Bhutan Wrap up

 Bhutan… I am not sure where to begin nor how to end. It has been such an amazing experience from start to finish. I have learned a lot about this country and it's people as well as myself. It has been interesting learning how healthcare systems work. Pros of a free healthcare system.. well everything is free! I mean you can get whatever you need and see as many doctors as you want and get as much therapy as you want AND equipment. Sounds great right… well, the cons.

 Here we see people standing in line to see the doctor. They get a "token" and wait. Everyday there are people waiting outside of the hospital to stand in line to wait. If you want to see a surgeon, you had better be sure that it is not on a non operating day. Even if you have an infection, you still have to wait for a non operating day. There are no narcotics unless you had surgery and you only get them in the hospital. I do not disagree with this, but people in America would not stand for it, they want narcotics and they want them now. Ibuprofen is what they get and they have to get it at the hospital pharmacy, you can not buy ibuprofen here. Treatment is often delayed because of this, so people get sicker and injuries get infected and hospital stays are longer. But, it is free. This is a good deal, right?! There is also a lack of specialist and so if you cut your finger, they may just sew it up and not check to see if the tendon is cut or nerves, so 2 weeks later when you go back to get the stitches removed and your finger does not bend.. then they realize the tendons are cut and then repaired 15 days later. Still sound good ? I mean the plus is that they can get as much therapy as they want , for as long as they want and get whatever splint they want and the therapist! Again, all things to consider. No system is perfect and there is no right or wrong system. Each system can be improved and that was part if my being there, help improve the system to make it easier as well as more efficient to handle hand injuries. The grass is always greener but is it really?Just some food for thought.  Bhutan is a beautiful and unique little country and  I have learned so much from them as well.

Here are some of my favorite little people. They were so sweet and came everyday to work. I enjoyed working with the kids as much as the adults and maybe even more. These kids have manners and respect adults and their parents don't interfere with treatment. Something I think Americans need to learn, it was interesting to see the relationships between parents and children as well as the level of respect at they have for each other and healthcare workers.

My sweet little girl!!! I miss her so much and she is really doing well. I am sad to miss seeing the final outcome. I got to see the progress over 5 weeks and she is really starting to progress and her hand is looking more normal. I love that transition with nerve and tendon injuries… the point when the hand starts looking healthy again and the movements are becoming more natural and not so "injured". Again…I am digressing , so I will stop.

This guy has made HUGE progress since I have been there!! And I am sad to miss the outcome! He had and abscess with a radial nerve injury and I found the second abscess, which took 3 days before he could see the doctor then had surgery and was admitted. Good news though, more and more radial nerve return and increase control of wrist extension and he can now lift his small finger and ring finger!! And now, I will miss the rest of the EDC return…

I saw this little girl 2 days before I let. She has a brain injury and some spasticity in her hand preventing her from any fine motor control. I made her a little yoke splint and then a little figure 8 splint to keep the fingers apart and allowing her to pick up things. When I asked if she will wear it in school she whispered "No, I am too shy to wear it and have people look at me".  That just broke my heart but I encouraged her to wear them. 

This is the center of Thimphu town. A cop stand in the circular booth and directs traffic.

The dogs of Thimphu, they are everywhere and quite adorable. They bark all night and sleep all day!

Finally, Buddha overlooking Thimphu. Bhutan is absolutely stunning and it has been and honor and privilege to be here.Until we meet again….

Thank you to all my family and friends for all your love and support during my journey. Thank you for reading my blog. I will actually miss blogging. Love to you all!!

Tashi Delek!

The weekend...

 The weekend flew by and it was full of monasteries and other fun adventures. The above photo was taken at the oldest Dzonga in Bhutan. It was full of beautiful murals inside and it was built in 1628. You are not allowed to take picture on the inside but these we on the outside and amazing.  We also did our usual market day and handicraft shopping, which is always fun! I will miss my saturday morning runs to Buddha and then follow up with coffee in a cafe and then market shopping and then whatever hike we decide to do in the afternoon. It has been an amazing journey and can't believe it is coming to and end. I have had to say good bye to three people and it makes me so sad. Each and every one of these people have touched my life in many different ways but I am honored to have met them and work and play side by side with them. I have learned so much form these people and fall more and more in love with this country every day.

 Simtokha Dzong. A Dzong is a monastery fortress and a Lhkhang is a monastery.

 Market day in Thimphu!

 This is Sunday's trip. We traveled to Paro, Chelela and Haa Valley. Once again, travel in Bhutan is rough, the highways are not straight …so a town that is 30KM which is about 20 miles takes an hour and it is switchbacks and all uphill. The drive is stunning but if you get car sick… it is not fun. It means taking dramamine or opening the window and praying that you don't puke! Roads are also not always paved. It is truly an adventure but rather fun! Paro was the first stop and this is the only flat town in Bhutan…I swear!! It was rather pleasant walking around without your butt and calves burning from walking straight up! We went to the local farmers market, which puts Thimphu's to shame! But I still love our market as well… and then shopped around the handicraft shops and had tea at 2 resorts!! My tour guide was a patient who i sin the hotel business, so he just took us to some beautiful hotels for tea!

 Bhutanese cornflakes…these are very hard and don't have much flavor. You can eat them with your tea or put them in your tea. It is actually pretty good.

 Some seriously great fruit!

 My tour guide!! The tall man with the hat and my travel companions!

 So, we took pictures in this family temple at a palace… BAD kids, but it was so beautiful and so we went for it!

 Then we travelled up and up the mountain side with lots of snow and ice to reach here!! It is 3988M which converts to almost 14000ft!!!! I got out and did not feel great and walked around and started feeling really funky… maybe the altitude got to me?! or the car ride? ;) Ok, it was the altitude… but the view just took your breath away!!! Along with the altitude! LOL

 This is baby Everst… that is what I like to call the Himalayans. It is Mt. Jomolhari

And las stop…the beautiful Haa Valley. You come down from Chelela and this little town is a line in the valley. We did see yak, deer, peacocks and pheasants along the drive. I forgot the yak pics, but will add in the next entry.
The next few days are going to be bittersweet. I have built a little life here in Thimphu and have made many friends. I know that one day I will return to see all the beautiful sites I did not see as well as to meet up with these amazing people again.

Last Friday in Bhutan! :(

I can not put my feelings into words how I feel about this experience as well as this beautiful country and these amazing people. I have been so humbled by these people and can't believe my time is coming to an end. We have laughed and learned from each other and provide excellent care to these people. I love our little hand therapy clinic and all the people that come to be treated and to work with. The patients are doing great and everyone is working hard and making progress. There are similar problems with the system and the staffing as there is in the USA… same problems, different country. Sad but true. But, these people are beautiful inside and out and I am honored to have had this opportunity to work with them as well as teach. 

As usual, I have a funny kid story, most because I don't treat kids. We were all busy with patients when this man and 2 year come into the clinic with grandma in tow… saying that his arm is dislocated. One of the therapist asks if there is an x ray and he says no, we did not go to the doctor. Both therapist look over at me and said will you see him?  " He is not crying, it will be OK"  I said sure, give him to the American girl who will make him cry when she puts it back in place!!! They both laughed and said 

"We don't know what is wrong?" I laughed and said, "He has a nursemaids elbow and I have to supinate his arm to pop it back in place." The man then said, " His parents are out of town and this has happened before and they told me what to do, but I couldn't do it!" So, I started talking and playing with the little boy and then supinated his arm and "pop" in it went with lots of screaming and crying, then immediate relief! "Thank you Dr. Erica!!! Such a beautiful American hand doctor" :) I LOVE this country!! ;) Hahahaha!!  Another funny quote…."Ahhhh, Madame! My leg wrist hurts!!!!" I started laughing so hard and say " Your leg wrist?! What is that called?" … " Madame, I can't think it is my leg wrist…. my ankle!!!!" Needless to say, we were all laughing so hard we were crying.  It is so much fun. I will miss all the crazy antics and translation errors and just plain craziness. 

Today though, was crazy by far. I got to work and no one was there, except my patient. I have some of them trained to come at appointment times, especially if they really want me to treat them.  Next thing I know it there are 3 patients waiting and then another therapist comes in. She starts treating and then another patient walks in and does not speak english and I had made her a splint and told her to come back today.  I start checking her splint and give her some exercises and then my little "Madame" kid's mom comes in with food and tea for me and the staff because I am leaving. The non english patient starts feeling dizzy and passing out… I help carry her to a bed. In the meantime, the other therapist ran out I was stuck trying to tell them to go to the ER and the 13 year old started translating for me! It was a circus!!1 Finally, another therapist came in and I just looked at him and explained the situation and he explained everything to them and we got them to the ER. ( I felt like I was back at SLUH!)  ;) But, all was well and food and fun was had by all!!!  Apparently everyone except me knew about this!  I am so touched and can't believe that they did all of it for me. Again, word escape me and I really can not put my feelings into words. It has been amazing. Last weekend.. I will be going to another monastery and then traveling to Haa valley. So more pictures and stories to follow!!! 

 This mornings food!!! Clearly people were hungry… also morning for us here in Bhutan is 10… I start at 9am!

 My awesome co workers and sweet Tenzin! I love this kid!

 I went to the ortho ward to help with shoulder taping and dressing changes … dry dressing on almost everything and they were ripping off new growth!!! UGH! Poor patients.

 So, the next time our patients complain…. ummmm, this is real. Falls are pretty common, the beds are high and no rails. No curtains and men, women and children in a ward. The bed to the left of the old woman with the mask was a young boy.

 Sunrise by my flat!

 Prayer flags on my run.

 Gorgeous scenery wherever I go.

 The river and some norbu in the window… these are "little gems" and represent the spirit of loved ones passed away. You will find them in the mountains or along the rivers.

 More prayer flags … in the amazing mountains

Just a government building in town.

The Weekend!

So the weekend started off with a dinner party at out apartment. Well, it actually started with tea and snacks with the Head of the Department and some staff after a clinical education session. The CME was fun and the PTT intern presented on a case study of a patient with a malunion of the distal radius. I coached the student on his case study and I reviewed things with him and I had also seen the patient with him and warned him what he was going to be asked…and yet he choked and had a difficult time answering the questions. I ended up giving them a lesson on reading x rays and classifying fractures. Fun for me! I think they liked it and learned a lot. The students did, but the films here SUCK and the lateral views were terrible but good enough for teaching. As usual, I digress and talk about hands and we all know I love talking about the hand and how it all works!!! LOL! I will stop here about that. ;) My patients are so amazing and I am getting very sad about leaving in 2 weeks.  The patients are getting worried and asking for home programs and some look to see if I am busy then if I am they leave and come back when I am free! So funny! I also had to give my criteria for a boyfriend today… detailed so he could look for someone for me to stay here in Bhutan. 

Enough work talk, back to the weekend! We started out with a dinner party, that I have already blogged about. And sorry… I am trying to finish up things for the department and see as much as I can before I leave!!  So, next we went to Depchenphug Monastery. It was small and beautiful and we could not go into one of the shrine rooms. ONLY Bhutanese in the national dress, But we did get to go into another room. I am learning a lot about Bhutan and Buddhism and how there are many different branches and Chinese Buddhism is different from Bhutanese and Tibetan.  It is very complicated and yet it is beautiful … the monks sit and chant and really explain things in depth. They are also very hardy things…these monasteries are perched on mountains and you trek straight up!!!! My butt is getting an amazing work out!! HAHAHAHA!!! 

So, here's to the last 2 weeks here and I am going to soak it all in. Do as much as I can and see what I can see. I really am having an amazing experience and can't put it in words how I feel. I love being here and teaching and talking about hands and working with these kids. 

Dinner party again… HAHAHA!

The market… I love this place with local and organic produce.

Dechenphug Monastery

My hiking buddies ! These are an amazing group of people!

Cheri Monastery… really high in the mountains!

The view from the top!

So, this guru, I can't remember his name… had 7 sons, but he thought that they were possessed by demons. So, he threw his sons into the river and if they survived, they were not possessed. 5 sons survived and were found alive! I did not do the story justice, but it was disturbing! I asked them why didn't they just perform and exorcist?! ;)

Tango Monastery which is also a Monk University...

It is Friday … again?

Somehow, the week just seems to fly here and there is so much to do and see. This week I went on a field trip to Godikum Hospital. It is about 12 KM away from Thimphu but takes about 45 to an hour to get to. Bhutan is not a 20 minute away from anywhere kind of city, it depends on where you are going and how many dirt roads and switch backs you are dealing with. While it is a tiny country the roads are very narrow and on cliffs…not for the car sick or weak kneed. Depending on who is driving, I have one eye open! LOL! Therefore I prefer walking. But, I digress… the hospital is in the middle of nowhere because it was the old leprosy hospital. It even has it's own small temple so the patients can pray. It is small but the patients get good care. The orthotic and prosthetic unit is small but they make everything from back braces, AFO, FKAFO, UE and LE prosthesis and orthotics. They equipment and methods are dated and prosthesis are very heavy. They don't use aluminum as in the country it rust pretty quickly. People wash clothes in a bucket, there are no washing machines and the water is not always reliable in the house, so going outside to get water to bring in is a common practice. ( yes, I bucket wash my clothes as well and hang them out to dry AND I have carried water in from outside) But, we do have a housekeeper and she does the majority of my laundry! :) She is amazing and I will miss her! They also have feet that can be used without shoes as some people who live in South Bhutan do not wear shoes..it is warmer in South Bhutan than here or in the east or North. Anyway, it was pretty amazing that they can so all the braces…for free, as many times as needed.
Patient update, I had to discharge my CUTE little boy because he got better…and needed to return home to east Bhutan. His elbow was -20 extension and has wrist extension and MP extension!!! Radial nerve palsy is resolving and he was happy to leave…I sent him home with theraputty and theraband and a ball and exercise program. It is really great that I can give them what they need without having someone tell me I can't! I am really going to miss that! My little girl is getting more control in her fingers and we are getting ready for her to go back to school and she will only get therapy 1x week. She is really sweet and is happy that her hand is getting better. I made her a thumb splint to help her oppose her fingers and hold onto objects…she had a spaghetti wrist, so median nerve and flexors were cut and repaired. Another patient is plotting and is trying to set me up with his friends so I will stay in Bhutan OR guarantee my return!! These people are so great and appreciative of all we do for them. It is amazing and refreshing. I also completed 12 protocols for the department and just in time, they have a new president and he wanted a copy of procedures that the department does! They were so thankful I had done that. I can't believe I have 2 weeks left here. It is so sad, it has been more than I imagined and I am so thankful that I have this opportunity.
We also had our first dinner party here at the apartment and I was taught to make some Bhutanese dishes! We shall see if I can recreate them..I also had some Bhutanese beer! ;)
Well, here's to the weekend!! More hiking and market exploring!!! It is also very cold here lately… i know 20 degrees is nothing, but remember… we have NO CENTRAL HEAT and poorly insulated homes. No heat in the hospital and gusty winds as we are in the Himalayas!!! But I  love this country and its people and all of its beauty.

 The hospital in the middle of nowhere and the workshop.

 The future K Pop star!!! He wants a blonde blue eyed or red headed girlfriend or Korean!!! Adorable!!! He has some wicked dance moves…. really.

 View from my awesome daily runs  in the mountains!

 Seriously, I was freezing and one of the boys moved the heater right under me!! That is how we roll in hand therapy!

 The national dish!! Ema Datse! Chiles with cheese and onions and soooo good!
Our guests and the cook! So fun!

Reason why I am here...

The weekend was amazing and we will get to that but TODAY… the whole reason why I came here was made clear to me. I have wondering if I have been making any impact and if I am truly helping them out. Today, the 3 of us (my co workers) sat down and reviewed the protocols I have written and the evaluation form and was told that I did exactly what they needed. It was not fancy and so over the top it was simple and practical and pertained to what they needed and what THEY would be able to carry through when I am gone. Then I was told that the other volunteer from Australia, while very amazing and helpful brings along a surgeon and fancy equipment and when she is gone, there is no use. I brought nothing fancy, just things I observed that I felt they needed. Number one, big sigh of relief and number two, the question of whether or not I am helping was made clear to me without even asking. Truly an amazing feeling and just affirmation that I am here for a reason and it is being fulfilled. Also, the hospital has a new president and wants procedure protocols and I have just written 10 protocols for them… perfect timing and done! As always though, the patient care is priority and I LOVE these patients and they work really hard and they are getting better.
So, on a lighter note. The weekend was filled with the vegetable market and an amazing hike to Tendin Lhakhang which is a monastery very sacred here in Bhutan and straight up the mountain. As everything is here…you walk uphill and occasionally down but then up again!! Not kidding…even the locals agree. Anyway, I crawled into a cave with very small opening to rid myself of attrition to get me closer to nirvana and climbed a cliff and walked around  rock to do it again. Anyone who knows mw well, knows I am a total klutz and I was fearing for my life climbing!!! There were several meditation caves that we visited as well as temples. It was very unexpected and completely amazing. Words can not describe the feeling you get visiting theses places that are sacred and clinging on the edge of a mountain. The feeling is serenity is unbelievable and it has been so amazing being here and experiencing all of it.

 Scenes from the market

 Some of the temple rooms and meditation caves, you can reserve one for months or years…

 The cave I crawled in and out of !!! I was terrified I would get stuck!!!

 Our monk guide! Who assured me I would not..

 My hiking buddies!!!

 Another of my hiking buddies!

The cliff rock!