Bhutan is working very hard to establish Emergency Medicine in their country. As a developing country, trauma remains one of the highest killers and it has been well established in many other countries that trauma often disproportionately affects the young. This causes a massive strain on the youngest and most productive members of society. Health Volunteers International is an organization that has been working to get EM physicians to come and spend time providing bedside teaching to Bhtanese EM physicians in training. I am hoping to go to Bhutan and not only attend in the emergency department but also help develop a long term curriculum that will allow the Bhutanese physicians to become more and more independent. I am planning to spend 6 weeks in country and then continue to be longitudinally involved with helping to develop EM in Bhutan. The ultimate goal with this project is to make the need for European and American EM physician consultation obsolete as the Bhutanese EM system becomes progressively more robust.
This project will have many target groups. In the short term, I will be providing clinical bedside teaching as well as giving lectures to local Bhutanese medical providers and trainees. The curriculum development work, which has been started and supported by the Bhutanese government, will ultimately provide a long term support structure for further EM development. By developing an EM system, not only is the goal to help facilitate the development of emergency medicine physicians but also to help further the pre-hospital and trauma system development. I will also be initiating a needs assessment within country and hope to highlight other areas of need once in Bhutan. Each project that will be pursued will have a Bhutanese champion and will be supported by myself to start. All of these projects are so important because emergency care and traumatic injury care very often disproportionately affect the lowest income and most vulnerable members of the population who do not have access to expensive medical care.
As mentioned above, there is a great deal of work that needs to be done to help empower the local Bhutanese medical providers and trainees while also developing EM infrastructure. Creating sustainable projects and medical infrastructure that will able to be run independently by local physicians is a core priority. As a result, I will be working with local physicians and trainees to help train the Bhutanese physicians and also find local physicians to collaborate and support every project we develop to ensure that there is local buy in and that all projects are in line with the goals of the medical providers and the local government. I will continue to provide support remotely once I return from Bhutan. My goal is to have this entire project lead by local physicians and to provide as much support as possible. I plan to come back for 2-3 months per year after the initial launch of this project to provide as much support as needed. I am an Emergency Medicine physician but am currently finishing up a fellowship in global health with a focus on EM education and systems development therefore I believe I am a passionate and qualified advocate for this project.
This trip was an amazing experience overall. While I was in Bhutan, I was able to work closely with the house officers in the Emergency Department to provide clinical supervision while also seeing patients independently at times. This helped me gain a true appreciation of the struggles patients as well as staff go through to provide the best care they can in a resource limited environment. I also spent a great deal of time, in collaboration with my husband Zach, teaching and working with the new class of medics in training, also known as the Emergency Medical Responders (EMR). While I focused more on simulation and clinical teaching, Zach worked with them to develop a fitness protocol and also fitness standards which will be used throughout the country. I have also included a few photos of their first fitness class which was one of my most fun and memorable moments in Bhutan. While it is hard to know what kind of impact we had on others we encountered in Bhutan, I know that my experience and the people we met had a lifelong impact on me and re-ignited my passion for clinical care and teaching.
