My Preliminary Postgraduate Training

Dr Maung Maung Nyo

Preamble

I reported for duty at the Medical College 2, Mingaladon on 28^th March 1964. It would be my place of work and training until I went to the UK. Dean Ko Ko Gyi welcomed me in his office that morning and called Professor H. Zaw Tun after my residential arrangements were worked out.

(Dean Colonel Ko Ko Gyi)

“Harry, Captain Maung Maung Nyo has just arrived. Will you see him now?” he asked. “OK. Thank you. I’ll send him now,” Dean Ko K Gyi said. Then he told me to go to the Department of Anatomy to report to Professor H.Zaw Tun. “Yes. Thank you, Bogmu. I’ll go to him now,” I said and went to the Department of Anatomy at Medical College 2. It thus started my career in anatomy.

Professor H. Zaw Tun

Professor H (Harry) Zaw Tun welcomed me in his room at the Department of Anatomy. He was the Head of Department and part time professor then. He was the full time Professor and Head of Department of Anatomy at Medical College1. Both medical colleges were under the then Rangoon University that was multi-faculty at the time.

“Welcome, Maung Nyo. I just finished my lecture, take a seat,” he said to me. “Thank you, Professor,” I said and sat down on a chair in front of him. “The Dean told me you are a smart chap and you got distinction in anatomy at the 2^nd MB examination. Tell me briefly about your self,” he asked.

(Dr Maung Maung Nyo)

“I was born in Monywa. I was selected a premedical student after winning a scholarship at the 7^th standard. I passed the special premedical matriculation examination with distinction in physics standing first in the whole country in 1955. Then, I passed 2^nd MB with distinction in anatomy in 1958. I graduated in March 1961. I served at the DSGH, Mingaladon, BMH, Maymyo, military hospitals and light advanced dressing stations in Mongton and Lashio. I’m single,” I told him.

“What about other subjects in the medical school? Any distinction in 2^nd MB Junior?” he asked again. “No, Sir. I got 78 % in organic chemistry exam. I got A or A- in the third year subjects,” I answered. In the old Rangoon University Grading A+ means above 80 %, ,A iswis above 75 % and A- is above 70 %. These Letter Grading has 5 % marks difference between each grade.

(Convocation Hall of the Rangoon University Where I graduated M.B.,B.S.)

“I asked this question especially because army fellows are usually not studious. They are just ‘easy go lucky’ fellows. Ph.D. training is a vigorous one. You have to work diligently day and night for at least three years in the UK. That’s possible only when you are matriculated or agreed upon by the professor concerned after a certain probationary period. If not they won’t recommend you to work for a Ph.D.” he explained to me.

(The Medical College 2, Later Institute of Medicne 2, Mingaladon, Rangoon)

He then asked me to follow him. He led me to the Common Anatomy Teachers’ Room. He introduced me to the teachers after calling them all to the room. “Here comes our new staff, Captain Maung Maung Nyo. He will work and study here before he goes for postgraduate study in UK,” “Welcome, Ko Nyo,” they all said. “Give him a room, Kyi Win,” Professor Zaw Tun told Dr U Kyi Win, the assistant lecturer and most senior full time staff at the Department. Dr Kyi Win willingly said,” Yes, Professor, he can take one table in this room. It’s vacant.” Thus my place was immediately settled.

(Department of Anatomy in 1970 When I became Head of Department)

Then, Professor Zaw Tun left me to be with other anatomists and he asked me to see him next morning after his lecture. I then befriended other anatomy teachers. I found my old classmates Dr Aye Cho and Taw Jim Lyang. They were very friendly to me. I made new friendship with Dr Khin Than Yi, wife of Dr Kyi Win and Dr Khin U May, Dr Gerrick Tin Pe Law, Dr Kyaw Nyunt and Dr Myat Thu Ya. I took tea with them and talked. We became good friends.

My Assignments

I attended the anatomy lecture given by Professor Zaw Tun. I think it was the development of the brain. Professor used a lot of pictures from the textbooks that were shown by epidiascope. He also showed them the Ciba Foundation’s neuroanatomical slides in the dark room that could accommodate only 20 students. So, he divided the students into 3 groups and explained each group for about 30 minutes. He was sweating, but he continued un-flinched. I marveled at his Cetana (Goodwill) and efforts.

(Professor Shwe Tin ,OG Department, and First Graduates of IM 2),

I knew later that Professor Zaw Tun was an embryologist and he was not an expert on neuroanatomy so that he taught more than was necessary. I had to modify the curriculum and teaching of neuroanantomy when I came back as a neuroanatomist in 1969.

“I can wait, if you are tired, Professor,” I told Professor Zaw Tun when we reached his room as I was with him all the time. “No, its OK now How was my lecture?” he enquired. This is a good trait of a professor asking the opinion of his junior staff and students on his performance. ”Excellent, Professor, I understood all of what you said and showed,” I honestly replied. “Good. Let’s sit down,” he said and we sat.

He took out two textbooks from the book self and gave them to me. He then said,” These are two recent books on anatomy, one on theory and another a dissection guide. You read the dissection guide and dissect one cadaver for two or three moths. Read the theory of dissection in the textbook. At the end of dissecting the whole body you take a demonstration and tutorial group. After that we’ll assess and discuss.”

(Logo Emblem of Institute of Medicine 2, Rangoon)

The textbook he gave was “The Structure of the Human Body by Gardner, Gray and O’Rahilly. It was a first class book that we prescribed to all the second MB students in Burma replacing the old Gray’s Anatomy. The other book was a dissecting guide by an American Anatomist. I finished the dissection of the whole cadaver in one and half months. Professor Zaw Tun was more than happy.” Congratulations, Maung Nyo. You are very smart and hard working. I’ll recommend you for a Ph.D.” “Thank you, Professor,” I replied.

(The Motto of the Institutes of Medicine in Burma: Service, Sympathy and Humanity,

Written In Pali and Burmese)

As a matter of fact I dissected the cadaver from 1.PM to 4.00PM every day, 5 days a week. I attended Professor’s lectures in the morning and at night I read from 7.00 P.M. to 2.00 A.M. the next morning. I then slept and got up at 7.00 A.M. I read gross anatomy of a part together with its developmental anatomy and histology. I also drew diagrams when I studied. I understood what I read and I remembered it fully.

Major (Later Colonel) Tin Ohn told me,” Ko Nyo, you are reading too much. Give some time for outside reading. Read a poem every morning. That will make you refreshed and vigorous.” Major Tun Hla Pru was my dissecting partner for some time as he was preparing to go for FRCS course in England. But, he was around the age of 40 years then. I was only 25 years of age. He said he could not read and progress the dissection like me, but he tried.

Part Time Demonstrator and Lecturer

I was given a demonstration and tutorial group of the 2^nd MB senior class. I remember Aung Kywe, Kan Thein, Maung Maung Yay, Alfred Ba Lwin and Hla Pe in the group. They were good students, but boisterous. I treated them as friends and they all responded well. I asked them important viva questions on the dissecting table and showed them the likely structures that used to be asked in the practical examination. Actually I visited to all the dissecting tables in the dissection room and I always discussed with whatever group or students that wanted me.

Aung Kywe was very simple as he came from Anya Ye U. He spoke short and simple. He was studious and he knew the subject. He joined my Department of Anatomy as a demonstrator for some time after graduation, later he moved to the Obstetrics Department, but he could not cope with its night duties. Ultimately he took up preventive and social medicine as a specialty. Kan Thein was a jolly fellow, sometimes late in the class. He later joined the Burma Army and became a surgeon and colonel. Maung Maung Yay migrated to England after graduation. He called me in Kuching when he visited Kuala Lumpur a few years ago. Alfred Ba Lwin used to attend the class with army uniform of the UTC (University Training Corps). He was also a jolly fellow.

(Senior Teachers of IM 2 Who are Demised: All from L to R:

1st Row: Rectors U E,Khin Maung Nyein; Prof.Col.s Tin Ohn,Myint Aung;

2nd Row: Prof.s Shwe Tin,Tin U,Khin Maung Win,Daw Phayt;

3rd Row: Profs Aung Myint,Sein Myint,Khin Myint Myint,Col.MaungMaung Myint)

I gave my lecture based on my reading. I used to read Gardner, Gray and O’Rahilly, Last and McGregor for gross anatomy; Arey and Hamilton, Boyd and Mossman for Embryology; Ham and Windle for histology; Ranson and Clark, and House and Pansky for neuroanatomy. Students complained that I talked fast and my lectures were full of facts that they could not retain. Yes, I was speaking fast to show off my command of English as I was taught by the Indian teachers during our undergraduate years. In those days talkpng English fast like Indians was regarded as your measure of fluency of English speaking. I knew that it was false when I arrived in London.

(My Late Supervisor Professor Ruth Bowen and Me at Her Home

During One Christmas Dinner, Probably 1968)

My supervisor Professor Bowden told me to speak slowly and legibly so that the other person can understand. It was the Received Pronunciation that is important. Some spoke Oxford English deliberately. I remember the leader of the Biafra secessionist movement in Nigeria speaking English with Oxford Accent on the television. He failed to impress the audience and his mission also faltered.

Then, I would visit the Library of the Medical College 2. It was an advanced library in Burma at the time. It subscribed to more than 400 current medical journals at the time and it had collected about 50,000 volumes of books and periodicals pertaining to the science and practice of medicine. Professor Woodruff of the London University wrote glowingly of the library in the British Medical Journal of the time. The library has deteriorated since then. The librarian U Myo Lwin was trained in the USA and got a Master’s Degree in library science. We used to discuss about the library often and sometimes we played chess at the lunch hours.

Captain Tha Tun was another chess player. He was at the time Registrar of Medical College 2. He occupied an ante room in front of the Dean’s room. He did all the administrative job of the college and he was very efficient. Later he moved back to the Directorate of the Medical Services and transferred to the Ministry of Foreign Affairs. He retired as an ambassador.

Practical Training

Apart from doing routine teaching duties I had to learn the practical aspect of running the anatomy department. I have to deal with the non-teaching staff also. They were kind and obedient to me. Some of them worked in the histology laboratory, some others worked in the preparation room. There were two clerical staff too.

Those in the preparation room had to inject the unclaimed cadavers in the mortuary of the RGH (Rangoon General Hospital) with preservative fluid that contained formalin, glycerol, phenol and sodium nitrite. Formalin is very pungent and its smell does not go away easily. I had to try injecting the cadavers myself and it took two or three tries to make the cadaver completely infused with the preservative fluid. Dr Maung Maung Taik, Head of the Forensic Department, kindly supplied the unclaimed cadavers.These cadavers were to be preserved in the tanks containing formalin. The cadavers were taken out every week for student dissection and they were kept again put in the tanks after dissection. We had to employ 4 laboratory assistants for such tasks.

(L to R: Profesor Kyee Paw and Dr Maung Maung Taik)

They also prepared bones for study. To make a white bone is not easy. The cadaver was first removed of all the muscles and soft tissues. Then it was immersed in distilled water and water was changed at the end of every week or fortnight. Some people used hydrogen peroxide to make the bones white. But it remains white for some time only. The bones then turn yellow. To make the bone permanently white you have to place the bone in distilled water until no tissue fluid comes out of the bone. It takes about 2 or 3 months. Then the bones are dried in the sun. That bone will remain white for ever. The dean of MC 2 bought a number of white bones (disarticulated) and skeletons from Calcutta. They were good, but costly.

I then had to do histological sections. I had to take small pieces of tissue about 0.5.centimeter thick, fix it in formalin or other fixatives and embed it in paraffin wax. Then I sectioned it in the microtome. Learning to use the microtome took about a week. Ability to cut good sections requires about a month’s training. Then, you mount the sections on the glass slides and stain with different histological stains.

“Read this book for microtoming and practice sectioning. This is your bible for microtoming,” Professor Zaw Tun gave ma a small book, “Microtomy by Baker”. I had to read and practise the microtome until I had the knack. I had also to sharpen the microtome knife. “You cannot do research in anatomy if you can’t use microtome, You must also know how to sharpen the knife,” Professor Zaw Tun told me. It was laborious, but I learned it.

Cutting serial sections of a tissue block is difficult. It’s more difficult to mount and stain them without loss of any sections. Then, to be able to reconstruct the cut and stained sections to be life-like is more difficult. I had to do it my self. Professor Zaw Tun gave me his larynx tissues of the embryo and I cut serial sections. Then I mounted them on the slides in series. I stained them and I did the reconstructions. He also gave me already cut sections on slides. It was the gift of Professor Bowden from London. I made all the reconstructions. He them wrote a paper for the upcoming Burma Medical Conference. I was the co-author of the paper and his assistant. He was the principal author.

Burma Medical Conference

I think it was the 22^nd Burma Medical Conference held in the Rangoon Medical College, Lanmadaw, Rangoon. It was in 1964 or 65. The title of our paper was “Development of the larynx: A new perspective”. Professor Dr Ba Than took the chair and it was well attended as all the Burmese doctors were afraid of him. I demonstrated the models of larynx, reconstructed models and showed the histological slides.

(Dr Ba Than M.B. (Cal) FRCS, FACS, FICS

Professor of Surgery and Dean, Rector of IM 1)

Professor Zaw Tun read the paper and said that the larynx simply developed from the laryngo-tracheal diverticulum and its mesoderm, canalization taking place from both ends, that’s from superior and inferior ends. Colonel Min Sein, former Professor of Medicine and Dean of Rangoon Medical College praised the paper as it’s original, but he suggested that the junior worker (that’s me) should read instead of the senior worker. Professor Zaw Tun smiled, acknowledged the suggestion and apologized.

(Institute of Medicine 1 Where the 22nd (?) Burma Medical Conference was Held)

It’s true that in those days most of the papers in the Burma Medical Conference were reviews or personal experiences and symposiums were common. In that conference we had two symposiums, one on breast cancer and another on peptic ulcer. I remember Dr Kyaw Lin talking about the anatomy of the female breast that included the pathology and surgery. Pathologist Dr Daw Aye Yi (Later Professor Rina Wong) complained that she had nothing much to say after him. Dr Maung Maung Aye who read on the surgical aspect said that anatomy deals with the dead bodies and surgery deals with the living patients. It was a sort of one upman-ship and joke. Professor Kyee Paw coordinated the final summation.

(Rangoon General Hospital)

Research

So I was involved in the research project of the development of the larynx from the very beginning. Professor Bowden then urged Professor Zaw Tun to write about it in the Journal of Anatomy when she came to Burma and discussed with him in 1965 after the conference. I was there showing her my reconstructed models and specimens. Professor Zaw Tun asked her to accept me as her Ph.D. student and she readily agreed as I was with her for the whole week in Rangoon. She saw me in the army uniform and she said I was young and active. Then, Professor Zaw Tun asked her to advise on what to read.

Her replies:

“1. Gross Anatomy: Usual British texts including Gray’s Anatomy. Cunningham’s Textbook and Manuals, R.J. Lasts Anatomy

2. Histology: Schaffer’s Histology, Ham’s Histology

3. Embryology: Arey’s Developmental Anatomy and Hamilton, Boyd and Mossman’s Embryology, Frazers’ Textbook of Embryology

4. Neuroanantomy: Ranson and Clark’s Textbook of Neuroanatomy

5. General Anatomy: Recent Advance in Anatomy (2^nd Series) and Tissues of the Body by Le Gros Clarke

6. Comparative Anatomy: Romer’s Vertebrate Body.

7. On bones: Skeleton of the Human Body by Frazer

That’s enough. He can read more when he comes,” Professor Bowden said.

“Oh, I’m glad to hear that. He has finished all these books, he read a lot,” Professor Zaw Tun said. I was happy to hear their comments.

Then I had to assist Professor Zaw Tun in dissecting the human embryos for the descent of the testis in human. He had done research on this topic in rat in the UK, and his thesis was based on that work. He shoed me his thesis and it was very thick. His Ph.D. degree was conferred by the University of St. Andrews in Scotland. Professor Tin Maung also did his research on bone growth in the same university, but he could not show me his thesis as he did not have it. Some said he did not finish it.

“ Ko Maung Maung Nyo, Ph.D. is not easy to get. You try to get it,” Professor Tin maung told me when I requested him to show his thesis. He was s good colleague of mine when I came back as I saved him from untimely retirement by the then Rector of the Institute of Medicine 1 Dr Ba Than. Dr Ba Than wanted me to take his chair in 1970, but I refused and Colonel Hla Han, Minister for Health and Education, gave me a new chair to me at Institute of Medicine 2 in 1972.

Translation

Dean Major Ko Ko Gyi knew me that I was able to write Burmese fluently having read my short stories and I have good command of both English and Burmese as he had read my written histories on mental patients. He therefore one day suggested me to translate one medical science article in Burmese that would be published in the “Pyin Nya Padetha Sasaung (University Academic Digest)” soon to be published. He asked me to choose an article myself and showed him I chose the original research paper on the structure of the liver by Davenport in the Anatomical Records. He agreed and let me translate. I did it every day and I finished in a month.

I showed the finished translation to him and he approved. I sent it to the said periodical and it was published in1966 when I was already in London. Professor Kyee Paw praised the translation as clear, concise and useful to the medical profession. Many medical doctors were surprised by my fluency in Burmese and ability to translate. Dean Major Ko Ko Gyi was happy as he heard the praises piled on his selected candidate for Ph.D.

Dr Daw Norma Saw

Then in 1965 Dr Norma saw was an assistant lecturer in the Medical College Mandalay was promoted to Lecturer and Head at the Medical College 2 just after the New Education System was announced by the BSPP Government. Together promoted at the same time were Dr U Kyi Toke and Dr May May Yi. They did not have postgraduate degrees at the time, but they were senior teachers and well versed in their subjects. Dr Norma Saw had been to the All India Institute of Medical Sciences in New Delhi, but she did not get a Master’s although she finished her thesis entitled, “Development of the Spinal Cord in the Human Foetuses.” It was a high standard work, but she failed in the written examination. She taught me various neurological staining methods.

(Dr Norma Saw, Sitting Left, with Students at the Thidar Hall)

Dr Kyi Toke was a pre-war graduate of the Rangoon Medical College and he taught gross anatomy well. Once he taught the peritoneal reflections of the abdomen and he used two or three towels to demonstrate the greater ometum. It was very fascinating and amusing. He asked Professor Bowden whether formalin has effect on the brain as some anatomists were behaving peculiarly in Burma. Professor Bowden laughed and said no. She asked me about him when I met her in London.

(Dr May May Yi, Sitting in the Centre Facing The Reader, at Thidar Hall)

Dr May May Yi was very able and attractive. She went for a Ph.D. in physiology to London, but she came back with a B.Sc (Special) degree in physiology. That’s an intercalated degree in the medical curriculum, but she went on to get M.Sc. in physiology from the Institute of Medicine Mandalay. She was promoted to lecturer, then professor and later she was appointed as the Director-General of Medical Research during the SLORC government. Dr Norma saw retired as lecturer at the Institute of Medicine 1. The University Council Rules stipulate that all the lecturers and professors must have postgraduate degrees in their field of study or specialty.

Social Sport and Student Activities

As I was trying to develop myself all round I involve myself in the various activities of the Medical College 2. I took part in sports particularly in tennis and badminton. I was a selected player in basketball and volleyball during my high school days, but I refrained from them as I was becoming older and studying hard. Some students and staff did not understand when I played with students, but it’s a socializing gesture. They thought a teacher and an army officer must stay aloof and must stand above the crowd!

I tried to write a handbook about Medical College 2 and I wrote the draft. It became the basis of the mimeographed Handbook of Medical College 2 or Institute of Medicine 2 when a delegation of the General Medical Council of Greta Britain and Northern Ireland visited Burma in 1967. And it was used again when the Institute published its final Handbook of Institute of Medicine 2 in 1969 when I edited and printed it at the Universities Press in Rangoon. I published another Handbook in 1977 when the GMC delegation again visited IM 2. I was the secretary of IM 2 GMC Recognition Committee welcoming them. They praised the IM 2 academic activities including the B.Sc. (Anatomy) programme.

I was a good friend of U Win Mun, Head of Department of Burmese at MC 2 and I encouraged him to stage extempore speeches for the students and to publish a student wall paper.

And socially, I supported some students to have the fund necessary for their tuition or examination. I even allowed two students to live on my premises free of charge when they had difficulty finding a suitable place to live and study. They have graduated and now migrated to the USA.

Envoi

I learned a lot under Dena Colonel Ko Ko GYi and Professor H. Zaw Tun at Medical College 2 before I went to the UK. Professor Bowden was very much impressed with me when she found me working enthusiastically in her Department having learned all the basic techniques in Rangoon. She recommended me for Ph.D. after a probation period of 3 or 4 months. It was the happiest day of my life. It meant I matriculated for Ph.D. of the University of London. I was the first Burmese to get it in anatomy.

(The Romantic Padauk Flowers, Pterocarpus indicus)

Dean Ko Ko Gyi was transferred back to the Burma Army Medical Corps and he retired as a colonel in Rangoon. I met him whenever I was in Rangoon. Professor H.Zaw Tun has moved to Canada but I saw him once in the 1990s at IM 1 in Rangoon. I read his “Development of Larynx” article in a North American Journal of Anatomy. I also found him cited for the development of larynx in the UNSW embryology notes. Dr Norma saw died recently.

Some of my first students have become professors: Ma Khin Win (Anatomy), Khine San Yin (Pathology), Zaw Win (Surgery), Win Myint (Surgery) and his wife Khin Thein Oo (OG) etc. Many more have become top administrators like Tin Win Maung (Director-General), Hla Pe (Director) etc. I’m proud of them.

Dr Maung Maung Nyo

02.03.2009