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.