WHO helping Bhutan battle NCDs, including heart disease and diabetes

September 2015

A chance encounter with a primary health-care worker in a remote, Bhutan, mountain valley village in 2012 literally changed Boko’s life – for the better.

Boko has her blood sugar level tested by a physician, Bhutan.

“It was by sheer luck that I attended a meeting and heard what this health worker had to say, all of which exactly matched with what I had been suffering for the previous 2 months,’’ says Boko, who was subsequently diagnosed with hypertension and diabetes.

The health worker visited the Bumthang district village of Chumey that day as part of a WHO-supported programme, run by the Royal Government of Bhutan, to curb the country’s rising trend of noncommunicable diseases (NCDs), primarily heart and lung diseases, cancers and diabetes.

Such conditions account for 56% of all deaths in Bhutan, with risk factors including harmful alcohol use, unhealthy diet, poor diets high in salt and tobacco smoking being deeply rooted in the country’s cultural traditions and, therefore, posing a serious challenge for effective health interventions.

In 2009, the government piloted a project in Bumthang and Paro, 2 of Bhutan’s 20 districts to roll out WHO’s Package of Essential Noncommunicable disease (PEN) interventions. The project was expanded nationwide in 2014 and today more patients are seeking medical consultations than ever before.

PEN aims to show health-care providers how to detect and manage NCDs by screening clients for diabetes, hypertension, overweight, early signs of cancer and educating people on the NCDs risk factors at the first level of care and through outreach. The PEN initiative also provides guidance on referring patients needing further treatment to higher levels of care.

46-year-old Boko, a roadside labourer, had believed that a diet eating rich foods like pork and butter was good for her health. At the end of the day’s work, she would join friends in drinking the locally brewed alcohol “ara” to recover from the grind of the day.

She was also noticing strange symptoms, such as being unable to quench her thirst despite drinking water often, urinating frequently, and losing – rather than gaining – weight despite eating large quantities of food, which are hallmarks of diabetes.

It was after meeting the primary health-care worker that she was advised to visit a hospital immediately for a further checkup, after which she was told that she had high blood sugar and high blood pressure and placed on a management programme, including medication and a strict healthy diet.

“I now know what and how much to eat. I used to weigh around 86 kilograms 3 years ago and now I weigh only 64,” she adds with a chuckle. Since then Boko has maintained her daily medication regime to control her hypertension, and regularly visits the hospital for follow-ups. While Boko’s work hadn’t changed, her lifestyle had.

“She is an obedient patient,” says Dr Chador, Bumthang Hospital’s chief medical officer. “We wish all patients are like her who always follow our advice.”

The burden of NCDs

In Bhutan, cases like Boko’s are typical, where NCDs prevalence has risen considerably due to changing lifestyles characterized by poor dietary habits and the marketing of unhealthy foods and beverages.

“Boko’s story reflects the socioeconomic challenges and exposure to NCDs factors faced by many in Bhutan,” says Dr Ornella Lincetto, WHO’s Representative to Bhutan. “The Government is well aware that the rise of NCDs poses a formidable threat to ensuring free health care for all.”

Bhutan’s adoption of the WHO PEN package has sent a strong signal that the government is serious about improving efforts to prevent, detect and manage NCDs.

Heart disease and women

Worldwide, cardiovascular disease remains an under-recognized and under-treated health problem in women. This is despite heart disease being the leading cause of death in women. On World Heart Day, 29 September 2015, WHO is calling on countries to take action to reduce heart disease in women.

“The WHO PEN intervention has been proven to reduce the risk of cardiovascular disease by 45%,” says Dasho Dr Dorji Wangchuk, Secretary, Ministry of Health, Royal Government of Bhutan. “The Government of Bhutan is actively working to ensure women attend clinics and benefit from PEN.”

PEN’s successful implementation in Bhutan lies in the fact that it was tailored to fit local needs and aligned with the country’s model of health service delivery. WHO is piloting the PEN initiative in several other countries.

For Boko, the PEN protocol has changed her life. Over the last 3 years, her blood sugar has come down to normal range, and the medicines provided are controlling her blood pressure.