Capital city zeroed-in to host MBBS program

Thimphu capital city

The MBBS program is expected to launch in the mid-2023 should everything peter out as planned

LHAKPA TSHERING

Thimphu

Thimphu is identified as the most feasible and suitable location for the immediate start of MBBS (Bachelor of Medicine and Bachelor of Surgery) program in the country.

This is considering several factors including readily available land space and all required departments with the national referral hospital (JDWNRH) as a teaching hospital.

Following cabinet’s directive to study three site locations – Thimphu, Gelephu, and Mongar – to establish the MBBS College, Thimphu is found a more cost-effective place to host undergraduate and postgraduate medical studies in the same teaching hospital to optimize the utilization of faculty members and specialists, laboratories, and other hospital resources.

The Assistant Professor of Epidemiology with the KhesarGyalpo University of Medical Sciences of Bhutan (KGUMSB), Dr. SitharDorjee, who is also a team leader of MBBS Project Secretariat, said that Thimphu is the best for the immediate start of the program within two to three years.

“If we want to start as early as possible, Thimphu is the only option, to begin with,” he said, adding that it also gives a unique architecture and has modern amenities compared to the other two regions.

One main reason is that JDWNRH has 381 beds capacity with all required departments for MBBS as a teaching hospital requires a minimum bed capacity of 250 to 300 for 50 MBBS student intake or depending on the numbers of students which Thimphu is ideal.

“We have the existing laboratories at JDWNRH and we can also use some laboratories at the Royal Centre for Disease Control (RCDC). It is one strategy but not the complete one,” says Dr. SitharDorjee.

Thimphu, he said, fulfills the case number and diversity requirements so that the students can get good exposure. “It is not only a national program, but we are aiming for 50 percent of international students from South Asia, South-East Asia, and even from the USA and Canada,” he said.

In addition, the availability of specialists for MBBS teaching, residents for tutoring and teaching support, and easy accessibility – close to Paro International Airport – for international students including visiting faculties makes Thimphu the first option to introduce the program.

“If we start in Thimphu, we can get all the good expertise and faculties. We need modern amenities to attract international students and visiting faculty as we have to depend on visiting faculties,” he said.

Meanwhile, based on the land space in Thimphu, the project management committee submitted the detailed project report (DPR) with recommendations – pros and cons of each site – to the cabinet. “We are waiting for the government’s directive on where and how to start the program,” says Dr. SitharDorjee.

However, he said that the biggest constraint in Thimphu is inadequate land space which is not optimal, and topography for future expansion. “We need adequate land space with a good landscape so that we can have a good facility campus with excellent amenities,” he said.

Also, the committee offered several options such as starting the program from Thimphu for a few years, subsequently moving to a better place after some 10 years in case Thimphu is not suitable while also exploring land space outside Gelephu and Mongar.

While Mongar is not feasible due to lack of adequate land space near Eastern Regional Referral Hospital (ERRH), Dr. SitharDorjee explains that lack of technical requirements and frequent roadblocks during summer will also present challenges to establishing the college.

“We think Mongar is not good, including site expansion. For foreign students, it will be too expensive to come to Paro and then go to Mongar. Even if their parents want to visit them, it is a long journey,” he added.

While they are considering Gelephu for the second option given the large land space, he said, the opening will take time because the government has to upgrade the Gelephu hospital. He said there are also certain factors including landscape and climate conditions.

“If we take the program to Mongar and Gelephu, we might face some difficulties. Some faculties may not be interested to come as teaching even if they want to teach and practice because of their domestic reasons,” says Dr. SitharDorjee.

To boost doctors’ numbers

As the government is striving to expand health services and establish specialized health centers including 500-bedded multi-disciplinary super-specialty hospital (MDSSH), 150 bedded Mother and Child Care hospital, Royal Center for Infectious Disease (RCID) at Gidakom, and 50-bedded Thimphu General Hospital, there will be a shortage of more health workers including specialists in certain specialties.

To boost the doctors’ number, sources say the MBBS program is expected to launch by mid-2023 should everything works out as planned. If this happens, several strategies would be adopted to decongest JDWNRH and Thimphu.

Dr. SitharDorjee said that having one MBBS college in the country of Bhutan size is necessary and it is the right time to start at the earliest. “In terms of the university’s self-sustenance without having to depend on the government fund, we can only sustain by starting MBBS,” he said.

The MBBS College will further bolster the ratio of doctors per 1000 populations in the country which Bhutan is still lower against the World Health Organization (WHO) recommendation of one doctor per 1000 population. Bhutan currently has 4.6 doctors per 10,000 populations short by 5.4 doctors per 10,000 populations – one of the lowest in the region.

Going by the human resource development (HRD) plan of the health ministry, there is a need to fill the gap of 195 General Duty Medical Officers (GDMO) by 2026.

“We have an acute shortage of specialist doctors besides the GDMOs. So the university has studied this projection – current requirements and what the requirements are in the next 10 to 15 years and we found an acute shortage,” Dr. Sithar Dorjee said.

He added, “If we look at the present requirement, it will take 30 years. That’s why we put the urgency to start this MBBS College as soon as possible to meet the internal requirement.”

And he said the urgency is to churn out the graduates so that currently employed GDMOs can go to their specialist studies. “That transition should be fast. But if we don’t generate the GDMOs, then we have no candidates going for the specialist programs. Then we might end up in a difficult situation having to depend on doctors from other countries,” he said. 

To introduce the in-country MBBS program is one of the principal activities outlined in the 12th Plan for the KGUMSB, which was approved with an estimated outlay of Nu 100-million budgets.