Author: Suzanne Caragianis
Published for: OT Australia in 2015
Martin Luther King said that “Of all the forms of inequity, injustice in health is the most shocking and the most inhumane”. I have written before to OT Australia about our work in Bhutan and wanted to give the OT community an update on the work we have been doing in Bhutan. Bhutan is a small country in the Himalayas which has recently become a democracy (2008). They measure Gross National Happiness and have an index which tracks indicators such as health, education and psychological wellbeing. They have limited financial resources and have encouraged the collaborative support from Aid agencies such as Health Volunteers Overseas (HVO).
Unfortunately, there are no OT’s in Bhutan, except for the occasional OT volunteer. We met Catherine Bunton in Bhutan who signed up with HVO and was working in psychiatry. In 2009 I completed an exploratory trip to Bhutan to assess the needs of Hand Therapy and Hand Surgery and in particular training and education. In response to the clear need for training and education in this area I started leading a team of volunteers on a yearly teaching program and 4 surgical programs.
Bill Clinton said “One of the greatest gifts anyone can give is a useful skill. Transferring that knowledge and that ability to use it can empower others in amazing ways”. After 5 years of annual visits to Bhutan and organising groups of volunteer OT’s (Hand Therapists), PT’s and Hand Surgeons, I saw the need to expand the program and get help from an established organisation who could take the work we have done and the relationship we have established further. Dr Griffin and I were fortunate enough to gain support from Interplast Australia and New Zealand, a large NGO based out of Melbourne which is half owned by the Royal Australian College of Surgeons and half owned by Rotary Australia. Interplast have been in existence for 32 years and have now worked in 26 countries. There are approximately 25 OT’s and PT’s who volunteer with Interplast. They were impressed by our work to date and wanted to collaborate on our work and extend the Bhutan program.
While excited by the opportunity, I was also nervous that I’d lose control and it may fail. Well I’m delighted to say our first Interplast trip happened in May this year and was an enormous success. We had a large team which consisted of 3 surgeons, 2 OT’s, an anaesthetist and OR Nurse. This enabled us to have our own operating theatre and work with local surgeons to train and upskill them. The two Plastic Surgeons ran a “Flaps course”. While Megan Fitzgerald, OT colleague from Melbourne and I undertook more informal training in the Hand Therapy Clinic in Thimphu which I helped establish 5 years ago. Last year we fund raised and bought the clinic a laptop computer and provided a number of training courses for additional learning. It has also enabled the young Physiotherapy tech’s working in the clinic to email regularly with patient photos and questions. Mentoring the local technicians is essential to establish sustainability.
This year we operated on 65 patients with hand and upper limb injuries, burns and congenital malformations. Megan and I saw over 200 patients in Thimphu, the Capital and I in Mongar, a regional hospital in the Far East where we have also established a small hand therapy clinic within the Physiotherapy Department. There are significant geographical barriers to travelling in Bhutan. The trip to Mongar by car is 2 days and necessitates climbing over 5 mountain passes. Patients can travel days to get from mountain villages to the regional hospitals. I was thrilled this year to see previous patients returning to show us their outcomes.
Two I’d like to share with you are two stories which were particularly powerful to me, the first, a farmer who sustained an incomplete amputation of his right dominant forearm above wrist. After successful surgery and a subsequent nerve transfer, he has gained movement and strength and functional sensation in the hand which has enabled him to resume farming and support his elderly parents. The other was a young girl who fell from a 3 story building fracturing bones in both arms and legs. When we arrive in Bhutan last year, she had been in a hospital bed for 5 weeks not moving, barely speaking or eating. To get her out of bed I told her she was a princess and that I was her helper for the next 2 weeks. I gained her confidence helping her walk to our little hand therapy clinic in the hospital grounds. I granted her 2 wishes, she chose chocolate which she shared with other children in the clinic, and the other was a doll. The day before I left Bhutan, a cleaner from the hotel told me she had recently had a ride in a taxi and the taxi driver was telling her how last year after his daughter had a severe accident and this Australian OT saved her life. Of course that’s an exaggeration but it does remind me of why I choose to volunteer, fundraise and mentor my colleagues in Bhutan.
Dr Peter Stern at last year’s Hand Surgery Conference in USA stated “Volunteerism cannot involve quid proquos – the act needs to be given from the heart”. “We have a moral obligation to balance the scale”. If you want to read more about our work, I have a yearly summary on my website www.sahandtherapy.com.au and if you wish to make a tax deductible donation to buy more equipment you can also do on the website. Stay tuned!