The Big Shift


Nepal, being a developing country, has seen remarkable changes in social, financial, and political aspects from the past. Similarly, there has been dramatic variation in the pattern of the diseases from the olden days. Nepal, like many countries, had struggled primarily with communicable disease killers including smallpox, HIV, malaria, leprosy, and tuberculosis. And, while few of these infectious diseases still prevail, it is increasingly high blood pressure, heart attacks, and traffic accidents that are sending people to health centers.

In the past, there have been several outbreaks of smallpox. The death of the son of King Pratap Malla (1641-1674) due to smallpox led to profound sorrow for his wife. The custom of Gaijatra was initiated in an attempt to lighten her sorrow, and to show that she was not the only one bereaved. The last big epidemic was in winter 1963. The disease is thought to be at least 3000 years old, spreading from Africa to India and China. Pockmarks have been found on mummified skulls unearthed in Egypt. During the 19th and 20th centuries, smallpox continued to infect susceptible people. By 1967, the disease remained endemic in 31 countries. However, Pakistan, India, Nepal, Bangladesh, and Ethiopia were declared free of the disease near mid-1970s.

Tuberculosis (TB)
Tuberculosis has been around for centuries in the world. In Nepal, TB spread like wildfire due to overcrowding and joint family arrangements. The fight against tuberculosis started with the building of Tokha Sanatorium, on the northern hill surrounding Kathmandu in 1934. Ever since, there has been continuous effort from all sectors to keep it under control. It is estimated that about 50,000 people develop active TB each year and that about 15,000-18,000 die every year from the disease. The big danger in future years is the combination of HIV/AIDS and TB and the development of multi drug resistance. The capital is very vulnerable because of the overcrowding, poor sanitation, and influx of susceptible persons from rural areas. Awareness among people and prompt diagnosis is very important in combating the disease.

Diseases of modernization
In the present situation, non-communicable diseases (NCDs) constitute a major public health problem, killing more people than communicable diseases. An estimated 50% of all deaths in Nepal are caused by NCDs every year, which is 8% more than a decade ago, according to the World Health Organization. The top killers are cardiovascular disease, followed by diabetes, cancer, chronic respiratory disease, and road accidents. Similarly, the concept of nuclear family and changing social and cultural ideas has led to increased stress and mental health issues in the new generation.

Physical inactivity, sedentary lifestyle, unhealthy diet, and alcohol use lead to increase in blood pressure, blood sugar, and fat levels in blood. The problem of high blood pressure has tripled in the last 25 years with younger people being sufferers and not being adequately treated. Most patients do not want to take medicines, and worry that once started they will not be able to stop. Control of excessive weight and brisk walking or aerobic exercises of 40-50 minutes at least 5 days a week are necessary measures to lessen the risks.
Health in ancient scriptures and books has been recognized as a state where man is in harmony with the internal and the external environment within the body. Stress can bring disharmony in the balance leading to many troublesome psychological and physiological conditions such as heart disease, blood pressure, and anxiety with depression. People still do not feel safe to talk about their mental health issues and are not keen on taking any medical or psychological support. They need to learn a lot about counseling, and about our traditional values of yoga and meditation.

Another very important issue of rapid urbanization and modernization is road traffic accidents. Reckless drivers, poor maintenance of vehicles, and poor roads contribute to more than 10,000 injuries and nearly 2,000 deaths annually. Having proper traffic sense, being thoughtful towards other drivers and pedestrians, and following the traffic rules would definitely help reduce accidents. There has been significant decrease in the incidences due to MAPASE rules, thanks to Nepali traffic police.

Finally, health care facilities, hygiene, nutrition, and sanitation in Nepal are of poor quality, particularly in the rural areas. The poor and excluded have limited access to basic health care due to high costs and low availability. Hence, there has to be complete effort from all sectors to promote health care services and awareness.

Human Immunodeficiency Virus/Acquired Immuno Deficiency Syndrome

Screening for HIV infection was started in the country in April 1986 and the first case of HIV/AIDS was diagnosed in a non-Nepali in July 1988. In the initial days, after first diagnosis, the number of HIV positive cases with development of full-blown AIDS and death had increased. The Government of Nepal’s National Center for AIDS & STD Control (NCASC) estimated that number to be closer to 70,000 in December 2007. According to another report, the prevalence rate was 0.28% in 2012, 0.3% in 2011, and 0.33% in 2010. The prevalence rate looked into 15 to 49 years age group, this group being more prone to be infected with HIV.

Unsafe sex and drug injection practices, civil conflict, and limited adequate health care delivery multiplied the difficulties of addressing HIV/AIDS. There has been substantial support from national and international NGOs for preventing the spread of sexually transmitted infections and HIV infection among at-risk groups; and for ensuring universal access to quality treatment, diagnostics, and support services for infected, affected, and vulnerable groups.

Leprosy is a disease that has affected the world community for ages. In past years, patients were thought as social stigma with the tendency to hide rather than seeking treatment. Institutions such as leprosariums were the last resort, and therapy for the disease was long and very limited. In 1966, with an estimated cases of 100,00 leprosy patients, leprosy control program using Dapsone monotherapy was started as a pilot project. This was expanded and integrated into general health services in 1987, and was followed by sincere efforts from different sectors like government, World Health Organization, NGOs, and INGOs for elimination of leprosy in all the districts.

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