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

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Dengue danger returns with monsoon

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

As Covid abates, Nepal sees dengue outbreak

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

Tom Robertson

The dangers of the dengue virus

Rivers have been the lifelines of civilisations with their dynamic ecosystems providing vital services for human survival and ecological balance through the ages.&nbsp; But accelerating anthropocentric footprints are causing severe, and often irreversible, damage to river systems across the world, including those across High Asia, a region that sustains nearly a fourth of the global population downstream. An example is the <a href="https://nepalitimes.com/here-now/how-the-bagmati-civilisation-is-becoming-uncivilised" target="_blank">Bagmati River</a> that courses through Kathmandu, crosses the Himalayan foothills to join the Ganga in India. A river that once shaped the <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/when-it-comes-to-water-pollution,3196" target="_blank">Kathmandu Valley Civilisation </a>is now a polluted and biologically dead water body constricted by urban sprawl, choked by construction debris, chemical waste and untreated sewage.&nbsp; The loss of a sacred river is tragic enough, but its hazards related to health, life and livelihoods are not limited to the Valley, nor is its enormity fully gauged by the metrics of fatality, income loss, flood return periods, runoffs, embankment failure.&nbsp; It is a systemic collapse of ecological integrity, socio-economic stability and cultural heritage, affecting its downstream users as well. The death of Bagmati is a peril for a population size way bigger than circa 5 million residents of Kathmandu Valley. The degradation started in the 1980s and has accelerated. Why has not enough been done to save this iconic river that runs through Nepal’s capital?&nbsp; The Bagmati River Basin Improvement Project (BRBIP) was designed to make headway in restoring the river with a sewage treatment plant, dams for storing water to support dry-season runoff, recharge groundwater, creation of <a href="https://archive.nepalitimes.com/page/resurrecting-bagmati-the-river" target="_blank">green biodiversity corridors</a> along the river bank to also serve as recreation areas, reduce the urban heat island effect, and also provide cultural continuity. The project also envisages collection of hydrological data for managing Bagmati multipurposewater systems and providing flood forecasts and early warnings aimed at protecting lives and property, among other things. Most importantly, the project takes the integrated water resource management approach, which, in principle, is a holistic and collaborative way of managing all elements of the water cycle to ensure water security, public and environmental health and amenity.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260329040336_9605240fa8c7d649ce49fbe43565130e3187e979338ccf959c4e9b8c581b7a4c.jpg" data-media-id="editor_3" data-image-id="20260329040336_9605240fa8c7d649ce49fbe43565130e3187e979338ccf959c4e9b8c581b7a4c" data-rendition-name="original" width="2126" height="1577" loading="lazy" alt="Bagmati NT"> </figure>  This should pave the way for managing a river as a connected ecological, social, and economic system by enabling coordination across agencies and disciplines, stimulating technological innovation and financial investment. The success of this approach depends on long-term political will and commitment that transcend political cycles, but also needs strong community and civil society in defining issues and proposing solutions, creating and sharing knowledge, taking independent action to inform practice, monitoring and evaluating policies, and participating in public decision-making. Civil society, especially, in making the <a href="https://archive.nepalitimes.com/page/encounter-with-bagmati-river" target="_blank">revival of the Bagmati River</a> a pressing governance issue. The Bagmati Action Plan 2009, a precursor to the BRBIP, was designed in response to lawsuits filed in 2000 and 2004 by an independent legal practitioner of Kathmandu against waste dumping in the river.&nbsp; It took him almost two decades of legal battle for Nepal’s Supreme Court to pass orders for mandatory septic tanks in all homes in Kathmandu Valley, relocation of squatters from Bagmati river banks to government-built houses, and embargo on dumping and burying garbage on the banks of the river and its tributaries. Despite court orders, however, actual results have been unsatisfactory. Restoration of Bagmati barely made it to any political debate or electoral manifesto this time. Treatment plants have not been operational for years, yet no one is held accountable. The population ignores waste segregation or single-use plastic rules to check littering.&nbsp; The current condition of the river therefore seems to have more to do with the lack of public awareness and behaviour change than the failure of various master plans. Why does the deep danger of a dead river fail to arouse widespread civil society concern, let alone action? The apathy is perhaps underlined by an innately anthropocentric understanding of the river as a mere resource to be exploited, rather than the backbone of existence.&nbsp; Such a paradigm shift is possible when river or river systems are understood to be necessary for &nbsp;a harmonious coexistence with human populations. The more pertinent question is not whether a dead river can be restored because there are many examples from around the world where that has been successfully achieved. It is whether we choose to restore our rivers for intergenerational equity. This would require a holistic perspective and political will to revive reverence for a river system so that its symbiotic relationship with human settlements can be restored. Roshni Gurung is Research Assistant, River Basins at the International Centre for Integrated Mountain Development (ICIMOD).

A lifeline becomes liability

As a direct fallout of the Israel-American war on Iran, Nepal on Monday nearly doubled the price of aviation fuel in a move that is going to impact during the spring peak tourism season. The steep price hike of jet fuel appears to have been made to cushion the impact on the general public. The price of petrol, diesel and cooking gas were also hiked for the third time in a month on Thursday.&nbsp; Aviation turbine fuel (ATF) will now cost $2,237/ton up from $1,207. The cost of ATF in Kathmandu was <a href="https://nepalitimes.com/news/sky-high-fuel-price-hits-nepal-s-tourism-airlines" target="_blank">already one of the highest among Asian airports</a>, and this price hike will affect mostly long-haul flights to Istanbul, Seoul and Narita for airlines that need to refuel in Kathmandu.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260404130420_4ae075d1e871fc5608cf242d6e309005d30cfdb6e6d0ecfb45ca7388a851c6aa.png" data-media-id="editor_1" data-image-id="20260404130420_4ae075d1e871fc5608cf242d6e309005d30cfdb6e6d0ecfb45ca7388a851c6aa" data-rendition-name="original" width="1784" height="1294" loading="lazy" alt="aviation turbine fuel prices"> </figure>  Domestic airlines, which paid Rs127 per litre, will now have to pay Rs251 for their turboprop planes. “We have no recourse but to pass this on to passengers as a fuel surcharge,” said one executive of a domestic airline in Nepal. As it is, Nepal Oil Corporation levied a hefty tax on petrol and ATF in order to subsidise diesel and cooking gas. Many analysts were expecting a fuel price hike, but the near-doubling of the price of ATF means the new Nepal government is trying to protect ordinary citizens from raising the price of diesel and LPG even more than it has so far. Aviation fuel in Nepal is trucked in on tankers from Indian refineries and its price is highest in Kathmandu, and less in Bhairawa and Pokhara — transportation costs being higher depending on distance. But even in Bhairawa, ATF prices have doubled for the only international airline that serves it, Thai AirAsia.&nbsp; Most airlines flying Kathmandu from nearer airports in India, the Gulf and Southeast Asia will be less impacted because they can fly in on full tanks and need minimum refuelling in Kathmandu. But carriers like <a href="https://nepalitimes.com/banner/high-cost-lays-aviation-low-in-nepal" target="_blank">Turkish Airlines</a>, Cathay Pacific, Korean Air, &nbsp;and Nepal Airlines which fly wide body aircraft on long-distance routes will be hit hardest.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026040305040_a40db74375ebe0c28e7c35477bc262df9ae392a84e7bfa4033996181d69e0209.jpg" data-media-id="editor_3" data-image-id="2026040305040_a40db74375ebe0c28e7c35477bc262df9ae392a84e7bfa4033996181d69e0209" data-rendition-name="original" width="1032" height="689" loading="lazy" alt="sky high prices"> </figure>  However, ATF costs have also been raised in regional airports like Hong Kong, India and Singapore. Aviation fuel at New Delhi airport has risen to $1,698/ton. Korean Air is adopting emergency measures to reduce expenses to make up for rising fuel costs. South Korea gets nearly all its fuel from the Gulf, and the blocking of the Strait of Hormuz has been especially damaging for the country. Fuel makes up more than a third of the operating cost of airlines, and even a small increase in ATF prices can make a big difference. Crude oil prices have increased 50% since the West Asia war began on 28 February, and global ATF prices have doubled.&nbsp; Airlines in Asia, including Nepal, face a double shock. The first is the higher fuel cost, and the second is that fewer people are travelling. Nepal’s tourism arrivals fell in March compared to February. India has added up to 20% fuel surcharge on domestic flights, and has reduced flights by 12%. Chinese airlines have also been affected, with China Eastern preparing for a significant impact of the Gulf war. It has added fuel surcharges to new tickets, as have Cathay Pacific, Thai International and Air Asia. Vietnam has drastically cut the number of domestic flights, and the Philippines will ration ATF. Australia imports 90% of its ATF mainly from China which has stopped export to ensure domestic supply to its own airlines. Carriers like Qantas have curtailed flights, changing aircraft type on long-haul routes, and a fuel surcharge of up to 20% have been added to tickets. Most Asian airlines are adding fuel charges only to new tickets, and the increase will not affect the price of pre-sold tickets issued for April and May.

Fuel price shock hits Nepal aviation

<a href="https://www.triarchypress.net/michael-thompson.html" target="_blank">Michael Thompson</a>, who died on 18 March after suffering a stroke a few weeks earlier, was a former Gurkha officer, mountaineer, and <a href="https://soscbaha.org/lecture-series/cultural-theory-and-clumsiness-some-lessons-from-nepal/" target="_blank">founding pillar of Cultural Theory</a>.&nbsp;
His daughter Ursula said it was a peaceful end, Mike himself had asked to be taken off medical support after doctors said they could do no more.
Together with his PhD adviser, the late Mary Douglas and fellow PhD student Steve Rayner of Oxford’s Institute for Science, Innovation and Society, Mike chose to generalise from years of anthropological work—unlike other social anthropologists—to filter out common traits of human behaviour across time and space, and then to apply that to modern society and its conflicts.
Cultural Theory has also been used to explain water and energy conflicts in Nepal and California, seat belt and pension fund battles in Europe, the underlying social dynamics of kibbutz in Israel, and what Mike liked to call “argumentative technology assessment” plus much more.&nbsp;
Unlike other ‘descriptive’ social sciences, Cultural Theory is ‘interpretive' in its orientation, which makes many in the ‘descriptive tradition’ rather uneasy with its ‘uncomfortable knowledge’.
A classic example is the massive almost six-year exercise that resulted in the multi-country, multi-author 4-volume study Human Choice and Climate Change led by Steve Rayner and Elizabeth Malone for the US Department of Energy and the Pacific North-West Lab.
It was, and perhaps still is, the first time that the social sciences looked seriously into climate change. However, its insights and conclusions were uncomfortable enough for it to be ignored, and only Mike Hulme of the Tyndall Center covered it as a chapter in his book Why We Disagree About Climate Change a dozen years later.
During my various lectures around the world, I myself have found younger scholars in China, India, South Asia, South-East Asia, Africa and Latin America much more welcoming and open about Cultural Theory interpretations than in Europe or America.
Mike liked to say that his own work on Cultural Theory was initially conceptualised while <a href="https://archive.nepalitimes.com/news.php?id=3633" target="_blank">he was in Nepal climbing mountains</a>. He was part of the British expeditions on Annapurna’s South Face in 1970 and Everest Southwest Face in 1975.
Even while working on his PhD under Mary Douglas, which was published by Oxford University Press as Rubbish Theory: The Creation and Destruction of Value. Mary Douglas and others having done work on the Cultural Theory of everyday goods and consumption (including drinking), Mike’s Rubbish Theory showed how unwanted trash or scrap eventually became invaluable antique.&nbsp;
Unfortunately, OUP withdrew the book after its eminent economics professor-board member objected to the book showing the limitations of economics in explaining value.
When I asked his wife Anne why Mike was not republishing it, she said it was probably because he is practicing what he preaches, hoping to see if that book can transit from discarded ‘waste’ to achieve ‘antique value’. &nbsp;It did, and was being put up on Amazon for an astronomical sum until Pluto Press republished it.&nbsp;
In line with Cultural Theory, which examines and explains everyday life, Mike’s sociology of mountaineering expeditions was published in Diadem Books’ Mirrors in the Cliffs in 1983 as a hilarious but astute piece titled Sahibs and Sherpas.
I first met Mike in April 1986 at the now famous <a href="https://nepalitimes.com/news/in-memoriam-jack-d-ives-1931-2024-rqpsk7eh" target="_blank">Mohonk Mountain Conference</a> in upstate New York, the conference with most of the world’s eminent mountain experts which resulted in a major scientific paradigm shift – the debunking of the <a href="https://archive.nepalitimes.com/news.php?id=1211" target="_blank">Theory of Himalayan Degradation</a>.&nbsp;
It resulted in the book <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/Sustainable-Mountain-Development-Getting-the-Facts-Right-Jack-D-Ives,946" target="_blank">Uncertainty on a Himalayan Scale</a> (with Warburton and Hatley), which was republished in 2007 by Himal book with a long updating foreword by Mike and me.
Our collaboration continued across many centres in the US and Europe starting with San Diego’s Western Behaviourial Sciences Institute in 1989/90 where I first met Mary Douglas and Steve Rayner (and became the first person in Nepal to tele-conference via landline phone connected to San Diego’s computer system).&nbsp;
We continued on to Battelle Pacific Northwest National Lab in Washington state that resulted in the monumental 4-volume Human Choice and Climate Change, and involved work with Oxford’s James Martin Institute for Science and Civilization, King’s College London, LOS Center in Bergen, places in Germany and very much at the <a href="https://iiasa.ac.at/options-magazine/summer-2022/people-profile-from-everest-to-systems-analysis" target="_blank">International Institute for Applied Systems Analysis (IIASA/Laxenburg)</a> since the early 1990s.&nbsp;
During forays to Europe and transits through London, I often stayed with Mike and Anne at their London Highbury-Islington house and later in Bath when he moved there. Incidentally, they had bought the London house rather cheap before its gentrification (their neighbour was a school where Tony Blair’s young children studied).
Between <a href="https://archive.nepalitimes.com/news.php?id=4675" target="_blank">mountaineering </a>and Cultural Theory, Mike worked as a builder, and he single-handedly retrofitted their London home, which he later sold to buy a much bigger and better house in Bath with money to spare as retirement fund.
The idea of what was good versus bad development in the Himalaya from a perspective was further developed as an IIASA/Oxford Science and Society research resulting in our 2017 book Aid, Technology and Development: the Lessons from Nepal.&nbsp;
While he was in Nepal for that research, we did manage to get him to deliver a <a href="https://soscbaha.org/lecture-series/cultural-theory-and-clumsiness-some-lessons-%20from-nepal/" target="_blank">Social Science Baha</a> lecture on the book’s essence, <a href="https://soscbaha.org/lecture-series/cultural-theory-and-clumsiness-some-lessons-from-nepal/" target="_blank">Cultural Theory and Clumsiness: Some Lessons from Nepal</a>.&nbsp;
Sometimes our collective writings came from discussions in the strangest of ways and places. After a long meeting at the IIASA schloss, we ended up in a pub for beer, and the discussions were around what it would take for a city to be a force for good and not one bad for the environment.&nbsp;
If such a city could be designed, one could plonk it on the middle of a degraded landscape, which theoretically should then heal itself. Someone less inebriated obviously took notes and circulated it, which eventually resulted in the Engineering Sustainability paper On Governance for Re-engineering City Infrastructure.
Another time, I had to give a keynote presentation at an IIED/Sussex STEPs Center dialogue in London’s Goodenough College on re-imagining Development in LDCs. Following that talk, we sat down and produced our Restoring Development Dharma with Toad’s Eye Science.
Just before Covid struck, we (including Bruce Beck and Joanne Linnerooth-Bayer from IIASA) had been working on a Cultural Theory examination of four schools of engineering thought, our last meeting was at Steve Rayner’s Keeble College in Oxford as part of that exercise.&nbsp;
Its earlier efforts were explored in our work on transboundary risk management in the Himalaya at Bergen’s LOS Center and also dealt with in a chapter in EARTHSCAN’s IIASA publication Transboundary Risk Management edited by Joanne and others.&nbsp;
It argued that risk is socially constructed in four distinctly varied ways, where facts and values are entangled, leading to competing technological preferences. Mike desperately wanted to follow up on the Keeble meeting at IIASA, but – given the Covid fears already underway – Anne put her foot down and had him quarantined at home.
Our other on-going effort was, given that IIASA was founded during the Cold War as a place for scientists of the Euro-American West and the Communist East to work together to build confidence for peace, but after the collapse of the Berlin Wall that division (hence raison d’etre) no longer existed – to develop a global North-South axis for IIASA’s work.&nbsp;
We believed that was where the great challenges of tomorrow development debates as well as environmental concerns (including climate change) would play out. Towards that end, he was working with a range of Global South scholars and was very anxious to see if an IIASA-Nepal Social Science Baha/South Asia Institute for History and Philosophy collaboration could be developed.&nbsp;
Mike retained interest in Nepal’s developments up to his very end, even when on hospital bed, asking his daughter to find out from me what was going on with Nepal’s March elections that saw a seismic upheaval which decimated all the old political parties.&nbsp;
When Ursula described the gist to him, I am sure he was inwardly pleased that it vindicated Cultural Theory as Political Science’s contention that moral high ground activist egalitarianism not given proper place at the policy table can strike back at insensitive bureaucratic hierarchism and market individualism’s crony capitalism with swift and lethal vengeance.
Michael Thompson’s physical presence will be greatly missed, but his impact on interpretive social science – and its extremely relevant application to Nepal’s and other LDC’s developmental conflicts – will live on.
Dipak Gyawali is an energy economist with the Nepal Academy of Science and Technology (NAST). He is a former minister of water resources.&nbsp;
To listen to Michael Thomson’s lecture at Social Science Baha in 2011 <a href="https://soscbaha.org/lecture-series/cultural-theory-and-clumsiness-some-lessons-from-nepal/" target="_blank">click here.</a>

Michael Thompson, 89

Along with the Sherpa community, it is perhaps Kathmandu Valley’s Newāh Civilization that has been the most studied by anthropologists, architects, historians and social scientists.&nbsp; Tomes have been written about the built environment of the Valley’s former kingdoms, the influence of Indian culture, and how it in turn inspired the temples, monasteries and monuments in Tibet, through China right up to Korea and Japan. Lately, there has also been an attempt to recognise and preserve not just the brick and mortar landscape of Kathmandu, but also the intangible heritage of the Newāh people. A critical component of the ancient festivals in the streets, alleys and baha of the inner cities are ritual plays and dance. Gérard Toffin is a social anthropologist with the Centre d’Etudes Himalayennes at the Centre National de la Recherche Scientifique (CNRS) in France, and has been researching in the region since the early 1970s, focusing on Newāh society and especially its Jyapu farmers. Lately, his work has focused on indigenous theatrical performances, and how they are evolving with modern influences.&nbsp; RECORDING RITUALS The result of his study is this hefty ethnographic book, Newar Theatrical Performances: Religious, Royal and Comic Aspects, delving into sacred performances. This is the first-ever detailed documentation of the minutest aspects of traditional plays and holy ceremonies of Kathmandu Valley. This book is not for the package tourist on a quick walkabout of Patan, the details and terminology can be daunting even for natives to navigate. But this is what social science research is supposed to do – take a deep dive into cultures that we take for granted either because we are a part of it, or because we have never bothered to find out its meaning.&nbsp; Dance forms with mythological themes, masked processions, gestures, facial expressions of the performers, have all been passed down from one generation to the next, adhering to age-old codes. The world is moving at an accelerated pace because of TikTok-induced globalised connectivity, but traditional gender or caste dynamics and hierarchies are carried over intact in many of these performances. It is as if traditional theatre itself is a time capsule giving us a peep into the past. Some of the performances and dance are in danger of going extinct as the population ages and the young migrate out. However, there has been a cultural renaissance among the Newāh guthi overseeing these ritual plays, dances, or chariot processions. The next generation of apprentices are being trained. This pride in heritage means that Kathmandu Valley civilization is not as endangered as it may appear.&nbsp; Gérard Toffin’s book is an important ethnographic work that will help preserve the Nepal Valley’s unique blend of urban-rural, cosmopolitan-agricultural, Hindu-Buddhist, indigenous-national. The Tantric choreography of Newāh theatre, just as the kama sutra depictions on erotic temple art, show Indian influence, but Toffin says they have been ‘Newarized’.&nbsp; One example is the sexually-explicit shadow play staged every year since 1690 CE by Jhyalcha Guthi in Patan that exposes the infidelity of King Yog Narendra Malla. Toffin devotes a whole last section of his book to irreverent plays (khyalah) that ridiculed the rich and powerful, the royals and upper castes and their shenanigans.&nbsp; He examines the importance of comic relief at a time when death was ever-present in historic Kathmandu with its frequent epidemics. One cholera outbreak in 1885 is estimated to have killed 10,000 people – a fifth of Kathmandu’s population at the time.&nbsp; The Saparu festival in Kathmandu and Mataya in Patan memorialised through street processions those who had died the previous year – and this was institutionalised into Gai Jatra by King Pratap Malla in the 17th century to console his queen after their second son was killed by an elephant. Families were asked to file past the palace to show the queen that she was not the only one grieving.&nbsp; Pratap Malla also allowed clowns, burlesque plays, and satirists to make the queen laugh. The Rana and Shah regimes which suppressed free speech continued the Gai Jatra tradition to allow citizens to let off steam. Rulers were lampooned, and the performances involved scatological jokes, cross-dressing and lewd acts.&nbsp; Interestingly, the Nepal Bhasa word ‘pyakha’ means both ‘dance’ and ‘theatre’ (today also ‘cinema’, as Toffin notes) and so the performances were also a combination of ritual dance, traditional music and a stage play. Stories involve gods, goddesses and mythological characters, and are passed down through generations of performers. (See adjoining article on Pāhāñ Charey.) Street performances by masked dancers, like in the ‘Katti Pyakha’ in Patan, enact divine themes. The moving deities demand as much reverence as their static idols in the inner sanctum of temples. The book devotes a whole section to the importance of cultic masked dances where the performer is possessed by the spirit, and goes into a trembling trance.&nbsp; Some of this is now simplified and secularised into performances for tourists in hotels, but the genuine original masked dance troupes still parade down the streets, proving that ancient and modern are made to co-evolve in ways that only Kathmandu knows how.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260329140352_aace3ece2e2cc577aa478d83de4b34930e6ff9c088d5f5e3f02fa178d124a60d.jpg" data-media-id="editor_0" data-image-id="20260329140352_aace3ece2e2cc577aa478d83de4b34930e6ff9c088d5f5e3f02fa178d124a60d" data-rendition-name="original" width="1136" height="702" loading="lazy" alt="Newa theatre book details NT"> </figure>