𝐀𝐢𝐥𝐢𝐧𝐠 𝐒𝐲𝐬𝐭𝐞𝐦𝐬, 𝐀𝐢𝐥𝐢𝐧𝐠 𝐏𝐚𝐭𝐢𝐞𝐧𝐭𝐬, 𝐚𝐬 𝐉𝐃𝐖𝐍𝐑𝐇 𝐖𝐫𝐞𝐬𝐭𝐥𝐞𝐬 𝐰𝐢𝐭𝐡 𝐃𝐢𝐬𝐨𝐫𝐠𝐚𝐧𝐢𝐳𝐚𝐭𝐢𝐨𝐧 𝐚𝐧𝐝 𝐒𝐡𝐨𝐫𝐭𝐚𝐠𝐞𝐬

…𝒊𝒏𝒗𝒆𝒔𝒕𝒊𝒈𝒂𝒕𝒊𝒏𝒈 𝑱𝑫𝑾𝑵𝑹𝑯’𝒔 𝒎𝒂𝒏𝒂𝒈𝒆𝒎𝒆𝒏𝒕 𝒘𝒐𝒆𝒔 𝒂𝒏𝒅 𝒑𝒂𝒕𝒊𝒆𝒏𝒕 𝒈𝒓𝒊𝒆𝒗𝒂𝒏𝒄𝒆𝒔 𝒔𝒑𝒂𝒓𝒌𝒔 𝒖𝒓𝒈𝒆𝒏𝒕 𝑫𝒆𝒎𝒂𝒏𝒅 𝒇𝒐𝒓 𝒓𝒆𝒎𝒆𝒅𝒊𝒂𝒍 𝒂𝒄𝒕𝒊𝒐𝒏 𝒊𝒏 𝒕𝒉𝒆 𝒉𝒆𝒂𝒍𝒕𝒉𝒄𝒂𝒓𝒆 𝒍𝒂𝒏𝒅𝒔𝒄𝒂𝒑𝒆

By Krishna Kumar Sanyasi

The Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) is a prominent healthcare facility in Bhutan, serving as a crucial referral center for patients across the country. With its extensive infrastructure and specialized medical services, JDWNRH plays a vital role in providing advanced healthcare to the people of Bhutan. However, recent concerns have been raised about the management system and the quality of service provided at the hospital. Despite being a major healthcare institution, the hospital has been marred by disorganization and subpar patient care, leading to growing dissatisfaction among both patients and healthcare workers.

One of the primary issues at JDWNRH revolves around the behavior of healthcare professionals. Complaints received through various channels, including verbal reports and social media platforms, have shed light on perceived partiality and instances of medical negligence, raising serious questions about the respect and care provided by the hospital’s staff. These concerns highlight the critical need for a thorough evaluation of the conduct of healthcare professionals and the implementation of measures to ensure equitable and compassionate treatment for all patients.

According to Pema Choden, a teacher by profession who underwent Thyroidectomy and happened to come to Thimphu, “It’s been a week since my surgery, and the post-operative care has been a crucial aspect of my recovery.

However, upon seeking assistance at the emergency ward in Thimphu, I was met with unexpected obstacles.” Choden expressed her dismay at the response she received, stating, “Despite the urgency of requiring dressing changes every two days, I was turned away at the emergency ward, with the staff citing time constraints as the reason. The refusal to provide essential care left me in a precarious situation, especially considering the long journey I had undertaken from Gelephu.”

Choden highlighted the lack of empathy displayed by the healthcare professionals, particularly emphasizing the demeanor of a female doctor whom she found to be harsh and dismissive. “I pleaded with them, explaining the urgency of my situation and the potential risks of infection. Despite having the necessary equipment and resources at their disposal, my requests were met with indifference and reluctance,” she added.

Expressing her disappointment at the perceived lapse in professional ethics, Choden cried, “It was disheartening to witness such a disregard for basic courtesy and care, particularly from individuals entrusted with the well-being of others. The incident has accentuated the importance of upholding the values of compassion and empathy in healthcare settings.”

A health staff member from the emergency ward revealed that they only deal with cases that require immediate care. When asked about dressing wounds, they clarified that they are not bound to do so as there is a special department for that. However, health staff expressed concern about the lack of staff, which has made their work more hectic.

According to her, “We have to deal with other major issues, and the lack of staff has made our work more challenging. We are not able to give immense care to everybody, which we feel guilty about. Nevertheless, we are giving our best despite our busy schedule.”

Rup Narayan, a retired civil servant, shared his frustrations about the treatment he received at a hospital during his frequent checkup visits. Narayan, who is elderly, expressed his disappointment at having to wait in long lines in the cold before receiving medical attention.

“I have to visit the hospital frequently for checkups, and upon coming early here in the cold, I am bound to wait in a queue,” Narayan explained. “After getting a token and waiting outside the chamber, I could see all the fishy things – the health workers taking their known patients for checkups.” Narayan went on to describe an incident where he felt he was unfairly treated by the hospital staff. “I was waiting outside the chamber after giving my prescription to nurses, but people who came after me were checked first,” he said. “I even argued with the nurse, but I was ignored and scolded, and they didn’t even check up on me well,” he scorned.

While on the topic of patient prioritization and misconceptions surrounding it, a nurse explained that there is a common misconception that patients who are seen immediately are receiving preferential treatment over others who may be waiting in line. The nurse clarified that some patients require immediate attention due to their critical condition, such as those in wheelchairs, those who have recently undergone surgery, or those who are in a critical state.

In these cases, it is necessary for the healthcare team to prioritize these patients to provide them with the care they need. The nurse emphasized that there is no favoritism or partiality in the way patients are prioritized and that the healthcare team strives to provide care to all patients in a timely manner. With nearly two decades of experience in the field, the nurse stressed the importance of understanding and empathy from other patients who may be waiting, as well as the importance of providing the necessary care to those in critical need.

A health worker has shed light on the challenging realities faced within the healthcare system. “Due to the severe shortage of staff, our ability to provide immediate care to patients is significantly hindered,” the health worker groaned.

The stark truth emerges: the nurse-to-patient ratio stands at a staggering 1:6, stretching resources thin and impeding swift medical attention. Night shifts paint a particularly daunting picture, with a lone nurse often tasked with overseeing a challenging twelve patients. The weight of responsibility in such circumstances is tough. The health worker emphasized the inherent difficulties faced in ensuring comprehensive care under such strained conditions.

Compounding these challenges is the unveiling of a new system by hospital management – the “extended hours” initiative. Under this scheme, nurses who are willing can do 12-hour shifts, spanning from the early morning at 8 AM to the late evening at 8 PM. This adjustment, while aimed at addressing staffing shortages, raises concerns about the toll it may take on the well-being and effectiveness of the healthcare team.

According to Dorji Phuntsho, a patient from the area, the hospital opens around 9 to 9:15 am, but patients have to wait as early as 7 am just to get in line for a token. Even after obtaining a token, it can take hours to finally meet with a doctor. Phuntsho believes that recruiting more employees and doctors at the hospital could help alleviate these issues and improve the overall healthcare experience for patients. The government should take action to address these concerns and ensure that patients receive timely and effective care. It’s time for change and improvement in the healthcare system.

A health worker at the (JDWNRH) sheds light on the challenges faced by both medical staff and patients alike. “We empathize with the patients’ plight; their urgency for treatment is palpable. However, the reality lies in the disproportionate health worker-to-patient ratio. With one nurse attending to 4 to 6 patients simultaneously, the quality of care and attention inevitably suffer,” the health worker highlighted. The escalating attrition rate among health workers has further exacerbated the situation, leading to a concerning decline in the standard of healthcare services provided. Despite the adversities, there remains a glimmer of hope in the form of potential governmental interventions. She expressed optimism that the new administration would prioritize bolstering the healthcare workforce, thereby addressing the pressing need for additional personnel and resources.

A nurse spoke out about the challenges facing the nursing profession in the current healthcare system. The nurse highlighted the crucial role that nurses play in patient care, emphasizing that without their presence, there would be significant issues. The nurse expressed frustration over the lack of recognition and appreciation for the work that nurses do, noting that many are choosing to go abroad where they are valued and compensated more fairly. In contrast, here, nurses often feel overshadowed by doctors and are treated as mere assistants, despite being responsible for much of the day-to-day care and support provided to patients. As a vital force in the healthcare system, nurses play a critical role in ensuring the well-being of patients and deserve recognition for their hard work and dedication.

The shortage of nurses, however, has serious implications for the provision of equitable healthcare services in the country. The country is currently short of nurses going by the nurses to population ratio. The ratio for every 1,000 populations is two nurses as per the OECD (Organisation for Economic Co-operation and Development). Additionally, the overall attrition rate is not a huge concern for the JDWNRH given the internationally considered attrition rate of somewhere at 10%, but the hospital is losing experienced and trained nurses, which have to be replaced by fresh graduates.

Currently in JDWNRH, a total of 1117 clinical staff members diligently serve, with 350 among them donning the noble mantle of nursing. Within this cohort, 60 dedicated nurses extend their care within the outpatient departments (OPD), while 290 others tirelessly attend to the needs of patients within the Inpatient departments (IPD). These compassionate caregivers are dispersed across approximately 30 distinct departments, where the nurse-to-patient ratio often stands at a challenging level. It is noteworthy that the nurse-to-patient ratio in the general wards stands at 1:6, reflecting the demanding nature of their responsibilities. In a broader context, the healthcare landscape of Bhutan reveals a significant statistic, with 4.6 doctors and 20.9 nurses per 10,000 individuals, marking one of the lowest ratios in the region. Notably, this falls below the World Health Organization’s recommended standard of one doctor per 1,000 individuals, underlining the need for continued efforts to bolster healthcare resources in the nation.

The revelations at JDWNRH stress the urgent need for systemic reforms and increased support for healthcare workers. By addressing staffing shortages, improving patient care standards, and recognizing the invaluable contributions of nurses, the government can pave the way for a healthcare system that prioritizes compassion, equity, and excellence. The time for change and improvement in healthcare delivery is now, ensuring that every patient receives the quality care they deserve.