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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

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. 

Our political leaders, foreign policy and diplomacy baffled our regional super power and the second largest economy of the world China at Its Belt and Road Initiative (BRI) which was initiated by president Xi Jinping and has been adopted by dozens of countries of the world. Hardly a few countries have dared to come out of this Chinese venture. China was so much perplexed that the third Road and Belt Forum for International Corporation in its meeting held on 17-18 Oct 2023 included two small operational projects, Panda Pack Project and Amity Living Water Project, in the list of projects under BRI against nine projects selected during PM Oli’s last visit on account of the BRI implementation plan remained held up in Kathmandu. The then Chinese envoy’s claim that the construction of Pokhara International Airport was made under BRI as he knew well that the project was started before Nepal signed it, showed the Chinese desperation. This agony of China has now been removed by PM Oli’s four-day visit (Dec 2-5) to China. Its constant efforts since 2020 to get its BRI implementation plan accepted by Nepal has now succeeded.

The government has published the contents of the BRI Cooperation framework. Belt and Road Initiative (BRI) may now be called Belt and Road Initiative Cooperation (BRIC) in Nepal, as mode of payment will now be ‘technical and aid assistance against the usual mode of payment being loan to aid assistance, which was unfamiliar to the BRI world. Nepal has now expanded the payment modalities including technician and aid assistance disregarding its previous stand on ‘grant’ only. It seems that the PM has used his autotype as a PM ignoring the stand of the Nepali Congress. The contents of the plan have been very carefully drafted, as what China has given with one hand seems to have been taken away with another.

It is feared that Chinese currency might become a legal tender by allowing China to use it for the projects financed by it. We must be thankful to God that the Chinese language has not been accepted as a medium of teaching as yet at the university-level.  Positively, PM Oli’s visit to China shows that he is not only a shrewd politician but also a smart diplomat as he got the BTIC signed, as the Chinese BRI implantation idea has been replaced by another nomenclature by Nepal. Had it not been signed, his visit could have been taken as a failed one. He has apparently given all that he could have. It is more than what was given during president Xi’s last visit in 2029. 

Negatively, PM Oli could not give all that (loan modality), which  he wanted to offer to please the Chinese leadership. That is probably the reason why he got irritated when the question regarding ‘loan’ was raised during his press conference at the airport. The consensual draft prepared by the joint expert committee that included the terminology of ‘BRI Cooperation Framework’ replacing the Chinese BRI Implementation Plan’ was only half-heartedly supported by the PM. This was probably the reason why he excessively talked here about not taking loans from China for any projects, which was definitely not acceptable to China.

Since PM Oli had already made up his mind to visit China, he accepted the consensus draft to preserve the alliance and the Chinese negotiators might have accepted it to negotiate further while finalizing the draft in China during the visit. China had not taken the Nepali defiance of sending the revised/modified version of the implementation plan kindly. Probably sensing the dissatisfaction, he did not take up the demand of converting the loan taken for Pokhara airport into grant, the issue, which was already communicated by Finance Minister Bishnu Paudel to Yang Weiqun, vice-chair of the China International Development Cooperation Agency, on Aug 23 in Kathmandu. It seems he did not raise the issue to irritate further the Chinese establishment, which might have delayed the BRI cooperation work plan accepted by it, as was done by the then PM Pushpa Kamal Dahal who did not raise the issue of border disputes with Indian PM Modi during his visit to India. 

However, in domestic politics he has proved himself as an unchallenged leader who can do anything indirectly which he cannot do directly. He has again outwitted Sher Bahadur Deuba by doing what he wanted to do despite his assurance of not doing that. He has obliged Deuba by accepting the prime ministership overnight betraying the strategic political partner Dahal. Alternatively, Deuba knows his inability to oppose PM Oli at this juncture, probably on account of personal problems. 

Glacial Lake Outburst Floods (GLOFs) in Nepal are becoming a significant hazard in the Himalayas, driven by climate change and an increasing number of glacial lakes. Nepal's GLOF history is marked by several catastrophic events that have caused widespread devastation. The earliest recorded GLOF occurred about 450 years ago in Seti Khola but its details are not available.  A recent article by Byers, Chand, and their team also reconstructed the GLOF history in the Kanchenjunga region, where they found the occurrence of GLOF since 1921. They found at least seven GLOF events in that region with the help of remote sensing and field observation, which were not recorded before. Besides, ICIMOD has compiled 24 events out of which 14 occurred in Nepal and 10 in Tibet (China), causing extensive damage in Nepal. A notable GLOF event occurred in 1985 when Dig Tsho burst, leading to a destructive flood that destroyed infrastructure, including a hydropower plant under construction. Another study by Shrestha and her team recorded 54 events in Nepal. These datasets also indicated that several events occurred and are occurring in remote mountains that were not noticed due to their impact being insignificant and remote in nature. The Thame GLOF that occurred in Aug 16 this year is another noticeable event that caused damage to Thame village and the downstream ecosystem despite the small size of the breached glacial lake.

The underlying causes of GLOFs are tied to the unique geographical and climatic conditions of Nepal. The Himalayas are home to thousands of glaciers, which have formed numerous glacial lakes, particularly in the high-altitude regions. These lakes are formed when glaciers retreat, leaving behind large volumes of water contained by unstable moraines. As global temperatures rise, the rate of glacial melting increases, leading to the expansion of these lakes. The moraines that contain them are often weak and prone to collapse, especially under the pressure of additional water, seismic activity or other triggering factors like avalanches or landslides.

GLOFs have severe impacts on both the natural environment and human settlements. The floods can destroy agricultural land and hydropower, disrupt transportation networks and lead to loss of life and property. In addition to physical destruction, GLOFs also contribute to long-term environmental changes, such as the alteration of river courses and the degradation of ecosystems. The socio-economic impacts are profound, particularly in rural and remote areas where communities rely heavily on agriculture and where infrastructure is limited.

Over the decades, Nepal has tried to monitor and mitigate the risks associated with GLOFs. The establishment of early warning systems, such as the one implemented at Tsho Rolpa back in the 1990s, one of Nepal's largest glacial lakes located in Dolakha district in the Tamakoshi river basin, is a critical step in disaster risk reduction. Initially, an experimental siphon system was installed in 1995 to release the water and lower the lake volume, but it stopped working after 15 months. In 1997, the then government installed additional siphones and an early warning system. An automatic early warning system was installed in 1998 with a GLOF sensing system and a GLOF warning system along the Rolwaling and Tamakoshi river valleys. Engineering interventions, such as the lowering of lake levels by three meters through controlled drainage, have also been employed to reduce the risk of outbursts through the GLOF risk reduction project, with funding from the World Bank, the Netherlands International Development Agency and the government of Nepal. However, a lack of continuous funding, research and proper coordination among agencies, along with the period of Maoist insurgency, hindered the progress of mitigation work. Again, in 2015, the Early Warning System was revitalized with the installation of hydrological, precipitation and automatic weather stations at different locations in the downstream region.

The community-based Flood and Glacial Lake Outburst Risk Reduction Project, also known as the Imja Glacier Lowering Project in the Dudhkoshi basin, was implemented between 2013 and 2017 to mitigate the risks of glacial lake outburst floods (GLOFs) and to reduce human and material losses in Solukhumbu district and catastrophic flooding events in the Tarai and Churia range. The project was implemented by the Department of Hydrology and Meteorology (DHM) in partnership with different stakeholders and funded by Global Environment Facility-Least Developed Countries Fund (GEF-LDCF), UNDP. Imja was considered one of the most potentially dangerous glacial lakes for GLOF, which is rapidly increasing in size and volume due to glacial melt and the action of lake water that continuously triggers the calving of the glacier. Key activities of the project included the establishment of early warning systems, community training for disaster preparedness and the construction of protective infrastructure. The project also emphasized community participation, ensuring that local knowledge and needs shaped the initiatives. Through these efforts, the project successfully improved local capacities to respond to flood risks, ultimately contributing to enhanced safety and security for affected populations. By excavating a channel through the moraine that holds back the lake, the project successfully lowered the water level by 3.6 m, thereby enhancing drainage capacity and reducing the risk of catastrophic flooding downstream. This intervention significantly improved safety for local communities, alleviating fears and allowing residents to pursue their livelihoods with greater security. Additionally, the project facilitated environmental monitoring of glacial dynamics, contributing to a better understanding of the ongoing changes in the region due to climate change. It also promoted awareness of GLOF risks and enhanced community capacity for disaster preparedness through training programs focused on emergency response. Furthermore, the project emphasized the importance of sustainable practices, reinforcing the need for ongoing research and actions to manage the impacts of climate change on Nepal’s glaciers. Overall, the Imja Glacier Lowering Project stands as a proactive model for disaster risk reduction, highlighting the critical integration of scientific research, community engagement, and sustainable environmental management in safeguarding vulnerable populations in the Himalayas.

Additionally, the government, in collaboration with different organizations, has undertaken research and mapping projects to identify high-risk lakes and develop preparedness strategies. The government has identified four additional glacial lakes—Thulagi in Gandaki basin and Lower Barun, Lumding and Hongu in the Koshi basin—to implement the structural intervention along with the early warning system and capacity-building. The government has proposed about $36.1m to the Green Climate Fund and the initiative is expected to start in 1-2 years.

Despite these efforts, challenges remain in effectively managing the risks associated with GLOFs. The remote and inaccessible nature of many glacial lakes makes monitoring difficult, and the unpredictable nature of GLOFs complicates forecasting efforts. Furthermore, the rapid pace of climate change poses a growing threat, as the continued retreat of glaciers is likely to create new glacial lakes and increase the volume of existing ones. As temperatures continue to rise, the frequency and intensity of GLOFs are expected to increase. Not only large-sized glacial lakes but small lakes may also have significant impacts. Thousands of such lakes in the high mountains have significant implications not only for Nepal but also for the downstream countries in the Himalayan region that share river basins with Nepal. Collaborative regional efforts are essential to address these transboundary risks. Updating current inventory, categorization of potentially dangerous glacial lakes, and regular monitoring mechanisms should be established under the government in collaboration with research institutions.