This morning we woke up early to move from Paro to the capital city Thimphu. It is about a 1-hour drive with very scenic views in the mountains.
We arrived at the hospital to have a kick-off meeting for our study. The focal point of the conference room was a large photo of the King as you can see below.
After the meeting we went on a tour of the hospital, viewing the wards, the pharmacy, and the microbiology lab.
We were all very impressed with the work that they are already doing in Bhutan for antimicrobial stewardship. The medications (including antibiotics) are reviewed by the pharmacy. Any restricted antibiotics require a form to be filled documenting the reason for the restricted antibiotic. There is a clinical pharmacist who reviews the cases throughout the hospital, visiting the ward and seeing the patient. Certain antibiotics such as cephalosporins are also documented and watched. We were also happy to see there are infection control practices in place such has contact precautions for multi-drug resistance organisms. In the ward if there is a contact precaution requirement, they place a blue screen (the wards are multiple people to a room so a single room isn’t possible), and keep equipment for the single patient which is sanitized before using again for another patient.
We also met the one neurosurgeon in all of Bhutan. All specialties receive the same income in Bhutan. It is always interesting to see which specialties become popular once you take pay differences out of the equation. Maybe infectious diseases would become the sought-after specialty…
After we were finished in the hospital, we went to see the very large Buddha up in the mountain, Buddha Dordenma. Construction started in 2006, and was completed recently in 2015. It is 51.5 meters tall, one of the largest Buddha statues in the world.
That evening a few of us went shopping, and I bought the traditional local skirt the women wear called Kira. I was excited to show back up at dinner wearing it!
The next morning we went to the office to solidify the process of interviews among our group, and put together all of the interview packets required for the study in Bhutan. I was excited to be able to work the from country WHO office! The building is beautiful.
After this we went to the hospital to see some of the patients with the clinical microbiologist involved in our project, Pem. We saw a young boy with Pyoderma gangrenosum with unknown underlying etiology. He had received multiple antibiotics for recurring infection of the wounds on his legs. His current culture revealed Pseudomonas aeruginosa, resistant to everything except Colistin. Exactly the reason we do what we do, we need more stewardship of antibiotics and increased infection control to prevent the increase in resistance and the spread of these highly resistant bacteria.
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