Orthopedic surgeon Anil Shrestha’s journey to medicine was laid down well before he was born. His father, noted industrialist Juddha Bahadur Shrestha, had aspired to become a doctor but was turned away from a medical school in India.&nbsp; "It became his mission that one of us, his sons, nephews, or nieces, would don that white coat," recalls Shrestha. That dream fell upon him, the youngest son, and he enrolled at Calcutta Medical College.&nbsp; Freshly graduated he returned to Nepal, where he hoped for a comfortable post at a hospital in Kathmandu. Instead, he was assigned to Jumla, a district which was even remoter and underserved than it is now. But that journey 40 years ago would prove transformative.&nbsp; "It was an eye-opener. I had no idea what rural Nepal was really like. When I reached Jumla, I asked myself why do we become doctors? It is because we have to make a difference," he recalls.&nbsp; The moment that would forever shape his approach to medicine happened at a government-run medical camp. An injured man had travelled from a remote village all the way to Kathmandu for surgery, selling his land to pay for it. He needed to remove his implants but faced a grim reality of having to sell more of his land to afford the procedure.&nbsp; "I thought to myself that we treat the x-rays, but we don’t treat the patients," &nbsp;Shrestha told us in an interview. &nbsp;"What good is a perfectly functioning hand if this man could no longer have a land to plough?" The encounter made the physician realise that healthcare in Nepal should look beyond symptoms and &nbsp;diagnoses, and consider the socio-economic realities of patients. He made it his mission to provide care that didn’t just fix bodies but addressed the underlying factors affecting people’s lives.&nbsp; He co-founded the <a href="https://noh.com.np">Nepal Orthopaedic Hospital</a> in 1998 to provide high-quality surgery at affordable prices. But when he arrived at the site near Gokarna, it was anything but promising.&nbsp; Read also:<a href="https://nepalitimes.com/here-now/nepali-surgeon-with-a-vision-for-the-world"> Nepali surgeon with a vision for the world</a>, Kunda Dixit  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2024101613108_1a9d74aa1c1b550ff9db42dd8092f214de353ffbb2eb48549db110201424cafd.jpg" data-media-id="editor_2" data-image-id="2024101613108_1a9d74aa1c1b550ff9db42dd8092f214de353ffbb2eb48549db110201424cafd" data-rendition-name="original" width="813" height="520" loading="lazy" alt="Nepal Orthopaedic Hospital"> <figcaption>Photo courtesy: NEPAL ORTHOPAEDIC HOSPITAL</figcaption> </figure>  "It was just two blocks of a one-story building," he recalls. "They said: Here’s the hospital. Run it. But buildings don’t make hospitals. You need doctors, you need equipment, you need patients."&nbsp; With a bold plan and support of friends and international donors, Shrestha started with 15 beds, providing care to anyone in need, regardless of their ability to pay. Initially, 93% of their operating expenses were covered by international donors but in less than 10 years, it had reversed the figures so that most of the cost was covered by internal resources. The hospital is self-sufficient today and does not turn away any patient that cannot afford the cost. Over the past 25 years, it has given more than $1 million in charity care.&nbsp; But Shrestha’s job was far from over. Realising the chronic lack of proper spinal care in Nepal, he got involved with the <a href="https://sisn.org.np/sirc/">Spinal Injury Rehabilitation Center in Sanga</a> in 2001, offering holistic treatment to paraplegic and quadriplegic patients. It was a leap of faith-started with a few friends, a handful of nurses, and no specialised doctors.&nbsp; "We just knew the need. People, especially women were falling off trees and cliffs, injuring their backs," Shrestha says, “They needed rehabilitation and physiotherapy, and we thought, why wait? You start small, and if you’re doing well, others will help you."&nbsp; Shrestha had long believed that healthcare in Nepal needed to reach the farthest corner, and after working with Nick Simons Institute (NSI) he realised that <a href="https://nepalitimes.com/news/jim-simon-s-gift-to-nepal">partnering with government hospitals</a> can better strengthen the overall health system. Shrestha’s journey took another turn when he was asked to join the board of OneHeart Worldwide, whose mission, to reduce maternal and neonatal mortality in Nepal’s most underserved areas, deeply resonated with him.&nbsp; Read also: <a href="https://nepalitimes.com/here-now/nepal-s-flying-doctor">Nepal's flying doctor</a>, Kunda Dixit  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241016131020_15d6c1483ea69455b998ba6fd6ecc0ac5eafe3af6effc2214f48f148bee0b540.jpg" data-media-id="editor_6" data-image-id="20241016131020_15d6c1483ea69455b998ba6fd6ecc0ac5eafe3af6effc2214f48f148bee0b540" data-rendition-name="original" width="2048" height="1365" loading="lazy" alt="Spinal Injury Rehabilitation Center"> <figcaption>A caretaker with a patient at the Spinal Injury Rehabilitation Center.</figcaption> </figure>  Shrestha’s approach to leadership is as grounded as his approach to medicine, it was never about control but rather always about enabler-ship. He explains: "Humility is key, and treating staff equally fosters a sense of unity and trust that is essential in difficult times.”&nbsp; He recalls a time at the Orthopaedic Hospital when funds were so tight that salaries could not be paid. The trust was so great that staff worked without pay for three months.&nbsp; Shrestha has a vision to open centres for spinal rehabilitation across all seven provinces of Nepal to provide specialised care – since the number of spinally injured patients rises dramatically because of highway accidents. He wants a health system where each district's hospital is properly equipped and functional, thereby discouraging referral of critical patients to Kathmandu over long and bumpy roads. &nbsp; His message to the next generation of Nepali doctors and social entrepreneurs: "You don't have to wait until everything is perfect to get started. All you need is an idea, and if you see a need, jump into it. Start small and you will always have people to help if you’re passionate and clear about your goals."&nbsp; Shrestha avoids the limelight, and had to be convinced to agree to this profile interview. He says, "When you build an institution, don’t think it’s yours. It belongs to everyone who helped along the way." Read also: <a href="https://nepalitimes.com/here-now/the-barefoot-doctor-of-rolpa">The barefoot doctor of Rolpa</a>, Pinki Sris Rana

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Doctor who does not just treat symptoms

A new mother in Kathmandu took her two-month-old baby to hospital to treat an infection. The doctor diagnosed upper respiratory infection (URI) and prescribed half a dozen medications, including the cough syrup Dextromethorphan. Dextromethorphan is not recommended for children under four by the US Food and Drug Administration (FDA) since 2008 after studies showed it to be ineffective for colds and causes damage to the central nervous system. In Saptari, a 14-month-old boy with chronic cough was taken to a private clinic multiple times. In each visit, the doctor there prescribed Dextromethorphan and Beclomethasone, a corticosteroid. The child’s skin became swollen and sore, and he was brought to Om Hospital in Kathmandu. Doctors concluded that his nervous system was affected by overdose of Dextromethorphan, and referred the baby to AIIMS Hospital in New Delhi. The baby died during treatment. A paper titled Adverse Events Associated with Pediatric Exposure to Dextromethorphan published in the medical journal Clinical Toxicology had already concluded that the cough syrup should only be given to children above four, and only for the most serious cases. Sixty percent of the 1,716 children under four in this study who were prescribed Dextromethorphan were found to have side effects ranging from vomiting, breathing problems, and effects on the nervous system. Other studies have noted that the drug can cause the respiratory system of children to slow down severely, leading to suffocation. Read also: <a href="https://nepalitimes.com/here-now/a-taste-of-our-own-medicine">A taste of our own medicine</a>, Yugeshwor Koirala A four-year-old boy in Bhaktapur suffering from cough and constipation was taken to a nearby private hospital. The doctor diagnosed common cold and prescribed six types of medicines including a nasal drug with the generic name Oxymetazoline, commonly used to treat nasal polyps. Oxymetazoline has also been prohibited for use in children under six by the FDA and other regulatory bodies. Doctors at the Bhaktapur hospital have been found to be prescribing this medicine to children to treat colds. Overuse of oxymetazoline can eventually cause inflammation of the nasal cavity, affecting breathing. As more and more Nepalis, especially children and the elderly, suffer from respiratory infections due to increasing air pollution, the misuse and overuse of drugs by an over-commercialised medical and pharmaceutical sector is also increasing. Doctors have also been found to be prescribing Montelukast, usually given only to patients with complications like asthma and rhinitis, to treat the common cold, sore throat, rashes or arthritis in children. FDA studies have shown that Montelukast in children and adolescents can cause behavioural and psychological side effects, including suicidal ideation. The drug has a black box warning, the FDA’s strictest alert to warn the public about its side effects, to be used only in cases where its benefit outweighs its harm.&nbsp; The Global Initiative for Asthma (GINA) guidelines also mention that parents must be made fully aware of the possible side effects of Montelukast before it is prescribed to children with asthma. Read also: <a href="http://archive.nepalitimes.com/article/nation/Antibiotic-resistance,1974">Antibiotic resistance</a>, Buddha Basnyat and Hellen Gelband&nbsp; Medical Sector on Steroids Doctors in Nepal also over-prescribe steroids, usually recommended to treat cancer, arthritis, vasculitis, asthma, muscular dystrophy, and arrhythmia, for children suffering colds and coughs. Steroids suppress the body's immune system, which is why doctors might prescribe them to address short-term health problems. The random prescription of such powerful medication can have long-term effects on health. At a clinic in Jhapa, doctors prescribed a one-year-old with a common cold, the steroid Prednisolone. When the cold persisted, the boy’s parents eventually began to buy the medicine over the counter whenever their son got sick. This went on for three and a half years until the child was unable to walk. When he was brought to a hospital in Kathmandu, doctors discovered that he had cataracts in both eyes as well as myopathy, a rare condition that causes the muscles of the legs to deteriorate. The child had to undergo cataract surgery, usually performed on elderly patients over 60. But there was no treatment for his myopathy. A study published in the British Medical Journal found that the prescription of steroids in children causes complications including obesity, diabetes, increased blood pressure, cataracts, weakened bones and muscles, as well as excessive body hair growth. Immunology and paediatric rheumatologist Dharmagat Bhattarai has seen many patients with disabilities and other lifelong health complications caused by the prescription of steroids to treat common colds.&nbsp; “Steroids should be used according to guidelines only in cases of serious diseases, to prevent amputations and in lifesaving situations,” says Bhattarai. “It cannot be used for general health problems.” Children under five are more susceptible to viral infections such as the common cold and diarrhoea, for which there is no specific medication. With proper care, such infections clear up on their own within a few days. An investigation by this paper of prescriptions by doctors in Kathmandu Valley showed that at least 8 out of 10 children who had been diagnosed with cold and cough had been prescribed unnecessary medication. Read also: <a href="https://archive.nepalitimes.com/article/nation/growth-of-antibiotic-resistance-in-nepal,1975">"Patients are impatient"</a>, Sonia Awale  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240419160452_d7c7652e36019a55861a667c5f4c475a30473ba893b1c44dc6f6f608e7424090.jpg" data-media-id="editor_3" data-image-id="20240419160452_d7c7652e36019a55861a667c5f4c475a30473ba893b1c44dc6f6f608e7424090" data-rendition-name="original" width="1000" height="1500" loading="lazy" alt="Pandemic of drugs overuse Page 10-11 NT #1208"> <figcaption>HEALTH IS WEALTH: Belmaya Nepali who mortgaged her house to pay off her hospital bills.</figcaption> </figure>  Molecular microbiologist Guna Raj Dhungana says: “Uncontrolled use of antibiotics cause pathogens to evolve, and develop the ability to fight the drug.” Physicians we showed the prescriptions to found that even in cases of viral infections, doctors in various hospitals in Kathmandu had recommended antibiotics like Amoxicillin, Azithromycin, Cefixime, Metronidazole, and Ofloxacin to children. Antibiotics are designed to fight bacterial infections, and they do not work for viral conditions. Excessive use of antibiotics causes antimicrobial resistance (AMR) which means the drugs will not work against more serious infections.&nbsp; The WHO has identified AMR as one of the top global public health threats, warning of as many as 10 million deaths each year by 2050 due prescription drugs failure.&nbsp; Infectious disease specialist Prabhat Adhikari estimates that even the stronger antibiotics have stopped working in 80% of patients with bacterial infections at ICUs of major hospitals in Kathmandu. Read also:<a href="https://nepalitimes.com/opinion/comment/nepal-s-wildlife-at-risk-from-drug-resistance"> Nepal’s wildlife at risk from drug resistance</a>, Siddhant Pandey “Patients who have had surgery are likely to develop infections, and people with heart failure are at risk of developing pneumonia when intubated,” explains Adhikari. “Antibiotics can be ineffective in treating such infections, causing premature deaths.” Most parents do not realise that minor conditions like the common cold can clear up in a week and do not require treatment and there is no needfor a trip to the hospital. Some doctors take advantage of worried parents to make a quick buck on commissions from pharmaceutical companies. “We can require prescriptions for certain drugs, but it all depends on the doctor’s conduct,” says healthcare expert Kiran Raj Pandey. International regulatory bodies have medical guidelines which are regularly updated. Once there is evidence that a certain drug has negative side effects, its use is restricted. Some doctors have not read those guidelines, and continue to prescribe discontinued medicines. Just as alarming is the nexus between the drug manufacturers and healthcare institutions in Nepal. Pharmaceutical companies pay as much as 60% of their profit to hospitals and doctors for prescribing their brands. Doctors therefore prescribe expensive and strong antibiotics to patients who can be treated with more affordable alternatives.&nbsp; For instance, European countries prescribe patients cheap penicillin-based antibiotics to treat pneumonia, whereas Nepali doctors prescribe expensive and last-resort antibiotics like Linezolid, Vancomycin, Meropenem, and Colistin. Read also: <a href="https://archive.nepalitimes.com/article/nation/I-am-an-amchi,3349">I am an amchi</a>, Sabine Pretsch “Pharmaceutical companies have incentivised doctors to prescribe more drugs with commissions and gifts,” says infectious disease specialist Anup Subedee. “Many doctors do not think in terms of whether their patient will get better but what will earn them more.” Misuse of prescription drugs is also driving many Nepalis, already overburdened with out of pocket medical costs, into poverty. Medicine makes up for nearly 75% of the total health expenditure of Nepalis. “Studies have shown that drug purchases can cause three to four percent of people to fall into poverty, and cause financial stress in up to 15% of families of patients,” says health economist Shiva Raj Adhikari. The mushrooming of private health institutions in Nepal has also created competition in the health sector such that hospitals and clinics try to make money through unnecessary medications and laboratory tests as well as other redundant administrative fees. In Nepal, the Nepal Medical Council (NMC) administers the licensing examination of doctors and regulates their medical practice. However, it does not monitor the conduct of individual doctors without a complaint. “It is not possible to check on the type and dosage of medication prescribed by an individual doctor, but we will review any complaints,” says NMC’s Satish Kumar Deo. Infectious disease specialist Subedee says that the NMC should audit prescriptions of doctors to check whether they follow relevant guidelines: “If the council has the professional skills, leadership and sense of accountability to do what is right, this problem can be solved overnight.”&nbsp; Read also: <a href="https://nepalitimes.com/here-now/medicine-goes-back-to-its-roots">Medicine goes back to its roots</a>, Sonia Awale

Pandemic of drugs overuse

<figure><img width="720" height="480" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114101124/63720a179c7e80680e0b5580jpeg.jpg" alt=""/><figcaption>Paul Farmer visiting Bayalpata Hospital in Achham run by Nyaya Health Nepal on its third anniversary in 2012. Photo: DEEPAK BISTA/NHN</figcaption></figure>When we were in 11th grade, my friends and I wanted to bring healthcare services to an impoverished village near Pokhara, my hometown. The best solution we could imagine was what is colloquially called a ‘health camp’: show up in a village with a doctor and some medications, go through hundreds of patients in a few hours, and leave.  We believed that since doctors and medications were expensive, and the poor could not pay, a health camp was the best we could do. In college, my anthropology professor introduced me to the <a href="https://www.newyorker.com/magazine/2000/07/10/the-good-doctor" data-saferedirecturl="https://www.google.com/url?q=https://www.newyorker.com/magazine/2000/07/10/the-good-doctor&amp;source=gmail&amp;ust=1645761874284000&amp;usg=AOvVaw3b9WqU9uyWoWQXT8nuhnk4">work</a> and writings of the physician and medical anthropologist Paul Farmer, who described relegating the poor to such meager services as, quite simply, a ‘failure of imagination’. His influence transformed my thinking regarding the most vexing problems in global health: the poor are not to blame for their economic condition and its attendant health challenges. Rather, the blame falls on our collective lack of imagination, which is rooted in, to borrow another phrase from Paul, ‘the idea that some lives matter less’. And that is how Paul began to live in my mind, as he did for thousands of others interested in healthcare.  Paul provided the requisite vocabulary to make sense of deep inequities, and he inspired with his actions. He and his team at the non-profit, Partners in Health, have brought life-saving healthcare services to indigent populations by supporting 230 healthcare facilities in 12 countries.  His work inspired me to go to medical school and co-found the non-profit organization <a href="https://possiblehealth.org/" data-saferedirecturl="https://www.google.com/url?q=https://possiblehealth.org/&amp;source=gmail&amp;ust=1645761874284000&amp;usg=AOvVaw0lctDu7mtRSz9-LxQCCK2B">Possible</a> with other like-minded medical students, all of us committed to expanding high quality healthcare in rural Nepal.  We had no track record, credibility, or adequate funding but Paul supported us. Graciously, he joined our Board, advised and mentored us, helped make connections, and let us leverage his credibility to raise funds. On the Partners in Health website, he <a href="https://www.pih.org/pages/mission-partners-supported-projects" data-saferedirecturl="https://www.google.com/url?q=https://www.pih.org/pages/mission-partners-supported-projects&amp;source=gmail&amp;ust=1645761874284000&amp;usg=AOvVaw0QSINhU0jOZ6rB98WFGhQo">included Possible</a> as an organisation expanding the mission for high quality care for the poor.  He shared his expansive platform by including <a href="https://www.pih.org/article/mental-health-in-nepal" data-saferedirecturl="https://www.google.com/url?q=https://www.pih.org/article/mental-health-in-nepal&amp;source=gmail&amp;ust=1645761874284000&amp;usg=AOvVaw3_FbKTKhT2o1BEL7JLC2RV">Possible’s work</a> alongside his. His generosity could have cut into his own fundraising efforts, but he always rejected the belief that the pie is small, and we should fight over it. He inspired us to fight for a bigger pie, and he willed that world into existence. Back in Nepal, we began with a small clinic in Achham, where 250,000 people had no access to even a single doctor. We faced many detractors, and sometimes we doubted ourselves. But his words, spoken clearly and earnestly, helped us form our moral compass and inspired a determination that would not countenance failure.  Because more funding was available for HIV programs, many advised us to open an HIV clinic, but we knew that Achham needed comprehensive services beyond strictly HIV care. Well-meaning supporters lamented, sounding much as my friends and I had in high school, that the best we could do was a series of health camps. Surely, they fretted, there was no money for anything long-term.  People seemed to have an unspoken collective agreement that when it comes to serving the poor, there are not enough resources. Paul had a phrase to describe this social myth: ‘socialisation for scarcity’. The reality is, he taught, there are enough resources in the world to provide high-quality health services to every poor person, but we fail to make this a reality. We back away from this challenge, simply because we assume it is not possible.  A well-wisher suggested that we build something in Kathmandu rather than in rural Nepal because people in Kathmandu can pay for services. This time, we thought of another phrase that Paul popularised as a reminder that the system needs to be built to serve those with the greatest needs. He called this ‘a preferential option for the poor’.  In 2009, we established <a href="https://www.nyayahealthnepal.org/" data-saferedirecturl="https://www.google.com/url?q=https://www.nyayahealthnepal.org/&amp;source=gmail&amp;ust=1645761874284000&amp;usg=AOvVaw2daT7Rc6LOR2LKA2EjC2hS">Nyaya Health Nepal</a>, a Nepal-based sister organisation to Possible, and collaborated with the Nepal government to expand to <a href="http://archive.nepalitimes.com/news.php?id=17650#.YhaPTejMKPo" data-saferedirecturl="https://www.google.com/url?q=http://archive.nepalitimes.com/news.php?id%3D17650%23.YhaPTejMKPo&amp;source=gmail&amp;ust=1645761874284000&amp;usg=AOvVaw3m5v35ikDhKesjhvT5U0Tp">Bayalpata Hospital</a>. In 2012, Paul <a href="http://archive.nepalitimes.com/blogs/thebrief/2012/06/22/dr-farmer-comes-to-nepal/?fbclid=IwAR2CfOIxGCHSF4JfjKrloDWHXpBJfI9sZLjtj88cWvajfHhPs9si9iCa7Tk" data-saferedirecturl="https://www.google.com/url?q=http://archive.nepalitimes.com/blogs/thebrief/2012/06/22/dr-farmer-comes-to-nepal/?fbclid%3DIwAR2CfOIxGCHSF4JfjKrloDWHXpBJfI9sZLjtj88cWvajfHhPs9si9iCa7Tk&amp;source=gmail&amp;ust=1645761874285000&amp;usg=AOvVaw201XBVs_ztoxyj50hJZze8">visited Bayalpata</a>, rounding on patients with the local clinicians, teaching and inspiring with his intellect and humor. He expressed genuine admiration towards the healthcare workers living and serving in rural Nepal.  He somehow managed to express more gratitude than he received, in a way most people would not expect from someone with his level of accomplishment. After the 2015 earthquake, our team expanded to Dolakha, and at its peak, was overseeing three permanent hospitals with 350 staff: a long way from sporadic health camps. A few years ago, I was in a small global health conference and we were waiting for Paul Farmer to speak. As most busy speakers do, we expected him to sweep in, give a talk, and jet off to the next event. I felt a tap on my shoulder. It was Paul. I was surprised to see him with the audience. We hugged. He asked me how I was doing and wanted to know how he could help with our work in Nepal. I thanked him for having highlighted the importance of mental health in high-profile global health meetings.  He thanked me for working in mental health, <a href="https://archive.nepalitimes.com/article/nation/Neglect-of-the-neglected,3157" data-saferedirecturl="https://www.google.com/url?q=https://archive.nepalitimes.com/article/nation/Neglect-of-the-neglected,3157&amp;source=gmail&amp;ust=1645761874285000&amp;usg=AOvVaw0auYYYnEoYwjjdnKwxAe0y">a persistently ignored area</a>. He then walked around the room, surprising and personally checking in with several people who were working in different parts of the world. Later, the organisers told me that Paul had asked for the list of attendees so he could check in with the people he knew were doing similar work in global health.  He did not need to do any of this. He had a way of being present with you, listening, inspiring, and building solidarity for his commitment to the most vulnerable. On 21 February, 2022, Paul passed away in his sleep in Rwanda, where he had been teaching and seeing patients at the University of Global Health Equity, a <a href="https://ughe.org/the-story-behind-the-university" data-saferedirecturl="https://www.google.com/url?q=https://ughe.org/the-story-behind-the-university&amp;source=gmail&amp;ust=1645761874285000&amp;usg=AOvVaw2OnM0VBt6sfqmNWZknDP__">world-class university</a> that he helped to establish. He was 62. He left behind three children and his wife, Didi Bertrand Farmer, a medical anthropologist from Haiti.  As Bill Gates <a href="https://www.theatlantic.com/health/archive/2022/02/paul-farmer-obituary-bill-gates/622876" data-saferedirecturl="https://www.google.com/url?q=https://www.theatlantic.com/health/archive/2022/02/paul-farmer-obituary-bill-gates/622876&amp;source=gmail&amp;ust=1645761874285000&amp;usg=AOvVaw2pWB2FnOg2yFeVjuBWHH4X">wrote recently</a>, the void Paul left cannot be filled by anyone. But I know that although he is gone, his work will continue through how he influenced us, through his incisive writing and inspiring legacy. He will continue to live in my mind, urging us not to succumb to failures of imagination, and instead to fight against socialisation for scarcity to boldly build a preferential option for the poor.Bibhav Acharya, MD is a psychiatrist, an Associate Professor at University of California San Francisco, and co-founder of <a href="https://possiblehealth.org/" data-saferedirecturl="https://www.google.com/url?q=https://possiblehealth.org/&amp;source=gmail&amp;ust=1645761874285000&amp;usg=AOvVaw2uxxH-GIR4y6Vtn4zPKdmr">Possible</a>, a nonprofit organization that has been working to improve health care in Nepal since 2007.<a href="https://twitter.com/BibhavAcharya" data-saferedirecturl="https://www.google.com/url?q=https://twitter.com/BibhavAcharya&amp;source=gmail&amp;ust=1645761874285000&amp;usg=AOvVaw2b7VkvX7y7Myrrsnt6EM7o">@BibhavAcharya</a> <img width="77" height="109" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114101124/63720a199c7e80680e0b5581jpeg.jpg" alt="">Read also:<a href="https://www.nepalitimes.com/here-now/at-the-covid-19-frontlines-in-rural-nepal/"> At the Covid frontlines in rural Nepal</a>, Priti Thapa

Paul Farmer on my mind

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121140/636b91ab9c7e80680e06f104jpeg.jpg" alt="" width="960" height="640"/><figcaption>Photo: BIKRAM RAI/NEPALI TIMES ARCHIVES</figcaption></figure>Prashuma Malla had never felt so helpless as a physician. Her patient, a man in his 40s, was suffocating, incapable of drawing in breath.But the hospital ventilators were all occupied, and the central supply of oxygen was very low. She pronated her patient while his wife sobbed near him.“With no oxygen, we can do nothing,” said the 28-year-old second year medical resident specialising in anaesthesia at Bir Hospital in Kathmandu. “It is scary. It is non-stop. I try to tell myself everything is OK. But what can we do? Eight people have already died on my watch.”Malla and her colleagues are on the <a href="https://www.nepalitimes.com/here-now/protecting-those-who-protect-us-from-covid/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/protecting-those-who-protect-us-from-covid/&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNEZnm1Wh-lIyg9tsnCRr9-mgD_R4Q">Covid frontlines in Nepal</a>. Her world is a haze of 36-hour intense, and often terrifying shifts, at Nepal’s oldest and best-known public hospital.As in many <a href="https://www.nepalitimes.com/here-now/protecting-those-who-protect-us-from-the-epidemic/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/protecting-those-who-protect-us-from-the-epidemic/&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNELCBtyZv7D1U8LDXT-i7HJPRZbeQ">government hospitals in Nepal</a>, relatives follow patients in the wards, providing food and running to pharmacies to purchase medicine. <a href="https://www.nepalitimes.com/here-now/nepals-frontline-workers-brave-it-out/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/nepals-frontline-workers-brave-it-out/&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNGmvFGTkOC_M_eTcOYyHWYTMLFBJw">Bir Hospital is overwhelmed</a>. People are sleeping in hallways, stairways, curled up on patients’ beds, pacing from room to room.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121140/636b91ad9c7e80680e06f105jpeg.jpg" alt="" width="1500" height="850"><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121140/636b91b09c7e80680e06f106jpeg.jpg" alt="" width="768" height="513"><figcaption>Crowded Covid ward at Teku Hospital. Photo: AMIT MACHAMASI</figcaption></figure>Doctors believe many relatives are sick as well, but the hospital does not have enough PPEs for them, and there is a serious shortage of oxygen.“We are exposed to the virus all the time,” Malla said of her shifts with the sickest of patients. “Everywhere you go is a Covid ward.”Malla and her colleagues have also become counsellors. But with every patient, her job gets harder because most are in their 30s and 40s, and increasingly some in their 20s are being brought in.In the chaos, it calms her to explain every detail to relatives. What does it mean to be intubated? Why once intubated it is hard to take patients off, and they usually die if they are taken out. No, they cannot take the body to be cremated: only police or soldiers can remove it from the hospital.“They are confused, they have never seen someone come off an intubator. I remind them: there is no guarantee,” Malla said.Every move Malla makes, every decision she takes, she reports to her superior. And every day at the shift handover, she has to be careful with the safety precautions.At the end of her shift that lasts more than 24 hours, Malla heads home on her scooter through light traffic because of the lockdown. She lives in a tiny two-room apartment with her two brothers, and is terrified of infecting them.She washes immediately, including her mask and face shield. Masks are always on, they cook together. Briefly unmasked, she eats alone on a miniature terrace. She talks on Viber with her parents in central Nepal.Every day, sometimes every hour, they remind each other to stay safe. She tries to focus on her online medical classes. She doesn’t want to fall behind. But always that nagging fear. Death is lurking. Near her. Floating and invisible.Although Nepal’s second wave appears to have peaked, and the official number of Covid-19 cases and mortality is down, there are <a href="https://www.nepalitimes.com/latest/nepal-covid-19-impact-worse-than-official-figures/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/nepal-covid-19-impact-worse-than-official-figures/&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNGD_zw--sdgKNcbkUD2EUdjZg82Lw">doubts about how accurate the figures are</a>.The number of daily recoveries is now higher than new infections, and the official death toll is hovering around 100 every day, which is half what it was three weeks ago. The number of active cases fell below 100,000 for the first time in more than one month on Saturday. But there are still more than 1,500 <a href="https://www.nepalitimes.com/latest/nepal-designates-more-hospitals-for-covid-19-treatment/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/nepal-designates-more-hospitals-for-covid-19-treatment/&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNHxZUs6NeKiFHYbFIJkkSZzx7D9vg">patients in ICUs</a> nationwide, with 450 of them needing ventilator support.More and more cases in city and <a href="https://www.nepalitimes.com/here-now/at-the-covid-19-frontlines-in-rural-nepal/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/at-the-covid-19-frontlines-in-rural-nepal/&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNFpAtg51hSoSi41jBs4YjPKQ9MsVA">district hospitals</a> now are from the hinterland, and there are indications that the <a href="https://www.nepalitimes.com/editorial/nepals-humanitarian-emergency/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/editorial/nepals-humanitarian-emergency/&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNGRytlb8jAYJB_hKJQNVCuwiFBmEQ">virus has spread to the remotest communities </a>in the mountains where there is no hospital care. And no <a href="https://www.nepalitimes.com/latest/life-hangs-by-an-oxygen-tube-in-nepal/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/life-hangs-by-an-oxygen-tube-in-nepal/&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNF2Eis06JvGsCzy_McEPymUP-h5sw">supplemental oxygen</a>.<a href="https://www.nepalitimes.com/latest/in-nepal-virus-climbs-from-plains-to-mountains/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/in-nepal-virus-climbs-from-plains-to-mountains/&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNEsKzdZRZejQF0SGnV4lSHoAk0EHQ">In rural Nepal</a>, there is now hope from ground-breaking tele-health that is transforming medical care.Hari Neupane is fighting Covid-19 with his cell phone. He is simultaneously a doctor, nurse and mental health expert, and works with <a href="https://www.healthfoundationnepal.org/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.healthfoundationnepal.org&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNGdGiTiG90TCoPVsSwtrWug2LqVYA">Health Foundation Nepal</a>, a Kathmandu-based volunteer-staffed telemedicine service that reaches out to patients across 35 districts in Nepal via its Kathmandu hotline.Neupane leads a team of seven doctors in Dang Valley in mid-western Nepal. Because of the large numbers of workers returning from India and its rudimentary medical facilities, Dang bore the brunt of the pandemic in both the first and second waves.As the monsoon approaches, it is soon rice planting season but a national lockdown has left fields, streets and roads empty, void of the everyday crowds and cacophony of passing trucks.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121140/636b91b39c7e80680e06f107jpeg.jpg" alt="" width="1500" height="1000"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121140/636b91b69c7e80680e06f108jpeg.jpg" alt="" width="1500" height="1000">In Dang in western Nepal, the highways are empty because of the lockdown, while farmers are busy preparing for rice-planting. Photos: HARI NEUPANE<a href="https://archive.nepalitimes.com/article/nation/long-distance-medicine-in-nepal,3521" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://archive.nepalitimes.com/article/nation/long-distance-medicine-in-nepal,3521&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNGKSSvGC8yUXhCQ9FP5G-0uZmJjng">Telemedicine is new in Nepal</a>, and medical teams in the field in Nepal are supervised by Ashok Devkota, a doctor of internal medicine in Providence, Rhode Island, in the United States The organisation’s seven full-time workers and 50 part-time physicians are all volunteers.Most of Neupane’s patients across Nepal have Covid symptoms, but most have not been tested. Working closely with local health posts, Neupane’s team identifies symptoms, using cell phones – voice, photos and videos – as medical communicators.They connect patients via cell phone with pharmacies and if necessary source portable oxygen. The very sick are referred to the hospital.“We focus on people in home isolation and counsel them on the medicines they need and how to get them. We prescribe steroids and do follow-ups and notify local government officials,” Neupane explained.In Dang, cell phones have become transformative lifelines at many levels. They are a critical means of money transfers from relatives working abroad, so that families can pay school fees, medical bills and food.This year’s lockdown has made day-long walks to access medical care virtually impossible. Even if patients can get to a hospital, chances of a bed are slim. In Dang, there are only 155 intensive care beds and 15 ventilators, most of them occupied.Health Foundation Nepal advertises its telemedicine counselling through social media and newspapers. It cannot take blood tests, but with the help of local health workers can monitor oxygen saturation, blood pressure and temperature and can gauge the condition of the patients to recommend a solution.“Telemedicine existed in Nepal before but before Covid people did not accept it much, but now it is helping save lives,” said Ashok Devkota, the Nepali doctor in the US who supervises medical staff like Neupane half-way around the world Nepal. And as long as Neupane’s cell phone stays charged, he is on duty.The pandemic and political crisis in Nepal have increased the risk of Nepal becoming an imploding catastrophe. The country was just beginning to recover from the 2015 earthquake, and was struggling with pre-existing health challenges, and earlier this year was beginning to think the worst was over when the second Covid-19 wave struck.The health and economic crises <a href="https://www.nepalitimes.com/latest/covid-19-to-reverse-child-survival-gains/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/covid-19-to-reverse-child-survival-gains/&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNHA2oJKTj8wDzac2WJdbkvphDJODQ">threaten the gains Nepal has made</a> in the past years in fighting malnutrition, immunisation against other infectious diseases, child labour, early marriage and women’s rights.But if Nepal is a petri dish of disasters, it is also one of innovation and individual dedication. This pandemic once again is a place where despair is often met by individual and community fortitude by medical workers like Prashuma Malla and Hari Neupane.Donatella Lorch is a former New York Times foreign correspondent who lived three years in Nepal. She blogs at: <a href="https://tangledjourneys.com/about/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://tangledjourneys.com/about/&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNEHm4HaaRyE_KrqKL6VlN7zbgNjlQ">tangledjourneys</a>

Nepal’s doctors are like soldiers fighting a war

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131144/636cf2839c7e80680e09d913jpeg.jpg" alt="" width="960" height="640"/><figcaption>Photo: BIKRAM RAI/NEPALI TIMES ARCHIVES</figcaption></figure>Prashuma Malla had never felt so helpless as a physician. Her patient, a man in his 40s, was suffocating, incapable of drawing in breath.But the hospital ventilators were all occupied, and the central supply of oxygen was very low. She pronated her patient while his wife sobbed near him.“With no oxygen, we can do nothing,” said the 28-year-old second year medical resident specialising in anaesthesia at Bir Hospital in Kathmandu. “It is scary. It is non-stop. I try to tell myself everything is OK. But what can we do? Eight people have already died on my watch.”Malla and her colleagues are on the <a href="https://www.nepalitimes.com/here-now/protecting-those-who-protect-us-from-covid/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/protecting-those-who-protect-us-from-covid/&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNEZnm1Wh-lIyg9tsnCRr9-mgD_R4Q">Covid frontlines in Nepal</a>. Her world is a haze of 36-hour intense, and often terrifying shifts, at Nepal’s oldest and best-known public hospital.As in many <a href="https://www.nepalitimes.com/here-now/protecting-those-who-protect-us-from-the-epidemic/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/protecting-those-who-protect-us-from-the-epidemic/&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNELCBtyZv7D1U8LDXT-i7HJPRZbeQ">government hospitals in Nepal</a>, relatives follow patients in the wards, providing food and running to pharmacies to purchase medicine. <a href="https://www.nepalitimes.com/here-now/nepals-frontline-workers-brave-it-out/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/nepals-frontline-workers-brave-it-out/&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNGmvFGTkOC_M_eTcOYyHWYTMLFBJw">Bir Hospital is overwhelmed</a>. People are sleeping in hallways, stairways, curled up on patients’ beds, pacing from room to room.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131144/636cf2869c7e80680e09d914jpeg.jpg" alt="" width="1500" height="850"><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131144/636cf2899c7e80680e09d915jpeg.jpg" alt="" width="768" height="513"><figcaption> </figcaption></figure>Doctors believe many relatives are sick as well, but the hospital does not have enough PPEs for them, and there is a serious shortage of oxygen.“We are exposed to the virus all the time,” Malla said of her shifts with the sickest of patients. “Everywhere you go is a Covid ward.”Malla and her colleagues have also become counsellors. But with every patient, her job gets harder because most are in their 30s and 40s, and increasingly some in their 20s are being brought in.In the chaos, it calms her to explain every detail to relatives. What does it mean to be intubated? Why once intubated it is hard to take patients off, and they usually die if they are taken out. No, they cannot take the body to be cremated: only police or soldiers can remove it from the hospital.“They are confused, they have never seen someone come off an intubator. I remind them: there is no guarantee,” Malla said.Every move Malla makes, every decision she takes, she reports to her superior. And every day at the shift handover, she has to be careful with the safety precautions.At the end of her shift that lasts more than 24 hours, Malla heads home on her scooter through light traffic because of the lockdown. She lives in a tiny two-room apartment with her two brothers, and is terrified of infecting them.She washes immediately, including her mask and face shield. Masks are always on, they cook together. Briefly unmasked, she eats alone on a miniature terrace. She talks on Viber with her parents in central Nepal.Every day, sometimes every hour, they remind each other to stay safe. She tries to focus on her online medical classes. She doesn’t want to fall behind. But always that nagging fear. Death is lurking. Near her. Floating and invisible.Although Nepal’s second wave appears to have peaked, and the official number of Covid-19 cases and mortality is down, there are <a href="https://www.nepalitimes.com/latest/nepal-covid-19-impact-worse-than-official-figures/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/nepal-covid-19-impact-worse-than-official-figures/&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNGD_zw--sdgKNcbkUD2EUdjZg82Lw">doubts about how accurate the figures are</a>.The number of daily recoveries is now higher than new infections, and the official death toll is hovering around 100 every day, which is half what it was three weeks ago. The number of active cases fell below 100,000 for the first time in more than one month on Saturday. But there are still more than 1,500 <a href="https://www.nepalitimes.com/latest/nepal-designates-more-hospitals-for-covid-19-treatment/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/nepal-designates-more-hospitals-for-covid-19-treatment/&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNHxZUs6NeKiFHYbFIJkkSZzx7D9vg">patients in ICUs</a> nationwide, with 450 of them needing ventilator support.More and more cases in city and <a href="https://www.nepalitimes.com/here-now/at-the-covid-19-frontlines-in-rural-nepal/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/at-the-covid-19-frontlines-in-rural-nepal/&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNFpAtg51hSoSi41jBs4YjPKQ9MsVA">district hospitals</a> now are from the hinterland, and there are indications that the <a href="https://www.nepalitimes.com/editorial/nepals-humanitarian-emergency/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/editorial/nepals-humanitarian-emergency/&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNGRytlb8jAYJB_hKJQNVCuwiFBmEQ">virus has spread to the remotest communities </a>in the mountains where there is no hospital care. And no <a href="https://www.nepalitimes.com/latest/life-hangs-by-an-oxygen-tube-in-nepal/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/life-hangs-by-an-oxygen-tube-in-nepal/&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNF2Eis06JvGsCzy_McEPymUP-h5sw">supplemental oxygen</a>.<a href="https://www.nepalitimes.com/latest/in-nepal-virus-climbs-from-plains-to-mountains/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/in-nepal-virus-climbs-from-plains-to-mountains/&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNEsKzdZRZejQF0SGnV4lSHoAk0EHQ">In rural Nepal</a>, there is now hope from ground-breaking tele-health that is transforming medical care.Hari Neupane is fighting Covid-19 with his cell phone. He is simultaneously a doctor, nurse and mental health expert, and works with <a href="https://www.healthfoundationnepal.org/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.healthfoundationnepal.org&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNGdGiTiG90TCoPVsSwtrWug2LqVYA">Health Foundation Nepal</a>, a Kathmandu-based volunteer-staffed telemedicine service that reaches out to patients across 35 districts in Nepal via its Kathmandu hotline.Neupane leads a team of seven doctors in Dang Valley in mid-western Nepal. Because of the large numbers of workers returning from India and its rudimentary medical facilities, Dang bore the brunt of the pandemic in both the first and second waves.As the monsoon approaches, it is soon rice planting season but a national lockdown has left fields, streets and roads empty, void of the everyday crowds and cacophony of passing trucks.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131144/636cf28c9c7e80680e09d916jpeg.jpg" alt="" width="1500" height="1000"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131144/636cf28f9c7e80680e09d917jpeg.jpg" alt="" width="1500" height="1000">In Dang in western Nepal, the highways are empty because of the lockdown, while farmers are busy preparing for rice-planting. Photos: HARI NEUPANE<a href="https://archive.nepalitimes.com/article/nation/long-distance-medicine-in-nepal,3521" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://archive.nepalitimes.com/article/nation/long-distance-medicine-in-nepal,3521&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNGKSSvGC8yUXhCQ9FP5G-0uZmJjng">Telemedicine is new in Nepal</a>, and medical teams in the field in Nepal are supervised by Ashok Devkota, a doctor of internal medicine in Providence, Rhode Island, in the United States The organisation’s seven full-time workers and 50 part-time physicians are all volunteers.Most of Neupane’s patients across Nepal have Covid symptoms, but most have not been tested. Working closely with local health posts, Neupane’s team identifies symptoms, using cell phones – voice, photos and videos – as medical communicators.They connect patients via cell phone with pharmacies and if necessary source portable oxygen. The very sick are referred to the hospital.“We focus on people in home isolation and counsel them on the medicines they need and how to get them. We prescribe steroids and do follow-ups and notify local government officials,” Neupane explained.In Dang, cell phones have become transformative lifelines at many levels. They are a critical means of money transfers from relatives working abroad, so that families can pay school fees, medical bills and food.This year’s lockdown has made day-long walks to access medical care virtually impossible. Even if patients can get to a hospital, chances of a bed are slim. In Dang, there are only 155 intensive care beds and 15 ventilators, most of them occupied.Health Foundation Nepal advertises its telemedicine counselling through social media and newspapers. It cannot take blood tests, but with the help of local health workers can monitor oxygen saturation, blood pressure and temperature and can gauge the condition of the patients to recommend a solution.“Telemedicine existed in Nepal before but before Covid people did not accept it much, but now it is helping save lives,” said Ashok Devkota, the Nepali doctor in the US who supervises medical staff like Neupane half-way around the world Nepal. And as long as Neupane’s cell phone stays charged, he is on duty.The pandemic and political crisis in Nepal have increased the risk of Nepal becoming an imploding catastrophe. The country was just beginning to recover from the 2015 earthquake, and was struggling with pre-existing health challenges, and earlier this year was beginning to think the worst was over when the second Covid-19 wave struck.The health and economic crises <a href="https://www.nepalitimes.com/latest/covid-19-to-reverse-child-survival-gains/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/covid-19-to-reverse-child-survival-gains/&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNHA2oJKTj8wDzac2WJdbkvphDJODQ">threaten the gains Nepal has made</a> in the past years in fighting malnutrition, immunisation against other infectious diseases, child labour, early marriage and women’s rights.But if Nepal is a petri dish of disasters, it is also one of innovation and individual dedication. This pandemic once again is a place where despair is often met by individual and community fortitude by medical workers like Prashuma Malla and Hari Neupane.Donatella Lorch is a former New York Times foreign correspondent who lived three years in Nepal. She blogs at: <a href="https://tangledjourneys.com/about/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://tangledjourneys.com/about/&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNEHm4HaaRyE_KrqKL6VlN7zbgNjlQ">tangledjourneys</a>

<figure><img width="957" height="638" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111152/636b866b9c7e80680e067852jpeg.jpg" alt=""/><figcaption>Photo: BIKRAM RAI</figcaption></figure>On 20 May, the Health Ministry released a condolence message for doctors including Ishwor Lal Acharya, Mukesh Chaudhary and Pujya Shree Karki who lost their lives to Covid-19.Nepal doesn't yet have an exact figure on the total number of <a href="https://www.nepalitimes.com/here-now/protecting-those-who-protect-us-from-the-epidemic/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/protecting-those-who-protect-us-from-the-epidemic/&amp;source=gmail&amp;ust=1622085873678000&amp;usg=AFQjCNE67Zklb3ITwY-EN9ZPs4LRP2MFtQ">medical staff</a> infected by the SARS-CoV-2 but the Nepal Health Research Council (NHRC) is currently conducting a study to find out. “Majority of our frontline health care provides have been fully vaccinated, so even if they are being infected, they are only mild to moderately sick,” says cardiologist and chair of the Nepal Medical Council (NMC) <a href="https://www.facebook.com/bhagawan.koirala" data-saferedirecturl="https://www.google.com/url?q=https://www.facebook.com/bhagawan.koirala&amp;source=gmail&amp;ust=1622085873678000&amp;usg=AFQjCNEOs-qwziT36jBSTwwrTvDCe4MA1A">Bhagawan Koirala.</a> “This combined with a better understanding of Covid-19, they are now more confident and have a better sense of responsibility this time around.”At the National Trauma Centre in Kathmandu, nursing staff Suman Chaudhary is back to work after recovering from the coronavirus herself and draws motivation from health workers who are battling the pandemic in major hotspots like Birganj.“This is our chance to make a real contribution and having been infected myself has given me a new perspective on how patients feel,” says Chaudhary who was pursuing Masters in Nursing at Bir Hospital during the first wave. “It is difficult to work in a PPE all day without water or bathroom breaks. I still feel weak and have shortness of breath, but watching people recover keeps us going.”Both Koirala and Chaudhary, however, agree that there is a <a href="https://www.nepalitimes.com/here-now/nepals-frontline-workers-brave-it-out/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/nepals-frontline-workers-brave-it-out/&amp;source=gmail&amp;ust=1622085873678000&amp;usg=AFQjCNG1eSnzgkQ-VmoauOQrzkj_c0eUzA">chronic shortage of medical staff</a> across the country. Hospitals outside Kathmandu and even Covid dedicated institutions are overstretched, and now doctors and nurses are themselves falling sick. In some hospitals, since patients and staff are all positive, nurses and doctors with mild symptoms have just kept working, since there is no one else to take care of the sick.Last week, more than 47 of Dhading District Hospital’s emergency and ward staff were infected with Covid-19, with many of them in isolation and some requiring ICU treatment even as the facility was finding it difficult to source enough <a href="https://www.nepalitimes.com/latest/why-is-there-still-an-oxygen-shortage/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/why-is-there-still-an-oxygen-shortage/&amp;source=gmail&amp;ust=1622085873678000&amp;usg=AFQjCNGkShQk2X-gpsUuQceFplgqsL0bSg">oxygen for existing patients</a>.“We are a hospital of only 8 doctors, 5 paramedics and 23 nurses and with no backup, we were very close to collapsing,” says Medical Superintendent at Dhading District Hospital Tribhuvan Jha, adding that everyone had to be called back to work after 10 days of isolation. “We are in this position due to a lack of preparedness, shortage of staff and limited infrastructure.”At Charikot Hospital in Dolakha, which is also a Covid-dedicated hospital, the majority of coronavirus patients are critical and there is at least one fatality every day. The 17 nurses work three shifts a day, and are unable to handle patient inflow, so the hospital has brought in community nurses from outlying villages. The hospital is consistently reporting a 45% test positivity rate among those tested.“If a majority of our health workers get infected and are in isolation, we have no Plan B and this is especially worrying because we are the sole care provider for Covid here,” says Binod Dangal of Charikot Hospital. “Medical staff are all  overworked, and they do not have any insurance or allowances.”As dire as the situation is in Nepal’s big cities and district hospitals, the <a href="https://www.nepalitimes.com/editorial/nepals-humanitarian-emergency/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/editorial/nepals-humanitarian-emergency/&amp;source=gmail&amp;ust=1622085873678000&amp;usg=AFQjCNE3z3JV_9xnJ0reDy2ABkI8VuY16A">pandemic has now infiltrated rural Nepal</a> where there is just one doctor for every 15,000 people. Kathmandu’s doctor-to-patient ratio is 1:850.In her village of Phediguth of Okhaldhunga district, <a href="https://www.nepalitimes.com/banner/saving-nepali-mothers-on-mothers-day/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/banner/saving-nepali-mothers-on-mothers-day/&amp;source=gmail&amp;ust=1622085873678000&amp;usg=AFQjCNErggt96LmoW-c38IzduDUsayQwIg">Rita Khatri</a> is the only skilled birth attendant. Despite the growing risk of the second wave, she is still performing deliveries and ante-natal check-ups wearing a mask and her single PPE suit. There are no tests of health workers and the public.“We are working despite fears of transmission, I wish we had more PPEs, masks and gloves so that we could conduct more regular check-ups and make home visits,” adds Khatri. “At the moment many people in the community have high fever and are staying at home, but there is no way to test them.” This time last year while in the grip of the first wave of a new pandemic, there was stigma associated with Covid-19 and people who were infected were ostracised in the community. There were many instances where <a href="https://www.nepalitimes.com/here-now/nepal-health-workers-battle-covid-19-but-also-stigma/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/nepal-health-workers-battle-covid-19-but-also-stigma/&amp;source=gmail&amp;ust=1622085873678000&amp;usg=AFQjCNECgLl_SyeWRy6kuDEPnEbsSFoCyQ">healthcare providers were mistreated</a>.Doctors and nurses interviewed for this report say that is still the case, but there is also more praise for frontline medical workers risking their own health to save lives. However, there is growing concern about the worry and over-work affecting the mental health of nurses and doctors.“Among other things we need psychological support and counselling. I have seniors who have children infected with the new variant, and they are having a hard time coping,” says Suman Chaudhary, nursing staff at the Trauma Centre in Kathmandu.As most of Nepal enters the fourth week of lockdown, nationwide daily Covid-19 infections, positivity rate as well as fatalities are going down slightly. The number of recoveries have also risen to nearly equal new confirmed cases on some days.Bayalpata Hospital in remote Accham District had to turn its Emergency Room into a Covid-19 ward last month to cope with a flood of patients. It had 33 patients, 18 of them needing high flow oxygen support. On Wednesday, it had only 12 Covid-19 patients with only two on oxygen. Four of those infected are medical staff. “The situation is easing somewhat here, in Mangalsen, Doti and Dadeldhura. There are beds available, and oxygen is coming in. But we are desperately short of medical staff,” says Mandeep Pathak, a physician at Bayalpata which is also caring for trauma and maternity patients from surrounding districts.However, the cases and the test positivity rate <a href="https://www.nepalitimes.com/here-now/its-an-emergency/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/its-an-emergency/&amp;source=gmail&amp;ust=1622085873678000&amp;usg=AFQjCNHx4NfPYsEDb5xqY31L966E2avOdg">have not gone down as expected</a> and fatalities nationwide have stayed above 160 for nearly two weeks now as the highly contagious and more lethal B.1.617.2 variant spreads rapidly through communities.Health Minister Hridayesh Tripathi sounded optimistic at a virtual press meet on Monday, predicting that there would be a decline in the infection rate in the next four weeks. As Nepal receives large shipments of oxygen cylinders, liquid oxygen, test kits, PPEs and masks, doctors say the emphasis now needs to shift to more testing, mass vaccination, and replenishing exhausted and over-stretched medical staff at hospitals, both in the cities and the districts. A non-profit One Heart Worldwide that works primarily in maternal care in Nepal’s 21 districts has been helping district hospitals by mobilising oxygen cylinders and medical kits it procured from China.<a href="https://www.nepalitimes.com/banner/what-can-be-more-fulfilling-than-saving-lives/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/banner/what-can-be-more-fulfilling-than-saving-lives/&amp;source=gmail&amp;ust=1622085873678000&amp;usg=AFQjCNFzGOK8F0-jy4gwuRmK8iyNBD7AIA">Executive director Surya Bhatta</a> gives three reasons why despite the lockdown the infection rate is still high. “There is virtually no contact tracing, people are still not following health protocols and patients isolating at homes are not doing it right, resulting in a gross underestimation of total cases and fatalities.”		
			<h2>Weddings into hotspots</h2>		
		Gopal Dahal in DhankutaOn 30 April, when a young man in Okhre village in Dhankuta district got married, the whole . The whole community was invited for the feast.But a few days later, the groom suddenly fell sick. When he showed coronavirus symptoms, a test at the primary health care centre confirmed he was <a href="https://www.nepalitimes.com/here-now/its-an-emergency/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/its-an-emergency/&amp;source=gmail&amp;ust=1622085873678000&amp;usg=AFQjCNHx4NfPYsEDb5xqY31L966E2avOdg">Covid-19</a> positive.Now, every household in Okhre village has members showing similar symptoms. Most of them had attended the wedding. Of the 51 people tested, 25 tested positive. “This is a crisis, the pandemic has spread to the whole village now,” says Ward Chair Palak Basnet.One of the guests at the wedding was a man who had returned recently from the Tarai with mild symptoms. He was hired to wash dishes at the wedding, and had died a few days after the feast. No one tried to find the cause of death, and there was no PCR test done. Dhankuta MP Jitendra Rumdali Rai says there are probably many more cases than the ones who have tested positive so far. “The pandemic is spreading out of control here because the municipality wasn’t able to manage it on time,” he adds.Okhre village has now been sealed off till 8 June. Some of those infected are in critical condition, and six who were more serious were taken to hospital in Dharan. It is difficult for the others because the municipality does not have an ambulance, and some who had taken sick relatives to Dharan returned because there were no beds, or it was too expensive. “Initially they were charging Rs10,000 per day for the bed and we paid Rs4,000 daily for the doctor. But then they hiked it to Rs14,700 and I couldn’t pay it any more,” says one patient’s family who returned recently from Dharan’s Bijayapur Hospital.Another <a href="https://www.nepalitimes.com/latest/rural-nepal-fights-back-covid-19/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/rural-nepal-fights-back-covid-19/&amp;source=gmail&amp;ust=1622085873679000&amp;usg=AFQjCNHu0t7Yl9XzW-TA064jBcggx4L-TA">coronavirus</a> patient says ambulances are also expensive, making it hard to get patients to hospitals. Buses refuse to take passengers who are sick.The municipality called an emergency all-party meeting and decided to set up a 10-bed isolation centre with two staff nurses, and a doctor. Talks are underway to get at least a pickup from Dhankuta Red Cross to use as an ambulance.

Sonia Awale

Protecting those who protect us from Covid

<figure><img width="957" height="638" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131128/636cee759c7e80680e09ae2fjpeg.jpg" alt=""/><figcaption>Photo: BIKRAM RAI</figcaption></figure>On 20 May, the Health Ministry released a condolence message for doctors including Ishwor Lal Acharya, Mukesh Chaudhary and Pujya Shree Karki who lost their lives to Covid-19.Nepal doesn't yet have an exact figure on the total number of <a href="https://www.nepalitimes.com/here-now/protecting-those-who-protect-us-from-the-epidemic/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/protecting-those-who-protect-us-from-the-epidemic/&amp;source=gmail&amp;ust=1622085873678000&amp;usg=AFQjCNE67Zklb3ITwY-EN9ZPs4LRP2MFtQ">medical staff</a> infected by the SARS-CoV-2 but the Nepal Health Research Council (NHRC) is currently conducting a study to find out. “Majority of our frontline health care provides have been fully vaccinated, so even if they are being infected, they are only mild to moderately sick,” says cardiologist and chair of the Nepal Medical Council (NMC) <a href="https://www.facebook.com/bhagawan.koirala" data-saferedirecturl="https://www.google.com/url?q=https://www.facebook.com/bhagawan.koirala&amp;source=gmail&amp;ust=1622085873678000&amp;usg=AFQjCNEOs-qwziT36jBSTwwrTvDCe4MA1A">Bhagawan Koirala.</a> “This combined with a better understanding of Covid-19, they are now more confident and have a better sense of responsibility this time around.”At the National Trauma Centre in Kathmandu, nursing staff Suman Chaudhary is back to work after recovering from the coronavirus herself and draws motivation from health workers who are battling the pandemic in major hotspots like Birganj.“This is our chance to make a real contribution and having been infected myself has given me a new perspective on how patients feel,” says Chaudhary who was pursuing Masters in Nursing at Bir Hospital during the first wave. “It is difficult to work in a PPE all day without water or bathroom breaks. I still feel weak and have shortness of breath, but watching people recover keeps us going.”Both Koirala and Chaudhary, however, agree that there is a <a href="https://www.nepalitimes.com/here-now/nepals-frontline-workers-brave-it-out/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/nepals-frontline-workers-brave-it-out/&amp;source=gmail&amp;ust=1622085873678000&amp;usg=AFQjCNG1eSnzgkQ-VmoauOQrzkj_c0eUzA">chronic shortage of medical staff</a> across the country. Hospitals outside Kathmandu and even Covid dedicated institutions are overstretched, and now doctors and nurses are themselves falling sick. In some hospitals, since patients and staff are all positive, nurses and doctors with mild symptoms have just kept working, since there is no one else to take care of the sick.Last week, more than 47 of Dhading District Hospital’s emergency and ward staff were infected with Covid-19, with many of them in isolation and some requiring ICU treatment even as the facility was finding it difficult to source enough <a href="https://www.nepalitimes.com/latest/why-is-there-still-an-oxygen-shortage/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/why-is-there-still-an-oxygen-shortage/&amp;source=gmail&amp;ust=1622085873678000&amp;usg=AFQjCNGkShQk2X-gpsUuQceFplgqsL0bSg">oxygen for existing patients</a>.“We are a hospital of only 8 doctors, 5 paramedics and 23 nurses and with no backup, we were very close to collapsing,” says Medical Superintendent at Dhading District Hospital Tribhuvan Jha, adding that everyone had to be called back to work after 10 days of isolation. “We are in this position due to a lack of preparedness, shortage of staff and limited infrastructure.”At Charikot Hospital in Dolakha, which is also a Covid-dedicated hospital, the majority of coronavirus patients are critical and there is at least one fatality every day. The 17 nurses work three shifts a day, and are unable to handle patient inflow, so the hospital has brought in community nurses from outlying villages. The hospital is consistently reporting a 45% test positivity rate among those tested.“If a majority of our health workers get infected and are in isolation, we have no Plan B and this is especially worrying because we are the sole care provider for Covid here,” says Binod Dangal of Charikot Hospital. “Medical staff are all  overworked, and they do not have any insurance or allowances.”As dire as the situation is in Nepal’s big cities and district hospitals, the <a href="https://www.nepalitimes.com/editorial/nepals-humanitarian-emergency/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/editorial/nepals-humanitarian-emergency/&amp;source=gmail&amp;ust=1622085873678000&amp;usg=AFQjCNE3z3JV_9xnJ0reDy2ABkI8VuY16A">pandemic has now infiltrated rural Nepal</a> where there is just one doctor for every 15,000 people. Kathmandu’s doctor-to-patient ratio is 1:850.In her village of Phediguth of Okhaldhunga district, <a href="https://www.nepalitimes.com/banner/saving-nepali-mothers-on-mothers-day/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/banner/saving-nepali-mothers-on-mothers-day/&amp;source=gmail&amp;ust=1622085873678000&amp;usg=AFQjCNErggt96LmoW-c38IzduDUsayQwIg">Rita Khatri</a> is the only skilled birth attendant. Despite the growing risk of the second wave, she is still performing deliveries and ante-natal check-ups wearing a mask and her single PPE suit. There are no tests of health workers and the public.“We are working despite fears of transmission, I wish we had more PPEs, masks and gloves so that we could conduct more regular check-ups and make home visits,” adds Khatri. “At the moment many people in the community have high fever and are staying at home, but there is no way to test them.” This time last year while in the grip of the first wave of a new pandemic, there was stigma associated with Covid-19 and people who were infected were ostracised in the community. There were many instances where <a href="https://www.nepalitimes.com/here-now/nepal-health-workers-battle-covid-19-but-also-stigma/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/nepal-health-workers-battle-covid-19-but-also-stigma/&amp;source=gmail&amp;ust=1622085873678000&amp;usg=AFQjCNECgLl_SyeWRy6kuDEPnEbsSFoCyQ">healthcare providers were mistreated</a>.Doctors and nurses interviewed for this report say that is still the case, but there is also more praise for frontline medical workers risking their own health to save lives. However, there is growing concern about the worry and over-work affecting the mental health of nurses and doctors.“Among other things we need psychological support and counselling. I have seniors who have children infected with the new variant, and they are having a hard time coping,” says Suman Chaudhary, nursing staff at the Trauma Centre in Kathmandu.As most of Nepal enters the fourth week of lockdown, nationwide daily Covid-19 infections, positivity rate as well as fatalities are going down slightly. The number of recoveries have also risen to nearly equal new confirmed cases on some days.Bayalpata Hospital in remote Accham District had to turn its Emergency Room into a Covid-19 ward last month to cope with a flood of patients. It had 33 patients, 18 of them needing high flow oxygen support. On Wednesday, it had only 12 Covid-19 patients with only two on oxygen. Four of those infected are medical staff. “The situation is easing somewhat here, in Mangalsen, Doti and Dadeldhura. There are beds available, and oxygen is coming in. But we are desperately short of medical staff,” says Mandeep Pathak, a physician at Bayalpata which is also caring for trauma and maternity patients from surrounding districts.However, the cases and the test positivity rate <a href="https://www.nepalitimes.com/here-now/its-an-emergency/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/its-an-emergency/&amp;source=gmail&amp;ust=1622085873678000&amp;usg=AFQjCNHx4NfPYsEDb5xqY31L966E2avOdg">have not gone down as expected</a> and fatalities nationwide have stayed above 160 for nearly two weeks now as the highly contagious and more lethal B.1.617.2 variant spreads rapidly through communities.Health Minister Hridayesh Tripathi sounded optimistic at a virtual press meet on Monday, predicting that there would be a decline in the infection rate in the next four weeks. As Nepal receives large shipments of oxygen cylinders, liquid oxygen, test kits, PPEs and masks, doctors say the emphasis now needs to shift to more testing, mass vaccination, and replenishing exhausted and over-stretched medical staff at hospitals, both in the cities and the districts. A non-profit One Heart Worldwide that works primarily in maternal care in Nepal’s 21 districts has been helping district hospitals by mobilising oxygen cylinders and medical kits it procured from China.<a href="https://www.nepalitimes.com/banner/what-can-be-more-fulfilling-than-saving-lives/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/banner/what-can-be-more-fulfilling-than-saving-lives/&amp;source=gmail&amp;ust=1622085873678000&amp;usg=AFQjCNFzGOK8F0-jy4gwuRmK8iyNBD7AIA">Executive director Surya Bhatta</a> gives three reasons why despite the lockdown the infection rate is still high. “There is virtually no contact tracing, people are still not following health protocols and patients isolating at homes are not doing it right, resulting in a gross underestimation of total cases and fatalities.”		
			<h2>Weddings into hotspots</h2>		
		Gopal Dahal in DhankutaOn 30 April, when a young man in Okhre village in Dhankuta district got married, the whole . The whole community was invited for the feast.But a few days later, the groom suddenly fell sick. When he showed coronavirus symptoms, a test at the primary health care centre confirmed he was <a href="https://www.nepalitimes.com/here-now/its-an-emergency/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/its-an-emergency/&amp;source=gmail&amp;ust=1622085873678000&amp;usg=AFQjCNHx4NfPYsEDb5xqY31L966E2avOdg">Covid-19</a> positive.Now, every household in Okhre village has members showing similar symptoms. Most of them had attended the wedding. Of the 51 people tested, 25 tested positive. “This is a crisis, the pandemic has spread to the whole village now,” says Ward Chair Palak Basnet.One of the guests at the wedding was a man who had returned recently from the Tarai with mild symptoms. He was hired to wash dishes at the wedding, and had died a few days after the feast. No one tried to find the cause of death, and there was no PCR test done. Dhankuta MP Jitendra Rumdali Rai says there are probably many more cases than the ones who have tested positive so far. “The pandemic is spreading out of control here because the municipality wasn’t able to manage it on time,” he adds.Okhre village has now been sealed off till 8 June. Some of those infected are in critical condition, and six who were more serious were taken to hospital in Dharan. It is difficult for the others because the municipality does not have an ambulance, and some who had taken sick relatives to Dharan returned because there were no beds, or it was too expensive. “Initially they were charging Rs10,000 per day for the bed and we paid Rs4,000 daily for the doctor. But then they hiked it to Rs14,700 and I couldn’t pay it any more,” says one patient’s family who returned recently from Dharan’s Bijayapur Hospital.Another <a href="https://www.nepalitimes.com/latest/rural-nepal-fights-back-covid-19/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/rural-nepal-fights-back-covid-19/&amp;source=gmail&amp;ust=1622085873679000&amp;usg=AFQjCNHu0t7Yl9XzW-TA064jBcggx4L-TA">coronavirus</a> patient says ambulances are also expensive, making it hard to get patients to hospitals. Buses refuse to take passengers who are sick.The municipality called an emergency all-party meeting and decided to set up a 10-bed isolation centre with two staff nurses, and a doctor. Talks are underway to get at least a pickup from Dhankuta Red Cross to use as an ambulance.

<figure><img width="1500" height="1000" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111140/636b83bd9c7e80680e067753jpeg.jpg" alt=""/><figcaption>Photo: MONIKA DEUPALA</figcaption></figure>Ever since he was a child, Ramesh* knew he wanted to be a doctor to serve society and "do something good for others". Even now, as an MBBS student at B P Koirala Institute of Health Sciences (BPKIHS) in Dharan, his zeal is intact. As a part of his curriculum, he is required not just to attend lectures but also complete clinical postings. And that is what he was doing till a few days ago when he tested positive for Covid-19."I started feeling unwell during the exams, and took a PCR test. The result came out positive. I have been isolating since," Ramesh told us on the phone from Dharan.In January, when the government announced the priority list for the <a href="https://www.nepalitimes.com/banner/nepal-begins-covid-19-vaccination-drive/" target="_blank" rel="noopener noreferrer">first round of Covid-19 vaccines</a>, medical interns and doctors were on it. Many admin staff working in the hospitals also qualified for the jab. However, missing from the list were medical students who work in close proximity with the patients as a part of the curriculum. BDS and MBBS students have to do ward and clinical postings in their third, fourth and fifth years. Nursing students too have hands-on training as part of their course work."We all know that wearing a mask is one of the best precautions we can take against Covid. But as dental students, we need to treat patients when they are not wearing masks. The risk of exposure is the same for us as the interns, yet we did not get the vaccine," says a dentistry student from BPKIHS, whose friend recently tested positive as well.<a href="https://www.nepalitimes.com/opinion/masks-and-vaccines-to-stop-nepals-2nd-wave/">Masks and vaccines to stop Nepal’s 2nd wave</a>, Sushil KoiralaAfter the first lockdown, BPKIHS like many others <a href="https://www.nepalitimes.com/latest/face-to-face-classes-online/" target="_blank" rel="noopener noreferrer">conducted classes online</a>. However, as the country opened up slowly, clinical postings for fourth year students started from 1 December. While they conducted PCR tests for those seeking admission in wards, those coming to the Out Patient Department (OPD) could not be monitored. "Even in wards, although patients were tested the same was not true for the visitors," says a final year medical student at BPKIHS. According to the students as many as 25 of these colleagues have tested positive over the past few months. Students say they have talked with the school administration, but were told there was no government protocol to get them the vaccine. Medical students from other schools that Nepali Times spoke to shared similar stories. "We would be a little more confident if we were vaccinated," says a medical student from Birat Medical College in Biratnagar. "It is not just about us being exposed or working, we have lost a lot of valuable time in terms of our course work.” After the first lockdown, classes here went online and the practical classes were conducted without hospital exposure. "But after the third year finals, we were called for clinical postings," says the student. "Maybe they could have given us the vaccine and we could continue with our classes."It is not just the students, new interns who recently graduated, have entered, or are soon entering the workforce were also left out.<a href="https://www.nepalitimes.com/banner/nepal-fights-infodemic-to-push-vaccine/"> Nepal fights infodemic to push vaccine</a>, Sonia AwaleGita* is a medical student at Kathmandu University's medical school recently passed her final exams, and is starting her internship. Even though she and friends were omitted from the priority list last year, she was planning to get the <a href="https://www.nepalitimes.com/latest/the-gift-of-the-jab/" target="_blank" rel="noopener noreferrer">Vero Cell jab</a> this time around. Poor planning and overcrowding prevented her from getting vaccinated, then she had to return to school to start her internship. "New interns who just started last Saturday were left out from the list," says an intern coordinator at a medical school in Biratnagar. "Students don't get the same level of protection as the faculty. We have talked to interns about safety measures and precautions. And we are also looking into simulation-based teaching for practical classes.”It is not just for the safety of students but the patients as well that the students and new interns need to be vaccinated. When they are vaccinated, they can ensure that the patients are not going to get infected through the ones who are treating them, say the students."While the vaccines may not work against the new variants and there are chances of being infected even when you are vaccinated, the severity of symptoms is less," says an intern doctor who tested positive after the second jab.With the lockdown on 28 April, medical schools have also now suspended classes. Trainee doctors in India are being pulled from the exams to work on the frontline, and Nepal’s medical students may have to do the same. "Maybe keeping this in mind, they could still give this a serious consideration and vaccinate the students and new interns," says a final year student at BPKIHS.Spokesperson for Ministry of Health Jageshwor Gautam, however, says that young people are still not a priority. "We are aware of the situation,  the reason medical students didn't get vaccines is because there are just not enough doses." Asked if medical students will be given priority once new vaccines arrive, Gautam replied flatly: "People above 60 years are still a priority. Everyone else comes after that."*Some names have been changed or withheld for privacy reasons.

Medical students deprived of Covid-19 vaccines

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110915110/636bb29f9c7e80680e07baf2jpeg.jpg" alt="" width="2048" height="1366"/><figcaption>Photo: BIKRAM RAI</figcaption></figure>Nepal reported the first death of a medical worker from Covid-19 last week, a 35-year-old health assistant in Mahottari district. Across the country, over 500 <a href="https://www.nepalitimes.com/here-now/nepals-frontline-workers-brave-it-out/" target="_blank" rel="noopener noreferrer">healthcare providers</a> including doctors, nurses and lab technicians have tested positive for SARS-CoV-2.But instead of crediting them for putting their own lives on the line at the frontlines of the war against the pandemic, heath workers in Nepal <a href="https://www.nepalitimes.com/here-now/overseas-nepalis-on-the-covid-19-frontlines/" target="_blank" rel="noopener noreferrer">are being ostracised</a>, publicly humiliated, and sometimes threatened by landlords and neighbours who fear that they will spread the virus.Even as they battle community transmission, in many cases it is the community itself that has turned against <a href="https://www.nepalitimes.com/here-now/overseas-nepalis-on-the-covid-19-frontlines/" target="_blank" rel="noopener noreferrer">medical personnel</a>.Over 20 staff at Bayalpata Hospital in Achham district have tested positive for Covid-19 in the last month, and all are currently isolated in the facility’s staff quarters because landlords have driven them out of their rented rooms in town.“The government has directed asymptomatic people to isolate themselves at home, but this shows just how difficult this is in reality,” says Bikash Gauchan, a doctor at Bayalpata. “It is harder to fight society than Covid-19.”Gauchan himself was in isolation after a previous outbreak and tested negative, but on a recent trip to the market to buy grocery, the shopkeeper stopped him from entering just because he worked at the hospital.At the Patan Academy of Health Sciences, the newly appointed director Rabi Shakya gets resignation letters from staff every day, and the reason cited by everyone of them is because of community harassment, or due to family pressure.“Health workers are already working in less than ideal conditions, they are not properly equipped, are overworked and have no incentives. Many don’t even have family support,” says Shakya. “They are risking their own health for the public, but when that very public turns against you, it is very painful.”Shakya says many younger doctors are now rethinking their decision to work in the medical field in Nepal. He adds, “Societal stigma stems from ignorance, and it means we have failed to communicate to the public how the virus is transmitted. Even some health workers themselves are not fully aware.”Says epidemiologist Mahesh Maskey: “It is ironic that these brave workers are receiving abuse from the very people they are protecting. I am surprised by how the psychology of fear has led us to do this, and I urge everyone to change their mentality.”https://youtu.be/6-IvZtDfPmYThe flood of positive cases in Kathmandu and other cities in the past month has led to public panic about Covid-19, and this is turning people against those who are self-isolating at home, or those working at close quarters with patients.Experts partly blame the relentless media focus on the daily case totals and fatalities, instead of the recovery rate, Nepal’s relatively low death rate, and the precautions the public needs to take. This has fed the notion that Covid-19 is highly lethal, fuelling the irrational fear.On Tuesday, Nepal recorded 1,069 new confirmed cases, 481 of them in Kathmandu Valley alone. There were 11 additional deaths, bringing the total to 239. However, what was buried in the news reports was that Tuesday also saw 768 recoveries, highest in a single day bringing the total recoveries to 22,178.Some doctors have retorted on social media with messages for those who stigmatise health workers, saying they should also think about who is going to save their lives when they find themselves in the ICU.Amidst the gloom and doom, there are glimmers of hope. Nepal Scouts, Nepal Medical Association and Higher Institutions and Secondary Schools' Association Nepal in coordination with the Ministry of Health have started a free bus service for medical personnel inside Kathmandu Valley to take them to and from hospital and their homes.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110915110/636bb2a29c7e80680e07baf3jpeg.jpg" alt="" width="800" height="450"><figcaption> </figcaption></figure>Charities are offering free daily meals for those without any source of sustenance. In Biratnagar, local youth groups are helping rehabilitate Covid-19 patients who have recovered (see below). And there are communities which have honoured medical frontline workers who live in their midst, saying they are true heroes.However, these are exceptions. Anisha Shakya, a medical officer at International Friendship Children Hospital says she and her colleagues are already working with limited equipment and resources, and the harassment heaped on health workers is stressful.She adds, “What would build morale is positive reinforcement, emotional support in this difficult time and more tolerance on the part of the public.”<h2>Youth help</h2>Kamal Rimal in Biratnagar<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110915110/636bb2a49c7e80680e07baf4jpeg.jpg" alt="" width="800" height="416"><figcaption> </figcaption></figure>Worried by the ostracisation and harassment of even those who have recovered from novel coronavirus infections, youth groups in Biratnagar have taken it upon themselves to help in their reintegration into society.They conduct home visits, sanitise homes and help with the management of funerals. Bargahi Youth Group recently helped perform the funeral of an individual who had passed away due to coronavirus in Birat Hospital, and who was shunned by relatives and the community. The entire team is now in quarantine. High Court Biratnagar recently ruled that the final rites of Covid-19 victim should be performed by the families, or as per their wishes.When a person was infected in Ashok Chok recently, locals blocked off the streets preventing residents from commuting.Nepal Communist Party Biratnagar Ward 8 committee chair Ram Pokhrel says increased fear of coronavirus in the community and the resulting societal stigma has forced his office to scale up the campaign.“We are sanitising homes among other things in order to prevent more incidents like this from happening in the future. But first and foremost, we need to change the way society thinks,” says Pokhrel, adding that even well-educated neighbours who are engineers and school principals were against the presence of infected individuals in the community.In its home visits and sanitisation campaign, the group tries to inform locals that the virus does not transmit if sufficient distance is maintained. They have also distributed masks, gloves, sanitiser and food rations to 54 households.Biratnagar Municipality members are also making home visits with immunity-boosting Ayurvedic herbs for those in self-isolation, and help them eventually reintegrate into society by boosting their morale.Former chair Binod Raut says he has sanitised about 70 houses with his own money: “Coronavirus is now spreading in the community. We are going house to house, informing people about how the virus spreads and sanitising the homes of infected people.”

Nepal health workers battle Covid-19, but also stigma

<figure><img width="825" height="460" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109141132/636bac7d9c7e80680e077f35jpeg.jpg" alt=""/><figcaption>Kanchan Bista at the government lab in Dhangadi says she wears three menstrual pads at once so she does not have to go frequently to the bathroom to change.</figcaption></figure>Until the COVID-19 crisis hit Nepal, the phrase ‘frontline health worker’ mainly referred to the 55,000 Female Community Health Volunteers (FCHVs) who form the backbone of the country’s rural health service for vaccinations and mother-child survival.With the pandemic, it has now come to mean doctors, staff nurses, hospital staff, counselors, health assistants, and even security personnel who are on the trenches at the frontlines enforcing rules, doing surveillance and detection, lab technicians, staffing quarantine centres, isolation wards and the medical personnel taking care of critical cases.Frontline health workers are exposed to massive viral loads, and so far 20 health workers and 12 security personnel have tested positive for a virus that they have been fighting in the public. Returnees from abroad have gone back to their homes, and with the threat of community transmission, Nepal is falling back on its <a href="https://www.nepalitimes.com/latest/enlisting-female-health-volunteers-to-fight-covid-19/" target="_blank" rel="noopener noreferrer">FCVHs for house-to-house surveillance and counseling</a>.Besides the constant risk of being infected, frontline workers have other woes: overwork, the lack of adequate personal protective equipment (PPE), extra allowance the government promised in March that has not arrived, the threat of eviction by stigmatisation by landlords has forced many to move to hotels.        <a href="https://www.nepalitimes.com/here-now/protecting-those-who-protect-us-from-the-epidemic/">Protecting those who protect us from the epidemic</a>, Ramu Sapkota"The workload is very heavy with 700 to 800 samples to be tested daily,” says Sanjay Chaudhary, a microbiologist at the Surkhet Provincial Hospital lab. “Some of us work in the PCR testing laboratories from six in the morning till two in the morning.” <figure><img width="1100" height="731" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109141132/636bac7f9c7e80680e077f36jpeg.jpg" alt=""><figcaption>Microbiologist Sanjay Chaudhary at the lab in the Provincial Hospital in Surkhet says it is difficult to work all day wearing a PPE, mask and gloves and sweating inside.</figcaption></figure>Chaudhary says it is difficult working in full PPE with mask, gowns, gloves and visors, and they are dripping with sweat inside. He tries to drink as little water as possible because going to the bathroom is such a ordeal.Ananda Mandal at the government lab in Dhangadi says he even wears an adult diaper so he does not have to keep going to the bathroom in his PPE. A throat and nasal swab of a patient takes up to six hours to give a result, and sometimes they need to be re-tested to confirm the result. Healthcare personnel like Mandal have to be in their PPE throughout, without drinking, eating, or going to the bathroom in the humid heat of the Tarai.Till 7 July, Nepal had 15,964 people testing positive for coronavirus with 9,118 in isolation.<a href="https://www.nepalitimes.com/here-now/bhutan-refugee-to-coronavirus-care-giver/">Bhutan refugee to coronavirus care-giver</a>, Gopal GartoulaAnother 29,700 are in quarantine centres, and there have been 35 fatalities. Fortunately, there have not been big numbers of critical COVID-19 cases needing ICU treatment or ventilators. This means the frontline workers most under pressure are lab technicians.At the COVID-19 laboratory in Bhaktapur Hospital, Nitu Adhikari says the general public has little understanding of how difficult working in a lab is. She says, “Some men wear diapers, some cut an opening in their PPEs when they have to use the bathroom and then seal it with tape afterwards. It is so difficult to get in and out of the gowns.” <figure><img width="1050" height="645" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109141132/636bac829c7e80680e077f37jpeg.jpg" alt=""><figcaption>Nitu Adhikari at Bhaktapur Hospital says the public has little idea how difficult it is working in a coronavirus lab.</figcaption></figure>All this stress and irregular eating exposes health workers to dehydration which can also lead to health problems. "When we watch the news about so many new PCR tests were done nationwide, let us give a thought to the frontline workers who put themselves at risk not just of infection but also long-term complications to carry out those tests in difficult conditions,” says health workers Radha Poudel in Jumla.A microbiologist working in a laboratory in Province 1 has diabetes, which puts him in a high risk group for COVID-19 infection. He needs to drink lots of water, and needs to use the bathroom frequently. But for the past three months, his meals have been irregular and he suffers from dehydration.“Even under normal circumstances, we do not work more than five hours at a stretch, and if they have to go to the bathroom, they have to change into another PPE,” says Runa Jha at the National Public Health Laboratory in Kathmandu.<a href="https://www.nepalitimes.com/here-now/overseas-nepalis-on-the-covid-19-frontlines/">Overseas Nepalis on the COVID-19 frontlines</a>, Upasana KhadkaHowever, this guideline is hardly ever put into practice. Most health facilities have barely enough PPEs for healthcare personnel, let alone to change in and out of during breaks. There is also the lack of testing kits, or improper and unreliable kits that give the wrong results.  Radha Poudel says the government has not paid attention to the problems faced by healthcare personnel despite the global focus on frontline workers. As a menstrual hygiene activist even before the coronavirus pandemic, Poudel is especially concerned about female health workers who have specific problems working in hospitals and labs during their periods.Kanchan Bista, a medical technologist at the government testing lab in Dhangadi says she wears three menstrual pads at once so she does not have to go to the bathroom to change. “It is very difficult to change and often there is no new PPE to get into afterwards,” she says.  Nitu Adhikari says the government has to ensure adequate PPEs so that lab technicians, doctors and nurses do not have to wear PPEs for long stretches. She adds: “There also have to be enough PPEs, diapers and pads for us to use. These problems need to be addressed so that those working on the frontline are comfortable and safe."Read also: <a href="https://www.nepalitimes.com/here-now/post-pandemic-mental-health-epidemic/">Post-pandemic mental health epidemic</a>, Sonia Awale

Nepal’s frontline workers brave it out

One smoggy winter morning in February 2019, Ekta regretted coming to her sculpture class. It was the first day of her period, and the 19-year-old wished she was home, curled up in bed with a hot water bag to soothe her cramps.
Her class was at Kalapremi Ceramic Studio, a dark room on the ground floor of a house in Maharajganj, and Ekta’s teacher was the artist Gopal Das Shrestha ‘Kalapremi’, a noted sculptor.
Two other students were already there, using all their muscle strength to knead the sculpting clay. Ekta, now 24, recalls how Kalapremi asked her if she was feeling all right. She avoided him, as she did not want everyone to know she was menstruating.
Kalapremi repeatedly asked Ekta what was wrong. She finally muttered that she was having her period, after which he grabbed her hand and led her to a partitioned corner of the studio and sat her on a chair. Before she could stop him, he slid his hand under her dress, and started massaging her abdomen.
“I was horrified,” Ekta recalls. “I told him to stop, but he didn’t listen, asking me not to be shy, saying he knew how to relieve my pain. He stopped only after I protested furiously.”&nbsp;
The art tutor then said, “You’re like my daughter. I’m doing it out of love to make you feel better, but you’re so stubborn.”&nbsp;
“Instead of saying sorry he acted like I was the one having crazy thoughts,” remembers Ekta, adding that from April 2016 to August 2020 beginning the time she was 16, the artist sexually abused and harassed her on several occasions. &nbsp;
Now, Ekta and the artist’s other former students are finally sharing their experiences and some are pressing legal charges against him, hoping that others do not have to endure what they did.&nbsp;
Award-winning artist and teacher Gopal Das Shrestha ‘Kalapremi’ (the name means ‘Art Lover’) is known for his ceramic art, sculpture, and contemporary pottery. He was <a href="https://nepalitimes.com/review/the-house-of-kalapremi">profiled in Nepali Times after a collaborative exhibition</a>, ‘Where the Wild Things Are’ at the Siddhartha Art Gallery three years ago.&nbsp;
His pieces, titled Gaalis, featured sculpted female figures with the heads of dogs, sheep, and donkeys (pictured) to depict derogatory terms for women. Some critics said the collection was a satire on feminists.
Kalapremi started his artistic and teaching career in 1983 and over the years taught at Bhanubhakta School, Kathmandu University School of Arts, Lalitkala Campus and at his private Kalapremi Ceramic Studio. He has also lectured at Jeonju University in South Korea and recently at Tabor Academy in the United States.
Seven of Kalapremi’s former students were interviewed for this story. Five female students said he touched them inappropriately in his studio or at Kathmandu University. Two male students said they witnessed him abuse and harass the women. In all cases, the students struggled to recognise the abuse when it occurred, and the lack of reporting systems left them to cope on their own for years.&nbsp;
Earlier this year, students shared a social media post hinting at Kalapremi’s history of abusive behaviour following which more students of the artist reached out sharing similar experiences. Some students spoke of abuse that happened as long as 20 years ago.
Kalapremi, 60, has denied the allegations. He told Nepali Times: “Some years ago, there was a movement encouraging people to hug and kiss. I used to do it purely out of friendship and love. But after seeing posts on social media last year calling out my behaviour, I realised my actions may have hurt some people. I understand now that I should have been more mindful.”
He added: “I am also an auxiliary health worker, so I know the exact points to massage to relieve menstrual pain. It’s not just menstruation, I take anyone who is ill to the hospital.”
Sexual abuse is much more rampant than reported given how difficult it is to prove it in court. The law defines sexual abuse as occuring when someone touches another’s private parts, coerces them into touching theirs, uses vulgar language, shows degrading images, or behaves indecently towards them without consent.&nbsp;
Ekta and her fellow students are consulting lawyer Suneeta Regmi Pokhrel, who says they know that even if the court decides in their favour, it is difficult to survive after speaking up, and influential men defend themselves saying they are being framed.&nbsp;
“They are in a lot of pain and weep when recalling how he abused them,” Regmi Pokhrel told us. “They are angry and have filed a case against him, but they are also terrified. They know he is a powerful man and they have seen how our society treats women who speak up against abusers. Unless people speak up, perpetrators will be emboldened.”
Art and academia in Nepal simply reflect the power imbalances in society where people with intersecting identities experience worse forms of abuse. Theatre actors Raj Kumar Pudasaini, Rajan Khatiwada, and Sunil Pokhrel were called out during the #MeToo movement in the Nepali theatre scene in 2019. Even after the allegations Pokhrel went on to receive national awards, while others continued to work without repercussions.
“If you speak up against abusers, you gradually get sidelined from projects,” explained a theatre artist who wished anonymity fearing professional setbacks. “The theatre scene in Nepal is quite small, you just have to make peace with the perpetrators and work with them if you want to sustain yourself.”&nbsp;
In academia there is a history of faculty members sexually harassing students and getting away with it. After Tribhuvan University (TU) lecturer Krishna Bhattachan was accused of harassing women students, the university said it would follow Nepal’s sexual harassment law and set up a reporting mechanism. But nothing happened to the professor, who had already retired. Instead, he counter-accused the students of 'attacking the indigenous people’s movement with baseless allegations' as <a href="https://kathmandupost.com/letters/2019/01/29/bhattachan-responds">he told the Kathmandu Post in 2019</a>. He continues to be featured as a prominent speaker including at TU.
Other faculty members previously accused of sexual harassment include Jagadish Murti Koirala from TU, Bishnu Prasad Acharya from Ratna Rajya Campus, and Bodha Raj Tripathee from Lalitpur Madhyamik Vidhyalaya. A woman staff member from TU also filed a sexual abuse complaint against Dambar Chemjong from TU.
Prominent figures like <a href="https://nepalitimes.com/news/the-rise-and-fall-of-nims-purja">mountaineer Nims Purja</a> have been <a href="https://www.nytimes.com/2024/05/31/sports/mountaineering-sexual-harassment-abuse-nims-purja.html">accused of sexual assault</a>, and cricketer Sandeep Lamichhane, actor <a href="https://nepalitimes.com/news/celebrity-rape-case-spotlights-nepal-laws">Paul Shah</a>, and former speaker of Parliament <a href="https://nepalitimes.com/news/mahara-arrested">Krishna Bahadur Mahara</a> have been accused of rape, but society-at-large has let off the alleged perpetrators amdist a larger debate about justice for survivors and punishment of perpetrators.&nbsp;
‘Gaushala-26’ is the court name given to the 18-year-old who accused Sandeep Lamichhane, former captain of Nepal’s national cricket team and skipper of Biratnagar Kings in the <a href="https://nepalitimes.com/here-now/here-comes-the-nepal-premier-league">ongoing Nepal Premier League</a>, of rape. She left the country citing society questioning her character affecting her mental health while Lamichhane got an outpouring of support. In May, the Patan High Court overturned a prior verdict that found Lamichhane guilty of rape and had sentenced him to eight years in prison. During the 23-month legal battle to pursue justice, Gaushala-26 faced threats of gang rape and acid attacks.&nbsp;
Exhausted by the struggle, Gaushala-26 sought to “move to a new world” where she could live free without hiding her identity.
Actress Samragyee Rajya Laxmi Shah in an Instagram video now deleted detailed the harassment she faced from a filmmaker during a movie shoot. She did not name any name but veteran actor Bhuwan KC filed a defamation case against Rana, but the court ruled that the charge lacked sufficient evidence.&nbsp;
Former Kathmandu mayor <a href="https://nepalitimes.com/opinion/theytoo">Keshav Sthapit also mocked the #MeToo movement</a>, calling accusations against him by journalists Rashmila Prajapati and Ujjwala Maharjan “a rape of men’s rights”.
Serial Abuse
Back at the Kalapremi Ceramics studio, another former student, 24-year-old Rajiv, says he felt the need to speak out after seeing his female classmates being abused.&nbsp;
“He frequently kissed them on their cheeks,” he told Nepali Times. “Whenever they walked into the studio he flailed his arms like a child asking for a hug. They awkwardly hugged him from the side, but he pulled them closer, held their chin, and kissed their cheeks.”&nbsp;
Rajiv says he also saw Kalapremi pull the women’s bra straps, touch their breasts, and slap their buttocks. The young students would freeze, not knowing how to react, and if they protested, he would say it was “normal in art”. Rajiv, 19 at the time like his classmates, remembers thinking perhaps the well-respected artist was right after all.
Another student, Luna, who took lessons at Kalapremi’s studio from 2020 to 2022 did try to confront the tutor after he made an obscene proposal to her. She recalls: “One day when the other students had left the studio and it was just the two of us, he told me that God had given him special artistic talent and he could transfer those powers to me. But to do that both of us will have to be naked, inside a dark room, and have sex.”
Luna, who was 18 then, was livid and told him she did not want any of his powers, but she says he laughed at her as if he was joking. She did not tell her family about the incident because she thought no one would believe her.&nbsp;
“They were all in awe of this famous artist and felt I should be grateful that to be learning sculpting from him,” she says. “I was scared to be alone with him in case he talked about sex again. My coping mechanism was to be rude so he wouldn’t try to come close to me.”
Seeing how some classmates were standing up to Kalapremi, Ekta too tried to push back against his advances, but she said he found ways to coerce her. Since Ekta, Rajiv, and Luna could not afford Kalapremi’s Rs30,000 monthly fee for lessons, he had offered them all a stipend to assist him in the studio.
“He had spondylosis and took me to his therapy sessions to learn massage techniques, then he often made me and other students massage him,” says Ekta. Whenever she refused, he would feign pain to make her feel sorry for him. “He would insist that I put my hands under his shirt so that I could massage him better,” she adds.
The art tutor often tried to “seduce sympathy” from Ekta by sharing how he had never been loved as a child and was “sexually frustrated” as an adult.&nbsp;
“At 7PM, he would pour himself Signature whiskey and immediately go off again about how he was sex-starved. I didn’t know how to respond. It took me time to realise alcohol was just an excuse to talk about sex,” Ekta says.
If convicted, Kalapremi could face financial penalty and/or a prison sentence of up to three years according to Section 224 of National Penal (Code) Act 2017.&nbsp;
Data suggests that victims of child sexual abuse on average take nearly 24 years to tell someone about their trauma, and some may never disclose it at all.&nbsp;
“In our culture, children are rarely taught about boundaries. They often react, show anger when adults pinch their cheeks. But adults insist they did it out of love, and force the children to accept it,” says Sita Lama, a psychotherapist at Manka Kura. “And even when someone touches them inappropriately they struggle to identify and verbalise it.”
When perpetrators claim to be “acting out of love”, Lama says survivors are likely to perceive it as something safe, rather than recognising it as abuse.&nbsp;
“It may take years for them to realise they were abused,” she explains. "And even when they become aware, the power imbalance with the abuser and the associated shame often prevents survivors from speaking up."
Other former students from the School of Art at Kathmandu University have also come forward years later, saying Kalapremi sexually abused them. As young adults, they felt his behaviour was off but were uncertain if it was inappropriate, illegal, or they did not know how to respond. After having understood that it was indeed abuse, they say they are speaking out now to protect others.&nbsp;
Amina Singh, a visiting faculty member at Kathmandu University, says there is no clause against sexual abuse in contracts of teachers, and there is no formal grievance handling mechanism for the students.&nbsp;
“So the only way students can to deal with sexual abuse is approach someone they trust,” she says.
Eight other former art students of Lalit Kala Campus and Srijana College of Fine Arts of Tribhuvan University and other private art studios in Kathmandu say they were also sexually abused by their art teachers. Three faculty members interviewed from these institutions said they saw the abuse, but felt it was futile to report it given how powerful the teachers were.
In the absence of a formal system, some longtime women artists warned each other about “problematic” artists. They shared &nbsp;a “heads-up” to be more cautious when collaborating with them, and avoided responding to their calls and texts after work hours.
To ensure art institutions are safe for all, galleries, museums, artist studios, and smaller art spaces need to develop policies on sexual harassment. This would include a code of conduct or studio policies that hold the leadership accountable and outline the principles of professional ethics.&nbsp;
Students and employees should inquire about accountability mechanisms for raising concerns, both formally and informally, advocates say.
Three years after Ekta left the ceramics studio, she learnt that Kalapremi had harassed many other women. Still trying to get a footing in the art industry, she attended a workshop in Kathmandu where women artists discussed ways to stay safe in the art sector.&nbsp;
Since it was a close-knit group Ekta opened up about how she felt violated and realised she was not alone, he had been abusing underprivileged students for years, and this was common knowledge among artists in Nepal.
Ekta says that even after she quit, Kalapremi continued sending her text messages like ‘I am thinking of you’, ‘Why have you stopped speaking with me’, or ‘I am waiting for your call’.&nbsp;
But what really forced her to act was when Ekta found out that he was sending similar texts to her younger sister.&nbsp;
“I’ve had enough,” she told us. “He abused me all these years but I won’t let him abuse my sister.” &nbsp;
Ekta, Rajiv and Luna are not the real names of the students.&nbsp;

‘Art Lover’ accused of sexual abuse

It was 8:15 in the evening of 25 March 1968 when everyone in the village of Batulechaur near Pokhara heard a deafening sound like thunder as a bright flashing object hurtled down to land in a field.&nbsp; That field belonged to Kul Timilsina, and the next morning he retrieved a sheet of metal about 2m by 1m and carried it home with the help of a few others, thinking it would be useful for his buffalo shed.&nbsp; Before he died at age 83 three years ago, Timilsina had told photo archivist Sunil Ulak that the black metal sheet was not rectangular and had rounded corners. There are a few witnesses still alive who have a clear recollection of the object that fell from the sky that night.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2024120707128_75cc85aac56b9cc4a77366471f058d7b3eb6868776811b0923845c2d0a61f014.jpg" data-media-id="editor_0" data-image-id="2024120707128_75cc85aac56b9cc4a77366471f058d7b3eb6868776811b0923845c2d0a61f014" data-rendition-name="original" width="1170" height="601" loading="lazy" alt="UFO over Pokhara"> <figcaption>The field in Batulechaur belonging to Kul Timilsina where fragments of a flying object fell from the sky in 1968.</figcaption> </figure>  One of them is Timilsina’s wife Gyanu, who was 22 at the time. She had been at home, and remembers hearing the big bang and the sky becoming very bright. “We saw the thing in the field in the morning,” she told us. “It looked like a lid, a covering of some sort. The way it was stuck in the ground, it must have fallen from the sky. We thought we could use it to dry clothes on, and took it home.”&nbsp; Another witness is Kul Narayan Paudel. “I was only eight then. We ran to the field to see what had fallen. It was a four-sided metal sheet. The elders took it away, and I don't know what happened to it.” &nbsp; Ram Bahadur Baniya, a teacher at the local school, says he had heard the sheet had been brought to the school, and later handed over to the Zonal Commissioner at the time, Nanda Prasad Malla. “But that is all hearsay,” he says.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2024120707128_0bf207a12063fb8155b3c8d9a00a94887b126380c9e0627527c84cf5e1101f54.jpg" data-media-id="editor_1" data-image-id="2024120707128_0bf207a12063fb8155b3c8d9a00a94887b126380c9e0627527c84cf5e1101f54" data-rendition-name="original" width="1170" height="610" loading="lazy" alt="UFO over Pokhara"> <figcaption>Gyanu Timilsina, wife of Kul Timilsina.</figcaption> </figure>  There are two versions of what happened to Kul Timilsina’s metal sheet. One is that an American Peace Corp Volunteer teaching at the nearby Bindyabasini School took it, and another is that it was handed over to the government. Recently declassified Central Intelligence Agency (CIA) and US State Department documents from the time say that the US Embassy in Kathmandu tracked down the object two years later and had it shipped back to the US. A telegram from the Department of State and Department of Defense tagged as ‘MOON DUST / Space Fragments’ dated 1 March 1972 stated: ‘1. Restored space fragment will be on board Embassy support flight 115 arriving Kathmandu on or about March 10. Fragment is packed in shipping crate (cargo no. 72-33365) marked in care of DAO.&nbsp; 2. State and Defense representatives examined fragments prior to shipment finding restoration acceptable.’  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241207071212_929d903ee06d41baa4f6040e981cd7c7d7bd75cc9c37c9b617d307fc8538d2df.png" data-media-id="editor_2" data-image-id="20241207071212_929d903ee06d41baa4f6040e981cd7c7d7bd75cc9c37c9b617d307fc8538d2df" data-rendition-name="original" width="856" height="568" loading="lazy" alt="UFO over Pokhara"> <figcaption>Declassified CIA documents about the investigation into the object sighted in Pokhara. </figcaption> </figure>  The documents show that the US government, military and intelligence agencies investigated this incident thoroughly when it occurred, and have continued to revisit it ever since, as recently as five years ago. What is even more intriguing is that the object that fell in Pokhara was not the only unidentified space object that fell to earth that year. There were similar sightings of objects falling from the sky in Ladakh, Sikkim and Bhutan between 19 February and 25 March 1968.&nbsp; These mysteries were the subject of a CIA investigation in 1968 titled ‘<a href="https://www.cia.gov/readingroom/docs/CIA-RDP81R00560R000100070007-8.pdf">Sighting of Unidentified Flying Objects in Ladakh, Nepal, Sikkim and Bhutan</a>’, and the report is part of the recent online declassification of 800,000 top-secret documents from the period.&nbsp; &nbsp;Although unidentified flying objects (UFOs) have a connotation now of being alien craft, it could be pieces of satellite, missile, rocket or even aircraft. The CIA report documents six sightings in 1968 and quotes local sources as describing all of them having similar characteristics: bright blue or red streaks in the sky accompanied by loud sounds like lightning and thunder and objects falling to the ground. Aside from the metallic object that was found in Batlechaur, there were other items also found nearby in Tallakot, Tureypasal, Armalakot and Maidan. Whatever the object was, it seems to have disintegrated even before it hit the ground.&nbsp; The CIA report records the first sighting on 19 February 1968 in various parts of Sikkim and Olangchung Gola and Ghunsa in eastern Nepal. The light was said to be ‘long and thin’ and giving out ‘green and red light’. &nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241207071212_c3c825027d966a2aedc846970390eebe063957503c7eacc8e01e0517843f9bbb.png" data-media-id="editor_4" data-image-id="20241207071212_c3c825027d966a2aedc846970390eebe063957503c7eacc8e01e0517843f9bbb" data-rendition-name="original" width="892" height="596" loading="lazy" alt="UFO over Pokhara "> </figure>  Two days later on 21 February, a soundless blue object was seen traveling fast across the sky above Thimphu in Bhutan. Then on 4 March there were multiple daytime sightings or white streaks in the sky at Chang La Pass, Fukche and Koyul in Ladakh. There were more sightings in Ladakh on the very day fragments fell near Pokhara on 25 March 1968.&nbsp; After the sightings in Pokhara, rumours started flying in Kathmandu that these were aliens trying to land on Earth, it could be Russian or Chinese spy planes or satellites, and some even say it as a sign from heaven that the end of the world was near. This was at the height of the Cold War. The Russians and Americans were testing their thermonuclear devices as well as intercontinental ballistic missile delivery systems. The Washington-Beijing rapprochement had not yet happened, and China was making quick progress testing atomic bombs. Within two years after its first atomic test, in 1966 China exploded its first hydrogen bomb at the Lop Nur site in Xinjiang, 3,000km to the north from Nepal. After neary six decades, what is still intriguing is that all the sightings within a few months of each other in 1968 were along the Himalayan arc bordering Tibet: from Bhutan, Sikkim Nepal, to Ladakh. The US military intelligence seems to have concluded that this was not a coincidence and there were frequent research trips to the site in Pokhara by American officials in the months after the incident. With the help of the Royal Nepal Army, the region north of Pokhara was thoroughly searched.&nbsp; A confidential memo dated 25 June 1968 by Jerry C Trippy to a ‘Mr Farley’ mentions that the US Air Force’s Foreign Technology Division had decided that the debris could be important because it may be related to a Chinese missile test or a Soviet ‘Vehicle Venik’ rocket.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241207071216_feb5425692dc36b20187de4e4fcc2ce9fd12b6d9e1b8724398e50bcdbf9032fe.jpg" data-media-id="editor_5" data-image-id="20241207071216_feb5425692dc36b20187de4e4fcc2ce9fd12b6d9e1b8724398e50bcdbf9032fe" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="UFO over Pokhara"> </figure>  On 28 August 1968 the US Embassy in Kathmandu sent a letter to Washington DC saying that the object could be of Soviet origin, possibly from when the rocket carrying the ‘Kosmos 208’ satellite re-entered the atmosphere. But why were the fragments falling to earth several weeks apart, and in the same region? No one knows where the metal sheet that Kul Timilsina recovered is now. It was definitely packed in a crate and taken to the US, and although it is rumoured that it was returned that is not very likely. Archivist Sunil Ulak heard from the Timilsina family that CIA officials had returned to the site five years ago. &nbsp; Interest in UFOs peaked in the US in the 1950s, with the Cold War space race and tests of atomic weapons and delivery rockets. CIA and scientists were being sent to investigate sightings, both publicly and privately. Could the Pokhara fragments as well as the sightings in Ladakh and Bhutan actually be alien craft falling to earth? The renewal in interest in space travel in large part due to Elon Musk’s SpaceX, UFOs and sightings are again subjects of public interest.&nbsp; Even 57 years later, even if there was definitive proof about whether the Batlechaur fragment was from a Chinese missile or a soviet rocket, it has not been made public in documents declassified so far. We may never know.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241207071216_b6938795f40731e7657fd6dcbb3cf460a326186a15eb11d4f832f602201ff598.jpg" data-media-id="editor_6" data-image-id="20241207071216_b6938795f40731e7657fd6dcbb3cf460a326186a15eb11d4f832f602201ff598" data-rendition-name="original" width="642" height="320" loading="lazy" alt="UFO over Pokhara"> </figure>  Sunil Ulak speculates if the debris actually came from an American aircraft, perhaps on an intel mission upon China. “Which could explain why they were so thorough in collecting the fragments in Pokhara,” he says. But that still does not explain the multiple sightings weeks apart in 1968.&nbsp; Indeed, US military aircraft were at that time flying frequent night-time missions from air force bases in India to supply weapons to Khampa guerrilla camps in Nepal located north of Pokhara in Mustang. It could very well be that the Chinese shot down one such aircraft. The other sightings could have been contrails of US spy planes, or Chinese anti-aircraft missiles.&nbsp; There were quite a few developments regarding UFOs in 2024. In a US congressional hearing in July, former intelligence officer David Grusch claimed that the government had long been involved in a program to investigate and retrieve non-human craft crashes, and then try to reverse engineer them. However Grusch did not show any evidence.&nbsp; The UAP Disclosure Act of 2024 was signed into law by Joe Biden in December 2023. It plans to oversee the public disclosure of UFO information. However, there is a clause in it that prevents disclosure if it would cause threats to military defense, intelligence operations or foreign relations.&nbsp; It is unlikely that the declassified documents about sightings in the Himalayan will cause any real surprise about definite evidence of alien life even if it was found. It seems humanity will continue, at least for now, to wonder about curious lights in the sky and whether there is anybody out there.&nbsp;

UFO over Pokhara

When Rastriya Swatantra Party (RSP) president Rabi Lamichhane was arrested in October on charges of defrauding depositors of cooperatives, the party’s vice president Swarnim Wagle gifted him Fareed Zakaria’s book, Age of Revolutions.
Since then, Lamichhane has been shunted around from Kathmandu to Pokhara to Chitwan and back to Pokhara to attend police investigations and court proceedings. He was being flown to Birganj via Kathmandu on Buddha Air on Monday. There is another pending case in Janakpur.
Human rights groups and civil society have criticised the government for hounding Lamichhane with inhumane treatment that borders on physical torture. The two parties in the coalition, Nepali Congress (NC) and the UML, see Lamichhane’s RSP as a potentially formidable challenge to their power.
Even if the fraud charges against Lamichhane are true, the Nepali public is increasingly looking at the government’s actions through the police and courts as political vendetta.
Despite all the travelling, sometimes by plane and often by road at night, Lamichhane appears to be in high spirits, waving to supporters who often gather if they know he is going to be driven around. A social media video shows him giving high fives to fellow passengers on a recent flight to Pokhara.&nbsp;
In the past weeks, streets in Pokhara have erupted with parallel protests by Lamichhane’s supporters as well as depositors of cooperatives who lost their savings to the scam.&nbsp;
Although family visits are allowed, prison officials in Pokhara told Nepali Times that not many people visit Lamichhane these days. He added, “When he does get visitors, he asks them to bring him books.”
Lamichhane is currently Nepal’s most high-profile public figure in custody, and highlights the stark difference between how influential prisoners are treated compared to ordinary inmates.
There are six prison cells at Kaski District Police Office’s two-story detention centre, three on each floor. And while authorities pack prisoners into already overcrowded cells, Lamichhane has an entire room on the second floor to himself.&nbsp;
He has also been allowed to call his family every few days. Other prisoners are not permitted phone calls except for emergencies.
Meanwhile, Lamichhane’s former business partner Chhabilal Joshi, an ex-Deputy Inspector General of Police with whom he established his Gorkha Media Network, is in custody under the same charges in the prison cell next to him.
Lamichhane is accused of siphoning off depositors' money to the tv network in which he was part-owner and anchor. &nbsp;
Both Lamichhane and Joshi are able to buy food from the police canteen instead of being served the regular meal like other prisoners. Joshi has also given his statement to authorities in Rupandehi and Kathmandu for his alleged role in the scam. Lamichhane is yet to be presented in Kathmandu for questioning.
While he was in custody at the Kathmandu District Police Complex, Joshi expressed his desire to sleep in a police officer’s office, reportedly assuring authorities that he would not run away and he was entitled to certain facilities as a former officer of the law.
“He seemed to be under the impression that he is still a police officer,” says a source at the Kathmandu District Police. “We made it clear to him that as someone accused of a crime, he was not entitled to special treatment.”
Former ministers Balkrishna Khand and Top Bahadur Rayamajhi, and ex-home secretary Tek Narayan Pandey, who were arrested in connection with the fake refugee scam last year, were similarly housed in the offices of law enforcement officials instead of prison cells. Khand has since been released after six months in jail.
While there is no legal provision to keep high-ranking officials in separate detention centres when they are arrested, authorities granting them special facilities is not uncommon. Law enforcement officials say VIP detainees expect preferential treatment while in police custody.
Among those is former Kosi Province minister Lila Ballav Adhikari, who was arrested from Biratnagar on 10 November over his alleged involvement in human trafficking and brought to Kathmandu. Adhikari had flown to Japan without government approval with three individuals on 29 October to attend a cultural conference, but had been sent back to Nepal from Narita.&nbsp;
His three companions were arrested at Kathmandu airport upon their arrival, but Adhikari was able to exit unscathed from the VIP lounge. Adhikari had resigned as the Kosi Province Minister for Internal Affairs and Law when it became public that his companions had been taken into custody, and was himself arrested shortly after. He has since been cleared by the courts.
Throughout his detention, Adhikari was kept separately from other inmates. Senior Superintendent of Police (SSP) Basant Rajouri, head of the Bhadrakali complex, says that while there is no separate detention area for VIPs, some detainees are kept separately depending on the nature of their crime.
However, sources say that arrangements were made for retired judges and others to visit Adhikari frequently worked at the office of a Deputy Superintendent of Police (DSP) during his time in custody.&nbsp;
“He used to constantly pester the authorities to let him sit outside in the sun, and to be able to use the police officer’s shower area,” added an officer.
Adhikari was released on 25 November after the government prosecutor’s office decided not to charge him in a move that was seen to expose the government’s double standards.
Over at Kathmandu’s Dilli Bazar Prison, former Kist Bank CEO Kamal Gyawali emerges from his prison cell into the courtyard of the prison’s ‘Ka (क)’ block every morning with a thick book in his hands, ready to give his daily sermon.
With his long beard, Gyawali, who is serving a prison sentence for banking fraud, looks the part of a religious guru as he implores his rapt listeners to “walk the right path, abandon bad thoughts and turn to scripture and spirituality”.&nbsp;
Afterward, the attendees gather to discuss politics and current affairs. Inmates at his daily sermons at the prison include other high-profile detainees, including former MP Ichchha Raj Tamang, who is in jail for money laundering and cooperatives fraud, former joint secretary Chudamani Sharma, who was convicted of corruption, as well as NC leader Chandra Bahadur Lama and Krishna Bahadur Upreti of the UML both of whom are on trial for embezzling billions of rupees.
Victims of the cooperatives scam that former lawmaker Tamang was involved in have made trips to the prison and requested visits, but he has refused to meet with any of them.
“Tamang often complains that the state has prevented him from returning the money to the victims by locking him up,” says a police officer at the Dili Bazar jail.
“All you hear every day from the VIP prisoners is that they have been framed,” adds the officer. “No one admits that they were involved in misdeeds.”
But while most high-profile prisoners complain about prison conditions, one exception is former provincial lawmaker Deepak Manange, who is serving a sentence at Dilli Bazar Jail for attempted murder.
“He is the happiest prisoner here,” says a warden. “Unlike the others, he doesn’t claim to have been framed, in fact he doesn’t seem to care that he is in prison.”
Manange is detained in the ‘Kha (ख)’ block of the prison complex, which he renovated at his own expense. The block previously housed female prisoners, but Manange used his influence to transfer them elsewhere. He faces no shortage of visitors, who range from political leaders to people from the underworld.
Along with Manange, other well-known prisoners in this block include Nepal Telecom Managing Director Sunil Poudel, and former executive director of the Surakshan Printing Centre Bikal Poudel, who are serving time for corruption.
Former prisoners at Dilli Bazar prison include ex-ministers Khum Bahadur Khadka and Shyam Sundar Gupta, NC leader Ganesh Lama, Maoist MP Balkrishna Dhungel, Nagarik Unmukti Party leader Resham Chaudhary, as well as former IGs Ramesh Chand Thakuri, Om Bikram Rana, and Hem Bahadur Gurung.
Section 54 of Nepal’s Prison Act assigns each prison’s internal administration the
responsibility of governing its prisoners, which means the more favourable the jail management is, the more comfortable it is for prisoners.
Dilli Bazar prison has been the prison of choice for many high-ranking prisoners, especially those convicted of white collar crimes, due to its more accommodating administrators. The prison, which has the capacity to house 700 inmates, is also less crowded than other jails.
Anuj Bhattarai, spokesperson of the Department of Prison Management, says that there is no legal classification in Nepal for felons to be assigned prisons based on the nature of their crimes.
“That Dilli Bazar Jail has a higher number of prisoners convicted of crimes like corruption is most likely a coincidence,” says Bhattarai. “There is no provision for influential people to be able to choose where they will be incarcerated.”&nbsp;
Translated by Shristi Karki from the Nepali original published in himalkhabar.com

What Nepal’s VIP prisoners do in jail

If you were raised in Nepal, you must have picked up its unique set of vocabulary: आन्दोलन, चक्का जाम, बन्द, राँके जुलुस, आफ्नो मान्छे, हाम्रो दल, कर्फु and many more words connoting political protest.
We became familiar with the acrid smell of burning tyres, and eyes smarting from tear gas. And yet, everyone speaks of another revolution in the making. Not by desire, but by suffocation.
We heard speeches about नयाँ नेपाल, but the New Nepal never arrived. The governance system changed, but it did not reflect on people’s lives — except for those close to centres of power. The state is still unreachable and is not bothered about <a href="https://nepalitimes.com/here-now/matter-of-life-and-debt">victims of loan sharks</a>, cooperative scams and other injustices.
Politicians continue to speak in sound bites, but fail to deliver. They have mastered the game of pointing fingers towards an external enemy and convincing people that they are never at fault. The political narrative is so disconnected from the actual analysis of the problem that suffocation doesn’t go away after every revolution.
No genuine effort has been made to deliver at all, which is why there is a palpable sense of disillusionment in the air forcing us to seek another revolution, even if Nepal may not be able to afford it.
How has the current system successfully held power, even if the public is deeply frustrated? How is it that for three decades we continue to be led by the same faces, who have time and again, proved to us that they may be great politicians but not national leaders?
<a href="https://nepalitimes.com/opinion/improving-internet-governance-in-nepal">My experience at the epicentre of politics</a> has led me to identify three cultures that have enabled political parties to keep a tight hold on power: acceptance, silence and dependency.
We accept things the way they are. We use fatalistic phrases like “नेपालमा यस्तै हो” or “नेपालको कानुन दैब जानुन”. While this resilience enables us to rise back up from devastating calamities, it is also a reason for our compliance with the status quo.
Despite so many ‘revolutions’ that have led to significant reforms, these phrases keep getting reinforced, to the point that the upcoming generations have made it their lingo.&nbsp;
This acceptance is not a symbol of law-abiding citizens, but citizens living in fear of those in power, unable to ask the whys and why-nots.
Innovation suffocates in this culture of acceptance of the status quo. This is manifested in remarks like “but we don’t have any laws for this,” or “we don’t have the capacity to implement this”. An innovator or entrepreneur therefore has to spend that energy to become a political lobbyist, often educating and convincing the bureaucracy.&nbsp;
Remember when locally assembled <a href="https://nepalitimes.com/banner/designed-and-made-in-nepal">Yatri motorbikes</a>, despite having willing customers, had to suffer to secure license numbers because of a lack of regulations? Instead of creating new laws, the government kept chanting the “We will promote Nepal-made goods” mantra, leaving entrepreneurs in a labyrinth of bureaucracy. The weight of acceptance of the law lies heavily on innovators. Fatalism is a tactic used by those in power to generate mass fear in society.
When we accept, we become silent. This is a pervasive phenomenon. We are trained to keep quiet, lest we ruffle feathers, burn bridges, or not get the help we need in future. We know, yet we don’t speak.
Read also: <a href="https://nepalitimes.com/here-now/bureaucratic-hurdles-in-researching-nepals-bureaucracy">Bureaucratic hurdles in researching Nepal's bureaucracy</a>, Daniel W Edwards
Here is one example: the 2021 census shows that the number of baby boys born for every 100 baby girls is 112. This is a clear indication of female foeticide because of boy preference in society.
Despite such horrifying realities, there is finger-pointing within the government between the Ministry of Health and Population with the Ministry of Home Affairs. At the citizen level, we know those who are involved in killing girls. Yet, we don’t speak up. The Nepal Medical Council reports state that despite this gender imbalance at birth, there is no indication of any action.
But why would anyone speak against one's own fraternity, no matter how vile the act is?
When we accept and keep quiet, we become dependent on those who yield power. From getting our government procedure completed on time to getting transfers, to accessing any of our legally protected rights as well, we are forced to depend on our networks of चिनेको मान्छे people we know by blood, village, relations, political affiliation.
The culture of dependency has been the established way in Nepal. If you drive a two-wheeler or four-wheeler, and you get into a small accident, you will be asked to sort it yourself, dialing up the most powerful person you know. It becomes a competition of who knows who.
Recently I was told that there were calls from the Ministry of Health and Population and another from the Prime Minister's Office for just one medical position in a private hospital. Each was pushing its own candidate. Guess which candidate got the position.&nbsp;
The dependency of people is not on the laws or the state, it is with people in power, a reliance on the network of somebody who knows somebody, including those not officially in power.
These cultures are deeply ingrained in our heads, and in society. Collectively they form a vicious circle that helps those in power to retain power. This is not the society we want to live in.
Then, what do we do as a collective to break away from this? How do we break away from the cultures of acceptance and silence that have created this dependency? What can we do to ensure that our children do not have to learn the jargon of आन्दोलन before they learn about the state?
These are the cultures political parties need to shed rather than use them to perpetuate their power. This is what <a href="https://nepalitimes.com/opinion/comment/an-alternative-to-alternative-politics-in-nepal">alternative politics</a> needs to be about.
Sumana Shrestha is a member of Parliament’s Education, Health and Information Technology parliamentary committee and represents the Rastriya Swatantara Party.

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‘Art Lover’ accused of sexual abuse

UFO over Pokhara

What Nepal’s VIP prisoners do in jail

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