Colin Powell’s Visit
Meaningful For Stability

By Chiranjibi Paudyal

THE visit by the Secretary of State of the United States Colin Powell to Nepal and the South Asia is very important at a time when the entire world under the leadership of the USA is fighting against terrorism. The visit of the US secretary of state is meaningful for Nepal as this is the first visit by a secretary of state of the USA, which has made remarkable contributions in the socio-economic development of Nepal since the establishment of diplomatic relations in 1947.

A lot of changes have taken place in the world especially after the terrorist attack of September 11 on the World Trade Centre and Pentagon where over 3,000 people lost their lives. The world has once again united to fight the terrorist menace and save the human civilisation. This was one of the greatest tragedies in the history of the mankind where so many innocent people of over 6o countries were killed. After the September 11 tragedy, the world united to fight against the evils of the civilisation and the war against the terrorism being waged has shown positive achievements. The cruel and the barbaric rule of the terrorist supporter Taliban came to an end and over 20 million people of the war torn country Afghanistan became free. Many other countries of the region and other parts of the world also waged the war against terrorism. The USA led coalition against terrorism, for which many countries of the world including Nepal supported, succeeded to dislodge the roots of menace of the human civilisation. It was feared whether the world would be divided in the name of religion when the US President announced, "either be with us or with the terrorists." No such division came into existence and the action against the terrorists went well, though it may not be in accordance with the plan of the coalition partner. The focus of the war against terrorism is in Afghanistan because of the base of the terrorist mastermind Osama bin Laden and his Al Qaeda terrorist organisation. This is the new phenomenon developed after the September 11 terrorist attacks in the USA but the South Asian region has lost the lives of hundreds of thousands of people because of terrorism. Almost all the countries of the region have been suffering from terrorism for a long time. Sri Lanka, India, Pakistan, Bangladesh and Nepal have suffered from the enemy of the mankind for the last few years. This is the time to end the menace of terrorism when there is an anti terrorist move throughout the world.

The USA has been a constant supporter of economic development of the region for a long time. The support of the US government to safeguard human rights and freedom of the press is noteworthy. The US contribution for the establishment of democratic system in the region including in Nepal is commendable. The support for the good governance, strengthening of democratic institutions and promotion of human rights and freedom of the press needs to be consolidated. The initial projects of the US co-operation in the 1950s were malaria control and education. The successful winning of the battle of malaria control especially in the Terai, the breadbasket of Nepal, opened a new era in the Nepal-US Cupertino. Literacy programme, primary and secondary education and distance learning education programme became very effective. The priority of the projects in the late 50s and 60s were transportation and communications, which later shifted to the development of health and agriculture. Support to the Vitamin A programme is one of the successful programmes of the USAID. The Vitamin A programme is said to have reduced the mortality rate by a large percentage of the children under five years of age. HIV/AIDS advocacy, maternity health, family planning, immunisations, micro finance, hydro power, irrigation, forestry, good governance, strengthening of democracy and many other areas have been covered under the USAID programme of the US government. The most significant contribution in Nepal’s development is made by various persons who have studied or trained in the USA. A large number of Nepalese professionals have got the opportunity to study in the USA which is the most effective and modern education system in the world.

The visit of the US secretary of state will add a new milestone in the history of Nepal-USA relations. The visit will be very important for the consolidation of democracy, fighting terrorism and corruption and promotion of human rights and freedom of the press. This is the first high level visit since the visit of S. T. Agnew, the US vice president, more than three decades ago. The support and assistance of the world’s super power, the USA, will certainly be meaningful in the overall development of Nepal. The visit is a moral support for Nepal which is facing a number of problems including poverty, illiteracy unemployment and violence. The visit is also expected to reduce the tension between India and Pakistan and help create peace and stability in the region. The recently concluded summit of the South Asian Association for Regional Co-operation (SAARC) has accorded a high priority to fight against terrorism. The heads of the states and the governments of the SAARC "recognising the distinct ominous link between terrorism, drug trafficking, money laundering and other trans-national crimes have emphasised the need to co-ordinate efforts at the national and regional levels to strengthen the global response to this serious challenge and threat to international security". They have also called upon the international community to assist member countries of the SAARC to deal effectively with the adverse economic effects of terrorism in general and to meet the rising insurance and security related costs in particular. The US co-operation plays an important role in the fight against the evils of the present day world. The visit of Mr. Powell is meaningful not only for creating an environment of regional peace and stability in the South Asia region but also help strengthen the bilateral relations between Nepal and the USA in the coming days.

Hospital Wastes: Time To Think And Act

By Bachchu Kailash Kaini

HOSPITAL has an undisputed role in the present day health care delivery system for an effective and visible impact on the health status of society. Over the past decade, hospitals have grown in size and become complex. Today more and more people attend the hospital for medical care and treatment. And hospital infection occurs in every hospital beyond doubt. Hence hospital staff and patients are prone to be affected by the infection due to the poor handling of hospital wastes. It becomes glaring only when it causes damage to the patients and hospital staff. Otherwise hospital waste and hospital acquired infection is overlooked by the authority and patients too.

Fast growing population, rapid urbanisation, lack of resources and inefficient management of waste are responsible for deteriorating environmental situation. Hospital waste poses specific problem due to the presence of sharp, infectious, hazardous and radioactive material in it. The danger not only affects patients, attendants and medical personnel, but also encompasses general population and sanitary personnel handling waste. The medical waste is being thrown on street or roadside along with garbage and rag pickers are seen picking up syringes, needles, plastic bottles, cans and so on. Sometimes it is heard that these items are being reused for various purposes, which is very dangerous to health.

Existing status of inefficient hospital waste management is due to various factors. There are no guidelines, rules and laws applicable to this subject and there is no particular authority observing and monitoring the hospital waste related activities. There are many government agencies related to this subject in our country such as Ministry of Health, Ministry of Environment and Population, Municipalities, Professional Health and Medical Councils, Nepal Health Research Council, and so on. But which agency is authorised and responsible for hospital waste related activities? It is not clear and not mentioned anywhere.

Lack of government initiatives to frame and implement guidelines and rules are the main responsible factors leading hospital waste management related problems. Other problems are lack of training and awareness for waste management, financial and other resource constraints and lack of the use of updated technology. Most of the employees handling hospital waste are not aware about the consequence of improper handling of hospital waste and could not take any preventive measures.

Many government owned central hospitals do not have incinerator. There is no incinerator even in the biggest government hospital – Bir Hospital. It would be economical to have a single high capacity incinerator to be used by all hospitals in Kathmandu Valley. Either government or private sector could manage it.

Environmental sanitation is an essential prerequisite for a healthy and disease-free life. Efficient handling of waste has not received due attention of the authority. Moreover, hospital waste is responsible for various health hazards, including serious diseases like AIDS and Hepatitis. Besides increasing mortality and morbidity, hospital infection prolongs the stay of the patient in the hospital that means considerable economic consequence to the patient, the hospital, the community and the country.

Hospital wastes mean all wastes coming out of the hospitals. Infectious waste from hospitals and health care establishments contain pathological wastes, used disposable, semi-wet products like used blood bags and so on. This waste is often thrown into the community bins and municipal container instead of being properly treated and disposed off. While waste collection and disposal should be the guiding principles, provision of facilities for organised collection, storage, transportation and final disposal are to be contemplated so as to meet public requirements against this waste being discharged into municipal waste streams. There is an urgent need to design, develop and implement appropriate systems for the safe and clean disposal of hospital wastes. While waste disposal is a short and medium term solution, the long-term approach should include waste minimisation and reduction in the pollution potential.

The management of hospital waste and bio-medical wastes should be viewed in the context of the poor status of urban solid waste management. Presently in most government hospitals and private nursing homes there is no specialised system of handling, collection, transportation and disposal of solid wastes including hazardous biomedical wastes. The general cleanliness of the hospital is far from satisfactory and it is primarily due to inadequate management of hospital wastes.

If the overall hospital management has to be improved and if hospitals are to function effectively as a centre of health care delivery to the community, hospital waste management needs to be given the priority it deserves. For this it is imperative that awareness must be created among the hospital managers as well as workers regarding the hazards associated with indiscriminate disposal of these wastes and necessity for segregation at source and safe collection and disposal. The Ministry of Health, Ministry of Environment and Population and Municipal Authorities must take adequate and appropriate legal and administrative measures in this regard to safeguard the health of the community.