Friday, July 15, 2011


The stats on my blog have revealed page views in the hundreds. I'm famous! More than one person has looked at it and some more than once. Woo-Hoo! I even have a follower or two.

I've been requested to provide information about medical care, more specifically, orthopaedics in this country. After all, that is why I'm here. Bhutan is still considered as a third world country although no longer in the bottom tier of world poverty. Medicine is up and coming as one of many priorities as the new King and democracy gains control. There must be dozens of government development programs either already in place, scheduled to start or in the planning stages currently. All kinds of ministries representing all walks of life, from road planning and building, to youth development, to international relations, to upholding religious standards and culture, to drug and narcotic prevention, sports development, tourism, etc. It's obvious that the country is in the midst of a fairly major reform.

The hospital itself is new, although when seen through a Westerner's eye, it looks primitive. Many services are available and many are not. Example: MRI, CT and plain x-rays are fairly easily done and of acceptable quality. There is, however no nuclear medicine or good ultrasound (OB excepted). There is no cardiac cath lab. The laboratory offers a solid base of testing but unfortunately, many reagents for the testing are out of stock. Therefore things like plasmapheresis gels cannot be run, and liver function tests are on hold. There is a limited amount and choice of antibiotics.

Orthopaedics is plagued by being heavily dependent on expensive equipment. There are three orthopaedic surgeons here, knowledgeable and capable but limited in what they are able to do for a large population. Most fractures can be adequately treated with very basic equipment, common sense and a dash of creativity. Infections are common and often times present late and well established making prolonged treatment necessary. Fancy surgery taken for granted in developed countries are hardly attempted here. Even basic arthroscopy has yet to take hold despite willingness by the staff and the presence of equipment. Total joint replacements are not done here. A set of instruments was purchased but no implants are available to use. People with advanced arthritis are necessarily referred out of the country for joint replacement, usually to India. Since medical care is free here, this is all done at the government's expense. Fortunately, India is very close (physically, politically and culturally) and on good terms with Bhutan, so negotiated discounted rates are given.

That's all folks.

No comments: