<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111413114/63722f839c7e80680e0c251djpeg.jpg" alt="" width="1200" height="800"/><figcaption>Photo: PRASANSA BUDHA LAMA</figcaption></figure>From 1991 to 2016, the maternal mortality rate in Nepal declined by a staggering 72% -- from 850 deaths per 100,000 live births to 239 in 25 years.This was a dramatic advance, but since then progress has slowed and almost plateaued off, mainly due to high rates of neonatal deaths.And at the current rate, Nepal will have to further bring down this figure by 71% by 2030 to meet its Sustainable Development Goals (SDGs) on maternal health. This is a considerable challenge given that Nepal has the highest maternal and neonatal mortality rates in South Asia, behind only Afghanistan.A shortage of skilled birth attendants, weak referral systems and difficulty in accessing treatment for complex pregnancies all point to the government’s chronic neglect of women’s health and the subsequent high mother-baby death rate.It is well established that the six pillars of safe motherhood are family planning, HIV/STD control, antenatal care, obstetric care, postnatal care and abortion care. And these can be strengthened through education, gender equality and access to primary health care. However, the Ministry of Health has overlooked these aspects, and this is undermining past gains.The 2015 Right to Safe Motherhood and Reproductive Health Act guarantees women the right to necessary counseling and maternity services from a midwife. But this does not apply to a majority of women in rural areas due to a lack of trained staff.Read also: <a href="https://archive.nepalitimes.com/regular-columns/GUEST-COLUMN/Saving-one-mother-at-a-time,816">Saving one mother at a time</a>, Bikash GauchanThe government needs to produce more than 10,000 midwives with a minimum of a three-year certificate if it is to reduce the maternal mortality rate to 75 for every 100,000 births by 2030, as per the SDGs.Under the previous Millennium Development Goal (MDG), Nepal had committed to reducing maternal mortality by three-quarters by 2015, which included midwifery education and services in the five-year plan. A policy was then formulated in 2006 to produce skilled birth assistants (SBA) with other staff to be given two months of training to develop 27 basic maternity services.The strategy includes basic nursing skills in nursing and medical education such as ANMI certification, BSc Nursing, MBBS and MDGP and aims to produce professional midwives in the long run.At present, Sudeni Maternal and Child Health Workers and Assistant Nurse-Midwife (ANMI) who underwent midwifery training for two months are deployed to communities as maternal health service providers.Since 2006, the program has produced more than 10,000 SBAs and reduced maternal mortality by 15% in the past decade at the cost of Rs1 billion, but we are yet to see the kind of progress we aspired to. The program has significantly increased awareness about maternal healthcare, but has not produced as many professional midwives.Read also: <a href="https://www.nepalitimes.com/editorial/nepali-ama/">Nepali Ama</a>, EditorialIn India, ANMI must have passed high school and undergone two years of training. In Nepal, those who have passed grade 8 and trained for 29 months can become ANMI. Therefore, people at the forefront of providing maternal and child healthcare are already lagging in resources, skills and education levels.In urban centres, mothers have the choice of obstetricians and gynecologists, but in villages, their best bet are ANMIs, many of whom have not even completed remote obstetric training. This negligence has cost the lives of many young mothers.Further, women accessing health facilities face humiliation, and even violence, and are stigmatised. The main reason for this is the lack of midwives, and the shortage of such an important position within the National Health Care System.Read also: <a href="https://www.nepalitimes.com/here-now/another-babys-life-is-saved-in-rural-nepal/">Another baby’s life is saved in rural Nepal</a>, Naresh NewarThere is also a tendency to announce popular programs only to source large budgets from state coffers. The President’s Program for Women’s Upliftment is an initiative to save the lives of mothers at childbirth.Launched in 2018, the program has only spent Rs36.6 million in three years when its budget was Rs50 million a year. In the same period, while it saved 360 women, 789 died without treatment.Expecting women in remote areas are constantly at risk due to the delays: at home while making a decision, on-road in lack of proper transport and at health facilities.Even then we can mitigate the illiteracy, ignorance and financial constraints that cause decision delays at home and on roads with public awareness programs. But the bigger challenge is that of local health facilities take time to transfer women to better-equipped hospitals.According to 2020 Maternal Infant Mortality Monitoring and Response (MPDSR), most maternal deaths were due to preventable causes such as bleeding, high blood pressure, infections and prolonged labour pains. The analysis also showed that 37% of women died on the way from one health facility to another, 30% at home, 23% in private and non-government hospitals and 10% on the way home from health facilities. Most of these deaths were of women under 34.Read also: <a href="https://www.nepalitimes.com/banner/balancing-life-and-death-in-nepal/">Balancing life and death in Nepal</a>, Ashmita Hamal and Naresh NewarBy mobilising skilled midwives at local-level health facilities, we can manage many complications and counsel families if a mother needs to be relocated. And one way to achieve that is by providing the ANMIs with a 3-year certificate level midwifery education.Midwives in essence stand for women's rights. They advocate for all women of reproductive age to receive the quality and dignified services they deserve, especially during pregnancy and childbirth.Midwives have proven their effectiveness in countries like Norway, Finland, Sweden, Denmark and the Netherlands for the past 250 years and have reduced maternal mortality rates to as low as 2 per 100,000 live births.With the maternity knowledge, skill and behaviour they have, only a midwife can determine the true condition of a woman in labour pain when there is no obstetrician and gynecologist present which is often the case across Nepal’s rural villages.If we want to save our mothers, it is of utmost importance that the Nepali state act immediately to produce midwifery practitioners.Laxmi Tamang is the president of the Nepal Midwifery Society.Adapted from the <a href="https://www.himalkhabar.com/news/130974">Nepali original</a> in Himalkhabar monthly magazine by Aria Parasai.Read more: <a href="http://archive.nepalitimes.com/news.php?id=16327#.Ys5GPOxBzAM">Homeward bound</a>, Sabhyata Timsina

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Midwives to the rescue in Nepal

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111413114/63722eef9c7e80680e0c24ebjpeg.jpg" alt="" width="768" height="1024"/><figcaption>Bhavana with her young son. Photo: RITA ALE MAGAR</figcaption></figure>It was a night that Rita Ale Magar says she will never forget. Bhavana, 17, from remote Dumre Dara village walked 2.5 hours to reach a birthing centre of Udaypur.The underage mother was already 16 days overdue, her blood pressure was alarmingly high and she was going through prolonged labour. She was having difficulty pushing out the baby and was in severe pain.This was the most complicated case the centre had received, and the nurses were understandably nervous. But Nurse Rita had to lead the team and take the decision to try to save both the mother and her baby who were at high risk.“This was the moment when I had to use all the knowledge that I was taught by my mentors,” recalls Rita, who is a beneficiary of the Simulation-Based Mentorship Program (SBMP) of the group, One Heart Worldwide.After nearly two hours, the baby was born but that was only the beginning of the ordeal. The baby was not breathing and had no heart rate or muscle tone.“All of us thought the baby was dead, but we had to try our hardest to save him. I had less than a minute to give my best,” adds Rita, still shaken as she narrates her experience.It was at that point she remembered the ‘Golden Minute’ session she had learned about at the mentorship program -- the time needed for newborn resuscitation of babies born with asphyxia and deprived of oxygen.Nurse Rita quickly cut off the umbilical cord, put the baby on the resuscitation table and gave him electric suction which allowed it to start breathing. But the baby still looked pale, and was having difficulty crying.At the same time, the mother’s condition was worsening, she was bleeding profusely. The nurse sought help from a paramedic team to ventilate the baby with an Ambu bag while she tended to the mother.The baby's condition started to improve, but since there was no neonatal intensive care unit at the birthing centre, Rita referred the baby to a hospital in Biratnagar. The baby boy has since recovered and is now healthy.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111413114/63722ef19c7e80680e0c24ecjpeg.jpg" alt="" width="389" height="515"><figcaption>Nurse Rita Ale Magar used the ‘Golden Minute’ to save a newborn who was suffering from severe complications. Photo: ONE HEART WORLDWIDE</figcaption></figure>“I was panicking but I benefited from my mentorship, and I will always be grateful to the clinical team from One Heart Worldwide who had trained me,” she adds.One would think that health professionals would not want to work in villages with minimal resources, but the opposite is true for Rita for whom being stationed in the far-off government birthing centre has been a challenge, but fulfilling when she can save lives like this recent case.Nurse Rita has delivered over 200 babies in the last three years. The birthing centre was initially under-equipped and she was the only Skilled Birth Attendants. This is where the One Heart came in to provide hands-on simulation exercises to nurses to get them ready for real-life birthing complications.Two nurses who received that simulated training were instrumental in saving the underage mother and her baby. They also counseled family members.Read also: <a href="https://www.nepalitimes.com/here-now/who-will-save-nepals-poor-new-mothers/">Who will save Nepal’s poor new mothers?</a> Rojita AdhikariThe patient, Bhavana did not know about the risks associated with pregnancies and was adamant about giving birth at home because she herself was born at home. Additionally, she had not seen anyone going to the birthing centre for delivery.Even after she was long past her due date Baavana was still not convinced about institutional delivery. It was only when she realised she was putting herself and her baby at risk did she relent.“Ultimately, she made the right decision but it was almost too late. Luckily, she survived. Saving her was so rewarding also because this could set an example to other villagers,” adds the nurse.But it is not easy for the villagers to get to the birthing centre due to the rugged terrain which further discourages them from accessing institutional delivery. There is no proper transport or ambulance service either. Most people have to walk over four hours to get to the centre which is especially inconvenient for pregnant women and girls.Says Rita Ale Magar: “But no matter how hard the journey, it is worth the effort because us nurses are here at the birthing centre to help mothers like Bhavana and their newborns.”Read more: <a href="https://www.nepalitimes.com/banner/no-conceivable-reason-for-unwanted-pregnancies/">No conceivable reason for unwanted pregnancies</a>, Rojita Adhikari

Balancing life and death in Nepal

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114121112/637222f59c7e80680e0c0327jpeg.jpg" alt="" width="760" height="486"/><figcaption>Govinda KC, Nepal’s crusading surgeon and health activist, plastering a patient’s ankle at the Mugu District Hospital on Sunday. He saw 177 patients for free in five days before travelling on to Jumla on foot. Photos: ACHYUTRAJ BHANDARI</figcaption></figure>Nepal’s  crusading surgeon and health activist Govinda KC has been on hunger strike 19 times since 2012, demanding medical education  reform and equitable healthcare. After retiring from his government job, KC has served patients in all 77 districts and other disaster-stricken countries. He is currently at Khandbari District Hospital in Sankhuwasabha where Nepali Times caught up with him.Excerpt from the conversation:Nepali Times: What is the state of healthcare in Nepal?Govinda KC: Most citizens from both urban and rural areas do not have access to healthcare. Many patients are too poor to afford quality treatment, and those who can not get quality care.The law specifies that 70 types of medicines should be available free of cost in district hospitals, 50 in primary health centres, and 35 in health posts. That is not the case in practice.Some government hospitals even charge money for medicines that are supposed to be free. And hospital fees are just too expensive, so they end up dying, being disabled for life, or sinking deeper into poverty.Health facilities in many rural districts are under-equipped, under-staffed and many patients have to return home without treatment. There are no big hospitals there to begin with, and even the urban poor cannot afford priate city hospitals.Doctors, nurses and office assistants have stuck around in government hospitals only because they are bound by contract. Some hospitals are led by junior non-physicians, making a chaotic and inefficient system.So, where is the problem? The problem in providing basic healthcare arises when the local representatives and  politicians do not work to provide it. When the 2015 constitution was announced, I was in satyagraha. My only demand was that our representatives be treated in health facilities in the same place as their voters. That demand was not fulfilled.The Constitution guarantees the citizen's right to health, but elected politicians do not care about health reforms. They are too busy getting rich overnight by commodifying education and health.I have been fighting to have hospitals and schools in every village, but people prefer to open hospitals in the city. Locals can have access to specialist services at a hospital in their village. This can also help to produce doctors, nurses and public health workers in the provinces. But no one is willing to do that. Politicians are on the payroll of the medical mafia.Do you regret going through all those hunger strikes? Many of my demands were not met. Some promises have been made, but not been implemented in practice. But some have been addressed, like the Medical Education Act was formed after multiple satyagraha. Then the Medical  Education Commission was formed.Before the Act, MBBS entrance exams were conducted by colleges and institutes in their own way, but now it is regulated by the Medical Education Commission.Only those who pass the entrance exams are now eligible for government scholarships and can pick their own college. Action is taken against private institutions if they do not follow the regulationsNow, medical colleges are selected based on their infrastructure, equipment and human resource.  Fees have also  dropped from Rs7-9 million to Rs4.2 million. Medical school is a lot cheaper now, especially for students who are unable to get scholarships.Government medical schools charged up to Rs10 million for  specialised education. Now, students do not have to pay, but get paid instead. After getting an MD they also need to serve for two years in a place assigned by the government. These contract doctors run the country’s healthcare todaySo, the hunger strikes have not been in vain. One of my demands was to have one government medical college in every province. At present, the Karnali Institute of Health Sciences is in operation in Jumla, and the physical infrastructure of Geta Medical College in Dhangadi has been completed. One medical college is soon opening in Dadeldhura after my hunger strike.Despite this, some goals have been lost to the challenges posed by the alliance of political  parties with the mafia. The construction of the Rapti Institute of Health Sciences in Dang was halted due to obstruction from local leaders, and a medical college in  Bardibas due to land acquisition issues.What policies should the government focus on now?First of all, access to basic services, human resources, equipment and medicine should be extended to people in rural areas and the urban poor. If primary health centres and district and provincial hospitals are improved, then 80-90% of patients do not have to  come to Kathmandu for treatment. The government needs to add more human resources to meet the current demand for healthcare.There should be a 15-bed operational hospital in each municipality. Hospitals should also be made free for people to have quality healthcare. The government should take actions against hospitals that operate without meeting proper standards.Additionally, the Medical Education Commission, Nepal Medical Council and other organisations should appoint qualified applicants, not political activists. In fact, the practice of hiring contract-based employees should be eliminated. Contract doctors have a higher chance of fleeing if they are not given temporary incentives to stay.Despite the huge demand for rural doctors, the Public Service Commission opens only 20 seats for doctors each year. This has to change.Any more hunger strikes?I am committed to campaigning for medical education reforms. Along with health and education, we are also fighting for good governance and social justice, without which reform is impossible.I also want to serve in remote areas, which is why I am here in Okhaldhunga. I will fight for people in all parts of the country to have quality, free, affordable and equal access to healthcare as guaranteed by the Constitution for as long as I can.Read more: <a href="https://www.nepalitimes.com/latest/govinda-kc-treats-patients-in-remote-nepal/">Govinda KC treats patients in remote Nepal</a>, Achyutraj Bhandari

"Nepalis are dying because they are poor”

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114121112/637222e29c7e80680e0c031ejpeg.jpg" alt="" width="1086" height="724"/><figcaption>Charikot Hospital. Photo: NYAYA HEALTH NEPAL</figcaption></figure>Nepal’s medical industrial complex has modernised healthcare in the country, but it has also pushed treatment out of reach of most citizens.Collusion between politicians and medical magnates has made it so expensive to become a doctor that it has set off a chain reaction to make hospital treatment unaffordable.Meanwhile, government hospitals are <a href="https://www.nepalitimes.com/here-now/at-the-covid-19-frontlines-in-rural-nepal/">under-funded, under-staffed and under-motivated</a>. Most medical personnel in district hospitals and health posts moonlight in private clinics, and patient treatment is substandard.Desperate families have to sell property, jewelry and other assets <a href="https://www.nepalitimes.com/banner/in-a-healthy-state/">to afford private treatment</a>, pushing even some middle-class families below the poverty line.Read more: <a href="https://www.nepalitimes.com/banner/in-a-healthy-state/">In a healthy state</a>, Nepali TimesBut there are notable examples of government hospitals that are running well because of various models of partnership with non-profits, foundations and charities. They prove that affordable high quality healthcare is possible, and those hospitals need not be so expensive to run.There is <a href="https://archive.nepalitimes.com/news.php?id=18362#.YrQjS-xByrc">Dhulikhel Hospital</a> which has a tiny registration fee, treatment is low cost, an insurance scheme pays for most treatment, and patients are charged according to their capacity to pay. Despite being a government hospital, Dhulikhel has upheld a consistently high standard of care and treatment.United Mission to Nepal has run a hospital in Tansen for over 60 years, a community hospital in Okhaldhunga, and was till recently managing Patan Hospital, providing high quality care at low cost to patients.Other public-private partnership institutions that could be models to be replicated across Nepal include:<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114121112/637222e59c7e80680e0c031fjpeg.jpg" alt="" width="1500" height="1000"><figcaption> </figcaption></figure><h3>Bayalpata Hospital</h3>After <a href="https://www.nepalitimes.com/opinion/is-free-health-care-possible-in-nepal/">Bayalpata Hospital</a> was established in Achham 20 years ago, for many years it did not have a single doctor. Treatment was so poor that even emergency cases had to be taken on a grueling 12 hour drive down to Dhangadi.In those days HIV tagged along with the migrant workers returning from India, and there was a full-blown AIDS and TB epidemic in Achham and other district in Far Western Nepal. The mortality rate, already very high among women and children, soared.In 2009, Nepali and American medical students inspired by the community health model of <a href="https://www.nepalitimes.com/latest/paul-farmer-on-my-mind/">Paul Farmer</a> set up Nyaya Health Nepal (formerly Possible) taking over  Bayalpata under a public-private partnership with the government.Since then, Bayalpata Hospital has upgraded its facilities (left) and <a href="https://www.nepalitimes.com/banner/state-of-the-art-rural-hospital/">treated nearly 1.5 million patients for free</a>, some of them for complicated caesarian and orthopedic surgeries.Read also: <a href="https://www.nepalitimes.com/opinion/is-free-health-care-possible-in-nepal/">Is free health care possible in Nepal?</a> S P KalauneeUp to 100,000 patients from Achham and surrounding districts come to Bayalpata because they get free treatment there, and many families have saved themselves from sinking into poverty.Bayalpata also runs a network of community health centres with an Electronic Health Record (EHR) system that digitally keeps track of all patients in the catchment area. The presence of just this one hospital has improved the health parameters of surrounding districts, bringing down the maternal and child mortality rates. Achham once had the highest maternal mortality rate in Nepal, today institutional deliveries make up 90% of total deliveries, and very few women die at childbirth.“We have a simple objective: to show that providing free and high quality treatment to the most underserved area of the country is possible at a very low cost,” explains Srijana Devkota of Nyaya Health Nepal.Once <a href="https://archive.nepalitimes.com/article/nation/Nation-Crowdfund-globally-act-locally,490">fully funded by international foundations</a> to run hospitals in Bayalpata and Charikot, NHN now provides free medical treatment in Achham for just Rs200 million a year, of which half now comes from the Sudurpaschim Province and local municipality.+977 - 4100517<a href="https://www.nyayahealthnepal.org/">https://www.nyayahealthnepal.org/</a><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114121112/637222e89c7e80680e0c0320jpeg.jpg" alt="" width="750" height="401"><figcaption> </figcaption></figure><h3>Spinal Injury Rehabilitation Centre</h3>The <a href="https://www.facebook.com/SpinalNepal/">Spinal Injury Rehabilitation Centre</a> (SIRC) in Banepa is a public-private partnership  providing treatment and rehabilitation to people with spinal injuries. It was started by journalist and civil rights activist Kanak Mani Dixit after his miraculous survival and recovery in a trekking accident in 2000 along the Annapurna Circuit that damaged his spinal cord.SIRC now <a href="https://www.nepalitimes.com/here-now/injured-use-internet-to-reach-physiotherapists/">helps rehabilitate up to 100 spinally injured patients</a> a year, and the numbers are going up every year due to injuries sustained in highway accidents and falls from trees and cliffs. The facility was located in Banepa because of its proximity to highways and nearby trauma centres. The hospital has also been providing community treatment and tele-rehabilitation services for follow-ups.Read also: <a href="https://www.nepalitimes.com/editorial/poor-health-makes-nepalis-poorer/">POOR HEALTH MAKES NEPALIS POORER</a>, EditorialThe hospital has medical officers, urologists, physiotherapists, occupational therapists, nursing care, prosthetics, orthotics, psychologists and consultants. Those who cannot afford to pay are still treated for free, others are charged the same rate as Bir Hospital.“Because patients often have to stay for more than five months, it may be difficult for them to afford the cost, so we charge them according to their capacity to pay,” says SIRC’s Raju Dhakal.SIRC’s annual running cost is Rs50 million, of which most comes from grants by non-profits and other fund-raising activities. The government also chips in with a budget for the physical construction and equipment as well as occasional allocations to cover budget shortfalls.infosirc@wlink.com.np, spinalnepal@gmail.com<a href="https://www.sirc.org.np/">https://www.sirc.org.np/</a><h3>Charikot Primary Health Centre</h3>The 2015 earthquake damaged <a href="https://www.nepalitimes.com/latest/unique-hospital-handover-in-dolakha/">Charikot Primary Health Centre</a> along with 98% of the medical facilities in Dolakha district. But the disaster was a blessing in disguise for the Charikot centre. It was rebuilt and upgraded to a full-scale 50-bed hospital and managed first by Médecins Sans Frontières and then by the non-profit Nyaya Health Nepal (NHN). Residents of Dolakha did not have to make expensive journeys to Kathmandu because medical treatment was available for free at Charikot.Read also: <a href="https://www.nepalitimes.com/opinion/dangers-of-privatising-health-insurance-in-nepal/">Dangers of privatising health insurance in Nepal</a>, Gaj B Gurung and Sushil KoiralaIn 2020, NHN handed over management of the hospital to Bagmati Province and Bhimeshwor Municipality which now run the facility with low cost treatment for up to 300 patients a day. The Charikot experiment has been hailed as a model for successful transfer by a private non-profit to the local government, and it has been running well despite the presence of two private hospitals in Charikot.“It has been a seamless handover from Nyaya Health to the government, and the level of care and treatment is the same,” says chief physician Binod Dangal. “We perform caesarean sections, orthopedics, telemedicine, free check-ups for the elderly, children and pregnant women, mental health counselling, and chronic illness monitoring.”+977 49 421125<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114121112/637222ea9c7e80680e0c0321jpeg.jpg" alt="" width="1080" height="608"><figcaption> </figcaption></figure><h3>Sagarmatha Chaudhary Eye Hospital</h3>For the past 30 years, the <a href="http://archive.nepalitimes.com/news.php?id=10071#.YrQlROxByrc">Sagarmatha Chaudhary Eye Hospital</a> in Lahan of Siraha district has been providing the cheapest cataract surgery in the world for just Rs1,200 per operation.Thirty years ago when the hospital started, it had only 12 beds. It now treats 470,000 people every year with patients coming in from as far away as southern India and Bangladesh, and they pay the same amount as Nepalis. Just in the last three years, the eye hospital has treated 321,000 foreign nationals.“It is possible to provide the services at an affordable cost because we are a non-profit, and have an economy of scale,” explains Abhishek Roshan of Sagarmatha Chaudhary Eye Hospital.Read also: <a href="https://archive.nepalitimes.com/article/editorial/health-tip-editorial,4032">Health tip</a>, EditorialThe hospital has <a href="http://archive.nepalitimes.com/news.php?id=10071#.YrQlROxByrc">also set up 15 eye care centres throughout the district, and takes treatment directly to the people</a> so they do not have to make the journey to Lahan. It has a separate department for paediatric services, care for newborn babies with vision problems. In 2021 alone, it performed 1,170 eye surgeries on children.Apart from providing treatment of retina, cornea, glaucoma, oculoplasty, the hospital also serves as an international research centre, collaborating with institutions like The London School of Hygiene and Tropical Medicine.The hospital subsidises its eye treatment for patients with revenue from its agribusiness ventures. A part of the hospital’s land is dedicated to fish farming, and an orchard for litchi and mangoes, as well as a bamboo grove.“Income from those ventures help us keep the cost of treatment down,” says Roshan. The hospital is also supported by Christian Blind Mission (CBM), the European Commission and Arvis.+977-33- 560080https://www.erec-p.org/sagarmathaRead more: <a href="https://archive.nepalitimes.com/article/nation/national-health-insurance-not-as-easy,4028">A national health insurance scheme is not as easy as it looks</a>, Sonia Awale

Taking wealth out of health

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110151120/636d08aa9c7e80680e0a602ejpeg.jpg" alt="" width="1500" height="1000"/><figcaption></figcaption></figure>The Covid-19 pandemic has now killed more people than the devastating 2015 earthquake. Officially, over 9,700 Nepalis have died due to the coronavirus in the past year and a half, but the<a href="https://www.nepalitimes.com/latest/nepal-covid-19-impact-worse-than-official-figures/" target="_blank" rel="noopener noreferrer"> real figure</a> is said to be at least three times more.At a glance, it seems that densely populated urban centres with the most infections have <a href="https://www.nepalitimes.com/editorial/the-covid-tsunami/" target="_blank" rel="noopener noreferrer">recorded the highest fatalities</a>. But analysing the available government data shows that the fatality rate among infected patients is higher in <a href="https://www.nepalitimes.com/latest/rural-nepal-fights-back-covid-19/" target="_blank" rel="noopener noreferrer">remote areas of the country</a>.In Bagmati province, of every 1,000 Covid patients, 11.9 individuals have lost their lives, but it is 21.1 in Karnali Province. District-wise, Kathmandu saw 9.1 deaths per 1,000 cases while Mustang recorded a whopping 111.9 fatalities per 1,000.Public health experts blame limited health care facilities in rural Nepal including ICUs, ventilators, drugs and oxygen for Covid-19 treatment for this huge discrepancy. They also have notably fewer doctors, nurses and other paramedics.“A majority of coronavirus patients recover but most of those who died did not survive because of the <a href="https://www.nepalitimes.com/latest/why-is-there-still-an-oxygen-shortage/" target="_blank" rel="noopener noreferrer">lack of medical oxygen</a> and this is also largely due to uneven distribution of health infrastructure,” says Bijay Acharya of the Massachusetts General Hospital, also associated with the US Nepal Health Foundation.He adds: “In many places, patients have died on their way to hospitals or while being moved from one to another. Many more people in the villages have likely passed away unable to access the treatment.”Binita Adhikari, a public health specialist affiliated with the Health Nepal Foundation and the Johns Hopkins Bloomberg School of Public Health agrees. “The fatality rate is high in remote Nepal also because many people who need treatment never reached the hospital. The Covid-19 outcome depends on how soon a person is diagnosed, hospitalised and receives treatment,” she says.The fact that the entire<a href="https://www.nepalitimes.com/here-now/at-the-covid-19-frontlines-in-rural-nepal/" target="_blank" rel="noopener noreferrer"> Karnali Province</a> has only two functional laboratories for Covid-19 testing (Karnali Academy of Health Sciences in Jumla and Surkhet’s Provincial Hospital) means that official figures for total cases in the region are largely under-counted. And this could also have made the fatality rate among confirmed cases higher.<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/latest/nepals-local-governments-lead-from-the-front/" target="_blank" rel="noopener noreferrer">Poor road infrastructure</a> and having to travel distance, sometimes several days, for diagnosis or to access hospital care also adds to the casualties. This also means additional expenses for the poor.The annual per capita income of people in Karnali is $606, which is nearly half of the national average, and a third of the population there is living below the poverty line. The region’s Human Development Index (HDI) at 0.538 is also much lower than the rest of the country.Even within Karnali Province, the poorest and the most disadvantaged have been disproportionately affected. The coronavirus mortality in Karnali stands at 2.1%, but in remote Dolpo, the figure rises to 7.01%. There is just one ventilator here at the district hospital, but even that is non-functional in a lack of skilled human resources to operate it. There are only two beds with oxygen.Similarly, the fatality rates in Mugu, Humla, Rukum East and Salyan were 6.1%, 5.15%, 4.86% and 4.07%, all much higher than the national average of 1.5%. These are also some of Nepal’s most economically and socially disadvantaged districts. Dolpo’s HDI is 0.4 and Mugu’s 0.39.“It is very likely the total number of people infected and dying of the pandemic in the region is much higher than reported. Much of this is due to continued lack of testing and contact tracing,” says epidemiologist Lhamu Yangchen Sherpa.Director of Teku Hospital at Kathmandu Anup Bastola agrees: “The high fatality rates in <a href="https://www.nepalitimes.com/latest/in-nepal-virus-climbs-from-plains-to-mountains/" target="_blank" rel="noopener noreferrer">remote districts</a> don’t necessarily mean they have more deaths, but that many of them have not had sufficient testing, which means most of the infected people barring those in critical condition didn’t reach us.”It is however clear that regions with good health infrastructure, economically sound environment, and with higher human development index are better placed to save those infected.While Solu, Bhojpur and Ilam saw districts 5.06%, 4.8% and 4.09% of their Covid patients succumb to the disease, Morang, Chitwan and Kaski reported only 1.02%, 1.25% and 1.52% fatality rates respectively. The figure is even lower for Kathmandu at 0.91%.Province-wise, after Karnali, Lumbini has the highest Covid death rate at 1.77%. This is followed by Gandaki at 1.73%, with the lowest being Bagmati (1.19%).There is also a huge <a href="https://www.nepalitimes.com/banner/once-nepal-gets-vaccines-they-need-to-be-fairly-distributed/" target="_blank" rel="noopener noreferrer">disparity in Nepal’s Covid vaccination drive</a>. Of the 1.42 million Nepalis (4.9% of the total population) who have been fully vaccinated, 55.45% of them are from Bagmati Province alone. Karnali accounts for a mere 3.5% of people who have received either both doses of AstraZeneca Covishield or VeroCell or a single shot J&amp;J vaccine.In other words, 14% of Bagmati residents have been fully inoculated versus 3% of Karnali people. The figure is even lower for Province 1, 2 and Far West where 2.4%, 1.71% and 2.78% of their population have been fully vaccinated.However, some public health experts have argued that the vaccination drive when doses are scarce should not necessarily aim right now for equity, but focus on high-risk, crowded cities with mobile populations, and regions along the Indian border.Says Bijay Acharya: “Age alone shouldn’t factor into who gets the vaccine first, economic status and social background should also be taken into account to ensure those other than the affluent also benefit. Areas with a high risk of infection and marginalised communities with poor health infrastructure should be equally prioritised.”Nepal government is in a process procure six million dose of Pfizer vaccines for teenages from 12-18 years of age in the next six to nine months' time. Health Ministry is in the final stages of preparing -80 degree Celsius storage facilities in all seven provinces.Translated by Sonia Awale from the <a href="https://www.himalkhabar.com/news/125201" target="_blank" rel="noopener noreferrer">original in Himal Khabar</a>.

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Nepal’s uneven Covid-19 deaths

<figure><img width="1400" height="663" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110814110/636a52fe9c7e80680e052328jpeg.jpg" alt=""/><figcaption>Photo: PRAKASH SINGH</figcaption></figure>Last month Kalpana BK delivered a healthy newborn baby on the way to <a href="https://www.nepalitimes.com/banner/state-of-the-art-rural-hospital/" target="_blank" rel="noopener">Bayalpata Hospital in Achham</a>, but her placenta did not come out spontaneously. As a female community health volunteer, she was usually the one providing support for women before, during and after they give birth. But when the road to the hospital was blocked for nearly 10 hours by a landslide (above) she became <a href="http://archive.nepalitimes.com/article/nation/people-politics-placentas-child-delivery-complications,3922" target="_blank" rel="noopener">the emergency</a>, bleeding massively and was increasingly short of breath.Luckily, once she finally made it to the hospital near Sanfebagar, Kalpana BK’s retained placenta was removed and she was transfused with blood. Today she is recovering from her life-threatening post-partum haemorrhage. More recently at Bayalpata, a surgical team was preparing to perform an emergency caesarean section to save both the mother and foetus. But the surgery was delayed for 20 minutes because of lack of water needed for the surgical team to scrub in, protecting the patient and her baby against infections. The delay significantly heightened the risk that the two lives would be lost, not saved.Across Nepal, <a href="https://www.nepalitimes.com/opinion/nepals-silent-emergency-springs-going-dry/" target="_blank" rel="noopener">traditional springs are going dry</a>, and hospitals are also affected. Without adequate water, staff at health facilities are finding it increasingly difficult to maintain cleanliness and best practices for preventing infections. When this happens, hospital-acquired infections are likely to rise. <figure><img width="1500" height="712" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110814110/636a53019c7e80680e052329jpeg.jpg" alt=""><figcaption> </figcaption></figure>Due to a combination of factors, such as <a href="https://www.nepalitimes.com/opinion/where-is-the-monsoon-this-year/" target="_blank" rel="noopener">lower rainfall</a> and <a href="https://www.nepalitimes.com/opinion/turning-on-the-heat/" target="_blank" rel="noopener">rising temperatures</a> caused by <a href="https://www.nepalitimes.com/banner/weather-warning-for-climate-meeting/" target="_blank" rel="noopener">climate change</a>, rampant construction of poor-designed roads, <a href="https://www.nepalitimes.com/banner/who-now-owns-nepals-forests/" target="_blank" rel="noopener">deforestation</a>, overpopulation, overconsumption and inadequate maintenance of pipes and wells, Nepal’s mountains are suffering <a href="https://archive.nepalitimes.com/article/editorial/h20-shortage,3456" target="_blank" rel="noopener">water shortages</a>.Roads are supposed to improve access of patients to hospitals, but have themselves become killers in two ways. <a href="http://archive.nepalitimes.com/article/nation/accident-prone-Mugling-Narayangadi-highway,3828" target="_blank" rel="noopener">Haphazard construction triggers landslides</a> that endanger lives, and roads are blocked, delaying patients like Kalpana BK from reaching hospitals in time. These two recent examples of a landslide and water shortage in Achham reflect the adverse impacts of worsening environmental conditions on our health system and their possibly devastating impact on people who are already ill and often vulnerable. So-called ‘natural disasters’ actually have a strong connection to human decision-making and are frequently caused by <a href="https://www.nepalitimes.com/banner/nepals-deadly-roads-take-their-toll/" target="_blank" rel="noopener">reckless road construction</a> that does not pay sufficient attention to environmental factors.Navin Bhatt, staff physician at Bayalpata Hospital, says environmental degradation can undermine health care delivery: “Deforestation is one of the causes of landslides, which lead to roads being blocked, hampering the transportation of people who are ill to the hospital. Rising temperatures are resulting in more <a href="https://www.nepalitimes.com/banner/hisss/" target="_blank" rel="noopener">snake bite</a> cases. The quality of healthcare services is affected by environmental pollution.” The urgency to recognise that health and the environment are strongly connected is growing worldwide. To raise awareness about the issue and motivate grassroots solutions to these problems, the World Health Organisation announced in its ‘Ten threats to Global Health in 2019’ that <a href="https://www.nepalitimes.com/here-now/air-pollution-is-more-dangerous-than-smoking/" target="_blank" rel="noopener">air pollution</a> and <a href="https://www.nepalitimes.com/editorial/climate-climax/" target="_blank" rel="noopener">climate change</a> are the number one public health threats. Nepal Government officials at all levels, health workers, environmental experts and development partners need to collaborate with advocates for <a href="https://www.nepalitimes.com/banner/between-existence-and-extinction-in-nepal/" target="_blank" rel="noopener">ecological balance</a>. Only when we work hand-in-hand rather than in isolation, can we take tangible steps to prevent environmental damage and restore healthy and resilient ecosystems.   Bikash Gauchan is a doctor in Achham. Nathaniel Uchtmann is a medical doctor and lawyer.

Environmental destruction is a medical emergency

In the black and white photograph, General Wangdu smiles broadly in front of the dusty cactus garden in Kathmandu’s Annapurna Hotel. With an ill-fitting jacket and shaggy hair he looks benign enough, but this was the last leader of the Tibetan freedom fighters who led the resistance against the Chinese from their remote mountain hideouts in <a href="https://nepalitimes.com/here-now/comings-and-goings-in-mustang">Mustang</a>. Five months later, Wangdu was dead. Snapped in March 1974, I had only recently arrived in Nepal. How did I meet this legendary fighter? Possibly with his devoted camp follower, Lynne Klapecki, and probably in the Om Restaurant near Freak Street which was the preferred <a href="https://nepalitimes.com/banner/hippie-trail-nostalgia-in-kathmandu">hippie hang-out</a>. Om Lobsang and his brother Yeshe were <a href="https://archive.nepalitimes.com/page/earthquake-brings-back-memories-of-camps-for-tibetan-refugees">refugees from East Tibet </a>whose cafe offered a friendly welcome and<a href="https://nepalitimes.com/multimedia/momo-loco"> the best momos</a> - they became my in-laws after I married their eldest brother Tenzin, but that was a decade later.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025052403054_4573b34282b0f5395c007243d6bef12c7ba76bfd520419e994cdcea048d795a1.jpg" data-media-id="editor_4" data-image-id="2025052403054_4573b34282b0f5395c007243d6bef12c7ba76bfd520419e994cdcea048d795a1" data-rendition-name="original" width="1000" height="1583" loading="lazy" alt="The last days of the Khampa NT"> <figcaption>Photo: LISA CHOEGYAL</figcaption> </figure>  Wangdu’s English was enthusiastically rudimentary, but even riding around town with him on the back of an aging <a href="https://nepalitimes.com/here-now/kathmandu-s-new-motorbike-museum">motorbike</a>, he was a commanding presence. Always flanked by armed outriders, impressive scars marked his forearms and a pistol hung from the cord around his neck. A charismatic guerrilla leader, Wangdu was celebrated by his followers for his tough commitment and respected for his measured pragmatism. He seemed so young to have shouldered such a responsibility of command, leading hundreds of hardened <a href="https://archive.nepalitimes.com/article/nation/50-years-after-the%20raid-into-Tibet,1012#google_vignette">Khampa combatants </a>through what had been a particularly <a href="https://nepalitimes.com/news/heavy-snowfall-over-nepal-himalaya">brutal winter in Mustang</a>, the last bastion to hold out against the Chinese invasion of their Tibetan homeland.&nbsp; The freedom fighters of Tibet, known as the Chushi-Gangdruk, had emerged to resist the <a href="https://nepalitimes.com/editorial/territorialism">Chinese takeover</a> of Tibet during the 1950s. Estimated to be 80,000-strong at the time of <a href="https://nepalitimes.com/here-now/what-or-who-after-the-dalai-lama">the Dalai Lama</a>’s final escape to India in 1959, the sheer number of Chinese deployed into Tibet eventually forced the Chushi-Gangdruk to retreat to Mustang, From this high Himalayan stronghold, they continued cross-border raids on the Chinese People’s Liberation Army (PLA) throughout the 1960s.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025052403054_8a4a935ba25ae79dc3a63bb5c14626927020e5ec098093c45ccb9a5982e009fd.jpg" data-media-id="editor_10" data-image-id="2025052403054_8a4a935ba25ae79dc3a63bb5c14626927020e5ec098093c45ccb9a5982e009fd" data-rendition-name="original" width="1114" height="676" loading="lazy" alt="The last days of the Khampa NT"> <figcaption>Guerrillas known as the Chushi-Gangdruk emerged to resist the Chinese annexation of Tibet during the 1950s. Photo courtesy: MIKEL DUNHAM</figcaption> </figure>  Their Kathmandu base was a small discreet lodge in a back lane near Rani Pokhari. Sipping sweet tea from a blue mug with a chipped lid, I sat bemused in a corner of the Mustang Hotel room whilst Wangdu and his cohorts received a battered brown suitcase from their CIA connection, a tousle-haired American in a leather jacket. Heaved onto the dingy bedspread that covered the thin mattress, it was clicked open to reveal piles of neatly stacked dollar bills.&nbsp; I cannot think why Wangdu allowed me to witness this handover but I was clearly no threat, a newly arrived world traveller with no understanding of the stakes nor any Nepali or <a href="https://nepalitimes.com/multimedia/tibetan-music-in-nepals-sacred-valley">Tibetan language</a>. Despite armed guards in the corridor,Wangdu radiated confidence and bravado, and there was a practiced familiarity to the tense transaction. This deadly dance for many years had been funded by the Americans, tolerated by <a href="https://nepalitimes.com/here-now/the-kingdom-within-a-republic">Mustang’s residents</a>, and permitted by King Mahendra and the Nepali authorities who it suited to turn a blind eye.&nbsp; But Mahendra died in 1972, and times were changing. Richard Nixon’s ping-pong diplomacy thawed the cold war and signalled a fresh entente with China. Nepal’s yet-to-be-crowned <a href="https://nepalitimes.com/here-now/if-birendra-was-alive-nepal-could-still-be-a-monarchy">King Birendra </a>was under pressure to curb the irritating incursions against the PLA launched from the Nepali territory of Mustang. Keen to appease his northern neighbour, on several occasions the King summoned Wangdu for peace talks but, despite increasingly overwhelming odds, Wangdu refused to surrender.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025052403054_a8efd5cfb92cd997bd7cb74296a936fef46e2f7428f9cd642b03f1ac4ea11ecb.jpg" data-media-id="editor_14" data-image-id="2025052403054_a8efd5cfb92cd997bd7cb74296a936fef46e2f7428f9cd642b03f1ac4ea11ecb" data-rendition-name="original" width="1055" height="885" loading="lazy" alt="The last days of the Khampa NT"> <figcaption>General Wangdu flanked by two Tibetan resistance fighters in Mustang in the 1970s. Photo courtesy: MIKEL DUNHAM</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025052403054_75969125a745847a2ef82b6fe8b9106c0b21a116d85b8efdf5d2ee89a347bb31.jpg" data-media-id="editor_15" data-image-id="2025052403054_75969125a745847a2ef82b6fe8b9106c0b21a116d85b8efdf5d2ee89a347bb31" data-rendition-name="original" width="1044" height="792" loading="lazy" alt="The last days of the Khampa NT"> <figcaption>King Birendra with General Wangdu (right in dark glasses) taken in 1974 possibly in Mustang after one of their few attempts at negotiation. Photo courtesy: RAJRNDRA KUNWAR</figcaption> </figure>  While I naively rode pillion around Kathmandu in the spring sunshine, Wangdu was in the midst of what turned out to be his final round of negotiations with the Nepal government. Refusing to cease hostilities with the Chinese, Wangdu must have suspected the cost of his decision, making his cheerful smile in the photograph all the more poignant and brave. It was only much later that I appreciated the significance of the moment. Wangdu had been sent to replace the first resistance leader in Mustang, Baba Gen Yeshe, a much derided corrupt character who stole money meant for his troops and exploited fleeing refugees by seizing their treasures. Baba Gen Yeshe never forgave Wangdu,and sought revenge in May 1974 by betraying him and his commanders to the Nepal authorities. Renewed Chinese incursions from the north, active PLA collusion with the Nepali forces under the new King, and treachery from within the Chushi-Gangdrukranks combined to seal their fate.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025052403054_e0987a7c90d76431b0d7d5e6115ebfe3dbda7ab939e5941e079c18d722e884c0.jpg" data-media-id="editor_16" data-image-id="2025052403054_e0987a7c90d76431b0d7d5e6115ebfe3dbda7ab939e5941e079c18d722e884c0" data-rendition-name="original" width="1400" height="769" loading="lazy" alt="The last days of the Khampa NT"> <figcaption>British television journalists George Patterson and Adrian Cowell embedded themselves with Khampa guerrillas and accompanied them from Tsum Valley on a cross border raid on a Chinese Army convoy in 1964. Photo: ESSAYS ON NEPAL / SAM COWAN</figcaption> </figure>  Mikel Dunham, renowned author of Buddha’s Warriors, writes: ‘It is possible that Wangdu was waiting for some cue from the Dalai Lama’s government-in-exile in Dharamsala, India. It is equally possible – during that last, <a href="https://nepalitimes.com/multimedia/the-human-cost-of-nepal-s-yarsa-gold-rush?fbclid=IwZXh0bgNhZW0CMTEAAR31-Cqw8oyIwMPzf_35e4Skr0ululJvLf3_vDkzHn-AYG2h8uPw2rqqErg_aem_tGVn5coY1-jA7fze_xqhew">desolate winter </a>– that he made the decision to go out in glory rather than admit defeat. Over the last fifteen years, Wangdu had experienced Tibet’s organized resistance being squeezed and shoved around by every conceivable outside force.&nbsp; First they had been pushed out of their own country by the PLA; then they had been refused sanction while on <a href="https://nepalitimes.com/opinion/borderlines/nepal-india-trans-boundary-bonds?fbclid=IwAR0PpJ5zUEbwdug3g_U3ar6FUugngRY0S8Tl2v_7wqzrsHmXWcXsKjvL4t4">Indian soil</a>; then they were abandoned by the Americans because, apparently, Nixon wanted to make friends with Wangdu’s mortal enemies, the communists; then they had been betrayed by the vampiric Baba Gen Yeshe – a Tibetan and, even worse, a fellow Khampa; and now, finally Wangdu’s army was being evicted by the Nepalis. One thing was certain: Wangdu was a warrior. To imagine Wangdu simply giving up and settling down in the pacific squalor of a <a href="https://nepalitimes.com/here-now/elderly-left-in-bhutan-refugee-camp">refugee camp </a>was unthinkable.’  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025052403054_8fc1ffef4ae751628b90ae781b66e11e51e4fdde2787207c9042efbee345ce49.jpg" data-media-id="editor_20" data-image-id="2025052403054_8fc1ffef4ae751628b90ae781b66e11e51e4fdde2787207c9042efbee345ce49" data-rendition-name="original" width="500" height="746" loading="lazy" alt="The last days of the Khampa NT"> <figcaption>The much derided Baba Gen Yeshe, the first Tibetan resistance leader in Mustang, who betrayed Wangdu for personal gain. Photo courtesy: MIKEL DUNHAM</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025052403054_b1d833cdb00d3ac4416b844d8730475cd88c238caaaf8da69889a584eea229a3.jpg" data-media-id="editor_21" data-image-id="2025052403054_b1d833cdb00d3ac4416b844d8730475cd88c238caaaf8da69889a584eea229a3" data-rendition-name="original" width="500" height="656" loading="lazy" alt="The last days of the Khampa NT"> <figcaption>Aditya SJB Rana of the Royal Nepal Army whose team ambushed Wangdu and his cohorts at the top of Tinker Pass in Darchula, West Nepal. Photo courtesy: GAUTAM SJB RANA</figcaption> </figure>  By August 1974 the game was up. Wangdu and six of his exhausted party were killed on their horses by <a href="https://archive.nepalitimes.com/news.php?id=7270">the Royal Nepal Army</a> on the brink of escape. The officer in charge, Aditya SJB Rana, cleverly predicted their route into India after they failed to silence a police radio in Yari. A carefully laid ambush trapped them near the summit of the Tinker Pass in Darchula,at 5,000 meters the highest military operation of its time. Wangdu’s body was helicoptered to Kathmandu, and a big show made of the royal Nepal victory.&nbsp; The Tibetan armed insurgency against China had reached its end.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250524030520_3ff9c6fc85a65bc9a2c3afe9736d9f5f9413de752e790a5d9dca0981ea94f9b4.jpg" data-media-id="editor_23" data-image-id="20250524030520_3ff9c6fc85a65bc9a2c3afe9736d9f5f9413de752e790a5d9dca0981ea94f9b4" data-rendition-name="original" width="1136" height="702" loading="lazy" alt="The last days of the Khampa NT"> </figure>

The Last Days of the Khampa

Starting 17 September Turkish Airlines will fly daily to Seville, one of Spain’s major tourist draws. This is Turkish’s sixth destination in Spain after Madrid, Barcelona, Valencia, Malaga, and Bilbao. Seville is in the Andalusia region on Spain’s south coast with a rich Moor history. There are approximately 30,000 Nepalis living in Spain.&nbsp;

Turkish to Seville

The newly-formed Himalayan Art Council is set to launch Nepal’s National Art Protection Platform that seeks to preserve <a href="https://nepalitimes.com/banner/the-history-of-heritage">Nepal’s unique cultural heritage </a>using<a href="https://nepalitimes.com/here-now/artificial-censorship"> AI-powered tools</a>. The Council seeks to safeguard <a href="https://nepalitimes.com/banner/nepali-art-going-places">Nepali art works</a> from neglect, theft and counterfeiting as well as preserve existing artwork and celebrate living masters by giving them a cultural space to continue the <a href="https://nepalitimes.com/banner/sacred-survival">sacred art traditions</a>. "We are introducing a new digital platform designed to preserve, verify and elevate <a href="https://nepalitimes.com/banner/nepals-new-generation-of-alternative-artists">Nepal’s art for generations to come,</a>” says a statement from the Council, adding that the digital platform will use AI told for authentication and blockchain to keep track of works of art. Artists can now be protected by <a href="https://nepalitimes.com/multimedia/ayo-ai?fbclid=IwAR1uwmTVq4gUB70ljfRezjzukD9ArWXPuMnUikopeQ8PoiZMjicToPSwhKE&amp;=1">AI tools</a> that detect forgeries, identify their work even when unsigned, and ensure they receive proper recognition and credit. The archives will be searchable with translated inscription and interactive guides. Says curator Meena Lama: “AI and blockchains are tools that give us the power to detect fakes and identify unsigned paintings and track every piece. With these tools we can restore trust, secure authorship and give artists the dignity they deserve.”  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250514170544_2ab58f6313c0458f75114a692b0016bd9efb3b59d5f8f07f0da72e1e37b82f53.jpg" data-media-id="editor_6" data-image-id="20250514170544_2ab58f6313c0458f75114a692b0016bd9efb3b59d5f8f07f0da72e1e37b82f53" data-rendition-name="original" width="1300" height="1000" loading="lazy" alt="Artwork at the Traditional Art Exhibition at Patan Museum."> <figcaption>Artwork at the Traditional Art Exhibition at Patan Museum.</figcaption> </figure>  The Council is also holding an exhibition of Nepali cultural masterpieces with 50 historical <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/Buzz-the-art,671">thangka and paubha </a>by past masters and <a href="https://nepalitimes.com/review/between-the-sacred-and-everyday">contemporary works by current artists</a>. This curated collection is a living tribute to <a href="https://nepalitimes.com/here-now/when-yaks-go-so-does-culture">Himalayan culture</a> with economic depictions of deities, mandala and sacred narratives. The exhibition at <a href="https://nepalitimes.com/multimedia/a-portal-into-patan-s-past-and-present">Patan Museum</a> also provides an opportunity to meet painters and custodians of art and culture. Read also: <a href="https://nepalitimes.com/review/golden-deities">Golden deities</a>, Sewa Bhattarai ‘The exhibition is only the first step in a long journey to ensure that Nepali art is no just seen but fully understood, <a href="https://archive.nepalitimes.com/article/nation/Narratives-of-Faith-and-Memory-Remembering-the-Lost-Sculptures-of-Kathmandu-exhibition,987">protected and remembered</a>,’ the Council says. Artist Kailash K Shrestha of Artudio has spent decades promoting thankha and paubha traditions because of their beauty and devotional meaning. But he also says artists are underpaid, exploited and ignored. He adds, “AI and blockchain are not just buzzwords, they are powerful tools that can protect Nepal’s artists from fraud, verify authenticity and build a permanent record of provenance.” Traditional Art Exhibition Till 17 May Patan Museum

Digital protection for Nepal’s art

<a href="https://www.instagram.com/prabalgurung/" target="_blank">Prabal Gurung</a> left Nepal for New York in 1999 to escape years of bullying, sexism and homophobia, and to pursue his dream of becoming a fashion designer. He <a href="https://www.youtube.com/watch?v=KqN0VaoAI5w" target="_blank">realised his dream</a>, but did not escape discrimination and racism in the new world. Propelled by passion for fashion, Gurung overcame everything America threw at him. He has attained <a href="https://www.vanityfair.com/style/story/prabal-gurung-recalls-his-first-met-gala-when-zoe-saldana-was-at-his-side?srsltid=AfmBOooy-H0oGgxMit864FnW_Pmw8mUnV8rYrh-co-f6OyYK6m2ip5hP" target="_blank">fame and recognition</a> for his haute couture dress designs while remaining true to his Nepali roots, and is even more resolute in <a href="https://www.youtube.com/watch?v=dSmNauyzACk" target="_blank">fighting prejudice</a> in all its forms. Prabal Gurung’s newly-released memoir <a href="https://www.amazon.com/Audible-Walk-Like-Girl-Memoir/dp/B0DG11HCDQ?fbclid=IwY2xjawKZfpxleHRuA2FlbQIxMQABHuZcIJO2OXyXcRm1oq1iG6wzeoF7VJFrQ7GXOFI0YxuZZ4id_CNvSZSZZIna_aem_pG_mOKG73RTnYvN8JaC4fA">Walk Like a Girl</a> is a saga of harrowing abuse in boarding schools in Nepal and India, only finding himself facing a different kind of bullying in the US. He prevails over it all to be where he is today: an award-winning American fashion designer with his own label. Walk Like a Girl was launched last week in New York at a time when everything Gurung fought for — tolerance, inclusion and diversity — are in retreat in his adopted country because of a president who has espoused a culture of bullying. The book is a searing, raw exposé of how cruel and abusive people can be even at a young age in school. On the other hand, it also shows that there are generous, compassionate and open-minded souls out there. In his book, <a href="https://www.youtube.com/watch?v=K4le_uWX7YE">Prabal Gurung</a> calls out those who tormented and tried to hold him back (some of their names have been altered). The moral of his story is: resist, never stop believing in yourself, do not let others define you, never lose sight of your dream, and help those who have been kept out. “Walk like a girl” was a slur used by bullies back in school in Nepal and India for Gurung’s effeminate ways. He fought back then, and he is still resisting by turning those words into something to be proud of.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250519170544_4ffc9c3f565dd2cfa754d10b224816897b82bb31ebaee91b6d79d469fc96f14e.jpg" data-media-id="editor_6" data-image-id="20250519170544_4ffc9c3f565dd2cfa754d10b224816897b82bb31ebaee91b6d79d469fc96f14e" data-rendition-name="original" width="1000" height="1253" loading="lazy" alt="Prabal Gurung NT"> <figcaption>Prabal Gurung at home in Kathmandu in the 1990s.</figcaption> </figure>  “Living through it all was one thing, but writing about it is one of the hardest things I have done in my life,” admitted Gurung during the launch. “I broke down constantly during the six-year writing process.” He continues: “I did not want this to be a victim’s book. I did not want to burden my readers with my emotions. I wanted my struggle to be an inspiration for others facing what I faced. I am grateful to those who bullied me in school, they made me a stronger person ready to face the world.” Indeed, this book is a departure from his earlier one titled simply, Prabal Gurung (Abrams, 2019), which was a lush pictorial autobiography of his career in fashion. Walk Like a Girl is not a typical fashion book, it is an intimate tale of <a href="https://archive.nepalitimes.com/news.php?id=16997">Gurung’s travails and triumphs</a>, and how he willed himself to succeed. Prabal pays a lavish tribute to his mother Durga Rana. We find out she is a descendant of the first wife of the eldest son of Jang Bahadur Rana who was banished to Palpa in the late 19th century. Prabal’s father served in the Singapore Police and that is where he was born before the family returned to Nepal when he was four. Gurung relates with brutal honesty about the violence his mother endured from his father. Durga raises three children as a single mother in Nepal, and Prabal credits her for his fierce determination to resist patriarchy and injustice, which in time manifests itself in his hyper-feminine and subversive dress designs. Writing the book has been a cathartic experience for Gurung, who says he is now relieved of the burdens of his past. It no longer haunts him, and he does not have to prove anything to anyone anymore. Walk Like a Girl has life lessons not just for the <a href="https://www.instagram.com/p/DJmOcSgxdWz/" target="_blank">fashion industry</a>, but for every other profession. How can my job serve a greater cause? Gurung tells us his work is <a href="https://asiasociety.org/blog/asia/why-designer-prabal-gurung-doesnt-want-just-stick-fashion" target="_blank">bigger than just making clothes</a>, it is about making the world a better place because it could do with a lot of improvement.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250519170544_d75296ad8bfdc00d88935f40d23543c6fea3d4d6a10e61a99d6cfc6127f2ee5b.png" data-media-id="editor_10" data-image-id="20250519170544_d75296ad8bfdc00d88935f40d23543c6fea3d4d6a10e61a99d6cfc6127f2ee5b" data-rendition-name="original" width="1516" height="1000" loading="lazy" alt="Prabal Gurung"> </figure>  This story of chasing the American dream may sound familiar to many immigrants: knocking on doors for jobs, rejections, trying to survive from day to day on expensive rent, and dealing with subtle racism in white America. Gurung finds racism is rife, and he is often mockingly called ‘gaysian’. He writes: ‘There was a strong hypocrisy — this idea of independence felt like a marketting ruse … and for all the talk of feminism in America, these high society women were trapped by the patriarchy just like in Nepal and India.’ After a trek to the Khumbu region in 2013, Gurung is inspired to use the colours, palette and textures of Nepal for his collection exhibited on Manhattan’s 8th Avenue. A major buyer tells him bluntly: “Stick to making pretty dresses … if I need to see a collection like this, I could buy a copy of National Geographic.” The New York Times was equally dismissive: ‘The designer tries to draw connections between blistered techo-fabric used to construct it and the topography of his homeland, Nepal. But, at the moment, he has lost his map.’ One potential investor tells Gurung he cannot design for Americana because “you do not look American”. Gurung wants to use expletives, but restrains himself. After a fundraiser in New York for the Nepal earthquake in 2015, some belittled his effort, saying: “Here comes the saviour."&nbsp; Read also: <a href="https://nepalitimes.com/review/prabal-gurung-by-prabal-gurung">Prabal Gurung by Prabal Gurung</a>, Kunda Dixit The Gurkha DNA must be dominant in Prabal Gurung’s genes because he does not take such mistreatment lying down. When asked by a fashion publicist why he was designing clothes for fat people, he snaps back: “Because of people like you.” He joins the Black Lives Matter and #MeToo movements, launches the Shikshya Foundation charity in Nepal, and has powerful allies among celebrities who wear clothes he designed: Michelle Obama, Oprah Winfrey, Sara Jessica Parker, Kamala Harris, Deepika Padukone … it is a long list.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250519150556_48a5f4211991a23fa85b64bbd5377575ca7081d97309d7542035591dda5180fe.png" data-media-id="editor_12" data-image-id="20250519150556_48a5f4211991a23fa85b64bbd5377575ca7081d97309d7542035591dda5180fe" data-rendition-name="original" width="1114" height="1534" loading="lazy" alt="Being Prabal Gurung by design"> <figcaption>Nigerian novelist Chimamanda Ngozi Adichie wearing Atelier Prabal Gurung’s design for Met Gala 2025 in which the theme was ‘Superfine: Tailoring Black Style’. </figcaption> </figure>  “I don’t dress women to look beautiful, they already are,” Gurung says. “I try to bring out their innate strength and grace.” <a href="https://www.instagram.com/stories/highlights/17908766880140171/" target="_blank">Admirers</a> tell Gurung he makes it all look so easy, but he used to put up a strong facade to not show his own vulnerabilities in public. “I was closed because of my childhood experiences,” he says. “I was always on guard to defend myself because I never knew where the next punch would come from.” But in <a href="https://www.youtube.com/watch?v=PPVepzPA210" target="_blank">Walk Like a Girl,</a> Gurung comes to terms with his vulnerability, and bares his soul. It has not been easy, it took sustained will power and support from his mother, sister Kumudini and a circle of close friends. “I made unbelonging my power,” he says. “Nepal is where I still have my heart and soul. Nepal grounds you. It is where people go to find themselves. But I escaped.” Recently appointed vice-chair of the <a href="https://cfda.com/about-cfda" target="_blank">Council of American Fashion Designers</a>, Gurung says: “I can’t believe I am here, it feels like it is happening to someone else. Writing this book, the healing has finally begun.” <h2>‘Everything is better in color’</h2> The Met Gala was two weeks later, and my table was an example of everything I’d been fighting for all these years as my guests represented everything I believed in: dynamic, powerful, influential women who were unapologetically original and unabashedly graceful. I was grateful to Anna for inviting me to host and dress a table that reflected my ethos—and for her guidance in doing so. I was also aware of the privilege as one of the first-­ever Asian fashion designers—not just from Nepal, but from the entire continent— to get the opportunity to do so. That fact was not lost on me. I reached out beyond the expected Hollywood celebrities and well-­known socialites to curate a table of exceptional women who inspired me. I invited Deepika Padukone and Alia Bhatt for their first-­ever Met Galas, as well as Michelle Yeoh, Mindy Kaling, Camila Cabello, Ashley Park, Denée Benton, KiKi Layne, Quannah Chasinghorse, and Grace Elizabeth. Together we checked many boxes: Asian, Black, Latinx, and Indigenous, each woman undeniably chic and powerful, a dazzling array of skin tones and experiences that proved my decades‑in‑the-­making hypothesis: everything is better in color. Excerpt from Walk Like a Girl Viking © 2025 by Prabal Gurung  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250519170520_6b91d560e9f072c37d16876901058c073a51ffa05e7ad1b9461d19e1c9c28215.jpg" data-media-id="editor_16" data-image-id="20250519170520_6b91d560e9f072c37d16876901058c073a51ffa05e7ad1b9461d19e1c9c28215" data-rendition-name="original" width="1136" height="702" loading="lazy" alt="Prabal Gurung book details NT"> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250519170520_345240c21be400e2ce2ec629b52bd82bb53890e5bd86fe95b48340d84b5f1748.jpg" data-media-id="editor_17" data-image-id="20250519170520_345240c21be400e2ce2ec629b52bd82bb53890e5bd86fe95b48340d84b5f1748" data-rendition-name="original" width="1136" height="702" loading="lazy" alt="Prabal Gurung book details NT"> </figure>  &nbsp;

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