<figure><img width="971" height="487" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410110/637204179c7e80680e0b2842jpeg.jpg" alt=""/><figcaption>Daily reported Covid-19 cases and deaths since January 2020, when the first case was detected in Nepal.</figcaption></figure>It was on 23 January 2020 that the first Covid-19 case was detected in Nepal. Two years later, the country is on the cusp of a <a href="https://www.nepalitimes.com/banner/vaccines-variants-and-a-third-wave/" target="_blank" rel="noopener noreferrer">third wave</a>.The time to sound an alarm about a new surge is long over. Action should have been taken months ago. All the government can do now is to launch a massive campaign to inoculate the unvaccinated, offer boosters to frontline workers, the elderly, and people in densely populated areas.Evidence elsewhere, including in neighbouring India, show that while the <a href="https://www.nepalitimes.com/opinion/omicron-is-coming-to-nepal-be-prepared/" target="_blank" rel="noopener noreferrer">Omicron strain</a> is 12 times more transmissible than previous variants, most of those infected do not need critical care in hospitals – unless unvaccinated or immuno-compromised.    Cases are rising fast in Nepal, doubling every 2 days to 3,075 new recorded infections on Wednesday. The positivity rate has soared 10 times in a week to 23.5%. At this rate, there will be 12,000 new confirmed cases by 16 January, which will be higher than the peak of the second wave in May 2021.“With Omicron now spreading in the community, we don’t need to gene sequence anymore,” says Epidemiology and Disease Control Division director Krishna Prasad Paudel.He is hoping Omicron will show a similar trajectory to elsewhere, and those infected will have <a href="https://www.nepalitimes.com/here-now/omicron-may-not-be-as-risky-but-take-care/" target="_blank" rel="noopener noreferrer">milder symptoms </a>compared to Delta. The new variant mostly impacts the upper respiratory tract, with lungs largely unaffected, hence lessening the need for oxygen and ventilators.However, Nepal’s low vaccination rate (50% partially, 40% fully) means that individuals need to continue taking precautions with masks and distancing.Read also: <a href="https://www.nepalitimes.com/latest/nepal-has-all-the-conditions-for-an-omicron-surge/">“Nepal has all the conditions for an Omicron surge”</a>, Nepali Times <figure><img width="2048" height="1366" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410110/637204199c7e80680e0b2843jpeg.jpg" alt=""><figcaption> </figcaption></figure>A double dose of the vaccine is not as effective against Omicron, and most Nepalis have passed six months since they were inoculated, meaning that their antibody levels have fallen considerably by now. <a href="https://www.nepalitimes.com/here-now/boosting-booster-jabs-against-omicron/" target="_blank" rel="noopener noreferrer">Boosters would provide more protection</a>, but the government is only offering those to high risk groups from next week.Although Omicron is now the dominant strain, Delta is still circulating, and causing deaths. We know from the past two years that it takes a few weeks for mortality to pick up after <a href="https://www.nepalitimes.com/latest/nepal-needs-to-prepare-for-new-covid-wave/" target="_blank" rel="noopener noreferrer">cases start rising</a>. This has been seen in India, and Nepal closely follows health trends there.“We need to keep a close watch on our mortality figures, find out which variant is causing most deaths, and we will have to prepare hospitals and healthcare workers once again,” warns epidemiologist Lhamo Yangchen Sherpa of IPAS.Across Nepal, many <a href="https://www.nepalitimes.com/here-now/at-the-covid-19-frontlines-in-rural-nepal/" target="_blank" rel="noopener noreferrer">rural hospitals are still understaffed</a> and do not have trained personnel to operate ventilators and run ICU wards. Not all new oxygen plants are functional yet.But Sangeeta Kaushal Mishra of the Health Coordination Division assures that the government is in a better position this time: “We are prepared for hospitalisations if cases are milder, but we don’t know how the virus will behave."The sheer transmissibility of Omicron could mean severe symptoms and even deaths among the elderly and those with pre-existing conditions like diabetes.  Elsewhere in the world, even vaccinated health workers have been infected, overwhelming hospitals.Read also: <a href="https://www.nepalitimes.com/latest/all-vaccines-prevent-severe-covid/">“All vaccines prevent severe Covid”</a>, Nepali Times <img width="1594" height="986" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410110/6372041d9c7e80680e0b2844jpeg.jpg" alt="">The first line of defence against Covid is still masks and distancing. The second is <a href="https://www.nepalitimes.com/latest/vaccines-are-the-only-solution/" target="_blank" rel="noopener noreferrer">mass vaccination</a>. Nepal still has a stockpile of over 10 million doses in refrigerated stores, and 6 million more doses in the pipeline. A syringe shortage reduced the vaccination rate, but Mishra expects the drive to pick up next week. More than 200,000 people were vaccinated on Wednesday.“We were lucky Omicron is mild, but we should use this  opportunity to inoculate both the unvaccinated and boost the  vulnerable on war footing,” says physician Buddha Basnyat of Patan Academy of Health Sciences.The government is starting mass inoculation of children from 12-17 years, and has shut down schools for three weeks until 29 January due to the new surge. Gatherings of more than 25 people have been banned, masks are mandatory outdoors, and people will need vaccine cards to enter public spaces from next week.“The fact that Omicron is much milder has made people even more careless, so we must once again reinforce the importance of masks, ventilation and distancing,” warns virologist Sher Bahadur Pun at Teku Hospital.Equally important is the institutional isolation of active cases and contact tracing. Experts believe official <a href="https://www.nepalitimes.com/latest/nepal-covid-19-impact-worse-than-official-figures/" target="_blank" rel="noopener noreferrer">figures are under-reported</a> and total cases and fatality figures are much higher. The Economist tracks ‘excess deaths’ across countries and estimates that 2.3 million people had died from Covid-19 by May 2021 in India, compared to only 200,000 official fatalities.Its calculations show that when Nepal recorded its highest daily Covid deaths of 246 on 19 May 2021, the actual number was 425. The real infection rate was also much higher than official data.Read also: <a href="https://www.nepalitimes.com/here-now/living-with-covid-in-2022/">Living with Covid in 2022</a>, Sonia Awale

Sonia Awale

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3rd wave in 2 years

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114091156/6372030d9c7e80680e0b27e9jpeg.jpg" alt="" width="1378" height="919"/><figcaption>Photos: AMIT MACHAMASI</figcaption></figure>Be it by naïveté, misplaced optimism, or a great faith in the healing powers of Himalayan air and turmeric, no one in Nepal had expected that we would be in the global epicentre of the Covid-19 surge fuelled by the <a href="https://www.nepalitimes.com/here-now/delta-variants-wake-up-call-for-nepal/" target="_blank" rel="noopener noreferrer">Delta variant in the spring of 2021</a>.Our miscalculation and gross lack of preparation cost thousands of lives and left so many Nepalis bereaved during this Dasain and Tihar. Shortly after <a href="https://www.nepalitimes.com/banner/we-knew-the-tsunami-was-approaching/" target="_blank" rel="noopener noreferrer">the Indian wave began in March</a>, Nepal recorded the highest number of Covid cases per capita, and the worst viral transmission rates on the planet. While the world focused on India, Nepal's health system was overwhelmed in a matter of days.Remember how we <a href="https://www.nepalitimes.com/here-now/helping-nepalis-breathe-again/" target="_blank" rel="noopener noreferrer">desperately searched for oxygen cylinders</a>, when every ICU bed was occupied and ventilators were in short supply? Remember rural communities where the situation was even worse, and so many Nepalis died without any medical attention? And there was the black market that forced many to pay exorbitant rates for life-saving oxygen, masks, and even paracetamol.We cannot afford to forget these terrible and deadly months. If we do, and do not prepare for the next wave, we will be bound to repeat them. With <a href="https://www.nepalitimes.com/latest/nepal-on-high-alert-for-omicron/" target="_blank" rel="noopener noreferrer">the Omicron variant </a>now spreading like wildfire across the globe, let us remind ourselves that Nepal experiences a surge in Covid cases a few months after the rest of the world. The Delta variant (which has been proven to be less transmissible than Omicron) took more lives in just a few months than the 2015 earthquakes.The current low case numbers in Nepal are not going to last. Repeating our mistakes of under-preparedness and apathy has the potential to kill thousands of more Nepalis in the coming months.While preliminary data shows that the Omicron variant is <a href="https://www.nepalitimes.com/here-now/omicron-may-not-be-as-risky-but-take-care/" target="_blank" rel="noopener noreferrer">less likely to hospitalise infected individuals</a> than Delta did, we need to take into account that this new variant spreads at a much faster rate. The relief we may feel from a smaller percentage of Covid patients needing life-saving care is cancelled out by there being an exponentially higher number of total infections.Our medical facilities will still be overwhelmed, leading to unnecessary loss of life on a large scale. In short, Omicron is <a href="https://www.nepalitimes.com/latest/nepal-has-all-the-conditions-for-an-omicron-surge/" target="_blank" rel="noopener noreferrer">not to be underestimated</a>, especially for densely populated communities in Nepal.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114091156/637203109c7e80680e0b27eajpeg.jpg" alt="" width="1221" height="814">We still have some time to prepare. Policy makers and individuals alike have important roles to play in the critical next weeks and months. We cannot squander this opportunity to save lives. National and local governments need time to act now on these critical areas:<ol><li><a href="https://www.nepalitimes.com/latest/all-vaccines-prevent-severe-covid/" target="_blank" rel="noopener noreferrer">Vaccinate Aggressively</a>: There are varying statistics on the percentage of Nepalis vaccinated, but no more than 40% of the population have been fully vaccinated. Booster shots are now necessary to adequately protect a population, so we still have a very long way to go.</li></ol>The good news is that even if we cannot fully vaccinate and provide boosters for the entire population, clinical experience shows that <a href="https://www.nepalitimes.com/banner/vaccines-variants-and-a-third-wave/" target="_blank" rel="noopener noreferrer">vaccinated individuals</a> have less need for Covid-19 hospitalisations and are much less likely to die from the Omicron variant. Decision makers can make our limited vaccine supply go further by prioritising vaccines for densely populated cities and in areas where Delta infection was low, as people in these areas are less likely to have natural immunity.<ol start="2"><li>Border Control: The devastating wave of the Delta variant in Nepal began a few weeks after it had taken hold in India. This was largely attributed to a spillage of the virus through the open southern border. We can support municipalities along the border to help contain the Omicron by strict health desks to screen individuals crossing the border. This will require increased funding and other resources.</li></ol><ol start="3"><li>Isolation and Quarantine Centres: Delta spread from India and urban areas into the countryside because we could not properly accommodate and care for infected patients in quarantine and isolation centres. There is time to re-establish these facilities before the next wave hits, and train frontline health workers and local governments based on guidelines that already exist. Again, as the variants (and our knowledge about them) evolve, we need to remain agile and empower our managers and healthcare workers to address the changing ground situation.</li></ol><ol start="4"><li>Oxygen Supply: During and after the Delta wave last year, the Ministry of Health and Population made commendable efforts to expand oxygen plant availability in the country, with support from international aid groups. These new plants need to be brought online and tested in the coming months, and MoHP must accelerate its efforts to meet its own requirement of having an oxygen plant at every 100 bed-hospital in the country.</li></ol><ol start="5"><li>Using Female Community Health Volunteers: FCHVs have been a key for many of Nepal’s remarkable gains in public health, including reducing maternal mortality rates. This network of local health workers was not fully deployed during the last Covid wave. We can use FCHVs to disseminate public health information, vaccine knowledge, and to play a frontline role in enforcing community guidelines to reduce local transmission of the virus, and to care for the infected. These volunteers and other community-based health workers need to be adequately compensated, and equipped with materials, protective equipment, and training.</li></ol>Properly mobilising and empowering FCHVs is the fastest and most efficient way to support rural communities that lack other options for advanced care. This will have a ripple effect across the national health system, and may be a key factor in avoiding another total collapse. All of these steps depend on implementation by the government and private healthcare system. We commend recent steps taken by the health department to test Nepalis returning from India, and to establish quarantine centres along the border.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114091156/637203139c7e80680e0b27ebjpeg.jpg" alt="" width="856" height="571">As individuals, we must <a href="https://www.nepalitimes.com/here-now/living-with-covid-in-2022/" target="_blank" rel="noopener noreferrer">continue to take responsibility</a> for protecting our loved ones by following public health guidelines for another few months at least. History shows we will not know for certain that Omicron has arrived in Nepal until after the variant is endemic in the population. These proactive measures can slow the spread, starting now:<ol><li>Mask up in all public places and when in close contact with members of at-risk populations. Doubling up on masks is a good idea, given the extremely contagious nature of Omicron.</li></ol><ol start="2"><li>Avoid touching the face with fingers, and frequently wash hands - at least 20 seconds with soap and water.</li></ol><ol start="3"><li>Avoid all public gatherings. If not, maintain social distance of at least 1m.</li></ol><ol start="4"><li>Support the local government by following protocols and encouraging elected officials to take proactive measures to protect the community. Volunteer to spread awareness or set up facilities if you can, and be ready to support your community when the next wave arrives. We Nepali are great at using ‘source-force’ to get things done - now is a great time to use your connections and networks to encourage people in positions of influence to take proactive steps to prepare for Omicron.</li></ol>In the age of Covid, it’ is every country and every community for itself. Delta taught us in Nepal not to trust promises of international aid to save us from the pandemic. We are on our own, and we only have each other to get through this.The Delta wave, like <a href="https://www.nepalitimes.com/banner/rebuilding-five-years-after-2015-quake/" target="_blank" rel="noopener noreferrer">the 2015 earthquakes</a>, also taught us that when the going gets tough, Nepalis come together and achieve miracles. Remember the community groups that blossomed across the country to create isolation centres, distribute food and supplies, and invented improvised oxygen concentrators.Remember the FCHVs and community members who risked their lives to travel into every corner of the country to deliver vaccines to the most vulnerable citizens.  This time, we have an opportunity to harness this grit and compassion when it is needed most - before the disaster strikes.Ramu Kharel is an emergency medicine physician at Brown University and has worked extensively in the frontlines of Covid-19. He runs a non-profit organisation HAPSA in Nepal that is working on Covid response.Ben Ayers is an American citizen based in Nepal for over 20 years.

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Omicron is coming to Nepal, be prepared

How Nepal must prepare for 3rd Covid wave

<img width="640" height="438" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131140/636cf1eb9c7e80680e09d8d5jpeg.jpg" alt=""/>Many public health specialists in Nepal have been heaving a sigh of relief that the infection graph for the second wave is <a href="https://www.nepalitimes.com/latest/covid-19-numbers-slightly-down-in-nepal/">starting to flatten</a>, but with reports of black fungus, third wave and new variants there is no respite.Everything that India has suffered since March has repeated itself in Nepal on a smaller scale. The  black fungus outbreak could be a microcosm of the post-second wave world, of  ‘epidemics within a pandemic’ as opportunistic infections and new Covid-19 waves prey on collapsed health systems.    In theory, Nepal should not have a strong flare-up like India because we have fewer risk characteristics, says epidemiologist Lhamo Yangchen Sherpa. “Covid is communicable so it spreads regardless of demographic factors, but black fungus is rarely contagious and selective.” she says. “India’s population has a higher proportion of elderly, diabetics and immunocompromised people than us, and these are the groups most vulnerable to black fungus,” she says.Indeed, there were reports in India of black fungus even pre-Covid, with 140 cases per million, which was the highest in the world. It currently has 12,000 cases and 300 deaths from the fungus that mostly affects Covid patients on ventilators and survivors on long-term steroid treatment.But for all we know, the infection may already spreading in Nepal, <a href="https://www.nepalitimes.com/latest/in-nepal-virus-climbs-from-plains-to-mountains/">starting from the Tarai and moving up</a> just like the Covid second wave. The ‘black fungus’ mucormycosis is found abundantly in the soil, and thrives on steroid overuse, especially on Covid patients with diabetes and other ailments. Cleared out easily by a healthy body, mucormycosis latches on to patients whose immune systems are compromised. “Covid treatment is a double-edged sword, it suppresses the virus-induced hyperimmune response but also raises blood sugar levels and weakens infection-fighting ability, making conditions perfect for mucormycosis,” explains Sherpa.The Health Ministry  announced in its daily briefing on Thursday that there were  6,825 new confirmed Covid-19 cases-- up from Wednesday's tally of 5,316--with 5,904 recovering. This brings the total number of active cases to 576,936, with 101,839 in isolation . Of the 1,444 in hospital ICUs, 398 are on ventilator support. Those in ICUs and ventilators face a double whammy as hospitals treat them with steroids and desperately reuse uncleaned humidifiers and discarded oxygen cylinders. According to the Health Ministry, 10 to 12 patients with black fungus have been detected so far, but there may be more.Covid survivors who needed critical ICU treatment and are continuing with steroids are left more susceptible to black fungus infection anytime. Nepal’s first recorded fatality from black fungus was a 60-year-old patient in Lumbini Provincial Hospital recently recovered from Covid.“Black fungus infection has been spotted even in those recovered from Covid for the past six weeks or more,” say Khemraj Bhusal a consultant physician at Greencity Hospital. But as stable survivors are sent home they become potential<a href="https://www.nepalitimes.com/latest/nepal-covid-19-impact-worse-than-official-figures/"> blind spots in black fungus tallies.</a>Hospitals in the frontlines can ill-afford to meet new shadow caseloads. Diagnosing mucormycosis infection early requires biopsies, sample examinations and even follow-up CT scans, requiring specialised personnel and advanced equipment that most district hospitals in Nepal do not have.  <figure><img width="640" height="441" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131140/636cf1ed9c7e80680e09d8d6jpeg.jpg" alt=""><figcaption>TU Teaching Hospital is one of the few facilities equipped to sample and test black fungus</figcaption></figure>While manageable if caught on time, the invasive nature of the disease is difficult to treat. In the most common rhinocerebral variety, the fungi eats through subcutaneous tissue and leaves behind characteristic black lesions on the septum and oral cavity. Infected tissues must be removed and eyes even sacrificed to save the brain from lethal infection. If left untreated, the infection has a mortality rate of 50%.   Treatment in such cases involves multiple organs, thus requiring teams of microbiologists, internal medicine specialists, intensivist neurologists, ophthalmologists, dentists and surgeons. But with civil service exams for doctors in limbo for years, rural hospitals lack the specialists necessary to deal with severe cases.Similar to the pandemic at large, life-saving shots against mucormycosis infection <a href="https://www.nepalitimes.com/here-now/aid-pours-into-nepal-but-where-be-vaccines/">are in short supply.</a>“Liposomal amphotericin B is an effective treatment, but fungal infections are normally so rare that antifungal production, and therefore supply, is low,” says Associate Professor of Microbiology at Tribhuvan University Megha Raj Banjara. Amphotericin treatment is extensive, with as many as 60 to 100 vials of injections needed across 4-6 weeks depending on infection severity. In the event of an outbreak, huge stockpiles are needed. Treatment is also costly, with one-day therapy costing upwards of Rs50,000.  <figure><img width="500" height="284" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131140/636cf1f09c7e80680e09d8d7jpeg.jpg" alt=""><figcaption>India has acted quick, importing 200,000 vials of AmBisome amphotericin B from American pharma company Gilead Sciences</figcaption></figure>Meanwhile, alternative medications like posaconazole and isavuconazole have toxic side effects, are also expensive and less effective. Imports of amphotericin are the only solution, but as with the pandemic, prospects do not look encouraging. India has already <a href="https://timesofindia.indiatimes.com/india/govt-imposes-restrictions-on-export-of-amphotericin-b-injections/articleshow/83141538.cms" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://timesofindia.indiatimes.com/india/govt-imposes-restrictions-on-export-of-amphotericin-b-injections/articleshow/83141538.cms&amp;source=gmail&amp;ust=1622790971413000&amp;usg=AFQjCNHfCYV-2Ni2HvdjXZzhn1JDrfiduQ">imposed restrictions on amphotericin B export</a>, itself shipping in 200,000 vials from Gilead Sciences in the US, with reports of hoarding and price gouging. Despite warning signs, there has been no appeal for amphotericin shipments from the Nepal government. If that ws not enough to worry about, India is seeing signs of an early third wave, with <a href="https://www.ndtv.com/india-news/maharashtra-preps-for-3rd-wave-as-covid-hits-8-000-children-in-1-district-2452564" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.ndtv.com/india-news/maharashtra-preps-for-3rd-wave-as-covid-hits-8-000-children-in-1-district-2452564&amp;source=gmail&amp;ust=1622790971413000&amp;usg=AFQjCNF8kNzDFxj6SwwwJkab1rJ7ZWoPLA">8,000 children infected</a> in a single district in Maharashtra state. With low vaccine penetration in the under-18 cohort, children in Nepal could be next, just like the first two waves.Meanwhile, 1,350,000 Nepalis above age 55 are set to miss timely booster doses as there is no possibility of securing Covishield shipments from India, according to Chief of Family Welfare Division of the Health Ministry Taranath Pokhrel. He said Nepal is trying to procure the Oxford AstraZeneca from other countries for this cohort, but so far there are no firm deals.The third wave is set to hit India around July, giving Nepal about a month and half to rush vaccine doses for its vulnerable age groups.  Till then, Nepalis will be left once more to fend for themselves. Aggressive self-medication and quack remedies such as cow dung baths are rampant, leaving Covid patients at increased risk of co-infections like black fungus.  “Patients are able to buy medicines without prescriptions from lax pharmacies.” says Sherpa. “Covid patients should avoid self-medication and only medicate under the strict supervision of health professionals or risk being exposed to secondary infections.”Simple changes can mitigate black fungus. Hospitals should routinely change humidifier water for ventilated patients and avoid sharing oxygen tubes and masks, says Binita Sharma, Chief Medical Director of Netra Jyoti Sangh. She says those with symptoms should immediately get checked up.To prevent future Covid-19 waves, experts say high-disruption strategies are needed at a time when <a href="https://www.nepalitimes.com/latest/as-covid-19-crests-nepal-eases-restrictions/">lockdowns are being relaxed.</a> Ultimately, it<a href="https://www.nepalitimes.com/latest/vaccines-are-the-only-solution/"> will be vaccines</a> and they are needed before the third wave.

Learning to live with Covid

<img width="640" height="438" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121136/636b910a9c7e80680e06f0c6jpeg.jpg" alt=""/>Many public health specialists in Nepal have been heaving a sigh of relief that the infection graph for the second wave is <a href="https://www.nepalitimes.com/latest/covid-19-numbers-slightly-down-in-nepal/">starting to flatten</a>, but with reports of black fungus, third wave and new variants there is no respite.Everything that India has suffered since March has repeated itself in Nepal on a smaller scale. The  black fungus outbreak could be a microcosm of the post-second wave world, of  ‘epidemics within a pandemic’ as opportunistic infections and new Covid-19 waves prey on collapsed health systems.    In theory, Nepal should not have a strong flare-up like India because we have fewer risk characteristics, says epidemiologist Lhamo Yangchen Sherpa. “Covid is communicable so it spreads regardless of demographic factors, but black fungus is rarely contagious and selective.” she says. “India’s population has a higher proportion of elderly, diabetics and immunocompromised people than us, and these are the groups most vulnerable to black fungus,” she says.Indeed, there were reports in India of black fungus even pre-Covid, with 140 cases per million, which was the highest in the world. It currently has 12,000 cases and 300 deaths from the fungus that mostly affects Covid patients on ventilators and survivors on long-term steroid treatment.But for all we know, the infection may already spreading in Nepal, <a href="https://www.nepalitimes.com/latest/in-nepal-virus-climbs-from-plains-to-mountains/">starting from the Tarai and moving up</a> just like the Covid second wave. The ‘black fungus’ mucormycosis is found abundantly in the soil, and thrives on steroid overuse, especially on Covid patients with diabetes and other ailments. Cleared out easily by a healthy body, mucormycosis latches on to patients whose immune systems are compromised. “Covid treatment is a double-edged sword, it suppresses the virus-induced hyperimmune response but also raises blood sugar levels and weakens infection-fighting ability, making conditions perfect for mucormycosis,” explains Sherpa.The Health Ministry  announced in its daily briefing on Thursday that there were  6,825 new confirmed Covid-19 cases-- up from Wednesday's tally of 5,316--with 5,904 recovering. This brings the total number of active cases to 576,936, with 101,839 in isolation . Of the 1,444 in hospital ICUs, 398 are on ventilator support. Those in ICUs and ventilators face a double whammy as hospitals treat them with steroids and desperately reuse uncleaned humidifiers and discarded oxygen cylinders. According to the Health Ministry, 10 to 12 patients with black fungus have been detected so far, but there may be more.Covid survivors who needed critical ICU treatment and are continuing with steroids are left more susceptible to black fungus infection anytime. Nepal’s first recorded fatality from black fungus was a 60-year-old patient in Lumbini Provincial Hospital recently recovered from Covid.“Black fungus infection has been spotted even in those recovered from Covid for the past six weeks or more,” say Khemraj Bhusal a consultant physician at Greencity Hospital. But as stable survivors are sent home they become potential<a href="https://www.nepalitimes.com/latest/nepal-covid-19-impact-worse-than-official-figures/"> blind spots in black fungus tallies.</a>Hospitals in the frontlines can ill-afford to meet new shadow caseloads. Diagnosing mucormycosis infection early requires biopsies, sample examinations and even follow-up CT scans, requiring specialised personnel and advanced equipment that most district hospitals in Nepal do not have.  <figure><img width="640" height="441" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121136/636b910d9c7e80680e06f0c7jpeg.jpg" alt=""><figcaption>TU Teaching Hospital is one of the few facilities equipped to sample and test black fungus</figcaption></figure>While manageable if caught on time, the invasive nature of the disease is difficult to treat. In the most common rhinocerebral variety, the fungi eats through subcutaneous tissue and leaves behind characteristic black lesions on the septum and oral cavity. Infected tissues must be removed and eyes even sacrificed to save the brain from lethal infection. If left untreated, the infection has a mortality rate of 50%.   Treatment in such cases involves multiple organs, thus requiring teams of microbiologists, internal medicine specialists, intensivist neurologists, ophthalmologists, dentists and surgeons. But with civil service exams for doctors in limbo for years, rural hospitals lack the specialists necessary to deal with severe cases.Similar to the pandemic at large, life-saving shots against mucormycosis infection <a href="https://www.nepalitimes.com/here-now/aid-pours-into-nepal-but-where-be-vaccines/">are in short supply.</a>“Liposomal amphotericin B is an effective treatment, but fungal infections are normally so rare that antifungal production, and therefore supply, is low,” says Associate Professor of Microbiology at Tribhuvan University Megha Raj Banjara. Amphotericin treatment is extensive, with as many as 60 to 100 vials of injections needed across 4-6 weeks depending on infection severity. In the event of an outbreak, huge stockpiles are needed. Treatment is also costly, with one-day therapy costing upwards of Rs50,000.  <figure><img width="500" height="284" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121136/636b910f9c7e80680e06f0c8jpeg.jpg" alt=""><figcaption>India has acted quick, importing 200,000 vials of AmBisome amphotericin B from American pharma company Gilead Sciences</figcaption></figure>Meanwhile, alternative medications like posaconazole and isavuconazole have toxic side effects, are also expensive and less effective. Imports of amphotericin are the only solution, but as with the pandemic, prospects do not look encouraging. India has already <a href="https://timesofindia.indiatimes.com/india/govt-imposes-restrictions-on-export-of-amphotericin-b-injections/articleshow/83141538.cms" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://timesofindia.indiatimes.com/india/govt-imposes-restrictions-on-export-of-amphotericin-b-injections/articleshow/83141538.cms&amp;source=gmail&amp;ust=1622790971413000&amp;usg=AFQjCNHfCYV-2Ni2HvdjXZzhn1JDrfiduQ">imposed restrictions on amphotericin B export</a>, itself shipping in 200,000 vials from Gilead Sciences in the US, with reports of hoarding and price gouging. Despite warning signs, there has been no appeal for amphotericin shipments from the Nepal government. If that ws not enough to worry about, India is seeing signs of an early third wave, with <a href="https://www.ndtv.com/india-news/maharashtra-preps-for-3rd-wave-as-covid-hits-8-000-children-in-1-district-2452564" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.ndtv.com/india-news/maharashtra-preps-for-3rd-wave-as-covid-hits-8-000-children-in-1-district-2452564&amp;source=gmail&amp;ust=1622790971413000&amp;usg=AFQjCNF8kNzDFxj6SwwwJkab1rJ7ZWoPLA">8,000 children infected</a> in a single district in Maharashtra state. With low vaccine penetration in the under-18 cohort, children in Nepal could be next, just like the first two waves.Meanwhile, 1,350,000 Nepalis above age 55 are set to miss timely booster doses as there is no possibility of securing Covishield shipments from India, according to Chief of Family Welfare Division of the Health Ministry Taranath Pokhrel. He said Nepal is trying to procure the Oxford AstraZeneca from other countries for this cohort, but so far there are no firm deals.The third wave is set to hit India around July, giving Nepal about a month and half to rush vaccine doses for its vulnerable age groups.  Till then, Nepalis will be left once more to fend for themselves. Aggressive self-medication and quack remedies such as cow dung baths are rampant, leaving Covid patients at increased risk of co-infections like black fungus.  “Patients are able to buy medicines without prescriptions from lax pharmacies.” says Sherpa. “Covid patients should avoid self-medication and only medicate under the strict supervision of health professionals or risk being exposed to secondary infections.”Simple changes can mitigate black fungus. Hospitals should routinely change humidifier water for ventilated patients and avoid sharing oxygen tubes and masks, says Binita Sharma, Chief Medical Director of Netra Jyoti Sangh. She says those with symptoms should immediately get checked up.To prevent future Covid-19 waves, experts say high-disruption strategies are needed at a time when <a href="https://www.nepalitimes.com/latest/as-covid-19-crests-nepal-eases-restrictions/">lockdowns are being relaxed.</a> Ultimately, it<a href="https://www.nepalitimes.com/latest/vaccines-are-the-only-solution/"> will be vaccines</a> and they are needed before the third wave.

Nepal’s only international aviation gateway, at Kathmandu airport, will cut night-time operation hours to allow construction of taxiways, and airlines have been told to curtail flights. This is expected to lead to more than normal chaos during the height of peak autumn and spring tourist seasons at an airport that is congested even at the best of times. The airport will close from 10PM to 8AM from 8 November-31 March 2025. The taxiways will now connect to the thresholds at both ends of the runway, making the airport more efficient in handling higher frequencies of landings and takeoffs. The parallel taxiway extension will allow international flights to land every 4 minutes instead of the current every 7 minutes. At present planes have to wait to land until a plane taking off backtracks along the runway.&nbsp; Kathmandu is Nepal’s only airport with international operations, and it has only one runway that is only one way in from the south over the mountains. With the taxiway improvement, the airport will be able to handle 42 aircraft landings and takeoffs per hour — double the current capacity.&nbsp; The Civil Aviation Authority of Nepal (CAAN) has been trying to entice international airlines to also start flying to and from the other two international airports at Pokhara and Bhairawa (Lumbini) by slashing landing and handling charges. But so far only Nepal Airlines operates a weekly flight to Bhairawa from Kuala Lumpur.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241018161016_046569e53d1d66cd445cc66c697c0ef724810aec9f54bdf827481e3cd6b80c32.jpg" data-media-id="editor_0" data-image-id="20241018161016_046569e53d1d66cd445cc66c697c0ef724810aec9f54bdf827481e3cd6b80c32" data-rendition-name="original" width="2356" height="1134" loading="lazy" alt="Kathmandu airport expansion"> <figcaption>Kathmandu Airport Expansion plan with extension of taxiways to the thresholds of runways 02 and 20 that will limit airport operations from 8 November 2024 - 31 March 2025. Areas in blue are existing structures, including the international terminal which in future will be the domestic airport, and the new international terminal near the north end of the runway,</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241018121028_6e17cc2ee87c1b02d78cb54905825b7aa15299b7a00f5eddb01a59579ab85c1a.jpg" data-media-id="editor_1" data-image-id="20241018121028_6e17cc2ee87c1b02d78cb54905825b7aa15299b7a00f5eddb01a59579ab85c1a" data-rendition-name="original" width="1353" height="1328" loading="lazy" alt="Kathmandu airport NT"> </figure>  CAAN has reportedly told international airlines to cut their flight frequency to Kathmandu citing the shorter operation hours and has told budget airlines to shift some of their flights to Pokhara or Bhairawa, or face cuts. Many airlines currently operate regular flights to and from Kathmandu between 10PM and 8AM: Air Arabia to Sharjah, Fly Dubai to Dubai, Jazeera Airways to Kuwait, Cathay Pacific to Hong Kong, Singapore Airlines, several Nepal Airlines flights, and one of four daily flights by Qatar Airways to Doha. Jazeera Airways, FlyDubai, and Thai AirAsia have applied and got permission from CAAN to begin regular flights to Bhairawa’s Gautam Buddha International Airport. Starting 9 November, FlyDubai will start making a stopover in Bhairawa before flying on to Kathmandu. Immigration, customs and security are all fully functional in Bhairawa. In Kathmandu, the next phase of the airport upgrade includes converting the current international terminal for domestic operations, the construction of a new international terminal where the domestic departure area is now, as well as moving the hangars and the Nepal Army Air Wing to the eastern side of the runway. The apron area will also double its parking space for widebody jets. This is part of a Airport Capacity Enhancement Project that was initially funded through a $80 million loan from the Asian Development Bank (ADB), and the entire masterplan is expected to cost $800 million. This project is the latest upgrade to Nepal’s only international airport since it saw its first flight in 1949. The current international and domestic terminals are too small to handle the current annual traffic volume of 8.5 million passengers a year that is growing at 20% a year.

Kathmandu airport to cut flight hours

As Kathmandu becomes more congested and polluted, and with remote online work becoming the norm, many professional Nepalis are planning to retire in Pokhara, or move there.&nbsp; With its stunning mountain panorama, balmy winters and proximity to a profusion of wilderness areas, builders are responding to this demand with new townhouses, housing development and apartments. One such block of flats is the 10-storey <a href="https://sungavaapartment.com/">Sungava Apartment</a> located at Phulbari above the Seti River, near the point where it flows into and under Pokhara. The imposing structure near Manipal Hospital is almost complete, and on a recent visit the site was strewn with huge boulders unearthed while digging the foundation.&nbsp; The Seti brought down these boulders during a gigantic flood that geologists estimate happened 800 years ago when a chunk of Annapurna IV broke off and ploughed into the glacier below. Today, Sungava (means ‘orchid’) sits safely on a high terrace, 100m above the blue-green Seti and commands a view of Dhaulagiri, Annapurna South, Machapuchre, Annapurna III and IV.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2024102411104_5f8fc736c86ea3c08d7bef43bb727081d3cc1a2caa55ae2b441717e6044de7e9.jpg" data-media-id="editor_1" data-image-id="2024102411104_5f8fc736c86ea3c08d7bef43bb727081d3cc1a2caa55ae2b441717e6044de7e9" data-rendition-name="original" width="2016" height="1512" loading="lazy" alt="High living below the Himalaya NT"> </figure>  The soil here is conglomerate that has solidified like concrete, and the boulders were extracted by heavy earthmovers. It is intriguing to think that these metamorphic rocks as big as cars, rounded by glacial grinding, were once a part of a much higher Annapurna IV. Even for those with little interest in geology, Sungava is an ideal place to contemplate the tectonic forces that pushed these peaks into the sky to be sculpted into delicate shapes by wind, snow, earthquake and avalanche over millions of years. The view of the Himalayan panorama from Sungava’s many balconies are breathtaking when not obscured by clouds, or the haze that drifts in from across the southern border. On most days, just watching the towering pyramid of Machapuchre (Tamu name: कतासुँ क्लिको) play hide and seek with the clouds is mesmerising. There are rocks aplenty at Phulbari, and it is probably the flowers that grew along the flat terraces e that gave the place its flowery name. The boulders will hopefully be turned into a rock garden while landscaping. An nearby restaurant complex is making the best use of the stones in its design, using flat rocks as outdoor benches and tables. Sungava was designed by the husband-wife architect team of Deepak Sherchan and Jyoti Joshi of <a href="https://thedarkmermaidamarbshrestha.blogspot.com/2013/12/creative-builders-collaborative-cbc.html">Creative Builders Collaborative (CBC)</a>, which also built Heritage Plaza, Indreni Apartment and numerous other projects in Nepal. Sadbhavana retains CBC’s trademark Newari-style masonry and here it borrows from the orange brickwork of the old town of Pokhara, integrating it with modern design elements. A few of those heritage houses are still standing in Ganesh Tole and Ram Krishna Tole in Pokhara’s old quarter.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2024102411108_5eb64a4885961b6d30781cefeb1e8a313da313ac5227c7a66b60f0c7d48d6fab.jpg" data-media-id="editor_3" data-image-id="2024102411108_5eb64a4885961b6d30781cefeb1e8a313da313ac5227c7a66b60f0c7d48d6fab" data-rendition-name="original" width="1362" height="595" loading="lazy" alt="High living below the Himalaya NT"> </figure>  About 400m from the apartment past a bend on the river, and down below three tiers of terraces in the canyon is a suspension bridge. Below it, the Seti is still swollen with post-monsoon flow as it tumbles away in a hurry to head down south.&nbsp; Back at the apartment, it is quiet, far away from the hubbub of Lakeside a 15 minute drive away, and in the lap of greenery. There are 52 units at Sungava and it already has a close-knit prospective community of professionals, including doctors, publishers, engineers, and businesspeople from the renewable energy and IT sectors.&nbsp; Some residents say they opted for a second home in Pokhara to make it a ‘base camp’ to explore the Annapurnas with its many hiking trails made newly accessible with new roads. With the NRN citizenship law, overseas Nepalis can now also buy the flats. &nbsp; The floor plans include options for north and south-facing 3-bedroom apartments with verandas, and the facility has underground parking has EV charging, heated pool, sauna and gym. There are still some unsold apartments with panoramic views of the mountains and one can imagine oneself at the kitchen with its huge window, humming a ditty while preparing breakfast: “खाना पकाउँ हिमाल हेरेर...”

High living below the Himalaya

When the United Nations held its Summit of the Future at its headquarters in New York in September, many world leaders, including Nepal’s Prime Minister K P Oli, highlighted the effect of climate breakdown in increasing the frequency and intensity of natural disasters. What did not get as much attention was the long term impact of the climate crisis on food production. In fact, heat stress, weather extremes and the consequences on rain-fed agriculture is already being felt worldwide, undermining the chances of the <a href="https://unstats.un.org/sdgs/">UN’s Sustainable Development Goals (SDGs)</a> being met by 2030.&nbsp; The SDG’s 17 targets commit countries like Nepal to reduce poverty and inequality, end malnutrition, protect the natural environment, and ensure that citizens all enjoy health, justice and prosperity without leaving anyone behind.&nbsp; However, besides the impact of climate breakdown on agricultural production, in Nepal the area under cultivation is impacted by urban expansion, falling productivity and the need for expensive inputs like fertiliser and pesticides.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241019041052_626413c5baf4dae407ac9579231b41daeb51510aa636b75aeb7489d94cca6a62.jpg" data-media-id="editor_1" data-image-id="20241019041052_626413c5baf4dae407ac9579231b41daeb51510aa636b75aeb7489d94cca6a62" data-rendition-name="original" width="999" height="1500" loading="lazy" alt="urban agriculture in Kathmandu"> <figcaption>Kathmandu's urban sprawl is eating into its fertile cultivable lands. Photo: TAYLOR MASON</figcaption> </figure>  Now, a new study led by Nepali researcher Prajal Pradhan at the University of Groningen in The Netherlands looks at how urban agriculture may offer a solution to falling food production and meeting SDG targets. The researchers evaluated 1,450 publications exploring the contributions of urban agriculture with both positive and negative effects, and published their findings in the journal Cells Report Sustainability. Urban agriculture can help achieve 17 SDGs, positively influencing 81 targets. However, it could also undermine 51 goals.&nbsp; Read also: <a href="https://nepalitimes.com/here-now/the-vanishing-land">The vanishing land</a>, Taylor Mason “Urban agriculture offers immense potential for sustainable development, but realising this potential depends crucially on adopting practices that minimise its adverse effects while maximising its benefits,” Pradhan explains. Urban agriculture can substantially enhance urban food security, provide employment to the urban poor, serve as ground water recharge in built-up areas, and preserve open spaces that can serve as safe havens during disasters like earthquakes. However, it also presents problems like the potential health risks from contamination and the need for expensive inputs. &nbsp; “Urban agriculture plays a definitive role in advancing the SDGs, but achieving this requires tailored, context-specific solutions that address the unique challenges of different regions,” says Yuanchao Hu of Wuhan University in China and who is a researcher at the Potsdam Institute for Climate Impact Research. “But it needs equitable access and rigorous management of environmental risks.”&nbsp; Rapid urbanisation is eating into Nepal’s most fertile agricultural land, which means farming in remaining open spaces inside cities can be a viable alternative, especially as food prices rise.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241019041052_7b7c9413086226fbdc630d45acf772cfa1ced77a8970b9056ec5ec7e5226fdf8.jpg" data-media-id="editor_3" data-image-id="20241019041052_7b7c9413086226fbdc630d45acf772cfa1ced77a8970b9056ec5ec7e5226fdf8" data-rendition-name="original" width="1500" height="999" loading="lazy" alt="urban agriculture in Kathmandu"> <figcaption>A vegetable patch in between new houses in Thimi. Photo: TAYLOR MASON</figcaption> </figure>  “The conversion of Nepal’s most fertile land into cities is a severe problem,” Pradhan told Nepali Times. “Crop cultivation, horticulture, agroforestry, beekeeping, livestock rearing, or aquaculture can all be farming activities within and around cities.”&nbsp; The study makes recommendations for sustainable practices that build on the positive aspects of urban agriculture while mitigating the downsides, thereby promoting more resilient cities in future. Research shows that urban agriculture has been helping many countries attain SDG targets by enhancing food security and biodiversity while helping education and preservation of open spaces.&nbsp; Indeed, many farmers from the hinterland who have settled in Kathmandu Valley or other urban areas of the country have been practicing urban agriculture, leasing neighbourhood patches or cultivating roof gardens both out of necessity because of inflation and falling income to grow their own food, and also as a fulfilling hobby. Saurav Dhakal, a sustainability advocate with Story Cycle and now research fellow at the Asian Institute of Technology in Thailand, says there are socio-economic and environmental benefits of urban agriculture. “It provides benefits to all urban dwellers, regardless of their income status,” says Dhakal, “families get fresh food, and there are many other benefits like water retention, heat regulation and biodiversity. These are all public goods, so special government incentives may be needed.” It is not unusual to see vegetable patches and even paddy fields within inner city Kathmandu where an older generation of farmers are using available fertile land and <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/rooftop-gardens-kathmandu,1415">roof gardens to produce fresh, nutritious food </a>to reduce their dependence on food items that have to be bought after being trucked in from large distances.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2024101905100_1291ce98dbbb8caed8702ac4b1d469b3e13016d7ecaaf3bfd5f91c974d3c0c77.jpg" data-media-id="editor_5" data-image-id="2024101905100_1291ce98dbbb8caed8702ac4b1d469b3e13016d7ecaaf3bfd5f91c974d3c0c77" data-rendition-name="original" width="1500" height="999" loading="lazy" alt="urban agriculture in Kathmandu"> <figcaption>An older generation of farmers are using any available fertile land to continue farming but it is getting more and more difficult. Photo: TAYLOR MASON </figcaption> </figure>  Nepal’s urban population grew rapidly from only 3.6% in 1991 to 25% today. There is large outmigration from the mountains to peri-urban areas of the Tarai, to Kathmandu Valley and Pokhara, with many young men then moving abroad for work. Kathmandu Valley’s population has swelled to nearly 3 million, and is growing at 6.5% a year. Dilip Shrestha, 71, used to work for Nepal Food Corporation, so he knew firsthand about inflation, shortages and vegetables with pesticide residue. So, when he designed his new house in Kathmandu, he built a spacious roof where he grows cucumber, ginger, garlic, coriander, onions, tomatoes, chili, beans, okra, pumpkin and lettuce. His family eats healthier, and he has reduced dependence on the market.&nbsp; The co-author of the Cell Reports Sustainability journal article, Daya Raj Subedi who is a PhD candidate at Beijing Forestry University, says urban agriculture also promotes inclusion and psycho-social wellbeing.&nbsp; He says, “A crucial finding of the study is the identification of opportunities and challenges associated with urban agriculture, it can promote sustainable transformation of society.” In Banepa, 55-year-old Bijaya Manandhar in her lifetime has watched the fertile farms of her neighbourhood that used to supply vegetables to Kathmandu, now completely built up with no open space left. The pandemic lockdown prompted her to turn to the family’s <a href="https://nepalitimes.com/banner/rooftop-agriculture-on-the-roof-of-the-world">ancestral livelihood by growing food</a> not on terrace farms, but on the roof terrace. Manandhar is now a part of <a href="https://nepalitimes.com/banner/rooftop-agriculture-on-the-roof-of-the-world%5C%5C">कौसी खेती र करेसाबारी क्रान्ती</a> (Rooftop Farming and Garden Revolution) which has an online membership of 52,000, and awards annual prizes to women who excel in urban agriculture.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241019041052_7257f5def8f823f35a799fa6f6825e153f2ffa406ac11325d4fe74049b79e96d.jpg" data-media-id="editor_8" data-image-id="20241019041052_7257f5def8f823f35a799fa6f6825e153f2ffa406ac11325d4fe74049b79e96d" data-rendition-name="original" width="1600" height="736" loading="lazy" alt="urban agriculture in Kathmandu"> <figcaption>Rooftop farming is gaining popularity as a form of urban agriculture. </figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241019041052_beff1a4494ce896dd8fd383ee1f518e5448bcf7ea8bb138255391c7bcb9769ed.jpg" data-media-id="editor_9" data-image-id="20241019041052_beff1a4494ce896dd8fd383ee1f518e5448bcf7ea8bb138255391c7bcb9769ed" data-rendition-name="original" width="4000" height="3000" loading="lazy" alt="urban agriculture in Kathmandu"> </figure>  Pradhan says the challenge now is to upscale such examples of successful urban agricultural practices so they support Neal’s efforts to meet SDG targets. He adds, “Crop cultivation around cities can be protected by land use plans and regulations. Promoting community-based agriculture, including rooftop gardens, requires community engagement and public-private partnerships across the food value chain.”&nbsp; Such support would accelerate the popularity of existing rooftop farming and community gardens in Kathmandu Valley, or kitchen garden initiatives in Pokhara, and building on traditional farming practices that are preserved and integrated into urban settings like in Bhaktapur and Banepa. In Lalitpur, the Women Entrepreneurship Facilitation Center promotes urban farming enhancing both sustainability and empowerment.&nbsp; Another co-author of the report, Yuanchao Hu from China says followup research of the team will aim to identify good practices in local urban agriculture practices. He adds, “There are examples of urban agriculture that optimise sustainability, ensuring that it remains a viable solution for cities globally while countries try to meet SDG targets.” Prajal Pradhan, Daya Raj Subedi, Kshitij Dahal, Yuanchao Hu, Prakriti Gurung, Sijal Pokharel, Sagar Kafle, Biplav Khatri, Sudeeksha Basyal, Monika Gurung, and Aruna Joshi. Urban Agriculture matters for sustainable development. Cell Reports Sustainability, 1:100217, 2024. [DOI: 10.1016/j.crsus.2024.100217] Prajal Pradhan (<a href="mailto:p.pradhan@rug.nl">p.pradhan@rug.nl</a>) This article is brought to you by <a href="https://nepalitimes.com/" target="_blank">Nepali Times</a>, in collaboration with <a href="https://inpsjapan.com/en/" target="_blank">INPS Japan</a> and <a href="https://sgi-peace.org/" target="_blank">Soka Gakkai International</a>, in consultative status with UN ECOSOC.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240630110640_30c3782f9c09219bf1c249b51483a3cfb7a53a06d117d2aebd23ca7080d12758.jpg" data-media-id="editor_14" data-image-id="20240630110640_30c3782f9c09219bf1c249b51483a3cfb7a53a06d117d2aebd23ca7080d12758" data-rendition-name="original" width="680" height="103" loading="lazy" alt="SDG logo"> </figure>

Back to the land in the cities

The 700-year-old Lakshmi Narasingha temple in Bhaktapur houses a rare half-lion and half-human incarnation of Lord Vishnu carrying the Goddess Lakshmi. The temple was destroyed in the 1934 mega earthquake that killed 10,000 people and destroyed many monuments in Kathmandu Valley. It was rebuilt by a German project in the 1980s, but as a single-storey structure instead of its original two-tier pagoda design.&nbsp; With new findings from in-depth research, Bhaktapur municipality began re-restoring the temple in 2021, preserving its original architecture.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241017131016_2fae38cce543ad7b1f6de632feb3e212e08ed1acedd747830e949d7b8e878f18.jpg" data-media-id="editor_0" data-image-id="20241017131016_2fae38cce543ad7b1f6de632feb3e212e08ed1acedd747830e949d7b8e878f18" data-rendition-name="original" width="2048" height="1365" loading="lazy" alt="In with the old in Nepal NT"> </figure>  “Our temples and heritage sites hold deep meaning. It is disheartening to witness how often they lose their original elements, whether by design or accident,” explains Kumar Chawal of the Consumer Committee of Bhaktapur. “There is a need to preserve our architecture and protect its historical value for future generations. Otherwise, we risk losing a vital part of our identity.” The Laksmi Narsingha restoration is similar to the Bhai Dega temple in Patan Darbar Square which also collapsed in 1934, but was rebuilt with a Moghul-style dome by the Rana government at the time. Only two months before the 2015 earthquake, heritage conservationists had started to rebuild Bhai Dega as the original three-tier based on early photographs. But priorities shifted when four other temples in the square were brought down by the 7.8M earthquake on 25 April 2015.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241017131016_697ea707d9ad163be5de5f2efbf5b70d3cab771adcc22f0fae6bf937c6cb0130.jpg" data-media-id="editor_1" data-image-id="20241017131016_697ea707d9ad163be5de5f2efbf5b70d3cab771adcc22f0fae6bf937c6cb0130" data-rendition-name="original" width="2048" height="1365" loading="lazy" alt="In with the old in Nepal NT"> </figure>  This showed how damage to monuments in Kathmandu Valley spanned from one earthquake to the next. Bhai Dega restoration remains half-complete to this day because money for its restoration ran out.&nbsp; Whereas Bhai Dega restoration was done by the Kathmandu Valley Preservation Trust with grants from western embassies and international foundations, in Bhaktapur it is the municipality itself that allocated the Rs30.7 million needed to restore the Lakshmi Narasingha temple. The expected date of completion is early 2025. The municipality and local communities are focusing on two main aspects: preserving the past and promoting localisation. The restoration team has designed a blueprint for the temple by using historical photographs and insights from older generations.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241017131016_182882fdc393c99e70d1d0490319e415229563666c4934e3a582426ebf00ca30.jpg" data-media-id="editor_2" data-image-id="20241017131016_182882fdc393c99e70d1d0490319e415229563666c4934e3a582426ebf00ca30" data-rendition-name="original" width="1200" height="560" loading="lazy" alt="In with the old in Nepal NT"> </figure>  “At first, the Lakshmi Narasingha temple had only one entrance, but during the demolition process, we uncovered the foundations of four doors. Now, we are restoring all of them. This is an example of how our ancient structures have changed over time, often without our knowledge,” says Chawal. “Constructing temples is not like building houses. They carry historical and spiritual values, which is why they hold a special place in our hearts,” he adds. By replicating ancient design elements and rebuilding the temple as accurately as possible to its original form, the team has stayed true to Bhaktapur’s soul. But the restoration also revived ancient techniques that were in danger of being forgotten, generating employment for woodcarvers, masons, and contractors. The community of Bhaktapur’s Gahiti neighbourhood near the famous Nyatapola Temple has also set aside specific days for locals to volunteer in the reconstruction work. This has encouraged young people to take pride in ownership of their heritage. Families have also supported the effort by donating funds for bells, the temple pinnacle, and other structural features to the temple.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241017131016_db850ec0c084cdbe54f65bee92dad2ad8122d20fd60ec87ec086fbb9d2f72bd6.jpg" data-media-id="editor_3" data-image-id="20241017131016_db850ec0c084cdbe54f65bee92dad2ad8122d20fd60ec87ec086fbb9d2f72bd6" data-rendition-name="original" width="2048" height="1365" loading="lazy" alt="In with the old in Nepal NT"> </figure>  “I feel at peace knowing I have contributed my sweat to restoring this temple,” said one volunteer. “It is our duty to preserve our temples and heritage. The Nyatapola area will look magical once this temple is completed.” Community mobilisation is a long-standing tradition in Bhaktapur. In the past, locals have actively participated in the restoration of other temples in the city, such as Bhairav and Nyatapola fostering a strong sense of ownership. This collective engagement has not only been crucial in preserving the city's historical monuments but also in strengthening the bond between local communities and their heritage, says officials at the municipality. While securing funding is essential, and the municipality showed it values heritage conservation, the Lakshmi Narasingha restoration is proof that active involvement and sense of responsibility of the local community is as important, if not more. Local involvement also means that the monuments will be cared for into the future, When locals take ownership of these efforts, the restored monuments are not only protected in the present but are also cared for in the future.

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