As we reach the one-year landmark of the pandemic that has killed over a half million Americans and sickened almost 30 million, imagine a country which has had less than a thousand cases of COVID-19, and only one death.
I’m not talking about New Zealand — for which some have claimed (incorrectly) that it’s island status and relative affluence have led to its admirable statistics.
I’m talking about a poor landlocked nation with only a little over 300 physicians for its 3/4 million population, a country with an open border with India — which has the second highest number of SARS-CoV-2 in the world — a nation which spends only 3.1% of its gross national product on health care, as compared to our 17.7%. I’m talking about the kingdom of Bhutan.
The health care they do provide is basic, but it is free to all. So is education and a right to five acres of land, sufficient food to eat, and clean water. It is all part of the kingdom’s policy of “Gross National Happiness,” (GNH) the brainchild of the fourth king of the present Jigme Singye Wangchuck and endorsed by its parliamentarian government — a creation by the king in 1998 as a way of turning the nation into a democracy.
GNH does not measure “happiness” per se, but instead is a formula that revolves around good governance, sustainable socio-economic development, cultural preservation and environmental conservation. (Bhutan is the only carbon negative nation in the world). The Bhutanese have an ingrained sense of trust and pride in their leaders, an understanding of science, a lack of materialism which is part of their Buddhist culture, a resilience, an altruism that would be the envy of many countries.
I’ve been fortunate to travel twice to Bhutan, the second time to volunteer for two months as a pediatrician, where I worked with three of the other five pediatricians in the country to train new doctors. I trekked through the high Himalayan mountains that cover most of the country. Villages, a day’s walk from any roads, all have “basic health units” staffed by national health workers who provide basic health care.
Children receive all their immunizations there, women receive good prenatal care, and villagers learn from them about everything from good nutrition to the effects of climate change. These health centers, clean water, improved sanitation and nutrition, and free health care are reasons that infant mortality has fallen from 183 per 1,000 in 1970 to 24 per 1,000 in 2019, and life expectancy has increased an incredible 30 years, from 40 years old in 1970, to 71.
According to Madeline Drexler in an article last month in The Atlantic, Bhutan was already drafting its preparedness plan in January 2020, within two weeks of the first outbreak of an identified virus in China. They began screening at airports, and all points of entry. They identified 300 possible contacts of an elderly American tourist, their first case, within six hours, and treated him well enough so that he survived after his flight home to the States.
My friend Namgay Dorgey, who co-owns a tour guide company in Bhutan, told me in an email that all borders were immediately closed. The loss of tourism is a big deal is Bhutan since it is their second-largest industry behind hydroelectric power from its glacial-fed rivers. The kingdom then banned all tourists, and shut down all non-essential businesses, but gave free accommodations, meals, and if necessary, mental health counseling, to all the thousands of Bhutanese who were quarantined.
In late March, at the time that our former president was calling COVID a “democratic hoax” and claiming that it would be “all over by Easter,” the Bhutanese government extended the quarantine to 21 days, to prevent the small chance of transmission that might occur in the window of time from two to three weeks.
Namgay wrote me that the present king, Jigme Khesar Namgyel Wangchuck, took a personal leadership role in the crisis, making trips to the border, to essential workers, and hospitals. He also made sure everyone who has been out of work has been fully compensated for lost wages.
When I worked in Bhutan, this king had just moved out of his grand dzong (a traditional grand monastery/castle) to a simpler home in a garden on the grounds. He used to drive his security detail batty by cycling around the capital city alone. Like other kings, he wore a crown with a raven in the middle with skulls around it, on ceremonial occasions, to scare away evil spirits. Yet his government chose a Yale trained epidemiologist to run their Department of Health. And their prime minister is a celebrated physician.
Despite the fact that smartphones are relatively new to the country (when I was there, we used flip phones), a contract tracing app was created, according to Drexler, and surveillance has been rigorous. In the meantime, a national campaign by actors, athletes and other celebrities was set up to help ensure compliance with masks, social distancing and contact tracing.
Seniors and services for reproductive health, maternal and child health, and prevention of violence against women were given special attention by the queen, who wields considerable weight in this non-macho nation.
In the meantime, Namgay is now proud to be one of thousands of orange-suited graduates of a volunteer program called DeSuung. These volunteers leave their families for weeks at a time to help out with whatever is needed to help the nation during this crisis. In this strongly Buddhist nation, it has been important that monks reinforced the government’s message and prayed for the health of the people.
The members of parliament voted to give up a month’s salary to help in financing relief efforts. The health minister spent weeks away from her family, working through the night. Citizens provided health ministry staff with the hot milk tea and ema datshi, or chiles and cheese, made from red hot peppers that dry on tin roofs throughout the country. The dish used to light my mouth on fire whenever I ate it, but the Bhutanese toughness extends to their taste buds!
Bhutan is not Shangri La. They have in the past persecuted Nepali nationals. Alcoholism, youth employment, climate change and the effects of modernization on its traditional culture are challenging problems.
But in the way this nation worked together to face a once in a lifetime pandemic, our health care leaders and our nation as a whole, could learn a lot from them. Hopefully, the $1.9 trillion relief bill passed by President Biden and the Democrats is a step in the right direction.
Dr. David Gottsegen works at Holyoke Pediatric Associates and lives in Belchertown.