Bhutan Health Journal
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Sexual Diversity in Bhutan
Get PDFThis article attempts to describe sexual diversity among people in Bhutan. We investigate ways in which Bhutan addresses sexual diversity in sex education and the law. We also review existing data to assess health issues affecting sexually diverse populations in Bhutan. Although limited, the available evidence indicates a higher likelihood of committing suicide, abusing substances, and facing barriers to accessing health care services and programs. The review finds the need for more representative researches for understanding sexually diverse people in Bhutan. The paper highlights the need for research with these populations with equal focus in ensuring active participation by the lesbian, gay, bisexual, transgender, inter sex & questioning (LGBTI&Q) community. The judiciary, education, and health system are crucial agencies that can facilitate and create accepting environments for the sexually diverse population in Bhutan
Liver parenchymal transection techniques
Get PDFWhile liver surgery has become safer with improvements in peri-operative management, parenchymal resection is the part of the procedure which is associated with major loss of blood and damage to important structures if not performed carefully. The ideal technique for hepatic parenchymal transection should be quick, easy to perform, reduce intra-operative blood loss and transfusion requirement, reduce post-operative bile leakage, and cause minimal damage to the surrounding hepatic parenchyma-- preferably at the lowest cost possible. This paper is a review of commonly used techniques for liver parenchymal transection during liver resections. According to the literature, there is little benefit of using the complicated and expensive devices over the simpler clamp crushing technique. We in our institution, who perform a large number of liver resections and living donor transplants, prefer to use the clamp crushing technique with a bipolar cautery for most resections and cavitron ultrasonic aspirator(CUSA) with a bipolar cautery for removal of part of the liver from a living donor
Rickets, BeriBeri, and Iron Deficiency: micronutrient deficiencies in children
Get PDFSome “forgotten” micronutrient deficiencies continue to be common in children. Deficiencies of vitamin D and/or calcium can cause rickets, a crippling condition related to poor mineralization of growing bones. Rickets is diagnosed by identifying skeletal deformities, elevation of alkaline phosphatase levels, and abnormal epiphyses on x-ray. Treatment is with vitamin D and calcium. Prevention hinges on improving the daily intake of calcium, regular sun exposure, or dietary supplementation. Beriberi is due to thiamine deficiency. Infants with beriberi present in heart failure while older children present with neurological abnormalities. Treatment is with thiamine, and prevention requires alterations to improve dietary thiamine intake – by supplementing mothers of breastfed babies, increasing legume and unpolished rice intake, and diversifying diets. Iron deficiency continues to be a problem for nearly half of the world’s children. Bhutan has made strides to eliminate this problem through active de-worming programs and iron supplementation programs.
National oral health survey in 6- and 12-year-old Bhutanese school children
Get PDFIntroduction: Dental caries is a highly prevalent and a significant public health problem affecting 70% to 95% of children, including adults in member states of the South East Asia region. Epidemiological data on the prevalence of dental caries amongst Bhutanese children at the national level is non-existent. The objective of this study was to determine the prevalence of dental caries, periodontal status, traumatic dental injuries and fluorosis in 6-and 12-year-old school children.
Methods: A descriptive cross-sectional survey in two age groups of school children in Bhutan was conducted in 2014. A total of 2904 students participated in the survey. A multistage cluster random sampling method was adopted that included samples from both urban and rural schools. The assessments for dental caries and periodontal conditions were done as per modified WHO methodology and criteria. Dental trauma and fluorosis were identified as present or absent irrespective of severity levels.
Results: Dental caries prevalence was 41.90% and 83.80% with mean DMFT/ dmft 0.80 and 5.54 for 12-and 6-year-olds respectively. Urban students had more caries than their rural counterparts. Overall, 13.00% of 12-year-olds had healthy gingiva but more calculus was detected in rural children. Dental trauma and fluorosis were very low (0.01% to 5.00%) in both the age groups.
Conclusions: Caries prevalence was very high in 6-year-olds while periodontal status in 12-year-olds was poor. Rural school children had lower caries levels compared to their urban counterparts. Imparting oral health awareness among parents can lower caries severity in younger children
Research Ethics Board of Health: a seven year review of the only ethics review board in Bhutan
Get PDFIntroduction: Research Ethics Board of Health (REBH), established in 2009, is the only ethics review board in Bhutan. The REBH was certified by the Strategic Initiative for Developing Capacity in Ethical Review (SIDCER), Forum for Ethical Review Committees in the Asian and Western Pacific Regions (FERCAP) in 2010 and recertified in 2013, and it received the Federal Wide Assurance (FWA) from the Office for Human Research Protections (OHRP), USA, in 2010 and in 2013. All researchers conducting health related research in Bhutan have to seek prior ethical clearance from REBH under the requirements of the National Health Policy 2011. Objective: The article aims to describe the performance of REBH, its standard and review procedure.
Methods: A descriptive study of records and database of REBH from 2009 to 2015.
Results: As of December 2015, the REBH has received 227 protocols with an average of 32 protocols per year. The median number of days for the initial review was 21 days (Min 0 days; Max 85 days). The median duration for approval of protocols from the date of receiving the application was 48 days. The average number of times the protocols were reviewed before issuing the approval letter was 2.
Conclusions: There has been a progressive increase in the number of protocols submitted to REBH. This indicated an increasing research culture in Bhutan. It takes about one and half months to get an approval from REBH; therefore, researchers have to consider the time required for ethical clearance process while planning research projects
Retained intraocular metallic foreign body causing retinal detachment
Get PDFA 60 year old farmer presented on 4th Sept, 2015with progressive diminution of vision in the right eye following trauma while hammering about a month previously. His vision was Hand Movement only in the right eye and 6/6 in left eye. The anterior segment showed normal findings, except mild anterior chamber reaction and an early cataract in the right eye. The left eye was normal except for an early age-related cataract. Fundoscopy revealed retained intra-ocular foreign body (ROOFB, subtotal RD with macula off in right eye. Interestingly, no entry wound was found. A B-scan and CT scan of the brain and orbit confirmed RIOFB and RD. On 9th September 23G PPV was done and RIOFB was removed. Fluid-air exchange, endolaser and silicon oil injection were done to attach the RD. On 6th February 2016 a cataract extraction with intraocular lens implantation and silicon oil removal was performed which improved the patient’s vision to 6/18p
Addressing childhood dental health in Bhutan
Get PDFDental health is a critical component to a society’s overall health. The national oral health article highlighted the high levels of dental caries in six-year-old children in Bhutan. Poor dental health in childhood has long reaching negative effects through adulthood. This is an important pediatric health problem which needs to be addressed to help eliminate and prevent a host of health-related complications and expenses
Department of pathology and laboratory medicine at Jigme Dorji Wangchuck National Referral Hospital striving for quality: external quality assessment scheme in hematology
Get PDFIntroduction: Quality Assurance comprising External Quality Assessment Scheme (EQAS) and Internal Quality Control (IQC) is an indispensible part of the laboratory analytical process to ensure reliable results from the laboratories. However, due to various challenges in many developing countries such as limitations in resources and manpower, EQAS samples are often given less importance at laboratories. The objective of this study is to assess performance on hematology EQAS samples received from Pacific Paramedical Training Center- External Quality Assesment Scheme (PPTC-EQAS) and International External Quality Assesment Scheme-United Kingdom (IEQAS-UK)since 2007 and 2008 respectively. The findings from this study will be helpful to establish an effective system to ensure timely follow up and corrective actions to improve the quality of laboratory services.
Methods:The feedback of the EQAS results submitted thrice a year to the PPTC-EQAS and six times a year to the IEQAS-UK since 2007 and 2008 respectively were reviewed to assess the laboratory’s performance and to determine the effectiveness of EQAS participation for improving the performance of laboratory hematology in Bhutan.
Results:For PPTC-EQAS, the average yearly scores were 69.00%, 75.00%, 87.66%, 87.50%, 70.00%, 80.33%, 80.50%, 85.00% for the years 2007-2014. For IEQAS-UK, the average yearly scores were 76.66%, 75.95%, 77.91%, 85.83%, 92.50%, 63.88% and 98.14% for the years 2008-2014. Our results show inconsistent performances on both EQAS samples despite gradual improvement over the last seven years.
Conclusions:We conclude that, strengthening the system for regular follow up and implementing corrective actions for the outlying results in addition to replacement of the equipment could improve the trend and ensure consistency of the performance
Principle of nutrition and dietetics in sowa rigpa
Get PDFAll living beings need food to live. It is a means of good life, health, and wellness. Inappropriate food will cause diseases and at the same time, food is the first medication against diseases. Just like anything in the universe, food is made of five elements: Earth, Water, Fire, Air, and Space. A balanced diet should contain all of the five elements. Although all plants contain these five elements, the varying ratios found in different plants make the six tastes: Sweet, Salty, Sour, Bitter, Pungent, and Astringent. A different taste has different functions in our body. Deficiency or an excess of a particular taste in food results in an imbalance of the three humours, causing diseases. As we have different nature of body constitution:Wind, Bile and Phlegm, the requirement for food varies from individual to individual