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

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Ke garne attitude kills people

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”

https://www.youtube.com/watch?v=kJLBI7sim0M&amp;feature=youtu.beA revolutionary treatment for open wounds has dramatically reduced the healing period of <a href="http://archive.nepalitimes.com/news.php?id=711#.XSckw-szaUk" target="_blank" rel="noopener">leprosy patients in Nepal</a>, saving them money and prolonged pain. The new procedure has huge implications internationally, as it reduces the medical cost for treating patients with chronic open wounds.The technique, called Leukocyte Platelet Rich Fibrin (LPRF), was <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6089057/" target="_blank" rel="noopener">devised for dental surgery</a> by Nelson Pinto of Chile and has proven to accelerate the healing of tissue. Now, it is also being used to treat hard-to-heal skin lesions of <a href="https://archive.nepalitimes.com/article/nation/diabetes-in-south-asia,3018" target="_blank" rel="noopener">diabetes</a> and leprosy patients.“LPRF has shown miraculous results in the treatment of chronic wounds in Nepal,” says dental surgeon Sushil Koirala who is pushing the new treatment in government hospitals. “It does not need special equipment, is cheap and, so simple even paramedics and nurses can perform it.”<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108131140/636a4f009c7e80680e04fce5jpeg.jpg" alt="" width="1400" height="1050"/><figcaption>SECOND CHANCE: Surgeon Indra Bahadur Napit guides a paramedic during a session of LPRF on a patient with leprosy at Anandaban Hospital. Pic: KUNDA DIXIT</figcaption></figure>There are three specialised leprosy hospitals in Nepal: Ananadaban in Lele, Green Pastures in Pokhara, and Lalgadh in Dhanusa. Anandaban Leprosy Hospital 16 km south of Kathmandu has been trying out LPRF on patients with excellent results.Leprosy is a biblical disease in which bacteria called Mycobacterium leprae damages the patient’s nerves and causes the fingers, toes and limbs to go numb, leading to further injuries. Leprosy is treated with antibiotics, but some patients suffer antigen reaction and need long-term rehabilitation.One of the patients at Anandaban is Phelit Sahi, who was ostracised by her community in Jumla because she had leprosy and had been living in a cave for 25 years. Reporters who had gone to cover a local event in a helicopter found out about her, and flew her to Kathmandu for treatment.Every week, doctors draw 80cc of blood from her and place it in a special centrifuge for 12 minutes. The clear plasma separates from the red corpuscles and is compressed to form a high-density fibrin clot which is applied to her wound.“She is among more than 100 patients that we have treated with LPRF, and we have gained enough experience in this technique to lead the way for the world,” says surgeon Indra Bahadur Napit at Anandaban, who presented his results at WHO in Geneva.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108131140/636a4f039c7e80680e04fce6jpeg.jpg" alt="" width="1400" height="933"><figcaption> </figcaption></figure>Raju Lama was 27 when he was diagnosed with leprosy, but because of late diagnosis, his fingers and toes were deformed, and he had to abandon his job. Doctors recommended amputating his right leg, but became the first patient to get LPRF treatment. He is happy with his “ragat upachar” (blood treatment) and says after several LPRF procedures his wounds are healing much faster.Ram Kumari Sah and her husband from Janakpur have been living with leprosy for decades. She does not feel pain in her hands and legs and often hurts herself. Her lesions become infected and never healed. This week, she was waiting for her turn at the LPRF ward in Anandaban.The hospital’s LPRF pilot study has shown that 97% of the cases healed completely within seven weeks. The results are so encouraging that news of this revolutionary treatment has spread through word of mouth. A dozen patients, currently at Anandaban were referred by hospitals in India. A team of Nepali doctors is also training doctors in Burma, Bangladesh and Nigeria.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108131140/636a4f069c7e80680e04fce7jpeg.jpg" alt="" width="1400" height="1003"><figcaption> </figcaption></figure>The new treatment is expected to add to Nepal’s success in reducing the prevalence of leprosy from 21 cases per 10,000 in the 1980s to less than 1 today. Nepal was officially declared leprosy-free in 2010 when the prevalence rate came down to 0.79%.However, in recent years, the prevalence rate is creeping up again, and was 0.94% in 2018. More than 3,000 new patients are diagnosed with leprosy every year, with most of the cases found in Province 2. Experts say this could be a result of active case finding and may not mean that the prevalence is increasing.Leprosy is curable with multidrug therapy but many do not get treatment on time. The incubation period is five years on average and symptoms may occur within a year, but can also take as long as 30 years to become visible, making the disease difficult to diagnose, and the delay leads to nerve damage and deformities. Leprosy is transmitted through the air during close and frequent contact with untreated cases.“Leprosy can afflict anyone but there is a correlation between the disease and poverty,” explains dermatologist Mahesh Shah. “If one’s immune system is strong, the bugs do not do any damage. But poor hygiene and nutrition increases susceptibiltity. Neglected people from neglected countries suffer from leprosy the most.”<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108131140/636a4f0a9c7e80680e04fce8jpeg.jpg" alt="" width="1400" height="1169"><figcaption> </figcaption></figure>Up to 40% of patients undergoing multidrug treatment develop a reaction, and need long-term hospitalisation. Since the patients are poor, most private hospitals are not interested in treating them. At Anandaban, treatment is free as it is supported by government grants and charities.Since 1% of cases suffer from relapse in Nepal, active door-to-door case finding is important to meet the WHO target of zero leprosy transmission by 2030.Even more daunting is to counter societal stigma and ostracisation of leprosy patients. Family members regard the disease as punishment from the gods, and even some medical interns and nurses refuse to touch patients despite patients being on antibiotics and unable to spread the disease. Nepal’s laws still allow husbands to divorce their wives if they have leprosy.“It is a complicated disease made even more so by stigma and ignorance,” says Napit, “but with LPRF, we now have a powerful weapon in our arsenal. A vaccine would be the final solution, but no one cares about leprosy. All the funding goes for diseases like HIV.”   <h2>Miraculous healing</h2>When Nelson Pinto’s favourite horse broke its leg, he had two options: either put it down or amputate its leg. The Chilean dentist decided on a third option.He drew some blood from the horse, spun it in a centrifuge to separate the autologous fibrin matrix which is rich in platelets, and applied the plasma to the horse’s wound. After a few weeks, the horse was cantering again.Pinto knew about the technique because Leukocyte Platelet Rich Fibrin (LPRF) was developed for dental implant treatment. The surgeon was so convinced that the new process would be useful in treating chronic open wounds that he embarked on a global crusade to spread its use.Pinto convinced fellow-dentist from Nepal, Sushil Koirala, whom he met at an international conference, to adopt the technique. Since then, Koirala has been trying to convince the government and private hospitals to adopt the procedure, but without much success. However, Anandaban Leprosy Hospital in Lalitpur has seen phenomenal improvements in the healing time of lesions among its patients. (See adjoining report above)LPRF is now used to treat diabetic wounds, lesions caused by leprosy, localised <a href="http://archive.nepalitimes.com/article/nation/burning-in-the-aftermath,3757" target="_blank" rel="noopener">burns</a> and surgical wounds, and with this, healing time is often cut in half. It is also being used in cosmetic surgery to remove wrinkles and rejuvenate the skin. The reason why it is so effective, Pinto explained during a trip to Nepal last month, is because it is completely natural and autologous, which means a patient is not receiving any foreign tissues or chemicals.And the treatment is cheap. A similar treatment used in Europe, which involves a kit manufactured by a multinational pharmaceutical company, costs $3,000 per patient. LPRF costs only $30. But it seems as though private hospitals are not interested in this treatment as patients heal so quickly. Many doctors are also not enthusiastic because LPRF can be administered by a paramedic or a nurse.Says Sushil Koirala: “The reason they don’t like it is because there is no money in it. LPRF only uses the patient’s blood and there are no chemicals or equipment involved for multinational companies to make money out of.”Koirala’s Punyaarjan Foundation has donated centrifuge machines to a few hospitals in Nepal including the Sushma Koirala Memorial in Sankhu, Anandaban Leprosy Hospital, Bir Hospital in Kathmandu and to three hospitals in Burma with varying degrees of acceptance.The Bible relates how Jesus Christ miraculously and instantaneously cured ten lepers at the gates of Jerusalem. LPRF may not cure leprosy lesions as quickly, but the procedure is nearly as miraculous.<h2>Life after leprosy</h2><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108131140/636a4f0d9c7e80680e04fce9jpeg.jpg" alt="" width="1400" height="1050"><figcaption> </figcaption></figure>Kumar Tamang, 47, is putting the final touches on his painting of an elephant with a bejewelled crown and a howdah. He dips his paintbrush on a palate and paints the border bright red. His fingers are numb and deformed by leprosy, yet he has been painting for 25 years. His love for Mithila art is on full display on the walls, pillars and ceiling of Shanti Sewa Griha, a leprosy clinic set up by the German charity, Leprahilfe, in 1992.Nearby, in a dark corner, is 50-year-old Nathuni Barai from Nawalparasi, who also has deformed fingers which he uses deftly to draw intricate patterns on a letter pad. Both Tamang and Barai are former patients at <a href="http://archive.nepalitimes.com/news.php?id=15213#.XSckyeszaUk" target="_blank" rel="noopener">Shanti Sewa Griha,</a> making a livelihood from products that Leprahilfe buys from fundraising. Their families live nearby, and their children attend a school set up by the charity.Now, nearly three decades after the clinic was set up, Shanti Sewa Griha runs a school and orphanage in Budhanilkantha, an organic farm in Sundarijal and a rehabilitation centre near Pashupati.As the number of patients grew, they were trained in painting, tailoring, quilt making, carpentry and jewellery making as a form of livelihood. Bags, uniforms, paintings, stationery and decorative items are sold as souvenirs to raise money for the upkeep of the shelters and to pay former patients.“This is a form of operational therapy which tries to break the vicious circle this disease has formed,” said Marianne Grosspietsch, one of the founders of Leprahilfe. “Our goal is to create hope in Nepal.”In 1974, Grosspietsch adopted a young boy named Puskar Limbu who had leprosy like the rest of his family. She took the boy to her home in Germany, treated his leprosy and sent him to school. Limbu went on to pursue a successful career in graphic design in Germany and is a grandfather himself today.Children of former leprosy patients have also gone on to become nurses and doctors.Kalpana Pariyar (pictured above) was 14 when she was diagnosed with leprosy before there was serious nerve damage to her fingers. She grew up in the shelter and married fellow-patient Krishna Majhi, whom she took care of until he died eight years ago. She now has a college going daughter and an eight-year-old son.“I have spent my entire life here. This is my home, this is where I made my life and found peace,” says Pariyar, looking up from her sewing machine on which she was weaving dhaka fabric.Sonia Awale

Sonia Awale

New treatment offers hope for Nepal’s leprosy patients

https://www.youtube.com/watch?v=Xf4OpwoblRc&amp;feature=youtu.beProblem: Some 70% of Nepalis are carriers of the tuberculosis bacillus and many of them have full-blown versions of the disease. Although diagnosis and treatment is available, the sick cannot travel to hospitals. How to test the sputum of patients, and deliver antibiotics in remote and road-less parts of Nepal?Solution: By drones.Nepal has been acclaimed for its directly observed treatment short course (DOTS) for treating tuberculosis, which demands a combination of antibiotics that are administered under supervision. However, TB is difficult to diagnose and treat in remote parts of this country.That is why the Britain Nepal Medical Trust (BNMT) is taking a big leap in treating TB with a pilot project in a remote part of Piuthan district in the mountains of central Nepal. Read also: <a href="https://www.nepalitimes.com/banner/tb/" target="_blank" rel="noopener">TB</a>, Sonia Awale<a href="https://www.nepalitimes.com/editorial/tb-or-not-tb/" target="_blank" rel="noopener">TB or not TB</a>, EditorialThe Trust has cleverly recycled the <a href="http://archive.nepalitimes.com/news.php?id=294#.XPkeWBYzaUk" target="_blank" rel="noopener">DOTS</a> acronym to DrOTS, this time to mean Drone Optimised Therapy System, and is running test flights in the district to collect sputum samples and deliver both diagnoses and treatment to patients living in up-country villages.The drone flies to health posts in the mountains, and returns sputum samples to the district hospital in Swargadwari Municipality and the public health centre (PHC) in Piuthan Municipality. The samples are tested using a <a href="http://archive.nepalitimes.com/news.php?id=17747#.XPkeaxYzaUk" target="_blank" rel="noopener">GenExpert kit</a>. If they are positive, patients are given DOTS treatment using smart pill boxes, which keep electronic records of whether or not patients have taken the antibiotics.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110813110/636a44c69c7e80680e04d34djpeg.jpg" alt="" width="1500" height="1125"/><figcaption>Photo: RAMU SAPKOTA</figcaption></figure>“We are using the drones experimentally to ensure that we can reach the hidden cases of tuberculosis, since every untreated patient is a potential carrier of the disease and can spread it,” explains Shraddha Acharya, BNMT coordinator in Piuthan.During the pilot phase, drones will be used only to collect sputum samples from remote settlements. If the tests are successful, the Trust hopes to use the unmanned craft to also deliver medicine.Thanks to the initiative, health personnel will no longer need to walk for days to deliver sputum samples from health centres in the villages to the district hospital and PHC for testing, and then return with medicines for those who test positive. The current system results in delays in getting medicines to patients, and also lack of supervision administering the antibiotics.Read also:<a 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 CawsCommunity Health Worker Sita GC (pictured above) says the drones are god-sent because they can deliver samples in 25 minutes, where earlier it took 2-3 days. “Logistics was a huge problem because of unreliable transport; now it is easy to diagnose and treat quickly,” she adds.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110813110/636a44ca9c7e80680e04d34ejpeg.jpg" alt="" width="640" height="427">Maxine Caws (pictured above) of BNMT, an epidemiologist with the Liverpool School of Tropical Medicine, says the drones are being tested in Piuthan because it is the mountain district in Nepal with the highest TB prevalence. Last year, the district treated 379 patients for tuberculosis, but 335 new cases were detected in the same period.The remote-controlled craft are handled by drone specialist Nepal Flying Lab. “We found this to be an exciting project because the drones are ideal for bridging distances to remote areas and the sputum samples and medicines are not too heavy,” says the lab’s Uttam Pudasaini, who adds this is the first time such deliveries are being tested in Asia.The drones weigh 9kg when empty and can carry another 7kg in a cargo hold designed to protect against biohazards; they can be airborne for 30 minutes. The craft flies at speeds of up to 1km per minute, and is controlled by a pilot at the takeoff point who coordinates with a health worker at the destination. In future, the project plans to train health workers to fly the drones themselves.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110813110/636a44cd9c7e80680e04d34fjpeg.jpg" alt="" width="640" height="427"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110813110/636a44d19c7e80680e04d350jpeg.jpg" alt="" width="640" height="427"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110813110/636a44d49c7e80680e04d351jpeg.jpg" alt="" width="640" height="359">The technology has been used for TB control in Zimbabwe and Papua New Guinea. In Nepal, the pilot project is funded by the Nick Simons Institute till December. “Further extension will be determined by whether it is successful and cost-effective,” says Caws.Sita GC says so far up to 35 positive cases of TB have been detected from sputum samples in Piuthan this month. However, many people refuse to give samples, and others do not follow instructions on taking antibiotics.The ministry of health is also involved in the drone trials. Spokesperson Mahendra Shrestha says that if the tests are successful the government will take over the program and try to replicate it for TB control in other remote areas.“If this project is successful, Piuthan and Nepal will be famous worldwide. But the biggest challenge is to first make the tests work,” says Shrestha.<h2>TB or not TB</h2><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110813110/636a44d79c7e80680e04d352jpeg.jpg" alt="" width="1500" height="1000"><figcaption> </figcaption></figure>There are 10 million new cases of tuberculosis every year, and the medieval disease still takes the lives of 1.5 million people annually worldwide.South Asia accounts for 40% of the global TB burden, with over 4 million cases as well as 40% of total fatalities, a third of them patients who succumbed after they failed to respond to treatment. But worsening air pollution, smoking and alcoholism are big risk factors for TB infection in the region.Some 11 Nepalis die every day from the highly contagious infection.There are 40,000 new cases of TB here every year, and Nepal also has a very high rate of latent TB infection. Despite antibiotics, it is often difficult to reach patients in underserved parts of the country and Nepal’s harsh terrain makes it hard to access diagnosis and treatment on time. Experts say there is huge under-reporting of cases.Nepal is a role model in the community-based DOTS (directly observed treatment short course), with its supervised administration of antibiotics to patients. Yet, experts say much more aggressive <a href="https://www.nepalitimes.com/banner/for-nepal-a-game-changer-in-tb-control/" target="_blank" rel="noopener">case detection and an early treatment system</a> should be in place if the country is to meet the UN target of reducing TB mortality by 95% and cutting new cases by 90%, by 2035.This means developing techniques to reach the poorest in the remotest parts of the country, and also requires increases in Nepal’s TB control budget and prioritising the infection otherwise known as the ‘poor man’s disease’.<a href="https://archive.nepalitimes.com/page/resistance-to-live-saving-drugs-threatens-to-set-back-progress-in-nepal" target="_blank" rel="noopener">MDR (multi-drug resistant) TB</a> is also spreading, as patients develop resistance to commonly used drugs for treatment. The last survey in Nepal showed that among previously treated cases, anti-microbial resistance was found in 15.8% of cases, against the world average of 18%.Nepal also has the added challenge of an open border with India and migrant workers continue to bring infections home, while many patients from India come to this country for treatment.The UN General Assembly held its first-ever, high-level meeting on tuberculosis last year to draw attention and generate investment for TB research, treatment and diagnosis. The SAARC TB Centre located in Kathmandu focuses on prevention and control of tuberculosis and TB/HIV co-infection. Research is also needed for non-resistant drugs with shorter regimen.Sonia Awale

Nepal tests and treats TB with a flying pharmacy

<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110714114/636902cc9c7e80680e037c85jpeg.jpg" alt="" width="640" height="480"/>The 15-year-old boy weighs 54kg, much more than an average Nepali his age. He is malnourished.His breakfast and lunch consist of biscuits, instant noodles and other packaged foods. His uncle buys him <a href="http://archive.nepalitimes.com/article/nation/diabetes-in-south-asia,3018" target="_blank" rel="noopener">fizzy, sugary drinks</a>. The boy does not like home-cooked meals, and when he does they are oily and deep-fried.Read also: <a href="https://www.nepalitimes.com/here-now/nepalis-binge-on-junk-foods-the-west-rejected/" target="_blank" rel="noopener">Nepalis binge on junk foods the West rejected...</a>, Duksangh SherpaWhen he came to me, the boy was already suffering from a sore back, he could not run, and found it difficult to climb the stairs to the third floor.There is a strong chance he will suffer from diabetes and hypertension by the time he is 25. His grandmother is worried about his addiction to sugar-sweetened sodas and packaged foods.While in the US, 15 years ago, I saw many obese adolescents, and remember thinking we had the opposite problem in <a href="http://archive.nepalitimes.com/article/nation/malnutrition-stunting-wasting,3603" target="_blank" rel="noopener">Nepal: under-nourishment</a> and stunting. Not any more, however, because urban Nepal is now seeing an American-style epidemic of malnutrition.It used to be rare to see an overweight child in Nepal’s schools, but today it is a common sight. In a recent informal survey of a school in Sindhupalchok, I found students mostly bring money from home to buy packaged food for lunch. Teachers themselves consumed junk foods for snacks, and had no idea about the lack of nutritional value. They purchased the packets out of convenience.The mothers of the students told me they always believed instant noodles were nutritious. They liked the fact that it was cheap, didn’t need to be cooked, and their children loved it. They were aghast when I showed them pictures of children gaunt with malnourishment. Some mothers asked: if junk food was so bad , then why were there so many celebrity-endorsed TV advertisements? If the government does not care about your health, we have to think of it ourselves, I answered.A three-year-old in Far Western Nepal was dying from malnutrition: not because she had nothing to eat, but because she had been eating the wrong food. Her mother took the child to a health centre, where she admitted her daughter only ate instant noodles and cheese balls. The girl was referred to the Nutrition Rehabilitation Center in Nepalganj, and was nursed back to health.I have an acquaintance who works in one of the instant noodle factories in Nepal, and he says he wouldn’t touch the stuff - he knew what went into it. “I would never eat it, and never give it to my children,” he told me.The junk food industry is all about creating demand through marketing and branding. It equates packaged foods with modernity, affluence, and a trendy lifestyle. What it is really all about is putting them in non-biodegradable single-use plastic into our landfill sites, and robbing our people of their health. Junk food is another symptom showing we are becoming a throw-away society, and if we are not careful we will throw away our children’s futures.Aruna Uprety is a public health specialist and co-author of the book 'Khana Khanu Bhayo'?Read also: <a href="https://www.nepalitimes.com/?p=10606&amp;preview=true" target="_blank" rel="noopener">Could Nepali cuisine go global?</a> Thomas Heaton<a href="http://archive.nepalitimes.com/news.php?id=2409#.W2L-r9UzbIU" target="_blank" rel="noopener">Junk food epidemic</a>, Aruna Uprety<a href="http://archive.nepalitimes.com/regular-columns/GUEST-COLUMN/promoting-nutritious-local-food-for-post-quake-children,524" target="_blank" rel="noopener">Local is best</a>, Aruna Uprety

Living to eat

In 2004, Poet Durga Lal Shrestha asked me to translate 223 little poems from Newa into English. They were each written as sestet-- terse in their form but heavy in imagery and sentiment. The novice translator in me struggled to find the best way to convey his poetry in English-- but the process became a tour as I discovered my mother tongue anew. The highlight, however, was Shrestha’s handwriting. His calligraphy is immaculate. He had given me photocopies from the notebook he had written the poems in and each page looked as though they were freshly out of the press. The letters bore a consistency, unswayed by the emotions of his poetry. Sometimes, I would just stare at the handwriting in admiration.&nbsp; Someone else had been similarly besotted by his writing: “I met him 25 years ago in the UK when he was the chief guest at a Mha Puja event organised by Pasa Pucha,” recollects Ojesh Singh, writer and engineer. “We were roommates. I noticed he couldn’t stop writing.”&nbsp; Shrestha, an octogenarian now, was a teacher at Kanya Mandir School for many years, where his writing was admired by colleagues and students. Known as Janakavi or People’s Poet, a title bestowed on him by the Nepal Bhasha Parishad, Shrestha is also the recipient of the Jagadamba Shree Puraskar for his contribution to literature.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251021071052_b109f2ee6dbac911fb8002e8e8bb33a50a8f755d26662f333535d32c8573e782.jpg" data-media-id="editor_0" data-image-id="20251021071052_b109f2ee6dbac911fb8002e8e8bb33a50a8f755d26662f333535d32c8573e782" data-rendition-name="original" width="1600" height="900" loading="lazy" alt="Digitising the savant calligrapher NT"> <figcaption>From left to right: Suman Shrestha, Ananda Kumar Maharjan, Durga Lal Shrestha, Ojesh Singh, and Arbindra Man Singh. Photo: SUCHITA SHRESTHA</figcaption> </figure>  “He would write on anything he could lay his hands on. On tissue paper, envelopes, cigarette boxes. It struck me how neat and tidy his writing was,” says Singh. “The structure and size were perfectly in sync-- and as an aspiring graphic designer then, I fell in love with his writing. Later, whenever I read his books, I thought it would be nice to read them in his writing.” After sitting with the notion of turning Shrestha’s writing into a digital font for years, in 2024, he reached out to a small group of people who he thought might be allies.&nbsp; “It was during Ojesh Ji’s book launch that we met and talked about the possibility of turning Durga Lal Shrestha’s writing into font,” recalls Ananda Kumar Maharjan, who has designed the Durga Lal Shrestha font and is affiliated with Callijatra, an organisation promoting Newa calligraphy.&nbsp; For Singh, the desire to immortalise the poet's handwriting wasn’t only coming from personal admiration, it was also about preserving the writing of a language and literature leader and activist. He offered to fund the font project, which meant paying for Maharjan’s time and dedication. He also drew into the conversation Shrestha’s son Suman, who has been an integral part of the process.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251021071056_372dc34ac3ce3b70445128131a11ade8f321756c6cc7615825c4451e85f56374.jpg" data-media-id="editor_1" data-image-id="20251021071056_372dc34ac3ce3b70445128131a11ade8f321756c6cc7615825c4451e85f56374" data-rendition-name="original" width="616" height="728" loading="lazy" alt="Digitising the savant calligrapher NT"> </figure>  The others involved in the process were journalist Arbindra Man Singh, who had been scanning Shrestha’s writing for the book Hastakshar, a collection of poems printed in the author’s handwriting. Also an enthusiast of converting Shrestha’s writing to a font, Singh provided help in bringing together the scans, based on which Maharjan picked the best letter for each alphabet to create a complete set.&nbsp; “Doing this was different from other font developments I have done in the past,” explains Maharjan, who has also digitised his own handwriting into a font, called Anand. “To create Durga Lal Shrestha’s writing as font, I had to analyse his writing archive and pick the best.”&nbsp; He adds: “There was a book published in his writing, so there were scans and digital archiving done by Arbindra Ji, which became the foundation for my work.” He had to find a prototype for each alphabet based on the scans. He traced the letters on Illustrator and copied them to a MAC software called Glyphs where he had to enter each letter, using a traditional Devanagari keyboard instead of Unicode.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025102108100_2f6b8c0f3cf91682707ac356e11ad50b342a4198f56490ab68d041e875b15edb.jpg" data-media-id="editor_2" data-image-id="2025102108100_2f6b8c0f3cf91682707ac356e11ad50b342a4198f56490ab68d041e875b15edb" data-rendition-name="original" width="818" height="766" loading="lazy" alt="Digitising the savant calligrapher NT"> </figure>  “I had to be very careful to keep it accurate. Conjunctions need attention,” Maharjan says. “There are half letters, saint letters, ligatures and open type features to pay attention to, this is more advanced than the fonts I’ve created in the past.” &nbsp; Maharjan has designed this font in three different variations that users can play with. “Writing changes with age. While young, people write better, but with age, it starts to change. Since Durga Lal Shrestha hasn’t been very well lately, his hand shakes when he writes. So, we had to pick the best of his writing from the records,” he adds. “People also tend to write in different styles depending on their mood so we took the best four of every letter and traced and picked one.”&nbsp; Handwriting is deeply intimate and in this day and age of tech, becoming lost.&nbsp; What bothers me about the day of phones is that I no longer know what the writing of those close to me look like. I no longer know how you press the pen between our fingers or how you tilt it against the paper or how you pause to write periods or how the nib makes a perfect tiny orb before you drag it just so, to turn it into a comma. The familiarity of the nuances of someone’s writing is lost on us.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251021071056_2c83ab2c3ed4cfa42e6a6a637d88fd879218fb5b7391e086ab5db1a8ec173654.jpg" data-media-id="editor_3" data-image-id="20251021071056_2c83ab2c3ed4cfa42e6a6a637d88fd879218fb5b7391e086ab5db1a8ec173654" data-rendition-name="original" width="992" height="1280" loading="lazy" alt="Digitising the savant calligrapher NT"> </figure>  Ojesh Singh agrees with me. He says it’s important to keep handwriting alive as people become more and more tech-dependent. People are likely to interact even less with letters on paper, but at least we can have fonts, he says.&nbsp; A set of six books by poet Durga Lal Shrestha is set to be launched on 31October. One of them, entitled, Kawa, is typeset in the Durga Lal Shrestha Font. The font will be made available to the general public after the books have been released. In July, I had visited Shrestha, who I also call Durga Lal Taaba, as many Newa people in my generation do. Seated in the quiet of his home, he conversed about literature and language with my father and my uncle. Coming out of Taaba, Newa, which has a utilitarian function for me to communicate with my parents, sounded more like a lyric.&nbsp; I asked him what he thinks about his handwriting being archived as a font. He replied: “This body is going to be gone eventually, so I thought maybe my handwriting could live on.” Suburban Tales is a monthly column in Nepali Times based on real people in Pratibha’s life.

Digitising the savant calligrapher

The winter air pollution season started early this year with emissions, Diwali firecrackers and crop residue burning making the air unbreathable across north India. Much of the pollution was transboundary, with prevailing winds carrying the suspended particulates from Pakistan, across India to Nepal and beyond. All this pollution and domestic emissions killed 41,300 in Nepal in 2023, and 85% of all deaths were because of noncommunicable diseases such as heart and lung disease, lung cancer, diabetes, and dementia, according to the State of Global Air (SoGA) 2025 report released Thursday. With the onset of winter, Kathmandu Valley’s own emissions are trapped in a surface inversion layer and as in previous years will have some of the worst air quality in the world.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251023131016_7c42a4e8b0dce01dfeeaaf89dbb10dbfa036b41163f3ebada88c7ce17dbded49.png" data-media-id="editor_0" data-image-id="20251023131016_7c42a4e8b0dce01dfeeaaf89dbb10dbfa036b41163f3ebada88c7ce17dbded49" data-rendition-name="original" width="921" height="850" loading="lazy" alt="Air pollution killing season starts early NT"> </figure>  The SoGa report says air pollution has now become the leading risk factor for deaths in Nepal, ahead of tobacco and high blood pressure. Interestingly, while the health impacts due to environmental risk factors such as unsafe water and sanitation have reduced significantly since 2000, the opposite is true for ambient PM2.5 (particles smaller than 2.5 microns). Globally, 7.9 million deaths were attributable to air pollution– about 1 in 8 deaths – in 2023. Of this total, 4.9 million deaths were attributable to PM2.5 exposure, 2.8 million were from household air pollution, and 470,000 were from ozone. Similarly, dementia attributable to air pollution resulted in 626,000 deaths and 40 million healthy years of life lost. And 95% of air pollution attributable deaths in adults over the age of 60 are due to noncommunicable diseases. The burden of noncommunicable diseases in relation to air pollution is rising worldwide and in Nepal. The SoGA report shows that nearly nine of ten global air pollution deaths are from chronic ailments, and half of all respiratory disease deaths are attributable to air pollution.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251023131020_8577f464b4a73007de5dd018b8ac91dae3a9c732dbb81a44b6aa5a0ced7df3df.png" data-media-id="editor_1" data-image-id="20251023131020_8577f464b4a73007de5dd018b8ac91dae3a9c732dbb81a44b6aa5a0ced7df3df" data-rendition-name="original" width="1080" height="1080" loading="lazy" alt="Air pollution killing season starts early NT"> </figure>  In Nepal, air pollution is responsible for three out of four COPD deaths, one out of three heart deaths and one out of five diabetes deaths. More than one third of lower respiratory infection deaths were due to air pollution. “The data presented in the State of Global Air report highlight the significant impacts of poor air quality on the health and well-being of billions of people around the world, especially those living in Asia and Africa,” says Pallavi Pant of the Boston-based Health Effects Institute (HEI) that released the report in collaboration with the Institute for Health Metrics and Evaluation and the NCD Alliance. She adds: “Growing momentum on air quality management across those hard-hit locations, including expansion of air quality monitoring, adoption of air quality regulations, and sector-specific interventions are yielding improvements for those most impacted.” Low- and middle-income countries stand to gain most by reducing air pollution, with particularly strong impacts on children, older populations, and people with pre-existing health conditions. Indeed, of the 41,300 air pollution deaths in 2023 in Nepal, 31,600 were in adults over the age of 60 years and 3,500 in children below five years. Death rate for air pollution in Nepal, which is 178 per 100,000, is more than 10 times higher than high-income countries, which is at 17 per 100,000.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251023131020_604e852aed4ffde0dc7d1df72fcd3e73d904136dfb1bb2407e53b7445f3ef72c.png" data-media-id="editor_2" data-image-id="20251023131020_604e852aed4ffde0dc7d1df72fcd3e73d904136dfb1bb2407e53b7445f3ef72c" data-rendition-name="original" width="1078" height="423" loading="lazy" alt="Air pollution killing season starts early NT"> </figure>  “Win-win solutions for air pollution and NCDs exist, with added benefits for climate, physical activity, nutrition, and many other global development priorities,” says Alison Cox, Policy and Advocacy Director at the Geneva-based NCD Alliance. “These policies are effective and deliver a strong return on investment - for the sake of our people and the planet we need to implement them faster.” Fine particle pollution (ambient PM2.5) is the largest driver of air pollution’s burden of disease worldwide as kit attributed to 4.9 million deaths and 124 million healthy years of life lost in 2023. Vehicles, power plants, factories, and homes, as well as agricultural and industrial activities, waste burning and wildfires are some of the biggest sources of pollutants. South Asia is among the regions of the world with the highest exposures to ambient PM2.5 , while more than 36% of people around the world live in areas where PM2.5 levels do not meet even the least stringent interim target. As per the report, 78% of Nepal’s 30 million population lives in areas where annual PM2.5 exposure exceeds the least stringent WHO Air Quality Interim Target of 35 µg/m3. Meanwhile, exposure to household air pollution due to the use of solid fuels for cooking remains an important driver for the disease burden in the country. “Ongoing efforts to meet global development goals are not achievable without directly addressing air pollution,” says Maria Neira, Commissioner of Our Common Air. “Countries and cities must focus their efforts toward reducing air pollution emissions, including household air pollution, which has particularly severe impacts on young children and older people across Asia and Africa.”

Air pollution killing season starts early

Nepal needs to enact and enforce animal law

This year, the <a href="https://nepalitimes.com/opinion/quo-vadis-un-80-9vthn7mg">United Nations is marking its 80th anniversary</a> and it is being celebrated with special events across the world to commemorate its establishment on 24 October 1945. It has also been 75 years since the first UN adviser, the Swiss geologist Toni Hagen, was sent to Nepal to explore development opportunities. In 1950, there were no roads and Hagen walked on foot across the length and breadth of Nepal’s mountains, valleys and plains. This year also marks the 60th anniversary of the United Nations Development Program (UNDP) in Nepal, and much of Hagen’s work laid the basis for the UN’s involvement in education, health, and connectivity in Nepal’s future development. Despite frequent changes in government and political system, Nepal has made remarkable progress. The poverty rate has gone down by half in the past 30 years to 20.27% of the population. Much of it has to do with remittances from Nepalis working overseas, but it is also a result of the Nepal government’s investment in education, health care and social welfare.&nbsp; There have been special initiatives like the Prime Minister’s Employment Program that have provided jobs to nearly 800,000 people in the country’s 743 municipalities — especially in those areas with lower Human Development Index (HDI) like the far-west and the Tarai.&nbsp; This year’s HDI report by UNDP shows that Nepal’s score had risen to 0.622, whereas it was only 0.404 in 1990. In the past 33 years, the average lifespan of Nepalis has risen by 15.6 years to 70.4 years, whereas it was only 54.8 in 1990. However, the country’s HDI ranking is still 145 among the world’s 193 countries. “Yes, there has been significant improvement in living standards in the past 60 years, road connectivity has improved, the maternal mortality rate has gone down dramatically, almost everyone has phones, there are schools,” says Saru Joshi of the thinktank Nepal Policy Institute. But, she adds: “It is still difficult to get citizenship papers, especially in the name of the mother, and this has excluded many women from banking services, inheritance. After all our progress in physical infrastructure, Nepal now needs to prioritise inclusive social development.”&nbsp; Some of this is also happening. Eighteen years ago, Nabaraj Subedi, 49, of a village in Baglung decided not to join his peers &nbsp;fleeing the Maoist conflict to find work overseas. He invested Rs500,000 to buy a diesel generator and start a small furniture business.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251024071044_eeef308e19a73de507a425b2c6afc47269884549cf4c8fac07ca9a4898c8e031.jpg" data-media-id="editor_1" data-image-id="20251024071044_eeef308e19a73de507a425b2c6afc47269884549cf4c8fac07ca9a4898c8e031" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Nawaraj Subedi"> <figcaption>Nawaraj Subedi, 49, proprietor of Tarakhola Furniture Factory. </figcaption> </figure>  Today, with the installation of the 380 kilowatt small hydroelectric plant, he does not need to depend on his unreliable generator to power his equipment anymore. There is now a road connecting his village, and Subedi has generated local jobs, opened a sales branch in the city, and gets orders from as far away as Pokhara and Chitwan. “My costs have gone down drastically because of the electricity, and sales have gone up because of the road connecting my furniture to markets. My business has expanded,” Subedi says. Back in 1960 in a report he prepared for the Nepal government on behalf of the United Nations, Toni Hagen had emphasised just this: investing in electricity generation and connectivity to uplift the remote rural areas of Nepal.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251024081024_188ab121dc3cf2816ee71a72cb3687493eda37ab99ecc04802d647c8c9b4cd2d.jpg" data-media-id="editor_2" data-image-id="20251024081024_188ab121dc3cf2816ee71a72cb3687493eda37ab99ecc04802d647c8c9b4cd2d" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Tarakhola Furniture Factory"> <figcaption>Subedi's staff at the Tarakhola Furniture Factory.</figcaption> </figure>  Subedi’s furniture factory gets its electricity from the nearby Tarakhola Hydropower, a company set up eight years ago with financial and technical support from UNDP’s Renewable Energy for Rural Livelihood (RERL) project. &nbsp; “The project completely transformed living standards in this village,” says municipality chair Dhan Bahadur BK. “It has helped create jobs locally, there is now money to invest in education and healthcare. Households can pay their electricity fees electronically through smart billing.”&nbsp; After working with the government on rural electrification, UNDP is focussed on using that power for local employment creation. A women’s group, for example, has bought an electric-powered potato processing machine that can produce chips.&nbsp; “We are 12 of us mothers, daughters, daughters-in-law who process, package and market the potato that we grow ourselves, and it has raised our income,” says Sukmaya Roka, 57, who chairs the group.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251024071044_70b22418699178bcdd0abb0aa308796980ecd29634bcda6ff113a7624e709751.jpg" data-media-id="editor_3" data-image-id="20251024071044_70b22418699178bcdd0abb0aa308796980ecd29634bcda6ff113a7624e709751" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Sukamaya Roka"> <figcaption>Sukamaya Roka, 57, chair of Sipa Aalu Chips Utpadan Samuha from Tarakhola Rural Municipality, Baglung. </figcaption> </figure>  Today, 6.1 million households in Nepal (92.2% of total) have electricity in their homes, up from 17.9% 30 years ago. Access to electricity has not just brought lights to homes, but improved everything from productivity, quality of education, healthcare and phone connectivity.&nbsp; “To see what electricity and roads can do, just look at our municipality,” says chair Dhan Bahadur BK, “citizens have become more self-reliant, more aware of the outside world.”&nbsp; NETTLES INTO CASH&nbsp; Just a little bit of training, resource backup and local empowerment can uplift the living standards of Nepalis. The progress made in harvesting abundantly-available allo (nettles) and turning it into household products is an example. When a landslide swept away his home and farm in a flood 40 years ago, Buddhi Purja of Parbat became destitute. But he took part in a government training program supported by UNDP and Australia to harvest the wild nettles that grew on mountain slopes and turn the fabric into bags.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251024071048_56c440c478dffbc13911369b6f4133baf658cc3667773cdb44b7c40e006463ce.jpg" data-media-id="editor_4" data-image-id="20251024071048_56c440c478dffbc13911369b6f4133baf658cc3667773cdb44b7c40e006463ce" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Rhitu Saugat Handicraft"> <figcaption>A worker at Rhitu Saugat Handicraft making a bag out of nettles.</figcaption> </figure>  “After the landslide, we had to go hungry if we did not get a day job,” Purja recalls, “but after this training we have found that we can turn nettles into cash.” His allo bags are now hanging in tourist shops in Pokhara Lakeside and Thamel.&nbsp; The idea that nettles can be processed into useful fabric has not spread across the country, and new ecologically conscious consumers in Europe and elsewhere now import Made in Nepal nettle products.&nbsp; Purja started out with an investment of Rs500,000, and had a Rs20 million business that employed 25 workers. The Covid crisis in 2020 affected the sales, but Purja has recovered from it, sent his daughter off to study abroad, and is thinking of diversifying his product range.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251024071044_ab6d15abcbb9a643e12a384f4bc488b7e210a8c95303fbe1b2f77716d26eede9.jpg" data-media-id="editor_5" data-image-id="20251024071044_ab6d15abcbb9a643e12a384f4bc488b7e210a8c95303fbe1b2f77716d26eede9" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Buddi Purja"> <figcaption>Buddi Purja, proprietor of Rhitu Saugat Handicraft in Pokhara.</figcaption> </figure>  While UNDP’s project has made successful businessmen out of people like Purja, nationwide it has created 187,000 jobs in rural medium-scale industries. Much of what has worked in Nepal has been at the community level with decentralised projects like these that use the entrepreneurship of people like Buddhi Purja, Navaraj Subedi, and Sukmaya Roka. It is tantalising to imagine how much more progress Nepal would have made if their work could be replicated nationside and upscaled to the state-level.

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