AFTER-ACTION REPORTS:

• Thailand-Burma - February 9-24, 2008
• Thailand-Burma - October 12, 2007
• Thailand-Burma March 20-April 5, 2007
• Tanzania July 4 – July 14, 2006
• Medical and Surgical Assistance: Karen Refugees
• Northwest Thailand, Karen Refugee Village Health Workers

Northwest Thailand, Karen Refugee Village Health Workers
REFUGEE RELIEF INTERNATIONAL MISSION 05-01

Background
A Refugee Relief International, Inc. team composed of four persons deployed to the Thai-Burma border on February 17th, 2005, to train village health workers under the auspices of the Karen Committee for Internally Displaced Persons (CIDP), Karen National Union. The health workers are part of the Backpack Medic program, begun in 2001 to provide health care to hundreds of thousands of internally displaced refugees inside contested areas of Burma.

The Karen are an ethnic minority group that has resided in the mountains of western Burma (now called Myanmar by the current regime in Rangoon). A predominantly Christian group, they have been historically persecuted by the Burmese majority, and the military government in Rangoon has waged genocide against them since the British withdrawal in 1947. The Karen resist as best they can, with no outside support.

The Refugee Relief International team’s mission was to give refresher training to the medics who are responsible for the great majority of medical care in areas that the Karen occupy.

The training team consisted of team leader Dr. John Padgett, PA-C, Ph.D., a physician assistant and clinical professor with combat experience with US Special Operations Forces in Viet Nam and Iraq; P.A. Vicki Chan-Padgett, MPAS, a medical school Program Director and former director of the US Air Force PA Program; Dr. John Elliott, D.D.S., an Iraq combat veteran and dental surgeon; and Matthew Padgett, medical student and public health volunteer.

P.A. Padgett taught medical subjects, while Dr. Padgett conducted a review of trauma management and wound care. Dr. Elliott gave a course in field dentistry and did some dental procedures on patients at Dr. Cynthia Muang’s border hospital. Matthew Padgett assisted as an assistant instructor, dental assistant and logistical coordinator.

Medical Training for the Backpack Medics
After link-up in Mae Sot, Thailand, with representatives of the Karen CIDP, the RRII team was transported to its quarters and from there to the training site near the Thai-Burma border. The 21 mixed male and female students had previously arrived from their dispensaries and health posts in areas occupied by the Karen.

The team paid a courtesy call on Dr. Cynthia Muang, director of the border hospital which treats sick and injured Karen and other ethnic Burmese minorities who can make it to Thailand for treatment. Dr. Muang’s hospital has been the recipient of international recognition for the free care provided to her people. RRII has provided assistance to the hospital in the past, having trained some of its clinicians, and has provided patient care, supplies and equipment to the hospital.

The following is a review of the curriculum taught during the refresher course:

• History Taking and Physical Examination Review: P.A. Padgett
• Field Management of Cardiac and Respiratory Problems: P.A. Padgett
• Field Dentistry, Dental Instrument Familiarization, & Dental Emergencies: Dr. Elliott
• Cardio-Pulmonary Resuscitation (CPR): All Team
• Assessment of the Trauma Patient & Initial Care of the Wounded: Dr. Padgett
• Rehydration, I.V. Therapy & Practical Exercise: All Team
• Wound Ballistics & Principles of Wound Management: Dr. Padgett
• Burn Management: Dr. Padgett
• Review of Common (Karen) Pediatric Medical Problems: Dr. Padgett
• Mass Casualty Management: Dr. Padgett
• Aseptic Technique, Suturing & Wound Care, w/Practical Exercise: All Team

To compliment the training, familiarize the students with the medications available locally, and to assist the medics with obtaining medicine for their patients, several types of medications were provided by Refugee Relief International, Inc. These included diuretics, adult and pediatric vitamins, antibiotics, anti-diarrheals, local anesthetics, analgesics, anti-inflammatories, anti-malarials, and I.V. solutions. RRII also provided a considerable amount of dressing material, needles and syringes, I.V. lines, dental material, suture, suture sets, and other instruments.

In addition to the medicine and equipment mentioned above, upon successful completion of the course each medic was given a new backpack stocked with first aid items to take back to the field.

Throughout the training, the medics were attentive, respectful and cooperative. They did not hesitate to participate in practical application of I.V. and suturing skills, and asked pertinent, thoughtful questions of their instructors. To assess student comprehension of the material, questions were asked of the students following blocks of instruction, and they were able to demonstrate competence in the subject matter.

Out-Briefing
At the end of the training, a meeting was held with political and military leaders of the Karen National Union and the Committee for Internally Displaced People. The team reported on the training, and their impression of the students. The Karen representatives thanked the team, and requested that RRII develop an ongoing training program for the Backpack Medics.

The concept that they wish to develop is one of initial training, followed by an increased levels of competence over a year, and finally a ‘train the trainer’ course, which would enable senior Karen medics to take the training program to their own people in areas under Karen control. The idea envisions four training sessions of approximately 2 weeks in length, with increasing levels of subject matter and competence, culminating in the trainer block. P.A. Chan-Padgett is working on a course curriculum for the requested course to present to the CIDP and the RRII Board of Directors for approval.

Following a successful mission, the team returned to the United States on 27 February, 2005.

Respectfully submitted,

John E. Padgett, PA-C, Ph.D.
Mission 05-01 Team Leader

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