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The World Antimicrobial Resistance (AMR) Awareness Week was celebrated from Nov 18–24, with the theme “Educate. Advocate. Act Now”, had a limited impact on community awareness and behavioral change toward rational antimicrobial use.

When bacteria, fungi, viruses, and parasites evolve over time and lose their ability to respond to medications, it’s known as AMR, which makes infections more difficult to treat and increases the risk of disease transmission, severe illness, and death. Designated as a ‘silent pandemic’ AMR has claimed three lives per minute, totaling around 36m deaths since 1990. Without urgent policy interventions, and preventative actions, the current projection indicates an alarming rise to 1.9m deaths annually by 2050. 

The economic impact is equally staggering, with the World Bank’s 2017 projection estimating that AMR could cost up to $1trn globally by mid-century and force an additional 28m into extreme poverty by 2050, with 93 percent of them residing in low-income countries. AMR was associated with 23,200 fatalities and attributed to 6,400 additional deaths in Nepal in 2019. The country ranks 52nd globally and 2nd in South Asia for age-standardized AMR mortality rates per 100,000 population.

AMR includes not only bacterial infections and antibiotic misuse but also resistance to antifungal medications, crucial for treating life-threatening infections in immunocompromised individuals. Fungal illnesses are prevalent in Nepal, especially among those with chronic conditions like diabetes, HIV, cancer, lung disease, and tuberculosis. 

A 2015 study estimated 1.87 percent Nepali population suffers from serious fungal infections annually, with conditions such as invasive aspergillosis and cryptococcal meningitis being prevalent among HIV/AIDS patients. Another 2020 research in Bhaktapur found that one-third diabetic patients had fungal infections, caused by Candida and Aspergillus species, resistance to fluconazole and ketoconazole, both broad-spectrum azole antifungals. This underscores the urgent need for improved diagnosis and treatment strategies to tackle antifungal resistance in Nepal.

Antifungal resistance affects both human and animal, with escalating antifungal use in veterinary and agriculture contributing to resistant strains. This dual threat compromises treatments, impacts livestock productivity, undermines food security and economics. Studies highlight widespread fungal contamination in food, feed, and livestock, emphasizing the urgent need for awareness, surveillance, rational use, stewardship and containment strategies to safeguard public health and agricultural productivity.

Aflatoxin contamination is a significant concern in Nepal, particularly in maize, rice, and animal feed. A 2005 study by Koirala and team observed high aflatoxin in staple foods, posing health risks like liver damage and immune suppression. Another 2024 research by Agriculture and Forestry University revealed very high levels of aflatoxin contamination in the dairy milk in Kathmandu, presenting a serious public health issue. Resistant fungal infections in livestock have reduced milk production and caused health issues.

The aquaculture sector in Nepal is also affected by fungal pathogens, which contribute to fish morbidity and mortality, threatening the livelihoods of small-scale farmers, as highlighted by Shrestha and team in 2020 through research at four fish farms. Similarly, a 2009 study by Aryal and Karki from Nepal Agriculture Research Council found a high prevalence of aflatoxins in poultry feed, further impacting the rural economy.

Climate change exacerbates the fungal threat by promoting fungal growth and aflatoxin production through erratic rainfall and seasonal variation. Poor air quality increases airborne fungi, worsening respiratory and skin infections, particularly in immunocompromised individuals. Shifting monsoon patterns and poor storage practices raise contamination risks, especially in crops like rice straw used for animal feed. Droughts enhance spore release from Coccidioides, while flooding spreads spores. Climate change also enables fungi to spread into new areas and adapt to higher temperatures, increasing the prevalence of pathogens like Candida auris.

The diagnostic approach to antifungal resistance in Nepal involves several key components. Precise fungal pathogen diagnosis is crucial for effective treatment, with traditional methods like laboratory culture and morphological identification being time-consuming and error-prone. Recent studies emphasize the need for rapid diagnostic tests to identify resistant strains for targeted treatment. Leveraging facilities developed during the Covid-19 pandemic, such as PCR, Next-generation sequencing (NGS) and serological tests, could enable robust, faster, precise diagnoses. 

The WHO’s AWaRe framework, which categorizes antifungals into Access for common infections, Watch for broader-spectrum requiring monitoring, and Reserve for last-resort options, can guide prescribing practices to contain resistance. Implementing this framework can optimize antifungal prescribing while reducing resistance. Nepal can adapt this framework to suit local healthcare needs, incorporating more accessible, user-friendly methods. 

However, patterns of antifungals use reveal concerning trends, with practitioners relying on broad-spectrum antifungals without proper diagnostics, leading to overuse and resistance. Additionally, antifungals used as growth promoters in livestock fosters resistance in animal pathogens, posing risks to human health via zoonotic transmission.

Antifungal resistance in Nepal is driven by several challenges such as limited awareness, inadequate surveillance, poor stewardship and weak healthcare infrastructure. Addressing this, the government must establish robust monitoring systems for antifungal resistance in food and feed, supported by regulatory frameworks to protect public health. Evidence-based education and training programs for healthcare providers, veterinarians, and farmers are essential to promote rational antifungal use and raise community awareness about contamination risks. Integrating fungal infections into livestock insurance and providing essential antifungal medications free of charge can improve accessibility.

Strengthening collaboration among the Department of Livestock Services, ‘One Health’ stakeholders and local governments is vital for enhancing prevention, diagnosis, and treatment capabilities. Implementing standard treatment guidelines and rational use policies can help mitigate overuse. Cross-sectoral collaboration among agricultural experts, veterinarians, and public health officials is vital. Paired with community campaigns, it can drive behavioral change toward responsible antifungal practices. Research institutions should prioritize studying local resistance mechanisms and innovating new solutions. Adopting the ‘One Health’ approach provides a framework for integrated interventions across human, animal, agricultural and environmental sectors, essential for effectively combating the escalating threat of antifungal resistance.

The authors are researchers at the Nexus Institute of Research and Innovation specializing in AMR

Slow and steady loses the race because the rabbit is wide awake. Be the rabbit and make a habit—to be on time.

It is not time that is running away but you who are unable to chase it. Time has always stood still; the clocks are just an invention for humans to be reminded that they are fleeting away. It sure is philosophical until you stop questioning ‘why’ and start answering ‘what.’ 

Generally, people who are late blame it on their mental health, saying, “I’ve got ADHD and get distracted very easily,” and picking up mental health symptoms on Google, trying to match them all that was not there. Some genuine, and most trying their best to make it. Infuriating is when some are chronically late for any reason other than the fact that they don't care enough about the people who are waiting for them. Encountering the problem, and excuses follow with “I was going to do this, but that came up.” But of all problems. 

Things take a turn when you are on time, but the lateness around swallows your productivity. Shift blame persists, and the traffic is accused. Everyone is in a hurry but rarely on time. 

A New York Times article suggests that consistent lateness is driven by optimism, such as believing a 25-minute commute will only take 10 minutes. Take that commute and slam it on the Kathmandu roads; you are gifted 15 minutes more. 

If you were a college student studying under the Tribhuvan University (TU) administration, it would be a miracle if your exam results came on time. I too waited and enjoyed the long holidays for them to publish. Being at the end of my second year and getting the first-year results was funny and fascinating. Honestly, everything was sadly expected from the saviours of the education system, only except in 2017, when nine faculties were given the results within three months. The World Bank had given them Rs 50m for timely publication.

Tardiness applies to not just coming on time but also when the work trusted upon is not met on time. It’s like a domino effect where you battle out each and every person’s impending procrastination, which is engraved in the Nepali personality. One would often disappear for a tea break. Astonishingly, when it comes to food, people are usually on time. 

There would be two types of late people: the deadliner, who finds their peak adrenaline rush nearer to the deadline, and the egoist, who’d be smug with the work done in the littlest time possible. I place myself in the former type. 

If there is a monkey on your back, call the punctually-challenged an hour before the planned time. Who knows, for I could be the monkey. Sometimes you don’t feel motivated enough to be there just to see an empty room, so you’d rather fall in with the herd. 

Now imagine in the fairy tales of Kantipur that you were getting a hefty sum of money for coming in early—increased productivity, improved relationships, a better reputation, and maybe refined planning. A method of positive reinforcement. Or maybe negative punishment, to be fired or expelled after three strikes, then trickles in the timeliness. Many students at my college would return home only because they were late to avoid facing detention—props to the creatives for finding a loophole.

There used to be a time when the Kathmandu denizens would hear the current-coughing Ghantaghar bell sounds around the valley, but today you’d just snooze your blaring alarm five minutes more, thinking, “I’ll just follow the Nepali time.”

In his famous poem on Nepal’s societal and political dynamics, Bhupi Sherchan described the country as ‘hallai halla ko desh’ (land of uproar and rumors). Reflecting on that sentiment, there was a time when whispers spread about Indian sweet shop owners allegedly conspiring against Nepal’s gudpak industry. This was during a crackdown by the Department of Food Technology and Quality Control (DFTQC) on gudpak shops in Kathmandu’s New Road in September 2011.

The raids unearthed alarming levels of toxins, bacteria, and acidic elements in gudpak, which could cause food poisoning. Shop owners faced legal battles and imprisonment, leaving many to believe it marked the end of this beloved Nepali delicacy. But gudpak proved resilient, making a remarkable comeback despite the setbacks.

For me, gudpak is more than just a sweet treat. It’s a comforting slice of my childhood, infused with nostalgia. Living in the UK, I often try to replicate its taste with Indian or Pakistani sweets like habsi haluwa. But nothing quite matches the unique charm of gudpak. Every bite reminds me of Kathmandu, where it was not just food but an emotional and communal experience.

Back in the day, gudpak was a treasured gift. Whenever someone traveled from Pokhara to Kathmandu, the one repeated request was, “Bring back gudpak.” It wasn’t merely a snack but a symbol of love, capable of lighting up entire households. I recall waiting eagerly for my uncle’s visits, certain he’d bring that familiar box of gudpak. It wasn’t just our family that celebrated. Even neighbors joined in on the excitement. Gudpak, in those moments, was about more than taste—it was about shared joy and community.

Though many renowned Gudpak shops in Kathmandu have closed, the sweet remains alive in my memories. Gudpak is a part of my identity, tying me to Kathmandu’s bustling streets and my childhood in Nepal.

The story of gudpak’s creation is as layered as the sweet itself. Some believe it emerged from Nepali confectioners’ creativity, blending leftover sweets into a harmonious new recipe. Others trace its origins to the early 20th century, crediting Panna Lal Maskey, who introduced gudpak to Kathmandu in 1933 at his Ason shop. The name itself derives from ‘gud’ (jaggery or edible gum) and ‘pak(h)’ (the process of cooking). This innovative fusion secured gudpak’s place in Nepal’s culinary heritage.

Gudpak starts with a creamy base of khuwa or khoa, made from buffalo or cow milk, renowned for its rich texture and flavor. The finest khuwa, often sourced from Banepa or Panauti, can even stand alone as a treat. Nuts, dried fruits, and spices—like almonds, cashews, dates, and watermelon seeds—are then folded into it. The result is a fragrant, caramel-colored delight, best enjoyed fresh for its gooey and soft texture.

Modern gudpak production has evolved, with gas stoves replacing traditional wood-fired methods. While techniques have changed, the essence of gudpak—a nutrient-dense, flavorful confection—remains intact.

Among gudpak varieties, sutkeri gudpak holds special significance. Made specifically for new mothers, it includes herbs like battisa powder (a blend of 32 herbs) and jesthalangwadi (another 14-herb mix). It’s believed to support postpartum recovery, providing energy, warmth, and immunity. Even today, it’s a cherished gift for new mothers, symbolizing nourishment and care.

Gudpak is a cultural emblem. A 2010 survey revealed that gudpak was particularly popular among the Newa community, often featuring in celebrations and festivals. Annually, about 579 metric tonnes of Gudpak are produced, with the industry valued at Rs 192.5 million. A kilogram of quality gudpak sells for around Rs 800, reflecting its continued importance in Nepali culture.

Despite its cultural significance, the gudpak industry faces challenges. Many iconic shops have closed due to competition from Indian sweets and Western desserts. However, stalwarts like Shree Ganesh Mithai Pasal and Best Mithai Sweet Shop continue to uphold the tradition, catering to loyal customers with authentic gudpak and pustakari.

Gudpak’s legacy endures, connecting generations and preserving its place in Nepal’s culinary and cultural landscape. In Kathmandu, gudpak remains a beloved treat, especially during festivals and as a gift for loved ones.

Whenever I long for home, I close my eyes and relive the sweet memory of gudpak—its rich flavor and emotional resonance tethering me to my roots in Nepal. It’s more than a confection. It’s an irreplaceable part of my life and identity.

Nepal’s geographic and ecological diversity is as vast as its topography. Within a compact territory between two big neighbors, Nepal features nearly every type of global climate and vegetation. The country is home to the world’s highest peak, Mount Everest, standing at 8,848.86 meters above sea level. At the other extreme, the landscape drops to as low as 200 feet above the sea level in Dhaijan, Jhapa, located in the easternmost part of the country bordering India. This striking contrast highlights the exceptional ecological and geographical variety that Nepal encompasses.

The topological variation has been the contributing factor in the cropping of the diversified races of people within the country. One of the squarely predominant races of people of Nepal are the Newars who had and have yet eminently sacrificed generation after generation for the making and growth of Newar heritage worthy to contribute in establishing several world heritage sites in Kathmandu valley alone.

The Newars are a community in Nepal, composed of both Mongoloid and Aryan ancestry. It is believed that those who trace their origins to the northern regions of Nepal are of Mongoloid descent, while those from the Indo-Gangetic plains are of Aryan heritage. There is also a prevailing belief that the Jyapus of the Kathmandu Valley and the Dhimals of eastern Tarai share a common origin. The Dhimals hold the belief that a branch of their community migrated from the eastern plains to the Kathmandu Valley, contributing to the formation of the Jyapu community. However, there is also a possibility that a group of Jyapus migrated eastward to the plains. The more widely accepted view, however, aligns with the Dhimal’s belief that the Mongoloid people migrated from the northern belt to the valley, shaping both communities.

The Newars, compounded with multiple casts and creeds divided into occupational groups, had established the specific identity with an enormous wealth of cultural heritage both in terms of tangible and intangible culture.

The tangible cultural treasures like structural designs encompassing settlements, houses, palatial structures, temples, the stupas monasteries, water spouts, dug wells both deep and shallow ones, Jibus (the platforms for performing arts), color combination in murals, frescos, paintings and Thankas, indigenously traditional skills and craftsmanship used in potteries, stone and wood carvings, metal crafts, remarkable accessories of life used in all different events of life giving moments are being accepted as invaluable human heritage. 

Intangible, yet, adhered in all tangible modes of Newar heritage: the philosophy of life,

value orientation, normative conceptions, and belief systems which grossly give impetus in all domains of life have remained the basic building blocks of cultural heritage throughout the ages and for all the time to come. And the cultural heritage that has been inherited from generations to generations has turned into cultural heritage. In this sense, culture bears the phenomenon of heritage and the heritage of the culture. Under the domain of cultural heritage, Newar cultural ecstasy could well be sensed through audio instruments, visual performances, oral testing and physical being together as well.

Each mode of cultural behavior and conduct bears serious philosophical impact on the Newar lifestyle. In other words, multiple aspects of intangible heritage are profoundly engraved into the tangible norms and values attached to the beings of the Newar heritage. Early in the morning, the juniors would pay regard to the seniors by bowing down to their feet. As the juniors would do so the bride does the same to the grooms. In absence of the know-how of the philosophical values attached to the practice of bowing down, one might consider them the symbols of domestic tyranny or male domination. But the fact of the matter would remain away from truth. Neither bowing down to the feet mean male domination nor submission. The implication that the practice casts upon societal value has a serious meaning. It bears the symbolic implication to the preparedness in extending mental support over the significant steps taken either by the husband in case of wives and/or in case of the juniors to the superiors. Life is a movement needing support of many in several ways.

The feet are the organs of the human body to make the body move to a destiny. With the help of the feet, we tend to carry ourselves to a certain destiny we assert ourselves to. The feet are the bodily organic mechanism to make ourselves capable of carrying or moving toward destiny. And it is all but symbolic to pay regard to the seniors by bowing down the feet. Regards and honors are expressed in terms of bowing down to the feet of the seniors and the honorables in the form of cultural practice. 

Sincere homage is also paid to the demised souls through offering of the Pinda,  an oval-shaped ball of wheat flour coated in black sesame seeds quite symbolic of the embryo inside the womb of a mother or a pregnant woman. As all Hindus believe in the cyclical process of birth and rebirth, so do the Newars—in incarnation and reincarnation. The values and beliefs rooted in such a philosophy need profound and serious analysis.

Cultural heritage is adopted by the practitioners either through a process of thorough understanding of the philosophical concept and symbolic meaning attached to them or without understanding them even. Philosophy without practice and practice without philosophy may not exist in any society, yet it is hard for everybody to keep a neat sense of the concept that one might even be practicing. The need for giving expression to the underlying meaning attached in them, thus, becomes an incredibly immense task.

As is the case with most of the cultural concerns, so is with the Newar culture that the symbols play a central role in interpreting the philosophical and conceptual bearing upon them. The philosophies of life and conceptual values have mostly been reflected through the symbols or the symbolic designs. The symbolic designs have mostly remained like an exquisite piece of artifact or even as simple as a log or a stone block. It could be glanced through a symbolic prism wherein one can enjoy a connoisseur's test. In most cases, the Ganesh or the Bhairav have remained in the form of a rock, a boulder or a stone block. The insider participants can without hesitation make sense of them. Thus a boulder would remain the symbolic presentation of the Ganesh or the Bhairav.

Cultural image and symbol could thus be created upon an object of nature either through carvings, paintings, crafts or even in abstract form. And cultural objects take turn in a noble piece of craftsmanship popularly accepted and adopted by the cultural participants irrespective of insiders or outsiders. Logically convincing or convincingly logical, proven scientific or scientifically proven interpretation and reinterpretation of the cultural objects or phenomena adds lively flavor on the human heritage of a given culture. Culture changes with time, innovation and interpretations that make sense. Likewise, the ecological impact on the Nepali hat the Topi bears a deep sense of meaning that reflects the mountain ecology. The Nepali black hat, Bhadgaunle Topi which has remained a marvelous piece of Nepali costume, bears a symbolic design after the mountaintop. The hat is designed after the dark rocky mountain top so as to reflect the ecological impact on it. The multi-coloured hat worn by most of the Nepalis has been designed after the summer peaks covered with beautiful wildflowers, projecting a very beautiful image of the country internationally.