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On 23 July 2022, the World Health Organization (WHO) declared monkeypox (mpox) outbreak a Public Health Emergency of International Concern. It’s a virus that belongs to the same family as smallpox and chickenpox. The outbreak was seen in 112 countries, with a total of 87,972 laboratory-confirmed cases and 1,097 probable cases, including 147 deaths, as of 19 June 2023. And the first case in Nepal was seen recently, on June 16. This has raised several concerns among the public about the possible outbreak of mpox in Nepal. “While mpox isn’t as contagious as Covid-19 since the virus isn’t airborne, there’s still a chance that this one case might lead to an outbreak if we aren’t careful,” says Dr Prajwal Pudasaini, a dermatologist at the Civil Service Hospital, Minbhawan, Kathmandu. According to a WHO report, an infected person can transmit the virus one to four days before showing any symptoms, and until the symptoms/rashes heal. The incubation period (the number of days between the start of infection and showing of symptoms) for the mpox is around three to 17 days. The common symptoms might last two-four weeks, which include high fever, swollen lymph nodes, and rashes. It transmits sexually, through skin-to-skin contact, saliva, mucus, and pus from rashes and droplets. The symptom starts with fever and rashes appear two-three days post-fever. “It can easily be confused with common viral fever, during which people might not maintain the needed distance,” says Dr Pudasaini. Also, since many people aren’t aware of mpox, they might not opt for medical tests. He adds that some might also confuse mpox with chickenpox, not knowing the difference between the rashes. “In the case of mpox, rashes first appear on palms, feet, and genitalia, whereas chickenpox appears all over the body,” he says. The rashes in mpox are filled with mucus/pus, unlike in chickenpox. “Also, people might not stay in isolation thinking they are already immune to chickenpox,” he adds. Despite that, the possibility of an outbreak is quite minimal, especially in Nepal because virus transmission is not possible without close physical contact, says Dr Janak Koirala, professor of infection disease/internal medicine at Patan Academy of Health Sciences (PAHS). “Since the first case was quickly identified, it might not have spread in a group,” he says, “But it’s necessary to follow the infected’s travel history, as well as trace and monitor her contacts.” Dr Rudra Marasini, director, Epidemiology and Disease Control Division (EDCD) under the Ministry of Health and Population (MoHP), says that the 60-year-old infected individual’s contacts have been traced and they are under close observation. “She had a travel history, and we have managed to contact everyone who came into contact with her within the 21 days prior to when her symptoms appeared,” he says. So far, only one of the contacts has shown signs of mpox, but the test result came out negative. Dr Hemanta Chandra Ojha, section chief, Zoonotic and Other Communicable Disease Control Section, EDCD, says other contacts haven’t shown any symptoms of mpox thus far. They will be under observation until the incubation period is over. “Since the illness didn’t originate in Nepal, it’s highly unlikely that this will turn into an outbreak,” he says. But to remain prepared, Dr Marasini mentions that medical professionals in Nepal have received training on dealing with cases of mpox. “We have 14 sites all over Nepal where professionals trained in handling mpox have been stationed,” he says. Dr Dharmendra Karn, a dermatologist, says most healthcare professionals began keeping themselves updated with the mpox virus after an outbreak in 2022. “We didn’t know when it would enter Nepal, so we have always stayed prepared,” he says. Also, for most individuals, the symptoms are only limited to fever and skin rashes, unless they are immuno-compromised. “It might prove to be fatal for infants, elderly and pregnant individuals, as well as people with chronic illnesses like diabetes, existing heart and liver issues, and HIV/AIDS,” says Dr Karn. In these cases, mpox might lead to other complications like meningitis, encephalitis, pneumonia, and organ failure. However, the mortality rate, so far, is less than one percent globally. “Much depends on the type of mpox variant,” says Dr Pudasaini. There are two variants of mpox prevalent globally—Central African (Clade I) and West African (Clade II). Among them, Clade II doesn’t cause much severity, whereas, according to Pudasaini, Clade I is thrice as lethal as the omicron virus. “Not knowing what variant we are dealing with, we can’t be sure on what the outcome might be,” he says. Nevertheless, the 2022 outbreak was caused by the subtype of Clade II called Clade IIb, which isn’t as severe as Clade I. Unfortunately, Nepal doesn’t have the mechanism to identify mpox variants. The best thing to do at the moment, Dr Karn believes, is to go back to the preventive measures everyone took during the Covid-19 pandemic. “We need to start maintaining distance, wearing masks, and using sanitizers,” he says. He adds that it’s necessary to inform people on the possible symptoms of mpox and precautions to take when one shows signs of infection. “Many people don’t even know what mpox is,” he says. Dr Koirala says it’s important to prevent the virus from reaching places like hostels, schools, and workplaces, where there is close contact. “It’s also transmissible from towels, clothes, utensils, and items used by the infected,” he says. If found in places where people remain together in a cluster for long hours, an outbreak cannot be prevented. But if there is an outbreak, doctors and medical professionals ApEx spoke to believe that Nepal’s healthcare system is well-equipped to handle it. “Many hospitals now have good isolation wards, ICUs, and have a good knowledge on dealing with medical crises,” says Dr Santa Kumar Das, deputy director, Tribhuvan University Teaching Hospital at Maharajgunj, Kathmandu. But there are a few improvements needed, like increasing the number of labs that conduct Polymerase Chain Reaction (PCR) tests for mpox. Currently, the test is only available at the National Public Health Laboratory (NPHL) in Teku. To prevent the virus from making inroads into the country, a proper screening system must be put in place to know whether a person is suffering from mpox, experts say. “The best way is to prepare a screening questionnaire, and send individuals showing symptoms for a PCR test,” says Dr Koirala. For now, the MoHP has stationed trained individuals at airports to perform proper screening. “We are doing everything we can to prevent the virus from entering the country,” says Dr Marasini. Data: Countries with maximum mpox cases since the 2022 outbreak, as of 6 June 2023

Source: Centers for Disease Control and Prevention (CDC) Symptoms Fever Rashes first appear on the palm, feet and genitalia two-three days post fever. Pus/mucus filled rashes appear all over the body Swollen lymph nodes Control measures Maintain physical distance Wear mask Use sanitizer Raise public awareness on the disease

Deputy Prime Minister and Home Minister Narayan Kaji Shrestha is traveling to China today. He will be leading a seven-member delegation to attend a trade fair in Chengdu. Bilateral engagements and visit exchanges between Nepal and China have increased in recent days. Only last week, Minister for Industry, Commerce and Supplies Ramesh Rijal attended the 13th Xinjiang-Kashi-Central Asia and South Asia Commodity Fair organized by the Kashi Prefecture Administration of China. Rijal delivered a statement at the opening ceremony of the event on 21 June, where he said that fairs and expos offered a good platform for exhibitors, entrepreneurs, and businessmen from South Asia and Central Asia to showcase their products, as well as to strengthen economic and people-to-people relations. He also appreciated the trade facilities provided by China to Nepali products while stressing the need for bolstering Nepali exports to China. In the second week of June, Chairman of the National Assembly, Ganesh Prasad Timalsena, also visited China. He met the Chairman of China’s People's Congress, Zhao Leji, and the two agreed to advance cooperation between the legislative bodies of the two countries. Leji said that leaders of the two countries have elevated the China-Nepal relationship to a strategic partnership of cooperation featuring ever-lasting friendship for development and prosperity. Beijing has also stepped up efforts to strengthen people-to-people relations with Nepal. For instance,  Himalayan Airlines resumed its direct flight between Kathmandu and Beijing this week following a three-year interval caused by the Covid-19 pandemic. According to the Nepali Embassy in China, direct flight between Kathmandu and Beijing, which takes place every Saturday, will play a significant role in promoting tourism, and socio-economic and cultural relations between the two countries. Also this week, a Sichuan Airlines charter flight arrived at the Pokhara International Airport this week, making it the first international flight to land at Nepal’s third international airport since its inauguration in January.  This week Nepal-China Friendship Dragon Boat Race Festival was organized in Pokhara where Chinese Ambassador to Nepal Chen Song said that it is an implementation of China’s Global Civilization Initiative (GCI). WeChat Pay, a mobile payment service run by China’s tech giant Tencent, was launched in Pokhara, while Tencent is joining hands with Nepal’s NMB Bank to launch the service. All these developments within a short period of time indicate China’s softer approach toward the Pushpa Kamal Dahal-led government.  Prime Minister Dahal himself is likely to visit China later this year to further cement the Nepal-China ties. Dahal visited India from May 31-June 3 this year. Key visits 

• Deputy Prime Minister and Home Minister Narayan Kaji Shrestha’s China visit
• Minister for Commerce and Industry Ramesh Rijal’s China visit
• Chairman of National Assembly Ganesh Timalsina’s China visit
• Former speaker Agni Prasad Sapkota’s China visit
• A four-member delegation of CPC visited Kathmandu
• Wang Xiaohui, CPC Secretary of the Sichuan province, visited Kathmandu

Kathmandu Mayor Balendra Shah faces a contempt of court case for a social media post denouncing Patan High Court’s interim order to allow the screening of ‘Adipurush’, an Indian film based on epic Hindu mythology ‘Ramayan’. Earlier, Shah had banned the screening of the film, raising objection to one of the lines that he claimed portrayed ‘Janaki’ (goddess Sita) as India’s daughter. However, it was ironic enough that Shah, who is also a rapper, was resorting to such a thing as censorship, and when his mayoral injunction was removed by the court of law, he decided to call Nepali government and courts “slaves” of India. Shah lit a tinderbox of controversy over a film and when things didn’t go his way, he turned it into a matter of ‘sovereignty’ and ‘independence’. Many say it is not the mayor who should be wielding the sword of censorship, that there is the Censor Board of Nepal. But the board gave the film its green light without removing the “controversial” dialogue. Nationalism is a popular ideology right now, and Mayor Shah seems to be cashing on it. Earlier this month when there was a controversy over the ‘Akhand Bharat’ mural inside India’s new parliament building, he had the map of ‘greater Nepal’ placed in his office. Many people praised Shah for this, saying that unlike the government of Nepal, the mayor had the courage to send a reply to India’s ‘Akhand Bharat’ mural. After much public criticism, the government finally sought clarification from India regarding the map mural. In the case of ‘Adipurush’ too, many people celebrated Mayor Shah’s decision to ban its screening and criticized the government for not even raising a peep. Shah’s historic mayoral election victory as an independent candidate reflected Kathmandu voters' frustration toward political parties. After coming to power, Shah performed many tasks that his predecessors could not. For instance, he dismantled illegally built structures around the city, improved road condition, brought transparency to municipal works, and took initiatives to preserve ancient heritages. He was rightly praised by the members of public for being a man of action. The only area where Shah and his office faced criticism was the decision to remove landless squatters from public land and indiscriminately seize the goods of street vendors. Some see his gentrification drive as hostile toward the poor. But his supporters continue to see him as an outsider maverick. Mayor Shah recognizes the deep-seated frustration of his supporters toward traditional political parties, so every now and then he panders to this frustration by taking jibes at the parties, leaders and government ministers. A few months ago he decided to stop collecting garbage from Singhadurbar, where most of the federal ministries lie, for non-cooperation with the city office for management of waste. As the issue grabbed media attention, Shah took to his social media saying to the effect that the ministers who work inside Singhadurbar must be disposed of to Sisdol landfill site first in order for Kathmandu to become a clean city. Naturally, his statement struck a chord with his supporters. More recently, when the government decided to announce the revival of Constituency Development Fund, Mayor Shah once again took a dig at lawmakers by comparing their status as that of municipal ward chairpersons. But it is one thing to criticize the government and another to brazenly refuse to follow a court’s order. This is not the first time Mayor Shah’s decision has landed in court. Recently, a team of municipal police shut down an education fair, which led the organizer to knock on the door of Patan High Court. The court then issued an interim order paving the way for the organizer to resume the fair. But the court order concerning the screening of ‘Adipurush’ has caused much controversy, as Mayor Shah has not only tried to undermine the sanctity of the court but of democracy itself. In his tweet related to his defiance of the court order, there are more than 1,000 replies, and the majority of them have advised Mayor Shah to accept the court’s order even if it does not feel right. His followers have cautioned him not to go against the court order. Then there are those who are of the view that major political parties that are running the country for over three decades have been flouting the court orders all the time, and it is not right to point the finger only at Shah. Former Supreme Court justice Balaram KC says Mayor Shah should have maintained restraint but what he wrote on his social media should not constitute contempt of court. He adds the controversy should have been settled by the court by inviting the two sides for discussion. Major political parties and their leaders are afraid of speaking against Shah, because they fear that criticizing the Kathmandu mayor will result in a public backlash. Instead, he is being praised by parties carrying a nationalist agenda. CPN-UML leader Bhim Rawal has defended Shah, saying that the court order shows that nationalism has become weak. He has written on his social media that all the state institutions such as legislative, judiciary, and executive should stand in favor of national interests. Similarly, Rastriya Prajatantra Party Nepal Chairman Kamal Thapa has said while some of Mayor Shah’s working style could be controversial, his heart is in the right place. KC, the former Supreme Court justice, says Mayor Shah enjoys unquestionable support, courtesy of major parties’ decades long failure to change. His ‘nationalist’ posturing has only solidified his position. There is no doubt that Mayor Shah has overwhelming support, but he should be careful not to let the fame and popularity get to his head. Rash actions and misplaced attention are not what his supporters want from him. With all the accolades and support, Shah is in a position where his actions and conducts are hardly seen with a critical lens. It is a dangerous position to be in when there is no one to tell him right from wrong.  

Smriti Bishwakarma, famously known as ‘Dmriti’, is a 22-year-old rapper from Jhapa, Koshi Province, who got well recognized in the Nepali music industry in a short period of time. Her journey began at the age of 16, right after completing her 10th grade. Rapping, for her, started as a hobby. In fact, she had never thought of becoming a rapper. But six years down the line, she is now fully focused on making a career out of it. Born in Kathmandu, Bishwakarma moved to Jhapa at the age of eight. Although there were a lot of changes she had to adjust to, one thing that always remained consistent, she says, was her family’s love for music. “No one from my family was a professional singer, but they loved singing now and then,” she says. Her childhood was mostly influenced by Bollywood music. And singing for her was a way of spending some quality time with herself. “I mostly got to be invovled in music during the three month break I had after I was done with school,” she says. She wrote her own lyrics and tried to incorporate it in a rap. In the process, she recorded one of her songs on her phone and posted it online. “That’s when my life took a different turn. The post got shared by Uniq Poet, of the best rappers we have,” she adds, “And that’s the reason why I continued doing what I did.” But she hadn’t yet decided to take up music as her career. Most families in Nepal prioritize education. Hers was the same. “They weren’t wrong either. I needed a degree because being an artist comes with a lot of uncertainties,” she says. She joined Nepal Academy of Tourism and Hotel Management (NATHM) to pursue a Bachelor’s degree, while pursuing music on the side. The sad thing about that arrangement was that she had no time to invest in music. “I felt like I was starting to lose myself,” she says. So she decided to drop out. But her journey in the Nepal music industry had yet not begun. She got into the industry only after winning the rap battle organized by Break Station, a hip-hop community in Nepal, at the age of 20. “At first, my time within the industry was quite overwhelming. I didn’t know what I was doing and everything was happening so fast,” says Bishwakarma, “But I was having fun too.” She got to mingle with several like-minded individuals which, she says, was quite helpful for her to grow as an artist. She used to record songs in a studio before she came to Kathmandu too, but what she didn’t have were people who understood her work the same way she did. “Having so many people on the same page as me was the best thing I got to experience once I was officially a part of the hip-hop industry,” she says. She thoroughly enjoys her profession and the process of creating. But the best part, she says, is when she listens to the song she made for the first time. “It’s the most satisfying feeling,” she says. But sustaining within the industry, she says, is another challenge. The major problem is making a stable income. “Everyone is doing their best, but we still have a lot to learn in terms of properly distributing albums. Right now, we are solely dependent on live shows to make money,” says Bishwakarma. Secondly, she says that the hip-hop industry is quite male dominated, and some of them are reluctant to acknowledge female rappers. “Even when I won the rap battle, my opponent told me he wanted me to win since I was a girl. It seemed like he was trying to say that he let me win and I didn’t earn it,” she says. She further adds that most people  ask her male colleague if they helped her write the lyrics for her songs. “They don’t want to believe that I wrote it,” she says. Also, she sometimes finds working professionally as a rapper to be quite overwhelming. “Not that I don’t like my work. But everyone needs a break,” she says, adding that is why she likes to go back to Jhapa time and again to stay with her family as well as be by herself. Right now, Bishwakarma is working on an Extended Play (EP) which will come out soon this year. But she is in no hurry. “I want to be patient and create something that I’m proud of,” she says, and it’s the same when it comes to building her career too. She says that she wants to give herself enough time to grow and improve. As far as the future is concerned, Bishwakarma says she doesn’t like to plan ahead.  “All I can do is work hard and see where it takes me,” she says.