Starting three thromde health centers in Thimphu should ease the burden on the national referral hospital. The JDWNRH, by name, is the national referral hospital, but in reality, the hospital is overwhelmed by the sheer number of people visiting it. We can safely surmise that 90 percent are self-referred patients.

As the best-equipped and the biggest hospital in the country, it is natural for the sick or their relatives to take patients to JDWNRH. This is even if a lot can be screened at the lower hospitals or clinics. 

With the new centres equipped with a medical officer,  health assistants, technicians and services like X-Ray, ultrasound, oral health, family health services, minor OT, and basic trauma services, it should ease the burden on the national referral hospital. Today, as we all know, the sick do not trust the clinics, basic health units and dzongkhag hospitals, not because of lack of services or facilities, but because of the belief that JD has better care or facilities.

It is ingrained in our minds that the bigger the hospital, better the services. It may be true, but when it comes to basic illness like a flu or a fever, the treatment is the same at all levels or grades of hospitals. If the national referral hospital needs time and space to cater to genuine and severe cases, or if they need to learn through treatment and research, health professionals cannot be burdened by catering to those who got to the hospital by self-referral or through connections. 

 Catering to 155,000 people from 20 dzongkhags and 500,000 OPD cases every year can not only overburden the national referral hospital but will leave them no time or opportunity to learn and improve services.

At the same time, a pertinent question is why are people not trusting the basic health units or the dzongkhag hospitals. If it is related to the quality of services – expertise or equipment, we need to improve it. If we can improve the quality, many would not want to spend time and money to come to Thimphu. 

An easier way to stop burdening the national referral hospital is sticking to rules. If the system says that they will prioritise attending to those referred by lower or dzongkhag hospitals, if they are not influenced by connections or give in to pressure from those in power, people will avail services at the dzongkhag or regional level. 

Today, it is seen as a failure if we cannot take the patient to Thimphu even if it can be treated at a BHU or a dzongkhag hospital. There is social pressure without understanding the need. If a patient needs to be genuinely referred, doctors know it. Genuine cases are even referred to hospitals outside the country at a huge cost. 

It is difficult to equip health centres. It is even more difficult to convince people that some common illnesses could be treated without coming to Thimphu.  However, if we have just hospitals or health centres without doctors, health assistants or basic equipment, the rush to Thimphu will continue.