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A 15-member* SMA-CFPS delegation visited Myanmar on a study tour from 14 to 19 January 1997. This coincided with the week-long 43rd Myanmar Medical Association Conference.  This was the second visit of delegates from SMA. The first visit of delegates from SMA to Yangon was in October 1996. 

Objectives 
The objectives of this visit were to participate in the Medical Conference, attend joint clinical sessions in Internal Medicine, Paediatrics and Surgery/Orthopaedics organised for the delegation by Myanmar Medical Association (MMA) as well as to discuss future collaboration on professional exchange and training with representatives of the MMA. 

The Myanmar Conference  
The SMA-CFPS delegation attended the opening ceremony of the Myanmar Conference. There was also a delegation from Thailand. We presented a slide projector and three overhead projectors to our host as well as plaques and ties from the SMA and the College. 

During the Myanmar Medical Conference, delegates from SMA-CFPS spoke in the Family Medicine Seminar and the Clinic Computerisation Seminar. In the family medicine seminar, there were 5 presentations. They were: an overview of health care delivery in Myanmar, delivered by Dr U Thein Swe, Deputy Director (Public Health), Department of Health, Union of Myanmar; an overview of health care delivery in Singapore, delivered by Dr Cheong Pak Yean, President, SMA; Family Medicine and WONCA, presented by Dr Alfred Loh; and Family Medicine development in Singapore, presented by A/Prof Goh Lee Gan. This was followed by development of undergraduate and postgraduate family medicine programmes also by A/Prof Goh Lee Gan. 

There was much interest shown in the development of Family Medicine in Singapore and some 200 participants attended. The presentations by our delegates stimulated much discussion on the options for training GPs and primary care doctors in Myanmar. As Myanmar is a big country, distance learning was felt to be a practical option. These could be supplemented by hospital conferences, attachments and workshops. 

The Deputy Health Minister, HE Lt Colonel Than Zin thanked the Singapore delegates for their presentations and expressed interest in developing further collaboration in professional training of the primary care doctors. The Myanmar Medical Association has been active in organising CME courses for its members. It was felt therefore, that some structuring of the CME programme to cover a broad based syllabus for primary care doctors in the country will be the first step. We could help in putting the programme together. Currently, the GP section of the Myanmar Medical Association has a 3 month A & E course for its GP members. 

The Clinic Computerisation seminar also stimulated interest. Following the presentations on challenges to computerisation in the clinical setting and the process of computerisation, there was a demonstration on a clinic management programme. 

Joint clinical sessions and visits to urban and rural health centres  
Highlights of the study tour were the joint clinical sessions and visits to the Mingalar Taung Nyunt Urban Health Centre and the Inntakaw Rural Health Centre. In these health centres, we saw the WHO strategy of Health for All 2000 put into action. It was interesting to note the similarity of the layout of the conference room with that found in a rural health centre in Malaysia or Thailand. The common features were an "ops room" atmosphere of charts on the walls showing the incidence of medical conditions, number of patients seen, staff manpower and summary health indicators. 

The visits to the Internal Medicine, Paediatrics and Surgical/Orthopaedic wards and case presentations were educational. Many were the results of infections of public health importance: tuberculosis, streptococcal sore throats, malaria, dengue, tetanus and the ascaris worm. Hepatic ascariasis is the cause of 80% of patients presenting with obstructive jaundice. We were shown a series of hepatocellular carcinomas in different age groups caused by Hepatitis B. A more detailed account of the clinical encounters is given by Drs Lee Kang Hoe, Elaine Tan, Tan E Ching and Elsie Yong on page N6. We received warm hospitality from our Myanmar colleagues in the hospitals and health centres we visited. The discussions and exchange of ideas on the presentation and management of the conditions presented were very useful. 

In Singapore today, many of the infections of public health importance have been controlled, thanks to the public health doctors in the Ministry of Health and the Ministry of the Environment. What is perhaps noteworthy is to recognise the silent contributions of public health and environmental sanitation. It is also important that our younger doctors be educated in the manifestations of these infections and certainly a short elective posting to the hospitals of Myanmar will add a practical dimension to the education process. As Singapore works towards being a regional medical centre, it is likely that our doctors may encounter patients with such infections in our consultation rooms. 

Future collaboration 
This study tour to Myanmar has built on the good friendship that has been fostered between the medical profession of Myanmar and Singapore. Discussions with representatives in the Myanmar Medical Association, the doctors in the Ministry of Health and the GPs disclosed many areas that doctors from both countries could collaborate and mutually help one another in working for good of the patient - the raison détre of doctoring.