Project members: Plastic surgeons: Dr Wim Theuvenet (MD, PhD) and Dr David Schiettecatte (M.D.).
Hand therapists/HAB volunteers: Ms Tanja Bakker (OT), Mw. Guusje Besteman (PT), Ms Jolanda ten Brinke-van Wijk (OT), Ms Lisette van der Mijl (OT), Dr Ton A.R. Schreuders (PT, PhD, CHT-NL)
Mawlamyine Christian Leprosy Hospital (MCLH) workshop
The initial idea of having a combined type of surgery-therapy workshop had to be abandoned due to the large number (about 50) of patients needing surgery. The surgeons were therefore not able to participate in the sessions and workshops and this left the therapists to draw up a 5-6 day programme by themselves. The first day was started with talks and learning from each others experiences and background and deciding on the time schedule and the topics as requested. All attendees were asked to give a presentation on their speciality.
The workshop contained:
- Presentations by the Myanmar therapists on leprosy, CP and amputation.
- Patient demonstrations; some pre- and other post operatively
- Splinting workshop: soft cast, paper and plaster of Paris
- Visit to wards and therapy department:
patients with CVA, spinal cord injury, backpain, CP
- The final day feedback was given. It was
an intensive 5-6 days and to some participants at a rather high level of specific knowledge.
In general the need for developing skills and knowledge for therapists is high. The surgeons are well trained and up to date with current surgical techniques and post-operative treatment regimens while the therapists sometimes have insufficient knowledge and experience to deal with the variety and number of patients. The PTs at MCLH already were involved in Early Active Motion after tendon transfers which they initiated after participating in the Anandaban workshop in Nepal last year.
The group therapists in Mawlamyine responded very enthusiastic and were eager to learn on any topic and training that was offered. Because of the small group there were good opportunities for discussions. The presentations of the therapists from Myanmar about their own patients gave us a good insight on their experience and what knowledge we could exchange.
Subjects we could consider for future visits: Presentations together with the surgeons for more insight in surgical techniques, principles of splinting, how to achieve a good fitting, the different models for different diagnoses. Hand problems in stroke patients and workshop in making adaptations on tools, cutlery and clothing.
Yenanathar Leprosy Hospital – Mandalay
At the Yenanathar Leprosy Hospital we were kindly welcomed by the director Dr Myat Thidas. We were shown around and saw quite a large number of leprosy patients, some already had surgery. Ulcer care was an important task for the staff. Several patients were seen that could have benefitted from therapy and surgery. In a building near the entrance where the care for patients with amputations was done 10-15 patients were busy doing their gait training. The prosthesis looked good and sufficient.
Mandalay Orthopaedic Hospital
We were kindly received the day before the workshop by Prof Win Ko and his colleague Prof Maung Mg Htwe and the director of the Hospital and information was provided about the people attendingthe workshop, facilities at this hospital etc. A 260 bedded nicely situated hospital in the middle ofMandalay, most patients were admitted due to trauma. Three hand surgeons are involved in all kindsof high level hand surgery. Only 11 PTs are working at this Hospital most with little training in hand therapy.
Presentations were given both by our group and the Mandalay staff who presented some most interesting case studies with the patient present during the workshop. After the workshop Prof Win Ko requested our group to consider a longer period of training for the therapists possibly in combination with the PTs from the General Hospital.
We thank Netherlands Leprosy Relief association, and Dr Zaw Moe Aung of The Leprosy Mission Myanmar for facilitating and sponsoring parts of this visit. We also thank BSN Netherlands for sending a shipment of soft cast material to Myanmar.