Nepal to send mpox sample to WHO lab in Thailand for clade analysis

In a bid to determine the clade of the mpox (monkeypox) virus, the Ministry of Health and Population is preparing to send specimens from infected persons to the World Health Organisation’s collaborating centre in Thailand.

 

photo: TKP

A clade is a subtype, genotype or group of viruses that originates from a common ancestor. So far, three clades of mpox viruses clade I, clade IIa and cladeIIb have been identified.

 

Officials say clade identification tells the virus’s virulence and transmissibility of the virus, which is necessary to curb the further spread of deadly disease. As the country lacks a system to carry out virus sub-typing, it sought help from the UN health body.

 

“We will probably send the specimen taken directly from the rash—skin fluid or crusts collected from the infected person—to the World Health Organisation’s collaborating centre in Thailand for clade identification,” said Dr Hemanta Chandra Ojha, an official at the Epidemiology and Disease Control Division.

 

“Identification of the virus’ clade will help us to figure out what extra measures are needed to mitigate the risks of further spread.”

 

Mpox is a rare disease caused by infection with the mpox virus. Last week, Nepal confirmed its second mpox case. A 36-year-old man from Tanahun, who returned from Saudi Arabia on December 19, tested positive for the disease.

 

The country confirmed its first case of mpox infection in June last year when a 60-year-old foreign national tested positive.

 

Experts say clade I, which is present in the Congo basin, causes up to 10 percent human mortality and is transmitted by rodents, although human-to-human transmission has also been recorded. Clade IIa, which exists in West Africa, has a low mortality rate, but clade IIb is currently spreading globally through human transmission. Clade IIb was responsible for infection in the first mpox case in Nepal.

 

According to Ojha, the health condition of the infected person is normal, and he could be discharged from the hospital in a few days.

 

With the confirmation of the second mpox case in Nepal, health authorities have stepped up surveillance measures to prevent a possible outbreak of the deadly viral disease.

 

Along with stepping up screening of passengers entering the country via the Tribhuvan International Airport, health authorities have requested dermatologists throughout the country to refer suspected cases for testing.

 

“We have also deployed health workers at the health desk at Pokhara International Airport and screened passengers who arrived from China for the dragon boat festival,” said Ojha. “We also conducted an orientation for health workers serving in strategic locations.”

 

Public health experts in Nepal say that screening suspects at health desks at international airports and land crossings is not sufficient to prevent outbreaks, as the first symptoms of mpox can take between five and 21 days for the first symptoms of mpox to appear, and not all cases can be detected at health desks.

 

Monkeypox cases have been reported in neighbouring India, with which Nepal shares a long, porous border. India has recorded at least 30 mpox infections since 2022.

 

Health experts say that even though mpox is usually mild and most people recover within weeks, the risks should not be underestimated. They stress the importance of precautions, saying that any disease seen in any corner of the world can reach Nepal due to the high mobility of people.

 

Mpox has been a neglected public health problem in parts of Africa for decades. The disease came to widespread attention after May 2022, when countries outside Africa began reporting new cases.

 

Since then, mpox has spread globally. More than 100,000 people from 122 countries have already tested positive for the disease.

 

Its symptoms include fever, headache, swelling, body aches, exhaustion, and itchy rashes on the face, hands, and feet.

 

As the disease primarily spreads through close person-to-person contact, public health experts recommend self-isolation and good hygiene to prevent transmission.

 

With the confirmation of the second mpox case in Nepal, the Ministry of Health and Population has stepped up surveillance measures to prevent a possible outbreak of the deadly viral disease.

 

Nepal reported the latest case on Friday. A 36-year-old man from Tanahun, who returned from Saudi Arabia on Thursday, tested positive for the disease.

 

Nepal confirmed its first case of mpox infection in June last year, when a 60-year-old foreign national had tested positive.

 

“We have increased health screenings of passengers entering the country from abroad, as per the instruction of the Ministry of Health and Population,” said Kanchhi Maya Twanju, a health worker deployed at the health desk set up at the Tribhuvan International Airport. “We have been instructed to send passengers having fever and those showing symptoms of mpox infection directly to hospitals.”

 

Mpox is a rare disease caused by infection with the mpox virus and one in 10 infected persons can die. Most common in remote parts of central and west Africa, the disease has now been reported in at least 122 countries. Beyond Africa, monkeypox is spreading chiefly in men who have sex with men, putting sexual health clinics on alert for new cases.

 

Along with stepping up screening of the passengers entering the country via TIA, health authorities have requested dermatologists throughout the country to refer suspected cases for testing.

 

“We have alerted dermatologists about the risk of an outbreak of mpox virus in the country and have requested them to refer suspected cases for testing,” said Dr Yadu Chandra Ghimire, director of the Epidemiology and Disease Control Division. “We will take additional measures following consultations with stakeholders, including the World Health Organisation’s Nepal representatives.”

 

Public health experts in Nepal say that screening suspects at health desks at international airports and land crossings is not sufficient to prevent outbreaks since it usually takes between five and 21 days for the first symptoms of mpox to appear, and not all cases of infection can be detected at health desks.

 

Monkeypox cases have been reported in neighbouring India, with which Nepal shares a long, porous border. India has recorded at least 30 mpox infections since 2022.

 

Health experts say that even if the rare viral infection is usually mild and most people recover within weeks, the risks should not be underestimated. They stress precautions, saying that every disease seen in any corner of the world can come to Nepal due to the high mobility of people.

 

“We didn’t expect that the infected person would come from Saudi Arabia, as there is no outbreak currently,” said Dr Sher Bahadur Pun, chief of the Clinical Research Unit at Sukraraj Tropical and Infectious Disease Hospital. “This incident shows that the deadly disease may come from any country, and we must remain vigilant and prepare agencies concerned accordingly.”

 

Doctors say preventing an outbreak of the deadly viral disease is not the sole responsibility of a single health agency, and it is impossible to do so.

 

“Every agency and person, including passengers, should shoulder the responsibility and take preventive measures,” Pun stated.

 

Mpox has been a globally neglected public health problem in parts of Africa for decades. The disease came to widespread attention after May 2022, with countries outside Africa reporting new cases.

 

Mpox has since spread globally. More than 100,000 people from 122 countries have already tested positive for the disease.

 

Its symptoms include fever, headache, swelling, body pains, exhaustion, and itchy rashes on the face, hands, and feet.

 

As the disease primarily spreads through close person-to-person contact, public health experts recommend self-isolation and good hygiene to avoid it.

 

Meanwhile, health officials informed that the condition of the infected man is normal and he will remain in hospital isolation for an additional two weeks.

 

They said that they are also working to trace close contacts between the patients on the plane and the taxi driver who took him to the hospital.

 

Nepal on Saturday confirmed its first case of monkeypox infection.

 

According to the Ministry of the Health and Population, a 60-year-old foreign national has tested positive for monkeypox infection.

 

"Health condition of the woman, who is a foreign national, is normal," said Dr Samir Kumar Adhikari, joint spokesperson of the Health ministry. "She is under observation of doctors at the isolation ward of a Kathmandu hospital."

 

The ministry refused to disclose the nationality of the infected woman and the country she had been last time.

 

According to Adhikari, the woman keeps traveling to Nepal and other countries frequently.

 

Specimens of the woman’s body fluids were tested at the National Public Health Laboratory, which confirmed infection of the virus.

 

Monkeypox is a rare disease caused by infection with the monkeypox virus and one in 10 infected persons can die. Most common in remote parts of central and west Africa, the disease has now been reported in at least 111 countries, including in Nepal. Its symptoms include fever, headache, swelling, body pains, exhaustion, and itchy rash on the face, hands, and feet.

 

As the disease primarily spreads through close person-to-person contact, public health experts recommend self-isolation and good hygiene to avoid it. The World Health Organization has designated the disease as a public health emergency of international concerns—which is the highest health alert.

 

More than 87,000 cases and 112 deaths from monkeypox have been reported in 2022, according to the UN health body.

 

Public health experts say that even if monkeypox infection is usually mild and most people recover within weeks, authorities concerned should not underestimate the risks. They stress taking precautions saying every disease seen in any corner of the world can come to Nepal due to high mobility.

 

The Epidemiology and Disease Control Division has alerted all agencies concerned about the growing risk of the spread of mpox, also known as the monkeypox virus, in communities.

 

The division’s alert follows Wednesday's declaration of a global public health emergency by the World Health Organisation. The UN agency defines an international public health emergency as an “extraordinary event” that poses a serious public health risk.

 

“We have also asked concerned agencies and officials to step up surveillance measures and send people suspected to have contracted the virus to the National Public Health Laboratory for the test,” said Dr Yadu Chandra Ghimire, director of the division. “We also held a discussion with the representative of the UN health body in Nepal and other officials concerned about the potential risk of the mpox virus spreading.”

 

Monkeypox is a rare disease caused by infection with the monkeypox virus. It is the second time since the UN health body declared mpox a global health emergency in two years, as the virus has spread alarmingly in the African continents and is at risk of entering other continents.

 

The WHO said that 524 people died and more than 14,000 cases of infection have been reported this year alone in Africa, which exceeded last year’s figure.

 

The mpox virus is transmitted through close contact such as sex, skin-to-skin contact, and the respiratory tract or mucous membranes.

 

Doctors say animal-to-human transmission often occurs through bites, scratches or direct contact with infected animals’ blood, body fluids or wounds. The virus causes flu-like symptoms.

 

Nepal had confirmed mpox infection in June last year after a 60-year-old foreigner tested positive for monkeypox infection.

 

Public health experts say that every disease seen in any corner of the world is possible to come to Nepal due to the high mobility of its own people and foreign tourists. They say it is relatively easier for people from any part of the globe to come to Nepal and that it increases the risk of any disease seen in any part of the globe arriving in Nepal.

 

“We cannot keep repeating the same mistake. When Covid spread in China, we thought that since we did not have a direct flight from disease-hit areas, the chance of the disease spreading to Nepal was low, but this proved to be wrong,” said Dr Shrawan Kumar Mishra, director at the provincial Public Health Laboratory of Madhesh Province. “Many people from our country travel to Africa, and our UN peacekeepers also serve there and return home. Anyone coming back from disease-hit countries must be kept in isolation for three weeks.”

 

Experts say screening at the health desks of international airports and land crossings alone is not enough to prevent a possible outbreak of monkeypox in the country since symptoms usually appear between five and 21 days after infection. Moreover, not everyone will have visible symptoms on their skin or limbs. They say that asymptomatic persons can also transmit the virus.

 

Symptoms of the mpox virus include fever, headache, swelling, body pains, exhaustion, and itchy rashes on the face, hands, and feet.

 

As the disease primarily spreads through close person-to-person contact, public health experts recommend self-isolation and good hygiene to avoid it.

 

Doctors say that even though monkeypox infection is usually mild and most people recover within weeks, the authorities concerned should not underestimate the risks.

 

Globally, more than 87,000 cases and 112 deaths from monkeypox were reported in 2022, according to the WHO

 

The UN health body said it is working with countries and vaccine manufacturers on potential vaccine donations and coordinating with partners through the interim Medical Countermeasures Network to facilitate equitable access to vaccines, therapeutics, diagnostics and other tools.

 

A World Health Organization official stressed on Tuesday that mpox, regardless of whether it is the new or old strain, is not the new Covid, as authorities know how to control its spread.

 

“We can and must tackle mpox together,” said Hans Kluge, WHO regional director for Europe, in a UN media briefing.

 

“So will we choose to put the systems in place to control and eliminate mpox globally? Or we will enter another cycle of panic and neglect? How we respond now and in the years to come will prove a critical test for Europe and the world,” he added.

 

Mpox, a viral infection that causes pus-filled lesions and flu-like symptoms, is usually mild but can kill.

 

The clade 1b variety has caused global concern because it seems to spread more easily through routine close contact.

 

A case of the variant was confirmed last week in Sweden and linked to a growing outbreak in Africa, the first sign of its spread outside the continent.

 

The WHO declared the recent outbreak of the disease a public health emergency of international concern after the new variant was identified.

 

Kluge said that the focus on the new clade 1 strain will also help in the fight against the less severe clade 2 variety that has spreading globally since 2022, allowing Europe to improve its response through better health advice and surveillance.

 

About 100 new cases of the clade 2 mpox strain are now being reported in the European region every month, added Kluge.

 

Mpox transmits through close physical contact, including sexual contact, but unlike previous global pandemics such as Covid-19, there is no evidence it spreads easily through the air.

 

Health authorities need to be on alert and flexible in case there are new, more transmissible clades or ones that change their transmission route, but there are no recommendations for people to wear masks, said WHO spokesperson Tarik Jasarevic.

 

The mpox outbreak in Africa is yet another example of how infectious diseases perceived to be “someone else’s problem”, and affecting mainly poor, developing countries, may suddenly pose unexpected global threats. Other examples of neglected diseases include the West Nile, Zika and Chikungunya viruses.

 

Mpox was discovered in 1958 (in captive monkeys, hence the original misnomer “monkeypox”) and the first human case was identified in 1970. Then for decades it was largely neglected by the scientific and public health communities, regarded as an uncommon infection in remote rural areas in tropical Africa without relevance for the rest of the world.

 

When a massive mpox outbreak hit developed countries in 2022, increased research funding led to a surge in scientific studies. On just one medical search engine, there’s been more research produced since April 2022 than in the preceding 60 years.

 

The 2022-23 global mpox outbreak happened despite repeated calls from African researchers for increased global investment in diagnostic, therapeutic and infection prevention tools for mpox. The WHO has now declared the current upsurge of mpox in central Africa a public health emergency of international concern.

 

This is the highest alert level for events that constitute a public health risk to other countries and requires a coordinated international response. We are infectious disease researchers who have worked on HIV, SARS-CoV-2 and other viral infections.

 

Mpox’s recent history is yet another reminder that an infectious disease in one corner of the world should not be regarded as someone else’s problem, as it can suddenly start to spread fast and far. It also highlights global inequities in resource allocation and access to vaccines, diagnostics and treatments. These were made available in many industrialised countries and helped curb the global outbreak, but are still largely lacking in most of Africa.

 

The 2022 outbreak

 

The disease has been renamed “mpox” but the name of the virus, for now, remains “monkeypox” (MPXV). It is closely related to the smallpox virus. MPXV was considered a zoonotic disease endemic in parts of central and west Africa. It was acquired mainly through close contact with wild mammals, especially handling bush meat, but there was no sustained human-to-human transmission.

 

Only very occasionally were cases seen outside the endemic areas, due to infected travelers or import of infected small mammals. This changed abruptly in 2022: a massive, rapidly evolving global outbreak caused over 99,000laboratory-confirmed cases in 116 countries. At its peak in August 2022, over 6,000 cases were reported each week.

 

This outbreak came as a total surprise: most cases were reported from non-endemic countries, mostly in men who have sex with men who had become infected during recent sexual encounters. Even though most cases were clinically not particularly severe and the death toll stands at just over 200, the global outbreak was declared a public health emergency of international concern by the World Health Organization on 23 July 2022.

 

Fortunately, case numbers soon plummeted due to a combination of behavioural changes and vaccination in at-risk groups. Modern vaccines and antiviral drugs with activity against mpox were made available in many affected high-income countries.

 

These had been developed and stockpiled in the US and Europe, mostly in preparation for a potential bioweapon attack using a poxvirus. The global outbreak in 2022 was caused by clade II of MPXV, which is endemic in west Africa and not as virulent as clade I MPXV, which so far has only been seen in the Congo Basin.

 

That first mpox public health emergency of international concern was declared over in May 2023. Clade II MPXV infections are still occurring globally, but the worst seems over—for now. Complacency would be misguided, as illustrated by the current mpox outbreak that is gathering steam.

 

Upsurge in Africa

 

The African region is experiencing an upsurge in mpox cases which started in 2023. As the continent which includes the areas where mpox has been endemic for a long time, Africa now presents a complex mosaic: Cases arising from the endemic, largely zoonotic, pattern that used to be predominant in the past; cases linked to the 2022 global outbreak, for example in South Africa. Most worryingly, ever increasing numbers of MPXV clade Ib infections reported from the Democratic Republic of Congo.

 

New, more dangerous strain

 

The current clade I MPXV (formerly called Congo Basin strain) is more virulent than the clade II (west African) strain, resulting in a higher case fatality rate. The ongoing outbreak has its epicentre in South Kivu province, eastern DRC, and has the potential to fuel a large pandemic. It has a distinct epidemiological pattern with sustained chains of human-to-human transmission, often via the sexual route. It may have increased transmissibility (we don’t know yet). The virus which causes it is the newly defined clade Ib lineage. It displays mutations that are the hallmark of human-to-human spread that is estimated to have been happening since September 2023. Case numbers are rising rapidly, even though many suspected cases are likely not tested and thus not counted as confirmed. Complicating matters, a commonly used test was found to miss infections with this lineage of the virus.

 

It affects mostly adults. The case fatality rate is higher than it was in the 2022 global outbreak. Already, this outbreak has resulted in mpox cases occurring in several neighbouring countries, including some (like Kenya) with no previous record of mpox.

 

The challenge is enormous. The eastern DRC is an area beset by multiple problems. This includes natural disasters, violence and infectious diseases including measles, cholera and poliomyelitis for the DRC.

 

In recent years the second-largest Ebola outbreak ever took place in the wider area and, despite the availability of vaccines and treatments, posed considerable challenges.

 

What needs to happen

 

A recent article we co-authored in The Lancet Global Health outlines what needs to be done to contain this outbreak and prevent it from turning into an epidemic, possibly even a pandemic.

 

Equitable access to diagnostic tests, vaccines and antiviral treatments requires political commitment and financial investments. Scientific investigations are needed to learn more about exposure settings, transmission routes and clinical presentations.

 

It’s important to find the best ways to make these interventions. We have proposed the establishment of an African-led, multidisciplinary, multi-country Mpox Research Consortium (MpoxReC) in Africa.

 

It should conduct research towards the elimination of mpox as a public health problem. There is no doubt that a disease in one corner of the world can suddenly become a global heath threat. It’s time the global health system woke up to this reality.

 

It has spread from Congo to neighbouring countries, including Burundi, Kenya, Rwanda and Uganda, triggering the action from the WHO.

 

The World Health Organisation on Wednesday declared mpox a global public health emergency for the second time in two years, following an outbreak of the viral infection in Democratic Republic of Congo that has spread to neighbouring countries.

 

An emergency committee met earlier on Wednesday to advise WHO Director-General Tedros Adhanom Ghebreyesus on whether the disease outbreak constitutes a “public health emergency of international concern,” or PHEIC.

 

PHEIC status is WHO’s highest level of alert and aims to accelerate research, funding and international public health measures and cooperation to contain a disease.

 

“It’s clear that a coordinated international response is essential to stop these outbreaks and save lives,” said Tedros.

 

Mpox can spread through close contact. Usually mild, it is fatal in rare cases. It causes flu-like symptoms and pus-filled lesions on the body.

 

The outbreak in Congo began with the spread of an endemic strain, known as clade I. But a new variant, clade Ib, appears to spread more easily through routine close contact, including sexual contact.

 

It has spread from Congo to neighbouring countries, including Burundi, Kenya, Rwanda and Uganda, triggering the action from the WHO.

 

“The detection and rapid spread of a new clade of mpox in eastern DRC, its detection in neighbouring countries that had not previously reported mpox, and the potential for further spread within Africa and beyond is very worrying,” Tedros added.

 

Tedros said on Wednesday that WHO had released $1.5 million in contingency funds and plans to release more in the coming days. WHO’s response plan would require an initial $15 million, and the agency plans to appeal to donors for funding.

 

Earlier this week, Africa’s top public health body declared an mpox emergency for the continent after warning that the viral infection was spreading at an alarming rate, with more than 17,000 suspected cases and more than 500 deaths this year, mainly among children in Congo.

 

Professor Dimie Ogoina, chair of WHO’s mpox emergency committee, said all members unanimously agreed that the current upsurge of cases is an “extraordinary event,” with a record number of cases in Congo.

 

Vaccines and behaviour change helped stop the spread when a different strain of mpox spread globally, primarily among men who have sex with men, and WHO declared an emergency in 2022.

 

In Congo, the transmission routes need further study, WHO said. No vaccines are yet available, although efforts are underway to change that and work out who best to target. The agency also appealed to countries with stockpiles to donate shots.

 

The Philippines has detected a new case of the mpox virus in the country, the first since December last year, its health department said on Monday, adding it was awaiting test results before being able to determine the strain.

 

The patient was a 33-year-old Filipino male who had no travel history outside the Philippines, the Department of Health (DOH) said.

 

“We are awaiting sequencing results and will update once available,” its spokesperson Albert Domingo said when asked about the strain.

 

The World Health Organization on Wednesday declared mpox a global public health emergency, its highest form of alert, following an outbreak in the Democratic Republic of Congo that had spread to neighbouring countries.

 

A new form of the virus has triggered global concern as it seems to spread easily through routine close contact.

 

A case of the new variant was confirmed on Thursday in Sweden and linked to a growing outbreak in Africa, the first sign of its spread outside the continent.

 

Pakistan on Friday confirmed at least one case of the mpox virus in a patient who had returned from a Gulf country, but said they did not yet know the strain of the virus.

 

The new case in the Philippines is the 10th laboratory-confirmed case the health department has detected. Its first case was in July 2022.

 

“Symptoms started more than a week ago with fever, which was followed four days later by findings of a distinct rash on the face, back, nape, trunk, groin, as well as palms and soles,” the Philippine DOH said in a statement.

 

The disease, caused by the monkeypox virus, leads to flu-like symptoms and pus-filled lesions. It is usually mild but can kill, children, pregnant women and people with weakened immune systems, such as those with HIV, all at higher risk of complications.

 

Nepal reported its first case of mpox, also known as monkeypox, in a 60-year-old woman two weeks ago. This came shortly after the World Health Organization declared an end to it as a public health emergency of international concern on May 11, 2023. Since then, however, no further mpox cases have been reported here.

 

For the first time, mpox showed sustained human-to-human transmission through sexual contact in the United Kingdom and worldwide. So far, there is no evidence to suggest transmission of mpox from monkeys or other animals to humans outside of Africa. Hence, I propose to call it “sexually transmitted pox virus” or “STpox virus,” as the patients develop “pox” or “skin eruption” after sexual contact. To avoid negative effects on trade, travel, tourism, animal welfare and cultural, national, social, regional, professional or ethnic groups, the WHO changed the name of the virus from "monkeypox" to "mpox" on November 28, 2022.

 

Human mpox was first reported in 1970 in the Democratic Republic of the Congo. However, it was named monkeypox because it was first detected in 1958 in monkeys kept for research. According to the WHO, the infection can spread through touch, kissing, sexual contact, animals, and contaminated material like sheets, clothes and needles. It can also transmit from pregnant mothers to their unborn babies and through respiratory droplets or short-range aerosols from prolonged close contact. Despite these potential transmission routes, there haven’t been any significant outbreaks of monkeypox in any communities or countries.

 

In India, the community spread of mpox was first reported in a patient in July 2022, with no travel history to countries affected by this viral infection or known to be endemic. However, no massive outbreak of mpox has been reported there since. According to the Centers for Disease Control and Prevention (CDC) of the USA, as of June 21, 2023, a total of 22 confirmed cases of mpox, including one death, have been reported in India. This suggests that through the above-mentioned routes (except sexual contact), the mpox virus cannot easily spread between people.

 

People with multiple sexual partners are at a higher risk of contracting the mpox virus. Studies have found that the majority of mpox patients were found to be involved in sexual activities, and the findings of genital, anal and oral mucosal lesions supported the strong likelihood of sexual transmission. A recent study published in the New England Journal of Medicine on August 25, 2022, revealed that 98 percent of the patients were non-heterosexual, and 95 percent had a history of close sexual contact. A large proportion of mpox cases diagnosed in the UK were found among non-heterosexual men, making it advisable for them to receive the vaccine to protect against this infection.

 

Mpox cases are unlikely to be reported accurately, particularly in Asian countries. This may be due to hesitations surrounding talking about genital or sexual health issues. As a result, in Nepal, sexually transmitted infections (STIs) remain one of the main public health problems. Likewise, every year, hundreds of Nepali youths planning to go abroad for employment are found to be infected with STIs, such as syphilis, during routine laboratory examinations. Most do not have a history of hospital visits, even if symptoms appear. People may not go to health care centres even after developing skin lesions (rashes) in and around genital and anal areas.

 

Moreover, many dermato-venerologists are unaware or reluctant to send samples of suspected mpox cases to confirm the virus. Mpox usually recovers fully in 2–4 weeks without hospitalisation for most mpox-infected patients. Several studies have also shown that most hospitalised patients did not show serious health issues due to mpox.

 

Mpox has been circulating in humans in Africa for at least 50 years and continues to cause illness and deaths, with a fatality rate as high as 11 percent. Despite this, WHO declared it a public health emergency of international concern only after it spread in high-income countries. Studies indicate that the current mpox virus has a lower fatality rate than the one previously spreading in Africa. Therefore, the reason for declaring mpox a public health emergency of international concern in 2022 seems unjustifiable.

 

Diseases in Africa do not receive attention until they spill over to high-income countries. Moreover, the West African clad (subtype Clade IIb), the causative agent of the current world outbreak of mpox (spreading beyond Africa), was found to be far less clinically severe than the original mpox virus version in Africa. Thus, mpox, currently circulating worldwide, should be considered another dermato-venerology disease, and there is no need to panic over this virus.     

 

Nepal reported another monkeypox or mpox case on Friday. A 36-year-old man from Tanahun, who returned from Saudi Arabia on Thursday, tested positive for the deadly disease.

 

“Yes, samples of the suspect, who has been admitted to the Sukraraj Tropical and Infectious Disease Hospital, have returned positive results,” said Dr Yadu Chandra Ghimire. “We collected the samples on Thursday and got a positive report today [Friday].”

 

Health authorities confirmed the first case of monkeypox infection in June last year.

 

A 60-year-old foreign national had then tested positive for the infection.

 

Monkeypox is a rare disease caused by infection with the monkeypox virus and one in 10 infected persons can die. Most common in remote parts of central and west Africa, the disease has now been reported in at least 122 countries . Its symptoms include fever, headache, swelling, body pains, exhaustion, and itchy rashes on the face, hands, and feet.

 

As the disease primarily spreads through close person-to-person contact, public health experts recommend self-isolation and good hygiene to avoid it.

 

According to health officials, the infected person, who is a migrant worker, was sent to the Dhapasi-based Grande International Hospital soon after arrival.

 

Doctors at the hospital suspected monkeypox infection, based on the symptoms, and referred the patient to Sukraraj Hospital.

 

“He had rashes in his private parts and blisters on hands and legs,” said a doctor at the hospital, requesting anonymity as he is not authorised to speak to the media. “The patient admitted to have had sexual contact in Saudi Arabia.”

 

Officials at the EDCD said they will start contact tracing from Saturday.

 

“We have to trace close contacts of the patient on the plane he travelled and the vehicle he used to go to hospitals,” said Ghimire.

 

Public health experts say that even if the rare viral infection is usually mild and most people recover within weeks, the risks should not be underestimated. They stress precautions saying that every disease seen in any corner of the world can come to Nepal due to the high mobility of people.

 

Monkeypox has been a globally neglected public health problem in parts of Africa for decades. The disease came into widespread attention after May 2022, with countries outside Africa reporting new cases.

 

Mpox has since spread globally. More than 100,000 people from 122 countries have already tested positive for the disease. India has recorded at least 30 mpox infections since 2022.

 

Beyond Africa, monkeypox is spreading chiefly in men who have sex with men, putting sexual health clinics on alert for new cases.

 

As the deadline to eliminate malaria approaches, cases of new infections—both indigenous and imported—have risen alarmingly in Nepal.

 

Nepal had committed to achieving ‘malaria-free’ status by 2026. For this, the country needs to bring down indigenous cases or local transmission to zero, achieve zero deaths starting from 2023, and maintain zero indigenous cases for three consecutive years.

 

However, the country has failed to bring down indigenous cases to zero in both 2023 and 2024.

 

Instead, cases of infections–both Indigenous and imported have risen alarmingly, which shattered any prospects of eliminating the disease within the deadline.

 

“Only 16 cases of local transmission or indigenous cases were confirmed in 2023, but we already have more than 20 cases this year,” said Dr Gokarna Dahal, chief of the Vector Control Section at the Epidemiology and Disease Control Division. “We had 649 imported cases in 2023, but in 2024, the number could reach 1,000.”

 

Malaria is caused by Plasmodium parasites. Infected female Anopheles mosquitoes carry these deadly parasites, according to the World Health Organisation.

 

Indigenous malaria cases are locally transmitted, meaning the infected person does not have a history of travel to a malaria-affected country. Officials say that the number of indigenous cases of malaria infection could rise further, as concerned health authorities have been verifying the reports.

 

“Now, it is impossible to meet the malaria elimination target, as we could not stop local transmission,” said Dr Yadu Chandra Ghimire, director of the division. “The new deadline for disease elimination could be 2030, the final deadline set by the UN health body.”

 

Officials say that open borders, budget cuts in the health sector, and mosquitoes moving to higher altitudes due to climate change have hindered Nepal’s malaria elimination goal.

 

They say that of the total imported cases, over 80 percent came from India. Some cases were imported from African countries. Nepali security personnel serving in UN peacekeeping missions in conflict-hit African countries also get tested positive for malaria.

 

Officials say the disease is unlikely to be eliminated in Nepal unless India eliminates it first. They say that due to proximity, and an open and porous border between Nepal and India and unregulated travel of people of both countries, it is impossible to eliminate malaria in Nepal, until the disease gets eradicated in the southern neighbour.

 

Several other factors, including cuts in the health budgets of government and aid agencies and shifts in vectors transmitting malaria to the hills and mountains due to global warming, also pose serious challenges to meeting the elimination target. Apart from this, most health facilities across the country lack entomologists, who are necessary for conducting surveillance.

 

Malaria has also been reported in mountain districts of Mugu, Bajura, and Humla, which were considered non-endemic in the past.

 

Officials say carrying out surveillance in the hill and mountain districts is more challenging than in the Tarai districts due to geographical difficulties.

 

According to Health Ministry officials improved surveillance measures could be a reason for the detection of more cases of infections.

 

Malaria-related deaths had stopped since 2016, but five years later, in 2021, the country recorded one death from the disease.

 

Officials at the health ministry said that until recent years, Plasmodium Vivax, a protozoan parasite, had been responsible for most of the malaria cases in the country, which caused relatively less severe diseases.

 

However, cases of Plasmodium falciparum, which most often cause severe and life-threatening malaria, have been rising. The parasite is common in many countries in Africa and the Sahara desert.

 

Over 1,500 children under five years of age from Banke district have been found suffering from malnutrition–either moderately or severely–in the last five months. The number could be even higher, as not all the children of the age group have been screened.

 

“The number of the diagnosed cases were reported by the health facilities, where ailing children were taken for treatment or reported by female community health volunteers,” said Angad Bahadur Shahi, chief of the Health Office, Banke. “A separate screening programme has been started, which will tell the exact scenario.”

 

Malnutrition is considered a silent health crisis in Nepal. The country has made significant progress in reducing stunting among children under five, which fell from 57 percent in 2001 to 25 percent in 2022, according to the Nepal Demographic and Health Survey-2022.

 

However, the progress is not the same in all provinces. More than 16 percent of the children under five years in Lumbini Province [Banke district is part of Lumbini Province] suffer from wasting—the most immediate, visible, and life-threatening form of malnutrition.

 

Child health experts say a sharp rise in moderately and severely acute malnutrition cases in Banke is alarming, which could hinder attempts to reduce malnutrition and overall hunger problems. The increase in the problems will also hinder the attempts to achieve the United Nations-backed Sustainable Development Goals (SDGs).

 

SDGs, a follow-up on the Millennium Development Goals (MDGs), aim to end poverty, hunger and all forms of inequality in the world by 2030. Nepal has set targets to meet those goals.

 

The country needs to reduce stunting to 15 percent from the existing 25 percent by 2030 to meet the SDGs targets, wasting to 4 percent from the current eight percent and underweight to 10 percent from the existing 19 percent.

 

Wasting or underweight for one’s height in children, if not treated properly and on time, is associated with a higher mortality risk, according to the World Health Organisation.

 

“Severe acute malnutrition is a medical emergency, and such children need immediate hospital admission and treatment,” said Dr Shyam Raj Upreti, a child health expert who is also the former director general at the Department of Health Services. “Detection of moderately acute malnutrition means the problems have started recently.”

 

He said these indicators show that efforts to rein in existing malnutrition problems and end them permanently are insufficient.

 

Malnutrition plays a major role in the under-five mortality rate. The problem also hinders children’s mental development and eventually affects the country’s economic health by weakening intellectual capacity, reducing productivity in adulthood, and increasing vulnerability to diseases, according to experts.

 

Health authorities have taken various measures to address malnutrition problems, including distributing ready-to-use food and running nutrition rehab homes in 24 federal and provincial hospitals. Severely acute malnourished children get admitted and treated in those centres.

 

Experts stressed addressing moderately acute malnutrition problems, which are likely to become severe if not treated timely.

 

“Many people consider malnutrition only a health problem, but it is a multisectoral problem, which needs a multisectoral approach to deal with,” said Upreti. “Treating severely malnourished children does not stop the problems. We need to address the poverty of their families.”

 

Experts said non-health interventions—awareness drives, improved financial conditions of people, their education levels, and sanitation conditions—could go a long way in improving health indicators, including nutrition status.

 

“We have made a multisectoral nutrition plan to address the existing malnutrition problems,” said Lila Bikram Thapa, chief of the Nutrition Section at the Family Welfare Division under the Department of Health Services. “Sincere efforts of all concerned stakeholders can address the existing problems.”

 

Malnutrition affects the physical as well as mental growth of children, which ultimately affects the country’s economic health, according to experts.

 

Germany has detected its first case of the new mpox variant, the Robert Koch Institute for public health said on Tuesday, adding that it viewed the risk to the wider population as low.

 

The patient is a 33-year-old man who was isolated after being admitted to hospital for treatment on Oct. 12, the health ministry in the western state of North Rhine-Westphalia said.

 

The case was detected in Cologne, the ministry said in a statement.

 

The results of more detailed testing showed on Oct. 18 that the patient had the clade 1b variant, a new form of the virus that is linked to a global health emergency declared by the World Health Organization in August.

 

The current outbreak originated in the Democratic Republic of Congo and has spread to neighbouring countries.

 

The patient in Germany is thought to have picked up the virus in an east African country, the state ministry said.

 

"The RKI currently considers the risk to the health of the general population in Germany to be low," the RKI said, adding it was monitoring the situation closely and would adapt its assessment if necessary.

 

The RKI noted close physical contact was required for transmission.

 

The first sign of the virus' spread outside the African continent came on Aug. 15 when global health officials confirmed an infection with a new strain of the mpox virus in Sweden.

 

Two patients in Norway have been diagnosed with the clade 2 variety of the mpox virus, the Oslo municipality said on Tuesday. Clade 2 is a less severe form of mpox than the clade 1b strain.

 

Dozens of feverish patients lay on thin mattresses on the floor of a makeshift mpox isolation ward in east Democratic Republic of Congo, as overstretched hospital workers grappled with drug shortages and lack of space to accommodate the influx.

 

Congo is the epicentre of an mpox outbreak that the World Health Organization declared to be a global public health emergency last month.

 

Vaccines are set to arrive within days to fight the new strain of the virus, while Congo’s President Felix Tshisekedi has allowed a first $10 million disbursement to fight the outbreak.

 

But at the hospital complex in the town of Kavumu, where 900 symptomatic patients have been taken in over the past three months, health workers are desperate for support.

 

“We run out of medicine every day,” said head doctor Musole Mulamba Muva.

 

“There are many challenges we struggle to overcome with our local means,” he said, noting that donations from international organisations rapidly dwindled.

 

Last week there were 135 patients in the mpox ward, children and adults combined, crammed between three large plastic tents pitched into damp earth without a floor cover.

 

Relatives that usually provide the bulk of meals in underfunded public facilities such as the Kavumu Hospital were banned from visiting the mpox ward to avoid contamination.

 

“We do not have anything to eat,” said Nzigire Lukangira, the 32-year-old mother of a hospitalised toddler.

 

“When we ask for something to lower our children’s temperature, they do not give us anything,” she said, coaxing honey into her daughter’s mouth.

 

The head of Congo’s mpox response team, Cris Kacita, acknowledged that parts of the vast central African country lacked medicine and that dispatching donations, including 115 tonnes of medicine from the World Bank, was a priority.

 

TRADITIONAL REMEDIES

 

Mpox causes flu-like symptoms and pus-filled lesions and, while usually mild, it can kill. Children, pregnant women and people with weakened immune systems are all at higher risk of complications.

 

Like other mothers in the Kavumu mpox ward, Lukangira had started improvising with traditional remedies to ease her baby’s pain. They dipped their fingers in potassium bicarbonate or salty lemon juice and popped their children’s blisters. Adult patients did the same to themselves.

 

Most cases came from the town itself and surrounding villages. Two other makeshift mpox wards have been set up in the area.

 

Local health ministry representative, doctor Serge Munyau Cikuru, called on the government to continue pushing for vaccines.

 

Kacita said high-risk contacts and nine priority areas had already been identified for the first vaccination stage.

 

There were 19,710 suspected cases of mpox reported since the start of the year in Congo by August 31, according to the health ministry. Of those, 5,041 were confirmed and 655 were fatal.

 

Movies, music, and memes: Nepal’s pop culture in 2024

 

Picture this: you’re basking under the sun scrolling Instagram one lazy winter afternoon, and there it is a clip from a Nepali movie that’s sparked countless memes. A few swipes later, you’re humming a catchy tune from a TikTok trend you swore you wouldn’t get hooked on. Minutes later, you open YouTube to watch the trailer of a film people can’t stop talking about.

 

This sums up Nepali pop culture in 2024 a whirlwind of viral moments, catchy music, and melodramatic movies that kept us glued to our screens. Let’s take a look at some of those moments.

 

The listing is in no order.

 

Movies: The good, the bad, and the tearjerkers

 

Many movies garnered a fuss this year, but ‘Purna Bahadurko Sarangi’ stole the show. Directed by Saroj Paudel, the film made everyone gather in cinema halls and cry on their way out.

 

Bijay Baral’s effort, combined with a melodramatic showcase of the caste struggles, was enough dough for Paudel to create a feast. Plus, seeing the audience’s reaction on social media played out in the movie’s favour. Apparently, many of us believe that “If it makes you cry, it has to be good.” And it was because ‘Purna Bahadurko Sarangi’ became the highest-grossing Nepali film ever, doing a business of over Rs480 million.

 

Lately, social drama films have been a trend. Every change in theatres looked like the same film where the poster design was slightly tweaked. It seems many filmmakers don't look for new ideas; they look for new social issues. Such films thrive by showing extreme poverty or suffering of the main protagonist.

 

‘Boksi Ko Ghar’ is one such movie where the protagonist’s sorrow and melodrama are over the top. The director, Sulakshyan Bharati, decided his plot device would be an innocent woman’s never-ending troubles. She suffered and suffered and died. In the end, the movie left you feeling empty and enraged.

 

Despite repeating similar patterns, movies about social issues did well this year. This means two good things are happening. First, people are growing weary of societal injustices and want them addressed. A way to do this is through mainstream movies starring popular actors. Second, these films have effectively informed people of our country's social and caste dynamics.

 

The movie industry is definitely doing its part to address social issues.

 

One of the most-anticipated releases of this year was ‘Chhakka Panja 5’, where actor Deepak Raj Giri became ‘Raja’ for the fifth time. The team behind the ‘Chhakka Panja’ series have delivered for many years. But this year, they had more misses than hits. The movie, like always, leans toward both comedy and social satire. But unlike the previous projects, the comedy part falls flat. Although the film achieved a huge commercial success, it has an IMDB rating of 5.6/10. This makes you wonder: how can a movie be poorly received but still do well?

 

The Nepali movie industry is known for producing many average action films, but a couple of such movies this year proved otherwise. ‘Agastya’ is one such movie. Though long, it is gripping and ends on a strong note. The visuals are well-shot, and the acting is pretty good. The other successful movie is ‘12 Gaun’, which ran for a long time in theatres. The improved action scenes are the film's highlight, but its South Indian template robs viewers of originality.

 

Unlike any other films released this year, ‘Shambhala’ is meditative. It is good even without the masala, glamour, and songs made for TikTok. Although many viewers deem the movie confusing and ‘too long,’ it is exactly the kind of film we need. The acting, music, and absorbing story make this movie worthwhile. Indian director Anurag Kashyap and actor Nawazuddin Siddiqui’s arrival for the movie's premiere also caused quite a stir, hyping the movie.

 

 

‘Bom Bahadur’ sneaked into the theatres and, after a few days, left as quietly as it came. The film didn’t even last a week.  Screengrab Via YouTube

‘Behuli from Meghauli’ proved to be a satisfying watch. Swastima Khadka’s portrayal of a desperate woman in love is well-executed. However, the movie did become a victim of the audience’s idiosyncrasies. The very act of going to the theatre, pulling out a phone, recording the movie and posting it online sounds idiotic, but it happens more often. It happens so much that one of the producers, Nischal Basnet, took to social media, saying, “Whoever records the movie on theatre and posts online, their social accounts will be banned. I want to thank the Cyber Bureau for supporting this step. It is a request not to steal intellectual property, and piracy is a crime.” Even the Film Development Board got involved and issued a warning.

 

An article (published on Kalakarmi.com) regarding this particular issue says that these days, ‘TikTok Review’ decides the fate of the movie maker. This means that once people see the reviews of movies on TikTok, they decide whether to watch them or not. Quoting this article, Raj Giri almost sarcastically wrote on Facebook, “If this news is true, then what will happen to our future?”

 

Many viewers see this as a good sign because the public’s review is much more believable to the public.

 

The other film that came and went this year is ‘Farki Farki’. After last year’s embarrassing flop, ‘Chhadke 2.0’, Anmol KC breathed a sigh of relief, as this year’s release wasn’t a total letdown.

 

‘Bom Bahadur’ sneaked into the theatres and, after a few days, left as quietly as it came. The film didn't even last a week.

 

Also, many Nepali feature films, including ‘Gaun Aayeko Bato’ and ‘The Red Suitcase’, went global this year. Overall, 2024 was good for Nepali films, although we await a fresh and innovative approach to cinema.

 

Music: Virals and struggles

 

If 2024 had a soundtrack, it would be ‘Rukum Maikot’. You could not travel by public transport or scroll social media without listening to SD Yogi and Shanti Shree Pariyar’s voices. At one point, it was on global trending on YouTube.

 

Before this, it was ‘Gorkhe Khukuri’ sung by Nischal Dawadi and Pariyar. Then came, ‘Kasmire Pachhyauri’. Social media supported these already catchy songs. Undoubtedly, a song’s popularity on TikTok plays a huge part. Once the song is hit on social platforms, people will slowly gravitate towards YouTube to listen. Let’s just hope that in this pursuit, we don’t start making songs just for people to dance on TikTok.

 

 

 

 

Sajjan Raj Vaidya’s ‘9841’ feels like summer. While the lyrics may be its weakness, the song carries a nice vibe.  Screengrab Via YouTube

Other numerous hits slowly emerged as the year went on. Bhupu Pandey’s ‘Pirai Pir’ is a relatable one. The song describes walking around faking a smile while you fight a hidden turmoil. Yabesh Thapa’s ‘Kasari’ reminds me of the winter in February when the song kept appearing on the feed. The other contrasting song that feels like summer is Sajjan Raj Vaidya’s ‘9841’. Although the lyrics are its weakness, the song carries a nice vibe. Shades of AP Dhillion’s ‘With You’ keeps oozing out of this song. Wangden Sherpa’s ‘Tadha Tadha’ (featuring Prajina) carries a similar summery vibe.

 

When the ‘Chhakka Panja 5’ release date neared, they launched ‘Breakup Song’. The comedic approach used here is refreshing. While there are conflicting views, the song became a huge hit. I don’t know what’s funny, the song or Deepa Shree Niraula asking, “Which one?” when she is informed her ex has died.

 

If you thought we were done, we weren’t. Sushant KC dropped ‘Bardali’, and its popularity has risen dramatically. Sometime later, Ekdev Limbu dropped the soothing ‘Jhim Jhimaune Aankha’. The other soothing song released this year is ‘Udaayo Mann’ from ‘Behuli from Meghauli’.

 

Despite great music and a vibrant scene, the industry has unresolved issues.

 

Some independent artists, Piroo Rana, Amit Jung, and Abiskar Bikram Gautam, spoke about their struggles and how ‘viral’ songs hurt their sincere efforts. Many struggle to get noticed, with viral trends dictating what becomes popular.

 

Besides persisting challenges, the Nepali music scene had a good year. Music producer Aasis Beats became the first Nepali to reach number one on Billboard after topping the UK Hip-Hop/R&B charts with British rapper Central Cee’s song ‘Band4Band’.

 

Another big moment this year was Sonu Nigam’s arrival in the valley. The iconic singer, who has voiced many beloved Bollywood hits, sang for Kathmandu on Wednesday.

 

However, this year, we lost a gem: Bhakta Raj Acharya, also known as Bhajan Shiromani. Throughout his career, he sang 400 songs, including ‘Hajar Sapana Haruko’, ‘Jati Chot Dinchhau’ and ‘Mutu Jalirahechha’.

 

 

 

 

If 2024 had a soundtrack, it would be ‘Rukum Maikot’.  Screengrab Via YouTube

Memes: A means of expression

 

Meme season changes every two weeks. With an infinite loop of content to view online, people keep coming up with new things to laugh at.

 

Most memes circulating on Nepali meme pages are based on what is happening in the country. To understand memes, one must be aware of recent political and social developments. Memes are also the public’s way of saying what they feel.

 

MemeNepal picked up on Nepal’s deteriorating air quality and pollution through a screengrab from the movie ‘PK’. In it, Aamir Khan sits at a railway station after an explosion, his face covered in dust, and the meme reads, ‘My white shoes these days.’

 

Similarly, people fill out the EDV form seeking employment in the US every year, but only a few are selected. A meme emerged to express missing out on the lottery.

 

 

Many people fill out the EDV form seeking employment in the US every year, but only a few are selected.  Via MemeNepal/Instagram

The meme community struck gold when the Nepal Premier League (NPL) began. NPL memes were especially targeted at teams struggling in the tournament. In one of the games, when Lumbini Lions were on the brink, MemeNepal posted a photo of actor Rajesh Hamal wearing the team’s jersey.

 

The meme read, ‘Only person who can save Lumbini Lions.’

 

But who can forget that we began 2024 with the ‘What’s that, brother?’? A remix of this meme even made it to Spotify. I hope this wasn't featured on anyone’s Spotify Wrapped.

 

However, the ‘Chill Guy’ grabbed the most attention this year. In it, there is a laid-back dog with hands in his pocket. This guy doesn’t care about the chaos around him. Why? It is because he is just a chill guy. Period.

 

Philip Banks, the creator behind this meme, wrote on X, “my new character. his whole deal is he's a chill guy that lowkey doesn't give a (expletive).”

 

This meme sparked many conversations, with some saying it is improving men’s mental health. Even El Salvador’s president, Nayib Bukele, posted the meme on X, announcing that he is just a chill guy. The dog even made it out of our devices. Someone painted the meme on a wall in Bangalore, India.

 

 

 

 

The ‘Chill Guy’ became a popular meme. Even El Salvador’s president, Nayib Bukele, posted it on X.  Via Memeosaa/Instagram

However, Banks, who started it all, has decided to copyright his creation. According to a story published in the Hindustan Times, any commercial use of the meme can result in serious legal action.

 

All said and done, Nepali pop culture remained vibrant throughout 2024. Even with countless ‘ifs’ and ‘buts’, the songs made us groove, movies made us cry, and memes made us laugh. Along with their entertainment value, the three core elements of popular culture reflected the public’s

 

 

Shanta Nepali is a filmmaker, entrepreneur, and founder of Shanta Nepali Production.

 

Alongside her filmmaking career, Nepali established the Shanta Foundation to empower marginalised women through art and storytelling. She is also the co-creator of Nepali Female Filmmakers (NFF), an open community that supports women in filmmaking through workshops, grants, and opportunities.

 

She has been to many places, as most of her filmmaking happens outdoors. This allowed her to work with different mountaineers and shoot documentaries. She says, “I used to film videos in high altitudes and climbed a few mountains for work.”

 

Nepali began her career in journalism, transitioning from print to radio and eventually to television. In television, she worked in production rather than in the news, as she felt that her work as a journalist didn’t have much of an impact. She used to work on the crime beat as she loved investigations and solving complex cases. As time went on, she found the work environment to be toxic and abusive. She shares, “I had to work late and meet different people at odd hours and places. The work environment was abusive, and there were many instances when people tried to harass me and take advantage of me.” This led her to choose travel and adventure.

 

Her first outdoor reporting experience was in 2009 with a Nepal Tourism Board project in Dhading while working in Ujyalo FM, promoting new trekking routes and homestays. This trip ignited her passion for exploring untold stories in Nepal’s remote areas, shifting her focus from crime to impactful storytelling. She says, “I discovered my passion for exploring new places, meeting people, and hearing their stories. Instead of revisiting the same individuals and locations in crime reporting, I found fulfilment in sharing ordinary people’s heartfelt stories.”

 

For work, she climbed mountains such as Chulu Far East (6059 meters in Manang) and Everest’s north side (7,000 meters). She even ascended to Europe’s highest peak as part of her projects. “When I’m in the mountains, I reach a different zone and connect with myself differently,” she explains. But later, she realised she didn’t see her future in mountain filmmaking due to its high risk and lack of security and facilities. The risks and physical demands of high-altitude filmmaking—from frostbite to life-threatening snowstorms—eventually made her step back from active mountaineering.

 

One of her harrowing experiences occurred in 2012 while shooting ‘Destination Nepal’ in Taplejung. While exploring the Lumba Sumba Pass, her team was trapped by heavy snowfall for four days. “We lost communication, and our navigation devices failed,” she recalls. Though they survived, some team members suffered severe frostbite. She feels scared just thinking about it and says, “We could’ve died if we were trapped there even for two more days.”

 

Working as a mountain filmmaker allowed her to build connections and gain confidence in her ability to lead projects. Eventually, she started her own production company. She shot travel shows when such content was rare. This equipped her with an understanding of TV show production.

 

Her love for storytelling deepened as she produced shows like ‘Kripa Unplugged’ and ‘Himalaya Roadies’, where she learned to manage large teams.

 

The skills and connections she built in her early years opened doors to international collaborations with platforms like National Geographic and Animal Planet. She even directed episodes for a documentary featuring actor Morgan Freeman.

 

After ‘Roadies,’ she took on more individual projects. With years of experience and exposure, she thought it was time to open a production company, so she started Shanta Nepali Productions in 2017.

 

Reflecting on her experience with international platforms, she highlights the contrasting work styles and mindsets between Nepal and the West. While punctuality and work prioritisation are key abroad, local context and culture play a significant role in Nepal. She emphasises the importance of balancing both approaches based on the situation.

 

Later, she started the Shanta Foundation in 2022 to empower women filmmakers, especially those from marginalised communities, through art and storytelling. A certain percentage of profit made from Shanta Nepali Productions is used in the Shanta Foundation. The foundation gives an award to a female filmmaker every year through the Nepal Human Rights Film Festival. It is running on internal funds only at the present, so they only have limited projects. Nepali says, “We want to do limited projects that are efficient and have an impact.”

 

Nepali Female Filmmakers (NFF) is an open community for female filmmakers which started as a Facebook group. It is a group of more than 200 women filmmakers at present. It began during the Covid-19 pandemic and organises script writing courses and training. It even provides small grants for emerging female filmmakers. It is also an open platform to share opportunities. Recently, she went to Los Angeles for a residency organised by Global Media Maker, which provided a small community grant. Using the grant, she organised a weekly cinematography workshop with NFF.

 

As someone from a marginalised community, Nepali observes that many still live in survival mode, unaware of the value of sharing their stories. Despite being independent and embracing risks from a young age, her journey as a filmmaker and journalist in a male-dominated field has been challenging. She compares it to navigating Kathmandu’s pothole-filled roads during the rain, requiring constant vigilance to avoid setbacks while moving forward. She says, “The outcomes that come while working without expectation give me immense happiness. It led me to start NFF. The increasing number of women filmmakers and the opportunities focused on them also make me happy.”

 

Nepali considers the success of TV shows like ‘Jaat ko Prashna’ and the upcoming ‘Caste Conversation’ key career milestones. These shows address caste issues, highlighting the lack of such discussions in families, schools, and communities. She believes caste discrimination is a human problem, not just a community issue, and her work often emphasises the lived experiences of marginalised people, as reflected in these productions.

 

She is currently working on her first feature film and a documentary. In the future, she wants to explore fiction filmmaking more. Her work has won various awards, including the John B Oakes Award in 2023. One of her short films, Dhye Dreams, was awarded the best documentary at KIMFF and the ICIMOD award. It was also awarded the best documentary at the Nepal-European Film Festival.

 

Nepali emphasises the importance of diverse representation in storytelling, saying, “Only people from certain groups are telling the stories of everyone. This leaves many unable to share their own experiences. People should be able to tell their own stories or be included in the storytelling process.”

 

For aspiring filmmakers, she advises entering the field only if they are passionate. “This profession demands confidence, immense commitment, and daily dedication,” she explains. Every day might look different, but you must consistently work on your craft to refine your skills.” Nepali also highlights the importance of working smartly rather than solely on hard work to make meaningful progress in the industry.

 

On May 10, 2024, 22-year-old Sita Maya Shrestha, a visually impaired student from Kathmandu now studying in New Delhi, found herself in a rare situation: fully immersed in a movie theatre. Why rare, one might question?

 

For Shrestha, this moment wasn’t just about watching a biopic of a visually impaired industrialist; it was about experiencing cinema in a way that she had never been able to in her home, in Nepal. The key difference? The film featured audio descriptions and closed captions—technologies still largely absent in Nepali movies, leaving visually impaired and deaf audiences isolated from mainstream entertainment.

 

In Nepal, where 2.2 percent of the population lives with some form of disability according to the 2021 census, lack of audio description and closed caption in movies and digital content is a glaring omission.

 

The census further breaks down the types of disabilities: 36.7 percent have physical disabilities, 16.88 percent have low vision, 5.37 percent are blind, 7.85 percent are deaf, 7.87 percent are hard of hearing, and 1.56 percent are both deaf and blind.

 

Despite this significant demographic, the concept of accessibility in Nepal is often limited to physical structures like ramps and elevators, neglecting the broader needs of those with sensory impairments.

 

Shrestha’s experience in New Delhi, where she watched the biopic Srikanth with the aid of the XL Cinema app, which provides audio descriptions, contrasted with her experiences in Nepal. Here, she often had to rely on those seated next to her to describe crucial scenes, a situation that left her feeling like a burden and eventually drove her away from theatres.

 

“For the first time, I didn’t have to depend on the person next to me to know what was happening,” Shrestha said. “I could enjoy the movie just like a sighted person. It allowed blind and visually impaired people to mix with sighted people and participate in discussions.”

 

The utility of these technologies extends far beyond personal enjoyment. Audio descriptions (AD) provide verbal explanations of visual elements during gaps in dialogue, making video content accessible to those who are blind or have low vision. This technology helps not only the visually impaired but also those who struggle with focusing on visuals, understanding explanations, or language barriers.

 

Closed captions (CC) convert the audio portion of a video into text, ensuring that individuals who are deaf or hard of hearing can access entertainment, news, and information.

 

Sami Lawati, a 20-year-old visually impaired woman from Kathmandu, has never been to a theatre in Nepal due to the lack of audio descriptions. “People often wonder why they’re necessary,” she said. “But with digital and social media trends being visual, and even educational content being primarily visual, it leaves us feeling excluded,” she added.

 

Realising the need, organisations like Blind Rocks, which have been advocating for inclusive visual content, premiered a music video with an audio description and closed caption in September 2023 at Singhadurbar, in the hall of the National Assembly’s Committee of Sustainable Development and Good Governance. The event, attended by lawmakers, aimed to sensitise them to the importance of accessible contents, said Lawati, who is a board member at Blind Rocks.

 

 

Audience at the premiere of ‘Sikka’ in June 2024.  Photo: Courtesy of Blind Rocks

Madhusudhan Ghimire, 23, head of Blind Rocks’ Talking Video Library, explained their focus on making music videos and documentaries accessible to the blind and visually impaired through audio description and to the deaf through closed captions.

 

“Audio description is new in Nepal,” Ghimire said. “We started with music videos to raise awareness, especially inside the government, and aim to make movies accessible, but limited resources have restricted our efforts to smaller projects.”

 

Ghimire also emphasised that making videos accessible with audio descriptions and closed captions benefits everyone, not just those with disabilities.

 

He compared it to the vibration feature on phones, which was initially designed for people with hearing impairments but is now widely used. “What may seem like an extra function or work for some can be a basic need for others,” he said.

 

However, as per Ghimire, despite many advocacy efforts, including meetings of Blind Rocks with the Film Development Board, Nepal in March 2024, there has been little progress. “They showed positive interest and said they would reach out to us soon, but there has been no response. We need to follow up on the matter as well,” Ghimire said.

 

The struggle for accessible cinema in Nepal is not just about entertainment; it’s about rights. Article 14 of Chapter 3 in the ‘Act Relating to Rights of Persons with Disabilities, 2074 (2017)’, states that people with disabilities have the right to participate in cultural programmes and services, including television programmes, films, dramas, theatres, and cinemas, in accessible formats.

 

Similarly, Article 17 guarantees the right to information in accessible formats, including electronic broadcasting institutions providing news and other programmes as specified by the government.

 

Yet, these rights remain largely limited to paper. “Despite the provisions mentioned in the Act, the rights are not being guaranteed on the ground, even from the government’s side,” said Rahul Chaudhary, a 28-year-old with a hearing disability from Madhesh Province, Dhanusha.

 

Chaudhary explained the importance of closed captions, often confused with subtitles, in providing a complete viewing experience for the deaf and hard of hearing.

 

“Closed captions include all audible information, assuming that the audience cannot hear the audio in the video,” Chaudhary said. “For example, with subtitles, I won’t know if someone is crying or sobbing, or if a dog is barking in the background. Closed captions provide all these necessary details. It may seem insignificant to those who have always been able to hear, but it’s vital for us.”

 

Chaudhary also pointed out that many developed countries, including neighbouring India and China, have incorporated these features into their visual content.

 

 

Screengrab from the accessible music video ‘Sikka’ produced by Blind Rocks. In the video’s closing scene, people with and without disabilities moving in a circle in solidarity.  Screengrab via YouTube

In China, since the establishment of the Guangming Cinema project in 2017, over 600 movies with audio descriptions have been made for theatres serving the visually impaired. In India too, the Information and Broadcasting Ministry issued a directive in 2019 requiring audio descriptions and closed captioning in cinemas.

 

“People often downplay the need for accessible movies or digital content, suggesting it’s less important than basic needs like food or shelter,” Chaudhary said, frustrated. “They argue that accessible roads and transport should be enough. But what about our right to equal participation in information and entertainment? Why should we settle for basic accessibility when we deserve the same access as everyone else?”

 

Even public service announcement (PSAs) audio/video produced by the government lack audio descriptions and closed captions. “Has the government considered how effective an earthquake rescue PSA video would be for visually impaired people without audio descriptions? Alternative solutions are needed,” Shrestha said.

 

Sugam Bhattarai, general secretary of the National Federation of Disabled-Nepal (NFDN) and visually impaired himself shared that in 2017, NFDN had published a Web Accessibility Guide that aimed to help web developers create accessible websites.

 

This guide was endorsed by the government, with a message from then-director general of the Department of Information Technology, Birendra Kumar Misra, encouraging its use across governmental agencies.

 

Bhattarai does acknowledge some progress in web accessibility but highlighted that many government websites remain inaccessible to the disabled. “Improvements like providing headlines and captions have helped, but issues such as the use of non-Unicode fonts and the lack of alt text [alternative text] for images persist,” he said.

 

“Nepal still has a long way to go in terms of web and digital accessibility. The guidelines for text, websites, and images are not fully met, and the concerns about audio descriptions and closed captions for video content and movies have been completely overlooked both by the government and the entertainment industry,” Bhattarai added.

 

The 14th edition of Film SouthAsia (FSA) will be held in Kathmandu from November 21-24, 2024, at Yala Maya Kendra, Patan Dhoka. This biennial festival showcases 47 South Asian documentaries, highlighting the region's diverse socio-political and cultural issues.

 

Nepali filmmakers have a notable presence this year. ‘Devi’ by Subina Shrestha delves into the struggles of a Nepali woman against societal norms. Devi, who was arrested during the civil war and was accused of being a rebel, was subjected to torture and endured the trauma of rape while in custody.

 

Tashi Lhazom’s ‘No Monastery No Village’ captures the complexities of a rural Buddhist community. The documentary explores the plight of the villagers caught between their deep devotion to their heritage and the danger of impending floods.

 

‘Wagging Tale’ by Samagra Shah is a short documentary about Rupak, who has dedicated his life to caring for street dogs.

 

‘No Winter Holidays’ by Rajan Kathet and Sunir Pandey tells the story of two women in their seventies who were once married to the same man. They must forget the past and work together to look after an empty, snowbound village for the whole winter.

 

In ‘Remnants’ directed by Dhanraj Barkote, he returns to his remote mountain village in northwestern Nepal, where he hasn't been for twenty years after losing his parents.

 

FSA aims to amplify critical South Asian voices through film, particularly emphasising Nepal's vibrant documentary scene.

 

‘12 Gaun’, directed by Biraj Bhatta and marking Sameer Bhatta's debut as an actor, became one of the most anticipated Nepali films recently. The buzz surrounding its trailer set high expectations, and I walked into the theatre eager to see what it had to offer. Unfortunately, my expectations were not met even though the actors performed well. The movie felt like a Nepali-dubbed version of a South Indian film, filled with repetitive plot points and overused tropes.

 

The story revolves around a secluded village ruled by the ruthless antagonist, Gajendra (Murali Dhar), who controls the village with the help of corrupt politicians. The plot bears striking similarities to the South Indian hit ‘KGF’, with the central conflict focusing on a couple’s desperate attempt to escape Gajendra’s tyranny for the sake of their unborn child. When the husband is killed, and the pregnant wife curses Gajendra, it sets off a revenge arc, but not before the child is gruesomely murdered in front of the entire village.

 

Fast-forward 22 years, and we meet the protagonist Ajay (Sameer Bhatta) in a fight scene straight out of a South Indian action flick set in Banaras. Ajay saves a woman (Sonu Chandrapal) from gangsters, and she immediately falls for him—a typical love-at-first-sight moment, followed by an imaginary love song. The music and lyrics felt cringy, and again, at the risk of repeating myself, they were heavily influenced by South Indian cinema.

 

The film keeps the audience guessing about Ajay’s true identity, especially since the child was supposedly killed, allowing viewers to piece together their theories. However, this is the movie's only real suspense, and even that falls flat. The eventual revelation is neither shocking nor impactful, as it can be easily predicted long before the truth is unveiled.

 

The film introduces another central character, Arjun (Biraj Bhatta). Initially portrayed as a villain involved in trafficking, Arjun turns out to be a hero fighting against the crime. This attempt to highlight social issues like girl trafficking is noble, but it’s buried under clichéd storytelling and underdeveloped characters.

 

Although Ajay is presented as the main protagonist of ‘12 Gaun’, his character frequently overshadows him, leaving the audience unsure who the story's main hero is. Furthermore, the film centres heavily on its male protagonists, with the female characters playing minimal roles. This sidelining of women characters is another echo of South Indian cinema’s formula, where women often serve as love interests with little impact on the overall plot. However, the character of Nancy Khadka is on the bold side, which is new to Nepali cinema.

 

The movie also features Suleman Shankar (IKU) as the typical comedic relief character whose sole purpose is to inject humour between the intense, action-driven sequences. However, like its Indian inspirations, the humour often feels forced and doesn’t blend well with the film's overall tone.

 

 

The plot is predictable and lacks the suspense and intrigue to keep audiences engaged. While there are efforts to create compelling action scenes that are decent compared to the usual Nepali films, the overall originality needs to be added. The performances of the actors are praiseworthy. Sameer Bhatta's debut acting is far better than that of most well-known Nepali actors. On the other hand, the Hindi dialogue delivered by certain characters felt unnatural and added to the film's awkwardness. In several scenes, the dialogue seemed to be directly taken from Hindi films and merely dubbed into Nepali, resulting in a lack of authenticity.

 

While diverse and new to Nepali cinema, the movie’s background score directly imitated Indian soundtracks. Though it matched well with the scenes and added depth, it failed to bring any sense of novelty. The cinematography, camera angles, and video edits were a step up from many mainstream Nepali films. Still, they couldn't save the movie from feeling like a mimicry rather than an original work.

 

Despite the packed theatre and excitement surrounding ‘12 Gaun’, it ultimately failed to meet expectations. While it represents a technical improvement in Nepali cinema, mainly in the field of action, the overwhelming reliance on South Indian templates and the lack of a unique voice left much to be desired. Fans of South Indian action dramas might appreciate this film, but for those looking for something fresh and innovative in Nepali cinema, ‘12 Gaun’ is a missed opportunity.

 

In short, the movie did justice to its action scenes, setting the bar high for other Nepali action movies, but it falls flat in originality and storytelling. It’s a visually improved film but suffers from an identity crisis, which makes it feel like just another copycat rather than a groundbreaking Nepali movie.

 

Directed by Saroj Paudel, ‘Purna Bahadurko Sarangi’ is a film teetering on melodrama that could even make the most demanding audience reach for tissues.

 

The movie opens up with the daughter asking her father (Prakash Saput) about her grandfather, Purna Bahadur (Bijay Baral). As the son recounts his memories, we witness Purna’s life. Set in a village with a mud house, we meet Purna, often referred to as “Purney” by the villagers, who earns his livelihood by singing and playing sarangi.

 

Through singing and playing his Sarangi Purney, in a musical battle, he wins over his future wife, Batuli (Anajana Baraili), and marries her, leaving his romantic rival, Harka, jealous. Strong scenes in the films bring the harsh realities of society to the forefront, making the audience flinch. Batuli’s family conducting her funeral rites just because she gets married to someone of another caste portrays the harsh realities of society.

 

Years pass, and Batuli gives birth to a child, Kancha (Swayam KC). I want to take a moment to praise KC’s acting. Even at such a young age, his performance is impressive and deserves recognition. Purney wishes the child to follow in his footsteps by playing the Sarangi, while Batuli does not want her child to make a living out of begging. Purna’s desire to pass on the Sarangi to his son reflects pride in their heritage and a resignation from the caste constraints that define their identity.

 

The film's inciting incident occurs when Purna’s father dies, and Batuli leaves Purney, taking Kancha to Kathmandu with Harka in hopes of a better future. Only the son returns to his father. As an audience, I thought the film would portray Batuli in the typical trope of villainising women for prioritising and taking bold actions for themselves. Instead, the movie represents Batuli as a woman who rejects a life of dependency and degradation and chooses instead to carve a new path for herself and her son.

 

Casting Batuli as the female protagonist, the movie, by adding the nuances of realism in the screenplay, tries to uncover instances of patriarchy within a typical family household. For example, Purna is absent from his house during significant occasions, such as when his wife goes into labour and gives birth.

 

The scene depicting Batuli’s labour pain is brilliantly crafted as it portrays that her suffering isn't just from the physical pain of childbirth but also from the emotional ache of her husband’s absence during such a crucial moment.

 

The movie's cinematography is notable as the camera allows each character’s emotional depth to shine. A scene with Batuli washing her face and drinking water is presented as a sexual innuendo hinting at Harkey’s longing to be with her. Similarly, Harkey's henchman’s teasing remark, “Your weapon isn't sharp enough,” highlights Harkey’s inability to assert himself both sexually and socially, which further reflects his failure to win over Batuli.

 

The language and diction of the movie are equally powerful, which provokes emotions in the audience to empathise with the sufferings of the marginalised community. Lines like “Seeudo Bhari Cha Mann Khali" (The forehead is full, but the heart is empty) depict the emptiness Batuli felt in her marriage. Similarly, when Purna falls ill, he tells his son, “Okhati k le kinney, ani parikhcya k le dinchas?" (How will you buy medicine? and how will you pay for exams?) which perfectly encapsulates the compounded challenges that marginalised individuals face.

 

Batuli’s departure from his life catalyses Purna to make choices that challenge the status quo. For example, Purna’s decision to send his son to school goes against the norm that children of his caste should continue the family tradition. Although he receives criticism from his friends, he is determined to educate his son.

 

 

Throughout the storyline, we meet with characters representing society’s contradictions or lacking full character development. For instance, the character of the principal of Kancha's school seems confusing. At times, he supports Purna’s desire to educate his son. Still, at other times, he opposes him, even throwing away the school shirt Kancha is wearing, saying, “Kaapi kalam chyaapne bhaneko ta hami ho, teslai sarangi banjaauna sika hai.” (We are the ones meant to hold notebooks and pens; teach him to play sarangi)

 

After the interval, the movie loses its charm, spoiling what could have been a remarkable film. The plot shifts its protagonist focus from Purna to his grown-up son, played by Prakash Saput. It is no wonder that Saput brings his over-the-top melodrama to the movie, which dilutes the narrative’s initial strength. Kancha excels academically, becoming a doctor and topping exams, fulfilling Purna’s dream of breaking free from caste restrictions. However, the movie’s heavy emphasis on the continued success of Kancha (as he tops his SLC, IAC, and MBBS) to defy caste-based limitations comes across as a bit unrealistic.

 

If one has to think practically, how can a Sarangi player afford to send his son to medical school, even with relentless hard work? The cost of medical school seemed glossed over in favour of emotional appeal, raising questions about whether Purna’s hardships were exaggerated for dramatic effect since such struggles might not be financially feasible.

 

Other elements, like Kancha not hearing from his father for eight months despite the availability of telephones or the villagers performing the funeral rites of Purna without informing Kancha, test the limits of realism. Given the strong connection between father and son, it seems unlikely that Purna would remain in the dark for so long. These narrative choices might have been intended to heighten the drama but stretched believability.

 

With the number of Nepali drama movies I have watched, one common aspect that unites almost everyone is their objective to make the audience cry. With this trend, it often seems as if people judge the quality of a movie with its ability to evoke tears from the audience. The audience seems to adhere to a similar formula when judging a movie’s worth. Videos on TikTok, for instance, of people in tears after watching ‘Purna Bahadurko Sarangi’ showcase this emotional approach, placing the film on a pedestal of greatness by viewers.

 

In this sense, ‘Purna Bahadurko Sarangi’ is a missed opportunity for a more nuanced approach to storytelling the pain of people belonging to the lower caste. For someone seeking a balanced narrative, the movie's focus on exaggerating emotions left me frustrated (or annoyed or vexed).

 

Apart from this, Bijay Baral, previously seen in supporting roles, has finally put his acting skills to the test as the lead character in this film. The movie’s songs are also worthy of appreciation.