<figure><img width="1334" height="889" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111016118/636d14189c7e80680e0a995ejpeg.jpg" alt=""/><figcaption>Children aged 12-17 started getting inoculated with the Pfizer BioNTech Covid vaccine in Kathmandu on Monday. Photo: AMIT MACHAMASI</figcaption></figure>Not long ago, <a href="https://www.nepalitimes.com/opinion/hope-hyperbole-and-hypocrisy-of-covax/" target="_blank" rel="noopener noreferrer">to boost or not to boost </a>was the dilemma of rich countries, even as developing nations were struggling to vaccinate their frontline workers and elderly with the first dose.
The argument <a href="https://www.nepalitimes.com/opinion/to-boost-or-not-to-boost/" target="_blank" rel="noopener noreferrer">has now reached our part of the world</a>, with some health experts even in Nepal recommending boosters shots for the immune-compromised and frontline workers. In fact, the government’s Teaching Hospital and a few others in Kathmandu this week administered a third booster shot to some patients suffering pre-existing diseases.
The recommendation has been met with some conflicting opinion at a time when only a little over 30% of Nepal’s target population has been fully inoculated against Covid-19. While over half the people in densely populated urban centres like Kathmandu have been vaccinated, parts of rural Nepal are still largely unable to access jabs.
“Our first and foremost priority must be to vaccine everyone, and if we have plenty more vaccines, which we are more than likely to have, the next step is to provide booster shots to people with co-morbidities and the elderly,” says Buddha Basnyat, a physician at Patan Academy of Health Sciences.
Infectious disease specialist at HAMS hospital Anup Subedee agrees: “If the question is what is more advantageous in terms of controlling the pandemic, vaccinating the unvaccinated or offering booster shots, the answer is to vaccinate everyone first.”
Having said that, Subedee adds that Nepal should provide the third dose of VeroCell to individuals who were inoculated with the Chinese vaccine, for higher efficacy, as recommended by the World Health Organisation (WHO).
The concern about boosters is mainly because antibody levels decline significantly after 6-9 months of being inoculated, as proven by studies around the world. And as one of the first countries in South Asia to start its Covid-19 vaccination drive, it has been six months since<a href="https://www.nepalitimes.com/here-now/protecting-those-who-protect-us-from-covid/" target="_blank" rel="noopener noreferrer"> frontline workers</a> were given jabs.
Some experts, however, say that the human body provides protection also from so-called ‘memory cells’ so that even if vaccine immunity drops, the T and P cells which produce antibodies only when a pathogen attacks. There is no exact estimate of how long the memory cells provide protection, but it is most likely long-term, which means the general population may not need booster shots just yet.  
Those who recover from Covid-19 are even better placed to ward off the infection and its complications, with natural immunity being more effective than that gained by vaccination. And according to the recent seroprevalence survey, over two-third of Nepalis have SARS-CoV-2 antibodies that provide them natural immunity.
“Given that 68% of people in Nepal have some form of protection and a significant chunk of the population is fully vaccinated, we don’t have to worry about boosters yet. Our infection rate, hospitalisations and morbidities have all largely declined,” says Sameer Dixit of the Centre for Molecular Dynamics Nepal, which conducted the seroprevalence survey.
The new surge in Europe has been associated with the Delta variant, which has already swept through every corner of Nepal and India, which means a majority of the people here have developed some immunity against it.
“So, we don’t have to panic about another major surge as of now,” Dixit adds.
This is <a href="https://www.nepalitimes.com/latest/too-early-for-nepal-to-let-its-guard-down/" target="_blank" rel="noopener noreferrer">not to say Nepal is out of the woods</a> yet. With a declining number of daily cases and fatalities, schools have reopened, there are wedding parties, crowded marketplaces and indoor seminars are happening all over the country.
Safety measures must be maintained despite higher vaccination rates and declining hospitalisations. This means, continuing to mask up, avoiding crowds and maintaining distance -- especially with the onset of winter and the seasonal risk of coronavirus, influenza and pneumonia infections. There are already reports of students, parents and teachers in Kathmandu schools testing positive for Covid-19.
The government had <a href="https://www.nepalitimes.com/latest/pfizer-vaccines-arrive-in-nepal/" target="_blank" rel="noopener noreferrer">set aside Pfizer </a>vaccines for the immunocompromised, but a lack of uptake meant that students up to age 12 are now being offered the US-made vaccine that has been certified for children.
Shyam Raj Upreti, Nepal’s focal person for the Covid-19 vaccine maintains that the government will start administering booster shots only after nearly 100% of the targeted population has received its first dose, the figure currently stands at about 40%.
Nepal has so far received 25 million doses of vaccines in <a href="https://www.nepalitimes.com/here-now/nepal-is-a-priority-for-vaccine-shipments/" target="_blank" rel="noopener noreferrer">donations or purchase</a>, 30 million more are in the pipeline. “We now have more than enough vaccines for our targeted population, and we are now starting with students,” says Upreti. “The new challenge is to increase vaccine acceptance among those who have so far refused to take it.”
Although surveys have shown that 97% of Nepalis trust vaccines, many pregnant women and those with co-morbidities are refusing to get shots, <a href="https://www.nepalitimes.com/banner/why-is-there-vaccine-hesitancy-in-nepal/" target="_blank" rel="noopener noreferrer">fearing side-effects</a>.
Experts caution that Nepal’s response to the pandemic needs to <a href="https://www.nepalitimes.com/banner/behind-the-masks/" target="_blank" rel="noopener noreferrer">extend beyond vaccinations</a>. The country has to be prepared for a possible surge, and this means contact tracing including the testing of the children, stringent quarantine and isolation, well-equipped health infrastructure and trained medical staff to operate them.
“Another surge might not be a major one but it could still be on a scale sufficient to significantly impact our economy and lives,” adds Anup Subedee. “So we have to be prepared. But a lot of it boils down to political will, and an efficient bureaucracy that is focused on controlling the pandemic.”
Indeed, Covid-19 is here to stay which means continued vigilance and precautions like <a href="https://www.nepalitimes.com/latest/keep-wearing-masks-after-the-lockdown/" target="_blank" rel="noopener noreferrer">masking and physical distancing</a>. Warns physician Buddha Basnyat: “Covid-19 is a wily virus, and it is still a formidable foe. We can’t let down our guards yet.”

Sonia Awale

original

674x448

610x380

500x500

400x266

400x240

400x203

301x200

1250x600

1084x550

Do Nepalis need Covid booster shots?

How Nepal must prepare for 3rd Covid wave

<figure><img width="1500" height="970" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110111156/636cd8d39c7e80680e092e63jpeg.jpg" alt=""/><figcaption>Photo: UNICEF</figcaption></figure>After immunising over 1.6 million Nepalis against Covid-19, the government now plans to administer the rest of the 600,000 jabs that it has in stock for second doses starting 20 April. But it needs at least another million shots to cover all those who inoculated in the first and second phases, as well as to complete the inoculation of those 55 years and above.The Health Ministry is banking on the remaining 1 million doses of the AstraZeneca Covidshield that it purchased from the Serum Institute of India. That consignment was not delivered on 15 March as promised after an Indian court banned export of vaccines before demand at home is met. The next batch of Covishield vaccine under the COVAX initiative is also not expected before May. However, the current suspension of vaccinations in Europe, Thailand and other countries may ease the worldwide shortage somewhat. “We will go ahead with second doses as planned, but the third phase aimed at the age group 55-64 will depend on vaccine availability and as of now we don’t have dates on when they are arriving,” admits Shyam Raj Upreti, head of the Government Covid Vaccine Strategy told Nepali Times.The Chinese government, on the other hand, has increased its gift of Sinopharm vaccines to Nepal from 500,000 to 800,000, but China has insisted that Nepal send a plane to collect it from Beijing.The shortfall in supply and procurement challenges forced the Health Ministry to allow private companies to import vaccines, including the Covaxin manufactured by Bharat Biotech in India. “The private sector can help bridge the gap in procurement limitation as well as allow people with the means and the interest to get vaccinated, but all this must be monitored and regulated,” says Sher Bahadur Pun, a virologist at the Teku Hospital.Average coverage was 73% of the eligible population in the first two phases, all of them with the Covishield AstraZeneca vaccine. However, media reports of the suspension of that vaccine in European countries this week due to fears of blood clot among some recipients may increase vaccine hesitancy in Nepal. The suspensions have baffled public health experts who warn that there is neither enough data to justify the decision, nor adequate evidence to blame blood clots on the vaccine. The fact that there have been no serious side effects in Nepal had increased the acceptance level of the vaccine in the public and among frontline health workers in Nepal. “The EU might have different standards from ours but it might be a good idea to monitor serious side effects,” says epidemiologist Lhamo Yangchen Sherpa. “However, the vaccine has been safe in this part of the world, so its benefits far outweigh the risk.”Some experts think the suspension of the vaccine campaigns in Europe may actually be a blessing in disguise for Nepal, which is facing delays in shipments of Covishield it ordered as well as remaining doses under the COVAX initiative from the Serum Institute. That delay and the heftier price tag was blamed on a rise in global demand. So far, the government has only administered Covidshield in Nepal and health authorities here see no reason to discontinue the vaccine without a real causal link between AstraZeneca and the blood clots.“The EU decision to suspend AstraZeneca is very random and counterproductive, it was probably influenced by politics,” says Buddha Basnyat of the Patan Academy of Medical Sciences. “There is evidence this vaccine is safe and protects us specifically from severe symptoms of Covid-19.”Meanwhile, reassured by the vaccination drive and a dramatic drop in infections, Nepalis have gone back to normal, and many have forgotten about precautions. With parts of India hit by a second wave with over 37,000 new cases and 171 additional deaths on Wednesday, experts have advised the Nepal government not to let up on communicating the need to mask up and avoid crowds. “Officials here have stopped testing and are focusing only on vaccinating but even those who have been inoculated must remember that they can still be carriers,” Lhamo Yangchen Sherpa told Nepali Times from Achham. “We have to continue to take safety precaution as if the pandemic is not over, which it is not.”

1.6 million vaccinated, 20 million to go

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111011114/636ccd779c7e80680e08bc80jpeg.jpg" alt="" width="2048" height="1365"/><figcaption>Photo: MONIKA DEUPALA</figcaption></figure>So far, 450,000 Nepalis have received the first dose of Covishield, reaching 85% of the target group in the <a href="https://www.nepalitimes.com/banner/nepal-begins-covid-19-vaccination-drive/" target="_blank" rel="noopener noreferrer">first phase of the country’s Covid vaccination drive</a>.Starting 7 March, 3.7 million Nepalis above 55 who make up 12% of the total population will get their shots against SARS-CoV-2. Teachers, students, bus drivers and other groups will also be included in the second phase.On the paper, Nepal looks like it is in a <a href="https://www.nepalitimes.com/latest/nepal-braces-for-new-wave-with-vaccine-drive/" target="_blank" rel="noopener noreferrer">better position with vaccination</a>, especially given that more than 100 countries <a href="https://www.nepalitimes.com/latest/90-in-poor-countries-will-miss-covid-vaccinations/" target="_blank" rel="noopener noreferrer">have yet to receive</a> even a single dose.“We have to applaud the government for its effort in bringing the vaccine earlier than expected and for rolling it out efficiently,” says Sameer Mani Dixit of the Centre for Molecular Dynamics Nepal. “Nepal will be among the first countries to take the vaccine to the majority of its population with the second phase in early March.”However, the vaccine campaign has been plagued with <a href="https://www.nepalitimes.com/banner/why-is-there-vaccine-hesitancy-in-nepal/" target="_blank" rel="noopener noreferrer">hesitancy and denial</a>. Even doctors and nurses were reluctant to inoculate themselves, resulting in a  low uptake. Failure to communicate, allay concerns about side effects, and ensuring access in remote areas were the main roadblocks to better coverage.“The very fact that the vaccines arrived in Nepal <a href="https://www.nepalitimes.com/here-now/when-will-nepals-covid-vaccine-turn-come/" target="_blank" rel="noopener noreferrer">much earlier than we anticipated</a> and once it did, we had to use it on the fly with the pandemic still going on, leaving us without a proper communication strategy,” admits Buddha Basnyat of the Patan Academy of Health Sciences.<a style="background-color: #ffffff; font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/opinion/glimmers-of-hope-for-nepal-on-vaccine/" target="_blank" rel="noopener noreferrer">Covishield</a>, developed by AstraZeneca Oxford University and manufactured by the Serum Institute of India is being used in the UK, the EU, India with Australia starting their vaccination soon. With the efficacy ranging from 70-80%, 0.5ml of 2 doses 4-12 weeks apart, the jab has been deemed safe with no severe reactions or any death.In the recent past, local governments used to deploy Tole Health Promoters (THP) in neighbourhoods before a vaccination drive for measles, polio and other infections to address the public’s safety concerns.Another effective communication tool would have been the use of social media platforms and mass media to increase awareness about the vaccine as well as promote its use. Elsewhere in the world, prime ministers and presidents being inoculated were being televised live. Celebrities took to the Internet to share their experience of vaccination.“Someone like Nirmal Purja would have been best to promote the campaign and increase the acceptance of the vaccine in the masses with his legions of followers,” says Sher Bahadur Pun, a virologist at the Sukraraj Tropical and Infectious Disease Hospital.Basnyat agrees that Purja with his <a href="https://www.nepalitimes.com/latest/nims-purja-does-it/" target="_blank" rel="noopener noreferrer">international mountaineering fame</a> and Gurkha commando background would have also bolstered Nepal’s vaccine diplomacy. “He could be our brand ambassador to take up our case to aid agencies given the UK’s stand on vaccine equity while also backing India’s interest to promote neighbourhood first policy with vaccines,” he added.The government has approved the second dose to be given anywhere between 8-12 weeks of the first one, prioritising vaccination of as many vulnerable individuals as possible before that.But the availability of the vaccine will be the main concern as we move on to the next stage of the campaign. With the 1 million dose Covishield <a href="https://www.nepalitimes.com/latest/jabs-and-jab-nots/" target="_blank" rel="noopener noreferrer">grant from India</a> in January, another 2 million that Nepal purchased this week from Serum Institute of India, 2.25 million (with the first 300,000 arriving first) under the COVAX initiative, and 500,000 doses of Sinopharm from China, the government has a stock of close to six million doses.  This means 3 million can be vaccinated soon.“The second phase is as challenging as it is important. But this is also the group likely to have a higher chance of reaction, so we need to be prepared locally to manage them,” says Shyam Raj Uprety, head of the government’s Covid vaccine strategy. “It is crucial to communicate different types of side-effects and explain that they signify that the vaccine is working.”Around the world, the total number of new coronavirus cases and fatalities is dropping. Although India has reported spikes in some states and Nepal will have to keep a close watch on New Delhi, Uttar Pradesh and Bihar, Nepalis have most likely developed localised immunity.A Nepal Health Research Council study has revealed that over 45% of hospital staff had developed antibodies by December, adding to the view that we are nearing herd immunity.“Once we have vaccinated a larger risk population, even if there is a second wave, it is unlikely to impact much because the group who were getting seriously sick will be protected,” adds Dixit.But even with the vaccine, Nepalis will still have to continue precautions. There is still uncertainty about duration of immunity, and whether vaccinated people can spread the virus.Says Basnyat: “This has been a pandemic of misinformation, we have to negate that with public engagement. Good thing is that Nepal can draw inspiration from past successful vaccination drives and can become a model for others.”<h2>Everything you wanted to know about vaccines</h2>Recently Nepali Times spoke with three experts with frequently asked questions from readers regarding the Covid-19 vaccination drive in Nepal.Excerpts of interviews with Virologist Sher Bahadur Pun at the Sukraraj Tropical and Infectious Disease Hospital, Shyam Raj Uprety, head of the Government Covid Vaccine Strategy and Sameer Mani Dixit of the Centre for Molecular Dynamic Nepal:<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111011114/636ccd7b9c7e80680e08bc81jpeg.jpg" alt="" width="1160" height="350">What are the precautions one should take before and after the vaccine?Sameer Mani Dixit: Covishield, the Covid vaccine we are using, is an intramuscular injection, 0.5ml in two doses 4-12 weeks apart. It is administered by a professional and after the jab, one will feel mild pain in the region.What’s the efficacy rate of the vaccine and how long does it work?Covishield has been used in the UK, EU, India and many other countries, Australia is getting ready to use it. It has passed phase 3 clinical trials with over 12,000 volunteers without any severe reactions or any death. The efficacy ranges from 70-80%.Once a person is vaccinated, there are antibodies that the body produces and then there are memory T and B cells. The lifespan of antibodies is about 3-6 months but we don’t know about the duration of the memory cells since the vaccine has just been developed. The assumption is that it will work from anywhere between 9-12 months but we will know for sure once people who have been vaccinated pass that stage.Do we have to get the same vaccine for the second dose?Ideally, the manufacturers of the vaccine suggest we take the same for both doses. But there are instances you may be able to take a second dose from a different company.Do people who have recovered from Covid-19 need to vaccinate?Sher Bahadur Pun: We don’t know exactly how long does the natural infection protect the body. The rough estimation is between 3-6 months. But it varies from one individual to another so it is recommended that people take the shot. Also, two doses provide longer protection.Can breastfeeding mothers take the vaccine?Manufacturers of Covishield have suggested pregnant women and breastfeeding mothers against taking this vaccine. But Nepal government recently said that those breastfeeding for six months or more could take it, but we don’t have concrete data yet so we don’t recommend it.How can people with vulnerable family members get them vaccinated?Shyam Raj Uprety: We identified health workers as the most vulnerable. We vaccinated them at their nearest convenient place. We will do the same for the next vulnerable group, take the vaccine to the communities.If someone is not on the priority list but still wants to get vaccinated, how can they get it? Can it be bought?It is unlikely for people who are not listed as the priority to get the shot. It is being administered for free for the priority group individuals and cannot be bought in the market. But after the most vulnerable are covered, the vaccine could be made available by the private sector.

Nepal fights infodemic to push vaccine

India and Pakistan are twins separated at birth. Tensions between them have been at a hair trigger ever since independence and has erupted into full scale conflict at least four times in the past 80 years.
The 22 April terrorist attack in Kashmir that killed 25 Indian tourists and a Nepali citizen, threatens to escalate tension between the two nuclear-armed nations. India has squarely blamed Pakistan for the attacks, and Prime Minister Narendra Modi has given his military “operational freedom” to respond. Pakistan has said it has credible intelligence of an Indian military strike and its officials have promised a “full spectrum” response — a code for a <a href="https://nepalitimes.com/editorial/thinking-the-thinkable">nuclear retaliation</a>.
For Nepal, the killing of its national in the Pahalgam attack comes as another stark reminder that in conflicts from Afghanistan to Iraq, from <a href="https://nepalitimes.com/opinion/how-to-agree-an-armistice-in-ukraine">Ukraine</a> to Israel, <a href="https://nepalitimes.com/news/10-nepalis-from-one-town-fighting-in-ukraine">Nepalis are getting caught in the crossfire</a>. The last time full-scale fighting broke out between <a href="https://nepalitimes.com/opinion/peacemongers-at-india-pakistan-border">India and Pakistan</a> on Kargil in 1999, at least 22<a href="https://nepalitimes.com/here-now/india-s-trial-by-fire-for-soldiers-from-nepal?%27%5C%22="> Nepalis fighting for the Indian Army</a> were killed in action.
Three of Nepal’s immediate neighbours (China, India, Pakistan) have nuclear weapons, and they do not have good relations. With China supplying weapons, <a href="https://nepalitimes.com/editorial/war-and-warming">missile technology</a> and other support to Pakistan, this triangular friction could set off a regional conflagration.&nbsp;
<a href="https://www.nature.com/articles/s43016-022-00573-0" target="_blank">Research at Rutgers University</a> has calculated that even a week-long tactical nuclear exchange between India and Pakistan would throw up so much smoke and debris into the atmosphere that it would block out the sun for years, and lead to a collapse of the <a href="https://nepalitimes.com/news/grow-nourish-sustain-together-world-food-day">global food system</a>. This does not take into account the radioactive fallout that prevailing winds would blow up to <a href="https://nepalitimes.com/here-now/lives-on-the-line-in-the-himalaya">the Himalaya</a>, contaminating glaciers that are the sources of <a href="https://nepalitimes.com/here-now/saving-what-is-left-of-himalayan-rivers">Asia’s main rivers</a>.
The impact of <a href="https://nepalitimes.com/news/climate-breakdown-linked-to-thame-flood">climate breakdown </a>on High Asia was already ringing alarm bells about its <a href="https://nepalitimes.com/news/himalayan-icecap-melting-faster-than-thought">shrinking ice cap</a> reducing the dry season flow of water downstream. Water was going to be the next strategic commodity, geopolitical experts warned, and the next wars in Asia would be over water.
That water war is already happening. India retaliated to the Kashmir attack by suspending the <a href="https://www.nytimes.com/2025/04/24/world/asia/india-pakistan-indus-waters-treaty.html" target="_blank">Indus Waters Treaty</a> of 1960 mediated by the World Bank that has withstood at least three wars between India and Pakistan. The treaty gives India control over the three eastern tributaries of the Indus (<a href="https://en.wikipedia.org/wiki/Beas_River" target="_blank">Beas</a>, <a href="https://en.wikipedia.org/wiki/Ravi_River" target="_blank">Ravi</a> and <a href="https://en.wikipedia.org/wiki/Sutlej" target="_blank">Sutlej</a>), while Pakistan got water from the Indus and two of its western tributaries (<a href="https://en.wikipedia.org/wiki/Indus_River" target="_blank">Indus</a>, <a href="https://en.wikipedia.org/wiki/Chenab_River" target="_blank">Chenab</a> and <a href="https://en.wikipedia.org/wiki/Jhelum_River" target="_blank">Jhelum</a>.
Pakistan was assured of 70% of the annual flow, and India could use a reasonable amount of water for<a href="https://archive.nepalitimes.com/news.php?id=15231"> irrigation and hydropower</a>. &nbsp;Within days of its threat, India stopped water flowing down to Pakistan from the Chenab river and is reportedly preparing to do the same on the Jhelum.
The sabre-rattling has reached a crescendo. Besides threats and counter-threats there are also symbolic drills, with the Indian Air Force practicing landing on an expressway in Uttar Pradesh by its Rafale, Su-30 and Jaguar fighter jets to demonstrate ‘operational readiness’. In response Pakistan test-fired its Abdali ballistic missile that can carry a nuclear warhead and has a range of 450km.&nbsp;
The danger is that with ultra-nationalist rhetoric and the beating the war drums by both sides, India’s government and Pakistan’s military may have to ‘do something’ to appease domestic public opinion. But any tactical strike, an artillery exchange, or territorial incursion could quickly escalate out of control.
Expecting an Indian retaliation for the Pahalgam killings, Pakistan is using<a href="https://nepalitimes.com/opinion/interfaith-collaboration-for-nuclear-disarmament"> nuclear deterrence </a>and warning of “catastrophic consequences”. The two neighbours came close to a nuclear exchange in 2019 after an attack on the Indian military in Kashmir, and prompt international intervention led by the United States cooled tensions.&nbsp;
This time, the <a href="https://nepalitimes.com/news/trump-shock-wave-hits-nepal">Trump administration</a> is too distracted and not as engaged. Pakistan has denied it was responsible for the terrorist attack and called on Washington to stop a possible Indian retaliation. India and Pakistan have stopped overflights by each other’s airlines, and some international carriers have even stopped flying over Pakistan fearing an air war.
Washington, Beijing, the UN and the EU have all urged restraint. Iran, which has good relations with both India and Pakistan has sent its foreign minister to urge both countries not to go into a tit-for-tat war. Iran has its own nuclear flashpoint to worry about with tensions in Israel, &nbsp;Yemen and Syria.
India and Pakistan both share similar problems of joblessness, <a href="https://nepalitimes.com/here-now/why-nepal-s-poverty-rate-is-stuck">poverty </a>and <a href="https://nepalitimes.com/here-now/climate-change-new-threat-to-nepal-s-rhinos">environmental threats</a>. Neither side needs the threat of a senseless war, and we in the neighbourhood do not need it either.&nbsp;
Kunda Dixit
This Editorial 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.

Nukes in the neighbourhood

The streets of Patan are alive this month with lavender jacaranda trees under rain-washed skies as <a href="https://nepalitimes.com/banner/the-red-god-rises-again-in-patan">the chariot of Rato Matsyendranath</a> is pulled across town. This is the festival of the rain god, and inevitably the heavens opened up and pre-monsoon showers pelted the chariot as it started being pulled in Pulchok last week. Thousands of devotees, onlookers and the chariot procession organisers thronged the streets on the first day last week. The rhythmic cymbals and drums exuded a vibrant energy as the enormous four wheels turned and the chariot lurched.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025051007050_81df97744db16f732a419dc1f1579d235ce3df37642b078f50b83bd4bd026688.jpg" data-media-id="editor_1" data-image-id="2025051007050_81df97744db16f732a419dc1f1579d235ce3df37642b078f50b83bd4bd026688" data-rendition-name="original" width="1000" height="1503" loading="lazy" alt="Divine chariot"> </figure>  The<a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/Red-rain-god,3141"> red rain god</a> has Hindu and Buddhist antecedents, alternatively called Bungadya and<a href="https://nepalitimes.com/here-now/kathmandu-s-gravity-defying-chariot-festival"> Karunamaya</a> — reflecting Kathmandu Valley’s syncretic mixture of the two religions.&nbsp; “Bungadya is a profoundly <a href="https://nepalitimes.com/opinion/12-full-opinion/marketing-the-intangible">intangible form of heritage</a>,” explains heritage expert Monalisa Maharjan. “It embodies traditional knowledge,<a href="https://nepalitimes.com/multimedia/reviving-nepal-s-craft"> artisanal skills passed down through generations</a>. Local communities and specific families have specified roles in being custodians of the heritage, ensuring their survival over the centuries.” There are many legends and stories about this annual tradition. Lichhavi king Narendra Dev is supposed to have brought Rato Matsyendranath from Assam to Kathmandu Valley to convince Guru Gorakhnath to lift a spell that created a two-year drought in Kathmandu.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250510050520_347a9a398f8a9abc4a7fb4e2774fde8264cccbdce8bdab23851ab3f0e73c3e8a.jpg" data-media-id="editor_6" data-image-id="20250510050520_347a9a398f8a9abc4a7fb4e2774fde8264cccbdce8bdab23851ab3f0e73c3e8a" data-rendition-name="original" width="1503" height="1000" loading="lazy" alt="Divine chariot"> </figure>  Matsyendranath was Gorakhnath’s mentor, and upon seeing him, the serpents were released, unleashing the rains. The chariot festival honours the return of this life-giving rain. The deity is seen as an icon for thriving agriculture, t<a href="https://nepalitimes.com/here-now/before-the-next-monsoon">he arrival of monsoon</a> showers, and the welfare of the community. Read also: <a href="https://nepalitimes.com/opinion/the-reign-of-the-god-of-rain">The reign of the god of rain</a>, Vidhu Prakash Kayastha Till this day, the Rato Matsyendranath festival is no ordinary celebration. Patan does not sleep for a month as the chariot is pulled through various neighbourhoods. It unfolds at a state level with the president (formerly the king) attending the climax of the Bhoto Jatra in Jawalakhel later this month.&nbsp; The intergenerational transmission of tradition is unique in the world, and the reason the festival is one of the most vibrant cultural expressions that thrives despite inroads of modernity. The other unique aspect is that it is a transnational festival, binding Patan with Guwahati in the Indian state of Assam.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025051005058_8bc685ada13045d863b28e3eed91c931da2b510714586af6fd7eb5d1e298a24a.jpg" data-media-id="editor_9" data-image-id="2025051005058_8bc685ada13045d863b28e3eed91c931da2b510714586af6fd7eb5d1e298a24a" data-rendition-name="original" width="1000" height="1503" loading="lazy" alt="Divine chariot"> </figure>  “Unlike Nepal, where the deity commands grandeur and devotion, many in Assam are unaware of Rato Matsyendranath,” says Khagen Sharma of Gauhati University, which convened <a href="https://nepalitimes.com/news/nepal-assam-connection-revived">a symposium in February in Guwahati on the rain god</a>. Attending was a delegation led by Lalitpur Mayor Chiribabu Maharjan, organisers of the festival, and builders of the chariot. After the symposium, a committee was formed to explore and revive the tradition in Assam as well. Although the team had planned to visit Nepal this month, logistical challenges delayed the trip. Still, there are plans to build a Guru Matsyendranath statue in Assam to reestablish regular worship practices in the Guwahati shrine.&nbsp; The vines used to build the chariot in Patan are sourced from the jungles of Assam. But Sharma notes that in recent years unclear regulations have blocked the official import of the vines, although they are still brought to Nepal informally. The <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/makers-of-machhindranath,2204">chariot making</a> has also had a taste of modernisation in recent times. In the past, even a single nail or piece of steel was avoided. But over time, the wooden structure, particularly the shaft between the wheels, has been replaced with bronze. When that too proved unstable, metal clamps were introduced, which have become a pragmatic compromise.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250510050524_b2a819a5791612f14c81d30fc393dbd3f99f0c64b90a9110e8b0855d944bfa93.jpg" data-media-id="editor_12" data-image-id="20250510050524_b2a819a5791612f14c81d30fc393dbd3f99f0c64b90a9110e8b0855d944bfa93" data-rendition-name="original" width="1500" height="998" loading="lazy" alt="Divine chariot"> </figure>  Another welcome change is the focus on safety. Builders climbing the chariot’s tower now wear harnesses and there are efforts in crowd control. The most visible change in recent years has been the involvement of Patan’s enthusiastic youth in the festival — the tradition is now passing to a new generation. Says Matsyendranath expert Vidhu Kayastha: “There is more energy, the young people in red t-shirts this year were very organised, these modern touches aren’t diluting our culture, they’re keeping it alive in new forms.” He adds, “We are <a href="https://nepalitimes.com/here-now/searching-for-a-homeland-away-from-home">reconnecting with our roots</a>, we have more resources, more awareness than ever before. We must not be swept away by western values that may not serve us, and in some ways, cause more harm than good. We must revive our own culture.”&nbsp;

Divine chariot

Most Nepalis thought they had seen the last of it after <a href="https://nepalitimes.com/news/11-56-25-april-2015-wkc9q2an">the 25 April 7.8 magnitude </a>earthquake ten years ago. But the Himalaya had more surprises in store. On 12 May, another 7.3 magnitude tremor that some said was an aftershock, but was strong enough to itself be a major earthquake, struck Dolakha.&nbsp; Not many people had heard of Singati till then — a cluster of houses by the Tama Kosi River along a narrow gorge that is the roadhead to Rolwaling Valley.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250508110520_57b6e316656851f71eca56ca6f98d9bbcc820c1a00d62af3c990725b4361244d.jpg" data-media-id="editor_1" data-image-id="20250508110520_57b6e316656851f71eca56ca6f98d9bbcc820c1a00d62af3c990725b4361244d" data-rendition-name="original" width="1000" height="1500" loading="lazy" alt="Climate magnifies earthquake risk in Nepal village NT"> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250508110520_016534fb2b6a79957402281cda768efb83a146786377e39e11df3e251d37159e.jpg" data-media-id="editor_2" data-image-id="20250508110520_016534fb2b6a79957402281cda768efb83a146786377e39e11df3e251d37159e" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Climate magnifies earthquake risk in Nepal village NT"> </figure>  It was here that dozens were killed on 25 April in the first earthquake. Hundreds of <a href="https://archive.nepalitimes.com/article/nation/Singati-rising-from-rubble-rebuilding,3703">Singati survivors</a> had lined up for food and relief supplies in the morning of 12 May when the second earthquake triggered a rock slide that buried a nearby camp. At least 50 people were killed. &nbsp; Three hours later, a US Marine Corps UH-1Y Venom helicopter landed in a nearby cornfield to pick up the wounded, and flew off. The aircraft lost contact with air traffic control in Kathmandu and its wreckage was located high on Kalinchok four days later. Six American servicemen, two Nepal Army soldiers, and five wounded civilians from Singati were killed. Today, Singati bears little physical scar of the multiple tragedies that struck the town ten years ago. Most <a href="https://nepalitimes.com/multimedia/bungamati-builds-back">houses have been rebuilt</a> as urban-style concrete structures, and Singati has become an economic hub on the road leading up to several hydropower plants and a<a href="https://nepalitimes.com/banner/off-the-beaten-trek-in-nepal"> popular trekking destination</a>.&nbsp; The town looks less like a village and more like a suburb of the Dolakha district headquarter of Charikot, 47km away.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250508110520_196f341d1df1403ba133e5dfeb837eec20d7cbcb4c8c56b17cc5598810de5df2.jpg" data-media-id="editor_6" data-image-id="20250508110520_196f341d1df1403ba133e5dfeb837eec20d7cbcb4c8c56b17cc5598810de5df2" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Climate magnifies earthquake risk in Nepal village NT"> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250508110524_ae66c4a92430f67db51b5e11e017059eedfbac4cb18c8e073f2a50cca1fe904e.jpg" data-media-id="editor_7" data-image-id="20250508110524_ae66c4a92430f67db51b5e11e017059eedfbac4cb18c8e073f2a50cca1fe904e" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Climate magnifies earthquake risk in Nepal village NT"> </figure>  “The demand for construction material, cement, iron rods and bricks peaked after the earthquakes,” says Suresh Khadka, who owns a hardware business here and now supplies material to the 456MW Upper Tama Kosi hydropower project that is undergoing repairs after it was damaged by a landslide last year. The demand for cement boomed since most residents believe, not necessarily correctly, that <a href="https://nepalitimes.com/banner/in-a-disastrous-state">cement houses are safer</a>. Although Khadka did well selling construction material after the earthquake, he worries that most new structures do not follow seismic-resistant building codes.&nbsp; The construction boom financed by bank loans has in turn forced many from Singati to <a href="https://nepalitimes.com/banner/making-overseas-migration-better">migrate overseas for work</a> so they can service their debt.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250508110524_50caa4530bd5ff9120cf7ab70a62173846d337ef448ff8bac339f3faa375a9e2.jpg" data-media-id="editor_10" data-image-id="20250508110524_50caa4530bd5ff9120cf7ab70a62173846d337ef448ff8bac339f3faa375a9e2" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Climate magnifies earthquake risk in Nepal village NT"> <figcaption>Suresh Khadka</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250508110520_ef8b7d3993fc3b5df852bbf952feb3fbabc96d6883b0d5eb74ee5c60f4123b83.jpg" data-media-id="editor_11" data-image-id="20250508110520_ef8b7d3993fc3b5df852bbf952feb3fbabc96d6883b0d5eb74ee5c60f4123b83" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Climate magnifies earthquake risk in Nepal village NT"> <figcaption>Phu Doma Sherpa (right)</figcaption> </figure>  “My family had no choice but to borrow money to rebuild our home since the government compensation was not enough, and ten years later we are still paying off the loan,” says Phu Doma Sherpa, 60. Because of the shortage of qualified masons and proper seismic engineering, <a href="https://nepalitimes.com/here-now/structural-problems">many of the buildings are of questionable building standards </a>and the traditional architecture has been abandoned, admits Kul Bahadur Budathoki, deputy chair of the municipality. “But these buildings were more expensive than what the government grants could cover, many people here are heavily in debt and the men have <a href="https://nepalitimes.com/here-now/every-day-is-closer-to-pay-day">migrated to the Gulf to pay their loans</a>,” Budathoki says.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250508110520_32f89e97b7e757fc9286c0bbb671f48ea8d4468e9634fa646d7247c650ad8480.jpg" data-media-id="editor_14" data-image-id="20250508110520_32f89e97b7e757fc9286c0bbb671f48ea8d4468e9634fa646d7247c650ad8480" data-rendition-name="original" width="1501" height="1079" loading="lazy" alt="Climate magnifies earthquake risk in Nepal village NT"> <figcaption>Kul Bahadur Budathoki</figcaption> </figure>  Singati is in a multi-hazard zone. The <a href="https://archive.nepalitimes.com/article/nation/Singati,3091">12 May 2015 earthquake </a>could have led to the collapse of Nepal’s largest glacial lake, <a href="https://nepalitimes.com/here-now/stairway-to-heaven">Tso Rolpa</a>, upstream. Due to global warming, the glacier has turned into an expanding lake 3.5km long, and its collapse would have unleashed a catastrophic Himalayan tsunami down the Tama Kosi Valley, with Singati directly in its path. Singati has literally risen from the ashes of 2015, with its residents beginning to recover from the trauma and financial toll. But it is not out of danger as <a href="https://nepalitimes.com/news/climate-breakdown-linked-to-thame-flood">climate breakdown </a>magnifies the risk from future earthquakes.

Climate magnifies earthquake risk in Nepal village

This is the 67th episode of Diaspora Diaries, a Nepali Times series in collaboration with Migration Lab providing a platform to share experiences of living, working, and studying abroad. <h2>Alpana Adhikari, UK</h2> Back in Nepal, I had worked as a nurse for a decade, but I had my heart set to go overseas. My reason for <a href="https://nepalitimes.com/banner/migration-not-a-wish-but-necessity-for-nepalis">wanting to migrate</a>, however, was a bit different as it was for my son. He has a disability, and considering his situation from multiple perspectives—including <a href="https://nepalitimes.com/here-now/it-s-all-in-the-mind">societal attitudes</a>, the preparedness of schools, and the availability of facilities for individuals with his condition—Nepal did not feel safe for my baby.&nbsp; I had to migrate, no matter what, for his sake. The facilities here in the UK for children with his condition are significantly better, and I am glad he and my husband will join me in a few months.&nbsp; I was applying via private routes like everyone else when the Government to Government pilot program between Britain and Nepal was announced. Even though the initial program targeted 100 nurses, only 40 of us were able to meet the criteria.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250511160536_46f6a3c05fd2d9bdac06a9a478f49079c2c69c783fcf0cc58b75da6128319745.jpg" data-media-id="editor_2" data-image-id="20250511160536_46f6a3c05fd2d9bdac06a9a478f49079c2c69c783fcf0cc58b75da6128319745" data-rendition-name="original" width="720" height="1280" loading="lazy" alt="DD 67"> <figcaption>Alpana Adhikari started working as a nurse in a hospital in the UK in March.</figcaption> </figure>  I made it to the UK &nbsp;in February 2024 without paying a single paisa to any broker. The G2G scheme was unique as we were treated with dignity and valued for our skills: they covered costs for the <a href="https://nepalitimes.com/opinion/free-visa-free-ticket-policy-in-limbo">ticket and visa</a>, reimbursed us for exams we had taken and costs involved in the preparation and testing of the Objective Structured Clinical Examination were also covered.&nbsp; I started work in March last year, and currently am based in the respiratory ward of a hospital. I am enjoying my work a lot. In one year, I have received 26 WOW nominations which are notes of<a href="https://nepalitimes.com/here-now/the-healer-of-far-western-nepal"> appreciation from patients </a>we have served. ‘Alpana is one of the kindest nurses I have seen. Awesome and talented … always smiling, never appears tired and helps everyone,’ one patient testimonial said. Another: ‘You can see clearly that she cares about her patients…She was cool amidst great stress and ALWAYS with a smile which gave me confidence.’ I am also the International Educated Nurses Advocate which means I can raise issues with management about issues facing <a href="https://nepalitimes.com/opinion/comment/nepali-nurses-now-britain-bound">international nurses</a> here.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250511160536_87b959c7550bbd1272ebf840d9f24735db008307ad825e4aa15e66c1662a7fd4.jpg" data-media-id="editor_6" data-image-id="20250511160536_87b959c7550bbd1272ebf840d9f24735db008307ad825e4aa15e66c1662a7fd4" data-rendition-name="original" width="1590" height="1600" loading="lazy" alt="DD 67"> <figcaption>One reason Alpana Adhikari migrated to the UK was so there would be better facilities for her son, who has a disability. </figcaption> </figure>  Recruitment from NHS linked hospitals is free but when we <a href="https://nepalitimes.com/editorial/safer-migration-for-women">migrate through private routes</a>, agencies either charge upfront costs or in some cases, there is wage deduction once the nurses start earning.&nbsp; I have met Nepalis who have paid up to Rs 1 million for the same job. These costs can go even as high as Rs3 million for work in caregiving or nursing homes. I am lucky not to have to pay anyone for my posting.&nbsp; But beyond costs, I think there is also a reputational advantage of coming through the government selection process at the hospital. Such programs need to be expanded more because <a href="https://nepalitimes.com/editorial/nepal-s-nurse-flight">nurses are migrating </a>anyway and it would save people a lot of unnecessary costs and hassles. I will always be protective about Nepal and am grateful for the experience I gained, but it is true that nurses lack dignity in the workplace back home. Nursing is laborious work and completing the education takes a fortune but the <a href="https://nepalitimes.com/here-now/nursing-grievances-against-the-state">pay for nurses in Nepal</a>, other than at a handful of hospitals, is unfairly low.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250511160540_2a483361070e6e65413cf3bcf3be7af0581044f85c3e6da25a66dc87042af9d9.jpg" data-media-id="editor_10" data-image-id="20250511160540_2a483361070e6e65413cf3bcf3be7af0581044f85c3e6da25a66dc87042af9d9" data-rendition-name="original" width="2048" height="1536" loading="lazy" alt="DD 67"> <figcaption>Alpana Adhikari while working as a nurse in Nepal.</figcaption> </figure>  It naturally makes nurses want to migrate. People often ask me what the difference in the UK and Nepal is. Work is similar but in terms of technology, there is less paperwork here as everything is digitised. Treatment is also more nurse-led and we have more say while making recommendations about medicine and discharging decisions which can be empowering. Read also: <a href="https://nepalitimes.com/here-now/nepali-nurses-gone-and-going-to-the-uk">Nepali nurses gone and going to the UK</a> I am not sure what it is about nursing but I am always in high spirits and energetic about showing up to work every day. To be a good nurse, you have to have the passion for <a href="https://nepalitimes.com/news/step-by-step-for-rural-health-care-in-nepal">patient care</a>.&nbsp; Sometimes people tell me it is because my family has not yet joined me which has freed up my time to singularly focus on work, but I do not believe that is true. Back home, too, I used to be as passionate about my job.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250511160540_47851c2c850c936b7bfb23da0f0e8a07620ea213ad929c229b6cca8711adc5d4.jpg" data-media-id="editor_13" data-image-id="20250511160540_47851c2c850c936b7bfb23da0f0e8a07620ea213ad929c229b6cca8711adc5d4" data-rendition-name="original" width="1024" height="768" loading="lazy" alt="DD 67"> <figcaption>Alpana Adhikari (left) during an International Nurses Day rally in Kathmandu.</figcaption> </figure>  What fuels my passion here is the appreciation we get. It is not just about the income. Sometimes after <a href="https://nepalitimes.com/here-now/you-must-be-having-so-much-fun-there?fbclid=IwZXh0bgNhZW0CMTEAAR0OsTusz4rvYDQLvB0bnwhlDvkS3zCQ-UvuoO5manWHC0LGI2c3XY7e6ZY_aem_hR-tZOp4xg1mINPJvwD7Nw">long hours at work</a> when it has been a particularly busy day, a phone message from my manager and colleagues appreciating me for a job well done can go a long way.&nbsp; Likewise, the WOW recommendations from my patients have boosted my confidence. One of my elderly patients who had a <a href="https://archive.nepalitimes.com/article/nation/stigma-and-silence-mental-health-nepal,3486">mental illness </a>and I bonded, and she felt comfortable enough to open up with me. She would then refer to me as her friend with everyone.&nbsp; It is little things like this that can make a big difference. Perhaps that is why my flat mate and colleagues often question why I don’t look tired even after a long shift. <h2>Binu Gurung, Japan</h2> It has been five-and-half years since I came to Japan under the Specified Skilled Workers (SSW) visa in the nursing category. I had previously come to Japan as a language student as well.&nbsp; I grew up in Ghandruk and had just started my Bachelor’s course when a friend suggested we try<a href="https://nepalitimes.com/business/nepalis-in-japan"> to go to Japan </a>so I just followed the trend and stayed here for three years as a student.&nbsp; Two years after returning to Nepal, I re-migrated to Japan under the SSW scheme which was at its early stages and only open to nursing initially.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250511160536_305bb5cb5095da6148911dae8b07356ece5b292148e6c8e57a39fd31d811624b.jpg" data-media-id="editor_17" data-image-id="20250511160536_305bb5cb5095da6148911dae8b07356ece5b292148e6c8e57a39fd31d811624b" data-rendition-name="original" width="720" height="960" loading="lazy" alt="DD 67"> <figcaption>Binu Gurung on arrival in Japan to work as a nurse three years ago.</figcaption> </figure>  I take care of the elderly Japanese who are mostly above 80 years of age, a few even above 100. I try not to get too attached to patients but it is of course not always easy because of the nature of the job and patients we serve.&nbsp; Patients dying of age is common as it is not a care facility where patients recover to return to their homes. Just recently, an elderly lady who had been here from the day I joined 5.5 years ago passed.&nbsp; These leave you a bit खिन्न and emotionally drained. Most are <a href="https://archive.nepalitimes.com/article/nation/dementia-brings-new-problem-that-families-have-little%20knowledge-of,2151">dementia patients</a> who do not &nbsp;even recognise their family members. Some elderly patients are reserved and do not feel comfortable as the work entails helping with personal care tasks like using the toilet or bathing and they can be irritable.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250511160536_c840a0b12c20c3d52d9eceec06a0bc8c90208f13e402c50f319583b1c1a93b87.jpg" data-media-id="editor_19" data-image-id="20250511160536_c840a0b12c20c3d52d9eceec06a0bc8c90208f13e402c50f319583b1c1a93b87" data-rendition-name="original" width="694" height="960" loading="lazy" alt="DD 67"> <figcaption>Binu Gurung's work involves taking care of elderly Japanese.</figcaption> </figure>  Building trust and rapport takes time, patience and familiarity. I do not think there is a way to explain how happy I feel when they are happy with the care we provide and thank us in smiles like we are their own family members.&nbsp; My own grandmother back in Nepal was in a similar situation requiring care before she passed and I am able to extend that kind of care to many patients.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250511160536_0f41ad57ae1ac5bd2f406d86cdc5f542b613cef6961d8fdf20c883ee38404b5e.jpg" data-media-id="editor_20" data-image-id="20250511160536_0f41ad57ae1ac5bd2f406d86cdc5f542b613cef6961d8fdf20c883ee38404b5e" data-rendition-name="original" width="1600" height="1067" loading="lazy" alt="DD 67"> <figcaption>Binu Gurung in Yokohama.</figcaption> </figure>  I know that this job is not for everyone. That is why some nurses who come to Japan because they want to just<a href="https://nepalitimes.com/banner/making-overseas-migration-better"> migrate overseas </a>at any cost without considering the kind of employment realise that caregiving might not be for them.&nbsp; You have to be mentally, physically and emotionally prepared for it. If you are short-tempered by nature, for example, it may not be the best fit. However, for those who are genuinely interested in care work like I am, there are many growth opportunities in nursing which are also financially rewarding.&nbsp; While working under the SSW visa, I was able to take training classes on the side and passed the national exam for nursing. I was then able to change my visa from SSW to nursing caregiver visa. My son joined my husband and I recently in Japan and has started school.

covid-vaccine-drive