It was not long ago when families of hospitalised Covid-19 patients were frantically searching for a dose of remdesivir or hydroxychloroquine. These drugs were hard to come by, and their price surged. Convalescent Plasma Therapy which uses blood from those who have recovered from an infection to treat new cases was similarly thought to be another effective regime for Covid patients. Until that point during the Covid-19 pandemic, there were no working vaccines. Even when the first vaccines were produced, there were not enough doses for Nepal while the<a href="https://nepalitimes.com/here-now/delta-variant-s-wake-up-call-for-nepal"> delta variant </a>was sweeping India. Covid hospitalisation was at an all-time high, hospitals were running out of beds as even younger populations succumbed to the disease. Today, these drugs and treatment regimes have been found to be completely ineffective. A RECOVERY (Randomised Evaluation of Covid-19 Therapy) Trial started at Oxford University found that hydroxychloroquine was no good for hospitalised Covid patients. Surprisingly, the Recovery Trial also showed that it was a <a href="https://nepalitimes.com/opinion/dhanvantari/a-covid-19-exit-strategy-for-nepal">widely available cheap steroid called dexamethasone</a> that was the most effective in some groups. “Dexamethasone is the real winner by far, it is such an easy and cheap drug to use, followed by Tocilizumab and Baricitinib which are more expensive and difficult to access drugs but showed additional mortality benefits in severe patients,” said Peter Horby, infectious disease specialist and co-lead of the RECOVERY trial during a meeting in Kathmandu last month. He added: “Aspirin, azithromycin, hydroxychloroquine, plasma therapy, colchicine and lopinavir-ritonavir had absolutely no effect on survival rates. In fact, there are potential harms of using hydroxychloroquine.” Hydroxychloroquine gained much momentum after then-US President Donald Trump endorsed the antimalarial drug for use in Covid patients. The Oxford University RECOVERY trial with 49,051 patients enrolled and 189 sites with Nepal being the biggest only after the UK, is the largest randomised controlled clinical trial of Covid-19 treatments, more than twice as large as any other trial. It has so far produced clear answers on 13 different treatments, and no other trial has determined international treatment guidelines in the way RECOVERY has.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240524040532_29bd53f7eeda6d1b28894f37af7008bdf4792910aa3d5f6a893bf9381dce9164.jpg" data-media-id="editor_2" data-image-id="20240524040532_29bd53f7eeda6d1b28894f37af7008bdf4792910aa3d5f6a893bf9381dce9164" data-rendition-name="original" width="1750" height="1169" loading="lazy" alt="Still learning lessons from COVID Page 10-11 NT #1213"> <figcaption>Hospitals in Kathmandu ran out of beds during the Covid-19 pandemic in 2021 and patients had to be treated outside the wards on the floor. Photo: NEPALI TIMES ARCHIVE</figcaption> </figure>  The major finding of the RECOVERY trial that dexamethasone reduces mortality among patients admitted to hospitals with Covid-19 who need oxygen therapy saved over 1 million lives globally just in 2021. But before the trial, there was uncertainty whether or not this treatment would work. “Many well-known doctors actively discouraged the RECOVERY team against using a cheap steroid dexamethasone, but they had based their opinion on much smaller studies,” explains Buddha Basnyat, physician with the Patan Academy of Health Science and the Principal Investigator for the RECOVERY Trial for Nepal. He adds: “But Peter Horby decided we need to do a trial that was sufficiently large to be able to conclude if the drug works, he cut through the fog of confusion and the British review board went with it. It was science at its best.” The trial also demonstrated that powerful antiviral treatments such as <a href="https://archive.nepalitimes.com/news.php?id=19634">monoclonal antibodies </a>when directed against the virus could reduce mortality in patients who have not developed their own antibodies, which many doctors doubted would work. In Kathmandu, Horby recalled meeting a South American minister and found out that they still had aspirin in their Covid treatment guideline. He said: “There is still work to do to get this information through the policymakers about what works and what doesn’t.” The Covid-19 pandemic was an extraordinary global crisis, but in some ways it is similar to the tendency of governments to intentionally look for expensive and complex solutions to <a href="https://nepalitimes.com/here-now/nepal-s-frontline-workers-brave-it-out">medical emergencies </a>when proven cheaper solutions are available. For example, <a href="https://nepalitimes.com/news/remove-barriers-to-life-saving-drug-to-prevent-maternal-deaths">Misoprostol is a cheap drug that can prevent maternal deaths </a>from post-partum haemorrhage. It was a part of the program launched in the mid-2000s to protect women who give birth at home but now it faces opposition, neglect and shortages in Nepal because it is so cheap.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240524040532_e70428427a6f5a50955c544ff4f2e7f9c4c86a4065f4680a3d999dc3f667b957.jpg" data-media-id="editor_6" data-image-id="20240524040532_e70428427a6f5a50955c544ff4f2e7f9c4c86a4065f4680a3d999dc3f667b957" data-rendition-name="original" width="2000" height="1199" loading="lazy" alt="Still learning lessons from COVID Page 10-11 NT #1213"> <figcaption>Peter Horby speaking about the RECOVERY trial in Kathmandu last month.</figcaption> </figure>  “Tranexamic acid is another cheap drug for post-partum haemorrhage. The same steroid for Covid-19 called dexamethasone is the most effective drug for the treatment of severe altitude illness,” says Basnyat, who specialises in mountain medicine. “There is a tendency to underutilise some of these affordable, simple and easily available lifesaving drugs at our disposal.” The RECOVERY trial also turned out to help build medical research capacity in Nepal. The Infectious Diseases Hospital at Teku and the Armed Police Hospital were<a href="https://nepalitimes.com/here-now/nepal-s-doctors-are-like-soldiers-fighting-a-war"> at the forefront</a> while the Oxford University Clinical Research Unit Nepal spearheaded the campaign and convinced the Nepal Health Research Council to participate. “Nepal played a crucial role in the expansion of the trial from the UK to the rest of the world,” Horby told Nepali Times. “Nepal recruited more patients than any other country outside the UK.” &nbsp; Indeed, Nepal was the single biggest contributor to the trial and the research contributed to the global science, and it was a big boost for fledgling research culture in Nepal. Says Basnyat: “We stood to gain scientifically from this but also showed young doctors and nurses in Nepal were randomising patients in a very standardised way, learning new things despite the tragedy that was Covid-19.” The RECOVERY platform has now transitioned into finding treatments and better care for pneumonia and other influenzas which <a href="http://archive.nepalitimes.com/article/nation/Antibiotic-resistance,1974">still kill hundreds of thousands of people worldwide</a>. Added Horby: “RECOVERY has shown the benefit of large, streamlined trials and how they could be applied to any common health problem. Trials are essential if we are to know what is effective and what is not, so ensuring we can deliver more trials is important for public health.”

Sonia Awale

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Still learning lessons from COVID

<figure><img width="1500" height="1000" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410114/637205539c7e80680e0b28adjpeg.jpg" alt=""/><figcaption>Frontline workers waiting for their booster dose at a hospital in Kathmandu last week. Photos: AMIT MACHAMASI</figcaption></figure>As elsewhere in the world, the <a href="https://www.nepalitimes.com/here-now/3rd-covid-wave-infects-nepals-frontliners/" target="_blank" rel="noopener noreferrer">Omicron-led third wave</a> in Nepal is starting to peak, but experts say the pandemic is far from over. The Health Ministry had previously projected new cases to soar to 20,000 a day, and the Omicron surge to peak in mid-February. But the fact that the variant spread rapidly like wildfire right across the country giving a majority of the population milder symptoms meant that it equipped them with antibodies to fight the infection.At Nepal’s biggest infectious diseases centre at Teku Hospital, virologist Sher Bahadur Pun predicts that the third wave will most likely peak in a few days, or by the end of next week.“For the past week, I have observed that the number of people coming in for tests and consultation every day has decreased by a half,” Pun says. “Of course, not everyone is coming to the hospital, but this is the beginning of the end of this wave.” To be sure, the government’s daily Covid-19 figures are gross under-estimations. Mostly symptomatic patients are testing, thus registering a very high positivity rate. Infected people with flu-like symptoms are isolating at home without a PCR test. There are also people self-testing with kits available at pharmacies, and these infections are not in the official tally.Even so, figures from elsewhere show <a href="https://www.nepalitimes.com/here-now/3rd-wave-in-2-years/" target="_blank" rel="noopener noreferrer">the Omicron surge</a> lasts only for a month or two. South Africa, where the variant was first detected in December, is over the hump. The UK and parts of the US have also passed their peaks. Many countries, including Australia, are now removing restrictions."It is too early to be sure about exactly when the high number of cases will subside completely," Andrew Pollard, of the team that developed the Astra Zeneca vaccine, told Nepali Times in an email interview from Oxford. "The main issue with rapid spread of Omicron is for the unvaccinated who may be at risk of severe disease, particularly if they are older adults and those with other health conditions."The spread of Omicron in Kathmandu Valley is expected to reach an equilibrium soon, with a steep fall in cases, says Bangkok-based public health expert Sushil Koirala. But he warns slower-moving outbreaks may continue outside the valley where the population is thinly spread. “These next 10 days are critical. It will tell us if the Omicron variant is indeed a quiet pass to a pandemic end-game, or we still have a big human cost to pay,” Koirala adds. “There is still little clarity on how severe this variant will be to those who are still unvaccinated and those who had the vaccines many months ago.” <figure><img width="1500" height="1000" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410114/637205569c7e80680e0b28aejpeg.jpg" alt=""><figcaption> </figcaption></figure>The World Health Organisation (WHO) last week issued an <a href="https://news.un.org/en/story/2021/12/1108932" target="_blank" rel="noopener noreferrer">optimistic projection</a> that the pandemic would probably be over during 2022 — provided inequalities in the vaccine coverage and treatment are addressed.  Global health researcher and economist Christopher J L Murray <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)00100-3/fulltext" target="_blank" rel="noopener noreferrer">writing for the journal Lancet</a> also said that after the Omicron wave, ‘Covid-19 will return but the pandemic will not.’ Pollard also explains that once health systems can cope with Covid-19, the pandemic could be considered over, but that doesn’t mean that the virus will be gone. "We have a pandemic because of pressure on health systems and deaths. With growing global immunity as a result of vaccination and previous waves of infection, both severe disease and deaths should decline during 2022," he says. Despite this, health experts in Nepal warn that severe infections needing hospitalisation have a lag of a few weeks after the surge in infections. And despite being a <a href="https://www.nepalitimes.com/here-now/omicron-may-not-be-as-risky-but-take-care/" target="_blank" rel="noopener noreferrer">milder strain</a> that primarily only affects the upper respiratory tract, Omicron can still lead to serious diseases in the elderly and people with co-morbidities. Indeed, ICU admissions and those needing ventilator support in hospital have tripled in one month, although nowhere near the figures in April-May. Also, the seven-day average for daily fatalities have remained below five.  Says infectious disease specialist Anup Subedee: “It will still take some time and a few more variants before the pandemic comes to an end. So our health system should be ever ready with the management and treatment of Covid-19, isolation and contact tracing.” Virologist Pun at Teku agrees: “We are now moving from pandemic to endemic, but this does not mean that we can sound the all clear. We must continue mass vaccinations and safety measures.” The general consensus is that increased vaccine coverage with boosting, more testing, whole genome sequencing to detect variants, and public adherence to safety measures will determine whether there will be a new surge, or if the virus will taper off. Nepal has 20 million doses of vaccines in stock for those waiting for first and second jabs, and has started booster shots for high risk groups. However, communication on location, eligibility and requirements for <a href="https://www.nepalitimes.com/latest/all-vaccines-prevent-severe-covid/" target="_blank" rel="noopener noreferrer">vaccination</a> centres is confusing and inadequate. With reports from India, Denmark and the Philippines of the even more transmissible ‘stealth Omicron’ sub-variant BA.2 that can evade PCR detection, Nepal needs to continue vigilance. This is also important to determine if the <a href="https://www.nepalitimes.com/here-now/delta-variants-wake-up-call-for-nepal/" target="_blank" rel="noopener noreferrer">Delta variant</a> is still circuiting and how dominant it is. “Our Covid figures from the last four days strongly suggest that we have passed the peak,” confirms Sameer Mani Dixit of the Centre for Molecular  Dynamics. “But we must keep a close watch on next week’s numbers to know for sure if the cases are just levelling off, still peaking, or if it was just a momentary decline.”

Omnipresent Omicron starts to lose its edge

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410114/637204ac9c7e80680e0b2875jpeg.jpg" alt="" width="960" height="641"/><figcaption>Crowd of people lining up for Covid vaccination outside Teku Hospital on Tuesday. Photos: AMIT MACHAMASI</figcaption></figure>During the devastating second wave last year, hundreds of people were dying every day. Hospitals had <a href="https://www.nepalitimes.com/here-now/helping-nepalis-breathe-again/" target="_blank" rel="noopener noreferrer">run out of ICU beds and oxygen cylinders</a>.This time, hospitals are running out of medical staff.As elsewhere, <a href="https://www.nepalitimes.com/here-now/3rd-wave-in-2-years/" target="_blank" rel="noopener noreferrer">the third wave</a> in Nepal is infecting healthcare workers, endangering not only patients with Covid pneumonia, but also those suffering from pre-existing conditions like kidney failure, diabetes, cancers or cardio-vascular diseases.This acute shortage in medical staff across Nepal due to the rapid spread of Omicron has prompted the Ministry of Health to consider shortening the isolation period for doctors, nurses and paramedics to five days. The US and India have already done so.Hundreds of <a href="https://www.nepalitimes.com/here-now/nepal-health-workers-battle-covid-19-but-also-stigma/" target="_blank" rel="noopener noreferrer">health workers</a> are testing positive daily in hospitals all over the country, turning health facilities themselves into a hotbed of the virus.On Tuesday, there were 10,258 new cases out of 22,828 tested, bringing the positivity rate up to 45%. This is the highest ever daily new cases for Nepal and also the highest positivity rate.International airlines flying out of Kathmandu are reporting a sharp increase in the number of passengers who cannot fly because of the PCR positive test results. So far passengers on domestic flights are not required PCR tests, only vaccine cards from next week.“Omicron is spreading like wildfire through all hospitals, in ours alone we have 35 staff testing positive,” says <a href="https://www.nepalitimes.com/banner/nepals-far-sighted-eye-care/" target="_blank" rel="noopener noreferrer">Sanduk Ruit</a> of Tilganga Eye Hospital in Kathmandu.One of the bigger facilities in Kathmandu, HAMS Hospital, has 16 of its clinical staff in isolation after testing positive. On 17 January, 52 staff of the Trauma Centre Hospital tested positive in one day, affecting emergency care of accident victims.Teaching Hospital and Bir Hospital in the Valley also have a similarly high number of doctors and nurses infected and isolating.“Health workers in every ward are infected, Covid has now spread from the emergency to the general ward, the blood bank, physiotherapy, ICU and even the administration,” director of the Trauma Centre Pramod Joshi told Nepali Times.The hospital is now primarily treating patients that need emergency care and surgery. “The hospital is full of patients and the ICU is packed as it always is,” he said.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410114/637204ae9c7e80680e0b2876jpeg.jpg" alt="" width="1641" height="1000"><figcaption> </figcaption></figure>The third wave has now even affected hospitals outside Kathmandu, which are struggling to cope due to a shortage of staff.<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/banner/state-of-the-art-rural-hospital/" target="_blank" rel="noopener noreferrer">Bayalpata Hospital</a> in remote Achham district has curtailed some critical services like C-sections because of sick staff. Charikot hospital in Dolakha district which had finally stopped reporting new Covid infections only last month is back to caring for an increasing number of coronavirus patients but with fewer staff.“Some of us have mild but manageable symptoms but we are still working, we had a shortage of healthcare workers even before this third wave,” Binod Dangal of Charikot Hospital said. “In fact, we have fewer people than we had during the second wave, we have equipment but no trained staff. We are no better prepared than we were before.”The only respite during the third wave is that the new strain is much milder. Because Omicron’s impact is largely confined to the upper respiratory tract, physicians say their patients do not need as much oxygen or ventilator support as was the case with the Delta variant which primarily affected the lungs.Most doctors in and <a href="https://www.nepalitimes.com/here-now/at-the-covid-19-frontlines-in-rural-nepal/" target="_blank" rel="noopener noreferrer">outside Kathmandu</a> say they expect infected staff to be back at work in a week after another test. Even so, given Nepal’s largely unprepared and limited healthcare infrastructure which works on a shift basis, medical staff having to isolate just a few days can seriously disrupt medical care, especially in rural areas where hospitals and doctors were always few and far between.Indeed, this latest crisis reflects on a pre-existing chronic shortage of doctors, nurses and trained medical staff, says <a href="https://www.nepalitimes.com/opinion/diary-of-a-covid-frontline-worker-in-nepal/" target="_blank" rel="noopener noreferrer">Bikash Gauchan</a> of the Gandaki Province Infectious and Communicable Disease Hospital in Pokhara.“What we are experiencing now is both an acute and chronic shortage of healthcare workers, and this carries a lesson for our government, to strengthen and prepare its medical resources for future pandemics,” he adds.<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/here-now/boosting-booster-jabs-against-omicron/" target="_blank" rel="noopener noreferrer">Booster shots for frontliners</a> including healthcare workers in Nepal  started this week, and the additional dose will provide much needed protection to doctors and nurses who work in close contact with possibly infected patients.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410114/637204b29c7e80680e0b2877jpeg.jpg" alt="" width="960" height="641"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410114/637204b49c7e80680e0b2878jpeg.jpg" alt="" width="960" height="641"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410114/637204b79c7e80680e0b2879jpeg.jpg" alt="" width="960" height="641"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410114/637204ba9c7e80680e0b287ajpeg.jpg" alt="" width="960" height="641">But crowded vaccination centres (pictured above) themselves risk being breeding grounds for infection. This time the queues are not just of the unvaccinated getting their first jabs, but also those waiting for boosters. Even if vaccinated, doctors say masks and physical distancing are mandatory.They warn the public <a href="https://www.nepalitimes.com/here-now/omicron-may-not-be-as-risky-but-take-care/" target="_blank" rel="noopener noreferrer">not to be complacent</a> because they are vaccinated and that Omicron is milder. Binod Dangal of Charikot Hospital says: “Most people are treating Omicron as a normal cold but it is very important for us to monitor the progress of the disease in the next few weeks, and prepare for adequate critical care.”At Nepal’s biggest infectious disease centre Teku Hospital, virologist Sher Bahadur Pun cites scientific studies to say that the shortage of healthcare workers will not persist, and the isolation period can be reduced. Nepal has likely passed the most infectious stage of <a href="https://www.nepalitimes.com/here-now/living-with-covid-in-2022/" target="_blank" rel="noopener noreferrer">Omicron spread</a> and it is now time to keep a close watch on people isolating at homes and in hospitals.Pun adds: “We must also investigate which strain is causing Covid deaths in Nepal because if Omicron had indeed replaced Delta, our figures for mortality should not be as consistent as it was before the third wave.”

3rd Covid wave infects Nepal’s frontliners

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110161148/636d1db19c7e80680e0af3d0jpeg.jpg" alt="" width="767" height="575"/><figcaption>Security personnel and relatives of the deceased attend a mourning at the premise of infectious disease hospital in Pokhara. Photos: BARSHA KAFLE</figcaption></figure>A 79-year-old woman lay on the emergency bed, diagnosed with pneumonia due to Covid-19. Even as she was gasping for breath she had a smile on her face, handing over an invitation card to the attending doctor who was also her relative.Her grandson’s wedding was four days later. Family members from across the world had flown into Pokhara for the ceremony. She died of severe acute respiratory distress syndrome with multiple organ failure a day before the wedding, and it had to be cancelled.As her physician, I had sleepless nights when her condition worsened. We <a href="https://www.nepalitimes.com/here-now/nepal-health-workers-battle-covid-19-but-also-stigma/" target="_blank" rel="noopener noreferrer">health-care workers are also human beings</a>. When we lose near and dear ones it takes a toll on our physical and mental health, we grieve when our patients die. We may hide our emotions but we suffer all the same.The woman was just one of many relatives I have lost during this pandemic. As I grieved with family members gathered at the hospital, we were once again reminded of the Buddhist teachings about impermanence. Yet none of us is ever ready.“But it must be easier for you to face death as a doctor,” one of the mourners said to me. No, it is just as difficult. If not more, because as a physician I had the added responsibility of saving her life.Army men dressed in PPE from head to toe had arrived to take her body for safe disposal. Relatives from across the world who had come to celebrate a wedding ended up attending a funeral.The Gandaki Province government established Nepal’s first provincial infectious disease hospital in July 2020. Since then, it has managed nearly 1,300 Covid-19 cases at a cost of Rs500 million.Tha Gandaki Province government established Nepal's first provincial infectious disease hospital in July 2020. Since then, it has managed nearly 1, 300 Covid-19 cases saving Rs500 million out of pocket expenditure of common people.We have lost 52 people to the coronavirus in the same period. The Covid-19 mortality rate in this provincial hospital is 4.1%, relatively high compared to the total number of people who were hospitalised.The global death rate now stands at 1.97% with a total of 5,318,277 fatalities. This figure is exceptionally high given it has only been two years. Even then, this figure does not include <a href="https://www.nepalitimes.com/banner/the-real-cost-of-nepals-second-wave/" target="_blank" rel="noopener noreferrer">the social, mental and economic consequences</a> to family and friends of the deceased.But each Covid death is also a lesson for us to learn from. Most of these deaths could have been prevented if only Nepal had a robust primary health care system, and if preventive measures were more strictly enforced.With the <a href="https://www.nepalitimes.com/here-now/omicron-may-not-be-as-risky-but-take-care/" target="_blank" rel="noopener noreferrer">rise of new variants like Omicron</a>, it is also advisable to up our vaccination drive and we should also start administering boosters to vulnerable populations given our stock of doses and those that are on the pipeline.A man in his late thirties was isolating at home in Pokhara after getting infected. He just had a common cold but I requested him to undergo hospital-based isolation as he was symptomatic. But just a few days after getting admitted, his symptoms worsened and his condition deteriorated. He was then transferred to another hospital, and died soon after.This was not a case that should have been fatal. Even after 12 years of clinical experience, some of the Covid-19 outcomes I have encountered in the past year have been unexpected and shocking. It must have been devastating for the young man’s family and friends.Earier this year, when a 86-year-old mukhiya from Mustang died at our hospital of Covid complications, hundreds of Thakalis travelled to Pokhara to show their respect to the deceased despite the coronavirus surge at the time. Young or old, the virus was indiscriminate.In November 2020, I myself had to self-isolate with an upper respiratory infection due to a coronavirus infection. I thought I would not survive the excruciating body ache, sleepless nights and high anxiety level. During those horrific 10 days at <a href="https://www.nepalitimes.com/here-now/at-the-covid-19-frontlines-in-rural-nepal/" target="_blank" rel="noopener noreferrer">Bayalpata Hospital in Achham</a> I was battling an infection that I was treating my patients for.An elderly couple had been admitted to our hospital with Covid, both of them had severe symptoms. The husband died within a few hours of admission, but his wife was not aware of his passing until she became critically ill herself, and the family decided to tell her the truth. She passed away a week after her spouse. Medical staff usually have seen it all, but so moved with sorrow they mourned too.Holistic <a href="https://www.nepalitimes.com/banner/this-is-how-to-upgrade-nepals-rural-health/" target="_blank" rel="noopener noreferrer">health care</a> is the central core of modern medicine. But the caregivers can provide only acute biomedical care to alleviate the suffering of Covid patients. Their psycho-social wellbeing and that of their family members are often ignored. And we have not even begun to think about the mental health and trauma of the frontline workers.Over 800,000 Nepalis have been infected with the coronavirus and 12,852 have died of the disease. It is time we study this data, in particular the common causes of Covid-19 deaths in Nepal. Is it heart attack, blockage of vessels in the lungs, multiple organ failure or acute respiratory distress syndrome?We must reshape our health policies based on these facts and evidence. We must ensure adequate preparation with ICU beds, oxygen supply, <a href="https://www.nepalitimes.com/latest/donated-ventilators-gather-dust-in-nepal/" target="_blank" rel="noopener noreferrer">ventilators</a> and other equipment that were in short supply earlier this year.Only then can we design a robust and customised care system to protect our population from future surges.Bikash Gauchan is the Executive Director of the Infectious and Communicable Disease Hospital in Gandaki Province.

Diary of a Covid frontline worker in Nepal

<figure><img width="1098" height="732" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110161148/636d1d329c7e80680e0af39djpeg.jpg" alt=""/><figcaption>Photo: AMIT MACHAMASI</figcaption></figure>The fact that Omicron was detected in an individual who had arrived in Nepal five days before the new variant was first identified in Botswana is proof it was already circulating and travel bans do not work.
<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/latest/nepal-on-high-alert-for-omicron/" target="_blank" rel="noopener noreferrer">The new strain</a> has been detected in over 40 countries mere two weeks after it was first detected. What is known so far of Omicron is that it is highly transmissible but likely not very severe as there has been no significant increase in hospitalisations among infected individuals in places with outbreaks.
“Looking at preliminary findings I don’t think it will lead to another <a href="https://www.nepalitimes.com/banner/the-real-cost-of-nepals-second-wave/" target="_blank" rel="noopener noreferrer">major surge or lockdowns like Delta</a>, but having said that we must be prepared and contain it to prevent further mutation and more virulent strains,” says epidemiologist Lhamo Yangchen Sherpa of IPAS Nepal.
She adds: “We do that by vaccinating as many people as possible including boosters if they are nearing expiry date as we know them to be, following safety measures especially indoors and by better communicating government policies to control the spread of new strains.”
One of the main concerns with Omicron is mutations in the spike protein that binds it to the receptor. Most vaccines including Pfizer, Moderna, AstraZeneca and J&amp;J primarily target this spike protein, so there are worries that the new variant will escape immunity afforded by jabs.
Mutations are natural, but coronaviruses make fewer of them than other viruses because of their much stronger <a href="https://www.sciencedirect.com/science/article/pii/S1097276520305189" target="_blank" rel="noopener noreferrer">proofreading system</a> to survive.
<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.indiaspend.com/indiaspend-interviews/omicron-wont-be-much-more-dangerous-than-other-circulating-covid-19-variants-790812" target="_blank" rel="noopener noreferrer">Speaking with India Spend</a>, Polly Roy, professor of virology at the London School of Hygiene &amp; Tropical Medicine said: ‘Even though we have a mutation, it’s not in the receptor-binding site area so much. Thus, if they change too much, the virus will not bind to host cells and will not survive. And the vaccines target that area, so the vaccines will still work against Omicron infection.’
Says infectious disease specialist at HAMS Hospital Anup Subedee: “Even if the vaccines are less effective against this variant, it will still provide significant immunity to fight off new infections. And given that antibodies wane over time, <a href="https://www.nepalitimes.com/here-now/nepal-health-workers-battle-covid-19-but-also-stigma/" target="_blank" rel="noopener noreferrer">Nepal’s frontline workers</a> and the elderly should be prioritised for boosters, if possible with vaccines known to have higher efficacy.”
There are also concerns that despite registering only mild symptoms Omicron could affect vulnerable populations much later as it is the younger mobile population who are usually infected first without much impact on their health. 
Most of the initial Omicron infections are said to be mild and among young and vaccinated people, which means Nepal could be ripe for another surge. 
“Don’t be surprised if we do,” says Sushil Koirala, a Nepali public health expert based in Bangkok. “We have all the necessary fuel to start the wildfire: low vaccination coverage, poor adherence to public health measures, lackluster preparedness, and questionable surveillance,” Koirala warns.
But <a href="https://www.nepalitimes.com/here-now/do-nepalis-need-covid-booster-shots/" target="_blank" rel="noopener noreferrer">the moral dilemma over booster</a> remains when over 60% of Nepal’s targeted population is yet to even receive the first dose.
“In an ideal world, universal coverage is the way to go but the government hasn’t been able to vaccinate the majority of Nepalis, so we cannot wait forever for boosters either,” adds Subedee.With the rapid spread of Omicron in the region, the Nepal government has announced that it will vaccinate at least 200,000 people a day and the Health Minister Birodh Khatiwada has asked people who have inoculated with two doses of vaccine to also receive the third dose to prevent <a href="https://www.nepalitimes.com/latest/nepal-needs-to-prepare-for-new-covid-wave/" target="_blank" rel="noopener noreferrer">the risk of the third wave</a>.
Khatiwada was quoted as saying that the government had a stock of 20 million doses of different jabs and it will start administering the booster from mid-December with 16,000 vaccination centres across the country.
So far Nepal has received 25,658,630 doses of the Covid vaccine of which some 660,000 doses still in stock. In the next three months, a total of 34,594,460 doses of different jabs are arriving in Nepal: 9,403,000 doses of AstraZeneca, 3,000,000 Coronavax, 2,386,800 VeroCell (one vial, one dose), 2,174,400 J&amp;J and 1,965,600 Moderna.
But the government’s focal person for vaccine Shyam Raj Upreti told Nepali Times health authorities are authorised to administer only an additional dose, not <a href="https://www.nepalitimes.com/latest/booster-lack-strands-israel-bound-nepalis/" target="_blank" rel="noopener noreferrer">a booster</a>, and only for immunocompromised people and individuals above 60 who had received VeroCell, as recommended by the WHO.
“Our priority is still to vaccinate the targeted population and hence those who are still not vaccinated,” adds Uprety. “And for this, we are focusing on activities to convince more people to inoculate, add vaccination booths to increase access and where required administer the doses door to door.”
At present, 29% of Nepal’s population has been fully inoculated while 33.9% have been vaccinated partially. Experts say better communication about vaccination schedules a few days before the campaign in local language and on platforms most consumed is crucial in further <a href="https://www.nepalitimes.com/opinion/giving-all-nepalis-a-shot-at-the-covid-vaccine/" target="_blank" rel="noopener noreferrer">increasing the uptake</a>.
Equally important is building a storage facility for Pfizer and Moderna vaccines that are in the pipeline to vaccinate children 12 and above. A limited number of students who revived Pfizer jabs last month are yet to receive their second dose, recommended after three weeks of the first.
Speaking on his social platform, Sameer Dixit of the Centre for Molecular Dynamics Nepal recommended patience over panic: “Let’s wait and watch until we have more concrete findings on Omicron. Until then mask up and vaccinate as soon as it is available. As for boosters, those in vulnerable groups should get it.”

Omicron may not be as risky, but take care

<figure><img width="1500" height="1125" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141156/636d02f09c7e80680e0a36a9jpeg.jpg" alt=""/><figcaption>Photo: KUNDA DIXIT</figcaption></figure>After nearly two years of nearly zero tourist arrivals and revenue, Nepal looks set to welcome international tourists again after the government on Thursday introduced <a href="https://www.nepalitimes.com/latest/nepal-relaxes-entry-for-tourists/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/nepal-relaxes-entry-for-tourists/&amp;source=gmail&amp;ust=1632570637352000&amp;usg=AFQjCNHnLyYWvLXJvsJU8eaBdNrKPZ6tVw">revised immigration</a> entry protocols. Tourists fully vaccinated against Covid, with the second dose 14 days before the date of travel, will no longer have to quarantine after landing in Kathmandu and can get visas <a href="https://www.nepalitimes.com/here-now/nepal-should-now-allow-visa-on-arrival/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/nepal-should-now-allow-visa-on-arrival/&amp;source=gmail&amp;ust=1632570637352000&amp;usg=AFQjCNHjF2QHUC13ukwzJScBCBN92EtMBQ">on arrival</a>. Earlier, they had to get visas from Nepal’s missions abroad and quarantine for seven days at a hotel in Kathmandu at their own expense.Partially vaccinated and unvaccinated visitors will have to obtain visas from Nepal’s embassies in their home countries or elsewhere, and will still have to spend 10 days in a government approved hotel in Kathmandu and get a PCR negative test before they go out and about.Tourists coming via land, except Indians who are visa-exempt, must arrive with their visas from Nepali diplomatic missions and be subject to a negative antigen test at the Chinese or Indian borders. “The government looked at the current trend of Covid infections, transmission and disease control to reach this decision,” says spokesperson of the Immigration Department Jhanka Nath Dhakal. “Entry of fully vaccinated tourists becomes easier as a lot of additional paperwork can be avoided.”   However, all visitors, including fully vaccinated ones will have to present a negative PCR or other test report done not longer than 72 hours before their flight, and bring a printout of the international arrival form at <a href="http://www.ccmc.gov.np/" data-saferedirecturl="https://www.google.com/url?q=http://www.ccmc.gov.np/&amp;source=gmail&amp;ust=1632570637352000&amp;usg=AFQjCNETnSNgD6N7OXNBWaTNnPNsbVT4UQ">www.ccmc.gov.np</a> to immigration for visa on arrival.The new protocols were issued even though the Covid-19 Crisis Management Committee (CCMC) itself does not have legal standing because an ordinance establishing it has lapsed because of the continued political impasse in Parliament.Nepal’s tourism industry had been lobbying strongly with the government to ease restrictions as the case load and fatalities in Kathmandu drop, and the vaccinate rate goes up in countries from where most visitors come to Nepal.  They argued that millions of jobs were at stake, investors were defaulting on loans for hotels, airlines and restaurants and the government was losing the $800 million it used to earn a year from tourism prior to the pandemic. <img width="1920" height="1080" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141156/636d02f59c7e80680e0a36aajpeg.jpg" alt="">Members of the tourism industry had criticized <a href="https://www.nepalitimes.com/banner/call-to-ease-entry-of-tourists-to-nepal/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/banner/call-to-ease-entry-of-tourists-to-nepal/&amp;source=gmail&amp;ust=1632570637352000&amp;usg=AFQjCNHqIs-F1N3YhbPuKTGkxsfontRJvw">earlier entry regulations</a> as being cumbersome and confusing, detracting potential visitors. For example, tourists needed to submit NTB or Department of Tourism-approved travel itineraries to obtain visas on-arrival while quarantining for seven days.  As a result, only tourists with well-connected agents could arrange the paperwork and arrive easily. Travel trade stakeholders complained of arbitrary visa requirements and ad hoc decision making.  While most tourists were previously discouraged by the convoluted regulations, news of the revised protocol has generated an overwhelmingly positive response.  Deepak Raj Joshi, the former CEO of the Nepal Tourism Board (NTB) is glad the government finally took the decision.“The tourism industry is now buoyant, stakeholders are pleased and demand from potential tourists is massive, so we must aggressively and effectively communicate the return of Nepali tourism into source markets,” Joshi says.  A streamlined entry process is a much-needed boost for tourism, one of the sectors hit hardest by Covid. Nepal got nearly 1.2 million tourists in 2019, but this figure dropped to only 220,000 in 2020 – mot of them who had arrived before the lockdown in March that year. So far this year, there have been only 70,000 visitors – most are either mountaineers or repeat trekkers, or those familiar with Nepal and have some connections here. <figure><img width="935" height="398" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141156/636d02f89c7e80680e0a36abjpeg.jpg" alt=""><figcaption>Tourist arrivals in Nepal from January to November 2020. Data: NEPAL TOURISM BOARD</figcaption></figure>Despite the <a href="https://www.nepalitimes.com/here-now/survive-2020-revive-in-2021-and-thrive-in-2022/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/survive-2020-revive-in-2021-and-thrive-in-2022/&amp;source=gmail&amp;ust=1632570637352000&amp;usg=AFQjCNEO67ibb82phNtJ_SPK2OBPcSmA1g">socio-economic fallout </a>from the pandemic, the tourism industry has prepared well to host tourists again. Vaccine penetration in the hospitality sector is high, and the new, simplified entry requirements are the next step in restoring a “new normal” for tourism alongside Covid in the long-run.Most frontliners working the tourism industry are already vaccinated, and in popular destinations such as Langtang, workers as well as locals are jabbed. Trekking and mountaineering may soon continue as normal, with expedition groups usually no larger than 20-30 members and everyone involved inoculated.There has been a trickle of trekkers coming to Nepal even under the older stricter rules, and there are expedition already at base camps of various mountains including Manaslu, Dhaulagiri and Kangchenjunga. There have been no climbing permits issued for Mt Everest.“Lobbying is underway to implement a ‘V-to-V’, vaccinated-to-vaccinated tourism model whereby vaccinated guests are hosted by vaccinated hospitality services,” says Joshi. Such a model is particularly relevant for tourists coming overland through border cities such as Birganj, Biratnagar and Nepalganj and have high vaccination rates, and the visiting Indians themselves are increasingly getting inoculated. Tourism as an industry is based on trust and hospitality as it sells services, leaving no room for negligence and error. This makes it a relatively safer sector than others, says Joshi. “If a tourism-based business doesn’t follow health guidelines and helps spread disease, it loses trust and trade for life, making the entire industry cautious and aware,” he says. “That the government readily allowed crowded religious processions to go on while stalling on safe tourism speaks volumes on flawed planning.” <img width="1448" height="2048" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141156/636d02fa9c7e80680e0a36acjpeg.jpg" alt="">Elsewhere, on-arrival visas have also been resumed for those returning for funerals of relatives, those who are convalescing, or returning to care for elderly citizens – but they have to produce negative Covid tests and recommendations from local governments and hospitals. On-arrival visas are also on offer for returning non-resident Nepalis and foreigners married to Nepali nationals. Nationals of the following countries will need to have visas before they arrive in Kathmandu: Zimbabwe, Swaziland, Cameroon, Somalia, Liberia, Nigeria, Ghana, Ethiopia, Iraq, Palestine, Afghanistan and Syria.

Nepal reopening for tourists

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141128/636cfd239c7e80680e0a0bcajpeg.jpg" alt="" width="768" height="512"/><figcaption>People lining up for Covid vaccination in Kathmandu this week. Photo: AMIT MACHAMASI</figcaption></figure>The unprecedented speed at which effective Covid-19 vaccines have been discovered is truly inspiring. The problem with acceptance and <a href="https://www.nepalitimes.com/opinion/im-sad-vaccines-are-delayed-in-nepal/" target="_blank" rel="noopener noreferrer">distribution of those vaccines</a>, however, is another story.Scientists can invent vaccines faster than ever, but political scientists cannot find answers to the problems of <a href="https://www.nepalitimes.com/banner/once-nepal-gets-vaccines-they-need-to-be-fairly-distributed/" target="_blank" rel="noopener noreferrer">vaccine denial and inequity</a>.If this pandemic had happened 50 years ago and an effective and safe vaccine had ultimately been found, in all likelihood the administration of these vaccines would have happened more smoothly, probably with more equity and <a href="https://www.nepalitimes.com/opinion/why-vaccination-should-be-compulsory/" target="_blank" rel="noopener noreferrer">much less fuss</a>.To be sure, there was similar opposition to the smallpox vaccine when it was first developed, but eventually it was mandated by governments and the disease eradicated. And millions of lives are saved annually in low income countries by vaccines against preventable diseases.But the speed with which medical science has come up with effective Covid-19 vaccines has been a game-changer. If this is followed by treatment protocols, it will be even more spectacular.And the best example to showcase efficacious treatment has been the Oxford University-lead Recovery (Randomised Evaluation of Covid-19 Therapy) trial in which Nepal was the first actively participating site outside the UK.In June 2020, the results of this trial showed that an inexpensive and widely-available drug, dexamethasone (a corticosteroid) substantially reduced deaths in <a href="https://www.nepalitimes.com/here-now/helping-nepalis-breathe-again/" target="_blank" rel="noopener noreferrer">hospitalised patients requiring oxygen</a>. As a result, the drug has saved millions of lives.For those of us in the health profession in Nepal, Covid-19 evoked a feeling of déjà vu. Common rampant infectious diseases like typhoid and tuberculosis are ideally controlled by <a href="https://www.nepalitimes.com/latest/nepal-covid-19-impact-worse-than-official-figures/" target="_blank" rel="noopener noreferrer">contact tracing</a> and treatment. Implementing these measures against another human-to-human infection like Covid-19 should therefore have been a no-brainer.Unfortunately, in South Asia contact tracing even for biblical diseases like typhoid and <a href="https://www.nepalitimes.com/banner/tb/" target="_blank" rel="noopener noreferrer">tuberculosis</a> is not done. We would have been able to more easily deal with Covid-19 if we already had contact tracing in place for these rampant, but overlooked, diseases mostly afflicting the impoverished.The trajectory of the pandemic has led to revelations. Herd immunity acquired with previous infections seems to be an unreliable and less robust way to seek protection from the virus. This was dramatically illustrated with the <a href="https://www.nepalitimes.com/here-now/delta-variants-wake-up-call-for-nepal/" target="_blank" rel="noopener noreferrer">spread of the Delta virus</a> in India where many people, including doctors, thought they had enough antibody protection.The BCG vaccine (against TB) was <a href="https://www.nepalitimes.com/latest/could-an-anti-tb-vaccine-be-protecting-nepalis/" target="_blank" rel="noopener noreferrer">thought by many to protect them</a>, and that has also turned out to be probably untrue. Protection afforded by prior exposure to other respiratory viruses including coronaviruses (non-Covid 19) also seems non-existent. The fallacious argument that we are hardy people from South Asia who are protected by our spicy diet also took a hammering.The most dramatic observation during this pandemic has been in human behaviour and psychology. Literate people (many in high income countries) refusing to <a href="https://www.nepalitimes.com/here-now/3-pronged-strategy-to-save-nepal-from-covid-19/" target="_blank" rel="noopener noreferrer">wear masks</a> or be vaccinated despite overwhelming scientific evidence, is bewildering.So, while vaccine stockpiles are nearing their expiry dates in the United States and parts of Europe, people in Africa and Asia are literally dying to be vaccinated.Vedic philosophy calls this era the Kali Yug, a time when knowledge does not translate into wisdom. When individualism takes precedence over collective welfare, people are unkind and intolerant to each other.Lack of humility and an excess of human hubris is also clearly in evidence during this pandemic. Leaders of countries who boasted that they were saviours of the world by promising vaccines were brought to their knees with <a href="https://www.nepalitimes.com/banner/vaccines-variants-and-a-third-wave/" target="_blank" rel="noopener noreferrer">the spread of the Delta variant</a>. Those who extolled their superior public health status have had to eat their words.Hypocrisy is also in full display. Early grandiose talk of vaccine equity in high income countries even before the discovery of the vaccine <a href="https://www.nepalitimes.com/opinion/hope-hyperbole-and-hypocrisy-of-covax/" target="_blank" rel="noopener noreferrer">was soon forgotten</a> as countries stockpiled up to four times what was needed to vaccinate their eligible populations with two doses.Many countries did not put their money where their mouths were, espousing vaccine nationalism. The concept of vaccine distribution equity is now like talk of motherhood and apple pie.The virus clearly showed us that the world needs not only universal health care and universal basic income but just as much universal behavioural therapy. Even in their enlightened self-interest, these countries should ensure universal vaccination because science has shown that the more people remain unvaccinated, the <a href="https://www.nepalitimes.com/opinion/no-country-is-safe-until-we-are-all-safe/" target="_blank" rel="noopener noreferrer">more the danger of variants mutating</a>.Here on, since 70% vaccine coverage will take time, Nepalis need to <a href="https://www.nepalitimes.com/banner/vaccines-or-no-vaccines-mask-and-distance/" target="_blank" rel="noopener noreferrer">continue to mask up and wash hands</a>. Those who are vaccinated must remember that it does not always protect them from infection, just severe symptoms, and they can be carriers to spread it to others. Vaccines only reduce mortality and morbidity and hospitalisations.Same with masks. Wearing a mask and going into crowded places defeats the purpose. Those following proper guidelines have noted that they are less sick than usual with respiratory and gastrointestinal ailments. The use of masks and frequent hand washing in Nepal’s unsanitary conditions may lead to a decrease of other common infections besides Covid-19.All presently available vaccines are effective in the prevention of <a href="https://www.nepalitimes.com/banner/nepals-uneven-covid-19-deaths/" target="_blank" rel="noopener noreferrer">Covid-19</a> infections, especially regarding hospitalisation. The important thing is not to miss the opportunity to get vaccinated with whatever doses are available whenever. All the available vaccines are safe and have very few, if any, contraindications even in pregnancy.There is much less vaccine hesitancy and denial in Nepal now, especially after people saw how unvaccinated people in their families and neighborhood could easily succumb to the virus.We have to psychologically prepare ourselves for the likelihood that the <a href="https://www.nepalitimes.com/banner/how-nepal-must-prepare-for-3rd-covid-wave/" target="_blank" rel="noopener noreferrer">pandemic will continue for many more months</a> unless the vast majority of us in the world are promptly vaccinated. Herd immunity from vaccination is much more reliable than herd immunity from natural infection.Amazingly, no world leader has gone beyond rhetoric to actually start delivering vaccines to all corners of the world. As the pandemic plays out, the best-case scenario is that Covid-19 antibodies will be present even years after vaccination or post-infection, as was noted with SARS (a different but deadly coronavirus infection in 2002) and provide protection for years to come.Or perhaps Covid-19 will peter out and become like the influenza virus requiring a jab every winter. Variants may continue to be a problem, but no one knows for sure as this is indeed a <a href="https://www.nepalitimes.com/opinion/what-is-novel-about-the-novel-coronavirus/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/opinion/what-is-novel-about-the-novel-coronavirus/&amp;source=gmail&amp;ust=1629080960620000&amp;usg=AFQjCNHYX5K-ItauU5qj1nRZM3tMxFIYsw">novel coronavirus</a>, and we are still learning. In all likelihood, vaccines will continue to be effective even against variants.One thing is for sure, all this shall also pass. But we have to learn lessons to be better prepared for the next pandemic.Buddha Basnyat is a physician and clinical researcher at Patan Academy of Health Sciences and a <a href="https://www.nepalitimes.com/opinion/what-is-novel-about-the-novel-coronavirus/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/opinion/what-is-novel-about-the-novel-coronavirus/&amp;source=gmail&amp;ust=1629080960620000&amp;usg=AFQjCNHYX5K-ItauU5qj1nRZM3tMxFIYsw">frequent health columnist</a> for Nepali Times.

Buddha Basnyat

Dying to get vaccinated

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141124/636cfc2c9c7e80680e0a0b73jpeg.jpg" alt="" width="1500" height="1000"/><figcaption>Photo: MONIKA DEUPALA</figcaption></figure><ul><li>Two years ago after going through a bad relationship, a 36-year-old Kathmandu-based doctor started getting suicidal thoughts. During the long months of lockdown, he would be on the rooftop and imagine jumping off to end it all. But before long he realised that he was causing self-harm, and sought help. He was diagnosed with depression, eight months into treatment he is rid of suicidal thoughts and is back to his outgoing ways.</li> <li>The bubbly young woman used to be the life of every party, but few of her friends and relatives realised what was going on inside her mind. As the pandemic hit, she started having violent thoughts about harming others and herself. The 22-year-old tried to deal with it herself, but two months ago she sought help from a mental health doctor. She was diagnosed with Obsessive Compulsive Disorder (OCD) and started treatment. Looking back, she advises others to also seek professional help in time.</li> <li>The young woman felt worthless, lacked confidence, avoided crowds and had self-inflicted cuts on her arm. Her inability to come in terms with her sexuality aggravated her sense of insecurity. When the pandemic foiled her plans, she blamed everything on herself, she felt irritated and uncertain, stopped attending virtual classes and her eating habits changed. She finally sought help for her depression and she is now under regular psychiatric counselling and medications. Grounding exercises in particular have helped her overcome self-harm and feelings of inadequacy. “I am okay now,” she says.</li></ul>As the pandemic turns lives upside down, there has also been a global <a href="https://www.nepalitimes.com/here-now/post-pandemic-mental-health-epidemic/" target="_blank" rel="noopener noreferrer">outbreak of mental health disorders</a>, and Nepal has reported a rise in suicides. However, as these cases show, professional counselling and medication can save lives.Recoveries rarely make news, only suicides do.“Most of my patients who attempted suicide have gone on to lead normal lives after they get treatment, and oftentimes they look back to their mental health crisis as nothing more than a lapse of judgment,” says psychiatrist and researcher Rishav Koirala.There has been a sharp rise in <a href="https://www.nepalitimes.com/latest/have-suicides-increased-during-nepal-lockdown/" target="_blank" rel="noopener noreferrer">suicides in Nepal</a> since the Covid-19 pandemic in March 2020 and subsequent lockdowns. Nepal Police data shows that in the last 12 months, there have been 7,141 reported deaths due to suicides nationwide, up from 6,252 the year before.Do not shy away from seeking help. If you, or anyone you know, would like to speak to a trained mental health professional, please contact:TUTH Suicide Hotline: 9840021600Transcultural Psychosocial Organisation-Nepal Crisis Hotline: 1660 0102005Mental Health Helpline Nepal: 1660 0133666Centre for Mental Health and Counselling Nepal Toll-free: 16600185080, Hotline: 1145Koshish Toll-free helpline: 166001-22322 (Bagmati Province)Patan Hospital Helpline: 9813476123National Suicide Prevention helpline operated by Mental Hospital Lagankhel and TPO: 1166<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141124/636cfc2e9c7e80680e0a0b74jpeg.jpg" alt="" width="640" height="475"><figcaption> </figcaption></figure>In a survey last year, <a href="http://www.tponepal.org" target="_blank" rel="noopener noreferrer">Transcultural Psychosocial Organisation (TPO) Nepal</a> which works with mental health compared five years of suicide data for March-July to see if there was any change during the lockdowns in 2020 and 2021.The results are revealing: suicides have been increasing steadily at an average rate of 8.5% every year, but it spurted to 19.4% in the first four months of the lockdown. Researchers also conducted key informant interviews across Nepal, who reported witnessing an increase in <a href="https://www.nepalitimes.com/latest/suicide-watch/" target="_blank" rel="noopener noreferrer">suicidal behaviours</a> in the community as well as health facilities.“We now have both quantitative and qualitative evidence that mental health problems have increased following the pandemic,” says TPO Nepal’s executive director Kamal Gautam. “And given that the majority of suicides are caused by psychological problems, we can say that Covid-19 has significantly contributed to its increase.”Mental health professionals have long been warning of an epidemic of psychological disorders following the Covid-19 crisis. They have reported an increase in anxiety, depression, post-traumatic stress disorder (PTSD), hypochondria, obsessive disorders and psychotic symptoms among the general population in the last two years.Economic collapse, job loss and slashed income due to the pandemic as well as <a href="https://www.nepalitimes.com/latest/in-nepal-lockdown-a-domestic-violence-spike/" target="_blank" rel="noopener noreferrer">increased domestic and sexual violence</a> and added workload during the lockdowns have all acted as contributing factors. In addition, those afflicted do not have normal social interactions that used to be a safety valve during more normal times.Moreover, many patients on treatment and medication have relapsed due to the limited access to health services, counselling and psychotropic drugs during the pandemic, and in many cases because of Covid phobia.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141124/636cfc319c7e80680e0a0b75jpeg.jpg" alt="" width="1052" height="690"><figcaption> </figcaption></figure>Up to 80% of suicides have mental health disorders as an underlying cause. A significant portion of cases are also a result of impulsive behaviour.Experts agree that the official <a href="https://www.nepalitimes.com/here-now/nepals-suicide-rate-vastly-underestimated/" target="_blank" rel="noopener noreferrer">numbers on suicides are vastly underestimated</a> due to a lack of suicide registry. Official figures are based solely on police data and post-mortems, and because of stigma associated with mental health, many families also often refrain from revealing the actual cause of death.Official records also do not take into account <a href="https://www.nepalitimes.com/here-now/in-the-minds-of-nepals-migrant-workers/" target="_blank" rel="noopener noreferrer">suicides of Nepali migrant workers overseas</a>, mainly Malaysia and South Korea. Similarly, suicides among those in the LGBTIQ community who have lost their limited sources of livelihood during the pandemic have been largely neglected.“Reported cases alone are not conclusive, but given that we now have a year and a half long trend and data, we have seen a significant increase in mental health disorders, and can assume that pandemic has played a crucial part in the rise in the number of suicides,” adds Rishav Koirala.<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.who.int/news-room/fact-sheets/detail/suicide" target="_blank" rel="noopener noreferrer">More than 700,000 people die by suicide</a> every year around the world, that is one in every 100 deaths -- more than HIV, malaria, breast cancer, or war and homicide. And for every suicide, there are many more who make attempts to end their lives.Nepal is among the countries with the highest suicide rates in the world and consistently ranks within the WHO’s top 10 list. The Nepal Health Research Council (NHRC)’s <a href="http://nhrc.gov.np/wp-content/uploads/2020/09/Factsheet-Adults-1.pdf" target="_blank" rel="noopener noreferrer">National Mental Health Survey</a> published earlier this year found the prevalence of suicidality (current suicidal thoughts, lifetime suicidal attempt and future likelihood of suicidal thoughts) to be high at 7.2% among Nepalis.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141124/636cfc339c7e80680e0a0b76jpeg.jpg" alt="" width="1464" height="752"><figcaption> </figcaption></figure>The first of its kind survey in Nepal interviewed 15,088 participants and was carried out before <a href="https://www.nepalitimes.com/opinion/coping-with-anxiety-in-new-lockdown/" target="_blank" rel="noopener noreferrer">the pandemic</a> from January 2019 to January 2020. The study revealed that 10% of Nepal’s adult population had mental health problems in their lifetime with 4.3% experiencing some disorders at present.Mood disorders and neurotic and stress-related disorders were among the most common <a href="https://www.nepalitimes.com/latest/tackling-nepals-mental-health-pandemic/" target="_blank" rel="noopener noreferrer">psychological problems among Nepalis</a>. The prevalence of lifetime disorders was found the highest in Province 1 (13.9%), in the age group 40-49 years (13.3%) and among males (12.4%). As for current disorders, Bagmati scored the highest (5.9%) as well as those in the age group 40-49 years (6.3%) and females (5.1%).These figures correlate with Nepal’s suicide data of the past five years. Despite fewer attempts, men accounted for 57% of total suicides, against 43% of women. Among minors, however, more girls died by suicide, which experts ascribe to possible victimisation and a higher prevalence of borderline personality disorder among younger females.Suicide deaths are also disproportionately distributed across Nepal with Province 1 recording 65 deaths per 100,000 populations. Lumbini and Gandaki follow closely with 58 and 52 per 100,000 respectively. Traditionally neglected by the state and economically disadvantaged Karnali, Far West and Province 2 regions have lower suicide rates.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141124/636cfc369c7e80680e0a0b77jpeg.jpg" alt="" width="2287" height="1816"><figcaption> </figcaption></figure>More people are dying of suicides in urban centres such as Kathmandu Valley and Ilam district, which reported 32 and 38 suicide deaths respectively per 100,000 populations last year against Rautahat’s 18 and Humla’s 6.This is in direct contrast with the global trends where 77% of suicides occur in low and middle-income countries. Unemployment and poor economic condition have long been associated with a high risk of suicides, but only up to a certain point, as proven by recent data. Japan, <a href="https://www.nepalitimes.com/here-now/dead-end-of-the-korean-dream/" target="_blank" rel="noopener noreferrer">South Korea</a> and Hungary with their higher per capita GDPs have some of the highest suicide rates in the world.“Poorer nations have weaker education and health systems, which translates into delayed or even lack of diagnosis but poverty is not a sole factor for suicides,” says Kamal Gautam. “Suicide is complex and there are multiple factors at play which means a linear approach to prevention would be incomplete, it needs an integrated approach.”Addressing underlying mental health disorders is the most effective way to prevent suicides. This means increased awareness and education about psychological disorders, which in turn can help <a href="https://www.nepalitimes.com/here-now/all-in-the-family/" target="_blank" rel="noopener noreferrer">reduce societal stigma</a>. An introduction to and discussion on mental health in the school curriculum can further sensitise the public.In addition to medication and counselling, societal structure and family dynamics is an important support system for individuals suffering from psychosis, trauma and depression. Telemedicine in particular has been essential in preventing self-harm during the pandemic-induced restrictions but mental health services need to be scaled up across the country.On the other hand, a strict regulation must be implemented on the <a href="https://www.nepalitimes.com/here-now/suicide-by-pesticide-in-nepal/" target="_blank" rel="noopener noreferrer">availability of pesticides</a>, an easy means of suicide for many. Access to alcoholic products must also be supervised with Nepalis known to self-medicate to cope with stress and trauma, in turn increasing the risk of self-harm and suicide.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141124/636cfc399c7e80680e0a0b78jpeg.jpg" alt="" width="1280" height="853"><figcaption> </figcaption></figure>But most of all, analysing suicide attempts can be a powerful tool for prevention. On average, there are six attempts behind every suicide. Up to 80% of people with suicidal ideation reveal their intention to either a family member, friends or their doctors within a month before their attempt.“We forget that even before the pandemic suicide rates were very high in Nepal and while the pandemic might have added to the problem, the figures alone don’t mean anything if we fail to also study suicide attempts to find a stronger link between the prevalence and the contributing factors,” says Rabi Shakya, psychiatrist and director of Patan Academy of Health Sciences.He adds: “Historically, there have been more suicides after than during the crisis due to the long-term socioeconomic impacts. So we must start preparing for the pandemic of mental health problems including suicides post-Covid. Our health care workers must be trained and fanned out across the country.”Nepalis are not new to mental health problems induced by a crisis. The 10-year-long Maoist insurgency killed 17,000 people but many more continue to suffer from <a href="https://www.nepalitimes.com/here-now/the-mental-scars-of-violence/" target="_blank" rel="noopener noreferrer">PTSD, depression, anxiety and distress</a>. A 2017 report published in the journal Lancet found as high as <a href="https://archive.nepalitimes.com/article/nation/stigma-and-silence-mental-health-nepal,3486" target="_blank" rel="noopener noreferrer">37.5% of the general public</a> had some form of psychological disorder.The <a href="https://www.nepalitimes.com/here-now/its-all-in-the-mind/" target="_blank" rel="noopener noreferrer">2015 earthquake</a> further added to Nepal’s epidemic of mental disorders. Survivors who had narrow escapes or lost family members reported increased panic attacks, anxiety and trauma.But <a href="https://archive.nepalitimes.com/article/editorial/the-republic-of-insomnia,3311" target="_blank" rel="noopener noreferrer">conflicts, disasters</a> and pandemics have shined a light on mental health with an increased national and foreign investment in prevention and management. With larger chunks of the population impacted, there is now more acceptance and the field is starting to get the priority it warrants.Says Rishav Koirala, WHO focal person for mental health post-2015 earthquake: “The best way to prevent suicides is to address underlying psychological disorders and crises, despite adding to the burden has helped normalise them because many more people can now relate and understand that they are treatable.”

Nepal sees spike in suicides during pandemic

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121148/636b94279c7e80680e06f1e3jpeg.jpg" alt="" width="2540" height="1426"/><figcaption>Richshaw operator Kancha Lama hardly gets one ride a day. He mostly depends on people distributing free food during the lockdown.</figcaption></figure>After two months in which there were new records of cases and fatalities every day, the second wave of the Covid-19 pandemic <a href="https://www.nepalitimes.com/banner/kathmandu-covid-19-lockdown-relaxed/" target="_blank" rel="noopener noreferrer">appears to be cresting in Nepal</a>, but it has left the economy in ruins with a crisis-ridden government offering no hope to citizens.<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/banner/we-knew-the-tsunami-was-approaching/" target="_blank" rel="noopener noreferrer">At its peak in mid-May</a>, there were more than 9,000 new infections and up to 250 deaths daily. And that was just the official count, models put the figures at least three times higher. However, the real impact of the pandemic is in the country’s economic meltdown, with more than half the employed losing their jobs.The Covid-induced lockdowns have pushed millions of  Nepalis back below the poverty line, which means they are now <a href="https://www.nepalitimes.com/banner/nepals-epidemic-of-hunger/" target="_blank" rel="noopener noreferrer">unable to access food and water</a>, basic health care and education. This has completely reversed Nepal’s gains in poverty reduction in the past ten years.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121148/636b942a9c7e80680e06f1e4jpeg.jpg" alt="" width="225" height="225">Back in March, at the tail end of the first wave, <a href="https://www.nepalitimes.com/latest/covids-collateral-damage/" target="_blank" rel="noopener noreferrer">Himalmedia’s tv magazine Saglo Samaj interviewed</a> farmers, tourist guides, hotel operators and taxi drivers most affected by the lockdowns.This week, the team revisited each of the same people to find out what had become of them. Their stories are a microcosm of a society ravaged by the pandemic, where the poor have got poorer.https://www.youtube.com/watch?v=Yni_6WWbmAo&amp;feature=youtu.beNepalis suffered altogether <a href="https://www.nepalitimes.com/banner/economic-cost-of-5-months-of-nepal-lockdown/" target="_blank" rel="noopener noreferrer">five months of lockdown in 2020</a>, and another nearly two months this year. The restrictions were eased this week, even though the daily number of fatalities and active cases are higher than when the lockdown was imposed on 29 April.The pandemic and the lockdowns have disabled every sector. Some 1.1 million people in the <a href="https://www.nepalitimes.com/latest/nepal-tourism-may-take-5-years-to-recover/" target="_blank" rel="noopener noreferrer">hospitality industry</a> have been directly impacted by the pandemic and more than half of Nepalis lost their jobs in the past month alone.Yet, the government has no clear plans to provide alternative employment opportunities for those who lost their jobs. In fact, it has been too <a href="https://www.nepalitimes.com/banner/court-debates-nepal-pm-olis-future/" target="_blank" rel="noopener noreferrer">preoccupied with a political power struggle for most </a>of the pandemic to plan a real exit strategy. Every response to the crisis has been too little, too late.On Tuesday, even though other districts prepared to relax their lockdown just as Kathmandu did, Nepal saw 4,522 new cases and 41 fatalities. There are a total of 52,648 active infections, 762 of them in ICU and 218 in ventilator support in hospitals across the country.Public health experts are already warning of a possible third wave and urging the government to make preparations for <a href="https://www.nepalitimes.com/latest/nepal-covid-19-impact-worse-than-official-figures/" target="_blank" rel="noopener noreferrer">increased contact tracing</a> and hospital treatment to avoid much devastation.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121148/636b942b9c7e80680e06f1e5jpeg.jpg" alt="" width="2552" height="1428"><figcaption> </figcaption></figure>MILKED DRYBuffalo milk is the only source of income for farmers in Kamdi village of Banke district in the western Tarai. But many of the dairy farmers were unable to sell their milk during the lockdowns in 2020. Later, they didn’t get a fair price and the Dairy Development Corporation was slow to pay even what they were owed.“The market is closed, there is barely any feed for the cattle. We are working day and night, but for nothing,” says Malati Prasad Yadav, who has 150 buffalos, but little income since the pandemic.The farmers took loans to buy feed and take care of the buffalos, but the second wave has quashed the little hope they had. They were hoping the government would announce a relief package in this year’s budget. But their hopes were dashed.“We are having to pour the milk into the drains, there are no consumers for ghee or cheese. We are running at a loss and there is no telling how long it will last,” says Saroj Pandey of the SJ Dairy in Nepalganj. “The government should boost the morale of farmers and local businesses, subsidise their electricity or promote Nepali goods by stopping import from the third country.”<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121148/636b942e9c7e80680e06f1e6jpeg.jpg" alt="" width="1500" height="844"><figcaption> </figcaption></figure>TOURISM AND REALISMOne of the hardest-hit sectors is tourism. And while professionals of most fields have had to cope with the challenges brought on by the pandemic, <a href="https://www.nepalitimes.com/latest/where-have-all-the-guides-gone/" target="_blank" rel="noopener noreferrer">tourist guides have been unemployed</a> for more than a year now.Four months ago, tourist guide Shankar Bhattarai had taken up teaching to make a living but was spending all his free time reading up about Nepal’s history and culture to better prepare himself for when the tourists would come back post lockdown. But the second wave killed what was left of <a href="https://www.nepalitimes.com/editorial/survive-revive-thrive/" target="_blank" rel="noopener noreferrer">Nepal’s tourism</a>.He has since given up any hope of normalcy and is constantly worried about debt collectors. Hoping for an alternative for tourists guides like himself, he was further depressed with this year’s budget.“There were provisions only for the big hotels and travel agents, we didn’t find ordinary tour guides like us anywhere in the relief packages,” says Bhattarai, who had been a tourist guide since 2011. “I’ve tried my best to promote Nepal through my work but at our time of need, we have no government support. I now question myself about staying back in Nepal.”<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121148/636b94309c7e80680e06f1e7jpeg.jpg" alt="" width="2537" height="1425"><figcaption> </figcaption></figure>UNSERVICEABLEBig businesses have their own woes. The three-star Airport Hotel in Kathmandu has seen only a handful of guests in more than a year. The hotel’s original staff of 100 is down to 10, and only 10 of its 62 rooms are kept serviceable.“We are doing much worse than last year, we did survive 15 months somehow, there were some domestic tourists, but then the second wave happened and it destroyed what little we had,” says owner Binayak Shah, adding that he has not been able to pay the monthly instalments on its loan for 17 months.He adds: “I have no income, so how can I pay them? This means sooner or later, the bank is going to blacklist me, and put this hotel up for auction.”<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121148/636b94339c7e80680e06f1e8jpeg.jpg" alt="" width="2544" height="1420"><figcaption> </figcaption></figure>DOWN AND OUTWhile some worry about paying millions in bank loans, daily wage labourers worry about the next meal. Kancha Lama has been operating a rickshaw in Kathmandu for 38 years, but his <a href="https://www.nepalitimes.com/banner/pandemic-puts-brake-on-kathmandus-rickshaws/" target="_blank" rel="noopener noreferrer">business is down and out</a>. He hardly gets one ride a day, and mostly depends on people distributing free food.“It’s easy for the government to tell us to stay home and eat healthy, where is the money? It doesn’t even allow me to beg on the streets. At least they should distribute rations for people like us,” says Lama. “If I get Covid, at least I will be out of this misery.”Bir Bahadur Lama is in Asan every day, and if it is his lucky day he will get a client or two to carry loads for them. Otherwise, he sits on the temple steps passing the day with other jobless porters. Before the pandemic, they used to carry loads for Asan’s many shops. Sometimes, good samaritans offer them food, but that is rare.“I just wish I did not have to sleep hungry and lockdown would end soon, that is all I wish for,” he says.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121148/636b94379c7e80680e06f1e9jpeg.jpg" alt="" width="2539" height="1430"><figcaption> </figcaption></figure>TAKEN FOR A RIDEDuring the lockdown last year, a bank took possession of Ganesh Tamang’s taxi which he had bought with Rs500,000 out of savings from years of toil in the Gulf.With no other source of income, he is now back to his village and raises livestock. “I often feel like I was born in a wrong country, to a wrong family, and at the wrong time, it wouldn’t have come to this anywhere else,” he says.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121148/636b943a9c7e80680e06f1eajpeg.jpg" alt="" width="1500" height="844"><figcaption> </figcaption></figure>Sagar Bohora has a sickly mother at home, and a family of young children dependent on him. But his taxi has broken down because it has not run much for the past year-and-a-half. He needs at least Rs30,000 for repairs, but he has barely enough after paying off the auto loan.“I only ask banks and financial institutions that they give us a few months until after the lockdown so that we can pay our dues, by then we will be able to get up, with or without government help,” says Bohora.<h2>Pandemic makes the poor poorer</h2><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121148/636b943c9c7e80680e06f1ebjpeg.jpg" alt="" width="2538" height="1424"><figcaption> </figcaption></figure>There is empirical evidence that the second pandemic wave has <a href="https://www.nepalitimes.com/latest/nepal-prepares-for-economic-fallout-of-pandemic/" target="_blank" rel="noopener noreferrer">further impoverished Nepal’s poor</a>. Even by modest estimates, some 9 million Nepalis have been pushed back below the poverty line due to Covid-19 induced lockdowns. In this week’s Saglo Samaj tv magazine, Shankar Sharma, former ambassador to the US and vice-chairperson of the National Planning Commission spoke to Kanak Mani Dixit. Excerpts:Kanak Mani Dixit: We went back to people we had interviewed four months ago, and found that their situation had further declined. Do they represent the current Nepali society?Shankar Sharma: They are an accurate representation. There are three categories that have been hit the hardest by the pandemic: the first are <a href="https://www.nepalitimes.com/latest/pandemic-offers-chance-to-revive-farming/" target="_blank" rel="noopener noreferrer">subsistence farmers</a> below the poverty line, this also includes disadvantaged groups. The next are people in the informal sector whose livelihood has been endangered with the extended closure of the market. Then there is the hospitality industry and unlike others, they haven’t been able to pick up after the first wave because the impact of the lockdown on the <a href="https://www.nepalitimes.com/banner/tourism-that-treads-lightly-on-the-land/" target="_blank" rel="noopener noreferrer">travel industry</a> is long-term. These businesses had loans and now their debt has accumulated.These impacts are directly reflected in our macroeconomic numbers. Economic growth rate last year was 2% and this year it won’t be more than 1%. Similarly, the World Bank estimates following the pandemic there are now a total 9 million people in Nepal below the poverty line.Would you say that because it is not monetised rural subsistence living is faring better?Back during the Maoist insurgency, some development partners had conducted a study about people who had migrated to the cities due to the violence. They asked people if they would go back to the village once the peace accord was signed, 93% of the respondents said no.One of the main reasons behind this was <a href="https://www.nepalitimes.com/editorial/back-to-the-future-of-farming/" target="_blank" rel="noopener noreferrer">Nepal’s agriculture</a> couldn’t compete with Indian and Chinese produce. This also led to more people migrating abroad. Experts have suggested the concept of contract farming, which is also included in this year’s budget and will do well for the country.But one of our biggest problems is our <a href="https://www.nepalitimes.com/banner/nepals-fake-poor/" target="_blank" rel="noopener noreferrer">inability to identify the poor</a>. The government has developed ID cards for their identification, but 23% of the poor are not on the list but 25% are those who have listed themselves in hopes of getting some relief. As a result, the real poor have been deprived even of their social security fund.What should we do to boost their morale and of the country?The affected people are those in rural Nepal but they also have an advantage of three levels of government. But it is still the responsibility of the central government to provide relief worth at least two months at $1 per day for its people. Unfortunately, there is no mention of this in the budget this year.The Nepal government has also allocated a total of Rs50 billion for training in the last two budgets but hasn’t been able to spend that money. This fund should be used in skill development for Nepalis post lockdown, effective spending of the budget is a must. Similarly, the government should support cottage and small industries so that they don’t close down. If we lack funding, we could use loans and grants we have received from international development partners.Despite the pandemic, there is still talk about Nepal graduating from Least Developed Country (LDC) status to a middle-income country. What will happen now?Following the pandemic, the United Nations has set a new deadline for the LDCs to graduate to lower-middle-income and middle-income countries. The good news is that we have made some progress in our per capita income, and the fact that our economy is now dependent on multiple factors is a positive sign. But what is worrying is that our economic growth is still lower than the average growth of underdeveloped countries. This means we will have to work more on increasing our living standard.It is said that Nepal is not a poor country, but the government just cannot seem to spend its development budget. If they were held more to account by civil society and media during this pandemic that might help? I think that is an appropriate conclusion to make. The government will always play the lead role, but it is important to highlight the importance of civil society and journalists in creating awareness about various programs at the local level such as the <a href="https://www.nepalitimes.com/banner/missing-the-plot-in-nepals-job-scheme/" target="_blank" rel="noopener noreferrer">Prime Minister’s Employment Scheme</a>, which goes a long way in rejuvenating elected representatives in villages and towns.

The real cost of Nepal’s second wave

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121144/636b92bf9c7e80680e06f167jpeg.jpg" alt="" width="1680" height="1118"/><figcaption>Photo: MANISH PAUDEL/NEPALI TIMES ARCHIVE</figcaption></figure>Soon after the coronavirus first emerged in Wuhan in December 2019, it spread rapidly within weeks to become an international public health emergency. Though it took months for the root of the illness to be identified, the virus was carried by human hosts in a highly interconnected globalised world.What would start as fever, chills, and flu-like symptoms began to lead to more severe cases of cardiac injury, respiratory failure and death. Those with pre-existing health conditions and the elderly were particularly vulnerable.The pandemic hotspots shifted from China to northern Italy, New York, then it was Brazil and the second wave that is ravaging India and Nepal. People were locked in at home for months to stop the spread, and it came at an additional cost – the rise of a mental health crisis globally.The Covid-19 pandemic has affected everyone and every aspect of our lives. The lockdowns may have helped contain the virus, but it <a href="https://www.nepalitimes.com/latest/nepal-prepares-for-economic-fallout-of-pandemic/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/nepal-prepares-for-economic-fallout-of-pandemic/&amp;source=gmail&amp;ust=1623901287419000&amp;usg=AFQjCNFNmR9X3YmCrQqNw1FBAGmfiCln2w">destabilised economies</a>, businesses went bankrupt, people lost jobs, again exacerbating the impact on mental health in societies.The coronavirus emerged because of the over-<a href="https://www.nepalitimes.com/here-now/the-nature-of-pandemics/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/the-nature-of-pandemics/&amp;source=gmail&amp;ust=1623901287419000&amp;usg=AFQjCNFdtI-md82Syn9kPX3XvQxEsytPFg">exploitation of nature</a> by a globalised mass consumption society. But the pandemic it unleashed has allowed us to think about that, and also allowed <a href="https://www.nepalitimes.com/here-now/coronavirus-shutdown-gives-nepals-nature-a-respite/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/coronavirus-shutdown-gives-nepals-nature-a-respite/&amp;source=gmail&amp;ust=1623901287419000&amp;usg=AFQjCNGjFSVplTP8JEJIO5Z3tiqLfAmkRw">nature to begin to restore itself</a>.Studies have shown that lockdowns in response to the pandemic have significantly improved the air quality in many big cities due to the shutting down of industries and fewer vehicles on the roads. From Kathmandu, the Himalaya suddenly came into view.The restrictions and lockdowns led to a decrease in economic activity, resulting in <a href="https://www.nepalitimes.com/banner/nepal-lockdown-proves-air-quality-can-be-improved/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/banner/nepal-lockdown-proves-air-quality-can-be-improved/&amp;source=gmail&amp;ust=1623901287419000&amp;usg=AFQjCNEYWiOv5AGc2wmkU8qJ7ukoSO2t4w">reduced air pollution</a> and emission of greenhouse gases. Ironically, while the virus was attacking the respiratory system, countermeasures taken against its spread were also <a href="https://www.nepalitimes.com/latest/double-whammy-air-pollution-and-covid-19/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/double-whammy-air-pollution-and-covid-19/&amp;source=gmail&amp;ust=1623901287419000&amp;usg=AFQjCNGpVy3V8L2xvmfYCZEjNngNVn1DWg">making it easier to breathe. </a>The ban on international travel also helped reduce the emission of greenhouse gases, dramatically demonstrating the path to reducing the impact of the climate crisis: the need to cap carbon dioxide emissions.The <a href="https://www.nepalitimes.com/here-now/the-carbon-footprint-of-nepals-tourism/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/the-carbon-footprint-of-nepals-tourism/&amp;source=gmail&amp;ust=1623901287419000&amp;usg=AFQjCNHf6W5H1b9EDeZu8Y_x1BnST3siyw">collapse of tourism</a> affected the economies of countries like Nepal, but it has allowed nature to regenerate. There is less waste along the trekking trails, less garbage.Across the world, people are consuming much less than they used to. It is hard to say if this frugality will persist in the post-pandemic era, but it has set a precedent. Many of us are focusing more on our health, and have adopted better eating habits.For nearly two months now, there is also less noise pollution. Kathmandu’s streets are silent, no roar of trucks, no honking, no construction work, and few jets overhead. Persistent ambient clamour is known to affect our physiological and physical health. With less unwanted noise, the soothing sounds of nature are more audible with bird song, frogs in ponds, and even the rustle of leaves on trees. The sound of silence, and comforting natural sounds carry many mental health benefits.Cities attract people because of economic opportunities and their cosmopolitanism. The absence of people in these urban centres during the pandemic have allowed them to restore themselves organically – showing us that we have to <a href="https://www.nepalitimes.com/banner/pandemic-is-a-chance-to-rethink-development/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/banner/pandemic-is-a-chance-to-rethink-development/&amp;source=gmail&amp;ust=1623901287419000&amp;usg=AFQjCNG6oAiPAlgzK0NmSxSIbDU0MyC4OA">tread more lightly on the environment</a>. For once, the focus has shifted from people to nature so that it has a chance to recover from years of abuse.All of this has come at a great price, no doubt, but Covid-19 has also shown us what we need to do for a sustainable lifestyle to reduce anthropogenic carbon and the burden on nature. If we focus away from the negative impact the pandemic has had on us, and redirect it to the nature around us, we see many positive outcomes that also have beneficial effects on our own lives.We have started focusing more on relationships because earlier most of us were too busy to find the time to do so. We have begun communicating more with family and friends. The pandemic also offers us a chance to rethink our lives, and our purpose.We have started consuming less because we realised that we do not need as much as we thought. There have been significant changes in consumer behaviour that have been good for the planet just because we use, and waste, less.The world is recovering from years of damage that we were so disrespectfully placing on the planet’s resources. In Nepal, we have seen signs of the ecosystem starting to rebalance itself. The question is whether government policies will reflect this in the coming years.It is terrible what Covid-19 has done to the world, but it has also shown us how to <a href="https://www.nepalitimes.com/banner/build-back-greener/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/banner/build-back-greener/&amp;source=gmail&amp;ust=1623901287419000&amp;usg=AFQjCNExv5VA-LyNgHQNsiZOMwoP0Jsqgg">improve the planet’s health</a>, and with it, the human condition. We desperately want to get back to our everyday lives, but being isolated has reminded us that even if we go back to the way we lived, we have to be mindful of our impact on the planet.We can rebuild the economy, but the damage humans are inflicting on nature is irreversible. The pandemic provides the chance to take action to restructure the way we live.Anjana Rajbhandary lives and works in Chicago. She writes this fortnightly Nepali Times column Life Time about mental health, physical health and socio-cultural issues.

Anjana Rajbhandary

Grow back greener

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.