Orthopaedics in the Buddhist kingdom of Bhutan.
Volunteering as the only orthopaedic surgeon in the small Asian country of Bhutan provided a fascinating introduction to international work. The orthopaedic work predominantly was trauma and osteomyelitis. Treatment of most problems was complicated by patient delays in obtaining medical care, usually related to transportation difficulties in a steep mountainous land with few roads. The complexities of enhancing orthopaedic care in developing countries include patient access to care, availability of adequate sterility for implantation of fixation devices, and determining in concert with the local government what is a sustainable level of care that can be taught to interested physicians in the country. Among the developing nations, Bhutan is one with a strong interest in the welfare of its people and has an economy that can afford to invest in healthcare. Despite these strengths, there remain interesting challenges for the orthopaedic volunteer. Exposure of the volunteer to the people and their culture enhanced the experience and provides a lure to continue volunteering.