New year eve

The doctors and the residents in the doctors colony are preparing to have a bon-fire dinner to welcome the new year. The spirit of the upcoming new year is surely stronger to beat the chill outside, that too after the first snowfall elsewhere in Bhutan. We are looking forward to having some fun and the kitchens are already busy as I write this note!

Another Powerful shake!!

A powerful quake once again shook the east.....at about 4 pm today ...it was almost of the same magnitude like the Sept 21st, but lasted shorter. I believe this time it was all over Bhutan. I wonder where the epicentre might have been? Going by the intensity, it must have been in the east only!

13 new doctors to join the health family

Thirteen MBBS graduates will join the health fraternity this January, after having cleared the RCSC exams , the results of which were declared recently. They will probably fill up the vacancies created by couple of doctors who would soon be proceeding for theirs masters course.

Mongar Hospital is expecting atleast two new doctors from the list. Let us see.

CME on clinical use of blood and blood products

A half day CME session on this topic was conducted by the Pathologist, Dr B.M Dhungel at the MRRH Conference hall. It covered a wide range of practical topics on blood and blood component therapy.It was very informative andI found it particularly relevant for the clinical staff including the nurses. 3.6 credits were awarded for the session. Hand outs on relevant sections of the presentation were distributed.

CME on Basics of Chemotherapy

An hour long CME session on this subject was conducted by the Senior Gynecologist , Dr Ugen Tshomo at the Hospital Conference hall. About 26 participants were present from all categories of hospital staff. It covered all aspects of chemotheraphy including the basic princicples, drug classifications, outcome, drug administrations and toxicity. I personally found it very informative and realised that we had made mistakes at times with the administration of drugs.

We had expected a good participation from the clinical staff but it was surprising and discouraging to see that less than half of the hospital nurses came for the CME. Although they keep on complaining that they lack CME credits and CME oppurtunities, they actually dont come when it is organised. Our typical characteristics!

Please vote

Dear friends,

Please vote on the Poll about the nursing services I have put up in the left side of your page. I have done a small study in this area and want to present this to our policy makers. I also want to know what you all feel in this regard! This is because the main drawback in our clinical services today is the extreme shortage of nursing staff.

Vectors of Scrub Typhus look like this!

Adult mite on left and larvae(chigger) on right!

New Hospital Compound to get a facelift

The new Mongar Hospital compound will soon get a facelift as the compound road leading to the staff quarterswill be black topped. The parking space infront of the new hospital complex will also be constructed soon. Work is about to start.

Arrow injuries: narrow escapes!

A patient from Trashiyangtse had to be evacuated to JDW today following an arrow injury just missing his eyeball. The metallic arrow head is said to be lodging somewhere in the maxillary sinus. The patient was however fine and there was no immediate threat to his life.

Bilirubin Encephalopathy

This is a known complication of severe untreated neonatal jaundice which is rarely seen nowadays. However , after almost two years of my stay in Mongar , we have a case currently in the NICU. This child was referred from S/jongkhar hospital with a Bilirubin of 34 mg%. The child had lethargy, poor feeding and retrocollis. He has improved now but will probably have some sequele. Though very common, prompt recognition and management of neonatal jaundice with phototherapy is mandatory to prevent such devastating consequences.

Provisional HRD Committe for Mongar Hospital

As per the instructions of the Minister, MOH , during the recent visit, a committe consisting of the Medical Superintendent, Nursing Suptdt, Medical specialist, Gynecologist, Pharmacist, AE with the Administrative Assistant( as the Secretary) has been instituted.It is expected to function as the main body responsible for planning, approving and nominating candidates for any trainings and workshops.

This is expected to reduce direct nomination from the HQ ( which we feel is many times inappropitate) and also ensure nomination of the most appropitate candidates depending on the job requirement.

Corruption,anti-Corruption, Life and Death!

We are all aware of the corruption that has been unmasked in our ministry. We are aware that the cases are under scrutiny by the ACC though not much update on what exactly is happening. We only know that some people have been suspended from their offices. Lets leave this for the ACC to dig and do the appropiate!

But the impact is not just corruption! It is creating some pertinent problems in patient management. Many essential and emergency drugs are out of stock and the DVED says it cannot procure until the ACC sorts things out. Today, I had no Phenobarbitone to control a childs convulsions. Yesterday , I had no dexamethasone to treat a child with stridorous viral croup. Ventilator and ABG machine spare parts cannot be procured.

So what if the ACC takes a couple of years to sort things out? Who will be responsible if a loose a child due to unavailability of some essential /emergency drug? Me? Ministry? DVED? ACC? I am lost!

Clinical discussion on Scrub Typhus

An hour long clinical discussion on this topic was organised at the MRRH conference hall today between 1-2 pm. I presented a small study on this topic which I had done recently following diagnosis of about 18 cases of Scrub Typhus between August to October this year. A detailed presentation on the epidemiology , clinical features, treatment and prevention of this zoonotic illness was made.

CME credits will be awarded to the participants.Further the Medical Superintendent also hinted that he would forward this presentation for inclusion in the Annual Clinical Conference sometime next year.

I am planning to continue the study on this zoonosis and know better about the prevalence and patient profile in the coming years. Any one interested to participate in the study from other hospitals is most welcome to join me.

Ophthalmology CME underway at Gyelposhing

A weeklong CME program is underway at Gyelposhing , Mongar for various categories of staff working in the Eye Units of different hospitals. It started on 21st and is expected to finish on 26th of this month. Senior eye specialist Dr Kuenzang , Dr Nor Tshering and Dr. B.B Rai ( both eye specialists ) are the resource persons.

A similar CME session was conducted recently in Punakha.

Honble Lyonpo with Mongar Hospital Staff

Lyonpo Zanglay Dukpa, the Minister of Health met with the staff of Mongar Hospital yesterday evening at the Wangchhuk Hotel. All the specialists, doctors and unit incharges were present during the 2 hour meeting in which Lyonpo updated us on the plans ,policies and innovative ideas being thought of in the Ministry. He also talked on the need for having a Human Resource committe, Management Committee, frequent management and clinical meetings, need to guide and teach the junior doctors, the need for CME. He stressed on the Cs in medical practice: CARE,COMFORT, COMPASSION AND CONSCIENCE.

There was a good interaction with the staff present.

Lyonpo hosted a dinner for the staff after the meeting during which informal but relevant discussions continued.

Dr Chencho becomes one of Ashoka Changemakers!

Dr Chencho Dorji, Senior Psychiatrist of JDWNRH, has been declared one the winners of the Ashoka Changemakers competition on "Rethinking Mental Health-improving community well being" for his entry Promoting Mental Health Treatment in Traditional Bhutanese Society. He wins USD 5,000 for this endeavour of his. We should all be proud of this achievement. You can read more about this at this link.http://www.changemakers.com/en-us/node/53889/winners

Beating the cold!

Badminton is the popular pastime for doctors at Mongar Hospital. With a well lit open air court and a big rush of players, the court is busy almost everyday. Participation has been even more with many on campus school students joining us these days.

We have been assured of a TT table soon by Dr Sonam Dukpa and we are all excited.

We wish we had a Tennis court too!

Khuru passion building!

Of late, it will be a usual sight for you to see Khuru being played under floodlights at the Mongar Hospital Premises. It has certainly gained momentum for the last one week or so with enthusiansts, mainly the hospital staff, staying late hours into the evening playing Khuru. I would call it a great pastime! And I myself certainly enjoyed playing it as well as winning a hundred buck note in one of the games!

Beasts of Burden or Bundle of Lies?

We are time and again reminded that the specialists in the apex hiospital in Thimphu are always over worked and they call themselves the "beasts of burden". While this is true for many sincere and hard working specialists, many eye brows have been raised recently if actually all the specialist are so busy! It has recently been found by some authorities either in the hospital or the Ministry that some of the specialists simply do less than expected. These rumors are now common talk around here. I simply wonder if this is true but also have some reason to speculate that it might be so! The Hon'ble Minister also hinted on this issue during his last visit to Mongar Hospital.

VAW workshop

A short half day "Training of Healthcare workers on management of violence against women including sexual offences" was organised at the MRRH conference hall today. Resourced by Dr Pakila Dukpa, Bhutan's only forensic expert, it covered a wide range of issues like domestic violence, womens and childrens' rights, sexual offences, laws on rape, crisis intervention and sampling techniques in medico legal issues. Similar program is being conducted in all other districts taking this important issue all over the country with a particular emphasis of sensitising the health care workers.

Mongar Hospital Laboratory fully computerised

With the introduction of the Laboratory Information System ( LIS) recently, the Mongar Hospital Laboratory services have been fully computerised. It is now possible to get a centralised computer printed report of all the investigations in a single form for a particular patient. With few initial hitches, the new system is expected to get smoothly functioning soon.

100 percent IMNCI coverage for Mongar

With the completion of training for both batches of health workers on the IMNCI, all the health workers in all health centres( BHUs) have been trained in this strategy. This integrated approach to childhood diseases is expected to make a remarkable difference in childhood mortality. The implementation of the same will be strictly supervised from time to time.

Senior specialists temporarily in Mongar Hospital

Two senior specialists from JDWNRH are temporarily in Mongar Hospital . Dr Sonam Dukpa(surgical specialist) and Dr Ugyen Tshomo( Gynecologits) are here to temporarily fill the gap as the Burmese doctors have gone on leave. They are expected to be here for about a month.

Core HIV/AIDS Committe for Mongar Hosptial

A core committee comprising of the medical superintendent, the medical specialist, the Laboratory technologist, and a pharmacy technician was formed on 4th December, to look into the activities related to HIV/AIDS in Mongar Hospital.

Nurse Assistants to be trained in Mongar Hospital

A group of 45 class 12 passed candidates selected to undergo the four months crash course of Nurse Assistants will join Mongar Hospital soon for their formal training. They will be trained by the senior nurses from Mongar Hospital during their stay here.

Meanwhile, the Nurse Assistants who were here last year have been sent to India for a formal GNM training.

Mongar Hospital gearing up to start the Dialysis Unit

Preparations are in full swing at the Dialysis unit to start Dialysis facilities at MRRH for the first time. Recently , four nurses and the Medical specialist completed short attachments at the Dialysis Unit in JDWNRH.

The commencement of this much waited facility is expected to bring great relief to many patients who have to go all the way to Thimphu for dialysis. It will also ease the chronic overload of patients at the Dialysis Unit in JDW.

New Nurses Join Mongar Hospital

A BSc nurse graduate and a GNM recently joined Mongar hospital. The former is on attachment and the GNM is posted here from Bhangtar. This will ease the nursing shortage to a certain extent.

Meanwhile, one labour room nurse and a neonatal nurse also joined their duties after completing a three month training in Bangkok.

IMNCI in full swing

The second batch of IMNCI training is in full swing at the MRRH conference hall. There are a total of 24 participants from various health centres in Mongar. Mixed with good clinical case exposure, the participants are finding the training very interesting.

The Program Officer for ARI/CDD Program, Mr Sonam Zangpo also met with the participants today and briefed them on the revitalisation of IMNCI in the country. He stressed the importance of this strategy in our Bhutanese context and appealed the participants to striclty follow the strategy in day to day management of under five children.The training will end on 9th of December.

Daily quake in Mongar?

Barely 24 hours after the last shake yesterday, we felt yet another earthquake at about 5:35 PM today. It seems that these quakes will become frightful accompaniments in the east. An earthquake-major or minor, is still scary.