Causing suffering

The Health Ministry has admitted that they have a problem: they have not been able to maintain an adequate supply of drugs to our hospitals. As a result, patients have had to postpone or even forgo medication. And doctors have been forced to direct their patients to private pharmacies, which, many times, have also been frustratingly out of drugs.

Worse still, the Health Ministry has admitted that they still do not know how to resolve the drug shortage issue, a problem that has reached chronic proportions during the past year. So they’ve announced that, as an interim measure, they will send officials to buy drugs directly from manufacturers in Bangladesh.

I suspect that the officials who’ll be going to Bangladesh will be mainly, if not entirely, ministry personnel, most of them from the Drugs, Vaccines and Equipment Division (DVED). If that is so, that could very well be the problem – a central agency unable to keep up with the growing and changing needs of referral hospitals in general, and the Jigme Dorji Wangchuck National Referral Hospital in particular.

DVED is the Health Ministry’s central procurement agency. They buy, stock and distribute drugs and equipment to hospitals throughout the country. That’s a lot of work, work that just gets more complicated as more people use the health system. Between receiving orders for drugs from individual hospitals to supplying them with the drugs is a logistical nightmare that includes compiling and approving orders from the field; tendering and awarding procurement contracts; receiving, verifying and storing drugs; and finally, distributing them to every hospital and clinic, throughout the country. And all that must be done within the framework of the government’s tight financial rules and regulations.

DVED’s centralized operations have served the nation’s health system faithfully till now. But the health system has changed drastically since the establishment of referral hospitals. And DVED would now find that procuring and delivering drugs to the new and growing referral hospitals is an increasingly difficult and complex matter, especially when their main task is still to service all the other hospitals throughout the country.

So it’s time to decentralize procurement, at least for referral hospitals, and definitely for JDWNR hospital. And why would JDWNR hospital be able to do a better job? Incentives.

When drugs run out, hospital staff take the flak. They are the ones who interact with patients every day, and the ones who, as far as patients are concerned, are at fault if hospital services are not adequate. So it is in the interest of hospital staff – nurses, doctors, technicians and administrators – to ensure that drugs, especially essential ones, are always available. Ministry officials, including DVED staff, cannot, and will not, share the same levels of concern.

So decentralize drug procurement. Allow JDWNR hospital to acquire drugs without having to deal with the bureaucracy of the ministry. Otherwise, be prepared to face more serious drug shortages, more frequently.

In fact, decentralize equipment procurement too. And all personnel matters, including training. And finance. And administration. Make the nation’s biggest and fastest growing hospital fully and truly autonomous. That way, hospital staff would feel a sense of control, a sense of ownership, a sense of purpose. And that would drive them to realize their full potential and to achieve their vision.

But the Health Ministry must regulate them. And make them fully accountable. That way, services would improve, drug shortages would drop, and the health sector’s biggest disease – widespread corruption – would finally be contained for proper treatment.

Photo credit: Kuensel

Doing their part

Wangda Dorji made history yesterday morning. He revealed that he is HIV positive. And by doing so, he became the first Bhutanese person to publically disclose that he is inflicted with HIV. He made his announcement and shared his painful story with the guests who had gathered to commemorate World AIDS Day.

Later, in the evening, four more people joined Wangda Dorji. Tandin Wangchuk, Pema Dorji, Sithal Chhetri and Tshering Choden, Wangda’s wife, also revealed that they have HIV. They, along with Wangda, who is the executive director of “Lhaksam”, a nonprofit support group for HIV patients, shared their personal stories on live national TV.

They told us about the torment they felt when they found out that they were infected with HIV. They told us about the agony they had to overcome knowing that they had infected others. And they told us about the suffering they have to endure due to the stigma of HIV/AIDS and widespread social discrimination.

They also told us that they had decided to come out in the open to ease the suffering of other HIV patients, and to educate the rest of us on the realities of HIV/AIDS.

The five of them are extraordinary people. They are brave beyond measure. They have suffered more than most of us ever will. And now, by making their identities and their stories publicly known, they risk exposing themselves to even more prejudices and discrimination.

But their courage has already boosted the fight against HIV/AIDS. They have given the disease a human face – a face that tells us that HIV is not a death sentence; a face that assures us that HIV patients are regular people who live full and productive lives; a face that implores us not to needlessly discriminate against those who have HIV.

They’ve done their part. Five positive people have come out in the open and, just like that, they have demystified HIV/AIDS.

The question now is, will we do our part? Will we learn about the disease? Will we join the fight against it? But most of all, will we treat the five of them, and others like them, as normal human beings?

Photo credit: Kuensel

55% of you said yes, abortion should be legalized.

38% of you said no, abortion should not be legalized.

And 7% of you said, “I don’t know”.

I don’t know. That, apparently, is the government’s position too – they don’t seem to know.

When asked about abortions, the prime minister reportedly accepted that our laws are “causing certain problems and deaths to mothers.”

He added that, “The debate on the issue will go on, and it would be interesting to see the kind of discourse the media promote.” But that “No initiative will be taken by the government for the time-being.”

What? The government will do nothing? The government will take “no initiative” even though abortions cause “deaths to mothers”?

That is irresponsible.

Be responsible. Take a stand. Do something!

To prevent abortion from causing “problems and deaths to mothers” either make sure to stop abortion completely – through a combination of tough laws, sex education, family planning and contraception. Or make sure to legalize it.

But it’s not possible to put a complete halt to abortions. Just look at how many of us travel across the border to undergo abortions even though we know that they are dangerous and we know that they are illegal. And think about why emergency contraception pills are in such high demand. (A medical shop in Thimphu claims that, when they were allowed to sell emergency contraception pills, the I-Pill was a fast-selling drug, second only to Sinarest).

So legalize abortion. But do so with strict term limits, guidelines and procedures. And to reduce the number of women opting for abortions in the first place, increase sex education, family planning, counseling and contraception use.

Not funny

We have a drinking problem.

We reportedly consume 7.5 liters of alcohol per person per year. Much of that is served in the more than 3,000 licensed bars that we have. That works out to one bar for every 250 people. And that does not take into consideration the large-scale production, sale and consumption of home brewed alcohol throughout our country.

That’s why alcohol abuse is a leading cause of non-communicable diseases. That’s why alcohol-related diseases make up a whopping 27% of all hospital inpatients. That’s why they account for a staggering 58% of all inpatient mortality. That’s why alcohol was the top killer in 2010.

We have a drinking problem. And the government realizes it. So in order to discourage the habit, they recently increased taxes on alcohol.

Total taxes on beer produced domestically or imported from India have doubled from 50% to 100%

And total taxes on beer imported from other countries have increased from 150% to 200%

The increases in beer prices will, no doubt, discourage us from drinking beer. But that, ironically, may encourage us to drink more locally produced hard liquor.

Why? Because taxes on the more popular locally produced liquors have not gone up proportionately. In fact, taxes on Special Courier, Black Mountain Whisky and Changta Whisky have not increased at all – not even by 1%. And taxes on Rock Bee Brandy and Sonfy Liquor have only marginally increased by 10% and 15% respectively.

So expect our people to drink less beer, a beverage that generally has less than 6% of alcohol by volume. And expect our people to drink more whisky, brandy and Sonfy all of which typically contain about 40% of alcohol.

We have a drinking problem. And it’s about to get worse.

• One out of every five adults consumed tobacco – they either smoked or used smokeless tobacco.
• One third of the adult population consumed alcohol regularly. One third of them were associated with hazardous drinking and binging.
• Most adults did not exercise to meet minimum health requirement. More than three-fourths of adults did not get any exercise at all during their free time.
• Two thirds of the adult population did not eat adequate fruits and vegetables.

The results also showed that our sedentary and indulgent lifestyles were already causing needless suffering. For instance:

• One out of every ten adults was receiving treatment for hypertension. One fifth of the adult population had raised blood pressure.
• One tenth of the adult population was either diabetic or suffered immediate risk of developing diabetes.
• Over half of the adults were overweight.

That was the story back in 2007. I wonder how it would look like today. It’s time for another survey, the results of which will probably force us to take non-communicable diseases seriously.

But some data is already available. The following table, prepared by Dr Gampo Dorji of the Department of Public Health, shows a disturbing trend.

This week, on the 14^th of July, Kuensel reported that a young woman died in Phuentsholing hospital from post abortion complications. The abortion had been performed on the 11^th of July, in Jaigon, just three days after the Bhutan Today article.

Many of our women have lost their lives attempting abortions. Many, many more have suffered life-threatening complications caused by abortions. And countless others have undergone the trauma of abortions in dangerous clinics across our border.

The media have done a remarkable job informing the public about the reality of abortions, especially about abortions that go wrong. But still, the subject is taboo.

We know what’s happening. But we chose to ignore the truth.

This cannot continue. We must talk about it. This conversation will, no doubt, be uncomfortable, even difficult. But for the sake of our women – for the sake of our sisters and our daughters – we must accept what’s going on. And we must look for solutions.

What do you think?

Should we legalize abortion? Or should we explore other solutions? Please give me your views. And please take the poll.

A powerful team

It’s the tourist season. And at mealtimes, tourists across our country – in restaurants and in dining tents – will regard, with some amusement, their guides roll and set aside small balls of rice.

“Bhutanese way of washing hand!” our guides will declare referring to their pre-meal rituals. Some of the tourists will, as always, give it a try, and end up, as always, with streaks of black starch on their hands. The other tourists will laugh. And the guides will attempt to explain how we, Bhutanese, “dry clean” our hands.

This traditional way of “washing” our hands may generate some fun. But it can be very problematic too. The Ministry of Health has identified the common cold and diarrhoea as the top two diseases infecting our people. And both of them spread easily when hands are not washed properly and regularly. Last year, hospitals around the country treated more than 300,000 incidences of the common cold and more than 92,000 incidences of diarrhoea and dysentery. Tragically many children, especially those below five, still succumb to these diseases.

Health experts say that washing hands with soap reduces the incidence of diarrheal diseases by half, and acute respiratory infections by 25%. That’s a huge reduction in needless suffering, one that we could very easily profit from. Just think about it: the simple act of washing our hands with soap – especially before eating or after using the toilet – can improve the quality of our lives immeasurably. It can also prevent many unnecessary premature deaths. But that’s not all: washing hands with soap can also fight the spread of many skin infections, other respiratory diseases,  intestinal worms and numerous other infections.

Yes, we could continue “washing” our hands with rice. But, let’s do so only after we’ve first washed them with soap.

Today, October 15^th, is Global Handwashing Day!

And during question hour today, I wanted to ask a second question, this one on an issue that we have not talked about at all in the National Assembly. I’d wanted point out the growing number of suicide cases in the country. And ask the minister of health if the government was responding to this terrible trend.

Unfortunately, I didn’t get to ask this question, as the Hon’ble Speaker did not allow it.

I’m worried that the number of suicide cases in our country is unusually high. And I’m worried that it is increasing.

In one month alone, in January 2009, 15 suicide cases were reported around the country. In January and February this year, 13 cases were reported.

According to police records, there were 53 suicide cases in 2008 and 49 cases in 2009. This year, as of April, the police have already recorded 25 suicide cases.

By any measure, these numbers should give cause for concern. But considering our small population, and our emphasis on GNH, these figures should be alarming.

25 suicides in 4 months. That, extrapolated, is 75 cases 12 months. That works out to 11.9 suicides per 100,000 people. And that would place us at number 34, if we were included in the list of countries by suicide rate.

Something is gravely wrong. And we – all of us, not just the government – need to do something about it.

1. The National Assembly is in session;
2. The World Cup is on; and
3. My cough persists. It refuses to go away, and has kept me, and my family, awake for many frustrating nights. But, countless home remedies and two ill-advised rounds of antibiotics later, good sense eventually prevailed – I consulted a physician. The specialist ordered a sputum culture, identified the offending bacteria, prescribed the right antibiotic, and, just like that, I’m already feeling better.

Six weeks ago, the Annual Health Bulletin announced that 37% of our children are stunting, that 4.6% of them are wasting, and that 11.1% are underweight.

This week, we learnt that the Right to Food Assessment Study concluded that 26.6% of our households are undernourished. That would also roughly mean that about a quarter of our population is undernourished. The study, it seems, was conducted sometime last year by FAO and the Ministry of Agriculture.

And recently, the Basic Health Worker in Chali has reported that “the number of malnourished children under the age of five in Chali geog under Mongar has almost doubled in just one year.”

We now know, from independent sources, that our people are undernourished. And that our children are stunting, wasting and underweight. So what are we doing about it? Not much. In fact, we seem to be doing nothing to specifically address this crisis.

What should we do? “Wage a WAR AGAINST MALNUTRITION,” cries Zekom. This is what Zekom implores:

Reducing poverty, especially rural poverty, is an obvious answer.

But, children cannot wait for Drukyul to get richer. Our nation’s future is being made NOW.

Wage a WAR AGAINST MALNUTRITION. Take the nourishing food to where the children and infants are — in schools and beyond schools — targeting the nutrition and trace elements missing in their diet.

Make sure to measure outcomes, in physical growth rates of beneficiary children, very frequently. You’ll be amazed how fast it works, if it’s done right. There’s nothing better than rapid positive results to fuel the FIRE in change agents’ belly, and inspire others to join hands.

Countries such as UK, Germany and Japan benefited from such programmes after the World War II. Concentrated orange juice and cod liver oil were delivered to every household with children under certain age in UK. Milk and various sources of vitamins were delivered to every infant and school lunches in Japan. Who financed these? USA. It was the top priority in their postwar reconstruction assistance efforts.

Recruit UNiCEF, UN World Food Programme, and other UN agencies as partners, and tap their global know-how on how to do it and do it right.

Where there is a will, there is a way.