Tenzin, Unidentified Monk, Nat in kira

BA in our Kitchen

The Operating Theatre and the OPD

We have been doing a number of interesting cases here. I will not gross people out with photos of the gory details. You are welcome to see them when we return. This is definitely a different brand of orthopedic surgery here. There are two types of cases here- both difficult. The first type is unusual things. These would include a Himalayan bear mauling, paraplegia due to tuberculosis of the spine, two machete injuries to the knee and pediatric hand burns from cooking fires. The other cases include usual things with unusual presentations. This is particularly evident in the pediatric population. We have operated on three children who had severe elbow fractures that did not show up to the clinic until they healed in a malunited position of their growth plate. These cases are extremely difficult. We do not have CT or MRI. Last week we reconstructed a child’s hand that was burned in a fire. All his fingers fused together into a ball and we separated them and skin grafted him from his abdomen. I also operated on a young lady who walked on her hands. She had contractures from CP and showed up in the outpatient department. There are also a lot of chronic bone infections that are difficult to treat. All these cases present late. It takes three days to cross the country by public bus and there are no domestic flights. The surgeons here are a delight and very skilled but are somewhat overwhelmed with business.
The outpatient department is great. The variety of patients is fascinating. Farmers come to clinic in their rice farming clothes with chronic injuries. Their red smiles of betel nut juice crack me up. Buddhist monks, nuns, and lamas show up in their crimson and saffron robes. Kids walk in with plaster casts that were placed two months ago. There are army guys in fatigues, Indian women in saris, and imported Indian laborers from the nearby hospital project. A highlight of my OPD experience was when I was asked to see the mother of the queen who had developed knee pain. She was in a VIP exam room. This consisted of a concrete sink, two stools, a wooden exam table with a pad, and an entourage of people. Lots of history, lots of gold jewelry, very little skin to examine, and very tentative treatment with NSAID’s. If I caused the queen mother to get gastritis I would be in trouble! A number of people have seen traditional healers as well. It is quite a menagerie on a daily basis. The hospital and the OPD are old but spotlessly clean. They make the best of their limited resources. Families are always attentively at the bedside even if the patient is there for weeks. Nurses wear traditional nursing caps and are called “Sister”. The operating room is clean but the concept of operating room sterile technique is taken to the limit. We are working hard on training the OR techs. This will be the role of any OR personnel that come during the next visit here. All in all, the medical experience here is quite amusing and rewarding at the same time.

Gross National Happiness and the Environment

These are a few of the interesting features of this country based on a benevolent monarchy who truly seems to care about the future of this country. It is almost like they waited to see what other mistakes developing counties in the region before they made them as well.
For instance: (Only in a kingdom)

1) Smoking is against the law here.
2) Bhutan is still 75 % covered in forest. They closed the plywood factory because it used too much wood.
3) The zoo was abandoned because the king and the Bhutanese believed that it was not in the Buddhist tradition to incarcerate animals. They freed all the animals and the low IQ takins (half goat-half cow, more later) hung out in town. Now they have their own sanctuary. Maybe they were not so dumb but they sure look it.
4) There are lots of National Parks and Wildlife Sanctuaries.
5) Some of the big peaks here have not been climbed because the king heard that the expeditions bothered the nomadic yak herders.
6) Plastic bags are not used. There is very little litter.
7) Schoolchildren are recruited to clean up the local streets.
8) Most of their animals are protected by law.
9) There have been only 60 cases of HIV, mostly on the truck route from India.
10) Health care reaches about 80% of the population. In the rural area this is in the form of rural health units. There is a thriving traditional medicine scene here with a very organized program of teaching and pharmaceuticals. Health care here is free. There is no private practice scene as of yet. Immunization of children is 100%.
11) Education is free. Unfortunately, you have to test to get more than a 10th grade education and competition is fierce. As more kids need jobs things might get sticky.
12) Men are required to wear the national dress “gho” for anything formal and most people wear them every day. This has kept a national tradition alive and made the place a lot more colorful and less contrived.
13) The architecture here is required to be built in a traditional manner. Mostly post and beam with recyclable materials (Bamboo, mud, etc)
14) They have hydroelectric power they SELL to India. They have no oil or gas and do not use much on their limited roads.
15) Cable TV is available since 1999 and is corrupting some minds. It is bizarre to see very simple farmers in the waiting room watching ESPN The internet has one government provider. It is not a monitored fake internet like Myanmar.
16) Per capita income is $1300.00 year. Despite this fact there is no famine in this place where most people are subsistence farmers. 98% of the farmers own the land they farm. They seem to be cautious in their acceptance of international development. Some of the big new expensive hotels scare me a bit.
17) With the exception of what I see and hear about Thimpu the government seems to have a plan to prevent urban sprawl and the stagnation and poverty that is produced by this problem.
18) I have not met a foreign aid worker yet that has not loved it here. The people are unbelievably honest and not pushy. BettiAnn left some of her stuff at a café for three days and it was there when she returned (including the bag of potato chips). I have asked some of the doctors about whether they believe that privatization of medicine will occur as it has in India. They look at me quizzically and respond “Why should it… we are all pretty happy”)
In general, the concept of Gross National Happiness appears to be alive and well. Although I have met a few people that do not seem entirely satisfied with their situation (especially refugees) the satisfaction of people with their simple uncomplicated lives seems almost embarrassing.