Quest to help save patients awaiting open heart surgery in Myanmar
Perfusionist training workshop in Myanmar
In recent years, changes in lifestyle habits in emerging countries have led to increased incidents of ischemic heart disease, including angina pectoris and myocardial infarction, as well as stroke. In Myanmar, ischemic heart disease is the third leading cause of death, responsible for 7.8% of deaths in this country.*1
At the same time, Myanmar has been plagued with a chronic shortage of medical professionals. Such professionals are imperative to performing open heart surgeries, which entail temporarily stopping and making incisions into a patient’s heart. Specifically, these procedures require coordination among cardiovascular surgeons and anesthesiologists as well as nurses and the perfusionists that operate heart-lung machines during surgeries. In 2014, Myanmar lacked a sufficient number of cardiovascular surgeons in comparison to its population of approximately 53 million people at the time, and the country only had around 10 perfusionists and five hospitals capable of performing cardiovascular surgeries. As a result, the number of cardiovascular surgeries conducted per year was only around 1,200.*2 Given Myanmar’s population of 53 million people at the time, this number was exceptionally low in comparison to the some 63,000*3 surgeries performed in Japan, which had a population of approximately 126 million. Moreover, it was common for patients to have to wait more than a year to undergo surgery.
Becoming aware of this situation, associates at Terumo’s Yangon Branch sought to find a way for Terumo to help address this issue, consulting with the head office in Japan and with business divisions in this process. Myanmar at the time already had a history of inviting overseas medical teams to perform cardiovascular surgeries and provide technical guidance to local medical staff. However, unlike physicians and surgeons, there was no curriculum for cultivating perfusionists at educational institutions in Myanmar. As such, the operation of heartlung machines during cardiovascular surgeries has been conducted by anesthesiologists and nurses in Myanmar. Furthermore, there were few opportunities to receive training in this field and the frameworks for cultivating medical staff with perfusion skills were not in place. Conversely, the duty of perfusionists in Japan was filled by clinical engineers that have completed a dedicated curriculum at a university, vocational school, or technical school and received national accreditation, making for a situation that was quite the opposite of that in Myanmar.
Turning its attention to this situation, Terumo formulated a plan to conduct perfusionist training workshops in Myanmar, gaining support from experienced and skilled Japanese clinical engineers in the process. After presenting our reason for conducting these trainings to the National Center for Global Health and Medicine, this initiative was certified as a project for the global expansion of medical technologies by the institute.
Following a preliminary survey of the situation in Myanmar, the trainings were carried out over the period spanning from September 2018 to January 2019. A total of three trainings were held in Yangon and Mandalay, and 44 individuals in total from five hospitals took part. Among the Japanese clinical engineers that led the training were those that had experience performing training in Myanmar. These engineers offered basic perfusion knowledge as well as instruction on how to operate heart-lung machines. In addition, hands-on training was provided using perfusion simulators. The participants were highly dedicated to learning, and they listened intently to explanations by lecturers and actively asked questions. Surveys after the trainings indicated that the hands-on training was very well received, and a message from Myanmar’s Ministry of Health and Sports applauded the meaningfulness of the trainings. Terumo acted as a liaison between Myanmar and Japan to help smoothen the training process, and therefore played a role in planning, preparing, and holding the trainings as well as in coordinating with the involved parties.
In the future, Myanmar will need to develop frameworks for cultivating perfusionists within the country. Terumo looks to assist in this process by supporting ongoing training to cultivate the perfusionists that will become the core of these frameworks. In so doing, we will seek to support the generation of a cycle in which the fostered perfusionists then become instructors to less experienced perfusionists.
Source: Global Burden of Disease Study, Institute for Health Metrics and Evaluation, 2017
The figures are estimated by Terumo.
Comment from Associates at the Yangon Branch
Former Branch Manager,
Terumo Singapore Pte. Ltd.
Branch Manager, Yangon Branch
Terumo Singapore Pte. Ltd.
The above positions and titles are as of the time of this interview.
On visits to medical settings in Myanmar, one issue that came to light was that people looking to undergo cardiovascular surgery in this country had to wait more than a year, and that many passed away while waiting. Myanmar had received support for cultivating cardiovascular surgeons from Japan and various other countries, but there were almost no efforts made to foster perfusionists. By addressing the situation where anesthesiologists and others have to perform the role of a perfusionist alongside their own, we thought it would be possible to save a greater number of patients. This desire to save patients was what inspired us to propose this project. The changes to living environments that accompany economic development are expected to increase the number of cardiovascular surgeries needing to be performed in the future. When considering this fact, it becomes clear just how meaningful this project was.
All three of the trainings performed as part of this project were incredibly well received. After taking part in lessons backed by the plentiful experience of the lectures and in hands-on simulator trainings, the participants expressed a desire to use the techniques they had learned to operate actual heart-lung machines. These trainings were a success, but this success would not have been possible without the clinical engineers that prepared, performed, and offered follow-up assistance for the trainings or without the support from the National Center for Global Health and Medicine or the cross-regional and cross-divisional teamwork of Terumo associates.
Myanmar has seen contributions to the improvement of its healthcare services through the dedicated efforts of many individuals in both the public and private sectors. Terumo has also made contributions to this country in the past, namely by helping with the transition from glass blood bags to plastic bags, which are safer and easier to use. We hope to continue offering such assistance in the future to see Terumo contribute to the society of Myanmar through healthcare.