The only sub-specialist in MFM, Dr Phurb Dorji is providing voluntary service at the hospital 

Bhutan requires four maternal-fetal medicine (MFM) specialists, two in the national referral hospital and one each in the regional referral hospitals, according to health officials.

MFM specialist is an ob-gyn with specialised training to manage high-risk pregnancies.

Jigme Dorji Wangchuck National Referral Hospital’s (JDWNRH) medical superintendent, Dr Gosar Pemba, said Dr Phurb Dorji is the only sub-specialist in MFM at the hospital.

“There are plans to train gynaecologist in MFM, but we don’t have a pool of human resources,” Dr Gosar Pemba said. “We cannot send general duties medical officers (GDMO) for this subspecialty, we have to send a gynaecologist.”

After doing general gynaecology, a gynaecologist has to undergo additional training of two to three years to become a subspecialist in MFM.

According to the hospital’s recent annual report, the hospital’s obstetrics and gynaecology department had six consultants and four residents besides medical interns in 2017.

In the report, it is stated that there is a need to train a consultant in reproductive medicine and MFM specialist and gynae -oncologist each to replace outgoing ones.

Dr Gosar Pemba said Dr Phurb Dorji is currently providing voluntarily MFM service to the patients at the JDWNRH. He resigned this year after serving in the health sector for nearly two decades as a gynaecologist and sub-specialist.

The hospital gives appointments to the patients who require MFM services and Dr Phurb Dorji attends to the patients. “He will provide his service to the patients at the hospital until he decides to do something.”

He said a doctor refers a patient for MFM service if she develops complications during pregnancy, usually when she has a health condition like diabetes, being sick or injured during pregnancy, a baby’s birth defect or growth problem.

The maternofoetal medicine unit at the hospital uses 3D scans. A 3D ultrasound scan provides more information about a known abnormality because it can show more detail from different angles.

Dr Gosar Pemba said it’s a high-end machine for obstetrics and a person needs to be trained in MFM to be able to use the 3D ultrasound.

Dr Phurb Dorji said since 2004, he attended to mothers who are sick during pregnancies and babies who are sick before they are born which together is called MFM.

“To provide this service, I was trained to operate the high-end ultrasound machine,” Dr Phrub Dorjis said. “We have to first do a postgraduate diploma medical ultrasound (DMU), which is a part of the training programme and also a degree by itself.”

He started MFM services at the hospital in 2005 after his training at the JDWNRH. “We had people helping us from abroad. Magee family supported us with USD 350,000 to buy the ultrasound machine and also to train human resources.”

He said this project between the government and Magee family ended in 2010. “The lifespan of a good ultrasound machine is five to six years.”

The ultrasound machine was replaced by the current one which was procured through  government fund and installed  in July 2013.

Besides the cases from the national referral hospital, Dr Phurb Dorji said the hospital receives referral cases from the dzongkhags because this facility is not available there. “Here we see the patients on an appointment basis.”

Before he resigned, Dr Phurb Dorji used to see the referral cases every Tuesdays and Thursdays. Patients from Thimphu were seen daily.

“Once we see them, we need to monitor them throughout the pregnancy period and help them deliver,” Dr Phurb Dorji said.

It takes about 20 to 30 minutes to scan a patient and Dr Phurb Dorji attends to about 20 patients a day.

Dr Phurb Dorji said not all MFM cases need to undergo the scan.

Of a total of 1,709 high-risk pregnancy cases seen at the hospital last year, 433 underwent 3D ultrasound.

Dechen Tshomo