Bhutan Vocation Training Team

Thanks to the generous support of the Rotary Foundation and the Rotary Clubs of Gawler & Thimphu, Interplast has been able to deliver a successful
two-week surgical and hand therapy clinical and training program in Thimphu, Bhutan. Through this visit, many lives have been changed through the
delivery of reconstructive surgical services and associated allied health support, and local doctors, nurses and hand therapists in Bhutan have received
crucial training in these areas. Interplast is grateful for the support of both the Rotary Foundation & the Rotary Clubs of Gawler & Thimphu with this
program, and looks forward to continuing this partnership to change futures across the Asia Pacific region.

For over 30 years Interplast has been sending fully qualified Australian and New Zealand volunteer
plastic and reconstructive surgeons, anesthetists, nurses and allied health professionals to 25 countries
in the Asia Pacific region. Volunteers provide free reconstructive surgery for those who would otherwise
not be able to afford these services, significantly improving the quality of life for people who are disabled
as a result of congenital or acquired medical conditions including cleft lip and palate, burn scar
contracture wounds, tumors and growths. Interplast also has a strong focus on training, mentoring and
building the surgical capacity of in-country medical personnel.
Since carrying out a needs assessment in August 2014 (following requests from local Bhutanese partners
to provide support in plastic and reconstructive surgery), Interplast has continued the work originally
started by Australian volunteers, Ms Suzanne Caragianis and Dr Philip Griffin who had been undertaking
volunteer programs in hand surgery and hand therapy to Bhutan for several years beforehand.
To assist in developing local plastic surgery capacity, Interplast started working with the Jigme Dorji
Wangchuk National Referral Hospital (JDWNRH), the Ministry of Health and the Khesar Gyalpo University
of Medical Sciences of Bhutan (KGUMSB) to establish a Memorandum of Understanding, to formalise the
partnership and plans for programs and activities moving forward, which commenced with the first
combined plastic and reconstructive surgery and hand therapy mentoring activity in May 2015. The MoU
was finalised and signed by all parties in April 2017.

 

Thanks to the generous funding provided by the Rotary Foundation & the Rotary Clubs of Gawler & Thimphu, Interplast implemented a plastic &
reconstructive surgery and hand therapy mentoring activity from 16 October – 3 November 2017. This was the sixth visit by an Interplast surgical
team and followed on from the previous visit in April 2017.
The team was based at the JDWNRH in Thimphu throughout this period. The aim of this visit was to consolidate the efforts of previous teaching
programs and to continue to teach reconstructive surgery techniques to the surgeons and related staff, as well as mentor and teach local and regional
physiotherapists and physiotherapy technicians in hand therapy.
The majority of the team departed Bhutan on the 26th of October, however Ms Svens (hand therapist) stayed on until the 2nd of November to see
and treat hand therapy patients for postoperative care and deliver additional training.
The October 2017 Interplast volunteer team to Bhutan consisted of the following members:
• Dr Tim Proudman (Plastic surgeon & Team Leader)
• Dr Mark Moore (Plastic surgeon)
• Dr Matthew Grills (Anaesthetist)
• Ms Vanessa Dittmar (Nurse)
• Ms Amanda McFall (Nurse)
• Ms Birgit Svens (Hand Therapist)
• Mr Darcy O’Neil (Hand Therapist)
The team as a whole had extensive prior experience with Interplast and in Bhutan. Together this combination of skills and experience helped deliver a
successful program. The entire team was Adelaide based.

 

 

 

 

 

 

 

 

 

 

 

 

In all of its activities, Interplast seeks to implement its ‘twin-track’ approach to programming, which both provides important capacity building of local
medical personnel while also meeting immediate medical need. This approach implemented in Bhutan focuses on giving patients access to life-changing
medical procedures that they would otherwise not be able to afford or access, while also building the capacity of local medical staff through a range of
formal and informal training and mentoring activities.

 

The team arrived in Thimphu early in the morning on the 17th of October and undertook screening at the Jigme Dorji Wangchuk National Referral
Hospital (JDWNRH) in the afternoon. On their arrival the team were informed that 4 of the 8 operating theatres were being renovated.
This meant the team did not have access to the usual theatre 7. They were therefore required to operate from 3pm to 8.30pm. A second theatre along
with the local staff was made available so both surgeons could operate at the same time.
The team screened 107 patients in the outpatient department on the first day (split into Hand and General Plastic Surgery 48 and ENT, Clefts and Head
and Neck 59). A total of over 160 patients were screened during the visit. A total of 50 operations were performed of varying complexity.. A surgical
bay was set aside for Interplast patients on the orthopaedic ward and the ENT ward. All activities were undertaken with local staff.
After the 8 am morning ward round the team would screen another 8 -10 patients each day before surgery started at 9am . During the day cases were
also scheduled for the team in general surgery, ENT, dental/oral surgery and orthopaedic theatres. The ENT surgeons had in particular arranged for ear
reconstruction for Dr Moore to undertake, and Oral Surgery had identified cleft lip and palate (primary and revision) and pharyngoplasty operations for
assistance.
There was an even gender split of patients (50% male & 50% female). The patient’s age range was evenly spread out for this program. 50% of
patients receiving surgery were aged between 19 and 45 years of age. A further 36% were aged 18 years and under. Patients aged 46 and over
accounted for 14% of patients receiving surgery.
Procedures undertaken on the 50 patients included 13 upper limb surgeries, 12 skin lesions and soft tissue deformity procedures, 6 burns
reconstruction surgeries, 6 head & neck procedures, 6 cleft lip and palate, 3 ear deformities and 3 trunk and lower limb procedures.
Please see the following for demographic details, including gender and age, of the patients consulted, and types of procedures performed.

     

Dechen , a 21 year old women from Samtse is an energetic young women with plenty of
drive. Working at a resort in Bumthang after completing her Class X, Dechen sustained an
injury which left her with a paralyzed left arm. When the Interplast team were able to
assess her, it was found that Dechen had damaged the artery and main nerve which
meant she was not been able to flex her fingers and lift her hand. With no feeling in her
thumb, index or middle finger the consequent impact of her life was significant.

“I am dependent on my friends to do simple work like washing
clothes. I feel handicapped because I cannot even tie my hair” -
Dechen

Due to the type of injury and the scarred wound bed standard means of nerve repair was not
possible. The Interplast team worked to transfer the nerve of the thumb index and middle
fingers to the side of another nerve. It will take 6 to 12 months to determine the extent of
Dechen’s recovery from surgery which made the extended follow up care provided by the
Interplast hand therapists and their students more valuable.

 

 

“In the meantime, she will be helped by the hand therapist who will remain here for a week after our main team
leaves to supervise management and help train local staff about the ongoing care that is required” - Interplast
volunteer surgeon Dr Proudman