Are patients experiencing under nutrition at JDWNRH?

The country’s premier hospital is still reeling under the problem of inadequate nutritional needs for its patients

SONAM PENJOR | Thimphu

Despite food services and nutrition care in the hospitals being a fundamental part of clinical care, lack of attention to nutrition care in the hospitals is common, often forcing the patients to opt for foods prepared outside hospitals.

Patients admitted at the national referral hospital (JDWNRH) are no exception to this shortcoming. Interviews conducted with the patients hospitalized at the referral hospital and their attendants show that nutritional care is not focused as is required by dietary norms.

Many patients admitted at the premier hospital say the meals they are provided, and as recommended by doctors and dieticians based on their ailment, are not being served at the hospital.

A diabetic patient in the hospital said that they do not specify the menus based on their disease conditions. “We still get the same menu like any other patients,” said the patient. “I think diabetic and other serious patients should be given low carbohydrate and low starch meals which is not happening.”

The patient went on to say that after taking the same menu that was served from the hospital he experienced increased level of glucose on the contrary.

Another patient suffering from asthma said that the foods provided by the hospital are tasteless with less quantity of spices and other necessary ingredients. “I rather choose to eat food brought from outside than eating the meals provided from the hospital because it doesn’t meet our dietary needs as recommended by doctors and dieticians themselves.”

He added that many patients throw the food into the bin which is a huge waste of resources. “I used to take only soup and the milk provided from the hospital kitchen. However, with the new rule of allowing one meal from outside it has become very convenient for us.”

Meanwhile, patient attendants at the hospital also claim that the meals provided from the hospital mess are not being provided based on the patient’s needs. “My mother was a diabetic patient but they give the same food as any other patients.”

“When we say meals to be provided according to the patient’s needs we don’t demand delicious food. But at least the hospital should be wary of the different needs of different patients as it is one crucial factor to fight the ailments,” said another attendant.

Some even questioned if the hospital administration meets their food services standard of the patient’s diet requirement in line with the Guideline for Inpatient Food Service System in Bhutan, 2019.

Another said that as the prime minister is a doctor by profession and had spoken about the need to provide a specific diet. He added that the time has come for the government to monitor the inpatient nutrition care in the hospitals.

One attendant added while free food services help the patients and their attendants, the qualities are being compromised. 

As she was referred from other districts, she says, there is no option for them than to go for the foods provided by the hospital. “Staying for longer durations in the hospital and always buying food from outside is not possible for humble people like us,” she added. “But honestly, I am not satisfied with the food services being provided here.”

While the inpatients’ food services system of the health ministry mandates hospitals to provide meals depending on the patients’ disease conditions, it is also evident that many people bring foods to the hospital to meet the dietary needs of their patients.

On this front, JDWNRH’s dietitian Sonam Tobgay agrees that the food services might have been compromised given they have to prepare meals for over 700 patients including their attendants at one single instance. 

Besides making best efforts to serve quality food for patients admitted at the hospital, he said, they also take public complaints and feedback seriously to improve nutritional care.

He also attributed the reason to budget constraints and lack of supply chain of food items to implement the guidelines strictly. “Despite challenges, the menus have been planned on a weekly basis to give them a variety of nutritional meals which cater for all dietary needs, and based on the body requirement of the patient,” Sonam Tobgay said.

Further, to provide a balanced diet for the patient, he said, they also focus more on providing a general diet to all the patients. “We also provide meals based on their disease conditions,” he claimed.

In addition, he said the hospital also evaluates the quality of food services by inviting officials from outside the nutrition department to taste the food besides surveying the patient attendants. “Based on their findings and feedback we work to address the issues,” he said.

Officiating chief program officer of JDWNRH, Tshering Cheki, said that the maximum complaints they received were on the quantity of spices such as salt and chili content in the curry. “We are also planning to provide separate curry for the attendants and patients,” she added.

According to the hospital administration, the prevalence of undernutrition care has been reported up to 54 percent of hospitalized patients – respondents.

Meanwhile, global studies show that malnutrition and undernutrition increase risks for complications including impaired wound healing, infections, and pressure ulcers; leads to longer hospital length of stay and hospital readmissions and is associated with increased risk of mortality.