CME on Advances in Infertility

An hour long CME session on the cited subject was held today at the conferrence hall. Dr Sonam Jamtsho, Gynecologist was the resource persons. It was a lively session with enthusiastic participation from the floor. Close to fifty staff attended the session. Out of the many modern techniques available, preparations are on to atleast start with in-utero insemination in cases of male infertility.

Improving health care

Please check the BMA forum for a debate on this issue..initiated by Dr Chencho following todays article on Kuensel. I have put my opinion there. It is worthwhile to think from all our side and put up our views. After all it is for all of us and for all Bhutanese. Lets see what you all have to say!

Mongar Doctor nominated for JICA training

Dr Jambay Dorji, GDMO of MRRH , has been nominated, along with Dr Norbu from CRRH, to attend a three weeks training in Infectious Diseases in Japan under the JICA Program. They will be leaving the country soon.

Under the same Program, we also have a neonatal nurse from Japan working with us for the last one year.

A tiring day!

Ward round-Pediatric, Neonatal and Maternity. Then OPD of about 30 cases and 12 echocardiograms...all within 6 hours.....what a hectic day!

A day at Chali BHU

Today I went to Chali BHU to examine the reported cases of Malnutrition. A total of 128 under five children came to the BHU. It took the entire day to examine all these children ..All children were weighed , their heights/lengths measured and their Z score calculated. Most of the children were found to be normal. A few cases of mild underweight were seen. Further , couple of children with heart murmurs were detected who have been called for a Echo. I will be preparing a detailed report of the children seen.No case of severe malnutrition was seen.

Eye Camp in Trashiyangtse

The Eye specialist, Dr Bhim B Rai will be conducting a week long eye operation camp at Trashiyangtse Hospital begining this Tuesday(the 26th). A lot of operations are expected to take place especially for people with cataracts. Lot of people will be able to see the world all over again!

The biggest gift you can give anyone is this...the eyes to see again!

Burmese specialists back from annual leave

Most of the Burmese specialists who went on leave will be back to duty by Monday. They had been away for about a month and half. It is learnt that they have already arrived to the capital.

Dr Sonam Dukpa, Senior Surgeon who was temporarily here to look after the surgical unit, will also leave on Monday.

Chali Malnutrition Issue

I will be going to Chali BHU on Monday to examine and sort out the reported cases of Malnutrition from Chali BHU sometime back. The children will be examined thoroughly and categorised on the degree of Malnutrition based on the WHO charts( Z score).

It is unusual for so many severe malnutrition cases from one BHU area. It came out in the media and seriously concerned us. Lets see what it turns out to be!

Mental Health and BHMIS Workshop

A workshop on above cited areas is scheduled for the health workers of Mongar and the eastern districts next week. Resource persons will be mobilised from within the region as per the DHO.

Nursing Cordination meeting

The monthly co-ordination meeting amongst the nursing staff was conducted today. About 20 staff nurses discussed various issues related to patient care, administrative lapses, maintenance aspects, patient escorts, and many other relevant issues.

CME Focal person for MRRH

The Human Resource Management Committe of MRRH has identified me as the co-ordinator and focal person for organising regular CME activity in the Hospital. With the availability of a LCD projector and the interests shown by most of the doctors, I hope to make this a regular activity which will be most probably weekly. I will appreciate healthy participation from all my colleagues, hospital staff and the hospital administration.

For the time being, we may not have any activity as majority of the specialists and doctors are on leave. By the begining of February, we shall go in full swing.

BPH Interview underway

The Selection interview for the Bachelors of Public Health is being carried out in different places for the short listed candidates. More than 150 candidates have been shortlisted by the Ministry earlier. The interview in the east is being conducted at Trashigang .

Two staff of MRRH who had been shorlisted are also attending the interview.

More Arrow injuries

Two patients are currently in the hospital following serious arrow injuries. Call it the aftermath of CHUNIPA losar! One of them is said to have lost eye sight in one of the eyes..how can we make our national sport safe?

BIMS Bill on the web

The Bhutan Institute of Medical Sciences draft bill has been put up on the JDW website for all of us to read and comment. I hope many of us will be interested to go through and give our comments to Mr Jamtsho, Project co-ordinator. I am yet to go through it line by line.

Paradoxes in Health!

1. Pneumonia and alcohol are biggest killers....yet we spend so much on HIV and AIDS!
2. Primary health care is yet to reach the grassroots..we talk of health tourism!
3. Essential drugs are in short supply,yet we have grand hospital structures!
4. Our nurses are in short supply, but they are plenty in the archery grounds!
5. Our attitudes are rotten, we talk of quality care!
6. Academics is a no no to most of us, but we will have a medical college soon!

Can you all add some?

Divorces: come so easy?

I hear of couple of divorces around..very frequently due to things like extra -marital affairs, in laws..bla bla... I just cannot imagine why people tie the knot so loose.. I mean if they can break it so easily... and I really get surprised that many have no remorse at all...life goes on as if nothing has happened!

Alcohol: the biggest Health Problem

Everyone will probably agree with me that Bhutan's major health problem is nothing else but alcohol. Alcohol related dosorders are one of the major causes of death and hospitalisation in the country. More than that , it is the main cause of crime, social dysfynctions, family break ups, youth related crimes, and so on. We call it our culture to drink , but does it mean that our own culture should also kill us? We need serious thought in this regard. And if we are thinking of a major achievement in health, we shoud seriously focus on alcohol and its consequences...not in trying to get the latest vaccines, drugs or equipment and certainly not things like medical tourism!

Elephant Menace

For the past few weeks, we have been hearing that few people have been killed by elephants in the south. There are currently two patients being treated for injuries either by elephants or due to attempts in chasing elephants.

Bear maul injuries are common in our country. Elephant related injuries -I find them new! Are we already intruding so much into their territory or are they intruding to ours?

29 inch TV for MRRH

A brand new 29 inch TV has been fixed a the reception of the hospital today. Sorry I forgot to find out who donated it!

Staff meeting MRRH

A 2 hour long co-ordination meeting was held today at the Hospital Conference Hall, chaired by Dr Ugen Thinley, Orthopedic surgeon. Various issues discussed include the issue of Ambulances,staff quarter maintenance, referral procedures, escorts during referrals, off-day leave demands by casualty staff, staff discipline and a recent incident where a staff nurse was verbally abused by an officer.

Unique New Year gift to 99 year old granny!!

On the last day of the year 2009, Dr B.B Rai and team operated a 99 year old granny, Mrs. Hari Priya Dhungyel from Pemathang, S/Jongkhar. She had senile cataract with retinal degeneration with presenting vision of Counting Finger at 3 metres. Next day, 01. 01. 2010, her post-operative vision improved to 6/18 with pin hole. Indeed, a very good improvement keeping in mind the presence of retinal degeneration. She had a very uneventful post operative period and managed to go home by bus all the way to S/jongkhar from Mongar!

What a wonderful new year gift to this granny who is about to touch 100 years of here life! This should have been flashed in the newspapers as a great success story of the medical science in Bhutan!

Courtesy: Dr BB Rai, Eye specialist.

Doctors: Where are you?

Today, I cannot believe my eyes..honestly... and yesterday I could not believe my ears.. you know why? Today because a Pharmacist is talking in the "BBS Drungtsho" as a specialist doctor!! He was flashed as Dr Tandin, Medical Specialist and was so comfortable being addressed as doctor by the BBS anchor repeatedly.

And yesterday..I heard that a Technologist has been suggested as Head of the Department of Pathology at JDWNRH, having transferred out the senior Pathologist from the hospital.

What is happening to health?

The Hospital that trained me!

It is with a lot of nostalgia that I post this picture here. After a long long time , I wanted to see Banaras again and the place where we did our MBBS from 1994 to 2000- six long years! So I opened the website to find many interesting things in the institute which was then regarded one of the top three in India. This beautiful hospital by the name of SS Hospital stands fresh in my memmory. I can still see most of our teachers holding the post of a Professor now. Many of our colleagues and juniors too have found a place in here as lecturers. A lovely place indeed. I need to go there again!

Some other doctors who did MBBS from this great institute are:

1. Dr Tashi Wangdi, now HOD, Medicine.

2.Dr Yeshi Penjor, now doing Cardiology in Bangladesh.

3. Dr Chandralal Mongar, now in UNICEF.

4.Dr Bhim Rai, Eye Specialist , MRRH.

5.Dr Tej Nath, DMO, Chukha.

6. Dr Bhim Nath, DMO Pemagatshel, now transferred to Trashiyangtse.

7. Dr Tika, now doing MS ENT in Malaysia.

8. Few other juniors whose names elude me at the moment!

Work on Blacktopping started!

Thanks finally!! The much hated MRRH compound road will soon be blacktopped. Work has started for last three days...we can atleast have a smooth emergency ride to the hospital at odd hours.

Teaching the Teachers

A couple of specialists were asked to teach relevant topics to school health co-ordinators in a workshop that is underway in Mongar. About fourty teachers are participating in a life skill management training . The doctors were asked to talk on subjects like first aid, common ailments,eye problems , dental problems and common ENT problems. Whiile all of us did our job in our own best ways, the body language on the other side was so so!

Who likes to learn medicine after all?

A fascinating story!! from the Telegraph

Golden heart in mouth, race saves lives
G.C. SHEKHAR

Chennai, Jan. 1: Dr Krishna Gopal will live not only in the memories of the 400 patients on whom he performed heart surgery but also in the heart of one he could not operate on. The dead surgeon’s heart is now beating in this patient’s body. Just as his kidneys have saved two more lives. The transplants were made possible against a tight deadline through a feat of co-ordination — which almost mirrored Hollywood — between four hospitals in three cities and the police of Chennai and Madurai, who cleared the roads to city airports. The state medical authorities did their bit, speedily granting a crucial licence. The organs were all transplanted last night, after Dr Gopal, 40, had died of head injuries caused by a fall from the terrace of his apartment in Madurai. The chief cardiac surgeon at Madurai’s Vadamalayan Hospital was declared brain dead on Wednesday after being admitted to the same hospital on December 26. His wife Jeyapriya Gopal, a media co-ordinator with Chennai’s Frontier Lifeline Hospital, immediately decided to donate his organs. “After keeping him alive through a ventilator for four days, the doctors said there was no brainstem activity. Since my husband had always talked about the merits of organ donation, I knew he would have wanted it this way,” Jeyapriya said. “So we told the doctors the body should be prepared for harvesting the heart, liver and kidneys. For someone who has performed 400 heart surgeries with a high success rate, there could be no greater tribute than his own heart beating in another patient’s body.” So a team of doctors flew in from Chennai’s Frontier Lifeline, where Dr Gopal had once worked before joining the Madurai hospital to serve the rural population. However, Vadamalayan Hospital’s application for an organ transplant licence was still pending. The director of medical services solved the problem by granting it on Wednesday itself. The Chennai doctors reached Madurai yesterday morning. They began removing the heart at 5.45pm and completed the job in less than an hour, in keeping with airline schedules — a harvested heart has to be transplanted within four hours. The organ was put in a double-walled, sterile and cooled container — an 18-inch cube-sized box — and rushed to the airport, 12km away, in an ambulance. The police blocked traffic en route for 40 minutes.
At 7.20pm, Paramount Airlines’ Madurai-Chennai flight took off, with a doctor carrying the box as cabin baggage. The flight landed at 8.20, but the hospital was still a 14km drive away through one of Chennai’s busiest roads, bustling with New Year’s Eve traffic. Chennai police, informed in advance, created a “green corridor”, allowing the ambulance to make it in 30 minutes. At Frontier Lifeline, surgeons had already opened up the patient’s chest and put the recipient (whose identity cannot be revealed) on a heart-lung machine. The transplant was able to meet the deadline. Creating green traffic corridors for the sake of transplants is common in Chennai.
Dr Gopal’s liver and eyes were found unfit for transplant — they were probably damaged by the fall — but his kidneys were taken out. Kidneys have a 12-hour transplant deadline. One was driven to another Madurai hospital, Meenakshi Memorial, which already had a functioning transplant unit. The other was put in the same kind of box as the heart and driven to Tirunelveli, where a patient was waiting. Aided by a police escort, the ambulance made the 160km distance in three hours and the organ was transplanted the same night. In spite of her grief, Jeyapriya personally co-ordinated the entire operation. “Getting the organs transplanted successfully was the only objective at that time. Else, my husband’s gift would not have benefited anyone,” said the mother of a 12-year-old son and nine-year-old daughter

TT Table for Mongar Hospital

With the kindest courtesy of Dr Sonam Dukpa, Senior Surgeon, the Hospital now has a brand new TT table for use by the staff at Mongar Hospital. This was a long felt need of the sports enthusiansts in the hospital. Free time will be much more fun henceforth.

Other than this, we had only facilities for badminton and Khuru!

Pediatric cases make up 20 % of patient load at MRRH

The Reception Unit has just compiled the annual OPD reports for the year 2009. Out of a near total of 60,000 OPD attendance, the Pediatric age group comprised of about 20 percent of the cases.

Transfer news on the air!

January...February as usual....transfers and transfer rumors always on the air...there is already some news of some of our doctors being transferred. Pathologist Dr Dhungel and GDMO Dr Jambay are said to be on the list. Dr Kesang from Trashiyangtse is said to have been transferred to Mongar Hospital.

Transfers mostly come as a surprise especially in our Ministry!

Clinical discussion on a case of eosinophilia

Today , we conducted an hour long clincal meeting on a baffling case of a 3 year old child with eosinophilia and shifting pulmonary infiltrates. It was attended by most of the doctors including Dr Sonam Dukpa, Senior Surgeon who made valuable inputs into the case. There was active participation from all the doctors.

However, as usual, the participation from the nursing staff was dissapointing! Only three turned up!

Nurse Assistants join their training at MRRH

A group of 44 class 12 passed candidates have formally joined the four month long nurse assistant crash course at Mongar Hosptial begining today. They will be trained on basic nursing skills like patient care, bedmaking, patient hygiene, patient assistance and assisting the professional nurses in the day to day patient care. Besides lectures, they will be attached to different clinical units for hands on training.

Similar training is being conducted for two other groups at Punakha and Paro Hospital.

Workshop time at Mongar

1. Mental health workshop for peripheral health workers ended on 1st January.
2. Workshop for school health co-ordinators underway at Wangchuk Hotel.
3. Two day workshop on Obstretic anaesthesia for OT/Anaesthesia staff ended today at MRRH.

Effects of the Quake

Well , I had never experienced any earthquake till the last 34 years of my life...and this year I have lost the count...may be it was the 5th or the 6th time...and now everytime a car drives in into the colony, I feel its the shake again...when my sofa moves a bit..i feel its a quake...when the pigeons shake the ceiling..i feel its the quake...

And the last one left us without water for two days and even internet connection for the same duration!

Can anyone tell me when will the ground shake again???

Scene from the BAZA GURU DUNG

Neonatal Mortality meeting

The quaterly neonatal meeting was organised at the doctor's lounge today . We discussed the neonatal deaths in the hospital for the last three months. There were a total of six deaths. This will be a regualr activity in the future.

Being the first time such a meeting was organised, the participation was limited. We hope to improve in the future.

Scenes from the New Year Celebrations at Doctors Colony, Mongar

Doctors and family members celebrating the new year at Mongar Hospital colony. Dr Sonam Dukpa and Dr Ugen Tshomo were our especial guests!