Understanding PCOS: A growing health concern beyond fertility

Many people may have heard the term PCOS, which stands for Polycystic Ovary Syndrome, although its exact cause is still not fully understood. Today, PCOS is recognized as the most common hormonal and metabolic disorder affecting women of reproductive age, impacting 6-20 percent of women worldwide. PCOS is mainly characterized by high levels of male hormone (androgens) in women, irregular or absent ovulation, and the presence of multiple small cysts in the ovaries, which can be detected through ultrasound.

Originally described in 1935 as Stein-Leventhal Syndrome, PCOS was once viewed only as a reproductive problem, causing missed periods, irregular menstruation, and difficulty in becoming pregnant. However, decades of research have revealed that PCOS affects far more than fertility. It is now known to be a serious whole-body condition, closely linked to weight gain, abdominal obesity, high blood pressure, abnormal cholesterol levels, insulin resistance, and chronic low-grade inflammation—all of which significantly increase the risk of diabetes and heart disease.

The most widely used diagnostic method for PCOS is the Rotterdam criteria, which requires the presence of at least two of the following: excess male hormones, irregular ovulation, and polycystic ovaries.

In Nepal, limited studies indicate that about 5-7 percent of women aged 20-30 are diagnosed with PCOS during medical checkups, while data on other age groups remain scarce. Unfortunately, public awareness of the condition is still very low, and access to reliable diagnostic services is limited. As a result, many women are diagnosed only when they seek medical help for infertility. Once pregnancy is achieved, follow-up care often ends, even though the health risks associated with PCOS continue throughout a woman’s life.

What is most concerning is that long-term exposure to high androgen levels in women with PCOS can lead to serious metabolic health problems over time. Emerging research also suggests that these effects may even influence the health of children born to mothers with PCOS, highlighting the need for further studies.

PCOS is therefore not just a fertility issue; it is a lifelong health condition that requires early diagnosis, continuous care, and greater public awareness to protect the long-term health of women and future generations.

Trivialization of academic research

Quality education is widely regarded as the backbone of a country’s development. Statistics show that nations that are successful, strong, progressive, and exemplary consistently maintain very high standards of education. Our government, too, has allocated a comparatively significant share of the national budget (around 11 percent) to this sector. It is often cited that Japan invested nearly 49 percent of its budget in education for several years following the Second World War. In India, Jagdish Gandhi introduced the concept of the Quality Circle into the academic ecosystem with the expectation of an overarching, education-induced transformation. One of the key indicators for measuring the quality of education is research. This argument is also advanced in the special issue publication Chetanako Muhan (2080), published by the Shreekant Adhikari Foundation. Yet today, research activities seem to be drifting away from their mission and turning increasingly into a mockery.

A few months ago, a distinguished speaker invited to a regional program proudly claimed, “I did research for half an hour today and discovered a few things.” As a presenter at the same program, this contributor found it difficult to comprehend whether research is something that can truly be completed in half an hour. On another occasion, a person with an academic identity uploaded a photograph on Facebook of himself on his mobile phone, and captioned it, “Doing some serious research.” Has research now been reduced to ‘mobile work’? Does merely knowing how to use Facebook qualify one as a researcher? Such questions persist.

Sometime later, this contributor received an email from a PhD researcher who had sent a questionnaire to measure patients’ perceptions of private hospitals. Despite visiting hospitals only to care for others, express goodwill, or attend meetings, the contributor has rarely been a patient in a private hospital for at least the past 15 years. Upon being informed of this, the sender casually replied, “No problem, just choose whatever option seems good and tick it.” These are only representative incidents, but taken together they clearly reveal how a dense and serious subject like research is being dangerously trivialized.

Research is a strong foundation and an essential pillar of academic life. Anyone completing a master’s degree is required to conduct at least one research project, which is often their first formal exposure to research. How far they pursue it thereafter depends on their sustained interest and commitment. Those who cannot fight should not join the army; those who cannot argue should not study law; those who cannot generate profit should not enter commerce; and those who cannot conduct research should think carefully before entering academia. Yet in recent times, distortions appear to be expanding far more rapidly than purity in academic research.

It is both pathetic and painful that thousands of identical research works under the same title circulate in academic circles. Research outputs lacking rigorous study and genuine effort—prepared and even home-delivered theses—are becoming increasingly common. At times, dissertations by unmarried researchers include acknowledgements thanking “my husband” or “my wife,” mistakenly referring to a friend’s spouse. Some pages read, “I am deeply grateful to my supervisor for continuous support, advice, suggestions, and tireless encouragement throughout the study,” even though the supervisor may never have met the student even once. Should one laugh or cry?

There is also a growing misconception that research must be based strictly on primary data. Many insist that “expert opinion doesn’t count, but respondents do.” Thick data requirements, non-numerical support, and deep interpretation are bluntly dismissed. Furthermore, the validity, participation, and honesty of respondents are rarely verified. Questionnaire-based studies often collect opinions rather than factual data. Research is not an election where whatever the majority says becomes truth. If the goal is to gather opinions, the choice of respondents should depend on whether the topic demands the views of the general public or of experts. For instance, if one is researching the usefulness of a political or electoral system, can conclusions be drawn merely by surveying random people on the street? Or is it more logical to sit in a library, study expert literature, examine prior research, and compare practices across countries?

Pushparaj Joshi’s book Research Methodology argues that comparative and analytical desk-based study must occupy a larger space in contemporary research. Nonetheless, the University Grants Commission and universities remain hesitant to recognize desk studies as legitimate research. The UGC tends to value time spent running around fields collecting data as grant-worthy, while time invested in dense comparative analysis grounded in core literature is largely disregarded.

Regardless of the method, once research is completed, publication is desirable. So-called “high-ranked” foreign journals demand exorbitant fees while offering prestige through labels such as Q1 to Q4 and Scopus indexing. At the same time, journals seeking modest collaboration or regional partnerships are branded as “predatory.” As many university research projects are donor-driven, assessment standards have become increasingly distorted. Commercial considerations now overshadow scholarly collaboration, turning publication into a transactional rather than intellectual exercise.

Recent data show that only seven medical science journals from our country are listed in these self-proclaimed, dollar-fee-driven rankings. No journals from other disciplines are included. In the social sciences, publication criteria appear heavily biased toward Western preconceptions and colonial narcissism. To secure space, publications must shape conclusions to fit Eurocentric narratives of supremacy—alongside paying hefty processing or publication fees.

How long will our universities continue to apply foreign and biased standards to evaluate local academic work? When will we break the illusion that “foreign” automatically means “international”? Is something international because of borders, or because of standards? The irony is that even the publications of our own universities and the University Grants Commission are excluded from these inflated and questionable rankings. 

There is also no shortage of “scholars” who possess negligible and nondescript publications of their own but are experts at offering heavy-handed advice to others. Another troubling aspect is the contradictory feedback given by evaluators. Many internal and external examiners speak superficially and in violation of basic research principles. This contributor has frequently witnessed reviewers contradicting their own earlier advice. Some say, “It’s not correct,” yet fail to explain what is wrong or how it can be corrected. Such distortions damage the very core of research.

Recently, a friend who claimed to have strong research skills bragged, “You don’t need to work hard anymore. Just give clear prompts or bullet points to ChatGPT, and it will instantly prepare a research article. Then you can submit it wherever you want.” Such remarks instantly dim whatever little enthusiasm and commitment remain. Due to the negligence of both researchers and regulatory bodies, genuine dedication to research is steadily being discouraged. Research was once an extraordinary and sacred mission. Today, it has been reduced to a cheap joke.

Surgery of socio-economic development

These days, two questions are so prominent regarding the socio economic development of Nepal. First, how can the good policies practiced by various successful countries be implemented to strengthen the internal economy? And second is why the development efforts failed to attract youth in the mainstream? To find the answers, we need to identify the way of achieving fruitful results according to the new generation’s desires. In the context, about the status of socio-economic development, currently, we can find three types of opinions. 

The first view claims that the country has made significant progress from a socio-economic perspective. The second logic is negative that denies the first view.  This logic did not see any adequate space for the future development of youth and the coming generation. The third view is mixed; and it compares the economic and social progress between past and present period and argues that some results have been achieved but it is not enough in comparison to other countries including neighbors; not enough as the demand and desire of the conscious people including new generation. This view is more realistic and fair since it shows the picture of yesterday's work, progress, and results as well as shortcomings and inadequacies of the past period. Therefore, to draw concrete conclusions, it will be better to divide Nepal’s development into different time periods.

Until 1956, the length of motorable roads in the urban areas of Nepal, basically in Kathmandu, Birgunj, and Biratnagar was 500 kilometers, out of that only half could be used throughout the year. There were two railways, Raxaul-Amlekhgunj and Jayanagar-Bijalpura, 130 kilometers long in aggregate. A ropeway of 67 kilometers was in operation from Bhimphedi to Kathmandu. There were two small canals named Chandranahar (Saptari) and Juddhanahar (Sarlahi) for irrigation purposes built by the government. Total hydro electricity generated was 3100 KW. In terms of health, there was Bir Hospital and Naradevi Ayurveda Hospital only. At that time, there were only four dozen high level educational institutions including Durbar High School and Trichandra College. The number of primary schools was near about four hundred. The literacy rate was below five percent. 

Even until the mid-decade of 1963, the development of physical infrastructures was less than a dozen. At the national level, the Tribhuvan Highway, Arani Highway, Prithvi and Siddhartha Highways were in operation but Raxaul-Amleshgunj railway was already closed. There was no electricity except in cities such as Kathmandu, Birgunj, Biratnagar and Bhairahawa. Until the 1970s too, Indian land had to be used to reach many parts of Nepal. By 1990 too, the length of the road, irrigated area of land and power generation capacity were 7,000 kilometers, 493,000 hectares and 238 MW respectively. The total number of schools was 2,1826 and the health institutions reached 1,100. During this period, the literacy rate reached 30 percent and the average age reached 55 years.

By the middle of July 2024, the length of the road reached 36,000 kilometers, the area of irrigated land was registered to 1.6m hectares and the renewable energy (electricity) capacity had increased by 14 times and recorded to 3,336 MW. In terms of social infrastructure, the number of schools and health institutions are 35,447 and 8,746 respectively. Now, the literacy rate is 77 percent and the average life expectancy rate is 71 years. The number of people below the poverty line has decreased to 20 percent, which was 49 percent in 1990. However, this poverty rate is the highest among South Asian countries. 

In this way, during the three and a half decades after 1990, in terms of numbers, Nepal has made significant progress in the areas of physical and social infrastructures but the achievement is not satisfactory in terms of quality and adequacy. Because of the total roads in terms of transportation, the percentage of black and gravel roads is 23 and 24 respectively; remaining is unpaved, which can only be used by vehicles for a few months. From a safety point of view too, the condition of the roads is poor. On the other hand, large vehicles carrying goods or passengers to Kathmandu from the eastern part of Chitwan have to travel an unnecessary distance of about 200 kilometers. The additional economic burden or cost created by this has adversely affected the competitiveness of the entire country and made daily life expensive. There is no significant progress in railways; ropeways are closed. Cable cars built by the private sector are used only for tourism purposes; those are not suitable for daily and business life. More than a dozen national pride and transformational projects are incomplete; the cost is increasing every year. Some projects that were supposed to be completed in five years have not been completed for 15 years, the initially estimated cost has not only doubled but also increased by six times. The achievements mentioned above, in comparison to today’s needs and standard of developed countries, it is clear that we are lagging behind. The per capita income in 1990 was $186, in 2024 this figure increased eightfold to $1517, but due to rapid depreciation of the Nepalese currency against the US dollar it could not strengthen the purchasing power of the people. In terms of region, the per capita income of Bagmati Province was $2,600, while that of Madhes Province was limited to $932, which is less than that of Karnali. This gap has increased dissatisfaction in people.

Comparing neighboring countries, according to the World Bank, Nepal’s per capita annual income is $1,500, while the average per capita income of South Asia is $2,700. The per capita income of the Maldives is almost nine times higher than Nepal’s income. Bhutan’s figure is $3,900, while India’s income is at the average level of South Asia. Bangladesh and Sri Lanka’s income is $2,600 and $4,500, respectively, Nepal is at the bottom. All these matters may have made the people frustrated. 

Against this backdrop, in order to drive the economy in line with the existing consciousness of the society and to move it in the right direction, on the one hand, it is necessary to change the constitution radically and on the other hand, drastic change in governance, systems, processes and procedures keeping the goal of optimal use of resources through good governance and effective management. In fact, the constitution is expansionary, because it increases the cost of state operation and demands a lot of financial resources rather than yielding resources. 

The issue of self-reliance should be taken in mind; because, the development of technology has dismantled the foundation of a self-reliance of the global economy. Nepal’s current economy is like a dependent one, it would be practical to make it interdependent; since currently, and building a self-reliant economy is just ideal thought where a country fulfills all the economic, social, and structural needs of its citizens through its own production and management without relying on foreign trade, aid, or investment. 

In today’s era, the economy cannot be completely self-reliant. China, USA, Japan, and Singapore are also not completely self-reliant. It is practical for Nepal to think of becoming self-reliant in food and electricity sector-wise. So, it is the right time to be proactive to overcome internal contradictions, conflicts, and inefficiencies and work to establish strong interconnections between Nepal’s economy and the global economy. This needs a multifaceted effort.

Lumbini’s cultural and economic importance on world stage

The afternoon of 13 Dec 2024, will be remembered as a significant milestone in the history of Gautam Buddha International Airport, Bhairahawa, due to the arrival of an Air China Airbus A320. This event was a historic achievement, as it marked the landing of a large-capacity aircraft at the newly established international airport. The chartered flight transported 227 Buddhist pilgrims from China to Lumbini, the birthplace of Lord Buddha, where they engaged in worship and prayer to promote global peace. The successful operation of such a large aircraft at Gautam Buddha International Airport not only demonstrated the airport’s technical capabilities but also affirmed its readiness to accommodate international flights of similar capacity.

Recognition of potential

Local entrepreneurs, associations, hoteliers, transportation providers, hospitality service providers, and gift shop operators expressed optimism and enthusiasm about offering services to international visitors. There is a shared confidence within the tourism sector that pilgrims and tourists from around the world will continue to visit Lumbini. The event was further celebrated by representatives from security, customs, and civil aviation authorities, marking a significant milestone in the development of Gautam Buddha International Airport as a center for tourism and aviation progress. The surrounding infrastructure meets international standards, reflecting the airport’s preparedness to serve high-end international travelers.

Gautam Buddha International Airport holds a unique position as the first facility dedicated to serving Lumbini, the birthplace of Lord Buddha, a figure of profound spiritual significance worldwide. Observers, including Air China crew members and pilgrims, shared emotional reflections upon disembarking, emphasizing the spiritual importance of this pilgrimage. An interaction with Air China staff highlighted their view of the airport as a world-class facility, and they expressed hope for regular flights connecting Beijing with Lumbini, viewing this as a milestone for Buddhist pilgrimage and cultural exchange.

Pilgrims expressing deep devotion and emotional fulfillment upon reaching Lumbini underscore the destination’s spiritual resonance and its capacity to attract visitors from around the globe. Such expressions exemplify Lumbini’s significance and its potential to welcome and inspire a diverse international audience.

On the same day, in Kathmandu, the Nanhai Roundtable Meeting took place, involving approximately 300 participants from over 28 countries, including China, Japan, Korea, Southeast Asian nations, Russia, and others. The event included high-level officials, diplomats, and representatives, serving as a vital platform for fostering international relations and economic cooperation. The event also generated considerable economic activity and underscored China’s friendship with Nepal, as China chose Nepal as the host country. It was an opportunity to promote Nepal’s profile globally.

However, the lack of active engagement by Nepalese institutions, such as the Ministry of Tourism and Culture, Lumbini Development Trust, and Nepal Tourism Board, was a concern. Their minimal participation during the event reflected a missed opportunity to showcase Lumbini’s cultural and economic importance on the world stage.

Infrastructure challenges

Despite decades of development efforts, Lumbini still faces significant infrastructural challenges. The area is plagued by poorly maintained walkways, litter, dusty roads, and inadequate sewage facilities, all of which undermine the sanctity and appeal of this globally significant spiritual destination. Additionally, initiatives such as electric buses introduced to improve visitor mobility remain inoperative, highlighting inefficiencies within the Lumbini Development Trust (LDT). Although a comprehensive master plan was established in 1978, little has been achieved in terms of development and upgrading the site to attract international visitors over the past several decades. The absence of innovative planning and strategic action has left Lumbini’s tremendous tourism potential largely unrealized.

To maximize the region’s prospects, the Nepalese government must prioritize developing a comprehensive business plan for Gautam Buddha International Airport that integrates tourism destination marketing, emphasizing Lumbini’s religious importance alongside Nepal’s natural attractions, such as the Himalayan peaks. Collaborative efforts between government agencies, private sector stakeholders, and international partners can transform Lumbini into a thriving tourism hub, leveraging its spiritual heritage to attract worldwide visitors.

There is considerable potential for Lumbini to become a prominent destination in spiritual tourism, capitalizing on global interest in Buddhist pilgrimage and cultural heritage. Immediate project initiation and strategic investment are essential to realize this potential, positioning Lumbini and Gautam Buddha International Airport as centers where heritage, religion, and economic development harmoniously converge to foster a prosperous Nepal.

Strategic advancements

In a recent public event in Kathmandu, Chinese Ambassador to Nepal Chen Song reaffirmed China’s commitment to supporting Nepal's economic development to enhance the well-being of the Nepalese people. Ambassador Chen emphasized China’s readiness to strengthen bilateral cooperation and advance socio-economic progress through strategic initiatives.

A notable milestone in this partnership is the commencement of Air China flights connecting Beijing with Lumbini. This development signifies improved connectivity, facilitating greater trade, tourism, and cultural exchanges. Enhanced air links not only bring China and Nepal closer but also open avenues for economic growth, especially in tourism and commerce.

China has historically been a key development partner for Nepal, offering opportunities for integration across trade, tourism, and infrastructure sectors. Strengthening these relationships can serve as catalysts for Nepal’s continued development, such as establishing economic hubs, expanding Nepalese exports to China, and increasing visitors to culturally significant sites like Lumbini.

Given Lumbini’s cultural and spiritual importance, there is immense potential to develop it into an international tourism hub, particularly attracting Chinese visitors. To realize these opportunities, Nepal must adopt dynamic leadership and forward-looking policies. Implementing transformative strategies, covering bilateral relations, infrastructure development, and policy reforms, will be crucial in unlocking the region's full economic potential and establishing Nepal as a central node for cultural, religious, and economic exchange in the region.