… to adjust the four promised  specialists 

Younten Tshedup 

Bumthang could get a bigger hospital even without asking for one, if the Druk Nyamrup Tshogpa wins the bye-election on November 19. This is because to accommodate the four promised specialists, the hospital would have to be expanded.

Health officials say that deploying four specialists at the existing 20-bed Wangdicholing hospital would not be practical. The hospital would require an expansion to house the specialists including new facilities for the specialists to work. Separate medical, paediatric and gynae wards including additional operation theatres would be a prerequisite with the new set of specialists.

The president of DNT, Dr Lotay Tshering promised four specialists at the earliest for Bumthang, as a reward to the people if his candidate, Dawa, won from the constituency.


Four specialists for Bumthang?

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

According to the population and housing census of Bhutan 2017, with 17,820 (8,428 female) people, Bumthang has a relatively low population density as compared to other dzongkhags. The poverty rate in Bumthang, as per the poverty analysis report 2017 is 2.1, compared to 14.0 for neighbouring Trongsa.

Bumthang was also not identified as one of the emergency obstetric, neonatal, essential surgical and trauma centres by the health ministry. The identification of these centres was done some three decades ago by the ministry. Today, of the eight centres identified in the late 1980s, only four are functional with at least one specialist.

Trongsa was one of the eight identified centres. Today the hospital in Trongsa doesn’t have a specialist. The centre was identified to cater services to the central parts of the country including Zhemgang, Bumthang and Trongsa.

If the hospital is established in Bumthang, people of Zhemgang would have to travel almost double the distance. The distance between Zhemgang to Trongsa is 90.8km against 168.5km from Bumthang.

However, the caseload (patient attendance) at the Wangdicholing hospital is relatively higher than some of its neighbouring dzongkhags. The hospital saw over 39,000 last year with an average of 100 plus patients every day.

But all these numbers do not correspond to using specialist services. Majority of them, according to health officials, are usually general cases.

Officials also said that because the deployment of specialists and additional staff would require the expansion of the existing facilities, dzongkhag such as Trongsa doesn’t have much room for expansion. Meaning, the facility could be, if required, shifted from Trongsa to Bumthang.


Shortage of specialist

The country today has an acute shortage of health specialists. Records with the health ministry show that there are 129 available specialists in the country today. To address the shortage, the current government brought in 19 specialists from Bangladesh earlier this year.

Health officials said that although this addresses the present need, sustainability is a question besides the huge cost implication for the government. The hired specialists are paid a minimum of USD 4,000 as monthly salary. One the other hand, Bhutanese specialists earn the regular civil service package with 45 percent professional allowance.

To address the shortage, 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.