A RAPIDLY DEVELOPING COUNTRY – PLAYING ”CATCH UP” WITH RADIATION THERAPY SERVICE PROVISION IN MYANMAR

I had the pleasure of working as a radiation therapy technologist (RTT)/dosimetrist mentor in the Radiation Oncology Department at Yangon General Hospital  (YGH), from July to December 2016. The role was organised through Australian Volunteers International. I normally work as an RTT/dosimetrist clinical educator at the Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, Australia. My time at YGH was a challenging experience, but I felt it was beneficial to the staff at that clinic and in turn, the patients treated over that time, and hopefully into the future.

This was my second mentoring visit to Myanmar. I was previously at the Radiation Oncology Department at Mandalay General Hospital in July and August of 2015. The experiences I had at that time, and the relationships formed, provided me with an up-close view of under-resourced radiation therapy services in Myanmar. There’s certainly a huge need for attention and effort, but there is cause for optimism too.

Myanmar’s history is one that shares many common features with other low income nations. It’s a resource rich country, that was subject to centuries of Western colonialism, and has recently emerged from several decades of a repressive military junta. The establishment of democracy, and end of strict economic sanctions by the EU in 2013 and the USA in 2016 mean that Myanmar is now experiencing an economic and cultural boom. Many people have seen a rapid rise in their standard of living, personal freedoms and have a positive outlook as a result. These societal in advances Myanmar have been uneven, and health service provision has been an area of slower growth.

For decades Myanmar had a total of about 12,000 medical doctors for a country of close to 50 million people, and radiation therapy services were limited to six Cobalt 60 units nationwide.  From 2013 to 2016, there were eight medical linear accelerator units and four brachytherapy units installed. The existing staff had no formal education or practical experience with these items of equipment. Their training needs were nominally met with a few days of vendor training, and short study trips to radiation therapy centres in other neighbouring developing nations like Thailand and India.

As described by other authors on the topic of radiation therapy services in the developing world, there is a rapidly rising need for cancer services in Myanmar. YGH treated approximately 2000 patients with radiation therapy in 2012, and this grew to about 7400 in 2016. The Myanmar Ministry of Health’s efforts to ensure satisfactory radiation therapy service coverage to their population have been partially helped by the upgrading of major equipment in their government hospitals. This is also complicated by parallel private radiation therapy centres, military radiation therapy centres, and health service companies which send wealthy patients to developed nations for treatment. Nevertheless, these factors combine to mean that there is a huge need to treat an ever-growing majority of patients with more sophisticated radiation therapy treatments, by a group of professionals in the public sphere, who still have large technical and organizational knowledge deficits.

My aim was to address these knowledge deficits. I was fortunate enough to work with a wonderful group of staff at YGH who were very hard working and welcoming, open to change, and were fast learners. As a result, we achieved some large and lasting technical practice gains in a relatively short amount of time. Some of the bigger achievements that were regularly taking place by the time I left YGH included:

  • Tattoos for isocentre placement
  • Shielded / shaped electron beams for clinical use,
  • 3DCRT mono-isocentric breast and supraclavicular fossa treatment,
  • Multiphase 3D conformal mono-isocentric head and neck technique, including junctional electron beams for post cervical chain node irradiation
  • Computerized patient and resource scheduling

There were also a large range of other reforms that were launched, to contribute to the development of a quality assurance culture. Other positive professional cultural changes have started. There is now a six month RTT workplace training scheme, which is part of the way through producing its first cohort of new RTTs who will work at various government radiation therapy centres in late 2017. There will also be a select number of medical physicists who will move to Thailand to study and gain a Masters Of Medical Physics, and there will be a Myanmar National Cancer Institute established in the Nay Pyi Daw.

However, resource and knowledge gaps still exist. Individual radiation oncologists, radiation therapy technologists and medical physicists from around the globe can help make a difference, through efforts to address the knowledge deficits described above. It is a lot to ask for any of us to travel to another country and to be a mentor to colleagues there, but there are also other ways to assist without leaving home. Any help would always be welcome and will make a difference.

If you are interested in helping, or have questions, please contact:

Craig Opie [Craig.Opie@health.nsw.gov.au]

Yangon General Hospital, Myanmar

Yangon General Hospital, Myanmar

Craig teaching staff at the radiation oncology department, Yangon General Hospital

Craig teaching staff at the radiation oncology department, Yangon General Hospital

Craig teaching the principles of patient set up for radiotherapy, at Yangon General Hospital

Craig teaching the principles of patient set up for radiotherapy, at Yangon General Hospital