Corona Daily 180: The Resilience of Bhutan

76-year-old American tourist Bert Hewitt and his wife landed in Bhutan in the beginning of March 2020. The couple mingled with locals to celebrate an annual festival in Punakha. The next day, he complained of stomach trouble and breathlessness. His oxygen level was ominously low. When tested, he became the first case of coronavirus in Bhutan. A cancer survivor, with his spleen removed, Hewitt also had high blood pressure.

One of the least developed nations, Bhutan dreaded the potential entry of the virus in the kingdom. Health officials immediately went into a contact tracing overdrive. It took them 6 hours and 18 minutes to trace nearly 300 contacts. 75 direct contacts were moved to quarantine facilities, and 225 isolated at home. King Jigme Khesar Namgyel Wangchuck supervised the process personally, staying up through the night. He sent Hewitt a pair of blue silk pajamas and a bedspread. Strangers sent letters and flowers to the hospital.

Still on a ventilator, Hewitt was evacuated in a specialized aircraft with a biocontainment unit to the USA. When he woke up after ten days, an American doctor told him, “whatever they tried in Bhutan probably saved your life.”

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Bhutan, the Himalayan kingdom sandwiched between India and China, is one of the few remarkable nations that has been independent throughout its history. For a population of 760,000, Bhutan has only 337 doctors, one PCR machine to test coronavirus, and a single doctor with advanced training in critical care. Its per person GDP is only $3412, but the kingdom measures its wealth in GNH (Gross National Happiness). (My series on Bhutan 1,2,3,4,5 tells you how GNH is not posturing, but a well-defined quantitative measurement). Bhutan has a fairly open border of 700 km with India.

In the last twelve months, Bhutan has had one coronavirus death.

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At the beginning and later in August, Bhutan followed a 21-day nationwide lockdown. Lotay Tshering, Bhutan’s Prime Minister, is a respected doctor and surgeon. During the lockdown, he decided to sleep in his office (see picture above). The cabinet ministers, senior officials and key staff across all ministries also decided not to go home. This was to avoid taking the virus home, and also to be able to work physically as the government’s top team. Some ministers cooked for one another. The Prime minster performed surgeries through the week. Members of parliament donated a month’s salary. Hotels offered free rooms for quarantine. Farmers donated crops. When lights in the Health Ministry’s office were on in the night, locals brought hot tea and homemade food for the officials.

The King set up a relief fund. $19 million have been distributed among 34,000 Bhutanese who lost their income. The program continues at least till the end of March 2021. During lockdowns, the government organized deliveries of food, medicine and essentials to all households. The government has created a registry of vulnerable citizens. Care packs including sanitizers, vitamins, masks were sent to 51,000 Bhutanese above 60 years of age.

Since schools were shut, lessons were organized on TV channels. Study materials were distributed to children living in rural areas.

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In November 2020, WHO singled out Bhutan for its health emergency readiness.

In 2018 itself, Bhutan along with the WHO representatives had evaluated its emergency readiness. An emergency operations center was established following the evaluation. Bhutan invested in MCK tents (Medical Camp Kit), quickly convertible into health care facilities. Tents were used in the pandemic for screening patients as well as treating them away from non-covid patients. In November 2019, the Health Ministry conducted a simulation exercise at the Paro International airport, Bhutan’s only airport. The scenario talked about a passenger from abroad bringing in a virus. The exercise included the police, armed forces, aviation, customs, flight crews and others.

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Bhutan has 760,000 people. Big nations can object to taking lessons from the tiny kingdom. But Big nations are made of thousands of small Bhutans. In a pandemic, local action may be even more important than national action.

Ravi