The Jigme Dorji Wangchuck National Referral Hospital hospital and the Thimpu Valley.
I will try to walk you through a day in our lives. The sunshine has broken through the clouds and the rain has stopped. We are still waking up a lot at night. This is either due to the altitude or the barking dogs. A dog’s life is not so bad in Bhutan. The Bhutanese believe that dogs have the best opportunity to be reborn or reincarnated as humans. They are also thought to be helpful in the afterlife by leading people with their tails to a better life. Hence, there are lots and lots of dogs around here. They are not fetching type dogs like our lab Lizzie. Instead, they like to curl up a lot in the middle of the street for naps. At any rate they compete for the magnitude of their barking every night when it is not raining. Earplugs are essential.

I walk down a path to the hospital about 500 meters. They are building a new hospital with Indian labor and the laborers live in corrugated metal lean-tos covered with blue plastic tarps. They collect rain water in big black bins for showers. They work long days. I do not assume they make more than a couple of dollars a day. A lot of them show up in the clinic with injuries. No OSHA requirements. Bamboo scaffolding four stories high bound together with cheap Indian manila twine is somewhat unstable. They build each story of the structure supported by a multitude of 4 inch poles and sticks and it looks like a giant jail. Some of them fall off the scaffolding and the hospital ER is quite convenient.

My walk to the hospital is quite pleasant. Bhutan is quite verdant and there are field of cosmos, dahlias, and sunflowers in bloom right in the middle of the city. There are fruit trees in our front yard. Thimpu is in a valley and I look up to some snow dusted mountains. Every building here has the ornate traditional architecture. They have gone through great lengths to maintain these traditions. The hospital is dilapidated but quite pretty. There is a gold spire in the center. Yesterday morning I walked past Buddhist nuns and monks with their prayer wheels rolling, men in their ghos, and women in their traditional kiras. There were a few people in Indian saris and a few in Nepali dress. Most people here wear traditional Bhutanese dress and it is quite colorful. I will send some pictures because it is hard to explain these outfits. The most fabulous outfits are the bizarre accessories. Yesterday I saw a patient with a traditional gho, a cowboy hat, sunlasses, knee length argyle socks and purple Converse high-tops. Yesterday I also came across thr Rinpoche (holy lama) in his crimson and gold monk outfit.

I usually walk through the filled emergency room and down to the outpatient department.
The halls are filled with patients in the early morn. It is an amazing menagerie of people. Small children are slung on the backs of their mothers. About a third of the adults are chewing doma which is actually betel nut. It is a nut mixed with lime powder and wrapped in a leaf. It turns your mouth bright red and stains your teeth black. It is their answer to a morning Starbucks. There are signs all over the hospital asking people to please not spit their doma in the hospital and people usually follow the rules if they can read. There are always interesting juxtapositions between old and new. The main orthopedic waiting room filled with about 60 people were all watching ESPN cable TV with Tiger Woods playing golf.

We have a great clinc. Some problems are the same as I see in Gig Harbor. For instance, instead of tennis elbow I see archery elbow. There are lots of people with back pain from carrying heavy loads. There are a multitude of old fractures and dislocations that never got to a health care facility for months that show up. Theses are the most difficult cases since we never see them in our country and the references that are written about management are historical at best. Other problems include falling from bamboo scaffolds, struck by arrows during archery tournaments, and a peculiar injury that I am not sure of yet that occurs when a person slips and falls into an Indian toilet and ruptures their Achilles. A fair number of people have tried some traditional medicine before they ventured to the referral hospital.