Health Care in Myanmar (Burma)

During my trip to Myanmar (Burma), I spent a week with the Otolaryngology Department at ENT (Ear Nose and Throat) Hospital, in Yangon (Rangoon). When I worked in Asia (in Thailand, India, Nepal, and Bangladesh) from 1987-2000, I had tried to visit Myanmar. Political unrest at the time, however, led to a military crackdown, and I could not get in. Since then, the political situation has opened. Professors Myo Min and Thein Tun (“TT”) arranged my visit.

My first impression was of how interested and receptive the doctors were. I gave three lectures, discussed difficult cases and examined patients for surgery, an entire day spent teaching, and they never tired. TT mentioned that the two patients I selected had traveled 400 miles to be here, and so I felt a strong impetus to do the surgery. I toured the hospital with TT. The in-patient beds were lined up in rows, simple metal cots with thin mattresses and no sheets or bedding. The floors were tile, the walls and ceiling white painted concrete, fluorescent lights, all quite stark and unembellished. The facilities were limited and spare, funding and resources obviously limited, reflecting the general atrophy of the economy. One could hardly expect first-rate medical facilities with the latest equipment in an impoverished third world nation. It occurred to me that however worthy volunteer work might be it could have only slight impact. It was only when the entire nation lifted itself up by embracing an open system (liberal democratic capitalism) with a free market economy that the healthcare system (along with everything else) could become innovative.

The nurses on the wards were tidy and professional. The quarters were clean. The in-patients stayed for extended periods, not like the US where the thrust was to move them out. Family members sat or slept (day and night) on the floor around the patient's bed. There are 14 provinces (states) in Myanmar, each with a single ENT physician. In the entire nation, there are about 50 ENT specialists. With a population of 50 million, this translated to one ENT doctor per million, a woefully deficient ratio. The government controlled health care in this country and employed all physicians, paying a salary of 15$/month! Doctors had to supplement their income by running private clinics at night. Most healthcare was free in Myanmar. There was no health insurance or malpractice. TT informed me that despite the low earnings and hard work, doctors happily did it, seeing it as part of Buddhist practice: acts of loving kindness to help others and reduce suffering.

The next day I performed two operations. The equipment was OK, but very basic. Everything was reusable including gloves, catheters, endotracheal tubes, and other items we would never think of reusing. There were no paper gowns or sheets, which were too expensive. What we routinely discarded or wasted in a typical OR in the US would be absolute treasure for them. Going into surgery carried some risks for me because I will not have my usual instruments. Still I go forward and make the best of it. The patients are quite stoic, accepting far more by way of discomfort than Americans would tolerate. A roomful of colleagues surrounded me, asking questions, trying to learn. It is what I enjoy most in medicine. The frustration I sense in them is that they are behind, with few resources to advance. I plan to work with local hospitals and equipment vendors to arrange shipments of equipment and supplies that are expired or substandard but of great value to them. Their desire and skill is there. Perhaps we can help them.