Oasis Health, Physical Education & Creative Arts 8 New

Health, Physical Education & Creative Arts - 8 51 c. Anemia Anemia is the condition of body in which there is lack of hemoglobin or RBC (Red Blood Cells) in the blood caused by disturbance in formation of hemoglobin and RBC or their loss and rapid destruction. It is a common problem in children and pregnant women. It is primarily caused due to deficiency of iron, copper, and vitamin B-12 (Folic Acid). Symptoms of anemia i. Patient has tiredness, dizziness, muscles weakness. ii. Pale nail, eyes, tongue, palm and appearances. iii. Fall in hemoglobin concentration below the normal range. iv. Breathlessness on exertion and impaired performance. Preventive measures of anemia i. Supply of balanced diet including iron, folic acid and vitamin-C ii. Regular monitoring of infestation of hook worms, Ascaris, and other internal parasites. iii. Avoid bare foot walk in open areas. iv. Supply of iron tablets incase of excessive loss of blood. d. Night Blindness It is the inability to see in the dim light or at night. It is most prevalent among children, though adults also suffer from this disease. It is mainly caused due to deficiency of Vitamin-A in food intake. There are two types of photosensitive cells on the retina of eyes. They are rod cells and cone cells. These cells respond to different types of light stimuli. Rod cells of retina are affected by the lack of Vitamin-A supply. As the rod cells respond to the dim light during vision, there is problem in reading, walking, and driving in dim light due to this disease.

52 Health, Physical Education & Creative Arts - 8 Symptoms of night blindness Preventive measures of night blindness i. Problem for the patient to see in dim light ii. Conjunctivae turn dry and wrinkled iii. Xerophthalmia or eye-dryness i. Appropriate supply of Vitamin-A in food intake ii. Identification and management of sources of Vitamin-A: dark green leafy vegetables, pumpkin, papaya, mango, eggs, fishes, carrot, etc. iii. Compulsory supply of Vitamin-A capsules for the children in time iv. Prevention of children from gastrointestinal diseases e. Scurvy It is a disease caused due to the deficiency of the Vitamin-C (Ascorbic Acid) in food intake. It is the disease of gums and teeth. It can affect children as well as adults and elderly people. Vitamin-C is not stored in human body, so it should be taken regularly. It is needed in small amount for us. Symptoms of Scurvy i. Bleeding gums and loose teeth ii. Spongy gums with swollen appearance iii. Weakness and fatigue, feeling of tiredness iv. Joints become swollen and painful in the later stage v. Internal hemorrhage in internal tissues causing anemia Preventive measures of scurvy i. Regular supply of Vitamin- C in food intake ii. Avoid over frying and over cooking of source food of Vitamin-C iii. Provide Vitamin-C tablets in case of any symptoms f. Rickets It is a disease of children in which the bones do not harden properly and are malformed due to lack of vitamin-D. Due to the deficiency of this vitamin, calcium and phosphorus cannot be utilized by the body.

Health, Physical Education & Creative Arts - 8 53 Symptoms of rickets i. Leg bones show abnormally bent (bow leg) shape. ii. Ribs seem protruding out. iii. Joints are knock-knee deformity with enlarged and nodular shape. iv Retardation in growth and physical development of the child occurs. Preventive measures of rickets i. Vitamin-D should be included in proper amount in dietary intake. ii. Source foods of vitamin D like cod liver oil, ghee, butter, eggs, should be managed frequently in the family diet. iii. Exposure to sunlight helps in synthesis of vitamin D in human body. Its importance should be given to people. iv. Proper treatment should be given in case of rickets in early stage. g. Goiter It is a disease caused due to the lack of iodine in body. Iodine is important for thyroid gland2 to secret thyroxin hormone. If iodine is not present in body with necessary amount, thyroid gland gets enlarged and becomes protruding outward from the throat. This is known as goiter. 2 Thyroid Gland: an endocrine gland that uses iodine to produce T3 and T4 (Thyroxine) hormones Larynx Cartilage Trachea Thyroid gland

54 Health, Physical Education & Creative Arts - 8 Symptoms of goiter i. Enlarged thyroid gland seems protruding out from the throat as a bulging and swollen mass. ii. Patient feels difficulty in breathing. iii. Physical and mental development is retarded. iv. Normal weight of thyroid gland is about 25 gm but it increases up to 200 to upto 500 gm. Preventive measures of goiter i. There must be inclusion of iodine regularly in food intake. ii. Iodized salt should be included for daily usage. iii. Sea-fishes, sea-vegetables contain iodine therefore such items can be managed as far as possible. iv. In case of scarcity of iodized salt and other natural sources of iodine, artificial iodine tablets and injections should be managed. v Ifthyroid gland excises out,the intake ofiodine injection, potassium iodite, or thyroxin must be referred as per the advice of doctors to regulate other body functions. 3.1.2 Methods of Preserving Nutrients We consume different food items from different groups in our everyday food intake.Allthe food items may not have proper nutrition values in comparison to the volume of food. This is because nutrient components like vitamins and minerals can easily escape out from food due to improper food handling. Some of the methods of preserving nutrients are given below: i. Rice grains should not be washed many times before cooking. It causes loss of vitamin B-12, which is present on the outer surface of rice grains. ii. Avoid washing vegetables after cutting them into small pieces. It causes loss of nutrients with loss of vegetable sap. It is better to wash vegetables before cutting them into pieces. iii. Many nutrient compounds are broken down and lost due to extreme heat for long time therefore overcooking of food should not be done.

Health, Physical Education & Creative Arts - 8 55 iv. Fried food items do not have proper nutrients. Nutrients are lost due to frying. v. Cover the food properly while cooking. vi. The vegetables like carrot, radish, cucumber, onion, etc. which are eaten raw should be cleaned properly before eating. vii. Baking soda should not be used in improper ways. viii. Use of spices should be minimized as far as possible. ix. Fruits and potato peeling should be done thinly because important nutrients are present on the inner layer of peels. 3.2 Food Security: Introduction and Elements of Food Security Food security is a concept that is used to think systemically about how and why malnutritionarises, andwhat canbedone to address and prevent it. Underlying it is a moral ideology that can be linked to realising the international goal of food as a human right. Issues of food security primarily focusses on the need to produce more food and to distribute it better. It prioritises the total availability of food calories at the national and global level as the primary means to address malnutrition, primarily undernutrition. Over time, the food security concept has been broadened considerably to encompass a wide range of factors that can have an influence on all forms of malnutrition ranging across the whole food system including recognition of the important social and cultural role that food plays. Elements of Food Security 1. Food availability: Enough nutritious food of sufficient quality needs to be available to people for their consumption. Availability can be affected by:

56 Health, Physical Education & Creative Arts - 8 • Production: how much and what types of food are available through food that is produced and stored locally. • Distribution: how is food made available (physically moved), in what form, when, and to whom. • Exchange: how much of food that is available can be obtained through exchange mechanisms such as barter, trade, purchase, or loans. 2. Food access: Individuals and households must be able to acquire sufficient food to be able to eat a healthy, nutritious diet, or have access to sufficient resources needed to grow their own food (e.g. land). Access can be affected by: • Affordability: the ability of individuals, households or communities to afford the price of food or land for producing food, relative to their incomes. • Allocation: the economic, social and political mechanisms governing when, where, and how food can be accessed by consumers and on what terms. For example, food may be unequally allocated according to age and gender within households. • Preference: social, religious, and cultural norms and values that influence consumer demand for certain types of food (e.g. religious prohibitions or the desire to follow a specific dietary pattern such as vegetarianism). 3. Food utilisation: People must have access to a sufficient quantity and diversity of foods to meet their nutritional needs but must also be able to eat and properly metabolise such food. Utilisation can be affected by: • Nutritional value: the nutritional value provided by the foods that are consumed, as measured in calories, vitamins, protein, and various micronutrients (e.g. iron, iodine, vitamin A). • Health status: the effect of disease (e.g. HIV/AIDS or diarrhoea) on the ability to consume the food and absorb and metabolise its nutrients. • Food safety: access to food free from food spoilage or from toxic contamination introduction during the producing, processing, packaging, distribution or marketing of food; and from food-borne diseases such as salmonella. • Preparation and consumption: the resources (e.g. cooking tools and fuel),

Health, Physical Education & Creative Arts - 8 57 knowledge and ability to prepare and consume food in a healthy and hygienic way. 4. Stability: Food may be available and accessible to people who are able to utilise it effectively, but to avoid increases in malnutrition and in order for people not to feel insecure, this state of affairs needs to be enduring rather than temporary or subject to fluctuations. 3.3 Consumer's Health Consumer is a person who consumes goods and services from the market. With this meaning of consumer, we can say that all the people are consumers because everybody purchases different sorts of goods and services from the market. According to Consumer Protection Act 2054 "consumer is a person or institution who consumes or uses the services and goods available in the market."In this respect consumer can be an individual, a family, a community or a nation. A producer of goods or services may be the consumer of other goods and services. So, every individual and institution of the world may be the consumer of one or another item. Consumers’ health means the state of health determined and affected by the use of goods and services from the market. The status of our health is dynamic. There are frequent ups and downs in its level. There are importantroles of the goods and services which we consume in our daily life. The trend of consumption plays important roles in determining our health level. If we have the knowledge of consumers' health education, we can make proper decisions in selection of goods and services from the market and to exercise the consumers' rights to the maximum level. Except this, it provides

58 Health, Physical Education & Creative Arts - 8 the learning experiences that affect efficient and economical use of different products and services. The concept of consumers' health came into existence after the industrial revolution of Europe in 1750-1850 AD. It increased rapid urbanization and density of population. People had to face unemployment problem as well as existence of individualistic mentality. Therefore, people were compelled to involve in corruption. As a result, consumable goods were also affected by adulteration. The first consumers' law was made in United States of America. It had various provisions forthe legalrights of consumers. The practice of cheating consumers by adulteration and wrong information is still in practice in our market. The modern age has increased anti-consumer behaviour due to excessive competition in every sector. Morality, humanity, honesty and positive attitudes are displaced by money, crimes, and inhuman behaviours day by day in many sectors. Producers, distributors, and sellers of various commodities are not exceptions from such cases. In such situation, consumers must be aware of all sorts of such fraudulent activities against them. Life style and living process advances with the advancement of socialization and development of human beings. In the ancient time, people used to manage all the things themselves. There was barter system in the ancient time. People used to exchange the things to fulfil their needs. Nowadays, people spend money in the market to obtain commodities needed for them. They cannot produce all the things needed for them. There is specialization in production of commodities. Those commodities are brought to the market on sale for the consumers. Consumers, then, obtain those goods and other services from the market. Consumers’ Rights Though, the government had made different laws related to consumers' concerns, Consumers' Protection Act was enforced in the year 2054 BS in Nepal. People use low quality goods primarily due to three causes. The causes are lack of awareness, poverty, and negligence. The consumers' forum and other related agencies are raising voice for the consumer's right. This has helped to pressurize the government to formulate and implement the law relating to consumer's health. Consumer's Protection Act 2054 has provision

Health, Physical Education & Creative Arts - 8 59 for important rights of consumers. In order to safeguard consumer interest, eight consumer rights are defined by UN Consumer Bill of Rights. They are also regarded as the rights of consumers health. i. Right to Safety - safeguarding against goods that are hazardous to life and property. ii. Right to Information - consumershave the rightto be informedregarding the price, quality, quantity, etc. of the products they buy. iii. Right to Choice - consumers should be provided with a wide variety of goods to choose from. iv. Right to be Heard - the right of consumers to have their complaints heard. v. Right to Satisfaction of Basic Needs - this right demands that people have access tobasic, essentialgoods andservices: adequate food, clothing, shelter, health care, education, public utilities, water, and sanitation. vi. Right to Redress - consumers have the right to seek redress regarding their complaints. vii. Right to Consumer Education - the right of consumers to be educated about their rights. viii. Right to a Healthy Environment - this is the right to live and work in an environment that is non-threatening to the well-being of present and future generations. Exercise A. Answer the following questions. 1. Define nutrition and malnutrition. 2. List out the diseases caused due to lack of nutritionn. 3. What is marasmus? How does it differ from kwashiorkor?

60 Health, Physical Education & Creative Arts - 8 4. Anemia is caused due to unhealthy food habit. Justify. 5. What do you mean by food security? Why should we pay proper attention to it? 6. List down the four major elements of food security? Describe each of them in short. 7. Describe the meaning and importance of consumers’ health. 8. List down any five rights of consumers. Describe any two of them. B. Tick (√ ) the best alternative. 1. Undernutrition stands for……………………. a. the lack of nutrients in food. b. defeciency of nutrition in our body. c. accumulation of excessive nutrition in tissues. 2. Anemia is caused due to the lack of………………… a. iron b. protein. . c. carbohydrates. 3. Goiter is the disease affecting ………………. a. Larynx b. Pharynx c. Thyroid. 4. ....... is not an element of food security. a. food availability. b. food utilization. c. food production

Health, Physical Education & Creative Arts - 8 61 4 Diseases, Safety and First Aid Before You Proceed There are many people living in the world. Not all people have equal life span. In the past, when disease germs and microorganisms were not discovered, human beings blamed devils, gods, and other supernatural powers for untimely demise of people. Nowadays, many disease germs are known with the effects of their attacks on our body. Scientists have developed new medications and technologies to defend against various kinds of germs and microorganisms. Human being is still not happy with this limit of achievements. Probably, the disease germs are also trying their best to produce newer species of germs and to develop their resistance against man-made medications. This struggle is going on from long ago. No one can guess how long it will go. Discuss about the emergence of diseases with your friends, neighbours, and parents.

62 Health, Physical Education & Creative Arts - 8 4.1 Introduction to Disease The term ‘disease’ is composed of a prefix ‘dis-’ and a word ‘ease’. Where, ‘dis-’ stands for ‘no’ or ‘without’, and ‘-ease’ means ‘comfort’. Therefore, we can simply conclude that disease is a condition without comfort. There are various types of diseases which may attack our body. Among them, some are communicable and some are non-communicable. Some of them are caused due to presence of harmful germs and worms while some are caused by lack or absence of nutrients. In this unit, we are going to study about some of the communicable and non-communicable diseases. 4.1. Veneral Diseases (Sexually Transmitted Infections, STIs) The diseases which are transmitted through sexual intercourse are grouped in STIs. The main cause of these infections is unsafe sex. Unsafe sex means to have sexual relations with many sexual partners without using condom. There are more than 20 STIs including HIV, Hepatitis–B, gonorrhea, syphilis, Chlamydia, and trichomoniasis. a. Syphilis Syphilis is one of the most common sexually transmitted diseases. Though it is transmitted through sexual intercourse, it affects the vital organs located in safe site of the body like heart, liver, and brain. It is caused by a microorganism, Treponema pallidum. Syphilis can also be acquired from a blood transfusion. It is transmitted through common use of syringes. It is found spreading among injecting drug users. Syphilis is also transmitted from a pregnant mother to the fetus through the placenta. There is almost fifty percent chance of transmission of syphilis from an infected mother to the fetus. Symptoms of syphilis The symptoms of syphilis gradually develop in a long period of time. There are three stages of syphilis on the basis of onset of symptoms of the disease – primary stage, secondary stage, and tertiary stage.

Health, Physical Education & Creative Arts - 8 63 i. Primary stage: The first sign of syphilis in its primary stage is an appearance of a chancre1 . It generally appears two to four weeks after infection. The most common locations for the chancre are the genitals, anus, lips, inner parts of mouth, and breast, etc. The chancre does not have any pain or itch. It disappears itself within one to five weeks. ii. Secondary stage: Secondary syphilis begins anywhere from one week to six months after the chancre heals. The symptoms include a pale red rash, fever, sore throat, headaches, poor appetite, weight loss, and hair loss. If it is not diagnosed and treated properly, it is developed into third stage of syphilis. iii. Tertiary or late syphilis: It is the third and final stage of syphilis. Late syphilis involves serious heart problems, eye problems, and brain or spinal cord damage. The patient becomes mentally deranged and dies. b. Gonorrhea In medical language, the prefix ‘Gono-’ denotes the genital organs and the suffix ‘-rrhea’ means discharge. In this way, the name of the disease suggests one of the main symptoms of this disease, i.e. unusual discharge of fluids from genital organs. Gonorrhea is caused by microscopic organism 'gonococcus of Neisser'. It affects on male and female genital organs including anus and throat, too. It is transmitted through the contamination of infected blood. It is also acquired with infected blood transfusion. Gonorrhea is the oldest form of STI. Symptoms of gonorrhea • In early stage of gonorrhea, there may not be remarkable symptoms. • The main characteristic feature of gonorrhea is the discharge of yellowish fluid with foul odor from the genital organs. • Swelling, appearance of red spots, and pain in the genital organs. • Fever with abdominal pain. 1 Chancre : a painless, itchless, granulated lesion that appears on any part of genitals, breast, lips, gums, or anus as the first symptom of syphilis and disappears itself within 1 to 5 weeks.

64 Health, Physical Education & Creative Arts - 8 • Frequent and burning urination. • There is accumulation of pus in prostate gland of males. • In females, there is lower abdominal pain, fever, nausea, and irregular menstruation cycle. • Gonorrhea may damage the reproductive organs resulting in infertility. • In infants, it is characterized with redness of eyes and its surroundings and over secretion of tear Preventive measures of syphilis and gonorrhea • There must be reliable blood monitoring before blood transfusion. • Common syringes should not be used. Encourage disposable syringes if needed. • Education about STIs and their mode of transmission should be given. • Avoid unsafe sex. If there are multiple sex partners, always use condom. • Identify the diseased person and treat him/her immediately. Penicillin has effective control over syphilis. • Do not use common razor, tattooing instruments, or any other piercing instrument that comes in contact with blood. c. HIV/AIDS The full form ofAIDS isAcquired Immune Deficiency Syndrome. It is caused by RNA retrovirus 'HIV (Human Immunodeficiency Virus). Syndrome is a collection of several signs and symptoms. More appropriately, it is also called a syndrome instead of disease because many signs and symptoms may be seen together in AIDS. HIV destroys the immune system of our body and creates a condition where there is deficiency of immune power. HIV virus attacks the CD4 positive T-lymphocytes and they increase their number billion times a day by continuous replication of viral RNA

Health, Physical Education & Creative Arts - 8 65 with the help of its replication enzymes. HIV was first recognized in USA in July of 1981 in some African (Haitian) people. Then, it is spreading all over the world rapidly. It is assumed that there are 7,500 people infected with HIV each day and there are more than 33 million people infected with HIV in the world at present. HIV entered lately in Asia. It was first reported in Nepal in the year 1988 AD. But it is increasing its number rapidly in Nepal. Different studies have shown that there were about 75,000 HIV-infected patients in Nepal. Surveys show that it is most prevalent among those people, who have returned from abroad. It has been remarkably found among injecting drug abusers too. It is transmitted to a healthy person by HIV contamination of blood, mucus, semen, and vaginal secretions. HIV is microscopic virus, which may be transmitted from an infected person to a healthy person in the following ways: HIV is transferred • By transfusing HIV-infected blood. • By sharing common syringe, needle, tattooing instrument, and other materials which come in contact with blood. • By indulging in unsafe sex (oral sex, anal sex, and sex without using condom). • By a pregnant mother to her unborn fetus. • By breastfeeding mother to her child through breast milk. • By accidental piercing with an infected-blood-contaminated syringe to health workers. HIV infection cannot be treated with any medication invented till now. But its adverse effects can be controlled to certain extent by using some anti-retroviral medications. There is a false belief that HIV can be transmitted if we go close to an infected person, work and live together. Such false belief has been a problem to make the infected persons adjusted easily in the family and society.

66 Health, Physical Education & Creative Arts - 8 HIV is not transferred • Through external touch and respiration. • By being and working together. • By sharing common room, latrine, bathroom, and utensils. • By hugging and kissing. • By mosquito and other insect-bites. • By playing, studying, and living together. • By having safe sex using condom properly. Signs and symptoms of HIV/AIDS HIV and AIDS do not have similar meaning. HIV is the name of virus and AIDS is the final stage of HIV infection. There is no AIDS immediately after entrance of viruses in the body. There are altogether four stages: incubation, acute infection, latency, and AIDS. HIV infection does not show any distinct symptom in the phase of incubation. The initial incubation period usually lasts between two to four weeks. Incubation is the period between the entrance of virus and the first sign of its effects. There are some minor signs in the second stage, acute infection may last an average of 28 days. This stage includes minor symptoms like fever, swollen lymph gland (lymphadenopathy), mouth and esophageal sores, and mild muscle pain (myalgia). The third stage, latency stage, may show very few or no symptoms at all and may last from two weeks to twenty years or more even. The final stage, AIDS, is the stage before death. This stage is characterized by various opportunistic infections. The immune power of AIDS victim becomes severely declined down. The following symptoms are seen in the AIDS stage. • Enlarged and painful lymph glands (lymphadenopathy). • Oral, pharyngeal, and esophageal sore. • Persistent unhealed skin wounds throughout the body surface. This

Health, Physical Education & Creative Arts - 8 67 may be Kaposi's sarcoma. • Remarkable weight loss. • Unhealed malignancy of any part of the body. • Continuous fever, cough, sores, diarrhea, etc. which remain unhealed. Preventive measures of STIs: (Gonorrhea Syphilis and HIV/AIDS) i. Neverindulge in unsafe sex. If the partneris doubtful, use condom. ii. Never use common syringe and needle for any purpose. iii. Awareness program for community people about STIs, HIV and AIDS should be conducted. iv. HIV monitoring must be done during blood donation and transfusion. v. HIV infected females should not be pregnant. vi. Spread the knowledge about condom and its method of appropriate use to prevent STIS and HIV/AIDS. vii. HIV infected persons should be behaved normally without any sort of isolation and discrimination. Proper counseling may support the adjustment of the patient in the family and society. viii. Provide proper care and help to the victims. ix. Health education should be made accessible to all. Inclusion of communicable diseases, precautions, safety measures, and prevention methods should be included in health education. x. If one's spouse (husband/wife) or sex partner is diagnosed with any form of STI, probability of infection becomes high. In this condition, immediate check-up and treatment should be done. xi. STIs should not be concealed at any circumstances. It should be treated in earlier stage. xii. Hesitation to discussions and education related to sex and sexrelated matters should be discouraged. STI, sexuality, safe and healthy sex-behaviors should be openly discussed among friends, teachers, and family members.

68 Health, Physical Education & Creative Arts - 8 4.2 Some Major Non-communicable Diseases • Cancer • Heart disease and cardiovascular diseases – Heart attack (Myocardial Infarction, MI) – Stroke (Cerebral attack or cerebral ischemia) • Rheumatic fever and rheumatic heart disease • Diabetes • Chronic obstructive pulmonary diseases (COPD) a. Cancer Cancer is a condition of over production of cells in our body. It is first developed from tumor. If the tumor is not treated in time, it develops into cancer. Cancer can spread from one part of the body to another part in later stage. It is the rapid formation of abnormal cells which grow beyond their usual limits and occupy adjoining parts of the body. Cancer occupies the biggest share among the diseases causing deaths all over the world. People mostly die of blood cancer, lung cancer, stomach cancer, and liver cancer. Cervical cancer and breast cancer are more prevalent among females where as prostate cancer is highly found in males comparatively. Cancer can be treated in its initial stage. If it is not diagnosed and treated in time, it can not be treated. Due to lack of knowledge, education, and health service centres, more than 70 percent of cancer deaths occur in underdeveloped and poor countries in the world. It is estimated that the trend of cancer-deaths will go on increasing and it will be 9 million and 11.4 million in the years 2015 and 2030 AD respectively. There are many causes of cancer. Some are known and some are still unknown. Some of the known causes of cancer are given below: Causes of cancer i. Intake of carcinogenic substances like nicotine, toxins, and carcinogenic chemicals formed in rotten fruits and vegetables

Health, Physical Education & Creative Arts - 8 69 ii. Intake of decayed, spicy, oily, and mucor-contaminated food items iii. Hereditary characters of cancer in the genes of parents iv. Exposure to strong rays which penetrate our body. The rays may be x-ray, cosmic rays, ultraviolet ray, and radioactive rays v. Tobacco, lime, beetle-nuts, and alcohol intake vi. AIDS is found mostly with generalized skin cancer called Kaposi's sarcoma vii. Some bacteria and viruses: For example: – Liver cancer by Hepatitis- B virus – Gastric cancer by Helicobacter pylori – Cervical cancer in females by Human Papilloma Virus (HPV) viii. Untreated wound for a long period of time ix. Disturbance of hormonal activities in body x. Excessive exposure to sunlight Signs and symptoms of cancer i. Abnormal growth and thickening of body parts. ii. Unhealed wounds with irregular bleeding for long period of time. iii. Unsolved indigestion for long period of time. iv. Tumors, wart, or moles grow in size. v. Pale appearance and fatigue. Prevention and control of cancer i. Modification of cancer-causing (carcinogenic) behavior to healthy behavior is advised. ii. Adoption of healthful habits like proper exercise and rest, intake of healthy and hygienic diet, yoga and meditation, etc. It is estimated that about forty percent chance of cancer is reduced just through healthful habits only. iii. Excessive exposure to sunlight and any other strong rays should be avoided.

70 Health, Physical Education & Creative Arts - 8 iv. Early diagnosis of cancer and timely attention to any abnormal growth or tumors or unhealed sores and wounds. v. Mothers should continue breast feeding to her baby throughout the full lactation period. vi. Wounds should be treated timely. vii. Environmental sanitation must be done to make it healthy. b. Heart diseases and cardiovascular diseases Heart is the busiest mechanical organ of our body that beats continuously from one’s fatal stage to death. It is one of the vital organs. Heart is made up of cardiac muscles and located inside the chest. It is a vital organ and its uninterrupted function is essential for survival. Stoppage of heartbeat is synonymous to death. More than 17.5 million people are dying each year due to heart disease. WHO has projected that this figure will be about 25.5 million in the year 2020 AD. The heart diseases are the result of our minor mistakes and negligence. It is a leading noncommunicable disease causing death of many people. The major factors of heart diseases are high blood pressure, high cholesterol, physical inactivity, diabetes, alcoholism, tobacco intake, unhealthy food habits, senescence, and genes inherited from parents. Cerebrovascular disease (disease of brain arteries), coronary artery disease (CAD), peripheral arterial disease, hypercholesterol, valve damage,rheumatic heart disease, heart attack and stroke, etc. are some examples of heart diseases. Heart attack (Myocardial Infarction, MI) It is one of the major fatal diseases in the world. The earlier symptoms of heart attack include shortness of breath and pain in the chest. The patient may die suddenly due to heart attack. Excessive use of fatty foods and food containing cholesterol causes arteriostenosis or narrowing of the arteries. The blood vessel that supplies blood to the heart muscle (i.e. coronary artery) is very thin and a small obstacle like a blood clot may block the supply of blood completely or partially; as a result, some

Health, Physical Education & Creative Arts - 8 71 portion of heart muscle is deprived of oxygen and other nutrients. Then the heart muscle loses the strength to pump blood out into the arteries. Ultimately the portion of heart-muscle starts dying too. This condition is known as heart attack. Most of the patients of heart attack experience some symptoms. Some may not have any symptoms and they may die suddenly of cardiac arrest or sudden stoppage of heartbeat. Symptoms of heart attack i. Persistent chest discomfort ii. Frequent burning pain in the chest iii. Shortness of breath iv. Abnormal sweating v. Palpitations (feeling of heartbeat over the ribs) vi. Lightheadedness, fatigue, and fainting vii. Sudden death due to cardiac arrest Stroke (Cerebral attack or cerebral ischemia) Stroke is the condition of sudden death of brain cells due to inadequate blood supply. There is disruption of blood vessels followed by blockage of blood supply towards the brain. Though it is associated with brain, it is studied as one of the heart diseases because it is associated with cardiovascular system of human body. This may result from either the blockage or rapture of a blood vessel. When there is no blood supply towards the brain, the casualty may die due to sudden interruption of blood supply in the brain. Depending on the area of brain damage, stroke may have the following symptoms Symptoms of Stroke i. Paralysis or inability of movement of any part of the body Area of temporarily blocked blood flow Blood clot in the middle cerebral artery

72 Health, Physical Education & Creative Arts - 8 ii. Speech impairment, iii. Loss of memory and reasoning ability iv. Loss of partial body function: vision loss, sense loss, hearing power loss, etc v. If not diagnosed and treated in time, the victim may go in coma or death. Preventive measures for heart attack and stroke i. Get education and awareness regarding heart diseases. ii. Adopt healthy food habits. Avoid intake of tobacco, alcohol, drugs. Avoid oily, spicy, and fatty foods. iii. Avoid intake of sugar and excessive carbohydrates. iv. Increase intake of healthier food items. Always be careful about balanced diet. Increase the intake of vegetables, fibrous foods, and fruits. v. Obesity increases workload to the heart. Excessive fatness can be reduced by doing regular physical exercise, yoga, and good food habit. vi. Reduce mental tension, anxiety, and depression. vii. Maintain the physical, mental, and social health as well. viii. Routine check up of blood pressure can indicate the probability of heart attack and stroke. Rheumatic fever and rheumatic heart disease Rheumatic heart diseases are associated with joint pains and infections of the bones and joints. Germs developed in the body during the conditions of tonsillitis2 and pharyngitis3 are the main causes of rheumatic fever and rheumatic heart disease. In the age interval between three to fifteen years, the onsets of tonsillitis and pharyngitis are found to be very common in children. If these are not treated properly and the onset is frequent, the patient is vulnerable to the infection of bacteria called "BetaHemolitis streptococcus Group-A". The bacteria travel in the body with bloodstream and reach the joints and heart. In the joints, they cause pain 2 Tonsillitis : inflammation of tonsils 3 Pharyngitis : inflammation of pharynx

Health, Physical Education & Creative Arts - 8 73 and swelling. Due to the presence of bacteria and their activities the victim gets fever too. The situation of these collective symptoms is termed as 'rheumatic fever'. In the heart, it damages delicate heart valves. Children suffering from rheumatic fever have damaged heart valves and heart muscle. Damage to the heart muscle and heart valves from rheumatic fever, caused by Streptococcal bacteria4 is called rheumatic heart disease. Rheumatic fever and rheumatic heart disease are two stages of the effects of the same causative agent. Rheumatic feveris the first stage ofrheumatic heart disease. In order to prevent rheumatic heart diseases, sore throat, tonsillitis, and pharyngitis should be treated properly in time. Antibiotic may be necessary to cure the sore throat, tonsillitis, and pharyngitis. Rheumatic fever is the condition of body with collective symptoms of joint pain, swelling, and fever developed as a result of an infection of streptococcus bacteria known as ‘Beta hemolitis streptococcus group-A’ in the body. Rheumatic heart disease is the condition characterized by damage of heart muscles, heart valves, joint pain, and swelling caused due to the infectious attack of the streptococcus bacteria called ‘Beta hemolitis streptococcus Group – A’ in the body. Though there is presence of a foreign causative agent in rheumatic fever and rheumatic heart diseases, they are considered as non-communicable because they do not transfer directly from person to person. They are caused due to internal aggravation of strep throat which may transfer through the contamination of causative agents. Prevention of rheumatic heart disease and rheumatic fever • Adopt hygienic and healthy lifestyle. • Remain safe from throat infections. • Get treated earlier if there is onset of tonsillitis and pharyngitis. c. Diabetes Diabetes is a kind of metabolic disorder in the body marked by excessive excretion of urine and persistent thirst. The term diabetes, if not specified to any other type, stands for diabetes mellitus (DM) in conventional practice. It is a chronic disease that occurs either when the pancreas 4 Streptococcal bacteria : a kind of Gram-positive spherical bacteria

74 Health, Physical Education & Creative Arts - 8 does not produce enough insulin or when the body cannot effectively use the insulin it produces. Insulin is a hormone that regulates blood sugar. Hyperglycaemia, or raised blood sugar in the blood, is a common effect of uncontrolled diabetes and over time leads to serious damage to the systems and organs, especially the nerves and blood vessels. Hyper = high level Glyc - = glucose, sugar -emia = condition of blood Hyper + glyc + emia = A condition with higher level of sugar in the blood The normal range of sugar is 70-120 mg% in the blood before meal. After having meal, glucose level increases up to 140 mg% in the blood. A diabetic person has increased glucose level more than the normal. First onset of diabetes is characterized by the increased glucose in blood but in the later stage sugar level of urine also increases. Insulin is a hormone produced from the pancreas that regulates blood sugar. Another form of diabetes is diabetes insipidus. It is a disease marked by excessive urination and thirst caused due to lack of anti-diuretic hormone (or vasopressin) in the body. This hormone helps in retention5 of water from the kidneys into blood circulation and prevents loss of water in the form of urine. Diabetes mellitus can be categorized into the following groups. Type 1 diabetes (Previously known as insulin-dependent, juvenile or childhood-onset) is characterized by deficient insulin production and requires daily administration of insulin. The cause of type 1 diabetes is not known and it is not preventable with current knowledge. Symptoms include excessive excretion of urine (polyuria), thirst (polydipsia), constant hunger, weight loss, vision changes and fatigue. These symptoms may occur suddenly. Type 2 diabetes (Formerly called non-insulin-dependent or adult-onset) results from the body’s ineffective use of insulin. Type 2 diabetes comprises 90% of people with diabetes around the world, and is largely the result of excess body weight and physical inactivity. Symptoms may be similarto those of Type 1 diabetes, but are often less marked. As a result, the disease may be diagnosed several years after onset, once complications have already arisen. 5 Retention: re-absorption back to the circulatory system.

Health, Physical Education & Creative Arts - 8 75 Until recently, this type of diabetes was seen only in adults but it is now also occurring in children. Gestational diabetes: Gestational diabetes is hyperglycaemia with onset or first recognition during pregnancy. Symptoms of gestational diabetes are similar to Type 2 diabetes. Gestational diabetes is most often diagnosed through prenatal screening, rather than reported symptoms. Source: http://www.who.int/en/diabetes, Feb. 2012 AD Signs and symptoms of diabetes i. The first sign of diabetes is frequent urination followed by excessive thirst. ii. Sweating increases remarkably. iii. Excessive hunger but gradual weight loss. iv. Increased fatigue and lethargy6 . v. Increased irritation and itching. vi. Weakness and fatigue in the patient. If it is not diagnosed in time, other chronic diseases are developed in the diabetic person. Some of the common chronic diseases are as follows: i. Diabetic retinopathy: It is a disease of retina of the eyes caused by diabetes. Increased sugar volume in the blood causes damage of blood capillaries on the retina causing blurred vision first and ultimately blindness. Data show that about 10% diabetics suffer from severe visual impairment after 15 years of diabetes and 2% become completely blind. ii. Diabetic neuropathy7 : It is the damage to the nerves and neurons due to diabetes. The symptoms of diabetic neuropathy are marked by tingling pain in the hands and feet, loss of memory, loss of reasoning power, and weakness. About 50% of diabetics get such problems. Persistent and non-healing feet ulcers are common in the later stage of diabetic neuropathy. iii. Diabetic cardiovascular disease: Cardiovascular diseases may be prompted by the increased level of sugar in the blood. About half of 6 Lethargy : feeling of having no energy in the body 7 Neuropathy : disease of nervous system

76 Health, Physical Education & Creative Arts - 8 the total diabetic deaths are associated with cardiovascular diseases like hypertension, heart attack, and brain stroke. iv. Kidney failure: About 20 percent of diabetic people get the complications in kidney functions and kidney failure. The increased sugar in bloodstream goes in the urine in the later stage of diabetes. Certain insects (example: ants) which like sweet taste, are seen in the latrine and urinals used by the diabetic person due to presence of sugar in the urine Prevention and Control of Diabetes i. Develop healthier food habit. ii. Avoid spicy, oily, fatty, and unhealthy food. iii. Decrease excessive carbohydrate and fats. iv. Avoid tobacco and alcohol use. v. Perform physical exercises like yoga on a regular basis. vi. Maintain physical fitness. Obesity and overweight motivate diabetes to occur. vii. Control mental tensions and enjoy life with happiness. viii. Monitor the glucose level frequently. ix. If sugar level is increased, follow the doctor's suggestions. Take the food for diabetic patients only. d. Chronic obstructive pulmonary diseases (COPD) COPD is a lung disease, which persists for long and cannot be treated completely. It creates problems and difficulties in breathing. Lung airflow is obstructed that interferes with normal breathing process. The nature and characteristics of COPD can be known by the meaning of terms included in its name.

Health, Physical Education & Creative Arts - 8 77 Chronic = diseases existing for long term Obstructive = that causes obstruction Pulmonary = pertaining to lungs Disease = abnormal condition of body COPD has been a great problem in poor and developing countries. About 90 percent of total death due to COPD occurs in low and middle income countries. There are more than 80 million of people with this disease in the world. It is also a leading cause of death particularly in polluted and industrial areas. In 2005, there were more than 3 million deaths due to this disease. This disease can be controlled with awareness, staying away from smoking, control of air pollution. It can be treated with available medications too. Causes of COPD The primary cause of COPD is dust inhalation and intake of tobacco smoke (including passive smokers). Main causes include air pollution (indoor and outdoor) dust produced from the industries, use of coal and wood for fuel, frequent respiratory infections during childhood, and respiratory organs infirmities. Prevention and control measures for COPD i. Avoid smoking. ii. Make the residential areas clean and dust-free. iii. Adopt appropriatepreventive measures to be safe from occupational dust. Use masks appropriately. iv. Respiratory diseases should be treated properly in time. 4.3 First Aid: Methods and Procedures ‘Aid’ is the assistance, or help given to somebody in a difficult situation. The difficult situations may result due to an accident, injury or any sort of sudden harm. Therefore, ‘first aid’ should be understood as the first assistance, or help given to a casualty until a medical personnel and service become available.

78 Health, Physical Education & Creative Arts - 8 The objectives of first aid are: i. To save the life of the casualty before appropriate medical care becomes available. ii. To manage medical care for the casualty as soon as possible. iii. To manage proper rest and provide consolation to the casualty. First aid can save life in difficult situations. There is a proverb, ‘accidents occur accidentally’, though some accidents occur due to negligence and lack of knowledge of safety education. In any sort of situation, first aid can be a milestone in the minimization of harm and continuation of life. The importance of first aid is belows: i. It helps in reduction of physical and mental harm to the casualty. ii. It helps in quick-management of proper health care to the casualty. iii. The casualty can get psychological comforts. iv. First aid can be the main source of proper information about accidents and probable harms. Availability of medical personnel and services can be made available by two ways: i. By taking the casualty to a medical center ii. By calling an ambulance or doctor to visit the casualty First aid is given by any person near the casualty. There may not be an expert at the time of accident orinjury. Therefore, everybody must have knowledge of first aid. Education about first aid brings knowledge to students about the need help the wounded, injured, fainted, drowned and other people having similar sudden health problems in different situations. 4.3.1 First aid on the basis of Time, Place and Nature of Casualty: Things to be Considered by the First Aid Provider. Methods and procedures of first aid are not the same in every situation. They differ according to time, place and nature of the casualty. Accidents may occur at any time. It is very difficult to provide first aid when it is to be given at night. Accidents and injuries may happen

Health, Physical Education & Creative Arts - 8 79 in remote places as well. Similarly, the intensity of the injury and risks differs according to the nature of the casualty. The first aid provider should be conscious enough to determine the level and quick steps to be taken with preference. The casualty should be provided with basic and life saving aid like stopping the bleeding, removal of obstructions in the respiratory tract etc. In the towns, we can call an ambulance or any other motor vehicle to take the victim to the nearest health center. In rural areas, we have to manage convenient carrying tool. If the victim is out of danger and recovering with rest, we should let him/her remain calm. It is the first aid provider, who should take the right decision with reference to the time, place and nature of casualty. 4.3.2 First Aid Box A first aid box is also called a first aid kit. It is a small box with essential materials and equipments required for providing first aid. It is generally used among students of schools. It is also kept at police stations, sports clubs, playground, vehicles, fairs, etc. Some of the common materials and devices kept in the first aid box are given below. First Aid Primary Care Guide Rehydration agent Small diary book (e.g. Jeevan Jal) Crepe and woven Bandages Thermometer Triangular bandage Thread and rubbers Tincture Iodine Torch light Gauze swabs Scissors Medium dressing Soap and handkerchief Pencil Safety pins

80 Health, Physical Education & Creative Arts - 8 Cotton swab Sterile info card Wound closure strips Scalpel Vinyl gloves Syringes Antiseptic wipes (e.g. Dettol) Sterile pieces of cloth Aspirin tablets Paracetamol tablets Micropore tape Ibuprofen tablets 4.3.3 Major Techniques of First Aid First aid techniques may differ according to the nature of the casualty, place of accident, and availability of resources. There are some common techniques of first aid. a. ABC Method of First Aid: ABC method stands for Airway, Breathing and Circulation Method of FirstAid.According to this method, airway organs like the mouth, nose, pharynx are checked carefully so that there is no obstacle in the path. Any foreign bodies like stone, straw, coin, pencil or other materials, if stuck along the airway, should be taken out safely. Breathing can be clearly examined in any kind of casualty. If breathing stops, the casualty dies. It must continue even in an unconscious casualty. After examining, if there is any problem, the first aid provider should provide artificial respiration to resume normal breathing. Circulation is essential for survival. It is examined by listening to the heartbeat or feeling the pulses at different pulse points of the casualty. If there is a problem in the heartbeat or blood circulation, cardiac massage should be given to the casualty. b. Artificial respiration Artificial respiration is a process of providing air with oxygen when one’s respiratory organs come to rest. This process can save the life of the casualty by maintaining the amount of oxygen needed for all the parts of the body. It should be done immediately after cessation. If there is no supply of oxygen for a long time, the casualty dies. In most of the cases, the sudden stoppage of respiration occurs due to some

Health, Physical Education & Creative Arts - 8 81 accident. In such situations, the casualty needs immediate first aid. The following steps should be followed for artificial respiration: i. Remove obstruction (if any) from mouth and nose. ii. Place the casualty in supine8 position, i.e. ventral part facing upward. iii. Raise the level of the head slightly up with the support of a pillow, thigh or any other soft thing so that the tongue does not obstruct the airway. iv. Close nostrils with the thumb and forefinger of one hand and grasp the chin with the other hand to open the mouth. v. If the mouth is strongly closed, pinch at the nostrils. vi. Grasp the chin to make the mouth open. vii. Seal your lips around the mouth and blow one breath every 3 to 4 seconds. viii. Observe the chestrise carefully. Give gentle chest compression for airto exhale. ix. If there is no heartbeat and pulse, heart massage is needed immediately. c. Cardiac Massage: Cardiac cessation is the stoppage, or pause, or interruption of the heart movement. It should not last for more than five minutes for the survival of the casualty. These is need of immediate first aid to save the life of the casualty in such a situation. The heart is a vital and most busy organ of the human body. It is an ever-working muscular organ that never takes rest during the whole life. In most of the cases, death is first noticed and confirmed by learning about the stoppage of the heartbeat and heart movements. But, we should not confirm the death of a casualty if there is no heartbeat for a very short period of time. Do not forget that short cessation of the heartbeat can be restored with cardiac massage. It is the rhythmic compression of somebody’s heart in order to restore the heartbeat and blood circulation after the person 8 Supine : lying or resting on the back with the face, palm and ventral parts facing upward

82 Health, Physical Education & Creative Arts - 8 has had a sudden stoppage of heartbeat. Method of giving cardiac massage: • Place the casualty in supine position (i.e, ventral part facing upward) • Place both the palms on the chest of the casualty one atop the other • Give rapid four compressions and make a pause for 4 to 5 seconds • Give one breath using mouth-to-mouth ventilation • Continue compressions, pause, and mouth-to-mouth ventilation until the heartbeat and normal respiration are restored. • Manage medical care as soon as possible Cardiopulmonary Resuscitation (CPR): It is the process of providing first aid by providing artificial respiration and cardiac massage simultaneously to a casualty who is suffering with difficulty in heartbeat and respiration. d. Risks and Safety Measures at School Safety Measures at School Schoolistheplacewheretherearestudents of various ages. By nature, children are restless and fidgeting. Therefore, they are highly vulnerable to accidents. They fall in accidents very frequently. So, school CPR for children and adults CPR for infants under 12 months

Health, Physical Education & Creative Arts - 8 83 should apply safety measures to keep the students safe from injuries and accidents by following the methods given below: i. Remove the things like broken desks, benches, wooden pieces, metals and slippery substances from the classroom. ii. Running, pushing, and playing in classrooms and other narrow places should be avoided. iii. Class monitors should be made in each class to monitor unsafe activities of students in absence of teachers. iv. Laboratory equipment should not be used without supervision of the teacher. 4.4 Safety, First Aid and Preparation of First Aid Box Safety Safety is the conscious measure of preventing accidents and injuries. It is the process of taking precautions to avoid accidents. Some of the accidents and injuries may be unavoidable but most of them can be prevented by taking proper precautions. Safety education is the process of changing our knowledge, attitude, and behaviours to be safe from potential accidents or injuries. Safety education helps us to be careful about the risks in different situations. Safety measures may be different in different situations because the risk factors associated in different places have different nature. Importance of safety education We have a popular saying, ‘prevention is better than cure’. If we adopt preventive precautions, a number of accidents can be avoided. The following points show the importance of safety education: i. Safety education helps people to minimise accidents and injuries. ii. Safety education guides us to adopt the safety measures in different situations. iii. Accidents may cause death or injuries. If we are careful with the knowledge of safety education, we can be safe from such circumstances.

84 Health, Physical Education & Creative Arts - 8 iv. School children have very active and fidgeting behaviours. Safety education given to them can save them from probable injuries while playing, walking, and doing different works. First AID: Preparation of First Aid Box ‘Aid’ is the assistance or help given to somebody in a difficult situation. Difficult situations may come up due to an accident, injury or any sort of sudden harm. Therefore, ‘first aid’ should be understood as the first assistance or help given to an individual until medical personnel and service become available. The medical personnel and service can be made available in two ways: i. By taking the casualty victim to a medical centre. ii. By calling an ambulance or doctor to visit the victim. First aid is given by any person around the site of casualty. There may not be an expert at the time of accidents or injuries. Therefore, everybody must have knowledge of first aid. The education of first aid brings knowledge, attitude and behaviour in students to help the wounded, injured, fainted, drowned, cut, animal-bitten and other people having similar sudden health problems in different situations. Objectives of First Aid i. To save the life of the casualty victim before an appropriate medical care becomes available. ii. To make medical care available forthe casualty victim as soon as possible. iii. To provide proper rest and consolation to the victim. iv. To provide artificial respiration and heart movement if necessary. v. To prevent from excessive blood loss in case of bleeding due to accidental cuts and injuries. vi. To avoid further worsening of the victim's condition. vii. To provide right and truthful information about the victim and nature of accident or injury to the medical personnel. In order to meet the objectives of First Aid, we must have some of the essential materials with us. Let’s manage the first aid box with the following procedure.

Health, Physical Education & Creative Arts - 8 85 i. Manage a wooden or a durable fibre/plastic box of a small bag-size. ii. Manage to keep the following materials as far as possible. They come in use to save a casualty’s life if used properly. A basic first aid kit may contain: • Bandages and dressings – a few adhesive bandages and gauze dressings to cover wounds. • Antibiotic cream – check the expiration date. It is used to avoid infection. • Scissors to cut dressings, clothing, rope, seatbelts and more. • Needle-nose tweezers to pull out splinters, ticks, thorns and rattlesnake fangs, plasters in a variety of different sizes and shapes. • Small, medium and large sterile gauze dressings, used to cover the wounds or cuts. • Sterile eye dressings. • Triangular bandages. • Crepe rolled bandages.

86 Health, Physical Education & Creative Arts - 8 • Safety pins. • Disposable sterile gloves. • Tweezers which are used to make grip on bandages, wound debris etc. First Aid for Different Accidents and Injuries a. Heat Stroke Heatstroke is a condition caused by your overheating, usually as a result of prolonged exposure to or physical exertion at high temperatures. There is very high temperature in the hot seasons in the Terai region of Nepal. During the hot weather, when hot wind blows, it can cause rise in the temperature of our body. Heatstroke can occur if the body temperature rises to 104 F (40 C) or higher. Heatstroke requires emergency treatment. Untreated heatstroke can quickly damage the brain, heart, kidneys and muscles. The longer the treatment is delayed, more the risks of serious complications or death. Symptoms of Heatstroke i. High body temperature. ii. Altered mental state or behavior, confusion iii. Body shaking, agitation. iii. Slurred speech, irritability, delirium, seizures and coma iv. Sweating. v. Nausea and vomiting vi. Flushed skin (Skin may turn red as the body temperature increases) vii. Rapid breathing viii. Rapid heart rate ix. Headache

Health, Physical Education & Creative Arts - 8 87 b. Frostbite Frostbite is an injury caused by freezing of the skin and underlying tissues. First your skin becomes very cold and red, then numb, hard and pale. Later, the color of the skin turns bluish and black when the effects are aggravated. Frostbite is most common on the fingers, toes, nose, ears, cheeks and chin. Exposed skin in cold, windy weather is most vulnerable to frostbite. Frostbite can occur on the skin covered by gloves or other clothing if they are thin and non-protective. The first stage of frostbite is called frostnip. It doesn't cause permanent skin damage. We can treat very mild frostbite with first-aid measures, including rewarming the cold skin. Severe frostbite requires medical attention because it can damage skin, tissues, muscle and bones. Possible complications of severe frostbite include infection and nerve damage. Common first aid measures to be followed for controlling the adverse effects of frostbite are: i. Keep the victim in warm place. ii. Do not massage the frostbitten part. It may further damage the underlying tissues. iii. Do not expose the frostbitten part directly to fire. iv. It is better to put the frostbitten part in lukewarm water. v. Provide warm water or fluid to the victim. vi. Seek medical assistance as far as possible, if the condition is worsening. c. Foreign body in the eye A foreign object in the eye is something that enters the eye from outside the body. It can be anything that does not naturally belong there, from a particle of dust to a metal shard. When a foreign object enters the eye, it will most likely affect the cornea or the conjunctiva.

88 Health, Physical Education & Creative Arts - 8 If a person has a foreign object in your eye, the person probably will experience the following immediate symptoms. • a feeling of pressure or discomfort • a sensation that something is in your eye • eye pain • extreme tearing • pain when you look at light • excessive blinking • redness or a bloodshot eye If we need to help someone who has problem with foreign body in the eye/s, the follwoing first aid steps are followed. • Wash hands. • Look at the affected eye in an area with bright light. • To examine the eye and find the object, look up while pulling the lower lid down. Follow this by looking down while flipping up the inside of the upper lid. • Tell the casualty to immerse the side of face with the affected eye in a flat container of water. While the eye is under water, request him to open and close the eye several times to flush out the object. • If the object is stuck, pull out the upper lid and stretch it over the lower lid to loosen the object. • Wash the affected eye with clean water with normal temperature. Precaution Removing a foreign object yourself may cause serious eye damage. Get immediate emergency treatment if the foreign object: • has sharp or rough edges • is large enough to interfere with closing your eye • contains chemicals • was propelled into the eye at a high rate of speed • is embedded in the eye • is causing bleeding in the eye

Health, Physical Education & Creative Arts - 8 89 4.5 Concept of Risk In simple word, risk is the possibility that some injury, loss or any unfavorable event will happen in the future. Risk is the potentiality of harmful and inauspicious situation to occur. In our everyday life, we need to tackle with several kinds of risks. Some of the risks are easy to avoid but some are inevitable. People fall in accidents and injuries when they cannot overcome the threats of risky situations and circumstances. Physical infrastructures like buildings, houses, roads and human residential areas are under the risk of natural calamities like landslide, earthquake, fire, volcano etc. If we identify the risks and their potential threats, we can minimize the hazardous effects to human being. Types of Risk In order to cope with the problems created by different kinds of risks, the nature of risk should be identified and analyzed. This can guide us for formulating the mitigating measures against the hazardous results. Risks can be categorized into the following two groups. They are the a. Risks Originated from Natural Phenomena b. Risks Originated from Huma Activities The earth has its own system of its natural processes. Water cycle, gaseous cycles, wind, geographical vividness, geothermal phenomena and movement of tectonic plates are some of the major dynamic aspects of the earth) When these processes and phenomena lose their balance, natural calamities occur. They may create moderate to heavy loss of human lives and properties. Some of the problems created by natural phenomena are discussed below: i. Earthquake Earthquake is an incident of shaking of the earth's surface. When there is earthquake, the man-made structures like buildings, roads, town area etc. are cracked or destroyed. People die and buried under rock, soil, concrete and other hard materials piled due to such devastation. It is a natural

90 Health, Physical Education & Creative Arts - 8 phenomenon and human has no control over such incidents. Regarding the risks, we can minimize the possible harms and hazards with appropriate precautions and measures against it. Precautions against the risk of the earthquake i. Apply anti-earthquake technologies while constructing houses. ii. Learn first aid for wound, fracture, bleeding and unconsciousness. iii. Learn how to turn off the gas, water, and electricity. iv. Make up a plan of where to meet your family after an earthquake. v . Don't leave heavy objects on shelves or at height (they'll fall during a quake.. vi. Anchor heavy furniture, cupboards, and appliances to the walls or floor properly with the help of experts. vii. Learn the earthquake plan at your school or workplace. viii. Learn the technique of ‘Drop, Cover and Hold on!’ and determine the safe places earlier. Considerations for safety during an earthquake a. ‘Drop, Cover, and Hold on!’ Drop to the floor, get under a sturdy table, and hold on until the shaking stops. If your entire body does not fit underneath the furniture, position your body so that at least your head and neck are covered. b. If you are indoors, stay there; most injuries occur when people inside try to move to a different location or try to leave. Avoid windows, exterior walls, stairwells, elevators, and objects that could fall. Be aware that the electricity may go out and the fire alarm or sprinkler system may turn on. c. If you are outside, get into an open area) Stay clear of buildings, power lines, street-lights, and anything that can fall on you.

Health, Physical Education & Creative Arts - 8 91 d. If driving, move out of traffic as quickly as possible and shut off the engine. Avoid bridges and overpasses, and anything that could fall onto your vehicle (car, bike etc.), such as trees, light posts, powerlines, and signs. e. If you are on bed, stay there. Hold on and protect your head with a pillow. Only move to a nearby safe place if you are under a heavy light fixture or something that may fall on you. f. If you are on a wheelchair, stay in it. Move to a safe location, lock your wheels, and cover your head and neck. After an earthquake, there may be minor to heavy devastation of physical properties and human lives. We must have patience at that time. Shaking may occur several times even for a year or more after a big earthquake.Such shaking incidents after a mega earthquake are called aftershock. ii. Storm A storm is a short-term disturbance of the atmosphere that is accompained with the mighty wind and usually by heavy or light rain, snow, hail, or thunder and lightning. During a storm, the wind may reach a speed of 64 to 72 miles or which is 103 to 117 kilometers per hour. There are many types of storms and each has its own dangers. The one common factor in every storms is that each of them could be dangerous in some aspect or another. It becomes very important to take proper precautions for your safety before any severe storm hits your neighborhood. Precautions on action to take during a severe storm • If you’re at home or inside, stay indoors and away from windows. Stay aware and wait out the storm. • Stay informed on weather updates via television, smartphone

92 Health, Physical Education & Creative Arts - 8 Exercise A. Answer the following questions. 1. What is a disease? How do you define veneral diseases? 2. Explain the three stages of development of syphilis with their general symptoms seen on each stage. 3. What is HIV? How does it differ from AIDS? 4. List any five preventive measures against STIs. 5. Write short notes on: a. Heart attack (Myocardial Infarction, MI) b. Stroke (Cerebral attack or cerebral ischemia) c. Rheumatic Heart Disease 6. List down the four major symptoms of diabetes mellitus. 7. Define first aid. List any five importance of first aid. 8. Draw a picture illustrating the materials and medicines kept in a first aid box. 9. What is heat stroke? How can we prevent ourselves from heat stroke? 10. How can we minimize the risks of the consequences of earthquake? B. Tick (√ ) the best alternative. 1. Treponema pallidum is the causative agent of ……………………. a. syphilis. b. gonorrhoea. c. AIDS. applications, or a radio. • During a lightning storm, always take shelter and stay away from electric or metal. Open spaces are unsafe. • If you’re in a vehicle, try to stay away from power lines and trees. • Stayawayfromgoodconductorsofelectricityduringathunderstorm.

Health, Physical Education & Creative Arts - 8 93 2. HIV stands for …………… a. Human Immunodeficiency Virus. b. Human Immune Vector c. Human Insuffiency Virus 3. COPD is a disease of ………. system. a. Respiratory b. Digestive c. Cardiovascular 4. ABC method of first aid primarily consists of ....... a. Airways, breathing, circulation b. Airtificial breathing and circulation c. Acute broader caring of casualty 5. There is threat of frostbite ....... a. near the animals living in cold b. when an insect has sharp and piercing mouth organs c. when the weather is extremely cold

94 Health, Physical Education & Creative Arts - 8 5 Sexual and Reproductive Health Before You Proceed ACTIVITY-A MINI RESEARCH WORK Are you an adolescent? What do people think about your age and developmental characteristics of your present life? Choose any ten of your intimate friends and conduct a research with the help of following MCQs (MultipleChoice Questions). Do not collect the names of your respondents/friends. Give a printed, photocopied, or a handwritten form to each of your friend. Request them just to mention their gender (male or female) and age in the form. MINI-RESEARCH QUESTIONNAIRE RESPONDENT'S AGE: ……Years. SEX: Male o Female o Please tick the best answers 1. Which of the developmental stage do you belong to? a. Baby b. Child c. Adolescent d. Adult 2. Whatdoyourparents tell aboutyourdevelopmental stage? a. Baby b. Child c. Adolescent d. Adult 3. What do your friends tell about your developmental stage? a. Baby b. Child c. Adolescent d. Adult 4. Whatdoyourteachers tell aboutyourdevelopmental stage? a. Baby b. Child c. Adolescent d. Adult 5. How do you label the changes on your body within last two years? a. No change at all b. Changes are there but it is not known to others c. Changes has made me noticeably different d. Changes are unexpectedly more 6. Have the differences made change in your lifestyle? a. Not at all b. To some insignificant extent c. I have to be more careful about my body and health d. The differences has reduced the risks down 7. How have you changed your friends' circle within the last four years? a. The friends' circle now is as it was before three or four years b. Few of my friends of opposite sexes are naturally not closer as earlier c. Closeness is more intimate with the friends of same sex d. Closeness is more intimate with the friends of opposite sex 8. Which of your body system has experienced more changes during the last two years? ? a. Reproductive b. Digestive c. Urinary d. Nervous 9. Have you ever seen any contraceptive device like condom or pills in reality? a. Yes, at my home b. Yes, with my friend c. Yes, at other place, (………………………….) d. Never seen 10. Have you ever watched or heard any advertisement of contraceptive device? a. Yes, from radio b. Yes, in television c. Yes, in papers d. Never seen 11. Do you think it is good to talk and share the matters of reproductive health and contraceptive devices with others? a. Yes, but only to close friends b. Yes, but only with siblings c. Yes, but only with sex partner d. No, not necessary 12. What would you choose if you are powered to change your gender now for only one time in your life? a. I am a girl now. I would be a boy if so. b. I am a boy now. I would be a girl if so. c. I am happy for being a girl d. I am happy for being a boy

Health, Physical Education & Creative Arts - 8 95 5.1 Responsibilities of adolescents Adolescence is the period of rapid growth and development. According to WHO, adolescents are the people in the age group 10-19 years. There are several physical, mental, social, and emotional changes during adolescence. The achievement of a person during adolescence is regarded as the base for adulthood. Therefore, the adolescents should be sincere for their future career at this age. Besides, they have different responsibilities towards themselves, their families, society, and the nation. a. Personal responsibilities i. Maintain personal health and hygiene to become a healthy person. ii. Become active for shaping future career by studying, training, and having work experiences. iii. Follow the guidelines of guardians,teachers, and the senior members ofthe society. iv. Abstain from tobacco, alcohol, and drugs. v. Take proper care about the sexual and reproductive health. Accept the changes in primary and secondary sex characteristics positively. vi. Share your ideas and knowledge with your friends and family members to keep themselves healthy and happy. b. Responsibilities towards their family i. Maintain good relationships with the senior and junior members of the family. ii. Give proper attention to the issues of family health like food, drinking water, indoor sanitation, etc. iii. Become cooperative for the accomplishment of family works. iv. Stand against the superstitious and unscientific health practices and motivate the family towards scientific health practices. v. Pay proper attention to the issues like immunization, nutrition, and healthful behaviours. vi. Share your ideas and knowledge with your family members to motivate them for the contribution towards your family.

96 Health, Physical Education & Creative Arts - 8 c. Responsibilities towards their community and nation i. Maintain good relationships with the members of the society. Always show caring and loving behaviours towards children and modest respect towards the senior members. ii. Show a genuine respect towards the existing social norms and values. iii. Advocate against unscientific, unhealthy and superstitious practices in the society. iv. Participate yourself in the social works and activities. v. Make your ample contributions to the preservation of natural and cultural heritages. vi. Share your ideas and knowledge about the personal responsibilities of citizen towards their community and nation with others. 5.2 Safer Sexual Behaviours Sexual behaviours are the activities related to reproductive and sexual phenomena of human body. It is primarily determined by the knowledge and attitude of an individual to human sexuality. It is very important that the adolescents pay proper attention to safer sexual behaviours. Because of production of sex hormones and development of reproductive organs, the adolescentsdevelopcuriosityandinterestinsex-relatedmatters.Theynaturally experience sexual desires as well. In such situation, the adolescents should be guided properly with education and counselling. Some of the guidelines for safer sexual behaviours are: a. Have proper knowledge about human sexuality and accept the changes on primary and secondary sex-characteristics positively. b. Protect yourself from: i. Unhealthy sexual behaviours (Having sex with the victims of STIs like HIV/AIDS, gonorrhea, syphilis etc., animal sex, anal sex, etc.) ii. Unsafe sexual behaviours (Having sex without using condom properly) iii. Illegal sexual behaviours (Having sex within blood-relation or minors, rape, etc.)

Health, Physical Education & Creative Arts - 8 97 iv. Immoral sexual behaviours (Sexual relation before marriage, sexual relation against social norms and values). d. Show respectful behaviour to the people of opposite gender. Always stand against teasing, mocking, bullying, harassing, etc. 5.3 Reproductive Health In simple words, reproductive health is the state of health affected by one's reproductive processes and phenomenon of human body. Reproduction is the process of producing offspring by the living things. Human health encompasses physical, mental, social, and emotional aspects. In this light, reproductive health can be defined as the state of health primarily concerned with the physical, mental, social, and emotional aspects of human sexuality and reproduction. According to WHO (World Health Organization), "Reproductive health is a state of complete physical, mental, and social well-being and not merely the absence of diseases or infirmities in all the matters related to the reproductive system and to its functions and processes." Reproductive health is, nowadays, taken in broader sense. It is also concerned with appropriate age at marriage, problems of pregnancy and child birth, unsafe sex behaviours, and prevention from sexually transmitted infections. 5.4 Safe Abortion 5.4.1 Concept Abortion is the deliberate ending of a pregnancy at an early stage. It is traditionally practised in illegal and unscientific ways like inducing trauma1 ,inserting toxic2 substances into theuterus, or by intake of abortive substance orally. Such superstitious practices are very often harmful to the health of pregnant woman and sometimes it becomes fatal3 . Safe abortion is a medical and scientific procedure to end an unwanted pregnancy at an early stage. Abortion should be safe from the point of views of physical, legal, psychological, and emotional aspects. In broader sense, safe abortion can be defined as the process of ending orterminating 1 Trauma = an injury 2 Toxic = poisonous 3 Fatal = causing or ending in death

98 Health, Physical Education & Creative Arts - 8 a pregnancy according to the ‘Safe Abortion Service Process 2060’4 by a legally licensed health practitioner. ‘SafeAbortion Service Process 2060’ has clearly made different provisions for safe and unsafe abortion. Registered and listed medical practitioners and health service providing centres are providing comprehensive abortion care (CAC) services in Nepal. 5.4.2 Legal Conditions of Abortion Abortion is legal only with the consent of the pregnant mother. Only the pregnant woman holds the right to choose to continue or terminate the pregnancy. If the pregnant woman is less than 16 years of age or not in a position to give her consent (unconscious or mentally impairment), the nearest guardian or relative can give the consent of abortion services. The following conditions are considered legal. i. Up to 12 weeks of gestation5 : According to the desire of pregnant woman. ii. Up to 18 weeks of gestation: If the conception is due to rape6 or incest7 . iii. At any time before delivery ofthe baby:If a certified doctor prescribes abortion because of a. Threat to the mother’s life. b. Possibility of severe harm to the mother’s physical or mental health. c. If the foetus is suffering from a severely debilitating orfatal deformity as certified by a registered physician. 5.4.3 Techniques of Safe Abortion Safe abortion can be done in the following ways: a. By oral medication for the termination of gestation up to 9 weeks (63 days) 4 ‘Safe Abortion Service Process 2060’= A legal provision promulgated by Nepal Government 2060 BS to control unsafe abortion in Nepal 5 Gestation = pregnancy 6 Rape = to have sex with somebody by force or by threatening 7 Incest = sexual activity between two people who are very closely related in a family, for example a brother and sister, or a father and daughter

Health, Physical Education & Creative Arts - 8 99 b. By using the medical instruments and surgical procedure for the termination of gestation up to 12 weeks. 5.4.4 Illegal Abortion Abortion is illegal in the following conditions: a. Termination of any gestation for the sole purpose of sex selection after determining the sex of the foetus. b. By forcing, luring, threatening, or such any other unethical activities. c. By adopting any other traditional, superstitious, or illegal method except indicated by the law of Nepal. 5.4.5 Unsafe Abortion and Its Harmful Esffects Unsafe abortion is the process of ending or terminating a pregnancy by any traditional, superstitious, and unscientific method that is against the existing law of Nepal. Unsafe abortion has the following adverse consequences. i. Threat to the life of mother ii. Probability of cessation8 of fecundity9 power of the mother iii. Infection in the uterus (womb) and other reproductive organs of the mother iv. Chronic10 pain in the lower abdomen v. Legal punishment and penalty vi. Condition that may lead to the excision of the uterus 5.5 Concept of Contraception Contraception is a method of preventing a woman from becoming pregnant. When a male and a female have desire to have sex but not a child, they use any one of the various methods of contraception. Contraception includes the methods and tools which prevent fertilization of the ovum by sperm. This situation eliminates the chance of conception and gestation. 8 Cessation = a pause or stoppage, termination of the capacity 9 Fecundity = the biological capacity or potentiality to bear a baby 10 Chronic = long term, not healing in short time

100 Health, Physical Education & Creative Arts - 8 5.6 Methods of Contraception The methods of contraception can be classified into two groups, i.e. natural and artificial methods of contraception. The artificial methods of contraception are further categorized into temporary, emergency, and permanent methods. Contraceptive Methods Natural Calendar method Withdrawal (Coitusinterrupts) method Temporary Permanent Emergency COC IUCD Female Male Pills IUD Foam tablet Vasectomy Minilap Laparoscopy Condom Female Male Norplant Depo-Provera Femidom Cervical Mucus method Basal Body Temperature method Breast feeding method Artificial Fig. Contraceptive Methods and Devices 5.6.1. Natural Methods of Contraception Natural methods of contraception do not need any artificial devices. It is the method of preventing gestation by natural system. The following techniques are followed in the natural methods. i. Calendar Method: A method in which the fertile and infertile time of woman is calculated on the basis of menstrual period and having sex restricted within the infertile period. ii. Withdrawal Method: A method followed by males in which the sperm and semen are ejaculated outside the vagina.