Environmental destruction is a medical emergency

Last month Kalpana BK delivered a healthy newborn baby on the way to Bayalpata Hospital in Achham, but her placenta did not come out spontaneously. As a female community health volunteer, she was usually the one providing support for women before, during and after they give birth. But when the road to the hospital was blocked for nearly 10 hours by a landslide (above) she became the emergency, bleeding massively and was increasingly short of breath.

Luckily, once she finally made it to the hospital near Sanfebagar, Kalpana BK’s retained placenta was removed and she was transfused with blood. Today she is recovering from her life-threatening post-partum haemorrhage. 

More recently at Bayalpata, a surgical team was preparing to perform an emergency caesarean section to save both the mother and foetus. But the surgery was delayed for 20 minutes because of lack of water needed for the surgical team to scrub in, protecting the patient and her baby against infections. The delay significantly heightened the risk that the two lives would be lost, not saved.

Across Nepal, traditional springs are going dry, and hospitals are also affected. Without adequate water, staff at health facilities are finding it increasingly difficult to maintain cleanliness and best practices for preventing infections. When this happens, hospital-acquired infections are likely to rise.

Due to a combination of factors, such as lower rainfall and rising temperatures caused by climate change, rampant construction of poor-designed roads, deforestation, overpopulation, overconsumption and inadequate maintenance of pipes and wells, Nepal’s mountains are suffering water shortages.

Roads are supposed to improve access of patients to hospitals, but have themselves become killers in two ways. Haphazard construction triggers landslides that endanger lives, and roads are blocked, delaying patients like Kalpana BK from reaching hospitals in time. 

These two recent examples of a landslide and water shortage in Achham reflect the adverse impacts of worsening environmental conditions on our health system and their possibly devastating impact on people who are already ill and often vulnerable. So-called ‘natural disasters’ actually have a strong connection to human decision-making and are frequently caused by reckless road construction that does not pay sufficient attention to environmental factors.

Navin Bhatt, staff physician at Bayalpata Hospital, says environmental degradation can undermine health care delivery: “Deforestation is one of the causes of landslides, which lead to roads being blocked, hampering the transportation of people who are ill to the hospital. Rising temperatures are resulting in more snake bite cases. The quality of healthcare services is affected by environmental pollution.” 

The urgency to recognise that health and the environment are strongly connected is growing worldwide. To raise awareness about the issue and motivate grassroots solutions to these problems, the World Health Organisation announced in its ‘Ten threats to Global Health in 2019’ that air pollution and climate change are the number one public health threats. 

Nepal Government officials at all levels, health workers, environmental experts and development partners need to collaborate with advocates for ecological balance. Only when we work hand-in-hand rather than in isolation, can we take tangible steps to prevent environmental damage and restore healthy and resilient ecosystems.   

Bikash Gauchan is a doctor in Achham. Nathaniel Uchtmann is a medical doctor and lawyer.