Bhutan embarked on the path to modern development under the far-sighted vision of His Majesty the Third Druk Gyalpo, Jigme Dorji Wangchuck. The first allopathic hospital in the country was established in Charayna, Langjophaka, in Thimphu in 1956. This marked the introduction of modern healthcare services with hospital-based patient care, and His Majesty laid the foundations for the establishment and expansion of the modern healthcare setup. In this article, we review the development of modern healthcare services in the Gelephu-Sarpang region.
At the time when the First Five Year Plan (FYP) was initiated in 1961, there were four hospitals in Thimphu, Paro, Wangdue Phodrang, and Trashigang. In the First FYP from 1961 – 1966, the Public Health Department, under a chief medical officer, was set up in Thimphu for proper organization and planning of healthcare services in the country. The existing hospitals were provided with trained medical staff. The First FYP document mentions two new hospitals being opened in Samtse and Sarpang, and two new dispensaries in Gasa and Zhemgang.
In 1964, the programme for the eradication of malaria was established with its headquarters and a laboratory in Sarpang, with sub-centres at ten different locations for insecticide spraying. The programme was supported by a team of experts from the National Malaria Eradication Programme of the Government of India. The programme now stands as the Vector-Borne Disease Control Programme in Gelephu town under the Ministry of Health.
In 1966, Sarpang Hospital had one medical doctor, one nurse, and two assistant nurses, one vaccinator, and five cooks. In the Second FYP from 1966 – 1971, Sarpang was one of the six places where engineering work for water supply was conducted involving the Bhutan Engineering Department and the Public Health Department. It was one of the three hospitals, with Thimphu and Paro hospitals, supplied with vehicles to operate mobile health units. These vehicles had been provided by the Government of the United Kingdom under the Colombo Plan. It was planned to equip Sarpang Hospital with an X-ray facility, but it could only be installed in 1975.
At the beginning of the Second FYP in 1966, among the 25 dispensaries across the country, the dispensaries in Gelephu, Paro, and Bumthang had one doctor posted. These three dispensaries had combined 3 doctors, 37 compounders, 25 nurses/vaccinators, and one dresser. All doctors were expatriates, while a few of the compounders were Bhutanese. Close ties were maintained with doctors stationed in the nearby tea gardens across the border in Assam and Bengal, who offered medical assistance to Bhutanese patients. In the Second FYP, dedicated funds were allocated to improve the medical cover provided by these dispensaries. The funds also facilitated the construction of a modest number of staff accommodations and the acquisition of necessary equipment.
For the convenience of medical planning, by 1971, the country was organized into seven medical zones with zonal headquarters in Thimphu, Paro, Samtse, Phuentsholing, Sarpang, Bumthang, and Trashigang. The number of hospitals increased from four to six, and dispensaries from 11 to 34 during the period from 1961 to 1971. In the Third FYP from 1971 – 1976, the Thimphu General Hospital was expanded from 50 to 100 beds with specialist facilities in surgery, medicine, midwifery, dentistry, pathology, and ophthalmology. By 1970, a dispensary had been established in Lhamoizingkha and Jigmechoeling, and in Norbuling in 1974.
In the Third Five Year Plan, the Royal Government instituted the Basic Health Units (BHUs) for the delivery of primary healthcare to remote habitations, with special emphasis on augmenting health services for the underprivileged and underserved areas of the country. Bhutan became a signatory to the Alma Ata Declaration on Primary Healthcare in 1978. Thereafter, the Royal Government focused on expanding the primary healthcare infrastructure through the establishment of a greater number of Basic Health Units and the appointment of Health Assistants, auxiliary nurse and midwives (ANM), and basic health workers (BHW).
The health infrastructure network in 1987 consisted of 46 Peripheral Health Posts (dispensaries), 68 Basic Health Units, and 27 hospitals. The hospitals were organized as district, regional, and national referral hospitals. Patients were referred for health services outside the country, mainly to Kolkata, Vellore, and Delhi for specialized diagnoses and treatment.
According to oral sources, there was a small dispensary in Gelephu in the 1960s at the current location where the Royal Bhutan Police stands. Information about the year when the Gelephu Dispensary was established could not be ascertained, but it appears in the records by 1966. Gelephu Hospital received its X-ray facilities in 1975, along with Sarpang, Trashigang, and Samtse Hospitals. In 1981, the National Institute of Family Health was established to facilitate the training of health workers on immunization and maternal and child health services. The institute was situated on the grounds where the current hospital complex is located.
The services of Gelephu Hospital appear in statistical records dating from 1983 onwards. In 1983, Gelephu General Hospital saw 32,733 outpatients and 1386 inpatients, while Sarpang General Hospital saw 18,469 outpatients and 842 inpatients. In the same year, the Thimphu General Hospital saw 75,533 outpatients, which was fewer than the 81,669 seen by the Indigenous Hospital.
By March 1987, Gelephu Hospital was the fourth-largest hospital among those not designated for leprosy care. By then, Thimphu General Hospital had 200 beds, Trashigang Hospital had 75 beds, Samtse Hospital had 59 beds, Gelephu Hospital had 40 beds, and Sarpang Hospital had 20 beds. Yebilaptsa Hospital then was a leprosy cum general hospital with 10 beds. Basic Health Units had been established in Jigmechoeling, Norbuling, Jangchubling, Lhamoizingkha, and Taklai under Gelephu Dzongkhag.
His Majesty the Third Druk Gyalpo also had the vision to preserve the Sowa Rigpa tradition with a set of unique practices. The first Sowa Rigpa clinic in the country was opened in 1968 in Dechencholing, Thimphu. With the Royal Government’s efforts to make Bhutanese Traditional Medicine accessible to all people, Gelephu Hospital established its Traditional Medicine Unit in November 1993.
By 2000, the country’s healthcare system had assumed a three-tiered level with the designation of two Regional Referral Hospitals and one National Referral Hospital. In the same year, the Thimphu General Hospital was renamed as the Jigme Dorji Wangchuck National Referral Hospital in honour of His Majesty the Third Druk Gyalpo. Until 2004, Yebilaptsa Hospital was designated as the Central Regional Referral Hospital, while Monggar Hospital was the Eastern Regional Referral Hospital. By 2005, Gelephu Hospital had been designated as a Regional Referral Hospital with an increased bed capacity to 60. In 2004, the CRRH Gelephu had four to six laboratory technicians, compared to 66 at the Jigme Dorji Wangchuck National Referral Hospital and one to two at dzongkhag hospitals. High-risk obstetric ultrasound services were established at the CRRH Gelephu in 2004, alongside the implementation of the Magee Project funding. In 2005, the CRRH was given administrative autonomy from Sarpang Dzongkhag and was placed under the Ministry of Health.
The Gelephu General Hospital was located north of the current location, just across the road where the old structure still stands (Figure). It had outpatient units and one common inpatient unit where both adults and children were admitted. There are stories about expatriate doctors who were general surgeons, orthopaedic surgeons, and a very strict obstetrician-gynaecologist who have touched the lives of those in need.
In Sarpang Dzongkhag, the current structure of Chuzanggang BHU was established in 1997, Umling BHU in 1999, Gakidling BHU in 2006, Senggey and Tareythang BHUs in 2011, Chhoekhorling and Maenchhulam BHUs in 2012. The structure in Jigmechoeling was upgraded to BHU in 2002 and the dispensary in Jangchubling was upgraded to BHU in 2005. In January 2020, BHUs Grade II were renamed as Primary Health Centres and BHUs Grade I were renamed as 10-bedded Hospitals.
In the Eleventh FYP from 2013 – 2018, the CRRH Gelephu was among the five that were being reconstructed; the others were Damphu, Wangdue, Samtse, and Dewathang Hospitals. The current CRRH building stands on the area that was earlier occupied by the National Institute of Family Health and subsequently by the Royal Bhutan Army. The construction of the current complex began in December 2012. The total expenditure of Nu 871 million was funded by the Government of India. It was inaugurated in July 2018 and was marked as one of the milestones in Bhutan-India friendship. The new hospital has upgraded digital X-ray technology and CT scan machines provided by the Government of Japan.
In the last two decades, the CRRH Gelephu has witnessed many milestones in the expansion of services and the establishment of specialties. Gelephu sits at a watershed point in time with exciting developments happening in the neighbourhood. We have attempted to summarize the progress the country has made in establishing and sustaining the healthcare system in the Gelephu-Sarpang region. However, as is evident from scanty pieces of information pieced together, humans are a species with amnesia. Much of what our fore bearers have done and achieved may often be forgotten. This article is a tribute to our visionary monarchs who have led this country to the level of social development that we have now and individuals who have worked on the ground to deliver health services through these facilities and touched the lives of many in their times of need.
Contributed by
Dr Thinley Dorji and
Monu Tamang
Central Regional Referral Hospital, Gelephu, Bhutan
Email: dorji.thinleydr@
gmail.com