The National Referral Hospital (full name Jigme Dorji Wangchuck National Referral Hospital) is the main hospital of Bhutan, located in the capital of Bhutan, Thimphu. Since it was established in 1972, the hospital has been supplying free basic medical treatment as well as advanced surgeries and emergency services to citizens from all over the country. It provides the most sophisticated health evaluation and management services in the country. Recently the hospital has added CT and MRI diagnosis equipment and improved lab services. The hospital has a library with many current textbooks. The hospital is one of five medical service centers within Thimphu. There are two more hospitals, one is the Military Hospital, Lungtenphu managed by the Royal Bhutan Army and the other one is Indo-Bhutan Friendship hospital in the main town of Thimphu, managed by the Indian Military Training Team (IMTRAT). There is a Basic Health Unit (BHU) at Dechencholing and an Outreach Clinic in Motithang and Hejo Health issues In 1991 the most prevalent diseases in Bhutan in order of seriousness were respiratory tract infections, diarrhoea/dysentery, skin infections, worm infections, malaria, conjunctivitis, peptic ulcer syndrome, otitis media, tooth and gum diseases, urinary tract infections and nephritis, childhood diseases, sexually-transmitted diseases, diseases of the female genital tract and complications in pregnancy and childbirth puerperium. The Obstetrics and Gynaecology Department handles about 3,000 deliveries annually. However, with growing demand, the existing worn-out equipment is insufficient in quantity and quality. Difficulties of proper monitoring and timely intervention has led to avoidable caesarean operations and stillbirths on rare occasions. Recently, assisted by the government of Japan, the department has been able to obtain new equipment including vacuum sets for delivery, phototherapy machines, infant warmers, foetal dopplers, CTG machines and ultrasound. Alcohol-related liver disease has been a major cause of death in Bhutan during recent years. Health ministry statistics showed that 98 of 1,471 patients in Thimpu Referral Hospital died of this cause in 2007. The hospital admitted around the same number of patients in 2008, but better medication helped lower the death rate. Between four and ten cases relating to domestic violence affecting women from all walks of life are reported to the hospital every day. Jealousy, intoxication, and financial problems seem to be the main causes. In October 2008, the hospital detected the first case of dengue fever of resident of the capital in a 63-year-old woman. The woman was admitted to