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News in 2024
The Starting Signal for a New Otologic Partnership
Our NGO EAGLE ENT, closely collaborating with Interplast, has been dedicated to the development of otologic surgery in Southeast Asia, particularly in Myanmar, for nearly 15 years. Between 2010 and 2020, under the leadership of Eberhard Biesinger, we conducted approximately 10 missions, performing various otologic surgeries, including middle ear and cochlear implants. One of our goals was also to provide "help for self-help," successfully training local colleagues in surgical techniques. This was achieved through local temporal bone courses and internships in Germany.
However, our activities in Myanmar have been suspended since the onset of the COVID-19 pandemic and the current political situation. Consequently, we have established a weekly online webinar for case discussions and "meet the expert" lectures over the past 1.5 years. Through this platform, we have also reached colleagues in Phnom Penh, Cambodia, fostering a friendly and collegial exchange.
Due to the lack of specialized and thorough surgical training in Cambodia, ear surgeries are scarcely performed and mostly limited to two hospitals. This is critical for a population of nearly 17 million with a prevalence of chronic ear infections, often accompanied by persistent hearing loss, of about 7%.
Our initial mission from January 2nd to 13th, 2024 aimed to conduct preliminary ear surgeries, assess local conditions, and meet key local personnel for future collaboration. Upon arrival, I was warmly welcomed at Phnom Penh airport by the deputy hospital director and a junior ENT doctor from the ENT department of Calmette Hospital. In the following days, I became familiar with the clinic, which mainly operates on outpatient care in the polyclinic. There are also 4 inpatient beds, primarily used post-operatively, mainly after sinus surgeries.
In the operating room, ENT does not yet have an operating microscope, so we relied on the neurosurgical microscope for ear surgeries, highlighting a clear need for investment. The ear instrument tray was well-equipped, mainly with South Korean instruments. Due to the absence of surgical ENT assistants, the junior ENT doctor had to assist with the surgeries, posing a challenge in terms of organization and operation flow. Consequently, the surgeries took longer than what we are accustomed to in Germany, making us appreciate our standards back home.
For mastoid operations, such as mastoidectomy for cholesteatoma and chronic ear infections, we used the neurosurgeons' drill. However, its larger handpiece offers less precision, especially near the facial nerve and the ossicles. For future operations and planned missions, we aim to provide an ENT drill through funding.
We assembled the microscope and Storz drill we brought along and conducted a small internal temporal bone course with an ear model for the young colleagues. Overall, the experiences in and around the operating room will help optimize procedures and equipment for future visits, ensuring better teaching for local doctors and excellent outcomes for patients.
Beyond the clinical experiences, I had significant meetings at the German embassy with our ambassador, Mr. Messerer, and the dean of the medical university, Professor Vento:
Mr. Messerer shared insights into the conditions in Cambodia, the local politics, and the health system with its funding opportunities. He also noted the significant gender disparity in government and leadership positions within companies, a reality I observed at the hospital, where there are notably fewer women in medical roles.
Professor Vento provided insights into the medical education system and the curriculum for medical students, which is fundamentally different, comprising 8 years of study, including mandatory courses like English. Practical skills in the clinic and peripheral subjects like ENT are taught only after graduation during specialist training. For us as ENT specialists, it is essential to offer our webinars and on-site training to residents and young specialists, given the lack of a developed postgraduate curriculum like in Germany.
Overall, this mission was thoroughly enriching, significantly enhancing our Cambodian-German friendship. Our goal is to soon bring two Cambodian colleagues to Germany for four weeks of internships to further their surgical training. Additionally, we plan a mission within the next year, bringing our entire team to treat and operate on more patients locally and conduct a temporal bone course for our local colleagues.
Continuation of Our Activities in Cambodia
With the continuation of our activities in Cambodia, the training of two colleagues from ENT Calmette Hospital in Phnom Penh was successfully realized. From April 27 to May 10, 2024, the two colleagues were able to intern at the ENT Department of the University Medical Center Hamburg-Eppendorf (headed by Professor Betz) upon invitation. They received instruction in the anatomy and surgery of the temporal bone and were shown ear surgeries. This was accompanied by practical work in the temporal bone laboratory on plastic models.
At the invitation of the German Society for Otorhinolaryngology, Head and Neck Surgery, the two also attended the annual congress, where they listened to international lectures and engaged in discussions with colleagues from around the world.
Following this, they continued their internship at the Landeskrankenhaus Salzburg (headed by Professor Rasp). Supported by the Austrian American Foundation, they were well accommodated at Schloss Arenberg. Daily, they attended ear surgeries and participated in practical exercises at the hospital. Safe and filled with enthusiasm to apply their new knowledge at home, they returned to Cambodia on May 18.
Thus, we have once again succeeded in realizing sustainable training. It is now planned that a team will fly to Cambodia at the end of the year to support the two colleagues in their surgeries.
News in 2023
Unfortunately, the war is still ongoing in Myanmar which is why continuing our in person engagement locally is not possible at the moment.
However, in the neighbouring country Cambodia our support is also much in demand and medically similar conditions prevail: suitable medical instruments and microscops are missing as well as sufficient medical training for the colleagues in order to carry out the delicate ear surgery. This is why we would like to become active there in 2024: first two Cambodian colleagues will come to Europe for training. In autumn 2024 it is then planned for out team to travel to Cambodia to organise surgical courses there and carry out surgeries in a combined team. We are already in close contact with the German embassy.
We are delighted to be able to contribute with our experience!
News in 2022
Every Sunday at 8:30 a.m. (Berlin time) we perform a zoom session with our burmesian colleagues. We talk about medical topics and have an interesting bilateral exchange.
If you want to join: please send an email!
Current news in 2021
The story of Lucy
2019 in Kalay, near the Indian boarder, we were introduced to a 2-year old girl named Lucy. Her mother told us that Lucy cannot speak and don´t react to external sounds. We had to tell the mother that the girl is deaf since birth and will never speak! Only a so called Cochlea implant could help, but there was no chance for the family to save enough money for the implant and the surgery. It was a very sad situation for all of us!
But coming back, there was this Lady who just lost her husband (see sponsors Charly Lamm) who spontaneously gave the money for Lucy. She was operated the same year.
Now – see the result!
Resurgence of Violence in Myanmar
We are very saddened that we had to stop our project in Maynmar. After the military gained power in a brutal manner on the first of February 2021, the country is in chaos. Many deadly victims of the civilian population, general strikes, the collapse of the health service, the closing of factories with subsequent unemployment.
Pupils and students have not been to school for more than a year. At the moment, the corona pandemia is spreading widley and there is threatening famine. Many of our colleagues have not been to work out of protest, have disappeared or have even been arrested. We cannot imagine how this country, which we have experienced as very welcoming and peace loving has changed its face.
Our project has now been temporarily stopped- for an indefinite time.
Potentially, we might be able to implement our successful concept in another country soon, potentially in Tansania. We will report as soon as we know more.
Until then we rest in thought with our friends and their families in Myanmar.
Current news in 2020
In January 2020 the „EAGLE“-team was able to perform the 3rd surgery course at the university clinic of Mandalay. This is by the way the only surgical ENT course held in whole country! 12 colleagues were taught in practical training with anatomical preparations and theoretical knowledge in lectures about middle ear surgery. We also thank the company Zeiss for providing us with the necessary surgical microscopes from Singapore.
Parallel to the course we performed 39 ear surgeries which were in part very complicated. With help from the organization „Ein Herz für Kinder“ („a heart for children“) and the company MEDEL we could present a cochlea implant to a little deaf-born boy and his very happy parents. Our colleague Dr. Win Htike Kyi was able to perform the surgery and implant the device in February 2020. We are very glad to have been able to give the gift of hearing to yet another child with the help of our friends!
After the surgical course in Mandalay a part of our team travelled back to the city of Kalay, were we spent some of our time in 2019. We performed follow-up examinations on the patients from last year with excellent results! Little Lucy, the child who received a cochlea implant to the right ear last year, is also living in Kalay. She wears the device the whole day and starts speaking her first words. A very pleasant success!
Now we hope that the current „Corona-Crisis“ will be passed within the rest of the year, so that we can continue the education and training of our colleagues in Myanmar. Besides our next efforts in Mandalay and Kalay we are planning to invite 2 burmese colleagues to Germany for further training.
Cochlea Implant Project for children born deaf - the Angelika Wagner Project
In Burma, most deaf born boys and girls will not have a chance to learn to hear. While in Europe a normal way of life is possible with a so called Cochlea Implant, implanted before the second year of life, children affected with deafness in Burma are facing a life on the margin of society, totally dependent on their relatives.
In remembrance of Angelika Wagner, our colleague and friend, who accompanied us many times over the last year as an anaethesiologist in her dream country Burma, we would like to build a centre to help those boys and girls. Our aim is to support those children so that they will be able to lead a normal way of life- and maybe even become doctors themselves in the future!
We hope to find people to support our project and maybe even take on a “godparenthood” (like for example the Lamm family, see also “sponsoring”).
News from 2019
After intensive preparations and a lot of support from the companies Zeiss, Kurz and Spiggle & Theis, who provided us with 6 microscopes as well as the surgical equipment, we were able to carry out jet another surgery course for 40 burmese colleagues in Mandalay. In this course we conveyed the principles of middle-ear-surgery in theory and practice.
The participants were thrilled to take part and were asking for a sequel in 2020.
After this we travelled to a town called Kalay close to the indian border. In this town an ENT doctor is practicing who has not done middle-ear surgery so far. We previously had been asked to support her and travel to this city of 300.000 inhabitants.
Until this year there has never been a team of foreign doctors in this part of the country. Accordingly, we were greatly welcomed and the supported by our Burmese colleagues.
The curiosity of the population was tremendous:
More than 1300 patients had applied to be examined by our western ENT-team. This monumental task could only be managed with the help of our Burmese colleagues. During the day we performed surgeries while in the evenings and at the weekend we had our consultation hours. The whole hospital stood by us with nurses and doctors from other faculties to sort out the difficult cases which needed surgery. The hospitality and camaraderie between doctors and nurses was inspiring!
As we were told afterwards, all operations went very well and we were asked to return in 2020 which we will be planning to do!
This mission shows again the sustainability of our efforts and that further support in education of our colleagues and care of the population is needed. At least concerning ear-surgery our work is surely exemplary for the development of the Burmese health care system.
Visitation and education of two burmese colleagues in Traunstein
From May 18th till May 30th 2018 with an invitation by EAGLE-ENT the two Burmese medics Dr. Myo Myat Maung and Dr. Han Min Htut came to visit Traunstein to learn more about hearing aids. With the kind support of the Company Seifert they were introduced to the basic knowledge of how to produce and adjust ear molds for hearing aids in the laboratories in Munich. Back in the branch office in Traunstein Mr. Pöpsel and his team showed them the principles of analogue and digital adjustment of the hearing aid for the patient. Furthermore, under the guidance of Dr. Biesinger, they got an insight into surgical and conservative treatments at the hospital and the ENT-center in Traunstein.
The goal was to provide them with the necessary abilities to independently adjust and program hearing aids back in Myanmar, provide for their patients and teach other colleagues and technical personnel. Therefore it will be possible to provide a broad supply of hearing aids for the Burmese population in the near future. Until now this has been limited to the bigger cities like Mandalay and Yangon and even there, the supply was not sufficient. Thankfully, the Seifert Company is also providing the necessary tools for the production and adjustment of hearing aids and the materials are already on their way to Myanmar.
These great achievements were favored by excellent weather which allowed trips into the surrounding mountains, to Salzburg and the beer garden. The EAGLE team in Munich organized an unforgettable day in the state capital with visits to the cultural highlights and the BMW museum. Special thanks go to BMW Schnitzer in Freilassing: Charly Lamm, one of the owners of Schnitzer BMW, couldn’t resist introducing our two guests to the world of racing for one evening.
With an excess baggage full of new insights it was time to go back to Yangon on May 31st.
After yet another great experience such as this we are already looking forward to our next EAGLE mission in January 2019: We will be organizing a surgery course with following supervised operations for our Burmese colleagues in the hospital of Kalay in the northeast of Mandalay, close to the Indian border.
Video: Thandwe and Mandalay - November 2017
Visit from Prof. Khin Khin Phyu, Chief Physician of the ENT Clinic in Mandalay
From 19.03. until 10.04.2017 EAGLE invited Prof. Khin Khin Phyu to visit and train in the Landeskrankenhaus Salzburg (ENT Department) and Traunstein. Prof. Khin Khin Phyu is the Chief Physician of the ENT Clinic in Mandalay, the second largest city in Myanmar. Thanks to the intensive collaboration with Prof. Dr. Gerd Rasp, director of the ENT-Clinic at the Landeskrankenhaus Salzburg and Dr. Biesinger and co-workers, she was intensively trained in microsurgery of the ear, including the middle ear- and cochlea-implants. In Myanmar, there are currently only a few colleagues who are able to perform middle-ear surgery. This is why this visit was an important step in the support of the training of our colleagues in Myanmar. For us, the function of Prof. Phyu is very important, too: in addition to her work at the hospital, she is in charge of the “National Deaf Project”. Associated with this project are regular visits by Prof. Phyu and her staff to the rural provinces in order to provide the necessary diagnostics and assistance for deaf people and especially children. In this function she can help us enormously during our visits to Myanmar. By communicating with the hospitals in which we will operate, she prepares our assignments, supports us logistically, and responsibly performs the follow-up of the patients we have operated on. She will provide us with young colleagues, who will train with us during our stays and maybe some of them will be able to come to Europe with our help.
The visit of Prof. Phyu was a great success on both sides. Not only did she learn a lot, but the future work for our team was placed on a fertile and sustainable basis
Implementation of the newborn hearing screening in Thandwe January 2017
We, Dr. med. univ. Melanie Vogl (29) and Dr. med. univ. Benedikt Biesinger (26), two freshly graduated young doctors, had the possibility to travel through Myanmar during our time off between our university degree and the start in the medical everyday life. At the beginning of January 2017 we boarded the plane from Munich to Yangon, in our luggage the Oto-Read Screener, a device for the early detection of deafness in small children and neonates.
At first we traveled the country for two weeks and had the chance to meet some young students who, by the aid of Stiftunglife, have the possibility to study in Myanmar. In Magwe we met the student Aung Ko Chit, who told us about the medical studies in Myanmar. Later in Mandalay, former royal city of Myanmar, we met Khin San, our local contact of Stiftunglife, and the nurse May Zin Theint along with some young nursing students. At our request, they took us across the Mandalay General Hospital and told us about their training and hospital activities during a cup of tea at the teahouse. The young students were all very interested and wanted to know everything about the health system in Germany and our medical studies. After a short while the initial nervousness and language difficulties were forgotten and a nice discussion about the training, family and hobbies of the girls arose.
On the second day in Mandalay, we were picked up at our hotel by Dr. Win Hitke Kyi, who had already been able to visit Salzburg in 2013, and the head of the ENT department Prof. Khin Phyu. Dr. Win proudly showed us his workplace, his family and the most beautiful corners of Mandalay. In the afternoon, two other young ENT physicians joined us and told us more about the medical studies there. They also reported about the difficult times during the military dictatorship as they tried - without permission of the government, but with the support of the dean - to install a forbidden university library. After a joint dinner with half the department, we made our farewells - almost like friends - with the request to come back soon to visit again.
Finally, in Ngapali we devoted ourselves to our actual project. We had planned the training of a couple of nurses for the Oto-Read Screener. For this screening a sensor with a silicone plug is inserted into the auditory canal. The device sends a signal and then measures a corresponding response if the middle and inner ear are working properly. In Germany this test is carried out on a standard basis for all newborn babies during their first week of life.
The project was organized by Oliver Esser, a local chef, and discussed with the management of the nearby clinic in Thandwe. Even large posters announced the newborn hearing screening throughout the town and Oliver informed the regional health minister about our project.
The training of the nurses was very efficient: after about 2 hours, 5 of the nurses were familiar with the device and had practiced the screening on each other and on ourselves. Detailed instructions with explanatory pictures, descriptions of maintenance, as well as all spare parts were handed over to the team together with the device. For the following day we arranged a second meeting to clarify any questions and to perform the screening on the first child patients.
When we finally entered the hospital on our last day in Thandwe, the waiting area was swarming of small children in blue and white uniforms. Oliver had told the English kindergarten Mami Su about our project. The kindergarden teachers and parents gladly accepted the offer of a free hearing screening and came to the clinic with a group of 20 3-4 year old nursery children. For our nurses this meant additional exercise with the device on children's ears.
We expected much shouting, tears and chaos. But for the children the trip to the hospital seemed not to be scary, but much more a very exciting spectacle. We always brought two children together with their parents into the examination room. While the one child was curiously watching the course, the second child eagerly presented the ear to be examined. Without flinching, all children sat through the screening and let us insert the silicone plug into their ears. After the examination they hopped from their plastic chairs, looked at us with their big dark eyes and faces painted with Thanaka paste and thanked us in English or Burmese. In the mean time we explained to the parents and kindergarden teachers the necessity of the test, especially in newborns and toddlers. For the future, one day per week will be set on which appointments for the newborn hearing screening will be given. At these dates, the parents can come back with siblings and tell their friends and family to come with their children. In the long term, we hope that this hearing test will be added as a routine examination to the Burmese mother-and-child passport.
Our special thanks go to Oliver Esser and his wife Khet Khet, who supported us on our entire trip and especially on site in Ngapali. Without them this project would not have been possible. We would also like to thank Khin San from Stiftunglife, who arranged the meetings with the students. Last but not least, we would like to thank all the participants at Eagle-ENT who have established the exchange with Myanmar and to all the sponsors and donors. Only with your help we can support the people of Myanmar.
Review 2016
2016 was all about setting our finances and communicating with our supporters and colleagues in Myanmar; making plans for new projects in 2017 and improving our surgical equipment.
Thanks to all our friends, colleagues and sponsors we can start into 2017 with new activities and full of ambition. Our plans are:
1. In January 2017 two recently graduated doctors will travel to Thandwe and establish the newborn-screening at the Thandwe hospital. This hospital will probably be the first to measure the hearing ability in newborn babies in. We are very proud to provide this possibility! This measurement will make it possible to identify babies with deafness in an early stage. A very important step as the brain development in deaf babies does not work properly and the ability so speak will not be provided once the baby is older than 2 years. However, if the disability is recognized early on by the newborn screening there are several possibilities to help these kids e.g. with a hearing aid, an operation or a Chochlea Implant.
2. In March/April we will once again invite a colleague from Myanmar to come to Salzburg to provide her with further training. Thereby she will be able to teach her colleagues at home and improve their knowledge. We will report about her achievements.
3. In November 2017 we are planning another mission in the Rhakine state – one of the poorest regions of Myanmar. We will plan operations and teachings for the doctors on site at Thandwe and Sittwe.
After the collapse of the burmenian kingdom the country was bled out by the colonial rule of England and Japan and brutalized by a ruthless military dictatorship over the last 30 years. However, since the last democratic elections in 2015 (once again we were in the country at election day) there has been an impressive change. Sadly it will take some time for the health care system to benefit from these changes. The gaps to fill are just too big. We – small but effective – are very happy to be a part of this reconstruction by supporting our burmenian colleagues with teaching and training in a sustainable way. In contrast to many other countries we notice a great interest in our efforts and the knowledge is passed on over the whole county in a pyramid scheme.
By your donations you are directly contributing to this change and we want to thank you very much for your support!
Our mission in 2015:
In 2014, we successfully established an ENT ward in the coastal town of Thandwe. As a result, we have been able to continue our medical and surgical efforts in this city. Because of the nearby beach Ngapali this is a strategically very important city in touristic respects.
Since establishing the ENT ward, we continue to find it being managed very well and all the instruments, including the microscope we brought last year, are complete and intact and in good condition. Consultations and surgery have become routine for us there and as a result procedures were successful and uneventful during our stay this year.
The second stop of our trip was Sittwe, the capitol of the state Rakhine (da hast du in dem Brief an den Journalisten einen anderen Namen geschrieben). Although an ENT specialist is working at the hospital there, no surgical instruments are available to perform necessary ear surgery. That means for the 3 million inhabitants of Rakhine there is not a single ENT doctor equipped to perform middle-ear surgery.
Patients with chronic ear infection have to accept their fate and any complications related to this normally manageable disease. Especially for children, these complications may prove fatal.
To illustrate the effect the ENT ward is having of the health of such patients, please imagine our full schedule during office hours. (what are the hours? How many hours?) With most patients coming from all over the state, sometimes travelling 2-3 days to receive a consultation and surgery if needed. All in all, we cared for some 330 patients during office hours (over how many days?) and were able to perform the necessary and often very difficult surgeries on 48 patients. And for next year, there are already scheduled more than 80 patients who desperately need surgery.
Taking all this into consideration, we are all the more motivated to continue our work. With our personal commitment on one hand side and the commitment of our colleagues in Myanmar on the other, we see a future that creates a ‘gamete’ for ear surgery.
Like many of our other colleagues from Myanmar, the ENT specialist in Sittwe showed a lot of commitment and motivation to learn more. Therefore, with the support of the University of Salzburg, we want to invite him to Europe to develop his surgical skills. In Salzburg, with the help of Prof. Rasp and in our clinic in Traunstein, he will receive the training and experience he needs to perform middle-ear surgery. Subsequently, we will visit him in 2016 to evaluate his training and performance to ensure he is skilled to complete successful surgeries. And if needed we will be able to remediate any areas he may need further training in. By working closely with our colleague, we will be able to continue our mission throughout the year.
Only with your support and your commitment are we able to help the people of Myanmar! And they are so very worth it.
If only you could see what we see. These people are so loving and gracious. And although we can barely communicate with them, their gratitude and thankfulness is easily read on their faces.
Please keep supporting us! Not only will your help improve the lives of so many patients but it also helps our colleagues in Myanmar provide sustainable health care for the people of Myanmar!
Dr. Biesinger
2014: successful installation of an ENT-Station in Thandwe
From October 10th to October 25th our team ( Lena Fischer, surgery nurse, Dr. Sabine Keiner, ENT clinic University Bonn, Petra Wagner and Angelika Wagner, both anaesthesists from Munich, Dr. Christin Idler from Traunstein, Dr. Christin Heiden and Dr. Eberhard Biesinger from Traunstein) were in Thandwe, a central point on the south-east coast of Burma. This city is situated in the state Rakhine, one of the poorest states in Myanmar, still troubled by the conflict between Buddhists and Muslims. With about three million people living in the state Rakhine you will find only one ENT physician in the capital Sittwe!
Tourism is slowly coming up, so complete medical care (especially in ENT) is crucial. Actually a lot of people are getting dependent on tourism and are awaiting a better future with great hopes. With the active support of Oliver Esser (owner of the Laguna Lodge on the coast), who organizes teams and aid groups all over the country, our surgery nurse Lena Fischer and Dr. Heiden were able to set the scene so that between October 12th and October18th we could operate on 28 patients, more than 250 patients were examined and given treatment and further advice.
Eight deaf-dumb children and post-lingual adults are being cared for by our collegues in Yangon in order to check the provision of a Cochlea Implant. After that week we were busy with following-up checks, the training of nurses and final clearing.
All in all we can say that after this 3-week effort a complete ENT-unit is technically and logistically ready for use. Further teams can now immediately start with both examinations and operations after their arrival. More than 20 patients are already on the list for the next mission.
We were received for report by the German Embassy in Yangon, and we went to see the Mary Chapman Foundation where more than 400 deaf-dumb children are educated and - as far as possible - are supplied with hearing aids. As to that fact the Med-El Company has set a great example. Joining our group in 2010, they did help with the professional education of speech therapists for aural rehabilitaion. By adjusting the equipment for aural rehabilitation they created a structure which allows complete supply and rehabilitation with Cochlea Implants.
It is obvious that people are desperately waiting for the government of Myanmar sending an ENT-specialist to Thandwe who will use our facilities and who can immediately start work. The Government has promised to do so, but it must be said that presently they are preparing the next democratic elections in 2015 and until then no state official (which doctors of medicine are in Myanmar) is allowed to leave bis actual position. All over the world people are hoping for a "good" result of these elections, probably a coalition of the parties of the military wing and the party of Aung San Sun Kyi. As to economics, the country is in the ascent and in Yangon you will find an ambiance of "gold-digging", real estate prices being higher than in New York.
Let's hope that health care will make progress as well and finally reach the poorest.
We are very proud of this mission that could not have been more effective and successful.
Lots of thanks to all our supporters! Of course we are looking forward to further funds so that we can continue and fulfil our commitments.