Session 1. Environmental health and sanitation
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SANITATION IN NEPAL
By Broughton Coburn
This paper will discuss many aspects of sanitation in Nepal, with special emphasis on the cultural, technological and institutional impediments to its widespread improvement. Institutional avenues for implementing appropriate sanitation technologies and their costs are explored.
Improved sanitation facilities are virtually non-existent in Nepal at present. The people are strong and, in general, sufficiently nourished, but gastro-intestinal ailments caused by pathogens spread by the poor and deteriorating sanitation are having a visibly damaging effect on the health of the population. Infectious skin disease is common, infant mortality is high and the likelihood of epidemics is real, all exacerbated by Nepal's poor sanitation. The Government of Nepal's drinking water supply program for rural areas currently has no sanitation component, but attempts have been made to combine the two in the past. Sanitation improvement demands a change in habits and lifestyle with no tangible return, and will be especially slow and difficult since the subject is embarrassing for most. Development projects such as roads or hospitals are often felt to be an addition to, if not extraneous to, the lifestyle of most, and require little sacrifice on the villager's part. Apathy fostered by a lack of recognition of the causal link between sanitation and health, in all levels of Nepalese society, are the primary stumbling blocks to the development of a self-perpetuating sanitation program.
The failure (at least 50%) and inadequacy of the improved sanitary installations that have been built in Nepal to date (primarily in the Kathmandu Valley) has been due to four major downfalls:
1. Inappropriate design and location, where the habits and desires of the local people have been given little consideration
2. Insufficient water supply
3. Erratic or non-existent maintenance
4. Lack of community participation and commitment to its construction and operation
In spite of the medieval picture of Nepal's sanitation, there are distinct possibilities for correcting each of these downfalls, and they are discussed in detail below.
The Terai and Hills
Shortly before sunrise on any morning, the bulk of the Terai and hills populace can be found squatting near creekbeds, field margins or trailsides performing an almost ritualized event: the daily elimination. The vast majority have their elimination before sunrise or shortly afterward. Few have shifted their pattern to the evening after dark, and elimination during the daytime is uncommon. The explanation for such a universal routine schedule is apparent: it is the most convenient time of day, there is more privacy, due to the darkness, and their eating habits consist of two large and identical meals consumed at the same times each day, allowing routine defecation habits to develop. Indeed, each villager's defecation patterns are interrupted only by sickness or a radical diet change. Some have confided to this author that they will go out to defecate in the morning regardless if they have the urge to. Just as a break in eating habits is considered to be a symptom of illness, a break in the daily elimination routine is likewise suspicious.
It is interesting that in some villages with distinct communal areas of defecation, the women will develop a pattern of defecating in the evening, while in the morning only the men will visit that area. Regardless of whether they defecate in the morning or the evening, in each neighborhood or village the women tent to synchronize. The opportunity for socializing, often not possible at other times, should not be overlooked as a reason for this. In some villages, the defecation areas are segregated by sex. None of these observed patterns are arranged or verbalized in any way by the villagers defecation is generally an embarrassing topic.
River banks ant creekbeds are the most popular defecation sites, because water is the cleaning agent of preference. The usual custom is to squat within ten meters of the flowing water source, walk over and then actually stand in the water while cleaning with the left hand (eating is done only with the right hand, and it is considered unpropitious to accept anything proffered by someone's left hand). It is not hard to imagine how gastro-intestinal pathogens are transmitted to the villagers downstream who depend on the same water source for drinking.
Where flowing water is not readily accessible, a villager will take a small rounded brass or aluminum pot (N. lota) or tin can holding no more than one liter, to a trail or field margin or unutilized area within the village. It is doubtful that effective cleaning of the left hand after wiping is achieved with one liter of water. The lota serves no other household purpose, except in some poorer houses where it may be rinsed and used for drinking. Soap is used only sporadically for hand washing upon return to the residence. Stones and corncobs are less frequently used for cleaning, though corncobs are the parent's agent of preference for small children. When children defecate on the verandah or activity area in front of the house, dogs (usually unowned scavengers) and chickens are called to consume the mess. Dogs consume significant, but unknown amounts of fresh feces. Sometimes they are also allowed to lick the villager's meal plates after eating and subsequent utensil washing is of questionable value. Chickens are perhaps the greater agents of disease transmission, as they frequently commute between the defecation areas and the residence, and contaminate the food of small children eating from bowls on the floor. Chickens are cooped only at night.
The Effect of Poor Sanitation on Health
Only the most sheltered short-term visitor can hope to avoid the ubiquitous gastro-intestinal pathogens. Among Nepalese, the fecal-borne pathogens most commonly responsible for illness and loss of working productivity are amoeba (Entamoeba histolytica), roundworm (Ascaris lumbricoides), giardiasis, salmonella spp. and other parasites such as hookworm and pinworm. A pathogenic variety of E. coli has been implicated in some cases of gastro-intestinal distress.
The concept of microscopic pathogens carried long distances in apparently clean water and affecting human health is not well understood by most Nepalese. Water purity is gauged by its clarity and occasionally by superstition or traditonal belief concerning its reported properties. For example, the hex that certain evil spirits have purportedly cast upon some water sources is often the explanation for clear, but contaminated water. Some citizens of a village in Syangja District in Central Nepal believe that a pregnant woman will risk having twins or triplets if she drinks from a certain nearby spring. In spite of the fact that many educated people notice flies breeding in fetid places and also 1-ending on food, they make no connection between this and gastro-intestinal distress.
Impediments to Change
Understandably, Nepalese regard feces with extreme revulsion, but this is almost ironic in light of their casual treatment of it, its prevalence on the waysides, and the religious respect and usefulness that they attribute to cattle manure. Defecating in agricultural fields, regardless of whether they are cultivated or fallow, is a transgression worthy of reprimand to the offender. Most Nepalese firmly retain the notion that it is improper and unsanitary to defecate in the same place every day. They say that this is the habit solely of the weasel, considered to be a particularly unhygienic animal. People who do build latrines and use them (foreigners and the educated, for instance) are often ridiculed and compared to this animal. But their aversion to defecate in a common place is further based on common sense and their experience with "latrines," usually naturally-occurring open, low places below a flat rock, which are occasionally used by villagers: dogs will not visit these areas, so some may feel that the dogs might go "undernourished" while the waste subsequently goes uncollected. An offensive smell issues from these pits, a problem, by comparison, of only the most heavily-visited waste areas, and fly breeding in these common pits is also more noticeable than in the "defecation areas."
The greatest single reason that villagers are averse to using pit latrines other than that of "tradition" or "habit," is that most Nepalese would like to see the nature of the produced stool, and they look specifically for worms (primarily Ascaris). This is not possible with most pit latrine designs, and is the greatest cause of ultimate abandon of latrines: villagers go out to use the latrine, and then deposit the stool on the side of the hole or on the footpad. Out of revulsion, the next visitor stands a foot or two further away, and so on until a trail of excrement leads away from the latrine.
Their reaction to the idea of reusing human waste as fertilizer is also one of revulsion, regardless of its state of decomposition. Educated villagers realize, however, that this belief is unwarranted and that people of other countries reuse their night soil.
Not surprisingly, one of the stronger impressions of Nepal that is left with trekkers and tourists is that of the atrocious sanitation and the total dearth of facilities. In Kathmandu, it is bothersome to observe where one is stepping every moment, and it is a source of inconvenience for tourists to return to their hotels by taxi to use the facilities. Trekkers have further difficulties in the mountains. The relatively dense population of rural areas allows the trekker little privacy even after he has hiked for several minutes away from a village or neighborhood. Stories of trekkers being chased out of villagers' fields are not uncommon. The litter of toilet paper localized along some popular trek routes is further displeasing to all. Of greater importance, Nepal's poor sanitation has earned it the distinction of being, health-wise, one of the most hazardous countries for tourists in the world.
The Newars of the Kathmandu Valley, the Sherpas of Solu-Khumbu, the Gurungs of Manang, some of the hill tribespeople and many of the educated populace of Nepal have little innate aversion to the use of latrines, but these groups comprise only ten percent of the population. They can be considered exceptions to the norm of the hills and Terai, and are covered separately here.
The Newars of the Kathmandu Valley
The Newars (over 250,000 population in the Kathmandu Valley) reside predominately in dense, urban-like towns and villages. The sanitation of these settlements is as medieval as the architecture and lifestyle. Raw sewage flows down open troughs in every path and alley, where it mixes with slaughter waste and solid garbage thrown from upper windows. Children to the age of four or five simply squat on the path or over the sewer trough, while adults use open areas or back alleyways, inevitably throughways for others. They figure that if they as individuals were to take responsibility for their own waste, their neighbors would befoul the environment anyway.
Besides, the Newars are divided into clans and sub-clans (similar to the Hindu caste system) with a street-sweeping and septic-tankcleaning clan of untouchables (Pode) whose inherited occupation is the removal of wastes. Some of the Pode are employed on contract by the wealthy, usually high-level government officials, to clean their septic tanks (which are seldom built correctly) or empty their septic vaults. Septic vaults are common in central Kathmandu city, and are being included more often in urban new-building construction, ant among a less wealthy sector. The Pode men who clean the vaults have been known to virtually submerge themselves in their medium, for a wage not exceeding Rs. 15/- NC (US $1.20) per day. Many of the Podes, primarily the women, are employed by the Gaou Panchayats or Nagar Panchayats (village or town councils) to clean the main streets and pathways and are paid Rs. 6/- ($0.50) per 6-hour day. Their yokes and hanging baskets (N. karpanna) into which waste is scooped with the rib bones of a water buffalo, are a common sight in Newer bazaar towns.
The street and septic wastes collected by the Pode are carried to common "town compost'' depots at the edge of town. Here they are piled into heaps growing no larger than 1m3 . They are removed once annually, again on a contract basis, to the fields of the farming clan of Newars (Jhyapu). Some aerobic fermentation does take place within these compost piles, as steam can be seen rising from them on cold winter mornings. They are not scientifically managed, however.
The Jhyapus have no aversion to using this town compost on their rice paddy and wheat and millet fields, and some farmers have the Podes apply the liquid septic vault wastes directly. They have no taboos concerning defecation on fallow agricultural land, probably because there are few other marginal lands suitable for that purpose. Also, they are not reluctant to use latrines, but the majority have not constructed them for the following reasons:
1. They can't afford to sacrifice the land necessary to build a latrine.
The Sherpas of Solu-Khumbu and the Gurungs of Manang
The Sherpas, in the Mount Sagarmatha (Everest) area particularly, have for many years constructed unscientific but effective aerobiccompost latrines. The wood floor of the latrine is built 1/2 to 2 meters off the ground, or occasionally attached as an outdoor "bathroom" to a second-story doorway. The waste drops to ground level and piles up until it is removed and spread on the fields before spring plowing. The sides of the latrine between the ground and the floor level are often contained by wooden or bamboo slats (often spaced, occasionally tight-fitting) on at least three sides. Dried leaves and pine needles are heaped in a corner of the latrine floor for cleaning after defecation, and are mixed with the latrine waste to make it a "better fertilizer." A significant proportion of the dried weight of this latrine compost fertilizer consists of leaves and needles. Fly-breeding is controlled in the darker latrines, but not completely. In spite of their recognition of the value of this waste product, not all of the Sherpas from this area use latrines. The cost for one latrine unit, were the materials and labor to be purchased, is similar to that for the pit latrine.
The Gurungs of Manang District also build, though less frequently than their ethnic relatives, the Sherpas, crude aerobic compost latrines of similar design. They have further developed stone outhouses with biscuittin roofs and hinged wooden doors, perched over the cliffs that border many of the villages. The waste is not collected from these outhouses, but disposal is effectively achieved. Labor and materials from their construction are usually donated as a part of community work projects (shramdaan), organized by the elected village leaders.
IMPROVED INSTALLATIONS AND CURRENT PROGRAMS
Unfortunately, few public sanitation facilities built with developmental aid or by local development groups have been successful. The chief cause of this is summarized by the downfalls listed in the introduction, further combined with caste prohibitions and inhibitions to change. The ultimate blame for these faults would seem to lie simply with a lack of community commitment and participation, but this is not universally to, and the attachment of blame fs often complex. Many communities have the consensus and commitment to improve their sanitation, but are poorly organized to manage the implementation of a project such as a community latrine. Who will supply the capital, who will use the latrines, who will maintain them, where will they be built, etc., are all questions that seldom come up in a traditional village context (but when they do, often end in chronic feuding) -questions that these communities must primarily address. From the experience so far gained with installed sanda tation systems, it appears that the lack of permanent accommodation for recurrent cost financing has been the biggest hindrance to their long-term success, even when it is but a fraction of the capital cost. To bypass this and other organizational problems, it is necessary to shorten the communication gap between central governing bodies (Zone and District Development Offices and village/town Panchayats) and the individual wards and citizens. "Getting lost in the shuffle" is a common fate for small decentralized projects, and it could similarly afflict rural sanitation programming.
Examples are briefly given below of some improved sanitation installations in Nepal, with suggestions of how some of their problems could have been diverted.
Ratna Park latrines:
(Kathmandu, NE and SW corners of the Tundikhel). Nepal's pilot community latrines, built and maintained by the Kathmandu Nagar Panchayat, they are cement trough-style septic tank (and drainage field?) systems. Water is sporadic and insufficient, but the units are tolerably maintained by the streets weepers, probably because of public outcry (letters in The Rising Nepal, etc.) over their tendency to deteriorate, and the pervasive smell of urine within a 20-meter radius of the units. Each complex is used by over 800 persons/day, and probably the same number urinate in the immediate vicinity regardless of the uncrowded conditions within the latrines.
Vishnumati River latrines:
(Across from Bhimsenthan, Kathmandu). These are two simple cement outhouses about 30 meters from the river, fouled and unused. They are of inadequate design and have insufficient water supply, no maintenance, etc.
Bhaktapur Central Sewage System:
(Bhaktapur District, Bagmati Zone) Part of the Bhaktapur development and temple restoration project sponsored by the Government of Germany. Over 60 public latrines of brick and cement have been built in one sector of the city, and over 100 private-home (indoor, bottomfloor) latrines have been installed for a token fee ($8.00). The improvement is remarkable: The casual impression is that an unbearable place has been transformed into an enchanting village of cleanliness seen only in Europe. The latrines are popular, but the water taps (1 for every 2-6 latrines) supply water inconsistently, since they are connected directly to the central water system, which is frequently shut off. The latrine wastes fall directly into flowing water, travel underground and empty into an oxidation pond at the end of town. No plan was made for reuse of the treated waste.
Women's Community Latrine Bio-gas System:
(Tyeagal Tote, Ward #7, Patan, Lalitpur Nagar Panchayat) Funded through U.S.A.I.D. and Peace Corps and the Division of Soil Science and Agricultural Chemistry of the Agriculture Department of the Government of Nepal. An 18-hole women's latrine complex was completed early in 1976, and now handles 4-800 women/day. It is crowded (waiting lines) from 3:30 a.m. to 7:00 a.m. Water supplied to the complex is sufficient but not plentiful. Wash water alone used in the latrines is not adequate to affect proper flow of wastes -the janitor must flush the wastes with excess water, twice per day.
This community latrine and the Bhaktapur latrine system are among the most successful community sanitation schemes in the country, but their destiny is uncertain after the foreign fuming sources are terminated. Ward #7 of Patan has established a very informal "latrine committee," but have been thwarted in all attempts to procure funding for maintenance (ca. $25/month) from the Lalitpur Nagar Panchayat. Further, the wards are not authorized to levy local taxes even for local projects.
There are no local donations of materials or labor for its construction, but the residents were directly involved in the site selection and design, and were paid to operate the system until September 1978 when the AID funding was frozen.
Lalitpur Community Latrines
Sponsored by the Lalitpur City Development Program (Lalitpur Nagar Bikeas Yojasna) 56 latrines were built at 12 locations throughout the town of Patan. Severely overdesigned by city engineers, with mistakes too numerous to mention here, virtually all of them were befouled and inoperable within two weeks of their dedication. No funding arrangement was made for their maintenance, and water supply was erratic. No local labor or materials were donated, and local residents were not consulted on their design and operation. Its current state of deterioration and filth continues to reaffirm local residents' beliefs that improved latrine systems never work.
Rasawa-Nuwakot Integrated Development Project Latrines
Headquarters: Kathmandu and Trisuli. A number of latrines were installed in rural areas as part of this World Bank-funded program. Visitors to the installations have said that they have gone unused.
(Lazzimpat, Kathmandu) UNICEF, in coordination with the National Development Service, has not built latrines as part of their health projects, but they have printed a small booklet (10,000 copies) in simple Nepali illustrating the need for improved sanitation, and the techniques for building simple pit latrines. Printing costs were approximately $0.25/booklet, and they were distributed to all the schools and health posts of the kingdom. They may have been of help to teachers who were concerned about school sanitation, but did not know how to build a latrine.
The simple improved village pit latrine, dug occasionally by villages who have had some education, is perhaps the most inspiring example of an appropriate technology that has developed entirely through local self-motivation. Additionally, these innovators have had a great impact on their neighbors in the village. There are some Brahmin Chhetri villages in the Pokhara area, for instance, where a significant proportion of the homes have pit latrines. Among the Gurungs and Magars in the outlying areas of West Nepal, pit latrines are sometimes dug by returning British and Indian Gurkha Armed Forces pensioners. They are by and large simple pits no more than two meters in depth, covered with open-framework bamboo or wood planking, and surrounded above with cut brush or bamboo screening. There is usually no expense invested in their construction since all materials are available locally on the homestead. The wastes are not reused. The only significant technical fault with their design is the open framework squatting platform which does not entirely preclude flybreeding. The reason for this is the owner's logical anticipation that if the latrine platform were to be plastered over except for a central hole, someone would eventually befoul it. With this design, if the pit is dug deeply enough, however, fly-breeding should be reduced. The replication of similar pit latrines throughout rural Nepal, initiated by local development and educational bodies/projects in conjunction with innovative local citizens will have the greatest chance (regardless of the proposed investment) of improving the country's hygiene and health.
SANITATION TECHNOLOGIES FOR NEPAL
Prerequisites for Successful Latrine Operation
The need for water:
With pit latrines, it is not necessary to supply water to each latrine, but it is more important that water be available closer to the house than the nearest natural flowing source. Same men use water carried from the river or spring to perform their daily ablutions (since it is carried almost exclusively by women), while many find it easier to go to the river themselves. A water tap can short-circuit this pattern. It is a direct incentive for villagers to use a latrine in the vicinity of the tap or their home. In some areas stones or other material are used for cleaning in preference to water, and in these areas latrines may see more use, since supposedly the patron would not be dependent on a nearby source of water.
All of the water-seal latrine systems such as aqua privies, septic tanks and septic vaults require a round-the-clock water supply. When it stops, it takes but a short time for the squatpans to become clogged and the vicinity befouled. A water tank large enough to accommodate periods of reduced water flow and heavy peak-period demand is essential. Peak demand can reach 1530 times the average demand, thus the importance of designing the water system to handle it cannot be overstated.
Minimal with homestead pit latrines, and doesn't require an untouchable caste laborer. Water-seal systems need janitors who make frequent visits to:
1. Clean messes and unclog latrines before they get out of control.
The purpose of constructing and using sanitary facilities must be communicated before they will be used, and before improved sanitation can be realized. Men must be shown that if the women have intolerable sanitation, the health of the men will be affected as well. Some of the institutional channels for such education are discussed below.
Design and Location:
The primary design consideration for village pit latrines is that they can be fashioned from locally available materials that do not have high-priority alternative uses. Simple pit latrines as described above are ideal in this respect. The use of materials not available within the village, especially imported components, normally act as disincentives for the construction of latrines, even when these materials are donated. Most villagers consider it illogical to use cement, for example, in the construction of a latrine, and will actively attempt to divert this coveted and relatively scarce commodity for other uses. The degree of improvement that cement and other imported components can bring to pit latrine design should be more thoroughly investigated. Comparison should be made between pit latrines with sealed floors and those with open framework floors with regard to their cleanliness and e effectiveness in reducing fly-breeding. For many areas, the trade-off may favor the open-framework floor. The feasibility of including a simple door for latrine hole should also be tested. Community latrines face the combined problems of general disregard and abuse of communal property, and the responsibility for maintenance. Bamboo screens shielding community latrines are soon removed by villagers who think that they "belong to nobody."
Lastly, the location of village pit latrines plays an important role in their success. Some private homestead latrines have gone unused after being located at a distance from the house that people feel is inconvenient. If the completed latrines are not specifically segregated by sex, the women of the community may forego using them at all.
Materials and labor for pit latrines are estimated as follows, though these are not considered costs by the typical villager:
These have specific design features that are peculiar to Nepal. Noteworthy among these are:
The pan. These are cast in cement and finished with a smooth surface in Kathmandu and some Terai towns; the technology is adaptable wherever cement is used. The ring of the pan, 3 cm. below the footpads, is usually flat; this can be special-ordered (at no extra charge) to slope inward so that the bowl of many of these pans is also virtually flat, and night soil can easily collect there if large quantities of water are not used for cleaning and flushing. The advantage of this flat "shelf" should not be overlooked, however: it allows the latrine patron to view his stool. The technical problem of possibly allowing this without leading to clogging and pile-up problems is significant, and worthy of further investigation. A flushing mechanism for each latrine is one answer to this. The effluent hole of many pan designs is too small (5-7 cm.) and has led to clogging.
All floor surfaces within the latrine should be plastered smooth and slope toward the pan. Red oxide can be mixed with a rich mixture of cement plaster for the floor, to provide a smooth, non-porous surface. It is important that stones not be used in water-seal systems. They cause clogging and can quickly fill the septic container. A consistent water supply will discourage this. Excess sand (brought in on the feet of patrons) can also fill the tank slowly. To help mitigate this, the entranceway to a latrine complex should be of brick or cement and kept clean. Water taps should be of the most durable self-closing type, installed with one-way screws.
The typical cost for a four-hole aqua-privy or septic vault system is estimated below:
Imported costs are unnecessary unless steel reinforcement is desired (if latrines are to be on a slab directly over the vault) and tin is substituted for tile roofing.
Gobar gas latrines:
Latrines connected to gobar gas (big-gas) plants have not proven popular in India, in spite of a 50% subsidy offer from the Khadi and Village Industries Commission. There are two gobar gas plant/community latrine systems in Nepal, each connected to four latrines. They are built in Tibetan refugee communities, and for this reason have been successful since Tibetans are not averse to the concept of a latrine. The idea of cooking one's food on any kind of human waste by-product is met by most Nepalese with disgust, but there are a growing few with working big-gas plants who are curious that it might be a wise use of resources and perhaps not so unappealing. The quality of the gas does not change with the attachment of a latrine. Only one of the 5-6 gobar gas latrines visited by this author in India was used by its owners. The cost of adding a latrine and influent pipe to a gobar gas plant under construction is about Rs. 800/- ($67.00). Retrofitting would be difficult, if possible at all.
In the women's community latrine big-gas digestor in Patan, the carbon: nitrogen ratio is too high for optimum gas production, the CO2 content is slightly too high (ca. 45%) for continuous gas combustion, and there is a difficult scum problem in the digester. Retention time is approximately 80 days in the digestor (at 18-22°C) and longer in the two "drying" pits. The scum which forms on the drying pits is occasionally removed with a rake and composted with other dried organic matter, such as leaves, and removed to the fields once a year. Some of the liquid portion of the effluent does escape to the original rivulet into which raw wastes formerly flowed, but only after an apparent BOD reduction (gauged by a noticed decrease in fly breeding and odor). It is not recommended that night soil be used as the sole substrate for big-gas digestion. Further, direct feed systems may develop scum problems impeding their proper operation, unless sufficient pre-digestion mixing can be achieved.
The composting privy (see the VITA sanitation booklet) is an intelligent adaptation of the pit latrine, requiring only a slightly greater minimum depth. If covered properly after filling, it should yield a fertilizer that is not only safe, but more importantly in terms of its appeal to villagers for reuse, unrecognizable as night soil.
Generally, the success of a latrine or sanitary system will be in direct proportion to the amount of community participation in its design, construction and operation. The women's community latrine complex (in Patan) and the Bhaktapur central sewage system, which have had only peripheral community participation, are the exceptions. It is noteworthy that these improved installations were constructed directly in the traditional community defecation areas, giving the residents no choice but to use them.
IMPLEMENTATION CHANNELS AND STRATEGIES
The following Government offices and other institutions are among those currently most suitable for absorbing a nationwide sanitation improvement scheme. Training and information dissemination are strongly emphasized. Most rural villagers have the wherewithal to dig simple pit latrines, specifically, but require education, motivation and technical guidance.
The National Development Service (Rastriya Bikeas Sewa, Tribhuvan University) is the mandatory one year of service at a rural post (usually a secondary school) that all Tribhuvan University students must complete before graduation. They are encouraged to initiate ant engage in local development activities. Severa nave built latrines at their posts, and for this have received guidance and material assistance from UNICEF. Mr. Andrew Quarmby is the sanitation advisor to UNICEF, and has worked advising students in sanitation and printing literature specifically for NDS students. A brief hands-on sanitation component in the NDS students' pre-posting training would be a logical approach to transfer the skills needed to build rural latrines. Many of the NDS students have teaching duties in their school posts, and they could easily include latrine-building objectives and techniques in their curriculum. Funds cold be made available to them to assist the school, and possibly individual students, in the construction of latrines.
UNICEF also works closely with the Health Ministry (Mr. Stewart McNab is the UNICEF nutrition officer) and they have acknowledged the integral part that sanitation plays in health and rural water supply --the two areas that UNICEF has most heavily invest in. However, other than distribution of their pit latrine booklet, specific address of rural sanitation issues by the Health Ministry and UNICEF has been minimal. Working with Health Ministry personnel for the establishment of improved sanitation at the forefront of health care and health education is a high priority. The inclusion of sanitary engineering in the training of paramedical personnel assigned to rural health posts could be an offshoot of this. Their family planning, soil conservation and "mother's milk" radio advertisements and documentary films (daakment) shown in rural villages, have had a very popular response.
The Department of Agriculture's extension programs are known to many farmers and are helpful to some through subsidy of the more innovative (risky) project activities. One of the more appropriate extension activities that the "Jts" (junior technicians) and "JTAs" (their assistants) could adopt would be the demonstration and encouragement of composting privies for fertilizer production. Unlike the more capital-intensive and risky agricultural projects that the extension agents commonly encourage, a compost privy program should be more attractive to the risk-aversive farmer. The innovative farmers of each district are the ones most likely to be interested, and it is precisely with them that the JTs have developed strong working relationships. The only disincentive is the unlikelihood of the farmer realizing a marked short-term increase in agricultural productivity; but such a program would no doubt be an intelligent and economical use of resources in the long run.
(Ministry: Kaiser Mahal, Kathmandu) The education system has also had a pervasive influence on all rural regions of the country; almost every household has a child who is or has studied in school at one time. The majority of all primary and secondary schools in the country, however, do not have any latrine facilities, and those that do seldom operate. Several school days per year are devoted to schoolarea work projects such as grounds beautification, pathway maintenance, garden planting and building construction. For this, students bring materials and tools from home and work is enforced in lieu of classwork or sports attendance. It would take but few of these project sessions to build school latrines. In the schools that do have facilities it seems, ironically, that the latrine patronage by students is greater than that by teachers.
The natural science curriculum taught in the school system would be the logical place to introduce these concepts to the young, but it is a rare teacher who has the ability to effectively communicate such abstract cause-and-effect relationships to a student body that is poorly prepared, easily distracted and culture-bound. But the education and participation of young students in sanitary techniques will be a major key to its improvement in the years to come; sanitation should have been included in the curriculum long ago. The eventual breakdown of caste prohibitions regarding the handling of night soil would be one beneficial, but extremely slow-to-realize outcome of this.
Gurkha Training Program
The British Gurkha Resettlement Program sponsors training programs for returned pensioners covering improved agriculture, animal husbandry, etc. Some of these training sessions are at the Paklihawa pension camp in the central Terai, and at another camp in the Eastern hills. The Agriculture Development Farm at Lumle, near Pokhara, also trains pensioners from that area. Their program structure and outreach methodology is ideally suited for the training of low risk sanitation technologies and concepts, and the trainees are generally innovative and educated, due to their background in the service. Being army pensioners, they are also well-respected citizens of their community. The pensioner resettlement fund also sponsors small individual village projects, such as drinking water systems.
In the Fall of 1978, the US Peace Corps/Nepal will initiate an innovative auxiliary "appropriate technology" component for volunteers being trained for positions in all fields. Sanitation concepts and the aspects of digging latrines will form a major part of this component, and all volunteers will be encouraged to build latrines at their village posts. Volunteers who have installed them in the field to date have had mixed, but steadily improving success in getting other villagers to consistently use them. Similar programs for other volunteer agencies are recommended. Working as full-time "sanitation extension agents," advising on latrine construction and organizing community educational programs and training sessions, would be a frustrating and potentially rewarding job for volunteers.
The Department of Tourism has had growing complaints of the poor sanitation that pervades touristed areas. The development of urban latrines that are acceptable to foreigners and yet tamper- and foulproof would be of keen interest to them. The digging of one labeled latrine per village along trek routes, for example, would preclude the inconvenience and embarrassing situations that trekkers now face. It is likely that a program of sanitation improvement in touristed areas would recover its cost through increased tourism income alone.
The successful implementation of all of the programs proposed above may depend largely upon the encouragement and cooperation of the Panchayats. This may be slow to evolve because of the often intangible results and potitical in-utility of improved sanitation. However, cooperation of the Panchayats with the central government and development programs has been good after repeated exposure to new concepts. Family planning, for instance, is now a household word. Roads, football fields, bridges and water systems are routinely built by centrally-organized, Panchayat-level implemented, and villager executed programs. Community latrines are also suitable to this shramdaan communal labor activity. The risk of failure for a system built in this manner is normally fairly high for much of Nepal, but an intelligent assessment of this local commitment to participate in latrine construction, operation and maintenance in the more innovative villages may determine which ones are distinctly low-risk. In city areas, a prohibition against urination in public places should be enforced.
The District Panchayats often have funds earmarked for community development purposes, but the kinds of projects undertaken typically meet the needs or desires of only a localized few. Unfortunately, latrines are not politically useful to the influential local politician, so their construction is seldom promoted in the decision-making process. Some of these decision makers are unaware of the extent of the degradation of their local sanitation, and this should be exhibited to them. As education and concern for health inspires citizens to press for better sanitation, the District Panchayat development programs will perhaps be further disposed to latrine investment.
The Back-to-the-Village Campaign (Gaou Pharka) was conceived ostensibly to assist the more rural areas in the management of their political affairs and to take development out to the grass-roots village level where it belongs. With strong central directives, they are in a position to help educate, encourage and offer guidance in improved sanitation. Each district office in turn has close ties with the Village Panchayat members in the district.
The Local Development Department is responsible for small-scale rural development projects such as schools, hospitals, footbridges and drinking water systems. Chiefly, they supply materials (much of it is donated by UNICEF) and engineers to rural project sites. Pipe and plumbing fixtures for a sanitary installation would normally be handled by the LDD. They are now set up to examine requests for materials and technical guidance to build latrine systems from village Panchayats. But few requests have been made, and there are few if any engineers with experience in sanitation systems. With the training of engineers and the solicitation of the numerous potential requests for assistance (now looking for a door to knock on), sanitation can take a place alongside "bridges" and "water supply" in the LDD. They have a rigorous policy of ascertaining the full extent of the community participation in a proposed project, since the LDD never supplies labor.
The health of Nepal's growing population and its status as a tourist paradise is in jeopardy unless the atrocious sanitation that plagues the kingdom can be abolished. But not only the physical health and beauty of the country is at stake. The side effects of the current unsanitary conditions are subtly undermining Nepal's ecology, culture, economy and capacity for development.
Ultimate improvement of the standard of living in all facets of life for the Nepalese has, and will come chiefly through community commitment and involvement. And ultimately, community participation is the best mechanism for assuming the task of sanitation improvement. A system that requires even a minimal daily commitment (its use and maintenance) will function only if the inspiration and motivation have come from the patrons themselves.
The simple pit latrine, perhaps with some minor modifications, is the most appropriate waste disposal technology for rural Nepal. The minimal investment of time and materials required most closely matches the benefits yielded and most villagers view these as insubstantial. Pit latrines are in appropriate for urban areas and large Newar bazaar towns. Here, if water and ongoing maintenance accommodations are plentifully supplied, an intelligently planned sanitation system will meet with success.
Incentives in the form of subsidy, donated materials or technical guidance may well encourage villagers to dig latrines, but they will not cause the villagers to use them. Nepal's rural villagers are as rational and innovative as their brethren from the developed countries; sanitation concepts have merely been missing from their traditional, and now, their present Western education. A full understanding of sanitation should be sufficient to convince most of the need for proper waste disposal.
It is unlikely that any single department of the Government of Nepal has the capability to manage a nation-wide decentralized sanitation improvement scheme. Thus, it is essential that development efforts be applied to all departments of the government and segments of society, with special emphasis on those listed in the preceding section. Simultaneous with the promotion of sanitation, it is important that field testing and data collection on the technology and sociology of rural sanitation begin, so that the numerous problems encountered heretofore can be prevented.
Fundamentally, it is essential that there be recognition in high government offices of the need for adequate sanitation, not only for the health of the populace but for the economical, and consequently political stability of the country. Many of those now working in government were raised in an age when sanitation facilities as such were virtually unknown, even while they were studying advanced Western sciences and abstract concepts. This basic naivete' may severely hinder the rapid development in all sectors of Nepalese economy and society that is proposed for the years to come.
Nepal has virtually no tradition of sanitation or waste management, and there are only token sanitary facilities at present. Gastro-intestinal disease spread by ubiquitous fecal-borne pathogens eclipses malnutrition as the primary source of ill health and loss of productivity. Ignorance of the interconnection between poor sanitation ant health is universal, while taboos and caste prohibitions regarding the management of night soil are prevalent. The aversion to defecating in the same place every day is compounded by villagers' need to see their stool -- significant hindrances to the promotion of latrines.
The population and the production of human waste is growing, and this waste has begun to markedly degrade the quality of local environments and severely contaminate streams that are downriver sources of drinking water. Nepal's dearth of the crudest sanitation measurements has rendered it a disenchanting health hazard for tourists, the principal source of foreign exchange.
Concern is growing among progressive-minded citizens, but the social, political ant technical mechanisms necessary to begin improvement of the present conditions are inadequate and poorly coordinated. The motivation of community interest, cooperation and participation will be a limiting factor in the success of a latrine system, and the most difficult to undertake.
Valuable experience has been gained from improved latrines installed to date: most have suffered from over design and recurrent cost recovery problems, factors that should be considered in future installations. Water-seal systems, suitable only for urban areas at this time, are heavily dependent on consistent water supply and maintenance for their operation. Pit latrines are the technology of choice for the bulk of rural Nepal. They are inexpensive, simply end easy to maintain; some educated and hill peoples have constructed and used them.
The education of Nepal's young in the concepts and techniques of sanitation, in conjunction with scattered functional/demonstration latrines built by innovative villagers will be one of the most expedient ways to begin the nationwide reversal of poor sanitary habits. Specifically, at this time some of the institutional channels which are best adapted for assuming a sanitation improvement program are:
* The NDS, A Tribhovan University program in which undergraduates undergo a mandatory year of field service and are urged to initiate local development projects.
* The education system, which could encourage the construction of latrines and include sanitation as part of its curriculum.
* The British Gurkha Resettlement Program, which trains innovative returning soldiers in improved agricultural techniques, could teach the principles of sanitation in demonstration workshops or as part of other training programs.
* Auxiliary sanitation training could be given to all foreign volunteers sent to work in the field.
* Compost privies could be encouraged through the pervasive and relatively successful agriculture extension programs.
* The Local Development Department could handle requests for materials and technical guidance from village Panchayats and local development bodies.
* The Department of Tourism could sponsor the construction of latrines in areas heavily visited by tourists and trekkers.
The success of all of these programs will further depend on concerted central government directives. For Nepal, sanitation is not an investment that villagers imagine to yield benefits, so the importance of thorough education and rational, directed incentives will be essential. The task is a difficult one, and necessarily long-term, but is of the utmost urgency.
HYGIENE INFORMATION PACKET
Guidelines for Purifying Water
In this method, water is allowed to boil for fifteen minutes after the first bubbles appear. It is important to follow this procedure because the process is dependent on both heat and time. Some organisms will be killed at high temperatures, but only after exposure to that temperature for a certain period of time.
Once the water has been boiled, a pinch of salt can be added to improve the taste.
Boiled water should be stored only in disinfected, covered containers with a tap for dispensing water to avoid contamination. A cup should never be used to remove boiled water from a container.
One problem with boiling water is fuel. In many places, the only available fuel is wood, which can be expensive. In addition, the excessive cutting of trees contributes to soil erosion, which may lead to flooding. Where possible, other fuels should be used. One such alternative fuel is gas that is produced from animal manure (buffalo, cow). This process is called biogas
Chlorine compounds render water safe to drink if the chlorine is added in the proper amounts and if the water is allowed to stand for 30 minutes before drinking. The amount of chlorine to add depends on the compound used and the condition of the water. Ordinary household bleach is an excellent source of chlorine.
Cloudy water contains organic matter which will combine with the chlorine, taking it away from its intended use as a disinfectant. The usual procedure in this instance is to double the dosage as indicated in the table below. The stronger chlorine compounds require proportionately less chemical to disinfect.
Dosage of Bleach Solution 5% Active Ingredient
Another excellent chemical used for disinfection of drinking water is iodine. This is commonly available as 2% tincture of iodine which can be purchased at any pharmacy. The usual dose is five drops of iodine for every liter of clear water. The dose is doubled for cloudy water, although it is better to first filter the water. Once treated, water should be allowed to stand for 30 minutes before use.
All disinfected water should be stored in a disinfected container complete with a lid and top. Care should be used in handling the iodine solution because of its staining properties.
Adrounie, Harry; Chelikowsky, Bruce R; and Hagen, David L. Environmental Health Field Manual for Sanitarians. Honolulu: Rural Sanitation Manpower Development Project, University of Hawaii, 1980.
Basic Guidelines for Personal and Dental Health
1. Always wash your hands with soap when you get up in the morning, after having a bowel movement and before eating.
2. Bathe often -- every day when the weather is hot. Bathe after working hard or sweating. Frequent bathing helps prevent skin infections, dandruff, pimples, itching and rashes. (Where water sources are limited, learn to conserve water. Take frequent sponge baths. Be sure not to contaminate your safe water supply. Pour the water you'll need into another container for use.)
3. In areas where hookworm is common, do not go barefoot. Hookworm infection causes severe anemia. These worms enter the body through the soles of the feet.
4. Brush your teeth at least once a day and, if possible, after every meal. If brushing is not possible for some reason, rub your teeth with salt and baking soda. (See Werner)
5. Ideally, being able to run a strong thread or dental floss between your gums and teeth is good. If this is not possible, toothpicks or sharpened sticks can be helpful.
6. If children or animals have a bowel movement near your house, clean it up as quickly as possible.
7. Hang or spread sheets and blankets in the sun often. If there appear to be bedbugs, pour boiling water on the bed and wash the sheets and blankets.
8. Beware of dogs and cats from outside. Don't let them into your house. They can carry fleas and other insects which can cause disease.
9. Try to clean your house often. Sweep and wash the floors, walls and beneath furniture. Fill in cracks and holes where roaches, bedbugs and scorpions can hide.
10. Ideally, all water that does not come from a pure water system should be boiled before drinking. This is especially important when there appear to be cases of typhoid, hepatitis, cholera or diarrhea. Water from holes or rivers, even when it looks clean, may spread disease if it is not boiled or disinfected before use.
11. Try to store foods in insect- and rodent-proof containers to prevent contamination. Keep food covered.
12. The common use of human feces for fertilizer makes it necessary to kill intestinal pathogens which may be on foods, such as fruits and vegetables. A disinfectant such as chlorine or iodine will kill these organisms.
13. Use clean cooking utensils and dishes They should be washed with hot water and soap, air dried in the sun if possible, and stored in a clean place. It is especially important to use hot water and soap when washing dishes used by a sick person so that germs will be killed and not passed on to healthy people.
14. Only eat meat that is well cooked. Be careful that roasted meat, especially pork, does not have raw parts inside. Raw pork can carry the organisms responsible for the disease trichinosis.
15. Be careful of food that is old or smells bad. It may be poisonous. Don't eat canned food if the can is swollen or squirts when opened. Be especially careful with canned fish.
16. Pay attention to your diet. Good nutrition helps protect the body against many infections.
17. If you smoke cigarettes, try to quit. Put your energy into something healthier and more constructive.
18. Try to get some kind of daily exercise like walking, doing calisthenics, bicycle riding or other activities in which you use your heart and lungs.
* Werner, David, Where There Is No Doctor
BASIC INFORMATION CONCERNING
Solid Waste Disposal
Our concern about solid waste is that if not properly disposed of, it attracts rodents and insects, water and air become Contaminated, fire hazards increase, unpleasant odors are common and the area looks unattractive. The rat is a very common inhabitant of places where solid waste is deposited. Food and shelter are provided and the rats multiply. Aside from the danger of a rat bite or problems associated with damage to crops and stored food, rats present a health problem in the form of typhus and plague. The flea, which is the vector, uses the rat as his transportation and ultimately its destination may be us. By removing the rats ' food and shelter, the rat population will be contained and the prospects of disease transmission occurring will decrease.
Insects will always be with us but we can reduce our exposure to them by taking simple, yet effective steps. Insects require food to live and a moist habitat to breed. Many types of solid waste, especially garbage, provide these two items. While other insects may be a problem, flies are the ones we are concerned about due to their ability to transmit organisms to man from an infected source. If solid waste is disposed of properly, the fly will have to search elsewhere for its food and breeding area.
Some ways in which to dispose of solid waste include:
1. Burning all garbage that can be burned. However, the main problem with this practice is that the solid waste is never fully incinerated. Besides the residue of ash, many of the items in the waste will be found intact. This applies not only to plastic or metal, but also to garbage. If the garbage is not fully burned, it retains its lure to our public health enemies, the rat and the fly. So another possible method for waste that isn't burned is:
2. Burying solid waste in the earth. Garbage that cannot be burned should be buried in a special pit or place far away from houses and the places where people get drinking water. (Werner) These wastes should be buried and covered with at least 45 cm. (1-1/2') of earth. Other methods include:
4. Composting organic material.
There are many different ways to dispose of excrete, and they all should adhere to the following requirements:
* The surface soil should not be contaminated.
The most common type of excrete disposal system found in rural areas is the pit privy. It is composed of a hand-dug pit over which is placed a squatting plate or slab. A shelter is usually constructed around this. The pit privy is a minimum-cost solution providing for defecation with or without water use, excrete storage, digestion of waste solids and seepage of urine and moisture into the surrounding soil. Once full, within 50 cm. (2') of the top, it should be filled in and another pit used. After nine to twelve months, the old pit may be uncovered and the sludge remaining used for fertilizer. It takes this time for all pathogenic organisms to die. Once emptied, the old pit can be used again.
The location of the privy is important Place it downhill and maintain a distance of at least 30 meters from a water source unless the well is very deep (30 meters or more). The size is also important. Ideally, pit privies should be designed to have at least four years storage capacity. The sludge volume for a dry pit (one which does not penetrate groundwater) is 40-60 liters (approximately 10-15 gallons) per person per year. Due to the digestion of sludge which takes place in the pit and percolation of liquid into the soil, the actual volume of material may be reduced to 20X of the total volume of feces and urine deposited. A pit 2.5 meters (8-1/2 feet) deep and 90 cm. (3-1/2 feet) square should serve a family of six for five years.
Adrounie, Harry; Cheliokowsky, Bruce R.; Hagen, David L, Environmental Health Field Manual for Sanitarians, Honolulu: Rural Sanitation Manpower Development Project, University of Hawaii, 1980.
GUIDELINES FOR ASSURING FOODS ARE CLEAN
Some illnesses are caused by unclean foods, foods which carry disease-causing organisms.
* * *
Lugol 's Solution
This is an iodine compound which is an effective disinfectant and is available at most pharmacies. The solution should contain 5% iodine or 50,000 ppm when purchased. It should be kept in a brown glass bottle. (Light in the presence of air will destroy the iodine very rapidly if it is kept in a clear glass container. The concentration will decrease in a brown bottle also, but much slower.) Lugol's should prevent a bright light from passing through the bottle and solution and a person should not be able to see the bottom of a tablespoon full of Lugol's when held in a brightly lit room. If these two criteria aren't met, then the Lugol's is weak and the amount used must be increased.
If using Lugol's, the following dilution schedule should be followed:
1. If Lugol's solution appears dark and is used within one month of the date of purchase, add five tablespoons to every four liters of water.
2. If Lugol's solution appears dark brown and is not used within one month of the date of purchase, increase the amount by one tablespoon per month after the first month of purchase. For example, during the first month after purchase, use five tablespoons and during the second month, use six tablespoons.
3. If Lugol's allows tight to pass through it, do not use it. Purchase a good bottle.
4. Always allow vegetables a contact time of 20 minutes with "good" Lugol's. Keep it in a cook, dark place.
5. The above schedule can also be used with chlorox.
GENERAL GUIDELINES FOR FOOD PURCHASING, STORAGE, PREPARATION AND SERVING
When you purchase, prepare and serve food, it is important to:
* Select good quality food. Food should smell fresh, come from a clean source, be protected from fifes and dirt and have a fresh attractive look and color.
Food can become unsafe to eat if it is
* Served by a person carrying disease germa
Keep everything clean. Cleanliness helps to keep away disease germs. Clean food is likely to be safe food.
When preparing foods:
* Store them for a very short time.
CAUSES OF INFECTIOUS DISEASE
A virus is the smallest organism that causes disease. It is classified between living and non-living matter. The body can become immune to viral diseases through antibodies, either produced in the body or introduced by means of immunization (vaccination). Some diseases caused by viruses are: common cold, flu, chicken pox and shingles, smallpox, polio, herpes, measles and pneumonia. Many viral illnesses are self-limiting and almost all viral infections do not respond to antibiotics.
These organisms are classified somewhere between animal and plant and are responsible for a wide variety of illnesses. Not all bacteria are pathogenic, and many are necessary for good health. Some diseases of bacterial origin are: tuberculosis, typhoid fever, shigella, venereal disease, tetanus, leprosy, yaws. Antibiotics are appropriate for bacterial infections. However, they kill many types of bacteria and may cause an imbalance and another (yeast) infection. The body produces antibodies to combat bacteria; immunizations produce antibodies as well. Bacteria may be controlled with disinfectants and antiseptics.
The fungus reproduces with spores and often appears as a skin disease. Examples of fungal diseases are ringworm, athlete's foot, jock itch and certain ulcers.
Protozoan or Parasitic
These are simple animals that cause illness either from within the body (amoeba, giardia, hookworm, tapeworm, roundworm, etc.) through the fecal-oral route of transmission, or from outside the body, as in insect bites or direct contact with the parasite. Some other examples include scabies, malaria and river blindness.
1. A bacteria or virus enters the human body trough the mouth, a break in the skin, a mucous membrane etc. Then lymphocytes - a type of white blood cell - discover the bacteria or virus recognizing a protein substance on the wall of the virus or bacteria kalled antigen as foreign or as neir normally belongim in the body.
2. The lymphocyte cells create proteins (called antibadiesunit) which are structurated in such a way as to join with the specific antigen.
Note: Scale is pur preseilly distoried under stand that a lymphocyte is many of times larger than a bacteria or a virus.
3. The lymphocyte releses the antibodies, which it has created into the fluids of the body to combine with the foregin proteins a, the surface of the bacteria or virus when combined this renders the virus or bacteria harmless to your body.
4. Another type of while blood cell enquits the now harmless bacteria or virus and carries it to other parts of the body to get rid of it.
5. This process makes immunisation possible. with immunization virus or bacteria are Pirst rendered harmless though the antigen on their walls remains intact A small amount of this substance introduced to your body Then your body creates antibodies to combine with that Labia specific antigen. Your body has then dereloped a large stock of those specific antibodies so thait if the, live virus or bacteria were to come into your body you would already have the "Knowledge" and/or the anti bodies to easily protect your self from the infection in'
From The Well Body Book, by Mike Samuels, M.D., and Hat Bennett. New York: Random House.
Vaccines are special "medicines" which if administered properly can prevent some diseases. We call this process immunization.
Immunization: Immunity and Antibodies
If you had whooping cough as a child, you only contracted it once because your body became immune to it. The body produces certain antibodies which are special proteins found in the blood. These antibodies fight the organisms that cause disease or the toxins (poisons) that organisms make. Antibodies attach themselves to an organism and kill it off or they attach themselves to toxins and stop them from causing harm. The antibodies which fight toxins are called antitoxins. A different kind of antibody fights each organism or toxin. For example, measles antibodies only fight measles virus. They have no effect on malaria. Antitoxins against tetanus are not helpful against diphtheria.
While a child is ill with measles, the body begins to produce the special antibody against the measles virus. The body continues making this antibody; thus the child becomes immune and never has measles again. When the body makes its own antibodies, it has an active immunity. The body becomes actively immune in two ways, either from the disease itself, or from a vaccine. These vaccines are grown from harmful organisms and either killed (dead vaccines) or made weak (live vaccines). Because the organisms in a vaccine are weak or dead, they cause no harm beyond what may be mild symptoms (such as a mild fever). When the vaccine is given, the body produces antibodies against the particular organisms, thus preventing the body from becoming ill from the disease itself. When disease makes the body immune, it has a natural active immunity. If vaccine is given to make the body immune, it has an artificial active immunity.
Active immunity is the best kind because it allows the body to continue producing its own antibodies. The only problem is that it may take several weeks or longer before the body becomes immune. If necessary, the body can be made immune immediately by injecting antibodies from another person or animal. These antibodies give the body a passive immunity for a relatively short period of time (usually about two weeks).
The body can receive natural passive immunity while still in its mother's uterus. The antibodies ant antitoxins are present in the mother's blood and are passed to the child's blood before birth. At birth, the child is immune to the same diseases as the mother.
Natural passive immunity explains why children do not usually have certain diseases until they are about three months old. By this age, most of the antibodies they were given at birth from their mothers have gone. By injecting new antibodies from an immune person or animal, we can give the body an artificial passive immunity. For example, we can inject tetanus antitoxin into an injured person who might have tetanus bacteria in his wound. The antitoxin makes the body immune immediately, before the body has had time to make its own antitoxin. The injected antibodies or antitoxin are soon destroyed, giving the body artificial passive immunity for not more than a couple of weeks.
It is important to remember that live vaccines die easily and become useless. Therefore, care must be taken in the transport and storage of such vaccines. The same is true of dead vaccines but to a lesser extent.
Examples of live and dead vaccines:
Following is a representative list of some of the most frequently used immunizations. The actual selection may vary from one volunteer to another and from one country to another, depending on regional considerations, local governmental guidelines and changing circumstances. For example, a local outbreak of measles or cholera might mean immunizations for everyone. It is the responsibility of each volunteer to make sure that his/her immunization records are kept up-to-date during Peace Corps service.
From OPTC Basic Health Training Guide (Draft)
LIST OF MAJOR DISEASES AND THEIR GEOGRAPHICAL AREAS Of ENDEMICITY *
* From OPTC Basic Health Training Guide (Draft)
Some of the diseases which are found in AFRICA, categorized in terms of how they are transmitted.
Vehicle borne (water, food, fomites/inanimate objects):
Vector borne (flies, mosquitoes, other insects):
Some of the diseases which are found in LATIN AMERICA, categorized in terms of how they are transmitted.
Vehicle borne (water, food, fomites/inanimate objects):
Vector borne (flies, mosquitoes, other insects):
Syphilis (sexually transmitted)
Some of the diseases which are found in ASIA and the PACIFIC, categorized in terms of how they are transmitted.
Vehicle borne (water, food, fomites/inanimate objects):
Vector borne (flies, mosquitoes, other insects):
Syphilis (sexually transmitted)
COMPETENCY ASSESSMENT/STUDY GUIDE
1. Name an example in each category. Describe its transmission, prevention and general treatment.
A. Vector borne diseases (transmitted by flies, mosquitoes or insects):
2. When should antibiotics be used? When are they inappropriate or dangerous?
3. Give at least three environmental factors that contribute to disease and ways in which they may be controlled.
4. Why do immunizations work?
5. Describe two ways of purifying water for drinking or food preparation.
6. Name five ways of maintaining personal hygiene.
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