Although smallpox is now ‘unfamiliar to the world today’ historian Elizabeth Fenn has written that it was ‘a misery commonplace in years gone by.’For centuries, the smallpox virus and the gruesome death and destruction it caused upended people's lives around the world and in Nepal. In this History of Disease series in Nepali Times in the past month I have recounted how smallpox traveled and killed in Europe and America, became a terrible test for survival for children in South Asia, and  struck down both royals and regular citizens in Nepal in the 19th century.We have seen how people devised inoculation and vaccination to fight the disease, and how vaccines and strong surveillance helped eradicate the disease around the world and in Nepal in the 1970s, but only 'by the slimmest of margins'.Several things about the history of the disease deserve special emphasis. As much as any influential king or prime minister, we sometimes forget that smallpox and other diseases shaped the course of human events.Part I: <a style="font-size: 15px; letter-spacing: 0.01em;" 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>Part II: <a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/opinion/the-smallpox-virus-in-british-india/" target="_blank" rel="noopener noreferrer">The smallpox virus in British India</a>Part III: <a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/opinion/smallpox-politics-and-power-in-kathmandu/" target="_blank" rel="noopener noreferrer">Smallpox, politics and power in Kathmandu</a>Part IV: <a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/opinion/how-nepal-eradicated-the-smallpox-virus/" target="_blank" rel="noopener noreferrer">How Nepal eradicated the smallpox virus</a><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022112916110/63861ea39c7e80680e0ccdd9jpeg.jpg" alt="" width="1500" height="1001"/><figcaption>Photo: MANISH PAUDEL</figcaption></figure>Viruses such as measles, influenza, hepatitis, polio, rabies, and HIV – as well as non-viral diseases such as cholera, TB, syphilis, and malaria – remade not just individual lives, but also physical, economic, and political landscapes.The fury of smallpox reminds us of the inescapable power of nature. Despite all our efforts, humans are part of nature, and life is fragile.We are living beings made up of cells and nutrients, subject to the rules of geography and biology, death and disease. This reality held true in the past, and holds true today, as much as we hope otherwise. Smallpox may have been chased away, but COVID-19 stands at the doorstep.Each disease has its own characteristics, its own biological personality, its own way of spreading through society and attacking human bodies. <a href="https://www.nepalitimes.com/here-now/the-mosquito-that-changed-nepals-history/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/the-mosquito-that-changed-nepals-history/&amp;source=gmail&amp;ust=1590041413347000&amp;usg=AFQjCNEvpoGS7wd8yELy9-vJ0LG1oby5kw">Malaria moved via mosquitoes</a> which liked warm weather, <a href="https://www.nepalitimes.com/latest/kathmandu-in-the-time-of-cholera/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/kathmandu-in-the-time-of-cholera/&amp;source=gmail&amp;ust=1590041413347000&amp;usg=AFQjCNGDo4ZWCamW139FFTuqWLpgRZuSoQ">cholera through germs in water</a>, and syphilis through sex. Due to these differences, each disease left its own unique imprint on history.<a href="https://www.nepalitimes.com/banner/big-story-of-small-pox-in-nepal/" target="_blank" rel="noopener noreferrer" 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=1590041413347000&amp;usg=AFQjCNF3MVYYqp8ZY4QHWix_z0-R_ABxUA">Big story of small pox in Nepal</a>, Tom RobertsonSmallpox spread through the air, moved easily from person to person, caused searing pain, and, if it did not kill, left behind disfigured, broken human bodies. In Nepal, if it had struck older people, not children, or if it had not left its victim's faces scarred and their eyes damaged, it might have brought less terror.On the other hand, if it had had a reservoir in animals (as many viruses do) it would have been much harder to eliminate, and we might still be facing its burning fevers and excruciating rashes today. Small pox’s particular biology shaped history in a particular way.Nature is not just a passive stage on which we humans act out our dramas as we wish. Instead, it is an actor in every drama, sometimes in the background, sometimes centerstage, but often coming and going at its own will, not ours.<a href="https://www.nepalitimes.com/opinion/the-smallpox-virus-in-british-india/">The smallpox virus in Nepal</a>, Tom RobertsonLooking back, if we recount the stories just of kings and queens and their political chess matches, we overlook some of history's main drivers and its most important stories. In fact, if we overlook disease history we will not understand the stories of kings and queens as well as we think. Can we really tell the history of Rana Bahadur, Girvana, Bimsen Thapa, and Bir Shumshere -- much less the stories of ordinary people around the country -- without understanding the central role of disease?Looking forward, we would do well not to forget nature's power to completely take over the course of events. Smallpox also reminds us that, even though humans share the same biology, diseases often affect some subsets of society more than others, particularly those with less money and power. In other words, biological forces may be universal but they play out in social landscapes as complex and uneven as Nepal's dadakada.In the Americas, smallpox even more than guns, gave Europeans a huge advantage over the indigenous people who had never encountered the disease before, and thus lacked immunity. <a href="https://www.nepalitimes.com/opinion/the-smallpox-virus-in-british-india/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/opinion/the-smallpox-virus-in-british-india/&amp;source=gmail&amp;ust=1590041413347000&amp;usg=AFQjCNHRE-p56xptgt9wTBUUjoc05RxNwA">In colonial India, smallpox and ideas about how to treat it divided the British from Indians</a> more than it brought them together.<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=1590041413347000&amp;usg=AFQjCNF3MVYYqp8ZY4QHWix_z0-R_ABxUA">In Nepal, smallpox preyed upon both rich and poor</a>, powerful and powerless alike. But as the 19th century Newar song 'Sitalamaaju Mye' reminds us, it divided Gorkha conquerors and Newar families. <a href="https://www.nepalitimes.com/opinion/smallpox-politics-and-power-in-kathmandu/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/opinion/smallpox-politics-and-power-in-kathmandu/&amp;source=gmail&amp;ust=1590041413347000&amp;usg=AFQjCNFFHANLUtlK0myrUwhb4qdFGZg4Pg">Smallpox shaped power struggles between Bhimsen Thapa and his political rivals</a>, and later, in the effort at eradication, altered relations between government health workers and individuals from impoverished ethnic minorities.<a href="https://www.nepalitimes.com/opinion/smallpox-politics-and-power-in-kathmandu/">Smallpox, politics and power in Kathmandu</a>, Tom Robertson No doubt, smallpox also shaped gender relations in ways we need more historical research on. Just as differences between diseases mattered in the course of history, so, too, did social differences.<a href="https://www.nepalitimes.com/opinion/how-nepal-eradicated-the-smallpox-virus/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/opinion/how-nepal-eradicated-the-smallpox-virus/&amp;source=gmail&amp;ust=1590041413347000&amp;usg=AFQjCNGC0hhwCb-vpWbsy8-oT_gcbRcM6Q">Nepal's successful effort to eradicate smallpox in the 1960s and 1970s</a> seems particularly relevant to us today. Nepal's last case in 1975 shows what it took to banish a complex disease in challenging circumstances: sustained governmental focus and coordination, adequate long-term funding, scientific knowledge, talented and dedicated staff, careful record keeping, program flexibility and adaptation to local culture and conditions, and dogged surveillance.Yet even at this moment of seeming human control, nature's power was on display. Smallpox eradication happened only with help from nature. Compared to malaria and polio, smallpox was relatively easy to control. It was so intense that it was easy to spot, and that intensity also made it difficult for contagious victims to move around infecting others. Smallpox did not strike a person twice. And unlike other viruses, it proved very susceptible to a vaccine. This history suggests some of the special challenges that COVID-19 poses.Here, too, social difference mattered. Nepal's eradication campaign shows the enormous challenge of protecting individual rights in moments of public health crisis. In Nepal and other South Asian countries, government personnel sometimes used violence to force citizens to get vaccinated. Some health workers grew so convinced of their righteousness -- the 'purity of purpose' in one man's self-description -- that they felt comfortable steamrolling the wishes of others, often people from socially marginalised groups with little say in society to begin with.<a style="background-color: #ffffff; font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/opinion/how-nepal-eradicated-the-smallpox-virus/" target="_blank" rel="noopener noreferrer">How Nepal eradicated the smallpox virus</a>, Tom RobertsonSuch coercion probably could have been avoided through more nimble policies, more extensive training, and better public education. Problems often sprouted, the historian David Arnold noted, when doctors and other health workers didn't understand how ordinary people saw the world and quickly dismissed their concerns as backward or superstitious -- when, as he put it, the medical system had grown ‘culturally and politically distant from the lives of its subjects’.In the end, the history of smallpox shows the fragility of life, but also the power of human perseverance. Smallpox struck down one of every three it infected. It stole beautiful children from their mothers and fathers. It stole sight from survivors. In some places, it wiped out entire families and laid waste to whole villages. It was deadly, ruthless, and horrific. It sometimes brought out the worst in human nature.But it also often spurred great ingenuity, compassion, togetherness, and resilience. In the face of disease, humans have found surprising ways to support each other, learn from the past, endure the suffering of the present, and find hope again in the future.This is the fifth article in the <a href="https://www.nepalitimes.com/opinion/big-story-of-small-pox-in-nepal/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/opinion/big-story-of-small-pox-in-nepal/&amp;source=gmail&amp;ust=1590041413347000&amp;usg=AFQjCNHAaHCW0Y2UQjeFfh0UQoUPVtsqbA">series </a>History of Disease. The next column will deal with danger of dengue in Nepal. <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/how-chitwan-was-opened,4159" data-saferedirecturl="https://www.google.com/url?q=https://archive.nepalitimes.com/article/Nepali-Times-Buzz/how-chitwan-was-opened,4159&amp;source=gmail&amp;ust=1590041413347000&amp;usg=AFQjCNEcTfdhSI0N9Tqo_qgoyZnrHCccug">Tom Robertson</a>, PhD, is researching the environmental history of Kathmandu Valley.Read other articles on smallpox in Tom Robertson’s History of Disease series in <a href="https://www.nepalitimes.com/opinion/how-nepal-eradicated-the-smallpox-virus/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/opinion/how-nepal-eradicated-the-smallpox-virus/&amp;source=gmail&amp;ust=1590041413347000&amp;usg=AFQjCNGC0hhwCb-vpWbsy8-oT_gcbRcM6Q">Nepali Times</a>.

Tom Robertson

original

674x448

610x380

500x500

400x266

400x240

400x203

301x200

1250x600

1084x550

Viruses past, present and future

In 1966, the <a href="https://www.who.int/news-room/detail/13-12-2019-who-commemorates-the-40th-anniversary-of-smallpox-eradication" target="_blank" rel="noopener noreferrer">World Health Organization (WHO)</a> launched a worldwide campaign to eradicate smallpox. The aim was ‘zeropox’ -- not just control of the disease, but its complete elimination.After an aggressive campaign run by Nepal's autocratic government, the country saw its last case ever in 1975. The program should be celebrated. But what should also not be forgotten is that it sometimes resorted to heavy handed methods. Balancing public safety and individual rights was not easy.Historically, smallpox had been one of the world's biggest and most terrifying killers. <a href="https://www.nepalitimes.com/opinion/the-smallpox-virus-in-british-india/" target="_blank" rel="noopener noreferrer">In South Asia, the disease attacked young adults and children</a>, those born since the previous epidemic, leaving many disfigured or blind. In Nepal in the 19th  century, smallpox left few communities unscathed, and <a href="https://www.nepalitimes.com/opinion/smallpox-politics-and-power-in-kathmandu/" target="_blank" rel="noopener noreferrer">even killed a king</a>.In 1966, smallpox still plagued 31 countries, annually infecting 10-15 million people and killing 2 million. Two areas caused the most concern: the horn of Africa and South Asia, including Nepal.Part I: <a style="font-size: 15px; letter-spacing: 0.01em;" 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>Part II: <a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/opinion/the-smallpox-virus-in-british-india/" target="_blank" rel="noopener noreferrer">The smallpox virus in British India</a>Part III: <a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/opinion/smallpox-politics-and-power-in-kathmandu/" target="_blank" rel="noopener noreferrer">Smallpox, politics and power in Kathmandu</a>Part V: <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>		
							<figure><img width="1282" height="1386" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022112916110/63861ea09c7e80680e0ccdd8jpeg.jpg" alt=""/><figcaption>Smallpox vaccination statue outside the World Health Organization headquarter entrance in Geneva.</figcaption></figure>Nepal, a WHO official wrote in the early 1960s, ‘must be considered as one of the areas most highly endemic for smallpox in South East Asia’. In 1958, a wave of smallpox hit Kathmandu. A 1965 survey revealed that <a href="https://www.nepalitimes.com/opinion/big-story-of-small-pox-in-nepal/" target="_blank" rel="noopener noreferrer">16% of the Valley's total population had struggled with the virus at some point in their lives</a>. Those were the ones the disease hadn't killed.Each year a few imported cases appeared in the western hills. Don Messerschmidt describes a late 1963 outbreak along the hulakibato in Lamjung, but the main problem areas were the Kathmandu Valley and the Tarai, particularly the eastern plains because of heavy cross-border movement.<a href="https://www.who.int/features/2010/smallpox/en/" target="_blank" rel="noopener noreferrer">WHO and the Nepal government launched a pilot program</a> in 1962 in Kathmandu Valley using new freeze dried vaccine, an improved version of the one Edward Jenner had devised in the 1790s, but got disappointing results.After two and a half years, only 30% of Valley residents were protected. WHO blamed ‘administrative problems and the religious and mundane objections of some sections of the population to vaccination’.In 1966, the program expanded countrywide, with new commitment and revised procedures, including better record keeping to prevent double counting. In 1971 the program started month-long mass vaccination campaigns. Each year for four straight years, several thousand temporary staff vaccinated 6 million Nepalis. Between 1967 and 1975, 39 million Nepalis got vaccinated or re-vaccinated.Another new strategy proved a game changer: aggressive surveillance and containment. Previously, officials had prioritised vaccinations. They had not traced and mapped infections, and thus did not know how many people had the virus and where. In 1971, a WHO official later wrote, ‘vigorous surveillance became the rule’.Surveillance meant routine house-to-house searches. Instead of waiting for cases to be reported, program workers went looking for them. Containment meant vaccinating and revaccinating the entire population near a newly discovered case. This was erring on the safe side by casting a broad net. The program also intensified tracing, detecting infection origins in a remarkable 95% of cases.The aggressive surveillance and containment methods delivered results. ‘It appeared that transmission had been interrupted,’ a WHO official noted later. Nepal had devised ‘a new and surprisingly effective tactic’.But then came a setback: ‘a tidal wave’ of new cases with nearly 2,000 new infections in 240 separate outbreaks. Three of every four of these cases were imports from Uttar Pradesh and Bihar in India where smallpox proved particularly recalcitrant. Of Nepal's 12 million population at the time, 90% lived within 100km of these Indian states.The program responded with more vaccination campaigns, surveillance, and containment, making steady progress. To address outbreaks in Morang the Nepal smallpox program in 1975 initiated a ‘watchdog’ system, a tactic recently devised in India. Staff were posted at the houses of infected people to ensure that they did not leave and that no unvaccinated person entered. Cash rewards were given to citizens and staff reporting new cases.In April 1975, Nepal saw its last case. A disease that had plagued Nepalis for centuries was gone. Looking back, WHO officials saw the surveillance and containment program as the key.‘The shift in strategy in 1971, laying great emphasis on surveillance-containment, was largely responsible for the success of the Smallpox Eradication Programme in Nepal,’ wrote the program's director in a 1977 wrap up report. ‘It is possible that transmission would have been interrupted earlier if the watchguard system had been adopted during 1974.’In many ways Nepal's eradication of smallpox was a heroic victory. The global smallpox program's director applauded Nepal's ‘remarkable accomplishments’. This narrative is not inaccurate but it is not the whole story.To begin with, smallpox eradication owed a great deal to biology. Compared to other diseases, smallpox was simply easier to eradicate. It was easy to see and diagnose (no asymptomatic infections) and did not re-infect people once gone. The disease's painful symptoms prevented movement, slowing transmission. Moreover, the vaccine was easy to administer and extremely effective. There was no virus reservoir among animals re-injecting the disease into human society again and again.Diseases like malaria and polio had far more natural advantages, and have proven much harder to eradicate globally.‘Without the particular characteristics of smallpox and the smallpox vaccine,’ historian Randall Packard has observed, ‘the disease would have been much more difficult to conquer, and the campaign would, in all likelihood, have failed. As it was, it only succeeded by the thinnest of margins.’One particular challenge was how to handle Nepalis who resisted vaccination. In the eastern Tarai, many people, particularly indigenous groups, held what a WHO report described as 'religious objections to vaccination’.WHO said this area became 'the scene of many problems of containment’. In Kathmandu, some Newar groups used to 'strongly object' to vaccination. In Kailali, some Tharus 'resisted vaccination for religious reasons'.Historian Susan Heydon notes that program workers often unjustifiably dismissed the concerns of Nepalis who resisted vaccination. Those who hesitated, she notes, were blamed as superstitious, derided as ‘backward and uneducated’.Instead, she faults the WHO program itself for not doing enough to educate the general population about the benefits of vaccination. She also notes that the program often administered vaccinations during hours next to impossible for ordinary working people.Eradication program workers also occasionally used unnecessary coercion. Coerced vaccinations were not common worldwide or in South Asia. But as historian Packard notes, there was a ‘tendency for aid workers to view themselves as somehow empowered to do whatever it takes to fulfill their mission, and to disregard local customs and laws’. In India and Bangladesh, historian Paul Greenough discovered that 'heavy-handed methods were sometimes relied upon'. On one occasion in Bihar in 1975, for example, health officials accompanied by police arrived at a tribal person's house by jeep at midnight, broke down the door, held down family members, and forcibly vaccinated them. Mandatory vaccinations and re-vaccinations as part of broad containment efforts sometimes sparked 'chaos' in villages.'Encounters with government vaccinators,' Greenough observes, were 'never about immunisation alone.' Religious, caste, and gender dynamics shaped interactions, as did ill will from previous health campaigns.One American health worker in India later recalled how a sense of unbridled self-righteousness led him to mistreat people. 'One of the rules was that everybody gets vaccinated. I was awful in my conviction of purity of purpose -- in breaking down doors and vaccinating crying women, etc.' To a large degree, the ends seemed to justify the means.Official reports, Greenough writes, often dismissed resistance and underreported coercion. He wishes there had been much more training for healthworkers and broader,more careful education for the public.In Nepal, one foreign smallpox fieldworker described how health workers sometimes had to search for Nepalis hiding from them in fear:‘... a good natured room to room search of houses with flashlights, accompanied by the village leader, would detect adults and children hiding under beds, in chests, large wicker baskets, and even in large clay storage vessels. However, the search was done as a game of hide and seek, with laughter after people were found and vaccinated, such as in one particular case where lifting the cover of a large wicker basket revealed two children hiding inside.’This may have been seemed like a game to health workers, but probably not to those Nepali men, women, and children with unknown government strangers searching for them. They seemed terrified.In the name of containing smallpox, a global health problem and an old scourge in Nepal, in the late 1960s and 1970s Nepal's government had tremendous authority to monitor and search Nepal's population. Maintaining public safety certainly justifies strong action, but the unnecessary infringement of individual rights and liberties must also be avoided as well.  This is the third in a <a href="https://www.nepalitimes.com/opinion/big-story-of-small-pox-in-nepal/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/opinion/big-story-of-small-pox-in-nepal/&amp;source=gmail&amp;ust=1588753218027000&amp;usg=AFQjCNEp4BFSGiWvId09CsLCgnF31j8F-w">series of articles</a> about the history of disease in Nepal. The fifth installment will look at what Nepal can learn from past epidemics in dealing with this one.  <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/how-chitwan-was-opened,4159" data-saferedirecturl="https://www.google.com/url?q=https://archive.nepalitimes.com/article/Nepali-Times-Buzz/how-chitwan-was-opened,4159&amp;source=gmail&amp;ust=1588753218027000&amp;usg=AFQjCNGtSUyejPwwFFhYdaZjZohWFJUIQw">Tom Robertson</a>, PhD, is researching the environmental history of Kathmandu Valley.

How Nepal eradicated the smallpox virus

<figure><img width="1016" height="1280" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121124/636b8dd59c7e80680e06b36djpeg.jpg" alt=""/><figcaption>Irish-born painter Thomas Hickey's painting in 1806 of three queens of Mysore where the royal woman on the right is pulling up her sari to spread awareness about small-pox vaccination. Photo: PRIVATE COLLECTION</figcaption></figure>The first record of smallpox in South Asia was in the 7th century, although the virus was probably widespread on the Subcontinent a millennia before that. In late 19th century India, for which we have the first reliable statistics, smallpox struck down more than 100,000 people a year, more in epidemic years. In some parts of north India, few escaped it. In Nepal, smallpox generally hit in the spring. ‘Transmission reached a peak during April and May,’ a 1977 WHO report notes, ‘and thereafter fell off rapidly as the monsoon increased relative humidity and hampered population movement.’Smallpox generally attacked children, and older people who hadn't already contracted the disease. ‘Since smallpox erupted epidemically roughly every five to seven years in most parts of India,’ historian of medicine David Arnold explains, ‘its principal victims were children born since the previous epidemic.’Smallpox was ‘the inevitable bridge which every child has to cross before entering into life,’ noted Sir Sayyid Ahmad Khan in India in 1879. ‘Recovery from the disease is considered second birth.’Part I: <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>Part III: <a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/opinion/smallpox-politics-and-power-in-kathmandu/" target="_blank" rel="noopener noreferrer">Smallpox, politics and power in Kathmandu</a>Part IV: <a href="https://www.nepalitimes.com/opinion/how-nepal-eradicated-the-smallpox-virus/" target="_blank" rel="noopener noreferrer">How Nepal eradicated the smallpox virus</a>Part V: <a href="https://www.nepalitimes.com/banner/viruses-past-present-and-future/" target="_blank" rel="noopener noreferrer">Viruses past, present and future</a>‘It has become quite a saying among the agricultural and even wealthier classes,’ a British planter in the 1860s noted, ‘never to count children as permanent members of the family until they have been attacked with and recovered from smallpox.’Symptoms did not show during the virus's two-week incubation period. Those infected felt fine, and some even travelled, taking the disease with them, although they were not yet contagious.But after two weeks, the first of smallpox's horrific symptoms hit: intense fever, often with splitting headaches, body aches, and vomiting. Children often broke into convulsions. After a couple days, the patient might feel better for a day or two, and even rejoin normal life. But by this point contagious, they risked passing along the infection. Then came a red rash, at first on the tongue but soon all over the body, even on the palms of the hands and the soles of the feet, causing tremendous pain.By the fifth day, fluid started accumulating in the now bigger and bluish pockmarks. Fever deepened. Eyelids, lips, and nose grew swollen. The afflicted person had trouble swallowing. They might fall into delirium. Lesions could form on the eyes. The patient could be hard to recognise. A dreadful smell was common, as were secondary infections. <figure><img width="930" height="758" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121124/636b8dd79c7e80680e06b36ejpeg.jpg" alt=""><figcaption> </figcaption></figure>At two weeks, scabs formed. They ‘encrust most of the body’, historian Fenn writes. The pain was awful, ‘any movement excruciating.’ The itching could be unbearable. Death, if it was to visit, normally arrived by this point. The disease also tore apart the lungs, heart, and liver. Smallpox consumed its human hosts ‘as a fire consumes its fuel, leaving spent bodies, dead or immune, behind,’ writes Fenn. In Nepal, as in much of north India, people thought of smallpox in religious terms, as a visitation by the goddess Sitala, ‘the cool one’. This understanding of disease came with its own remedy: ‘Smallpox was conceptualised,’ historian Arnold writes, ‘not as a disease but rather as a form of divine possession, and the burning fever and pustules that marked her entry into the body demanded ritual rather than therapeutic responses.’  Sufferers showed respect and honour to Sitala with the proper prayers and offerings. 'Oh Mother Sitala,' 19th century Newaris used to sing, 'do not afflict us! Deliver the people, we beg you a thousand times!'In addition to prayers to Sitala, some South Asians, including Nepalis, used inoculation to head off the disease. They intentionally give their children mild cases of smallpox, hoping that death would not result. Once recovered, the patient would have life-long immunity. Inoculation carried risks and did not work as well as the vaccine developed from cowpox by Edward Jenner in the 1790s, especially after it was improved during the mid 19th century. But inoculation did save many people from death. Otherwise, smallpox killed one in three of those who got it.As early as 1802, and for much of the nineteenth century, the British tried to introduce Jenner's vaccine into its Indian colony. But they ran into lots of obstacles, many of their own creation, so it took until the early 20th before vaccinations became common.What happened? For starters, until the 1850s, the British vaccine was not as effective as they thought, especially in India's heat. Vaccination required person to person contact. Vaccination also cost more than the British wanted to pay, so they did not build the necessary health and education infrastructure. In addition, cultural gaps surrounding the belief in Sitala, which the British tried to crush instead of to accommodate, also interfered. Many resisted vaccination. ‘To some Hindus,' Arnold explains, 'recourse to any form of prophylaxis or treatment was impious, likely to provoke the goddess and further imperil the child in whose body she currently resided.’ Ultimately, he emphasises, the big problem was that the British administration and medical system in India was‘culturally and politically distant from the lives of its subjects’. But by the early 20th, the British had improved the vaccine and its delivery, done a better job of explaining its benefits, and begun to meet with more success. In the decade after 1935, for instance, each year roughly 4.3 million people in Madras alone, almost 10% of the population, received vaccinations.Just as in India, the smallpox virus periodically ravaged Nepal, causing tremendous suffering, killing many, and leaving behind scarring and blindness. It affected all levels of society, even Nepal's royal family on several occasions in the 19th century.  This is the second in a <a href="https://www.nepalitimes.com/opinion/big-story-of-small-pox-in-nepal/" target="_blank" rel="noopener noreferrer">series of articles</a> about the history of disease in Nepal. Forthcoming columns will explore the role of smallpox in Kathmandu’s power struggles in the 19th century, and its eradication campaign in the 1960s. Tom Robertson, PhD, is researching the environmental history of Kathmandu Valley.

The smallpox virus in British India

When we think of Nepal's history, mostly political events jump to mind: the expansion of the Gorkhali state, Jang Bahadur's takeover, or the 'People's War’. We rarely think about disease. But diseases have shaped the course of history in the Himalaya in many unexpected and important ways. Perhaps no disease did so more than malaria, which plagued low hill valleys and especially Tarai forests for centuries. Its near complete eradication in the 1960s has altered the lives of almost every Nepali in one way or another. Viruses somewhat similar to the coronavirus have also touched the lives of countless Nepalis, and shaped larger events. Measles, influenza, hepatitis, <a style="letter-spacing: 0.01em;" href="https://www.nepalitimes.com/banner/polio-hunt/" target="_blank" rel="noopener noreferrer">polio</a>, and rabies have killed or maimed thousands. In 1918, the <a style="letter-spacing: 0.01em;" href="https://www.nepalitimes.com/opinion/remembering-a-pandemic-100-years-ago/" target="_blank" rel="noopener noreferrer">Spanish Influenza</a> cut down 12-18 million Indians, and probably tens of thousands of Nepalis. In some districts in north India, 1 in 10 died. Near Agra, 1 in 7 died. More recently, 50,000 Nepalis now live with HIV, many others have been lost to this virus which first appeared three decades ago.Part II: <a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/opinion/the-smallpox-virus-in-british-india/" target="_blank" rel="noopener noreferrer">The smallpox virus in British India</a>Part III: <a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/opinion/smallpox-politics-and-power-in-kathmandu/" target="_blank" rel="noopener noreferrer">Smallpox, politics and power in Kathmandu</a>Part IV: <a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/opinion/how-nepal-eradicated-the-smallpox-virus/" target="_blank" rel="noopener noreferrer">How Nepal eradicated the smallpox virus</a>Part V: <a href="https://www.nepalitimes.com/banner/viruses-past-present-and-future/" target="_blank" rel="noopener noreferrer">Viruses past, present and future</a> <figure><img width="2048" height="1393" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121120/636b8d9e9c7e80680e06b359jpeg.jpg" alt=""/><figcaption>Health worker administering a small pox vaccine on a person in Sanischare of Jhapa. Photo: BETH PRENTICE AND BOB FRANK</figcaption></figure>Before COVID-19, perhaps the most feared virus in Nepali history was smallpox. Until its eradication in the mid 1970s, smallpox (biphar in Nepali, chechak in Hindi) regularly terrorised Nepali towns and villages. It struck mostly children, causing excruciating pain, killing many, and leaving survivors permanently disfigured. Every year saw new cases, but every five or ten years, a broader epidemic would tear through communities, particularly dense settlements such as Kathmandu and avenues of trade and communication, such as Nepal's postal routes. A large outbreak hit Kathmandu in 1958, and a pockmark survey in 1965 showed that 16% of the Valley's population had contracted smallpox at some time in their lives. And they were the survivors -- the virus killed roughly one of every three it afflicted.Unlike diseases like cholera that hit the poor in greater numbers, smallpox was an equal opportunity killer. It struck down both raja and raiti. Several times it invaded Nepal's royal palace.The last case of smallpox in Nepal appeared in 1975. The disease, historian <a href="https://www.colorado.edu/history/elizabeth-fenn" target="_blank" rel="noopener noreferrer">Elizabeth Fenn</a> has written, is ‘a misery commonplace in years gone by but unfamiliar to the world today'. <a href="https://www.nepalitimes.com/latest/kathmandu-in-the-time-of-cholera/">Kathmandu in the time of Cholera</a>, Tom RobertsonViruses like smallpox and COVID-19 originate in animals before spreading to humans. Coronavirus developed in bats, but no one knows where smallpox came from. Today, experts believe that as many as 100 million types of viruses exist in animals worldwide, waiting to jump to humans under the right conditions. Once in the human body, viruses become tiny engines of infection of simple but deadly design, little bits of genetic coding packaged in a protein that hijack the body's cells, transforming them into ‘virus producing factories', as historian of medicine Frank Swowden has put it. The virus then reproduces exponentially, killing its host cells and, unless checked, overwhelming the body's defenses.  All diseases have different characteristics and personalities. Their origins, methods of transmission, symptoms, and social impact vary widely. Smallpox spread easily. It moved not by bite of flea or mosquito but from human to human contact, normally through droplets coughed or sneezed into the air. Because the disease caused open sores in a patient's mouth and throat, a single sneeze or cough could launch thousands of infected particles into the air. The virus could also spread through beds and items of clothing. If you lived in a house with a relative suffering from smallpox, and if you had never had the disease before, you had a 50-50 chance of getting it. There was no cure.<a href="https://www.nepalitimes.com/here-now/the-mosquito-that-changed-nepals-history/">The insect that changed Nepal's history</a>, Tom Robertson <figure><img width="2300" height="2728" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121120/636b8da19c7e80680e06b35ajpeg.jpg" alt=""><figcaption> </figcaption></figure>Smallpox was horrific. Perhaps only bubonic plague and cholera sparked more terror. It left survivors badly pockmarked and often blind. Historically, smallpox caused three-quarters of all blindness in India. Smallpox, an Indian observer noted in 1879, ‘touches the keenest of human susceptibilities; for there are thousands in this country who, though spared by it from death, still have traces of its violence in the deep marks on the face or the loss of an eye’.Around the world, the smallpox virus wrought havoc and dramatic social change. In Europe, it ripped through the dense, disorganised cities and towns of the 17th and 18th  centuries. Half of Europe's population carried scars from the disease. Smallpox afflicted rich and poor alike. It killed England's Queen Mary and Prince William, ending the house of Stuart.In the Americas, smallpox spurred even more devastation and turmoil. Because indigenous groups had no previous exposure and therefore no immunity, they died in much higher rates than Europeans. Whole communities were wiped out. <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 Times  <figure><img width="1278" height="716" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121120/636b8da59c7e80680e06b35bjpeg.jpg" alt=""><figcaption> </figcaption></figure>The massive waves of death cleared the way for European settlement and spurred the import of slaves from Africa, many of whom had immunities from childhood. Smallpox acted as an ‘unwitting instrument of empire,’ according to Fenn.In its tragic wake, smallpox also prompted important public health innovations. In many parts of Asia, including India and Nepal, people for centuries used variolation -- inoculation using live virus -- to block the disease. A string infected from a mild case of the disease would be rubbed under the skin, thus actually giving the person the disease. Some would perish, but most survived, thereby gaining immunity from future outbreaks.A less risky and more broadly effective vaccine was developed in Britain in the 1790s. A country doctor named Edward Jenner, noticing that milkmaids never contracted smallpox, discovered that intentionally giving humans cowpox -- a virus related to smallpox -- could create immunity to the disease without inoculation's painful symptoms and risk of death. Jenner predicted that vaccines like his could one day eradicate smallpox from the planet. ‘The annihilation of the smallpox, the most dreadful scourge of the human species,' he wrote in 1801, 'must be the final result of this practice.’That prophecy became reality in the 1970s -- but only after a century of misguided British efforts in colonial India, and only after a complicated and controversial global eradication campaign in the 1960s and 1970s that only succeeded, as one historian of medicine put it, ‘by the thinnest of margins’. Coronavirus differs from smallpox in important ways. Nonetheless, revisiting smallpox's history in the Himalaya can help us better understand the interconnected social, medical, and political landscapes in which we live. This is the first in a <a href="https://www.nepalitimes.com/opinion/big-story-of-small-pox-in-nepal/" target="_blank" rel="noopener noreferrer">series of articles</a> about the history of disease in Nepal. Forthcoming columns will explore British attempts to spread vaccination in India and the role of smallpox in Kathmandu’s power struggles in the 19th century, and its eradication campaign in the 1960s. <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/how-chitwan-was-opened,4159" target="_blank" rel="noopener noreferrer">Tom Robertson</a>, PhD, is researching the environmental history of Kathmandu Valley.

Big story of small pox in Nepal

Many of us former Nepal Peace Corps volunteers (PCVs) would agree that our time in Nepal changed in significant but very different ways our perspectives on life if not the future paths we chose to follow. Of no one was this truer than Dorothy Mierow. Dorothy was born in 1920, in Colorado Springs. Her father Charles C Mierow was a classics scholar and Latin professor, who served for ten years as president of Colorado College.&nbsp; Dorothy developed an interest in animals as a child, graduated with a BA degree in natural history from Carlton College in 1942, a Master’s in biology from the University of Pittsburgh, and another Master’s in geography from the University of Minnesota.&nbsp; As a young woman, Dorothy traveled with her father throughout Europe, including a visit to ancient Greek ruins, and took a Magellan Tour by cruise ship around the world in 1958.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025071901074_0bad133ab22aada319e74bbad95d563e191371db291c08f373839fbd15440262.jpg" data-media-id="editor_0" data-image-id="2025071901074_0bad133ab22aada319e74bbad95d563e191371db291c08f373839fbd15440262" data-rendition-name="original" width="903" height="1178" loading="lazy" alt="How the Peace Corps changed a volunteer's life"> <figcaption>HOME AWAY FROM HOME: Dorothy Mierow as a college student in her native Colorado.</figcaption> </figure>  She was a college teacher during much of the 1940s, also teaching at a girls’ school in Hawaii. Then back to her native Colorado in 1953, where she became a curator and later director of the Colorado College Natural History Museum. She taught geography classes, and in her free time, Dorothy climbed 22 of Colorado’s 14,000-foot peaks. Traveling in India in 1960, Dorothy decided to spend two weeks in Nepal. In late 1961, she filled out an application to join the Peace Corps and specified that she wanted to go to Nepal, ‘because I admired the people so much when my father and I were there on our trip’.&nbsp; Dorothy reached Kathmandu in September 1962 as the first group of American Peace Corps volunteers in Nepal. She stood out from the others: one of the few women in that group, surely the oldest at age 41, a world traveler, and a woman who already had established a professional career.&nbsp; One doubts if Dorothy had had a husband and children whether she would ever have gone to work and spend much of the rest of her life in Nepal.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025071901078_68e84ade1ffb0f6c83c7f8fa5c1e7315b5f6c543217f96cde012e4d86f171515.jpg" data-media-id="editor_1" data-image-id="2025071901078_68e84ade1ffb0f6c83c7f8fa5c1e7315b5f6c543217f96cde012e4d86f171515" data-rendition-name="original" width="1259" height="910" loading="lazy" alt="How th Peace Corps changed a volunteer's life NT"> <figcaption>Pokhara Bazar in 1962.</figcaption> </figure>  The Peace Corps assigned Dorothy to teach geography at Tri-Chandra College. After the school closed in the winter due to lack of heating, USAID and the College of Education asked Dorothy to help train general science teachers.&nbsp; She taught for two months and became involved in a textbook-writing project, commenting: ‘I would like the children to know something about public health, conservation (the trees are going fast and so is the soil), and learn the names of some of their common birds, trees, and flowers. They are more impressed with electricity, airplanes, and cell structure.’ When a new college opened in Pokhara in 1963, Dorothy was transferred there and lived with a Nepali family. The college boasted 30 students and no permanent buildings.&nbsp; In October 1963, Dorothy wrote: ‘Pokhara is a town of almost 5,000 people … We are in a fertile valley surrounded by foothills … There is a small Mission Hospital … a Leper Hospital and Tibetan Refugee Camp started by the Red Cross and now run by the Swiss. With winter approaching, more Tibetans are appearing in town, often with pack horses or donkeys. Some have been carrying large boxes of powdered milk,donated (by USAID) to the camp from the airport … There is no electricity, and the transportation problems make many items scarce and expensive. I am really a sort of a museum. The landlord brings all kinds of people in to see how I live and count my shoes and dresses. They express amazement at my books, pictures, tin oven, Nepali dolls from Kathmandu, screened food shelves and curtained closet.’ The standard term for Peace Corps volunteers was two years, but Dorothy extended her term and was still at Prithvi Narayan College at the end of 1965, when she wrote that she had 20 Geography students in the first-year class and 6 in the second year preparing for the IA Examination. The college enrollment was 125 students, and the foundation for a new science building was being excavated.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025071901074_c6a80e5e0db0c705b2f8733c6d30dc0386fe3abbd2238ea9d947b7d746f94a29.jpg" data-media-id="editor_2" data-image-id="2025071901074_c6a80e5e0db0c705b2f8733c6d30dc0386fe3abbd2238ea9d947b7d746f94a29" data-rendition-name="original" width="902" height="605" loading="lazy" alt="How the Peace Corps changed a volunteer's life"> <figcaption>Mierow and friends at Phewa Lake.</figcaption> </figure>  Dorothy noted that she ate one meal a day at the (Shining Mission) Hospital but otherwise lived on dal-bhat, momo, and potato curry at local shops. However, she had developed a new passion: to build what she initially called the Pokhara Museum of the Himalaya. In commendable Peace Corps fashion, Dorothy always worked with Nepalis and respected the culture. ‘The greatest joy and satisfaction I have had has been from the building of a Museum-Library in memory of my parents … It has been possible to feel like a wealthy benefactor with the money saved by father for the family’s education and now available for the education of others… (Father) would have loved to be in on the founding of a new college and be able to plan a library. Several hundred of the books to be in the museum-library came from his collection and were carefully selected to be of use for students in Nepal…’&nbsp; ‘The museum part is to satisfy my own inclinations and was thought of when I found how little diversion there was for the people of Pokhara… It is part of the University requirements for the college that it should have a geography and biology museum. The museum building is small but adequate.&nbsp; I have tried to design it in harmony with Nepalese architecture and decorate it with some of the art of the best artists or woodcarvers… Posts holding up the porch roof are carved by Cottage Industries to represent different peoples of Nepal in typical costumes. The door was carved by a local wood carver and has typical birds of Nepal around it. Inside are 10 roof-support carvings designed by the retired Director of the National Museum in Kathmandu, Mr. C.M. Maskey.&nbsp; They were carved by the best wood carvers in Patan very skilfully. The building has three rooms: the library, the exhibition room, and a smaller workroom which can be used by our newly formed Woman’s Club as well as other groups or classes.’  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025071901074_03d3359c65389d30a0134e9a4862778994121e7e833b7d28b18e06e36fc76ff8.jpg" data-media-id="editor_3" data-image-id="2025071901074_03d3359c65389d30a0134e9a4862778994121e7e833b7d28b18e06e36fc76ff8" data-rendition-name="original" width="629" height="599" loading="lazy" alt="How the Peace Corps changed a volunteer's life"> <figcaption>Mierow with local women in Pokhara in 1969.</figcaption> </figure>  Dorothy promoted her project to influential Nepalis connected with organisations whose support she solicited: The Department of Archaeology, the Department of Agriculture, the Godavari Botanical Gardens; Tribhuvan University’s Science and Education Department, Nature Conservation Society.&nbsp; The museum was opened officially in early 1967. The Annapurna Natural History Museum, the building Dorothy designed and had constructed, is still open and features some exhibits which she created many years ago.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025071901074_54326a8a0685e980e782378076de2f5cd02d2426e9b0d94eed972d3dbe83af26.jpg" data-media-id="editor_4" data-image-id="2025071901074_54326a8a0685e980e782378076de2f5cd02d2426e9b0d94eed972d3dbe83af26" data-rendition-name="original" width="1333" height="1000" loading="lazy" alt="How the Peace Corps changed a volunteer's life"> <figcaption>The Annapurna Natural History Museum.</figcaption> </figure>  Dorothy returned to America in 1967, but she longed for Nepal. In the spring of 1969, she again tried to enroll as a Peace Corps volunteer but was told that as she had spent more than four years, she would not be eligible for another assignment. Undeterred, she persuaded the college in Pokhara to invite her to return as a teacher.&nbsp; UNICEF and the Forestry Department sponsored Dorothy to prepare charts on trees, birds, animals and flowers in colour for distribution to the schools of Nepal. Dorothy, back in the Peace Corps, returned to Pokhara and the Museum in 1972. She formed a friendship with her former geography student from Sikles, Chandra Prasad Gurung, and in 1974, she brought Chandra to America, where he enrolled in Colorado College and studied cultural anthropology.&nbsp; Chandra subsequently earned his PhD in geography from the University of Hawaii and returned to Pokhara to become director of the Annapurna Conservation Area Project. Gurung actively promoted ecotourism, landscape conservation, and biodiversity conservation in Nepal. His life was cut short along with those of 23 other Nepalis and foreigners who perished in a helicopter crash near Taplejung in September 2006.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025071901074_322d3c3ac6f1b08ffa07c44a19998b937a7db9eb43527f7539cf6481e1546314.jpg" data-media-id="editor_5" data-image-id="2025071901074_322d3c3ac6f1b08ffa07c44a19998b937a7db9eb43527f7539cf6481e1546314" data-rendition-name="original" width="2500" height="1000" loading="lazy" alt="How the Peace Corps changed a volunteer's life"> <figcaption>Mierow's four books on Nepal and its biodiversity. </figcaption> </figure>  Dorothy worked with several well-known Nepalis to publish her paintings and photos in beautifully illustrated books. She and Hemanta Mishra of the National Parks and Wildlife Service wrote Wild Animals of Nepal (Ratna Pustak Bhandar, 1976). More than 400 photos Dorothy took on treks to the Everest region, Gosaikunda, Muktinath, Jumla and Rara Lake, as well as travels in the Tarai, appeared in Himalayan Flowers and Trees (Sahayogi Prakashan, 1978).&nbsp; The botanist Tirtha Bahadur Shrestha identified the species. Dorothy and Kesar Lall published This Beautiful Nepal (Sahayogi Press, 1981). Birds of the Central Himalayas (1988) contained Dorothy’s paintings of 250 species of birds found along the areas of the Kali Gandaki River, Pokhara, Chitwan and the central Tarai. Dorothy summed up her life and work in Nepal in Thirty Years in Pokhara (Pilgrims Book House, 1997). Dorothy returned to Pokhara and her adopted Gurung family several times during the 1980s and 1990s to celebrate festivals and meet old friends. Her final years were spent at her mountain cottage in Green Mountain Falls north of Colorado Springs. She died at the age of 79 in August, 2000. Nepal gave new meaning and purpose to Dorothy Mierow’s life. Daniel W Edwards was a Peace Corps volunteer in 1966 and is the author of several books on Nepal. The author thanks Special Collections, Tutt Library, Colorado College.

How the Peace Corps changed a volunteer’s life

· On the night of 15 May, two glacial lakes burst in Tharka in Humla and the debris flow washed away homes and bridges.&nbsp; · Last week, a slurry surge on the Kali Gandaki in Upper Mustang caused at least Rs15 million in damage, and was traced to a melting glacier. · Dozens are feared dead after <a href="https://nepalitimes.com/news/rasuwa-flood-likely-a-glof">an expanding glacial lake in Tibet overflowed</a>, sweeping down into Nepal and damaging four hydropower plants generating 230MW, nearly 8% of the country’s total grid supply.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250718060748_45225dc707c1e9c2968ca8dbf6e564e01e4eb6e2ff254fb8eb940cf62cdd910b.jpg" data-media-id="editor_1" data-image-id="20250718060748_45225dc707c1e9c2968ca8dbf6e564e01e4eb6e2ff254fb8eb940cf62cdd910b" data-rendition-name="original" width="2667" height="1500" loading="lazy" alt="Rasuwa flood"> <figcaption>Miteri friendship bridge connecting Nepal and China was swept away in the Rasuwa flood. Photo: PRAKASH CHANDRA TIMILSENA / NPL</figcaption> </figure>  And those are just in the past month. Climate scientists say Himalayan glacial lake outbursts are becoming more frequent and destructive, and a warning for Nepal not to put all its eggs in the hydropower basket.&nbsp; <a href="https://nepalitimes.com/editorial/when-it-rains-it-pours-ksqprbu3">Record precipitation last September</a> unleashed floods that killed 200 people, and temporarily slashed Nepal’s total generation capacity of 3,000MW by nearly half. The <a href="https://nepalitimes.com/banner/nepal-valley-suffers-quadruple-disaster">Melamchi flood of 2021</a> caused by <a href="https://nepalitimes.com/multimedia/the-not-so-permanent-frost">permafrost melting</a> on a glacier upstream nearly destroyed a $800 million water supply scheme, Nepal’s largest infrastructure project which four years later still has not resumed full operation. The <a href="https://nepalitimes.com/news/sikkim-flood-is-warning-to-nepal">glacial lake overflow in Sikkim</a> caused by record rainfall in September 2023 that destroyed the $1.2 billion Chungthung Dam and caused catastrophic damage to infrastructure on the Teesta River. This was a warning to the cascade of hydropower plants on the Arun and Marsyangdi river basins.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250718060736_6f61797a6be308321e3bae26e55d2f64cba4b9e5eb262adacb9e92fb5f3c6152.jpg" data-media-id="editor_6" data-image-id="20250718060736_6f61797a6be308321e3bae26e55d2f64cba4b9e5eb262adacb9e92fb5f3c6152" data-rendition-name="original" width="919" height="549" loading="lazy" alt="hydro disasters and hydropower plants"> </figure>  Nepal has set a target of generating an additional 28,500MW by 2035 -- out of the feasible 48,000MW -- but how viable is an energy strategy that is exposed to heightened risk due to climate breakdown? &nbsp; “As extreme weather events increase, we must design and build infrastructures respecting river flow and topography,” says former Energy Secretary Dwarika Nath Dhungel. “We must make the best use of our water resources, but not by letting excavators loose everywhere mining riverbeds and building haphazardly where we shouldn’t.”&nbsp; Although no project can be disaster-proof, <a href="https://nepalitimes.com/banner/climate-smarter-himalayan-infrastructure">climate smart design</a> can minimise damage from flash floods and landslides. Recent disasters have driven up insurance premiums for energy projects in Nepal, and smaller ones cannot even afford them. The 456MW Upper Tamakosi hydroelectric project which is still not fully functional after the September floods has claimed insurance worth Rs1.8 billion. The alternative to high risk high investment hydropower projects is <a href="https://nepalitimes.com/here-now/what-s-cooking-in-nepal-besides-politics">energy diversification</a> to other renewables such as solar, wind or biogas. Nepal gets annual sunlight of 300 days with 6-7 hours on average to total 50,000 terawatt-hours (TWh) per year.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250718060744_4acd452b4117180ca9bb5d3be839ff46dfd5464e4d507f5ad3704cef6253bc48.jpg" data-media-id="editor_9" data-image-id="20250718060744_4acd452b4117180ca9bb5d3be839ff46dfd5464e4d507f5ad3704cef6253bc48" data-rendition-name="original" width="1080" height="720" loading="lazy" alt="solar power"> <figcaption>Farmers in Tarai using solar powered water pump. Photo: GHAMPOWER</figcaption> </figure>  The Solar and Wind Energy Resource Assessment (SWERA) calculates that Nepal could source 3,000MW from wind energy alone, considering 10% of the area with more than 300W/m2 wind power density. <a href="https://nepalitimes.com/opinion/people-power/decentralising-power-in-nepal">Solar energy</a> stations are cheaper and quicker to build, and would be an ideal alternative to reliance on hydropower.&nbsp; “There has been some investment in solar power, especially from the state sector,” says water expert Madhukar Upadhyay. “But there is an issue of land acquisition since the arrays need a lot of space. It is comparatively easier to get a permit to put up a hydropower plant on a river.” As for biogas, there is simply no incentive to build on past success with household level plants to <a href="https://nepalitimes.com/here-now/more-bullshit">promote industrial-scale production</a>. Scaling up biogas by integrating it with urban biodegradable waste would still be a viable alternative to LPG.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250718060744_715d44afd5eb4ba8dafa209b0ad0f19400665797b5f078f5636821e600f96684.jpg" data-media-id="editor_12" data-image-id="20250718060744_715d44afd5eb4ba8dafa209b0ad0f19400665797b5f078f5636821e600f96684" data-rendition-name="original" width="1419" height="954" loading="lazy" alt="windmill"> <figcaption>A wind mill in Hapsikot in Nawalpur. Photo: WINPOWER NEPAL</figcaption> </figure>  Nepal’s public sphere is buzzing with excitement over the discovery of potentially 430 billion cubic metres of methane gas beneath Dailekh district that, if properly harnessed, would meet the country’s energy demand for the next 50 years. Even though a feasibility study is awaited, politicians from the prime minister down see this as a petro bonanza that will make Nepal rich. But drilling, storage and distribution of CNG in the country’s current kleptocratic state make that unlikely. If Nepal was to get rich solely on its hydro-energy potential, it could have done so in the past 50 years. Says Dhungel: “This is not exactly a new discovery, but it is premature to celebrate until its extraction is proven to be cost effective. And let us hope it does not get <a href="https://nepalitimes.com/news/balance-of-power">tangled in geopolitics</a>, since China is involved in the prospecting and drilling, which could make India uneasy.”&nbsp; The country suffers from the Dutch Disease curse even before its resource is fully exploited. And the same cronyism, corruption and rent-seeking structure cannot deliver the riches we expect from Dailekh’s methane discovery. Now, <a href="https://nepalitimes.com/here-now/right-climate-for-nepal-s-energy-transition">with hydropower in jeopardy</a>, Nepal’s planners will have to evolve a new strategy for energy security into the future. But first, governance needs to be cleaned up with long-term strategic planning that takes climate risk into account. For example, do we need to mine fossil gas when there are renewable options? Will Dailekh take Nepal away from its climate commitments? Says Madhukar Upadhyay: “Nepal has always been resource rich and management poor. And the larger the resource, the bigger our management incapacity. It is a societal malaise.”&nbsp;

Nepal’s Resource Curse

चौतारा rest stops have long been an integral part of scenic touristic town of <a href="https://nepalitimes.com/news/pokhara-six-decades-ago">Pokhara </a>but are now rarely seen as the city bursts at the seams. They say inhabitants of Pokhara saw a plane before they saw cars. Indeed, the grass airfield was built in the 1950s, while the Kathmandu highway 20 years later. Before roads, people walked to get around, pausing to rest or even nap under the shade of banyan-pipal trees. <a href="https://nepalitimes.com/here-now/pokhara-s-desperation-and-hope">Pokhara airport’</a>s ‘terminal’ in those days was a shady chautara where passengers waited for their flights. The chautara bore silent witness to daily life, whether it was travellers seeking a brief respite from the summer heat or villagers gathering for a chat in the mornings and evenings. But with the roads came vehicles, and then houses started filling up spaces, even farmlands. Pokhara began transforming from a serene village to a <a href="https://nepalitimes.com/news/pokhara-comes-alive-at-night">bustling city</a>.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250719010724_d101fa482441ce67afdf5bc4e4547b334e7662c1cf0a20e9d31a0e8dff66f04b.jpg" data-media-id="editor_3" data-image-id="20250719010724_d101fa482441ce67afdf5bc4e4547b334e7662c1cf0a20e9d31a0e8dff66f04b" data-rendition-name="original" width="2147" height="1581" loading="lazy" alt="Trees of life and living NT"> <figcaption>Photo: DURGA RANA MAGAR</figcaption> </figure>  The banyan-pipal trees were chopped down to make way for wider intersections and buildings. The once-iconic rest stops that carried Pokhara’s identity had all but vanished. “Building chautara was once considered a religious duty, which is why so many of them were constructed across Pokhara,” says archivist Sunil Ulak. <a href="https://archive.nepalitimes.com/news.php?id=10927">Ekai Kawaguchi</a>, a Japanese Buddhist monk, who visited Nepal 120 years ago en route to Tibet, documented <a href="https://nepalitimes.com/banner/no-visitors-in-pokhara-to-admire-view">the landscape of Pokhara</a> and its surroundings. In his book, Three Years in Tibet, he reflects on the natural beauty of the town and its shady trees. A chautara used to be surrounded by ponds, where shepherds would bring their cattle to drink from while they took a nap under the shade. The gentle rustling of leaves in the cool breeze lent a soothing melody as did the chirping of birds, while the insects took refuge in the branches and leaves. Read also: <a href="https://nepalitimes.com/here-now/pokhara-800-years-ago">Pokhara 800 years ago</a>, Kunda Dixit This ‘nature’s breeze’, as botanist Kalyan Panta puts it, is now history due to <a href="https://nepalitimes.com/banner/cost-of-living-in-a-big-city">haphazard urbanisation</a>. “When the wind strikes against one leaf, it creates a domino effect and other leaves start waving as well,” he explains. There were 632 chautara in the city until 1977, and by 2000 the number had fallen to 278. But in some wards the number of trees fell from 55 in 1984 to only five now.&nbsp; The gradual loss of these resting places has meant habitat <a href="https://nepalitimes.com/banner/between-existence-and-extinction-in-nepal">destruction of birds and insects</a>, it has also damaged the environment and natural beauty of the city.&nbsp; Researcher Jagannath Adhikari’s study showed that infrastructure projects ignored the environment, and concluded that that urbanisation in Pokhara was unsustainable.&nbsp; The destruction continues to this day. Recently, old chaurata in wards 6, 13 and 14 were cleared to make way for a sacrificial ritual. In fact, ward 6 got a permit from the local government to clear its remaining trees.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250719010724_cee1d4faf8376e7ba18b9c7012ea4215b7c3fbf7e0983b0c97005df5567d6de0.jpg" data-media-id="editor_9" data-image-id="20250719010724_cee1d4faf8376e7ba18b9c7012ea4215b7c3fbf7e0983b0c97005df5567d6de0" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Trees of life and living NT"> <figcaption>Photo: DURGA RANA MAGAR</figcaption> </figure>  But in wards 13 and 14, the Human Service Foundation cut down some 33 trees for which it is in a dispute with the metropolitan city as there is no unclear jurisdiction regarding who gives the permit. The Kaski Division Forest Office is currently investigating the matter. Elsewhere in ward 19, the ward office had launched ‘मेरो रूख, म काट्छु’ campaign due to an alleged chaos caused by monkeys in the area. The decision was rescinded after an all-around opposition.&nbsp; To be sure, there are policies in place to protect trees such as the Gandaki Province Forestry Act, 2080, and the Regulations, 2081. The province government also introduced an act in 2019 per which no tree, including pipal, silk cotton and other <a href="https://nepalitimes.com/opinion/suburban-tales/trees-trees?%2F">trees of natural and historical importance</a> shall be damaged, eroded or removed. But the local government, responsible for implementing the Act, is doing the opposite. “If this rapid rate of tree felling continues, neither trees nor chautara will survive for the future generation,” conservationist Ram Bahadur Poudel tells us, adding that old trees are being cleared under the pretext of pruning branches. Interestingly, Ulak notes that Pokhara-8 was called सिमलचौर in the past because there were so many majestic silk cotton trees, but there are very few left, if any, and hence altering the identity of a place. With modernisation, people have questioned the significance of chautara in this day and age. But they still have relevance. Urban centres in Pokhara and Kathmandu are much hotter than the outskirts because of the <a href="https://nepalitimes.com/news/in-the-heat-of-the-moment-5xcycyot">urban heat island effect</a>. Says archivist Ulak: “While their original purpose was to provide rest, today they continue to play a crucial role in regulating temperature, beautifying the city, and preserving our environment.”

Trees of life and living

Nepalis are living longer than ever. By 2028, the country is set to join the ranks of other <a href="https://nepalitimes.com/news/nepals-demographic-window-is-closing">ageing societies</a> around the world, and by 2054, 1 out of every 7 people in Nepal will be over 65. Life expectancy at birth has risen dramatically from just 55 in 1990 to 71 today, &nbsp;thanks to improvements in public health and access. But as more people live longer, the country must also prepare for a parallel rise in age-related illnesses and the complex social and medical needs that come with an <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/need-to-prepare-for-ageing-society,3624">ageing population</a>. Extended families have always acted as a safety net for <a href="https://nepalitimes.com/news/home-sweet-home-for-older-nepalis">the elderly</a>, with children and grandchildren shouldering most caregiving duties. But with more than 1,600 <a href="https://nepalitimes.com/banner/migration-not-a-wish-but-necessity-for-nepalis">Nepalis migrating </a>every day, older parents are left behind with no one to care for them. <a href="https://nepalitimes.com/editorial/the-new-equaliser">Remittances</a> from migrating youth, which account for nearly a third of Nepal’s GDP, have kept the economy afloat. But money sent home cannot make up for the chronic departure of kin and caregivers, who are often the first to catch the signs and symptoms of disease in elders. In rural areas where over 85% of Nepal’s elderly live, the absence of this daily vigilance means early signs of illness often go unnoticed until they become debilitating. As a result, chronic conditions like hypertension, diabetes, and depression are left unmanaged.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250720130748_213f2c65f2638872e9ac0550a7ac251e4960c3726dc5c76215962a23ba71dff1.jpg" data-media-id="editor_5" data-image-id="20250720130748_213f2c65f2638872e9ac0550a7ac251e4960c3726dc5c76215962a23ba71dff1" data-rendition-name="original" width="1064" height="701" loading="lazy" alt="Smart ageing is Nepal’s next frontier"> </figure>  Geriatric medicine is largely absent from medical curricula and there is no national plan in place to manage cognitive decline, memory loss and confusion. These are often mistaken for signs of normal ageing, instead of <a href="https://archive.nepalitimes.com/article/nation/dementia-brings-new-problem-that-families-have-little%20knowledge-of,2151">dementia</a>, delaying care until it is too late. The same pattern plays out with strokes, osteoarthritis, and vision problems — conditions that could be managed early but are instead allowed to spiral into <a href="https://nepalitimes.com/opinion/comment/changing-disability-to-this-ability-h68f6sq2">disability</a>. Nepal is not ready for an older future. It needs a strategy for ‘smart ageing’ where the focus is not adding years to life, but enhancing years lived through the intelligent application of policy, infrastructure, and crucially, <a href="https://nepalitimes.com/opinion/comment/tech-and-transition-in-nepal">technology</a>. Many models of smart ageing, however, are sculpted around modern societies where independent living in later life is the norm. Furthermore, eroding traditional family care and an underdeveloped formal care system means there is a large gap that can’t simply be filled by copy-pasting from foreign models. Nepal must shape its own version of smart ageing. The <a href="https://nepalitimes.com/news/healthcare-moving-from-hospitals-to-homes?%2F">tech boom</a> has led to homegrown digital healthcare apps such as Hamro Doctor, Cura Health, Jeevee and Health Yaad Ayo which offer teleconsultations, online appointments, and at-home test bookings. As <a href="https://nepalitimes.com/review/nepal-s-new-digital-landscape">smartphones and internet access</a> extend to the most rural fringes of the Nepali countryside, geography is no longer a barrier to the use of these digital tools. What limits their use is the lack of digital proficiency among the older generation. Others find the idea of turning to a device instead of a familiar, reassuring face unfathomable. That is why <a href="https://nepalitimes.com/opinion/addressing-nepals-digital-divide?ref=blog.togglecorp.com">digital literacy</a> efforts must be paired with guided human support to build trust alongside technical skill. Such a model of community-led digital mediation is already gaining traction elsewhere. In the UK, ‘digital health ambassadors’—often young people or even schoolchildren—are trained to co-design and advocate for online platforms that resonate with peers who might otherwise feel excluded from automated health services. A Nepali version could engage cohorts of nursing students, tech-savvy youngsters and returnee migrants to assist elders in navigating digital health platforms and troubleshooting problems, and most of all, normalising the idea of health apps being a reliable recourse.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250720130748_fcb94ab76e76b5574189757e88d76fccad4e115e78dd9eae92a3bd4c882c3431.png" data-media-id="editor_12" data-image-id="20250720130748_fcb94ab76e76b5574189757e88d76fccad4e115e78dd9eae92a3bd4c882c3431" data-rendition-name="original" width="2246" height="1590" loading="lazy" alt="Smart ageing is Nepal’s next frontier"> </figure>  Nepal’s own network of Female Community Health Volunteers (FCHVs), whose credibility is rooted in long-standing relationships across rural communities, could be similarly upskilled, their roles in <a href="https://nepalitimes.com/here-now/target-2030-for-maternal-and-newborn-health">maternal and child health </a>expanded and repurposed to also include geriatric tech support. However, there is a limit to how much older adults can adapt to new technologies. So, Nepal should simultaneously invest in passive technologies—tools that monitor and act for the elderly, instead of demanding active use. That is where wearables and in-home smart health devices collectively known as 'gerontechnology' come in. Picture an 82-year-old in far-flung Rolpa, away from the facilities of an urban hospital. Installed in her home are low-cost motion sensors that monitor prolonged inactivity or signs of a fall, instantly triggering alerts to the nearest health post when necessary. On her wrist, a wearable bracelet continuously tracks her sleep, vital signs, oxygen saturation, and glucose levels. This data is encrypted and synced to a digital dashboard accessible by health staff at the local post. If the system flags an acute risk—such as a potential stroke or hypoglycemia—a nearby health worker is dispatched immediately to her home. If her readings over time indicate a trend toward a <a href="https://nepalitimes.com/news/why-do-so-many-nepalis-have-high-blood-pressure">chronic condition</a> like diabetes, community health volunteers step in. They help schedule a virtual consultation with an endocrinologist in Butwal. Based on the advice received, she gets a prescription and picks up her medication from the local community pharmacy, along with a smart dispenser to ensure she sticks to her treatment plan without missing doses. This is not as far-fetched as it may sound. Many of the individual devices forming this connected medical system called an Internet of Medical Things (IoMT) already exist in Nepal as imported commercial products. What is missing is a stronger framework for <a href="https://nepalitimes.com/business/public-health-partnership">public-private collaboration</a>: one where health tech companies continue developing locally adapted tools, and the government actively integrates these innovations into public health delivery. <a href="https://nepalitimes.com/opinion/people-power/nepal-as-an-ai-power-bank">Nepal’s tech ecosystem</a> is maturing, but policymaking must evolve in tandem, especially when it affects an older generation largely resistant to change. The backlash against the recent mandate requiring National Identity Cards for accessing social security benefits revealed the pitfalls of imposing top-down reforms without adequate preparation or support for seniors. For Nepalis to age well, community caregivers, doctors, innovators, and above all, the state, must step in where families have stepped away. The goal is not to replicate traditional care, but to build a coordinated system of support that connects everyone through technology. The future is older for Nepal, let us be wiser too. The writers are pursuing their undergraduate studies in biomedical engineering at the Hong Kong Polytechnic University.

history-of-disease