Karam Asmaro, MD
Karam Asmaro, MD
Neurosurgery · Detroit, MI

Neurosurgery Mission Trip to Myanmar

October 31st
Yangon, Myanmar (Burma)

Project Description

Every year, a neurosurgeon from our institution in Detroit, Michigan flies to Myanmar to operate on large, challenging brain tumors and cerebral aneurysms. The surgeries are performed by our team in conjunction with the Burmese surgeons to further the education and expose them to the techniques which we utilize here in the United States. We travel with a circulator/scrub nurse and a biomedical engineer in case we run into any equipment issues. This year, I'm joining a senior neurosurgeon, Dr. Jack Rock--who was awarded National Humanitarian Award by the American Association of Neurological Surgeons (AANS) this past May in New Orleans. By having established rapport and good working relationship with the surgeons there over the last few years, it enhances the efficiency of the trip and helps having a structured organization to what we aim to accomplish. The trip will consist of operating on the challenging cases they've accrued since the last trip a year ago, train the neurosurgery residents in bedside, lifesaving/diagnostic bedside procedures and give neurosurgical education lectures across the main hospitals in the country.
Our aim is to empower the neurosurgeons in Myanmar with the microsurgical techniques, tools and knowledge to be independent physicians able to perform lifesaving surgeries while also tackling the most challenging brain pathologies. Aside from the surgical front, our goal is to educate young surgeons there to make sound clinical decisions in terms of committing patients to the operating room or pursuing different treatment modalities.

Population Served

Given the complex nature of the procedures, the surgeries are performed in the capital Yangon. The patients, however, travel from all over the country, including rural areas to receive care which has been the experience of the team over the last several years. We intend to provide care to patients with complex pathologies requiring specialized care that's outside the realm of the surgical teams available in their country.
The population of Myanmar was chosen because of the pre-established relationship with the neurosurgical community there. We have found this to be helpful in streamlining the process and increasing the efficiency of our trips. For example, the teams in Yangon know what to expect of us and have the patients who require the most expertise ready and scheduled for surgical intervention upon our arrival. We have found this to be useful in terms of maximizing our impact in terms of patient access and care but also in maximizing our time spent operating with our Burmese colleagues.

Expected Impact

Our intention is to provide an immediate and long term impact of the work we perform in Myanmar and South East Asia. The immediate impact is on the patients with longstanding neurological issues and debilitating disease after a successful operation. The long term impact, however, will stem from educating young residents and neurosurgeons from the seminars and operating abreast of each other.
Of note, the Yangon neurosurgical boot camp that was held in 2017 hosted 45 residents and 25 faculty from nearly a dozen countries including Myanmar, Thailand, Cambodia, Vietnam, Nepal, Singapore, and South Korea over a span of two days.

Trip Photos & Recap

In Myanmar and other developing countries in Southeast Asia, patients may not have adequate access to simple healthcare, let alone complex neurosurgical workup and treatment. The majority of the population lives in poverty and in rural areas far from medical centers capable of providing acute or complex care. The purpose of our trip was mainly to provide complex neurosurgical care utilizing a team approach with the native neurosurgery staff and residents of Myanmar to empower and enhance their skills. The statement of these trips, which have been ongoing for more than five years, is to establish long lasting changes which positively impact the care delivered to the general population.

Inherent to the specialty, contemporary neurosurgery is routinely accomplished with advanced cutting edge technology. It is by far the most technologically dependent specialty among other branches of medicine and surgery. Along with better understanding of anatomy, technology is the reason that has improved the way we deliver care, ameliorate suffering, and cure disease when it comes to surgery of the nervous system. The advancement of technology has widened the disparity of care delivered in developed countries compared to the rest of the world. Over the years and with help of many individuals and companies, Dr. Jack Rock's team--the leader of the mission who is a neurosurgeon in Detroit, Michigan--has delivered many vital devices and instruments that have facilitated advanced operative neurosurgical care. From the first awake craniotomy for brain tumor to the first endoscopic case, more and more is being done over the years.

The first weekend in Yangon revolved around the International Society for Pediatric Neurosurgery meeting which saw neurosurgeons from all over the country, Japan, Italy, India, and our team from the USA. My talk was on pineal region tumors' diagnosis, workup, and management. Throughout the week, I operated alongside the neurosurgery residents of North Okkalapa General Hospital. There are two operating rooms for neurosurgical procedures, one reserved to trauma cases--where I scrubbed in with the residents--and another room reserved for elective, generally more complex cases where Dr. Rock and the Myanmar staff scrubbed in. The lack of advanced equipment and hemostatic agents in the operating room was met with a similar scenario in the wards and ICU. For example, many patients were being extubated while still comatose because of ventilator shortage; as a result, some patients expired from respiratory failure. Outside of the operating room, we discussed several high yield topics and gave lectures utilizing evidence based medicine.

Although a tremendous amount of progress has been made, the trip is not without its challenges. A great deal of improvement remains to be seen in the diagnosis, workup, imaging, operative, and postoperative care and rehab of neurosurgical patients. We were confronted with these challenges on daily basis but it is our duty to persevere and reduce the gap between Westernized medicine and the rest of the world.