Message for Medical Personnel in Burma ( Prepare for the worst)

This is an article from The Irrawaddy.

Medical Personnel Should Prepare for the Worst in Burma [Commentary]
By Saw Lwin
September 24, 2007

Shivers went down my spine Sunday night when I heard the news that Daw Aung San Suu Kyi met and greeted demonstrating monks in Rangoon at the front gate of her house where she has been under house arrest for most of the last 19 years. The barricades to the front of her compound were opened for the monks to pass through.

The news mentioned that Daw Suu was in tears when she saw the monks. They must have been tears of hope, joy, pain and respect. The same tears well in our eyes whenever we hear about her brave struggles and those of the people inside Burma.

I feel optimistic when I see that there has been no intervention by the military dictators and their thugs as of the evening of September 23 However, sobering memories of 1988 still surface.

We were excited and optimistic when Gen Sein Lwin, who gave the order to shoot demonstrators in August 1988, was replaced by Dr. Maung Maung, who refrained from giving such orders. Peaceful demonstrations grew even larger throughout the country.

But we were crushed brutally after the military coup by Gen Saw Maung. The shooting started again on September 19, 1988. An estimated 3,000 people were killed in August and September of 1988 by military and special police forces.

As health workers, we faced challenging circumstances in our efforts to treat wounded demonstrators in the streets and hospitals. Shots were fired as we tried to bring the wounded to safety. We could not use ambulances. Hospitals and clinics were short of medical and surgical supplies and filled with wounded people. Sadly, many wounded didn’t make it to hospitals and their whereabouts were not known.

After the massacre, a network of 37 free clinics was established in Rangoon by health workers and communities with support from individuals and monks. Many monasteries granted permission to open free clinics at their compounds and doctors, nurses, paramedics and others volunteered their services. However, it covered only a small response to a greater need.

In retrospect, we realized that we were not well prepared to respond to the medical challenge. We did our best, but we believed that we could have done more if we had anticipated and prepared for the brutal suppression.

Despite our deepest hopes for a peaceful resolution to the current situation, now is the time to prepare in the event the military leadership orders another unspeakable action against the protesting monks and nuns, or against civilians:

• First, while there's still a chance, efforts should be taken to prevent a brutal suppression against the monks and people: Urge China, India, Asean, the European Union and the UN to send strong messages to the military junta to refrain from violent suppression of the protesting monks and nuns in Burma and to expect serious international actions if such suppression is carried out.

• Train people along the protest paths on first aid. People need to become familiar with first aid responses to muscle cramps, exhaustion, gunshot wounds, internal injuries, eye injuries, tear-gas injuries, fractures, injuries from high-pressure water cannons, dog bites (in case canine units are used), and other consequences of violence. Equip them with adequate first aid kits (international agencies should make kits available) and establish necessary support from health professionals.

• Prepare for triage services. Shelters for triaging the wounded should be identified early. Prepare for timely referral to appropriate health facilities for the seriously wounded—including plans for transportation, health workers and security in treatment areas.

• Prepare how to prevent monks and nuns from suffocation in case they are put into crowded vans.

• Stock appropriate medical and surgical supplies at local, township and district hospitals and clinics in the event of mass casualties. Authorize clinic/hospital staff to provide necessary care for wounded people without having to fear punitive actions by the military (this should be assured by the Ministry of Health and UN agencies).

• Provide ways and means to continue care for the wounded whether they are discharged from the health facilities or put into jails.

• Neighboring countries should be prepared to provide necessary health and social assistance to displaced populations who might seek refuge in the border areas.

While not a complete list of recommendations by any means, this covers basic areas that if addressed early can allow a more effective medical response to catastrophic events.

I reiterate my deepest hope that this list will never have to be used in Burma. But we must hope for the best and prepare for the worst. If given a chance, I believe that the people of Burma from different ethic, religious and political backgrounds will be united to work together for the betterment of everyone in the country.

Saw Lwin, a pseudonym, is a Burmese medical doctor