<figure><img width="1165" height="600" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109141116/636ba8469c7e80680e0737cejpeg.jpg" alt=""/><figcaption>All photos: HEALTHY SMILES</figcaption></figure>Health care facilities are in much demand during the Covid-19 pandemic, but one branch of medicine that is not seeing any patients is dentistry. The patient cannot wear a mask, it is impossible for the dental surgeon to maintain physical distance during treatment, and patients, dentists and their nurses all face extended exposure to virus-carrying aerosols.The World Health Organization (WHO) has advised patients to delay visiting their dentists during the pandemic, and the Nepal Ministry of Health has told dental surgeries to close during the lockdown period.However, dentists interviewed for this overview told Nepali Times if there is one field of medicine that is most prepared to stop the spread of infections, and who were already following strict protocols, it is oral care.“Long before Covid-19 dental clinics already had strict protocols to prevent the spread of airborne infections, so if any doctors already had  preventive measures in place it would be dentists,” says dental surgeon Sushil Koirala of the <a href="http://www.punyaarjanfoundation.org.np/main/" data-saferedirecturl="https://www.google.com/url?q=http://www.punyaarjanfoundation.org.np/main/&amp;source=gmail&amp;ust=1598755551072000&amp;usg=AFQjCNG60e9232rmC_ehPE51HjcNhCR4iw">Punyaarjan Foundation.</a>Koirala says most dentists in the region were already following the WHO protocol from the SARS epidemic in 2003, and even before that dental clinic staff in Nepal have been taking precautions against tuberculosis, seasonal influenza, and other airborne pathogens.<a href="https://www.nepalitimes.com/here-now/protecting-those-who-protect-us-from-the-epidemic/">Protecting those who protect us from the epidemic</a>, Ramu SapkotaFor the first four months of lockdown after March, the government ordered all dental clinics closed, and had allowed oral care departments in two hospitals to remain open for dental emergencies. However, they soon closed after staff tested positive for the novel coronavirus. From March to mid-July most dentists spoke to their patients on the phone about symptoms, and depending on the case, the patients were given advice, prescribed painkillers or antibiotics.Over 90% of the cases were gum infections or tooth decay due to excessive snacking during the lockdown. Most could be treated with analgesics and mouthwash. “With the more serious cases, we practiced a crude form of telemedicine where we asked the patient to take a live video of their oral cavities so we could advise on a course of action,” Koirala says. “Some of my patients learnt to take really good selfies.”Even when the restrictions were partially lifted on 21 July, clinics were still largely empty because the patients were too scared to visit, and the staff stayed away. Dental clinics then followed their standard protocols, adding new guidelines on pre-appointment interviews, disinfection of surgery after every patient, personal protective equipment, and procedures like limiting the number of patients and minimising contact.<a href="https://www.nepalitimes.com/latest/tb-patients-in-limbo-due-to-covid-19/">TB patients in limbo due to COVID-19</a>, Devika Agarwal <img width="1138" height="600" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109141116/636ba8499c7e80680e0737cfjpeg.jpg" alt="">Some innovative clinics like Healthy Smiles in Kathmandu developed their own protocols a based on guidelines issued by the US Centre for Disease Control (CDC) and have <a href="https://youtu.be/MV048n6EuPE" data-saferedirecturl="https://www.google.com/url?q=https://youtu.be/MV048n6EuPE&amp;source=gmail&amp;ust=1598755551072000&amp;usg=AFQjCNEeNub-ibeeEVrwxo8E6Oz-ul--QQ">made videos</a> to illustrate the process to patients.“As this is a droplet infection with aerosol transmission, our attempt is to minimise it with online screening of limited patients, social distance and masks, well ventilated rooms with negative pressure along with high vacuum dental suctions and a floor level exhaust at floor level,” explains dental surgeon Neil Pande of Healthy Smiles.After every patient, the entire outer wear is changed by all to ensure no cross contamination between patients. The donning and doffing of PPE is carried out in a strict sequence and disinfected before cleaning. All the surfaces are decontaminated with 70% alcohol three times, once immediately after and other twice after, with an interval of one hour. Healthy Smiles actually got Nepali engineers to design and build its new ventilation system that sucks air out of the surgery and passes it through HEPA filters to decontaminate it.<a href="https://www.nepalitimes.com/latest/govinda-kc-treats-patients-in-remote-nepal/">Govinda KC treats patients in remote Nepal</a>, Achyutraj Bhandari“We believe infection control to be one of the main pillars of the healthcare system, and it is even more important during this pandemic,” Pande says. “It has completely changed the face of dentistry.”Elsewhere in developed countries, many dentists have defied the WHO’s recommendations saying they are already used to taking necessary precautions to prevent infections. In fact, they argue that patients may suffer other health complications if they cannot see their doctors in time, and that oral infections can worsen the outcome of patients with Covid-19.  In Singapore, where a very strict testing and tracing regimen is in place, dental clinics have remained open and the flow of patients is at 80% of pre-pandemic level. In Australia, except in the state of Victoria, most dentists are seeing patients.In Nepal, Punyaarjan Foundation has <a href="http://www.punyaarjanfoundation.org.np/main/" data-saferedirecturl="https://www.google.com/url?q=http://www.punyaarjanfoundation.org.np/main/&amp;source=gmail&amp;ust=1598755551072000&amp;usg=AFQjCNG60e9232rmC_ehPE51HjcNhCR4iw">published a booklet</a> and posters in Nepali that allow individuals and families to self-evaluate their own risk levels with various activities. Says Sushil Koirala: “Dentists are taught to be extra-cautious about infections, and with this publicity material we want to share that knowledge with the Nepali public -- that the only way to fight infectious disease transmission is through individual responsibility and discipline.Read also: <a href="https://www.nepalitimes.com/here-now/kidney-patients-dying-due-to-covid-19-lockdown/">Kidney patients dying due to COVID-19 lockdown</a>, S Dhiren

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Need to see a dentist during the pandemic?

https://www.youtube.com/watch?v=kJLBI7sim0M&amp;feature=youtu.beA revolutionary treatment for open wounds has dramatically reduced the healing period of <a href="http://archive.nepalitimes.com/news.php?id=711#.XSckw-szaUk" target="_blank" rel="noopener">leprosy patients in Nepal</a>, saving them money and prolonged pain. The new procedure has huge implications internationally, as it reduces the medical cost for treating patients with chronic open wounds.The technique, called Leukocyte Platelet Rich Fibrin (LPRF), was <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6089057/" target="_blank" rel="noopener">devised for dental surgery</a> by Nelson Pinto of Chile and has proven to accelerate the healing of tissue. Now, it is also being used to treat hard-to-heal skin lesions of <a href="https://archive.nepalitimes.com/article/nation/diabetes-in-south-asia,3018" target="_blank" rel="noopener">diabetes</a> and leprosy patients.“LPRF has shown miraculous results in the treatment of chronic wounds in Nepal,” says dental surgeon Sushil Koirala who is pushing the new treatment in government hospitals. “It does not need special equipment, is cheap and, so simple even paramedics and nurses can perform it.”<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108131140/636a4f009c7e80680e04fce5jpeg.jpg" alt="" width="1400" height="1050"/><figcaption>SECOND CHANCE: Surgeon Indra Bahadur Napit guides a paramedic during a session of LPRF on a patient with leprosy at Anandaban Hospital. Pic: KUNDA DIXIT</figcaption></figure>There are three specialised leprosy hospitals in Nepal: Ananadaban in Lele, Green Pastures in Pokhara, and Lalgadh in Dhanusa. Anandaban Leprosy Hospital 16 km south of Kathmandu has been trying out LPRF on patients with excellent results.Leprosy is a biblical disease in which bacteria called Mycobacterium leprae damages the patient’s nerves and causes the fingers, toes and limbs to go numb, leading to further injuries. Leprosy is treated with antibiotics, but some patients suffer antigen reaction and need long-term rehabilitation.One of the patients at Anandaban is Phelit Sahi, who was ostracised by her community in Jumla because she had leprosy and had been living in a cave for 25 years. Reporters who had gone to cover a local event in a helicopter found out about her, and flew her to Kathmandu for treatment.Every week, doctors draw 80cc of blood from her and place it in a special centrifuge for 12 minutes. The clear plasma separates from the red corpuscles and is compressed to form a high-density fibrin clot which is applied to her wound.“She is among more than 100 patients that we have treated with LPRF, and we have gained enough experience in this technique to lead the way for the world,” says surgeon Indra Bahadur Napit at Anandaban, who presented his results at WHO in Geneva.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108131140/636a4f039c7e80680e04fce6jpeg.jpg" alt="" width="1400" height="933"><figcaption> </figcaption></figure>Raju Lama was 27 when he was diagnosed with leprosy, but because of late diagnosis, his fingers and toes were deformed, and he had to abandon his job. Doctors recommended amputating his right leg, but became the first patient to get LPRF treatment. He is happy with his “ragat upachar” (blood treatment) and says after several LPRF procedures his wounds are healing much faster.Ram Kumari Sah and her husband from Janakpur have been living with leprosy for decades. She does not feel pain in her hands and legs and often hurts herself. Her lesions become infected and never healed. This week, she was waiting for her turn at the LPRF ward in Anandaban.The hospital’s LPRF pilot study has shown that 97% of the cases healed completely within seven weeks. The results are so encouraging that news of this revolutionary treatment has spread through word of mouth. A dozen patients, currently at Anandaban were referred by hospitals in India. A team of Nepali doctors is also training doctors in Burma, Bangladesh and Nigeria.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108131140/636a4f069c7e80680e04fce7jpeg.jpg" alt="" width="1400" height="1003"><figcaption> </figcaption></figure>The new treatment is expected to add to Nepal’s success in reducing the prevalence of leprosy from 21 cases per 10,000 in the 1980s to less than 1 today. Nepal was officially declared leprosy-free in 2010 when the prevalence rate came down to 0.79%.However, in recent years, the prevalence rate is creeping up again, and was 0.94% in 2018. More than 3,000 new patients are diagnosed with leprosy every year, with most of the cases found in Province 2. Experts say this could be a result of active case finding and may not mean that the prevalence is increasing.Leprosy is curable with multidrug therapy but many do not get treatment on time. The incubation period is five years on average and symptoms may occur within a year, but can also take as long as 30 years to become visible, making the disease difficult to diagnose, and the delay leads to nerve damage and deformities. Leprosy is transmitted through the air during close and frequent contact with untreated cases.“Leprosy can afflict anyone but there is a correlation between the disease and poverty,” explains dermatologist Mahesh Shah. “If one’s immune system is strong, the bugs do not do any damage. But poor hygiene and nutrition increases susceptibiltity. Neglected people from neglected countries suffer from leprosy the most.”<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108131140/636a4f0a9c7e80680e04fce8jpeg.jpg" alt="" width="1400" height="1169"><figcaption> </figcaption></figure>Up to 40% of patients undergoing multidrug treatment develop a reaction, and need long-term hospitalisation. Since the patients are poor, most private hospitals are not interested in treating them. At Anandaban, treatment is free as it is supported by government grants and charities.Since 1% of cases suffer from relapse in Nepal, active door-to-door case finding is important to meet the WHO target of zero leprosy transmission by 2030.Even more daunting is to counter societal stigma and ostracisation of leprosy patients. Family members regard the disease as punishment from the gods, and even some medical interns and nurses refuse to touch patients despite patients being on antibiotics and unable to spread the disease. Nepal’s laws still allow husbands to divorce their wives if they have leprosy.“It is a complicated disease made even more so by stigma and ignorance,” says Napit, “but with LPRF, we now have a powerful weapon in our arsenal. A vaccine would be the final solution, but no one cares about leprosy. All the funding goes for diseases like HIV.”   <h2>Miraculous healing</h2>When Nelson Pinto’s favourite horse broke its leg, he had two options: either put it down or amputate its leg. The Chilean dentist decided on a third option.He drew some blood from the horse, spun it in a centrifuge to separate the autologous fibrin matrix which is rich in platelets, and applied the plasma to the horse’s wound. After a few weeks, the horse was cantering again.Pinto knew about the technique because Leukocyte Platelet Rich Fibrin (LPRF) was developed for dental implant treatment. The surgeon was so convinced that the new process would be useful in treating chronic open wounds that he embarked on a global crusade to spread its use.Pinto convinced fellow-dentist from Nepal, Sushil Koirala, whom he met at an international conference, to adopt the technique. Since then, Koirala has been trying to convince the government and private hospitals to adopt the procedure, but without much success. However, Anandaban Leprosy Hospital in Lalitpur has seen phenomenal improvements in the healing time of lesions among its patients. (See adjoining report above)LPRF is now used to treat diabetic wounds, lesions caused by leprosy, localised <a href="http://archive.nepalitimes.com/article/nation/burning-in-the-aftermath,3757" target="_blank" rel="noopener">burns</a> and surgical wounds, and with this, healing time is often cut in half. It is also being used in cosmetic surgery to remove wrinkles and rejuvenate the skin. The reason why it is so effective, Pinto explained during a trip to Nepal last month, is because it is completely natural and autologous, which means a patient is not receiving any foreign tissues or chemicals.And the treatment is cheap. A similar treatment used in Europe, which involves a kit manufactured by a multinational pharmaceutical company, costs $3,000 per patient. LPRF costs only $30. But it seems as though private hospitals are not interested in this treatment as patients heal so quickly. Many doctors are also not enthusiastic because LPRF can be administered by a paramedic or a nurse.Says Sushil Koirala: “The reason they don’t like it is because there is no money in it. LPRF only uses the patient’s blood and there are no chemicals or equipment involved for multinational companies to make money out of.”Koirala’s Punyaarjan Foundation has donated centrifuge machines to a few hospitals in Nepal including the Sushma Koirala Memorial in Sankhu, Anandaban Leprosy Hospital, Bir Hospital in Kathmandu and to three hospitals in Burma with varying degrees of acceptance.The Bible relates how Jesus Christ miraculously and instantaneously cured ten lepers at the gates of Jerusalem. LPRF may not cure leprosy lesions as quickly, but the procedure is nearly as miraculous.<h2>Life after leprosy</h2><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108131140/636a4f0d9c7e80680e04fce9jpeg.jpg" alt="" width="1400" height="1050"><figcaption> </figcaption></figure>Kumar Tamang, 47, is putting the final touches on his painting of an elephant with a bejewelled crown and a howdah. He dips his paintbrush on a palate and paints the border bright red. His fingers are numb and deformed by leprosy, yet he has been painting for 25 years. His love for Mithila art is on full display on the walls, pillars and ceiling of Shanti Sewa Griha, a leprosy clinic set up by the German charity, Leprahilfe, in 1992.Nearby, in a dark corner, is 50-year-old Nathuni Barai from Nawalparasi, who also has deformed fingers which he uses deftly to draw intricate patterns on a letter pad. Both Tamang and Barai are former patients at <a href="http://archive.nepalitimes.com/news.php?id=15213#.XSckyeszaUk" target="_blank" rel="noopener">Shanti Sewa Griha,</a> making a livelihood from products that Leprahilfe buys from fundraising. Their families live nearby, and their children attend a school set up by the charity.Now, nearly three decades after the clinic was set up, Shanti Sewa Griha runs a school and orphanage in Budhanilkantha, an organic farm in Sundarijal and a rehabilitation centre near Pashupati.As the number of patients grew, they were trained in painting, tailoring, quilt making, carpentry and jewellery making as a form of livelihood. Bags, uniforms, paintings, stationery and decorative items are sold as souvenirs to raise money for the upkeep of the shelters and to pay former patients.“This is a form of operational therapy which tries to break the vicious circle this disease has formed,” said Marianne Grosspietsch, one of the founders of Leprahilfe. “Our goal is to create hope in Nepal.”In 1974, Grosspietsch adopted a young boy named Puskar Limbu who had leprosy like the rest of his family. She took the boy to her home in Germany, treated his leprosy and sent him to school. Limbu went on to pursue a successful career in graphic design in Germany and is a grandfather himself today.Children of former leprosy patients have also gone on to become nurses and doctors.Kalpana Pariyar (pictured above) was 14 when she was diagnosed with leprosy before there was serious nerve damage to her fingers. She grew up in the shelter and married fellow-patient Krishna Majhi, whom she took care of until he died eight years ago. She now has a college going daughter and an eight-year-old son.“I have spent my entire life here. This is my home, this is where I made my life and found peace,” says Pariyar, looking up from her sewing machine on which she was weaving dhaka fabric.Sonia Awale

Sonia Awale

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New treatment offers hope for Nepal’s leprosy patients

Everyone in the world is running some kind of race. Some chase recognition. Some chase money. Others run simply to stay ahead of others. But there are some who run for others. They are not trying to overtake anyone, they do not do it for fame, they are not getting paid to do it. But they run to pay for the upliftment of those less privileged. Bal Joshi, 41, is originally from Surkhet. His father was involved in the democratic movement during the days of absolute monarchy and he remembers frequent police searches of the house. And with his father in hiding, the young Joshi had to take care of the family. When the family’s small shop failed, his mother took the young Bal and his brother back to the village, and that is where he completed his education, walking four hours roundtrip every day between home and school. He ran most of the way, and without realising it he has been running ever since. Life was hard. Rent, food, education. His mother struggled constantly. There were days when there was no money even to buy kerosene for the stove. At one point, he sold his calculator, worth Rs 300, for just Rs 80 to get by.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251229031252_edb16b64a3d362a8dc86870bfa5deaad03a84e67d47f37cfd0bb5a8e584691fe.jpg" data-media-id="editor_0" data-image-id="20251229031252_edb16b64a3d362a8dc86870bfa5deaad03a84e67d47f37cfd0bb5a8e584691fe" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Running for dear life NT"> </figure>  At 15, Joshi moved to Nepalganj to continue his education. He initially stayed with his uncles, but eventually began living on his own. The transition to city life was difficult, and he experienced significant economic hardship while trying to pursue his studies. There were times when he struggled to meet basic needs, and at one point he sold his calculator just to get by. When he was 17, after hearing that his father was seriously ill, Joshi travelled to Gujarat to bring him back home. His father died soon after, and Joshi took on responsibility for supporting his family. It was his mother who taught him that despite scarcity, life had to be lived with dignity. Joshi started working at a newspaper at the age of 16 as a proofreader, and later became a journalist. During the Maoist war when children were being orphaned as a result of violence by both sides, he became active in the Sahara Group, and at 19, he began managing an orphanage that took in conflict-affected children. In Bajhang, after the army killed a man on suspicion of being a Maoist, his wife jumped into the Seti River and ended her life. Their two children were taken into army custody. During the rescue process, Joshi met Sunaina Adhikari of the ICRC and back in Nepalganj they decided to get married. The conflict was still raging in western Nepal in 2005, when Joshi went to the United States. In Maryland, he initially worked at a Bengali-owned Subway outlet, spending long hours on his feet behind the counter. He changed jobs frequently, financing his education along the way, and ultimately graduated with a degree in finance in 2008. He joined Hancock Whitney Bank in Texas, and has risen up the ranks to be Senior Vice President. A colleague inspired him to run as a way to stay healthy. But it soon turned into something more meaningful — running more than a dozen 50km marathons for charity.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251229031252_165a6d935860cf6707178aa2ac7395733883158f425bbe0ebed125529d601f61.jpg" data-media-id="editor_1" data-image-id="20251229031252_165a6d935860cf6707178aa2ac7395733883158f425bbe0ebed125529d601f61" data-rendition-name="original" width="999" height="1500" loading="lazy" alt="Running for dear life NT"> </figure>  Last year, Joshi returned to Nepal to run the Everest Marathon, and raised $42,000 which he donated to <a href="https://onestepfoundation.org/" target="_blank">One Step Foundation</a> which works on health care, child welfare and cultural preservation in Nepal and around the world. In June this year, Joshi and his family climbed Kilimanjaro, raising $19,000 for 80 HIV-affected orphaned children in Tanzania. During the Diwali festival he ran 220km in Nevada’s Red Canyon and raised $25,000 for cataract surgeries through the the <a href="https://www.theruitfoundation.org/" target="_blank">Ruit Foundation</a> in Nepal for cataract surgeries.&nbsp; Joshi does not run competitions, and is not trying to break any records. His motto is: “My race, my pace.”&nbsp; Turning his childhood scarcity into helping others, he says: “We all share sunlight, rain, air, and soil, nothing is truly just your own. I grew up without shoes, and I am fortunate to be able to distribute shoes to those who walk barefoot.” We ask Bal Joshi what (and where) next? His answer: the <a href="https://www.worldmarathonchallenge.com/" target="_blank">World Marathon Challenge</a> that will go around the world to run seven marathons in seven continents in seven days beginning in Antarctica at end-January.&nbsp; Joshi aims to run wearing the daura suruwal and Nepal’s flag as to show where he comes from, and how far in life he has come.

Running for dear life

A day after Rabi Lamichhane and Balen Shah <a href="https://nepalitimes.com/news/old-vs-new-in-nepal-in-2026-z6l4fgrd">came together to form an electoral alliance</a>, Kulman Ghising has also joined forces with the two leaders, merging his Ujyalo Nepal Party with the RSP.&nbsp; Following last-minute negotiations before Monday’s midnight deadline for parties to file their list of candidates for the Proportional Representation (PR) seats, Lamichhane and Ujyalo Nepal chair Anup Kumar Upadhyay signed a seven-point agreement to unify the two parties, with Balen Shah as witness.&nbsp; Per the deal, Ghising will be the vice-chair of the RSP, joining DP Aryal and Swarnim Wagle as the party’s seconds-in-command. The earlier agreement between Lamichhane and Shah retained Lamichhane as RSP chief, and promised Shah prime ministership if the party wins a majority in Parliament in March.&nbsp; Ghising’s team reportedly has a 17% share on the list of PR candidates filed by the RSP at the Election Commission. Balen has also fielded his own picks, and together the party has the likes of cricketer Gyandenra Malla, actress Reema Biswokarma, rights activist Mohna Ansari, climate activist Tashi Lhazom, and singer Prakash Saput as PR candidates. Ghising had held multiple rounds of talks with the RSP chair and the Kathmandu Mayor to discuss possible collaborations, but had failed to reach a power-sharing agreement. On Monday, Ghising had met with Lamichhane heeding a last-ditch effort from GenZ leaders, in particular Sudan Gurung, as they tried for the final time to get the interim Minister on board with Lamichhane and Shah before the PR list submission deadline.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025123004128_99e23ae7b6a042e71d271e3e74f7527086a7bb55779e6781bc9e7b711c8303e7.jpg" data-media-id="editor_1" data-image-id="2025123004128_99e23ae7b6a042e71d271e3e74f7527086a7bb55779e6781bc9e7b711c8303e7" data-rendition-name="original" width="1595" height="1087" loading="lazy" alt="Sudan Kulman Balen"> <figcaption>Photo: SUDAN GURUNG / FACEBOOK</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025123004128_d9f530704ab4c6e27eebf51f8e9fb55fed1d4281c99d089d06455cc7448bfda7.jpg" data-media-id="editor_2" data-image-id="2025123004128_d9f530704ab4c6e27eebf51f8e9fb55fed1d4281c99d089d06455cc7448bfda7" data-rendition-name="original" width="1026" height="1084" loading="lazy" alt="Balen and Sudan NT"> <figcaption>Photo: BALEN SHAH / FACEBOOK</figcaption> </figure>  The three are now set to make a formidable team to challenge mainstream parties at the polls. News of this alliance has been welcome to Nepalis who are looking for any alternatives to break the stronghold of the Oli-Deuba-Dahal trio over Nepali politics in recent history.&nbsp; But they will also carry each other’s baggage.&nbsp; Lamichhane, who was jailed for defrauding cooperatives depositors last year, was welcomed back as RSP party chair with open arms after he was released on bail last week. And while he has maintained his base of loyal supporters, he was subject to widespread criticism after he walked out of detention amid the jailbreak during the September protests, prompting his eventual voluntary return to prison.&nbsp; His party’s silencing and expulsion of critics within the RSP has also drawn direct comparison with the leadership structure of Nepal’s mainstream parties. Prominent leaders like Sumana Shrestha have left the party over disagreements with leadership.&nbsp; Meanwhile, Balen’s impassioned campaign resonated with Nepalis disillusioned with establishment leaders during the 2022 election and made him mayor of Kathmandu. The mayor’s direct, no-holds-barred style of communication and commentary has attained him much support beyond his constituency.&nbsp; But his unyielding, often unempathetic leadership style and policies— like his dismissal of street vendors and informal businesses during his drive to free up Kathmandu’s footpaths— have also earned him detractors. His recent outburst on social media in November that included expletives against both of Nepal’s neighbours and the US, as well as Nepal’s three main parties and the RSP was also widely criticised.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251230041212_fc2088daf32bac93541ebf25ca07725d75a721ae83440749ac8fa09d8fe308f2.jpg" data-media-id="editor_3" data-image-id="20251230041212_fc2088daf32bac93541ebf25ca07725d75a721ae83440749ac8fa09d8fe308f2" data-rendition-name="original" width="890" height="1255" loading="lazy" alt="Agreement NT"> <figcaption>The seven-point agreement between RSP and Ujyalo Nepal Party.</figcaption> </figure>  Ghising, credited with ending Nepal’s prolonged load-shedding during his tenure as the chief of Nepal Electricity Authority, has a reputation of getting the job done. His public goodwill earned him a seat on Prime Minister Sushila Karki’s interim Cabinet following the youth protest.&nbsp; But he has also been under scrutiny for funds misappropriation as well as controversial power purchase agreements during his tenure as NEA chief. Ghising had foregone the leadership position at his Ujyalo party, preferring to play the role of patron until closer to the election date, but was nonetheless criticised for his political and electoral aspirations while being a member of the transitional government. It now remains to be seen if and when Ghising will step away from his position in the interim Cabinet and begin campaigning with his new partners.&nbsp; As it stands, the involvement of prominent GenZ figures in bringing together Ghising, Shah, and Lamichhane has established youth leaders as major players in Nepal’s post-September political landscape. These leaders will have significant pull with young and first-time voters. But not all young leaders are impressed with this new triumvirate. Some have pointed out that the unity between these three leaders is no different from the political opportunism and quid-pro-quo power-sharing culture established and followed by Nepal’s mainstream leadership for the last three decades which culminated into the GenZ movement of September.

Kulman follows Balen to RSP

Koreana Coffee Guff begins with a scene where Narayan Wagle, the editor-turned-farmer, appears in reverse cameo, as a character in a novel. He has just landed at Incheon in the dead of winter.&nbsp; The opening premise reminds one of Tolstoy’s saying about how stories begin either when someone goes on a journey, or when a stranger comes to town. ‘The winds of each city are its original inheritance, shaped by its local language, its specific topography and the buffets of the airborne wings of birds and airplanes,’ Wagle writes.&nbsp; The author is both on a journey and a stranger to the town. The word ‘stranger’ might need to be redefined here, as he has visited Korea several times before. But if every journey is new, then he is a stranger of sorts — stranger to the people he meets for the first time in the book, stranger to the reader who will encounter him for the first time like I did in high school reading the English translation of his 2005 Madan Puraskar winning novel Palpasa Cafe.&nbsp; Koreana is non-fiction, and was first published in 2017 in Nepali, and recently rendered into English by Prawin Adhikari, who specialises in translating Nepali works into English in such a way that they do not read like translations at all.&nbsp; Even so, I turned to a few chapters from the original text, curious to see how ideas have morphed. Take Wagle’s journey to Ansan Mountain. It is the same mountain, but something different happens in the two languages. The inexplicable feeling is that the translation has to conquer the mountain itself. At its best, the book gives the reader a peek into Wagle’s mind, his internal monologues, his writing ideas, his thoughts on the people around him, his deep yearning and respect for nature, his exploration of Seoul and Korea, where he is attending the Asian Literary Creative Writing Workshop in 2017.&nbsp; BACK TO THE LAND ‘All cities appear the same everywhere,’ he writes of Seoul, speaking of how ‘development’ has masked the original charm of a city rebuilt after war. In recent years, Wagle has moved on from being the editor of Kantipur, to activism, and has now returned to his ancestral land in Tanahu to farm.&nbsp; Clues to this metamorphosis can be detected in this book, which was written nearly ten years ago and before his transition. Wagle used to write a column called Coffee Guff, and the book carries that conversational style.&nbsp; But not all monologues land. Thoughts rooted in a specific time and space like the hike to Ansan where the author reflects on buildings, birds, and trees feel connected with a context and background. Then there are those that bring in a new metaphor, a new reflection, a new connection in almost each new sentence which make it difficult to follow the author’s stream of consciousness.&nbsp; Halfway into the book, we finally meet the writers who have come from different parts of Asia for the workshop. Not speaking a common language, the writers have to rely on interpreters and Google, which turns their exchanges into quirky moments of laughter.&nbsp; Writers are an important part of the book, the lens through which Wagle invites us to see the world. Poets Manjul from Nepal and Shiva Ryu from Korea make guest appearances. Through two Korean writers who share the surname Kim, we get a glimpse into Korean history and society, and how writing is intertwined with politics.&nbsp; This Korea is different from the Kpop idols and skincare routine that has dominated recent imagination of the divided peninsular nation. Wagle writes, ‘Literature attempts to unite, politics impedes it. They are being continuously thwarted by the conflicts ongoing in the nation’s politics.’&nbsp; One of the Kims is Kim Min-jung (김민정), author of The World’s Most Expensive Novel, that explores what it means to be a writer in Korea.&nbsp; Reading Koreana feels like a hike through a jungle. If one is able to move past the tangled and stretched monologues, the book can hold moments of awe and wonder. But there is always a desire for a clearer trail to follow. &nbsp;&nbsp; Narayan Wagle’s characteristic witticism is there aplenty, his observations are astute. Writers exploring their craft and readers curious of what is churning inside Wagle’s mind will find treats -- sometimes well-crafted, other times to be searched between the lines. &nbsp; Alfa M Shakya is a writer, researcher, and podcaster. She runs and hosts ‘How’d You Create That?’, an art podcast about the creative process.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251230071252_5503c9fb08d62adb328d8f817b353604429559d3d9c6542edf3663c3f8c554e5.jpg" data-media-id="editor_0" data-image-id="20251230071252_5503c9fb08d62adb328d8f817b353604429559d3d9c6542edf3663c3f8c554e5" data-rendition-name="original" width="1136" height="702" loading="lazy" alt="Korean coffee guff English translation review"> </figure>

Coffee guff from Korea

From stone spouts to cast-iron mains, Nepal’s water system and its struggle to provide safe water tells a larger story of power, disease, dependency — and lessons for the future. From 1823 to 1891, the Nepali state made just two notable interventions in Kathmandu’s drinking water system. The first was when Prime Minister Bhimsen Thapa commissioned a stone pout (hiti) to tap groundwater within the valley’s traditional supply system. The second came nearly 70 years later with Nepal’s first industrial-era water system, the Bir Water Works in 1891 under Prime Minister Bir Shumsher Rana. Linking these two milestones was the spectre of cholera. From the 19th century on there were seven global cholera pandemics. <a href="https://www.sciencedirect.com/science/article/pii/S0264410X19309995#bb0325" target="_blank">Originating in Asia</a>, the disease reached Europe and the Americas, the Vibrio cholera bacillus breeding in poor sanitation wherever it found it. The first wave erupted in 1817, followed by others in 1829, 1852, 1863, 1881, 1889 and, finally, in 1961, the seventh pandemic which still lingers on. London, the epicentre of the Industrial Revolution, was repeatedly stricken. In Britain ‘miasma’ foul air was blamed. &nbsp;In Nepal, cholera was seen as divine damnation. By the late 19th century, as Nepal’s relationship with Britain deepened, the Bir Water Works was inaugurated in 1891 as a defence against cholera. Whether cholera also shaped Bhimsen Thapa’s decision in 1823 is less clear. Contemporary records note the commissioning of Sundhara, but do not refer to the cholera epidemic raging at the time. The silence itself is telling: Nepal’s elites were ruling in the shadow of the disease. Bhimsen Thapa first resided in Thapathali Palace, which was built in 1802 by Nain Singh Thapa, father of Mathabarsingh Thapa, who would briefly become prime minister in the 1840s. In 1806, Bhimsen Thapa moved to Bagh Durbar, a new complex on the western edge of Tundikhel. Historians are vague about the water supply in the residences of the nobility, but wells and water hauled from rivers, ponds, canals, and other sources were likely the primary sources. A small hiti north of Bagh Durbar, near today’s Sun Dhara, may have supplied the palace. In 1823, Bhimsen Thapa had it enlarged, making it the last and largest state-built hiti in Kathmandu. Even as Bhimsen Thapa was involved in palace intrigues and border conflicts, Britain was engineering pipelines. By the late 18th century, Sir Thomas Simpson had invented the bell-and-spigot joint, making long-distance pipes viable. Fluid dynamics, dealing with pumps, pipes, and filters, was becoming a foundational discipline. In Kathmandu, the scourge continued. Cholera struck Kathmandu repeatedly, in 1862, 1867, 1872, 1874 and 1875. The 1872 epidemic, <a href="https://nepalitimes.com/news/kathmandu-in-the-time-of-cholera" target="_blank">according to historian Tom Robertson</a>, claimed between 200 and 250 lives a day. On average, cholera killed between 1,200 and 1,500 people annually in Kathmandu Valley, an enormous toll for its small population. The summer of 1885 was especially calamitous: a cholera epidemic ravaged Kathmandu and its periphery from the beginning of June until late August. The disease even breached the royal palace, reportedly killing 23 people, mostly young girls. Records show that 909 people received treatment at the British Residency dispensary, and estimates suggest that as many as 10,000 people perished in a city of 50,000. In November that year, Bir Shumsher seized power in a coup. He inherited not only a premiership but a Valley ridden with disease. Cholera was endemic, and it was accompanied by typhoid, smallpox, goitre, syphilis, and chronic dyspepsia. The The British Residency dispensary at Lainchaur was inadequate. “In a poor country like ours, wealth means health,” Bir Shumsher remarked, an unusually pragmatic admission that epidemics were not divine punishment but structural afflictions of urban life. He soon pledged to expand health care. In 1889, he opened Bir Hospital and staffed it with Indian doctors to treat cholera, typhoid, smallpox, and other prevalent illnesses. PIPED WATER Bir Shumsher also recognised the need for safe drinking water. Between 1866 and 1872, he had served as Nepal’s ambassador in Calcutta, and he must have seen water mains already in operation there, and a filtration plant inaugurated in 1870. Madras had installed such a system as early as 1800, Bombay constructed the Vihar and Tulsi reservoirs in the mid-19th century. In Kathmandu British Residency personalities such as George Gimlette must have urged Bir’s government to quicken the construction of the hospital and water system, yet the archival traces of such exchanges still await historical scrutiny. By the late 19th century, the British had developed a technological ecosystem for water supply, intakes, pipes, fittings, reservoirs, and trained engineers. Bir Shumsher appealed to the British Government in India for engineering assistance. A British engineer named Mr Feigneur surveyed Kathmandu to prepare maps, and estimated the volume of water that could be brought from the Rudramati River. In 1889, a more experienced engineer, Lockhart Matthew Sinclair arrived. He was a Scotsman educated at Wellington College and the Royal Indian Engineering College, with prior experience in constructing waterworks in Jubbulpore and the Viceregal Palace in Shimla. Appointed State Engineer of Nepal (1889–1892), Sinclair reviewed Feigneur’s plans, updated them, and chose the Bishnumati River as the source of the city’s drinking water. Sinclair’s design included a reservoir at Panipokhari, at 1,330m elevation and 30m above &nbsp;Tundikhel, thereby enabling gravity-fed distribution in pipes. With a capacity of 7,327 cubic metres, the reservoir could store nine days of supply.&nbsp; The system was designed to serve about 70,000 residents through both private connections and public standpipes. The reservoir was a single-compartment tank with an arched brick roof covered in earth and turf. Its brick walls were bonded with lime mortar and aggregate, and its floor was dressed with fly stone. Work on the valley’s water supply began in 1888, three years after Bir Shumsher seized power. The following year, Bir Hospital and the Bir Water Works took shape. The project involved some 40km of imported cast-iron pipes, weighing 1.866 million kg and inscribed with the marks of Scottish foundries ‘Ally and McLean’ and ‘Glasgow’. Construction required 620,000 man-days of labour and cost over Rs600,000. Transport costs inflated prices: <a href="https://commons-nepal.com/the-first-kaldhara-in-the-four-cities-of-the-valley/" target="_blank">a load of cement</a> costing Rs10 in Calcutta was worth Rs33 by the time it reached Kathmandu. Bir Water Works was inaugurated in September 1891, six years after the cholera epidemic. Water flowed out of 131 taps, including eight in Lainchaur, six in the royal palace, eleven in the prime minister’s palace, sixteen around Tundikhel, thirteen in Thapathali, seven in Thamel, and two in Naxal. The system’s designation, the term ‘works’ , echoes the Chelsea, Calcutta, and Glasgow Water Works, underlining its industrial pedigree. Water was also supplied to Phora Durbar, Bir Shumsher’s palace of music and dance whose fountains sprayed rose-scented water in a display of opulence. The <a href="https://commons-nepal.com/the-first-kaldhara-in-" target="_blank">Bir Dhara Works</a> was more than an engineering scheme: it was Nepal’s first modern public-health intervention. Safer drinking water curbed waterborne disease, and the number of cholera outbreaks declined, but were not eliminated.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260103020144_d5c22de54c0eaab680a166c5a7482839fdc09b60679109021d0504252a810254.png" data-media-id="editor_4" data-image-id="20260103020144_d5c22de54c0eaab680a166c5a7482839fdc09b60679109021d0504252a810254" data-rendition-name="original" width="865" height="535" loading="lazy" alt="Cholera and drinking water in Kathmandu"> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260103020144_a46075b6d759585df56a2bb8e5a07d85de7d9a69406165c32784fe30012c9971.jpg" data-media-id="editor_5" data-image-id="20260103020144_a46075b6d759585df56a2bb8e5a07d85de7d9a69406165c32784fe30012c9971" data-rendition-name="original" width="2791" height="3859" loading="lazy" alt="Cholera and drinking water in Kathmandu"> </figure>  “Now we have water to fight cholera, and I believe cholera will no longer prevail. After four years of piped water, the benefits have been greater than expected,” Bir Shumsher said in a proclamation. Despite this, the prevalence of poor sanitation, open defecation, cramped housing, and malnutrition meant that typhoid, smallpox, and dyspepsia remained endemic. The Bir Dhara system marked Kathmandu’s transition from reliance on wells, rivers, springs, and hiti to piped water, operating for several decades and laying the foundation for the expansion of drinking water services across the country in the late twentieth century. <a href="https://commons-nepal.com/the-first-kaldhara-in-the-four-cities-of-the-valley/" target="_blank">Extensions followed in Patan</a> under Chandra Shumsher, and Bhim Shumsher later added the Tri Bhim Dhara. Piped water systems were subsequently constructed in towns such as Kirtipur, Bhaktapur, Dhankuta, Pokhara, Dhulikhel, and Jajarkot which itself saw a deadly cholera outbreak in 2009.&nbsp; CHOLERA METAPHOR In 1933, Nepal’s first water bureaucracy, the Pani Goswara, was established, formalising state involvement in urban water supply. Yet even till the late 20th century, households continue to rely on a mix of sources, including public water networks, private vendors, rooftop storage tanks, borewells, wells, hiti, and household filtration. The lack of reliable water supply places disproportionate financial, physical, and psychological burdens on low-income households, underscoring how decades of infrastructure expansion have not translated into universal, reliable service. during challenges in governance, investment priorities, and regulation. Bir Shumsher also attempted to introduce <a href="https://www.ukaalo.com/news/cholera-in-kathmandu-1958/" target="_blank">basic hygiene measures</a>, such as pit latrines with squatting slabs. However, there is no record of these facilities being built in his palaces, later built palaces, or elsewhere. Sanitation conditions remained poor for both the elite and the general population. Open defecation or the use of crude pit latrines without proper waste disposal was common. With no drainage or sewer systems, human waste accumulated near homes, contributing to the spread of waterborne diseases. In 2019, Nepal declared itself ‘open defecation free’, a policy milestone, but this achievement masks the persistence of deeper problems. Urban areas generate some 867 million litres of wastewater daily, yet only 7% of it is treated before being discharged. Sewage flows untreated into rivers and streams, spreading cholera, typhoid, dysentery, and other diseases, particularly among children and vulnerable communities. Safe disposal of faecal sludge continues to be a major struggle for many communities and local governments. Besides Jajarkot, Godavari in Kathmandu Valley had a localised outbreak in 2024. This year, Birganj was struck by a cholera outbreak caused by a lethal combination of unreliable water supply, groundwater overpumping, poor drainage and hygiene, and unsafe waste disposal. And Nepal’s peacekeepers deployed after the earthquake in Haiti in 2010 were blamed for spreading cholera that ultimately killed 30,000 people in the Caribbean nation. The Bir Water Works was more than a reservoir and pipes. It was Nepal’s first brush with modernity, mediated through engineering and haunted by cholera. More than 134 years on, cholera remains a threat and a reminder of Nepal’s challenges in water and sanitation governance. The issue is not merely ensuring access to safe water but also building public trust that quality essential services can be delivered equitably, sustainably, and with resilience. Ajaya Dixit is a Kathmandu-based researcher exploring Nepal’s water history since the mid-eighteenth century to inform ethical water and river management in a changing climate.

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