Lam Neten of Chukha Rabdey, along with 30 monks, are conducting a three-day kurim to prevent famine and the outbreak of diseases like dengue in the country.
Healthcare-associated infection (HCAI) is the most frequent adverse event in health care.
Programme analyst with the Department of Medical Services’ health care and diagnostic division, Pem Zam, said endemic burden and epidemics of HAI were major public health problems.
According to WHO, HCAI, also known as nosocomial or hospital-acquired infections (HAI) is an infection occurring in a patient during the process of care in health facilities, which are not present or incubating at the time of admission but occurs after 48 hours of admission.
In case of surgical site infections, it includes infections up to 30 days after surgery and up to 90 days if there is implant or prosthesis.
Presenting the findings of a study on HAI at the fifth biennial health conference in Tsirang, which ended yesterday, Pem Zam said HAI had a significant economic impact at both the patient and population levels, including out-of-pocket costs to patients and costs incurred through loss of productivity due to morbidity and mortality.
WHO estimates that on an average seven percent in developed and 15 percent in low and middle-income countries suffer from at least one HAI at any given time, with attributable mortality estimated at 10 percent.
In Bhutan, according to a point prevalence survey (PPS) carried out in 15 hospitals in October last year, the overall prevalence of HAI was found to be 6.7 percent.
A total of 373 eligible patients from 15 hospitals were surveyed on the day of the study, of which 25 patients had HAI.
It was found that the national referral hospital in Thimphu had the highest prevalence of HAI at 8.83 percent. This, she said could be because the hospital has the highest bed strength with multispecialty facilities.
In terms of types of HAIs, the surveillance found that surgical site infections are the highest at 32 percent, followed by clinical sepsis (24 percent) and ventilator-associated pneumonia (12 percent).
The microbiology findings in the identified HAIs found that 64 percent had no growth while Klebsiella pneumonia accounted the highest with 24 percent, acinetobacter spp at eight percent and E.Coli at 4 percent.
“These are the three organisms that were present in the culture,” she said.
The PPS provides a snapshot of only one day so she said that this might not reflect the overall HAI in the country. The other limitation of the surveillance is that there was no capacity for routine HAI surveillance.
Poor planning and budgeting for infection control and medical waste management activities at the dzongkhag health facility level, lack of dedicated infection control focal persons, lack of microbiology services, mismanagement of trained infection control focal especially when they are transferred are the challenges faced in infection control.
In 2009, a prevalence survey in JDWNRH was conducted. Prior to this, Pem Zam said that there was no report or baseline on HAI in the country.
Similar to the recent PPS, this study also found that surgical site infection was the most common infection at 54 percent of all HAI cases.
It was also found that there was a lack of established guidelines and protocols for instituting such surveillance system in the hospitals.
In 2012, the infection control and waste management programme with the ministry has developed routine surveillance, ‘the standard protocol on HAI surveillance in hospitals’.
In line with this, monitoring of HAIs was initiated on pilot in the three referral hospitals and Phuentsholing hospital for two years.
HAI rate for 2013 and 2014 from routine HAI surveillance was found to be 0.25 percent and 1.3 percent respectively.
Pem Zam said that the low HAI rate means it is likely underestimated due to under reporting. It could also be because of lack of dedicated infection control focal points. “The focal persons that we have in the hospitals and BHUs’ primary responsibility is patient care and being an infection control focal person is their secondary responsibility.”
The report of the pilot project was presented to the ministry that instructed the programme to go ahead with PPS on HAI. Since the PPS was carried out in 2014, the surveillance was rolled out to 15 hospitals so far.
Surgical site infection, Urinary Tract Infection (UTI), pneumonia (healthcare-associated pneumonia and Ventilator-associated pneumonia) and bloodstream infection including clinical sepsis are the most common HAI in the country.
Hand hygiene, standards precaution, decontamination environment cleaning, infection control in health workers and medical waste management are the components of infection control in place at the health facilities.
According to WHO, many infection prevention and control measures, including hand hygiene, are simple, low-cost and effective. However, they require staff accountability and behavioural change.
Awareness and training of health professionals on HAI, ensuring adoption of the national infection control and medical waste management guidelines, increasing frequency of HAI point prevalence surveillance two to three times in a year, and rolling out PPS to other hospitals and BHU and establishing facility-based routine reporting and surveillance of HAI for accurate monitoring are some of the future plans to control HAI.
Dechen Tshomo | Tsirang
The Royal Monetary Authority (RMA) has issued additional policy directives on the Priority Sector Lending (PSL) based on the experience of the past one year in implementing the PSL.
According to the additional policy directives, PSL proposals on automobile workshops will be determined by the dzongkhag.
This directive was issued considering that the local government is the most appropriate agency to determine if an automobile workshop is needed in the locality.
The RMA issued the additional directives with the PSL report for the second quarter of 2019 last week. They are expected to improve the PSL system.
The additional policy directives states that the financial institutions must assess the proposals approved by the dzongkhag within a turn around time of 30 working days after the receipt of the proposal.
The RNR sector has been entrusted to recommend proposals that are not in the priority list to the Ministry of Agriculture and Forests. The ministry will then assess the proposal in consultation with respective dzongkhags.
The directives state that the project assets will qualify as equity. But the proponent must produce 30 percent equity for purchase of machineries and other assets for the projects and the loan will be directly disbursed to the vendor of the asset by the bank.
The Royal Insurance Corporation of Bhutan and Bhutan Insurance Corporation Limited are not required to lend under the PSL as they are providing affordable insurance schemes, especially crop insurance. However, the two insurance companies will be required to review the pricing of their insurance products often.
According to the second quarter report issued last week, the majority (79 percent) of the PSL projects to be approved continue to be based on agriculture. The projects are clustered around similar ideas while proponents were all individuals with only a handful of groups.
A total of 1,486 PSL applications were received as of the second quarter of 2019, of which 1,197 projects were approved.
Thimphu received 268 project applications, which was the highest among dzongkhags. The financial institutions collectively assessed 1,002 projects as of second quarter 2019 and approved 450 projects.
More than half the projects that were rejected were on account of poor credit history of the clients. The financial institutions collectively sanctioned Nu 413.62 million (M).
A total of Nu 289.63M were disbursed as of the second quarter of 2019.
The PSL initiative was launched on December 13, 2017 for implementation with effect from January 1, 2018.
A five-year-old child was allegedly raped on September 18 in Dagana.
The incident took place around noon when the girl’s mother was on duty. She works as a cleaner in one of the schools. The girl was at home with her stepfather.
According to the mother, the suspect is a friend of the stepfather.
She said the stepfather was in the kitchen preparing lunch when the incident happened.
She said her husband told her that when he returned from the kitchen, the girl and the suspect were not there.
“It was learnt that the suspect has lured my daughter to go with him to buy noodles.”
The mother said when she came home for lunch around 2:30pm, she found her daughter crying. “She had scratch marks all over her face. When I asked about it, she said she fell down.”
She also found her daughter bleeding. “It seemed like my daughter was warned not to tell anyone, as she kept lying and crying.”
The principal of the school reported the matter to the police.
The child was admitted in Dagapela hospital for a night and sent home yesterday afternoon.
According to the mother, the suspect kept visiting her home and she never suspected him to do something like this.
The police arrested the suspect at 7:30pm yesterday.
Rinchen Zangmo | Dagana
A class II student of Drugyel Lower Secondary School in Paro was raped and murdered on her way from school in the evening of September 19.
Sources in Paro said the girl was dropped off at Satsam Choeten by a friend’s mother around 3pm. Her mother stays a few kms above the main road.
Her body was found later that night in a bush. She was strangulated and there were evidences of rape.
While police were not available for comments, sources said the senior superintendent of police (Crime) and other officials are investigating the case.
It was learnt that there was no suspect identified in the case as of yesterday evening.
The Supreme Court (SC) has reportedly accepted the Anti-Corruption Commission’s appeal against JPLP tax evasion judgment rendered by the larger bench of the High Court.
Sources from the SC said that the appeal case is yet to be assigned to one of the benches for hearings.
ACC appealed to the SC earlier this month after the state prosecutor, Office of the Attorney General (OAG), decided not to appeal against the ruling of the larger bench, which overturned the judgment of High Court’s bench III.
After reviewing the judgment passed on August 15, ACC informed the state prosecutor on the need to appeal before the SC. The last date for appeal was on August 29.
“Upon follow-up by the ACC, it was informed albeit verbally that the Attorney General is not appealing the case although screening corpuses had unanimously consented to appeal,” the commission stated in the appeal letter to the Chief Justice. “The ACC strongly believes that the ruling of the larger bench and OAG not appealing the case will set grave and erroneous precedence.”
ACC’s appeal letter stated that there is a huge stake both to the state and the taxation regime of the country if the matter is to be closed with the judgment of the larger bench, High Court (HC). ACC officials said that the judgment rendered by the trial court and the larger bench was almost same.
The commission requested the SC to permit ACC to appeal the case on behalf of the State. “Since OAG is yet to intimate ACC in writing the ground for not appealing to the SC, the commission is not in a position to submit the details for now.”
The commission, however, assures that the submission for appeal will be made within two weeks.
The larger bench presided over by three justices upheld the Phuentsholing drungkhag court’s ruling passed in July 2017. Both courts ruled that Jatan Lal Prasad, the owner of Jatan Prasad Lal Prasad (JPLP) enterprise in Phuentsholing, is liable to pay Nu 14.487 million (M) for evading tax amounting to Nu 184M in four years from 2011 to 2014. The figure was worked out after calculating the 24 percent penal interest and 200 percent fines.
Both the larger bench and lower court considered purchase cost deductions of Nu 118.651M for the income of four years.
The bench III of HC, however, had altered the lower court’s judgment and increased JPLP’s tax liability from Nu 14.487M to Nu 126.897M by including purchase cost after the OAG appealed against the lower court ruling.
The bench III on January 30 this year ruled that the purchase/direct cost deduction is allowed only during normal course of filing the tax returns given in the Income Tax Act of Bhutan (ITA) 2001. The ruling also stated that once the tax evasion is established, deductions are disallowed under general provision of the ITA.
Aggrieved by the bench III ruling, which had erred in interpreting section 35.2 of chapter 5 of the general provisions of the ITA by considering purchase as non-deductable and sentencing JPLP to an imprisonment of five years, legal counsel appealed to the larger bench on February 4 seeking the interpretation of taxation law.
The larger bench stated that taxpayers are mandated to pay just, fair, and equitable taxes as determined by the specific tax laws, whether it is direct or indirect tax. Such taxes are levied on the basis of net profit earned from the operation of a business.
The ruling also stated that for the purpose of earning profit or income, there has to be an investment. “If there was any tax evasion like in the current case, tax evasion can be possible only after the operation of a business.”
“In case of evasion, the enforcement is to impose fines and penalties. The basic essence of Income Tax Law is that the taxable income is the net profit of a business and not the total sales amount or turn over,” the ruling stated.
The larger bench also directed Jatan Lal Prasad to pay additional fine amounting to Nu 213,500 as per ITA and Anti-Corruption Act in lieu of five years imprisonment after deducting 92 days the appellant spent under custody.
The bench III after altering the decision of the lower court had sentenced Jatan Lal Prasad to five years in prison (non-compoundable). The lower court, in addition to the fine and penalties provided under ITA, imposed an additional penalty of Nu 7.875M on appellant as fine in lieu of imprisonment.
Jatan Lal Prasad was released on bail amount of Nu 80M by OAG on September 16, 2015 after the ACC detained him for three months and two days and denied bail as he couldn’t arrange a guarantor and pay Nu 184M for tax evasion.
The Election Commission of Bhutan (ECB) has called a by-election in Bumdeling gewog, Trashiyangtse for September 25, one month after the gup was convicted on August 23 for rape of a minor.
The gewog will get a new gup in less than three months after he was arrested on July 12.
However, in Zhemgang, even after one year and two months since the Goshing gup Sangay Lethro was suspended for alleged corruption, uncertainty remains over when the gewog will get its gup. The case, which took place between 2011 and 2015, is ongoing in the Panbang dungkhag court.
Sangay Lethro said that he was expecting the court’s verdict by the end of this month or early October. The gewog will further remain without a gup even after the dungkhag court’s verdict if the accused is found guilty and decides to appeal to higher courts.
Chang gewog in Thimphu remained without a gup for almost two years since the suspension of its former gup, Kanjur. The former gup was eventually convicted for corruption and a by-election was held in June this year.
According to local leaders and dzongkhag officials, prolonged absence of elected officials at the local level not only affects services but also leaves the gewog disadvantaged in terms of development activities.
Mangmi and officiating gup of Goshing gewog, Pema Samdrup, said that people of his gewog have been raising the issue of lack of a gup. He said his role did not suffice that of the gup and that the gewog was left in uncertainty in terms of when it will get a gup.
He said he did not receive additional benefits for the additional responsibilities. The chairperson and deputy chairperson of a DT are entitled to an additional responsibility allowance.
The suspension of the Goshing gup also left the Zhemgang Dzongkhag Tshogdu without a thrizin (chairman). In such a case, the officiating thrizin neither receives additional benefits nor the full-fledged power, but additional responsibilities.
In an earlier interview, Zhemgang’s officiating DT Thrizin and Bardo gup, Kinzang Jurmey, said that he did not enjoy the power of the Thrizin. “As an officiating Thrizin, sometimes we hesitate to take decisions.”
An LG member can also be removed for failure to attend more than two consecutive sessions of the local government (DT/GT) without the leave of absence from authorized person, according to the LG Act.
The suspended gup has missed three consecutive DT sessions.
“People have voted for me to serve them. I feel sad for not being able to do that as I am suspended,” said Sangay Lethro. He is said to be receiving 50 percent of his salary.
According to Section 35 of the election Act, election to fill a vacant post shall be held within 30 days from the date of vacancy.
However, Sangay Lethro still remains the gewog’s gup as he enjoys the right to be presumed innocence until proven guilty in accordance with the law.
An election official said that ECB would not call a by-election of a local government post until there is a vacancy.
Observers say that the courts should expedite such cases and that there should time limit fixed on how long an elected official can stay out of office.
The election Act requires a local leader to vacate his post for prolonged ill health. But lack of a provision on how long a local government member can remain on suspension can leave a gewog without a gup for an uncertain number of months or years.
A year ago, around this time, the news of 11 babies dying one after another at the neonatal intensive care unit (NICU) in Thimphu shook the nation.
The death of the new-borns was attributed to the failure to institute infection control measures, which caused a bacterial infection outbreak at the NICU of the national referral hospital in Thimphu. In plain terms, hospital-acquired infections (HAI).
This is the one case many Bhutanese can relate to. What is coming is even disturbing. Not to scare people, but HAI is becoming a new challenge in our health system.
A survey report shared at the biannual conference in Tsirang where all the top health officials gathered, found that overall prevalence of HAI at 6.7 per cent. The percentage might sound small, but it is a great cause of concerns.
It is a concern because we are not prepared to deal with it. It is a concern because the national referral hospital has the highest prevalence rate. Hospital-acquired infections like Klebsiella pneumonia accounted for the highest with 24 per cent.
While the survey can be brushed aside for not reflecting the overall HAI in the country, there are enough reasons to worry. Although HAI can be controlled, we do not have the planning or the resources to do so.
This indicates our priorities. Health officials are aware that more resources and attention in preventive efforts could reduce the burden on the treatment part. But our focus is not there.
Studies conducted by health officials have found that poor planning and budgeting for infection control and medical waste management activities, lack of dedicated infection control focal persons and microbiology services, mismanagement of trained infection control focal are the challenges faced in infection control.
A decade ago, a prevalence survey found that surgical site infection was the most common infection at 54 per cent of all HAI cases. This indicates that we are losing our focus.
What are we doing?
HAI is the new global trend. It is a new health problem. Infection control, health officials point out, is secondary. The focus is on patient care. The irony is that those they care are at risk of HAI. Research findings imply that hospitals are the key facilitator of transmission and suggest that diseases are spreading from person-to-person primarily within hospitals.
To a layman, visiting a hospital means treatment and care for the sick or the injured. The last thing they expect is losing loved ones from HAI. It is already happening.
A new challenge in the health field is the so-called superbug, a strain of drug-resistant bacteria. Superbug would be a bigger challenge for those without resources or knowledge to deal with them.
The best way to deal with drug-resistant infections is to avoid getting them in the first place. Good hospital hygiene, which includes early identification and isolation of patients carrying these bacteria, could not only delay the spread of these pathogens, but also successfully control them.
Simple measure like hand hygiene and behavioural change are effective. In our case, one effective way is controlling the crowd at the hospitals. We could start with the simple doable things like good hygiene and avoiding spurious equipment.
Mountain ecosystems are the source of water, energy, agriculture and other goods and services for over half of the world’s population, but the Himalayan region is the most vulnerable to the impacts of climate change.
Officials from Afganistan, Bhutan and Nepal who managed the integrated water resource management in the mountainous river basins under the Asian Development Bank (ADB) came together to share best practices and challenges in Thimphu on September 18.
To read more, please subscribe by registering at www.ekuensel.com
With poor internet services, service delivery is affected in all the all the five gewogs in Trongsa, according to gups.
This was reported during the sixth Dzongkhag Tshogdu (DT), which was held recently.
To read more, please subscribe by registering at www.ekuensel.com
Dorji Tshewang, 38, was herding yaks in the mountains of Sephu, Wangduephodrang, when his son, a class XI student, told him that there would be a running competition in the mountains.
His son was home on summer break.
To read more, please subscribe by registering at www.ekuensel.com
The number of dengue fever cases that declined at the beginning of this week in Phuentsholing has started to increase again.
Phuentsholing general hospital recorded 54 positive cases yesterday. On September 18, 80 dengue positive cases were recorded from the 128 samples collected. Only seven cases reported on September 15, while 17 cases were reported on September 14.
To read more, please subscribe by registering at www.ekuensel.com