Thursday, 1 December 2016

Constitution of India – Dr Ambedkar’s Contribution

After India was born as an independent nation on 15 August 1947, its greatest achievement in its early years was the framing of its constitution that provided the social, political and economic framework that led to its emergence as a vibrant and dynamic democracy as well as an emerging regional power in south Asia.

When the first government of independent India took charge, under the guidance of Mahatma Gandhi and the first Prime Minister of India Pandit Jawaharlal Nehru, the gigantic task of laying out the constitutional framework was given to Dr Bhim Rao Ambedkar.

The Constitution Drafting Committee appointed by the Constituent Assembly on 29 August 1947 was chaired by Dr Ambedkar. Though the committee had six other members, Dr Ambedkar who was the chief architect, through his vision for a just and equal society, laid out an elaborate constitution. The Constitution of India was adopted on 26 November 1949 and it accommodates diverse culture, language, religion and ways of life of 1.25 billion people to this day.

Life of Dr Ambedkar
Dr Bhimrao Ambedkar (14 April 1891 – 6 December 1956) was born as a low caste and was subjected to socioeconomic discrimination in his early years. He however excelled in school and went to earn doctorates in law and economics from renowned universities abroad. He was one of the political leaders during the independence movement who advocated for social inclusion and integration of all Indians in the post-independence era to bring about the union of India.

His work included promotion of education especially among the untouchables, called the Harijans or Children of God by Mahatma Gandhi.

Basic features of the Indian Constitution
The structure of the Constitution of India comprises of the preamble, 25 parts with 448 articles, 12 schedules, 5 appendices and has accommodated 100 amendments, making it the world’s longest constitution. A reason for the length of the constitution is because it incorporates the experiences of all leading constitutions of the world as Ambedkar had said, “there was nothing to be ashamed of in borrowing because nobody holds any patent rights in the fundamental ideas of a Constitution.”

It provides sovereign power of governance to the people of India where it is declared in its Preamble that the constitution was adopted and enacted by the people.

It establishes a parliamentary form of governance where the State is headed by the President and the Government is headed by the Prime Minister. The Prime Minister of India and his council of ministers are accountable for all of their actions to the Parliament.

The constitution guarantees fundamental rights to its people such as right to equality, right to freedom, right against exploitation, right to freedom of religion, cultural and educational rights, and right to constitutional remedies.

The constitution through its Directive Principles of State Policy lays down guiding principles for framing of laws and principles both at the union and at state levels. These are not justiciable rights of the people but are fundamental to create social and economic conditions, through laws, plans and programmes, under with citizens can lead a good life.

The judiciary under the Indian constitution enjoys independence from the executive and legislature.

Shaping the Indian Constitution
Dr Ambedkar played a significant role in shaping the social framework of independent India. His views on social justice, equality and inclusion, and fundamental rights were shaped by his education in law, economics and politics and by his personal life and active participation in dialogue and negotiation during the independence movement. Thus, Dr Ambedkar’s constitution offered a wide range of constitutional safeguards and guarantees such as socio-economic rights, civil liberties, freedom of religion, the abolition of untouchability and the prohibition of all forms of discrimination among others.

Dr Ambedkar’s vision of democracy
Dr Ambedkar’s vision of democracy was based on the fundamental idea of “government of the people, by the people and for the people.” The constitution provided the political and legal framework at two levels: the union government and the Supreme Court at the centre and the state governments and the High Courts forming a federal structure.

The Members of the Parliament at the centre and the Members of the Legislative Assembly in the states are elected through universal adult suffrage allowing people’s participation.

Dr Ambedkar also viewed that democracy was only a means to the end of achieving social progress and economic development. He called upon those elected to power to govern with ethics, morality and constitutional morality, which is to abide not just by the legal provisions of the constitution but also to the spirit of the constitution. The Indian constitution is thus rigid to preserve its basic framework and spirit, but also flexible to have accommodated 100 amendments thus far.

The Constitution of the Kingdom of Bhutan
When the Bhutanese Constitution was drafted, His Majesty the Fourth Druk Gyalpo commanded that it was wise to study constitutions from other countries. Dr Ambedkar’s vision and philosophy has found inspiration among the writers of the Bhutanese constitution that was deliberated with people from twenty dzongkhags and was adopted by the people of Bhutan on 18 July 2008.

Our constitution that is structured with the Preamble, 35 articles and 4 schedules is the world’s shortest. It establishes a Democratic Constitutional Monarchy with parliamentary democracy, institutionalizes monarchy, and commands the conservation of environment and preservation of culture among others. It also enshrines the Principles of State Policy with the overall directive to “promote those conditions that will enable the pursuit of Gross National Happiness.”

The former chief justice of Bhutan, Sonam Tobgay has said that “Bhutan wanted a rigid Constitution that would withstand untimely amendments” and allow its sprit to mature and nurture a vibrant democracy.

The constitutions of India and Bhutan establish democracy, the former the oldest, the latter the youngest, as a means to further social transformation in the former and realise Gross National Happiness in the latter through the principles of state policies and other framework enshrined in them. The writers of our constitution had a vision for better times and prosperous nation in posterity but it is subject to the lot of people who implement it.  

However good a Constitution may be, it is sure to turn out bad because those who are called to work it, happen to be a bad lot. However bad a Constitution may be, it may turn out good if those who are called to work it, happen to be a good lot.
– Dr BR Ambedkar

Written by Dr Thinley Dorji (MBBS)

This is adapted from the essay written on the life of Dr BR Ambedkar on his 125th Birth Anniversary Celebrations in April 2016 organized by the Nehru-Wangchuck Cultural Centre, Indian Embassy, Thimphu, Bhutan.

This article was published by the Embassy of India in Bhutan in the Kuensel on 26 November 2016.

Miracles from doctors

Until recently, doctors in Bhutan were indispensable. It is no longer the case. Now, Bhutan has 244 doctors, 957 nurses, 514 health assistants and many others that provide service to the people (AHB 2015). There are several hundreds more undergoing training in neighbouring countries and they will join in the service of the nation soon.
            More doctors joining the service in Bhutan is only one aspect of socio-economic development of Bhutan. Bhutan is now professionalizing its human resources in fields such as law, economics, engineering, agriculture, geology, etc. And not to forget, people have easy access to information through mass media and social media.
            The health sector has achieved tremendous successes in multiple health indicators since the introduction of allopathic medicine in 1961. The life expectancy has increased from 49 years in 1994 to 68.9 years in 2010, infant mortality rate decreased from 102.8 to and 30.0 per 1000 live births in 2012 and maternal mortality rate decreased from 770 to 86 per 100,000 live births in 2012. Bhutan has also achieved multiple successes in the Millennium Development Goals. How was Bhutan able to achieve so much success in a short span of time? All through this time, Bhutan had acute shortages of both financial and human resources while giving free healthcare to all.
            While we have achieved commendable success in serving our people well. As a result, it was natural for people to have increased expectations from the doctors, nurses, technicians and the health system as a whole.
            An example: A person in the village wants to be seen by a doctor; a person in the district wants to be referred to Thimphu hospital; a person in Thimphu wants to be referred abroad. Now people rather wish to be seen by a specialist than by a generalist or a junior doctor.

The health system in Bhutan – what all of us must know
There are several health systems that exist in our country. The allopathic system of western medicine was established in 1961. The indigenous medicine and many other local practices have been here for thousands of years. The Ministry of Health promotes all of them. Each is an alternative choice to the people.
            Health is a delicate condition. If you are healthy now, you can fall sick – so the preventive sector, the public health measures like prevention of tuberculosis, vaccination programmes, sanitation and hygiene programmes. And for those who are sick, their health needs to be restored – so the curative sector, the hospitals, comes into picture.
            The hospitals in Bhutan are three tiered. The Basic Health Units and District Hospitals are the nearest to the people and are staffed by MBBS qualified doctors and nurses (not all BHUs). If a case needs to be seen by specialist doctors and need better facilities for patient care, they are referred to the Regional or to the National Referral hospitals.

JDWNRH as a teaching hospital
Since 1974, the JDWNRH has been a hospital that provided training to nurses and technicians. In 2012, internship programme for MBBS graduates was instituted and residency programme instituted in 2014. Since then, in many of the departments in JDWNRH, there is a hierarchy of doctors who look after the in-ward patients.
The intern doctors are junior-most doctors who have graduated with MBBS from Sri Lanka or Bangladesh, registered under the Bhutan Medical and Health Council. These doctors, otherwise, would have qualified to work as intern doctors under respective medical councils in Sri Lanka or Bangladesh. The Intern Medical Officers are made to work in many disciplines of medicine and treatment such as medicine, surgery, obstetrics and gynaecology, paediatrics including radiology, ophthalmology, dermatology, community medicine, etc. This programme is to give exposure to the Bhutanese context in order to produce general doctors who can serve as jack of all trades in the district hospitals.
In the next hierarchy are the residents, who are undergoing a four year specialist training in major departments such as medicine, surgery, obstetrics and gynaecology, paediatrics and ophthalmology. The residents are those under training to be a master of one.
There are specialists in many fields providing expert opinions in patient care. They are the masters in their specialised field.
The road to having good specialist doctors begins with good intern doctors. If our country needs more specialist doctors, for example, to perform kidney transplant in Bhutan, we need at least few vascular surgeons, nephrologists, intensivists, etc. who will come from the pool of current junior doctors.

Do all cases need to be seen by a specialist?
Not all cases of patients need to be seen by specialists. There are cases that can be treated by a general doctor and many people in the district hospitals get good quality care from general doctors. In fact, in Sri Lanka, a country barely richer than Bhutan in terms of per capita income, most people are happy with the care given by their General Practitioners (GP), the general doctors. These GPs sort out the minor problems and the specialists get time to do what they are intended for.
            Therefore, for our patients in districts to get good quality care, it is essential for general doctors to be competent in solving the problems that are solvable at the district levels.

What else is different in the three tiers of hospitals?
Besides the staffing structure described above, these three tiers of hospitals have different capacities to provide service. More number of drugs and better technologies are available at referral hospitals for the care of patients.

The core of medical ethics
Allopathic medicine is a collection of best practices and scientific evidence collected from the times of Hippocrates till now. Hippocrates (460 – 370 BC) is the Father of Medicine and every health institution bears his portrait or his pedestal.
            A doctor is bound professionally by the Hippocratic Oath to do to the best of his capability for the best to his patient. In Bhutan, our cultural values of jampa, nyingje and jangchub sem are our guiding principles.
            In addition, there are four principles of ethical medical practice:
            (1) Beneficience: It demands that the health care provider should only do what is good for the patient. A doctor may, based on his clinical judgement, decide that a chest x-ray is of little use to the patient, while many an instance, people wish for a lok-par because they do not know what, why and when an x-ray in necessary to be conducted for a patient.
            (2) Non-maleficience: It requires the health care provider to do no harm to the patient. If a case is not within the capacity of one doctor to manage it, it is his responsibility to involve someone who is competent (someone senior, or someone from another department) to manage the disease condition.
            (3) Autonomy: Like everyone else, the patient or the guardian of a minor has the right to decide whether to accept the treatment. However, the right to decide for themselves must come with proper understanding of the disease and the treatment by the patient. However, currently in Bhutan, there is no specific legislation that explicitly gives autonomy to patient.
            (4) Justice: The healthcare provider must think how best to provide justice. For example, to produce an x-ray image, it requires what is called a plate on which image is formed. If at a hospital where the government supplies limited number of plates, why should a doctor do an x-ray on a patient who does not require it?
            However, the medical world is full of exception and anomalies. Supposedly, if a doctor didn’t do the chest x-ray and failed to diagnose a chest disease, the patient can sue him in the court of law.

When can a patient sue a doctor?
Currently, there are no specific laws that protect the patients or the doctors. If a patient feels aggrieved due to the care provided by a doctor, can you sue a doctor? Generally, in other countries, four of the following elements need to be established to prove that there was medical negligence of medical malpractice on the part of the doctor:
            (1) Doctor-patient relationship: There must be an established doctor-patient relationship. If someone died while a doctor was just passing by his house, the relatives cannot sue him for not doing anything because he was not his treating doctor.
            (2) The doctor commits an act of commission or omission: The patient party feels that an act of commission or an omission has caused them harm.
            (3) The person has suffered harm due to the doctor’s acts.
            (4) The causality of harm to the person is established that it was due to the doctor’s acts. The event of a hurt to patient or death of someone can be of many causes. In the court of law, the reasoning of medicine is applied to establish that it was the doctor’s act that resulted in death.

When does death occur?
A marvel of human body is that it has its ability to correct things if they go wrong. However, this physiological ability to self-correct fails when there is compromise beyond a point of no return. The role of a doctor is to prevent the derangement from reaching this point.

Grief reaction
The loss of a loved one is a life-changing event in one’s life. There is a series of emotional states a person goes through called the ‘grief reaction’. The stages are first denial of the event, followed by anger, bargain, depression and finally acceptance. The whole process in a normal person is complete by maximum six months. If the grief reaction lasts beyond six months, it is not normal.
            In our culture, the period of mourning and funeral lasts 49 days that brings kith and kin in an event of show of social support that helps the relatives sail through the bereavement phases. As doctors, we should be mindful that the event of death that occurs in our wards, and that the hospitals herald a series of events in the lives of close relatives.

The human value of life
A man is a social animal. We have a closely knit society with kith and kin that come together in the event of illness. Doctors are entrusted with social and professional mandate to preserve life. With increased expectations of an ever more informed society, there is an increasing demand for doctors to deliver god-like miracles to all ailments, be it of the body or of the mind.

Dr Thinley Dorji
The views expressed in this article are that of the authors’ and does not represent that of any of the organisations mentioned.

Published in the Kuensel, 05 November 2016

Friday, 15 April 2016

Zhabdrung’s Bhutan 400 years later

On the eve of Zhabdrung kuchoe, today, it took me to Drukgyal Dzong in Paro, right next to the Chinese border on the west. What remains of ruins now was once a glorious dzong (fortress). The massive structure reminded me of Zhabdrung.

Who was Zhabdrung as a person? When he came to Bhutan 400 years ago in 1616, he came into a land that did not stand the chance of survival for it was ruled by local chieftains and lords in each valley. What Zhabdrung did was to bring all of them under the Drukpa rule and gave the idea of nationhood to Bhutan. He must have been a powerful man, highly charismatic and his leadership is beyond words.

Drukgyal dzong is perched on a rock and this massive structure is entirely build with stone slabs. The walls are so huge that at some points they are more than a metre thick. It has an inner courtyard with the central tower that was photographed by John Claude White in the early 1900s. The tower stands today, but its collapsed inside. What looks like a small tower on one face is actually a large rectangular structure. The chambers around the dzong are so huge that I could imagine the lives of monks and courtiers in history.

It also has secret passages that served as both escape routes and to draw water. I am interested to learn the actual mechanism how they drew water. Pray the archaeologists shed light on this. These escape routes also have small caved in windows. The apertures of these windows are small on the outside to prevent the bullets from getting in, while the aperture is larger on the inside. I imagine soldiers must have died in these escape routes.

It has watchtowers at least on two directions, the north and the west. The Taa dzongs stand and such round structures were built with such mastery. The overall architecture is masterpiece. Whoever the architect was, it represents that Bhutanese had ingenuity that made the Drukpa nation survive 400 years.

Drukgyel Dzong renovation: With the birth of the Gyalsey, His Majesty and the Royal Government have started work to renovate the dzong to its former glory. What is special about this is that it marks four centuries after this man named Zhabdrung came to Bhutan and established what led to current Bhutanese nation. The dzong is in its initial state of assessment. We have Bhutanese geologists drilling the rocks to assess its foundation, Bhutanese architects studying the ruins and faces of the dzong, and other experts.

Restoration of this dzong will give rise to an architectural masterpiece and restore the glory of the Drukpas over their victory over the war with the Tibetans and Mongols.

Written in reverence to Zhabdrung, who came to Bhutan in 1616 and started work that led to the rise of the Bhutanese nation, the Wangchuck kings and now a happy and flourishing Bhutan.

Wednesday, 2 March 2016

Pain and pain relief methods in labour

Pregnancy is a joyful experience and all hopes begin with the birth of a cute little baby. The birth of every little baby inspires the labour team to do more.

Labour is the process of giving birth to a baby, and is looked after by a team of doctors, nurses, midwives, support staff and led by the obstetrician. Before the advent of modern medicine in Bhutan, labour was a closed room process and the mother was taken care of by the experienced older women. When you listen to the stories of how your grandmother or mother gave birth, they don’t usually focus on the “pain” part of the story. This is because in many cultures, pain is not considered as a problem unless it affects your function. A pain in your foot is not a problem until it is severe enough to prevent you from walking. A woman in labour is anyway supposed to be bed bound, so it does not affect her ability to function.

Though we have many ways of describing different types of pain (a lot of descriptive expressions in Sharchokpa, Khengkha or other dialects), labour pain is not often described as it is embarrassing in our culture to talk about labour. However, with more educated women, many travel outside the country paying huge sums of money for obstetric care when there are available specialists, doctors, nurses and midwives in our country.

What is pain? And what is labour pain?
Our body senses many things through our senses – sight, smell, taste, touch. Pain is usually an unpleasant sensation but it has many important functions for the body. For example, when you accidentally touch a hot iron, you quickly withdraw your hand. In this, pain helps prevent further damage to your fingers. All body parts can experience pain, except the brain because any insult that can cause pain inside the brain is necessarily fatal (this is different than headache).

A pregnant woman undergoes many changes and her uterus enlarges to hold a baby of 2 – 3 kilograms at term. During labour, the baby is pushed out by force of contraction of the uterus. This contraction plus the stretching of the tissues and ligaments cause pain.

Science tries to measure everything in number. Pain can also be measured with various tools and quantified, but there is always a subjective component to pain. Labour pain nevertheless is one of the most severe pains known to mankind. However, with discoveries in science, there are many ways to help reduce pain on medical and humanitarian grounds.

Methods of pain relief in labour
Of the many methods to help relieve pain, this article is on pain relief in labour. There are many methods of pain relief in labour ranging from simple methods to ones requiring trained personnel depending on the place of delivery.

A simple and cost effective method of relieving labour pain is “psycho-prophylaxis” in which the pregnant woman is told about the stages of pregnancy and about labour pain in anticipation. These are done through antenatal (before birth of baby) pregnancy classes in major hospitals. This part of education can be done at all levels of obstetric care since 97.9%[1] of pregnant women have at least one encounter with a health personnel during her pregnancy.

Opioid analgesics
Analgesics are drugs that can relieve pain. The type of analgesic drug given to women in labour is from Step 2 or Step 3 of the severity of pain ladder (World Health Organisation pain ladder, Step 1 drug is paracetamol). The commonly used drug is pethidine, given as an injection in the shoulder. It is a good drug that relieves pain and sedates the mother (makes the mother sleepy), but there is risk of arrest in respiration in both the mother and the baby if given in excess and at wrong timing. To prevent this fatal respiratory arrest, the doctor needs training (an MBBS graduate can handle this).

Inhalation agents
There are gaseous drugs that can be inhaled as and when the woman gets labour pain. But these agents are slowly being phased out under the Montreal Protocol (for which Her Majesty the Gyaltsuen is the Ozone Ambassador) for its ozone depleting compounds such as nitrous oxide. In addition, it is cumbersome for the mother and not a popular method.

Regional anaesthesia
This method of pain relief can ensure a painless delivery. There are several methods of regional anaesthesia, one of which is the epidural analgesia. In this method, the anaesthetic agent (pain relief drug), usually bupivacaine or lignocaine, is delivered through an injection into the spine of the mother. This blocks nerve impulses from the lower half of the mother’s body and the mother is fully awake, hence it’s called “regional” analgesia (compared to general anaesthesia when a patient is fully unconscious).

In epidural analgesia, a special needle is used to inject the drugs at a particular point in the lower part of the mother’s back (just outside the dural covering of the spinal cord, to be exact). The anatomy in this part of the body consists of several layers of tissue and the needle must reach the correct depth of tissue plane before delivering the drug. For this, the doctors need special training. Usually, it is delivered by a medical officer in anaesthesia under the guidance of a specialist anaesthetist or by a registrar or a specialist in anaesthesia. This limits its availability only in tertiary care hospitals.

Apart from anaphylactic reaction to pain relief drug (which can be treated with drugs, if not fatal), it can cause other complications to the mother. For this, nurses must be trained on how to detect these complications at an early stage.

In addition, to provide an epidural analgesia, a surgical epidural set is needed which will be taken care of by the already existing facilities at major hospitals.

There are other forms and concepts of pain relief in labour which are too expensive to be afforded by the government and they are not necessarily good methods.

Who decides what type of pain relief the woman gets?
In an ideal setting, the woman has all the right to make an “informed” decision on the type of pain relief. The doctor must offer options with the pros and cons of each method and the woman makes an “informed decision”.

However, in resource poor settings like ours, and in hospitals where necessary expertise are available, the obstetrician (the doctor who looks after pregnant women) makes the decision to provide epidural analgesia when there are certain situations (“indications”) in the mother. On the other hand, the obstetrician can decide not to provide epidural analgesia in conditions (“contra-indications”) such as very low blood pressure, bleeding tendencies or skin infection in the epidural site. Since it is the anaesthetist who actually delivers the epidural, the anaesthetist can decide not to provide it in cases of bleeding tendencies, spinal deformity or chronic low back pain. These are all specialist opinions.

In hospitals manned by only MBBS doctors (and not specialists), opioid analgesics can be given. And in all hospitals and institutions capable in delivering a baby, must always comfort and simply talk to the mother. It is noted that every intervention in medicine is like pulling a chord from a network of strings, so every intervention must be taken with a good knowledge, thoughtful decision and the simplest and the safest interventions chosen first. It must also be noted that a pregnant women is not a patient though she visits hospital unless she visits due a medical illness, and she is not yet a mother until she delivers a baby, she is a normal person.

What does the country gain from the re-introduction of epidural analgesia?
The re-introduction of epidural analgesia with the birth of His Highness the Gyalsey is a good omen in obstetrics and anaesthesiology in Bhutan under the kind and wise initiative of Her Majesty the Gyaltsuen.

It is a big milestone in the course of modern health in Bhutan. The women of our country now have an opportunity for painless labour and make pregnancy even more joyful. The health system and health personnel get an opportunity to upgrade their skills and is a general indication that our health system can offer much and many more to our people under the wise, strong and continued leadership of Their Majesties.

Dr Thinley Dorji MBBS (Col)
Published in Kuensel, page 10, 6 February 2016

[1] National Health Survey Bhutan 2012

Saturday, 13 February 2016

This Unquiet Land - India

This Unquiet Land is written by the most prominent face of Indian journalists, Barkha Dutt against her backdrop of growing up in an urban middle class family while observing the country around her change. I also grew up in an urban middle class, rather lower-middle class, grew up in Thimphu and seen the changes in the capital city as well as the country.

Though both my parents are not highly educated and not hold any important posts in public offices, I remember the BBS radio used to be played at our home after my father bought it from Jaigaon on our way back from village in the winter of 1997. The BBS radio would be kept playing, may be because my mother wanted to listen to the Sharchokpa songs. Sharchokpa broadcast would last one hour and the next hour used to be Lhotshamkha broadcast – that is how I learnt my meagre Nepali. Till then, a tape recorder with radio was a household necessity.

Then came 1999. I was at the Changlimethang ground (it was not much of a stadium then) to witness the Silver Jubilee celebrations. For me that day, those three big balloons were the most important only to realise that the BBS that giving radio broadcasts, then started to give television broadcast. Those days, we didn’t own a television set. It was much later, may be in 2001 when having a television set became a necessity, that my parents bought a small television set.

Of the many channels and programmes on television, I came across NDTV as a good source of Indian news. And it became a habit to watch three news channels – BBS, BBC and NDTV – apart from other channels such as Cartoon Network and Nickelodeon.

The first face I knew on NDTV was Barkha Dutt because she would host many programmes (and consume more air time I guess). It was through this channel that I continue to consume Indian news. With no one to explain the situations or the background in which the news happened, watching more and more news connected some of the dots. I did not understand some of the news such as the Manmohan Singh government going for confidence vote over the civil nuclear programme issue. What I only knew was that they needed 272 Member of Parliaments to vote to stay in power.

In my effort to understand more about how India functions, I read news and books. Some of them give complementary information while some give contradictory information on the same event. Nevertheless, one event can never be described in the same way by two people (this is called Rashomon effect).

Barkha Dutt in her book This Unquiet Land gives a background understanding on the current affairs in India in some of the selected topics (many of which are sensual for journalists). It talks on the place of women and gender inequality, the problems of caste and reservation system, the perennial problem with Pakistan, Kashmir and Hindu-Muslim fights in the name of God. It also describes the current trajectory of politics in India.

Over the years, I have seen many changes both my own country and in India. Despite all its problems and noises with virtually everyone shouting even on television panel discussions, India is a land of such diversity and I am always awed by it.

*Disclaimer: This is not a book review, I am no expert on India, and today only I came to know that NDTV stands for New Delhi Television haha :D 

Saturday, 6 February 2016

The Auspicious Birth of The Prince of Bhutan

The Auspicious Birth of The Prince of Bhutan

Time of the rise of the Fire Monkey,
Place auspicious at the Lingkana Palace,
The Prince who wheels the nation and the dharma
Was born, the Prince of Bhutan.

With the blessed prophecy of Guru Rinpoche,
The deeds of Ngawang Namgyel, the father of Bhutan, and
The dynamic dynasty, the Wangchuck kings
Have brought the nation to this time.

Time it is the twenty first century
Our ways remain as our fathers,
Our means a beneficiary of time,
At peace are the people of the Fifth King.

The time the Prince was born
At more peace are the people of the Fifth King,
O father, we revere the father Khesar Namgyal
O mother, we adore the mother Jetsun Pema.

Je, the fearless holder of our dharma, in the time of Winter,
In the Glorious Fortress of the Religion, Tashichhoe Dzong,
Stood in secret state of meditation, and the monks
Offered prayers in all temples in the land.

The lamas on the mountains and
Villagers in the valleys
Offered prayers, all of hope and auspiciousness.
May these auspicious prayers, O Lord, be all answered!

At the birth of a baby, the birth of hope,
People of medical hands were at the service
When our beloved Jetsun became a mother to the Prince,
Such auspiciousness for medicine in our land.

The Glorious Palden Drukpa, with merry and glee,
Welcome the birth of the Prince of Bhutan.
In the blessings on the Prince of Bhutan
དཔལབཀྲ་ཤིས་ཕུན་སུམ་ཚོགས་པར་ཤོག།    །།
May the nation find higher peace, happiness and prosperity.

རང་ལུགས་གནམ་ལོ་ཤིང་ལུག་  ཟླ་༡༢་པའི་ཚེས་༢༨། འཕྲིན་ལས་རྡོ་རྗེ། ཀོ་ལོམ་བོ། སྲི་ལངྐ།
On 6 February, 2016, Thinley Dorji, Colombo, Sri Lanka.

Tuesday, 2 February 2016

The MBBS syndromes

The following article describes the various types of MBBS syndromes. The very fact that I am writing this article shows that MBBS is full of syndromes. These set of syndromes are subject to change with opinion from others who have gone through all the 6 syndromes.

1. Pre-MBBS syndrome = excitement
When I got selected for MBBS after Class XII, I was super excited. I sent messages on through Facebook to seniors and friends asking them, “Do you have any books that I can read now so that it might help me in MBBS”. Through my friends I got to an ebook on medical terminologies that was shared by Dr Dinesh Pradhan (who is now a Registrar in paediatrics). Even with my enthusiasm, I couldn’t finish reading that simple book from the first to the last page. This was an indication that in MBBS, you will never be able to read your books “from cover to cover”, unless it’s a very tiny book.

Next, I and a few friends met Dr Pakila Drukpa at a career counselling programme at Yangchenphug. He noted our enthusiasm (which was at its peak) and took us to the JDWNRH library. There, I saw the thick textbooks and tried to read Grey’s Anatomy. I could have read only a few pages and importantly I don’t remember a thing from that page. It was an indication that medical textbooks will be thick, and the small books will be written in several volumes.

During those times, in first half of 2010, when I contacted seniors in Sri Lanka and asked them several times to recommend a medical book that I can read, all of them said, “just enjoy your free time”. At that time, I didn’t know what “free time” meant until Term 1 started in college.

Every year down the line, juniors asked me the same questions I asked when I was a pre-MBBS person. I advised the same, “enjoy your free time”. Thus, pre-MBBS syndrome is a consistent phenomenon.

2. First year MBBS syndrome = wasting money
When guys first come to Sri Lanka, they find money has no value. When my batch were new comers in Colombo, our seniors took us for shopping at Majestic City. There, my friend Pema bought a pair of slippers and it cost him a hefty Rs 3000. Every one said, “three thousand for a chappal!”. The moment we stepped out of our rented homes, money went in thousands and thousands. Then I realised, I was not realising how much money I was spending. So, I calculated the conversion factor, 1 Sri Lankan Rupees equals 0.4 ngultrums. So, whatever I was buying, I converted into ngultrums… but this never helped. So still all my stipend money was going in thousands and thousands until I came to realise on several occasions what “broke” meant.

So where did all these money go? That I realised when I was packing my things to go back to Bhutan after finishing my MBBS. I had bought so many things that were not of any use – kitchen utensils such as a kettle. I don’t know why me and my housemate Pema decided to buy a kettle. In our five years together, we never owned a gas stove to even boil some water in that kettle. Clothes! We gave away bundle and bundle of clothes equivalent to a small jaypee shop. And every weekend, we went to Majestic City (if you come to Colombo and don’t visit the Majestic City, it means you haven’t visited Colombo). The tuk tuks, when we were in first year, did not have meter. So they charged hefty amounts, and still we hadn’t realised the value of Sri Lankan rupees.

But as we grew up, slowly the value of money was driven into by repeated episodes of broke days, one in April-May, and in October-November when stipend was deposited for six months in these later months. Wasting money led to broke days, and the severe problems arise during broke days.

At one time when I was in my senior years, many of our juniors were broke and when our repeated calls and emails to DAHE to send the stipend was not answered, we wrote a letter to the newly elected Prime Minister Tshering Tobgay to release our stipend at the earliest. Well, when the director visited Colombo, he told, “You don’t have to write to the Prime Minister to get your stipend.”

This I write because, some juniors are seen wasting money and are at risk of getting into broke stages.

3. Second year MBBS syndrome = frustration
In first year, we are all the time in the college for lectures and studies. From the second year, we get to go to the hospitals for clinical training. Our excitement in clinical training is immediately dampened by frustration due to lack of Sinhalese language. Language becomes a big barrier and most of the time is spent standing in the wards and trying to learn Sinhalese.

4. Middle year MBBS syndrome = module years
The middle years are a battle with modules. We study for module exams with all our effort because if we fail these so many module exams, we will have to re-sit the exam. Studying is such a nuisance, and these years are a battle of module after modules. Heaps of notes are photocopied, lectures are mostly recorded so that guys can sleep in the afternoon lectures and can be listened at a later convenient time.

Over these years, guys wonder when will I ever get graduated? When will these module exams finish! The module exams indeed come to an end after the fourth year. At that moment, guys think, I have learnt everything because I have passed all module exams. Then comes the next syndrome.

5. Final year = the shinkansen year
The final year is likened to a train. Final year is like a train journey that begins very early in the morning. So it is like you wake up for a at 1 am for an early morning 4 am Druk Air flight from Bangkok. You wake up, wipe your eyes, drive away your sleep with your adrenaline and off goes 8 weeks of professorial appointment. You re-learn everything. The stuff that you left in your previous years as stuff too boring, you must know them in final year. If not, you pay with your marks in exams (countless exams in the final year).

Over the final year, the anxiety and stress for final year exam increases exponentially, time becomes an extremely scarce and highly valuable resource.

And then Final MBBS happens.

6. Post-MBBS syndrome = emptiness syndrome
Until the end of final MBBS exams, guys are all hopeful and excited that the end of MBBS has come. But it’s very much like a couple wanting their son to get a job and settle in life. When that happens, the son settles for a job elsewhere and the parents live an empty life. All the excitement of the end of MBBS lasts a few days and then there’s nothing. There’s this huge gap of holidays and waiting for the results.

Well, when you have reached the destination, you begin to miss the journey.