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

“Let's have another cup of tea,” <a href="https://nepalitimes.com/here-now/ujwal-thapa-s-light-shines-on-n0tfurod">Ujwal Thapa</a> of the alternative Bibeksheel Nepali party told the young activist Pukar Bam ten years ago. The two had 12 cups of tea that day, discussing ways to get Nepal out of its political deadend. Thapa contested the Constituent Assembly election in 2013 as an independent from Kathmandu, and formed Bibeksheel Nepali to galvanise youth impatient for change, fielding candidates in the first federal election in 2017.&nbsp; Ujwal Thapa was a political guru who was way ahead of his time, and his protégés were among the RSP’s winning candidates in last week’s election. Pukar Bam was a core member of Bibeksheel Nepali until its dissolution, and won the Kathmandu-4 seat this time. Other former Bibeksheel members who won the election from the RSP in Kathmandu include Ranju Neupane from Kathmandu-1, Sasmit Pokharel from Kathmandu-5, and Biraj Bhakta Shrestha in Kathmandu-8. As votes were counted and the results from Kathmandu began to come in, the candidates paid fulsome tribute to Ujwal Thapa’s mentorship and in inspiring idealistic youth to become a part of an alternative political force.&nbsp; Today, as RSP members of Parliament, they are no longer an alternative, but a part of Nepal’s new mainstream politics. Thapa returned to Nepal after finishing his undergraduate computer science degree in the US at the peak of the Maoist insurgency. His foray into politics began when he traveled to Nepal’s western mountains to train communities in mediation. After the war, he started a computer design company for young entrepreneurs entering the workforce. But he became frustrated with the inability of the second Constituent Assembly to promulgate the Constitution, and the power struggle between political parties played out in the streets that led to frequent shutdowns paralysing the country.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260313120348_d18647d53a3b2927328067c35b2e3e6eecf9aefe13f23384e73a2c17211cd9cb.jpg" data-media-id="editor_1" data-image-id="20260313120348_d18647d53a3b2927328067c35b2e3e6eecf9aefe13f23384e73a2c17211cd9cb" data-rendition-name="original" width="823" height="682" loading="lazy" alt="The RSP's activist DNA"> <figcaption>Thapa with Pukar Bam, who was elected to Parliament last week from Kathmandu-4. Photo: PUKAR BAM / FACEBOOK</figcaption> </figure>  PROTEST TO POLITICS Ujwal Thapa had had enough, and rallied people from across walks of life, leading peaceful, silent demonstrations proclaiming 'नेपाल खुल्ला छ' against prolonged, violent strikes. Citizens fed up with the main political parties organised to defy the shutdowns. Thapa’s activism and vision for a new Nepal drew disenchanted and previously apathetic youth into politics and to join the Bibeksheel Nepali Party in 2013.&nbsp; Thapa was the pioneer of alternative politics in Nepal, and was leading a youth force long before the GenZ became synonymous with Nepal’s September Storm. He mentored and guided social activists who are today influential youth leaders engaged in non-traditional politics. “Ujwal Thapa, with his entrepreneurial spirit, wanted to address people’s pain-points, and believed that activism was the starting point to alternative politics,” explains <a href="https://nepalitimes.com/opinion/nepal-loses-rare-purpose-driven-leader">Ashutosh Tiwari</a>, former member of Bibeksheel Sajha party. “He sought to build confidence, motivate, and build a community for young people, which drew a lot of people into Bibeksheel.” He adds: “ And while people might say that Bibeksheel never got big, that was never its point. Its function was to be an early talent incubator, which is what it did as evident by the result of this election.” Thapa died in 2021 of complications related to Covid-19, and Bibeksheel had two mergers with Rabindra Mishra’s Sajha Party before being permanently dissolved in 2021. But many of its idealistic members joined Rabi Lamichhane’s RSP, formed just four months before the 2022 federal election. Such was the groundswell of support for change that the RSP became the fourth-largest in Parliament. In 2017, Ranju Neupane (then Ranju Darshana) was the youngest mayoral candidate for Kathmandu at age 21, and contested the federal election in 2022. Pukar Bam himself lost the 2022 election in Kathmandu-1 as an independent.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260313120348_6302a9b534f57191d9a2cb2c31b31449873c6cc27d375344a248dd90847921dd.jpg" data-media-id="editor_3" data-image-id="20260313120348_6302a9b534f57191d9a2cb2c31b31449873c6cc27d375344a248dd90847921dd" data-rendition-name="original" width="1729" height="1365" loading="lazy" alt="The RSP's activist DNA"> <figcaption>Photo: SOCIAL MEDIA</figcaption> </figure>  Sashmit Pokharel also ran an unsuccessful campaign as an independent candidate in Kathmandu during the 2022 provincial election. Later, he was a member of the City Planning Commission under Balendra Shah when he was elected mayor of Kathmandu in 2022.&nbsp; Last week, the RSP swept the election with a supermajority of 182 seats in Parliament. Voters placed their trust in the party and its leaders to steer Nepal in a new direction after the youth unrest in September.&nbsp; In many ways, Nepal’s youth have decided, just as Ujwal Thapa once did, that enough is enough with corruption, malgovernance, nepotism and dynastic politics.&nbsp; In the <a href="https://nepalitimes.com/review/the-man-who-shook-our-minds">documentary</a> about his life, Dimag Ghochne Manche, released earlier this year, some RSP nominees who previously worked with and were mentored by Thapa spoke of the impact he had on their lives, career, and activism. Among them is Biraj Bhakta Shrestha, former minister of Youth and Sports who is now a second time RSP parliamentarian. “I tell everybody that if it hadn’t been for Ujwal Dai, I would not have gotten into politics,” he says in the film.&nbsp; It would be unfair to attribute all the success of the hard-fought campaigns entirely to Ujwal Thapa’s protégés and former coworkers.&nbsp; But his ethos and vision for Nepal was what inspired them, and will in the coming years be reflected in national politics through the young idealists he mentored. Says Ashutosh Tiwari: “There are many Bibeksheels outside of RSP in constant and open communication with their old friends who have been elected. They will be keeping the lawmakers in check so that they do no stray too far from the values that they grew up with.”

RSP’s activist DNA

The series Nepal Made profiles Nepali products and the people who make them possible While premium beauty product outlets were closing during the Covid-19 pandemic, two young women gambled on setting up a new skin and haircare brand with natural ingredients mostly sourced from Nepal and suited for the Nepali complexion. Arushree Sharma Khatiwada and Megha Agarwal were batchmates in school before they left for studies abroad, returning to set up Avani Nepal after year-long rigorous research into ayurveda-based cosmetic products. Avani in Sanskrit means ‘earth’, and as the name suggests it is committed to bringing all natural, pure and authentic range of beauty solutions.&nbsp; “We found a gap in the Nepali market demand for cosmetics, which is why we decided on a brand sourced from all-natural Himalayan herbs that are not used or explored properly,” says co-founder Khatiwada.&nbsp; Nepal is a treasure trove for medicinal plants and those with therapeutic properties. After all, legend has it that Hanuman flew right across the subcontinent from Sri Lanka to the Himalaya to find a rare medicinal plant to save the life of Lord Ram, who was wounded in battle. When he could not find the specific plant, he tore off a whole mountain and brought it down. Read also: <a href="https://nepalitimes.com/multimedia/looking-good-by-doing-good">Looking good by doing good</a>, Sudiksha Tuladhar  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260314120356_32323fd084540236fe4edb3b98286c131d67c73310279c8038510da1e1ae1bc0.jpg" data-media-id="editor_1" data-image-id="20260314120356_32323fd084540236fe4edb3b98286c131d67c73310279c8038510da1e1ae1bc0" data-rendition-name="original" width="3024" height="2012" loading="lazy" alt="Avani"> </figure>  Medicinal plants in Nepal range from yarsagumba to jatamasi and 500 other species traditionally used in the Ayurveda as well as now in the wellness industry. Avani is also trying to experiment hibiscus, Himalayan honey and other plants to eventually launch an export drive. Running a business in Nepal is no easy task, especially for small scale locally crafted products but in a few years, Avani has ammased loyal customer base and have many repeat customers. “While it was tricky initially, we were determined to launch our products with the best quality ingredients and in an affordable price range,” says Khatiwada. Following a worldwide trend and emulating the method used by Korean cosmetic brands, Avani has deployed celebrities and influencers to increase its outreach through tikTok , Facebook and YouTube. &nbsp;Actresses Barsha Shiwakoti and Shilpa Maskey and makeup artists like Lemi have reviewed their products favourably. Sutainability is a big part of the brand, and Avani uses glass bottles, cardboard boxes, paper bags for all its products. Plastic use is cut to a minimum, and where used is recycled.&nbsp; “Many people think that sustainable brands are expensive, we want to bust that myth,” Khatiwada told us. “We focus on being eco-friendly using ethically sourced materials that are paraben, silicon, and cruelty free.”&nbsp; Read also: <a href="https://nepalitimes.com/here-now/proud-to-wear-dolpo">Proud to wear DOLPO</a>, Vishad Raj Onta  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260314120356_da0d7d4082a9aa51c96ecbcb8a2e7a5bc60e27de202fb339a522036aa3f50b49.jpg" data-media-id="editor_3" data-image-id="20260314120356_da0d7d4082a9aa51c96ecbcb8a2e7a5bc60e27de202fb339a522036aa3f50b49" data-rendition-name="original" width="1048" height="1280" loading="lazy" alt="Avani"> </figure>  Avani has expanded its business to get a toehold in Nepal’s tourism and wellness industry, and the products are carried by spas in leading hotels and resorts in Kathmandu and Pokhara such as the Terraces, Marriott, and Kavya resort, and is in talk with the Hideaway Resort in Pokhara.&nbsp; The skin and haircare brand that initially started with 10 products has since expanded its line to 60 with goods placed in more than 100 stores across Kathmandu. Plans are in the works to expand to India, China and in Japan partnering with Okada. Avani Nepal’s founders say that they support empowerment through employment and training opportunities for women at the company. Khatiwada herself has been engaged with organisations such as Nepal Women Chamber of Commerce, and Nepal Youth Entrepreneur Forum. Additional support from the government such as the provision of lower excise duties has helped but guidance for export and other business regulations is as crucial. Such an environment would also foster opportunities for the youth who are otherwise moving away for jobs or study abroad. “While everyone is trying to go abroad, opportunities can be created here in Nepal itself, with adequate support from the government,” says Khatiwada. “In the meantime, we are eyeing for long term benefits. We are trying to create a legacy for cosmetic brands in Nepal.” Read also: <a href="https://nepalitimes.com/here-now/java-in-the-himalaya-y1ilc21h">Java in the Himalaya</a>, Vishad Raj Onta

Redefining the criteria for beauty

&nbsp;With a near two-thirds majority, the RSP has a chance that no other party in Nepal has ever had--to reboot how Nepal is run. Winning an election with such an overwhelming majority was one thing, but running an effficient government will be a whole new ball game. From the start, it will not be easy because the country is running straight into a major economic crisis due to the West Asia war.&nbsp; With 125 first-past-the-post direct wins and 57 proportional representation seats — over 47% of the total 10.7 million valid votes — the RSP has 182 seats in Parliament. The Nepali Congress (NC) is a distant second with 38 seats, while the UML is trailing with 25. Three more made it to the national party list: Nepali Communist Party (17), the royalist RPP (5) and the new entry Shram Sanskriti Party (7) led by former Dharan mayor Harka Sampang. Shram Sanskriti’s performance is also a clear indicator that identity politics is still a potent force. The RSP with its majority can now form a stable government for the next five years, but there are issues that may surface with the choice of Cabinet members and other appointments. PM candidate Balendra Shah and party chair Rabi Lamichhane both have big egos and are ambitious, and Nepal cannot afford rumours of a split be a self-fulfilling prophecy. There is precedent. The last two-thirds government under the Communist Party of Nepal formed after the alliance of UML and Maoist Centre in 2022 collapsed following a power struggle between two cop comrades K P Oli and Pushpa Kamal Dahal. History in Nepal has a habit of repeating itself. No elected government in Nepal has ever completed a full five-year term, so the RSP has a chance to rewrite history. Besides egos and the West Asia crisis, the party has other challenges: legacy parties rule local governments and the National Assembly. The RSP’s rejection of provincial elections and federalism in 2022 did not seem to have affected its votes in the Madhes, but local governments at the periphery will be trying their level best to make it difficult for the centre. The RSP’s strategy should be not to alienate the old parties, but try to win them over and collaborate to build bases outside of major urban centres.&nbsp; Some think Balendra Shah’s aloof and uncommunicative nature could hide an authoritarian streak. And Rabi Lamichhane has been scathing about media exposes of his alleged wrongdoings. Despite this, the RSP's strategy should be to avoid alienating civil society any more than necessary.&nbsp; The media’s role in a democracy is to play the adversarial check-and-balance role, especially when one party is so dominant. However, the press must give up its corrosive, cynical coverage that almost hopes the RSP will fail from day one -- especially since social media offers no help on that score. There are so many things wrong with Nepal that even at the best of times, and even with a supermajority government, it would be impossible to solve them all overnight. But voters are an impatient lot, and they expect a lot pronto.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260313080320_388d87c728fce65393a7042b4e649fe73af559b3459c45d8aff7f320acbd62dd.jpg" data-media-id="editor_0" data-image-id="20260313080320_388d87c728fce65393a7042b4e649fe73af559b3459c45d8aff7f320acbd62dd" data-rendition-name="original" width="1500" height="1033" loading="lazy" alt="Page 1 map"> </figure>  Effective governance takes time, and the RSP must be given the chance even if it fails to make course-corrections. Shah and Lamichhane, on the other hand, must show restraint and prove their critics wrong. Instead of posting inflammatory content on their social media feeds and deploying cyber militias to troll critics into silence, they could try developing a thicker skin. The RSP could work on a clear strategy and plan of action to get this country back on its feet. The party's rise was built on emotion, not ideology. But every party needs ideals, just saying it is against corruption is not enough. Its stance on federalism, secularism, inclusion, need to be clarified. The RSP's lofty promise to bring young Nepalis home will be easier said than done. What will they return to? How can we make this worthwhile? And how do we provide jobs for the other 500,000 Nepali youth who enter the job market every year?&nbsp; Nepal will need liberal policies regarding domestic investment and FDI to reform manufacturing, industry, tourism and infrastructure to ensure jobs at home, while also working toward achieving the 7% annual growth rate projected by the RSP.&nbsp; Rabi Lamichhane has introduced the term 'development diplomacy’ to steer the country away from traditional geopolitics toward economic partnerships with India, China, and other international partners. But the environmental cost of mega projects must also be taken into account in the rush to development.&nbsp; The RSP’s anti-corruption drive, implementing a high-level commission to investigate assets acquired since 1990, must also include judicial reform. Meanwhile, quality health services and education must be affordable and accessible.&nbsp; Cleaning up the bureaucracy will be critical. Electoral reform including election spending and out-of-country voting must be a priority from the get go. It is a long to-do list. But for the very first time, the Nepali people are genuinely excited about their new leaders and the promised transformation. Not another Switzerland or Singapore, people just want better development, more efficient service delivery, meaningful jobs at home and an accountable government.&nbsp; That should not be too much to ask. Sonia Awale

As clear as a bell

The Asian Development Bank approved a $40M soft loan for Nepal’s Digital Transformation Project. The project aims to develop a citizen service portal, improve the national social registry, establish a government-wide data exchange platform, digitise 11 high-impact government services, and strengthen cybersecurity. The World Bank had previously approved a $50M loan for the same project.&nbsp;

ADB $40M Loan

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diabetes-mellitus

A deadly sugar rush

RSP’s activist DNA

Redefining the criteria for beauty

As clear as a bell

ADB $40M Loan