Orange, yellow and brown. Sama Bajracharya fills the canvas with colours, her forehead creased in concentration and a smile playing at her lips. Sama is 47 and has <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/A-for-autism,270">autism</a>, a neurological and developmental disorder that affects how people interact with others, communicate, learn, and behave. It took years for Sama’s parents to come in terms with and understand her challenges.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240416110452_d76000000456e391ebecd6304ca0352da0df367a097a24fba40845620bd0167e.jpg" data-media-id="editor_1" data-image-id="20240416110452_d76000000456e391ebecd6304ca0352da0df367a097a24fba40845620bd0167e" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Autism awarness with art"> <figcaption>A colourful painting by Sama Bajracharya.</figcaption> </figure>  It was not until a teacher identified her difficulties – an inability to follow lessons, recognise letters and play with other students. She often withdrew and remained isolated. Her parents took her to a doctor who diagnosed her with autism. Because not much was known about the condition at the time, her parents held onto the hope that she would be cured. For 18 years, her mother Ratna Shova Bajracharya took her to traditional healers, dya majus and ayurvedic hospitals. “I did everything that I could, I just wanted to see her live like everyone else happy,” says Ratna Shova.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240416110456_3783e96dfaeb643383995c2bb37ef189a55c704889ea55ef769842526f132a3f.jpg" data-media-id="editor_2" data-image-id="20240416110456_3783e96dfaeb643383995c2bb37ef189a55c704889ea55ef769842526f132a3f" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Autism awarness with art"> <figcaption>Sama with her mother Ratna Shova.</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240416110456_a9006224a4e882de540cfc8ad3f9bb298c2b4fb66eaa8f2b48e4b83f68630126.jpg" data-media-id="editor_3" data-image-id="20240416110456_a9006224a4e882de540cfc8ad3f9bb298c2b4fb66eaa8f2b48e4b83f68630126" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Autism awarness with art"> <figcaption>Sama with her sister Nima walking towards a bus station.</figcaption> </figure>  Upon learning there was no cure from a specialist, Ratna had to adjust their lives to accommodate Sama’s needs. This was not easy as sometimes Sama would exhibit aggressive behaviour including self-harm, throwing objects, breaking mirrors and threatening to jump off the window. A turning point came in 2005 when Sama met Sarita Dangol during an art event for people with autism. A senior artist, Sarita started mentoring Sama in arts and crafts. Art became a form of therapy for Sama, promoting mental and physical stability. Read also: <a href="https://nepalitimes.com/multimedia/the-art-of-healing">The art of healing</a>, Sewa Bhattarai Seeing the impact arts had on her, Sarita along with Sunila Bajracharya co-founded Mikha - The Creative Begins in 2022 to help empower other individuals like Sama by providing them a platform to explore and grow through art.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240416110456_da249677323f0b78b936809ea68be00dd17f6530c1f8028723d318c71faafb8e.jpg" data-media-id="editor_5" data-image-id="20240416110456_da249677323f0b78b936809ea68be00dd17f6530c1f8028723d318c71faafb8e" data-rendition-name="original" width="1500" height="1015" loading="lazy" alt="Autism awarness with art"> <figcaption>Sama likes knitting.</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240416110456_1dc69dfe3b36b094726ca5ee1fd63f5754a623d4ab8efc8d52e6b5b86a1945f9.jpg" data-media-id="editor_6" data-image-id="20240416110456_1dc69dfe3b36b094726ca5ee1fd63f5754a623d4ab8efc8d52e6b5b86a1945f9" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Autism awarness with art"> <figcaption>Sama hugs her knitting mentor after her art classes.</figcaption> </figure>  Mikha has become a source of joy for Sama, she excitedly attends classes with her classmates Sabha and Ritu both of whom have been diagnosed with down syndrome. In 2023, Sama participated in the International Disability Dance and Art Festival in Delhi and showcased her artistic and dancing talents, instilling a sense of confidence in her.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240416110456_8c1556b05170bbe7cbb2f2a1959e26fe3ccfb294c3a86f4fc9b84ba225ccbffb.jpg" data-media-id="editor_7" data-image-id="20240416110456_8c1556b05170bbe7cbb2f2a1959e26fe3ccfb294c3a86f4fc9b84ba225ccbffb" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Autism awarness with art"> <figcaption>Sama with her friends Sabha and Ritu during their art class.</figcaption> </figure>  Read also: <a href="https://nepalitimes.com/here-now/the-mental-scars-of-violence">The mental scars of violence</a>, Sewa Bhattarai According to the 2021 Census, there are 4,886 individuals with autism in Nepal, out of 647,744 people surveyed. This is 0.8% of the sample population. In 2019, the Autism Care Nepal Society (ACNS estimated) that some 300,000 children were living with autism in Nepal. There has been a <a href="https://nepalitimes.com/here-now/why-are-autism-cases-rising-in-nepal">worrying increase in autism among younger Nepalis</a>, partly due to increased awareness and diagnosis of the condition. Management and support systems, however, are sorely lacking.&nbsp;

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Autism awareness with art

https://youtu.be/3q459iYj9HAAshna Lama flips a black folio. Each page has a stark female figure in white. Some standing up, others sitting, some lying down or meditating.The flowy edges enclose shards and squiggles, as if hiding a deep hurt within. The drawings seem to signify how women try to keep their pain inside, while keeping a bubbly facade.Ashna Lama herself is a chirpy 21-year-old who laughs a lot, makes self-deprecating jokes in her singsong voice. Few can tell that this cheery face masks a difficult struggle with anxiety attacks and depression.Lama grew up in an artistic family with the smell of acrylic and turpentine. She sketched from a young age, expressing her sadness in art. The current series ‘The Fragility of Anxiety’ was drawn in <a href="https://www.nepalitimes.com/here-now/its-all-in-the-mind/" target="_blank" rel="noopener">2015 after the earthquake when she had panic attacks</a>, and was put on medication.Read also: <a href="https://www.nepalitimes.com/here-now/its-all-in-the-mind/" target="_blank" rel="noopener">It's all in the mind</a>, Sonia Awale“I was traumatised, I didn’t speak to anyone for four days. There were a lot of thoughts running through my mind,” recalls Lama. “Then I turned to my sketchbook and started drawing, and these figures just flowed. When I concentrated on sketching I didn’t think of anything else, and the focus calmed me down.”<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110714114/636902b49c7e80680e037c7cjpeg.jpg" alt="" width="572" height="1024"/><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110714114/636902b69c7e80680e037c7djpeg.jpg" alt="" width="575" height="1024">Three years later, Ashna is ready to exhibit the sketches alongside her own poetry at the one-day exhibition at Hotel Annapurna on August 12. Lama says the black pages of the notebook spoke to her, and resonated with her art. She describes her <a href="http://archive.nepalitimes.com/regular-columns/all-in-mind/the-silent-scream-depression-is-common-but-only-few-get-treatment,588" target="_blank" rel="noopener">bouts of depression</a> as “spiraling into blackness”.Read also: <a href="https://www.nepalitimes.com/?p=10636&amp;preview=true" target="_blank" rel="noopener">All in the family</a> , Prakriti Kandel<a href="https://www.nepalitimes.com/banner/the-art-of-healing/" target="_blank" rel="noopener">Art has historical association with mental health</a>. Frieda Kahlo painted self portraits to deal with debilitating injuries, Monet was highly anxious, Picasso was said to be schizophrenic, and Van Gogh depressed and bi-polar. Lama says her art is also a reflection of her inner turmoil.“When the pressure cooker is about to burst and the whistle goes off, the steam is art. If it is too much to handle, I draw," says Lama, adding it was not easy to decide to share her work and open up about her deepest emotions. But she decided to go for it to spread awareness of mental health in Nepal, and break the taboos.Lama found out she was getting too dependent on medication. Once, having lost her pills she started banging her head on walls, hoping she would pass out. The drawings have helped her get off medication, and she says many others with mental health issues may also need an outlet for expression.Read also: <a href="https://www.nepalitimes.com/?p=10647&amp;preview=true" target="_blank" rel="noopener">Raising children can be a therapy</a>, Ketan Dulal<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110714114/636902b99c7e80680e037c7ejpeg.jpg" alt="" width="1500" height="1381"><figcaption> </figcaption></figure>After she came out to talk publicly about her affliction, Lama found many opened up too. They were lonely, and felt as if they were the only ones suffering. It helped to share.“Mental health is so little understood in Nepal. There is so much stigma, and I want to generate some discussion through this exhibition. It is for people who appreciate the effort it takes to bare your innermost soul to an outsider,” says Lama.Once a science student and a part-time model, she decided to take a clean break and enrolled in an art school in Florence. She says formally studying art in the city of Michelangelo, Botticelli, Raphael, and Dante gave more definition to her form of expression. She also paints commissioned work where she digresses from signature black to dabble in rainbow hues.The future? Lama wants to return to Nepal and learn thangka painting: “I want to sweat it out, grinding gemstones to make colours, using the techniques to make my own kind of art.”It would be a homecoming for Ashna Lama, shedding black for the vividness of life in her own country.Read also: <a href="https://www.nepalitimes.com/?p=10641&amp;preview=true" target="_blank" rel="noopener"> Addicted to the joystick</a>, Suprasanna AryalThe Fragility of AnxietyHotel Annapurna 12 August, 4:30-6:30PM<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110714114/636902bc9c7e80680e037c7fjpeg.jpg" alt="" width="640" height="917"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110714114/636902bf9c7e80680e037c80jpeg.jpg" alt="" width="640" height="921">

Ashna comes out of the black

<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221107121148/6368f09f9c7e80680e0359e3jpeg.jpg" alt="" width="1000" height="668"/>A child looks on intently as Shradha Shrestha paints the blank walls of Kanti Children's Hospital at Maharajganj. "Look at aunty painting a tiger on the wall," says the child's mother. In fact, Shrestha is painting a giraffe.Shrestha and Kiran Maharjan were busy at work the past few months, painting the walls of Nepal's only government hospital for children. The young patients, their parents, doctors, nurses, and staff came by to watch them work, offer feedback and suggestions. As the murals slowly took shape in the busiest corridors, the colourful paintings raised spirits and added some beauty to an otherwise grimy hospital.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221107121148/6368f0a29c7e80680e0359e4jpeg.jpg" alt="" width="5024" height="3354">Shrestha and Maharjan are part of the ‘Health Transformed by Art’ project that has been trying to bring the therapeutic value of art into Kathmandu’s hospitals with support from Siddhartha Art Gallery."Art is usually seen only in galleries, so we thought, why not bring it outside - to hospitals - where the power of art, and its engagement and expression, is very much needed," explains coordinator Shristi Shakya. With Raju Giri and Anoj Subedi, the group chose nature as the theme, for its healing potential, and they picked Kanti Children's Hospital because its patients hail from all over the country.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221107121148/6368f0a69c7e80680e0359e5jpeg.jpg" alt="" width="5893" height="3934">Speaking at the opening of the exhibit, art critic Abhi Subedi explained the purpose of art has always been mental and spiritual wellbeing. Following the 2015 earthquake, many art groups went around affected areas, conducting painting workshops for children. When they returned to their classrooms, students were told to draw their experiences as a means to deal with trauma.The results showed how art provides a medium for children to articulate their feelings and find some relief from stress. Still, art's therapeutic value had not been recognised in Nepal, and its potential for healing is not a widespread concept.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221107121148/6368f0aa9c7e80680e0359e6jpeg.jpg" alt="" width="1000" height="668">For this project, art therapist Lajja Dixit first trained 11 artists on art therapy. They then conducted art-based therapy workshops in the cancer ward. After that, the team of Shristi Shakya, Raju Giri and Anoj Subedi collected non-hazardous hospital waste like bottles, caps, containers, tubes for installation art pieces. Waste from Kanti, Norvic, Manmohan, Om, Grande, and Gangalal hospitals was sterilised and sorted, then upcycled into installations by artists including students from Kathmandu University and Shrijana College of Fine Arts. It would have otherwise become landfill.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221107121148/6368f0ad9c7e80680e0359e7jpeg.jpg" alt="" width="1000" height="668">Working in a government hospital had its challenges: not only did the team have to wait for six months just to get permission, the artists were not allowed to work during the doctors' rounds. This meant working until 1am. The results are there for all to see: a colourful, bright orange phoenix soaring above a statue of Queen Kanti, and tiny birds in blue, red and yellow hanging from the ceiling.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221107121148/6368f0b09c7e80680e0359e8jpeg.jpg" alt="" width="1080" height="815">The works also carry subtle messages concerning the politics of medical care, and how it should be affordable and accessible to all Nepalis. Mekh Limbu's installation displays a row of tiny medicine bottles, but instead of labels they have pictures of Nepal's herbs. The piece is a commentary on how the people suffer from a lack of drugs, despite Nepal being rich in medicinal plants.Hospital director Ganesh Rai is happy with his hospital doubling as an art gallery: "I don't know much about art, but a lot of people have complimented me on the fresh look of the hospital. It spreads positive energy, which is helpful for the children.”<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221107121148/6368f0b29c7e80680e0359e9jpeg.jpg" alt="" width="1000" height="668">Siddhartha Art Gallery hopes to continue this project in other hospitals around Nepal. "These are cynical times, but idealism, hard work and integrity of the artists have brought us this far," says the gallery's director Sangeeta Thapa, whose own recent health scare was an impetus for the project."As I was lying in a hospital, I would get calls every day from the artists. They asked me to decide on one thing after another, shared their problems, their ideas," said she as she broke down in tears at the inauguration. "It was difficult for me to handle all that, but it came to mean so much to me, personally, as well. This project to heal others has ended up healing myself."<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221107121148/6368f0b59c7e80680e0359eajpeg.jpg" alt="" width="1000" height="668"><figcaption> </figcaption></figure>Also read: <a href="http://archive.nepalitimes.com/article/Nepali-Times-Buzz/street-art-mural-in-Kathmandu,3840" target="_blank" rel="noopener">Walls as art, not barriers,</a> Shaleen Shah<a href="http://archive.nepalitimes.com/page/street-art-nepal-earthquake">Murals of Hope</a>, Stephene Huet<a href="http://archive.nepalitimes.com/article/Nepali-Times-Buzz/Buzz-Kathmandu-murals-wall-paint,707" target="_blank" rel="noopener">Colourful capital</a>, Sangam Shilpakar<a href="http://archive.nepalitimes.com/article/Nepali-Times-Buzz/Koloring,289" target="_blank" rel="noopener">Kolorful Kathmandu</a>, Tserign Dolker Gurung<a href="http://archive.nepalitimes.com/news.php?id=5119#.W1gzptUzbIU" target="_blank" rel="noopener">A Nepali feminist in Japan</a>https://www.youtube.com/watch?time_continue=1&amp;v=fjdTxkRmLTs

The art of healing

On Tuesday, leader of the monarchist RPP once again gathered on Kathmandu’s streets to deliver fiery speeches, but this time there was no arson and looting and no need for riot police to fire live rounds or tear gas.
RPP leaders demanded the release of their members including vice-president Rabindra Mishra and MP Dhawal Shamsher Rana were arrested during the violent <a href="https://nepalitimes.com/news/republicans-and-royalists-on-nepal-s-streets">28 March protests at Tinkune </a>which left two dead. 
They denounced the current leadership of the main parties, demanding the <a href="https://nepalitimes.com/editorial/nepal-party-reincarnating-hindu-monarchy">restitution of Nepal as a Hindu kingdom</a>. They also said the government was responsible for the fatalities on 28 March because it provoked its rally with a tear gas attack even before it started.
It has now been revealed that the police fired at least 100 live rounds from high powered assault rifles at the crowd. Twenty-one of the 120 injured received bullet wounds, and most of them were bystanders and people trying to reach home. 
Tuesday protest on the Ring Road in Balkhu was much more subdued, and comparatively fewer RPP supporters showed up. The arson and vandalism in the previous protest appears to have cost some support for <a href="https://nepalitimes.com/news/the-ghost-of-monarchy-returns-to-haunt-nepal">former king Gyanendra </a>especially for the anointment of medical tycoon and bank defaulter <a href="https://nepalitimes.com/news/street-politics">Durga Prasai </a>as ‘commander’ of the Tinkune rally.
Some monarchists acknowledge Gyanendra’s mistakes when was king 2001-2008, but say he has had a lot of time to reflect on his shortcomings and seems more disciplined and committed. His supporters have tried to build on nostalgia among some Nepalis for<a href="https://nepalitimes.com/news/why-invest-in-nepal"> domestic stability </a>and international respect that <a href="https://nepalitimes.com/here-now/if-birendra-was-alive-nepal-could-still-be-a-monarchy">the monarchy</a> commanded. 
“Nepalis were promised better service delivery, opportunities for the underserved, as well as better, more honest use of state resources, but the <a href="https://archive.nepalitimes.com/news.php?id=16992">people in leadership </a>have not been able to deliver on their commitments,” says RPP leader Prakash Chandra Lohani. “The gap between their rhetoric and reality has widened, the people feel betrayed, and the respect Nepali people had previously had for them has changed to revulsion.” 
Indeed, many commentators have warned the three main parties and their <a href="https://nepalitimes.com/editorial/politics-as-usual">serial prime ministers</a> who have ruled Nepal for much of the past 30 years should address rising public anger with them, and see the writing on the wall.
‘<a href="https://nepalitimes.com/news/nepal-government-changes-again">The UML, NC and Maoists</a> must introspect about their conduct,” warns Gunaraj Luitel, editor of Nagarik, in an op-ed this week. ‘These leaders for life may save themselves from simmering public anger, but they will not be able to save the system. The monarchist wave can only be dispelled when citizens are assured of <a href="https://nepalitimes.com/here-now/nepal-s-local-election-gives-power-back-to-people">better governance</a> through <a href="https://nepalitimes.com/latest/real-world-training-for-youth-leaders">younger leaders</a>, and reforms.’ 
Rifts between radical royals who are gunning for a return to <a href="https://nepalitimes.com/here-now/mob-movement-and-mayhem">Panchayat-style absolutism </a>and moderate monarchists who favour a constitutional king have also weakened the movement somewhat. The split between the RPP and RPP-Nepal cost the royalists numbers in Parliament in 2022, and both parties denounced the violence last month, albeit shifting the blame on the government.
The irony is that the same royalists who want to scrap the republican Constitution had formed electoral alliances with the UML during the 2022 elections. RPP-Nepal chair Kamal Thapa contested the 2022 election with the UML. Thapa has not taken part in the last two rallies, saying he will only be a part of a movement under a national flag, and not a RPP party banner.
For his part, the RPP’s Rajendra Lingden is said to be hesitant to censure some of his party’s more radical royalists for fear of fissure within his ranks, despite his aversion to Durga Prasai’s role. 
Analysts have questioned why <a href="https://nepalitimes.com/news/old-is-still-gold-in-nepali-politics">supporters of the monarchy </a>have decided to reestablish an institution that would not ultimately have executive decision-making power. There are doubts about whether authoritarian-minded Gyanendra will be satisfied being a <a href="https://archive.nepalitimes.com/news.php?id=13957">ceremonial king</a>. 
Read also: <a href="https://nepalitimes.com/news/nepal-s-deja-vu-on-black-friday">Nepal’s déjà vu on Black Friday</a>, Sonia Awale
"The Nepali people will not accept <a href="https://nepalitimes.com/here-now/forgotten-woman-who-sheltered-communist-activists">an absolute monarchy </a>at this point of time, and both the public as well as <a href="https://archive.nepalitimes.com/news.php?id=8371">king Gyanendra</a> are fully aware that there is no other possibility beyond a constitutional monarchy," asserts the RPP’s Lohani. “The traditional monarchy’s institutional capacity might have been enough to meet the needs of feudal Nepal, but an absolute monarchy is impossible both in concept and practice in the context of <a href="https://archive.nepalitimes.com/regular-columns/Economic-Class/waiting-for-an-industrial-revolution,784">modern day Nepal</a>.”

New year revolutions

Besides multiple <a href="https://nepalitimes.com/news/republicans-and-royalists-on-nepal-s-streets">street demonstrations </a>that gridlocked Kathmandu’s traffic for the past weeks, public discourse in Nepal has also been dominated by dangerously <a href="https://nepalitimes.com/here-now/air-pollution-is-more-dangerous-than-smoking">high air pollution levels</a>. Caused mostly by hundreds of <a href="https://nepalitimes.com/news/wildfire-season-starts-early-in-nepal">forest fires </a>raging across the country, the smoke contains suspended soot particles that harms <a href="https://nepalitimes.com/opinion/playing-with-poison">human health</a>. Thursday’s rain have cleared the air somewhat, and many people will soon forget how bad the air quality was. But the time to address the roots of next summer’s fire season is now.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250411060440_d1a119716a9031aadfdd611d299348d436842d376a03e664b8d773957a237524.jpg" data-media-id="editor_4" data-image-id="20250411060440_d1a119716a9031aadfdd611d299348d436842d376a03e664b8d773957a237524" data-rendition-name="original" width="502" height="540" loading="lazy" alt="Wildfires"> <figcaption>EXTINGUISHED: Forest fires raging all over Nepal in the week after 3 March (above) reduced air quality, creating a public health hazard in Kathmandu and across the country. Each red dot is a fire detected by infrared sensors on the NASA Fire Information for Resource Management System (FIRMS) satellite. But the rain on Thursday doused most of the fires (below) with more rain forecast over the weekend.</figcaption> </figure>  The reason everyone was talking about air pollution was because the<a href="https://nepalitimes.com/banner/nepal-is-going-up-in-smoke"> smoke from wildfires</a> was visible. But much more toxic are the invisible and odourless <a href="https://nepalitimes.com/news/nepal-doubles-its-carbon-footprint">gases from vehicular and industrial emissions </a>which have always been there. The theme of World Health Day on 7 April this week was ‘Healthy Beginnings, Hopeful Futures’ dedicated to <a href="https://nepalitimes.com/opinion/comment/saving-more-mothers-and-babies">preventing maternal and newborn deaths</a>. It is estimated that in Nepal, 30% of neonatal mortality can be blamed on air pollution. But that is only part of the story. Harmful as fine particulate matter is to human health, carbon monoxide, nitrogen dioxide, ground-level ozone and other gases in vehicular emissions are more hazardous to health. While the concentration of suspended particulate matter tinier than 1.5 microns (PM2.5) is closely monitored, these toxic gases are invisible, not measured much, and the public is not aware about the dangers they pose. Surface ozone is produced by the interaction of various gases found when <a href="https://nepalitimes.com/news/fossil-fuels-poison-air">burning fossil fuels</a>. Besides being poisonous, ground level ozone contributes up to 0.23°C to <a href="https://nepalitimes.com/here-now/nepal-s-mountains-are-melting">global warming</a> because it is also a greenhouse gas. A new policy brief by the Clean Air Fund titled The Case for Action on Tropospheric Ozone blames surface ozone for a half a million premature deaths every year, 54.8% of which are in South Asia. Ozone also stunts plant growth and reduces crop yields by 26% globally, and 11% loss in <a href="https://nepalitimes.com/news/economic-benefits-of-saving-the-ecology">forest productivity</a>, the report adds.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250411060456_aa02a923f8b27544ae54d0220162678f5bbb5eeb8fc3c466173c22c49b3e9a85.jpg" data-media-id="editor_11" data-image-id="20250411060456_aa02a923f8b27544ae54d0220162678f5bbb5eeb8fc3c466173c22c49b3e9a85" data-rendition-name="original" width="998" height="724" loading="lazy" alt="Gas Chambers"> </figure>  Read also: <a href="https://nepalitimes.com/here-now/bad-air-and-polluted-politics">Bad air and polluted politics</a>, Sonia Awale Ground-level ozone is not emitted directly into the air like other gases, but is formed when oxides of nitrogen (NOx), carbon monoxide (CO) and volatile organic compounds (VOCs) released from automobile tailpipes or industry smokestacks react chemically with each other in the presence of sunlight. The main source of carbon monoxide in Kathmandu Valley are its 1.2 million two-wheelers. “Usually the concentration of carbon monoxide is 200-500 parts per billion (ppb), this has increased up to 3,000 in Kathmandu. Meanwhile, ground-level ozone has gone from 70-80 ppb to 150 ppb,” says Ravi Sahu, regional air quality specialist with the Kathmandu-based International Centre for Integrated Mountain Development (ICIMOD).&nbsp; Sahu says <a href="https://nepalitimes.com/news/no-smoke-without-fire-p7vb9dcj">rampant forest fires of the past weeks</a> have also added to carbon monoxide and ozone in the air, not just the fine particles that make up the visible smoke. He adds, “There isn’t much awareness about <a href="https://nepalitimes.com/banner/poisoning-the-air-we-breathe">ground-level ozone and carbon monoxide</a>, we need to urgently look into it.” A distinction must be made between good and bad ozone. Stratospheric ozone protects living beings from harmful ultraviolet (UV) radiation from the sun.&nbsp; Tropospheric ozone can again be separated into two types: ozone in the free atmosphere which is a greenhouse gas much more potent than carbon dioxide, and ground-level ozone which has adverse impacts on health and agriculture. ‘Cutting tropospheric ozone presents a unique challenge as it requires smart and fast action across multiple greenhouse gases and air pollutants, as well as multiple economic sectors,’ notes the Clean Air Fund's policy briefing. ‘It is a growing and neglected problem that needs an integrated approach on both a local and global level to tackle climate change and air pollution together.’ Dying young There was a time when Nepal made it to international news bulletins only if there were fatalities on Mt Everest. Now, Kathmandu’s bad air frequently makes headlines all over the world. This past week, the concentration of PM2.5 that harms human health was up to 40 times the WHO recommended guideline — adding to the poisonous gases already present from vehicle emissions. The Department of Environment says 40% of the pollution in the past weeks was from wildfires sparked by nearly 6 months without substantial rain over central Nepal. Most of the rest is from vehicular and industrial emissions from Kathmandu itself and across the southern border. NASA’s Fire Information and Resource Management System (FIRMS) which issues daily maps of fires, showed hundreds of blazes raging across Nepal on Wednesday, mainly in Chitwan, Parsa and along the East-West Highway.&nbsp; “If we look at the figures for the last few years, it is clear that wildfires have become the biggest source of air pollution, they are seasonal but have overtaken vehicular emissions,” says urban planner and environmentalist Bhushan Tuladhar. “Forest fires, stubble burning, and open burning of garbage are the bigger problems now. Nepal, India, Bangladesh, and Pakistan are at risk every year, we shouldn’t further delay in finding solutions,” warned air quality expert Bhupendra Das during an event on air pollution organised on 7 March by the Nepal Forum of Environmental Journalists (NEFEJ).&nbsp; Indeed, studies have shown that in winter 60% of the air pollution over Kathmandu is transboundary from the south, and in November it is compounded by smoke from crop residue burning by farmers in India and Pakistan blown in by prevailing winds. Forest fires are a regular pre-monsoon occurrence in Nepal, often intentionally set by farmers and herders to stimulate new grass growth for livestock. Winter rains have failed for eight of the past ten years, and this means the fires often spread out of control. The other reason for the increase in wildfires is the doubling of forest fires to 46% of the country’s area in the past 25 years. But this has happened simultaneously with outmigration, with some mountain districts losing 30% of their population between 2011-2021. With less pressure on forests for fodder and firewood, the undergrowth of community forests is loaded with dry fuel just waiting for a spark. The bowl-shaped topography of Kathmandu, Pokhara and other valleys further concentrates pollutants as they are trapped by surrounding mountains. But a year with a high number of wildfires is usually followed by a year or two with fewer incidents. For example: there were 6,537 fires in 2021 but the following year the number was down to 1,528. There were 5,216 fires last year, this year the number has already reached 1,800, and the trend is likely to be broken. Heavy rains forecast for the coming days are expected to douse some of the fires and clean up the air. But the damage has been done: Kathmandu residents of all age groups this week crowded clinics and hospitals with burning eyes, itchy throats, difficulty breathing, headaches, and dizziness. But in the longer term, soot particles that are tiny enough to jump the blood-air divide in lung capillaries do not just cause Chronic Obstructive Pulmonary Disease (COPD), asthma, but also cancers, heart attacks, strokes, birth defects and other chronic diseases. The latest Air Quality Life Index (AQLI) report by the University of Chicago shows that the annual concentration of PM2.5 in Kathmandu’s air rose from 17.87µg/m3 in 1998 to 31.33µg/m3 in 2022. Air pollution has got worse by 75% in Kathmandu in 25 years. During this time, air pollution has reduced the average life expectancy of Kathmandu’s residents by 3.5 years. According to the Health Effects Institute in Boston, dirty air is among the biggest public health concerns in Nepal killing over 42,100 a year. The adverse impact of high levels of air pollution is not limited to public health, it is seriously affecting tourism. Operators in Pokhara this week said that there were many negative online posts by visitors unable to see the famous panorama of Machapuchre and the Annapurnas even from Sarangkot. Aviation is also affected, as planes have to circle sometimes for hours burning a lot of fuel because of runway visibility being below minima at Kathmandu airport. The higher fuel cost is just passed down to customers, making air tickets in and out of Kathmandu some of the highest in the world. Kathmandu, with a population of four million, has not implemented a concrete policy to curb toxic air despite having formulated various action plans and repeated commitments by the government to protect the environment and control air pollution. The Department of Environment’s 2017 Air Quality Management Action Plan for Kathmandu put forward a policy to reduce air pollution caused by vehicles which was approved by the Cabinet, but has yet to be put to practice. The action included the immediate implementation of the Euro 5 emission standard to reduce pollution emitted by vehicles. However, Nepal has not even been able to implement Euro 4 standards so far. India, meanwhile, has already moved forward with the implementation of the Euro 6 standards. Says Ravi Sahu: “Air pollution in Nepal is not just about air pollution, it has ties to tourism, aviation, the economy so we must be prepared for annual conditions like forest fires, and this requires urgent interdisciplinary collaboration.” &nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250411050452_821d09e283d8a590f1369bfb71b9b7fc6d950726e0651ea86c6488d04deb1742.jpg" data-media-id="editor_15" data-image-id="20250411050452_821d09e283d8a590f1369bfb71b9b7fc6d950726e0651ea86c6488d04deb1742" data-rendition-name="original" width="839" height="784" loading="lazy" alt="Silent Killers"> </figure>  &nbsp;

What is invisible is more dangerous

82 in २०८२

Here in the mountains of far-western Nepal, the biggest threat to life and limb is gravity. Women collecting fodder fall from trees, boys grazing goats fall off cliffs, heavily loaded tractors plunge from dirt roads carved out of steep slopes. There is nothing to be done about those who die on the spot. But for the severely wounded there is only one hospital: Bayalpata. And it is there that <a href="https://www.youtube.com/watch?v=CJzWlnYd0ZM&amp;t=8s" target="_blank">orthopaedic surgeon Mandeep Pathak</a> is the last hope for many wounded people. Pathak, 42, is too modest to tell us how many lives he has saved over the past 10 years he has worked at Bayalpata. But hospital records show he has performed more than 4,000 operations in the past decade, many of them so patients did not suffer permanent physical disabilities. Pathak also did 800 major life-saving surgeries in that time. “I treat patients with injuries, but I wish I could also treat poverty,” Pathak says, emerging from Bayalpata’s surgical theatre one recent afternoon. <div class="embed-block"><iframe width="700" height="415" src="https://www.youtube.com/embed/CJzWlnYd0ZM?si=s_rkbU4YDaw87gqH" title="YouTube video player" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share" referrerpolicy="strict-origin-when-cross-origin" allowfullscreen></iframe></div> Sudurpaschim Province in Nepal’s far-west is far away from everything: from Kathmandu, from adequate medical care, from food security, and far from the reach of government services. It has suffered state neglect for centuries, its men mainly migrating to India for seasonal work to families who depend on subsistence agriculture. Pathak remembers the searing sadness he felt when a patient once told him, “Doctor, I sold the last of my rice to pay to come here, please give me a medicine that I can take on an empty stomach.” Pathak was born in Kathmandu, and after getting his MBBS from Kathmandu University, he got an MD from The Philippines. At a time when many Nepali doctors and staff nurses were emigrating, Pathak did not just return to Kathmandu but decided to go to one of the remotest districts in Nepal to serve those most in need. The hospital was established in 2009 in the village of Bayalpata, and has been managed by the non-profit <a href="https://www.nyayahealthnepal.org/" target="_blank">Nyaya Health Nepal (NHN)</a> as a public-private partnership treating 100,000 patients a year for no fees at all. NHN is now preparing to hand over the running of the hospital to the Sudurpaschim provincial government so its <a href="https://nepalitimes.com/banner/this-is-how-to-upgrade-nepals-rural-health" target="_blank">model of hospital management</a> can be replicated.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250414130456_b59dabd4604a24426a55fe91c0e5866b5029858bdb4c4028c331557aeb5408ae.jpg" data-media-id="editor_4" data-image-id="20250414130456_b59dabd4604a24426a55fe91c0e5866b5029858bdb4c4028c331557aeb5408ae" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Bayalpata hospital"> <figcaption>Bayalpata hospital in Achham.</figcaption> </figure>  People from not just Achham but surrounding districts, and from as far away as Humla, bring patients to Bayalpata, sometimes walking for days. Some with complicated pregnancies are brought in stretchers, young children with broken arms walk into the emergency, and sometimes there are mass casualties when a tractor or bus falls off a road. And Pathak is always there with his team performing triage, and doing orthopaedic surgeries that would be difficult even in Kathmandu. Recently, his team did a hip replacement at <a href="https://nepalitimes.com/banner/state-of-the-art-rural-hospital" target="_blank">Bayalpata Hospital</a>. Mild mannered, modest, soft-spoken, hard-working, professional are the words families of patients who have been treated at <a href="https://nepalitimes.com/here-now/nepal-s-rural-lifeline" target="_blank">Bayalpata Hospital </a>use to describe Mandeep Pathak. But the surgeon is too busy to let all this get to this head.&nbsp; Asked why he does not emigrate like his peers or get a lucrative position at a private hospital in Kathmandu, Pathak answers simply, without a trace of self-importance, “I do not think I could get the satisfaction or sense of fulfilment anywhere else.” When travelling to attend medical congresses overseas or visit family in Kathmandu, Bayalpata has other doctors to take care of patients, but many wait patiently till Pathak returns for their consultation or surgery.&nbsp; When he returns from seminars abroad after learning the latest skills, Pathak’s suitcases are not full of clothes or presents, but titanium bone implants, external fixation rods, or intramedullary nails to be used in <a href="https://nepalitimes.com/news/altruistic-healthcare-models-in-nepal" target="_blank">surgeries at Bayalpata</a>.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025041414040_5356278472c1eb2b9e4af1d593d6234cc8dc5e5161a8c614197c01abefadbd80.jpg" data-media-id="editor_8" data-image-id="2025041414040_5356278472c1eb2b9e4af1d593d6234cc8dc5e5161a8c614197c01abefadbd80" data-rendition-name="original" width="2048" height="1368" loading="lazy" alt="surgery"> </figure>  Before Bayalpata Hospital was established, most people suffering broken bones had to travel down to Dhangadi or Nepalganj for treatment. No more. Although Pathak’s specialisation is orthopaedic oncology, he is mostly treating fractures and rejoining broken bones.&nbsp; Now as Bayalpata’s Hospital Director, Pathak also has administrative and fundraising duties. He has to take the 10-hour ride down to Dhangadi often to meet various Sudurpaschim ministries to release the hospital’s budget — that is sometimes more difficult than the most complicated surgery. Recently, he had to cancel an appointment with the Chief Minister to rush back to Bayalpata because there was a patient who needed emergency surgery. “I told myself, let me save this patient first, then I will try to save the hospital,” he recalls.&nbsp; Once, when he had to be away for a month on emergency surgery training in the US, the family of a 90-year-old woman who had dislocated her hip after falling from a staircase was waiting for him to return. Her son told Pathak: “Doctor, either put her out of her suffering, or cure her.” Pathak told him it was too dangerous to operate at her age, but the son said his mother was in so much pain it was worth the risk. The operation was touch-and-go, but it was successful. The woman who had been brought in on a stretcher, walked out of the hospital three days after the operation.&nbsp; A few months later, a 27-year-old woman was brought into the ER bleeding profusely from an arm mangled by a thresher machine. Even in that state, she was breastfeeding her baby. Pathak welled up seeing this display of selfless motherhood, as he wheeled her into surgery. She needed three operations, but now has full use of her hand. <div class="embed-block"><iframe width="700" height="415" src="https://www.youtube.com/embed/xJdxLD0hBqo?si=mOpM2R_DsYL88Lfg" title="YouTube video player" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share" referrerpolicy="strict-origin-when-cross-origin" allowfullscreen></iframe></div> It is the sense of achievement from such recovery that keeps Mandeep Pathak here in this isolated village in the middle of nowhere. Bayalpata Hospital has not just saved lives, it also saves families from poverty because they do not have to take sick relatives to expensive city hospitals.&nbsp; In January, a woman was brought to Bayalpata with both hands broken. She said she had taken a fall, but Pathak did not believe her. When alone in the surgery, she finally admitted that her husband had beaten her.&nbsp; It was her husband who had brought her to hospital for treatment, but she refused to file a police report. Pathak quietly put both her arms in casts, thinking about the poverty, patriarchy and injustice in society that he is unable to treat.