Myanmar recently opened its door to the outside world after more than half a century of isolation from its military rule. Due to this, the impoverished nation of 60 million has substantial numbers of poor people with blindness – most commonly caused by cataracts and corneal disease.
Prof Gerard Sutton was recently invited to go to Myanmar to teach corneal surgery at Mandalay. Unfortunately Prof Sutton’s suitcase with his surgical instruments went missing after his flight and he had to make do with what was there. Arriving on the afternoon of Tuesday 28 February, 2014, Prof Sutton and Dr Raj Devasahayam were greeted at the Mandalay Eye Ear Nose and Throat Hospital by Prof Yee Yee Aung and other ophthalmology staff. They were to stay for four days and had brought six corneas from the Lions New South Wales Eye Bank to teach corneal surgery.
The clinic was crowded with more than 50 patients for Prof Sutton to review. A short list of 10 potential recipients was selected for corneal transplantation.
The following day, the 10 patients were reviewed again to select three recipients for the day’s transplants. The 10 potential recipients were assembled in the examination room with a crowd of eager young surgeons and nurses. They determined three of the most needy from an assessment. One patient displayed a perforated cornea with iris extrusion. Another was a 16-year-old Buddhist monk with traumatic injury to his cornea. The third recipient was a middle-aged man.
Prof Sutton started the first transplant surrounded by a group of young enthusiastic surgeons. A number of surgeons had been selected to perform the transplants. The transplants required resourcefulness as the theatre was very basic, surgical instruments were minimal and old. Despite these difficulties, the surgeries went well. Prof Sutton commended the surgeons on how quickly they had learned and displayed their skills.
The same day Dr Raj Devasahayam visited the Mandalay Eye Bank, at the same hospital. There were three technicians, although the processing area and laboratory were old, there was ample room. Equipment was minimal. Processing of corneas in the laboratory would have been difficult. A teaching session was held for the Eye Bank staff. The collection of eyes and their processing is very basic in Mandalay, hence there was a great deal of eagerness and enthusiasm shown by the staff. In 2013 they had only 47 corneas that were transplanted and all donors came from one source – the local morgue.
Prof Sutton and Dr Raj Davashayam arrived at the hospital again the next day. The street in front was lined with hawkers and food stalls. There were several women squatting in the front foyer with baskets of food. The hospitals in Myanmar do not provide food or general care for patients – family and friends need to do that.
The three recipients from the transplant the previous day were examined and the outcomes were excellent. The remaining seven patients were reviewed and three recipients were selected for the day’s transplants. One lady required a complicated procedure where a good cornea from one eye was to be transplanted to the other eye, and the first eye would have a replacement transplant. Another older woman and a 26-year-old monk were also selected.
Due to unforeseen circumstances, prior to surgery, the three corneas that had been kept in the Eye Bank overnight needed to be re-assessed before use. Suddenly, all the problems they face in ophthalmology in Myanmar became very obvious. The equipment was old and faulty and there was no microscope in the laboratory. Someone said they thought a nearby hospital had one and a very old microscope that used a mirror to reflect light into it was found.
After more than half a day of scrubbing, decontamination and repair of old equipment, a reasonable environment was established in one of the rooms. The corneas were tested and determined to be very good. Prof Sutton’s luggage with his surgical instruments had been found and arrived at the hospital. The patients were prepared and the transplants were commenced. Surgery was completed late in the night. All patients were reviewed the next day and the outcomes were excellent.
Dr Raj Devasahayam presented a lecture on Eye Banking to all the ophthalmic surgeons on the final day. The audience were keen, curious and extremely interested.
At the conclusion of the visit, Prof Sutton and the team had a discussion on the outcomes. The teaching sessions for the corneal surgery and Eye Banking had been enthusiastically attended. The final assessment of the six corneal transplants was excellent. The relationship between the Australian team and the Mandalay ophthalmologists appeared to be one of trust and faith. It was a successful visit in every way. The Australian surgeons left Myanmar with a strong belief that they had made a small difference, and that there was much more that could be achieved.