Reports in Global Health
Myanmar is no longer deaf to the world
Thursday 2 February 2012
By Mr Robin Youngs FRCS
Immediate Past President of the RSM Section of Otology
Myanmar, or Burma, as it is officially known by the British Government, has been the subject of increasing press attention in recent months. Signs of a relaxation in the political situation have followed the elections of November 2010. Although the government is still dominated by the military there have been a number of reformist moves in an apparent attempt to end its international isolation. There has been engagement with foreign powers including landmark visits by Hilary Clinton and Andrew Mitchell, the UK Secretary for International Development. Measures have included dialogue with Aung San Suu Kyi, whose picture is now permitted to be printed in the media. In parallel with political changes Burma is now considered to be the "must see" destination for discerning tourists.
However welcome these measures, the situation for Burma's 55 million people in terms of health remains poor. Life expectancy is low and infant mortality is high. Diseases prevalent in poorer countries are common. Major problems include communicable diseases such as malaria, HIV and TB. Access to health care for the 70% of the population who live in rural areas is difficult. Rates of tobacco smoking, particularly among men, are high. The Myanmar Ministry of Health recognizes the difficulties and has actively engaged with organizations such as WHO and the UN. The scale of the issues involved in such a large and populous country is, however, huge.
A group of ENT surgeons from the Gloucester and Hull who have formed a partnership with Burmese colleagues have been able to observe the changes at first hand. The collaboration goes back to 2003 when Robin Youngs, Nick Stafford and Kate Evans first travelled to meet their counterparts in Rangoon.
As in other poor countries, ENT conditions are common in Burma and are important public health issues.
Deafness is the world's commonest disability. Being an "invisible" disability it often fails to attract attention on the Global Health stage. The ramifications of deafness are however, profound. Deaf children may fail to develop normal speech and language. Deaf adults may find it difficult to secure employment. The elderly deaf are frequently socially isolated. Burma, like most poor countries, has a high incidence of deafness. The most frequent causes are chronic otitis media, ototoxic drugs, industrial noise damage and age-related inner ear degeneration. The majority of the population does not have access to diagnostic facilities or treatment such as middle ear surgery or hearing aids. There is a single state-employed audiologist for the country's 55 million people.
With high rates of tobacco smoking head and neck cancer is common. Patients often do not have access to diagnostic facilities, or cannot afford them. Consequently presentation is often very late and curative treatment is not possible. Often these patients are middle-aged men who are the main source of income for a family.
The UK team have been concentrating on working with their colleagues in the National ENT Teaching Hospital in Rangoon. The focus has been on the delivery of high-quality surgical skills tuition. Surgical skills teaching and simulation is expensive, and the Burmese doctors would not normally have access to this type of event. There have been courses in endoscopic sinus surgery, temporal bone surgery and head and neck reconstruction, all funded from the UK. The courses have been well supported by instrument companies such as Karl Storz Ltd. and Medtronic Ltd.These companies have also been generous in the donation of surgical equipment to the Rangoon ENT Hospital so that the Burmese doctors can develop their surgical skills. Some of these events have involved collaboration with other agencies such as the Thai Rural Ear Nose and Throat Foundation. Surgical procedures on Burmese patients have been undertaken with the focus being on direct teaching and supervision of local trainees.
Members of the UK team have first-hand experience in the work of NGO's particularly in the field of deafness prevention, diagnosis and rehabilitation. The principle thrust has been the development of Community Ear Care as a basis of providing assistance for deaf people in poorer communities. There is potential to develop such services in Burma in line with the WHO's strategy of providing services for people with deafness and hearing impairment. In addition a number of UK audio-vestibular physicians of Burmese origin are providing expertise, training and guidance in deafness rehabilitation and hearing aid fitting.
There is a great desire for this successful partnership to continue and develop. In this respect a numbers of possibilities are under discussion. The frequency of visiting ENT teams will increase to twice a year. A cohort of UK ENT surgeons with skills in education and training are being recruited. It is planned to use the Medical Training Initiative (MTI) scheme to bring senior Burmese trainees to the UK for 1-2 years of surgical training. Burmese trainees are also keen to sit the Intercollegiate DOHNS diploma. In developing this partnership the British and Burmese ENT doctors have been grateful of the continued support of The Myanmar Ministry of Health, Vicky Bowman and Andy Heyn (past and present British Ambassadors to Burma) and the Britain-Burma Society in London.
