In November 2019, my husband, Todd, and I set off on the adventure of a lifetime as volunteers for three months in the Kingdom of Bhutan. We are both medical professionals: I am a DMU Class of 2003 graduate board-certified in family medicine with a certificate of added qualifications in hospice and palliative care; my husband is a mental health therapist. We found our perfect fit volunteering with Health Volunteers Overseas. My primary role was doing strategic development for palliative care, a new concept in the country. My husband saw patients for mental health therapy and taught undergraduate students.
Bhutan is often referred to as the happiest country on earth. Gross National Happiness (GNH) is a concept by which the Bhutanese live. The term was coined in 1972 by the fourth king of Bhutan, Jigme Singye Wangchuck, who said in an interview, “Gross National Happiness is more important than Gross National Product.” Since that time, the Bhutanese government has used the GNH Index to measure the collective happiness and well-being of their population.
While Gross National Happiness is a way of life for the Bhutanese, it does not remove the fact that they are people, just like you and I, who suffer from the same day-to-day problems as all people around the world. In Bhutan, cancer diagnoses are often made at later stages of the disease and require travel to either the capital city of Thimphu or to India for treatment. The symptom burden can be heavy for both patients and families, who are often uprooted to care for their loved one in temporary housing.
I was incredibly honored to be able to help provide care for patients alongside three talented nurses, Yangden, Nima and Ambika. They took me under their wing and helped orient me to the shops and markets of Thimphu as well as helping me to purchase a traditional Bhutanese kira and tego to wear. Wearing the traditional clothing of Bhutan was quite an honor for me, and patients were thrilled to see me walk into their homes wearing it.
The palliative care program initially started with home visits twice weekly, which we were able to expand to three times weekly during my time with the team. One particular challenge that stands out for me was availability of medications. Bhutan has a limited formulary and supply of medications, with all medications needing to be imported, often only annually. The establishment of palliative care resulted in an increase in the use of medications such as morphine, leading to a subsequent shortage. For the first six weeks of my time in Bhutan, we had no morphine to dispense to our patients. I was impressed at the incredible resourcefulness of the palliative care nurses, patients and families in navigating this complex situation.
I was fascinated to witness the complex rituals performed by the lamas. One memorable patient told me, “In Bhutan, religion and medicine are intertwined.” When we arrived in a patient’s home, the whole neighborhood would often gather for these blessings. I brought home with me many special treasures bestowed upon me during these visits: a piece of cloth from a guru’s robe, seeds blessed by thousands of monks thousands of times, prayer inscriptions, prayer flags, and cords knotted with blessings blown into them.
I am honored to have had the opportunity to participate in the development of such a meaningful program for the Bhutanese. During my time in Bhutan, I collaborated with other physicians from Health Volunteers Overseas, the World Health Organization, the Bhutan Cancer Society, the International Red Cross Society and the Ministry of Health. We were able to set forth a plan for continued development and expansion of palliative care over the next several years. This truly was an experience of a lifetime for me. I made many lifelong friends, learned more than I ever could have imagined, and as a result there is no doubt in my mind that I have become a better physician.
Julia Jenkins, D.O.’03, FAAFP, MMM, is a family medicine and hospice and palliative care physician in central Iowa who is a medical director for naviHealth. Her personal interests include hiking, cooking and world travel.