Plight of the Junior Specialists.

Many Junior specialist are forced to work on the grade and salary of a GDMO or a nurse. While most specialists are given specialists cadre, some of the Junior specialists have been seriously affected by the position classification.  The ministry recently turned down applications for fast tract promotion submitted by some of us saying that no promotion is due before 4 years. At this pace, my personal concern is that we will reach our retirement age by the time we enter specialist cadre, but having worked all throughout as a specialists!

And this is unfair!

A year into Blogging!

Around this time last year, I started blogging as a novice. A year into it, I have derived immense pleasure in doing this as my leisure activity and also as a means to update our colleagues elsewhere about Mongar Hospital. I have received good feedback from those who have seriously read the threads and that is what keeps me going. But there are some mischievous readers who simply log in and mark everything as "funny"..obviously that is someone who must be jealous of my work or is not my wellwisher. I have no ill-feelings.

I am glad that through this blog, a dentist couple previously working in India, found a way to come to Bhutan. They found a job at JDW!

Thanks everyone and am glad that the page views have now crossed 3000! I welcome your comments and suggestions please.

Everyone Looks, but few actually SEE!

Dear Doctors, brothers, sisters, ward boys and girls in the delivery ward and NICU.

Thank you all for rendering your saving, healing and nurturing hands.

We would like to express our heartfelt gratitude for saving our baby daughters life and others who are admitted here. We will not forget the sleepless nights you have spent nurturing our babies. Really and truly, we remain indebted to the tireless service you all render in stabilizing the condition of patients who aspire to live their lives to the fullest span. We would also like to assume that the noble deed you commit never go unobserved in the eyes of the almighty. He would rather rejoice in heavenly abode above that: my son and daughters are realizing that service to the humanity on earth”. More over your profession is in the prophecy of the lord Buddha, whoever shall attend sick shall attain me.”

Thus, we admire your job and appreciate your services. Finally we wish you all the best and healthy lives bestowed with happiness and prosperity.

THANK YOU ALL…

Yours truly indebted parents,

Thinley Namgay and Pema Yangdon.

This note was left by parents of  a 1.2 kg baby girl who was delivered here, resuscitated at birth by a NICU nurse and was in the NICU for her initial 5 weeks and weighed 1.7 kg at discharge!

PS: The baby in the picture is no this baby though!

This is what somebody( must be our own staff)has to say in KOL!

Quote:

why is it trhat some staffs has to work soo hard when some are sitting,chatting eating in the name of dialysis.it is not fair when some wards has acute staff shortage .why the hosp management is not functioning ,it seems it has to have a fast action....

Unquote:
http://www.kuenselonline.com/2010/modules.php?name=Forums&file=viewtopic&t=699

.

Condolences and Prayers

The charming Chamkhar town was reduced to ashes in  matter of few hours. It will not be the same again. It was a lovely site to pass through and drive by the town till recently. It is extremely sad and tragic!

My deepest condolences to the families affected. Our prayers and always with you.

Visit to the Book Fair

A three day book fair is underway at the Mongar Sports Ground. Various stalls packed with visitors, mostly school children and teachers, were seen on the first day.

For otherwise calm  Mongar, this will be a good timeout!

If you havent been there, do so..you may find something for your kids!

Somethings needs to be done soon!

We have probably waited quite for sometime for availability of some of the essential medicines like Iron tablets. With no good pharmacy around , it has become practically impossible to give this basic medicine to many of our needy patients. We can turn down patients a few times but not always..and it is sometimes embarrasing for the doctors and staff to tell the patients that such and such is not available.

I wonder if the Ministry or the DVED has no solution at all?

We are equally affected by non availability of some antibiotics like cloxacillin and even chloramphenicol.

External consultant reviews the EMOC Project

An external consultant was today at the hospital meeting various stakeholders, to review the EMOC program and progress. He was accompanied by the Program Officer of Reproductive Health Program, Khina Maya.He met with the Pediatrician, Gynecologist , EMOC focal person and some other relevant people.

ILI update

The personnel from the PHL, JDWNRH, briefed the doctors and other relevant staff on the status of Influenza Like Illness Surveillance in the country. The findings of the past two years were presented to the audience.

Plans to start the Severe Acute Respiratory Illness ( SARI) Surveillance , was also discussed.Question answer session saw a lively discussion on the actual problems faced during recording and reporting.

Working Lunch and refreshments were provided for the participants.

EMoC Training

A Five day workshop covering the Basic Obstretic Standards and Emergency Obstretic Care along with some essential neonatal protocols, concluded today at Gyelposhing BHU.

Similar workshop for the second batch of staff will commence from the 14th of this month. The revised standards were published in 2009.

The picture shows how our friends from the BHUs managed their accomodation during the training...hmm.. something I too would love to experience! Looks tempting!

LAN finally!

Finally the so called LAN lines have been pulled to our chambers and duty stations. At the moment, they are busy fixing the lines and it will be a few days before we can have net connection at our chambers.

Internet connection at work is necessary:

• quick literature searches
• quick tele-consultaions
• updating oneself during free time
• social networking ofcourse!

Nice Lecture on Sepsis

Visiting HVO Volunteer and ER Specialist, Dr Jared Hubell, gave an hour long lecture on this common topic yesterday at the conference hall. It was a well covered and relevant lecure focussing the important aspects of diagnois and treatment. Dr Jared highlighted on the missing links that he observed during his short service at the ER in JDWNRH.

The 6 hour and the 24 hour bundle sepsis therapy he talked about was impressive. Question answer sessions followed the lecture. About 50 participants registered for the lecture.

Refreshments were served as well. Meanwhile, his better half Katherine, who accompanied him, handed over a large bag of childrens' clothes to be given to the poor and the needy.

Thank you two and have a pleasant stay in Bhutan!

Improving Efficiency!

I was particularly concerned about the delay in radiological diagnostics at JDW. It is said that dates for USS and Echo are given as later as 2 to 3 weeks! With five radiologists and several Technicians, I thought there should not be such a long waiting list for USS particularly.I believe , lot of time is spent on typing the reports. I understand not more than about 10-20 Echos are done daily. How can we improve this:

1.Reports can be hand written as and when the scan is over

2.Reports can be brief especially if normal study.

3.Or Standard formats can be utilised.

4.Deploying assistants to write reports as the scan is being performed is another way, especially with Echos.

5.Given the adequate machines, may be atleast 2 radiologists can devote to ultrasound along with other Technicians.

Just my thoughts anyway!

Biswakarma Puja

It was formally organised at the hospital colony with initiatives from Nagendra( Engineer ) of the Hospital.

Milestone for MRRH: Dialysis begins

Begining today, MRRH will probably be able to cater to the need of renal dialysis to patients of eastern Bhutan. Two patients , who were till date being dialysed at JDW, were successfully dialysed here today.

This is definitely a great achievement for Mongar Hospital. This is going to avoid lot of referrals and un-necessary travels for the patients .

It will be handled by the Medical specialist and a team of five trained nurses.

It is definitely a proud moment and my heartiest congratulations to all involved in this mamoth task.

Check Mongar Hospital Group in Facebook for more pictures!

Consequence of Local/traditional treatment

Recently , Kuensel made headline on the death of a child following some local treatment. It is not uncommon for us to see this almost everyday in our practice. In my personnel experience, a lot of children are subjected to such forms of treatmet like sucking and incissions, before actually coming for medical attention.

From my personnel point of view, this practice should be strongly discouraged as it seems to have plenty of harmful effects than any benefit to the patients:

1. Leads to delay in seeking medical care.
2. Introduces infection through sucking or incissions.
3. Can lead to dangerous and life threatening bleeds if cut /incissed over a vessel or if the patient has a bleeding tendency.
4. Can lead to transmission of dangerous blood borne infections like HIV/Hepatitis B
5. Can lead to pain and unnecessary discorfort in an already sick patient.
6. Leads to ugly bruises and scars especially if done in a visible part of the body.
7. Patients might be forced to pay some money for an attempt which will not provide any relief.
8. Gives false sense of security to the family, thereby further delaying medical attention.

I have here posted a picture of a child who came to me today and complained of headache. He was having an upper respiratory infection. The three bruises on his forhead were created in turn by his father, mother and a sibbling to relieve his headache. Now will this family need a hospital?

Food for thought!

At last , computers for specialists!

Thanks to the Telemedicine Program. Specialists in Mongar Hospital will now have computers in their chambers, and they have already arrived and had been fixed in some chambers. This will enable steaty practice of Telemedicine and internet for patient care.

New face of Mongar Hospital

This is how our hospital looks after the recent completion of the Hospital Parking .

Hospital Management Training

A ten day training on this area is scheduled at RIHS, Thimphu for hospital administrators working in various hospitals across the country. DMOs, CMOs, Superintendents, Administrative Officers, nursing superintendents/incharges have been called for the training.

Dr Tapas, Medical Superintendent and Br Thinley Penjore , will attend the training from Mongar Hospital. Resource Personnels are expected from outside the country.

Annual Rimdro

Day long Annual Rimdro was organised at the Hospital complex yesterday. A lot of people,both from within and outside the hospital attended the ceremony.

German Doctor in MRRH

A German Gyenecologist( Dr Dirk) is presently at MRRH, working in the Gyne/Obstretic Unit . He will be here for a period of seven months. This will greatly ease the work load for our lone Gynecologist beside providing an oppurtunity to learn from each other.

Staff leave for training

Three staff from our hospital recently left for training abroad.

1. Kesang Wangmo for NICU, Bangkok
2. Sonam Dekar for Pediatric Critical Care, Bangkok
3. Lungten Pem for Diploma in Ultrasound, Chennai

The Team here in Bangkok (HIV/AIDS Training)

Seven of us are really having fun and enjoying the training also. The way they are is fantastic. Very much ahead and very very systematic. The visit to the isolation ward yesterday was awesome!

Health DG vistis MRRH

The Director General of Health visited Mongar Hospital on 1 st August. The hospital visit was conducted in the morning while the evening was spent with the staff on a dinner at the HVOs quarters. Petinent issues are said to have been discussed. I am away and not very informed about the actual discussions.

New batch of Nurses to Join soon

New batch of nurses who passed out this July will soon join the Ministry of Health. All the candidates seem to have cleared the joint interview and are now waiting for the appointment letters.

The news is not so good for Mongar as I understand that only about four of them are being posted to Mongar. This will hardly make a difference to the huge gap of nursing shortage existing in Mongar Hospital at the moment. Moreover, couple of them are going for trainings soon.

Off to Bangkok

I will not be able to update the blog for sometime( may be about 2 weeks) as I am going away to Bangkok to attend a training on HIV/AIDS. Please bear with no posts or few posts please.

Other people in the team include Dr Damber, Dr Subba, Dr Lotay,Dr Kinley( Ped), Dr Thukten, Mr Thupten(Pharmacist).

CME: Poisoining

Today, we had a CME session on Poisoning , in which the medical specialist, Dr Kesang, discussed in detail the approach to cases of Poisoning in the Emergency Department. Common poisonings were discussed including Mushroom Poisoining. A brief account on snake poisoning, use of charcoal and other emergency procedures were discussed.

Second round HPV vaccination

The second round HPV vaccination will be conducted nation wide tomorrow. Most of the recipients will be school girsl after the age of 12 years.The first round was conducted in May.

Some of us(doctors) from MRRH will be going for supervision of the activity.....

Updated: here is a picture from one of the vaccination sites!

ACC in action!

Officials from the Anti-Corruption Commission are stationed at MRRH for last couple of days and verifying all the equipment that have been procured and supplied to the hospital during 2007-2008, with the establishment of the new Hospital.

Clinical Case Conference on Tuesdays

Here onwards, the clinical case conference where in doctors of MRRH meet to discuss a puzzling case or an interesting case, will be done on Tuesdays instead of Thursdays. The regular CMEs will be done on Thursdays, provided participation is encouraging.

Meanwhile , the surgical specialist discussed a case of Gynecomastia in a young male (due to adrenal cortical tumor) toaday.

Improving Casualty Services

The doctors, casualty staff and the administration sat together for more than an hour to discuss some of the management issues in the Casualty particularly pertaining to patient monitoring, timely information to the specialists and more vigilance on the part of nurses and clinical staff caring for patients admitted to casualty.

Change of CME schedules

Henceforth, the weekly CME sessions conducted on Fridays till date, will now be conducted on Thursdays. This change was made as the OT staff felt that they are not able to attend on Fridays due to OT of two departments.

The Clinical conference amongst doctors will be done on Wednesdays.

CME: Evidence Based Medicine

An interesting discussion ensued following the presentation on this important and evolving area of Evidence Based Medicine by Dr Min, anaesthesiologist of our hospital. He covered all the vital aspects of this fascinationg area (which has always been one of my favourite topics).

About 35 participants attened the session.

Case of Anasarca

A case of anasarca in a 48 year old lady which has been a diagnostic puzzle in the medical ward was discussed at the clinical case conference at the doctors Lounge today. Most of the doctors attended the session including the medical superintendent.Diagnostic possibilities were discussed and further course of investigating this patient was outlined.

It was obviously not a straightforward case of kidney , liver or a cardiac disease. Appeared more like a disorder with multisystem involvement.

High Patient load

The last three days at Mongar Hospital has been extremebly busy, with all time high patient loads in all the out patient departments. The Pediatric OPD alone saw more than fifty outpatients today, stretching our work beyond capacity.

We believe that it is because of the many students and parents being free to come to the hospital as it is a summer break for most of the schools.

Road blocks affect ambulance movement

Two ambulances deputed on patient referral directly from Mongar to JDW were held last night at Nobding due to heavy rains and landslides. However, the roads were cleared early this morning and the ambulances could move to Thimphu after about seven to eight hours of delay.

Casualty Grand Round

From the 2nd of July , we have started doing a grand round daily at the casualty Unit. At 9 AM, all the specialists would gather there at the casualty and discuss all the cases that have been admitted there during the previous night. This is aimed at training the junior doctors , ACOs and the casualty staff on basic emergency management and also to reach a consensus management plan in difficult cases. This is possible through the inputs of all the doctors and specialists who are expected to participate daily.

We look forward for co-operation from all doctors and clinicians concerned.

CME: Reduced Fetal Movements

An hour long CME session was organised yesterday ( July 2nd ) at the conference hall on this important topic. Dr Sonam, the gynecologist conducted the session very interestingly. Overall, it was a very informative and educative session covering the etiology and management of reduced fetal movements in a pregnant women.

Like in the previous session of Ocular emergencies, the attendance in the session was dissapointlingly poor, with participants numbering to less than 20. If the trend continues, the CME sessions, which are mainly planned and informed in advance targetting the nursing fraternity, may soon become a thing of the past.

The clinical case conference attended by most doctors will continue as the participation has never faded.

Clinical Case Conference

A case of Thrombocytopenia in a young lady who was in her second trimester of pregnacy and whose illness started with a spontaneous abortion, was discussed at the doctors Lounge.Most of the doctors and specialists were present for the discussion.

The most likely cause discussed was gram negative sepsis with/without DIC.

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