Health and Physical Education Book 8_2077 Editioin

Recap S Environmental health refers to those aspects of human health and disease that are determined by the factors in the environment. S The ultimate goal of environmental health is to control possible negative impact and maintain healthy environment for quality and productive life. S According to WHO, “Environmental sanitation the control of all those factors in man’s physical environment which exercise or may exercise for adverse effect on his health and survival.” S The diseases caused by drinking or ingesting water contaminated by human or animal faeces and urine containing pathogenic bacteria or viruses are called waterborne diseases. S The diseases like typhoid, hepatitis ‘E’, giardiasis, diarrhoea, dysentery, and cholera are common water borne diseases. S More than 12 thousand individuals are killed by the diarrhoeal diseases in Nepal. S About half of the total population of the country is not getting piped water. Water supplied to the public is also not safe for drinking. S Mixing of harmful elements in water causes water pollution and affects human health. S Use of the same thing time and again without processing of any alteration in its physical and chemical properties is called reuse. S Distillation involves boiling water then condensing the steam into a clean container. S Recycle refers to the reuse of things time and again after adopting certain measures of recycling process. S Recycle helps to reduce the use of raw materials in one hand and the cost of the material become cheaper in other hand. S Air supplies us with oxygen, which is essential for our bodies to live. Without it, we would die within minutes. S An airborne disease is a pathogenic disease that can be transmitted from an infected person to another through the air. S Influenza, chickenpox, anthrax, tuberculosis, smallpox; flu, measles, bronchitis, pneumonia, common cold, mumps, whooping cough, diphtheria, etc are the examples of airborne diseases. S An unwanted and unpleasant sound that is harmful to health and productivity of human health is called noise pollution. 101

EXERCISE A. Answer the following questions. 1. What is environmental health? 2. Explain any one water purification method. 3. Illustrate any two practical methods of reduction principle. 4. Mention any two preventive measures of waterborne diseases. 5. Write the difference between reuse and recycle. 6. Write any two importance of proper use of latrine. 7. Write the need and importance of air. 8. Mention any two causes of airborne diseases. 9. Mention any two effects of noise pollution. B. Choose correct option from the bracket. 1. The pathogens of airborne disease travel through respiratory droplets during ................................ (running/sneezing/sitting) 2. Adding chemicals chlorine and potassium paramagnet in drinking water is called......................... (boiling/distillation/chemicalization) 3. Developing our habits like using jute and paper bags while buying goods from the market to replace polythene bags is known as................................ (recycle/reuse/reduction) 4. Distillation involves the various processes like.................................... (boiling, condensing and cooling/boiling, vaporization and steaming/condensing, cooling and boiling) 5. ...............................(Pebbles, charcoal and sand/Pebbles, dust and charcoal/ Stone, sand and sponge) are used in the domestic water filtration process. C. Write short notes on: a. Sanitation b. Waterborne diseases c. SODIS d. Signs and symptoms of cancer e. Noise pollution 102

Unit Safety and First Aid 8 Learning Achievement After completing this unit, students will be able to: M Define safety education and tell its importance. M Tell the aims and importance of First Aid. M Tell the safety measures and First Aid to sprain, fracture, electric shock, altitude sickness, shock and snake bite. Safety Education Accidents may occur due to the lack of knowledge on safety rules and measures as well as carelessness. Sometimes, accident may take place due to failure of machines, unfavourable weather also. The rate of accidents is increasing with the pace of physical development and modernization. Safety education is an educational process which teaches about the rules, means and measures to keep individuals safe from the incidence of accidents. It educates people about safety rules and measures at work, at school, work place, on road, etc. In fact, safety education prepares us for safe and productive life. Some of the importance of safety education are mentioned below: Importance Safety Education It helps to reduce the rate of incidence of accidents. It helps to transform major accidents into minor ones. It helps people to live a safe and productive life. People can be saved from disabilities, injuries and even from premature death. First Aid First Aid is an emergency help provided to a casualty before the arrival of a medical treatment. Hence, first Aid is not a medical treatment. The responsibility of a First Aid ends as soon as medical treatment begins. If we get the skills of First Aid, we can prevent the casualty from untimely death. 103

Aims of First Aid To protect life of the casualty. To promote recovery of the casualty. To provide sympathy to the casualty. To protect the condition of the casualty from being worse. To carry the casualty to the nearest hospital as per the need. To provide necessary information to the doctors regarding the condition of the casualty. A. Safety Measures and First Aid of the following Accidents i. Sprain Sprain is an injury to the ligaments caused by sudden over stretching of the joint ligaments and tissues. Sprain usually occurs at ankle, wrist, etc due to sudden tearing or stretching of joints beyond their normal range. Signs and Symptoms Sprain site ^ Swelling, pain and tenderness at the site of sprain ^ Discolouration of surrounding skin ^ Muscle spasm and loss of strength ^ Warmth and redness at the injured area ^ Difficulty in moving the injured part Safety Measures ^ Precaution should be taken while working at home and playing games ^ Should not jump unnecessarily ^ Should walk properly ^ Stay in good physical shape through regular exercise ^ Should warm up body before playing game ^ Should not lift heavy weight beyond physical strength ^ Should play games in discipline First Aid ^ Keep the victim in a comfortable position ^ Put bandage at the sprain area ^ Do not allow victim to walk or move injured part ^ Carry the victim to nearby hospital for further check up ^ Try to ice the area as soon as possible after the injury and continue it for four to eight times a day 104

ii. Fracture A fracture is a condition that alters the contour in the bone. Fracture often occurs when there is a high force or impact put on a bone. Fractures are commonly caused by fall, automobile accident or sports injuries. There are many types of fractures. Some fractures break the bone completely while others just cause a crack in the bone. Types of Fracture Close Fracture Closed Fracture A clean break to the bone that does not damage surrounding tissue or tear through the skin is known as a closed fracture. It is also known as a simple fracture. Open Fracture A fracture that penetrates through the skin and exposes the bone and deep tissues to the exterior environment is called open fracture. It is also known as compound fracture. It is generally more serious than simple fractures with a much higher risk of infection. Signs and Symptoms ^ Intense pain at the fractured site Open ^ Visible deformity in the injured area Fracture ^ Grating sensation on the affected bone ^ Discoloured skin around the affected area ^ Swelling and tenderness around the injured area ^ Bleeding from the injured site in the case of open fracture ^ Bone comes out the skin in the case of open fracture Safety Measures ^ Keep rooms free of clutter ^ Make provision of adequate light in the house ^ Apply safety measures while climbing tree, high wall, etc. ^ Fix hand rail and railing at the stepladder and terrace ^ Follow the traffic rules while driving or walking on the road ^ Play games and sports only after the warm up ^ Practice games and sports only in the presence of well qualified coach ^ Eliminate wires and cords that run across the walking areas 105

First Aid ^ First, check the nature of fractures whether it is open, closed or complicated ^ Keep the victim lying down and still as much as possible ^ Don’t move the casualty except if necessary to avoid further injury ^ In the case of broken bones in limbs, immobilize the area using a splint or sling ^ If there is bleeding, place a clean cloth or hand over the wound and apply gentle pressure to stop the bleeding ^ Take the casualty to the hospital as soon as possible iii. Electric Shock Electric shock is a state caused by the sudden discharge of electric current through a part of the body. When we come in contact with a naked electric wire or electric device with flow of electric current, we get electric shock. In minor electric shock, it may burn the outer layer of the skin (epidermis) or damage subcutaneous tissues too. In severe electric shock, muscle contraction, paralysis and sudden death may happen. Electric shock is always dangerous and may become fatal too. Signs and Symptoms ^ The victim may become unconscious ^ Disorder of heart beat ^ Difficulty in breathing ^ Muscle pain and contraction ^ There will be burnt mark at the site of electric shock Safety Measures ^ Get proper knowledge for handling electrical devises and gadgets ^ Do not touch the naked electric wire and devices ^ Explain the safety rules to the children for using the electric switch and plugs properly ^ Never touch electric wires and devices with wet body or bare hands and feet ^ Only the electrician should set the electrical wire and devices at the school, house and other places as well First Aid ^ Turn off the main switch using bad conductor in the case of low voltage electric shock 106

^ In the case of high voltage electric shock, call for emergency help to the authority ^ If the accident has occurred at the place where there is no switch to put it off, separate the victim from the electric current with the help of bad conductor like dry bamboo, dry wood, etc. ^ Do not touch victim if s/he is still in contact with the current flowing naked electric wire or devices ^ Place the victim in rest condition by covering him with warm cloth ^ Provide plenty of water to drink and liquid food if s/he is conscious ^ Provide artificial respiration if the victim is unconscious ^ Take the victim to the hospital as soon as possible if necessary iv. Altitude Sickness Altitude sickness is an illness caused by ascent to high altitude characterized by nausea, short breathing, rapid heartbeat, mental confusion and headache resulting from the shortage of oxygen. Altitude sickness usually takes place at the place above 3,000 meters altitude. In this condition, brain and lungs are badly affected. Signs and Symptoms ^ Deterioration of neuro-muscular coordination ^ Headache, nausea and vomiting ^ Short breathing and rapid heart beat ^ Fatigue and insomnia ^ Fainting and convulsion may occur ^ In severe condition, bleeding occurs from nose, ears and eyes Safety Measures ^ Do not climb very high altitude once at a time ^ Climb high altitude mountain with oxygen facility ^ Always climb with well trained and experienced assistants and friends ^ Always carry First Aid items and essential medicines while climbing high mountain peaks ^ Always follow the suggestions of experienced and experts while climbing mountain peaks First Aid ^ If the person gets headache and dizziness while climbing on uphill, lower the victim at least 500 m downward 107

^ Oxygen should be given to him/her if available ^ Let the victim rest completely ^ Hot drink can be given to the victim ^ Carry to the nearby health clinic or hospital in the case of severe condition v. Shock Shock is a sudden loss of consciousness. It occurs when the blood supply to the brain is temporarily inadequate and there is a fall in blood pressure. People who become unconscious do not respond to loud sounds or shaking. They may even stop breathing or their pulse may become faint. The sooner the person receives emergency first aid, the better their position will be. Signs and Symptoms ^ The person will be unresponsive to touch, sound or other stimulation ^ Inability to move parts of his or her body ^ Difficulty in breathing ^ Bluish skin colour ^ Inability to speak ^ Unconsciousness Safety Measures ^ Do not let bleeding from the wound and injured site ^ Do not go through stressful physical hard work ^ Drink plenty of water and eat balanced diet regularly ^ Handle electrical appliances carefully and safely ^ Avoid drugs, alcohol and cigarettes ^ Avoiding stressful situation First Aid ^ Lay down the person on his/her back on a firm surface ^ Loosen any constrictive clothing ^ Let the person lie on the ground and rest for at least 15-20 minutes ^ Keep the person warm until medical help arrives ^ Do not let the person get up too quickly [Initiate CPR if pulse is not found] ^ Place the victim in head low position on a flat surface. ^ Kneel down at the right side of the victim nearby his/her shoulder. ^ Clear the mouth for easy passage of air. 108

^ Then close the nostrils of the victim with the hand that was used to press the forehead. ^ Take a deep breath and place the mouth over the victim’s mouth firmly and blow air into the casualty’s lungs until the chest rises. ^ Overlap the left palm with the right palm and the fingers of both hands should be interlocked to one another. ^ Gentle pressure should be given on the sternum for 4/5 times. Then artificial respiration should be given after each cardiac massage. ^ Push down on the chest at about 100 compressions each minute. ^ Cardiac massage should be continued until the victim start of heart beat again or medical help is reached. vi. Snake Bite The incidents of snake bites are generally observed during the summer season. Terai region of Nepal is highly affected area for snake bite because various types of poisonous snakes are found there. Poisonous snake bites, leaves the mark of two long teeth called fangs. On the other hand, if the snake is not poisonous it leaves the mark of several small teeth at that place. Kraits, Banded Krait, Lesser Black Krait, Greater Black Krait, Coral Snake (Naag), Vipers and King Cobra are some highly poisonous snakes available in the Terai and Hilly region of Nepal. Signs and Symptoms ^ Colour of the skin gets changed ^ Mark of teeth can be observed at the bitten site ^ Victim feels difficulty in breathing ^ S/he feels nausea and vomiting ^ Numbness in the face and limbs ^ Froth can be seen in victim’s mouth ^ Dimness in eye sight is observed ^ The victim becomes unconscious in the advanced stage Safety Measures ^ Do not walk with bare feet ^ The surrounding of the house should be kept clean ^ Shoes or gumboot should be used while walking ^ Torchlight should be used while walking at night ^ Burrows and holes in the earth should be closed down with the clay ^ Bushes and grass should be cleared from the surrounding of the residential area 109

Poisonous snake Marks of poisonous snake bite Poison sac Marks of non-poisonous snake bite Fangs Non-poisonous snake First Aid ^ Keep the victim calm and still ^ Do not attempt to suck the venom out by mouth ^ Never use a cold compress on the bite ^ Do not cut at the snake bitten area ^ Do not elevate the bitten part from the level of the heart ^ Use tourniquet just two inches above the bitten area. It should be loosened in every 15 minutes for few seconds ^ Do not let casualty sleep and take him/her to the nearest hospital or snake bite centre as soon as possible [Activity] Organize a First Aid training class in your school for selected students by inviting First Aid trainer in coordination with your school management. Word Meaning Grating : unpleasantly harsh or grating in sound Penetrate : to enter or pass through something Sling : a band suspended from the neck to support an injured arm or hand Spasm : a painful and involuntary muscular contraction Sprain : a painful injury to a joint caused by a sudden wrenching of its ligaments 110

Recap S Safety education is an educational process which teaches about the rules, means and measures to keep us safe from the danger of incidence of accidents. It encourages individuals to follow safety rules in order to keep them safe from the danger of incidence of accidence. S It educates people about safety rules and measures at work, at school, work place, etc. S First Aid can be defined as an immediate care provided to the casualty or ill person during the incident of accident before the arrival of medical treatment. S Responsibility of a First Aider ends as soon as medical treatment is available. If we get the skills of first aid, we can prevent the casualty from the untimely death. S Sprain is an injury due to tearing of ligaments and tissues violently so as to cause pain and swelling at an ankle, wrist and other joints. S A fracture is a broken bone that alters the contour in the bone. Fractures often occur when there is a high force or impact put on a bone. S Fractures are commonly caused by fall, automobile accident or sports injuries. S A clean break to the bone that does not damage surrounding tissue or tear through the skin is known as a closed fracture. It is also known as a simple fracture. S A fracture that penetrates through the skin and exposes the bone and deep tissues to the exterior environment is called open fracture. It is also known as compound fracture. S Electric shock is a state caused by the sudden discharge of electric current through a part of the body. S When we come to contact with a naked electric wire or electric devices with flow of electric current, we get electric shock. S Electric shock is always dangerous and may become fatal too. S Altitude sickness is an illness caused by ascent to high altitude characterized by nausea, short breathing, rapid heartbeat, mental confusion and headache resulting from the shortage of oxygen. S Altitude sickness generally takes place above 3,000 meters altitude. In this condition, brain and lungs are badly affected. S Shock is a sudden loss of consciousness. It is caused when the blood supply to the brain is temporarily inadequate and there is a drop in blood pressure. S People who become unconscious do not respond to loud sounds or shaking. They may even stop breathing or their pulse may become faint. S Terai region of Nepal is highly affected area for snake bite because various types of poisonous snakes are found there. S Poisonous snake bites, leaves the mark of two long teeth (fangs). On the other hand, if the snake is not poisonous it leaves the mark of several small teeth at that place. 111

EXERCISE A. Answer the following questions. 1. What is safety education? 2. Mention the importance of safety education in your life. 3. What is First Aid? 4. What are the aims of First Aid? 5. Mention the signs and symptoms of sprain. 6. What is fracture? Mention its First Aid. 7. What is an open fracture? 8. What is shock? Mention any two safety measures of it. 9. How can you identify poisonous and nonpoisonous snake bite? 10. Mention the First Aid to Snakebite. B. Tick the correct option from the following. 1. First Aid ends as soon as: a. Medical service is available b. First Aider is available c. Engineering service is available d. Telephone service is available 2. There is tearing of ligaments and tissues violently in........................ a. Shock b. Hypertension c. Sprain d. Broken bone 3. Which of the following falls under the sign of poisonous snake bite? a. Mark of small teeth b. Mark of the tail c. Mark of saliva d. Mark of fangs 4. Altitude sickness is an illness caused by ascent to high altitude due to: a. Shortage of Oxygen b. Shortage of Nitrogen c. Hypothermia d. Hyperthermia 5. Which of the following comes under the symptom of electric shock? a. Froth can be seen b. Bluish skin colour c. Muscle spasm d. Burnt mark can be seen C. Write short notes on: a. Sprain b. Shock c. CPR procedure d. Altitude sickness e. Signs and symptoms of poisonous snake bite 112

Unit Family and Community Health 9 Learning Achievement After completing this unit, students will be able to: M Introduce community health. M Explain the relation between family and community. M Mention the activities for the promotion of family and community health. M Mention the utilization of health services from health post, primary health centres and hospitals. All individuals live in a family. The group of individuals living together under the same room and related by blood, marriage or adoption is called a family. There are two types of family. In nuclear family, there are father, mother and their unmarried children. Similarly, in a joint family, there are father, mother, grand parents, son, daughter-in -law, grand sons, grand daughter and so on. Different families forms a community. Community health can be considered as an innovative approach, which can provide preventive, curative promotive and rehabilitative health services through the joint effort and coordination between individual, community and the state. According to Winslow, “Community health is the science and art of preventing disease, prolonging life and promoting health and efficiency through the organized community efforts.” Thus, community plays an important role for the enrichment of community health programs. A. Relation between Family and Community Family is the first and foremost school for everyone. It helps to cultivate good habits of family members. It can shape healthy and hygienic habits and responsible behaviour among the family members. So, family is very important to keep the community healthy. An individual needs family support to take part in community work. Family having good culture and positive attitude can contribute in solving community health problems. When a family starts to keep the surrounding clean, the neighbouring families feel moral 113

pressure and start to maintain healthy habits. Hence, a family can be a key factor to maintain sound health in community. The concept of community health is based on the joint effort of individual, community and the government. Equal participation of all community members is necessary for the management of community health problems. When the community members come together they can easily handle the issues of nutrition, hygiene, sanitation and various health hazards of their community. It encourages public participation and cooperation among the people which makes possible to manage the sewage, drinking water, schools, public toilets, play grounds, public parks, health centers, etc. B. Activities to be Carried out for the Promotion of Family and Community Health a. Health and environment education should be provided to the community people. b. Provision of free distribution of contraceptive devices. c. There should be provision of nutritious food to the children. d. There should be proper management of solid wastes, sewage and public latrines. e. Awareness campaign on family planning, sanitation, solid waste management, safe drinking water, proper nutrition, etc. f. Routinely immunization against the infectious diseases. g. Treatment of common diseases in the community through community based health organizations such as health posts, sub health post and primary health centers. h. Public awareness programs should be carried out to control social problems like gambling, drug abuse, alcoholism, smoking, playing cards, etc. C. Utilization of Available Health Services in the Community The condition of health in our country is not so good. Most of the people in our community are deprived of health facilities and services. Majority of the people are living in poverty, ignorance, and malnutrition. They have poor access to health and sanitation. The diseases like diarrhoea, cholera, tuberculosis, pneumonia, bronchitis, asthma, etc are common in our country. In some communities, people still believe in Dhami and Jhankri instead of health workers. Every-year thousands of people become vulnerable to untimely death due to minor diseases like cholera, dysentery, diarrhoea, pneumonia, typhoid, etc. The government agencies and other different 114

national and international organizations are putting their effort to upgrade health facilities in the country but they are not in the level of satisfaction. Some of the health institutions and their health services are described below: i. Sub-health Post Sub - health post is the bottom level health service institution. It provides basic health services to the community people. The government has adopted the policy to establish at least one sub-health post in each village development committee. There are altogether four staff members in a sub-health post. It is headed by Auxiliary Health Worker (AHW). Status of Manpower in a Sub-health Post Status of Manpower Number Auxiliary health worker (AHW) 1 Maternal child health worker (MCHW) 1 Village health worker 1 Peon 1 Total no. of staff 4 ii. Health Post Number 1 Health Post is one-step higher basic 1 level health institution compared to 1 sub-health post. The number of health 1 workers in health post is determined according to ecological region. There 1 or 2 are seven staff members in Terai region, 1 whereas six health workers are mobilized in Himalayan and Hilly region. The 6 or 7 government has planned to promote sub-health post into health post and the health post into primary health centre. Status of Manpower in a Health Post Status of Manpower Health Assistant or Senior Auxiliary Health worker Auxiliary health worker (AHW) Maternal child health worker (MCHW) Office Assistant Village health worker Peon Total no. of staff 115

Services Available Health post provides the different types of basic health services that include maternal and child health care, family planning, immunization, nutrition education, preventive health care. Moreover, it provides promotive and curative health services to people. In addition, health post coordinates health programs launched by different organizations and institutions as well as district hospital. It also facilitates, regulates and monitors the functions of sub-health posts. iii. Primary Health Centre (PHC) Number Primary health centers are having more 1 facilities than health post. The government 1 has aimed to convert the health post into 1 primary health centers. Furthermore, the 2 government has a policy to establish one 2 primary health centre in each electoral 1 constituency. 1 2 Status of Manpower in a Primary Health Centre 1 12 Status of Manpower Medical Officer (MBBS doctor) Staff nurse Health assistant or senior auxiliary health workers (HA/SAHW) Auxiliary health workers (AHW) Auxiliary nurse and midwives Lab assistant Assistant accountant Village Health Workers (VHW) Peon Total no. of staff Primary health centre provides better quality services than health posts. There are three beds, one for maternal service and two other beds are for emergency service. The primary health centers provide the health services as given below: e Maternal and child health care service e Family planning service e Maternity service e Nutrition awareness programme e Assists, evaluate and monitor the health post and sub-health post e Controls the prevalence of communicable disease 116

e Provides treatment to the patients eRefers the complicated cases to the hospital [Activity] Visit a health post or primary health center nearby your school under the supervision of your teacher and observe the health service provided by the health workers of those institutions. Then discuss in the class about the benefits of those services in that community. iv. Hospital A hospital is a health care institution. It provides treatment to patients by specialized staff and equipment. It is run by professional physicians, surgeons, nurses and other supporting staff. In a hospital, more specialized health services are available with advanced equipment, sophisticated laboratories and the team of specialists. There is B. P. Koirala Health Science Institute, Dharan provision of outdoor and indoor service. Patients are sent to their houses after the diagnosis and treatment of the disease in outdoor service. On the other hand patients are admitted in the hospital and treatment is done with special care in the case of indoor service. Besides this, 24 hours emergency service is also available in hospital. The emergency department provides services to casualties and patients in critical condition. Classifications of Hospitals Hospitals can be classified into two types. One is on the basis of service nature and another is on the basis of region. Service oriented hospitals are classified as general, special and teaching hospitals. There is provision of treatment of all kinds of diseases in general hospital. On the other hand, there is provision of treatment of particular diseases in the special hospital. TB hospital, cancer hospital, orthopedic hospital, etc are the example of special hospital. In teaching hospital different types of treatment is also provided and medical students are produced from that institution. Ayurveda Hospital Ayurveda is a system, which helps to maintain health of a person by keeping the individual’s body, mind and spirit in perfect equilibrium with tune of nature. It is widely regarded as the oldest form of healthcare in the world. Ayurveda believes that the universe is made up of five elements: air, fire, water, earth and ether. 117

1. There is Department of Ayurveda as central unit at the top level in Nepal. The function and area of this department is to formulate policy and planning and to do supervision, evaluation and co-ordination of the Ayuraved hospitals and dispensaries in the country. 2. Under the Department of Ayurveda, there are Zonal Ayurved Hospitals, Zonal Ayurved Dispensaries, District Ayurveda Hospitals and Ilaka Ayurveda Dispensaries in different parts of the county. In the context of Nepal, there is an Ayurved Department in the central level. Currently, Ayurvedic health care is provided from 2 hospitals located in Naradevi in Kathmandu with 50 beds and Bijouri in Dang with 15 beds, 14 Zonal Dispensaries, 50 Ayurvedic Health Centers and 305 Ayurvedic Clinics. Homeopathy Hospital Initially, Pashupati Homeopathic Hospital was established in 1953 AD (2010 BS) with the OPD service and six bedded facilities at Harihar Bhawan, Lalitpur. Free homeopathic treatment and services are currently available at Pashupati Homeopathic Hospital from government level. It is run by one senior medical officer and two homeopathic physicians. In the private sector, the well equipped Nepal homeopathic medical college was established to run bachelor of homoeopathic medicine and surgery (B.H.M.S) in Biratnagar. Similarly, Bhaktapur homeopathic medical college was established in 2008 AD. It has been estimated that around 70 qualified homeopathic doctors are running their private clinics in Nepal. Allopathic Hospitals Allopathic hospital provides treatment to patients by specialized staff. There is provision of more specialized and special treatment of the diseases by the team of specialists. Outdoor, Indoor and 24 hours emergency services are available in such hospital. The services like CT scan, ECG, EEG, Organ Transplantation, Ultrasonography (USG), Surgery, Pediatric, Gynecology, Cardiac, ENT services are available in the central hospitals. There are generally more than 400 beds in the central hospitals. Patan Hospital, Bir hospital, Maternity Hospital, Thapathali, Kanti 118

Bal Hospital, Sahid Gangalal and National Heart Center, are some examples of the central level government hospitals of Nepal. Under the central level hospitals, there are 2 regional hospitals, 10 zonal hospitals and 60 district hospitals. D. Youth Friendly Reproductive and Sexual Health Service Youths have unique reproductive and sexual health needs. The various aspects like hygiene of sexual organs, information and knowledge about sexually transmitted infections, sexual education and safe sexual behavior are the scope of youth friendly reproductive and sexual health (YFRSHS). Young people take on new responsibilities and experiment with independence. When encouraged, they have the potential to change negative social norms and pave a brighter future for themselves and their future families. However, youths are vulnerable to infection of HIV/AIDS, unsafe sexual behaviour and drug abuse due to lack of knowledge and life skill. Hence, there should be provision of quality sexual and reproductive health services to the adolescents and youths in time. The government of Nepal has made its efforts to provide those aforementioned health services to the target population through health posts, sub-health posts and primary health centers in the grass root level so as to make the services accessible throughout the country. To attract the adolescents and youth in the health institutions, the sexual and reproductive health services should be provided by making youth-friendly, simple, affordable, and accessible to all and maintaining privacy. The following aspects should be considered while providing youth friendly reproductive and sexual health services: The subject matters and issues related to sexual and reproductive health provided in the curriculum should be taught by creating youth friendly environment. There should be management of youth friendly health related materials. Sexual and reproductive health service related information should be placed or demonstrated in appropriate places. There should be provision of curtain for privacy in the health examination room. Health services should be provided promptly and efficiently. E. Responsible Behavior and Counseling towards the HIV infected Persons Every human being has immunity power to fight against the diseases. The virus that destroys the immunity power of a man is known as Human Immuno Deficiency Virus or ‘HIV’. HIV destroys a type of white blood cells called CD4+T cells or T-Lymphocytes. An HIV-infected person moves to the AIDS stage when CD4+T cell count falls below 200 per ml blood and attacked by opportunistic diseases like tuberculosis, persistent diarrhoea, cancer of skin and lymph nodes. Because of taboos, it is still believed that to talk about the sexuality is to cross the limitation of the moral and social ethics. Among the various factors it becomes a major reason of high prevalence of HIV/AIDS in our country. HIV can be transmitted via unsafe sexual 119

contact, transfusion of infected blood and sharing of infected needles. We should perform respectful behaviour towards the people living with HIV/AIDS (PLWA). Some of the responsible and respectful behaviour towards PLWA are as follows: Not to discriminate the persons living with HIV/AIDS with the fear of infection or other reason. We should treat them as other normal people. School going children and school dropout children with HIV positive should be given regular counselling. They need to be aware of transmission of HIV/AIDS to other persons. Teaching learning environment should be created also for the HIV victims paying equal respect as others. There should be provision of free education to encourage them for teaching learning activities. There should be guarantee of lodging and fooding of those infected children whose parents are already demised. They can be encouraged for living a long life even after HIV infection. They should be given help and support by friend circle. Check the medicines they are taking. Read the instructions to find out when they need to be taken. Be encouraging and loving to them. If they are too sick to leave their bed, make sure that they have something to drink and a snack nearby. Keep a watchful eye. Look around to see if the house is clean, that there are no hygiene problems and there is enough food. If the sick person lives alone, invite him/her in your family and encourage others in the community to visit them. Do not humiliate and perform risky behaviour to the infected persons. We should suggest them to be away from smoking, alcoholism, drug abuse and unsafe sexual behaviour. [Activity] Organize a rally by involving all the secondary students of your locality to aware people about the prevention and control over HIV and AIDS in your community under the close supervision of your school management. Word Meaning Lymph node : a bean shaped mass of tissue found along the vessels of the lymphatic system Persistent : ever ceasing or continuous Taboos : forbidden, social prohibition or ban 120

Recap S According to Winslow, “Community health is the science and art of preventing disease, prolonging life and promoting health and efficiency through the organized community efforts.” S Family is the first and foremost school for everyone. It helps to cultivate good habit of all family members so that it can shape healthy and hygienic habit and responsible behaviour. S Equal participation of all community members is necessary for the management of community health problems. S When the community members come together they can easily handle the issues of nutrition, hygiene, sanitation and various health hazards. S Community health encourages public participation to manage the sewage, supply of drinking water, public toilets, play grounds, health centre, etc. S Provision of free distribution of contraceptive devices should be made to control the problem of rapid population growth. S There should be proper management of solid wastes, sewage and public latrines to keep the surrounding clean and safe for living. S Routinely immunization against the infectious diseases should be conducted in the community level. S Health post provides different types of basic health services that include maternal and child health care, family planning, immunization, nutrition education and preventive health care. It also facilitates, regulates and monitors the functions of sub-health posts. S Primary health centre provides better quality services than health posts. There are three beds, one for maternal service and two other beds are for other emergency service. S A hospital is a health care institution providing treatment to patients by specialized staff and equipments. In a hospital, more specialized health services are available with advanced equipments, sophisticated laboratories and the team of specialists. S Currently, Ayurvedic health care is provided from 2 hospitals located in Naradevi in Kathmandu with 50 beds and Bijouri in Dang with 15 beds, 14 Zonal Dispensaries, 50 Ayurvedic Health Centers and 305 Ayurvedic Clinics. S According to the CBS, 2015 AD, there are altogether 403 hospitals including private, community, government and cooperative hospitals. S Free homeopathic treatment and services are currently available at Pashupati Homeopathic Hospital from government level. It is run by one senior medical officer and two homeopathic physicians. S There are generally more than 400 beds in the central hospitals. At present, there are altogether 403 hospitals according to CBS, 2015 AD. 121

EXERCISE A. Answer the following questions. 1. What is community health? 2. Explain the relation between family and community. 3. Mention the activities that are to be carried out for the promotion of family health. 4. Write down the services which can be delivered through primary Health Center. 5. Explain briefly about Allopathic Hospital. 6. Explain briefly about Ayurveda Hospital. 7. What is family health? 8. Write any two differences between Health Post and Sub-health Post. 9. Explain briefly about Homeopathic Hospital. B. Write True or False. 1. Participation of all community members is not necessary for the management of community health problems. 2. PHC provides basic health services to the community people. 3. Pitta is responsible for metabolism in the organ and tissue systems. 4. AFRSHS guarantees quality sexual and reproductive health services. 5. The fall in density of T-Lymphocytes in the blood causes AIDS. C. Write short notes on: a. Primary Health Center b. Manpower in Health Post c. Ayurveda Hospital d. Basic health service Community Work Visit an Ayurvedic dispensary nearby your home. Observe the health services provided by that dispensary and discuss it in your class. 122

PHYSICAL EDUCATION Learning Achievement After the completion of this part, the students will be able to: M Do various activities of Physical Exercise. M Perform drills in the timing of drum. M Perform Physical Training according to the timing of drum or Madal. M Do Yogasana. M Play various games of Field-Events according to rule. M Perform various events of Athletics according to rule. Unit Physical Exercise 1 Physical Education Physical education is an educational course related to the shape and size of human body. We learn various ways of keeping our body and mind active, healthy and strong through different physical activities in this subject. The main objective of Physical education is to prepare a physically, mentally, socially and emotionally fit citizen through the physical activities. Physical Exercise Physical exercise is any physical activity that keeps our body physically fit, strong, healthy and active. Regular physical exercise makes the different parts of our body active. It helps for the growth and development of our body. It should be done carefully and with a happy and peaceful mind. It is not necessary that the physical exercise needs an open and wide ground; it can be done even at home. Different physical exercises can be done at a spot. We should be careful that sometimes the physical exercise may harm if it is done when we are not feeling well. Physical exercise can be done at any time. However, it is better to do it in the morning because it provides energy and keeps the body active throughout the day. It is also done to warm the body before playing games. Physical exercise can be helpful to develop stamina, strength and flexibility in our body. 123

Importance of Physical Exercise e It keeps us fit and healthy. e It maintains good appetite, good digestion and also keeps the body and mind fit and fresh. e It helps in our physical, mental, social and emotional development. e It develops a handsome/beautiful personality. e It develops social qualities in the individuals. e It helps in the growth and development of organs. e It increases the resistance power. e It keeps the internal and external condition strong and also develops a holy spirit. e It makes us disciplined and mentally sharp. e It provides satisfaction and happiness in life. Things to consider while doing physical exercise a. Physical exercise should be performed only in the presence of teacher, instructor or supervisor. b. Warm up and cool down exercises should be included in every physical exercise. c. Physical exercise should not be done immediately after meal. d. We should drink enough water before, during and after physical exercise. e. The volume of physical exercise should be decreased if we are tired or the weather is not suitable. Some important exercises 1. Warm-up exercises We need to warm up our body before doing any physical exercise or playing any physical game. There are different warm up steps according to the games. We should do the exercise of hands, wrist and fingers before playing volleyball. Likewise, we should mainly focus on the exercise for waist, hands etc before playing football. Players should run first before learning to play. Exercises for hands, legs, back, the stomach should be done accordingly. A trainer or teacher should first show the ways to do it. 124

2. Exercise for Shoulder, Knee, and Waist a. Exercise for shoulder: While learning the skills to play Volleyball, Kabaddi, Shot Put, Javelin throw, etc, we must do the exercise of shoulder. We should first run in a line before doing the exercise of shoulder. Then, we should push the wall for a moment. If there isn’t any wall, the players can push each other’s palm in pairs. Likewise, we should make the right hand a ‘V’ shaped and place the left hand on it and slowly pull towards the right. This act should be done with both the hands turn by turn. b. Exercise for knee: Before playing or learning the skills of football, basketball, high jump, long jump, etc, we should first do the exercise for the knees. The teacher or instructor should first do and show the activities. Activity: 1 (Pull and bend the legs) Before doing the exercise for the knees, we should first do jogging. Then, we should pull and bend our legs, stand on left leg and pull right feet to hip. For this, we should pull the right feet with right hand. This should be done turn by turn with both legs. Activity: 2 ( Stretch the legs) Stand in a row and follow the count of the instructor. Count-1: Put the right leg ahead and bend it. Count-2: Put the hands on the right knee. Count-3: Stretch the left leg hard Count-4: Stand at ease. Change the legs and do in the same way for 4-5 times. c. Exercise for waist: It is important to do the exercise for waist before playing any game or learning the skills of various games. If we do the exercise for waist, there may be less problem of waist pain. The following activities should be performed for the exercise of waist: Activity: 1 (Bend the body front and back) Stand in attention position and follow the count of teacher. Count-1: Bend your body to touch the ground with fingers. 125

Count-2: Stand in normal position. Count-3: Hold the waist and look at the sky. Count-4: Stand in the initial position. Repeat this process for 5-6 times. Activity: 2 (Bend the body right and left) Stand normally in attention position and follow the count of the teacher. Count-1: Keep the hands straight up together, hold the left hand with the right, and pull towards the right. Count-2: Come to the stand at ease position. Count-3: Again, with the left hand holding the right, bend towards the left. Count-4: Come to the attention position. Repeat this process for 5-6 times. 3. Exercise for Arms and Chest We should focus on the exercise for arms and chest before playing Volleyball, Basketball, Shot Put, Javelin Throw, and Wrestling, etc. Some methods of exercise for arms and chest are discussed below: Activity: 1 (Catch and pull hands) Stand in pairs; one in the front and other in the back, facing the same direction. The one, standing in the front should keep the hands straight backward and the other, standing in the back should pull them downwards. After doing this exercise for 30-35 seconds, change the place and do it by both turn by turn. Activity: 2 (Catch and pull elbow) For this activity, at first, stand in a row. After that, raise right hand and bend it to the back of the neck. Then with the left hand, hold at the elbow of the right hand and pull it towards the left side of back of the neck. It should be done again with the left hand too. 4. Exercise for back The exercise of back reduces the possibility of back pain. Some methods for the exercise for back are discussed below: 126

Activity: 1 (Touch the feet with hand) Stand in a row in attention position and follow the count of teacher. Count-1: Expand the legs and touch right feet with left hand. Count-2: Stand straight and place hands on the waist. Count-3: Touch the left feet with right hand. Count-4: Stand in initial position. While touching the feet, another hand should be straight pointing towards the sky. This process should be done 3-4 times. Activity: 2 (Bend the back looking at sky) At first, stand in a circle and follow the instruction of teacher. Count-1: Jump, expand the legs and hold the back with both hands. Count-2: Slowly bend the back looking at sky. Count-3: Come back to normal position. Count-4: Jump and come to the attention position. This process should be done for 2-3 times. Word Meaning Ease : absence of difficulty or effort Initial : existing or occurring at the beginning Javelin throw : a track and field event where the javelin, a spear is thrown. Stamina : the ability to sustain prolonged physical or mental effort 127

Recap S Physical education is an educational course related to the shape and size of human body. S The main objective of Physical education is to prepare a physically, mentally, socially and emotionally fit citizen through the physical activities. S Regular physical exercise makes the different parts of our body active. S It is better to do physical exercise in the morning because it provides energy and keeps the body active throughout the day. S Physical exercise maintains good appetite, good digestion and also keeps the body and mind fit and fresh. S We need to warm up our body before doing any physical exercises or playing any physical game. S While learning the skills to play Volleyball, Kabaddi, Shot Put, Javelin Throw etc, we must do the exercise of shoulder. S Before playing or learning the skills of football, basketball, high jump, long jump etc., we should first do the exercise for the knees. S If we do the exercise for the waist, there may be fewer problem of waist pain. S We should focus on the exercise for arms and chest before training or playing Volleyball, Basketball, Shot Put, Javelin Throw, and Wrestling etc. S The exercise of the back reduces the possibility of back pain. 128

EXERCISE Answer the following questions. 1. Write down the steps for the following exercises. a. Exercise for shoulder b. Exercise for knee c. Exercise for waist 2. How can we do the exercise for our arms and chest? 3. How is the exercise of knees done? 4. What are the benefits of regular exercise? 5. What is cool down exercise? 6. What is physical exercise? 7. What is the advantage of backbone exercise? 8. What is the advantage of exercise of chest? 9. Which game requires the exercise of arms? 10. Which game requires the exercise of waist? 11. Why is warm up exercise necessary before playing games? Write. 12. Write down any one method of backbone exercise. 13. Write down any one method of shoulder exercise. 14. Write down any one method of waist exercise. 15. Which two games are supported by arm and chest exercise? 16. Which two games are supported by shoulder exercise? 17. Write one advantage of physical exercise. 18. Write the steps of backbone exercise. 129

Unit Drill 2 Introduction The physical activity performed repeatedly according to the command of the group leader or commander along with the drum’s beat or count is called drill. It is a sequence of exercise. It is generally considered as an activity related to military training that involves the constant repetition of a set pattern of movements or tasks. Nowadays it is taken as an inseparable activity of the civic life. It is a physical activity performed in group. Generally, it is performed while presenting the scout or students in the inauguration ceremony of sports. Objective of Drill The main objective of drill is to develop skill and ability to perform a group work in a disciplined manner. Importance of Drill Drill develops a habit of performing works in group with good coordination. It brings uniformity in the group activity. It reduces fatigue and increases appetite. It helps to keep the body active and balanced. Drills make our body strong and help in the development of personality. It helps an individual to be hard working, obedient, patient, leader and helpful. Drill is performed according to the order and direction of the commander. As it is performed in group, it is enjoyable as well. Steps of Drill There are three steps in drill which should be followed in sequence. They are: 1. Instruction: In this step, the commander gives an instruction to the participants to be ready for the action. 2. Command: In this step, the commander gives an order to perform the action immediately. 130

3. Action: In this step, the participants perform actions according to the instructions and order of the commander. Fall Out This command is not a dismissal order. Upon the command Fall Out, the group leaves the position in ranks but remain nearby. On the command Fall In, the squad resumes the place in ranks, and comes to attention. Fall Out command is given for the rest for a short time in the middle of the drill. Fall Out command is given when the group is at attention position. On the command of Fall Out, the group turns right together and moves a step to the right, facing the right and moves forward some steps to its place for rest. Dismiss The Dismiss command is given when the drill is over. This is also commanded at attention position. This is the last stage of drill. In this command, after stepping one step to the right with a salute, the group leaves the position and moves forward. Word Meaning Enjoyable : giving delight or pleasure Squad : a small number of soldiers assembled for drill Uniformity : the quality or state of being the same 131

Recap S The physical activity performed repeatedly according to the command of the group leader or commander as per the drum’s beat or count is called drill. S Generally, drill is performed while presenting the scout or students in the inauguration ceremony of sports. S The main objective of drill is to develop skill and ability to perform a group work in a disciplined manner. S Drill helps an individual to be hard working, obedient, patient, leader and helpful. S Instruction, Command and Action are the three steps of drill. S Fall Out command is given for the rest for a short time in the middle of the drill. S The Dismiss command is given when the drill is over. EXERCISE Answer the following questions. 1. Define drill. 2. How dismiss is done in drill? 3. How ‘Fall Out’ is done in drill? 4. In which condition, the troop is made dismissed in drill? 5. What are the steps of drill? 6. What is ‘Dismiss’ in drill? 7. What sort of capacity does drill develop in a person? 8. When is ‘Dismiss’ command given? 9. When is drill demonstrated? 10. Which part of body is exercised by drill? 11. Why drill is important? 12. Why is ‘Fall Out’ command given? 132

Unit Physical Training 3 Introduction Physical Training is called P. T. in short form. It refers to the exercise of all the parts of body. All the activities that help in keeping the body healthy and fit are called physical training. The physical training was considered as the drill of Army and Police in the past. It has been developed as part of common life and a regular activity of schools. Physical Training is the most important activity for physical fitness and healthy life. It can be done in single, double or in group as per the necessity and condition of the person. Importance of Physical Training M It keeps our body physically fit, fresh and healthy. M It helps to make our body stretchy, energetic and smart. M It fulfills the exercise of all the parts of our body. M It teaches to be disciplined and work accordingly. There are various forms and techniques of physical training. Some of the forms of physical trainings are discussed below: P. T. No. 1: Physical Training for Stretching Body The participants should stand in attention position and perform the following actions in counts: 1. Raise your hands to the shoulder height and stretch it. 2. Raise and stretch your hands above the head from the front. 3. Side your hands and make them straight. 133

4. Bring your hands down from the side and come to attention position. Repeat the actions and stop at count 8. P. T. No. 2: Physical Training for Hands and Legs The participants should stand straight with crossed hands in the front of the waist and perform the following actions in counts: 1. Bend both your knees and stretch your crossed hands toward sides. 2. Bring both the hands down and stand straight with crossed hands in the front. Repeat the actions and stop at count 16. P. T. No. 3: Physical Training for Arms The participants should stand straight with crossed hands in the front of the waist and perform the following actions in counts: 1. Raise your hands without bending from the sides and cross above the forehead. 2. Down the hands and cross in the front. 3. Open the hands and stretch toward the sides at shoulder’s level. 4. Lower the hands and cross them in the front. Repeat the actions and stop at count 16. 134

P. T. No. 4: Physical Training for Chest The participants should stand straight with crossed hands in the front of the waist and perform the following actions in counts: 1. Extend the legs about 20 cm apart and extend hands to the sides. 2. Bring the hands down from the front and make them crossed in the front of the waist. 3. Raise the hands up, extend them sideways, extend the chest and tilt the head backward. 4. Bring both the hands in front of the waist making them crossed. Repeat the actions and stop at count 16. P. T. No. 5: Physical Training for Waist The participants should stand extending the legs about 20 cm apart. They should keep their hands down sideways and perform the following actions in counts: 1. Raise the right hand sideways and bend it leftward. 2. Come back to the initial position. 3. Raise the left hand sideways and bend it rightward. 4. Come back to the initial position. Repeat the actions and stop at count 16. 135

P. T. No. 6: Physical Training for Back The participants should stand extending their legs about 20 cm apart. They should keep their hands down sideways and perform the following actions in counts: 1., 2. & 3. Bend the trunk forward and try to touch the ground with fingers. 4. Come back to the initial position. 5., 6. & 7. Bend the trunk backward keeping both hands on the waist. 8. Come back to the initial position. Repeat the actions and stop at count 16. P. T. No. 7: Physical Training for Chest and Waist The participants should stand with hands down sideways and legs about 20 cm apart. Then, they have to perform the following action in counts: 1. Rotate the trunk leftward keeping right hand in the front of waist and left hand on the back. 2. Rotate the trunk rightward keeping left hand in the front of waist and right hand on the back. 3. Repeat no. 1 4. Repeat no. 2 5. Swing both the hands leftward. 6. Swing both the hands rightward. 136

7. Swing both the hands leftward. 8. Stand at initial position. Repeat actions and stop at count 16. P. T. No. 8: Physical Training for Shoulder and Neck The participants should stand at attention position and perform the following actions in counts: 1. Extend the legs apart and touch the shoulders with the fingers of respective hands. 2. Raise the hands straight upward and the heels to stretch the body. 3. Bring the hands down to put on the shoulders and down the heels on the ground. 4. Come back to attention position. Repeat the actions and stop at count 16. P. T. No. 9: Physical Training for Chest The participants should stand at attention position and perform the following actions in counts: 1. & 2. Extend the left leg leftward and bend the trunk to touch the left toe with fingers. 3. & 4. Raise the trunk upward and bend gradually backward. Stretch the hands backward down and keep the chest stretched. 137

5. & 6. Raise the trunk upward and bend frontward to touch the right toe with fingers. 7. & 8. Raise the trunk upward and bend gradually backward. Stretch the hands backward down and keep the chest stretched. Repeat the actions and stop at count 16. P. T. No. 10: Physical Training for Rotating Body The participants should stand extending their legs about 20 cm apart and stretching both hands rightward straight from the shoulder. They should perform the following actions in counts: 1., 2., 3., & 4. Lower the hands and body frontward and rotate the upper part of body from right to left, raise up the trunk with the hands leftward straight from the shoulder. 5., 6., 7. & 8. Lower the hands and body frontward and rotate the upper part of body from left to right, raise up the trunk with the hands rightward straight from the shoulder. Repeat the actions and stop at count 16. P. T. No. 11: Physical Training for Jumping with both Legs The participants should stand at attention position at first and perform the following actions in counts: 138

1, 2, 3 & 4. Keep both the hands straight down on either side of thigh and jump four times lightly. 5, 6, 7 & 8. Extend both the hands and legs and join them simultaneously. Repeat the actions and stop at count 16. P. T. No. 12: Physical Training for Cool down (A) The participants should stand straight with crossed hands in the front of the waist and perform the following actions in counts: 1. Bend the knees and gradually extend the hands sideways, raise the heel upward and stand straight on toes. 2. Bring the hands to initial position and stand straight. Repeat the actions and stop at count 16. P. T. No. 13: Physical Training for Cool down (B) The participants should stand at attention position and perform the following actions in counts: 1 & 2. Take long breath and raise both hands upward from the front. 3 & 4. Lower the hands from sideways with breathing out and come to initial position. 139

Word Meaning Simultaneously : at the same time Stretch : extend by force Swing : move or cause to move back and forth or from side to side Recap S Physical Training refers to the exercise of all the parts of body. S Physical Training helps to make our body stretchy, energetic and smart. S Physical trainings and their benefits: P.T. No: 1 For stretching body P.T. No: 2 For exercise of hands and knees P.T. No: 3 For exercise of arms P.T. No: 4 For exercise of chest P.T. No: 5 For exercise of waist P.T. No: 6 For exercise of back P.T. No: 7 For exercise of chest and waist P.T. No: 8 For exercise of shoulder and neck P.T. No: 9 For exercise of chest P.T. No: 10 For exercise of rotating body P.T. No: 11 For exercise of jumping with both legs P.T. No: 12 For exercise of Cool down “A” P.T. No: 13 For exercise of Cool down “B” 140

EXERCISE Answer the following questions. 1. What is physical training (PT)? 2. Why is physical training necessary? 3. How is the physical training done for waist? 4. Which PT No. is useful for the exercise of arms? 5. Why is PT No. 13 done? 6. Why should we do all forms of physical training while doing PT? 7. Write down any two advantages of physical training. 8. Which part of our body is exercised by the following PT? a. PT No. 1 e. PT No. 5 i. PT No. 9 b. PT No. 2 f. PT No. 6 j. PT No. 10 c. PT No. 3 g. PT No. 7 k. PT No. 11 d. PT No. 4 h. PT No. 8 141

Unit Yoga 4 Introduction Yoga is a Hindu spiritual and ascetic discipline. It includes breath control, simple meditation, and the adoption of specific bodily postures. It is widely practiced for health and relaxation. Yoga is self-discipline. It is a way of life which plays an important role in the development of personality. It is also a medical science of physical and mental diseases. It makes the body free from physical, mental and spiritual sickness and creates freshness and happiness in our daily life. Importance of Yoga M Yoga shows the pathway of self realization. M Yoga is practical approach to achieve ultimate goal of life. M Yoga alleviates our sufferings M Yoga is a science of personality development. It aims to achieve success through a series of physical and mental exercises. At the physical level, the methods comprise various yoga postures or ‘asanas’ that aim to keep the body healthy. The mental techniques include breathing exercises or ‘pranayama’ and meditation or ‘dhyana’ to discipline the mind. Creates peace Encourages self care Improves circulation Develops positive attitude Benefits Increases joint flexibility of Yoga Reduces anxiety Raises consciousness Reduces high blood pressure Relieves back pains 142

Ashtanga Yoga “Ashta” means eight and “Anga” means limbs. So, Ashtanga Yoga means “eight- limbed yoga”. They are described by the sage Patanjali in the Yoga Sutras. The Astanga Yogas are: 1. Yama : moral codes 2. Niyama : self-purification and study 3. Asana : posture 4. Pranayama : breath control 5. Pratyahara : sense control 6. Dharana : concentration 7. Dhyana : meditation 8. Samadhi : self realization In this lesson, we will practice some postures (Asana) and Pranayama. Surya Namaskar (Sun Salutation) It is a set of 12 powerful Yoga Asanas (postures). The regular practice of Surya Namaskar improves the circulation of blood throughout the body, maintains health and helps one remain disease-free. These postures are good ways to keep the body in shape and the mind calm and healthy. It is best to practice early in the morning on an empty stomach. It should be done along chanting Mantras in every posture. In simple words, Surya Namaskar is a combination of 12 different postures, followed in a particular sequence with a specific breathing pattern. Procedure of Surya Namaskar One can keep a small carpet or a small piece of cloth to stand on it. But it should be clean and kept safely after the entire activity is over. Also there are 12 names of lord Sun, which will be chanted during the entire exercise. Each round consists of 12 postures or positions and there are 12 rounds in total. Step: 1 Stand with your feet together and palms folded in front of your chest. Close your eyes properly and chant the Mantra-Om Mitrayah Namaha. Then breathe normally. Health benefits Promotes balance, stimulates the respiratory system, exercises shoulder, back and neck muscles 143

Step: 2 Raise your arms over your head and shoulders with the palms touching each other and biceps touching your ears. Stretch your abdomen as much as possible and lean backwards. Inhale and chant Om Khagaya Namaha. Health benefits Promotes balance, promotes digestion, exercises arms and shoulder muscles, tones the spine, promotes flexibility in back and hips Step: 3 Bend forward and place your palms at the side of your feet. Touch your knee with forehead and exhale deeply, while chanting Om Suryaya Namaha. Health benefits Promotes blood circulation, tones abdominal tracts, stretches back and leg muscles, stimulates spinal nerves, stimulates lymphatic system Step: 4 Take one leg back and place the other leg in the front with palms firm on the ground. Raise your head and inhale while chanting Om Bhanuvae Namaha. Health benefits Exercises spine, strengthens hand and wrist muscles Step: 5 Bring the leg that was in front next to other one and keep the hips off the floor with both your hands supporting the body in a push-up position. Exhale and chant Om Ravi Namaha. Health benefits Stimulates blood circulation, strengthens the heart, strengthens wrist and arm muscles, relieves neck and shoulder tension 144

Step: 6 Lower your knees, chest and forehead with your palms firmly on the ground next to your chest and elbows bent upwards. Hold your breath here and chant Om Pushnae Namaha. Health benefits Strengthens leg and arm muscles, increases flexibility in neck and shoulders, stretches arms, shoulder, neck and back muscles, exercises back muscles, releases tension in neck and shoulder Step: 7 Lower your waist and raise your upper body. Look upwards and keep your arms straight. Then inhale at a slow pace and recite Om Hiranya- Garbhaya Namaha. Health benefits Stimulates circulation to abdominal organs, tones digestive tract, stretches upper and lower body, promotes flexibility in the back, stimulates nerves in spine Step: 8 Raise your hips and bring your head to the floor with eyes on the navel and heel on the floor. This position will exactly look like an inverted ‘V’. Then as usual exhale and chant Om Marichiye Namaha. Health benefits Stimulates blood circulation, strengthens the heart, strengthens wrist and arm muscles, relieves neck and shoulder tension Step: 9 In this step, the posture is the same as the fourth step but the legs should be exchanged. Inhale and chant Mantra Om Adityaya Namaha. Health benefits Exercises spine, strengthens hand and wrist muscles 145

Step: 10 In this step, the posture is the same as the third step. You need to exhale while hymning Om Savitre Namaha. Health benefits Promotes blood circulation, tones abdominal tracts, stretches back and leg muscles, stimulates spinal nerves, stimulates lymphatic system Step: 11 This stage is same as the second stage. Inhale and chant Om Arkaya Namaha. Health benefits Promotes balance, promotes digestion, exercises arms and shoulder muscles, tones the spine, promotes flexibility in back and hips Step: 12 This stage marks the final stage of Surya Namaskar and it is similar to the first stage. You have to breathe normally and recite Om Bhaskaraya Namaha here. Health benefits Promotes balance, stimulates the respiratory system, exercises shoulder, back and neck muscles 1 2 3 4 5 6 7 8 9 10 11 12 146

Asana Asana is defined as ‘posture or pose’. Its literal meaning is ‘seat’. It is a part of Yoga. In Yoga, Asana refers both to the place in which a practitioner sits and the posture in which he or she sits. In the Yoga Sutras, Patanjali defines “Asana” as “to be seated in a position that is firm, but relaxed”. Asana makes the body active, healthy and flexible. It is useful in various conditions. Some of the Asanas are described below. 1. Setu Bandhasana It is a Sanskrit name where it indicates bridge. The word is divided into two parts: “Setu” means bridge whereas “Bandha” means lock or bind. Since, it resembles to bridge hence known as bridge formation pose. Procedure 1. To begin it, lie on your back. 2. Fold your knees and keep your feet hip distance apart on the floor, 10-12 inches from your pelvis, with knees and ankles in a straight line. 3. Keep your arms beside your body, palms facing down. Inhaling, slowly lift your lower back, middle back and upper back off the floor; gently roll in the shoulders; touch the chest to the chin without bringing the chin down, supporting your weight with your shoulders, arms and feet. Feel your bottom firm up in this pose. Both the thighs are parallel to each other and to the floor. 4. If you wish, you could interlace the fingers and push the hands on the floor to lift the torso a little more up, or you could support your back with your palms. 5. Keep breathing easily. 6. Hold the posture for a minute or two and exhale as you gently release the pose. Benefits ^ Strengthens the back muscles, ^ Relieves the tired back instantly, ^ Gives a good stretch to the chest, neck and spine, ^ Calms the brain, reducing anxiety, stress and depression, ^ Opens up the lungs and reduces thyroid problems, ^ Helps improve digestion, ^ Helps relieve the symptoms of menopause and menstrual pain, ^ Helpful in asthma, high blood pressure, osteoporosis, and sinusitis. Contraindication ^ Avoid doing this pose if you are suffering from neck and back injuries. 147

2. Makarasana (Crocodile pose) Makarasan or the Crocodile pose is a yoga asana used for relaxation. In sanskrit, ‘Makar’ means crocodile and ‘Asana’ means a pose. Makarasana is a yogic pose useful for people with back and shoulder problems. Procedure 1. Lie down on the floor on your stomach with your hands folded under the head. 2. Place the palms on your shoulders in a relaxed way and close your eyes. 3. Stretch the legs as far as possible. The toes should point outwards. 4. Relax the whole body. Breathe normally and slowly. Feel the whole body touching the ground and the deep relaxation in all your muscles. 5. Relax in this posture for 2-5 minutes. Releasing Procedure 1. Slowly bring the feet together. 2. Unfold the arms and come to the Prone Position. Benefits This asana can be done as a relaxation pose between other asanas or it can be relaxation method when you are tired. You can be in this asana for a prolonged period of time if you are tired after a workout. It gives deep relaxation to the shoulders and the spine. Alternate procedure for Makarasana Procedure 1. Lie down on your chest with head on the floor 2. Place the elbows on the ground. And raise your head and shoulders. 3. Rest the head in the palms of the hands. 4. The legs should be kept straight and relaxed. 5. Keep the eyes closed. 6. Remain in this position for 2-5 minutes 148

Releasing Procedure 1. Slowly remove the palms from under the chin and roll over and lie down on your back. 2. If you feel any tension in the back muscles, you may want to do a slight forward bend, without strain. Please remember that too much of forward bending should be avoided by patients with slipped disk. Benefits This variation of Makarasana is excellent for people suffering from spondylitis, slipped disk or any other spinal disorder. They can maintain this position, for as long as it is comfortable. This variation is also good for asthmatic patients and people with lung disorders. 3. Halasana This yoga pose gets its name from the plow (a popular farming tool commonly used in agriculture to prepare the soil for sowing crops). Procedure ^ Lie on your back with your arms beside you, palms downwards. ^ As you inhale, use your abdominal muscles to lift your feet off the floor, raising your legs vertically at a 90 degree angle. ^ Continue to breathe normally and supporting your hips and back with your hands, lift them off the ground. ^ Allow your legs to sweep in a 180 degree angle over your head till your toes touch the floor. Your back should be perpendicular to the floor. This may be difficult initially, but make an attempt for a few seconds. (Tip: Do this slowly and gently. Ensure that you do not strain your neck or push it into the ground.) ^ Hold this pose and let your body relax more and more with each steady breath. ^ After about a minute (a few seconds for beginners) of resting in this pose, you may gently bring your legs down on exhalation. (Tip: Avoid jerking your body, while bringing the legs down.) Benefits ^ Strengthens and opens up the neck, shoulders, abs and back muscles ^ Calms the nervous system, reduces stress and fatigue ^ Tones the legs 149

^ Stimulates the thyroid gland, strengthens the immune system ^ Helps women during menopause Contraindication ^ Avoid practicing Plow Pose (Halasana) if you have injured your neck, suffering from diarrhea and high blood pressure. ^ Ladies should avoid practicing Plow Pose (Halasana) during pregnancy and during the first two days of the menstrual cycle. ^ Consult a doctor before practicing Plow Pose (Halasana) if you have suffered from chronic diseases or spinal disorders in the recent past. Pranayama Pranayama is mainly an exercise with air. The Sanskrit word ‘prana’ means breath or life force, while ‘ayama’ means regulation or control. Pranayama is a scientific method of controlling the breath, leading to better health for both mind and body. It is the fourth part of the Astang Yoga (eight limbs) described by Patanjali in the Yogasutra. Pranayama develops the power of concentration and clarity of thought. It also increases the mental and physical powers. Benefits ^ Increases and enhances the quantity and quality of prana. ^ Clears blocked nadis (energy channel in yoga) and chakras( center of spiritual power in body). ^ Makes one energetic, enthusiastic and positive. ^ Brings harmony between the body, mind and spirit, making one physically, mentally and spiritually strong. Breathing is the only means to supply our bodies and its various organs with the oxygen which is vital for our survival and purifies the blood stream, removes waste products and toxins from the body. Breathing also affects our state of mind. The air is regarded as a great purifier as well as giver of life to the inner organs of the body. The body makes good use of air during pranayama. The breathing process chiefly involves two activities; inhaling and exhaling. Of these the former is called “Puraka” and the latter “Rechaka” in Yogashastra. The state when these two activities are made to halt is given the name “Kumbhaka” in Yoga Studies. There are various types of Pranayama. Some of them are described below. 1. Bhastrika Bhastrika Pranayama means “bellows breath”: exhaling quickly and forcefully. In Sanskrit, Bhastrika means the ‘bellows’. Just as the blacksmith blows his bellows 150