Changangkha Lakhang and the zoo

Last week Andy and I went to Changangkha Lakhang. This is a local monastery, where many families from Thimphu bring their babies for the naming ceremony. It is an old structure. I've shown pictures of it in previous posts, so I won't go into enormous detail. However, there were a couple of interesting things:

Prayer Wheel

Old Kitchen

Prayer flags

Went with  my apartment mates Keith and Jen for a final dinner together at the Cypress owned by a Nepali family. Had a great dinner:

Earlier today (29 March) Andy and I went to the Takin Preserve. This was just shy of 4 hours total walking. 

The takin is the national animal of Bhutan.  This is one seriously weird looking animal, as evidenced by the pictures below. However, the day was sparkling and warm and dry. It was a great workout and we were rewarded with the site of these animals.

That's probably going to be it for posts and pictures. Rest up this afternoon, dinner tonight, then clean up and pack tomorrow.  I fly to Bangkok on Druk Air, Bangkok to Stockholm via Thai Air, Stockholm to Newark via SAS, and then up to Boston via United.

No great philosophical take home messages from this trip. Nice people, trying their best in the face of multiple obstacles that would stop most of us cold in our tracks. We'll leave it at that.

Tango time

There are two monasteries ~15 miles north of the city, Tango and Cheri. Tango has been turned into a Buddhist university. We (my apartment mates and I) hired a cab for the morning and drove up to Tango. My two roommates are devoted Buddhist converts. Their sincerity and genuine interest prompted the cabby to join us for the mini-pilgrimage and to act as guide and interpreter with the monks, completely spontaneous.

It was quite interesting to drive there; I had not been on the north side of the city before. We steadily ascended, passing through some more upscale neighborhoods. Leveling out, we passed a small shrine dedicated to the Guru Rimpoche, a stunning painting of him was also seen on the rocks.

We parked and ascended a very steep path through a rhododendron and conifer forest. Some of the rhododendrons were in bloom.

We first visited Tandinay, a small outlier chapel built into the side of the hill. To reach the chapel, we needed to climb ladders through natural passageways in the rocks.

My roomies!

Some of you may wonder why there are no interior pictures. That's because it is considered extremely impolite to photograph the inside of the temple.

We continued to Tango proper. Again, built into the side of the mountain it was a rather large complex. We explored the interior and visited the library. My roommates and our driver did some devotional activities. In one room, the monks were praying and playing music. One of the horns was made from a human thigh bone.

Came back to the city and stopped at MK's for lunch. My guilt was assuaged by a late afternoon trip to the hospital, where I found out there was only one stable patient in the unit. In retrospect, a perfect day to do other things.

The Haa Valley

Last weekend we went for a day trip to the Haa Valley. This trip took us to the west of the capital. Although it was a lot of driving, it was a breathtaking trip.

We left Thimphu in the early morning and entered the valley at a more southerly point, worked our way north, and then started our return to Thimphu through the highest mountain pass in Bhutan, slightly over 13000 feet. The day was absolutely clear and sparkling, and we were afforded terrific views of the distant Himalayas.  Although this map is likely irrelevant to most readers, here's our itinerary:

We climbed steadily, and then encountered Dobji Dzong, an old dzong that had been used as a prison until 1976 and is now a monastery. It is set on a promontory. The location and structure are both quite striking:

We did not go down and visit.

We continued past terraced rice paddies in early spring, a site we saw throughout our trip. I stood and watched the valley below us, and it felt as though time stood still. I could not tell if we were in 2014 or 1614. Here are some samples from throughout the trip:

We were fortunate enough to catch a couple of interesting sites along the way. First, we saw an archery contest. Some of you may have read my previous postings about archery (see 2010, The National Sport). This contest was interesting in that there was no level ground for a single playing field. One team was on one side of a valley, and the other team was on the side of the valley. Because the target areas were so small, the archers actually had a shielded area for their protection.

Close group

Far group, a bit hard to see, sorry.

 Scenery was great at this stop, and I got to see another one of those really neat looking Bhutanese cats:

The pictures could be endless; it was incredibly photogenic. Everywhere, there were snow-capped peaks and deep green forests covering the local hills. After stopping in Haa, we visited the white and black monasteries. A cow wandered unconcernedly (both cow and local folks) through town.

White Monastery

Black Monastery. The grey paint is extremely unusual.

Cow. Maybe a bull?  Didn't get that close to check.

We climbed toward Delelu pass, the highest paved road pass in Bhutan, and saw a yak herd:

Pretty cool.

We finally reached the pass. The views were spectacular.

And then we came home. We had yak burgers a couple of days later; they were delicious.
Next:  We play hooky and go to Tango

A Fruitful week

So, here it is Friday afternoon in old Thimphu. From the standpoint of getting stuff done for the hospital, it's not been a bad week.

First, I gave a talk on how to use UpToDate. It was well received. It was interesting in that when I asked for someone to take responsibility for being the liaison, suddenly everything needed to be cleared through administration... However, it looks like someone is stepping up to the plate and we'll do fine.

I finally made contact with the interns and had a good presentation with them. I'll do a few more with them before I go.

The ICU has a blood gas machine!!! It is an easy to use point of care device, and gives electrolyte data and lactate/glucose as well as blood gases. We have used it extensively, and it has really made a difference in care. I think because it is so easy to use it will become part of practice. Thank heaven!

Sales/tech rep teaching how to use the device.

 

There it is!

Obviously, I am not the motive factor for this change, but I am thrilled that it has taken place.

The other thing that happened is that one of the docs put in a central line for high volume fluid administration and CVP monitoring. I was thrilled. The patient herself is quite interesting, with tuberculous enteritis. She perforated her small and large bowel and is in the ICU after surgery for the resulting peritonitis.

A subclavian line! What a welcome sight.

Given the aggressive use of lab testing in the U.S., it's rare that we see really pronounced EKG abnormalities from electrolyte disturbances.  Here's some nice U waves from a K of 2.1

Andy Hertler organized and gave a tumor board. He did a great job:

I haven't said much about IT. It's been a bit interesting, to say the least. Bandwidth at the hospital is quite limited, and the wifi drops in and out all the time. Each area has it's own WiFi and username/password combination, really quite strange.  The computers are also quite slow. Now, part of it is that they are using older computers (e.g. Dell Optiplex G360, which is probably about 8 years old.) However, when I did a bit of rummaging around in the system specifications, they are running Windows 7 Ultimate typically in 512 mb or 1 gb.  Not exactly going to be a powerhouse with all that virtual RAM swapping.  However they do have a network, they do use it, and they are trying.  Can't ask for more.

This weekend we will go traipsing around the Haa valley, fully armed with our road permit (if you leave the capital area and you are a "chilip" (= Maine "from away") you need written permission from the immigration authorities.

Punakha

Punakha is the name of a town about 3 hours by car from here, over hair-raising roads. The roads are made even more hair-raising by the construction. Let's put it this way: OSHA and the National Transportation Safety Board would put a plastic bell over the entire country and quarantine it.

Anyway, the trip to Punakha was breath-taking. We go up through Dochu-la which is a pass through the mountains. The huge Himalayan peaks are visible in the background if you are lucky, and briefly we were lucky. There was a nice little cafe where we stopped for tea and crackers, and then proceeded on to Punakha. We passed through a botanical preserve, where some of the wild rhododendrons and magnolias were in bloom.

Monastery at the top of the pass

Memorial to the short war in 1995 (?) against Indian rebels

Rice terraces

There was some sort of festival at the dzong (monastery/seat of civil authority/seat of religious authority for the region) and we were witness to the reenactment of a battle against the Tibetans. We were able to see several of the temple rooms, which are utterly beautiful.

Punakha Dzong; another one of those must-take Bhutan pictures

Local holy men

Traditional dress

Reenactment of battling the Tibetans

Unrelated, there was a beautiful tree in bloom at the dzong, shown below. Also, this is the first of what  I hope are a bunch of pictures of Bhutanese cats. They have very distinctive markings and are quite beautiful.

We ate at an overpriced tourist cafe; good enough but way too expensive, and way toned down in terms of heat.  After lunch, we went to see the dzong at Wangdue.  After we were almost there, our driver told us that it was not accessible because of construction. We had a good look from a distance but that was about it.

The Wangdue Dzong, from a distance

Work today (10 March 2014) included a bedside bronchoscopy and stabilizing a young (21) woman with hypertensive encephalopathy. Unfortunately, I am teaching far less than I'd like. No pictures, sorry.

Up to the Buddha

Andy and I walked up to the Buddha. This is my third trip. They are still not done. However, there has been considerable progress:

They now have some information about the statue:

 

Truly massive. Gorgeous day, we walked up in our shirtsleeves. However, it was very windy.

As usual, I was distracted by sights along the way.

Here are some pinecones:

One of the local practices is to put devotional offerings in small caves or indentations in rock walls. This was on the trip up to the Buddha, on the side of the road:

I thought this was extremely cool. Look carefully. You can see where this chunk of cliff simply fell away. The top of the freestanding mound of rock and earth fits into the top of the surrounding space. It may be a little hard to see:

Finally, I saw this painting on the side of a mountain:

Tomorrow we go to Punakha. That will be a good trip.