Inviting CME Proposals

I would like to request all the specialists,doctors and staff of MRRH,to volunteer ( as Resource)for the weekly CME sessions on Friday. It has been very smooth going ever since we started having these sessions about three months back. Participation has been encouraging and we would like this to continue as usual. Please submit your proposals to me for forwarding to BHMC for approval of credits.

Thanking you for your encouraging participation so far!

Pentavalent gets a green signal

The expert WHO committee, which was involved in the investigation following the incidences of suspected deaths to Pentavalent, has concluded that the vaccine was not responsible for the reported deaths. This means that the vaccine will probably be re-started in the country again .

I think this is the reality and that the vaccine should be re-started sooner than later.

Nurse Assistants

Twelve nurse assistants, who recently completed their training for four months, have been appointed to work at Mongar Hospital. They will support the nursing staff in the ward, mainly on non clinical errands. Many of them are expected to go for GNM training to India sometime in the future.

CME: Maternal Collapse

Dr Sonam Gyamtsho, Gynecologist, presented on this rare but important subject of " Maternal Collapse", few of which have occured in our country in the past. Overall the important causes and management, highlighting on the multi-disciplinary team that is required, was emphasised. About 26 participants were present for the CME.

EMOC Workshop

A three day workshop will commence tomorrow at Bumthang to discuss issues related to EMOC and Neonatal care in the country. Program officers and all the EMOC focal persons will be attending the workshop at Hotel HOME.I will also be attending the same to discuss the neonatal part.

Another five day long workshop on Mental Health is already underway at Bumthang Hospital from today , mainly for the new group of doctors who have recently joined service.

Mongar Hospital staff selected for training

Two Mongar hospital staff have been selected for further training , through the open competition conducted by the Ministry of Health.

• JB Darnal,ACO for field course in Epidemiology(Thailand)
• Lungten Pema, Ultrasoud Technician for diploma in Ultrasonology( India)

Our congratulations to both!

Neonatal Equipment through JICA

The JICA office, through the neonatal nurse currently posted at NICU, Mongar , has supplied some essential neonatal equipment that was felt necessary for a long time.These include neonatal stethoscopes and saturation probes. These will be very useful for the unit.

Clinical Discussion: CLL

A case of 60 year old with anemia and splenomegaly that was confirmed to be CLL was discussed today. Clinical history, findings and a differential diagnosis was discussed by Dr Kesang, GDMO.

Away at Paro

I am away at Paro for couple of days for a workshop on Research Ethics and have not been able to update the site. Will catch you all once am back to station.

CME: Approach to Coma

A very comprehensive coverage on "Approach to coma cases' was made by Dr Kesang, Medical Specialist, on the CME session today. Common causes, relevant history and physical findings,and basic management aspects were outlined.

Alcoholic liver disease leading to hepatic encephalopathy as one important and common cause of coma in our set up was especially highlighted.

Clinical Meeting: HSP

A case of Henoch Shonlein Purpura in a 15 year old adolescent patient was discussed today at the Doctors Lounge,where most of the doctors were present. A detailed outline of vasculitis syndromes was also presented by the Medical Specialist, Dr Kesang.

Proposal of conducting such meeting weekly was discussed with the doctors present.

First Phase HPV Vaccination

The first phase of vaccination against Cervical Cancer commenced today with girl children between 12-18 getting the first of the three dose series of the vaccine.

I had the priviledge to witness the event at Lingmethang and Gyelposhing schools. Apart from some grins from the children, everything seemed going smooth. Meanwhile some other doctors including the Medical Superintendent have been deputed to supervise the event at various vaccination centres in the Dzongkhag.

The campaign will go on for another two days.

Making Mongar Hospital Academically Active!

It's already been smooth going since we started having regular CMEs on Fridays . More than 15 sessions have so far been organised which have helped the staff to fetch CME credits required for their promotions and career enhancement.

To keep the doctors and specialists engaged, we are also planning to have a clinical case conference every week ( Thursdays) on some interesting cases that we encounter in our practice.This will be mainly for doctors and ACOs although all interested can join. We have already had few such conferences where we discussed Chronic Eosinophilic Pneumonia, Fanconii Anemia and Hypertension in the Young.

The last discussion on Hypertension was particularly fruitful!

HPV Vaccination Awareness

Various doctors from Mongar Hospital visited the Schools around in an attempt to create awarenesss about the upcoming HPV Vaccination aimed at preventing against cervical cancer.

As there was lot of confusion on the consent issue, the DoPH has sent a letter stating that this is not necessary for vaccination. This will surely ease the job of the vaccinators and improve coverage.

First phase will kick off on 5th May!

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.

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?