Clinical case of Severe Myalgia

A nine year old boy from Dremtse, unde Mongar Dzongkhag is admitted with three days history of fever and severe muscle pain especially at the calves. There is marked tenderness of muslces all over the body.He does not look toxic but the pain is incapacitating. No documented fever after admission.
Total count 27,000 with neutrophilic Predominance, ESR 108. SGOT= 21, CPK Pending.
What is the most likely diagnosis? 1. Polymyositis 2. Viral myositis 3.Parasitic myositis like Trichinosis. 4.Others?

Please share your thoughts

Hospital without water

The heavy rains for the last two days has disrupted the entire water supply for Mongar hospital including the residential colony. We are finding tough time meeting the needs and it is especially tough for the hospital to run without a steady water source. It might take a few days to restore the connection again.

Briefing on Surgical checklist

Almost two hours of brainstorming was done on the implementation of the surgical checklist that was initiated recently in the referral hospitals. An audit conducted by the program for MRRH revealed that about 30 percent of the operated cases overall had filled the cheklist.

This was certainly thought to be a good begining and it was decided that its use will be further strengthened from now onwards. Some changes to the actual format of the checklist were also discussed.

Dechen Chophel and Tandin Wangchuk from the Quality Assurance Division, MOH were present for the discussion.

Quality Assurance meeting for Drungtshos and sMenpas

A workshop to this effect is underway at the conference hall, MRRH , conducted by the Quality Assurance Division of the Ministry of health. It is expected to last for three days and is being attended by sixteen participants.

MRRH to get better IT facilities

The hospital will soon get a new server and LAN cables to upgrade the internet and network facilities within the hospital. This has been made possible through the Telemedicine Program.

The previous server has been non-functional for over a year and despite having more than fifty computers in the hospital, there is no easy access to internet and email facilities especially for the doctors and the specialists. This has also led to the total collapse of Telemedicine services .

With the new facility, it is hoped that all specialist chambers , like in JDW, will be connected to internet through the LAN system.

It is hoped that this will revive the Telemedicince services that once existed in this hospital.

Talking Telemedicine

I am attending a Telemedicine workshop/consultative meeting at the RIHS ,Thimphu which will conclude tomorrow. Although I came with lot of enthusiasm, the number of participants called is dissapointingly low. Mongar hospital and JDW are well represented, but the district and peripheral collegues who are actually given the equipment, are not in the scene.

We are discussing the current status of the Telemedicine, which is widely viewed as a dying or defunct project, and ways and means to sustain and take it forward.

The only area which seemed to show some activity is the SAARC Telemedicine Link with PGI Chandigarh and SGPGIMS, Lucknow with weekly CMEs( althought the number of participants was discouraging).

We will come up with certain definite recommenations on day two and will probably give the way forward for telemedicine in Bhutan.

Good news for Mongar is that the whole Telemedicine equipment will get a facelift soon with a new server and a bette LAN facility.

Scene from the Archery ground!

The ongoing open archery tournament organised by the Mongar Sports Association...

The Mongar Hospital team is participating as well.

Upcoming workshops in the East

A short( probably a day long) workshop on life support for nurses will be organised soon at Mongar hospital , for nurses in eastern Bhutan.

Another workshop on vector borne diseases will be organised at S/Jongkhar soon, which is also for the nursing staff. Final dates are yet to come out.

As usual, this time of the year ,nearing the financial closure, are more busier than usual, as the programs wake up to finish the last available budget in their respective areas!

Mushroom Poisoning

Two cases from the same family( father and son) have been admitted to Mongar Hopital with symptoms of severe poisoning following intake of wild mushroom. They were referred from Trashigang Hospital.

Both patients have features of liver toxicity with very high transaminases.While the father is improving, the child is critically ill.

Food for thought!

Indigenous unit on life support:

Posted on Friday, June 11 @ 02:01:41 EDT by chencho -->

Mongar Hospital 11 June, 2010 - Shortage of staff in the indigenous medical unit of Mongar hospital has become a major challenge to serve the growing number of patients visiting every day.Karma Chezom, 96, of Wengkhar was up early morning and rushed to the regional hospital at around 9 am last Monday. She took a prescription form and showed it to the dungtsho (traditional physician). She got the medicines at around 3 pm after waiting for five hours.
Currently, there is only one Dungtsho and a sMenpa in the unit. The problem gets worse, when one them is out on medical leave.
About 30 to 50 patients, including both OPD and herbal steam treatment, from the eastern districts visit the hospital everyday.
“The unit functions during government holidays, if it falls between Monday to Friday, to maintain the treatment course, especially for those undergoing herbal steam treatment,” said Dungtsho Tandin Phurpa. “We’re facing a difficult time handling the large number of outpatients, given the manpower shortage.”
According to the hospital’s administration officer, the requisition was forwarded to the ministry, but nothing has happened so far. As per the royal civil service commission’s requirement the regional referral hospital has slots for two dungtshos and sMenpas each.
More than three thousand patients visited the unit in the past six months, ever since the herbal steam bathing facility started in November last year. The unit has 14 beds for patients needing steam bath treatment.
Records indicate that steam bath patients are usually those suffering from post-traumatic pain, swelling of hands and legs, neurological disorder, obstinate skin diseases, joint and back pains and gout.
By Tshering Namgyal

Poor show on CME

Despite advance notice and information, the attendence , at the CME session today was dismal . While our people continue to cry that they don't get CME credits, they actually don't turn up when it is organised. This is the paradox!

However, all the doctors were present in the session which encouraged us to continue.

One Day H1N1 workshop

A one day workshop on this topic is being organised at the Conferene Hall of the Hospital today. This is for the hospital staff including the nurses and the technicians. Dr Gembo Dorji is the principal resource person.

Incidentally, following reports of the outbreak or H1N1 at Kanglung, a student from there has been admitted to the isolation ward for suspicion of the same disease.

There was a recent report of increased number of flu cases at Riserboo Hospital as well.

Meanwhile all of us must take adequate precautions to prevent the spread of this infection.

Farewell Yuka!

The hospital gave an official farewell to YUKA AIDA , Japanase volunteer nurse, who worked in the NICU for the last two years. She was in the country as a JOCV volunteer through the JICA Program. She will be leaving Mongar next week and flying out of the country in another week or so.

Meanwhile a new hospital administrative officer has also joined Mongar Hospital and four maintenance staff who had been on contract have resigned.

Mongar Hospital now

It had been sometime since I visited the canteen . I found some time yesterday to go for a quick tea and a plate of momo with a senior colleague and friend.

And as I stepped out of the canteen, the hospital looked a bit more different than what I used to see earlier. And just caught this picture for you all.

And can you suggest whether that lone old tree should stay there or should be done away?

Restoring Sight to Hundreds: the best gift you can think of!

In the last four months, more than 250 patients with cataracts and other ocular problem.s were operated during the mobile eye camps conducted by the Eye Team from Mongar Hospital headed by Dr Bhim B Rai, eye specialist of the hospital. Besides conducting the camps at all the district hospitals in the east, the team also travelled to as far as Nganglam with sophisticated equipment required for the delicate operations.

This benifits most of the old and elderly patietns who have been blinded by cataracts, where the lense tissue opacifies as an aging process, taking away the power of sight, which is the worst handicap you can think of!

Congratulations to the team and do keep this up!

Maty Staff discuss CTG

The Maty ward staff along with the Gyenecologist and MCH staff discussed the CTG( Cardiotocogram), an invaluable tool for monitoring the fetal condition during labour. Some of the staff recently attended a short attachment in JDW on this subject.

Radiology Workshop

A four day Radiology workshop for the Technicians is underway at the Conference Hall of Mongar Hospital from today. Radiologists from the National Referral Hospital are around to resource the workshop.