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When an APEX team visited Shukraraj Tropical & Infectious Disease Hospital at Teku, Kathmandu on the morning of September 9, there was a huge crowd inside its premises. Even those suffering from minor fever and throat problems seemed worried about possibly contracting the dreaded dengue and had thronged to the only tropical and infectious diseases hospital in the capital. They were lined up in long queues waiting to consult the doctors. Among the doctors they wanted to see was the hospital’s Chief Consultant and Spokesperson Dr. Anup Bastola. This morning he was busy checking patient reports and counselling people not to panic but to consume plenty of liquid (and medicines, when needed). Kamal Dev Bhattarai and Dinesh Gautam had caught up with Dr Bastola before the start of his busy shift to learn about the recent outbreak of dengue fever, preparations for its control, and possible precautionary steps.

Why has the dengue fever that had before been confined to some Tarai districts spread over Kathmandu and other hilly districts?

The mosquitoes which transmits dengue were prevalent in Kathmandu valley for many years, as was the case in Pokhara and other parts of the country. Dengue is spread through the bite of Aedes female mosquitos. When a mosquito bites a person who has dengue virus in blood, the mosquito gets infected. Later the inspected mosquito can transmit the virus to a healthy people. Similarly, mosquitoes that comes from eggs of infected mosquitoes can transmit dengue to people. Now, the temperature of Kathmandu is right for the growth of mosquitoes as well. Last year, we had identified some dengue-infected folks in Khusibu area who had gotten the virus via the dengue-infected people outside the valley.

Mosquitos then bit those Khusibu residents and the virus spread in other areas of Kathmandu. This year, too, the outbreak of denuge began from Khusibu, Thulo Bharyang and Balaju areas of Kathmandu valley and the number of infected is increasing by the day. It is spreading due to the travel of infected people from one place to another. As far as the hilly areas are concerned, there is rapid urbanization and development. Several goods and materials are transmitted there from Tarai/Madhes areas. The mosquitos also travel from Tarai along with humans and various means of transport.

Is it because of climate change and urbanization that dengue is spreading fast even in hilly areas?

Yes, dengue is spreading due to rapid urbanization. Even our hilly districts these days have the temperature and humidity suitable for the growth of mosquitoes. Human migration is a major reason for its spread. Dengue would not have spread in Kathmandu valley had infected people not travelled here. For example, during Dashain, people from Tarai/Madhes and even abroad visit Kathmandu, bringing the virus with them. It is not only in Nepal, dengue is fast spreading in other South East Asian and South Asian countries as well. Even the mountainous country of Bhutan is not immune. Dengue is spreading in the hilly areas of India too. Human migration, rising temperature due to climate change and urbanization are the major culprits.

Was such a rapid spread of dengue anticipated?

This year, there have been some unusual developments. In the past, there was an outbreak at the end of the monsoon season. So we expected dengue to appear during this Dashain season as well. But this year it started to appear in April-May. First, there was an outbreak in eastern parts such as Dharan and Morang. If you see our immediate history, there was a big outbreak of dengue in Tarai in 2009, then in 2013-2014, in 2017, and now. The numbers are already large this year. This will further increase in coming weeks and months.

Are we prepared to fight dengue?

The Epidemiology and Disease Control Division under the Department of Health has already taken some measures. Now, we have three tiers of government and we have allocated budget for all levels to fight dengue. We have purchased necessary kits. Similar, the division has launched training programs, inviting representatives from the concerned provincial and local level departments as well as health officers. But possible areas of dengue outbreak are always unpredictable. For example, on the basis of this year’s outbreak, we make preparations for next year but we may be wrong. What we lack is strategic planning.

There is a need to map out possible areas of dengue outbreak for successful prevention. But the government does not appear serious about it.

We make plan for next year on the basis of current outbreak. This approach is not flawless. After the outbreak in Khusibu last year, we had discussed the possibility of outbreak in other areas but we failed to come out with the right policy and planning. When it comes to controlling the dengue outbreak, the efforts of Ministry of Health and Population is insufficient. There is a need for integrated planning and intervention. There is a need for behavioral change at the individual level. Now, we have a strong government at the grass-root level and they can play vital role in controlling dengue. We need a systematic campaign to search and kill mosquito larvae. We can control it if every ward launches a campaign to search and kill the larvae. When it comes to long-term planning and policy, all line ministries should sit together. The government has to think seriously and all government bodies should be engaged. In the past, we used to think the outbreak would be confined to Tarai. We were wrong. There is possibility of a pandemic in coming years if we don’t start preparing now.

What kind of policy interventions can there be in controlling dengue?

Other countries have strong legislation. In Singapore, if government authorities find mosquitoes breeding in the houses of common people, they would be subjected to a fine of $200. In June, dengue larvae were found in the houses of 900 households in Singapore and they were punished. So only government efforts are insufficient. Now, we are in a very primitive stage. We have to start thinking long-term. Every social organization should be involved. In India, state governments are promulgating several laws. In Kathmandu, there are abandoned tires, mismanaged flower pots, unruly bushes everywhere. These are perfect breeding ground for mosquitoes. Along with laws, what is needed is a mega-campaign of people to control dengue.

What is the status of facilities and manpower at local level to fight dengue?

The staff adjustment process is underway. So there is lack of doctors in some places. Similarly, local governments are yet to manage the required human resources. We need to ensure manpower at local level who can identify the symptoms of dengue to prevent possible deaths. Now dengue has spread over 44 districts and Province no. 3 is highly vulnerable.

There are some misconceptions about dengue. Some say people would be infected only if mosquitoes bite during the day while others say morning and evening are the risky times.

You could be bitten round the clock. For example, if you go in the jungle or to a park in the day, such mosquitoes can bite you and you may develop dengue fever. But these mosquitoes will be more active in mornings and evenings. So it is better to stay at home in the evening and take precautionary measures. In broad daylight, the mosquitoes will be less active.  

What are the dengue symptoms? And how can it be cured?

The main thing to understand is that we can see symptoms only in 10 percent of infected people. For example, if 10,000 are infected, there will be clear symptoms only in 1,000 people. Of them, 500 show the symptoms of viral fever and remaining 500 show symptoms of dengue fever. But with proper medical care, only around 1 percent of those with dengue fever will die. This dengue fever is dangerous. Its symptoms are sudden high fever, severe headache, pain behind the eyes, severe joint and muscle pain, fatigue, and vomiting, among others. You may see red rashes in the body. People suffering from dengue should consume plenty of liquid and use only paracetamol, not other medicines. Only those people who suffer from repeated vomiting, pain in stomach and respiratory problems should be admitted to hospital.

Who are most vulnerable groups?

Infants, pregnant women, fat people, and people having other diseases such as blood pressure and diabetes are vulnerable. If these people contract dengue, they need to be admitted to a hospital as they are likely to see more complications.

What lesson can we learn from the current spread of dengue?

First, we have to think about safety measures to stay save. Our priority should be searching the larvae and killing them everywhere. For example, just like the Bagmati clean-up campaign, we need another mega-campaign. People and all institutions should come together for this. We have to decrease the density of mosquitoes. At the individual level, we have to change our behavior. It should be no less than a national agenda.

On 17 September 2015, Nepal’s Constituent Assembly (CA) endorsed a new version of the constitution and set September 20 as the day for its promulgation. The very next day, India dispatched its then foreign secretary S. Jaishankar as a special envoy to convince Nepali leaders to delay the constitutional process. Soon after landing in Kathmandu, Jaishankar went to then CPN-UML Chair KP Oli’s residence in Balkot and urged him not to issue the stat­ute in a hurry. Jaishankar then held talks with then Prime Minister Sushil Koirala and senior CPN (Maoist Cen­ter) leaders. There was apparently a harsh exchange of words between Jaishankar and Nepali leaders over the constitution and the demands of Madhes-based parties. Maoist leader Pushpa Kamal Dahal report­edly told Jaishankar that he should have visited 15 days earlier to make India’s case. All leaders conveyed a clear message to Jaishankar: the constitution would be promulgated on the set date as the CA had already endorsed it.

A senior ruling NCP leader recalls, “Jaishankar was furious. He warned that the constitution’s acceptance by other countries would be mean­ingless if India did not endorse it.” Oli then sent Pradeep Gyawali to Delhi as his envoy to convince Indian leaders of the validity of the constitutional process. Gyawali was meeting senior Indian government officials, including Jaishankar, when the constitution was promulgated back home.

Much water under the bridge

Coincidentally, Jaishankar was recently in Kathmandu as the Indian Minister for External Affairs for the fifth meeting of the Nepal-India Joint Commission. Through him, Prime Minister Oli extended an invitation to his Indian counterpart Narendra Modi to be the chief guest at Nepal’s Constitution Day cele­brations on Ashoj 3 (September 20). It’s probably too late now for Modi to accept the invitation, but the invite has raised an obvious question: Why did Oli extend it to the prime minister of a country that has not officially welcomed Nepal’s constitution? On 20 Sep­tember 2015, India had only ‘noted’ the promulgation of a new consti­tution in Nepal. Immediately after, it imposed an almost five-month-long economic blockade, ostensibly in support of the protesting Mad­hes-based parties; the real reason behind India’s disapproval of Nepal’s constitution remains a matterof speculation.

India even launched an interna­tional lobbying campaign to per­suade other countries that Nepal’s constitution is not inclusive and needs amendment. Only after the first amendment, which partially fulfilled the demands of the Mad­hes-based parties, did India lift the blockade.

A lot of water has flown under the bridge in the past four years. Madhes-based parties initially boy­cotted the 2017 local elections held under the aegis of the new consti­tution, but eventually joined the electoral process. They took part in the federal and provincial elections and have formed the government in Province 2. Similarly, they have lent support to the Oli government, and a top Madhesi leader Upendra Yadav is now a deputy prime minister. In a way, Madhes-based parties have accepted the charter, though they have not given up their demand for an amendment. India, however, no longer speaks about constitu­tion amendment. Jaishankar did not mention it in his recent meetings with leaders of Madhes-based par­ties. But India’s position in favor of an ‘inclusive constitution’ remains unchanged.

Kashmir conundrum

Observers say if Modi were to attend the Constitution Day cele­brations on September 20, it would signaled India’s endorsement of Nepal’s constitution. But why did PM Oli invite his Indian counterpart knowing full well that Modi has a packed calendar in September? He is scheduled to address an Indian audience in Houston, Texas on Sep­tember 22 and the United Nations General Assembly on September 28. Or was Oli hinting at the kind of impromptu foreign visits of Modi like his 2015 trip to Pakistan or 2018 visit to the Maldives?

“If PM Modi wanted to, he could have come to Nepal for a few hours on September 20,” says a foreign ministry official request­ing anonymity. “But it is also our fault. How could we invite India’s prime minister without any preparation?”

But this official also believes that Modi could have come here had the Nepal government taken a clear position on Kashmir, as Jaishankar had apparently urged PM Oli to do during his recent Kathmandu visit. India wanted Nepal to clearly state that Kashmir is an internal matter of India. But Nepal was under pressure from Pakistan and China not to issue such a statement.

In a surprise statement on Sep­tember 4, Foreign Minister Pradeep Gyawali said that amending the Indian constitution to change Jammu & Kashmir’s status “was entirely the domain of the Indian government… and so we have no comment on that decision.” Many analysts have interpreted this com­ment as an endorsement of India’s recent steps in Jammu & Kashmir. But is this enough to lure Modi to Nepal? They are unsure.

Oli’s surprise?

“If the government wants to cel­ebrate the Constitution Day as a national day by inviting foreign dig­nitaries, there has to be sufficient consultations and preparations,” says Vijaya Kanta Karna, a political analyst. “By inviting Modi, the gov­ernment seems to be angling for full Indian support for the constitution.”

Some Madhes-based parties and civil society groups observe this day as a ‘black day’, as dozens of Mad­hesis were killed during protests around the time of the constitution’s promulgation. This is why “Modi’s participation in the Constitution Day celebrations would have hurt the sentiments of the Madhesi peo­ple,” says a senior Madhesi leader requesting anonymity.

Madhes-based parties have been pressing the government to amend the constitution without delay. As soon as PM Oli returns from Singa­pore, where he is currently undergo­ing medical treatment, these parties are preparing to hold decisive talks on amendment. Leader of Rastriya Janata Party Nepal (RJPN) Raj Kishor Yadav says, “Our talks with PM Oli will determine our next move.” Pub­licly, Oli has made it amply clear that he is not in favor of another amendment.

Yet a section of the Madhesi lead­ership believes that Oli has ‘softened’ of late. “Perhaps it is the awareness of his mortality, but I find him much more amenable on Madhesi issues these days,” says another top Mad­hesi leader. “Perhaps he could just spring a last-minute surprise on constitution-amendment as well.”

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Raj Kishor Yadav is the current head of the six-member Rastriya Janata party-Nepal (RJPN) presidium. The Madhes-based opposition party has 17 seats in the federal lower house, joint third in the legislature with the Samajbadi Party Nepal. The RJPN has been strongly raising the issue of constitution amendment. It has also asked the federal government to come up with a clear stand on the unfolding Kashmir issue and says it rejects the report of the India-Nepal EPGs. To achieve constitution amendment, it is now in merger talks with the Samajbadi Party. Biswas Baral and Kamal Dev Bhattarai caught up with the HoR member from Siraha-4 for insights on these issues.  

What is RJPN’s position on the recent developments in India-administered Kashmir?

It is India’s internal matter. India’s decision to scrap Article 370 of the constitution was endorsed by both its houses, and the Indian President has also authenticated it. Constitutionally and legally, there is now no space for questions. As a neighboring country, we should support India’s official position. When it comes to human rights, it is a global issue that the Indian government has to be sensitive about.

Do you think Nepal should clearly say Kashmir is India’s internal matter?

Yes. As Kashmir has been dealt with within the constitutional framework of India, it would be good if Nepal government comes up with a formal statement acknowledging as much.

You spoke of human rights as a global issue. Shouldn’t Nepal speak up about the human and civil rights of Kashmiris then?

At this point, Nepal government should endorse the decision of its Indian counterpart. If tomorrow a big human rights issue emerges, Nepal could react on the basis of facts on the ground. But till date I have not heard of grave human rights violations in Kashmir.  

Madhes-based parties seem displeased with the final report of the Nepal-India Eminent Persons’ Groups (EPG). Why?

It would be inappropriate to speak about the content of a report that is yet to be made public. Nor has it been submitted to the two governments. Nonetheless, we have had some reservations since the inception of the two EPGs. One reservation was regarding representation in the Nepali EPG. When we talk about Nepal and India, it is not confined to state-to-state relation. In this relation Madhes is always a big factor. We are the citizens who live along the border, and so we are directly affected by the state of our bilateral relation. So there should be representation of Madhes in the EPG. Without this, no report would be true to the ground realities.

But what can you do? The report has already been finalized. There are also allegations that India is promoting you to reject it.

Again, we have had reservations right from the start and I have also spoken about it in the parliament. The report will be acceptable neither to Nepal nor to India. New EPGs should be formed by incorporating the views of the people living along border areas of the two countries. Even if Nepal government accepts the report, we will reject it.

Without knowing what is there in the report, how can you say it is flawed?

If you see the global context, the issue of representation comes up high in political struggles everywhere. In a process that is going to determine our fate, there should be our representation because we have a unique understanding and experience of the issue. It is related to the psychology of people living in border areas. We have better knowledge of it. So a report prepared without our representation would not be in keeping with the ground realities.

Did you communicate your concerns on the EPG with the Indian Minister for External Affairs S Jaishankar during his recent Kathmandu trip?

The issue of EPG did not figure prominently in that meeting. We express our concerns over the EPG with the Nepal government. It is the responsibility of Nepal government to address security and other concerns of its citizens. We believe Nepal government should be more sensitive to our reservations over the EPG. 

In a separate context, currently there seems to be no environment for the amendment of the constitution as per your demand or for another popular uprising in Madhes. What will the RJPN do then?

This constitution is incomplete, as we had been saying even before its promulgation. Now, everyone realizes that there are certain flaws in it that need to be removed. It would good for the country if this issue is addressed without any delay. Mainly, the prime minister should be positive on our demand.  PM Oli assures us that the constitution is a dynamic document and amendable; that it is not something written in stone unlike the Bible or the Koran. It is an urgent matter that is being needlessly delayed. For over a year we supported this government. Later, we did not find a sense of urgency to amend the constitution. We withdrew our support and are now in the opposition bench. We still hope the government takes us seriously. After the prime minister returns from Singapore, we will hold formal talks with him and ask him to amend the constitution, to withdraw cases against our leaders and cadres including against Resham Chaudhary, and to address other issues related to Madhes. If PM Oli and other parties do not listen, we will be compelled to hit the street.

But you don’t have many options, do you?

The understanding that the prime minister is not ready to amend the charter and that Madhes-based parties cannot lead another movement is superficial. First, the seriousness and sensitivity of any issue determines how we move ahead. The prime minister has never rejected our demand of amendment. As far as the concern that we cannot lead another movement is concerned, movements happen as per the demands of time and people. People expect PM Oli to correct himself and his two-third government will be ready to amend the constitution. But they are growing impatient. We will take decisions based on people’s mindset. We are convinced that people will take to the streets if we launch such a movement.

How do you tackle the perception that Madhes-based parties are losing the trust of their constituencies and thus are in no position to lead another Madhes movement?

The way some people see Madhes through Kathmandu’s lenses is biased, and subjective rather than objective. Let’s evaluate the current power balance in the country. The Nepali Congress, the country’s oldest party, does not have a government in a single province; but we have a government in at least one province. We carry the agenda of people so they are always with us. We also have strong organizational base which has been seen in various Madhes movements and during elections. We are also aware that people expect the next Madhes movement to reach to a logical conclusion.

Are you seeking India’s support in constitution amendment?

Constitution drafting and promulgation is an internal matter. Nepal’s government should take all internal stakeholders into confidence. We launched the 2015 Madhes movement and it hit India because of the open border. That is why India expressed its concern with Nepal government. We imposed the blockade. How India dealt with its security issues is not our concern. But when we talk of constitution amendment, India is naturally linked. If you go back to 2008, Nepal government signed an agreement with Madhes-based parties with the Indian ambassador at the time playing the role of a mediator—at the request of Nepal government. The Indian side was involved because the Nepal government sought its presence. Our demands are linked to India in order to attack us and create an illusion. But whenever Nepal government finds itself in trouble, it seeks India’s support.

What is the progress in the merger talks between the RJPN and Samajbadi Party Nepal? It seems like the RJPN wants to elevate itself from a regional party to a national one.

Certainly. We want to accommodate all the oppressed and marginalized people. We should move towards national consolidation, and there is a need for alternative political forces for this. Certainly. It has now been proven that it is difficult to resolve national issues without being a national party. The NCP carries a communist ideology, Nepal Congress is a liberal democratic party and ours will be alternative political party which raises the agenda of social justice and equality.

Various parties and groups have launched separate movements and highlighted underlying issues. But we failed to coalesce those movements into a strong political force capable of addressing all those problems. Now the RJPN should push for unification with likeminded people. We want to initiate unification talks with the Samajbadi Party and other political forces. There are some progressive leaders inside Nepal Communist Party and Nepali Congress on national agenda. We want to associate with them as well.

There are reports of rifts in the RJPN concerning the proposed merger with the Samajbadi Party.

The RJPN seeks respectful unification. We want to merge the two parties in order to form a new party with new thinking and vigor. There are some gaps in our understanding of some issues and we are trying find a common ground. In this period, there was no meeting of the six-member presidium. Only the political committee met. I was under pressure to hold the meeting to prepare party’s official position on national and intra-party issues.

What are the conflicting issues?

They are mostly organizational issues. The RJPN was formed after the merger of six different Madhes-based parties. There were conflicting understanding on several organizational issues. Some of them have already been resolved. We are discussing how to talk with the government and prepare for another movement. We will talk to PM Oli as soon as he is back in Nepal.