Dispatch from Yangon: Promoting nursing care in Southern Myanmar

Marilyn Moonan, MSN, RN, CPN, is a clinical nurse educator for surgical programs and a global health nursing fellow in the Global Health Program at Boston Children's Hospital. She has traveled to to Myanmar and Ghan, but she has also traveled extensively with Operation Smile over the past fifteen years to Asia, Africa, and South America.



As I walked into the inpatient pediatric oncology waiting area at Yangon Children's Hospital—a relatively modern, well-equipped hospital in Yangon, Myanmar—a beautiful young woman approached me. She was holding her son, a 15-month-old boy who had Down syndrome. In English, she repeatedly sobbed, “Please help me.”

An interpreter explained that she and her husband were farmers from rural northern Myanmar (more than 700 miles from Yangon, an urban area of more than 5,000,000 people) and that recently their son had not wanted to breast feed, had been sleeping a lot and had developed lumps in his neck. They had previously traveled to Thailand, where their son was diagnosed with acute lymphoblastic leukemia (ALL) .  The parents had sold their farm to travel to Yangon so their son could receive chemotherapy.

I smiled and put my arm around her but could not think of what to say that would give her comfort. It was my first day at Yangon Children's and my first experience in my yearlong global health nursing fellowship with Boston Children's Hospital's Global Health Program. With this single chance meeting in the waiting area, it took all of 15 minutes for me to begin to understand the challenges that families and medical staff in Myanmar face in providing quality, consistent health care.

The challenges of care

Normally, I'm a clinical nurse educator for Boston Children's surgical programs. But in June 2015, a colleague and I traveled 28 hours on three flights for a unique opportunity: to be catalysts for positive change in the nursing care provided to families and children in a region of the world where so many factors complicate that being achieved with any regularity. 

There are many distinct health care system challenges in Myanmar. The nation allocates only 2 percent of its GDP to health care, the lowest amount in all of Southeast Asia. Nursing is task-oriented, and nurses are only paid approximately $100 per month. Nurses are not specifically trained for pediatric oncology and rotate throughout the hospital every six months. One nurse and one resident are together responsible for a ward of as many as 50 pediatric oncology patients at night. 

Despite these challenges, the nurses we worked with were extremely caring and clinically competent. They were thirsting for knowledge and enjoyed learning about any topic that we presented.


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A map of Myanmar. Yangon is on the southern coast. (United Nations/Wikimedia Commons)


This visit to Yangon lasted just over a week. I checked in on mom and baby each day that I was in the hospital. The baby had responded well to the treatments. I found out that the mom had taken on the role of comforting other mothers with children on the unit, often carrying their babies through the unit while hers slept, so they would have some relief.
I saw her one more time when it was time for me to fly home. We exchanged smiles, hugs and well wishes, but there was finality in our goodbyes. I knew there was little if any chance that our paths would ever cross again. There was no way that we could stay in touch; she did not have access to or the Internet in her remote village.


Forces of nature

Several months after I returned home, I began hearing about devastating flooding in northern and other areas of Myanmar. Nurses that we had met in Yangon shared horrifying photographs—a dead infant floating in a flooded village; a toddler chest deep in mud, holding a dead, mud-covered snake. More than 100 people died, and thousands were displaced as mudslides wiped away their homes. Water sources were contaminated, power sources were cut, and roads and bridges were washed out.
I thought about that beautiful family and wondered if they had escaped the fury of Mother Nature. I also worried about the storms' effects on the oncology patients I'd met. How do they maintain their fluids when their water was contaminated? How do they avoid infection? How can they possibly even think about making it to a follow-up appointment? The overall rate of oncology treatment abandonment in Myanmar is thought to be about 25 percent. I am sure that this year's extreme flooding only exacerbated the problem.

In the past year, we have In the past year, we have been able to teach 15 nurses “Helping Babies Breathe”, 20 Nursing students & nurses about the child with respiratory dysfunction, the child with GI dysfunction, pediatric health assessment, pediatric growth & development, infection control, IV infiltration & phlebitis. We taught 68 nurses about error prevention training, pressure ulcers, recognition & management of shock.  Finally, 26 nurses, a pediatric Surgeon, and nephrologist were taught about the child with renal dysfunction & transplant. Teaching methods consisted of simulation, just in time teaching, bedside rounding, and formal lectures. We have continued teaching thorough web conferencing, email and social media. It has been thrilling to see the nurses teaching this content to other nurses throughout the hospital and community. As we continue our work in Myanmar, we hope to continue building strong partnerships with inter-professional teams at Yangon Children's, working for sustainable change and knowledge transfer.

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