A combined up-flow anaerobic sludge blanket and biofilter as an improved alternative on-site sanitation in urban Bhutan: lab-scale to pilot studies

University of Technology Sydney. Faculty of Engineering and Information Technology.Providing public sewerage system for all emerging towns in Bhutan is a big challenge. This study observed about 80% of urban population in Bhutan depends on the on-site sanitation comprising septic tank and soak-pit. A proper soak-pit is essential for current on-site sanitation in disposing hazardous septic tank effluent through soil treatment. However, the survey showed about 40% of the existing urban on-site sanitation in Bhutan lacks soak-pit posing a significant risk to public health and environment from septic-tank effluent discharged into the environment. Most urban plots were found impractical for soak-pit installation due to small plots, high build-up areas and compacted soil fills. This study underscored the need of an alternative on-site sanitation that does not require soak-pit for final effluent disposal. Therefore in this study, a combined up-flow anaerobic sludge blanket (UASB) and anaerobic biofilter (ABF) system was explored as a complete on-site wastewater treatment system to provide improved alternative to the current on-site sanitation. UASB replaces septic tank for effective treatment of blackwater while watertight ABF replaces soak-pit. Shredded waste plastic bottles is used as ABF media for further treatment of UASB effluent and greywater combined to produce final effluent that can be safely discharged to the environment without the need of a soak-pit. Currently, greywater is discharged into the drains without treatment. The use of waste plastic bottles makes biofilter not only cheaper but helps solve mounting plastic waste problem in Bhutan. Both bench-scale studies using synthetic wastewater and 1000 L/day UASB-ABF pilot-scale demonstration in Bhutan using real wastewater from 2-3 households were conducted as part of the work. These studies have shown the new treatment system is effective compared to current on-site system producing final effluent lower than 125 mg/L COD, 30 mg/L BOD and 100 mg/L TSS that meets the effluent discharge standards of Bhutan. However, E.coli removal was five log units, which suggests that with process optimisation, E.coli removal can be further enhanced. Waste plastic bottle strips, charred bamboo beads & industrial slags were also observed to be an effective biofilter comparable to the commercial media. Economic assessment indicates the capital and maintenance cost of UASB-ABF wastewater treatment system is affordable as it is not significantly higher than the current on-site sanitation system. The new system is slightly more complex but it is also an opportunity to create new wastewater service industry that provides specialised contract services contributing to Bhutan’s economy

Celebrating Culture and Diversity

Event Schedule: 4:30 - 7:00 p.m.The Intersection of Culture and Mental Health: Perspectives from Bhutan Dr. Sonya Lorelle and her guests from Bhutan, Nr. Nirola and Ugyen Dorji, will discuss their perspectives of the culture and the mental health issues and challenges they face in Bhutan. 7:00-7:30 p.m.Refreshments 7:30-10 p.m. Leveraging Diversity in School and in LifeIn this fun and interactive workshop, Mr. Sylvester Baugh will assist participants in expanding their understanding of culture from race and ethnicity to a total way of life

Celebrating Culture and Diversity

Event Schedule: 4:30 - 7:00 p.m.The Intersection of Culture and Mental Health: Perspectives from Bhutan Dr. Sonya Lorelle and her guests from Bhutan, Nr. Nirola and Ugyen Dorji, will discuss their perspectives of the culture and the mental health issues and challenges they face in Bhutan. 7:00-7:30 p.m.Refreshments 7:30-10 p.m. Leveraging Diversity in School and in LifeIn this fun and interactive workshop, Mr. Sylvester Baugh will assist participants in expanding their understanding of culture from race and ethnicity to a total way of life

The impact of academic performance on self-esteem among the female students studying in different colleges under Royal University of Bhutan

The current study was carried out among the female students of The Royal University of Bhutan to evaluate the relationship between academic performance and self-esteem, and the factors affecting self-esteem.  The study adopted concurrent triangulation design of mixed methodology to collect and analyse the data. A total of 491 female students participated in the survey and of which 34 of them participated in focus-group interview.  The result of the quantitative analysis showed that there is a positive relationship between academic performance and self-esteem (rho=.170, p<.05), which attests to the similar earlier findings. Qualitative analysis explored Ackerman’s nine factors influencing self-esteem. Of the nine factors influencing self-esteem, parental influence was shown to have the most effect on the participants’ self-esteem. Based on the findings, the current study made a number of recommendations

Aversive reaction between disulfiram and betel quid among inpatients with alcohol use disorder in Bhutan: A preliminary study

Betel Quid (BQ) is commonly used in the Asia-Pacific region. Disulfiram is prescribed for people with alcohol use disorders (PwAUDs) after the completion of detoxification as an alternative to rehabilitation. This prospective observational study reports the aversive reactions and common symptoms of Disulfiram and BQ in PwAUDs. Participants included PwAUDs admitted to the psychiatric ward at the Jigme Dorji Wangchuck National Referral Hospital for detoxification, who were on Disulfiram and using BQ at the same time. Aversive reactions between Disulfiram and BQ were observed for 100 patients over a year. Twenty participants showed aversive reactions between BQ and Disulfiram. Common symptoms included sweating, diarrhea, dizziness, tremors, palpitations, shortness of breath, nausea and vomiting, and headache. Since PwAUDs in Bhutan are inducted on Disulfiram after detoxification, and most use BQ simultaneously, this study will help inform health care providers to educate people about the aversive reactions of Disulfiram and BQ

Water-based therapies of Bhutan: current practices and the recorded clinical evidence of Balneotherapy

Medical water therapy (also called medical hydrology) is practiced worldwide both for relaxation and treatment of diseases. While this practice is still thriving in Bhutan, there is a lack of proper documentation and critical study. Therefore, the current study reports on the water therapies practiced in Bhutan and their health benefits. We used four-stage process: (1) a review of literature on balneotherapy (both traditional textbooks and scientific papers); (2) listing and surveying the hot springs, mineral, and holy spring waters; (3) reviewing the health records of the patients maintained at the traditional hospitals and interviewing traditional physicians and patients about health benefits; and (4) reviewing available literature to identify existing clinical trials data to provide evidence for hydrotherapies. We found three main forms of hydrotherapies are practiced in Bhutan, which comprises herbal bath therapy, balneotherapy, and spiritually empowered waters.The most popular hydrotherapies are herbal bath and hot spring therapies. Herbal bath therapy needs traditional physicians' prescriptions, while hot springs do not require it. Through field surveys, ten different hot springs (tsha-chu) and 17 medicinal water or mineral springs (sman-chu), and 17 holy spring-waters (sgrub-chu) were identified. In general, medical water therapies are used by the Bhutanese people to treat various ailments, including gastritis, neurological disorders, arthritis, dermatological diseases, and rheumatological and musculoskeletal disorders. Even though a lack of scientific evidence makes it difficult to draw concrete conclusions on their traditionally claimed efficacy and safety, there are clinical evidences documented from other countries

Gender with marital status, cultural differences, and vulnerability to hypertension: Findings from the national survey for noncommunicable disease risk factors and mental health using WHO STEPS in Bhutan

Cardiovascular disease is the leading cause of death in the Kingdom of Bhutan. Thus, the early detection and prevention of hypertension is critical for reducing cardiovascular disease. However, the influence of sociocultural factors on vulnerability to hypertension needs further investigation. This study performed secondary data analysis on 1, 909 individuals in a cross-sectional study (the National survey for noncommunicable disease risk factors and mental health using World Health Organization (WHO) STEPS approach in Bhutan– 2014). Multivariate logistic regression demonstrated a significant association between gender with marital status and hypertension. Women had a higher odds ratio than men (Ref) when married (AOR: 1.27, 95% confidence intervals (CI): 1.23–1.31), and when separated, divorced, or widowed (AOR: 1.18, 95% CI: 1.12–1.26). People who speak the Tshanglakha language scored the highest odds (AOR: 1.24, 95% CI: 1.20–1.27), followed by Lhotshamkha (AOR: 1.09, 95% CI: 1.06–1.12) and Dzongkha (Ref) after adjusting for various social and biomedical factors. Additionally, tobacco use displayed decreased odds for hypertension. To promote the early detection and prevention of hypertension, these cultural factors should be considered even within small geographic areas, such as Bhutan. It is necessary to strengthen hypertension preventive strategies for people who speak Tshanglakha and Lhotshamkha. Furthermore, careful consideration should be given to preventing hypertension among adults aged 40 years or more, women who are married, separated, divorced, or widowed, and men who never married in Bhutan

Yield of Brain MRI in Clinically Diagnosed Epilepsy in the Kingdom of Bhutan: A Prospective Study

Background: People with epilepsy (PWE) in low- and middle-income countries may not access the health resources that are considered optimal for epilepsy diagnosis. The diagnostic yield of magnetic resonance imaging (MRI) has not been well studied in these settings. Objectives: To report the diagnostic yield of brain MRI and identify clinical associations of abnormal MRI findings among PWE in a neurocysticercosis-endemic, resource-limited setting and to identify the proportion and putative structural brain causes of drug-resistant epilepsy. Methods: PWE were prospectively enrolled at the Jigme Dorji Wangchuck National Referral Hospital in Bhutan (2014-2015). Each participant completed clinical questionnaires and a 1.5-Tesla brain MRI. Each MRI was reviewed by at least 1 radiologist and neurologist in Bhutan and the United States. A working definition of drug-resistant epilepsy for resource-limited settings was given as (a) seizures for >1 year, (b) at least 1 seizure in the prior year, and (c) presently taking 2 or more antiepileptic drugs (AEDs). Logistic regression models were constructed to test the cross-sectional association of an abnormal brain MRI with clinical variables. Findings: A total of 217 participants (125 [57%] female; 54 [25%] neurocysticercosis (n = 26, 12%, including 1 child) and congenital/perinatal abnormalities (n = 29, 14%, including 14 children). The number of AEDs (odds ratio = .59, 'P' = .03) and duration of epilepsy (odds ratio = 1.11, 'P' = .02) were significantly associated with an abnormal MRI. Seizure in the prior month was associated with the presence of mesial temporal sclerosis (odds ratio = .47, 'P' = .01). A total of 25 (12%) participants met our definition of drug-resistant epilepsy, with mesial temporal sclerosis (n = 10), congenital malformations (n = 5), and neurocysticercosis (n = 4) being the more common findings. Conclusions: The prevalence of abnormalities on brain MRI for PWE in resource-limited settings is high as a result of a diffuse range of etiologies, most commonly mesial temporal sclerosis. Drug-resistant epilepsy accounted for 12% of the referral population in a conservative estimation

The national architectural training and building research centre in Bhutan

Bibliography: p. 204-208