Wednesday, 10 September 2008

Bhutan : Care providers – Overloaded and undervalued

9 September, 2008, - It’s not rare to find Bhutanese, who visit the Thimphu national referral hospital, return with grievances. Their list of complaints includes long lines outside the doctors’ chambers and harsh treatment from health staff. Be that as it may, doctors say there is always the other side to a story.

Shortage of doctors and nurses in the country and long hours of work to make up for it could be the source of their sorely tried patience.

A Thimphu doctor starts duty at 9:00 am. He goes to the wards for his routine checks and arrives two hours later at his chamber. By then a chain of patients will be waiting outside. He barely finishes attending half the queue when the clock strikes 3:00 pm. If he is lucky he gets to go home but there are almost always emergencies and surgeries that need his attention. The next day, whether he had late night emergencies or not, his routine begins at the same time, 9:00 am.

“Doctors are human beings and we have our limitations,” said Urologist Dr Lotay Tshering.

Dr Lotay Tshering said that, to give a detailed examination, it required at least 20 minutes for a patient. But after the ward round doctors are left with about four hours, which is just enough to see about 15 patients only. He says he has more than 50 patients waiting outside his chambers daily.

“If I’m to see 15 patients and I didn’t give them adequate time and attention, then it’s my fault,” said Dr Lotay. “But we need clear directives whether to make all 50 patients happy or choose 15 genuine cases.”

Then there are those who try to rush through the formalities in an hour or two requesting for faster doctor services. Dr Lotay said there were times when a doctor’s patience were put to the test. “I might be the first doctor the patient is seeing but, to me, he is the 31st patient and, after answering and instructing the same queries, we lose our patience.”

Dr Lotay also said that half their time was spent in non-surgical work. “We need an adequate administrative support with a good set of office and assistants, who’ll handle the paperwork.”

Medical director, Dr Ngawang Tenzin, said that ideally there should be a set of teams in the outpatient department (OPD), operation theatre, and the wards but, because of an acute shortage of manpower, a doctor was looking after everything.

Thimphu national referral hospital has 34 doctor specialists, excluding the three from RBA and three on contract, plus eight general duty medical officers.

Dr Ngawang Tenzin said that crowding in the referral hospital could be avoided if people followed the system - from BHU to district hospitals to regional hospitals, which were also well equipped.

“But most prefer to come here even if their cases could be handled by district hospitals,” he said, adding that, if people utilised district services, the case load, especially the OPD ones, would go down.

The services in the new 350-bedded hospital, which was expected to be complete soon, would also be opened as per the manpower available, said Dr Ngawang.

The Ministry of Health’s chief planning officer, Sonam Dorji, said that, to avoid queue-jumping, a token system was introduced. “There is crowding because there’s one waiting room for reception, laboratory, pharmacy and doctors’ chambers. With the new hospital, hopefully, that will be solved.

“We’ve initiated recruitment on contract the nursing assistants so that skilled nurses have time to give better nursing care,” said Sonam Dorji, adding that intake of students at the Royal Institute of Health Sciences was also raised.

By Kesang Dema

No comments: