Actual ways to get injured in Bhutan and be seen by the American doctor
10. Backache from carrying heavy loads. Bhutanese are very prone to backaches and this tends to clog up our clinic when we have more important things to see. We do have a number of paraplegics and quadraplegics from spine injuries who stay in the orthopedic ward for a very long time, because there is no place for them to go in their villages.
9. Hit by taxi. Not surprising given the quality of the local driving.
8. Hit by arrow during archery tournament. Targets are 140 meters from the shooting line, and spectators line the entire path of the arrow, leaving only a 10-meter wide corridor. Straight shooting is rewarded with songs. Even a slight error can mean disaster, but this actually does happen to people in the crowd.
7. Gored by ox. Ox and cows frequent the roads and paths, many have long horns. Most are friendly and slow-moving, but...you get the idea.
6. Fell off roof. I don't know why people here have a propensity to imbibe their alcohol while sitting on the roofs here, but it's not uncommon for us to see people after a fall from a roof, and we ask no further questions.
5. Hit by stone. A woman was admitted with a broken upper arm. I asked "what happened," and was told by Sister Wangchoezem, the head nurse, "Hit by stone." "How was she hit by a stone?" I asked. The reply: "A stone hit her arm, sir." "But," I persisted, "how did it happen that the stone hit her arm?" "Oh, she was hit by a stone." I gave up and put a metal rod in her humerus without further clinical information.
4. Fell into open fire during epileptic seizure. I've had three patients so far this month with this scenario. Unfortunately one of them was a small baby who was tied to her mother's back at the time her mother had a seizure; the baby was badly burned on her hand. Today we released burn contractures and made it so she could open her wrist, use her thumb and index finger, and grafted some skin from her groin area to fill in the missing skin.
3. Suprachondylar elbow fracture. At home, I may see only a few of these per year, in children. In Bhutan, we see these every few days. This is a fracture of the end of the humerus bone right above the elbow joint. We manipulate them back into place, and under X-ray guidance pin them in place. On earlier trips to Bhutan we did not have X-ray to help us and probably didn't do a very good job. I don't know why they're so common here, but I have an idea that it may have something to do with both genetics and nutrition.
2. Dawa Transport bus accident. Riding the buses here is very risky. A few times a year, an entire busload of people will go over a cliff. Those who survive have multiple fractures, which creates a backlog of fractures to plate/rod/cast.
1. Fell into Indian toilet. This prize-winning injury happens when people slip while using a squatting floor toilet. Some of these have metal edges which are sharp, and the usual injury is a cut through the Achilles tendon. We see a couple of these a month, and I have seen them on every trip to Bhutan.
