CME on Neonatal Resuscitaion

Practical Session

An hour long interactive session on Neonatal Resuscitation was organised today at the hospital conference hall.
Ms Sonam Choden and Br Thinley were  the resource person, supported by the Pediatrician.


Some of the newer recommendations were highlighted as well.

Enjoyed our Sunday trip to Lajab!

Trekkers:
Myself!
Dr Kesang
Dr Sonam
Br Phuntsho
Br Tara and Wife
Ms Sonam
Br Sonam(BHW)

Specialist meet Hon'ble Health Minister

We at MRRH, had the opportunity to meet the Hon'ble Minister of Health over dinner yesterday here in Monggar during which we were able to discuss at length the discrepancies in the grading of junior specialists in the PCS system.We tabled most of the issues regarding the specialist grade that confront us now. Infact, Lyonpo was not well informed that we have specialist working in the grade/cadre of medical officers. He has agreed to take this for discussion with RCSC and has instructed our HRD colleagues to   discuss with RCSC upon their arrival back to Thimphu.If needed, Lyonpo is also willing to take it to the Cabinet for discussion. Lyonpo felt and agreed that:

1. All specialist should be directly placed to ES 3 C upon completion of training.

2. In case the sub level in the current system is done away with( there is some discussion going on it seems), specialist on reaching P2A( which usually after 4 years of specialization) be placed in ES 3A

3.He agreed that problem and discrepancies were genuine and all efforts will be taken to rectify them.

Regarding the Entry grade for MBBS, Lyonpo said that it was discussed at length by the Ministry 2 years back  and RCSC would not consider it easily

All the specialist here were present and we spoke on behalf of all our junior specialist colleagues working throughout the country.  

Just hope that something good  may happen to all of us!

Senior Administrative Officer superannuates

The Hospital fraternity met over a merry, fun filled evening with songs and dances, to bid farewell to the senior Administrative Officer who  will be superannuating at the end of the month. This means that he hospital will loose one of the most senior staff, not only in the hospital , but in the whole country.

Mr Dorji Thinley joined the health services in 1976 as a Health Assistant and served in various capacities including DHSO post. With five children who have all done their University Education, Dorji Thinley appeared  a contended man as he retires.

We all Wish him good luck in what ever he does after his retirement.

Nurses Learn EKG

Dr Kesang, Medical Specialist, took a class for basic ECG interpretation for the nurses on 18.11.2011. It was a very basic orientation to ECG for the nurses.

A lot of cardiac cases are seen at MRRH and this knowledge would help the nurses in alerting the Physician early.

Hon'ble Lyonpo at MRRH

The Minster of Health, Lyonpo Zanglay Drukpa, visited MRRH on the morning of 10th November, after  the three day Annual Health Conference came to an end on 9th .Lyonpo visited some of the units including the Maternity , Dialysis and ICU and met with some of the patients.

Following that, Lyonpo spent some time with the doctors over a cup of tea at the new hospital canteen, during which he shared some of the problems facing the ministry at the moment and the steps being taken to sort them out.He also hinted that some of the staff who have spent many years in the same place need to be transferred on case by case basis rather than making it a routine exercise.

Doctors beat Techs

To observe the  Birthday of our beloved fourth King, we had a  KHURU match between Doctors and Technicians team at MRRH. As usual, the doctors team beat the Techs in a best of three 21 point games.

It was  a great match with plenty of kareys!

Mongar Rambling Rowdy Hikers!(MRRH)

Doctors including two HVO Volunteers made a day long trek from the hospital to the Taksha Monastery through the walking trail below the hospital compound,crossing the suspension bridge, through the heart of Konbar, right up the hill till Takchu.

That was on Sunday 30th October. It was a real tough climb for some of us with reserved stamina! Overall it was fun. The ladies from the doctors colony treated us with a  lovely lunch at Konbar and the kids who accompanied them had a great day out!

MRRH One Day Khuru Tournament

Sunday was a good time pass today. 50 staff composed into 10 teams took part in the intra-hospital Khuru tournament.With initial knock out rounds, three teams qualified to play the final of 25 rounds.

Winning teams were given cash prizes and a lunch was served midway through the tournament. It was interesting!

Clinical Meeting

Dr Kesang Namgyel, Medical Specialist ,  presented  a case on " Sudden Cardiac Arrest" at the Conference Hall on 20th October . A rare case of survival after sudden cardiac arrest was discussed. Attendance from all levels of staff  was good. 

He also highlighted the new CPR guidelines of 2010 especially the change from ABC to CAB sequence.

MRRH in second Medical Conference

MRRH was represented at the Second Annual Medical Conference by:

1. Dr Puru, Pediatrician.
2. Dr Nidup, Radiologist
3. JB Biswa, ACO
4. Br Sonam Dargay, Surgical Unit

Three research papers were presented at the conference. They are:

• Congenital Heart disease by Dr Puru
• Scrub Typhus  by Dr Puru
• Outbreak of Dysentry in Silambi by Mr JB, ACO

The detailed presentations can be found at JDWNRH webiste under Download section.

Trashigang will have a National Pediatrician!

Another good news for the east! Trashigang Hospital will  soon have a  Pediatrician- Dr Tulsi Sharma, who recently completed MD Pediatrics from Sri Lanka.This will be a great benefit for the people of Trashigang and the surrounding areas and will also reduce the pediatric load at MRRH.

Trashigang will have a national Gynecologist

Trashigang Dzongkhag Hospital,  a 40 bedded hospital and Comprehensive EMOC centre, will soon have a  national Gynecologist.Dr Pema Bhutia is expected to join soon. It was left without one since the Burmese Specialist left earlier this year.An Italian Orthopedic Surgeon has also been recently posted to Trashigang.

This will greatly ease the work load at MRRH, especially for these two departments.

MRRH Website getting ready!

MRRH will soon have a website ....Check www.mrrh.gov.bt for the skeleton. Most of the things are under construction. This effort of our IT Colleague should be appreciated.

Just one GNM?

Despite a huge shortage of Nursing Staff in the hospital, I understand that only one GNM has been posted to MRRH. I think the administration really needs to bug up and insist on more staff. Many districts have more that the number of nurses they actually need, going by the workload!

Hospital Based IMNCI

The ARI /CDD Program, DoPH, is in the process of  preparing manuals for the Hospital based IMNCI( Integrated Management of Neonatal and Childhood Illnesses) which is likely to be implemented beginning later this year in some of the district hospitals in the country. Two hospitals each in the east, west and the central region have been selected to initially start the program.

We recently met in Paro to finalize the manuals for the same. This strategy is aimed to equip the general doctors and clinical officers in the district hospitals with basic management skills in Pediatrics especially in the absence of a Pediatrician. The initial training in this regard is expected to begin sometime in October this year.

Easing Nursing Services

The Labour  Ministry's announcement to train 268 GNMs in India by 2013 should come as a good news for the  health sector and the nursing fraternity. This should have come long before we planned to build these large state-of the-art hospitals like JDW or MRRH which are  now fully  functional but with a large shortage of nursing staff.

With this announcement, I guess atleast the shortage can be reduced by about 50 percent in few years time.

Mongar Hospital has acute shortage of  nursing staff in most of the wards including the ICU. NICU and Cabins could not be started solely because of the nursing shortage.

UNICEF Rep visits MRRH

Dr. Gepke Hingst, UNICEF Representative in Bhutan , visited the hospital on Friday and spent time in the MCH following up on the Pentavalent Introduction. She was interested to know if anything adverse or otherwise happened after the re-introduction. She also had a brief discussion with me on main areas of Pediatric Morbidity and Mortality. She found some time to go around the new hospital complex as well.

Welcome the Pentavalent

June 11th 2011, will yet be another great milestone in the history of the country's health sector. Once suspended in 2009, Pentavalent will make a come back tomorrow with a nationwide launch. Having five antigens in one injection, Pentavalent will protect children from Diptheria, Tetanus, Whooping cough, Hepatitis B and Hemophillus Influenzae infections.

The health sector across the country is well prepared for the launch. I as a Pediatrician, would like to urge all parents to come forward at vaccinate your child with Pentavalent. Children due to get the 6 week dose of vaccine will be eligible for this and will have to complete 3 doses ( 6 weeks, 10 weeks, 14 weeks).

Hospital Meeting

The hospital conference hall went buzzing on Saturday afternoon when a meeting to discuss some  of the Departmental problems  was called. The Hospital MS chaired the meeting.Most doctors, Unit In charges and administration staff were present.Some of the problems faced by the laboratory and OT were highlighted.

Major chunk of the discussion was on the work-load currently faced by the laboratory in the background of  acute shortages or absence of some of the essential Laboratory services.

Microbiologist talks to the staff

Dr Tshokey, the country's first clinical Microbiologist, who recently joined JDWNRH, made an hour long presentation on the antibiotic resistance, the theme of this years WHO day . More than 40 staff including the doctors attended the lecture. A prolonged discussion followed after the presentation. Besides, Dr Tshokey also visited the Laboratory and inspected the Microbiology department.

STI/HIV/AIDS: External Consultant reviews Program

A UNICEF fielded external consultant and the PHL In-charge, Binay Thapa, were here to meet relevant people involved in the cited subject. It was basically a part of the piloted assessment program in the country. The MS,some Specialist Doctors, laboratory staff, PMTCT focal person, and other relevant staff attended the session that lasted two hours. It was an interactive meeting with active involvement of all who were there.

Pentavalent will be back

Pentavalent Vaccine, initally started in September 2009 and suspended till date due to reports of adverse events, will be back to the immunisation schedule begining June 10 this year. The adverse events were investigated thoroughly and concluded that pentavalent is not the cause of those adverse effects.

Health workers under Mongar Dzongkhag are attending a two day workshop, which ended today, to the same effect.  It was mainly to improve communications to the general public regarding the re-introduction.

Sunday Picnic

Residents of Doctors colony were off  to Ligmethang this Sunday for a  Picnic. Though the weather did not favor us much, it was fun filled day. The kids especially enjoyed the time at the river side. They also enjoyed the quick sight of the  Kurichu Dam later part of the day.

Sunday Trek

Seven doctors( me included!) and including Dr Sam Baker, a US based HVO Volunteer, went out on a half day trek, up the slope of Kilikhar to the ridge overlooking Drepong, made to the Pokchulung Lhakhang along the ridge, and then down via Kadam , in about 4 hours. It was fun!

Ended with a delicious lunch at Taras ( canteen owners) place.

BHMC Deputy Registrar briefs the staff

Mr Nima Sangay, Deputy Registrar of the Bhutan Health and Medical Council, briefed the hospital staff on the salient medico-legal aspects of medial practice. The discussion covered areas like medical certificates, death certificates, documentation, medical negligence etc.

Fruitful discussions followed during the course of his presentation.

Maternal and Neonatal Mortality Meet

The EMOC focal person convened a meeting of the neonatal and maternal mortality review committee today at the doctors lounge. We discussed the neonatal deaths for the last quarter of 2010 and the first quarter of 2011. There have been 4 neonatal and one maternal death in this period. Staff from the maternity ward also participated.

The committee members include the MS, DHO, Pediatrician , Gynecologist and EMOC focal person.

WHO day Observation

We observed the WHO day today at the Hospital Conference hall from 2 PM onwards. After the MS read out the Message of the Regional Director, Dr Krishna, Pathologist discussed on the concepts and mechanisms of drug resistance. I briefed the floor on the messages of the WHO and its startegies on antimicrobial resistance worldwide.

An interesting revelation of the anti-microbial resistance pattern at the hospital was also shared with the gathering.

Worth reading

According to The Lancet, non-communicable diseases (NCDs), mainly heart disease, stroke, diabetes, cancers, and chronic respiratory disease, are responsible for two out of every three deaths worldwide and the toll is rising. A landmark global alliance between leading scientists and four of the world's largest NGOs brings together evidence from a 5-year collaboration with almost 100 of the world's best NCD experts and proposes a short-list of five priority interventions to tackle the increasing global crisis. Reducing tobacco and salt use, improving diets and physical activity, reducing hazardous alcohol intake, and achieving universal access to essential drugs and technologies have been chosen for their health effects, cost-effectiveness, low costs of implementation, and political and financial feasibility.

http://www.citizen-news.org/2011/04/emerging-global-mandate-to-save-36.html

Meeting Peripheral Health Workers

A two day workshop on infant feeding is  underway at the DYT Hall. Variety of other issues including the child mortality and maternal mortality related issues were discussed.

The MS also spoke on rabies and its management with public health perspective. Other local health issues are expected to be discussed on the second day.

Abstract of our report on Child Mortality

III. Some Vital issues

With the exception of three cases who died in the hospital, rest of the deaths occurred at home  This means that the parents have not sought medical attention during the last moments of the child’s life and the illness leading to their death. We believe that many of these deaths could have been prevented if the child was in the health care facility. Delay or denial of seeking medical attention is still an important contributory factor leading to morbidity and mortality in our country. This is a direct reflection of overall   low literacy rate, ignorance, poverty and  social problems.

Female Literacy is a vital contributory factor to the quality of child care and health seeking behavior of a family. To our current knowledge, there is no better tool than this. Unless female literacy improves to comfortable levels, it is difficult to expect a rapid decline in childhood mortality.

Decline in childhood mortality is parallel to socioeconomic development in the country. Presence of roads, transportation facilities and telephone coverage obviously facilitate better healthcare. A smoke filled home due to lack of electricity is a direct risk factor for a child’s health as it can contribute to Pneumonia  and other respiratory illnesses.

Alcohol use is widely prevalent in our society including the female population. Alcohol directly contributes to poor maternal health, complications of pregnancy, low birth weight, child neglect, broken families and several social problems that have a direct impact of children’s health. Out of the 29 deaths stated above, at least 3 of them were associated with an alcoholic mother, who failed to bring the child for medical care!

Community Participation is indispensable in the success of any public interventions. This is surely discouraging seeing the large number of home deliveries, home deaths and failure to seek medical care. Every family is informed of the need to deliver in the health care setting or call a trained attendant and every one is informed of the presence of health facility in their locality, yet, many of our people do not come forward. Therefore, it is not appropriate to directly blame the health care delivery system alone, which in our opinion, is doing its best at the prevailing situation.

Family planning and limiting the number of children is the personnel choice of an individual couple. Such decisions are made by the clients after appropriate counseling and information from health workers. In other words, its purely informed choice. Opting for a permanent family planning method like vasectomy and tubectomy is again the choice of the family or the couple, knowing the availability of other temporary and alternative methods. No couple is forced to opt for any family planning methods by the health workers.

Declining births and declining deaths ( in older age group) is part of a  demographic cycle that every nation passes  through and it may best be regarded as a part of the nations over all socio-economic progress. Whether the current birth rate and the trend of decline is a concern for country’s future in terms of population size or not , is a debatable issue. We feel that that this should be left to experts in population studies to study the pattern of population growth over the last century and accordingly predict the pattern for the future.

WHO Day, April 7

Update on Clinical Use of Blood.

A half day session on Appropriate clinical use of blood was organized today. It covered all aspects of blood transfusion related topics covering major specialties. A prolonged discussion followed on some of the practical aspects faced in the hospital from time to time.

A working lunch was served, funded by the DMS.

Check this out!

http://www.bhutanobserver.bt/%e2%80%9cdangerous%e2%80%9d-indigenous-healers-thrive-despite-modern-hospitals/

Eye Camp

Dr Dechen, Eye Specialist and Pediatric Ophthalmologist from JDWNRH, Thimphu is currently stationed at Mongar for the eye camp. Lot of patients are availing the services at the moment. OPDs appeared packed for the last few days. A group of visually handicapped students from Khaling have also been brought in for operation.  I also took the opportunity to screen them for congenital heart diseases.

Meet to discuss Under five deaths

Following  the concerns raised during the recent Mid Term Review Meeting   and upon the high command of the Hon’ble Prime Minister and subsequent directives from the GNH Commission, the health sector of the Dzongkhag formed a committee to study the detailed deaths reported in the  year 2009. The committee consisting of the following relevant people met on 25^th March and discussed in detail the issues and concerns pertaining to the  high reported child mortality in the district.

1. Dr Tapas Gurung, Medical Superintendent ,MRRH.
2. Mr Tsering Dorji, DHSO , Mongar Dzongkhag
3. Dr P. Bhandari, Child Specialist, MRRH
4. Dr Sonam Gyamtsho, Gynecologist, MRRH
5. Mr Kuenzang Thinley, Focal Person, Emergency Obstretic Care.
6. Hem Kumar Nepal, In-charge, Neonatal ICU

Under five mortality for 2009 was 34/1000 Livebirths , which is the fifth highest in the country. Gasa, Lhuntse, Wangdue and Trashigang have mortality rates higher than Mongar. A report to the same effect is being prepared.