𝐉𝐃𝐖𝐍𝐑𝐇 𝐀𝐭𝐭𝐞𝐧𝐝𝐚𝐧𝐭 𝐀𝐫𝐞𝐚𝐬 𝐒𝐭𝐫𝐚𝐢𝐧 𝐔𝐧𝐝𝐞𝐫 𝐎𝐯𝐞𝐫𝐜𝐫𝐨𝐰𝐝𝐢𝐧𝐠 𝐚𝐧𝐝 𝐏𝐨𝐨𝐫 𝐇𝐲𝐠𝐢𝐞𝐧𝐞

…𝒊𝒏𝒂𝒅𝒆𝒒𝒖𝒂𝒕𝒆 𝒇𝒂𝒄𝒊𝒍𝒊𝒕𝒊𝒆𝒔 𝒂𝒕 𝑱𝑫𝑾𝑵𝑹𝑯 𝒄𝒂𝒍𝒍 𝒇𝒐𝒓 𝒊𝒎𝒎𝒆𝒅𝒊𝒂𝒕𝒆 𝒂𝒕𝒕𝒆𝒏𝒕𝒊𝒐𝒏 𝒕𝒐 𝒊𝒎𝒑𝒓𝒐𝒗𝒆 𝒑𝒂𝒕𝒊𝒆𝒏𝒕 𝒔𝒖𝒑𝒑𝒐𝒓𝒕 𝒔𝒑𝒂𝒄𝒆𝒔

By Tashi Tshewang

Hospitals are the cornerstone of any country’s healthcare system, serving as places of vulnerability, treatment, and recovery. In Bhutan, the dedication of healthcare professionals remains a pillar of strength, especially at the Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) in Thimphu. As the nation’s premier medical facility, it provides critical care to patients with the most serious conditions, while their families and loved ones wait, often for days, by their side.

To accommodate those accompanying critical care patients, JDWNRH has designated an attendant area outside the Intensive Care Unit (ICU). While this initiative is commendable, acknowledging the emotional and logistical needs of attendants, the condition of this space raises significant concerns. Overcrowding, poor ventilation, stained walls, cracked tiles, and unclean restrooms are some of the challenges faced daily by those waiting, often in distress. With limited seating, inadequate sleeping arrangements, and insufficient hygiene, the area becomes overwhelming, especially for those traveling from rural areas or those spending long nights without relief.

This situation highlights a critical oversight in hospital infrastructure planning. While the medical services provided at JDWNRH may meet high standards, the supportive spaces for families and attendants are falling behind, affecting their comfort, well-being, and overall hospital experience. For attendants already burdened with worry, such environments exacerbate stress, fatigue, and frustration, further straining communication and coordination with medical staff.

These conditions reflect larger structural limitations rather than neglect by individuals. Aging infrastructure, inadequate funding for upkeep, and the absence of routine maintenance systems have contributed to the situation. As Bhutan continues to modernize its healthcare system and invest in digital health, equal attention must be given to the physical environments that support patient care.

At the 15th Meet the Press session, the Ministry of Health discussed ongoing efforts to strengthen ICU infrastructure in the country. According to the Ministry, all ICUs follow strict waste segregation practices using color-coded bins, as outlined in the National Guideline on Infection Control and Medical Waste Management 2018 (currently under revision). Support staff are routinely trained in safe waste handling, and ICU cleaning protocols are rigorously enforced, with audits conducted after each session based on a specific checklist. Looking ahead, a major infrastructure boost is expected with the establishment of the Multi-Disciplinary Super Specialty Hospital (MDSSH). The new 400-bed Inpatient Department (IPD) will feature dedicated ICU units across departments, significantly enhancing the accessibility, quality, and preparedness of critical care services. Moreover, the hospital’s design incorporates comprehensive waste management systems to ensure safe and sustainable operations.

Medical Superintendent Dr. Sonam Tshering acknowledged the concerns raised by attendants and discussed the challenges of managing space. “We understand the concerns raised by attendees and acknowledge the challenges they face. But the truth is, we simply do not have any additional space to expand even if we wished to. The hospital is already operating at full capacity, and the infrastructure was not designed to accommodate a large number of attendants who stay for extended periods. Infrastructural limitations are a reality we face daily, and every inch of space is already accounted for.”

Despite efforts to improve the situation, the hospital continues to face challenges with public misuse of facilities. Hygiene and order are often compromised due to overcrowding and non-compliance with basic rules, especially in sensitive areas like the ICU.

“We have tried our best on the issue of smoking,” Dr. Tshering said. “The Bhutan Narcotic Control Authority (BNCA) has supported us by conducting surprise inspections, but we cannot constantly monitor every corner. Hospital staff cannot go around asking every individual not to smoke or litter, it’s simply not feasible. Responsibility must be shared. The attendees themselves must cooperate. We appeal to them to use the toilets properly, avoid littering, and follow basic cleanliness protocols. These facilities are limited, and their misuse affects everyone, including other patients and their families.”

Sherub Namgay, who has been attending to his father in the ICU, shared his concerns: “I have been here for almost two weeks now. While the ICU facilities for patients are commendable, the conditions for attendees like us are quite poor. There are only three rooms, and we are forced to adjust and manage with whatever space is available. The toilet facilities are a major issue. There are just two toilets, and they get blocked quickly. It becomes really unhygienic, and for people who are already mentally and physically exhausted, this adds more burden.”

Namgay also highlighted the issue of smoking. “People smoke here even though it’s not allowed, and cigarette filters are thrown all around. When we try to say something, they take it personally; some even get aggressive. We don’t know who to report to or how to address it. Waste is scattered everywhere, and there’s no proper place to dry our clothes. Those with family nearby can manage somehow, but for people like us who have traveled from remote areas, it’s a very sad and difficult experience,” he said.

Kinley, an attendee from Mongar, also expressed frustration. She said, “I came all the way from Mongar to attend to my brother in the ICU. What I see here is that there’s no proper cleanliness. It’s disheartening. For people like us, already going through emotional stress, the hygiene condition makes it harder. Especially as a woman, it’s very uncomfortable. There are no separate toilets for men and women, and the existing ones aren’t safe. The doors are weak and barely close properly.”

The lack of gender-sensitive infrastructure, basic hygiene, and designated utility areas remain serious concerns, particularly for those traveling long distances and staying for extended periods. Many attendees struggle to maintain dignity and comfort under these conditions.

She continued, “Even when it comes to washing plates or clothes, it’s all happening in the same room that’s attached to the toilet. That doesn’t feel hygienic at all. I really wish there was at least one water tap outside, somewhere we could wash our plates without feeling like we are compromising our health or dignity. These small things can make a big difference to people like us who have nowhere else to go.”

Another attendee expressed concern and said, “I could see people smoking even though this is a hospital. It’s really shameful. Some go into the toilets to smoke, and it creates such an unhealthy environment, especially for those already emotionally and physically exhausted.”

The attendee also pointed out the discomfort of shared, overcrowded spaces and said, “The place we sleep and take rest is so compact, and there’s no separation between male and female attendees, which makes it very awkward. On top of that, the electric sockets are in poor condition; some don’t even work properly. It really increases the risk for us, especially when we rely on them to charge our phones or use small appliances. It’s not just uncomfortable; it’s unsafe.”