The Recent History of Epidemics in Bhutan

In July 1918, there was an outbreak of cholera in Paro and Thimphu. More than fifty people died.  On the request of our first King and with the support of the Government of India, Dr John Anderson Graham sent two medics. In two weeks the duo contained the epidemic and treated all the patients. Dr Graham was a dear friend of our first King and lived in Kalimpong.

The two medics were Dr Ethel Constance Cousin, M.D.B.S and Nurse Brodie. At the time, both the ladies were working in the Church of Scotland’s Medical Mission in Kalimpong. The pair trekked eight days braving the elements and crossed four high mountain passes to reach Paro.

The British documented the 1918 epidemic but it is little or not known in Bhutan. The story of the two English ladies made the front page of the monthly magazine, “The Woman’s Guild Life and Work, ” February 1919 issue. The British Political Officer makes a brief mention of it to the Foreign office in London.  Dr Cousins letter provides the insights of the events.

The Women’s magazine article reads, “Absence of any medical aid and any form of sanitation, many hundreds were dying.” From the article, we learn that as the situation worsens, Gongzim Sonam Tobgay Dorji wired Dr Graham for two doctors to be sent to Bhutan. By then, a supply of medicines had already been sent to Paro. The life-saving drugs were of no use, as Bhutanese refused to enter the house of the sick to distribute them. The magazine article talks about how Bhutan had to obtain special permission from the Government of India to allow Dr Cousins and Nurse Brodie to come to the rescue.

On 31st July, Dr Cousins is already on her way to Bhutan. She is in Yatung and writes a letter to her family from the Dak Bungalow. In the letter, she writes about how early in the month she received news that cholera had broken out in Bhutan. Gongzim Sonam had sent a letter to the Charteris Hospital requesting for medicines which were immediately dispatched. 

Few days later, on 20 July, the hospital received the second telegram requesting for two doctors to be sent to Bhutan to distribute the medicines and treat the patients.

The Doctor’s letter, talks about how Dr Graham sent her the telegram, “I got it in the middle of the hospital round.” She said that when she showed the letter to her superior, he received it very coolly saying, “we have no doctors to spare.”  Not dissuaded, Dr Cousins went straight to see Dr Graham who was delighted to hear about her interest to volunteer. The Doctor known for his kindness told her that it was a splendid opportunity with untold possible results for the future. 

Dr Cousins then approached Nurse Brodie who needed little convincing. In her letter to the family she writes, “We could not possibly refuse the first appeal for medical help ever made by Bhutan.”  

The magazine provides details of the treatment in Bhutan. According to the press clipping, “During their stay in Paro, they treated 242 cases of cholera, performed five operations under most primitive conditions, distributed medicine to 2,377 persons and disinfected 92 houses.”

The article says that hundreds of people had died previously in the Paro valley. But, happily, these measures were successful beyond all expectations. Within a fortnight of the arrival of the two medical volunteers, the epidemic was practically put to an end. 

The article talks about the warm treatment and affection the two ladies received from the Bhutanese populace. Everywhere they went, they were warmly greeted. Before the pair left the country, the officials of Paro formally thanked them for their service. The group photo taken on the occasion was featured on the front page of that issue of “The Women’s Guild”. 

The King’s Letter

By end of August the two medics make it back to the Charteris Hospital in Kalimpong.  Few months later, they receive a handwritten letter from our King, with a sweet smelling white scarf. The letter was written from Bumthang on the 16th day of the 9th month which corresponds to 20 October. The Translation of the letter is as:

“Three Shris

To the two Doctor Memsahibs,

From the King of Bhutan

I hope the two memsahibs are nowadays enjoying good health.  I am glad to say we here are enjoying our former good health.

When the recent epidemic visited Paro and the surrounding districts, you two Memsahibs, giving the toil hardship of the journey, came and gave your skill and medicine to the stricken people so that now all are well.

Thus, you conferred a great benefit on the country and people of Bhutan for which I now send you my sincere thanks.”

Who was Dr Cousins?

While no information on Nurse Brodie has surfaced yet, we know who Dr Cousins was. She was born in 1882 in the island country Madagascar. She was the daughter of 

Rev. William Edward Cousins. Like her father, she became a missionary. 

At the age of three, she returned to England with her siblings. She studied at the Walthamstow Hall School for the daughters of missionaries. Later, she graduated from Oxford University. 

In November 1911, she went to North India as an unpaid medical assistant for the Church of Scotland. There, she ran the sanatorium. Two years later, she was transferred to the Church of Scotland’s medical mission in Kalimpong, also known as the Charteris Memorial Hospital.

It was during her period of service in Kalimpong (1913-1923) that she was requested to help combat the cholera epidemic in Bhutan.

When she left Kalimpong the people of the hill station wrote a letter to W.M.M. Lachlan, Secretary, Church of Scotland, Edinburgh: “She was always kind and a most sympathetic friend of the poor, and the people of Kalimpong and its vicinity for miles around. Not only was she very popular but the women folk of this place used to look upon her as their most kind benefactress and benign savior.”

In 1923, Dr Cousins returned as a permanent member of staff to the Almora Sanatorium. She worked in the Sanatorium until her death in May 1944. Her papers and photos are archived at SOAS University of London.


In the past 200 years, seven cholera pandemics   have occurred. The sixth cholera pandemic (1899–1923) that affected Bhutan was a major outbreak. Locally known as the Mi Ney or the disease spread by humans and characterized by severe leg cramps, the epidemic erupted in India. The mortality rate of the epidemic in India was high, killing as many as 800,000 people. It spread to the Middle East, North Africa, Eastern Europe, and Russia. 

Two years after the outbreak of cholera, in 1921, at the invitation of Gongsar Uygen Wangchuck, Dr Graham visited Bhutan in the summer. During the visit, our first King conferred the prestigious gold medal; most probably as appreciation for his help to contain the cholera outbreak and treat the patients. Dressed in gho with the gold medal pinned on his chest and sword dangling from his waist, Dr Graham said: “ I tell you, I felt end of swell and the crowd wondered who their unknown Bhutanese official was.” 

Other Epidemics

In addition to the 1918 cholera outbreak, Bhutan had to deal with deadly outbreak of the influenza.  The pandemic infected over a third of the world’s population striking down completely healthy young adults, while sparing those with weaker immune systems.

From  1905 to 1945, in 40 years, British reports have recorded one cholera, four influenzas (1918, 1921, 1922, 1923), nine rinderpest (1918, 1919, 1920, 1923, 1924, 1926, 1928, 1931, 1932) and nine smallpox outbreaks (1918, 1923, 1926, 1927, 1932, 1933, 1940, 1943, 1944 ) in our country. 


The year 1918 was a difficult period for Bhutan. The outbreak of cholera and influenza claimed the lives of hundreds of our people. Between 1905 and 1945, there were at least 23 epidemic outbreaks of four different kinds. Lacking western medical facilities, our first King acted swiftly and with the help of close friend and affectionate medics, we were able contain the epidemics and treat the people.

Contributed by 

Tshering Tashi