Visions and Impressions

IMG_3141I’ve been asked by my mother to provide some details. Today, January 29th, is her birthday so this is for you, Mom. To all others: warning, this is a long entry.

My first post from Bhutan was more a log of what we did and when. So I be more descriptive in this entry.

Our apartment is 3 bedroom, 2 bath. We have a single entrance up to our third floor unit. God forbid if we have an earthquake or a fire. The master has an attached bathroom. The bathrooms are nice – marble floors and nice fixtures, including electric water heaters for each bathroom that are affixed on the walls. We aren’t using one of the bathrooms much as it’s too cold, same with one bedroom and the sitting room. The girls are sharing a bedroom with one of the space heaters; Ross and I have a space heater and the third heater is in the space that includes the kitchen and living area.  The space heaters all have different plugs and every room has different outlets. With no central heat, getting space heaters to work is very important. Our building looks like a very large house with six or so units. The owner is on the ground floor in front; her parents in the back. Ours is the attic unit. Cozy sloping ceilings with skylights – plastic instead of metal roof on those parts. Most of the windows have plastic sheeting too, as they are all single pane. The kitchen has two burners with a propane tank under the counter. Now I know why people around the world protest about high cooking oil prices. When you don’t have an oven you use a lot of cooking oil. The kitchen also has a water heater on the wall. I just bought a pair of gloves for dishwashing. What a wonderful addition to the kitchen. It’s the small things in life that can give great pleasure. Our greatest luxury is a washing machine! I don’t have to wash by hand so I consider myself very fortunate. The washing machine and the refrigerator share a plug so I have to remember to plug the fridge back in after washing clothes.

Our building is just outside the wall of the “hospital colony” – a collection of buildings that houses hospital employees. Fortunately Bhutanese love shortcuts. All the walls have ladders over them, or a pile of stones that one can clamber over. Paths go beside and around buildings and walls to get to the shortest path possible. We’ve adapted to the shortcut mentality – anywhere we go we look for a cut through.IMG_3051

So to get to work, on the first day on which we weren’t picked up, we walked the long way around to a gate in the wall  The next day we took the rocks over the wall. A few days later I saw a man hop over the wall right by our front gate. Every few days we find a closer shortcut. It has definitely shaved several minutes off our commute. Currently we’re going out our front gate to the end of the road, up and over the wall by decent ladder and walk through the colony. We cut around a building, down some stairs, then to the end of a short road and down a very steep set of metal stairs. This drops us off at the OR laundry – green sheets and OR gowns hung up to dry, while dogs wander around. The OR is a short distance for me and Ross goes to the central stair to get to the Medicine Wards two floors up.IMG_3054

ORs start around 9am. So I have time to walk the girls to school and wander in to work. I don’t have a formal assignment yet. So I help out and offer advice where needed or appropriate, while trying not to overstep whatever bounds there may be. Sometimes this is very uncomfortable situation. But I hope it improves as I find my place over the next three months. For those of you, who know OR stuff – most ORs that I have seen have Drager Fabius ventilators. Medications are basic – usually one or two drugs per class and some interesting gaps. they are getting ready to request drugs for the next year and I’m suggesting clonidine, IV calcium channel blocker and magnesium. Any other suggestions for inexpensive drugs with multiple indications?

Most of the people in Bhutan speak some English. I thought there would be more English spoken as it’s the language of instruction. In the OR, staff speak a variety of the languages of Bhutan. Dzongkha is the official language and the language of western Bhutan where we are in the capital, Thimphu. But everyone speaks multiple languages – They are often speaking in Sharchop to each other which is an Eastern Bhutanese language. So I don’t stand chance really at being able to understand unless they throw in an english word – like “Esmolol”.

The hospital was opened in 2010 and gets a lot of use. I’ll let Ross tell you about the wards (6 to a room, mixed gender, charts at the end of the beds on a clipboard) and the clinic with 100+ patient waiting their turn (no appointments). I had my first private consultation today from a nurse anesthetist who has been diagnosed with atrophic gastritis and may have H pylori for the third time. Ross has picked up quite a few patients, getting curbsided in the halls. The medicine department has integrated him quite well and I think he will have a great impact on education and clinical quality. Me, I’m not sure… I was feeling a little discouraged but was thanked by the surgeon for assisting with a pheo and later got a phone call for pre-op optimization by one of the anethesiologists. So maybe as I settle in I will feel more useful.  I get here at 9am and leave in the mid-afternoon. On Wednesdays and Fridays I’m teaching CRNAs. The group of four have been practicing for years and were brought back to the main hospital for further training. They hope to start an in-country CRNA training program. My assignment, on paper was to help set up a medical residency program in Anesthesiology. But they’ve sent their sole resident to Bangkok for the year.

After work, Ross or I get the girls and go home. We have more time for family activities than ever before. We do homework, go shopping, play cards, watch movies. Bronwyn requested to go to Memorial chorten today. She has her own prayer wheel and likes to walk around the chorten with the other supplicants. I don’t think she prays but it feels good to her. We spend quite a bit of time shopping – we have to carry everything home after all. And there isn’t a single store that has everything we need. The stores don’t carry fresh vegetables. One goes to a certain part of town (Hong Kong Alley) during the week and the farmers market Thursday thru Sunday. Ross and I went with the girls after a trip to the Chorten this afternoon. I bought broccolini, garlic, potatoes, ginger, mangoes (expensive off season), avocados, watermelon, lettuce. Yum!

The market is down by the river. Two stories – produce from Bhutan on the second floor and indian imports on the first. There is a big trade deficit with India. The local produce is awesome – organic, no refrigeration, picked and sold fresh and ripe. We are eating quite well as there isn’t much processed food. Interestingly, there is only one variety of most vegetables. Red onions only. Tomatoes one type. There are different sizes of bananas however. I prefer the tiny ones. I spend a lot of time in the evening chopping vegetables for stir fry. I did make a very good kobacha squash soup in the pressure cooker. It is very difficult however to cut squash and pineapple with dull knives.

Thimphu is the capital of Bhutan. It’s in a somewhat narrow valley so it has spread up and down the river and lateral valleys. We are not too far from ‘downtown” but far enough out that it’s quieter and there aren’t as many dogs. Across the street is one of the royal residences so it’s relatively uncrowded near us. We are just above Memorial Chorten – with a shortcut it takes about 5 minutes to get there. Longer when we have to go back up the hill. I think one of the things that surprised us the most about Thimphu is the trash and pollution. With all the talk of Gross National Happiness, the last shangri-la and environmental protections put in place, I expected the place to be pristine. Lots of trash EVERYWHERE! and contaminated run off from buildings, exhaust out of cars. Many people where cotton facemasks when walking around town. I’ll refer you to a blog about trekking in Bhutan (http://www.markhorrell.com/blog/2011/why-bhutan-is-not-worth-the-tourist-fee/) to get a perspective that many don’t hear about.

The girls are at a private school run by a woman from New Zealand. She’s been here for over thirty years. We were happy to find this option as the local schools don’t open until March and we needed childcare. It was hard to find alternatives as most places don’t have an internet presence. It’s probably the most expensive school in the country but it’s close to our place and I think it will be good for the girls. The kids at the school are rich Bhutanese (at least one royal family member) and expats (teachers, lawyers, consultants, UN and world bank). Parents hang out in the morning and talk after dropping off the kids at 8:30. Work doesn’t start until 9am after all – and time is stretchable.

We have begun hiking the area. We had a couple of unexpected holiday days which we used to good effect. Our first work week (second week in country) it snowed in Thimphu valley. So a national holiday day was declared. We walked up to Buddha point in the afternoon. Lots of people went to Buddha point – a giant buddha statue on the mountainside overlooking the valley. Young people were hanging out the car windows throwing snowballs as they drove by. People build little snowmen on their car hoods so as we were walking up the mountain we could admire the mini sculptures going down. This week we got another unexpected holiday as local elections (Thimphu Thromde) were being held. The girls still had school so Ross and I walked to the other side of the valley (across the river) and hiked straight up, essentially. We both admitted the scramble made us nervous. With middle age has come increasing responsibilities and decreasing confidence in our athletic abilities. We didn’t make it to the monastery we were aiming for but had a good hike, nonetheless, and passed through a nearby monastery. It’s the journey not the destination, right? On weekends, we have gone to the market on Saturday morning. Ross goes to a teaching session midday on Saturday. Sundays have been reserved for our big hikes. We attempted Phajoding (late start as we stopped to see the Takins) but only Ross made it to the monastery. This last weekend we went to Tango and Cherig monasteries. They are across a valley from each other. Tango has a large buddhist studies program and a nice trail to the top – paved with concrete and stones. Helpful signs exhort one to be a better buddhist (being satisfied is the greatest of riches). We took a taxi to the trailhead and told the driver to return in 6 hours. The road is probably only 10km but took 35 minutes to get there. We went up and down at Tango and then walked over to the trailhead for Cherig. The girls played with four little puppies in between which was the highlight of the day for them. At Cherig, just as we were crossing the old bridge a tour group was coming the other direction. I recall an older guy looking surprised to see us. I was surprised too as there are essentially no tourists these midwinter days. As we crossed the bridge we entered a flat area that had a chorten (stupa) and some religious paintings. A film crew was set up and some members told Ross that they were filming a movie. In fact, it is the first Hollywood feature to be allowed to be filmed in Bhutan. We hiked up to Cherig – very nice and hooked up with a family group from Paro. Lots of families making visits to monasteries on weekends and we just join in. They showed us how to carry a large stone around the main temple. I believe it is a type of penance. The stone symbolized the weight of your transgressions. I probably should have made two trips around the temple.  We met up with the family again at the “Demon Subjugating Temple” in the complex. However there was a sign at the entrance that non-Bhutanese need special permission letter to enter and Bhutanese must be in traditional dress. So we sat outside with the one guy in jeans and a hoodie. Lucky for us, the man from Paro went inside and asked the monk if we could enter – and we were granted permission. No letter but in we went. I’m not versed in Buddhism so I cannot say what I actually saw that was different than the other monasteries we have visited. And the guy in casual dress got to go in too as he borrowed a gho from a relative or friend who then stood outside in his boxer shorts. As we prepared to leave the mountainside monastery we spied wild mountain goats (Tango has monkeys and Cherig has the goats). B and I went to take a look and she got butted right off her feet. It left a bruise on her leg and almost knocked her off the mountain. Next time we will keep our distance from mama goat. Needless to say she was a bit traumatized. When we got to the end of the trail, the tour group was still there! What the heck are they still doing here, I thought. Then realized they were actors pretending to be tourists. They are making a horror movie with the working title, “The Temple”. I wonder if they have been able to go to the demon subjugating temple, too? I’m not keen on horror movies but I’ll have to see this one.IMG_3084

Thimphu is in a narrow valley and work is close. But between walking the girls to school and back, to work and to market I’m logging several hilly miles a day. It has started to get easier but I still feel the elevation when walking quickly up hill. Running downhill is easy!

We are getting to know our way around town and starting to see people we know out and about. I think we’re stick out – caucasian family of four always walking around town. We are in a good place.

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2 thoughts on “Visions and Impressions

  1. Thank you Elizabeth. It is a great birthday present. Hugs and kisses

    Sent from my iPad

    On Jan 28, 2016, at 10:10 PM, Rate and Rhythm wrote:

    WordPress.com easteelemd posted: “I’ve been asked by my mother to provide some details. Today, January 29th, is her birthday so this is for you, Mom. To all others: warning, this is a long entry. My first post from Bhutan was more a log of what we did and when. So I be more descriptive in”

    Liked by 1 person

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