Bhutan Health Journal
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Oral Health & Dentistry in Bhutan: call for actions to address a public health urgency
Get PDFIntroduction: Bhutan’s healthcare approach in achieving the sustainable development goal 3 (SDG 3) has been largely through primary healthcare as enshrined in the universal health coverage (UHC). Bhutan has forged a unique primary healthcare model in which oral health is integrated in its primary care initiatives. The Oral Health program under the Department of public health was established in 1999 with clear line objectives. The program has achieved commendable successes over the years. However, with changing needs, enhancing and mainstreaming of oral health and dentistry in the country must be accorded a top priority. This is particularly important as the Oral Health Policy and service standards were drafted fourteen years ago in 2007. The 2021 World Health Orgnization (WHO) agreement “to provide basic oral health services to all”, to which Bhutan is signatory, needs to be strictly implemented. Therefore, oral health dialogue was conducted to deliberate on the oral health systems in the country with experts from the field who were from within and outside Bhutan. This oral health policy dialogue generated important themes such as strategic and competent workforce, capacity development, need to transform oral health services in more people centric ways and mainstreaming oral health in other health policies
Incidence and clinical profile of ectopic pregnancies in a tertiary hospital; A two-year Retrospective study
No full textIntroduction: Ectopic pregnancy is an emergency and a life-threatening condition which is an important cause of major maternal morbidity and mortality. This study was designed to determine incidence, common identified risk factors, clinical presentations, management, morbidity and mortality due to ectopic pregnancy at the national referral hospital in Thimphu, Bhutan.
Methods: This was a retrospective study of all cases of ectopic pregnancies for a period of two years from 1st January 2018 to 31st December 2019. Socio-demographic characteristics, risk factors, clinical presentations, investigations and mode of treatments were extracted. Simple descriptive statistics such as frequencies, percentages, mean and range were utilised.
Results: There were 9603 pregnant women admitted for delivery, out of which 122 were ectopic pregnancies. The incidence of ectopic pregnancy was 12.7/1000 pregnancies. Majority of them were in the age group of 21-30 years and 32.69% of the affected were nulliparous. While Pelvic inflammatory disease was seen in 41.35%, 20.19% were unmarried. Abdominal pain, amenorrhea, and vaginal bleeding were the most common symptoms. Among the ectopic pregnancies, 99.5% were diagnosed with ultrasound. A total of 94.23% had undergone surgical intervention, of which only 1% had laparoscopic surgery. No maternal mortality had occurred.
Conclusions: Women with past history of pelvic inflammatory disease, previous miscarriage, unmarried, and nulliparous presenting with history of amenorrhea, abdominal pain, vaginal bleeding should be a high index of suspicion for ectopic pregnancy. Timely diagnosis and intervention in the form of surgical or medical management will reduced the morbidity and mortality due to ectopic pregnancy
Benefits of bloodletting procedure among Bad-mKhris-mGo-Nad patients: A prospective observational study
Get PDFIntroduction: Bad-mKhris-mGo-Nad is a type of headache caused by imbalance of bile and phlegm humor. In gSo-ba-Rig-pa, headache is categorized in two categories such as primary headaches and secondary headaches. In total there are 14 types of headaches and Bad-mKhris-mGoNad is one among the principal headaches. The gSo-ba-Rig-pa based bloodletting therapy for Bad-mKhris-mGo-Nad has been practiced by the traditional medicine practitioners since the inception of gSo-ba-Rig-pa more than 2500 years ago. Bloodletting is also believed to be one of the most important and effective therapy in the treatment regime of gSo-ba-Rig-pa. The Subsequent Tantra (last tantra) states that the bloodletting is the best remedy for all types of bile and blood-related disorders. This study was conducted to observe the effectiveness of bloodletting procedure among diagnosed cases of Bad-mKhris-mGo-Nad.
Methods: It was an observational prospective study conducted at the National Traditional Medicine Hospital, Kawangjansa, Thimphu. The three main parameters measured were frequency, duration, and severity of the headaches. The samples consisted of 31 patients with 23 females and 8 males. Data collection was carried out over the span of seven months (June - December, 2018)
Results: The association test between before and after 10 days, before and after 30 days of bloodletting was conducted on 30 patients by using Mid-Point test in Open Epi and the result was observed to be statistically significant at p< 0.05.
Conclusion: This study shows that the bloodletting therapy on Tshoksang reduces the pain duration and frequencies of headaches. Moreover, it was also established to be effective in reducing the severity of the headache caused by Bad-mKhrismGo-Nad
Pterygium and associated factors among adults: a hospital-based prospective study
Get PDFIntroduction: The aim of this hospital-based study was to assess the prevalence and associated factors of pterygium among adult patients visiting the Ophthalmology Outpatient Department (OPD) in the Jigme Dorji Wangchuck National Referral Hospital (JDWNRH), Thimphu.
Methods: A cross sectional study was carried out in the ophthalmology OPD in the national referral hospital, Thimphu from 1st January, 2018 to 31st December, 2018, during which 1599 adult patients were selected through systematic random sampling.
Results: The prevalence of pterygium was 12.8% (95% CI: 11.2 -14.5). Among 271 eyes with pterygium, the distribution of grade 1, grade 2 and grade 3 pterygium was 34.7%, 56.1% and 9.2% respectively. Pterygium wasmost common in the age group of 36-55 years. The significant factors associated with pterygium were age group, occupation and usage of sunglasses. Individuals who were 36-55 years (adjusted OR 2.70, 95% CI 1.82-4.0) and >55 years (adjusted OR 2.17, 95% CI 1.34-3.50) had significantly higher risk than 18-35 years (p< 0.002), and not using sunglasses (adjusted OR 1.97, 95% CI1.17-3.33, p = 0.007) significantly increased the risk of pterygium. Indoor occupation, particularly being a student was protective against pterygium (OR 0.08, 95% CI 10.02-0.33, p< 0.001). Only 14.1% used sunglasses and among them, 27.6% were aware that sunglasses can protect from ultraviolet radiation.
Conclusion: This study found a high prevalence of pterygium among adults aged 18 years and above. Those aged 36-55 years and an occupation involving outdoor activities were affected more. Encouraging usage of sunglasses may reduce pterygiu
Angiofibrolipoma of the soft palate: A very rare cause of upper air way obstruction in an infant.
Get PDFIntroduction: Infants and children are very prone to air way obstruction due to smaller and immature air ways. There are multiple causes of upper airway obstruction in infants like infections, congenital lesions and rarely tumours of the upper airway. However, angiofibrolipoma, a rare variant of lipoma causing intermittent respiratory distress in an infant has not been reported until now.
Objective: To report a very rare case of angiofibrolipoma arising from the soft palate in an infant.
Case report: Two and half months old female child reported to the department of otolaryngology with a history of intermittent airway obstruction since one month of age. After evaluation she was found to have a fleshy polypoidal mass above the laryngeal inlet arising from soft palate causing airway compromise. She underwent surgical excison with bipolar cautery under general anaesthesia.
Conclusion: Few cases of angiofibrolipoma has been reported in adults but none has been reported in children. This is to report a case of angiofibrolipoma in child causing airway obstruction
Cases of scar endometriosis after caesarean section
Get PDFIntroduction: The presence of functional endometrial tissue in the surgical scar, which commonly follows caesarean section is called scar endometriosis. It is a very rare condition which is commonly misdiagnosed.
Case report: We report two cases of scar endometriosis which developed after caesarean section. One case was misdiagnosed as a keloid for a long duration (12 years) and other one was not diagnosed despite the characteristic presenting symptoms. Both the cases underwent surgical excision with free resection margins and histopathological confirmation of diagnosis.
Conclusions: Clinicians must be aware of varying presentations of scar endometriosis to ensure timely diagnosis and treatment
A cross-sectional job satisfaction survey of physicians in Bhutan to address the problem of retention
Get PDFIntroduction: A persistent shortage of physicians and relatively high attrition (>10% over 7 years) have been longstanding challenges for Bhutan despite efforts at improvement. Little is known about physicians’ job satisfaction. The study was done to assess level of job satisfaction amongst physicians in Bhutan and identify factors affecting it, thereby be able to better understand factors affecting physician retention.
Methods: A national, cross-sectional study on job satisfaction of all Bhutanese physicians was conducted in 2016. Physicians were defined as satisfied if they answered yes to >50% of general survey questions about job satisfaction and and associations between demographic or job characteristics (e.g., married vs. unmarried, clinical vs. non- clinical) and job satisfaction were examined. Physicians were also queried about specific elements of their jobs (e.g., pay, working conditions) and explored associations between demographic or job characteristics and job elements.
Results: Of 147 physicians who completed the job survey, 94 (64%) were classified as satisfied. There were significant differences in job satisfaction between married and unmarried physicians (72% vs 49%, p=0·01), specialists and generalists (73% vs 55%, p=0·04), nonclinical and clinical physicians (89% vs 61%, p=0·02), and physicians in referral and district hospitals (75% vs 48%, p <0·01). Across all demographic and job characteristics, salary satisfaction was low (11%). In multivariable analysis, non-clinicians had significantly greater satisfaction than clinicians with salary, annual leave, and work-family balance. Physicians in referral hospitals had significantly greater satisfaction than physicians in district facilities with work hours and working conditions.
Conclusion: Survey findings suggest that, although job satisfaction appeared high, improved physician retention may require increased pay, opportunities for promotion to desired settings and job categories, and improved staffing and work conditions in district healthcare facilities
Introducing Medical Humanities to Health Professional Education in Bhutan: A discussion on challenges and possible solutions
No full textHealthcare around the world is facing a series of challenges. Though there is publicity given to the technical dimensions, there is an urgent need to make healthcare more humane. This has become more essential given the volumes of information available in current context. The available information has resulted in patient knowing more than the health professionals about their own health needs. The concept of medical humanities is new and gaining awareness. This could be solution to ailing medical practices not just in Bhutan but also globally. This is reflected in many of the policies where medical humanities is gaining attention
Indications and types of hysterectomy in the National Referral Hospital of Bhutan, 2020
No full textIntroduction: Hysterectomy, the removal of uterus, is a major gynecological surgery performed in Bhutan. It is performed for both benign and malignant gynecological conditions. This study was conducted to assess the socio-demographic profiles, types of hysterectomies and their indications, and duration of surgery and duration of peri-operative hospital stay among women who had hysterectomy at the national referral hospital of Bhutan.
Method: This was a retrospective study conducted at the Jigme Dorji Wangchuck National Referral Hospital, Thimphu. Data of women, who had hysterectomy from 1st January to 31st December, 2020 was extracted into a structured questionnaire by investigators from the patients record maintained at the record section, JDWNRH. Ethical approval was sought from the Research Ethics Board of Health. Data were entered into EpiData 3.1 and was analyzed using descriptive commands of STATA 13.1
Result: Hysterectomy comprised of 9.8% of gynecological surgery in 2020. The commonest route of approach was total abdominal hysterectomy which comprised of 81.7% of hysterectomies. It was found out that 92.9% of hysterectomies were performed under general anesthesia and 97.4% of the surgeries were done as elective or planned cases. The mean (+SD) duration of surgery from skin incision to closure was shortest for vaginal hysterectomy (68.8 + 17.6 minutes) and longest for total laparoscopic hysterectomy (210 + 35.2 minutes). The duration of peri-operative hospital stay was shortest for vaginal hysterectomy.
Conclusion: Total abdominal hysterectomy was the common approach despite vaginal hysterectomy being performed under regional anesthesia with shorter duration of surgery and shorter hospital stays