Guest Column

Remembering a Myanmar Surgical Pioneer

By Dr. Myint Zan 7 December 2019

Today marks the 35th anniversary of the passing away of Dr. San Baw, my late father, in Mandalay on Dec. 7, 1984.

Dr. San Baw pioneered the use of ivory hip prostheses to replace fractured thighbones in January 1960, when he inserted an ivory hip prosthesis in an 83-year-old Burmese Buddhist nun, Daw Pun Nya.  From 1960 until his retirement in 1980, Dr. San Baw used ivory hip prostheses to replace the fractured thighbones of about 400 patients whose ages ranged from 13 or 14 to 87.

Some of the recipients gave prior consent to Dr. San Baw and his assistant Dr. Sein Lwin (now based in Fort Lauderdale, Florida) to conduct postmortem operations on them to confirm the process of “biological bonding” or “creeping substitution” between bone and ivory. As of 1969, Dr. San Baw’s patients showed an 87 percent success rate. Patients with ivory hip prostheses were able not only to walk, squat and cycle, but also—for some younger patients—to play football.

At least three patients inserted with ivory hip prostheses are (as of end of November 2019) still alive. The youngest patients inserted with ivory prostheses—Daw Than Htay, now 64, and Daw Amar Tin, now 67, from separate villages near Mandalay—were about 13 and 15 respectively when they had prostheses inserted in their left hips. Both women recall that their operations took place no later than 1970, and 50 years later they can still walk without assistance. During the period that Dr. San Baw was working with ivory prostheses in Myanmar in the 1960s and 1970s, there was no killing of elephants; the ivory used was taken from elephants that had died naturally.

An ivory hip prosthesis

Another beneficiary of my late father’s work who is still living is Daw Than Than (born Sept. 23, 1923) of Mandalay. Around 1994 or 1995, when Daw Than Than was in her early 70s, Prof. U Meik, a former student and junior colleague of Dr. San Baw, replaced her left hip with an ivory prosthesis.

Daw Than Than dislocated her right hip again after a fall in October 2014 and Prof. Dr Sein Hla Oo inserted a metal prosthesis. As of October 2018, Daw Than Than had the distinction of being the only person in the world over the age of 90 with an ivory prosthesis in her left hip and a metal prosthesis in her right hip.

Since the late 1990s, the worldwide ban on the trade of ivory products has mandated that ivory can no longer be used for hip replacements.

Between 1960 and the early 1980s, Dr. San Baw implanted ivory prostheses in about 400 people in Myanmar, but it appears he never performed the surgery on a foreigner. However, the late Dr. Subramaniam, professor of orthopedic surgery at the University of Malaya Hospital in Kuala Lumpur, Malaysia, informed me that in January and February of 1976, when Dr. San Baw was visiting Malaysia, he did treat at least one Malaysian child suffering from infantile pseudarthrosis of the tibia (a so-called “extra shin bone” in children) using his own technique—yet another San Baw innovation.

In 2018 I established a fund in honor of my late father at his alma mater, the University of Pennsylvania Graduate School of Medicine.

Dr. San Baw at a conference in 1969

Over 60 years after his graduation (in absentia) from the Graduate School of Medicine (GM) at the University of Pennsylvania in February 1958, the Inaugural San Baw, M.D. GM ’58 Honorary Lecture in Orthopedic Innovation was held on Nov. 29, 2018 at “U Penn”. Dr. Bartlomiej (Bartek) Szostakowski, an orthopedic surgeon from Poland, delivered the Inaugural Lecture, titled “Dr. San Baw—The Forgotten Innovator in Orthopedic Biologic Reconstruction”. I also give a presentation, “Dr. San Baw: A Son’s Tribute”.

In Myanmar, with the help of revived sponsorship and funding by Prof. Dr Myint Zan (professor of law) and the Myanmar Orthopedic Society, the Dr. San Baw Research Fund will continue to be used for various research activities, primarily—but not solely—related to orthopedic research and training. And I have been informed that, supported by my donation to the Department of Orthopedic Surgery at the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania, the San Baw Honorary Lecture will be held on an annual basis “in perpetuity”.

On the 35th anniversary of the passing of my late father, with this article I respectfully offer my tribute to him.

Dr. Myint Zan taught law and law-related subjects at universities in Malaysia, Australia, the South Pacific and the United States from 1989 to 2016.

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