John Ogle, MD
John Ogle, MD
Pediatric Infectious Disease · Denver, CO

Bhutan 2019

April 1st

Project Description

My wife Eileen Moore and I are retired pediatricians. We volunteered with HVO (Health Volunteers Overseas) as teachers in Bhutan for the month of November 2017. We were asked to return for April 2019. Our role in Bhutan was as teachers for the pediatrics residents, attendings and medical students. Eileen is a general pediatrician and taught in the outpatient clinics. I am inpatient hospitalist and pediatric infectious diseases specialist. I prepared and presented many requested lectures; Eileen and I were both teachers at the bedside. Direct patient care is not allowed for international physicians.

Population Served

The National Referral Hospital in Bhutan started a pediatric residency 4 years ago. There are 5 faculty members: 4 are generalists and 1 is a neonatologist. Our role will be as teachers for the residents, students and faculty. The national referral hospital serves the entire country of 750,000 people. There are no pediatric specialists in Bhutan except for a single neonatologist. HVO has partnered with the National Referral Hospital to provide experienced teachers and sub-specialists.

Expected Impact

The goal of HVO and the Pediatric Residency at the National Referral Hospital is to train Pediatricians for the entire country. Currently there are very few pediatricians in Bhutan. Most physicians working throughout the country have little training or expertise in providing care to seriously ill infants and children. Consequently, expert care to these vulnerable patients is often delayed.
We propose to add our knowledge and expertise to the HVO program advancing pediatric care for the country of Bhutan.
The visa process for Bhutan is tightly regulated. The visa application process is lengthy and takes 3-4 months. Planes arrive in Paro, Bhutan from India, Thailand or Nepal on the National Airline: Druk Air. Tickets are purchased directly from Druk Air through official Bhutan Travel agents. It may not be possible to book through the Dox Foundation travel portal for the final leg of the flight into Bhutan but we are happy to use the portal if it is possible.

Trip Photos & Recap

My wife Eileen and I are retired pediatricians from Denver, Colorado. We spent April 1-30, 2019, in Bhutan teaching pediatric residents at the National Referral Hospital in Thimphu, Bhutan. This was our second trip to Bhutan as we spent November 2017 teaching there.
There is no medical school in Bhutan, so all of the faculty and residents trained outside of Bhutan; the pediatric residency is now 5 years old. Health Volunteers Overseas (HVO) partners with the Ministry of Health in Bhutan to provide specialist teachers. I am an inpatient pediatrician and work in pediatric infectious diseases; Eileen is an outpatient pediatrician.

I started each morning in the 7 bed pediatric ICU and then continued rounds on the 32 bed pediatric ward. Eileen was a preceptor in the very busy outpatient department. Our goal was to succinctly teach at the bedside in a fast-paced clinical setting. The staff pediatricians are superb generalists and the pediatric residents are hardworking, dedicated, and very smart. Most afternoons we presented didactic lectures for the residents at their teaching conference. The residents are eager to learn so teaching is very fun!

The pediatric health conditions include a wide range of common conditions. Pneumonia, bronchiolitis, seizures, gastroenteritis and dehydration were common reasons for admission. Congenital heart disease, glomerulonephritis, and nephrotic syndrome are also common. Frequent outpatient concerns include viral infections, upper respiratory tract infections, and rashes.

In November 2017, we saw children with fatal encephalopathy and multi-organ failure. Most of the children were less than 6 months old, breast fed, and deteriorated after a minor respiratory or gastro-intestinal illness. A remarkable series of observations and hypotheses led to a trial of thiamine administration at the time of referral or admission to the hospital. There was dramatic reduction in mortality and morbidity of children with encephalopathy after thiamine administration. It is suspected that a thiamine deficient diet causes mothers and their babies to develop symptomatic thiamine deficiency (beri beri). (A nice summary of the investigation and outcomes is in the uploaded HVO newsletter.)

Bhutan is a small country about the size of Switzerland with a population of about 750,000 people. The high Himalayas of Tibet are north of Bhutan while tropical India is to the south. The country is beautiful with high mountains and forested valleys. Bhutanese people are very kind and friendly.

Bhutan is a wonderful country to visit and very nice for medical volunteers. Thimphu is 12 time zones from Denver, so it takes a few days for biological clocks to adjust. Thimphu is at about 7,500 feet elevation also some adjustment to the altitude is needed.

Financial support from the Doximity Foundation helped make our trip to Bhutan successful! I would be happy to speak in much greater detail to anyone interested in Bhutan!