The Valley so utterly lacks public toilets that for many it’s a tough time when they have to answer a pressing call of nature

The Kathmandu Valley is one of the heavily populated settlements in the country. According to 2011 census, 1.5 million people live in the cities proper and three million in its urban agglomeration across the Kathmandu Valley, which includes the towns of Lalitpur, Kirtipur, Madhyapur Thimi, Bhaktapur and other newly declared municipalities. The Kathmandu Metropolitan City alone has a population of 1,003,285 and is spread over an area of 49.45 square kilometres. For the entire population of around four million, there however are only 75 public toilets available in the city – mostly in the bus parks and temple areas. The city proper has a population density of 20,288 people per square kilometre. If all public toilets are usable with running water facility, one public toilet needs to serve 65,500 people at a time. The concept of public bathroom is almost non-existent in the Kathmandu Valley. A study conducted a few years ago revealed a shocking fact that most of the public toilets were out of order even though the municipalities had given the responsibility of managing them to private contractors, who are only concerned with collecting fees for answering a call of nature. Many of those contractors who have won such contract have, instead, used the space for petty business.

Tirtharaj Rai, a contractor who operates a public toilet at Bhrikutimandap, lamented that he had no other option than to provide the area of public toilet for business purpose because he has to pay Rs 116,199 to the Social Welfare Council every month. But he collects only Rs 50,000 from the public toilet users in a month. He has to raise rest of the money by renting the area of the public toilet to street vendors. If he has to pay a hefty amount of money to the concerned agency, how can he maintain basic cleanliness of the public toilet? The dirty public toilets have not only affected public health but also contributed to environmental pollution. More than that, none of the public toilets is disabled-friendly.

While the government has given special emphasis on providing basic sanitation facilities to the rural population, it has largely neglected basic needs of the urban population. In an effort to meet the universal target of total sanitation for all by 2017, the government and international agencies focused on rural communities by launching drives against open defecation. However, the government paid little attention to improve sanitation in the urban centres. The Valley was declared open defecation-free zone many years ago without adding even a single public toilet and bathroom. This kind of drive was launched only to show the international community that Nepal too is committed to universal sanitation for all. A proper restroom is still a luxury in the Valley. All 17 municipalities in the Valley must give top priority to building public restrooms with minimum facilities at convenient places where a large number of people assemble. The Kathmandu Metropolitan City has started providing free Wi-Fi at public places, including the Pashupatinath Area. It is a good initiative. But all municipalities can best serve the public by adding more public toilets/ washrooms at convenient places.

Alternative to surgery

Nepal utterly lacks interventional radiologists, with only two persons with the expertise across the country. Due to lack of interventional radiologists in the country many patients are forced to undergo expensive surgeries. Interventional radiologists are those who use image guidance methods to gain access to vessels and organs. They then can treat certain conditions through the skin that might otherwise require surgery. According to Dr Swoyam Prakash Pandit, a consultant radiologist at Bir Hospital, many patients have been forced to undergo surgeries due to lack of interventional radiologists.

Interventional radiology is an alternative to open surgery. This procedure reduces risk, pain and recovery time for patients. Dr Pandit says plans are afoot to produce more interventional radiologists. The government must look into this particular aspect of health care, as this could save time and money of patients who have to undergo surgery when an alternative method could have treated them. For example, children suffering from retinoblastoma can be treated through interventional radiology, but they have to be referred to the United States or India.