Sonam sprained two fingers at a football match in Changlimithang on Saturday.  As he was being substituted, his friends brought out the names of at least three local healers he should immediately visit.

The nearest was the national referral hospital with x-ray machines, orthopedists and painkillers available all round the clock.  But Sonam went to see a school caretaker, reputed for fixing sprains and fractures.  Yesterday, he had to go to the referral hospital, as one finger was not fixed.

This is in the capital city among the so-called educated lot.  So, when we hear that one in 10 patients visiting Trashigang hospital had visited a traditional healer first, it is not surprising.

But what transpires after getting treated by a local healer is worrying.

Sometimes local healers can get it completely wrong.  A classic case is the woman diagnosed with gallstones, which the healer tried to suck from a small cut in her stomach.  Local healers are popular.  That’s why they outnumber trained doctors, health assistants, menpas and nurses.  As of today, there are 1,683 of them in the country, far more than trained health officials, including doctors and specialists, whose number as of 2012 was 1,471.

Local or traditional healers were helpful and common when hospitals were few and trained people fewer.  Today, we have almost one basic health unit in every gewog, and most gewogs are connected with roads.  Yet villagers prefer to seek local healers’ help.  In urban areas, the numbers are few and related only to a few cases like fractures.  Statistics show that about six percent of the population consulted a traditional practitioner in 2007.

Seeking the help of these practitioners is deeply engrained in our minds and even with the most sophisticated health system, they will be around.  There is a strong connection with the pows and pams (shaman), astrologers and traditional healers.  From rituals to preventing illness to treating them, they have become a part of the Bhutanese psyche.

If their role can be restricted to prevention by performing ritual, there will be no complications that doctors can complain of.  But they will continue to be the first to contact during illness in the backwaters.  What we can do is bring them along on board.  Training them on basic safety measures – like sterilising a blade before use.  Shamans might be good at treating ailments that are related to the mind or psychology, like possession.  But beyond that it is safer for them to refer patients to hospitals or BHUs.

There are awareness campaigns and some training.  These should be enhanced.  It would be easier to target 2,000 local healers than thousands of villagers across the country.  For a change, we should target and discourage local healers from treating patients, if they feel it is beyond their capacity.  Honesty among healers would help achieve this, rather than banking on ego.

Some illness, like appendicitis, could get complicated if medical help is delayed.  Not all stomach problems are thribkham (a strong belief that eating something from strangers makes you sick).