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

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Taking wealth out of health

<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111412118/6372219c9c7e80680e0c02c6jpeg.jpg" alt="" width="1000" height="662"/>This year’s health budget kept the contribution to health insurance of the previous year's allocation of Rs7.5 billion. However, the plan to hand over the institutional management of health insurance programs to the private sector through the Ministry of Finance defeats the fundamental goal of the health security.This is not entirely surprising, of course, because the Health Ministry had passed a <a href="https://archive.nepalitimes.com/article/nation/national-health-insurance-not-as-easy,4028">narrow and poorly thought model of health security</a> for Nepal, and there were already concerns that it would eventually be handed over to the private sector and traded as a commodity.A private company can contribute to a health insurance program. But can they really contribute to national public health security, understand equity, expand <a href="https://www.nepalitimes.com/editorial/poor-health-makes-nepalis-poorer/">access to the poorest and the most marginalised</a> population, and negotiate with the government providers for quality services? Are they fundamentally designed to serve the poor?Read also: <a href="https://archive.nepalitimes.com/article/nation/national-health-insurance-not-as-easy,4028">National health insurance not as easy</a>, Sonia AwaleThe private sector has a role in contributing to achieving Universal Health Coverage by mainly serving the affluent. The poor neither can afford private health insurance nor access expensive private hospitals. Even if they are admitted to hospitals, they have to bear <a href="https://www.nepalitimes.com/opinion/is-free-health-care-possible-in-nepal/">catastrophic expenses</a> pushing them into the vicious cycle of poverty.The private insurance companies only pool the resource, they do not share the risk for those who cannot afford to pay the premium. It will be naïve to assume that such companies could be easily maneuvered to deliver services as a fair-price approach. There are around 20 registered private health insurance companies and 366 private hospitals in Nepal, and some are <a href="https://www.nepalitimes.com/latest/nepal-tries-to-ensure-covid-19-insurance/">selling health insurance at exorbitant premiums</a> many times higher than the current premium cap.There are six national health security indexes: prevent, detect, response, health, norms, and risk. During the pandemic, insurance companies got richer by <a href="https://www.nepalitimes.com/latest/nepal-tries-to-ensure-covid-19-insurance/">selling fake insurance schemes</a> while the hospital profits bulged through expensive Covid treatment. Very few hospitals treated Covid patients with a humanitarian approach. None of their technical advancements helped effectively prevent, detect, and respond to the pandemic.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111412118/6372219f9c7e80680e0c02c7jpeg.jpg" alt="" width="1641" height="1000"><figcaption> </figcaption></figure>The current health insurance program has identified the elderly, completely disabled, leprosy, Multi-Drug Resistant TB patients, people living with HIV, and ultra-poor as target populations to waive their premium. Though not adequate, this is an equity approach.But none of these target populations are <a href="https://archive.nepalitimes.com/article/nation/national-health-insurance-not-as-easy,4028">eligible for private health insurance</a>, or they will have to pay a much higher premium. It will be unwise to assume that these companies will change overnight and be equitable. They are powerful enough to influence government policy and have the power to bend them to suit their commercial interests.Read also: <a href="https://www.nepalitimes.com/editorial/poor-health-makes-nepalis-poorer/">Poor health makes Nepalis poorer</a>, EditorialInstead, the government should <a href="https://archive.nepalitimes.com/article/editorial/health-tip-editorial,4032">strengthen the Health Insurance Board</a> and explore ways to integrate health security with the broader social security scheme. In the short term, there are urgent but straightforward reforms like recruiting adequate and skilled human resources, strengthening the organisational systems, revising the design of service purchase strategy and equity, and gradually, having effective providers/purchasers split for better implementation.Ultimately, the program will benefit by forming a broader and more robust social security structure, co-incidentally introduced at the same time by the government. It would be able to absorb costs by pooling tax-based health care contributions and merging subsidies given to the treatment of cancer, renal failure, and other chorionic diseases under one integrated umbrella.But the current government does not appear serious about <a href="https://www.nepalitimes.com/opinion/health-insurance-must-be-an-election-agenda/">reforming health insurance</a>, and simply does not understand the fundamental principles of health security. Health insurance is not just limited to providing health care, but is a part of broader health security.Read also:  <a href="https://archive.nepalitimes.com/article/editorial/health-tip-editorial,4032">Health tip</a>, EditorialThe idea that health security can be strengthened by passing the buck to the private sector amounts to abandoning the constitutional commitment to provide health care, not as a service but as a citizen's fundamental right. The Nepal government is a signatory to achieving the health targets of the Sustainable Development Goals.As argued by Nepali Congress leader Gagan Thapa, who is one of the pioneers who <a href="https://archive.nepalitimes.com/article/editorial/health-tip-editorial,4032">pushed health insurance</a> in Nepal, they contribute to strengthening the health system, strive for healthy populations, cushion the poor and provide them access to health services. It is a vehicle for mobilising adequate health resources, enhancing health security, and ultimately achieving Universal Health Coverage.These goals cannot be met by trading the people's health as mere commodities.Gaj Gurung has a PhD in public health from Chulalongkorn University and Sushil Koirala is a public health expert. Both are based in Bangkok.Read more: <a href="https://www.nepalitimes.com/opinion/is-free-health-care-possible-in-nepal/">Is free health care possible in Nepal?</a> S P Kalaunee

Dangers of privatising health insurance in Nepal

In 2013, while writing <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/Flu,294">a weekly health column</a> in this paper, I explored the potential for <a href="https://www.cdc.gov/coronavirus/mers/index.html" target="_blank" rel="noopener">MERS </a>(Middle Eastern Respiratory Syndrome) to spread among Nepalis working with camels in the Gulf states. Despite all the dire predictions of how that coronavirus could be brought back to Nepal and spread in the population, it is still a mystery why there was no MERS outbreak here. Viruses do have their own predilections.This time, although <a href="https://www.nepalitimes.com/banner/why-nepal-must-watch-about-coronavirus-but-not-panic/" target="_blank" rel="noopener">Nepal officially has had only one person diagnosed</a> with the novel coronavirus (COVID-19) who later recovered, it is utterly foolhardy to think that we may escape this pandemic. In Italy, there were only four cases in 20 February, but three days later it soared to 400 cases. That virulence is what is new about this novel coronavirus.Even if Nepal does not have a surge of cases now, there is every likelihood that we will have to deal with an outbreak next winter. In addition how COVID-19 will interact with a summer dengue outbreak like last year in Kathmandu is anyone’s guess. It is important to be prepared with preventive aspects.Read also: <a href="https://www.nepalitimes.com/editorial/this-is-a-test/" target="_blank" rel="noopener">This is a test</a>, Editorial<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101152/636b79239c7e80680e0646e5jpeg.jpg" alt="" width="960" height="640"/><figcaption>An Army personnel demonstrates how to wear protective gear while treating possible COVID-19 patients in Nepal. All Photos: BIKRAM RAI</figcaption></figure>Masks for the general public are more for self-assurance than anything else. People who are coughing and have symptoms should wear masks. But widespread use of masks for the general public may only deplete the limited supply of masks where they are actually needed in hospitals. The most important prevention is <a href="https://www.nepalitimes.com/banner/covid-19-revives-nepals-wash-drive/" target="_blank" rel="noopener">washing hands </a>properly with soap and water 5 to 6 times per day and avoid touching the face. Keeping a reasonable distance from one another is also important. The elderly need to be especially careful.One of the most crucially helpful decisions that the Chinese government took in December 2019 after the novel coronavirus struck Wuhan was to rapidly share the molecular structure of the virus (its genomic sequence) with the world. This made it possible for drug manufacturing companies like <a href="https://www.modernatx.com/" target="_blank" rel="noopener">Moderna</a>, a biotechnology company based in the US, to start working on a vaccine.Read also: <a href="https://www.nepalitimes.com/banner/a-shot-in-the-arm-for-vaccines-in-nepal/" target="_blank" rel="noopener">A shot in the arm for vaccines in Nepal</a>, Sonia AwaleThe first human trial against COVID-19 will start later on this month. This is incredibly fast because in earlier times, it would take at least six years before a vaccine was developed. Although an effective vaccine is the best defence against COVID-19, what can be done for prevention in Nepal here and now is more important.First, the good news. It is now well known that about 80% of COVID-19 victims will have mild symptoms not requiring hospital admission. Of the rest, 15% will be severe and 5% may be critical, possibly requiring ventilators in an intensive care unit. Even if only 0.5% of patients from South Asia’s population of 1.8 billion require ventilators, it is easy to imagine the tragic scale of this potential  emergency.The Wuhan data from Chinese doctors also revealed that it was the elderly (mostly male) that took the brunt of the disease and that children were not symptomatic, even though they may be infected by the virus. The findings also showed that about 1% of the patients who suffer from  COVID-19 die.This is the stark difference between COVID-19 and other causes of influenza where the death rate is only 0.1%. That is, COVID-19 kills ten times more people, and they are mostly above 60 years old. Although 1% may sound small, actual numbers will be numbing when large populations are infected.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101152/636b79249c7e80680e0646e6jpeg.jpg" alt="" width="3600" height="2400"><figcaption> </figcaption></figure>Besides vaccines, there are also drug studies going on to fight COVID-19. One such medicine is called <a href="https://www.kaletra.com/" target="_blank" rel="noopener">Kaletra</a>, commonly used for HIV patients. Many other drug trials (including the antimalarial drug cholroquin) are going on.The incubation period (the time from infection to symptoms) was also studied in Wuhan and forms the basis of the quarantine period of 14 days. The average incubation period is five days but may be up to 12 days. To be on the safe side a two-week quarantine is recommended, after which it is unlikely that the symptoms will manifest.Unlike some western countries, China, Singapore, Taiwan, and South Korea practiced widespread contact tracing to control the disease. If someone was diagnosed with COVID-19, the health professionals took a detailed history of  who their contacts (including family and friends) were, and followed up to see if they developed symptoms. Contact tracing helped stem the spread of the disease in these countries.Buddha Basnyat is a clinical researcher at Patan Academy of Health Sciences and a <a href="https://www.nepalitimes.com/opinion/what-is-novel-about-the-novel-coronavirus/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/opinion/what-is-novel-about-the-novel-coronavirus/&amp;source=gmail&amp;ust=1585631034431000&amp;usg=AFQjCNE0aoyspsOeHIBjtexE2rB8xE3KOw">frequent health columnist</a> for Nepali Times.

Buddha Basnyat

What is novel about the novel coronavirus?

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101152/636b79289c7e80680e0646e7jpeg.jpg" alt="" width="960" height="640"/><figcaption>A quarantine zone at Nepal Army's headquarters in Tundikhel. Photo: BIKRAM RAI</figcaption></figure>By now the novel coronavirus pandemic has affected every corner of the globe. If it has not brought disease, it has at least brought the <a style="background-color: #ffffff; font-size: 16px; letter-spacing: 0.15px;" href="https://www.nepalitimes.com/editorial/fear-goes-viral/" target="_blank" rel="noopener">fear of infection</a>. Cities, and indeed entire countries, are in lockdown. Fortress Europe has raised its walls higher. Airlines are grounded. Nepal has banned trunk international routes from Friday night. Even countries with excellent public health facilities and emergency preparedness plans are overwhelmed.Nepal is now <a href="https://www.nepalitimes.com/opinion/global-thinking-and-local-action-on-coronavirus/" target="_blank" rel="noopener">so closely intertwined with globalisation</a> through migration, tourism and trade that its <a href="https://www.nepalitimes.com/here-now/nepals-economy-already-weak-takes-direct-hit/" target="_blank" rel="noopener">already-fragile economy has been badly hit</a> even before a full-blown health emergency hits. Ironically, less-developed countries seem to have a built-in resilience that comes from being crisis-prone -- since they are lower down in the economic ladder, they have a shorter distance to fall.Read also: <a href="https://www.nepalitimes.com/editorial/poor-health-makes-nepalis-poorer/" target="_blank" rel="noopener">Poor health makes Nepalis poorer</a>, EditorialDespite Nepal’s surprisingly <a href="https://www.nepalitimes.com/banner/born-in-nepal/" target="_blank" rel="noopener">dramatic improvements in mother-child survival </a>over the past two decades, <a href="https://www.nepalitimes.com/editorial/poor-health/" target="_blank" rel="noopener">the public health system here is in crisis</a>. State-of-the-art modern hospitals in the city, while reducing the need for Nepalis to go abroad for treatment, are out of reach of a majority of the population. Government health facilities are more affordable, but for the most part medical care there is not up to mark.Nepalis are still afflicted by easily preventable water-borne diseases like <a href="https://archive.nepalitimes.com/news.php?id=16988#.XnMUhagzbSF" target="_blank" rel="noopener">typhoid and diarrhoea</a>, vector-borne infections like malaria, encephalitis or dengue, and illnesses like <a href="https://www.nepalitimes.com/banner/nepal-tb-cases-grossly-underestimated/" target="_blank" rel="noopener">tuberculosis </a>and acute respiratory infections that spread through breathing. Great inroads have been made in reducing the impact of communicable diseases in the past decades through awareness programs, vaccinations and safer drinking water, but children in <a href="https://www.nepalitimes.com/banner/this-is-how-to-upgrade-nepals-rural-health/" target="_blank" rel="noopener">remoter parts of Nepal</a> are still dying of simple infections.Read also: <a href="https://www.nepalitimes.com/banner/a-shot-in-the-arm-for-vaccines-in-nepal/" target="_blank" rel="noopener">A shot in the arm for vaccines in Nepal</a>, Sonia AwaleOn top of this, urbanising Nepal now also has the added burden of <a href="https://www.nepalitimes.com/editorial/poor-health/" target="_blank" rel="noopener">non-communicable afflictions</a> like diabetes, cardio-vascular ailments and renal disease. As families move from the districts to the cities, changes in diet and more sedentary habits have given rise to an epidemic of lifestyle-related diseases. This is compounded by genetic susceptibility among South Asians for diabetes and heart disease.For example, a study by the BPKIHS in Dharan showed that while the national average for <a href="https://archive.nepalitimes.com/article/nation/diabetes-in-south-asia,3018" target="_blank" rel="noopener">Type 2 diabetes </a>prevalence is 8.1% of the population, the incidence in Dharan was 14%, while it was only 1% in Taplejung. The prime minister’s own second kidney transplant this month showed that <a href="https://archive.nepalitimes.com/article/editorial/health-tip-editorial,4032" target="_blank" rel="noopener">ignoring risk factors and not diagnosing non-communicable diseases</a> can lead to a huge health burden for families and the state. A small percentage of Nepalis have health insurance, so many middle income families fall below the poverty line due to medical expenses. Many Nepali migrant workers have been forced to seek jobs abroad to pay back debts incurred during hospitalisation of family members.Last summer’s explosion of dengue in Kathmandu Valley was <a href="https://www.nepalitimes.com/banner/mosquitoes-move-up-mountains-as-the-earth-warms/" target="_blank" rel="noopener">blamed on climate change</a>. But it was actually a perfect storm of crowded and squalid living conditions, poor drainage, greater mobility of people, and a particularly wet monsoon. None of these factors have been addressed, so we are staring at a recurrence of dengue this year even while we cope with <a href="https://www.nepalitimes.com/banner/why-nepal-must-watch-about-coronavirus-but-not-panic/" target="_blank" rel="noopener">a possible COVID-19 outbreak</a>.Public health has not been a national priority for successive governments in Nepal. Even if it has, it is only in paper and has not really been translated into <a href="https://www.nepalitimes.com/opinion/is-free-health-care-possible-in-nepal/" target="_blank" rel="noopener">accessible and affordable healthcare</a> for the general public. Governance failure has contributed to this state of affairs, but there is also the virus of corruption that has afflicted the entire government healthcare system. A politico-business nexus has also infected <a href="http://archive.nepalitimes.com/news.php?id=19560" target="_blank" rel="noopener">medical education</a>, putting it out of reach of deserving poorer students.Read also: <a href="https://www.nepalitimes.com/editorial/when-panic-goes-viral/" target="_blank" rel="noopener">When panic goes viral</a>, EditorialInto this mix, we now have the coronavirus scare. Officially, Nepal has just one case in which the patient recovered and has been discharged. The government has tested about 500 people, and all have been negative. Experts have confirmed that the tests are credible, and proper protocols are in place. But not enough tests have been done to determine if there are more people out there with the virus.At $75 per test, the kits are expensive. This is where international help would be needed, and if the case rate rises the country will also need help with containment and mitigation. Nepal has been lucky so far that there is no indication of community transmission yet. But our luck could turn any day.

This is a test

At 6 feet and one inch, Hira Bahadur Ghalan was exceptionally tall for a Nepali. In 1936, when people came to his Tamang village near Tistung looking for porters, they recruited him on the spot. This was no ordinary job, Hira Bahadur would lead gangs of 30 or more porters to carry cars bought by Rana rulers from Bhimphedi to Kathmandu.&nbsp; Those were the days when the only motorable roads in Nepal were in Kathmandu, but the capital was not connected to anywhere else by road. So, before cars could carry people, people had to carry cars. More Nepalis had carried cars than ridden in one. The porters were paid Rs5 for the job, and sometimes the Rana owners gave Hira Bahadur a Rs25 baksheesh. One of the cars his community helped carry was a 1939 Daimler Benz gifted by Adolf Hitler to King Tribhuvan to woo Nepal away from the British. The rusted dusty vehicle is now in the Narayanhiti Palace Museum.&nbsp; Hira Bahadur hauled cars for 25 years until his knees gave way, he died at age 90 eight years ago — the last surviving car porters of Nepal from Chitlang Valley.&nbsp; Hira Bahadur Ghalan had three sons and three daughters, one of them is Maila Kaji Lama, who at age 68, is a chauffeur in Kathmandu. His son, Manjil Lama is a pilot with Summit Air, flying to remote Himalayan airstrips. Three generations of one family worked in professions that followed a century of transportation history in Nepal. &nbsp; After the <a href="https://nepalitimes.com/multimedia/the-long-and-winding-road-to-india">Tribhuvan Rajpath was finished in 1957</a> and the ropeway upgraded, Hira Bahadur was out of a job. He tilled the family farm, watching trucks and buses headed to and from Kathmandu on the hairpins.&nbsp; As a child, Maila Kaji was fascinated by cars and wished one day to be able to drive one. After he failed Grade 8, he came to Kathmandu in 1975 and got a Rs20/month job at a petrol station in Maiti Devi. “I watched King Birendra’s coronation and was impressed by the glamour of Kathmandu, and decided to stay here,” Maila Kaji says.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026041816040_a1a41e47dec8500727702f700e43af625f059043cbcd283f13b247344b3a20aa.png" data-media-id="editor_1" data-image-id="2026041816040_a1a41e47dec8500727702f700e43af625f059043cbcd283f13b247344b3a20aa" data-rendition-name="original" width="1974" height="1608" loading="lazy" alt="car carriers"> <figcaption>Maila Kaji</figcaption> </figure>  Former minister Ramesh Nath Pandey used to bring his Volkswagen Beetle to the station, and Maila Kaji started taking care of his car. Later, he drove a Russian Jeep for former minister and geographer Harka Gurung. Along the way, he fell in love with the daughter of a Brahmin colleague, and married her. “My father back in Tistung did not approve of our inter-ethnic marriage, and not speak to me for five years,” Maila Kaji recalls. Manjil Lama grew up in Kathmandu, and did well in science in school. He had wanted to go the US to become a pilot like his friends, but was denied a visa.&nbsp; “The visa officer told him I did not earn enough,” says Maila Kaji, “so I sold some property and sent Manjil to flying school in the Philippines.”  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026041816040_e9091162840baa6d182de2d7cc6f09e43ec9cfd9a9b6e71e7e7b14bc72da3537.png" data-media-id="editor_2" data-image-id="2026041816040_e9091162840baa6d182de2d7cc6f09e43ec9cfd9a9b6e71e7e7b14bc72da3537" data-rendition-name="original" width="1434" height="1754" loading="lazy" alt="car carriers"> <figcaption>Manjil Lama</figcaption> </figure>  After returning to Nepal, Manjil Lama now flies Let 410s of Summit Air to difficult air strips like Lukla and Simkot, and has logged over 2,000 hours. He has to go to the Czech Republic regularly for simulator training. Says Maila Kaji Lama: “My father worked hard carrying cars to raise us, I started from scratch to become a driver to support my family, and my son is now a pilot with experience in flying in the world’s toughest terrain.” &nbsp; Watch <a href="https://www.youtube.com/watch?v=lvT3iTi8yw4" target="_blank">video clip from S Dillon Ripley here</a>.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260419020448_40f8b1bdaace08106ca5c24819b6e7a34fb2109a9a3ec5c6ac179b3309e686ed.png" data-media-id="editor_4" data-image-id="20260419020448_40f8b1bdaace08106ca5c24819b6e7a34fb2109a9a3ec5c6ac179b3309e686ed" data-rendition-name="original" width="900" height="1582" loading="lazy" alt="car carriers"> </figure>

Grandfather carried cars, son drives cars, grandson flies planes

Sudan Gurung is dancing. It is 2009. He has an emo fringe falling over one eye and is spinning on a polished floor. His dance shows dedication — moves that take years of bruised elbows to land. The clip is 16 years old, and had been sitting in the dead archives of YouTube and old Facebook pages, watched by almost nobody. This month <a href="https://www.tiktok.com/@4gr4j/video/7621892206902725909">it has 1.9 million views</a>. Because Gurung is now Home Minister, and is embroiled in a scandal barely two months into office. Within days of becoming an RSP candidate, his pre-political life became public and was put back into circulation. The b-boying, the DJ sets, and the YouTube video of him dancing in a music clip. The youth of Nepal, well-versed in snappy TikTok edits and aura compilations, immediately turned to making <a href="https://www.tiktok.com/@aayvik/video/7626069452177542408">videos of Sudan Gurung's swag</a>.  <figure><img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026042202040_71df4d531423e7c941abde95fb8106346c70ab0afb71bbeb520cc570f14ba178.jpg" data-media-id="editor_2" data-image-id="2026042202040_71df4d531423e7c941abde95fb8106346c70ab0afb71bbeb520cc570f14ba178" data-rendition-name="original" width="2300" height="1000" loading="lazy" alt="When aura meets audit"></figure>  TikTok remixed the footage to trap beats. The comments settled on a nickname that has now crossed into everyday speech: ‘Homie Minister’. <div class="embed-block"><blockquote class="tiktok-embed" cite="https://www.tiktok.com/@yalexthwreal/video/7622325255792512276" data-video-id="7622325255792512276" style="max-width: 605px;min-width: 325px;"> <section><a target="_blank" title="@yalexthwreal" href="https://www.tiktok.com/@yalexthwreal?refer=embed">@yalexthwreal</a> <a title="sudangurung" target="_blank" href="https://www.tiktok.com/tag/sudangurung?refer=embed">#sudangurung</a> new home minister of Nepal😎 <a title="fyppppppppppppppppppppppp" target="_blank" href="https://www.tiktok.com/tag/fyppppppppppppppppppppppp?refer=embed">#fyppppppppppppppppppppppp</a> <a title="sudangrg" target="_blank" href="https://www.tiktok.com/tag/sudangrg?refer=embed">#sudangrg</a> <a title="home" target="_blank" href="https://www.tiktok.com/tag/home?refer=embed">#home</a> <a title="minister" target="_blank" href="https://www.tiktok.com/tag/minister?refer=embed">#minister</a> <a target="_blank" title="♬ original sound - •⪨н є α я т ❤н α ¢ к є я ⪩• - Music Universe 🎧" href="https://www.tiktok.com/music/original-sound-%E2%80%A2%E2%AA%A8%D0%BD-%D1%94-%CE%B1-%D1%8F-%D1%82-%E2%9D%A4%D0%BD-%CE%B1-%C2%A2-%D0%BA-%D1%94-%D1%8F-%E2%AA%A9%E2%80%A2-7308733170064231170?refer=embed">♬ original sound - •⪨н є α я т ❤н α ¢ к є я ⪩• - Music Universe 🎧</a> </section></blockquote> <script async src="https://www.tiktok.com/embed.js"></script></div> Home Minister Gurung is in charge of the Nepal Police, Armed Police Force, Department of Immigration, and the country's internal security apparatus. Calling him ‘homie’ collapses the distance between that office and the Discord server where the movement that brought him into power organised itself. What is harder to explain is why these nostalgic clips are doing the narrative work for Gurung's political standing. A teenager on a dance floor in a Thamel club, filmed before smartphones had decent cameras, is now functioning as political currency for a powerful, but embattled, home minister. The footage is not an argument. Gurung is not doing anything in it that relates to home affairs. He is just dancing. The comments compare him to <a href="https://www.tiktok.com/@4gr4j/video/7621892206902725909">Korean film heroes</a>. A separate <a href="https://www.tiktok.com/@tandavyt7/video/7622151050128018708">48,000-like edit</a> is captioned ‘Our New Home Minister Aura’. The replies are full of people saying they get chills listening to him speak. Political legitimacy in Nepal has been built out of many things over the last 70 years, but it has never been built out of this. The question is: what happens when the job starts demanding things his style, boldness, and swag cannot provide. Because political aura in Nepal used to be a slow harvest, now it isn’t. BP Koirala spent eight years in prison under the Panchayat. He wrote fiction at Sundari Jal. The writing survived, the prison sentences survived, and that experience became the template for what a serious Nepali politician looked like: someone the state had tried to break and failed. Legitimacy was accumulated by having their lives taken away, and refusing to bend the knee. The old mechanics of legitimacy produced politicians who could be audited. The record was made of words, dates, votes, and years behind bars. A voter who wanted to know what a leader stood for could read his writings. A journalist digging for inconsistency had somewhere to look. The system was slow, often corrupt, and frequently boring. In fact, boring used to come with the job. A minister was supposed to be slightly dull — evidence that the person was doing the unglamorous work of reading files and sitting through committee meetings. Today, boring is a disqualification. The attention economy rewards velocity and visual charge, a politician who cannot generate either does not exist in the feed, and that means does not exist at all. The legacy parties are still issuing press statements criticising the new guard in the grammar of paper trails and procedural failure. But the audience has stopped reading, they scroll for their next viral bite. Sudan Gurung, unlike the old parties, understands exactly which grammar the feed rewards. Just look at what he has been up to. On his first evening as Home Minister, he posted a photo of himself sleeping on a sofa inside the ministry. Caption: creation cannot be greater than the creator, government is not above the people. The image travelled further in 12 hours than any ministerial press release has ever done. A minister napping on a sofa, phone-shot, zero production, read by the public as evidence of a minister who had skipped the motorcade and got straight to work. Gurung used Facebook to announce, the names of former ministers and businessmen he intended to arrest. Each name was posted before the arrest, not after. The feed became the announcement venue for state security action.  <figure><img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260422010456_2fa1918e1dd031d01f38b4001ee306d9414073cec0b795fa43a75cb5a8deb8c7.png" data-media-id="editor_6" data-image-id="20260422010456_2fa1918e1dd031d01f38b4001ee306d9414073cec0b795fa43a75cb5a8deb8c7" data-rendition-name="original" width="926" height="868" loading="lazy" alt="When aura meets audit"></figure>  This is not how the Ministry of Home Affairs has ever been operated. It is how a YouTuber releases a series. Sudan Gurung is a political content creator. As home minister, he is an influential influencer constantly, kinetically doing something in the visual medium. Much like Prime Minister Balendra Shah's sunglasses, Gurung's aura, authenticity and swag are a brand asset, instantly recognisable at thumbnail size. Balen's rap career supplies a pre-political archive that authenticates him the same way Gurung's DJ sets and b-boying clips authenticate him. The aesthetic is doing the work a manifesto used to do. The work is authenticity, and the strategy is auramaxxing. The emo fringe predates the ministry. The DJ sets predate Hami Nepal. The b-boying predates the earthquake, the NGO, the September uprising, the interim cabinet, all of it. Whatever Gurung is now, he was already that person before the office existed. This is the real spectacle of the Homie Minister: authenticity. Nepal’s youth have grown up watching heavily-polished, talking-point ministers speak in a language aimed at nobody in particular, But this grainy archival clip of the current Home Minister from 2009 is honest.  <figure><img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260422010456_5d6dff3a09e8b7e77dc60c3aa567c9e02b6bd5f90f94e20737ec05cc9a09023b.jpg" data-media-id="editor_7" data-image-id="20260422010456_5d6dff3a09e8b7e77dc60c3aa567c9e02b6bd5f90f94e20737ec05cc9a09023b" data-rendition-name="original" width="1800" height="1000" loading="lazy" alt="When aura meets audit NT"></figure>  The effect has transcended the GenZ. <a href="https://www.tiktok.com/@ektapokharel/video/7623242573481561365">A TikTok trend </a>captioned NOT ONLY OUR HOME MINISTER, WE ARE ALSO FROM THAT ERA now has <a href="https://www.tiktok.com/@sonykhadka/video/7624106790266948872">millennials posting their own</a> archive photos from the same period, aligning themselves with Gurung's pre-political aesthetic. The aura is doing <a href="https://www.tiktok.com/@_thakuri/video/7623397397556645141">cross-generational work</a>. It is a shared legibility, spanning at least 15 years of Nepali youth culture, and the current Home Minister is standing at its centre. The traditional politician’s entire adult life is a performance of identity. Every photograph is lit for the media, every statement is vetted. The persona is the product, and the product has been in development for 30 years. This makes the old guard legible but, suspect in the attention economy. A generation raised on authenticity-as-currency reads the decades of careful performance as evidence of something to hide. The polish is the problem. The nostalgic Sudan Gurung party clips invert this. The polish is absent. The footage cannot be performance aimed at the viewer, because the viewer did not exist in 2009 and neither did the political stakes. The clip is therefore read as real, in a way a press conference can never be. It is just a kid dancing, and he happened to grow up to be the Home Minister. But Sudan Gurung's job is not to go viral. The Ministry of Home Affairs requires the person running it to file a complete asset declaration and to avoid holding financial interests in entities that might come before the state. None of this work is content. A correctly filed asset declaration does not get remixed into a trap beat. A functioning immigration database is not a TikTok. The paperwork that constitutes actual governance is structurally boring in exactly the way the old parties are structurally boring, and for the same reason. It is the slow, procedural, checkable apparatus that the old system was built to produce and that the new system has not yet learned to replace. And it is ironic that it is painstaking follow-the-money paper trail investigative journalists in the legacy media who have uncovered the evidence. You cannot auramaxx your way out of a share registry. You cannot post your way past a conflict-of-interest statute. No amount of fire outfits and wild DJ transitions does anything for you when a journalist pulls the initial shareholder list of a micro insurance company and finds your name at number 49. <a href="https://www.tiktok.com/@blox.drop/video/7622173520981658900">Auramaxxing was engineered</a> for the mechanics of reaching office. It is the reason Sudan Gurung is Home Minister and Gagan Thapa is not. The question that has not yet been tested, and is now being put to public test, is whether the same weapon works when the terrain changes. The terrain does change when you assume power. TWO CLOCKS Two clocks are running, and they do not sync. The first clock was built for auramaxxing. A clip posted at eight in the morning peaks by noon. A sofa photo is already remixed before the minister has left the building. The feedback loop is fast and legible, and a politician playing this clock gets real-time data on what to post next. The old guard never learned to read it, which is a large part of why they lost the election. The second clock is the one the ministry actually runs on. It measures in quarters, court calendars, and the slow grind of investigation files moving between offices. A share registry takes weeks to pull. A money-laundering case moves at the speed of the prosecutor's office, which is to say, it often does not appear to move at all, until one morning it does. The second clock does not care whether the minister is currently trending. These two clocks have collided. The first one made Sudan Gurung home minister in weeks. The second is pulling out documents that may take months to fully surface and years to adjudicate. The mechanics that won the office are not the same that determine whether the office holds. This is the asymmetry. A politician whose legitimacy is built on <a href="https://www.tiktok.com/@s.u.m.e.e/video/7622165783254158613">high velocity videos</a> is structurally exposed to a process that runs slower than the news cycle, because the archive of aesthetic proof was not engineered to answer documentary evidence. It was engineered to displace the demand for documentary evidence in the first place. When that demand returns, as it always does once a politician takes office, the digital archive keeps performing, but the documents keep getting uncovered. And the two tracks do not communicate. The old guard knew this clock because they had no other clock to know. What they lost in charisma they gained in durability: a politician built over 20 years of parliamentary record is harder to dislodge with a single document because they have already survived thousands of documents. The new guard has not been stress-tested against its own paper trail. Sudan Gurung is now being tested. If he survives this, and he might, a new template will have been proven. A politician can enter office on the strength of a dance clip, face a paper trail that would have ended the career of a politician in a previous era of Nepali politics, and continue to govern because the public has decided that an old dance clip is more persuasive than the hard copy document of the company registrar. The clip is still in circulation, the sofa photo still reads as sincerity. The arrest of a former prime minister that the courts reversed has faded from the feed, which runs faster than judicial reversal, and that is the whole point. If Sudan Gurung does not survive it, a different lesson gets written. Auramaxxing turns out to be a weapon that works in one direction only: it gets you the job, and then it leaves you exposed. The movement that installed Gurung in the name of ending elite capture will have to decide whether its own hero is subject to the same audit it demanded of everyone else. If the answer is yes, the movement retains its moral coherence. If the answer is no, the movement becomes the thing it replaced, only faster. Both outcomes are live. If Gurung walks through this, the technique gets copied. If he does not, the technique gets revised. Whether the gap closes on him, or he rewrites the gap, is the thing to watch.

When Aura meets Audit

Only 70 years ago, Kathmandu was the isolated capital of a country that had no modern surface transport link with the rest of the world.&nbsp; The idea of building a road to connect Nepal with India actually first came up during the last years of the Rana regime, after the British had left India. Construction actually began in 1952, and the serpentine route took five years to complete.&nbsp; Named Tribhuvan Rajpath, after the reigning king who initiated it, the alignment was from Thankot (1,301 m) at the western edge of the Kathmandu Valley to Nagdunga, Naubise, Tistung, Palung, Daman, Sim Bhanjyang (2,504m), Lamidanda, and Bhainse.&nbsp; At Bhainse, the highway joined the existing road to Bhimphedi and it was another 31km to Hetauda and Amlekhganj. There was a railway line between Amlekhganj and Birganj.&nbsp; After regular bus and truck service from Raxaul to Kathmandu began in 1961, the entire road popularly became known as the Tribhuvan Rajpath.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026041610044_a11b48a75c7877a0f68634f8be07d26a3f354e78ebd9adddc7d17252fddf1d1b.jpg" data-media-id="editor_0" data-image-id="2026041610044_a11b48a75c7877a0f68634f8be07d26a3f354e78ebd9adddc7d17252fddf1d1b" data-rendition-name="original" width="4608" height="3072" loading="lazy" alt="Highways NT"> <figcaption>The village of Chitlang on the main route to Kathmandu before the Rajpath was built. In the distance is the Chandragiri ridge above Thankot. Photo: DAN EDWARDS</figcaption> </figure>  <h2>Chronology&nbsp;</h2> (Based on US State Department cables and media reports) November 1945: Gen Bahadur SJB Rana asked an American official if a road could be constructed from the Indian border to Kathmandu. Nepal wanted such a road built across the mountains after first constructing an East-West artery road in the Tarai, and the government was interested in purchasing US surplus war equipment. Gen Rana inquired if there were US firms who could conduct a survey. April 1947: The Nepal government told a US official it was important to upgrade the 20-mile trail from Bhimphedi over the mountains to the Kathmandu Valley into an all-weather road and sought an estimate from the US for doing so. May 1948: Bijaya SJB Rana informed a US official that a survey for a one-lane motor road between Kathmandu and the Tarai had been completed. The road was to follow the Bagmati River to Makwanpur, then connect at Bhimphedi with the road to Amlekhgunj. The road from Tripureswor to Bhainse along the Bagmati River and via Bhimphedi would have been about 60km. (The distance from Kathmandu on the Tribhuvan Rajpath is 122 km.)  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026041610044_bb531baf5d73e00d2032814ac8abb86979a87d781abc066fcb984997aad930e6.jpg" data-media-id="editor_1" data-image-id="2026041610044_bb531baf5d73e00d2032814ac8abb86979a87d781abc066fcb984997aad930e6" data-rendition-name="original" width="4608" height="3072" loading="lazy" alt="Highways NT"> <figcaption>The road climbing the hills toward its destination of Kathmandu. Photo: DAN EDWARDS</figcaption> </figure>  July 1948: The government decided to go ahead and build a motorable road from Amlekhganj to Thankot and complete it in two years. December 1948: Construction of the motor road from Kathmandu to Amlekhgunj via the Bagmati River corridor was started. April 1949: Gen Singha SJB Rana told a US official that the motor road from Kathmandu to the Tarai and the Indo-Nepal border would be completed by the spring of 1950. February 1950: Nepal sanctioned Rs300,000 to make the 6-foot-wide road from Kathmandu along the Bagmati River to Hetauda. Of this, Rs100,000 was allocated for road-building material and machinery. Subsequently, the road would be developed into a broader motorable road at a cost of Rs7.5 million. February 1952: Nepal’s budget speech noted that a plan was underway for a road between Bhainse and Kathmandu. PM Matrika Prasad Koirala laid a foundation stone near Teku for construction of the ‘Kathmandu Hetauda Roadway’.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026041610044_e66d3b81848ec19da48be8b41cacfa8b8e2bad093719b39eda27755c9616ea9a.jpg" data-media-id="editor_2" data-image-id="2026041610044_e66d3b81848ec19da48be8b41cacfa8b8e2bad093719b39eda27755c9616ea9a" data-rendition-name="original" width="4608" height="3072" loading="lazy" alt="Highways NT"> <figcaption>Rajpath winding its way north of Bhainse. Photo: DAN EDWARDS</figcaption> </figure>  February 1952: A party of Indian engineers came to Nepal to determine the best route for a road from Raxaul to Kathmandu. March 1952: Prime Minister Jawaharlal Nehru told Parliament: “So far as India’s security is concerned, we consider the Himalayan mountains as our border.” Ministry of External Affairs official (S.N. Hakar) told a US official that the Indian government was willing to proceed with constructing the Raxaul-Kathmandu road and had sent a survey party to determine the most suitable mountain route. May 1952: Swiss experts had made surveys for a proposed new road between Bhimphedi and Thankot. Nepal government requested financial help to build the road, and India was considering the project.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026041610044_35e390c1a4812f45af7892d681230e04c63727d9006b6614ed79aaa7c22c1ece.jpg" data-media-id="editor_3" data-image-id="2026041610044_35e390c1a4812f45af7892d681230e04c63727d9006b6614ed79aaa7c22c1ece" data-rendition-name="original" width="4608" height="3072" loading="lazy" alt="Highways NT"> <figcaption>With a constant stream of trucks, buses and jeeps, the narrow Rajpath once was Nepal's busiest highway. Photo: DAN EDWARDS</figcaption> </figure>  Summer 1952: Work on a new road was at a standstill, so Nepal asked India for assistance. Indian engineers surveyed two routes: one following the Bagmati River, the other road through Daman that was later adopted. July 1952: Nepal’s Ministry of Planning decided to construct a road between Kathmandu and Raxaul, awaiting Cabinet approval soon. Prime Minister Matrika Koirala said the proposed road was longer than necessary, but it was a better route ‘for strategic reasons’, because it did not require many bridges. August 1952: King Tribhuvan said road construction from Kathmandu to Bhimphedi would “begin soon”. September 1952: An Indian Military Team began construction of the Kathmandu-Bhainse road without a formal agreement being signed with the Nepal government.&nbsp; February 1953: The Indian Ambassador said the road would be hard surfaced within a year. September 1953: Prime Minister Matrika Koirala inspected the completion of a ‘jeepable track’. December 1953: The road was named ‘Tribhuvan Rajpath’. April 1954: Reports circulated that Swiss engineers criticised the alignment, arguing it would have been easier, faster, and cheaper to build over the existing foot trail between Bhimphedi and Thankot through Kulekhani. July 1954: Heavy monsoon rain damaged much of the roadway that had been built.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026041610044_b5b2a1833f1366e532f1629f47c124d877df7b6f8a34b6c83f6c21ec3e4415dd.jpg" data-media-id="editor_4" data-image-id="2026041610044_b5b2a1833f1366e532f1629f47c124d877df7b6f8a34b6c83f6c21ec3e4415dd" data-rendition-name="original" width="855" height="1123" loading="lazy" alt="Highways NT"> <figcaption>Crown Prince Mahendra inspecting construction progress on the Tribhuvan Rajpath in October 1954. Photo: ROYAL PALACE</figcaption> </figure>  November 1954: The Indian ambassador said flood damage was so great that the road would be delayed by two years. May 1955: Twenty military trucks brought rice from Amlekhganj to Kathmandu on the Tribhuvan Rajpath. King Tribhuvan died in Zurich. December 1956: A gravel road was completed, with trucks and buses plying between Amlekhganj and Kathmandu. December 1956: Nepal government abolished regulations that required Nepali nationals to carry permits for travel within Nepal, except for women below the age of 45. 1957: Reduction in price of goods carried to Kathmandu by truck: Sugar, Rs0.13 per kg. Wheat flour Rs0.13 per kg. Kerosene Rs0.25 per litre. February 1957: An article in The Motherland newspaper in Kathmandu noted urgent action was needed to avoid Kathmandu being cut off from the Tarai during the monsoon. The correspondent wrote, ‘In a recent journey from Amlekhganj I found that almost all the bridges are in a very bad state…Now, because of the dry rivers the scores of vehicles that ply the road cross the rivers on the water level. But during monsoons… these rivers will be impossible to cross without bridges. On the road itself, landslides and big holes have made the journey a great undertaking.” April 1957: The first regular passenger bus left Amlekhganj at 12:30PM and arrived in Kathmandu completing a journey of 14 hours.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026041610044_60807e067f2d0b80bdc5e59860e9bc240b495ef606efc9301ef54ea5731d42df.jpg" data-media-id="editor_5" data-image-id="2026041610044_60807e067f2d0b80bdc5e59860e9bc240b495ef606efc9301ef54ea5731d42df" data-rendition-name="original" width="5211" height="4000" loading="lazy" alt="Highways NT"> <figcaption>Daman, one of the highest points on the Rajpath, often saw snow in winter. Photo: DAN EDWARDS</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026041610044_baac4747267c751ab7b0e5ef24697fb5001c4c55e04a82d92c89282bd01a325c.jpg" data-media-id="editor_6" data-image-id="2026041610044_baac4747267c751ab7b0e5ef24697fb5001c4c55e04a82d92c89282bd01a325c" data-rendition-name="original" width="648" height="960" loading="lazy" alt="Highways NT"> <figcaption>Travelers could view the Himalayas from a view tower at Daman. Photo: DAN EDWARDS</figcaption> </figure>  June 1957: Eight thousand Nepali workers and about 500 Indian Army personnel were at work on the road.&nbsp; 30 June 1957: India officially handed the road over to Nepal. India had spent INR32.5 million on the project.&nbsp; January 1958: The road from Amlekhganj to Bhainse was upgraded. July 1961: The gravel road from Raxaul to Birganj was blacktopped. Trucks began transporting goods from Raxaul directly to Kathmandu, avoiding the need for transshipment from train to truck in Amlekhganj, or use the ropeway from Bhimphedi. 1961: Passengers could travel from Raxaul to Kathmandu in a day, whereas it took a week by train to Amlekhganj, bus to Bhimphedi and then on foot. September 1962: Nepal’s 3-Year Plan aimed at broadening and black-topping the road between Bhainse and Raxaul, bypassing the Chure tunnel, and constructing several bridges along the route. 1963: Travelers going to Kathmandu by land: Road, 158,000, Nepal Government Railway, 66,500. Railway passenger service ended in June 1965.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026041610044_2a95eb144dad74271a0fa3a27fab6b45bbab0a1c4be59d21120ad14c08e258fd.jpg" data-media-id="editor_7" data-image-id="2026041610044_2a95eb144dad74271a0fa3a27fab6b45bbab0a1c4be59d21120ad14c08e258fd" data-rendition-name="original" width="2048" height="1344" loading="lazy" alt="Highways NT"> <figcaption>A bus providing ‘deluxe service’ in 1963 is ready to leave Amlekhganj for Kathmandu. Note the railway tracks of the Nepal Government Railway. Photo: RON ELLIOTT</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026041610044_d02013692e84d6add7a6e0ce66c2b552cd53bb084db2aa8df0593bbcf84c2c04.jpg" data-media-id="editor_8" data-image-id="2026041610044_d02013692e84d6add7a6e0ce66c2b552cd53bb084db2aa8df0593bbcf84c2c04" data-rendition-name="original" width="2048" height="1352" loading="lazy" alt="Highways NT"> <figcaption>Vehicles found it difficult to pass on many parts of the Rajpath in 1963. Photo: RON ELLIOTT</figcaption> </figure>  1965: Tribhuvan Highway was considered a useful addition to Nepal’s economic infrastructure, but it could not act as a prime mover in the nation’s economic development. It did play a major role in the 1960s in transporting material and equipment needed to implement development projects in the Kathmandu Valley. September 1966: Nepal took over maintenance of the Tribhuvan Rajpath from the Indian Aid Mission.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026041610044_5488ba1e92f6395ff882392ccbaef2270622632682eccb412d8de7b128f6f397.jpg" data-media-id="editor_9" data-image-id="2026041610044_5488ba1e92f6395ff882392ccbaef2270622632682eccb412d8de7b128f6f397" data-rendition-name="original" width="1764" height="1184" loading="lazy" alt="Highways NT"> <figcaption>Trees still lined the Rajpath near Thankot in 1967. Photo: DAN EDWARDS</figcaption> </figure>  1971: A UN-Nepal study said the best alignment for an alternative road was from Kathmandu, Pharping, Kulekhani, Bhimphedi to Bhainse. 1975: Nepal's Department of Roads’ engineer concluded: ‘The Tribhuvan Rajpath has been built without design speed consideration… The pavement was not constructed to any designed standard… irrespective of quality of material, and later the road was black topped without consideration of traffic intensity and load-bearing capacity of sub-base… utilisation of low-quality material in the Bhainse-Thankot section… Quality control was neither maintained in Bhainse-Thankot nor the Bhainse-Raxaul section. Local materials were used irrespective of their quality to complete the work in the earliest possible time and in the cheapest possible manner. Brick work was done in negligible quantity. Cement used was ordinary portland cement…’ &nbsp;&nbsp;&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026041610044_26c74f45991efb3dc29d616e8acafb3163661ae6573c5314538e59c54d5ca0a5.jpg" data-media-id="editor_10" data-image-id="2026041610044_26c74f45991efb3dc29d616e8acafb3163661ae6573c5314538e59c54d5ca0a5" data-rendition-name="original" width="2368" height="1365" loading="lazy" alt="Highways NT"> <figcaption>Bhainse in 2017. The road divided here, one going to Bhimphedi on the right, the main road proceeding to Kathmandu on the left. Photo: DAN EDWARDS</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260416100416_4d9321abf4d912796842fe963a493501e1aceff462300ecdd9bd5e0b8ba7f294.jpg" data-media-id="editor_11" data-image-id="20260416100416_4d9321abf4d912796842fe963a493501e1aceff462300ecdd9bd5e0b8ba7f294" data-rendition-name="original" width="649" height="1667" loading="lazy" alt="Highway info NT"> </figure>  Even 70 years after it was built, there is still speculation about India's security concerns vis-a-vis China, and how Indian Army engineers purposely made the road longer than it needed to be over the 2,500 Sim Bhanjyang pass instead of following the river route.&nbsp; There is also some evidence that although the Rana regime had first requested the US for help with the highway, Nehru did not want the Americans involved in Nepal. Which is why the Tribhuvan Highway became an Indian military project.&nbsp; There was similar concern from India about the Kodari Highway linking Kathmandu to China, and King Mahednra is famously supposed to have said: "Communism will not come here in a taxi."&nbsp; Geopolitics still affects Nepal's strategic highways. After decades, links to China are still rough and often blocked. Kathmandu-Tarai Fast Track is delayed by years, and not expected to be completed during this decade. Trucks and buses still bypass the Tribuvan Highway with a 200km detour via Mugling because the other alternative routes like the Tika Bhairav or Chhaimale routes are not suitable for heavy vehicles.&nbsp; The shortcut through Chitlang that the Swiss proposed in the 1950s is still too difficult. And a 25km section of the Japanese-built BP Highway to the eastern Tarai has been knocked out by the 202 flood. Dan Edwards was a Peace Corps volunteer in 1966 and is the author of several books on Nepal. This is the fourth instalment in a new limited series in Nepali Times on the historic transportation infrastructures of Nepal.

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