An anthropological history of Nepal's Female Community Health Volunteer program: gender, policy, and social change.

BACKGROUND: Community health workers (CHWs) are central to Primary Health Care globally. Amidst the current flourishing of work on CHWs, there often is a lack of reference to history-even in studies of programs that have been around for decades. This study examines the 35-year trajectory of Nepal's Female Community Health Volunteers (FCHVs). METHODS: We conducted a content analysis of an archive of primary and secondary research materials, grey literature and government reports collected during 1977-2019 across several regions in Nepal. Documents were coded in MAXQDA using principles of inductive coding. As questions arose from the materials, data were triangulated with published sources. RESULTS: Looking across four decades of the program's history illuminates that issues of gender, workload, and pay-hotly debated in the CHW literature now-have been topics of discussion for observers and FCHVs alike since the inception of the program. Following experiments with predominantly male community volunteers during the 1970s, Nepal scaled up the all-female FCHV program in the late 1980s and early 1990s, in part because of programmatic goals focused on maternal and child health. FCHVs gained legitimacy as health workers in part through participation in donor-funded vertical campaigns. FCHVs received a stable yet modest regular stipend during the early years, but since it was stopped in the 1990s, incentives have been a mix of activity-based payments and in-kind support. With increasing outmigration of men from villages and growing work responsibilities for women, the opportunity cost of health volunteering increased. FCHVs started voicing their dissatisfaction with remuneration, which gave rise to labor movements starting in the 2010s. Government officials have not comprehensively responded to demands by FCHVs for decent work, instead questioning the relevance of FCHVs in a modern, medicalized Nepali health system. CONCLUSIONS: Across public health, an awareness of history is useful in understanding the present and avoiding past mistakes. These histories are often not well-archived, and risk getting lost. Lessons from the history of Nepal's FCHV program have much to offer present-day debates around CHW policies, particularly around gender, workload and payment.

Slurry phase biodegradation of heavy oily sludge and evidence of asphaltene biotransformation.

Oily sludge management is a global environmental concern due to its hazardous nature. Oily sludge obtained from a refinery in India had 19-21% oil content. The oil was highly enriched in the asphaltene fraction. Slurry phase biodegradation of this oily sludge in presence of a 3-membered bacterial consortium was optimized in presence of Triton X-100 to increase the bioavailability of hydrocarbons. Triton X-100 at 4 times the critical micelle concentration (CMC) showed the highest degradation where oil removal of 53.1% was achieved from a 10% sludge slurry over 90 days. GCxGC analysis of n-alkanes present in the oily sludge after the biodegradation study showed an increase in the lower n-alkanes, i.e., dodecane and tridecane over the first 30 days, whereas the higher n-alkanes were removed to a much higher extent. Heptadecane showed the maximum extent of degradation with 94.9% removal in 90 days and an initial degradation rate of 0.079 day-1. The, maximum rate of degradation was observed for pentacosane (0.083 day-1) with 93.7% removal in 90 days. The increase in the lower n-alkanes may be attributed to biotic transformation of the asphaltene fraction which was also confirmed through FTIR and pyrolysis GCxGC analysis. Biodegradation was found to cause changes in the pyrolysis product of asphaltenes where four and three-ring pyrolysis products decreased while the one and two-ring pyrolysis products increased. In presence of the consortium asphaltene removal over 90 days was 12% whereas only 0.4% removal was obtained in the abiotic controls.

Characterization and biodegradability assessment of water-soluble fraction of oily sludge using stir bar sorptive extraction and GCxGC-TOF MS.

Percolation of water through oily sludge during storage and handling of the sludge can cause soil and groundwater contamination. In this study, oily sludge from a refinery was equilibrated with water to obtain the water-soluble fraction (WSF) of oily sludge. The WSF had dissolved organic carbon (DOC) of 166 mg/L. Human cell line-based toxicity assay revealed IC50 of 41 mg/L indicating its toxic nature. The predominant compounds in WSF of oily sludge included isomers of methyl, dimethyl and trimethyl quinolines and naphthalenes along with phenol derivatives and other polynuclear aromatic hydrocarbons (PAHs). Biodegradation of WSF of oily sludge was studied using a consortium of Rhodococcus ruber, Bacillus sp. and Bacillus cereus isolated from the refinery sludge. The consortium of the three strains resulted in 70% degradation over 15 days with a first-order degradation rate of 0.161 day-1. Further analysis of the WSF was performed using the stir-bar sorptive extraction (SBSE) followed by GCxGC-TOF MS employing a PDMS Twister. The GCxGC analysis showed that Bacillus cereus was capable of degrading the quinoline, phenol and naphthalene derivatives in WSF of oily sludge at a faster rate compared to pyridine and benzoquinoline derivatives. Quinoline, phenol, biphenyl, naphthalene, pyridine and benzoquinolines derivatives in the WSF of oily sludge were reduced by 87%, 92%, 88%, 77%, 40% and 62%, respectively with respect to the controls. The WSF of oily sludge contained, n-alkanes, ranging from n-C12 to n-C18 which were removed within 2 days of biodegradation.