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.