Emergency, Triage, Assessment and Treatment (ETAT) training in Myanmar

The Royal College of Paediatrics and Child Health (RCPCH) and The Myanmar Paediatric Society, worked in partnership to improve the quality of hospital care for seriously sick and injured children and newborns in Myanmar. This was through an Emergency, Triage, Assessment and Treatment (ETAT) training, two year package of training with ongoing support and mentorship, leading to sustained changes in clinical practice.  In total, from the four ETAT+ courses, 110 health workers were trained including 14 instructors.  Dr Yin Yin Aung was one of the instructors at a recent ETAT+ course.

In Myanmar 1 in 20 children does not live to see their 5^th birthday ^[1].

In Sagaing where Dr Yin Yin delivered the ETAT+ training, of every 1,000 live births, 68 children die before their 5^th birthday, far exceeding the national average.  In this age group, acute respiratory infection (ARI) is one of the most common childhood illnesses and is the third leading cause of death, following preterm and birth asphyxia.  Diarrhoea (the fourth leading cause of death in the country) and fever are common childhood illnesses too, with the fever mostly symptomatic of a cold or severe diseases such as malaria, dengue haemorrhagic fever, and Japanese encephalitis.

Below, Dr Yin Yin Aung explains how as part of a team of paediatricians they are working to reduce these unnecessary, and preventable deaths.

“I am a Paediatrician and have been practicing for five years now.  I chose this career because I love children and wanted to work with them.  I am also a lecturer at the University of Medicine, Myanmar, as I want to who wants to pass on skills to other paediatricians.  I balance the two by doing ward rounds or clinical duties in the morning, and teaching the medical students in the afternoon.

At Mandalay Children’s Hospital, we see so many patients, with over 100 children admitted each day.  At the moment, we have many cases of Dengue fever.  We only have 550 beds and often have to bring in extra beds, but still the Paediatrician to patient ratio is very low.

I became interested in the Emergency, Triage, Assessment and Treatment (ETAT) training, because it lays out objectives that match my passion for teaching and providing quality care for sick children.

At first, with a blessing from my seniors, I attended the Generic Instructor Course (GIC) which saw me qualify to be an instructor after three days.  I loved doing the instructor course. The course’s teaching style was very good and systematic.  What stood out for me, were the case scenarios, and doing the practice.  I find this a very good teaching process and way of learning.

For me, what is exceptional about teaching, is passing on knowledge to others so that they can change their ideas and practice.  I delivered the ETAT+ training in Sagaing to twenty-seven health workers, seven doctors and twenty nurses.  The main challenge was the language barrier as most nurses had difficulty understanding the language.  Luckily enough, we had a mixed faculty of four international and five local instructors.  We worked together to translate for those who did not understand English. This increased my confidence in teaching the course.

I noticed that our daily teaching and learning processes are very different compared to the ETAT+ course.  People in Myanmar, I must say are very shy in asking questions but the ETAT+ skills motivated people to speak out more.  I think the mix of doctors with nurses was very useful for this too in Sagaing, we had one nurse instructor.  This was really positive.

The course has certainly been very beneficial for me.”

[1] http://dhsprogram.com/pubs/pdf/FR324/FR324.pdf