Saturday, January 21, 2012


One of my favorite parts of the course was Frank's set of Megacodes. Once or twice each day, Frank ran the medics outside and had them quickly treat a variety of emergency traumas. As with all procedures, repetition and practice are key, and the megacodes served as the best way for the medics to memorize the basics and familiarize themselves with treatments.

Day Five -- Saving the best for last

What a day: hands down the best day of the course! We did so much, and the medics got a chance to show us and, most importantly, themselves how much they have learned throughout the week.

The day commenced with perhaps the most memorable part of the course: actual surgery (though of course not on humans). The medics practiced throat and chest tube insertions, suturing, fasciotomies, and amputations. Several of the instructors then demonstrated several more advanced procedures, in addition to giving detailed anatomy lessons.

Here, our devoted instructors prepare the medics for the first procedures

After lunch, Jess and Monica gave a lesson on splinting, followed by a review of anesthetics and nerve blocks by Jaime.

More Thoughts:
The medics were very attentive all week. The final day was a highlight: medics practicing in the animal lab the procedures on pigs. We started early in the morning while cool and finished before the flies arrived. The medics practiced surgical airways (crichothyrotomies and tracheostomies), chest tubes, fasciotomies, venous countdowns, and finally amputations. Each table had at 4-5 medics, at least one senior medic as the senior trainers, and one of our volunteer teachers. It was exciting to see their skills in action.

The teachers then did thoracotomies, pericardotomies, and laparotomies on their pigs.
While the animal lab was a bit sad for the pigs, it was the best way to teach these skills that the medics will be using to save lives. And the medics and staff were thrilled to have all of the tasty pork.

Then we did more hands on training with plaster splints with Jess and Monica. Then anesthetic dosing and regional blocks with Jaime.

The medics then did their final test and all passed!

Then back in the evening for closing ceremonies, with heartfelt speeches by the coordinating trainer, Larry and Frank, and presentation of their certificates and pins. The medics were rightfully proud. The medics then hosted us to a grand pork feast!

The next morning half of us left at 4am for the airport. It was a long week with little sleep.

Mixed feelings now: Pleased and proud of the medics and the training. Sad to miss the medics, our fellow volunteers, and the profound feeling of being useful and appreciated.
-- Loren


Prior picture from the GHAP website of a trauma medic performing a jungle amputation after landmine injury using a Leatherman Multitool:

Thursday, January 19, 2012

Day Four: It all comes together

Today was another huge day: Chest Trauma by Monica with clips from Three Kings (with George Clooney), Abdominal Trauma and Drug Dosing by Jaime (tough lectures to give and well done), Head, Neck, and Spine by Aaron, Nutrition for the Trauma Patient by Meredith, and Multiple Patient Incidents/Disasters by Frank. Loren and Jess did Ortho: Fractures and Dislocations with innovative models. Everyone helped out with Trauma megacodes.
Tomorrow is our last day: surgical lab and splinting with plaster, use of Ketamine and Lidocaine, a post test and then a final ceremony.
Seth has been a huge help as chief blogger, photographer, model maker, patient, and team international human rights attorney.
The medics are doing great and are highly motivated. They are quite engaged in the training and improving their skills with each passing day.

Wednesday, January 18, 2012

Day Three Afternoon -- Larry takes charge (awesome fasciotomy and amputation lessons)

Larry, with help from Loren and Jaime, spent the afternoon teaching the basics of fasciotomies and amputations, and then walked each medic through a simulated procedure using our self-made limb models (sugarcane for bone; diaper for muscle; plastic bags for fascia and skin). The students were incredibly engaged, and each had an opportunity to perform a simulated fasciotomy and amputation on their own model.

Who is this savage?

Is he really a doctor?

Yes, and a very good one. We swear. Really. We promise.

Tuesday, January 17, 2012

Day 2 -- Evening

After a succesful day of teaching trauma assessment in simulation codes, we returned after dinner for advanced surgical cricothyrotomy training. In true international medicine fashion, we constructed trachea "Cric" models out airway tubing, gloves, toilet paper, and tape. Each medic was able to successfully perform a Surgical Cric airway on these home made models.

Some interesting facts about our heroic medics:- longest trip for a medic to get to the training was 5 days including walking miles over mountainous terrain, a boat, and finally a car ride. (And I thought my 24 hours of travel on a cramped economy flight was rough ;-.) In 2011, the 19 medic teams treated 106 major trauma victims with 8 amputations and 17 fasciotomies. Over 31 medics have made it to this year's trauma training with 14 of those being first timers.

Day 2 Afternoon -- IVs, Complicated Surveys, Body Temperature

The afternoon was a whirlwind of short lectures and demonstrations on a variety of subjects. Aaron and Sophie ran through installing an IV line, and taught the more complicated venus cutdown for difficult IV access cases

Later, Loren expanded on the morning's lessons by going through a detailed primary and secondary survey, while Frank ran everyone outside for a Megacode --- an emergency review in which each medic performed a primary survey on one of their colleagues. Frank then ended the day's instruction with tricks on how to work on a patient while maintaining their core body temperature.

Day Two --- Evening

What a full and fantastic day. We had great presentations today by our faculty on assessment and management of the trauma patient. A jungle trauma course on steriods! The medics were engaged and dug working with Frank: they call him Dr. ABC because of the megacode drills he puts them through outside on the mats.
We are heading back after a quick dinner to practice airway management.
I am already exhausted but happy.
Karen, Karreni, Americans and Australians training together under the tropical sun and stars.

Day Two -- Morning

The team arrived bright and early, and was thrilled to see that the final group of medics had arrived, bringing the total to around 35. After a quick snack and coffee, we were ready to go.

Frank, our trauma specialist, kicked off the morning with an excellent session on primary surveys. He demonstrated how any medic can, even in the most difficult conditions, quickly and efficiently perform a primary exam and begin to treat even a severely wounded patient.

Next, Jaime, an ER Doctor from California, walked the medics through a complete secondary, while Meredith, a senior medical student, gave a quick talk on shock and relevant treatments.


Monday, January 16, 2012

Day One -- Afternoon/Evening

As more medics arrived in the afternoon the trauma team leaders gave field reports on trauma cases over the past year in their respective regions.

By the evening session the complete group of over 30 medics had arrived and the remaining groups gave field reports on their regions. Based on this initial data the teams treated 106 trauma patients, 31 of those experienced landmine injuries and 31 had gun shot wounds. Other common injury types included accidents involving falling trees and animal bites.

As the medics gave their reports they also shared difficulties they faced while providing care. One medic asked for help treating a patient with phantom limb pain after recovering from an amputation. Another medic discussed mental health issues for patients surviving amputation as well as for medics working with trauma patients. Another medic talked about a patient of his that died after a severe landmine injury to both legs in which the medics were unable to move him due to intense conflict in the region.

These reports gave us a sense of what the medics are dealing with on a daily basis and will also help us tailor our training to better meet their needs.

Day One - Morning

With only half of the medics having arrived, the team decided to proceed with introductions and some anatomy and trauma care overview. Some participants also assembled trauma kits for later in the week, while others finalized presentations or prepared models and equipment.

The training commenced with a brief introduction, followed by a refresher course on basic anatomy.

Next, our Trauma Specialist and ER Physician discussed the basics of trauma and first responder care, highlighting issues relevant to medics working in combat and other hazardous situations.

Some brief thoughts on this week's peace agreement between the KNU and Burmese Government

While the recently signed ceasefire between the Burmese government and the Karen National Union (KNU) may portend a decrease in violence and direct combat, the agreement changes little in the lives of many of the Karen medics participating in the training. Many provincial borders and Karen population centers remain littered with land mines, and fighting in other parts of the country continues. Landmine accidents are sure to continue, and the relative isolation of many Karen villages means that many medics play a vital role in general trauma care within their communities.

In short, while the Karen leaders may have reached an accord with the Burmese government, little has changed in the day-to-day work of many of the medics.

Brief Overview of GHAP's Work in Thailand

The semi-annual GHAP training in Northern Thailand teaches trauma care to Burmese Karen medics, many of whom travel for days and across the border in order to attend.

The medics have a variety of experience: some have just started their medical training, while others have years of practice and have performed advanced trauma care in some of the most extreme jungle environments. Many of the medics are the only real trauma experts in their regions, and perform both combat medic services and serve as trauma surgeons in their communities.

While the fighting between Karen forces and the Burmese government wanes and waxes, there remain thousands of landmines and other unexploded ordinance strewn around Karen populations centers, and injuries remains common. As such, many of the medics, especially those in more remote provinces, are constantly on call, and must be skilled in everything from basic wound and burn care to fasciotomies and amputations.

GHAP, with its partner group AAI, aims to teach the medical skills necessary for Karen medics to operate independently and decrease mortality rates from survivable injuries . It further seeks to teach skills suited to the rough conditions in which the medics operate, and in ways through which the medics can pass on skills to those unable to attend the trainings.

The six-day training includes lessons in basic anatomy and wound care, to more advanced courses in intubation and airway management, orthopedic treatments, and amputations. All of the medical professions involved in the training volunteer their own time and receive no remuneration.

Sunday, January 15, 2012

A little bit of pre-training fun

While we're looking at 8-12 hours of training per day, the team does deserve to have a little fun. Naturally, dinner and karaoke ensued.

Arrival in Northern Thailand

We arrived in Northern Thailand on Saturday afternoon. After a quick meal, everyone set about planning lessons and discussing various educational models and strategies.

The team is comprised of:
- One Trauma Medic Specialist
- Five Emergency Room Physicians
- A Nurse educator
- An OB/GYN Resident
- One medical student
- Our excellent GHAP Trauma intern
- A human rights lawyer (and impromptu blogger and photographer) along for the ride

We are expecting between 20 an 35 Karen medics to attend, but won't know the exact numbers until training begins tomorrow morning. For now, the afternoon has been spent drinking coffee at the hotel, planning lessons, and discussing teaching strategies. Tomorrow we will head out to the training site and meet the medics.