Renu Silwal

One thing medicine has taught me is that disease doesn't always look the way we expect it to. Some of the patients I diagnose with hypertension, diabetes, or dyslipidemia are physically active farmers. They walk long distances every day, work tirelessly in the fields, and often consume mostly home-cooked meals made from local foods and grains. It challenges many of the assumptions we commonly make about non-communicable diseases. We often emphasize physical activity and lifestyle modification in prevention, and these are undoubtedly important. But experiences like these make me wonder if our understanding of non-communicable diseases is sometimes more complex than the conversations we have around them. Medicine constantly reminds me that health and disease rarely fit neatly into simple explanations. Have others working in healthcare or public health noticed similar patterns in their own communities?

Temperatures here in Nepal seem to be rising day by day, and the heat is often accompanied by high humidity. For some people, summer means swimming, relaxing indoors, adjusting their schedules, or escaping to cooler places. But for many others, especially those whose livelihoods depend on working outdoors, the heat is not something they can simply avoid. Farmers, construction workers, street vendors, and daily wage earners continue to work under the sun because they have families to support and bills to pay. During breaks, they rest wherever they can find a patch of shade before returning to work. And after a long day, many return home without access to fans, air conditioning, or other ways to escape the heat. As temperatures continue to rise, we have to ask ourselves; how can we better protect the people who are most exposed to these extreme conditions, yet have the fewest resources to cope with them? True climate action isn't just about reducing emissions, it's also about protecting the most vulnerable among us.

Lately, I've been noticing a shift in my OPD. More and more patients seem to be presenting with non-communicable diseases such as hypertension, diabetes, dyslipidemia, hyperuricemia, and even various cancers. These conditions no longer feel like occasional finding, they are becoming a significant part of everyday clinical practice across different age groups. While communicable diseases remain important, Nepal appears to be undergoing a significant shift in disease patterns. National data suggest that over 70% of deaths are now due to non-communicable diseases, and from my own OPD experience, these conditions are becoming an increasingly common part of everyday clinical practice. It makes me wonder, are we seeing more of these conditions because we have better access to investigations and health screening? Or have changes in diet, physical activity, stress levels, urbanization, and lifestyle significantly altered the health profile of our communities? Perhaps it's a combination of both. Research has long highlighted the growing burden of non-communicable diseases globally, but witnessing this shift firsthand in the OPD makes those statistics feel much more real. For those working in healthcare, public health, or even within your own communities, have you noticed a similar trend? What factors do you think are driving this change?

Lately, I’ve been thinking a lot about how AI is quietly changing the way we think not just the way we work. When we instantly look something up or ask AI for an answer, it sometimes feels like we are renting information instead of truly owning it. We read it. Use it. Then forget it almost immediately. I’ve noticed this in myself too. Sometimes I even second-guess things I already know, simply because a device is there to confirm it for me. I remember retaining information so much better when learning required more effort - opening a physical book, searching page by page, sitting with the material longer. The friction of learning made things stick. Of course, AI is incredibly useful, and I don’t think the answer is rejecting technology. But I do think there’s an important balance to protect : not outsourcing every thought, every memory, or every moment of deep focus. Maybe one of the most important skills moving forward will be knowing when to use AI and when to trust our own minds first. Curious if others have noticed this shift in themselves too.

Lately, the weather in Nepal has been feeling more and more unpredictable. It’s Baishakh, a time that usually isn’t known for constant rain in many parts of the country - yet this year it has been raining heavily and repeatedly. And strangely, when the usual monsoon periods come, the rainfall often feels delayed, irregular, or insufficient. For many people, this may just feel like unusual weather. But for farmers in Nepal, these shifts can be devastating. Many farmers still rely heavily on traditional seasonal weather patterns for planting, harvesting, and drying crops. So when those patterns suddenly shift, the losses become financial, physical, and emotional. Rice left out to dry after harvest gets damaged by unexpected rainfall. Strong winds and untimely storms have reportedly destroyed banana farms in different areas. Climate change is often discussed through global statistics and policies, but sometimes its impact is visible in much smaller and more personal ways - in damaged crops, uncertain harvests, and farmers no longer being able to trust the seasons they once knew so well. I’m curious if people in other countries are also noticing unusual shifts in weather patterns where they live. Has farming or daily life around you been affected too?

As AI becomes more involved in healthcare, I often wonder about something beyond accuracy and efficiency. Can AI truly recreate the empathy patients feel from another human being? Not just answers or explanations - but the warmth of a person sitting beside you during difficult moments. The reassurance in someone’s tone. The feeling of being heard when you are overwhelmed and confused. I remember a patient coming to me with all the reports of her mother, unsure about what to do next or how to proceed. During our conversation, she told me that one of the reasons she came back was because of the warmth and kindness she felt during her mother’s care. Not just the treatment itself, but the way things were explained; calmly and kindly. In a way that made difficult decisions feel a little less frightening. AI may eventually learn how to respond with comforting words but can something trained to simulate empathy truly make people feel emotionally safe the same way another human can? And maybe the bigger question is: As healthcare becomes more technological, how do we make sure we do not lose the human side of healing along the way? Curious to hear what others think - especially people working in healthcare or AI.

We often talk about sustainability as something new- innovation, systems, technology. But for many in the older generation, it was just how life worked. Nothing was really “waste.” An empty coffee jar became a masala container. Ice cream tubs turned into storage for grains or leftovers. Plastic bags were folded and reused until they couldn’t be anymore. Even food was treated differently. Vegetables were used fully-peels, stems, leaves. Meat wasn’t just selective cuts, almost every part had a use. And whatever remained didn’t go to a bin- it went to cattle, or back to the soil. It wasn’t called sustainability. There were no frameworks or labels. It was simply respect for resources, for effort, for what was available. But somewhere along the way, convenience replaced that mindset. Now we’re trying to redesign systems to solve a problem that didn’t exist in the same way before. Maybe the answer isn’t only in building new solutions, but also in remembering what we already knew. What’s one “waste” item you remember your grandparents always reusing?

A small but meaningful step towards sustainability in Nepal 🇳🇵 The idea of converting petrol and diesel vehicles into electric ones is gaining attention and it’s a direction worth appreciating because this isn’t just about switching to EVs. It’s about rethinking how we use what we already have. Instead of discarding older vehicles, conversion allows us to extend their life. Less waste. Less resource extraction. A more circular approach to mobility. In a country where resources are limited, solutions like this matter even more. Of course, policies are only the first step. The real impact will depend on how well this is implemented - clear guidelines, infrastructure, and accessibility will be key. But as a concept, this is a promising shift. Sometimes sustainability doesn’t start with something new, it starts with making better use of what already exists. english.ratopati.com/story/57397/... Would love to hear thoughts, could this work at scale in Nepal?