8 - 13 Jan 2012
Team with a Mission
by Dr Eric Lee, CA-1 Resident
The plane skidded to a halt on the tarmac runway of Yangon International Airport and we grabbed our bags and headed for the exit. It was 8 Jan 2012, and I was traveling as part of a team from NUH on a surgical mission trip to Defence Services Orthopaedics Hospital (DSOH), Yangon. This was one of a series of trips organised on an approximately yearly basis which focused on oral and maxillofacial plastics and reconstructive surgery, and was currently led by A/P Lim Thiam Chye from the Dept of Plastic Surgery, NUH.
The prospect of practising anaesthesia in a foreign land as a junior trainee was to me both intriguing and daunting at once, daunting largely because of the need to function with unfamiliar and possibly limited equipment, facilities and drugs, yet intriguing because I have always loved traveling, and one of the great appeals of anaesthesia to me when I signed up as a resident was the vast number of opportunities to practice in a diverse range of unique and potentially challenging healthcare settings.
I had often heard seniors speak of exciting trips to far-flung corners of the Earth, and I was pleased to finally have the chance to go on an overseas work trip myself. It helped that the senior I was traveling with, Dr Tan Wah Tze, had much experience in this area, having been part of a successful SAF-led surgical mission to Afghanistan.
DSOH is a 500-bedded military orthopaedic hospital located about 45min drive from downtown Yangon. A preop preview of the patients and tour of the hospital on the first day revealed where the main anaesthetic challenges would lie; while the patients were largely very healthy, and ranged from teenage to middle-aged, a number of patients presented with significantly altered airway anatomy (from tumour, war injuries or injuries from road traffic accidents) and would not be amenable to standard airway management during induction.
Equipment and facilities while modest, were certainly more than sufficient for the conduct of safe general anaesthesia but required good understanding of the equipment and proper attention to technique, safety and vigilant clinical monitoring.
Over the next three days, A/P Lim and his team of registrars, joined by a pair of surgeons from New Zealand, performed an array of maxillofacial surgeries- reconstructions, fracture fixations and cosmetic procedures, and on the anaesthetic end we were kept busy with a host of difficult airways (for example, one had developed ankylosis of the temporomandibular joint and had been completely unable to open his mouth for the last few years) and were glad to have brought with us a fibreoptic bronchoscope, which helped greatly with intubation on more than one occasion.
As a junior trainee, the take-homes were many; from airway management, to learning to quickly adapt to unfamiliar equipment and drugs (my first time using halothane!) and learning how to modify the anaesthetic technique to suit the needs of each situation, to planning contingencies for the unexpected and managing supplies and logistics while also learning to communicate and function as part of not just a multidisciplinary but also multinational team.
The latter was made easy by our gracious and accommodating hosts at DSOH, who went to great lengths to ensure that our needs were most well looked after.
A postop review of the patients in the ward showed that things had gone well, and the smiles all around were worth all the traveling and long hours in the OR. It never escaped me for a moment the privilege extended by Myanmese people in inviting us to work with them, and the honour it was for us to be a representative of our own country in some way. Our trip to Yangon was made complete on the last day with tours of the magnificent Myanmese Pagodas (including the awe-inspiring Shwedagon), gemstone museum, as well as stops at for shopping at the popular street markets, an enjoyable end to a memorable and educational week.
