Last month, Finance Minister Bishnu Paudel and Pokhara Mayor Dhanraj Acharya were burned when hydrogen-filled balloons exploded at the launch of <a href="https://nepalitimes.com/news/pokhara-s-tourism-woes">Pokhara Visit Year 2025</a>. Both were flown to Kathmandu for treatment. In 2023, Nepali Congress Member of Parliament (MP) Chandra Bhandari was severely burned in a kitchen fire. He was taken to India for treatment. His Rs5.6 million medevac and treatment bill was paid by the government. It took the<a href="https://archive.nepalitimes.com/article/nation/burning-in-the-aftermath,3757"> burn injuries </a>of <a href="https://nepalitimes.com/here-now/what-nepal-s-vip-prisoners-do-in-jail">high-profile figures </a>in Nepal to finally spark action on an issue that affects mainly the country’s poorest. “We call this the burns paradox,” says Kiran Nakarmi at the Nepal Cleft and Burn Centre at Kirtipur Hospital, where the Pokhara patients received care. “Treatment is costly and <a href="https://archive.nepalitimes.com/news.php?id=19400">most victims are poor</a>."&nbsp; About 60,000 people suffer <a href="https://nepalitimes.com/here-now/removing-scars?fbclid=IwAR2MiX-ZhGNSsqUwgDYfvLWE3a7ZeLaHncz66MMKLQGtSSraTjr9cF5mIWo">burn injuries</a> in Nepal each year and 2,200 of them die. The demand for care in Kirtipur is growing.&nbsp; In 2014, it treated 90 <a href="https://archive.nepalitimes.com/article/nation/A-burning-desire-to-help,881">burn patients</a> and this more than doubled to 194 in 2015, reached 373 in 2016, and peaked at 790 in 2023. Last year the Centre treated 753 patients, and in January alone this year it was 111. Ninety-two percent of cases come from outside Kathmandu from 75 districts,” says Nakarmi. “When we started it was 42%.”&nbsp; Ideally, burns treatment should be decentralised so that local levels have primary <a href="https://nepalitimes.com/news/altruistic-healthcare-models-in-nepal">burn care centres</a> no more than two hours away, where patients can get initial treatment like cooling and dressing of wounds, and fluid replacement. Read also: <a href="https://nepalitimes.com/here-now/removing-scars?fbclid=IwAR3YJaMAa7AekbmwWYy3UlNnJkDj8XZk8qRxcagXd7Sl0M4m4SzolGs_0ow">Removing Scars</a>, Yugeshwor Koirala If necessary, they could be transferred to regional centres to handle surgery for minor burns. The government has already designated six such facilities across the country, and Nakarmi says the Centre could train their staff. He clicks forward on a slide to show a female patient brought in two months ago with her buttocks and thighs burned. “The wound was deep, it was not going to heal on its own. She needed some kind of graft.” If surgeons at a regional facility were properly trained, they could have done the graft. Instead, the patient waited for one month before coming to Kirtipur.&nbsp; Nakarmi is looking for funding for a 70-bed national burn care centre at Kirtipur Hospital, where patients can be isolated from the risk of infection that comes with sharing space in general wards. Another MP, Bindabasini Kansakar, is herself a<a href="https://nepalitimes.com/here-now/nepal-s-acid-attack-survivors-find-a-saviour"> survivor of an acid attack </a>by a spurned suitor in 2013. She registered a Bill in Parliament last year that includes specialised burn units in all <a href="https://nepalitimes.com/editorial/devolution-for-development">government hospitals </a>with 100+ beds, and in some private hospitals and medical colleges in Kathmandu. She is also calling on the government to create a fund to give immediate <a href="https://nepalitimes.com/news/justice-delayed-justice-denied-byrx8a1c">financial support to victims </a>and their families, discounts for women and children, especially from poorer communities, as well as training for health staff, twice yearly awareness programmes at local levels, and strong penalties to deter acid attacks and intentional burn injuries. Parliament’s delay in passing the Bill is ‘deeply frustrating, especially given my personal experience,’ Kansakar wrote to us.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250314110312_8d1a63b9d63d2ee0c116ffa1bc46e9a3aa5e63e7cdeeceb5a67fd7e772fbe957.jpg" data-media-id="editor_11" data-image-id="20250314110312_8d1a63b9d63d2ee0c116ffa1bc46e9a3aa5e63e7cdeeceb5a67fd7e772fbe957" data-rendition-name="original" width="1446" height="717" loading="lazy" alt="burn incidents in Nepal"> <figcaption>Member of Parliament Bindabasini Kansakar before an acid attack by a spurred suitor in 2013 (left), after, and now. </figcaption> </figure>  ‘I know first-hand the physical, emotional, and financial struggles<a href="https://archive.nepalitimes.com/news.php?id=18771"> burn victims </a>endure. Delays mean more victims are left without proper care, financial support, or legal protection,’ she added. ‘If burns affected wealthier or more influential communities, the response might have been swifter. This inequality is precisely why the Bill is so crucial — to ensure<a href="https://nepalitimes.com/news/justice-delayed-justice-denied-byrx8a1c"> justice and support for all victims</a>, regardless of their social standing.’ Burn incidents are the second most common injury in rural Nepal, according to the World Health Organization, and researcher Kamal Phuyal says that making just a handful of simple adjustments to everyday life could prevent most major burns. Before <a href="https://nepalitimes.com/news/ways-nepal-can-rebound-from-covid-19-2966ixvu">Covid-19</a>, he ran a research project in three municipalities in the mountains, hills and Tarai. After six months gathering data, the team told locals to make changes in their communities to prevent burns. For the next two and a half years, Phuyal worked with health staff, female community <a href="https://nepalitimes.com/news/enlisting-female-health-volunteers-to-fight-covid-19-b4qlgy1e">health volunteers</a> and other locals. In that time, the number of major burns in the three districts dropped from 21 to zero for two years running. The most effective change was to stop people from cooking on the ground. “If you can put the <a href="https://nepalitimes.com/here-now/what-s-cooking-in-nepal-besides-politics">cooking stoves</a> just three feet (1m) off the ground, 50% of burns can be eliminated,” explains Phuyal.&nbsp; Nakarmi says that 70% of patients at Kirtipur Hospital, too, got burn injuries in the kitchen. “It should be the safest place to be, but it is the most unsafe,” she adds. Phuyal says<a href="https://nepalitimes.com/here-now/deputies-drive-development-in-rural-nepal"> local representatives</a> were convinced by his findings and, especially in Makwanpur, eager to make changes. He expected them to adopt a policy to approve construction of a house only if the plans included putting the cooking space 1m off the ground, to reduce burn incidents, Phuyal explained at a training session at Sushma Koirala Memorial Hospital (SKMH) last October. But <a href="https://nepalitimes.com/news/nepal-s-uneven-covid-19-deaths">Covid-19</a> hit, the project ended, the officials were replaced after elections, and the work lost momentum. Today, no <a href="https://nepalitimes.com/banner/local-government-by-the-people-for-the-people-of-the-people">local government</a> seems to have moved forward on <a href="https://archive.nepalitimes.com/news.php?id=18770">burn prevention</a>. During the training session at SKMH, the hospital’s deputy director, Rojina Shilpakar, described some of the burn cases at the facility in recent months. In Dailekh district, two boys were severely burned while collecting fodder. “The parents all thought that they would die so they didn’t take them for medical help. But after two weeks they survived and the story was posted on <a href="https://nepalitimes.com/news/the-social-media-contagion">social media</a>.” The hospital reached out and arranged for both boys to be brought to Kathmandu, one to Kirtipur Hospital and the other to SKMH, with burns on 40% of his body. “He was emaciated, just flesh and bones, covered in <a href="https://nepalitimes.com/banner/medicine-goes-back-to-its-roots?fbclid=IwAR31DMkL6vtx8KFvX3KG79Jf6omKN8H8VZ0Dr9G-1UWtIBlFHNphMJi8mrY">herbal medicine </a>that looked like mud,” recalls Shilpakar. If he had been brought for treatment quickly, he could have recovered sooner, she adds. But he was <a href="https://nepalitimes.com/banner/nearly-half-of-nepali-children-still-malnourished">malnourished,</a> and contractures had developed where one part of the body sticks to another, preventing movement. “We couldn’t take him to the operating room right away because of his malnourished condition. He had to gain some weight, increase his haemoglobin levels. Even skin grafts were not taken properly, so it affected the <a href="https://nepalitimes.com/banner/the-art-of-healing">healing,</a>” explains Shilpakar. <a href="https://nepalitimes.com/editorial/pandemic-of-poverty">Poverty</a> prevents many families from<a href="https://nepalitimes.com/here-now/it-s-an-emergency-nepal-needs-to-improve-trauma-care"> seeking care</a>, although both facilities will not turn away burn cases for <a href="https://nepalitimes.com/news/poor-cash-rich-nepal">lack of money</a>. SKMH paid the bills for the Dailekh boys' treatment, including an eight-month hospital stay. Now seven, the youngster has already had a follow-up surgery and is likely to need more operations as he grows. Smaller <a href="https://nepalitimes.com/news/healthcare-moving-from-hospitals-to-homes">hospitals</a> outside Kathmandu often do not not accept severe burn cases, and instead send them immediately to a larger facility. “If the patient dies within a few hours, they will be blamed, So they just try to push them away,” adds Shilpakar. SKMH has been <a href="https://archive.nepalitimes.com/news.php?id=16801">training health workers</a> from across the country to treat burns since 2012. This includes countering the prevalent belief at the time that burn victims should not be given fluids. Patients would reach the centre <a href="https://nepalitimes.com/multimedia/dirty-dangerous-difficult-and-dehydrating">dehydrated</a>, and then go into acute <a href="https://nepalitimes.com/opinion/comment/saving-kidneys-to-save-nepal">kidney failure</a>. Some with a high percentage of burns die. Those cases have decreased in the last few years because <a href="https://nepalitimes.com/opinion/comment/nepal-health-workers-at-risk-of-workplace-hazards">health workers </a>have been trained, including to give fluids to patients. The treatment at the Cleft and Burn Centre has become much more effective since it opened in 2014. Says Nakarmi: “Back then we could not save anyone who had 40% burns or greater. Now we can save half of victims with 40% burns, and if someone has 60% burns, they have a 15% chance of survival. We aim to save half of patients with 60% burns.” The centre developed a six-day training for health staff on burns care for workers from facilities country-wide, but funding was provided by <a href="https://nepalitimes.com/news/how-usaid-cut-affects-nepal">USAID</a> and has been cut. There is no replacement in sight. Recent increase in government support for burns treatment seems to have been sparked by the case of MP Bhandari. In October, the government announced free treatment for patients from the<a href="https://nepalitimes.com/here-now/why-nepal-s-poverty-rate-is-stuck"> poorest families</a>.&nbsp; “But there is a little catch,” says Nakarmi. “The treatment of destitute burn victims, are supposed to be covered right? But everyone else also wants to get support. A lot of Nepali people are not destitute, but they are poor. We just try to cover their costs as much as possible.”

Marty Logan

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A burning problem that needs solutions

Pritam Kunwar was born with a cleft lip and palate in Pokhara, but his family could not afford treatment for his condition. His face was disfigured, his speech was unintelligible, and the food he ate would often get into his nasal cavity.&nbsp; Finally, at 15 he received cleft surgery, but without post-operative therapy his speech was still impaired. Then one day, at age 26, his life changed. He used to make a living rowing boats at Phewa Lake, where a foreigner hopped on for a ride. He turned out to be a plastic surgeon volunteering in Nepal who referred him to Fishtail Hospital. That is where he met Shankar Man Rai. Kunwar underwent a second surgery, and received speech therapy. Today, he holds a Taekwondo black belt, and runs an academy by Pokhara’s Lakeside, training young women in self-defence. “Before my second surgery, the students at my martial arts academy did not understand a word I said, but after I could speak properly they learnt faster,” recalls Kunwar.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20230804080844_7e557a7682a0bc504237ed5cf9b1b6082ecf346ee34a541c43ae00d25377a2d2.jpg" data-media-id="editor_0" data-image-id="20230804080844_7e557a7682a0bc504237ed5cf9b1b6082ecf346ee34a541c43ae00d25377a2d2" data-rendition-name="original" width="7238" height="2400" loading="lazy" alt="Removing scars 2"> <figcaption>Pritam Kunwar was born with a cleft lip and palate in Pokhara. After two surgeries and speech therapy, he now runs a Taekwondo academy training women in self defence.(Photo: Jana Ašenbrennerová)</figcaption> </figure>  On average, one out of every 500 live births in Nepal is a case of cleft lip or palate, birth deformities in which the lip or palate fail to fuse. Incidence in Nepal is higher than in most parts of the world for reasons which are unclear, but may have to do with a combination of genetic and environmental factors.&nbsp; However, the numbers afflicted are going down due to awareness and treatment at the <a href="https://nepalcleftandburncenter.org/">Nepal Cleft and Burn Center</a> at Kirtipur overlooking Kathmandu.&nbsp; “Before the 1980s, cleft and burn treatment through plastic surgery was unheard of in the country,” explains Shankar Man Rai, who is now a plastic surgeon and director of the Kirtipur centre. “International volunteer teams carried out the procedures, while Nepali doctors remained under-equipped.” Since then, Rai’s team has seen that scenario change. Improved awareness of the condition means parents bring their children for treatment to the 30-bed Centre almost as soon as they are born.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20230804080844_56ba408f9cd1b497374609fc6002f6a5412b99432d4aff498f8f8fca81445e6d.jpg" data-media-id="editor_2" data-image-id="20230804080844_56ba408f9cd1b497374609fc6002f6a5412b99432d4aff498f8f8fca81445e6d" data-rendition-name="original" width="3600" height="2400" loading="lazy" alt="Removing scars"> <figcaption>Shankar Man Rai(Photo: Jana Ašenbrennerová)</figcaption> </figure>  Nepali paediatric and general surgeons were trained by the international teams, and for over 25 years Rai’s team has been treating thousands of burn and cleft patients free of cost. The facility is funded by two non-profits, ReSurge International and Smile Train. The facility at Kirtipur was inaugurated in 2014, but the <a href="https://nepalcleftandburncenter.org/">Cleft and Burn Center </a>was initiated in 2002 by American textile retailer Jim Webber after meeting Rai in Nepal. Webber ran the Tibet Rug company, and organised financial support from other rug importers from Nepal to help fund the project.&nbsp; Since then, the Center has been Nepal’s first and leading teaching hospital specialising in deformity-correction surgery. Today, it is being run by Kirtipur Municipality and the non-profit <a href="https://www.phectnepal.org/">Public Health Concern Trust Nepal (phect-NEPAL)</a>, providing free treatment not just to patients at the centre but through camps in remote parts of the country.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20230804080844_a5ba78663011d44d14e8c3f4d8dccbf4eb23c07d9d5dd7770187c4788023878b.jpg" data-media-id="editor_5" data-image-id="20230804080844_a5ba78663011d44d14e8c3f4d8dccbf4eb23c07d9d5dd7770187c4788023878b" data-rendition-name="original" width="2048" height="1365" loading="lazy" alt="Removing scars"> <figcaption>Photo: PHECT NEPAL</figcaption> </figure>  Kiran Nakarmi is the head of the Department of Burns, Plastic and Reconstructive Surgery at Kirtipur Hospital who worked with Rai to set up the centre. He says a cleft lip is easily recognised in infants, and can now even be diagnosed via ultrasound before birth. “Timely treatment is important because it yields better speech outcomes,” Nakarmi explains. “Our focus is on comprehensive care. Surgery alone is not enough, it needs follow-up with speech and occupational therapy and counseling.”  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20230804080848_ee0057f9cd2d17d2834babd2164720028ef66b3d41fec3199246d7e21b2d4d91.jpg" data-media-id="editor_6" data-image-id="20230804080848_ee0057f9cd2d17d2834babd2164720028ef66b3d41fec3199246d7e21b2d4d91" data-rendition-name="original" width="3600" height="2400" loading="lazy" alt="Remioving scars 6"> <figcaption>Kiran Nakarmi looks at a patient.(Photo: Jana Ašenbrennerová)</figcaption> </figure>  The Kirtipur center’s camps have reached many rural parts of Nepal, impacting more than 20,000 cleft patients. Initially, speech therapists used to go to the camps but now has trained nurses like Kabita Bhattarai Gurung to carry out the same task.&nbsp; The outreach camps provide free food, lodging, orthodontic treatment, parental counseling, and speech therapy to patients, a model which Rai says can be replicated globally.&nbsp; The caseload for cleft palates has fallen sharply and the Kiritpur center which used to carry out up to 1,200 cleft operations a year till a decade ago now performs half that.&nbsp; <h2>Burning need</h2>  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20230804080844_9a3c5a83db7f5f9ef918acbe1093472f7c9c2c6e9266078038b34420e00208bf.jpg" data-media-id="editor_7" data-image-id="20230804080844_9a3c5a83db7f5f9ef918acbe1093472f7c9c2c6e9266078038b34420e00208bf" data-rendition-name="original" width="3600" height="2400" loading="lazy" alt="Removing scars"> </figure>  But with the decline in cleft cases, there has been a growing need to treat burn patients at Kirtipur.&nbsp; Bhesh, 14, was playing in his home in western Nepal when he heard his mother shriek from the kitchen. She was cooking when the open fire spread and engulfed the house.&nbsp; Read Also: <a href="https://archive.nepalitimes.com/article/nation/burning-in-the-aftermath,3757">Burning in the aftermath,</a> Sahina Shrestha Four days later, both Bhesh and his mother arrived at Nepal Cleft and Burn Center. The long ride had been excruciating, and with burns over 30% of her body, his mother died shortly after. Bhesh went through several surgeries and skin grafts. Over a third of the patients admitted to the Centre are children, and half are women.&nbsp; “We think that the home is the safest place, but that is where most burn injuries occur,” says Rai. “The proportion of children with burns at the Center shot up to over 40% during the pandemic. At home they were more at risk.” Rural women are exposed to open fires, and children suffer because they are largely unsupervised in high-hazard settings. Disfigured burn patients have to deal with social stigma because they are seen as a sign of bad luck.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20230804080848_0f27d63b1f3a521c61cdb69bc45799d40ba1bea94c60d094cab9e6b5d7279035.jpg" data-media-id="editor_9" data-image-id="20230804080848_0f27d63b1f3a521c61cdb69bc45799d40ba1bea94c60d094cab9e6b5d7279035" data-rendition-name="original" width="3600" height="2400" loading="lazy" alt="Removing scars"> </figure>  The Center also treats burn violence usually perpetrated against women in the homes of in-laws, and this adds to the count of the 110 people who die of burns each year in Nepal. “Burns survivors in Nepal need more support,” says<a href="https://archive.nepalitimes.com/news.php?id=18771"> Wendy Marston, co-founder and advisor of Burns Violence Survivors (BVS) Nepal</a>. “Small acts of kindness from all of us, such as the spreading of education, and charitable giving, can go far in helping these survivors and patients.” BVS Nepal works with underserved patients in over 12 hospitals, providing funds for their treatment, therapy, and setting up businesses for survivors. Its prevention approach is shared by the Burn and Cleft Center which also holds burn awareness camps for community health workers and local people. “For household burns, awareness is surely the first step towards prevention,” Rai says. “But we can’t simply tell people what to do if they don’t have the means to act.” A WHO study shows that burns are the second most common injury in rural Nepal, accounting for 5% of disabilities in the country,&nbsp; Read Also: <a href="https://www.nepalitimes.com/here-now/tsering-sumjok-is-all-right">Tsering Sumjok is all right</a>, Sahina Shrestha “When we first started treating burns, we began with disabilities caused by post-burn contractures,” explains Nakarmi. “If the wound is in a place such as a joint, this causes the patient to lose mobility.”&nbsp; The Kirtipur team prioritises comprehensive care for burn contractures. But unlike with cleft palates, they failed to see any decline in the caseload even after years of effort. Rai says this is because burn survivors are not getting the treatment needed. Surgeons hope that using flaps and grafts they can reduce the occurrence of contractures. Nepal’s difficult geography keeps patients like Bhesh from quickly receiving care. Burn survivors from all over the country are referred to the few specialised centres in Kathmandu, but there is usually a long waiting list and it takes weeks before a doctor can see them.&nbsp; The Kirtipur Center has largely succeeded in minimising waits by enabling surgeons to go to patients instead of the other way around. This means patients at the Center receive the surgery they need within days of being admitted.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20230804080852_34cfa9c4509717fa9b1fb8ff4184effa8d3e8d199b834ffae5ca43c117dd6611.jpg" data-media-id="editor_12" data-image-id="20230804080852_34cfa9c4509717fa9b1fb8ff4184effa8d3e8d199b834ffae5ca43c117dd6611" data-rendition-name="original" width="3600" height="2400" loading="lazy" alt="Removing scar"> </figure>  But there are challenges. “Your treatment is not possible here,” were the words that Nepali Congress leader Chandra Bhandari heard at the Nepal Burn and Cleft Center where he was rushed there after suffering severe burn wounds in a gas cylinder explosion in February. Bhandari was eventually medevaced to Mumbai where he was successfully treated.&nbsp; “It is unfair that any Nepali should have to go abroad for burn treatment,” Bhandari told Nepali Times. “Our surgeons are the best in the world, yet they have had to rely solely on individual and community effort. The government urgently needs to support the surgeons, and I pledge to do what I can.”&nbsp; There are only 30-40 reconstructive plastic surgeons in the country, eight of them at Kirtipur, which offers a residency program for reconstructive plastic surgery affiliated with the National Academy of Medical Sciences program at Bir Hospital, whose curriculum was developed by Rai.&nbsp; While cosmetic plastic surgery is a booming profession in Nepal, the niche dedicated to burns treatment has not got the attention it deserves. Kirtipur Hospital, for instance, only has seven ICU beds, The country’s only skin bank at the Center has got only 31 donations in the nine years since it was set up.&nbsp; Read Also: <a href="https://archive.nepalitimes.com/article/nation/A-burning-desire-to-help,881">A burning desire to help</a>, Kunda Dixit With little government support, the Center mostly runs on international help for free treatment to about 600 patients a year. But even as its focus shifts from clefts to burns, international assistance is skewed in favour of cleft palates.&nbsp; “We get more donations than we need for clefts,” Rai reveals. “Burns are where we need greater investment, but because they are more expensive and complex, and have higher odds of ending in mortality, there is less interest from donors.” Not only is the government not providing needed help, its bureaucracy puts up obstacles every step of the way. Kirtipur Municipality received a donation of Rs2,900,000 for urgent burn treatment supplies. But red tape has delayed delivery. The Center now has an ambitious plan to establish a sustainable fund for free burns treatment by encouraging donations from well-to-do local Nepalis and the diaspora. The goal is not to have to turn to international donors for money. The Nepal Cleft and Burn Center will soon open a branch in Itahari of Sunsari district with the same level of care as Kirtipur.&nbsp; Says Nakarmi: “We don’t need big, lavish burn hospitals all over the country. We need a lot more primary burn centers where rural patients can receive immediate care, and then be referred to the larger centers if need be.” Nepal has seen major improvements in burn and cleft palate surgeries in recent years thanks to doctors like Rai and Nakarmi. Says Rai: “I am sure we will see a day when no patient seeking treatment in Nepal has to live with scars, both figuratively, and literally.”&nbsp;

Removing Scars

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410110/637203b79c7e80680e0b2821jpeg.jpg" alt="" width="960" height="695"/><figcaption>Tsering Sumjok Gurung with German plastic surgeon André Borsche (left) and Peter Hinze (right). Borsche had treated her childhood injury at the Sushma Koirala Memorial Hospital in Kathmandu. All photos courtesy: PETER HINZE</figcaption></figure>Last November, in the waiting room of a hospital in Bad Kreuznach in Germany, Tsering Sumjok Gurung caught glimpse of a familiar face.The tall man with graying hair and moustache was wearing a white coat over a yellow jumper. He was none other than plastic surgeon André Borsche who had treated her horrific childhood burn injury at the <a href="https://www.skmt.org.np">Sushma Koirala Memorial</a> Hospital in Kathmandu ten years previously.“It was an emotional reunion for both of us,” Tsering, now 23, remembers. “He was very friendly and wanted to see how my injuries had healed.”Tsering was 18 months old that summer when her family made the annual migration up to high pasture to graze their yaks. One day, while her mother was tending the livestock, Tsering fell off her crib right into the fireplace. She was badly burnt on her back, and right arm.Read also: <a href="https://archive.nepalitimes.com/article/nation/A-burning-desire-to-help,881">A burning desire to help</a>, Kunda Dixit<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410110/637203ba9c7e80680e0b2822jpeg.jpg" alt="" width="308" height="462">There were no doctors in her village of Bhijer, so she was treated for the next four years by the local <a href="https://archive.nepalitimes.com/article/nation/I-am-an-amchi,3349" target="_blank" rel="noopener noreferrer">amchi healer</a>. This kept her alive, but the skin on her right arm was fused with the torso. All her childhood, Tsering was carried around in a doko bamboo basket.“Burns are common in <a href="https://www.nepalitimes.com/banner/dazzling-dolpo/" target="_blank" rel="noopener noreferrer">Dolpo</a> because home life revolves around the kitchen fire,” says Tsering. “I was lucky.”Despite being painful to move around, Tsering started going to school in Bhijer and excelled in studies. In Grade 2, a group of wealthy American and Swiss trekkers visited the school that they had supported. They noticed Tsering, examined her injuries, and helped bring her to Kathmandu for school and treatment. Over the years, the two families have also funded a hospital and a cheese factory in the village.Tsering used to watch her classmates in Kathmandu run and play, or dance in school programs, but could not participate because of her injury. She was eventually admitted to the Sushma Koirala Hospital, which is supported by INTERPLAST-Germany, where André Borsche and his team performed five major operations with reconstructive surgery. Every week, she had to make a painful bus ride from her dorm in Boudha to the hospital in Sankhu for physiotherapy and follow-ups.She missed many classes, but she made up for it by reading books which inspired her to become a doctor, so she could serve her community in Dolpo. Not able to afford higher education, in 2017 she started working as a hostel warden at a school in Chobar.That is when she met German journalist Peter Hinze who was researching his first book on <a href="https://www.amazon.com/The-Great-Himalaya-Trail/dp/3957281377" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.amazon.com/The-Great-Himalaya-Trail/dp/3957281377&amp;source=gmail&amp;ust=1641892465582000&amp;usg=AOvVaw3DjWYFudXKEdEQ0H4UlQmW">The Great Himalayan Trail, </a>and Tsering later travelled with him to Upper Dolpo to make a film with herself as the lead character.Tsering was back in Bhijer for the first time in ten years, and her family and neighbours were surprised how much she had grown and changed. Her injuries were not visible anymore, and no one could believe that a little girl who had such terrible injuries would be so transformed.Read also: <a href="http://archive.nepalitimes.com/news.php?id=18771#.Ydv72C8w3u0">Lending a hand</a>, Nepali Times“I met the right people who helped me get treatment otherwise my life would have been different,” Tsering says. “Even now, there are many children in my neighbouring villages who are not as fortunate.”The film project was cancelled because of the pandemic, but Hinze converted the research into the book 100000 Schritte zum Glück about Dolpo, and invited Tsering to Germany for the unveiling in November. The book made it to number 4 on Amazon's best seller list in Germany.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410110/637203bd9c7e80680e0b2823jpeg.jpg" alt="" width="169" height="242">And he had a surprise in store – a meeting with the surgeon who had treated her in Kathmandu all those years ago. It was an emotional and joyful reunion.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410110/637203bf9c7e80680e0b2824jpeg.jpg" alt="" width="960" height="641"><figcaption> </figcaption></figure>“This was one of the best days in my 26-year career, when I could see the wonderful result of our charity work,” said André Borsche.Tsering was equally happy: “I made it from my family stone hut in Bhijer to the hospital in Germany to meet the surgeon who changed my life.”Read also: <a href="https://www.nepalitimes.com/here-now/nepals-acid-attack-survivors-find-a-saviour/">Nepal’s acid attack survivors find a saviour</a>, Sabina Devkota<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410110/637203c19c7e80680e0b2825jpeg.jpg" alt="" width="750" height="1000">In the hospital, Borsche examined her burn scars and was satisfied with how well her back had healed. He suggested one more operation, but Tsering refused any more treatment.“I am over medical procedures for now,” Tsering told Nepali Times on her return from Germany. “After all those surgeries, I am put off by the sight of blood. I don’t want to think about the pain afterwards. For now I think I am ok.”These days, when Tsering is not busy with her full-time work at the Chobar school, she helps Hinze with Project Dolpo, a private initiative to help those who need assistance in her home district. She gets frequent calls from families in Dolpo who are in distress.Says Hinze: “I think this is a motivating story about a girl who never gave up, and who trusted herself. It shows how when help gets to the right people, the underprivileged and the almost forgotten, it can make a big difference to their lives.”This past week in Kathmandu, Tsering has been busy taking a seven-year-old boy from Dolpo who was also badly burnt with boiling water, and was brought to Kathmandu for treatment. Tsering has been taking the patient to the burns hospital in Kirtipur for medical attention.“It happened to me, and now to this boy. These accidents occur so frequently and Upper Dolpo just does not have the facilities to treat burn injuries,” says Tsering.For now, she wants to complete her education and ultimately return to Dolpo: “I feel it is my responsibility to give back to my community. The only way my village is going to develop is when young people like me get educated, and head back to help others like us. There is so much to do.”Read also: <a href="https://www.nepalitimes.com/here-now/the-prolonged-trauma-of-acid-attack-survivors/">The prolonged trauma of acid attack survivors</a>, Laxmi Basnet

Sahina Shrestha

Tsering Sumjok is all right

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

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.

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