𝐄𝐦𝐞𝐫𝐠𝐞𝐧𝐜𝐲 𝐌𝐞𝐝𝐢𝐜𝐚𝐥 𝐒𝐞𝐫𝐯𝐢𝐜𝐞𝐬 𝐅𝐚𝐥𝐥 𝐒𝐡𝐨𝐫𝐭 𝐈𝐧 𝐍𝐚𝐧𝐨𝐧𝐠 𝐆𝐞𝐰𝐨𝐠

…𝒍𝒐𝒏𝒈 𝒅𝒊𝒔𝒕𝒂𝒏𝒄𝒆𝒔, 𝒔𝒕𝒂𝒇𝒇 𝒔𝒉𝒐𝒓𝒕𝒂𝒈𝒆𝒔, 𝒂𝒏𝒅 𝒍𝒂𝒄𝒌 𝒐𝒇 𝒂𝒎𝒃𝒖𝒍𝒂𝒏𝒄𝒆𝒔 𝒄𝒓𝒆𝒂𝒕𝒆 𝒃𝒂𝒓𝒓𝒊𝒆𝒓𝒔 𝒕𝒐 𝒆𝒔𝒔𝒆𝒏𝒕𝒊𝒂𝒍 𝒎𝒆𝒅𝒊𝒄𝒂𝒍 𝒄𝒂𝒓𝒆 𝒊𝒏 𝑵𝒂𝒏𝒐𝒏𝒈 𝑮𝒆𝒘𝒐𝒈

By Sonam Choden

Access to timely healthcare remains a major challenge in remote regions of the country, where geography, limited infrastructure, and resource shortages create barriers to essential services. Nanong Gewog, located about 37 kilometers from the old Pema Gatshel town, is one such isolated area within Pema Gatshel Dzongkhag. The relocation of the Dzongkhag headquarters to Denchi has added nearly 20 kilometers to the journey, increasing the distance to almost 57 kilometers. This added remoteness has made it harder for residents to obtain prompt medical care, especially during emergencies.

The healthcare facility at Tsatsi, around 13 kilometers from the Nanong Basic Health Unit (BHU II), was supported by a Health Assistant until early 2024, when the position was vacated and has not been filled since. This vacancy has left Tsatsi and surrounding villages in Lumang Gewog of Trashigang Dzongkhag without consistent access to basic medical services. The absence of primary healthcare in these communities has had a serious impact on residents’ health and safety.

Despite handling an average of 15 outpatient visits per day, the PHC is a crucial provider of primary care in a region where difficult terrain makes travel to other facilities challenging. The loss of the Health Assistant, combined with the absence of an ambulance- damaged in an accident in 2019- has worsened the situation. Villages such as Chengri, Dungmanma, and Tsho Gonpa in Lumang Gewog, as well as Khenadang (Zobel Gewog) and Daggor (Shumar Gewog), have had no reliable emergency transport.

Dorji, the Tshokpa of Raling Chiwog, said, “Villagers without private vehicles must travel long distances to reach Pema Gatshel Hospital, often paying taxi fares of around Nu. 3,000.” Dorji Tshering, the Livestock Extension Officer of Nanong Gewog, added that while those with private cars can manage, residents without vehicles face heavy financial burdens due to high taxi costs. He stressed that appointing a Health Assistant would benefit the entire community.

Jamtsho also expressed concern about transportation difficulties, especially when urgent care is needed. He noted that long travel times and expensive transport increase health risks by delaying access to medical attention.
Efforts to improve the situation have included formal requests to the Ministry of Health, submitted in October 2024 and again in February 2025, asking for the appointment of a Health Assistant and the provision of an ambulance, either new or secondhand. The Ministry confirmed that since late 2024, Tsatsi PHC has been permanently staffed by one Health Assistant under its National Medical Services deployment plan. However, a nationwide shortage of Health Assistants limits further staffing increases at this time.

Looking ahead, there is cautious optimism. By June 2025, 15 Health Assistants are expected to graduate from the Khesar Gyalpo University of Medical Sciences of Bhutan (KGUMSB), with intake increasing to 30 trainees in 2026. This expanding workforce may allow the Ministry to reassess staffing needs in Tsatsi and other remote health centers. The Ministry will continue to evaluate additional staffing based on demand and available resources.

Despite these developments, the ambulance remains unreplaced, a critical gap in emergency services for the most isolated communities. Although the Ministry reaffirms its commitment to equitable healthcare, no timeline has been given for restoring ambulance services to Nanong Gewog.

Currently, the Nanong Primary Health Centre serves approximately 1,444 people across four Chiwogs. It also provides healthcare to six institutions, including two schools, a nunnery, and government offices. The outpatient department sees between 15 and 30 consultations daily, reflecting steady demand.

A national assessment projects that seventy ambulances across Bhutan will reach the end of their 15-year operational life by 2029. To address this, the Ministry plans to purchase at least fourteen ambulances annually from 2024 through 2029, at an estimated annual cost of Nu. 102.2 million. However, due to budget limits, only three ambulances are proposed for procurement this fiscal year, focusing on facilities that have lost vehicles and those with high referral volumes.

In line with the 13th Five Year Plan, the National Medical Services will conduct thorough reviews of caseloads, remoteness, and service needs to prioritize ambulance deployment effectively.

The case of Nanong Gewog highlights the ongoing challenges in delivering healthcare to remote parts of the country. The lack of a Health Assistant and the absence of emergency transport have severely limited access to prompt medical care. While the recent appointment of a Health Assistant and the planned increase in health workers offer hope, critical gaps remain. Urgent action, particularly in restoring emergency transport, is essential to ensure fair and effective healthcare for this remote population.