Health in Bhutan
Encyclopedia
Health in Bhutan is one of the government's highest priorities in its scheme of development and modernization. Health and related issues are overseen by the Ministry of Health, itself represented on the executive Lhengye Zhungtshog
(cabinet) by the Minister of Health. As a component of Gross National Happiness
, affordable and accessible health care is central to the public policy of Bhutan. The Constitution of Bhutan
charges the Royal Government with ensuring a "safe and healthy environment," and with providing "free access to basic public health services in both modern and traditional medicines."
(FYP) of the Ministry of Health. The first democratically appointed Health Minister, Lyonpo Zangley Dukpa, is the head of the Ministry of Health. He is a member of the Druk Phuensum Tshogpa (DPT)
party from Khar
-Yurung
constituency in Pemagatshel District.
Two major pieces of Bhutanese legislation
establish a framework for personnel and medicines. The Medical and Health Council Act of 2002 incorporates the Medical and Health Council as a legal entity to regulate medical schools, courses, and professional credentials. The Medicines Act of 2003 establishes the Bhutan Medicines Board and Drugs Technical Advisory Committee. The Act authorizes several subsidiary organizations, including the Bhutanese Drug Regulatory Authority, Drug Testing Laboratory, and teams of Drug Inspectors. These agencies have rulemaking and law enforcement authority on drugs, medicines, and even price controls, but must operate within the laws of Bhutan
. Both pieces of legislation contain offenses germane to their subject matter, supplementing the Penal Code.
s had at least one hospital, with the exception of Gasa
. Thimphu
had 5 hospitals, while Chukha, Samtse
, and Trashigang Districts each had 3. Every dzongkhag had a number of smaller medical facilities, and Thimphu had an indigenous hospital facility available.
These hospitals and smaller facilities were supported by 3,756 Ministry of Health employees in thirteen categories: 176 doctors; 556 nurses; 92 nurse's assistants; 505 "health workers;" 35 Dzongkhag Health Officers and Assistants; 41 drungtshos (traditional physicians); 52 smenpas (traditional physicians); 12 pharmacists; 79 pharmacy assistants and technicians; 13 lab technologists; 549 other technicians and assistants; and 1,601 administrative and support staff.
(2,892 per 10,000 people) and pneumonia
(1,031) among children under age 5; skin infections (1,322); conjunctivitis (542); hypertension (310); and intestinal worms (170). Less widespread were diabetes (38 per 10,000 people); alcohol-related liver disease
(23); and cancer
(17). Incidence of malaria
and tuberculosis
was generally low, at 10 and 15 cases per 10,000 people, respectively.
Influenza
, including H1N1
("swine flu") and H5N1
("bird flu") strains, are present in Bhutan. As of 2009, there were 6 confirmed cases of H1N1, none of which were fatal. Bird flu, however, has resulted in at least one outbreak in Phuntsholing
and remains a "serious concern" of the Ministry of Health.
, representing just over 0.3% of the population. Through 2010, infection rates remained modest though increasing, totaling 185 reported cases, or 0.1% of the population. The Ministry of Health attributed climbing numbers to promiscuity, drug use, and the prevalence of HIV/AIDS in neighboring countries.
regimen. In 2010, the Ministry of Health noted a growing trend of unsafe abortion
s among Bhutanese women (466 in 2003; 1,057 in 2009), apparently performed in neighboring India
, contributing to Bhutan's high maternal mortality
rate.
In 2011, Bhutan had a maternal mortality rate of 200 per 100,000. This is compared with 254.9 in 2008 and 1145.4 in 1990. The under 5 mortality rate, per 1,000 births was 81 and the neonatal mortality as a percentage of mortality under 5 years was 43. In Bhutan the number of midwives per 1,000 live births was 15 and the lifetime risk of death for pregnant women was 1 in 170.
The National Food Quality and Safety Commission chaired by the Minister of Agriculture and comprises ten additional members from various relevant government ministries and agencies regulating agriculture, health, commerce, home affairs, legal affairs, and the environment. The Commission formulates the government's food policy, while the BAFRA is responsible for advising and implementing the Commission's policies, including health and safety inspections. BAFRA inspectors have broad authority to search, document, test, and seize food wherever it is transported, stored, prepared, or served; inspectors may also destroy unsafe food when it poses a "clear and present danger for human health or the environment." The Act further establishes health guidelines for businesses that serve or trade in food, including provisions allowing for food testing, and defines government authority in regulating food imports and exports. The Food Act, like other Bhutanese legislation
, defines relevant offenses and penalties for failing to conform to proscribed laws and regulations.
sale and consumption is actively discouraged by the government of Bhutan through educational, economic, and penal incentives. The Tobacco Control Act bans the sale of tobacco, taxes imports, and places restrictions on quantities individuals may possess. The Act also authorizes the Tobacco Control Board, through the Tobacco Control Office, to provide cessation programs in health facilities and to work with rehabilitation centers in diagnosing and counseling tobacco dependence. The Tobacco Control Office is occupied by the Bhutan Narcotic Control Agency and headed by its executive director. The Office acts as the agent
of the Board responsible for coordinating most of the actual implementation of Bhutan's tobacco policy. The Ministry of Health, Ministry of Economic Affairs, Ministry of Finance, Ministry of Education, and Ministry of Home and Cultural Affairs
are all responsible for implementing the laws in the Act and the policies of the Board in specified arenas.
.
Ara
, the traditional alcohol of Bhutan, is most often home made from rice
or maize
, either fermented
or distilled
, and may only be legally produced and consumed privately. Ara production is unregulated in both method and quality, and its sale has been prohibited in Bhutan since a severe crackdown. However, because Ara returns far more profit than other forms of maize, many Bhutanese farmers have pressed for legal reform. The Bhutanese government, meanwhile, is intent on discouraging excessive alcohol consumption, abuse, and associated diseases through taxation and regulation.
Through government efforts to reduce ara
production and consumption in Lhuntse District, eastern Bhutan, locals conceded something should be done to curb the distinctly eastern Bhutanese tradition of heavy drinking. The government's strategy is to reduce ara production and consumption gradually until it is eliminated. Alcoholism and ara production have been notable topics of political discussion Bhutan, especially at the local level. Ara, however, is also culturally relevant for its religious and medicinal uses.
To address drug-related issues, the Narcotics Act creates the Narcotics Control Board and the Narcotics Control Agency. The Narcotics Control Board, made up entirely of government appointees and chaired by "a relevant Cabinet Minister," is responsible for formulating drug policy, while its ancillary Narcotics Control Agency is chiefly responsible for implementing the Board's policy and advising the Board. The Narcotics Act provides enforcement and investigation powers to drug enforcement agencies, including the Royal Bhutan Police
and Narcotics Control Agency. Under the Narcotics Act, every person and entity is subject to inspection by competent authorities.
The Narcotics Act mandates drug treatment under the auspices of the Narcotics Control Board and punishes repeat offenders and those who otherwise fail to abide by the terms of treatment. The Board is bound to ensure treatment, rehabilitation, and social reintegration of drug-dependent persons, through interventions, counseling, and detoxification; it is thus required by law to maintain adequate personnel and institutions to provide such services. Records of treatment must be kept confidential. Persons dependent on drugs are subject to compulsory treatment and rehabilitation; those who refuse to submit voluntarily must be confined in criminal custody. The Act authorizes courts to impose treatment as part of sentencing in cases related to drugs, and provides for probation
-like "periodic attendance before a panel for review and evaluation of treatment and progress." Successful compliance with such a regimen allows courts to discharge other penalties related to narcotics, such as prison terms and fines. The Narcotics Act further sets forth about a dozen offenses and penalties regarding compliance with the Act, further supplementing the Penal Code.
The Bhutanese media, for its part, have recognized dire societal problems resulting from and associated with substance and alcohol abuse. In response, the Bhutan Observer
has encouraged religious and community support for those seeking recovery.
ese health care
development accelerated in the early 1960s with the establishment of the Department of Public Health and the opening of new hospitals and dispensaries throughout the country. By the early 1990s, health care was provided through twenty-nine general hospitals (including five leprosy hospitals, three army hospitals, and one mobile hospital), forty-six dispensaries, sixty-seven basic health units, four indigenous-medicine dispensaries, and fifteen malaria
eradication centers. The major hospitals were in Thimphu
, Geylegphug, and Tashigang. Hospital beds in 1988 totaled 932. There was a severe shortage of health-care personnel with official statistics reporting only 142 physician
s and 678 paramedic
s, about one health-care professional for every 2,000 people, or only one physician for almost 10,000 people.
Training for health-care assistants, nurses' aide
s, midwives, and primary health-care workers was provided at the Royal Institute of Health Sciences
associated with the National Referral Hospital
, which was established in 1974. Graduates of the school were the core of the national public health system and helped staff the primary care basic health units throughout the country. Additional health-care workers were recruited from among volunteers in villages to supplement primary health care.
The government has maintained a system of universal health care
for all of its citizens. However, the number of Hospitals in Bhutan has been limited, and some dieseases, such as cancer
cannot be treated in Bhutan. Patients that cannot be treated in Bhutan are taken to hospitals in India
, and their treatment is paid for by the government of Bhutan.
The most common diseases in the 1980s were gastrointestinal infections caused by waterborne parasites, mostly attributable to the lack of clean drinking water. The most frequently treated diseases were respiratory tract infections, diarrhea
and dysentery
, worm
s, skin infection
s, malaria
, nutritional deficiencies
, and conjunctivitis
. In 1977 the World Health Organization
(WHO) declared Bhutan a smallpox
-free zone. In 1979 a nationwide immunization
program was established. In 1987, with WHO support, the government envisioned plans to immunize all children against diphtheria
, pertussis
, tetanus
, polio, tuberculosis
, and measles
by 1990. The government's major medical objective by 2000 was to eliminate waterborne parasites, diarrhea and dysentery, malaria, tuberculosis, pneumonia, and goiter. Progress in leprosy
eradication was made in the 1970s and 1980s, during which time the number of patients had decreased by more than half, and by 1988 the government was optimistic that the disease could be eliminated by 2000.
It was estimated in 1988 that only 8 persons per 1,000 had access to potable water. Despite improved amenities provided to the people through government economic development programs, Bhutan still faced basic health problems. Factors in the country's high morbidity and death rates included the severe climate, less than hygienic living conditions, for example long-closed-up living quarters during the winter, a situation that contributes to the high incidence of leprosy, and smoke inhalation
from inadequately ventilated cooking equipment. Nevertheless, in 1980 it was estimated that 90 percent of Bhutanese received an adequate daily caloric intake.
Although there were no reported cases of acquired immune deficiency syndrome (AIDS) through the early 1990s, the Department of Public Health set up a public awareness program in 1987. With the encouragement of the WHO, a "reference laboratory" was established at the Thimphu General Hospital to test for AIDS and human immunodeficiency virus (HIV) as a precautionary measure. To further enhance awareness, representatives of the National Institute of Family Health were sent to Bangladesh
in 1990 for training in AIDS awareness and treatment measures.
Lhengye Zhungtshog
The Lhengye Zhungtshog is the highest executive body in Bhutan. It was created in 1999 by Jigme Singye Wangchuck, the fourth King of Bhutan....
(cabinet) by the Minister of Health. As a component of Gross National Happiness
Gross national happiness
The assessment of gross national happiness was designed in an attempt to define an indicator that measures quality of life or social progress in more holistic and psychological terms than only the economic indicator of gross domestic product .-Origins and meaning:The term...
, affordable and accessible health care is central to the public policy of Bhutan. The Constitution of Bhutan
Constitution of Bhutan
The Constitution of Bhutan was enacted July 18, 2008 by the Royal Government. The Constitution was thoroughly planned by several government officers and agencies over a period of almost seven years amid increasing democratic reforms in Bhutan...
charges the Royal Government with ensuring a "safe and healthy environment," and with providing "free access to basic public health services in both modern and traditional medicines."
Health care system
The Ministry of Health has provided universal health care in Bhutan since the 1970s. Health care infrastructure and services are planned and developed through Five Year PlansFive-Year Plans of Bhutan
The Five Year Plans of Bhutan are a series of national economic development plans created by the government of Bhutan since 1961.The government of Bhutan has played a pervasive role in its economy and development...
(FYP) of the Ministry of Health. The first democratically appointed Health Minister, Lyonpo Zangley Dukpa, is the head of the Ministry of Health. He is a member of the Druk Phuensum Tshogpa (DPT)
Bhutan Peace and Prosperity Party
The Bhutan Peace and Prosperity Party, or Druk Phuensum Tshogpa , is one of the major political parties in Bhutan. It was formed on July 25, 2007 as a merger of the All People's Party and the Bhutan People's United Party, which were both short-lived...
party from Khar
Khar Gewog
Khar Gewog is a gewog of Pemagatshel District, Bhutan....
-Yurung
Yurung Gewog
Yurung Gewog is a gewog of Pemagatshel District, Bhutan....
constituency in Pemagatshel District.
Two major pieces of Bhutanese legislation
Bhutanese legislation
Bhutanese legislation is created by the bicameral Parliament of Bhutan. Either the upper house National Council, the lower house National Assembly, or the Attorney General may author bills to be passed as acts, with the exception of money and financial bills, which are the sole purview of the...
establish a framework for personnel and medicines. The Medical and Health Council Act of 2002 incorporates the Medical and Health Council as a legal entity to regulate medical schools, courses, and professional credentials. The Medicines Act of 2003 establishes the Bhutan Medicines Board and Drugs Technical Advisory Committee. The Act authorizes several subsidiary organizations, including the Bhutanese Drug Regulatory Authority, Drug Testing Laboratory, and teams of Drug Inspectors. These agencies have rulemaking and law enforcement authority on drugs, medicines, and even price controls, but must operate within the laws of Bhutan
Bhutanese legislation
Bhutanese legislation is created by the bicameral Parliament of Bhutan. Either the upper house National Council, the lower house National Assembly, or the Attorney General may author bills to be passed as acts, with the exception of money and financial bills, which are the sole purview of the...
. Both pieces of legislation contain offenses germane to their subject matter, supplementing the Penal Code.
Health care facilities
As of 2009, there were 31 hospitals across Bhutan. Most dzongkhagDzongkhag
A dzongkhag is an administrative and judicial district of Bhutan. The twenty dzongkhags of Bhutan are further divided into 205 gewogs. Some larger dzongkhags have one or more of an intermediate judicial division, known as dungkhags , which themselves comprise two or more gewogs...
s had at least one hospital, with the exception of Gasa
Gasa District
Gasa District or Gasa Dzongkhag is one of the 20 dzongkhags comprising Bhutan. Its capital is Gasa Dzong near Gasa. It is located in the far north of the county and spans the Middle and High Himalayas. The dominant language of the district is Dzongkha, the national language...
. Thimphu
Thimphu District
Thimphu District is a dzongkhag of Bhutan. Thimphu is also the capital of Bhutan and the largest city in the whole kingdom.-Languages:...
had 5 hospitals, while Chukha, Samtse
Samtse District
Samtse District is one of the 20 dzongkhags comprising Bhutan.-History and culture:...
, and Trashigang Districts each had 3. Every dzongkhag had a number of smaller medical facilities, and Thimphu had an indigenous hospital facility available.
These hospitals and smaller facilities were supported by 3,756 Ministry of Health employees in thirteen categories: 176 doctors; 556 nurses; 92 nurse's assistants; 505 "health workers;" 35 Dzongkhag Health Officers and Assistants; 41 drungtshos (traditional physicians); 52 smenpas (traditional physicians); 12 pharmacists; 79 pharmacy assistants and technicians; 13 lab technologists; 549 other technicians and assistants; and 1,601 administrative and support staff.
Emergency and health hotline
On May 2, 2011, Bhutan launched its telephonic Health Help Centre (HHC), which had proved successful over the prior two months. The HHC number is 112. The HHC provides two services: Emergency Response and the Healthcare Helpline, both accessible through landed and mobile phones. Emergency responses are served by 61 ambulances in 37 locations with 59 emergency medical technicians around the kingdom, equipped with GPS and GIS technology. The Helthcare Helpline dispenses medical advice.Funding
The cost and availability of health care facilities – some of which operate on a 24-hour basis – is a subject of discussion in Bhutan. Issues of affordability and sustainability have called into question Bhutan's proposed funding schemes.Health issues
As of 2009, most Bhutanese had access to potable drinking water (83%) and basic sanitation (91%). Widespread health concerns included diarrheaDiarrhea
Diarrhea , also spelled diarrhoea, is the condition of having three or more loose or liquid bowel movements per day. It is a common cause of death in developing countries and the second most common cause of infant deaths worldwide. The loss of fluids through diarrhea can cause dehydration and...
(2,892 per 10,000 people) and pneumonia
Pneumonia
Pneumonia is an inflammatory condition of the lung—especially affecting the microscopic air sacs —associated with fever, chest symptoms, and a lack of air space on a chest X-ray. Pneumonia is typically caused by an infection but there are a number of other causes...
(1,031) among children under age 5; skin infections (1,322); conjunctivitis (542); hypertension (310); and intestinal worms (170). Less widespread were diabetes (38 per 10,000 people); alcohol-related liver disease
Alcoholic liver disease
Alcoholic liver disease is a term that encompasses the hepatic manifestations of alcohol overconsumption, including fatty liver, alcoholic hepatitis, and chronic hepatitis with hepatic fibrosis or cirrhosis. It is the major cause of liver disease in Western countries...
(23); and cancer
Cancer
Cancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...
(17). Incidence of malaria
Malaria
Malaria is a mosquito-borne infectious disease of humans and other animals caused by eukaryotic protists of the genus Plasmodium. The disease results from the multiplication of Plasmodium parasites within red blood cells, causing symptoms that typically include fever and headache, in severe cases...
and tuberculosis
Tuberculosis
Tuberculosis, MTB, or TB is a common, and in many cases lethal, infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis. Tuberculosis usually attacks the lungs but can also affect other parts of the body...
was generally low, at 10 and 15 cases per 10,000 people, respectively.
Influenza
Influenza
Influenza, commonly referred to as the flu, is an infectious disease caused by RNA viruses of the family Orthomyxoviridae , that affects birds and mammals...
, including H1N1
H1N1
'Influenza A virus is a subtype of influenza A virus and was the most common cause of human influenza in 2009. Some strains of H1N1 are endemic in humans and cause a small fraction of all influenza-like illness and a small fraction of all seasonal influenza. H1N1 strains caused a few percent of...
("swine flu") and H5N1
H5N1
Influenza A virus subtype H5N1, also known as "bird flu", A or simply H5N1, is a subtype of the influenza A virus which can cause illness in humans and many other animal species...
("bird flu") strains, are present in Bhutan. As of 2009, there were 6 confirmed cases of H1N1, none of which were fatal. Bird flu, however, has resulted in at least one outbreak in Phuntsholing
Phuentsholing Gewog
Phuentsholing Gewog is a gewog of Chukha District, Bhutan. The gewog has an area of 139.8 square kilometres and contains 19 villages. Phuentsholing Gewog is part of Phuentsholing Dungkhag, along with Dala and Logchina Gewogs....
and remains a "serious concern" of the Ministry of Health.
HIV/AIDS
In 2011, there were 246 reported cases of HIVHIV
Human immunodeficiency virus is a lentivirus that causes acquired immunodeficiency syndrome , a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive...
, representing just over 0.3% of the population. Through 2010, infection rates remained modest though increasing, totaling 185 reported cases, or 0.1% of the population. The Ministry of Health attributed climbing numbers to promiscuity, drug use, and the prevalence of HIV/AIDS in neighboring countries.
Maternal and child healthcare
As of 2008, 90% of the population were covered by the government's immunizationImmunization
Immunization, or immunisation, is the process by which an individual's immune system becomes fortified against an agent ....
regimen. In 2010, the Ministry of Health noted a growing trend of unsafe abortion
Abortion
Abortion is defined as the termination of pregnancy by the removal or expulsion from the uterus of a fetus or embryo prior to viability. An abortion can occur spontaneously, in which case it is usually called a miscarriage, or it can be purposely induced...
s among Bhutanese women (466 in 2003; 1,057 in 2009), apparently performed in neighboring India
India
India , officially the Republic of India , is a country in South Asia. It is the seventh-largest country by geographical area, the second-most populous country with over 1.2 billion people, and the most populous democracy in the world...
, contributing to Bhutan's high maternal mortality
Maternal death
Maternal death, or maternal mortality, also "obstetrical death" is the death of a woman during or shortly after a pregnancy. In 2010, researchers from the University of Washington and the University of Queensland in Brisbane, Australia, estimated global maternal mortality in 2008 at 342,900 , of...
rate.
In 2011, Bhutan had a maternal mortality rate of 200 per 100,000. This is compared with 254.9 in 2008 and 1145.4 in 1990. The under 5 mortality rate, per 1,000 births was 81 and the neonatal mortality as a percentage of mortality under 5 years was 43. In Bhutan the number of midwives per 1,000 live births was 15 and the lifetime risk of death for pregnant women was 1 in 170.
Food safety
Bhutan regulates public health and safety in regards to food under the Food Act of 2005. The Food Act establishes the National Food Quality and Safety Commission and the Bhutan Agriculture and Food Regulatory Authority ("BAFRA"), both of which are overseen by the Ministry of Agriculture. While the Ministry of Agriculture is singularly authorized to author regulations under the Food Act, the Minister of Agriculture may delegate authority to ministries responsible for health, trade, and customs.The National Food Quality and Safety Commission chaired by the Minister of Agriculture and comprises ten additional members from various relevant government ministries and agencies regulating agriculture, health, commerce, home affairs, legal affairs, and the environment. The Commission formulates the government's food policy, while the BAFRA is responsible for advising and implementing the Commission's policies, including health and safety inspections. BAFRA inspectors have broad authority to search, document, test, and seize food wherever it is transported, stored, prepared, or served; inspectors may also destroy unsafe food when it poses a "clear and present danger for human health or the environment." The Act further establishes health guidelines for businesses that serve or trade in food, including provisions allowing for food testing, and defines government authority in regulating food imports and exports. The Food Act, like other Bhutanese legislation
Bhutanese legislation
Bhutanese legislation is created by the bicameral Parliament of Bhutan. Either the upper house National Council, the lower house National Assembly, or the Attorney General may author bills to be passed as acts, with the exception of money and financial bills, which are the sole purview of the...
, defines relevant offenses and penalties for failing to conform to proscribed laws and regulations.
Tobacco
TobaccoTobacco
Tobacco is an agricultural product processed from the leaves of plants in the genus Nicotiana. It can be consumed, used as a pesticide and, in the form of nicotine tartrate, used in some medicines...
sale and consumption is actively discouraged by the government of Bhutan through educational, economic, and penal incentives. The Tobacco Control Act bans the sale of tobacco, taxes imports, and places restrictions on quantities individuals may possess. The Act also authorizes the Tobacco Control Board, through the Tobacco Control Office, to provide cessation programs in health facilities and to work with rehabilitation centers in diagnosing and counseling tobacco dependence. The Tobacco Control Office is occupied by the Bhutan Narcotic Control Agency and headed by its executive director. The Office acts as the agent
Government agency
A government or state agency is a permanent or semi-permanent organization in the machinery of government that is responsible for the oversight and administration of specific functions, such as an intelligence agency. There is a notable variety of agency types...
of the Board responsible for coordinating most of the actual implementation of Bhutan's tobacco policy. The Ministry of Health, Ministry of Economic Affairs, Ministry of Finance, Ministry of Education, and Ministry of Home and Cultural Affairs
Ministry of Home and Cultural Affairs
The Bhutanese Ministry of Home and Cultural Affairs is the government ministry within the Lhengye Zhungtshog which oversees law and order; the civil administration; immigration services; the issuance of citizenship documents, and other related documents; the...
are all responsible for implementing the laws in the Act and the policies of the Board in specified arenas.
Alcohol
Bhutan also seeks to discourage alcohol consumption because of its effects on health and happiness. In 2011, the government passed its Alcohol Control Regulation, which imposed up to three times the previous taxes on alcohol. As a result, alcohol sales have dropped and prices have risen. Alcohol consumption among students has risen in the recent past, resulting in several expulsions from Bhutan's elite Sherubtse CollegeSherubtse College
Sherubtse College was the first accredited college in Bhutan, founded in 1966. As of 2003 it became part of the newly created Royal University of Bhutan system that comprises all public post-secondary schools in Bhutan....
.
Ara
Ara (drink)
Ara, or Arag, is a traditional alcoholic beverage consumed in Bhutan. Ara is made from rice, maize, millet, or wheat, and may be either fermented or distilled. The beverage is usually a clear, creamy, or white color.-Production:Ara is most commonly made from rice or maize at private homes or farms...
, the traditional alcohol of Bhutan, is most often home made from rice
Rice
Rice is the seed of the monocot plants Oryza sativa or Oryza glaberrima . As a cereal grain, it is the most important staple food for a large part of the world's human population, especially in East Asia, Southeast Asia, South Asia, the Middle East, and the West Indies...
or maize
Maize
Maize known in many English-speaking countries as corn or mielie/mealie, is a grain domesticated by indigenous peoples in Mesoamerica in prehistoric times. The leafy stalk produces ears which contain seeds called kernels. Though technically a grain, maize kernels are used in cooking as a vegetable...
, either fermented
Fermentation
Fermentation may refer to:* Fermentation , the use of fermentation in food preparation* Fermentation , a metabolic process whereby electrons released from nutrients are ultimately transferred to molecules obtained from the breakdown of those same nutrients* Fermentation , the process of...
or distilled
Distillation
Distillation is a method of separating mixtures based on differences in volatilities of components in a boiling liquid mixture. Distillation is a unit operation, or a physical separation process, and not a chemical reaction....
, and may only be legally produced and consumed privately. Ara production is unregulated in both method and quality, and its sale has been prohibited in Bhutan since a severe crackdown. However, because Ara returns far more profit than other forms of maize, many Bhutanese farmers have pressed for legal reform. The Bhutanese government, meanwhile, is intent on discouraging excessive alcohol consumption, abuse, and associated diseases through taxation and regulation.
Through government efforts to reduce ara
Ara (drink)
Ara, or Arag, is a traditional alcoholic beverage consumed in Bhutan. Ara is made from rice, maize, millet, or wheat, and may be either fermented or distilled. The beverage is usually a clear, creamy, or white color.-Production:Ara is most commonly made from rice or maize at private homes or farms...
production and consumption in Lhuntse District, eastern Bhutan, locals conceded something should be done to curb the distinctly eastern Bhutanese tradition of heavy drinking. The government's strategy is to reduce ara production and consumption gradually until it is eliminated. Alcoholism and ara production have been notable topics of political discussion Bhutan, especially at the local level. Ara, however, is also culturally relevant for its religious and medicinal uses.
Narcotics and treatment
Bhutan regulates drugs – from pharmaceuticals to narcotics – through the Narcotic Drugs and Psychotropic Substances and Substance Abuse Act 2005 ("Narcotics Act"). Its stated legislative purpose is "to ensure that drugs are available exclusively for medical, veterinary and scientific purposes." To this end, the Narcotics Act emphasizes education and treatment as means of combatting illegal drug use. The Act sets forth a fivefold schedule for substances under which Schedule I includes the most restricted substances and Schedule V includes substances "liable for abuse but [not falling] under International control."To address drug-related issues, the Narcotics Act creates the Narcotics Control Board and the Narcotics Control Agency. The Narcotics Control Board, made up entirely of government appointees and chaired by "a relevant Cabinet Minister," is responsible for formulating drug policy, while its ancillary Narcotics Control Agency is chiefly responsible for implementing the Board's policy and advising the Board. The Narcotics Act provides enforcement and investigation powers to drug enforcement agencies, including the Royal Bhutan Police
Royal Bhutan Police
Law enforcement in Bhutan is the collective purview of several divisions of Bhutan's Ministry of Home and Cultural Affairs. Namely, the Ministry's Bureau of Law and Order, Department of Immigration, and Department of Local Governance are responsible for law enforcement in Bhutan...
and Narcotics Control Agency. Under the Narcotics Act, every person and entity is subject to inspection by competent authorities.
The Narcotics Act mandates drug treatment under the auspices of the Narcotics Control Board and punishes repeat offenders and those who otherwise fail to abide by the terms of treatment. The Board is bound to ensure treatment, rehabilitation, and social reintegration of drug-dependent persons, through interventions, counseling, and detoxification; it is thus required by law to maintain adequate personnel and institutions to provide such services. Records of treatment must be kept confidential. Persons dependent on drugs are subject to compulsory treatment and rehabilitation; those who refuse to submit voluntarily must be confined in criminal custody. The Act authorizes courts to impose treatment as part of sentencing in cases related to drugs, and provides for probation
Probation
Probation literally means testing of behaviour or abilities. In a legal sense, an offender on probation is ordered to follow certain conditions set forth by the court, often under the supervision of a probation officer...
-like "periodic attendance before a panel for review and evaluation of treatment and progress." Successful compliance with such a regimen allows courts to discharge other penalties related to narcotics, such as prison terms and fines. The Narcotics Act further sets forth about a dozen offenses and penalties regarding compliance with the Act, further supplementing the Penal Code.
The Bhutanese media, for its part, have recognized dire societal problems resulting from and associated with substance and alcohol abuse. In response, the Bhutan Observer
Bhutan Observer
The Bhutan Observer is Bhutan's first private bilingual newspaper. It was launched as a private limited company by parent company Bhutan Media Services , and began publishing on June 2, 2006, in Thimphu...
has encouraged religious and community support for those seeking recovery.
History
BhutanBhutan
Bhutan , officially the Kingdom of Bhutan, is a landlocked state in South Asia, located at the eastern end of the Himalayas and bordered to the south, east and west by the Republic of India and to the north by the People's Republic of China...
ese health care
Health care
Health care is the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in humans. Health care is delivered by practitioners in medicine, chiropractic, dentistry, nursing, pharmacy, allied health, and other care providers...
development accelerated in the early 1960s with the establishment of the Department of Public Health and the opening of new hospitals and dispensaries throughout the country. By the early 1990s, health care was provided through twenty-nine general hospitals (including five leprosy hospitals, three army hospitals, and one mobile hospital), forty-six dispensaries, sixty-seven basic health units, four indigenous-medicine dispensaries, and fifteen malaria
Malaria
Malaria is a mosquito-borne infectious disease of humans and other animals caused by eukaryotic protists of the genus Plasmodium. The disease results from the multiplication of Plasmodium parasites within red blood cells, causing symptoms that typically include fever and headache, in severe cases...
eradication centers. The major hospitals were in Thimphu
Thimphu
Thimphu also spelt Thimpu, is the capital and largest city of Bhutan. It is situated in the western central part of Bhutan and the surrounding valley is one of Bhutan's dzongkhags, the Thimphu District. The city became the capital of Bhutan in 1961...
, Geylegphug, and Tashigang. Hospital beds in 1988 totaled 932. There was a severe shortage of health-care personnel with official statistics reporting only 142 physician
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
s and 678 paramedic
Paramedic
A paramedic is a healthcare professional that works in emergency medical situations. Paramedics provide advanced levels of care for medical emergencies and trauma. The majority of paramedics are based in the field in ambulances, emergency response vehicles, or in specialist mobile units such as...
s, about one health-care professional for every 2,000 people, or only one physician for almost 10,000 people.
Training for health-care assistants, nurses' aide
Aide
Aide may refer to:* A person who assists another; an assistant. In military contexts; an officer who acts as assistant to a more senior one; an aide-de-camp.* Aide , a purported Basque deity....
s, midwives, and primary health-care workers was provided at the Royal Institute of Health Sciences
Royal Institute of Health Sciences (Bhutan)
The Royal Institute of Health Sciences is one of two main medical education centers in Bhutan, the other being the Institute of Traditional Medicine Services. The RIHS was established in Thimphu in 1974 as a member college of the Royal University of Bhutan, and is associated with the National...
associated with the National Referral Hospital
National Referral Hospital (Thimphu)
The National Referral Hospital is the main hospital in Bhutan, located in the capitol, Thimphu. Since it was established in 1972, the hospital has been supplying free basic medical treatment as well as advanced surgeries and emergency services to citizens from all over the country...
, which was established in 1974. Graduates of the school were the core of the national public health system and helped staff the primary care basic health units throughout the country. Additional health-care workers were recruited from among volunteers in villages to supplement primary health care.
The government has maintained a system of universal health care
Universal health care
Universal health care is a term referring to organized health care systems built around the principle of universal coverage for all members of society, combining mechanisms for health financing and service provision.-History:...
for all of its citizens. However, the number of Hospitals in Bhutan has been limited, and some dieseases, such as cancer
Cancer
Cancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...
cannot be treated in Bhutan. Patients that cannot be treated in Bhutan are taken to hospitals in India
India
India , officially the Republic of India , is a country in South Asia. It is the seventh-largest country by geographical area, the second-most populous country with over 1.2 billion people, and the most populous democracy in the world...
, and their treatment is paid for by the government of Bhutan.
The most common diseases in the 1980s were gastrointestinal infections caused by waterborne parasites, mostly attributable to the lack of clean drinking water. The most frequently treated diseases were respiratory tract infections, diarrhea
Diarrhea
Diarrhea , also spelled diarrhoea, is the condition of having three or more loose or liquid bowel movements per day. It is a common cause of death in developing countries and the second most common cause of infant deaths worldwide. The loss of fluids through diarrhea can cause dehydration and...
and dysentery
Dysentery
Dysentery is an inflammatory disorder of the intestine, especially of the colon, that results in severe diarrhea containing mucus and/or blood in the faeces with fever and abdominal pain. If left untreated, dysentery can be fatal.There are differences between dysentery and normal bloody diarrhoea...
, worm
Worm
The term worm refers to an obsolete taxon used by Carolus Linnaeus and Jean-Baptiste Lamarck for all non-arthropod invertebrate animals, and stems from the Old English word wyrm. Currently it is used to describe many different distantly-related animals that typically have a long cylindrical...
s, skin infection
Skin infection
A skin infection is an infection of the skin. Infection of the skin is distinguished from dermatitis, which is inflammation of the skin, but a skin infection can result in skin inflammation...
s, malaria
Malaria
Malaria is a mosquito-borne infectious disease of humans and other animals caused by eukaryotic protists of the genus Plasmodium. The disease results from the multiplication of Plasmodium parasites within red blood cells, causing symptoms that typically include fever and headache, in severe cases...
, nutritional deficiencies
Malnutrition
Malnutrition is the condition that results from taking an unbalanced diet in which certain nutrients are lacking, in excess , or in the wrong proportions....
, and conjunctivitis
Conjunctivitis
Conjunctivitis refers to inflammation of the conjunctiva...
. In 1977 the World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
(WHO) declared Bhutan a smallpox
Smallpox
Smallpox was an infectious disease unique to humans, caused by either of two virus variants, Variola major and Variola minor. The disease is also known by the Latin names Variola or Variola vera, which is a derivative of the Latin varius, meaning "spotted", or varus, meaning "pimple"...
-free zone. In 1979 a nationwide immunization
Immunization
Immunization, or immunisation, is the process by which an individual's immune system becomes fortified against an agent ....
program was established. In 1987, with WHO support, the government envisioned plans to immunize all children against diphtheria
Diphtheria
Diphtheria is an upper respiratory tract illness caused by Corynebacterium diphtheriae, a facultative anaerobic, Gram-positive bacterium. It is characterized by sore throat, low fever, and an adherent membrane on the tonsils, pharynx, and/or nasal cavity...
, pertussis
Pertussis
Pertussis, also known as whooping cough , is a highly contagious bacterial disease caused by Bordetella pertussis. Symptoms are initially mild, and then develop into severe coughing fits, which produce the namesake high-pitched "whoop" sound in infected babies and children when they inhale air...
, tetanus
Tetanus
Tetanus is a medical condition characterized by a prolonged contraction of skeletal muscle fibers. The primary symptoms are caused by tetanospasmin, a neurotoxin produced by the Gram-positive, rod-shaped, obligate anaerobic bacterium Clostridium tetani...
, polio, tuberculosis
Tuberculosis
Tuberculosis, MTB, or TB is a common, and in many cases lethal, infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis. Tuberculosis usually attacks the lungs but can also affect other parts of the body...
, and measles
Measles
Measles, also known as rubeola or morbilli, is an infection of the respiratory system caused by a virus, specifically a paramyxovirus of the genus Morbillivirus. Morbilliviruses, like other paramyxoviruses, are enveloped, single-stranded, negative-sense RNA viruses...
by 1990. The government's major medical objective by 2000 was to eliminate waterborne parasites, diarrhea and dysentery, malaria, tuberculosis, pneumonia, and goiter. Progress in leprosy
Leprosy
Leprosy or Hansen's disease is a chronic disease caused by the bacteria Mycobacterium leprae and Mycobacterium lepromatosis. Named after physician Gerhard Armauer Hansen, leprosy is primarily a granulomatous disease of the peripheral nerves and mucosa of the upper respiratory tract; skin lesions...
eradication was made in the 1970s and 1980s, during which time the number of patients had decreased by more than half, and by 1988 the government was optimistic that the disease could be eliminated by 2000.
It was estimated in 1988 that only 8 persons per 1,000 had access to potable water. Despite improved amenities provided to the people through government economic development programs, Bhutan still faced basic health problems. Factors in the country's high morbidity and death rates included the severe climate, less than hygienic living conditions, for example long-closed-up living quarters during the winter, a situation that contributes to the high incidence of leprosy, and smoke inhalation
Smoke inhalation
Smoke inhalation is the primary cause of death in victims of indoor fires.Smoke inhalation injury refers to injury due to inhalation or exposure to hot gaseous products of combustion. This can cause serious respiratory complications....
from inadequately ventilated cooking equipment. Nevertheless, in 1980 it was estimated that 90 percent of Bhutanese received an adequate daily caloric intake.
Although there were no reported cases of acquired immune deficiency syndrome (AIDS) through the early 1990s, the Department of Public Health set up a public awareness program in 1987. With the encouragement of the WHO, a "reference laboratory" was established at the Thimphu General Hospital to test for AIDS and human immunodeficiency virus (HIV) as a precautionary measure. To further enhance awareness, representatives of the National Institute of Family Health were sent to Bangladesh
Bangladesh
Bangladesh , officially the People's Republic of Bangladesh is a sovereign state located in South Asia. It is bordered by India on all sides except for a small border with Burma to the far southeast and by the Bay of Bengal to the south...
in 1990 for training in AIDS awareness and treatment measures.
See also
- National Referral Hospital (Thimphu)National Referral Hospital (Thimphu)The National Referral Hospital is the main hospital in Bhutan, located in the capitol, Thimphu. Since it was established in 1972, the hospital has been supplying free basic medical treatment as well as advanced surgeries and emergency services to citizens from all over the country...
- Universal health careUniversal health careUniversal health care is a term referring to organized health care systems built around the principle of universal coverage for all members of society, combining mechanisms for health financing and service provision.-History:...
- Tobacco Control Act
- Traditional Tibetan medicineTraditional Tibetan medicineTraditional Tibetan medicine is a centuries-old traditional medical system that employs a complex approach to diagnosis, incorporating techniques such as pulse analysis and urinalysis, and utilizes behavior and dietary modification, medicines composed of natural materials and physical therapies...