Zaw Wai Soe’s research while affiliated with University of Medicine Myanmar and other places

Trabalhar Juntos pela Saúde: da multiprofissionalidade à transdisciplinaridade Foi atualmente publicada em italiano a primeira edição da coletânea Trabalhar Juntos pela Saúde: da multiprofissionalidade à transdisciplinaridade, cuja organização editorial foi de Leopoldo Sarli, ex-professor associado do Departamento de Medicina e Cirurgia, da Universidade de Parma (UNIPR), agora aposentado, e por Giovanna Artioli, professora contratada do mesmo Departamento. A publicação da editora brasileira Rede Unida foi incluída na Série Saúde Coletiva e Cooperação Internacional que tem como objetivo a divulgação de produções que desenvolvam e tragam ao debate questões relacionadas ao campo de saberes e práticas da Saúde Coletiva e que derivam de ações de cooperação internacional. O objetivo é mobilizar análises comparativas dos sistemas de saúde e, sobretudo, diálogos entre iniciativas, fortalecendo e estimulando práticas colaborativas, discussões e o crescimento de articulações de pesquisadores e trabalhadores da saúde e da educação em torno de temas comuns relevantes para o campo da saúde e das políticas públicas. Esta publicação foi gerada em colaboração dos organizadores com o grupo de trabalho “Interprofessional Research in Medical Humanities for Global Health” (www.healthcaremaster.unipr.it), do Departamento de Medicina e Cirurgia da Universidade de Parma, graças à mobilização de um rede de pesquisadores e especialistas de instituições públicas e privadas que foram convidados a compartilhar suas reflexões sobre o tema por ocasião do seminário internacional “Trabalhar juntos pela saúde: da multiprofissionalidade à transdisciplinaridade”, realizado de 20/04/2023 a 11/05/2023 em quatro reuniões on-line. A iniciativa foi inspirada na observação de Edgar Morin (A cabeça bem-feita: repensar a reforma e reformar do pensamento, Rio de Janeiro: Bertrand Brasil, 2000) sobre como há [...] inadequação cada vez mais ampla, profunda e grave entre os saberes separados, fragmentados, compartimentados entre disciplinas e, por outro lado, realidades ou problemas cada vez mais polidisciplinares, transversais, multidimensionais, transnacionais, globais, planetários (p. 13). Em vez de corrigir esses desenvolvimentos, [...] ensinam a isolar os objetos (de seu maio ambiente), a separar as disciplinas (em vez de reconhecer suas correlações), a dissociar os problemas, em vez de reunir e integrar (p. 15). As consequências desta inadequação são claramente visíveis na relação entre o que o Sistema de Saúde Italiano disponibiliza aos usuários e a qualidade percebida pela própria população. O evento foi aberto com a apresentação de um podcast criado pelo Grupo de Trabalho e que está disponível no link <https://www.spreaker.com/episode/trailer--52470989>. Além dos organizadores, falaram outros professores da Universidade de Parma: Dimitris Argiropoulos, pedagogo, Antonio Bonacaro, enfermeiro, Giancarlo Condello, especialista em educação física, Carlo Quintelli, arquiteto, e professores de outras universidades italianas e estrangeiras. Administradores, cientistas políticos, escritores, antropólogos, sociólogos e profissionais de saúde ofereceram a sua contribuição. Os temas abordados vão desde a análise semântica dos termos, à análise psicológica das dificuldades inerentes ao trabalho em conjunto, à adaptação da atividade profissional ao progresso científico e tecnológico, ao papel dos meios de comunicação social, da política e da contribuição de disciplinas como como pedagogia, história e arquitetura. Experiências foram relatadas desde a Bélgica, o Brasil, os Estados Unidos, a França, a Inglaterra, o Mianmar e a Suíça. Tudo está relatado detalhadamente na coletânea agora publicada. Particularmente intensa foi a colaboração dos professores e pesquisadores brasileiros Ricardo Burg Cecim e Alcindo Antonio Ferla, muito ativos na implementação em seu país das ideias surgidas no seminário, e que acolheram a visita de representantes do Departamento de Medicina e Cirurgia da UNIPR no intervalo entre o evento e a publicação da coletânea para discutir os temas abordados: Antonio Bonacaro, professor associado de Enfermagem, Clelia D'Apice, doutora em Ciências Médicas e Cirúrgicas Transnacionais, e Maria Augusta Nicoli, pesquisadora, além de coordenadora italiana da Rede Unida. Na intenção dos organizadores e da editora, a edição italiana do volume será seguida de uma edição em inglês e outra em português. Accedi: https://editora.redeunida.org.br/project/lavorare-insieme-per-la-salute-dalla-multiprofessionalita-alla-transdisciplinarita/

Objectives: Traumatic brain injury (TBI) is a global health problem, whose management in low-resource settings is hampered by fragile health systems and lack of access to specialist services. Improvement is complex, given the interaction of multiple people, processes and institutions. We aimed to develop a mixed-method approach to understand the TBI pathway based on the lived experience of local people, supported by quantitative methodologies and to determine potential improvement targets. Design: We describe a systems approach based on narrative exploration, participatory diagramming, data collection and discrete event simulation (DES), conducted by an international research collaborative. Setting: The study is set in the tertiary neurotrauma centre in Yangon General Hospital, Myanmar, in 2019-2020 (prior to the SARS-CoV2 pandemic). Participants: The qualitative work involved 40 workshop participants and 64 interviewees to explore the views of a wide range of stakeholders including staff, patients and relatives. The 1-month retrospective admission snapshot covered 85 surgical neurotrauma admissions. Results: The TBI pathway was outlined, with system boundaries defined around the management of TBI once admitted to the neurosurgical unit. Retrospective data showed 18% mortality, 71% discharge to home and an 11% referral rate. DES was used to investigate the system, showing its vulnerability to small surges in patient numbers, with critical points being CT scanning and observation ward beds. This explorative model indicated that a modest expansion of observation ward beds to 30 would remove the flow-limitations and indicated possible consequences of changes. Conclusions: A systems approach to improving TBI care in resource-poor settings may be supported by simulation and informed by qualitative work to ground it in the direct experience of those involved. Narrative interviews, participatory diagramming and DES represent one possible suite of methods deliverable within an international partnership. Findings can support targeted improvement investments despite coexisting resource limitations while indicating concomitant risks.

In this viewpoint, we examined the ongoing crisis of the Myanmar health system following the military takeover of 1 February 2021, the health challenges faced by the population, and the tragic conditions in which the health professionals find themselves. We describe the efforts undertaken by representatives of the democratic health and university institutions to create the conditions for a resumption of the call for peace throughout the country and strengthen the resilience of the health system. In particular, we present the interim health service strategy devised by the Myanmar Ministry of Health (MOH), as appointed by the democratic government. The MOH’s plan represents the entry point to use health as a bridge for peace and restoration of democracy and human rights, showing that the health sector of a country can be reshaped and revitalized in times of great adversity.

The question of whether small non-government organizations with comparatively small budgets can make a substantial contribution to sustainable improvement in health care in low- and middle-income countries is crucial to funding global surgical projects. The Royal Australasian College of Surgeons and its Fellows have partnered with local organizations and clinicians to deliver a wide range of projects in South East Asia. These projects have proved sustainable and have increased healthcare capacity in these nations. This provides strong evidence that small non-government organizations such as the Royal Australasian College of Surgeons can make a major contribution to global surgeryI.

The need to develop intensive care services parallels the progression of health care delivery in low and middle income countries (LMICs). In the last 5 years Myanmar has undergone a period of rapid expansion in health care provision, but the burden of both critical illness, and critical care provision, remains difficult to quantify. Several accounts have been published attempting to survey these in LMICs as recognition of the value of critical care has grown. We were invited to undertake a national survey of adult intensive care provision in Myanmar. The work presented many challenges, but two fundamental issues were: 1. There is no internationally agreed definition of what defines an intensive care unit. 2. There is also no validated means of assessing intensive care delivery in LMIC’s. We developed a tool based on previously published surveys in LMICs and the available national standards for intensive care provision, working with local clinicians to ensure local relevance. The tool surveys multiple domains including facilities, access to equipment, drugs and consumables, workforce, medical education, and governance processes. We located 17 adult intensive care units across three cities in Myanmar (Yangon, Mandalay and Nay Pi Taw) but could not locate any intensive care units outside these areas. The survey was undertaken in English, using local and UK translators as necessary. Initially, a paper survey was distributed, followed by a visit from members of both the UK and Myanmar team. We found 95 level 3 intensive care beds across the 17 hospitals (Myanmar population is approximately 61 × 106). All units delivered a mixture of level 2/3 care, with all beds equipped to deliver level 3 care with the exception of renal support, which was virtually absent. Our workforce assessment showed nurse: patient ratios of 1:3 level 3 patients as the norm. Ongoing medical education, including training in intensive care medicine, and resuscitation training, especially for nursing staff, was limited. Specialist medical advice (microbiology, radiology) and AHP support (dieticians, SLT, physiotherapy) within intensive care was also very limited. The presence of guidelines, governance structures, and IT support was minimal and rarely formalized. Critical care outreach was undeveloped with referrals to ICU usually made by phone call. Our survey tool provides a means for assessing the development of ICU provision both at an individual hospital level and nationally, with the next step to develop and deliver a national ICU plan informed by its data.