{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T07:56:20Z","timestamp":1791186980185,"version":"4.1.0"},"reference-count":24,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Science Reports"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>\n                      In Bhutan, patients frequently choose between allopathic health professionals and Traditional Medicine (\n                      <jats:italic>Sowa Rigpa<\/jats:italic>\n                      ) practitioners based on personal faith and cultural preferences. However, beyond these formally recognized systems, uncertified local healers provide alternative cultural and spiritual healing methods that are often associated with ethical dilemmas and delayed clinical management. This study aimed to comprehensively describe the socio\u2010demographic characteristics, clinical diagnoses, and specific types of local healing treatments received by patients admitted to a remote tertiary care hospital in eastern Bhutan.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cross\u2010sectional study was conducted at the Eastern Regional Referral Hospital in Mongar from January 1 to December 31, 2021. The study included all hospitalized patients who had consulted a local healer prior to hospital admission, identified through structured admission interviews. Data were gathered via interviewer\u2010administered standardized pro forma to ensure accuracy across all demographics, particularly given educational disparities, and analyzed using SPSS software (version 23). Ethical clearance was obtained from the Research Ethical Board of Health, Ministry of Health, Bhutan.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 5,041 total admissions during the study period, 8.6% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009434) had utilized local healers prior to presentation. These individuals were predominantly young adults (38.7%), married females (63.4%), farmers (56.5%), and individuals with no formal education (58.8%). Motivations for seeking traditional care included positive past experiences, family pressure, community hearsay, firm belief in traditional healing, and skepticism toward allopathic medicine. Furthermore, 80% reported healthcare delays based on healer advice, with primary presentations spanning trauma or surgical conditions (27%), pregnancy and delivery (22.8%), and non\u2010communicable diseases (18.4%). Nearly all patients (98.4%) received treatments lasting under 7 days, and over half spent less than Nu 1,000.\n                    <\/jats:p>\n                    <jats:p>A pediatric subgroup analysis of 60 children (0\u201312 years) who received Local Healing revealed that most treatment episodes were brief (median 1 day, IQR 1\u20132) and moderately costly (median Nu 1,000, IQR 300\u20134,250), with trauma as the leading diagnosis among school\u2010age children and non\u2010specific (\u2018Other\u2019) conditions predominating in younger children. Notably, sucking of the genitalia was reported in all pediatric respondents with valid data (100%), raising child\u2010safeguarding concerns.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Approximately one in twelve admitted patients initially sought care from local healers, delaying formal medical intervention until traditional methods failed. While shaped by community trust and familial influence, this reliance underscores the need to address pre\u2010hospital delays through targeted public health messaging.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/hsr2.73106","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T09:51:57Z","timestamp":1787737917000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Utilization of Local Healing Practices Among Patients Admitted to a Remote Tertiary Care Hospital in Eastern Bhutan: A Cross\u2010Sectional Study"],"prefix":"10.1002","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4976-2239","authenticated-orcid":false,"given":"Pelden","family":"Wangchuk","sequence":"first","affiliation":[{"name":"Department of General Practice Eastern Regional Referral Hospital Mongar Bhutan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-6390-582X","authenticated-orcid":false,"given":"Phuntsho","family":"Norbu","sequence":"additional","affiliation":[{"name":"Department of Nursing Eastern Regional Referral Hospital Mongar Bhutan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7324-3028","authenticated-orcid":false,"given":"Yeshey","family":"Dorjey","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Eastern Regional Referral Hospital Mongar Bhutan"},{"name":"Department of Postgraduate Medicine Khesar Gyalpo University of Medical Sciences of Bhutan Thimphu Bhutan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-3790-7041","authenticated-orcid":false,"given":"Sonam","family":"Lhundrup","sequence":"additional","affiliation":[{"name":"National Centre for Traditional Medicine Services Ministry of Health Thimphu Bhutan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4932-8704","authenticated-orcid":false,"given":"Thinley","family":"Dorji","sequence":"additional","affiliation":[{"name":"Department of Postgraduate Medicine Khesar Gyalpo University of Medical Sciences of Bhutan Thimphu Bhutan"},{"name":"Department of Internal Medicine Central Regional Referral hospital Gelephu Bhutan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,26]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000039005"},{"key":"e_1_2_14_3_1","first-page":"1","volume-title":"Health Monitor, African Traditional Medicine Day [Internet]. WHO, editor","author":"Amazigo U.","year":"2010"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.1055\/S-0040-1709374"},{"key":"e_1_2_14_5_1","first-page":"1","volume-title":"A Review of Traditional Medicine Research in Sri Lanka: 2015\u20132019 ISBN: 978\u201092\u20109022\u2010898\u20101 [Internet]","author":"WHO","year":"2021"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.51648\/jac.3"},{"key":"e_1_2_14_7_1","unstructured":"Department of Traditional Medicine Services Ministry of Health Royal Government of Bhutan Thimphu. Report on Nationwide Mapping and Documentation of Local Healers in Bhutan 2019 Department of Traditional Medicine Services Ministry of Health Royal Government of Bhutan Thimphu [Internet]. 1st ed. 2020. Available from:www.health.gov.bt."},{"key":"e_1_2_14_8_1","volume-title":"Rural Health\u2014Investment, Research and Implications","author":"Subedi B.","year":"2023"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.3126\/JMMIHS.V6I1.30533"},{"key":"e_1_2_14_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/S44250-025-00321-8"},{"key":"e_1_2_14_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(15)00515-5"},{"key":"e_1_2_14_12_1","doi-asserted-by":"publisher","DOI":"10.12688\/WELLCOMEOPENRES.21241.2\/"},{"key":"e_1_2_14_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/S11013-020-09676-4"},{"key":"e_1_2_14_14_1","unstructured":"Medical and Health Professional Council. Medical and Health Professional Council [Internet]. 2026 [cited 2026 Jan 6]. Bhutan Qualifications and Professionals Certification Authority. Available from:https:\/\/www.bmhc.gov.bt\/."},{"key":"e_1_2_14_15_1","unstructured":"Ministry of Health. Integrated Stepwise Household Survey 2023. Thimphu; 2023 [cited 2026 Aug 2]. Available from:https:\/\/moh.gov.bt\/wp-content\/uploads\/2025\/01\/Final_National-Health-Survey-2023-1.pdf."},{"key":"e_1_2_14_16_1","unstructured":"Ministry of Health. Ministry of Health Bhutan. 2025 [cited 2025 Dec 19]. Overview \u2013 MOH The advent of Modern Health services in Bhutan. Available from:https:\/\/moh.gov.bt\/pages\/overview\/."},{"key":"e_1_2_14_17_1","unstructured":"B.Dzongkhag Administration MongarDzongkhag Administration Mongar Bhutan. 2025 [cited 2025 Dec 19]. Dzongkhag Administration Mongar \u2013 Mongar Dzongkhag. Available from:https:\/\/mongar.gov.bt\/."},{"key":"e_1_2_14_18_1","unstructured":"Eastern Regional Referral Hospital Eastern Regional Referral Hospital Annual Report 2024 ERRH 20251\u2013101. Available from:http:\/\/www.errh.gov.bt."},{"key":"e_1_2_14_19_1","doi-asserted-by":"publisher","DOI":"10.1186\/S12906-018-2129-5"},{"key":"e_1_2_14_20_1","unstructured":"World Health Organization. Global traditional medicine strategy 2025\u20132034 [Internet]. 2025 [cited 2026 Jan 6]. p. 1\u201338. Available from:https:\/\/iris.who.int\/server\/api\/core\/bitstreams\/cf37a4ad-4d27-4244-a7ee-001de39841ee\/content."},{"key":"e_1_2_14_21_1","unstructured":"View of Strengthening Bhutanese Traditional Medicine in healthcare service delivery in Bhutan | Bhutan Sorig Journal [Internet]. [cited 2025 Dec 13]. Available from:https:\/\/bsj.com.bt\/index.php\/bsj\/article\/view\/87\/55."},{"key":"e_1_2_14_22_1","unstructured":"African Medical Traditions: Healing Practices and Cultural Insights [Internet]. [cited 2025 Dec 9]. Available from:https:\/\/www.medlifemovement.org\/medlife-stories\/global-topics\/the-fascinating-traditions-of-healing-and-medicine-in-african-cultures\/."},{"key":"e_1_2_14_23_1","doi-asserted-by":"publisher","DOI":"10.4103\/0975-9476.100171"},{"key":"e_1_2_14_24_1","doi-asserted-by":"publisher","DOI":"10.1136\/BMJOPEN-2023-083004"},{"key":"e_1_2_14_25_1","doi-asserted-by":"publisher","DOI":"10.1186\/S12889-023-15113-Z"}],"container-title":["Health Science Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hsr2.73106","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/hsr2.73106","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hsr2.73106","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T07:42:50Z","timestamp":1791186170000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/hsr2.73106"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,26]]},"references-count":24,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1002\/hsr2.73106"],"URL":"https:\/\/doi.org\/10.1002\/hsr2.73106","archive":["Portico"],"relation":{},"ISSN":["2398-8835","2398-8835"],"issn-type":[{"value":"2398-8835","type":"print"},{"value":"2398-8835","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,26]]},"assertion":[{"value":"2026-03-07","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-14","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-26","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e73106"}}