<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110811118/636a2ab39c7e80680e04592fjpeg.jpg" alt="" width="1400" height="933"/><figcaption>TB OR NOT TB: Birat Nepal Medical Trust team in Hetauda on Wednesdady used the Holi festival to raise awareness about tuberculosis in Nepal. Photo: Antonio Beltrán Rodríguez</figcaption></figure>Tuberculosis killed 33 million people worldwide between 2000-2015, more than the entire population of Nepal. The infection still kills three people every minute all over the world, and 11 Nepalis a day. This perfectly curable medieval disease is the <a href="https://www.nepalitimes.com/banner/tb/" target="_blank" rel="noopener">biggest infectious killer</a> in the world today, more than HIV or malaria. In sharp contrast, <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/ebola-in-asia,1764" target="_blank" rel="noopener">Ebola</a>, which receives far more media coverage, killed only four people in 2017.Read also:<a href="https://www.nepalitimes.com/editorial/tb-or-not-tb/" target="_blank" rel="noopener">TB or not TB</a>, Editorial<a href="https://www.nepalitimes.com/banner/tb/" target="_blank" rel="noopener">TB</a>, Sonia Awale<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110811118/636a2ab69c7e80680e045930jpeg.jpg" alt="" width="800" height="702">World Tuberculosis Day on 24 March is an opportunity for governments to renew efforts to control this devastating disease. More than 40% of the world’s TB cases occur in South Asia. While much research and funding focuses on HIV-associated TB and <a href="https://archive.nepalitimes.com/page/resistance-to-live-saving-drugs-threatens-to-set-back-progress-in-nepal" target="_blank" rel="noopener">multi-drug resistant (MDR) TB</a> in sub-Saharan Africa, HIV infected individuals make up only 9% of global TB cases and less than 1% had MDR TB in 2017. Despite a huge sample size, there is a lack of research on TB in South Asia, particularly India, and on cases not associated with HIV. If nothing is done, TB will cost another 28 million lives in the next 10 years.These shocking figures may seem like numbing statistics, but at an emotional level in Nepal, we all know people, including many family members, who have suffered and died of TB. Many readers also may have suffered from TB, and fortunately have been cured. <a href="https://www.nepalitimes.com/editorial/tb-or-not-tb/" target="_blank" rel="noopener">Tuberculosis</a> is so rampant in South Asia that every working day, clinicians struggle with the question in any random patient: Is this TB? This is in sharp contrast to the western world where TB is essentially a biblical disease.While Nepal is a role model in the community-based DOTS (directly observed treatment short course) treatment, which ensures index patients are taking their medicines, this alone will not suffice in the battle against TB, since a patient would often have already infected others in the household and workplace. Which is why active case finding and early treatment is the key. But tragically there is massive under-reporting -- Nepal gets over 40,000 new cases of TB a year with over 4,000 deaths, but many do not get diagnosis and treatment due to lack of resources for TB control.The first ever prevalence survey for TB in Nepal is currently underway, and preliminary findings show a substantial increase in the estimate of total TB cases in the country. This would be consistent with the results of other prevalence surveys in the region, which have all demonstrated that the burden of TB has been substantially underestimated in South Asia. For example, evaluation of data from multiple sources in India showed an increase of more than 80% in the estimated incident TB cases from 1.6 million to 2.9 million in 2014. Although better than DOTS, just active case finding and treatment will not be enough to bring TB under control.This is where George Comstock’s work becomes relevant in Nepal and South Asia. In the 1950-60s this epidemiologist worked with the largely Inuit population in the town of Bethel in Alaska. He determined that, although patients and their household contacts were being treated properly, the rates of TB in the community was not declining as predicted. He felt that unless latent TB infection was treated, the TB organism ‘pool’ would continue to perpetuate the disease. Many people who are exposed to the tuberculosis organism will just have an infection, that is latent TB, without any symptoms.Comstock started treating latent TB infections with one drug (isoniazid) which, sure enough, brought down TB cases in Bethel. Since then, multiple studies all over the world have shown that treating latent TB infection this way helps substantially decrease the TB pool in the community and make a resounding impact in the control of TB. Indeed, this is how TB has been nearly removed from many poor communities in the West. For many reasons, including financial and perceived concerns of isoniazid’s liver toxicity, Comstock’s game plan has never been taken seriously in South Asia. It is time we change this and replicated the strategy.In 2018, the World Health Organization (WHO) emphasised treatment of latent TB in high incidence countries. This will be a game-changer in Nepal, besides the <a href="http://archive.nepalitimes.com/news.php?id=17747#.XJN9YyIzaUk" target="_blank" rel="noopener">highly efficient Gene Xpert machine</a> used for active case finding. By decreasing the pool of tuberculosis patients, we have a chance to meet the lofty <a href="https://www.who.int/tb/post2015_strategy/en/" target="_blank" rel="noopener">WHO END TB strategy</a> of reducing global incidence by 90% and deaths from TB by 95% by 2035. But even these targets only represent a reduction in TB to the levels seen in developed western nations today, not elimination.These targets are not achievable unless there is a dramatic escalation in TB control efforts and a significant paradigm shift in our approach. To attain the target, the annual decline in global TB incidence rates must accelerate from 2% per year in 2015 to approximately 17%  per year by 2025. This requires the deployment of George Comstock’s strategy to act now, and to observe this year’s TB Day slogan ‘It is time for action’.Buddha Basnyat is a physician at Patan Hospital and Max Caws is with the Britain Nepal Medical Trust in Kathmandu.

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For Nepal, a game-changer in TB control

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

How the Peace Corps changed a volunteer’s life

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

Nepal’s Resource Curse

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

Smart ageing is Nepal’s next frontier

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

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