Larger questions hang over private practice

MoH proposes to RCSC to hire retiring doctors on a special contract

 

This paper in its last issue published an open letter by an eminent  former Dungtsho Sherab Jorden, who announced that he would no longer see patients after he was served a letter by the Bhutan Medical and Health Council (BMHC) asking him to stop practicing traditional medicine.

Apart from an outraged reaction from many of his patients and other people who had been cured by him, the letter has also thrown open bigger questions over the issue of private practice in Bhutan.

Meanwhile, in response to some questions the BHMC clarified that the letter to the Dungtsho had been served on the basis of the Medical and Health Council Act 2002 and BMHC health guidelines.

BMHC Assistant Information and Media officer Tshewang Dorji said, “There were three grounds on which the letter was sent to the Drungtsho after the matter was discussed first in the Professional Ethics Committee and then the Executive Committee where the decision was taken.”

The matter first came to the attention of the BHMC after an article by another media outlet highlighted the contributions of the Dungtsho and his treatment. Tshewang clarified that no patient had come to the council with any complaints.

He said that as per the Act and guidelines private practice is not allowed in Bhutan. He said no one is allowed to take money for treating patients and moreover the treatment even if done for free should be in a medical facility like a hospital.

The Dungtsho had clarified in his letter that a nominal fee of Nu 200 was being collected but those were all for religious purposes like Moenlam Chhenmo, Drupchen, fasting rituals etc for which he had receipts.

Tshewang said that a check had been done on the Dungtsho’s home last year by the BHMC and at the time itself he was asked not to continue any practice. Tshewang said the BHMC found that the Drungtsho was not sterilizing his needles but only dipping them in a Dettol solution.

However, this particular charge was refuted by the Dungtsho who said that after using a needle on the patient, he, in front of the patients always puts it aside and later in the evening boiled it to a high temperature to sterilize it only after which it was dipped in Dettol. He clarified that the needles were thrown after a second use. The Dungtsho said his patients can vouch that he follows this safe process.

The Dungtsho said that he was well aware of various diseases that can be transmitted through infected needles and so every professional care was taken to sterilize them and then throw them.

However, Tshewang also clarified that the Dungtsho had earlier registered as a medical practitioner through the registration committee with the BHMC.

The Health Secretary Dr Dorji Wangchuk who is also the Chairman of the Executive Council said, “The Council’s most important guiding principle is that no one is allowed private medical practice.”

He said that in the case of Dungtsho Sherub he is known as a very renowned teacher of traditional medicine and also offers free treatment to people including eminent people like Namkhai Nyingpo Rinpoche.

The BHMC will not be stopping at the Dungtsho but it is also looking at what is happening in private diagnostic centers.

Though private practice is not allowed the government has allowed for private diagnostic centers. Currently of the two centers one is the Menjong Diagnostic Center run by Dasho (Dr) Gado Tshering and Dr Sonam Drukpa and the second one is the Pedkar Diagnostic Center run by Dr Lobzang and Dr Ballabh Sharma.

A BHMC official said that they had informally heard that though the diagnostic centers are only for technical diagnosis there was some form of private practice going on.

One recent example is the Druk Air incident of the deplaning of a sinus patient where contrary to the same Medical Act an air worthiness certificate had been issued by Dasho (Dr) Gado Tshering.

The BHMC official said that Dasho has been asked to given an explanation and the BHMC is looking into the case.

At the same time the BHMC is also drawing up special regulations for the diagnostic centers as the official said it was difficult to regulate them without any existing regulations.

In the bigger picture there is an increasing demand both from within the health system and also patients to allow for private medical practice of some kind.

The Health Secretary said that many issues are cropping up on how many doctors who are retiring their prime can be employed. He said that the Council would have to think of a way out on the issue.

The secretary said that private practice was originally banned as it was feared that doctors would not go into remote areas, but there is also now a case of many good doctors retiring and not being allowed to practice.

Meanwhile, according to sources, there is some pressure and lobbying from within the Health Ministry itself to see if private practice of some kind can be inserted into the upcoming Health Bill, which is currently being drafted.

However, the Health Minister Lyonpo Tandin Wangchuk said that though he was initially in favour of having some private practice he felt the time was not yet right.

“It could lead to many government doctors leaving the hospitals which would become more like training grounds for private doctors,” said the minister. He said the same people asking for private practice would suffer in the end.

Lyonpo said that the aim of the health system was to ensure equitable distribution of doctors and health professionals across the country and private practice would affect this.

The Health Minister, however, acknowledged that internationally doctors are considered to reach their prime through practice by age 50 or 60 but in Bhutan government doctors have to resign by that age.

The minister said that to address both this and the shortage of doctors the ministry had put up a proposal to the Royal Civil Service Commission (RCSC) to allow hiring superannuated retired doctors on a special contract. He said this could also be an encouragement to doctors to finish their full term and then have something to look forward to even after retirement. This could also address issues like not losing skilled people like the Dungtsho and also allowing them to practice in the hospital. The proposal is under consideration.

Meanwhile to address the perennial doctor’s shortage, the Health Ministry had requested for a second batch of Cuban doctors after the recent one is heading back on completing their contract. The only problem with such an arrangement is that though Bhutan mainly needs specialists, Cuba sends its doctors in a non-negotiable package of eight specialists with around nine general doctors.

The advantage is that though the international rate of hiring doctors is around USD 3,500 to USD 4,000 the Cubans only charge around USD 1,500 per doctor. However, on the flipside even this USD 1,500 coming to around Nu 100,000 is way above the salary of Bhutanese doctors which has lead to some unhappiness among the local doctors.

The government in the meantime has to juggle between managing an increasing demand for private practice, shortage of doctors, retiring doctors and need to keep health service accessible to all.

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