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“It’s actually civilians that are targeted”- Dr Matthew Spreadbury on Delivering Emergency Trauma Response in Myanmar

Dr Matthew Spreadbury is a surgery resident currently living and working in Norway. Here, he talks with Iain Overton about his experiences working as a surgeon in Myanmar, performing emergency and trauma response interventions for civilians injured by explosive weapons in Karenni State. He shares a story of pain and catastrophic human impact, but also of hope.

Photocredit – Free Burma Rangers

Dr Spreadbury: My name is Matthew Spreadbury, I’m 30 years old, and I’m currently living in Bergen, Norway. I’m a general and vascular surgery resident working at Haukeland University Hospital. I’ve got a heart for going to the places where the need is greatest, and that’s led me on several adventures around the world: South Sudan, Kenya, Rwanda and most recently, Burma. It’s really a country where there’s very little coverage, very few people in the Western sphere know about what’s happening in some of these places.

Photocredit  -Thomas Hurst

Iain Overton: The areas where you seem to be doing a lot of medical work are areas where there are clearly low levels, and sometimes high levels, of conflict. What is your primary focus when you’re out there working? Are you doing mainly conflict trauma, or is it more holistic, just providing a wider service?

Dr Spreadbury: It really depends on the situation I am in. When I was out in the bush in South Sudan, near the border with Ethiopia, a few years ago, people didn’t have an understanding of what is clean water, and what is not clean water. So there wasn’t a system established to perform a surgery. It’s more about seeing what the needs are and responding to them. Like, “okay, this is more public health.” Whereas in Burma, it was really responding to military trauma. In Karenni State, It was aggressive, open warfare. And that was really about trying to stabilize patients and send them on to the next level of care which was about an hour and a half away, in the nearest hospital. It was about establishing a frontline casualty collection point, taking care of the wounded, and as needed performing life-saving surgery.

Iain Overton: How long were you there?

Dr Spreadbury: Two and a bit months, not all on the frontlines.

Iain Overton: And on a daily basis during that time, how many patients were you seeing?

Dr Spreadbury: It’s hard to say, because, at the front, there is a fog of war and miscommunication is rife. So there were many patients who didn’t actually come to us. Many were driven to local clinics or the hospital by the resistance groups, or by a lone volunteer with an ambulance. When I turned up, we saw anywhere between five to ten patients a day. They’re not dramatic numbers. But on other days, when there’s heavy shelling, it could be many more. The day after I left, there was an airstrike. They had 30 injured patients. It was a mass casualty situation, which was completely overwhelming for what these small health clinics can take care of. So it’s very variable.

Iain Overton: And the sort of violence that you were witnessing in Burma, was it largely explosive violence, or was it also small arms?

Dr Spreadbury: Both. I’d say that there were very few life-threatening survivable injuries that I saw where I could intervene and help save someone’s life. It was either minor injuries through small arms fire, which were mainly superficial wounds, or it was catastrophic injuries, for example, a Russian MiG fighter jet strafing someone. There the trauma burden is too high to survive. Landmines, horrible things, are unfortunately very prevalent on both sides, as a means of protection, of protecting someone’s land, or laid by the Burma army. I saw the effect of landmines causing catastrophic injuries. It’s modern warfare being used by a professional military against local civilians who are trying to protect themselves.

Photocredit  -Thomas Hurst

Iain Overton: For the reader, can you give a bit of context as to why this war is waging?

Dr Spreadbury: Sure. So Burma got independence in 1948, from the British, and within four or five years, a military dictatorship had taken hold of the country. The military has power in the main cities, pretty much, in the lowlands, and they’re the ethnic Burmese. They speak Burmese. Whereas in the highlands, in the jungle, pretty much every area that borders from west, north and east, there are the ethnic tribes, the Kachin, the Karen, the Wa, the Rohingya – which you heard about in 2017 – and they have fought against the military pretty much on and off since the early 50s. Burma has the world’s longest-running civil war, over 70 years and counting, and still very few people know about it, which in my mind is shocking. So, what escalated recently, in the last year or two, is that there was a process for a democratically elected parliament. Aung San Suu Kyi was chosen by the people to be their prime minister. On 1st February 2021, the day that she should have taken power, the military staged a coup d’etat, in the sense that, although civilian rule never really had much power before (it’s always been under the guise of the military), now the military has really increased their bombardment and attacks on the ethnic groups who are protesting and who have been fighting for freedom for over 70 years. What is new is that the Burmese people don’t recognise the military dictatorship either and have formed the Civil Disobedience Movement which is allied with the ethnic groups.

Iain Overton: You talk about airstrikes, and you’ve talked about landmines. The nature of airstrikes suggests that this might be an uneven war, with a well-funded state against ethnic groups. Is that an accurate description?

Dr Spreadbury: It is, I mean, some people have said that it’s like a military from this century fighting one from the last century. I saw Russian MiG fighter jets flying over us and the people that are defending themselves are the local resistance forces. Like the Karenni National Defense Force, and a few other groups just where I was, and they are unfortunately poorly funded, poorly armed, and poorly trained. I saw homemade shotguns, I even saw muskets being used on the front, against a modern military.

Burma Army airstrikes

Iain Overton: Are civilians being dragged into this conflict? Did you see, in your time, civilian local ethnic groups being injured by this weaponry?

Dr Spreadbury: Yes, it’s indiscriminate. It’s actually civilians that are targeted. There’s a scorched earth policy at the moment, where, one day at the front I was looking out, and I could just see four plumes of smoke rising up on the horizon at 600 meters away. And that’s the Burma army just torching villages, torching livestock and farming equipment. It’s designed so that people are forced to flee. Real evil is happening there. It’s not just military groups against military groups.

Photocredit  -Thomas Hurst

Iain Overton: You’re talking about the primary care that you were delivering, in terms of emergency response. Are there sufficient medical services there for the complex needs that explosive weaponry use will have in terms of injury and impact?

Dr Spreadbury: The short answer is no. I was in Karenni State, only about 100 kilometres from the capital Naypyidaw. There are roads, there is some degree of infrastructure, and every small village will have a maternity clinic. And these maternity clinics have some basic medical supplies, and they were repurposed as our mini emergency rooms, let’s say, or casualty collection points. In terms of surgery, there was no surgical capacity before I briefly turned up on the front. The nearest hospital, from where we were, was about an hour and a half away. We would drive through the mountainous roads. There were fantastic surgeons and doctors there, who are Burmese, who after the coup have, in a sense I’d say, switched sides and joined the civil disobedience movement, and fled the major towns and came to seek refuge with ethnic groups for safety. They have done a very good job of establishing a system of health care. The hospital was just overrun with war-wounded patients. There were about 100 surgical patients in a tiny hospital, with one or two general surgeons, and general practitioners, doing fantastic work and really remarkable surgery under the circumstances. But at the front? Very little.

Photocredit – Free Burma Rangers

Iain Overton: And in terms of rehabilitation and other services, things like prosthetics, or plastic surgery, or even psychosocial assistance for the victims of trauma, is there anything really in place for people impacted?

Dr Spreadbury: I would say that what you just mentioned, isn’t even on the list. It’s not a concern right now. We’re still at the first stage of stopping the bleeding. Can we get a tourniquet on the bleeding point? Because really, there on the front, in trauma surgery we talk about the golden hour in which to intervene and save someone’s life. So many people are unfortunately bleeding out, without even receiving the principles of trauma first aid. So to think about rehabilitation prosthetics, there’s no system there. For context, there is no one from the outside world there apart from the Free Burma Rangers. They are a humanitarian organization working with the people that are affected by conflict in Burma. And they’re the only people there who are filming what is happening and getting the news out, and helping the people. Apart from them, there is no other major organization working where they work.

Iain Overton: You’ve obviously been to a number of places around the world where conflict has been dominant. Would you say that what’s happening in Burma is almost shockingly underreported?

Dr Spreadbury: Absolutely, absolutely. I’ve tried to break the news to the British media, and Norwegian media, but people aren’t interested. It’s really sad to say, but perhaps it’s because it’s an isolated conflict, halfway around the world, that shares a border with China and it is not on our doorstep. It’s really heartbreaking, genuinely, trying to tell the story and many people don’t even know where Burma is.

Iain Overton: The weaponry systems you’re seeing, you seem to be suggesting they were largely purchased from the Russians.

Dr Spreadbury: Yes. The Burma army buys weapons from the Russians. And we saw these fighter jets and attack helicopters flying over. I don’t know about the mortars, or where they came from, but they were heavy, 120-millimetre mortars.

Photocredit – Free Burma Rangers

Iain Overton: What do you think people can do to assist or to help be motivated on this issue?

Dr Spreadbury: The first thing is, I think, recognition. It’s about trying to get the news out. I mean, anything that the Free Burma Rangers put out, read it and share it. Secondly: support them because they do fantastic work. In a way, they’re the only humanitarian aid group working at the front in the most dangerous places right where the need is. They buy rice to feed refugee camps because no one else is there. They bring tarps to build shelters for the people. They evacuate people left for dead to safety. They provide medical care. Increasing social awareness of what’s happening in Burma is important. There are very many hopeful people in the civil disobedience movement and the opposition government, the National Unity Government, who have made a plan for a return to democratic rule. So there are many things happening on the democratic side of the resistance movement.

Iain Overton: How did you find yourself there? How did you find out about this conflict?

Dr Spreadbury: When I came back from a trip to South Sudan in 2020, I saw a documentary about the Free Burma Rangers, this humanitarian organization. I thought, wow, there are people there who live out faith in a similar way to what I experienced in South Sudan. They go to the sound of need, they turn up and start serving out of love in whatever capacity they have, be it medical, or in other ways. So I got in touch with Dave Eubank, who started the Free Burma Rangers, and I asked “Hi, do you need a surgeon,” and he said “Yes. If God leads you, come.” Since then it took about two years of trying to find the right time to come to Burma.   

Iain Overton: Just finally, in terms of optimism, or the future (or maybe it isn’t optimistic), what do you think the future will be for this conflict? Will it creep on for years to come? Or is there hope?

Dr Spreadbury: There’s always hope. We have this hope as an anchor. And one thing that Dave said a lot on the front was that, you don’t have to beat the Burma army. You don’t have to win the war. You just have to not lose it. And for the people who are doing the day-to-day fighting against the Burma army, I think there is a lot of hope that the army cannot sustain what they’re doing. Before it was just the ethnic groups which they were opposed to. Now it’s the entire Burmese population. People who are in the main cities are also feeling the brunt of the oppression of the Burma army, and they’re rioting in the streets despite a brutal crackdown in Rangoon. So there’s a lot of hope in the future. Burma shall be free one day, but we don’t know when. Every day I hear conflicting reports of things going well or things going poorly. But I believe that there is a lot of hope in the future. For now, the resistance groups need a lot of funding and support.


Images courtesy of Dr Matthew Spreadbury.


Statistics:

  • Burma has the world’s longest-running civil war, 70 years and counting.
  • In Karenni State, there are over 230,000 internally displaced people. This accounts for more than 50% of the population there.
  • There are over 100,000 internally displaced people on the Thai border seeking help, in addition to 90,000 people in UN camps on the border.
  • Around 10,000 civilian homes are estimated to have been burnt down since the coup in 2021.

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