The Bhutanese Leading the way.
Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) has been planning to have new Psychiatric ward for a long time but due to lack of budget or fund, the hospital still uses the old boys’ hotel of Royal Institutes of Health Sciences (RIHS) which was built in around 1974.
Currently there are 9 psychiatric patients and 10 patients undergoing alcohol and drugs detoxification. Only 20 beds are there in the ward.
The medical superintendent of the hospital, Dr. Gosar Pemba said they want to have a separate psychiatric ward but due to lack of budget, they could not have another one.
Dr. Gosar said the psychiatric ward was supposed to be shifted in the old mother and child hospital but because of the new construction of Ear, Nose, and Throat (ENT) hospital funded by Thailand they could not be shifted.
“We are looking for budget, donation from outside or if the government is willing to fund from inside, we are looking to construct new psychiatric ward along with OPD, everything in one building,” said Dr. Gosar.
Dr. Gosar also highlighted on the recent suicide case where a patient strangulated himself in the ward. They have never thought a patient would commit suicide with his belt. Since then the hospital has been strictly checking and monitoring each patient.
He said the building should be safe for the patients. There are some patients who batter themselves. For them, the room should have padded walls as well.
The hospital is also aware that the taxis parked in front of psychiatric ward bring in alcohol for the patients who are undergoing alcohol detoxification. The hospital have placed in security around the clock but still it happens. However, hospital cannot help the patients if the patients does not help themselves, said Dr. Gosar.
Dr. Gosar said due to space constraint, both psychiatric patients and alcohol and drugs detox patients are in same building. He said they should be kept in a different ward.
Psychiatrist of JDWNRH, Dr, Nirola said the hospital has been witnessing quite a number of patients. He said in a day, 20 to 30 patients visit Psychiatrists and it has been challenging since the demand has become really big they they have only two psychiatrists in the hospital.
He said main challenge is that JDWNRH is the only hospital that has psychiatrists, so a lot of patients seems to come even from far and wide.
“Even though the hospital has tried to promote people going to the local hospitals, trained general doctors to take care of minor psychiatric problems and have even encouraged people to call psychiatrists but at the end of the day when you do not have a separate ward, many hospital have reluctant to admit the patients when required admission. So that is the reason why JDWNRH has been receiving increasing numbers of patients,” he said.
Over the last two decades, they have been trying to create a lot of awareness through different medium and so now mentally ill people seek help unlike in the past.
Dr. Nirola said the reasons for the increasing number of psychiatric patients in country is with the modernization, a lot of competition is happening in the employment sector, a lot of young people are getting stressed out and these leads to a number of psychiatric problems.
The cause of psychiatric problems are multi-factorial as it can be because of the situation, genetic or the chemical imbalance that happens in the brain and so ultimately something that triggers it is stress.
Dr. Nirola said even if a person have the gene of having a psychiatric illness, the person may not have that gene coming out strongly if the environment is good and there are a lot of protective factors but when all these things are not good then the person tends to get ill.
JDWNRH has been seen a lot of issues when it comes to relationship problem among married people and domestic violence has become a big deal, alcoholism, drug use, and all these leads to psychiatric illnesses.
“A lot of suicides happens frequently because people are not seeing a bright light in the future because of lack of opportunity, employment, and the tough competition they have to face,” said Dr. Nirola.
The current psychiatric ward has been put in a makeshift type of an arrangement, started in 2004. Before that all the psychiatric patients were kept in the general ward.
The hospital is planning to shift the psychiatric ward in the old ward. The building is also safe and strong enough when it comes to structure. “So if we get it than we will have to redesign the building suitable for psychiatric patients,” he said.
Ideally a psychiatric unit should be in a areas where patients can have extra curriculum activities such as playground and space for outdoor activities.
“My uncle was admitted there, though I am grateful for the help and assistance he got to be a better human but I was not so happy to see him put up in a place like that. We have improved medical and rehabilitative care, although psychosocial evidence-based services are not widely accessible at the moment. The place was designed as a hostel. It is sad to see people cramped in,” said Tashi who has been looking after her sick uncle.
She said her uncle was not happy at all with the place as he hoped for more lights and good ambience and the people who works there are also not happy to work on such horrible conditions. “Much remains to be done. We require better facility in terms of infrastructure,” she said.
Similarly, many patients’ attendant had the same thoughts about the ward.
