Bangkok Anesthesia Regional Training Centre (Supported by the World Federation of Society of Anesthesiologists And the Royal College

of Anesthesiologists of Thailand) _________________________ Activity Report 1996 2008 _________________________ 1. Background and philosophy WFSA-RCAT Bangkok Anesthesia Regional Training Centre (BARTC) was developed by the initiation of Dr. Kester Brown (Australia), Dr. Robert Hare (Australia), Prof. Mitsugu Fujimori (Japan) who supported Prof. Thara Tritrakarn (President of the Royal College of Anesthesiologist of Thailand at that time) to set up a regional training centre in Bangkok, Thailand in 1996. The objective is to promote teaching and training of anesthetic personnel in developing countries in Asia by means of financial and educational support. The aim is to train future trainers to form a critical mass and enable them to teach more junior colleagues in their own countries and to reach the highest standard appropriate to their medical practice at home. The teaching program The program is a twelve-month structured teaching program and consists of lecture, discussion, bed side teaching and hand-on practical training of various anaesthetic techniques and care in the operating room and ICU. There are 20 lectures, 18 bed side topics and 8 special experiences. Lectures cover various aspects of physiology, anatomy, pharmacology and clinical anesthesia care of patients with common and uncommon diseases of the region. Trainee will participate in all departmental educational activities. Special experience includes CPR and advanced cardiac life support training, the use of library and medical informatics, opportunity to attend various medical congress or meeting in Bangkok and other cities, meeting and discussion with visiting professors or lecturers from abroad. Rotation Trainee spends their first 6 to 8 months in a participating university hospital to pave their basic and clinical knowledge and skill then rotates to 2 provincial hospitals. The practice in provincial hospital is closer to the practice at home of trainee. Trainee get more practical skill and knowledge that are more able to adapt or adopt when they go back home. With less competition for cases with Thai residents and students, trainee has the opportunity to do more manual skill in general and regional anesthesia. Trainees of the year 2006 class highly praised the provincial hospitals rotation. The duration for this rotation is then increased from 2 to 4 months to give maximum benefit to trainee in the year 2007 class. Trainee may request to spend more time in particular area of interest or home requirement i.e. pediatric, obstetric or cardiothoracic anesthesia during their rotation in the university hospital. Trainee from children hospital in Mongolia rotated to National Children Hospital for 2 to 6 weeks and evaluated that was very beneficial to them.

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Participating institutions With the support of the Royal College of Anaesthesiologists of Thailand, the Department of Anaesthesiology of 3 university teaching hospitals and 3 general hospitals have participated in this program since 1996. They are: 1. Faculty of Medicine Siriraj Hospital, Mahidol University 2. Faculty of Medicine Ramathibodi Hospital, Mahidol University 3. Faculty of Medicine Chulalongkorn Hospital, Chulalongkorn University 4. Chonburi Hospital, Chonburi Province, Ministry of Health 5. Ratchaburi Hospital, Ratchaburi Province, Ministry of Health 6. National Children Hospital, Bangkok, Ministry of Health Executive committee The executive committee consists of a director, an honorary secretary, chairman of anesthesia department and a co-ordinator of the 6 participating institutes. The officers of 20042007 are: Director: Prof. Thara Tritrakarn Siriraj Hospital Honorary Secretary: Prof. Jariya Lertakyamanee Siriraj Hospital Committee: Prof. Ungkab Prakanrattana Siriraj Hospital Assoc. Prof. Sureerat Srisawat Ramathibodi Hospital Assoc. Prof. Wanna Somboonviboon Chulalongkorn Hospital Assoc. Prof. Thitima Chinachoti Siriraj Hospital Assoc. Prof. Supranee Niruthisard Chulalongkorn Hospital Assoc. Prof. Wanawimol Saengchote Ramathibodi Hospital Assist. Prof. Orawan Phongraweewan Siriraj Hospital Assoc. Prof. Oranuch Kyokong Chulalongkorn Hospital Assoc. Prof Prasatanee Janthorn Ramathibodi Hospital Dr. Sunida Atichart Chonburi Hospital Dr. Wiroj Pengpol Ratchaburi Hospital Dr. Anchalee Attchoo Queen Sirikit National Institute of Child Health

WFSA support World Federation of Societies of Anesthesiologists (WFSA) provides financial support as scholarships to trainees to be trained at BARTC. Three scholarships were awarded each year in 1996, 1997 and 1998. The number has increased to 4 since 2000. The scholarship provides one round trip economic airfare, accommodation and living expense (same amount as the local Thai anaesthesia resident). There is no levy of tuition fee, no university charge. The participating departments receive minimal compensation for teaching and consumable training materials, e.g. cost of making slide, teaching material and handout, etc. Teachers, lecturers and tutors do not get any financial compensation for their extra work. All of them have been contributing on the basis of spirit and good deed to help other colleagues in the anesthesia profession to help their people.

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Entry requirement Applicants must be medically qualified, holding a perment post in a government teaching hospital, having had prior experience in full time anaesthesia for at least 3 years in his/her home country with or without enrolling in the formal training. They must have communicable spoken and written English language ability. Recognition and certification This is an important issue. Without proper certification, anaesthesiologists who have completed the training and returned home are not recognized as specialist even though they have gained considerable knowledge and skill. A WFSA Diploma of Anaesthesia (DA) would be ideal but WFSA Executive Committee ruled that WFSA is not a training institute and can not confer a degree or diploma. The matter was resolved by having BARTC, under the auspices of the Royal College of Anaesthesiologists of Thailand and the support of WFSA, issued a Diploma of Anaesthesia (DA) degree to the successful trainee who passed the evaluation process. The diploma was signed by the Chairman of Executive Committee or the President of WFSA, the President of the Royal College of Anaesthesiologists of Thailand and the Director of BARTC. The diploma is equivalent to a Master Degree in medicine. Evaluation The evaluation consists of a pre-test, formative and final summative evaluation. After 2 months of adaptation period, a pretest was done to evaluate the trainees back ground. This was used to tailor the training to individual knowledge and skill. Some of trainees have passed basic formal training at home but many countries in this region do not have formal training in anesthesia. Formative evaluation was given by the trainee mentors who judge their progress in learning, performance and clinical skill. It is given 60% weight in the final evaluation. The final oral and written examinations (MCQ) are the rest 40% weight. Overall problems 1. Language barrier is the major problem. English is not the trainees second language but is the third or fourth language after their native language, French or Russian. The ability to understand, read and communicate is therefore limited. Considerable time and effort is needed to teach and train them. The first and third classes were taught in Thai which was more comprehensible to Laotian trainees than English but it is still their third language. 2. Variation in the academic back ground and clinical experience of trainees cause difficulty in teaching them as a class. Some trainee has enrolled in basic anesthesia training at home but most of them have no formal training. Some has worked as general practitioner (GP) for over 15 years and some worked in anesthesia as apprenticeship for over 10 years without formal training. A tutor or mentor assigned to individual trainee is essential to help he/she get proper training and hands on experience. During the first 2-3 month, trainee is assigned to be attached to a teacher for 2-4 weeks and moved to another teacher to help trainee to improve their basic understanding and adaptation until they are comfortable with the new environment. 3. Clashing with the pre-existing residency training and training of nurse anesthetists. They competed for cases, for time and for attention of teachers. 4. Without knowledge of Thai language, trainees from abroad can not communicate with patient and can not read patients chart. This is a major hindrance of their learning. A local anaesthesia resident is usually assigned to help each of them. 5. All consultants have a very heavy workload. It is difficult for them to take extra load without any incentive or compensation. Even all participating teachers are willing to teach this extra class with high spirit of good deed but some kind of reward or recognition is needed.

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Post training follow up: by country Mongolia The 11 graduates from BARTC have formed a critical mass and have made dramatic improvement of anesthesia care and education in Mongolia. They introduced many new techniques to Mongolia e.g. spinal and regional anesthesia in children, parenteral nutritional support in children. The safety of anesthesia has been emphasized and reinforced. They have strengthened and unify anesthesia training in Mongolia. The training duration is going to increase from 1 year to 3 year program. They organized training courses for doctors and nurses. They setup pain clinic in Mongolia. They invited speakers from USA, Australia, Thailand and Korea to give refresher course in Ulaan Baatar. Dr Shagda Enkhtuvshin, the first Mongolian BARTC graduate and the head of the team has received the best doctor of the year award for 3 consecutive years. Laos PDR There are 12 Laotian trainees from BARTC. Four of them work in provincial hospitals in Laos and 7 work in teaching hospitals in Vientiane. They are important teaching team in anesthesia in Laos. The French government has launched 3 year training program in Laos with teaching faculties from France and hope that the local faculties will carry on later. Dr Traychit Chantasiri, the firs class graduate, received scholarship to continue his training in Luxemburg. He joined the French team to start doing cardiac surgery in Laos in 2005. Cambodia Seven graduates from BARTC work in teaching hospitals in Phnom Penh and 2 in provincial hospitals. They are active in anesthesia activities in their country. They help in organizing annual Cambodian national anesthesia meeting. Vietnam Three trainees from BARTC, 1 is working in teaching hospital in Hanoi. He is active and is an important force in organizing the 12th Asean Congress of Anesthesiologist in Vietnam. Another is working in a private hospital in Ho Chi Minh City. The last one immigrated to Australia in 2004 Myanmar All 3 graduates work in teaching Yangon General Hospital. They are important teaching force in Myanmar. Dr Soe Nyunt persuaded BARTC to hold the First WFSA-BARTC refresher course in Myanmar on February 1, 2007 Bhutan There are 2 trainees from Bhutan. One works in Thimphu, the capital of Bhutan. Another works in a provincial hospital in the eastern part of Bhutan. They are the only 2 Bhutan nationality anesthesiologists. Bhutan has no medical school, no specialist training. Imported doctors and anesthesiologist from India are the source of help. WFSA Refresher Course Refresher course is an effective way for transferring knowledge or new information to many people who have some background knowledge or information. BARTC organized many WFSA refresher courses in developing countries in Asia i.e. 1991 Hanoi, Vietnam 1993 Ho Chi Minh City, Vietnam

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1995 1998 1998 2004 2006 2007 Ho Chi Minh City and Hue, Vietnam Vientiane, Laos PDR Haiphong, Vietnam Phnom Penh, Cambodia Ulaan Baatar, Mongolia Yangon, Myanmar

Future plan The aim of helping future trainer anaesthetists from developing countries to enable them to train their junior colleagues in their home countries will be continued for at least another 4 years. A three-year anesthesia training program has recently been established in Nepal, Laos, Cambodia and Vietnam. The future trainees may have a higher academic background than those in the previous classes. The training program may have to be changed to suit the need of the trainees. Advanced training in subspecialty, e.g. cardiovascular, neuro, paediatric anesthesia, ICU, pain medicine will be available for them to choose. Some kind of certification or degree of advance training that will be recognized as higher than their local degree and higher than Diploma of Anaesthesia (DA) may have to be considered. Higher Certificate of Advanced Training may be an example. A mixture of trainees without previous formal training and those with 1 and 3 year training is expected. This will complicate the training and the evaluation. With good intention, high spirit and commitment, BARTC will try its best to make the program succeesful. Organizing WFSA refresher course in developing countries is a quick way of transfering updated knowledge or information to a big group of attendance. It is important to select the topics and content that is applicable and suitable to the need and the practice of anaesthetists in less affluent countries. They have limited equipment, drugs, money and human resource. BARTC will bring visiting and regional lecturers to the neighbouring countries in the future refresher course in Laos, Cambodia, Vietnam, Mongolia and Myanmar.

2. The classes
The first class (1996-1997) Three Laotians were awarded scholarships and successfully completed the program (June 1, 1996 May 31, 1997) and were awarded the Diploma of Anaesthesia from WFSARCAT-BARTC. They were: 1. Dr. Traychit Chanthasiri, Mahosot Hospital, Vientiane, Lao PDR 2. Dr. Sisongkham Phanmany, Mahosot Hospital, Vientiane, Lao, PDR 3. Dr. Vanpheng Norasingh, Mahosot Hospital, Vientiane, Lao, PDR They had 6-8 years experience in clinical anaesthesia in their home country but had never had formal training before coming to BARTC. They now returned to Lao PDR and are teaching their junior colleagues in Mahosot Hospital which is the major teaching hospital in Lao PDR. Thai language was used in this class. The Laotian doctors understand Thai language and read Thai textbook. The second class (1997-1998) Three scholarships were awarded to the second batch of trainee:

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1. Dr. Boualy Suvanavong, Mahosot Hospital, Vientiane, Lao PDR 2. Dr. Serey Seng, Phreah Kossamak Hospital, Phnom Penh, Cambodia 3. Dr. Kinh Nguyen Quoc, Viet Duc Hospital, Hanoi, Vietnam Only Dr. Boualy completed the program and was awarded the Diploma of Anaesthesia. Dr. Kinh attended the course for 3 months and left to attend a Ph.D course in Hanoi. Dr. Serey attended the course for 6 months and went home to visit his family in Cambodia in the middle of December 1997 and did not come back. Cambodia had political trouble and a mini civil war in October to December 1997. His resignation was received in February 1998. English language was used in this class. Language barrier caused difficulty in communication. Difference in academic background and clinical experience among the 3 trainees from different countries created a difficult problem in teaching and training. It was decided that the selection of candidate by their national society or authority was not appropriate. Candidates should be selected by merit of their background, experience and local situation in each country. Candidates should have similar background and clinical experience. The third class (1998-1999) The executive committee of BARTC organized WFSA refresher course in Lao PDR on March 25-26, 1998. They made a site visit and interviewed candidates for the third batch. Scholarships were awarded to: 1. Dr. Phiphorn Boonmala, Friendship Hospital, Vientiane, Lao PDR 2. Dr. Sithideth Sayavong, Savannakhet Provincial Hospital, Lao PDR 3. Dr. Vilayphone Kounlavong, Mahosot Hospital, Vientiane, Lao PDR They had 3-5 year clinical experience in anaesthesia but had never had a formal training before coming to BARTC. Thai language was used in this class. They joined the local Thai residents in lecture and all other teaching activities. They all completed the program and returned home. Dr. Sithidej is the only trained anesthesiologist in his province of Savannakhet. He is now chairman of department of anaesthesiology in his hospital and is responsible not only to giving anaesthesia but also training his young colleagues. The fourth class (2000) After reviewing and evaluating the previous 3 batches, the executive committee of BARTC decided to make a major change in the fourth class as the following: 1. Change the rota schedule to have each trainee start at one institution and remain there for 8 months. Trainee will get acquaintance and learn more from consultants. Subspecialty rotation, e.g. cardiovascular, pediatric, neuroanesthesia, etc, can be arranged according to trainees interest and performance. A month rotation to three different institutions is arranged to give the trainee the opportunity to get exposure to different clinical setting and teaching. They will meet more consultants in Thailand which will be helpful for future co-operation. A month rotation to a provincial hospital is also provided to give the trainee the opportunity to expose to the practice more similar to their home practice. 2. Rearrange teaching topics to be 20 lectures, 18 bed side topics and 8 special experiences to be more compact and to facilitate more comprehensive discussion in the operating room and stimulate more self study. 3. Change the starting date of the class from June to January. This is to avoid clashing with the start of the first year residency training on 1st June in each institute. It will allow consultants to have more time to spend with the trainees of BARTC. The new opening of the class applied from the 4th class of the year 2000. 4. A consultant will be assigned to take care of each trainee for 1 to 3 months and rotates to other consultants through out the year to make sure that they will get proper training and are well looked after. 5. English will be used in the fourth class.

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Four scholarships were awarded to anaesthesiologists to train at BARTC as the fourth class. They are: 1. Dr. Enkhtuvshin Shagdar, Maternal & Child Health Research Center, Ulaan Baatar, Mongolia 2. Dr. Sithan Ky, National Pediatric Hospital, Phnom Penh, Cambodia 3. Dr. Kim Anh Le Thi, Danang General Hospital, Danang, Vietnam 4. Dr. Hoang Truong Thanh, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam All of them have 4-5 years prior experience in anaesthesia. Dr. Enkhtuvshin and Dr. Le Thi completed their specialization course at home before coming to BARTC. All 4 trainees completed the training, received Diploma of Anesthesia and returned home and help improving anesthesia practice and teaching at home. Dr. Enkhtuvshin Shagdar has made great contribution in improving anesthesia standard in Mongolia. Prof. Choijamts Gotto, Director of Maternal & Child Health Research Center, Ulaanbaatar, Mongolia reported that she introduced 24 new techniques learned in Thailand to Mongolia. She organized the First National Anesthesia Meeting in Mongolia in 2001. She invited a group of anesthesiologists from Mayo Clinic, USA (led by Prof. Sait Tarhan) to join the Second National Meeting in 2002. She was awarded Best Doctor of the year 2002. She is planning a project training of nurse anesthetist in Mongolia as she has seen in Thailand. In 2003 she was again awarded Best Doctor of The Year. She organized and made several short VDO presentations on children safety which were repeatedly shown on the Mongolian National Television in 2003. She received a scholarship from Chung Num University to further her study in Korea for 6 months in 2004. Prof Choijamts Gotto also reported that they have organized a conference presented by physicians who had training in Thailand which gathered over 70 anesthetists. They also set up Thai Mongolian Students Association in 2003. Thank to WFSA for supporting this educational activities. The fifth class (2001) Four scholarships were awarded to 1. Dr. Bayarsaikhan Bazardargia, Anaesthesiology and Intensive Care Department, Maternal and Child Research Medical Center, Ulaanbaartar, Mongolia 2. Dr. U Soe Nyunt, Department of Medical Sciences Institute of Medicine (1) and Yangon General Hospital, Yangon, Myanmar 3. Dr. Sonephet Phomma, Anesthesia, Champasak Provincial Hospital, Champasak Province, Lao PDR. 4. Dr. Amphanh Xaypangna, Anesthesia Department at Pakse Hospital, Pakse, Lao PDR Dr. Sonephet and Dr. Amphan were from Southern Laos. When they returned home, they are the important force in improving anesthesia practice in Southern Laos. Dr. Soe requested and had training in thoracic anesthesia for 4 months to prepare himself to be posted to work in a chest hospital in Yangon, Myanmar. All of them completed the course and received DA. The sixth class (2002) The 4 WFSA scholarships were award to 1. Dr. Myagmar Ariuntungalag, Dept. of Anaesthesiology, Pediatric Surgery Clinic, Maternal and Childrens Health Research Center, Ulaanbaatar-24, Monglolia 2. Dr. Garjaman Rai, Riserboo Hospital, Trashigang District, Eastern Bhutan, Bhutan 3. Dr. Sovonnarith Chhay, National Pediatric Hospital, Russian Federation Blv., Khan Tuol Kork, Phnom Penh City, Cambodia 4. Dr. Phonexay Somsaath, Anesthesia service, Mahosot Hospital, Vientiane, Lao PDR.

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The Government of Thailand awarded a scholarship to 5. Dr. Phouva Photilak, Sayaburi Hospital, Sayaburi Province, Lao PDR. The Japan International Co-operation Agency (JICA) of Cambodia awarded a scholarship to 6. Dr. Te Kuy Chiv, National Maternal and Child Health Center, Phnom Penh, Cambodia Dr. Garjaman Rai has never had any experience in anesthesia. He was a general practitioner for over 15 years. He was the first Bhutan doctor to have anesthesia training and was the first anesthesiologist in Eastern Bhutan. Dr. Phouva Photilak worked in a remoted Provincial Hospital of Sayaburi. Five trainees completed the course, passed the examination and received DA. Dr. Phonexay Somaath dropped out after having 3 months of training due to family problems. They all returned home working for their people and their countries. The seventh class (2003) The scholarship was given to 2 Mongolian and 2 Cambodian anesthesiologists. They are: 1. Dr. Boldbaatar Odgerel, Dept. of Anesthesiology and Intensive Care, Pediatric Surgery Clinic, Maternal and Children Health Research Center, Ulaanbaatar-24, Mongolia. 2. Dr. Bayalagmaa Khuvtsagaan, Dept. of Anesthesia and Intensive Care, First Central Clinical Teaching Hospital, Ulaanbaatar, Mongolia. 3. Dr. Chin Kosal, Preah Bat Norodom Sihanouk Hospital, Phnom Penh, Cambodia. 4. Dr. Chan Dara, Svay Rieng Hospital, Svay Rieng Province, Cambodia. The four trainees have settled well in Bangkok in January 2003. Unfortunately, there was a violent racial exasperation in Cambodia in February 2003. The Royal Thai Embassy in Phnom Penh was burnt down and Thai people fled from Cambodia. The Thai Government severed the political tie with Cambodia and expelled Cambodian from Thailand. We had difficult time in obtaining permit for the 2 Cambodian anesthesiologists to continue their staying in Thailand. Fortunately, the political tension resolved in a relatively short time of a few months and they were allowed to stay until completing of the training. Father of Dr Bayalagmaa Khuvtsagaan who had lung carcinoma became critically ill in November 2003. She was allowed to take the final examination 1 month before the other trainees. She returned home and lived with her father in the final week of his life. The other 3 trainees passed the evaluation and graduated on December19, 2003. They all returned home to work in their home countries. The eighth class (2004) The scholarship was given to 2 Mongolian and 2 Cambodian anesthesiologists. They are: 1. Kherlen Ponkhoon, Maternal and Child Research Center of Mongolia, Ulaan Baatar 24, Mongolia. 2. Dr Regjii Bazarragchaa, Sukhbaatar District University Hospital, Ulaanbaatar, Mongolia 3. Dr Chan Sovandy, Preak Kossamak Hospital, Phnom Penh, Cambodia 4. Dr Kol Virin, Preah Ang Duang Hospital, Phnom Penh, Cambodia. The 2 Mongolian anesthetists had completed their formal one and a half year basic training in anesthesia at home but the 2 Cambodian have 3-4 years working experience in operating room and anesthesia but never had any formal training in anesthesia before coming to BARTC.

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They all had settled well and made a good adaptation to the new place and new environment. They were enthusiastic and making good progress in their training. All of them completed the training and passed the evaluation, received the Diploma and returned home. Dr Chan Sovandy persuaded the teachers to visit Cambodia and joined the Annual Meeting of the Cambodian Society of Anesthesiologists and Reanimation in November 2004. Four members of the Executive Committee of BARTC visited Phnom Penh on November 19 22, 2004. They gave lectures at the Meeting , made a site visit to 5 hospitals where the alumni of BARTC work. The ninth class (January 15, 2005 January 14,2006) The scholarships were given to 4 anesthesiologists from Bhutan, Cambodia, Mongolia and Myanmar. They were: Dr Deepak Tamang (M, 45) J.D.W. National Referral Hospital, Bhutan Thimphu, Bhutan e-mail: deetam91@yahoo.co.uk Dr. Moe Thu Lin (F, 39) Anesthesiology Department, Myanmar Myanmar Yanggon General Hospital Yangon, Myanmar Phone: 95-1-256112 (ext.857) Dr. Bilegmaa Demberel (F, Department of Intensive Care Unit , National Mongolia 37) Cancer Center, Ulaabaatar-48, Mongolia E-mail: bilegmaa_01@yahoo.com Seng Sakal (M, 39) Preah Kossamak Hospital Street 271 Sangkat Cambodia Toul Kork II, Khan Toul Kork Phnom Penh Dr Deepak Tamang is an Indian and married to a Bhutan wife. He has settled in Bhutan. He has been working as an emergency surgical general practitioner for over 20 years. He appreciated the need and extreme shortage of anesthesiologist in Bhutan. He decided to take a carrier as anesthesiologist. He has never had any training in anesthesia before. They all completed the training and passed the evaluation and returned to work in their home countries. The tenth class trainees The tenth class training of BARTC began on January 15, 2006 and ended on January 14, 2007. There are 5 trainees in this class. Their names are the following: Dr. Erdenedalai Altaikhuu Dr. Mungun Banzar Dr. Enkhtsetseg Dorjpalam Dr. Bounnheun Khaykhamphithoune Dr. Maung Maung Swe Dept. of Anesthesiology, The Shastin Central Hospital, Bayangol duureg, Ard Ayushiin gudamj-1, Ulaanbaatar, Mongolia Maternal and Child Medical Research Center of Mongolia, Amarsanaa Street, Bayangol District, Ulaanbaatar-24, Mongolia Dept. of Anesthesiology and Intensive care Medicine, Central Clinical Hospital II, Ulaanbaatar, Mongolia Dept. of Anesthesiology, Mahosot Hospital, Vientiane, Lao PDR. Medical Officer (Anesthesia), Department of Anesthesia, Yangon General Hospital Mongolia Mongolia Mongolia Lao Myanmar

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The first four of them were sponsored by WFSA and the last one was supported by WHO. Three of them are anesthesiologists from Mongolia, one from Laos and another from Myanmar. All of them have spent their 8 months rotation in a participating university hospital. They rotated to 2 provincial hospitals for 1.5 month each. Language barrier is the most important problem of the 4 trainees except Dr Swe from Myanmar who has good command of English. Back ground knowledge of Dr Swe and the 3 Mongolian is much higher than the Laotian. These problems make the teaching and training very difficult. Anyhow all of them have made significant progress in their training. They passed the exit examination in December and were conferred a Diploma of Anesthesia Degree. All of them returned home. WFSA-BARTC Refresher course was held in Ulaan Baatar, Mongolia on July 24 -25 , 2006 with 104 participants. Prof Annekhe Meursing, President of WFSA and Prof Thara Tritrakarn were the leaders of the team. We visited 5 hospitals in UB and a provincial hospital in Tuv province. The visitors were very impressed by the contribution the former trainees of BARTC have made to their country. They have significantly improved anesthesia care and education in Mongolia. Full report is attached. The eleventh class trainees The WFSA scholarship was awarded to 2 Mongolia, one Cambodia and another from Vietnam. The eleventh class started on January 15, 2007. Their names, hospitals and countries are the following: Dr. Dulamragchaa Department of Anesthesiology and Intensive Mongolia Chimedbazar Care, Pediatric Surgical Clinic, Maternal and Child Medical Center E-mail: bazaraal@hotmail.com Dr. Khajidmaa Anesthesiology and Intensive therapy General Mongolia Tumendemberel Hospital of Murun soum Khuvsgul province, Mongolia Dr. Nguyen Ngoc Tuyen Anesthesiology Dept., Vietnam-Czech Vietnam Hospital, No. 1 Nha Thuong Stree, Haiphong, Vietnam E-mail: tuyen_gmhs@yahoo.com Dr. Ay Sovuth Preah Kossamak Hospital Street 271 Sangkat Cambodia Toul Kork II, Khan Toul Kork Phnom Penh The 2 Mongolians had attended 1 year training course at home. The Cambodian and the Vietnamese have worked in anesthesia for 3 and 5 years but had never attend any formal training course. All trainees spent the first 6 months in the assigned university hospital and rotated to Chonburi and Ratchaburi Hospital for 2 months each and came back to the university hospital to prepare for the final examination. All trainees had the opportunity to attended the 15th AEAN Congress of Anesthesiologists at Pattaya on November 10-13, 2007 and the Annual Scientific Meeting of Siriraj Hospital on March 5-9, 2007. All trainees have made a good progress in their training and passed the examination. The graduation and conferment of the Diploma of Anesthesia (DA) was on December 18, 2007. One of the trainee ( Dr Khajidma Tumendemberel) developed acute abdomen in September. She was admitted and had a laparoscopic gynecological surgery. She had no insurance coverage and could not afford. BARTC shouldered the investigation expense (27,005

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Baht) and Siriraj waved the surgery cost. The medical insurance coverage should be added in the scholarship. The twelfth class trainees The scholarships were awarded to one Myanmar, 3 Mongolians. Their names, hospitals are the following: Dr Aung Htet completed basic training at home and received M.Med.Sc. (Anaesthesiology) from University of Medicine(1), Yangon. The three Mongolians had one year training in anesthesia and 2 to 5 years experience in anesthesia and intensive care. Summary The WFSA Bangkok Anesthesia Training Center has trained 44 trainees from developing countries in Asia since 1996. Thirty seven completed the training and graduated, 3 dropped out. Four of them are currently in the training. Twelve of them are from Laos, 13 from Mongolia, 10 from Cambodia, 4 from Vietnam, 3 from Myanmar and 2 from Bhutan. __________________________________________________________

3. Name and address of BARTC trainees by year of training (1996-2007)

1st Class (June 1, 1996 May 31, 1997) Dr. Traychit Chantasiri, Department of Anesthesiology, Mahosot male, Hospital PO Box 7692, Vientiane Lao PDR Tel. (856-21) 223067 Dr. Vanpheng Norasing, Department of Anesthesiology, Mahosot female, Hospital PO Box 7692, Vientiane Lao PDR Tel. (856-21) 223067 Dr. Sisongknam Phanmany, Department of Anesthesiology, Mahosot male, Hospital PO Box 7692, Vientiane Lao PDR Tel. (856-21) 223067 Lao PDR Lao PDR Lao PDR

2nd Class (June 1, 1997 May 31, 1998) Dr. Boualy Suvanavong, Department of Anesthesiology, Mahosot male, Hospital PO Box 7692, Vientiane Lao PDR Tel. (856-21) 223067 Dr. Serey Seng, male Intensive and Anesthesia Unit of Preah Kossomar Hospital, Phnom Penh, Cambodia Dr. Nguyen Quoc Kinh, male Department of Anesthesiology, Viet Duc Hospital, No.40-Trang thi Str, Hanoi, Vietnam

Lao PDR

Cambodia Vietnam

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3rd Class (June 1, 1998 May 31, 1999) Dr. Phiphorn Boonmala, Mithaphap Hospital, putting Anesthetic Lao PDR male, and refueling Section , Vientiane, Lao PDR. Tel. 856-41- 3306 Dr. Sithideth Sayavong, Anesthesiology service Savannakhet Lao PDR male, Provincial Hospital, Lao PDR. Tel. 856-41-212171 Fax : 856-41-212731 Dr. Vilayphone Kounlavong, Department of Anesthesiology, Mahosot Lao PDR female, Hospital PO Box 7692, Vientiane, Lao PDR Tel. (856-21) 223067

4th Class (January 15, 2000 January 14, 2001) Dr. Houng Troung Than, Department of Anesthesiology of the male, University of Medicine and Pharmacology in Ho Chi Minh City Binh Dan Hospital, HCMC, Vietnam Dr. Le Thi Kim Anh, female, Department of Anesthesiology, Danang Hospital, Danang City, Vietnam Dr. Sithan Ky, male, Surgical Department, National pediatric Hospital, Phnom Penh City, Cambodia Dr. Shagdar Enkhtuvshin, Maternal and Child Research Centre, female, Ulaanbaatar, Mongolia

Vietnam

Vietnam Cambodia Mongolia

5th Class (January 15, 2001 January 14, 2002) Dr.Bayarsaikhan Bazardargia, Anesthesiology and Intensive Care male, Department, Maternal and Child Research Medical Center, Ulaanbaatar, Mongolia Dr. U Soe Nyunt, male, Department of Medical Sciences Institute of Medicine(1) and Yangon General Hospital, Yangon, Myanmar Dr. Sonephet Phomma, male, Anesthesia, Champasak Provincial Hospital, Champasak Province, Lao PDR. Dr. Amphanh Xaypangna, Anesthesia Department at Pakse Hospital, male, Pakse, Lao PDR.

Mongolia Myanmar Lao PDR Lao PDR

6th Class (January 15, 2002 January 14, 2003) Dr. Myagmar Ariuntungalag, Dept. of Anesthesiology, Pediatric Surgery female, Clinic, Maternal and Childrens Health Research Center, Ulaanbaatar-24, Mongolia Dr. Garjaman Rai, male, Riserboo Hospital, Trashigang District, Eastern Bhutan, Bhutan Dr. Sovonnarith Chhay, male, National Pediatric Hospital, Russian Federation Blv., Khan Tuol Kork, Phnom

Mongolia Bhutan Cambodia

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Penh City, Cambodia Sayaburi Hospital, Sayaburi Province, Lao PDR. Dr. Phonexay Somsaath, Anesthesia service, Mahosot Hospital, female Vientiane, Lao PDR. National Maternal and Child Health Center Dr. Te Kuy Chiv, male, P-O-BOX 113, France Street, Sangkat Srah Chak, Khan Daun Penh, Phnom Penh, Cambodia Supported by Government of Thailand Supported by JICA Dr. Phouva Photilak , male, 7th Class (January 15, 2003 January 14, 2004 Dr. Boldbaatar Odgerel, Dept. of Anesthesiology and Intensive Care , female, Pediatric Surgery Clinic, Maternal and Children Health Research Center, Ulaanbaatar-24, Mongolia Dr. Bayalagmaa Khuvtsagaan, Kh. Bayalagmaa, Anesthesiologist, female, Department of Anesthesia and Intensive Care, First Central Clinical Teaching Hospital, Ulaanbaatar, Mongolia Dr. Chin Kosal, male, Preah Bat Norodom Sihanouk Hospital, Street 271, Sangkat Tum, Nuptek Khan Chamkamon, Phnom Penh, Cambodia Dr. Chan Dara, male, Svay Rieng Hospital, Svay Rieng Province, Cambodia Lao PDR Lao PDR Cambodia

Mongolia

Mongolia

Cambodia Cambodia

8th Class (January 15, 2004 January 14, 2005) Dr. Kkherlen Ponkhoon, Dept. of Anesthesiology, Maternal and female, Children Health Research Center of Mongolia, Ulaanbaatar-24, Mongolia Dr. Regjii Bazarragchaa, male, Dr. Chan Sovandy, male, Dept. of Anesthesiology, Sukhbaatar district, University Hospital, Mongolia Preak Kossamak, Street 271, Sangkat Thelkork II, Khan Thou Kork, Phnom Penh, Cambodia Operating Room, Preah Ang Duong Hospital, Battambang Province, Cambodia

Mongolia

Mongolia Cambodia

Dr. Kol Virinn, male,

Cambodia

9th Class (January 15, 2005 January 14, 2006) Dr. Demberel Bilegmaa, Anesthesiologist and reanimatologist of female, Intensive Care Unit in National Cancer Center of Mongolia, Ulaanbaatar-48, Mongolia Dr. Moe Thu Lin, female, Department of Anesthesiology Yangon

Mongolia

Myanmar

14
Dr. Deepak Tamang, male, Dr. Seng Sakal, male, General Hospital, Myanmar Casualty Department, JDW National referral Hospital, Thimphu, BHUTAN Preak Kossamak, Street 271, Sangkat Thelkork II, Khan Thou Kork, Phnom Penh, Cambodia Bhutan Cambodia

10th Class (January 15, 2006 January 14, 2007) Dr. Erdenedalai Altaikhuu, Dept. of Anesthesiology, The Shastin male, Central Hospital, Bayangol duureg, Ard Ayushiin gudamj-1, Ulaanbaatar, Mongolia E-mail: erdenedalai0086@yahoo.com Phone home:-680368 Phone mobile:-99870086 Dr. Mungun Banzar, female, Maternal and Child Medical Research Center of Mongolia, Amarsanaa Street, Bayangol District, Ulaanbaatar-24, Mongolia E-mail: munguu_banzar2005@yahoo.com Phone mobile:-99132197 Dr. Enkhtsetseg Dorjpalam, Dept. of Anesthesiology and Intensive care female, Medicine, Central Clinical Hospital II, Ulaanbaatar, Mongolia E-mail: ee_dr2003@yahoo.com Phone mobile:-97699177817; 97611301355 Dr. Bounnheun Dept. of Anesthesiology, Mahosot Hospital, Khaykhamphithoune, female, Vientiane, Lao PDR. E-mail: Bounnheun.k@ahoo.com Phone mobile: 009 856 7708547 Phone home 009 856 21412145 Dr. Maung Maung Swe, male, Medical Officer (Anesthesia), Department of Anesthesia, Yangon General Hospital Email: maungswe@yahoo.com Phone : 00995117815 HP: 0951 583676

Mongolia

Mongolia

Mongolia

Lao

Myanmar

11th Class (January 15, 2007 January 14, 2008) Dr. Dulamragchaa Department of Anesthesiology and Intensive Chimedbazar, female, Care, Pediatric Surgical Clinic, Maternal and Child Medical Center E-mail: bazaraal@hotmail.com Dr. Khajidmaa Anesthesiology and Intensive therapy General Tumendemberel, female, Hospital of Murun soum, Khuvsgul province, Mongolia Dr. Nguyen Ngoc Tuyen, Anesthesiology Dept., Vietnam-Czech male, Hospital, No. 1 Nha Thuong Stree, Haiphong, Vietnam

Mongolia

Mongolia Vietnam

15
E-mail: tuyen_gmhs@yahoo.com Dr. Ay Sovuth, male, Preah Kossamak Hospital Street 271 Sangkat Toul Kork II, Khan Toul Kork Phnom Penh Cambodia

The 12th class Dr. Aung Htet, male 33 yr

Anesthesiology and intensive care unit, Yangon General Hospital, Yangon, Myanmar Dr,Unurzaya Department of Anesthesiology, Sonsonyagalan, female, 33 Second General Hospital, Peace Avenue, Ulaan Baatar Dr. Bolormaa Batnasan, National Cancer Center, Nam Yan Ju female, 33 Street, Bayar-Zurkh district, Ulaan Baatar Dr.Amarzaya Tsedevdorj, Department of Anesthesiology, State female, 33 Research Center of Maternal and Child Health, Ulaan Baatar 4. BARTC trainees by country (1996-2008)
Total Lao PDR Cambodia Mongolia Vietnam Myanmar Bhutan Total 12 10 16 4 4 2 48 Graduated 2007 12 10 13 4 3 2 44

Myanmar Mongolia Mongolia Mongolia