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Mental health is non-entity in Bhutan:Dr Damber Nirola

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Dr. Damber Kumar Nirola is the only practicing psychiatrist in the country.  Nirola talked to Namgay Zam of Radio Valley for her ‘let’s talk about it’ show on 20th August. A range of issues about the state of mental health conditions in Bhutan is discussed.

Dr. Damber Nirola
Dr. Damber Nirola

Besides being a psychiatrist looking after patients in OPD ward, Nirola is the head of psychiatric department, a visiting lecturer at institute of nursing and public health, technical adviser to the ministry of health. He works from 9am to 3pm Monday to Friday and 9am to 1pm on Saturdays both in ward and OPD at Jigme Dorji Wangchuk National Referral Hospital, Thimphu Bhutan. Recently he has been conferred the title of International Certified Addictions Counselor I (ICAC I) after having undergone a series of trainings conducted by the Colombo Plan Asian Center for Certification and Education (CP ACCE) for Addiction Professionals leading to the certification. With this he has been working as the national and regional trainer for the CP ACCE for the last one year.

Proficient in all major languages of Bhutan, and also in Hindi,  Nirola is a preferred psychiatrist for many patients speaking Dzongkha, Sarchhopkha(Tsangla), Lhotshampkha(Nepali) and even Hindi. He claims his language skills to be greatest advantage of being a psychiatrist.  Nirola joined civil service in 1989 and has worked as District Medical Officer(DMO) in Trongsa and Punakha until 2002. “I wanted to go for a post graduate studies, but certain hiccups occurred; because of the problem related to south I could not get chance to go out for study”, says Nirola.

Coming back to Thimphu in 2002, he apprenticed with Dr. Chencho, another psychiatrist and a senior who ultimately recommended him to go for a study program of the government slot. “But it did not come easily,” he says. “I applied at a very recognized institute in Banglore, National Institute of Mental Health and Allied Sciences, and all of a sudden decided to become a psychiatrist.”

Later he went to Bangladesh for completing his post graduate study.

 Nirola admits that psychiatry is regarded non-entity. Not much attention was paid to this specialization of medical field until as recently as 2002. But he says, “I do not regret for choosing to become a psychiatrist.” Working with people of various mental disorders, is something to understand them whole, not just providing medicines. “At the end of the day, when you are able to put a smile on a depressed face, it is all that matters,”  Nirola feels pride.

Pointing out the major causes of psychiatric disorders, Nirola gave an array of causes like physical and psychological changes in brain, social and environmental factors, childhood experiences, chronic illness etc.

Discussing about the challenges,  Nirola says the biggest hurdle is to take care of those who have come for getting the mental health services. According to him, it is not possible to see more than 8 or 10 patients a day. When there are more patients, quality service cannot be provided as it involves a great deal of talking and understanding a person’s family life, social relationships and other factors.

Other challenge is to educate people on a long term basis. There is no manpower to handle the cases. We need a whole set of manpower, not just a psychiatrist. Until and unless we have set of service providers at all level, we cannot do justice to the mentally ill people.

The other constraint is the budget allocated for mental health department. The hospital gets a small amount for some repair and maintenance work, but it is not sufficient for real treatment. Developing a different cadre of manpower for mental health requires a significant amount, and I do not know from where it comes.

“It is equally worrying to know that young people, as young as 8 years, completing suicide. I feel that had they come for the service at early period of the idea, we could have helped.”

Nirola adds, “ It is time that we review our status report of 2002 on mental health. We cannot rely on the 10 year old data and we have to do a national level survey.”

The audio belongs to Radio valley, transcribed and reproduced here with due permission of Namgay Zam.

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