<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

<a href="https://nepalitimes.com/here-now/waiting-for-bipin-joshi" target="_blank">Nepali student Bipin Joshi</a>, who was taken captive by Hamas on 7 October 2023, was not on the list of those freed following the end of the bombardment and fighting in Gaza.&nbsp; On Monday morning, the Israeli military notified Bipin's family and Nepal’s ambassador to Israel Dhan Prasad Pandit, that there is no evidence of him still being alive. However, Nepal's Foreign Ministry is yet to be notified by Israel's government of Bipin's status. The news came three days after a US-brokered ceasefire between Israel and Hamas came into effect, and hostage and prisoner exchanges by the two sides started Monday morning.&nbsp; Almost 2,000 Palestinians held in Israeli prisions are expected to be released by Israel in exchange for the hostages during the next phase of the peace deal between the two parties, and the bodies of deceased hostages remaining in Gaza are also expected to be returned.&nbsp; Bipin Joshi was among a group of Nepalis who had arrived in Israel in 2023 just weeks before 7 October 2023 as part of a ‘learn and earn’ program to work and earn in kibbutz farms there.&nbsp; Along with other students Joshi had been working on a farm in Kibbutz Alumim in southern Israel near Gaza. <a href="https://nepalitimes.com/here-now/war-in-israel-earthquake-and-grief-in-nepal">Ten Nepali students were killed </a>while taking cover in shelters near their farms in two separate attacks by Hamas fighters.&nbsp; Joshi’s colleagues, fellow Nepalis who survived the attack, recall gunmen lobbing two grenades into the bunker that they had taken cover in. Bipin hurled one of the grenades out, they say, but the other one exploded, killing and injuring Nepalis inside. &nbsp;&nbsp;&nbsp;&nbsp; Shortly after, Bipin was captured by Hamas along with a Thai national and led away into Gaza. CCTV footage showed Bipin alive and at a hospital in Gaza on the day of the attack itself after he was taken hostage.&nbsp; Thirty-one Thai citizens, who like Nepalis worked in farms in Israel, were taken hostage during the Hamas attack, the highest number of foreign captives in October 2023.&nbsp; <a href="https://nepalitimes.com/news/deft-diplomacy-freed-thai-hostages">Deft Thai diplomatic engagement</a> with officials from Iran, Egypt, and Qatar brought about the release of 23 of its nationals in 2023. Five more Thai nationals were released earlier this year.&nbsp; In August, Joshi’s family visited Israel at the invitation of the government and urged the international community to push for his return. Bipin’s mother Padma and sister Pushpa have been at the United Nations to lobby for his release.&nbsp; His family last week also released a video clip of Bipin briefly speaking on camera, reportedly obtained by Israel and said to be filmed in November 2023, around a month after he was taken captive. Joshi looks healthy in that video.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251013091028_d551c7f88204c52217152fb5db655bb5a5f8bf2cff1e6a055326ebf64453ff9f.png" data-media-id="editor_3" data-image-id="20251013091028_d551c7f88204c52217152fb5db655bb5a5f8bf2cff1e6a055326ebf64453ff9f" data-rendition-name="original" width="2848" height="1528" loading="lazy" alt="Bipin Joshi NT"> </figure>  More than 67,000 Palestinians have been killed during the last two years of the genocide in Gaza. About 1,200 people were killed during the Hamas attack on 7 October 2023, while more than 251, including Bipin Joshi, were taken as captives.&nbsp; This is the third ceasefire implemented in Gaza since 7 October 2023 after previous ones in November 2023 and January 2025. This 20-point deal facilitated by intermediaries US, Qatar, Turkey, and Egypt included terms for Hamas to give up its arms, and for a devastated Gaza to be governed by a Palestinian body of independent technocrats, while Israeli troops will withdraw in stages from Gaza.&nbsp; Hamas has agreed to relinquish control of Gaza, but has rejected the demand for disarmament, saying the group will demobilise but is prepared to resume fighting if Israel breaches the ceasefire.&nbsp; Following the ceasefire, Palestinians in Gaza have begun long journeys back to homes reduced to rubble by Israel’s two-year assault on the strip. The flow of humanitarian aid in the city has also increased following the peace deal.&nbsp; Israel's closure of humanitarian corridors in the past months had blocked the entry of food and medicine into Gaza, causing widespread famine. The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) has said that the restriction of aid into the beseiged city has left as many as <a href="https://www.unrwa.org/newsroom/news-releases/gaza-unrwa%E2%80%99s-lancet-study-reveals-alarming-surge-child-malnutrition">54,600 children acutely malnourished</a>.&nbsp; Meanwhile, US president Donald Trump landed in Israel on Monday as hostages were being released, and world leaders are expected to head to Egypt for an international summit to discuss the next steps in Gaza, Israel, and West Asia.&nbsp;

Nepali hostage in Gaza not alive: Israel

In the very first page of the first chapter of Nepal 2043: The Road to Prosperity are two maps. The first places Nepal right at the epicentre of Asia, and in the second the Kathmandu is at exactly the midpoint between Mumbai and Beijing. With his trademark optimism, author Sujeev Shakya says Nepal is not land-locked but land-linked to three billion people in China and India. We just need those two economic engines to pull us in the same direction. ‘With China and India becoming the two largest economies in the world in the next two decades … Nepal is the most valuable piece of real estate in the world,’ Shakya writes. For one thing, Nepal does not look beyond India and China for tourism — with the right policies it can attract millions of tourists just from those two countries. Nepal is set to graduate from a low- to a middle-income country by 2026 and to a high-income country in 2043 — hence the name of the book. The year 2043 in the Bikram Sambat calendar is also 2100 — a new Nepali century. The book delves into the past, present and future of Nepal and analyses enablers including hydropower, a fundamental transformation of which will drive the 2043 goal. The commoditisation of electricity will be the biggest transformation. Nepal can deploy ‘Cyber Gurkhas’ to attract foreign investors with the management of data centres with climate friendly renewable energy. Access to technology such as precision agriculture, a data-driven approach to farming to improve food production, reduce environmental impact and enhance profitability could be Nepal’s strategy into 2043 and beyond. ‘Earlier, we needed ploughs and strong hands in agriculture. Now, you need a computer and strong fingers,” Shakya writes, citing a neighbour’s son who inspects his crops from drone cameras. A farmer in an Ilam teashop tells the author he asks AI questions in Nepali, and it answers promptly. The biggest enabler of all is Nepal’s young demography with 62% of the population in the active 15-60 age bracket, while 28% are younger than 14. Nepal’s dependency ratio has dropped to the lowest in history with 100 Nepalis having to support 62 dependents. But this demographic dividend window is closing. Nepal’s total fertility rate declined from 2.62% in 1981 to 0.92% in 2021 — below replacement level. We have less than 30 years left to make the best use of the youth, many of whom are currently studying and working abroad. Nepal’s biggest resource, therefore, is its diaspora spread across the world who send home $20 billion a year. Migration is not just a necessity but an aspiration for many Nepalis, and they are an important source of contacts, investment and soft power. This young and educated group has taken advantage of connectivity and digitisation in all arenas of national life. TikTok and Instagram have become e-commerce platforms, or mobile app-riven digital services. Nepal’s software companies exported over $1 billion worth of IT products last year. Next we need a change in the bureaucratic mindset to eliminate paper and manual processes, which would also contribute to reducing corruption. Shakya comes up with many revelations: 81% of Nepalis live in houses they own, much higher than most other South Asian countries which means higher disposable income. Nepal has the highest tax-to-GDP ratio in South Asia. The banking sector is twice the size of Bangladesh despite Nepal having just one-fifth of its population. In 2021, 12.62% of the population had demat accounts in Nepal, while India had only 5.32%. For every five male investors, there are four women in Nepal while it is 10:1 in India. With such figures and prospects, how come Nepal just went through a violent uprising that took the shortest time to topple a democratically-elected government in modern history? One early chapter of 2043 is actually dedicated to how Nepalis have always thrived on chaos. When people faced up to 20 hours of power cuts a day, people worked around the load-shedding schedule, woke up at ungodly hours to cook and stock up on inverters. They did not put up a fight, or even protest. ''Generally, Nepalis are used to taking things lying down, and perhaps this also needs to change,' says Shakya, writing that line before last month’s uprising. ‘On the one hand, some of these issues speak volumes about the average Nepali’s patience and perhaps optimism that things will change in the long run. On the other hand, one is also forced to wonder how much longer they will be able to put up with unfavourable conditions if things don’t change.’ It does seem Nepali had enough with corruption, governance failure and political apathy to the concerns of ordinary people. The final chapter lists the non-negotiables to realise the 2043 Nepal Roadmap: democratic values and freedom of speech, a capitalist welfare state and socio-political transformation to tackle corruption and impunity. The book notes, ‘Countries transitioning to democratic rule experienced a 20% increase in GDP over a 25 year period compared to what they would have achieved under authoritarian regimes. After the end of the Shah rule in 2006, Nepal’s GDP rose from US$10 billion to US$44 billion by 2024.’ The government’s Vision 2030 document projects Nepal’s GDP at US$100 billion, and the Vision 2043 estimates that it will be a US$423 billion economy with a per capita of US$12,100. However, it will need more than optimism and practical action to make these projections real. China and India loom large throughout the book with examples of small city states like Singapore which have taken advantage of their strategic location. Despite the tension between India and China, the two will have to collaborate given the inherent advantages. China has replaced the United States as India’s biggest trading partner. Sujeev Shakya is a great admirer of former Singaporean diplomat and author Kishore Mahbubani, and he has written a blurb for the book. He quotes Mahbubani saying that for the past 2,000 years, apart from the last two hundred, Asian countries have dominated the world, and it is quite natural that the world’s economic centre is returning to Asia. And Nepal is strategically placed to make the most of it because of its location between two of the world’s fastest growing economies. We just have to get our politics right, and have a strategy for equitable growth in the new Nepali century.  <figure><img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251016091052_78b2d1495d59cd492a17693e0e770b65230c7cb749393ac6643f4676b73832ef.jpg" data-media-id="editor_0" data-image-id="20251016091052_78b2d1495d59cd492a17693e0e770b65230c7cb749393ac6643f4676b73832ef" data-rendition-name="original" width="1136" height="702" loading="lazy" alt="Sujeev Shakya book details NT"></figure>

Retrofitting Nepal for future shocks

In the aftermath of the GenZ protests last month, as new PM Sushila Karki chose the first members of her Council of Ministers, youth collectives urged that it reflect the country’s diversity by including women, youth and people from various ethnic and socio-cultural backgrounds.&nbsp;
It took another couple of weeks for Karki to include &nbsp;bureaucrat and public health expert Sangeeta Mishra as &nbsp;Health Minister in her next tranche of ministers. Almost immediately, people dug up a video of Mishra calling herself “Nepali, but a native Indian”.
She was telling it like it was: Mishra is a naturalised Nepali citizen. But there was outrage in the ultra-nationalistic cybersphere. Mishra’s name was withdrawn from the list of ministers, with government officials citing an ongoing investigation at the CIAA.&nbsp;
With her Cabinet still incomplete a month after taking office, Prime Minister Karki was preparing to induct GenZ as ministers. A leak in the media floated the names, one of which was of Tashi Lhazom, a climate activist and filmmaker from Humla’s Limi Valley.&nbsp;
Almost immediately, social media erupted with discriminatory, xenophobic and misogynistic epithets against her: that she supported a separatist movement, that she was a foreign agent, that her citizenship was disputed, that she did not ‘look’ or ‘speak’ like a Nepali.&nbsp;
Political figures like Gyanendra Shahi, a prominent voice calling for the restoration of a Hindu monarchy, added fuel to the fire by making bigoted and false remarks about her heritage.
The former Commissioner of the National Human Rights Commission, Mohna Ansari, wrote on social media that it was shameful to question Lhazom’s identity: ‘Ms Tashi Lhazom is as Nepali as you are. Our society’s ugliest face and biggest flaw is doubting our own. Real patriotism embraces diversity — fake nationalism must end.’
Ansari, a human rights lawyer and activist, has also often been subject to Islamophobic and derogatory comments on digital platforms. &nbsp;
In response, the Indigenous GenZ Collective released Lhazom’s Nepali citizenship certificate to debunk the mistruths spreading on digital as well as mainstream media.
What makes a Nepali? What does a Nepali look or sound like? Who is a Nepali?
‘Had my name been Tashi Poudel, Thapa, Bhattarai or Ghimire, this would not have happened,’ Lhazom said in an interview with Kantipur following an avalanche of bigotry against her. ‘They questioned me because I do not look Nepali, or speak Nepali like a Khas. Because it is not my mother tongue.’
It is an indictment of Nepali society that indigenous Nepalis have to present proof, at the slightest inconvenience of mostly the dominant groups, of being a citizen of this nation simply because they might not fit into an imagined idea of Nepali nationhood by virtue of physical appearance, speech, geography, or faith.
And while we celebrate the successes of Nepal-born naturalised foreign citizens (some now hold elected office in the US) we refuse to afford the same respect to naturalised Nepali citizens, and those born in Nepal to excluded groups, nor do we expect them to work in the national interest if they are given responsibility to govern. And women are singled out twice as much for scrutiny.
Then cyber Nepal went into a tizzy when videos appeared of a biker’s group clad in black t-shirts emblazoned with the acronym ‘TOB’ which was interpreted to stand for ‘Tibetan Original Blood’ and linked to the Free Tibet movement.
The accusations snowballed into disinformation, xenophobia, and even calls for violence against Nepalis of Tibetan heritage and the Tibetan community in Nepal.&nbsp;
In the aftermath of the September protest, the hope was that politics and the bureaucracy would finally be rid of orthodox political actors. But first, we as a nation need to collectively examine the biases and bigotry that exist in Nepal’s socio-cultural space.&nbsp;
Otherwise, Nepal’s multiculturalism will be limited to just words in the Constitution and political tokenism.
No one who is in government now or in future can be expected to be completely free of subjective opinions, ideology, affiliation to a cause, or prior activism. And such criticism falls disproportionately on activists, advocates, and members from underserved and underrepresented communities.&nbsp;
One cannot be apolitical and hope to participate in politics, and as we move forward to rebuild the system it must not just reflect diverse communities, but also celebrate diversity of thought and beliefs.&nbsp;
Resorting to ethnocentrism, racism and chauvinism with conspiracy theories and discriminatory dog-whistling about fellow citizens is a disservice to Nepali nationhood. It is Nepal’s diversity that makes us strong.&nbsp;
Shristi Karki

What makes a Nepali?

Nepali Times: You just climbed Mt Everest without oxygen and then skied down the mountain. How does one even train for something like that?&nbsp; Andrzej Bargiel: What made skiing down Everest possible was all the years of experience I’ve gained in high-altitude mountains. Spending a lot of time in the high mountains helps me read the snow, the conditions, and potential hazards. I need to ski often, especially in steep and exposed terrain, so that it becomes a place where I feel completely at home.&nbsp; I also climb regularly, I am an IFMGA mountain guide. I also run, ride a bike, and work out in the gym. Like in any endurance sport, I have to prepare my body for the demands of an expedition.&nbsp; What motivated you to do Everest? This was actually my third attempt on Everest. After many years of ski mountaineering and racing, I felt it would be great to use that experience to take on a meaningful project in the Himalaya. It’s about exploring what’s really possible, testing my limits, and seeing how far I can go. I was inspired by people like Davo Karničar, Fredrik Ericsson, and Hans Kammerlander, who showed that skiing in the high mountains can truly be done.&nbsp; What do you have to be most careful about when skiing at such high altitude? You really have to manage your energy well, because you need to be ready to spend many hours at very high altitude — even above 8,000 meters. Risk management is essential. You have to read the signals nature gives you and make the right decisions, choosing safe moments to move. The dangers are always there: avalanches, crevasses, extreme fatigue, and exposed terrain, so you have to stay fully aware and focused. Safety comes first, always. You also need to stay open to changing your plans, because in the mountains, things don’t always go the way you expect.&nbsp; Why did you choose autumn and not spring?&nbsp; Autumn is really the only season when you can think about making a full ski descent from the summit all the way to base camp. In the spring there’s much more ice left after winter, and the snow cover is broken. A full descent simply isn’t possible then, because too much rock and ice are exposed. Of course, in spring it’s easier to climb the mountain. The conditions are more stable, the snow is firmer, there’s less avalanche risk, and you don’t have to wade through deep snow. The autumn ascent is very complex and demanding, which is why so few expeditions attempt it. But in autumn, skiing becomes possible. Several meters of fresh snow fall on Everest’s slopes, covering the rocks and ice, and that transforms the mountain into something wild, beautiful, and most importantly skiable. What was your favourite part this time? The moment I remember most fondly was reaching the summit — and that first stretch just below the top, when I clicked into my skis and started moving down through surprisingly nice snow. It felt smooth and natural, a kind of free, easy glide down toward the Hillary Step. I could feel the movement, the flow, and at the same time this awareness that I was skiing from the highest point on Earth. It was just a really good feeling. The Icefall was another special moment. I felt from a skier’s point of view that it really worked. I could make my turns, and the descent itself was fun, technical, but a beautiful one too — full of variety, weaving through ice towers and seracs that looked incredible in the sunlight. It was challenging, but also just pure joy.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251015141012_e9e671e07b089a7d59e4b9ba34df993180ae2dfcae3786113a4d48c515427b3d.jpg" data-media-id="editor_0" data-image-id="20251015141012_e9e671e07b089a7d59e4b9ba34df993180ae2dfcae3786113a4d48c515427b3d" data-rendition-name="original" width="1365" height="2048" loading="lazy" alt="Andrzej Bargiel NT"> </figure>  And what was most challenging? The hardest moment came on 14 September, during our first summit push attempt. We were breaking trail in deep snow and reached the South Col in the evening. I already knew we wouldn’t be going higher that night, so I decided to stay there, to use the climb to acclimatise.&nbsp; But after that attempt failed, the team completely lost faith that the project could still succeed. Almost everyone started packing up, convinced it was over, nobody thought that the snow would stabilise enough.&nbsp; I skied down from the Col early the next morning in really good conditions, while the rest of the team descended on foot. Rebuilding belief within the team that it could still be done was the toughest part, mentally. It took me several days to bring that energy and motivation back, to make everyone believe again that we could try once more. What was your support crew like?&nbsp; I want to thank the whole team — all team members from Poland, all those who contributed to the project, all the sponsors, and the Seven Summit Treks crew, especially Dawa Sherpa, who had the courage to go to the top with me.&nbsp; In the end, his courage made it possible. Doing it alone would have been almost impossible. With him there, I felt safe, and that made all the difference. What potential for skiing do you see in the Himalaya?&nbsp; Huge. There’s massive potential here both for ski touring and for a more recreational form of skiing. In the Himalaya, there are so many mountains you can ski from, and they don’t have to be eight-thousanders.&nbsp; There is an incredible amount of snow even in the lower valleys during the winter, which makes it a really interesting place for skiing. You can find great powder and enjoy long, wide runs.&nbsp; The key, I think, is to keep developing local guiding structures. There should be more certified guides in Nepal, Sherpas gaining guiding qualifications, and a proper professional rescue service. That would definitely increase the sense of safety for both skiers and tourists coming to the mountains. I’d love to come back to the Himalayas one winter just to ski in those lower parts — in deep snow, on much longer and wider skis – that would be pure pleasure. At those lower altitudes, the fun can be so much greater, with a more relaxed, freeride kind of feeling.

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