Ministry’s ignorance of machine breakdown threatens lives of HIV patients

Untitled-1To be afflicted by a lifelong disease is curse enough, but due to a malfunction in a check-up machine, the life of one HIV positive patient has been a living hell.

What is more is he says he is not the only one suffering and is speaking for many other HIV patients in Bhutan who are suffering a similar fate.

In the last few weeks 30-year old, Sithal Chettri, from Chengmari in Samtse and an HIV positive patient, has suffered from an array of diseases, experiencing recurring fever, fatigue, sores on his tongue and mouth, continuous diarrhea and skin infection.


All of this, according to him, is because the only two Cluster of Differentiation 4 (CD4) check-up machines are broken down and without adequate chemicals both in the Thimphu national referral hospital (JDWNRH) and Phuentsholing hospital.

Without these machines Sithal cannot monitor his CD4 or white blood cell levels which if they fall below 300 can lead him to succumb to AIDS (Acquired Immuno-Deficiency Syndrome) where even a common cough and cold can be lethal.

It is only with these machines that Sithal can records his white blood cell levels and take anti retro viral drugs to kill the HIV virus if his white blood cell count is becoming too low.

His CD4 count has now lapsed for some seven months. He has been running from hospital to hospital overwhelmed with desperation but his CD4 check up is yet to come to fruition. He says that other HIV patients in the Thimphu and Phuentsholing would be suffering silently as they did not have the courage to come out in the open like him.

CD4, or a white blood cell is an infection-fighting system in human body. The HIV patients are required to undergo the check up every three months. This enables the patient to determine the number of CD4 cells in their body. The CD4 count helps tell how strong their immune system is and also indicates the stage of the HIV disease, guides treatment, and predicts how the disease may progress.

But with CD4 check-up machines in the hospitals around the country broken down, Sithal Chettri and most of his other friends infected and living with HIV disease are left to the mercy of how soon the machine will be functional. Since the machine broke down, a lot of Bhutanese people living with HIV could not do their CD4 check-ups.

In a walk-in interview provided by Sithal Chettri to The Bhutanese, he said over the past few weeks, he has made several trips to hospitals in Thimphu and Phuntsholing. “Every time, I’m told by the medical officials that the machine is not working and remains to be repaired,” said Sithal Chettri.

When he recently went to JDWNRH on April this year for the CD4check up, officials told him the machine was out of order since two weeks back.  He waited a few more weeks and even in his second visit to the hospital a few days back, he was told the same thing.

Prior to that he made three trips to Phuntsholing hospital and every visit has been futile.

“In my first visit, they said the hospital ran out of reagent,” Sithal Chettri said adding, when I visited the second time, I was informed the machine is out of service. He paid a third visit but was again told they have no reagent.

He wondered when all the machines are broken down in Thimphu and Phuntsholing, how can government for that matter the health ministry remain complacent doing nothing about it. He said it is very important for HIV patients to undergo CD4 count regularly to keep tab of disease status, it should receive the highest priority and immediate attention from the government. “This is an issue of precious human lives with HIV infection.”

He said this is a big loophole in the system. “As much as they care for their own lives, they should also think of our lives.” He pointed out that such carelessness from the responsible government and health personnel would kill many other HIV patients who are suffering silently.

When Sithal Chettri last did the CD4 check up seven months ago, before the machines in hospitals broke down unanimously, his last CD4 level was 516. A normal CD4 count is from 500 to 1,500 cells per cubic millimeter of blood.

Sithal has already started showing signs of his CD4 count plummeting. The fact that his CD count is low is evident from his physical body being riddled with diseases He said that he is enduring all this only because of the government’s carelessness.

Sithal Chettri has a wife and two sons. And his wife is also expecting. He said, he is not worried about his own death more so if it comes due to government’s negligence but he is worried of his family’s welfare. He said he is the only bread earner in the family and when he is gone, the future of his family is at stake.

He also claimed that he has already spent  a lot of money in traveling from one hospital to another looking for a working machine. The next option is going out of the country to India seeking for the help. But, he said, he has no money left to do that. “Now if machines in Bhutan don’t come alive soon, we are all dead.”

Sithal Chettri was detected HIV positive and came to know about it in 2006. He was one among the five HIV positive who came out in the open through media outlets when Bhutan joined the International Community to observe World AIDS day in December 2011.

But Sithal Chettri said, he sometimes regrets having made such a move. “We did this foreseeing support but on the contrary, we have to endure many incidents of discriminations.” Even last December, although few HIV patients were contemplating to come out, they chose not to because of what those who have already come out are going through.  But for him, there is no turning back now.

He said he has willingly approached media with such a plight. This, he said, is for sake of other HIV patients who are suffering from similar fate. “I’ve already come out in public; hence it is appropriate for me to voice out the plights of HIV patients especially those behind the curtain. It is not right for others to suffer also,” said Sithal.

The Ministry of Health agreed that the machines were out of order for few weeks and have been restored from 18 April.

The CD4 machine in Thimphu according to the officials was out of order which required minor maintenance as it was heavily utilized. Having felt the need to restore the machine almost immediately, the officials reinstated it on 18 April.

Also the ministry claimed that the machine in Phuentsholing did not actually go out of order but was not used as it was on the verge of expiring and was restored on 18 April.

Health Minister Zangley Dukpa said that if any machine which is very critical for a patient is running out of order the ministry receives notification before three months in advance. He said that CD4 machine which was out of order for few weeks did not threaten lives of the HIV patients.

Sithal, however, maintains that in the last 7 months he had to face a no five times from both Thimphu and Phuentsholing due to either machines not working or there not being enough chemicals.

The Health Minister assured that there is no discrimination for the health care of people living with HIV and the ministry even calls each patient to ensure that they are consuming their regular dosage of medicine on time.

The first case of HIV in Bhutan was reported in 1993. Since then, 297 cases have been declared of which 55 died so far from AIDS. Of the total figure, 51% are female and 49% are male. Today, there are 229 people living with HIV in the country.

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  1. For God sake, life of HIV positive patients does not depend on the machine. Treatment can be given even without CD 4 count if the physician feels necessary after assessing the clinical condition of a patient. 

  2. Yes, if the CD4 before seven month was 515 as reported and if the person mentioned has taken his ART medicine in time and with discipline, i too dont think he needs to worry unless he has been ignorant about his medicine and lifestyle. If I am not wrong if the CD4 is more than 500 then the patient needs to do check up every six month and not 3 months as reported. I also don’t believe on the claim that CD4 machine was under breakdown since seven months as my friend who is HIV positive did his CD4 count check up just 3 and half months back. He is strictly adhering to his medicine regime and living a great life without any problem as such. It is important for HIV positive patient to adhere to medicine and live a modest lifestyle with proper diet and exercise. As per the latest report in scientific journal, with better ART medicines available the HIV positive people can live as normal and as long as any normal people without HIV. I think the government and the ministry of health and the person concerned to take care of HIV positive people in JDWNRH are doing great job. They not only take care of patient with respect and dignity, they regularly advise patient to take medicine in time, do their check up in time and try to find out if they are facing any problem. I don’t think you ll find such care and concern atleast in our neighbouring countries. The ART drugs has done great advancement. I only wish that ministry of health keep abreast of all latest research and more effective medicines available in other countries and try to bring those latest and more effective drugs for betterment of HIV positive people in the country and to make their life better. 

  3. The Editor/The Author

    This article has overlooked key points:

    (1) Patient’s confidentiality has been breached by exposing not only his identity (just that he has come out in public) but also his medical records. PATIENT’S information is NEVER given out to the public. The author is reminded hereby that it is a gross misconduct from medical-journalism point of view.

    (2) A diligent compliance to anti-retroviral therapy (ART) by taking the drugs on time is more SIGNIFICANT from management point of view than knowing the CD4+ count. Health care is a dynamic system which works on the rule of optimum. Thus, since Mr S is already taking his ART medicines, it will be optimum that he will need to continue is medicines whatsoever the value of CD4+ count.

    (3) The author has mentioned that ART kills the human immune deficiency virus (HIV) which is yet to be established as a FACT. Any fact, treatment or advice given to the people by the medical field is based on multilayer research and analysis; how much ART kills the virus is yet to be established.

    (4) The immediate person responsible pertinent to this article is the HEAD OF THE LABORATORY of respective hospitals, who must discharge his duty as per the job description given by the RCSC. In this case there was apparently inadequacy of management which the department must sort out and the ministry (not the minister) must regulate their employees provide optimum service to the people.

    (5) The article could have concentrated on strengthening the ministry of health as a public service system rather than politically sabotaging the minister (not that this article is written in defense of the minister). We must remember that the minister is only an administrative post that changes every 5 years but what remains is the HEALTH CARE SYSTEM. We should criticise and help improve and develop the system.

    For your consideration Mrs Zangmo, the author and the Editor,

    Thank you!

  4. Be care ful Author!…. Be mindful

  5. Palden Drukpa

    Please!!!! people, don’t blame the author, she did a good job.
    HIV patients are the susceptible lot of the population undergoing a lot of discrimination. They have higher chances of dying and I respect the patient’s fear and concern for his health. I am diabetic and if machine to check my glucose breaks down, I would have done the same or worse.
    There is no breech of confidentiality because the patient chose to walk-in at the newspaper. He felt he had a right to health care as a Bhutanese citizen. He was showing his fear of dying and his desperation..
    Let’s hope the free medical care for HIV and other patients improve from now on in Bhutan as per the command of our leaders and the constitution of Bhutan.

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