Bhutan 101

I had planned to write up a very brief overview of Bhutan to save you all the trouble of burrowing around on Wikipedia and Lonely Planet, but first a word about yesterday's devastating earthquake in Nepal.  The destruction is hard to comprehend, especially in a country when infrastructure is severely lacking even in the best of times.  Recovery will be long and very difficult, and hopefully the world will jump in immediately to help.  I don't expect a direct effect on my trip to Bhutan, as I am entering via Bangkok, and the quake was only felt as a level 4 in Thimphu, 250 miles from Kathmandu.  However, many tourists arrive in Bhutan via Kathmandu so airport closures and delays may have a ripple effect on the region.

Although there are many similarities in geography and culture between Nepal and Bhutan, there are also important differences.  Population density in Bhutan is 19 people per square km; in Nepal it is 208.  Bhutan received 115,000 foreign visitors in 2013, and Nepal 800,000.  Summiting peaks (anything over about 18,000 feet) is strictly forbidden in Bhutan, and all tourists must travel with government approved guides, obviously a huge difference from free market tourism Nepal.  This was a major issue in the massive storms last year that left hundreds of trekkers stranded in Nepal, often with very little central information about where people might be.  In addition, Nepal has seen considerable political strife over the years, while Bhutan has a stable and benign government and has seen great strides in heath care in the last two decades.

Bhutan was essentially closed to outsiders before the 1970's.  It has never been conquered (not that the Tibetans didn't try), never been Christianized, and still does not allow foreign missionaries and accepts only a very few NGOs.  Only a few thousand tourists a year visited  in the early 1990's, but tourism is now seen as a major economic force and numbers have more than doubled in the last 5 years.  TV and internet arrived in 1999 and 2000; cell phone towers now dot the rural mountains and valleys far from any motorable roads, erected by hand and pony labor and powered by solar panels. 

The population of Bhutan is 754,000 in a land area 1/6 the size of Oregon.  The roads you see on the map above are literally the only ones that exist on which you can drive a wheeled vehicle and most are barely a single lane wide and suffer frequent landslides and bridge washouts; 70% of the population lives in rural areas on subsistence agriculture, often several days' walk from the nearest road.  The topography is so steep that the international airport in Paro had to get special permission to build a shorter than normal runway because there is no more available flat land!

Quick heath factoids:  ( comparable numbers for the United States are in parentheses.)
Life expectancy at birth M/F:  68/69  (76/81)
Per capita health care spending $253 ($8895)
Population > 60 years old:  7% (20%)
Maternal mortality per 100k births:  120  (28)
Deaths by age 5 per 1000 live births:  36 (7)
DPT and measles vaccination rates at age 1:  96%, 94%  (94%, 91%)
Daily tobacco smokers:  3.3% (18%)
Obesity M/F:  4.7/6.6%  (30/33%)
Hypertension and diabetes:  28%, 12%  (17%, 10%)
Leading cause of death: Heart disease, lung disease, stroke  ( heart disease, dementia, lung cancer)
Average number patients per doctor (2007):  USA 390; Haiti 4000; Bhutan 20,000; Liberia 33,000.

Want more?  http://www.who.int/gho/countries/btn.pdf?ua=1,  http://www.who.int/gho/countries/usa.pdf?ua=1, http://bigthink.com/strange-maps/185-the-patients-per-doctor-map-of-the-world