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On Feb 4, the world gathers under the new World Cancer Day theme, “United by Unique,” to emphasize the transformative power of personalized, patient-centered care in the global fight against cancer. This theme, which will guide efforts from 2025 to 2027, highlights the need to put individuals and their stories at the heart of cancer care. For Nepal, this presents an opportunity to reimagine its healthcare landscape, focusing on equity, tailored treatments and the human connections that strengthen resilience in the face of cancer.

A significant burden

Nepal’s cancer burden remains significant, with GLOBOCAN 2022 data revealing 22,008 new cases and 14,704 deaths annually. The most common cancers—lung, breast and cervical—continue to impact thousands, with lung cancer alone causing 15 percent of all cancer-related deaths. However, these numbers only tell part of the story. Behind each statistic lies a person—a father battling lung cancer, a mother fighting breast cancer, or a young girl grappling with cervical cancer. Their journeys are defined not only by their diagnoses but also by the unique social, economic and emotional challenges they face.

In rural Nepal, a cancer diagnosis often means traveling long distances for treatment, navigating financial hardship and confronting cultural stigmas. Recognizing these challenges, “United by Unique” underscores the need to build systems that see each patient as an individual with distinct needs.

A whole-person approach

Personalized care goes beyond tailored treatments; it focuses on addressing the whole person, considering their unique circumstances, challenges and needs. In Nepal, this requires understanding the specific risk factors that contribute to cancer, such as tobacco use, diet and environmental pollutants, and creating interventions that resonate with diverse communities.

Tobacco use remains the leading cause of lung cancer in Nepal. Smoking, a deeply ingrained habit for many, requires more than generic anti-smoking campaigns. Personalized tobacco cessation programs that consider cultural attitudes, social contexts and individual motivations can significantly reduce smoking rates. These programs should offer tailored guidance, support systems and resources to help individuals quit smoking while addressing the underlying factors that perpetuate tobacco use.

Access to cancer screening is another critical aspect of personalized care. In Nepal, women in remote areas often face barriers to breast and cervical cancer detection due to a lack of healthcare infrastructure and awareness. Expanding mobile clinics and implementing localized awareness campaigns can bridge this gap, ensuring that early detection services reach those most in need. These efforts can empower women to take proactive steps in managing their health and reduce the burden of advanced-stage cancer diagnoses.

Psychosocial support is equally essential in the fight against cancer. Beyond its physical toll, cancer significantly impacts mental well-being. Providing counseling services and support groups tailored to patients' life stages, family dynamics, and cultural backgrounds can greatly improve their quality of life. These initiatives not only offer emotional relief but also foster a sense of community and resilience among patients and their families, reinforcing the holistic approach central to personalized care.

Care and advocacy

The theme “United by Unique” invites us to listen to and amplify patient voices. Each story sheds light on barriers in the healthcare system, from delayed diagnoses to limited treatment options. These narratives can inspire advocacy efforts for better policies, increased funding and greater collaboration among healthcare providers.

In recent years, initiatives in Nepal have shown the power of a human-centered approach. Programs like community-based cancer awareness drives and partnerships with local organizations have improved outreach and fostered trust among marginalized groups. However, more needs to be done to integrate patient feedback into the design of healthcare services.

Personalized care

Achieving the vision of “United by Unique” in Nepal demands a comprehensive and multifaceted strategy to strengthen systems for personalized cancer care. A crucial first step is investing in infrastructure by establishing provincial cancer centers equipped with advanced diagnostic tools and treatment facilities. This will bring care closer to communities, reducing the need for patients to travel long distances and ensuring timely access to essential services. Equally important is promoting equity in care by addressing financial, geographic and social barriers that prevent many individuals from accessing treatment. Subsidized care, transportation support and inclusive policies can help bridge these gaps and ensure no one is left behind.

Leveraging technology is another vital component of this approach. Digital tools can be used to maintain detailed patient records, enabling healthcare providers to create personalized treatment plans and monitor follow-up care effectively. Technology also facilitates better communication and coordination among care teams. Additionally, fostering partnerships with international organizations, NGOs and local governments can enhance resource sharing, expertise and innovation, strengthening Nepal’s overall healthcare capacity. Finally, empowering patients and their families through educational programs is essential. Providing information about conditions, treatments and care processes equips families to offer informed support to their loved ones, creating a foundation for holistic and compassionate care. Together, these strategies can transform Nepal’s cancer care landscape and bring the vision of personalized care to life.

One patient at a time

This World Cancer Day, Nepal stands united with the global community to affirm that every patient’s journey matters. “United by Unique” challenges us to move beyond one-size-fits-all solutions and focus on the humanity at the core of healthcare. Together, by placing individuals at the center of cancer care, we can close gaps, foster hope and create a brighter future for all.

The author is a public health professional

By all accounts, the country is not on the right path. Nepal is facing a multitude of challenges that require immediate and concerted efforts to address. From agriculture and corruption to climate change and political instability, the issues are deeply interconnected. Without urgent action, the country risks further decline, with long-term consequences for its economy, society, and democracy. To support my argument, I have identified the 10 major problems Nepal is facing today.

Agriculture

I do not want to rely on government statistics, but based on my visits to Karnali, Sudurpashchim and areas surrounding the Kathmandu valley, I can say that Nepal’s agricultural sector is witnessing an alarming decline, with decreasing productivity. On one hand, there is a lack of youth willing to work in agriculture; on the other, a small group of local politicians and government officials are hijacking government subsidies, sidelining genuine farmers. One must be an active member of a political party to receive fertilizer and seed subsidies. Additionally, some people are forging fake agricultural documents to siphon funds that never reach the farmers. Market access for local farmers remains a major issue. Fertile agricultural lands are dangerously becoming barren, and their visible impact will be evident within the next 10 years.

Corruption

For a long time, everyone has been saying that corruption is everywhere, so this issue may seem redundant. However, believe me, it has reached an alarming level, especially at the local level. Corruption has severely compromised the quality of infrastructure projects. There is a dangerous nexus between politicians, government officials and contractors. For instance, I have personally witnessed cases where less than 30 percent of the allocated budget is actually spent on infrastructure projects. Corruption exists even in small health posts—people do not receive the free government-provided medicines because they are diverted to private pharmacies for profit. Corruption has permeated every level of budget allocation and project implementation.

Economy

Government indicators may suggest a gradual economic recovery, as it is also a necessity for the government to manipulate economic data to show progress. For example, the current government has claimed improvements compared to the previous administration. However, the overall sentiment in society clearly indicates that the economy is struggling. Business owners are under severe stress. Visit any small shop, and you will hear about the difficulties they face. People are hesitant to start new businesses due to high loan risks. Even top businesspeople are gradually losing confidence in the national economy. Whether you talk to a small tea shop owner or a leading business figure, optimism is hard to find.

Climate change

Again, this may not sound like a new issue because everyone is talking about it, but Nepal is facing a severe crisis due to climate change. Unfortunately, for our politicians, it is not a matter of urgency. But don’t just blame them—even US President Donald Trump called climate change a hoax. However, visit farms and talk to farmers, and you will feel its devastating effects firsthand. The September floods swept away agricultural lands around the Kathmandu valley. Over the past few months, prolonged droughts have seriously affected winter crops. In the coming years, both floods and droughts will continue to impact vital areas such as water availability, crop production, biodiversity and human settlements.

Misinformation and disinformation

This has emerged as one of the biggest risks to society. Social media platforms are filled with disinformation, and it is disheartening to see that people believe misinformation more readily than the facts. There is a low level of awareness about deepfake technology and how such content is created. This issue could lead to social unrest at any time. Politicians are aware of the spread of disinformation, yet there is no urgency to address it. Passing a few laws alone will not be enough; the government must launch a large-scale awareness campaign. Without it, disinformation could create security threats and other serious problems.

Youth migration

Every young person with a high school degree wants to go abroad. At college classrooms, I hear students discussing their plans to leave. In tea shops, I hear young people talking about how to gather funds to migrate. And in my home village in Kavre, I rarely see young people—most have already left. When I travel abroad, I find many Nepalis working and studying there. This trend does not need further explanation; its long-term economic impact will be severe, especially in the next decade.

Geopolitical tensions

Growing geopolitical tensions are gradually affecting Nepal. The Russia-Ukraine war has had economic and social repercussions here. Additionally, the escalating tensions between the US and China during Trump’s administration will not spare Nepal. Meanwhile, the growing influence of major global powers is increasing polarization within Nepali society. Our politicians are losing their ability to manage or leverage these global developments for the country’s benefit.

Political vacuum

Nepal currently has seven national political parties. Three major ones—Nepali Congress, CPN-UML, and CPN (Maoist Center)—united to promulgate the 2015 constitution. Superficially, it appears that these parties still dominate the political landscape. However, dissatisfaction is growing. More and more people are beginning to believe that traditional parties can no longer solve the country's problems, yet credible new political alternatives have not emerged. Even dedicated local-level cadres of major parties—except those who benefit directly—are considering changing their voting preferences in the next election. This has created a political vacuum at the local level. Which political force will fill this gap?

Pessimism

Nepalis are getting increasingly pessimistic about the country’s future. A majority believe conditions will worsen rather than improve. Many have lost hope that economic growth will create jobs and opportunities. This growing pessimism is contributing to rising mental health issues, which in turn are causing a surge in crimes.

Constitution

The 2015 constitution played a crucial role in maintaining peace, but it is now under threat. Anti-constitution forces are gaining momentum. Meanwhile, the commitment of political parties to the constitution is wavering. If the constitution and current system come under attack, the public is unlikely to rally to protect them because they feel the constitution has failed to improve their lives. If people do not safeguard the constitution, political instability could worsen at any time, potentially endangering democracy itself.

“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.

The race to decarbonize the transportation sector has brought two primary contenders to the forefront for heavy-duty applications: hydrogen-powered vehicles (HPVs) and battery electric vehicles (BEVs). Road transport, especially that of commercial vehicles such as trucks and buses, and other large vehicles is pivotal to the global supply chain and public transportation but at the same time contributes highly to emissions of greenhouse gases. Both technologies promise reduced emissions, but their viability for heavy-duty transport varies based on energy density, infrastructure, operational range and cost.

Energy density

Energy density is a critical factor for heavy-duty vehicles since large vehicles have very high energy requirements. Hydrogen fuel cells utilize both compressed hydrogen gas and liquid hydrogen, which possess energy densities of approximately 120 MJ/kg and 141 MJ/kg, respectively. This in turn gives hydrogen vehicles high energy densities allowing for large ranges without compromising payload capacity. In contrast, lithium-ion batteries used in BEVs have an energy density of approximately 0.2 MJ/kg. The lower energy density implies that very large and heavy batteries are needed for long ranges, which may decrease the payload. Advances in battery technology such as solid-state batteries are an example of working on the mentioned gap but are yet to be developed fully.

Capital and maintenance costs

In the acquisition and maintenance cost comparison for heavy-duty transport, hydrogen trucks, which cost approximately $350,000 for a 40 kg fuel tank capacity, are much costlier than electric trucks that, on average, cost $150,000 for a 150-kWh battery pack, because of the immaturity of fuel cell technology. But in the long run, hydrogen trucks are more cost-effective in terms of total cost of ownership (TCO) because the fuel cell has a much longer lifespan than batteries and has lower maintenance costs than electric trucks. Although electric trucks are more economical at purchase, they have higher maintenance costs over time, primarily due to battery degradation and eventual replacement.

Refueling and charging infra

Refueling time is a major operational consideration, and since hydrogen vehicles can be refueled in 5-15 minutes, they outperform electric vehicles. For example, the Shell refueling station in Long Beach, California, has a capacity of about 1 MW at 700 bar high-pressure and can refuel 50 hydrogen-powered vehicles with 30-40 kg tank capacity per day. But charging of BEVs takes much longer compared to refueling of HEVs. High output fast chargers—DC chargers over 350 kW like in Tesla’s V4 supercharging station for its semi trucks with massive ~900 kWh packs—can charge a battery to 80 percent within half an hour and limit vehicle throughput to 10-15 per station per day. Standard charging mechanisms include AC chargers, which usually take many hours and therefore are not efficient for heavy-duty transport with tight schedules. Hydrogen refueling stations are currently expensive to establish, costing $1-2m per station with a capacity of 500 kW to 1 MW. EV charging infrastructure is more modular, with Level 2 stations i.e. AC fast charging stations (6 kW to 20 kW) costing $2,000-$5,000 and fast-charging stations (25 kW to 350 kW) costing $50,000-$100,000.

Operational range and cost

Current hydrogen-based heavy-duty vehicles need to be refueled between 500-800 km, although prototypes such as the Toyota Kenworth T680 fuel cell truck have been produced with the capability of covering more than 1000 km. Hydrogen vehicles contain fuel tanks of 30-40 kg of hydrogen and are built to work under a pressure of up to 700 bar. The cost of hydrogen fuel is between $6- $10 per kg, meaning that the operating cost per kilometer is between $0.12 and $0.20 for a conventional heavy-duty truck. Medium and heavy-duty BEVs, like the Tesla Semi, based on battery capacity can drive 500-800 km using a battery with a maximum capacity of 1 MWh. In other countries, it costs $0.10 to $0.20 per kWh to charge the electricity, hence the operation cost of $0.10-$0.15 per km is comparatively higher than that of Nepal. According to a study by the NEA, the cost of operating electric vehicles in Nepal is 15-20 times lower than petrol vehicles: for electric cars, it is Re 0.7 paisa per kilometer, Re 0.8 for SUVs or jeeps, Re 0.9 for microbuses and Rs 1.2 for large buses.

The green aspect

Environmental aspects shape the complex relations between hydrogen and battery-electric vehicles. Hydrogen’s environmental impact hinges on its production method: green hydrogen, produced through the electrolysis of water using electricity from renewable sources, is a cleaner but comparatively expensive solution, while gray hydrogen produced from natural gas has a high CO2 output. Technologies like carbon capture and storage (CCS) have improved the blue hydrogen to fill this gap. A notable environmental advantage of hydrogen-powered vehicles is that their byproduct is just water vapor, and thus doesn’t emit any carbon into the atmosphere. Even though electricity used by BEVs can be from renewable sources, the two main environmental issues are associated with batteries. The exploitation of such strategic minerals such as lithium, cobalt and nickel brings with it questions on resource depletion as well as the impact on the environment. However, recycling or disposal of the batteries becomes a concern when the BEV batteries degrade over time—typically after about 10 years.

Hybrid model

Hybrid models combining hydrogen and battery technologies are emerging as a promising solution. These vehicles are driven by hydrogen fuel cells as the main power source and batteries that will be used for auxiliary/peak load. This approach enhances the efficiency of the features inherent in both technologies, including the range of operation and regenerative braking. For instance, the Honda CR-V e: FCEV incorporates hybrid systems to balance performance and efficiency that provide 29 miles of range via battery, adding to the 241 miles from the fuel cell. The hybrid model is more appropriate for developing countries like Nepal, where establishing extensive hydrogen refueling infrastructure is expensive and not feasible in all locations. Thus, by incorporating a battery as an extra power source, the hybrid model allows vehicles to cover the necessary range to reach refueling stations. Current trends are to further invest in R&D of lighter fuel cell systems and higher capacity batteries to cut costs and ease integration.

Conclusion

The heavy-duty vehicle registration in Nepal was about 18,500 units in 2023 and is projected to reach around 20,400 units by 2026. This highlights the potential for hydrogen and electric technologies to play a pivotal role in the decarbonization of the transportation industry. Heavy-duty transport may benefit from hydrogen or electric technologies but each has its strengths and weaknesses. Hydrogen has the highest energy density, fast refueling time, and longest-range satisfaction compared to battery electric vehicles, making it suitable for long-distance use. Nevertheless, hydrogen remains an immature technology, with the problem of expensive hydrogen production and the lack of refueling stations persisting.  These issues can be solved through strategic solutions such as government subsidies, incentives for green hydrogen production and policies to encourage private sector investment. BEVs are cheaper with regard to energy, require less maintenance and have a more extensive charging network. However, they have relatively less energy density, longer charging time and limited traveling distance, which are not suitable for commercial purposes for heavy-duty applications. That is why hybrid models are considered to be intermediate solutions that combine the possible benefits of both technologies. The choice ultimately depends on specific use cases, availability of infrastructure and regional energy policies. As the world continues to look for sustainable production of heavy-duty vehicles, both hydrogen and electric technologies are likely to coexist in the coming years as well.