Yes, you are still a baby

I still breastfeed my 27 months old daughter. When I tell her that she is now an elder sister (I say, you are now Ana, okay?), she instantly replies, "No Ana. Baby." She means, she is not yet an elder sister but a baby. I thought as a mother, the least I can do is breastfeed her and not deprive her of it.

It sometimes get very tiring, especially at night when she sleeps after refusing to eat dinner. But despite all the nagging going on, I always find myself feeling connected to her in a very special way, because it is something only I can do.

Bhutan should not privatize health yet!

The people of Bhutan have been enjoying free health services till date. The health sector has always been one of the top priorities in the government plan and has always ensured that the people had free access to health care. While the standard of the medical facilities in the rural areas may not be up to the standard as seen in the developed countries, the aim of these basic health units are to attend to the basic health care services such as common ailments like cold, fever, water borne diseases etc. On this front, Bhutan has been performing commendably well and the Ministry of Health reports that the basic health coverage is 90 percent (WHO 2010). It also reports that, because of the free health care access, there has been a prominent decrease in the mortality and morbidity in the recent years with life expectancy at birth rising from 33 years in 1960 to 66 today. Moreover, there is a remarkable improvement on key health indicators, such as immunization coverage, elimination of leprosy and endemic goitre.

Despite these achievements, there are people who are unhappy with the services that the free medical facilities have been delivering. People complain of having to wait a long time to see a doctor and the inefficiency of the whole procedure of medical access. Recently, there have also been cases of hospitals going through drugs shortage (Kuensel 2012), thus rendering people to go home helpless after they had come all the way to the hospital, walking a long way from their villages. So, having said that, my argument is, should medical facilities in Bhutan be privatised in order to ensure prompt health services? I will argue that while it seems like a solution, it will bring more damage to the country than good by creating inequity and income gap, thus ruining the achievement the free health facility has brought so far.

Considering the situation of Bhutan where 69% of population lives in the rural areas (National Statistical Bureau 2005) depending on subsistence farming, it would be impractical to privatise the medical facilities. Moreover, 23% of our population lives under poverty line of Nu 1,100 per person per month (Nationals Statistical Bureau 2007).  Firstly, it would create a gap between the poor and the rich. For example, while people who can afford to buy sophisticated treatment can live better even when they are struck by serious sickness, people in rural areas may die from even curable diseases such as diarrhoea (Wangchuk 2007). One can observe this trend already. It is not unknown for people with high income to go for treatment to Bangkok or India at their own expense even when the treatment for that particular disease is offered for free in the country. Since they can afford it, they find it worthwhile to explore the better medical facilities that these countries offer. Analysing this scenario, I do not see the need to privatise the health care facilities in Bhutan with the aim to make their services more efficient or prompt because people who will want to access these private health facilities are already doing it. While, privatising it may mean keeping the economy inside the country, it will definitely create a bigger gap between the rich and poor. Furthermore, the doctors and specialists will then want to work in the private hospitals and clinics which offer better pay compared to the government hospitals. Consequently, the standard of the health care services in the government hospitals will go down and the problem of shortage of doctors and specialists will aggravate. This will then force even the people with low income to go to the private hospitals, which they will not be able to afford. Eventually, they will end up not getting the required treatment because it is not available in the government hospitals where it is free, and they cannot afford in the private hospitals where it is available.

For example, if the health care services in Bhutan were not free, I would have lost my mother who was diagnosed brain tumour and had to be referred to a hospital in India in 2008. It was because of this benevolent scheme of health facility in our country that she could be attended by the well experienced neurosurgeon that was beyond our affordability. One can imagine how many similar situations there would be in a country like ours where people struggle to meet ends meet every day. And one can well foresee what will happen to these people if their right to health is taken off by privatising it.

However, Dorji (2008) argues that the free health care services make people develop dependency and devaluation of services and the service providers develop a complacency hindering the provision of effective health care services. But research (for example Feynberg 2009) shows that privatisation is not the solution because as seen in the US, private health care does not ensure successful delivery of efficient and quality healthcare services.

So, it shows that currently many people in the country are not yet ready for privatisation of health care services. While the opening of the new clinic by Dasho Gado Tshering, former Health Ministry (Bhutan Broadcasting Service 2012), indicates that it cannot be prevented in the future, it is not yet time. Privatising it now will create a duel health system where the rich and poor are demarcated (Solution Exchange 2007). More importantly, Bhutan should first study and analyse the situation in the country, without jumping into plan by adopting methods in other countries and it should place specific regulatory measures and legal frameworks before taking such step.

References:

Bhutan Broadcasting Service 2012, ‘Bhutan’s first private clinic opens’, Bhutan Broadcasting Service, 30 June, viewed 1 November 2012< http://www.bbs.bt/news/?p=14726>.

Dorji, C 2008 ‘Bhutanese Health Care Reform:A Paradigm Shift in Health Care to Increase Gross National Happiness’, Proceedings of the Fourth International Conference on Gross National Happiness, The Centre for Bhutan Studies, Thimphu, pp. 413-436.

Kuensel 2012, ‘How 96 percent was arrived at’ Kuensel, 28 April, viewed 1 November 2012 < http://www.kuenselonline.com/2011/?p=30488> .

National Statistical Bureau 2007, Bhutan living standard survey 2007, National Statistical Bureau, Thimphu, Bhutan, viewed 1 November 2012< http://www.nsb.gov.bt/pub/surveys/blss/blss2007.pdf>

National Statistical Bureau 2005, Results of population and housing census 2005, National Statistical Bureau, Thimphu, Bhutan, viewed 1 November 2012< http://www.nsb.gov.bt/pub/phcb/PHCB2005.pdf>

Solution Exchange Bhutan, 2007, Is Privatization the Answer to Quality Healthcare?  14 December, viewed 1 November 2012< http://www.solutionexchange-un.net.bt/(A(loykpedQzAEkAAAANGIzNDViY2EtODY4My00Mzk0LWIyYWUtZTliMDFlZGY5OTZm43B1xu75nuwlxNK2epkdbl6sCCU1))/ConsolidatedReports/cr-se-bhutan-05110701-1.pdf>

Wangchuk, S 2007 ‘Should health care in Bhutan be privatised?’ Kuensel, 20 September, viewed 1 November 2012< http://www.kuenselonline.com/2011/?p=739>.

World Health Organisation 2010, Country cooperation strategy at a glance, World Health Organisation, India, viewed 1 November 2012<http://www.who.int/countryfocus/cooperation_strategy/ccsbhutan.pdf>

I'm Home

When I had to take a very difficult subject in the final semester, I panicked that it might detain my return. When I chose my course, I wanted the duration to be 18 months because I thought two years was too long, and one year was too short. I didn’t want to be away from home too long. I am glad things did go as planned – at least this once. And now, I am home.

I missed my mother. I missed my country. But until the plane descended and I saw Paro Valley, I didn’t realize the intensity of how much I have missed home. I craned my neck and watched out the window, wanting to carve each small detail of the landscape in my mind:  clumps of clouds strewn overhead, the small isolated houses on the hill tops and down in the valley looked heavenly. I thought even the long zig zag footpaths that go to these houses have happy stories to tell.

A chill winter wind welcomed us home as we got out the plane. But I thought, ‘it isn’t as cold as I thought it would be.’ My brother and driver from my office welcomed us. My mother waited in the car. I went straight to her – she sat near the window, her eyes already wet. We hugged and I cried too. I felt an enormous gratitude (to the almighty) for bringing me and my family back home safe.

I am home. Yes, I am home. It is where I belong. No matter where I go, I will come back here. It is where my heart is. 

A Mother Needs a Big HEART

There are so many joys in being a mother. The moment I held my baby in my hands, I felt that I was blessed. The enormous feeling of love that you feel in your heart as you hold the tiny, gentle hands in yours, the swell of love that engulfs you as you watch your little one sleeping peacefully next to you – and that special bond that you feel as you breastfeed her – there is no other gift in life that makes you feel that way. The excitement of all gifts big or small dies down overtime. But in being a mother? The moment of joy stays with you forever. Despite the occasional feelings that she is going to drive you mad because you can’t keep up with the energy and curiosity of a child.

While a child is always looking for something, putting a finger in a hole there, or pressing a button here, she is always exploring and learning; she is making sense of the world that she is in. But because she has this excitement and zeal to see more and to know more, the mother has to have a big heart. A really big heart. Because you are a mother and a child at this age (1-2 years) cannot be controlled by reasoning, you are in a dilemma of what you should do. There are social gatherings that you cannot forego because you are a mother. Besides, you feel that the way to let a child grow up is not by closing the rest of the world out. The way to let the child see the world is to live as naturally as possible – letting the things around us run as they usually do; and letting ourselves go around life as usual. Except, at times it gets really, really difficult.

There were many times when I felt torn that I had not taken her into account when I made a decision to take part in something. When you are at someone’s house as a guest, you are ill at ease – having to follow your child and keeping an eye to make sure that she is not breaking something, or spilling something on the carpet. But despite all this I-wish-I-were-not-part-of-this-gathering feeling, we have to be a part of it. I can’t explain why I must torture myself and my baby that way – but I have always taken part as I would if I were not a mother. And the expense of it all is that, after a while she gets tired and agitated. Her sleep time gets disturbed. And then, I blame myself for not being a good mother.

For example, today we were at the Victoria Market in Melboune (it is an open market like the one we have in Bhutan). While my husband and other friends shopped, we played at the nearby park. I decided to do that because I thought I had to consider her first. When I knew she had had enough time at the park and was getting sleepy, we joined the others. But she got sleepy and yet she could not sleep. She got so agitated. She did not want to stay on the stroller. She was pushing herself out from the straps with so much strength that she was almost out of them. So I took her out thinking that we were almost done at the market and she deserved to be out too. But the moment she was out, she ran around the shop, touching things here and there. And then, she slipped and hit her forehead so hard on the concrete floor and got a very bad big swelling on her left forehead. People around were shocked and aghast. I felt so bad. On top of that feeling, I was blamed. My husband’s hysterical remark was that, I simply don’t know how to look after a child.

This is how it is. Despite all your effort to be a good mother, despite all the love that you feel, you fail somehow. There is always something that you don’t get right. For me, I can only soothe myself by crying with her and blaming myself. Then I make a decision that I will lock ourselves in and not join the others. This time, I am almost sure that I will not go shopping or attend a social gathering out of an obligation to not hurt the sentiments of others. There are already three appointments of such obligations and I am wondering how best to take back my words. It is so difficult to live when you are a person who has to keep the word that you have given. I have put myself on torture many a times because of this principle that I must stick to. This time, for my daughter, I may break it. For me, it is she that matters the most. I must have a big heart. 

It is Here and I Must Thank You

I don’t remember when was the last time I felt so euphoric and relieved to have achieved something. I probably did when I finished my engineering degree, but I don’t remember it now. This time, when I finished my masters in IT, I had a sense of relief run over me as if it was what I always wanted and I now had it in my grips for the rest of my life. I think the sense of achievement and relief is more today because I am a wife and a mother and the commitment and discipline required to shoulder the responsibility as a student more than tripled – and I am proud today for having made it without any major obstacle.

While I felt it like a big challenge in the beginning, I was happy that I could now sort out my time and priority and was surer about how much time I should dedicate to each of the obligations. My family received my first priority and I am glad that is how it was. They dedicatedly stood beside me and this is what they deserve. In fact, they deserve much more. And it is in fact sad that I can only thank them. But what better way than to genuinely feel the gratitude, right?

So as I stand here today, having achieved one important milestone in my life, I thank my husband and daughter from the bottom of my heart. Without them, it would have been impossible to even dream. I was sorry that he had to go through the troubles of looking after our five month old daughter who could be soothed only by breastfeeding for 8 hours at a time sometimes. But he has in his nature to do the things he does in the best way. And even when it came to parenting, he did it in the finest way. As I look back to 18 months before, I see them going for walks almost every day, our little daughter sometimes falling asleep in the pram, he singing lullaby and rhythmically soothing the gentle ears.

As a top undergraduate engineering student delivered the valedictory speech at the graduation ceremony and thanked his parents and friends, tears welled up in my eyes – my daughter and husband, the two most beautiful people in my life stood in my mind and I recollected all the days of sacrifices they had to make to suit my class schedules and assignment due dates. Without this flexibility and compromise, I would not be standing here today.

I think in life, what you achieve and how far you walk depend on your partner and his support. I am glad I have one who knows my heart and my ability, and believes in me. (Thank you Honey. You complete me.) Likewise, I promise that I will stand by you and our daughter throughout my life.