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

New and old, businessmen and former diplomats, engineers and academics — they have all been trooping to the Election Commission to register political parties ahead of the Sunday deadline.
Till press time Thursday, five new parties had been registered and 21 new parties were in the process of applying. Behind the scenes, new parties are head-hunting, well-known figures are shopping for parties to join, while older parties are splitting or uniting to form new united parties.
“It is reason for optimism that people are enthused to form new parties,” notes political analyst Indra Adhikari. But, she adds, this does not mean that despite the celebrity status they will win votes and succeed in politics.
The outlier in all this are the Nepali Congress (NC) and the UML, which are still licking the wounds after being swept out of power by the GenZ protests in September. Neither are too keen on elections because of the prospect of losing badly.
Former prime minister K P Oli is the most recalcitrant, and seems to want to scuttle elections so Parliament will be reinstated. After announcing that he was stepping down, the NC’s Sher Bahadur Deuba has had a change of heart in Singapore and is gunning to restore Parliament.
Neither party and their leaders have shown any remorse for the 8 September massacre, or understood the outrage on the streets against their decades-long incompetence and corruption. &nbsp;
Among those registering parties are various GenZ youth groups and family members of those killed during the September protests. Notable among the new parties certified this week was Gatishil Loktantrik Party (गतिलो) backed by Buddha Air founder Birendra Basnet and led by sociologist Dinesh Prasai. Dharan Mayor Harka Sampang’s Shram Sanskriti Party is also registered.
Energy and Infrastructure Minister in the interim government Kulman Ghising has backed the Ujyalo Nepal with former secretary Anup Kumar Upadhyaya as its chair. Ghising has been playing coy about his political ambitions, and is planning to resign from his cabinet post before elections.&nbsp;
Ghising had been talking to Rabi Lamichhane’s RSP about joining, but that negotiation failed. Former RSP lawmaker Sumana Shrestha was supposed to join Ghising, but pulled out following Ghising’s reluctance to resign from government.
Ghising has much public support because he is credited with ending power cuts as head of the Nepal Electricity Authority, but is now getting flak for being unwilling to give up his ministerial portfolios while still wanting to contest elections. &nbsp;
Ujyalo has hit other snags. GenZ activist Tashi Lhazom, who was considered for a Cabinet position last month but was dropped by Prime Minister Sushila Karki, has said she is not in Ujyalo despite being listed as a Central Committee member. Another member has said that he will not be a part of Ujyalo due its “a lack of political culture”.
Even though Nepalis from across backgrounds and professions are eager to participate in the country’s new political landscape, there are doubts about the structure of their parties, ideology and electoral platforms.&nbsp;
Hurriedly set up parties without a shared philosophy have less chance of political influence and longevity. For example, the RSP was formed just months before the 2022 polls to become the fourth-largest party in Parliament, has lost its momentum, and its leader is in jail.
“Parties like the RSP, which did some positive work after being elected, have still not been able to establish a clear ideological roadmap or organisational structure,” Adhikari says. &nbsp;“It is easy to form parties, the real work goes into building an institution, which is the hard part”
Meanwhile, despite expectations of increased and inclusive youth participation not just at the polling booths but also on the ballot, only a few GenZ-led parties are applying at the Election Commission. They include the Rastriya Pariwartan Party and the Rastriya GenZ Party Nepal. Most other parties are led by men in their 40s, even in their 70s.&nbsp;
Analysts note that despite hopes of young blood in politics, Nepalis are still inclined to trust those with experience, as evidenced by GenZ’s choice of Sushila Karki to succeed KP Oli as Prime Minister after the September protests.&nbsp;
“So it will be difficult for young Nepalis without prior political experience to lead parties and it will be even more difficult for them to cultivate enough public trust to get votes,” says Adhikari.&nbsp;
Then there are the old political players, who have been breaking up and making up new alliances. Resham Chaudhary quit his Nagarik Unmukti Party and registered a new one.
Last week, Puspha Kamal Dahal’s Maoist Centre, and Madhav Kumar Nepal’s Unified Socialists merged along with smaller leftist parties to form the Nepali Communist Party (NCP). Disgruntled former UML members like Bhim Rawal have also joined the NCP. On the other hand, Janardan Sharma has fallen out with Dahal and is going his own way.&nbsp;
Even though the NC, UML and NCP show little sign that they have learnt their lesson and will be turning a new leaf, they still have the party organisation and vote banks to fall back on at election time in the runup to 5 March. &nbsp;
Says Adhikari: “At the end of the day, Nepali society remains hyper-partisan. And although the newly-formed parties and their popular candidates may give older leaders a run for their money, established parties will still benefit from their solid vote base.”

Party Time

It was pure drama: the political transition in Madhes unfolded by the dawn’s early light. At around 4AM on Monday, Province Head Sumitra Subedi Bhandari quietly departed Janakpur saying she was headed to Kathmandu for health reasons.&nbsp;
Outgoing Chief Minister Jitendra Sonal, whose coalition had begun to unravel, even saw her off, asking supporters to clear the road for her motorcade.
But an hour later, instead of continuing on to the capital, Bhandari stopped in Bardibas on the East-West Highway. There, as the sun started rising over the misty plains, she administered the oath of office to Saroj Kumar Yadav of the CPN-UML, invoking Article 168(3) of the Constitution.&nbsp;
Bhandari is also a member of the CPN-UML. The provision she invoked is typically used only after coalitions fail under Article 168(2), and the timing and location of the swearing-in have since drawn scrutiny.
Bhandari was subsequently relieved of her duties, and former National Planning Commission member Surendra Labh Karna was sworn in as the new Madhes province head on Tuesday.
Sonal had formed his government barely a month ago, with the backing of 56 provincial lawmakers but it became evident he would not secure the 54 votes needed to survive a confidence motion.&nbsp;
Several lawmakers in his coalition publicly signalled they would abstain. Still, the seven-party alliance that opposed Yadav’s appointment argues that the Province Head, who is the highest constitutional rank in the provincial structure, acted prematurely and under pressure from central UML party command.&nbsp;
A coalition of seven parties, including the Nepali Congress (NC), had been urging the Province Head to invite them to form a new government under Article 168(2). At the same time, the UML, which had been holding demonstrations outside the Province Head’s office in Janakpur, was calling for the formation of a minority government under Article 168(3).
The alliance of the seven parties that included the NC and Maoist Centre took to the streets. By mid-morning, protests had escalated outside Madhes Bhawan with cadre vandalising both the Chief Minister’s office and the Province Head’s office.
This was the third government in Madhes to fall since the 2022 provincial elections, and it follows a similar pattern. The previous Chief Minister Satish Kumar Singh of the Janamat Party, resigned before a scheduled confidence vote after losing the support of his own party and others including NC and LSP.&nbsp;
His resignation unfolded amid nationwide GenZ protests against corruption, demanding accountability and reform. The recurring instability points to a structural tension in Nepal’s federalism.&nbsp;
Provincial politics remain closely tied to alliances shaped in Kathmandu. The withdrawal of support by parties like the NC and Maoist Centre in provinces often reflects national-level calculations rather than provincial priorities.
As a result, the Provincial Assembly is repeatedly consumed by survival of the coalition instead of governance. Development work stalls. Budget execution slows. Public frustration grows. In a province that was at the forefront of the movement for federalism to counter what is seen as neglect, apathy and discrimination by Kathmandu, the sense that the system may not delivering on its promise is becoming increasingly pronounced.
If federalism is to be strengthened, provincial governments must be able to function with a degree of autonomy that currently exists more in principle than in practice. Otherwise, the perception that federalism is costly, unstable, and ineffective will continue to expand, providing fertile ground for anti-federal sentiment that is already gaining traction.
Earlier examples such as the NC General Secretary Bishwo Prakash Sharma in January calling for a new government in Madhes led by his party demonstrates how the central party leadership deliberately intervenes in provincial affairs. His remarks came during campaigns for bi-elections in Madhes when former CM Singh had been in office for six months only.&nbsp;
Likewise, in early June 2024, the federal coalition in Kathmandu shifted from a Maoist Centre and NC to form a new alliance between the NC &nbsp;and the UML. Within a day, coalition negotiations in Madhes changed to mirror this.
UML leaders publicly stated: “The issues at the federal and provincial levels will be resolved together.” This indicated that the realignment in Madhes followed national party decisions rather than provincial deliberation.
The events that unfolded in Madhes are a reminder that federalism in Nepal is still in transition, and that its success depends on political actors honouring the constitutional framework.

Chronic instability in the Madhes

The very first frame in The Lama’s Son starts with a vision of Shangrila and the quest of a mythical utopia in the Himalaya when the rest of the world is crumbling away. It is also the personal search of filmmaker Kesang Tseten, but what he finds there are adherents of the Bon Po faith clinging to the last remnants of a culture as it erodes away like the sandstone cliffs of Mustang. “It was while editing the documentary that the story became distilled: how does what we see in the high Himalaya relate to the notion of the Shangrila idyll that especially the West ascribed to them,” asked Tseten during a recent trip to Kathmandu from Berne where he now lives. He continued: “Often and perhaps rightly criticised as an orientalist construct, I wondered if there was any basis at all to the Shangrila notion, and I hung the film on that idea.”&nbsp; Tseten takes us to the vast vistas of Mustang and Dolpo, a landscape of his Tibetan ancestors. This is as much an intimate documentation of families on Nepal’s Himalayan rimland torn between remoteness and globalness as it is about Tseten’s own quest for rootedness.&nbsp; We start from Lubra, a 3,000m village in Mustang the 15 households of which follow the Bon faith. Lama Tsultrim is from a 900-year-old lineage of the animist faith and an exponent of the tradition that is slowly being subsumed first by Buddhism and now modernism. For Tseten, the material is familiar, and not at all exotic as it is for non-Nepalis and indeed for many urban Nepalis. Bon, founded in Tibet, predates Buddhism, but over time, the two religions have come to resemble each other.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251113111156_ecf8148fbaa17b93c81ddfa3ed244bed266e3ef6af0cd5e6ca7b64c181b97d45.jpg" data-media-id="editor_0" data-image-id="20251113111156_ecf8148fbaa17b93c81ddfa3ed244bed266e3ef6af0cd5e6ca7b64c181b97d45" data-rendition-name="original" width="1920" height="1080" loading="lazy" alt="The periphery cannot hold NT"> </figure>  ‘Both believe in karma, rebirth, and that humans can become enlightened. Nature and spirits are predominant in Bon, and rituals are what keep them benign and alight,’ says Tseten, who rarely narrates in his documentaries. “This is not really a personal film as such, but it has a point of view,” Tseten said. “I decided to have a voice-over on this one and cast my presence in the film.”&nbsp; Lubra's Lama Tsultrim is called upon to perform rituals from Kagbeni and other villages, but there is no one to continue the tradition after him, which is passed from father to son. Lama Tsultrim’s son (hence the title of the film) is a sushi chef in New York and has been gone for 20 years. “The Lama is like a setting sun, his son should come back and take over his father’s responsibilities,” says a local youngster chatting with friends. “If he dies tomorrow, where do we go? We can’t just light butter lamps ourselves to the gods.” It is not only the Lama’s son who has left. The village is nearly empty, and more are planning to leave. One of them is Chimi, a teacher who will be joining her fiancé who is an Uber driver in New York. Her brother is already in Hong Kong. In Lo Manthang a local is back home for a three-month vacation after being in New York for 12 years. A shopkeeper was in Japan for several years, and has returned. “Everything has changed, our language, our tsampa, our religion. We used to work and live together, now the children live separately,” says a middle-aged woman. “There are roads now, and vehicles stop right outside our house, but what’s the point? No one stays home.”  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251113111156_47b4c4984fa33e42791b16dba1f078aaa7f9d8bd51ca3bfd5415b436c3a0bf2c.jpg" data-media-id="editor_1" data-image-id="20251113111156_47b4c4984fa33e42791b16dba1f078aaa7f9d8bd51ca3bfd5415b436c3a0bf2c" data-rendition-name="original" width="1920" height="1080" loading="lazy" alt="The periphery cannot hold NT"> </figure>  Like most of Tseten’s films, The Lama’s Son is an honest documentation of a place and people whose lifestyle, culture and heritage cling precariously to the past. In Dri village we come across local women filling their buckets with water. Tseten asks them why the village is so empty: “Where is everyone?” The women reply that they are “here, there and everywhere”. Then it is their turn to ask Tseten about where he lives and what he is doing in their village. Migration is a recurring theme in Tseten’s documentaries from We Corner People, In Search of the Riyal, or Saving Dolma. His previous film Diversity Plaza documented the lives of Nepali and Tibetan emigrants in Jackson Heights in the borough of Queens in New York.&nbsp; Diversity Plaza was shown at DOC NYC in 2023, and The Lama’s Son will be one of only two Asian films shown next week at one of the biggest documentary film festivals in the world.&nbsp; “The Lama’s Son is not loud, not attention grabbing but intimate, so I was surprised they chose a quiet film for a big, flashy event,” Tseten told us. In Lama’s Son, we also see how climate breakdown is impacting Nepal’s trans-Himalayan regions. Lama Tsultrim shows us the aftermath of a recent glacial flood that swept away houses and fields. The debris-covered farms are as hard as cement.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251113111156_c82126a3c2dc4577b99beb9bef20aafa16f532a3f41e59caea17c93914c59fff.jpg" data-media-id="editor_2" data-image-id="20251113111156_c82126a3c2dc4577b99beb9bef20aafa16f532a3f41e59caea17c93914c59fff" data-rendition-name="original" width="1920" height="1080" loading="lazy" alt="The periphery cannot hold NT"> </figure>  The nearby village of Dhey at 3,900m is a high and dry cold desert. Farmers get one crop in a year, but the springs have gone dry and there is no snow in winter. So they are relocating to New Dhey, closer to the road. We follow Kesang Tseten to Samling in Dolpo, which at 4,200m is another Bon village. Locals are preparing for the Walchu festival in which Lama Sherrab carries out elaborate rituals to appease spirits that can turn malevolent. But unlike Lama Tsultrim in Lubra, Lama Sherrab has a community of lamas to help him, including two sons, one of whom will eventually take on his role. We move on to the adjacent village of Bicher and listen in as locals talk about how despite being dirt poor, they thrive in scarcity and are resilient. “We wear sheepskin, eat stew and yak meat, and drink wine. But we are very poor, we have nothing. Look at how dirty our clothes are. We may be dirty, but we have few illnesses,” says one. But even here in Upper Dolpo, a week’s walk from the nearest road, things are changing. There are mobile phones, readymade clothes and instant noodles.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251113111156_d1472165cfa9ffa6edbf72de59167e8cbddcc2bf4a7928f7830e099966259a78.jpg" data-media-id="editor_3" data-image-id="20251113111156_d1472165cfa9ffa6edbf72de59167e8cbddcc2bf4a7928f7830e099966259a78" data-rendition-name="original" width="1920" height="1080" loading="lazy" alt="The periphery cannot hold NT"> </figure>  At the Walchu ritual, Tseten watches men and women with hand-woven blankets and down jackets sing and dance after the main ceremony. He narrates: “Bon is sustained by a way of life that fosters a fine but fragile balance between nature and people, where humans come before gods. This is what lies at the heart of Shangrila if there is such a thing.” The film then takes us half-way around the world to a Bon centre in New York, but (spoiler alert) the eponymous Lama’s son never appears. He did not want to be filmed, but it makes for a more powerful portrayal of the life of emigrants forever trapped between two worlds. “Bon villages may be in danger, but the Bon has spread widely across the world,” narrates Tseten, a director who likes to call his storytelling ethnographic, and avoids coming to an apt conclusion. Lama Sherrab’s words after the Walchu ritual is a perfect segue:&nbsp; “Whether you say om mani padme hum (in Buddhism) or matri mi yu (in Bon) they are the same. When you go up, it’s the same heavenly realm. If you go down, it’s still the lord of death who awaits. There isn’t a separate heaven and hell for Buddhists and Bon, it has to be the same for both.” &nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025111312110_82817ef48840bb6baa1732d5b0b90c90ead2f9bd9eb0c289940fa61d8058de8d.jpg" data-media-id="editor_4" data-image-id="2025111312110_82817ef48840bb6baa1732d5b0b90c90ead2f9bd9eb0c289940fa61d8058de8d" data-rendition-name="original" width="7087" height="10004" loading="lazy" alt="The Lama's Son NT"> </figure>  The Lama’s Son by Kesang Tseten, 2025 Shunyata Films To be screened at DOC NYC 16 November at 2:05PM local time, Online: 17-30 November Details <a href="https://www.docnyc.net/film/the-lamas-son/">here</a>.

The periphery cannot hold

You do not have to be a climate expert or atmospheric pandit to claim that Nepal is not pulling its weight on the grand narratives of the Anthropocene. As a heavily populated ‘country-on-an-incline’ from the Tarai to the Himalaya, Nepal is a thermometer of global warming.&nbsp; Its people are human witnesses to environmental and climate breakdown, but remain mute observers to the unfolding crises. Nepal should be leading the pack at the COP30 climate conference in Belém, backed by science and lived experience. But it is doubtful that two of the most crucial climate-related subjects central to the culture, economies and human wellbeing in the Himalaya and South Asia will be discussed at the summit that started this week in Brazil.&nbsp; The first topic that should be raised at COP is Black Carbon or the South Asian Brown Cloud, made up of tiny suspended particles in the air. This is not just a transboundary health hazard, there is now enough science to make the case that Himalayan snowmelt is accelerated significantly by the albedo effect that makes ice melt faster because of reduced reflectivity. But Kathmandu has not been able to make governments near and far listen. In 2014, I wrote a short piece published in Outlook magazine explaining why India’s Prime Minister Modi looking northward from a SAARC Summit retreat in Dhulikhel was unable to see the Jugal Himal range barely 30km away. His view was obscured by the pollution layer arriving from as far away as Lahore with substantial contribution from the Delhi region. That summit itself was an opportunity for Nepal to inform the Indian and Pakistani prime ministers that much of the haze, smog, dust and soot that settles on our slopes was generated in Sindh, Punjab, Punjab, Haryana, Western UP and Delhi NCR, carried by prevailing westerly winds up to the Himalaya. The forest fires within Nepal as well as Kathmandu Valley’s pollution contribute to the haze, but the shroud that suffocates the region through autumn, winter and spring is mostly transnational. Last year, these anthropogenic fine aerosols actually curled over the Bay of Bengal and invaded the airspace of Sri Lanka and Maldives.&nbsp; Even as the soot particles accelerate glacial melt and impact everything from infrastructure to public health, the most visible effect is on tourism. Nepal’s economic future is based on tourism, and much of this relies on being able to see the snow mountains. Why should travellers go to Pokhara if they cannot see the Annapurnas?&nbsp; Hoteliers in Nagarkot have started a campaign: ‘Visit Nagarkot 2025: More than Sunrise and Sunset’. While clever, the slogan is a response to the acclaimed Himalayan vista from Everest to the Annapurnas from the hill station, now obscured by the brown curtain of haze for most of the year. As the bellwether country of South Asia when it comes to the climate crisis, Nepal must build diplomatic confidence to reach out to the governments of Pakistan and India even in their present state of antagonism. Kathmandu must launch ‘haze diplomacy’ for its own sake and for the region.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251113001132_16c9941da7b31c1d4683c06dc0f8a572803240701270606848851f915140329c.jpg" data-media-id="editor_0" data-image-id="20251113001132_16c9941da7b31c1d4683c06dc0f8a572803240701270606848851f915140329c" data-rendition-name="original" width="1005" height="695" loading="lazy" alt="permafrost"> </figure>  IMPERMANENT FROST&nbsp; Permafrost is understood mostly as a phenomenon of the Arctic, Antarctica, Siberia and Alaska. Mountains elsewhere did not figure, though it was natural for the ground to freeze all year round at high altitudes.&nbsp; In the Himalaya, besides the snowfields and glaciers, frozen moisture binds rocks and stabilises slopes. But global warming is melting the permafrost that used to cement mountain flanks, including boulders, sand and scree slopes. Some of the debris (गेग्रान) did tumble down, but much of it remained entombed on high, thanks to permafrost. Pokhara Valley and the Seti River reaching all the way up to the base of the Annapurnas, is the best place to observe this dance of geology between gravity and the mountain range. Rubble from the collapse about <a href="https://nepalitimes.com/here-now/remembering-the-seti-disaster">700 years ago of paleo-Annapurna IV </a>created the sediment field on which Pokhara is situated today. However, much of the debris from the crumbled mountain is still lodged up on and around Annapurna IV, but the binding is loosening with the warming earth. A <a href="https://www.icimod.org/event/analysing-permafrost-in-the-hindu-kush-himalaya-using-open-access-tools/">2024 report by the International Centre for Integrated Mountain Development (ICIMOD)</a> indicates that global warming is thawing the permafrost across High Asia. Among the unintended consequences of climate breakdown is that mountains and moraines are collapsing, with <a href="https://www.icimod.org/press-release/everest-region-a-hotspot-of-cryosphere-linked-hazards-icimods-new-study-on-nepals-2024-thame-flood-confirms/">cascading impact</a> that includes glacial lake outburst floods, reduced groundwater recharge as well as winter flow in the Ganga, Indus and Brahmaputra. No one has calculated the total volume of rubble locked in by permafrost across the Himalaya. Despite the increased risk, there is accelerated construction of highways, hydropower projects, housing and tourism infrastructure across the Himalaya. While the COP conferences discuss rising oceans and receding glaciers (without doing much about it), Himalayan permafrost has been melting unremarked. In their path-breaking September 2024 <a href="https://nepalitimes.com/multimedia/the-not-so-permanent-frost">article in Nepali Times</a>, Wilfried Haeberli and Alton C Byers argued that the extreme events of the past few years that led to mountain and moraine collapses, unleashing destructive debris flows downstream, were the result of melting permafrost. Haeberli and Byers suggest that the avalanches and floods including those of <a href="https://archive.nepalitimes.com/article/nation/Anatom-of-a-Himalayan-tsunami,1330">Seti (2012)</a>, <a href="https://www.icimod.org/article/understanding-the-chamoli-flood-cause-process-impacts-and-context-of-rapid-infrastructure-development/">Chamoli (2021)</a>, Birendra Tal (2023), <a href="https://www.sciencedirect.com/science/article/pii/S2772883825000251">Sikkim (2023)</a>, <a href="https://nepalitimes.com/news/climate-breakdown-linked-to-thame-flood">Thame (2024)</a>, <a href="https://himat.org/publication/byers-rockfall-induced-2019/">Barun (2017)</a> and <a href="https://nepalitimes.com/banner/drones-to-the-rescue-in-melamchi">Melamchi (2021)</a> were the result of the thawing of frozen ground. They say that the collapse of the lateral moraine on the <a href="https://nepalitimes.com/news/sikkim-flood-is-warning-to-nepal">South Lhonak glacial lake</a> in Sikkim on 4 October 2023 that swept away more than 100 people, destroyed the $1 billion Chungthang Dam as well as houses, roads and farms far downstream, was also caused by cloudburst on a lateral moraine that had lost its permafrost adhesive. There will be permafrost sceptics, as there have been climate change deniers. But it is time to wake up to the reality that the Himalayan peaks are no longer the immutable sentinels as regarded by humanity since prehistoric times.&nbsp; Modern society has pumped so much greenhouse gas into the atmosphere that now even the mountains are giving up. And we have not even begun to think about the bacteria and viruses locked away in the permafrost up the slope.&nbsp; Loss of permafrost adds to the cumulative impact of climate breakdown, including extreme weather events, drought and cloudbursts, heat waves in the plains affecting lives and livelihoods, creating mass migration, social unrest, and upending politics and geopolitics. The government and polity of Nepal have a duty to themselves and the larger humanity to wake up to the climate breakdown. The Sagarmatha Sambaad conclave organised by the Government in May failed to emerge as a pulpit for global warming and associated ills. Our political class, bureaucracy and academia should make up for lost opportunities to rise to the occasion and take the lead.&nbsp; Kanak Mani Dixit is writer, commentator and founding editor of Himal Southasian.

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