As an emergency department physician at St. Luke’s, Dr. Charles Washington has every modern medical convenience at his fingertips. He can order tests on demand or consult with specialists; luxuries Dr. Washington has come to deeply appreciate after volunteering to train medics working in remote Eastern Myanmar, once known as Burma.
“It’s night and day,” says Dr. Washington. “These medics are working in places without electricity, without oxygen, with limited access to antibiotics and pain medication…but they’re still saving lives.”
Dr. Washington recruits his St. Luke’s trauma and emergency medicine colleagues to travel to Thailand once a year to train these Myanmar medics. They are not doctors or nurses, yet remain the only source of health care for a half-million impoverished members of ethnic groups that occupy the border region, including the Karen.
The Karen were in conflict with the Burmese military regime for nearly six decades. They have had no access to government hospitals, and were under strict blockades that banned medical supplies, with support coming relief agencies. Instead, the Karen trained mobile backpack medics to deliver care in these areas known as the “Black Zones.”
“There are large swaths of the country that the government doesn’t provide any healthcare, so those people are doing traditional healing, managing on their own, or trying to enter Thailand without documentation to seek care there. They really don’t have options besides these medics,” explained Dr. Washington. Additionally, “there’s not a way I could go into those communities because the Myanmar government doesn’t want foreigners in those areas.”
In January, the St. Luke’s team of Dr. Washington, Dr. Deric Patterson, nurse Anne Wardle, and scribe Nick Thompson spent their own money and vacation time to travel to Thailand. They delivered medical supplies donated by Hands of Hope, including surgical equipment like scalpels and scissors. As desperately as the medics need those supplies and will smuggle them back to Myanmar, it’s the medical team’s expertise that is most in demand.
Working with the NGO, Community Partners International, and in partnership with the Karen Department of Health and Welfare, the St. Luke’s team trained 28 medics in one week. Many of the medics walk through the jungle up to six days and risk crossing the Thai border without paperwork to learn the basic, but critical emergency evaluation and management skills. The education is based on trauma and emergency care in combat situations.
“Over the last decade or so the combat has decreased and the conflict has decreased, but with the peace comes other problems,” said Dr. Washington. “There are more motorbikes, so more motorbike crashes, tractor crashes, people are still getting infections, people are still getting pneumonia, and people are still getting sick.”
Dr. Washington says the trauma and emergency management training also remains relevant because many of the Karen live in a region with one of the highest rates of injuries from landmines leftover from the conflict. Medics routinely amputate limbs with no electricity or running water. Their only form of sterilization is a rice cooker powered by solar power.
“Either they perform these procedures and take care of these people or the person likely dies, so it’s a dire situation. It’s always a risk-benefit to figure out who will benefit from a procedure versus how we are going to put someone at risk doing a procedure,” explained Dr. Washington. “It really focuses you on trying to stabilize the patient and identify the acute problems they have.”
The medics’ job is one of honor, not wealth. They have no salaries and are often paid only in rice, vegetables and shelter. It’s also a job that was once considered a crime punishable by death. Dr. Washington says medics were targeted by the government and risked their lives, even injury, to help.
“When you take away a person’s access to health, you take away their hope.”
Political shifts within Myanmar have allowed those threats to lift, but medics remain the predominant health care providers in the border regions. Dr. Washington learned of their dangerous work while living in Northern Thailand in 2007 and 2008 during his medical training with Johns Hopkins University. He’s gone back every year since, and for the last five years served as the director of this particular CPI program. CPI has trained more than 300 in-field trauma and emergency health workers are trained so far, and are now working to train others inside the Myanmar borders.
“As there has been peace in Myanmar there’s less focus on these areas, but this is still very much a population in need. So, I’m happy to use my knowledge and skills to help advance the health system in that region,” said Dr. Washington. “It’s very rewarding to go over. It drives me through the year and re-emphasizes why I went into medicine in the first place.”
Here at home in Idaho, there’s another motivation and connection for Dr. Washington. Because of the six decades of fighting, many Karen fled Myanmar and resettled as refugees in Boise and Garden City. That commonality, Dr. Washington says, helps cement a lasting impact on those colleagues who give their time and expertise.
“They (the volunteers) come in wide-eyed learning so much, and learning what the medics do with limited resources, and then obviously hearing the stories of the medics and the sick patients they take care of in these very austere environments. It’s very eye-opening for them, and just getting a better appreciation, then having that connection with the Treasure Valley and the Karen, it’s like these are people who are refugees in my community who have gone through these things, and may have been taken care of by these medics. That just brings it even more full circle for them.”
You can learn more about the Black zones, the brave Myanmar medics and hear from Dr. Washington during a special event on May 4. He is hosting a screening of the film, “The Black Zone” at The Flicks. This documentary by Grace Baek covers her decade long journey following workers on this covert and daring medical relief program.The screening will be followed by a Q & A with Dr. Washington. The film is not rated but is suitable for teens and adults. Tickets are $15 in advance and at the door.
Anita Kisseé is the Treasure Valley public relations manager for St. Luke’s Health System.