The JDWNRH

JDWNRH is the Jigme Dorji Wangchuck National Referral Hospital of Bhutan, seen below.

Jigme Dorji Wangchuck was one of the kings of Bhutan (the 3rd I believe, grandfather to the current 5th king).  I am assigned to the Psychiatric Ward of JDWNRH.  The psychiatric ward is pictured below.  Astute readers may notice that the Psych Ward is in the oldest and most run down part of the hospital.  Of course, if you work in the mental health field, this will come as no surprise to you.  In fact, I feel right at home.  The psych ward is in some ways similar to that you would find in the States.  There are 18 beds, 10 for detox patients (alcoholism is a big issue here) and 8 for psychiatric patients.  The psych ward is staffed by 2 psychiatrists  (who spend most of their time in outpatient psychiatry rather than on the ward), several psychiatric nurses, a detox counselor, and one man who has a bachelor's in psychology who they seem to be grooming to be a therapist.  

There are also some interesting differences between this psych ward and what I might find at home.  There is no locked unit, and no attempt at confidentiality in the sense that anyone can come and go through the ward (although they do attempt to screen visitors to detox patients).  A reporter from the local newspaper walked in last week hoping to interview a patient about a story on alcoholism, and was allowed to do so with the patient's consent. The dog in the photo above also wanders in and out as he pleases.  He has nudged the door open into our counseling room at times, looking for treats, I think.  

Another interesting difference is that patients here are required to have a personal attendant (a family member or friend) with them in the hospital.  The attendant stays with the patient as much as possible, and even sleeps there with the patient.  Patients are also assigned two-to-a-room, so the rooms can get pretty full of people.  The attendants are responsible for bringing meals to the patients and accompanying them around.  I have seen children accompany their parents (who are patients) to rounds, which caught me off guard at first.  One woman needed to be admitted but had no one to take care of her young children, so she was allowed to keep them with her. 

Activities on the ward include morning check-in meetings, art therapy, meditation class taught by a lama, and "anxiety clinic", which is being morphed into a stress management class/group.  They also have an ECT room ("shock therapy").  I have not seen this used but my understanding is that it is used fairly regularly.  

I have decided that one of my goals is going to be to implement a daily (or 3 times per week) psychotherapy group into the routine.  I will have existing staff co-lead with me to train them and hopefully make it sustainable after I am gone.  There is much work to do on this, but we started today (with three group members and three leaders). Not an ideal situation but I must say I was pleased at our first attempt. We did not cover much ground.  BUT... One patient with very flat affect and virtually no speech (almost catatonic) in the 4 days she has been at the hospital smiled and laughed two times (!!) and after we were done, one of the staff said "I think maybe group therapy is more helpful than individual therapy".   I will take it.  I walked home with a smile on my face, despite facing the Hill of Doom :-)

First Post from Hope

First Post from Hope:

EXPLORING BHUTAN

My dad started homeschooling us today. It was really fun and calming because my dad goes at my pace. This is our schedule:
1 hour of work (usually math)
20 minutes of outside time (like a hike)
small snack
1 hour of work (usually grammar, spelling and religion)
30 minutes of reading.

When my mom went to work on Monday, dad, Eden, Trey and I hiked down the Hill of Doom toward the downtown area in the afternoon to go exploring. 

It is very steep.  You can see the downtown area after the building with the green roof. 

You can see Trey in this one. 

 

We are walking east to west now (flat) toward main town.  The hospital my mom works at is on the left.   The main prayer Chorten in town (where people and pray together) is the gold topped sphere in the middle of the picture.  We are about half way to the main part of town at this point.   

 



 

This is the entrance to the hospital where mom works. 

First we went to Zombala 1.  They have only two items on the menu:  Momos and fried rice.  We had momos which is a boiled dumpling with spiced beef.  It was very good and I ate it all.  I also had a bottled Pepsi just to see how different if was from back at home.  One word:  Blah! 

Then we went to 8 Eleven, one of the bigger grocery stores in town.  We got a bunch of weird stuff like milk in a box, potato sticks in a bag like chips, Chicken nuggets shaped like dinosaurs, Mango juice (again in a box), and Litchi juice.

Then the hike back up the Hill of Doom.  It was hard and tiring but I think I can get used to it. 

That night we went to dinner with Vincent's parents at a restaurant called the Rice Bowl. 

On Day Two of us learning from dad, we took a hike in our neighborhood at recess.  We went uphill.  When the road ended, we just kept walking on our first mountain trail. 

To our surprise (and dad's happiness) we found that the mountain trail led to a water something.  Dad says it supplies water for our neighborhood and needs to be uphill from our house to provide pressure.  As we headed back, we saw a skull stuck in the dirt!!  It freaked me out!  Dad thinks it was a dog skull. 

That is all for now.  Hope.   

 

First Post from Trey

A post from Trey:  Today I met a new friend, his name is Vincent.  He is 11-years old.  He came over to Bhutan with his mom and dad from Wisconsin.  My mom brought him over to our apartment from her work at the hospital.  He is funny and fun to play with.

My dad is nice to teach us.  We started school on Monday at 7am.  We had recess at 8am.  At recess we explored our yard at our apartment. 

Here are some pictures of the outside of our apartment and our new yard:

This is our apartment.  The home owners live on the second floor and the third floor.  We live on the ground floor. 

This is our front door.

This is me standing in our courtyard.  The wall and gate surround us.


This is the view outside our apartment from three of the corners of our courtyard. 

 

That is all for now.  "Trey Out".

First Days in Bhutan aka Dear Central Heating aka Eden Took a Caffeine Pill

First, a disclaimer.  This is Amy writing, not Eden.  I will get to that in a minute.  After 5 days, 2 weather related flight delays, one unexpected 24 hour layover in LA, and one city-wide shutdown in Bangkok, Eden and I are in Bhutan.  Our first reactions are that it is stunningly beautiful, and the weather is actually mild and pleasant.  However, as one title of this post suggests, there is no central heating.  Our two-bedroom apartment, which would otherwise be quite comfortable, is so cold that we are dressing in layers while inside, then take some of the layers off to go outside.  Two small space heaters are our only source of heat, and we can not have them plugged in while we have the internet on.  So, we have warm time, and then internet time, then warm time, and so forth.  The good news is that my husband is very handy and creative in situations like this, so we are holding out hope that when he and Hope and Trey arrive on Sunday, our situation will improve.

The other interesting living situation is the massive hill that is the road to our apartment.  This, I was not prepared for.  Other people that we have met don't refer to coming to visit us, or to stopping by, they say "I will trek up to see you", or "I will make the journey up to see you".   Obviously my cross-country running daughter is fairing better than I am, but she has been patient with me. The other humbling thing is watching Bhutanese who are clearly 30 years older, and 30 years younger, than me whiz by me up this beast of a hill as if they are just on a leisurely stroll.  It has to get easier. I am telling myself it is preparing me for the actual "trekking" we want to do while we are here.

So, we spent our first days just focusing on the necessities:  food, heat, and internet.  That pretty much consumed all of the first three days, but we are still not warm.  Today was more fun.  I started work, and we met a wonderful, helpful family from Chicago who took Eden and I under their collective wings.  Brian is also a psychologist working at the hospital, and he spent a great deal of his day getting me oriented.  Meanwhile, his wife and son kept Eden entertained all day, then we were treated to coffee and homemade crepes and fascinating conversation at their apartment after work.  Now to the final title of this post:  As Eden started to crash from jet lag, his wife graciously offered Eden a caffeine pill, which she accepted.  If you know Eden, you can imagine how this plays out.  She and her 11 year old companion were soon racing in the streets.  However, caffeine pills only last so long.   She is now experiencing a post-caffeine crash and therefore delegated the first post-writing honor to me.  Ironically, she refuses to take an Advil for the headache, because she "doesn't fight fire with fire".

I think that is all for now.  Work wise, there is much to process and think about as I figure out how I can be most useful.  More on that later.