Doctor's advice on rescuing flood victims: What to do if injured?

 Doctor's advice on rescuing flood victims: What to do if injured?

Families at risk should follow the instructions given by the administration and security personnel. Special priority should be given to moving children, the elderly, the disabled and the sick to a safe place.

The floods from Tibet have damaged settlements, roads, bridges and other structures in Rasuwa, Nuwakot and surrounding areas.

Dr. Shreeram Tiwari urged people to check the site of the disaster before going for rescue and to put their safety first.

Dr. Nabin Poudel and Dr. Bipin Nepal suggested not to move broken limbs, apply pressure if there is a lot of bleeding and to quickly take the injured to a health facility.

Kathmandu. Due to the floods from Tibet, there is loss of life and property in the areas around the rivers including Rasuwa and Nuwakot.

The increase in the flow of the Bhotekoshi and Trishuli rivers has damaged settlements, roads, bridges and other structures. The work of rescuing those at risk and moving the displaced to a safe place is ongoing.

Due to the flood, some people may be drowned, swept away, or buried in collapsed structures. In such cases, security personnel and trained rescue teams are deployed to rescue. However, ordinary people at the scene may also try to rescue someone on their own if they see someone in distress.

In such a situation, the first thing to pay attention to is whether the person going to rescue is safe or not. It may be necessary to know.

According to experts, while rescuing from floods, rushing into the water, trying to pull a person who is being swept away, or pulling the injured by the hands and feet can make the condition of the rescuer and the injured more serious.

According to Dr. Shreeram Tiwari, former head of the emergency room at Bir Hospital, it is most important to assess the risk of the scene before going to rescue.

“Before going to help others, your own safety comes first. You should check whether the scene is safe. You should only go to rescue by checking whether the water flow has decreased, whether the ground is in a state of collapse, and whether the house or structure is in a state of collapse,” he says.

According to him, if the rescuer himself gets into an accident while trying to save someone, the problem can get worse. Therefore, the policy should be to first secure the scene and only then rescue.

‘Do not immediately enter the water after seeing someone trapped in a flood’

Even if the floodwaters appear shallow from the outside, if the water flow is still strong, houses or structures are in danger of collapsing, the ground may sink, or electric wires may be in the water, the general public should not go to the scene to rescue them.

As much as possible, security personnel and trained rescue teams should be informed.

According to Dr. Tiwari, the current disaster situation is different from a normal accident. Since a large area has been affected in a short time, there is great pressure on the available rescue and health teams.

‘The current disaster has come at a terrible time on short notice. Health workers are on standby in the hospital. However, there may be problems in bringing the injured to the hospital as roads and bridges have also been damaged,’ he says.

‘When rescuing a drowning person, your own safety comes first’

After seeing a drowning person, you should think about your own safety before approaching him.

If a trained diver or rescue team is available, it is safer to entrust the task to them. People who do not have the necessary equipment and training to go into the water and rescue should not attempt such an attempt.

However, if it is possible to help from a safe place, they can help by informing the rescue team, informing them of the incident, and arranging for the injured to be taken to the hospital.

According to Dr. Nabin Poudel, a consultant neurologist and orthopedic specialist working at a civil hospital, there are many things that need immediate attention even after a drowning person is pulled out of the water.

‘First, you should check whether the patient has a pulse and whether he is having difficulty breathing. If there is something stuck in the mouth, it can be removed,’ he says. ‘You should not treat the patient carelessly or move the body unnecessarily if you are not trained in this.’

If you suspect a broken bone, do not try to fix it yourself

A limb can be broken by falling, being swept away, or bumping into something in a flood. In some cases, the bone may even be dislocated. In such a situation, one should not try to push or pull it inwards to straighten it, says consultant Dr. Poudel.

According to Dr. Poudel, if a limb is suspected to be broken, the injured person should not be taken to the hospital by walking or moving the injured limb. The injured limb should be immobilized using available materials and safely transported to the health facility.

‘In the case of a broken limb, splinting, that is, to keep the broken limb stable, the limb should be placed on available materials such as cardboard, sheets or boards and tied so that it does not move,’ he says.

The purpose of this is not to fix the bone, but to prevent the injured part from moving further while being taken to the hospital and to prevent internal damage.

What should you do if you see a head injury?

If the person has a head injury, is unconscious, is behaving abnormally, or is having trouble moving any part of the body, do not lift or move them unnecessarily.

According to Dr. Poudel, if there is a suspicion of an injury to the head and neck, the body should be kept as straight and stable as possible and taken to a place where there are health workers.

"If there is a head injury, you should lie down and take the person to a health facility without moving their head. If there is a neck injury, if the person's limbs are immobile, they should be placed on a board."

"They should be carried in the same position," he says.

If there is a suspicion of a neck or back injury, do not lift the limbs

Many people who have been injured in an accident lift them by holding their limbs or by two or three people from different directions. But in cases of spinal injury, doing so can be very risky.

According to Dr. Poudel, a person suspected of having a spinal injury should not be carried by pulling, swinging or lifting their limbs.

"Our habit is that if we see a person, we lift them by pulling their limbs. But in cases of spinal injury, we should not carry them that way. It can further aggravate the injury," he says. "If there is any doubt, the body should be moved in the same position on a board or hard flat surface as much as possible."

What should you do immediately if you see a patient bleeding profusely?

When swept away in a flood or falling into a collapsed structure, various parts of the body can be injured and bleed profusely. According to Dr. Bipin Nepal, a specialist in blood transfusion medicine, the first priority in cases of heavy bleeding is to reduce bleeding and take the patient to the nearest health facility or hospital as soon as possible. Applying continuous pressure by placing a cloth or gauze on the wound can reduce bleeding.

“If the cloth gets wet, it is better to apply pressure by adding another clean cloth on top rather than removing it repeatedly and looking at the wound. If there is an object embedded in the wound, do not remove it yourself,” says Nepal.

Similarly, do not move the injured limb unnecessarily or bandage it tightly. Even if a bandage is needed, it should be done as per the advice of the health worker so as not to affect blood circulation, says Dr. Nepal.

Transporting the injured to the nearest health facility

After providing first aid at the scene, the injured should be taken to the nearest health facility as soon as possible. However, since the current flood has also damaged roads and bridges, it may be difficult to bring the injured to the hospital by ambulance.

Dr. According to Tiwari, coordination between local health institutions, hospitals, administration and rescue teams is necessary in such situations.

‘Currently, it may be difficult to bring an ambulance by road because the roads and bridges are damaged. In some cases, we may have to rely on helicopters,’ he says.

According to him, there may be a situation where rescue and air routes need to be coordinated with the Chief District Officer and administration of the concerned district.

‘Rescue’ is not just about pulling people out of the water

When we think of rescue in a flood, we think of the scene of wading into the water and pulling people out. But from a medical point of view, rescue work cannot be done just like that.

Moving the person at risk to a safe place, preventing the condition of the injured from worsening, controlling bleeding, stabilizing the broken limb, not moving the body in case of spinal injury, and getting them to a place where there are health workers as soon as possible are also important parts of rescue.

More importantly, he says, the person who goes to rescue should not risk his own life.

Dr. Tiwari says, ‘From a humanitarian perspective, we all try to go to save another person. But it is not good to go that way if the person going is not safe. When one person is in trouble, another person is also at risk.’

Therefore, if you see a person trapped in floodwaters, the safest way is to first inform the rescue team from a safe distance, understand the situation at the scene, and help them when the trained team arrives.

Hospitals are also on standby

Keeping in mind the possibility of a large number of injured people from the flood, hospitals are on standby for emergency treatment.

According to Dr. Tiwari, health workers have been kept on standby in Trishuli, Rasuwa, Kathmandu and other areas.

But since the disaster area is large, coordination is necessary in all aspects from rescue to treatment.

‘When a patient arrives at the hospital, treatment priorities are determined based on severity. Patients with excessive bleeding, difficulty breathing, unconsciousness, and serious injuries to the head, chest, or abdomen may require immediate treatment. We are on standby,’ he says.

What should the general public remember in the current situation?

Citizens in flood-prone areas should not go to risky places to watch the flow of the river or make videos. Even if the water appears to have receded, the flow may suddenly increase.

Families at risk should follow the instructions given by the administration and security personnel. Special priority should be given to moving children, the elderly, the disabled and the sick to a safe place.

If someone is found injured, first ensure their safety, then check their breathing and level of consciousness, apply pressure if there is a lot of bleeding, stabilize broken limbs and limbs, and if there is a suspicion of an injury to the head, neck or back, take them to a place where there are health workers in a way that does not bend the body.

Why does the body move by itself, and who takes away the control of the body?

 Why does the body move by itself, and who takes away the control of the body?

Physiotherapy, vocational rehabilitation, speech therapy and regular exercise also improve quality of life.

Why does the body move by itself, and who takes away the control of the body?

Uncontrolled changes in body movements are called movement disorders, which are caused by disturbances in the nervous system of the brain.

Many of us have seen the problem of someone's hands constantly shaking, neck twitching, face twitching involuntarily, hands not moving when trying to write or legs moving at night when trying to sleep.

Most people ignore these symptoms as the effects of aging, weakness, stress or vitamin deficiency. But such symptoms can be a sign of a disturbance in the system that controls the movement of the brain. This problem is called 'movement disorder' in medical language, i.e. disease related to uncontrollable movement.

The human brain is the most complex and amazing part of the body. Walking, running, writing, speaking, smiling, eating or even the smallest activities are controlled by the brain in a very subtle way.

Some special parts of the brain, especially the basal ganglia, cerebellum and the nerve network connecting them, are making the movement of the body balanced, smooth and coordinated. When there is a problem in these parts, the body starts to move against the patient's will.

The most common problem is tremor. When drinking tea, holding a spoon or signing, the hands may tremble, sometimes even the head or voice may tremble. Essential tremor and Parkinson's disease seen in many elderly people are the main causes.

Not all tremors are Parkinson's, therefore, an accurate diagnosis is essential. Parkinson's disease is one of the major neurological diseases that increase with age. Symptoms such as slow movement of limbs, body stiffness, hand tremors when resting, loss of balance and reduced facial expression are seen.

Previously, this disease was considered very complicated, but now, thanks to effective drugs, restorative treatments and modern surgical techniques, patients can live an active and dignified life for a long time.

Another important problem is dystonia. In this, some muscles of the body contract uncontrollably, so the neck becomes bent, the eyes keep closing by themselves, the mouth or voice changes, or the hands go into an unnatural state. Its special type is writer's cramp.

In such a condition, the person can do all other work normally, but only after starting to write, the hand becomes stiff, the fingers become crooked and it becomes difficult to hold the pen. This problem can be seen in students, teachers, bank employees, writers and people who have to write a lot.

It is ignored for years as a simple weakness or mental stress, while with timely treatment, good improvement is possible.

In some patients, the limbs of the body move irregularly like dancing. It is called Korea. Slow jerking movements are called athetosis and sudden jerking movements are called myoclonus.

Some children and young people have the habit of blinking their eyes, opening their mouths, shaking their necks or making noises. Such conditions are called tics. Most of these are treatable.

Restless legs syndrome is a problem that many people experience but is less discussed. It has a strong urge to move the legs especially in the evening or when resting at night. The patient feels crawling, tingling, burning or pulling in the legs.

Moving the legs gives relief for some time, but when resting again, the problem recurs. As a result, sleep is disturbed, fatigue throughout the day, irritability and reduced ability to work. Most people don't care, thinking of it as a habit or a gas problem. But it is also a neurological disease and effective treatment is available.

Why do these diseases appear?

There can be many reasons. Changes in brain cells with age, hereditary effects, stroke, brain injury, long-term use of certain drugs, lack of iron in the body, diabetes, kidney disease or other neurological diseases can also cause uncontrolled movement.

Identification and treatment

To identify the disease, the patient's history, neurological examination, blood test if necessary, MRI, CT scan and other special tests are done. The most important thing is not to self-medicate and consult a specialist without delay.

As far as treatment is concerned, it varies according to the disease. Many patients get better with medicine. Botulinum toxin injections are very effective in many patients with dystonia.

Physiotherapy, vocational rehabilitation, speech therapy and regular exercise also improve quality of life. When drugs don't work enough, modern functional neurosurgery offers new hope. Its most successful technique is Deep Brain Stimulation.

In this, a small electrode is placed in a certain part of the brain and a light electrical stimulation is given by a battery connected under the skin. It can significantly improve Parkinson's disease, essential tremor, dystonia and some other movement related diseases by controlling abnormal nerve signals.

This treatment is successfully available not only in the developed countries of the world, but also in Nepal. Deep Brain Stimulation services are regularly available with us, and most patients have seen significant improvement and encouraging results from this treatment.

In society, such diseases are still considered to be the effects of old age, devastation, weakness or mental problems There is a tendency to misunderstand it. Due to such confusion, many patients are deprived of treatment.

The reality is, most movement disorders can be controlled if detected early, and many patients can return to a normal life.

If any part of the body starts shaking for no reason, if it is difficult to write, if the neck or face starts bending on its own, if there are uncontrollable tremors, or if there is a problem of moving the legs at night, it should not be considered normal. It is wise to consult a neurologist or neurosurgeon in time.

Only with a health-conscious citizenry, timely diagnosis and access to modern treatment can we reduce the disability caused by uncontrolled movement disorders.

Why is the coordination of science, spirituality, and human consciousness necessary in education?

 Why is the coordination of science, spirituality, and human consciousness necessary in education?

We have a rich Eastern knowledge tradition, but the ability to communicate with modern science is also developing.

Why is the coordination of science, spirituality, and human consciousness necessary in education?

It is essential to include the human and psychological aspects in health education, including palliative care and the experience of the last stages of life.

Nepal's education system is currently at a critical juncture of change. Artificial intelligence, biotechnology, neuroscience, mental health, and global social change have changed the situation. Education can no longer be just a means of passing exams, getting jobs, or teaching technical skills.

Today's generation needs not only knowledge, but also the ability to understand life, mental strength, moral decision-making ability, compassion, self-discipline, and the skill of remaining balanced in uncertain situations.

Many countries around the world have begun to recognize this need. Mindfulness, stress management, socio-emotional learning, palliative care, positive psychology, end-of-life care, and consciousness-related studies are gradually expanding in schools and universities. Modern science is also studying the relationship between the body, brain, emotions, and behavior in greater depth than ever before.

In such a situation, an important question arises—can Nepal develop an education system that establishes a balanced dialogue between its own knowledge tradition and modern science?

Nepal is not only a country of mountains and natural beauty; it is also an important center of Vedic, Upanishadic, Yogic, and Buddhist knowledge traditions. Thousands of years ago, sages and sages deeply pondered on the fundamental questions of human life, nature, consciousness, health, ethics, and the universe.

The ideas developed in the Vedas, Upanishads, Bhagavad Gita, Patanjali Yoga Sutras, Ayurveda, and other ancient texts about the body, mind, breath, self-discipline, meditation, compassion, life, and death have enriched the knowledge tradition. These texts are still studied today as important sources for understanding the development of philosophy, history, culture, and human thought.

Similarly, yoga is not just a method of physical exercise; it has traditionally been interpreted as a holistic way of life that disciplines the body, mind, and behavior. Practices such as pranayama, meditation, introspection, restraint, and compassion emphasize the inner development of the individual. Modern science has begun to study some aspects of these practices—especially meditation, mindfulness, and controlled breathing exercises—and the potential health effects of these practices. While positive evidence has been found in some areas, many questions are still the subject of research.

Therefore, the need today is not to accept ancient knowledge as superstition or to completely reject it in the name of modern science. What is needed is to conduct critical and evidence-based studies of these knowledge traditions in dialogue with history, philosophy, culture, and contemporary scientific research. It is necessary to creatively connect the wealth of knowledge developed by the sages and sages with modern research, neuroscience, psychology, medical science, and pedagogy. If this can be done, it will give a new direction to the national education system and create the possibility of establishing Nepal's unique identity in the global knowledge community.

This does not mean making religious/religious education mandatory in the curriculum. Nor does it mean presenting any religious or spiritual belief as scientific truth. Rather, it is about creating an environment where the various perspectives that human civilization has developed on life, health, consciousness, and death are studied based on evidence, history, philosophy, and critical thinking.

For example, thousands of scientific studies have been published on meditation and controlled breathing exercises in the last three decades. Some studies have shown that regular meditation practice can help reduce stress, anxiety, and emotional imbalance. There is also increasing evidence that controlled breathing exercises can have a positive effect on the autonomic nervous system, heart rate variability, and physical responses to stress. However, not all claims of all types of yoga or pranayama have been scientifically confirmed.

Therefore, where the evidence is strong, it should be taught based on evidence; where research is ongoing, it should be presented as a subject of open research.

Another important aspect is health education. Today, most students studying medicine, nursing, pharmacy, public health, physiotherapy, etc. receive education focused on the diagnosis, treatment and life-saving skills of disease. This is very necessary. But not every treatment is successful, and every human life ends in death one day. Therefore, future health workers need to understand death not only as a biological event, but also as a deeply human, psychological, social and cultural experience for the patient and his family.

In many universities around the world, subjects such as palliative care, grief management, sensitive communication with patients, end-of-life decisions and death studies are gradually being made an important part of health education. It is time for Nepal to think about including such subjects according to its own cultural context.

Similarly, the body is not only a biological structure that can get sick It is not enough to understand only the brain. Science has proven that thousands of biochemical reactions are taking place inside the body every moment. Chemicals like dopamine, serotonin, oxytocin, endorphins, cortisol, melatonin affect our emotions, thinking, memory, sleep, immune system and behavior.

Nutrition, exercise, sleep, stress, social relationships and lifestyle also affect these biochemical processes. This is why the concept of ‘holistic health’ is becoming important again in health science today.

Eastern yoga and meditation traditions have also emphasized breathing, self-discipline, diet, meditation and mental balance for thousands of years. The relationship between modern science and these traditions is not yet fully established, but the field of dialogue and research is expanding rapidly. Nepalese students should have the opportunity to study both sides from a critical, evidence-based and open perspective.

Another interesting topic is consciousness. Modern neuroscience is studying the brain processes related to consciousness, while philosophy, psychology, Vedanta, and Buddhist thought offer different explanations about the nature of consciousness. So far, a complete scientific explanation of consciousness is not available. For this reason, consciousness studies are developing as an interdisciplinary research field in prestigious universities around the world. Nepal can also explore the possibilities of research, dialogue, and educational development in this area.

Some may understand such a proposal as an attempt to expand religious education. But that is not the real purpose. The basis of the education system should always be the scientific method, critical thinking, evaluation of evidence, and intellectual freedom. No philosophical or spiritual concept should be studied as the ultimate truth, but as ideas developed by human civilization. Similarly, claims that are not confirmed by science should not be presented as scientific facts. This balance makes the education system credible.

Nepal has a rare opportunity. We have a rich Eastern knowledge tradition, but the ability to communicate with modern science is also developing. If these two can be connected on the basis of research, evidence, philosophy and critical thinking, Nepal can present a new educational model not only for its students, but also for the world.

The education of the future should not be just a means of producing good engineers, doctors, teachers or administrators. It should produce citizens who are scientifically minded, culturally aware, mentally strong, compassionate and able to maturely engage with the complex questions of life.

Education should teach technology, but also self-discipline. It should teach science, but also ethics. It should teach research, but also compassion. And along with preparation for life, it should also develop the ability to understand the final journey of life with dignity.

Where the ultimate goal of education is not just to produce successful professionals, but to produce holistically developed, responsible and humane citizens.

Has the role of the health system against gender-based violence been exhausted?

 Has the role of the health system against gender-based violence been exhausted?

One-stop crisis management centers are operating in 97 hospitals across the country to provide health care and legal assistance to victims of violence.

To make the campaign against gender-based violence effective, it needs to be permanently included in the organizational structure of the Ministry of Health and Population.

Any type of humiliating, painful or threatening behavior that occurs or may occur on the basis of gender is gender-based violence. The act of pressure, coercion or arbitrary deprivation of freedom also falls under gender-based violence.

Gender-based violence is deeply embedded in our society. It begins at the fetal stage. Abortion based on gender identity is the first stage of violence. Family and social discrimination during childhood and adolescence is the next stage.

After this, discrimination occurs at the reproductive age, sexual violence or discrimination is deprived of property and resources in old age.

A question that always arises in everyone's mind: Are only women victims of violence?

Answer: ‘No’.

Men and sexual and gender minorities are also victims, which is also confirmed by the data available in our regular health system. About 10 percent of those who seek services from one-stop crisis management centers due to gender-based violence are men. About 3-4 percent are sexual and gender minorities, while the rest are women. Even when analyzing this data, women are more likely to be affected.

Gender-based violence is an issue related to public health, human rights, and social justice. Domestic violence, sexual violence, child marriage, human trafficking, harmful traditional practices, and other forms of gender-based violence have long-term effects on women’s physical, mental, social, and sexual and reproductive health.

More than 60 percent of violence is perpetrated by acquaintances and acquaintances. Violence against women can occur in the public, private, and at any time in life.

There is a gender inequality gap in society. Different gender identities are also a major cause of discrimination. According to the Nepal Demographic Health Survey 2022, 23 percent of women aged 15 to 49 in Nepal have experienced physical violence.

The report states that 8 percent of women have experienced sexual violence in their lifetime. 27 percent have experienced physical, mental or sexual violence in their lifetime. 17 percent of women have experienced violence from their partners in the last 12 months. Of the women who have experienced sexual violence, 58 percent have neither told anyone about their pain nor sought any kind of help.

Similarly, the report shows that 14 percent do not seek help even if they tell someone, such as a friend or neighbor, about their pain. However, 28 percent of women seem to have sought help after violence. Since health institutions are the first contact and service center for victims of violence, the role of the health sector is not limited to treatment alone, but also includes psychosocial counseling, forensic evidence collection, safe referral, rehabilitation and multi-sectoral coordination, implemented by the Government of Nepal through the One-Stop Crisis Management Center (OCMC).

What is the One-Stop Crisis Management Center?

It is a multi-sectoral service system that provides free access to health care and other essential services to victims or affected persons through a single door. Through this, victims are provided with emergency health care, mental health and psychosocial counseling, forensic examination, legal aid, safe shelter, and effective referral services to the police, judicial bodies, and social rehabilitation services as needed.

The OCMC, which operates with the privacy, dignity, safety, and rights of the victim at the center, has been playing a significant role in making the health response to gender-based violence effective, accessible, and coordinated.

Is it necessary or not to provide the role of the health system against gender-based violence in the organizational structure of the Ministry of Health and Food Hygiene?

Currently, 97 hospitals across the country have one-stop crisis management centers, which is a significant achievement. This achievement needs further strengthening of its leadership, coordination, monitoring, and program management in the federal structure. This issue does not seem to have found a place in the newly approved structure of the Ministry.

It is necessary to make policy arrangements to effectively implement the right to health, gender equality, the right to a life free from violence guaranteed by the constitution, and the commitments made by Nepal at the international level.

The main foundations of which are presented below:-

- The health sector is the first and most important service point for victims of gender-based violence, which cannot be done by other sectors.

- A permanent structure is necessary to make services including the One-Stop Crisis Management Center sustainable and institutionalized.

- There is a need for clear leadership and coordination of this issue and the One-Stop Crisis Management Center service between the federal, provincial, and local levels.

- It is necessary to coordinate the role of the policy level to provide integrated management of health services related to gender-based violence, mental health, sexual and reproductive health, and forensic services, etc.

A health structure with clear responsibilities of the health sector is necessary for the implementation of national and international commitments, because since no single sector can cover the campaign against gender-based violence, it is called multi-sectoral.

Sarkar The response that the health sector has so far provided is only 28 percent of the access to the One-Stop Crisis Management Center, which is being provided by the health sector. This tells us that there is still work to be done.

To date, among the sectors that have presented some progress and achievements on behalf of Nepal in international forums on gender equality or gender-based violence, the One-Stop Crisis Management Center system and service is also a major achievement.

If this issue is not included in the structure of the health sector for a policy and coordinating role in the federal structure of such an important service, it will be a leadership crisis for this sector itself.

Health response to gender-based violence is an integral part of the health service system. Therefore, it is necessary to institutionalize it within the permanent organizational structure of the Ministry of Health and Food Hygiene, not as a project or temporary program, with clear responsibilities, sufficient human resources, a sustainable budget, and an effective monitoring system.

Why is genetic testing necessary during pregnancy? Who should get it done, when?

 Why is genetic testing necessary during pregnancy? Who should get it done, when?

Genetic testing is not something to be afraid of. Its purpose is to identify whether the child has any genetic problems in a timely manner.

According to pediatrician and genetic specialist Dr. Surbhi Aryal, although genetic testing is not necessary for everyone during pregnancy, it is considered very important in special situations.

It is natural for parents to have many questions and concerns about the health of the baby during pregnancy. In particular, whether the child has any congenital or hereditary problems has become a matter of interest for many.

In recent years, access to genetic testing has been expanding in Nepal as well, which has made it possible to identify some serious diseases in the womb. Who needs genetic testing? How much does family history affect? ​​When and which tests are performed? Is the test safe or not? And what options are available to parents if a problem is found in the test?

Pediatrician and genetic specialist Dr. A detailed conversation with Surbhi Aryal:

Should all women undergo genetic testing during pregnancy or is it only recommended for special situations?

Not all pregnant women need genetic testing. But in some special cases, it may be necessary if the doctor recommends it. For example, if the pregnant woman is over 35 years old, has had a genetic disease in a previous child, has a history of hereditary diseases in family members, or is suspected of having a genetic problem, then testing may be necessary.

Similarly, if a dual marker or quadruple marker test shows a risk, further confirmatory testing is required. In some cases, even if both parents are ‘carriers’ of a disease, testing of the unborn child is necessary. For example, if both husband and wife are carriers of thalassemia, special testing is done because there is a possibility of passing the disease on to the child.

How much does family history increase the risk of a genetic disease in an unborn child?

Family history is considered very important in genetics. Many genetic diseases are hereditary, so if someone in the family has the condition, the baby may also be at risk.

For example, some diseases, such as hemophilia or Duchenne muscular dystrophy, are X-linked, which means they are usually passed down from the mother's side. If a pregnant woman has a history of these diseases in her siblings or maternal grandparents, she should definitely tell her doctor.

Thalassemia, spinal muscular atrophy, and many other diseases can also cause the disease in her child if the parents are carriers. Therefore, it is important to be open about your family health history with your doctor during your prenatal check-up.

When is the best time to have genetic testing?

Different tests have different times.

NT scan: Between 11-13 weeks

Dual marker test: In the first trimester

Quadruple test: Up to about 20 weeks

NIPT: After 10 weeks

Chorionic villus sampling: At 12-13 weeks

Amniocentesis: After 14-15 weeks

When is the most appropriate test to perform?

Which tests are done depends on the age of the fetus, risk factors, and medical needs.

Which diseases can be detected through genetic testing?

Genetic testing helps identify many types of hereditary and chromosomal diseases. Down syndrome is one of the most commonly tested diseases. In addition, trisomy 13, trisomy 18, and other chromosomal problems can also be detected.

If there is a history of a specific genetic disease in the family or if the parents are carriers, monogenic diseases can also be identified through gene testing. Current technology has developed the ability to detect many types of genetic diseases during pregnancy.

How safe are these tests during pregnancy?

Many parents worry about whether genetic testing will affect the baby or the mother. But most tests are safe. Ultrasound and screening tests using maternal blood do not harm the mother or the baby. They are considered completely safe.

Invasive tests such as CVS or amniocentesis may have a small risk because they use needles. However, the risk is very low when performed by an experienced specialist. If the doctor recommends it, there is no need to be afraid.

What options do parents have if a problem is found in the test?

If the test shows a genetic problem in the baby, the first thing to do is to consult a geneticist, genetic counselor or pediatrician to understand the nature, severity and future of the disease.

Every disease is different. In some cases, special monitoring, additional tests or a plan to deliver in a special health facility may be made.

In some serious diseases, the baby's life expectancy may be very low. In such cases, a decision can be made about the available options with the advice of a specialist.

Is treatment possible after genetic diseases are detected in the womb?

Most genetic diseases are not curable by taking medicines like other diseases. In such cases, the main focus is on supportive therapy, rehabilitation services, regular monitoring and long-term management. Therefore, early detection of the disease is the most important aspect.

What is the access and cost of genetic testing in Nepal?

Until a few years ago, samples had to be sent abroad for many genetic tests. It was a situation where there was no such thing as a genetic test. Now, dual marker, quadruple test, NIPT and many invasive tests are available in Nepal.

However, these services are mainly concentrated in urban areas. They are yet to be expanded to rural areas. When it comes to cost, not all tests are very expensive. Some screening tests start at around Rs. 5,000, while some complex tests may cost more. Therefore, the idea that ‘genetic testing is very expensive’ is not entirely correct.

Does the risk of genetic diseases increase as the mother ages?

As a woman ages, the chances of changes in the chromosomes in the egg increase. This may also increase the risk of chromosomal problems in the child.

Especially when pregnant at the age of 35 or above, the chances of Down syndrome, trisomy and other chromosomal abnormalities are relatively high, so doctors recommend additional tests in such cases.

What are the common misconceptions or misconceptions about genetic testing?

There are still some misconceptions in society about genetic testing. First, the idea that ‘if no one in the family has a genetic disease, the child will not have it either’. In fact, not all genetic diseases are hereditary. Some can even appear in new forms.

Second, the misconception that ‘genetic testing is a test to distinguish between sons and daughters’. Its main purpose is to identify whether a baby has a genetic disease, not to determine gender.

Third, the idea that ‘this test is too expensive for ordinary people to get it done’. Not all tests are expensive and are recommended only according to medical necessity.

How do you see the future of genetic services in Nepal?

The future of genetic services in Nepal is very promising. The services currently available need to be expanded to rural areas, not limited to urban areas.

This requires skilled manpower, infrastructure, and government investment. Over time, this service is likely to become an important part of basic health care.

Finally, what is your message to parents?

Genetic testing is not something to be afraid of. The aim is to identify the child early if there is a genetic problem. If the doctor has advised screening or confirmatory testing, then you should do it with confidence.

If the disease is identified early, it is easier to provide the necessary counseling, planning, and management. Therefore, it is wise to prioritize the doctor's advice without getting confused.

How at risk is Nepal from the Hanta virus that has swept the world?

 How at risk is Nepal from the Hanta virus that has swept the world?

Since the initial symptoms of many infectious diseases are very similar to each other, laboratory tests are helpful in distinguishing the infection.

According to the World Health Organization, 3 out of 8 people have died from Hanta virus seen on a cruise ship.

Although Hanta virus is transmitted through the feces, urine or saliva of infected rats, it has been confirmed that the 'Andean' species can be transmitted from person to person.

Nepal is at risk of Hanta virus, but even if it has not been confirmed as an outbreak, regular testing and research are necessary.

Recently, the Hanta virus seen on a cruise ship has swept the world. According to the information published by the World Health Organization a few days ago (on May 8), 3 out of 8 people have died.

That is, about 38 percent of the infected have died. This human-to-human transmission is considered very rare, but currently, dozens of cases on cruise ships have become a matter of concern and interest.

At the time of writing, the main source of infection is unknown. Information on the circumstances under which it spread from person to person is yet to be released.

Hantavirus can be transmitted to humans through contact with the feces, urine, or saliva of infected rats. Even if an infected rat does not show symptoms, it can still cause death if it infects humans.

The mortality rate of the Hantavirus strain seen in the Americas is many times higher than that of the Hantavirus strain seen in Europe and Asia, which is about 50 percent. Recently, a cruise ship has seen a mortality rate of about 38 percent. The World Health Organization has reported that the mortality rate of the Hantavirus strain seen in Europe and Asia is up to 15 percent.

Although Hantavirus is said to be transmitted only through the feces, urine, or saliva of infected rats, the ‘Andean’ strain of Hantavirus can be transmitted from person to person to some extent.

The Hantavirus strain currently circulating on cruise ships has also been confirmed by gene sequencing to be ‘Andean’. Hantavirus is mainly divided into two types based on symptoms, which also vary according to geographical location.

First, Hanta pulmonary syndrome and second, hemorrhagic fever with renal syndrome.

Hanta pulmonary syndrome is mainly seen in the Americas, while hemorrhagic fever with renal syndrome and Hantavirus are seen in Europe and Asia.

Hanta pulmonary syndrome is characterized by symptoms such as fever, chills and dizziness, muscle pain, diarrhea, nausea or vomiting, abdominal pain, and low blood pressure. If it becomes complicated, coughing, difficulty breathing, chest tightness, and pneumonia may occur.

These symptoms may appear within one to six weeks of infection.

Hemorrhagic Fever with Renal Syndrome Hanta virus causes chills, stomach pain, headache, nausea, blurred vision, red eyes, and later complications, bleeding, and there is a risk of kidney failure.

These symptoms appear one to two weeks after infection, and sometimes up to 8 weeks. This Hanta virus is seen in Asia, especially in countries like China, Korea, Japan, and Russia. Research articles have also been published that Hanta virus has been seen in neighboring India. But there is no information that it has taken the form of a major outbreak.

Is there a risk of Hanta virus in Nepal?

Hanta virus is transmitted when it comes into contact with rat feces, urine, or saliva. Rats are seen in significant numbers in all villages and cities in Nepal.

The number of people who come to Teku Hospital for treatment of rat bites is also high. Most people with such problems do not come to the hospital. There is a lot of contact between humans and rats in Nepal too.

Hundreds of scrub typhus cases are reported in Nepal every year. The main source of scrub typhus infection is the mite found in rats. This also clearly shows that the risk of any infection that can be spread by rats in Nepal is high.

Hanta virus is no exception. In 2017, a tourist fell ill and was admitted to the ICU immediately after returning to his country after visiting Nepal. A research article was published stating that the person had been diagnosed with hanta virus. This was published in an American medical journal in 2020.

This also indicates that the risk of hanta virus is present in Nepal.

However, as in India, there is no confirmation of an outbreak in Nepal yet. Since this infection is not included in routine laboratory tests, we are unaware of the status of hanta virus in Nepal.

Blood tests of tourists infected with hanta virus in Nepal show a decrease in platelet count and an increase in liver enzymes, which the author has experienced is also widely seen in fever patients in Nepal.

However, the possibility of Hantavirus seems to be overlooked when sending for diagnostic tests for limited infections. Since a large number of fever patients are still not diagnosed in Nepal, there is a need to increase the scope of testing.

In the case of a new infection or a first-time infection, testing for that infection should also be included in routine testing. Since the initial symptoms of many infectious diseases are very similar to each other, laboratory testing is helpful in distinguishing infections. Only if the infection is diagnosed can treatment, prevention, and counseling be correct.

Currently, the World Health Organization has stated that the risk of further spread of this virus is low. However, the number of infections on a cruise ship at the same time is so high. And as the problem becomes more complicated and the mortality rate is higher, it cannot be ruled out that the contagiousness and lethality of this virus has increased compared to the past.

Nepal cannot completely ignore the risk of the virus, given the confirmed research on this virus and the frequent contact with rats, which is considered the source of the virus.

If national guidelines were developed in Nepal, prioritizing research on Hanta virus, it would be useful for health workers in diagnosis, treatment, and prevention.

Selling hydropower to Silicon Valley in the name of data centers may not bring real benefits to Nepal

 Selling hydropower to Silicon Valley in the name of data centers may not bring real benefits to Nepal

A few months ago, a well-intentioned development consultant working in Nepal explained to me why Nepal is a perfect fit for green computing (environmentally friendly data centers). His argument was that the country is ideal because of its abundant hydropower, cool mountainous climate, and its location between two of the world’s largest digital economies. He was right in a way. But he failed to understand what all of this would ultimately lead to.

To put it simply, the proposal is to let a foreign company build a data center here, run it on Nepal’s own hydropower, attract foreign investment, and call it green. It sounds like a win, but personally, I don’t think it’s a win.

In green computing, the word ‘green’ refers almost entirely to the source of electricity. Everything else is left out of the equation. Data centers, in particular, are heavy users of water. Large hyperscale infrastructure can consume up to 10 million liters of water per day for cooling.

Nepal is facing a severe seasonal water crisis, and the rivers that feed the hydroelectric system are the same ones that farming communities have depended on for centuries. No one is talking about this water trade-off. That is, no one is talking about how much water is lost to agriculture and locals when water is used to run data centers, or what Nepal has to lose.

In addition, there is another big problem of embedded carbon (the hidden carbon emitted during the manufacture and transportation of goods). The cement and rods used to build buildings, and the large server machines transported by trucks and ships, are also contributing to pollution. These servers break down every three to five years and have to be replaced.

This leads to a huge amount of electronic waste. There is no effective system in Nepal to recycle and reuse such old machines or hardware. So this electronic waste will eventually end up in some corner of the country, where those foreign investors probably won't even notice. There are many other things that are good in Nepal, but our waste management or recycling system is not good.

If we look deeper into the issue of electricity, this argument also proves to be weak. It is true that Nepal produces more electricity. However, in my experience, this is only during the rainy season. Even today, when the water level in the rivers decreases during the dry season in winter, households and industries have to face electricity shortages.

If Nepal provides electricity to these data centers of foreign companies, that electricity cannot be sold to India at a good price. Similarly, domestic industries that are trying to produce something in the country do not get that electricity either. Nor can that electricity be delivered to the remote homes of Karnali, which are still burning kerosene.

What Nepal should not forget is that this country has spent the past few decades in extreme load shedding. The situation was so miserable that even in Kathmandu, the electricity was out for 16/17 hours a day. At that time, the phrase ‘lights gone out’ was always on people’s lips. I remember, I used to use the ‘lights come’ app myself to know when the electricity would come back. After such a long struggle, ending that dark era and letting the electricity that was barely collected run for our own country and not for our own country is like ‘walking in the opposite direction’.

The argument that these data centers ‘create jobs’ sounds the most tempting. But when you dig deeper, this is also the thing that proves to be the most hollow. In a large data center, barely a few dozen people get permanent jobs, and that too in security guards and general maintenance work. The main technical work that pays well is done by specialists, who are often foreigners.

It is true that they bring in big investments. But that money immediately goes abroad. Because that money could be used to buy server machines from America or other Asian countries and pay for software licenses. The government gives various tax breaks to bring such companies to Nepal, which also results in the loss of revenue that the country is supposed to get.

In the end, what happens is that Nepal gives its land, electricity, political support, and even the transmission line or infrastructure. However, all the profits from this go abroad.

My country, Ireland, said ‘yes’ to all these things (offshore data centers and tax breaks). And the situation there over the last 10 years has taught us a valuable lesson. Ireland’s calculations were not entirely wrong. Companies there were only charged 12.5 percent corporate tax (minimum tax). This not only filled the country with data centers, but also large technology companies like Google and Meta opened their European headquarters in the capital, Dublin. This really benefited the Irish economy. However, the story of the data centers is different.

In the 2010s, Ireland became a data center hub in Europe, thanks to its cool Atlantic climate, access to the European market, and low taxes. In 2015, data centers consumed only about 5 percent of the country's total electricity, but by 2023, they were consuming 21 percent. According to AirGrid, the country's national electricity transmission system operator, data centers will consume about a third of the country's electricity by the mid-2030s. .

On the one hand, Ireland has set its own goal of producing 70 percent renewable energy by 2030. But on the other hand, this goal has been undermined by the fact that foreign servers are consuming electricity. The electricity infrastructure there could not cope with this pressure. Due to which, in 2022, the Electricity Authority completely banned the connection of new data centers in the capital Dublin.

The biggest hit has been to the general public. According to the latest statistics (May 2026), the people of Ireland are buying electricity at the most expensive price in the European Union. Citizens there are paying almost 40 percent more than the average price in Europe. Having to pay more than 40 cents per unit, an average household is facing an additional financial burden of about 480 euros (about 82 thousand rupees) per year on its electricity bill alone.

The issue of water has also become another big problem there. Microsoft's data center at Grange Castle (for drawing too much water) has been the subject of so much controversy and scrutiny that when the UN's special representative visited Ireland to assess the state of the clean environment, Microsoft refused to let him enter its data center.

The number of jobs it has provided is no longer a mystery. Even if all the data centers across Ireland were combined, only a few thousand people would be directly employed there. This is an area that alone generates 20 percent (one-fifth) of the country's electricity. Billions have been invested in building transmission lines to deliver electricity to it. These data centers occupy so much land; many homes could be built there for the general public. In comparison, these jobs are a very small and disappointing return.

Ireland had many such facilities that Nepal does not have. Ireland is a member state of the European Union (EU), it has a reliable legal system. On top of that, the first language is English. In addition, the country has decades of experience in making deals with big tech companies. Its tax-free policies have not only brought data centers, but also large offices for companies like Google and Meta. Where tens of thousands of engineers found jobs and a ‘knowledge-based economy’ developed along with server machines.

But that may not be the case in Nepal. Nepal will only get server racks. But people will not get desks to work. Despite such favorable conditions, data centers in Ireland have crippled public infrastructure, caused electricity shortages and provided jobs to only a few people who could not fill a football stadium in the name of employment. In such a situation, Nepal will have to make deals on even weaker ground, the results of which are sure to be worse than Ireland’s.

I have been closely monitoring the actual development of the technology sector here, living in Nepal for more than a decade. As expected, Nepal’s IT services exports will reach $1 billion by 2025, which is more than double in the last three years.

Nepali engineers who studied at world-renowned universities like MIT and Carnegie Mellon in the US are returning home with investments and international networks. Nepal is really building a strong foundation now. This development is not happening by becoming ‘cheap workers’ in the supply chain of foreigners, but by Nepali engineers themselves becoming founders and owners of companies.

However, this so-called ‘green compute’ (foreign data center) plan is nowhere in line with the real progress of the country. It is trying to make Nepal a mere shepherd who provides water and electricity. Where local resources are used, but the real profit is taken by someone else.

Whose law applies to the data of a company kept in Nepal but registered abroad? What if a foreign government exerts legal pressure tomorrow? Such questions are never discussed seriously before an agreement is signed.

Nepal is between two large countries like India and China. Both these countries do not take digital infrastructure (data centers, etc.) built in their neighborhoods for granted. The decision to bring a US company to the Chinese border (Nepal) and set up a data center, or to allow a Chinese company to open a data center at a distance that India considers a security threat, cannot be dismissed for long as ‘it’s just a business decision’. This could quickly become a matter of geopolitical tension.

Once large data center buildings are built here and machines are connected, Nepal’s negotiating position becomes even weaker. Because those machines have to be repaired by foreign experts, and the spare parts needed to keep them running have to be imported from abroad. Thus, Nepal is forced to rely on foreigners structurally.

One argument is always heard in support of this. That is, isn’t it better to run a data center using hydropower in Nepal than to run a data center burning coal (and polluting it) in some other country? However, this is just an illusion created by showing a false alternative. The main question here is not what to use instead of coal. The main question is how Nepal uses the excess electricity it has and how to make good use of this short opportunity to benefit on its own terms.

Sell electricity directly to foreign countries at a good price, open industries in the country and invest in our own infrastructure in a way that benefits Nepalis first. These are the options that bring sustainable development to the country. However, a foreign data center is something that, if it were to arise from here tomorrow, would affect almost all of us. The money will be taken with it.

As I write this article, there is talk of more investment coming in. The first project approved will be called a pilot project. When the second project comes, it will be called momentum. And, when it reaches the third project, it will be given the form of policy.

Nepal has very little time left to decide what kind of economy it wants to build. Nepal must make a clear decision before this opportunity is lost. Otherwise, foreign consultants will move on to another country with favorable conditions.

(The author Jonathan Clark has been living in Nepal since 2015. This article is a translation of his blog. He published a blog titled ‘Who Actually Benefits When Nepal Sells Hydro to Silicon Valley’ on his website on 7 May 2026. He created a software called ‘ConX’ in 2015 and sold it to the American company ‘Houzz’ in 2021. Jonathan currently works as the ‘Director of Engineering’ in the same company. He mostly lives in Lalitpur.)

Can Nepal not make its own vaccine?

 Can Nepal not make its own vaccine?

At that time, the demand for the vaccine against Covid was very high, while India did not have enough vaccine for its own citizens.

It is said that although there was a need for vaccine production in Nepal, policymakers ignored it and a vaccine production company should be established.

The context is during the Covid-19 pandemic. Nepal was importing 2 million Covid-19 vaccines from India. After sending the first batch of 1 million, the second 1 million vials could not arrive. The import of the vaccine to Nepal was stopped due to a court order there.

The main reason for this is that there was not enough vaccine for their country. After this, Delta, which is considered the most deadly of the Covid variants, badly affected Nepal after India. If the second 1 million vaccines had arrived at that time, perhaps many deaths could have been saved.

Similarly, the recent resurgence of Japanese encephalitis has seen an increase in the number of infected deaths in the last few years. Nepal must rely on imports for this vaccine as well. Apart from these, vaccines are considered the surest way to prevent the outbreak of many other infectious diseases.

Past and present experiences of these studies also show that as we enter the 21st century, vaccines are the only solution for new (like Covid) and previously controlled and resurgent diseases (like Japanese encephalitis).

Although some medicines are currently being produced domestically, there is no vaccine production. It seems that policymakers have almost ignored the need for vaccine production.

Is it that Nepal itself cannot produce a vaccine for use in humans? Or has the health sector not yet realized the need for it, been unable to do it, or is not interested?

There are not enough health centers or hospitals in Nepal. Moreover, health centers equipped with the necessary physical infrastructure and resources are even more limited. In such a situation, if any infection spreads or takes the form of an epidemic, there will be a shortage of hospital beds, resources, and health workers.

This increases the risk of patient death. When I was working at Teku Hospital two and a half decades ago, dozens of patients with diarrhea and cholera were admitted every hour during the rainy season.

Similarly, Japanese encephalitis has a high mortality rate, so dozens of people were admitted every week during the mosquito season. Most of those admitted had to die because they arrived at the hospital late.

Generally, the impact of Japanese encephalitis is greater in the Terai. Due to the lack of sufficient hospital beds and manpower there, they were forced to come to Kathmandu.

But later, after the vaccine against Japanese encephalitis was used in Nepal, the mortality rate decreased sharply. At that time, support for the vaccine came from neighboring China. The support itself is not bad, but the question is for how long?

Nepal had expected foreign support for the vaccine during the Covid epidemic. At Nepal's request, India agreed to provide the Indian-made vaccine called Covoshield. However, when the second batch was to be sent, the vaccine could not reach Nepal because the court there had ordered to give priority to its citizens first and not to export it.

This decision is not surprising. Because at that time, the demand for the vaccine against Covid was very high, while India did not have enough vaccine for its own citizens. At that time, 'vaccine diplomacy' was also very popular.

There was a competition among developed countries to develop the vaccine against Covid the fastest. At that time, Covid was present as a great enemy against humanity, and the world was working day and night to develop a vaccine to protect itself from it.

After the Covid vaccine was stopped from India, another neighboring country, China, received the Covid vaccine as assistance. This also shows how important vaccines are during major epidemics.

The role played by the Serum Institute of India during the Covid pandemic is also an example of how much relief can be provided in an epidemic when a vaccine manufacturing company is available.

Although Covid itself is a new disease, scientists were able to develop a vaccine faster than expected due to their hard work day and night. Naturally, the possibility of developing a new vaccine is also greater in developed countries due to the presence of high-quality research laboratories and excellent scientists.

During an epidemic of a highly infectious and deadly disease that terrifies the world, only a limited number of vaccines are produced by limited production organizations in limited countries. In this case, the possibility of sending it to other countries or the rest of the world is also reduced.

But if the vaccine formula or the 'components' used in the vaccine can be obtained and a vaccine manufacturing company is available, India can be taken as an example that vaccine production can be continued. If there was a vaccine manufacturing company in Nepal during the Covid pandemic, human losses could have been prevented to a large extent. It was a situation where we had to sit and stare at foreigners.

It has only been a few years since the Covid pandemic ended. Those moments are still very tragic, especially for those who have lost their relatives to Covid or who have managed to survive severe Covid.

But it has also taught us some lessons.