Hospital Based IMNCI

The Hospital based IMNCI training was recently conducted in the entire country. ACOs , nurses and doctors were trained in the five day modular training Program that basically focused  on standard managment of Pediatric Emergencies and major causes of morbidity and mortality in the developing world.

Mortality Meeting

In the second mortality meeting today ( 4/5/2012), a case of 57 year old who died of suspected aortic dissection , was discussed by the Medical Specialist. Doctors and Nurses participated in the meeting.

The patient had been referred from Pemagatshel hospital with severe chest pain.

A Day in the Life of a Solitary Specialist

Went to work at 8 AM instead of  9 AM   expecting a heavier load on Monday as usual. Completed ward round of 15 inpatients, made the discharges and updated the patient files. Did a lumbar puncture and a  bone marrow. Went to Echo Lab and did 7 Echo-cardiograms in half an our(patients with prior appointments) and then reached the OPD to see a huge heap of prescriptions....it was 11:20 then....and in the next few hours( had no time to peep into my watch afterwards), managed to score a CENTURY! Meaning that I had to see exactly 100 patients( don't ask me how much time I gave to each patient). It was 2:30 PM then!( Thanks to my loving wife, she managed to send me a cup of tea in between).Obliged to a Echo request from the medical ward during which  another echo request came all the way from Trashigang Hospital. Did that also...Then some one reminded me of another Echo waiting in Maty ward. Did that also. It was 3:30 PM and I called it a day!

Summary:  one and half hours extra! Rounds, OPDs, Clerking, Discharges, Procedures , all by one man.

Hundred OPD patients ( with several phone interruptions in between !) Ten Echos in between!

And oh , forgot to mention: At least 4 telephone calls last night that robbed my sleep off!

Must think again before we talk about quality of services we can provide!

Specialist Clinic at Lhuntse Hospital

A team of four specialists ( Gynecologist, Pediatrician, Radiologist and Orthopedic Surgeon) conducted clinic at Lhuntse Hospital from 9 AM to 12 :30 PM at Lhuntse Hospital. A crowd of over 100 patients turned up for the clinic. Both ward  and OPD patients were seen. 

More than 15 patients also had an Ultrasound Scan, which otherwise is not possible at Lhuntse.

Specialist will be visiting the hospital every alternate month as per the instructions from the Ministry of Health.Similar clinics will be conducted in other district hospitals in the region.

Annual Hospital Rimdro

The two day Annual Hospital Rimdro was organized from 25th to 26th April at the hospital compound. This has been  a regular annual event for the last few years .It saw an excellent participation and contribution from the staff members.

Mortality Meeting

In the first of its kind(Mortality Meeting) at MRRH, the Medical Specialist Dr Kesang Namgyel, presented a case of  possible Pulmonary Embolism that took the life of a patient recently.The patient was initially referred from Kanglung to the Ortho Unit here.

The attendance was good with mainly nursing staff. Some other useful topics like IV Canulations, Catheters were also discussed.

The officiating MS, Dr Sonam briefed the meeting on the rationale of organizing such a meeting and plan to continue in the future.

General Body Meeting

The first meeting , after the Officiating MS, Dr Sonam Gyamtsho, took over the charges, was conducted yesterday ( 4th April) for almost three hours. A wide range of issues were discussed and the attendance to the meeting was good with a packed hall. Some of  the issues discussed were:

• TA/DA claims and tour proposals
• Hospital Quarter Allocations.
• Dress codes
• Lab issues
• Training nominations and many more!

Meeting on Sweepers !

The entire hospital sweepers and some of the administrative officials including some doctors had to meet to sort out some of the issues related to hospital cleanliness and  gardening. It was found that the gardening aspect had been neglected after the departure of the previous MS, who was particular with cleanliness and flower garden around the new hospital.

The relevant staff were instructed to sincerely work towards making the hospital clean, beautiful and patient friendly.

Friendly Khuru

The doctors team, this time, was  defeated by the Nurses/Tech team in the friendly Khuru match organised as usual , as a time pass , on Sunday, the first of April. Despite a larger "BAH', there was a paucity of Kareys overall. 

The loosing team sponsored the lunch and drinks served during the match

Specialist Round at Lhuntse Hospital

Five specialist from MRRH visited Lhuntse Hospital and saw various kinds of patients there. They also conducted a thorough round of indoor patients with the doctors there.

A regular such visit would benefit the public of Lhuntse immensely.

Drugs to Vaccines!

We had been tolerating the shortage of essential medications for almost a year now. Before it found a solution, now it is time for vaccines. Most of the essential primary vaccines are out of stock and clinics are compelled to send back parents who come on schedule to immunise their children.

Hopefully, this will not last long!

From the Farewell dinner for Maki and Br KJ (30.1.12)

Mass Farewell!

Eight staff who have been transferred out of MRRH were given a farewell dinner at Lotus Pond on the evening of 28th January. It was attended by more thatn 40 staff from the hospital.

The outgoing staff include Dr Namsa, Dr Kuenga, Lab Tech Tshering, Sonam ( dental), Karma( drug store), Lhadon( lab) and few others.

Plenty of farewell speeches there!

One GDMO and Three Assistant Nurses Join MRRH

We would like to welcome them all to Mongar Hospital  Family.

However , the shortage of nurses will continue despite this and we would have preferred to have atleast one more GDMO from this batch. It is learnt that most of the ANs were retained at JDW.

Hospital Staff enjoy KHURU on Chunipa Losar

Happy Chunipa Losar to Everyone!!

Kuensel Headline on nursing shortage!

Today (17 Jan, 2012), there is a Kuensel headline highlighting the shortage of nurses in the country , leading to inability to utilize many of the available beds/units in the hospitals. I agree to that.

There are some rumors that about 30 nurses who passed out from India have not yet been employed ! Can Kuensel  investigate why that is so? 

Congratulations Dr Bhim B Rai( Vitreo-Retinal specialist)

Our Ophthalmologist, Dr Bhim B Rai , has recently returned to the country following a 18 months fellowship in Retina( Super-speciality). He was in US ( Utah) for sometime and then subsequently in Tilganga Eye Institute in Nepal.

Our heartiest congratulations to the first  and only Retina specialist in the country and the first super-specialist from Mongar Hospital!

We are proud of you and  the country will greatly benefit from your services.

Why the BSc conversion criteria is not fair?

Because:

1. 1985 near graduated nurses will have few years to serve and will be least beneficial for the nursing services in the long run.
2. Senior the nurses, less likely is the probability of passing entrances!
3. High Chances that required seats will not be filled in one go.
4. Demoralises other junior nurses.
5. Everyone should get equal oppurtunities, atleast to sit for entrance!
6. What is the point of having English,  General Knowledge etc. when the field is purely Technical and not administrative?

Just my thoughts!

MRRH website hacked?

Looks like our hospital official website has been hacked! Mr Omapati, I hope you will notice this and do needful soon.

Dentist couple to Join MRRH

Dr Manjunath , a Prosthodontist and his wife Sunitha, Periodontist, will be joining MRRH from 9th Januarry . The Indian specialist couple is in the country for about 2 years  and had been working at JDW until now. There is also information that one more national dental surgeon will be coming to MRRH after transfer of Dr Kuenga Penjore to Bajo.

Incidentally, Dr Manjunath and his wife were interested to come and work in Bhutan after they came across this blog  of mine in the internet...:)

Who will head MRRH?

With news that the current MS, Dr Tapas Gurung being transferred to Gelephu, there have been no appropiate guesses as to who will replace him. Dr Gurung has been serving at MRRH for about 6 years and is one of the senior administrators in the Ministry.

Any one coming to MRRH should have some credible qualifications and experience as it is a Referral Hopital with more than 350 staff.

I don"t have any particular guesses as well!

State of Pharmacy in the Hospital!

This is what  a patient had to face today!


Normal   Saline:     To purchase!


NAHCO3 drops:  To purchase


Cetrizine:              To purchase


Vaseline:              To Purchase!


So all of us can imagine where we are heading in terms of  pharmaceutical supplies that is seriously affecting the entire country for almost a year now.

Scenes from the New Year Party at MRRH!

Nyelop and Khuru!

As usual, a day long Khuru match was organized between the doctors team and team from the maintenance unit with 9 players in each team. While the weather was not so supportive, the match saw an intense battle, with the maintenance team finally beating the doctors with one point, in the deciding game. Seen in action is the Gynecologist, Dr Sonam Gyamtsho!

Farewell to Senior Staff

Sister Taumo, senior MCH staff resigned from her job with effect from Jan 2012. An overwhelming number of hospital staff came for the farewell at Druk Yul Hotel. He served the Ministry of Health for over 30 years!

About a month ago, her husband and the Administrative Officer of this hospital, superannuated.

We wish the couple a great life ahead of retirement.

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!