The Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) in Thimphu will introduce radiation therapy service for the benefit and convenience of referral patients and their escorts.

The service is expected to be in operation by the end of this year.

The hospital’s president, Lhab Dorji, said, cancer remains the most referred case. On an average, 1,200 patients are referred abroad every year, mostly to Kolkata and Vellore in India for treatment. About 50 percent of those referred are cancer patients.

The annual out country patient referral cost increased from Nu114.2M (million) in 2010 to Nu 192.9M last year.

Health minister Tandin Wangchuk said that by introducing the service, patients might not have to travel abroad to avail the service, which is a hassle. Providing the service at home would save about 30 percent of the referral cost.

Lhab Dorji said that besides the substantial amount of money spent on radiotherapy and chemotherapy, the patients suffer when they are referred for treatment abroad. “Introducing the service in the country will also develop the capacity of the country to carry out the specialised service.”

He said it is expensive for patients and escorts to stay in a hotel for long durations and have to adjust in a guesthouse. Getting appointments, getting a place to live in, a problem in communicating and commuting are some of the challenges faced by the referred patients and escorts especially if they are from rural areas.

“There is also a risk of people especially from remote villages to get lost in the city. In fact, a Bhutanese man was lost in Kolkata earlier this year and we could not find him,” Lhab Dorji said.

He said that in the case of patients referred for a kidney transplant, the patients are kept in the hospital where staff take care of them. But for cancer patients, they are sent back after their chemotherapy or radiotherapy is done.

Considering these factors, Lyonpo Tandin Wangchuk said that the hospital board approved the introduction of radiotherapy service in the country. The hospital took about two years to study, negotiate and get the approval to introduce the service.

Lhab Dorji said the linear accelerator (LINAC), a machine that is used for external beam radiation treatments for patients with cancer is in the country and the bunkers, which were made during the construction of the hospital, are being prepared for the operation of the service.

The machine is imported from Germany.

Lyonpo said that radiotherapy is a complicated service and requires many specialists and engineers to operate. Which is why, the service is being outsourced to an international firm. “It might take ages if we have to start the service by ourselves.”

The service is outsourced to an international aid organisation, CARE Australia for 12 years. The firm will install LINAC at JDWNRH by end of next month and will have a nuclear physicist, an oncologist and a surgical oncologist as and when it is required.

Lhab Dorji said that most cancer surgeries are carried out in the national referral hospital, after which the patients are referred abroad for radio and chemo therapies.

He said the hospital recently started carrying out some chemotherapy sessions for its patients. “If a patient requires a few sessions of chemotherapy after doing radiotherapy in India, we bring the drugs from the hospitals outside and carry out the session here.”

The team from CARE Australia will provide the whole treatment at the national referral hospital. The team will be under the oncology unit in JDWNRH.

“We have trained our technicians who will be attached to the team. CARE Australia will also train an oncologist in the country in the coming years so that he or she can take care of the service after 12 years,” Lhab Dorji said.

Lyonpo said that university postgraduates could also take up specialisation in the course. “Of the four specialised services that will be introduced in the country in cardiology and paediatric, this is the major one.”

The hospital will pay Nu 1 million every month for using the machine while the payment for the service will be on the patient basis.

The hospital also plans to install a brachytherapy machines six months after the operation of the radiation therapy service. Lhab Dorji said that there are some legal formalities to be carried out to have a brachytherapy service and also a proper assessment is required. “Brachytherapy is explicitly used for the treatment of cervical cancer.”

Health officials said there would be no nuclear waste from LINAC. In brachytherapy machine, they use an isotope of iodine that emits radiation, which has to be changed every 72 days.

“Since we don’t have a nuclear agency in the country, we will be working with a firm in India to replace the isotope. The firm will take the used isotopes so no nuclear waste will be in the country,” he added.

Lhab Dorji said people may question the standard and quality of the treatment but assured that the hospital will maintain the standard and quality of treatment. “The government is spending a huge amount to introduce the service but we will be reducing the referral cost,” Lhab Dorji said.

Dechen Tshomo