𝐈𝐧𝐭𝐞𝐧𝐬𝐢𝐟𝐢𝐞𝐬 𝐁𝐚𝐭𝐭𝐥𝐞 𝐀𝐠𝐚𝐢𝐧𝐬𝐭 𝐓𝐮𝐛𝐞𝐫𝐜𝐮𝐥𝐨𝐬𝐢𝐬 𝐀𝐬 𝐂𝐚𝐬𝐞𝐬 𝐑𝐢𝐬𝐞 𝐀𝐦𝐨𝐧𝐠 𝐘𝐨𝐮𝐭𝐡

…𝒚𝒐𝒖𝒏𝒈 𝒑𝒆𝒐𝒑𝒍𝒆 𝒎𝒂𝒌𝒆 𝒖𝒑 𝒎𝒂𝒋𝒐𝒓𝒊𝒕𝒚 𝒐𝒇 𝒏𝒆𝒘 𝒄𝒂𝒔𝒆𝒔 𝒂𝒔 𝒅𝒆𝒍𝒂𝒚𝒆𝒅 𝒅𝒊𝒂𝒈𝒏𝒐𝒔𝒆𝒔 𝒂𝒏𝒅 𝒔𝒕𝒊𝒈𝒎𝒂 𝒄𝒐𝒏𝒕𝒊𝒏𝒖𝒆 𝒕𝒐 𝒊𝒎𝒑𝒂𝒄𝒕 𝒓𝒆𝒄𝒐𝒗𝒆𝒓𝒚

By Yeshi Dolma

Tuberculosis (TB), one of the oldest and deadliest infectious diseases, continues to pose a serious public health challenge in Bhutan. According to the Ministry of Health, TB cases in the country rose from 864 in 2023 to 920 in 2024. Notably, over 58 percent of the cases were among young people aged 15 to 34. Cases of drug-resistant TB (RR/MDR-TB) also remained a concern, with 61 cases reported in 2024.

While the increase in numbers is concerning, it also reflects enhanced surveillance and improved diagnostic capacity.
Globally, TB remains a leading cause of death. The World Health Organization (WHO) reported 10.8 million new TB cases and 1.25 million deaths in 2023. Dr. Tereza Kasaeva, Director of WHO’s Global Programme on Tuberculosis and Lung Health, described TB as a “global crisis,” exacerbated by COVID-19, conflict, and deepening social inequities.

In Bhutan, health authorities are stepping up their response. On World Tuberculosis Day 2025, the Ministry of Health reaffirmed its commitment to reducing TB incidence by 80 percent and TB-related deaths by 90 percent by 2030.

A key component of the national strategy is innovation. In February 2025, Bhutan launched its first AI-powered mobile TB diagnostic van. Equipped with a digital X-ray machine, Qure.ai software for immediate image analysis, and a GeneXpert machine for molecular diagnosis, the van is already making an impact.

“It’s a game-changer,” said Phurpa Tenzin, a health official. “The van allows us to bring one-stop TB diagnostic services to even the most remote communities- places where access to healthcare was once a major barrier.”
But beyond technology, the fight against TB remains deeply personal.

Tshering Peldon, 29, shared her experience of being diagnosed with TB after more than two years of symptoms and inconclusive test results.

Her illness began with a persistent dry cough and fatigue, which she initially dismissed. “I was told to rest more, eat better, and not worry,” she said. But her condition deteriorated. It was only during a visa medical screening that a chest X-ray finally revealed she had active tuberculosis.

“I didn’t know whether to feel relieved that I finally had an answer, or afraid of what came next,” she recalled.
Though her treatment lasted six months, she said the toll was far greater. The daily regimen of pills caused side effects including nausea, appetite loss, and fatigue. “Some days I couldn’t even get out of bed,” she said. The illness also isolated her socially and professionally.

“People think TB is just a six-month illness, but for me, it stole two years of my life,” she said. Her case illustrates how atypical symptoms and limitations in standard testing can delay diagnosis. “It shouldn’t take a visa application to save someone’s life,” she added. “We need more awareness and better diagnostic tools because TB doesn’t wait.”
Another case involves a young student preparing to study in Japan on a prestigious scholarship. She was diagnosed with active TB during her visa medical screening, despite showing no symptoms.

“It was devastating,” she said. “I had worked so hard for the scholarship, and everything changed in a moment.” While she hopes to resume her studies after completing treatment, the emotional impact of the delay remains significant.
In another instance, Karma (name changed), a job seeker was found to still be TB-positive after completing six months of treatment. Health officials attributed the treatment failure to missed doses during the regimen.

“Even one missed dose can lead to treatment failure and increase the risk of drug-resistant TB,” said a health official.
Karma is now undergoing a second round of treatment under strict supervision through the Directly Observed Treatment (DOT) program. The experience has delayed his employment opportunities and taken a toll on his physical and mental well-being.

His case highlights the importance of treatment adherence- not only for individual recovery but also for preventing the emergence of drug-resistant strains, which are harder and more expensive to treat.

In Thimphu, 11-year-old son of Rashmika Gurung was diagnosed with TB after months of unexplained fatigue, stomach pain, and weight loss.

“At first we thought it was just a regular illness,” Rashmika said. “But when he started crying without explaining why, we knew something was seriously wrong.” After multiple hospital visits, a diagnosis was finally made.

Her son had to stop attending school and begin treatment immediately. “He had to take several large pills daily, which made him vomit and lose his appetite. Some days he was too weak to get out of bed,” she said. Though he has recovered, the family continues to deal with the emotional aftermath. “He had to repeat a school year, and the social stigma was crushing,” she added.

Bhutan has also seen an increase in asymptomatic TB cases, often discovered during routine screenings for visas, scholarships, or training programs.

“They show no typical symptoms like fever or weight loss, making early detection difficult,” said Maj (Dr) Yeshey Om Tshering, one of Bhutan’s leading TB experts.

According to Maj (Dr) Yeshey Om Tshering, the country is also seeing a rise in asymptomatic cases, particularly identified during visa, scholarship, or training medical screenings. These cases often go unnoticed due to the absence of classical symptoms such as persistent fever, cough, or weight loss. She outlined several barriers to early diagnosis, including atypical or extra-pulmonary symptoms that don’t involve the lungs, delays in seeking medical help, and difficulties in diagnosing children who often have a low bacterial load.

Dr. Yeshey also emphasized the range of factors contributing to TB transmission, including poor ventilation, overcrowding, substance abuse, and compromised immune systems due to HIV or diabetes. Many people also remain unaware of extra-pulmonary TB, which affects organs other than the lungs.

“Public awareness is absolutely crucial,” she said. “Many patients stop treatment because of side effects, but that only makes things worse. Untreated TB can become drug-resistant and far more dangerous.”

To ensure adherence to treatment, Bhutan implements the Directly Observed Treatment (DOT) strategy. Under this program, health workers supervise patients during their medication intake and follow up to ensure completion.
“They remind patients at the end of each treatment cycle to return for the next,” explained a health official. “This helps build trust and saves lives.”

The burden of TB is most concentrated in eight dzongkhags: Thimphu, Chukha, Mongar, Samtse, Sarpang, Samdrup Jongkhar, Paro, and Wangduephodrang. These districts accounted for over 80 percent of all TB cases in 2023 and remain the focus of intensified screening and outreach efforts.

Despite the challenges, health officials are determined to curb the disease.

“We are fighting not just a bacteria, but stigma, ignorance, and time,” said Dr. Yeshey.
As Bhutan continues its battle against TB, each diagnosis, treatment, and recovery marks a step forward in safeguarding public health.