<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410118/637205999c7e80680e0b28c6jpeg.jpg" alt="" width="1920" height="1080"/><figcaption>When the only ambulance in Diprung Chuichumma could not attend to all the emergencies, Chair Bhupendra Rai himself drove the infected to health centres.</figcaption></figure>KhotangLast year, as Nepal plunged headlong into <a href="https://www.nepalitimes.com/banner/the-real-cost-of-nepals-second-wave/" target="_blank" rel="noopener noreferrer">the second wave</a> of Covid-19, cities around the country including Kathmandu Valley announced lockdowns, and people of Diprung Chuichumma Rural Municipality of Khotang streamed back home.The people were home, but they also brought the virus with them. The only ambulance in the municipality could not attend to all the emergencies, so Chair Bhupendra Rai donned a PPE and started driving the infected to the health centre in his own car. Sometimes, he would go door-to-door carrying patients on his back to the car.The municipality set up a 25-bed isolation centre, ramped up awareness campaigns, and carried out antigen tests. Vice-chair Sapana Rai was equally involved. Those who couldn’t be treated inside the municipality were taken to hospitals in Kathmandu and  Biratnagar.“We entered politics for the people. So, when they were suffering, we couldn’t just sit back and relax, we had to be hands-on in serving them and taking the lead from the front,” Bhupendra Rai told us on the phone from Khotang as he waits for word on <a href="https://www.nepalitimes.com/banner/dance-of-democracy/" target="_blank" rel="noopener noreferrer">the date for local elections slated for April</a>.This <a href="https://www.nepalitimes.com/latest/nepals-local-governments-lead-from-the-front/" target="_blank" rel="noopener noreferrer">local government team was proof</a> that elected grassroots politicians understand the need of their area, are more accountable, and are willing to serve their constituents.The Omicron surge is spreading, but this time there are not as many cases of Covid-19 in the village. But the Rais are not taking any chances. The municipality has increased the number of antigen tests and encouraged the infected to isolate at home.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410118/6372059c9c7e80680e0b28c7jpeg.jpg" alt="" width="2048" height="1152"><figcaption> </figcaption></figure>Kathmandu may have a shortage of cetamol painkillers, but there is plenty stockpiled here to meet villagers’ needs. And the municipality has deployed health volunteers to accelerate the vaccination drive.“Whoever could walk to the centre are all vaccinated, now we need to reach those who cannot come on their own,” says Rai.As schools nationwide remained closed during the lockdown, the municipality deployed more than 200 teachers with masks on who went house-to-house tutoring students. It also bought produce from local farmers who could not take it to market due to the lockdown and distributed to needy families. This ensured food security as well as income for the local farmers.When Bhupendra Rai was elected in 2017, there were not enough roads in his rural municipality. Every monsoon, the constituency would be locked in as the Sunkosi and Sapsi river flooded. Today, a motorable bridge connects this remote village to the rest of the country. Every household has electricity and access to drinking water.“All this would not have been possible without the local elections and local representatives in place, it forced us to perform,” says Rai.Tehrathum<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410118/6372059f9c7e80680e0b28c8jpeg.jpg" alt="" width="2048" height="1149"><figcaption> </figcaption></figure>To the east in Laligurans Municpality, Tehrathum Mayor Arjun Mabuhang also worked on connectivity as soon as he got elected five years ago. Having seen <a href="https://www.nepalitimes.com/uncategorized/elected-contractors/">rampant corruption in road contracts</a>, Mabuhang got the municipality to buy its own excavators to build roads with the help of locals, cancelling out middlemen.“Now all the wards have roads and there is ownership amongst the people because they themselves were involved in building them,” says Mabuhang.He also introduced a program to upgrade agriculture by supporting dairy farmers and offering grants for vegetable and fruit farming, poultry, and pig farms. The roads helped get the produce to market.Says the mayor: “Because I am from here and I myself have seen the ground reality and know what the people here need, I work in the areas that benefit the people most. We did what we could with the budget we were given, but we need to work more on improving schools.”Sindhupalchok<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410118/637205a39c7e80680e0b28c9jpeg.jpg" alt="" width="960" height="720"><figcaption> </figcaption></figure>In Sindhupalchok’s Jugal Rural Municipality, Deputy Chair Srijana Tamang has been single-mindedly working on improving education. As a child, she remembers walking for hours from home to school and back. In winter night fell quickly on her way home, and during the monsoon she would be covered from head to toe in leeches.When she was elected five years ago, one of the first things Tamang and Chair Hom Narayan Shrestha worked on was to appoint new teachers and upgrade school buildings, some of them destroyed in the earthquake.Having worked as a social worker in the past, Tamang recognised the priority areas for her rural municipality, and her background and familiarity with the people helped her not only gain an edge during the elections but prepared her to deal with the problems of her community.“When I was elected, I really wanted to prioritise roads and education, but <a href="https://www.nepalitimes.com/latest/rural-nepal-fights-back-covid-19/" target="_blank" rel="noopener noreferrer">the pandemic meant we had to address more urgent issues</a>,” adds Tamang, who offered RT PCR testing and monitored the spread of the disease, turning a local school into an isolation centre. With Omicron, Tamang believes the people are more aware, and better prepared.“The pandemic was the first big challenge for me as a local representative,” says Tamang. “But knowing that we are working for our people and our families, there is always a greater sense of responsibility.”In 2020, while Tamang was away on official business, a <a href="https://www.nepalitimes.com/here-now/deadly-monsoon-in-nepal-turns-deadlier/" target="_blank" rel="noopener noreferrer">massive landslide at Lidi</a> killed 39. She travelled overnight to help with the rescue and relief effort and got support to rehabilitate those made homeless. She got geologists to prepare a disaster risk map of her municipality to prevent future disasters, and prepare for them.Jhapa<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410118/637205a69c7e80680e0b28cajpeg.jpg" alt="" width="2048" height="1536"><figcaption> </figcaption></figure>Jhapa’s, Kamal Rural Municipality has the distinction of being among <a href="https://www.himalkhabar.com/news/125595?fbclid=IwAR1g00nElAMlIzStd-FiN7M-f6PZ1H3KQXE6V0f8Y4ztDNxclOSJ9KWQPZs" target="_blank" rel="noopener noreferrer">four of the 753 municipalities around the country ranked cleanest</a> in budget disbursement by the Office of Auditor General. It is a well-deserved recognition for Chair Menuka Kafle for whom tackling leakage and corruption was a priority.For any project with a budget over Rs5 million, the municipality went through a strict tender process. It also stopped giving out advances for projects and kept track of expenditure.“For the others to follow the rules, we had to lead by example, so we made sure that we were meticulous about accounting,” says Kafle.Over the last five years, the rural municipality has constructed more than 70km of roads, upgraded bridges, and ensured that all wards have electricity. Kafle distributed carts to women fruit and vegetable vendors and launched income generation activities for women.“When women are economically independent, they don’t have to depend on others and can make their own decisions,” says Kafle.The municipality offered cash incentives to encourage pregnant women to visit health centres for regular check-ups and registration of new-borns. When Kafle first got elected, many people in the community <a href="https://www.nepalitimes.com/latest/is-democracy-too-expensive-for-nepal/">did not believe that a woman could run the office</a>.During important meetings people would ignore her and seek out the male Deputy Chair. These days Kafle is in high demand.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410118/637205a99c7e80680e0b28cbjpeg.jpg" alt="" width="1080" height="486">Says Kafle: “We women who are in power have to work hard to build trust in the community and do everything within our power so that women who come after us don’t face so much difficulty.”

Sahina Shrestha

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All politics is local

<figure><img width="1920" height="1080" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121140/636b922f9c7e80680e06f133jpeg.jpg" alt=""/><figcaption>Photos: DIPRUNG CHUICHUMMA RURAL MUNICIPALITY</figcaption></figure>Sabitra Devkota of Diprung Chuichumma rural municipality in Khotang had been isolating at home for four days after testing positive for Covid-19 in late May when she fell unconscious. There was no one to take her to hospital. Devkota’s relatives informed Diprung Chuichumma rural municipality Chair Bhupendra Rai about her situation. Rai immediately drove to Devkota’s house and took her to hospital himself.Devkota is one of many Covid-positive residents of this village in Khotang district of eastern Nepal whom Chairperson Rai has helped this month. With the vice-chair Sapana Rai, the two leaders have been actively on the frontlines as the deadly second Covid wave that has battered the country’s urban hubs <a href="https://www.nepalitimes.com/latest/in-nepal-virus-climbs-from-plains-to-mountains/" target="_blank" rel="noopener noreferrer">sweeps across rural Nepal</a>.Out of 300 Covid-19 PCR tests done in the village, 93 came back positive last month. And as cases began to rise, the only ambulance operating within the municipality was unable to attend to the increased number of calls. So Bhupendra Rai donned a PPE and turned his official vehicle into an ambulance. He now drives Covid-infected patients to hospital himself, spending more time on the road than he does at his desk.Inaccessibility to roads in some areas of the municipality means that Rai’s vehicle sometimes cannot reach near enough for people to walk to. When that happens, Rai goes into their homes and carries them out to his vehicle himself.  <img width="1920" height="1080" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121140/636b92329c7e80680e06f134jpeg.jpg" alt=""><img width="800" height="450" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121140/636b92359c7e80680e06f135jpeg.jpg" alt="">He has to be hands-on, he explains, in order to reduce the risk of the infected person’s family members being exposed to the virus.“I wear a PPE and masks at all times, so the chances of me contracting the virus are relatively less than when relatives come in contact with infected people while helping them,” says Rai.Vice-chair Sapana Rai has been equally involved in the efforts, working with Bhupendra Rai to provide aid to Covid-positive residents, take people to get antigen tests at the temporary Covid hospital, and arrange for isolation facilities depending on the severity of individual Covid cases.<a href="https://www.nepalitimes.com/latest/a-little-help-goes-a-long-way-in-home-isolation/">A little help goes a long way in home isolation</a>, Nepali Times <figure><img width="1920" height="1080" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121140/636b92379c7e80680e06f136jpeg.jpg" alt=""><figcaption> </figcaption></figure>The municipality has set up a 25-bed isolation centre with supplemental oxygen. “Asymptomatic individuals are told to isolate at home,” explains Bhupendra Rai, “while those who show serious symptoms are kept in this isolation facility.” The two village leaders have also been coordinating to send critically ill Covid-19 patients for treatment to Kathmandu, Dhulikhel or Charikot.Testing has also been ramped up across each tole to manage the spread of the virus before the situation gets out of hand. In fact, as health workers go <a href="https://www.nepalitimes.com/latest/rural-nepal-fights-back-covid-19/" target="_blank" rel="noopener noreferrer">door-to-door</a> conducting antigen tests, Rai is usually right alongside them. “I have been accompanying health workers to keep the morale up,” he says.<a href="https://www.nepalitimes.com/here-now/at-the-covid-19-frontlines-in-rural-nepal/">At the Covid-19 frontlines in rural Nepal</a>, Priti Thapa<iframe src="https://www.facebook.com/plugins/video.php?height=420&amp;href=https%3A%2F%2Fwww.facebook.com%2Fito.diprungmun%2Fvideos%2F868380697356377%2F&amp;show_text=false&amp;width=560&amp;t=0" width="560" height="420" style="border:none;overflow:hidden" scrolling="no" frameborder="0" allowfullscreen="true" allow="autoplay; clipboard-write; encrypted-media; picture-in-picture; web-share"></iframe>So far, 14 patients in the municipality have recovered from the disease during the second wave. Khotang is among the few districts in Nepal not under prohibitory orders. As such, the local government has advised Diprung Chuichumma residents to stay home unless strictly necessary to go outside. Additionally, they have tightened security measures, putting out an order that requires anyone entering the municipality from outside to have a negative test report.The local government has also been actively pushing out campaigns on Covid prevention. “We have been providing support to Covid-positive individuals while simultaneously running awareness programmes across the municipality,” says vice-chair Sapana Rai.Meanwhile, constant exposure to the virus has meant that Bhupendra Rai has not come in close contact with his own family in a month. Rai is diligent about showering and disinfecting when he gets home from work every day. He stays and takes his meals in a separate room, and doesn’t venture into the kitchen or to where his family gathers. Rai believes in leading from the front. “Now is not the time for us to give out orders to others while we stay in a bubble of safety,” he says. “We were elected to serve the people. If we unite now to fight this virus, there will be brighter days ahead.”Read also: <a href="https://www.nepalitimes.com/banner/nepals-doctors-are-like-soldiers-fighting-a-war/">Nepal’s doctors are like soldiers fighting a war</a>, Donatella Lorch

Nepal’s local governments lead from the front

On Tuesday, leader of the monarchist RPP once again gathered on Kathmandu’s streets to deliver fiery speeches, but this time there was no arson and looting and no need for riot police to fire live rounds or tear gas.
RPP leaders demanded the release of their members including vice-president Rabindra Mishra and MP Dhawal Shamsher Rana were arrested during the violent <a href="https://nepalitimes.com/news/republicans-and-royalists-on-nepal-s-streets">28 March protests at Tinkune </a>which left two dead. 
They denounced the current leadership of the main parties, demanding the <a href="https://nepalitimes.com/editorial/nepal-party-reincarnating-hindu-monarchy">restitution of Nepal as a Hindu kingdom</a>. They also said the government was responsible for the fatalities on 28 March because it provoked its rally with a tear gas attack even before it started.
It has now been revealed that the police fired at least 100 live rounds from high powered assault rifles at the crowd. Twenty-one of the 120 injured received bullet wounds, and most of them were bystanders and people trying to reach home. 
Tuesday protest on the Ring Road in Balkhu was much more subdued, and comparatively fewer RPP supporters showed up. The arson and vandalism in the previous protest appears to have cost some support for <a href="https://nepalitimes.com/news/the-ghost-of-monarchy-returns-to-haunt-nepal">former king Gyanendra </a>especially for the anointment of medical tycoon and bank defaulter <a href="https://nepalitimes.com/news/street-politics">Durga Prasai </a>as ‘commander’ of the Tinkune rally.
Some monarchists acknowledge Gyanendra’s mistakes when was king 2001-2008, but say he has had a lot of time to reflect on his shortcomings and seems more disciplined and committed. His supporters have tried to build on nostalgia among some Nepalis for<a href="https://nepalitimes.com/news/why-invest-in-nepal"> domestic stability </a>and international respect that <a href="https://nepalitimes.com/here-now/if-birendra-was-alive-nepal-could-still-be-a-monarchy">the monarchy</a> commanded. 
“Nepalis were promised better service delivery, opportunities for the underserved, as well as better, more honest use of state resources, but the <a href="https://archive.nepalitimes.com/news.php?id=16992">people in leadership </a>have not been able to deliver on their commitments,” says RPP leader Prakash Chandra Lohani. “The gap between their rhetoric and reality has widened, the people feel betrayed, and the respect Nepali people had previously had for them has changed to revulsion.” 
Indeed, many commentators have warned the three main parties and their <a href="https://nepalitimes.com/editorial/politics-as-usual">serial prime ministers</a> who have ruled Nepal for much of the past 30 years should address rising public anger with them, and see the writing on the wall.
‘<a href="https://nepalitimes.com/news/nepal-government-changes-again">The UML, NC and Maoists</a> must introspect about their conduct,” warns Gunaraj Luitel, editor of Nagarik, in an op-ed this week. ‘These leaders for life may save themselves from simmering public anger, but they will not be able to save the system. The monarchist wave can only be dispelled when citizens are assured of <a href="https://nepalitimes.com/here-now/nepal-s-local-election-gives-power-back-to-people">better governance</a> through <a href="https://nepalitimes.com/latest/real-world-training-for-youth-leaders">younger leaders</a>, and reforms.’ 
Rifts between radical royals who are gunning for a return to <a href="https://nepalitimes.com/here-now/mob-movement-and-mayhem">Panchayat-style absolutism </a>and moderate monarchists who favour a constitutional king have also weakened the movement somewhat. The split between the RPP and RPP-Nepal cost the royalists numbers in Parliament in 2022, and both parties denounced the violence last month, albeit shifting the blame on the government.
The irony is that the same royalists who want to scrap the republican Constitution had formed electoral alliances with the UML during the 2022 elections. RPP-Nepal chair Kamal Thapa contested the 2022 election with the UML. Thapa has not taken part in the last two rallies, saying he will only be a part of a movement under a national flag, and not a RPP party banner.
For his part, the RPP’s Rajendra Lingden is said to be hesitant to censure some of his party’s more radical royalists for fear of fissure within his ranks, despite his aversion to Durga Prasai’s role. 
Analysts have questioned why <a href="https://nepalitimes.com/news/old-is-still-gold-in-nepali-politics">supporters of the monarchy </a>have decided to reestablish an institution that would not ultimately have executive decision-making power. There are doubts about whether authoritarian-minded Gyanendra will be satisfied being a <a href="https://archive.nepalitimes.com/news.php?id=13957">ceremonial king</a>. 
Read also: <a href="https://nepalitimes.com/news/nepal-s-deja-vu-on-black-friday">Nepal’s déjà vu on Black Friday</a>, Sonia Awale
"The Nepali people will not accept <a href="https://nepalitimes.com/here-now/forgotten-woman-who-sheltered-communist-activists">an absolute monarchy </a>at this point of time, and both the public as well as <a href="https://archive.nepalitimes.com/news.php?id=8371">king Gyanendra</a> are fully aware that there is no other possibility beyond a constitutional monarchy," asserts the RPP’s Lohani. “The traditional monarchy’s institutional capacity might have been enough to meet the needs of feudal Nepal, but an absolute monarchy is impossible both in concept and practice in the context of <a href="https://archive.nepalitimes.com/regular-columns/Economic-Class/waiting-for-an-industrial-revolution,784">modern day Nepal</a>.”

New year revolutions

Besides multiple <a href="https://nepalitimes.com/news/republicans-and-royalists-on-nepal-s-streets">street demonstrations </a>that gridlocked Kathmandu’s traffic for the past weeks, public discourse in Nepal has also been dominated by dangerously <a href="https://nepalitimes.com/here-now/air-pollution-is-more-dangerous-than-smoking">high air pollution levels</a>. Caused mostly by hundreds of <a href="https://nepalitimes.com/news/wildfire-season-starts-early-in-nepal">forest fires </a>raging across the country, the smoke contains suspended soot particles that harms <a href="https://nepalitimes.com/opinion/playing-with-poison">human health</a>. Thursday’s rain have cleared the air somewhat, and many people will soon forget how bad the air quality was. But the time to address the roots of next summer’s fire season is now.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250411060440_d1a119716a9031aadfdd611d299348d436842d376a03e664b8d773957a237524.jpg" data-media-id="editor_4" data-image-id="20250411060440_d1a119716a9031aadfdd611d299348d436842d376a03e664b8d773957a237524" data-rendition-name="original" width="502" height="540" loading="lazy" alt="Wildfires"> <figcaption>EXTINGUISHED: Forest fires raging all over Nepal in the week after 3 March (above) reduced air quality, creating a public health hazard in Kathmandu and across the country. Each red dot is a fire detected by infrared sensors on the NASA Fire Information for Resource Management System (FIRMS) satellite. But the rain on Thursday doused most of the fires (below) with more rain forecast over the weekend.</figcaption> </figure>  The reason everyone was talking about air pollution was because the<a href="https://nepalitimes.com/banner/nepal-is-going-up-in-smoke"> smoke from wildfires</a> was visible. But much more toxic are the invisible and odourless <a href="https://nepalitimes.com/news/nepal-doubles-its-carbon-footprint">gases from vehicular and industrial emissions </a>which have always been there. The theme of World Health Day on 7 April this week was ‘Healthy Beginnings, Hopeful Futures’ dedicated to <a href="https://nepalitimes.com/opinion/comment/saving-more-mothers-and-babies">preventing maternal and newborn deaths</a>. It is estimated that in Nepal, 30% of neonatal mortality can be blamed on air pollution. But that is only part of the story. Harmful as fine particulate matter is to human health, carbon monoxide, nitrogen dioxide, ground-level ozone and other gases in vehicular emissions are more hazardous to health. While the concentration of suspended particulate matter tinier than 1.5 microns (PM2.5) is closely monitored, these toxic gases are invisible, not measured much, and the public is not aware about the dangers they pose. Surface ozone is produced by the interaction of various gases found when <a href="https://nepalitimes.com/news/fossil-fuels-poison-air">burning fossil fuels</a>. Besides being poisonous, ground level ozone contributes up to 0.23°C to <a href="https://nepalitimes.com/here-now/nepal-s-mountains-are-melting">global warming</a> because it is also a greenhouse gas. A new policy brief by the Clean Air Fund titled The Case for Action on Tropospheric Ozone blames surface ozone for a half a million premature deaths every year, 54.8% of which are in South Asia. Ozone also stunts plant growth and reduces crop yields by 26% globally, and 11% loss in <a href="https://nepalitimes.com/news/economic-benefits-of-saving-the-ecology">forest productivity</a>, the report adds.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250411060456_aa02a923f8b27544ae54d0220162678f5bbb5eeb8fc3c466173c22c49b3e9a85.jpg" data-media-id="editor_11" data-image-id="20250411060456_aa02a923f8b27544ae54d0220162678f5bbb5eeb8fc3c466173c22c49b3e9a85" data-rendition-name="original" width="998" height="724" loading="lazy" alt="Gas Chambers"> </figure>  Read also: <a href="https://nepalitimes.com/here-now/bad-air-and-polluted-politics">Bad air and polluted politics</a>, Sonia Awale Ground-level ozone is not emitted directly into the air like other gases, but is formed when oxides of nitrogen (NOx), carbon monoxide (CO) and volatile organic compounds (VOCs) released from automobile tailpipes or industry smokestacks react chemically with each other in the presence of sunlight. The main source of carbon monoxide in Kathmandu Valley are its 1.2 million two-wheelers. “Usually the concentration of carbon monoxide is 200-500 parts per billion (ppb), this has increased up to 3,000 in Kathmandu. Meanwhile, ground-level ozone has gone from 70-80 ppb to 150 ppb,” says Ravi Sahu, regional air quality specialist with the Kathmandu-based International Centre for Integrated Mountain Development (ICIMOD).&nbsp; Sahu says <a href="https://nepalitimes.com/news/no-smoke-without-fire-p7vb9dcj">rampant forest fires of the past weeks</a> have also added to carbon monoxide and ozone in the air, not just the fine particles that make up the visible smoke. He adds, “There isn’t much awareness about <a href="https://nepalitimes.com/banner/poisoning-the-air-we-breathe">ground-level ozone and carbon monoxide</a>, we need to urgently look into it.” A distinction must be made between good and bad ozone. Stratospheric ozone protects living beings from harmful ultraviolet (UV) radiation from the sun.&nbsp; Tropospheric ozone can again be separated into two types: ozone in the free atmosphere which is a greenhouse gas much more potent than carbon dioxide, and ground-level ozone which has adverse impacts on health and agriculture. ‘Cutting tropospheric ozone presents a unique challenge as it requires smart and fast action across multiple greenhouse gases and air pollutants, as well as multiple economic sectors,’ notes the Clean Air Fund's policy briefing. ‘It is a growing and neglected problem that needs an integrated approach on both a local and global level to tackle climate change and air pollution together.’ Dying young There was a time when Nepal made it to international news bulletins only if there were fatalities on Mt Everest. Now, Kathmandu’s bad air frequently makes headlines all over the world. This past week, the concentration of PM2.5 that harms human health was up to 40 times the WHO recommended guideline — adding to the poisonous gases already present from vehicle emissions. The Department of Environment says 40% of the pollution in the past weeks was from wildfires sparked by nearly 6 months without substantial rain over central Nepal. Most of the rest is from vehicular and industrial emissions from Kathmandu itself and across the southern border. NASA’s Fire Information and Resource Management System (FIRMS) which issues daily maps of fires, showed hundreds of blazes raging across Nepal on Wednesday, mainly in Chitwan, Parsa and along the East-West Highway.&nbsp; “If we look at the figures for the last few years, it is clear that wildfires have become the biggest source of air pollution, they are seasonal but have overtaken vehicular emissions,” says urban planner and environmentalist Bhushan Tuladhar. “Forest fires, stubble burning, and open burning of garbage are the bigger problems now. Nepal, India, Bangladesh, and Pakistan are at risk every year, we shouldn’t further delay in finding solutions,” warned air quality expert Bhupendra Das during an event on air pollution organised on 7 March by the Nepal Forum of Environmental Journalists (NEFEJ).&nbsp; Indeed, studies have shown that in winter 60% of the air pollution over Kathmandu is transboundary from the south, and in November it is compounded by smoke from crop residue burning by farmers in India and Pakistan blown in by prevailing winds. Forest fires are a regular pre-monsoon occurrence in Nepal, often intentionally set by farmers and herders to stimulate new grass growth for livestock. Winter rains have failed for eight of the past ten years, and this means the fires often spread out of control. The other reason for the increase in wildfires is the doubling of forest fires to 46% of the country’s area in the past 25 years. But this has happened simultaneously with outmigration, with some mountain districts losing 30% of their population between 2011-2021. With less pressure on forests for fodder and firewood, the undergrowth of community forests is loaded with dry fuel just waiting for a spark. The bowl-shaped topography of Kathmandu, Pokhara and other valleys further concentrates pollutants as they are trapped by surrounding mountains. But a year with a high number of wildfires is usually followed by a year or two with fewer incidents. For example: there were 6,537 fires in 2021 but the following year the number was down to 1,528. There were 5,216 fires last year, this year the number has already reached 1,800, and the trend is likely to be broken. Heavy rains forecast for the coming days are expected to douse some of the fires and clean up the air. But the damage has been done: Kathmandu residents of all age groups this week crowded clinics and hospitals with burning eyes, itchy throats, difficulty breathing, headaches, and dizziness. But in the longer term, soot particles that are tiny enough to jump the blood-air divide in lung capillaries do not just cause Chronic Obstructive Pulmonary Disease (COPD), asthma, but also cancers, heart attacks, strokes, birth defects and other chronic diseases. The latest Air Quality Life Index (AQLI) report by the University of Chicago shows that the annual concentration of PM2.5 in Kathmandu’s air rose from 17.87µg/m3 in 1998 to 31.33µg/m3 in 2022. Air pollution has got worse by 75% in Kathmandu in 25 years. During this time, air pollution has reduced the average life expectancy of Kathmandu’s residents by 3.5 years. According to the Health Effects Institute in Boston, dirty air is among the biggest public health concerns in Nepal killing over 42,100 a year. The adverse impact of high levels of air pollution is not limited to public health, it is seriously affecting tourism. Operators in Pokhara this week said that there were many negative online posts by visitors unable to see the famous panorama of Machapuchre and the Annapurnas even from Sarangkot. Aviation is also affected, as planes have to circle sometimes for hours burning a lot of fuel because of runway visibility being below minima at Kathmandu airport. The higher fuel cost is just passed down to customers, making air tickets in and out of Kathmandu some of the highest in the world. Kathmandu, with a population of four million, has not implemented a concrete policy to curb toxic air despite having formulated various action plans and repeated commitments by the government to protect the environment and control air pollution. The Department of Environment’s 2017 Air Quality Management Action Plan for Kathmandu put forward a policy to reduce air pollution caused by vehicles which was approved by the Cabinet, but has yet to be put to practice. The action included the immediate implementation of the Euro 5 emission standard to reduce pollution emitted by vehicles. However, Nepal has not even been able to implement Euro 4 standards so far. India, meanwhile, has already moved forward with the implementation of the Euro 6 standards. Says Ravi Sahu: “Air pollution in Nepal is not just about air pollution, it has ties to tourism, aviation, the economy so we must be prepared for annual conditions like forest fires, and this requires urgent interdisciplinary collaboration.” &nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250411050452_821d09e283d8a590f1369bfb71b9b7fc6d950726e0651ea86c6488d04deb1742.jpg" data-media-id="editor_15" data-image-id="20250411050452_821d09e283d8a590f1369bfb71b9b7fc6d950726e0651ea86c6488d04deb1742" data-rendition-name="original" width="839" height="784" loading="lazy" alt="Silent Killers"> </figure>  &nbsp;

What is invisible is more dangerous

82 in २०८२

Here in the mountains of far-western Nepal, the biggest threat to life and limb is gravity. Women collecting fodder fall from trees, boys grazing goats fall off cliffs, heavily loaded tractors plunge from dirt roads carved out of steep slopes. There is nothing to be done about those who die on the spot. But for the severely wounded there is only one hospital: Bayalpata. And it is there that <a href="https://www.youtube.com/watch?v=CJzWlnYd0ZM&amp;t=8s" target="_blank">orthopaedic surgeon Mandeep Pathak</a> is the last hope for many wounded people. Pathak, 42, is too modest to tell us how many lives he has saved over the past 10 years he has worked at Bayalpata. But hospital records show he has performed more than 4,000 operations in the past decade, many of them so patients did not suffer permanent physical disabilities. Pathak also did 800 major life-saving surgeries in that time. “I treat patients with injuries, but I wish I could also treat poverty,” Pathak says, emerging from Bayalpata’s surgical theatre one recent afternoon. <div class="embed-block"><iframe width="700" height="415" src="https://www.youtube.com/embed/CJzWlnYd0ZM?si=s_rkbU4YDaw87gqH" title="YouTube video player" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share" referrerpolicy="strict-origin-when-cross-origin" allowfullscreen></iframe></div> Sudurpaschim Province in Nepal’s far-west is far away from everything: from Kathmandu, from adequate medical care, from food security, and far from the reach of government services. It has suffered state neglect for centuries, its men mainly migrating to India for seasonal work to families who depend on subsistence agriculture. Pathak remembers the searing sadness he felt when a patient once told him, “Doctor, I sold the last of my rice to pay to come here, please give me a medicine that I can take on an empty stomach.” Pathak was born in Kathmandu, and after getting his MBBS from Kathmandu University, he got an MD from The Philippines. At a time when many Nepali doctors and staff nurses were emigrating, Pathak did not just return to Kathmandu but decided to go to one of the remotest districts in Nepal to serve those most in need. The hospital was established in 2009 in the village of Bayalpata, and has been managed by the non-profit <a href="https://www.nyayahealthnepal.org/" target="_blank">Nyaya Health Nepal (NHN)</a> as a public-private partnership treating 100,000 patients a year for no fees at all. NHN is now preparing to hand over the running of the hospital to the Sudurpaschim provincial government so its <a href="https://nepalitimes.com/banner/this-is-how-to-upgrade-nepals-rural-health" target="_blank">model of hospital management</a> can be replicated.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250414130456_b59dabd4604a24426a55fe91c0e5866b5029858bdb4c4028c331557aeb5408ae.jpg" data-media-id="editor_4" data-image-id="20250414130456_b59dabd4604a24426a55fe91c0e5866b5029858bdb4c4028c331557aeb5408ae" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Bayalpata hospital"> <figcaption>Bayalpata hospital in Achham.</figcaption> </figure>  People from not just Achham but surrounding districts, and from as far away as Humla, bring patients to Bayalpata, sometimes walking for days. Some with complicated pregnancies are brought in stretchers, young children with broken arms walk into the emergency, and sometimes there are mass casualties when a tractor or bus falls off a road. And Pathak is always there with his team performing triage, and doing orthopaedic surgeries that would be difficult even in Kathmandu. Recently, his team did a hip replacement at <a href="https://nepalitimes.com/banner/state-of-the-art-rural-hospital" target="_blank">Bayalpata Hospital</a>. Mild mannered, modest, soft-spoken, hard-working, professional are the words families of patients who have been treated at <a href="https://nepalitimes.com/here-now/nepal-s-rural-lifeline" target="_blank">Bayalpata Hospital </a>use to describe Mandeep Pathak. But the surgeon is too busy to let all this get to this head.&nbsp; Asked why he does not emigrate like his peers or get a lucrative position at a private hospital in Kathmandu, Pathak answers simply, without a trace of self-importance, “I do not think I could get the satisfaction or sense of fulfilment anywhere else.” When travelling to attend medical congresses overseas or visit family in Kathmandu, Bayalpata has other doctors to take care of patients, but many wait patiently till Pathak returns for their consultation or surgery.&nbsp; When he returns from seminars abroad after learning the latest skills, Pathak’s suitcases are not full of clothes or presents, but titanium bone implants, external fixation rods, or intramedullary nails to be used in <a href="https://nepalitimes.com/news/altruistic-healthcare-models-in-nepal" target="_blank">surgeries at Bayalpata</a>.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025041414040_5356278472c1eb2b9e4af1d593d6234cc8dc5e5161a8c614197c01abefadbd80.jpg" data-media-id="editor_8" data-image-id="2025041414040_5356278472c1eb2b9e4af1d593d6234cc8dc5e5161a8c614197c01abefadbd80" data-rendition-name="original" width="2048" height="1368" loading="lazy" alt="surgery"> </figure>  Before Bayalpata Hospital was established, most people suffering broken bones had to travel down to Dhangadi or Nepalganj for treatment. No more. Although Pathak’s specialisation is orthopaedic oncology, he is mostly treating fractures and rejoining broken bones.&nbsp; Now as Bayalpata’s Hospital Director, Pathak also has administrative and fundraising duties. He has to take the 10-hour ride down to Dhangadi often to meet various Sudurpaschim ministries to release the hospital’s budget — that is sometimes more difficult than the most complicated surgery. Recently, he had to cancel an appointment with the Chief Minister to rush back to Bayalpata because there was a patient who needed emergency surgery. “I told myself, let me save this patient first, then I will try to save the hospital,” he recalls.&nbsp; Once, when he had to be away for a month on emergency surgery training in the US, the family of a 90-year-old woman who had dislocated her hip after falling from a staircase was waiting for him to return. Her son told Pathak: “Doctor, either put her out of her suffering, or cure her.” Pathak told him it was too dangerous to operate at her age, but the son said his mother was in so much pain it was worth the risk. The operation was touch-and-go, but it was successful. The woman who had been brought in on a stretcher, walked out of the hospital three days after the operation.&nbsp; A few months later, a 27-year-old woman was brought into the ER bleeding profusely from an arm mangled by a thresher machine. Even in that state, she was breastfeeding her baby. Pathak welled up seeing this display of selfless motherhood, as he wheeled her into surgery. She needed three operations, but now has full use of her hand. <div class="embed-block"><iframe width="700" height="415" src="https://www.youtube.com/embed/xJdxLD0hBqo?si=mOpM2R_DsYL88Lfg" title="YouTube video player" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share" referrerpolicy="strict-origin-when-cross-origin" allowfullscreen></iframe></div> It is the sense of achievement from such recovery that keeps Mandeep Pathak here in this isolated village in the middle of nowhere. Bayalpata Hospital has not just saved lives, it also saves families from poverty because they do not have to take sick relatives to expensive city hospitals.&nbsp; In January, a woman was brought to Bayalpata with both hands broken. She said she had taken a fall, but Pathak did not believe her. When alone in the surgery, she finally admitted that her husband had beaten her.&nbsp; It was her husband who had brought her to hospital for treatment, but she refused to file a police report. Pathak quietly put both her arms in casts, thinking about the poverty, patriarchy and injustice in society that he is unable to treat.

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The healer of far-western Nepal