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“Death sits in the bowels,” and “bad digestion is the root of all evil,” proclaimed Hippocrates, the Greek philosopher and “father of medicine”, in the fourth century BCE. These quotes resonate profoundly in modern science as researchers continue to unveil the critical role the gut plays in both maintaining health and contributing to disease. Far from being just a digestive bowel, our gut harbors a complex and dynamic microbial ecosystem that influences nearly every aspect of our health.

The anatomy

The gut or gastrointestinal (GI) tract spans from the mouth to the rectum, and is crucial for digestion and nutrient absorption. However, its significance goes far beyond breaking down food. The gut is home to approximately 100 trillion microbes—bacteria, archaea, fungi and viruses—that outnumber human host cells by ten-fold. This bustling microbial metropolis, known as the gut microbiome, is often considered an “essential organ” due to its indispensable functions. 

Weighing roughly two kilograms—comparable to the human brain size—the gut microbiome contains 150 times more genes than the human genome. Over millennia, these microbes have co-evolved with humans, establishing a symbiosis that profoundly influences our physiology, immune system and even mental health.

A landmark study (Almeida et al 2020) published in Nature Biotechnology highlighted the staggering gut microbiome diversity. The study cataloged 204,938 reference genomes and 170m protein sequences from 4,644 bacterial species found in the human gut. Despite these advances, much of the gut microbiome remains an uncharted territory, with 70 percent of its microbial populations still uncultured in the laboratory and poorly understood.

Diverse, complex microbiota

The gut microbiota (GM) is a highly diverse and intricate microbial community, comprising over 1,000 heterogeneous species dominated by six major phyla, Firmicutes (Clostridium, Lactobacillus, Enterococcus), Bacteroidetes (Bacteroides), Actinobacteria (Bifidobacterium), Proteobacteria (Escherichia coli), Fusobacteria, Verrucomicrobia, and Cyanobacteria. Of these, Firmicutes and Bacteroidetes dominate adult gut microbiota, accounting for 80-90 percent composition.

The dominant fungal species are Candida, Saccharomyces, Malassezia and Cladosporium. Meanwhile, the gut virome, the viral counterpart of the microbiome, is vast and largely uncultivated. Enteroviruses, parechoviruses, and sapoviruses are common residents. A Journal of Clinical Microbiology 2012 case report highlighted the gut virome diversity in stools collected from two healthy infant siblings during their first year of life, identified 15 enteric genera Adenovirus, Aichivirus, Anellovirus, Astrovirus, Bocavirus, Enterovirus, Parechovirus, Picobirnavirus, and Rotavirus. Additionally, the gut DNA viromes of Malawian one-year-old infant twins, with severe acute malnutrition, revealed Anellovirus, Picobirnavirus, and HPeV-1/-6 as the most frequently observed viruses.

Archaea are less diverse but highly conserved, with Methanobrevibacter smithii being the most frequently observed species across all six continents.

Each individual’s GM is a unique microbial signature, shaped by genetics, immune function, diet, lifestyle, environment, epigenetics and early microbial exposure during birth and breastfeeding. These microbes colonize different GI tract sections, with the highest biomass found in the caecum and proximal colon.

Health guardians 

GM performs crucial functions for maintaining health. In digestion and metabolism, gut microbes break down complex carbohydrates, synthesize vitamins such as B and K (via Bifidobacterium, Lactobacillus, Salmonella, Streptococcus, Clostridia, and Listeria), and produce short-chain fatty acids (SCFAs) like butyrate, which nourish colonic cells and regulate inflammation.

While humans cannot digest fiber, bacteria possess glycoside hydrolases/ polysaccharide lysases that ferment plant polysaccharides. Gut bacteria Eubacterium, Roseburia, Faecalibacterium and Coprococcus ferment indigestible fibers like resistant starches, and cellulose, generating butyrate, provides energy to colonocytes. Butyrate enhances bowel health by regulating colonic motility, improving blood flow and preventing pathogen overgrowth. GM Bacillus subtilis and E. coli synthesize riboflavin (vitamin B2), essential for cellular metabolism. With 70 percent of the immune system in the gut, microbes train immune cells to differentiate pathogens, ensuring immune balance. Furthermore, they strengthen the intestinal barrier, preventing harmful pathogens and toxins from entering the bloodstream.

Through the gut-brain axis, they influence mood, cognition and behavior, impacting conditions like anxiety and depression. Maintaining a healthy balance of GM, known as ‘normobiosis’, is crucial for overall well-being. Disruptions to this balance, ‘dysbiosis’, fosters pathogen overgrowth triggering health issues.

Declining diversity

Modern lifestyles and urbanization have significantly reduced GM diversity, impacting health. Processed diets, irrational antimicrobial use, sedentary lifestyles, high salt/protein intake and limited exposure to natural environments have caused a multigenerational loss of beneficial microbial signatures, key for immune resilience. A 2024 study in Kazakhstan revealed stark differences in gut diversity between urban and rural populations. Urban microbiomes showed reduced diversity, elevated Firmicutes/Bacteroidetes ratios and higher prevalence of Coprococcus and Parasutterella. Rural populations exhibited greater microbial diversity, with abundant Ligilactobacillus and Paraprevotella, correlating with their fiber-rich diets. Interestingly, a Nepali study (Jha et al 2018) found traditional Himalayan populations (Chepang, Raute, Raji, and Tharu) had distinct microbiome signatures compared to Americans, emphasizing lifestyles impact on gut diversity.

This GM diversity depletion is linked to autoimmune diseases and chronic inflammation. Dysbiosis is implicated in obesity where excessive Firmicutes enhance fat absorption. Inflammatory bowel disease (IBD) (Crohn’s disease, Ulcerative colitis), features reduced alpha diversity and shifts favoring pathogenic Gamma-proteobacteria. Colorectal cancer patients exhibit harmful bacteria, such as Fusobacterium nucleatum, genotoxic E. coli, Enterotoxigenic Bacteroides fragilis, produce metabolites fostering tumorigenesis. Dysbiosis also influences metabolic disorders (diabetes) and neurodegenerative diseases (Alzheimer’s, Parkinson's) through inflammation and the gut-brain axis.

Advancements

Advancements in gut microbiome research herald a new era of personalized medicine. Probiotics/prebiotics restore microbial balance by enhancing beneficial GM, while fiber-rich diets and healthy lifestyles promote gut health reducing inflammation. Conversely, ultra-processed foods, artificial sweeteners and emulsifiers disrupt this balance, decreasing diversity and driving inflammation. Innovations like fecal microbiota transplant treat C. difficile infections and hold promise for IBD.

Despite progress, gut microbiome research is still in its infancy, with challenges in decoding complex host-microbe interactions. Investigating gut microbial signatures of exceptional mountain climbers, like Sherpas, and ethnic Nepali communities could lead to personalized therapies. Technologies like metagenomics/metabolomics offer breakthroughs in diagnostics and therapies. Deepening our understanding of this hidden world within us can unlock new avenues to enhance well-being and resilience.

On Sept 20, 2023, Nepal launched its first Bus Rapid Transit (BRT) lane, connecting Bhaktapur’s Suryabinayak to Kathmandu’s Ratna Park. This initiative was introduced with the aim of improving public transportation efficiency, particularly during peak hours (9–11 am and 4–6 pm), by reducing traffic congestion and ensuring faster travel times for commuters. While the BRT lane represents a significant step toward addressing Kathmandu’s chronic traffic problems, it has also sparked a debate about its necessity and effectiveness. Could the resources allocated to this project have been better utilized to address more pressing urban challenges, such as the delays faced by emergency medical services? This question is particularly relevant in a city where traffic congestion often prevents ambulances from reaching hospitals in time, putting lives at risk.

The BRT lane was conceived as a solution to Kathmandu’s worsening traffic congestion, which has long been a source of frustration for residents and a barrier to economic productivity. According to experts from the transport ministry, the dedicated bus lane was designed to streamline public transportation, reduce delays, and provide a more reliable alternative to private vehicles. By separating buses from general traffic, the BRT lane aimed to ensure faster and more predictable travel times, especially during rush hours when the city’s roads are most congested.

However, the success of the BRT lane depends heavily on effective management and enforcement. While the initiative has shown some promise, its impact has been limited by underutilization outside peak hours and the persistent challenges of traffic management in Kathmandu. Buses often remain stuck in traffic, disrupting schedules and frustrating both passengers and drivers. This raises questions about whether the BRT lane could have been designed to serve a dual purpose, such as accommodating emergency vehicles during non-peak hours.

While the BRT lane addresses the issue of public transportation efficiency, it does little to alleviate the challenges faced by emergency medical services. In Kathmandu, ambulances often struggle to navigate through gridlocked streets, leading to delayed response times that can have life-threatening consequences. The sound of ambulance sirens is a common yet distressing feature of the city’s soundscape, serving as a constant reminder of the urgent need for better infrastructure to support emergency services.

Jamali Tamang, a regular bus commuter, shared her observations: “I’ve seen ambulances stuck in traffic during peak hours. It’s frustrating and heartbreaking. Dedicated lanes for emergency vehicles could save lives.” Tamang also emphasized the importance of public awareness campaigns to educate citizens about the importance of keeping such lanes clear. She suggested that the BRT lane could be repurposed for ambulance use during non-peak hours, allowing both buses and emergency vehicles to coexist without compromising efficiency.

Ambulance drivers, who are on the front lines of this crisis, echo these concerns. Nim Bahadur Oli Chettri, four years experienced ambulance driver, recounted his struggles: “It’s incredibly challenging to navigate crowded roads. While some drivers make their way, others ignore us, wasting precious minutes.” Chettri, who previously worked as a bus and truck driver in Saudi Arabia, highlighted the stark contrast in infrastructure and policies between the two countries. “In Saudi Arabia, emergency services are systematic and efficient. Here, the lack of clear policies and infrastructure makes it much harder.”

Several cities around the world have successfully implemented measures to prioritize emergency vehicles, offering valuable lessons for Kathmandu. In Japan, for instance, there are no dedicated ambulance lanes, but strict road rules require drivers to yield to emergency vehicles. This culture of discipline and respect for emergency services ensures that ambulances can navigate through traffic with minimal delays. Similarly, Singapore has experimented with converting certain lanes for emergency use during peak hours, while the UK allows ambulances to use shoulders or middle lanes when necessary. In South Korea, designated lanes in some areas ensure faster emergency responses, particularly in major cities like Seoul.

These examples demonstrate that with proper planning and enforcement, emergency lanes can significantly improve response times. However, implementing such measures in Kathmandu presents unique challenges due to the city’s inadequate road infrastructure and lack of clear policies.

Kathmandu’s road infrastructure remains ill-equipped to handle the growing number of vehicles on its streets. Narrow roads, haphazard parking, and poor traffic management exacerbate congestion, leaving ambulances stranded in traffic. Ganesh Man Singh Rai, an Information Officer at the Department of Transport Ministry, acknowledged these challenges: “Our limited resources and road capacity make dedicated emergency lanes seem almost impossible. However, traffic officers do their best to prioritize ambulances.” Rai emphasized the need for improved road infrastructure and stakeholder collaboration to make such initiatives feasible.

“Designating a dedicated lane for emergency vehicles is undoubtedly a good idea, but the challenge lies in ensuring its effective implementation across the numerous roads we have. The real solution, however, also depends on the honesty and discipline of drivers and riders. When they responsibly move aside to allow emergency vehicles to pass, significant improvements become visible, enabling ambulances to navigate more efficiently”, he added.

SP Sanjay Bahadur Raut, Spokesperson of the Kathmandu Valley Traffic Police Office, echoed these sentiments. “While dedicated emergency lanes are a good idea, their implementation is challenging due to narrow roads and increasing vehicle numbers. A balanced approach is essential to accommodate all road users.” Raut highlighted the efforts of traffic officers to clear paths for ambulances, even creating space from opposite lanes in urgent situations. “Every second counts in emergencies, and we prioritize getting ambulances through as quickly as possible.”

He shared, “In urgent situations, when there is high traffic, some of us may even go as far as creating space from the opposite side of the road. This is a rare and considerate act as we prioritize the safety and speed of emergency responders.”

The consequences of delayed emergency responses are dire. Dr. Manoj Yadav, an emergency medical officer at Everest Hospital, shared alarming insights: “We’ve seen patients’ conditions worsen due to traffic delays. Dedicated ambulance lanes could save lives.” He explained that ambulances in Nepal vary in functionality, from basic models to advanced units equipped like mini ICUs. However, even the best-equipped ambulances are rendered ineffective if they cannot reach patients in time. “Many patients die en route to hospitals, especially when traveling from distant locations,” Yadav added.

Yadav also highlighted the disparities in ambulance services across the country. “The hospital provides ambulances with some facilities, but many vehicles from other hospitals only offer oxygen, and some don’t even provide that. There are three types of designated ambulances: the general ambulance, which has no special facilities and is used only for non-emergency cases; the semi-ambulance, which includes basic support for minor injuries and accidents; and the advanced ambulance, which is equipped with ECG, ventilation, and designed like a mini ICU for more critical patients.”

The growing urban challenges in Kathmandu demand innovative solutions. Repurposing underutilized transit lanes for emergency vehicles could address critical gaps in the city’s emergency response system. Strict enforcement mechanisms would be necessary to prevent misuse, ensuring these lanes remain clear for life-saving purposes. Public awareness campaigns could also play a vital role in fostering a culture of responsibility among drivers.

Ultimately, the BRT lane represents progress, but its limitations highlight the need for a more holistic approach to urban planning. By prioritizing emergency services and improving road infrastructure, Kathmandu can transform its transportation system into one that not only moves people efficiently but also saves lives. The time has come to rethink idle transit lanes and turn them into pathways that serve the greater good.

The introduction of the BRT lane in Kathmandu is a commendable effort to address the city’s traffic congestion. However, its underutilization outside peak hours and the pressing need for better emergency response infrastructure suggest that a more balanced approach is needed. Dedicated ambulance lanes, combined with improved road infrastructure and public awareness campaigns, could save countless lives and ensure that emergency services are not hindered by traffic. As Kathmandu continues to grow, it is imperative that urban planning prioritizes not only efficiency but also the well-being and safety of its residents. By learning from global examples and fostering collaboration among stakeholders, the city can create a transportation system that truly serves the needs of all its citizens.

The new generation might not be familiar with the term ‘kodoski,’ but it was quite popular in our time. The term is a simple combination of two words: ‘kodo’ (millet) and ‘raksi’ (liquor). I was familiar with millet liquor but had never heard of ‘tongba’. 

When I arrived at the Gurkha Welfare Center in Sorhakhutte, Kathmandu, for higher studies, I was introduced to tongba—a traditional, indigenous, hot, millet-based alcoholic beer from Eastern Nepal. During the cold winter evenings in Kathmandu, tongba, paired with a plate of momo and crispy sukuti (dried meat), made for excellent company.

Millet, particularly kodo (Paspalum scrobiculatum), has historically been considered the food of the poor. There was a time when people would cook millet dishes secretly. If someone was preparing dhido (a traditional millet dish) and an important guest visited, the family would hide the dhido and cook rice instead to serve the guest. Society unnecessarily glorified rice over millet.

Times have changed. Urban restaurants now include millet-based dishes in their menus, which has helped elevate the prestige of kodo. Media and society have also highlighted the health benefits of millet. Additionally, the demand for kodo-based raksi and tongba has surged. While tongba was traditionally a winter drink, it’s now available year-round.

The Gandaki Rural Municipality in Gorkha has begun producing and distributing local liquor under the brand name ‘Gandaki kodo ko raksi’ (Gandaki millet liquor), with other municipalities following suit. However, Nepalis are consuming millet products, including kodoski, unsustainably and often associating them unnecessarily with national pride. It’s essential for all Nepali to understand that Kodo isn’t exclusive to Nepal. It’s also widely popular in India. In Bengali and Odia languages, this millet is called kodo, while in Hindi, Marathi, Punjabi, and Gujarati, it is known as kodra—a name derived from the Sanskrit word kotrawa.

Kodo or millet originated in Africa and was domesticated in the Indian subcontinent around 3,000 years ago. Known for its drought-resistant properties, it thrives in dry regions and is one of the world’s oldest grains. Both African and Asian countries cultivate this millet in dry and semi-arid climates, where it serves as a staple food crop. In India, kodo is primarily grown in the Deccan region, the southern peninsula, and areas south of the Narmada River, with cultivation extending to the foothills of the Himalayas, including Nepal.

Millet is an excellent grain to consume due to its nourishing nutritional profile, making it a suitable replacement for rice or wheat. It contains significantly more protein, fiber, and minerals than rice, one of the major staple grains. Millet is particularly high in protein, with an eight percent composition. It also contains glutelin protein. Compared to wheat (0.2 percent fiber) and rice (0.2 percent fiber), kodo stands out as a top-quality source of dietary fiber, boasting nine percent fiber content.

In Nepal, a remarkable diversity of about 22 millet species exists, serving multiple purposes ranging from food and feed to fodder. These include both cultivated and wild varieties.

According to official data, Nepal imported 15.2m kilograms of millet worth Rs 754.43m in the fiscal year 2023/24. In 2022/23, imports were higher, totaling 18.4m kilograms valued at Rs 732m. Notably, 2023 was declared the International Year of Millet (IYM) by the United Nations General Assembly during its seventy-fifth session.

Looking back, in 2008/09, Nepal imported 12.37m kilograms of millet valued at Rs 65.32m. Despite being the world’s 13th largest producer of millet, Nepal’s production has been insufficient to meet the growing demand. The majority of Nepal’s millet imports come from India.

A 2020 study by the Food and Agriculture Organization (FAO) reported that Nepal produced 320,953 tons of millet that year, while India produced a staggering 12.49m tons. In the previous fiscal year, Nepal imported 15.29m kilograms of millet from India.

If Nepal wants to consume more millet, the country needs to increase domestic production. Otherwise, millet will become yet another item that makes Nepal dependent on imports.

To adopt a sustainable approach to millet production, Arjun Prasad Khanal of the Ministry of Agriculture and Livestock Development, Nepal, wrote in the International Journal of Environmental and Agriculture Research in 2023, “Nepal needs to bring the millet crop from its existing state of ‘marginal, underutilized, and poor man’s crop’ into the ‘commercial, trade potential, and high-status crop’ of Nepal.”

He further emphasized, “The inner Tarai and Hilly regions of Nepal have tremendous potential for producing quality millet. It’s like a situation where the ‘iron is already hot,’ and it’s up to Nepal to either shape it properly or watch it cool down, missing a valuable opportunity.”

In a recent initiative, Kushma Municipality in Parbat district has started cultivating millet on 200 Ropanis (101,744 square meters) of fields that had been lying fallow for years. This year, the municipality produced 16 Muris of millet, generating revenue of Rs 80,000 by utilizing the previously unused land. The initiative, part of the Prime Minister’s Employment Program, aims to connect unemployed youth with agricultural employment and maximize the potential of fallow land. The municipality chose this area because it was historically known for millet farming and remains highly fertile, yielding an abundant harvest.

My advice to every municipality is to follow Kushma Municipality’s example and prioritize millet production. Otherwise, we risk ending up with ‘Nepali kodoski’ made from imported Indian millet.

The author is a London-based R&D chef

After the April 2015 earthquake in Nepal, India committed $250m in grant assistance for post-earthquake reconstruction in Nepal, the Embassy of India in Kathmandu said on Monday. “The grant was allocated in four different sectors—Housing ($100m), Education ($50m), Health ($50m) and Cultural Heritage ($50m). A JPMC (Joint Project Monitoring Committee) mechanism was set up in Aug 2017 to monitor the progress of these projects,” the statement added.

India and Nepal held the fifth meeting of the JPMC on post-earthquake reconstruction projects on Monday in Kathmandu. The Indian delegation was led by Munu Mahawar, Additional Secretary (North), Ministry of External Affairs, Government of India and the Nepalese delegation was led by Padma Kumar Mainalee, Joint Secretary, Ministry of Urban Development, Government of Nepal.

The meeting was also attended by several other representatives of the Governments of India and Nepal, consultants and other stakeholders engaged in implementation of the projects.

The meeting carried out a comprehensive review of the progress of the Government of India assisted post-earthquake reconstruction projects in housing, education, health and cultural heritage sectors in Nepal. It acknowledged the successful completion of the projects agreed under the housing sector in 2021 and the education sector in 2024.

According to the Embassy of India, Kathmandu, in health and cultural heritage sectors, both sides expressed satisfaction on the progress achieved and agreed to expedite the early completion of projects under these sectors.

Since the last JPMC meeting in Oct 2023, Government of India has handed over 26 projects in the education sector including Tribhuvan University Central Library in Kathmandu, 32 projects in the health sector and three projects in the cultural heritage sector, amounting to Rs 3.35bn.

In addition, 43 projects in the health sector and nine projects in the cultural heritage sector amounting to Rs 1.73bn have been completed during this period, as per the Embassy of India Kathmandu.

Both sides appreciated the positive socio-economic impact of the reconstruction projects, particularly in employment generation and extension of health and education facilities in remote areas.

AS (North) also visited the Gusthal Mahavihar reconstruction project, a cultural heritage site located in Guita Tole, Lalitpur Metropolitan City-8. During the visit, he reviewed the project’s progress and engaged with members of the user community.

Both sides agreed to hold the next meeting of the JPMC on a mutually convenient date.