PoohHD

“I want to talk to you about one of the biggest myths in medicine, and that is the idea that all we need are more medical breakthroughs and then all of our problems will be solved.” — Quyen Nguyen

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In frame: 16-year-old Meena Nepali from Jajarkot, Nepal, giving birth in the middle of a road. Nine months pregnant, Meena was on her way to the nearest primary health centre, six hours away from her village. 

Nepal’s rural hinterlands are known for a persistent sad situation—lack of access to timely health services, especially primary maternal healthcare. Precious lives are being lost to various factors such as illiteracy among locals, high levels of poverty, and above all, lack of public health awareness and reach in remote regions.

It is known that poor road connectivity remains a significant hurdle in remote hills. Getting patients to health facilities could be significantly improved if there was better road connectivity between the small towns, villages and district headquarters. On top of that, people suffer due to illiteracy. They rely on shamans and prayers instead of availing medical services and go to the health posts only as a last resort—usually when the patient is in a critical state and is beyond saving. Therefore, the administration needs to understand that the establishment of health posts isn’t sufficient by itself. Improving awareness of the services available there is just as significant.

In Nepal, women’s forthrightness in taking issues into their own hands is sadly a rarity, especially in remote areas where poverty, illiteracy and social ostracism are rife. Women often have to bear the brunt of such societal ills. Usually oblivious to women’s issues, the males of the house fail to grasp the gravity of timely medical intervention, which culminates in a life and death situation for expectant mothers.

An issue as important as maternal health cannot be studied in isolation. Providing health services is only the first step in tackling the maternal health gap. In reality, the administration should concentrate on improving general literacy around maternal health care involving both women and men and improving connectivity, sparing people an arduous walk or being carried on stretchers. The health posts should also be staffed with skilled attendants and stocked with essential medicine. Nepal continues to experience an imbalance and faulty distribution of healthcare professionals, especially in remote regions, which needs to be immediately redressed.

Maternal mortality in Nepal has consistently fallen from 539 deaths in 1996 to 239 in 2016; it can be seen that Nepal has been making considerable progress. But the gaps in maternal health aren’t unmanageable—it is more a case of casual negligence, hoping things will improve on their own. Nepal’s resolve shouldn’t be about achieving satisfactory results but about reducing maternal mortality much less than the UN’s Sustainable Development Goal target of 75 for every 100,000 births by 2030.

Photo Credit: Hemant KC, RSS

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The kid’s coming with me.

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A Brief History: Antibiotics and The Resistance That Followed

Antimicrobials have emerged as an incredibly effective form of chemotherapy in the history of medicine, with an unparalleled track record in saving lives and significantly mitigating infectious diseases that once posed the most substantial threats to human health throughout our existence. Contrary to the belief that antibiotic exposure is unique to the modern "antibiotic era," recent research has unveiled compelling evidence. For instance, traces of tetracycline have been detected in ancient Sudanese Nubian human skeletal remains dating back to 350–550 CE, revealing that these individuals had been exposed to tetracycline-containing substances in their diets. Similarly, a histological examination of skeletal samples from the late Roman period in Egypt's Dakhleh Oasis indicated the presence of tetracycline in their diet, as suggested by discrete fluorochrome labelling. This presumed consumption of tetracycline may have conferred a protective effect, as the incidence of infectious diseases was low among the Sudanese Nubian population, and no bone infections were observed in the Dakhleh Oasis samples.

Tetracyclines stand out among antibiotics due to their unique property of strong chelation, leading to their incorporation into the mineral structure of bones and tooth enamel. This results in permanent markers of areas where tetracycline exposure was metabolically active. Detecting traces of other antibiotics in ancient populations is far more challenging, often relying on surviving customs and anecdotal accounts. For instance, stories about the antibiotic-like qualities of red soils in Jordan, historically used (and still utilized today) to treat skin infections as an inexpensive alternative to pharmaceutical products, eventually led to the discovery of antibiotic-producing bacteria in these soils. These actinomycete bacteria produced antibiotics like actinomycin C2 and actinomycin C3, which bind to a unique DNA conformation and have limited chances of preservation in ancient samples.

Another avenue of potential antimicrobial exposure in the pre-antibiotic era may have been through the remedies employed for centuries in traditional and alternative medicine, particularly within traditional Chinese medicine (TCM). A notable example is the identification of artemisinin (qinghaosu), a potent anti-malarial drug, extracted in the 1970s from Artemisia plants that Chinese herbalists had used for millennia to treat various ailments. The presence of antimicrobial activity has also been noted in several other herbs used in TCM. Discovering active components within these ancient remedies could potentially expand the array of antimicrobials available in mainstream medicine. Simultaneously, the selective pressures exerted by these antimicrobial activities over TCM's long history might have played a role in the accumulation of antibiotic-resistance genes within human populations.

Unveiling the natural history of antibiotic resistance genes can be achieved through phylogenetic reconstructions. This analysis suggests that genes conferring resistance to various classes of antibiotics existed in nature long before the antibiotic era. For instance, the phylogenetic analysis of serine and metallo-β-lactamases indicates that these ancient enzymes originated over two billion years ago, with some serine β-lactamases persisting on plasmids for millions of years. In Klebsiella oxytoca, a highly congruent phylogenetic relationship between β-lactamase and housekeeping genes suggests that these genes have been evolving for over 100 million years within this host. A similar analysis of β-lactamases in metagenomic clones from 10,000-year-old "cold-seep" sediments indicates that the diversity of these enzymes is primarily a result of ancient evolution rather than recent developments.

The start of antibiotic era

The inception of the modern "antibiotic era" is typically associated with the names of Paul Ehrlich and Alexander Fleming. Ehrlich's concept of a "magic bullet" designed to target disease-causing microbes while sparing the host was inspired by his observation that synthetic dyes like aniline, newly available at the time, could selectively stain certain microbes without affecting others. Ehrlich postulated that chemical compounds could be synthesized to exclusively combat parasites within the host organism. In 1904, he initiated a systematic screening program to discover a remedy for syphilis, a then-ubiquitous and nearly incurable disease. Syphilis, caused by Treponema pallidum, was typically treated with inorganic mercury salts, which had severe side effects and limited efficacy. Collaborating with chemist Alfred Bertheim and bacteriologist Sahachiro Hata, Ehrlich synthesized numerous organoarsenic derivatives of the highly toxic Atoxyl drug, testing them on syphilis-infected rabbits. In 1909, they encountered the sixth compound in the 600th series, labeled as 606, which successfully cured syphilis-infected rabbits and showed promise in limited human trials. Despite the cumbersome injection procedure and side effects, this drug, marketed as Salvarsan by Hoechst, achieved great success. Alongside a more soluble and less toxic derivative called Neosalvarsan, it remained one of the most frequently prescribed drugs until the emergence of penicillin in the 1940s. Remarkably, the mode of action of this century-old drug remains unknown, with recent resolution of its chemical structure controversy.Ehrlich's systematic screening approach laid the foundation for drug discovery in the pharmaceutical industry, resulting in the identification of thousands of drugs, including antimicrobials. During the early days of antibiotic research, this approach led to the discovery of sulfa drugs, including sulfonamidochrysoidine (KI-730, Prontosil), synthesized by Bayer chemists Josef Klarer and Fritz Mietzsch and evaluated by Gerhard Domagk for antibacterial activity in various diseases. Prontosil, however, served as a precursor to the active drug, and the active component, sulfanilamide, was unpatentable due to its prior use in the dye industry. Since sulfanilamide was cost-effective and not under patent protection, numerous companies began mass-producing sulfonamide derivatives. The legacy of this early antibiotic class is evident in one of the most widely encountered cases of drug resistance: sulfa drug resistance, often associated with class 1 integrons. Once established on a mobile genetic element, sulfa drug resistance can be challenging to eradicate, as it provides a fitness advantage to the host even without antibiotic selection. Nonetheless, modified derivatives of this ancient class of synthetic antibiotics remain a viable therapeutic option, exemplifying the ongoing struggle between humans and microbes. Two other successful classes of synthetic antibiotics in clinical use are quinolones, such as ciprofloxacin, and oxazolidinones, like linezolid.

Many are familiar with the somewhat serendipitous event on September 3, 1928, that led to Alexander Fleming's discovery of penicillin in 1929. While the antibacterial properties of mold were known from ancient times, and previous researchers had made similar observations regarding the antimicrobial activity of Penicillium, it was Fleming's unwavering persistence and belief in the idea that made the difference. For 12 years after his initial observation, Fleming attempted to engage chemists in solving the ongoing challenges related to the purification and stability of the active substance. He supplied the Penicillium strain to anyone requesting it but eventually abandoned the idea in 1940. Fortunately, in the same year, an Oxford team led by Howard Florey and Ernest Chain published a paper describing the purification of penicillin in quantities suitable for clinical testing. Their protocol paved the way for the mass production and distribution of penicillin in 1945. Fleming's screening method, which involved observing inhibition zones in lawns of pathogenic bacteria on agar-medium plates, required fewer resources than animal disease models, making it widely adopted for screening antibiotic-producing microorganisms by researchers in academia and industry. Fleming was also one of the first to caution about the potential for penicillin resistance if used inadequately or for too short a duration during treatment.

Less known is the fact that the first hospital use of a drug that would now be categorized as an antibiotic was Pyocyanase, prepared by Emmerich and Löw in 1899 from Pseudomonas aeruginosa (formerly Bacillus pycyaneus). Importantly, Emmerich and Löw observed that both the bacterium and the prepared extracts exhibited activity against various pathogenic bacteria, leading them to experiment with the extract for treating different diseases. However, inconsistent results and the extract's toxicity to humans led to the discontinuation of this treatment. Further research confirmed the production of antibiotic substances by Pseudomonas aeruginosa, which were identified as quorum sensing molecules, specifically 2-alkyl-4 quinolones. Another quorum sensing molecule of Pseudomonas aeruginosa, N-(3-oxododecanoyl) homoserine lactone, and its non-enzymatically formed product, 3-(1-hydroxydecylidene)-5-(2-hydroxyethyl)pyrrolidine-2,4-dione, also displayed potent antibacterial activities.

The discovery of the first three antimicrobials—Salvarsan, Prontosil, and penicillin—served as exemplary milestones, shaping the paradigms for future drug discovery research. Subsequent research by various scientists led to the identification of numerous new antibiotic classes, with the golden era of discovering novel antibiotic classes spanning from the 1950s to the 1970s. Unfortunately, no new classes have been discovered since then. Consequently, as the rate of discovery declined, the predominant approach for developing new drugs to combat emerging and re-emerging antibiotic-resistant pathogens has been the modification of existing antibiotics.

Antimicrobial Resistance  

Before the widespread use of penicillin, there were early signs that bacteria could break it down through enzymatic degradation. However, overall, the outlook was relatively optimistic. An earlier study examining potential resistance development under controlled laboratory conditions concluded that "Syphilis has now been treated with arsenicals for about 40 years without any indications of an increased incidence of arsenic-resistant infections, and this work gives grounds for hoping that the widespread use of penicillin will equally not result in an increasing incidence of infections resistant to penicillin". Surprisingly, this remains true for T. pallidum , but not for many other pathogenic bacteria, including the Enterobacteriaceae, which have developed resistance not only to original penicillin but also to semi-synthetic penicillins, cephalosporins, and newer carbapenems.

Multidrug-resistant bacterial infections carry high mortality rates. Each year, approximately 25,000 patients in the EU succumb to infections caused by multidrug-resistant bacteria (ECDC/EMEA Joint Working Group, 2009), and over 63,000 patients in the United States lose their lives annually due to hospital-acquired bacterial infections3. The estimated economic burden of infections caused by multidrug-resistant bacteria in the EU includes additional healthcare expenses and productivity losses of at least EUR 1.5 billion annually (ECDC/EMEA Joint Working Group, 2009). Treating hospital-acquired infections caused by just six species of antibiotic-resistant bacteria was estimated to incur an additional cost of at least $1.3 billion in 1992 dollars ($1.87 billion in 2006 dollars) – surpassing the annual spending on influenza3.

Numerous comprehensive reviews have discussed various antibiotic resistance mechanisms. Within the framework of the "bullet-target" concept, these mechanisms can be categorized as either target-related or bullet-related. Targets can be: (i) safeguarded through modification (mutations rendering them insensitive to antibiotic action, e.g., mutations in RNA polymerase conferring resistance to rifampin); (ii) altered by enzymes (such as methylation of an adenine residue in 23S rRNA, making it insensitive to macrolides); (iii) replaced (e.g., ribosomal protection proteins conferring resistance to tetracyclines); and (iv) shielded at cellular or population levels (formation of a protective barrier through secretion, such as the secretion of large amounts of exopolysaccharides). The bullet can be: (i) modified to lose its effectiveness, as seen with acetylation of aminoglycosides; (ii) destroyed (e.g., β-lactam antibiotics by β-lactamases); and (iii) expelled from the cell, as in efflux pump mechanisms of resistance.

Recent research in the field of antimicrobials and resistance indicates that not all interactions between bacteria and antibiotics can be explained by the classical bullet-target concept. For instance, a recent study on a novel antibiotic resistance mechanism adopted the "kin selection" concept, as this resistance mechanism operates at the population/system level. This well-established theory in the macro-organismal world also appears applicable to the microbial world, where a small number of antibiotic-resistant bacteria provide protection for antibiotic-sensitive cells, ensuring the survival of the entire population under antibiotic pressure. Furthermore, in complex biofilm communities, protection against antibiotics extends to all community members, regardless of kinship, necessitating a conceptual framework operating at the system level. Thus, the conceptual basis of microbe-antibiotic interactions has expanded beyond the bullet-target model to encompass the complexity of these interactions.

What about prevention?

The primary challenge we encounter with antibiotic therapy is the inevitable emergence of resistance to newly introduced antibiotics. This pattern has recurred on numerous occasions, creating an ongoing race between the discovery and development of new antibiotics and the bacteria's response, which adapts by developing resistance mechanisms. So, the question arises: How can we safeguard the effectiveness of antibiotics and prolong their efficacy? Addressing these issues demands a multifaceted approach, as there are various factors at play.One significant factor to consider is the human consumption of antibiotics. Unsurprisingly, there is a strong correlation between the level of antibiotic-resistant infections and the extent of antibiotic usage. In some cases, patients may request antibiotics when they are not warranted, such as for viral infections, and it is crucial to educate them about the ineffectiveness of antibiotics in such situations. Importantly, a lack of understanding about antibiotic resistance is positively associated with a higher prevalence of resistance. Additionally, adhering to the prescribed antibiotic regimen can be challenging, particularly for infections necessitating prolonged therapy with multiple antibiotics, as is often the case with tuberculosis. Even with complete compliance, empirical prescription of antibiotics (which accounts for the majority of prescriptions) can contribute to the spread of antibiotic resistance. Developing rapid antibiotic resistance profiling tests would be beneficial in initiating the most effective therapy promptly, bypassing the challenges posed by resistant pathogens. Furthermore, using a recombinant β-lactamase during the intravenous administration of ampicillin in therapy may help prevent the emergence of antimicrobial resistance in the gut microbiota.The situation differs in countries where antibiotic sales are inadequately regulated, allowing antibiotics to be obtained without a prescription. In such cases, personal decisions regarding antibiotic purchase and use are influenced by cultural and economic factors. Self-medication often lacks the essential components of successful therapy, including accurate diagnosis, appropriate antibiotic selection, proper usage, compliance, and treatment efficacy monitoring, thereby exacerbating the growing resistance problem.Domesticated animals also require antibiotic therapy when infected. However, agricultural antibiotic use extends beyond treatment alone. Antibiotics are employed for growth promotion and prophylactic purposes in food animals, as well as for broad and less-targeted treatment in aquaculture and horticulture. The Scandinavian countries have demonstrated the effectiveness of implementing programs focused on optimal disease prevention practices, responsible antimicrobial use, and the discontinuation of antibiotic growth promoters in food animal production. These measures have led to a reduction in antimicrobial usage and prevented the emergence of a favourable environment for antimicrobial resistance. With the ban on growth-promoting antibiotics in 2006, other EU countries have been adopting similar measures to mitigate the occurrence and dissemination of antibiotic resistance stemming from agricultural sources.

References

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National Health Policy, 2019

The Constitution of Nepal has established basic health care as a fundamental right of its citizens. As the country has moved to federal governance system, it is the state’s responsibility to ensure the access of quality health services for all citizens based on contextual norms of federal system.

This National Health Policy, 2019 has been formulated on the basis of the lists of exclusive and concurrent powers and functions of federal, state and local levels as per the constitution; the policies and programmes of the Government of Nepal; the international commitments made by Nepal at different times; and the problems, challenges, available resources and evidences in the health sector.

Policies:  

1. Free basic health services shall be ensured from health institutions of all levels as specified;

2. Specialised services shall be made easily accessible through health insurance;

3. Access to basic emergency health services shall be ensured for all citizens;

4. Health system shall be restructured, improved, developed and expanded at federal, state and local levels as per the federal structure;

 5. In accordance with the concept of universal health coverage, promotional, preventive, curative, rehabilitative and palliative services shall be developed and expanded in an integrated manner;

6. Collaboration and partnerships among governmental, non−governmental and private sectors shall be promoted, managed and regulated in the health sector and private, internal and external investments in health education, services and researches shall be encouraged and protected;

7. Ayurveda, naturopathy, Yoga and homeopathy shall be developed and expanded in an integrated way;

8.  In order to make health services accessible, effective and qualitative, skilled health human resources shall be developed and expanded according to the size of population, topography and federal structure, hence managing health services;

9. Structures of Health Professional Councils shall be developed, expanded and improved to make health services provided by individuals and institutions effective, accountable and qualitative;

10. Domestic production of quality drugs and technological health materials shall be promoted and their access and proper utilisation shall be ensured through regulation and management of efficient production, supply, storage and distribution;

11. Integrated preparedness and response measures shall be adopted to combat communicable diseases, insect−borne and animal−borne diseases, problems related with climate change, other diseases, epidemics and disasters;

12. Individuals, families, societies and concerned agencies shall be made responsible for prevention and control of non−communicable diseases and integrated health system shall be developed and expanded;

13. In order to improve nutritional situation, adulterated and harmful foods shall be discouraged and promotion, production, use and access to qualitative and healthy foods shall be expanded;

14. Health researches shall be made of international standards and the findings and facts of such reports shall be effectively used in policy formulation, planning and health system development;

15. The health management information system shall be made modern, qualitative and technology−friendly and integrated health information system shall be developed;

16. Right to information related to health and right of a beneficiary to know about the treatment shall be ensured;

17. Mental health, oral, eye, ENT (ear, nose and throat) health services shall be developed and expanded;

18. Quality of health services provided by all health institutions including hospitals shall be ensured;

19. Good governance and improvement shall be ensured in policy−related, institutional and managerial structures in the health sector through timely amendments;

20. In accordance with the concept of health across the lifecycle, health services around safe motherhood, child health, adolescence and reproductive health, adult and senior citizen shall be developed and expanded;

21. Necessary financial resources and special fund shall be arranged for sustainable development of the health sector;

22.Urbanisation, internal and external migration shall be managed and public health problems associated with such phenomena shall be resolved;

 23. Demographic statistics shall be managed, researched and analysed to link them with the policy decisions and programme designing;

24. Antimicrobial resistance shall be reduced, one−door health policy shall be developed and expanded for the control and management of communicable diseases, environmental pollution such as air pollution, sound pollution and water pollution shall be scientifically regulated and controlled;

25. Necessary arrangements shall be made to reduce the risks of immigration process on public health and to provide health protection to Nepalese staying abroad.

[phdwithpooja]

Like A Dandelion Up Through The Pavement, I Persist

Some 3 yrs ago, I started drawing to escape sadness. Back then, I could draw fuck all, but whatever bits of drawings I did, they gave me peace. I realized that whenever I picked up a pencil and a paper, I let go of at least one thing that was holding me back from being happy. In early days, I avoided drawing faces because to me, a human face was delusional. There'd be a smile on it but you never know what they're going through. 

I wasn't depressed. I looked alright to people. I'd smile and laugh and make sure that I kept them away from seeing what was wrong with me. I had my guards up all the time. I drew sitting inside the walls I built around me. I never talked to anyone about what was killing me inside because there really was nothing that made sense to me, let alone to others. I knew people were temporary but every time I drew someone, a part of me hoped that they'd somehow leave a permanent mark. I did not draw to get famous and earn money out of it. I drew because I found a safe haven within the empty canvass and a number 4 pencil. I drew to escape the emotional sufferings. I drew not knowing that someday I'd look back and thank the stars for aligning in order to make me a better person.  

Recently, I came across a post by Wentworth Miller, the prison break guy. A post where he tried to justify his obsession with food when he was emotionally suffering. Despite people's hate towards his unhealthy lifestyle, he's smiling and learning to stay positive because if not for food, it could have been drugs, alcohol or even suicide. He ended his note with a heart touching line, 'Like a dandelion up through the pavement. I persist.' He was not angry at the people who made fun of his weight, even though he did admit that it 'hurt to breathe'. But along with everything in life, he got to assign meaning to it. He assigned strength, healing and forgiveness. Of himself and others.

Reading his story did make me sad, but it also made me realize everyone is suffering in one way or the other. I could have ran a riot or just suffered in silence but instead I turned to drawing and sketching. So yes, sometimes, you don't realize that even though there are friends and family who love you, it's all up to you to find peace within yourself. And I don't know why it's so important to put this here but if you're reading this and you have a certain suffering in you, it's never too late to understand it and find a way out. I don't care if you find the answer within yourself or you need to seek help, please just do it now.

Oh and if you were wondering, I still do the drawing thing. Here is a photo of two drawings I made, one when I first started to draw and the other being the most recent one. Of course I love the fact that I've improved in ways everyone can see, but most of all, I'm glad that I've somehow found ways to deal with the sufferings. Because like Wentworth said, like a dandelion up through the pavement, I persist. *inserts a smiling emoji*

[phdwithpooja]

had we known we'd lose you, we would have painted you in the sky forever

I don't know when it all began, but ever since a very good friend of mine suggested we look at the temples of mangalbazar standing tall in front of us in a different way, I became a fan of 'temples pasted in the sky'.  Whenever we'd hang out in and around mangalbazar, we'd sit back and focus on imagining the temples, specially the Hari Shanker temple, as drawings and paintings in the sky. We'd begin with the gajur and end up having just half of the temple 'painted' in our 'canvas' because truth be told, our canvas was placed way too high.  Sure, it was a different approach of seeing the beauty of an already flawless structure, but still, we'd be in awe every single time. People walking by probably thought we were talking about the architectural features of the temples, but little did they know, we were creating our own form of art.

The recent massive earthquake, however, came with a bang and along with it came the destruction of our heritages. Among them were our temples too. Our beloved Hari Shanker temple that we loved to trace in the blue sky. Our form of art. All brought down by one strong force of nature.

The very first time I went to the durbar square area after the destruction, I sat there in tears watching the empty canvas staring back at me. I sat there wishing I could trace our temple just one more time so I could embrace its immaculate beauty. I sat there trying to force my imagination skills to at least sketch an outline but it gave up on me. It was then that I knew, we had lost our happy place.

True, the temples we've lost may soon be replaced by new ones but they can never be replaced in our hearts. Our empty canvas will forever long for the colors of the lost temples.

  -

[phdwithpooja]

Women’s World Cup 2015: Had They Been Men, They Would Have Gotten Grass

USA just won the FIFA Women's World Cup for the third time, defeating the defending champions Japan. It was an absolutely amazing end to a month long football festival that took place in Canada. The final game had everything a football fan could ask for. Early goals, a hat-trick, goals from set pieces, an amazing long distance goal, the other team not giving up till the end, proud coaches, loud supporters and even an own goal! And then came the trophy. Did you see it? Did you see how the trophy was comparatively smaller than the ones presented to the winners of the men's world cup? Did you? I bet most of you didn't.

I bet most of you didn't even know that those brilliant football players played all of the matches on turf instead of natural grass. You might wonder what bad it would do to them, but let me enlighten you. Playing in turf is equivalent to rubber bullets flying after the players whenever they ran. The synthetic pitches bake in the sun. Clouds of rubber pebbles fly into players’ eyes, and the turf makes it difficult for them to gauge the way the ball will bounce. It's not that the players did not protest over this topic. Earlier this year, 84 players representing 13 different countries dropped their lawsuit against FIFA. The players sued FIFA and the Canadian Soccer Association for gender discrimination because all six tournament venues were to feature artificial turf. In the months that followed, FIFA and CSA variously threatened protesting players with suspension, delayed a court decision despite the players’ need to know what surface the tournament would be held on so they could train accordingly, and suggested they would either defy an adverse legal ruling or cancel the tournament altogether.  But as the tournament drew nearer, the players had to withdraw their lawsuit in order to allow the players and their coaches to focus exclusively on preparing for the unique conditions and challenges posed by artificial turf because what’s worse than competing for a World Cup title on artificial turf? Not competing at all! The World Cup is played once every four years and, for many of the players, it’s a once-in-a-lifetime opportunity, so they had to back down. But, had they been men, the law suit would have been a fixture of every international news cycle. Had been men, they would have gotten grass. Instead, the plaintiffs were women, and the dropped lawsuit received cursory news coverage before it evaporated altogether.

Well, not just the turf, even the pay gap is a real issue when it comes to FIFA. All the women's teams competing in the world cup made only 2.6% of the money the men made. FIFA invested  576 million for the men in 2014 and only 15 million for the women this year. Even the 16 teams that did not make it out of the group stage in last year's World Cup got paid four times more than the winning team.  Why does this discrimination take place when it's the same sport and the same tournament? Yes, the men's World Cup brings in more money, but we also hear the hype about it for years before it actually starts. FIFA just doesn't put as much into promoting the women's teams and World Cup — only about 15% of what it spends on the men. Arguing that the women's teams need to pull in the same viewing numbers to get paid more is not just nearly impossible, it's absolutely unfair! Even then, the 2015 women's World Cup final was the most-watched U.S. football game ever — including men's. It's clear that there's not a lack of interest from viewers. The lack of interest comes from FIFA's leadership.

One more thing that bothered me was the unfair draw conducted by FIFA this year. In every World Cup, seeded teams are dispersed among the groups in a random draw. But in this year’s Women’s World Cup , FIFA decided to assign the seeded teams to groups before the draw. That is, officials purposely chose where each team started the tournament and thus could pretty much predict that by placing top-ranked Germany in Group B and no. 3 France in Group F, those teams would likely meet in the quarterfinals. Now, they'd never be that dumb to do the same(make two titans play in quarterfinals) in case of the men's World Cup, right? But FIFA had no problem doing it in the Women’s World Cup, where making sure the stadiums are filled takes precedence over ensuring any sort of compelling competition. Sure, these match-ups could have happened naturally, but the fact is that they didn’t. The path to the World Cup final was shaped by TV ratings and ticket sales. But, since FIFA promised to always use real grass in the future, hopefully they’ll also do a real draw next time.

The Women's World Cup has far too much of a man-made element — an element that does not exist at the men's World Cup. Women’s football teams have long fought for recognition and respect not just from the public, but also from the male organizers of the sport. Sweat-soaked, blood-stained, and turf-burned, the women of the 2015 World Cup redeemed the tournament and made it memorable for all the football fans around the world. They have inspired us in every possible way and have carved the path for young and aspiring footballers. Here's to hoping that concrete steps will be taken to make things right with the World Cup players and that things will be better for women’s football in general.

[phdwithpooja]

Just Let Her Be!

Hi, If you're a girl who enjoys stuffs that the society thinks only boys should, then you'll probably agree to what I have to say here today. Be it your friends, your classmates or even your family members, you're always being made to question upon your interests. There's always someone who wonders why you are into sports that are 'boyish'. Now, I'm not saying that there aren't those who appreciate it and think you're 'cool', but would they think the same about you if you weren't a sports lover?

If you're a boy and you're reading this, don't you dare think you're on the innocent side! How many times have you announced it to yourself and your friends that you want a girl who likes the same football club as you do? And when you finally find a girl who enjoys football and also happens to support the same team, you question her knowledge on football. You ask her whether she knows the offside rule or not. You interrogate her as if she has committed a crime by loving a football club instead of crushing over some hot player. Do you do this with a boy too? The answer my friend is NO! We talk about gender equality and how men and women are two wheels of a same cart, but when you see a girl talk about football and tactics, you tell her to go back to kitchen. Why do some of you say 'I don't want to talk football with a girl'? Because you fear that she might out do you in a debate on a man's sports? Tell me!

So yeah, I never knew you had to belong to a certain gender to enjoy watching certain sports. I never knew I'd be called an 'attention seeker' for posting stuffs on social media sites about those sports. I never knew I'd be told that my love for football and motor racing is my 'selling point'. I just never knew. Probably because I had no idea that outside my own little world, I would be judged for idolizing a football player based on his playing style rather than his hair style. Or that if I roam around the city in a football shirt, people would think I borrowed it from a male member of my family. Why can't people just mind their own little business and stop the judgment? Now, I'm not a feminist or an award winning debater, but rather a free spirited human being who enjoys watching men and women  live their dreams. So next time you come across a female sports lover, just let her be! 

[phdwithpooja]

Why Does Love Have To Be A Secret?

People fall in love every day. It's not like we plan on falling in love and it comes to us. Love doesn't work that way. Butterflies in stomach isn't all that's there about love. Living together happily ever after isn't all that's there about love. Love isn't just four words which remind us of heart shaped balloons and red roses. Love is so much more that all that. Love is everything from waking up to sleeping with that one person in your heart, whether they're right beside you or 5000 miles away. Whether you talk every day or don't talk at all.

If only we'd stop for a minute and look into whom we love and who loves us, there'd be more love and less hate in this world. If only we'd accept the love and appreciate it, we'd probably live longer. I wish we would not deny the fact that we love someone. This is all just good when I write it but I wish our hearts would gather enough courage to express love. I wish we did not have to suppress how we feel about someone and just go ahead and tell them. I wish we did not expect the same love would come back to us, because love doesn't always have a boomerang effect. Not all of us as lucky and that's perfectly fine.

But we live in a world where people give up on each other so fast that if there ever was a competition on who gives up easily, there'd be thousands flocking in to win it. Why do we give up without thinking for a second? Why do we never consider holding on? Why do we wait for the right moment when the moment is right whenever we want it to be? But most importantly, why are we scared of telling someone we love them?  Why does love have to be a secret?  

[phdwithpooja]

Almost Died, But Here I Am

Death is inevitable. My mother once told me, "Life is like riding a public bus. You don't get down unless you've reached your stop." I always thought this was true.  She always has her own way with words. Less scarier. More understandable. Maybe that's why whenever I am in trouble or pain, I think of her calm words. Maybe that's why when I was covered in bricks and beams, she was the first person I thought of. Maybe that's why I held on and didn't give up against the rage of nature.

It all started out with a normal aftershock-y Tuesday. We'd be hit with few shakes but we had learned to take it coolly. It was all a part of our daily life after the 7.9 RC earthquake that devastated Nepal. We had learned to live again. But when another 7+ hit us on 12th May, a garage wall fell on me. With all its bricks and cements and windows and door, it covered me from head to toe. For a few panicking seconds I thought I would die. I was ready to let go of the pain.  But something inside me made me get up(on my own!). I could see blood, which automatically made me think of my mother. I cried for her and pleaded people to take me to her before taking me to a hospital. And those good people did the same. Seeing my mother made me weak. Seeing me weak made her cry. The circle of mother-daughter relationship is weird. I guess this is how it works.

So, I lived. I survived. True, I'm weak and have a torn muscle and cuts and wounds and bruises like I've been punched by Manny the Pacman, but here I am. Here I am, telling you about how I almost died. Had I died, I would have missed out on a whole lot of things. Things that mean a lot to me. I would have missed Liverpool being a total ass on Gerrard's last home game. I would've missed the family laughing over each other's snoring styles. I would've missed the smell of rain on earth. I would've missed all the group messages on viber that keep me going. I would've missed going around the town searching for cotton candy. I would've also missed typing with one hand because the other one is hanging by a sling. I would've missed more that I could think of, but above all, I would've missed watching my mother sleep, because ever since the 25th, I've never slept without watching her sleep. It was my safe haven.

All in all, I guess once in a while, we need to be hit by a wall to realize that life is more than just breathing in and out, that life is more about living and less about leaving. Life has its own complications but it isn't as bad as you think it is. Life is about enjoying the bus ride until you reach your stop. So, buckle up and enjoy  it.

[phdwithpooja]

Be A Substitute

I've been here for 21 years now, and never have I ever felt as a first priority to anyone. I've always been the substitute. The substitute they'd turn to when their first(or their second) choice fails to meet their needs. It may sound like utter crap but that's life. And to be completely honest, I don't mind at all(well, sometimes I do though). I guess some of us are sent on Earth to make others happy. I guess some of us are put on here to let people know that we're always available whenever they need us. But there are those very few lucky ones who get to be the firsts. The first child, the first friend you call, the first love, the first something. I don't remember being anyone's first. This is supposed to be a sad thing but when you think of it, it's not. Does it really matter if you are treated as a priority or an option? Does it really matter if you are second in line? Because all that really matters is, not letting yourself down with what you are to someone else. People who know how to set their priorities straight are god's gift to this lame planet. I know who my first priority is. I know what my first priority is. I know someone who doesn't and won't take me as a substitute. And that someone obviously is me. I know it would definitely be super nice to have someone to talk about life at 2 am, but not everyone has a heart as big as your own. It would be heartwarming to be someone's first, but what's the use if that won't last for more than few months? What's the use of promises and feelings that will eventually shatter you when you realize all of that was fake? What's the use of being someone's fake first priority? So yeah, go out, be a substitute. Make the humans happy. Let them have a part of you so that down the line they'd wish you were more than just an option.

[phdwithpooja]

Steven Gerrard Gerrard..!

When Steven Gerrard scored that 86th minute goal against Olympiacos ,I knew I'd be his loyal follower. Even though it was Robbie Fowler whose Liverpool story made me an LFC fan, I can say with immense pride that it was Steven Gerrard who turned me into a supporter. Not just that, the fact that he made his Liverpool debut on 29th November, exactly 5 years after I was born, makes it even more special for me even though he played for a mere 3 minutes that day. From a Scouser who dreamt of playing for Liverpool to the cult hero of the Kop, Stevie's journey makes us proud of who he is. If you'd ask me, I've never seen a Liverpool without him, and I'm pretty sure it's the same with most of the Kopites my age. We grew up under Steven Gerrard's influences. We smiled with him, we laughed with him and there were times when he made us cry too. It was all a part of unconditional love we had for him, because he was(is and will always be) our supernova.

A complete midfielder, he evolved tactically, coming into his own in a box-to-box central midfield role, which allowed him to be effective both offensively and defensively. In addition to creating goals, Gerrard has the ability to score goals due to his striking ability from distance with either foot (despite being naturally right-footed). An accurate set-piece and penalty kick taker, his main attributes are his pace, work-rate, stamina, vision, ball striking, and his accurate, varied passing range, which allows him to set the tempo of his team's play and create attacking chances. He also possesses good technical and aerial ability, as well as notable defensive attributes. In particular, Gerrard's tactical intelligence and ability to read the game allows him to break down the opposition's attacking plays. In addition to his footballing attributes, Gerrard is highly regarded for his leadership, determination, and influence on the pitch.

Few seasons ago, when there were speculations that he'd join some other clubs, he said it was more important to win a couple of trophies and achieve something that is a lot more difficult than go down the easy road and move to a club where it becomes easier. He made us believe in loyalty and trust. He taught us life lessons in ways no one possibly could. And even though we knew he'd never let us down in any possible way, we also knew that we'll have to let him go at some point of time, but we've always brushed it off because we've never had the courage to do so. When there were hints that he might be here only for one more season, we wondered what it would be like to see him in colors other than ours. So, the news of Stevie leaving Liverpool at the end of this season has hit us like a tornado. We know he's leaving to explore and experience the football world beside Liverpool, but it hurts beyond imagination. And now that we only have some 100 days left with him as our captain, there are tons of questions hovering my mind. Who will take those picture perfect corner kicks? Who will kiss the camera and send his love to millions of us at home? Who will slide to the corner flag after a brilliant goal? Who will lift the confidence of the players when they need it? Who will we look forward to in the derby? And even though he'll always be our Captain Fantastic, who will we turn to when we need a miracle?

All said, Gerrard will forever be in our hearts. We all have shimmering hopes that after few seasons away from us he'll come back and be united with us again. We're just not ready to let him go, not because of his stats(which, aren't that bad either!), but because he is the best footballer in the world! But if we do look back, his honors include two FA Cups, three League Cups, one UEFA Champions League, one UEFA Cup and two UEFA Super Cups. He is, to date, the only footballer ever to have scored a goal in an FA Cup Final, a League Cup Final, a UEFA Cup Final and a Champions League Final. In 2005, he was honored as the UEFA Club Footballer of the Year and won the Ballon d'Or Bronze Award too. He has also been named in the PFA Team of the Year a record eight times, the UEFA Team of the Year and FIFA World XI three times, and was named PFA Players' Player of the Year in 2006 and the FWA Footballer of the Year in 2009. But most importantly, he will always be number one in the '100 players who shook the Kop'.

So, with heavy heart, I'd like to wish him all the best. The people who'll get to see him play for the team they support have no idea what it'll be like to have a supernova in their team. They'll be the second luckiest lot after us to have a complete football player drone their colors. And even though he'll always be Mr. Liverpool, we know he'll give his best for any team he'd play because like we always say, Steven Gerrard Gerrard, he can pass 40 yards, he's big and he's effing hard!

[phdwithpooja]

Goodbye 2014!

For me, 2014 was a rollercoaster year. There were sooooo many ups and downs, if it would've been a real rollercoaster I'd have puked a few times and probably would've passed out too! Anyways, I'm just glad it's over. I don't really want to go over each and every high and low events of the year and get into the thinking business because that will end up in me being depressed as hell and then I'll punch the wall and curl into a ball and cry myself to sleep. Now, we don't want me to do that, do we? So to begin with, 2014 wasn't really a good year for my heart. The weak and fragile organ went through few ups and downs of its own along with a certain superhero who stayed there for a while but then idk what happened, he flew away. Sad no? Ohhh well, that's life. Lesson number one that 2014 taught me, Fernando Torres is the only hero for you. Its either him or no one.

Then came my beloved Liverpool Football Club's  ups and downs. From an 11 match winning streak at the beginning of the year to 7 points from 6 games in winter, Kopites sure as hell suffered a concussion-esque year. There were laughter and joy and heart break and tears when we came 2nd on the league table and let the title slip away from our hands. We were the best team in England with hardly 15 fit players  in the first half of the year. When we reached the 2nd half, we spent some £100 million and became the only English club to not qualify for the round of 16 in the Champions League. But I guess that's life. Lesson number two, Liverpool Football will someday kill you. But it'll be worth dying for. So keep calm and Carra on!

One of the very few reasons I love 2014 was, I got to go back to the pool. Oh it was heavenly! I didn't swim for a whole year due to health issues but when I took the first dip, trust me, I cried happy tears. Part of life? It sure is. Talking about good things of 2014, I met few really really really good people who made me smile and made me realize that earth is a good place to be alive in. Pantman made me the happiest person alive(only for a while though), my favorite scum didn't let me cry over stupid things, Arun came home after 2 and a half years, so did Suyog and Sammy. Dashain was a blast and so was Christmas and birthdays. McFly became McBusted, which kinda made me sad at first but I was happy for all 6 of them. Their self titled album is so rad, I can't stop listening to it. Tom and Gi became the coolest parents ever when Buzz was born, Danny and Georgia got married, Harry and Izzy are the cutest couple ever and Dougie and Elle are too perfect to be true. I've always loved Matt and James but I love them even more now that they are a part of McBusted too. I met Mika Haekinnen, who smiled and gave me an autographed photo of his. I won a NYY baseball shirt, a Michael Owen signed England shirt, a signed Liverpool shirt, tickets to go see ISL(I didn't go though). My drawings turned out to be so powerful, every player I drew scored a goal either the day I drew them or the next day(even Torres and Oezil scored!). Liverpool Ladies won the WSL for the 2nd consecutive time, Michael Schumacher woke up from induced coma and made me smile(But Jules Bianchi went into an induced coma after a really horrible accident and made me sad again) , LFC Nepal Ladies won a not-so-friendly futsal game against the Chelsea Nepal Ladies, which was so cool, I don't really have words to describe it. Derek Jeter, my favorite baseball player, retired. Carra retired. Fernando Alonso left Ferrari. Luis Suarez left Liverpool. I left my jumper in a bus. My man Torres left Milan for A Madrid(on a loan). I watched few movies and left the theatre in tears. Many planes left airports and never came back. Kids left for school and didn't come back. It made my heart break into a million pieces. So I guess the leaving business was high in 2014. Lesson learnt? You never know when people leave. Love them for as long as they're here.

So I guess that's it. It really isn't but well I'd like to keep everything else to myself and just let the bad things go and hang on to the good ones. Here's to hoping that 2015 will be better than 2014, not just for me, but for all you sad souls too. Goodbye 2014!

[phdwithpooja]

This Is A Compliment....... Not!

My name is 'BABY'. You lean over and spit at my feet. It lands in a puddle in front of me. I am thirteen and on my way home from school. I run with my backpack banging like the echo of your words against my back like you are chasing me all the way home.

My name is 'SWEETIE'. I am fifteen and I'm out with my friends for the first time. We get a little lost and you follow us for a full block. You name my friends 'HONEY' and 'DARLING'.

My name is 'FINE MISS'. It’s two in the afternoon and I feel my heart slam against my ribs. I forget the fact that I'm eighteen and want to run to my mommy and cry because I'm scared.

My name is 'DAMN GIRL'. We are walking down the street. There are ten of you and two of us. You snap a picture when you think we’re not looking. You give us dirty howls and laugh like this is funny.

'This is compliment. This is just something boys do to get ladies.'

My name is 'STOP FROWNING'. My name is 'SMILE'. My name is 'WHY DID YOU EVEN GLANCE AT HIM? YOU WERE ASKING FOR IT!'. My name is 'PRETTY THING'. My name takes nice words and turns them into bullet wounds. My name is 'NICE BODY' and it turns out that if you shout things at a stranger, they sound like knives more than flowers. My name is 'GIRLS LIKE YOU NEVER KNOW THEIR PLACE' and every single 'nice' thing you say to a woman is something you’d never utter to another man because you know that it’s derogatory. My name is 'A REASON TO GET PUT IN JAIL' and if another man spoke to your mother, sister or girlfriend like that, you’d kill him.

My name is 'SEXY' and every time I hear someone raising their voice I am thirteen again and I don’t know who you are but I’m running home with a weight on my shoulders because your words are like a slap to my spine and all of a sudden I am scared and alone.

My name is 'hey! this is a COMPLIMENT!'. So I looked it up in the dictionary and it said, 'A polite expression of praise or admiration'. Hence, I think you’ve got the definitions mixed up. Compliments are supposed to make me feel good not afraid for my life. Compliments are a way of saying 'I appreciate you and I thought you should know it.'

And if you really meant it as a compliment, you’d care about how I would take it. But you don’t mean it like that. You mean it to show off, you mean it to make us object, you mean it to shove our names into your back pocket so you can tell your friends 'I saw the HOTTEST LITTLE THING yesterday' and they can groan about how we just walked away because you don’t see us go home with a lump in our throat and all the lights on and we triple-check our locks and we don’t fall asleep at all because your compliments knocked us over and took away who we are.

In reality, it doesn’t sound like a compliment, it sounds like a threat. And if you really wanted to make us feel good - would you stop doing it? Please.

[phdwithpooja]

I Wish I Had A Demon In Me

I wish I had a demon in me.

I'd back-stab someone and feel the pleasure that's in it.

I'd make fake promises and leave midway.

I'd break trusts and not feel bad about it.

I'd be abusive and get a good night's sleep.

I'd replace people easily without any guilt.

I'd  be everything but me, because from what I've seen, the world is a better place if you have a demon in you.

I wish I had a demon in me so I'd be a part of this ruthless world. But sadly I don't. 

[phdwithpooja]

Movies aye!

                                        I am a book person. I don't really like watching movies. It's probably because half way through the movie I either get bored or end up crying. There, I said it. Movies make me cry. I know it's stupid but well there's not much of a choice if you are an emotional wreck.

But there are a few movies I loved and can watch over and over again, which includes Transformers and Fast & Furious series. It clearly shows how much I love action figures and not romantic flicks. I hate romantic movies. They make me sad and I end up curling myself into a ball and cursing my love life, which I don't have. I also have a thing for movies about sports and sportspersons. From The Damned United to Coach Carter and Ice Princess to 42, I loved each and every sports related movies, probably because I'm into sports. They are inspiring, heartwarming and make us believe in ourselves.

Then there are the Disney movies. Who doesn't love Disney movies! Not just the animated ones, but all the Disney movies ever made, are too good to be true. From the classic Beauty and The Beast, Cinderella, Little Mermaid, Snow White and The Seven Dwarfs to the 21st century Tangled, Brave and Frozen. I enjoyed them all. Hannah Montana the movie, Camp Rock, Lizzie McGuire the movie, High School Musical series and Sky High are also some relatable movies as they showcase the importance of friendship and togetherness.

Besides the above mentioned movies, the ones inspired from books and real life events are good too. When I was in school, we had really cool foreign teachers who made us watch movies like Charlie and The Chocolate Factory & James and The Giant Peach after they've read the books out loud in the class. We even had brownies baked by our lovely teachers as the movie snacks. So cool no?

But being a girl, I've watched a few girly movies too. Mean Girls, Freaky Friday, Parent Trap, Princess Diaries, Cinderella Story, Prince & Me, The Perfect Daughter, If Only, 16 Wishes, What A Girl Wants, Raise Your Voice and Angus, Thongs & The Perfect Snogging. Then there are the movies about dancing and all. Step Up series, Stomp The Yard, So You Think You Can Dance, Bring It On are few movies related to dance which are universally nice, so I've watched them too.

Oh well, it may seem like I've watched a hell lot of movies, but trust me, this is nothing. This isn't even normal movie watching rate. There are people who hit the cinema halls every week to watch the movies. It's weird but maybe that's what they like so don't judge them. And, if you want me to watch any movie, let me know!

[phdwithpooja]

I don't change. That's why people leave.

As long as I've known, I've never changed. I'm lazy. I get good grades. I read books. I love football. I'm probably the only female human in Nepal who watches formula one and understands it. I swim. I love watching stars at night and in the morning when it's still dark. I love fireworks too. Not that I've seen any for real, but I will one day. I love cotton candy. I hate winter. I also hate rain. I am a galaxy defender. Tons of people don't know what that really means. They think it's something to do with sci-fi movies. Well it's not. A galaxy defender is someone who loves McFly, that English pop rock band who broke Beatles' record. But then we live in an ignorant world who listens to crappy boy bands because the whole world is listening to them, so 3 out of 5 people I've met have never heard of McFly and I don't blame them because like I just said, we live an ignorant little world. Also, I am scared of heights. I once went to a certain tall monument. God knows I had my heart in my mouth ready to jump out and give up. Oh and I am tall and skinny. Many people say I look like a certain bollywood actress, but that's all irrelevant. I am usually nice to everyone. Not 'nice' nice, but I don't sugar coat anyone. I don't like a whole lot of people and a whole lot of people don't like me either. I've never really been in love with anyone. Once, I thought it was love but then you know how teenage hormones are. It was just a really very very bad experience. Besides, you don't need someone else to be happy. I love Liverpool Football Club though. And a certain Spaniard known as Fernando Torres. I also know there are tons of people who are annoyed by things I do and say. To be honest, I won't 'stop annoying them' because, it's not really my problem they're annoyed. I stay the same. You're annoyed by me? Go away! Simple. I am short tempered and whenever I'm angry, I punch the walls. That hurts real bad though. But its all a part of mood swings. I've come across few people who expected me to change for them. I didn't. So they left. I've also come across those who leave but then tell me to stay the same and how I'm the nicest person they've ever met. They think I don't know that. Well, the truth is, I don't change. That is why people leave.