Although the Government of Myanmar is committed to advancing the health of the populace it is a daunting task. At a township hospital, the first line of defense for health care, there are little if any supplies and materials. The photos show the only surgical instruments that the doctor has to use (compared to the thousands in a modern American hospital) and the supplies on in the right side photo constitute the anesthesia system. No general anesthesia is available and patients undergo major abdominal and pelvic surgery with spinal anesthetic and IV sedation. Chest trauma requiring surgery is not survivable unless the patient can get to a district hospital, which can be 3-10 hours away by boat, car or moped.