This is the front of the new hospital, directly behind this sign is the emergency department - you can see the ambulances in the background. The adorable little guy on this sign is the 6th King (K6 for those of you in the know). On either side of him are K4 and K5. The fact Bhutan provides free, universal health care to its people is a significant source of pride for the country, and in general I was struck by the gratitude people had for the health care. My patients did not have any expectations for perfection, endless patients and gratitude for their Bhutanese doctors and for volunteers willing to come to spend time.
I was asked a few times near the time I was leaving what I thought of the care in Bhutan - if I would trust the ED for my family and friends. It is an interesting question and made me reflect on what is the same and what is different and what we all want in our health care.
In the end, people are people, they don’t want to be sick or die in any culture or community. People don’t understand how healthcare works anywhere in the world, and often we distrust what we don’t understand. We have never understood medicine and probably never fully will, just before it was one doctor or healer telling you what they knew. As humans, we are programmed to rely on relationships so we could trust this relationship for our health. But now our health care is made up for systems of care, systems that try to bring forth data and expertise to the problem at hand and systems are inherently flawed and harder as humans to trust. This is true in any community and your ability to trust the system, and therefore the care of your health depends on if you have a navigator of that system you trust, be it a primary care doctor, nurse, family member, friend or specialist who has gone the extra mile.
The system of care in Bhutan’s emergency department has a lot less fancy toys and less clean protocols than in the US. But in that space of less, the art of healing is no less. There are a lot more smiles, less blame for deviation and more conversations about care and what patients want. In a world of little to no malpractice less harmful and costly modalities like ultrasound have been allowed to grow and flourish in a way I could only dream of in the US. Appendicitis rarely got a CT, trauma cases that are stable, even with a positive FAST are allowed to heal without the CT as they likely will not need intervention anyway. We titrated peripheral pressors for a few days with a bedside look at the IVC without a central line. We femoral blocked hip fractures and let them get back in the car with family if they chose to drive back to India to have the surgery closer to home instead of opioids and an ambulance ride. The arrow in the aorta, the NSTEMI, metastatic cancer all got on a commercial flight to India instead of a $100,000 air medical transport who's risks again struck too close to home when we lost a crew back in Alaska just a few days ago.
But just like from the patients perspective of care being so reliant on the relationship, the care delivered in Bhutan comes from an intensely caring group of doctors and nurses.
The care is remarkable because of the nurse who calmly, on her own, bagged a patient that just arrived intubated as she troubleshoots the suction that is not working, the monitor who’s battery died and the donated vent machine which is different from the other three in the room without ever looking flustered or frustrated. Nurses who balance not only the needs of the usual demands of doctors in their department, or other departments and of the patients, but also the first responder students and a never-ending string of volunteer doctors like me who write medications the wrong way, never know the antibiotics at hand and need to be explained that “giddiness” means “dizziness.”
The care is remarkable because doctors who come in after a night shift or on their day off to hear a lecture and learn something new. Doctors who work with half staff to give each other breaks when their staffing is cut or let their female colleges go home one hour early to keep breastfeeding. Doctors who will come in and help on busy shift out of the kindness of their heart, and maybe the bribe of a beer or a dinner. Doctors who make a life-saving diagnosis by hearing an S3 gallop in triage or can diagnose and treat without labs or imaging available for hours.
So would I trust my loved ones with the care in this developing country? Absolutely. They had the necessary tools like gloves and clean needles and what they lacked they more than made up for in skill, dedication, and compassion.
K5 is known as the King of the People and the care I witness in the ED was really truly the care of the people and an honor to be a part of.