A Day in the Life

My time here in Bhutan is quickly coming to an end.  With only two weeks left, I've done all the touring I’m going to do and am busy wrapping things up and beginning to say my goodbyes.  Mostly I've written about the sightseeing I've done, and I thought today I’d write a bit about how I spend most of my time – working at the psychiatric ward of Jigme Dorji Wangchuck National Referral Hospital (JDWNRH). 

Typical Thimphu sidewalk

That's marijuana on that thar hill!

 I leave my apartment each weekday around 8:45 for a ¼-mile walk uphill to the hospital.  I travel along sidewalks that mostly look like this one, past a small hillside growing wild marijuana, up this dirt path to a raised sidewalk that eventually takes me past the main hospital to the psychiatric ward. There I’m enthusiastically greeted by Bella, the clinic mascot who knows I keep a bag of treats hidden away for her.

Dirt path leading up to raised sidewalk

Raised sidewalk leading to JDWNRH

Main hospital buildings

Fountain in front of new hospital building

Psychiatric ward

Bella, happy after getting her daily chewstick

Downstairs are the psychiatric patients, 4 rooms that accommodate 2 patients each.   Upstairs is the detox unit with 5 rooms for 10 patients.  The accommodations are not exactly five-star. Each patient is required to have an attendant (usually a spouse, parent, or sibling) stay with them.  If all beds are full, the patient and attendant share a bed.  Sometimes male and female patients share the same room. 

Monday, Wednesday, and Friday mornings we have rounds.  The psychiatric staff, including the psychiatrist from the main part of the hospital, all gather around a big table (actually about eight small desks pushed together in a large rectangle).  Each patient comes in by turn with their attendant, and we discuss their progress and needs. Most of the discussion is in Dzongka or Nepali.

On alternate mornings, the patients attend exercise group.  There are also psychoeducation groups for the detox patients who are trying to recover from alcohol and other drugs (most commonly pain meds brought in from India and marijuana), as well as art therapy and meditation groups for all the patients.

Individual therapy is a challenge.  Only a handful of the patients speak enough English to talk in depth.  I generally work with those with the most English, often working with either the lone Bhutanese counselor or our young intern.  Both have only bachelors-level training, so part of my job is training and mentoring their clinical skills as well.  Clinical issues tend to have very different presentations than anything I worked with in the States or Mexico: depression and anxiety with fainting, somatoform and conversion disorders, amnesia, psychosis, and a host of other serious problems.  

In addition to the inpatients, we see outpatients (who drop in throughout the day without appointments) referred by the psychiatrist and conduct a weekly anxiety group.  I’ve also got a few private patients that I see outside of the hospital.  Every day brings new challenges and surprises, but it’s all been an incredibly gratifying learning experience.

Haa Valley

This has been a very international week:  Had dinner one evening at the home of a French couple who are here teaching French and German at the local college. Also there was a woman from Germany, another from Mexico City, and an India/American. Needless to say, the company and conversation were great.  

The next day was the 4^th of July, and I went to a holiday bash that has been an annual event for many years at the home of a couple who are the US Consular Wardens here in Bhutan.  We had hamburgers, hot dogs, and plenty of other food while sitting around a campfire along with a video of fireworks displayed on a huge screen in their beautiful backyard.

Waiting for the road crew to take a break before we could pass.

The next morning I was up early for a visit to Haa Valley where they were having their annual Summer  Festival.  There were lots of native dancers, traditional foods, and exhibits of nomadic farmers and the many products they make from the yak herds they tend. 

Traditional dancers

Nomadic yak farmer in full yak herder costume 

Inside a typical nomadic farmers tent

Shooting the breeze Bhutanese style

Adjusting her kira and tego

Traditional boots -- awesome, aren't they?

Traditional dancers

Young dancer practicing her moves

Dancer in beautiful traditional outfit

My second morning there, while the rest of the

I can't imagine a more scenic setting for a home!

group I was traveling with were hiking, I was treated to a visit at the home of the in-laws of our guide.  They live about 8 miles out of Haa town and farm wheat along with their herd of about 100 yaks (the yaks are “vacationing” for the summer months in the highlands).

The house in the photo is actually two homes. While I was visiting the family living in the left half, there was a "puja" going on in the home on the right.  Pujas are religious ceremonies performed by lamas for healing the sick, driving out evil spirits, blessing new homes, and annual general blessings of every Buddhist home. I could hear the chanting, drums beating, and blowing of the long trumpets throughout my visit.

Having tea with Tshering's mother-in-law and niece.

Wooden stairway leading to upstairs living quarters.

Tshering in the food storage room downstairs.

Saying farewell.

Family farming together

Roadside kids

Haa town sits at about 9000 feet elevation. 

That's over 13,000 feet elevation.

Our route back to Thimphu took us over Chelela Pass which, at just over 13,000 feet, is the highest motorable road in Bhutan.  All of the roads here in in Bhutan are narrow, winding roads, with constant hairpin turns, and panoramic views of the Himalayas.  It is said that the runway at Paro airport is the longest stretch of straight road in the entire country!

On top of the world!

Every view is amazing!

The only straight stretch of road in the whole country is the Paro airport runway!

Rice paddies in the valley near Paro