Painful solutions

I couldn’t sleep well last night. I shivered and shook, and tossed and turned as powerful antibiotics tried to fight off an infection and a growing fever. I’m a lot better now. But my whole body aches. I feel drowsy. And I spent most of the day in bed.

The cause of my misery is my tooth. Yes, it’s the same one that I treated about three months ago. This time the dentist, Dr Pratap Tamang, a veteran, examined my tooth, ordered an x-ray and decided that, if I wanted to save the painful tooth, he would have to administer a root canal treatment.

“Shouldn’t we just extract it?” I suggested. “No!” Dr Tamang decided firmly, “the opposite tooth is good, so you should undergo an RCT”.

Images of my son – then only 13 years old – enduring the painful ordeal flashed in my mind. And I thought, “Why me?” But those same images of a brave young man readily agreeing to take to the dentist’s intimidating chair, many times over a whole month, reassured me. So I agreed.

Dr Thapa opened his appointment book. He flipped page after completely booked page, and announced that he would be able to start my treatment only after three weeks. I’d have to wait before I undertook the infamous ordeal.

In order to avoid the normal morning rush, I’d gone to the dentist a little before their closing time, 2:30 PM. As expected the hospital was almost empty by then. Nurses, technicians and doctors were making their way out of the hospital to meetings, to their homes or to attend to personal work. And by the time I left, the cleaning staff were already preparing the hospital for the next day.

This is a waste of resources. Especially, since the demand for health services in the capital is still growing and growing exponentially. So, I’m glad that the government is seriously considering ways to extend the hospital time by starting “off hour clinics”. But we continue to be plagued by a shortage of health personnel. And we cannot expect our professionals to work beyond their normal working hours without adequate incentives. So we need to recruit more people. Or we simply pay the existing staff for working after hours.

This, obviously, is easier said than done. A patient’s treatment involves a whole range of health professionals from doctors and nurses to technicians and administrative staff. And, of course, cleaners. So calculating who should get what and how much will not be easy.

But we must make a beginning. And the dental department, which is mostly independent from the rest of the hospital, is a good place to start. Lessons learnt from there will be useful if and when we develop a hospital-wide system.

Off hour clinics, whether fully subsidized by the government, partially privatized or fully privatized, need to be seriously considered.

I don’t want to wait so long for the root canal treatment. And I certainly don’t want to bear another tooth ache before the treatment. So, right now, I am in the mood to welcome an off hour clinic for the dental department.

A big problem

We have a problem. In our last poll, 94% of you claimed to either know or think that drug abuse is already a problem in Bhutan. On the other hand, only 5% of you said that drug abuse is not a problem in our country. 1% admitted that they don’t have a clue.

I suspected that substance abuse was growing, especially among out youth. But, I had no reason to think that it was already a problem. The poll results have forced me to rethink my views – that’s why I kept the poll up for so long. Next week, I plan to discuss this issue with the government including the Ministry of Health, Ministry of Education and Bhutan Narcotic Control Agency. I’ve also arranged to meet some youth.

This week’s poll asks: “how prepared are we to cope with disaster?”

A problem

Last Friday, an MP asked the health minister, Lyonpo Zangley Dukpa, what his ministry was doing to address the growing problem of drug abuse in our country. In his response, Lyonpo Zangley informed the National Assembly that, in 2008, a total of 418 people had been arrested for drug abuse. And that, in the same year, in 2008, 132 drug dealers had been arrested and charged in our courts.

Now look at the numbers. 132 drug dealers and 418 drug addicts were caught in the same year. That’s only 3.17 drug addicts caught for every drug dealer caught. And that can’t be right. The average drug dealer must surely have many more customers. And so, 132 drug dealers would actually cater to several times the 418 drug addicts who were caught.

But consider this: no one really knows how many drug dealers there actually are in our country. It’s obviously more than 132. And, obviously, the greater the number of people selling drugs would mean that we have an even greater number of people using them.

And consider this: in the last month alone, Thimphu police arrested 57 drug abusers.

We have a problem.

Impressive healthcare professionals


I had a toothache last week. So on Friday, I went to the JDWNR hospital where Dr Kuenga Penjor, a young dentist, showed me that one of my molars had developed a big cavity beneath an old filling. He quickly removed the old filling, cleaned the cavity, and applied a new filling. My aches gave gone, and my tooth now feels as good as new.

Dr Kuenga studied dentistry for six years at the Patna Dental College under a GOI scholarship. He is only 26 years old and has already decided to become an orthodontist. I’m impressed.

I’m also impressed with his assistant, Sangay Wangmo, a trainee at the Royal Institute of Health Sciences. I’m impressed with Sangay because, when I last saw her, more than two years ago, she was working at the Ministry of Labour and Human Resources as a receptionist. But she wanted to do more. So she enrolled at the RIHS. Another year and she’ll be a certified dental technician. Well done.

Deadly numbers

My cousin, Lop Nob Tshering, died last week. He was a teacher at Dechenchholing MSS and had barely turned 45. He died at home, suddenly. Family and friends all agree that he died because of alcohol – he was a chronic alcoholic.

No one knows how many people die at home from alcohol related problems. My cousin lived in Thimphu. And yet he died suddenly and at home. Imagine what happens outside Thimphu. Imagine the number of alcohol related deaths that go undetected. That number must surely be much higher than the number of people dying because of alcohol in our hospitals.

And how many people die in our hospitals? In the last four years 606 patients were admitted to the JDWNR Hospital with alcohol related illnesses. 138 of them died there; they never recovered. For many years now, the leading cause of death in the hospital has been alcohol related illnesses.

But of the patients who recovered and were discharged from the hospital, some would have started drinking heavily again, become ill and died without going back to hospital. How many? No one knows.

Then there are people like my late cousin. They may or may not have been to hospital, may or may not have been admitted, but eventually die because of alcohol.

The point is this: no one has a clue. Even the numbers reported by the health minister in the National Assembly yesterday is very different from the information I got from JDWNRH. He reported that of the 1471 people were admitted to JDWNRH in 2007 of alcohol related diseases, 98 of them died. JDWNRH told me that the numbers for 2007 were 167 and 37 respectively.

So first things first: we need reliable data. We need to know how many people are alcoholics; how many have died; the costs, in free medical services, to the government; and the costs to society and the economy. We also need to know why, when and how so many of us become dangerously alcoholic.

Only when we know and accept the gravity of the situation will we be able to formulate clear policies and workable strategies to reduce alcoholism among us.

Then we can get down to the serious business of implementing the policies. And for that here’s good advice from Aum Zekom: “What works is a strong teamwork between concerned public agencies and citizen’s social organizations, supported by compassionate society, and led by a strong political leadership who champions the cause.”

Today’s deadly numbers: The photograph is of the JDWNRH medical ward. Of the 27 patients there today, 7 had liver cirrhosis. Of the 9 patients in the cabins, 3 had liver cirrhosis. All of them were caused by chronic alcoholism.

Without alcohol there would be more happiness

Dorji died a few days ago. He was my classmate in Kanglung. He died of alcohol related problems.

Dorji was among the 75 of us who entered Class XI in Sherubtse College, Kanglung in 1982. Another two of my classmates from this batch have also died – Devi Bhakta and Thinley Penjor. Both of them died from alcoholism.

One of my classmates was recently in the ICU. He’s still recovering from alcohol related complications. At least three more classmates are chronic alcoholics. And many of us are heavy drinkers.

Alcohol has already killed three of my classmates. And it threatens to kill three more in the near future.

This is just the tip of the iceberg among my classmates.

And the very tip of a very large iceberg in our beloved Drukyul – with less alcohol there would be more happiness.

A Girl with AIDS

My blogging efforts are paying off – yesterday I was invited to a private screening of “A Girl with a Red Sky”, a film about HIV/AIDS.

The film is short. But it is powerful. Tashi Gyeltshen, the film’s writer and director, presents a series of matter-of-fact conversations between the protagonist, a nine-year old girl dying of AIDS, and Death who has come to get her.

The film highlights the horrors of HIV/AIDS from a very different perspective – it shows Death shocked by the ruthlessness of the dreaded disease.

“A Girl with a Red Sky” was funded by UNICEF and YDF, and has reportedly already caught the attention of international HIV/AIDS activists. I am not surprised.

Nor will I be surprised if the film wins some international awards. Three Bhutanese directors have already shown the way: Dorji Wangchuk (for School among Glaciers, and Long Walk to Education), Kesang Chuki Dorji (for Doma Sellers) and Ugyen Wangdi (for Price of a Letter)

Well done, Tashi, and good luck.

(Of the 19 new HIV/AIDS cases detected in our country last year, 2 were infants.)

A bigger (and better?) hospital

In the fall of 1974 the brand new 60-bed Thimphu Referral Hospital was inaugurated to commemorate the coronation of His Majesty the Fourth King. The hospital has served Thimphu and all of Bhutan faithfully for the last 34 years.

Yesterday, Her Majesty the Queen Mother, Ashi Tshering Pem Wangchuck inaugurated the brand new 350-bed Jigme Dorji Wanchuck National Referral Hospital to commemorate the coronation of His Majesty the King and 100 years of monarchy. Our new hospital comes equipped with central heating and cooling, 8 OTs, 64 ICUs, central oxygen supply, 48 cabins, ward cubicles, digital x-ray, telemedicine facilities and satellite links to the best hospitals in India. State-of-the-art stuff priced at almost Nu 1 billion and financed mainly through GOI assistance.

The aim is to develop the JDWNRH into a tertiary hospital capable of providing high-end diagnostic and curative services for all Bhutanese. This makes good sense considering the number of Bhutanese traveling to India and Thailand for medical treatment. There’s even talk of medical tourism!

To achieve this lofty aim, however, the hospital will first have to be staffed with enough doctors, nurses and technicians. This will be difficult and expensive, especially since we already have a severe shortage of health professionals. Many foreign doctors will have to be recruited, and his is okay both as a stop gap measure and means to promote transfer to knowledge.

But don’t forget our existing health professionals – too many of them are unsatisfied, many are contemplating resignation, and some have already submitted their resignations. We cannot afford this. If we want the new JDWNR Hospital to serve Bhutan as faithfully as the old General Hospital, we need to take care, first and foremost, of our own health professionals, especially doctors. So, the inauguration of our new hospital may be a good time to review and overhaul their service conditions and their career prospects. Otherwise we’ll end up with a bigger hospital that’s not necessarily better.

And what will become of the old hospital? It will be razed to make way for the new medical college. Excellent!

By the way, the Thimphu Menkha, located in Langjophakha, served as Thimphu’s hospital from the early 1960’s till it was relocated in 1974. That hospital had only two doctors – the Late Lyonpo (Dr) Tobgyel and Dasho (Dr) Samdrup. Those medical poineers worked with no internal plubming, no electricity, and no telephones. By all accounts they did a good job.

And the Thimphu Menkha in Langjophakha? It’s now used as family quarters for the Tashichodzong police.