Visit to Myamnar for National Intensive care Symposium
4th Sept. -10 Sept. 2017
Dr Rowan Burnstein
Dr Tom Bashford
Dr Dhupal Patel
Intensive care provision in low and middle income countries (LMICs) is often under resourced, despite a high
burden of need. Efforts to improve global surgical and anaesthetic care, in line with the recommendations of
the Lancet Common on Global Surgery, will be hampered unless improvements can be made in the quality
and capacity of intensive care. This is particularly pertinent to the care of major trauma patients, with trauma
constituting 11% of the global burden of disease and representing a significant unmet challenge to health care
systems. However effective intensive care underpins all other clinical specialties, providing the ability to
support and treat any patient with organ failure. Intensive care is a complex specialty, and relies on a system
of people, equipment, infrastructure, and care processes to function effectively.
The Cambridge-Yangon Trauma Intervention Project (CYTIP) is an institutional health partnership between
Cambridge University Hospitals NHS Trust (CUH), through their global health charitable programme
Addenbrooke’s Abroad, Yangon General Hospital (YGH), and the University of Medicine 1 (UM1). This
multidisciplinary partnership has been funded by UK Aid through the Tropical Health and Education Trust
(THET) and has sought to improve the care of trauma patients at YGH by improving medical education,
transfusion, pathology, orthopaedic, nursing, physiotherapy, and intensive care services. The partnership has
promoted exchange visits between Cambridge and Yangon over the past three years with the design and
delivery of bespoke teaching courses in each of the target areas. In addition, the partnership has led to
development of long-term volunteering placements for CUH staff to work in Yangon, and has also been a key
contributor to the recent award of funding from the UK National Institute of Health Research (NIHR) to establish
a Global Health Research Group on Neurotrauma, linking the University of Cambridge with UM1.
The intensive care project within CYTIP has been an area of particular strength, the cornerstone of which has
been the Delivering Trauma Intensive Care (DelTICa) course. This three-day, multidisciplinary course seeks
to improve intensive care by training physicians and nurses in the systems and processes that underpin
effective intensive care, irrespective of the level of material resource. The basis of this course was the
observation that deficiencies in care rarely arise from of lack of clinical knowledge or skills, but may often occur
through a lack of understanding of the systems that are required to deliver safe intensive care.
In 2016, the CYTIP intensive care team were invited by UM1 to survey the current provision of intensive care
in Myanmar and to provide recommendations for development based on the results of this and their shared
understanding of the difficulties of intensive care in Myanmar gained from the health partnership. This was
funded through a combination of the existing THET grant and a further award from the Rangoon General
Hospital Reinvigoration Charitable Trust (RGR). Several surveys of intensive care from LMICs have recently
been published, detailing different methodologies and reporting similar material constraints. Drawing on these
different approaches, and the available consensus documents around intensive care provision from other
settings, the CYTIP intensive care team undertook a nationwide census of the publicly-funded intensive care
capacity in Myanmar.
In September 2017, the results of this census were presented at a national workshop, hosted by the Myanmar
Ministry of Health and convened by UM1, to which all those with direct involvement in intensive care in
Myanmar were invited. The focus of the workshop was to discuss a 10-year plan for intensive care in Myanmar
drawing on the results of the census, the experience of the attendees, and the institutional and academic
experience of the CYTIP team.
Myanmar Collborators and Dr Rowan Bernstein, Dr Tom Bashford and Dr Dhupal Patel.
National Intensive care Symposium attendees, Department of Health and Sport Nay Pi Daw.
Attendees for DelTICa course (Delivering Trauma Intensive Care).
National newspaper article on intensive care symposium.