The 12th Mountain Medicine World Congress is being held in Kathmandu 21-24 November, with more than 400 delegates from over 30 countries taking part.The biennial conference is being organised by the International Society for Mountain Medicine (<a href="http://ismm.org/congress/">ISMM</a>) together with the Himalayan Rescue Association (<a href="http://himalayanrescue.org.np/">HRA</a>) and the <a href="https://mmsn.org.np/">Mountain Medicine Society of Nepal</a>. <img width="156" height="250" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221107171136/636934369c7e80680e03dfe1jpeg.jpg" alt=""/>The Congress will continue to focus on science and research and offer a comprehensive overview of ongoing topics of interest in mountain medicine, including emergency mountain medicine.Read also: <a href="https://www.nepalitimes.com/banner/going-to-great-heights-to-prevent-altitude-illness/" target="_blank" rel="noopener">Going to great heights to prevent altitude illness</a>, Peter Hackett<a href="https://www.nepalitimes.com/opinion/trekkers-with-the-trots/" target="_blank" rel="noopener">Trekkers with the trots</a>, David R ShlimLocated in the Central Himalaya with some of the highest terrain in the world, and a popular destination for mountaineers and trekkers from all over the world, Nepal is an ideal venue for the Congress.Nepali climbers have accompanied expeditions for many decades to the world’s highest mountains not just in Nepal, but all over the world. In addition, and increasing number of young Nepalis are discovering their own country, and can be found in large numbers on trekking trails that used to be frequented by foreigners. <figure><img width="1338" height="787" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221107171136/636934389c7e80680e03dfe2jpeg.jpg" alt=""><figcaption>ON A HIGH: The inaugural session of the 12th Mountain Medicine World Congress in Kathmandu on Wednesday. More than 200 delegates from 30 countries are taking part. Photo: NAVIN BHATT</figcaption></figure>Nepal also has a long history of research in mountain medicine starting with the Silver Hut  studies in the early 1960s, one of the first to look at the effect of high altitude on the human physiology. The <a href="http://archive.nepalitimes.com/article/review/The,448">Sherpa people</a> are probably the most studied, breath-analysed and blood-taken community in the world, as scientists try to find out how their bodies have evolved to high altitude.Even today, many Himalayan expeditions have medical research components, like the study of two mountaineers who were on Mt Everest this spring, while their twins stayed at sea level. The goal was to study possible changes in their gene expression.  Local organisers of the Kathmandu conference this week are mostly young Nepali doctors of the Mountain Medicine Society of Nepal (MMSN) which is dedicated to keeping the Himalaya safe by researching and increasing awareness of mountain medicine. They will be presenting findings on <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/Altitude-illness-awareness,1381">altitude illness</a>, cold, avalanche hazards, search and rescue, exposure to ultraviolet radiation, etc. The conference has offered 80 scholarships for young Nepali doctors to attend the meeting with support from Maniraj Neupane, an internal medicine intern in Pittsburgh.The Himalayan Rescue Association has been a pioneer in mountain medicine in the Himalaya for almost 40 years, with its clinics in Pheriche and other popular trekking and mountaineering routes.Among the speakers at the conference are Peter Hackett who has done pioneering research into mountain medicine as medical director at the HRA, and David Shlim who has studied traveller’s diarrhoea. <h2>At Altitude</h2> <img width="640" height="360" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221107171136/6369343b9c7e80680e03dfe3jpeg.jpg" alt="">As trekkers, mountaineers and other visitors to the high mountains climb higher, they can be affected by altitude sickness especially in its life-threatening forms like <a href="http://en.wikipedia.org/wiki/High-altitude_cerebral_edema">high altitude cerebral edema (HACE)</a> and <a href="http://en.wikipedia.org/wiki/High-altitude_pulmonary_edema">high altitude pulmonary edema (HAPE</a>).The initial symptoms of acute mountain sickness (headache and nausea) are warning signs that need to be heeded by descending immediately. Not heeding the signs means the lungs start filling up with water, and excessive brain swelling at altitude or HACE may lead to psychosis, violent behaviour, and eventual death.The Himalayan range, which includes 14 peaks above 8,000m, and begins where the European Alps reach the highest point. Hypoxia (lack of oxygen) stress that climbers feel in the Himalaya is much greater and therefore much more medically significant than in the Alps or perhaps even any other mountain range in the world.In his inaugural keynote to the Congress in Kathmandu on Wednesday, Peter Hackett reminded the audience that the best antidote to altitude illness is still to take the patient down while administering bottled oxygen. <img width="312" height="850" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221107171136/6369343d9c7e80680e03dfe4jpeg.jpg" alt="">

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High Alert

Just three weeks in, Prime Minister Balendra Shah has already shed two ministers, and is having to contend with the economic fallout of the West Asia war plus the global order that it has upended.&nbsp;
The new dispensation in Nepal has aroused interest in New Delhi, Beijing as well as Washington. The ouster of Home Minister Sudan Gurung, whose first act in office was to arrest former prime minister K P Oli, has foreign policy wonks scratching their heads.
The US sent Assistant Secretary of State for South and Central Asian Affairs Samir Paul Kapur on a special mission to figure out what is happening in Kathmandu. In town at the same time was Cao Jing, Deputy Director General of the Asian Affairs Department of China’s Ministry of Foreign Affairs. And Prime Minister Shah is preparing for an official visit to India.
For the Americans, it is mostly about containing China and looking after the welfare of Tibetan refugees, while pushing its own MCC Compact and State Partnership Program (SSP). Beijing is mindful of the post-Dalai Lama era, and does not want instability in Nepal to encourage free-Tibet activities. India lately seems more wary of American activity in what it considers its backyard.
The Chinese appear relieved to see Sudan Gurung go. Only last week, Ambassador Zhang Maoming met Gurung during which he raised the issue of Tibetan and Taiwanese activities in Nepal, seeking firm commitment that Kathmandu would not harbour activities hostile to Beijing.
“Geographically we are close to Tibet and not to the Mainland, so China remains suspicious of us, especially after the TOB and free-Tibet components that emerged from the GenZ protests,” says geopolitical analyst Indra Adhikari.
Kapur, for his part, met RSP Chair Rabi Lamichhane, Finance Minister Swarnim Wagle and Foreign Minister Shishir Khanal. Although investment and infrastructure was on the agenda, the main issue seems to have been about Tibetan refugees. In nearly parallel meetings with ministers, Cao Jing warned Nepal not to be too cosy with the Americans.
For Indian academic and Nepal watcher Sukh Deo Muni, all this harks back to American activity in Nepal during the height of the Cold War. He tweeted: ‘US senior diplomat Paul Kapur's statement in Kathmandu must be understood carefully in New Delhi. He said the US does not want China or any other country to dominate Nepal.’&nbsp;
‘Any other country’ could be a pointed reference to India, and what this means is that Nepal may now have to navigate even more carefully a tri-polar world order reshaped by the West Asia war.&nbsp;
Nepali journalist based in New Delhi Akanshya Shah agrees that the United States may not be seeing Nepal through the Indian lens anymore, while New Delhi does not want heightened US activity in what it considers its sphere of influence. All this is further complicated by recent frostiness in Washington-New Delhi ties.
“New Delhi doesn’t have that familiarity factor it used to with old leadership in Nepal, but it is curious about what the young Balen Shah will do and what kind of relation he will pursue with India,” she adds. “Certain decisions of the Balen government such as ending VIP culture and delivering passport at homes have hugely resonated with the Indian people, he has in some ways become a role model among the youth in India as well.”
India has invited Prime Minister Shah for an official state visit, which will be his first foreign trip as per tradition. Shah graduated in structural engineering from a college in Bengaluru, and knows India well. Shah has injected religious elements into his public exposure as prime minister and this could help project Nepal’s ‘soft power’ in dealing with India.
But he has also been a nationalist on the Limpiyadhura map dispute, and there are other thorny issues like air connectivity, river projects and power exports that need to be ironed out.&nbsp;
Sukh Deo Muni warns that the old Indian diplomatic approach based on religio-cultural stakeholders in Kathmandu may not work anymore. He wrote: ‘India's Modi government must prepare itself well to deal with new Nepalese leadership and their empowered support base, which is self-confident, highly nationalist, aspirant and impatient.’
The RSP’s 22-page National Commitment document said Nepal should abandon its historical ‘buffer state’ identity to serve as a ‘vibrant bridge’ between regional and global powers. Much of this debate is theoretical, and there is much navel-gazing that distracts from regional realpolitik.&nbsp;
“Whether we are a buffer state or a vibrant bridge, in today’s heightened geopolitical scenario we have to have good relations with good neighbours,” explains Akanshya Shah. “What is of paramount importance is that our ties are based on the aspirations of the young generation, so that they are engaged.”
Indra Adhikari goes as far as to say that the concepts of “buffer state” and “vibrant bridge” have both failed and Nepal is neither. “We have had zero roles in mediating or de-escalating the tensions between India and China to call ourselves a buffer state. As a vibrant bridge, we cannot facilitate trade of the two countries. The new government should have researched and consulted more before proposing the same outdated and failed foreign policy concepts.”&nbsp;
What will be much more important for Prime Minister Shah is to continue Nepal’s traditional policy of ‘equidistance’ and convince his interlocutors that it is not an anti-Indian stance.&nbsp;
“At a time when there is increased interest of big powers in Nepal, we need to do a bit of our own homework for the systemic reforms we want,” says Akanshya Shah. “As for India, we first need to clearly define what we want on connectivity, energy and culture. But most importantly, we have to capitalise on the goodwill of India which we haven’t been able to in the past.”
Adds Indra Adhikari: “When it comes to fundamental aspects of foreign policy that ensures and enhances the well being of our citizens, national parties should all have one unified voice that doesn’t change when the government does. Only then the future generations can own it.”

Love thy neighbours (and America)

Krishna Bahadur Ramtel was returning home after visiting a temple when his family insisted on climbing the Dharara viewtower in Kathmandu. He climbed up the narrow steep stairs with his mother-in-law and sister-in-law. His wife was nine months pregnant and chose to stay behind. At the top, Ramtel was holding the balcony bars when the tower started swaying at 11:56AM on 25 April 2015. The 62m tall Dharara, built and rebuilt after previous earthquakes, then collapsed into a jumble of bricks and masonry. “I heard screams everywhere, I told my mother-in-law and sister-in-law not to panic,” recalls Ramtel after regaining consciousness on a pile of rubble (pictured, below). Rescuers extricated his legs from under a brick arch and rushed him to the hospital, which was already crowded with patients writhing in pain.  <figure><img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260423120420_76bbf4eefc3b54464f585ac4fac81ac602cc10f7be56871860114724074847bb.jpg" data-media-id="editor_0" data-image-id="20260423120420_76bbf4eefc3b54464f585ac4fac81ac602cc10f7be56871860114724074847bb" data-rendition-name="original" width="801" height="399" loading="lazy" alt="Dharara survivor"><figcaption>Photo: KRISHNA BAHADUR RAMTEL / FACEBOOK(Photo: Sonia Awale)</figcaption></figure>  His wife survived, but his in-laws did not. Ramtel was devastated, more so for his wife who was going to be a new mother, but lost two family members. His right leg needed an operation, but he made a complete recovery. His child was born soon after, and Ramtel’s wife had to take care of her baby as well as her injured husband. But tragically, she lacked the help of her mother and sister. The 7.8M earthquake 11 years ago this week killed 8,962 people in Central Nepal. Because it was Saturday, Dharahara Tower was more crowded than usual, and at least 180 bodies were later retrieved from the ruins. Most like Ramtel who miraculously survived were on the balcony, while those climbing or descending the staircase were killed. Built by Prime Minister Bhimsen Thapa in 1832, there were originally two towers. But one collapsed and other was damaged in the 1834 earthquake and rebuilt. Exactly 100 years later, another earthquake brought it down again. It was again restored only to collapse in 2015.  <figure><img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260423120420_25be3e1f9f78a3c08dcf16d5ac6663f8fbb860073d1eaf740c02b8dd18e1ea21.jpg" data-media-id="editor_1" data-image-id="20260423120420_25be3e1f9f78a3c08dcf16d5ac6663f8fbb860073d1eaf740c02b8dd18e1ea21" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Dharara survivor"><figcaption>Photo: ADITYA KHARE(Photo: Aditya Khare)</figcaption></figure>  Only the base of the original tower remains as a memorial inside the Dharahara complex, where a reinforced concrete tower now stands. Dubbed ‘Seto Tower’ by Prime Minister Balendra Shah when he was mayor of Kathmandu is broader than the previous tower and even has a lift that goes up to the viewing deck. But Ramtel says he not going anywhere near Dharara. He says, “That place holds memories that I do not want to remember, but I cannot forget either.” Soon after his operation, Ramtel returned to his hometown in Dhading where more members of the extended clan offered support. But now he lives in Kathmandu with his family, his son is now 11 and he recently had another child.. “Being alive is a blessing. As long as one is living, there will be struggles, and I am ready to face them all,” he tells us.  <figure><img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260423120420_4a205fcd45f87cf1251742f6ed09f447d5f3ff363f1c65c646da46c9c456339d.jpg" data-media-id="editor_2" data-image-id="20260423120420_4a205fcd45f87cf1251742f6ed09f447d5f3ff363f1c65c646da46c9c456339d" data-rendition-name="original" width="640" height="427" loading="lazy" alt="Dharara survivor"><figcaption>Photo: BIKRAM RAI / NEPALI TIMES ARCHIVE(Photo: Sonia Awale)</figcaption></figure>  NO PREPAREDNESS While 25 April serves as a reminder of the last major earthquake in Nepal, 16 January is marked annually as Earthquake Safety Day, coinciding with the 8.3M megaquake of 1934. Seismologists say the 7.8M disaster was not the big earthquake that Kathmandu experiences every 80-100 years, and the Big One is yet to hit. Building standards are still regularly flouted in densely populated parts of Kathmandu, which worries Ramtel. “The government acts only after the disaster has happened, people and the authorities forget quickly and move on. There is little preparation, and we expect God to save us,” says Ramtel, who also survived because of divine intervention.

Living to tell the tale

Nepal is experiencing a worrying spread of dengue fever higher up into Himalayan valleys where the mosquito-borne disease was unknown until a few years ago.&nbsp; In 2025, 15 of the country’s 16 high-altitude districts reported infections, marking an unprecedented ascent of the vector and virus over 2,400m. A Tribhuvan University study has confirmed the presence of Aedes aegypti and Aedes albopictus mosquitoes and their larvae, in Jumla (2,438m).&nbsp; In Solu Khumbu district, no systematic scientific research has yet been conducted, but dengue cases have been reported in patients without travel history, suggesting the presence of vectors at the base of Mt Everest as well.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260425060412_7f9b36514e85af9da5501f83b2d34c7bb12b01ae8e8e00317898938b47cf4544.jpg" data-media-id="editor_0" data-image-id="20260425060412_7f9b36514e85af9da5501f83b2d34c7bb12b01ae8e8e00317898938b47cf4544" data-rendition-name="original" width="2000" height="1333" loading="lazy" alt="Mosquitos ascend to the base of Mt Everest NT"> <figcaption>Chandannath Municipality, 2,438m, in Jumla is the highest that the dengue-carrying Aedes aegypti and Aedes albopictus mosquitos have been detected.</figcaption> </figure>  Until recently, Aedes mosquitoes had only been detected up to 2,100m. Over the past two years, however, dengue has spread across almost the entire country, affecting 76 of Nepal’s 77 districts in 2024 and 2025.&nbsp; The Epidemiology and Disease Control Division data shows 42,647 people were infected since January 2024, 19 of whom died. But the number of unreported infections is probably much higher. Scientists from the Nepal Health Research Council (NHRC), in collaboration with the Institute of Tropical Medicine in Antwerp, collected mosquito samples to analyse them and examine how they are adapting to warmer temperatures and &nbsp;resistance to insecticides. The specimens are carefully observed, photographed, and catalogued, allowing researchers to document patterns of survival, distribution, and resistance.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260425060412_cadd8a73f7f0bff79d174eea921dc6046f3a4f52a0cc34f3d4c2e12a8cc9ce29.jpg" data-media-id="editor_1" data-image-id="20260425060412_cadd8a73f7f0bff79d174eea921dc6046f3a4f52a0cc34f3d4c2e12a8cc9ce29" data-rendition-name="original" width="2000" height="1333" loading="lazy" alt="Mosquitos ascend to the base of Mt Everest NT"> <figcaption>Santos Pandey, Pratima Bhandari and Sangita Chand examine dengue vector mosquitoes under a microscope at the NHRC laboratory in Kathmandu.The entomology unit uses stereomicroscopes to identify the subtle differences between the Aedes aegypti and Aedes albopictus mosquitos. Differences in thoracic markings in the insects helps determine disease risk and guide surveillance and control strategies for dengue and other mosquito-borne illnesses.</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260425060412_48b8ed502a8cc47da9c6e8c6bd856e7961ffc0e804174ff7fb190057a286c7b7.jpg" data-media-id="editor_2" data-image-id="20260425060412_48b8ed502a8cc47da9c6e8c6bd856e7961ffc0e804174ff7fb190057a286c7b7" data-rendition-name="original" width="2000" height="1333" loading="lazy" alt="Mosquitos ascend to the base of Mt Everest NT"> <figcaption>A female Aedes aegypti mosquito under a microscope. Studying both larvae and adults to detect colour or shape variations may indicate insecticide resistance or adaptation to different altitudes. Each specimen is photographed for analysis and digital archiving.</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260425060412_cdf3ecfc317963e228ab08134300f38d818f394046f085169a2be9f886a134c2.jpg" data-media-id="editor_3" data-image-id="20260425060412_cdf3ecfc317963e228ab08134300f38d818f394046f085169a2be9f886a134c2" data-rendition-name="original" width="2000" height="1333" loading="lazy" alt="Mosquitos ascend to the base of Mt Everest NT"> <figcaption>Sushila Devi Shah, 38, at the Sukraraj Tropical and Infectious Disease Hospital last year. She suffered severe muscle and eye pain, headache, and fever, the main symptoms of dengue. Complications can be serious if untreated.</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260425060412_4a3ada611edf7551f76969b8ab2b7d7482aedacdfaec570c1024851c9bc57ccd.jpg" data-media-id="editor_4" data-image-id="20260425060412_4a3ada611edf7551f76969b8ab2b7d7482aedacdfaec570c1024851c9bc57ccd" data-rendition-name="original" width="2000" height="1333" loading="lazy" alt="Mosquitos ascend to the base of Mt Everest NT"> <figcaption>Shiva Rajbanshi of the NHRC captures mosquitos and larvae in a breeding site. This work helps assess mosquito distribution and guides prevention efforts in areas where rising temperatures allow mosquitoes to survive and proliferate.</figcaption> </figure>  Experts attribute the spread of dengue into Nepal’s mountainous regions primarily to global warming, which creates more favourable conditions for mosquito survival and reproduction, even in areas once considered at low or no risk. The dengue-carrying mosquito mainly bites in the early mornings and evenings when people are out and about. Increased mobility within Nepal with the spreading road network and greater international connectivity have also contributed to circulating the virus. As a result, dengue is reaching Himalayan communities with poor healthcare facilities.&nbsp; In these remote and hard-to-access areas, many residents continue to rely on traditional Tibetan medicine, known as Sowa Rigpa, practiced by traditional Amchi healers who enjoy strong cultural trust and have long served as key healthcare providers within local communities.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260425060412_fbd0e125f59b7c071a61f700d08f1e37409ecc647afa8ec888c0ed8a7fc991ce.jpg" data-media-id="editor_5" data-image-id="20260425060412_fbd0e125f59b7c071a61f700d08f1e37409ecc647afa8ec888c0ed8a7fc991ce" data-rendition-name="original" width="2000" height="1335" loading="lazy" alt="Mosquitos ascend to the base of Mt Everest NT"> <figcaption>Jomsom at 2,743m has seen erratic and extreme weather patterns with dry months becoming drier, and the monsoon seeing intense storms in this arid region. Average temperatures are rising, creating favourable conditions for mosquito-borne diseases. In 2025, nine cases of dengue were reported in Mustang district.</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260425060412_59398ee65a096665bb5c2c82b92de3443809673e6bdbe1405ee92b6886210cb7.jpg" data-media-id="editor_6" data-image-id="20260425060412_59398ee65a096665bb5c2c82b92de3443809673e6bdbe1405ee92b6886210cb7" data-rendition-name="original" width="2000" height="1333" loading="lazy" alt="Mosquitos ascend to the base of Mt Everest NT"> <figcaption>Khedup Loden Gurung checks a patient’s pulse in a clinic in Jomsom at 2,743m last year. Amchi are traditional Tibetan healers trained in Sowa Rigpa. Diagnosis is based on pulse reading (nad-par), visual examination of urine and tongue, and dialogue with the patient. Because Sowa Rigpa focuses on the individual’s overall energetic state rather than on specific pathogens, there is no direct equivalent to the biomedical concept of ‘dengue’.</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260425060412_421aba7152f520b640016061901108a9b7755e0feff157e7585f4f3fd2eb2ca4.jpg" data-media-id="editor_7" data-image-id="20260425060412_421aba7152f520b640016061901108a9b7755e0feff157e7585f4f3fd2eb2ca4" data-rendition-name="original" width="2000" height="1333" loading="lazy" alt="Mosquitos ascend to the base of Mt Everest NT"> <figcaption>Handmade Sowa Rigpa herbal remedies crafted using traditional methods. After drying and processing, medicinal plants are ground by hand and combined according to precise traditional formulas. The mixtures are prepared into powders, pills, or pastes using simple tools and manual techniques passed down through generations. Before distribution, the medicines are ritually blessed.</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260425060412_22970174d6ad5a7c192ec43d89eae0a8aed47ed77e9a670d85f1f473ddcfe136.jpg" data-media-id="editor_8" data-image-id="20260425060412_22970174d6ad5a7c192ec43d89eae0a8aed47ed77e9a670d85f1f473ddcfe136" data-rendition-name="original" width="2000" height="1333" loading="lazy" alt="Mosquitos ascend to the base of Mt Everest NT"> <figcaption>Khedup Loden Gurung treats a young patient in a clinic in Jomsom. Rooted in Buddhist monastic culture, many amchis approach healing as an act of compassion and service, practicing medicine as a vocation rather than a commercial activity for profit.</figcaption> </figure>  Practiced across the Himalayan region and influenced by Indian Ayurveda and Buddhist philosophy, Sowa Rigpa combines clinical observation, herbal remedies, and a holistic view of health, in which body, mind, environment, and spiritual dimensions are deeply interconnected. To curb the spread of dengue, Nepal’s health authorities have a two-pronged prevention and awareness. Strategy involves using insect repellents and mosquito nets, proper household environmental management, and community campaigns to eliminate stagnant water and strengthen vector surveillance.&nbsp; The goal is to improve the capacity of communities to respond promptly to emerging health threats in a territory increasingly exposed to the impacts of climate change. Vaccines against the two main strains of dengue exist, but they are expensive and have side effects. Prevention and vector management are therefore the primary strategies available to combat dengue.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260425060412_4ca7d50a4edd99f2ac930a21794a9e9a42d070565bf0fc1d7254405f5bd2e329.jpg" data-media-id="editor_9" data-image-id="20260425060412_4ca7d50a4edd99f2ac930a21794a9e9a42d070565bf0fc1d7254405f5bd2e329" data-rendition-name="original" width="2000" height="1333" loading="lazy" alt="Mosquitos ascend to the base of Mt Everest NT"> <figcaption>Solukhumbu District Hospital at Phaplu, 2,413m. Hospitals in these highland areas work under challenging conditions, managing a range of health needs with the resources at hand.</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260425060412_3e51b4047b04ce428a171efc1047a71d2e5cbe1dbf6dfe2738d2c8ac433fee05.jpg" data-media-id="editor_10" data-image-id="20260425060412_3e51b4047b04ce428a171efc1047a71d2e5cbe1dbf6dfe2738d2c8ac433fee05" data-rendition-name="original" width="2000" height="1333" loading="lazy" alt="Mosquitos ascend to the base of Mt Everest NT"> <figcaption>Bijay Singh Kushwaha collects sample blood from Nara Maya Khatri, 87, admitted with suspected dengue for a rapid diagnostic test. In recent years, such cases have become more familiar in the region, and the hospital is increasingly accustomed to managing them.</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260425060412_61aa4750bf8948fce4ad2f2c1d80ca6d9849f58827c8232a2c3649c9d4c8b2c0.jpg" data-media-id="editor_11" data-image-id="20260425060412_61aa4750bf8948fce4ad2f2c1d80ca6d9849f58827c8232a2c3649c9d4c8b2c0" data-rendition-name="original" width="2000" height="1333" loading="lazy" alt="Mosquitos ascend to the base of Mt Everest NT"> <figcaption>Sunita Baral and her team work in the NHRC laboratory.</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260425060412_2742b31fa889984e5c87c41c614a4b9d848fc41095ec1dd70d2b303ec29d8435.jpg" data-media-id="editor_12" data-image-id="20260425060412_2742b31fa889984e5c87c41c614a4b9d848fc41095ec1dd70d2b303ec29d8435" data-rendition-name="original" width="2000" height="1333" loading="lazy" alt="Mosquitos ascend to the base of Mt Everest NT"> <figcaption>Pramod Shrestha installing a data logger at an NHRC mosquito breeding site last year to track temperature and humidity in real time — conditions that determine the mosquito life cycle, influencing development, survival, and egg hatching. Certain species including Aedes aegypti and Aedes albopictus, prosper only within narrow climatic ranges, so these measurements help understand how mosquitos adapt to climate change.</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260425060412_09706a1f0d5ea8e7e9f393b770a52e3b34e95e1fc5e01b816e0c39920582faf1.jpg" data-media-id="editor_13" data-image-id="20260425060412_09706a1f0d5ea8e7e9f393b770a52e3b34e95e1fc5e01b816e0c39920582faf1" data-rendition-name="original" width="2000" height="1333" loading="lazy" alt="Mosquitos ascend to the base of Mt Everest NT"> <figcaption>Fog in Pokhara Valley moving up the Annapurnas, just as dengue-carrying mosquitoes move up the mountains. Rising temperatures, coupled with unseasonal pre-monsoon downpours provide ideal breeding conditions for dengue-carrying mosquitos. These conditions enable vectors to survive at increasingly higher altitudes. Public awareness and prevention remain key factors to limit the spread of the dengue virus.</figcaption> </figure>  ©2026YuriSegalerba ©YuriSegalerba ©YuriSegalerba©YuriSegalerba

Mosquitos ascend to the base of Mt Everest

Daniel J Miller arrived in Nepal as a Peace Corps Volunteer in 1974, and spent four years in villages above 3,500m, recording the lives of livestock herders.&nbsp; His photographs and ethnographic observations offer a valuable visual documentation of how the lives of Himalayan humans were (and are) intertwined with their yaks, sheep, goats and the ecosystems they shared. Miller later worked for USAID, the Asian Development Bank, World Bank, and the International Centre for Integrated Mountain Development (ICIMOD). He travelled across Afghanistan, Bhutan, the Tibetan regions of China, Mongolia, Pakistan, and Nepal, documenting livelihoods of the inhabitants of High Asia.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260425060420_8c73e8c123a1b4cb9f9dd3a2fe8b4b8f97ac9ad16486651bfe14bba15a903e2a.jpg" data-media-id="editor_0" data-image-id="20260425060420_8c73e8c123a1b4cb9f9dd3a2fe8b4b8f97ac9ad16486651bfe14bba15a903e2a" data-rendition-name="original" width="1500" height="1017" loading="lazy" alt="Rangelands of the Himalayan Range NT"> <figcaption>A fast-moving herd crosses the dry plateau.ICIMOD - All Rights Reserved.</figcaption> </figure>  The Himalaya is not just a high altitude wilderness, it is a living ecosystem that includes grasslands, shrublands, forests, wetlands and a cold desert. These accounts for 60%, about 2 million sq km, of the region.&nbsp; Miller's work captured the essence of this diverse landscape, its pastoralists and their livestock, and communities whose livelihoods depended on seasonal movement across high passes. &nbsp; Miller’s photographs romanticised the rangelands and the nomadic lives of its people, while encapsulating its inherent beauty and resilience. He photographed nomad camps and caravans, documenting seasonal landscape use and migration as herders moved up to summer pastures and down in winter. &nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260425060420_ff707c0855b3743a372dbcbde79d4d3ea7e9e56a5cdbb9c188b72c2eb525230d.jpg" data-media-id="editor_1" data-image-id="20260425060420_ff707c0855b3743a372dbcbde79d4d3ea7e9e56a5cdbb9c188b72c2eb525230d" data-rendition-name="original" width="1515" height="1000" loading="lazy" alt="Rangelands of the Himalayan Range NT"> <figcaption>Mounted herders gather on a green alpine slope.ICIMOD - All Rights Reserved.</figcaption> </figure>  Miller wrote in his book Drokpa: Nomads of the Tibetan Plateau and Himalaya: ‘Moving across the grasslands with their animals, their home a tent, nomads evoke freedom.’ His images show a world shaped by indigenous knowledge, vibrant culture, and a harmony between people and their ecosystems.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260425060420_daa370021ec4fa2c95210154d37ab7f2512a542d6217c158752052b558438bb8.jpg" data-media-id="editor_2" data-image-id="20260425060420_daa370021ec4fa2c95210154d37ab7f2512a542d6217c158752052b558438bb8" data-rendition-name="original" width="1107" height="1500" loading="lazy" alt="Rangelands of the Himalayan Range NT"> <figcaption>Daniel J Miller with his book.</figcaption> </figure>  CLIMATE CHANGE From the Yunnan mountains to Afghanistan, the Himalayan arc supports the livelihoods of 30 million pastoralists, sustaining a rich bio-cultural diversity. Today, this balance is being disrupted in an unprecedented scale by climate and demographic change.&nbsp; Because crops struggle to grow in this harsh, high terrain, livestock is what sustains mountain communities. For the Drokpa, Bakarwal, Brokpa and Changpa, livestock is their biggest asset. &nbsp; The animals can survive temperature as low as –40°C. But global warming over the last 25 years has severely impacted the herds, weather systems and ecology of the Himalaya.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260425060420_379bdaf911d92d43e9fea7e460200b85efb32afd4fb72ac70efdeab783208b59.jpg" data-media-id="editor_3" data-image-id="20260425060420_379bdaf911d92d43e9fea7e460200b85efb32afd4fb72ac70efdeab783208b59" data-rendition-name="original" width="1511" height="1000" loading="lazy" alt="Rangelands of the Himalayan Range NT"> <figcaption>Sheep spread across a wet meadow showing pastoral livelihoods depend on pockets of fragile forage in high-altitude rangelands.ICIMOD - All Rights Reserved.</figcaption> </figure>  Livestock increasingly suffer respiratory problems, loss of appetite and stress, weakening age-old pastoral systems. The mortality among the animals has increased, forcing herders to seek alternative migration routes and graze animals in unfamiliar and often riskier terrain.&nbsp; What were once well-established pastoral routes are also being disrupted by border controls, protected areas, highways and hydropower plants. Pastoral livelihoods that relied on predictable climatic rhythms are increasingly vulnerable. Wildlife populations are declining, and with them, centuries-old knowledge systems.&nbsp; The gradual loss of rangelands is threatening ways of life that depend on mobility, and intergenerational transmission of pastoral wisdom.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260425060420_bee79ad2f8c40ab562e184a836194da9b69d85c4f9ecafb93e986dd169738de4.jpg" data-media-id="editor_4" data-image-id="20260425060420_bee79ad2f8c40ab562e184a836194da9b69d85c4f9ecafb93e986dd169738de4" data-rendition-name="original" width="1554" height="1000" loading="lazy" alt="Rangelands of the Himalayan Range NT"> <figcaption>A pastoral camp spreads across the high rangelands, where tents, horses and open pasture show the mobility that has long sustained herding life in the Hindu Kush Himalaya.ICIMOD - All Rights Reserved.</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260425060420_1b0a939b622148631f1aab81f17b0291146baef69eac1bcce635e988104a3f3c.jpg" data-media-id="editor_5" data-image-id="20260425060420_1b0a939b622148631f1aab81f17b0291146baef69eac1bcce635e988104a3f3c" data-rendition-name="original" width="1539" height="1000" loading="lazy" alt="Rangelands of the Himalayan Range NT"> <figcaption>At a seasonal camp, pastoral households stand at the centre of the rangeland, holding together family, livestock, culture, and mobility.ICIMOD - All Rights Reserved.</figcaption> </figure>  Miller’s work reminds us of what it was like in the 1970s, how much things are changing today. His photographs show lush pastures and fluid seasonal movement in regions where grasslands are now turniong into desert, springs are going dry, and extreme weather disrupt long-established migration cycles.&nbsp; Miller’s photographs of caravans and herders are an urgent call for action. They remind us that rangelands are livings sytems, interlinked with human survival, biodiversity and cultural identity. &nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260425060420_43067c16b97b0646b37b9bfa52602222a266a849bf8a2870ac628daa44a14c37.jpg" data-media-id="editor_6" data-image-id="20260425060420_43067c16b97b0646b37b9bfa52602222a266a849bf8a2870ac628daa44a14c37" data-rendition-name="original" width="1500" height="1247" loading="lazy" alt="Rangelands of the Himalayan Range NT"> <figcaption>At 72, Miller is ready to ride.</figcaption> </figure>  Often, the burden of these changes falls on women and the elderly. Their traditional skills spinning wool into blankets, weaving hand-knotted carpets, crafting garments, and building yak-hair tents are becoming a lost art. &nbsp; In pastoral kitchens, the craft of preserving raw milk by turning it into chhurpi and ghee is declining with outmigration, water scarcity and warming trends.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260425060420_3fe1b1475afa1708587e7dcaebda539854c855a4d4283c360c2a3befbe98ce3d.jpg" data-media-id="editor_7" data-image-id="20260425060420_3fe1b1475afa1708587e7dcaebda539854c855a4d4283c360c2a3befbe98ce3d" data-rendition-name="original" width="1739" height="1000" loading="lazy" alt="Rangelands of the Himalayan Range NT"> <figcaption>Goats and sheep are handled in a dusty enclosure, showing the daily labour and care of livestock by pastoralists in harsh terrain.ICIMOD - All Rights Reserved.</figcaption> </figure>  RECOGNISING PASTORIALISM The future of Himalayan rangelands depends on recognising pastoralism not just as an endangered way of life, but &nbsp;a system that must be valued and sustained. This demands innovative approaches that support the people who continue to serve as the custodians of these fragile landscapes.&nbsp; The International Year of Rangelands and Pastoralists (IYRP) 2026 unites global institutions and offers opportunities to recognise the value of rangelands and safeguard them before the loss is permanent.&nbsp; Saurav Thapa Shrestha is a Communications Associate at the International Centre for Integrated Mountain Development (ICIMOD) in Kathmandu.

international-society-for-mountain-medicine

High Alert

Love thy neighbours (and America)

Living to tell the tale

Mosquitos ascend to the base of Mt Everest

Rangelands of the Himalayan Range