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Bhutan’s unique quarantine tradition

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In the summer of 1949, there was an epidemic outbreak in Bumthang. The un- diagnosed disease killed 30 people and almost wiped out Shingyer village. With no access to western medical help, the second King quarantined the whole village for more than eight months. However, he kept open the lines of communication and food supply.

According to Lopen Zijid Drakpa, every time there was an epidemic, the King used to issue kasho for isolation.

Shingyer is one of the 10 villages in Ura gewog. “As the epidemic in Shingyer spread throughout the village, the area was isolated by restricting contact with its inhabitants.” Dasho Karma Ura wrote concerning the epidemic in his novel, The Hero with a Thousand Eyes which is based on the life of Dasho Shingkhar Lam who shares the story of Yulsung or the quarantine of a village.

According to the historical novel, there were only two access routes to the village, the Karma Koray and Shaythangla passes, both of which were closed. No one got in or out except the King’s messenger, who every day walked to the outskirts of the village. At a fixed place he would meet the village messenger. The two worked out a safe distance from one other, at which each could speak to and be heard by the other but they were sufficiently far apart to prevent any infection.

After receiving the daily report on health status and food supply in the village, the messenger would take the news back to the King.  Based on the report, His Majesty would replenish the monthly food supply. Every month, the King’s men would deliver rations, leaving them 100 metres away from the village. The rations were usually placed below a bough of an old tree. The villagers would then collect the rations.

In the past, when a person was infected by rim ney or an infectious disease, they would be moved out of the village to the nearby forest. To protect one’s village or Yulsung, the villagers would build a house for the patient and the caregiver in the forest.

The caregiver, often a family member, would live next to the patient but maintain safe distance. He or she would manage the rations and cook daily meals leaving them at a safe distance for the patient to pick up.

When the patient died, it was common practise for the men from the village to bury the body in the forest. Usually after a year, once the body had decomposed, the remains are removed and a proper cremation would take place.

Shingyer in Ura is a farming village. As in most highland settlements, the staple food of the village was buckwheat.  After eight months, the King sent the hero of the novel to organize the harvesting of buckwheat. In Dasho Karma Ura’s book, Dasho Shingkar Lam states, “I mobilized a man from each house in Ura and descended to the outskirts of Shingyer.”

After the harvest, “I yelled to ask each household to leave a number of bags to pack their harvest.” The epidemic had disturbed the cultivation routine. Half the fields were empty and weeds had engulfed the remainder, dwarfing the crop. After threshing the buckwheat, the Uraps filled the bags and left them out in the fields for the owners to collect.

From the novel, it can be said that around that time there was an outbreak of smallpox in Trongsa. His Majesty strictly prohibited movement of the people. There was an incident where a Trongsap jumped the quarantine. He was immediately arrested and made an example of.

When the 1949 epidemic broke out in Bumthang, Bhutan did not have any hospitals. There were only two doctors, two veterinary assistants and two compounders.  Bumthang and Haa were the only dzongkhags to have dispensaries, but both were understaffed and had limited medical supplies. It is not clear what role our medics played during the epidemic outbreak.

The first western qualified doctor, Dr Phangchung, graduated in 1931 but his friend and classmate, Phub Gyeltshen did not. Dr Kabo Tshering graduated in 1942. All three studied at Campbell Medical School in Calcutta. In 1928 the first two compounders, Babu Khoe and Kurtop Tobgay, graduated from Charteris Hospital in Kalimpong. The two first veterinarians, Babu Karchung and Babu Jitshi graduated in 1929 and 1930 respectively from the Bengal Veterinary College in Calcutta.

Dr Bjorn Melgaard co-author of, “Medical History of Bhutan,” believes that the 1949 undiagnosed epidemic could likely have been ma chem or smallpox, or even the plague.

Smallpox

In 1974, ma chem was eradicated from Bhutan. Five years later, in 1979 it was eradicated from the world.

Over the centuries, smallpox broke out many times, claiming the lives of many Bhutanese. For example, from 1905 to 1945, there were nine such outbreaks. Six were in southern Bhutan and the remainder in western Bhutan. The First King hired vaccinators from Jalpaiguri, India to vaccinate the people on four of these occasions (1923, 1927, 1943, 1944).

In 1964 the government created 19 posts for vaccinators. The following year, there was an outbreak of 74 cases of smallpox in Wangduephodrang. According to “The Medical History of Bhutan,” the government increased the number of vaccinators to 25 and a mass vaccination campaign was conducted in 1966.

The 1965-1966 outbreak began amongst Nepalese and Indian workers and spread to the local population. At the time, Bhutan was building the highway to eastern Bhutan and had hired these workers.

To contain the outbreak, the patients were brought to Thimphu and quarantined in a hut in Mothithang. While the exact numbers are not known, 60% of the people who were isolated died.

Fortunately, it was the last major outbreak in the country. According to “The Medical History of Bhutan”, after the 1965-66 outbreak, there were only four further outbreaks close to Bhutan.  Between 1966 and 1974 there were 89 cases, with the source traced to either West Bengal or Assam. The number of vaccinations between 1967 and 1975 was relatively small in relation to the estimated population. In 1974, smallpox broke out in Kalikhola linked to the outbreak in Assam. There were only three cases and all survived. Research has shown that the outbreaks were easily contained because of geography and sensibility. The fact that villages were far apart and separated by hills and gorges made it easier to contain any outbreaks. The second reason attributed was the sensible traditional practice of isolating the patient and his family at the onset of illness at some distance from the village.

The 1949 un-diagnosed epidemic of Shingyer believed to be smallpox killed 30 people.  Sixty percent of the people who were isolated after contracting smallpox through the 1965-1966 outbreak died. In 1949, when Bhutan had few medics, no hospitals and limited medical supplies, the second King imposed Yulsung and enforced it strictly making no exceptions. In 1965, even with improved public health system, the third King quarantined the infected and used the 25 vaccinators to conduct mass vaccinations.

Historically, in times of the outbreak of smallpox, Bhutan relied for protection on the tradition of Yulsung and trusted the Kings to help contain the disease and tide us over the deadly epidemics.

Contributed by

Tshering Tashi

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