Arriving at Pier 21 Food Terminal on a hot Saturday morning in Bangkok, I was extremely excited to meet the four BARTC Fellows currently studying in Bangkok: Drs. Nay Myo Htun (Myanmar), Undram Maisakhan (Mongolia), Sokha Sann (Cambodia) and Tashi Wangchuk (Bhutan), as well as the incredible BARTC Programme Head Dr Jariya Lertakyamanee and Programme Coordinator Chusana Rungjindamai. Our lunch was followed by a trip to the Siriraj Bimuksthan Medical Museum where together we learned about the history of medicine in Thailand.
The food was delicious, and the museum fascinating, but what really made the day special was getting to know the Fellows. Their enthusiasm for anaesthesiology, and for improving anaesthesia care in their home countries was incredible.
As I had previously only spent two days in Bangkok, I was in awe of the buzz and speed of the city. The Fellows too, having only started their Fellowships three weeks before I arrived, were enthralled by new sights and sounds. Our trip across the city from the Food Terminal to the museum was a great adventure. We learned more about each other as we transferred from Skytrain to Skytrain, hopped on the express river boat, and sat outside the Medical Museum watching the boats travel up Chao Phraya River.
What struck me most was the genuine excitement that each Fellow had about being awarded the Scholarship and their appreciation to the WFSA for giving them the opportunity. Each Fellow had their own life, family and job in their home countries, but believed that learning all they could from the BARTC scholarship would help them to improve anaesthesia care when they returned.
And they were not the first to make that decision. The Fellows could all tell me about colleagues from their home countries who had been BARTC Fellows in previous years, or had been involved in other training courses in Thailand.
As I learned more about anaesthesia practice in their countries it became clear why Fellowships like BARTC are so important and popular in the region. Dr Tashi Wangchuk, has spent many years realising his desire to qualify as an anaesthesiologist, which is challenging thing to do in Bhutan. He has spent a number of years outside of the country, in Cuba and now in Thailand, to acquire the skills he needs to qualify and become the fifth government anaesthesiologist in the whole of Bhutan.
Dr Sokha Sann has similarly studied in an amazing number of countries in the region, but returned to Cambodia and was working at a Phnom Penh hospital before travelling to Thailand to take up the BARTC scholarship.
I formally interviewed the Fellows at the very end of the day and had them repeat some of the sentiments they had already shared with me in conversation. As we sat in a circle, each Fellow would speak and find that the others would nod their heads in agreement. The challenges they spoke about transcended their borders and highlighted fundamental challenges within many health systems:
“I think my country’s greatest challenge is firstly, we still need a lot of training for both junior and senior anaesthesiologists. Secondly, we have been left behind, especially in equipment. We can’t do a lot of advanced anaesthesia techniques because there’s a lot of financial limitations and things like that. There are also very few anaesthesiologists and so it is very hard reach all patients,” explained Dr Nay Myo Htun.
Dr Undram Maisakhan agreed with these problems, saying:
“Mongolia has a small population of about 3 million. There is little equipment and new technology, whereas here [in Thailand] there are many, many new techniques and new pieces of equipment.”
Interestingly, many Mongolian anaesthesiologists have trained abroad and do have the skills to operate complex equipment, but such equipment is simply not available for them at home.
This is quite the opposite of Bhutan where there is an extreme shortage of anaesthesiologists:
“Our country’s population is in small pockets not in a big town, and people are scattered throughout the mountainous terrain which means some district hospitals are run by single nurse anaesthetists,” Dr Wangchuk explained.
“The nurse anaesthetists train in Bangkok for one year, when they go back they do apply what they have learned, but they never update their learning. There is no way of continuing their medical education. I want work on and share my knowledge with those working in anaesthesia services in my country.”
VIDEO: Dr Tashi Wangchuk tells me about his most interesting case since beginning the BARTC Fellowship - an obstetric patient with malignant hyperthermia
Talking to the Fellows about what they hope to achieve when they return to their home countries was a really encouraging discussion. Each one has specific ideas about how they would like to tackle the key issues within their home countries.
From Dr Sann’s interest in improving national anaesthesia guidelines, to Dr Nay Myo Htun’s drive to teach his juniors different aspects of pain management and intensive care medicine, I was left with little doubt that I was speaking to the next generation of leaders in Asian anaesthesiology.
In all, it was a wonderfully inspiring trip.
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