Most disasters strike without warning. But dengue fever which spreads when infected mosquitos breed in monsoon puddles, is largely predictable and preventable. Densely populated Kathmandu with stagnant pools of water has all the ingredients for another outbreak like the deadly one in 2022. Last year there were about<a href="https://www.nepalitimes.com/news/new-dengue-outbreak-likely-this-monsoon" target="_blank"> 55,000 infections and 88 fatalities</a> officially reported across Nepal in its biggest dengue outbreak yet, the real figure is probably higher. Hospitals were out of capacity, over-medication was rampant, and almost every house in Kathmandu had multiple members struck down with infection. This year, Nepal had already seen <a href="https://kathmandupost.com/health/2023/07/08/dengue-spreads-to-66-districts-one-person-dead-over-1-200-test-positive" target="_blank">over 1,000 dengue infections </a>by end-June. Starting in Dharan where one person has already died, the disease has now reached most of the 77 districts. Even so, many cases are never reported, and many recuperate at their homes. Furthermore, 80% of dengue cases are asymptomatic. “We are not even at the peak of the dengue season, and cases are already surging. It is very likely that this will further increase as rains begin to dwindle post-monsoon,” warns Sher Bahadur Pun, virologist at the Sukraraj Tropical and Infectious Disease Hospital in Kathmandu. “Nepal’s poor surveillance and record keeping also means diseases like dengue are seriously under-reported.”&nbsp; Lack of public awareness about dengue management and prevention adds to the problem. A third of dengue patients admitted to Teku Hospital last year <a href="https://www.nepalitimes.com/banner/as-covid-abates-nepal-sees-dengue-outbreak" target="_blank">did not even know</a> that the disease is mosquito-borne and spreads in the daytime.&nbsp; “At least this wasn’t the case with Covid-19, but with dengue, people struggled to adopt the correct precautions due to lack of knowledge,” explains Pun. “Even more alarming: once infected, people took strong medications like painkillers and antibiotics unaware that they are ineffective and often even harmful in dengue.”&nbsp; Although there is no specific medication for dengue, doctors recommend paracetamol to ease the fever and enough fluids to replenish the body. Dengue has no cure.&nbsp; Dengue was first reported in Nepal in 2004, but it was not until 2019 that it spread like wildfire in major urban centres. Two years of Covid lockdowns significantly reduced the caseload after the 2019 outbreak, but last year, it struck again.&nbsp; Read also: <a href="https://www.nepalitimes.com/news/new-dengue-outbreak-likely-this-monsoon">New dengue outbreak likely this monsoon</a>, Sonia Awale  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20230717150716_97f01f95d37cc29c4c2a68ba54185635449829fa53a3064d0b83ba5714263db9.png" data-media-id="editor_4" data-image-id="20230717150716_97f01f95d37cc29c4c2a68ba54185635449829fa53a3064d0b83ba5714263db9" data-rendition-name="original" width="1072" height="577" loading="lazy" alt="Dengue graph NT"> <figcaption>Trend of dengue cases in Nepal 2006 - 2023 June, SOURCE: MoHP Situation Update</figcaption> </figure>  But even as dengue starts to spread in Kathmandu Valley, elected local officials do not seem to be too concerned. When the Ministry of Health and Population called on all local unit representatives in the Valley to discuss the outbreak on 9 July, 12 out of the 18 units <a href="https://kathmandupost.com/health/2023/07/11/dengue-search-and-destroy-campaign-to-be-launched-in-kathmandu-valley" target="_blank">avoided the meeting altogether.</a> Although there are some fumigation and dengue search and destroy campaigns <a href="https://kathmandupost.com/health/2023/07/11/dengue-search-and-destroy-campaign-to-be-launched-in-kathmandu-valley" target="_blank">set to be launched in Kathmandu</a> soon, with the monsoon already started, it may be a case of too little <a href="https://www.nepalitimes.com/banner/state-of-malaise" target="_blank">too late</a>. It should have started before the onset of the monsoon. “Though not as many as last year, we are already seeing a worrying number of mosquitoes near areas with stagnant water. And when they fly into homes, chances are the virus is already spreading from those infected,” explains Pun.&nbsp; This negligence and delay in action comes despite repeated warnings from experts. Officials knew far in advance that <a href="https://www.nepalitimes.com/news/new-dengue-outbreak-likely-this-monsoon" target="_blank">last year’s virus is still in mosquito larvae, waiting for the monsoon</a>, and yet, preventive measures, emergency preparedness, and capacity building were ignored. The risk of dengue fever will rise in the coming months of August and September, although some public health experts say serious dengue outbreaks seem to happen after a gap of two years. With climate change, mosquitos are moving up the mountains in Nepal, bringing mosquito-borne disease like malaria, encephalitis and dengue higher. The number of cases officially recorded between January and June this year is nine times higher than last year. Districts like Sankhuwasabha are on the <a href="https://edcd.gov.np/uploads/resource/64a3d5414aad6.pdf#:~:text=This%20figure%20was%20more%20than,of%20cases%20reported%20in%202019.&amp;text=As%20of%2030th%20June%2C%202023,listed%20details%20in%20Figure%202." target="_blank">top-ten list</a> for most cases reported, even though it is in the high mountains, and indicating how global warming is <a href="https://www.nepalitimes.com/banner/mosquitoes-move-up-mountains-as-the-earth-warms" target="_blank">pushing mosquito breeding grounds further north.</a> Bagmati is once again the hardest-hit province, possibly due to higher population density. Read also:<a href="https://www.nepalitimes.com/banner/dengue-days-are-here-to-stay"> Dengue days are here to stay</a>, Sonia Awale  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20230717150716_b1a8b5c7b8e50f5e388f04a41877f2520ffa8f334c04343b357fd034d4166e6d.png" data-media-id="editor_12" data-image-id="20230717150716_b1a8b5c7b8e50f5e388f04a41877f2520ffa8f334c04343b357fd034d4166e6d" data-rendition-name="original" width="1088" height="433" loading="lazy" alt="Dengue graph"> <figcaption>Dengue cases reported by province in 2023 January to June.  SOURCE: MoHP Situation Update</figcaption> </figure>  Tackling Dengue: what does it really take? Ugonnaya Caleb-Ugwuowo recalls treating children and pregnant women struck down with dengue fever in a local hospital in Lagos. The Nigerian doctor and public health expert specialises in managing outbreaks, and says she often felt helpless at being unable to correctly diagnose and treat them due to lack of facilities. Nepal could learn from Nigeria's experience. Dengue fever is endemic in almost all states in Nigeria. “Although the country is still struggling, the challenges and epidemics Nigeria has faced over the years have shaped our understanding of what it takes to tackle outbreaks like the ones Nepal faced last year and in 2019,” says Ugonnaya.&nbsp; It starts with surveillance, she says, adding: “The government in Nepal should, as a matter of urgency, conduct dengue surveys in all provinces to assess the proportion and magnitude of different <a href="https://www.nature.com/scitable/topicpage/dengue-viruses-22400925/#:~:text=The%20Dengue%20Serotypes,antibodies%20in%20human%20blood%20serum." target="_blank">dengue serotypes</a> circulating freely. Following this, dengue should be made reportable from all local health institutions directly into the national health information system." Dengue fever for the first time, though debilitating, often does no harm. But getting it a second time with a different serotype poses a significantly higher risk of the disease progressing to haemorrhagic fever, where blood thins out and can start leaking from veins, causing potentially fatal internal bleeding. This is what makes serotype surveys so important. A <a href="https://academic.oup.com/jtm/advance-article-abstract/doi/10.1093/jtm/taad034/7087081?redirectedFrom=fulltext" target="_blank">study</a> aiming to report dengue serotypes seen in Kathmandu during last year’s outbreak showed DEN-1 and DEN-3 to be the dominant serotypes, with only negligible cases of DEN-2 reported. But such studies should be conducted nationwide, so that the risk of infection with other serotypes can be correctly determined. Sri Lanka and Bangladesh, both of which have reported elevated levels of dengue infections this year, have direct flights into Nepal. “Although the inflow of infected tourists also poses a great threat, the greater concern should be the mosquitoes in and around places where these tourists go, like airports, temples and major tourist sites,” warns Pun. If barring flights is not an option, vector control is the best way to minimise transmission. For this, fumigation and dengue search and destroy efforts should be concentrated in tourist sites first. Simple source reduction strategies like covering open water containers, using insecticides in canals, parks and fields exist, but deploying genetically modified mosquitoes to reduce the population of disease carriers can also control vector-borne diseases. Caleb-Ugwuowo adds that Nepal already has a decentralised framework of healthcare, so proper surveillance is possible. More importantly, the two previous outbreaks have given experts an idea of what needs to be done: capacity building in hospitals, sanitation and drainage facilities, public awareness, and emergency preparedness before the disease strikes. Pun agrees: “We must learn from other countries as well as from our own past experience, and act to contain this outbreak. Things will get progressively worse in the next few weeks, so there is no time to beat around the bush, especially with dengue already knocking at our doors.” Read also: <a href="https://www.nepalitimes.com/banner/mosquitoes-move-up-mountains-as-the-earth-warms">Mosquitoes move up mountains as the earth warms</a>, Sonia Awale

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Dengue danger returns with monsoon

<a href="https://www.nepalitimes.com/banner/dengue-days-are-here-to-stay">Dengue ravaged Nepal last monsoon</a>, with over 55,000 hospitalisations and 88 fatalities. But that is just the official count, and many who died from the mosquito borne virus that caused haemmorhagic fever were healthy adults. Public health experts had warned last year that the virus would strike again in the 2023 rainy season because the virus hibernated with the larvae of infected mosquitos. They say the larvae are just waiting for the puddles to hatch, and with it the virus can again spread exponentially. Waiting until the monsoon to target mosquito breeding areas will be too late. “Local government must start the search-and-destroy larvae campaign now, we cannot wait for the rains,” warns virologist Sher Bahadur Pun at Teku Hospital. “Dengue is a real public health crisis and we cannot prevent it without the government and the communities working together, individual precaution can only go so far.” The key is to raise awareness, preferably through school children so that we can reach their families and subsequently the community at large, about the nature of aedes mosquito that carries the dengue virus and the protective measures. Last year, almost every family in Kathmandu had multiple members suffering from <a href="https://www.nepalitimes.com/news/state-of-malaise">dengue</a>. Although 90% of patients were asymptomatic, they helped spread the virus.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20230408040436_c88bd2e1183ab33f7763f64b18be6b6945cfae7fa1a6c1b793c9ffdeb3cf739f.jpg" data-media-id="editor_2" data-image-id="20230408040436_c88bd2e1183ab33f7763f64b18be6b6945cfae7fa1a6c1b793c9ffdeb3cf739f" data-rendition-name="original" width="5827" height="3885" loading="lazy" alt="dengue"> <figcaption>Photos: SUMAN NEPALI</figcaption> </figure>  Dengue patients generally have two weeks of high-grade fever accompanied by extreme muscle and joint aches, loss of appetite, nausea, and pain in the eye sockets. Many who had both dengue and Covid said dengue was much worse. <a href="https://nepalitimes.com/news/another-covid-wave-but-milder">Covid-19 is also back again</a>, possibly with a circulation of a new variant in the region. So all three levels of government must prepare for both outbreaks simultaneously. “Dengue is among the biggest public health challenges of the 21st century, given the disease burden and its socioeconomic impact in these parts of the world,” says Buddha Basnyat, physician at Patan Academy of Health Sciences. “And there is every potential of another outbreak given that we have not learned our lesson from previous outbreaks or taken any measures to prevent another one this year.” Indeed, Kathmandu had a major dengue outbreak in 2019, just before Covid-19 spread out of China in December of that year. There were over 17,000 official cases that monsoon but they were largely adult patients, most of which had milder symptoms and the fatality was very low. But <a href="https://www.nepalitimes.com/banner/as-covid-abates-nepal-sees-dengue-outbreak">last year’s outbreak</a> was much more widespread and serious. Although debilitating, fatality from dengue is rare but there were more complications and deaths. The mosquito eradication campaign came too late, and by that point dengue was out of control. We did not learn the lessons of 2019, and we haven’t learned the lessons of 2022. “How not to get dengue? It is simple, do not get bitten by a mosquito,” says Pun. “But preventing a mosquito bite is anything but simple because we do not do anything until it is too late.” Unlike the anopheles mosquito which carries the malaria parasite, aedes is active during the daytime, particularly in the early hours of the morning and evenings. This means avoiding the outdoors during these hours, if possible. So, mosquito net or coils at night do not help. Insect repellents should not be toxic, and contain the active ingredient that the aedes mosquito avoids. Full-sleeve clothes are always a better alternative.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20230408040436_960e7fc347fa61878bfa623db07296c1e068a4c932f1257bbc43b70a56e7421b.jpg" data-media-id="editor_5" data-image-id="20230408040436_960e7fc347fa61878bfa623db07296c1e068a4c932f1257bbc43b70a56e7421b" data-rendition-name="original" width="1000" height="699" loading="lazy" alt="dengue"> </figure>  Also important is the knowledge of the breeding habits of aedes mosquito. Any pool of water is a fertile breeding ground, even egg shells and water bottle caps in garbage piles. &nbsp;Fumigation, as some Kathmandu wards did two months into the outbreak last year, was ineffective because the virus was already spreading from already-infected people. In short, destroying the larvae by removing possible breeding sites is the best preventive measures. “Every step that the government took last year after the onset of the pandemic, take them now. In fact, the people should pressure their local governments to do so right away,” adds Basnyat. Unlike Covid and most other infectious diseases, a dengue reinfection is even more dangerous and can be fatal. <a href="https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30007-3/fulltext">Writing in the journal The Lancet</a> in 2020, authors Sudeep Adhikari, Buddha Basnyat and Kripa Maharjan explain: ‘Primary infection with any serotype in a non-immune population generally causes mild disease. When secondary infection with another serotype occurs in the same population, there is antibody-dependent enhancement, which usually causes severe dengue. Over time, this secondary infection might lead to a so-called explosion of the disease.’ Such an explosion occurred in 2022 in Nepal’s urban areas, affecting mostly children and young adults. Misdiagnosis also caused complications in patients. Hospitals were overwhelmed and many patients had to be turned away. There was rampant overtreatment, often with antibiotics which are ineffective against viruses. With global warming, disease vectors like mosquitos and the virus are also <a href="https://www.nepalitimes.com/news/nepal-s-dengue-outbreak-exposes-climate-risk">moving to higher altitudes</a> spreading not just dengue but malaria, kalazar and chikungunya. &nbsp; Additional reporting by Ritika Tewari.

Sonia Awale

New dengue outbreak likely this monsoon

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114131156/63723b9b9c7e80680e0c95d2jpeg.jpg" alt="" width="4993" height="3241"/><figcaption>Vermilion rice paste and barley shoots prepared for Tika. All photos: SUMAN NEPALI</figcaption></figure>After two years of <a href="https://www.nepalitimes.com/latest/this-years-dangerous-dasain/" target="_blank" rel="noopener noreferrer">relatively muted Dasain festivities</a> due to the Covid-19 pandemic, Nepalis were all revved up to make up for it this year. However, heavy post-monsoonal rains over most of Nepal drenched Tika on Wednesday.The rains, combined with a lingering <a href="https://www.nepalitimes.com/banner/dengue-days-are-here-to-stay/" target="_blank" rel="noopener noreferrer">dengue epidemic in Kathmandu</a> did put a damper on the festivities, but did not seem to dampen the Dasain spirit.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114131156/63723b9f9c7e80680e0c95d3jpeg.jpg" alt="" width="640" height="427"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114131156/63723ba39c7e80680e0c95d4jpeg.jpg" alt="" width="640" height="427"><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114131156/63723ba69c7e80680e0c95d5jpeg.jpg" alt="" width="2304" height="1536"><figcaption>People leaving for their home towns for Dasain and crowded marketplace with people shoping for the festivities.</figcaption></figure>On 5 October, families celebrating the festival across the country observed Tika, the main day of <a href="https://www.nepalitimes.com/banner/where-are-you-going-this-dasain/" target="_blank" rel="noopener noreferrer">Dasain</a> when elders bless younger ones with ceremonial vermilion-rice paste on the forehead and sacred barley shoots. The celebration continues until the full moon night of 9 October.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114131156/63723ba99c7e80680e0c95d6jpeg.jpg" alt="" width="640" height="427"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114131156/63723bac9c7e80680e0c95d7jpeg.jpg" alt="" width="640" height="427"><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114131156/63723bb29c7e80680e0c95d8jpeg.jpg" alt="" width="4809" height="3387"><figcaption>Various rituals performed throughout Dasain festivities.</figcaption></figure>Dasain has been marked for millennia as a symbol of good vs evil, but probably originated as a harvest festival, and evolved into family get togethers. It is also traditionally accompanied by <a href="https://www.nepalitimes.com/banner/high-on-swings/" target="_blank" rel="noopener noreferrer">playing on bamboo swings</a> and flying kites -- although this Dasain was too wet for kite fights.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114131156/63723bb69c7e80680e0c95d9jpeg.jpg" alt="" width="1600" height="1066"><figcaption></figcaption></figure><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114131156/63723bb99c7e80680e0c95dajpeg.jpg" alt="" width="2048" height="1312"><figcaption></figcaption></figure>Nepali Times photojournalist Suman Nepali brings these and more in this photo feature depicting this year’s <a href="https://www.nepalitimes.com/banner/top-dasain-destinations/" target="_blank" rel="noopener noreferrer">Dasain</a> festivities.

Dasain 2022

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114131144/637238939c7e80680e0c7392jpeg.jpg" alt="" width="960" height="640"/><figcaption>VECTOR FOR VIRUS: Stagnant pools of water, an ideal breeding site for the dengue mosquito, outside the Sukraraj Tropical &amp; Infectious Diseases Hospital at Teku, which on Thursday saw 250 new dengue patients. Photo: SUMAN NEPALI</figcaption></figure>It is not called ‘breakbone fever’ for nothing. Every bone, every muscle, every joint throbs with searing pain, as my body burned with high fever. It was not just for a day or two, it lasted weeks. The fever has finally subsided, but I am too weak even to walk.As a public health graduate myself, and someone who has covered health and environment for this publication, I am used to covering disease outbreaks. But my experience with Covid last year, and now being struck down by dengue, I became the story I was reporting on.It has been two months since the first cases of dengue surfaced in Kathmandu Valley. There was  an outbreak in 2019, and everyone thought it would pass.But this monsoon, there has been no letup. The virus has spread like wildfire, exposing just how woefully unprepared national and local governments are in preventing a disease that has no cure.The fever has now spread to all 77 districts with 10,000 patients in hospitals, many thousands more are recovering at home. Doctors have reported Covid patients with dengue complications.“We are at the peak of the dengue outbreak,” warns Sher Bahadur Pun, virologist at the Sukraraj Tropical &amp; Infectious Disease Hospital in Kathmandu which is seeing 250 patients a day. “I wish I had better news, we are at the mercy of the virus, and will just have to wait for winter.”But Kathmandu Mayor Balen Shah posted on Facebook asking the public not to wait for winter. He said money had been allocated for wards, many are carrying out  ineffective fumigation.Roshan Pokhrel, Secretary at the Ministry of Health says: “There is no cure for this. The only way is to search and destroy mosquito breeding grounds.”Read also: <a href="https://www.nepalitimes.com/banner/state-of-malaise/">State of malaise</a>, Sonia AwaleBut that is easier said than done. Draining stagnant pools is too late, infected mosquitos are already inside homes. The female Aedes aegypti mosquito has ideal breeding areas during this wet monsoon, and climate change is letting the virus move to higher elevations.A female mosquito can lay up to 700 eggs even in a small pool of water, and can pass on the virus to its offspring. The mosquitos then can fly and infect in a radius of 300m, and they bite mainly in the daytime so that mosquito nets while sleeping are not really a deterrent. When the pools dry up, the larvae lie dormant and carry the virus next summer.“Preventing mosquito bites is still the priority, people need to know about effective repellents, especially the ones containing DEET (diethyltoluamide), recommended by WHO and CDC as the most active ingredient in insect repellents,” says Buddha Basnyat, a physician at Patan Academy of Health Sciences.Also important is to assure patients that although painful, dengue is rarely fatal, Basnyat assured me this week as I tried to regain my strength after two weeks of high fever.Last month, I was preparing a review of new studies about air pollution when I started feeling feverish. It got difficult to even sit at my desk. Wincing with pain, I barely met the deadline for page 1. At that point, air pollution seemed to be the least of my problems.The next two weeks are a blur. Fever that reached and stayed at 103°F for days on end, even touching my skin was painful, my eye sockets hurt. Paracetamol was the only medicine, and I needed cold presses to keep the fever down.One evening, the temperature hit 104°F and that was when I felt like I was hallucinating. With such high fever, sleep is impossible. I could not even toss and turn because of the pain.Eating was out of the question, even drinking water took enormous effort. Aside from the pain was the nausea and retching, which made the pain worse.Read also: <a href="https://www.nepalitimes.com/opinion/the-dangers-of-the-dengue-virus/">The dangers of the dengue virus</a>, Tom RobertsonI cannot explain in words just how unpleasant dengue is. God forbid, you have to experience it yourself.The other experience of my convalescence was how the medical profession in Kathmandu from doctors to pharmacies are abusing this epidemic for unethical profit. There is no medicine for dengue, just paracetamol to numb the pain, water to replenish the body’s fluids, and rest – lots of it.My neighbourhood in Patan is a dengue hotspot, every household has at least one person who is sick. Some neighbours have been prescribed antibiotics, even though they are harmful to dengue patients.“Dengue is a viral infection, prescribing antibiotics does no good,” Buddha Basnyat told me. “They are prescribing Azithromycin used for typhoid and typhus. This misuse can actually lead to resistance against those diseases.” Virologist Pun at Teku Hospital says he is getting patients at his fever clinic with complications because of antibiotic intake. Patients buy antibiotics over the counter in the misguided notion that it will make the fever go down.The only effective prevention is to remove mosquito breeding grounds, but with the city being in the state it is in with garbage piles, open drains and potholes, it will need a mass awareness campaign with enforcement and fines as is done in other tropical Asian cities.Climate change means that mosquito vectors and their pathogens are moving up, and besides dengue we will also have to watch out for malaria or encephalitis in areas they were unheard of before.“Vector insects are moving from the southern plains to the northern mountains and with them the diseases they carry,” explains Pun.This means Nepalis may have to experience more deadly outbreaks before the most vulnerable people become a priority for the state.Read also: <a href="https://www.nepalitimes.com/banner/mosquitoes-move-up-mountains-as-the-earth-warms/">Mosquitoes move up mountains as the earth warms</a>, Sonia Awale-----------------------------<h2>Operation Search and Destroy</h2><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114131144/637238959c7e80680e0c7393jpeg.jpg" alt="" width="1000" height="699"><figcaption> </figcaption></figure>Dengue is a viral infection transmitted to humans through the bite of infected Aedes aegypti or Aedes albopictus mosquitos. Because there are four different serotypes, an individual previously affected can get even more severe dengue due to the body's auto-immunity.There is no cure for dengue. A vaccine is available, but it is recommended only for those previously infected. Patients can be tested for dengue with RT-PCR or enzyme-linked immunosorbent assays (ELISA).Prevention is better than cure, and this is most true for dengue. Some 80% of dengue cases are asymptomatic, but for the rest it could be a very painful experience for up to 2 weeks.Painkillers are not advised, only paracetamol, up to 1,000mg at one time 3 times a day.The only antidote to dengue is to deprive the mosquito of stagnant pools of water to breed. It can be a plastic bottle cap in a garbage dump or the inside of a discarded tyre, anything is suitable for the female mosquito to lay her eggs.She can lay up to 700 eggs in their two-week lifetime. And if the mother is infected, all her offspring are born with the virus too. These mosquitos can fly and infect everyone in a 300m radius.Dengue was first detected in Nepal in 2004 on a visitor. Since then there have been cases every year with the biggest outbreaks in 2019 and this year. Once present in the environment, the virus can remain for years since the infected mosquito larvae can carry it into next summer.The only way to prevent dengue and other mosquito borne diseases like malaria and encephalitis is to declare Operaton Search and Destroy on their breeding grounds.Read also: <a href="https://www.nepalitimes.com/here-now/climate-health-emergency/">Climate-health emergency</a>, Sonia Awale

Dengue days are here to stay

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114131128/637235369c7e80680e0c4975jpeg.jpg" alt="" width="5827" height="3885"/><figcaption>All Photos: Suman Nepali</figcaption></figure>For the past two years, the preoccupation of the government and people of Nepal has been with the pandemic. But just as the fourth wave of Covid-19 started to subside, Kathmandu and other towns across Nepal have been hit by dengue outbreaks.For the past few weeks, Shukraraj Tropical and Communicable Disease Hospital in Teku has been crowded with patients with fever. At first, epidemiologists there thought it was a new Covid strain, but the symptoms were different: severe body ache, eye pain, high fever and nausea.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114131128/6372353a9c7e80680e0c4976jpeg.jpg" alt="" width="2304" height="1536"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114131128/6372353d9c7e80680e0c4977jpeg.jpg" alt="" width="2304" height="1536">In Kathmandu Valley, there were hotspots mostly in inner city Patan and the outskirts. Hundreds of patients have been admitted into hospitals, and the number of cases diagnosed in hospitals has surpassed 1,000 -- more than in the previous outbreak in the summer of 2019.Last year, there were only 10 patients at the Teku hospital in the second week of August last year, whereas there were 295 dengue patients just in the past week.This week, 120 dengue cases were reported in Lalitpur, 70 in Rupandehi, 110 in Kathmandu, and dozens more in Nawalparasi West and Bhaktapur, seven each in Dhading, Gulmi and Kapilvastu, six from Arghakhanchi, and five each from Tehrathum, Sindhuli and Makwanpur. There are six patients with dengue in ICU.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114131132/637235419c7e80680e0c4978jpeg.jpg" alt="" width="2304" height="1536">The number of dengue patients in hospitals has now exceeded those suffering from Covid. Doctors say there are probably thousands more with dengue fever recovering or being treated at home.  Dengue is transmitted from one infected person to the next by bites of the Aedes aegyti mosquitos during the day, and is caused by four different virus sero-types. Patients infected with one serotype of the virus will not have immunity against the other three types and there can be multiple infections.  Also called 'break-bone fever' patients contract the disease 3-7 days after the mosquito bite, and the high fever usually lasts up to a week, although it leaves the weak for up to a month.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114131132/637235459c7e80680e0c4979jpeg.jpg" alt="" width="2304" height="1536"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114131132/637235489c7e80680e0c497ajpeg.jpg" alt="" width="2304" height="1536">There is no treatment for dengue, since antibiotics are not effective against viruses. Doctors recommend paracetamol to ease pains and to bring down fever, and plenty of fluids. More severe cases of dengue can result in internal haemorhage and may require hospitalisation.“People still do not believe that mosquitoes bite during the day. While sleeping at night, they adopt all the safety standards from the hammock, but they ignore it during the day," says Sher Bahadur Pun, the head of the hospital’s clinical research unit.He says that measures should be taken to avoid mosquito bites in schools and offices as well as at home. “People are aware when they are at home, but they should be most aware in schools, offices, areas where houses are under construction and there are pools of stagnant water,” he says.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114131132/6372354b9c7e80680e0c497bjpeg.jpg" alt="" width="5905" height="3937">Pun's informal survey among patients at Teku showed that a third of them do not even know that dengue is transmitted by mosquito bites during the day. This is why the viral fever is spreading among students, with cases of entire classes of some schools being sick.Pun also warns against taking strong medications for dengue, and says that certain pain-killers and antibiotics can actually make the patients' condition worse.“Dengue causes severe body ache, so people look for strong medications for this. We have been giving cetamol for fever, which sometime does not alleviate pain like other painkillers,” says Pun. "However, using Brufen, Flexzone, Nims can be very harmful."<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114131132/6372354f9c7e80680e0c497cjpeg.jpg" alt="" width="5210" height="3473">A study conducted  at Teku Hospital on the outbreak of dengue in Nepal from 2006 to 2019 found that many patients had become sicker because of prescription medicines they took without consultation, or because doctors had prescribed the wrong medicine thinking it was some other kind of fever.Recently, Pun came across a dengue patient  who was bleeding from the eyes after taking Flexzone continuously for five days. "I had never seen such a case before," he says, "patients who are being treated at home should be admitted to the hospital immediately if they have serious problems."Read more: <a href="https://www.nepalitimes.com/opinion/the-dangers-of-the-dengue-virus/">The dangers of the dengue virus</a>, Tom Robertson

As Covid abates, Nepal sees dengue outbreak

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022112916110/63861ea79c7e80680e0ccddajpeg.jpg" alt="" width="799" height="536"/><figcaption></figcaption></figure>There have been few days without rain this April and May in Kathmandu. That means more disease for Kathmandu. Not COVID-19, but the virus we used to talk about -- last year's scary unknown disease, dengue.The year 2019 saw Nepal's worst ever outbreak of dengue, with 15,000 people infected, many times the previous high. Dengue was particularly bad in the Kathmandu Valley. At least six people died.The medical journal The Lancet has warned that Kathmandu could see a dengue ‘explosion’ because it has become ‘an ideal breeding ground’ for the mosquito that carries dengue -- the notorious Aedes aegypti. Already in 2020, four cases have been reported in Kathmandu, and four in Lalitpur.<a href="https://www.nepalitimes.com/banner/big-story-of-small-pox-in-nepal/" target="_blank" rel="noopener noreferrer">Big story of smallpox in Nepal</a>, Tom Robertson<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/banner/viruses-past-present-and-future/" target="_blank" rel="noopener noreferrer">Viruses past, present and future</a>, Tom RobertsonDengue spiked in 2019 with outbreaks around the developing world. In recent years, Delhi, Dhaka, Ho Chi Minh City, Senegal and Singapore have faced bad outbreaks. A dengue outbreak in Delhi in 2015 inundated hospitals and clinics across the city.Dengue likes warm humid conditions. Before corona, dengue was the world's fastest growing dangerous virus, increasing four-fold in just over a decade. Two of every five people around the world, nearly 3 billion people, live in dengue risk areas where it is a leading cause of illness. Each year approximately 100 million people contract the disease, and over 20,000 die.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022112916110/63861eaa9c7e80680e0ccddbjpeg.jpg" alt="" width="961" height="540"><figcaption> </figcaption></figure>Like malaria, dengue is actually several different diseases that we give a single name. There are four dengue viruses: Dengue 1, 2, 3, and 4. A person can catch each one, and get sick as many as four times.A first infection generally brings only mild flu symptoms, if any at all. But a second infection can cause ‘severe dengue’ with plasma leakage, bleeding, and shock. This can kill. No treatment exists for dengue, but generally symptoms can be managed.<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/here-now/climate-health-emergency/" target="_blank" rel="noopener noreferrer">Climate health emergency</a>, Sonia Awale<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/banner/mosquitoes-move-up-mountains-as-the-earth-warms/" target="_blank" rel="noopener noreferrer">Mosquitoes move up mountains as the earth warms</a>, Sonia AwaleDengue's main mosquito host, Aedes aegypti, is no ordinary mosquito. In a species known for death and deviousness, it has few rivals. Not many mosquitoes have so successfully defied human efforts at control, including in recent decades.Long before dengue, Aedes aegypti carried a far deadlier disease: yellow fever. During the 16th and 17th, slave ships brought yellow fever carrying A. aegypti from Africa to the Americas, devastating indigenous populations and reshaping the region's balance of power. In the early twentieth century, the A. aegypti -- yellow fever combination almost blocked the construction of the Panama Canal.Most wildlife avoid humans. Not A. aegypti. It loves us, particularly the ecological disorder we often create. The more humans, the more disturbed ecosystems, the more A. aegypti. Cities, especially disorganised cities, create ideal habitat: lots of standing water for breeding and lots of humans for feeding.Dengue's other mosquito carrier is A. albopictus.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022112916110/63861eac9c7e80680e0ccddcjpeg.jpg" alt="" width="640" height="463"><figcaption> </figcaption></figure><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022112916110/63861eaf9c7e80680e0ccdddjpeg.jpg" alt="" width="640" height="635"><figcaption> </figcaption></figure>The Lancet points to dengue's major causes: climate change, relentless and haphazard urbanisation, brisk trade and transit from dengue-infested areas, and poor health infrastructure. As Kathmandu grows and gets more connected to other parts of Asia, dengue spreads.Climate change has been overrated as a cause. Warming temperatures can extend the range of Aedes carriers but other causes deserve more attention. ‘Last summer’s explosion of dengue in Kathmandu Valley was <a href="https://www.nepalitimes.com/banner/mosquitoes-move-up-mountains-as-the-earth-warms/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/banner/mosquitoes-move-up-mountains-as-the-earth-warms/&amp;source=gmail&amp;ust=1590920172779000&amp;usg=AFQjCNHqCreNEFDji4GDyS_wUW1JkpUOGA">blamed on climate change</a>,’ the Nepali Times recently noted, ‘but it was actually a perfect storm of crowded and squalid living conditions, poor drainage, greater mobility of people, and a particularly wet monsoon.’The real problem is disorganised urbanisation. The A. aegypti carrier thrives in small collections of clean water in flower pots, old car and truck tyres, uncovered water containers, and even puddles. It bites people early morning and at dusk.<a href="https://www.nepalitimes.com/here-now/nepal-is-a-microcosm-of-all-of-the-changes-in-world-health/" target="_blank" rel="noopener noreferrer">"Nepal is a microcosm of all of the changes in world health"</a><a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/here-now/ke-garne-attitude-kills-people/" target="_blank" rel="noopener noreferrer">K garne attitude kills people</a>, Laxmi BasnetNepal, like much of the developing world, has witnessed dramatic and disorderly urban growth in recent years, much in the lowlands along highways. ‘Nepal's Tarai," Mukesh Pokhrel recently wrote also in this newspaper, "is turning into one endless elongated metropolis.’Kathmandu itself grew four-fold between 1980 and 2010, and is one of the fastest growing cities in one of the world's fastest urbanising regions.'<a href="https://www.nepalitimes.com/banner/mosquitoes-move-up-mountains-as-the-earth-warms/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/banner/mosquitoes-move-up-mountains-as-the-earth-warms/&amp;source=gmail&amp;ust=1590920172779000&amp;usg=AFQjCNHqCreNEFDji4GDyS_wUW1JkpUOGA">Cities like Kathmandu are perfect breeding grounds</a> for the Aedes mosquito,' says Jeremy Farrar of the Wellcome Trust in an interview with this paper. 'Kathmandu’s climate is changing, the city is growing exponentially in a haphazard way and the mosquito loves highly dense populations of people.'<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/banner/east-west-city/" target="_blank" rel="noopener noreferrer">East-West City</a>, Mukesh Pokhrel<a href="http://archive.nepalitimes.com/news.php?id=19301#.XtI_7y2B3-Y" target="_blank" rel="noopener noreferrer">Dengue fever</a>, Buddha BasnyatThe Lancet highlights what might happen in a dengue explosion in Kathmandu. ‘A tug-of-war might occur between the worried well and the truly sick,’ it says. ‘Hospitals might be overwhelmed and many needy patients with other diseases could be turned away.’Doctors inexperienced with the disease pose a particular worry. They could misunderstand its dynamics and cause unnecessary deaths by over-treating with unneeded antibiotics, transfusions, and excessive intravenous fluids. This has happened elsewhere.The dengue-carrying Aedes aegypti mosquito is difficult to control. Brazil eradicated it twice, in the 1950s and in the 1970s, and twice it returned. Several factors explain why: a lack of sustained careful epidemiological surveillance, insecticide resistance, the high costs of materials and wages, insufficient community participation and coordination with the health sector, and, crucially, the spread of haphazard urban development. Narrow control programs inevitably run into trouble.The World Health Organisation (WHO) stresses both micro and macro efforts to fight dengue. Individual families can put tight lids on water containers. They can eliminate breeding spots such as empty cans, bottles, and tires. It also says community engagement and building country capacity for environmental management and disease surveillance is important.“Locally adapted vector control measures such as household water storage management and, more importantly, engaging individuals and communities to manage their immediate environment are essential to controlling the spread of the disease,” says Raman Velayudhan, head of WHO’s Vector and Ecology Management Unit.School-based awareness programs, The Lancet authors noted, can help block dengue's spread. ‘Students are good learners and can be taught to effectively use repellents and mosquito nets and get rid of water collections near their homes and schools; students will then spread this information to their parents.’ Several countries have implemented successful school programs.Historian Frank Snowden sums it up: "Dengue takes full advantage of societal neglect and the absence or cessation of vector control programs."Tom Robertson, Ph D, is an environmental historian who writes about the history of malaria in Nepal. And just wrote a <a href="https://www.nepalitimes.com/banner/big-story-of-small-pox-in-nepal/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/banner/big-story-of-small-pox-in-nepal/&amp;source=gmail&amp;ust=1590920172779000&amp;usg=AFQjCNFk193f6QnfjiWqivawrVZt2FPA4A">five-part series on smallpox</a> for Nepali Times as part of his History of Disease column.

Tom Robertson

The dangers of the dengue virus

Epidemics are nothing new in Nepal. In fact, the country’s history is littered with references to frequent outbreaks of cholera, influenza, measles and other disease that killed thousands at a time Nepal.Yet, despite knowledge about prevention or the availability of vaccines, Nepalis still continue to die in large numbers. An outbreak of diarrhoea killed 200 people, mostly children, in Jajarkot in 2009. Last year’s unprecedented eruption of <a href="https://tropmedhealth.biomedcentral.com/articles/10.1186/s41182-020-0194-1" data-saferedirecturl="https://www.google.com/url?q=https://tropmedhealth.biomedcentral.com/articles/10.1186/s41182-020-0194-1&amp;source=gmail&amp;ust=1586755561427000&amp;usg=AFQjCNF2kQRkqfQlK6HcTgAWijq2RpcGaQ">dengue in Kathmandu</a> infected 15,000 and <a href="https://www.nepalitimes.com/banner/mosquitoes-move-up-mountains-as-the-earth-warms/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/banner/mosquitoes-move-up-mountains-as-the-earth-warms/&amp;source=gmail&amp;ust=1586755561427000&amp;usg=AFQjCNEBf6yExopyyX2QWQrwe2mffPJ09w">killed at least a dozen people</a>.So, for Nepal the only difference between the coronavirus pandemic and previous disease outbreaks is that it is global in scope, and it has wrecked the economy. The government has been more proactive this time, compared to previous epidemics in taking strict measures to prevent the spread, like the <a href="https://www.nepalitimes.com/latest/nepal-covid-19-lockdown-extended-till-7-april/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/nepal-covid-19-lockdown-extended-till-7-april/&amp;source=gmail&amp;ust=1586755561428000&amp;usg=AFQjCNHcPke1rqEHuZS0-wb1tig9mHFzYw">lockdown</a> which has now lasted nearly three weeks.Even so, experts say Nepal’s response was unnecessarily delayed. Nepal was one of the first countries outside China to report a case of COVID-19 when a Nepali student who had returned from Wuhan tested positive for the virus on 24 January. He later recovered, and right new cases have been detected since, but it was only in the second week of April that the government finally began mass testing in western Nepal and Tarai districts, where there have been returning migrant workers from India.<a href="https://www.nepalitimes.com/opinion/remembering-a-pandemic-100-years-ago/">Remembering a pandemic 100 years ago</a>, Buddha Basnyat<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121112/636b8b679c7e80680e06b298jpeg.jpg" alt="" width="4096" height="2730"/><figcaption>A doctor based in Sukraraj Tropical and Infectious Disease Hospital explains on COVID-19. Photo: BIKRAM RAI</figcaption></figure>The mosquito-borne haemmorhagic fever is already being reported in all seven provinces. Cases have been arriving in hospitals which are already on high alert of COVID-19. A double epidemic would mean medical facilities will be overwhelmed.“We are not new to epidemics. Thousands of children continue to die of easily preventable diarrhoea every year and there will be another dengue outbreak this summer, but where is the preparedness?” asks Gangalal Tuladhar, a disaster expert and politburo member of the ruling Nepal Communist Party. “It is a primary duty of a responsible government to prepare for any disaster or an epidemic before it strikes.”<a href="https://www.nepalitimes.com/here-now/nepal-is-a-microcosm-of-all-of-the-changes-in-world-health/">“Nepal is a microcosm of all of the changes in world health”</a>, Nepali TimesIt is ironic that a senior member of a ruling political party that commands a near two-thirds majority in Parliament is the one complaining about the government being lax. To be sure, the government has been strict in enforcing the lockdown, and Prime Minister Oli hinted during a conference call with provincial chief ministers on Saturday that the lockdown may need to be extended because the virus was spreading in India.Also, local government have been crediting with taking effective prevention measures, including house-to-house surveillance and monitoring of high-risk individuals. Swab collection and mass testing of high risk groups has started in earnest.<a href="https://www.nepalitimes.com/here-now/confusion-persists-about-lockdown-rules/">Confusion persists about lockdown rules</a>, Alisha Sijapati<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121112/636b8b6b9c7e80680e06b299jpeg.jpg" alt="" width="640" height="427"><figcaption> </figcaption></figure>Still, Nepal’s lack of preparedness to fight public health emergencies has been similar to the apathy shown about enforcing building codes and having a rescue and relief strategy in place for future mega-earthquakes.It took the devastating 2015 earthquake to finally push the policymakers to develop the Disaster Risk and Management Act in 2017 – more than five years after it was languishing in the legislature. Unlike the Natural Calamity Act 1982 that is centred on the relief, the new Act listed 22 kinds of disasters in Nepal and it focuses on preparedness. Epidemics however have been categorised under ‘non-disaster’ in the new Act.<a href="https://www.nepalitimes.com/banner/rebuilding-five-years-after-2015-quake/">Rebuilding five years after 2015 quake</a>, Alisha SijapatiEpidemics has been lumped together with famine, fire, pest or micro-bacterial attack, industrial accident, toxic gas hazard, chemical radiation leakage, gas explosion, toxic food intake, environmental pollution, deforestation, physical infrastructure damage and accidents during disaster relief.“Placing snakebites and outbreaks together itself shows that we haven’t really understood what an epidemic means. There is a huge difference in how we have to deal with them,” says Baburam Marasini, former head of the Epidemiology and Disease Control Division.The emergence of COVID-19 on top of the reoccurrence of pre-existing diseases mean countries need health institutions with medical staff equipped to deal with epidemics, research wing to undertake new studies on emerging diseases, and a strong system that can take immediate steps to control spread of a contagion.<a href="https://www.nepalitimes.com/banner/rebuilding-five-years-after-2015-quake/">The climate connection to Covid-19</a>, Rastraraj Bhandari“We need to make laws taking infectious diseases into account, strengthen local infrastructure as well as increase capacity of the health sector,” Marasini says.  “We have to turn COVID-19 into an opportunity to build a new health structure and strengthen existing laws.”Chronic lack of coordination and turf battles between the Department of Health Services, National Public Health Laboratory, Epidemiology and Disease Control Division, Epidemiology and Epidemic Management Section, Teku Hospital and Animal Disease Investigation and Control Division have added to the problem.Says public health expert Madhav Chaulagain: “We are unprepared not just for new emerging epidemics but for the pre-existing diseases and seasonal disasters too.”<a href="https://www.nepalitimes.com/here-now/in-nepals-weather-erratic-is-the-new-normal/">In Nepal’s weather, erratic is the new normal</a>, Olivia Molden and Tyler McMahonClose to three years after Nepal adopted a decentralised federal structure, provincial governments have to fly COVID-19 samples to Kathmandu in lack of regional laboratories and hospitals specialising in infectious diseases.The root of the problem is a culture not primed for prevention, but for cure. Also a ‘ke garne’ fatalistic attitude that tends to leave solving a known problem until after the disaster hits.“We think about building modern hospitals to cure people. What developing countries like us should really be focusing on is prevention and preparedness,” says Gangalal Tuladhar. “We are lucky we still have time to prepare for COVID-19. It is time to work on prevention.”Read also:<a href="https://www.nepalitimes.com/latest/cash-flow-crisis-for-migrants-and-families/">Cash flow crisis for migrants and families</a>, Upasana Khadka<a href="https://www.nepalitimes.com/opinion/what-is-novel-about-the-novel-coronavirus/">What is novel about the novel coronavirus?</a>, Buddha Basnyat

Ke garne attitude kills people

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101152/636b79289c7e80680e0646e7jpeg.jpg" alt="" width="960" height="640"/><figcaption>A quarantine zone at Nepal Army's headquarters in Tundikhel. Photo: BIKRAM RAI</figcaption></figure>By now the novel coronavirus pandemic has affected every corner of the globe. If it has not brought disease, it has at least brought the <a style="background-color: #ffffff; font-size: 16px; letter-spacing: 0.15px;" href="https://www.nepalitimes.com/editorial/fear-goes-viral/" target="_blank" rel="noopener">fear of infection</a>. Cities, and indeed entire countries, are in lockdown. Fortress Europe has raised its walls higher. Airlines are grounded. Nepal has banned trunk international routes from Friday night. Even countries with excellent public health facilities and emergency preparedness plans are overwhelmed.Nepal is now <a href="https://www.nepalitimes.com/opinion/global-thinking-and-local-action-on-coronavirus/" target="_blank" rel="noopener">so closely intertwined with globalisation</a> through migration, tourism and trade that its <a href="https://www.nepalitimes.com/here-now/nepals-economy-already-weak-takes-direct-hit/" target="_blank" rel="noopener">already-fragile economy has been badly hit</a> even before a full-blown health emergency hits. Ironically, less-developed countries seem to have a built-in resilience that comes from being crisis-prone -- since they are lower down in the economic ladder, they have a shorter distance to fall.Read also: <a href="https://www.nepalitimes.com/editorial/poor-health-makes-nepalis-poorer/" target="_blank" rel="noopener">Poor health makes Nepalis poorer</a>, EditorialDespite Nepal’s surprisingly <a href="https://www.nepalitimes.com/banner/born-in-nepal/" target="_blank" rel="noopener">dramatic improvements in mother-child survival </a>over the past two decades, <a href="https://www.nepalitimes.com/editorial/poor-health/" target="_blank" rel="noopener">the public health system here is in crisis</a>. State-of-the-art modern hospitals in the city, while reducing the need for Nepalis to go abroad for treatment, are out of reach of a majority of the population. Government health facilities are more affordable, but for the most part medical care there is not up to mark.Nepalis are still afflicted by easily preventable water-borne diseases like <a href="https://archive.nepalitimes.com/news.php?id=16988#.XnMUhagzbSF" target="_blank" rel="noopener">typhoid and diarrhoea</a>, vector-borne infections like malaria, encephalitis or dengue, and illnesses like <a href="https://www.nepalitimes.com/banner/nepal-tb-cases-grossly-underestimated/" target="_blank" rel="noopener">tuberculosis </a>and acute respiratory infections that spread through breathing. Great inroads have been made in reducing the impact of communicable diseases in the past decades through awareness programs, vaccinations and safer drinking water, but children in <a href="https://www.nepalitimes.com/banner/this-is-how-to-upgrade-nepals-rural-health/" target="_blank" rel="noopener">remoter parts of Nepal</a> are still dying of simple infections.Read also: <a href="https://www.nepalitimes.com/banner/a-shot-in-the-arm-for-vaccines-in-nepal/" target="_blank" rel="noopener">A shot in the arm for vaccines in Nepal</a>, Sonia AwaleOn top of this, urbanising Nepal now also has the added burden of <a href="https://www.nepalitimes.com/editorial/poor-health/" target="_blank" rel="noopener">non-communicable afflictions</a> like diabetes, cardio-vascular ailments and renal disease. As families move from the districts to the cities, changes in diet and more sedentary habits have given rise to an epidemic of lifestyle-related diseases. This is compounded by genetic susceptibility among South Asians for diabetes and heart disease.For example, a study by the BPKIHS in Dharan showed that while the national average for <a href="https://archive.nepalitimes.com/article/nation/diabetes-in-south-asia,3018" target="_blank" rel="noopener">Type 2 diabetes </a>prevalence is 8.1% of the population, the incidence in Dharan was 14%, while it was only 1% in Taplejung. The prime minister’s own second kidney transplant this month showed that <a href="https://archive.nepalitimes.com/article/editorial/health-tip-editorial,4032" target="_blank" rel="noopener">ignoring risk factors and not diagnosing non-communicable diseases</a> can lead to a huge health burden for families and the state. A small percentage of Nepalis have health insurance, so many middle income families fall below the poverty line due to medical expenses. Many Nepali migrant workers have been forced to seek jobs abroad to pay back debts incurred during hospitalisation of family members.Last summer’s explosion of dengue in Kathmandu Valley was <a href="https://www.nepalitimes.com/banner/mosquitoes-move-up-mountains-as-the-earth-warms/" target="_blank" rel="noopener">blamed on climate change</a>. But it was actually a perfect storm of crowded and squalid living conditions, poor drainage, greater mobility of people, and a particularly wet monsoon. None of these factors have been addressed, so we are staring at a recurrence of dengue this year even while we cope with <a href="https://www.nepalitimes.com/banner/why-nepal-must-watch-about-coronavirus-but-not-panic/" target="_blank" rel="noopener">a possible COVID-19 outbreak</a>.Public health has not been a national priority for successive governments in Nepal. Even if it has, it is only in paper and has not really been translated into <a href="https://www.nepalitimes.com/opinion/is-free-health-care-possible-in-nepal/" target="_blank" rel="noopener">accessible and affordable healthcare</a> for the general public. Governance failure has contributed to this state of affairs, but there is also the virus of corruption that has afflicted the entire government healthcare system. A politico-business nexus has also infected <a href="http://archive.nepalitimes.com/news.php?id=19560" target="_blank" rel="noopener">medical education</a>, putting it out of reach of deserving poorer students.Read also: <a href="https://www.nepalitimes.com/editorial/when-panic-goes-viral/" target="_blank" rel="noopener">When panic goes viral</a>, EditorialInto this mix, we now have the coronavirus scare. Officially, Nepal has just one case in which the patient recovered and has been discharged. The government has tested about 500 people, and all have been negative. Experts have confirmed that the tests are credible, and proper protocols are in place. But not enough tests have been done to determine if there are more people out there with the virus.At $75 per test, the kits are expensive. This is where international help would be needed, and if the case rate rises the country will also need help with containment and mitigation. Nepal has been lucky so far that there is no indication of community transmission yet. But our luck could turn any day.

This is a test

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108151116/636a65199c7e80680e059911jpeg.jpg" alt="" width="1500" height="1000"/><figcaption>HIGH AND DRY: A village in Mustang is one of the increasing number of settlements that have been abandoned because of water shortage caused by climate change. Photo : GOPEN RAI</figcaption></figure>In the past, Nepalis have migrated to India for seasonal labour and military recruitment. Today they fly overseas for work. Tomorrow they may have to migrate in increasing numbers because of climate-induced disasters.But the reason for migrating remains the same: <a href="https://nepalitimes.atavist.com/recharging-the-mountains-" target="_blank" rel="noopener">reliance of Nepal’s farmers on rain-fed agriculture</a>, which leaves them vulnerable to <a href="https://www.nepalitimes.com/opinion/where-is-the-monsoon-this-year/" target="_blank" rel="noopener">erratic monsoons</a>. And as extreme weather events become more frequent due to the climate emergency, more and more Nepalis may be forced to move out.Read also:<a style="background-color: #ffffff; font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/?p=37135&amp;preview_nonce=066ab9802a&amp;preview=true" target="_blank" rel="noopener">Migration mitigation,</a> Editorial<a style="background-color: #ffffff; font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/?p=37197&amp;preview_nonce=e98b9c3c62&amp;preview=true" target="_blank" rel="noopener">Women in climate hot spots face challenges adapting, Marty Logan</a>Already, <a href="https://www.nepalitimes.com/editorial/climate-damage/" target="_blank" rel="noopener">climate change</a> is causing more frequent <a href="https://www.nepalitimes.com/here-now/the-waste-land/" target="_blank" rel="noopener">droughts</a>, flash floods and rising temperatures, reducing crop yields across Nepal. Climate change has lowered the water table and dried natural springs, the <a href="https://www.nepalitimes.com/banner/a-terrifying-assessment-of-himalayan-melting/" target="_blank" rel="noopener">snowline has receded across the Himalaya</a>, and <a href="https://www.nepalitimes.com/opinion/climate-for-change/the-great-himalayan-thaw/" target="_blank" rel="noopener">glaciers are retreating dramatically</a>.The shortage of water is already <a href="https://nepalitimes.atavist.com/high-and-dry-upper-mustang" target="_blank" rel="noopener">forcing entire villages to relocate</a>, and the situation is expected to worsen in the next few decades as the dry season flow from snow-fed rivers declines because little ice remains to melt.Nepalis have been migrating for centuries to escape <a href="https://www.nepalitimes.com/banner/nepals-great-income-divide/" target="_blank" rel="noopener">poverty</a>, indebtedness and monsoon failures. All these push factors have now been magnified by climate-related hazards, and are already resulting in increased mobility.Read also:<a href="https://www.nepalitimes.com/latest/clock-starts-ticking-at-cop-25/" target="_blank" rel="noopener">Clock starts ticking at COP25</a>, Josie Wang<a href="https://www.nepalitimes.com/latest/the-carbon-footprint-of-tourism/" target="_blank" rel="noopener">The carbon footprint of tourism</a>“We are witnessing a rapid rise in temperature and a resulting climate shift. But <a href="https://nepalitimes.atavist.com/recharging-the-mountains-" target="_blank" rel="noopener">people in rural mountainous</a> and coastal areas have not been able to adapt to these changes, forcing them to move,” explained climate expert Manjeet Dhakal, who is in Madrid for the United Nations climate summit, COP25, citing the example of pastoralists relocating in Mustang district because of prolonged drought.Scientists have had to revise estimates of the rate of global warming because the impact is being felt much earlier than expected, with <a href="https://www.nepalitimes.com/opinion/turning-on-the-heat/" target="_blank" rel="noopener">heat waves</a>, larger forest fires, more intense storms, unseasonal blizzards and extreme rainfall events. The past decade was the hottest ever on record, Europe saw its hottest ever June this year, sub-Saharan Africa experienced unprecedented drought, while Cyclone Fani triggered the evacuation and displacement of 3.5 million people in Bangladesh and India in May.Here in Nepal, over 80,000 people were infected with <a href="https://www.nepalitimes.com/banner/mosquitoes-move-up-mountains-as-the-earth-warms/" target="_blank" rel="noopener">dengue this monsoon</a> in an unprecedented outbreak that scientists said was exacerbated by a warming climate. Bara district recorded <a href="https://www.nepalitimes.com/here-now/groound-zero-in-pheta/" target="_blank" rel="noopener">a rare tornado</a> that killed 80 people, and razed villages. <a href="https://www.nepalitimes.com/editorial/flood-of-recrimination/">Floods in the Tarai</a> are <a href="https://www.nepalitimes.com/banner/nepal-villages-learn-to-cope-with-climate-crisis/">getting worse every year</a>.“There are many reasons for people to migrate, but the additional stress from the risks of increased floods and droughts, or changes in farming or water supply, may just push people’s decision past the tipping point,” said David Molden, director of the International Centre for Integrated Mountain Development (ICIMOD). “For others, there may be no choice but to migrate if a water source is lost, or the damage from floods or droughts is too great.”Read also: <a href="https://www.nepalitimes.com/banner/the-third-pole-is-warming-faster-than-expected/" target="_blank" rel="noopener">The Third Pole is warming faster than expected</a>, Kunda Dixit<a href="https://www.nepalitimes.com/banner/a-terrifying-assessment-of-himalayan-melting/" target="_blank" rel="noopener">Terrifying assessment of a Himalayan melting</a>, Kunda Dixit Migration usually begins as a temporary response, but many people have had to relocate permanently or have been displaced. Millions of climate refugees are moving across borders. Human mobility of any kind in the face of the changing climate will have an enduring impact on societies and economies.“When some members of a family migrate, the country’s dependence on remittance will increase. When entire families migrate, the country will lose a major portion of its labour force. Eventually, dependence on remittance and a shrinking labour force will inhibit the economy,” said Dhakal.As far back as 1990, the Inter-governmental Panel on Climate Change (IPCC) warned that the single greatest impact of <a href="https://www.nepalitimes.com/banner/weather-warning-for-climate-meeting/" target="_blank" rel="noopener">climate change</a> would be on human migration. Now, experts are saying there may be 200 million climate refugees worldwide by 2050. By then, 42 million Bangladeshis and 36 million people in coastal India will have to relocate because of rising sea levels.A recent Oxfam report named climate change-fuelled disasters as the number one driver of internal displacement over the last decade, having forced more than 20 million people to leave their homes annually.Read also:<a href="https://www.nepalitimes.com/editorial/climate-climax/" target="_blank" rel="noopener">Climate climax</a>, Editorial<a href="https://www.nepalitimes.com/editorial/climate-damage/" target="_blank" rel="noopener">Climate damage</a>, Editorial“If the current development pathway and governance persists, human mobility upheaval will have huge humanitarian and social costs. We in Nepal may not remain immune to this disruption even though we are landlocked,” says water expert Ajaya Dixit.Following the 2015 Paris Agreement, the executive committee of the Warsaw International Mechanism established a task force on displacement to develop recommendations to avert, minimise and address displacement due to climate change. Agencies, including the International Organisation for Migration, are building support for the second phase of the task force in <a href="https://www.nepalitimes.com/latest/clock-starts-ticking-at-cop-25/" target="_blank" rel="noopener">Madrid this week</a>.Climate migration is also being discussed in 25 panels and events at COP25. With a rising backlash against migrants and refugees worldwide, it is likely that climate change impacts will cascade, stretching institutional capacity and governance and increasing the cost of adaptation. As displaced people move onto other people’s land, political confrontation and conflict between native populations and migrants can result.Governments represented in Madrid need to devise policies not just to reduce emissions, but to deal with the political, cultural and economic fallout of climate migration.Says Dixit: “The <a href="https://www.nepalitimes.com/editorial/climate-climax/" target="_blank" rel="noopener">climate crisis</a> poses an existential threat. Let us hope human ingenuity and collective wisdom will prevail to begin much needed transformative action.”

Nepal must prepare for climate migration

https://www.youtube.com/watch?v=qYrj1Et-9PkSir Jeremy Farrar is a British medical doctor and researcher with 30 years of experience in tropical and infectious diseases. In 2013, he was appointed director of the Wellcome Trust, one of the biggest global charities working in medical research. Nepali Times caught up with Farrar this week in Kathmandu, a place he visits often. Excerpts from the conversation:Nepali Times: What explains your interest in Nepal?Jeremy Farrar: I first came to Nepal in about 1989 or 1990. Since then, I have been working mostly on infectious diseases but increasingly on non-infectious diseases. I spent 18 years in Vietnam and moved back to London 6 years ago. I'm interested in where there are inequitable challenges of health, which I can see getting worse than better, and I think science as part of society can make a difference, and all of that is true in Nepal.You were with Oxford University collaborating with Patan Hospital.Most of my work was based on typhoid in Vietnam and Dr Buddha Basnyat of Patan Hospital quite rightly termed South Asia as the ‘capital of typhoid’. The burden of typhoid in this part of the world is massive. So in 2004 I came here and started a partnership that has been ongoing for the last 15 years. It started with typhoid, but now it has branched out to include other infections particularly important in Nepal.Since you started coming to Nepal how has the health situation here changed?In some ways Nepal is a microcosm of all of the changes that are happening in low and low-middle-income countries. <a href="http://archive.nepalitimes.com/news.php?id=12158#.Xa_yEZIzbIU" target="_blank" rel="noopener">Nepal is still struggling with the burden of infectious diseases </a>but it is now also having to deal with the double whammy of infectious diseases that have not disappeared and the increasing burden posed by non-communicable diseases. The real problem for countries such as Nepal is dealing with both at the same time, and those require quite different public health measures, and require governments to make informed, evidence-based policy decisions.Read also:  <a href="http://archive.nepalitimes.com/news.php?id=17306#.Xa_yFZIzbIU" target="_blank" rel="noopener">Myadhe joro aka typhoid fever</a>, Buddha Basnyat<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108141156/636a60b19c7e80680e056e92jpeg.jpg" alt="" width="1500" height="1000"/><figcaption>Photo: Sonia Awale</figcaption></figure>We just suffered an unprecedented dengue epidemic in Kathmandu.  Dengue is the infectious disease of the 21st century because it is driven by all of the changes we are going to see: environment change, climate change, urbanisation, travel and movement of people and therefore vectors. <a href="https://www.nepalitimes.com/banner/mosquitoes-move-up-mountains-as-the-earth-warms/" target="_blank" rel="noopener">Cities like Kathmandu are perfect breeding grounds</a> for the Aedes mosquito. Kathmandu's climate is changing, the city is growing exponentially in a haphazard way and the mosquito loves highly dense populations of people. If you put together environmental and climate change and the mosquitoes gradually spreading further north from India into the Tarai and increasingly into Nepal, it's inevitable that Kathmandu and the lower lands of Nepal will suffer from dengue outbreaks.Read also: <a href="https://www.nepalitimes.com/here-now/climate-health-emergency/" target="_blank" rel="noopener">Climate-health emergency,</a> Sonia AwaleOn top of these, we still have TB and leprosy.In my professional career of 35 years I have never been more optimistic about <a href="https://www.nepalitimes.com/banner/nepal-tb-cases-grossly-underestimated/" target="_blank" rel="noopener">tuberculosis</a>. If you take the big three infectious diseases of the world (TB, HIV, malaria), in 30 years HIV has gone from being a death sentence in a few week after diagnosis to a difficult disease but one you can manage long term. In the last 20 years there has been amazing progress in malaria with insecticide-laced bed nets and the Chinese herbal drug called Artimisinin, the most important malaria drug ever invented.TB has not made that much progress. We are still using a diagnostic test invented in the 19th century. There has been no new tuberculosis drug since the last 40 years. We have not really understood how it transfers from one person to another. But that is being transformed. With the coming of a new pipeline of drugs that are now being used in South Asia and sub-Saharan Africa, the treatment period will shorten, making it much easier. But perhaps more important than that, for the first time there is the possibility of a tuberculosis vaccine that will prevent infection and disease. We have to make sure that it gets developed properly, then manufactured and made accessible in an equitable way at a price that is affordable for everybody.Read also: <a href="https://www.nepalitimes.com/banner/tb/" target="_blank" rel="noopener">TB</a>, Sonia Awale<a style="background-color: #ffffff; font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/banner/for-nepal-a-game-changer-in-tb-control/" target="_blank" rel="noopener">For Nepal, a game-changer in TB control</a>, Buddha Basnyat and Maxine CawsWellcome Trust is also involved with snakebite research. What are the real problems tackling this?Snakebite is the biggest disease nobody has heard of. It affects mostly impoverished people in rural communities who have no political voice. <a href="https://www.nepalitimes.com/here-now/snakebite-is-treatable-no-one-need-die-from-it/" target="_blank" rel="noopener">Snakebite treatment</a> is still using 19th century or early 20th century interventions, which are expensive to produce, difficult to access and not available to those who really need them. If people are bitten in low or low-middle income countries, chances are they will never get treated. We are interested in bringing in technologies that have been used in cancer and infectious diseases to produce a treatment that counteracts the snake venom.Read also: <a href="https://www.nepalitimes.com/banner/hisss/" target="_blank" rel="noopener">Hiss</a>, Sonia AwaleIs mental health an area you are working on?In addition to funding discovery science, we have a small number of focused areas, where there has been little progress in the past. Mental health is the next one we are launching. Mental health has not attracted much investment or young people interested in working on it, and it's often placed into different parts of the health system with separate hospitals. Mental health still caries enormous stigma everywhere in the world. So we've not had the investment in science, public health and in clinical care of people, and we haven't had the advances in prevention and treatment. This is not only a health issue but also of social justice and economy. Working in collaboration with various partners we are trying to transform mental health from being an issue of stigma and no progress to one that people are willing to talk about, that becomes a normal part of society and where we make scientific and health progress that will reduce the burden of this massive problem.

“Nepal is a microcosm of all of the changes in world health”

Earlier this month, Nepal received Rs1.6 billion from the World Bank as part of its <a href="https://nepalitimes.com/news/will-nepal-ever-be-paid-for-saving-trees">Forest Carbon Partnership Facility (FCPF)</a>, rewarding the country for increasing its carbon sink capacity. Nepal is the first in South Asia to benefit from this facility, and it is specifically to recompense the country for increasing forest cover in 13 Tarai districts between 2018-2024. “We are also trying to get another Rs13 billion from the facility while also preparing for free market-based carbon trading in the international market,” says Nabaraj Pudasaini of the REDD (Reducing Emissions from Deforestation and Forest Degradation in Developing Countries) Implementation Centre. Big emitters of greenhouse gases are under pressure to reduce their carbon emissions, and many have signed agreements to do so by investing in decarbonisation projects in developing countries. Countries that emit more than a specified amount of carbon would be able to buy emission rights from countries that emit less. Nepal is internationally known for its community forestry program which has been largely credited for <a href="https://nepalitimes.com/banner/tree-mendous">increasing tree cover to over 45%</a> in less than three decades. But this achievement had not been adequately recognised or rewarded internationally before. Forests, especially in the tropics, absorb and store large amounts of carbon while releasing oxygen in a process known as photosynthesis. <a href="https://www.fao.org/forest-resources-assessment/en/">Preventing deforestation</a> and increasing canopy cover is considered a much more achievable goal than reducing emission in the scale necessary to limit global average temperature to 1.5°C above pre-industrial levels. COP11 in Montreal in 2005 first proposed reducing carbon emissions by improving forest quality by halting degradation. By 2015, a new mechanism of financial assistance was created to help less developed countries with sustainable management of forests <a href="https://www.un-redd.org/">(called REDD+)</a>. Under this new mechanism, countries receive aid based on their efforts to prevent forest degradation and increase carbon sink, and in 2021 the World Bank was entrusted with implementing it. Nepal’s FCPF receipt this month was calculated on the basis of 2.4 million tons of carbon stored at a rate of $5 per ton. In the second phase, Nepal will receive more than Rs4 billion within the next year for storing an additional 7 million tons of carbon. Eighty per cent of this amount obtained from carbon trading needs to be spent on local beneficiaries and indigenous communities.&nbsp; But carbon trading is not easy, Nepal needs to prove that protected forests will not be destroyed in future.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241121091132_c8a381c9a95aa86fec558951650d97bb87914741f01766982ba2b086af001f16.jpg" data-media-id="editor_4" data-image-id="20241121091132_c8a381c9a95aa86fec558951650d97bb87914741f01766982ba2b086af001f16" data-rendition-name="original" width="1500" height="999" loading="lazy" alt="Greenbacks for greenery NT "> <figcaption>Photo: KUNDA DIXIT</figcaption> </figure>  Explains carbon trading expert Yugan Manandhar. “Forests should be handed over to the community and shown that they are managed sustainably. Proving this will be particularly challenging; forest encroachment and degradation is rife in the Tarai.” <a href="https://nepalitimes.com/multimedia/nepal-is-going-up-in-smoke">Deliberate forest fires</a> have also added to the challenge because they increase carbon emissions and reduce the sink capacity of forests. The basis for the amount that Nepal received was set five years ago by calculating the carbon reserves of forests in the 13 Tarai districts. In the meantime, sustainable forest management, tree plantation, forest destruction and erosion control were prioritised to increase carbon reserves in those forests. Nepal is signing another carbon trading agreement during the ongoing Baku climate conference. The <a href="https://www.leafcoalition.org/">Lowering Emissions by Accelerating Forest finance (LEAF Coalition) </a>proposes to sell the carbon stored in the forests of Bagmati, Gandaki and Lumbini provinces. For this, Nepal signed the letter of intent three years ago at COP26 in Glasgow. The target is to store 70 million tons of carbon in 32 million hectares of forest in the three provinces per which Nepal will receive Rs13 billion in four years at $10 per ton with provisions to increase the rate if various conditions are met. However, the agreement in itself doesn’t guarantee the amount. According to the targets set by Nepal, forest degradation should be stopped and carbon reserves increased by protecting tree cover. Preparations are also underway for clean air carbon trade because it has offset fossil fuel use by introducing 30,000 electric vehicles. Nepal has been selected for the first round to receive $40 million within one and a half years through the Clean Air System of the World Bank. Given that most of Nepal’s energy mix is from biomass, replacing them with electric stoves can significantly improve health by reducing indoor pollution as well as strengthen the country’s capacity for carbon trade. “Nepal's goal now is to sell carbon in the free market where carbon credits are bought and sold based on supply and demand in an open and transparent manner,” adds Pudasaini of the REDD Implementation Centre. “Nepal can now set its own price and bargain with interested buyer countries and organisations.” Lately, India has been discussing setting up a carbon market. Nepal has exported Rs12.72 billion worth of electricity to India so far this fiscal year, which can be traded under Nepal’s carbon market. “Carbon trading can create significant economic benefits for Nepal, which will help reinvest in development and environmental protection projects,” says Manandhar. “But we must prioritise sustainable management of forests, cutting older trees and allowing regrowth as well as promoting electric stoves and electric vehicles.”

Greenbacks for greenery

Khukri Rum is <a href="http://archive.nepalitimes.com/news.php?id=3719#.WurBk6SFPIU">one of Nepal’s most iconic brands</a>, and is now launching a new Cask Series premium product to sell in Nepal and abroad. The Cask Series Smoked Finish Khukri Rum is a limited edition with only about 7,000 bottles, most of it for export and rest to be sold to rum connoisseurs in Nepal itself. Each bottle is numbered and will mention the cask from which it is derived. “We are working on taking a classic Nepali rum to a new luxury premium brand category, the Cask Series will only be produced this year with new product ranges in future,” explains Subash Lamichhane, managing director of Nepal Distilleries that first started making Khukri rum in 1959 in Balaju and has never stopped. Fermented from molasses in Bara district in the Tarai after the annual sugarcane harvest, the rum is matured for at least eight months during distillation. The distillery bottles the classic Khukri XXX, Coronation Khukri XXX, Khukri White Rum and Khukri Spiced Rum.&nbsp; The distillery is now adding this limited edition of its ‘Cask Series’. While the original rum is stored in huge wooden vats, the rum used for this more exclusive line is in smaller casks made either from oak or sal, with charred insides to give the rum a smoky flavour. The Cask Series rum is indeed smokier than the classic, while the spiced rum tastes toasty and mostly of cardamom. The company has a tasting suite with a master blender and tasters who have to approve the palate test.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241122131124_10b8ddca93b37b0348bf964b4f09e7fac6ef4e754cca6231368850539cd558e2.jpg" data-media-id="editor_1" data-image-id="20241122131124_10b8ddca93b37b0348bf964b4f09e7fac6ef4e754cca6231368850539cd558e2" data-rendition-name="original" width="1498" height="1000" loading="lazy" alt="Khukri Rum"> </figure>  The packaging for the Cask Series is as special as the process. A sturdy patterned box that opens up to a black glass bottle with gold lettering, and an indication of which cask the rum is from. These are then shipped to premium customers around the world One of the reasons this is the more expensive premium line is because the casks are smaller than the vats and the blenders reject more than half of the rum in the casks when the aging period is complete. The trick for the blender is also to decide when to take the run out of the cask.&nbsp; Says Lamichhane: “If we have 25 casks, we expect to throw away about fifteen.”Over the decades, Nepal Distilleries have created and maintained a brand that feels quintessentially Nepali, and has served as Nepal’s ‘ambassador’ with exports to Germany, Korea, Belgium, Finland, the Czech Republic, besides the existing markets among Nepalis in the US, UK, Hong Kong and Australia. &nbsp;Its unique <a href="https://nepalitimes.com/here-now/khukri-rum-sharpens-its-act">khukri shaped bottle</a> first introduced for King Birendra’s coronation in 1975 has been a collector’s item. The bottle and rum have been a staple for Nepalis and visitors to take as gifts when they leave the country, and is used as decoration on bar tables around the world. Now, nearly 40 years later, even that bottle will soon be getting a makeover with a sharper design and sleeker handle. “Our bottle design has always been instantly recognisable, and it is,” says Lamichhane. The Himalayan restaurant at The Hague, for example, has a Khukri Coronation bottle adorning its bar (page 6-7). In Washington DC Himalayan Heritage Restaurant &amp; Bar offers ‘Nepalese Khukri Rum’ mojito in its drinks menu with fresh mint, soda water, lime juice and sugar syrup, for $12.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241122131124_b9474db3fc83c85845348dddc30c49652ee1f17229531867fa241de50849cedc.jpg" data-media-id="editor_3" data-image-id="20241122131124_b9474db3fc83c85845348dddc30c49652ee1f17229531867fa241de50849cedc" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Khukri Rum NT"> <figcaption>Christopher Armes, master blender of the Cask Series.</figcaption> </figure>  A distinct element of the award-winning <a href="https://nepalitimes.com/business/khukri-rum-gets-award">classic Khukri rum</a> is its burgundy colour from caramel sourced from cooking sugar and blended with the raw rum. The spirits are then stored in a warehouse with floor-to-ceiling vats. The vats are not just for storage, the wood in the vats imparts flavour into the rum, and removes a lot of the harshness. &nbsp; On a visit this week, the bottling room was just about to begin for the day and the production line was churning out different shapes and sizes of Khukri Rum bottles. Most of the process is automated, including screwing bottle caps, sticking labels, placing the government seal, and packaging. The only manual intervention is the quality control where bottles are held against the light to check for sediment and colour. A mural on the wall of the distillery in Balaju depicts the rum-making process. A lady slings sugarcane on her shoulder, the molasses is churned in a pot, water is channelled into the distillation process, cinnamon, cloves and cardamom are added to a container, and finally there is a bottle of the classic Khukri Rum against a Kathmandu backdrop.

Khukri goes premium with new rum

Turkish Airlines has introduced a new amenity kit collection designed in collaboration with French fashion house Lanvin for international business class passengers on flights more than five hours. It consists of five pieces designed for sustainability and elegance. Bags are reusable and will consist of Lanvin cosmetic products like hand and body lotions and lip balm. Eye masks and socks are made from recycled materials, earplugs are packaged in paper and the toothbrush is bamboo.

Turkish amenity kit

Nepal now generates a surplus of electricity and it is all from renewable hydropower. Nearly half the country is under forest cover. Despite meeting these decarbonisation goals, Nepal’s hydropower plants are threatened by increased risk due to climate impact.&nbsp; Till <a href="https://nepalitimes.com/editorial/when-it-rains-it-pours-ksqprbu3">28 September</a>, Nepal was <a href="https://nepalitimes.com/news/india-nepal-sign-power-exchange-deal">exporting just over 1,000MW</a> of electricity to power-hungry India, when flash floods and landslides unleashed by historically heavy rains damaged over 30 hydropower plants across the country, temporarily <a href="https://nepalitimes.com/news/power-to-the-people">slashing nearly half the power generation.</a> The 456MW Upper Tamakosi in Dolakha was the hardest hit and it will take six months and Rs2 billion to repair. This has significantly reduced exports as well as domestic generation. Two months later, Nepal has still not been unable to fully keep its export commitment, and is actually paying Rs100 million in fines to India. Thirty-seven existing and under construction projects under the Independent Power Producers' Association Nepal (IPPAN) suffered Rs2.5 billion in damage. One of them is the 22MW Bagmati project in Makwanpur which was almost completely buried in flood debris. Even before <a href="https://nepalitimes.com/news/60-dead-64-missing-in-nepal-floods">record-breaking rain in September</a>, 15 other hydropower projects had been damaged by floods. Last year, floods caused by heavy localised rain damaged 28 hydropower plants. World governments met in Baku for COP29 to discuss the Loss &amp; Damage Fund and the Adaptation Fund, but for countries like Nepal the commas and brackets are meaningless until they are turned into $ and €. And likelihood of adequate compensation for climate-related damage is a long way off, if ever. Nepal’s national strategy is to use its vast hydropower resource as clean energy to spur economic growth, job creation, and boost export revenue. But the plants are located in narrow Himalayan valleys prone to landslides and floods even at the best of times. Now, those <a href="https://nepalitimes.com/opinion/comment/changing-climate-for-investment-in-nepal">risks have been heightened by weather extremes</a> due to climate breakdown. At present, Nepal generates over 3,300MW of clean hydropower, and the target is to reach 12,700MW in the next five years. Projects equivalent to 6,000MW are under construction or ready to start. The Ministry of Energy, Water Resources and Irrigation has an Energy Development Roadmap and Action Plan with the target of producing 28,500MW by 2035 by when more than half of it will be exported.&nbsp; “The climate crisis will further change the rainfall patterns making hydropower generation a big question mark in the future,” Manjeet Dhakal in Baku, who is also the Nepali adviser to the LDC Chair at the United Nations Framework Convention on Climate Change (UNFCCC). “We are building hydropower projects on rivers without evaluating risk. This whole process needs to be reviewed and reconsidered.” The report of the National Adaptation Plan published by the Ministry of Forest and Environment last year mentions that hydropower production, transmission and distribution will be at risk from flash floods, debris flows, glacial lake outbursts and rising temperatures.&nbsp; This risk is not confined to Nepal. Average global temperatures have increased by 1.3°C compared to the pre-industrial era. Worse, the Himalayan mountains are warming faster than the global average by 0.7°C because of elevation-dependent warming. A study conducted by our own Department of Hydrology and Meteorology in 2017 showed that the average temperature in Nepal has increased in the last four decades. Scientists say this is leading to extreme weather unleashing floods and landslides on slopes already destabilized by seismicity.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241124071128_d22901a360e8958f606d80ffa21defba05a671f65afec65539dc21a6885d8345.jpg" data-media-id="editor_5" data-image-id="20241124071128_d22901a360e8958f606d80ffa21defba05a671f65afec65539dc21a6885d8345" data-rendition-name="original" width="1333" height="1000" loading="lazy" alt="Right climate for Nepal’s energy transition NT"> <figcaption>BIBLICAL RAIN: Photo taken during catastrophic rain on 27-28 September at the Upper Tamakosi project site that destroyed the control room, killing four staff and burying the sedimentation tanks. Photo: RSS</figcaption> </figure>  Increased atmospheric temperatures has made the monsoon rains more erratic. It does not rain when it is supposed to, and it comes down in torrents when it is not supposed to. The September floods happened two weeks after the monsoon was supposed to retreat from central Nepal. Kathmandu Valley received half its annual precipitation in just over a day. &nbsp; Winter precipitation has also failed, especially in the high mountains and trans-Himalayan valleys. Thirteen of the past 19 years experienced winter drought. This impacts on dry season flows of the rivers, reducing hydropower generation. Nepal’s power capacity normally goes down by one-fourth during winter, but the gap is widening. The Kabeli corridor could only generate 20MW November-March even though plants there have an installed capacity of 200MW. Similarly, Upper Tamakosi only produced 65MW at most against its 456MW capacity last winter. The Nepal Electricity Authority (NEA) pays producers double the price for winter electricity, Rs8.40 per unit. Even though winter operation is highly profitable the rivers run low and NEA has to import from India to meet the winter demand. “This is not just a weather problem but a serious challenge also for the country's energy future, good climate-friendly design should be combined with policy and effective implementation,” says Subarna Das Shrestha, a hydropower investor and CEO of Sanima Mai Hydropower. “Insurance premiums have gone up as well, and settlement for damage is not timely.” <a href="https://nepalitimes.com/opinion/climate-risk-to-hydropower-investment">Hydropower investment</a> at one time was regarded as having a high rate of return. Now, some investors have become <a href="https://nepalitimes.com/banner/climate-smarter-himalayan-infrastructure">wary of the risks involved</a>. Says IPPAN’s Uttam Blon Lama: “Hydropower projects expected to give stable returns are now looking risky. Not only is climate adaptation design and planning expensive, but future repair and maintenance costs will also skyrocket.” Nepal has only one storage type dam <a href="https://nepalitimes.com/multimedia/rivers-be-dammed">in Kulekhani</a> and another one is being built in <a href="https://nepalitimes.com/multimedia/missing-pieces-of-the-hydropower-jigsaw">Tanahu</a>, but they are also at risk. In September, the sluice gates of Kulekhani Dam had to be opened causing loss of life and destruction downstream. Nepal has to learn lessons from the deadly collapse of the $1 billion <a href="https://nepalitimes.com/news/sikkim-flood-is-warning-to-nepal">Chungthang Dam in Sikkim</a> in October 2023 cause by a glacial lake burst. Glacial Lake Outburst Floods (GLOFs) in Nepal pose potentially catastrophic risk to infrastructure. The <a href="https://nepalitimes.com/here-now/lives-on-the-line-in-the-himalaya">Thame flood in August</a> was a relatively minor debris flow that damaged half of this village in the Everest region when <a href="https://nepalitimes.com/news/climate-breakdown-linked-to-thame-flood">two glacial lakes at 4,760m burst</a>. Luckily there was no loss of life. Of the <a href="https://nepalitimes.com/here-now/lives-on-the-line-in-the-himalaya">47 high-risk glacial lakes</a> in the eastern Nepal Himalaya, 21 are in Nepal and the rest are in rivers in China that are tributaries of the Arun and Bhote Kosi where Nepal has major hydropower plants under construction, or planned.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241123021128_b596cd8520c57a6c5476031e7a3ea6510f26b464c4d5351d2bc10f6f7d6b70d8.jpg" data-media-id="editor_14" data-image-id="20241123021128_b596cd8520c57a6c5476031e7a3ea6510f26b464c4d5351d2bc10f6f7d6b70d8" data-rendition-name="original" width="871" height="648" loading="lazy" alt="Page 10-11 map #1236 NT"> </figure>  Global temperature rise is accelerating the melting of Himalayan snow and ice, increasing the <a href="https://nepalitimes.com/here-now/living-below-nepal-s-melting-mountains">number and size of glacial lakes</a> so that we do not even have names for them. Imja Tso did not even exist in the old trekking maps until 25 years ago, but is now a 2km long lake. “Natural moraine dams in the mountains are weak, and the projects downstream can face major destruction if they burst, and the risk will only increase in future,” warns climatologist Arun Bhakta Shrestha at the <a href="https://www.icimod.org/">International Centre for Integrated Mountain Development (ICIMOD)</a>. <a href="https://nepalitimes.com/here-now/terrifying-assessment-of-a-himalayan-melting">An ICIMOD assessment in 2019</a> projected that if present heating trends continue, as they probably will, the Himalaya will lose two-thirds of our glaciers by the end of this century. “Generally speaking, hydropower developers hand over the project to the government after 30 years but by that time given the climate risks, they may not be an asset anymore,” says Manjeet Dhakal. Indeed, the cascade of expensive projects India is building on the Arun River are supposed to be handed back to Nepal in 25 years, but there is a big ‘if’ about whether they will survive that long. &nbsp;&nbsp; Planning of hydropower projects is still based on historical hydrological data, and does not take into account future temperature rise and its consequences. Investors, on the other hand, say that planning hydropower projects with climate components would make them even more expensive.&nbsp; “It’s not that we aren’t preparing for climate risk, we design keeping in mind the once-in-100-year flood,” says Blon of IPPAN. “But if we start designing based on once in 1,000 years flood, the cost would be so high that we won’t be able to build them at all.” Nonetheless, Subarna Das Shrestha of Sanima Mai Hydropower says that there is no option but to go for climate smart infrastructure despite the higher cost. Sanima Mai's powerhouse, for example, is completely underground. The strategy could also be to spread the risk by building less expensive plants located on rivers all over the country. Nepal is also diversifying away from its sole reliance on hydroelectricity, which at present supplies 92% of the power in the grid. Most of the rest comes from solar plants, where the total potential has not even been scratched. &nbsp; 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_21" data-image-id="20240630110640_30c3782f9c09219bf1c249b51483a3cfb7a53a06d117d2aebd23ca7080d12758" data-rendition-name="original" width="680" height="103" loading="lazy" alt="SDG logo"> </figure>  &nbsp;