April 7, 2014
Over the last two days, I had the opportunity to travel outside of Thimphu to explore epilepsy care in more remote areas of Bhutan.
We left early in the morning, with our goal destination the town of Gasa, the main city in the Gasa district in the north part of Western Bhutan, and home to about 3,000 people. There is essentially only one route to Gasa, the final 18km of which was recently completed. Leaving early in the morning was an attempt to beat the construction road blocks that can close the road for up to 2hrs at a time. Though there are only 60-70km between Punakha and Gasa, that leg of the journey takes about 4 hours as the vehicle carefully weaves its way along narrow roads that cling to the sides of mountains. The views along this journey are spectacular, and I can only marvel at the challenge that road construction in this part of the world must represent.
View approaching Gasa:
The town of Gasa hosts the town (and district's) health unit. We were pleasantly greeted by the staff of this facility, all of whom were no strangers to the challenges that care in this type of setting represents. The region has strong traditional beliefs and firm cultural roots. As such, the facility (similar to many hospitals in Bhutan) shares care with a traditional medicine service. The facility has access to diazepam, phenobarbital, and phenytoin. If patients need to be transported to a larger facility, they have to make a similar journey to our own.
Traditional Medicine Unit and Gasa Hospital:
Neurocysticercosis is suspected to be a significant contributor to the burden of epilepsy in Bhutan, but the exact prevalence is unknown. This disease is primarily contracted via undercooked pork, and studies done in neighboring countries to Bhutan have shown a high burden of disease. Cysts deposit in the brain and act as a focus for seizure activity, particularly in the cortex. While healthcare workers in Bhutan are well aware of neurocysticercosis, in talking with local individuals in areas like Gasa, there is sometimes little awareness of this condition or the risk that consuming dried, raw pork may represent.
Our trip to Gasa allowed us the opportunity to view medical care in more remote areas of Bhutan. The potential for telemedicine, particularly in the form of epilepsy care, has much potential for regions such as Gasa. Learning more about the topography of Bhutan, the cultural beliefs, and the range of access to medical care has been enlightening and will help strengthen the foundation of our project.