The Improving Global Health Programme - leadership development in the NHS through overseas placement.

The Improving Global Health (IGH) programme develops leadership capacity within the National Health Service (NHS) in a novel way. NHS employees collaboratively run quality improvement projects within organisations in low-income and middle-income countries with whom long-standing healthcare partnerships have been built. Leadership behaviours are developed through theoretical and experiential learning, alongside induction and mentorship. The health systems of overseas partners are strengthened through projects that align with local priorities. This article develops solutions to two main problems: how reciprocal global health programmes can be designed and how global health programmes based in leadership can attract women and black and minority ethnic groups into leadership. The outcomes of both sides of the IGH programme are described here. The overseas perspective is described using the reflections of two current partners, highlighting improvements in the local healthcare system and demonstrating growth in local team members. The UK perspective is evaluated using two surveys sent to different groups of returned IGH participants. Leadership, global health and quality improvement skills improve, having a significant and long-lasting impact on career trajectory. The IGH programme is attracting women and black and minority ethnic groups into leadership. Through collaboration and reciprocity, the IGH programme is developing a new cadre of NHS leader that is diverse and inclusive. The use of long-standing healthcare partnerships ensures that learning is shared and growth is mutual, creating development within the overseas and UK partner alike.

The development of palliative care education and training for GPs in Yangon, Myanmar: a workshop success.

BACKGROUND: Palliative care is an important but often overlooked component of primary care. In Myanmar, early emergence of palliative care is being seen, however no formal community-based services yet exist. Present challenges include resource scarcity and inadequate education and training. AIM: Our goal was to improve understanding and approach towards palliative care by GPs in Yangon. METHOD: An initial survey was performed among 42 GPs in Yangon, Mandalay, and Meiktila in March 2019 demonstrating a gap in current training needs and willingness by GPs for this to be improved. A 2-day workshop, the first ever of its kind, was subsequently designed and held for 20 local GPs, consisting of interactive seminars delivered in Burmese. RESULTS: Improvement in knowledge and confidence were used as measures of success. A true/false-style quiz was distributed pre- and post-workshop demonstrating a mean total score improvement of 15%. Self-reported confidence rating scores regarding confidence when: 1) managing palliative patients; 2) providing holistic care; and 3) breaking bad news, increased by a mean of 25%. CONCLUSION: The greatest outcome from this workshop, by far, was the enthusiasm and awareness it generated, support was even gained from the President of the Myanmar Medical Association despite his initial reservations about developing this area. Ultimately, the workshop behaved as an advocate for the introduction of a regular palliative care lecture into the local Diploma in Family Medicine curriculum; it also spurred a group of GPs to further this work and turn the workshop into a regular teaching event.

Continuing professional development for GPs in Myanmar: a pilot programme.

BACKGROUND: The quality of general practice in Myanmar is currently highly variable. No formalised system of revalidation yet exists and so engagement with continuing professional development (CPD) activities and motivation to further one's own knowledge is sporadic. AIM: To train GPs in three key areas; 1) recording CPD activities and maintaining a portfolio logbook; 2) reflecting on learning; and 3) what a future formalised CPD credit system may involve. METHOD: Sixty-one GPs were recruited in March 2019 and given training on the above. Logbooks were issued, which were completed by the GPs while attending a simultaneous 3-month 'GP CPD Refresher' course, organised by the GP Society of Myanmar. The logbooks were then marked and individualised feedback given before issuing CPD accredited certificates. RESULTS: All GPs agreed the pilot helped them to better understand how to maintain a CPD logbook and the importance of doing so (retention rate = 67%). All GPs also reported they would now be more likely to continue to keep a portfolio. Finally, all GPs surveyed felt a credit reward system, used as tangible evidence of CPD participation, would positively influence their future engagement with CPD. CONCLUSION: Improving general practice is a key component in helping Myanmar develop its healthcare system; one step required is making engagement with CPD compulsory for the revalidation of clinicians. This pilot has highlighted existing inadequacies within current training of GPs, as well as the potential benefits of implementing a CPD credit reward system.

The impact of gold mining and agricultural concessions on the tree cover and local communities in northern Myanmar.

Myanmar offers unique opportunities for both biodiversity conservation and foreign direct investment due to projected economic growth linked to natural resource exploitation. Industrial-scale development introduces new land uses into the landscape, with unknown repercussions for local communities and biodiversity conservation. We use participatory mapping of 31 communities, focus groups in 28 communities, and analyses of forest cover change during 2000-2010 using MODIS vegetation continuous fields images, to understand the social and environmental impacts of gold mining and agricultural concessions in Myanmar's Hukaung Valley (~21,800 km2). Local communities, particularly the poorest households, benefit from work and trade opportunities offered by gold mining and agricultural companies but continue to depend on forests for house construction materials, food, and income from the sale of forest resources. However, gold mining and agricultural concessions reduce tree cover, potentially reducing access to forest resources and further marginalizing these households. Our analyses do not provide evidence that long-term resident communities contributed to forest cover loss between 2000 and 2010. We argue that landscape management, which recognizes local community rights to customary community use areas, and appropriate zoning for commercial land uses and protected areas could contribute to both local livelihoods and protect biodiversity throughout Myanmar during economic growth.

A comparison of chronic pain prevalence in Japan, Thailand, and myanmar.

BACKGROUND: Pain has been regarded as important in the improvement of quality of life (QOL). In the advanced countries of Europe and the North America, a number of large-scale epidemiological surveys on pain, particularly chronic pain, have thus been performed in general populations. However, few epidemiological surveys of chronic pain have been reported from developing countries, and no surveys appear to have examined chronic pain in the least developed countries. OBJECTIVES: To compare the incidence of chronic pain in Asian countries, using Japan as an advanced country, Thailand as a developing country, and Myanmar as one of the least developed countries. STUDY DESIGN: Cross-sectional study in 4 hospitals. SETTING: A university hospital and a general hospital in Japan, a university hospital in Thailand, and a general hospital in Myanmar. METHODS: Patients were 1,000 nursing staff working in Japan, 448 nursing staff working in Thailand, and 405 nursing staff working in Myanmar. The survey was performed by requesting all nursing staff to anonymously answer the questionnaire. Data were used to calculate chronic pain prevalence, pain site, presence or absence of consultation with doctors, methods of handling pain other than consultation with doctors, and whether pain was controlled for each country. The results were then compared between countries. RESULTS: The prevalence of chronic pain in Myanmar was 5.9%, which was significantly lower (P < 0.01) than in Japan (17.5%) or Thailand (19.9%). The most frequent pain sites were the lower back, head, and shoulders in Japan, and the shoulders, ankle, upper back, and head in Thailand, whereas in Myanmar, no clear certain tendencies were observed. The most frequent method for handling pain other than consultation with doctors was over-the-counter drugs in Japan, massage in Thailand, and relaxation therapy (meditation) in Myanmar. LIMITATIONS: Limitations of this study were the cross-sectional design study, the small number of hospitals included, the limitation of patients to nursing staff, and the omission from the questionnaire of questions regarding body height and weight, working situation, family background, trauma history, sports activity history, smoking history, psychological/character tests, QOL, and pain levels of patients. CONCLUSION: The prevalence of chronic pain was significantly lower in Myanmar than in Japan or Thailand. With regard to the site and treatment of chronic pain, no clear tendencies were observed between countries, suggesting that frequency and the character of chronic pain differ from country to country around the world.

Traumatic lumbosacral spondyloptosis treated five months after injury occurrence: a case report.

STUDY DESIGN: A case report. OBJECTIVE: To describe a case of traumatic lumbosacral spondyloptosis and present a literature review. SUMMARY OF BACKGROUND DATA: Traumatic spondyloptosis is a very rare injury caused by high-energy trauma. Eight cases of traumatic spondyloptosis of L5-S1 have been reported, including only 1 case treated 8.5 months after injury occurrence. METHODS: A 45-year-old Myanmar male experienced severe lower back pain and paresis of the lower extremities after a landslide disaster. Plain radiographs showed spondyloptosis, with the 5th lumbar vertebra located anterior to the 1st sacral vertebra. Computed tomography myelography demonstrated complete bilateral pars interarticularis fracture dislocation at L5-S1 and a complete block between L5 and S1 with apparent spondyloptosis. Neurological function of this patient improved after conservative treatment for 5 months; however, his severe lower back pain persisted. Thus, surgery for in situ posterior decompression and fusion of L3-S1 was performed. RESULTS: Lower back pain of the patient had nearly disappeared 2 weeks after surgery, and he was able to walk for more than 1 hour without assistance 2 years after surgery. CONCLUSION: We performed posterior decompression and in situ fusion of L3-S1 for the patients with traumatic lumbosacral spondyloptosis treated 5 months after injury, and the surgery produced a favorable clinical outcome.

Relationship between brassiere cup size and shoulder-neck pain in women.

There are very few reports in regard to relationship between breast size and shoulder-neck pain. The purpose of this study is to examine the correlations among breast size, brassiere cup size, and moment-in-time reporting of shoulderneck pain in a group of adult women. Three hundred thirty nine female volunteers from the hospital staff answered the questionnaire. Breast size, brassiere cup size, and shoulder-neck pain were self-reported by each participant. The relationship among breast size, brassiere cup size and shoulder-neck pain was investigated. Spearman's test showed no significant relationship between shoulder-neck pain and brassiere cup size. However, after participants were classified into two groups (small brassiere cup size and large brassiere cup size with 219 and 120 participants, respectively), there was a significant positive correlation between shoulder-neck pain and large brassiere cup size (p<0.05). There was no significant relationship between shoulder-neck pain and breast size. In conclusion, large brassiere cup size is an important cause of shoulder-neck pain.

Magnetic resonance imaging findings of remnants of an intradural oil-based contrast agent: report of a case.

BACKGROUND: Myodil (iophendylate), an oil-based positive contrast media, now discontinued, was widely used for performing myelography 30-70 years ago. We identified this agent as the explanation for uncommon magnetic resonance imaging (MRI) findings in a patient with thoracic spinal fracture. DESIGN: Case report and literature review. FINDINGS: An 81-year-old man complained of back pain after falling down stairs. Anamnesis revealed that he had undergone myelography with an oil-based contrast agent about 60 years previously as a part of the diagnostic workup for back pain and sudden onset of gait difficulty. Plain radiography of the thoraco-lumbar spine showed a fracture of the eleventh thoracic vertebra and a radio-opaque, oval shadow at the level of the T9-T10 vertebrae. Many small radio-opaque dots with the appearance of a string of pearls were seen from T8 to L3 vertebrae. MRI revealed a sharply demarcated intradural extramedullary mass, of approximately 5 mm in diameter on the left side of the dura in the region of the T9-T10. The mass showed high signal intensity on T1-weighted MRI, and low signal intensity on T2-weighted MRI. CONCLUSIONS: Increased awareness of this rare presentation of procedures performed in the past is essential when atypical radiographic images are encountered. This case illustrates rare sequelae of Myodil use manifesting decades after administration.