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Loss of a loved one is deeply emotional. This obituary paper is about Professor Gregory G. Maskarinec (May 16, 1951-June 16, 2022), a true friend, an academic intellectual and an honest researcher of medical anthropology. Working with him and sharing ideas with open mind was a great opportunity for me and many scholars in Nepal. Based on collaborative work, interaction and the interview with Professor Gregory, in his remembrance, I have highlighted his academic background and work experiences, friendship and collaborative work, my privilege and opportunities to write about him for his professorship and some of the dreams that could not happen due to his sudden demise. My deepest sympathies are with his family. [ABSTRACT FROM AUTHOR]

Qualitative research is crucial in exploring the complexities of human experiences, behaviors, perceptions, and social phenomena. It is particularly effective in generating hypotheses, exploring new research topics, and capturing the subjective aspects of human interaction and experience. It emphasizes social, economic, and political context, cultural nuances, and participants' voices for comprehensive and holistic understanding. Determining an appropriate sampling method and adequacy of sample size remains a challenging aspect of qualitative research methodology. This paper highlights the key issues related to sampling approaches, sample size, and trustworthiness in qualitative research. [ABSTRACT FROM AUTHOR]

Nepal has been practicing the federal system in health since the promulgation of the constitution in 2015. The new threetier system of one federal, seven provincial and 753 local governments have set up ministries, departments, and health units at each level. Less than four years into this system, the country faced the COVID-19 pandemic. The pandemic created both opportunities and challenges for the federal health system. This study aims to identify those factors from the viewpoint of implementers of the health system. After an extensive literature review, exploratory qualitative research was carried out with twenty public health workers and elected representatives from all the tiers of government, including the federal ministry and governments of Lumbini Province. The data was analyzed using the R package for Qualitative Data Analysis (RQDA). Thematic analysis was performed using the World Health Organization's six building blocks of health system as an analytical framework. The participants highlighted many opportunities after federalization in Nepal. The presence of government closer to people helped to make policies and plans as per local needs. Decentralized power to make decisions at the local level made human and financial resources readily available to local governments leading to better service delivery at the time of need. In contrast, the challenges were difficulty transiting into the new system of governance, poor coordination among the different government tiers, and the lack of local expertise to manage and lead the health system during severe constraints posed by the global pandemic of an unprecedented nature. The study showed that the federalization in Nepal has met the goals of devolution of the power structure and better health system management. However, there are specific areas of improvement to ensure a more functional health system. [ABSTRACT FROM AUTHOR]

There is a long history of menstrual restrictions, stigmas and taboos across nearly all religions, regions and cultures. The origins of myths and misconceptions have often been linked to various religious texts and women were prohibited from participating in normal life while menstruating. Culturally, in many parts of the world, menstruation is still considered 'dirty' and 'impure', although this is not true. Menstruation is often associated with feelings of shame, horror, danger, disgust, and sin. There have been initiatives to change the perception that menstruating women are not polluted, thus bringing an end to traditional customs such as not being allowed to sleep in their own home or touch male relatives to more extreme forms of isolation such as being confined to the 'cow shed'. This paper draws on research conducted between 2019 and 2021 under a British Academy-funded Global Challenge Research Fund project entitled 'Dignity Without Danger'. The study employed qualitative methods, covering 160 qualitative interviews and 16 focus group discussions among different caste and ethnic groups in three different ecological areas (mountain, hill, and tarai) in seven provinces in Nepal. Today, menstruating women have relatively more freedom to discuss this topic due to increased awareness that menstruation is a natural process. However, our study shows there are still differences between cultures, religions, castes and ethnic groups, and regions, and a single narrative does not represent the issues related to menstrual exclusion in Nepal. The study shows that many menstruating girls and women are still restricted in a number of diverse ways, from not offering prayers, entering or worshiping in temples, touching holy books, and participating in religious rituals. In some areas, more extreme practices persist which discriminate against women when menstruating. Our research highlights that education and an interdisciplinary, multisector approach are required if menstrual discrimination is to be addressed. Finally, this paper emphasizes the necessity for providing correct knowledge about menstruation to the entire community including elders, males and religious leaders as well as adolescents and young girls. Such knowledge will help them practice safe and hygienic menstrual practices, challenge and reduce their traditional beliefs, misconceptions and restrictions regarding menstruation that are essential to achieving menstrual dignity. [ABSTRACT FROM AUTHOR]

Most epidemiological studies focus on the direct causes of diseases while wider, social causal factors are ignored. This paper briefly highlights the history of major epidemics and the role of Anthropocene and Capitalocene for the emergence and reemergence of pandemics like COVID-19. Books, journal articles, and statistics offer information that can explain the phenomena. A historical inquiry can inform us about the fundamental causes of pandemics. Human security and ecology are intertwined, and the global effect of pandemics responded to at the national level is inadequate. The lessons from the past and present help us devise effective ethically and socially appropriate strategies to mitigate the threats. If the present crisis is not taken seriously at the global level, the world has to face more difficult challenges in years to come. [ABSTRACT FROM AUTHOR]

Professor David Sanders, a well-renowned academic, consummate activist and commentator, and a great public intellectual, passed away on 30th August 2019 at the age of 74. He was a champion of economic and social justice, being one of the pioneers who argued for the importance of primary health care. He emphasized the importance of involving communities, particularly that health workers should be accountable to communities and play a crucial role in promoting health and preventing disease. This paper highlights David Sanders' contribution in public health teaching, research, and advocacy for almost five decades. [ABSTRACT FROM AUTHOR]

In focus is the experience of being a Tuberculosis (TB) patient in the mid-west Tarai of rural Nepal. The information derives from a longitudinal qualitative study between 2005 to 2017 in one and the same community. The findings show few changes in the experience of being a TB patient. The availability of anti-TB medicine free of cost within the government health services was greatly appreciated. The cause of TB, ways and means of transmissions, and the need for preventive measures, however, were not well understood. In the case of Child-TB, the expectation of numerous visits to the government treatment centre for the picking up of medicines was a strong deterrant. In consequence, most child-TB cases were diagnosed and treated within the private sector. The distribution system of the medicines, particularly within the government system, clearly added to the burden of being a TB patient and much would have been gained had the arrangement been more patient-friendly, a difference which most likely had also resulted in more children being treated within the public services rather than within the money-geared private sector. Various misunderstandings about the cause/s of the disease need to be addressed. And, much would be gained was the central directive of "patient support", truly implemented and was a true "two-way communication" to take place. [ABSTRACT FROM AUTHOR]

Prolonged delays between first symptoms and diagnosis easily result in more impairment in newly detected leprosy patients, and aggregate negative consequences for individuals and their families. In cases of infectious leprosy, longer delays increase the risk for the spread of the disease. Limited studies have been carried out to explore the causes for delays in Nepal. This is a community level qualitative study conducted in Dang district. The information was obtained through in-depth interviews with 8 leprosy affected persons, 8 contacts, 8 community members and 5 service providers in Dang district. Skin patches were regarded as a simple skin disease, in particular of paucibacillary patients who had a limited number of skin lesions and no nerve damage. A local medical shop was the first choice for medicine to treat skin conditions. Delays in diagnosis of leprosy occurred at many stages from the development of the symptoms to consultation of health care services. The use of traditional medicine, a belief in self-cure and visit to traditional healers, and misdiagnosis (a disease other than leprosy by the health worker) and inadequate knowledge about the disease and its early symptoms were the main factors that influenced the delayed diagnosis. Delays accumulated as the result of series of help-seeking actions that reflected local socio-cultural beliefs and practices. Misdiagnoses could be reduced if adequate information on leprosy is given to community people and health service providers. Specific interventions are needed to promote knowledge and a good attitude among contacts and community members. To reduce patient delay, public health promotion is needed to increase the awareness of leprosy, and the health service delay should be reduced by improving diagnostic skills in public and private sectors. Addressing both components of delays will decrease the time to diagnosis and ultimately the extent of transmission of the disease and reduce the risk of nerve function impairments. [ABSTRACT FROM AUTHOR]

In focus is the emic perspective on cause/s of tuberculosis. The ethnographic data is from two major studies in one and the same community in the Hill district of Pyuthan, in the Mid-Western Development Region. The findings show a pooling of old and new influences with a dazzling plurality of thoughts and ideas within a framework of great uncertainty. Moreover, changes in perceptions over the last decade and an half are quite marginal. For health workers to function efficiently the perceived causes of patients and their communities need to be understood and taken into account. [ABSTRACT FROM AUTHOR]

Tuberculosis (TB) constitutes one of the major public health problems in Nepal. Our theoretical framework, in this paper, is to explore people's understanding of the culturally constructed reality, the local explanatory model, for causes of Tuberculosis. The ethnographic data were collected from 'Solubang' village of Pyuthan district in 2005 and 2012/13. The finding shows that assumed and suggested cause(s) of TB are multiple but most often within a framework of great uncertainty. Compared to 2005, people were better aware of the need for timely treatment in 2012/13. The arrival of the biomedical anti-TB medicines has changed the situation for the better and is widely recognized but perception on causes of TB and its prevalence have not changed drastically, and mortality rates have not decreased at the speed hoped for. [ABSTRACT FROM AUTHOR]

The issue of surrogate motherhood has started public debates in Nepal. With surrogacy a child becomes the object of a legal transaction, while the surrogate mother is used, in effect as an incubator, and the hospital declares commissioned parents' name of a newborn child. The poor women in low-income countries have been used as means to compensate for the reproductive deficiencies of high-income infertile parents. Do purchasing cheaper services, receiving surrogates easier, and having the possibility of gender selection, all in the poor countries, support 'surrogacy tourism' or is it a kind of exploitative relationship? Until today, Nepal's laws do not have any specific provision to deal with surrogacy and, therefore, it is urgent to address the challenges with commercial surrogacy and establish a precise legal policy. [ABSTRACT FROM AUTHOR]

There have been changes in the economic and social relations in Nepal. The market has been providing opportunities for choosing livelihood options. Livelihood diversification, particularly non-farm, appears to be growing in extent and importance in recent years. Although local wage labor has increased in farm sector, agriculture is not a path out of poverty. The relationship between caste and hereditary occupations has been less significant and there has occurred a significant shift in the bases of power. There is an increase in class consciousness and a decrease in caste consciousness; wealth is replacing birth as the basis of social power and prestige. [ABSTRACT FROM AUTHOR]

This paper highlights the informal inner circle network approach to maintaining relationships and reciprocating favors within a system that significantly affect the performance of incumbents in formal bureaucratic organizations. While this is a general sociological problem in any society, this article deals with how afno manchhe behavior is manifested in Nepal. Without afno manchhe relations, one risks marginalization, disappointments and failures in one's struggle to realize important goals in life. In such a situation, the malfunctioning of administration and dissatisfaction arise at every level. There is thus a significant relationship between one's position in afno manchhe networks and inclusion-exclusion processes. This of course has consequences for the widespread practice of corruption in Nepal. [ABSTRACT FROM AUTHOR]

Caste as a system of social stratification was an encompassing system in the past. There was reciprocal system of exchange goods and services. With time, occupation and mode of generation of livelihood of various caste groups changed, and the traditional form of jajmani system fizzled out. This paper provides an account of changing perspectives of caste relations in social science writing and political discourse. The discourse of caste has been shifted from ritual hierarchy and social discrimination to an instrument to mobilize people for economic and political gain. [ABSTRACT FROM AUTHOR]

One of the core concerns of medical anthropology is to explore how people in different cultures and social groups explain the causes of ill health, the type of treatment they believe in, and to whom they turn if they do become ill. This article focuses on the understanding of illness causation by the Newars in Kirtipur and their concern about biological and socio-cultural aspects of healthy behavior, and particularly with the ways in which they have been coping in everyday life. The basic method of data collection for this study was formal and informal discussions with the elderly Newar males and females, followed by discussions with youths to explore the variations in their perceptions. The findings show that the understanding of illnetiology is multi-causal. The individual, natural, social, and supernatural causes are not mutually exclusive but are usually linked together in a particular case. In any specific case of illness, moreover, people's explanatory model varies in how they explain its etiology. [ABSTRACT FROM AUTHOR]

Various studies show that more than 600,000 women in Nepal are suffering from prolapsed uterus and that 200,000 of those needed immediate surgery. Many of the women with prolapse could recall the exact moment they first felt the prolapse and found difficulty to share the problems due to fear of stigma. Stories ranged from seven days immediately after the first delivery to after the birth of the fifth or sixth child; during cooking rice to sneezing and long coughing; fetching water in a big bucket to working in the field. If detected at an early stage, uterine prolapse (UP) can be controlled by pelvic exercises. For severe cases, the remedy is to insert a ring pessary to stop it from descending which has to be changed every four months. In extreme cases, uterine tissue protrudes from the vagina causing extreme discomfort. The only remedy is hysterectomy in which the uterus is surgically removed. The operation costs are about NRs 20,000. The Government of Nepal and other donor organizations have allocated funds to provide services to about 10,000 to 12,000 women suffering from uterine prolapse as humanitarian support each year and services are likely to be expanded in future. Women suffering from UP have not been able to get benefit from such assistance due to deep rooted socio-cultural perceptions and practices. The number of suffering women, on the other hand, would not decrease from existing curative management policy without hammering the root causes of UP. Moreover, a clear vision and strategy is needed to shift from humanitarian aid to a more sustainable public health intervention. [ABSTRACT FROM AUTHOR]

There has been a long debate in the literature over whether the caste system is a unique social phenomenon or simply one manifestation of processes of social stratification which have a wider generality. New divisions and differentiations have been giving rise to new antagonism and social norms. Caste is not today what it was before 1950; and it has not become completely class or replica of it in Nepal. [ABSTRACT FROM AUTHOR]

About 35 percent of the total demand for medicines in Nepal is covered by Nepali Pharmaceutical companies, and such companies are moving ahead for producing different kinds of medicines. The Government of Nepal, Department of Drug Administration (DDA) has formulated different regulations and guidelines to ensure ethical practices in the medical sector of Nepal. Ethical Promotion of Medicine-2007 was developed and released to encourage the improvement of health care through the rational use of medicine and discourage unethical practices. It is distressing that the guidelines have not been implemented properly due to the conflict of interests among concerned stakeholders. The cost of medicine has been very expensive and poor people have always suffered. [ABSTRACT FROM AUTHOR]

The article looks at the livelihood strategies in the rural areas in Nepal, giving particular focus on the trade of non-timber forest products such as the Wintergreen which is widely available in the Dolakha District. The nature, habitat, and ecology of Wintergreen, also known as Dhasingre, Dhasingare, or Machino, are investigated. It also examines the various actor groups involved in Wintergreen's essential oil value chains, to wit the harvesters, the Community Forest User Group (CFUG), the primary processors which are either privately owned or cooperative-managed, the district level traders, the domestic manufacturers, and the national trader and marketing cooperative. Wintergreen trade's impact on Nepal's economy and governance is discussed.

About 35 percent of the total demand for medicines in Nepal is covered by Nepali Pharmaceutical companies, and such companies are moving ahead for producing different kinds of medicines. The Government of Nepal, Department of Drug Administration (DDA) has formulated different regulations and guidelines to ensure ethical practices in the medical sector of Nepal. Ethical Promotion of Medicine-2007 was developed and released to encourage the improvement of health care through the rational use of medicine and discourage unethical practices. It is distressing that the guidelines have not been implemented properly due to the conflict of interests among concerned stakeholders. The cost of medicine has been very expensive and poor people have always suffered. [ABSTRACT FROM AUTHOR]