What was the defining moment that led you to this innovation?
“...As the brother of two siblings with schizophrenia I was determined to study psychiatry and find ways to address their health needs in tradition-bound Bhutan...”
Bhutan, an isolated country in the Himalayas, only in the 1960s introduced a modernized education and health care system. Still, change comes slowly and most Bhutanese seek health treatment from religious and traditional medicine, seeing a doctor only when traditional practices have failed. Modern medicine has not grown significantly over the past decades, due to staffing and funding constraints. The first generation of doctors and health workers lack basic skills in managing psychiatric cases and modern mental health care was introduced in the country only in 1997. Since then, a core group of two psychiatrists and five psychiatric nurses were trained abroad.
Extending psychiatric services to the wider population is hampered by limited training of primary health care workers and limited demand from the population. The strategy is to integrate mental health care through the well developed network of primary health care services. This entails training and exposing primary health workers, doctors, and nurses on basic psychiatric skills and management.
There is also a need to create public demand for such services by way of health education campaigns. The scope of the campaigns has to spread beyond influential leaders to religious healers, shamans, astrologers, and herbal doctors, who can influence patient decisions. Stigma and discrimination of the mentally ill still exists, and this pilot also aims to address that.
The defining moment that lead to the development of this unique project was the realization that we could address these challenges at the same time. The success of the pilot project has inspired us to set bigger goals, extending this success to the rest of Bhutan and acting as a ‘best practice’ to other countries.
Tell us about the social innovator behind this idea.
"...My name is Chencho Dorji, and I am the first trained psychiatrist in the Kingdom of Bhutan..."
I became a psychiatrist after two of my siblings became ill with schizophrenia, with no treatment options available. Now with treatment, both my siblings are doing well and leading productive lives.
After completion of my psychiatry residency training in Sri Lanka and Australia in 1999, I began building a comprehensive mental health care program in Bhutan, facing many challenges!
An initial challenge was from within the health system. First, I had difficulty finding cases to treat. Only a handful of patients with suspected psychiatric disorders were referred to me and none came at their own initiative. Bhutanese knew little about psychiatry and those that did refused to see me because of the stigma attached. People believed that treatment was only for the “mad or insane” and those consulting me were labeled as having “madness”. Even the hospital administration doubted there would be any work for a psychiatrist, let alone a need for a separate ward, and I initially worked emergency department shifts instead. Slowly my outpatient numbers grew, more and more people came to see me as they witnessed patients improve with treatment.
Initially psychiatric patients were kept in the general ward, and doctors and nursing staff were ambivalent as they had little prior experience in managing these cases. However, in 2004 for the first time in Bhutanese history, a separate psychiatry ward with eight beds was established in Thimphu, with two psychiatric nurses that were trained abroad.
Since that difficult start, we have treated more than 500 inpatients and 3000 outpatients, and trained more than 300 health workers.
In 2007, I was awarded the Hubert Humphrey Fellowship to study Addiction Psychiatry at the Bloomberg School of Public Health, Johns Hopkins University, USA.
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