presented with several patients for minor cosmetic procedures. The previous year I had come to understand that these cases were the price we paid to operate here; that there would be a few patients, usually children of middle ranking officers (the more powerful would be treated in Singapore), who would demand minor cosmetic operations. Nasal tip implants were popular and interest had increased significantly since the previous year.
The clinic took us back to the fundamentals of medicine: history, examination and differential diagnosis. Special tests were not so special: CT scanning although available, would turn up at the least expected, but always welcome, time.
It was here that several charming Asian characteristics were on show. The first, a desire for all things European. Both Rajan (UK Indian) and TC (Singapore Asian) are internationally renowned surgeons. Yet it was Gavin and I, the white Caucasians who were the stars. This was quite justifiable for Gavin, a skilful anaesthetist (we often work together), but quite flattering for me.
The second was the time-honoured tradition of respecting elders, regardless. The Chief of Surgery was a venerable, very old and Yoda-like civilian surgeon, regarded by many as the founding father of craniofacial surgery in Mynamar. His status reflects having trained all of Myanmar’s top medical brass and his diagnostic skills put ours to shame, most of the time. However, where our opinions differed, etiquette, and the concept of saving face made further discussion problematic.
Surgery
The week went well. Through intermittent powercuts, improvised surgical equipment and an ever-attentive bevy of local surgeons we operated, hoping to make a difference.
The day would start and finish with a ward round. Apart from wound checks, it was hard to tell how things were going; when asked, patients had no pain, and felt well. This may have not been simply lost in translation: these patients, despite what we had done to them, seemed genuinely quite comfortable. The same procedures back home would not have been nearly so well-tolerated.
We were well looked after. The military had catered for every detail, from facilitating the customs process, with our mini-mountain of medical supplies, through to our own dining room and military cooks and waiting staff. There was no doubt that the army remained top dog still.
On our last day, we had a ritualistic handing-over of the remaining medical equipment, including a craniofacial plating set, provided by Stryker-Leibinger. It was all very well received and we hoped that it would be put to good use.
Travel in Myanmar
Having completed our surgery, Gavin and I then headed up to Inle Lake, Myanmar’s largest lake. Villagers here spend their whole lives afloat: homes, schools markets and gardens.
Our guide was a pleasant local man, who spoke very good English; Gavin and I were his third tour group ever. He and his colleague lead us into the mountains around the lake where we spent the night in a local house, asleep on the floor. The open fire served as stove and heater. There were no windows and it was the middle of winter.
We were the first tourist party through here, they told us, and something of a novelty. We even managed to continue the medical theme, examining an old lady with a hemi mandibular resection and dispensing penicillin for a man with impressive tonsillitis.
Final word
The week went well. I’m sure we made a positive difference to those we operated on. Yet I hope our greatest legacy will be to the local surgical staff – that they will keep in contact and evolve their specialties. There is no doubting their abilities, it is only their knowledge and the tools they have that need improving.
Myanmar has been described as the undiscovered Asia. It shares the Andaman coastline with Thailand, with its unspoilt beaches. The food is all that you would expect and the hospitality generous and sincere. But things are changing, quickly, as Myanmar heads inexorably towards capitalism. Visit now.
