There and Almost Back Again…
Year: 2025
Type: article
Abstract: My first introduction to the Himalayan Kingdom of Bhutan was in 2017. I was a 1st-year resident, and the trip would forever stay with me. Nearly 6 years later, while pursuing my Fellowship in Head-and-Neck Surgery at TMC Kolkata, a conversation with Dr. P Arun gave me a chance to express my desire to visit the country again. It seemed almost a dream come true when he put me in touch with Dr. Phub Tshering, HOD Department of ENT and Head-and-Neck Surgery, Jigme Dorji Wangchuck National Referral Hospital (JDWNRH). Things were set in motion and in March, I landed in Paro with two large suitcases, with no idea of what lay ahead! I was ecstatic to have a chance to explore the mountains, to learn about the Land of the Thunder Dragon, but perhaps more than that, to test myself. It seemed strange to me, that in the 1 h it used to take me to drive from work to home in Kolkata, I was in the mountains. The winding roads from Paro to Thimphu along the Paro Chu (Chu means river in Dzongkha), the brown hills dotted with fluttering prayer flags, and scattered monasteries made me feel at home. The hospital authorities had arranged for accommodation at a residential apartment within walking distance from the main campus of the hospital. In a week, I had settled in and started working. Our department had seven consultants and four residents along with many technicians. I had initially been worried about the language since I knew next to nothing of Dzongkha. Over the next few weeks, everyone helped me to learn basic phrases, and I am happy to say by the end of 6 months, I could understand the language somewhat, and speak enough to know the chief complaints! Besides Dzongkha, other languages such as Sharchop and Nepali are spoken along with other dialects. Two things stood out almost immediately – the warmth of the people and the realization that in some ways, despite all our different backgrounds, medicine is a universal language. The outpatient department complex for ENT had six well-equipped rooms complete with otoscope, nasal endoscopes, Hopkins telescope, and fibre optic laryngoscope. Recordkeeping was done online, and every day, we would get to examine a wide variety of cases. Operating theatre (OT) was scheduled for 1 day in a week, and some days, we would work off-hours in case there was a backlog. The OT complex has 10 operating rooms. The ENT OT was well-equipped with microscopes and endoscopes. Most surgical procedures can be performed there, including total laryngectomy and segmental mandibulectomy. Reconstructive surgery with local flaps had been the norm until now, but with a trained plastic surgeon having joined, free flap surgeries are underway. Benign thyroid neoplasms are common and form a bulk of the head-and-neck cases. Fresh after completing my fellowship, I was nervous initially to start operating independently, but Dr. Phub has been an excellent mentor and encouraged me. In the 6 months I worked there, I was able to independently operate on nearly 50 patients. It was here that I first operated on parotid and thyroid malignancies independently. Health care in Bhutan is free of cost, and a lot of emphasis is being given to training healthcare assistants in palliative care as well as screening for oral cancer. JDWNRH does not have facilities for chemotherapy or radiotherapy, hence patients are referred to India for further treatment. Most of my life, I have believed in a saying by Douglas Adams – ”Time is an illusion. Lunchtime doubly so.” But not in Bhutan, and certainly not in my department. It was a pleasant change to have lunch at 12:30 every day and then continue to clinics. Everyone in the unit would bring something to the table. The common ingredient was chili! I believe by the end of 6 months, I had developed a high tolerance to chilies. It was a welcome break to have a reduced workload and achieve a work–life balance. Evenings were spent strolling by the Thimphu Chu, or walking through the vibrant markets and pausing at the ice cream parlor at the Clock Tower. Weekends were spent trekking in and around Thimphu, and on some occasions, even traveling to other places such as Phobjikha, Paro, Trongsa, and Punakha. I learned many things professionally and personally. Dr. Phub Tshering and his team have been terrific and supported me throughout my stay. The residents I have worked with were smart, well-trained, and very hardworking. I found patience goes a long way as a surgeon. There is a sense of responsibility, drive, and desire to get better. It was a remarkable experience, and I was glad to be associated with the entire team at JDWNRH [Figures 1 and 2].Figure 1: Jigme Dorji Wangchuk National Referral Hospital, ThimphuFigure 2: Team at Jigme Dorji Wangchuk National Referral HospitalEveryone asked me “Why Bhutan?” After the hectic fellowship, it gave me an opportunity to work at a slightly slower pace and reflect on many aspects of operating independently. Life had slowed down just enough and yet offered a sense of adventure. I had a chance to live in the serenity of the rolling green hills veiled with rain clouds, trek, and discover how I fare in a completely different environment. I learned to hear myself a little better in the quietness of the mountains, and I would like to go back again. I read a book “A Journey into Bhutan” by Jamie Zeppa. There is a line in the book which goes “Namé Samé kadrinché” which roughly translates as “Beyond the Sky and the Earth, Thank You…” I think that perhaps sums up how very grateful I am to Dr. Arun and Dr. Phub for making this dream a reality for me. OTHER FACTS ABOUT WORKING IN JIGME DORJI WANGCHUK NATIONAL REFERRAL HOSPITAL, BHUTAN The attachment at JDWNRH was voluntary service and not salaried. However, the hospital will try to arrange for a suitable, fully furnished accommodation As there is no set protocol for Indian Doctors, anyone interested in working in the Department of ENT and Head and Neck can directly contact Dr Phub Tshering. Dr Phub Tshering is also willing to guide other doctors and connect them to respective department headsEmail id: [email protected]To work in Bhutan, an invitation letter must be sent by the hospital authorities clearly stating the date of arrival in the country, date of joining, and duration of stay. Once this letter is received, the online portal may be used to submit the relevant documents. (under - New Registration, Non-CID holders) https://www.bmhc.gov.bt/online-system/ A Certificate of Good Standing is required by the Bhutan Medical Council for processing temporary registration The temporary registration processing requires 5000 INR A work permit will be issued after arrival at JDWNRH. The hospital authorities will aid in the process, and a work permit card is issued by the Department of Immigration. This allows one to leave the country and return any number of times for the period it’s valid for. Please carry extra passport-size photos. Processing charges for the work permit will be around 2000 INR No SDF is charged for the duration of stay. Visiting dependents do not require to pay SDF or hire guides if they remain in Thimphu or Paro Although there is no hindrance in traveling from Thimphu to Paro or Punakha, route permits are needed for travel to other parts of the country. It is advisable to plan trips a month in advance so that the route permits may be issued. The request for one must be made to the MSVP at least 2 weeks before the trip Best time for travel – March to May and September to November INR is acceptable but UPI payment is possible only if one has an account with the Bank of Bhutan which is possible after the work permit comes through. Disclosure This material has never been published and is not currently under evaluation in any other peer-reviewed publication. Ethical approval Not applicable. Informed consent Not applicable. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
Author: Shaoni Dhole Sanyal
Institution: Tata Medical Center
Language: English
Topic: Global Health and Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4411466725
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