30TH JANUARY 2019
By Stuart Tuckwood
It’s cooler now in Yangon, not quite near as cold as I’m told Cambridge or Scotland is, but much more pleasant than when we arrived in September. It’s down to a shivery 34 degrees Celsius during the day, cold enough for the locals to be wearing coats and occasionally fluffy hats.
The frequent deluges that punctuated much of our early time here have passed. Having never owned an umbrella previously I had finally given in and bought one after 40 minutes stranded under a tin roof during a particularly heavy downpour. I believe since then it has rained once so it’s clearly a very lucky one.
A mysterious fruit has appeared hanging from the branches of the dense trees surrounding our apartment block. As of yet we’ve been unable to identify it but whatever it is, it clearly is very valuable to the people of Yangon.
A week or two ago I was standing by our back window, in only a pair of boxer shorts because of the heat, making a cup of coffee, when I realised there was a wisened old man about three feet away from me, suspended at an alarming height in a tree, in the midst of a hunt for this fruit. Given how often we’ve seen patients in the hospital admitted following ‘falls from height’ this gave me real concern. I was worried that any noise from me would startle him into losing what seemed to be a very precarious grip on a high branch.
Seconds later he looked around and made eye contact with me, as if he’d sensed I was watching him. We nodded at eachother and he genuinely didn’t seem that surprised to see a westerner in his underwear watching him. As I watched he unslung a long thin pole with a twisted piece of wire on the end that had been on his back and used it to hook one of the fruit from a distant branch, like you might hook a duck at an arcade.
It was extremely impressive and you’ll be glad to hear he made it down safely. Later that day two teenage boys scaled the tree and again noticed me watching, please believe this was just a coincidence as I don’t tend to spend most of my days staring vacantly out of the window. I didn’t have the heart, or the language, to tell them that a pensioner had already stripped the tree of the valuable fruit.
We’ve continued to be very busy with our project here, working on a few different fronts with one eye on how to sustain our progress once we’ve left. We’re almost about to finish a period of research and data collection that we hope will yield interesting information on the work of the intensive care unit in Yangon General and the management of trauma patients.
We’re running weekly teaching sessions where we discuss aspects of trauma and nursing care and work with the nurses on improvements we have tried to introduce on the ICU.
Currently we are in the midst of auditing the performance of a care bundle we have implemented together with the nursing team to assess how well it is being carried out. This aims to improve the practice of the nurses and the doctors relating to how they handle invasive lines on the intensive care unit, hoping to reduce the incidence of line associated infections and spread of infectious organisms.
Conducting quality improvement initiatives in healthcare can be challenging in any area and is fraught with difficulties in resource challenged settings. Given the burden on the local healthcare staff we’re realistic about the progress that is achievable in short time frames but we are really encouraged by the enthusiasm the local staff have shown towards quality improvement. But that’s a topic for another day!
We have also begun running weekly sessions of life support simulation training for the ICU nurses and nursing masters students. The culture of learning here is often focused on didactic, lecture based teaching and there is little ongoing professional development and training for nurses. The ICU nurses we have been working with have been enthusiastic about the bedside practical learning we have done together and so we decided to run a simulation course for them on life support.
So far the feedback has been overwhelmingly positive and there has been a noticeable improvement in the life support skills of the nurses taking part.
I’ve spoken before on this blog about the amazing people we’ve encountered in Yangon and it still continues to fascinate me. Whilst I was sitting outside the hospital shortly after arriving a little old man sat down next to me. He took my arm, held it against his own and started laughing very loudly and saying ‘so white!’.
When I walked into a fast food outlet in a shopping centre earlier to procure food for my ever-hungry colleague the eight Burmese staff behind the counter regaled me with a welcoming song in perfect unison. I felt very special until the next customer walked in and they repeated the feat.
It was my birthday last week and Livi had kindly brought a cake to the ICU and invited some of our colleagues and friends working here with us to join and have some. Whilst some of the physiotherapists I was working with were treating a patient, I asked them infront of the patient’s family to join us for some cake. This patient has been in the ICU for a while and we’ve talked to her family several times as they speak fairly good English. The next day as I was in the room, the patient’s daughter touched my arm and said, ‘enjoy the last year of your twenties!’.
At other times it can be a somewhat terrifying place. There is a Buddhist festival of lights in a place called Taunggyi in Myanmar where brightly lit hot air balloons are sent skywards over huge masses of people in the evenings. They are laden with an average of 60kgs of fireworks which are set off over the crowds as they fly. So possibly not the strictest health and safety standards.
On New Year’s Eve we went for dinner and then some drinks at a rooftop bar. They ushered in the New Year by sending out some of the barmen to fire fireworks off the roof from handheld poles, fortunately just the one landed near the bar and showered us with bright sparks.
Whilst coming home one day I began to feel something was a bit wrong with the taxi I was in. It took me a little while to suss out that the footbrake was obviously not working very well at all and that the driver was coping by just using the handbrake every time we needed to stop in traffic. I’m not hugely fussed by taxis providing heated seats or free bottled water but I do tend to be expect the car to have functioning brakes.Paragraph
I’d be happy to write and complain about the heat here also but I suspect I will get little sympathy from anyone in Britain given it’s sub-zero in Cambridge currently. In fact I doubt anyone will have read on this far after my initial joke about the weather. Thanks for reading
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