Health services in Bhutan face shortage of doctors and modern equipment. We have only 300 doctors and around 1000 nurses. The current ratio of doctors to population is around 1:2300 and ratio of doctors to nurses is 1:300. Doctors and nurses are overworked, under-compensated and patients sometimes bear the brunt of their frustrations with long lines and unsatisfactory services. However, free health care is a basic component of GNH and we have no options but to improve the services. Given the time and the investment that it takes for doctors to be trained, we should come up with training Associate Doctors, or Nurse Practitioners as they call in other countries. This focus may allow is to not only improve services inside but also eventually train an army of associate doctors who could explore other countries to work with their skills where market in health care runs into trillions of dollars.
The problem is to focus on efficiency and quality of services mainly in patient interface rather than requiring specialized doctors to stay in places where their skills may not be utilized or they may not have the facilities and eco system to use them. The key is to put in an efficient system both in the rural and the urban areas where access to primary care should be upgraded with qualified health Associate Doctors (nurses) and specialized services should be accessed through remote means or patients then transferred to referral hospitals.
Associate doctors (nurses) are trained in 4 years instead of 6-7 years for doctors and they have all the requisite skills for providing all primary care. Calling them doctors in our cultural context would provide them the social status and the clout for people to reach out instead of looking for health specialist who may not have the time or the expertise to provide the best initial care.
The Associate Doctors shall be well trained, well paid and also versed in spirituality in the art of compassionate care giving during a patient’s illness and death, a key to Buddhist teachings. This may be an area where our Buddhist monks and nuns and the religious communities also have to play a vital role in engaging more with the community in areas of health and spirituality. Our custom of doing religious rituals and offerings along with medical treatment should not become exclusive of each other, but rather a combined practice and services that should be facilitated through the Health Policies. Such skills I believe, will not only complement our traditional aspect of care giving to the sick and the elderly, but a rare skill for export of services to countries like Japan and other modern societies who are increasingly facing aging problems and spiritual and compassionate emptiness.
While health care in Bhutan should be free and good, there is no harm in exporting this valuable skills to the outside world especially when it promotes our fundamental Buddhist values of compassion and the objectives of a happy universal society.