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Orthopaedic

The Orthopaedic Unit of JDW National Referral Hospital is the apex orthopaedic referral centre in the country. Presently the orthopaedic ward has beds for 30 in-patients, which remain fully occupied almost throughout the year.

The Orthopaedic Unit was started in the early 1970s. The unit was then run by expatriate orthopaedic/general surgeons. The services offered then were very basic due to lack of both skilled manpower and sophisticated equipment. In 1993, a US based Health Volunteer Over Seas (HVO) Program, started Orthopaedic Over Seas (OOS) program in Bhutan. Since then we have been receiving one volunteer orthopaedic surgeon every month for an average duration of 4 weeks through the program. But it was only in 1999 that our first national orthopaedic surgeon joined the hospital and took over the charge of the unit. Since then we have come a long way and our service providing capabilities have improved tremendously both in terms of skilled manpower and latest equipment.

Responsibilities and Functions

Our main responsibilities include:

  1. Inpatient care services, -daily ward rounds
  2. Outpatient Clinic, – 6 days a week.
  3. Routine Operations, – 2 days a week (Mondays and Thursdays).
  4. Emergency services, – 24 hours a day.
  5. Teaching and training of the support staff, eg. the RIHS students, ortho-technicians and ACOs.

Services

Our main services include:

  1. Orthopaedic trauma management services, especially fracture care.
  2. Bone and joint infection treatment.
  3. Management of soft tissue injury of the extremities.
  4. Paediatric orthopaedic services.
  5. Elective/corrective orthopaedic services
  6. Arthroscopic surgery

Common clinical problems managed by the Orthopaedic Unit currently include:

  1. Fracture care, both acute and late presenting.
  2. Infections of the bone and joints – acute and chronic, including tuberculosis.
  3. Surgical problems of the spine, including sciatica, trauma and infections.
  4. Bone tumors, both benign and malignant.
  5. Arthritis, tendonitis, generalized aches of major joints – eg. hip and knee.
  6. Specific wound management problems, especially burns on the extremities.
  7. Musculoskeletal problems specific to children.
  8. Sports injuries.
  9. Hand injuries.

Future Departmental Prospects:

It has been well established in the medical literature that traumatic injury is one of the major problems faced in the world today, in particular as the use of motor vehicles increase. Statistics show that more people die each year in the World from traumatic injuries than die from HIV/AIDS and TB combined. As traumatic injury often involves fractures of the limbs, spine, pelvis, etc, the need for increasing surgical services capabilities cannot be over-emphasized. As such our department is in great need of expansion not only in members but in equipment and facilities. We are optimistic that with the continued enrollment of two candidates every year for orthopaedic technician’s training at the RIHS, we will be able to staff all our district hospitals with one othopaedic technician in the future which will go a long way in improving the basic orthopaedic services in the districts.

The JDWNRH department of orthopaedic surgery is responsible for the selection of candidates for future training in orthopaedic surgery, both for expansion of the department in Thimphu and for expansion to all parts of Bhutan. At present there are two Bhutanese physicians doing postgraduate orthopaedic training in Thailand and with their return upon successful completion they will continue to expand orthopaedic services both in Thimphu and beyond.

Furthermore, as the department expands in size, it is anticipated that more orthopaedic services will be made available in the future, including the following sub-specialty services:

    1. Spine surgery..
    2. Sports medicine.
    3. Joint replacement.
    4. Hand and upper-extremity, including micro-surgery
    5. Paediatric

It should also be noted that the JDWNRH department of orthopaedics also has as one of it’s major priorities the expansion of Bhutanese orthopaedic surgeons throughout the Kingdom of Bhutan, and not just the Thimphu valley. We are pleased to note that amongst many young Bhutanese physicians there is great interest to obtain postgraduate training in orthopaedic surgery and we believe that the future of orthopaedic surgery in Bhutan is extremely bright.

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