Reaching beyond Australia to improve the lives of others

Max Esser was bothered by the figures. In a country with a population of 57 million, Myanmar had fewer than 550 orthopaedic surgeons. As he chatted to some of his international colleagues following a medical meeting in Yangon in 2011, he wondered how more doctors could be encouraged to train in the specialty. It was then that he conceived the idea of using a surgical skills laboratory as a teaching facility.

Chiang Mai Surgical Skills Course 2016 with Professor Max Esser (centre),joined by Thai Orthopaedic Surgeon, Dr Siriprong Chiewchantanakit, from Chiang Mai (centre right).

This was not the first trip to Myanmar for the Associate Professor, a consultant orthopaedic surgeon specialising in hip, knee and other orthopaedic conditions at Melbourne’s Alfred Hospital. A year earlier, he had been approached by the Royal Australian College of Surgeons to train general practitioners in Myanmar in basic trauma techniques. He embraced the challenge – and the country.

“Myanmar was a country of some sophistication,” recalls Associate Professor Esser (MBBS 1974). “It had a medical system that was analogous to our own in Australia, but it had little exposure to many of the more recent orthopaedic surgical techniques. This initiative was intriguing because it was an attempt to train the trainers. It had the potential to be a huge multiplier of knowledge.”

His positive response to his professional peak body’s call to arms was not surprising to those who know Professor Esser. He has been a world traveller since childhood and has always believed that people should contribute when and where they are able. Making a difference in the lives of others has long resonated with him.

It’s a lesson he learnt as a child growing up in Hawthorn where his father, Alfred, used the front half of his home as a surgery. He liked the idea that his father could make people better, that he could somehow improve their lives by improving their health.

Alfred Esser had studied medicine at the University of Cologne but fled Hitler’s Germany in 1935 when he understood he had no future there. On his arrival in Glasgow as a refugee, he was told that he would have to retrain if he wanted to practise family medicine in Australia, where he planned to build a new life. He arrived in Melbourne in 1938 and immediately volunteered to join the Australian army. Those who joined the medical corps were given the rank of captain so that, briefly, he was the only German officer in the Australian army.

Professor Esser at The MASTT Program, Myanmar Alfred Surgical Techniques and Trauma, at the University of Medicine Anatomy School, Mandaly, Myanmar. From left to right; Dr Gerard O’Reilly (MBBS 1992), Senior Accident and Emergency Physician at Alfred Hospital, Professor Max Esser, Ms Kerry Currell, Senior Charge Nurse Operating Room, Alfred Hospital, Professor Moe Moe Tin, General Surgeon, Myanmar, and Dr James Kong, General Surgeon, Hong Kong, Honorary Professor of Surgery, University of Medicine 1, Myanmar.

Professor Esser was the eldest of Alfred and Wilma Esser’s three children. They encouraged their children to embrace a global view, taking Max with them on a trip around the world when he was just 10. But it was a basic mountaineering course in the Himalayas at age 16 that proved to be a defining moment in the life of the Scotch College student.

“We were given challenges that seemed almost impossible to achieve and we were able to overcome them,” he recalls.  “For example, we were dropped into the jungle at night and given 24 hours to make our way back to base. On another occasion, we embarked on a five-day walk above the tree line in the Himalayas with limited food available.”

The experience taught him the power of resourcefulness and resilience, lessons that have served him well in life.

Professor Esser graduated from Medicine at the University of Melbourne in 1974 and although, for a short time, he flirted with the idea of following his father into a career in general practice, he felt more comfortable in surgery. He did his orthopaedic surgery training in the UK, Ireland and California.

“It has been an enormously interesting and fulfilling career,” he reflects. “What has been particularly satisfying about it is that you can have a patient who has been immobilised with the pain of a fracture, or arthritis, and a day after surgery, he or she can walk. It’s a tangible, rapid and visible result for your surgical endeavours.”

Teaching surgical techniques to a generation of surgeons in Myanmar has been especially satisfying for the academic. The first program, held in Chiang Mai and which attracted around 25 surgeons, some established and others at the end of their post-graduate training in Myanmar, was concentrated on surgical approaches to the pelvis and the acetabulum. It was the first time this sort of post-graduate training had been offered to surgeons from Myanmar.

“They had not had the exposure to surgical skills using cadavers and models of bones,” says Professor Esser.

Second and third programs, given in Chiang Mai and Mandalay, were offered to junior surgeons, emergency department physicians and trainee anaesthetists. The training was focused on emergency operations on trauma-related injuries that could be managed in general hospitals in Myanmar.

Medical staff attending the Pelvic Surgical Approach Course, in a surgical skills laboratory, Chiang Mai, which in 2013, was the first surgical skills course with the participation of Thai, Myanmar and Australian surgeons.

Professor Esser’s work in Myanmar has been greatly supported by a multi-disciplinary team at the Alfred Hospital, including an accident and emergency physician, an anaesthetist, a general surgeon, a neurosurgeon, a second orthopaedic surgeon and two nurses.

Dr Mark Fitzgerald ASM (MBBS 1981), Director of Trauma Services at the Alfred Hospital, has been instrumental in helping put in place a three-year program – The Myanmar Australia Trauma Management Program – to increase the knowledge and capacity of trauma doctors and nurses in Myanmar. It has been funded by the Department of Foreign Affairs and Trade.

Sharing such specialist techniques has made a difference in the lives of people in Myanmar. It has also boosted the morale of the medical profession.

They have an active, organised medical education which is based on the British model and they manage instructions with ease," explains Professor Esser. "They're a very intelligent, sophisticated people who have had immense problems as a result of political upheaval over the last 50 years."

He has been a witness to the nation’s progress made over the past eight years.

“On first visiting Myanmar, in 2010, there were no accident emergency physicians,” he recalls. “There were emergency staff, but they were not fully trained.

“Today, there is significant growth in the number of trained staff in accident and emergency as a result of the collaboration between the Royal Australian College of Surgeons and the Australasian College for Emergency Medicine to develop this discipline in Myanmar.

“It’s an example of the incredibly constructive, proactive results of both of these organisations.”