No budget has been allocated to date to set up a surveillance system

Health: If an Ebola case comes home, Bhutan would have to spend an amount that is several times more than the amount that’s spent on the country’s health system today.

It’s for this reason that despite the outbreak of Ebola Virus Disease being far away from home, public health officials and the World Health Organisation (WHO) country office are stressing on the adage “prevention is better than cure.”

“One Ebola case in Bhutan will be considered a national emergency for Bhutan,” the draft Ebola risk communication strategy, 2014, states. “The health facilities in Bhutan are already over stretched and will within no time be overwhelmed even if one Ebola patient comes into Bhutan.”

The risk of Ebola coming to Bhutan is “very low” at present because it doesn’t share borders with any of the affected countries as well as don’t have direct inbound flights from affected countries.

“However, there is a high risk for Bhutan to be affected by Ebola considering the number of international travellers coming to Bhutan, porous borders with India and also Bhutanese working in Ebola affected countries,” the strategy states. “If they have close contact with Ebola cases, they could be index cases for Bhutan; and the capacity to cope with Ebola cases is very limited.”

For instance, if an Ebola patient were to be kept in isolation in Paro hospital, the district’s health facility would need additional manpower. “We need at least three doctors and additional nurses to keep a check on the patient in shifts,”

Paro’s district health officer Dechenmo said during a WHO organised media sensitisation workshop on Ebola recently in Paro.

Over 1,000 passengers fly into the Paro international airport daily from different destinations while thousands more enter the country through the land crossings at the borders every day. “If the neighbouring countries get Ebola cases, then the risk for Bhutan becomes high,” the strategy states.

Based on a WHO checklist on preparedness, the health ministry has estimated a budget of Nu 52.08M that would be required for Bhutan to implement its Ebola control measures.

The WHO reports that the situation is expected to continue for the next six to nine months.

However, while discussions have been held and are still ongoing, the budget has not yet come through.

Limited knowledge on the symptoms and associated risks of Ebola and the attitude that the disease cannot reach Bhutan given the distance could be some reasons on why the issue isn’t getting attention, say health officials.

“We are ready on paper and we have requested but the budget as such is not forthcoming for us to put in place the surveillance measures,” health secretary Dr Dorji Wangchuk said. “We are still having dialogues even though there has been no case reported in the region.”

The ministry, according to the health secretary is not overdoing by proposing to put in place these measures. “We would like to take these as investments just as BAFRA did during the H5N1 outbreak,” he said. “We are also waiting for the airport’s expansion work to complete to set up the screening measures.”

National leadership is identified as one of the essential components for control according to public health officials besides community awareness and support.

“We are stuck on this plan for a month now and we just need the budget to get it all started,” chief program officer of communicable diseases division, Dr Karma Lhazeen said. “Ebola is an opportunity for Bhutan to be prepared for all public health emergencies.”

One of the agencies that would be closely involved is the department of disaster management. Health officials however said that its preparedness and response budget would be activated only if earthquakes and other disasters occurred and of it affected a certain number of people.

“But is our disaster team aware that even one case of Ebola would be a disaster,” a participant at the media sensitisation workshop, that WHO and health ministry organised said. “There is a need to convince authorities that money is needed to set up the surveillance system.”

By Sonam Pelden, Paro