Suzanne Caragianis led a large team of volunteers to Bhutan for a combined intensive program of hand surgery, therapy and education courses from January 24th until 7th February 2014.

She was supported by Dr Michael Hayes (Orthopaedic Surgeon), Dr Helen Segmuller (Orthopaedic Hand Surgeon from Switzerland), Dr Susan Hillier (Physiotherapist), Vanessa Holohan (Physiotherapist) and Megan Fitzgerald (Hand Therapist). The two surgeons worked closely with local orthopaedic surgeons in both Mongar and Thimphu, to teach them new skills and introduce new ways of doing some procedures.

They saw many complex cases including burns, congenital abnormalities, infected wounds, comminuted fractures, tendon reconstructions and repairs and amputations. The challenges of doing such complex cases are many but one is the time involved to complete each procedure and another is getting access to an operating theatre in a small but very busy hospital that has resources for urgent emergency cases only.

The hand therapists saw a large number of in-patients, post-operative patients and out-patients in the hand clinics and on the hospital wards. They worked closely with the two physiotherapy technicians in Thimphu and the one in Mongar to continue teaching them the theory and practicals of hand therapy and upper limb anatomy. Bhutan now has three physiotherapy technicians who are becoming quite proficient in assessing and treating hand injuries and fabricating custom-made splints and it is very rewarding to see.

The two physiotherapists, Susan Hillier and Vanessa Holohan, taught two 3-day courses on stroke, cerebral palsy and the shoulder to a group of almost 60 students from most districts of Bhutan. The courses were a good mix of theory and practical with some in-patients and out-patients participating in the course for real assessment and treatment purposes.

We found the two courses to be a great success by the number of attendees, their participation in class, the extent of the questions asked and their sincere gratitude for the opportunity to learn from us. We believe this course has improved their skill level and will be of benefit to the people of Bhutan.

Further fundraising prior to this visit allowed us to purchase more surgical and medical equipment including a Nerve Conduction/EMG Unit which was donated to the hospital in Thimphu and is the first machine of this kind in Bhutan. It will allow the local doctors to better diagnose nerve injuries.

The outcomes achieved on this visit are in line with those of our long-term vision to establish hand surgery and hand therapy clinics in Bhutan and assist with the continuing education of the medical staff and assist with provision of medical and therapy equipment.

The plan for 2015 is for another intensive hand surgery and hand therapy camp in May, which will be attended by at least two surgeons and two therapists. We are also in the process of developing links with Interplast Australia and New Zealand, a not-for-profit organisation that focuses on plastic surgery for people in need in the developing countries in the south-east Asia region.

We are hopeful that by working together with this organisation we can make a larger impact in Bhutan and help many more people.

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