The Bhutanese Leading the way.
The Emergency Department (ED) of the Jigme Dorji Wangchuck National Referral Hospital (JDWNRH), in Thimphu received 36,886 patients in 2018.
The department starts to get overcrowded after 3 pm everyday. Records maintained by the department show that treatment of battery and fighting cases are common on weekends. It has also been observed that patients prefer to get treated at the emergency to avoid hospital queues between 9 am to 3 pm.
“Everybody expects to be taken inside straight away. People come to emergency after 3 pm even with a minor headache. The Emergency department is always crowded,” the Medical Superintendent, Dr Gosar Pemba, said.
He also said emergency services are meant for those seriously injured in an accident, or for complicated cases requiring immediate medical attention. “People don’t know the meaning of emergency,” he said, adding that if a person can walk to the emergency then it is not an emergency case.
A triage system is followed in ED to determine and prioritize which patients need immediate medical attention. However, they do not conduct the triage if a patient is airlifted or brought in a serious condition.
On the other hand 45-year-old Zeko said he once rescued a man lying in a pool of blood on a roadside. He took the injured man to hospital on time, but he said the ED made them wait for more than an hour before the injured man could get checked and treated.
“The injured man was having difficult time to even stand due to dizziness. I asked for a stretcher but all the stretchers were occupied and same with the wheelchairs. I had to hold him for long. Luckily after more than an hour, his mouth and head got stitched,” Zeko said.
“If such a practice continues for long, to keep people waiting with blood all over the body, then one-day people may stop visiting the hospital. People need treatment, not criticism,” he added.
Similarly, Tshering Pem, 32, said that some of the hospital staff need to learn on how to deal with patients because people come to hospital with a hope for better treatment.
She said, “We understand their busy schedule, but we want them to treat us well. Talking politely can heal a patient in many ways. It is not right to shout at the patient to breathe when a patient is having hard time to breathe. Rather they should treat her.”
She said it is disheartening to see how patients are treated and that is why it is better to go to a private clinic than the hospital. She further said that the hospital staff give priority to those people they know.
As for the numerous complaints from patients against the ED staff for being rude, harsh and irresponsible, Dr Gosar Pemba said the emergency staff are always busy attending to patients so it takes time to see the new patients that come in. “The moment you come into an emergency department, they cannot just leave the earlier patients and start seeing you,” he added.
He said the wheelchairs and stretchers are in constant use as the ED struggles to accommodate the sheer number of patients, so much so that some patients have to be placed on stretchers along the corridors. The Medical Superintendent said due to the space crunch, the hospital requested for a budget to expand the ED during the 12th FYP.
Meanwhile, he said that hospital doesn’t hold the responsibility of providing a parking space of all the patients that come to the hospital. “They can come in a taxi, just to drop rather than every individual driving a car. However, in any emergency they can always provide parking,” he added.
He said that the parking space is expected to free up once the community health shifts into its new building. The psychiatric ward will then move to the current community health department and the current psychiatric ward will be dismantled and converted into a parking space. The upcoming mother and child hospital and a separate eye hospital will also have their own parking spaces.
A medical doctor on the condition of anonymity said that if a survey is done in the hospital then the maximum complaints will come on the ED given the nature of urgent cases that come there and also the crowding that happens.
He said that there is a need to put in more doctors in the ED and also similarly increase the the equipment and facilities there as there is only so much that a certain number of staff and equipment can do.
He said that while it is true that patients have to wait he said that Bhutanese are not aware of EDs in foreign countries where patients are even kept waiting for hours.
The Health Minister Lyonpo Dechen Wangmo in an earlier interview said that the triage system is being improved at the ED and it already has an internal section for more serious patients. She said that more improvements will be made.
