ABSTRACT
Background: A World Health Organization (WHO) package of essential noncommunicable (PEN) disease interventions was piloted in two districts of Bhutan by non-physician health workers. They conducted risk assessment among patients aged over 40 years who visited the outpatient department of health institutions. Blood glucose was also measured among those who were overweight/ obese (body mass index ≥23 kg/m2) or had a high waist circumference (>80 cm in women and >90 cm in men). Appropriate counselling, treatment and referral were provided to the patients. The performance of the PEN project in detecting and managing noncommunicable diseases (NCDs) and their risk factors was assessed. Methods: All health institutions of Paro (one district hospital and three basic health units [BHUs]) and Bumthang districts (one district hospital and four BHUs), were included in the PEN pilot assessment study. All patients who had presented to the clinics in the pilot districts from 1 June to 31 August 2012 constituted the study population. The data were collected from the clinical form, supervisor’s report and monthly report of the PEN project. The characteristics of patients with an NCD at registration and at the third follow-up visit were compared in a before–after analysis. Absolute changes in the characteristics of patients were computed for those who had completed the required followups during a 3-month assessment period. Results: In a 3-month period, 39 079 patients had attended clinics in the pilot districts. About 10% of the clinic attendees (3818/39 079) were aged over 40 years; of these, 22.6% (864/3818) had a high blood pressure, and 49.7% (1896/3818) were overweight/obese or had a high waist circumference. Screening of overweight/ obese/high waist circumference cases revealed that 26.1% (494/1896) had high blood sugar levels. Out of the 896 patients who were registered on PEN protocols, 13% had >20% risk of developing cardiovascular diseases (CVDs) in next 10 years as per the WHO/International Society of Hypertension risk-assessment charts. Among 444 who had three follow-up visits, high 10-year-CVD risk (>20%) had declined from 13% to 7.3%. Among 400 persons with hypertension, use of medication increased and high blood pressure declined from 42.3% to 21.5%. Among 115 persons with diabetes, use of anti-diabetes medication increased and high blood sugar declined from 68/100 to 51/100. Conclusion: Implementation of the PEN intervention in the primary health-care setting of Bhutan led to improvement in blood pressure and diabetes control, and reduction in CVD risk.
ABSTRACT
This article attempts to discuss the positive aspects of healthy living based on gso.ba rig.pa philosophy and principles, which are crucial for general wellbeing, health, competence and long life. It will focus on three humors and five elements of our body, as they are considered as the basic pillars of our body and vital energies. Since mind is the creator of all phenomena, an attempt is made to describe the mind and how it affects our health status. The food and behavior are described in detail as they are very important for maintaining optimal health, wellbeing and long life.
ABSTRACT
The number of aging population is increasing worldwide and putting enormous pressure on public health system in every country. Therefore, it is of crucial importance to focus on prevention of age related disorders through various means, both from modern and ancient healing systems. An integrated approach is better than single system in dealing with not only the age related disorders, but also any health issues of all human beings This paper will attempt to list down all the chud.len and their ingredients and the methods of preparation, so that the people of the world can have access to such ancient wisdom. The dietary practices and menu for healthy diet during old age as per the gso.ba-rig.pa system will also be included and behaviour practices as per the season and climatic conditions will be highlighted. An attempt will also be made to introduce the concept of spiritual practices of longevity through visualization of Amitayus or other personal deities, and recitation of long life mantras and prayers. Lastly, the process of dissolution and graceful dying as per gso.ba-rig.pa principles and practice will be covered as death is inevitable.
ABSTRACT
Traditional medicine in Bhutan is known as gSo-ba Rig-pa and is one of the oldest surviving medical traditions in the world. Other medical systems, such as Chinese medicine, Indian Ayurvedic medicine, Unani medicine, Greco-Roman medicine and the country's rich cultures and traditions have greatly influenced the way traditional Bhutanese medicine evolved. However, Buddhist philosophy remains the mainstream of this medical system. gSo-ba Rig-pa's principles are based on the perception the human body is composed of three main elements: rLung ('Air'), mKhris-pa ('Bile') and Bad-kan ('Phlegm'). When these three elements are balanced in the body a person is said to be healthy. The pathophysiology is also different from other medical systems, and the close link to Buddhism is reflected in the spiritual dimensions and the perception that all suffering is caused by ignorance. The treatment of diseases includes behavioral modification, physiotherapy, herbal medicines, minor surgery and spiritual healing. This makes the traditional Bhutanese medicine a unique and holistic health care system. The traditional medicine is an integrated and recognized part of the formal health care services in Bhutan under the auspices of the Ministry of Health. The article highlights three main points which can be learned from the Bhutanese experience: (1) the strong tradition of herbal medicines within gSo-ba Rig-pa forms a unique opportunity to prospect for new leads for development of pharmaceuticals, (2) the availability of the traditional medicine along with biomedicine broadens the health care choices for patients, and (3) the experiences of integrating two conceptually very different health care systems within one ministry contains important managerial lessons to be learned.