Photographs and text by Marco Sacco
According to the WHO – World Health Organization – the United Nations agency that deals with the achievement of the best possible health condition of every inhabitant of the planet, it is estimated overall that 24% of diseases and 23% of all deaths – about 12, 6 million a year – are linked to environmental risks such as air, water and soil pollution, chemical exposures, climate change and radiation. Nepal is not an exception and environmental pollution remains a major health problem, especially in urban areas where most of the population is in direct contact with infected water and exposed to air pollution. In particular, the latter causes over 21,000 deaths each year, causing more victims of road accidents, which in the same period of time kill about 2,000 people.
In Kathmandu, the exacerbated and unchecked air pollution, caused by under-regulated urbanization and traffic, as well as the haphazard use of chemicals (by construction workers) fuel the exposure to dust and smog by the population . Not only that, the deposition of waste in landfills and/or the combustion of the same, the use of furnaces for the production of bricks, the use of biomass and kerosene for heating and cooking (often burned without flue or ventilation) increase the causes of air pollution in Nepal. The geographical position is added to human activity: in the valley, where the Kathmandu district is located, the creation of a “gray cloud” suspended over the city is favored. Although easily visible, it hardly disperses, occluding the city.
Exposure to unhealthy air (both indoor and outdoor) is responsible for the dramatic increase in the number of people suffering from disorders of the cardiovascular system, such as allergic rhinitis, bronchial asthma, cough, dyspnea and shortness breath, lung cancer, bronchial pneumonia chronic obstructive and stroke. As always, the most affected by these diseases are the elderly and children.
In addition to the problems mentioned above, air pollution is related to pneumococcal disease, caused by bacteria that can lead to pneumonia and meningitis, because the average immune response of the population is very low. In fact, the ability of the immune response is a sensitive indicator that allows to demonstrate how harmful the atmospheric pollution is, as claimed by dr. Santa Kumar Das, MD of the Respiratory Diseases at the Tribhuvan University Teaching Hospital, according to studies by Geneé S. Smith conducted at the University of North Carolina.
There is a significant association between PM2.5, CO and TB, ie the causes and effects of air pollution are closely related even when it comes to tuberculosis (TB). In fact, a growing number of studies have highlighted the potential role of atmospheric pollutants on the incidence of tuberculosis, already a public health problem in Nepal, according to DOHS, the nepali Department of Health Services. Not only does outdoor air pollution decrease the efficiency of the immune system, but also the immune function of people using charcoal, wood and kerosene for cooking is inhibited.
A study by Lalita Ramakrishan, a professor at the University of Cambridge’s department of medicine in the United Kingdom, proves that macrophages on the surface of the lungs are the first line of defense when a bacterium enters the lung. The macrophages is a type of white blood cell that engulf the bacteria digesting them, often managing to stop tuberculosis infection in the lungs. However, when the smoke fills the lungs, the macrophages are obstructed, reducing their ability to neutralize the bacteria. Clogged macrophages are not able to effectively kill the bacilli of Koch (bacteria responsible for TB infection), allowing them to multiply and allowing the infection to turn into a full-blown disease.
“The Kathmandu valley is not a good place for people who are allergic to dust, in fact the number of patients with respiratory problems has increased by 20%” according to what was stated by dr. Dirgha Singh Bom. The areas where road expansion is taking place are the most affected by dust pollution. “No place in the Kathmandu Valley is free from pollution, but those who live in houses by the roadside should be more cautious about their health,” said Dr. Kabir Nath Yogi, Head of the Respiratory Diseases Unit at the Tribhuvan University Teaching Hospital “Dust particles suspended in the air from construction and vehicle emissions are the main causes of the increasing cases of respiratory problems and other health problems related to air pollution in Kathmandu”, adds Dr. Kabir Nath Yogi. Using appropriate masks, educating people about the increasing risks of exposure to harmful air pollutants and regular controls are some of the precautionary measures to be taken, he continued to state.
“Ensuring the right of citizens to live in a healthy environment through effective monitoring of environmental pollution for the protection and promotion of health” is one of the challenges of the government of Nepal, as publicly reported in the lastest annual report of the Department of Health Service. But is this a realistic medium-term goal? The government and people know that it is only possible with drastic changes?
