Friday, December 25, 2015

Gidakom, my destined place of posting

Life in other place is full of happiness knowing though it will never be to the fullest. It’s wonderful to begin with fresh life, with new companionship, doing new things, even eating new food. It does take some time to adjust to just starting out chimes, but the necessity of living in the present endures any hardships.
I grew up in one of the remotest village with an understanding that everyone has the same value as a human being, including persons with disabilities. As a kid, I have seen many physically disabled people neglected by individuals, families and society as a whole. Being a Buddhist country, disability, as many people consider, a curse of bad deeds in previous life had left many disabled persons unattended years ago. But, with public awareness and social education through CBR and other rehabilitation programmes, disabled persons at least enjoy the right to basic health and education. I had a desire to work with physically challenged persons and help them in promoting their rights after graduating from my college in bachelor’s degree in prosthetics and orthotics in India. On completion of my course, RCSC placed me at Gidakom hospital, the only Centre for Prosthetics & Orthotics as a Prosthetist and Orthotist. I was then exposed to varied orthopaedically disabled Bhutanese people. And it’s indeed my dream come true, helping them stand on their own feet and enjoy every right that other Bhutanese enjoy with whatever the resources available at the P & O unit of Gidakom hospital.
Bhutan is a developing country in South Asia. Though the basic health services are available to all people of Bhutan through its national, regional, district and BHUs, Prosthetic and Orthotic services for the person with physical disabilities are only available at Gidakom hospital at present, which serves as the National Centre of Prosthetics and Orthotics. Apart from rehabilitation professionals, physically disabled persons and their families, not many people know about the prosthetic and orthotic services. Seriously, few might have never heard of it before and some simply might have ignored since they are able person. To the rehabilitation professionals, person with disabilities and their families, prosthetic and orthotic services is their every night dream, every day hope and every time goal of rehabilitating the person with physically challenged to make them stand on their own feet and enjoy the right to equality and non-discrimination, live independently in the community, exercise franchise, stand for opportunities and hold public office, etc. In Bhutan, the services are very recent rehabilitative modality incorporated in to the field of medicine under ministry of health, royal government of Bhutan. A very low percentage of Person with physical disabilities in Bhutan have been receiving marginal amount of prosthetic and orthotic services in Gidakom hospital. The prosthetic and orthotic profession is involved in the manufacture and provision of prosthetic devices for amputees (potential prosthetic users) and persons with other physical impairments, such as weakness or deformity (potential orthotic users). Prosthetic and orthotic services are concerned with physical rehabilitation provided by medical and allied health professionals associated with a prosthetic and orthotic department. This includes patient assessment, prescription and manufacture of devices, fitting, training, follow-up and repairs.
How many of you seriously know about prosthetic and orthotic science? Prosthetics and orthotics is the modern treatment and rehabilitative modality that deals with the orthopaedic and neuromuscular disorders and insufficiencies including congenital loses and accidental or traumatic amputations. Prosthetic and orthotic treatment returns the handicapped individual from his own world of darkness of suffering to the real world as an able individual capable to serve the society and thus achieve the dignity, esteem and self sufficiency. It enables the individual, once again to view the world as it is.
Prosthetic is a specialty within the medical field concerned with the evaluation, fabrication, and custom fitting of artificial limbs, known as "prostheses" that replace the lost body part either congenitally or due to trauma which includes total limbs, figures, partial hand, partial foot, etc. Prostheses enhance the function and lifestyle of persons with limb loss. The prostheses must be a unique combination of appropriate materials, alignment, design, and construction. Prostheses are an artificial device that replaces a missing body part, which may be lost through trauma, disease, or congenital conditions. A Prosthetist is the primary clinician responsible for the prescription, manufacture, and management of prostheses. Other prosthetic professionals include prosthetic technicians and assistants.
Orthotic is a specialty within the medical field concerned with the evaluation, design, fabrication and custom fitting of orthopedic braces, known as "orthoses" which leads to the mechanical correction of orthopaedic deformities by supporting the weaker body parts, preventing unwanted movement, etc. An orthoses is "an externally applied device used to modify the structural and functional characteristics of the neuromuscular and skeletal system". An Orthotist is the primary clinician responsible for the prescription, manufacture, and management of orthoses. Other orthotic professionals include orthotic technicians and assistants.
The discipline of prosthetics and orthotics is indispensible in the field of modern treatment without which the total rehabilitation of the orthopaedically handicapped individual is incomplete. According to the definitions in international standards prosthetic and orthotic service delivery includes; patient ass
Though the exact national figure on disability is not available as no such survey has been conducted so far, but by a rough estimate more than 300 prostheses and orthoses are fitted in Bhutan every year at Gidakom hospital.
There is an enormous need in developing country like Bhutan for prostheses and orthoses. Natural disasters and road traffic accidents had increased amputees and different diseases have left many people disabled. The services for prosthetics and orthotics are limited to a centre at Gidakom hospital. This has resulted in very limited services to people in smaller urban or semi-urban areas. Those who do travel to the centre to obtain P & O services usually receive inadequate services. Prostheses or Orthoses are designed and fabricated quickly and given to the patients without adequate training in how to use them properly.
In the case of prostheses, patient who come to the only centre for services rarely have their stumps prepared properly for the design and fitment of sockets. This results in shrinkage of the stump as soon as the new prostheses are used, so the socket no longer fits. The patient from the rural area discovers this after he has returned home. Few patients can afford to return to the city for designing new socket and prostheses as a whole. This cost both government and patients.
The lack of braces in rural areas is most evident. Families may bring their children with disabilities to the city to obtain a brace. However, children quickly outgrow their braces, which must be adjusted or replaced. Families cannot afford to go to the city each year, so the children stop using the braces and experience the well-known consequences.
These people who do not benefit from the services they seek are perhaps the minority in rural areas. The majority who need services do not seek them, many for economic reasons and some because of lack of awareness about possible services.
In order to provide clinical orthotic and prosthetic services to the people of Bhutan who need them, personnel must be trained to provide the needed services on time.
The national plan for the distribution of prosthetic and orthotic services should begin by establishing services at regional hospitals and, as and when feasible, should plan for further distribution of services to the district hospitals. 
Gidakom is located west of Thimphu with the nearest highway point at Khasadrapchu. It is half an hour drive from the main Thimphu town. The small valley of Gidakom is centered by Bjemina village in the north and Tsendendapsa in the south beautified by Bjemina River and giant hills. The valley blessed with rich minerals under Mewang geog boast of its 7 mining quarries.
On the sloppy hill of Gidakom lies the age old hospital popularly known as Leprosy Mission Hospital. Of course now most of the people call it as TB Hospital of Bhutan. Initially, Gidakom hospital was established in the 1960s as a Leprosy Mission hospital and up until 2001 had medical direction provided by the physicians working from the mission. The 60 bed hospital became the district hospital of Thimphu on 26 July 2011.
The hospital has a general ward and TB/leprosy cottage and OPD apart from a small Prosthetic & Orthotic unit attached with physiotherapy unit that caters the P & O services to the section of physically challenged people. Though not much development was brought, the hospital caters the health facilities through an age old buildings established by the mission. The hospital delivers general health services to the people of nearby villages apart from the specialized treatment of MDR-TB patients referred from other hospitals. The leprosy cottage still has few leprosy infected patient living under the care of Royal mother Azhi Kezang Choden.   
Life has never been as what we all would have desired. But life goes on with the clicks of time and alternate day night. Every happy moment comes with its own share of sadness. After all I look forward to happy days. These lovely place and work, it will remain forever in my memory, but for now, I have got miles to travel, promises to keep, and dreams to fulfill, and achieve my destination, before my eternal sleep. Because you and I can make a difference!

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