AFTER-ACTION REPORTS:

Thailand-Burma (Myanmar) Border January, 2010

The team approaches the cliff up which they must climb to the village

A team of four volunteers from Refugee Relief International, Inc (RRII), returned to the area of the Thai-Burma (Myanmar) border in February, 2010, to continue the vaccination program begun in 2008, offer medical and surgical assistance, and conduct additional training for the graduate General Medical Officers (GMO). While there, team was able to provide requested medical and surgical treatment for traumatic and non-traumatic surgical cases.

The Karen identified an area of need for vaccinations: a new refugee village of over 500 persons, newly escaped from the persecution of the Burmese (Myanmar) military junta, who had never been vaccinated. The Karen health authorities, while expressing the need for all vaccinations available against contagious disease, asked that our team give priority to vaccinating against Hepatitis B. Using our previous experience in establishing and maintaining a “cold chain” to keep vaccine viable, RRII was able to provide over 500 doses of Hepatitis B vaccine, as well as the equipment necessary to administer it.

The journey into the area where the mission would be conducted was typical of an RRII mission to a denied environment: a long journey over dusty jungle paths, a boat journey, and a climb up a 150 rock face in order to access the village. The team provided medicine and medical and dental supplies, as is the RRII custom, based on requests from the Karen and previous experience. The Karen have no outside government support, and their archaic medical system survives primarily on donations.

Dr. Mohler advises a GMO graduate as they prepare to repair a land mine injury on a floating border clinic

The team was shown a case that is sadly typical of the situation along the Thai-Burma border. The junta, currently known by the Orwellian term State Peace and Development Committee (SPDC) had forced a Burmese man into servitude as a porter, carrying military equipment over the jungled mountains. He had tried to make his escape, only to trip a land mine. A Karen patrol came upon him and transported him to the nearby medical facilities where we were staying. The GMO whom RRII previously trained had kept the wound clean, but a surgeon was required to fully close it. RRII surgeon David G. Mohler, MD, was able to assess the wound, and the surgical team of Dr. Mohler, John Padgett, PA-C, PhD, and medical student/ EMT/Paramedic Instructor Florian Schmitzberger were able to perform sequential surgeries necessary to bring about a closure that saved the foot and which will allow for eventual weight baring.

Dave Mohler & John Padgett with a surgical candidate

A patient with a congenital hemangioma of the lip was brought to the team with a request to perform the surgery necessary to remove it. Following a long and difficult operation in the village’s hot surgical facility, the patient was left with a greatly improved cosmetic and functional result. Other patients with a variety of medical and surgical problems were helped, to include those with debilitating degenerative joint disease.

Under the supervision of team educator Vicki Chan-Padgett, MPAS, PA-C, the team provided GMO students present continuing medical education in various medical subjects. Basic medical history taking and physical examination techniques were reviewed.

The team met with members of the Karen leadership, and it was requested that RRII continue and expand the GMO program, to include the training of a new class of 20 students, beginning the fall of 2010. The team was shown the training facilities in a safe area on the border donated by a local church group. The Karen are very enthusiastic about building and expanding the GMO program, and are currently giving the GMO responsibilities to treat, teach, and administer medical facilities in Karen controlled areas. RRII plans to respond to the need by sending a training team in late 2010.

PA Chan-Padgett teaching GMO

Team member Schmitzberger injects a degenerative joint

“After” photo of the saved foot