<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111413118/6372307e9c7e80680e0c256cjpeg.jpg" alt="" width="1641" height="1000"/><figcaption>Photo: NYAYA HEALTH NEPAL</figcaption></figure>Viral hepatitis is a disease of the liver that is preventable, treatable and curable in most cases. It is a disease where elimination can and must be achieved.On this World Hepatitis Day, the World Health Organisation is highlighting the need to bring hepatitis care closer to the people. This means making hepatitis care available, affordable and accessible to one and all who need it without discrimination.This is a crucial component in the quest towards elimination of viral hepatitis as a public health threat by 2030. Elimination would translate to 90% reduction in incidence and 65% reduction in mortality by 2030, compared with the corresponding figures of 2015.The action against hepatitis cannot wait any longer. Firstly, it is the only communicable disease where mortality is showing an increasing trend. Globally, approximately 354 million people are suffering from hepatitis B and C and one person is dying every 30 seconds due to its complications.South-East Asia has 20% of the global morbidity burden of hepatitis. An estimated 218,000 people died due to hepatitis in the Region in 2019. About 95% of all hepatitis-related deaths are due to cirrhosis and liver cancers caused by the hepatitis B and C virus.Second, viral hepatis is a disease that is completely preventable. Clean food and good personal hygiene, along with access to safe water and sanitation, can protect us from hepatitis A and E. Measures to prevent hepatitis B and C need to focus on full coverage with hepatitis B immunisation including a birth dose, as well as access to safe blood, safe sex and safe needle usage.Third, a world free of hepatitis is practical and feasible, and it is one of the few infectious diseases the elimination of which is tangible. We do have the tools to diagnose, treat and prevent chronic viral hepatitis, and thereby eliminate viral hepatitis.Safe and effective vaccines exist to prevent hepatitis B, alongside new and powerful antiviral drugs that can manage chronic hepatitis B and cure most cases of hepatitis C. These interventions together with early diagnosis and awareness campaigns have the potential to prevent 4.5 million premature deaths in low- and middle-income countries by 2030.However, access to these services is often out of reach of communities as they are usually available at centralised/specialised hospitals at a cost which cannot be afforded by all. People continue to die because of late diagnosis or lack of appropriate treatment, if they are being diagnosed or treated at all. Early diagnosis is the gateway for both prevention and successful treatment.Modest testing and treatment coverage is the most important gap to be addressed for an effective response to the hepatitis epidemic. If we look at the treatment cascade of the South-East Asia Region, only about 10% of people with hepatitis know their status. And of those who know their status, only 5% are on treatment. Of the estimated 10.5 million people with hepatitis C, just 7% know their status, of which around 1 in 5 are on treatment.This gap, primarily attributable to general lack of awareness, needs to be patched up. This is what this year’s World Hepatitis Day campaign on 28 July is all about. It highlights the need to accelerate the fight against viral hepatitis by testing and treating the real people who need it, i.e. closing the equity gap by “leaving no one behind”.Even before Covid-19, very few countries were on track to reach the 2030 elimination goals set by WHO. The pandemic has put elimination efforts further behind. Rather, it has potentially jeopardised national elimination programs. Fear of Covid-19 has been a substantial barrier to hepatitis testing and treatment throughout the crisis.Amid all the challenges, the Region has continued to implement key interventions to prevent, detect and treat hepatitis, and to engage and empower at-risk populations. Since 2016, when the Region launched its Action Plan for Viral Hepatitis 2016–2021, nine countries have achieved more than 90% coverage of the third dose of hepatitis B vaccine. Four countries have achieved the hepatitis B control target of less than 1% seroprevalence among children over 5 years of age.En route to the 2030 target of eliminating hepatitis, there are some transitional targets to be achieved. By 2025, together we must reduce new infections of hepatitis B and C by half, reduce deaths from liver cancer by 40%, and ensure that 60% of people living with hepatitis B and C are diagnosed and that half of those eligible receive appropriate treatment. This can only be achieved if hepatitis care reaches to the community. In order to do so, several priorities must be addressed, and these include the need to:<ul><li style="font-weight: 400;" aria-level="1">Enhance political commitment across all countries of the Region and ensure sustained domestic funding for hepatitis.</li> 	<li style="font-weight: 400;" aria-level="1">Improve access to drugs and diagnostics by further reducing prices, including integrating costs in national health and domestic financing.</li> 	<li style="font-weight: 400;" aria-level="1">Develop communication strategies to increase awareness as the vast majority of the people do not know that they are infected, especially among subpopulations that are at higher risk of hepatitis B and C.</li> 	<li style="font-weight: 400;" aria-level="1">Innovate service delivery to maximise the use of differentiated and people-centred service delivery options across HIV, viral hepatitis and STIs to tailor and deliver services according to people’s needs and preferences in line with the primary health care approach. Decentralising hepatitis care to peripheral health facilities, community-based venues and locations beyond hospital sites brings care nearer to patients’ homes. Bringing care closer to the community will also need innovations to strengthen community engagement, community-based service delivery and community-led monitoring.</li></ul>For the first time, an integrated Regional Action Plan for viral hepatitis, HIV and STIs 2022–2026 is being developed by WHO. This integrated regional plan will ensure effective and efficient utilisation of limited resources available for the Region and will guide countries to adopt a person-centred approach rather than a disease-specific one.All countries of South-East Asia must accelerate the coverage of testing and treatment services, including through large scale adoption of innovative technologies, simplified approaches at the primary health care level, and community participation. WHO remains committed to make South-East Asia free from viral hepatitis by 2030.As we observe World Hepatitis Day, we must look forward and act together with communities and all stakeholders for a future free of hepatitis. This will lay a firm foundation for a healthier, more equitable and more prosperous Region and the world.Poonam Khetrapal Singh is the WHO Regional Director for South-East Asia.

Poonam Khetrapal Singh

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Bringing hepatitis care closer to you

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410118/637205c69c7e80680e0b28d5jpeg.jpg" alt="" width="1400" height="933"/><figcaption>Photo: SONIA AWALE</figcaption></figure>The last Sunday in January is World Leprosy Day. Since 2006, I have issued an annual Global Appeal to End Stigma and Discrimination against Persons Affected by Leprosy, supported by influential individuals and organisations around the world.Amid the coronavirus pandemic, which has shown how easily fear and anxiety about a disease can fuel prejudice, I believe this call to eliminate <a href="http://archive.nepalitimes.com/news.php?id=711#.YfYlNi2B3ow" target="_blank" rel="noopener noreferrer">stigma and discrimination</a> is more important than ever.Leprosy, also known as Hansen’s Disease, is a chronic infectious disease caused by the bacillus Mycobacterium leprae. It mainly affects the skin and peripheral nerves and is one of the oldest diseases in human history. Yet each year, around 200,000 new cases are reported globally.In Nepal, 2,304 new cases were reported in 2020 and it is one of 23 countries on the WHO’s priority list for leprosy. Most cases are found in Madhes Province bordering India.Today an effective treatment exists in the form of multidrug therapy (MDT) and with early detection and treatment, the disease can be cured without complications. But if treatment is delayed, <a href="http://archive.nepalitimes.com/news.php?id=39#.YfYl-S2B2b8" target="_blank" rel="noopener noreferrer">leprosy can cause progressive impairment</a> and lead to permanent disability.There are an estimated 3-4 million people living with some form of disability due to leprosy. This fact, together with deep-seated fears and misperceptions about this age-old disease, has subjected persons affected by leprosy and even their family members to severe discrimination, which continues to this day.Since becoming WHO Goodwill Ambassador for Leprosy Elimination in 2001, I have visited some 120 countries to see the situation for myself. This has led me to think of leprosy in terms of a motorcycle: the front wheel symbolises curing the disease, and the back wheel represents eliminating discrimination. Unless both wheels are turning together, we will not reach our ultimate goal of zero leprosy.As regards to the front wheel, efforts against the disease, including new case detection, have been badly disrupted by the spread of the novel coronavirus and efforts to prevent transmission. In 2020, the number of new cases reported was down to 37% year on year, according to the WHO, largely due to the impact of Covid-19.Concerning the rear wheel, I have worked hard to have leprosy recognised internationally as a human rights issue since the early 2000s, when I first approached the Office of the UN High Commissioner for Human Rights. One result has been the adoption in 2010 of a UN General Assembly on elimination of discrimination against <a href="http://archive.nepalitimes.com/news.php?id=15213#.YfYl_y2B2b8" target="_blank" rel="noopener noreferrer">persons affected by leprosy</a> and their family members.But the real measure of success will be when principles and guidelines accompanying the resolution are fully implemented. Because of the pandemic, however, awareness-raising efforts in many areas have stalled, and some people have found that Covid-19 is exacerbating the discrimination they already experience as persons affected by leprosy.This is why last August I launched a <a href="https://www.shf.or.jp/en/dont-forget-leprosy-campaign/" target="_blank" rel="noopener noreferrer">campaign called ‘Don't Forget Leprosy’</a> to ensure that leprosy and the needs of those affected by the disease are not overlooked, even amid the pandemic. The campaign stresses the importance of early detection and treatment, as well as the need to eliminate stigma and discrimination.The term 'don't forget' covers many things: that leprosy still exists, that people affected by leprosy and their families still face social prejudice, and that there are healthcare professionals doing their best in difficult circumstances to provide needed services.In Nepal, a country I have visited many times over the years, what has impressed me has been the strong cooperation I have found between the <a href="http://mohp.gov.np/eng/program/communicable-disease/leprosy-control-program" target="_blank" rel="noopener noreferrer">Ministry of Health and Population</a> and leprosy NGOs. They make the most of their respective strengths and complement each other’s efforts, and in this way have helped to advance measures against leprosy throughout the country.Working in partnership with the ministry’s leprosy control program, <a href="https://tlmnepal.org/blog/anandaban-hospital/" target="_blank" rel="noopener noreferrer">Anandaban Hospital</a> near Kathmandu, Lalgadh Leprosy Hospital &amp; Services Center in Janakpur and the Green Pastures Hospital in Pohkara provide both medical and social support. They provide treatment and rehabilitation, and assist with reintegration into the community.I would also like to give a mention to the leprosy center established in Surkhet with the support of the Sasakawa Health Foundation, operated with the dedicated effort of local people and contributing to community medical care.Nepal has also pioneered a <a href="https://www.nepalitimes.com/banner/new-treatment-offers-hope-for-nepals-leprosy-patients/" target="_blank" rel="noopener noreferrer">revolutionary treatment for leprosy wounds</a> saving money and prolonged pain for the patients. The technique called Leukocyte Platelet Rich Fibrin (LPRF) originally devised for dental surgery accelerates the healing of tissue and is now being used widely in the country to treat hard-to-heal skin lesions of diabetes and leprosy patients.Over the past 50 years we have come a long way toward our goal of a world free from leprosy and the discrimination it causes. We must not allow the progress we have made to be undone by the impact of <a href="https://www.nepalitimes.com/here-now/omnipresent-omicron-starts-to-lose-its-edge/" target="_blank" rel="noopener noreferrer">the Covid-19 pandemic</a>.Together with my annual Global Appeal and the activities that partner organisations will be carrying out for World Leprosy Day this year, I hope it will put the disease back in the spotlight and show that our work to end the medical and social problems related to leprosy is not yet done.Please add your voice to the campaign and make this a collective effort. Together we can be heard loud and clear: “Don’t Forget Leprosy.”Yohei Sasakawa is WHO Goodwill Ambassador for Leprosy Elimination as well as the Japanese Government Goodwill Ambassador for the Human Rights of Persons Affected by Leprosy. He is the chair of The Nippon Foundation.

During the pandemic, don’t forget leprosy

As the COVID-19 pandemic sweeps the globe, hospitals have been overwhelmed. <a href="https://www.nepalitimes.com/banner/why-nepal-must-watch-about-coronavirus-but-not-panic/" target="_blank" rel="noopener">Nepal is ahead of the curve, but if the case load is to rise steeply </a>as it has done in Italy or Spain, the government needs to start preparing ICUs, ventilators, and protective gear for hospital staff.At present, nurses, doctors, interns and resident doctors and other medical personnel in Nepal’s hospitals lack personal protective equipment (PPE), and they fear for their own lives while <a href="https://www.nepalitimes.com/editorial/this-is-a-test/" target="_blank" rel="noopener">treating patients with suspected coronavirus</a>.Patients can be carriers and spreaders of the virus without showing any symptoms. Thousands have been visiting hospitals to get tested, have chest x-rays done, and could be unknowingly infecting medical staff.“If we find issues with the patient’s lungs after the chest x-ray, we monitor them closely for infection,” says a doctor at a medical college in Kathmandu. “By the time we confirm whether they have been infected, the virus could infect many others in the hospital treating them, like myself.”<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101156/636b7a029c7e80680e064735jpeg.jpg" alt="" width="714" height="960"/><figcaption>A doctor wearing makeshift protective gear while treating a patient in Karnali hospital.</figcaption></figure>Many doctors and even interns do not have a choice, and treat patients without PPE. “If you don’t go to work, the medical college won’t give a certificate,” the doctor complains.Staff at the Sukraraj Tropical and Infectious Diseases Hospital in Kathmandu which gets most of the referrals of suspected coronavirus cases are most at risk. Sagar Kumar Rajbhandary works 12 hour shifts at the Teku hospital, and says PPE are must-have given the number of patients coming in for checkups every day.“We need at least a 100 PPE units right away, but we have not got it yet,” says Rajbhandry. The anti-biohazard equipment include respirator masks, sterile hoods, gowns, and goggles.For the past month, hospitals across Nepal have been treating patients coronavirus symptoms without proper PPE, and the medical system is ill-prepared for a major outbreak.Read also: <a href="https://www.nepalitimes.com/opinion/nepal-locked-down-now-what/" target="_blank" rel="noopener">Nepal locked down, now what?</a>, Marty Logan <figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101156/636b7a049c7e80680e064736jpeg.jpg" alt="" width="720" height="960"><figcaption> </figcaption></figure>“Since a few units of PPE are not going to be enough, and because they are so expensive we have no choice but to start making them locally,” says Paras Pandey at Bheri Hospital in Nepalganj who is not waiting for help from Kathmandu, and has already made 200 PPE at a local garment factory.The PPE gown is improvised from thin plastic, and the goggles have been made from transparent stationery, while the helmet is fashioned out of elastic apparel material. Pandey says other hospitals in the region have also copied the design.Protective gear are being manufactured at four other sites, including by the Innovation Centre of Mahabir Pun (see box), the Karnali Health Science Institute, the Dharan-based BP Koirala Health Science Institute.Although these Nepal-made PPE are not as high quality as imported ones, they at least offer some protection to medical staff. One imported PPE can cost anywhere up to Rs20,000, but a locally manufactured one costs only Rs250.“We got local tailors to make 50 PPEs on the first day itself, they are cheap but effective, and serve the purpose for now,” said Mangal Rawal of the Karnali Health Science Institute.https://youtu.be/c_57ssQF8Ywhttps://youtu.be/mGo7TuZu61ghttps://youtu.be/EVX4SlY28IUTourism entrepreneur Suman Pandey says if the government only gave him permission, her could get workers with experience in making trekking gear to start assembly line manufacture of PPEs. He has already made two prototypes which could be also worn by ambulance drivers and helicopter pilots transporting infected people.The PPE also needs to be disposed of properly after use in the medical wards, the ICU or even in front of a patient getting tested for COVID-19. One doctor or nurse needs at least eight units of PPE every day.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101156/636b7a079c7e80680e064737jpeg.jpg" alt="" width="720" height="960"><figcaption> </figcaption></figure>Bhogendra Raj Dotel at the Ministry of Health, is currently working to procure more PPEs, but there is a shortage in the world market. In case, all flights have stopped, so there is no way to bring them here quickly.“It is not possible for donor countries to respond because they are dealing with shortages themselves,” Dotel explains. Suppliers who used to source PPEs from Singapore, Thailand, China and India are not getting new units because they have stopped exports.Nepal’s hospitals also have a chronic lack of oxygen cylinders and ventilators even at the best of times. If the pandemic hits Nepal with full force, medical facilities just do not have the equipment to treat critically ill patients.Read also: <a href="https://www.nepalitimes.com/opinion/nepal-locked-down-now-what/" target="_blank" rel="noopener">Protecting Nepal's elderly from COVID-19</a>, Alisha SijapatiBesides this, the government procurement process is cumbersome, and although a tender was issued for PPE, gloves, boots, digital thermometers and other essential items on 15 March, delivery is uncertain.The department had requested bids to supply materials for a 1,000 bed isolation ward and 235 ventilators. But even these would not be enough if the infection rate rises.The Nepal office of <a href="http://www.nsi.edu.np/en" target="_blank" rel="noopener">Nick Simons Institute (NSI) </a>flew in 11 portable ventilators from the United States and they arrived on 16 March. NSI is also committed to supply 1,000 locally-made PPE to the government.China has also committed to help with medical supplies including PPE, but Mahendra Shrestha of Department of Health Services said they had not yet arrived.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101156/636b7a099c7e80680e064738jpeg.jpg" alt="" width="640" height="853"><h2>How Facebook came to the rescue</h2>Ma<a href="https://www.nepalitimes.com/banner/drones-to-the-rescue/" target="_blank" rel="noopener">habir Pun</a>, the Magsaysay Award winning Nepali activist, knew that Nepal’s health system would not be able to function unless nurses, doctors and technicians had protective gear for treatment of patients.Since imports were impossible because of flights being cancelled, Pun decided that his centre would start churning out PPEs. He even brought 2,500 metres of fabric, but could not find a single tailor shop open in Kathmandu Valley.So on 23 March, he <a href="https://www.facebook.com/mahabir.pun">posted a message on his Facebook page</a> asking for tailors. He has nearly 100,000 followers, and the word spread quickly. Soon Pun started getting inundated with phone calls from tailors and garment shops all over the city.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101156/636b7a0b9c7e80680e064739jpeg.jpg" alt="" width="600" height="400"><figcaption> </figcaption></figure>Garment factories in Balaju and Putali Sadak offered to stitch prototypes, which are now ready. “We will now show them to doctors, and if they approve we will start mass producing protective gear and distribute them to hospitals all over the country,” Pun told Nepali Times.

Protecting those who protect us from the epidemic

In preparation for a COVID-19 outbreak, the Nepal Army set up a quarantine zone at their headquarters in Tripureswor, Kathmandu. The camp, which has 54 tents that were gifted by the Chinese government, can accommodate 108 patients with 2 in each tent.Isolation rooms, regular check-up rooms and a tap water system has also been established.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101152/636b78ef9c7e80680e0646d1jpeg.jpg" alt="" width="960" height="640"/><figcaption>Quarantine zone at Nepal Army's headquarters. All Photos: BIKRAM RAI</figcaption></figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101152/636b78f29c7e80680e0646d2jpeg.jpg" alt="" width="960" height="640"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101152/636b78f49c7e80680e0646d3jpeg.jpg" alt="" width="960" height="640">Army personnel demonstrates how to wear protective gear when treating patients of COVID-19.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101152/636b78f69c7e80680e0646d4jpeg.jpg" alt="" width="960" height="640"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101152/636b78f99c7e80680e0646d5jpeg.jpg" alt="" width="960" height="640"><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101152/636b78fb9c7e80680e0646d6jpeg.jpg" alt="" width="960" height="640"><figcaption>All personnel treating patients are required to wear protective eye wear, masks, gloves and scrubs that fully cover them.</figcaption></figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101152/636b78fe9c7e80680e0646d7jpeg.jpg" alt="" width="921" height="637"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101152/636b79009c7e80680e0646d8jpeg.jpg" alt="" width="960" height="640"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101152/636b79039c7e80680e0646d9jpeg.jpg" alt="" width="960" height="640"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101152/636b79069c7e80680e0646dajpeg.jpg" alt="" width="959" height="639"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101152/636b79089c7e80680e0646dbjpeg.jpg" alt="" width="960" height="640">.

Nepal Army's quarantine zone

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101152/636b789a9c7e80680e0646adjpeg.jpg" alt="" width="900" height="600"/><figcaption>Visitors arriving at Tribhuvan International Airport. Photo: BIKRAM RAI</figcaption></figure>The <a href="https://www.nepalitimes.com/banner/why-nepal-must-watch-about-coronavirus-but-not-panic/">COVID-19 epidemic</a> is subsiding in China where it originated, and is now erupting in outbreak clusters across the world. First carried by international travellers (mainly new year holiday makers from China in January-February), it spread through public places. Interestingly, pilgrimage sites like Qom in Iran, a little known evangelical sect in Daegu in Korea, churches in northern Italy, and a synagogue New York were cluster epicentres.A virus is a strand of genetic material that can infiltrate cell nuclei, splicing itself into the DNA of the host and commanding the organism to be its vehicle for transmission. Being a mutant, the COVID-19 is one step ahead of genetically engineered vaccines, and is so smart it piggy-backs on the mobility of human beings to go around the world.The virus has figured out that it does not make much sense to make the humans it infects so sick that they cannot travel – defeating the purpose of maximum infection. COVID-19 patients can be carriers even though they do not show any outward signs of being infected. Even if they have a sore throat or a cough, they are not bed-ridden and commute to work or travel on business, spreading the virus along the way.This mode of transmission is also designed for maximum effect. After leaping the animal-human barrier, it took the easiest path for human-to-human infection by entering the respiratory tract through touch or cough droplets. The virus likes the cold, which is why it spread so quickly during the northern hemisphere winter.Now that the epidemic has gone global, nationality profiling at airports is absurd. On Monday, police at Nagdhunga stopped buses and asked if there were any Chinese on board.  Removing visa on arrival for travelers from ‘infected countries’ does not make sense anymore – you either go whole hog and stop all outsider travel altogether like Bhutan has done, or you let everyone in after screening.In fact, for all we know Nepal is already an ‘infected country’ we just have not bothered to diagnose anyone. Nepal’s officials appear to believe in a vaccine called ‘Pashupatinath’, and expect the protector deity to see us through this crisis. Who knows, it may be our lackadaisical attitude towards personal hygiene, sanitation or waste management that has given Nepalis a certain immunity against viral infections.Scientist <a href="https://www.nepalitimes.com/banner/why-nepal-must-watch-about-coronavirus-but-not-panic/">Sameer Mani Dixit at the Central for Molecular Dynamics</a> calls this the ‘hygiene hypothesis’ – by allowing germs to thrive we develop an immunity to viral and bacterial infections just like a vaccine would. Dixit says it was “pure miracle” that the 2012 MERS epidemic did not affect Nepal in a big way.The coronavirus epidemic adds to the burden of older existing infections that afflict  Nepalis, and takes attention away from bigger bacterial killers like <a href="https://www.nepalitimes.com/banner/tb/">TB</a>, <a href="http://archive.nepalitimes.com/news.php?id=12158">typhoid</a> and <a href="https://archive.nepalitimes.com/news.php?id=16988">diarrhoea</a>, vector-borne eukaryote parasites like <a href="https://www.nepalitimes.com/banner/mosquitoes-move-up-mountains-as-the-earth-warms/">malaria</a>, or other insect-borne virus like <a href="https://www.nepalitimes.com/here-now/nepal-is-a-microcosm-of-all-of-the-changes-in-world-health/">dengue</a> and encephalitis. A public health system already overstretched to deal with these chronic epidemics is not at all prepared for yet another virulent onslaught.However, we cannot expect superstition or lack of sanitation to save us. Nepal is now linked to the global economy, and as such this worldwide epidemic has hit two of the mainstays of our economy: migration and tourism, which together account for nearly 40% of the GDP.As <a href="https://www.nepalitimes.com/opinion/labour-mobility/crossborder-virus-and-nepali-migrant-workers/">Upasana Khadka shows in her column</a>, Nepal is paying a price for such an overwhelming reliance on migration. The moratorium on migrant workers flying to Korea and Qatar is a gut punch to Nepal’s economy. Nepali workers in the Gulf, Malaysia and Korea-Japan are already affected by the slowdown in the global economy.And the COVID-19 scare hit Nepal right at the start of the <a href="https://www.nepalitimes.com/latest/lets-call-off-visit-nepal-year-2020/">Visit Nepal 2020</a>, which means the country will not meet the already unrealistic target of bringing 2 million tourists this year with an ill-planned campaign. March arrivals, except Chinese tourists, were still all right, but there have been massive cancellations of treks and expeditions for April. As our report shows, the impact on employment and income for service providers in hospitality and farmers dependent on selling produce to hotels is huge. VNY2020 has already been put off, and the government has taken the welcome step of using the budget to improve tourism infrastructure.Despite fear going more viral than the epidemic itself, there are some positive outcomes from COVID-19. Nepal’s hospitality industry has once more recognised the importance of domestic tourism. China’s recognition of the animal-transmission route may actually help <a href="https://www.nepalitimes.com/banner/coronavirus-outbreak-may-curb-wildlife-trafficking/">save endangered species like pangolins</a> from extinction. Oil prices have come down, and global economic downturn has reduced air pollution and carbon emissions.Read also: <a href="https://www.nepalitimes.com/editorial/when-panic-goes-viral/" target="_blank" rel="noopener">When panic goes viral</a>, Editorial

FEAR GOES VIRAL

https://www.youtube.com/watch?v=qYrj1Et-9PkSir Jeremy Farrar is a British medical doctor and researcher with 30 years of experience in tropical and infectious diseases. In 2013, he was appointed director of the Wellcome Trust, one of the biggest global charities working in medical research. Nepali Times caught up with Farrar this week in Kathmandu, a place he visits often. Excerpts from the conversation:Nepali Times: What explains your interest in Nepal?Jeremy Farrar: I first came to Nepal in about 1989 or 1990. Since then, I have been working mostly on infectious diseases but increasingly on non-infectious diseases. I spent 18 years in Vietnam and moved back to London 6 years ago. I'm interested in where there are inequitable challenges of health, which I can see getting worse than better, and I think science as part of society can make a difference, and all of that is true in Nepal.You were with Oxford University collaborating with Patan Hospital.Most of my work was based on typhoid in Vietnam and Dr Buddha Basnyat of Patan Hospital quite rightly termed South Asia as the ‘capital of typhoid’. The burden of typhoid in this part of the world is massive. So in 2004 I came here and started a partnership that has been ongoing for the last 15 years. It started with typhoid, but now it has branched out to include other infections particularly important in Nepal.Since you started coming to Nepal how has the health situation here changed?In some ways Nepal is a microcosm of all of the changes that are happening in low and low-middle-income countries. <a href="http://archive.nepalitimes.com/news.php?id=12158#.Xa_yEZIzbIU" target="_blank" rel="noopener">Nepal is still struggling with the burden of infectious diseases </a>but it is now also having to deal with the double whammy of infectious diseases that have not disappeared and the increasing burden posed by non-communicable diseases. The real problem for countries such as Nepal is dealing with both at the same time, and those require quite different public health measures, and require governments to make informed, evidence-based policy decisions.Read also:  <a href="http://archive.nepalitimes.com/news.php?id=17306#.Xa_yFZIzbIU" target="_blank" rel="noopener">Myadhe joro aka typhoid fever</a>, Buddha Basnyat<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108141156/636a60b19c7e80680e056e92jpeg.jpg" alt="" width="1500" height="1000"/><figcaption>Photo: Sonia Awale</figcaption></figure>We just suffered an unprecedented dengue epidemic in Kathmandu.  Dengue is the infectious disease of the 21st century because it is driven by all of the changes we are going to see: environment change, climate change, urbanisation, travel and movement of people and therefore vectors. <a href="https://www.nepalitimes.com/banner/mosquitoes-move-up-mountains-as-the-earth-warms/" target="_blank" rel="noopener">Cities like Kathmandu are perfect breeding grounds</a> for the Aedes mosquito. Kathmandu's climate is changing, the city is growing exponentially in a haphazard way and the mosquito loves highly dense populations of people. If you put together environmental and climate change and the mosquitoes gradually spreading further north from India into the Tarai and increasingly into Nepal, it's inevitable that Kathmandu and the lower lands of Nepal will suffer from dengue outbreaks.Read also: <a href="https://www.nepalitimes.com/here-now/climate-health-emergency/" target="_blank" rel="noopener">Climate-health emergency,</a> Sonia AwaleOn top of these, we still have TB and leprosy.In my professional career of 35 years I have never been more optimistic about <a href="https://www.nepalitimes.com/banner/nepal-tb-cases-grossly-underestimated/" target="_blank" rel="noopener">tuberculosis</a>. If you take the big three infectious diseases of the world (TB, HIV, malaria), in 30 years HIV has gone from being a death sentence in a few week after diagnosis to a difficult disease but one you can manage long term. In the last 20 years there has been amazing progress in malaria with insecticide-laced bed nets and the Chinese herbal drug called Artimisinin, the most important malaria drug ever invented.TB has not made that much progress. We are still using a diagnostic test invented in the 19th century. There has been no new tuberculosis drug since the last 40 years. We have not really understood how it transfers from one person to another. But that is being transformed. With the coming of a new pipeline of drugs that are now being used in South Asia and sub-Saharan Africa, the treatment period will shorten, making it much easier. But perhaps more important than that, for the first time there is the possibility of a tuberculosis vaccine that will prevent infection and disease. We have to make sure that it gets developed properly, then manufactured and made accessible in an equitable way at a price that is affordable for everybody.Read also: <a href="https://www.nepalitimes.com/banner/tb/" target="_blank" rel="noopener">TB</a>, Sonia Awale<a style="background-color: #ffffff; font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/banner/for-nepal-a-game-changer-in-tb-control/" target="_blank" rel="noopener">For Nepal, a game-changer in TB control</a>, Buddha Basnyat and Maxine CawsWellcome Trust is also involved with snakebite research. What are the real problems tackling this?Snakebite is the biggest disease nobody has heard of. It affects mostly impoverished people in rural communities who have no political voice. <a href="https://www.nepalitimes.com/here-now/snakebite-is-treatable-no-one-need-die-from-it/" target="_blank" rel="noopener">Snakebite treatment</a> is still using 19th century or early 20th century interventions, which are expensive to produce, difficult to access and not available to those who really need them. If people are bitten in low or low-middle income countries, chances are they will never get treated. We are interested in bringing in technologies that have been used in cancer and infectious diseases to produce a treatment that counteracts the snake venom.Read also: <a href="https://www.nepalitimes.com/banner/hisss/" target="_blank" rel="noopener">Hiss</a>, Sonia AwaleIs mental health an area you are working on?In addition to funding discovery science, we have a small number of focused areas, where there has been little progress in the past. Mental health is the next one we are launching. Mental health has not attracted much investment or young people interested in working on it, and it's often placed into different parts of the health system with separate hospitals. Mental health still caries enormous stigma everywhere in the world. So we've not had the investment in science, public health and in clinical care of people, and we haven't had the advances in prevention and treatment. This is not only a health issue but also of social justice and economy. Working in collaboration with various partners we are trying to transform mental health from being an issue of stigma and no progress to one that people are willing to talk about, that becomes a normal part of society and where we make scientific and health progress that will reduce the burden of this massive problem.

“Nepal is a microcosm of all of the changes in world health”

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108131156/636a52509c7e80680e0522e9jpeg.jpg" alt="" width="1400" height="787"/><figcaption>Pic: DIANA BARR</figcaption></figure>David Williams grew up in rural Australia among all kinds of creepy crawlies. He kept lizards and snakes as pets, even venomous ones. He has been bitten six times, but that has not put him off research into finding a cheaper and more effective anti-venom to treat bites.Williams now heads the Global Snakebite Initiative and has been helping in <a href="http://archive.nepalitimes.com/news.php?id=17330#.XULEUvIzbIU" target="_blank" rel="noopener">snakebite</a> management in Cambodia and Papua New Guinea. He is in Kathmandu for the first international conference on snakebite in Nepal this weekend, and spoke to Nepali Times.Read also: <a style="background-color: #ffffff; font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/?p=30833&amp;preview=true" target="_blank" rel="noopener">HISS</a>, Sonia AwaleNepali Times: Why hold a snakebite conference in Kathmandu?   David Williams: One of the main reasons the conference is being held here is that Nepal has got a lot of expertise, doctors who are very interested in research and want to fix the problem and initiatives like the motorcycle volunteers. There are many diseases that have no cure or treatment, but snakebite is something that is eminently treatable, nobody should have to die from it. So with a reasonably modest amount of investment by health ministries and supporting organisations, we can solve the problem of snakebite. Nepal has all the elements necessary to tackle its snakebite epidemic, and save lives.What are the main challenges?There is a solution to <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/Buzz-a%20pound-of-prevention,575" target="_blank" rel="noopener">snakebite problems</a>, but it is largely a matter of investment. Production of anti-venom requires putting the money into establishing manufacturing facilities, having a proper quality control and a regulatory agency that is able to provide oversight of manufacturing. The same goes for collecting venom. So it is a matter of commitment, and spending the money to do it in the right way. The things that hospitals need to have in order to effectively treat snakebite patients are often the same types of medical consumables that are needed for a lot of other diseases. So if you have a strong health care system that is functioning well with the right drugs and treatment, then we are likely to achieve better outcomes.But are these <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/tips-for-surviving-snakebites,1471" target="_blank" rel="noopener">interventions</a> possible in Nepal? It is a lot easier and cheaper to prevent snakebite than to deal with consequences, so community education and awareness for behavioural change is probably the most important aspect. Another is having sufficient stock of effective anti-venoms. Countries have to ensure that reliable supply, and one way to go about is to ask for World Health Organization (WHO) assistance. The good thing is that there has been some strong research in this area with which Nepal should be able to take an initiative to be able to make anti-venom within the country and not rely so much on India. It is especially important to have addition supply of anti-venom this time of the year, when snakebite becomes an epidemic.The WHO wants to halve snakebite deaths by 2030. Is this realistic? It is fairly easy to achieve and there is good evidence to back this up. In Ghana it was found that if you introduce effective treatment, train nurses and doctors who deliver the treatment, and educate the community to come to the hospital sooner, fatalities can be reduced by as much as 80% in a very short period. It took Ghana only 18 months. So I think having 12 years from now to <a href="http://archive.nepalitimes.com/news.php?id=19557#.XULEV_IzbIU" target="_blank" rel="noopener">cut the fatality</a> and disability by 50% is quite a reasonable target. At core it is about effective treatment, health workers who know how to give treatment and communities that prioritise getting that treatment.Is climate change pushing venomous snakes up the mountains? If the world keeps warming, yes. As the weather warms up here in Nepal with climate change, you will start finding venomous snakes in areas where they were never found before because it was too cold. Another aspect that can contribute is changes in the habitat. For example, with deforestation you create open habitats that a lot of venomous snakes, such as the cobras and the Russell vipers, actually find more conducive to their lifestyle.Read also:<a href="http://archive.nepalitimes.com/news.php?id=17330#.XULEUvIzbIU" target="_blank" rel="noopener">Snakebite!</a>, Buddha Basnyat<a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/Buzz-a%20pound-of-prevention,575" target="_blank" rel="noopener">An ounce of venom</a>, Buddha Basnyat<a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/tips-for-surviving-snakebites,1471" target="_blank" rel="noopener">Snakebite Survival,</a> Buddha Basnyat

“Snakebite is treatable,  no one need die from it.”

Nepal’s only international aviation gateway, at Kathmandu airport, will cut night-time operation hours to allow construction of taxiways, and airlines have been told to curtail flights. This is expected to lead to more than normal chaos during the height of peak autumn and spring tourist seasons at an airport that is congested even at the best of times. The airport will close from 10PM to 8AM from 8 November-31 March 2025. The taxiways will now connect to the thresholds at both ends of the runway, making the airport more efficient in handling higher frequencies of landings and takeoffs. The parallel taxiway extension will allow international flights to land every 4 minutes instead of the current every 7 minutes. At present planes have to wait to land until a plane taking off backtracks along the runway.&nbsp; Kathmandu is Nepal’s only airport with international operations, and it has only one runway that is only one way in from the south over the mountains. With the taxiway improvement, the airport will be able to handle 42 aircraft landings and takeoffs per hour — double the current capacity.&nbsp; The Civil Aviation Authority of Nepal (CAAN) has been trying to entice international airlines to also start flying to and from the other two international airports at Pokhara and Bhairawa (Lumbini) by slashing landing and handling charges. But so far only Nepal Airlines operates a weekly flight to Bhairawa from Kuala Lumpur.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241018161016_046569e53d1d66cd445cc66c697c0ef724810aec9f54bdf827481e3cd6b80c32.jpg" data-media-id="editor_0" data-image-id="20241018161016_046569e53d1d66cd445cc66c697c0ef724810aec9f54bdf827481e3cd6b80c32" data-rendition-name="original" width="2356" height="1134" loading="lazy" alt="Kathmandu airport expansion"> <figcaption>Kathmandu Airport Expansion plan with extension of taxiways to the thresholds of runways 02 and 20 that will limit airport operations from 8 November 2024 - 31 March 2025. Areas in blue are existing structures, including the international terminal which in future will be the domestic airport, and the new international terminal near the north end of the runway,</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241018121028_6e17cc2ee87c1b02d78cb54905825b7aa15299b7a00f5eddb01a59579ab85c1a.jpg" data-media-id="editor_1" data-image-id="20241018121028_6e17cc2ee87c1b02d78cb54905825b7aa15299b7a00f5eddb01a59579ab85c1a" data-rendition-name="original" width="1353" height="1328" loading="lazy" alt="Kathmandu airport NT"> </figure>  CAAN has reportedly told international airlines to cut their flight frequency to Kathmandu citing the shorter operation hours and has told budget airlines to shift some of their flights to Pokhara or Bhairawa, or face cuts. Many airlines currently operate regular flights to and from Kathmandu between 10PM and 8AM: Air Arabia to Sharjah, Fly Dubai to Dubai, Jazeera Airways to Kuwait, Cathay Pacific to Hong Kong, Singapore Airlines, several Nepal Airlines flights, and one of four daily flights by Qatar Airways to Doha. Jazeera Airways, FlyDubai, and Thai AirAsia have applied and got permission from CAAN to begin regular flights to Bhairawa’s Gautam Buddha International Airport. Starting 9 November, FlyDubai will start making a stopover in Bhairawa before flying on to Kathmandu. Immigration, customs and security are all fully functional in Bhairawa. In Kathmandu, the next phase of the airport upgrade includes converting the current international terminal for domestic operations, the construction of a new international terminal where the domestic departure area is now, as well as moving the hangars and the Nepal Army Air Wing to the eastern side of the runway. The apron area will also double its parking space for widebody jets. This is part of a Airport Capacity Enhancement Project that was initially funded through a $80 million loan from the Asian Development Bank (ADB), and the entire masterplan is expected to cost $800 million. This project is the latest upgrade to Nepal’s only international airport since it saw its first flight in 1949. The current international and domestic terminals are too small to handle the current annual traffic volume of 8.5 million passengers a year that is growing at 20% a year.

Kathmandu airport to cut flight hours

As Kathmandu becomes more congested and polluted, and with remote online work becoming the norm, many professional Nepalis are planning to retire in Pokhara, or move there.&nbsp; With its stunning mountain panorama, balmy winters and proximity to a profusion of wilderness areas, builders are responding to this demand with new townhouses, housing development and apartments. One such block of flats is the 10-storey <a href="https://sungavaapartment.com/">Sungava Apartment</a> located at Phulbari above the Seti River, near the point where it flows into and under Pokhara. The imposing structure near Manipal Hospital is almost complete, and on a recent visit the site was strewn with huge boulders unearthed while digging the foundation.&nbsp; The Seti brought down these boulders during a gigantic flood that geologists estimate happened 800 years ago when a chunk of Annapurna IV broke off and ploughed into the glacier below. Today, Sungava (means ‘orchid’) sits safely on a high terrace, 100m above the blue-green Seti and commands a view of Dhaulagiri, Annapurna South, Machapuchre, Annapurna III and IV.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2024102411104_5f8fc736c86ea3c08d7bef43bb727081d3cc1a2caa55ae2b441717e6044de7e9.jpg" data-media-id="editor_1" data-image-id="2024102411104_5f8fc736c86ea3c08d7bef43bb727081d3cc1a2caa55ae2b441717e6044de7e9" data-rendition-name="original" width="2016" height="1512" loading="lazy" alt="High living below the Himalaya NT"> </figure>  The soil here is conglomerate that has solidified like concrete, and the boulders were extracted by heavy earthmovers. It is intriguing to think that these metamorphic rocks as big as cars, rounded by glacial grinding, were once a part of a much higher Annapurna IV. Even for those with little interest in geology, Sungava is an ideal place to contemplate the tectonic forces that pushed these peaks into the sky to be sculpted into delicate shapes by wind, snow, earthquake and avalanche over millions of years. The view of the Himalayan panorama from Sungava’s many balconies are breathtaking when not obscured by clouds, or the haze that drifts in from across the southern border. On most days, just watching the towering pyramid of Machapuchre (Tamu name: कतासुँ क्लिको) play hide and seek with the clouds is mesmerising. There are rocks aplenty at Phulbari, and it is probably the flowers that grew along the flat terraces e that gave the place its flowery name. The boulders will hopefully be turned into a rock garden while landscaping. An nearby restaurant complex is making the best use of the stones in its design, using flat rocks as outdoor benches and tables. Sungava was designed by the husband-wife architect team of Deepak Sherchan and Jyoti Joshi of <a href="https://thedarkmermaidamarbshrestha.blogspot.com/2013/12/creative-builders-collaborative-cbc.html">Creative Builders Collaborative (CBC)</a>, which also built Heritage Plaza, Indreni Apartment and numerous other projects in Nepal. Sadbhavana retains CBC’s trademark Newari-style masonry and here it borrows from the orange brickwork of the old town of Pokhara, integrating it with modern design elements. A few of those heritage houses are still standing in Ganesh Tole and Ram Krishna Tole in Pokhara’s old quarter.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2024102411108_5eb64a4885961b6d30781cefeb1e8a313da313ac5227c7a66b60f0c7d48d6fab.jpg" data-media-id="editor_3" data-image-id="2024102411108_5eb64a4885961b6d30781cefeb1e8a313da313ac5227c7a66b60f0c7d48d6fab" data-rendition-name="original" width="1362" height="595" loading="lazy" alt="High living below the Himalaya NT"> </figure>  About 400m from the apartment past a bend on the river, and down below three tiers of terraces in the canyon is a suspension bridge. Below it, the Seti is still swollen with post-monsoon flow as it tumbles away in a hurry to head down south.&nbsp; Back at the apartment, it is quiet, far away from the hubbub of Lakeside a 15 minute drive away, and in the lap of greenery. There are 52 units at Sungava and it already has a close-knit prospective community of professionals, including doctors, publishers, engineers, and businesspeople from the renewable energy and IT sectors.&nbsp; Some residents say they opted for a second home in Pokhara to make it a ‘base camp’ to explore the Annapurnas with its many hiking trails made newly accessible with new roads. With the NRN citizenship law, overseas Nepalis can now also buy the flats. &nbsp; The floor plans include options for north and south-facing 3-bedroom apartments with verandas, and the facility has underground parking has EV charging, heated pool, sauna and gym. There are still some unsold apartments with panoramic views of the mountains and one can imagine oneself at the kitchen with its huge window, humming a ditty while preparing breakfast: “खाना पकाउँ हिमाल हेरेर...”

High living below the Himalaya

When the United Nations held its Summit of the Future at its headquarters in New York in September, many world leaders, including Nepal’s Prime Minister K P Oli, highlighted the effect of climate breakdown in increasing the frequency and intensity of natural disasters. What did not get as much attention was the long term impact of the climate crisis on food production. In fact, heat stress, weather extremes and the consequences on rain-fed agriculture is already being felt worldwide, undermining the chances of the <a href="https://unstats.un.org/sdgs/">UN’s Sustainable Development Goals (SDGs)</a> being met by 2030.&nbsp; The SDG’s 17 targets commit countries like Nepal to reduce poverty and inequality, end malnutrition, protect the natural environment, and ensure that citizens all enjoy health, justice and prosperity without leaving anyone behind.&nbsp; However, besides the impact of climate breakdown on agricultural production, in Nepal the area under cultivation is impacted by urban expansion, falling productivity and the need for expensive inputs like fertiliser and pesticides.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241019041052_626413c5baf4dae407ac9579231b41daeb51510aa636b75aeb7489d94cca6a62.jpg" data-media-id="editor_1" data-image-id="20241019041052_626413c5baf4dae407ac9579231b41daeb51510aa636b75aeb7489d94cca6a62" data-rendition-name="original" width="999" height="1500" loading="lazy" alt="urban agriculture in Kathmandu"> <figcaption>Kathmandu's urban sprawl is eating into its fertile cultivable lands. Photo: TAYLOR MASON</figcaption> </figure>  Now, a new study led by Nepali researcher Prajal Pradhan at the University of Groningen in The Netherlands looks at how urban agriculture may offer a solution to falling food production and meeting SDG targets. The researchers evaluated 1,450 publications exploring the contributions of urban agriculture with both positive and negative effects, and published their findings in the journal Cells Report Sustainability. Urban agriculture can help achieve 17 SDGs, positively influencing 81 targets. However, it could also undermine 51 goals.&nbsp; Read also: <a href="https://nepalitimes.com/here-now/the-vanishing-land">The vanishing land</a>, Taylor Mason “Urban agriculture offers immense potential for sustainable development, but realising this potential depends crucially on adopting practices that minimise its adverse effects while maximising its benefits,” Pradhan explains. Urban agriculture can substantially enhance urban food security, provide employment to the urban poor, serve as ground water recharge in built-up areas, and preserve open spaces that can serve as safe havens during disasters like earthquakes. However, it also presents problems like the potential health risks from contamination and the need for expensive inputs. &nbsp; “Urban agriculture plays a definitive role in advancing the SDGs, but achieving this requires tailored, context-specific solutions that address the unique challenges of different regions,” says Yuanchao Hu of Wuhan University in China and who is a researcher at the Potsdam Institute for Climate Impact Research. “But it needs equitable access and rigorous management of environmental risks.”&nbsp; Rapid urbanisation is eating into Nepal’s most fertile agricultural land, which means farming in remaining open spaces inside cities can be a viable alternative, especially as food prices rise.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241019041052_7b7c9413086226fbdc630d45acf772cfa1ced77a8970b9056ec5ec7e5226fdf8.jpg" data-media-id="editor_3" data-image-id="20241019041052_7b7c9413086226fbdc630d45acf772cfa1ced77a8970b9056ec5ec7e5226fdf8" data-rendition-name="original" width="1500" height="999" loading="lazy" alt="urban agriculture in Kathmandu"> <figcaption>A vegetable patch in between new houses in Thimi. Photo: TAYLOR MASON</figcaption> </figure>  “The conversion of Nepal’s most fertile land into cities is a severe problem,” Pradhan told Nepali Times. “Crop cultivation, horticulture, agroforestry, beekeeping, livestock rearing, or aquaculture can all be farming activities within and around cities.”&nbsp; The study makes recommendations for sustainable practices that build on the positive aspects of urban agriculture while mitigating the downsides, thereby promoting more resilient cities in future. Research shows that urban agriculture has been helping many countries attain SDG targets by enhancing food security and biodiversity while helping education and preservation of open spaces.&nbsp; Indeed, many farmers from the hinterland who have settled in Kathmandu Valley or other urban areas of the country have been practicing urban agriculture, leasing neighbourhood patches or cultivating roof gardens both out of necessity because of inflation and falling income to grow their own food, and also as a fulfilling hobby. Saurav Dhakal, a sustainability advocate with Story Cycle and now research fellow at the Asian Institute of Technology in Thailand, says there are socio-economic and environmental benefits of urban agriculture. “It provides benefits to all urban dwellers, regardless of their income status,” says Dhakal, “families get fresh food, and there are many other benefits like water retention, heat regulation and biodiversity. These are all public goods, so special government incentives may be needed.” It is not unusual to see vegetable patches and even paddy fields within inner city Kathmandu where an older generation of farmers are using available fertile land and <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/rooftop-gardens-kathmandu,1415">roof gardens to produce fresh, nutritious food </a>to reduce their dependence on food items that have to be bought after being trucked in from large distances.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2024101905100_1291ce98dbbb8caed8702ac4b1d469b3e13016d7ecaaf3bfd5f91c974d3c0c77.jpg" data-media-id="editor_5" data-image-id="2024101905100_1291ce98dbbb8caed8702ac4b1d469b3e13016d7ecaaf3bfd5f91c974d3c0c77" data-rendition-name="original" width="1500" height="999" loading="lazy" alt="urban agriculture in Kathmandu"> <figcaption>An older generation of farmers are using any available fertile land to continue farming but it is getting more and more difficult. Photo: TAYLOR MASON </figcaption> </figure>  Nepal’s urban population grew rapidly from only 3.6% in 1991 to 25% today. There is large outmigration from the mountains to peri-urban areas of the Tarai, to Kathmandu Valley and Pokhara, with many young men then moving abroad for work. Kathmandu Valley’s population has swelled to nearly 3 million, and is growing at 6.5% a year. Dilip Shrestha, 71, used to work for Nepal Food Corporation, so he knew firsthand about inflation, shortages and vegetables with pesticide residue. So, when he designed his new house in Kathmandu, he built a spacious roof where he grows cucumber, ginger, garlic, coriander, onions, tomatoes, chili, beans, okra, pumpkin and lettuce. His family eats healthier, and he has reduced dependence on the market.&nbsp; The co-author of the Cell Reports Sustainability journal article, Daya Raj Subedi who is a PhD candidate at Beijing Forestry University, says urban agriculture also promotes inclusion and psycho-social wellbeing.&nbsp; He says, “A crucial finding of the study is the identification of opportunities and challenges associated with urban agriculture, it can promote sustainable transformation of society.” In Banepa, 55-year-old Bijaya Manandhar in her lifetime has watched the fertile farms of her neighbourhood that used to supply vegetables to Kathmandu, now completely built up with no open space left. The pandemic lockdown prompted her to turn to the family’s <a href="https://nepalitimes.com/banner/rooftop-agriculture-on-the-roof-of-the-world">ancestral livelihood by growing food</a> not on terrace farms, but on the roof terrace. Manandhar is now a part of <a href="https://nepalitimes.com/banner/rooftop-agriculture-on-the-roof-of-the-world%5C%5C">कौसी खेती र करेसाबारी क्रान्ती</a> (Rooftop Farming and Garden Revolution) which has an online membership of 52,000, and awards annual prizes to women who excel in urban agriculture.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241019041052_7257f5def8f823f35a799fa6f6825e153f2ffa406ac11325d4fe74049b79e96d.jpg" data-media-id="editor_8" data-image-id="20241019041052_7257f5def8f823f35a799fa6f6825e153f2ffa406ac11325d4fe74049b79e96d" data-rendition-name="original" width="1600" height="736" loading="lazy" alt="urban agriculture in Kathmandu"> <figcaption>Rooftop farming is gaining popularity as a form of urban agriculture. </figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241019041052_beff1a4494ce896dd8fd383ee1f518e5448bcf7ea8bb138255391c7bcb9769ed.jpg" data-media-id="editor_9" data-image-id="20241019041052_beff1a4494ce896dd8fd383ee1f518e5448bcf7ea8bb138255391c7bcb9769ed" data-rendition-name="original" width="4000" height="3000" loading="lazy" alt="urban agriculture in Kathmandu"> </figure>  Pradhan says the challenge now is to upscale such examples of successful urban agricultural practices so they support Neal’s efforts to meet SDG targets. He adds, “Crop cultivation around cities can be protected by land use plans and regulations. Promoting community-based agriculture, including rooftop gardens, requires community engagement and public-private partnerships across the food value chain.”&nbsp; Such support would accelerate the popularity of existing rooftop farming and community gardens in Kathmandu Valley, or kitchen garden initiatives in Pokhara, and building on traditional farming practices that are preserved and integrated into urban settings like in Bhaktapur and Banepa. In Lalitpur, the Women Entrepreneurship Facilitation Center promotes urban farming enhancing both sustainability and empowerment.&nbsp; Another co-author of the report, Yuanchao Hu from China says followup research of the team will aim to identify good practices in local urban agriculture practices. He adds, “There are examples of urban agriculture that optimise sustainability, ensuring that it remains a viable solution for cities globally while countries try to meet SDG targets.” Prajal Pradhan, Daya Raj Subedi, Kshitij Dahal, Yuanchao Hu, Prakriti Gurung, Sijal Pokharel, Sagar Kafle, Biplav Khatri, Sudeeksha Basyal, Monika Gurung, and Aruna Joshi. Urban Agriculture matters for sustainable development. Cell Reports Sustainability, 1:100217, 2024. [DOI: 10.1016/j.crsus.2024.100217] Prajal Pradhan (<a href="mailto:p.pradhan@rug.nl">p.pradhan@rug.nl</a>) This article is brought to you by <a href="https://nepalitimes.com/" target="_blank">Nepali Times</a>, in collaboration with <a href="https://inpsjapan.com/en/" target="_blank">INPS Japan</a> and <a href="https://sgi-peace.org/" target="_blank">Soka Gakkai International</a>, in consultative status with UN ECOSOC.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240630110640_30c3782f9c09219bf1c249b51483a3cfb7a53a06d117d2aebd23ca7080d12758.jpg" data-media-id="editor_14" data-image-id="20240630110640_30c3782f9c09219bf1c249b51483a3cfb7a53a06d117d2aebd23ca7080d12758" data-rendition-name="original" width="680" height="103" loading="lazy" alt="SDG logo"> </figure>

Back to the land in the cities

The 700-year-old Lakshmi Narasingha temple in Bhaktapur houses a rare half-lion and half-human incarnation of Lord Vishnu carrying the Goddess Lakshmi. The temple was destroyed in the 1934 mega earthquake that killed 10,000 people and destroyed many monuments in Kathmandu Valley. It was rebuilt by a German project in the 1980s, but as a single-storey structure instead of its original two-tier pagoda design.&nbsp; With new findings from in-depth research, Bhaktapur municipality began re-restoring the temple in 2021, preserving its original architecture.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241017131016_2fae38cce543ad7b1f6de632feb3e212e08ed1acedd747830e949d7b8e878f18.jpg" data-media-id="editor_0" data-image-id="20241017131016_2fae38cce543ad7b1f6de632feb3e212e08ed1acedd747830e949d7b8e878f18" data-rendition-name="original" width="2048" height="1365" loading="lazy" alt="In with the old in Nepal NT"> </figure>  “Our temples and heritage sites hold deep meaning. It is disheartening to witness how often they lose their original elements, whether by design or accident,” explains Kumar Chawal of the Consumer Committee of Bhaktapur. “There is a need to preserve our architecture and protect its historical value for future generations. Otherwise, we risk losing a vital part of our identity.” The Laksmi Narsingha restoration is similar to the Bhai Dega temple in Patan Darbar Square which also collapsed in 1934, but was rebuilt with a Moghul-style dome by the Rana government at the time. Only two months before the 2015 earthquake, heritage conservationists had started to rebuild Bhai Dega as the original three-tier based on early photographs. But priorities shifted when four other temples in the square were brought down by the 7.8M earthquake on 25 April 2015.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241017131016_697ea707d9ad163be5de5f2efbf5b70d3cab771adcc22f0fae6bf937c6cb0130.jpg" data-media-id="editor_1" data-image-id="20241017131016_697ea707d9ad163be5de5f2efbf5b70d3cab771adcc22f0fae6bf937c6cb0130" data-rendition-name="original" width="2048" height="1365" loading="lazy" alt="In with the old in Nepal NT"> </figure>  This showed how damage to monuments in Kathmandu Valley spanned from one earthquake to the next. Bhai Dega restoration remains half-complete to this day because money for its restoration ran out.&nbsp; Whereas Bhai Dega restoration was done by the Kathmandu Valley Preservation Trust with grants from western embassies and international foundations, in Bhaktapur it is the municipality itself that allocated the Rs30.7 million needed to restore the Lakshmi Narasingha temple. The expected date of completion is early 2025. The municipality and local communities are focusing on two main aspects: preserving the past and promoting localisation. The restoration team has designed a blueprint for the temple by using historical photographs and insights from older generations.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241017131016_182882fdc393c99e70d1d0490319e415229563666c4934e3a582426ebf00ca30.jpg" data-media-id="editor_2" data-image-id="20241017131016_182882fdc393c99e70d1d0490319e415229563666c4934e3a582426ebf00ca30" data-rendition-name="original" width="1200" height="560" loading="lazy" alt="In with the old in Nepal NT"> </figure>  “At first, the Lakshmi Narasingha temple had only one entrance, but during the demolition process, we uncovered the foundations of four doors. Now, we are restoring all of them. This is an example of how our ancient structures have changed over time, often without our knowledge,” says Chawal. “Constructing temples is not like building houses. They carry historical and spiritual values, which is why they hold a special place in our hearts,” he adds. By replicating ancient design elements and rebuilding the temple as accurately as possible to its original form, the team has stayed true to Bhaktapur’s soul. But the restoration also revived ancient techniques that were in danger of being forgotten, generating employment for woodcarvers, masons, and contractors. The community of Bhaktapur’s Gahiti neighbourhood near the famous Nyatapola Temple has also set aside specific days for locals to volunteer in the reconstruction work. This has encouraged young people to take pride in ownership of their heritage. Families have also supported the effort by donating funds for bells, the temple pinnacle, and other structural features to the temple.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241017131016_db850ec0c084cdbe54f65bee92dad2ad8122d20fd60ec87ec086fbb9d2f72bd6.jpg" data-media-id="editor_3" data-image-id="20241017131016_db850ec0c084cdbe54f65bee92dad2ad8122d20fd60ec87ec086fbb9d2f72bd6" data-rendition-name="original" width="2048" height="1365" loading="lazy" alt="In with the old in Nepal NT"> </figure>  “I feel at peace knowing I have contributed my sweat to restoring this temple,” said one volunteer. “It is our duty to preserve our temples and heritage. The Nyatapola area will look magical once this temple is completed.” Community mobilisation is a long-standing tradition in Bhaktapur. In the past, locals have actively participated in the restoration of other temples in the city, such as Bhairav and Nyatapola fostering a strong sense of ownership. This collective engagement has not only been crucial in preserving the city's historical monuments but also in strengthening the bond between local communities and their heritage, says officials at the municipality. While securing funding is essential, and the municipality showed it values heritage conservation, the Lakshmi Narasingha restoration is proof that active involvement and sense of responsibility of the local community is as important, if not more. Local involvement also means that the monuments will be cared for into the future, When locals take ownership of these efforts, the restored monuments are not only protected in the present but are also cared for in the future.