Stories From Health Workers: Tragedy of Land Mines
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Planet Care
801 Cedar Street
Suite 200
Berkeley, CA 94710
510-594-4027
info@planetcare.org
In our most recent trip to the border, there were two landmine victims who arrived at the clinic within two days. Both required amputations. One had arrived after spending two days waiting for care in a brand new Burmese government hospital, waiting for care that would never arrive, as the recently constructed building was not staffed with physicians, and had no medical supplies. After this potentially fatal delay in care, the patient was transported across the border by his family, realizing that medical care would only be found at the Mae Tao Clinic (MTC) in Thailand.
Fortunately for him, Win Kyaw, one of the Backpack Health Workers, had recently arrived from the field for training and resupply. Win Kyaw is one of the most experienced Backpack Health Workers who runs a major referral clinic across the border in Burma (funded by BRCP), has received several trainings in amputations (from GHAP and other groups), and has performed numerous amputations. Although exhausted from treating victims of recent conflict in his area, he performed an amputation below the knee under the supervision of Dr. Richard Hahn (GHAP surgeon and trainer), hoping to preserve maximal function for the patient.
Post-operatively, the patient was the beneficiary of numerous interventions at Mae Tao Clinic, that are the result of years of hard work by Dr. Cynthia Maung, the MTC health workers, and the international organizations like BRCP and GHAP that have supported MTC. He received blood transfusions that had been safely screened for HIV and hepatitis, antibiotics to prevent infection, and dressing changes.
We remember one of the dressing changes quite vividly. Amidst the crowded beds (hard wooden tables) of the trauma care building, the patient first had the dressing removed. A foul stench emanated from the wound, signifying that an early infection had taken hold. The wound required debridement, or removal of dead tissue, which is extremely painful. Because the supply of general anesthetics and opiates for serious pain is so limited, the patient was given a rag to bite. Ibuprofen, 200mg, three times per day, was all he had been given for pain. The patient's pregnant wife stood by the bedside, in tears, waiting for the procedure to be completed. However, we noticed another figure, a small woman with bilateral amputations, holding his head during the debridement, wiping beads of sweat from his forehead.
Mya win is a young girl (18?) who was the unfortunate victim of a landmine injury about two years ago. She lost both legs, both AKA (above the knee amputations), which left her with very poor ambulatory function. AKAs leave a person with much less function, and people with bilateral AKAs are often limited to wheelchairs. Along the thai-burma border, this is tantamount to a life sentence of immobility, as wheelchair access is not a top priority for Burmese refugees, either on the Thai side or in the jungles of Burma. She has managed to survive with bilateral amputations because of care at the MTC, and is now a semi-permanent resident of the small, overcrowded trauma inpatient unit where landmine victims are treated. Although severely limited, she is able to walk slowly with prostheses and crutches provided at MTC. Here she has found her place, sweeping the floor, cleaning the beds, and alleviating the suffering of landmine victims that she remembers all too well. The patient's infection improved, and Win Kyaw was able to close the wound. Thereafter he received a prostheses from MTC and returned to his village.
-- Tom Lee, MD, and Grace Baek
Copyright Planet Care
