Perspectives on chronic musculoskeletal pain management among healthcare professionals in Bhutan: A qualitative study.

INTRODUCTION: Musculoskeletal pain disorders continue to be one of the leading causes of disability worldwide. Best practice care recommends patient-centred biopsychosocial models of care. Little is known about the chronic musculoskeletal pain management in low- and middle-income countries. OBJECTIVES: To explore the management of chronic musculoskeletal pain by healthcare professionals in Bhutan. METHODS: This study employed a qualitative design involving 19 Bhutanese healthcare professionals managing chronic musculoskeletal pain in Bhutan. We collected data using a semi-structured interview guide. Thematic analysis was done manually. RESULTS: Healthcare professionals reported that patients rely on a combination of home remedies and seek help from local healers and hospitals for chronic musculoskeletal pain management. While healthcare professionals understand chronic musculoskeletal pain as multi-dimensional phenomenon, the primary focus was on identifying and treating structural anomalies. Time constraints, inadequate knowledge and skills, lack of confidence, facilities and expertise were reported as barriers to the effective management of chronic musculoskeletal pain. They proposed a need for clinical guidelines, relevant skills training and creating awareness of chronic musculoskeletal pain. CONCLUSION: The management of chronic musculoskeletal pain in Bhutan is focused on identifying and treating physical abnormalities. Healthcare professionals consider psychosocial dimensions important but lack any form of actionable interventions in this domain.

Situation of physical activity in the prevention of non-communicable diseases in Bhutan: challenges and the way forward.

Bhutan is a lower-income-middle-income country in the Himalayas, between India and China. Non-communicable diseases (NCDs) are the leading cause of death and premature mortality in Bhutan, accounting for 69% and 71% of all deaths in 2014 and 2019, respectively. Although the World Health Organisation (WHO) identified physical activity as a key strategy to reduce the burden of NCDs, with rapid urbanisation, motorised transportation, and rural-urban migration, people are adapting to sedentary lifestyles, inflating the incidence of NCDs in the country. The increasing incidence of NCDs exerts a burden on the human and financial resource constraints in the health system in Bhutan. In this view point, we report evidence-based benefits of physical activity for health promotion, primary prevention of NCDs and health benefits for individuals living with NCDs. We also briefly assess the situation of physical activity in Bhutan. Then, shortcomings of existing NCDs prevention programmes are discussed along with opportunities and ways forward to effectively implementing physical activity to harness the benefits of physical activities.

Physiotherapy services in patient care in Bhutan.

Physiotherapy and rehabilitative services are an integral part of patient care, but in many developing countries they are not considered a priority and are either not available or not easily accessible to those who need them. Bhutan is one such country where healthcare is provided free of cost to all, but as of 2021 physiotherapy services were available only in 26 of 48 hospitals and 19 of 20 districts. The number of physiotherapy professionals per 10,000 population is 1.4 with significant rates of attrition. There is lack of awareness among patients and other health professionals about physiotherapy and rehabilitation services. The country needs to integrate physiotherapy and rehabilitation services into the overall health policy framework and develop proper planning of human resources and infrastructure to meet the current and future demands.