My Hospital Training After Graduation
Preamble
(Rangoon General Hospital)
I use the word “Hospital Training” as my practical training after graduated M.B., B.S. as distinct from the House Surgeon training or internship as it was not exactly similar. Legally I trained from 7th of April 1961 to 31st July 1962 at the Defence Services General Hospital, Mingaladon, Rangoon and Base Military Hospital, Maymyo (Now, Pyin-Oo-Lwin) in various capacities including in charge of a medical ward.
During our times, the house surgeon training in
(Dr Ba Than , Surgeon, Professor, Dean and Rector)
7 CRS (Casualty Receiving Station)
Mya Oo and I reported to the Director Colonel Hla Han of the Defence Services Medical Corps that we had graduated at our first attempt. He was pleased and gave the date of commission on the day our results were published that is 7th April 1961. (It;s a World Health Day , now).
(Rangoon Medical College)
I was given a Burma Commission Number senior to Mya Oo that remained constant through out my medical career. We were asked to report for duty to Major Kyaw Nyunt (Later Colonel and Director of BAMC) at the 7 CRS (Now No. 2 Military Hospital,
Then he continued,” You both will work with me before you are posted officially to the BMH. I’m glad you can help me with my heavy load of works. First tell me what are your interest and specialty you would like to pursue in the future?” “Medicine”, I said without any hesitation or thinking. Mya Oo thought for some time and slowly said, “Maybe surgery, but not yet decided.” “ OK, Ko Nyo helped me with OPD and medical cases, mainly in the male ward. Ko Mya Oo, take care of women and children in the Family Wing, but both of you are free to see and go any where here. OK?”, Major Kyaw Nyunt said.
(L to R: Drs Mya Oo, Daw Khin Nyunt, Myo Thwe, MMN, Daw Khin Nu)
Thus we had to see the OPD, emergency and warded patients at the 7 CRS that catered for the health of military personnel and their families in Rangoon that amounted to about 30 to 50 thousands at minimum at the time excluding the navy personnel. And we had to do the 24-hour orderly medical officer (OMO) duties on Saturdays, Sundays and holidays. We were given bachelor quarters in the compound of the 7 CRS.
(Shwedagon Pagoda, Serene and Graceful at All Times)
Daily Routines
I got up at 6.00 AM in the morning, exercised for about half an hour and then took a shower. I made my own breakfast for two of us and ate usually fried rice or toasts and coffee. Then I dressed up and went to the male OPD by about 7.30 AM. Major Kyaw Nyunt would be there together with long lines of soldiers and civilians.
Yes, 7 CRS looked after the civil employees of the Ministry of Defence and I have a feeling we looked after about 200 to 300 patients a day. At first, Major Kyaw Nyunt taught me how to write down the patient’s name, number and unit, showed OPD treatment that was quick, effective and minimal for treatable patients and to admit serious and doubtful cases either at 7 CRS or to refer to the DSGH at Mingaladon. He let me manage myself all the cases after a few days as I learned his routines quickly and I had the experience of running the OPD at MGH and RGH. He said impressively of me,” Ko Nyo, you know more medicine than when we graduated.” I was pleased and proud; I worked harder.
(L to R: Drs MMN, Hla Oo, Thein Maung Myint)
Interesting Cases
1. A healthy soldier of about 25 years of age came to the OPD every day for his white patch on his lip and forehead. I diagnosed it as a case of leucoderma and told him,” There is no treatment that would cure it.” But , the patient told me, “ Without attending the OPD here I would be asked to do a lot of heavy works daily, Bogyi.” Bogyi means Captain and Bohmu means Major in Burmese. “ But, you joined the army for duties, you can’t avoid it.”, I told him. Major Kyaw Nyunt intervened and said, “ No, Ko Nyo, what he said s right.They need some rest. They are being asked to do heavy duties daily. So, give him C for light duty and let him take ultra-violet treatment here every day.” I had the experience of leucoderma or vitiligo as my friend Dr Win Pe had it. He took treatment from various consultant physicians and dermatologists in
2. A new recruit of about 20 years of age came to us with he complaint of tiredness on exertion. His condition was normal in appearance and I did not find any health problem. I thought he was malingering to avoid heavy duties and he wished to resign from the army. “ Ko Nyo, can you examine him as I did not find any thing abnormal?”, Major Kyaw Nyunt told me. I looked at him thoroughly and found him a bit breathless with ashen grey face. I asked him to sit and stand up repeatedly for about 5 minutes and examined his heart and pulse. I thought I heard a presystolic murmur in the mitral area. “ I think he has mitral stenosis, Bohmu.”, I told Major Kyaw Nyunt. "Then , let us refer to DSGH for complete investigation and treatment.”, Major told me. He was discharged from the army after a month after it was confirmed that he did have a rheumatic mitral stenosis. We’re shown the ECG and chest X-Ray etc of his case later.
3. One Saturday noon time, a nice looking young man of about 30 years of age came to my OPD with a son of about 7 or 8 years.” Saya, please help us. He was just bitten by a snake.”, he told me. I examined the boy and found the snake bite, fang marks on the right hand. ‘Oh, he must be playing with the snake.”, I told him and dressed the wound and made preparations for injecting polyvalent antivenin. “ He was moving the pots of plants and he yelled as he was bitten. I think it must be a green snake, but we did not see it.”, his father answered. “Ok, we have two common typs of anake in
4. One night at about 11.00 PM, an old worker of about 50 years came to me with severe pain on the sole of the right foot. I was on duty and I examined him. He had a temperature of about 102º F with a hectic bounding rapid pulse of about 90/minute. The right sole was swollen, red and tender. It was a case of severe abscess. “What happened to your foot? It must have been several days now!” I asked. “Yes, he walked on a nail about 3 days ago. He is a carpenter here building the hospital. He applied Htone ( liquid chalk), but go on working daily as he is a daily worker. Only now, he can’t tolerate pain any longer and comes to see you, Bogyi (Captain)”. “OK, I’ll do what I can as you are a civilian.” I therefore gave him immediate pethidine injection, anti-tetanus toxoid and penicillin injections after asking and testing for penicillin sensitivity. After that I cleaned and dressed his wound with local anaesthetic. The patient was immediately relieved of pain and fever. He was lucky that there was no tetanus and gas gangrene infecting him. I did not refer this case to DSGH, Mingaladon as he was a civilian not entitled to admission there.
5. One early morning at about 7.00 AM the Medical Assistant on duty came to me and said,” Bogyi, there is an emergency case of a lady with respiratory difficulty. Please come and see immediately.” So I followed him without wearing the uniform and there was a girl of about 16 breathing helplessly. Her face was blue and her hands and feet were clawing and twitching. I examined her and told her elder brother who was accompanying her,” Well, this is a case of tetany due to rapid breathing. It’s not asthma, nothing to be afraid of.” Then, I managed to give her calcium gluconate injection for immediate relief and oxygen inhalation. She recovered immediately. I then gave her Calcium-Sandoz oral fluid to be taken daily. I advised her not to breathe rapidly and not to meditate. Her brother, a captain at the War Office, told me,” She is very ambitious and high-minded. She breathes rapidly when she is angry. She used to have this spasm often, doctor.”
6. One day after noon, Major Kyaw Nyunt took me to the operating theatre and showed me what we could do there. He said,” I some times did minor or common surgical operations here like circumcision, vasectomy, herniotomy and haemorrhoidectomy or pile operation. We can also set fractures. But, you may do whatever you wish if you can. Please help me today as I have 5 vasectomy, 2 herniotomy and 2 hyroocoele. Enough for one after noon."So I assisted him to his satisfaction. He said,” Ko Nyo, you are also good in surgery although you said you are more interested in medicine.” I just smiled and I did not tell my fiasco with Dr Kyaw Maung and Mr Peter Randle for high marks in surgery at the examination! Then, Win Hlaing came to visit me during my duty and he saw the operating theatre so clean and well-supplied. He asked, “ Maung Nyo, could you do a small operation on me here?” I replied,” For what?” “ To circumcise me as my prepuce is too narrow and closed.” “ OK. But do you trust me?” He smiled,” Of course I trust you, but I will talk Ivan (Win Pe) to accompany me here.” I did the circumcision on Dr Win Hlaing together with Dr Win Pe at the 7 CRS on that Saturday. It was an uneventful minor operation. Major Kyaw Nyunt asked me on the next Monday morning,” Ko Nyo who are the patients you operated on Saturday?” “ They are my class mates in the medical schools. I just did a circumcision. Any problem?” “ No problem. It’s OK if they are your friends. But don’t operate on other civilians here without prior approval from the War Office for security reason.” “Thank you, Major.”
7. One after noon outside the office hours Colonel Hla Han, our Director of BAMC, came to our residential quarters with Sister Daw Khin Ohn Chit (?). “Bogyi, here is Colonel Hla Han to see you.”, she said to me. I saluted him and said,” Anything I can do, Sir?”.He said, “ Can you find calcium pantothenate injection for me.I need it urgently now.” “ OK. Colonel. Sister, who holds the key to the medical store? Let’s go and find out.”, I told her. Daw Khin Ohn Chit replied,” I hold the key and I’ll find out for you, Bogyi.You entertain the Colonel here.” “ OK, good.”, I answered and took Colonel Hla Han into our lodge and let him sit on a seat. “ Director, please sit and wait for a few minutes. Please have coffee too.” So saying I gave him a cup of coffee. Mya Oo came out of his bed room and smiled. He did not say anything. I told him, “ Ko Mya Oo, please make company with our Diector. I’ll go and check the medical store.” I went to the medical store and looked for calcium pantothenate. We did not find any.We found calcium gluconate, calcium chloride, Calci-osteilein, Calcium Glucose-D. I came back and reported to Colonel Hla Han. He said, “ It’s OK. I’ll ask Captain Thein Han to order it from abroad.” Later Major Kyaw Nyunt told me it was for the Chief of Staff General Ne Win as he accompanied him abroad very often. Majot Kyaw Nyunt was his personal physician for General Ne Win for a long time. Captain Thein Han later became a Colonel and Managing Director of the Trade Corporation 10 dealing with medicines and Medical Equipment.
8. Majr Kyaw Nyunt was a real gentleman and he never scolded me even if I did something wrong. One Saturday afternoon at about 2.00 PM I told the MA ( Medical Assistant) on duty with me that I was going to the RGH for a walk and I would come back soon. There I met my girl friend and she gave me lunch at the
9. One week day, a woman of about age 18 years was brought to 7 CRS with bleeding from the birth canal. I was called upon as no other doctor was available. I took her history particularly menstrual history and examined her, She was found to be in near shock due to bleeding, but actually there was not much bleeding and I gave her immediate blood transfusion. I found her to be the youngest daughter of a senior major and not yet married, though she had a fiancee. She had an over due menstruation. I diagnosed it as a case of threatened abortion. I told her elder sister who was accompanying,” I think it’s a threatened abortion. I will give conservative treatment here as blood transfusion and conservative treatment of drugs, but I have to refer her to
We were posted officially to DSGH, Mingaladon after abut a month at 7 CRS. Mya Oo and I reported for duty to Colonel Maung Maung Aung at the DSGH. “ Good! Two young doctors joining us. What are your interest first before I allot you duty each to any ward?” he asked us. “ I’m for medicine.”, I answered. Ko Mya Oo replied,” I’ll go to surgery if Ko Nyo is going to medicine.”
(L to R: Col. Myint Maung Maung, Dr MMN, Col. Saw Aung Mya Thein)
Thus I was posted with Colonel Tin Ohn at the medical division or wards and Mya Oo was posted to surgical division or wards with Colonel Myint Aung. We immediately joined our division after the Commandant had allocated us at the Officers Mess for lodging. We’re given separate rooms with a batman to look after our personal requirement like bedding, ironing of uniforms and polishing the boots. Meals were also provided at the Officers Mess.
It was an ideal life without any need for looking after yourself except working for the hospital. Medical officers at the time were far and few in between and all were very friendly, unassuming and generous to help each other. Colonel Tin Ohn and Majot Tun Hla Pru lived in their rooms upstairs with Mya Oo and me downstairs. Major Maung Maung and Captain Aye Myint also shared one room each. They were not medical doctors, but Maung Maung was in charge of the medical laboratories and Aye Myint was in charge of the motor vehicles of the DSGH. Besides, Maung Maung’s father and sister were medical doctors. Aye Myint's girl friend was also a medical doctor working as a captain in the DSGH. So we all are related by work and functions. Aye myint later became a colonel, protested against the BSPP Regime and he is now abroad.
We had a messing service and bar in another building where lady doctors like Majors later Clonels Daw Sein Yee, Daw Shu Po and Daw Thein Nwe lived upstairs. We all ate food downstairs and had beer occasionally. I remember our friends Drs Hla Shwe (Golly), Than Nyein, Myint Tun Thein (Tun Tun, Saytheikpan), Kyaw Myint, Win Hlaing, Ne Lin etc came to drink beer at our expense. Mya Oo and I willingly hosted them both drink and meal that evening. It cost us a monthly allowance each. Than Nyein is now an NLD Representative in Parliament recently releaed from prison.
I still remember Dr Hla Shwe telling us, “ Ko Nyo and Mya Oo, you both are sincere and progressive, but I have a doubt that you can change the militarist basis of the Burma Army!” He thought that we joined the army to change its nature.
Routines at the DSGH
Every day I rise up at about 6.30 AM and took a shower, Then, I dressed up the uniform and ate the break fast. From there I went to the medical divisions at DSGH at about 8.00 AM. I joined Captain Marie Ohn at Medical Ward 2 downstairs. Medical Ward 1 was upstairs. We first signed the Diet Sheets for the patients and by 8.30Am we made a Ward Round. We checked the old cases and we asked Colonel Tin Ohn to see serious or ambiguous cases. New cases were seen and examined immediately. W then went to the Skin Ward to see dermatological cases.
We had tea at about 10 AM and we the did other duties like going to the Radiological Unit with patients for X-Ray or to see cases at the Family Wing. We would have lunch by 11.00 AM. In the afternoon after 12.00 noon we saw interesting cases with Colonel Tin Ohn or other specialists. We also saw new cases as the case may be. In the evening we played football or billiards. I usually played billiards.
(L to R: Col Myint Maung Maung, Dr MMN, Col. Tin Maung Aye)
It’s interesting to visit the Radiological Unit or Department as the Officer in Charge Major Hla Shwe was fond of teaching us English. He said he passed the matriculation examination from the
He would also show me Radiographs of interesting cases with a brief history. Once he showed me a chest X-Ray with mottled patches in both lungs. The patient had a fever with a sore in the left foot. I said, “It may be streptococcal infection or military T.B. But I’m sure it’s due to leg infection.” It was proved by bacterial culture that it was due to staphylococcal infection of the leg. Colonel Tin Ohn said, “ Ko Nyo, you are brilliant.”
Once I was asked by Major Han Tun to check the health of Colonel Sein Win at the Officers Ward. I went to him, paid due salute and examined him. I was only a lieutenant medical officer at the time. I noted down the findings in details and rported to Major Han Tun over the telephone. He said, “ Ko Maung Maung Nyo, what are you saying? I do not understand a word of what you said.” I replied, “ You asked me to check the health of Colonel Sein Win. I found every thing normal; heart, lungs, blood pressure, liver, cranial nerves etc. He is fit.” Oh, I see. Ko Nyo, I have forgotten much of medicine. I’m now working in the surgical ward. Thank you.”
He became an Officer on Special Duty with the Ministry of Health and later Director of Health and a WHO Representative in
I had to undertake OMO or Orderly Medical Officer duty every month at first, but every fortnight later to look after the patients of the whole DSGH on that day after office hours. I had to take care of all emergency and OPD cases coming o the DSGH that day and made the whole hospital round at 10.00 PM. At 7.00 AM the next morning I had to write the OMO Report indicating the important cases so that day duty doctors and specialists could take care of. I used to write the building conditions like leaking roofs and unlighted area of he wards etc for improvement. The Adjutant Officer humourously complained that I was trying to mend the old hospital DSGH to become a new one.
Colonel Tin Ohn and my colleagues encouraged me to do so more. Colonel Tin Ohn gave me a project to study the peripheral neuritis cases in DSGH. It was interesting. Even malaria and amoebic dysentery gave rise to it apart from common causes like Vitamin B 1 deficiency and lead poisoning.
Mya Oo was not happy with Colonel Myint Aung who told him that he was so indecisive and slow thinking. He could not become a good surgeon, he was told. He was therefore posted to the Orthopaedic Ward under Colonel Lao. There also he was not very active and eventually he moved to medical division when I moved to the
BMH, Maymyo
I reported for duty to the Commandant Colonel Balakrisna in Maymyo. He looked at me asked, “ How old are you?” I said, “ Just finished my 22 year birthday on 21 July.” “ Oh, you are too young to be a doctor. We usually became doctors at about the age of 25 years in our times.” Then he asked me, “ What is your interest?” “Medicine, Sir.”, I answered. I was thus posted to Medical Ward 2 under Colonel Tin Oo. I assisted him in all the works of Ward 2 and I accompanied him to see cases through out the BMH. Major Aiyyapan was a consultant in charge of Medical Ward 1 and I also visited there frequently. We became good friends later.
( Maymyo or Pyin Oo Lwin Town Centre)
We had a Tea Club and all the medical officers met at about 10.00 AM in the tea Club. There were about 10 or 12 medical officers and the atmosphere was very informal and friendly. I was the youngest officer, single and studious. So I had to take OMO duty frequently. But the benefit ws that I could take part in orthopaedic and general surgical operations, saw cases at the family Wing apart from my medical and psychiatric duties. We had a small psychiatric ward at BMH and Colonel Balakrisna took care of the patients. But I took preliminary history, physical and psychological examaintaion and wrote the chart for each patient for him.
(Cherry Blossoms , Emblem of Maymyo)
He was impressed with my writing and said,” Maung nyo, your English is very good. Most Burmese nowadays cannot write like you.” It may be a pep talk, but I was glad and read psychological medicine texts. I used to write complete medical historr for each patient I examined and Colonel Ko Ko Gyi later told me he was impressed by my English and thorough. He even considered recommending me to send for DPM in
Memorable Events at BMH, Maymyo
1. Once I was examining a patient who complained of fits often and it was disgnosed as a case of epilepsy. But he would talk often of his parents who were rich and famous although he was just a sergeant in the army. His friends did not cooroborate his family history. He had a left eye squint and he was tall. He dressed properly while taking outpass to leave the hospital. He was arrested by the Police and sent back to the BMH after a rowdy night in town. I was examining him alone in his Detention Ward. I had been friend with him for about two weeks now. I thought he was a mental case, maybe General Paralysis of Insane due to his behaviour and paranoid ideas. I told this case to the Commandant and he agred with me. He was sent to
2. One day I examined a Warrant Officer aged about 50 years who complained of tiredness, weight loss, indigestion and frequent constipation. I found him anaemic and thin, but there was no jaundice or ascites. I found his liver stony hard. I diagnosed him as suffering from Cancer liver probably from a primary lesion in the digestive tract. He did not smoke or drink. He had been in
3. An officer was admitted to he orthopedic ward with multiple communited fractures of both femur (thigh bones) ue o a car accident. He was unconscious at the time of admission. But, we revived him with blood transfusions and ample antibiotics and steroids. He revived, underwent nailing of both femurs and he was discharged after about 6 month able to walk with clutches. I wondered the proficiency of the orthopaedic surgeon and also of the advantages of the intramedullary nails.
4. One midnight on my OMO duty the family Wing Sister (Staff Nurse in charge) telephoned me to see a woman with reteained placenta fatre birth. I went there and found a 30 + year-old woman on the labour couch helpless. I examined her found o be physically OK except that the placenta did not come out one hour after normal delivery of the second child. I told the patient and Staff not to worry and read the Textbook of Obstetrics for Retained Placenta. It said I could remove by hand under anaesthesia for common retention and if unsuccessful surgical intervention was recommended. So, I asked the Staff to prepare for ether anaesthesia and manual removal. I gave he patient glucose transfusion and sedative tranquilizers. Fortunately, after half an hour of trial and error, the whole placeta came out and the patient was awake and alert I wrote this story in Burmes for lay people as a case of retained placenta not to panic. My class mates teased me for writing such un-heroic event, but for me it was heroic as I was managing it alone.
5. I met Dr Khin Myat Hla at the BMH and she was sporting and vivacious. She stood second to Dr Mullerwoth at the Final part Ii Exmination. Dr Ba Than was fond of her and said she was smart and studious but emotional and romantic. She fell in love with writer Maung Kyi Lin and they would walk in the rain, sing in the moon and would rise a bus in
6. Then I would go to the surgical ward for interesting cases and surgical training. I was allowed to do circumcision, vasectomy, sebaceous cyst removal, herniotomy, pile injection without supervision. I was also allowed to do appendectomy after assisting two or three operations. I assisted gastrectomy, thyroidectomy, Caesarean Section and mastectomy. I could set fractures like Colles’ fracture and clavicular fracture with POP (Plaster Of Paris). I also assist in intramedullary nailing of compound fractures and operations on prolapsed intervertebral discs that Major Soe Then did. He was trained in the Mayo’s Clinic for about 5 years. H married a White American lady and came back to
7. The best things were social events. We had a monthly Officers Night. All the Officers danced, drank and sang. I was not successful in any one of them and the Officers excused me for being too young and studious. I remember one Christmas night when I was drunk with cocktails and sang Burmese song like “Bawa Thanthaya (This Cycle of Life). I danced with a teenage daughter of a staff nurse and every one clapped for us. Her mother, the Staff Nurse, invited me to their home for dinner afterwards, but I did not enjoy it as the girl was only at the 8th standard. But I enjoyed teaching First Aids to students at
(Mandalay Fort and Moat)
8. I was elected the Maymyo Representative of the Maymyo Branch BMA of the Upper Burma Medical Association in 1961 and 1962. I used to go down in BMH provided vehicle from Maymyo to
Good News
One day in January or Febryary 1962 Colonel Hla Han came to BMH, Maymyo and met us. He urged us to work hard for the army and country. He said he would send promising officers for further training abroad. Colonel Balakrisna introduced me to him, but he said, “ I knew Maung Nyo.” Colonel Balkrisna told me later that he had recommended me to go MRCP and Colonel Hla Han agreed to send me. I was overjoyed.
Bad News
On the morning of March 2, 1962 Colonel Balakrisna asked us to assemble in the Cinema Hall of the BMH and for an important meeting. He called me to his room before that asked me, ‘ Maung Nyo, did you hear any big news today?” “Yes Sir, I heard that the Army had taken over the State Power.”. I answered. He said, “That’s correct. Tell me your opinion first.” “I think It’s a sad news as the army should not be involved in politics. It should remain clear of politics. It must be a service organization serving the people.”
” What you said is true. But if a house is burning every one should try to quench the fire.
Conclusions
I had a very profitable time and training at BMH, Maymyo from August 1961 to July 1962. I trained not as a house officer or intern but as an assistant to surgeon, physician and psychiatrist. But I was involved in the investigation and management of all cases covering various specialties. I had seen more than an average house officer and got training in the management or operation of common medical, surgical and Ob/gyn cases.
Besides I was a studious student and I read relevant textbook or literature before and after each interesting case.
I also gained a lot of fiends in Maymyo. Dr S. Hla Maung ( Later S. Hla Mong) took me to his home and introduced me to his mother, brothers and their families. I had an open house in their home for any meal I wished to take. I’m most grateful to them and I’m very sad to learn the deaths of their mother and three brothers now. I have been to Maymyo twice or thrice after my posting at BMH then. I love Pyin Oo Lwin.
Dr Maung Maung Nyo
04.02.2009
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