Mongar Regional Referral Hospital

The Mongar Regional Referral Hospital (MRRH), also known as the Eastern Regional Referral Hospital (ERRH), is the principal tertiary-care institution for eastern Bhutan. It is located on the eastern edge of Mongar town in Mongar dzongkhag, at an elevation of about 1,600 metres above the Kurichhu valley. The hospital functions simultaneously as a regional referral hospital for the eastern region, as the district hospital for Mongar dzongkhag, and as the technical backup centre for district and basic-health-unit facilities across eastern Bhutan.^[1]

The current 150-bed facility was constructed with financial assistance from the Government of India at a reported cost of about Nu 537 million, including medical equipment, and was commissioned to replace the earlier district hospital. It serves a catchment population drawn from the six eastern dzongkhags — Mongar, Lhuentse, Trashigang, Trashi Yangtse, Pema Gatshel and Samdrup Jongkhar — and from Bumthang in central Bhutan.^[1]

Within Bhutan's three-tier public-health architecture, MRRH sits between the network of basic health units and district hospitals on the one hand, and the Jigme Dorji Wangchuck National Referral Hospital in Thimphu on the other. Cases beyond the regional hospital's specialist capacity — primarily complex oncology, cardiac and neurosurgical work — are referred onward to JDWNRH or, with government sponsorship, to hospitals in India.

Origins and upgrade to regional referral status

Mongar acquired a small district hospital in the 1960s as part of the early build-out of public health services under the First and Second Five Year Plans. The facility was progressively expanded through the 1980s and 1990s, and the Royal Government designated it as Bhutan's first regional referral hospital outside Thimphu in the late 1990s in response to the long travel distance between eastern dzongkhags and the capital.

A new 150-bed facility was developed during the 2010s with Government of India financial assistance and inaugurated to replace the older buildings. The redevelopment added intensive-care capacity, four operation theatres, an upgraded laboratory, a centralised oxygen supply, modern radiology including ultrasound and digital X-ray, and lifts that allowed the facility to operate over multiple floors. As of recent reporting, the hospital does not provide MRI or CT scanning services, with patients requiring those investigations being referred to JDWNRH.^[1]

Clinical services

The hospital provides services across the standard tertiary specialities. Clinical departments include internal medicine, paediatrics, obstetrics and gynaecology, general surgery, orthopaedic surgery, ophthalmology, ear-nose-and-throat, dermatology, psychiatry, dentistry, anaesthesiology, emergency medicine and pathology. A separate Bhutanese Traditional Medicine unit provides Sowa Rigpa services alongside biomedical care, in line with national policy of integrating traditional medicine into public-health delivery.^[1]

Support services include a central laboratory, blood bank, pharmacy and physiotherapy unit. The hospital is the regional centre for medical oxygen distribution to district hospitals in the east and operates an emergency-response network linking it to district hospitals in the six surrounding dzongkhags.

Role within national health system

Bhutan's public-health policy has historically emphasised universal free access to basic services, with referral upward through district hospitals to regional referral hospitals and finally to JDWNRH. Mongar's role in this system is to absorb cases that exceed district-hospital capability across eastern Bhutan, reducing the volume of long referrals to Thimphu. The Royal Centre for Disease Control and the Ministry of Health use MRRH as a sentinel site for surveillance of communicable disease, maternal and child health and non-communicable disease in the eastern region.

Specialist staffing has been a recurring challenge. As with other regional referral hospitals in Bhutan, MRRH depends in part on visiting specialists from JDWNRH and from teaching hospitals in India. The Khesar Gyalpo University of Medical Sciences of Bhutan, established in 2013, has begun to graduate Bhutanese physicians who are progressively replacing expatriate staff.^[2]

Practical information

• Address: Mongar Regional Referral Hospital, Mongar town, Mongar dzongkhag
• Website: www.mrrh.gov.bt (also errh.gov.bt)
• Catchment: six eastern dzongkhags and Bumthang
• Beds: 150
• Operating theatres: four
• Imaging: ultrasound, digital X-ray (MRI and CT not available on site)

References

1. About Us — Mongar Regional Referral Hospital
2. About Hospital — Eastern Regional Referral Hospital
3. Clinical Departments — Eastern Regional Referral Hospital
4. Ministry of Health, Royal Government of Bhutan
5. Khesar Gyalpo University of Medical Sciences of Bhutan