The Best of the Bureau/The_Best_of_the_Bureau_Bureau_Development_Inc._1992.iso/dp/0040/00409.txt

Text File | 1992-08-07 | 21KB | 353 lines

$Unique_ID{bob00409}
$Pretitle{}
$Title{Nepal
Chapter 6.    Health and Welfare}
$Subtitle{}
$Author{George L. Harris}
$Affiliation{HQ, Department of the Army}
$Subject{health
katmandu
medical
government
country
hospital
hospitals
nepal
water
development}
$Date{1973}
$Log{}
Title:       Nepal
Book:        Nepal, Bhutan, Sikkim, An Area Study: Nepal
Author:      George L. Harris
Affiliation: HQ, Department of the Army
Date:        1973

Chapter 6.    Health and Welfare

     The mode of life of the majority of the people reflects the isolation and
poverty of rural areas and the concentration of the nation's small wealth in
the hands of a few. Most families are poor and many are deeply in debt.
Serious deprivation is apparent in the bad diet and inadequate housing of most
of the people and in the general unavailability, particularly in the
countryside, of modern medical care, education and other social services.
Floods, droughts, famine and landslides periodically strike various
localities. The few rich live comparatively well, but share with the rest of
the people such problems as the lack of an abundant and pure water supply and
the prevalence of a great variety of virulent diseases.

     Despite these conditions there is optimism about the future in many
villages where private citizens or groups of citizens are trying to raise the
level of health and welfare and to fill deficiencies in public services. In
some predominantly Gurkha areas, for example, returning soldiers have taken
the initiative in organizing and financing schools and small dispensaries.
Elsewhere, local authorities have formed committees to provide a public water
supply or have seen to the improvement of trails, roads and bridges.
Development schemes introduced and maintained by the central government are
also bringing about long-term improvements on a nationwide scale, but their
effectiveness is often attenuated by the shortage of funds or by
administrative problems caused by transportation difficulties and the lack of
modern communications.

Standards of Living

     The country is economically undeveloped, and its limited wealth is
unevenly distributed among the population. The few sizable estates belong to a
handful of leading families in Katmandu, whose incomes derive principally from
land and foreign investments and whose standard of living is substantially
higher than that of the rest of the people. Smaller but still appreciable
differences in living standards are apparent in different parts of the
country, and even within a small village there may be a great disparity
between the resources of one or two affluent families and those of their less
fortunate fellow villagers. The problem of poverty is most acute in the west,
especially in the Piuthan district about 145 miles west of Katmandu, which is
said to be the most destitute and backward district in the kingdom. The east
includes relatively prosperous sections such as the predominantly Sherpa
Okhaldhunga district, south of Mount Everest.

     Peasant cultivators, who comprise the overwhelming majority of the
population, live typically in simple, sparsely furnished dwellings of mud,
wattle or stone. They produce all or nearly all their own food, which is none
too plentiful, even during the best harvest, but must barter for or buy other
needed commodities such as salt, cloth and kerosene. Most farms are too small
to produce a sizable, salable surplus, so that the average cash income among
families of this group is the equivalent of from $5 to $10 per year.

     Many farmers are deeply in debt. Interest rates are high and loans are
frequently carried over extended periods of time. The usual sources of credit
are Brahman moneylenders, mostly former civil servants who built up their
personal wealth while in office, and the relatively large landowners of the
village, in whose hands money and land were becoming increasingly concentrated
before the initiation of the land reform program in 1955.

Health

Diet and Nutrition

     The common diet is high in carbohydrates and low in protein and vitamins.
Nutritional deficiencies are manifested in all parts of the country in low
resistance to disease and in the prevalence of beriberi and goiter. Shortages
of food develop in particular sections from time to time because of droughts,
floods or marketing and transport difficulties.

     Rice is the staple food wherever it can be grown; elsewhere, dependence
is on potatoes, corn, millet or barley. One of these foods is the basis of the
main meal of the day, eaten in late morning. If income permits, a similar meal
is eaten in the early evening. It is customary to drink tea in the morning
and at other times during the day.

     Rice is ordinarily accompanied by dal, a sauce made of lentils cooked
with salt and saffron, and sometimes a few onions fried in ghee (clarified
butter). A rough kind of bread is made from millet; other cereals are made
into porridge. Onions, beans, radishes and a variety of additional vegetables
and fruits are consumed when available.

     Milk, cheese and ghee represent a regular and important part of the diet,
but meat, fish, game, poultry and eggs are relished luxuries. Not all such
foods are considered suitable for consumption by all ethnic and social groups,
however. In addition to abiding by the proscription against the killing of
cattle or eating of its flesh as do Hindu of all castes, those of the highest
and most orthodox castes may also refuse to eat chicken or ducks. On the other
hand, all will usually eat wild game, including pigeons, deer, wild boar and
goat meat. Most Newar eat buffalo meat, but the highest castes among them do
not.

Water Supply

     The four major rivers and their tributaries drain nearly the entire
country, but public water supply systems making use of these resources have
yet to be developed. Consequently, there are intermittent or chronic
scarcities of water in both urban and rural areas. Low pressure often causes
stoppages in piped water systems. Even in places where wells, springs and
rivers furnish an adequate supply, the water is generally contaminated and
dangerous to drink without boiling. Development and purification of the water
supply should, in the opinion of many Nepalese, have priority over programs
to improve sanitation, medical care and agricultural methods.

     In early 1963 both the central government and local authorities were at
work on irrigation and drinking water projects with Indian financial support.
Part of the funds were to be spent for improvement of the water supply at
Katmandu, where engineers hoped to increase the daily available supply from
10 to 25 gallons per person.

Diseases

     Poor health conditions in the early 1960s were evident in the high rate
of infant mortality, the short life expectancy, the prevalence of disease and
the large number of persons suffering from physical handicaps of various
kinds. It was estimated that as many as two out of every three children failed
to survive infancy and that life expectancy averages between 25 and 30 years.

     The most prevalent of the more serious diseases are malaria and
tuberculosis. Malaria is most common in the central part of the Tarai, but it
also occurs over the entire southern portion of the country from the Indian
border northward to the lower slopes of the high Himalayan range. Over 1.2
million persons in the eastern part of the country alone are said to have the
disease. The incidence of tuberculosis is high throughout the country,
especially in urban areas.

     Other diseases of major importance are smallpox and cholera-which occur
in epidemic form and are greatly feared-typhoid, syphilis, leprosy, filariasis
(a parasitical infestation), trachoma and, in the mountain regions, goiter.
Dysentery and other intestinal diseases are so commonplace that they are
thought of as normal rather than as pathological conditions. The incidence of
asthma seems to be relatively high. Alcoholism is a problem among returned
Gurkha