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 Country Situation
Bhutan is a mountainous country and
emergencies usually arise due to the following factors:
 Road accidents because of the rugged terrain.
Flash floods from monsoon rains or bursting of
glacial lakes.
Earthquakes as the country
is in earthquake zone.
Fire
In the recent years, emergencies related to
Indian militants who have taken refuge in the Bhutanese forests.
Other occupational hazards (falls and animal
attacks).
Chemical hazards from insecticides.
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As the country is highly rugged
and rocky, motor roads are narrow and pass through dense forests and vertical
cliffs. As the traffic is increasing in the recent years, road accidents are
increasing year by year.
The Road Safety and Transport
Authority (RSTA) is doing much work to improve this
situation. Backed by the 1999 Road Safety and Transport Act, motor vehicles
are constantly under scrutiny for their roadworthiness. Besides the annual
fitness checks, public transport vehicles are checked more frequently. The
mobile inspectors and traffic police inspect all public vehicles after they
are boarded and just before the departure. Their carrying capacity has been
reduced significantly over the years. The running life of the vehicles has
also been reduced to 5-8 years depending on the type of the vehicle.
Insurance requirements are also very strict.
Similarly, licensing for drivers
has been tied up with training requirements and refresher training during
their renewals.
These vehicles have to play
audiotapes carrying messages about road safety in order to educate the
transport staff and the passengers. The national newsweekly carries road
safety messages in all the issues and similar messages are disseminated using
the television service from time to time.
Together with other sectors like
the Public Works Department, the RSTA examines the road network and carries
out both repair and widening works. In order to control pollution, emission
tests have been introduced for all the vehicles in liaison with the National
Environment Commission.
Bhutan is also bothered by flash floods
from monsoon rains and bursting glacial lakes. Much preventive action is
being taken. The flacial lakes are constantly
monitored and when danger is detected, arrangements are made to drain water
so that they do not burst causing floods. Similarly, roads and bridges are
constantly watched for dangers from monsoon floods.
Although earthquake problems are
not known in Bhutan’s
history there has not been much damage by earthquakes for a long time now.
However, being in the earthquake zone, preventive measures are being taken.
The designs of new houses incorporate certain amount of measure for safety
from earthquakes and the tallest permitted construction in Bhutan is five storeys for the same purpose. Emergency exits are also
new features coming into building designs although no such provision existed
in the previous building designs.
As the houses are mainly
constructed with timber, fire hazards including forest fires are very common
in Bhutan.
Fire fighting teams are stationed in every big settlement in the country for
this reason besides improving the household safety measures.
Although it has not been a
regular feature, one of the major problems in the recent years has been the
presence of three well-known Indian militants groups hiding in the jungles in
southern Bhutan.
Not only they loot and collect contributions from the bordering districts of Assam and West Bengal,
they hindered the economic activities of the country. The country has
negotiated with them for six years to leave the country peacefully and these
efforts have failed. As per the decision of the National Assembly, the
Government had to finally use force to drive them out in December 2003. A lot
of preparations have gone for this emergency. Besides the military
preparations, the Ministry of Health had to prepare for dealing with the
casualties. Starting with 1999, the Ministry trained 222 health workers
consisting of doctors, nurses, and health workers and prepared its Emergency Medical Teams (EMTs)
headed by one of the Directors from the Health Ministry. Emergency Services
Back-up teams from the key hospitals and trauma centers supported these EMTs. In preparation for this emergency, a national
emergency medical services guidelines was prepared together with the
development of a standard training manual for EMTs
that included topics of triaging, CPR, first aid, etc. among other things.
Simulated disaster exercises were also part of the training.
As the settlements are in close
proximity to the forest areas, it is often a case that a farmer is brought to
the hospital from animal attacks. Further, cutting fodder from tall trees,
people also sustain injuries. These are altogether another type of emergency
that the country’s hospitals are prepared to handle.
Although chemical hazards are minimum, the health facilities do have to deal with these
cases from time to time. There have been cases where people consumed fresh
vegetables still containing insecticides used to protect them from worms and
caterpillars and got sick. Similarly summer mushrooms often poison people.
There have also been cases where employees assigned to kill stray dogs with
poisons died of contaminations. Concerned sectors are also taking into
consideration the threat of food contamination and preparing to deal with
them.
Bhutan also had to prepare to deal with
SARS threat during 2003 like the rest of the countries in the Region. WHO’s technical guidance has been very helpful for the
country. Besides outbreak of diseases as a natural occurrence or imported
from other countries, direct biological warfare threat may not be a danger
for the country although biological warfares were
not unknown in the mid 1800s when Bhutan was torn by civil conflicts among
the various feudal lords in the country. At that time it was often a practice
to send an expensive clothing gift to a rival leader after making that gift
to be worn by a person infected by small pox and other deadly diseases.
So far Bhutan has not dealt with
radiation emergencies, but preparations can start for that too.
Initiatives taken
The initiatives taken to prepare
the country to deal with the specific problems mentioned above are already
mentioned under each heading. The broad initiatives may be discussed under
the following headings.
The Health Ministry has appointed
focal units in the Ministry to deal with the emergency health activities.
With technical support from the Regional Office, a general review of the
situation took place in 2003. With WHO funding, a
Programme has been initiated on EHA for the first time.
Trauma units have been set up in
at least three places with ICU, OT, Laboratory and X-ray facilities. Blood
banking facilities have also increased with identified live donors, as the
storage facilities are not so good.
As mentioned above, Emergency
Medical Team system has been established although their training content
should now be broadere to deal with problems other
than armed conflicts. Training manuals will also have to be improved and
broadened.
In 2003, the Government also
requested for exposure of concerned people in the Programme to other
countries that had experience of dealing with emergencies so as to learn from
these experiences. We had put this proposal up to the Regional Office. As the
funds were short, this did not materialize. The Programme hopes for support
and guidance of the concerned Technical Unit in the WHO Regional Office.
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