What is the longest time you have resisted nature's call? And what is the feeling afterwards, after you have relieved? Ask anyone, and they will say the feeling is heavenly. But the shortage of public rest rooms in the Valley makes it habitual for its denizens to strike hard bargains with the call of nature. Either hold it for the longest period a human can, or let fly in public places doing one's best to remain modest.

Yes, eschewing one's pride. And besides the public transport mayhem this has become the single biggest problem for commuters in the capital. Geeta Gautam, a first year student of Green Tara College of Health Science, usually avoids drinking water before leaving the house. The reason? Finding an appropriate public rest room to empty her bladder is next to impossible.
"Until it starts to get into my head, I don't go to the public rest room," says Gautam. But when she does, she faces the inevitable unpleasant smell and conditions of the rest room, often leaving her nauseated.
A street vendor begging anonymity, reports, "How can a person like me, who has to save every single penny to run my household, pay Rs. 3 just to pee! Given no other option, he does his business behind the bushes or discreetly in an alley. In such, drinking water never comes to mind unless he is dehydrated.

Environmental and Occupational Health Specialist Dr. Sunil Kumar Joshi observes, "Like the street vendor's story, there are many others whose water intake is lower than the body requires, which has other health effects, dehydration being the most common." Nevertheless, holding back on fluid intake is not necessarily the best move.
"Severe dehydration due to inadequate water intake during hot days might cause inadequate urine formation, which results in kidney failure," adds Dr. Rajani Hada, Kidney Specialist at Bir Hospital. Besides, inadequate intake of water might result to renal stone disease, one of the causes of both acute and chronic kidney failure.
Besides inadequate water intake, holding urine for a long period of time like Gautam and the street vendor is a common trend among city dwellers. Reasons for this are clear, there are only 33 public rest rooms (including those in business complexes such as Bishal Bazaar) to cater to the Valley's 3,000,000-strong population. Even these latrines contain no facilities for children and physically-challenged. Two restrooms in Kuleshwor and Boudha are out of order, while places such as Durbar Marg and Thamel, two of Kathmandu's biggest tourist hubs, have no public restrooms at all.
The situation is similar in other busy areas such as Putalisadak, New Baneshwor, Babar Mahal and Anamnagar. If the situation continues, what kind of impression is Nepal going to give in the year 2011 - Tourism Year. As the saying goes, if you want to know what a man's house is like check his restroom. The same goes for the country.
The KMC is not entirely to blame. 'As there are no free spaces available in busy areas such as Putalisadak, building restrooms is impossible. To make such places more people-friendly we are in the pipeline to install mobile restrooms," says Chief of Environment Management Department at KMC Rabin Man Shrestha.
Besides space-related issues, other nuisances created by public exist in areas such as Kalimati. The KMC demolished old-styled restrooms there to replace them with better ones. But according to Shrestha, locals didn't allow the KMC to complete the project.
Until then, men struck in such busy places are either compelled to urinate out in the open or hold on. Kamal Sing (name changed) says, "I try not to urinate in open areas, but if I am tempted then yes, I urinate in the open." Some commuters even hop into a nearby restaurant and order food in order to allow them to use the restaurant's bathroom. Women are cut off from this option so they are forced to hold on until they reach their home or a shopping mall.
"Children, adolescents, and mainly women develop urinary tract infections if they are habitual urine holders or urinate on contaminated latrines," says Dr. Joshi.
 
The accumulation of urine has further effects on the physiology of a healthy person. "Nearby organs like the kidneys are affected when the bladder overstretches with urine," says Dr PK Chettri, Associate Professor at Nepal Medical College.
"An overstretched bladder causes back-flow of urine to the urethra and kidneys, which leads to kidney swelling. Thus normal functioning of the kidney gets hampered," adds Dr Joshi. Holding urine can also predispose one to urinary bladder stones. "This can result when liquid intake is low and urine is held for a long time," says Dr. Joshi.
When urine accumulates in the bladder the brain sends an impulse to release the waste from the body. But making a habit of holding urine affects this normal mechanism, causing the brain to delay sending the impulse. By the time the brain reacts, it is too late to find an appropriate place to discharge. Hence, we find children discharging without warnings.
"The issue is quite common among children, but this does not make adults the exception," says Dr Joshi. "Sick people urinating in public places should flush the rest room properly, as it is a common place for bacteria to proliferate."

A recent study conducted by the Green Youth Network, an informal network of environmental science students, on eleven different public restrooms (excluding mall and mobile restrooms), show 90% of public rest rooms operated under the KMC are cleaned three times a day. The general public consistently lists "no proper sanitation measures used in the public lavatory" among its top concerns.
But, according to research, 18% of public rest rooms in the Valley do not have a water supply and 55% use tainted water. Only 45% provide soap.
"Usually when I get back from college I take public vehicles from Jamal. There are times I need to use the rest room in between. So without much option left I force myself to visit public rest rooms. Lack of water supply in the latrine makes the place stink," says Samrina Tamang, a third year bachelor student.
Beside the low priority given by the government to public rest rooms, the public plays its part in adding to deteriorating conditions of such common property. Complaints on how irresponsible the public is when it comes to public rest rooms come from operators and caretakers. Users not paying the charge, dumping rubbish in the pans, thereby blocking toilet function, and spitting wherever they like tops their list of grievances.
The same research shows that the number of men who visit public rest rooms is higher than women. An average of 12-38 women visit the public lavatory per day compared with 45-140 men. The reason for this may be the lack of women-friendly rest rooms in the Valley. Male and female rest rooms usually have the same entrance, doors have holes and lack proper ventilation.
A busiest public rest room in Ratnapark has several non-functioning doors in the ladies' rest rooms and also lack proper flush systems. Ajay Deuja, a money collector in this rest room wears a facemask to avoid the foul smell. "The rest room is much cleaner than it is used to be couple of years back," says Deuja.
To ensure proper function and sanitation management, the KMC sends staff to public rest rooms for thorough examinations, according to Rabin Man Shrestha. Some rest rooms are also leased to private sectors or individuals as it has been found that leased public latrines are better managed in terms of sanitation and hygiene. "A public restroom is much cleaner in places like the one in Ratnapark, which has other services such as hair-cutting salons and juice shops," says Shrestha.
Rest rooms in some shopping centers, such as Kathmandu Mall, are a haven for shoppers as they are comparatively cleaner and women-friendly. The newest addition is the mobile rest room which has people thronging in it and is currently installed in Basantapur Durbar Square. But there have been complaints of its odd location.
In addition to the above complaints is the high charge to use the public rest rooms. Public rest rooms charge Rs. 3 to urinate and Rs. 5 to excrete. However, Rabin Man Shrestha claims the situation to be different. "The official rate for public comfort rooms is Rs. 2 and Rs. 3 respectively, according to the nature of use," adds Shrestha. "Recently a warning notice has been circulated to one of the rest rooms near Ratnapark which allegedly charged more than the actual rate."
"Nepalis are not that foolish. The culture of using public latrines will increase if the public are provided with such facilities at minimal cost," says Keshab Sthapit, former mayor of Kathmandu. He emphasizes the need to strictly regulate the actual rate of the latrines. "It’s an amount of money with which a commoner can drink a cup of tea."
In neighboring countries, Bangladesh for example where corporate houses invest in public rest rooms, such concepts which deal with corporate houses’ social responsibility have just entered Nepal. Kanchan Pandey of the Research Department, Nepal Investment Bank says, "Usually we fund the projects we receive proposals for. And if there is any- project related to the public rest room sector, we can go through it. If found appropriate we can fund it." Sthapit also stresses the involvement of private sectors for the better functioning of rest rooms and its funding.
Still, for most of us, more immediate concern,, are at issue when it comes to the mechanics of preserving our health through timely urination. And it seems that these days in Nepal, meeting the body's most basic functioning is still a challenge.

Source: Republica, June 26, 2009