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Kuber Adhikari, a well-known internet personality, is an Intellectual Quotient (IQ) tutor for the Public Service Commission’s examination. He has been working as a teacher for approximately ten years. His expertise in teaching material related to the intellectual quotient has earned him the title of ‘IQ King’ in the online community.

Adhikari was born and brought up in Dailekh, Karnali Province. This was also where he went to school. Due to political disturbance in 2000 during the Maoist insurgency, his entire family had to move to Kathmandu. From a very young age, he was intelligent and studious. He had always intended to become an engineer. But due to financial constraints to sustain in the capital, he chose to become an army officer instead.

For the post, he had to prepare for the commission’s exam. That year, he put his heart and soul towards the preparation. He and his friends were taking the test at the same time. In the middle of the examination, he was stopped by the invigilator for helping out his friend. “My dreams came to an abrupt end,” he says. 

In the Public Service Commission, intellectual quotient subjects are a part of the selection process. But there weren’t many teachers or resources available in the early years because the IQ program was new in Nepal. Keeping that in mind, he and his friends decided to start their own private preparation center in Baneshwor, Kathmandu, in order to put their collective experience to good use. “I wasn’t planning on teaching for a long time,” he says. But the heartfelt praise from his students persuaded him to reconsider. Later, he realized that he enjoyed teaching and chose to continue.

Back in his days, not many people aimed to get into public service. But that changed after 2015, with many people showing interest in it. With that, the number of students looking for coaching classes grew, which fueled Adhikari’s drive to teach. He once traveled to Dhankuta for Public Service’s orientation in 2017 which was organized by Chintang Rural Municipality for the students who can’t afford paid classes. There, he found that students used to travel three hours by foot to get to the coaching center. He says he finally understands peoples’ desire to get into public service.

Additionally, he felt obligated to facilitate the learning process in all parts of Nepal. As a guest instructor, he has visited about 57 districts for orientations. He says that not every district has proper access to needed study materials or information. However, he says that some districts are working on offering free classes to tackle the situation. 

When students have to come to Kathmandu, their expenses become high. They need to pay for services like hostels, food, class and transportation. To ease their situation, he decided to help people collectively by sharing his classes videos on YouTube channels like ‘IQ Kuber Adhikari’ and ‘Teach for Nepali’ (personal account) for which he has also earned YouTube’s Silver Play Button. He has written a number of books for students’ convenience, including ‘All in one IQ’. It’s one of his bestselling books in the market. 

“Youth involvement in the Public Service Commission has grown tremendously,” claims Adhikari. According to him, lack of job opportunities in the private sector could be the main reason behind this popularity. In addition, he says that the deeply ingrained belief in Nepali society that employment stability comes from either government agencies or by going abroad might have contributed to this growth. 

He states that working at governmental agencies guarantees a secure career. Even during the Covid-19 pandemic when private sectors faced severe financial setbacks, government workers were receiving paychecks. 

According to him, in terms of building a career, teachers are like guardians for students and he strongly believes that teachers should create a friendly space where students can ask anything without hesitation. “Teaching is difficult, as it’s not always about teaching for the sake of teaching. Rather it’s about engaging with students to help them understand better,” he adds. He says that his best achievement as a teacher is the fact that he has never once heard his student complain about his classes being boring in his 10 years of teaching career.

Most people nowadays depend on online platforms for studies. So he is working on improving and modernizing teaching methods using digital platforms and social media. “The app ‘Ambition Guru’ was developed by our team with the aim of aiding students in their preparation for various exams, including those for public service, as well as medical and engineering entrance exams, among others,” he says.

Adhikari draws attention to the struggles of people in rural areas as they don’t have proper access to educational materials to prepare for public service’s examination. For such areas, besides physical classes, he and his team are working on developing innovative ideas for simple learning by making significant investments. He emphasizes that the government needs to be responsible enough to ensure proper internet connection and communication all across Nepal. He expects the government to work on budget allocation for e-learning and different free teaching programs.

Health experts have expressed concerns regarding growing  misuse of antibiotics, as it is threatening to outpace the ability of medicines to cure infections. They warn that the misuse of antibiotics could pose a high risk for pandemics of infections. 

Infection with drug resistant microbes increases the morbidity, mortality, length of hospitalization and treatment cost of patients.

The World Health Organization has also warned that if people do not change the way antibiotics are used now, the new antibiotics will suffer the same fate as the current ones and become ineffective. 

What is antimicrobial resistance?

Antimicrobial Resistance (AMR) occurs when bacteria, viruses, fungi and parasites change over time and no longer respond to medicines making infections harder to treat and increasing the risk of disease spread, severe illness and death. 

As a result of drug resistance, antibiotics and other antimicrobial medicines become ineffective and infections become increasingly difficult or impossible to treat. That means the germs are not killed and continue to grow. Resistant infections can be difficult, and sometimes impossible, to treat.

AMR is an urgent global public health threat, killing at least 1.27m people worldwide and associated with nearly five million deaths in 2019, according to the Centers for Disease Control and Prevention of the United States of America.

Antibiotic resistance can affect anyone and will lead to a situation when there are no antibiotics because the antibiotics which we have will not work. It will affect agricultural products and their livestock too as there has been a wide use of antibiotics in livestock as well. 

The WHO has declared AMR among the top 10 global health threats. It can no longer be addressed by single, isolated interventions with limited impact. 

Factors associated with antimicrobial resistance 

Self-medication, unnecessary use, incomplete dose, inadequate awareness, public preferences, economic condition, professional ethics, unavailability of antibiotics prescribers, unclear law/policies, easy accessibility of antibiotics in pharmacies/medical shops and lack of antimicrobial resistance surveillance are some of the factors causing antibiotic resistance in Nepal. 

Similarly, no evidence-based practices for antibiotic prescriptions, unregistered pharmacies, inadequate laboratory facilities for culture and susceptibility, less motivated health workers for service delivery, over-prescription of antibiotics, and patients not finishing the treatment play an important role in causing antibiotic resistance in Nepal. 

“Multiple pregnancies, abortion and unhygienic birthing centers are some of the risk factors for antimicrobial resistance in females as antibiotics are used during pregnancy,” says Dr Bibeka Shrestha, an expert working in antimicrobial resistance. 

A cross-sectional survey with 516 samples of clinicians, private drug dispensers, patients, laboratories, public health centers and livestock and poultry farmers, conducted by KR Rijal and team in 2017, showed that 79 percent of respondents purchased antibiotics directly over the counter.

Section 17 of the Drugs Act states that no person shall sell or distribute such drugs without prescription of a doctor as categorized not to be sold or distributed without such prescription. 

Condition in Nepal 

Nepal experiences an extremely huge burden of infectious diseases such as respiratory tract infections, enteric fever (typhoid, paratyphoid fever), urinary tract infections and other bacterial infections. Researchers have reported a high burden of drug resistant/multidrug resistant bacteria in the country. 

In a research conducted by Dr Anup Bastola and his team in Sukraraj Tropical and Infectious Disease hospital between 2015 and 2019, Salmonella spp and Shigella spp bacteria were mostly resistant to ampicillin/amoxicillin, cotrimoxazole and chloramphenicol. 

In the research Assessment of Antibiotics Use and its Resistance in Nepal conducted by Nepal Health Research Council recently among 1,079 doctors/health workers, only 32 percent of the doctors/health workers have access to laboratory facility for Antibiotic Susceptibility Testing (AST). Among them, only 49 percent recommend antibiotic susceptibility testing before prescribing antibiotics which is a significant reason for influencing rational prescriptions of antibiotics.

Among the 521 pharmacies, the majority of the drug dispensers (43.4 percent) dispense antibiotics without a doctor’s/health worker’s prescription. Azithromycin (24.5 percent), Amoxicillin/Amoxyclav (20.5 percent), Cefixime (14.8 percent), Ciprofloxacin (14.1 percent), and Metronidazole (nine percent) were the most commonly dispensed antibiotics without prescriptions from doctors and health workers.

Of the 2,122 outpatients, 22 percent did not consume a full course of antibiotics. Similarly, about 10 percent and eight percent of the outpatients consume antibiotics as prophylaxis and consume double dose antibiotics for fastest recovery respectively. Around 22 percent of them save residual antibiotics for treating similar symptoms in future. Additionally, around 28 percent of the outpatients mentioned that they buy antibiotics without doctor’s/health worker’s prescriptions.

About 85 percent of health workers/doctors did not prescribe antibiotics by their generic name. Similarly, more than one-third i.e. 37.8 percent of prescribed medicines were antibiotics which is higher than the WHO set standard. 

In a cross-sectional study conducted by Karuna Kayastha and team at International Friendship Children’s Hospital Kathmandu from August 2017 to 2018 in among 1,443 samples that included urine, pus, wound swab, endotracheal tip, catheter tip, and blood were collected from pediatric patients below 15 years  extended-spectrum β-lactamase (ESBL) production in Escherichia coli and Klebsiella species E. coli (n = 79), Klebsiella pneumoniae (n = 18), and Klebsiella oxytoca (n = 6) were isolated from different clinical specimens. Of which, 64 (62.1 percent) exhibited multidrug resistance.

Among the total of 103 bacterial isolates, 62.1 percent (64/103) were found to be multi drug resistant; the highest multidrug resistant strains were detected in K. pneumoniae (88.9 percent; 16/18), followed by E. coli (57 percent; 44/79) and K. oxytoca (50 percent; 3/6)

“Nepal is one of the major contributors to the growing burden of antimicrobial resistance due to widespread use of antibiotics,” says Dr Santosh Dulal, health expert working on antimicrobial resistance.  

According to the National Tuberculosis Control Centre 350 to 450 multidrug resistant tuberculosis are notified annually. 

Multidrug-resistant TB is caused by a TB germ that is resistant to at least isoniazid and rifampin, the two most potent TB drugs. These drugs are used to treat all persons with TB disease, the center says. 

“There must be rational use of antibiotics. The government must train the health workers on prescribing the antibiotics,” says Dr Bastola, communicable, infectious and tropical disease health expert. 

Nepal has a high prevalence of infectious and communicable diseases that contribute to higher morbidity and mortality. The infectious disease with the highest contribution to premature mortality in Nepal in 2019 were lower respiratory infections, diarrheal diseases and typhoid fever as per the Nepal Burden of Disease 2019. “When there is antibiotic resistance then it poses risk on the treatment of these diseases,” says Dr Dulal. 

Though the government has made a national action plan for antimicrobial resistance (2021-2026), it has yet not been endorsed by the government. 

Methods of prevention

Irrational use of antibiotics and illegal import of medicines need to be strictly controlled. Immunization and vaccination program to prevent and surveillance initiatives on antimicrobial use as antimicrobial resistance involving government agencies, medical personnel, veterinarians, livestock producers/farmers is needed. 

Unless the infection prevention is done there remains the risk for antimicrobial resistance. This is why the government must work to prevent infections. 

There is also a need for strict monitoring and regulations to prevent dispensing of antibiotics, (Colistin for animals) or reserve group of antibiotics from pharmacies without prescriptions.

Mind it

• Do not distribute antibiotics and consume it 
• Pay attention on cleanliness and maintain distance with patients 
• Take all the necessary vaccines
• Follow medical advice 
• Only prescribe medicines upon laboratory reports 
• Properly manage hospital waste 
• Surveillance, monitoring and research
• Coordinate at different levels
• Keep AMR on curriculum of schools and colleges
• Strict punishment for violating regulations
• Make treatment guidelines available to clinicians and health workers

Weavers are renowned for their remarkable nest-building skills. These small birds create intricate nests, often resembling woven baskets, using grasses, leaves, and various materials. These nests serve as excellent protection from predators and harsh weather conditions.

The tale of a weaver underscores the creativity and ingenuity of nature, inspiring humans to cherish and learn from the world around them. It also highlights how observing animal behavior can spark innovative ideas in human architecture and design.

Within weavers’ colonies, complex social structures exist, with dominance hierarchies among males impacting their access to resources and nesting sites.

Some weaver bird species nest in colonies, resulting in a captivating spectacle of numerous nests in close proximity. This communal nesting behavior offers collective vigilance against predators, ensuring better protection.

Similar to humans, male weavers showcase their nest-building prowess as a courtship display to attract females. The more elaborate the nest, the higher the chances of attracting a mate.

Females evaluate males based on the quality of their nests, as it signifies the male’s genetic fitness and ability to provide a safe environment for their offsprings.

Weavers use various vocalizations to communicate with one another. These sounds convey warnings about predators, signal social interactions, and establish territorial boundaries.

Certain weaver bird species are migratory, embarking on long journeys to find suitable breeding and feeding grounds. Every year, when spring season starts, weavers migrate from the Tarai region of Nepal to the bank of Balkhu river in Kathmandu. They reproduce and return in mid-summer.

Once the eggs hatch, both male and female weavers take care of the newborn. They feed the chicks and protect them from potential threats.

In this generation, depression and anxiety have become major issues and it’s high time we take care of our mental health. We should be cautious about mental health as we might not be aware of the potential triggers. Since anyone might go through mental health issues, priority must be given to it. When I experienced it, I understood it. 

Life was going well. I was having a good time and hanging out with my friends and family. Although there were highs and lows, I was satisfied with myself. As I mentioned, everything was going smoothly but one morning I woke up with a heavy pounding heart and didn’t know what was going on. I woke up because I felt a kind of shiver go through my body. I had a strange feeling as I was shivering rather than sweating during summer. The fear was there.

I looked around my room and suddenly felt like I didn’t belong there. I felt detached from myself, the surroundings, and reality. It was a battle with myself. I realized I was having anxiety and what felt like a panic attack. From that day, I started having anxiety frequently which was not normal at all. I thought I could take care of myself but it got worse. In time, I felt completely detached from myself and the world.

Voices were louder than before. I started feeling lightheaded, experiencing brain fog as I felt heavy and numb. I was having trouble thinking. When I was anxious, there used to be pain in both of my hands, like hundreds of needles were being stabbed inside them and my body temperature and heart rate used to increase. It felt unreal. I didn’t know what was going on. I used to cry a lot. When I looked in the mirror, I once had the impression that I didn’t know who I was, that something wasn’t right. That was the time I decided to go see a psychiatrist.

I was already experiencing anxiety while waiting for my turn in a hospital because the voices around me seemed loud and seeing so many people made me feel uneasy. During my session with the psychiatrist, I broke down in tears as I explained to him that if I have to endure these feelings for longer than a month, I don’t want to live. He advised me to give it some time and to keep a positive outlook because everything would be okay. He also recommended medications.

After the visit with the psychiatrist, I was diagnosed with anxiety disorder and depression. Every day was a struggle. I still felt like time was moving extremely slowly, that there was no point in life, and I lacked the energy to face another day during that time. As time went by, I started taking the medications and also went for counseling, and that really helped. Although I haven’t totally recovered yet, I’m getting better. However, there are times when I feel terribly depressed. 

Every day, I suffer mentally in different ways. I occasionally think I’m doing okay, but after a while, I start to doubt my abilities and start feeling worthless. Knowing my symptoms, I used to divert myself if I felt anxious. Walking and reading books were helpful. I used to stand up and walk whenever I felt anxious, and it helped. From my suffering, I got to learn so many things about mental health and how vital it is that we look after our mental health. And it is so important to prioritize ourselves.

Furthermore, to all those suffering mentally, I would like to say that I know it’s super hard but this will pass for sure. At some point, you may feel like you can’t make it and there is no hope but always respond to negative thoughts with positive ones. I know it may feel like a war in your mind but at least try and push yourself. Despite how simple it may seem, this is exhausting. Accepting that you have a mental disease is the first step towards overcoming it. That is why don’t forget that you are doing this for you. There’s always room for hope.

Physical and mental issues exist. Everyone takes medication when they experience physical difficulties, so it’s crucial to consider doing the same if you are experiencing mental issues. Additionally, keep in mind that seeing a psychiatrist and/or a counselor is not a huge thing, and taking medication if necessary is acceptable. This is just a simple reminder that we will get through this and that you aren’t alone.