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One health: from buzzword to public health practice in Nepal

One health: from buzzword to public health practice in Nepal
We’re miles outside of town, progress slowing as the jeep plunges in and out of massive potholes. All around us stretch green fields divided by long straight rows of bright purple flowers. Nepali farmers are out in the fields beside their homes, each of which boasts a tower of straw and a smattering of chickens or goats.
This is just the right place for the College of Veterinary Sciences, Agriculture and Forestry University, Chitwan, which conducts research that can help farmers optimize production and protect their animals’ health. The Global Antibiotic Resistance Partnership (GARP)-Nepal working group supports young researchers here to focus their studies on antibiotic resistance. Lining the walls leading upstairs are scientific posters describing investigations into resistant isolates in poultry and antibiotic use in aquaculture, among more traditional agricultural topics.
Dr. Amit Sharma, one of those young GARP-supported researchers, has been studying antibiotic use in the growing aquaculture industry in Nepal, where fish production grew by more than 10 percent per year from 1990 to 2014.  Of the 40 farmers he interviewed, antibiotics were used by less than one-third. However, these farmers are operating at small scale, growing fish in backyard ponds—nothing to rival salmon farming in Argentina, for instance, which relies heavily on antibiotics for disease control in their high-density fisheries. The largely antibiotic-free practices in Chitwan must be encouraged and strengthened, lest farmers be tempted to increase production at the expense of greater antibiotic use.
Meanwhile in Bharatpur, the nearest town, Nepal’s only national cancer referral hospital, BP Koirala Memorial Cancer Hospital, stretches over a huge piece of land with sections for palliative care, outpatient and diagnostic services. The hospital chairman, Dr. Prakash Raj Neupane, stresses that doctors here still tend to use antibiotics post surgery, rather than prophylactically. This is a serious problem, as a much greater volume of antibiotics is used when given post-, rather than pre-surgery, creating even more pressure on bacteria to develop resistance.
Farther east, at the BP Koirala Institute of Health Sciences, Dharan, Professor Paras Pokharel, GARP-Vice Chair, is trying to bring these diverse challenges together by introducing the idea of one health—an approach to combating antibiotic resistance that integrates the animal and human health communities—to his public health students.
“Have you heard of this concept before?” he asks the room, filled with a mix of nursing, medical, and public health students. No one raises a hand. Through awareness weeks, essay competitions, collaborative research and cross-sectoral lectures, GARP-Nepal hopes to change the siloed research on AMR in order to tackle the issue together.
Nepal’s Minister of Health, Mr. Ram Janam Chaudhari, is putting the one-health concept into action. He has committed to tackling the challenge of antibiotic resistance, incorporating animal and human health into his draft National Action Plan on antibiotic resistance. He also tells us that he plans to focus on expanding access to primary health care—including antibiotics—to the remotest regions of Nepal, such as where he hails from in the western part of the country.
In spite of the cracks running through the corners of classrooms and hospital labs alike—remnants of the April 2015 earthquake that caused such devastation here—energy and enthusiasm to tackle the problem of antibiotic resistance runs high among GARP working group members, and they are spreading their enthusiasm across the country, farm to clinic.
One health may be easy to say, but it is harder to put into practice. By bringing together veterinary, public health and clinical professors and students—who engage in research with implications for all fields and share information between sectors—GARP-Nepal is building the foundation of a truly operational one-health approach to curbing antibiotic resistance.
Molly Miller Petrie is a Senior Research Analyst at CDDEP. 
Photo courtesy Molly Miller-Petrie.