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.

PLWHAs

A three day meeting of counsellors and people living with HIV/AIDS concluded today at Mongar. Around 28 participants including patients and people affected by the conditions were present. Senior counsellors from the HISCs in Thimphu and Phuntsholing resourced and co-ordinated the meeting.

World Bank Team visit Mongar Hospital

Dr Gembo Dorji from the Ministry of health along with two consultants from the World Bank visited the hospital today and met with the specialists and relevant people from the nursing and laboratory services. They made visits to many units , departments and waste disposal sites .

They were here to review the progress of World Bank funded activities.

Publications??

I want to know if any of our senior colleagues have published research papers( original research)from Bhutan in any of the International Journals...Actually I want to know what is the proper procedure and how long it takes to publish an article provided it is accepted?

Any answers?

By Profession and Being Professional

Health is a highly specialised field where every service provider is trained and hence is a service provider in a particular area by profession. Nurse by profession, Technician by profession, Doctor by profession and so on. I have been particulary interested to watch people do their duties and decide for myself if someone, and including myself, is being professional in doing whatever we do. Well I cannot be the judge for myself. But I try to figure out how other people do their primary responsibilities...whether they are just something by profession or they are truly professional. It is hard to believe but seems true that most of us do not do our jobs professionally...I am particularly critical about the nursing services and the level of care they provide...for they are the backbone of any health care delivery system...It is sad to see that spotting a truly professional individual has become a rarity!

My personnel feelings only!

German Doctors visit MRRH

A group of German doctors paid a brief visit to the hospital today. They went around the hospital wards, OT complex and patient guest house. They also met with some of the specialists and discussed the possibilities of sending some doctors on a short term basis . They were mainly interested to help the surgical departments.

Workload increasing!

Workload a the Hospital has increased tremendously at the moment....few patients in casualty, full NICU and two patients in ICU , full ward of 18 beds..and a OPD load of 50 patients...cannot handle easily...it is this kind of load which compromises quality of care.

All we can do is our best.

Clinical case discussion: KALA AZAR

Dr Namsa, GDMO , presented a case of fever and massive splenomegaly, that was confirmed as Kala -azar( Visceral Leishmaniasis) which has been reported from several pockets in eastern Bhutan. It was initially detected from Kengkhar under Mongar Dzongkhag. Caused by a parasite called Leishmania donovani, it is transmitted by a small mosquito like arthropod called sandfly, the picture of whihc is depicted here.

Kala-azar is endemic in India, Nepal and Bangladesh.

New Dental Surgeon joins MRRH

After a vacant post of nearly 3 months, a new dental surgeon, Dr Kuenga, joined MRRH from yesterday. There had been no dentist at the this hospital after Dr Kapil resigned earlier to return to India.

Professor Jack in Mongar

Professor Jack, the Head of Overseas Pathology, USA, was in Mongar for a day. He visited the hospital and the laboratories in particular. At dinner yesterday evening, he met with the specialists of Mongar Hospital.

Professor Jack is said to have suplied laboratory equipment and LIS software worth millions of dollars to Bhutan. He has visited Bhutan several times and his assistance has benefitted almost all the hospital laboratories across the country.

Increasing OPD load

OPD attendance is getting higher day by day. I had to clear 60 odd OPD patients today- thats after doing a full ward around. The load at the general OPD was not less either.

Imagine you do a full ward round....then see 60 patients.....what quality of service can we provide?

Foreign doctors at MRRH

Two doctors- a hand surgeon and a orthopedic resident, are temporarily at MRRH working with the Orthopedic Unit. They are expected to be here for a period of three months.

Heat Returns to Mongar

Barely had we finished disconnecting and re-storing our bhukhari which had been on continous use for last four monhts, I note that its suddenly a scorching heat outside. A drastic change in temperature...call it global heating!

Eye Camp in Pemagatshel and Riserboo

A team of eye unit staff lead by Dr BB Rai, Ophthalmologist, left for Pemagatshel today for a week long eye camp in which they will be operating mainly cataract cases. A similar camp was recently completed in Lhuntshe and Trashiyangtse hospitals.

Hospital Staff to attend H1 N1 workshop

Three staff from Mongar Hospital will attend the training on H1N1 at Gelephu commencing 25th March for a period of three days. Binay Thapa, Hem Kumar and Dr Gyembo will be attending the same.

Quality Assurance meet

We had almost a three hour long meeting in the cited subject today. Most of the doctors, nurses and unit incharges were present. Major area of discussion was the casualty and how we can improve the services. The Medical Specialist proposed that one specialist should be the over-all incharge of the casualty on a rotation basis.Dr Ugen Thinley and Drugtsho collectively briefed the gathering on the formation of the Religious Affairs Committe.A lunch was also served before the meeting began.

Draft Pediatric Emergency Guide Ready

The document is now ready for printing and distribution amongst the doctors in the eastern region for initial review and comments. Its now a 32 page document covering only the common and life threatening emergencies. I am wondering if spiral binding facilities are in place in Mongar! And if Mongar Hospital has some budget to spare!

Today's CME

The Eye Surgeon today conducted a CME on the cited subject covering some of the most dramatic emergencies in ophthalmological practice. He covered major vision threatening emergencies like acute glaucoma, chemical injuries, blunt injuries and central retinal artery obstruction in detail. This was one of the most comprehensive and practically useful CME's we have had in the last couple of weeks.

Some of the other emergencies which could not be covered today will be taken at a later date.

Committe for Religious Affairs

The Hospital Drungtsho proposed the formation of a committe for religious affairs which will organise various religious activities like annual Rimdro, visit of Lams and Religious leaders to the hospital. The comittee is in the process of formation.

Farewell Dr Jambay!

Dr Jambay, GDMO, who has been transferred to Haa BHU I, was officially given a farewell today. He had been in this hospital for last two years. We all will miss him especially from the badminton courts!

Two new members were also welcomed to the Mongar Hospital family-

Dr Krishna, Pathologist and Mr Om Luitel, IT officer.

Druk Star: A descent way to spend a boring weekend!

I found this a good way of spending some time in the weekend especially when you dont want to go out. You can see a good blend of Bhutanese talents singing live including some veterans who are there as the judges or the guest. Its a matter of pride that our country is keeping abreast to the tunes of the outside world!

And of course, Jangchuk Choden is a sure promise to the Bhutanese singing industry! A star will be born soon...She has a talent , she has a voice for the modern Bhutanese.

Bad Sunday!Sad sunday!

Today became a bad sunday for me... I lost two critically ill children both very young and innocent lives, who could not wait to see even their first birthday! Sometimes God is cruel to snatch them away so early and leave their parents and all of us devastated.

Hope He will take care of them now.........we did our best but could not keep them with us. May their souls rest in peace!

Orthopedic CME

An hour long CME on common ortho problems epecially covering common joint dislocations and management was held yesterday.About 40 staff attended the session.

Finally an IT Person for MRRH

After months of running without an IT Personnel, MRRH finally has one newly appointed computer graduate for the IT section, who joined duty from today. One of the previous staff was transferred and another is under training outside.

Hon'ble Lyonpo visits MRRH

The Hon'ble Minister of Health, Lyonpo Zanglay Dukpa , visited Mongar Hospital today and spent time with the staff and nursing assistants. He interacted freely with the nurse assistant trainees and listened to their opinion. He encouraged the staff to work hard and re emphasized on CARE,COMPASSION,CONSCIENCE AND COMFORT!

Scenes from Todays CME: Labour management

Pathologist to join soon.

Senior Pathologist, Dr Krishna, will soon join MRRH after having been transferred from JDWNRH. He replaces Dr Dhungyel, who is away for 6 months training in Onco-pathology to Thailand and has also been transferred to JDWNRH.

Medical Superintendent attends Budget meet

The Medical Superintendent, Dr. Tapas Gurung, is in Thimphu to attend the one day annual budget meeting scheduled for 3rd March.