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 :-)