Reflection on Reflections

There has been a spate of Reflections published recently by prominent elderly leaders of the medical profession. Retirement and old age are a time for reflection and these leaders have vast experience and so many things to say as well as the ability say so. There have also been a few Biographies of them by former junior staff or pupils.

There are four categories of publications by members of the medical profession.
(a) scientific papers that contribute to medical science and published in medical journals – descriptive, observational; to prove, verify or refute a hypothesis
(b) recollections, reflections, reminiscences and accounts of their personal and professional lives – they are autobiographies, some of which include commentaries on medical issues and also about life in general, as the elderly are inclined to do
(c) biographies about their friends, colleagues, teachers or superiors whom they admire; compilations of bio-data
(d) books or articles published for the medical profession – aimed at informing, educating, sharing experience, posing questions, giving comments, raising issues
(e) books and articles for the non-medical public – providing valid scientific information about health and disease; and offering general advice on health care, and prevention and treatment of disease –
(f) books and articles within the domain of the Arts – novels, plays, essays, articles

Doctors are prolific writers and the total number of doctor-cum-authors listed and included in the Compilation (စာရေးသော မြန်မာဆရာဝန်များ) published by the Doctor/Author Branch Section (စာရေးဆရာ ဆရာဝန်အဖွဲ့) of the Myanmar Medical Association (2014) is (320) and most publications of each of them have also been mentioned therein.

Some of the published books and articles belonging to category (b), (c) and (d) which I have received, procured and read or seen mentioned in the above Compilation have been selected rather arbitrarily as noteworthy and are the following

1. Growth and Development of Medical Research in Myanmar (1886-1986) by Aung Than Batu published by Myanmar Academy of Medical Science in 1963.
2. Reflections of a Director-General (Medical Research) by Aung Than Batu and translated into Burmese by Aung Than Batu and Aung Gyi, published by the author and printed at the MMA Publishing House, (Sarana), Yangon.2016.
3. Message of Felicitations and Blessings for the DMR on its 50th Anniversary by Professor U Mya Tu in the Golden Jubilee Commemorative Volume of DMR (1963-2013) published 2013.
4. Vignette of BMRI in early days by Dr U Ko Ko in the Golden Jubilee Commemorative Volume
5. History of Medical Education in Myanmar during Colonial Administration by Professor Mya Oo, published by the Institute of Medicine 1, Yangon.1995
6. History of Medical Education in Myanmar (1886-2010), edited by Aung Than Batu & Ko Ko and written by 32 authors from academic departments of the Universities of Medicine and similar institutions. Published by the Academy of Medical Science.2015
7. Our Medical School- Let’s not forget it (ဒို့ဘဝဆေးကျောင်း မမေ့ကောင်း) in Burmese by Prof. Aung Khin (Surgeon) Published by Yone-kyi-chet-sarpay (ယုံကြည်ချက် စာပေ) 2011. Distributed by Pyin-nyar-shin-sar-pay taik (ပညာရှင် စာပေတိုက်)
8. The School of Life from inside the Hospital (ဘဝဆေးရုံ ဇတ်လမ်းစုံ) in Burmese, by Prof. Aung Khin (Surgeon) Published by Pyin-nyar-shin-sar-pay-taik (ပညာရှင် စာပေတိုက်) 2012
9. Memoirs of O.G. U Soe Myint (အိုဂျီဦးစိုးမြင့် နှင့် ဘဝမှတ်တမ်း) in Burmese, translation by Dr Kyaw Myint (Radiologist) Published by Jyu-sarpay. Book No.35 (ဂျူးစာပေ စာအုပ် အမှတ် ၃၅) 2007
10. Tribute to Prof. U Soe Myint (OG): “A Paragon of Virtue” by his adoring pupils (Tabei) (တပည့်များ) in Burmese, MMA Publishing House, Theinbyu St, Yangon
11. The General Hospital under Japanese rule- Recollections by Dr Myint Swe. (မှတ်မိသေးတယ် ဂျပန်ခေတ်ဆေးရုံကြီးဝယ်) Published by Hantharwady Press (ပာံသာဝတီ).Yangon. 1967A Turbulent Life by
12. Dr Kyaw Aung. (Bawa law kadan in English/Burmese) translated by Dr Kyaw Myint (Radiologist). Published by MMA Publication House 2nd edition in 2017.
13. Dr Mya Thein Han- the Brigadier-General who saves lives by Min Yuwei (မင်းယုဝေ) (2015) (အသက်ကယ်သော ဗိုလ်မှူးချုပ်၊ ဆရာဝန်ကြီး ဒေါက်တာမြသိန်းပာန်) Published by Winn-sar-pay, Bahan, Yangon (ဝင်းစာပေ)
14. Unexpected Risks and Struggle (အမှတ်မထင် စွန့်စားခန်းများ.) by Dr Khin Let Ya Published by Zun-pwint- sarpay.(ဇွန်ပွင့်စာပေ) Bahan, Yangon. 2007
15. Six Decades of Medical Education in Myanmar: An Overview by Professor Myint Myint Khin (21.3.2004) published in Medical Education Unit Bulletin, Volume 9, No. 3, p 2-11.December2008, University of Medicine, Mandalay
16. A Doctor’s life without Respite (မနားရသော သမားတစ်ဦး၏ဘဝခရီး) by Kanbawza Khin Hlaing . Published by Gangaw-sarpay in 2009. (ကံ့ကော်မြိုင်စာပေ၊ မျိုးဆက်စာပေဖြန့်ချီရေး)
17. Elderly Doctors by MMA Women Section (1999, 2004) ( သက်ကြီးဆရာဝန်/ဆရာမကြီးများ) (မွေးသက္ကရာဇ် ၃၁-၁၂-၁၉၂၈ မှ အထက်၊ မွေးသက္ကရာဇ် ၃၁-၁၂-၁၉၃၄ မှ အထက်)
18. To keep live forever, our cherished Memories by Dr Kyu Kyu Swe. 2012. Published by the MMA Publishing House, Yangon
19. 19. Miscellany (ရေရေရာရာ ထွေတလာ) by Dr Mg Mg Nyo
20. Young blood, young children (မျိုးဆက်သွေး၊ မျိုးဆက်ကလေး). A collective Biography of Professor Thein Thein Myint by her pupil. Published by MMA Publishing House, MMA, Theinbyu St,
21. Reminiscences of my Endeavours for Advancement of Medical Education, Health-Work Force & Health System Development (1961- 2010).Volume 1 on Medical Education (1961-1996)
22. Living healthy and happy at the sunset of Life(ပျော်ရွှင်ကျန်းမာ ဘဝဆည်းဆာ) edited by Dr Ko Ko, Dr Myint Myint Khin and Dr Aung Than Batu and written by 12 experts including several leaders of the Medical profession in Myanmar. Published by Sarana Company, MMA publishing house, Yangon.
23. Biography of Professor Maung Maung Sein, by his students and junior colleagues.
24. Dr Myint Maung Maung- Professor Myint Maung Maung (Obstetician & Gynaecologist) was awarded the “Theikpan Kyaw Swa” title in the Independence Day Awards, for the military (2019); and must therefore have done something significantly important for military medical science to be given this high honour but I have not come across any important book published by him and so have not made any relevant comments.
25. Historical Overview and Development of Orthopedic Surgery Discipline in the Defense Services by Colonel Than Zin (retd), Emeritus Professor of Orthopedic Surgery, Defense Services Medical Academy, and Deputy Minister for Health (retd.). Unpublished Manuscripts.
26. Dr. Ko Ko’s “I, international civil servant”.(in Burmese and published after his death in 2016 by a committee of the Myingyan Literary Society from hand written note written and left by Dr. Ko Ko.

I have not considered and not done a critical review of category (a) (e) since it is not my intention to do so now nor is MJCMP the place to do so. Category (f) was avoided for the same reasons and also because I do not have the competence for such a task.

I will focus on category (b), (c) and some aspects of category (d) written by authors under their names but excluding official publications of government departments, institutions and organizations in which they may have participated.

Most of the selected autobiographies contain a mixture of their professional activities; private, personal lives; and happenings around them amidst the changing political, social and economic situation in the country and make comments and provide personal insight; but the scientific background and changes taking place in medical science, medical care and public health are very little mentioned except in one. The private and professional lives described are intertwined, one influencing the other. Some of their descriptions of people and events are such that, although of some interest to medical readers, can only be amusing and fully appreciated by friends and contemporaries of the author. The description of the personality and prowess of the teachers of their generation though and of the teaching methods prevailing then are valuable to present day medical students and faculty. Descriptions of their own academic endeavors and professional careers also paint vivid pictures of conditions in the medical world for subsequent generations. The biographies give similar accounts of these top leaders but being written by admiring students and juniors are not all objective and do not reveal much about the thinking behind the successful, noteworthy deeds performed.

Most of these top leader and oldies belong to the pre World War II generation and all include vivid descriptions of the harrowing life in war time Burma under Japanese rule. But similar accounts by other non-medical authors are innumerable and these writings by the medical authors only add a few more. However accounts of medical education, the medical school and hospital during war time under the puppet Dr. Ba Maw government provide rare insight but unfortunately short and sparse because the medical school and hospitals opened were short lived and lasted about one year only.

The elderly authors held highly important responsibilities at national level and some were pioneers in the major disciplines of medical science so that their accounts tell of what makes a top professional – clinician, teacher, researcher; and the qualities that contribute to becoming an outstanding or successful medical professional – director-general, professor, departmental head, etc. Also, the positions they occupied enabled them to describe the birth and development of major institutions, departments, disciplines, sub-disciplines – Institutes of Medicine, Research Institutes, Departments of Internal Medicine, Surgery, Child Health, Obstetrics & Gynecology, Radiology, Nutrition, etc.

I will select a few of them and present my viewpoints on how relevant, useful and inspiring they are to the medical reading public in general.

1. Our Medical School- Let’s not forget it by Dr Aung Khin. (2001)

This book vividly and memorably narrates the life of a medical student of the 1950’s. It describes what and how each of the medical subjects are taught, learnt and the tough final examination in a way understandable and interesting to the non-medical public. Details of hostel life at the Latter street hostel- how students wait daily at 8 pm for a glimpse of the off-duty nurses who have returned to change dress and rest in their rooms of the Nurses Quarter across Canal/Anawrahtar street; torrid views of iniquities taking place at the Hong Kong Hotel opposite Latter street; the belly-full meals served daily and end of month grand dinners; the delicious street-food sold for a pittance but which most students cannot frequently afford – all told with humor and nostalgia, but some of the personalities and quirks of fellow students recalled may be appreciated only by contemporaries. Pranks such as the challenge and acceptance of the proposal to go alone at night into the College dissecting room full of corpses by one daring hosteller who signed his name on the black-board and the bedlam created among the group who went to check it when someone jokingly screamed in alarm; the trip at midnight to Kyandaw Cemetery by a group of students who attempted to make any passing ghost move a three-legged water-pot stand are retold very humorously. The book also includes accounts of hospital life and the comradely relationships with nurses and other hospital personnel – all interspersed with advice and homilies for the younger generation.

2. Memoirs of O.G. U Soe Myint by Dr U Soe Myint and translated by Dr. Kyaw Myint

This includes a detailed account of the private and professional activities of a Medical Officer serving in the Malaria campaign – one of the vertical control campaign launched by post-war government supported by WHO.

The most memorable episode retold is that of a gangrenous leg amputation he had to do unexpectedly to save the patient’s life, with surgical instruments improvised from carpenter’s tool bought from the bazaar, in a peripheral hospital while on tour, in place of the poorly incompetent Indian regular doctor-in-charge although it was not his responsibility as a malaria control medical officer, and about which he described in detail in the MJCMP April 2001 issue. His highly commendable and inspiring achievements in building up the Department of Obstetrics and Gynecology in Mandalay and in improving the teaching of the subject including initiation of postgraduate MRCOG programs and getting them recognized by the UK Royal College of Obstetrics & Gynecology are recounted in detail; future generations will have to recognize him as one of outstanding pioneers in this specialty. He introduced and popularized urogenital surgical techniques for vesico-vaginal fistula (VVF) and relieved the suffering and restricted social life of many women who previously hid their embarrassing condition.

His book included details of his romantic life, his personal struggle to support his family and about war-time conditions; and while his grit and determination in face of adversity and obstacles are highly admirable, many details of his personal life will be of more interest to his colleague, friends and pupils; and the war time experiences add one more to innumerable such accounts by others. A book certainly to be read by all O&G’s for information, lessons and inspiration; by the medical profession for information about how earlier generations made efforts to improve medical education and establish their specialties; as well as by others for pleasure and general information about medical life in those early days of Independence

(OG Dr Soe Myint passed away in October 2016)

3. A Doctor’s Life without Respite by Kanbawza Khin Hlaing (2009)

This book is also about the medical student’s life and what and how medical knowledge was taught and medical skills shown and practiced in the 1950’s like others already mentioned before but from a different angle. Then it gives the unique account of the dedicated professional life and experiences of a medical officer in the Shan States, working without respite day and night when called for to provide satisfaction. We learnt that Dr Kanbawza Khin Hlaing was renowned, admired, respected, and trusted by all in the Northern Shan States – government officials, the civilian population and also the rebels who were rampant in those days. He could travel immune and safe anywhere, at any time, visiting patients, providing solace and helping the community in many ways. He was like a king- benign and thoughtful for them. His attitude and tolerance can be judged by a tragic episode in his personal life when he himself gave his first wife in marriage to another with whom she had fallen in love.

I know him to be clever, studious and diligent and am surprised to learn from his book that he became depressed and suffered from a temporary mental breakdown in the UK when he went for the FRCS examination in 1963, but fortunately recovered on return and treatment in Myanmar and eventually went back to UK in 1965 and got the FRCS in 1966.This tells about how stressful life can be for postgraduates going abroad for foreign degree and diplomas.

(Dr. Kanbawza Khin Hlaing passed away in 2010)

4.History of Medical Education in Myanmar during Colonial Administration by Professor Mya Oo (Rector) published by the Institute of Medicine 1, Yangon.1995

This is not autobiographical but gives a comprehensive, very well documented and referenced account of the initiation and development of western medical education during the colonial period in British Burma; it is the principal source of factual information, together with a few others, for the definitive history of medical education in Myanmar.

5.Reminiscences of my Endeavours for Advancement of Medical Education, Health-Work Force & Health System Development (1961- 2010).Volume 1 on Medical Education (1961-1996) by Professor Mya Oo

This is also is not autobiographical but as he states in his introductory remarks, it is –

” a historical account of 50 years of my active professional life in medical education, health work force and health system development spanning from 1961 to 2010 playing different role at different periods working in partnership with my colleagues. Their contributions were also portrayed by authentic documents and photographs of my personal collection”

He could well write so because of his initial participation as a young medical officer, then because of his progressively high qualifications, talent, competence, and good fortune in being present at the right place and at the right time he rose to be Medical Specialist in DSGH, head of the first Medical Kidney Unit in Myanmar (1970), Rector of IM 1,Yangon; and Deputy Minister of Health; and was able to do many progressive things in medical education for the military as well as civilian population.

His account of the Burma-US Joint Survey Project in 1961 by the International Committee for Nutrition for National Defense (ICNND) is little known in medical circles, the results of which in the civilian population were the basis on which the Anemia Research Project and Liver Disease Research of BMRI was launched, and other similar programs in the military. His role as representative of the Myanmar Government as well as of the UK Royal Colleges and the difficult and complicated negotiations he had to undertake in UKand in Myanmar for the clinical M.Med.Sc. courses and degrees to be recognized by the UK Royal Colleges, and for the clinical M.Med.Sc. Examinations to be held in conjunction with the Royal College Part II Examinations in Myanmar are little known to many medical post-graduates and faculties nowadays and paved the way for all parts of the MRCP Examination to be entirely held in Myanmar.

6.Message of Felicitations and Blessings for the DMR on its 50th Anniversary by Professor U Mya Tu in the Golden Jubilee Commemorative Volume of DMR (1963-2013) published 2013

These two articles by Dr Mya Tu, Founder Director-General of the Burma Medical Research Institute (predecessor of the Department of Medical Research) tell about how he dreamed of establishing a medical research institute in Myanmar and how it became true in 1963. He then describes how the process took place, acknowledges and mentions the colleague who took part in this great endeavor. He concludes sagely his good wishes for DMR with the words: – “May you have the hindsight to know where you have been:
The foresight to know where you are going;
And The insight to know where you have gone too far” (or too near)
(Dr. Mya Tu very recently passed away in Canberra, Australia, on August 7th 2018)

7. Vignette of BMRI in early days by Dr U Ko Ko in the Golden Jubilee Commemorative Volume

This supplements Dr Mya Tu’s account of the initiation of BMRI. Dr Ko Ko was the person who had to make arrangements and hand over the building complex and compound of the Harcourt Butler Institute of Public Health to Dr Mya Tu who then converted it into the BMRI. It also includes part accounts of Dr Ko Ko career as a public health specialist and the re-organization of the Department of Health in 1964/65
(Dr Ko Ko passed away in YGH, Yangon, Jan 2018)

8.Growth and Development of Medical Research (1886-1986) by Aung Than Batu published by Myanmar Academy of Medical Science in 1963.

This is the definitive History of Medical Research in Myanmar – from 1886 onwards through a span of 100 years to 186; tracing its development during the colonial period, early awakening period after Independence, through the beginning of organized medical research in the 1960’s, up to the period of sustained growth and maturity in 1970′ and 1980’s. It is factual- describing what happened, when and where; and explanatory, telling how things happened, and sometimes why and why not.

9.Reflections of a Director-General (Medical Research) by Aung Than Batu and translated into Burmese by Aung Than Batu and Aung Gyi.

This is an account of the reminiscences and recollections of a Director-General of Medical Research- concerning his personal life in the past and particularly about his personal professional experiences- the two being closely entwined and complementing each other in many places and periods.

It reveals the ‘making’ of a director-general of medical research who is also a clinician, clinical teacher, clinical researcher and research director at national and international level; and therefore aims to interest and benefit the younger generation of medical professionals-of medical practitioners, medical teachers, medical scientists and medical researchers. It aims also to be of interest to a wider audience desirous of knowing how the author’s generation struggled to achieve what they did in medical care, medical science, medical education and medical research, and how his experiences at a personal level reflected the changes that took place on a larger scale around him in the country at that time. The accompanying Burmese translation also makes it accessible to the non-medical public. It won the Tun Foundation for Biography (English) for 2017.

10.Six Decades of Myanmar Medical Education: an Overview by Professor Myint Myint Khin She identified three issues of paramount importance that will have the greatest impact-good or bad-on the state of medical education in the country

(a) “The Human factor” Tomorrow’s doctors will need to do better technologically, be very proficient in computer science, information technology (IT), and robotics. At present teachers are unduly bogged down by administrative and semi-administrative duties which are ad-hoc and can be trivial and inconsequential. Such built-in stress without let-up may eventually end up in the “burnt-out syndrome”: resigned, inert, ineffectual. She said “she spent the best years of her life working under difficult and unaccommodating times and survived but had not much to show. The only solace I have is that I was somehow instrumental in bringing out the potential in a handful of students and helped their future.” A surprising, painful and depressing admission! I hope it is not true. I think not a handful but many more, and the multiplier effect may be enormous. “Regarding the students, the raw material that medical teachers are presented to mould into the desired form”, she says, “correctly that in the majority the only asset brought over from high school is the ability to recall some facts that have been collected over the years – rote learning; whereas the main objectives and essence is to stimulate intellectual curiosity and make students want to learn, think and reason. She adds late that “skill development will be the most problematical; doctors need a huge number of skills; skills are time consuming and to teach and learn;” and that “doctors need to be more competent clinicians than ever and that student: patient ratio has become a critical limiting factor in developing clinical skills”.

(b) “Work Ethics” She enumerates some of the elements: “punctuality, duty-consciousness, sense of responsibility, mutual respect, honesty, sincerity, etc.” She says “there is a general laxity; that work ethics cannot be taught or learned, but imbibed from the work environment, and most importantly from the behavior and attitude of one’s teachers and seniors”

(c) “The Language factor”

She states her firm belief that changing the medium of instruction from English (lingua franca) was the fatal flaw that helped pave the way to the rapid decline in standard in medical as well as general education.”

Different view-points have been given by other knowledgeable and responsible educators concerning the medium of instructions in high schools; all of whom concede that English should still be the medium in professional teaching institutions till such time when translation of the international professional literature can be immediately done as in Japan, etc.

The Future She states that “issues confronting us will call for analysis that is searching, not alienated from reality and above all unbiased. Then only can we hope for meaningful and workable options for solving the problems.

She concludes by saying that: “so long as we have faith in ourselves, and determination to better our future, with our capabilities and inherent sense of goodwill, and given the chance to prove ourselves to the full, we Myanmar can reach for the stars”

An inspiring and hopeful thought!

(Dr Myint Myint Khin passed away at the SSC Hospital, Ygn, June, 2014)

11. Unexpected Risks and Struggle (a hmat ma htin sun sa khan myar.) by Dr Khin Let Ya This is the story of a young woman, well trained as a doctor in Myanmar, who ventured to a foreign land to pursue a medical career – not as a government scholar, not as a person with large private financial means, but as an ordinary person and who managed, by grit, courage, determination and ambition to eventually attain high qualifications and high positions regionally and returned to Myanmar for a well-earned retirement.

A story to inspire many of the younger generation She has now occupied herself by writing about events and people whom she is privileged to know intimately and politically, including her distinguished father, Bo Letya, one of the Thirty Comrades.

12. Dr Kyaw Aung’s “My turbulent life.” This book is revealing. It shows that even if you do goodyou can get into trouble with the Law. It also reveals how horrible an ordinary prisoner’ life is like injail.How pitiable and undeserved it was for Dr Kyaw Aung to get into all this; he was reprieved only through the effortsof sincere good friends like Professor Hla Myint (Ah- Ba) and Brigadier General Kyaw Win (DMS, Defense Services)

13. Historical Overview and Development of Orthopedic Surgery Discipline in the Defense Services by Colonel Than Zin (retd.). As indicated by the title, this manuscript is about the historical aspects and administrative details of the development of orthopedic surgery in the military, where such services are so essential; and written largely from the personal perspective ogle took place the author. The point of interest is that, in the 1950’s, soon after Independence, when internal armed struggle broke out, Israeli medical specialists came to the rescue to the Base Military Hospital, Mingaladon, (later to become Defense Services General Hospital) and helped to provide, train and develop orthopedic, traumatology and prosthetic services. Major Lao, trained in UK was the pioneer who headed the Orthopedic and Traumatology Ward. Previously, military amputees had to be sent to Poonah, India, for their prosthesis. The book contains little known facts about orthopedic services in the early years in the military and should be published for the record in the military or as part of an account of the development of surgery in Myanmar.

14. Dr. Ko Ko’s “I, International Civil Servant”. (in Burmese) This is an autobiographical account of Dr Ko Ko’ school and college years and as Civil Assistant Surgeon (nowadays termed township medical officer).His book recounts how he became the first MBBS graduate to enter service as public health officer under the Directorate of Health Services. He rose through the ranks to become the Director (Disease Control) having played the major role as outstanding leader in pioneering public health services and teaching, and re-organizing the health services during the government of the Revolutionary Council in a way that emphasized the preventive and social aspects in health care as well as medical education. He was largely responsible in Myanmar for eradicating small pox and eliminating leprosy and trachoma as public health problems. After joining the WHO/Southeast Asia Region he rose through the ranks, eventually becoming elected as Regional Director from which he retired as Emeritus Regional Director and returned to Myanmar to head the Myanmar Academy of Medical Science as well as to participate importantly in many other professional and non-professional social organizations. He was a kindly, lovable character about which he did not mention in his writings.

The most memorable incident that he mentions in his book is his interview with Dr Suvi, Director of the Harcourt Butler Institute for Public Health, who called him up on learning that he had applied for state scholarship for the postgraduate graduate qualification of Diploma of Public Health (DPH) and was proceeding to Edinburgh, UK to acquire it Dr Suvi said, “Aye, if you are interested, it is an honorable subject; but I tell you, whoever works in the public health service will, on retirement, not be able to buy a house. To do so, he will have to marry a rich wife. Despite this advice, Dr Ko Ko went on to acquire the DPH and pursue an outstanding career in public health. He did not marry a rich wife!