The Final Bhutan Post

Yup, this is it. Last one. Life is too complicated for me to be able to go back out for a month, at least for now. Maybe when I retire...

Picking up from the last posting, which was about National Day, December 17th. It's hard to talk about the patients. It is very depressing in some ways; the ICU had about a 50% mortality. We did manage to pull through a fellow with pancreatitis; he spent about 10 days on a ventilator and amazingly avoided pneuomnia. The amount of alcoholic liver disease is staggering, as is the number of head injuries and strokes. The World Health Organization says that non-communicable disease will be the next big problem in developing countries. They are very, very right.

Most of this is a bunch of interesting random stuff, to give a flavor of what life was like. I also got invited to some parties and festivals, which are worth recounting.

Dogs: last year, I said there are dogs everywhere. There still are. Mostly, they get along with us humans just fine. However, the husband of the physiotherapy volunteer was spontaneously attacked and underwent rabies prophylaxis Here's a picture of some unusual behavior; I really don't know what this was about:

No idea what they were doing hanging out on the median divider.

Shopping and markets: One of the neat things about doing volunteer work in a country is that you get to live there, as opposed to tour there. Shopping is a bit different. I've shown pictures of the markets in previous posts. Here are a couple more:

Just past those two buildings is the open air market. As you get closer, you see that the streets are jammed with people, there are dozens of stores, and they sell just about anything/everything that a Bhutanese might want.



This part of the open air market sells grains: rice, corn, wheat, barley in many different shapes and sizes. For a carb freak like me, it was like walking around heaven.

 The hospital: I thought that a couple more pictures might round out what it was like here:

Lab waiting area. This is before it gets crowded, when there is literally no place to sit and people are packed shoulder to shoulder.

This is the corridor in front of the ICU. There are no waiting rooms. People sleep on the floors. There are a couple of alcoves, and folks will bring mats and food and literally camp out. I wish I were joking, but cooking fires are explicitly prohibited. Apparently it has been an issue among visitors.



The picture is a bit small. This is a picture of just inside the main entrance to the hospital compound. The people sitting on the sidewalk are vendors; folks standing around are customers. Doma (betel nut), soft drinks, snacks, fruits. It's chilly, but acceptably warm in the sun.



Around town: Here's several pictures from around town that were just fun. I ultimately found myself pretty limited in my excursions, so these are all from Thimphu. My cardiopulmonary endurance was just fine, but my left leg was sufficiently weak to interfere with being really ambitious. Next trip is to a nice, flat, river delta. Flat ground poses no problems.

So, you guys think they worry about detailing cars in the US??? This is typical for Bhutan and India. Indian trucks have Hindu themes; Bhutanese are Buddhist. Lots of overlap in the iconography, though.

I thought this was cool. Young guy just contemplating life and enjoying the sun. Rocks on the roof are ubiquitous, even in/on more substantial dwellings.

Traditional older Bhutanese dwelling.



Monastery



Another picture of the monastery. The building was several hundred years old. Unfortunately my visit collided with two busfuls of Indian tourists. I waited til they left.

What a hoot. I love the name. Good store.



Last year I said the that the city was quite pedestrian friendly. Throughout the city there are thoroughfares like this, where walkers can slither between buildings and avoid long detours needed to stay on a paved road. A little weird at night, feels isolated, but they are safe (except for dogs.)

The last four or five days were a social whirlwind. Christmas eve was spent at the apartment of a couple of Indian nurses, one of whom is Christian; he threw a Christmas dinner.  He should not be a nurse, but should own a restaurant. Wow, what a great meal!

The next night I went to a puja, which is a festival. The puja to which I was invited was held by Tandin's family, the head nurse in the ICU. She grew up on a farm outside of Thimphu. We walked down through the dry rice paddies to her home, where we were plied with a variety of appetizers, suja (salt tea), and beer. This was one of the most unhealthful meals I have ever eaten, putting German cooking to shame. One dish was slabs of cheese with sugar, covered with melted butter.  After the appetizers, we had the main course. You weren't allowed to leave until your triglycerides were 1000, your glucose 400, and couldn't stand because you had drunk so much. Unfortunately, the pictures I took did not work out that well. The meal, by Bhutanese standards, was quite good, with all sorts of meats and chilies and tons of rice. A couple of interesting items. First, this puja is a yearly thing, a rededication of the home and being thankful for the harvest. When we left we were given a kg. or so of rice. Second, there were many people at this festival, friends of this family through different sets of contacts. "Affinity groups," if you will, were in separate rooms and didn't mingle. I guess that is custom.

The last night I was in Bhutan I was given a going away party by the nurses and a couple of the docs.  As usual, everyone was quite gracious, friendly, and I think genuinely sorry to see me go. They are good people; I shall miss them.

So that, dear reader, is that. The trip home was uneventful and without disruption. I have been home for just shy of two weeks, and in some respects it is as though I never left. However, I will always have the memories of two months as a doctor in the Himalayas, adopted and cared for by some of the nicest people I've met.

Bye.