The Bhutanese Leading the way.
The eye hospital in the Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) sees on average 500 patients in a day. The hospital saw 916 patients on 19 August 2022, which was the highest patient load overall compared to all departments.
An official from the eye hospital in JDWNRH shared, through an email, that 10,417 patients were attended in the month of July alone, followed by 12,508 patients in August 2022. In a day, one doctor attends about 70 to 80 patients on average, and in August, each eye doctor were attending about 100 patients per day, and they are done looking after Out-Patient Department (OPD) at 4:30 pm.
The cases range from refractive errors, cataracts, injuries, conjunctivitis, squint, glaucoma, and retina including patients referred from other departments and wards for consultation for various eye issues.
The official said that August was a busy month because it coincided with school summer break. Patients from all over the country came to Thimphu. Some patients came with serious issues, but most people showed up for their routine checkup as part of keeping their eye healthy. The entire hospital saw a rush for patients in all departments.
The current challenge the eye hospital faces is that it does not have a sheltered waiting area for patients, and the appointment system is not being used, as most people want to walk in and not wait in queue. Also, because the eye hospital is a tertiary center, many procedures are done, and the OPD is different from other OPDs where the patient just has to see the doctor and take medication.
Currently, there are 7 ophthalmologists. The eye hospital in JDWNRH conducts surgery every day, where two surgeons are in the Operation Theatre daily, and 4 to 5 surgeons in OPD daily.
The department also has to conduct activities of the primary eyecare program where outreach mobile surgical eye camps are conducted. Over 20 camps are done per year, which means that one surgeon and a team of 5 staff will be out of the eye center at that time. About 250 surgeries or more are done in a month.
The official also said the National Eye Center is critically understaffed. Currently, there are only 4 optometrists and 12 ophthalmic technicians assisting the consultants. In ophthalmology, in particular, treatment modality is exceptionally different from other clinical departments.
Each patient requiring consultation with an ophthalmologist must undergo vision and refraction, with the preliminary examination usually done by optometrists. When there are two OTs functioning daily, half of the technicians would get engaged in OT, and this creates shortages in the general OPD, minor procedure room, and diagnostic unit. “People from outside are always viewing the drawbacks, but the fact is each doctor attends about 100 patients in a day,” said the official.
The nationwide rapid assessment of avoidable blindness survey (RAAB 2018) estimated a 33 percent decrease in the prevalence of blindness in Bhutan between 2009 and 2018, thus achieving the objective of the WHO global eye health action plan 2014–2019. Between 2009 and 2018, there was a decrease in cataract blindness from 0.7 percent to 0.4 percent; and a substantial increase in cataract surgical coverage from 72.7 percent to 86.1 percent, combined with improved visual outcomes. Conjunctivitis was no more health morbidity in 2020 as it was in the past. Unoperated cataracts and corneal opacities have also reduced in the last two decades.
In Bhutan, the avoidable causes of visual impairment are still high (88.9 percent); 74.3 percent is attributable to cataract and refractive error. With population growth and aging, the incidence of refractive error and posterior segment diseases, including diabetic retinopathy, age-related macular degeneration, and glaucoma, is rising, according to the RAAB 2018.
