Pancha Ram Chaudhary Tharu, a 30-year-old construction worker from Kapilvastu, Nepal, returned home after being deported from Malaysia for testing positive for lymphatic filariasis, commonly known as "Hatti Paile" in Nepal. His story mirrors that of many others who sought opportunities abroad only to face unexpected health challenges.

Pancha Ram's journey to Malaysia in January 2024 was fueled by hopes of providing a better life for his wife and 18-month-old daughter back home. However, his aspirations were dashed when he was deported to Nepal in February 2024 after testing positive for the disease during routine medical tests conducted every six months by the Malaysian authorities.

Having taken a loan of Rs 270,000 to finance his trip, Pancha Ram now faces the daunting task of repaying the debt without the means to do so. His situation is not unique, as evidenced by the case of Prabhas Rajbanshi, another deported worker burdened with a Rs 370,000-loan and uncertain prospects.

Prabhas, whose wife is pregnant, is now struggling with the challenges of finding labour work to sustain himself and his family. His plea for assistance echoes the desperation felt by many in similar circumstances, as he implores, "If you really want to help, please help me get my money back from the manpower company."

Unlike Pancha Ram, who managed to recover a portion of his loan from the manpower company, Prabhas has been denied any possibility of reimbursement by his employer.

Both Pancha Ram and Prabhas represent a growing number of individuals who have fallen victim to lymphatic filariasis, a disease that not only threatens their health but also dashes their hopes of financial stability, prosperity and their dreams to provide a future for their families. Its debilitating effects render those afflicted severely disabled, further exacerbating their struggles.

Nepal has set ambitious targets to eliminate lymphatic filariasis by 2030 and has organised mass drug administration campaigns to achieve this goal. Despite significant progress in many districts – with 13 declared as non-endemic, four districts have completed the mass drug administration (MDA) and are now in the process of the final survey to stop it, and 53 districts have already stopped the campaign – seven districts, namely, Kapilvastu, Rasuwa, Rautahat, Sarlahi, Dhanusha, Mahottari and Jhapa continue to grapple with high infection rates at the community level.

Among the South Asian countries, Bangladesh, Maldives and Sri Lanka have successfully eliminated the disease. So has Thailand. Malaysia is on the verge of eliminating it, potentially prompting the decision to deport infected workers back to their home countries.

Lymphatic filariasis, transmitted by the Culex mosquito, causes abnormal swelling of body parts, notably the legs, breasts, arms and scrotum with lifelong disabilities, posing a significant public health problem in Nepal.

The key to preventing lymphatic filariasis lies in the widespread distribution of safe and effective medication. Dr. Rudra Marasaini, Director of the Epidemiology and Disease Control Division (EDCD), and Dr. Bimal Chalise, Chief Consultant Physician at Sukraraj Tropical and Infectious Disease Hospital, emphasise the safety and efficacy of preventive medications provided during the MDA, which has minimal side effects. Dr. Rudra further stresses the importance of community-wide medication intake (mass drug administration) to prevent its transmission.

Despite the availability of preventive measures, many Nepali workers, among whom 16 have come in contact with the Teku Hospital, like Pancha Ram and Prabhas, have had their dreams shattered by a disease that could have been easily avoided. As they contemplate their uncertain future, barred from returning to Malaysia, they are left with few options but to seek opportunities elsewhere, perpetuating a cycle of economic uncertainty and hardship.

In the face of such challenges, prioritising health becomes imperative. Preventive measures against diseases like lymphatic filariasis are crucial. It's the responsibility of each individual to take the prescribed medicine available at the nearest health facility from Baisakh 16th to 24th, 2081 B.S., which is administered in the presence of a health worker.

These doses are tailored to individual height and weight, thus requiring supervision. Only through collaborative efforts to eradicate the disease can individuals like Pancha Ram and Prabhas realise their dreams without the threat of illness overshadowing them.

"The situation could have been easily avoided if I had taken a few tablets available at the nearby health post during last year's campaign," says Pancha Ram. "I've lost money, and now I'm barred from returning to Malaysia. I have no employment prospects here, so please take this matter seriously and obtain the necessary medication.

"Additionally, I urge the Nepal Government to include the lymphatic filariasis tests in the routine whole-body checkups required before travelling abroad. If I had undergone this test here, my job, money and all my dreams wouldn't be in jeopardy. I'm uncertain about my future now; perhaps, I'll consider applying for work in Saudi Arabia later on, as there seems to be no hope for me in Nepal."

Upadhyaya is Communication Officer at FAIRMED, Nepal