One in every three Nepalis carries the <a href="https://nepalitimes.com/editorial/tb-or-not-tb">tuberculosis</a> bacillus. There may be no active symptoms, but they can at any point progree into a full blown infection. TB kills up to 47 Nepalis daily. If so many people died every day in road traffic accidents, it would make headlines every day. But they do not because tuberculosis afflicts the poorest people in the poorest parts of Nepal.&nbsp; The annual 17,000 fatalities from <a href="https://nepalitimes.com/banner/for-nepal-a-game-changer-in-tb-control">tuberculosis in Nepal</a> are preventable with cost-effective treatment. A new pilot study in Chitwan and Piuthan in the past two years showed that 1,160 (out of 1,173 household contacts) completed the Tuberculin Skin Test (Mantoux Test) of whom 542 (45%) were positive. After doing a chest x-ray, 509 met the eligibility criteria for TB preventive therapy. 500 (97%) gave consent to the treatment.&nbsp; Researchers were pleasantly surprised. As in other countries in the region, they were expecting very few to agree to take preventive therapy medicines because they did not have TB symptoms, so a 95% agreeing to the treatment was exceptionally high. “People in Chitwan and Piuthan who participated in the study were not sick, they were just carrying the TB bacteria, but they agreed to take the preventive drugs because they have all known of relatives who had died of TB,” explains Buddha Basnyat, a physician who advised the Birat Nepal Medical Trust (BNMT) that conducted the research.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240325030340_43b4bc93b22c3964ee021a9dc9df40f9da783917b2ebfbe798a03a82276421a7.jpg" data-media-id="editor_2" data-image-id="20240325030340_43b4bc93b22c3964ee021a9dc9df40f9da783917b2ebfbe798a03a82276421a7" data-rendition-name="original" width="1500" height="1125" loading="lazy" alt="Tuberculosis preventive therapy in Nepal"> <figcaption>Health care volunteers during an outreach screening program in Dhanusha as part of active case-finding for tuberculosis in local communities.</figcaption> </figure>  BNMT is now extending the study to Nawalparasi and Rupandehi with the National Tuberculosis Control Centre. Latent TB is more prevalent in the Tarai districts because of their higher population density. With Nepal suffering such an <a href="https://nepalitimes.com/here-now/nepal-tb-cases-grossly-underestimated">enormous disease burden from tuberculosis</a>, one would have thought World TB Day on Sunday 25 March would have got more attention. But it was overshadowed by Holi celebrations. It would have been interesting to see how many in the crowds attending the concert at Darbar Marg would test positive. Scientists worry that the World Health Organisation’s END TB strategy of reducing global tuberculosis incidence by 90% and deaths by 95% in the next ten years is too ambitious unless latent tuberculosis cases are also treated.&nbsp; What makes this failure all the more tragic is that tuberculosis is a completely preventable and treatable infection. Every $1 invested in TB gives a $39 return, yet there is little investment and advocacy to combat this biblical illness. South Asia accounts for some 40% of all TB cases and 38% of all TB deaths — most of them occurring in the thickly-populated states across the Nepal border in India. The region also has a high burden of multi-drug resistant TB, one-third of global cases. In the past, Directly Observed Therapy Short Course (DOTS) drug therapy in which patients were administered medicines at health posts was considered a cure-all for tuberculosis. <a href="https://archive.nepalitimes.com/news.php?id=294">Nepal had a high success rate for DOTS</a>, but there were loopholes in the program: latent cases remained hidden and only the cases that came to the health system were treated. DOTS also added to the pre-existing stigma so that patients travelling to the health posts would be identified as having tuberculosis. In one instance, a patient in Bardia chose to take a dangerous tiger-infested jungle route to reach the health post. &nbsp; Meanwhile, BNMT had been setting up a strong community network of health volunteers, and was <a href="https://nepalitimes.com/banner/nepal-tests-and-treats-tb-with-a-flying-pharmacy">tracking active TB cases</a>. Unlike DOTS, it involved meeting family and friends of patients, allowing more case detection and treatment. Even so, they were not looking for latent infections.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240325030340_39b79cbd0799bee83a8ae67fd8016d9c75b539d89679e5a4328a7b8540bbca01.jpg" data-media-id="editor_6" data-image-id="20240325030340_39b79cbd0799bee83a8ae67fd8016d9c75b539d89679e5a4328a7b8540bbca01" data-rendition-name="original" width="1687" height="1125" loading="lazy" alt="Tuberculosis preventive therapy in Nepal"> <figcaption>Female Community Health Volunteers (FCHVs) have played a significant role in active case finding.</figcaption> </figure>  Latent cases can progress to active tuberculosis especially when a patient's immune system is weak because of malnutrition, illnesses like HIV, or age. In fact, half of TB worldwide can be attributed to undernourishment. Latent TB can be confirmed in two simple steps: a Mantoux test with an above 10 score and a clear chest x-ray. If positive, the patient is given the 3HP preventive therapy — a once-weekly treatment with isoniazid-rifapentine for 12 weeks. This treatment can prevent reinfection for as long as six years, and is not to be confused with the one for active cases which requires daily treatment for six months. “On an individual level, you can still get reinfected if you are living in a house with active cases. But if you treat the community at large with preventive therapy, you drive down the prevalence of TB and in turn, people won't get reinfected,” explains Maxine Caws of BNMT. She adds: “If we can use preventive therapy to push down the reservoirs of infection then we extend the amount of time people are protected as is the case in Europe for example where people don't get TB anymore because they are not exposed to the bacteria at all. We have to eradicate that reservoir.” The traditional BCG vaccine given within 28 days of birth is effective against childhood tuberculous meningitis and miliary disease, but does not prevent TB in adults. Efforts are underway to develop a new effective vaccine but there are many challenges.&nbsp; TB vaccine development is difficult because exposure to the tuberculosis bacillus does not seem to induce sufficient protective immunity. A new viable vaccine could take a decade, but in that time 13 million more people would die.&nbsp; “We cannot wait and do nothing until a new effective vaccine is developed. Preventive therapy is a vaccine until we have one,” adds Basnyat. Indeed, the 3HP preventive therapy after diagnosis costs only $5 per regimen. So, Nepal’s strategy should be a simultaneous focus on 3HP preventive therapy and case finding.&nbsp; The problem has been a lack of priority for preventive therapy at national and international levels because it does not involve costly research and interventions, and the patients are poor. Explains Caws: “On paper, we have very strong policies but the commitment in terms of funding from the governments has not materialised, essentially because it is not affecting the rich unlike with Covid when we threw everything at it to have a vaccine developed in a year.” TB’s main problem, <a href="https://nepalitimes.com/opinion/comment/pandemic-eclipses-nepals-tb-epidemic">unlike Covid</a> and HIV/AIDS is that it is a disease of the poor.&nbsp;

Sonia Awale

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Ending TB is possible, and cost-effective

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114101144/63720e899c7e80680e0b7923jpeg.jpg" alt="" width="1400" height="933"/><figcaption>Photo: ANTONIO BELTRÁN RODRÍGUEZ</figcaption></figure>Daily wage labourers Dharma and Gita lost their jobs during the pandemic. The young couple exhausted their meagre savings in less than a month, after which they started to buy food on credit. Still unable to repay loans, they limited their diet to one small meal a day.Soon, Gita started feeling weak. She often had a fever and cough. As the lockdown extended, her health deteriorated and the medicines were of little help. The couple even took a PCR test which came out negative. They visited five different health centers and bought bags full of medicines. The treatment was so expensive they had to sell their two cows. A month later, and heavily in debt, she was diagnosed with tuberculosis.Tuberculosis mainly afflicts the poorest. The numbers are staggering: one in every three people globally is infected by Mycobacterium tuberculosis, and even if they carry the bacteria most people do not get sick unless their immune system is weakened due to disease or malnutrition.And yet, this easily preventable and curable biblical disease thrives in Nepal and the Subcontinent due to inadequate measures taken to prevent, diagnose and treat the infection.A 2020 National TB Program report revealed that over 100,000 people are living with tuberculosis in Nepal. This figure is much higher than previously estimated but has most likely increased since as many patients have been unable to access treatment during the pandemic.Of these cases, 40,000 patients were not diagnosed or treated at government centres, which means nearly one in every two people were not diagnosed. Oftentimes, people reach standard TB treatment and care after months or even years. Their pathway to cure is complex, long and include misdiagnosis leading to unnecessary prescriptions. This in turn could lead to unnecessary death and suffering. Patients are also ostracised by friends and families, resulting in self-isolation from communities.These challenges are exacerbated by Nepal’s limited health infrastructure. Health care centres are understaffed and poorly managed, maintenance of laboratory equipment, as well as supply of quality chemicals for tests, are erratic.Across Nepal’s Tarai, settlements are overcrowded, people live in extreme poverty, hygiene and sanitation are at a bare minimum. In the hills and the mountains, difficult geographical terrain and poor road networks pose obstacles for people seeking health care.These deeply-rooted structural inequities collectively resulted in magnified impact on TB service delivery during the pandemic. As a result, we observed increased deaths from the disease.In 2018, global leaders committed to reducing TB by 2022. To meet this goal, we need comprehensive intervention programs with sufficient investment for prevention, early diagnosis and treatment. There are four key areas that require increased funding to decrease TB fatalities:1 PreventionWe saw how the world community got together to rapidly develop vaccines for Covid-19 with unprecedented funding and resources. TB on the other hand has only one vaccine and a very weak one at that. Developed over a century ago, BCG does not prevent adults from developing TB disease.UnderNepal's national TB program, young children living with adults who have TB are provided medicines to kill any TB bacteria they have inhaled and prevent the development of the disease. The Birat Nepal Medical Trust for the first time in Nepal is providing a shorter 12-dose course of TB preventative medicine to adults infected with the bacteria to stop them from getting sick and spreading the disease.In 2020, only $684 million of the estimated $2.16 billion needed globally for TB research and development was available from donors. Covid-19 on the other hand received over $100 billion in just two years to develop vaccines. The pandemic exposed this global inequity, and is proof of what sufficient funding and political commitment can achieve.If funding for the global TB prevention program is increased by 3-4 fold, we could design better community-based services, develop a more effective vaccine and promote shorter treatment regimens, all of which will achieve a TB-free Nepal sooner.TB awareness and health promotion messages also do not get as much coverage in the media as they used to. World TB Day, observed every year on 24 March, should serve as a reminder that TB is an epidemic and needs accelerated efforts for elimination.2 Diagnosis and InnovationGovernment health centres provide TB diagnosis and treatment free of cost. Yet, people spend a lot of money and time before they are correctly diagnosed and enrolled in treatment. This is because symptoms of the disease are common to many infections. People develop cough and fever and immediately resort to taking paracetamol and general antibiotics before realising that they have TB.Moreover, Nepal needs to quickly adopt GeneXpert machines which use PCR testing, and chest X-ray that diagnoses early-stage TB effectively and efficiently. Investment should be concentrated to expand, strengthen and maintain these diagnostic tools at health centers all over the country. Health care providers should be similarly trained to operate these machines.GeneXpert technology should be deployed with active case finding where community health workers make home visits to screen and identify TB patients. This method also commonly known as contact tracing was applied in containing the spread of the Covid-19 virus, and has been used in TB programs for decades.Although proven to be effective, new diagnostic technologies are expensive and active case-finding strategies require large and sustained financial commitments. One might question if a country like Nepal can afford such investments. But the question we should be asking is, can we afford not to?The costs of the continued TB epidemic are far greater than the investments required to reduce it. Investing in better  tools including tax waivers on the import of TB diagnostic machines and test kits, and increased global funding for implementation of active case finding strategies for low and middle-income countries like Nepal are urgently needed.3 Community-based Treatment and Care Incomplete or delayed treatment can cause drug resistant TB and even death. Therefore, the treatment of tuberculosis should be patient-centred.TB programs have been implemented in Nepal for over half a century, we now have plenty of experience to employ the best strategies and  to eliminate the scourge.One of the challenges to eradicating TB is the long duration of treatment. Under the DOTS program, tuberculosis patients have to visit health centres daily for medication to be taken in the presence of care providers. But this could expose them to other TB patients, and resulting stigma. It is also time-consuming and comes with additional transport expenses.Investment in research and development of shorter course treatment regimens, and scaling up telemedicine is a priority area.4 Social Protection TB and poverty form a vicious cycle, each fuelling the other. It is mainly the neediest in society who are most affected. Having TB increases financial strain in their families with far-reaching socio-economic consequences. Children may have to forgo education and seek employment to compensate for the loss of income in families with an infected adult. Providing cash to families after the diagnosis will alleviate the financial burden.TB also causes malnutrition making people more vulnerable. Providing diversified food packages with appropriate nutritional value will be a big support, it will also help reduce the mental stress of fulfilling family needs.But these are just a few recommendations, a study to identify feasible and acceptable support for people with TB will enable us to design an improved tuberculosis support program. These should incorporate health education to people with TB and their families to better understand the disease, cope with its treatment and overcome stigma.Ultimately, it is the government’s responsibility to protect the lives of its people. Therefore, investing in and incorporating locally appropriate social protection schemes within the TB program should be the key agenda and priority of policymakers.The slogan this World TB Day today on 24 March is ‘Invest to End TB. Save Lives’, which reiterates the need to increase funding to prevent, diagnose and treat TB. Without substantial investments that will accelerate collective efforts of the community, country and the world, it is unlikely we will win the fight against TB, reverse the huge setback caused by the pandemic or save lives.Kritika Dixit is the Research Manager at Birat Nepal Medical Trust (BNMT) and a doctoral student at Karolinska Institutet, Sweden. Rajan Paudel is the Research Associate at BNMT.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114101144/63720e8c9c7e80680e0b7924jpeg.jpg" alt="" width="80" height="109"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114101144/63720e8d9c7e80680e0b7925jpeg.jpg" alt="" width="82" height="109">Read also: <a href="https://www.nepalitimes.com/banner/for-nepal-a-game-changer-in-tb-control/">For Nepal, a game-changer in TB control</a>, Buddha Basnyat and Maxine Caws

Pandemic eclipses Nepal's TB epidemic

Samsung Nepal has opened pre-orders for the Galaxy A57 5G and A37 5G. Both phones run Samsung’s One UI 8.5, featuring AI capabilities like voice transcription, Circle to Search, and photo editing. They feature a 50MP triple-camera system, a Super AMOLED display, and six years of OS and security updates.

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‘One early morning, we heard the ambassador’s wife cry out, “Ram, Ram, Ram!” A disaster has befallen Nepal!” She had heard on the radio that a fire had consumed Singha Durbar." This is not about the arson attack on 9 September 2025, but the one on 8 July, 1973. It started in the South Wing of the then single-largest building in all of Nepal. It took two days to bring the blaze under control, requiring the use of explosives to demolish one wing to protect the imposing western facade. As Bhekh Bahadur Thapa recalls in the English translation of his memoir A Life in Public Service: Nepal from Autocracy to Democracy, he was then on leave from the Nepal government serving with the IDRC in Ottawa.&nbsp; He had already served as Nepal’s Finance Secretary at age 25, went on to be Finance Minister and Governor of Nepal Rastra Bank. He was already younger than some of the GenZ ministers in Nepal’s present RSP government. Thapa, now 89, was at the launch of the book in February which was attended by former diplomats and bureaucrats. After speeches by panelists, there was a question from the audience about how Thapa had managed to be the diplomat he was, managing Nepal’s international relations on the world stage.&nbsp; Writer and journalist Akhilesh Upadhyay, who was moderating the panel, responded by going into the section of the book where we see Thapa as an ambassador to the US, playing tennis with White House officials, cultivating a network of contacts to project the identity and welfare of Nepal, and making it possible for a state visit by King Birendra to Ronald Reagan’s America. The book is full of anecdotes that suggest Thapa was a clever and strategic diplomat, always calm and unruffled, easily making friends in high places with his maturity and engaging sense of humour. Thapa’s memoir is heavy on details about Nepal’s administrative history during the years he was active in public service, serving as minister and ambassador under three kings: Mahendra, Birendra and Gyanendra, and alongside five prime ministers.&nbsp; Aside from an insider look on how certain treaties, development deals and research projects in Nepal came into fruition, Thapa goes into great detail about his personal and professional relationships with the kings, ministers, ambassadors, foreign leaders and politicians.&nbsp; As a reader, one is struck by the level of detail around the events that unfolded in Nepal over the years during Thapa’s tenure. Was Thapa recording a journal over the years of the events and the conversations that transpired, or were they committed to his phenomenal memory? Either way, the reader gets a glimpse of Nepal’s recent history from the early days of the Panchayat, through the People’s Movement and the democracy period, the Maoist insurgency, Royal Palace massacre of 2001, and Gyanendra’s coup of 2005.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026041204048_125dc8ae300a1e33124f394abe724d42727f83e067b0201d2008b58d60c459a4.jpg" data-media-id="editor_0" data-image-id="2026041204048_125dc8ae300a1e33124f394abe724d42727f83e067b0201d2008b58d60c459a4" data-rendition-name="original" width="1584" height="1000" loading="lazy" alt="How to win friends and influence nations NT"> </figure>  Not enough is said about the political parties of the time whose presence led to the way Nepal’s multiparty democracy came to be shaped. The book keeps its focus on the administration and the key figures around it, mostly those in the Panchayat era. Towards the second half of the book, we do start to hear about political parties, but not in great depth. Another figure whose presence in the book is conspicuously less prominent is that of his wife, Rita Thapa — the person who seems to have rescued him every time financial quandary or family care became a challenge. Yet, we do not see her as a full person. Perhaps because of the personal tragedies in his life, the children are also barely mentioned.&nbsp; The book is therefore less personal and more technical. Throughout, we learn about Thapa’s thinking as he navigated the world of diplomacy to win him the trust of those who mattered. There are tips here for a new generation of Nepali officials and diplomats about how much commitment and focus is needed to be good at one’s job and serve the national interest. This book adds to tomes that have been written on Nepal’s fragile relationship with India. ‘India has always wished for Nepal to remain dependent on it,’ writes Thapa, who served as Nepal’s ambassador to India and later in the Eminent Persons Group &nbsp;on Indo-Nepal relations that has been allowed to languish. The book has several insights into the Indo-Nepal trysts with diplomacy and agency.&nbsp; China’s role is also recorded, viewed through conversations during a visit to Beijing, but all that was before Nepal’s neighbour to the north emerged as a world economic and military power. The book also has such sudden instances of quirkiness and humour. For instance, we see a young Thapa in America explaining to a government official why he would like to return to Nepal instead of settling down in the US. “Because, Nepal is beautiful,” he said. The text is immaculate and does not read much like a translation, credit for which clearly goes to the team that put the edition together: translator Prawin Adhikari, &nbsp;Anagha Neelakanthan and Bhekh Thapa’s daughter, Manjushree. As Nepal enters a new era of governance and diplomacy, A Life in Public Service: Nepal from Autocracy to Democracy should be essential reading for students of political science, economics and foreign affairs who can gain a fresh perspective on the country’s trajectory.&nbsp; There are dozens of forgotten state secrets recorded in the book, but the reader must also remember this is a story told from one person’s perspective and there may be others.&nbsp; So, what really made Thapa the diplomat he was? I met him in 2004 at the Kantipur TV studio when he was serving as king Gyanendra’s foreign minister. He was there for a studio interview, and I was just done with my English newscast.&nbsp; He surprised me at the door: “Pratibha! I’ve been reading your articles in The Kathmandu Post. You must keep writing.” I thanked him, glad to have been noticed for my work by a stranger. That was perhaps one of the things that set Thapa apart — he excelled at staying close to those in power, while also noticing those who were not.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260412040412_213e706136a038ec9f5e2b8c6d7f7c1e9ceed9479e22fe2884872ad7bd20955f.jpg" data-media-id="editor_1" data-image-id="20260412040412_213e706136a038ec9f5e2b8c6d7f7c1e9ceed9479e22fe2884872ad7bd20955f" data-rendition-name="original" width="1136" height="702" loading="lazy" alt="Book details"> </figure>

How to win friends and influence nations

Prime Minister Balendra Shah on Wednesday broke tradition and met with 17 foreign envoys collectively, a move that was a notable departure from how his predecessors operated.&nbsp;
Shah had already set himself apart by talking less, listening more, and delegating to trusted friends. But by meeting all ambassadors at one go in the presence of the Foreign Ministry, he signalled a paradigm shift in how he wants Nepal to be seen: no longer just balancing India and China, but as a country confident about its <a href="https://nepalitimes.com/opinion/guest-editorial/tripolar-contestation-over-nepal">strategic importance and place in the world</a>.
In just two weeks, the <a href="https://nepalitimes.com/news/rsp-dos-and-don-ts">RSP has sprung into action </a>on multiple fronts to implement its ambitious 100-point, 100-days action plan. It has taken short-term measures to mitigate the impact of the Gulf war, as well as medium- and long- term measures to streamline the bureaucracy. A few high-profile figures have been made examples of to drive the message home.
Earlier this week, the government recalled six politically appointed ambassadors, the most notable being long-serving Shankar Sharma from New Delhi. The Kathmandu District Court issued arrest warrants against former prime minister Sher Bahadur Deuba and his former foreign minister wife Arzu Rana on charges of money laundering and corruption.
Each ministry has been trying to clean up the accumulated rot from the past three decades: regulatory overhaul of microfinance, education, health and service delivery.&nbsp;
These actions widely disseminated campaign-style on YouTube and TikTok have made most Nepalis hopeful that the party they installed in power means business.
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BACKLASH
But such attempts to overhaul a long-entrenched political culture were bound to face backlash. In their impatience and enthusiasm to get things done, some of Prime Minister Shah’s ministers have over-reached.
It was common knowledge that government-paid advertising in the mainstream press was kickback-driven, but the PMO’s directive that official notices be published or broadcast only on state-run media has been denounced — especially as the media industry struggles to stay afloat.
More serious are some recent appointments by ministers of relatives and figures closely associated with the RSP to key positions. This has rankled because this party built its political plank on ending nepotism and graft.&nbsp;
News that Home Minister Sudan Gurung allegedly had not paid rent on leased land, which illegally encroached on the lake in Pokhara did not help. &nbsp;
Prime Minister Shah himself has come under scrutiny for appointing a kitchen cabinet full of male buddies from his time as Kathmandu mayor. To douse criticism he brought in as adviser investigative journalist Deepa Dahal, who has exposed corruption in high places of the previous coalitions.&nbsp;
Shah’s appointment of another political adviser Asim Shah to the head Constitution Amendment Task Force, is also seen as problematic. He is a filmmaker and former lawmaker, but does not have a background in constitutional law.&nbsp;
Even more controversial is the Cabinet’s decision to appoint RSP Chair Rabi Lamichhane’s legal counsel, Narayan Kandel, as Attorney General. Kandel used to be a UK permanent resident, and does not have as much experience practicing law in Nepal.&nbsp;
Kandel’s appointment drew flak and raised eyebrows, and with the pending legal cases against Lamichhane this appointment represents a flagrant conflict of interest.
Health Minister Nisha Mehta was also accused of favouritism after reappointing Junu Shrestha, wife of Labour Minister Dipak Kumar Shah, as member of the Health Insurance Board which had earlier suspended her. The Labour Minister’s rambling rant at the Board’s meeting on Tuesday has not helped the RSP’s image.&nbsp;
(UPDATE: On Thursday, Prime Minister Shah sacked the Labour Minister after the RSP found him in breach of the party's code of conduct and discipline. He served 14 days in the Cabinet, one of the shortest tenures for a minister in Nepal )
It is hard to know what <a href="https://nepalitimes.com/news/ball-in-balen-s-court">Balendra Shah is thinking</a>, and how Rabi Lamichhane is going to justify some of these moves. After all, making politics, governance, and bureaucracy a meritocracy has been the core tenet of the RSP, and it risks alienating its mainly youth base if these missteps persist.
But at least for now, most RSP supporters seem to be giving the party the benefit of doubt.

world-tuberculosis-day

Ending TB is possible, and cost-effective

Pandemic eclipses Nepal's TB epidemic

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How to win friends and influence nations

Nepal’s new government springs into action