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Myanmar UK Health Alliance Newsletter

July 2020
Welcome to the Myanmar UK Health Alliance Newsletter!
We hope that these newsletters are informative and interesting, bringing you the latest updates, news and events. If so, please do spread the word and encourage others to join by emailing May.Khin@THET.Org. If not, you are able to unsubscribe via the link at the bottom of the page.

We hope that all members of the MUKHA community have stayed safe and well during this pandemic. Despite all the challenges, many of our partners have kept the learning process alive through virtual sessions. We found the feedback from these sessions extremely encouraging, proving that nothing can stop the dedication of healthcare professionals to continue learning, sharing skills and experiences. This is the new era we must embrace and the MUKHA community has proven that we can overcome any adversities if we work together.
Recent Updates and Highlights

British Society for Surgery of the Hand (BSSH) Training Course
Hand Fracture Course, 26th - 27th February 2020, University of Medicine (1), Medical Skill, Simulation and Research Centre, Yangon
Sponsored by the BSSH and led by Dr. Nik Jagodzinski (Consultant T&O Hand Surgeon, Barnstaple, Devon) and his team, the course was largely based on the Surgical Art - hand fracture course that David Bell (Consultant Hand and Plastic Surgeon, Whiston, Liverpool) teaches, which covers wiring, external fixation and plating techniques for metacarpal and phalangeal fractures. Additionally, the team facilitated sessions on; K-wiring on saw-bone hands and wrists, wiring techniques for the distal radius and carpus, conservative management of hand fractures using splints and casts and finally a session on rehab of hand injuries by Dr. Henrietta Clay (Occupational Hand Therapist, Barnstaple, Devon).
On day one, 73 participants attended with the majority being 3rd year orthopaedic post-graduate students as well as 15 ED nurses. Participants to the course came from different hospitals in Yangon, Mandalay and Magway. On day two, four Physiatrists and 12 physiotherapists joined the training together with orthopaedic post-graduate students.

Better Health Program (BHP)
BHP is a program funded by the UK Foreign and Commonwealth Office (FCO). Through continued engagement and coordination between BHP and relevant government departments, the programme was kicked-off as planned despite Covid-19. Activities conducted thus far are needs assessments and initial gap reports outlining: challenges, bottlenecks in relation to NCDs in cancer, NCD data strategy, NCD monitoring and reviews of teaching methodologies and the public health curriculum.

Delayed engagement, irregular communication and reporting due to Covid-19 were some of the challenges faced by the team. Additionally, based on the findings and further engagement with relevant government departments, an agreement was reached on the development of a module linking infectious disease prevention in NCDs with a system strengthening approach for Covid-19. This module will be included in the Public Health curriculum.

Public Health England (PHE) activities between April and June 2020

As part of a 5-year UK Official Development Assistance (ODA) project on International Health Regulation (IHR-2005), Public Health England (PHE) has been working with the Myanmar Ministry of Health and Sports to strengthen the country’s health system so that the country is ready to assess, detect, notify and respond to any health threats of national or international concerns. Although the IHR project focuses on preparedness, PHE has supported the Myanmar MOHS in their response to the COVID-19 pandemic between April and June 2020 as follows:
(I)  Lab system strengthening
  1. Delivered an interactive e-learning course on the use of Class-2 Biosafety cabinets (BSC-2) training to 52 lab staff (22 from National Health Laboratory and 30 from the Department of Medical Research, Myanmar). This e-learning course is for lab scientists who are routinely working with Class II Biosafety cabinets as well as for those who are currently handling COVID-19 samples. Trainees received a certificate upon completion, which will be valid for a year.
  2. Following the BSC-2 e-learning course, PHE has donated and shipped two handheld vane anemometers to NHL. The instrument will monitor the airflow of biosafety cabinets to ensure that the safety cabinet is performing to standards and providing the expected protection to the laboratory technicians.
(II)  Chemical and Poison Workstream
Led by the Department of Medical Research, technical inputs continue to be provided on the development of a research paper focused on increased use of chemical disinfectants during the COVID-19 pandemic. The purpose is to improve the safe use of disinfectants in the response.
(III)  Surveillance workstream
(Technical review of Myanmar Surveillance Bulletin produced by the CEU of MOHS)
This is one of the planned activities agreed before COVID-19. PHE conducted a technical review of the monthly epidemiology bulletin produced by CEU as part of the IHR Strengthening Project workplan. The review provides recommendations for future bulletins and to work with CEU to agree on next steps in revising the bulletin, including developing a standard template and SOP. This will help develop staff skills on data management, analysis and presentation, and create in-house capacity in the CEU to produce an improved end product.
Royal College of GP and General Practitioners in Myanmar activities in response to Covid-19

The one-year RCGP - Myanmar GP Society GP Quality Improvement Project was due to start in January 2020 and to be completed by the end of December 2020, with 4 visits to Myanmar planned throughout the year. The first visit of the RCGP Quality Improvement of Myanmar General Practice was due to take place in mid-March 2020 but had to be delayed due to Covid-19. The majority of activities, such as face to face workshops for groups of 20-30 Myanmar general practitioners, gathering quality indicator data and visiting individual general practices to discuss development plans, had to postponed until safe travel arrangements can be guaranteed. However, with the aim to continue on the path outlined in their objectives at the start of the year, the RCGP’s are currently in the process of adapting their activity to ensure project success. As such, the group has changed from a face to face approach to a distance learning approach through social media and communication platforms.
A challenge presented during the Covid-19 pandemic was the continuation of patient care for non-Covid related health concerns.
In such challenging times, it is more important than ever for UK GPs and Myanmar GPs to work together, sharing experiences and learning from each other.
There are multiple elements to the remote Quality Improvement (QI) training program:
  • Large Webinars: For GPs from all over Myanmar, sharing learning and experiences during Covid-19.
  • QI Champions Program: Training and mentoring focused on local/smaller groups to continue with our initial QI Program.
  • Myanmar GP Society Quality Improvement Group/RCGP Supported Facebook Group: to share experience and learning between UK and Myanmar GPs. The Group has 173 members.
The QI Champion Programme Program will consist of:
QI Themes (audit, infection control, significant event analysis, leadership)
  • Set Curriculum (mutually agreed)
  • Use of the QI Handbook produced from the 2018 QI Project
  • Remote delivery (Zoom*)
  • Small Groups (up to 10-12)
  • Monthly sessions over a period of 6 months
  • Interactive participation with self- learning, application in practice, audit
  • Feedback and Evaluation- participants & program
*Zoom meetings have been held with Myanmar GP Societies in Mandalay, Meiktila, Toungoo and Pathien who have agreed to participate in the 6 month QI Program. There will be 10-20 Myanmar GPs in each locality participating in the program. The first QI Program session with Pathein GP Society will start on the 8th of July.
To date 2 large webinars with Myanmar GPs have ben conducted:
  1. 5 April 2020 - Exchanging experience on Covid-19 Pandemic between UK and Myanmar General Practice. This was a 2-hour webinar attended by over 80 GPs. Discussions were on protecting patients and doctors including the use of PPE, remote consultations -advantages and disadvantages.
  2. 31 May 2020 - RCGP Myanmar GP Webinar - 'Discussion on Ethics during Covid-19 Pandemic'. More than 100 GPs joined.
The RCGP recruited additional RCGP Trainers/Co-trainers and organized RCGP Volunteers into local teams, with each team having a diaspora UK GP for linguistic support. Each team will work with the same Myanmar GPs for 6 months to build relationships and ensure continuity.
Brighter Future Foundation’s fundraising efforts for PPE donations to Myanmar
By Dr. Maung Maung Kyi (Chair of Brighter Future Foundation)
Late morning on Saturday 28th March, a video call was received via Messenger from Yangon. It was from Brighter Future Foundation's (BFF) founding member, Dr.Thinn Thinn Hlaing, who is also the Country Director for the Tropical Health & Education Trust (THET) and Dr. Aung Aung Lwin, previous Chairman of BFF. The conversation aimed to discuss ways to support Yangon Division preparedness and response during the Covid-19 pandemic.
The initial request had come via Yangon Division Covid-19 Committee Task Force, led by Professor Zaw Wai Soe. Based on this, BFF decided to try and aim to deliver, initially, 5000 sets of Personal Protection Equipment (PPE) at an approximate cost of $50,000 (£40,000).
Soon after the phone call, Dr. Aung Aung Lwin swung into action and wrote a message on BFF’s Facebook account, including a timeline of our intent. It was 11:57am 28th March. I’m still not sure whether because it was a Saturday, or because it was the first week of lock down in the UK, the response was phenomenal! One thing I am sure of, is the number of friends Dr. Aung Aung Lwin has and also of their willingness to contribute towards the impending pandemic back home. By 15:05, the donations and pledges had reached £25,791.73. A record in donations and generosity in just three hours!! That’s £8,597.24 per hour, £143 or so every minute!!! BFF had received donations from 219 individuals abroad totaling £25,562.84. Of course, there were donations made in Myanmar as well, with the shortfall to be made up by BFF’s own funds.
The plan was to purchase 5,000 units of FFP2 masks (as FFP3 masks were unavailable), 5,000 tier 2 gowns and 1,000 reusable goggles, all supplies to come from China. The trials and tribulations came, not only from some of the orders BFF made, but also from making payments. A very trying time for our treasurers, Dr.Khin Zar Nyo and Dr. Thandar Aye, who were supposed to make international transactions during the lockdown period. With their homes being around 150 miles apart, it was impossible to sign documents together. We thank the Tropical Health and Education Trust (THET), who have helped with our payments to the Chinese supplier.
The other testing time was when the Chinese government intervened and stopped all PPE shipments out of Shanghai. Dr. Thinn Thinn Hlaing rose to the occasion and managed to get assistance from the Chinese Embassy in Yangon. All went smoothly afterwards.
1st April: 200 KN95 masks, 500 surgical masks, 20 hand gel bottles, and 20 antibacterial wipes donated to West Yangon Hospital.
21st April: 100 KN95 masks donated to Yangon General Hospital Emergency Department.
28th April: KN95 masks, hand sanitisers and antibacterial wipes donated to Medical/Endocrine Wards, Yagon General Hospital.
28th April: 350 KN95 masks donated to Intensive Care Unit, Yangon General Hospital
29th April: 200 KN95 masks and 24 hand sanitizers donated to Yangon Mental Health Hospital, Ywar Thar Gyi.
4th May: 5,000 KN95 masks donated to Yangon Division Management Committee.
3rd July: Surgical masks and gowns donated to Myawaddy Hospital. (Hospital involved in managing returnees from Thailand/Malaysia)
All this was made possible because of the donations from the Myanmar diaspora community in the UK and around the world. We thank everyone who helped along each step of the donation process.
MCQ Writing Course for faculty members from five medical universities for the new integrated curriculum

The medical universities of Myanmar have recently agreed a new national undergraduate curriculum. As a next step, all universities who took part in the development of the curriculum will assess the curriculum to ensure a nationwide approach. Students tend to learn what they think is likely to be assessed. Hence if the system of assessment accurately reflects curriculum aims, students will learn intended outcomes.
Throughout June, over 100 members of faculty across the above mentioned five medical universities attended a distance-learning course delivered by Dr. Nicola Williams via Zoom. These weekly interactive workshops reinforced learning from a theory course in late 2019 and provided practical experience in writing MCQ exam questions. Having first worked in both large and small groups, participants submitted assignments between the modules. Those assignments were returned with detailed individual feedback. A collation of all the work, anonymized, was placed in a community web space so that each could learn from the others experience. The course was supported by a purpose-written handbook which was further developed in response to emerging needs as the course progressed.
First Online Webinar of Cambridge University Hospital NHS Foundation Trust and ICU specialists in Myanmar
On 29th June 2020, the first online Zoom seminar was held with Myanmar partners, bringing together intensive care consultants from a range of hospitals in Myanmar with intensive care consultants, anaesthetists and microbiologists from Cambridge who have been working throughout the Covid-19 pandemic as front line clinicians in the UK.

The purpose of the meeting was to share first-hand experience of managing hospitals, staff and patients during the pandemic; highlighting lessons learnt, useful experiences and pitfalls, and applying known evidence in a practical manner. Throughout the afternoon, repeated themes arose emphasising the importance of preparation and planning, teams and team work, looking after staff and the importance of staff who are not traditionally involved in face to face care working in the critical care units (microbiologists and pharmacists being of critical importance).

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