ABAH Bridges the Bhutanese Society and Western Medicine

So that we may learn and grow from each other

 

WEstern Medical & Health Education

 

Equipment donation program

 

Bhutanese Traditional Medical Sciences

 

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Dr. Anayat Yaganagi Control of Disease Program

 

Support American and Bhutanese Medical Students, Residents, Fellows and Faculty

 

With the International Medicine Programs of the George Washington University School of Medicine and Health Sciences we send students from the Global Health Track for summer experience in Bhutan, as well as third and fourth year students on for-credit rotations. include their students in our opportunities.

We partner with RAD-AID International Inc to complete the Radiology Readiness Assessments as part of our equipment acquisition project.  The Medical Students have played a major role in accomplishing this essential task to engage RAD-AID in Bhutan.

Our new partner in 2016 for program development and medical and public health education is Eastern Tennessee State University in Johnson City.  This fine state school serves the Appalachian region and is keenly interested in Global Health and the Himalayas. At the Initial Planning Conference for Health Development co sponsored by the Associate Dean for International Medicine and ABAH on August 4, 2016, Dean Wykoff presented a fascinating parallel between Appalachia and Bhutan.

 

Accomplishments:

In 2016, Alissa McInerney completed the RAD-AID Radiological Readiness Assessments in Gelephu and Thimphu, completing the national assessment of the Regional Hospitals. Sheconducted an investigation in promotion of culturally appropriate implementation of our major medical equipment program, such as CT scanner for Mongar and Gelephu hospitals. The Institutional Review Board of the GWU School of Medicine and Health Sciences has given permission for this investigation.  She did 41 interviews with mothers as part of her cultural issues in radiology study,

Prior Projects

In 2013 Ian Barrows a GWU first year medical student spent the summer at the National Institute of Traditional Medical Sciences and the Jigme Dorji Wangchuck National Referral Hospital. He spent 10 days on his way over learning about traditional medical substances, analysis, and scientific investigation at Glaxo-Smith-Kline's Tres Cantos Laboratory in Madrid Spain.

In 2014, Rob Dufour who started Radiology Residency in 2014 at UVa in Charlottesville, VA, made a visit to Mongar (which urgently needs a CT scanner) on behalf of ABAH and  RAD-AID  laying groundwork for Radiographic Readiness Assessment in Mongar and Thimphu.

In 2014, Ke Sun, then a first year student spent two weeks in Bhutan and 6 weeks at GWU designing a software approach to link the district hospitals to the electronic surveillance system being developed at JDWNRH in Thimphu.  He presented his project in a Poster Presentation at GWU Research Day in 2016.

In 2015, Trent Hope and Danielle Canter advanced this project working with Ministry of Health, Department of Radiology at National Referral Hospital, Eastern Regional Referral Hospital in Mongar, and Khesar Gyalpo Univeristy of Medical Sciences of Bhutan.  WHO and Union for International Cancer Control in Geneva are collaborating partners with RAD-AID International in this multi site project. This is part of our attack on stomach cancer.

Travels we have sponsored to date:

2016 Alissa McInerney, MS IV, The George Washington University of Medicine and Health Sciences

2015 Trent Hope, MS I, The George Washington University of Medicine and Health Sciences, and

        Danielle Canter, MS I, The George Washington University of Medicine and Health Sciences

2014 Rob Dufour , MS IV, The George Washington University of Medicine and Health Sciences  in April of that year

2014 Ke Sun, MS I, The George Washington University of Medicine and Health Sciences in June of that year

2013 Ian Barrows,  MS I.  The George Washington University of Medicine and Health Sciences for a full summer at Institute of Traditional Medical Sciences

2013 Erik Blutinger,  MS III,  The George Washington University of Medicine and Health Sciences for site visit with Ministry of Health and ERRH in Mongar, Eastern Bhutan

2011Erik Blutinger, MS I,  The George Washington University of Medicine and Health Sciences with Ministry of Health

2006 Meena Bhatia, MS I,  The George Washington University of Medicine and Health Sciences

 

 

Gifts in Kind Medical Equipment Developing Health Care Infrastructure

 

Our Purpose

 

We initiated and lead a program that seeks a first CT scanner for the Mongar Referral Hospital.  We partner with other compassionate organizations, such as RAD-AID International, Project HOPE and other nonprofit culturally sensitive and respectful foundations. We work in close collaboration with the Ministry of Health and World Health Organization. We intend a broader ongoing program of targeted donations of medicines and medical supplies that will help the Ministry of Health increase budget saving and improve the availability of appropriate medical care. The program will work in close collaboration with the Minister of Health himself or designees in every step of the implementation process.

Current National Radiographic Assets and Capabilities

           

Despite its rugged terrain and limited resources, Bhutan continues to make great strides in healthcare. It declared universal childhood immunization coverage in 1991 and has stayed on course to achieving its health-related Millennium Development Goals by 2015. Life expectancy rose from 37 to 66 years of age from 1960 to 2005, and infant mortality rates have dropped from 103 to 40.1 per 1000 live births from 1984 to 2005. In trying world economic times, Bhutan is now struggling to create cost savings and reduce expenses of health care which is provided by the Royal Government free to all.  There is no private practice of medicine in the country.

The mountainous terrain makes access to care challenging despite the launch of the Health Help Center (HHC) in May of 2011. This year, HHC seeks to provide integral care including interventional health and counseling, to 90% of the population within one hour of dialing “112” from a telephone/mobile network. In 2011, there were reportedly 60 ambulances equipped with GPS and emergency medical equipment in the country. The program offers a complaint logger system and aims to reduce prolonged waiting times for health care by early active intervention.

Health challenges include a rise in the prevalence of hypertension (beginning in 2004) and access to care. Health professionals are unable to access many villages, health cost are rising, patient needs and expectations are changing, and new medical technology is badly needed.      
Bhutan faces a rise in the number of non-communicable diseases that may be prevented by the installment of CT and digital mammography services.

Currently, Bhutan has only one CT-scanner in the whole country, a single machine based in Thimphu, at the Jigme Dorji Wangchuck National Referral Hospital (JDWNRH). Bhutanese radiologists are competently interpreting these CT images themselves and have internet access for instant communication to other sites or image referral and consultation.

According to a former Head of the Department of Radio-diagnosis and Imaging, Dr. Dechen Nidup, the country urgently needs a minimum of two brand-new CT machines (helical and 16 slices minimum) to be placed, one each, in Mongar (Eastern Regional Referral Hospital) and Gelephu (Central Regional Referral Hospital). Limited access to this communication is available uponrequest. The new hospital in Gelephu will be completed in 2015. The new Mongar Referral Hospital is ready to receive equipment now. JDWNRH and Mongar hospitals both have abundant reliable electric power resources and do not experience frequent outages. Manpower and educational infrastructure for expanding maintenance personnel are also plentiful.  The Ministry of Health has given high priority to acquiring CT scanners but its expendable resources are limited and assistance is needed.

Additionally, there are no mammogram services present in Bhutan.  Clinical diagnosis is aided only by low quality ultrasound imaging. This absence of mammography makes the installment of new digital mammography machine a moral imperative. JDWNRH has the human resources (with multiple technicians) in place for the installment and maintenance of a machine yet lacks the finances to do so. If donated, diagnostic mammography services and walk-in screening services will be planned for all women at-risk. Already, there are plans to initiate breast health awareness in Bhutan yet the fundamental equipment is still lacking.

Priority Request

 

            In Letter Ref No. MOH/DMS/(42)2012-6454 of 12 April 2013 from the Royal Ministry of Health the Secretary (Acting Minister of Health) and Director General of Medical Services stated in order to reach the final 10% of the population with and improve generally the quality of health services, Bhutan requires two CT scanners, one Mammography Machine, Ultra sound machines and laboratory analyzers.  The first priority is a CT-scanner for the Regional Hospital in the East at Mongar that serves 250,000 Bhutanese. This has been the consistent statement of the Royal Minister of Health, other officials, and medical colleagues over the past year. The acquisition of a new CT scanner for Mongar is our current focus but not our only goal.

            In Letter dated 12 April 2013 the Governor of the Province of Mongar, Dasho Sherab Tenzin, states again the need for the CT-scanner and that it will go a long way for the saving of lives and costs.  The new hospital in Mongar completed in 2011 has a designated room for a CT scanner providing incontrovertible evidence of this priority and an effective consistent planning process and readiness to receive this equipment.

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Exchanges of Students and Faculty Between the United States and Bhutan

We promote understanding of traditional Bhutanese medicine in the West through academic exchanges of students and faculty with  Bhutan.  We partner with the George Washington University School of Medicine and Health Sciences International Medicine Programs to provide highest levels of academic excellence and support. 

We are also developing and plan to launch in collaboration with the George Washington University Business School unique Medical Schole Tours that will allow academic and culturally respectful travelers to visit the National Institute of Traditional Medical Sciences, traditional and Western clinical facilities, to interact with practitioners and to experience first hand the integration of Western and traditional medical services to the people of Bhutan. 

We support Bhutanese controlled relations with Western pharmaceutical companies to assist in identification and production of traditional medicines.

The Foundation actively supports the integrated practice of traditional medicine in the health-care system and  the  cultural uniqueness of its underlying theory and practice.

Read a brief narrative of how H.E. Dujom Rimpoche assisted the new Pediatric Ward in 1983 to solve a difficult cross-cultural challenge:  Ghosts in the Ward (excerpt from R. Morrow, "Anthropology in the practice of medicine," Proceedings of the Southern Anthropological Society, 1997).

Traditional Medical Services Booklet, 2005

Innovatons in Integration of Traditional Bhutanese Medicine, presented by Ian Barrrows and Dr. Morrow at Prevention 2014 in New Orleans, LA

 

 

Prevent and Understand the Spread of Disease in Bhutan

The Dr. Anayat Yaganagi Program for Control of Diseases

This Program is named in honor of Dr. Anayat Yaganagi who was the Superintendent of Thimphu General Hospital (now the Jigme Dorji Wangchuck National Referral Hospital)  who at the request of the third Druk Gyalpo HM Jigme Dorji Wangchuck developed Western medical services, especially in the remote Eastern Region, and in 1983 at the request of the fourth Druk Gyalpo HM Jigme Singye Wangchuck transformed the central hospital into the National Referral Hospital and initiated the Pediatric Services in the new building constructed by UNICEF..  He  recruited Dr. Morrow to be the first Child Specialist in this new Service in 1983.

In 2014, ABAH made a special donation of US$4000(Nu 360,000) to send two Bhutanese professionals to Sri Lanka for training in Palliative Care.  this is part of the management program for cancer, since without sufficient diagnostic eguipment many patients present late in the course of their disease.  This program in Palliative Care is functioning at JDWNRH and Alissa McInerney made a site visit in April 2016.  They are training and will expand these services to the rest of the health care system.

in 2016, ABAH made a special donation of US $1000 (Nu 60,000) to the Eastern Referral Regional Hospital Poor Patient Welfare Fund.  This was in honor of our Patron,  HRH Ashi Kesang Wangmo Wangchuck, and Dr. Anayat.

The Equipment Donation Program is a vital part of improving diagnostics in Bhutan for early detection and control and treatment of disease and injury. The initial priorities we follow were  set forth in authorizing letters received by the Executive Secretary in April 2013 at a meeting in Thimphu with Bhutanese Ministry of Health. Consultation,  best medical and public health practices and collaborative counterpart relationships guide our priorities and activities.

We are collaborating with University of Cincinnati Children's Hospital and Harvard Medical School and Massachusetts General Hospital on a project led by Dr. Ardythe Morrow and Dr. James Richter on the high incidence of Cancer of the Stomach.  This disease was mentioned as early as 2006 as a high priority to Dr. RobertMorrow in consultation with Health Authorities in Thimphu. To read a copy of the 2006 assessment visit and consultations click here.

 

We collaborate now with Dr. Ardythe Morrow, also a member of our Board of Directors, of Cincinnati Children's Medical Center Department of Neonatology and a world famous breast milk researcher and epidemiologist.  She is developing a proposal to study the primordial micro biome in remote Eastern Bhutan in collaboration with Dr. KP Tshering of the UMSB in Thimphu and the Ministry of Health and Eastern Regional Referral Hospital.

 

Our current priorities for activities in Bhutan are the development of a tumor registry, support of surveillance activities, control of diabetes and hypertension which are newly emerging chronic diseases. Hepatitis C, and especially the initiation of a Breast Health Program for Breast Cancer prevention and early detection and treatment.

For recent publications on the challenge of Helicobacter pylori and stomach cancer click here:

Epidemiology of H pylori in Bhutan:  The role of environment and geographic location, 2013byDorji Dorji, Tashi Dendup, Hoda Malaty, Kinley Wangchuck, Deki Yangzom and James Richter.

Extremely high prevalence of H pylori infection in Bhutan, 2013 by Vilaichone RK et al

Antibiotic resistance rate of H pylori in Bhutan, 2013 by Viliachone RK et al

For the recent World Bank report that shows differential between Small Area Poverty in Eastern and Western Bhutan click here:

World Bank Report on regional poverty levels in Bhutan, 2010

 

 

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