Visiting the Hospital

Last Tuesday I went to the hospital in Thimphu, the largest hospital in the country (the full name of hospital is the Jigme Dorji Wangchuck National Referral Hospital), to get my health certificate for the dependent visa. This is a process that everyone has to go through to get a visa or a job (and maybe other things as well). This involves showing up at the hospital after 4pm, paying a sum of money (for me it was the equivalent of about $10), filling out a very brief form, and waiting in line to see the doctor. When Matt did this he didn’t even get his blood pressure taken. I got more of an exam, if you can call it that: pulse taken, brief look at my eyes and mouth, brief listen to my heart (though I don’t think he could have heard much), and maybe a brief listen to my lungs. The doctor also took my blood pressure and asked if I had had any previous illnesses. I wonder what they would do if you actually had a long list of issues? I don’t think he would be equipped to handle that given the number of people he needed to see. I wasn’t even asked if I took any medications. 

Understandably people complain about this process. It’s cumbersome, bureaucratic, and I’m pretty sure it wouldn’t catch most actual health problems - only ones with very obvious symptoms. Not to mention the fact that I'm pretty sure some people were only in the exam room long enough to obtain a signature. In my opinion, if they really wanted to know about our health, they would have us at least fill out a health history form. I told this to Matt and he said he’s heard talk that this process is more of a way of getting people registered in the system than actually checking up on their health. In any case, I got my health certificate (even though my blood pressure was high when the doctor took it and he never even tried for a second reading...) and all my paperwork for my visa has been turned in. Hurray!

Budhi, who is Bhutanese and used to be a nurse, also came to the hospital with me (Matt, too, joined us when we got to Thimphu). He now works at the infirmary on campus and does other odd jobs. He was very helpful as I didn’t know a) where the hospital was, or b) where to go within the hospital to get the health certificate.  Because Budhi used to work at the hospital, he also offered to bring me up to the OB ward after I finished with the certificate process. 

The hospital itself looks very beautiful from the outside, being built in the traditional Bhutanese style. 

Jigme Dorji Wangchuck National Referral Hospital
(Photo: oobhutan.blogspot.com)

The inside can only be described as drab, largely because of the general lack of windows and decoration. Matt described is as somewhat of an overly Western, overly sterile-looking take on the hospital. Maybe utilitarian is another way to describe it. Walls are whitewashed and all floors are a dark green stone (from what I remember). However, this is in comparison to the new and beautiful hospitals that I have been to in the US. I don’t want to put down the hospital, only try to describe it. This is also a public hospital that offers universal health care, something the US hasn’t yet accomplished. I’m sure we could do with less fanciness and better access to care.

The OB ward was much smaller than I expected. I think there were three delivery rooms and one postpartum room with 4-6 beds (I didn’t look too carefully because I didn’t want to be intrusive).  Other than that, there were was pretty much only a nurses station and a table for the doctor. The charge nurse allowed me to come in and look around (this involved taking off our shoes and slipping into hospital-provided rubber shoes - too bad I wasn’t wearing socks!) but said that I needed to talk to the nursing superintendent of the hospital about a job (I wasn’t surprised by this). In any case, it was interesting to see the ward even though it was only briefly. The NICU (neonatal intensive care unit) was right down the hall but I declined the offer to see that unit. I feel weird looking just to look (plus I figured I’d be back).

On Wednesday I took it upon myself to contact the nursing superintendent. And guess where I found her phone number? On the hospital’s website! This was quite shocking to me. Many of the doctors and employees list their work numbers, cell phone numbers, and occasionally an email address there. This makes sense when you consider that there’s no voicemail and sometimes no other way to get in touch with them. However, I still find it strange because it’s exactly the opposite of what happens in the US. It’s still astonishing to me how much easier it is to access people in many other countries. 

I first called the nursing superintendent's office number but didn’t get an answer. I hesitated for awhile about calling her cell phone but figured if it’s on the website, might as well call. She answered this time and I explained to her who I was and what I wanted to do, all the while half expecting her to say, “And how did you get my number?”. Thankfully she just spoke to me like it was normal to get a random cold call on your cell (which it is here). She told me to meet her at the hospital between 11 and noon on Thursday so we could discuss my working or volunteering as a nurse. 

At the appointed time, I showed up at the hospital, called her, and she came down to meet me in the lobby of the same building where I had gotten my health certificate (there is a nearby but separate entrance for the building where the wards are). Luckily I was easy to spot, being the only white person present. We passed several waiting rooms of people as she brought me up the flights of stairs to her office. We had a very casual discussion about what I wanted to do and other chit-chatty things. She basically stated that I could either work as a contract nurse or as a volunteer, but that she thought it might be difficult for me to make the shifts based on transport from where we are living (she is correct - I would have to pay for a taxi in at least one direction, which really adds up). The nursing shifts are 8am-2pm, 2pm-8pm, and 8pm-8am. From what she told me, it seems like the long night shift is due to transport issues and nurses rotate through all shifts. 

She told me that I needed to “write an application”, which I assumed meant that I needed to fill out an application (as in the US). She actually just meant that I needed to write a letter to the Ministry of Health (MOH) explaining who I was and what I wanted to do. After she found out that I had no idea where the MOH was located, she decided that I could write the application while I was there in her office (hand-written!) and she would bring it to the MOH for me. With the letter I gave a copy of my CV, a copy of my nursing license, a copy of my passport, and two passport-sized photos (you need those for everything here). It seems that this will be sufficient for me to become registered in Bhutan. She also said that she would call me when all of this was completed. She thought perhaps early October but we shall see. There are several holidays coming up which usually leads to decreased efficiency (I'm fairly certain this is an international phenomenon). 

So whenever all of this gets processed, I will be starting as a volunteer nurse in the birth center (which is not a center, but in fact the small ward I described earlier). I’m VERY excited. I decided to start as a volunteer for several reasons. First, since I’m still a new nurse and will be learning a whole new system (and perhaps even new medical language), I’m going to feel incompetent and useless for awhile. I feel much better doing that as a volunteer. Second, paying jobs don’t offer as much flexibility (and for now, it's nice to have the option to travel or do other things besides work at a hospital). Third, there’s the issue of transport. If I don’t have to be there at the prescribed shift times, I can get free or cheap transport into town in both directions. And finally, if I really don’t like it, I won’t feel as bad quitting. I don’t anticipate not liking it but it will be a completely different nursing experience than in the US so I have no idea how I will feel about it. 

I’m still in the process of getting in touch with other people connected to maternal health. It may also be possible for me to do something more public health-related while I’m here (like I said, flexibility will be good for now). I’ll keep the updates coming! And no doubt I'll have more information on the hospital and health care system as I spend more time here living and working.