July 10, 2017

The story of Bhutan Emergency Aeromedical Retrieval (BEAR) begins in the fall of 2016. A 14-year-old boy fell from the roof of his house near Trashigang (in eastern Bhutan), breaking his arm and ribs, and tearing his right lung. Breathing quickly became a struggle. Running to the scene, the health assistant examined the boy and called for immediate helicopter evacuation to the Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) in Thimphu. On the way, however, his lung completely collapsed, the flow of blood to his heart slowed, and he stopped breathing. I was on duty when he arrived at the emergency department of JDWNRH. His heart was still beating, but after 45 minutes of effort, we were unable to save him.

We were heartbroken. Not only could his death have been easily prevented by timely resuscitation and emergency care, but he is one of many who could have been saved with the right treatment at the right time. Discussing the case with our most veteran resuscitation nurses, I wondered: What if we could deliver ICU-level emergency care anywhere in the country within an hour? What if we were to create a helicopter-based emergency team? 

Seven months later, after many meetings and presentations, preparations, and trainings,  WE ARE LIVE!

On May 31, 2017, we received our first call from southern Bhutan, where a 47-year-old woman was speared in her chest by a gaur. Her friends immediately informed the village health assistant, who called the BEAR team into action. We mounted onto the helicopter, but were stopped by the weather. Storms blocked our way. We were devastated! We know that patients with these wounds rarely survive more than a day without treatment. She barely survived the night, but at daybreak we went for her.  We landed and reached her side by 7 am–she was in severe respiratory distress and in shock.  Her right side was soaked with blood. She had been fighting all night long, and when she saw us, she had little left to give. She fell unconscious, stopped breathing, and her heart rate dropped to nothing. Then in front of the civilian crowd, the health assistants, and the flight team, we resuscitated her. Our team was smooth and calm while we vented her chest, gave her IV resuscitation meds and ventilatory support–all in an open field. We finally got her back and kept her under anesthesia until our return to Thimphu. Last week, she walked out of the hospital, smiling and laughing with her husband. She is alive. And our debt to the 14-year-old Bhutanese boy we lost last October has been repaid.  

In the following weeks, you will hear several stories of people we have served across Bhutan. We are overwhelmed by the support and encouragement we have received. Here is what the Prime Minister of Bhutan His Excellency Lyonchhen Dasho Tshering Tobgay had to say about us.  

Dr. Charles Haviland Mize, Mr. Kiran Biswa Diyali, and Mr. Lhab Dorji––The BEAR Team

Here are some additional stories from the BEAR rescues:

1. On June 5, 2017, two men were badly injured in a compressed gas explosion, and both were in hemorrhagic shock from blood loss. One had a large piece of metal shrapnel in his side and in his hipbone, and the other had his skull blown open. Both men were kept under observation at the Bumthang District Hospital until the BEAR Team flew in, systematically attended to them, and evacuated them to the Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) in Thimphu. For the first man, the BEAR Team removed the shrapnel, ligated the bleeding vessels, transfused blood, and brought him back to the JDWNRH, where he underwent surgery. One week later, he walked out of the hospital, alive and well. For the second man, the BEAR Team cleaned the debris from his brain, replaced his skull flap, and stopped the bleeding vessels of the scalp. The team placed him under anesthesia and then contacted the neurosurgical team by radio to arrange for immediate operative repair. The BEAR Team transported him back to JDWNRH, where he underwent immediate surgery. Two weeks later, he was discharged from the hospital in excellent health.
2. A teacher in the mountain village of Lunana (located at an elevation of 14,900 feet) broke his leg in multiple places after a major fall off a cliff. In severe pain, and weak from the loss of blood, he could not manage to walk or ride a mule to get help. The nearest road access was nine days away. The BEAR Team was called into action, and after landing on a small ledge, found the patient and went to work. They gave him IV pain medicine and sedatives, reduced and splinted his leg, and carried him on a mountain path 218 yards back to the helicopter. Once back in Thimphu, the BEAR Team arranged for him to have orthopedic evaluation and surgery. We are happy to report he is now able to walk again.
3. In another call from Samtse in southern Bhutan, the BEAR Team responded to a report about an infant in distress. Upon arrival, the team found a nine-month-old girl struggling to breathe, despite aggressive measures by the local medical staff. The girl tired out and fell unconscious–but the BEAR Team was ready to act. They placed her under anesthesia, inserted a breathing tube, gave her antibiotics and anti-viral medicine, and supported her during the stormy one-hour flight back to Thimphu. After one week in the pediatric intensive care unit, she left the hospital with her mother, a healthy girl once again.
4. Early one Sunday morning, we had one of the hardest cases of my career. A woman was in hemorrhagic shock, dying from placental abruption, and pregnant with twins. We left shortly after dawn to reach her up in the mountains of Trashiyangste and landed in a small village without doctors or nurses. She lay limply in the stretcher, still bleeding heavily, and we needed to act quickly with no back-up or resources other than what we brought. By far the most common outcome in this setting is for the mother and her unborn children to die. We knew the odds were against us, but we were determined to act and act aggressively. In order to stop the bleeding, we decided to risk inducing labor of the premature twins. Then, we delivered the twins, and resuscitated them (not breathing due to prematurity)–first one, and then the other. While I worked on the children, my colleague, a pediatric physician who joined our mission, attended to the mother, and managed to control the bleeding. Forty-five minutes later, the mother was alive but weak, and no longer bleeding. Her tiny babies lay on her chest, warm and breathing softly. We thought we were going to lose them all–but by some miracle, we managed to save all three of them. We then loaded them up into the helicopter and transported them to Mongar Regional Hospital (in Eastern Bhutan), where the children were admitted to the neonatal intensive care unit and the mother to obstetrics. Today, all three of them are healthy and doing well.