Join us in supporting mental health care in Bhutan

Bhutan is  a remote, landlocked country situated in the Himalayas between Tibet and India.  Historically an independent Buddhist kingdom, it became a constitutional monarchy in 2012. Health care is free in Bhutan, but with an estimated population of approximately 800,000, villages often accessible only by unpaved cart roads,  and an average income of under $3 a day, access to care is limited and the health care system rapidly evolving. Health Volunteers International Overseas has been active in Bhutan for many years, providing clinical education services for numerous medical and surgical specialties in ongoing programs, including Mental Health.   

Physicians, including interns and residency trainees, are civil servants in Bhutan, earning a fixed and modest salary that precludes purchasing textbooks and continuing educational materials.  Over the past four years, with your support and from my personal resources,  I have been able to provided several thousand dollars worth of textbooks, subscriptions for continuing education resources and video training series to psychiatric residency trainees and counseling students, establishing a substantial starter library as well.

For more on the health care system in Bhutan: http://drukjournal.bt/wp-content/uploads/2021/08/Bhutanese-Health-and-the-Health-Care-System.pdf

Margaret and I spent our first three months in Bhutan in 2019, returning to the US at the onset of the COVID pandemic.  Anticipating an annual return, we found the country closed to volunteers until our second three month visit in the Spring of 2023.  Much has changed in the arena of psychiatry and mental health care since our first visit.  

At the initiative of his majesty, the King, Jigme Khesar Namgyel Wangchuck, and under the direction of her majesty, the Queen, Jetsun Pema, the PEMA Secretariat, a major national initiative to improve mental health in Bhutan was launched. https://thepema.gov.bt/her-majesty-speech/

During our 2019 visit, inpatient psychiatric services were housed in an old dormitory building, outpatient services elsewhere on the campus. In 2021 services were consolidated in the original general hospital building, built in 1961, a clear improvement, but far from optimal. As part of the PEMA Secretariat initiative, construction has started on the first dedicated psychiatric care facility in Bhutan. https://thepema.gov.bt/pema-center/ The current twenty bed inpatient capacity will increase to sixty, including open and closed units, a child and adolescent unit, and a substance use disorder unit. This vision of the PEMA Secretariat is an ambitious one that will require a rapid upscaling of training for psychiatric and mental health clinicians.  

The two psychiatry residents in training during my first visit in 2019, Dr. Bikram Chetri and Dr. Puja Subedi have completed training, bringing the total number of psychiatrists in the country to only six. Another resident, Dr. Ngwang Samten, is in his third year of training and two first year residents have recently joined. In addition, Bhutan has inaugurated its first in-country medical school. It will be difficult to balance the clinical demands on the current psychiatric medical staff with the educational needs of the trainees. The need for assistance from outside the country for training is high.

HVO's mission is to provide education to enhance the clinical services in the countries they serve.  I will be returning to Bhutan to help with a diverse range of training needs.  My primary focus will be on instruction and supervision of the three psychiatric residency trainees and rotating general interns, but in addition I will be teaching clinical Mindfulness Practices for fourth year counseling students and Practice Ethics for the second year counseling students.  As a career psychiatrist with additional certification as a Buddhist Chaplain and Mindfulness Meditation teacher, I feel both uniquely qualified and uniquely privileged to bring my efforts at blending western medicine and Buddhist psychology to psychiatric education in Bhutan.  I hope you will find this mission worthy of your support and I am grateful to each and every one that has and will contribute support.

This educational mission is entirely self-funded. Margaret will be volunteering independently at the Draktsho Center for Training of Special Students and Youth.  Health Volunteers Overseas handles the logistics of our trip but provides no funding.  I estimate the cost of provided educational materials to be three thousand USD and donations will initially be directed to these. Our personal expenses, including travel, housing and daily needs will be approximately ten thousand USD. It's a sizeable total, but keep in mind, a $50 to $100 contribution will buy a textbook that is sorely needed and will be greatly appreciated.

Many blessings and much gratitude,

Steven J Sonnenberg MD