Dressed in kira and a white coat ...

… the purpose of my visit to Bhutan was revealed in the eyes of the patients before me today. After receiving a nod of approval for being in national dress on my first official day of work, the head surgeon took me under his wing and explained each patient’s case during Orthopedic Rounds. As I became a part of the team of fifteen clinicians caring for these patients, I caught myself demonstrating facial expressions of either absolute shock or sorrow. While being empathetic towards my patients, I also feel that I usually maintain an expression equal to that of my white coat … overall objective, but with a few wrinkles here and there that just make me human …

A 25 year-old male had been in a traffic accident and admitted to the hospital with a broken right leg and an inability to move his left leg. His right leg was put into a cast and was stable, but the etiology of the absent movement in his left leg was questionable. MRI and CT throughout the spine were unremarkable, but EMG/NCS testing for further investigation is not available in Bhutan. The orthopedic surgeon asked the patient’s physiotherapist if he could do any tests to help identify the cause of this patient’s absent leg movement, and as a team we performed clinical tests and hypothesized various causes. The diagnosis is still in question and I look forward to problem solving with the local docs and physios.

As we continued to round on the patients, I learned that it is orange season in southern Bhutan. The next individual before us had been working as an orchard farmer. A fall out of an orange tree had resulted in a broken neck and spinal cord injury. Adequate stabilization of his neck had not occurred during surgery and x-rays revealed continued instability, which could place him at risk for further damage to his spinal cord. This 34 year-old man had to have a halo brace donned, a heavy contraption made up of circular metal rings that connect to rods drilled into the skull, and the outcome appears questionable. After stating this however, the orthopedic surgeon told this patient and the medical team a story of a man from Poland who had once come to Bhutan … this man had a similar injury and used a wheelchair. Despite these conditions, he had been able to find a wife and together they had two children … thus, even in the face of a devastating bodily injury, opportunities can be had in life.

While my senses will need to accustom to the sights and smells that are new to me, I feel honored to be a part of the JDWNRH team. I think that mutual learning took place today. Based on my observations of the patients with spinal injury, I am planning to deliver an in-service on the ASIA scale (a standardized test for individuals with spinal cord injury) and hope this can contribute to the local clinicians' diagnoses and prognoses. What I learned and took home today is that respect, collaboration, and optimism are at the core of Bhutanese healthcare.

(Pictures: Top - Myself dressed in half kira (bottom only) outside of my apartment; Bottom - National Referral Hospital)