Trauma training course: innovative teaching models and methods for training health workers in active conflict zones of Eastern Myanmar

Abstract

Background: Myanmar has struggled through decades of internal conflict, which has negatively impacted the country's health outcomes. Recent government changes have brought hope and reduced conflict. The ethnic minority groups have suffered the brunt of the health consequences and reside in regions that lack health infrastructure, resources, and providers. Due to the chronic lack of healthcare providers within conflict areas, health workers (HWs) have been trained in an effort to fill the void. Research has shown that these non-physician clinicians positively impact health outcomes in developing countries. These HWs are supported by community-based organizations in collaboration with foreign non-governmental organizations. Started in 2000, the trauma training course was developed to meet the educational needs of these HWs.

Methods: Essential procedures for HWs in conflict zones were identified, and teaching methods were adapted to develop models that were simple, reproducible, cost effective, and able to facilitate effective learning within the limitations of these challenging environments. This paper presents simulation models developed to teach trauma injury evaluation and management in resource-limited settings to HWs.

Results: Material and construction of the models described include breathing, chest, cricothyroidotomy, circulation, wound repair, fracture/dislocation, splinting, fasciotomy/amputation, and an animal model. In 2013, a pre/post test and post-training evaluation were completed, which demonstrated an increase in understanding of the material and satisfaction with the training.

Conclusions: The simulation models described engage the HWs in clinical skills practice specific to injury management, which builds upon the HWs existing knowledge and facilitates an increased understanding of life-saving procedures. Through observation of the HW performance and HW feedback, these simulation models have increased the understanding of trauma management. Limitations include lack of a graduated learning system for the HWs, logistics, and time constraints. Despite the barriers faced, we feel that this is a necessary program that has reduced morbidity and mortality due to traumatic injury in the geographic areas that the HWs serve. With the changing political environment in Myanmar and the development of peace agreements between the government and the ethnic minority groups, these HWs can be integrated into Myanmar's evolving health system.

Keywords: Conflict; Health worker; Myanmar; Simulation; Trauma training.

Figure 1

The breathing model. Photographs on the left represent expiration, while photographs on the right represent inspiration.

Figure 2

Chest model. The first photograph displays the chest model with normal physiology. The second photograph displays the chest model with a hemothorax and a chest tube.

Figure 3

Assembly of cricothyroidotomy model. The first two photographs display the components, the third photograph displays the respiratory tubing with a small cutout window, which is subsequently covered with the finger of glove (fourth photograph), toilet paper (fifth photograph), and finally tape (sixth photograph).

Figure 4

Cricothyroidotomy model. From left to right, the first photograph displays the initial incision, followed by insertion of the tube, and confirmation of the tube.

Figure 5

Circulation model. The first photograph displays the complete model, comprised of a saline bag, intravenous tubing, and a plastic water bottle stuffed with a towel. The second photograph displays pulsatile bleeding. The third and fourth photographs demonstrate the HWs managing a vascular injury with direct pressure.

Figure 6

Wound repair model. A photograph of a HW practicing simple interrupted sutures.

Figure 7

Fracture/dislocation model. The photographs on the left show a dislocated fracture, while the photographs on the right show a reduced fracture.

Figure 8

Demonstration of one reduction method taught to the HWs with the fracture/dislocation model.

Figure 9

Examples of splinting demonstrations with locally available supplies.

Figure 10

Production of the fasciotomy/amputation model. The first photograph displays the sugar cane pieces. The second photograph displays a sugar cane piece with two pieces of colored cellophane attached with tape. The third photograph displays the addition of paper towels to the model. The fourth photograph displays the completed model.

Figure 11

Fasciotomy/amputation model simulation. The first photograph displays the initial incision. The second photograph displays cutting and gentle dissection through the fascia and muscle layers with scissors. The third and fourth photographs display the identification, gentle dissection, and ligation of the vasculature. The fifth photograph displays cutting of the bone with a wire saw.

Figure 12

The photographs display goat (left photograph) and pig (right photograph) animal models demonstrating cricothyroidotomy and chest tube thoracostomy placement.

Figure 13

Number of patients by year seen by the HWs involved in the trauma training course.