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Cases of dengue infection have reached an alarming level in Kathmandu and other parts of the country. The first case in Kathmandu was reported in May, and the caseload has crossed well over 1,000 in little over four months. Countrywide, the infection numbers have surpassed 8,000 and there have been at least a dozen fatalities.  Epidemiologists and public health experts say the relevant government health agencies should take immediate steps to contain the infection before the situation takes a turn for the worse.    Hospitals and health facilities across the country have been reporting a rise in daily dengue cases. At Kathmandu’s Sukraraj Tropical and Infectious Disease Hospital, most hospital visits and admittance are concerning dengue these days.  Dr Manisha Rawal, the hospital director, says nearly 2,800 people have tested positive for dengue since mid-July and 240 people needed to be admitted. “We are receiving 150 to 200 patients daily,” says Rawal. “Ten or so cases are serious and the patients need hospital stay.” She says since dengue has no cure or standard treatment, it should be considered a dangerous disease. She says dengue patients present a wide range of symptoms from mild to severe. The only thing hospitals and health facilities can do for severely ill patients is administer them medicines to relieve their symptoms.  The first case of dengue in Nepal was reported in 2004. The infection has been reported regularly since. In 2010, over 900 dengue cases and five deaths were reported, in what was Nepal’s first dengue epidemic. Dengue was classified as an epidemic in 2016, 2017, 2018 and 2019 as well, with the disease stalking more than 60 districts.  A disease historically endemic to the region with hot climate, dengue is now being reported in hill areas, including Kathmandu. Dr Baburam Marasini, former director at Epidemiology and Disease Control Division, told ApEx in a recent interview that climate change had contributed to the spread of the mosquito-borne diseases like malaria and dengue in the hill and mountain regions of Nepal.      Dr Rawal suggests as dengue cases are rising, the members of public should take necessary precaution, like wearing full-sleeves, using mosquito nets and repellents at home and covering the areas containing stagnant water, where dengue-carrying mosquitoes (Aedes aegypti) are known to breed.        

Tucked between souvenir shops in Agra, India, close to the majestic Taj Mahal, is a small, cozy café—the Sheroes Hangout. It’s run by five acid attack survivors and began out of a crowdfunding initiative that collected $4,500 in 2014. Similarly, at the Lahore Beauty Salon in Pakistan, acid attack survivors can train to be beauticians. Both these ventures began out of an urgent need to provide acid and burn violence survivors a means of livelihood as job opportunities were rare, their scars an instant turnoff for potential employers.  In Nepal, too, acid and burn survivors have been unable to find jobs. This has not only made it impossible for them to rebuild their lives, but also dampened their spirits on a daily basis. Sabita Mahat, a burn survivor, says her application for a foreign job got rejected after the agent saw her photo. She was just 17 when her husband set her on fire because she flushed his drugs down the toilet. “I have two small children. I still need more surgeries to be able to move my neck properly. How will I do all this if nobody gives me work?” she says. As tears threaten to spill over, she adds she hasn’t left a stone unturned in trying to earn a decent living. She used to be a makeup and henna artist. She did face-painting. She sold customized clay planters and piggy banks. She even tried starting a pickle business. Each time, her ventures either faltered after promising starts or they weren’t financially viable. Now she is over two million rupees in debt.  “I was getting my paperwork ready to go to Cyprus for a babysitting job. I thought if I worked hard for a few years, I would be able to pay back my loans. But the government apparently isn’t allowing Nepalis women to go abroad for work,” says Mahat.  Rumi Rajbhandari, founder, Astitwa, a non-profit that works for the rehabilitation of acid and burn violence survivors, says Mahat is one of the stronger ones she has seen in her over a decade-long career. But now even Mahat is frustrated. She has worked hard to turn her situation around but nothing seems to work in her favor and that can be depressing at times, says Rajbhandari. “It’s harrowing to be judged by your scars and not your capabilities,” she adds.  Living with scars and disfigurement in a society that values beauty can be an ordeal. The many acid and burn violence survivors I have met over the years have all confessed to covering up and trying to hide from prying public eyes. This makes reintegration into the society almost impossible. Worse, acid and burn violence cases often occur in low-income families, and victims are mostly women. The cost of immediate treatment and multiple surgeries thereafter coupled with zero job prospects causes an even bigger economic setback.  “People look at us with curiosity or pity. For them, we are different. And our society has never been accepting of those who don’t fit in,” says Mahat. She tells me about a friend of hers, another survivor, who is working at a bank in Hetauda, the capital of Bagmati Province. She got the job a couple of years ago because of connections but there have been multiple efforts to compel her to leave. Her colleagues don’t include her in team lunches or photos. Mahat says her friend is upset, but continues to fight for her right and refuses to quit. Quite a few acid and burn survivors work as domestic help in Kathmandu as well. But getting those jobs hasn’t been easy either. Rajbhandari recalls an incident when a burn survivor was rejected at three homes. In one, she was hired and fired in a day as the employer said “her granddaughter was scared of their new maid because of the ugly scars”. Working as a domestic help already comes with a fair share of challenges as many of the survivors don’t have full mobility in their limbs. Their scars stretch, itch, and burn, making it difficult for them to cook and clean.  Jenny Khadka, who suffered 20 percent burns on her neck, chest, and arms when her husband threw acid on her after she refused to go back home with him, says she is tired of the government’s empty promises. Promises of justice and jobs for the victims are made when there’s news of an acid or burn violence but it’s conveniently sidelined when the media furor dies down. “The government, so far, hasn’t done much to ease our sufferings. It would be foolish of us to keep hoping,” says Khadka with a shrug and a smile.  Until recently, Khadka was employed at Kumari Bank Limited, at its Bafal branch in Kathmandu. After two extensions of six months each, she is now jobless. The branch manager apparently wants her back but she hasn’t heard from her former employers yet. Employing acid and burn survivors is good for the company’s profile, she says. Once that goal is achieved, survivors are dispensable. “My colleagues were nice to me. But there wasn’t a single client who didn’t ask me what had happened to me,” she says. “She has such a pretty face, too bad about the scars,” was something whispered about her on a regular basis. Astitwa conducts training and workshops on jewelry-making, pottery and other informal skills. They sell the products made at various school and college fairs and to individual customers through online orders, says Sampada Uprety, program coordinator. The idea is to ensure survivors have some cash coming in as 20 percent of every order goes to the one who works on it. But this, Uprety adds, is by no means a regular thing. Orders are few and far between. It doesn’t fetch a stable income.  Kamal Phuyal, sociologist, talks about the theory of the three Ps—Power, Property, and Prestige—while discussing survivor’s reintegration. These are essentially what every human being strives for, he says. But in the case of most acid and burn victims, there is a lack of all three from the very beginning. “Attaining one of the three Ps will empower them and help them achieve the other two. Organizations working for acid and burn victims and the government must join forces to generate economic opportunities,” says Phuyal.  Phuyal plans to help Astitwa train Khadka to become a counselor. He says she has the potential to do well in the sector because of her own experiences, despite not having studied much. This, he believes, will establish her place in the society. Rajbhandari, on the other hand, adds she sees many changes in survivor’s attitude to life when they can earn. Being financially independent frees them from their abusers too, she says, as having nowhere to go, many victims continue to live with their husbands or in-laws.  “Money plays an important role in reestablishing their self-worth. But when jobs are difficult to come by, when they are looked at and rejected, it has a deep psychological impact that is worse than the trauma they went through when they were burnt,” says Rajbhandari. Mahat dreams of survivors like her coming together and starting something of their own—similar to the Sheroes Hangout—to create jobs for themselves. But then she isn’t hopeful it would work in Nepal. “The fact is people are still largely disgusted by us,” she says. 

Quest Pharmaceuticals is a WHO-GMP-certified science-based healthcare company. Established in 2001, the company is currently celebrating its 20th anniversary. As per the study of IQVIA, a leading global provider of advanced analytics, technology solutions and clinical research services to the life sciences industry, Quest is placed second in the ranking of pharmaceutical companies in Nepal in the year 2021. Quest was jointly founded by Prithvi Rajbhandary, Uttam Kumar Shrestha, Shailendra Prasad Verma, and Umesh Lal Shrestha. They continue to form the core company members. “Quest is a ‘family-friend business’ founded by the unison of friends. We are the second generation,” says Aseem Rajbhandari, associate director of strategy and operations. The major inspiration behind establishing Quest, he adds, was the idea to contribute to Nepal’s economic sector and make it self-reliant and independent. Before Quest, there were already many pharmaceuticals producing medicines under general category and only one company manufacturing specialized medicines. The company started out by manufacturing and marketing highly specialized cardio and diabetic medicines. Today, Quest manufactures over 100 medicines; nearly 90 percent of them belong to the chronic disease segment. “We envision Nepal to be self-sufficient in international standard quality healthcare and medication, which are safe, affordable and easily available,” says Rajbhandari. The company places high priority on R&D and investing in innovative machines and reverse engineering equipment to produce high quality products. Besides overseeing the strategy and operations, Rajbhandari also looks after the HR and IT departments, strategic planning, financial risk management, and regulatory compliance for Quest. “I used to work in the US as a financial analyst before coming to Nepal to join the business,” he says. “It has been five years since I joined Quest and I have learned a lot over these years.” Rajbhandari likes to believe that he and the other second-generation leaders at Quest are in the transition phase. The Covid-19 pandemic was a huge learning experience for them. Supply of raw materials, most of which come from India, was heavily constrained due to the border closure. “It was an unforeseen challenge for the company,” says Rajbhandari. “But we managed to overcome the challenge because we had a system in place.” He says the current challenge for Quest is the hike in the price of raw materials, while having to adhere to the price cap. “It has always been a major issue for us, given we are highly dependent on imports.” Another challenge is cyber security threats and growing market competition. But Rajbhandari feels challenges and difficulties have made Quest and its team stronger and resilient. “They push us to come up with good strategies to improve ourselves.” Rajbhandari is grateful to the Quest staff members for the company’s success. “We have a great working culture. We have over 500 employees and as a brand, we are one of the preferred ones in the market,” he adds. Quest plans to expand into new markets, such as dermatology, in the near future. To this end, the company is conducting industry-relevant feasibility studies. The company is also focusing on the export of its products. Rajbhandari is confident that Nepali products are as good as foreign ones and more affordable. “Since we are planning to enter the export market, we have to meet additional quality parameters,” he says. “This will further increase our product quality.”

Tetri Devi’s family is suffering because she has borrowed 40kg of rice from a village landlord some 25 years ago. The 55-year-old from Sano Dhirapur village of Matihani Municipality, Dhanusha, says the landlord had made her sign a bond before lending her the rice and now he is using the document to extort her. “My husband was sick at the time and I needed the rice to feed my family,” she says. “I had never imagined it would come to this.” Over the years, Tetra Devi paid Rs 32,000 as interest to the landlord, who, unbeknownst to her, also captured what little land her family owned. “The landlord and government survey officers colluded and left us landless. Who is going to help us now?” Tetra Devi is among dozens of people in her village who have been conned by local landlords. They have been left high and dry by their loan shark landlords. When Garatiya Devi was unable to pay Rs 2,500 loan to Jaikumar Sah, her son agreed to work as a driver at Sah’s home. She says Sah had even agreed to pay her son Rs 15,000 as monthly salary, but he never paid. “My son was supposed to get Rs 45,000 after working for three months, but the landlord [Sah] refused to pay, saying he was keeping the sum as an interest.” But Garatiya Devi’s trouble did not end there, as she would later find out that Sah had filed a case against her for defaulting on a loan of Rs 700,000. “I am still facing the case at the District Court and my properties remain frozen pending the court ruling,” laments Garatiya Devi.  “The landlord threatens me all the time. I get abuses hurled at me and I cannot do anything.” Ramo Khwate is also facing litigation for non-payment of loan after he was unable to pay Rs 50,000 loan that he had taken from Binod Sah at a high interest rate. He had used the loan money to send his son abroad for employment about 10 years ago. “I managed to pay Rs 250,000 as interest for five years and after that I could not manage any longer,” says Khwate. “The landlord has filed a court case demanding Rs 788,000. I cannot get that kind of money.” Khwate remembers Sah taking his thumbprint on more than one bond agreement while issuing him the loan. He claims that Sah misused his thumbprint. “I am illiterate so I agreed to give my thumbprint on three different papers after he told me that the agreement was not correctly drawn up.” Like Khwate, Garatiya Devi and Tetra Devi also feel their landlords took advantage of their ignorance and a lack of political reach. Hopeless, they have demanded the federal government to intervene. Their delegation even reached Kathmandu to press their demand. A government task force formed to look into their demand has already submitted its findings to the Ministry of Home Affairs. Dhanusha Chief District Officer Upendra Neupane says the victims are hopeful the government will deliver them justice. “We have been getting many complaints after the government formed the task force and we found out that most of the cases have reached the court,” he says. “We will take our next step as per the recommendation of the government.”