Just as Nepal was recovering from the Covid pandemic in 2022, the government with GAVI, the Vaccine Alliance, inoculated almost 8 million school-children against typhoid.&nbsp; What was even more remarkable was that this vaccine was earlier trialled among 20,000 people in Lalitpur, showing a significant reduction in typhoid incidence with efficacy rate of an impressive 80%, and was the subject of a <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa1905047">research paper in the New England Journal of Medicine in 2019</a>.&nbsp; This kind of <a href="https://nepalitimes.com/banner/a-shot-in-the-arm-for-vaccines-in-nepal">Typhoid Conjugate Vaccine (TCV) </a>has also been used in Malawi and Pakistan where there has been a drop in typhoid cases. The trial was undertaken by the Oxford University Clinical Research Unit (OUCRU) Nepal which was set up in Lalitpur in 2003 to control endemic typhoid fever in Nepal and the region. Besides vaccines, OUCRU-Nepal has also carried out ground breaking randomised controlled trials in the treatment of typhoid fever. Its seminal paper in the journal Lancet Infectious Disease in 2016 influenced WHO to suggest that the fluoroquinolone drugs which was chosen at the time for typhoid fever should not be used in the empirical treatment of typhoid fever in South Asia. Nepal’s successes both in the prevention and treatment of typhoid fever will be showcased at the <a href="https://www.ascodd2024.org">17th Asian Conference on Diarrhoeal Diseases and Nutrition (ASCODD)</a> in Kathmandu 8-11 December titled Emerging Enteric Infections and Impact of Climate Change. Over 300 experts will attend the conference, including Andrew Pollard who helped develop the Oxford AstraZeneca Covid vaccine and Edward Thomas Ryan, immunologist at Harvard University and Massachusetts General Hospital, among others. Buddha Basnyat and Andrew Pollard were the two principal investigators for the typhoid conjugate vaccine trial in Lalitpur. “The conference is a one of a kind platform bringing together researchers, policymakers, and public health professionals from across Asia and beyond to address critical challenges in diarrhoeal diseases, nutrition, and public health,” says Abhilasha Karkey, medical microbiologist and director of OUCRU Nepal. Typhoid fever is prevalent in countries with poor hygiene and is transmitted through the faecal-oral route. If untreated, it can cause complications leading to death. Treatment is straightforward, but antibiotic resistance is a growing problem. “Typhoid, much like tuberculosis, is a biblical disease,” explains Buddha Basnyat, chair at the OUCRU Nepal. “It is hardly heard of in developed countries, except in travelers from our part of the world.” Indeed, South Asia including Nepal has an incidence of about 500 cases per 100,000 population. Anything over 100 per 100,000 is regarded as ‘alarming’. Hotspots include cities like Kathmandu, Karachi, New Delhi, Dhaka and Kolkata. It goes without saying that the best antidote to diseases like typhoid fever and cholera is safe drinking water and better hygiene, which can only be guaranteed with political accountability and education. “Careful study of typhoid burden, and performance of typhoid vaccines in children, led by OUCRU-Nepal based at the time in Patan Hospital in Nepal in collaboration with the Oxford Vaccine Group, has been central to the development of policy by the World Health Organisation,” Andrew Pollard told Nepali Times. He added: “As a result of the contribution of the Nepali investigators, more than 60 million children have been protected against typhoid around the world in the past two years and many tens of millions more will be protected in the decade ahead.” Typhoid fever is also often misdiagnosed. Nine years ago in the aftermath of the Nepal earthquake, there were several deaths across the country as they were wrongly diagnosed because of the widespread use of the Widal test that is consistently known to give false results. In reality, these patients had typhus fever which is spread to humans by fleas, lice, and chiggers, and required a different antibiotic, not ceftriaxone, a potent antibiotic for typhoid fever. &nbsp; <h2>ASCODD 2024</h2>  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2024120703124_d067362901ebf9142bfbac6ed2995c9c7efb05b5f98bb6856dab66b66aaea956.jpg" data-media-id="editor_3" data-image-id="2024120703124_d067362901ebf9142bfbac6ed2995c9c7efb05b5f98bb6856dab66b66aaea956" data-rendition-name="original" width="1200" height="500" loading="lazy" alt="ASCODD"> </figure>  The ASCODD 2024 is a platform for Nepal to present its public health research, including in the prevention and treatment of enteric illnesses like typhoid. The conference theme is Emerging Enteric Infections and Impact of Climate Change. Another key highlight is the launch and discussion of Nepal’s National Cholera Control Plan which reflects the country’s commitment to eliminating the disease. The last big cholera outbreak was in Jajarkot in 2009 that killed 111 people, mainly children, and in 2016 in Kathmandu with 169 cases. “At the conference, we will explore the latest scientific advancement in diagnostics, treatment, vaccines while emphasising equitable access to these tools in resource-limited settings and in climate vulnerable countries like Nepal,” says Abhilasha Karkey, director of OUCRU Nepal. Keynote speaker is the former director general of the International Vaccine Institute (IVI) John Clemens and other sessions will look at the latest trends in antimicrobial resistance, the impact of the climate crisis on enteric diseases and community-based interventions.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241211031252_74274eb986c631c2771ea65770c4d0abb8dfcb3548d736fac096ca88656b3e56.jpg" data-media-id="editor_4" data-image-id="20241211031252_74274eb986c631c2771ea65770c4d0abb8dfcb3548d736fac096ca88656b3e56" data-rendition-name="original" width="1904" height="1254" loading="lazy" alt="17th Asian Conference on Diarrhoeal Diseases and Nutrition"> <figcaption>The Asian Conference on Diarrhoeal Diseases and Nutrition (ASCODD) president Firdausi Qadri addressing the crowd in Kathmandu. </figcaption> </figure>  What is the difference between typhoid fever and typhus fever? Typhoid fever is often confused with other illnesses not just because they sound the same, but have common symptoms. Typhoid fever is caused by the bacteria Salmonella typhi or Salmonella paratyphi via water or food contaminated with fecal matter. It leads to high fever, rashes, headache, general weakness, diarrhoea. Typically, these last for a week but are clearly preventable with better hygiene and vaccines. Treatment is a course of antibiotics. There is an alarming increase in antibiotic resistance. Typhus fever is a rickettsial disease mainly transmitted through vectors such as mites, fleas, lice and ticks, and have non-specific symptoms similar to a bad cold, including fever, chills, headache, muscle pains and rash. A common antibiotic called Doxycycline is used in the treatment of the disease, but misdiagnosis has led to deaths in Nepal.

Sonia Awale

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Nepal’s success in typhoid vaccine trial

<figure><img width="1236" height="856" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85a09c7e80680e067804jpeg.jpg" alt=""/><figcaption>Photo: AMIT MACHAMASI</figcaption></figure><h2>1. Oxygen</h2> To save lives, Nepal’s most urgent need now is oxygen. Not just cylinders, but oxygen generators, concentrators and liquid oxygen. Most infected people are not succumbing to Covid-19, they are <a href="https://www.nepalitimes.com/here-now/helping-nepalis-breathe-again/" target="_blank" rel="noopener noreferrer">dying because of low oxygen saturation</a> in the blood, and lack of hospital beds -- patients who need not have died of coronavirus. Dire as the situation is in the cities, Nepal’s pandemic has now <a href="https://www.nepalitimes.com/editorial/nepals-humanitarian-emergency/" target="_blank" rel="noopener noreferrer">infiltrated the remotest villages</a> where there is no hospital care and no oxygen. The virus is preying on people already suffering malnutrition, previous ailments, and decades of structural state neglect. In Rolpa, Humla and other remote districts, between 80-90% of PCR tests are coming back positive, and it takes a week to get results. Patients are either not isolating, or not following precautions.Kathmandu's doctor-to-patient ratio is 1:850, but in rural Nepal it is one doctor for every 15,000 people, and hospitals and medical staff there <a href="https://www.nepalitimes.com/here-now/at-the-covid-19-frontlines-in-rural-nepal/" target="_blank" rel="noopener noreferrer">are already overstretched</a>.Close to 60% of all swabs collected nationwide are from Bagmati Province, with nearly half of them in Kathmandu Valley, says epidemiologist Lhamu Yangchen Sherpa. She adds: “There just aren’t enough tests and contact tracing is minimal, official total cases and fatalities are grossly underestimated.” <figure><img width="1497" height="746" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85a39c7e80680e067805jpeg.jpg" alt=""><figcaption> </figcaption></figure><figure><img width="984" height="519" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85a69c7e80680e067806jpeg.jpg" alt=""><figcaption> </figcaption></figure>Hospitals in Kathmandu Valley with roof helipads have multiple daily rescue flights, but even these facilities are <a href="https://www.nepalitimes.com/banner/we-knew-the-tsunami-was-approaching/" target="_blank" rel="noopener noreferrer">at breaking point</a> with patients being turned away. Understaffed and under-equipped hospitals in the districts do not stand a chance. Even where hospitals exist, many families avoid them for fear of being infected and take wrong medication from pharmacies.Case in point are recent deaths due to misdiagnosis across the country. <a href="https://www.nepalitimes.com/banner/a-shot-in-the-arm-for-vaccines-in-nepal/" target="_blank" rel="noopener noreferrer">Typhoid disease</a> simulates Covid-19 with similar symptoms, and the widespread Widal test is known to give false positives.“Covid patients are being prescribed antibiotics to fight typhoid, only to turn critically ill in a few days’ time,” says Buddha Basnyat of Patan Academy of Health Sciences. “This is the reason behind some of the latest Covid fatalities.” <figure><img width="1280" height="720" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85a89c7e80680e067807jpeg.jpg" alt=""><figcaption> </figcaption></figure>As in India, Nepal is beginning to see a slight bending of the curve for new infections, but health experts expect the fatality rate to remain high for some more time.  There were 190 Covid deaths in the past 24 hours and 6,543 recoveries. Of the total 8,305 new cases on Thursday, Kathmandu Valley accounts for 3,232 infections. 7,814 people are undergoing treatment in hospitals with 1,748 in ICU and 492 in ventilator support. “After the relentless patient pressure of the past month, we have seen a decline in those requiring admissions,” says virologist at Teku hospital Sher Bahadur Pun. “The virus has now infected a majority of people in the cities, and this combined with the lockdown means we may be getting to the halfway mark of the second wave.” <h2>2. Vaccines</h2> A prolonged lockdown is not the answer. If it was, the <a href="https://www.nepalitimes.com/latest/covid-19-numbers-slightly-down-in-nepal/" target="_blank" rel="noopener noreferrer">reduction in the number of cases and the positivity rate</a> this week would have been steeper. Even while the government tries to increase oxygen supply to hospitals, the only long-term strategy is to vaccinate at least 70% of Nepal’s eligible population.Doctors report a marked difference between the recovery of people who are vaccinated against those who are not. Says virologist Pun at Teku Hospital: “Except for a few rare cases, all patients in critical condition and those dying are the ones who for one reason or another had not been vaccinated.”But Nepal has run out of its vaccine stock, leaving 1.4 million people still waiting for their second dose of AstraZeneca Covishield in a lurch, after India banned its export, and the COVAX Facility could not supply its remaining 1.8 million vaccines to Nepal because of the global supply bottleneck.  <figure><img width="1440" height="1080" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85ac9c7e80680e067808jpeg.jpg" alt=""><figcaption> </figcaption></figure>The Nepal government and pressure groups in Nepal and the United States <a href="https://www.nepalitimes.com/here-now/nepal-needs-urgent-american-vaccine-support/" target="_blank" rel="noopener noreferrer">have strongly urged the Biden administration</a> to immediately rush some of its AstraZeneca doses to Nepal.Meanwhile, the UK, the US and Canada have authorised vaccines for use in children and adolescents, sparking outrage in the global public health community for prioritising an age group that is rarely critically affected by Covid-19. The World Health Organisation’s director-general Tedros Adhanom Ghebreyesus has urged rich countries to instead donate doses to the <a href="https://www.nepalitimes.com/latest/unicef-urges-g7-to-dispatch-vaccines/" target="_blank" rel="noopener noreferrer">COVAX Facility</a> for poorer states that have barely covered health workers and the most vulnerable groups. Speaking at the British Parliament last week, noted vaccinologist and the principal researcher of Oxford University’s AstraZeneca vaccine, Andrew Pollard, called the decision to inoculate children in wealthy nations ahead of high-risk groups in poorer countries “morally wrong.” Pollard has worked extensively in the region, leading research into the burden and transmission of typhoid in Nepal, Bangladesh and Malawi, and the impact of typhoid vaccine in these areas. He also runs surveillance for invasive bacterial diseases, and studies the impact of pneumococcal vaccines in children in Nepal.In Nepal, vaccination will grind to a halt this week after the current campaign to inoculate 300,000 people in the 18-59 age group with their second dose of the Chinese VeroCell ends.  <figure><img width="960" height="640" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85af9c7e80680e067809jpeg.jpg" alt=""><figcaption> </figcaption></figure><img width="960" height="640" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85b29c7e80680e06780ajpeg.jpg" alt=""><img width="960" height="639" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85b49c7e80680e06780bjpeg.jpg" alt="">Although <a href="https://www.nepalitimes.com/here-now/nepal-is-a-priority-for-vaccine-shipments/" target="_blank" rel="noopener noreferrer">Foreign Minister Pradeep Gyawali says</a> the government is in “final negotiations” for 2 million doses of Sinopharm VeroCell vaccines by June, there is no movement at the Ministry of Health. Ongoing talks to procure 8 million doses of <a href="https://www.nepalitimes.com/opinion/vaccine-geo-politics-and-sputnik-v/" target="_blank" rel="noopener noreferrer">the Sputnik V</a> have hit a production capacity snag in Russia. “We can implement lockdowns only for so long, the only exit strategy is vaccines. Science delivered, now our politicians must do the same,” says Buddha Basnyat, a physical at the Patan Academy of Health Sciences. “The Nepal government must procure vaccines using every diplomatic channel possible, and rich countries must realise that they are not safe until countries like Nepal are also vaccinated.” Activists have been trying to convince <a href="https://www.nepalitimes.com/latest/leading-public-figures-call-on-uk-government-for-oxygen-for-nepal/" target="_blank" rel="noopener noreferrer">the US government and Europeans</a> that Nepal has a lot of experience in successful vaccination campaigns against polio, smallpox, measles. It has over 50,000 female community health volunteers (FCHVs) reaching children with vaccines every year.  <figure><img width="1024" height="768" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85b79c7e80680e06780cjpeg.jpg" alt=""><figcaption> </figcaption></figure><img width="2048" height="943" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85ba9c7e80680e06780djpeg.jpg" alt=""><img width="1920" height="864" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85bd9c7e80680e06780ejpeg.jpg" alt="">Similarly, Nepal’s health system has amassed vast experience in maintaining the vaccine cold chain even in the remote mountains. It also has trained human resource overseeing DOTS (Directly Observed Therapy, Short-course) for tuberculosis management all over the country who can lend a hand in equitable distribution of vaccines in <a href="https://www.nepalitimes.com/latest/rural-nepal-fights-back-covid-19/" target="_blank" rel="noopener noreferrer">rural Nepal</a>.Says epidemiologist Lhamo Yangchen Sherpa: “It’s not too late, we can still use existing resources like FCHVs to better mobilise vaccination, conduct contact tracing, dispel any remaining vaccine hesitancy, and use public health professionals in prevention.”

It’s an Emergency

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101152/636b79289c7e80680e0646e7jpeg.jpg" alt="" width="960" height="640"/><figcaption>A quarantine zone at Nepal Army's headquarters in Tundikhel. Photo: BIKRAM RAI</figcaption></figure>By now the novel coronavirus pandemic has affected every corner of the globe. If it has not brought disease, it has at least brought the <a style="background-color: #ffffff; font-size: 16px; letter-spacing: 0.15px;" href="https://www.nepalitimes.com/editorial/fear-goes-viral/" target="_blank" rel="noopener">fear of infection</a>. Cities, and indeed entire countries, are in lockdown. Fortress Europe has raised its walls higher. Airlines are grounded. Nepal has banned trunk international routes from Friday night. Even countries with excellent public health facilities and emergency preparedness plans are overwhelmed.Nepal is now <a href="https://www.nepalitimes.com/opinion/global-thinking-and-local-action-on-coronavirus/" target="_blank" rel="noopener">so closely intertwined with globalisation</a> through migration, tourism and trade that its <a href="https://www.nepalitimes.com/here-now/nepals-economy-already-weak-takes-direct-hit/" target="_blank" rel="noopener">already-fragile economy has been badly hit</a> even before a full-blown health emergency hits. Ironically, less-developed countries seem to have a built-in resilience that comes from being crisis-prone -- since they are lower down in the economic ladder, they have a shorter distance to fall.Read also: <a href="https://www.nepalitimes.com/editorial/poor-health-makes-nepalis-poorer/" target="_blank" rel="noopener">Poor health makes Nepalis poorer</a>, EditorialDespite Nepal’s surprisingly <a href="https://www.nepalitimes.com/banner/born-in-nepal/" target="_blank" rel="noopener">dramatic improvements in mother-child survival </a>over the past two decades, <a href="https://www.nepalitimes.com/editorial/poor-health/" target="_blank" rel="noopener">the public health system here is in crisis</a>. State-of-the-art modern hospitals in the city, while reducing the need for Nepalis to go abroad for treatment, are out of reach of a majority of the population. Government health facilities are more affordable, but for the most part medical care there is not up to mark.Nepalis are still afflicted by easily preventable water-borne diseases like <a href="https://archive.nepalitimes.com/news.php?id=16988#.XnMUhagzbSF" target="_blank" rel="noopener">typhoid and diarrhoea</a>, vector-borne infections like malaria, encephalitis or dengue, and illnesses like <a href="https://www.nepalitimes.com/banner/nepal-tb-cases-grossly-underestimated/" target="_blank" rel="noopener">tuberculosis </a>and acute respiratory infections that spread through breathing. Great inroads have been made in reducing the impact of communicable diseases in the past decades through awareness programs, vaccinations and safer drinking water, but children in <a href="https://www.nepalitimes.com/banner/this-is-how-to-upgrade-nepals-rural-health/" target="_blank" rel="noopener">remoter parts of Nepal</a> are still dying of simple infections.Read also: <a href="https://www.nepalitimes.com/banner/a-shot-in-the-arm-for-vaccines-in-nepal/" target="_blank" rel="noopener">A shot in the arm for vaccines in Nepal</a>, Sonia AwaleOn top of this, urbanising Nepal now also has the added burden of <a href="https://www.nepalitimes.com/editorial/poor-health/" target="_blank" rel="noopener">non-communicable afflictions</a> like diabetes, cardio-vascular ailments and renal disease. As families move from the districts to the cities, changes in diet and more sedentary habits have given rise to an epidemic of lifestyle-related diseases. This is compounded by genetic susceptibility among South Asians for diabetes and heart disease.For example, a study by the BPKIHS in Dharan showed that while the national average for <a href="https://archive.nepalitimes.com/article/nation/diabetes-in-south-asia,3018" target="_blank" rel="noopener">Type 2 diabetes </a>prevalence is 8.1% of the population, the incidence in Dharan was 14%, while it was only 1% in Taplejung. The prime minister’s own second kidney transplant this month showed that <a href="https://archive.nepalitimes.com/article/editorial/health-tip-editorial,4032" target="_blank" rel="noopener">ignoring risk factors and not diagnosing non-communicable diseases</a> can lead to a huge health burden for families and the state. A small percentage of Nepalis have health insurance, so many middle income families fall below the poverty line due to medical expenses. Many Nepali migrant workers have been forced to seek jobs abroad to pay back debts incurred during hospitalisation of family members.Last summer’s explosion of dengue in Kathmandu Valley was <a href="https://www.nepalitimes.com/banner/mosquitoes-move-up-mountains-as-the-earth-warms/" target="_blank" rel="noopener">blamed on climate change</a>. But it was actually a perfect storm of crowded and squalid living conditions, poor drainage, greater mobility of people, and a particularly wet monsoon. None of these factors have been addressed, so we are staring at a recurrence of dengue this year even while we cope with <a href="https://www.nepalitimes.com/banner/why-nepal-must-watch-about-coronavirus-but-not-panic/" target="_blank" rel="noopener">a possible COVID-19 outbreak</a>.Public health has not been a national priority for successive governments in Nepal. Even if it has, it is only in paper and has not really been translated into <a href="https://www.nepalitimes.com/opinion/is-free-health-care-possible-in-nepal/" target="_blank" rel="noopener">accessible and affordable healthcare</a> for the general public. Governance failure has contributed to this state of affairs, but there is also the virus of corruption that has afflicted the entire government healthcare system. A politico-business nexus has also infected <a href="http://archive.nepalitimes.com/news.php?id=19560" target="_blank" rel="noopener">medical education</a>, putting it out of reach of deserving poorer students.Read also: <a href="https://www.nepalitimes.com/editorial/when-panic-goes-viral/" target="_blank" rel="noopener">When panic goes viral</a>, EditorialInto this mix, we now have the coronavirus scare. Officially, Nepal has just one case in which the patient recovered and has been discharged. The government has tested about 500 people, and all have been negative. Experts have confirmed that the tests are credible, and proper protocols are in place. But not enough tests have been done to determine if there are more people out there with the virus.At $75 per test, the kits are expensive. This is where international help would be needed, and if the case rate rises the country will also need help with containment and mitigation. Nepal has been lucky so far that there is no indication of community transmission yet. But our luck could turn any day.

This is a test

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

POOR HEALTH MAKES NEPALIS POORER

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”

Typhoid is just another part of Nepal’s adventure tourism package<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221104141144/6365176d9c7e80680e02c277jpeg.jpg" alt="" width="800" height="1203"/>There is never a good moment to contract typhoid, and I’ve had it three times in Nepal. With a two-week incubation period, many different strains, and highly contagious through shit and spit, I never did work out where I picked it up each time.The first was on a 1985 recce, a trek that turned out to be the nascence of the <a href="http://archive.nepalitimes.com/article/Nepali-Times-Buzz/annapurna-base-camp,3697">Annapurna</a> Conservation Area Project (ACAP). It is humbling to find that you cannot put one foot in front of another, especially when hiking with super-scientists Roger Payne (whales), Iain Douglas Hamilton (elephants) and Bruce Bunting (WWFUS).We had been despatched on our mission by Nepali conservationist Hemanta Mishra who went on with others to push through the ground-breaking ACAP idea. Nepal’s conservation areas and especially Annapurna are still cited as a world model of how a nationally protected park managed by local communities can become self-supporting through tourism.Iain and I were climbing the Landrung hill through sunny terraced fields when the fever hit. One minute I was fine, and the next I was shuddering with sweat and dazed with weakness. Every step was an effort and the afternoon sun sheered into my eyes.“If this was Kenya I would suspect bilharzia or yellow fever,” Iain declared unhelpfully. He supported me safely home, peering with puzzled concern through heavy horn-rimmed glasses. Despite a variety of antibiotics the fever lasted 16 days, debilitating limbs, sapping the soul, the mind teetering on the edge of delirium. It took me weeks to find the strength to walk across my tiny garden, and many months before I recovered normal energy levels.Nearly ten years later I caught a lighter bout in Kathmandu and lay shivering in our Maharajganj house trying to get better quicker by enforced rest, gripped by the first Poldark video series about glamorous smugglers along the Cornish coast. It was 1994 and I needed to regain my strength fast as I was due in Kyrgyzstan -- tourism colleague Oliver Bennett of Deloittes was relying on me for a government tourism marketing strategy.Oliver was an old school consultant, always dressing as though in his native city of London -- to my certain knowledge wearing pinstriped suits on every mountain, lake and beach assignments.The shortage of fuel in post-Soviet Kyrgyzstan meant the Bishkek airport was closed. Instead, battling weakness, I flew to Tashkent and was driven 12 hours through breathtakingly remote country by a couple of nuclear physicists who needed to make a buck – the economy was a shambles and I never met a single Kyrgyz who did not long to be back in the USSR.Nurturing my strength and thanks to Oliver’s protection, I managed to struggle through. Part of our brief was ecotourism training sessions with the budding Kyrgyz private sector. Emerging from the Soviet system, they had trouble with the concept of capitalism, enquiring with all seriousness whether their companies were permitted to make a profit.Exploring the historic Silk Route attractions of Kyrgyzstan, the hooves of Genghis Khan’s invaders could be readily imagined hammering across the open grasslands. We sampled Issikul Lake mineral treatments, formerly reserved for the communist elite, pummelled by fierce ladies in white coats with strong fingers.In woodland dachas, as guests of friendly mountaineers trying to start adventure travel businesses, we drank vodka in fragrant saunas.We marvelled at ancient engraved marker stones and discussed snow leopard viewing with Elburz mountain smugglers. I galloped knee to knee down a verdant valley with the gallant EBRD client Khalid after milking mares with yurt-dwelling nomads. At the evening feast Oliver, squatting in his crumpled suit, had to cope with the prized sheep’s eyes. I was disdained having asked one brightly clad nomad lady how long her child had been riding horses -- since birth, of course.By the third attack I thought I was getting used to typhoid. This time was in <a href="http://archive.nepalitimes.com/article/Nepali-Times-Buzz/Mustang-in-march,2108">Mustang</a> with a group of down-under friends on a 2008 circuit of the trans-Himalayan high spots around Lo Manthang. We had hoped to circumambulate Mount Kailash so it was a compromise, defeated by the fluctuating vagaries of Tibetan visa policy.They were an experienced bunch, and loved the rugged walking and splashed ochres of Mustang’s grandiose scenery (photo, left). We had happily negotiated sheer drops to view prehistoric paintings, explored ancient stupas within a cliff-face cave, avoided charging thar on a steep hillside, and even glimpsed a pair of snow leopards on a distant ridge – or so the excited horsemen assured us.I was zigzagging up the dusty trail to Tsarang, having linked arms to cross the flooded river in our boots, and couldn’t understand why my unwilling feet suddenly had no energy. Highland Doctor Jamie was waiting for me at the top. “I’m all right,” I protested.“No you’re not.” Jamie’s Scottish lilt was emphatic. “Looks like typhoid to me and we can’t risk waiting for a helicopter.” For the next three days back to <a href="http://archive.nepalitimes.com/article/Nepali-Times-Buzz/going-to-jomsom-in-the-off-season,3878">Jomosom</a> he followed my pony closely as I swayed precariously in the saddle, helping me stagger into my tent at night. Haggard, dusty and sweat stained I remember little of the flight to Kathmandu, and this time was hospitalised on a drip, and instructed to stay in bed for days. I did not demur, and can confirm first hand that compulsory rest is the best road to recovery.Read also:<a href="http://archive.nepalitimes.com/article/Nepali-Times-Buzz/annapurna-base-camp,3697">Fully booked in the sanctuary</a> ,  Shreejana Shrestha<a href="http://archive.nepalitimes.com/article/Nepali-Times-Buzz/Mustang-in-march,2108">Mustang in March</a>,  Cynthia Choo and Kenji Kwok

Lisa Choegyal

Infectious enthusiasm for travel

Climber, expedition leader and later a supplier of bottled oxygen to Himalayan mountaineers, Henry Barclay Todd died on 3 November 2025 in his favourite place on earth, Kathmandu.&nbsp;
Todd was larger than life, a metaphor often used, yet it could not be more fitting. Standing nearly 2m tall, and possessing an unshakeable will, he lived life on a grand scale, both in body and spirit.&nbsp;
Todd was a pillar in the Himalayan climbing community, supporting many mountaineers across Nepal and Pakistan, making it possible for them to fulfil the dream of standing on the world’s highest peaks. He believed deeply in the strength, skill, and potential of the Sherpa people, and offered them opportunities that might otherwise have remained out of reach.&nbsp;
“Thank you, Henry. Your trust changed my life. Rest in peace, my leader, my teacher, my friend,” said Dorjee Gyelzen Sherpa in his tribute.
Born in 1945 to Royal Air Force officer Henry Todd and May Todd of the Women’s Royal Air Force, Henry spent his early years in Singapore. He led a lively childhood with his two brothers, far removed from the mountains that would later define his path.&nbsp;
A gifted swimmer like his father, Henry never pursued the sport professionally. Instead, after returning to Dundee as a teenager and attending seven different schools, he set off for London, where he began working for an insurance company before finding his true calling in adventure.
Henry Todd first came to Nepal in the mid-1980s and made his first attempt on Ama Dablam in 1987, an expedition that marked the beginning of an extraordinary and colourful climbing career. <a href="https://www.himalayandatabase.com/" target="_blank">The Himalayan Database</a> lists 61 expeditions that he led in Nepal alone — there were more in the Karakoram, Argentina and the Alps.&nbsp;
But Todd would joyfully say that a few hard Scottish ascents held a more personal meaning to him than even the greatest Himalayan summits.
Over the decades, he crossed paths with many legendary climbers like Anatoli Boukreev, Jerzy Kukuczka, Doug Scott and Chris Bonington as well as celebrities including members of Pink Floyd and Nobel Prize laureates whom he befriended.&nbsp;
He had a gift to never name-drop, but would simply mention that he had had lunch with Minnie Driver (niece of his long-time friend Andra) or that he had bought his first car from Donald Sutherland. For Todd, these were not bragging rights, they were simply part of the colourful tapestry of his life.
Todd’s life was filled with extraordinary experiences from surviving plane crashes, avalanches and earthquakes to quietly solving countless problems, which was one of his favourite past-times. His hands, famously large and steady, were always ready to help whether in the chaos of the mountains or the calm of a base camp.&nbsp;
With his sharp sense of humour and the beloved exclamation “Whoopie!”,he could bring lightness even to the toughest moments. He never tired of taking on challenges or helping when someone was in need, and he enriched so many people’s lives with his endless stories.
His legacy is immense. He helped build the human backbone of Himalayan climbing, enabling generations of climbers to test themselves in the world’s highest places. With his passing, an era of bold, spirited Himalayan guiding has come to a close.
Todd survived by a loving family, many close friends and a global community of climbers and Sherpas who will never forget him and his endless tales.&nbsp;
His family said in a statement: ‘Henry’s strength, warmth and unyielding belief in others will live on far above the clouds. He was indestructible in our eyes and in our hearts, he always will be.’
There will be a memorial service at Pashupati Temple in Kathmandu on 8 November 2025 around lunchtime.

Henry Barclay Todd, 80

The autumn mountaineering season is not over yet, and already there have been 12 fatalities on Himalayan peaks in Nepal.
Of the 1,450 climbing permits issued, 436 were for Mt Ama Dablam (6,812m), 374 for Mt Manaslu (8,163m) and 186 for Himlung Himal (7,126m). There were deaths on all three mountains.
The death of two French climbers on Ama Dablam happened before unseasonal blizzards hit the mountains. But Cyclone Montha from the Bay of Bengal brought on high winds and up to 1m of snow in the peak trekking and mountaineering season.
This increased avalanche conditions, and made helicopter evacuation of stranded and injured climbers difficult. Lower down the mountains, more than 1,000 trekkers from Nepal and around the world were stuck in the Annapurnas, Manaslu circuit and the Khumbu.
However, there have also been allegations that it was not just the weather that delayed rescues. Multiple levels of bureaucracy and the need for flight permits to restricted areas like Manang and Manaslu critically delayed evacuation flights.
Italian climbers Farronato Stefano and Caputo Alessandro were found dead in their tent at Panbari Himal Camp I (6,887m) in the Manaslu area. They had been trapped by heavy snowfall since 28 October, and their bodies were found on 4 November by a team from the expedition organisers, Sherpa Alpine Trekking Service. The team was made up of high level mountain guides and expedition leader Valter Perlino.
The team had been climbing to Camp 3 but decided to descend to base camp because of thrombosis in Perlino’s left foot. The two climbers who would eventually get trapped decided to break at Camp I, a decision that would prove fatal after the projected six-day snowfall arrived two days early.
“They were sleeping in a tent and were buried under 2.5 metres of compacted snow. It happened during the night between Thursday and Friday. While they were sleeping, absurd,” said Perlino.
A deadly incident took place the morning of 3 November, when five foreigners and two Nepalis died in an avalanche on Yalung Ri at 5,630m in the Rolwaling. They were part of a larger group of 15 that were acclimatising for an attempt on the nearby Dolma Khang (6,332m).
Local authorities in Gauri Shankar Conservation Area say calls were immediately made to helicopter companies as well as various ministries in Kathmandu that have to issue permits to fly to the region bordering China.
But the permits for rescue flights to Rolwaling Valley were delayed by eight hours. Rescue flights in these areas require permission from the Ministry of Tourism, the Ministry of Defence, the Home Ministry, and the Civil Aviation Authority of Nepal (CAAN).
Experts say this should be exempted in times of emergency when time is of the essence. CAAN spokesperson Pratap Babu Tiwari claimed to not know of the avalanche on Yalung Ri and deflected questions to the permission department.&nbsp;
There was a similar tragedy on Himlung Himal in Manang as well. Australian Chin-Tark Chan, 49, was climbing with 8K Expeditions and fell ill on 27 October at about 6,800m, developing snow blindness and loss of mobility. The guides immediately called the US insurance company Global Rescue for authorisation of a longline rescue.
Global Rescue refused, saying a rescue at that height would violate Nepal’s aviation rules and put the pilot at unacceptable risk. They asked the guides to transport Chan to Camp 3 at 6,400m to a permitted altitude. Seeing it was a life-or-death situation for its client, 8K called in an aerial rescue anyway, but the helicopter could not land due to bad weather. Chan died slightly below Camp 3 on 29 October.
Global Rescue said in a statement that it was ready to send in a helicopter after Chan had been transported to Camp 3, but several hours were lost for that attempt, and the weather did not get better in the next few days.
To underscore just how dangerous helicopter rescues in the Himalaya can be in bad weather, a chopper from Altitude Air skidded off the helipad at Lobuche below Mt Everest while trying to rescue trekkers in whiteout conditions.&nbsp;
CAAN announced a ban on flights during blizzards or dense fog. While rescue missions are often heroic and courageous, they should not be foolhardy if conditions are unsafe and the risk to pilots and rescuers too high. This autumn was a lesson for future expeditions and for the Nepal government.&nbsp;
The Italian duo on Panbari were caught out by snow that arrived two days ahead of schedule, but the group on Yalung Ri should have postponed their ascent after multiple warnings from the Department of Hydrology and Meteorology to avoid high altitudes.

Deadly autumn in Himalayan climbing

This is the 73rd episode of Diaspora Diaries, a Nepali Times series in collaboration with Migration Lab providing a platform to share experiences of living, working and studying abroad. I don’t remember playing with dolls as a little girl. There is not much to remember from my childhood.&nbsp; My responsibilities began at a very young age, as I had two younger brothers to take care of. I was born in Sarlahi, but we moved around quite a bit as my father was in the government and got transferred frequently.&nbsp; From Rasuwa to Dang, from Nepalgunj to Kathmandu. I struggled to adjust in Kathmandu because I joined Grade 9 in the middle of the term. The education was different and fellow students also did not support me initially. But over time, I adjusted and made friends. I did not dream of becoming a nurse. It was by accident. I wanted to pursue medicine, but failed the entrance exam by a few marks. I did not want to lose a year, so decided to take up microbiology instead.&nbsp; I got married after my undergraduate, and my husband encouraged me to take up something more technical like nursing or engineering instead of Masters in Microbiology. As my quantitative background was weak, I chose nursing. I felt like I was born to be a nurse. Juggling my married life and studies was difficult. My teachers would often ask me why I am falling behind. It was not easy, but I managed and took up a full-time job as a nurse. There are challenges being a nurse in Nepal. You are overworked, underpaid, there is lack of appreciation. Superiors can be overbearing. These problems persist. But the bright spot is that you get to serve fellow Nepalis, and be close to your family.&nbsp; Just like I had no intention initially of becoming a nurse, I had no intention of migrating overseas. But life had different plans for me. After my baby boy was born, I noticed that something was off. Even at nine months he had not started crawling or sitting. As a nurse I knew something was wrong, and I took him for check-ups. He tested negative for down syndrome, but he had a heart defect.&nbsp; The cardiologist recommended that I take him to India where he was diagnosed with Williams Syndrome, a rare genetic condition that affects 1 in 10,000 people. It delayed his development. I looked for therapy. It was either not effective, or too expensive. Some schools also refused to admit him, and it drove me to tears.&nbsp; My family members overseas in the UK, US told me to emigrate as there were better facilities for differently abled children. So I decided to apply to the UK. Luckily just then there were calls for candidates under the Nepal-UK government-to-government pilot scheme for 100 nurses. Only 40 met the criteria, and I was one of them.&nbsp; I still remember the day I received the news on the day of my puja. There were people around me, and they told me that it was the result of my fasting and devotion on that auspicious day. Perhaps it was. Life was taking a new turn, and I was happy. I made it to the UK in February 2024 without paying a single paisa to any broker. The G2G scheme was unique as we were treated with dignity and valued for our skills: they covered costs for the ticket and visa, reimbursed us for exams we had taken and costs involved in the preparation and testing of the Objective Structured Clinical Examination were also covered.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251106071148_dc5a0d0ea3024b34a4f2735754f8eb67a650bc7f61b98c75d589676c65b02a0c.jpg" data-media-id="editor_0" data-image-id="20251106071148_dc5a0d0ea3024b34a4f2735754f8eb67a650bc7f61b98c75d589676c65b02a0c" data-rendition-name="original" width="1200" height="1600" loading="lazy" alt="Nurses NT"> </figure>  It was of course difficult to leave my son behind. But I was doing it for his future. I had the option of taking him from the start, but it was a new place and I wanted to be well-settled and knowledgeable about the options available for him before bringing him along. As I packed, he would ask me to take him with me in my suitcase. It did not seem like he was affected by my departure, and it was only later that his teachers said that he would express his feelings more openly at school. He just did not know how to tell me he missed me, and he would tell teachers he was worried I had forgotten him if we did not speak for a day.&nbsp; He missed me, and that realisation made me emotional. But I had to carry on. Life in the UK was difficult in the beginning. Even so, I wanted to prove to myself that I could do it. Fortunately I had cooperative staff who patiently answered my questions. I think I would have been irritated if I were in their place. But they did not seem to mind, and their support and guidance made it easy for me to adjust to the new work environment. APPRECIATION I still struggle to understand the accent of my English patients, and have ask the matron for help. They compliment me on my English, but I can speak better than I understand. The good thing about working in the UK is that you are appreciated for your work, which can be motivating. Sometimes, after a long day’s work you get a message from your supervisor acknowledging your work with a thank you. That’s enough to erase your tiredness.&nbsp; So far I have received 32 WOW nominations which are acknowledgements from patients for a job well done. It can be motivating, especially in the beginning. The main difference between the Alpana who first left Kathmandu for the UK and the Alpana now is that I am a much more confident person. What makes a good nurse? Skills, knowledge and qualifications are of course a given. But mostly, you need humanity. A smiling face. The way you communicate. Your empathy. These attributes can already solve many problems that patients are facing. This is my second time back home in the last 20 months. And this time, I have arranged for my son’s visa. I will go back after Tihar with my son and husband.&nbsp; I am happy, but also a little nervous about what awaits us. What kind of school will I put him in? Will it really be different from schools here? Will his needs be addressed? Will it be like here, or will he be able to adjust?&nbsp; But I am determined to make it work. Success for me would be if he adjusted well and there is a change in his condition. He still cannot recognise alphabets and read words like kids in his age group. Hopefully he will get learning support in the UK. He also has a knack for music, and this is common among individuals with Williams Syndrome. His ears perk up when he hears music, and he takes part in musical events at school. He still does not recognise letters &nbsp;but he uses voice commands to search for guitar videos on YouTube. I will enrol him in music classes, and help him develop this gift. For now, I worry how he will behave on his long flight. He has a short attention span and gets restless. He is also very social and will want to speak with everyone around him, and might irritate fellow passengers.&nbsp; I have already started trying to make him understand that he will need to behave on the flight. He nods in agreement. Let’s see how it goes. &nbsp;

“I felt like I was born to be a nurse”

A month after September’s GenZ movement in Nepal, nurses working in private hospitals took to the streets demanding better work conditions, and salaries equal to what government nurses are paid.&nbsp;
The strike started at Pokhara’s Manipal Teaching Hospital before spreading nationwide, and nurses working at government hospitals joined in.&nbsp;
Nurses at private hospitals are forced to work for far less than Nepal’s minimum monthly wage of Rs19,550 — without overtime, breaks, and other benefits and under physically and mentally taxing conditions. This is driving many qualified nurses to emigrate.
For newly-appointed Health Minister Sudha Sharma Gautam in the interim government, the strike became her first order of business. She met representatives of the Nursing Association of Nepal (NAN), the protesting nurses, and others from the health sector.&nbsp;
An agreement was reached under which private hospitals and medical colleges will pay nurses a minimum monthly salary of Rs34,730. &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
“It is a shame that nurses have been working under such exploitative conditions all this time” says Radha Adhikari, at the School of Health and Life Sciences of the University of the West of Scotland. “The agreement is basic, and there is a long way to go to improve their working conditions. But it is a start.”
NAN chair Chandrakala Sharma has said the ministry’s task force to look into working conditions will also look into facilities for nurses in government hospitals.&nbsp;
“We are committed to solidifying the wage agreement by amending relevant laws within this month,” Sharma said in a video posted by NAN on Facebook. “Our movement is not over, we are still protesting and &nbsp;following up with the Ministry.”
NAN issued an ultimatum to the government to implement the agreements within 48 hours. That deadline has now lapsed and the nurses are back on strike. Many of those protesting now accuse NAN of betraying them.
Jyoti Ranabhat of the Nurses Struggle Committee was present in the meeting, but refused to sign the agreement. “It did not address what we were demanding, we will now go it alone into Plan B,” she tells Nepali Times.&nbsp;
Previous grievances of the nurses did result in similar agreements, but private hospitals failed to comply with government’s past directives — most recently the minimum salary and benefit determined by the state in December 2024.&nbsp;
The Nepal Nursing Council says there are 126,580 registered nurses, specialists, midwives, and Auxiliary Nurse Midwife (ANM) professionals in Nepal. Yet, nursing positions at hospitals remain vacant.&nbsp;
The reason for understaffing is a mass emigration of medical professionals, including nurses. Nursing student enrollment is also declining and there is disinterest in a profession that does not afford health workers quality of life, respect, or dignity.
“Our fight is not with the private sector, it is by definition profit-oriented, our grievance is with the state,” says Ranabhat. “The government is responsible to provide us dignity, respect, and fair pay.”&nbsp;
GREENER PASTURES
Poor pay and working conditions are driving doctors and nurses abroad in large numbers in recent years. Many have simply quit the profession, leading to a shortfall in medical professionals. 

The shortage of nurses is a global phenomenon, and countries like the US, UK and Australia have compensated for their own shortage by offering jobs from countries like the Philippines, India and Nepal.&nbsp;
Nepal Nursing Council data shows that outmigration of nurses rose sharply after 2002, and an estimated &nbsp;20,000-45,000 nurses have left since.
“The state’s denial, derision, and disregard of nurses has caused resentment and disillusionment in the community, driving nurses out,” says Ranabhat. “Ultimately, Nepalis will pay the price when there are no nurses left here.”
Many Nepali nurses who have gone abroad are happy with the respect and quality of life in their jobs abroad. But many others face exploitative recruiters in Nepal and employers abroad. Nursing consultancies have mushroomed as nursing colleges struggle to meet demand.&nbsp;
Adhikari herself worked at United Mission Hospital Tansen before moving to the UK 30 years ago, and remembers that working conditions then were much better for nurses.&nbsp;
“Nepal’s health sector has gone downhill since privatisation,” she states. “Medical colleges are only concerned with supplying doctors and nurses internationally, because that is what makes money.”
But once Nepal’s nurses are abroad, there is no guarantee that they will have jobs in the nursing sector. Many find themselves working outside their field of expertise, in hospitality or sales.&nbsp;
“Nepal has become a production hub for nurses, and Nepali nurses have become products for export,” adds Ranabhat. &nbsp;“People might think this will add to remittances, but no one is thinking about what will happen to Nepal’s health sector.”&nbsp;
For many, nursing has become a way out of Nepal rather than a vocation. In 2022, the government signed an agreement with the UK to send Nepali nurses to work there at zero cost, with benefits and protection equal to UK nurses.&nbsp;
The pilot phase was expected to recruit 100 nurses, and applications opened in July 2023, with 45 nurses said to be selected by Britain’s NHF representatives by the end of 2023. Forty-one of them obtained labour permits.&nbsp;
They may be treated well, but the reality of working in the international health sector is not as straightforward.
Radha Adhikari told us from Scotland: “Market saturation, exploitation, discrimination based on race, gender, and foreignness prevent nurses from finding the right, respectful jobs even here. Ultimately, migration cannot be sustainable for Nepal’s nurses.”

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