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Bhutan, officially the Kingdom of Bhutan is a small landlocked country in South Asia, located at the eastern end of the Himalayas and bordered to the south, east and west by the Republic of India and to the north by the People's Republic of China. Bhutan is separated from the nearby country of Nepal to the west by the Indian state of Sikkim, and from Bangladesh to the south by West Bengal. Bhutan existed as a patchwork of minor warring fiefdoms until the early 17th century, when the area was unified by the Tibetan lama and military leader Shabdrung Ngawang Namgyal, who fled religious persecution in Tibet and cultivated a separate Bhutanese identity. In the early 20th century, Bhutan came under the influence of the British Empire, followed by Indian influence upon Indian independence. In 2006, Business Week magazine rated Bhutan the happiest country in Asia and the eighth-happiest in the world based on a global survey. Bhutan's landscape ranges from subtropical plains in the south to the Sub-alpine Himalayan heights in the north, with some peaks exceeding 7,000 metres (23,400 ft). The state religion is Vajrayana Buddhism, and the population of 691,141 is predominantly Buddhist, with Hinduism the second-largest religion. The capital and largest city is Thimphu. After centuries of absolute monarchy, Bhutan held its first democratic elections in March 2008. Bhutan is a member of the United Nations and the South Asian Association for Regional Cooperation (SAARC); it hosted the sixteenth SAARC summit in April 2010. The total area of the country is currently 38,816 square kilometres (14,987 sq mi). Laparoscopic Surgery is developing very fast in Bhutan.