Air Pollution, Kathmandu - PhMuseum

Air Pollution, Kathmandu

Marco Sacco

2018 - Ongoing

Nepal

According to the WHO - World Health Organization - the United Nations agency that deals with the achievement of the best possible health condition of every inhabitant of the planet, it is estimated overall that 24% of diseases and 23% of all deaths - about 12, 6 million a year - are linked to environmental risks such as air, water and soil pollution, chemical exposures, climate change and radiation . Nepal is not an exception and environmental pollution in the little Himalayan state remains a major health problem, especially in urban areas where most of the population is in direct contact with infected water and exposed to air pollution. In particular, the latter causes over 21˙000 deaths each year, causing more victims of road accidents, which in the same period of time kill about 2˙000 people .

We are used to thinking of Kathmandu as a forced passage to the very pure peaks of the Himalayas (it is enough to evoke Everest or the Annapurna massif), it is difficult to imagine it as one of the most polluted cities in the world. Unfortunately in the Nepalese capital the exacerbated and unchecked air pollution, caused by under-regulated urbanization and traffic, as well as the haphazard use of chemicals (especially by construction workers) fuel the exposure to dust and smog by the population. Not only that, the deposition of waste in landfills and/or the combustion of the same, the use of furnaces for the production of bricks, the use of biomass and kerosene for heating and cooking (often burned without flue or ventilation) increase the causes of outdoor and indoor air pollution in Nepal.

Located at 1400m altitude, the Kathmandu valley is literally surrounded by sub-Himalayan mountains. This geographical position does not allow the constant and complete air exchange in the metropolis. On the contrary, it favors the creation of a “gray cloud” suspended over the city. Although easily visible, it hardly disperses, occluding the capital.

Exposure to unhealthy air (both indoor and outdoor) is responsible for the dramatic increase in the number of people suffering from disorders of the cardiovascular system, such as allergic rhinitis, bronchial asthma, cough, dyspnea and wheezing, lung cancer, COPD - chronic obstructive pulmonary disease - and stroke. As always, the most affected by these diseases are the elderly and children.

In addition to the problems mentioned above, air pollution is related to pneumococcal disease, caused by bacteria that can lead to pneumonia and meningitis, because the average immune response of the population is very low. In fact, the ability of the immune response is a sensitive indicator that allows to demonstrate how is harmful the atmospheric pollution, as claimed by dr. Santa Kumar Das, Respiratory Ward doctor at the Tribhuvan University Teaching Hospital, according to studies by researcher Geneé S. Smith conducted at the University of North Carolina .

There is a significant association between PM2.5, CO and TB, i.e. the causes and effects of air pollution are closely related even when it comes to tuberculosis (TB). In fact, a growing number of studies have highlighted the potential role of atmospheric pollutants on the incidence of tuberculosis, already a public health problem in Nepal, according to DOHS, the nepali Department of Health Services. Not only does outdoor air pollution decrease the efficiency of the immune system, but also the immune function of people using charcoal, wood and kerosene for cooking is inhibited .

A study by Lalita Ramakrishan, a professor at the University of Cambridge's department of medicine in the United Kingdom, proves that macrophages on the surface of the lungs are the first line of defense when a bacterium enters the lung. The macrophage is a type of white blood cell that envelops bacteria neutralizing them and often succeeding in stopping tuberculosis infection in the lungs. However, when the smoke fills the lungs, the macrophages are obstructed, reducing their ability to inhibit the bacteria. Clogged macrophages are not able to effectively kill Koch's bacilli (bacteria responsible for TB infection), allowing them to multiply and allowing the infection to turn into a full-blown disease .

“The Kathmandu valley is not a good place for people who are allergic to dust, in fact the number of patients with respiratory problems has increased by 20%” according to what was stated by dr. Dirgha Singh Bom. The areas where road expansion is taking place are the most affected by dust pollution. “No place in the Kathmandu Valley is free from pollution, but those who live in houses by the roadside should be more cautious about their health” said dr. Kabir Nath Yogi, Head of the Respiratory Ward Unit at the Tribhuvan University Teaching Hospital “Dust particles suspended in the air from construction and vehicle emissions are the main causes of the increasing cases of respiratory problems and other health problems related to air pollution in Kathmandu”, adds dr. Kabir Nath Yogi. Using appropriate masks, educating people about the increasing risks of exposure to harmful air pollutants and carrying out regular health checks are some of the precautionary measures to be taken, he continued to state.

“Ensuring the right of citizens to live in a healthy environment through effective monitoring of environmental pollution for the protection and promotion of health” is one of the challenges of the government of Nepal, as publicly reported in the lastest annual report of the DoHS - Department of Health Service -. But is this a realistic medium-term goal? The government and people know that it is only possible with drastic changes?

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  • View of the Kathmandu valley from the highest point of Buddhist temple Swayambhunath. From this point is possible to observe the city within the valley and the suspended “gray cloud” that occlude the Nepal capital.

  • Teku. The alley of a slum submerged in rubbish. The air is unbreathable as a result of the deposition of waste. Over to deposition of waste, there’s open sewer.

  • Stale dust in the air forces people to cover themselves to protect their eyes, mouth and nose. Not all population uses masks due to the presence of dust and smog.

  • In one the most Kathmandu critical area, Kalimati, a mother cover his newborn with a veil. There aren’t any perception of the risks of air pollution and people use homemade methods to defend themself and their children, but these are insufficient.

  • On board the tuk-tuk, a little bus of public transport, a young girl and use mask. Wherever protective masks are recommended.

  • Ring Road. In Kathmandu there aren’t trash cans on the streets, so a largest part of population throw waste on the ground. At the end of the day or at sunrise, who have shops or works at the borders of the roads lights the residues.

  • Teku. In the slum that rises on the Bagmati, sacred river. The winter drought brings to light the rotten muddy ground full of waste. The air is unbreathable due to the esalations from the river and due to the sewer drains.

  • Teku dump. The only day off for a group of kids who work in the landfill. They bivouac in a concrete pipe, the only day they do not work into a dump, on Saturdays. With the only good clothes and a mobile. Otherwise, they have nothing. They know what they live, they know what to hoped for. They are 12-14 years old and they are the major hit of air pollution.

  • Construction workers exposed to the carcinogenic fumes of bitumen, to dust and smog of adjacent traffic. This is a group of workers in Baluwatar that have never used any personal protective equipment in the two weeks of work. They work about 12 hours every day and they sleep in a camp on the workplace. They are fully exposed to emissions.

  • Thamel. A worker on the construction site dirty by dust on the face. He admits that have lung disorder since several years ago, when he started to work on the roads. He doesn’t knows what has, but he feels pain on the lungs and have and unstoppable cough. His unique protection device is a plastic bag.

  • The containment of construction dust is non-existent. In addition, the established practices are also ignoring the minimum precaution dictated by common sense.

  • Teku. In a house without electricity, the only source of light is a kerosene lantern. Another plague is the use of kerosene indoor. Few people use the kerosene for cooking or heating because the cost of a tank is the a bit cheaper than gas and who haven’t money prefers use wood or charcoal. But kerosene is frequently used for lighting in the slums where there isn’t electricity. This mother lives with is family and his son (2 years old) and use kerosene all the day because in the tight spaces of slum, in the day hours, every home are in the dark. As the rest of inhabitants of Teku slum, she ignore the risk of kerosene combustion gases.

  • Inside a slum along the Bagmati, an elderly woman (in the company of her grandchildren) holding an aerosol to alleviate the lung pains she accuses. She not knows what problem exactly she has. She admits that sometimes takes drugs without any medical prescription and recognize his pills/aerosol only by colors.

  • The waiting room of the OPD of the Tribhuvan University Teaching Hospital, on the day of the visits dedicated to respiratory problems.

  • Dr. Kabir Nath Yogi, head of the Respiratory Diseases Unit at the Tribhuvan University Teaching Hospital, visits a woman who has adenitis due to tuberculosis. Every Thursday morning he visits persons who have lungs problems or he controls to former hospitalized patients.

  • Teku. During a visit to the slum, in the house of the regent shepherd the Christian church, a woman presents herself with freshly made slabs at Bir Hospital and with a diagnosis of COPD.

  • The most complex cases are treated in a special room. A patient, during the convalescence of tubercolosis, waiting for an injection.

  • The Respiratory ward at T. U. Teaching Hospital. A father, hospitalized, is sleeping with his son. In the ward, that is full of hospitalized people, there aren’t checks for relatives. Every relatives is free to visits the patient, but this behaviour is not safe because expose children, the most weakest, and adults to an unhealtly ambient.

  • A patient in the Respiratory Department of the Tribhuvan University Teaching Hospital during aerosol therapy.

  • The isolation room for patients with active tuberculosis. After the first treatments in hospital, the patient have a long and complex therapy. A course of treatment can last from 6 months to 18-24 months depending on the patient's adherence to the prescription. In order for the treatment to be effective and to prevent resistance to anti-tuberculosis drugs, the World Health Organization has proposed a strategy called Directly Observed Therapy or DOT, which consists of a treatment regimen in which there is a doctor that make sure that the patient regularly takes his dose of medication. Several studies have shown that the DOT strategy is able to reduce the duration of treatment to 6-8 months.


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