Climbing mountains

Nepali Times issue #195 7-13 May 2004

As the planet heats up, mass migration will cause the next big movement of people worldwide. Millions will flee the tropics and move up the mountains to escape heat waves and rising seas.

Some of this is already happening. Vector-borne insects like mosquitoes are also moving to higher altitudes so that malaria, dengue and kala azar are now widespread in the Nepal's mountain towns.

Excerpts of a report on kala azar published in Nepali Times 20 years ago this week on issue #195 7-13 May 2004.

In the village of Juri near Janakpur, Ram Sewak Adhikari says half his extended family of 35 has kala azar. His wife died of the diseases, after he sold his plot of land to pay for her care, leaving him destitute. Unable to take care of his 10-year-old son and 8-year-old daughter, he sent them to live with a maternal uncle. Now he doesn’t have a home and goes wherever work is available.

Kala azar is relatively unknown among Nepal’s many diseases, and therefore may be the most neglected. It belongs to a disease group called leishmaniasis which has a wide range of clinical symptoms: cutaneous, monocutanesous and visceral. These symptoms include highly undulating fever, weight loss, fatigue, abdominal pain, cough and diarrhoea. . The local name means ‘black sickness’, because the skin of some patients darkens.

Of kala azar cases, 90% occur in Bangladesh, India, Nepal and Sudan. DDT used in India by the National Malaria Eradication Program in the 1940s ravaged the sandfly population and also interrupted the transmission of kala azar. By the mid- 1950s, no new cases were recorded and in the mid-1960s it had become an almost forgotten diseases in the country.

However, when the national malaria campaign was interrupted, kala azar reappeared in 1970 in Bihar. Soon, kala azar appeared in Bangladesh and shortly afterwards it entered Nepal’s Tarai and the disease is now present in 13 districts in Nepal bordering Bihar.

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