The advent of Modern Health services in Bhutan

The history of Bhutan’s Health services is the history of two traditions viz..-Traditional and Allopathic medicines. There are few supportive reports of first Indian-trained physicians and paramedics practising and establishing the western medicine in the kingdom in the early part of the twentieth century, but the Sowa Rigpa or the Traditional medicine, the Tibetan methods of medicine was also being practiced in Bhutan as far as the seventh century.

Today, both Traditional and Allopathic methods of medicine are practiced and implemented in the kingdom without any sense of competition and discrimination. The Bhutanese people enjoy and have the right to attend to both types of medicinal treatments, whichever turns out to be the best for his/her disease.

Allopathic/Modern Medicine Practice

There is scant information available on the introduction of the western medicine in Bhutan. The earliest modern medical service in Bhutan was available in Southern Bhutan when Compounder Khoe was posted at Sarpang, but for all the other towns the services of the local tea garden doctors across the border was used maintaining very good personal relations with them.

A number of licentiate (LMF) physicians trained in India provided services in Thimphu and Paro independently, in their capacity primarily as royal physicians. Dr. Tobgyel joined service as the first LMF physician at Kungarapten in 1951 after completing his LMF course at Jalpaiguri Jackson Medical School. He was again sent for his MBBS in 1952 and rejoined service after completing his two years condensed MBBS course and thus becoming the first MBBS doctor of the country. In 1954 he reported for duty at Dechencholing Palace, Thimphu to His Majesty Jigme Dorji Wangchuk. The entire modern health delivery facility for Thimphu started from a one-room dispensary at Tashichhodzong and thus the beginning of planned Health Services Delivery was started by His Late Majesty, Third King, Jigme Dorji Wangchuck.</p>

Simultaneously, paramedics (compounders) continued to be trained at Charteries Hospital, Kalimpong and trained compounders were posted at remote towns. Compounder Kinley (later D.C Kinley) was posted at Kalikhola. In Samchi, Sarbang, Chirang and Sibsoo the local officers had made small dispensaries to meet the health care needs of their people engaging expatriate compounders to start with. His Late Majesty then commanded the construction of a 20-bedded indigenously architectured hospital at Thimphu, which was completed in 1956. Another hospital at Samchi with 10 beds was built engaging Finish Missionary doctors (nuns). The training of compounders continued, although more of the on-the-job training/apprentice was completed formally at Charteries hospital, Kalimpong and subsequently posted to the different dispensaries in the country.

Thus, by the time planned socio-economic development programme of the country was started in 1961 we had two hospitals (Thimphu and Samtse) and 11 dispensaries at Haa, Paro, Trongsa, Bumthang, Trashigang, Sibsoo, Tsirang, Samdrupjongkhar, Kalikhola and Dagapela. All of these were staffed by expatriate doctors and nurses, and very few national medical and paramedical personnel. During that time, several paramedics (compounders) were trained in India and subsequently posted to different dispensaries in the country. The infrastructure development began with opening of Thimphu Hospital in 1961 followed by Samtse, Trashigang, and Gelephu district hospitals. Some dispensaries were also opened in the 60s, followed by BHUs in early seventies in Trongsa and Bumthang. The real expansion of infrastructure began only in the 80s with emphasis on the Primary Health Care approach, which was propounded at the Alma Ata declaration in 1978 to which Bhutan is a signatory.As of today there are now 28 hospitals, 156 BHUs and 654 Outreach clinics.

RIHS was stared in 1974 to train Bhutanese paramedical personnel, which is the foundation of the Bhutanese health system. It marked an important step in the development of self-reliance in health manpower for the country, while training of medical personnel continued to rely mostly on neighboring regional medical schools. Despite the introduction of western medicine, traditional medicine has retained its role in providing health services in Bhutan. Ever since its introduction, sowa rigpa has played a significant role along with spiritual remedies offered by religious institutions. Sowa Rigpa was recognized as the official medical tradition and was integrated into the health system in 1967.

Traditional Medicine Practice

At a time when anything that is traditional is indiscriminately put aside vis-à-vis modern science, Bhutan has a unique opportunity rise above the challenge posed by modern development. It can keep pace with discoveries of the last century without losing valuables indigenous knowledge. One important field is the traditional medicine. Traditional medicine was first introduced into Bhutan around the 17th century after the arrival of Zhabdrung in 1616. Tibetans had always referred to Bhutan as Lhomenjong or the valley of medicinal herbs because of its fertility, mountains and verities of medicinal plants that are found at different altitudes ranging from 200 to 7800 meters above sea level.

After sixteen century, Bhutanese went to Tibet to learn medicine. The principal of reciprocity whereby Tibet provided schools for training Bhutanese doctors, and Bhutanese doctors in turn transported medicinal plants as far as Lhasa or Kham was practiced. Most of the trained doctors would return to Bhutan and set up their own practices in monasteries or dzongs. Traditional medicine was greatly supported especially after 1885 when the Penlops and Dzongpoens patronized the profession. The courts privately employed or kept at least one or two physicians.

The Traditional medicine service was officially started as an offshoot of the Department of Health services. While the Government bore the main brunt of finance, the international agencies like Disarmo e Sviluppo (DISVI, an Italian NGO), WHO and UNICEF were also involved. In 1967 the Government recognized the scientific and cultural importance of traditional medicine. After it became a part of national health system people
were given the choice of opting for allopathic and traditional medicines. In 1979, first two traditional dispensaries and a school for traditional medicine were established in Thimphu. The donation of some pharmaceutical machines in1982 by WHO enabled it to start planning expansion of dispensaries to other districts such as Punakha, Trashigang, Trongsa, Bumthang, and later Haa. Opening of other traditional dispensaries in all districts began slowly.

In 1988 the Government, through DISVI involvement, established a Coordination Centre at an indigenous dispensary in Thimphu. These facilities included a laboratory, outpatient department, hostel and a library for training. It made possible for the introduction of modern scientific methods into practices of traditional medicine. Plants and other materials used in medicinal formula were tested for their chemical and pharmaceutical contents. Over the next four years, National Institute of Traditional Medicine (NITM) was established with support from DISVI. NITM as the centre for development of traditional medicine became a base for future development of traditional medicine, whose activities range from training to research, production of medicine and treatment of patients

It was Drungthso Pema Dorji who institutionalized traditional medicine in Bhutan. His grandfather, Drungthso Chimi Gyeltshen treated Ashi Om, the queen of His Majesty Jigmi Wangchuck. She instructed him to pass on the practice to his grandson and in 1946 Pema Dorji left to train as a Drungthso in Lhasa Chakpori in Tibet. He qualified in 1953 and returned to Bhutan where he worked for 9 years under his uncle, Neten Tsewang Gyeltshen in Trongsa Dzong. In 1968, with Drungthso Sherab Jorden, he laid the foundation stone for the first traditional hospital to be set up by the government in Dechencholing. The principal indigenous hospital functions were transferred to the new indigenous hospital in Kawajangsa, which was opened in 1979.

IThe NITM has three functions namely, the training of Drungthso and sMenpa (traditional compounders), treatment of patients, and research into and production of indigenous medicine. The institute now has a pharmaceutical production capacity and is assessing the possibilities of marketing its herbal products to the West. In the periphery, indigenous units are attached to the district hospitals and these services are now available to all 20 districts.