Overall View of Visit to Rumtek

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)