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Good morning, everyone. We're going to start in three minutes. Ok. Yeah. Yeah. Ok. That's fine. Ok. Hello. Um Good morning, everyone. My name is May and I'm going to be the conference coordinator for you guys today. So, um I would like to say thank you and um welcome to the healing in conflicts conference. Uh It is such a pleasure to see so many familiar faces as well as the new ones both here in person and joining us online. Um Today, we brought together a remarkable group of people, um visionaries, innovators and change makers who are all united by a shared passion for transforming health care in the most challenging circumstances. So, first of all, a big thank you to the Royal College of Surgeons of England for their incredible support in making this conference happen to our brilliant speakers. Uh Thank you for uh being here to share your knowledge and um experiences with us and um to all our ha hardworking uh organizers, you've outdone yourself. And of course, um to all of you are wonderful uh attendees. Thank you for uh taking the time to be part of this special event. So we hope this conference um not only uh inspire but also spark meaningful conversations and connection. So let's keep this uh interactive and engaging. So, feel free to ask questions at the end of each presentation and uh share your thoughts. Um Let me remind you that the toilets and the loggers are on the left hand side of this conference room. And um you can also find the fire exit and assembly point for the emergencies on the right hand side of this conference room. OK. So to kick things off, it is my absolute honor to invite doctor that clinical fellow in trauma and orthopedics at university hospitals, Dorset to deliver the opening speech. So doctor Wu the stage is yours. Good morning, everyone. Thank you for coming and joining us in this conference. So, but before I start, uh I would like you to send my GRA to, to Royal College of Surgeons England and Metal for helping us with this conference. Uh So first, before we go for what's happening in Myanmar, lots of people don't know where Myanmar is. So whenever we introduce ourselves, we're from Myanmar or Burma, nobody knows. And we have to name our neighboring countries or someone they might know so that they know where we're from. So, right, so what's happening in Myanmar right now? So back in 2021 there is a military coup happened, the military junta for took control of the country from the elected government entertain them. So this has not to peaceful protests against this military coup nationwide. Everyone from all sectors, med medical medicine, engineering, all and all the government sectors. They started to protest and they started a movement called civil disobedience movement, which we call it the CDM to recheck the military reign over the country. This movement has become a foundation of Myanmar Spring Revolution and the remaining members of the elected party, they form a government, a shadow government called the national unity government to fight against this military junta in terms of diplomacy and international relations. So later on, people realize that protests against this military is not going to do anything or help to liberation. So many people leave their loved one behind, love families, their jobs and they joined the ethnic organizations, the armed organizations to fight back the gov this military government. So yeah, this is the example news of what the military agent has done to the country. So the they do airstrikes to everywhere. So this is one of the city called MTA when where they just on the city, right. So there are also medics who try to aid the wounded in these crackdowns and stuff. These medics are also get the day, get shot and leading many of them to join the ethnic forces to help to provide health care in this revolution. So with most of the medics has gone to these areas, it has led uh a quite collapse in this health system in Myanmar. So countless number of air strikes across the country since uh 2021 lead, aiming at civilians hospitals resulting in a large number of casualties and internally displaced people. So these these images are taken from a youtube channel which they did the documentary in the hospital in these areas. So giving healthcare is a challenge for us a third world country and imagine providing healthcare in this area with very limited resource, manpower support, technology, it could have been unimaginable. So this church is also another casualty uh like the mill people who have set this fire on this church and whoever tried to help uh stop the fire, they were either get shot pain and they do put land mines so that nobody can help. So these issues, they're not just limited to our own country. If you look at the world, there are many wars going on, Ukraine Gaza, et cetera and by sharing the knowledge, everyone might have encountered this conflict at some point by sharing knowledge and this experience and we hope we can get a better idea of healthcare to provide in these areas. Thank you and welcome to the conference. Thank you for your incredible speech. Uh Doctor Tau. So um our first speaker is Mister Yoko, a general surgeon from Myanmar and a pivotal leader in the civil disobedience movement as a clinical director of Luke Hospital and president of the Doctors Society of Kan he has tirelessly worked to deliver health care in the conflict zones. His talk today, Jungle Operations and Freedom Journey will give us a glimpse into the resilience and the ingenuity required to establish healthcare systems in forest locations during the Myanmar revolution. So before we begin, uh please be aware that some of the images in this presentation include uh se open wounds which may be sensitive for some viewers. So please join me in welcoming M Yo Koko. Yeah, Lima, we are now starting. Would you mind sharing the screen as like we did yesterday? Sorry. Yeah, our introduction. Finish a little bit early. Huh? Yeah. To uh hello, good morning, ladies and gentlemen. Um you can go go uh Chief Sergeant and Glen G of Blue Hospital and president of the Delta Society are currently and president of uh currently Medicare College. Nice to meet you all. Uh Today, I would like to praise them Zenger operation in the freedom Germany test also take weeks. Yeah. Yeah. Uh Hello mister T and, and can you see uh my power point? Yes, ago. We all can see your bob. Why and we all can hear your voice clearly. Thank you so much. OK. Thank you. And uh uh there is a our bone shelter in the jungle and in early 2022 we have no anesthetic. So I'm put into some operation like craniotomy. Uh did major trauma like hemoton uh splenotomy, splenic Gonal surgery. R Gonza surgery got perforation by high spinal anesthesia at that time. Not easy for me. Uh I have played two roles. I have done not only operation but also an aesthetic role. It require. Luckily we have no mortality at that early era, mid 2022 1. And I started drawing with us with the head and I started, I got to head to toes, operation including traumatic brain injury, craniotomy, eye trauma, surgery, light cornea and anation, sun operation. Thom trigger injury, open thoracotomy and abdominal surgery, trauma. Do gi hepatobiliary spleen, urinary tract, major vessel repair, et cetera and uh orthopedic operation like external position and the bone in fracture. I have done not only trauma but also nontrauma operation. I breast gi hepatobiliary urological operation and otic and gynecological operation and do all operations. At first. No other specialty in Jangle. Only one sergeant in general hospital up to the NRD 2022 in 2023. 1 OG and my engineer sergeant reach in 2024 2. Auto sergeant. Re uh we have done all orthopedic operation before they reach and I would like to present some case series case 126 year old man civilian from one of the IDB camp all currently chaos state, Myanmar. Uh he had golf uh led by injury to sh from the Obama military on June 2024 on arrival. The patient was with shock was 10 on examination let open chest wound back. My junior daughter closed the wound and placed uh in intercourse, the drainage too. At that time, I was not in the hospital. They told me that there was coming out pieces all from wound. I thought it was not possible because the patient was stable and not masses blood in underwater sea border. When I saw, I asked my junior, what about lockdown or diaphragm? He said, ok, I instructed them what to do next. Just a three atrial abdomen, ap and lateral. And first scan in general, we have no CT scan. So we have constructed trauma pattern and what organs that made by clinical features? H three and ultrasound on just 3 g diaphragmatic hernia on left side and first is positive. And so I had decided to do laparotomy, an operated finding. Uh there were greatful injury and left, left tear and herniation uh into five centimeter. Uh ma hemo and I had to do splintery and repair all diaphragm. Um Second operation was done. Y from primary back in focus uh at fast weight and daily dressing for may do this stand. But the patient became more and primary but was deteriorated with skin and muscle necrosis. You can see this photo. There is a necrosis of the back. Bone Deb was done, necrotic skin and marker was placed on the left cavity piece of the left lung was removed one side was three centimeter in dimension. Uh new intercourse was inserted, uh, base of the left lung because there was a risk of pass col. Then in this photo, there is a, uh you can see uh base of the left lamb then who was slow bad by, as there was tension in W plus what coming on from ICD 2, 200 to 300 M per day. And by more was again in bad w in Facebook or day of second operation. At that time, I have decided to do careful dressing, quick dressing with the go back covering uh to prevent all I have thought future plan. It wound his master flood or ac string uh plastic bag to cover the wound. Luckily, the wound was closed and second secondary to child was 10. We my finally the patient was discharged due the admission days were 51 days and this is my second time open chest operation in jungle uh dis patient and is her sister B Atlanta. Uh She's also my patient for uh a directed to me at the same time of her brother admission case. 211 year old boy with head injury, brain tissue exposed due to the Ner by Ry at 16, November 2023 his father was dying on the spot by the sign were OK to pass. And li present D CS 12 and 15 brain tissue was in the right frontal brighter region, the midline. And uh there are also and there were also left sided hemiplegia, a scar, xray depress scar file in right fronto brighter bone. Uh You can see in this photo uh there's a depressed scar fragment. Operation was done, wound debridement, remove depressed bone fragment and send hematoma. Uh And uh the operation is a uh uh evaluation of the uh uh side hematoma drain was inserted and SCAT was low back. Now. Um POSTOP day two, the blind was D CS 5950 he had cry and sad, please cause my dad we have no answer because his father was dying in a strike. Last time, the weakness was still present. So we found him reha rehabilitation center after 12 postop days after one man, he had done hand grid and wolf powerful by five and he's smiling now history 21 year old man with right but injury due to Shaner at 14, November 2023. Uh due to the nerve of the heavy weight on arrival, the patient was in shock. After resuscitation, the patient was stable. A three abdomen. I elect 40 body present in the right side to the L1 and F and positive preoperation was done re thinking according to the plan plate H three abdomen and ultrasound, fall body is present in the right to the L1 in H three and uh venous hematoma in ultrasound. So the main problem was around the right kidney bland renal consulting surgery or nephrectomy inter findings. The patient was stable. So I just out intraabdominal injury before going to the right kidney all OK by one and zone two, right sided hematoma, right? Renal illustration bra high was done but was all caught around the high I decided to do right. Nephrotomy for central hematoma continued to explore. Uh have you ever seen water pumping from that? Yes. Just like that. The blood was coming out from the inferior. It was the first time in my life. At the same time, the danger sound was had over my head. So just as part of my rea I thought ran out ST another time. We will run as hard as the just sound, the bone shut. But at that time when I was in my hand while I'm pressing the bleeding boy, I have known that I can run because I have my life all my life. But I couldn't, my head can start to lose any life due to coo they are young and valuable life will not lose if there is no coup. We all other team members were afraid of this sound, but we all will continue the operation inferior. We not give an injury approximately in our junior uh who was planned with certain skin forces. Another bleeding point from your to repair first by 50 proline. Then IVC was repaired by 50 pro. This was very anxiety moment, 5 to 10 times pro few bleeding from IVC during repel and to 10 units. Of blood work, trust you. There is a intra no and uh and here we have a long, long and your aorta partially tell your breath. Now, the patient is OK. One man show uh at first, uh there is only, there was only one surgeon in our hospital, so I have to do all operation. This is a multi injury patient. He has a landmark injury is uh left leg is already amputated and uh right left, very severe injury and very dirty one and also have a uh uh scrotal injury, hemo and the right eye injury. So there there were mo injury. So I have decided to do what operation uh was done first. Uh uh I had tried the most dangerous for life. So I have done uh laparotomy fast for hemoton. Uh in LA in laparotomy, there were three I operation and the right urethral injury. So I have 10 repair I and the repair all uh right, uh urethra and all the uh 10 a frame uh feeding to uh to prevent venous uh ureter stenosis uh because we have no them. And then uh I have turned the uh the left above knee amputation and uh uh wound of the right left as right left and right eye and then the uh go uh laceration. Uh There is a uh uh split skin graft. Now, the patient is OK. And again, the chest now and traumatic brain injury. Uh there is a one of traumatic brain injury. Uh He has also attacked by the uh Habiba uh on arrival. Uh His G CS is 10 by 15 and, and his uh vision was lost. Uh and there was a deep breath uh scar fracture on uh a three and uh brain tissue exposed. There is uh his photo brain tissue was exposed and uh deep breath scar fracture on inter finding there is a uh brain tissue exo uh depress scar fracture on the uh right and O bone and uh sub hematoma. So I have uh them, the one man uh remove all the um uh depress scar fragment and the evacuation of the uh hematoma. Uh After two days, his vision was cut bad and uh his G CS is 15 by 15, but uh last Friday weakness uh was still present. Uh This video is after one month video, he can walk and this uh uh second piece of the uh uh traumatic brain injury, uh scar fraile and uh uh a hematoma and sat hematoma. Uh uh he, he was due to uh attacked by the on arrival. His GG uh his G CS uh was done by done by 15 and uh left sided uh he hemiplegia was, and this photo is uh this photo is after 10 day of operation. Uh He can walk uh and uh right-sided, sorry, left-sided. Uh FP was present after one year. Uh Is he he is all OK. With no neologic. There is another, just a focus of brain injury surgery. Uh There is another case of the traumatic brain injury, uh foreign body in situ and depressed scar fracture on the frontal bone. Uh So I have turned the remove of uh uh to remove uh uh uh depressed scar fragment and the foreign body is also OK. Now, uh uh uh uh from the nose, uh this another case of the to brain injury. Uh um uh he was also operated and after two days he can do his normal activity like the uh washing of the face and cleaning out the tooth head injury data, January 2022 to about 2024. Uh uh total operated cases was uh well, uh 26 cases among these patients are alive and 18 patient are dead. So my operated mo mortality rate uh is 69% and uh other are um conservative patient. Uh total 65 patient a month, 60 patient or alive and five patients are. So uh what rate of the conservative patient or the head injury is 8% and there uh were 91 patient of the uh head injury and then the 68 patient uh alive and 23 patients are dead. So um uh modality rate of the uh total head injury. Uh patient is 25%. Uh there is only traumatic brain injury data. Uh January 2022 to October 2024 operation was the same and, and uh conservative patient, uh uh uh 29 patient a month. These 24 patients are alive and five patients. So, uh modality rate of uh um conservative patient uh of to brain injury. Uh uh uh uh uh is um 70 70% to the traumatic brain injury. Uh, patient. Well, uh 55 patient, uh, a man, these 32 patients are alive and 23 patients are dead. So uh mortality rate of uh uh traumatic brain injury, patient is 42%. How we differentiate between traumatic brain injury and other head injury in jungle, no computerized tomography. So only with clinical features and scar, there's a, a model of the scar xray uh ap and let's you uh uh they will uh foreign body in the brain, foreign body in the brain. Uh There's a facial injury uh before and after another facial injury before and after vascular injury. Uh uh this patient uh have uh uh both uh femoral vein and artery injury to do that. Uh landmine. Um Sorry, I had uh uh this uh after repairing of the uh both uh artery and vein. Uh uh the patient is now, OK. And I can see the limb, there's another case of the artery injury. Uh uh after repairing the patient is OK. And uh there's another case of uh vascular injury. Uh he had cause the break here. Artery injury and, and repair it. And it is now ok, morbidity of the vascular injury, total vascular repair uh where 28 case a man, the four cases and amputation ha time. Uh so 24 cases, uh very first two cases failed because I have no experience in vascular repair and delay. Notice another two cases for a very severe injury, bone and muscle loss uh to and there uh to beard tampon and beard s uh synthesis west under the guidance of ultrasound and E CG. Uh This patient uh is a case. Uh, uh he has got a very severe injury to the bladder and re uh so, uh I have done the bladder repair and uh red uh regular repair uh with uh colostomy. And luckily, uh the bladder repair was th uh so second operation was done. Um, uh bladder, uh bladder was rerepair. Um uh I like King. Uh at that time, uh uh the bladder repair was free again. And so at that time, operation was 10. Uh, at that time, I have decided to do I do because I can save the bladder. Uh There is a iliac ku and there's a ilio uh colostomy, sorry, bladder nerve injury, totally separate from the urethra. This operation is very difficult for me. Uh uh because um injury site is uh uh narrower space in the PPI. Um But luckily, uh uh the operation was a, um there's a uh u uh urethra catheterization and there uh sub catheterization, right, ureter injury, rep and be shoot number eight in because uh we have no distance uh renate. This patient is a R consult being surgery. Uh He had got uh grateful uh renal BNCH injury. Now, uh this uh hematoma uh removed uh around uh around the RNA and the rep uh right kidney was repaired. Now, the patient uh is OK, some mile saving case. Uh this gave uh has a b left injury to the landmine. His uh left already amputated and the right left is very crushed and um uh soft tissue lost and uh open tibia fracture. Uh You can see in the photo uh uh for the l saving it is very difficult in this case. But patient request, he don't want to lose his right left. Uh his left left uh was already uh lost. I have to explain uh about uh his right leg is difficult uh to save but uh he refused to ation. So I have decided to do uh uh left uh baloney ation. And the uh um one of the right uh was uh for the uh bone pressure, external visit was applying and luckily the wound was better and better day by day after four men and I can see his right left. Now, uh he can walk with prothesis and he finally vocal amputation. Uh There's a landmark injury. Uh He has lost uh uh Metata and Santa B. But kin was in and kin was intact. Uh There's a kin and there is a tibial uh to remove the cartilaginous. So, and, and then I have to diffuse kin and uh tibia bone. There's uh uh and uh faced with uh K wire, there's a, as example of the para amputation, uh para amputation, para amputation. Now, he can uh stand and walk without prothesis. Yes. Yeah, of is another partition. He can climb to the hill without prothesis. It's another amputation. He can try auto cycle without prothesis. There is another viral amputation. He can drive the car without prothesis. And he has also uh uh right uh uh comminuted female pressure on the affected side. These are one a for uh orthesis uh like a shoe and I have 1025 cases of PLF why have I done uh one patient request? They don't want to lose their life and two difficult to get prothesis in jangle previous year. Uh Advantages of the amputation can was it friend played football, try car and models I get without prothesis. Don't need special. The book no barrier and can do nearly normal disadvantages like shorter than normal size. Approximately two centimeter sun master wasting difficult to get prothesis. Uh There is a total operation during revolution. Uh Only my operation may 2021 to December, 2022 surgery, neurosurgery, auto neurovascular and gynecology. Uh Total operation was 255 cases. And this is only my trauma operation. January 2023 2. Uh out about 2024 surgery, neurosurgery, neurosurgery vascular auto 2, 233 cases was uh were done and chest trauma, almost all of the chest trauma. 44 cases can well, man with intercourse, the drainage too and man, 44 cases, two cases were done open thoracotomy and one case was as a war data, more than 95% of chest injury were successfully managed by ICD two train. There's a nontrauma operation. 2023 to 2024 general surgery, upper gi lower G IU surgery, hepatobiliary ent breast genic oncology, plastic surgery, and pediatric surgery. Uh I have 10 137 cases. My total operation during journey and 625 cases. Mortality, man, 635 operation, 26 cases where HBR mostly traumatic brain injury, morbidity may be around about 20 cases. I have no data. Uh This all are due to world. We have a co team now and we have can pass as much as we can although we have limited resources and then to all our local and international supporter for they have without then we can do this healthcare. Thank you and thank you, Mister Muko for such an incredible and moving presentation. Hearing about these difficult surgeries you've performed in this conflict areas, often with very limited resources has been truly inspiring um your stories of both challenges and miracles remind us of the like immense medication and the multiple skills required in these situations. And um it also showed us uh how important it is to bring attention to these matters. Um The world needs to see more of this and understand how what is happening in Myanmar, especially in these areas, conflict areas uh where the media will cover stories like this. So they need more help and more support so that uh they can use um the resources as much as they can. And uh we're also really grateful for the work that you've done and also for sharing your experiences uh and the, the stories with us today. Uh So we have a few minutes for the Q and A session. So is there any um questions in person or uh anybody from joining us online? Please let me know and I'll, I'll call on you.