NOTE: The water tank has been completed.
PDF print – Summary of Report
United Mission Hospital
PROJECT: Construction of a 1500m3 water tank
Water Tank Project Video
Tansen hospital was established in 1954, when the United Mission was permitted to start work in Nepal. Tansen hospital was the first place where medical care was given. Up till then the Nepali people had to go to India for medical care.
Dedication Ceremony Photos
Dr.Rachel Karrach, Adrion Los, Ed Kramer, Jeena John and Krishna Bahadur Rawal
Krishna Bahadur Rawal, Chairman of Tansen Rotary Club, Ed Kramer, Engineer and Ganesh Gimere, Personal Manager
Ed Kramer and Dr. Rachel Karrach
Pun Narayan, Pastoral Care Department Supervisor
Ed Kramer speaking
Adrion Los and Ed Kramer – Engineers
Ed Kramer and Jeena John
To all who contributed to the water tank project, we what to thank you for your financial help and the completion of the project. Also, to the many people that worked on the project, thank you as well for your hard work in the construction of the water tank.
United Mission Hospital, Tansen (UMHT) is an acute care general hospital situated in Tansen, Palpa District. The Mission of the Hospital is to promote health, prevent illness and treat disease among the people of Palpa and surrounding districts, by providing high-quality health care at the level of a zonal hospital in the Name and Spirit of Jesus Christ, irrespective of colour, caste, creed, gender or financial status and to make Him known in word and deed. UMHT is a referral hospital for Palpa and surrounding districts.
The United Mission Hospital, Tansen is committed to helping its staff to develop their full potential. UMHT is a training hospital with a clear mission to train up medical nursing and paramedical professionals both for the immediate needs of the Hospital and for wider service in Nepal.
Project Title: Rainwater Harvesting Water Tank
Organization Name: Tansen Mission Hospital
Contact Information: Dr. Rachel Karrach, Hospital Director
United Mission Hospital Tansen
P.O Box 126
Location: Tansen Mission Hospital, Palpa, Nepal Hospital compound
Purpose of project: To build an extra tank for rainwater harvesting as the present storage capacity is insufficient to guarantee an undisturbed running of the hospital.
Impact: Over the years the hospital operations have been hampered because of shortage of water. Because of that a rainwater harvesting system has been installed through which rain is collected from the hospital roofs and the roofs of the compound houses. The total capacity of this system is 1188 m3. However because of the decline of water received from Tansen municipality it has become more and more difficult to run the hospital during the dry season. By building an additional water tank of 1500 m3 this problem can be solved. There is sufficient rain available to fill this new tank.
Estimated costs: The estimated cost of the implementation of this project is USD 250,000 with current prices. The actual building costs are estimated at USD 290,000 at the time of construction.
Mission Statement: “We serve, Jesus heals”
At present the hospital has 165 beds, staffed with 257 medical and 159 supporting staff. Daily an average of 300 outpatients visit the hospital. Common diseases are infections (meningitis typhoid, gastroenteritis, tb, HIV and parasites), chronic lung disease, alcoholism, heart disease, diabetes, injuries, malnutrition and pregnancy complications.
The budgeted running expense for the fiscal year from July year 2013-July 2014 is Nrs 230,340.000 (USD 2,303,400) and capital expenditure is estimated at Nrs 39,809,000 (USD 398,090). The capital expenditure will only be spent if revenue covers first the running expenses. The experience of the last 10 years is that the hospital manages to cover these expenses. Roughly 80% of the patients are able to pay.
Salaries are roughly 55 % of the budget, medical supplies and consumables about 25%. Thus approximately 80% of cost is directly “medical”. The hospital fees have been increased with about 10 % p.a.
The Tansen hospital was awarded the title “best hospital Nepal” in 2012, is fully nongovernmental and is part of the UMN activities in Nepal. As a matter of fact, the government has requested UMN to continue its role and involvement, instead of handing it over to the state, as proposed by UMN.
The government of Nepal (27.0 mill. people) is described as non-functional after the assassination of the royal family was followed by political instability, mismanagement and a prolonged civil war. Corruption is also a disturbing factor. Unemployment is rampant reportedly at 46%.
In contrast UMN has been able to maintain its Christian vision of compassion for the poor and suffering. The team of anywhere between 10 to 20 expats, in an otherwise all Nepali staffed hospital, has been able to make a remarkable difference in the quality of health care and the education of Nepali physicians in its 55 year existence. We believe that the ongoing involvement of UMN is crucial for the foreseeable future. The vision is to grow the capacity of the hospital to 250 beds over a 5 year period as, at this point, patients still need to be turned away when all the spots on the floor are filled.
SITUATION / RATIONALE
Tansen Mission hospital is located at the outside of Tansen Municipality. As Tansen and the hospital is situated mainly above the town, the supply of water always has been a problem. Initially the supply of water to the municipality could meet the demand. As the hospital is situated at the end of the water system of Tansen municipality, it only receives the “leftovers” from the water available to the town. Over the years the water supply from the municipality is decreasing. A solution was found to pump water from a well at the village of Dovaghat, located about 300 m below the hospital to the tanks of the Hospital compound. However the people of the village are not happy about this water supply as they feel they need the water themselves as they use it for their fields to generate a living. Therefore the water supply from this village is very unreliable.
Rain harvesting at the hospital has been done since about 40 years. During this time, water deliverance from the municipality decreased slowly while the demand of the hospital continued to grow. When new buildings were constructed, part of the plan was always to harvest rain from that particular building and to add to the storage capacity by constructing a new tank. At the moment there is a storage capacity of 1188 m3 available. The system works very well, however the tanks are filled very quickly as in the Tansen area, there is an average yearly precipitation of around 1750 mm. With the present area of roofs this gives a potential of harvesting about 10.000 m3 water per year. The present storage capacity with the inflow from the municipality is insufficient to cover the need for water at the end of the dry period, which are the months April, May and part of June. During that period, the hospital has to minimize the use water and sometimes has to stop operating. In the year 2011, 80 m3 of water had to be purchased from private sources and in 2012, an extra 100 m3 was needed. This water was delivered by truck. In the light of the decreasing inflow from the municipality, action has to be undertaken to secure sufficient water during the dry period. To solve the yearly problems with water shortage, the following actions are planned:
1. Build a reinforced concrete water tank with a capacity of 1500 m3 at the location of the present tennis court.
2. Replace the old shower heads in the hospital and compound houses with new water saving heads. Toilets will continue to be without flushing tanks so that waste water can be used for flushing.
3. Replace water taps, where possible, with automatic taps as ordinary taps are easily left open losing water unnecessarily.
4. Install water meters to every building at the compound.
5. At the moment inhabitants of compound houses pay a very small fee for the use of water. The fee is USD 0,75 per month and USD 0,15 for each additional family member. The fee to be paid will be raised considerably on the basis of the actual use of water, to remind that water is a scarce commodity.
With this extra capacity and the implementation of water saving devices in the hospital and compound houses, the hospital will be able to run its medical services without interruptions. In the years to come a study will be executed in which way a separate water source can be found through which the hospital can become independent from the water inflow from the municipality.
The costs to implement these plans are estimated at USD 225,000 for the construction of the water tank etc. and USD 25,000 for water saving devices. The total costs of this project are thus estimated as being USD 250,000. These are present costs, in the middle of the year 2013. The tank will probably only be built in the middle of 2014 or later. The current inflation in Nepal is about 15 % per annum, therefore the actual building costs are estimated as being USD 290,000. However, it should be noted that the hospital is located in an area at high risk for earthquakes and that the cost is significantly higher because of the need to build the tank to resist earthquakes as much as possible.
A study was carried out to investigate what size of water tank would be sufficient to solve the water problem. This study shows, that with a minimum of rain and the minimum inflow from town during the years 2009-2012 the system with an extra storage tank of 1000 m3 will be able to supply the hospital with sufficient water all year round on the basis that the municipality delivers at least an average of 26 m3/day. This report is available for your information. However this year proved that the water supply declined and the hospital experienced a water problem in March, April and May. Therefore we aim to build a tank with a capacity of 1500 m3 unless a further investigation (see below) proves that a tank of 1000 m3 will do in the current situation. We only will carry out this further investigation if sufficient funds are pledged.
The report of the study was discussed with the research institute KWR water in Nieuwegein (kwrwater.nl) in The Netherlands.
They offered a further study to calculate the total effective capacity needed to optimize the amount of rainwater harvested based on daily rainfall data and a demand pattern of the hospital and compound on hourly basis. Given the life time of the system, the robustness of the system is also evaluated with a sensitivity analysis considering changes in rainfall, roof area, amount of water received from other sources (as Tansen municipality) and demand.
They will conduct the following activities:
• Evaluation of the relation between storage capacity – rainfall and demand to determine total effective capacity of tanks for rainwater harvesting on daily rainfall data and hourly demand pattern
• Sensitivity analysis for changes in rainfall, changes in demand of the hospital, various roof area and different percentages of supply by rainwater harvest.
• Recommendations to upgrade the system.
This study would give insight on how to cope with the diminishing inflow from the municipality and a long term vision for the need for an investigation of an additional water source.
The costs for this research is USD 8.500 (incl. VAT) , which is on top of the costs to build the water tank (€ 290.000) .
FUNDS FOR CONSTRUCTION ARE ESSENTIAL
The hospital isn’t able to fund this water tank itself as the income from patient fees aren’t sufficient to cover the normal running costs of the hospital. For the construction of buildings and investments in equipment the hospital has to look for outside funding. It is very urgent that the hospital is able to build this tank as in the dry season the work in the hospital is hampered because of lack of water. At times, in the dry season, all the investments made in the hospital are in vain as no critical medical care can be given. Moreover, the hospital has been awarded the best hospital in Nepal since last two years. To be able to maintain the high standards now reached sufficient water supply is critical. Your support to be able to realize this water tank is essential.
REALIZATION OF THE PROJECT
Of the needed USD 290.000 USD 165.000 has been pledged. The house architect “Himalayan consulting architects and engineers Pvt Ltd” from Kathmandu, has been asked to make a detailed design of the tank up to international standards. After the design is approved the architect is asked to prepare a contract to be used for bidding by at least three well known contractors. After the best bid is chosen by the hospital construction can start. It is expected, that construction time will be around 9 months. Therefore we aim to start in November 2014 as to have the tank finished and in use by June 2015, at the start of the next monsoon.
It is anticipated, that we will be able to start with the construction of the tank in Autumn 2014. At the moment we can’t foresee problems we may encounter during construction. At this moment we can envisage the following problem we might encounter:
1. Political unrest because of which the construction can’ t continue until solved. The hospital has no influence on that.
2. High inflation in Nepal. The inflation at present is around 13 %. This is counted for in the budget. If inflation rises dramatically extra funds will be needed.
3. The soil on which the tank rests has on one side rock and the other side soil. After removing a concrete slab and digging to foundation level it can be seen if additional soil has to be removed as to give the tank a solid foundation. We can solve this by excavating to foundation level and decide then if additional work has to be carried out.
We will measure the success of the project by comparing the water-usage data from previous years with those after completing of the project. The project is successful when all year round sufficient water for the hospital is available.
The hospital monitors the use of water since three years. The inflow from the town supply is measured and the levels in the storage tanks. From June 2013 rainfall is measured also. Because of these figures we have an insight in the use of water. These figures will be used for the evaluation of the project.
The project will be evaluated in June 2016 after the new watertank has been in use for one year. Then we also can evaluate what the contribution of water saving devices has been.
Ing. Ed Kramer