<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110161124/636d17e59c7e80680e0ac790jpeg.jpg" alt="" width="696" height="547"/><figcaption>Mosquirix</figcaption></figure>The endorsement on Wednesday in Geneva by the World Health Organisation (WHO) of the new malaria vaccine Mosquirix has been described as a milestone for Africa, but experts doubt if it will be as useful in the Subcontinent.WHO described the Mosquirix injection as a groundbreaking discovery and recommended its widespread use among children in sub-Saharan Africa and in other regions with moderate to high Plasmodium falciparum transmission.Every year, malaria kills 260,000 children under five in Africa. The new vaccine, the first to be backed by the WHO for the mosquito-borne parasitic disease, reduces severe infections by 30%, which translates into 78,000 lives saved annually.“This is a historic moment. The long-awaited malaria vaccine for children is a breakthrough for science, child health and malaria control,” WHO Director-General Tedros Adhanom Ghebreyesus announced at a <a href="https://www.who.int/news/item/06-10-2021-who-recommends-groundbreaking-malaria-vaccine-for-children-at-risk">press conference</a>. “Using this vaccine on top of existing tools to prevent malaria could save tens of thousands of young lives each year.”The vaccine called RTS,S (trade name Mosquirix) was proven effective six years ago, and through successful pilot immunisation programs, has reached more than 800,000 children in Ghana, Kenya and Malawi since 2019.The landmark vaccine however may not be as applicable in Nepal and the Subcontinent because malaria parasite here is different. The new vaccine was developed to fight Plasmodium falciparum, but in Nepal and South Asia the dominant malaria-causing parasite is P. vivax. Only a few candidates for P. vivax currently under trial and rhe progress has been slow.“The vaccine, its studies and recommendation are all Africa-centric,” explains Buddha Basnyat, as physician at the Patan Academy of Health Sciences. “A malaria vaccine with 30% efficacy against severe infections is being welcomed, and yet Covid vaccines, all of them known to reduce complications and fatalities by 80-90% are still rejected by vaccine deniers.”The approval of the new vaccine does have a lesson for Nepal and the rest of the world for vaccine acceptance as the <a href="https://www.nepalitimes.com/banner/the-jabs-and-jabnots/">Covid-19 pandemic</a> continues to spread and make people sick.Malaria is one of the oldest diseases known to human and still infects over 200 million people annually – 95% in Africa. The WHO and the United States led the global campaign to eradicate malaria in the 1950s and 60s, and while the effort fell short in many countries with mosquitoes quickly developing resistance to the insecticides, the program was relatively successful in Nepal.While <a href="https://www.nepalitimes.com/here-now/the-mosquito-that-changed-nepals-history/">writing for this paper in 2018</a>, environmental historian Tom Robertson stated: ‘Just as malaria shaped Nepal’s past, its almost complete removal in the 1960s and 1970s has shaped Nepal’s present, launching vast demographic, environmental, and political changes that are still playing out.’He continued: “The near complete removal of the disease from Nepal meant that there were vast movements of people from the hill ridges to valley floors and to the Tarai, as well as movement north from the plains. There was large-scale deforestation and habitat loss, and tumultuous social and political reconfigurations.”In the coming decades, malaria control was further aided by mass campaigns to raise awareness about preventives measures such as maintaining hygiene, clearing stagnant waters, and the use of treated mosquito nets and repellants.However, there is no clear data to estimate the disease burden of malaria in Nepal at present. Despite its decreasing trend, climate change is said to be pushing parasite-carrying mosquitos to higher elevations in the Himalaya.In 2019, Kathmandu saw its biggest dengue outbreak yet with 80,000 infections in five months with <a href="https://www.nepalitimes.com/banner/mosquitoes-move-up-mountains-as-the-earth-warms/">outbreaks also in higher altitudes</a> where mosquito-borne diseases were previously unheard of. There are also seasonal outbreaks of viral encephalitis, which is also spread by mosquito bites.“Vector insects are moving up the Himalaya as warming increases, and so are the diseases they carry. Climate change is leading to changes in the geographic pattern of diseases,” Meghnath Dhimal of the Nepal Health Research Council told Nepali Times in 2019.His research has shown that mosquitoes do not just travel to higher altitudes in vehicles, but increasingly complete their life cycles in what used to be colder places. Added Dhimal: “Not just dengue: at any moment you can also have outbreaks of Chikungunya, Japanese encephalitis and Zika in the mountains of Nepal due to global warming.”

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New malaria vaccine may not help Nepal

<figure><img width="1500" height="1146" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110111128/636cd2309c7e80680e08f8f8jpeg.jpg" alt=""/><figcaption>One misconception about the Tharu people is that they never got malaria. In fact they did, but less than hill settlers. A US-led insecticide spraying campaign against malaria in Chitwan in the 1950s. Photo: USOM RECORDS, US NATIONAL ARCHIVES, COLLEGE PARK, MARYLAND.</figcaption></figure>The Tharu make up 5% of Nepal’s population. One in every 20 Nepalis is Tharu. They outnumber the Gurung, Limbu, and Newa peoples. And yet, most Nepalis often know very little about Tharu culture and history. There are many things told about the Tharu. Most are wrong.The first day of the Nepali month of  माघ which this year falls on 14 January is ‘Maaghi’, the Tharu new year. Chitwan Tharu celebrate the day with pwakaa (पोका in Nepali) -- anadi sticky rice wrapped in banana leaves reheated in the coals of a fire. Dangaura Tharu in western Nepal celebrate with feasts and dancing. They also elect new community leaders known as barghar.Maagh 1 is also the day when tenants would decide whether to continue with their landlords--some of whom were Tharu and some पहाडी hill people-- or move elsewhere. Before the 1950s, because labourers were hard to find to work in the malarious animal infested Tarai, they had more leverage over the terms of their work than in later years.Several different Tharu groups live across the Tarai, each with its own language: The Kochila in the East, the Chitwan Tharu in the central area, and Dangaura, Deshauria, and Rana Tharu in the western Tarai. One anthropologist wrote a book about Nepal's Tharu called Many Tongues, One People.The Tharu are the original inhabitants of much of the Tarai, because although they sometimes got malaria, they got it less often and with less severe consequences than hill people and people from the plains.The malaria eradication project in the 1960s <a href="http://archive.nepalitimes.com/article/nation/60-years-after-1954-devastating-flood-same-failings-of-government-today-post-quake,2433">dramatically changed Tharu lives</a>. In Chitwan, for instance, in 1955 the Tharu (and related groups such as the Bote and Darai) formed almost 100% of the region's population of 25,000. By 1970, <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/how-chitwan-was-opened,4159">they had dropped to 14%</a> of the population as 125,000 migrants moved in during those years.Birendra Mahato, Director of the Chitwan Tharu Culture Museum outside Sauraha, says: "Tourist guides and hotel owners used to spread very inaccurate ideas. They often put us down. Now NTNC (National Trust for Nature Conservation) is giving training to new guides. They now have a much better idea."Indeed, there are several misunderstandings about Tharu communities. Some of them are:   Misconception 1: Historically, The Tharu Were HuntersThe Truth: Tharu were farmers who herded cattle and fished but did not hunt.In The Kings of Nepal &amp; the Tharu of the Tarai, Gisele Krauskopff writes: ‘The hunting practices of the Tharu have been stressed in many hunters’ books and are part of the biased image of ‘the savage forest dwellers.’ But hunting, and especially hunting as a subsistence technique to provide meat, is not central to the Tharu way of life...Their subsistence is based on a close relationship between paddy cultivation and fishing. The Tharu used to live near the forest, but not in it. They were first and foremost forest clearers, which means that the forest had to be pushed back.’ Misconception 2: The Tharu Lived in an Ancient Tarai ForestThe Truth: Tharu lived not in the forest but near it, often near grasslands, and over the years the forest grew and fell back.Krauskopff writes: ‘Because of the relative isolation of the Tarai, a previously malaria-infested land, prejudiced observers of the 19th and beginning of the 20th centuries created a false image of the Tharu...as savage dwellers of a primeval forest -- which the Tarai is not. Old kingdoms have risen and fallen there for at least 2000 years. The forest retreated when farming expanded under prosperous political conditions; the jungle took over in times of instability and conflict.’Misconception 3: Tharu Are Uncivilised जंगलीThe Truth: The Tharu made many ingenious adaptations to their Tarai environmentAccording to this derogatory inaccuracy, the Tharu are forest dwellers little smarter than animals. They lack knowledge and skills. They collect forest products but don't use their brains. They do not farm. They are ignorant of the outside world. They are too backward to wear clothes."Even now some people in Kathmandu and Pokhara call us uncivilised," says museum director Mahato. "The Tharu live in the jungle, they say. Many hill people don't know about the Tarai."But in fact, the Tharu have developed many skills useful for their Tarai environment: agriculture, irrigation, house construction, fishing, handicrafts, herbal medicine, forest vegetables, midwifery, wood carving, and animal domestication. All require deep knowledge about the environment."If Tharu weren't smart in this environment, they couldn't have survived. They were knowledgeable in irrigation, agriculture, जडीबुटी herbs, and fishing. They were skilled in lots of things. That was civilised."When outsiders from the hills came to places like Chitwan, they often misunderstood because the Tharu had unfamiliar habits and spoke their own languages. Migrants learned from the Tharu about irrigation, wild animals, and Tarai agriculture. Some learned the Tharu language and respected the Tharu and their traditions. Misconception 4: The Tharu Never Got MalariaThe Truth: Tharu got malaria less often than other groups, and died less often than others, but infants often got it, and some died.Many outsiders, and even some Tharu themselves, think that the Tharu never got malaria. They say Tharu did not get malaria because they ate snails, rice liquor, and spicy chilies. This is wrong. Elderly Tharu will tell you about malaria fever and shivers.Tharu got malaria and sometimes died from it. ‘It should be remembered that resistance to malaria is acquired after a certain time and that even in a generally resistant population,’ writes Giselle Krauskopff. ‘Tharu children died of malarial fever.’Compared to hill Nepalis, the Tharu acquired malaria less often and with fewer consequences. They had genetic immunities-- high rates of alpha-thalassemia, a genetic pattern common in populations who have lived in malarial areas for generations that reduces both vivax and falciparum malaria, decreasing morbidity by up to tenfold. They also acquired immunities: Those who survived one or two malarial fevers often developed an ability to fight off later attacks.These immunities meant that malaria posed less of a threat to those who survived infancy. But there was a high infant death rate. A visiting journalist noted in 1962: ‘In hundreds of villages, the child population was destined for malaria in their first year of life as surely as if the mosquitoes flew in with a list of names of the newly-born.’Mahato says, "Sometimes outsiders, and even the Tharu themselves, say the Tharu never got malaria. Both are wrong. Sometimes I get into arguments with Tharu people who say this. They say to me “नचाहिने कुरा किन गर्छस?” Many are politicised. Older Tharus tell me that they got it."To say the Tharu sometimes got malaria should not undercut the argument that the malaria and resettlement programs of the 1950s and 1960s often misunderstood, overlooked, and pushed aside Tharu interests.Misconception 5: Tharu Society Was Disconnected from Nepali SocietyThe Truth: Tharu groups before the 1960s had many interactions with other Nepalis and the Kathmandu government. Tourist brochures often describe Tharu society with phrases such as ‘untouched by civilization’, ‘timeless’, ‘in total isolation’, ‘living in another time’, and ‘forgotten by civilisation’.That is hardly the case. Even during malaria days, the Tharu had regular contact with groups from both the north and the south. Traders from the north would come every winter. In many places, Tharu tenants worked for hill landlords. The Tharu worked for the Nepal's rulers as land clearers and tax collectors. In some places, Rana and other elite visited Tharu areas for huge hunting expeditions. They relied upon Tharu workers to build roads, provide supplies, drive elephants, and find tigers.That said, it is true that the Tarai's malaria limited the interactions of the Tharu with outside groups, and gave them limited autonomy.To learn more about the richness and complexity of Tharu life, please read any of the books cited here or visit the Chitwan Tharu Culture museum near Sauraha, Chitwan. Happy New Year.___________________________________________ <h2>Americans deride Tharu knowledge, 1959</h2> <figure><img width="1920" height="1200" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110111128/636cd2339c7e80680e08f8f9jpeg.jpg" alt=""><figcaption> </figcaption></figure>These official US photos compare traditional Tharu agriculture and modern 'scientific' agriculture. The images appeared on facing pages of a book produced in 1959 by the US government to celebrate its assistance to Chitwan and Nepal. At the time, the US ran a large resettlement program in Chitwan. American officials often wrongly saw the Chitwan Tharu as part of an outdated past. According to the implied narrative in the photos, the Chitwan valley was evolving from unproductive 'backward' traditions to super-productive, science-based civilisation along the lines of the American Midwest. The photos suggested that the Tharu had little to offer this new Nepal. That was wrong. Tharu taught migrants many things. Some of the new methods succeeded, but some often failed or brought environmental problems. <h2>Rescuing Tharu history from the shadows</h2> <figure><img width="1351" height="1000" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110111128/636cd2369c7e80680e08f8fajpeg.jpg" alt=""><figcaption> </figcaption></figure>Rana hunting expeditions couldn't have happened without expert Tharu mahouts, as this 1913 photo (above) from a hunt connected to Tribhuvan's coronation shows. But Tharus themselves rarely hunted. Instead they farmed, grazed cattle and buffalo, fished, trapped small animals, and gathered herbs and other resources from the grasslands and forests. __________________________________________Writings on Recent Tharu HistoryDr. Gisele Krauskopff. ‘From Jungles to Farms: A Look at Tharu History’ in The Kings of Nepal &amp; the Tharu of the Tarai, ed. Pamela Meyer (Los Angeles: Rusca Press, 2000).Dr. Arjun Guneratne. ‘The Tharu of Chitwan, Nepal’. In Disappearing Peoples?: Indigenous Groups and Ethnic Minorities in South and Central Asia, edited by Barbara Rose Johnston and Barbara Brower (London: Routledge, 2007), p. 91–106.Guneratne, Arjun. Many Tongues, One People: The Making of Tharu Identity in Nepal. Ithaca: Cornell University Press, 2002.Muller-Boker, Ulrike. The Chitwan Tharus in Southern Nepal: An Ethnoecological Approach. Stuttgart: Franz Steiner Verlag, 1999.Thomas Robertson. ‘DDT and the Cold War Jungle: American Environmental and Social Engineering in the Rapti Valley of Nepal’. Journal of American History 104, no. 4 (March 1, 2018): 904–30.Locke, Piers. “The Tharu, the Tarai and the History of the Nepali Hattisar.” European Bulletin of Himalayan Research. 38 (2011): 61–82.Read also:<a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/how-chitwan-was-opened,4159">How Chitwan was Opened</a> by Tom Robertson<a href="https://www.nepalitimes.com/here-now/the-mosquito-that-changed-nepals-history/">The Insect that Changed Nepal's History</a> by Tom Robertson<a href="https://archive.nepalitimes.com/article/nation/land-reform-in-cold-war-Nepal,4192">Tom Robertson, PhD</a> is a historian and creator of the मिठो लेखाई videos on writing technique. He has been researching malaria and Tharu history since 2007, and is an adviser to the Chitwan Tharu Culture Museum.

Tom Robertson

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5 Myths about the Tharu

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

The dangers of the dengue virus

<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121112/636b8bc79c7e80680e06b2c0jpeg.jpg" alt="" width="2000" height="896"/>Governments in industrialised countries must not ignore the plight of poorer nations facing the coronavirus pandemic, or the disease will not be brought under control.African nations report growing numbers of cases, and more and more infections are being detected in countries with endemic poverty in Asia as testing picks. There are growing fears that developing countries could soon see major outbreaks they will not be able to cope with.A potential paralysis of <a href="https://www.nepalitimes.com/latest/nepal-must-hope-for-the-best-prepare-for-the-worst/" target="_blank" rel="noopener">already vulnerable healthcare systems</a> would not only have a drastic impact on public health, but could also push people further into poverty and deprivation. If developed countries in Europe and North America bring COVID-19 under control, there is a threat that the disease would rage on in developing countries, with the danger that it could spread back into places like North America and Europe.<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/latest/nepal-must-hope-for-the-best-prepare-for-the-worst/" target="_blank" rel="noopener">Nepal must hope for the best, prepare for the worst</a>, Buddha Basnyat and Sudeep AdhikariRich states must keep a focus on helping other countries with weak healthcare systems, despite the fact they are fighting their own battle with the disease.“High income countries are completely consumed with what is happening in their own states, but it would be good if they could give at least some focus to poorer countries,” Amanda Glassman of the Washington-based Global Centre for Development think-tank. “If things are not brought under control in less developed countries, it could come back to hurt developed countries later on.”But while there have been <a href="https://www.nepalitimes.com/latest/could-an-anti-tb-vaccine-be-protecting-nepalis/" target="_blank" rel="noopener">far fewer registered cases of the disease</a> in Africa, Asia and South America, many health experts believe that those numbers could very quickly rise dramatically. Some countries also face extra burdens of other endemic diseases, <a href="https://www.nepalitimes.com/here-now/epicentre-of-two-disasters-in-west-nepal/" target="_blank" rel="noopener">recent natural disasters</a>  or coping with large-scale refugee influxes.“Sub-Saharan Africa is already struggling with the Ebola virus and the locust invasion and associated famines. It now faces a third war against the coronavirus. In many countries, resources are stretched thin,” said Dan Steinbock of the Difference Group advisory organisation.South Africa has the world’s worst HIV/AIDS epidemic and it is not known how a major coronavirus outbreak may affect treatment for those with HIV/AIDS or outcomes if they are infected with COVID-19. In Latin America, where more than two thirds of people live in extreme poverty, doctors have already warned of the strain widespread coronavirus infections could put on hospitals and health workers.Any major COVID-19 outbreak could affect incidence, and treatment of other diseases in some African states, says Ambrose Talisuna at the WHO Regional Office for Africa. “We saw this with Ebola outbreaks in some African countries. There was a diversion of resources to the disease and the healthcare system couldn’t deal with the shock of the outbreak. People died of malaria, people couldn’t get treatment for tuberculosis.”There would also be serious economic problems. Not only would massive financial resources have to go into healthcare rapidly, but measures implemented to contain the virus’s spread, such as travel restrictions, business closures, quarantines, would very soon affect people’s incomes.<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/here-now/ke-garne-attitude-kills-people/" target="_blank" rel="noopener">Ke garne attitude kills people</a>, Laxmi BasnetOne potential advantage some less developed countries may have in dealing with an initial outbreak is their experience with other deadly infectious diseases. In the Democratic Republic of Congo, a devastating Ebola outbreak has just been brought under control. Tests for COVID-19 could simply be added to existing Ebola screening on entry into the country.Some of the poorest in the world in Asia, Latin America and Africa, have begun introducing strict measures to try and halt the spread of the disease. These have included closing borders and lockdowns. While WHO has supported the use of such measures, they have been shown to have had an enormous economic toll with sectors such as travel, transportation, tourism and retail, among others, all seriously affected.“The <a href="https://www.nepalitimes.com/latest/what-nepal-can-learn-from-china-about-covid-19/" target="_blank" rel="noopener">draconian measures that China opted for</a> have been very costly. But all alternatives would have been much worse. The Chinese leadership had to choose between extensive economic damage in one to two quarters with probable virus containment, or far greater economic devastation coupled with drastic increases in cases and deaths,” explained Steinbock.But the costs cannot, and should not, be borne by developing nations alone, development experts say. While local governments can help businesses and individuals with measures such as tax relief, providing financial support through loans, and exemptions from health and social security payments, other countries have a role to play.This month the World Bank made $12 billion available in immediate support to help countries coping with the health and economic impacts of the global outbreak. The International Monetary Fund has said $10 billion could be mobilised in loans to low-income countries tackling the virus. On March 13 WHO and its partners launched the <a href="https://www.who.int/news-room/detail/13-03-2020-who-un-foundation-and-partners-launch-first-of-its-kind-covid-19-solidarity-response-fund" data-saferedirecturl="https://www.google.com/url?q=https://www.who.int/news-room/detail/13-03-2020-who-un-foundation-and-partners-launch-first-of-its-kind-covid-19-solidarity-response-fund&amp;source=gmail&amp;ust=1587206340290000&amp;usg=AFQjCNEFMIPH219XuGD5cfiwkL2SpBnokg">COVID-19 Solidarity Response Fund</a> which aims to raise funds from private and corporate individuals to contribute to global response efforts. Meanwhile, the Global Fund for HIV, TB and malaria is to allow some funds to be used for the virus response while the United Nations’ Central Emergency Response Fund global emergency response fund has made $15 million available.Over a month ago, WHO chief Tedros Adhanom Ghebreyesus launched a $675 million preparedness plan hoping to contain the crisis and pave the way to deter future crises. But that is less than 1% of the US 2020 military budget. In late February, the European Commission earmarked $124 million for the WHO response plan, but others have not proved as generous.Added Steinbock: “No matter how it is funded, experts agree that developing countries must be given whatever help is needed to contain the disease. If cases escape detection in poor countries, then it is more likely than not that weak healthcare systems, coupled with endemic poverty and social instability could result in a secondary epidemic with potential global impact.”IPS

A COVID-19 third wave in the Third World?

<figure><img width="1500" height="1000" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108151124/636a67049c7e80680e0599b7jpeg.jpg" alt=""/><figcaption>Lavkant Chaudhary</figcaption></figure>As they enter Lavkant Chaudhary’s Masinya Dastoor exhibition at the Siddhartha Art Gallery, the visitors are strongly drawn to one particular work on display.  They are three canvases titled DDT depicting circles within circles in the first one. Chakra, the circle of life, but it is also a bullseye, and the tiny figures of animals and people are rendered in the style of a traditional Tharu folk art. The figures are the size of an adult mosquito, and a greyscale exterminator points directly at the centre of the target, ready to spray dichlorodiphenyltrichloroethane.The other painting are lifelike paintings of three DDT cans amidst a backdrop of insects, and the third is of a colourful cloud of butterfly silhouettes. <figure><img width="1500" height="1476" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108151124/636a67089c7e80680e0599b8jpeg.jpg" alt=""><figcaption> </figcaption></figure>Chaudhary says the American-supported <a href="https://www.nepalitimes.com/here-now/the-mosquito-that-changed-nepals-history/" target="_blank" rel="noopener">eradication of malaria</a> from Chitwan and the Tharu homeland in the Tarai destroyed not just mosquitoes but but also the Tharu people. The paintings, he says are the “silenced histories of the Tharu community.”The Tharu were genetically immune to malaria, but once the disease was eradicated by killing mosquitos, settlers came in to clear the forests, land was bought at a pittance from Tharus unable to read the land deeds.The Masinya Dastoor is expression through art of an aboriginal people the rulers in Kathmandu treated as expendable. The works are housed in two floors with earthy acrylic on canvas paintings (pictured below), land title copies with ink superimposed, wood carvings, an art installation and video. Each artwork across these various medium connect back to the historical persecution of the Tharu people. <img width="1500" height="1573" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108151124/636a670b9c7e80680e0599b9jpeg.jpg" alt="">Chaudhary says he used to be as ignorant about Tharu history as the rest of Nepalis, but was inspired when he began researching his community during a six-month art project initiated by Artree Nepal in Bhaktapur after the 2015 Earthquake.“All I came across were recurring stereotypical ideas about the Tharu. We were just <a href="https://www.nepalitimes.com/banner/tharu-escargots/" target="_blank" rel="noopener">water snail eaters</a>  jungle dwellers, alcohol drinkers, and an honest tribe. That was our identity,” he recalls.Sangeeta Thapa of the Siddhartha Art Gallery says some indigenous groups in Nepal were taken as bonded labourers since Lichhavi times 1,400 years ago. Later on, under the Shah and Rana dynasties when the caste hierarchy was codified into the first Mulki Ain of 1854, indigenous groups were placed under the category of paani chalne masinya matawali (touchable but enslavable alcohol drinkers) which made them expendable by the state. <figure><img width="1500" height="1000" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108151124/636a670e9c7e80680e0599bajpeg.jpg" alt=""><figcaption> </figcaption></figure>Despite slavery being abolished in 1926, the <a href="https://archive.nepalitimes.com/article/nation/Modern-day-domestic-slaves-domestic-workers,3785" target="_blank" rel="noopener">kamaiya bonded labourer system</a> persisted until it was outlawed as late as 2004. But by then the Tharu had lost most of their land.One of Chaudhary’s art installations is of small wooden boxes hung from the ceiling, each filled with grain and a single brass bullet. Next to it, the Diary series recreates pages carved into wood from the diary of Jokhan Ratgainya, a Tharu journalist and revolutionary who was killed in June 2001. <figure><img width="1500" height="2078" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108151124/636a67119c7e80680e0599bbjpeg.jpg" alt=""><figcaption> </figcaption></figure>In one corner, the Tamasuk series, with pen and ink drawings on Nepali paper, leads into the Dastoor series, stippling drawings of day to day activities on archival paper prints of the dastoor (legal orders).The second floor hosts large striking oil paintings that detail day to day scenes alongside violence: from the conflict years, and the Tikapur massacre of 2015. Another installation is of ghaila pots hanging inside a darkroom which projects light on the walls. On one wall, a video replays a barmasiya folk song and then shows a burning miniature village as eyewitness accounts of violence. <img width="1500" height="1000" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108151124/636a67149c7e80680e0599bcjpeg.jpg" alt="">Chaudhary writes in a description that he has used art to fill the gaps left by Nepal’s mainstream media to communicate the atrocities: “I found strength in unearthing what has remained silent and kept silent by the Nepali media, the state, and civil society.”His art speaks volumes about displacement and resistance, easily comparable to the struggles of indigenous peoples in the subcontinent and beyond. The mix of mediums, attention to detail and the historical narrative woven into each work makes for an exhibition that is an experience, one that sheds light on Nepali history and the indigenous peoples who have been silenced.Masinya Dastoorby Lavant ChaudharySiddhartha Art GalleryUntil January 9 2020

Atrocities against Tharu expressed in art

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108151120/636a66739c7e80680e059980jpeg.jpg" alt="" width="1500" height="1000"/><figcaption>Photo : BIKRAM RAI</figcaption></figure>There used to be a time when the main public health threat in Nepal was from infectious diseases like <a href="https://www.nepalitimes.com/here-now/the-mosquito-that-changed-nepals-history/" target="_blank" rel="noopener">malaria</a>, encephalitis, <a href="https://www.nepalitimes.com/banner/tb/" target="_blank" rel="noopener">TB</a> and typhoid. Whether vector-borne or transmitted through contaminated air or water, the most cost-effective way to address them was through prevention. Communication was the first line of defence against communicable diseases.Things have changed. Awareness has grown because literacy rates are up. Most Nepalis now suffer from non-communicable ailments like cardiovascular diseases, <a href="https://archive.nepalitimes.com/article/nation/diabetes-in-south-asia,3018">diabetes</a>, <a href="http://archive.nepalitimes.com/article/Nepali-Times-Buzz/A-mysterious-rash-of-kidney-failures,3639" target="_blank" rel="noopener">renal failure</a> and malignancies. These need treatment in medical facilities at a time when the over-commercialisation of hospitals has made healthcare unaffordable for a majority of the population. In fact, <a href="https://www.nepalitimes.com/editorial/poor-health/" target="_blank" rel="noopener">poor health</a> is making Nepalis poorer.Read also:<a href="https://www.nepalitimes.com/opinion/is-free-health-care-possible-in-nepal/" target="_blank" rel="noopener">Is free health care possible in Nepal?</a>, S P Kalaunee<a style="background-color: #ffffff; font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/?p=37821&amp;preview_nonce=9ce6a7c55d&amp;preview=true" target="_blank" rel="noopener">Federalism leaves Nepal’s medical sector ailing,</a> Sewa BhattaraiAlso, communicable diseases have not been completely overcome. Diarrhoeal dehydration and other water-carried infections are still major killers. One of the reasons Nepal’s progress in reducing child mortality has stalled is because of the state’s failure to ensure adequate and safe drinking water in remote regions. In this paper we have also reported on <a href="https://www.nepalitimes.com/banner/nearly-half-of-nepali-children-still-malnourished/" target="_blank" rel="noopener">stunting and wasting among children</a> due to malnutrition.In addition, <a href="https://www.nepalitimes.com/here-now/air-pollution-is-more-dangerous-than-smoking/" target="_blank" rel="noopener">worsening air pollution</a> has caused an epidemic of chronic obstructive pulmonary disease (COPD), which has led to lung infections in all age brackets and causing terminal pneumonia and other complications in the elderly. At current levels of PM2.5 concentration in the air, studies show, the average lifespan of city dwellers in Nepal could be reduced by up to four years.Read also:<a href="https://www.nepalitimes.com/here-now/nepal-is-a-microcosm-of-all-of-the-changes-in-world-health/" target="_blank" rel="noopener">"Nepal is a microcosm of all of the change in world health"</a><a href="https://www.nepalitimes.com/editorial/poor-health/" target="_blank" rel="noopener">Poor health</a>, EditorialNepal’s burden of non-communicable diseases and injuries has doubled in the last 25 years, with nearly 15% caused by <a href="https://www.nepalitimes.com/banner/nepals-deadly-roads-take-their-toll/" target="_blank" rel="noopener">road traffic accidents</a> or natural disasters. Traffic accidents are now the second biggest killer of young Nepalis. Just in the past three weeks, 90 people have been killed on highways due to poor road condition or carelessness.A vivid indication of the threat of non-communicable diseases is today’s prevalence of diabetes. South Asians are genetically more susceptible to cardiovascular diseases and diabetes, but there are now new risk factors caused by increasing rural to urban migration. While the world prevalence average for both types of diabetes is 8%, research has shown that 14% of people in Dharan suffer from the disease. Taplejung, from where many have migrated to Dharan, has a rate of only 1%. The reason is clear: increased intake of carbohydrates and a more sedentary lifestyle when people move to cities.To meet these challenges, Nepal desperately needs <a href="https://www.nepalitimes.com/opinion/is-free-health-care-possible-in-nepal/" target="_blank" rel="noopener">affordable and accessible medical care</a>. At the moment, hospital treatment is neither. The poor in remote, underserved areas of the country are disproportionately vulnerable. As our report from Bajura shows, the problem is further complicated because confusion over federalism, budget and jurisdiction has left most rural government hospitals underfunded and underserved. It is imperative that the government act quickly to resolve the retention crisis caused by medical staff getting themselves transferred out of their jobs in remote areas.Read also: <a href="https://archive.nepalitimes.com/article/nation/national-health-insurance-not-as-easy,4028" target="_blank" rel="noopener">A national health insurance is not as easy as it looks</a>, Sonia Awale<a href="https://www.nepalitimes.com/banner/this-is-how-to-upgrade-nepals-rural-health/" target="_blank" rel="noopener">This is how to upgrade Nepal's rural health</a>, Sewa BhattaraiA survey last year showed that half of all <a href="https://archive.nepalitimes.com/article/nation/national-health-insurance-not-as-easy,4028" target="_blank" rel="noopener">medical expenditure of Nepalis families</a> is out-of-pocket, and 60% of that is for treatment of non-communicable diseases and injuries. The federal government allocates only about 10% of its budget to health care, and the focus is still on communicable diseases. Donor priority is also not on non-communicable diseases and injuries. A study of government hospitals by the Nick Simons Institute shows a huge unmet need in remote areas for basic surgery like caesarean sections and orthopaedics.One bright spot ahead is the success of pilot insurance schemes being tried out in various parts of the country. In a <a href="https://www.nepalitimes.com/opinion/is-free-health-care-possible-in-nepal/" target="_blank" rel="noopener">commentary this week</a>, S P Kalaunee of Nyaya Health, an NGO that helps the government manage hospitals in Achham and Dolakha, presents a proven 60:25:15 formula of health insurance. In this arrangement, non-profits, the private sector and all three levels of government can make medical care affordable to all Nepalis, if upscaled. Under the scheme, 60% of the cost of care comes from insurance, provincial governments pay 25% and municipalities take care of the remaining 15%.Parts of the scheme are being tried out in <a href="https://www.nepalitimes.com/banner/this-is-how-to-upgrade-nepals-rural-health/" target="_blank" rel="noopener">Bayalpata Hospital in Achham</a> (which last week <a href="https://www.nepalitimes.com/banner/bayalpata-hospital-in-nepal-wins-global-design-award/" target="_blank" rel="noopener">won the Global Architecture Festival award</a> in Amsterdam for its design). Insurance reimbursement covers the cost of insurance-covered care, the local government allocates funds required for basic and emergency healthcare, and the provincial government pays for managing the cost of referrals beyond insurance coverage. Internationally, this has become an issue with 12 December marked as Universal Health Coverage Day.Nepal’s constitution now guarantees basic and emergency healthcare as fundamental rights of citizens, and puts the responsibility on to the state. The government  can no longer keep passing the buck on providing universal insurance for its citizens.<h2>10 years ago this week</h2>Nepali Times <a href="http://archive.nepalitimes.com/issue/480" target="_blank" rel="noopener">issue #480 of 11-17 December 2009</a> carried an <a href="http://archive.nepalitimes.com/news.php?id=16572#.XfId7ZMzaUk" target="_blank" rel="noopener">interview on page 1 with Baburam Bhattarai</a>, who was then vice-chair of the Maoist party.  Excerpts:‘From the very beginning, we have said that the basis of the federal system should be nationality. In Marxist terms, nationality means a common language, geography, economy and psychological make-up. A group of people that shares these qualities is called a nationality.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108151120/636a66769c7e80680e059981jpeg.jpg" alt="" width="392" height="600">On this basis we have proposed to constitute federal autonomous units in Nepal and we also practised this during the People’s War. Since the very beginning we have been consistent that federalism should be along the lines of nationality.’

POOR HEALTH MAKES NEPALIS POORER

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108131144/636a4f509c7e80680e04fcfejpeg.jpg" alt="" width="1250" height="934"/><figcaption>George Brooks inspecting vegetable farm in the early 1950s. Photo: US NATIONAL ARCHIVES</figcaption></figure>Race formed a contentious part of the early Cold War in South Asia. During the 1950s, several African American aid workers found themselves in the middle of a changing Nepal, and a changing world.The first African American technician in Nepal was George Talley Brooks, a 30-year-old entomologist who arrived with his wife Mary in September 1952. He was the only African American in Kathmandu among 10 Americans mostly from rural states, in the years just before Martin Luther King and the civil rights movement changed the US.Brooks and his wife had their own motivations for coming to Nepal, amidst larger historical forces of Cold War competition between the US and the communist bloc.‘The coloured peoples of Asia and Africa, who total two-thirds of the world’s population, seldom think about the United States without considering the limitations under which our 13 million Negroes are living,’ US Ambassador to India and Nepal <a href="https://archive.nepalitimes.com/article/nation/land-reform-in-cold-war-Nepal,4192" target="_blank" rel="noopener">Chester Bowles</a> wrote in 1953.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108131144/636a4f529c7e80680e04fcffjpeg.jpg" alt="" width="1250" height="1290"><figcaption> </figcaption></figure>South Asian audiences often asked Bowles about the treatment of African Americans, particularly segregated schools and violence against blacks. ‘I can think of no single thing that would be more helpful to us in Asia than the achievement of racial harmony in America,’ Bowles noted.As ambassador, Bowles encouraged the recruitment of African Americans for US overseas work. ‘I have tried in every way I know to get qualified Negroes assigned to our posts in India ... the Negroes we have had have done us a world of good,’ he wrote.George Brooks' main job in Nepal was to devise ways to control crop pests, including with <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/how-chitwan-was-opened,4159" target="_blank" rel="noopener">pesticides</a>. Because of his entomological expertise, he was brought into <a href="https://www.nepalitimes.com/here-now/the-mosquito-that-changed-nepals-history/" target="_blank" rel="noopener">malaria control programs using DDT</a>. He and George Moore, the American mission’s first physician, designed one of the first malaria programs in Nepal, in Balaju.Brooks also accompanied US Operations Mission (USOM) Director <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/how-chitwan-was-opened,4159" target="_blank" rel="noopener">Paul Rose</a> on the 1952 survey trip to Chitwan that led to America’s major project in Nepal for the next decade, and whose first on-the-ground American director, Herman Holliday, was also non-white. Brooks enjoyed malaria work so much that he switched to <a href="https://www.nepalitimes.com/editorial/poor-health/" target="_blank" rel="noopener">public health</a> for the rest of his career.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108131144/636a4f569c7e80680e04fd00jpeg.jpg" alt="" width="1250" height="1555"><figcaption> </figcaption></figure>Unlike some of his American and Nepali colleagues, Brooks did not look down on Nepal’s rural peasants. In a report, he noted Nepal's ‘crude and inefficient’ agricultural methods but also spoke of ‘the ingenuity of the people’. Relations with his American teammates were mixed. Brooks got on well with fellow scientist and malaria worker George Moore. Pictures show the two of them together on a research trip to Helambu.But according to Nancy Dammann, who worked for the US Information Service in Nepal, the other Americans (mostly from the American South) at first ‘snubbed’ Brooks and his wife ‘because they were black’. A former history teacher, Mary Brooks made some of her less accomplished white neighbours nervous.Yet, Mary and George Brooks got along well with Nepalis. Interested in Nepali history and language, Mary Brooks had good relations with Nepali women. She and her husband were the first Americans to invite Nepalis to their house. Most other Americans mixed with Nepalis only at work and at official receptions.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108131144/636a4f599c7e80680e04fd01jpeg.jpg" alt="" width="1500" height="1143"><figcaption> </figcaption></figure>Dhruba Bhakta Mathema, who worked for the US program, grew very fond of George Brooks and, because of him, America more broadly. About Brooks, Mathema once told me, “We learned that those who studied could advance despite their background and colour.”The British Embassy in Kathmandu also kept the African American couple out. “We don’t invite Negroes to our parties if we can help it,” a British second secretary told Dammann. In June 1953, Brooks and his wife were deliberately left off the invitation list for the coronation party of Queen Elizabeth. Once they learned of this, the other Americans refused to attend as well. ‘I was proud to watch my southern countrymen decide to turn down the coronation invitation,’ Dammann wrote.American race relations often came up in conversations with Nepalis. After one dinner at the home of Foreign Minister Khadgaman Singh, a former political prisoner, an informal debate was set up between George Moore, the only American present, and a supporter of Nepal’s Communist party.As Moore later recalled, the Communist leader gave an animated talk in front of the guests, highlighting corruption in the US, exploitation of the poor and racial discrimination, including the violence American blacks faced, such as lynchings. Moore, a New Jerseyian who had recently worked in Virginia, countered that the situation had changed and that American blacks now had many opportunities. As Exhibit #1, he pointed to George Brooks.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108131144/636a4f5b9c7e80680e04fd02jpeg.jpg" alt="" width="1000" height="652"><figcaption> </figcaption></figure>It was a complicated time. In the late afternoon one day in 1954, several Americans drove into Kathmandu to shop, arriving in the city centre to find themselves in the middle of a Communist anti-American rally. Noticing the American jeep, the demonstrators quickly surrounded it. Red Saunders, the American who was driving, navigated slowly through the crowd. Suddenly, someone cut the top of the jeep with a knife, terrifying its American occupants, who quickly returned to their Rabi Bhawan compound, rattled but unharmed.One of the women in the car was Mary Brooks, an outspoken critic of racial hierarchy and discrimination in the US. It is unlikely that the protestors knew that the jeep held one of the African Americans that their compatriots often used as evidence of America’s exploitative ways. Unfortunately, there’s no record of how Mary Brooks or the others involved made sense of the contradictions of the event, or the profound complexities of early Cold War politics.Tom Robertson, PhD, is the author of ‘Front Line of the Cold War: The US and Point Four Development Programs in Cold War Nepal’ 1950-1953 in the June issue of Studies of Nepali History and Society. He is director of Fulbright Nepal. His views are his own.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108131144/636a4f5e9c7e80680e04fd03jpeg.jpg" alt="" width="500" height="487">

African Americans in Cold War Nepal

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221107171136/636934889c7e80680e03dfffjpeg.jpg" alt="" width="1400" height="700"/><figcaption>Photo: UNICEF</figcaption></figure>Polio eradication is one of the most ambitious public health initiatives undertaken in human history. Launched in 1988 by the World Health Organization (WHO) the campaign aimed to rid the world of the virus by 2000. But 30 years on and $15 billion later, even though polio cases worldwide have been reduced by 99%, there are still isolated pockets of the disease. And unless every last case is removed, there will always a chance that the infection will come back.Encouraged by the eradication of small pox, WHO launched the campaign in 1988. The organisation debated the wisdom of spending so much time and money to exterminate a disease when there were many other more pressing health concerns like <a href="http://malaria https://www.nepalitimes.com/here-now/the-mosquito-that-changed-nepals-history/" target="_blank" rel="noopener">malaria</a>, <a href="https://www.nepalitimes.com/banner/tb/ or diarrhoea" target="_blank" rel="noopener">TB</a> or diarrhoea that kill many more people.https://www.youtube.com/watch?v=KQd_-6W_9Gg&amp;feature=youtu.beThomas Abraham, a journalist who taught health reporting at the University of Hong Kong, has tried to answer this and other questions in his new book <a href="https://www.amazon.co.uk/Polio-Odyssey-Eradication-Thomas-Abraham/dp/1849049564" target="_blank" rel="noopener">Polio: The Odyssey of Eradication</a>. He says polio was held hostage by geopolitics, and traces the reason why countries opted for a weak vaccine against a strong virus. The author concludes that future global campaigns that zero in on just one disease must be weighed against the necessity of upgrading public health, especially in poorer countries.In Nepal, indigenous <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/Bouncing-back-higher-wheelchair-basketball,3802" target="_blank" rel="noopener">polio</a> was eliminated in 2000 after the country responded to WHO’s eradication goal by adding polio to its successful campaign of vaccination against other diseases. However, there were still polio cases in Nepal brought over the border from India. The last case of polio was detected in Rautahat district in 2010, and <a href="http://archive.nepalitimes.com/blogs/thebrief/2014/03/28/polio-free-nepal/" target="_blank" rel="noopener">Nepal was finally declared polio free</a> four years later.In response to a query from Nepali Times this week, however, Abraham said Nepal is not out of the woods yet. “If polio re-emerges in India, particularly UP and Bihar, this would be a major challenge to Nepal,” he said. “Also, if levels of routine childhood immunisation fall in Nepal there is a danger of outbreaks of vaccine derived polio, as we are seeing in a number of countries.”Even though polio has been largely removed, there are still cases in Pakistan, Afghanistan and Nigeria where vaccination campaigns have been thwarted by religious extremists. Ironically, enmity between India and Pakistan and the heavily guarded border between the two countries has minimised the risk of polio spreading via India to Nepal.Polio derived from oral vaccines has emerged as a new threat to the eradication campaign. By 2016, WHO deployed a combination of Inactivated Polio Virus (Salk vaccine) and bivalent oral vaccine to prevent further outbreaks.“Routine immunisation levels need to remain high in order to maintain Nepal’s polio-free status. Luckily, we have a strong disease surveillance system to detect any new polio cases,” said Jhalak Sharma Gautam of the Department of Health Services.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221107171136/6369348b9c7e80680e03e000jpeg.jpg" alt="" width="640" height="869"><figcaption> </figcaption></figure><a style="background-color: #ffffff; font-size: 15px; letter-spacing: 0.01em;" href="http://archive.nepalitimes.com/news.php?id=16116#.W_aWJTgzaUk" target="_blank" rel="noopener">Polio</a> is one of the oldest diseases to afflict humans, but it wasn’t until the beginning of 20thcentury that there were outbreaks in Europe, North America and Australia. US President Franklin D Roosevelt was paralysed by poliomyelitis, and because of this the US threw considerable political influence and funds to back polio vaccine research.The first was the Salk vaccine that used inactivated poliovirus, and protected individuals injected with right dose, but it did not stop the transfer of the disease. The Sabin vaccine in 1961 employed a weakened poliovirus to be administered orally. It was cheaper and easier to use and protected individuals from paralysis as well as stopped polio transmission, which eventually led to it being chosen as a tool of eradication.Despite its success, the Global Polio Eradication campaign has been criticised for its huge cost and for widening the gap between local health needs and global health programs. In his book, Abraham puts his experience as a foreign correspondent to good use by visiting the frontlines of the battle against polio in Pakistan, India and Nigeria. He writes about the <a href="https://www.nytimes.com/2018/01/22/health/polio-pakistan-killing.html" target="_blank" rel="noopener">assassinations of polio vaccinators in Pakistan</a> and Afghanistan by the Taliban.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221107171136/6369348e9c7e80680e03e001jpeg.jpg" alt="" width="1250" height="441">A considerable portion of the book deals with a long-standing debate about whether targeting a single disease for eradication should take precedence over strengthening national health systems. This resonates with WHO’s own reluctance to endorse polio eradication for a long time in favour of a strong primary health care system.This book is a recommended read for public health professionals, but it has lessons for anyone who wants to better understand the inner workings of health systems, donor agency priorities, and what goes on behind the scenes in Geneva.Abraham is neither an epidemiologist nor a medical practitioner, he is a journalist with over 25 years of experience covering conflict, politics and health. Maybe that is why the book reads more like a thriller with an engaging real-life account of what goes right (and what can go wrong) in the fight against a disease-causing pathogen.Read also:<a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/Bouncing-back-higher-wheelchair-basketball,3802" target="_blank" rel="noopener">Bouncing back</a>, Shreejana Shrestha<a href="http://archive.nepalitimes.com/news.php?id=16116#.W_aWJTgzaUk" target="_blank" rel="noopener">Laxmi dreams of flying</a>, Rupa Joshi

Sonia Awale

Polio hunt

<figure><img width="1500" height="1146" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221104141144/636517409c7e80680e02c268jpeg.jpg" alt=""/><figcaption>OUTBREAK: Experimental spraying for mosquitos on inner walls of houses in the Tarai in the 1950s. Pic: USOM records, US National Archives, College Park, Maryland</figcaption></figure>since 1900, who has most significantly changed the flow of events? Many people would point to influential political actors like Chandra Shumshere or King Mahendra, even Prachanda.My answer: the Anopheles minimus mosquito.Although mountains loom large on Nepal’s horizon, much of the country’s history has been shaped by a lowland disease: <a href="http://archive.nepalitimes.com/regular-columns/Comment/learning-from-malaria%20,971">malaria</a>. One visitor to Nepal in the 1920s (somewhat dramatically) called malaria ‘a name which hums an undertone of death throughout the chronicles of Nepal’.Malaria has long plagued the Tarai, but also, places like Pokhara in the hills. Just as malaria shaped Nepal’s past, its almost complete removal in the 1960s and 1970s has shaped Nepal’s present, launching vast demographic, environmental, and political changes that are still playing out. <figure><img width="640" height="384" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221104141144/636517439c7e80680e02c269jpeg.jpg" alt=""><figcaption> </figcaption></figure><a href="http://archive.nepalitimes.com/article/Nepali-Times-Buzz/Buzz-guts-of-the-anopheles,548">Anopheles minimus</a> was a central actor in these stories. It carried the country’s most dangerous malaria and its susceptibility to chemical spraying hastened the decline of the disease. Had this little mosquito possessed different habits, Nepal’s history would have unfolded very differently: malaria would have killed fewer people, and its removal would not have been so quick and complete.Many people think of malaria as a Tarai disease that originates in dirty, stagnant water during the monsoon. In fact, Nepal’s malaria was several different diseases, came mostly from clean water, declined during the height of the monsoon, plagued the hills as well as the Tarai, and affected various parts of the Tarai differently. ‘The whole of the Tarai,’ one scholar has noted, ‘was not equally malarious.’Malaria is not just one disease, but ‘a kaleidoscope of different infections’. Nepal had two types of malaria: vivax (‘the great debilitator’) and falciparum (‘the deadly killer’). Falciparum often caused anemia, and if untreated, brought epilepsy, blindness, brain misfunctions—and even coma and death.It was most likely falciparum that Father Giuseppe de Rovato described in 1868: ‘At the foot of the hills, the country is called ‘Teriani’; and there the air is very unwholesome from the middle of March to the middle of November: and people in their passage catch a disorder called in the language of that country Aul, which is a putrid fever, and of which the generality of people, who are attacked with it, die in a few days.’ “Mosquitoes are justifiably unloved, but unjustifiably understudied by historians.” <img width="100" height="115" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221104141144/636517469c7e80680e02c26ajpeg.jpg" alt=""> John McNeill Historian Two mosquito species carried malaria in Nepal: Anopheles fluviatilis and Anopheles minimus. Both preferred to breed near clean water in Nepal’s two main malarial zones: hill valleys, and the forest belt on either side of the Chure Range.‘No elevation short of 3,000 to 4,000 feet above the sea,’ British resident<a href="http://archive.nepalitimes.com/news.php?id=3246#.Wrh4gtRua70"> Brian Hodgson</a> noted in the mid nineteenth century, ‘suffices to rid the atmosphere of the low Himalaya from malaria.’This was mostly vivax, not falciparum, but it still had big impact: hill communities generally placed their settlements above 3-4,000 ft and only partially cultivated the fertile land of valley floors.Another surprise: not all of the Tarai had bad malaria. Indeed, by the 1960s, the southern belt along the Indian border between Nepalganj and Biratnagar had very little malaria. This shocked government entomologists who searched for malaria-carrying mosquitos but found neither An. minimus nor An. fluviatilis.It was the forest belt that harboured the country’s most dangerous malaria. Straddling the Chure hills, this strip included Inner Tarai valleys like Chitwan, Sindhuli and the undisturbed northern parts of the Tarai.Here, the main carrier of the most lethal form of malaria (falciparum) was the Anopheles minimus. Because it was very small and bit softly and mostly at night, it often went undetected, making it particularly dangerous. Shirtless men sitting in the evening air for an hour or two could get 25-30 bites. <figure><img width="640" height="458" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221104141144/636517479c7e80680e02c26bjpeg.jpg" alt=""><figcaption> </figcaption></figure>But the minimus was easily wiped out by insecticides like DDT. This was because, as a Nepali entomologist once told me, minimus acted ‘like a king’. It had refined tastes. Unlike other mosquitos, it preferred not animal but human blood, and after feasting sought out comfortable accommodations — resting inside houses, not outside. DDT was easiest to spray on walls inside houses, exactly where minimus liked to hang out.During the 1950s and 1960s, <a href="http://archive.nepalitimes.com/article/Nepali-Times-Buzz/how-chitwan-was-opened,4159">the World Health Organisation and United States</a> led a global campaign to wipe out malaria in scores of countries around the world, including Nepal. Many of these efforts fell far short of the goal, mostly because the mosquito carriers proved hard to eliminate or they developed <a href="http://archive.nepalitimes.com/news.php?id=5624#.Wrh4zdRua70">resistance</a> to insecticides and medicines. In Nepal, however, despite manpower shortages and a daunting geography, eliminating the Anopheles minimus proved relatively easy. Although never reaching complete eradication, Nepal’s program proved far more successful than most.The near complete removal of malaria in a country whose history had been moulded by the disease brought dramatic changes: vast movements of people from the hill ridges to valley floors and to the Tarai, as well as movement north from the plains. There was large-scale deforestation and habitat loss, and tumultuous social and political reconfigurations. Almost everyone was affected, but especially the Tharu, one of Nepal’s largest ethnic groups, who lived primarily in or near the forest belt.These changes would probably never have come, at least not in exactly the same form, had the Anopheles minimus possessed slightly different habits. Indeed, if it had not liked resting exactly where DDT was sprayed, malaria might still be a dominant force in Nepali life.This little non-human actor deserves a big place in Nepal’s history books alongside the much better known political movers and shakers. Tom Robertson is an environmental historian and Executive Director of Fulbright Nepal. A longer version of this article will appear in this month’s Journal of American History.Read also:<a href="http://archive.nepalitimes.com/regular-columns/Comment/learning-from-malaria%20,971">Learning from Malaria</a>, Bjørn Lomborg<a href="http://archive.nepalitimes.com/news.php?id=5624#.Wrynky5ubIV">The return of the parasites</a>, Hemlata Rai

malaria