Building specialist pool: long-term investment  

Younten Tshedup  

To address the shortage of medical specialists in the country, the government earlier this year brought in 19 specialists from Bangladesh on a two-year contract.

The specialists included seven anaesthesiologists, five general and an orthopaedic surgeon, three paediatricians, a gynaecologist, a medical specialist, and a nephrologist (sub-specialist).

Two of the specialists left the country. It was learnt that while one of the specialists had left due to personal issues, the other was found to be a non-practitioner, although his certificates stated otherwise.

Concerns were raised if such incidences continued, as recruiting foreign specialists, for now, was the only short-term option to address the shortage, more issues would arise.

Speaking to Kuensel, Prime Minister Dr Lotay Tshering, said that the selection criteria, set based on the number of years of experience, were scrutinised by the Bhutanese and Bangladeshi embassies. The salary package was also based on the number of years of experience.

Lyonchhen said that although the selection process had incidentally allowed a non-fulltime practitioner to get through, stopping the recruitment of foreign specialists altogether, would not solve the  shortage issue in the country.

“If we are to consider this, then we cannot bring foreign specialists at all. Having a good screening and observation system in place can address the issue better.”

Lyonchhen said that the Bangladeshi specialists work with the Bhutanese counterpart and many of them were ‘real professionals’ both in terms of clinical management as well as in academics. “None of them has actually shown any inferiority in terms of knowledge and skills. But some just couldn’t cope up with the environment and patient load.”

The prime minister said that the bigger problem was that of not getting specialists. “Actually, we wanted some more doctors but we couldn’t get them because what they earn here in a month is what they make in less than a week in their country.”

Doctors who had agreed to come, Lyonchhen said, were those who valued Bhutan’s GNH ideals, the clean environment and the country’s rich culture.

Efforts to bring in specialties from India and Sri Lanka were futile as not many showed interest, mainly due to the financial aspect. Doctors from Bangladesh came following Lyonchhen’s state visit to Bangladesh last year, where he had put up the requisition for specialists.

 

Building specialist pool 

Shortage of medical specialists is an issue bothering the health ministry and the government. The country today has 129 specialists. There are also close to 100 doctors who are currently pursuing their post-graduation (specialisation), both within and outside the country.

Most doctors are expected to complete their training by the end of the current government’s term in 2023. However, Lyonchhen said that his worry was not about the five years.

“If that was my worry, I would have done everything in our first year and by 2023, they would have joined the system,” he said, adding that his concern was for generations. The government continues to send doctors for specialisation within and outside countries to build the country’s specialist pool.

Nganglam’s Member of Parliament, Choida Jamtsho, during the question-and-answer session of the National Assembly yesterday, questioned the prime minister on the government plans to deploy specialists in dzongkhag, regional and other hospitals, amid the shortage.

Lyonchhen said that of the many priorities, the DNT government’s primary objective was to strengthen the healthcare system in the country and deployment of specialists was a major part of the objective.

Lyonchhen said that it takes at least nine years to produce a specialist. “The present shortage of specialists is not the current government’s doing. If there is a shortage after 10-15 years, we will take the blame.”

He added that despite the shortage, the government managed to send four specialists to Samtse and seven to cater to the 27,000 plus population in Phuentsholing. The two regional referral hospitals in Gelephu and Mongar have 21 and 27 doctors respectively.

The doctor to population ratio in the country currently is about 1:2,000 against the World health Organisation’s recommendation of 1:1,000. “We have come a long way. JDWNRH has one of the best surgeons to patient ratio in the world today.”

While shortage was a problem, Lyonchhen said that it was equally important to efficiently use the specialists. “At the rate at which we are going, by 2030 we might have to conduct selection for specialists.”

Bumthang will get its specialists   

Lyonchhen said that as promised, Bumthang will get the four specialists, which he had pledged during the recent Chhoekhor-Tang bye-elections. “It is declared and we have to do it.”

Lyonchhen said that the specialists, as promised, would be sent as soon as possible. Irrespective of the results, he said that people in Bumthang would have got the road blacktopped including the doctors in due course of time. “My appeal was that if they respected my request, I would help expedite the process. They needed a road and we needed votes, so I said let’s work together.”

He added, “People said it was a blackmail. But there is no campaign without pledges.”

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