Production of IEC material on POPs and its Dissemination through Interaction Programs

PAM_NGO Project Report

TABEL OF CONTENTS

1. EXECUTIVE SUMMARY ...................................................................................1 2. BACKGROUND OF PROJECT ...........................................................................2 2.1 Project Objective ................................................................................................................. 3 2.2 Project Activities ................................................................................................................. 4 3 COMPLETION OF THE PAM_NGO PROJECT .................................................4 4. NATIONALLY AND INTERNATIONALLY DISTRIBUTION OF POSTERS.......10 4.1 National dissemination of the Posters.......................................................................... 10 4.2 Personal Distribution of Poster...................................................................................... 10 4.3 Posters distribution through Post .................................................................................. 11 4.4 Posters distribution through Participating in Pharmacy Expo 2005..................... 11 4.5 International dissemination of the Posters .................................................................. 12 5. PROJECT OUTPUTS..........................................................................................16 6. LESSON LEARNED AND WAY FORWARD .................................................16

ANNEXES

Annex 1. Lists of the Participants at three poster launching programs Annex 2. Article on POPs and Medical Waste published in Pharma Club`s Newspaper. Annex 3. Media Coverage of Interactions and Poster Launching Programs Annex 4. Tool Kits provided to all the participants

Production of IEC material on POPs and its Dissemination through Interaction Programs.

1. EXECUTIVE SUMMARY The knowledge about POPs, POPs conventions and its relation with the incineration technologies to the general public and concerned agencies was very limited; they were not well aware of its side effect on health and environment. The program has been found to be more effective with respect to awareness raising about POPs, developing network among the all stakeholders including government officials and local authorities and making available access to information on POPs and related issues. The production of educational material posters and its dissemination through organizing interaction program as well as widely distribution of such poster has been proved as one of the successful model in raising awareness. The poster launching and interaction program has been successful in terms of raising awareness among the local authority, medical workers, NGOs, CBOs, agricultural department, health department, local peoples, journalist and others about the relationship between POPs and waste management especially medical waste management using either open burning or incinerators and their adverse effects to the human health and environment. Program has also successful in terms of bringing the entire concerned government agency in a common forum to discuss and come into common consensus to think beyond the incineration technology. The availability as well as access to information and current situation of waste management especially medical waste management was restricted earlier, it is therefore assumed that at least participants at all the locations were supplied with a tool kits comprising of power point presentation, dioxin fact sheet, incinerator ban and moratoria as well as the WHO policy on waste management and highlighting the necessity of the promotion of non-burning mode of technology as long term strategies proved to be a good sources of information. The information about POPs and Medical Waste Incineration, impact of dioxin and furan, non-burning technology promotion slogans has been also widely disseminated through the posters. Which has been circulated widely among all the concerned stakeholders.

The continuation of the similar program with its increased resources for capacity building program for the different level health professional as well as personnel involved in the medical waste handling and making available required accessories needs for the separate waste at source, treat with non-burning mode of technology at least for the demonstration purposes is found to be urgent to convince all the concerned authorities to opt for the non-burning technology of waste management. The NGO and Local bodies collaboration have resulted a very good potential to bring all the concerned with medical waste management i.e. Doctors, Health Care Institutes, Medical Association, Local Authorities etc and hence, a need has been felt to continue such interaction program with rest of the municipalities in order to accelerate the awareness about non-burning mode of technology along with some promotional schemes.

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Though the project was small enough in terms of its resources and time period, the impact it has resulted is far weighting. Thus it is strongly recommended to continuation of similar program through out the country with increased technical and financial package to develop a functional waste management system using non-burning mode of technology is urgent.

2. BACKGROUND OF PROJECT

Health Care Institutions are meant to ensure healthy community health. But, with the increasing load of hospital waste, especially owing to the increased use of disposable materials, it is becoming a major source for transmitting various diseases and putting those who handle it and live in its proximity, at risk. There are several governmental and non-governmental hospitals, medical shops, nursing home, blood transfusion service; medial colleges have been established mostly in urban area. With a bonafide intention of providing medical facilities to the public, it is also obvious that they are major sources of contaminated hazardous medical wastes. The medical wastes include all types of wastes produced by health care units, clinic, and doctor’s offices and other medical and research facilities such as fetuses, bloods, syringe, fibers, expired medicines, clinical wastes, pathological wastes, infectious wastes, and pharmaceutical waste. But none of these or a very few medical service centers have been practicing separation but not safety disposal, destruction of their wastes and found to be either burned in open space backyard of the hospitals or discarded into the nearby waste container in the roadside. As a result, patients, patient’s family members staying to care their patients, general public and even nurse & doctor have been reported to be affected from such hazardous medical wastes. In order to manage these hazardous medical wastes, it has been already known that some of the governmental and non-governmental hospitals, local authorities responsible for the waste management have been already imported such costly pollution prone incineration technology without conducting Environmental Impact Assessment (EIA) as required by Environmental Protection Act 1996. Moreover, we do not have our own emission standard of incinerator fixed by concerned authority, lack of expertise as well as guideline for the operation and monitoring. Most of them are of substandard type. Thus, it is important to ban the incineration in the country to protect the people from exposing to the increased toxic air pollution. Since it has been seen that the amount of dioxin and dioxin like chemical released into the air from medical waste incinerators in hospitals and laboratories dwarfs all other sources of dioxin. Incinerator is also one among the identified major source of dioxin and dioxin like chemicals. Dioxin is also listed in to the dirty dozen of the POPs.

Nowadays, Incinerator is proved as major sources of dioxin and furan like gases of persistent nature. US EPA has identified incinerator as one of the third largest source of dioxin gas. Thus, instead of solving the problem of waste, it aggravated it. Incinerator only changed the biological problem into a chemical one. When solid and liquid toxic wastes burn in the incinerator, and then it is transformed into gaseous emissions dispersing pollutants over land, water, and into the atmosphere. These include a toxic chemicals and metals like mercury, lead, and cadmium. In

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addition, potent carcinogens like dioxins and furans are created when chlorinated products like syringes; catheters, PVC tubing, blood bags, bleached paper etc. are incinerated.

Further, incinerator ash is highly toxic as it contains heavy metals whose concentration increases especially if the air pollution control equipment is not able to trap all the pollutants. The heavy metals in the ash might leach and pollute the groundwater, if it is dumped into a landfill.

Dioxin gas causes cancer of liver, kidney, stomach, other soft tissues and also reduce the immunity as well as reproduction capacity will generated from the combustion of hazardous medical wastes containing plastic products. The gas emissions as well as a residue mainly ash from such technology had also been proved to be toxic.

Incineration emissions and ash residues have been implicated in the serious contamination of the environment, the food supply, eggs and even breast milk, and have been associated with a growing litany of health problems including various cancers, reproductive disorders, immune system dysfunction, and birth defects.

Incinerators of all kinds provide an ideal environment for dioxin formation. Dioxin is formed not just in old or poorly operated incinerators, but even in the most sophisticated state-of-the-art incinerators.

The Dioxin and Furan are listed under Stockholm Convention on Persistent Organic Pollutants (POPs) May 2001, to which the Nepal is a signatory member (5 April 2002) and hence must obliges to eliminate such substance from the earth rather than promoting its generating source like Incinerators. The awareness raising through the production of educational posters especially on POPs and its related issue in relation with incineration will be a crucial steps towards elimination of the POPs and its generating source as aimed by POPs convention. This was aimed through this completed project under IPEN/IPEP.

Overall the knowledge about the POPs, POPs conventions and its relation with the incineration technologies to the general public to concerned agencies is very limited; they are not well aware of its side effect on health and environment. Thus the production of posters in both Nepalese and English language and make access to it to the all needy people from grass root level to the policy level will be a more convincing tool to raise awareness and know how about POPs and POPs convention and puts pressure towards reducing or elimination of its source like open burning and incinerators. 2.1 Project Objective The major aim of this project was to raise awareness about the POPs, POPs convention and its relation with the incineration technologies to build a pressure on the concerned government authority to put ban on it. The objectives of this program are also extending to minimize the environmental and human health impacts of medical waste and prepare responsible health care workers through this educational program.

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2.2 Project Activities Overall the knowledge about the POPs, POPs conventions and its relation with the incineration technologies to the general public to concerned agencies was very limited; they are not well aware of its side effect on health and environment. Production of IEC material (Posters) will exclusively focused on POPs, POPs Conventions, and its relation with incineration, impact of incineration on public health and environment, and some facts and figures about the incinerations. The posters were containing awareness raising slogans reflecting the issues of POPs and Incinerators. Thus the production of posters and other materials in both Nepali and English language and make access to it to the all needy people from grass root level to the policy level, all medical institutions were proved to be a more convincing tool to raise awareness and know how about POPs and POPs convention and mound pressure towards reducing or elimination of its source like incinerators.

The poster were produced in both English and Nepali language and distributed widely through hosting three different interaction program one each at Kathmandu (central Nepal), Biratnagar (eastern Nepal) and Butwal western Nepal. Where the related stakeholders were invited and interact for one day and formally launch the posters through highlighting the issues of POPs and its relation with the incineration and also discuss about the other related issues. The interaction program were participated by the representative of all health care institutes, related district health officers, pesticide inspectors, chief district officers, representative of ministry of health and its department, ministry of environment, science and technology, ministry of agricultures and related department, ministry of health and its respective department, representative of local bodies like municipalities, NGOs, and journalist etc. The produced posters were distributed among all relevant sectors of people and organization through various means.

3 COMPLETION OF THE PAM_NGO PROJECT

Center for Public Health and Environmental Development (CEPHED) from Nepal under International POPs Elimination Network (IPEN)/ International POPs Elimination Project (IPEP) agreement has produced an educational poster on " STOP INCINERATION" in two languages e.g. Nepali (national language) and in English as per the proposed activities. The poster was designed with the close coordination with the Regional Coordinator for South Asia, Ms. Upasana Chaudhary. The poster contains the massage about the possible impact of waste incineration on environment and public health. Posters also include the pictorial presentation of some of the badly operated incineration in the name of waste management especially medical waste management in the different part of the country at different hospitals and local authorities occupied land. It has also contained the massage of safe management of medical waste and provoke about the promotion of safer environmentally friendly alternative technology to incineration. The poster value has been enhanced through spread of massage about the deadly impact of incineration over public health and environment with showing the link of the intergenerational impact. Through the means of these educational posters, it has been aimed to

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highlight the issues of waste incineration especially medical waste incineration and its relation with the Persistent Organic Pollutants (POPs) such as Dioxins and Furan. The poster also contain the massage about the promotion of safer alternatives to incineration of medical waste such as separate at source with color coding, treat with non-burning mode of technologies, and adopt 3R (Reduce, Recycle and Reuse) principles to protect our self and our future generations.

With tfrom CposterNepaland ot30th OmunicjoinedThis imanaglaunch

Fig.3. Kathm

Fig. 1. Poster in English Language

he above said aims and in line with the IPEP objEPHED has produced and launched these poste

launching program on "POPs and Medical Was as per the proposed activities. One in Kathmandher in Biratnagar on 16th July 2005 and third posctober at Butwal. This is due to the seekingipalities for the future continuation of the prog the hand and ask us to come to their municipalits very good start of working together with theement including medical waste. The followiing programs.

Poster launching program at andu

Fig.4. Poster launching progrBiratnagar

Fig 2. Poster in Nepali Language

ectives of raising awareness on POPs, we rs through organizing an interaction and te Management" in three major cities of

u, Capital city of Nepal on 13th July 2005 ter launching program was completed on

of local level collaboration with some ram. At least some municipalities have

y to host this kind of interaction program. local bodies responsible for the waste ng picture shows three location poster

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Fig. 5. Poster launching program at Butwal

am at

In Kathmandu, the English language poster was launched by POPs Focal points/POPs Enabling Activities Project coordinator Mr. Jay Ram Adhikari of POPs Enabling Activities and highlights the issue of POPs and Waste Incineration. Mr. Anand Kumar Shah, President of CEPHED, launched the Nepalese language poster. Likewise the representative from Ministry of Agriculture and Plant Protection Directorate- Pesticide Registrar Mr. Bhakt Raj Palikhe etc. also highlighted the POPs issues in the same program.

SiTuIn

SitheBu

Fig 6. Poster launching by Project Coordinator Mr. Jay Ram Adhikari, POPs Enabling Activities Project, MOEST/UNIDO at Kathmandu

milarly in another program at Biratnagar, posters were launched by Regional Director Mr. lsi Gautam from Regional Agricultural Directorate and highlight the issue of POPs and

cineration.

milarl locatwal

Fig.9. Poster launching by Regional Director Mr. Tulsi Gautam, HMGN/Regional Agriculture directorate at Biratnagar

y in the third poster-launchil body responsible for the municipality has cordially in

Fig. 7 Poster launching by CEPHED Chairman Mr. Anand Kumar Shah at Kathmandu

ng program, which has been organizewaste management including medicavited us and also accepts our request

Fig.8. Speech from Pesticide Registrar Mr. Bhakt Raj Palikhe at Kathmandu

Fig. 10. Poster launching by Regional Director Mr. Tulsi Gautam, HMGN/Regional Agriculture directorate at Biratnagar

d in collaboration with l waste in Butwal. The to work collaboration

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for the safer medical waste management and hence we organized third poster launching program jointly with the Butwal Municipality on October 30th 2005.

Fig. 11. Poster launching by Executive Secretary, Mr. Anand Raj Dhakal, Butwal Municipality at Butwal

Fig. 12. Speech by Executive Secretary, Mr. Anand Raj Dhakal, Butwal Municipality at Butwal

In this program, the Executive Secretary Mr. Aanand Raj Dhakal of the Butwal municipality formally launched the both Nepali and English language posters and deliver his speech highlighting the issue of waste management and problem of their working municipality as well as share his experience gained while he participated in abroad training. The poster launching and interaction programs was participated by NGOs, INGOs working on POPs and environment issue, concerned government agencies such as POPs Convention Focal Point representatives, POPs Enabling Activities Project coordinators, representative from Ministry of Environment, Science and technology, Ministry of Agriculture and Cooperatives, Representatives from Plant Protection Directorate/Pesticide Registrar and Regional Agricultural Directorate. The poster launching and interaction program was also well participated by representatives from municipalities, which are local authorities responsible for manage the solid waste management including medical waste, health care institutes (Doctors, Nurses, Matron-waste handlers etc.), Pharmaceutical company, pharmacists, students from Environmental Science Department of various universities and journalists. The program were also participated by other professional like Environment Engineers, Agricultural Scientist, Environmental Scientist etc. Participants at different poster launching and interaction programs at three locations namely Kathmandu (Central Nepal), Biratnagar (Eastern Nepal) and Butwal (Western Nepal) respectively. List of all participants is listed in Annex 1.

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Mr. Ram Charitra Sah, Environment Scientist and Project Advisor for this project (NGO_PAM), presented technical papers on "POPs and Waste Management in Nepal" in the program at all the three locations. The technical paper described about the POPs, dirty dozen, waste management practice in Nepal and then linked the issue of POPs with waste incineration especially with the medical waste incineration.

Fig 13. Participants at Kathmandu Fig.14. Participants at Biratnagar Fig. 15. Participants at Butwal

Paper also detail described about the medical waste, its compositions, present situation, management practices, medical waste & laws (acts, regulations, and international conventions e.g. Basel and POPs convention). The paper exclusively highlighted the Stockholm Convention on POPs and its objective of eliminating POPs and their sources from earth to highlight issues of incineration as one of the major sources of POPs and then "STOP INCINERATION" poster were highlighted. As aim was to spread awareness about "STOP INCINERATION", it was important to provide the safer alternatives. Thus the paper also highlighted about all the possible safer alternatives of waste management such as separation at source with color coding, treatment technologies (thermal, chemical, biological, irradiation, mechanical and sharp management etc). All these technologies were described in details. The paper concluded by saying waste incinerations are the source of POPs (Dioxin and Furans) and hence replace incineration with the non-burning safer, environmentally friendly alternatives to eliminate POPs and its sources from mother earth. An article entitled "POPs and Medical Waste" has been published to localize all the above-mentioned issue of POPs and its relation with medical waste management practices. This article contains brief information on POPs, types of POPs, Stockholm convention on POPs, impact of POPs on public health, wild life and aquatic life. Article also contains brief description about medical waste; pharmaceutical waste and other associated issue and its composition and management practice in Nepal. Moreover, it gives a complete scenario of waste management. With these instants through this article it has been requested to realize the thematic message of the poster "STOP INCINERATION" by illustrating different possible non-burning mode of technologies such as thermal process (autoclave and microwaves), chemical process, irradiative process, Biological process, Mechanical process and sharp management. This will also help to achieve the objective of protection of public health and environment for POPs as envisages by POPs convention. This article has been published in a by monthly Pharma Club (a network of pharmaceutical companies of Nepal) newsletter no.6, Oct-Nov. 2005 (Annex 2) circulated among most of the pharmaceuticals companies of Nepal.

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The program were covered by major newspapers like Gorkhapatra daily(government owned newspaper), Kantipur daily, Annpurna Post daily at national level where as some local papers like Darsan daily in Biratnagar, Mechikali, Jan Shangharsh and Butwal today national daily have covered the issue and events in Butwal (Annex 3). One of the interesting lessons learned from the poster launching and interaction program is that while describing the alternative to incinerations, a representative from a Koshi Zonal Hospital from Biratnagar immediately ask for the Needle Destroyer and request for the concerned municipalities representative to provide them. This shows that the alternative to the incinerations is not informed to the real users. So the health care institutions were highly appreciated the program and opted to go for non-incarnation technologies can be considered and the major achievement at this stage of our small efforts towards POPs and its source elimination objectives of IPEN/IPEP. Similarly at the third poster launching and interaction program that were organized in collaboration with the Butwal Municipality has proved very much successful in terms of awareness raising and thinking about technology's prose and cones while selecting any waste management technology. As expressed by one of the planning chief officer, Mrs. Nirmala Adhikari while delivering her vote of thanks and closing remarks of the program. She said that we were thinking of going for the incinerator with out looking at other available technologies. This particular program has opened our eyes to think beyond the incineration. She also highlight the fact agreed up on by a participants Mr. D.B Khatry, Doctor of Khatry Medical Center that we are the one who emitting the dioxin and furan like chemical into the environment. That is the doctor community were agreed that their miss management or open burning of waste is the source of the toxic chemicals like dioxin and furan. She also highlighted the need of further collaboration and continuation of such program along with some technological assistance will be highly appraised. After program concluding we meet with the official responsible for the environment and sanitation section Mr. Sagar Gynawali , Environment Engineer , who are really interested to develop some model project and promise to help from the Butwal municipality as the first demonstration pilot project for the safer waste management program. Thus with this event in collaboration with the local bodies will proved even more useful in terms of developing future program in association with the real responsible authority in Nepal towards safer, sustainable and environmentally friendly technology development. The participants were provided a tool kits (Annex. 4) comprising of organizational brief introduction, power point presentation of technical paper on " POPs and Waste Management in Nepal", dioxin fact sheet, incineration bans and moratoria, WHO`s policy paper on Safe Health Care Waste Management which highlight the fact of promoting non-incineration alternative as their long term strategies.

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The participants were also given the posters to disseminate with their colleagues. The poster is also distributed widely to other part of the country such as Birganj, Janakpur, Kathmnadu, and Biratnagar etc.

4. NATIONALLY AND INTERNATIONALLY DISTRIBUTION OF POSTERS

4.1 National dissemination of the Posters In addition to the poster launching and distribution during workshop, posters have been distributed personally, by post and up on meeting with concerned official and person associated with health sector. The posters are also deposited in the central contact places where concerned people can visit and take the posters. Such as Library of Nepal Health Research Council, POPs enabling project office under Ministry of Environment, Science and Technology etc. Along with the posters distribution, an appeal note to stop Fig. 16. Participants study poster at Kathmandu

Incineration and promote environmentally friendly technologies have been attached with each distribution.

4.2 Personal Distribution of Poster As our organization based in Kathmandu, Capital city of Nepal, we try to maximize the out put of the posters and hence decided to distribute the poster in major urban areas including our capital city through personal efforts as well as through post. Our members and associate members offer help towards distribution of posters personally and with help of some local people in most of the major cities of Nepal. We distributed posters in concerned government ministries and departments, Pharmacy Company, Nursing homes, Regional Medical Store, District Public Health Department, District Agriculture Office, Hospitals, and Pesticide retailer shops, Medical Shops etc in all major urban areas. Here it is important to acknowledge our members efforts towards distribution of posters. Mr. Ram Charitra Sah with help of Mr. Kameshwar Yadav, and Mr. Dinesh Shah distributed posters widely in all major hospitals, medical shops, government ministries (Environment, Health and Agriculture) and related department in Kathmandu and Pokhara.

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Fig.17. Posters ready for manual distribution

Mr. Anand Kumar Shah and Mr. Suman Adhikary had distributed the poster widely in Kathmandu, Janakpur Municipalities, Nepalganj, Dang, Ghorahi, Chitwan among Nursing homes, District Public Health Department, District Agriculture Office, Hospitals, and Pesticide retailer shops, Medical Shops etc. Mr. Subashan Bajracharya had distributed the posters widely in Biratnagar among Nursing homes, Eastern Regional Medical Store, District Public Health Department, District Agriculture Office, Hospitals, Pesticide retailer shops and Medical Shops etc. Mr. Ram Charitra Sah had also distributed the posters in Nawalparasi, Bara, Parsa, Siraha districts among Schools, Municipalities, Village Development Committee, Health posts and medical shops. Mr. Ram Charitra Sah and Mr. Surendra Batash had distributed the posters among Nursing homes, District Public Health Department, District Agriculture Office, Hospitals, and Pesticide retailer shops, Medical Shops etc. in Birganj. Mr. Ram Charitra Sah, is also involved in teaching of a Post Graduate Student of Environment Science, in Khowpa College, Bhaktpur, under Tribhuwan University and also shared the posters and technical paper among all the faculty members and student he taught, proved as the source of information for the students. 4.3 Posters distribution through Post In addition to poster distribution during interaction and poster-launching program, and personal distribution, posters were also widely circulated through postage to all the municipalities, district hospitals, medical colleges and other relevant organization such as NGOs, INGOs, and Donor consortium working on waste management and medical waste issue. Fig. 18. Posters ready for postal distribution 4.4 Posters distribution through Participating in Pharmacy Expo 2005 In addition to all, posters were also distributed among all the interested participants and visitors to a Pharma-Expo, organized by Nepal pharmaceutical Association in Kathmandu September 2005. Where about 75 national and international Pharmacy Company have participated in the Pharma Expo 2005 and visited by about 50,000 of people. The most of the visitors is some what related to the medical and health sectors. Thus the poster has been circulated among most concern people through its distribution during the Pharmaceutical Expo 2005 as shown in figures given below.

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Fig.19. Posters under distribution at Pharma Expo 2005 Fig. 20. Posters under distribution at Pharma Expo 2005

4.5 International dissemination of the Posters Some of our organization members are also associated with various international networks and use to travel and participate in different international forum, meeting and conference. Especially Mr. Ram Charitra Sah, Environment Scientist and Advisor for this PAM Project has been shared, displayed and disseminate these posters with wide sector of people, organizations and events in the international level. Some of them are as follows.

• Shared with UNIDO officials (Dr. S.P.Doha) at Kathmandu, while participating in a Prioritization Workshop organized by POPs Enabling Activities Project, A project undertaking by focal ministry of POPs. The ministry of Environment, Science and Technology in the early this year February 2005.

• Shared with WHO health sector officials at WHO Headquarter, Geneva, Switzerland in

June 2005.

• Shared with wider participants of the World Youth Foundation's international conferences on Disaster Management and Environment in Malacca Malaysia in August 2005. Display the poster and Distributed to wider participants from 17 countries including India, Bangladesh, and Malaysia, representative of UNEP, Australia, Philippines, and China etc.

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Fig. 21. Posters under distribution at FOEI Meeting, Malaysia

• Shared with wider participants of the Friends of the Earth International (FOEI) meetings at Penang, Malaysia. Where representative from about 70 countries have been participated. The poster were displaced as well as distributed in all parallel events of the meeting like International Financing Institute (IFI) meeting, Friends of the Earth International's Pre-Conference, Strategizing and Visioning meeting as well as Extraordinary General Meeting (EGM) in October 2005.

Fig. 23. Posters under distribution at FOEI Meeting, Malaysia Fig. 22. Posters under distribution at FOEI Meeting, Malaysia

• Some posters were sent to Dr. Mahmood A. Khwaja, Provisional Co-Chair, IPEP, South Asia, Sustainable Development Policy Institute (SDPI), Pakistan to be shared with among the organizations working on this POPs issue.

• Some posters were sent to Mr. Manny C. Calanzo, Assistant Southern Coordinator,

GAIA and Mrs. Merci Ferer, HCWH Regional Coordinator at Philippines to be shared with among the organizations working on this POPs issue. Posters have been seen in the HCWH and GAIA office in Philippines.

• Some posters were sent to Ms. Monica Wilson, Ms. Ann Leonard, and Ms. Firuzeh

Mohmood through one of the participants from North America visiting Washington DC and promise to post it to the Health Care Without Harm (HCWH) and GAIA headquarter Office at Berkley.

So, internationally posters were equally distributed among a wide range of countries and organizations directly as well as indirectly working on the POPs and waste management issue. Posters have gained its appreciation among a wide range of foreign delegates to which we are able to share these posters at different international forums.

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Pictures showing different activities under the same program.

Fig. 24. Participants at Kathmandu

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Fig. 25. Participants at Biratnagar

Fig. 26. Participants at Butwa Fig.27. Poster at Medical Shop, Kohalpur, Western

Fig. 28. Poster at Pharmacy Company Stall

Fig. 29. Posters in the hand of student and teacher

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Fig. 31. Poster at Medical Shop, Nepalganj, Western Nepal Fig. 30. Poster at Medical Shop, Simara, Central Nepal

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Fig. 32. Poster at District Health Post, Nawalparas

Fig 33. Poster demonstrating by children'

Fig. 35. Poster at Health post's Building

Fig. 34 . Poster at Village Development Committee's

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5. PROJECT OUTPUTS

(i) The poster launching and interaction program is successful in terms of raising awareness among the local authority, medical workers, NGOs, CBOs, concerned ministry (Ministry of Environment, Science and Technology, Ministry of Health, Ministry of Local Development and Ministry of Agriculture and Cooperatives) and their departments, local peoples, journalist and others about the relationship between POPs and waste management especially medical waste management using either open burning or incinerators and their adverse effects to the human health and environment.

(ii) Program has been also successful in terms of bringing the entire concerned government

agency in a common forum to discuss and come into common consensus to think beyond the incineration technology. For example the particular government as well as local authorities directly responsible for POPs and waste management issue in the country launched the posters. This can be proved by stating that the POPs enabling activities project coordinator from Ministry of Environment, Science and Technology (MOEST)–Focal point for POPs convention, Regional Agricultural Director and Municipality's executive secretary have happily accepted our invitation and launched the posters along with their valuable speech. This will gave us an opportunity to develop a network among the relevant stakeholder participated in the poster launching program in all the three locations.

(iii) The availability as well as access to information and current situation of waste management

especially medical waste management was restricted earlier, it is therefore assumed that at least participants at all the locations were supplied with a tool kits comprising of power point presentation, dioxin fact sheet, incinerator ban and moratoria as well as the WHO policy on waste management highlighting the necessity of the promotion of non-burning mode of technology as long term strategies proved to be a good sources of information to the participating peoples and their respective organizations. The information about POPs and Medical Waste Incineration, impact of dioxin and furan, non-burning technology promotion slogans has been also widely disseminated through the posters. Which is circulated widely among all the concerned stakeholders also serves as the source of information.

6. LESSON LEARNED AND WAY FORWARD

(i) Poster launching program was targeted to the medical professional and hence, some

of the doctors, waste handlers of health care facilities present in the poster launching programs were appraised such interaction program as they said that this interaction program have given us ample opportunity to learn about various treatment technology and health related issues of medical waste management. As one of the Doctor participants said that " We are burning out medical waste into our premises and exposing our self as well as public to the Dioxin and Furan unknowingly.

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(ii) The most important and one of the very convincing responses from the posters massage dissemination is to continuation of the program with its increased resources for making available required accessories required for the separate at source, treat with non-burning mode of technology at least for the demonstration purposes. Since people from a local authorities who have established an incinerator is also willing to go for the non burning mode of treatments such as Kathmandu Metropolitan City, but require some technical as well as financial back up to adopt the non-burning technologies. These lessons were learned in all the three places where the posters were launched in close coordination with Municipalities.

(iii) Local bodies responsible for the waste management including medical waste

management needs technical and financial backup to opt for the non-burning mode of waste treatment and hence continuation of such education and awareness program along with increased technical and financial input towards developing a model hospital managing their waste using non-burning technologies will be the potential area for future collaboration with the local bodies. Some of the municipalities are ready to collaborate with such innovative projects. This needs to be considered for the second phase of the program.

(iv) Capacity building program for the different level health professional as well as

personnel involved in the medical waste handling is strongly felt necessary. Thus capacity building training program as well as developing a model hospital demonstrating a functional waste management system based on the non-burning mode of technology will be a great turning point to realize success of the alternative to incineration technology. So there is need to initiate such project in collaboration and coordination with the participating hospital as well as local authority responsible for the waste management. Hospitals as well as local authority are ready to collaborate with us and hence there is a high potential to initiate such project under next phase of PAM_NGO.

(v) The NGO and Local bodies collaboration have resulted a very good potential to bring

all the concerned with medical waste management i.e. Doctors, Health Care Institutes, Medical Association, Local Authorities etc and hence, a need has been felt to continue such interaction program with rest of the municipalities in order to accelerate the awareness about non-burning mode of technology along with some promotional schemes.

(vi) There is a need to continue the second phase of this IEC material production and

launching through interaction program into the other part of the country through its additional package of distribution of small scale equipments such as needle destroyers, colored boxes for separate collection, protective gears for the health professional engaged in the hospital waste handling.

(vii) The discussion among one of the participants from Canada in the Friends of the Earth

International Meeting in Penang, Malaysia. She is describing about the situation of waste management and use of incineration in Canada. After seeing the massage, she

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took a number of posters and told me to share with the concerned agencies promoting the incineration and ask them to follow the massage of separating at source and not use the incineration for all type of waste as it has been clearly pointed out in the poster by saying that only 10 % of the waste needs special treatment. Thus our efforts have been proved to initiate the campaigning even at the international level.

(viii) Posters are so popular among the international participants, organizations to which it

has been shared so far and hence it is hoped that it has not only national significance but also proved significant at international level.

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Annex 1. List of participants

1. List of Participants on " Interaction and Poster launching program on POPs and Medical Waste Management" at Kathmandu, July 13, 2005.

S.No. Name Organizations Tel Sectors/Designation Email1 Puspa Ratna Shakya Ministry of Envt., Sc.&

Tech. (MOEST) 4247391 Government

2 Mukund PrasadUpadhaya

Omnica Pharmaceutical Lab

6540059/89 Pharmacy

3 Subodh Gautam Kantipur Daily 4480100/4470178 Journalist subodhe@hotmail.com 4 Deependra Deendukhee Jan Aashtha Weekly 4442552/44300885 Journalist middlepark@hotmail.com 5 Puskar Mathema Gorkhapatra Daily 4222921 Journalist pmathema@ccsl.com.np 6 Birendra Kumar Yadav PAIRD -Nepal 5549954 Engineer birenyad58@yahoo.com 7 Ram Bahadur Shreshtha Ministry of Ag. and

Cooperative 4226050 Under Secretary rbshrestha@moac.gov.np

8 Drub NarayanManandhar

POPs project Consultant for Govt.

4429604 Pesticide Expert

9 Kumari Shabha LUMANTI 5544926 NGO10 Indu Shah LUMANTI 5544926 NGO11 Pradip Kumar Mandal Himalayan White House

College 5550430 Lecturer dusbahanekarke@yahoo.com

12 Dipendra Mahasheth Kupandol 5550430 Lecturer dipendra_mahasheth@yahoo.com

13 Dr. Pramod Bhatta Government Aurbedh Hospital/Tribhuwan University

6630282 Doctor, Public Health bhattapromod@yahoo.com

14 Besuram Humagain NPA 4482657 brhumgain@yahoo.com15 Dilip Kumar Suwal Bhaktpur Municipality 6611522 Local Authority/bodies 16 Vikram Basyal CKV/JICA 2111331 Clean Kathmandu

Valley Project Supported by Japan

17 Lal Bahadur Thapa Forum for Justice 4783532 NGO, IPEP partner ffj@enet.com.np 18 S.K.Shah NIMST 4238165 19 Arun Acharya National Health Research

Council (NHRC) 4483201 Health Consultant yaps99@hotmail.com

20 Kapur Poudel National Health Research Council (NHRC)

4483201 Health Consultant kapur_poudel@hotmail.com

21 Bhakt Raj Palikhe Plant Protection Directorate, Pesticide

5541601 Government, PesticideRegistrar Office

pesticide@wlink.com.np

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Registrar and Monitoring Division

22 Jay Ram Adhikari POPs Enabling Activities Project, MOEST

4220970 Project Coordinator pops_nepal@yahoo.com

23 Purshottam Manandhar Mannadhar Agrovet 4262165 Pesticide Dealers24 Rakesh Regmi CEMECA Consultancy P.

Ltd. 4218344 Environment

Consultancy regmi2@hotmail.com

25 Nihal Bahadur Rana NORVIC Hospital 4258554/4219686 Hospital sagarmatharana@hotmail.com 26 Raj Kumar dikpal Annapurna Post 4770629 Journalist 27 Santosh Kumar Gupta Zero Waste Nepal 5525076/5523104 NGO santosh@zerowaste.org.np 28 Bhagbati Kunwar Amrit Science Campus 4351450 Student, Env. Sc. bhagwatikunwar@hotmail.com 29 Pradeep Amatya Lalitpur Sub-

Metropolitan City 5522778 Local Authority pradeepamatya@yaho.com

30 Rana Pratap Shingh Institute of Engineering (IOE)

5553571 Professor/Consultant rana@multinepal.com.np

31 Madan Kumar Suwal Khowpa Collecge 2132069 Student, Env.Sc. logtoms@yahoo.com 32 Rosy Makaju Khowpa College 2132069 Student, Env.Sc. rosymakaju@yahoo.com 33 Dr. Baidnath Mahato NARC, Khumaltar 5523143 Senior Scientist bnmahato7@hotmail.com34 Shankar Kumar Shrestha MOEST/POPs project 4225258 Program Officer skumar871@hotmail.com35 Yash Tandukar Waste Processing

Society(WPS)

36 Bikalpa Gautar SchMES College Student, Env. Mgmt. bikkubhai@hotmail.com 37 Maya Kumar Bhatt Khwopa College 5544142 Student, Env.Sc. mayalu_luck@yahoo.com 38 Man Kumar Dhamala Khwopa College Student, Env.Sc. 39 Bhoj Raj Ayer SHELGA 4787865 NGO, IPEP Partner shelga@enet.com.np 40 Suman Adhikari PSI Nepal 4470303/4371893 INGOs, Health sector phrysadhikari@yahoo.com 41 Ram Charitra Sah CEPHED, Environment

Scientist 4470303/4461508 NGO cephed04@yahoo.com

42 Kameshwar Yadav CEPHED, Geologist 4470303/4461508 NGO yadav_kames@hotmail.com43 Anand Kumar Shah CEPHED, Chairman 4470303/4461508 NGO cephed04@yahoo.com 44 Bijay Sikdel CEPHED, Vice Chairman 4470303/4461508 NGO cephed04@yahoo.com 45 Subashan Bajracharya CEPHED, Secretary 4470303/4461508 NGO cephed04@yahoo.com 46 Nitesh Kumar Shah CEPHED, Electronics

Engineer 4470303/4461508 NGO niteshsah@yahoo.com

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2. List of Participants on " Interaction and Poster launching program on POPs and Medical Waste Management" at Biratnagar, July 16, 2005.

S.No. Name Organizations Tel Sectors/Designation Email1 Tulshi Gautam Regional Agricultural

Directorate 021-522158/522158 Regional Director

2 Prakash Kumar Dangi Regional Agricultural Directorate

021-522158/522158 Agriculture Officer

3 Ram Pabij Mandal Regional Agricultural Directorate

021-522158/522158 Agriculture Officer

4 Bhagirath Yadav Regional Agricultural Directorate

021-522158/522158 Agriculture Officer

5 Ganu Upreti Koshi Zonal Hospital 021-530103 Medical Officer 6 Shova Lama Koshi Zonal Hospital 021-530103 Medical Officer 7 Nirmala Suwal Koshi Zonal Hospital 021-530103 Medical Officer 8 Bina Shrestha Koshi Zonal Hospital 021-530103 Medical Officer 9 Naina Katuwal Koshi Zonal Hospital 021-530103 Medical Officer koshi_morang@hotmail.co

m 10 Gita Bhandari Koshi Zonal Hospital 021-530103 Medical Officer 11 Arjun Thapaliya Biratnagar Sub-

Metropolitan City 021-530712/525452 Local Authority

12 Sarda Thapalia Biratnagar Sub-Metropolitan City

021-530712/525452 Local Authority

13 Mohan Bahadur Karki Biratnagar Sub-Metropolitan City

021-530712/525452 Local Authority/Environment Engineer

14 Rajednra Pradhan Biratnagar Sub-Metropolitan City

021-530712/525452 Local Authority

15 Sabita Ghimere Biratnagar Sub-Metropolitan City

021-530712/525452 Local Authority ruppbrt@cworld.com.np

16 Ambika Pd. Dhakal Abadh Narayan Nursing Home

021-522811 Medical Officer

17 Ram Prasad Sibakari District Agriculture Development Office

021-526568 Agriculture Officer

18 Mahendra Bista Dashan Daily 021-535326 Journalist 19 Bhim Ghimire Kantipur Daily 021-525958/522141 Journalist bhim_brt@hotmail.com 20 Mina Joshi Nepal Red Cross Society 021-525281/523325 21 Ragendra Prasad Shah Biratnagar 021-527861 Local People/ Lecturer 22 Kameshwar Yadav CEPHED, Geologist 01-4470303/4461508 NGO yadav_kames@yahoo.com23 Ram Charitra Sah CEPHED,

Environment Scientist 01-4470303/4461508 NGO cephed04@yahoo.com

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3. List of Participants on " Interaction and Poster launching program on POPs and Medical Waste Management" at Butwal, October 30,

2005.

S.No. Name Organizations Tel Sectors/Designation Email1 Bisheshwar Prasad

Mishra AMDA Hospital Butwal 071 544450 Hospital

Administration amdascwh_btw@wlink.com.np

2 Sagar Gnawali Butwal Municipality 071 544276/541283 Local Authority sagargnawali@yahoo.com

3 Kamala Kunwat Butwal Today 071 551346/47 Journalist kunwatkamala@yahoo.com

4 Laxman Poudel Jansangharsa Daily 071 540973/546645 Journalist lachupd@yahoo.com 5 Bell Prasad Gautam Mechikali Daily 071 551088 Journalist 6 Dr D.B. Khatry Khatry Medical 540933 Doctor d_khatry@yahoo.com 7 Rohit Raj Chhetry NC Doctor Association

Lumbini Zone 54413 Chairman, Doctor

Association

8 Bhim Tulachan Lumbini Nurshing Home 543749 Doctor bhimtlachan@hotmail.com

9 Tej Kumar Pathak Forum for Consumer Interest Protection

542051 NGO

10 Babu Ram Bhattarai Lumbini Zonal Hospital 540085/541200 Waste Manager 11 Rang Nath Regmi Butwal Municipality 071 544276/541283 Local Authority 12 Shiva Narayan Shah Butwal Municipality 071 544276/541283 Local Authority 13 Anand Raj Dhakal Butwal Municipality 071 544276/541283 Executive Secretary,

Local Authority

14 Yam Bahadur Thapa Butwal Municipality 071 544276/541283 Local Authority 15 Damodar Gyawali Butwal Municipality 071 544276/541283 Local Authority 16 Sher Bahadur Poudel Butwal Municipality 071 544276/541283 Local Authority 17 Dol Raj Poudel Butwal Municipality 071 544276/541283 Local Authority 18 Bhuwa Prasad Luitel Butwal Municipality 071 544276/541283 Local Authority 19 Bishnu Prasad Khanal Butwal Municipality 071 544276/541283 Local Authority 20 Dhageshwar Pokhrel Butwal Municipality 071 544276/541283 Local Authority 21 Mrs. Nirmala Adhikari Butwal Municipality 071 544276/541283 Planning Chief, Local

Authority

22 Khem Bahadur Poudel BTO 544710 Hospital 23

Liladhar Basyal BTO 544710 Hospital

24 Yamlal Khanal FIHD 546408/548886 NGO yamlal@hons.com25 Kameshwar Yadav Program Officer/

CEPHED 01 4461508 NGO

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26 Ram Charitra Sah Environment Scientist / CEPHED

01 4461508 NGO

27 Saroj Kumar Shah Chemical Engineer CEPHED

071 547284 NGO

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