Feature
In the Heart of Mandalay Electrophysiologist and cardiologist Dr Tim Gattorna writes of his time in Mandalay where he and a team of volunteers were helping local colleagues on the path to modernisation. Last year I was fortunate to have had the opportunity to visit Mandalay General Hospital (MGH) with Open Heart International. Our mission was to provide educational and procedural support for electrophysiological services to the local cardiology team, where the clinical demand is high. Open Heart International, an initiative of the Sydney Adventist Hospital (SAH), is a volunteer organisation that mobilises teams of medical, nursing and allied health professionals along with medical consumables, supplies and equipment to provide surgery in developing countries. It first began in 1986 in response to the overwhelming need for surgery for rheumatic heart disease in Tonga. Mandalay was the last city of Burma to fall to the British in 1885, with the last Burmese King exiled to India to live out his life. Mandalay is considered the heart of Burmese Buddhism and traditional Burmese ways. Grind of poverty It was clear that the country is burdened by poverty and lack of infrastructure and recent flooding has been devastating, causing great loss of life and livelihood. The middle class earns US$300 a month (nurses earn <US$70 a month). The wealthy are the military or business owners and the divide is wide. Mandalay General Hospital serves all of upper Myanmar and a population of 2.5 million. Healthcare is public and funding by the government has been very limited until recently. Private donations have significantly contributed to the development of the hospital’s facilities. A new multilevel cardiac building was completed in 2014 on a strict donated budget of US$500,000 including a coronary care
Hard at work in the EP Lab
MEDICAL FORUM
Dr Tim Gattorna (left); Dr Shaun Anderson and Monks (above)
unit and wards. However, the equipment still in use is well beyond what is considered acceptable by Australian hospital standards. The wards are large open rooms filled with beds, which spill into the corridors. Two of the cardiologists at MGH have undertaken EP fellowships in Singapore in 2011 and 2014 respectively, although, due to a lack of local equipment, have not, until recently, had the opportunity to perform procedures, resulting in deskilling and a growing patient wait list. The wait is over Our first task was to review a list of 24 patients with supraventricular tachycardia awaiting ablation that had been collated and prioritised before our visit. These patients were highly symptomatic despite medications.
We were touched to hear that these patients had waited all year for the ‘experts from Australia’ to arrive and many were travelling several hundred kilometres to attend the hospital. Even more surprising was that, without realising it, we had already passed some of these patients and their families camped out on the hospital grounds on our way to the cath lab that very morning. Fortunately, technical issues such as equipment or power failure did not trouble us. Last year, one patient remained in darkness on the operating table for two hours until power was restored but she was undeterred. She had waited so long for the procedure she didn’t want to miss out! The case mix was interesting with a large proportion of the SVTs due re-entrant tachycardia via concealed accessory pathways (or three), with one fascicular ventricular tachycardia thrown in just to keep us on our toes. We also performed pacemaker implantations, including cardiac resynchronisation therapy (CRT), assisted at the pacemaker clinics, and provided the local techs with practical support. It was a rewarding experience and I felt proud to be there with my colleagues to help the people of Myanmar. I am confident the local electrophysiology team are appropriately trained and skilled to take on the challenges ahead. On their side they are determined, motivated and enthusiastic. I hope to be invited back next year to provide further education and support, and will be interested to see how they have progressed.
FEBRUARY 2016 | 21