INTERNATIONAL NEUROANESTHESIA NEWS
Neuroanaesthesia Services of Myanmar: The Current Status from a Humble Beginning
Professor Aung Shwe Saw
President, Myanmar Society of Anaesthesiologists
Myanmar is one of the Southeast Asian countries with a population of 53,713,298 which ranks 26th in the world by population. The population density is 82 per km2, with a total land area of 252,237 square miles; 36.8 % of the population live in urban area (data 2018). The healthcare system of Myanmar is organized by fifteen state and regional tertiary hospitals. Three of the regional hospitals have neurosurgical units with neurosurgeons and neuroanesthesiologists whereas others have only trauma units. Most of the neurosurgical cases include traumatic brain injury (TBI) mainly due to road traffic accidents; the incidence of TBI is much higher than other neighboring countries. Neurosurgical practice in recent years has been increased with procedure including brain and spinal tumor, cerebrovascular, and spine surgeries performed in tertiary care hospitals.
Neurosurgery in Myanmar was started during 1969 at Yangon General Hospital which is the main teaching hospital, and is also the premier medical school of the country. It was the first neurosurgical unit of Myanmar, began involving two neurosurgeons and two anesthesiologists. Neuroanaesthesia service was started with limited neuromonitoring modality. At that time, one ICU bed with ventilator and non-invasive monitor was available. All cases used to be transferred to general ICU whenever ventilatory support is required. At present, there are four neurosurgical units in regional hospitals; three of them are based in tertiary hospitals in Yangon and the fourth one is in Mandalay.
Yangon General Hospital is the main neurosurgical unit in Myanmar in which 70 to 150 neurosurgical cases are carried out each month. Up to 2010 cases were performed under general anesthesia with Inhalation anesthetic agents. Currently, care is being offered with two operating room (ORs), four well-equipped ICU beds, and three extended ICU beds without facilities like ventilator and non-invasive monitor.
Mandalay General Hospital is the major teaching hospital of University of Medicine, Mandalay, with a capacity of 1,000 beds. The neurosurgical unit was started in 2004; at present, approximately 2000 neurosurgeries are performed every year that includes 1200 to 1400 emergency cases with the service of four neurosurgeons and two neuroanesthesiologists. The number of cases is more in this hospital as this hospital is the main tertiary hospital in upper part of Myanmar. As of now, there is no neuro ICU or HDU facilities available, and cases are transferred to general ICU for ventilatory care.
No. (1) Defense Services General Hospital (1000 bed) is the main neurosurgical unit of Myanmar Military Medical Services. The Department of Neurosurgery was started with two neurosurgeons and one neuroanaesthesiologist in 1991. At present, the neurosurgical unit has six neurosurgeons with three neuroanesthesiologists offering care to the neurologically injured patients.
The latest neurosurgical unit in Yangon came up at North Okkalapa General Hospital; it is the teaching hospital of University of Medicine, Yangon. In 2017, the neurosurgical department was reorganized. It went on to become the second largest neurosurgical center in Yangon in terms of patient inflow, operating approximately 300 neurosurgical cases. There is no dedicated neuro ICU facility available and the cases are transferred to general ICU. In Myanmar, there are six medical universities and five of them have master’s degree training course and four universities have doctorate training. As a part of the training program during MMedSc (Anesthesiology), the anesthesia postgraduate residents are expected to learn one-month Neuroanaesthesia clinical training. Dr. Med.Sc (Anaesthesia) training program has neuroanesthesia module for four months.
Myanmar Society of Anaesthesiologists was founded in 1993 and has formed special interest groups (SIGs) such as Neuroanesthesia. The Neuroanaesthesia interest group has been formed with the aim of expanding education and training on neuroanesthesia and neurocritical care. The Society became one of the members of the Asian Society for Neuroanesthesia and Critical Care (ASNACC) in 2017. This year, two members (anesthesiologists) from Myanmar Society of Anaesthesiologists visited Prasat Neurological Institute, Bangkok to undergo Neuroanaesthesia training for three months. As a part of the academic activity, a refresher course on Neuroanaesthesia and Critical Care was organized during May 2018 by the Myanmar Society of Anaesthesiologists, in joint collaboration with the Indian Society of Neuroanaesthesiology and Critical Care (ISNACC).
Government of Myanmar is planning to establish new Neurosurgical specialty Hospitals in Yangon and will also establish neurosurgical units in State and Regional Hospitals. Myanmar Society of Anaesthesiologists has the plan for human resources to cover the government plan of expanding neurosurgical units. Hence, it is the right time to work closely together with (ASNACC) countries for improving the skill and knowledge of Neuroanaesthesia service in Myanmar.
