We are excited to inform you about an inspiring project that Bodhi Seeds (formerly Bodhi Heart) began sponsoring in spring at Rumtek Monastery in Sikkim, the seat of the Karmapas. We are in the process of creating a Health Care Clinic that will benefit monastics and lay people, both young and old, men, women and children in need of healthcare. This is a long term project that will take 2-4 years to establish. The clinic has the blessings of the Dzogchen Ponlop Rinpoche and is being coordinated with the administration of Rumtek monastery. The initial part of this project began in spring 2010 with our Exploratory Medical Expedition to Rumtek.

The medical team used its own resources in order to fund this trip, so that all money raised will go directly for medical care. Funds raised will go towards:

1. Quality vitamins, ointments, and antibiotics
2. Medications
3. Medical equipment, supplies, and laboratory basics

Medications and equipment will be bought in India, in this way we will keep costs down and those who will be using the equipment and medicines will be familiar with those products of local origin.

The medical team has consulted with those who have created medical clinics in Asia and have estimated that the funds needed to set up a basic clinic will be $10,000 U.S. In addition, further funds will be needed to buy medications, supplies and laboratory basics. In all, a total estimate of $14,000 U.S. is needed for the full set up of the healthcare clinic. This clinic will be an on-going Bodhi Seeds project and we will keep you updated on its progress. As mentioned earlier, it will take 2-4 years to establish an ongoing clinic.

Bodhi Seeds also continues to support many Tibetan children by sponsoring their school education, and helping monastics with their studies with such projects as the Library fund which bought 10 computers to further their education. We also recently bought a computer for our Bodhi Seeds administrator in India, to aid in communications between Rumtek and Bodhi Seeds America.

The Medical Clinic is part of the greater vision of Bodhi Seeds to help as many Tibetan refugees at Rumtek as possible. Become a part of this exciting project by giving donating what you can, all funds received go directly to the creation of the medical clinic. As always, thank you for your generosity!!

This recommendation is really the culmination of all the talks that we had with all the interested people at Rumtek Monastery as well as the observations that we were so fortunate to experience when we opened the dispensary in the monastery to see who would come and with what needs.  We were grateful to have been able to relieve some of the illness.  The monks let us know that they were very happy that plans were in motion to set up a clinic.  And, we were very inspired with the intent and energy that was behind the continuation of meeting these goals.

OVERALL VIEW OF VISIT TO RUMTEK 
March 21, 2010

By Don Ross and Susan Kirchoff

We visited rumtek Monastery between the dates of March 4-22, 2010 to offer assistance in starting a western medical clinic.  We saw approximately 60 patients, ages 18 months to 96 years old.  In being here during this season, we were not present during the rainy season that brings diarrheal disease or winter with the increase in respiratory illness.

We found that the monks in the late adolescent to middle age appear to be on the whole quite healthy, with the exception of probable GERD or dyspepsia and sinusitis.  Older monks, older villagers, and pre-adolescent children and toddlers appear to have a variety of illnesses.

Children suffered with respiratory infections, ear infections, infected abrasions from trauma, high fever, vomiting (measles prodrome), ringworm of the head and body, impetigo, carbuncle, scabies and eye trauma.  The youngest village children seem to be in the midst of a measles outbreak.  These children had very high fevers, as high as 40.2 C.  We could not determine whether children were de-wormed or vaccinated for DPT, polio, Hepatits B, BCG or MRM.

In the older population of monks and villagers, we saw a high prevalence of hypertension. Some were on medication, some were not.  In either case, we could not determine whether or not these people had adequate follow up in order to prevent the consequences of hypertension which include stroke and heart disease.  Though we saw some cases of very high blood pressure, there were no instances of milgnant hypertension which required immediate treatment.  The very elderly villagers varied in well being.  We saw one instance of Stage 4 skin ulcer and another who at 96 was alert and ambulatory despite osteoarthritis.  The elderly we saw presented withmultiple joint pain, constipation, decreased vision, but on the whole very healthy.  One monk presented with congestive heart failure.

Dental disease was prevalent.  We saw many with dental caries and several with dental abscesses which required urgent dental intervention.

We understand that there are cases of multi-drug resistant tuberculosis being treated at the monastery, but we did not see these monks and could not ascertain their compliance.  Though we expected the prevalence of diabetes to be high, we did not record any patients who had the disease.  Similarly, we expected to find anemia, especially amongst the villagers and possibly in the monastic population because of vegetarian diets, but could not ascertain whether this was a problem.  We also expected to see thyroid disease, but saw no clinical evidence of this.  All of these conclusions are based only on clinical findings as we had nolaboratory and lacked proper instruments.

RECOMMENDATIONS CHECK LIST AND SUGGESTED TIME LINE

1. Hire a four year degree nurse with at least 5 years of experience and develop the role as described below under Nursing Functions. Suggested completion date:  June 1, 2010
2. Locate an M.D. to serve in the role of primary care physician to the monastery and the village.  The M.D. will visit at least weekly at first, and will establish a medical protocol for the nurse to follow.  Suggested completion date:  June 1, 2010
3. Obtain state recommendations for the vaccination of children and de-worming.  This includes:  MRM, DPT, DT, Hepatitis B, BCG.  Give al children vaccinations.  The model for this already exists in the Monastery. Medications for tuberculosis were provided by the state and are given from the dispensary by the nurse.  Similarly, it may be possible to extend this model by having the nurse administer vaccinations and de-worming medication and maintaining records per state protocols.  Suggested completion date:  June 1, 2010
4. As teachers have greatest access to children, educate teachers regarding diagnosis and treatment of common skin diseases:  lice, ringworm and scabies. Make medication for these diseases readily available via a standing order from the doctor. Suggested completion date:  December 1, 2010
5. Obtain basic laboratory specimens in the clinic (urine and blood).  Coordinate pick-up, delivery and reporting between a specified Gangtok laboratory and the Rumtek doctor of nurse.  Suggested completion date:  December 1, 2010
6. Sponsor dental and eye clinics yearly.  Begin January 1, 2011
7. Sponsor specialty clinic to address the high prevalence diseases: hypertension and GERD.  Begin January 1, 2011
8. Include pre-natal care as needed.
9. Restock formulary as needed.  Suggested date:  on-going
   

NURSE’S ROLE

1. Administers running of the clinic.  Reports to the monastery health care director.  Schedules clinic hours and follow up, maintains medical records, financial records, inventory of supplies and medications, house-keeping, sanitation.  Supervises clinic bookkeeper and house-keeper.
2. Clinical work includes:  attending physician visits with patients and advocating for the patient’s needs, follow up on all orders and patients that do not keep follow up appointments
3. Public health work includes:  vaccinations, de-worming, tuberculosis drugs, and following medical protocol for the on-going medication needs of the patient when physician is not in attendance, regular home visits to home bound and others as needed.
4. Coordinates with other agencies such as the state and local health departments.
5. Organizes monastic and community groups on health education, disease process and prevention.
6. Clinic nurse role can include visit to school for well-child care (weight, height, nutrition, mental and physical assessment)
   

Hello all,

I would say that we have been in a confused but open space, just seeing and hearing and feeling all that is possible.

Now, I can come to some clarity and say that through the work of so many people at many meetings and many cups of tea, a framework seems to be forming. And, we have come to a mental space that allows some giving of western medical attention!  It was very interesting this morning when Jay had consented to see an elderly man.  The dispensary was locked, but the Tibetan Medicine Doctor Dubje said to come into his office.  So, Jay did a Western medical exam with dr. Dubje interpreting. Now, Dr. Dubje will take Jay’s recommendations to a doctor/hospital in Gangtok to get western medical help there. Very interesting working together of the two practices.  This is necessary to continue.  There are many more stories of interest, to say the least.

Regarding the overall project picture:  it has been determined that an old structure that was donated by  Rinpoche will be restored and serve as a clinic.  This may take 6 months or more to complete.  That is a long term goal. 

In the short term:  the plan is to stock the dispensary in the monastery with supplies and medications, and to hire a M.D. and a nurse to come weekly. 

It has taken many meetings and many cups of tea with wonderful people to come to these conclusions.  Dr. Jigme(his father served as the physician for the 16th  Karmapa) was especially helpful and will help in finding the doctors and nurses that are needed.

This is all I can report for now.  We will go to Gangtok tomorrow with Gen. Sec. Chungyalpa to meet with Tashi Densapa and do other research into locating good pharmacies and medical supply houses. 

Being well,

Susan Kirchoff and Don Ross