Stories From the Field:

BHUTAN

Neurology Research in Bhutan

Sara Grundy's trip to Bhutan was supported by an MGH Global Health Travel Award. Ms. Grundy is a Clinical Research Coordinator for the Neurological Clinical Research Institute (NCRI) at Mass General.

Our time in Bhutan was spent working at Jigme Dorji Wangchuck National Referral Hospital in Thimphu, where we worked on two separate neurology research projects. Bhutan is a low income country in Asia that currently has no practicing neurologists. These studies aim to expand neurological care to Bhutan and other rural, low income countries by providing alternative technologies for diagnosis of neurological conditions.

The primary goal of the trip was to set up, train staff and start recruitment for the study called Optical Parameters in Brain Development. The goal of this study is to establish a correlation between retinal parameters, measured using Optical Coherence Tomography (OCT) technology, cortical development and cognitive status in children. The use of this technology would provide an alternative method for determining cortical development to MRI, which is more expensive and often unavailable in low income and rural settings. This study had previously recruited patients in Kenya, and we have expanded recruitment to Bhutan.

The OCT scan is a quick non-invasive procedure that involves placing ones head on a chin rest and looking in different directions as the machine takes pictures of the eye. The simplicity of the scan makes this ideal for children. During the trip we recruited our first twenty participants between ages 3 and 9, who were recruited through the department of Ophthalmology and referred for an eye exam by their school. During the time in Bhutan, we also trained local research staff and Ophthalmology residents on how to use the OCT machine, so the project can continue after we left.

In addition to the OCT study, we continued work on the Bhutan epilepsy project, where we recruited an additional 71 participants to come in for an EEG. Many were pediatric patients, who in addition to a normal EEG, received a smartphone based EEG. The smartphone based EEG has the ability to bring epilepsy diagnostic technology to more rural areas where neurological care and epilepsy treatment is unavailable. In Bhutan there are currently no neurologists, and this project aims to alleviate some of the burden caused by epilepsy in the country. Because of the lack of neurologists, we worked with doctors in the Department of Psychiatry, who are depended on to treat epilepsy cases.

We also expanded the project to determine the effects of Doma chewing on brain activity and EEG results. Doma is a drug in Bhutan that is very prevalent and widely available. We recruited six participants with epilepsy who were willing to chew Doma while receiving their EEG.

Each participant is also given a survey on seizure frequency, medication, and how epilepsy impacts their life to determine the economic burden of epilepsy in Bhutan. Women were also given a survey on pregnancy, birth and contraceptive use. In Bhutan, epilepsy is often believed to be contagious and a supernatural disease. One of the participants had his family leave him because they were afraid of his epilepsy. Part of our work therefore also involves raising awareness to the disease so that it will better understand and not feared as it is now.