<img width="1492" height="1000" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110151116/636d07e79c7e80680e0a5fe8jpeg.jpg" alt=""/>Twenty-three million children worldwide missed out on basic vaccines through routine immunisation services in 2020, 3.7 million more than in 2019, due to Covid induced global service disruptions, a <a href="https://www.who.int/data/immunization" target="_blank" rel="noopener noreferrer">latest survey by the WHO and UNICEF</a> has revealed.
Up to 17 million of these children likely did not receive a single vaccine during the year, widening already immense inequities in vaccine access. Most of these children live in communities affected by conflict and in under-served remote places with limited access to health facilities, food and hygiene.
“Even as countries clamour to get their hands on Covid-19 vaccines, we have gone backward on other vaccinations, leaving children at risk from devastating but preventable diseases like measles, polio or meningitis,” says Tedros Adhanom Ghebreyesus, WHO Director-General. 
He adds: “Multiple disease outbreaks would be catastrophic for communities and health systems already battling Covid-19, making it more urgent than ever to invest in childhood vaccination and ensure every child is reached.”
Disruptions in immunisation services were widespread in 2020, with the WHO Southeast Asian and Eastern Mediterranean Regions most affected. As compared with 2019, 3.5 million more children missed their first dose of diphtheria, tetanus and pertussis vaccine (DTP-1) while 3 million more children missed their first measles dose. 
During the first wave in 2020, villages in Nepal’s Dhading and Gorkha districts suffered outbreaks of measles because families were unable to vaccinate their children either because the health post was closed due to the pandemic, parents were concerned about Covid-19 transmission, or the lockdown prevented travel to health posts. 
“This evidence should be a clear warning. The Covid-19 pandemic and related disruptions cost us valuable ground we cannot afford to lose and the consequences will be paid in the lives and wellbeing of the most vulnerable,” says UNICEF Executive Director Henrietta Fore. 
She adds: “The pandemic has made a bad situation worse. With the equitable distribution of Covid-19 vaccines at the forefront of everyone’s minds, we must remember that vaccine distribution has always been inequitable, but it does not have to be.”
Even prior to the pandemic, global childhood vaccination rates against diphtheria, tetanus, pertussis, measles and polio had stalled for several years at around 86%. 
This rate is well below the 95% recommended by WHO to protect against measles, often the first disease to resurge when children are not reached with vaccines, and insufficient to stop other vaccine-preventable diseases. Just two years ago, there were widespread measles outbreaks.
“This is a wake-up call, we cannot allow a legacy of Covid-19 to be the resurgence of measles, polio and other killers,” says Seth Berkley, CEO of Gavi, the Vaccine Alliance. “We all need to work together to help countries both defeat Covid-19, by ensuring global, equitable access to vaccines, and get routine immunisation programs back on track.” 
School closures due to the pandemic have also affected vaccinations against human papillomavirus (HPV), which protect girls against cervical cancer later in life. Globally only 13% of girls were vaccinated against HPV, falling from 15% in 2019, which means 1.6 million missed out on the shot in 2020.
Nepal government had introduced the HPV vaccine for all girls aged between 11-13 years as part of the regular immunisation program in 2019.
The WHO, UNICEF and Gavi are working together to restore services and vaccination campaigns by ensuring that Covid-19 vaccine delivery is independently planned for and financed and that it occurs alongside, and not at the cost of childhood vaccination services while also strengthening immunisation systems as part of pandemic recovery efforts.
The Global Immunisation Agenda 2030 aims to achieve 90% coverage for essential childhood vaccines, halve the number of entirely unvaccinated children, and increase the uptake of newer lifesaving vaccines such as rotavirus or pneumococcus in low and middle-income countries.

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Pandemic hits non-Covid vaccines for children

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109141136/636badaf9c7e80680e077fabjpeg.jpg" alt="" width="1400" height="933"/><figcaption>Photo: GOPEN RAI</figcaption></figure>On Friday, it will be four months since Nepal closed the country down to prevent the spread of  SARS-CoV-2, the virus strain that causes COVID-19. Of the 40 who have died of the infection in Nepal, two are children below 5.But many more children have died during the four months of lockdown compared to the same period last year because of lack of access to health care due to the restriction on mobility, interrupted vaccination campaigns and the lack of medicines.However, the coronavirus grabs all the headlines. Mortality due to non-COVID-19 causes does not make the news – even though it is clear that a lockdown enforced to control one disease has caused far more deaths from other prevalent diseases, and threatens to undermine Nepal’s progress in infant and child survival over the past four decades.“The COVID-19 crisis and lockdown have pushed many families into poverty, many have lost their sources of income, l<a href="https://www.nepalitimes.com/latest/eu-unicef-support-child-nutrition-during-lockdown/" target="_blank" rel="noopener noreferrer">eading to malnourishment among children</a>,” says Jhalak Gautam of the Child Health Division at the Health Ministry. “Increased malnutrition means children are more susceptible not only to COVID-19 but to many other infectious diseases such as measles and diphtheria.”Under-5 child mortality rate in Nepal had declined substantially from 271 deaths per 1,000 live births in 1969 to 32 in 2018. Government figures show that since 17 July 2018-16 July 2019, a total of 1,357 children under 5 died of various infectious diseases all over the country. Preliminary figures for the same period 2019-2020 is 1,263 – even though only 78% of the data has been collected.Initial government figures also show that a total of 204 children under 5 have died across the country during the lockdown between 14 March-14 June. This number was at a much lower 151 during the same period last year.This data clearly show that the total child death numbers collected by Female Health Care Volunteers is higher this year — meaning they died at home. The number of those who have died at hospital in the same three months this year is lower than last year probably because parents are not taking children to hospital when they are sick during the lockdown.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109141140/636badb39c7e80680e077facjpeg.jpg" alt="" width="1714" height="1210"><figcaption> </figcaption></figure>An expert at the Health Information Management System says when all the data for this year comes in, it is bound to be much higher than last year. This means the lockdown has pushed Nepal back in meeting its health targets under the United Nations’ SDGs (Sustainable Development Goals).Under the SDG target, Nepal is supposed to bring child mortality down further to 25 deaths per 1,000 live births by 2030. Persistent childhood malnutrition is a major reason for infant and child mortality remaining high despite dramatic progress in the 1990s. <a href="https://www.nepalitimes.com/banner/nearly-half-of-nepali-children-still-malnourished/" target="_blank" rel="noopener noreferrer">Figures for stunting, wasting and anaemia in Nepal have plateaued in the last decade</a>  Now, the lockdown has added to the challenge.Says Elke Wisch, UNICEF Representative to Nepal: “Progress made on children’s nutrition in the last decade is at risk of being reversed as rising numbers of children are facing malnutrition due to loss of household income and resulting food insecurity. The social and economic loss for Nepal resulting from the deterioration in children’s nutrition status will be felt long after the COVID 19 crisis is over.”The lockdown has also disrupted <a href="https://www.nepalitimes.com/banner/a-shot-in-the-arm-for-vaccines-in-nepal/" target="_blank" rel="noopener noreferrer">vaccination campaigns</a> across the country, leading to <a href="https://www.nepalitimes.com/here-now/meanwhile-a-measles-outbreak-in-nepal/" target="_blank" rel="noopener noreferrer">measles outbreaks in Dhading and Gorkha</a> in April. Although regular immunisation services have now been restored in health facilities in all 77 districts, parents have been unable to take their children for shots because of restrictions on transportation and also because of the fear of COVID-19 transmission in health posts.In fact, the WHO and UNICEF earlier this week stated that preliminary data for the first four months of 2020 points to a <a href="https://www.who.int/news-room/detail/15-07-2020-who-and-unicef-warn-of-a-decline-in-vaccinations-during-covid-19" target="_blank" rel="noopener noreferrer">substantial drop in the number of children completing three doses of the vaccine</a> against diphtheria, tetanus and pertussis (DTP3), first time in 28 years. Moreover, at least 30 measles vaccination campaigns were or are at risk of being cancelled, which could result in further outbreaks in 2020 and beyond.“Vaccines are one of the most powerful tools in the history of public health, and more children are now being immunised than ever before,” said Tedros Adhanom Ghebreyesus, WHO Director-General. “But the pandemic has put those gains at risk. The avoidable suffering and death caused by children missing out on routine immunizations could be far greater than COVID-19 itself.”With schools closed for the past four months, children in many schools are also not getting their lunches. Domestic violence has also seen a spike during the lockdown, with many of the victims children. There is also evidence of a <a href="https://www.nepalitimes.com/latest/child-marriages-up-during-nepal-lockdown/" target="_blank" rel="noopener noreferrer">rise in child marriage</a>  anxiety, stress and <a href="https://www.nepalitimes.com/here-now/post-pandemic-mental-health-epidemic/" target="_blank" rel="noopener noreferrer">mental disorder</a>Nepal appears to be on track to proving correct the grim prediction in May by the Johns Hopkins Bloomberg School of Public Health that 1.2 million children worldwide could die from pre-existing diseases like malaria, pneumonia or diarrhoea in the next six months due to the disruption to health services and food supplies due to the lockdown. That makes <a href="https://www.nepalitimes.com/latest/pre-existing-diseases-may-kill-more-children/" target="_blank" rel="noopener noreferrer">6,000 fatalities a day</a> – a whopping 45% rise in child mortality.“Under a worst-case scenario, the global number of children dying before their fifth birthdays could increase for the first time in decades,” UNICEF Executive Director Henrietta Fore warned. “We must not let mothers and children become collateral damage in the fight against the virus. And we must not let decades of progress on reducing preventable child and maternal deaths be lost.”<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109141140/636badb69c7e80680e077fadjpeg.jpg" alt="" width="3600" height="2400"><figcaption> </figcaption></figure>Another aspect of the pandemic that Nepal has to be careful about is that while worldwide data show that children are relatively safe from contracting SARC CoV-2 which has mainly affected people above 70 years, in Nepal children also seem vulnerable.Health Ministry data show that the rate of infection among children below 5 is 2.2% and increasing – much higher than the global average. The infection rate among young children was at just 1% a month and a half ago.Many of the infected children belong to families who returned from India in the past three months, but children have also been infected by people who flouted lockdown rules and safety measures. This is why Far-west Province has the highest coronavirus infection rate among children at 5%.Nepal has also seen a <a href="https://www.nepalitimes.com/latest/why-are-younger-people-in-poor-countries-dying-of-covid-19/" target="_blank" rel="noopener noreferrer">disproportionate number of COVID-19 infections and mortality among a younger population</a>  Experts say this is mainly due to young returnee migrant workers from India, Malaysia and the Gulf, who make for the majority of the coronavirus cases in the country. Moreover, testing across the country so far has focused on returnees.“Unlike elsewhere, in Nepal people with co-morbidity have a higher risk of dying regardless of the age group, and this is worrying,” says epidemiologist Sher Bahadur Pun of the Health Ministry. “But we must widen our testing to come to a concrete conclusion about this. So, <a href="https://www.nepalitimes.com/opinion/prevention-while-searching-for-a-cure/" target="_blank" rel="noopener noreferrer">until we have a vaccine</a> we must wear masks, maintain physical distance and follow hand hygiene. This includes children.”

Sonia Awale

Children are collateral damage in Nepal lockdown

It was pure drama: the political transition in Madhes unfolded by the dawn’s early light. At around 4AM on Monday, Province Head Sumitra Subedi Bhandari quietly departed Janakpur saying she was headed to Kathmandu for health reasons.&nbsp;
Outgoing Chief Minister Jitendra Sonal, whose coalition had begun to unravel, even saw her off, asking supporters to clear the road for her motorcade.
But an hour later, instead of continuing on to the capital, Bhandari stopped in Bardibas on the East-West Highway. There, as the sun started rising over the misty plains, she administered the oath of office to Saroj Kumar Yadav of the CPN-UML, invoking Article 168(3) of the Constitution.&nbsp;
Bhandari is also a member of the CPN-UML. The provision she invoked is typically used only after coalitions fail under Article 168(2), and the timing and location of the swearing-in have since drawn scrutiny.
Bhandari was subsequently relieved of her duties, and former National Planning Commission member Surendra Labh Karna was sworn in as the new Madhes province head on Tuesday.
Sonal had formed his government barely a month ago, with the backing of 56 provincial lawmakers but it became evident he would not secure the 54 votes needed to survive a confidence motion.&nbsp;
Several lawmakers in his coalition publicly signalled they would abstain. Still, the seven-party alliance that opposed Yadav’s appointment argues that the Province Head, who is the highest constitutional rank in the provincial structure, acted prematurely and under pressure from central UML party command.&nbsp;
A coalition of seven parties, including the Nepali Congress (NC), had been urging the Province Head to invite them to form a new government under Article 168(2). At the same time, the UML, which had been holding demonstrations outside the Province Head’s office in Janakpur, was calling for the formation of a minority government under Article 168(3).
The alliance of the seven parties that included the NC and Maoist Centre took to the streets. By mid-morning, protests had escalated outside Madhes Bhawan with cadre vandalising both the Chief Minister’s office and the Province Head’s office.
This was the third government in Madhes to fall since the 2022 provincial elections, and it follows a similar pattern. The previous Chief Minister Satish Kumar Singh of the Janamat Party, resigned before a scheduled confidence vote after losing the support of his own party and others including NC and LSP.&nbsp;
His resignation unfolded amid nationwide GenZ protests against corruption, demanding accountability and reform. The recurring instability points to a structural tension in Nepal’s federalism.&nbsp;
Provincial politics remain closely tied to alliances shaped in Kathmandu. The withdrawal of support by parties like the NC and Maoist Centre in provinces often reflects national-level calculations rather than provincial priorities.
As a result, the Provincial Assembly is repeatedly consumed by survival of the coalition instead of governance. Development work stalls. Budget execution slows. Public frustration grows. In a province that was at the forefront of the movement for federalism to counter what is seen as neglect, apathy and discrimination by Kathmandu, the sense that the system may not delivering on its promise is becoming increasingly pronounced.
If federalism is to be strengthened, provincial governments must be able to function with a degree of autonomy that currently exists more in principle than in practice. Otherwise, the perception that federalism is costly, unstable, and ineffective will continue to expand, providing fertile ground for anti-federal sentiment that is already gaining traction.
Earlier examples such as the NC General Secretary Bishwo Prakash Sharma in January calling for a new government in Madhes led by his party demonstrates how the central party leadership deliberately intervenes in provincial affairs. His remarks came during campaigns for bi-elections in Madhes when former CM Singh had been in office for six months only.&nbsp;
Likewise, in early June 2024, the federal coalition in Kathmandu shifted from a Maoist Centre and NC to form a new alliance between the NC &nbsp;and the UML. Within a day, coalition negotiations in Madhes changed to mirror this.
UML leaders publicly stated: “The issues at the federal and provincial levels will be resolved together.” This indicated that the realignment in Madhes followed national party decisions rather than provincial deliberation.
The events that unfolded in Madhes are a reminder that federalism in Nepal is still in transition, and that its success depends on political actors honouring the constitutional framework.

Chronic instability in the Madhes

This is the 73rd episode of Diaspora Diaries, a Nepali Times series in collaboration with Migration Lab providing a platform to share experiences of living, working and studying abroad. I don’t remember playing with dolls as a little girl. There is not much to remember from my childhood.&nbsp; My responsibilities began at a very young age, as I had two younger brothers to take care of. I was born in Sarlahi, but we moved around quite a bit as my father was in the government and got transferred frequently.&nbsp; From Rasuwa to Dang, from Nepalgunj to Kathmandu. I struggled to adjust in Kathmandu because I joined Grade 9 in the middle of the term. The education was different and fellow students also did not support me initially. But over time, I adjusted and made friends. I did not dream of becoming a nurse. It was by accident. I wanted to pursue medicine, but failed the entrance exam by a few marks. I did not want to lose a year, so decided to take up microbiology instead.&nbsp; I got married after my undergraduate, and my husband encouraged me to take up something more technical like nursing or engineering instead of Masters in Microbiology. As my quantitative background was weak, I chose nursing. I felt like I was born to be a nurse. Juggling my married life and studies was difficult. My teachers would often ask me why I am falling behind. It was not easy, but I managed and took up a full-time job as a nurse. There are challenges being a nurse in Nepal. You are overworked, underpaid, there is lack of appreciation. Superiors can be overbearing. These problems persist. But the bright spot is that you get to serve fellow Nepalis, and be close to your family.&nbsp; Just like I had no intention initially of becoming a nurse, I had no intention of migrating overseas. But life had different plans for me. After my baby boy was born, I noticed that something was off. Even at nine months he had not started crawling or sitting. As a nurse I knew something was wrong, and I took him for check-ups. He tested negative for down syndrome, but he had a heart defect.&nbsp; The cardiologist recommended that I take him to India where he was diagnosed with Williams Syndrome, a rare genetic condition that affects 1 in 10,000 people. It delayed his development. I looked for therapy. It was either not effective, or too expensive. Some schools also refused to admit him, and it drove me to tears.&nbsp; My family members overseas in the UK, US told me to emigrate as there were better facilities for differently abled children. So I decided to apply to the UK. Luckily just then there were calls for candidates under the Nepal-UK government-to-government pilot scheme for 100 nurses. Only 40 met the criteria, and I was one of them.&nbsp; I still remember the day I received the news on the day of my puja. There were people around me, and they told me that it was the result of my fasting and devotion on that auspicious day. Perhaps it was. Life was taking a new turn, and I was happy. I made it to the UK in February 2024 without paying a single paisa to any broker. The G2G scheme was unique as we were treated with dignity and valued for our skills: they covered costs for the ticket and visa, reimbursed us for exams we had taken and costs involved in the preparation and testing of the Objective Structured Clinical Examination were also covered.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251106071148_dc5a0d0ea3024b34a4f2735754f8eb67a650bc7f61b98c75d589676c65b02a0c.jpg" data-media-id="editor_0" data-image-id="20251106071148_dc5a0d0ea3024b34a4f2735754f8eb67a650bc7f61b98c75d589676c65b02a0c" data-rendition-name="original" width="1200" height="1600" loading="lazy" alt="Nurses NT"> </figure>  It was of course difficult to leave my son behind. But I was doing it for his future. I had the option of taking him from the start, but it was a new place and I wanted to be well-settled and knowledgeable about the options available for him before bringing him along. As I packed, he would ask me to take him with me in my suitcase. It did not seem like he was affected by my departure, and it was only later that his teachers said that he would express his feelings more openly at school. He just did not know how to tell me he missed me, and he would tell teachers he was worried I had forgotten him if we did not speak for a day.&nbsp; He missed me, and that realisation made me emotional. But I had to carry on. Life in the UK was difficult in the beginning. Even so, I wanted to prove to myself that I could do it. Fortunately I had cooperative staff who patiently answered my questions. I think I would have been irritated if I were in their place. But they did not seem to mind, and their support and guidance made it easy for me to adjust to the new work environment. APPRECIATION I still struggle to understand the accent of my English patients, and have ask the matron for help. They compliment me on my English, but I can speak better than I understand. The good thing about working in the UK is that you are appreciated for your work, which can be motivating. Sometimes, after a long day’s work you get a message from your supervisor acknowledging your work with a thank you. That’s enough to erase your tiredness.&nbsp; So far I have received 32 WOW nominations which are acknowledgements from patients for a job well done. It can be motivating, especially in the beginning. The main difference between the Alpana who first left Kathmandu for the UK and the Alpana now is that I am a much more confident person. What makes a good nurse? Skills, knowledge and qualifications are of course a given. But mostly, you need humanity. A smiling face. The way you communicate. Your empathy. These attributes can already solve many problems that patients are facing. This is my second time back home in the last 20 months. And this time, I have arranged for my son’s visa. I will go back after Tihar with my son and husband.&nbsp; I am happy, but also a little nervous about what awaits us. What kind of school will I put him in? Will it really be different from schools here? Will his needs be addressed? Will it be like here, or will he be able to adjust?&nbsp; But I am determined to make it work. Success for me would be if he adjusted well and there is a change in his condition. He still cannot recognise alphabets and read words like kids in his age group. Hopefully he will get learning support in the UK. He also has a knack for music, and this is common among individuals with Williams Syndrome. His ears perk up when he hears music, and he takes part in musical events at school. He still does not recognise letters &nbsp;but he uses voice commands to search for guitar videos on YouTube. I will enrol him in music classes, and help him develop this gift. For now, I worry how he will behave on his long flight. He has a short attention span and gets restless. He is also very social and will want to speak with everyone around him, and might irritate fellow passengers.&nbsp; I have already started trying to make him understand that he will need to behave on the flight. He nods in agreement. Let’s see how it goes. &nbsp;

“I felt like I was born to be a nurse”

A month after September’s GenZ movement in Nepal, nurses working in private hospitals took to the streets demanding better work conditions, and salaries equal to what government nurses are paid.&nbsp;
The strike started at Pokhara’s Manipal Teaching Hospital before spreading nationwide, and nurses working at government hospitals joined in.&nbsp;
Nurses at private hospitals are forced to work for far less than Nepal’s minimum monthly wage of Rs19,550 — without overtime, breaks, and other benefits and under physically and mentally taxing conditions. This is driving many qualified nurses to emigrate.
For newly-appointed Health Minister Sudha Sharma Gautam in the interim government, the strike became her first order of business. She met representatives of the Nursing Association of Nepal (NAN), the protesting nurses, and others from the health sector.&nbsp;
An agreement was reached under which private hospitals and medical colleges will pay nurses a minimum monthly salary of Rs34,730. &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
“It is a shame that nurses have been working under such exploitative conditions all this time” says Radha Adhikari, at the School of Health and Life Sciences of the University of the West of Scotland. “The agreement is basic, and there is a long way to go to improve their working conditions. But it is a start.”
NAN chair Chandrakala Sharma has said the ministry’s task force to look into working conditions will also look into facilities for nurses in government hospitals.&nbsp;
“We are committed to solidifying the wage agreement by amending relevant laws within this month,” Sharma said in a video posted by NAN on Facebook. “Our movement is not over, we are still protesting and &nbsp;following up with the Ministry.”
NAN issued an ultimatum to the government to implement the agreements within 48 hours. That deadline has now lapsed and the nurses are back on strike. Many of those protesting now accuse NAN of betraying them.
Jyoti Ranabhat of the Nurses Struggle Committee was present in the meeting, but refused to sign the agreement. “It did not address what we were demanding, we will now go it alone into Plan B,” she tells Nepali Times.&nbsp;
Previous grievances of the nurses did result in similar agreements, but private hospitals failed to comply with government’s past directives — most recently the minimum salary and benefit determined by the state in December 2024.&nbsp;
The Nepal Nursing Council says there are 126,580 registered nurses, specialists, midwives, and Auxiliary Nurse Midwife (ANM) professionals in Nepal. Yet, nursing positions at hospitals remain vacant.&nbsp;
The reason for understaffing is a mass emigration of medical professionals, including nurses. Nursing student enrollment is also declining and there is disinterest in a profession that does not afford health workers quality of life, respect, or dignity.
“Our fight is not with the private sector, it is by definition profit-oriented, our grievance is with the state,” says Ranabhat. “The government is responsible to provide us dignity, respect, and fair pay.”&nbsp;
GREENER PASTURES
Poor pay and working conditions are driving doctors and nurses abroad in large numbers in recent years. Many have simply quit the profession, leading to a shortfall in medical professionals. 

The shortage of nurses is a global phenomenon, and countries like the US, UK and Australia have compensated for their own shortage by offering jobs from countries like the Philippines, India and Nepal.&nbsp;
Nepal Nursing Council data shows that outmigration of nurses rose sharply after 2002, and an estimated &nbsp;20,000-45,000 nurses have left since.
“The state’s denial, derision, and disregard of nurses has caused resentment and disillusionment in the community, driving nurses out,” says Ranabhat. “Ultimately, Nepalis will pay the price when there are no nurses left here.”
Many Nepali nurses who have gone abroad are happy with the respect and quality of life in their jobs abroad. But many others face exploitative recruiters in Nepal and employers abroad. Nursing consultancies have mushroomed as nursing colleges struggle to meet demand.&nbsp;
Adhikari herself worked at United Mission Hospital Tansen before moving to the UK 30 years ago, and remembers that working conditions then were much better for nurses.&nbsp;
“Nepal’s health sector has gone downhill since privatisation,” she states. “Medical colleges are only concerned with supplying doctors and nurses internationally, because that is what makes money.”
But once Nepal’s nurses are abroad, there is no guarantee that they will have jobs in the nursing sector. Many find themselves working outside their field of expertise, in hospitality or sales.&nbsp;
“Nepal has become a production hub for nurses, and Nepali nurses have become products for export,” adds Ranabhat. &nbsp;“People might think this will add to remittances, but no one is thinking about what will happen to Nepal’s health sector.”&nbsp;
For many, nursing has become a way out of Nepal rather than a vocation. In 2022, the government signed an agreement with the UK to send Nepali nurses to work there at zero cost, with benefits and protection equal to UK nurses.&nbsp;
The pilot phase was expected to recruit 100 nurses, and applications opened in July 2023, with 45 nurses said to be selected by Britain’s NHF representatives by the end of 2023. Forty-one of them obtained labour permits.&nbsp;
They may be treated well, but the reality of working in the international health sector is not as straightforward.
Radha Adhikari told us from Scotland: “Market saturation, exploitation, discrimination based on race, gender, and foreignness prevent nurses from finding the right, respectful jobs even here. Ultimately, migration cannot be sustainable for Nepal’s nurses.”

Nepal haemorrhaging nurses

Prime Minister Juddha Shamsher Rana built the NJJR probably to transport logs cut on his forested birta land north of Janakpur to sell in India. The 2’6” narrow-gauge railway extended north from Jaynagar, India 29km to Janakpur and another 22km to Bhutaha/Bijalpura, cost 680,000 Indian rupees to build, and opened for business December 1937. The Nepali engineer in charge of construction was Capt Tilak Bahadur Rayamajhi, who in 1908 was one of the first Nepalis to receive a civil engineering degree in India.&nbsp; After 1950, the line from Janakpur to Bhutaha had little commercial value and was out of service. Until the late 1970s, there were no proper motorable roads connecting Dhanusha and Mahottari Districts with India. The NJJR was the only transportation alternative for people who had to otherwise go on foot, bicycle or ox carts to India.&nbsp; The NJJR also played an important role in religious tourism, as hundreds of thousands Indian pilgrims visited Janakpur annually to participate in the Bibaha Panchami, Rama Navami, and Janaki Navami. For the Bihari peasant bound for Janaki Mandir in 1955, sitting on the roof of a slow-moving train was a luxury compared to trudging 29km on foot from the Indian border. The first manager of the NJJR in Janakpur was Lt Hem Bahadur Gadtaula-Chhetri. The general manager from 1942-58 was Rekha Bahadur Rayamajhi of Bhojpur, posted at the railway’s main office at Jaynagar.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251106071140_971118917423dec021d89591fe5fef4f7218698595773f6006b4d50c5c57cf94.jpg" data-media-id="editor_0" data-image-id="20251106071140_971118917423dec021d89591fe5fef4f7218698595773f6006b4d50c5c57cf94" data-rendition-name="original" width="1014" height="680" loading="lazy" alt="NJJR Dan Edwards NT"> <figcaption>A steam train excursion for foreigners in 1999. The last steam excursion on the Janakpur Railway ran in 2006. Photo: GORDON EDGAR</figcaption> </figure>  Rama and Seeta, the railway’s first two appropriately named locomotives, were built in Berlin in 1936. In view of the rising power of Adolf Hitler’s Germany at that time, was Prime Minister Juddha trying to cultivate the Third Reich in hopes of reducing Nepal’s virtually total dependence on British India?&nbsp; In 1939 Adolf Hitler gifted a Mercedes-Benz 230 Pullman Landaulet to Juddha as a way to convince him not to let the British use their Gurkha regiments against Germany in World War II. The car had to be disassembled and carried over the mountains to Kathmandu and reassembled.&nbsp; The Nepali Congress-led campaign against Rana rule received considerable support in Janakpur and the eastern Tarai. In December 1951, King Tribhuvan rode the NJJR from Jaynagar to Janakpur, and thousands thronged to catch sight of a king of whom they had heard but never seen. As operations on the Nepali Government Railway came to an end, its European-made engines were transferred to the NJJR. King Mahendra ordered two more locomotives named Chandra and Surya for the NJJR in 1962. They were built in Leeds and traveled from Liverpool to Calcutta to Jaynagar to begin their service.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251106071140_55e4b768ef0ae7682dec8092169bbedc070656d46d9d0a80039fd960a23ae335.jpg" data-media-id="editor_1" data-image-id="20251106071140_55e4b768ef0ae7682dec8092169bbedc070656d46d9d0a80039fd960a23ae335" data-rendition-name="original" width="2144" height="1399" loading="lazy" alt="NJJR Dan Edwards NT"> <figcaption>Inside the Nepal Janakpur Jayanagar Railway workshop at Khajuri. By the early 2000s, management was unable to control rising payroll and administrative costs nor secure adequate funds for the railway. Photo: GEOFF WARREN</figcaption> </figure>  The NJJR was renamed Janakpur Railway (JR) in 1965 and became the Nepal Railway Company in 2004. Unlike most government-owned enterprises in Nepal of that era, the JR and Nepal Government Railway operated at a profit for many years. In 1947, its total income was 225,000 Indian rupees, with a profit exceeding 100,000 rupees.&nbsp; In FY1974/75, the railway had revenues of 2.6 million rupees and a profit of 443,000 rupees. It is unclear if depreciation expenses were accounted for. Only from the mid-1980s did the railway begin to lose money. The NJJR did a booming passenger business. Ridership increased from 197,000 in 1960/61 to 1.4 million in 1977/78. Revenue increased from 770,000 rupees in 1966/67 to 2.6 million rupees in 1974/75. Yet warning signs appeared in the 1970s that the railway was living on borrowed time.&nbsp; &nbsp;A foreign consultant conducted a comprehensive study of the railway in 1975 and concluded that ‘the entire railway is very old and worn out, and unless a total rehabilitation’ of the railway was undertaken, it would ‘be forced to close in a very short time’.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251106071140_240ed714ee4cb369005439a3fb982d6142fd028e7cf6b0c0338519a8abc6afd4.jpg" data-media-id="editor_2" data-image-id="20251106071140_240ed714ee4cb369005439a3fb982d6142fd028e7cf6b0c0338519a8abc6afd4" data-rendition-name="original" width="1387" height="784" loading="lazy" alt="NJJR Dan Edwards NT"> <figcaption>A second class ticket issued in 2004 costing Rs7.25 between Janakpurdham to Jaynagar. Photo: FUZZ JORDAN</figcaption> </figure>  CHUGGING ALONG An investment of two million rupees resulted in some improvements between 1976 and 1979 but rolling stock and most infrastructure were neglected for another 15 years. Yet somehow the JR’s trains kept chugging along for the next 42 years, often late, with service frequently suspended due to floods.&nbsp; Nearly every year, monsoon rains swept away some of the 135 bridges and tracks and embankments. An RSS News Agency bulletin in August 1975 noted that parts of Janakpur were ‘under 2.5 feet of water’, and the railway tracks near Khajuri were covered by four feet of water.&nbsp; The Jaynagar line was damaged in many places by the swollen Jaladi, Kamala and Jamuni Rivers. Trains to Bijalpura were suspended. For each week railway service was suspended a loss of 75,000 rupees resulted.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251108131132_4a189fa9999b50037f1774b183e62e2caad6177f594ba57a28d93bd674644163.jpg" data-media-id="editor_3" data-image-id="20251108131132_4a189fa9999b50037f1774b183e62e2caad6177f594ba57a28d93bd674644163" data-rendition-name="original" width="1202" height="770" loading="lazy" alt="NJJR MAP"> </figure>  There were also accidents. Trains made only two or three roundtrips daily between Jaynagar and Janakpur and ran at slow speeds, so there were few passenger fatalities, but there were frequent derailments due to the worn rails and overloaded carriages. A RSS report in 1976 said a train derailed near Mahinathpur, and some passengers riding on the roof fell off and were injured. ‘Such accidents occur because the coaches are not regularly maintained and repaired. The speed of the train has been reduced from 12 to 8 miles per hour, since the old and rickety coaches rattle and sway from side to side if driven too fast. The trains take an incredible 4 to 5 hours to cover 28 kilometres,’ the report noted. Gangs of dacoits occasionally boarded trains and robbed passengers. Another RSS report in December 1972 said ‘Six dacoits armed with guns and revolvers looted 13 railway passengers travelling from Janakpurdham to Jaynagar [last] Sunday. The [loot] included wrist watches, gold rings, currency notes and other paraphernalia of the passengers…The dacoits raided third-class bogie number 2 soon after the train started from Khajuri station. The dacoits after plundering the passengers jumped down from the running train about two miles from the Nepal-India border [and fled into India.]’  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251106071140_de60de1d7fdd0a9d29f19440ed68d773f754c10ef01a8c7e3385097eab6a8419.jpg" data-media-id="editor_4" data-image-id="20251106071140_de60de1d7fdd0a9d29f19440ed68d773f754c10ef01a8c7e3385097eab6a8419" data-rendition-name="original" width="1498" height="1000" loading="lazy" alt="NJJR Dan Edwards NT"> <figcaption>Narrow-gauge tracks in Jayanagar in India going north toward Nepal. Photo: FUZZ JORDAN</figcaption> </figure>  Strikes and political protests also stopped the train from time to time. From the early 2000s Maoist and Tarai-based groups enforced stoppages with threats and intimidation that closed schools, shops, government offices, and brought transport services to a halt. Six minor political parties organised a strike in Janakpur in May 2001. Agitators stopped a train near Janakpur and pelted it with stones, breaking windows and injuring the driver. The railway came to a standstill in May 2004 after Maoists set fire to the Mahinathpur station. During February-March 2006, the Maoists obstructed rail service six times. A cylinder bomb exploded inside a train near Parbaha station in May 2009 injuring 30 passengers. Between 1993-2003, the railway had nine general managers who had influence with Kathmandu’s political and bureaucratic elites, but none of whom knew much about railways. Management was unable to control rising payroll and administrative costs nor secure adequate funds for the railway.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251106071140_df754214acd19eaab3b56ceaa0d96f0b66f9f0f8fd29fb4a533d860f627f483f.jpg" data-media-id="editor_5" data-image-id="20251106071140_df754214acd19eaab3b56ceaa0d96f0b66f9f0f8fd29fb4a533d860f627f483f" data-rendition-name="original" width="1700" height="1140" loading="lazy" alt="NJJR Dan Edwards NT"> <figcaption>Coal was unavailable, so Seetaa-Ram, the railway’s first two locomotives, burnt wood for fuel. Photo: BASIL ROBERTS</figcaption> </figure>  Revenue ‘leakage’ was significant, as perhaps twenty percent of the passengers rode without tickets. Railway staff was bloated, in 1996 there were 340 on the payroll, many of them with political connections who needed jobs. Safety measures for railway operations were non-existent.&nbsp; There were no performance reviews, no criteria for promotion, and no training opportunities for workers to improve their skills. But the locals continued to ride their beloved railway. For 56 years, the Janakpur Railway received no foreign assistance, not even one rupee of foreign aid. That changed in 1994 when the Indian government provided two used diesel locomotives and 12 used coaches. Two years later, India supplied two more engines and 12 more coaches and promised some upgrades.&nbsp; This gave the railway a new lease on life, but the road network in the eastern Tarai had expanded,making the railway redundant. It also did not connect with the East-West Highway, the major transportation artery across the Tarai, nor could it seamlessly interconnect with India’s broad-gauge rail network at Jaynagar.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251106071140_7a52a3c5a3fe4e6320135d90632dcfcee6085a32637a3f71e1e644c5e8d3b19f.jpg" data-media-id="editor_6" data-image-id="20251106071140_7a52a3c5a3fe4e6320135d90632dcfcee6085a32637a3f71e1e644c5e8d3b19f" data-rendition-name="original" width="3239" height="1429" loading="lazy" alt="NJJR Dan Edwards NT"> <figcaption>Pashupati, Nepal's first locomotive, in retirement at Khajuri in 1996. Photo: FUZZ JORDAN</figcaption> </figure>  The railway carried no goods, all cargo traffic migrated to trucks. During the 1980s and 1990s, British and European train spotters traveled to India to ride its few remaining steam locomotives, including those of the Darjeeling Himalayan Railway. Some took a side trip to Jaynagar where they, without Nepal visas, were thrilled to ride a train to Janakpur without encountering a border check post or immigration officials. Other visa-complying tour groups arranged steam trains for 60,000 rupees or more.&nbsp; The last steam excursion ran in 2006, and after that, foreign interest in the railway evaporated. Cascading financial losses and government indifference coupled with irregular, unreliable service finished on the Janakpur Railway.&nbsp; Seventy-six years of remarkable narrow-gauge railroading in Nepal ended not with a bang but a whimper on January 20, 2014. Sic transit gloria. Dan Edwards was a Peace Corps volunteer in 1966 and is the author of several books on Nepal. This is the third instalment in a new limited series in Nepali Times on the historic transportation infrastructures of Nepal.

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