DNT says it can deliver its promise of 4 specialists in Bumthang

Younten Tshedup 

In the late 1980s, the health ministry had a vision to establish eight health facilities as emergency obstetric, neonatal, essential surgical and trauma centres including two separate trauma services centres in the country.

Today, after more than three decades, only four of the eight facilities including the three referral hospitals are operational – Phuentsholing, Samtse, Trashigang, and Wangdue. These hospitals are equipped with at least one specialist in each of the fields – gynaecology, paediatrics, medicine, surgery, and anaesthesiology.

Shortage of these specialists has been the major challenge in executing the plan. Records with the health ministry show that there are 129 available specialists in the country today. However, there are only 68 specialists in gynaecology (13), paediatrics (14), medicine (9), surgery (15), and anaesthesiology (17) today.

With the government now planning to deploy four specialists in all the hospitals across the country, the pressure on the limited pool of specialists is expected to increase.

Among others Bhutan’s need for specialists in a hospital include a gynaecologist, paediatrician, medical specialist, and a surgeon. However, health officials said that for a surgeon and a gynaecologist to function, he or she would also need an anaesthesiologist. An anaesthesiologist would also need a nurse anaesthetist and anaesthesia technicians, an operation theatre nurse and technicians, as they have to function as a team.

Prime Minister Dr Lotay Tshering, campaigning as the president of the DNT in the Chhoekhor-Tang constituency has promised to recruit four specialists at the earliest for the Wangdicholing general hospital.

Wangdicholing is not in the list of centres identified by the health ministry. The remaining four facilities the ministry identified in the 1980s are Damphu in Tsirang, Trongsa, Yebilaptsa in Zhemgang and Dewathang in Samdrupjongkhar.

More than 30 years ago, the ministry had also identified hospitals in Reserbu, Trashigang and Gedu in Chukha to be upgraded into a trauma service centre, which would also require specialists in the fields of medicine and surgery.

Officials from the health ministry said that priority for the deployment of specialists would be in the eight centres first.

Going by the health ministry’s human resource standard for health, deployment of services at health facilities in the country are based on factors such as catchment population, proximity to the nearest referral point, presence of other institutions, poverty rate of the catchment population, and number of female population age 15-49 among others.

Health experts say that beside these conditions, patient turnout requiring specialist services including facilities and equipment at disposal would also determine the deployment of specialists.

DNT can deliver

The prime minister is confident and has assured that the promise would be fulfilled.

Speaking to Kuensel last night, Lyonchhen said that although the current practise to send specialists was based on the population and requirements of the respective dzongkhags, Bumthang was prioritised as a token of gratitude for the people of Chhoekhor-Tang, should its candidate Dawa win.

However, even if Dawa loses, Lyonchhen said that the specialists would be provided but it would ‘take its own time’.

Should the government win one more seat in the Parliament, one way to achieve the promise would be by recruiting expats. This has been done in the past by former governments. The DNT government also recently recruited 19 specialists from Bangladesh to address the shortage in the country.

However, this way of fulfilling the pledge would come at a huge cost. Today the Bangladeshi specialists are paid a minimum of USD 4,000 as monthly salary. One the other hand, the Bhutanese specialists earn the regular civil service package with 45 percent professional allowance.

Besides the huge expenditure, sustainability is another question. In the past, after the then government left, so did the hired specialists.

To address such situations, the government has been focussing on building the human resource pool in the country. Today, almost 100 doctors are pursuing their post-graduation (specialisation), both outside and within the country. Majority of these doctors are expected to complete their training by 2023.

Officials from the ministry said that developing the specialists’ pool was a major challenge mainly because it was difficult getting admissions in medical universities. Limited seats and high standards maintained by respective institutes made it difficult for Bhutanese to get entries in medical colleges.

Also, it was learned that not many take up specialisation courses (post-graduation or masters) as it was considered ‘risky business’ and required a very long duration. A post-graduation course in medicine spans over four years following a five to seven years degree course (MBBS).