<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108151120/636a664f9c7e80680e059974jpeg.jpg" alt="" width="1200" height="793"/>Around the world, in rich countries and poor, financing healthcare is one of the biggest challenges. In poor countries, it becomes a life-or-death issue.Over 40% of global healthcare expenses are still covered by patients and their families, and more than half the world’s population lacks access to essential health services. Medical bills push 100 million people into extreme poverty every year.Nepal has taken remarkable strides in healthcare in past decades despite internal conflict and instability, but <a href="https://archive.nepalitimes.com/article/nation/national-health-insurance-not-as-easy,4028" target="_blank" rel="noopener">medical care is still unaffordable</a> or inaccessible to most. More than half the healthcare expenditure of Nepalis is still covered out of pocket. Nearly a third of families spend over 10% of their annual income on medical care.Read also: <a style="background-color: #ffffff; font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/banner/this-is-how-to-upgrade-nepals-rural-health/" target="_blank" rel="noopener">This is how to upgrade Nepal's rural health</a>, Sewa Bhattarai <a style="background-color: #ffffff; font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/banner/state-of-the-art-rural-hospital/" target="_blank" rel="noopener">State of the art rural hospital</a>, Marty LoganThursday, 12 December, is Universal Health Coverage Day, an important date to remind ourselves of the next steps we need to take to achieve healthcare for all. The 2015 constitution of Nepal declares basic and emergency healthcare as fundamental rights of citizens, putting the responsibility of financing such care on the state. Following federalism, municipal governments have got the responsibility to manage basic and essential care. A national health insurance bill has been passed and is being implemented.The state guarantees quality healthcare without financial burden on citizens, for which the insurees pay Rs3,500 per year for a family of five, and receive care worth Rs100,000. This is expected to reduce the burden of out of pocket and catastrophic expenses, while the government covers the premium for citizens under the poverty line.Read also: <a href="https://archive.nepalitimes.com/article/nation/national-health-insurance-not-as-easy,4028" target="_blank" rel="noopener">A national health insurance scheme is not as easy as it looks</a>, Sonia Awale<a style="background-color: #ffffff; font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/editorial/poor-health/" target="_blank" rel="noopener">Poor health</a>, EditorialThere is also a provision for free essential drugs and free treatment for patients with cardiovascular disease, cancer, spinal injuries, renal ailments and sickle cell anaemia, through the Disadvantaged Citizens Medical Treatment Fund.None of these initiatives is being implemented fully yet, but with federalism Nepal has a chance to build an accountable and sustainable healthcare system. The country therefore needs to focus on the following areas to manage health financing to meet the targets of the Sustainable Development Goals:<ul><li>Increase public sector healthcare investment to at least 7% of annual national budget. This should also be targeted towards reducing external aid.</li> 	<li>Empower people for self-care and make treatment more strategic and efficient as the burden shifts from communicable to non-communicable diseases.</li> 	<li>Focus on primary health care and improve services at the first point of care with comprehensive, accessible and community based care.</li> 	<li>Coordinate multisectoral policy action involving education, agriculture and social behaviour.</li> 	<li>Launch a priority national campaign to spread insurance coverage. Enrollment can be top-down starting with all government officials and then the public at large.</li></ul>A mixed financing model using tax-based funds through the treasury, and premium-based funds through health insurance can work for public, private, community, and other hospitals that run under the state-non-state partnership. An example of state- non-partnership is Bayalpata Hospital in Achham district, managed through a public-private partnership between the ministry of health and population and the non-profit Nyaya Health Nepal, where insurance reimbursement covered over 60% of the hospital’s operating costs.The hospital provides healthcare with no user fees. The care is extended from hospital to communities using a network of community health workers. How can care delivery with no user fee sustain? Can Nepal afford to provide such care to its entire population?It is possible. The country should effectively implement the national health insurance program, and strategically invest tax based funding. In the mixed financing model, for a ‘district level hospital, insurance can cover 60% of healthcare operating costs, and tax-based funding can take care of the rest. But to ensure effectiveness, the tax-based investment will need to be unrestricted and tied to audited performance indicators. The cost of care should also incorporate the extension of hospital-based services into communities in the catchment area.Bayalpata Hospital serves both as a primary care facility and also as a referral hospital. In this case, the tax-based contribution can be split into the three government tiers, with the federal government providing support for infrastructure, and provincial and local governments covering the cost of basic healthcare, and referral care not covered by the insurance.Insurance reimbursement then covers the cost of insurance-covered care, the local government allocates funds required for basic and emergency healthcare, and the provincial government pays for managing the cost of referrals beyond insurance coverage.<a style="background-color: #ffffff; font-size: 15px; letter-spacing: 0.01em;" href="https://archive.nepalitimes.com/article/nation/Nation-Crowdfund-globally-act-locally,490" target="_blank" rel="noopener">Bayalpata Hospital</a> provides basic and referral care, and its tax-based contribution can be split into the three government tiers, with the federal government providing support for basic infrastructure and provincial and local governments covering the cost of basic and referral care not covered by the insurance.Insurance reimbursement then covers the cost of insurance-covered care, the local government allocates funds required for basic and emergency healthcare, and the provincial government pays for managing the cost of referrals beyond insurance coverage.The proposed model has a 60:25:15 ratio to pay for health care, with 60% from insurance and provincial and local governments paying 25% and 15% of the cost. When the benefit package increases to cover the cost of healthcare without capitation, the share of health insurance coverage percentage will increase significantly, thereby reducing the tax-based direct public sector investment.S P Kalaunee is Executive Director of Nyaya Health Nepal, which manages Bayalpata and other public hospitals in partnership with the ministry of health and population.

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Is free health care possible in Nepal?

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221104141144/6365179b9c7e80680e02c286jpeg.jpg" alt="" width="1400" height="905"/><figcaption>IN GOOD HANDS: Community Health Worker Bhajan Kunwar checks patient Namsara Tamrakar at her home in Chandika village of Achham. Pics: Marty Logan and Srawan Shrestha</figcaption></figure>Rounding a steep curve on the road to the district capital of Mangalsen a startling set of modular structures comes into view. The modern buildings look out of place in this scenic, but underserved, region of western Nepal.The construction is part of a $4 million expansion of <a href="http://archive.nepalitimes.com/news.php?id=17650#.WreWXNRua70">Bayalpata Hospital</a>, a unique medical facility that is a model for public-private partnership to improve medical care in Nepal’s remote interior.Inside the ward, orthopaedic surgeon Mandeep Pathak is examining an elderly man with a swollen knee. Clearly visible on an x-ray monitor is a short pin inserted by a general practitioner a few weeks ago, after the patient fell and broke his kneecap.https://www.youtube.com/watch?v=SuWvlDGasEAIn the same room with the surgeon today is Community Medical Assistant (CMA) Khagendra Pant, who is wrapping plaster around the arm of a small boy. Thanks to training at the hospital, Pant was able to diagnose the boy’s injury as a clean fracture that did not require an operation.Such training means Bayalpata now has to refer just 10-20% of orthopaedic cases to hospitals in Dhangadi and Nepalganj, compared to nearly 70% two years ago.“I am proud to say that all the basic trauma care can now be done by general practitioners. Plus they can diagnose cases and decide which need to be referred to outside centres,” says Pathak.Training is integral to Bayalpata’s mission, says Director of Medical Education <a href="http://archive.nepalitimes.com/regular-columns/GUEST-COLUMN/Saving-one-mother-at-a-time,816">Bikash Gauchan</a>: his hospital has continuing medical education for clinicians, and on the job training for future nurses and other staff. General practitioners from various centres learn rural surgery at Bayalpata while mid-level staff come to improve their clinical knowledge.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221104141144/6365179e9c7e80680e02c287jpeg.jpg" alt="" width="1400" height="650"><figcaption> </figcaption></figure>For some <a href="http://archive.nepalitimes.com/article/nation/aim-for-fewer-patients-in-achham-possible-hospital,2022">patients who travel many days</a> to reach Bayalpata, access to basic surgery here means avoiding an expensive trip to the city. People whose limbs were fractured as long as three years ago delayed treatment until surgery was available at the hospital because they couldn’t afford the trip to a city hospital.Treatment at Bayalpata and at another hospital in Dolakha run by the non-profit Possible, is <a href="http://archive.nepalitimes.com/article/nation/Nation-free-for-all-healthcare,491#.UbrA4ueLA1s">free</a>. The group believes healthcare is a fundamental human right protected by Nepal’s Constitution, and should have no cost at point of delivery.Possible is funded by donations and Nepal government grants, which will grow as its hospitals attain clinical targets, such as the percentage of women who give birth in a facility with a trained clinician. Operating expenses last year were $4.8 million, of which 9% came from the government.Arrivals are registered in the hospital’s Electronic Health Record (EHR), which puts patients’ information at the fingertips of clinicians throughout the hospital, and eliminates bulky paper records.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221104141144/636517a19c7e80680e02c288jpeg.jpg" alt="" width="1400" height="823"><figcaption> </figcaption></figure>One patient already on the EHR is Namsara Tamrakar. Sitting cross-legged on a raised, wooden platform outside her home in Chandika village (left), the elderly woman shows visiting hospital staff that she knows how to use her inhaler, but it is empty.Three years ago, a doctor at Bayalpata diagnosed her with chronic obstructive pulmonary disease and prescribed medicine via inhaler. Now Community Health Worker Bhajan Kunwar (see box, left) visits regularly to follow up. Like others, Tamrakar’s house has a small blue metal tag on an outside wall with a unique household ID. The houses are also geo-tagged.Kunwar’s visit is guided by CommCare, a software developed by Dimagi and customised by Possible that includes counselling information and checklists for each patient. Plans are to integrate CommCare with the EHR so that field followups are immediately reflected in the hospital’s system. Eventually, Bayalpata’s EHR will be linked to a national data system.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221104141144/636517a49c7e80680e02c289jpeg.jpg" alt="" width="1400" height="1024"><figcaption> </figcaption></figure>Kunwar takes Tamrakar’s blood pressure: 120 by 80. The woman is happy to hear the news and to see Kunwar again: “She comes, does a check-up, and tells me what sickness I have, and if it is getting better or worse. She insists I go to Bayalpata for a follow-up.”The hospital's <a href="http://archive.nepalitimes.com/article/nation/Nation-Crowdfund-globally-act-locally,490">community health program</a> focuses on maternal and child health as well as non-communicable diseases such as hypertension, diabetes and respiratory ailments. Possible employs 56 community health workers looking after more than 80,000 people in Achham and Dolakha. It is planning to more than quadruple that number next year.Bayalpata Hospital started in 2009, when the group <a href="http://archive.nepalitimes.com/article/nation/Crowding-it-out,1003">Nyaya Health</a> (now Possible) took over an abandoned government facility. Then it had five beds and treated up to 12,000 patients a year. Last year, Possible saw 86,000 patients at Bayalpata: the goal is to treat 150,000 people annually after the new wards, emergency room, administration building, a dormitory and remaining small houses for on-call staff are added.“Our integrated, hospital-to-home approach will be a model for Nepal, and beyond,” explains Gauchan, “and we will be proving that in a resource-limited setting, health care expansion, providing universal health coverage to people is possible.”But is the Bayalpata model really replicable? Skeptics say that two hospitals could have been built for the cost of the new buildings, which feature rammed earth technology, solar energy and rainwater collection, and that only substantial donor support made the expansion possible.Gauchan admits that the initial investment may seem high but says it will be more cost-effective in the long run.He adds: “The existing infrastructure for rural health care is way less than the minimum needed to address the emerging burden of non-communicable diseases and road accidents as well as infectious diseases. That is why we are investing in a very robust infrastructure.”<h2>Community spirit</h2>In 2011, Bhajan Kunwar (pictured above) was living an “Ok” life with her husband Purna and children in Bhageswor village of Achham when her sister-in-law Shavitra asked for a favour.Shavitra had been hearing rumours that her husband, who was working in India, was having an affair or had even remarried. Would Purna take her to India to find out? Purna agreed, and brother and sister set off with a friend. En route, Purna received a phone call from Shavitra’s husband warning them not to come, or there would be trouble.They continued anyway, and after crossing the border got on a train. That night, a group of men, perhaps including police, boarded the train and took Purna away. He later called Shavitra’s husband to say he had been kidnapped and would be killed unless help came quickly.Police found Purna’s body the next morning, on the roadside in Ahmednagar, east of Mumbai. It looked like he had been run over, but Bhajan believes he was murdered.Widowed at 25 and with two small children, Bhajan spent the mourning period worrying about how she would afford to send the children to school, and if her mother-in-law and community would accept her becoming the breadwinner for her husband’s four younger brothers and sisters and their families. (Her father-in-law had died earlier).That month, Bayalpata Hospital had a vacancy for a community health worker for the area. Bhajan was hired and six years later, still visits on foot the more than 700 households in her catchment area, checking that patients are taking their medicines, and much more (see main article).“This hospital made me strong,” she tells us. "Before I didn’t know anyone in my village and I didn’t know so many things.” Now with a college certificate, Bhajan advises young women to get educated before they get married. “I tell them ‘if I can do it, you can do it too’. I believe in myself and don’t care what others say about me. If you are true and honest, no harm will come to you.”Bhajan says she will never forget her husband. “But I have to live for my children, and control my mind and my heart. If I am strong, they can have a regular life. The hospital is now my husband, I cannot imagine leaving it.”Marty Logan in Achham<h2>Operating remotely</h2>When nine-year-old Samir Tamang was bitten by a dog on his way to school in Rayale village of Kavre last week, he had to take a two-and-a-half hour long bus ride to Kathmandu with his grandfather Suk Bahadur Tamang, for a rabies vaccination at Teku Hospital.Samir missed school and his grandfather, who works as a driver in Kathmandu, had to ask for leave from his employers.“We are relatively close to the capital, but imagine what it must be like for people living in remote parts of Nepal where there are no roads,” says Suk Bahadur.Indeed, despite the spread of basic health care in Nepal, emergency treatment and procedures like mending broken bones or caesarean sections are not yet available in rural areas. This means families have to sell property or borrow from moneylenders to be able to afford treatment in the cities. Studies have shown that many Nepali families are driven to poverty if relatives are referred to private hospitals.Unmet surgical needs in remote districts remain a major public health issue in Nepal, according to a recent study in 39 remote area hospitals commissioned by the Nick Simons Institute (NSI).One day this week, an informal survey of patients at the government-run Bir and Teaching Hospitals in Kathmandu showed that a majority of the patients were from remote districts, some as far away as Piuthan and Jajarkot.The NSI study shows that except for caesarean sections in Dolakha, Lamjung and Panchthar, very few government hospitals elsewhere were able to do simple operations of the abdominal cavity, or even mend broken bones.Nepal’s surgery rate falls well below the Lancet Commission target of 5,000 operations per 100,000 population. If the goal is to have a surgical facility within two-hour travel distance for patients, at present only a third of the population can reach an orthopaedic surgeon, and only 22% have access to abdominal surgery.However, the survey reaffirms that the presence of a medical general practitioner (MDGPs who can perform caesarean sections and other relatively simple surgical procedures) can change this. District hospitals with resident MDGPs can eliminate the need for patients to make expensive and extended trips to the cities for treatment.The minimum personnel at a district hospital should include an MDGP, obstretrics doctor, anaesthesia assistant, staff nurse and biomedical technician. However, Nepal’s density of hospitals with such staffing is very low (0.4-3.1 per 100,000) as against the Lancet Commission target of 20 per 100,000 population.“In the long run we need specialists but placing three of them in each district hospital will take a long time. For the next 5-10 years, MDGPs will be the answer to solve surgical problems throughout the country,” explains Anil Shrestha, NSI’s Executive Director.The study recommends an MDGP-led generalist surgical team with proper staff, drugs and equipment to upgrade emergency surgical care in all district hospitals.Adds Shrestha: “The government has to strengthen strategically located district hospitals and make them functional to take care of surgical needs throughout the year. It is entirely possible to do.”Sonia Awale in KavreRead also:<a href="https://www.nepalitimes.com/editorial/poor-health/">Poor health</a>, Editorial <a href="http://archive.nepalitimes.com/news.php?id=17650#.Wrydky5ubIV">Resurrection Accham</a>,  Paavan Mathema<a href="http://archive.nepalitimes.com/article/nation/aim-for-fewer-patients-in-achham-possible-hospital,2022">Boy walked eight days to treat broken arm</a>,  Tsering Dolker Gurung<a href="http://archive.nepalitimes.com/article/nation/Nation-free-for-all-healthcare,491#.UbrA4ueLA1s">Free-for-all health</a>,  Duncan Maru and Roshan Bista

Marty Logan

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State of the art rural hospital

The Kangchenjunga Trek in far-eastern Nepal is a remote and less-crowded adventure that offers raw wilderness, diverse cultures, and breathtaking terrain below the world’s third highest mountain. Kangchenjunga (8,586m) grabbed the world’s attention before Mt Everest ever did because its imposing rampart dominated the northern horizon from Darjeeling, the summer refuge for the British in India. The Kangchenjunga massif is more a mountain range rather than a peak, its high ridge stretching 25km from Nepal to Sikkim.  <figure><img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251211111236_1f51f10becbb6bd01248f5845c6055479201365b1357fbbc6479b6724ea2185c.jpg" data-media-id="editor_0" data-image-id="20251211111236_1f51f10becbb6bd01248f5845c6055479201365b1357fbbc6479b6724ea2185c" data-rendition-name="original" width="938" height="726" loading="lazy" alt="Kangchenjunga trail map"></figure>  Sikkim considers the mountain sacred, and has banned mountaineering expeditions. But the various prominences of Kangchenjunga are increasingly popular for climbers via the north face in Nepal. For non-mountaineers, even the Kangchenjunga trek can be arduous, especially in winter. It is one of the last pure wilderness areas in Nepal, traversing sparsely populated valleys that are rich in biodiversity because of the high annual rainfall. Even when Nepal was a forbidden land, among the first foreign visitors was British botanist J D Hooker who explored the Nepal side of Kangchenjunga in 1850 to collect plant samples. The peak was first climbed in 1955, two years after the first ascent of Mt Everest.  <figure><img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251215071228_7dd4ddc943554012654df0a2f5065ed364b8349c31888ac8cbe175b4540d1dfd.jpg" data-media-id="editor_1" data-image-id="20251215071228_7dd4ddc943554012654df0a2f5065ed364b8349c31888ac8cbe175b4540d1dfd" data-rendition-name="original" width="1280" height="597" loading="lazy" alt="Kangchenjunga in winter NT"></figure>   <figure><img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025121509128_a857e5e9cfc7fea2f5f0b060b8f6e9f6582abc1ac1fd1a60abad90a9d55adbff.jpg" data-media-id="editor_2" data-image-id="2025121509128_a857e5e9cfc7fea2f5f0b060b8f6e9f6582abc1ac1fd1a60abad90a9d55adbff" data-rendition-name="original" width="720" height="1280" loading="lazy" alt="Kangchenjunga in winter NT"></figure>  The establishment of Kangchenjunga Conservation Area in September 2006 was accompanied by tragedy when 24 people, including Nepal’s nature preservation pioneers were killed in a helicopter crash. The Conservation Area is now the only one managed completely by the local indigenous people. It has 70 varieties of orchids, 30 rhododendron types, and 15 out of 28 endemic plants of Nepal. Kangchenjunga still gets very few of the 200,000 foreign trekkers who visit Nepal every year, but improved road access in recent years is making it more popular. Trekkers have a choice of exploring the North Base Camp (Pangpema) or the South Base Camp (Yalung Glacier), or combine both for the full Kangchenjunga Circuit (map). This trek is considered strenuous, with long walking days, high altitude, and tea house accommodation that is much more basic than the Everest or Annapurna regions. Trekkers have to be fit and with prior hiking experience. Most teams take tents and camp, and carry most of their food.  <figure><img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025121509128_895ccc1d918f88c255dbeccea19c990bcaa792f384750559cb7257b99f177be7.jpg" data-media-id="editor_3" data-image-id="2025121509128_895ccc1d918f88c255dbeccea19c990bcaa792f384750559cb7257b99f177be7" data-rendition-name="original" width="1280" height="597" loading="lazy" alt="Kangchenjunga in winter NT"></figure>  FULL CIRCUIT Because the region is restricted, trekkers must obtain a permit and be accompanied by a licensed guide. A full circuit can take three weeks, while doing only the North or South Base Camps will take two weeks, including flying from Kathmandu to Bhadrapur and jeep to Taplejung or a rough trail to Hellok. The lower forested stretches are teeming with wildlife, and this is red panda and snow leopard country. The streams and ponds have amphibians and reptiles, some of which have not yet even been classified. The route also passes the homelands of the Limbu, Rai and Tibetan communities with the local culture and architecture more intact than in most other mountain areas of Nepal.  <figure><img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025121509128_90c129a639376621ece0aa067a601573f8b06d934c089a0fa929a7ce9c12018b.jpg" data-media-id="editor_4" data-image-id="2025121509128_90c129a639376621ece0aa067a601573f8b06d934c089a0fa929a7ce9c12018b" data-rendition-name="original" width="1280" height="597" loading="lazy" alt="Kangchenjunga in winter NT"></figure>   <figure><img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025121509128_f51e595e5a18d573365cc611dbf1a49cfb19b2b8ee40164ed500179e2a2b04f8.jpg" data-media-id="editor_5" data-image-id="2025121509128_f51e595e5a18d573365cc611dbf1a49cfb19b2b8ee40164ed500179e2a2b04f8" data-rendition-name="original" width="720" height="1280" loading="lazy" alt="Kangchenjunga in winter NT"></figure>  The best seasons to trek are spring (March–May) and autumn (September–November). There are fewer trekkers and climbers in winter, and many of the birds and wildlife have migrated down to warmer climes. Despite its beauty, trekkers should be prepared for challenges like long distances between villages, unpredictable weather, and limited emergency rescue options due to the remoteness of the area — all even more challenging in winter. Norbu Lama is an international hiking guide with www.dolpocaravantreks.com and just returned after leading a trek to Kangchenjunga Base Camps.

Kangchenjunga in winter

Ancient heritage meets dern distillery craft as the US-based The Nepali Spirit Company this month makes its global debut with Kathmandu Ayla. Inspired by Nepal’s ancient rice whiskey tradition, the product is the first of four handcrafted spirits that brings Kathmandu Valley’s 1,000-year-old ayla tradition to the world stage. “The first four products combine history, culture, and tradition and it has taken eight years to get to this launch point,” says CEO of The Nepal Spirit Company Kashish Das Shrestha, who is also publishing a book on the history of alcohol in Nepali culture. The other three ayla products are Masala Whiskey aged in Brazilian Amburana casks and spiced with black cardamom from Nepal, Annapurna Ayla, and Haku Chaku Himalayan Espresso Liqueur made with organic Nepali coffee, and chaku (dark molasses).  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251216141244_ab74945dc60ce5ff83fe7a88596fc032c18705e7cda9dc62df21694d3ad83b85.jpg" data-media-id="editor_0" data-image-id="20251216141244_ab74945dc60ce5ff83fe7a88596fc032c18705e7cda9dc62df21694d3ad83b85" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="The American Ayla NT"> </figure>  “I started visiting international whiskey auctions six years ago and after reading about distilling, my passion for spirits grew, and I felt the urge to tell the story of Nepal’s heritage spirits to the world,” explains Shrestha. Once poured in Nepal’s royal courts, ayla is a clear rice whiskey that is a millennia-old living heritage of Kathmandu used in rituals from birth to death and traditional life milestones of its inhabitants. Ayla is distilled to capture the classic aromas and flavors, with a soft sweet after taste. It can be enjoyed neat, sipped through meals, or enjoyed as shots. With more than 15% of Nepal’s population living and working abroad, there is a cultural demand for ayla in the diaspora from Asan to Amstredam to Australia.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251216121236_0db0ec396832736fef60b636d7012a917be65471408c81383a40613f928f9e78.jpg" data-media-id="editor_1" data-image-id="20251216121236_0db0ec396832736fef60b636d7012a917be65471408c81383a40613f928f9e78" data-rendition-name="original" width="1000" height="1270" loading="lazy" alt="The American Ayla NT"> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251216141236_a84ede74c67a61e75af2f0cc1c985b4d04ff2292c6bd0bd0b841f4d2c7b593aa.jpg" data-media-id="editor_2" data-image-id="20251216141236_a84ede74c67a61e75af2f0cc1c985b4d04ff2292c6bd0bd0b841f4d2c7b593aa" data-rendition-name="original" width="1778" height="1000" loading="lazy" alt="The American Ayla NT"> </figure>  &nbsp;“We also believe ayla is a wonderful way to tell Nepal’s story to the world,” says Lilu KC Shrestha, Chief Operating Officer of the company. “We intend to use our platform to promote Nepal in any way we can, and also find ways to give back to the country. It was high time a world-class Nepali spirits brand entered the global market, and we are proud to take the lead.” Aside from the ayla itself, the bottle and packaging was conceived by New York-based designer Sahara Shrestha to reflect a complete Nepaliness. “Each bottle and box is a love letter to Nepal, and every detail is an expression of respect and appreciation of Nepali heritage and our desire to share it with the world,” says Kashish Das Shrestha. “And ayla itself is a sacred part of our culture, so we wanted to make sure the bottle reflects this reverence.”  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251216141244_d2746204c64802ff81453d7a8749f516bf3c62538fe3c98400a9b3978c03b273.jpg" data-media-id="editor_3" data-image-id="20251216141244_d2746204c64802ff81453d7a8749f516bf3c62538fe3c98400a9b3978c03b273" data-rendition-name="original" width="1920" height="1475" loading="lazy" alt="The American Ayla NT"> <figcaption>Aylarita</figcaption> </figure>  The bottom of each bottle has an embossed Mandala representing the universe and its interconnectedness. A glass molding of Himalayan peaks Chomolungma and Nuptse signifies the earth and heaven. The bottle cap is a black and gold rendering of the metal plates that hang from Kathmandu’s temples. The logo of The Nepali Spirit Company is also inspired by the unti, a traditional vessel used to pour ayla. While its top is typically adorned with a peacock, the company’s design replaces it with rice stalks. This motif is also on the label of Annapurna Whiskey named in honour of both the mountain and the goddess, the giver of grain. For a new take, ayla can be paired with a lime wedge lathered in honey, cumin, and salt, or on the glass rim. It can also be mixed into cocktails to make Aylarita, Aylatini, or Aylapolitan. <a href="http://www.thenepalispirit.com/" target="_blank">www.thenepalispirit.com</a>, @TheNepaliSpirit

The American Ayla

When Winston Churchill addressed the Canadian Parliament in December 1941, he recalled that generals of Nazi-occupied France had said that England would “have her neck wrung like a chicken”. Churchill went on to quip: “Some chicken.” As the laughter and applause subsided, he added: “Some neck.” (Even longer laughter and applause) We do not know who first started calling the narrow corridor that joins India to its northeastern states a 'Chicken’s Neck', but there also was the hint of a Churcillian connotation. Akhilesh Upadhayay in his new book In the Margins of the Empires: A History of the Chicken’s Neck, uses this strip as an entry point to explore a region adjoining Nepal, Bhutan, China, Sikkim, Darjeeling, India’s northeast and the tectonics that shaped its geo-strategic terrain.&nbsp; Upadhyay’s Chicken Neck is an organic whole, connected through centuries by transboundary traders, travellers, monks, spies, missionaries, mountaineers, and more. And as infrastructure and connectivity improves, smaller countries like Nepal and Bhutan (and earlier Sikkim) are caught up in the region’s rivalries. The tri-junction of the Chicken’s Neck is a potential flashpoint that has obsessed India’s military strategists ever since Partition in 1947 and the formation of East Pakistan, and the Chinese annexation of Tibet. India found itself squeezed between Chumbi Valley in China to the north and Pakistan to the south. So, when Sikkim started acting too independent for its own good 50 years ago, India engineered its annexation and turned it into its 22nd state. The 1962 Sino-Indian war elevated its strategic importance even more. Alarm bells ring in New Delhi each time there is trouble around the Chicken’s Neck: the Naxalite uprising had to be swiftly crushed, the Indian military moved in to liberate Bangladesh, Gorkhaland and ULFA activities were dangerously nearby, Bhutan had to be appeased. Every once in a while things would flare up between India and China, as in the 2017 Doklam standoff.&nbsp; And last year’s regime change in Bangladesh has rattled New Delhi enough to deploy its Rafael fighters and BrahMos cruise missiles in the Chicken’s Neck. It is now the most densely militarised strip of real estate in this part of the world. &nbsp; As a journalist and former editor of Kathmandu Post, Upadhyay also peers at the Chicken’s Neck through Nepal’s perspective. After all, Jhapa (where the author is originally from) sits right there astride India’s strategic lifeline.&nbsp; Geopolitics is at the front and centre of the book that takes readers back to the time Nepal was a closed Himalayan kingdom.&nbsp; Nepal may be a yam between two boulders, but it may just as well be a thicker Chicken’s Neck as far as New Delhi and Beijing are concerned. Nepal’s rulers have always had to walk the tightrope between China and India. Khampa guerrillas, covertly helped by American and Indian intelligence, raided Chinese military convoys from bases in Nepal, and King Mahendra had to do some intricate diplomatic footwork. India is often described as Nepal’s closest friend, but our relations with China go back as long in terms of the Lhasa trade, Bhrikuti and Arniko, religious exchanges and people-to-people relations. While Nepali researchers are wary of touching on Chinese, Indian or American sensitivities, Upadhyay’s journalistic background means he has no qualms about tackling the subject head-on, and objectively. He spent more than a year researching the book, sniffing around Siliguri, Bagdogra, Naxalbari, Darjeeling and the villages on the Jhapa side. Then he travelled to Olangchung Gola to listen to ordinary people of the Himalayan rimlands. Despite the perception about rigid frontiers between nation states, the book hints at how absurd the notion is. The Chicken’s Neck is also a wild elephant migration corridor, disturbed by the India-Bangladesh border fence, new expressway embankments, airport runways, and expanding cities. Similarly, the people on the Nepal-tibet border used to cross over to graze yaks — this expanded the gene pools of not just the yaks but also the nomadic humans who moved with the herds.&nbsp; Despite the hard borders, trade flourishes. Upadhyay marvels that a shop in Phungling in Taplejung has embroidered saris from Siliguri and fluffy jackets from China. he finds that residents in the northeastern and southeastern tips of Nepal have more in common with kin across the border in Tibet or India than with someone from Kathmandu. Nepal was once one of the biggest trade hubs in ancient times, and our products were treated as equals in Indian border cities. People too, could move freely, especially if they were and are from bordering Tarai cities.&nbsp; Nepal’s rich history and culture was shaped by the proximity to neighbours, and despite borders it is still cemented by marriages and trade — especially in the Nepali-speaking lands to the east. Its geographical positioning makes Nepal not landlocked but land-linked, adjacent to the largest emerging economies of the world. Nepal needs to deploy its soft power with effective diplomacy to take advantage of these two empires, and not be choked by their rivalry. The book was going to press when the GenZ protests ignited in September, but Upadhyay nevertheless managed to insert the current political transition into the pages with deft editing. &nbsp;The final section of the book examines at least three possible scenarios that may unfold as South Asia continues to be shaped by great power rivalries and imperial contests that have weakened the unilateral influence of the west.&nbsp; Akhilesh Upadhyay extrapolates from the Chicken’s Neck, zooming out for a wider perspective on the Subcontinent. &nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025121912124_0ae772e7736a65f53a99599b5724ca133a64fdea0e61c7170ea81f9dd95c7af0.jpg" data-media-id="editor_0" data-image-id="2025121912124_0ae772e7736a65f53a99599b5724ca133a64fdea0e61c7170ea81f9dd95c7af0" data-rendition-name="original" width="1136" height="702" loading="lazy" alt="In the Margins of Empires: A History of the Chicken’s Neck NT"> </figure>

Some chicken, some neck

This is the first instalment of our new series Nepal Made, where we profile world-class Nepali products and the people behind them. The Himalaya is the home to Ayurveda, the preventive and curative medicinal practice that relies on the tremendous diversity of plant life. This is where Hanuman is said to have come to find a specific rare herb when Ram was wounded in battle. When he could not find it, he tore off a whole mountain and hauled it down to Lanka. Since then, herbal medicines and care products have been steadily modernised in India and Nepal. Now, one Kathmandu-based company, Herveda, is going global with an all-natural skincare brand that blends traditional knowledge of medicinal plants with modern technology. Originally a Sanskrit word, Ayurveda literally means ‘the science of life’ and promotes physical and mental wellbeing through a holistic knowledge system that is 4,000 years old. Ayurvedic products have gotten more popular as global demand rises for all-natural, chemical-free cosmetic and wellness products, instead of wasteful fast fashion and beauty trends. Herveda was founded by Prativa Pandey, a scientist-entrepreneur and mother of two. She did her PhD in nanotechnology chemistry from Northwestern University in the United States and returned to Nepal in 2015 after the earthquake, staying back to explore the market and launch her brand.  <figure><img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251218141216_b699e74ee82333951b99b22648705dc916deb8eef3d425c77c1e2f3b1058a64d.jpg" data-media-id="editor_0" data-image-id="20251218141216_b699e74ee82333951b99b22648705dc916deb8eef3d425c77c1e2f3b1058a64d" data-rendition-name="original" width="1000" height="1500" loading="lazy" alt="Looking good by doing good NT"></figure>  “I wanted to do something in Nepal, but didn’t want to be a doctor or engineer,” says Pandey at the elegant Herveda showroom in Jhamsikhel. “Whatever knowledge that I had gathered, I wanted to spread it in my own country.” Nepal is rich in traditional medicinal herbs and Ayurvedic plants, but proper utilisation and mobilisation has always been lagging. Most of the benefits are reaped by large companies and not local farmers. Pandey wanted to change that. To ensure that it gives back to the community, Herveda collaborates with farmers and local traders for fair trade. “I have always been fascinated by the medicinal herbs found in Nepal, and wanted to create high value products with them. It was a way to combine valuable indigenous knowledge with my academic research background,” adds Pandey. “I did not require a huge investment, just a proper marketing strategy.”  <figure><img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251218141216_350f6eb1511523ea54a8aba468f20a7dffcb5def3fade4dcced30324417f83bc.jpg" data-media-id="editor_1" data-image-id="20251218141216_350f6eb1511523ea54a8aba468f20a7dffcb5def3fade4dcced30324417f83bc" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Looking good by doing good NT"></figure>  According to the Trade and Promotion Center under the Ministry of Industry, Nepal’s import of cosmetic products is increasing every year, driven by demand from a younger population. These younger customers are also more conscious about the products they use. For brands like Herveda, it is important that customers engage in wellness and skincare in an ethical and sustainable manner. Apart from being all natural, Herveda’s flagship store in Jhamsikhel has a reuse box where consumers can drop used bottles, which are then recycled. The store also displays products from 35 local businesses. Pandey believes that Nepali brands should cross-promote and complement each other: “Rather than competing, I believe we should support each other. 1+1 can be 11, and not two.” Effectiveness and functionality hold great importance for Herveda. which employs 25 scientists to develop and lab test its products at its research institute. Currently, there are products ranging from Rs400-2,000, which include lip balms, serums, and essential oils. A signature product is the Berry Boost Radiance Mask, which contains Spikenard (Jatamansi), Ashwagandha, Orange Peel, and Rhododendron.  <figure><img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251218141216_7ec1104e0dd63db2fbbfe666034b468fe5b7e6876fde8b5446cb9d9fe27566cf.jpg" data-media-id="editor_2" data-image-id="20251218141216_7ec1104e0dd63db2fbbfe666034b468fe5b7e6876fde8b5446cb9d9fe27566cf" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Looking good by doing good NT"></figure>  Herveda exports to the United States and plans to expand to China and Europe. The products get a 50-100% markup in the international market. The company recently received a grant from UKAid to expand the market as well as build capacity to scale up. It has partnered with Agriplayer software to help to develop QR codes on its products, which consumers will be able to scan to track the product sources and evaluate pricing. Nepal lags behind in rules and regulations, and the lack of monitoring has allowed low quality cosmetic products to penetrate into the market. Herveda has got an international certification from USFTA, which is important for its foray into the export market. “For the cosmetic industry to scale up, there should be a central testing facility that is well equipped and meets international standards. Additionally, export should be made easy,” adds Pandey. “If there are too many barriers to entry, no one will be willing to invest.”

accham

Is free health care possible in Nepal?

State of the art rural hospital

Kangchenjunga in winter

The American Ayla

Some chicken, some neck

Looking good by doing good