Article Text

Myanmar paediatricians during military coup: we strike and survive
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  1. Thet Htar Shwe Sin Win1,
  2. Myint Me Me2,
  3. Wah Wah Winn3,
  4. Kaung Myat Kyaw4
  1. 1Department of Paediatrics, University of Medicine Magway, Magway, Myanmar
  2. 2Department of Paediatrics, William Harvey Hospital, Ashford, UK
  3. 3Department of Paediatrics, Yangon Children Hospital, Yangon, Myanmar
  4. 4Neurology Department, Darent Valley Hospital, Dartford, UK
  1. Correspondence to Dr Myint Me Me, Department of Paediatrics, William Harvey Hospital, Ashford, UK; myintmeme85{at}gmail.com

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After Myanmar military coup on 1 February 2021, medical professionals and other government staff went on strike, joining the civil disobedience movement (CDM).1 The junta’s security forces brutally suppressed CDM doctors and nurses providing voluntary medical services in the community even during the third wave of the COVID-19 pandemic.2–4 Medical university boards and professional bodies were replaced by promilitary persons.

Healthcare for paediatric population was mainly provided by government and private sectors. The government funded building, equipment, limited medications and staff for free care at civil hospitals. However, patients have to pay full cost for private care. Almost all of the government staff work in private practice out of hours to provide adequate financial income.

Being at risk of death and torture, a group of CDM paediatricians and paediatric trainees founded the Spring Doctors for Children (SDC) on 3 June 2021 to deliver quality paediatric care to the community in a different way, support each other and maintain professional development.

Out of 631 paediatricians and 124 paediatric trainees working in government hospitals, 150 (23.7%) paediatricians and 93 (75%) trainees joined the SDC.

The 24-hour care provision to children and young adults was conducted using telemedicine, with two teams doing 12-hour shifts via the SDC Facebook page. Using Facebook as a medium has advantages as it has not been easy for the military to track and trace and is widely used within the civil society in Myanmar. Patients who needed to be seen in person were referred to retired or private paediatricians linked with the SDC.

From June 2021 to January 2022, a total of 190 patients (93 female) were consulted for 220 medical conditions (patients may have more than one consultation or multiple problems). The mean age was 3.2 (±3.2) years and the modal age was 1 year. Only 6% of children have weight-for-age Z score of <−2. Majority of the patients (57%) were from Yangon, the largest city in Myanmar. Fever was the most common presentation (n=93, 43%), followed by skin problems (n=24, 11%) and gastroenteritis (n=17, 8%). Symptomatic control and parents/patient education were the main management tools. Of the patients, 88% recovered or had complaints under control, while 7% were referred for management of life-threatening or special conditions. Good feedback was obtained from 91 service users (see figure 1).

Figure 1

Overview of the 24-hour telemedicine given by the Spring Doctors for Children from June 2021 to January 2022.

Despite difficulty, clinical governance was an essential component of care. The protocol team wrote clinical guidance for telemedicine adapted from local and international guidelines, second edition (online supplemental appendix 1). Auditing of care in December 2021 showed 87% compliance with the management guideline (online supplemental appendix 2).

The SDC provided 86 postgraduate and 31 undergraduate lectures and 5 public health education talks on paediatric topics. The SDC allowed members to practise paediatrics in very difficult circumstances, developing self-confidence and maintaining professionalism. A well-being workshop for paediatric family members and counselling sessions to share concerns regarding insecurity, risk of arrest, financial hardship and inevitable impact on family members were especially welcomed.

Despite the restrictions we are working under, support from the international medical communities will enable us to continue to develop trainees’ competencies, professional knowledge and accreditations.

Ethics statements

Patient consent for publication

Acknowledgments

We thank each and every member of the Spring Doctors for Children for their efforts in delivering quality healthcare, teaching and recording, the family of all patients for their trust and feedback to the Spring Doctors for Children, and finally Dr Shane Delamont from Darent Valley Hospital for his advice on the article.

References

Supplementary materials

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Footnotes

  • Contributors MMM did the planning, data collection and write-up of the article. THSSW was involved in planning, data checking and review of the article’s final draft. WWW did data collection and review of the article’s final draft. KMK was involved in planning, data calculation and advice on writing, and English-language review of the article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

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  • Competing interests None declared.

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