By Livi Rees

Hi readers! Apologies for the lack of entries as the last few weekends have been very busy and I have been having problems with the keyboard on my computer which has made writing a long entry impossible. I have managed to borrow a computer for today so will try to catch you up as best I can!

The last few weeks have been slightly disjointed, first with the Thadinyut festival at the end of October where we had a few days off, then with a weekend trip to Bangkok to renew our visas. The expiry of our visas coincided with my birthday so we celebrated with some Thai massage and by eating some of the western foods that are harder to find in Yangon. We stayed in one of the more touristy areas of Bangkok which was a bit of a culture shock after having been in Yangon for a month, and we were glad to come back to our little flat despite an invasion of ants which had seems to have occurred during our time away! Unfortunately the battle with the ants is still ongoing, and has this has quickly become a dominant topic of conversation in our household, much to the amusement of the guests we have had visiting recently.

The week before last, Caroline – one of our physiotherapist colleagues from NCCU at Addenbrooke’s – came out to Yangon and stayed with us for a few days as she was delivering a training course to physiotherapists from Yangon General Hospital and other local hospitals. The physio team that are part of the partnership between Cambridge Global Health Partnerships and YGH come out several times a year and have set up a practice development team amongst the physios here who they are supporting to work towards sustainable improvements in the practice of physiotherapy in Yangon. Caroline asked Stuart and myself to help out on the training course last week, and we delivered a couple of talks as well as running breakout sessions covering more practical skills like patient assessment and tracheostomy suctioning.

After the training course Stuart accompanied Caroline up to Mandalay for a few days on a scoping exercise as the plan going forward is to set up a practice development team there too, creating two hubs to allow the dissemination of good practice across Myanmar. While Stuart was away, Jackie – another colleague from NCCU – arrived to help us with our project ahead of the arrival of the rest of the team that have just arrived from Cambridge this weekend. There has been an influx of people this week as we will be the Delivering Trauma Intensive Care (DelTICa) course that the Cambridge-Yangon Trauma Intervention Partnership has run for the past few years. Jackie is a nurse as well and came out to Yangon last year as part of the DelTICa course, so has been giving us valuable feedback on our ideas for projects going forward, as well as coming into the ICU with me every day and helping us with our Friday teaching last week.

On Friday we ran a session on ECG interpretation and touched on the management of cardiac arrest rhythms. The nurses’ knowledge of ECGs is very good, and we spent some of the session picking rhythm strips from Stuart’s ALS book and working through rhythm recognition and the changes that have taken place in the heart that would contribute to such arrhythmias. The nurses are very keen for us to do some training with them on life support, so we are planning this for future sessions. We have been able to source a CPR mannequin from another department in the hospital so we can do some practical sessions as well.

I will leave you with some photos from the last few weeks!

On the full moon day of the Thadingyut festival we went on Thida’s (the lead nurse of ICU) recommendation to the Shwegadon Pagoda as it is the main religious centre of Yangon. It was very atmospheric, full to the brim of worshipers and as the sun set the pagoda was lit up by hundreds of oil lamps

Group photo of Caroline, ourselves and the delegates from the physiotherapy course we helped teach on.

A view of the Grand Palace in Bangkok, the residence of the Thai Royal family and the site of one of the most important depictions of Buddha in Thailand.

Close up of some of the protector deities supporting the extremely ornate facade of Wat Arun, a temple situated close to the river in Bangkok. We took a boat down the length of the river to reach here, a lovely way to explore.

The physios from the course kindly presented us with gifts of traditional dress to thank us for our role on their teaching.

Following the physiotherapy course we have been working with some of the physios in ICU, here they are showing me how they perform passive range of movement exercises to stretch muscles, an important technique for preventing complications in bed bound patients.

Going through some arhythmias from Stuart’s ALS book with the nurses, we tried to alternate practicing rhythm recognition with discussions about the pathophysiological processes underlying these arhythmias.