Orienteering

I feel like I have spent most of my first two weeks here in Thimphu feeling a bit lost in time and space,  but things are finally making a little more sense.  For example, if you come to the Jigme Dorji Wangchuck National Referral Hospital and want to find the operating room, go through the main entrance and up to the second floor (which you might call the third floor, but entry is floor zero); go past all the signs to the operating room and turn right at the little sign for Microbiology.  Then another right down a narrow unmarked hallway and through the white painted plywood door into an anteroom full of shelves of shoes.  You made it!  Just be sure you remove your street shoes or you will be stopped and scolded.

Want the Cancer Registry?  Go down the long set of emergency ramps to the first floor and turn left into the doorway labeled "Blood Bank."  At the first office on the right, push through the crowd of people to a door wedged open with a red chair covered in shredded plastic.  If you see a shy woman in a bright blue silk jacket you made it.

Way-finding around town is no easier.  Even the capitol city, with population 80,000, has virtually no street names, and the locals don't use them anyway; there are no address numbers on houses and businesses.  Forget what you see on google maps--all directions are given in relation to known landmarks like the stadium, memorial chorten or large hotels.  Turn at this shop, go up the little alley, around the corner (was that left, or right?)...   If you are looking for a specific destination wear comfortable shoes and prepare to ask many people and go in many meandering circles.  Keep your eyes on the ground at all times while moving, lest you fracture your femur falling off a three foot curb or into a gaping hole in the sidewalk.

Who needs a show of force with such pleasant security guards?

 

Herding cats.

Hospital schedules and rounds are barely controlled chaos--I introduced the HOD to the term "herding cats" which he immediately appreciated.  Some days our crowd of 3 attendings, two residents, 3 interns, a gaggle of nurses and one sweating, befuddled HVO volunteer (me) actually all start together at 8:30 as planned.  Then phones start ringing, and the crowd from the hallway finds a way past security to ambush us.  Patients use any special connection to avoid the huge lines at the outpatient clinics--first a long line to the "sorting hat" to get a number token to a certain clinic, then hours waiting with the 70-90 patients lined up to see a single doctor.  An oncolgy nursing assistant pounces as I am dropping off my purse in the work room, "My sister from out of town has fever and chills and terrible headache for one week.  I gave her a liter of saline.  Can you see her?"  I've asked other volunteer docs about the best strategy--order labs and direct to the clinic?  See the patient only if it is simple?  Resist all advances on the theory it will only encourage more of the same?  As far as I can tell, no money changes hands on any of these exchanges, and there may or may not be an entry in a medical record (carried home by the patient).  But what goes around comes around, and maybe someday I will want to jump a line, too.

Lobby line