Ingenuity, Innovation and cost-effectiveness

One of the things i recall from when i was small was how expensive wheelchairs are. I remember how often wheelchairs would be donated by donors from more affluent parts of society and the world, to nursing homes, orphanages and hospitals. 

I am exposed to a lot of things at Teaching Hospital. I wanted to show and share with you one such thing I’ve come across.

This is a picture of one of the wheelchairs that is used at Teaching Hospital. I marveled at how innovative and ingenious this wheelchair is. To use a plastic chair attached to a steel frame. 

An unfortunate reality in the third world (including Nepal) is the lack of an effective support system for those with special needs. But with a great deal of ingenuity and innovation and a little bit of money, a successful support system can be introduced and maintained. 

This wheelchair is proof of that!

Hospital incinerator at TUTH

Incineration is a high-temperature dry oxidation process that reduces organic and combustible waste to inorganic, incombustible matter and results in a very significant reduction of waste volume and weight. This process is usually selected to treat wastes that cannot be recycled, reused, or disposed of in a landfill site. 

The combustion of organic compounds produces mainly gaseous emissions, including steam, carbon dioxide, nitrogen oxides, and certain toxic substances (e.g. metals, halogenic acids), and particulate matter, plus solid residues in the form of ashes. If the conditions of combustion are not properly controlled, toxic carbon monoxide will also be produced. The ash and wastewater produced by the process also contain toxic compounds, which have to be treated to avoid adverse effects on health and the environment.  

Incineration of waste materials converts the waste into ash, flue gas and heat. The ash is mostly formed by the inorganic constituents of the waste, and may take the form of solid lumps or particulates carried by the flue gas. The flue gases must be cleaned of gaseous and particulate pollutants before they are dispersed into the atmosphere.   

Incineration is unquestionably effective but it is associated with serious air quality concerns. Because atmospheric oxygen is used as the reagent, a large volume of air must constantly pass through the system. Unless the exhaust air passes through a control device, all substances that are volatile at the operating temperature of the system will be emitted with the exhaust stream. For example, hospital incinerators were once significant sources of environmental mercury contamination. In addition, the operating conditions inside incinerators can lead to the formation of organochlorine compounds such as dioxins. 

The location of an incinerator can significantly affect dispersion of the plume from the chimney,  which in turn affects ambient concentrations, deposition and exposures to workers and the community.  In addition to addressing the physical factors affecting dispersion, siting must also address issues of permissions/ownership, access, convenience, etc. Best practices siting has the goal of finding a location for the incinerator that minimizes potential risks to public health and the environment (EPA 

1997). 

This can be achieved by: 

• Minimizing ambient air concentrations and deposition of pollutants to soils, foods, and other 

surfaces, e.g., 

1- Open fields or hilltops without trees or tall vegetation are preferable. Siting within 

     forested areas is not advisable as dispersion will be significantly impaired. 

2- Valleys, areas near ridges, wooded areas should be avoided as these tend to channel 

    winds and/or plumes tend to impinge on elevated surfaces or downwash under some 

    conditions. 

• Minimizing the number of people potentially exposed, e.g., 

1- Areas near the incinerator should not be populated, e.g., containing housing, athletic 

    fields, markets or other areas where people congregate. 

2- Areas near the incinerators should not be used for agriculture purposes, e.g., leafy 

    crops, grasses or grains for animals. 

The following picture is of a incinerator located at the Teaching Hospital in Maharajgunj. The picture was taken from the pediatric ward of the hospital. On multiple occasions i have experienced the thick plume from the chimney make its way into the pediatric ward, at which point the nurses and the relatives of the patients close the windows. Its unfortunate the incinerator is not ideally located and the children at the pediatric ward are those that suffer the most. I urge the hospital administration to address this issue swiftly and decisively. 

References-

1- 'Treatment and disposal technologies for health-care waste’, www.who.int

2- www.hercenter.org

The Water supply

"Turbidity is a measure of the cloudiness of water, and an indication of filtration effectiveness. Cloudy water is a sign of the presence of microorganisms that can cause gastrointestinal illness. Although controlled at the original filtration source, soil runoff and other factors can affect turbidity levels by the time water reaches a faucet". 

www.freedrinkingwater.com 

A clean water supply in a hospital is of immeasurable importance. The following picture was taken a few weeks ago at the Dental OPD of the TUTH. 

I received these pictures a few weeks ago and i decided to add them to this blog because they show a grave shortcoming. I was informed that the brown water flowed for nearly half an hour and a few dentists were forced to wash their hands in this water after the dentists had completed the procedures. 

I urge the hospital administration to ensure clean water to be supplied throughout the hospital. And where infrastructure is lacking, they should be introduced. 

Introduction- TUTH

'According to the objectives of IOM, Institute of Medicine, to facilitate the education, research and health care, T. U. Teaching Hospital was established in 1983 with the generous support of Japanese Government. 

It was graciously inaugurated by His Majesty King Birendra Bir Bikram Shah Dev in February, 1986. T. U. Teaching Hospital is an integral part of the Institute of Medicine of Tribhuvan University. 

It performs two distinct functions. As a teaching hospital, it provides practical field for the academic training programs (basic, graduate and postgraduate) of the Institute and, as a national hospital, renders medical care and services to those who need them. Besides, it conducts medical research projects and provides a major impetus to Biomedical and Health Sciences Research in Nepal. The establishment of the Teaching Hospital was a landmark in the evolution of medical education in Nepal.'

www.teachinghospital.org.np

Introduction- Roles of TUTH

Tribhuvan University Teaching Hospital has been established to fulfill the following roles: 

1- To provide a teaching base for the Institute of Medicine for all types of academic programs. 

2- To provide tertiary level of health services to the patients in Nepal and be a lead national hospital in this area. 

3- To act as the main center to conduct health researches in Nepal and resolve problems in this area in     Nepal. 

 The Teaching Hospital, is the premier teaching hospital of Nepal and is the most coveted tertiary hospital of  Nepal. 

www.teachinghospital.org.np

Introduction- Mission of TUTH

Mission

1- TUTH will provide the best care to every patient through integrated clinical services, education and research. 

2- Services will be provided by a team of compassionate multi-disciplinary, highly trained doctors, nurses, technician and others. 

3- It will provide best quality services to the seekers at an affordable cost within Nepal and serve appropriately to patients who cannot afford it.

www.teachinghospital.org.np

The Point of this

I am not a guest in Nepal. Nepal is home to me. I am privileged to be a part of the T.U. Teaching Hospital.

I walk in to the hospital every day, and i see the gardens by the entrance. I see patients and their families lying outside in the sun or away from it in Summer. I see a long line of patients waiting to get O.P.D tickets. I see the buildings encompassing 444 beds, beds that are almost always full. I walk down the halls and i feel myself part of the hospital. One among hundreds and thousands of people who work there.

I am not writing this to lay blame to anyone. I am not writing this to play critic at this hospital. I will not lay blame to an institution that helps so many people. The point of this is to raise awareness. To get the patients and their families to be a bigger part of the hospital. To have expectations that the administration will strive to meet. The point of this is to show the administration what they can do to make the hospital more friendly and understanding of everyone who comes to Teaching hospital for treatment. 

That is the point of this. 

If you want to share something, please send me details and pictures at ramadhu13@gmail.com