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I am perhaps little more wise now: Dr. Nirola

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Dr. Damber Kumar Nirola is the only working psychiatrist in Bhutan. He often feels quite overwhelmed by the job he is doing, sometimes overworked too. With the growing number of mental health cases in the country, many of them unreported or neglected, the role of singular psychiatrist has been ever challenging. Dr. Nirola accepts the lack of health professional’s network to identify the mental health issues plaguing the grass-root population, but cheers at having some good practices of general health system in place. Dr. Nirola flew to Toronto for a workshop held June 4-6 that discussed wide array of mental health issues globally. BNS caught Dr. Nirola in Toronto on the last day of his meeting, and got consent for this exclusive interview via email. 

Dr. Damber Nirola
Dr. Damber Nirola

BNS: What made you to fly to Toronto so suddenly?
Dr.Nirola: I am currently working with Dr. Farrah J. Mateen Assistant Professor at Department of Neurology AC-720, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, on a research project on epilepsy in Bhutan called “Bhutan Epilepsy project” [http://www.bhutanbrain.com/]
We are currently carrying out research on epilepsy in the following aspects:
1. Knowledge, attitude and beliefs about epilepsy among the patients or caregivers,
2. Knowledge, attitude and beliefs about epilepsy among the health professionals;
3. Assessment of quality of life of people suffering from epilepsy
4. Prevalence of neurocysticercosis as a cause of epilepsy
5. Smartphone device to record electro-encephalogram [EEG] for diagnosis of epilepsy.
In absence of a Neurologist in Bhutan, the Psychiatry department of JDWNR Hospital has been providing services to most of the epilepsy cases who visit the hospital. Dr. Chencho Dorji, my predecessor, initiated the project and I took it over from him after when he decided to take leave in January 2014.
Our project is funded through Grand Challenges Canada [GCC] and since the current meeting was convened jointly by the GCC and the National Institute of Mental Health Canada. I was invited for the meeting through the epilepsy study.

BNS: Being the only psychiatrist in service of the country, what challenges are posed for addressing the mental heath at grass-root level of Bhutan’s rural populace?
Dr. Nirola: We have a lot of challenges working in the field of mental health in Bhutan. There is poor understanding about mental health and mental illnesses among the general population. There is strong stigma attached with mental illness because of which people try to underplay the symptoms and do not seek help at all, or in time. We have been seeing increasing number of people succumbing to suicide due to untreated depression. Interestingly it is also becoming apparent that people do not seem to realize that they could be suffering from mental illnesses making it difficult for them to seek help in time.
As a clinician working at the tertiary level hospital, I am fairly over worked. Being a clinician it becomes difficult to free myself for providing supervision to people who work at the grass root level. In principle, we have trained almost all the general doctors and health workers to provide mental health care all over the country but I fear we have not been able to reach everyone. There is a wide gap between the need for treatment and the actual availability of services. This is what worries me a lot.

BNS: Any lessons you learned from, or chance to share with other delegates of the training?
Dr. Nirola: We aren’t doing badly in strategizing our mental health interventions. Most other countries are trying similar things that we had been doing for many years. For example, we have integrated the treatment of common mental illnesses in general practice since 2001 and I see that some of the countries are just thinking that this is a good idea. The only worry that we have is, we are very poor in researches, making it difficult for us to backup our activities with evidence-based data. We need to do a lot in terms of research.

BNS: You had earlier said that mental health is not an entity in Bhutan. How will such international training and workshops will help you establish resources in Bhutan to address mental health problems?
Dr. Nirola: Well, Mental health is a very small component of the overall health activities in Bhutan. We have been having very rudimentary mental health services even at a tertiary level hospital. We don’t have a complete team of mental health workers.
Through exposure in such international meetings and workshops we gain ideas about how to best utilize the services of existing resources rather than ruing over not having any.

BNS: What are the cross-cutting issues of mental health you discussed in the workshop in Toronto? Possible to share?
Dr. Nirola: Issues such as these were discussed:

Participants in session/ Photo: Dr. Nirola's facebook
Participants in session/ Photo: Dr. Nirola’s facebook

1. Mental health innovations from various countries were presented and discussed. Sustainability of such programs and the way forward were deliberated and discussed.
2. Ideas such as engaging service users in delivering mental health services were highlighted.
3. Some recent researches in Understanding Link between Early childhood development and mental health outcomes were presented and discussed.
BNS: Psychiatric disorder is burgeoning health problem faced by Bhutan comparing to its population size. How will you and other health professional pool resources to address the problem? Which are the key resources you need in urban and rural areas?

Discussing mental health in Toronto/Photo Dr. Nirola's facebook
Discussing mental health in Toronto/Photo Dr. Nirola’s facebook

Dr. Nirola: Recently the Ministry of Health has expedited some activities to face the challenges of growing mental health issues, especially the recent surge of suicide. We have started training a group of health workers on suicide and crises management. We have drafted mental health strategy plans and suicide prevention strategy plans. The ministry is also in the process of establishing a suicide prevent program within the ministry.
Capacity building of the existing human resources and partnering with relevant stakeholders is one great strategy that we can bank on for the time being.

BNS:What packet of panacea are you taking home this time?
Dr.Nirola: I am going back with experiences of people working in the field of mental health from different places. I am perhaps a little more wise now; and given the opportunity, I will be able to share my experiences with the policy makers back home so as to extend our reach to those who could be suffering silently in the far-flung areas of our country.

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