<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.”

In the black and white photograph, General Wangdu smiles broadly in front of the dusty cactus garden in Kathmandu’s Annapurna Hotel. With an ill-fitting jacket and shaggy hair he looks benign enough, but this was the last leader of the Tibetan freedom fighters who led the resistance against the Chinese from their remote mountain hideouts in <a href="https://nepalitimes.com/here-now/comings-and-goings-in-mustang">Mustang</a>. Five months later, Wangdu was dead. Snapped in March 1974, I had only recently arrived in Nepal. How did I meet this legendary fighter? Possibly with his devoted camp follower, Lynne Klapecki, and probably in the Om Restaurant near Freak Street which was the preferred <a href="https://nepalitimes.com/banner/hippie-trail-nostalgia-in-kathmandu">hippie hang-out</a>. Om Lobsang and his brother Yeshe were <a href="https://archive.nepalitimes.com/page/earthquake-brings-back-memories-of-camps-for-tibetan-refugees">refugees from East Tibet </a>whose cafe offered a friendly welcome and<a href="https://nepalitimes.com/multimedia/momo-loco"> the best momos</a> - they became my in-laws after I married their eldest brother Tenzin, but that was a decade later.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025052403054_4573b34282b0f5395c007243d6bef12c7ba76bfd520419e994cdcea048d795a1.jpg" data-media-id="editor_4" data-image-id="2025052403054_4573b34282b0f5395c007243d6bef12c7ba76bfd520419e994cdcea048d795a1" data-rendition-name="original" width="1000" height="1583" loading="lazy" alt="The last days of the Khampa NT"> <figcaption>Photo: LISA CHOEGYAL</figcaption> </figure>  Wangdu’s English was enthusiastically rudimentary, but even riding around town with him on the back of an aging <a href="https://nepalitimes.com/here-now/kathmandu-s-new-motorbike-museum">motorbike</a>, he was a commanding presence. Always flanked by armed outriders, impressive scars marked his forearms and a pistol hung from the cord around his neck. A charismatic guerrilla leader, Wangdu was celebrated by his followers for his tough commitment and respected for his measured pragmatism. He seemed so young to have shouldered such a responsibility of command, leading hundreds of hardened <a href="https://archive.nepalitimes.com/article/nation/50-years-after-the%20raid-into-Tibet,1012#google_vignette">Khampa combatants </a>through what had been a particularly <a href="https://nepalitimes.com/news/heavy-snowfall-over-nepal-himalaya">brutal winter in Mustang</a>, the last bastion to hold out against the Chinese invasion of their Tibetan homeland.&nbsp; The freedom fighters of Tibet, known as the Chushi-Gangdruk, had emerged to resist the <a href="https://nepalitimes.com/editorial/territorialism">Chinese takeover</a> of Tibet during the 1950s. Estimated to be 80,000-strong at the time of <a href="https://nepalitimes.com/here-now/what-or-who-after-the-dalai-lama">the Dalai Lama</a>’s final escape to India in 1959, the sheer number of Chinese deployed into Tibet eventually forced the Chushi-Gangdruk to retreat to Mustang, From this high Himalayan stronghold, they continued cross-border raids on the Chinese People’s Liberation Army (PLA) throughout the 1960s.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025052403054_8a4a935ba25ae79dc3a63bb5c14626927020e5ec098093c45ccb9a5982e009fd.jpg" data-media-id="editor_10" data-image-id="2025052403054_8a4a935ba25ae79dc3a63bb5c14626927020e5ec098093c45ccb9a5982e009fd" data-rendition-name="original" width="1114" height="676" loading="lazy" alt="The last days of the Khampa NT"> <figcaption>Guerrillas known as the Chushi-Gangdruk emerged to resist the Chinese annexation of Tibet during the 1950s. Photo courtesy: MIKEL DUNHAM</figcaption> </figure>  Their Kathmandu base was a small discreet lodge in a back lane near Rani Pokhari. Sipping sweet tea from a blue mug with a chipped lid, I sat bemused in a corner of the Mustang Hotel room whilst Wangdu and his cohorts received a battered brown suitcase from their CIA connection, a tousle-haired American in a leather jacket. Heaved onto the dingy bedspread that covered the thin mattress, it was clicked open to reveal piles of neatly stacked dollar bills.&nbsp; I cannot think why Wangdu allowed me to witness this handover but I was clearly no threat, a newly arrived world traveller with no understanding of the stakes nor any Nepali or <a href="https://nepalitimes.com/multimedia/tibetan-music-in-nepals-sacred-valley">Tibetan language</a>. Despite armed guards in the corridor,Wangdu radiated confidence and bravado, and there was a practiced familiarity to the tense transaction. This deadly dance for many years had been funded by the Americans, tolerated by <a href="https://nepalitimes.com/here-now/the-kingdom-within-a-republic">Mustang’s residents</a>, and permitted by King Mahendra and the Nepali authorities who it suited to turn a blind eye.&nbsp; But Mahendra died in 1972, and times were changing. Richard Nixon’s ping-pong diplomacy thawed the cold war and signalled a fresh entente with China. Nepal’s yet-to-be-crowned <a href="https://nepalitimes.com/here-now/if-birendra-was-alive-nepal-could-still-be-a-monarchy">King Birendra </a>was under pressure to curb the irritating incursions against the PLA launched from the Nepali territory of Mustang. Keen to appease his northern neighbour, on several occasions the King summoned Wangdu for peace talks but, despite increasingly overwhelming odds, Wangdu refused to surrender.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025052403054_a8efd5cfb92cd997bd7cb74296a936fef46e2f7428f9cd642b03f1ac4ea11ecb.jpg" data-media-id="editor_14" data-image-id="2025052403054_a8efd5cfb92cd997bd7cb74296a936fef46e2f7428f9cd642b03f1ac4ea11ecb" data-rendition-name="original" width="1055" height="885" loading="lazy" alt="The last days of the Khampa NT"> <figcaption>General Wangdu flanked by two Tibetan resistance fighters in Mustang in the 1970s. Photo courtesy: MIKEL DUNHAM</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025052403054_75969125a745847a2ef82b6fe8b9106c0b21a116d85b8efdf5d2ee89a347bb31.jpg" data-media-id="editor_15" data-image-id="2025052403054_75969125a745847a2ef82b6fe8b9106c0b21a116d85b8efdf5d2ee89a347bb31" data-rendition-name="original" width="1044" height="792" loading="lazy" alt="The last days of the Khampa NT"> <figcaption>King Birendra with General Wangdu (right in dark glasses) taken in 1974 possibly in Mustang after one of their few attempts at negotiation. Photo courtesy: RAJRNDRA KUNWAR</figcaption> </figure>  While I naively rode pillion around Kathmandu in the spring sunshine, Wangdu was in the midst of what turned out to be his final round of negotiations with the Nepal government. Refusing to cease hostilities with the Chinese, Wangdu must have suspected the cost of his decision, making his cheerful smile in the photograph all the more poignant and brave. It was only much later that I appreciated the significance of the moment. Wangdu had been sent to replace the first resistance leader in Mustang, Baba Gen Yeshe, a much derided corrupt character who stole money meant for his troops and exploited fleeing refugees by seizing their treasures. Baba Gen Yeshe never forgave Wangdu,and sought revenge in May 1974 by betraying him and his commanders to the Nepal authorities. Renewed Chinese incursions from the north, active PLA collusion with the Nepali forces under the new King, and treachery from within the Chushi-Gangdrukranks combined to seal their fate.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025052403054_e0987a7c90d76431b0d7d5e6115ebfe3dbda7ab939e5941e079c18d722e884c0.jpg" data-media-id="editor_16" data-image-id="2025052403054_e0987a7c90d76431b0d7d5e6115ebfe3dbda7ab939e5941e079c18d722e884c0" data-rendition-name="original" width="1400" height="769" loading="lazy" alt="The last days of the Khampa NT"> <figcaption>British television journalists George Patterson and Adrian Cowell embedded themselves with Khampa guerrillas and accompanied them from Tsum Valley on a cross border raid on a Chinese Army convoy in 1964. Photo: ESSAYS ON NEPAL / SAM COWAN</figcaption> </figure>  Mikel Dunham, renowned author of Buddha’s Warriors, writes: ‘It is possible that Wangdu was waiting for some cue from the Dalai Lama’s government-in-exile in Dharamsala, India. It is equally possible – during that last, <a href="https://nepalitimes.com/multimedia/the-human-cost-of-nepal-s-yarsa-gold-rush?fbclid=IwZXh0bgNhZW0CMTEAAR31-Cqw8oyIwMPzf_35e4Skr0ululJvLf3_vDkzHn-AYG2h8uPw2rqqErg_aem_tGVn5coY1-jA7fze_xqhew">desolate winter </a>– that he made the decision to go out in glory rather than admit defeat. Over the last fifteen years, Wangdu had experienced Tibet’s organized resistance being squeezed and shoved around by every conceivable outside force.&nbsp; First they had been pushed out of their own country by the PLA; then they had been refused sanction while on <a href="https://nepalitimes.com/opinion/borderlines/nepal-india-trans-boundary-bonds?fbclid=IwAR0PpJ5zUEbwdug3g_U3ar6FUugngRY0S8Tl2v_7wqzrsHmXWcXsKjvL4t4">Indian soil</a>; then they were abandoned by the Americans because, apparently, Nixon wanted to make friends with Wangdu’s mortal enemies, the communists; then they had been betrayed by the vampiric Baba Gen Yeshe – a Tibetan and, even worse, a fellow Khampa; and now, finally Wangdu’s army was being evicted by the Nepalis. One thing was certain: Wangdu was a warrior. To imagine Wangdu simply giving up and settling down in the pacific squalor of a <a href="https://nepalitimes.com/here-now/elderly-left-in-bhutan-refugee-camp">refugee camp </a>was unthinkable.’  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025052403054_8fc1ffef4ae751628b90ae781b66e11e51e4fdde2787207c9042efbee345ce49.jpg" data-media-id="editor_20" data-image-id="2025052403054_8fc1ffef4ae751628b90ae781b66e11e51e4fdde2787207c9042efbee345ce49" data-rendition-name="original" width="500" height="746" loading="lazy" alt="The last days of the Khampa NT"> <figcaption>The much derided Baba Gen Yeshe, the first Tibetan resistance leader in Mustang, who betrayed Wangdu for personal gain. Photo courtesy: MIKEL DUNHAM</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025052403054_b1d833cdb00d3ac4416b844d8730475cd88c238caaaf8da69889a584eea229a3.jpg" data-media-id="editor_21" data-image-id="2025052403054_b1d833cdb00d3ac4416b844d8730475cd88c238caaaf8da69889a584eea229a3" data-rendition-name="original" width="500" height="656" loading="lazy" alt="The last days of the Khampa NT"> <figcaption>Aditya SJB Rana of the Royal Nepal Army whose team ambushed Wangdu and his cohorts at the top of Tinker Pass in Darchula, West Nepal. Photo courtesy: GAUTAM SJB RANA</figcaption> </figure>  By August 1974 the game was up. Wangdu and six of his exhausted party were killed on their horses by <a href="https://archive.nepalitimes.com/news.php?id=7270">the Royal Nepal Army</a> on the brink of escape. The officer in charge, Aditya SJB Rana, cleverly predicted their route into India after they failed to silence a police radio in Yari. A carefully laid ambush trapped them near the summit of the Tinker Pass in Darchula,at 5,000 meters the highest military operation of its time. Wangdu’s body was helicoptered to Kathmandu, and a big show made of the royal Nepal victory.&nbsp; The Tibetan armed insurgency against China had reached its end.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250524030520_3ff9c6fc85a65bc9a2c3afe9736d9f5f9413de752e790a5d9dca0981ea94f9b4.jpg" data-media-id="editor_23" data-image-id="20250524030520_3ff9c6fc85a65bc9a2c3afe9736d9f5f9413de752e790a5d9dca0981ea94f9b4" data-rendition-name="original" width="1136" height="702" loading="lazy" alt="The last days of the Khampa NT"> </figure>

The Last Days of the Khampa

Starting 17 September Turkish Airlines will fly daily to Seville, one of Spain’s major tourist draws. This is Turkish’s sixth destination in Spain after Madrid, Barcelona, Valencia, Malaga, and Bilbao. Seville is in the Andalusia region on Spain’s south coast with a rich Moor history. There are approximately 30,000 Nepalis living in Spain.&nbsp;

Turkish to Seville

The newly-formed Himalayan Art Council is set to launch Nepal’s National Art Protection Platform that seeks to preserve <a href="https://nepalitimes.com/banner/the-history-of-heritage">Nepal’s unique cultural heritage </a>using<a href="https://nepalitimes.com/here-now/artificial-censorship"> AI-powered tools</a>. The Council seeks to safeguard <a href="https://nepalitimes.com/banner/nepali-art-going-places">Nepali art works</a> from neglect, theft and counterfeiting as well as preserve existing artwork and celebrate living masters by giving them a cultural space to continue the <a href="https://nepalitimes.com/banner/sacred-survival">sacred art traditions</a>. "We are introducing a new digital platform designed to preserve, verify and elevate <a href="https://nepalitimes.com/banner/nepals-new-generation-of-alternative-artists">Nepal’s art for generations to come,</a>” says a statement from the Council, adding that the digital platform will use AI told for authentication and blockchain to keep track of works of art. Artists can now be protected by <a href="https://nepalitimes.com/multimedia/ayo-ai?fbclid=IwAR1uwmTVq4gUB70ljfRezjzukD9ArWXPuMnUikopeQ8PoiZMjicToPSwhKE&amp;=1">AI tools</a> that detect forgeries, identify their work even when unsigned, and ensure they receive proper recognition and credit. The archives will be searchable with translated inscription and interactive guides. Says curator Meena Lama: “AI and blockchains are tools that give us the power to detect fakes and identify unsigned paintings and track every piece. With these tools we can restore trust, secure authorship and give artists the dignity they deserve.”  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250514170544_2ab58f6313c0458f75114a692b0016bd9efb3b59d5f8f07f0da72e1e37b82f53.jpg" data-media-id="editor_6" data-image-id="20250514170544_2ab58f6313c0458f75114a692b0016bd9efb3b59d5f8f07f0da72e1e37b82f53" data-rendition-name="original" width="1300" height="1000" loading="lazy" alt="Artwork at the Traditional Art Exhibition at Patan Museum."> <figcaption>Artwork at the Traditional Art Exhibition at Patan Museum.</figcaption> </figure>  The Council is also holding an exhibition of Nepali cultural masterpieces with 50 historical <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/Buzz-the-art,671">thangka and paubha </a>by past masters and <a href="https://nepalitimes.com/review/between-the-sacred-and-everyday">contemporary works by current artists</a>. This curated collection is a living tribute to <a href="https://nepalitimes.com/here-now/when-yaks-go-so-does-culture">Himalayan culture</a> with economic depictions of deities, mandala and sacred narratives. The exhibition at <a href="https://nepalitimes.com/multimedia/a-portal-into-patan-s-past-and-present">Patan Museum</a> also provides an opportunity to meet painters and custodians of art and culture. Read also: <a href="https://nepalitimes.com/review/golden-deities">Golden deities</a>, Sewa Bhattarai ‘The exhibition is only the first step in a long journey to ensure that Nepali art is no just seen but fully understood, <a href="https://archive.nepalitimes.com/article/nation/Narratives-of-Faith-and-Memory-Remembering-the-Lost-Sculptures-of-Kathmandu-exhibition,987">protected and remembered</a>,’ the Council says. Artist Kailash K Shrestha of Artudio has spent decades promoting thankha and paubha traditions because of their beauty and devotional meaning. But he also says artists are underpaid, exploited and ignored. He adds, “AI and blockchain are not just buzzwords, they are powerful tools that can protect Nepal’s artists from fraud, verify authenticity and build a permanent record of provenance.” Traditional Art Exhibition Till 17 May Patan Museum

Digital protection for Nepal’s art

<a href="https://www.instagram.com/prabalgurung/" target="_blank">Prabal Gurung</a> left Nepal for New York in 1999 to escape years of bullying, sexism and homophobia, and to pursue his dream of becoming a fashion designer. He <a href="https://www.youtube.com/watch?v=KqN0VaoAI5w" target="_blank">realised his dream</a>, but did not escape discrimination and racism in the new world. Propelled by passion for fashion, Gurung overcame everything America threw at him. He has attained <a href="https://www.vanityfair.com/style/story/prabal-gurung-recalls-his-first-met-gala-when-zoe-saldana-was-at-his-side?srsltid=AfmBOooy-H0oGgxMit864FnW_Pmw8mUnV8rYrh-co-f6OyYK6m2ip5hP" target="_blank">fame and recognition</a> for his haute couture dress designs while remaining true to his Nepali roots, and is even more resolute in <a href="https://www.youtube.com/watch?v=dSmNauyzACk" target="_blank">fighting prejudice</a> in all its forms. Prabal Gurung’s newly-released memoir <a href="https://www.amazon.com/Audible-Walk-Like-Girl-Memoir/dp/B0DG11HCDQ?fbclid=IwY2xjawKZfpxleHRuA2FlbQIxMQABHuZcIJO2OXyXcRm1oq1iG6wzeoF7VJFrQ7GXOFI0YxuZZ4id_CNvSZSZZIna_aem_pG_mOKG73RTnYvN8JaC4fA">Walk Like a Girl</a> is a saga of harrowing abuse in boarding schools in Nepal and India, only finding himself facing a different kind of bullying in the US. He prevails over it all to be where he is today: an award-winning American fashion designer with his own label. Walk Like a Girl was launched last week in New York at a time when everything Gurung fought for — tolerance, inclusion and diversity — are in retreat in his adopted country because of a president who has espoused a culture of bullying. The book is a searing, raw exposé of how cruel and abusive people can be even at a young age in school. On the other hand, it also shows that there are generous, compassionate and open-minded souls out there. In his book, <a href="https://www.youtube.com/watch?v=K4le_uWX7YE">Prabal Gurung</a> calls out those who tormented and tried to hold him back (some of their names have been altered). The moral of his story is: resist, never stop believing in yourself, do not let others define you, never lose sight of your dream, and help those who have been kept out. “Walk like a girl” was a slur used by bullies back in school in Nepal and India for Gurung’s effeminate ways. He fought back then, and he is still resisting by turning those words into something to be proud of.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250519170544_4ffc9c3f565dd2cfa754d10b224816897b82bb31ebaee91b6d79d469fc96f14e.jpg" data-media-id="editor_6" data-image-id="20250519170544_4ffc9c3f565dd2cfa754d10b224816897b82bb31ebaee91b6d79d469fc96f14e" data-rendition-name="original" width="1000" height="1253" loading="lazy" alt="Prabal Gurung NT"> <figcaption>Prabal Gurung at home in Kathmandu in the 1990s.</figcaption> </figure>  “Living through it all was one thing, but writing about it is one of the hardest things I have done in my life,” admitted Gurung during the launch. “I broke down constantly during the six-year writing process.” He continues: “I did not want this to be a victim’s book. I did not want to burden my readers with my emotions. I wanted my struggle to be an inspiration for others facing what I faced. I am grateful to those who bullied me in school, they made me a stronger person ready to face the world.” Indeed, this book is a departure from his earlier one titled simply, Prabal Gurung (Abrams, 2019), which was a lush pictorial autobiography of his career in fashion. Walk Like a Girl is not a typical fashion book, it is an intimate tale of <a href="https://archive.nepalitimes.com/news.php?id=16997">Gurung’s travails and triumphs</a>, and how he willed himself to succeed. Prabal pays a lavish tribute to his mother Durga Rana. We find out she is a descendant of the first wife of the eldest son of Jang Bahadur Rana who was banished to Palpa in the late 19th century. Prabal’s father served in the Singapore Police and that is where he was born before the family returned to Nepal when he was four. Gurung relates with brutal honesty about the violence his mother endured from his father. Durga raises three children as a single mother in Nepal, and Prabal credits her for his fierce determination to resist patriarchy and injustice, which in time manifests itself in his hyper-feminine and subversive dress designs. Writing the book has been a cathartic experience for Gurung, who says he is now relieved of the burdens of his past. It no longer haunts him, and he does not have to prove anything to anyone anymore. Walk Like a Girl has life lessons not just for the <a href="https://www.instagram.com/p/DJmOcSgxdWz/" target="_blank">fashion industry</a>, but for every other profession. How can my job serve a greater cause? Gurung tells us his work is <a href="https://asiasociety.org/blog/asia/why-designer-prabal-gurung-doesnt-want-just-stick-fashion" target="_blank">bigger than just making clothes</a>, it is about making the world a better place because it could do with a lot of improvement.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250519170544_d75296ad8bfdc00d88935f40d23543c6fea3d4d6a10e61a99d6cfc6127f2ee5b.png" data-media-id="editor_10" data-image-id="20250519170544_d75296ad8bfdc00d88935f40d23543c6fea3d4d6a10e61a99d6cfc6127f2ee5b" data-rendition-name="original" width="1516" height="1000" loading="lazy" alt="Prabal Gurung"> </figure>  This story of chasing the American dream may sound familiar to many immigrants: knocking on doors for jobs, rejections, trying to survive from day to day on expensive rent, and dealing with subtle racism in white America. Gurung finds racism is rife, and he is often mockingly called ‘gaysian’. He writes: ‘There was a strong hypocrisy — this idea of independence felt like a marketting ruse … and for all the talk of feminism in America, these high society women were trapped by the patriarchy just like in Nepal and India.’ After a trek to the Khumbu region in 2013, Gurung is inspired to use the colours, palette and textures of Nepal for his collection exhibited on Manhattan’s 8th Avenue. A major buyer tells him bluntly: “Stick to making pretty dresses … if I need to see a collection like this, I could buy a copy of National Geographic.” The New York Times was equally dismissive: ‘The designer tries to draw connections between blistered techo-fabric used to construct it and the topography of his homeland, Nepal. But, at the moment, he has lost his map.’ One potential investor tells Gurung he cannot design for Americana because “you do not look American”. Gurung wants to use expletives, but restrains himself. After a fundraiser in New York for the Nepal earthquake in 2015, some belittled his effort, saying: “Here comes the saviour."&nbsp; Read also: <a href="https://nepalitimes.com/review/prabal-gurung-by-prabal-gurung">Prabal Gurung by Prabal Gurung</a>, Kunda Dixit The Gurkha DNA must be dominant in Prabal Gurung’s genes because he does not take such mistreatment lying down. When asked by a fashion publicist why he was designing clothes for fat people, he snaps back: “Because of people like you.” He joins the Black Lives Matter and #MeToo movements, launches the Shikshya Foundation charity in Nepal, and has powerful allies among celebrities who wear clothes he designed: Michelle Obama, Oprah Winfrey, Sara Jessica Parker, Kamala Harris, Deepika Padukone … it is a long list.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250519150556_48a5f4211991a23fa85b64bbd5377575ca7081d97309d7542035591dda5180fe.png" data-media-id="editor_12" data-image-id="20250519150556_48a5f4211991a23fa85b64bbd5377575ca7081d97309d7542035591dda5180fe" data-rendition-name="original" width="1114" height="1534" loading="lazy" alt="Being Prabal Gurung by design"> <figcaption>Nigerian novelist Chimamanda Ngozi Adichie wearing Atelier Prabal Gurung’s design for Met Gala 2025 in which the theme was ‘Superfine: Tailoring Black Style’. </figcaption> </figure>  “I don’t dress women to look beautiful, they already are,” Gurung says. “I try to bring out their innate strength and grace.” <a href="https://www.instagram.com/stories/highlights/17908766880140171/" target="_blank">Admirers</a> tell Gurung he makes it all look so easy, but he used to put up a strong facade to not show his own vulnerabilities in public. “I was closed because of my childhood experiences,” he says. “I was always on guard to defend myself because I never knew where the next punch would come from.” But in <a href="https://www.youtube.com/watch?v=PPVepzPA210" target="_blank">Walk Like a Girl,</a> Gurung comes to terms with his vulnerability, and bares his soul. It has not been easy, it took sustained will power and support from his mother, sister Kumudini and a circle of close friends. “I made unbelonging my power,” he says. “Nepal is where I still have my heart and soul. Nepal grounds you. It is where people go to find themselves. But I escaped.” Recently appointed vice-chair of the <a href="https://cfda.com/about-cfda" target="_blank">Council of American Fashion Designers</a>, Gurung says: “I can’t believe I am here, it feels like it is happening to someone else. Writing this book, the healing has finally begun.” <h2>‘Everything is better in color’</h2> The Met Gala was two weeks later, and my table was an example of everything I’d been fighting for all these years as my guests represented everything I believed in: dynamic, powerful, influential women who were unapologetically original and unabashedly graceful. I was grateful to Anna for inviting me to host and dress a table that reflected my ethos—and for her guidance in doing so. I was also aware of the privilege as one of the first-­ever Asian fashion designers—not just from Nepal, but from the entire continent— to get the opportunity to do so. That fact was not lost on me. I reached out beyond the expected Hollywood celebrities and well-­known socialites to curate a table of exceptional women who inspired me. I invited Deepika Padukone and Alia Bhatt for their first-­ever Met Galas, as well as Michelle Yeoh, Mindy Kaling, Camila Cabello, Ashley Park, Denée Benton, KiKi Layne, Quannah Chasinghorse, and Grace Elizabeth. Together we checked many boxes: Asian, Black, Latinx, and Indigenous, each woman undeniably chic and powerful, a dazzling array of skin tones and experiences that proved my decades‑in‑the-­making hypothesis: everything is better in color. Excerpt from Walk Like a Girl Viking © 2025 by Prabal Gurung  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250519170520_6b91d560e9f072c37d16876901058c073a51ffa05e7ad1b9461d19e1c9c28215.jpg" data-media-id="editor_16" data-image-id="20250519170520_6b91d560e9f072c37d16876901058c073a51ffa05e7ad1b9461d19e1c9c28215" data-rendition-name="original" width="1136" height="702" loading="lazy" alt="Prabal Gurung book details NT"> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250519170520_345240c21be400e2ce2ec629b52bd82bb53890e5bd86fe95b48340d84b5f1748.jpg" data-media-id="editor_17" data-image-id="20250519170520_345240c21be400e2ce2ec629b52bd82bb53890e5bd86fe95b48340d84b5f1748" data-rendition-name="original" width="1136" height="702" loading="lazy" alt="Prabal Gurung book details NT"> </figure>  &nbsp;