Infection Control : Hospital Acquired Infections

This issue was discussed today at the Conference hall for over one and half hours.A presentation on Hospital Acquired Infection , which was investigated in the ICU was presented to the floor by Binay Thapa, Microbiologist. A prolonged discussion with recommendations were made by the doctors.

Clinical Case Conference: Hypertension in Young

An hour long clinical case conference on an important and very frequently encountered topic was organised at the Doctors Lounge today. Dr Kesang Namgyel, Medical Specialist , preseented a case of Hypertension in the young, which was followed by a detailed discussion on aprropiate evidence based management of this common ailment. The Junior doctors and ACOs were particularly sensitized on when and what medicines to start, how to follow up and when to consider secondary causes of hypertension. The presentation was followed by a healthy discussion covering common problems encountered in the management of Hypertension at our set up.

I am sorry for not being able to take a picture today!!

Staff Get-Together

Saturday evening was fun for many staff of Mongar Hospital. Initiated and organised by Dr Kesang, a drink-dance-dinner party kept the participants full of rare fun. It was organised at the doctors colony and nearly 60 staff came for the gathering. The only dissapointment was some rain in between though it failed to dilute our enthusiasm.

Must have such gatherings once in a while!

Disaster Preparedness

It could not have been more appropiate! Dr Hoffman, a Hand surgeon at the Kaiser Medical Centre in California, presently working as an HVO Volunteer in Mongar Hospital, made an excellent presentation on this issue sharing his recent and first hand experience at Haiti, following the disastrous earthquake.

While Bhutan also recovered from a major shake in September last, another major shake is forecasted any time in the future. Dr Hoffman made relevant suggestions that are practical in our set up and emphasized that pre-planning, a disaster management team , traiging and flexibility of roles are the cornerstone of a successful management strategy in case of a mass casualty.

Lets hope and pray that such a thing never happens again!

Infection Control Core Group Meet

The core group on Infection Control met at the doctors Lounge yesterday, for an hour to discuss the plan of action in the next three months. The budget for some of these activities has reached the office of the DHO. Monthly activities will be conducted. Proposed activities include a presentation on the recent ICU infection of two ventilated babies, visit to the municipal waste disposal site, meeting with the Dzongkhag Municipal Committe.

We will next be meeting tentatively on the 28th of April.

Internet at the Doctors Lounge

Finally after two years of proposing and re-proposing, the Doctors Lounge now has a computer and Internet Connection. This is will help doctors to browse the net and conduct some telemedicine during the free time they get in between patients.

HPV and H1N1 training( Vaccines)

A one day training on these areas was organised at Gyelposhing BHU for the participants from various BHUs. HPV was covered by Dr Sonam, Gyenecologist and H1N1 part by myself. While Vaccine for HPV has reached, Vaccine for H1N1 is still awaited. Tentative dates of vaccination is next month.

Seen on the picture is Gyelposhing BHU I.

ICU/NICU Meet

The ICU/NICU staff with the medical and the child specialist met for a 2 hour meeting yesterday at the Doctors Lounge. All the concerns put forward by the staff were discussed in detail.

Most of the talk was dominated by some petty issues raised by some disgruntled people.

CME: Head Injury

An hour long session on this subject was conducted today and was attended by a record 53 people. There was a good interactive session at the end of the presentation. All salient aspects of head injury and its management were covered in simple details.

The Resource for this important clinical topic was our Surgical Specialist, Dr Myat.

Casualty Meeting

A short meeting to discuss the problems of the Casualty Unit was held today. All the staff working in Casualty along with the nursing superintendent and two specialists( Medical and Pediatric) attended.

Another meeting was called separately to discuss the problem of ambulance movement and the authority to sign the movement orders.

Clinical Case Conference

We discussed an interesting and rare case of Fanconii Anemia at the doctors Lounge today. Almost all the doctors were present including Dr Hofman, Hand Surgeon on HVO deputation who is in Mongar on a short term.

With the reported incidence elsewhere, Bhutan could just be having a single case or two of this rare condition.

Staff Farewell

Senior EPI Technician, Mr Ngawang Pelzang, retired from service after 37 long years in the goverment service. All the Hospital staff gathered to bid him a farewell.

Good Luck ,Ata Ngawang!

Water Festival- The Burmese New year

This morning we had some fun at the doctors colony where we threw jugs and buckets of water at each other drenching ourselves. Our Burmese Specialists and all the doctors residing in the colony participated. It was some great fun!

Doctors and Nurse Assistants on Picnic

The student Nurse Assistants who are about to complete their four month crash course, together with the doctors and their tutors are off to Lingmethang on a picnic. The Burmese specialists and the Medical superintendent also joined the group. It s a good way of killing time in the weekend although the heat down there might be diluting their excitement!

And ofcourse , the doctors colony appears deserted today!

Japanese Festival

A 2 day Japanese Festival was organised at the Lower secondary school from yesterday. Many JICA volunteers working all over the country are participating in the event. Full day events including cultural program in the evenings were organised.

Mongar Hospital current has a neonatal nurse volunteer through the Program.

ACC Team at Mongar Hospital

A team of Anti- Corruption Commision officials were at Mongar Hospital inspecting the various equipment procured in the recent years. Detailed account of the visit and their purpose is not clear to me at the moment.

Eye Camp in Samdrupjongkhar

There will be a week long eye camp in Samdrupjongkhar begining this Monday. This will be lead by Dr Bhim B Rai, Eye specialist at Mongar Hospital. They will mainly be operating cataract cases and ofcourse provide other ophthalmological services to the needy patients during their stay there.

Training Neonatal Nurses

The Department of Public Health, MOH, is keen to train Neonatal Nurses at the Regional Referral Hospitals for a period of one month. A letter to this effect has reached our hospital few days back. This came as a big and funny surprise to me because the concerned people have not done any homework as to whether the regional hospitals have the set up and the facilities conducive for an attachment training. For instance, both the hospitals do not yet have a proper neonatal set up. In Mongar, neonates are nursed together in the adult ICU. There are only two formally trained neonatal nurses in the whole hospital( one of which is not currently working in the neonatal ward for health reasons). Most of the nursing is done by nurses trained in adult ICU.

And in this set up, how can we train neonatal nurses which is a highly specialised area? I have expressed my concern to the Program accordingly.

There is a remote possibility that we may be able to start a separate NICU after July -August this year provided that we are given sufficient number of nurses from the fresh pass-outs.

CME: BLS and ALS

A one and half hour CME on this topic was conducted today by the Anaesthesiologist. It covered some of the most vital aspects of basic and advanced life support including the latest recommendations. Practice drills will be arranged with individual units soon. About 40 participants
attended the session.

First Patient referral to Guwahati from Mongar in recent years

A young female patient with pulmonary embolism will be evacuated to Guwahati early tomorrow, probably to down town hospital. Approval for direct referral to Guwahati has been sought from JDWNRH.

Referral to Guwahati from Mongar surely seems a more convinient option than referring the patient all the way to Thimphu and then to India from there. This proposal has been submitted for discussion at the Annual Health Conference.

Specialists Visit District Hospitals

Some of the specialists( Medical and Orthopedic) visited Lhuntse Hospital today in-order to supervise the clinical care and streamline referral services from the Districts. In the process, they also attended huge crowd of patients who had turned up to the hospital. This will be of immense benefit to the public if it can be continued on a regular basis. It was purposely planned for the weekend in order to avoid disturbance of services at the referral hospital during other working days.

Quality Assurance Workshop

A two day workshop on Quality Assurance is scheduled for 4th and 5th of April at the Mongar Hospital Conference Hall. This is being organised by the Quality Assurance Division in the Ministry of Health. Similar workshop is being conducted in other districts in the east at the moment.

HPV Vaccination

The country will soon be introducing vaccine against Human Papilloma Virus, an agent causing cervical cancer in women. To this effect, there will be a one day training /workshop for healthworkers today i.e the 3rd April,2010 at Mongar Hospital.

Preparations are also on for nationwide H1N1 vaccination soon. A training to this effect was already conducted earlier.