<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

As a direct fallout of the Israel-American war on Iran, Nepal on Monday nearly doubled the price of aviation fuel in a move that is going to impact during the spring peak tourism season. The steep price hike of jet fuel appears to have been made to cushion the impact on the general public. The price of petrol, diesel and cooking gas were also hiked for the third time in a month on Thursday.&nbsp; Aviation turbine fuel (ATF) will now cost $2,237/ton up from $1,207. The cost of ATF in Kathmandu was <a href="https://nepalitimes.com/news/sky-high-fuel-price-hits-nepal-s-tourism-airlines" target="_blank">already one of the highest among Asian airports</a>, and this price hike will affect mostly long-haul flights to Istanbul, Seoul and Narita for airlines that need to refuel in Kathmandu.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260404130420_4ae075d1e871fc5608cf242d6e309005d30cfdb6e6d0ecfb45ca7388a851c6aa.png" data-media-id="editor_1" data-image-id="20260404130420_4ae075d1e871fc5608cf242d6e309005d30cfdb6e6d0ecfb45ca7388a851c6aa" data-rendition-name="original" width="1784" height="1294" loading="lazy" alt="aviation turbine fuel prices"> </figure>  Domestic airlines, which paid Rs127 per litre, will now have to pay Rs251 for their turboprop planes. “We have no recourse but to pass this on to passengers as a fuel surcharge,” said one executive of a domestic airline in Nepal. As it is, Nepal Oil Corporation levied a hefty tax on petrol and ATF in order to subsidise diesel and cooking gas. Many analysts were expecting a fuel price hike, but the near-doubling of the price of ATF means the new Nepal government is trying to protect ordinary citizens from raising the price of diesel and LPG even more than it has so far. Aviation fuel in Nepal is trucked in on tankers from Indian refineries and its price is highest in Kathmandu, and less in Bhairawa and Pokhara — transportation costs being higher depending on distance. But even in Bhairawa, ATF prices have doubled for the only international airline that serves it, Thai AirAsia.&nbsp; Most airlines flying Kathmandu from nearer airports in India, the Gulf and Southeast Asia will be less impacted because they can fly in on full tanks and need minimum refuelling in Kathmandu. But carriers like <a href="https://nepalitimes.com/banner/high-cost-lays-aviation-low-in-nepal" target="_blank">Turkish Airlines</a>, Cathay Pacific, Korean Air, &nbsp;and Nepal Airlines which fly wide body aircraft on long-distance routes will be hit hardest.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026040305040_a40db74375ebe0c28e7c35477bc262df9ae392a84e7bfa4033996181d69e0209.jpg" data-media-id="editor_3" data-image-id="2026040305040_a40db74375ebe0c28e7c35477bc262df9ae392a84e7bfa4033996181d69e0209" data-rendition-name="original" width="1032" height="689" loading="lazy" alt="sky high prices"> </figure>  However, ATF costs have also been raised in regional airports like Hong Kong, India and Singapore. Aviation fuel at New Delhi airport has risen to $1,698/ton. Korean Air is adopting emergency measures to reduce expenses to make up for rising fuel costs. South Korea gets nearly all its fuel from the Gulf, and the blocking of the Strait of Hormuz has been especially damaging for the country. Fuel makes up more than a third of the operating cost of airlines, and even a small increase in ATF prices can make a big difference. Crude oil prices have increased 50% since the West Asia war began on 28 February, and global ATF prices have doubled.&nbsp; Airlines in Asia, including Nepal, face a double shock. The first is the higher fuel cost, and the second is that fewer people are travelling. Nepal’s tourism arrivals fell in March compared to February. India has added up to 20% fuel surcharge on domestic flights, and has reduced flights by 12%. Chinese airlines have also been affected, with China Eastern preparing for a significant impact of the Gulf war. It has added fuel surcharges to new tickets, as have Cathay Pacific, Thai International and Air Asia. Vietnam has drastically cut the number of domestic flights, and the Philippines will ration ATF. Australia imports 90% of its ATF mainly from China which has stopped export to ensure domestic supply to its own airlines. Carriers like Qantas have curtailed flights, changing aircraft type on long-haul routes, and a fuel surcharge of up to 20% have been added to tickets. Most Asian airlines are adding fuel charges only to new tickets, and the increase will not affect the price of pre-sold tickets issued for April and May.

Fuel price shock hits Nepal aviation

It is only April, and Himalayan expeditions are already making rotations to acclimatise on Annapurna and Dhaulagiri, and will soon be making summit pushes.&nbsp; On Mt Everest, Icefall Doctors are fixing ropes and ladders into the Western Cwm as international climbers arrive at Base Camp. Spring 2026 is going to be the busiest and most crowded so far in the Nepal Himalaya. The main reason is that China has closed expeditions from the north side for eight-thousanders Everest and Cho Oyu, and also Xixapangma.&nbsp; The closure is informal, from what one can make out. The Chinese have not put out any official statement, but there are no permits either. The reason seemingly was the ‘Rising Dragon’ firework display last September by pyrotechnic artist Cai Guo-Qiang near Xigatse.&nbsp; Working with outdoor wear company Arc’teryx, Guo-Qiang set off an impressive sequence of orange and white fireworks that wound up a mountain. The spectacular display was criticised for damaging the fragile ecology of the Tibetan Plateau. But this cannot be the only reason the north side is closed. Experienced Everest blogger Alan Arnette anticipates that about 125 climbers will shift to the Nepal side of the mountains, and expects there to be up to 900 summits this spring — up from the highest spring number so far of 876 climbers on top in 2019.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260404050428_8c31812bf38f699c4faa74f25814a6ddaee397f71a629e549023f29250f05082.jpg" data-media-id="editor_0" data-image-id="20260404050428_8c31812bf38f699c4faa74f25814a6ddaee397f71a629e549023f29250f05082" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="mountaineering"> <figcaption>Photo: KARMA TENZING</figcaption> </figure>  The early Base Camp arrivals are having problems with their first rotations because of heavy snow this season. Unlike previous springs, this year has seen back-to-back blizzards at high altitudes since February. The increased snow load on the slopes have increased avalanche danger right across the mountains.&nbsp; There has been an increase in numbers on Everest despite the West Asia war, flight disruptions, LPG shortage and new regulations. The permit fee has gone up for the first time since 2015 from $11,000 to $15,000 this year.&nbsp; The Tourism Bill passed by Nepal’s Upper House last year would have required climbers to have first summitted a 7,000m peak in Nepal before attempting Everest. However, the Department of Tourism has confirmed that there are no new experience requirements this season. Some want this rule changed to include 7,000m peaks anywhere in the world. That could be one reason people are rushing to climb Everest before the Nepal government changes its mind and enforces the new regulations on prior experience on Everest. “It’s probably going to encourage a lot of people that simply are not ready to go,” reckons Alan Arnette. “Once again, we may see a lot of inexperienced people on the mountain trying to get in before the rule comes into place, if it does.”&nbsp; Arnette has always been sceptical of Everest regulations, and points out many instances where rules have been announced but not implemented over the ten years that he has been tracking them. For example, a helicopter ban to Everest Base Camp was announced last year, but rescinded. A rule requiring climbers to bring down waste was never seriously enforced. Since there is so much money involved for the government and for the operators, any any rule that would reduce revenue is never fully implemented. This year there is another ‘High-Altitude Trash Quota’ rule requiring climbers and guides operating above Camp 2 to collect and bring down at least 2kg of waste from the higher camps.&nbsp; The Nepal government has tried to diversify peaks on offer by reducing the royalty on climbs, but the draw of Everest, Annapurna and other eight-thousanders seems to be too great. Even when the permit fees for some remote peaks like Kangri Shar, Himlung and Api, were reduced to $400, there are few takers.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260402120436_a90cd44858e97086f773aa1fbd592b3434bb07d89cd4a1843b2ca32a84e7c72d.jpg" data-media-id="editor_1" data-image-id="20260402120436_a90cd44858e97086f773aa1fbd592b3434bb07d89cd4a1843b2ca32a84e7c72d" data-rendition-name="original" width="1500" height="1125" loading="lazy" alt="Photo Damien Francois"> <figcaption>Photo: DAMIEN FRANCOIS</figcaption> </figure>  TIME LAPSE Clients and expedition operators have been trying to shorten the time needed to complete an Everest expedition from the city of origin to the top and back. Since Nepal has no rules about spending a certain number of days in acclimatisation, this has allowed some expedition organisers to use new technology.&nbsp; Austrian operator Lukas Furtenbach last May led a group of four British ex-military clients to the summit within a week of leaving London. This climb was scrutinised because the group had practiced breathing xenon gas, a substance that increases the count of red blood cells and is banned in competitive sports. The climbers had also trained for months at home in hypoxic tents, and used supplemental oxygen during the actual climb.&nbsp; The success of that expedition prompted an investigation by Nepal’s Ministry of Culture, Tourism, and Civil Aviation, but there was nothing it could do because the team had taken the xenon in Germany two weeks before their trip. But even if they had administered the gas in Nepal, it would technically not be illegal. Furtenbach is firmly in favour of speed, and of using the gas. “The only reason why we are working with xenon is to make climbing safer, to protect climbers from high altitude sickness,” he says, arguing that the less time climbers spend on the mountains, the less their exposure is to disasters, sickness, and they also generate less trash.&nbsp; His firm, Furtenbach Adventure, offers a three-week Everest South Flash expedition, at a cost of €100,000, using custom oxygen systems. Other expeditions take up to two months.&nbsp; A young American duo of Ryan Mitchell and Justin Sockett got to Everest Base Camp five days ago. They are preparing for an oxygen-free summit attempt.&nbsp; ‘ Being around these mountains for one day has already brought me so much joy. Every time I come back to the Khumbu I feel more familiar and connected,’ posted Mitchell. He and Sockett have since summitted Lobuche East (6,119m) as they continue to acclimatise and wait for the Khumbu Icefall route to be fixed.&nbsp; There are other sans-O2 trips planned this climbing season in Nepal. Norwegian Kristin Harila, the fastest in the world to climb all 14 8,000ers (in 92 days), is attempting the Nuptse, Lhotse, and Everest three-peak climb without supplemental oxygen. American Tyler Andrews and Ecuadorian Karl Egloff are continuing their race to break records in Everest. While Andrews is attempting the Fastest Known Time from Base Camp to the top without oxygen, Egloff is taking it a step further and going for a round trip: from Base Camp to the summit and back in record time.&nbsp; Both Egloff and Andrews had attempted these climbs in 2025 spring, but abandoned around 7,000m due to bad weather.&nbsp; Kami Rita Sherpa wants to extend his all-time record of total Everest summits to 32, while Kenton Cool from England is chasing 20, a non-Nepali record.&nbsp; The first summits of the season will be in late April, or early May depending on weather. Besides Everest, there are a lot of interesting climbs on lesser known peaks.&nbsp; The Japanese trio of Masayuki Takenaka, Tatsuro Sugimoto, and Ryota Nomura, for example, are attempting the unclimbed Jarkya Himal (6,473m) near Manaslu. &nbsp;&nbsp; <h2>Fake rescues</h2>  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260402120436_600c0176e24327fd3dfcfd634e4b871f3e5314aa00eb4885ad137ac6f9c4a3b6.jpg" data-media-id="editor_2" data-image-id="20260402120436_600c0176e24327fd3dfcfd634e4b871f3e5314aa00eb4885ad137ac6f9c4a3b6" data-rendition-name="original" width="800" height="519" loading="lazy" alt="Fake rescues"> </figure>  This year’s spring climbing season has coincided with Nepal’s new government taking action against alleged perpetrators in fake rescues and insurance fraud. The Central Investigation Bureau (CIB) has already arrested more than a dozen trekking agency executives, hospital managers and helicopter company executives for medevac insurance fraud. Climbers are known to fabricate medical emergencies, get flown down from as high as Camp II on Everest, and then submit false insurance claims.&nbsp; Sometimes one flight is made to look like many using fake invoices. Trekking companies are also involved in fake rescues of hikers who just get tired of walking.&nbsp; Too many fake claims could lead to insurer’s losing confidence in the industry, and increased premiums, leading to delayed responses in real accidents.&nbsp; As a result of the scandal, there is now more scrutiny from the government about rescues. Already, helicopter operators have to wait for permission before carrying out rescues while their application is vetted.&nbsp; The worry is that this could cause unnecessary delays when time is of the essence in mountain rescue. Already, medevacs are delayed because of the bureaucracy needing permits to fly to sensitive regions bordering China. Last year, a climber died on Himlung because helicopter rescue took too long while operators ran from door to door in Kathmandu to obtain necessary permits. <h2>Mingma David Sherpa, MP</h2>  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260402120432_05c1600440327f4ae4bcae641b634714951f45702080a88d4e2628587190aa25.jpg" data-media-id="editor_3" data-image-id="20260402120432_05c1600440327f4ae4bcae641b634714951f45702080a88d4e2628587190aa25" data-rendition-name="original" width="960" height="958" loading="lazy" alt="Mingma David Sherpa"> </figure>  Meet Mingma David Sherpa, Nepal’s first mountaineer to be nominated to Parliament. Sherpa is a self-made professional climber from Rolwaling, who rose up from an expedition porter to a record-breaking mountaineer and expedition organiser. As an insider, he is now in a position to streamline laws related to Nepal’s trekking and mountaineering sector. He is co-owner of EliteExped with Nims Purja, and in 2021 the two were part of a team of Nepali climbers to be the first to make it to the top of K2 in winter, the second highest mountain in the world in Pakistan.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260402120432_c4ec586e7a27b09a72e61925a3897d843f864563d9e82a3fd3e25293e22cbe54.png" data-media-id="editor_4" data-image-id="20260402120432_c4ec586e7a27b09a72e61925a3897d843f864563d9e82a3fd3e25293e22cbe54" data-rendition-name="original" width="2082" height="1396" loading="lazy" alt="Mingama David Sherpa"> </figure>  Mingma David was also on Purja’s Project Possible to climb all the 14 eight-thousanders in six months, shattering the previous record of seven years. He was featured in Purja’s documentary 14 Peaks: Nothing is Impossible.&nbsp; At age 30 he became the youngest climber to reach the top of all 14 eight-thousanders for which he was awarded the Piolet d’Or. Mingma David has taken part in dozens of successful rescues of fellow climber, including the highest ever long-line rescue on Dhaulagiri and saving the life of fellow-climber from 8,600m on Everest. <h2>April Fool</h2>  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260402120432_775afff27d4a2889a60730aa25bbc5f8eb8ea343528c8c031a6febbfd74814c4.jpg" data-media-id="editor_5" data-image-id="20260402120432_775afff27d4a2889a60730aa25bbc5f8eb8ea343528c8c031a6febbfd74814c4" data-rendition-name="original" width="1365" height="1820" loading="lazy" alt="Furtenback Adventures"> </figure>  The Austrian expedition outfitting company Furtenbach Adventures spoofed the anticipated crowds on an April First post on social media this week, showing ‘a fully galvanized, weather-resistant steel staircase, complete with a sturdy handrail’ to make the Hillary Step bottleneck on Mt Everest less dangerous.

Nepal Himalaya Spring 2026

Along with the Sherpa community, it is perhaps Kathmandu Valley’s Newāh Civilization that has been the most studied by anthropologists, architects, historians and social scientists.&nbsp; Tomes have been written about the built environment of the Valley’s former kingdoms, the influence of Indian culture, and how it in turn inspired the temples, monasteries and monuments in Tibet, through China right up to Korea and Japan. Lately, there has also been an attempt to recognise and preserve not just the brick and mortar landscape of Kathmandu, but also the intangible heritage of the Newāh people. A critical component of the ancient festivals in the streets, alleys and baha of the inner cities are ritual plays and dance. Gérard Toffin is a social anthropologist with the Centre d’Etudes Himalayennes at the Centre National de la Recherche Scientifique (CNRS) in France, and has been researching in the region since the early 1970s, focusing on Newāh society and especially its Jyapu farmers. Lately, his work has focused on indigenous theatrical performances, and how they are evolving with modern influences.&nbsp; RECORDING RITUALS The result of his study is this hefty ethnographic book, Newar Theatrical Performances: Religious, Royal and Comic Aspects, delving into sacred performances. This is the first-ever detailed documentation of the minutest aspects of traditional plays and holy ceremonies of Kathmandu Valley. This book is not for the package tourist on a quick walkabout of Patan, the details and terminology can be daunting even for natives to navigate. But this is what social science research is supposed to do – take a deep dive into cultures that we take for granted either because we are a part of it, or because we have never bothered to find out its meaning.&nbsp; Dance forms with mythological themes, masked processions, gestures, facial expressions of the performers, have all been passed down from one generation to the next, adhering to age-old codes. The world is moving at an accelerated pace because of TikTok-induced globalised connectivity, but traditional gender or caste dynamics and hierarchies are carried over intact in many of these performances. It is as if traditional theatre itself is a time capsule giving us a peep into the past. Some of the performances and dance are in danger of going extinct as the population ages and the young migrate out. However, there has been a cultural renaissance among the Newāh guthi overseeing these ritual plays, dances, or chariot processions. The next generation of apprentices are being trained. This pride in heritage means that Kathmandu Valley civilization is not as endangered as it may appear.&nbsp; Gérard Toffin’s book is an important ethnographic work that will help preserve the Nepal Valley’s unique blend of urban-rural, cosmopolitan-agricultural, Hindu-Buddhist, indigenous-national. The Tantric choreography of Newāh theatre, just as the kama sutra depictions on erotic temple art, show Indian influence, but Toffin says they have been ‘Newarized’.&nbsp; One example is the sexually-explicit shadow play staged every year since 1690 CE by Jhyalcha Guthi in Patan that exposes the infidelity of King Yog Narendra Malla. Toffin devotes a whole last section of his book to irreverent plays (khyalah) that ridiculed the rich and powerful, the royals and upper castes and their shenanigans.&nbsp; He examines the importance of comic relief at a time when death was ever-present in historic Kathmandu with its frequent epidemics. One cholera outbreak in 1885 is estimated to have killed 10,000 people – a fifth of Kathmandu’s population at the time.&nbsp; The Saparu festival in Kathmandu and Mataya in Patan memorialised through street processions those who had died the previous year – and this was institutionalised into Gai Jatra by King Pratap Malla in the 17th century to console his queen after their second son was killed by an elephant. Families were asked to file past the palace to show the queen that she was not the only one grieving.&nbsp; Pratap Malla also allowed clowns, burlesque plays, and satirists to make the queen laugh. The Rana and Shah regimes which suppressed free speech continued the Gai Jatra tradition to allow citizens to let off steam. Rulers were lampooned, and the performances involved scatological jokes, cross-dressing and lewd acts.&nbsp; Interestingly, the Nepal Bhasa word ‘pyakha’ means both ‘dance’ and ‘theatre’ (today also ‘cinema’, as Toffin notes) and so the performances were also a combination of ritual dance, traditional music and a stage play. Stories involve gods, goddesses and mythological characters, and are passed down through generations of performers. (See adjoining article on Pāhāñ Charey.) Street performances by masked dancers, like in the ‘Katti Pyakha’ in Patan, enact divine themes. The moving deities demand as much reverence as their static idols in the inner sanctum of temples. The book devotes a whole section to the importance of cultic masked dances where the performer is possessed by the spirit, and goes into a trembling trance.&nbsp; Some of this is now simplified and secularised into performances for tourists in hotels, but the genuine original masked dance troupes still parade down the streets, proving that ancient and modern are made to co-evolve in ways that only Kathmandu knows how.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260329140352_aace3ece2e2cc577aa478d83de4b34930e6ff9c088d5f5e3f02fa178d124a60d.jpg" data-media-id="editor_0" data-image-id="20260329140352_aace3ece2e2cc577aa478d83de4b34930e6ff9c088d5f5e3f02fa178d124a60d" data-rendition-name="original" width="1136" height="702" loading="lazy" alt="Newa theatre book details NT"> </figure>

All the world’s a stage in Kathmandu

Nepal is known internationally for its successful community forestry programme, and the country has doubled its forest cover to over 45% in the last 25 years.&nbsp; But the opposite is true for densely populated urban centres like Kathmandu Valley which have turned into concrete jungles, with no remaining open spaces. Air pollution is increasing to hazardous levels, and the urban heat bubble means the temperature in the city is 2°C-3°C higher than in the outskirts. But there is a solution with a proven track record from similar densely populated cities in Japan — the ‘Miyawaki Method’ of growing local varieties of trees in any small patch of land in the city and turning them into compact forests. Named after Japanese botanist Akira Miyawaki in the early 1970s, carefully selected native trees and plants grow in tiny plots of land, or even in household backyards. They regenerate degraded urban soil, and help restore some greenery and biodiversity back to sterile city centres. The group Lily Leaves has planted Miyawaki forests in six sites across Kathmandu, and is on a mission to green all the river corridors in the Valley. So far, it has planted more than 17,000 trees belonging to nearly 40 species in patches of land along the Bishnumati and Swayambhu, and is eyeing the UN Park area along the Bagmati. “It is extremely important to connect with nature and greenery in cities,” says Lily Katuwal of Lily Leaves. "Besides restoring nature, these forests also clean air pollution and reduce summer temperatures.” Unlike traditional reforestation where trees of the same species are planted in bulk at a distance of 3-4m, Miyawaki prioritises native varieties best suited to Kathmandu Valley’s microclimate. The saplings are packed densely together, spaced only 60cm apart. After they start growing, native grass and undergrowth also thrive. The most recent plantation was along the banks of the Bagmati in Sanepa where, in addition to camphor and jacaranda which are grown in the area, native species such as kabro (Ficus lacor), kanike (Forget-me-not), parijat (Night-flowering Jasmine or Coral Jasmine), chanp (Plumeria), harro (Ink Nut) and barro (Bahera) were planted. A new site in Kirtipur is being readied for the next plantation. Miyawaki has been carried out elsewhere in various parts of Nepal, primarily in Dhanusha which has seen forest regrowth that has brought back insect, bird, reptile and amphibian life.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260402120428_e70c196852945760d082fc73ee18ea6883d13c16186893c00c10fd0a0ea12105.jpg" data-media-id="editor_0" data-image-id="20260402120428_e70c196852945760d082fc73ee18ea6883d13c16186893c00c10fd0a0ea12105" data-rendition-name="original" width="1201" height="1600" loading="lazy" alt="Planting seeds for a greener Kathmandu"> </figure>  EMPOWERING WOMEN Lily Leaves employs just 17 women, six of whom have hearing disabilities. Many have been neglected or abandoned by their in-laws for various reasons. They have a livelihood and learn new skills so they can also find jobs elsewhere.&nbsp; “We trained them in plantation and other skills including tailoring, as well as jewelry, bag and reusable pad making,” says Katuwal. “They are now experts in planting trees.”&nbsp; Lily Leaves gets support from Pipal Tree International in the UK and Nepal, and hopes that the idea of compact urban forest spreads. This is especially important in areas like Taudaha, which is an important stopover for migratory birds. Once noted for its aquatic and avian biodiversity, Taudaha has become lined with concrete and has turned into a loud picnic spot. Urban expansion has encroached upon what used to be the floodplain of the Dhobi Khola, Bishnumati, Bagmati and Manohara rivers. The open spaces along the river corridors are being turned into green belts haphazardly. For many wards, the concept of green space is to have cement pavements and ornamental hard-to-maintain potted plants instead of allowing urban forests to grow back naturally. “Apartment buildings and housing colonies that are being constructed can include green spaces that can increase the real estate and rent value of property,” Katuwal says. “Engineers designing the buildings can suggest such changes so that we remain connected with nature.” Although Lily Leaves needs to have permission from local ward and municipal councils before implementing any program, it continues to face challenges in ensuring smooth coordination.&nbsp; In one such plantation along the Bishnumati River corridor, for example, a heavy earthmover uprooted young trees that were just beginning to thrive. Despite this setback, Katuwal’s team returned to replant them. The land mafia often covets the last remaining open spaces in Kathmandu, deploying local strongmen to try to take them over. &nbsp;They tear down fences, uproot saplings and loot tools. There is a lack of awareness about the importance of greening the city. But now that the former mayor of Kathmandu Balendra Shah is prime minister, national awareness could translate into more urban forests not just in Kathmandu but also in overcrowded urban centres across Nepal. Says Lily Katuwal: “We just plant the seed in people’s minds. Once people in the neighbourhood see that restoring nature lifts their quality of life and increases land prices, there is support. That is when the power of a good example spreads, and communities build on the idea.” &nbsp;

accham

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Nepal Himalaya Spring 2026

All the world’s a stage in Kathmandu

Planting seeds for a greener Kathmandu