SITUATION

United Mission Hospital Tansen is located in Tansen Municipality. On the south side of the hospital a small village has been built mainly to support the patients in the hospital. The name of this village is Bhusaldada. Shops where food can be bought, small guesthouses etc. are the main activities. The waste water from this community flows into the same gulley as the one in which the black water from the hospital is disposed of.

At present the disposal of waste and the care of the environment doesn’t have a high priority in Nepali society. For example taps are left running, without closing after use, waste is dropped at any place, there are hardly any waste water cleaning plants in the country.

In 2014, the hospital started with a program to make the hospital more sustainable also in respect to the environment. At those days, for example, hospital waste was mainly dropped outside the hospital compound, whereas papers and plastics were burned. In Tansen there is and has always been a shortage of potable water. In the dry season, surgery had to be postponed regularly because of the lack of water. Water, needed for the washing of hospital linen, had to be heated with propane gas. Waste water is disposed of via a gulley, untreated and the dirty water passes houses of poor people who use this for irrigating their crops. During the monsoon, the waste water mixes with the run off of rainwater, polluting the clean rain water. People use this water for irrigation their fields. Nearby this dirty stream groundwater comes to the surface and people drink from this spring water.

Hospital management felt that this was an unwanted situation and a plan was drawn to make the hospital more sustainable. The following plan was drawn:

  1. Use more rain water from monsoon rains to supplement the potable water frown town in order to become more self-sufficient so no water shortages have to hamper surgery.
  2. Minimize the waste of water in the hospital. Use push taps and where applicable thermostat shower taps.
  3. Install sun boilers to heat the water by sun necessary for the washing facility of the hospital.
  4. Separate the waste. Collect all plastics to be recycled, glass to be recycled and burn paper in an effective new incinerator.
  5. Oxygen project. In 2016 the hospital built their own oxygen plant.
  6. Design and build a waste water sewerage plant that cleans the waste water of the hospital, village Bushaldada, situated next to the hospital and the compound of the hospital.

The different stages of this project and its status is described as follows:

  1. Watertank project

In 2014, the hospital had different water sources. The hospital receives piped water from the municipality. This water source is unreliable. The hospital has a small spring from which water is drawn and the hospital saves rainwater from the roofs of the hospital and stores it in underground water tanks. These water sources aren’t sufficient for the hospital. Especially in the dry season (April-June) the running of the hospital is hampered due to a lack of water.

First it was investigated how much water the hospital is using. Then how much rain comes down during the monsoon, how many liters of water can we catch using the roofs? How much piped water is supplied by the municipality and how much can we expect from the own source of the hospital. On the basis of these data it was calculated what size of water tank would be needed in an average year. It seemed, that a water tank of 1,000,000 liters would do the job. The hospital has a tennis court on the compound and that was situated much lower than the hospital compound buildings. This was an ideal situation for the new water tank.

It was calculated that the costs would be around USD 300,000. As the hospital aims to treat poor people as cheaply as possible, the hospital didn’t have the funds to finance this water tank. So outside funds were sought. Five private charities were willing to support the construction of this water tank.  In the beginning of 2015 we were able to start with the construction. Luckily, the big earthquake of April 2015 didn’t affect the construction as no concrete was poured yet. The water tank was ready in the beginning of 2016 and it was inaugurated on the 1st of May 2016. Up till now the hospital’s own source and the storage capacity from rainwater supplies about 17 % of its needs.

Water saving project

In Nepal in general, people tend to let water flow lavishly without bothering if enough water is available. The hospital has worked hard to make people aware of the shortages of water and the costs involved. It has become clear that it is very difficult to get a change of behavior in which water is used sparingly. So the hospital investigated all the places in the hospital where water is used and in how to reduce outflow. It was found that push taps serve this purpose so that only the necessary water is being used and no water is wasted. At most places push taps have been installed. At bathrooms thermostat taps will be installed to minimize wastage of water.

Sun boilers

The hospital has a laundry where clothing and linen of the hospital is being washed. They use a lot of hot water. This water had to be heated by means of electricity. Communal electricity isn’t very reliable, regularly power is shut off and hospital has to switch to its own diesel generator. This isn’t cheap and also bad for the environment. In 2014 the hospital installed sun boilers with which the hot water for the washing area is heated. In Nepal the sun shines nearly all days except during the monsoon when cloudy days occur. The costs for these sun boilers (solar panels) were USD 8,100.

Waste project

The hospital had an old incinerator, located just outside the hospital compound. Most items were burned with the exception of glass that was just dumped into a bamboo area. On most days, the smoke of the incinerator drifted towards the hospital. This smoke was very unhealthy. Management wanted to improve this situation. So the waste disposal project was started. At a convenient location on the hospital compound a new incinerator was constructed and covered and locked premises were erected where waste is separated. There are partitions where waste glass is stored, plastics, paper, rubber gloves etc. At a regular basis waste is collected and transported to a recycling factory. The costs for the incinerator and sheds were about USD 11,574.

Oxygen project

The hospital was used to purchase and use oxygen cylinders. We built an oxygen plant so that we can produce our own oxygen. This is important for several reasons.  After a natural disaster such as the 2015 great earthquake, landslides blocking the roads during the monsoon each year, or political disturbance such as the Indian border blockade or strikes, we can maintain our oxygen supply to our patients.  It is environmentally sound too not to have 2 journeys per week to collect oxygen cylinders from 40 km away and reduces our carbon footprint.

It also appeared to be cheaper to produce our own oxygen. In 2016 an oxygen plant was erected on the premises of the hospital. The costs for this plant were USD 128,395.

Waste water project

At present the waste water of the hospital, the compound buildings and the village next to the hospital (Bhusaldada) is being collected and disposed of at several locations. The waste water from the compound buildings passes through a septic tank (unknown if they still work) and sink pit and is dumped over the cliff into the environment.

The waste water from the hospital and the village Bhusaldada is heavily polluted and runs through a gulley down the hill till a stream with the name Sisne Khola. On the way this water penetrates the soil, and may pollute ground water. Close to this gulley, a natural spring exists where local (poor) people collect their drinking water and use the water for their household. Beside this the waste water is used from time to time to water gardens of the poor people living close to the gulley, as piped water is in short supply. During the monsoon the rainwater from the pavement round the hospital and Bhusaldada runs down the gulley and is heavily polluted through the waste water from the hospital and Bhusaldada. This water is used to irrigate the paddy fields. Further downstream this polluted water flows into the Tinau river from where the population of Butwal and Bhairawa take their drinking water (approx. 1 million people) An unhealthy situation. The aim of the hospital is to heal people who are sick. Because of this untreated waste water, the hospital may also be eligible to sickness of people. The hospital wants to prevent it. The hospital has a program on preventive healthcare, so it is very much motivated to remove this illness source.

The design for a waste water plant that is easy to maintain and that can be copied at other places in Nepal was made by a Dutch Water Board. The design of this waste water system is ready, the hospital is looking for funds to be able to build this system through which it is possible to eliminate this source of illnesses. It is estimated that this plant will cost about USD 413,000. A description of the proposed works with a cost estimation is below.

The aim of the hospital is to work as much as possible on sustainability. It has a maintenance department to maintain the hospital buildings and other systems a biomedical maintenance department where hospital equipment is repaired. With these new initiatives, the hospital has solved most of the hazards it caused to the environment. The hospital will promote these achievements as much as possible, motivating other hospitals and parties to work on sustainability. Up till now, the managers of other Nepali hospitals have come to see for themselves what impacts these projects have on the environment. 

Water tank is below tennis field; building at the back is oxygen plant; on the left side hospital buildings.

Inside water tank

Solar water heaters

Waste separation building; at the back incinerator

Detail of waste separation building

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