28th September 2019, The Wesley, London
Executive Summary
Following the first and second Myanmar Diaspora event in 2017 and January 2019, Health Education England (HEE) and the Tropical Health and Education Trust (THET) hosted a third full day event on 28th September 2019. The main objectives of the day were to provide an opportunity for individuals engaged in the Myanmar UK Health Alliance (MUKHA) and other members of the Burmese diaspora in the UK to network and receive updates on the progress of MUKHA and the recent partnership work. There were two groupwork sessions held to allow time for attendees to feed into the future of MUKHA including on what should be improved and implemented to better serve engaged diaspora and partners in Myanmar.
This event differed from the previous event in January as the invitations to attend were targeted at Burmese diaspora and partners who were related to one of three of the following thematic groups (in bold) previously identified by the Ministry of Health & Sports (MoHS) in January 2019:
- Medical Education
- GP training
- Nursing training
- Laboratory services improvement
- Digital Health Information system development
The reason these three groups were targeted is due to there being a good mix of diaspora, other UK experts and MoHS personnel represented in each group. Short-term and medium-term plans are also progressing off the back of webinar discussions conducted over the last six months. Based on reflections from past events, it was felt that the attendees needed more common interest topics to enable conversations to be more focused.
In total there were 45 attendees. These spanned from health professionals such as Burmese GPs and cardiologists residing in the UK to staff members from partners including HEE, World Child Cancer and Cambridge Global Health Partnerships. We were very fortunate to be joined by 9 Burmese professors and doctors from the Myanmar health sector. These included:
- Professor Zaw Wai Soe (Chair of Rectors Committee and The Rector of the University of Medicine 1, Yangon)
- Professor Khin Maung Lwin (The Rector at the University of Mandalay)
- Professor Myat Thandar (Professor at the University of Yangon)
- Dr Thida Hla (Deputy Director General for the Department of Medical Services)
- Professor Myat Thu (Head of Neurosurgery)
- Professor Khine Shwe Wah (Head of Emergency Medicine)
- Professor Mu Mu Naing (Head of the Department of Anaesthesiology at the University of Medicine (1), Yangon)
- Dr. Myint Oo (Vice President of GPs)
- Dr. Than Soe (Secretary of GPs)
The Keynote Address could be conducted by Professor Zaw Wai Soe.
The morning also included an update from Dr Thinn Thinn Hlaing on the progress of the thematic groups. This was followed by three presentations from RCP, RCGP and Cambridge Global Health Partnerships who discussed their recent partnership work in Myanmar. There was then an opportunity for the attendees to split down into thematic groups for group work based on their expertise and interests to discuss the future of MUKHA and diaspora engagement.
Background and Objectives
In 2016 Health Education England (HEE) was asked to lead a delegation of organisations to explore existing UK health activity in Myanmar, to gain a better understanding of the priorities and needs of the Myanmar Ministry of Health and Sports (MoHS) and the potential for better collaboration through the creation of a Myanmar UK Health Alliance (MUKHA).
Parties engaged in the delegation (UK’s Department of Health, Public Health England, DFID, and the UK’s NHS, Royal Colleges and higher education institutions) agreed to setting up an Alliance and the creation of a Memorandum of Understanding, to boost coordination and collaboration around national priority areas. HEE and the Tropical Health & Education Trust (THET) partnered to establish the Alliance and initially manage operations, including the establishment of an in-country office.
Five national priority areas have been identified from the Ministry of Health & Sports at the meeting held on 9th January 2018 in University of Medicine 1, Yangon. These priorities are:
- Medical Education
- GP training
- Nursing training
- Laboratory services improvement
- Digital Health Information system development
Five thematic working groups were formed with key decision makers from Myanmar MoHS and UK experts in relevant thematic areas. The importance of engaging with Myanmar diaspora was also identified and a network was established. In 2017, the first diaspora engagement event was held organised by MUKHA and THET and a second followed in January 2019.
The third diaspora engagement meeting, held on 28th September 2019 in London, aimed:
1. To increase the visibility of the Alliance and raise awareness of its role in Myanmar health system strengthening.
2. To update and explore the opportunities to work together with Burmese diaspora and UK experts on continuing activities of MUKHA thematic working groups
3. To encourage and stimulate ongoing and further engagement from UK partners and diaspora.
4. To stimulate linkages and learning across the range of organisations already, or likely to be, engaging in health partnership work in Myanmar.
5. To agree on next steps for the improvement of MUKHA and its function within the diaspora population promoting opportunities and partnerships.
Event Summary
Introductions
- Welcome: Ed Tonkin (THET, Programmes Manager)
- Keynote Address: Professor Zaw Wai Soe (Chair of Rectors Committee and The Rector of University of Medicine 1, Yangon).
- MUKHA Update: Dr. Thinn Thinn Hlaing (THET, Country Director Myanmar)
Presentations: ‘Partnerships and working with diaspora’
Presentation 1: Royal Society of Physicians
Dr Emma Mitchel presented on the partnership work that had taken place through the RCP in Myanmar. She outlined the main role as supporting educational needs in geriatric medicine, Advanced Communication Skills PACES course, NYGH and AKI/EWS. As well as:
- The MTI programme.
- Exchange programmes/opportunities.
- Quality Improvement (QI) activities.
- Health of older people in Yangon through the HOPe-YGN project.
- Support of post graduate curricular: E learning, influencing local leaders, QI skype coaching, joint grant-based work.
Within this presentation, Dr Michel also highlighted the challenges that have been faced. These include: geographical barriers, the political situation, the dynamics of co-ownership in collaboration and ensuring that activities are aligned with the wants/needs of the MoHS and local staff. The opportunities for diaspora were shown to include the development of nonclinical skills in QI, leadership, management and research. Diaspora may also have the opportunity to be part of project development, technical support and mentorship through the RCP.
The session concluded with two questions. Firstly, on the level of laboratory involvement which currently is a challenge and being redesigned by RCP. Secondly there was a discussion on the number of Burmese health professionals who work or train in the UK and do not return to Myanmar to work. The RCP does not have data on this and it was noted that this is a continuing issue as not all trainees or professionals will return.
Presentation 2: Royal College of General Practitioners
RCGP gave an update on their 12-month long project in Mandalay and Meiktila in partnership with the Myanmar GP Society, University of Medicine, and Thames Valley & Wessex Leadership Academy. During this time over 60 Myanmar GPs were trained in Quality Improvement skills with Facebook being used to continue communication.
The challenges faced during this were credibility and sustainability of the project, amongst others. There is a risk of this being unsustainable due to difficulties in recruiting UK volunteers as health professionals can struggle to balance this with other pressures and priorities. The opportunities for diaspora if they were to be involved include developing new skills that could enhance their work in UK, extended networks with other stakeholders and the potential for further roles in other local and international settings.
There was a discussion on referral pathways and where the barriers lie in referrals from primary GPs to specialists. It was highlighted that GPs will generally write a referral letter to the hospital but will not receive one back from them. This can lead to GPs feeling discouraged even though this is very useful for the hospital to receive. However, there have been instances of these letters being ignored.
Presentation 3: Cambridge Global Health Partnerships
Dr Tom Bashford gave an update of the work being conducted in partnership with Cambridge Global Health Partnerships and Yangon General Hospital in trauma care – the Cambridge-Yangon Traunma Intervention Project. The goal of this project is to make Yangon General Hospital into a major trauma centre. There were long term placements used in this project alongside return placements. Development of neurotrauma services have also more recently been focused on with teams from Cambridge conducting training.
Dr Bashford highlighted some of the challenges of partnership work including: working across cultures, language barriers and the context of the Myanmar health system. There has also been a challenge around how, as partnerships develop, the strategic direction becomes more difficult to navigate. This is in part due to ministry priorities and needs careful negotiation. Cultural fluency on both sides is needed and therefore diaspora are a brilliant resource for local knowledge and communication as well as project development.
Dr Bashford’s presentation was followed by a discussion on rehabilitation and how this starts as soon as the operation is over. Difficulties were highlighted around the lack of understanding from neurosurgeons that there are services available but that there are low numbers of physiotherapists.
There was also a discussion on the development of care plans. Dr Bashford talked about the qualitive research that is helping to steer the development of care plans that are realistic rather than aspirational.
Group Work 1
After the presentations, the attendees split into 5 groups, depending on where the attendee’s interest lay with the 3 thematic groups (medical education, GPs and laboratory services). They were asked to brainstorm around these questions:
How can diaspora assist in identifying challenges of partnership work?
What other areas are diaspora uniquely placed in to be able to assist?
The groups then presented on their thoughts:
General Practitioners
- Language
- Connections/networks
- GP community
- Constraints
- Barriers
- Continuity/momentum
- Younger generation in Myanmar – very enthusiastic, self-funding for extra exams
- How to communicate – know who’s out there and mentorship
- Different interests (soft skills, clinical, admin, governance)
- Exchange through international work
- Two-way exchange
- Buddying system
- Setting up a system
- Organisational practice
- Changing curriculum and views on GPs
Medical Education
- Mentorship
- MTI scheme
- Nonclinical skills – educational skills
- Website
- Need to try to understand the social and cultural inequalities such as working conditions
- Leadership
- Educational skills
- Linking specialists and organisations
- Dialogue
- Engagement
- Meeting the right individuals
- Utilising retired personnel
- Who is who
- Coordinating challenge: have a database of over 100 diaspora but this can be extended and need coordination – could this be THET?
- Ground level ice breaking
- Contacting society, social meeting, small projects
- Lead in every specialty
- Developing local protocols/SOPs
- Engaging post graduate students
Laboratory Services
- Engagement with IBMS and MMTA
- Training by any of the diaspora could be more effective (language and cultural understanding
- Curriculum needs to be reviewed and better quality
- Recruitment and retention needs to be addressed to reduce turnover from government and private laboratories. Also felt that they are underpaid and there aren’t many opportunities
- Openness of receivers to help and support from THET/UK/partnerships
- Listening to the diaspora who know best about deficit in the current set up
- Structured training programmes
- Educate the medics on pathology requirements
- Clarity on scope of practice and code of conduct for technicians. Diploma knowledge is not same as degree
- Need to advocate for how important laboratory work is
Key Outcomes
- A request for coordination of diaspora in the UK by starting to compile a more comprehensive list of diaspora with their expertise and willingness to contribute/volunteer included – Dr. TTH agreed to compile the database and share this (timeline is 6 months).
- A suggestion has been made to develop MUKHA website – to be discussed with HEE/THET in order to review the budget availability and how this website will be developed, utilised and managed.
- Discuss whether a session/s could be included in the next diaspora event with a focus on training in a practical skill.
- THET will share key resources from THET and HEE including:
THET Principles of Partnership
For other presentations please contact Kate.Frewer@THET.org