MYANMAR: Innovations- Local Resources

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MYANMAR: Innovations- Local Resources

Using what's available

Innovation can mean finding high-tech solutions. But not always.

The use of local materials is indeed an important lesson for all the local medical staff, aside from resolving the little problem of height. In a resource-strapped environment, the difficulty of sending advanced equipment and materials to address local needs is that when the humanitarian organization leaves, the supply will probably be cut. Enabling the local staff to rely on themselves is the most ideal and sustainable way to ensure the running of all kinds of work in a place with very limited resources.

The improvised ostomy bag.  

The improvised ostomy bag.

 

Sometimes you really need to twist your brain to find the right local materials for different situations. DIY-ing colostomy bags that collect patients’ excreta was one of the most unforgettable experiences. After brainstorming, Rodel, our ward nurse from the Philippines came up with a brilliant idea of a DIY ostomy bag - connect a surgical glove with the sterilized lid of a jar of coffee powder. Then, tie it on the patient and make sure the glove gets changed every day. This could avoid leakage that previously happened when we simply used adhesive tape to stick the “colostomy bag” glove onto the patients’ stoma (the opening in the abdomen where excreta is removed).

But then we received a baby who was only four days old and his stoma was as small as a quarter. The lid of the coffee jar was way too big for him. We eventually used a lid from a glue stick instead and connected it with a condom and a surgical glove. And that was the “colostomy bag for babies”. Do not look down on these little tricks. The local medical staff then know how to make their own colostomy bag to cope with urgent needs even there is no way to get the real ones. This takes us one step closer to achieving the objectives of our project

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Myanmar: Small Silver Linings

So I have now been here for some time and I have experienced every possible emotion from fatigue and hopelessness to sheer joy and gratefulness.

In my position in the MSF hospital, I am the doctor for the pediatric intensive care unit (ICU) and women's health, labor & delivery,  pediatric neonatal unit and the tetanus unit. We have one other doctor who is a general practitioner and she is responsible for the general floor. We are assisted by four local medical assistants, one for each unit. Our hospital has been over capacity since I arrived averaging 120-130 patients in pediatrics on a given day (I believe the beds are for 70-80 patients but we have twins in many beds and mattresses on the floor everywhere).

In my neonatal unit, I accept very low birth weight infants (1.25kg/2.75lbs and above) with gestational ages as early as six months. The tetanus room has had five to eight children at a time, mostly neonates as they get the infection from the umbilical cord once it’s cut. The Pediatric ICU is overflowing with malaria, malnutrition and respiratory illnesses.

The first weeks were extremely hard on me, I spent a lot of time and energy focusing on what I could not do, instead of acknowledging how much we were accomplishing. I was worried about gaps in my knowledge as I am a Obstetrician/Gynecologist, not an ICU doctor (though I am so grateful for the ICU training I received in residency). I was draining myself emotionally and realized mentally I would not survive if I kept going this route.

Two small miracles happened for me right around the same time and it was the turning point I needed.

My second small miracle happened right around the same time. I have been struggling with malnutrition. The mortality rate is high when a malnourished child goes into shock and it has been extremely frustrating for me, especially since malnutrition is not something I see in the US.

A patient was transferred to me from the feeding center for decompensation - a sudden deterioration in condition - and by the time she arrived she was in shock; non responsive, cool extremities, and thready pulses. Again my hope for resuscitation was not great and the fluid balances in malnourished children can be tricky.

We gave a small bolus and started antibiotics. She responded a little to the fluid so we gave another small bolus and then placed a nasogastric tube to rehydrate. We gave ReSoMal (a rehydration solution for malnourished children) through the night. I said good night and gave strict instructions to the night staff. I didn't hear from them that night so I was not sure what to expect the next morning, but once again when I arrived there she was sitting up in bed drinking. I wanted to cry, I was so happy.

She was my first malnourished child in shock to recover. She continued to improve and started to gain weight and has now returned to the feeding center.

The days are still up and down and the bad days are still bad but I'm starting to see all the good we do here as well and I keep holding out for small miracles!

 

 

 

 

 

 

 

 

During my first week here, a mom brought in her two-week-old baby who had been born at home. The baby had stopped breast feeding and was having trouble breathing. We placed a pulse oximeter on the child and her level was really low (saturations were in the 50's). She had crackles in her lungs and a loud murmur. I knew she was in heart failure. I told the mom we would do what we could but the child may not survive the night.

We started oxygen, gave a small bolus for dehydration [a small volume of fluid], started antibiotics, some maintenance fluids as the child was too sick to breast feed and gave diuretics. I really did not think the child would make it through the night, but the next morning there she was breathing fast and retracting but still alive. She now had edema [swelling] and a liver edge (signs of worsening heart failure) so fluids were stopped and a nasogastric tube (NGT) was placed. Mom was taught how to express breast milk and how to place it in the tube for the child. 

The patient survived for days like this, her lungs were full of fluid, all I could hear were crackles on auscultation. She weighed less than 4 lbs and all her efforts went towards breathing (all we have is 5 liters of oxygen by nasal cannula to support breathing). I talked with mom daily and she knew I had a guarded prognosis, but I would continue to do what I could.

Then one morning, I did my exam and they were gone, the crackles were just gone. I heard clear breath sounds. I must of listened for what felt like ages but I couldn't believe what I was hearing, or wasn't hearing. Over the next 10 days, she continued to improve. She started breast feeding and the NGT was removed.

She came off oxygen. Finally, she gained weight and was able to come off diuretics. One month and one day later, I was sending her home. She still has a murmur and she may get sick again but for now she's thriving. I told mom she is my miracle child. (For the medical people my only explanation was persistent pulmonary hypertension that slowly improved with time.)

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Myanmar: Untold Stories

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Myanmar: Untold Stories

It’s an often perilous journey - one that frequently ends in tragedy. In early September, 46 bodies were recovered after a boat crammed with refugees capsized; 11 days ago, another boat sank with 80 people on board. Fewer than twenty survived. Yet still the refugees keep coming - the risk on the water preferable to that of staying and facing Myanmar’s military. 

My heart weighs heavily. Anyone at home who has kept up with the news, particularly the Rohingya refugee crisis fleeing to Bangladesh due to the hidden genocide events. A month ago Rohingya insurgents declared a month-long unilateral ceasefire, allowing aid like the MSF team to reach north-western Myanmar without harm. The Arakan Rohingya Salvation Army (Arsa) had strongly encouraged us and all concerned humanitarian actors to resume humanitarian assistance to all victims of the crisis, irrespective of ethnic or religious background during the ceasefire period; Not to mention the government encouraging refugees to fell the border during this month of safe passage through rebel-held crossing points, that period ends tonight. 

There are a few cases that will stick with you forever, where the unseen cannot not be reversed: 

  • A woman who lives in the camp with her daughter, where her husband and son were killed, and her other daughter was raped then killed. The woman suffer from anxiety, heart palpitation and was “crying, crying, crying”. —> Their condition is difficult. It’s so miserable.   
  • A small girl had started to cry when my colleague entered the tent. When asked the girl’s mother why the daughter was scared, she said it was because of his pants. Rohingya usually wear a lungi, a kind of sarong with a knot at the top where valuables are stored. His pants reminded her of the pants the military wears. “ It feels like they’re not burning our houses, it feels like they’re burning us”
  • 13 month old - cheekbones jutted out below sunken eyes - measuring tape around her pencil-thin arm and placed her on the scales = 5.5 kg (less than the weight of a healthy child half her age)
  • 8 month old - a skeletal girl died after admitted with severe malnutrition and pneumonia
  •  A woman gave birth in no man’s land; another held up a 7-day old baby begging for help; another arrived to the clinic with her leg blown off apparently in a landmine explosion where the border of Myanmar is mined to deter fleeing members. 
  • Most heartbreaking have involved teenage girls with intellectual disabilities who were raped repeatedly. 
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One of the worst cases is that of a woman who fled her village without her child when it came under fire. She suffered from intense feelings of guilt, exacerbated by seeing other mothers with their children. After a few weeks of searching with the help of teammates, we were able to reunite her with her child and I'd say I can definitely leave with my heart feeling full. 

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