Leprosy has been known as a disease in Bhutan for many years. Written accounts of it by Foreigners who have been visiting the country in the last two centuries make note of it. However, the first hospital in the capital to focus on treatment of lepers in the country was set up only in 1968.
In the early 1960s, when the fledgling Health Services was set up, combatting leprosy was at the top of the country’s agenda. In September 1964 Bhutan’s government invited The Leprosy Mission to start a leprosy service in cooperation with the Government. By then TLM had set up a hospital in Purulia, India. Set up in 1874 in Ireland and developed as a British-based organisation, the goal was to heal, and give dignity to leprosy-afflicted people around the world.
When Alfred Dennis (Eddie) Askew (1927-2007) visited Bhutan, it was as head of a three-man team. At the time, he was only 37 years old but already had 14 years of working experience with leprosy in India. During the 1950s and 60s, the disease was considered deadly and highly stigmatising. The fact that the number of people suffering from it was on the rise did not help either.
But Eddie jumped into the fire. In 1950, one month after his marriage, he set sail to India with his wife. He started his career as a principal of the school for the children of those affected by the disease in Purulia. After two years, the mission appointed him as the supervisor for their 600-bed home and hospital.
The goal of Eddie’s maiden visit and mission to Bhutan in 1964 was to do a preliminary study of the prevalence of leprosy. During their stay in the country, the team met many people suffering from untreated leprosy. They also held meetings with the Prime Minister and other government officials.
After their Bhutan mission, the team fielded their report. Written from Purulia the report was dispatched to TLM’s International office in London. In 1965, Eddie returned home to Britain, where he took up the post of executive secretary at TLM’s office in London. Known for his strong Christian beliefs, droll sense of humour, art and poetry, and his practical expressions of love for those in need, the man played an instrumental role in supporting the Mission’s work in Bhutan. He spent his retirement painting and wrote 16 books, the sale of which raised around £2.5m for TLM.
The Result
The result of the report was that within a month, TLM received its first volunteer to work in Bhutan. Like Eddie, Dr. Gottfried Riedel (1921-2014) had served with The Leprosy Mission since 1951. But unlike Eddie, the German volunteer was already an experienced doctor.
Dr. Riedel worked in Bhutan from 1966 to 1968 supporting the National Leprosy Programme. When he first arrived in the country he was stationed in Thimphu. At the hospital, he performed general medical work. He also assisted the Health Department in establishing a leprosy control programme. Plans for construction of a leprosy hospital in Gidakom were already being hatched.
During his stay TLM expanded their work up to Mongar. They built hospitals in Yepilabtsa and Lhuentse. When the Gidakom leprosy hospital was opened by Her Majesty Ashi Kesang Choeden Wangchuck in August 1968, Dr. Riedel was already in place as Superintendent. In the two years since his arrival, the doctor had surveyed most of the country for leprosy. Shortly, afterwards, he left Bhutan returning back in 1982 and worked here until 1986.
The Caesarean Section
In an interesting turn of events, during 1966 the doctor created history by performing the country’s first caesarean section (commonly referred to as c-section), the surgical procedure in which a baby is delivered through a mother’s abdomen. Although he had no background in surgery, Dr. Riedel was called upon to operate on patients. Thus, he ended up carrying out Bhutan’s first c-section, in 1966.
The operation is described vividly in his book, “Mitt Gott über Mauern springen” (trans. Jump over the wall with God). The following is a translation from the book.
“In the evening I had to return to the hospital (Thimphu) as a primipara (first delivery) with a transverse lie of the baby had arrived and needed a caesarean section. Since the woman had elevated blood pressure, I was not very comfortable with the situation but, under the circumstances, the only possibility of bringing the child into this world was to perform a caesarean section. I had never performed a caesarean on my own and my time in the gynaecological ward was 17 years behind me.”
The book talks about how after the dinner, the doctor studied the surgery book. He then went to see Dawa Dem, the Head Nurse. At the time, neither the nurse nor any of her staff had received any training in this type of surgery. No caesarean section had ever been performed in Bhutan. But all got involved with great zeal.
Dr. Riedel said that the team was able to identify the necessary surgical equipment and he then distributed the tasks among his assistants.
He said that he performed the operation with a light basic anaesthesia and lumbar anaesthesia. Unfortunately, none of his colleagues from IMTRAT and Dantak were available to assist. So, he had Phub Dorji controlling the patient’s blood pressure while Dawa Dem assisted with the surgery. Blood transfusions were not available, but he gave an infusion.
In the book, the Doctor talks about how he placed the surgery book on a stool next to the operation table and assigned another assistant to turn the pages. Fortunately, there was no shortage of helpers. As with all major operations, he started with a small prayer, in recognition of the fact that much could go wrong. The operation took a long time since he had – for every step – first to read what it said in the book and then to perform the procedure. But all went well and everyone was happy when a small boy was delivered. His first cry was greeted with many hellos.
The mother understood the procedure surprisingly well. When she came around and the medical team put the baby in her arms, she was a bit confused about how she could have given birth this way but also somewhat proud that she had done it.
Over the years, TLM in co-operation with the government of Bhutan became responsible for leprosy control over much of Bhutan from Haa to Mongar.
In his “Medical Account of Journey in Bhutan 1968” Danish Dr. Claus Brun includes a section on Leprosy, commenting that he and his wife were especially impressed by the work which Dr. and Mrs. Riedel had carried out in Gida Kom, “where they under primitive conditions had created a highly effective unit and shown what results can be achieved with active treatment.”
The medical report highlights the treatment meted out to the lepers, “Since patients with leprosy are not ostracized in Bhutan, they are not easily detected. Furthermore, since many are reluctant to leave their village to seek western type medical help, good examples like Gida Kom are of immense importance for the acceptability of modern treatment and thus the control of Lepra in the country.” Dr. Brun’s observations concerning the leprosy situation during the year of his visit are worth a mention. He said that the Lhuentse leper colony in the Kurtoe valley was run by a compounder.
This compounder was Tobgyal. He is described as a dedicated man, who was hampered in his possibilities by the lack of access to medical supplies. All the compounder had was sodium carbonate, “and this state of affairs seemed to have existed for a long time.”
Dr. Brun’s concluded his remarks stating “A disquieting fact was that a considerable number of young children were roaming around in the colony in close contact with the patients and probably highly exposed to infection. The magnitude of the leprosy problem in Bhutan is hard to evaluate, but is likely that a number of undiagnosed cases exists in many of the isolated villages in remote areas.”
Conclusion
In the early 1960s, when the Bhutanese Health Department focused on improving the health of its people, control of leprosy was given top priority. They began in September, 1964 with the help of volunteers from The Leprosy Mission. In 1966, the 50 bed Gida Kom Leprosy was established near the capital, Thimphu. Interestingly, one of the early volunteers who came to combat leprosy, Dr. Gottfried Riedel, also distinguished himself by performing the first C-section in Bhutan.
Contributed by
Dr Bjorn Melgaard and Tshering Tashi