In 2014, when Surendra Bajracharya was conducting an autism screening camp in Doti, he came across the most unusual case he had seen till then and since. A 46-year-old man had been carried by his brother in a doko basket on his back all the way from his home in the village. The patient had spent his childhood tied up on a leash due to his impulsive behaviour, unusual mood reaction and fits. He had never learnt to move on his own. “He could not speak or walk. We first thought he had cerebral palsy,” recalls Bajracharya. “But after examining him we felt his symptoms matched those of people with autism.” Read also: <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/A-for-autism,270">A for autism</a>, Sulaiman Daud and Cindrey Liu The patient and his brother were orphaned at a young age, and it was the brother who was his guardian and nurse all his life. There was no other support system in the family or community.&nbsp; As the office head of Autism Care Nepal Society (ACNS), Surendra Bajracharya has seen everything from a parent dying by suicide due to being overwhelmed by his autistic child to children being caged in attics and enduring social ostracisation because of their condition. But of late, there has been growing awareness in Nepal about autism. In the last decade, ACNS has seen a steady rise in the total diagnoses from just 11 in 2008 to over 300 in 2022. This does not necessarily mean an increase in incidence, but is a good indicator of greater awareness and concern about autism among parents and the public. Read also: <a href="https://archive.nepalitimes.com/news.php?id=18281">A care in time</a>, Paavan Mathema  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20230818080852_9e5862b5c4f2ce7e8e1c4936c3b119c6f3b33d1d4860105f4225922c57a61c10.jpg" data-media-id="editor_2" data-image-id="20230818080852_9e5862b5c4f2ce7e8e1c4936c3b119c6f3b33d1d4860105f4225922c57a61c10" data-rendition-name="original" width="812" height="464" loading="lazy" alt="Autism increasing"> <figcaption>Total number of cases of autism diagnosed in Nepal from 2008 - 2022.</figcaption> </figure>  However, the increase in cases of autism has also been linked to unhealthy dietary practices, especially junk food by the mother during pregnancy. <a href="https://www.nepalitimes.com/news/the-other-pandemic-mental-health">Following the Covid-19 pandemic</a>, doctors are also reporting an unusually high number of children with what they call ‘virtual autism’. Excessive screen time before two years of age, they believe, is associated with a decrease in cognitive and language development. “We have enough reason to believe that virtual screen time is the primary catalyst for this drastic rise in cases,” states Bajracharya. “They grew up confined in their homes, overexposed to screens and away from social interactions during the pandemic.” According to the World Health Organisation (WHO) estimates, 1 in every 100 children globally has autism. Nepal's 2021 Census reported 4,886 individuals with autism out of 647,744 people surveyed, which is 0.8% of the sample population. “Although recognising autism as a disability in the National Census was a first for Nepal, the actual prevalence of autism spectrum disorders is higher than reported,” adds Bajracharya. “And it is likely that increasing screen time will further worsen the problem in children.” In 2019, <a href="https://autismnepal.org/">the ACNS</a> estimated that there were some 300,000 children living with autism in Nepal. More credible data is crucial for Nepal to base its interventions and policies on autism care.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20230818120828_2c3654d64356af0197ef8753a96da89e57e8d8255a0f5cdc68eda8e9a988c12d.jpg" data-media-id="editor_5" data-image-id="20230818120828_2c3654d64356af0197ef8753a96da89e57e8d8255a0f5cdc68eda8e9a988c12d" data-rendition-name="original" width="924" height="594" loading="lazy" alt="Autism in Nepal"> </figure>  At the Centre for Autism in Kathmandu, parents are increasingly aware of the special needs of their children, but lack adequate service and support. “There is no incentive for autism caregivers in Nepal,” says Manju Shrestha, an autism specialist at the centre. When Shrestha joined the centre two years ago, there were 32 children enrolled. In two years, that number has almost tripled to 92, with many mildly autistic children progressing into mainstream schools after substantial improvement. “Most parents approach us with concern about their toddler’s delayed speech,” explains Shrestha. Among other symptoms, delayed language development, hyperactivity, restricted behaviour, repeating words and phrases over and over, or playing with the same toys the same way every time are the most common signs that parents have started correctly identifying on their own. But despite such strides in public awareness due to the Internet and social media, the government has been slow to act. The Disability Act 2074 has classified <a href="https://archive.nepalitimes.com/news.php?id=18502">disability</a> into four categories on the basis of severity: namely profound (A), severe (B), moderate (C) and mild (D). Individuals in each group get assigned a different coloured identity card with which they can access different levels of care and privileges. But with autism, children often do not get assigned the correct card. “Although an autistic child may need the same level of care as someone with leprosy, they are only assigned category B, while those with physical disabilities are assigned group A,” explains Shrestha. Such misplaced categorisation means the child’s family receives a lower allowance which falls short of helping them afford necessary therapy.&nbsp; “The problem lies in the difference between autism and other physical disabilities,” argues Shrestha. “To most people children with autism may look completely normal. They may even utter a few words, occasionally respond, and seem just like any other child. But the psychological and emotional care they need is significantly different.” Autism Care Nepal Society and <a href="https://centreforautism.com.np/">Centre for Autism</a> are two of only a handful of special needs schools that understand this difference. They employ autism-friendly teaching and learning methods tailored to the needs of each individual child, helping them progress at their own pace.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20230818080856_22f33d80714b875edde5a4092593e2bb4efefe50b1165c84260c926763a72341.jpg" data-media-id="editor_8" data-image-id="20230818080856_22f33d80714b875edde5a4092593e2bb4efefe50b1165c84260c926763a72341" data-rendition-name="original" width="1536" height="1024" loading="lazy" alt="Autism care"> <figcaption>Surendra Bajracharya lecturing volunteers in an autism awareness workshop.</figcaption> </figure>  On a national level, the availability of such institutions, therapists and specialists is inadequate. To bridge this gap between the rising cases and insufficient specialists, ACNS has been running a diploma in special education in autism spectrum disorder. ACNS also conducts several awareness and training projects across Nepal, including a parent-child training project that has seen widespread success in 44 districts across all seven provinces. Plans are underway to set up a new National Centre for Autism in Lalitpur to provide education, training and other services to individuals and families affected by autism. ACNS hopes to work with the Ministry of Education, Ministry of Health and Ministry of Women, Children and Social Welfare to diversify and decentralise autism care. While much of the ignorance and taboos associated with autism are dissipating with increased knowledge and awareness, the condition remains a public health concern in Nepal. The cases are going up and those afflicted are increasingly younger.&nbsp; Experts say the government has to abandon its one-size-fits-all approach in dealing with autism spectrum disorders. For a health issue as wide-ranging and variable as this, care must also be provided to meet diverse needs. Says Manju Shrestha: “Recognising the abilities, talents and sparks within each child with autism demands drastic shifts in our present state of healthcare and education. This change is long overdue.” As for Surendra Bajracharya, the middle aged man he met in Doti nine years ago is still etched in his mind, and it inspires him to do more. He says, “The innocence in his eyes … it is tragic that people have to suffer so much from an affliction when care can be made available.”&nbsp;

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Why are autism cases rising in Nepal?

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111413114/63722eef9c7e80680e0c24ebjpeg.jpg" alt="" width="768" height="1024"/><figcaption>Bhavana with her young son. Photo: RITA ALE MAGAR</figcaption></figure>It was a night that Rita Ale Magar says she will never forget. Bhavana, 17, from remote Dumre Dara village walked 2.5 hours to reach a birthing centre of Udaypur.The underage mother was already 16 days overdue, her blood pressure was alarmingly high and she was going through prolonged labour. She was having difficulty pushing out the baby and was in severe pain.This was the most complicated case the centre had received, and the nurses were understandably nervous. But Nurse Rita had to lead the team and take the decision to try to save both the mother and her baby who were at high risk.“This was the moment when I had to use all the knowledge that I was taught by my mentors,” recalls Rita, who is a beneficiary of the Simulation-Based Mentorship Program (SBMP) of the group, One Heart Worldwide.After nearly two hours, the baby was born but that was only the beginning of the ordeal. The baby was not breathing and had no heart rate or muscle tone.“All of us thought the baby was dead, but we had to try our hardest to save him. I had less than a minute to give my best,” adds Rita, still shaken as she narrates her experience.It was at that point she remembered the ‘Golden Minute’ session she had learned about at the mentorship program -- the time needed for newborn resuscitation of babies born with asphyxia and deprived of oxygen.Nurse Rita quickly cut off the umbilical cord, put the baby on the resuscitation table and gave him electric suction which allowed it to start breathing. But the baby still looked pale, and was having difficulty crying.At the same time, the mother’s condition was worsening, she was bleeding profusely. The nurse sought help from a paramedic team to ventilate the baby with an Ambu bag while she tended to the mother.The baby's condition started to improve, but since there was no neonatal intensive care unit at the birthing centre, Rita referred the baby to a hospital in Biratnagar. The baby boy has since recovered and is now healthy.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111413114/63722ef19c7e80680e0c24ecjpeg.jpg" alt="" width="389" height="515"><figcaption>Nurse Rita Ale Magar used the ‘Golden Minute’ to save a newborn who was suffering from severe complications. Photo: ONE HEART WORLDWIDE</figcaption></figure>“I was panicking but I benefited from my mentorship, and I will always be grateful to the clinical team from One Heart Worldwide who had trained me,” she adds.One would think that health professionals would not want to work in villages with minimal resources, but the opposite is true for Rita for whom being stationed in the far-off government birthing centre has been a challenge, but fulfilling when she can save lives like this recent case.Nurse Rita has delivered over 200 babies in the last three years. The birthing centre was initially under-equipped and she was the only Skilled Birth Attendants. This is where the One Heart came in to provide hands-on simulation exercises to nurses to get them ready for real-life birthing complications.Two nurses who received that simulated training were instrumental in saving the underage mother and her baby. They also counseled family members.Read also: <a href="https://www.nepalitimes.com/here-now/who-will-save-nepals-poor-new-mothers/">Who will save Nepal’s poor new mothers?</a> Rojita AdhikariThe patient, Bhavana did not know about the risks associated with pregnancies and was adamant about giving birth at home because she herself was born at home. Additionally, she had not seen anyone going to the birthing centre for delivery.Even after she was long past her due date Baavana was still not convinced about institutional delivery. It was only when she realised she was putting herself and her baby at risk did she relent.“Ultimately, she made the right decision but it was almost too late. Luckily, she survived. Saving her was so rewarding also because this could set an example to other villagers,” adds the nurse.But it is not easy for the villagers to get to the birthing centre due to the rugged terrain which further discourages them from accessing institutional delivery. There is no proper transport or ambulance service either. Most people have to walk over four hours to get to the centre which is especially inconvenient for pregnant women and girls.Says Rita Ale Magar: “But no matter how hard the journey, it is worth the effort because us nurses are here at the birthing centre to help mothers like Bhavana and their newborns.”Read more: <a href="https://www.nepalitimes.com/banner/no-conceivable-reason-for-unwanted-pregnancies/">No conceivable reason for unwanted pregnancies</a>, Rojita Adhikari

Balancing life and death in Nepal

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111144/636b84729c7e80680e067796jpeg.jpg" alt="" width="1500" height="1125"/><figcaption>Rita Khatri, 21, is the only skilled birth attendant in her village of Phediguth of Okhaldhunga district, where she has helped to promote institutional birthing despite the challenges posed by the pandemic. All photos: NARESH NEWAR</figcaption></figure>Unlike many of her nursing colleagues who yearn to go abroad or find a job in a city hospital, Rita Khatri returned to her home village in Okhaldhunga after completing her training as a skilled birth attendant in Kathmandu.It was not easy for the 21-year-old to be taken seriously by her own community in Phediguth village of Champadevi Municpality, she had to earn their trust and respect one safe delivery at a time.But just as families in surrounding villages came to depend on her for vital <a href="https://www.nepalitimes.com/latest/3-nepali-mothers-still-die-daily-at-childbirth/" target="_blank" rel="noopener noreferrer">prenatal care and safe deliveries</a>, the Covid-19 pandemic hit. Now, on top of all the other health challenges in rural Nepal, there is the additional danger of being infected with this contagious new strain of the coronavirus that has spread across the country.Because of its remoteness and lack of connectivity, the pandemic has not affected this scenic district of eastern Nepal as seriously as other parts of the country. Still, there are 90 active Covid-19 cases in the district and a dozen people on average test positive every day.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111144/636b84769c7e80680e067797jpeg.jpg" alt="" width="1500" height="1125"><figcaption> </figcaption></figure>Being a trained midwife, Rita Khatri’s main worry is that restrictions on travel and fears about the <a href="https://www.nepalitimes.com/here-now/birth-and-death-during-a-pandemic/" target="_blank" rel="noopener noreferrer">virus will affect maternal and neonatal health services</a> as most villagers are afraid to visit her birthing centre for check-ups and deliveries.“I am scared that the pandemic will set back all the work we have done here to reduce home deliveries and to improve maternal and infant survival,” Khatri says. “We had finally managed to convince families to opt for institutional birthing, but that might now change.”Staff at the centre are also worried about their safety, since this <a href="https://www.nepalitimes.com/editorial/this-is-war/" target="_blank" rel="noopener noreferrer">second wave is much more deadly</a> than the one in 2020. Last year, Khatri had helped mothers even when most government health posts had shut down in the districts, many staff were afraid to come to work, and if they did were afraid to even touch their patients.But Khatri kept the birthing centre open, and carried out 32 deliveries in 2020, some of them complicated ones where the <a href="https://www.nepalitimes.com/here-now/birth-and-death-during-a-pandemic/" target="_blank" rel="noopener noreferrer">mothers’ life would have been in danger</a> if they had given birth at home.“Closing down would have meant risking the lives of many mothers,” says Khatri, who has been trying to convince as many families as possible who are under her care that it was safe to visit the birthing centre.https://www.youtube.com/watch?v=ESmZURVRyN4It is much more difficult this year to convince both mothers and staff. Still, Khatri says, “I am also apprehensive about being infected, but I am the only SBA around here, and I want to ensure as many <a href="https://www.nepalitimes.com/banner/infant-deaths-up-during-nepal-lockdown/" target="_blank" rel="noopener noreferrer">institutional deliveries</a> as possible and save mothers and their babies from risking home births.”Khatri says that for her, nursing is not just a job. It is an occupation through which she wished to serve her community where there is no doctor for miles around. There is a steely determination in her thin voice as she says, “I will keep my doors open no matter how bad the pandemic is, this is what I was trained to do.”The community has a new esteem for Rita Khatri because of the dedication and hard work she displayed last year, and villagers are glad that they have her to go to for <a href="https://www.nepalitimes.com/opinion/newborn-deaths-and-a-vision-for-a-post-pandemic-nepal/" target="_blank" rel="noopener noreferrer">safe motherhood</a>.It has not been easy for Khatri to earn this trust. When she first returned home to Okhaldhunga to join Phediguth Health Post, villagers heard that a new ‘doctor’ had arrived. But when they came to visit, they were visibly disappointed that it was just a girl they knew from the village.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111144/636b847a9c7e80680e067798jpeg.jpg" alt="" width="1500" height="1125"><figcaption> </figcaption></figure>But within a few months, Khatri proved herself through her profesionalism and ability to handle the most complicated maternity cases at the birthing centre which was upgraded with help from the non-profit, <a href="https://www.nepalitimes.com/banner/what-can-be-more-fulfilling-than-saving-lives/" target="_blank" rel="noopener noreferrer">One Heart Worldwide</a> (OHW).Not every delivery goes right, there are some which need specialist treatment or caesarian sections, others suffer post-partum haemorrhage and some mothers are already in a critical condition because they are brought to the centre too late. When the mother or child cannot be saved, Khatri has sometimes been slapped, kicked and verbally abused by angry relatives.“I could understand their frustration, but I did not let anything demoralise me,” says Khatri. “I was trying to the best of my ability to save their lives.”Today, everyone respectfully calls Khatri ‘Sister’, and some even call her ‘Doctor’. Many also have apologised for mistreating her in the past, and come bearing gifts to show their gratitude. “I refuse to take them because I am just doing my duty,” Khatri tells us.Champadevi Health Post has upgraded its maternity room, but there are many others across Nepal that are struggling with <a href="https://www.nepalitimes.com/banner/this-is-how-to-upgrade-nepals-rural-health/" target="_blank" rel="noopener noreferrer">proper buildings, equipment and staff</a>. The biggest challenge is the lack of nurses trained as skilled birth attendants.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111144/636b847d9c7e80680e067799jpeg.jpg" alt="" width="1500" height="1125"><figcaption> </figcaption></figure>When Rita Khatri joined the Phediguth Health Post, its birthing centre did not have proper equipment, not even a maternity bed for deliveries. Most deliveries happened late at night without electricity, and mothers were in prolonged labour sometimes lasting 16 hours. Some of Khatri’s patients preferred lying on the floor to give birth because they found the table that served as a maternity bed so uncomfortable.Without electricity, staff had to stumble in the dark during deliveries, and it was difficult to keep the maternity room warm without heaters. Khatri tried unsuccessfully with the local government to get power supply, but it was One Heart Worldwide that installed solar-powered lights. Little by little, the facility was improved to be the clean and bright birth centre it is today.Khatri is modest about her accomplishment: “This is the least I could do for my birthplace, so giving birth is safe."To donate to Phediguth Health Post: Account name: Phediguth Health PostRastriya Banijya Bank, OkhaldhungaAccount number 207000290101

Saving Nepali mothers on Mother’s Day

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110111152/636cd8879c7e80680e092e49jpeg.jpg" alt="" width="1500" height="1125"/><figcaption>Phediguth village in Okhaldhunga where poor roads make access to health facilities difficult for complicated maternity cases. All photos: NARESH NEWAR</figcaption></figure>Stories of birthing are not the kind of conversation that children in Nepal usually have with their mothers. Surya Bhatta’s career path, however, took a new turn when his mother shared her own story of how she survived a near-death complication when she was giving birth to his elder sister.His mother was married at 11, and had her first baby at 16. Access to health services in their home village in Dhading was limited at the time, and she suffered from severe postpartum complications.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110111152/636cd88b9c7e80680e092e4ajpeg.jpg" alt="" width="640" height="364"><figcaption> </figcaption></figure>“Luckily, my mother survived but we all know many Nepali mothers still face similar risks due to poor maternal health,” says Bhatta, now executive director of One Heart Worldwide (OHW), a US-based organisation working in Nepal.At 34 Bhatta is proud to be playing a role to save the lives of mothers like his mother. Although the country has made vast improvements in reducing the maternal mortality rate from 539 per 100,000 live births 25 years ago to 240 today, it is still unacceptably high.An estimated 2,000 new <a href="https://www.nepalitimes.com/here-now/who-will-save-nepals-poor-new-mothers/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/who-will-save-nepals-poor-new-mothers/&amp;source=gmail&amp;ust=1615874753197000&amp;usg=AFQjCNEu5wCZ54G1e7vKzay3LB7DTXI7mA">mothers still die</a> in Nepal every year —  most of them because health posts are not properly equipped and staffed. The maternal mortality rate also went up in 2020 because the lockdown and pandemic prevented many mothers from getting to hospitals or birthing centres.Bhatta and his colleagues have been working to improve maternal neonatal health care, and with a 70-strong team is setting up birthing centres and hospitals in Nepal’s most remote districts to upgrade care for mothers and babies.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110111152/636cd88e9c7e80680e092e4bjpeg.jpg" alt="" width="200" height="191">Starting from five villages of Baglung in 2010, One Heart has expanded to 21 districts and helped renovate and equip more than 500 birthing centres in 164 municipalities where road access is still limited. The centres work with local municipalities on a cost-sharing public-private-partnership formula.https://www.youtube.com/watch?v=tVA--CRk3nMMany government health posts in rural municipality wards are under-resourced and often struggle to even buy standard maternity delivery beds and lifesaving equipment. There is inadequate <a href="https://www.nepalitimes.com/banner/federalism-leaves-nepals-medical-sector-ailing/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/banner/federalism-leaves-nepals-medical-sector-ailing/&amp;source=gmail&amp;ust=1615874753197000&amp;usg=AFQjCNEX5KH1MBkZwv3gDbQd0uKEItLdXg">infrastructure</a> for pre-natal, delivery and post-natal care, and a chronic shortage of trained midwives in rural areas.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110111152/636cd88f9c7e80680e092e4cjpeg.jpg" alt="" width="1500" height="1710"><figcaption> </figcaption></figure>Nurses are not trained to handle complicated cases during and after delivery, and as frontline maternity workers face the wrath of local communities when mothers and babies die.Bhatta and his team have zeroed in on training nurses at health posts to become skilled birth attendants, an intervention that directly saves lives. One Heart’s trained nurses and renovated birthing centres now care for more than 72,000 pregnant women across Nepal annually.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110111152/636cd8929c7e80680e092e4djpeg.jpg" alt="" width="1500" height="1125"><figcaption> </figcaption></figure>“Even during the pandemic rural municipalities were able to find resources to share half the cost of construction to renovate the birthing centres,” says Bhatta who works in partnership with local governments and community groups.Bhatta sets program priorities after consultation with local elected representatives, tries to raise money locally, and then tops it up by competing globally for international grants. He says, “We can’t make our people always dependant on international aid. We need to be innovative by taking risks with new ideas.”<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110111152/636cd8959c7e80680e092e4ejpeg.jpg" alt="" width="1500" height="1125"><figcaption> </figcaption></figure>The partnership approach for upgrading birthing centres through cost-sharing is innovative, and one that encourages local ownership, clearly outlining outcomes. It went ahead because local governments under Nepal’s new federal structure were willing to start implementation immediately.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110111152/636cd8989c7e80680e092e4fjpeg.jpg" alt="" width="1500" height="1125"><figcaption> </figcaption></figure>“Entrepreneurship is needed in the social sector not for profit making, but for creating quality service that can go up to scale,” explains Bhatta. “Social entrepreneurship is all about evidence-based work that guide organisations to reduce risks and help improve through sustainable local health systems. There are challenges in Nepal, but there are so many opportunities to overcome them through partnerships like this.”<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110111152/636cd89b9c7e80680e092e50jpeg.jpg" alt="" width="1500" height="964"><figcaption> </figcaption></figure>Bhatta makes a case for Nepalis to return home after higher education overseas, just as he himself did after graduating from Dartmouth in the United States, fulfilling the promise he had made to his mother that he would make a difference for as many Nepali mothers like her as possible.He says, “I am proud of the team we have built, I feel we are making a difference especially for rural communities. What can be more fulfilling than helping save lives?

“What can be more fulfilling than saving lives?”

<figure><img width="1500" height="1000" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111011114/636cccdf9c7e80680e08bc46jpeg.jpg" alt=""/><figcaption>Photo: WFP NEPAL</figcaption></figure>The Government of Japan is to provide assistance worth $3.47 million to the <a href="https://www.nepalitimes.com/banner/grow-nourish-sustain-together-world-food-day/" target="_blank" rel="noopener noreferrer">United Nations World Food Programme</a> (WFP) Nepal, to support families worst-hit by the loss of income because of the Covid pandemic. The Mother and Child Health and Nutrition Programme will fund projects in five districts of Provinces 1 and 2.
The support is in the long line of the Japanese government’s continued assistance to Nepal to improve the health and nutrition of young mothers and children. Outgoing Japanese Ambassador to Nepal Saigo Masamichi and WFP Nepal Country Representative Susan Jane Pearce signed the grant agreement. 
“This partnership between the Japanese Government, the Government of Nepal, and WFP has the potential to improve the health and nutrition of 19,000 <a href="https://www.nepalitimes.com/latest/the-lost-covid-generation/" target="_blank" rel="noopener noreferrer">children</a> aged 6 to 23 months and 49,700 pregnant and breastfeeding mothers through specialised nutritious food. Community Food Banks equipped with food storage facilities will be set up targeting 25,000 households,” said Masamichi during the signing event.
Jhapa, Morang, Sunsari, Saptari and Siraha districts, prone to annual flash floods and landslides made worse by the climate crisis, are the core project areas. The assistance will also help populations whose livelihood was disrupted by the Covid-19 lockdowns and the economic collapse, mainly in rural locations where agriculture is the primary source of income for families.
A series of surveys by UNICEF Nepal and Sharecast Initiative last year concluded that <a href="https://www.nepalitimes.com/editorial/pandemic-of-poverty/" target="_blank" rel="noopener noreferrer">42% of households in Nepal have no income</a> as an impact of the pandemic. The study also showed that another 19% families have a monthly income of less than NRs10,000.
A separate study by the Ministry of Agriculture showed that nearly <a href="https://www.nepalitimes.com/latest/nepalis-eating-less-due-to-lockdown-hardships/" target="_blank" rel="noopener noreferrer">a quarter of families in Nepal are eating less</a>, and 6% had run out of food following the coronavirus crisis. Province 2 is among the most vulnerable of the districts suffering the impact.
The grant will further boost the ability of 2,500 government officials and health specialists to support health and nutrition services during pregnancy and childbirth, monitor child growth, and provide nutrition counselling at 100 municipal health facilities.
Says Susan Jane Pearce of WFP Nepal: “Covid-19 has had severe impacts. By supporting the production and consumption of locally available and traditionally consumed nutritious food and through shock-responsive community food banks, we hope that this project will increase dietary diversity among the poor and food insecure households and build community resilience to climatic shocks.”

Japan to assist Nepali mothers and children

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110915118/636bb4569c7e80680e07bb98jpeg.jpg" alt="" width="640" height="427"/><figcaption>Photo: OM ASTHA RAI/NEPALI TIMES ARCHIVE</figcaption></figure>The world recorded an all-time low under-five deaths in 2019, but the COVID-19 pandemic has resulted in major disruptions to health services that threaten to undo decades of hard-won progress and put millions of additional lives at stake.There were 5.2 million children who died of preventable causes last year, compared to 12.5 million in 1990. But UNICEF, the World Health Organisation (WHO) and World Bank say the pandemic may force the mortality rate up again.“The global community has come too far towards eliminating preventable child deaths to allow the Covid-19 pandemic to stop us in our tracks,” says HenriettaFore, UNICEF Executive Director. “When children are denied access to health services because the system is overrun, and when women are afraid to give birth at the hospital for fear of infection, they, too, may become casualties of COVID-19.”Indeed, although SARS-CoV-2 seems to <a href="https://www.nepalitimes.com/latest/why-are-younger-people-in-poor-countries-dying-of-covid-19/" target="_blank" rel="noopener noreferrer">spare the younger population</a>, disruptions in medical care and in the supply chain for essential medicines is leading to a spike in non-coronavirus fatalities among children.For instance, the under-5 child mortality rate in Nepal had declined substantially from 271 deaths per 1,000 live births in 1969 to 31 in 2019 -- a dramatic 78% reduction from 1990 levels.Health services to prevent or treat causes of child death such as preterm, low birth weight, complications during birth, neonatal sepsis, pneumonia, diarrhoea and malaria, as well as vaccination, have played a large role in this progress.But following Covid-19 lockdown, Nepal saw a <a href="https://www.nepalitimes.com/banner/children-are-collateral-damage-in-nepal-lockdown/" target="_blank" rel="noopener noreferrer">30% increase in the number of under-fives who have died</a> in the March-April-June this year compared to the same period last year – mainly due lack of transport to take sick children to hospital, or reluctance to seek medical attention because of the fear of the virus.A rapid assessment conducted by UNFPA in coordination with Family Welfare Division during the initial phase of the lockdown period in Nepal also reported more than 60% decline in antenatal visits and 35% <a href="https://www.nepalitimes.com/banner/infant-deaths-up-during-nepal-lockdown/" target="_blank" rel="noopener noreferrer">decrease in institutional delivery as compared to before the restriction</a>.A UNICEF survey conducted over the past few months across 77 countries found that almost 68% of countries reported disruption in health checks for children and immunisation services, 63% in antenatal checkups and 59% in post-natal care.A recent WHO survey in 105 countries revealed that 52% of countries were experiencing disruptions in health services for sick children and 51% in services for management of malnutrition.“The fact that today more children live to see their first birthday than any time in history is a true mark of what can be achieved when the world puts health and well-being at the centre of our response,” says Tedros Adhanom Ghebreyesus, WHO Director-General. “Now, we must not let the COVID-19 pandemic turn back remarkable progress for our children and future generations.”Based on the responses from countries that participated in the surveys, the most commonly cited reasons for health service disruptions included parents avoiding health centres for fear of infection, transport restrictions, suspension or closure of services and facilities, fewer healthcare workers due to diversions or fear of infection due to shortages in personal protective equipment, and greater financial difficulties.Back in May, initial modelling by Johns Hopkins University also showed that <a href="https://www.nepalitimes.com/latest/pre-existing-diseases-may-kill-more-children/" target="_blank" rel="noopener noreferrer">6,000 additional children worldwide could die per day</a> due to disruptions due to COVID-19.To be sure, <a href="https://www.nepalitimes.com/opinion/newborn-deaths-and-a-vision-for-a-post-pandemic-nepal/" target="_blank" rel="noopener noreferrer">newborns</a> across the world were at highest risk of death even before Covid-19 pandemic. In 2019, a newborn baby died every 13 seconds. Moreover, 47% of all under-five deaths occurred in the neonatal period, up from 40% in 1990. Severe disruptions in essential health services due to Covid-19 have only added to the challenge.Says John Wilmoth, Director of the Population Division of the UN Department of Economic and Social Affairs, “While this report highlights the negative effects of the Covid-19 pandemic, it also draws attention to the need to redress the vast inequities in a child’s prospects for survival and good health.”

Covid-19 to reverse child survival gains

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110914114/636ba5fc9c7e80680e0736f8jpeg.jpg" alt="" width="1500" height="1000"/><figcaption>Photo: RSS</figcaption></figure>A report published online in the journal <a href="https://www.thelancet.com/action/showPdf?pii=S2214-109X%2820%2930345-4" data-saferedirecturl="https://www.google.com/url?q=https://www.thelancet.com/action/showPdf?pii%3DS2214-109X%252820%252930345-4&amp;source=gmail&amp;ust=1597502712571000&amp;usg=AFQjCNHILFhzVJvsa3-jDtOse6F5jqCotw">The Lancet Global Health</a> this week revealed that the COVID-19 pandemic has caused 50% fewer women in Nepal than usual to give birth in hospitals, resulting in higher risks for premature births, stillborn deliveries and newborn deaths.The study, conducted in nine hospitals across Nepal found that the stillbirth rate at hospitals and birthing centres increased from 14 per 1,000 before the lockdown to 21, and the neonatal mortality increased from 13 per 1,000 livebirths to 40.‘An urgent need exists to protect access to high quality intrapartum care and prevent excess deaths for the most vulnerable health system users during this pandemic period,’ the report noted.While the study focused on the indirect impacts of the pandemic on maternal and neonatal health service delivery, and did not attempt to calculate deaths resulting from these impacts, it warned: ‘During the COVID-19 pandemic, women and their babies (both in utero and neonates) are susceptible and at risk due to gaps in care that can result in adverse birth outcomes, including mortality.’It continued: ‘The decrease in the number of institutional births and increase in adverse outcomes are especially concerning because of Nepal’s fragile health system, and raisequestions on policies regarding strict lockdowns in low-income and middle-income countries.’In fact, <a href="https://www.nepalitimes.com/banner/children-are-collateral-damage-in-nepal-lockdown/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/banner/children-are-collateral-damage-in-nepal-lockdown/&amp;source=gmail&amp;ust=1597502712571000&amp;usg=AFQjCNF8MuMWip3DU9TRCsEF_50a5L1Atg">Nepali Times had reported</a> earlier this year that ‘many more children have died during the four months of lockdown compared to the same period last year because of lack of access to health care due to the restriction on mobility, interrupted vaccination campaigns and the lack of medicines.’‘Initial government figures also show that a total of 204 children under 5 have died across the country during the lockdown between 14 March-14 June. This number was at a much lower 151 during the same period last year,’ our report said.According to Lubna Baqi, Nepal Country Representative for the UN Population Fund (UNFPA): “The finding of (this week’s) study are deeply troubling. A drop in institutional deliveries by 52.4% has significant implications on health outcome as noted in the study. A further drop in institutional deliveries will have a devasting impact on maternal and newborn health.”An online rapid assessment by UNFPA in April found a similar decline, about one-half, in deliveries in health institutions. In June, Ministry of Health Spokesperson Mahendra Shrestha said fewer than 45% of women were giving birth in facilities, down from 75% before the Coronavirus pandemic.The Lancet study, based on monitoring in nine hospitals in Nepal, found decreases in:-       Institutional births (by roughly 50%)-       Foetal heart rate monitoring during labour-       Breastfeeding within one hour of birth-       Women being accompanied during delivery.The authors speculate that ‘the increase in preterm birth could also be associated with the distress of COVID-19-related social restrictions, considering psychosocial stress during pregnancy .’They add: ‘The increased proportion of admitted women having complications during admission, including preterm birth, during the COVID-19 lockdown period, might suggest that women at high risk of complications are disproportionately attending health facilities or that the number of complicated cases has increased due to delays and other challenges of the lockdown.’Those challenges are unfortunately already familiar in Nepal: lack of transportation to health facilities, a shortage of personal protective equipment (PPE), lack of gloves and other equipment for managing childbirth, and poor readiness of health facilities, etc.The Lancet study did report witnessing some improved practices, such as more skin-to-skin contact between mothers and newborns and better hand-washing. It suggests a ‘need to continue communication with policy makers and programme coordinators to address such inequalities and coverage gaps so that additional deaths can be averted’.In an interview earlier this year Baqi noted, “It’s good to have the ministry of health at the federal level saying, ‘Of course essential services must continue’ but there’s a big gap in implementation.”On Friday she added via email: ‘While current attention is on preventing and treating COVID-19 cases, it is likely that maternal and newborn mortality has increased across the country due to poor utilisation of services on the one hand and lack of preparedness on the other hand.’Baqi also pointed to shortages of trained personnel — including skilled birth attendants — essential life-saving drugs and PPEs. “The above concerns have received inadequate attention, among competing priorities, and limited financial resources have been mobilised to bridge the gaps in reproductive, maternal, child and adolescent health,” she said.The Lancet Global Health paper concludes: ‘Pandemic lockdowns threaten lives and jeopardise progress that has been made in the past two decades in Nepal, potentially derailing on-track efforts to achieve the Sustainable Development Goals by 2030, especially for maternal and neonatal survival.’

Infant deaths up during Nepal lockdown

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110914114/636ba5539c7e80680e0736bbjpeg.jpg" alt="" width="1232" height="691"/><figcaption></figcaption></figure>A survey of Nepal’s children during the lockdown has confirmed what experts had feared – that there has been an adverse impact on education and nutrition for a majority of them.More than half the families polled reported a loss of jobs or earnings, and this resulted in one-third of the households facing shortages of food, medicines and other necessities.This has impacted children within those households most directly, according to the first of a monthly tracking poll conducted nationwide by <a href="https://www.unicef.org/nepal/sites/unicef.org.nepal/files/2020-08/UNICEF%20Child%20and%20Family%20Tracker%20Survey.pdf" data-saferedirecturl="https://www.google.com/url?q=https://www.unicef.org/nepal/sites/unicef.org.nepal/files/2020-08/UNICEF%2520Child%2520and%2520Family%2520Tracker%2520Survey.pdf&amp;source=gmail&amp;ust=1597041203631000&amp;usg=AFQjCNGo2GmsIcJifQwp6zpDl4nROHaGhw">UNICEF Nepal</a> and <a href="https://www.sharecast.org.np/" data-saferedirecturl="https://www.google.com/url?q=https://www.sharecast.org.np/&amp;source=gmail&amp;ust=1597041203631000&amp;usg=AFQjCNEKj_ojDQ7aoqzexOM0-k93e6VWwg">Sharecast Initiative</a> at the end of May.Because more than two months have passed since the poll was taken, the situation for Nepal’s children is likely to be even more precarious. Some 7,500 households with at least one child was covered in the survey – more than 70% of them engaged in agriculture and a quarter with salaried jobs.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110914114/636ba5569c7e80680e0736bcjpeg.jpg" alt="" width="1220" height="691"><figcaption></figcaption></figure>Province 2 reported the highest rates (77%) of job and earnings losses, and those whose incomes were most affected by the COVID-19 lockdown lived in sub-metropolitan cities. People living in big cities and in Gandaki Province were less affected by the lockdown.This is sure to mean that the pandemic and the lockdown is widening already skewed income disparities within Nepal. Those earning less than Rs20,000 a month were the ones whose livelihoods have been most adversely impacted by the impact of the pandemic on the economy.Households facing the brunt of this income loss reported shortages of food, medicines, fuel and other essentials. Since the survey was conducted in May, many households were already low on food, and there were supply chain disruptions. <a href="https://www.nepalitimes.com/editorial/high-risk-remittance/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/editorial/high-risk-remittance/&amp;source=gmail&amp;ust=1597041203631000&amp;usg=AFQjCNExiQa1A5as__NPWZT6xxO45hciig">Remittances from Nepali abroad fell by half</a> in April, compared to the same month last year.“The survey was done in the early stages of the lockdown, so we expect the impact to be greater now,” says Madhu Acharya of Sharecast Initiative that conducted the survey.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110914114/636ba5589c7e80680e0736bdjpeg.jpg" alt="" width="1261" height="607"><figcaption></figcaption></figure>Although 64% of those surveyed said they were not suffering any shortages, rural respondents in Sudurpaschim and Province 2 reported the most food shortages. The shortages were manifested in families not being able to afford meat, eggs, dairy products, and some vegetables. This is expected to increase malnutrition among Nepali children under five, <a href="https://www.nepalitimes.com/banner/nearly-half-of-nepali-children-still-malnourished/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/banner/nearly-half-of-nepali-children-still-malnourished/&amp;source=gmail&amp;ust=1597041203631000&amp;usg=AFQjCNG5yDD3eoaiEaLZ7WwB4QofCnI1Jg">43% of whom were already malnourished.</a>More than half the children in Karnali Province are stunted because of insufficient nutrition. Many of the most vulnerable children who were getting in school meals have not been able to go to school for the past five months and have been <a href="https://www.nepalitimes.com/latest/nepals-out-of-school-children-get-food-at-home/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/nepals-out-of-school-children-get-food-at-home/&amp;source=gmail&amp;ust=1597041203631000&amp;usg=AFQjCNG5tSrVm9ytGDAOD5UQYEULWR1SOA">missing out on supplemental nutrition</a>.One in every five household polled in the survey in May said their children were getting a reduced variety and smaller portions in fewer meals. Understandably, the reduction in food intake was highest in households with lowest incomes – one-third of them said their children were getting less food.Some 18% of mothers said they were breastfeeding more to compensate for reduced food intake of their small children, with the numbers much higher (32-34%) in Sudurpaschim and Karnali Provinces.Some 16% of breasting mothers of children under two from the poorest families reported that they were eating less, even though 90% of Nepali mothers said they were breastfeeding their children.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110914114/636ba55b9c7e80680e0736bejpeg.jpg" alt="" width="1238" height="652"><figcaption></figcaption></figure>UNICEF says that although some of these changes could be related to existing pre-monsoon shortages, it warns that the response of households to reduce food intake in children is worrying.The survey shows that in May most families had been coping by digging into their savings (better off families), or by borrowing money from friends and relatives (poorer households).Preliminery government statistics show that there has been <a href="https://www.nepalitimes.com/banner/children-are-collateral-damage-in-nepal-lockdown/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/banner/children-are-collateral-damage-in-nepal-lockdown/&amp;source=gmail&amp;ust=1597041203631000&amp;usg=AFQjCNG9CTMVDT2NWEjU0J5AJwHpS9VRuw">a 30% increase in the number of under-fives who have died</a> in the March-April-June this year compared to the same three months last year – mainly due lack of transport to take sick children to hospital, or reluctance to seek medical attention because of the fear of the virus.The survey found that although 83% of pregnant women had access to ante-natal care, the figure was much lower for Province 2 (74%). Disaggregating that data by ethnicity, it was found that only half the Tarai Brahmin mothers polled had health checkups during their pregnancy in May. Surprisingly, the figure for Tarai Dalits was a much higher 77%.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110914114/636ba55e9c7e80680e0736bfjpeg.jpg" alt="" width="1233" height="680"><figcaption></figcaption></figure>Perhaps the most serious impact of the lockdown has been on education. Even in May, 95% of households said their children had stopped going to school, and 52% were not even studying at home. O<a href="https://www.nepalitimes.com/here-now/digital-divide-exposes-class-divide-in-nepal-schools/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/digital-divide-exposes-class-divide-in-nepal-schools/&amp;source=gmail&amp;ust=1597041203631000&amp;usg=AFQjCNEUD9JnlY3pwhqxNosy9-vm1futCQ">nly 29% had access to distance learning</a>, but that only half were using it.That means only about 12% of Nepali children are taking classes online, or through radio/tv. Even here, the disparity is stark: while up to a third of children in higher income households were using distance learning tools, only 5% in poorer families were doing so.“The continued loss of access to education in low income families might have irreversible negative effects on the country’s economy and adversely affect the potential of the country to ensure equitable and sustainable development,” UNICEF concludes.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110914114/636ba5619c7e80680e0736c0jpeg.jpg" alt="" width="1259" height="706"><figcaption></figcaption></figure>The more positive aspect of the survey results is that there is high level of awareness about the way in which COVID-19 is transmitted, and most families appeared to be taking the necessary precautions.More than 93% knew how the coronavirus spread, what preventive measures to take and most said they were washing hands frequently with soap, staying at home, and wearing masks when outside. This means preventive measures against SARS-CoV-2 could also <a href="https://www.nepalitimes.com/opinion/prevention-while-searching-for-a-cure/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/opinion/prevention-while-searching-for-a-cure/&amp;source=gmail&amp;ust=1597041203631000&amp;usg=AFQjCNEl2beu0G5Dd2ZkbXxsSXNNMYqUjg">protect Nepalis from other prevalent infections</a> like diarrhea, typhoid, tuberculosis and other respiratory diseases.The household members told enumerators they got most of their information about the disease from radio (82%), from family and friends (72%), mobile ring tone (38%) and ward officials.More results of the UNICEF-Sharecast report <a href="https://www.unicef.org/nepal/sites/unicef.org.nepal/files/2020-08/UNICEF%20Child%20and%20Family%20Tracker%20Survey.pdf" data-saferedirecturl="https://www.google.com/url?q=https://www.unicef.org/nepal/sites/unicef.org.nepal/files/2020-08/UNICEF%2520Child%2520and%2520Family%2520Tracker%2520Survey.pdf&amp;source=gmail&amp;ust=1597041203631000&amp;usg=AFQjCNGo2GmsIcJifQwp6zpDl4nROHaGhw">here.</a>

COVID-19 impact on food and school in Nepali children

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109141136/636badaf9c7e80680e077fabjpeg.jpg" alt="" width="1400" height="933"/><figcaption>Photo: GOPEN RAI</figcaption></figure>On Friday, it will be four months since Nepal closed the country down to prevent the spread of  SARS-CoV-2, the virus strain that causes COVID-19. Of the 40 who have died of the infection in Nepal, two are children below 5.But many more children have died during the four months of lockdown compared to the same period last year because of lack of access to health care due to the restriction on mobility, interrupted vaccination campaigns and the lack of medicines.However, the coronavirus grabs all the headlines. Mortality due to non-COVID-19 causes does not make the news – even though it is clear that a lockdown enforced to control one disease has caused far more deaths from other prevalent diseases, and threatens to undermine Nepal’s progress in infant and child survival over the past four decades.“The COVID-19 crisis and lockdown have pushed many families into poverty, many have lost their sources of income, l<a href="https://www.nepalitimes.com/latest/eu-unicef-support-child-nutrition-during-lockdown/" target="_blank" rel="noopener noreferrer">eading to malnourishment among children</a>,” says Jhalak Gautam of the Child Health Division at the Health Ministry. “Increased malnutrition means children are more susceptible not only to COVID-19 but to many other infectious diseases such as measles and diphtheria.”Under-5 child mortality rate in Nepal had declined substantially from 271 deaths per 1,000 live births in 1969 to 32 in 2018. Government figures show that since 17 July 2018-16 July 2019, a total of 1,357 children under 5 died of various infectious diseases all over the country. Preliminary figures for the same period 2019-2020 is 1,263 – even though only 78% of the data has been collected.Initial government figures also show that a total of 204 children under 5 have died across the country during the lockdown between 14 March-14 June. This number was at a much lower 151 during the same period last year.This data clearly show that the total child death numbers collected by Female Health Care Volunteers is higher this year — meaning they died at home. The number of those who have died at hospital in the same three months this year is lower than last year probably because parents are not taking children to hospital when they are sick during the lockdown.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109141140/636badb39c7e80680e077facjpeg.jpg" alt="" width="1714" height="1210"><figcaption> </figcaption></figure>An expert at the Health Information Management System says when all the data for this year comes in, it is bound to be much higher than last year. This means the lockdown has pushed Nepal back in meeting its health targets under the United Nations’ SDGs (Sustainable Development Goals).Under the SDG target, Nepal is supposed to bring child mortality down further to 25 deaths per 1,000 live births by 2030. Persistent childhood malnutrition is a major reason for infant and child mortality remaining high despite dramatic progress in the 1990s. <a href="https://www.nepalitimes.com/banner/nearly-half-of-nepali-children-still-malnourished/" target="_blank" rel="noopener noreferrer">Figures for stunting, wasting and anaemia in Nepal have plateaued in the last decade</a>  Now, the lockdown has added to the challenge.Says Elke Wisch, UNICEF Representative to Nepal: “Progress made on children’s nutrition in the last decade is at risk of being reversed as rising numbers of children are facing malnutrition due to loss of household income and resulting food insecurity. The social and economic loss for Nepal resulting from the deterioration in children’s nutrition status will be felt long after the COVID 19 crisis is over.”The lockdown has also disrupted <a href="https://www.nepalitimes.com/banner/a-shot-in-the-arm-for-vaccines-in-nepal/" target="_blank" rel="noopener noreferrer">vaccination campaigns</a> across the country, leading to <a href="https://www.nepalitimes.com/here-now/meanwhile-a-measles-outbreak-in-nepal/" target="_blank" rel="noopener noreferrer">measles outbreaks in Dhading and Gorkha</a> in April. Although regular immunisation services have now been restored in health facilities in all 77 districts, parents have been unable to take their children for shots because of restrictions on transportation and also because of the fear of COVID-19 transmission in health posts.In fact, the WHO and UNICEF earlier this week stated that preliminary data for the first four months of 2020 points to a <a href="https://www.who.int/news-room/detail/15-07-2020-who-and-unicef-warn-of-a-decline-in-vaccinations-during-covid-19" target="_blank" rel="noopener noreferrer">substantial drop in the number of children completing three doses of the vaccine</a> against diphtheria, tetanus and pertussis (DTP3), first time in 28 years. Moreover, at least 30 measles vaccination campaigns were or are at risk of being cancelled, which could result in further outbreaks in 2020 and beyond.“Vaccines are one of the most powerful tools in the history of public health, and more children are now being immunised than ever before,” said Tedros Adhanom Ghebreyesus, WHO Director-General. “But the pandemic has put those gains at risk. The avoidable suffering and death caused by children missing out on routine immunizations could be far greater than COVID-19 itself.”With schools closed for the past four months, children in many schools are also not getting their lunches. Domestic violence has also seen a spike during the lockdown, with many of the victims children. There is also evidence of a <a href="https://www.nepalitimes.com/latest/child-marriages-up-during-nepal-lockdown/" target="_blank" rel="noopener noreferrer">rise in child marriage</a>  anxiety, stress and <a href="https://www.nepalitimes.com/here-now/post-pandemic-mental-health-epidemic/" target="_blank" rel="noopener noreferrer">mental disorder</a>Nepal appears to be on track to proving correct the grim prediction in May by the Johns Hopkins Bloomberg School of Public Health that 1.2 million children worldwide could die from pre-existing diseases like malaria, pneumonia or diarrhoea in the next six months due to the disruption to health services and food supplies due to the lockdown. That makes <a href="https://www.nepalitimes.com/latest/pre-existing-diseases-may-kill-more-children/" target="_blank" rel="noopener noreferrer">6,000 fatalities a day</a> – a whopping 45% rise in child mortality.“Under a worst-case scenario, the global number of children dying before their fifth birthdays could increase for the first time in decades,” UNICEF Executive Director Henrietta Fore warned. “We must not let mothers and children become collateral damage in the fight against the virus. And we must not let decades of progress on reducing preventable child and maternal deaths be lost.”<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109141140/636badb69c7e80680e077fadjpeg.jpg" alt="" width="3600" height="2400"><figcaption> </figcaption></figure>Another aspect of the pandemic that Nepal has to be careful about is that while worldwide data show that children are relatively safe from contracting SARC CoV-2 which has mainly affected people above 70 years, in Nepal children also seem vulnerable.Health Ministry data show that the rate of infection among children below 5 is 2.2% and increasing – much higher than the global average. The infection rate among young children was at just 1% a month and a half ago.Many of the infected children belong to families who returned from India in the past three months, but children have also been infected by people who flouted lockdown rules and safety measures. This is why Far-west Province has the highest coronavirus infection rate among children at 5%.Nepal has also seen a <a href="https://www.nepalitimes.com/latest/why-are-younger-people-in-poor-countries-dying-of-covid-19/" target="_blank" rel="noopener noreferrer">disproportionate number of COVID-19 infections and mortality among a younger population</a>  Experts say this is mainly due to young returnee migrant workers from India, Malaysia and the Gulf, who make for the majority of the coronavirus cases in the country. Moreover, testing across the country so far has focused on returnees.“Unlike elsewhere, in Nepal people with co-morbidity have a higher risk of dying regardless of the age group, and this is worrying,” says epidemiologist Sher Bahadur Pun of the Health Ministry. “But we must widen our testing to come to a concrete conclusion about this. So, <a href="https://www.nepalitimes.com/opinion/prevention-while-searching-for-a-cure/" target="_blank" rel="noopener noreferrer">until we have a vaccine</a> we must wear masks, maintain physical distance and follow hand hygiene. This includes children.”

Sonia Awale

Children are collateral damage in Nepal lockdown

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109141132/636bac049c7e80680e077f0djpeg.jpg" alt="" width="1152" height="532"/><figcaption>A mother in Kalikot District measures arm of her child using a MUAC tape after receiving a short orientation on family MUAC NT</figcaption></figure>The European Union and UNICEF are collaborating to prevent malnutrition in Nepali children due to the socio-economic impact of the COVID-19 crisis and have contributed €250,000 to monitor child health.COVID-19 crisis and the lockdown in its fourth month has pushed thousands of Nepali families into deeper poverty, leading to increased <a href="https://www.nepalitimes.com/banner/junk-food-is-making-nepali-children-shorter/" target="_blank" rel="noopener noreferrer">malnourishment among children</a>. Moreover, with Female Community Health Volunteers (FCHVs) unable to make regular visits during the lockdown, families’ access to health services has been reduced further.After taking great strides in reducing malnutrition that saw stunting decline from 57% in 1990s to 36%, figures for stunting, wasting and anaemia in Nepal <a href="https://www.nepalitimes.com/banner/nearly-half-of-nepali-children-still-malnourished/" target="_blank" rel="noopener noreferrer">have plateaued in the last decade</a>.Even before the lockdown, one in three children in Nepal were still malnourished. According to the 2016 Demographic and Health Survey, wasting (low weight for age) among Nepali children under 5 still hovers at 10% — a mere 1% decrease from 8 years ago.The UN’s Sustainable Development Goals require Nepal to reduce wasting to less than 5% by 2030. Stunting needs to be well below 15% in 10 years to meet the global target, it is about 36% now."Across Nepal, the COVID 19 crisis is putting children’s lives and their futures in jeopardy. Progress made on children's nutrition  in the last decade is at risk of being reversed as rising numbers of  children are facing malnutrition due to loss of household income and resulting food insecurity", said Elke Wisch, UNICEF Representative to Nepal. "The social and economic loss for Nepal resulting from the deterioration in children’s nutrition status will be felt long after the COVID 19 crisis is over."The €250,000 will support the 'Family MUAC' intervention under which MUAC (Mid-Upper Arm Circumference) tapes will distributed to 308 local governments across 30 districts in Nepal. The tapes enable parents and caregivers to monitor the health of their children themselves.The existing Multi-Sector Nutrition Plan volunteer in all local governments will facilitate the intervention and the partnership will also provide essential supplies such as ready-to-use therapeutic food.'Family MUAC' allows for the early detection and referral of children with acute malnutrition to the nearest health centre and subsequently to nutrition rehabilitation centres, all the while reducing the exposure of FCHVs and the community to the virus.“During the last 10 years, the EU has supported Nepal to combat malnutrition, with tangible results. However, the COVID-19 crisis is making this battle more difficult.” said Veronica Cody, EU Ambassador to Nepal. "Through increasing its financial support, the EU wants to send a strong signal to Nepal: the EU is and will be by your side to leave malnutrition behind."Since 2016, the European Union and UNICEF have been supporting Nepal to scale up its Multi-Sector Nutrition Plan across the 30 districts that have a high prevalence of maternal and child malnutrition. The key nutrition-specific interventions have included treating malnourished children, protecting, promoting and supporting <a href="https://www.nepalitimes.com/banner/back-to-the-nipple-in-nepal/" target="_blank" rel="noopener noreferrer">breastfeeding</a> and providing Vitamin-A and other micronutrients.The nutrition-sensitive interventions have included promoting hand washing, management of kitchen gardens, and ending early marriage, as well as supporting the related policies. This latest contribution will be shortly followed by a renewed EU support of €23.35 million, which will reinforce the implementation of the nutrition plan until the end of 2022.

EU, UNICEF support child nutrition during lockdown

Nepal’s only international aviation gateway, at Kathmandu airport, will cut night-time operation hours to allow construction of taxiways, and airlines have been told to curtail flights. This is expected to lead to more than normal chaos during the height of peak autumn and spring tourist seasons at an airport that is congested even at the best of times. The airport will close from 10PM to 8AM from 8 November-31 March 2025. The taxiways will now connect to the thresholds at both ends of the runway, making the airport more efficient in handling higher frequencies of landings and takeoffs. The parallel taxiway extension will allow international flights to land every 4 minutes instead of the current every 7 minutes. At present planes have to wait to land until a plane taking off backtracks along the runway.&nbsp; Kathmandu is Nepal’s only airport with international operations, and it has only one runway that is only one way in from the south over the mountains. With the taxiway improvement, the airport will be able to handle 42 aircraft landings and takeoffs per hour — double the current capacity.&nbsp; The Civil Aviation Authority of Nepal (CAAN) has been trying to entice international airlines to also start flying to and from the other two international airports at Pokhara and Bhairawa (Lumbini) by slashing landing and handling charges. But so far only Nepal Airlines operates a weekly flight to Bhairawa from Kuala Lumpur.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241018161016_046569e53d1d66cd445cc66c697c0ef724810aec9f54bdf827481e3cd6b80c32.jpg" data-media-id="editor_0" data-image-id="20241018161016_046569e53d1d66cd445cc66c697c0ef724810aec9f54bdf827481e3cd6b80c32" data-rendition-name="original" width="2356" height="1134" loading="lazy" alt="Kathmandu airport expansion"> <figcaption>Kathmandu Airport Expansion plan with extension of taxiways to the thresholds of runways 02 and 20 that will limit airport operations from 8 November 2024 - 31 March 2025. Areas in blue are existing structures, including the international terminal which in future will be the domestic airport, and the new international terminal near the north end of the runway,</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241018121028_6e17cc2ee87c1b02d78cb54905825b7aa15299b7a00f5eddb01a59579ab85c1a.jpg" data-media-id="editor_1" data-image-id="20241018121028_6e17cc2ee87c1b02d78cb54905825b7aa15299b7a00f5eddb01a59579ab85c1a" data-rendition-name="original" width="1353" height="1328" loading="lazy" alt="Kathmandu airport NT"> </figure>  CAAN has reportedly told international airlines to cut their flight frequency to Kathmandu citing the shorter operation hours and has told budget airlines to shift some of their flights to Pokhara or Bhairawa, or face cuts. Many airlines currently operate regular flights to and from Kathmandu between 10PM and 8AM: Air Arabia to Sharjah, Fly Dubai to Dubai, Jazeera Airways to Kuwait, Cathay Pacific to Hong Kong, Singapore Airlines, several Nepal Airlines flights, and one of four daily flights by Qatar Airways to Doha. Jazeera Airways, FlyDubai, and Thai AirAsia have applied and got permission from CAAN to begin regular flights to Bhairawa’s Gautam Buddha International Airport. Starting 9 November, FlyDubai will start making a stopover in Bhairawa before flying on to Kathmandu. Immigration, customs and security are all fully functional in Bhairawa. In Kathmandu, the next phase of the airport upgrade includes converting the current international terminal for domestic operations, the construction of a new international terminal where the domestic departure area is now, as well as moving the hangars and the Nepal Army Air Wing to the eastern side of the runway. The apron area will also double its parking space for widebody jets. This is part of a Airport Capacity Enhancement Project that was initially funded through a $80 million loan from the Asian Development Bank (ADB), and the entire masterplan is expected to cost $800 million. This project is the latest upgrade to Nepal’s only international airport since it saw its first flight in 1949. The current international and domestic terminals are too small to handle the current annual traffic volume of 8.5 million passengers a year that is growing at 20% a year.

Kathmandu airport to cut flight hours

As Kathmandu becomes more congested and polluted, and with remote online work becoming the norm, many professional Nepalis are planning to retire in Pokhara, or move there.&nbsp; With its stunning mountain panorama, balmy winters and proximity to a profusion of wilderness areas, builders are responding to this demand with new townhouses, housing development and apartments. One such block of flats is the 10-storey <a href="https://sungavaapartment.com/">Sungava Apartment</a> located at Phulbari above the Seti River, near the point where it flows into and under Pokhara. The imposing structure near Manipal Hospital is almost complete, and on a recent visit the site was strewn with huge boulders unearthed while digging the foundation.&nbsp; The Seti brought down these boulders during a gigantic flood that geologists estimate happened 800 years ago when a chunk of Annapurna IV broke off and ploughed into the glacier below. Today, Sungava (means ‘orchid’) sits safely on a high terrace, 100m above the blue-green Seti and commands a view of Dhaulagiri, Annapurna South, Machapuchre, Annapurna III and IV.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2024102411104_5f8fc736c86ea3c08d7bef43bb727081d3cc1a2caa55ae2b441717e6044de7e9.jpg" data-media-id="editor_1" data-image-id="2024102411104_5f8fc736c86ea3c08d7bef43bb727081d3cc1a2caa55ae2b441717e6044de7e9" data-rendition-name="original" width="2016" height="1512" loading="lazy" alt="High living below the Himalaya NT"> </figure>  The soil here is conglomerate that has solidified like concrete, and the boulders were extracted by heavy earthmovers. It is intriguing to think that these metamorphic rocks as big as cars, rounded by glacial grinding, were once a part of a much higher Annapurna IV. Even for those with little interest in geology, Sungava is an ideal place to contemplate the tectonic forces that pushed these peaks into the sky to be sculpted into delicate shapes by wind, snow, earthquake and avalanche over millions of years. The view of the Himalayan panorama from Sungava’s many balconies are breathtaking when not obscured by clouds, or the haze that drifts in from across the southern border. On most days, just watching the towering pyramid of Machapuchre (Tamu name: कतासुँ क्लिको) play hide and seek with the clouds is mesmerising. There are rocks aplenty at Phulbari, and it is probably the flowers that grew along the flat terraces e that gave the place its flowery name. The boulders will hopefully be turned into a rock garden while landscaping. An nearby restaurant complex is making the best use of the stones in its design, using flat rocks as outdoor benches and tables. Sungava was designed by the husband-wife architect team of Deepak Sherchan and Jyoti Joshi of <a href="https://thedarkmermaidamarbshrestha.blogspot.com/2013/12/creative-builders-collaborative-cbc.html">Creative Builders Collaborative (CBC)</a>, which also built Heritage Plaza, Indreni Apartment and numerous other projects in Nepal. Sadbhavana retains CBC’s trademark Newari-style masonry and here it borrows from the orange brickwork of the old town of Pokhara, integrating it with modern design elements. A few of those heritage houses are still standing in Ganesh Tole and Ram Krishna Tole in Pokhara’s old quarter.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2024102411108_5eb64a4885961b6d30781cefeb1e8a313da313ac5227c7a66b60f0c7d48d6fab.jpg" data-media-id="editor_3" data-image-id="2024102411108_5eb64a4885961b6d30781cefeb1e8a313da313ac5227c7a66b60f0c7d48d6fab" data-rendition-name="original" width="1362" height="595" loading="lazy" alt="High living below the Himalaya NT"> </figure>  About 400m from the apartment past a bend on the river, and down below three tiers of terraces in the canyon is a suspension bridge. Below it, the Seti is still swollen with post-monsoon flow as it tumbles away in a hurry to head down south.&nbsp; Back at the apartment, it is quiet, far away from the hubbub of Lakeside a 15 minute drive away, and in the lap of greenery. There are 52 units at Sungava and it already has a close-knit prospective community of professionals, including doctors, publishers, engineers, and businesspeople from the renewable energy and IT sectors.&nbsp; Some residents say they opted for a second home in Pokhara to make it a ‘base camp’ to explore the Annapurnas with its many hiking trails made newly accessible with new roads. With the NRN citizenship law, overseas Nepalis can now also buy the flats. &nbsp; The floor plans include options for north and south-facing 3-bedroom apartments with verandas, and the facility has underground parking has EV charging, heated pool, sauna and gym. There are still some unsold apartments with panoramic views of the mountains and one can imagine oneself at the kitchen with its huge window, humming a ditty while preparing breakfast: “खाना पकाउँ हिमाल हेरेर...”

High living below the Himalaya

When the United Nations held its Summit of the Future at its headquarters in New York in September, many world leaders, including Nepal’s Prime Minister K P Oli, highlighted the effect of climate breakdown in increasing the frequency and intensity of natural disasters. What did not get as much attention was the long term impact of the climate crisis on food production. In fact, heat stress, weather extremes and the consequences on rain-fed agriculture is already being felt worldwide, undermining the chances of the <a href="https://unstats.un.org/sdgs/">UN’s Sustainable Development Goals (SDGs)</a> being met by 2030.&nbsp; The SDG’s 17 targets commit countries like Nepal to reduce poverty and inequality, end malnutrition, protect the natural environment, and ensure that citizens all enjoy health, justice and prosperity without leaving anyone behind.&nbsp; However, besides the impact of climate breakdown on agricultural production, in Nepal the area under cultivation is impacted by urban expansion, falling productivity and the need for expensive inputs like fertiliser and pesticides.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241019041052_626413c5baf4dae407ac9579231b41daeb51510aa636b75aeb7489d94cca6a62.jpg" data-media-id="editor_1" data-image-id="20241019041052_626413c5baf4dae407ac9579231b41daeb51510aa636b75aeb7489d94cca6a62" data-rendition-name="original" width="999" height="1500" loading="lazy" alt="urban agriculture in Kathmandu"> <figcaption>Kathmandu's urban sprawl is eating into its fertile cultivable lands. Photo: TAYLOR MASON</figcaption> </figure>  Now, a new study led by Nepali researcher Prajal Pradhan at the University of Groningen in The Netherlands looks at how urban agriculture may offer a solution to falling food production and meeting SDG targets. The researchers evaluated 1,450 publications exploring the contributions of urban agriculture with both positive and negative effects, and published their findings in the journal Cells Report Sustainability. Urban agriculture can help achieve 17 SDGs, positively influencing 81 targets. However, it could also undermine 51 goals.&nbsp; Read also: <a href="https://nepalitimes.com/here-now/the-vanishing-land">The vanishing land</a>, Taylor Mason “Urban agriculture offers immense potential for sustainable development, but realising this potential depends crucially on adopting practices that minimise its adverse effects while maximising its benefits,” Pradhan explains. Urban agriculture can substantially enhance urban food security, provide employment to the urban poor, serve as ground water recharge in built-up areas, and preserve open spaces that can serve as safe havens during disasters like earthquakes. However, it also presents problems like the potential health risks from contamination and the need for expensive inputs. &nbsp; “Urban agriculture plays a definitive role in advancing the SDGs, but achieving this requires tailored, context-specific solutions that address the unique challenges of different regions,” says Yuanchao Hu of Wuhan University in China and who is a researcher at the Potsdam Institute for Climate Impact Research. “But it needs equitable access and rigorous management of environmental risks.”&nbsp; Rapid urbanisation is eating into Nepal’s most fertile agricultural land, which means farming in remaining open spaces inside cities can be a viable alternative, especially as food prices rise.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241019041052_7b7c9413086226fbdc630d45acf772cfa1ced77a8970b9056ec5ec7e5226fdf8.jpg" data-media-id="editor_3" data-image-id="20241019041052_7b7c9413086226fbdc630d45acf772cfa1ced77a8970b9056ec5ec7e5226fdf8" data-rendition-name="original" width="1500" height="999" loading="lazy" alt="urban agriculture in Kathmandu"> <figcaption>A vegetable patch in between new houses in Thimi. Photo: TAYLOR MASON</figcaption> </figure>  “The conversion of Nepal’s most fertile land into cities is a severe problem,” Pradhan told Nepali Times. “Crop cultivation, horticulture, agroforestry, beekeeping, livestock rearing, or aquaculture can all be farming activities within and around cities.”&nbsp; The study makes recommendations for sustainable practices that build on the positive aspects of urban agriculture while mitigating the downsides, thereby promoting more resilient cities in future. Research shows that urban agriculture has been helping many countries attain SDG targets by enhancing food security and biodiversity while helping education and preservation of open spaces.&nbsp; Indeed, many farmers from the hinterland who have settled in Kathmandu Valley or other urban areas of the country have been practicing urban agriculture, leasing neighbourhood patches or cultivating roof gardens both out of necessity because of inflation and falling income to grow their own food, and also as a fulfilling hobby. Saurav Dhakal, a sustainability advocate with Story Cycle and now research fellow at the Asian Institute of Technology in Thailand, says there are socio-economic and environmental benefits of urban agriculture. “It provides benefits to all urban dwellers, regardless of their income status,” says Dhakal, “families get fresh food, and there are many other benefits like water retention, heat regulation and biodiversity. These are all public goods, so special government incentives may be needed.” It is not unusual to see vegetable patches and even paddy fields within inner city Kathmandu where an older generation of farmers are using available fertile land and <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/rooftop-gardens-kathmandu,1415">roof gardens to produce fresh, nutritious food </a>to reduce their dependence on food items that have to be bought after being trucked in from large distances.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2024101905100_1291ce98dbbb8caed8702ac4b1d469b3e13016d7ecaaf3bfd5f91c974d3c0c77.jpg" data-media-id="editor_5" data-image-id="2024101905100_1291ce98dbbb8caed8702ac4b1d469b3e13016d7ecaaf3bfd5f91c974d3c0c77" data-rendition-name="original" width="1500" height="999" loading="lazy" alt="urban agriculture in Kathmandu"> <figcaption>An older generation of farmers are using any available fertile land to continue farming but it is getting more and more difficult. Photo: TAYLOR MASON </figcaption> </figure>  Nepal’s urban population grew rapidly from only 3.6% in 1991 to 25% today. There is large outmigration from the mountains to peri-urban areas of the Tarai, to Kathmandu Valley and Pokhara, with many young men then moving abroad for work. Kathmandu Valley’s population has swelled to nearly 3 million, and is growing at 6.5% a year. Dilip Shrestha, 71, used to work for Nepal Food Corporation, so he knew firsthand about inflation, shortages and vegetables with pesticide residue. So, when he designed his new house in Kathmandu, he built a spacious roof where he grows cucumber, ginger, garlic, coriander, onions, tomatoes, chili, beans, okra, pumpkin and lettuce. His family eats healthier, and he has reduced dependence on the market.&nbsp; The co-author of the Cell Reports Sustainability journal article, Daya Raj Subedi who is a PhD candidate at Beijing Forestry University, says urban agriculture also promotes inclusion and psycho-social wellbeing.&nbsp; He says, “A crucial finding of the study is the identification of opportunities and challenges associated with urban agriculture, it can promote sustainable transformation of society.” In Banepa, 55-year-old Bijaya Manandhar in her lifetime has watched the fertile farms of her neighbourhood that used to supply vegetables to Kathmandu, now completely built up with no open space left. The pandemic lockdown prompted her to turn to the family’s <a href="https://nepalitimes.com/banner/rooftop-agriculture-on-the-roof-of-the-world">ancestral livelihood by growing food</a> not on terrace farms, but on the roof terrace. Manandhar is now a part of <a href="https://nepalitimes.com/banner/rooftop-agriculture-on-the-roof-of-the-world%5C%5C">कौसी खेती र करेसाबारी क्रान्ती</a> (Rooftop Farming and Garden Revolution) which has an online membership of 52,000, and awards annual prizes to women who excel in urban agriculture.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241019041052_7257f5def8f823f35a799fa6f6825e153f2ffa406ac11325d4fe74049b79e96d.jpg" data-media-id="editor_8" data-image-id="20241019041052_7257f5def8f823f35a799fa6f6825e153f2ffa406ac11325d4fe74049b79e96d" data-rendition-name="original" width="1600" height="736" loading="lazy" alt="urban agriculture in Kathmandu"> <figcaption>Rooftop farming is gaining popularity as a form of urban agriculture. </figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241019041052_beff1a4494ce896dd8fd383ee1f518e5448bcf7ea8bb138255391c7bcb9769ed.jpg" data-media-id="editor_9" data-image-id="20241019041052_beff1a4494ce896dd8fd383ee1f518e5448bcf7ea8bb138255391c7bcb9769ed" data-rendition-name="original" width="4000" height="3000" loading="lazy" alt="urban agriculture in Kathmandu"> </figure>  Pradhan says the challenge now is to upscale such examples of successful urban agricultural practices so they support Neal’s efforts to meet SDG targets. He adds, “Crop cultivation around cities can be protected by land use plans and regulations. Promoting community-based agriculture, including rooftop gardens, requires community engagement and public-private partnerships across the food value chain.”&nbsp; Such support would accelerate the popularity of existing rooftop farming and community gardens in Kathmandu Valley, or kitchen garden initiatives in Pokhara, and building on traditional farming practices that are preserved and integrated into urban settings like in Bhaktapur and Banepa. In Lalitpur, the Women Entrepreneurship Facilitation Center promotes urban farming enhancing both sustainability and empowerment.&nbsp; Another co-author of the report, Yuanchao Hu from China says followup research of the team will aim to identify good practices in local urban agriculture practices. He adds, “There are examples of urban agriculture that optimise sustainability, ensuring that it remains a viable solution for cities globally while countries try to meet SDG targets.” Prajal Pradhan, Daya Raj Subedi, Kshitij Dahal, Yuanchao Hu, Prakriti Gurung, Sijal Pokharel, Sagar Kafle, Biplav Khatri, Sudeeksha Basyal, Monika Gurung, and Aruna Joshi. Urban Agriculture matters for sustainable development. Cell Reports Sustainability, 1:100217, 2024. [DOI: 10.1016/j.crsus.2024.100217] Prajal Pradhan (<a href="mailto:p.pradhan@rug.nl">p.pradhan@rug.nl</a>) This article is brought to you by <a href="https://nepalitimes.com/" target="_blank">Nepali Times</a>, in collaboration with <a href="https://inpsjapan.com/en/" target="_blank">INPS Japan</a> and <a href="https://sgi-peace.org/" target="_blank">Soka Gakkai International</a>, in consultative status with UN ECOSOC.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240630110640_30c3782f9c09219bf1c249b51483a3cfb7a53a06d117d2aebd23ca7080d12758.jpg" data-media-id="editor_14" data-image-id="20240630110640_30c3782f9c09219bf1c249b51483a3cfb7a53a06d117d2aebd23ca7080d12758" data-rendition-name="original" width="680" height="103" loading="lazy" alt="SDG logo"> </figure>

Back to the land in the cities

The 700-year-old Lakshmi Narasingha temple in Bhaktapur houses a rare half-lion and half-human incarnation of Lord Vishnu carrying the Goddess Lakshmi. The temple was destroyed in the 1934 mega earthquake that killed 10,000 people and destroyed many monuments in Kathmandu Valley. It was rebuilt by a German project in the 1980s, but as a single-storey structure instead of its original two-tier pagoda design.&nbsp; With new findings from in-depth research, Bhaktapur municipality began re-restoring the temple in 2021, preserving its original architecture.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241017131016_2fae38cce543ad7b1f6de632feb3e212e08ed1acedd747830e949d7b8e878f18.jpg" data-media-id="editor_0" data-image-id="20241017131016_2fae38cce543ad7b1f6de632feb3e212e08ed1acedd747830e949d7b8e878f18" data-rendition-name="original" width="2048" height="1365" loading="lazy" alt="In with the old in Nepal NT"> </figure>  “Our temples and heritage sites hold deep meaning. It is disheartening to witness how often they lose their original elements, whether by design or accident,” explains Kumar Chawal of the Consumer Committee of Bhaktapur. “There is a need to preserve our architecture and protect its historical value for future generations. Otherwise, we risk losing a vital part of our identity.” The Laksmi Narsingha restoration is similar to the Bhai Dega temple in Patan Darbar Square which also collapsed in 1934, but was rebuilt with a Moghul-style dome by the Rana government at the time. Only two months before the 2015 earthquake, heritage conservationists had started to rebuild Bhai Dega as the original three-tier based on early photographs. But priorities shifted when four other temples in the square were brought down by the 7.8M earthquake on 25 April 2015.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241017131016_697ea707d9ad163be5de5f2efbf5b70d3cab771adcc22f0fae6bf937c6cb0130.jpg" data-media-id="editor_1" data-image-id="20241017131016_697ea707d9ad163be5de5f2efbf5b70d3cab771adcc22f0fae6bf937c6cb0130" data-rendition-name="original" width="2048" height="1365" loading="lazy" alt="In with the old in Nepal NT"> </figure>  This showed how damage to monuments in Kathmandu Valley spanned from one earthquake to the next. Bhai Dega restoration remains half-complete to this day because money for its restoration ran out.&nbsp; Whereas Bhai Dega restoration was done by the Kathmandu Valley Preservation Trust with grants from western embassies and international foundations, in Bhaktapur it is the municipality itself that allocated the Rs30.7 million needed to restore the Lakshmi Narasingha temple. The expected date of completion is early 2025. The municipality and local communities are focusing on two main aspects: preserving the past and promoting localisation. The restoration team has designed a blueprint for the temple by using historical photographs and insights from older generations.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241017131016_182882fdc393c99e70d1d0490319e415229563666c4934e3a582426ebf00ca30.jpg" data-media-id="editor_2" data-image-id="20241017131016_182882fdc393c99e70d1d0490319e415229563666c4934e3a582426ebf00ca30" data-rendition-name="original" width="1200" height="560" loading="lazy" alt="In with the old in Nepal NT"> </figure>  “At first, the Lakshmi Narasingha temple had only one entrance, but during the demolition process, we uncovered the foundations of four doors. Now, we are restoring all of them. This is an example of how our ancient structures have changed over time, often without our knowledge,” says Chawal. “Constructing temples is not like building houses. They carry historical and spiritual values, which is why they hold a special place in our hearts,” he adds. By replicating ancient design elements and rebuilding the temple as accurately as possible to its original form, the team has stayed true to Bhaktapur’s soul. But the restoration also revived ancient techniques that were in danger of being forgotten, generating employment for woodcarvers, masons, and contractors. The community of Bhaktapur’s Gahiti neighbourhood near the famous Nyatapola Temple has also set aside specific days for locals to volunteer in the reconstruction work. This has encouraged young people to take pride in ownership of their heritage. Families have also supported the effort by donating funds for bells, the temple pinnacle, and other structural features to the temple.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241017131016_db850ec0c084cdbe54f65bee92dad2ad8122d20fd60ec87ec086fbb9d2f72bd6.jpg" data-media-id="editor_3" data-image-id="20241017131016_db850ec0c084cdbe54f65bee92dad2ad8122d20fd60ec87ec086fbb9d2f72bd6" data-rendition-name="original" width="2048" height="1365" loading="lazy" alt="In with the old in Nepal NT"> </figure>  “I feel at peace knowing I have contributed my sweat to restoring this temple,” said one volunteer. “It is our duty to preserve our temples and heritage. The Nyatapola area will look magical once this temple is completed.” Community mobilisation is a long-standing tradition in Bhaktapur. In the past, locals have actively participated in the restoration of other temples in the city, such as Bhairav and Nyatapola fostering a strong sense of ownership. This collective engagement has not only been crucial in preserving the city's historical monuments but also in strengthening the bond between local communities and their heritage, says officials at the municipality. While securing funding is essential, and the municipality showed it values heritage conservation, the Lakshmi Narasingha restoration is proof that active involvement and sense of responsibility of the local community is as important, if not more. Local involvement also means that the monuments will be cared for into the future, When locals take ownership of these efforts, the restored monuments are not only protected in the present but are also cared for in the future.

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