Universal Truths

Published on April 18, 2016
It is almost startling to realize how many of the EM challenges and opportunities in many countries mirror those in other countries. We are much more connected in these struggles than we may realize.

I recently traveled 42 hours from the US to Mandalay, Myanmar to attend the Myanmar Emergency Medicine Updates Symposium, organized and sponsored by the University of Medicine, Mandalay. Myanmar (formerly Burma) is in the very early stages of EM system development. The students and physicians here are bright, energetic, enthusiastic, and they are very interested in improving patient care and medical education, and in collaborating with “outside” EM entities. The first EM post-medical school training programs, preliminary certification and “grandfathering certification,” and an emergency physicians organization have all begun.

That said, one of my strongest take-aways from this trip was observing how similar the struggles facing emergency medicine are in varied corners of the world. Take policy and administration, for instance. In Myanmar, there is a lack of appreciation for the true breadth and depth of the specialty by government officials and hospital and medical school administrators. There’s also a lack of understanding of the specialty and fear of its implementation by the other medical specialties. Sound familiar?

Within the treatment setting, patients with multisystem or complex problems can receive fragmented care because of reliance on the multispecialty care delivery model, while others are routed to specific hospital specialists (some based in single specialty hospitals) based on presumptive chief complaint. Ambulance personnel have no medical training and just transport patients, and there is no defined trauma care specialty.

Like so many other regions, Myanmar has funding and resource limitations (non-availability of some medications such as tPA and some lab tests such as venous carboxyhemoglobin, for example). Doctors working in the publicly-funded health facilities leave their public health facility in the afternoon to go work at a private healthcare facility in the afternoon and evening (where they make most of their income). Finally, there is little or no EM training in medical schools, and there are few senior mentors for training in the specialty.

It is almost startling to realize how many of the EM challenges and opportunities in a place like Myanmar mirror those in other countries. We are much more connected in these struggles than we may realize.

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