Violence against women on the rise
Mamata Nepali (21) of Tila Rural Municipality-4, Jumla, was beaten to death by her husband Aite Sarki on March 12. In another incident on the same day, police arrested three men on charge of raping a 29-year-old woman in Ghorahi municipality, Dang district. These are among the latest instances of violence against women in the country. The United Nations has defined gender-based violence (GBV) as any act that results in, or is likely to result in physical, sexual, or psychological harm or suffering to women, including threats of such acts, coercion, or the arbitrary deprivation of liberty, whether occurring in public or in private life.Despite significant progress made in policy formulation and programs by the government, violence against women still continues across the country. Data paint an alarming pic Nepal Police data reveal that the violence against women has drastically increased across the country in the past 10 years. According to the data, 2,250 cases of violence against women and children were reported in the fiscal 2068/2069 BS. Ten years later (2078/2079 BS), the number rose to 17,000. Experts working in the field of women’s rights point out the patriarchal mindset of people, taking women as second class citizens, a rise in the tendency of reporting the incidents and use of various social media as some of the causes for a rise in the number of cases of violence against women. “Forms of violence have changed in the last few years. The violence against women has now started on social media,” said Sabin Shrestha, advocate. In the fiscal 2078/79, crimes against women, children and senior citizens numbered 21,342. The highest number of crimes against women was in Madhesh Province (5056) followed by Lumbini Province (3,605). The number of crimes against women and children stood at 337 in the year 2053/54, Nepal Police report reveals. Among the types of crimes against women and children, domestic violence is largely reported. Nepal Demographic Health Survey data reveal that 34 percent of women who have experienced spousal physical or sexual violence have sustained injuries. Cuts and bruises are the most common types of injuries reported. Unequal power relations between the male and female is one of the major causes behind violence against women in Nepal, the experts say. “Women are confined, they do not have access and are controlled. Also, there is a feeling that anything can be done to a woman. Devoid of livelihood, women suffer from all kinds of violence,” said Laxmi Aryal, Program and Training Manager at WOREC Nepal. Cases go unreported Despite a large number of women undergoing violence against them many of the cases go unreported. “It is difficult for a woman to open up about the violence she has undergone. Unfriendly judicial process, lack of family support, finances, victim blaming on social media are some of the causes for women to file cases against the perpetrator,” said Shrestha. People should have proper information about the process of reporting the cases. They should also know about the process to file cases. “Lack of information about the process to fight against violence, agencies to get help from, lack of evidence, difficult judicial procedure, stigmatization and worries regarding children’s future prevent women from reporting the cases,” said Aryal. With hurdles in the system, women prevent themselves from reporting the cases. According to the NDHS, 66 percent of women who have experienced any type of physical or sexual violence have not sought any help or talked with anyone about resisting or stopping the violence they experience. Power dynamics and politicization of the cases have also prevented women from reporting the cases. Shrestha points out that the verdicts on recent high-profile rape cases have started deterring women from reporting the crimes against them. “It has made women think that they will not get justice. Power and politics affect the cases. So, women think they will not get justice,” Shrestha said. Preventive measures The NDHS reveals that 22 percent of women in Nepal aged 15-49 years have experienced physical violence since age 15 and seven percent have even experienced sexual violence. Six percent of women who have ever been pregnant have experienced violence during pregnancy. Chairperson of CPN-UML KP Sharma Oli, on the International Women’s Day (March 8), had stressed the need for all sides of the society to cooperate and raise awareness to discourage all sorts of violence against women. “There should be laws in place that root out all sorts of violence against women, gender discrimination and violence by booking perpetrators and compensating victims,” Oli had said. The experts say that the psychological part of men should also be looked at. “The current situation is difficult. Younger generations have their own issues. There is frustration among people. Psychological aspects of the people should be discussed to lessen the number of cases,” said Shrestha. “Respect for the marginalized ones, clear provisions and policies to address the issues, building strong networks, changing the mindset of people, mobilization of youths, discussions, male engagement, amendments in acts and regulations and review of discriminatory policies will help reduce the number of cases,” suggested Aryal. GBV prevention fund Compensation, services such as shelters, legal aid and psychological counseling are necessary for women to fight the violence against them. The government has adopted legislation and institutional arrangements to advance women's human rights. As such, the government has established a GBV prevention fund at the center. But, from among the 753 local levels across the country, only 115 municipalities have established this fund. The Ministry of Women, Children and Senior Citizens had initially released a budget of Rs 100,000 each for every local level in the country for establishing the fund. Province 1 government has also granted an additional 500,000 rupees to the rural municipalities and municipalities in the province. The rights activists suggest that all three tiers of the government should work together to amend laws, policies and practices that give rise to cases of GBV. The Ministry of Health and Population runs the One-stop Crisis Management Centre (OCMC) in coordination with government hospitals, but most victims of domestic abuse are unaware of the service. The center was established at Paropakar Maternity and Women’s Hospital in 2011-12. A total of 94 hospitals now run OCMCs across all seven provinces. These centers provide temporary rehabilitation, legal aid, and health services, including psycho-social services and rehabilitation free of cost to the survivors. These provisions are meant to ensure that survivors of GBV and those affected by it receive health services, legal aid and counseling services as well as other required services without discrimination of any kind. Factsheet
- Women with five or more children experience physical violence more often (35 percent) than women with no children (9 percent)
- Experience of physical violence is more common among employed women, irrespective of whether they are employed for cash (28 percent) or not for cash (21 percent), than among women who are not employed (17 percent)
- Divorced, separated, or widowed women are more likely to have experienced physical violence (46 percent) than currently married women (25 percent) and never married women (6 percent)
- Most ever-married women who have experienced physical violence since age 15 report current husbands as perpetrators (84 percent) and 11 percent report former husbands. Seven percent report mothers-in-law and 5 percent report other in-laws as perpetrators
Breaking the glass ceiling
The United Nations is celebrating this year’s International Women’s Day under the theme DigitALL: Innovation and technology for gender equality this year.
Sabitri Dhakal of ApEx caught up with some of the women, who have made their marks in different sectors. They shared their triumphs, tribulations and plans for the big day.
Ayasha Shakya, taekwondo player
The day brings attention to the women’s rights movement, gender equality issues, women’s reproductive rights and women’s achievements in various fields. But rather than recognizing women and their work on this particular day, it would be better if we could celebrate their works and achievements each day. Everyone in the society, be it the children, adults or the elderly should recognize the works and understand that women are special and can achieve like men.
I have no plans for the Day as I am recovering from an injury.
The day makes the woman at least feel good because it is a holiday for them. People should understand that women too need rest and time.
Muna Ghimire Shrestha, heavy equipment operator
People have stereotypes about women. They think women are weak and cannot handle machines. If given proper education and training, there is no such work that a woman cannot do. The works should not be stereotyped. On this women’s day, I encourage Nepali women to learn skills and work for their economic independence rather than going abroad, only to face difficulties. If you work hard, success will follow you.
I think the celebration of this big day is city-centric. To address the issues of women, the voices of women living in rural areas should also be heard. If we can bring to light the issues of women living in rural areas, then the real problem of women will be visible. The problems facing women should be discussed and resolved through policy intervention.
Jaya Dhakal Guragain, principal, educator
The works done by women should be recognized and honored. There should be support for a woman from all – family, colleagues and colleagues.
Though things are changing for the better, the challenges facing women still remain. Being in the profession mostly handed by men, I feel there are challenges facing a woman at the workplace. Unsupportive colleagues are the main problems. I have experienced competitive feelings in males when a woman reaches a leadership position. Also people try to humiliate a female if she is in a leadership position because they cannot stand it. But one must not be deterred. Instead of celebrating the day and recognizing women’s work, if colleagues, family and society become helpful for women, they can achieve much more in life. Also there should be a proper and equal pay scale for women.
I will be celebrating the day staying at home, giving time for myself.
Rabina Shrestha, math teacher
Mathematics has been described as a difficult subject. I grew up hearing that a girl cannot solve math problems like a boy. But I was always interested in mathematics and thought of making a career by teaching the subject.
There is a stereotypical thinking that a female teacher cannot handle teenage children at school. But it is not so. If you have proper teaching skills and knowledge about the subject matter, you can effectively handle the classroom.
Celebrating the International Women’s Day is acknowledging the works and achievement of women and highlighting the issues of women. There should be equality and no discrimination on the basis of gender.
Dr Sangeeta Mishra, women’s health activist
Women’s health has been ignored in the country. We have not been talking about issues like gender-based violence and mental health of women. All these issues inspired me to work as a woman health activist.
Being a woman in the male dominating profession is challenging. There are rooms filled with males and you will be the single woman in the room. They expect you not to speak. But you can’t sit without speaking. But when you speak, they don’t take you seriously. If you try to enforce some of the ideas, then you are labeled as being a man. You face different levels of challenges once you reach a certain position. There is an unseen glass ceiling but one must break it. Women should be included in decision-making and forming policies, including those related to women.
If we are to change the lives of women, we should work from zero. We are looking for women who can talk and work, while there are very few such women. Women, who can speak for the unseen women, are lacking.
We celebrate women’s day every year under different themes. We must work the whole year on such themes to bring changes in the lives of women. The women must face direct competition. I will be working for a conference on women’s health on the big day.
Bhoj Kumari Shahu, chef
Though cooking in the households is done mostly by women, cooking in restaurants and hotels is done by men. This is because of the lack of faith in women’s capabilities. I was encouraged by my brother to study hotel management. I got interested in cooking and also took training. Working in a kitchen with 75 males was challenging for me. People speak rough words, touch you knowingly/unknowingly. But if you want to carry on, you need to adjust and act like a man. You can’t give excuses every time. You must work together.
The message I would like to give to women is look at women who have challenged the stereotypical society and work to bring changes.
Gyanu Adhikari, writer
I used to be excited about International Women’s Day earlier. I used to feel that it would inform people about women’s issues and rights. Looking at the current scenario, I feel the information has not reached the country’s targeted population. We have not been able to raise awareness on the issue.
I think the issues should be dealt with as per the geographical locations because we can’t decide everything from Kathmandu.
There are multiple challenges for women when it comes to working with men. There is male ego. They don’t show it but it can be felt in their behavior. Women are still considered secondary. We need to work together with men. Avoiding them or running away from them won’t help. The women must show their skills and potential; only then will people believe them. Women can reach higher positions if they work hard.
Archana Aryal, homemaker
Being a homemaker is challenging. You need to take care of your children, manage finances, take responsibilities and give up your career. Homemaking was my choice. Seeing my children grow up, I feel satisfied.
But the society does not regard the household chores as proper work. I think women’s work inside houses should be acknowledged. They are never paid and acknowledged for the work they do.
If the families just share the burden of household chores, I think many women will heave a sigh of relief. I have no specific plans for the day. It will just be a normal day for me.
Rising flu cases a grave threat to public health
Cases of seasonal influenza are on the rise in Kathmandu, of late. According to Sukraraj Tropical and Infectious Disease Hospital, at least 25 cases of influenza A have been reported in the hospital since January this year. “At least 30-35 patients with symptoms of influenza are visiting the hospital’s OPD,” said Dr Milan Bajracharya, consultant physician at the Sukraraj Hospital. The visitors show symptoms like cough, runny or stuffy nose, sore throat, fever, headache, fatigue and bodyache. Hospital officials say the infected have A(H1N1) and A(H3N2) viruses in their systems. A contagious viral infection, influenza attacks the respiratory system. Type A influenza poses a serious threat to public health. According to the World Health Organization (WHO), it can cause widespread outbreaks and disease. “Some of the children visiting the hospital showed symptoms like vomiting and diarrhea,” said Dr Sher Bahadur Pun, chief, Clinical Research Unit, Sukraraj Hospital. Health experts warn that a large population may get infected if precaution is not taken. Seasons of influenza Each year, Nepal sees two seasons of influenza virus—in January-March and in July-August. Change in weather is a major cause behind rising influenza cases in the country, according to the experts. “Whenever there is a difference of about 15 degrees between minimum and maximum temperatures, the human body faces difficulty adapting to changing weather. The body can’t maintain immunity and people fall ill,” said Dr Baburam Marasini, public health expert and former director at the Epidemiology and Disease Control Division (EDCD). Infects all People from any age group can contract influenza, though those with low immunity, elderly, pregnant women, organ transplanted patients and cancer patients are more prone. “The virus is already in the community. Keep in mind that it infects people with low immunity the most,” said Dr Bajracharya. To reduce the severity of infection on people who have undergone organ transplantation, the experts advise maintaining minimum contact with visitors. Cases are on the rise, but most of them go unreported. “We have call centers, but they receive very little information about influenza cases,” said Dr Abhiyan Gautam, deputy health administrator at EDCD. Influenza cases are rising this year also because people have stopped practicing health safety measures, according to Dr Marasini. According to him, the cases of influenza were fewer when the country was reeling under the Covid-19 outbreak. “People were alert; they were following safety health protocols, which shielded them from influenza,” said Marasini “But as the risk of coronavirus decreased, they stopped following health protocols, causing a surge in the number of flu cases.” The experts warn that crowded areas like schools and offices offer a perfect setting for spread of the virus. Per the WHO, when an infected person coughs or sneezes, droplets containing viruses are dispersed into the air and can spread up to one meter, and infect persons in close proximity who breathe these droplets in. The virus can also spread through infected hands. Infections may rise in coming days, the experts say. “Children born when coronavirus was first detected in the country (2020) may be prone to infection as it is the first time they are coming into contact with the virus,” said Dr Marasini. The experts point out that a large number of people may already have been infected, but most of them don’t want to visit hospital. As for those staying home, they caution the former to not take medicines without consulting a medical practitioner. “Most of the people take antibiotics. It is counterproductive,” added Dr Bajracharya. Experts say that most of the infected recover within a week without requiring medical attention. However, influenza can cause severe illness or death, particularly among high-risk groups, including the very young, the elderly, pregnant women, health workers and those with serious medical conditions, the UN health body explains. People, suffering from influenza, are also susceptible to pneumonia. Complications from the influenza are categorized as severe acute respiratory illness (SARI). According to the EDCD, 216 cases of SARI were reported on the 37th epidemiological week, while 247 cases were reported on the 36th week. The epidemiological week begins from the second week of January each year. “For a week, I have been suffering from sore throat, cough, fever and body aches. I took rest and drank plenty of fluids. As it didn’t help, I visited a doctor. I am under medication now,” said Puja Budathoki (30) of Baneshwor. Medical experts suggest people to visit health centers if they have complications. Earlier on 29 March 2019, a 21-year-old male had succumbed to influenza A (H5N1). That was the first reported human case of Influenza A in Nepal. The EDCD has been providing medicines to patients suffering from SARI for free. Oseltamivir, sold under the brand name Tamiflu, is an antiviral medication used to treat and prevent influenza A and influenza B, viruses that cause the flu. The first outbreak of influenza in Nepal, caused by influenza A/H3 serotype, was detected in 2004 at a Bhutanese refugee camp in southeastern Nepal. Since then, the country has witnessed an increasing number of influenza positive cases with two major epidemics in 2004 and 2009. The epidemic in 2009 was due to influenza A (H1N1), with the first cases seen in June 2009 among people returning from the US. Kathmandu at increased risk A study conducted by Bimalesh Kumar Jha and his team in 2016-17 and published in 2020 in National Library of Medicine found the prevalence of influenza to be higher in Kathmandu and nearby districts. Because the transmission of influenza virus mainly occurs through aerosol inhalation and spreads more rapidly in crowded areas, these districts had higher prevalence of influenza in comparison to other districts. The Kathmandu valley and nearby districts are surrounded by mountains and experience distinct climatic conditions and lower temperatures, compared to other districts. As higher temperatures enhance defense mechanisms and decrease replication of influenza virus, the valley having lower temperature favors influenza virus replication, which might also be the reason behind higher prevalence rate, the team suggested. Safety measures To help prevent influenza, one must practise the same health measures such as maintaining social distance, handwashing and wearing masks, covering one’s cough and sneezes as they were done to prevent Covid infection, the experts advise. To prevent transmission, people should cover their mouth and nose with a tissue when coughing, and wash their hands regularly.
Gas cylinders: A ticking time bomb?
The gas cylinder explosion at the residence of Nepali Congress lawmaker Chandra Bhandari has once again brought to light the risks associated with such cylinders. Lawmaker Bhandari has suffered burns in the fire that erupted after the blast at his house in Buddhanagar on Wednesday, whereas his mother Harikala Bhandari (86), who suffered 70 percent burns, died in the course of treatment at the Kirtipur Hospital on Thursday. Lawmaker Bhandari, who suffered 25-30 percent burns, was airlifted to Mumbai for treatment on Thursday after the hospital recommended his transfer to a foreign medical institution with better medical facilities, citing a worsening condition of the injured and lack of specialized treatment in Nepal. As for the reasons behind the burns, the hospital said in a press release: “Hot air and smoke probably caused inflammation in their windpipes.” At Tulsipur (Dang) on Thursday, two persons sustained burns in a gas cylinder explosion. On January 16, 2019, one woman died and four sustained injuries when a gas cylinder went off at Deep Jyoti in Tokha municipality-9, Kathmandu. While on November 6, 2021, a gas cylinder explosion at Mangal Bazaar claimed four members of a family while they were preparing food. Nepal Police data suggest that most of such explosions have occurred at homes. The records suggest that 10 such incidents were reported from across the country in the fiscal 2020-2021, which killed three people and left 10 injured. Of the 10 places where the blasts occurred, eight were homes, a shop and a workshop each. “The leakages and explosions are happening because a lot of people in the cities use gas cylinders for cooking in the households,” says Shree Krishna Thapa, program manager at Burns Violence Survivors Nepal. These incidents have set off alarm bells, bringing safety issues to the fore. As for risk reduction measures, experts suggest that the government should regulate the safety status of gas cylinders and monitor the market regularly to reduce chances of blasts and death/injuries in such incidents. Hydraulic tests necessary Experts point that gas-bottlers supplying low-quality cylinders are mainly to blame for a growing number of accidents involving the cylinders. “Cylinders are sold in the market without subjecting them to hydraulic tests. Hydraulic tests should be conducted to measure a cylinder’s capacity to withstand pressure as a gas cylinder cannot withstand pressure forever,” says Prof Dr Binay Kumar Jha, Central Department of Chemistry, Tribhuvan University. Life of cylinders decreases because of damages that occur during their loading and unloading, observes Prof Jha. “The cutting of the foot ring and neck rings of the cylinders, and welding also decrease the cylinder’s capacity to withstand pressure. Tampered cylinders should be immediately destroyed.” LPG regulation The Liquefied Petroleum Gas (LPG) Regulation 2065 states that a cooking gas cylinder should be subjected to hydraulic tests after it is 10 years old. Such tests should be conducted every five years thereafter. The regulation clearly mentions that repaired cylinders, cylinders welded after cutting the foot-ring and neck-ring or containing oily substance in the valve should be smashed or crushed. The gas cylinder used for refilling the cylinders should clearly bear the name of the cylinder manufacturer and its logo, the name of the gas filling industry name and its logo, hydrostatic tests conducted, working or test pressure, weight of the cylinder without gas, capacity of water, weight of gas filled in the cylinder, and the date of testing. The gas depots should not sell the gas cylinders which do not have proper weight, or the cylinders from which the gas is leaking, or the damaged cylinders. Those cylinders should be marked with a special symbol and so be separated, the regulation points. If the gas used for the domestic or business purpose is differentiated by weight and color, then the gas cylinders for domestic purpose should not be sold for business purposes. But the regulation remains on paper. Consumers need to be aware Despite the regulation, cylinders that would not pass the safety standards are circulating in the market. “We can see a lot of cylinders that are very old. The government and the LPG bottlers are not serious about their quality,” points Madhav Timalsina, president of Consumer’s Right Investigation Forum. The cylinders, stoves, regulators and pipes should have quality. “The government should take immediate action to control the supply of low-quality cylinders. Otherwise, these ‘bombs’ in our homes may explode anytime,” says Timalsina. Consumers also need to be aware while using LPG cylinders, consumer activists say. Don’t switch lights Any ignition source–open flame, electric spark, etc–can ignite gas in the room and cause an explosion. To prevent electric spark, one must not turn on an electrical device or disconnect it from the wall after detecting the hazard. “Do not turn on or turn off a light switch or other electrical device. Anything electrical may cause a spark and trigger fire if there’s gas leakage. It could be a light switch, candles or matches.” Dr Jha suggests that the government give subsidies to auto sensor and auto cut regulators so that everyone can use it and make mandatory tests for checking the gas regulators. Avoiding burns LPG cylinders, if not handled properly, can lead to disastrous and fatal consequences. If the gas escapes into a confined space and is ignited, explosion can occur. Following safety precautions should be followed to reduce chances of accidents.
- The distance between the gas cylinder and stove should be three meters.
- Windows should be kept open in the event of gas leakage.
- The regulator knob should be turned off if the cylinder is not in use.
- Flammables and plastics should not be kept close to gas cylinders and cooking areas.
- The kitchen should be well-ventilated.
- Quality rubber tubes and regulators should be used.
- Cylinders should be stored in a cool, dry and well-ventilated area out of direct sunlight and away from the heat and ignition sources.
- Electrical appliances near LPG cylinder should be handled properly.
- The expiry dates of cylinders should be checked. They are marked with an alphabet and a number. The alphabet shows the month and the number shows the year.
- Do not apply any lubricant, or tape to cylinder valves, fittings or regulators
- Do not drop or bang cylinders against each other.
- Leave the cylinder cap in place until the cylinder is secured and ready for use.
- Make sure that the cylinder is not giving off an odor or making a hissing sound. Never open a damaged valve.
- Nylon, fleece, silk, polyester, etc clothes are highly inflammable.
- Keep the body part suffering burns in running water for at least 30 minutes. Rush the victim to the hospital
Bibeksheel Sajha plans a comeback
Bibeksheel Sajha Party is regaining its Bibek (wisdom) after a long hiatus, it appears. Once considered a torchbearer of alternative politics in a country fed up with under-performing mainstream political parties, this party split more than once due, mainly, to internal contradictions. Now, it is planning to stage a comeback from the footnotes of Nepal’s contemporary political history. On Saturday, the general convention held in Kathmandu elected Samikchya Baskota Chairperson of the party unanimously, along with Ranju Darshana as its General Secretary. Prakash Chandra Pariyar, Milan Pandey and Bimala Adhikari are vice-chairs of the party. But for others seeking to be part of the party’s apex body, it may not be a cakewalk. In all likelihood, those aspiring for 61 central committee member positions in the party will have to contest elections to land these berths. For bringing the party back from the brink, a number of members, who had ditched the party on different grounds, returned to the party fold. This move also facilitated the general convention. Like in the fashion of the Aam Aadmi Party in India, Bibeksheel Sajha was expected to make its presence felt in Nepal. But that did not happen as the party landed in splitsville more than once due to conflicts in its rank and file. The party founded on July 26, 2017 after the merger of Sajha Party and Bibeksheel Party split on January 11, 2019, only to merge again on December 09, 2020 under the joint leadership of Rabindra Mishra and Ujwal Bahadur Thapa. The lessons from the past are not lost on the party, that is what the new leadership says. Talking to Annapurna Express about the challenges and plans to tackle them, Baskota and Darshana shared that leading the party was not an easy task, but they were ready to take up the challenge. “We have come to this point after multiple splits and reunions. Crevices have formed at all three levels of the party structure. We need to repair damaged structures,” said Ranju Darshana, general secretary of the party. “We are aware of past debacles. We must make the party stronger if we are to bring about desired changes in the country. We plan to form teams in provinces, districts, wards and at local levels. We will be working to promote leadership at every level,” added Darshana. The importance of inter-party dialogue is not lost on the new leadership. “Bibeksheel Sajha Party is committed to starting dialogues with different parties,” Darshana said. She also stressed the need to make party members financially independent by promoting entrepreneurship. The new leaders are aware of the hard work required to make the party stronger by winning hearts and minds of the members and the public at large. “We are aware that members may have some ideological differences. But we need to sort out these differences rather than letting them destroy the party. We have learned this lesson from the past,” said Baskota. The party aims to regain its strength (lost after the split) with leaders planning to visit villages, wards and local areas for the same. What does the party plan to do next? “We will conduct provincial and district conventions within a year for the leadership,” said Baskota. The party also aims to hold dialogues, discussions and share forums with the public, expand its organizational base, work against corruption and prepare for the elections.
Turkey-Syria quake: A wake-up call for Nepal
The magnitude-7.8 Turkey-Syria quake has triggered a humanitarian disaster, with around 16,000 people already killed, thousands missing, a huge population without supplies and many people awaiting rescue under the rubble. Against this backdrop, experts say, Nepal, an earthquake-prone country, should learn lessons from the 7.8 tremor and step up disaster preparedness. The quake on the far-off shores of Turkey and Syria has brought back memories from the 2015 Great Gorkha Earthquake (magnitude-7.6), which left more than 600,000 houses destroyed and nearly 9,000 people dead. Jolts of lesser magnitudes have followed the Gorkha quake, including the recent ones in the Sudurpaschim Province. Despite these rude shocks, not much has changed in Nepal in terms of disaster preparedness, point experts. Lack of open spaces, a crowded outcrop of high-rises and a large population in core city areas pose a huge threat to lives and properties. Learning lessons from the past, Nepal should shore up disaster preparedness, experts say, warning that casualties could rise in Nepal in the event of a massive quake. “The Turkey-Syria earthquake and the 2015 Gorkha earthquake have shown that we need trained rescue workers, cutters and equipment to break the building chunks to rescue people caught under the rubble,” says Anil Pokhrel, chief executive at the National Disaster Risk Reduction and Management Authority. Increase in the number of concrete buildings should also be a cause for concern as the collapse of such structures can cause increased losses of lives and properties, per experts. They stress that the country needs radars to locate people under the debris and trained human resources for rescue operations. “We lack trained human resources and equipment. We need to address this shortfall by producing trained human resources and adding equipment needed for search and rescue across the country,” says Pokhrel. The government should invest in study to assess the safety status of schools, health centers and government buildings. “These structures should be categorized on the basis of their safety status.” “The government should invest in research to find out why many buildings did not collapse in the 2015 earthquake. Policies on construction of homes should be revised on time,” observes Amod Mani Dixit, chair at National Society for Earthquake Technology-Nepal (NSET). Other expert prescriptions include the construction of earthquake-resistant buildings and shoring up of disaster preparedness at local levels, apart from management of safe places for the rehabilitation of rescued people. “This is a wake-up call for all Nepalis. We have forgotten the 2015 earthquake altogether. Building construction codes are not followed and we have no knowledge about technologies that can minimize the impact of a quake. We are ill-prepared to deal with natural disasters,” says Dixit.
Fat-cut surgery getting popular
With the number of people being obese and getting fatter, health centers in Kathmandu have started weight loss surgery. Heard until a few years ago in Kathmandu, the weight loss surgery has been one of the attractions for people to help them look attractive, keeping their weight maintained. Sedentary life and work, changing lifestyles and modes of transportation, intake of foods rich in fat and sugar, rapid urbanization, imbalance between calories consumed and expended are some of the causes for overweight and obesity in Nepal, health experts say. Situation in Nepal A nationwide population-based 2022 survey conducted in Nepal found prevalence of diabetes mellitus to be 8.5 percent. The research paper published in National Library of Medicine by Namuna Shrestha and others sampled 13,200 participants aged 20 years and above in 400 clusters of 72 districts of Nepal. The research findings revealed that the prevalence of diabetes was 8.5 percent in the country. The occurrence of diabetes was higher in the upper age groups (40-59) and 60+ years compared with the group aged 20-39 years. Overweight and obesity are important risk factors for diabetes, the research revealed. It showed that participants who were overweight and obese had about two times higher odds of having diabetes than those with a normal BMI. A cross-sectional study conducted among 266 students of class 9 and 10 in Chitwan found 9.77 percent students overweight and three percent obese. The paper published in the Journal of College of Medical Science-Nepal found that the majority of overweight was among female students of 13-15 years age group from private school. Also eating snacks while watching television is associated with being overweight. Students who take snacks while watching television were significantly overweight as compared to those who do not 13.33 percent vs 6.11 percent. The National Demographic Health Survey 2016 concluded that overweight/obesity in men and women increases with wealth and household food security. Obesity The World Health Organization has defined overweight and obesity as abnormal or excessive fat accumulation that presents a risk to health. A body mass index (BMI) over 25 is considered overweight, and over 30 is obese. It has said that 39 million children under the age of five were overweight or obese in 2020. For adults, WHO defines overweight as BMI greater than or equal to 25 and obesity as BMI greater than or equal to 30. “Body-mass index is a simple index of weight-for-height that is commonly used to classify overweight and obesity in adults. It is defined as a person’s weight in kilograms divided by the square of his height in meters (kg/m2).” Childhood obesity The prevalence of overweight or obese children and adolescents aged 5–19 years increased more than four-fold from 4 percent to 18 percent globally from 1975 to 2016, the WHO says. One in 13 children and adolescents in Nepal between the age of 5 and 19 are obese in Nepal. Obesity among children and adolescents (between the age of 5 and 19) has increased 29 times in the past four decades, UNICEF says. Keeping in view the increasing number of obese children and adolescents, the American Academy of Pediatrics has issued its first guideline on childhood obesity. Children struggling with obesity should be treated early, including with medication and surgery, the new US guidelines says. Health problems Excessive weight gain has numerous health problems. “People who are obese are under a risk to develop diabetes, sleep apnoea, heart problems, raised cholesterol level, blood pressure, problems during pregnancy, etc,” said Dr Alark Devkota, Rajouria DM diabetes and endocrinology, Nepal Diabetes Endocrine Polyclinic, Baneshwor. Dr Devkota also points to psychological stress, difficulty during pregnancy and the risks of obesity. Lifestyle modification and regular exercises are recommended to maintain weight. But those who have tried all the measures of losing weight and have failed there are weight loss surgeries available. Bariatric surgery Nepal’s health centers are providing weight loss surgery for people who are very obese. This surgery is also called bariatric or metabolic surgery. The process involves surgery of the stomach and making it smaller in size. “The treatment helps to decrease one’s appetite, changes hunger hormones and control hunger cravings. It restricts the amount of food which can be consumed and also decreases hunger,” said Dr Koshish Pokharel, bariatric and metabolic surgeon at HAMS Hospital. A total of 15 such surgeries have been conducted at HAMS hospital in the past three months. The cost for the surgery is between Rs 350,000 and 400,000. “The surgery is conducted on persons with more than 35 BMI,” informed Dr Pokharel. “It is also beneficial for people with obesity, diabetes, have sleep apnoea, etc,” said Dr Shail Rupakheti, gastrointestinal surgeon and director at Star Hospital. Junk food popular among children Children craving for foods rich in sugar and savoring to their hearts’ content is what we see each day. Consumption of junk food such as noodles, chips, cakes and similar other items are the causes of obesity in children, point the doctors. “When children grow up eating such junk food, they suffer from diseases such as diabetes, back pain, high blood pressure from a young age,” said Dr Aruna Uprety, a nutritionist and public health expert. Eat local Consumption of locally available foods is healthy and nutritious. Children should be given foods rich in protein, minerals, carbohydrates, fats and fiber. Prof Dr Uma Koirala said, “Baked items should be avoided as they have trans fat. There is trans fat in processed and baked items such as cakes, breads, cookies, pizza, fried foods, French fries, doughnuts, instant noodles, etc. Consumption of such foods poses risks to cardiovascular diseases.” The nutritionists advise eating healthy and balanced diets to maintain good health. They advise eating foods we have been consuming for ages. “Rice, lentils, green leafy vegetables, roti, pickles and our seasonal foods are both nutritious and healthy,” said Uprety. They advise regular exercises to maintain weight and stay healthy.
Eliminate trans fat before it kills you
Medical experts have warned that consumption of trans fat is harmful for health. The proportion of chronic heart disease due to trans fatty acid intake is 4.38 percent in Nepal, the World Health Organization has reported. Five billion people globally remain unprotected from harmful trans fat, a new status report from the UN health organization has found, increasing their risk of heart disease and death. Though a number of people are suffering from chronic heart diseases in the country they are unaware of trans fat and the health risks associated with it. “Nepali people are not serious about the consumption of trans fat and its health risk. Public has ignored it,” says Dr Sachin Dhungel, senior consultant cardiologist at Gautam Buddha Community Heart Hospital, Butwal. Trans fats are artificial compounds, mostly formed through an industrial process. These fats are produced by adding hydrogen in vegetable oil. It helps the oil to become solid at room temperature and has a long shelf life. Some meat and dairy products also have a small amount of naturally occurring trans fats. The WHO has said that industrially produced trans fats or trans-fatty acids are commonly found in packaged foods, baked goods, cooking oils and spreads. They are mostly found in processed and baked items such as cakes, breads, cookies, pizza, fried foods, French fries, doughnuts and fried chicken, biscuits and rolls, instant noodles etc. “These food items are easily available and people are influenced by lucrative advertisements. The taste of the foods prepared in the oil is enhanced, luring people to consume them,” says Prof Uma Koirala, nutritionist. Instead of consuming junk and processed food items, she suggests eating homemade food items. She also advises against eating foodstuff cooked in oil that has been repeatedly heated, as it increases bad cholesterol in the body. “Trans fat is liquid oils turned into solid fats during food processing. Trans fat deals a double whammy to cholesterol, by increasing LDL (bad cholesterol) and decreasing HDL (healthy cholesterol),” adds Koirala. Medical experts say trans fat in foods deposit in veins and could create blockage in the long run, which in turn raises the risk of coronary heart diseases, stroke, cancer and type two diabetes. Nepal Burden of Disease 2019 study reports that cardiovascular diseases (CVDs) were the leading cause of deaths, with 24 percent of total deaths attributed to cardiovascular diseases. The proportion of deaths attributable to CVDs was 26.8 percent in males and 20.7 percent in females. Trans fat intake is responsible for up to 500,000 premature deaths from coronary heart disease each year around the world, according to WHO. “Trans fat helps in increasing cholesterol level and forms plaque, narrowing the blood vessels. When there is a blockage in the blood vessels, it impacts the function of the heart. The blockage can rupture the vessels and cause heart attack and stroke. People are even under the risk of paralysis,” says Dr Dhungel. He adds at least 25 patients with high blood pressure, cholesterol level, and heart attack are visiting the Butwal based hospital daily. The health risk is more in people over 40 but people below 40 are also suffering from high blood pressure, high cholesterol and heart problems because of the consumption of foods rich in trans fat, say doctors. Since WHO first called for the global elimination of industrially produced trans fat in 2018–with an elimination target set for 2023–population coverage of best-practice policies has increased almost six-fold. Forty-three countries have now implemented best-practice policies for tackling trans fat in food, with 2.8 billion people protected globally. Despite substantial progress, this still leaves five billion people worldwide at risk from trans fat’s devastating health impacts with the global goal for its total elimination in 2023 remaining unattainable at this time. Situation in Nepal There is a wide use of trans fat in food items produced in Nepal. Also the consumption of such foods is high here. The government has approved the Multisectoral Action Plan for Prevention and Control of Non-communicable Diseases (2021–2025), which includes a trans fatty acid target of two percent to be implemented by 2023. The WHO has said that currently, 9 of the 16 countries with the highest estimated proportion of coronary heart disease deaths caused by trans fat intake do not have a best-practice policy. These countries are Nepal, Pakistan, Bhutan, Australia, Azerbaijan, Ecuador, Egypt, Iran, and the Republic of Korea. To achieve the goal, the WHO organized a capacity building workshop on eliminating trans fatty acid in Nepal in July 2022. Analysis of trans fatty acid in commonly consumed foods has been completed, providing further evidence for the need to introduce trans fatty acid regulations in Nepal. The best way for preventing the health risk is to avoid eating food items prepared in trans fat. “We must replace oils containing high trans fats with healthier options. Mustard, sunflower and soya based oils are better,” advised Koirala. Fat is necessary for health. It helps in metabolism. The daily intake of oil such as in cooking vegetables and in lentils is healthy. It helps in regular metabolism. But an intake of trans fat will have an adverse effect on one’s health. The government has made policies but their implementation is lacking. The market must be regularly inspected, consumers and sellers should be made aware, and the quality of the foods made in Nepal and those imported from other countries must be maintained, say medical experts. “Trans fat has no known benefit, and huge health risks that incur huge costs for health systems,” says WHO Director-General, Dr Tedros Adhanom Ghebreyesus. “By contrast, eliminating trans fat is cost effective and has enormous benefits for health. Put simply, trans fat is a toxic chemical that kills, and should have no place in food. It’s time to get rid of it once and for all.”
