HPE Book 10_2076 Edition

Ü Establishment of pressure groups like mothers’ group, youth club and bal samuha to avoid and discourage bad habits from the society Ü To report to the police if anybody is involved in criminal activities indulging in bad habits Activities You can see some persons indulged in the bad habits in your community. What sorts of efforts can be applied to make them quit those bad habits? Discuss this issue with your friends and present the conclusion in the class. 9.5 Smoking, Drugs and Alcoholism 9.5.1 Smoking Tobacco is the dry leaves of the plants of Nicotiana Tobaccum. All species of tobacco plants contain the recreational drug called nicotine, in all parts of plants except the seeds. It is a powerful poison. Tobacco products can generally be divided into two types: smoked tobacco and smokeless tobacco. Tobacco smoking directly affects the lungs, heart and brain. In addition to the risk of heart disease, smoking increases the risk of chronic bronchitis, respiratory disorders, retarded fetal development and so on. The smoke includes vaporized chemicals, gases, particles of tar, nicotine and hundreds of cancer causing substances. All these are harmful substances to health. Among them, carcinogens cause cancer and other fatal diseases too. A. Causes of Smoking It is found that smokers fall sub consciously in a habit by imitating the smokers in the society. The smokers give different answers if they are asked the reason of smoking. People start smoking due to multiple physiological, psychological and social factors. However, the main causes for smoking are listed below: Sometimes as a matter of entertainment and fun and under the pressure of their bad company. If all senior members at home have the habit of smoking, the children also imitate such habit. Some people begin to smoke by the influence of smokers in their society and working places. Some people start smoking for a status symbol. Children being curious about its taste start smoking. Health, Population and Environment Education-10 251

Some young persons begin to smoke as a fashion. Many others imitate smoking under the impression of various advertisements. They fall under the false impression that smoking increases their thinking power and it also stops their worries and anxieties. B. Effects of Smoking In the following section, we shall study about immediate effects and long-term effects of smoking on our health. 1. Immediate Effects M Coughing is often the result of smoking M Smoking causes headache, vomiting and stomach pain M Bad breathing M Giddiness and nausea M It causes heart beating faster 2. Long-term Effects Smoking for a long period of time results into some effects known as long-term effects. They are as follows: M Teeth, skin and fingers become pale because of the direct effect of nicotine M Nicotine is stored in different sensitive organs of our body M Heart beating becomes faster, blood- pressure increases and often the smoker feels irritated M Social prestige is damaged M Wounds may appear in the gums and in the mouth M There is a possibility of heart attack Healthy Lungs Smoker’s Lungs and lungs-cancer M Sometimes incidence of miscarriage and still birth may happen as a direct effect of smoking M Smoking may affect the movement of heart leading to death M Women may become sterile due to smoking 3. Preventive Measures M Avoid the company of bad friends and smokers. M Family members must be aware about the bad effects of smoking. M Efforts should be made to declare certain areas as smoke prohibited areas. 252 Health, Population and Environment Education-10

M At present, Government of Nepal has banned the advertisement of smoking and other intoxicating things from radio, TV and other NO electronic means. The advertisement of smoking from other sources too should be restricted. M Parents should practice healthy habits. If they have smoking habit it should not be in front of the children. M Increment in the tax of tobacco. M Youngsters should be encouraged for other recreational activities. 9.5.2 Alcohol An alcoholic beverage is a drink that contains ethanol. It is believed that the alcoholic beverages have been consumed by humans since the beginning. The use of alcohol has been a traditional practice in all most all human societies. Different people use it in different manner for different purposes. Some people use it as a form of religious rituals. Some consume it in some special ceremonies and others consume it to entertain themselves at party and meeting with friends and family. Alcoholic beverages are divided into three general classes such as beer, wine, and distilled beverages (liquors). A distilled alcohol or liquor is an alcoholic beverage produced by distilling ethanol by means of fermenting grains, fruits or vegetables. For the most common distilled beverages: such as in whiskey and vodka, the alcohol content is around 40 percent. Vodka, gin, whiskey, brandy, etc are the examples of distilled beverage. On the other hand, wine and beer are fermented beverages produced from grapes and food grains. In which, wine involves a longer fermentation process than beer (months or years), resulting in an alcohol content of 9 percent to 16 percent. Similarly alcohol content in beer is 5-7% in average. In the context of Nepal along with those wine, beer and liquors the local alcohol like jad, raksi, chhyang, aaila, nigar and tongba are commonly available in the market. Alcohol is legally consumed in most of the countries around the world. So, selling and drinking wine is not an illegal practice in most of the society. However, alcohol Health, Population and Environment Education-10 253

consumption is injurious to our health. It is said that a glass of pure alcohol once at a time is a fatal dose to human body. A. Reasons for Drinking Alcohol The reasons for drinking alcohol may differ from person to person and culture to culture. However, some reasons are listed as follows: Due to the assumption of reducing tension. In getting together with friends as a recreational purpose. Some have logic that alcohol helps in digesting food. Some are attracted by advertisements. Some use it as beverage which gives energy to them. Some use alcohol under the pressure of his circle. Some people have tradition to drink. Due to lack of proper guidance. Broken environment at home. In some ethnic communities, alcohol is used in social rites and rituals. Young people are curious towards its taste and start drinking. B. Effects of Alcohol 1. Immediate Effects M Alcohol acts as both a ‘stimulant’ and a ‘depressant’. M Decrease in thinking capacity. M Results in uncontrolled activities. M Body becomes imbalance and passive. M Family life and personal relationship are disturbed. M It reduces the eye muscle’s ability and causes poor focus, double vision and reduction in night vision. M Impairs memory and judgment. 2. Long-term Effects Healthy Liver Liver after alcoholic cirrhosis M Overuse makes the drinker vulnerable to peptic ulcers, cirrhosis, pancreatitis, gastritis and heart disease. 254 Health, Population and Environment Education-10

M The gastrointestinal tract is usually affected and digestion becomes worse. M The liver is the principal engine, adversely affected by alcohol. M Alcoholism leads to infertility. M It adversely affects the social prestige of the individual. M Increases the risk of heart failure and stroke. C. Prevention of Alcoholism M One must avoid the company of the friends who have already formed the habit of drinking alcohol. M If there is a culture to drink wine, it must gradually be reduced. Family members should be educated about its hazards. M Drinking alcohol should be prohibited in public places. M Health education must be extended to make aware of the adverse effects of drinking alcohol. M Advertisement of alcohol must be banned. M Increment in the alcohol taxation. M Self control. 9.5.3 Drugs A drug is a substance which may have medicinal and intoxicating performance when taken into a human body and is not considered as food. According to WHO, “A drug is any substance that when taken into the living organism may modify one or more of its functions.” In other words, drug is a substance that affects the structure and functioning of a living organism. The term medicine is sometimes preferred for therapeutic drugs in order to distinguish them from narcotics and other addictive drugs which are used illegally. In other words, drug is “a chemical substance used in the treatment, cure, prevention, and diagnosis of disease.” When properly used, therapeutic drugs relieve pain and suffering, cure disease and maintain good health. If abused, they can severely damage health and well-being. While talking about the narcotic drugs, some drugs stimulates the body, some of them are proved to be depressant, while some of them hallucinate the user. Cocaine, Brown Sugar, Heroin, Opium and Hasis are the example of some common narcotic drugs. Such drugs can cause addiction and habituation. Recreational substance use is the use of psychoactive substances to have fun for the experience. Many recreational drugs are legal and culturally accepted. These recreational substances include alcohol, tobacco, and betel nut products. Although many recreational drug use is controversial. Moreover, cigarettes and alcohol can be perceived as legal drugs. Lysergic acid diethylamide (LSD), is an illegal recreational drug derived from a parasitic fungus. LSD is the most well-known hallucinogenic drug. Illegal drugs aren’t good Health, Population and Environment Education-10 255

Opium Plants Heroin Marijuana for anyone particularly for kids and teens whose body is still growing. Narcotic or illicit drugs can damage the brain, heart, and other important organs. Cocaine, for instance, can cause heart attack. While using drugs, people are also less able to do well in school, sports, and other activities. Addiction of these illicit drugs may even ruin the precious life. Strictly speaking, all medicines are drugs, but not all drugs are medicines. For example, the articles such as plastic glue, paint thinners and removers, brown sugar, dendrite, heroin, cocaine, etc are drug but they cannot be considered as medicine. Difference between Drug Abuse and Addiction Drug Abuse Drug Addiction Ü Drug abuse is persistent or Ü Drug addiction is a condition in excessive intake of drugs for which the addict is committed reasons other than medical, in an to the drug physically and amount, frequency and manner psychologically. that damage the physical and mental functioning of an individual. Ü In simple term, it can be said as the Ü In simple term, it can be said repeated misuse of drugs. as physical and psychological dependency on drugs. Ü Drug abuse may result into drug Ü Drug addiction results into addiction. tolerance ladder (dose needs to be increased to get the same level of satisfaction and functioning). Ü It does not develop withdrawal Ü It develops withdrawal symptoms symptoms over the abuser. among the addicts. Ü In this condition, it is easy to rescue Ü In this condition, it is a little bit the hooked persons. difficult to rescue the addicted persons. 256 Health, Population and Environment Education-10

A. Reasons for Drug Abuse Drugs are taken to forget discomfort and frustrations of life. The addicted friends usually influence their friends to this habit. In Nepal, some people use drugs to worship and please Lord Shiva. Drift towards western culture, sense of pseudo freedom and urbanization. Personality problem also makes a person more prone to drug addiction. The smugglers may trap the persons in drug abuse. Imitating elders and celebrities. B. Effects of Drug Abuse Memory power becomes weak. There is disharmony between thinking and activities. Change in facial appearance and looking intoxicated all the time. Increase in heart beat and blood pressure. Loss of appetite and the body becomes exhausted. Vomiting and the feeling of nausea. Social reputation of an individual gets degraded. Injecting drug with an unsterilized syringe may cause STIs like AIDS, Hepatitis ‘B’ and ‘C’. Reduction in reproductive performance. Drug addiction leads to social disorder and criminal activities. Immunity power weakens, which leads to ill health. C. Way to Control and Prevent Drug Abuse We must aware the people of the harmful effects of drug addiction through community participation. There must be effective control mechanism against smuggling of narcotic drugs in the society. There should be management of sports and other recreational programs so that in leisure time, young people will involve themselves in such activities. There should be discussion on the adverse effects of drug addiction among family members and neighbors. There must be a good relationship among the family members. Laws against smuggling of illicit drugs must be implemented strictly. Encouraging the child to believe in himself. Advising addicts to seek treatment from hospitals and counselling from rehabilitation centres. Health, Population and Environment Education-10 257

Summary Ü The concept of community health developed in England at the beginning of the 19th century as public health. Ü Community health is the science and art of the preventing disease, prolonging life, and promoting health and efficiency through the joint effort of individuals, community and the state. Ü It is a justice based innovative health approach, which provides preventive, curative, promotive and rehabilitative health services. Ü The strength of the community health depends upon the role of individuals, community, and the government. Ü There must be proper coordination and involvement of statistician, health experts, sociologists, researchers, and the community members not only between doctors and between epidemiologists to promote community health programs. Ü Preventive Health service encompass a variety of interventions that can be undertaken to prevent or delay the occurrence of disease or reduce further transmission or exposure to disease. Ü Preventive care can include immunizations, lab tests, physical exams and prescriptions. Diagnostic services help your doctor understand your symptoms or diagnose your illness. Ü The process of producing immunity to an infectious disease in an individual through vaccination is called immunization. Health promotion involves public policy that addresses health determinants such as income, housing, food security, employment, and quality working conditions. Ü Health promotion is aligned with health equity and can be a focus of NGOs dedicated to social justice or human rights. Ü In Nepal, Expanded Immunization Program was started after the eradication of Smallpox in 2034 BS (1975 AD). Ü Expanded program on Immunization including BCG, DPT, Oral Polio Vaccine, and Measles was expanded to all 75 districts by 1989 AD. Ü Currently eleven antigens are provided through the routine immunization under National Immunization Program of Nepal. Ü Drug is a chemical substance used in the treatment, cure, prevention, and diagnosis of disease, hence when properly used therapeutic drugs relieve pain, suffering and cure disease. If abused, they can severely damage health and well- being. Ü Cocaine, Brown Sugar, Heroin, Opium and Hasis are the example of narcotic drugs. Such drugs can cause addiction and habituation. Ü Recreational drugs are the psychoactive substances that have been used to have drugs fun. Ü Many recreational drugs are legal and culturally accepted. These recreational substances include alcohol, tobacco, and betel nut products. Ü Lysergic acid diethylamide (LSD), is an illegal recreational drug derived from a parasitic fungus. LSD is the most well-known hallucinogenic drug. 258 Health, Population and Environment Education-10

EXERCISE A. Very short answer questions. 1. What do you mean by community health? 2. When was expanded immunization started in Nepal? 3. What is promotive health service? 4. Name any two health services that fall under preventive health service. 5. Mention any two functions of regional level health service delivering agencies. 6. Write any two roles of health post in preventing health problems. 7. Mention any two long term effects of alcoholism. 8. How many beds are there in a primary health center? 9. Mention any two objectives of NHEICC. 10. Name any two chemicals found in tobacco which are injurious to health. 11. What is the target of 13th three year interim plan for Infant Mortality Rate? 12. Write the full form of DOTS. B. Short answer questions. 1. Explain any two major health problems of Nepal? 2. Write any five policies formulated by the 13th Three Years Interim plan of Nepal. 3. Write any five differences between primary health centre and health post. 4. Describe briefly the reason behind inadequate health services in Nepal. 5. Why is malnutrition considered as one of the major health problems of Nepal? Give reasons. 6. “Life style of Nepali people is the major health problem of Nepal.” Justify. 7. Give introduction to Nepal Heart Foundation and elaborate its activities. 8. What contribution is made by the establishment of primary health center in promoting community health? Explain. 9. Mention the objectives and programs of Nepal Anti-Tuberculosis Association. 10. “Prevention is better than cure”. Justify the statement. 11. Explain various kinds of bad habits with suitable examples. 12. Why is lack of health education considered as a major health problem in the context of Nepal? C. Write differences between: 259 1. District hospital and central level hospital 2. Drug abuse and drug addiction 3. Preventive and curative aspect of health service 4. Health post and primary health centre Health, Population and Environment Education-10

D. Write short notes on: 1. Family Planning Association of Nepal 2. Role of family for community health 3. Nepal Leprosy Relief Association 4. Zonal hospital 5. Expanded Immunization Program E. Long answer questions. 1. What is community health? Analyze the scope of community health. 2. Critically examine the various aspects of health services with suitable examples. 3. Elucidate the role of individuals and community to solve the community health problems. 4. You can see some people smoking even in public places. Mention the reasons of smoking and suggest the possible measures to minimize this social problem. 5. Give introduction to CB-IMCI. Mention the objectives and functions of CB- IMCI. 6. Critically evaluate the activities undertaken by some non-profit making organizations such as FPAN, NATA, NLRA of Nepal in terms of their contribution in the health sector. 7. Mention the recent health policy of Nepal. Is this policy strong enough to promote the health status of the people in the country? Project Work Conduct a case study about the organizational structure and service delivery system of a health post or community hospital of your locality under the sub-titles that are given below: I. Introduction a. Background of the Study b. Objective of the study c. Significance of the Study d. Limitation of the Study II. Methodology a. Study Area b. Sources of Data c. Method of Data Collection III. Findings IV. Conclusion and Recommendation 260 Health, Population and Environment Education-10

UNIT PRIMARY HEALTH CARE, PRECAUTIONS AND SECURITY 10 ON RISK Learning Achievement After completing this unit, students will be able to: Tell the meaning and importance of First Aid. Elaborate the important points to be considered while providing First Aid. Tell the essential articles to be available in the First Aid box. Explain the process of Expired Air Resuscitation-EAR and External Cardiac Compression. Tell the process of First Aid of wound, choking, snake bite, allergy, high altitude sickness, frostbite, drowning, sprain, etc. Explain the ways to keep sound human health and safe life style. 10. 1 Methods and Procedure of First Aid 10.1.1 Meaning of First Aid First aid is the immediate care given to someone suffering from an injury or illness until the arrival of a doctor or admission to hospital. In other words, First aid is the help given to someone who is injured or ill, to keep them safe until they can get more advanced medical treatment by seeing a doctor, health professional or go to hospital. It can be considered as the assistance provided to the casualty or ill patient at the time of emergency with such materials as may be available there. First Aid is not a medical treatment so the responsibility of a First Aider ends as soon as medical treatment begins. 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. If we get the skills of first aid, we can prevent the casualty from untimely death. For the effective First Aid, s/he should be resourceful, tactful, courageous, kind and skilful. The aim of first aid is to prevent a deterioration of the victim’s situation, to aid recovery, and to preserve life. In serious cases, first aid may be necessary to keep the victim alive. Health, Population and Environment Education-10 261

Objectives M To save life M To minimize injuries M To hasten healing M To prevent illness from becoming worse M To prevent the casualty’s condition from deteriorating any further. 10.1.2 Importance of First Aid e First Aid can reduce the physical and mental stress of the patient e It can save the condition of casualty from worsening e It helps to save the life of casualty e It helps to inform the doctors about the previous condition of the patient e It helps to develop confidence in the victim e It is possible to carry the casualty to the hospital safely from the accident spot 10.1.3 Points to be Considered by the First Aider e Reach the accident spot as soon as possible e Assess the situation quickly and calmly e Ask for the permission to the casualty’s relatives or the persons at the accident spot to begin with the First Aid e Sympathy should be given to the casualty to promote their confidence level e Make sure whether the respiration has stopped or not. If casualty cannot breathe begin artificial respiration right away e Never give an unconscious person anything by mouth e If there are more than one casualty prioritize the most life-threatening conditions e Always protect yourself and the casualty from danger e Don’t touch an open wound without gloves e Call for the doctor, police and ambulance immediately if the case is serious 10.1.4 First Aid Box A Set of First Aid Items The box where we keep various kinds of articles that are essential during the First Aid to the casualty during the accident is called First Aid Box. The First Aid Box should be available at school, club, office, play ground, vehicles, police post, fair, etc. The First Aid Box should be belonged to the First Aider. The following articles should be there in a First Aid Box: 262 Health, Population and Environment Education-10

1. Plasters of different sizes 2. Gauze dressings First Aid Items 3. Sterile eye dressings 4. Triangular bandages 5. Crêpe rolled bandages 6. Safety pins 7. Disposable sterile gloves 8. Tweezers 9. Tourniquet 10. Adhesive tape 11. Cotton swab 12. Thermometer 13. Safety pins 14. Small note book 15. Dettol 16. Tincture benzene 17. Tincture Iodine 18. Brufen 19. Paracetamol 20. Jeevanjal 21. Spirit 22. Blade 23. Scissors 24. Soap 25. Clean hanky 26. Torch light 10.1.5 Major Methods of First Aid The condition of casualty should be identified by observing the nature of incidence of accident. Then First Aid should be provided as per the priority basis. The First Aider need to have the knowledge and skill of ABC. The person having the knowledge of ABC can safeguard the life of the victim. The term ABC stands for Airway, Breathing, and Circulation. The following activities fall under the ABC method: Opening Airway The first aider needs to make sure the casualty’s airway is clear. Let the casualty lie on their back, and then to place one hand on his/her forehead and place two finger from the other hand on the casualty’s chin and gently tilt the head back while slightly raising the chin further upwards. Any obstructions need to be removed from the casualty’s mouth, including dentures. Adequate Breathing With victim’s airway open, look, listen, and feel for breathing for 5-10 seconds by placing your cheek near victim’s mouth and watching for chest to rise and fall. When the first aider has determined that the airways are not obstructed, he/she must determine the casualty’s adequacy of breathing, and if necessary provide artificial respiration. Sufficient Blood Circulation If the casualty is not breathing and no pulse the first aider should go straight for chest compressions and artificial respiration. The chest compressions will help to resume circulation of blood. Health, Population and Environment Education-10 263

A. Artificial Respiration (Expired Air Resuscitation-EAR) Artificial respiration is a First Aid provided to the casualty to restore breathing. It is required to the casualties of heart attack, poisoning, drowning, stroke, choking, electric shock, etc. Some procedures of mouth to mouth respiration are mentioned below: M Place the victim on his/her back laying face upward (supine position) M Clear the mouth for easy passage of air M Press the head backward by keeping one hand firmly on the forehead of victim and another hand at the chin of the victim to maintain upward position M Then close the nostrils of the victim with the hand that was used to press the forehead M 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 M Blow air into the lungs in every 4 to 5 seconds until the victim starts breathing again or medical help arrives B. Cardiac Massage (External Cardiac Compression-ECC) The process of saving the life of victims through artificial respiration and cardiac massage is called cardiopulmonary resuscitation (CPR). So, to save the life of the victim, First Aid provider should give cardiac massage and artificial respiration simultaneously. We have to provide cardiac massage to the victim when heart beat stops within 3 to 5 minutes otherwise s/he cannot be revived. Heart beat stops due to shock, accident, heart attack, etc. Among them heart attack is the common cause of stoppage of heart beat. In this situation, the victim is unconscious and heart beat is absent. The procedure of cardiac massage is Mentioned Below: Ü Place the victim in head up position on a firm surface Ü The First Aid provider should kneel down at the right side of the victim nearby his shoulder Ü Then the First Aid provider should overlap the left palm with the right palm and the fingers of both hands should be interlocked to one another 264 Health, Population and Environment Education-10

Ü Gentle pressure should be given on the sternum for 4/5 times. Then Artificial Respiration should be given after each cardiac massage Ü Cardiac Massage should be continued till the start of heart beat again or till the medical help arrives Activities Arrange an orientation class of First Aid through the coordination with a First Aid Trainer. Give demonstration of Expired Air Resuscitation and External Cardiac Compression under the instruction of the trainer. 10.1.6 Some Accidents and its First Aid Methods A. Wounds Wound is an injury which causes damage in the structure of the underlying tissues or organs by an external agent or force. In other words, wound is the loss of continuity of tissues following an injury or operation. Wound can be classified as open wound and closed wound. In open wound, the skin structure is broken and external bleeding is observed whereas in the closed wound, only the subcutaneous tissues or internal organs are damaged and external bleeding is absent. The wound may vary from the simple peeling off of skin to deep cut with heavy bleeding. 1. Classification of Open Wound i. Incisions (Incised wound) The wound caused by a clean, sharp-edged object such as a knife, razor, glass or splinter is called incised wound. ii. Lacerations (Irregular tear-like wounds) The wound caused by some blunt objects is called lacerated wound. Lacerated wound usually may appear in irregular cut. iii. Abrasion Superficial wound in which the topmost layer of the skin (epidermis) is scraped off. Abrasion is often caused by a sliding fall onto a rough surface. iv. Avulsion An injury in which a body structure is forcibly detached from its normal point of insertion is called avulsion. Health, Population and Environment Education-10 265

v. Puncture wound The wound caused by an object puncturing the skin such as a splinter, nail or needle is called puncture wound. vi. Gunshot wound The wound caused by a bullet or similar object through the body is called gunshot wound. There may be two wounds, one at the site of entry and one at the site of exit, generally referred to as a “through-and-through”. 2. Classification of Closed Wound i. Hematoma This wound is also called a blood tumor. It is caused by damage to blood vessels that in turn causes blood to collect under the skin. ii. Crush Injury This kind of wound is caused by an extreme amount of force applied over a long period. It also damages blood vessels, which in turn causes blood to collect under the skin in large scale. First Aid to simple wound is mentioned below: i. Stop Bleeding To stop the bleeding from the wound is the very first duty of the First Aider. Heavy bleeding may lead the casualty to death within 15 to 30 minutes. Bleeding Control Procedure • Press the bleeding area with clean cloth, pad or handkerchief • Elevate the bleeding area slightly above the chest level • Add more clean clothes on top of wet cloths and keep on pressing until the bleeding stops • In the case of limbs, use big handkerchief, scarf, shawl or tie and tourniquet to control bleeding Points to be consider while using tourniquet • Tie with tourniquet just 2/3 inches above the wound firmly (neither too loose nor too tight) • Never use wire, thread and rope as tourniquet • The tourniquet should be loosen in every 10/25 minutes for few seconds to let the blood pass to all tissues ii. Cleaning the Wound We should clean the wound with antiseptic solution. It can protect the wound from infection. We should clean the wound with antiseptic solution like Savlon, Dettol, 266 Health, Population and Environment Education-10

Betadin, etc. During this process, all kinds of foreign objects like Splinters, Nails, broken glasses, etc should be taken out properly. iii. Wound Closure Cleaning Wound When bleeding stops, the wound should be closed if the skin is broken widely. If necessary, the wound should be closed as soon as possible. It helps to recover the wound soon and leaves a small scar. B. Burn Burn is the tissue damage due to heat, electricity, sunlight, chemical or nuclear radiation. Similarly, the tissues damaged by moist heat like hot water and steam is called scalding. Burn can be generally classified into three types depending on the degree of skin and tissue damage. They are first degree, second degree and the third degree burn. 1. First Degree Burn In first degree burn, there is damage of superficial skin (i.e. epidermis). It occurs due to the sunlight, scalding by boiling water and steam. The signs like redness on skin, mild swelling and minor pain are present. It gets healed without leaving any scar. 2. Second Degree Burn In the second degree burn, there is damage of both dermis and epidermis (i.e. deep structure of the skin). In this type of burn, the symptoms like blisters, pain, swelling and white discharge are observed from the burn site. 3. Third Degree Burn In the third degree burn, there is the damage of the skin to its full depth and damage the tissues beneath the skin such as fat, nerve cells and bone also. In this type of burn, the symptoms like complete damage of all layers of skin, white liquid discharge and destruction of subcutaneous tissues are observed. The First Aid to the Burn are Mentioned Below: e Victim should be separated from the fire or hot objects e Blanket or any thick cloth should be used to put out the fire if the cloth of victim is burning Health, Population and Environment Education-10 267

e Immerse the burnt part in cold water in the case of first and second degree burn e Do not destroy the blisters e Do not apply any cream or ointment on the burnt site e Burnt part should be covered with clean cloth to keep it safe e Victim should be provided with adequate liquid to drink e Do not remove the burnt clothes if they are very much attached to the body parts e Take victim to the nearby hospital as soon as possible C. 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 (i.e. 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. Poisonous snake Marks of poisonous snake bite Poison sac Fangs Non-poisonous snake Marks of non-poisonous snake bite Signs and Symptoms of Poisonous Snake Bite M Colour of the skin gets changed M Mark of teeth can be observed at the site of the snake bite M Victim feels difficulty in breathing M S/he feels nausea and vomiting M Froth can be seen in victim’s mouth M Dimness in eye sight is observed 268 Health, Population and Environment Education-10

M Blood is seen in urine, sputum and vomit M The victim becomes unconscious in the advanced stage First Aid M Keep the victim calm and still M Confirm the bitten area and scratch it with a sterilized blade or knife to let the poison flow out with blood. Do not elevate the bitten part from the level of the heart M Use tourniquet just two inches above the bitten area. (i.e. it should be loosened in every 15 minutes for few seconds) M Do not let victim sleep and take him/her to the nearest hospital or health centre as soon as possible D. Electric Shock Electric shock is a state caused by the sudden discharge of electric current through a part of the body. When we come to contact with a naked electric wire or electric devices 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 fatal. Symptoms of Electric Shock M The victim may become unconscious. M Disorder of heart beat. M There will be burnt mark at the site of electric shock. First Aid M Do not touch victim if s/he is still in contact with the current flowing naked electric wire or devices M Turn of the main switch using bad conductor in the case of low voltage electric shock M In the case of high voltage electric shock, call for emergency help to the authority M 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. M Provide artificial respiration if the victim is unconscious Health, Population and Environment Education-10 269

M Place the victim in rest condition by covering him with warm cloth M Provide plenty of water to drink and liquid food if s/he is conscious M Take the victim to the hospital as soon as possible if necessary E. Frostbite Frostbite is an injury that is caused by exposure of parts of our body to temperatures below freezing point. The cold causes freezing of our skin and underlying tissues. The fingers, toes and feet are most commonly affected but other extremities, including the nose, ears and cheeks, can also develop frostbite. Frostbite occurs when tissues are damaged due to freezing temperatures. Frostbite is most common on the. Exposed skin including fingers, toes, nose, ears, cheeks and chin are most susceptible to frostbite. There are different degrees of frostbite. They are mentioned below: First-degree frostbite just affects the epidermis Second-degree frostbite may affect the epidermis and part of the dermis Third-degree frostbite affects the epidermis, the dermis and the fatty tissue beneath the dermis Fourth-degree frostbite affects the full thickness of the skin, the tissues that lie underneath the skin, and also deeper structures such as muscles, tendons and bone Symptoms M Skin that feels hard and waxy with a white or grayish yellow color M In superficial frostbite: aching pain, numbness, at affected area most often on hands, feet, face, and ears M In deep frostbite: there is loss of sensation at the affected part and may even appear blackened and dead tissues. M Significant pain as the areas are rewarmed and blood flow reestablished. First Aid M Assess for any hypothermia M Remove any rings, watches or constricting items from the affected limbs M Replace the wet clothes with dry clothing M Keep hands under the armpits M Do not rub the affected area, as this can cause further tissue damage 270 Health, Population and Environment Education-10

M Do not walk on toes or feet which are affected by frostbite M If a hand or a foot is affected by frostbite, wrap it in a blanket for protection If possible, avoid walking on frostbitten feet, as fractures can occur M Protect the casualty from any possible re-freezing M Provide warm drinks to the casualty to prevent dehydration M Place the affected body part in warm (not hot) water at around 40°C and be careful not to put it near direct heat as this can cause more damage M Then take them to hospital keeping their limb raised. F. High Altitude Sickness Altitude sickness is an illness that is caused by ascent to high altitude characterized by nausea, short breathing, rapid heartbeat, mental confusion and headache resulting from the shortage of oxygen. This type of illness takes place at the place above 2,500 meters altitude. In this condition brain and lungs are badly affected. Symptoms M Headache, nausea and vomiting M Short breathing and rapid heart beat M Fatigue and insomnia M Deterioration of neuro-muscular coordination M Fainting and convulsion may occur M In severe condition, bleeding occurs from nose, ears and eyes First Aid M If the person gets headache and dizziness while climbing on uphill, lower the victim at least 500 m downward M Oxygen should be given to him/her if available M Let the victim rest completely M Hot drink can be given to the victim M Carry to the nearby health clinic or hospital in the case of severe condition G. Heat Stroke Heatstroke is a condition that causes overheating of body as a result of prolonged exposure to physical exertion in high temperature. The heat stroke can occur if our body temperature rises to 104° F Health, Population and Environment Education-10 271

(104° F) or higher. Heatstroke requires emergency treatment. The cause of heat stroke is an elevation in body temperature, often accompanied by dehydration. Heat stroke is a medical emergency and can be fatal if not promptly and properly treat. Symptoms M Body temperature above 104° F M Dizziness and headache M Lack of sweating despite the heat M Red, hot, and dry skin M Muscle weakness or cramps M Nausea and vomiting M Rapid heartbeat M Rapid shallow breathing M Confusion, disorientation M Unconsciousness M Seizure First Aid M Move the person to a cool, shady area M Fan air over the patient M Apply ice packs to the patient’s armpits, groin, neck, and back M Immerse the patient in a shower or tub of cool water M Provide cold water or fruit juice H. Drowning Drowning is defined as respiratory impairment from being in or under water. In other words, drowning is the process of experiencing respiratory impairment from submersion/ immersion in liquid. Drowning generally occurs when someone is unable to breathe because his/her nose and mouth are submerged in water. People get drowned accidentally into the water bodies like swimming pool, pond, river, lake, well, etc. Symptoms M Head tilted back with mouth open M Floating face down M Gasping for air M Trouble breathing 272 Health, Population and Environment Education-10

M Coughing M Chest pain M Vomiting M Sleepiness due to lack of oxygen to the brain First Aid M Take the casualty out of the water M As soon as the casualty has been rescued from the water, check if s/he is breathing M If the person is not breathing, check pulse M If there is no pulse and breathing, start artificial resuscitation and chest compression M Repeat it until the victim begins breathing M Replace their wet clothes with dry ones M If they start breathing again protect them for hypothermia by covering with warm blankets I. Choking The state of preventing from breathing by constricting or obstructing the throat due to the foreign objects like bones, coin, marble, lapsi, toy piece, etc is called choking. Besides this, sometime, swallowed food may get stuck at the windpipe. It also causes choking. Symptoms M Suffocation, cough, struggling to breath M Pale and bluish face due to lack of oxygen M Victim cannot speak M Victim may become unconscious Prevention M Keep the objects like coins, buttons , marbles, pen , marker caps etc away from the children M Cut meat into small pieces chew your food thoroughly M Do not give popcorn, nuts, or hard candy to children younger than 4 years M Keep balloons and plastic bags away from any child who may put them in his or her mouth M Chewing and swallowing carefully and quietly without talking M Never hold pen caps, bottle caps etc in mouth M Never try to swallow a handful of nuts or any other food once at a time Health, Population and Environment Education-10 273

First Aid M Keep the victim in comfortable position M Ask the victim to cough loudly M Sometimes, the foreign object can be removed from the throat by hitting slightly on the back by the palm of hand M If the foreign object cannot come out by the above technique, give 2 to 3 inward and upward thrusts against the abdomen by placing the arms around the victim’s waist from behind with the help of enclosed hands till the objects come out from mouth M Once, the foreign object is out, give artificial respiration if necessary M If the foreign object does not come out even after applying all the techniques mentioned above, take the victim to the nearest health centre or hospital as soon as possible J. Poisoning A poison is a substance which taken into the body may damage the health or even kill a person. There are three basic routes of poisoning such as ingestion, inhalation and injection. Symptoms M Burning sensation in the mouth, pharynx and stomach M Nausea and vomiting M Excessive salivation M Breathlessness M Abdominal pain and diarrhoea M Excessive sweating M Dilation of eye pupil M Blurred vision M Loss of muscle control M Confusion and convulsion First Aid M Place the victim in a comfortable position M If the person vomits, clear the airway M Provide water for drinking if the victim is able to drink M Ask for vomiting to the victim if s/ he is conscious M Clean the mouth and throat properly after vomiting M If the person vomits, turn his or her head to the side to prevent choking M Vomit sample should be carried to the hospital for examination 274 Health, Population and Environment Education-10

M Allow gastric lavage if the victim cannot vomit M Do not allow vomiting in the case of kerosene, petrol or acid poising M If the poison has spilled on clothes, remove the clothing and flush the skin with water M If the person starts having convulsions, give convulsion First Aid M Remove any poison tinged clothing from the body using gloves M In the case of inhaled poison, get the person into fresh air as soon as possible M Begin CPR if the person shows no signs of breathing and circulation K. Sprain Sprain is an injury due to wrenching and tearing of ligaments and tissues violently so as to cause pain and swelling at an ankle, wrist or other joints. It is an injury to the ligament caused by sudden over stretching. It occurs due to sudden twist or stretch (wrench) of the joints beyond their normal range of motion. Symptoms M Swelling, pain, tenderness at the site of sprain M Discoloration of surrounding skin M It is difficult to move the swelling part First Aid M Keep the victim calm M Put bandage at the sprain area M Ice bag can be applied to reduce swelling M Do not allow victim walk with or move injured part M Carry the victim to nearby hospital for further check up. Activities Invite a First Aid trainer in your school and manage First Aid training to the selected students with the coordination of school administration. 10.2 Human Health and Safe Lifestyle 10.2.1 Human Health Human health is the condition of a person having complete health and fitness. According to WHO, ‘Health is a state of complete physical, mental and social wellbeing Health, Population and Environment Education-10 275

and not merely the absence of disease and infirmity’. This definition emphasizes the importance of wellbeing of people in physical, mental and social state besides being free from disease and infirmity. Physical health means physical development and fitness whereas healthy thinking and mental development is related to mental health. Social behaviour of an individual is related with social health. The abilities of a person like co-operation, friendship, leadership infers social health. Sound health is the integration of physical, mental and social and spirituals qualities of a person. Health of the individuals may feel better in one aspect whereas s/he may feel worse in other aspects. Some characteristics of a healthy person are illustrated by the diagram that is given below: A. Balanced Diet A balanced diet means getting the right type and amount of food to supply energy for maintaining body cells, tissues, and organs, and for supporting normal growth and development of the body. In other words, the diet which contains all the nutrients in right quantity and proportion keeping our body healthy and productive is called balanced diet. The term “balanced” diet simply means that a diet meets nutritional needs of a person while not providing too much of any nutrients. A balanced diet is essential for our good health. There are different kinds of foods available in our surrounding. Indeed, balance diet makes our body healthy and strong. A balanced diet contains 50-60% carbohydrates, 20-30% fats and 15 to 20% proteins with sufficient quantity of vitamins and minerals. In order to have a balanced diet, we must eat at least one foodstuff in required quantity from the following groups. For this, we also should have knowledge of how many calories we need to consume every day. The foods that are found in our locality can be divided into different groups as given in the table given below: Group of Foods Name of the Foods Animal Sources Milk products: milk, ghee, curd, cheese, butter, etc. Meat, fish, egg, etc. Plant sources Cereals Rice, wheat, maize, corn, millet, buckwheat, etc. Pulses and legumes Gram, cow pea, peas, mung dal, beans, rajmah, etc. Oil Almond, mustard, coconut, sunflower, soyabean, etc. Green leafy vegetables Spinach, cabbage, lettuce, mustard leaves, kurilo, etc. Fruits Mango, guava, banana, apple, grapes, pomegranates, etc. 276 Health, Population and Environment Education-10

We can have balanced diet from the foods that are available in our locality. Vegetables and fruit are important part of balanced meal. Fruits and vegetables are the vital source of vitamins and minerals. They supply vitamins and minerals to keep our immune system strong. There is evidence that people who eat fruits and vegetables everyday are at lower risk of heart disease, stroke, and cancer. Meat, fish, legumes, and eggs are all good sources of protein and minerals. They are essential for growth, and repair of the body. Legumes include beans, peas, lentils, groundnuts, and soybeans. Milk and dairy foods such as cheese and yoghurt are good sources of protein. They also contain calcium, which helps to keep our bones healthy. Fat is also the good sources of energy for the body but too much consumption can lead to obesity. Some of the importance of balanced diet is mentioned in the following points: M Supplies energy for all the cells in the body adequately, M Helps in the physical and mental development, M Increases immunity power in the body, M Protects from nutrient deficiency diseases, M Provides support to vital organs like heart, kidney, intestine, etc., M Helps in the synthesis of essential antibodies, enzymes and hormones. Activities Prepare a balanced diet chart in a chart paper and discuss about its role, need and importance in the maintenance of physical, mental and spiritual health of human being. B. Healthy Environment Healthy environment is an important aspect of human health. The various activities of physical, biological and social aspects of environment directly and indirectly affect human health. There is interaction between environment and man. Positive interaction between human and environment ensures healthy environment and sustainable living and quality of life. On the other hand, negative interaction between human and environment results into environmental degradation, loss of biological resources, poor sanitation, energy crisis, social disintegration and ultimately low quality of life. Health, Population and Environment Education-10 277

Healthy environment plays an important role for the attainment of quality of life. Different aspects of human life such as healthy residence, balanced and safe food, safe drinking water, fresh air, culture and tradition play important role to make people healthy and productive. We need to keep our home, surrounding, neighbourhood and community always clean. There should be proper management of solid wastes and sewage at our home, neighbourhood and community to ensure healthy environment. We can enjoy sound health in healthy environment. Healthy environment ultimately brings positive impact on mental, social, spiritual, emotional aspect of health of the people. Some of the importance of healthy environment is mentioned below: It helps to maintain physical and mental health It helps to prevent from pollution borne diseases It helps to maintain quality of life It helps to ensure sustainable living C. Physical Dynamics The process of making our body active and dynamic through physical exercise, yoga, pranayam, meditation, etc is known as physical dynamics. The different parts and organs of our body become active due to the physiological dynamics. It helps to maintain sound health. Human health and physical dynamics are the two inseparable parts. At present, a large number of people are dying from non-communicable diseases in comparison to the communicable diseases. Some common diseases are cardio vascular diseases, cancer, diabetes, hypertension, etc. Regular physical exercise, yoga, pranayam and meditation increase immunity power of the individual. At the same time, it also makes our body active and healthy. In addition, it also boosts up the self-esteem. However, the wrong way of yoga, byayam and physical exercise may hamper the health and physical fitness of the individuals. There will be unnecessary weight gain and the body systems may not perform their functions properly. Physical dynamics more than necessity is also injurious to health. The following rules should be followed while doing pranayam and byayam: As much as possible pranayam and byayam should be practiced in the open space The physical exercise which gives more physical exertion should not be practiced It better to eat food only after two hours of physical exercise. Physical exercise should not be practiced right after eating food 278 Health, Population and Environment Education-10

Physical exercise should not be practiced with the intension of merely the development of a particular part of the body Pranayam can be done at any condition but byayam can be practiced only on the basis of physical condition of the individual Activities Organize a talk program on physical fitness and healthy life style inviting epidemiologist, dietician, physician and yoga guru in your school under the supervision of your subject teacher. 10.2.2 Safe Life Style We need to follow health rule to keep ourselves healthy. We can enjoy a healthy life if we follow health rule in our daily life. The act of translating healthy behaviour in daily life to keep healthy, safe and prosperous living is called safe life style. The activities like consumption of balanced diet regularly, practice of appropriate pranayam, proper rest and sleep, personal hygiene, etc are the examples of the safe life style. Each individual should make such a life style so that he/she can be away from the bad habit such as smoking, alcoholism. Health status of an individual is determined by the life style s/he follows. Healthy life style gives us, happiness, good health and long life. So, we need to develop the habit of wake up before the sun rise, regular bowl clearing, regular bathing and proper care of hygiene. At the same time, we need to do pranayam and physical exercise daily in the open space and should take breakfast and meal at proper time. We have to respect our seniors and love and care our juniors. Good nutrition, physical dynamics, adequate rest and sleep and adoption of safety measures for safe and prosperous life are foundation of safe life style. Moreover, eating healthy food, proper management of mental stress, keeping away from alcoholism, smoking and drug abuse should be adopted as healthy life style in our daily life. Some of the tips for healthy life style are mentioned below: e Eat safe, healthy and nutritious balanced diet regularly e Do pranayam and physical exercise regularly e Adopt safety measures to prevent ourselves and our family e Proper management of mental stress e Establish mutual relation with family and friend circle e Keep away from smoking, alcoholism and other bad habits e Take care of personal hygiene e Do not make company with the persons with bad habit e Be informed and show readiness to adopt safe life style Health, Population and Environment Education-10 279

Summary Ü First Aid is an immediate care provided to casualty or ill person during the time of incidence of accident before the arrival of medical treatment. Ü The box where we keep various kinds of articles that are essential during the First Aid to the casualty during the accident is called First Aid Box. Ü The process of saving the life of victims through artificial respiration and cardiac massage is called cardiopulmonary resuscitation (CPR). Ü Wound can be defined as the damage in the structure of the underlying tissues or organs and loss of continuity of tissue by an external force or agent. Ü Burn is the damage of tissues by the dry heat like electricity, sunlight, chemical or nuclear radiation. Similarly, the tissues damaged by moist heat like hot water and steam is called scalding. Ü The state of preventing from breathing by constricting or obstructing the throat due to the foreign objects like bones, coin, marble, lapsi, toy piece etc is called choking. Ü Poisonous snakebite leaves the mark of fangs (front two long teeth). On the other hand, non-poisonous snake leaves the mark of several small teeth at the bitten site. Ü Electric shock is a state resulted by the sudden discharge of electric current through a part of the body. In severe electric shock, muscle contraction, paralysis, and sudden death may happen. Ü High altitude sickness is an illness resulted by ascending high altitude. Nausea, short breathing, rapid heartbeat, headache, fatigue, bleeding and mental confusion characterize it. Ü Choking is the state of preventing from breathing by constricting or obstructing the throat due to the foreign objects like coin, marble, bone piece, etc. Ü An injury due to wrenching and tearing of ligaments and tissues violently to cause pain and swelling at ankle, wrist or other joints is called sprain. Ü Frostbite is an injury that is caused by exposure of parts of our body to temperatures below freezing point. Ü Altitude sickness is an illness that is caused by ascent to high altitude characterized by nausea, short breathing, rapid heartbeat, mental confusion and headache resulting from the shortage of oxygen. Ü Heatstroke is a condition that causes overheating of body as a result of prolonged exposure to physical exertion in high temperature. The heat stroke can occur if our body temperature rises to 104° F (104° F) or higher. Ü The process of making our body active dynamic through physical exercise, yoga, pranayam, meditation, etc is known as physical dynamics. Ü The act of translating healthy behaviour in daily life to keep healthy, safe and prosperous living is called safe life style. Ü Good nutrition, physical dynamics, adequate rest and sleep and adoption of safety measures for safe and prosperous life are foundation of safe life style. Ü Moreover, eating healthy food, proper management of mental stress, keeping away from alcoholism, smoking and drug abuse should be adopted as healthy life style in our daily life. 280 Health, Population and Environment Education-10

EXERCISE A. Very short answer questions. 1. What is First Aid? 2. Illustrate any one aim of ABC rule. 3. Mention any two techniques to stop external bleeding. 4. Write any two symptoms of drowning. 5. What is physical dynamics? 6. Why do you need healthy life style? 7. Mention any two measures of keeping healthy environment. 8. What is CPR? B. Short answer questions. 1. Mention the objectives and importance of First Aid. 2. Elaborate the First Aid procedure of open wound. 3. How do you control external bleeding from the wound as a First Aider? 4. What is poisoning? Mention the symptoms and First Aid of poisoning. 5. Illustrate the points that are to be considered by First Aider. 6. What is balanced diet? What are the importance of balanced diet? 7. Make the list of essential articles that should be available in a First Aid Box. C. Write differences between: 1. Open wound and Closed wound 2. High altitude sickness and Frostbite D. Write short notes on: 1. Artificial resuscitation 2. First Aid to snake bite 3. Heat Stroke and its First Aid E. Long answer questions. 1. What is choking? Explain the symptoms, prevention and First Aid of choking. 2. What is burn? Explain the types of burn and their First Aid procedure. 3. Terai Region is highly prone to snake bite during the summer season. If you were a First Aider, how would you distinguish whether the casualty has been bitten by a poisonous snake or non-poisonous snake before you start First Aid procedure? Project Work Invite a First Aid trainer and make the arrangement of medicines, stretchers and other essential materials for the First Aid in your school with the coordination of the school management. Give mock demonstration of First Aid to other students according to the instruction of the First Aider. Health, Population and Environment Education-10 281

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A Set of Model Question “Group A” (Very short answer questions) Attempt all the questions from this group. (11x 1 = 11) 1. What is meant by physical aspect of environment? 2. How do you calculate midyear population? 3. What is the ultimate goal of development? 4. Mention the sub-division of Mountain region. 5. Name any two conditions of quality of life. 6. What is Buffer zone? 7. Mention any two symptoms of dengue fever. 8. What is RH incompatibility? Evaluate in a sentence. 9. Write a difference between preventive health services curative health service. 10. What is external cardiac compression? 11. Illustrate any one aim of ABC rule. “Group B” (Short answer questions) Attempt all the questions from this group. (9 x 4 = 36) 12. Describe the relation of science and technology with health, population and environment education with suitable example. 13. Define Infant Mortality Rate. Suppose, 2100 live births were recorded in Itahari Sub-metropolitan City in 2016 AD. Among them, 162 infants died before completing one year of age. Find Infant Mortality Rate of that place. OR Define Rate of Natural Increase. According to the census of 2001 AD, the CBR and CDR of Nepal were recorded 33.1 and 9.6 respectively. Find RNI of that country. 14. Examine the role of agriculture in the development of the nation. 15. What types of human activities deteriorate the ecosystem of Terai region? Analyze with appropriate examples. 16. What is gender equality? Mention the role of women empowerment for quality of life. 284 Health, Population and Environment Education-10

17. Justify the role of In-situ and Ex-situ for the preservation of biodiversity. OR ‘Proper conservation of habitat is necessary for the promotion of species richness of biodiversity’. Justify the statement. 18. How can you identify a person infected by Dangue fever? Illustrate its mode of transmission preventive measures. 19. How can you identify the second phase of labour? What sorts of care are required during this phase? 20. Write the differences between primary health centre and health post. OR Write the differences between drug abuse and drug addiction. “Group C” (Long answer questions) Attempt all the questions from this group. (4 x 7 = 28) 21. Give an introduction to permanent contraception and compare the male sterilization with female sterilization. 22. What is quality of life? How can you measure quality of life of the people through Physical Quality of Life Index and Human Development Index? 23. What is rare plant? Mention the medicinal and other importance of the following plants: a. Golden Michelia b. Spikenard c. Serpentina d. Himalayan Yew e. Panch Aunle f. Yarshagumba 24. Give a brief introduction to NGO and evaluate the objectives and programs undertaken by Family Planning Association of Nepal, Nepal Red Cross Society and Nepal Heart Foundation to promote the health status of the people. Health, Population and Environment Education-10 285

A Sample of Project Work Situation Analysis on Access to Drinking Water Among the Residents (A Case Study of Teku, Kathmandu) A project work for Health, Population and Environment Education Prepared by: .............................................. (Student’s name) Submitted to: The Faculty of Health, Population, and Environment Education Name of the School Address Month, Year 286 Health, Population and Environment Education-10

Chapter - 1 (Introduction) 1.1 Background of the Study There are various types of solid wastes including municipal, agricultural, and special (health care wastes, household hazardous wastes, sewage sludge) waste. Unmanaged solid waste disposal is one of the main causes of environmental degradation in the urban areas of the developing countries including Nepal. In this context, solid waste refers to low liquid content waste materials, which includes municipal garbage, industrial wastes, sewage sludge, agriculture waste, etc. The waste management problem is increasing especially in the urban area. Therefore, solid waste management is accepted as a growing issue that has caused environmental pollution especially in the urban area. According to the report of IUCN Nepal, (1997 AD) solid waste generation per head per day in Kathmandu city was 0.56 kg. At the same time, solid waste generation for all municipalities in average was estimated to be 0.25 kg per day per head. According to this estimation, the total daily generation of the solid wastes at present is more than 225 metric tons daily from the urban areas of our country. According to the Municipal Act, 1989, AD, the respective municipality is the main responsible institution for the cleaning locality and management of solid wastes. Safe‐drinking water and safe disposal of the wastes are considered as the most vital components for reduction of disease burden of the people. Solid waste management is the process of treating solid wastes and offers variety of solutions for recycling items that do not belong to trash. Waste management is the generation, prevention, characterization, monitoring, treatment, handling, reuse, and residual disposition of solid wastes. Safe drinking water and waste management are the basic areas of the sanitation. Safe drinking water and sanitation is the prime foundation of human development. Because of high priority accorded to this sector and involvement of various agencies in it, about 80 percent people have the facility of drinking water and about 43% have been provided with sanitation service, at present. However, the disparity between urban and rural areas in the availability of water and sanitation service, lack of coordination in the activities of various agencies, and maintenance of quality and sustainability of the service are appeared as major challenges of this sector. Lack of supply of expected quantity of drinking water and government’s inability to provide adequate qualitative drinking water and sanitation service according to the demand of rural and urban people are the main problems of this sector. Health, Population and Environment Education-10 287

1.2 Objective of the Study General Objective The general objective of the study is to assess the knowledge of the respondents about the current situation of drinking water and sanitation in the study area. Moreover, it also assesses the impact of unsafe drinking water and lack of sanitation on the health of the people of that area. Specific Objectives M To know the level of knowledge of the respondents about safe drinking water and solid waste management practice in the study area. M To know the perception of the respondents about the situation of drinking water in the study area. M To know the knowledge of the respondents on impact of unsafe drinking water on the health of the people in the study area. 1.3 Significance of the Study Safe drinking water and sanitation is the prime foundation of public health. Lack of supply of expected quantity of drinking water and government’s inability to provide adequate qualitative drinking water and sanitation service according to the demand of people have worsen the urban life. At the same time, solid waste management is accepted as a growing issue that has caused environmental pollution especially in the urban area. Safe-drinking water and safe disposal of the wastes are considered as the most vital components for reduction of health problems of the people. In this context, the people residing in the study area also have not remained untouched by these problems but we do not have actual information about it. Therefore, we believe that the present study on this sub-population would definitely provide baseline information about the level of knowledge and practice on sanitation. 1.4 Limitation of the Study This study has been conducted to know the situation of drinking water at Teku, Kathmandu. However all possible efforts have been made to make this research work reliable, the following are the limitations, which may be acceptable to this study: This study is limited within Teku Kathmandu. The result of this study may not be generalized for other places. This study does not use any statistical tools for the selection of sample population and data analysis. Being a student there is budget limitation too so that we cannot spend too much of money for this study 288 Health, Population and Environment Education-10

Chapter - 2 (Methodology) This Study was conducted to obtain information about the current situation of drinking water and practice in solid waste management in the study area. This chapter elaborates the methods that are applied to accomplish the study objectives. 2.1 Study Area This Study was conducted in Teku, Kathmandu. This is the densely populated urban area. People from different parts of the country have been settled down in this place. Though a very large number of households are observed in this place, only 25 households were randomly selected in our convenience as sample population. 2.2 Sources of Data Two types of data have been used in this research study. They are primary and secondary in nature. Primary Source of Data The first hand data for the study was obtained from the field survey conducted in the study area. We did not know the total number of households of that place. In this situation, we selected 25 households from the locality of Teku in our convenience for the purpose of collection of the primary data. Secondary Source of Data We have made citation of different books, magazines, journals, and internet websites as the secondary sources of information in this research work. This source has been used while writing background of the study. 2.3 Method of Data Collection First, 25 households were randomly selected altogether from the study area to make the study convenient. Then the head of the household were selected as respondents from the study area in view of keeping the gender balance among them. Similarly, education as being one of the important factors in comprehending the meaning of questions, a balance was tried to achieve respondents with different levels of educational attainments. The primary data was collected by face-to-face interview method with the help of questionnaire. The already prepared questions were directly asked to the respondents. A set of questionnaire was developed as a tool for interview to collect the data about the sanitation and socio-demographic characteristics. Along with questionnaire and interview, observation was also done to know the existing situation of the drinking water and sanitation of that area. Health, Population and Environment Education-10 289

Chapter - 3 (Data Analysis and Presentation) 3.1 Distribution of Population by Sex and Educational Status Education is an important indicator of the social status of an individual and a fundamental factor of personality development. Hence, we felt that education information is inevitable and the respondents were asked about their educational status. At the same time, it is said that sex is also an important demographic factor in the analysis of research work. It helps us to the variation in the level of knowledge about sanitation and their sensitivity towards it. The distribution of the respondents by sex and education is illustrated in the table given below: Table 1: Distribution of Respondents by Sex and Education Status Sex Population Percentage Male 12 48.0 Female 13 52.0 Education Status Population Percentage University 2 8.0 Higher Secondary 3 12.0 Secondary 4 16.0 Lower Secondary 6 24.0 Primary 10 40 Illiterate NA 0.0 Total 25 100.0 NA: Not Available Source: Field Survey, 2072 BS The above table revealed that out of the total number of respondents, 48 percent was female and 52 percent were the male respondents. Similarly, amongst the respondents 8% were university graduates, (12%) higher secondary, (16%) secondary and 40% of them had primary level education. 3.2 Distribution of Population by the Source of Drinking Water The quality of drinking water is precisely determined by its sources. Therefore, the respondents were asked about the sources of drinking water that they were using for the drinking purpose. The following table reveals the status of the respondents by the access to the sources of drinking water: 290 Health, Population and Environment Education-10

Table 2: Distribution of Respondents by the Source of Drinking Water Sources of drinking water Population Percentage Public Tap 11 44.0 Well 4 16.0 Pump 2 8.0 Tanker 5 20.0 Jar/Bottle 3 12.0 Total 25 100.0 NA: Not Available Source: Field Survey, 2072 BS The above table revealed that (44%) of the respondents were found to be having access to public tap for drinking water followed by tanker and well (20% and 16%) respectively. At the same time, (12%) of them were found to be using jar and bottled water and (8%) were found using pump water as the source of drinking water. 3.3 Distribution of Population by Reasons of Water Pollution During the time of interview, the respondents were asked to give opinion about the reasons of pollution in water. They gave different reasons for water pollution. The following table reveals the status of the respondent’s response towards this query. Table 3: Distribution of Respondents by Reasons of Water Pollution Reason of Water Pollution Population Percentage Rapid population growth 6 24.0 Pollution in the water sources 2 8.0 Lack of replacement of old pipes 8 32.0 Lack of water treatment plants 3 12.0 Improper distribution 5 20.0 Don’t know 1 4.0 25 100.0 Total Source: Field Survey, 2072 BS The above table revealed that 24 percent of the respondents opined that water pollution occurs due to rapidly increasing population. Similarly, (32%) of them said that it is due to lack of timely replacement of the old pipes. At the same time, (20%) of them said that the cause of water pollution is improper distribution system. Among them (4%) respondent could not say the reason of water pollution. Health, Population and Environment Education-10 291

3.4 Distribution of population by Purification Method of Drinking water During the time of interview, the respondents were asked about the methods they were applying to purify drinking water at home. They gave different versions about the purification method of drinking water, they have been doing at home. The following table illustrates the distribution of the respondents by the method of purification. Table 4: Distribution of population by Purification Method of Drinking water Method Population Percentage Filtration 15 60.0 Boiling 3 12.0 Chemical use 4 16.0 Euroguard 1 4.0 Doing nothing 2 8.0 Total 25 100.0 Source: Field Survey, 2072 BS The above table reveled that out of the total respondents, (60%) of them do filtration, and (12%) do boiling and (16%) use chemical substances in the drinking water before use. At the same time, (4%) of them are using water of euro guard while (8%) of them are using directly without any kind of filtration. 3.5 Distribution of Respondents by the Place of Disposal of Solid Wastes Waste should be managed at the place from where it generates. More disposable waste is produced in the city area due to the high density of population in comparison to the rural area. The respondents were asked that where did they dispose the refused wastes. The distribution of the respondents is revealed by the table that is given below: Table 5: Distribution of Respondents, by the Place of Disposal of Solid Wastes Place of Disposal of Solid Wastes Population Percentage Water sources 2 8.0 Public container 8 32.0 Open field 1 4.0 Along the road side 6 24.0 Municipal vehicle 8 32.0 25 Total 100.0 Source: Field Survey, 2072 BS 292 Health, Population and Environment Education-10

The above table revealed that the solid waste management practice was varied among the respondents. During the survey, it was found that majority of the respondent disposed the solid wastes in the public waste container and municipal vehicle (37.78%) respectively. At the same time, (26%) of them found to be refusing them along the roadside and (4%) of them were found to be disposed it in the open field. In fact, place of disposal of solid waste in this study area or place depends on facilities available nearer to respondents’ house and their attitude. Chapter - 4 (Finding, Conclusion and Recommendation) 4.1 Findings Out of the total number of respondents, 48 percent was female and 52 percent were the male respondents. Amongst the respondents (8%) were university graduates, (12%) higher secondary, (16%) secondary and (40%) of them had primary level education. (44%) of the respondents were found to be having access to public tap for drinking water followed by tanker and well (20% and 16%) respectively. At the same time, (12%) of them were found to be using jar and bottled water and 8% were found using pump water as the source of drinking water. (24%) of the respondents opined that water pollution occurs due to rapidly increasing population. (20%) respondents said that the cause of water pollution is improper distribution system. (60%) respondents were found doing filtration, and (12%) do boiling and (16%) use chemical substances to purify the drinking water. (8%) respondents were found to be drinking water directly without any kind of purification process. (37.78%) of the respondents were found disposing the refuses into the public container and municipal vehicle. (26%) of them were found to be refusing the waste along the roadside while (4%) of them were found to be disposed it in the open field. 4.2 Conclusion Male respondent’s population had outnumbered the female population. Only (44%) of the populations had access to the public tap water. Health, Population and Environment Education-10 293

Majority of the population opined that drinking water is polluted due to lack of timely replacement of the old pipes. Majority of the population was found using filtered water for drinking but still (8%) population were drinking water directly without any kind of purification process. About a quarter of the population (26%) were found to be refusing the waste along the roadside. 4.3 Recommendation The government and the concerned authority need to increase their capacity in the supply of clean and safe drinking water through public tap. Public awareness need to be increased for public sanitation and sewage management. The government and the municipality need to be more accountable for all possible measures over water pollution. Provision of awareness campaign and strict punishment should be carried out without any delay. 294 Health, Population and Environment Education-10

References: Appendix Bedi Yas Pal, 1997, “A Handbook of Preventive and Social Medicine”, (Delhi: Anand Publishing Co). Pande, B.D et. al., 2000, “Environment Education Source Book for Bachelor’s Program”. (Kathmandu:IUCN Nepal). Sharma, P.D., 2007, “Ecology and Environment”, (Meerut,India: Rastogi Publication). (A Set of Model Questionnaire) Part - I: Household Related Questionnaire 1. Age : ............... 2. Sex: a. Male ( ) b. Female ( ) 3. Type of family : a. Joint ( ) b. Nuclear ( ) 4. Education: ............................. [Part- II: Sanitation Related Questionnaire] 295 3. Which of the following are the sources of drinking water at your house? a. Public Tap b. Well c. Pump d. Tanker e. Others Health, Population and Environment Education-10

4. Do you think that the water you are drinking at your home is clean and safe? a. Yes ( ) b. No ( ) 5. If No, which of the following reasons are strongly related with not having drinking water clean and safe? a. Rapid population growth b. Pollution in the water sources c. Lack of replacement of old pipes d. Improper distribution of water e. Lack of water treatment plants 6. Have you applied any methods to purify water before drinking? a. Yes ( ) b. No ( ) 7. If Yes, Which of the following methods have you applied? a. Filtration b. Boiling c. Using chemicals d. Euro guard 8. Where do you dispose the refuse waste generated from your home and workplace? a. Water sources b. Public container c. Open field d. Along the roadside e. Municipal vehicle ******* 296 Health, Population and Environment Education-10