April 2nd, 2014
Greetings from Bhutan!
Flying into Bhutan, one immediately gains an appreciation for the unique position of the country. Nestled in the Himalayas, the flight into Paro requires a skilled pilot to navigate the beautiful mountains that surround Paro's airport. There are a limited number of flights that come into the country each week, and as such, the country continues to maintain a feeling of beautiful seclusion.
Bhutan is steeped in rich Buddhist tradition and culture. Over the last several years, the country has evolved while seeking to maintain firm roots in Bhutan's culture heritage. Walking down the streets, people can be seen wearing the traditional gho and kira, while simultaneously listening to the latest music hits from Lady Gaga and Katy Perry. Cars and taxis have become more common throughout the country, though the capital continues to be one of only two capitals in the world that does not have a traffic light, instead employing traffic guards at the city's hub.
It is a country of approximately 1 million people, many of whom live in rural areas separated by mountains and connected by narrow roads. The urban center of Bhutan is the capital, Thimphu, which also houses the country's primary referral center, the Jigme Dorji Wangchuck National Referral (JDWNR) Hospital. Medical care is free in Bhutan for all citizens, and all lab tests and imaging are also covered by the government.
I was intrigued to learn about access to neurologic care in Bhutan upon my first visit to the hospital. There are no neurologists in the country of Bhutan, and most epilepsy care is provided by psychiatrists, who are very familiar with seeing referred cases of epilepsy from many parts of the country. According to the physicians I met at JDWNR, neurocysticercosis is a common problem in the country (exact prevalence unknown) and may contribute significantly to the burden of epilepsy. Neurocysticercosis is a disease caused by tapeworm cysts which infect the brain parenchyma, commonly transmitted via undercooked pork. In Bhutan, neurocysticercosis is primarily diagnosed by imaging. The JDWNR facility has an MRI machine (the only one in the country), a CT machine, and access to at least five different anti-epileptic medications. There is no EEG machine in Bhutan, and no epilepsy specialists that would be able to interpret such a test.
I am looking forward to learning more about epilepsy care in Bhutan during my visit, and I am grateful for the warm welcome I have received in this beautiful country.