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It is not solely about being sick if you have raised blood pressure. Your doctor or healthcare provider may discover that your blood pressure is elevated and request a series of blood tests, electrocardiography or echocardiography. If your blood pressure remains consistently high, you may be prescribed medication to lower it to a normal level.

Often, we associate taking medicine with being sick. Yes, medicine is typically taken to treat a disease. However, when it comes to certain conditions that currently do not cause any trouble or symptoms, we often question why we should take medicine. Yes, that is a valid question—why should I take medicine?

Blood pressure—normally we measure it as systolic and diastolic. The normal range for systolic blood pressure is 90 mmHg to 120 mmHg. It can vary within this range, meaning it could be any number between 90 and 120, such as 96, 104, 110 or 120. All of these measurements are considered normal. Diastolic blood pressure should fall between 60 mmHg and 80 mmHg, and can also vary within this range.

This blood pressure refers to the pressure exerted by the blood ejected from the heart into the arteries. It is influenced by factors such as the pumping force of the left heart, the characteristics of the vessel wall and the pathway between the left heart and the arteries, including valves and any muscular narrowing.

If the blood pressure measurement is higher than 120 mmHg systolic or 80 mmHg diastolic, we consider it to be above normal. If it exceeds 140 mmHg systolic and 90 mmHg diastolic, we classify it as hypertension.

If blood pressure consistently remains on the higher side, it can have numerous negative effects on our vital organs. It may damage the kidneys, heart, brain, eyes and peripheral vessels. Although persistently high blood pressure may not be felt as discomfort by the body, its slow and continuous effects are detrimental to vital organs. The continuous adverse effect on the brain can lead to a stroke, on the heart can lead to a heart attack, on the kidneys can lead to kidney damage, and on the eyes and peripheral vessels can cause damage and narrowing. Statistics show that stroke, heart attack and kidney damage are more frequently observed among individuals with hypertension.

So, medical science, along with simple logic, suggests that keeping blood pressure within the normal range is important in order to decrease the risk of stroke, heart attack and kidney damage. When there are no symptoms, it is understandable that we may question the need for medication and be hesitant to take any. However, there are also alternative options available.

Making certain changes to our lifestyle can help reduce blood pressure. Brisk walking for at least 30 minutes a day, five days a week, may lead to a reduction of 4-5 mmHg. Including green leafy vegetables and fruits in our diet can further contribute to lowering blood pressure. Following a low-salt diet is also effective in reducing blood pressure. Reducing weight, if overweight, can also help reduce blood pressure. Quitting smoking is known to reduce blood pressure. Meditation or deep breath exercises, along with relaxation techniques, can lead to a decrease in blood pressure. Additionally, avoiding stress reduces blood pressure. Good sleep and management of snoring can also help reduce blood pressure.

So, there are many lifestyle management techniques that can help reduce blood pressure. However, if following a healthy lifestyle does not result in a reduction in blood pressure or if one is unable to maintain a healthy lifestyle, it is important to prevent damage to vital organs caused by consistently elevated blood pressure.

Try to maintain a healthy lifestyle, even if you do not have hypertension. If your blood pressure falls between systolic 120-139 mmHg or diastolic 80-90 mmHg, continue to prioritize a healthy lifestyle. However, if your blood pressure does not appear to be under control or remains high after a few months, do not hesitate to start taking medication.

Medicine is simply a pill that helps maintain normal blood pressure. We frequently discuss side effects, and this is indeed true. Many medications have no side effects, while others may have a few or even serious ones. Your physician will discuss this matter with you.

But when considering rare side effects, hypertension can increase the risk of fatal adverse effects and even death.

Therefore, it is important to control our blood pressure, either through a healthy lifestyle or with medication.

Every monsoon season, Nepal grapples with the life-giving rains turning into a potential threat, unleashing devastating floods and landslides. Overflowing rivers and streams inundate surrounding areas, causing loss of life, livestock, homes and infrastructure. Heavy rain disrupts agriculture and destroys precious topsoil, shattering lives. In the past one decade alone, over 1800 people have lost their lives due to monsoon disasters in Nepal. During that period, about 400 people have gone missing and more than 1500 people have suffered injuries. 

The recent monsoon has been particularly brutal, with reports of casualties, missing individuals and widespread damage. This year’s monsoon can affect as many as 1.8m people and four lakh households. As of 10 Aug 2024, the monsoon has claimed 170 lives since June 10 when it began. Initial reports show it has displaced over 4,279 families, inundated 384 houses, destroyed 270 homes, 102 sheds, 43 bridges, two schools and two government offices, inundating 182 houses and damaging hundreds more.

Many times, human factors have added to the losses. Look at the recent example of the Simaltal landslide mishap of July 12 night. The landslide swept two buses, and it is believed there were 65 people in the buses, of which three passengers swam to safety. While 25 bodies have been found, others remain missing. In the first place, the landslide seems to be a result of improper slope management while constructing the Mugling-Narayanghat Highway, and opening Simaltal-Bangesal-Dumre rural road on the slopes above the highway. Secondly, driving the vehicles on a rainy night under the compromised visibility added to the risks.

Settlements in the river banks adjoining roads are another major reason for heavy losses. The high losses due to the Melamchi flood of 15 June 2021 resulted not only from the climate change and associated heavy rains, but also from the fact that human settlements had extended to lower alluvial deposits. In many places, improper construction of roads over small streams and flawed sewage management systems result in inundation whenever heavy rains occur. Such was the case of the 2021 Kapan Flood, right in northern Kathmandu.

The impact goes beyond immediate losses. Displaced communities face a desperate struggle to secure food, shelter and medical care. Livelihoods are disrupted, and the psychological trauma can be long-lasting. The economic toll is significant, with destroyed infrastructure and hampered agricultural production impacting the entire nation.

Post-disaster management

In the face of such devastation, the need for a swift and coordinated response to deliver life-saving aid is paramount. One approach gaining traction is the ‘one-door policy’, where all relief efforts are channeled through a single government entity. This centralized system promises streamlined resource allocation and standardized distribution. 

Following the 2015 Gorkha earthquake, Nepal received massive humanitarian support from home and abroad. Rescue workers worked day and night to rescue the people buried under rubble of collapsed structures. Nepalis are grateful for this. We also witnessed, in the flood of donor agencies, some taking advantage of the distressed situation and engaging in improper activities. Besides, many would go to some easily accessible poor countryside, distribute aid materials, take selfies and post them on social media. This way, some areas received more than what they needed and others received too little. This prompted the government to adopt a one-door policy.

By directing all aid through a central channel, the government can ensure resources are strategically deployed toward the most critical needs. This eliminates duplication of efforts and fosters fairness in distribution. Additionally, a single point of contact enhances accountability and fosters trust with donors. However, bureaucratic hurdles can create bottlenecks, delaying aid delivery when swift action is crucial. Local NGOs, with established relationships and a deeper understanding of local nuances, can tailor aid distribution more effectively.

The one-door policy has been a source of debate in Nepal. The policy introduced in 2015 has been implemented to prevent uneven aid distribution and ensure remote areas received support. However, this centralized approach faced criticism for being slow and inefficient. Many NGOs and private entities felt hamstrung by the need for government approval, leading to delays. In the aftermath of the 2017 floods and landslides, the government again enforced the one-door policy. While the intention was to streamline efforts, critics argue it led to logistical challenges and inefficiencies. There were reports of aid being stuck in red tape while victims remained underserved.

The way forward

One-door-policy does not discourage local governments from actively coordinating rescue works and distribution of reliefs to the needy. To facilitate prompt response, domestic NGOs may be allowed to cooperate with local governments. As to the foreign governments and INGOs willing to support, we should make sure that they comply with our one-door-policy, that they do not take advantage of our calamity to create one or another form of social disharmony, that they do no harm to the self-respect of our suffering people, that they do not try to impose or promote their interests, and that they confine their support to the extent we need.

A mountainous country located in a quake-prone region, Nepal faces multiple threats of heavy rains, floods, landslides, GLOFs, droughts, famines, fires, epidemics, earthquakes and other disasters. Keeping this in view, the government has formed a high-level National Council for Disaster Risk Reduction and Management under the Prime Minister. Through a collaborative approach that marries centralized control with local expertise, Nepal can build resilience and ensure life-saving aid reaches those who need it the most.

A key point in the seven-point agreement signed by Nepal’s two largest political parties, Nepali Congress (NC) and CPN-UML, in early July is amendments to the Constitution. However, almost two months after forming a powerful coalition, no specific details have emerged about the proposed amendments.

Both domestic and international observers are eager to know what changes NC and UML intend to make to the 2015 Constitution. It’s also unclear whether the two parties are fully aligned on the amendments. Neither NC nor UML has begun internal discussions on the specifics of the amendment. The issue of constitutional amendment carries different meanings for various political groups. The CPN (Maoist Center), which was ousted from power, has accused NC and UML of attempting to roll back the constitution's progressive provisions.

Maoist leaders, including Chairperson Pushpa Kamal Dahal, frequently claim that NC and UML want to weaken progressive elements of the Constitution. For royalist parties like Rastriya Prajatantra Party (RPP), constitutional amendment means removing the constitutional monarchy and reestablishing Nepal as a Hindu state. On the other hand, for the Maoists, amendment is about granting more rights to marginalized communities. It is up to NC and UML to initiate discussions on potential changes, though recent remarks by senior leaders hint that one major focus could be the electoral system.

Senior leaders of both NC and UML argue that the current electoral system—combining first-past-the-post (FPTP) and proportional representation (PR)—contributes to political instability, as it makes it difficult for any one party to secure a majority. However, this proposal faces opposition from Maoist, Madhesi, and smaller parties, who see any changes to the electoral system as undermining the country’s inclusive political framework. Major parties are pushing for raising the electoral threshold to limit the number of smaller parties in Parliament, while small parties argue this is a move toward a two-party system.

Currently, only the parties securing a minimum of three percent in the House of Representatives and 1.5 percent in the provincial assembly of the total valid votes under the PR category are allocated PR seats. Parties that have seats both in FPTP and PR seats are eligible to become the national party.

In the 2022 national elections, only a few parties, including NC, UML, the Maoists, and newer parties like Rastriya Swatantra Party and Janamat Party, managed to cross the three percent vote threshold required to secure PR seats. Many smaller parties, such as CPN (Unified Socialist) led by former Prime Minister Madhav Kumar Nepal, failed to meet the threshold and could not get the national party status.

There are also rumors that NC and UML want to remove secularism from the Constitution, but the parties have remained silent on the issue. Voices within NC are calling for the party to support the reinstatement of Nepal as a Hindu state through constitutional amendment. However, amending the Constitution is a complex issue. Once initiated, all political forces will likely push for their own agendas, making consensus difficult.

NC Chief Whip Shyam Ghimire emphasized the need for a common consensus among political parties. Madhes-based parties, like the Loktantrik Samajbadi Party (LSP) led by Mahantha Thakur, are closely monitoring the constitutional amendment process. LSP has formed a three-member committee under Laxman Lal Karna to consult with other parties on constitutional changes that address Madhesi issues. The committee has been tasked with the responsibility of preparing a comprehensive report on the Madhes issues they want to address by amending the Constitution.

The ruling coalition has agreed to hold all-party discussions on constitutional amendments. In a meeting on Monday, ruling party leaders, including those from NC and UML, stressed the need to amend the constitution in a way that gains broad consensus among all political parties. According to leaders, top leaders of the ruling parties are of the view that the Constitution should be amended to make it more refined and universally acceptable. Besides NC and UML, the ruling coalition also consists of Janata Samajbadi Party and Loktantrik Samajbadi Party. 

UML Chief Whip Mahesh Bartaula said that at Monday’s meeting, the parties agreed that there should be comprehensive discussions to amend the constitution. Opposition parties, especially the Maoist Center, have been accusing the NC and UML of trying to revert to the 1990 constitution through constitutional amendments. NC Chief Whip Shyam Kumar Ghimire said that the parties in the ruling coalition will push for maximum consensus from parties and stakeholders for the constitutional amendment. 

A two-thirds majority in both the House of Representatives and the National Assembly is needed to amend the Constitution. This means the ruling coalition needs to secure the support of at least 184 lawmakers in the 275-members House of Representatives. NC and UML have a combined 167 lawmakers. UML lawmaker Top Bahadur Rayamajhi is suspended, while Speaker Devraj Ghimire, who is from UML, can only vote in case of a tie. This means NC and UML need the support of 18 more lawmakers.

They plan to seek support from parties like Rastriya Prajatantra Party (14),  Janamat Party (6), Janata Samajbadi Party (5), Loktantrik Samajbadi Party (4) and Nagarik Unmukti Party (4), among others. Although the coalition looks comfortable in the lower house, the equation is not so favorable in the National Assembly. The UML-NC coalition needs the support of at least 40 members in the 59-members upper house. CPN (Maoist Center) is the largest party in the National Assembly with 17 seats, while NC and UML have 16 and 10 seats, respectively.  NC and UML need the support of 14 other lawmakers for any amendment to the constitution to pass through the upper house. Likewise, NC President Sher Bahadur Deuba also called for unity among ruling parties.

This summer, Kathmandu experienced its highest temperature ever recorded. The Department of Meteorology and Hydrology (DHM) reported a scorching temperature of 35.3°C on June 15. The city is urbanizing at an annual rate of four percent, and its built-up area has grown to almost four times its size since the mid-1980s. Consequently, the risks associated with the Urban Heat Island effect are also increasing. Research by Mishra et al. (2019) indicated a 5°C temperature variation between forest land and developed land in the Kathmandu Valley. As rapid population growth and unplanned urbanization continue in the valley, the temperature difference is also expected to increase.

Urban Heat Island, or UHI, is a phenomenon where urban areas experience considerably higher temperatures than their surrounding rural areas. The main causes of UHIs include anthropogenic factors, heat absorption by urban infrastructure, and the albedo effect. The albedo effect is a measure of how reflective a surface is. Darker surfaces absorb more heat and release it back into the atmosphere, while lighter surfaces reflect heat away. Therefore, as cities replace natural landscapes with buildings, roads and pavement, which absorb and retain heat, the overall temperature increases. The impacts of UHIs are far-reaching, including air pollution, higher energy consumption, disruption of urban ecosystems and adverse health outcomes, especially for vulnerable populations such as the marginalized, elderly, and urban poor.  

In a country where urban poverty has increased from 15.46 percent in 2010-11 to 18.34 percent in 2022-23, and where the Kathmandu Metropolitan City’s handling of the urban poor has been condemned by Human Rights Watch, critical questions arise—How will the rights of street vendors, landless individuals, slum dwellers and other vulnerable groups be safeguarded amidst rising temperatures? 

Additionally, with heat-related illnesses expected to increase due to the UHI effect, it is crucial to assess whether the healthcare system in Nepal is prepared to handle the added pressure. Will vulnerable groups, with their limited capacities, have access to essential health services, adequate housing, a decent standard of living and an overall quality of life, or will they continue to be mistreated? Despite global awareness regarding UHIs, the concerned authorities in the Kathmandu Metropolitan City are yet to acknowledge the alarming rise in temperatures this summer.

In contrast to this local inaction, cities around the world are actively addressing the UHI effect with innovative solutions. For example, Indian cities like Ahmedabad, Bhopal, Jodhpur and Surat have introduced cool roofs-roofs covered with reflective materials that bring down temperatures inside and outside buildings. Applying white reflective paint on roofs is a simple yet effective strategy that has seen widespread adoption globally. 

Abu Dhabi has introduced self-shading tower blocks, Medellin has developed extensive green corridors, Paris is creating cool islands, Seville has implemented a policy of shade and Singapore boasts of its renowned Gardens by the Bay. These diverse approaches demonstrate how cities are dealing with the UHI effect based on their unique environments and challenges.

In response to escalating temperatures, cities are also appointing Chief Heat Officers (CHOs) – a term coined by a branch of the American think tank Atlantic Council called the Adrienne Arsht-Rockefeller Foundation Resilience Center (Arsht-Rock). CHOs are responsible for developing and implementing strategies to combat extreme heat, protect vulnerable populations and enhance urban resilience to rising temperatures. Miami paved the way by appointing the world’s first CHO, and other cities, such as Phoenix, Athens, Freetown, and Dhaka North followed suit. Notably, Dhaka North was the first Asian city to appoint a CHO.

While cities worldwide, including those in South Asia, are making commendable strides in addressing UHIs, Kathmandu Metropolitan City’s lackluster approach to this issue is highly concerning. Kathmandu must learn from other cities and implement targeted strategies to mitigate the UHI effect or face intensified challenges in the coming years. The rising temperatures in Kathmandu represent the broader challenges posed by global warming, climate change and increased urbanization. These issues demand urgent attention, action and innovative solutions from policymakers, urban planners and the general public.

While initiatives such as Urban Green Spaces (UGS), tree plantations and community-managed forests are underway, a significant gap remains in addressing and raising public awareness on UHIs. Comprehensive research, robust satellite-based data collection and substantial evidence are essential to guide sustainable urban planning. Given the pace and scale of urbanization, the government of Nepal must step up its efforts in urban governance and take appropriate mitigation and adaptation measures by coordinating with relevant ministries and departments to plan greener, smarter and liveable cities. This involves prioritizing the conservation of natural resources and natural heat sinks, investing in alternative energy solutions, and implementing innovative strategies to enhance urban resilience. It is also crucial that policies and plans be grounded in a deep understanding of the local context, addressing challenges facing vulnerable groups, and ensuring that no one is left behind.

The author holds a Master’s degree in Public Policy