In a corner seat on the first floor of Bir Hospital, a middle-aged kidney patient winces in pain. Next door, a lady has nerve damage, and is unable to feel the growing wound on her sole. Two floors up, a crowd of desperate patients wait for an appointment with an endocrinologist. This week, the hospital in Kathmandu was filled with different medical complications. But many of them were related to a single disease: diabetes. “On any given day, we see up to 200 patients in our department, and more than half have to do with diabetes mellitus,” says consultant endocrinologist Manil Bajracharya at Bir. Diabetes mellitus is a condition where the body either does not produce enough insulin, or does not use it effectively, resulting in dangerously high blood sugar levels. Untreated, it can lead to life-threatening complications, including disorders of the cardiovascular system, eyes, kidneys, and nerves. In Nepal, the incidence of diabetes is on the rise, with an estimated 8.7% of adults between 20-79 living with the condition in 2021. This number was 3.6% in 2011, and is expected to reach 9.4% by 2045. “This rise most likely has to do with rapid changes in lifestyle and diet,” explains Bajracharya. “We have seen a shift from traditional cereal and vegetable-based diets to ones rich in animal products and processed foods high in fat and sugar content. This nutritional transition, combined with reduced physical activity, has significantly increased the risk of diabetes.” Bagmati Province has a five times higher prevalence of diabetes than the Karnali. Other provinces with urban centres like Gandaki and Lumbini also have a high burden of the disease. Read also: <a href="https://nepalitimes.com/opinion/comment/saving-kidneys-to-save-nepal">Saving kidneys to save Nepal,</a> Rishi Kumar Kafle  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240607150624_2deb3cabd4a1367ea0656a84e817aa0c8bcc920bb4b33bda30037272931024b0.jpg" data-media-id="editor_1" data-image-id="20240607150624_2deb3cabd4a1367ea0656a84e817aa0c8bcc920bb4b33bda30037272931024b0" data-rendition-name="original" width="3952" height="3021" loading="lazy" alt="Diabetes in Nepalis NT"> </figure>  “Nepalis who migrate to cities often have reduced physical activity and transition to high-calorie diets, which contribute to obesity and elevate the risk of diabetes,” says Bajracharya. City dwellers are twice as likely to develop diabetes compared to rural Nepalis. Diabetes mellitus has no cure, but it can be managed through careful monitoring, lifestyle changes, and improving medications. Many people diagnosed with diabetes live for years without experiencing serious symptoms. But Nepal has a huge gap: 43.5% of adults living with diabetes do not know that they have the disease. This means two out of every five cases go undiagnosed, and therefore untreated.&nbsp; “If diabetes isn’t detected on time, it can become life-altering, and may even be fatal,” adds Bajracharya. Raman Tamang did not know he had diabetes until a wound started growing on his foot. “I first thought it was just a normal cut. But it grew and started stinking. It got so bad that my family started avoiding me,” says Tamang. When he was brought to Helping Hands Community Hospital in Chabahil, his wound had turned chronic. A patient with long term diabetes suffers nerve damage. This results in the loss of sensation in the feet. Elevation in blood glucose also reduces the body’s ability to heal wounds. “Minor cuts, scrapes, or wounds often go unnoticed until the body can no longer heal them on its own,” explains orthopaedic surgeon Hem Limbu at Helping Hands.&nbsp; Read also: <a href="https://nepalitimes.com/here-now/junk-food-is-making-nepali-children-shorter">Junk food is making Nepali children shorter</a>, Marty Logan  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240607150624_4e61c5cb980f287da4393eaf277d0c7418dbe95ffb717bb761ffa6f25d8418de.jpg" data-media-id="editor_3" data-image-id="20240607150624_4e61c5cb980f287da4393eaf277d0c7418dbe95ffb717bb761ffa6f25d8418de" data-rendition-name="original" width="1281" height="841" loading="lazy" alt="Diabetes in Nepalis NT"> </figure>  Called diabetic foot ulcers, such wounds often persist and in the worst cases may get infected and have to be amputated. Across the globe, 85% of all amputations happen due to diabetic foot ulcers. “We have to amputate almost half of all cases of diabetic foot because many patients come too late,” adds Limbu. Not amputating the leg can lead to infections spreading to the bloodstream. Studies have shown that 19-47% of diabetic patients in Nepal also have diabetic retinopathy, where high-glucose blood damages blood vessels in the retina of the eye, impairing vision. However, less than 30% of Nepalis who have diabetes know about this risk of blindness. And an additional 50% never get their eyes checked despite living with diabetes. Diabetes also elevates the risk of kidney failure, heart disease, and stroke.&nbsp; An estimated 9,000 Nepalis under 60 died due to some form of complication attributable to diabetes in 2021. Then there are 9.2% of Nepali adults who are prediabetic with elevated blood glucose levels that could reach diabetic levels if their lifestyle does not change. “But because most don’t know they have the condition, proper screening and awareness are essential,” says Hem Limbu. Read also: <a href="https://nepalitimes.com/here-now/myopia">MYOPIA</a>, Yugeshwor Koirala  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240607150624_fcdcf19b68a2f40d6b17f9753cc6d6fa13d511dae2a4b649a665db07c9c23a72.jpg" data-media-id="editor_5" data-image-id="20240607150624_fcdcf19b68a2f40d6b17f9753cc6d6fa13d511dae2a4b649a665db07c9c23a72" data-rendition-name="original" width="1262" height="849" loading="lazy" alt="Diabetes in Nepalis NT"> </figure>  Screening involves a blood test, and to manage high blood sugar, patients require insulin replacement therapy through injections or an insulin pump. But insulin resistance can often be managed with dietary modifications and exercise. “Prediabetes is gaining increasing recognition as a significant health concern, and a growing number of adults are seeking assistance even for mild symptoms,” notes Bajracharya. While this trend reflects improved awareness, it is equally vital to identify prediabetes in younger adults. Developing diabetes at a young age prolongs the duration of the condition and escalates the risk of complications. Timely diagnosis and effective management can mitigate complications: reducing the risk of diabetic retinopathy by up to 95%, foot ulcers and amputations by 85%, kidney disease by 70%, and both cardiovascular disease and stroke by 50%. “Prevention is better than cure for most diseases, but for diabetes, prevention and early detection are the only cures. Once the disease advances, reversing its effects becomes exceedingly challenging, necessitating lifelong symptom management,” adds Bajracharya. “So Nepal’s challenge isn’t just about forming an action plan for diabetes awareness, screening and treatment, but about implementing it in areas where essential drugs and equipment are out of reach.” In urban cities, the challenge is different. Drugs, diagnostic services and self-monitoring equipment are accessible, but so are processed foods and sugary drinks. “After essential healthcare services are in place, preventing and managing diabetes comes down to personal choices and attitudes. Whether or not diabetes continues to surge in Nepal, therefore, depends on each individual more than anything else,” says Bajracharya. &nbsp; Read also:<a href="https://archive.nepalitimes.com/news.php?id=18379"> Diabetic dilemma</a>, Buddha Basnyat

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A deadly sugar rush

Just few days into office, President Donald Trump has brought about a work-stop to ongoing USAID supported projects and complete stop to new grants or aids. The executive order was justified under Trump’s ‘America First’ promise, and it has shaken up recipient countries, including Nepal. Since 1951, USAID has provided $1.5 billion in aid to Nepal. The breakdown for recent years is $105.94 million for 2020-21 and US$ 125 million in 2018-19. In 2022, USAID and Nepal signed a five-year Development Objective Agreement worth $659 million (pictured, above).&nbsp; Some of the key sectors where USAID has supported and supports Nepal with aid include health, education, agriculture, infrastructure; economic growth, humanitarian aid and women and children empowerment. All of these projects will be affected, and grants disbursement suspended. According to USAID’s Country Development Cooperation Strategy (December 2020-December 2025), the overall goal of the USAID’s development cooperation in Nepal is to realise ‘A more self-reliant, prosperous, and inclusive Nepal that delivers improved democratic governance and health and education outcomes.’ Four identified development objectives are:&nbsp; i) More Effective, Participatory, and Equitable Democratic Ecosystem ii) Broad-Based and Inclusive Economic Growth Fostered iii) Inclusive Health and Education Systems Strengthened iv) More Equitable and Improved Natural Resources and Disaster Risk. Under these development goal and objectives as per the data available under Government of Nepal’s Aid Management Platform (AMP) there are currently USAID supported 21 key projects ongoing in Nepal.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250126090140_0bd9163cb9826464409887995eb8f2eff42c7cf1269610c3761773cde59ff52c.jpg" data-media-id="editor_0" data-image-id="20250126090140_0bd9163cb9826464409887995eb8f2eff42c7cf1269610c3761773cde59ff52c" data-rendition-name="original" width="1005" height="825" loading="lazy" alt="USAID fund in nepal after Trump"> </figure>  These 21 projects with some data missing totals a commitment of $178,140,467 from 2021-2029 in Nepal. Of these commitments $89,115,031 (about half) have already been disbursed. With Trump’s executive order the rest of the 50% is now going to be on hold until the review is completed and further decisions are made by the new US administration.&nbsp; Most development goals of USAID in Nepal are embedded with key principles like ‘equity’ and ‘inclusive’. With the Trump government’s aversion to the previous emphasis on Gender, Equity, Inclusion and Accessibility (GEIA) principles, projects focusing on those issues will be hit hardest. USAID upheld policies and actions that promoted equal access and opportunities for all people, with an emphasis on the Tarai, gender issues, family health and through contractors on human rights and democracy. The impact on Nepal’s development aid will be substantial, affecting livelihoods in incomes generated by USAID supported projects. Individual independent consulants already received notices over the weekend that the work they were &nbsp;doing under a USAID contract is subject to work-stop now.&nbsp; The question is whether the 5-year Country Development Cooperation Strategy for Nepal that finishes by end-2025 will go ahead. And when the new post-2025 Strategy is formulated, it is certain that the Trump’s administration will not entertain GDEI, which so far has been people-centered and not political.&nbsp; Kishor Pradhan is an independent development consultant concentrating on development information and knowledge management issues. <a href="mailto:kishorpradhanktm@gmail.com" target="_blank">kishorpradhanktm@gmail.com</a>

How USAID cut affects Nepal

They are rare, they are elusive and they are so well camouflaged, they are difficult to see, even when they are right there. That is why <a href="https://nepalitimes.com/opinion/comment/nepal-brings-back-the-snow-leopard">snow leopards</a> are called the ‘Ghosts of the Himalaya’. And because they are also regarded as being sacred, they are called ‘God’s Pets’.&nbsp; Nepal has <a href="https://nepalitimes.com/news/does-nepal-really-have-too-many-tigers">tripled its tiger population</a> in 12 years since 2010. There have been successive years with zero rhino poaching and the numbers have bounded back. But few know about the country’s success story with snow leopard conservation. Preliminary data from an on-going census shows that Nepal ranks fourth among the 12 snow leopard range countries in central and South Asia. This is despite the country having just 2% of the total area where snow leopards can be found.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250127070148_0f22a5439d56e5db58d8f65789ee4ff5e87a29c898d5e8cbff60bf8f1814af4b.jpg" data-media-id="editor_2" data-image-id="20250127070148_0f22a5439d56e5db58d8f65789ee4ff5e87a29c898d5e8cbff60bf8f1814af4b" data-rendition-name="original" width="1311" height="724" loading="lazy" alt="snow leopards in Nepal NT 1"> <figcaption>Despite possessing just 2% of the snow leopard range across Central and South Asia, Nepal has the fourth highest number of elusive mammals in the world. Photo: TASHI R GHALE </figcaption> </figure>  Nepal also leads in <a href="https://nepalitimes.com/news/satellite-tracking-snow-leopards-in-nepal-to-study-climate-impact">snow leopard research</a>. Less than 3% of the snow leopard range has been studied through camera traps and genetic studies, but it is Nepal that has done the most. <a href="https://nepalitimes.com/here-now/nepal-leads-in-snow-leopard-study">Over 100 Years of Snow Leopard Research</a> by the World Wildlife Fund (WWF) in 2021 showed that 74% of the snow leopard habitat in northern Nepal has been the subject of research into the species. “We are leading globally when it comes to snow leopard conservation and study, starting from 2013 in Kanchenjunga using GPS to study their habitat,” says <a href="https://nepalitimes.com/here-now/conversation-with-mr-conservation">Ghana S Gurung of WWF Nepal</a>. “We also found via camera traps they went as high as 5,800m and as low as 2,600m.” There are an estimated 300-500 snow leopards across high mountain Nepal with Dolpo, Manang and <a href="https://nepalitimes.com/banner/participating-to-save-kangchenjunga">Kangchenjunga</a> the main hotpots for the endangered species. Unlike with tigers and rhinos which are poached by wildlife traffickers, snow leopard killings are mostly retaliatory for killing livestock. Snow leopards attack yaks, sheep and goats of herding communities in the mountains. One of the most effective methods to protect the species from traps and poisoning is to help local communities build mesh wire corrals. The San Francisco-based <a href="https://snowleopardconservancy.org/">Snow Leopard Conservancy</a> through the Nepal group <a href="https://www.mountainspirit.org.np/">Mountain Spirit</a> has designed and tested portable corrals that can move with herders.&nbsp; “They move all year around so that the livestock have enough pasture to graze on, which is why it was important that our improved corrals could be dismantled and moved around,” explains Shailendra Thakali of the Snow Leopard Conservancy. The team consulted herders in Manang and Mustang while developing the corrals based on traditional design, with a stone base but wire mesh on the sides and the roof as well as strong wire gates for secure closure. They are also using fox lights to deter activities at night.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025012803018_4a166ea1124008cfcf551ffd59c5841acb2bc9c443d9fbe56490b280492eb441.png" data-media-id="editor_9" data-image-id="2025012803018_4a166ea1124008cfcf551ffd59c5841acb2bc9c443d9fbe56490b280492eb441" data-rendition-name="original" width="2244" height="1246" loading="lazy" alt="corraling"> <figcaption>Improved corrals in Manang and Mustang made up fo mesh wires to protect livestock from snow leopard attacks. Photo: PURNA MAN SHRESTHA</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250127070152_009bc57c5d2244a393a8423d56098f921ed29b8d0a60a9c15422dd58615b5e5b.jpg" data-media-id="editor_10" data-image-id="20250127070152_009bc57c5d2244a393a8423d56098f921ed29b8d0a60a9c15422dd58615b5e5b" data-rendition-name="original" width="4032" height="3024" loading="lazy" alt="snow leopards in Nepal NT 1"> <figcaption>The corrals are portable allowing herders to move them as they take livestock for grazing in high Himalayan pastures. Photo: PURNA MAN SHRESTHA</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250127070152_3b84ce156de1ed1deea79d23a15c1a3dfa5a412dca3644deec1333bda7f91cd0.jpg" data-media-id="editor_11" data-image-id="20250127070152_3b84ce156de1ed1deea79d23a15c1a3dfa5a412dca3644deec1333bda7f91cd0" data-rendition-name="original" width="1500" height="1125" loading="lazy" alt="snow leopards in Nepal NT 1"> <figcaption>Local herders in Manang and Mustang were consulted while developing improved corrals. Photo: BRIAN PENISTON</figcaption> </figure>  Tourism and agriculture in Manang and <a href="https://nepalitimes.com/here-now/comings-and-goings-in-mustang">Mustang</a> dropped during the pandemic, and the Conservancy also helped herder communities with alternative livelihoods.&nbsp; “We trained them in basic hotel business such as lodge management skills but more importantly to restore abandoned pastures by planting jimbu which is highly valued for cooking in Kathmandu and Pokhara,” says Brian Peniston, also with the Snow Leopard Conservancy. “The tourist figures have now increased considerably and this has directly benefited 1,000 households in three municipalities.” <a href="https://www.wwfnepal.org/">WWF Nepal</a> has also collaborated with the Department of National Parks and Wildlife Conservation (DPNWC) to train locals in Dolpo and Kangchenjunga to make their own mesh wire corrals with subsidies on raw materials.&nbsp; WWF has partnered with Amchi traditional medicine practitioners to promote conservation of snow leopard in mountain communities where people trust faith healers. School eco-clubs also involve youth in conservation.&nbsp; “We must trust communities and promote local ownership when it comes to wildlife conservation, and if it were not for the communities there, snow leopards would be long gone,” says Gurung of WWF Nepal. “It is important to revive the belief that snow leopards are sacred because they are god’s pets, tie them up with the spiritual, cultural and traditional belief of the people.” Community-managed livestock insurance schemes have attained zero retaliatory killings in Kangchenjunga where WWF and the government has sent up an endowment worth Rs10 million to compensate herders for snow leopard kills. A similar scheme is being implemented in Dolpo which has double the density of snow leopards compared to Kanchenjunga.&nbsp; But the compensation mechanism is cumbersome and often inefficient. Claimants need to provide photographic evidence with tags of the livestock still attached but snow leopards often go for the head and tags are lost. The evidence has to be submitted promptly, and this is difficult for herders in isolated villages.&nbsp; Insurance agents are based in headquarters like Chame in Manang and are not willing to travel all the way up. Similarly, photographic evidence needs to be assessed by veterinarians who are also reluctant to go to remote areas that take up days. “The compensation policy hasn’t changed in the last 20 years,” says <a href="https://nepalitimes.com/review/snow-leopard-redux">Tashi R Ghale</a>, high-altitude wildlife photographer and conservationist. “Here in Manang, herders would get Rs6,000 in compensation for a yak when the market rate was Rs20,000. The market rate is now Rs150,000 but they still get only Rs6,000. Even then, they have to wait for months.” Brian Peniston feels improving and tailoring compensation suitable to the landscape is of utmost priority, and the schemes need to be more accessible and effective as well as herder friendly. He adds, “Local governments should be handed authority in these matters, and it should be equal parts trust and verify. It is over-verification at the moment.” Climate breakdown has added to the challenge of snow leopard conservation. Either blizzards or winter droughts mean fewer prey for the mountain cats, this in turn has also led to leopards preying on livestock. Usually, the wild prey to livestock ratio in a snow leopard diet is 70:30. Blue sheep (pictured below) are the main prey species for snow leopards, but there is now competition with lowland spotted leopards which have moved up the mountains, while the Himalayan wolf has descended. The prey density may not have decreased, but predator species have more than doubled.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250127070156_f23ed8414be46782c90df4198d46c30f423d63d59f97343f89760283011c7c0b.jpg" data-media-id="editor_15" data-image-id="20250127070156_f23ed8414be46782c90df4198d46c30f423d63d59f97343f89760283011c7c0b" data-rendition-name="original" width="1400" height="1050" loading="lazy" alt="snow leopard conservation in Nepal"> <figcaption>The climate crisis has meant that lowland spotted leopards which have moved up the mountains, while the Himalayan wolf has descended, leading to a reduced number of blue sleep which is one of the main prey species for snow leopards. Photo: SHAILENDRA THAKALI</figcaption> </figure>  Other disrupters include <a href="https://nepalitimes.com/multimedia/the-human-cost-of-nepal-s-yarsa-gold-rush">overharvesting of yarsagumba</a> and increased movement in this fragile landscape, with adverse impacts on all wildlife, not just snow leopards. Expansion of the road network to the remotest corners of the country is another concern, adding to the risk of human-wildlife conflict and poaching.&nbsp; “There has been much research on snow leopard behaviour in the last 30 years but what we haven’t done nearly enough is study human behaviour,” says Peniston. Despite the challenges, the rebound of snow leopard populations has increased the opportunity to <a href="https://nepalitimes.com/banner/trekking-to-save-nepals-snow-leopards">snow leopard viewing eco-tourism</a>, as is being practiced in Dolpo.&nbsp; Says <a href="https://nepalitimes.com/review/ice-to-water-alv4lorf">Tashi R Ghale</a>: “Local communities here in Manang and Dolpo are doing what they can, but the Nepal Tourism Board needs to step in to promote snow leopard trekking and tourism. The co-benefits would motivate communities to protect the big cats.” &nbsp;&nbsp;&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250127070156_698d64632273185cecbcaca626c7c49861ba54a0930119843792572f01114942.jpg" data-media-id="editor_19" data-image-id="20250127070156_698d64632273185cecbcaca626c7c49861ba54a0930119843792572f01114942" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="snow leopard conservation in Nepal"> <figcaption>FIND ME: Elusive in nature, snow leopard sightings are rare and often only detected on camera traps (below). Spot the snow leopard in this picture taken by conservationist Tshiring Lhamu Lama in Dolpo, a hotspot for big cats in Nepal. Photos: TSHIRING LHAMU LAMA</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025012708018_42acdb2ba0c5941b1c3a89ede1bac048808d6424f4c70aadb68df6ab5176bbb6.jpg" data-media-id="editor_20" data-image-id="2025012708018_42acdb2ba0c5941b1c3a89ede1bac048808d6424f4c70aadb68df6ab5176bbb6" data-rendition-name="original" width="2041" height="1314" loading="lazy" alt="Snow leopard conservation in Nepal"> </figure>  &nbsp;

Ghosts of the Himalaya

In December, the Nepal government announced it would not allow a Beijing-appointed Tibetan spiritual leader, the Panchen Lama, to attend a Buddhist conference in Kathmandu. Immigration at the airport was put on high alert to ensure he did not try to sneak in.&nbsp; Coming soon after Prime Minister K P Oli’s visit to China, that decision underscored Nepal’s precarious tight-rope act in addressing religio-political sensitivities in its relations with China. The Panchen Lama episode can be seen as a test for Nepal’s handling of the succession of the Dalai Lama, who turns 90 in July. “When the time comes to find a successor to the Dalai Lama, Nepal will face a larger policy dilemma,” predicts Sudheer Sharma, author of two recent books on Nepal-China relations. “The government is still unclear what it will do if the successor is chosen from the Tibetan community in Nepal, or from China or India.” <a href="https://nepalitimes.com/news/dalai-lama-gets-block-of-glacial-ice">The Dalai Lama</a> is the spiritual leader of Tibetan Buddhism and a symbol of Tibetan identity; he is revered as the manifestation of Avalokitesvara, the Bodhisattva of Compassion. He was born in 1935 in northeastern Tibet and was formally recognised as the Dalai Lama in 1940.&nbsp; He has been living in exile in Dharamsala for the past 65 years after fleeing Lhasa following the Chinese takeover. He has been allowed to make a low-profile visit to Lumbini only once in 1987, and never after that due to objections from China.&nbsp; Nepal does not have a national strategy to handle the presence of <a href="https://nepalitimes.com/news/nepal-s-sherpas-mourn-tengboche-abbott">religious leaders</a>. If there are policies, they are ad-hoc or undeclared, depending on the government of the day in Kathmandu. The Nepal government, under Chinese pressure, even prevents public celebrations marking the Dalai Lama’s birthday on 6 July. “The Dalai Lama’s attempts to visit Nepal again have been stopped &nbsp;since Nepal thinks he is not only a religious leader, but a political figure as well,” says Sharma. “There is no discussion in Nepal’s political circles regarding the succession of the Dalai Lama. The topic is regarded as a non-issue.”&nbsp; Over the years, the Dalai Lama has made various statements regarding his succession. At times, he has suggested that he will write a will to select a successor from within the Tibetan community. On other occasions, he has hinted that the next Dalai Lama could be chosen from a “free country”, and could even be a woman.&nbsp; The Panchen Lama succession in 1995 could provide a hint about how the post-Dalai Lama era will play out. The Panchen Lama is the second most important spiritual leader in Tibetan Buddhism, and heads the <a href="https://archive.nepalitimes.com/news.php?id=18580">Tashilhunpo Monastery in Xigatse</a>, the epicentre of the 7 January earthquake, located 250km away from Lhasa.&nbsp; The Panchen Lama traditionally has the role of finding the next Dalai Lama, but the previous Panchen Lama (Lobsang Trinley Lhundrup Choekyi Gyaltsen) has been missing since 1995, after the Chinese installed their own candidate (Gyaltsen Norbu). The present Panchen Lama’s visits are carefully planned, and he has made only one foreign visit so far, to Thailand. “Nepal did not permit Panchen Lama’s visit as he is Chinese Communist Party-appointed, thus making him a political figure,” says Amish Mulmi, author of the book All Roads Lead North.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250124090148_3bb3d803c04c34657d0ac9759ca904073f75734a446506f8a57e50178b381c00.jpg" data-media-id="editor_3" data-image-id="20250124090148_3bb3d803c04c34657d0ac9759ca904073f75734a446506f8a57e50178b381c00" data-rendition-name="original" width="1087" height="697" loading="lazy" alt="Dalai Lama NT"> </figure>  What China was trying to do through the Panchen Lama’s visit for the Nanhai Conference in Kathmandu last month was to project its soft power, and perhaps prepare the ground for the Dalai Lama succession. But the ban raised the question of what Nepal will do if there is a visit by Hindutva figures from India at events in Nepal.&nbsp; Religious leaders and figures from various faiths regularly visit Nepal for devotional events, meetings and conferences. Their trips are often significant for promoting dialogue and cultural exchange, and cannot be banned under the Constitution. “We did the Nanhai Conference, and in future religious leaders will definitely visit Nepal. The question arises whether or not to allow them to engage in political activities or not,” says Mulmi. “Religion has always been political. So Nepal must not take easy decisions and must think it through.” Although Nepal and Tibet fought wars in the past two centuries, they share deep-rooted and ancient cultural, religious and trade ties. After the Chinese annexation of Tibet 70 years ago, Kathmandu gradually started dealing directly with Beijing.&nbsp; Today, Nepal is the only country with a consulate in Lhasa, a city from where the only direct international flight is to Kathmandu. Over the years, these ties have evolved, with shifts in trade dynamics and people-to-people interactions reflecting broader regional and global changes. Despite this, the historical bond between Nepal and Tibet remains a significant aspect of present-day bilateral relations with China, and this is why the selection of the next Dalai Lama has resonance here. “It is clear that China has been trying to adopt Tibetan Buddhism as a soft power. It is trying to co-opt Tibetan Buddhism on the lines of China’s ambitions and narratives,” explains Mulmi.&nbsp; The Dalai Lama’s <a href="https://archive.nepalitimes.com/news.php?id=14733">considerable following</a> in Nepal, India, Europe and the United States is an irritant for Beijing. Recent Sino-American tensions have therefore given the spiritual ownership of Tibetan Buddhism a geopolitical dimension, and in this the Dalai Lama succession will become an important factor.&nbsp; Relations between Washington and Beijing during the second Trump term will have a bearing on this. As a buffer state between India and China, Nepal has historically tried to maintain equidistance between the two powers.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025012308014_95372c819980513e21490c3abe2aa8e712af6c89c5829e04d5f57880ad4f2a23.jpg" data-media-id="editor_5" data-image-id="2025012308014_95372c819980513e21490c3abe2aa8e712af6c89c5829e04d5f57880ad4f2a23" data-rendition-name="original" width="2500" height="1000" loading="lazy" alt="What (or who) after the Dalai Lama NT"> <figcaption>THEIR HOLINESSES: The Dalai Lama, who will be 90 in July (left), and China-installed Panchen Lama (above). Traditionally, it is the Panchen Lama who has a role in finding a new Dalai Lama. Photos: TENZIN CHOEJOR (left) / CHINAN NEWS SERVICE (right)</figcaption> </figure>  But China has rarely stuck its neck out for Nepal. Despite repeated requests for military help during its war with the British East India Company in 1814-16, the emperor in Beijing refused.&nbsp; Explains Sudheer Sharma: “China did not want to get involved with the British. They thought of their own national interests then, and they are thinking of their own national interests now with India.” During the Khampa Uprising in the 1960s, Kathmandu was also squeezed between American support for the guerrillas and China’s objections to Nepal being used as a base. But with the Nixon-Mao rapprochement in 1972, the Americans stopped helping the Khampas. Nepal then yielded to pressure from Mao Zedong to mount a military campaign to drive them out.&nbsp; Nepal was left to manage and host Tibetan refugees, and balance that with China’s security concerns. Explains Amish Mulmi: “Nepal has pretty much done everything China has asked to do, including deporting Tibetans. China doesn’t need to be insecure, but Nepal needs to maintain a careful balance.” Today, despite Donald Trump’s chest-thumping and <a href="https://nepalitimes.com/editorial/trump-s-second-coming">threats of a tariff war against Beijing</a>, he and Chinese President Xi Jinping are on the same page regarding democracy and freedoms. Which may mean Washington could once more leave the Tibetans in a lurch, and this could have a direct bearing on the Dalai Lama succession sequence. The United States' shifting foreign policy has often been criticised for leaving allies and partners to fend for themselves. Trump may revive his pressure on Japan, Korea and Taiwan to pay for the US defence umbrella.&nbsp; Nepal’s stance on the Tibetan community relies on marking boundaries and offering protection. During Chinese President Xi Jinping’s visit to Nepal, China proposed that Nepal sign an extradition treaty which Nepal politely refused. “Nepal has tactfully not let the Chinese side extend a longer hand on the Tibetan issue,” says Sharma. “Possibly, we are learning our lessons from history.” The question of who will choose the successor to the Dalai Lama will be decided by geopolitics, and China’s increased stature as a global economic power.&nbsp; Beijing could insist on sticking to tradition to let its candidate for the Panchen Lama make the final decision. This would allow it to move the seat of the Dalai Lama from Dharamshala back to Lhasa. The present Dalai Lama could also appoint his own candidate, but that person will not be allowed into Tibet by China. In that case, we may have a situation where there are two Dalai Lamas.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250127030140_c9048725407641601bc68568db19e48197154cd6396f39d67ab113d94c26e675.jpg" data-media-id="editor_7" data-image-id="20250127030140_c9048725407641601bc68568db19e48197154cd6396f39d67ab113d94c26e675" data-rendition-name="original" width="1910" height="757" loading="lazy" alt="Voice for the Voiceless Dalai Lama"> <figcaption>Dalai Lama's latest book Voice for the Voiceless details his dealings with China over the last seven decades. </figcaption> </figure>

What (or who) after the Dalai Lama?

Between the 1980s and 2000s, over 5,000 <a href="https://download.ssrn.com/11/01/06/ssrn_id1736064_code1383023.pdf?response-content-disposition=inline&amp;X-Amz-Security-Token=IQoJb3JpZ2luX2VjEBkaCXVzLWVhc3QtMSJIMEYCIQCiYUc7BuJ7zaDn%2BOTCFOWBgNKqYarnapqY%2FWZbamFVsgIhAOC%2FPFXHR9Dx6xTicWMj5%2BJXdIEGZ7LxKRyjrCe61Ng9KsYFCPL%2F%2F%2F%2F%2F%2F%2F%2F%2F%2FwEQBBoMMzA4NDc1MzAxMjU3IgzWD1Y1XNz2kaOS3jEqmgX0TbxyBTTrZrpd%2B5N72pFzJAwc%2BxTF8Dc0GnVG2tUGUYyxBt1YmfEqAw5cdOuRCZV23SSKkJwndg9IwI3yrjZGBp9XKxg4lK4Vq0Qy9RMmma5hNCVnA2T0MwGghlnmkgWPZA5ouZPiKFAecf4PE5qml2fu1wj72LEAig5R77cN6nC6%2BxTcygMiuiHrR9yZB4RyvTD9s58avGqUcn9hcIUdku3ydvAGVEgczzgEMCesRMtSgqzHz3E9bju9QLR5RpcDRp0wptfQ89uGXgyBGLCX%2BAl6uareSxQCSaDOthP4PmswWI7y7kBJbQp1pZq8r56Yoa3Qf5WVtmxbsWmDtbOsaSBa0yB6EIS8RKFGeQ%2Bcz%2BnEsOoPHIS%2BqO1k1%2BQuihjN0T66SnWFo8rl8Cv2g4GghY9p9DR3wopBJ6cE%2FtDJMY%2BZ03LkUwS%2Fc7ckyaRpfPX5g6Bb9J56a%2BNA5lnIV5o%2Fpjp%2BZJaVIvEzciyzzTwP58wznmcy3xppvK%2BwXBzBR96cPMXKTdNv9%2FqJ5jlnsgSRJpHWE3UyHbFucwQYXi19i7mCglFSuSkkL5Tg9nQWvXpuP9Z9VmMlQfQ%2F%2FpsfA6KlL81K3UK%2Bp%2FJB2mxQD9SYexZvAf1g21NUSF%2F8I19orsNrT6LutAnoJU%2FOTgO3qMbdgnR%2FuBytI3POnQAEIfbG0Za%2FrEDJ9j8CEbasNXsBMqkx8JKGRG2PUHMRC2xl5Z%2BNIbpsqGB8t%2BvAt40osDpgZStiyeiGdC1nMakUzZtBjWlttzoirCdemwPKJ8M%2BEohj2%2BLEN92yaOKdFewns0gjh%2BUxcotGvBo%2F7QZFappBNjLlR0PyanjcuB4MndEQjeIrd67ntscTKiLDI%2FfzwCHulsl6nbMpewpWFAYwg67guwY6sAGb3VJ2q%2F36hWhrVa8igP2hswnnLlcIU2uhOZa5ge2hCXkUYhL1BcSJfoWy2LwrWCXtdFo%2BT7KMU3p6O3jySdxSop8F4iO%2BJBiXVjSiXm%2FqZo3ri8sVwUgo4ksJI%2BT4AbfK3D3VGYapBgU5LdX%2FjkNwSVoR1vz4vMIyF56i7MKeYG1nFLgc0l9cIjrQI6eY869uIbgZ1XKqqBsuavCbYjSbSy7dMP0QSym%2FgmoWILGE0Q%3D%3D&amp;X-Amz-Algorithm=AWS4-HMAC-SHA256&amp;X-Amz-Date=20250103T172339Z&amp;X-Amz-SignedHeaders=host&amp;X-Amz-Expires=300&amp;X-Amz-Credential=ASIAUPUUPRWE65YAH56X%2F20250103%2Fus-east-1%2Fs3%2Faws4_request&amp;X-Amz-Signature=9b654b526e0779da4fa9f54e2fcde04ac9f7e91fb50d4f8094b1039ebb19e21b&amp;abstractId=1736064">Nepali children were adopted abroad</a>, primarily to the United States, France, and Spain. While international adoption was intended to provide vulnerable children with better opportunities, child trafficking and irregular practices prompted Nepal to suspend adoptions in 2007, and overhaul its policies. By 2010, stricter regulations aligned with the <a href="https://www.hcch.net/en/instruments/conventions/specialised-sections/intercountry-adoption">Hague Adoption Convention</a> drastically reduced adoption numbers. Today, many of these children, now adults, are returning to Nepal in search of their roots, only to encounter a society that no longer recognises them, legally or socially. Behind the statistics lie the <a href="http://hdl.handle.net/1854/LU-01GRNPPXAC1Z3AETV9HARNCG5Q">deeply personal and emotional journey</a> of adoptees returning to reconnect with their past, seek family, and rediscover a sense of belonging. These stories reflect a broader struggle for identity and the complexities of bridging two worlds. Maya Adopted at 9 by a family in Barcelona, Maya carried fragmented memories of her early life in Nepal including the painful recollection of the day her mother and sister vanished, leaving her and her younger siblings behind. She had faint images of her mother, elder sister, and the village where she once lived. In June 2017, Maya came to Nepal accompanied by Chandra Kala and two friends, Jay and Vikram. With only a few photographs of her mother Tulsi, her elder sister Pargati, and her brother-in-law Kamal, along with a street name, Maya arrived in Birendranagar after a 20-hour bus ride from Kathmandu. “Now that we’re close, I feel like I can’t face them,” she confessed to Chandra Kala, wrestling with anxiety about what she might uncover. “I’m nervous. I don’t know if I’ll recognise them or if they’ll recognise me. I don’t know how they’ll react or what they’ll say. And then there’s him [Kamal]. I have such bad memories of him. I don’t know if I can handle this.” Chandra Kala reassured her, reminding her of her courage and the importance of this moment. Maya and her companions asked around the town with little success until a shopkeeper recognised Kamal and directed them to a nearby village. Jay went to confirm and returned excitedly, shouting, “It’s her! It’s your sister!” Maya froze, paralysed by fear and anticipation but she pushed ahead. At the village, Maya’s sister Pargati initially struggled to recognise her. Jay introduced Maya: “Do you recognise her? This is your younger sister. She’s come all the way from Spain to find you.” Slowly, realisation dawned, and the two women embraced, bridging the decades of separation with tears and disbelief. The next day, Maya met her mother Tulsi in an emotionally overwhelming reunion. Tulsi rushed into the room and embraced Maya tightly, sobbing uncontrollably: “Mero chhora-chhori, gaye, gaye… my children they went, they went …” Once the tears subsided, Tulsi and Pargati began recounting the heartbreaking circumstances of their separation. After the death of her husband, Tulsi faced relentless judgment in their village when Kamal stayed with the family before his marriage to Pargati. The villagers accused Tulsi of impropriety, calling her पापी (sinful) and demanded that the family leave. “We didn’t want to leave, but the village didn’t want us here,” explained Pargati. “We left intending to bring you and your siblings later. But when we returned, you were gone.”  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250103120140_da7482d222e0a03b783c5e1df25536ed416d7b7475442e7fd40e54451572142e.jpg" data-media-id="editor_3" data-image-id="20250103120140_da7482d222e0a03b783c5e1df25536ed416d7b7475442e7fd40e54451572142e" data-rendition-name="original" width="384" height="512" loading="lazy" alt="Searching for a homeland away from home NT"> <figcaption>An adoptee and companion return to Bal Mandir in Kathmandu after 19 years. Photo: CHANDRA KALA CLEMENTE-MARTINEZ</figcaption> </figure>  Tulsi recalled how she had entrusted Maya and her siblings to relatives, hoping they would be cared for temporarily. However, when she returned, the children had been sent away without her knowledge. “I only trusted them because I had no other choice,” Tulsi said through tears. “I didn’t know they would send my children away. What kind of mother does that make me? They called me a bad mother, but what else could I have done?” The reunion brought healing and answers but it also exposed the societal pressures that had fractured Maya’s family. Despite the challenges, Maya spent the rest of her visit bonding with her sister, nieces, and younger half-sister, Sunita, slowly bridging the gaps created by time and distance. Maya’s journey was a testament to the courage required to confront the past, the pain of uncovering difficult truths, and the hope of rebuilding connections once lost. Her story highlights the enduring emotional complexity faced by adoptees navigating their history and identity. Ashmita Unlike some adoptees whose main focus is reuniting with their biological family, 26-year-old Ashmita’s priority has been to uncover the institutional details surrounding her adoption. She wanted to understand what the orphanage and the government knew about her background and why so much information seemed concealed. “I just want to know where I come from,” she said. “Even if I never find my biological family, having a better sense of the places and people connected to my story would mean so much.” For many adoptees, returning to Nepal is not just about reconnecting emotionally, it is about seeking formal recognition as members of the Nepali community. However, the legal framework in Nepal often fails to acknowledge their unique status.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250103120144_bf0158b7829cf5db44382d7386d3b123032adad3f9e10e28096b80cd09170ba6.jpg" data-media-id="editor_4" data-image-id="20250103120144_bf0158b7829cf5db44382d7386d3b123032adad3f9e10e28096b80cd09170ba6" data-rendition-name="original" width="384" height="512" loading="lazy" alt="Searching for a homeland away from home NT"> <figcaption>A mother reunites with her don after 18 years. Photo: CHANDRA KALA CLEMENTE-MARTINEZ</figcaption> </figure>  In Nepali law, adoptees are left in limbo: their birth parents are not considered legal parents, and their ties to the country are effectively erased upon adoption. This lack of recognition creates significant hurdles, particularly in two key areas: accessing pre-adoption records and obtaining Non-Resident Nepali (NRN) status. Despite international norms like the Convention on the Rights of the Child, which guarantees the right to know one’s origins, institutions often refuse to cooperate. Orphanages and non-profits in Nepal, which hold critical pre-adoption records such as birth certificates and citizenship documents, frequently withhold this information, reflecting the systemic reluctance to provide transparency. In numerous cases, records that should include family names, addresses, or relinquishment agreements were either incomplete or falsified. These practices not only prevent adoptees from reclaiming their histories but also perpetuate their disconnection from their heritage. Ashmita’s initial requests for information from her adoption agency were met with delays and incomplete responses. When she turned to the orphanage where she spent her early years, she encountered even greater resistance. At one point, the director of the orphanage issued veiled threats. Nevertheless, Ashmita persisted and managed to find the name of the individual who had brought her to the orphanage. However, the person had disappeared, leaving yet another gap in her story. A breakthrough came when Ashmita accessed a police report that suggested she might have been born in a different municipality than the one in her adoption records, prompting her to seek help from local authorities. The police took an interest in her case and began investigating possible connections to her birth family. While progress was slow, they meticulously followed leads to help her trace her origins. “It’s not easy,” Ashmita said of the process. “But every small step feels like I’m piecing something back together.” She also noted that societal perceptions could add to the difficulty. At times, she felt questioned about her identity and her right to seek answers. “People have asked me why I care so much or even suggested that I’m not Nepali anymore because I was adopted abroad,” she reflected. Ashmita’s story is a complex account of persistence in the face of institutional and personal challenges. While her search has not yet provided all the answers she seeks, it continues to offer her insights into her early life and the systems that shaped her adoption journey. &nbsp;“These records are sealed for a reason. They are not meant to be reopened,” said a government official. Even an NGO representative said: “It’s better for everyone if the past remains in the past.” An orphanage director asked: “Why are you asking these questions? This is not your place anymore.” Hari Prasad Sacré The Non-Resident Nepali (NRN) card is a lifeline for Nepali diaspora members, granting them residency and property rights in Nepal. Yet, adoptees are notably excluded from this framework. While the law stipulates eligibility for individuals whose parents or grandparents were Nepali citizens, it makes no provision for adoptees whose legal ties to their Nepali parents were severed by adoption. When Hari Prasad Sacré, a Nepali adoptee, sought to obtain an NRN card at the Nepal Embassy in Belgium, he encountered officials unfamiliar with processing an NRN request from an adoptee. His case was the first of its kind, setting a precedent but also highlighting the systemic barriers adoptees face. "You are not eligible; your surname is Sacré, it is not a Nepali name," an embassy staff said.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250103120140_9bdc24b7e34930059f895048ab7dc0ad3ca23b16907c572f01a8d5404a5feac5.jpg" data-media-id="editor_5" data-image-id="20250103120140_9bdc24b7e34930059f895048ab7dc0ad3ca23b16907c572f01a8d5404a5feac5" data-rendition-name="original" width="446" height="512" loading="lazy" alt="Searching for a homeland away from home NT"> <figcaption>Hari Prasad Sacré receives tika from his father Khul Prasad Adhikari during Dasain, a few weeks after receiving his NRN card. Photo: HARI PRASAD SACRÉ</figcaption> </figure>  Sacré’s situation was legally ambiguous. Although his biological parents, including his father, Khul Prasad Adhikari, are alive and he maintains contact with them, he no longer had “legal” ties to Nepal due to the adoption process. Carrying a Belgian surname the embassy staff was initially convinced the adoptee couldn’t claim Nepali origin. Nepali law, which does not recognise biological parents as legal guardians once a child is adopted, created complications for the NRN application. To navigate this complexity, Sacré relied on a testimony from his father. Issued by a local government body in Kaski, the testimony affirmed that Hari had been put up for adoption and was of Nepali origin. While this enabled the embassy to approve his NRN card, the process was unnecessarily protracted and emotionally charged, highlighting the inadequacy of current policies to accommodate the unique situations of adoptees. Sacré’s case represents a rare instance where biological parents were alive and willing to provide testimony, but many adoptees are not as fortunate. A large number of adoptees were declared “orphans” during the adoption process, even when their parents were alive. This severed their legal ties to Nepal, stripping them of documentation that could later prove their origin. For others, the absence of living biological relatives or access to their original adoption records creates insurmountable barriers. Without clear documentation or a family member to vouch for their Nepali heritage, adoptees are excluded from the NRN framework. This denies them the rights and privileges afforded by the card, including property rights, legal recognition, and a formal connection to their homeland. Current laws fail to account for the complexities of adoptees’ legal status, leaving them disconnected from their cultural and legal heritage. Adoption papers, as evidence of Nepali descent, should be accepted as proof, granting adoptees rightful access to the NRN card and ensuring their inclusion in Nepal’s diaspora. Such reforms are crucial to ensure that all adoptees, regardless of their circumstances, can reclaim their heritage and establish a sense of belonging in Nepali society. Without these changes, the systemic exclusion of adoptees will persist, perpetuating inequities and denying them the opportunity to step up as active members of the Nepali diaspora. Sacré’s case serves as both a precedent and a call to action. It exemplifies the challenges and triumphs of adoptees navigating complex bureaucracies and advocates for a more inclusive and equitable approach to reconnecting adoptees with their homeland. Nepal can draw inspiration from South Korea, where the government has actively supported the reintegration of adoptees into their society. The F4 visa, established through efforts by organisations like the Global Overseas Adoptees’ Link (GOA'L), grants adoptees the right to live and work in Korea, while dual citizenship acknowledges their dual identity as members of the diaspora and their country of origin. GOA’L further fosters reconnection by offering language classes and cultural exchange programs, creating opportunities for meaningful reintegration and belonging. As Nepal refines its NRN citizenship framework, explicitly including adoptees could address the severance of legal and cultural ties caused by international adoption. Such inclusion would provide adoptees a pathway to residency, citizenship, and rights, enabling them to reconnect with their heritage. Complementing this with programs for language acquisition, cultural immersion, and historical education would honour Nepal’s responsibility to the approximately 5,000 children sent abroad. Nepal could establish a dedicated organisation similar to South Korea’s GOA’L and help adoptees access pre-adoption records, navigate legal processes, and engage in cultural exchange initiatives. It would also serve as a bridge between adoptees and Nepali society, fostering mutual understanding and collaboration. This article is based on doctoral studies by <a href="http://hdl.handle.net/1854/LU-01H4Z85GPS63ZWDJ3WB2E6KS70">Hari Prasad Sacré</a> and <a href="https://www.tandfonline.com/doi/full/10.1080/10357823.2022.2142932">Chandra Kala Clemente-Martínez</a>. Hari Prasad Sacré, PhD, is a postdoctoral researcher at Ghent University in Belgium, specialising in cultural translation, multilingualism, and identity in education. His PhD, Reading Illiteracy, explored fractured multilingualism and illiteracy in displaced identities such as adoptees, with work published in leading journals like Critical Arts and the European Journal for Cultural Studies. Chandra Kala Clemente-Martínez, PhD, is a postdoctoral researcher at the AFIN Research Group, Autonomous University of Barcelona, with a PhD in Social Anthropology. Her research focuses on family strategies, reproductive decisions, and adoption, with extensive fieldwork in Spain and Nepal examining adoptee reunions and related governance and rights.

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