It was at 2:45AM in the morning, I was in a deep sleep when I got a call from the hospital. The nurse on duty said there was a woman in labour who had had two previous C-sections. Half-asleep, I realised our resident gynaecologist was away on training and immediately rushed to the ward. The patient was 39-year-old Nim Diki Sherpa, wincing in pain and fully dilated. She had not had a single <a href="https://nepalitimes.com/here-now/saving-one-nepali-mother-at-a-time">ante-natal checkup</a>, and said she did not even know she was pregnant because she had taken a depo<a href="https://archive.nepalitimes.com/article/from-nepali-press/Ftnp-the-curse-of-the-contraceptive,493"> contraceptive injection</a>. Her husband was away and she was brought to Bhojpur District Hospital by neighbours who also had no idea she was pregnant.&nbsp; As resident medical officer with only an advanced skilled assistant birth attendant (ASBA), I was clueless about what to do next. Because of her two previous C-sections, this could be a complicated case needing referral. But our referral centre was too far away for this <a href="https://nepalitimes.com/here-now/nepal-s-air-ambulance-saves-mothers">emergency</a>. With our medical superintendent, we gathered at the operation theatre <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/book-review-Admissions-Henry-Marsh-Neurosurgeon,4055">for surgery</a> and took the patient’s consent. Pre-anaesthetic check-up and preloading were done and the patient wheeled in.&nbsp; Blood grouping and crossmatch was done, and two hospital staff donated their own blood since the blood bank did not have stock. Because the patient was writhing in pain, the spinal anesthesia was administered with some difficulty.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250522090524_8a340dc6217599bf9cce8eb2315731089307e3b06a31baef5b622d5ad40ac71e.jpg" data-media-id="editor_4" data-image-id="20250522090524_8a340dc6217599bf9cce8eb2315731089307e3b06a31baef5b622d5ad40ac71e" data-rendition-name="original" width="1280" height="643" loading="lazy" alt="Saving one mother at a time NT"> </figure>  I was the main surgeon with another <a href="https://nepalitimes.com/here-now/saving-nepali-mothers-on-mother-s-day">birth attendant</a>, an experienced nurse and anaesthesia assistant. An incision was made near the C-section scars, but as we entered the abdominal cavity there was a sudden gush of blood. We could not figure out where it was coming from.&nbsp; After separating the muscle, I could see that it was as we had feared: a uterine rupture. We made a T-shaped incision to deliver the baby which was drowning in blood. The anaesthesia assistant, medical superintendent and nurse started resuscitating the baby, and I waited for it to cry while trying to deal with the mother’s bleeding. I felt I had lost one life, and could not save the other. We took the uterus out from the incision, traced the source of the bleeding, and started clamping with all the instruments we had.&nbsp; I had seen one case of peripartum hysterectomy during my training, and knew that a case like this was touch and go. Remembering tips from the training, I asked for long artery forceps. It was not in the set, but the nurse tracked one down in the store, disinfected it with betadine and handed it to me.&nbsp; There was no time to autoclave it, and I remembered my trainer telling me that we should all adapt to the situation at hand (अवस्था अनुसारको ब्यबस्था). His advice rang loudly in my ear. There was little hope, but I tried to keep calm and started suturing layers of incisions. All the while the anaesthesia assistant managed to keep everything under control. There was massive bleeding and we transfused two-pints of whole blood. I remembered what the mother had said before she was anaesthetised: “Doctor, do everything to <a href="https://nepalitimes.com/here-now/saving-one-nepali-mother-at-a-time-c2plk4ko?fbclid=IwAR3pJwcfeEosJdmBoF623hnjWjHoqIddTwWGMkPoOFNWqMujm1irA1auFr4">save my life</a>.”  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250522090524_e63c9f48bc630d4dea355d15554f2228a1ae9879c816fbcad42396e7f7f11d40.jpg" data-media-id="editor_7" data-image-id="20250522090524_e63c9f48bc630d4dea355d15554f2228a1ae9879c816fbcad42396e7f7f11d40" data-rendition-name="original" width="1200" height="1600" loading="lazy" alt="Saving one mother at a time NT"> </figure>  After three continuous hours at surgery, dawn was breaking as the mother’s bleeding started to come under control and her blood pressure started rising. But we still had a long way to go. The medical superintendent had arranged for <a href="https://nepalitimes.com/here-now/nepal-s-air-ambulance-saves-mothers">helicopter medevac </a>and she was airlifted out soon after.&nbsp; With me in the surgery team that night were fellow doctors Praveen Mandal and Shivaji Rijal, anaesthesia assistant Durga Nanda Chaudhary and nurses Sumitra Shiwa and Basanta Moktan. Advanced skilled birth attendant (ASBA) is a 70-day training given to MBBS doctors by the National Health Training Center and Nick Simons Institute (NSI) with clinical exposure in obstetrics after which they are expected to manage <a href="https://nepalitimes.com/banner/saving-nepali-mothers-and-babies-district-by-district">complicated deliveries in rural government hospitals</a> with cesarean section independently. Nepal has dramatically reduced<a href="https://nepalitimes.com/here-now/now-and-then"> maternal mortality ratio</a> from 536 per 100,000 live births thirty years ago to 145 now – mainly because of antenatal checkups, institutional deliveries and an increased number of advanced skilled birth attendants.&nbsp; Over the past three decades, the lives of countless <a href="https://nepalitimes.com/opinion/comment/saving-more-mothers-and-babies">Nepali mothers </a>have been saved. Like Nim Diki Sherpa, mothers have been saved one at a time by dedicated doctors and nurses working with limited resources and equipment. Read also:<a href="https://nepalitimes.com/here-now/nepal-lagging-in-safe-motherhood"> Nepal lagging in safe motherhood</a>, Sudiksha Tuladhar There were many lessons we learnt that day. I learned what it is to take a leadership role in a life-or-death situation. Back at Paropakar Maternity Hospital training in Kathmandu a senior consultant gynecologist once told me to scrub when a patient is bleeding profusely. He knew that one day I would be alone trying to save a life. “There is no running away,” he had said. “There is no excuse, you either try or let a patient die.” Once trained, circumstances will not let you choose. You cannot say ‘I wasn’t trained for this’, you have to adapt to the situation at hand with whatever you have.

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Saving one mother at a time

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114121112/637222f59c7e80680e0c0327jpeg.jpg" alt="" width="760" height="486"/><figcaption>Govinda KC, Nepal’s crusading surgeon and health activist, plastering a patient’s ankle at the Mugu District Hospital on Sunday. He saw 177 patients for free in five days before travelling on to Jumla on foot. Photos: ACHYUTRAJ BHANDARI</figcaption></figure>Nepal’s  crusading surgeon and health activist Govinda KC has been on hunger strike 19 times since 2012, demanding medical education  reform and equitable healthcare. After retiring from his government job, KC has served patients in all 77 districts and other disaster-stricken countries. He is currently at Khandbari District Hospital in Sankhuwasabha where Nepali Times caught up with him.Excerpt from the conversation:Nepali Times: What is the state of healthcare in Nepal?Govinda KC: Most citizens from both urban and rural areas do not have access to healthcare. Many patients are too poor to afford quality treatment, and those who can not get quality care.The law specifies that 70 types of medicines should be available free of cost in district hospitals, 50 in primary health centres, and 35 in health posts. That is not the case in practice.Some government hospitals even charge money for medicines that are supposed to be free. And hospital fees are just too expensive, so they end up dying, being disabled for life, or sinking deeper into poverty.Health facilities in many rural districts are under-equipped, under-staffed and many patients have to return home without treatment. There are no big hospitals there to begin with, and even the urban poor cannot afford priate city hospitals.Doctors, nurses and office assistants have stuck around in government hospitals only because they are bound by contract. Some hospitals are led by junior non-physicians, making a chaotic and inefficient system.So, where is the problem? The problem in providing basic healthcare arises when the local representatives and  politicians do not work to provide it. When the 2015 constitution was announced, I was in satyagraha. My only demand was that our representatives be treated in health facilities in the same place as their voters. That demand was not fulfilled.The Constitution guarantees the citizen's right to health, but elected politicians do not care about health reforms. They are too busy getting rich overnight by commodifying education and health.I have been fighting to have hospitals and schools in every village, but people prefer to open hospitals in the city. Locals can have access to specialist services at a hospital in their village. This can also help to produce doctors, nurses and public health workers in the provinces. But no one is willing to do that. Politicians are on the payroll of the medical mafia.Do you regret going through all those hunger strikes? Many of my demands were not met. Some promises have been made, but not been implemented in practice. But some have been addressed, like the Medical Education Act was formed after multiple satyagraha. Then the Medical  Education Commission was formed.Before the Act, MBBS entrance exams were conducted by colleges and institutes in their own way, but now it is regulated by the Medical Education Commission.Only those who pass the entrance exams are now eligible for government scholarships and can pick their own college. Action is taken against private institutions if they do not follow the regulationsNow, medical colleges are selected based on their infrastructure, equipment and human resource.  Fees have also  dropped from Rs7-9 million to Rs4.2 million. Medical school is a lot cheaper now, especially for students who are unable to get scholarships.Government medical schools charged up to Rs10 million for  specialised education. Now, students do not have to pay, but get paid instead. After getting an MD they also need to serve for two years in a place assigned by the government. These contract doctors run the country’s healthcare todaySo, the hunger strikes have not been in vain. One of my demands was to have one government medical college in every province. At present, the Karnali Institute of Health Sciences is in operation in Jumla, and the physical infrastructure of Geta Medical College in Dhangadi has been completed. One medical college is soon opening in Dadeldhura after my hunger strike.Despite this, some goals have been lost to the challenges posed by the alliance of political  parties with the mafia. The construction of the Rapti Institute of Health Sciences in Dang was halted due to obstruction from local leaders, and a medical college in  Bardibas due to land acquisition issues.What policies should the government focus on now?First of all, access to basic services, human resources, equipment and medicine should be extended to people in rural areas and the urban poor. If primary health centres and district and provincial hospitals are improved, then 80-90% of patients do not have to  come to Kathmandu for treatment. The government needs to add more human resources to meet the current demand for healthcare.There should be a 15-bed operational hospital in each municipality. Hospitals should also be made free for people to have quality healthcare. The government should take actions against hospitals that operate without meeting proper standards.Additionally, the Medical Education Commission, Nepal Medical Council and other organisations should appoint qualified applicants, not political activists. In fact, the practice of hiring contract-based employees should be eliminated. Contract doctors have a higher chance of fleeing if they are not given temporary incentives to stay.Despite the huge demand for rural doctors, the Public Service Commission opens only 20 seats for doctors each year. This has to change.Any more hunger strikes?I am committed to campaigning for medical education reforms. Along with health and education, we are also fighting for good governance and social justice, without which reform is impossible.I also want to serve in remote areas, which is why I am here in Okhaldhunga. I will fight for people in all parts of the country to have quality, free, affordable and equal access to healthcare as guaranteed by the Constitution for as long as I can.Read more: <a href="https://www.nepalitimes.com/latest/govinda-kc-treats-patients-in-remote-nepal/">Govinda KC treats patients in remote Nepal</a>, Achyutraj Bhandari

"Nepalis are dying because they are poor”

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114121112/637222f09c7e80680e0c0324jpeg.jpg" alt="" width="960" height="640"/><figcaption>Photo: POSSIBLE HEALTH</figcaption></figure>Ever since Finance Minister Janardan Sharma in his budget speech last month announced a plan to hand over management of Nepal’s national health insurance program to the private sector, experts are concerned that it will make medical treatment unaffordable for most people.Indeed, privatising health insurance is like the government abandoning its people, experts say, and it defeats the very purpose of the program — to provide affordable care for the most underserved communities who can neither access private plans nor expensive hospitals."Health insurance delivers the right of citizens to proper healthcare. As soon as it is implemented through a for-profit company, the social security aspect will be forgotten and serve purely as a business,” warns public health expert Sharad Onta.Private companies already provide health insurance schemes to those who can afford its expensive premium. The private sector therefore mainly serves the affluent, as public health experts Gaj B Gurung and Sushil Koirala <a href="https://www.nepalitimes.com/opinion/dangers-of-privatising-health-insurance-in-nepal/" target="_blank" rel="noopener noreferrer">argue in their op-ed</a> for Nepali Times:‘But can they really contribute to national public health security, understand equity, expand access to the poorest and the most marginalised population, and negotiate with the government providers for quality services? Are they fundamentally designed to serve the poor?’Read also: <a href="https://www.nepalitimes.com/banner/sick-of-it/">Sick of it</a>, Sagar BudathokiIn 2017, then health minister Gagan Thapa introduced a national insurance scheme with a premium of Rs2,500 a year for a benefit package of Rs50,000 for a family of five. This was later increased to Rs3,500 premium and Rs100,000 payout. But this is still too low, and needs to be revised.Hospitals also complain of late reimbursement, and some are considering pulling out of the program. Dhulikhel Hospital alone is owed Rs250 million in reimbursements. Patients are not happy about the service either, and are dropping out.But it is too early to give up, says SP Kalaunee, former director of Nyaya Health Nepal which implements the national insurance scheme at its Bayalpata Hospital in Achham.“Nepal’s health insurance policy is fairly new and such challenges are to be expected,” he says, “But they can be and should be addressed within the existing structure.”He adds: “The goal of the program was to make healthcare accessible, affordable and equitable to all. The fact that we have an additional feature to the program to strengthen service providers means it was never just a financial mechanism.”Read also: <a href="https://www.nepalitimes.com/banner/taking-wealth-out-of-health/">Taking wealth out of health</a>, Anita BhetwalA mandatory health insurance scheme where people pay the premium based on their per capita income could eventually include benefits that include treatment of chronic illnesses, say experts.Hiring competent staff with expertise in the field at the Health Insurance Board (HIB) might be a good start to improving the existing program. HIB should also be an autonomous body capable of making its own decisions without interference from the Health or Finance Ministry.Digitising reimbursement will also address some of the grievances, especially as the program should also look into signing up as many hospitals and care providers including the private establishments for the scheme. The private sector can be involved, but only in carrying out research on the sustainability of the program and for technical expertise.Nepal’s healthcare is divided into three levels:<ol><li>Primary health care (PHC) which is free in government hospitals</li> 	<li>Secondary care which is paid for by national health insurance and has waived premiums of the elderly, completely disabled, leprosy and Multi-Drug Resistant TB patients, people living with HIV, and the ultra-poor.</li> 	<li>Tertiary care that needs specialised treatment of chronic illnesses like cancers for which the government provides up to Rs100,000.</li></ol>Read more: <a href="https://www.nepalitimes.com/banner/in-a-healthy-state/">In a healthy state</a>, EditorialAll three aim to eliminate user fees at the point of care, but there are implementation challenges — the main one being the lack of government investment in the health sector and the limited understanding of what constitutes good health.“Health is more than just treatment and hospitals. A large part of it is prevention, from preventive measures against infection to building safer roads so that there are fewer road traffic accidents,” explains Sangeeta Kaushal Mishra of the Ministry of Health and Population.But health is not the priority of the government and there is not much investment in training medical personnel, making it incapable of meeting public demand. This gap is now being filled by the private sector.The government’s lack of capacity can be addressed to some measure by working with non-profits much like Nyaya Health Nepal and Nick Simons Institute which work with government hospitals to upgrade service.Read also: <a href="https://www.nepalitimes.com/opinion/is-free-health-care-possible-in-nepal/">Is free health care possible in Nepal?</a> S P KalauneeCommunity outreach is another crucial aspect in building a people-centric health system, and Nepal has a head start with its thousands of female community health volunteers across the country. They are primarily responsible for high childhood immunisation rates and reducing maternal mortality.  This now needs to expand to also include healthcare professionals at the grassroots, and retaining them.In the meantime, Nepal’s national health insurance policy also needs to address emerging problems like non-communicable diseases which with injuries make up two-thirds of death and disabilities in Nepal. The program must also include provisions for geriatric care and mental health conditions, all the while making sure the interests of the most vulnerable in the society are addressed."Private entrepreneurs will not fulfil the responsibility of the state. The access to the health care of the poor will be further weakened as soon as health insurance is privatised,” warns Damodar Basaula of the Health Insurance Board.Ensuring accessible and affordable health care for the people is the prerequisite of any government. Passing the buck to the private sector or any other group will further impoverish families unable to pay the medical cost of treating relatives.Says SP Kalaunee: “If you do not invest in the lives of people now it will cost much more tomorrow. The national health insurance program is set to become our biggest investment soon, and we must prepare the groundwork for it."Read more: <a href="https://archive.nepalitimes.com/article/nation/national-health-insurance-not-as-easy,4028">A national health insurance scheme is not as easy as it looks</a>, Sonia Awale

Sonia Awale

Ensuring health insurance for all Nepalis

Ancient heritage meets dern distillery craft as the US-based The Nepali Spirit Company this month makes its global debut with Kathmandu Ayla. Inspired by Nepal’s ancient rice whiskey tradition, the product is the first of four handcrafted spirits that brings Kathmandu Valley’s 1,000-year-old ayla tradition to the world stage. “The first four products combine history, culture, and tradition and it has taken eight years to get to this launch point,” says CEO of The Nepal Spirit Company Kashish Das Shrestha, who is also publishing a book on the history of alcohol in Nepali culture. The other three ayla products are Masala Whiskey aged in Brazilian Amburana casks and spiced with black cardamom from Nepal, Annapurna Ayla, and Haku Chaku Himalayan Espresso Liqueur made with organic Nepali coffee, and chaku (dark molasses).  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251216141244_ab74945dc60ce5ff83fe7a88596fc032c18705e7cda9dc62df21694d3ad83b85.jpg" data-media-id="editor_0" data-image-id="20251216141244_ab74945dc60ce5ff83fe7a88596fc032c18705e7cda9dc62df21694d3ad83b85" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="The American Ayla NT"> </figure>  “I started visiting international whiskey auctions six years ago and after reading about distilling, my passion for spirits grew, and I felt the urge to tell the story of Nepal’s heritage spirits to the world,” explains Shrestha. Once poured in Nepal’s royal courts, ayla is a clear rice whiskey that is a millennia-old living heritage of Kathmandu used in rituals from birth to death and traditional life milestones of its inhabitants. Ayla is distilled to capture the classic aromas and flavors, with a soft sweet after taste. It can be enjoyed neat, sipped through meals, or enjoyed as shots. With more than 15% of Nepal’s population living and working abroad, there is a cultural demand for ayla in the diaspora from Asan to Amstredam to Australia.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251216121236_0db0ec396832736fef60b636d7012a917be65471408c81383a40613f928f9e78.jpg" data-media-id="editor_1" data-image-id="20251216121236_0db0ec396832736fef60b636d7012a917be65471408c81383a40613f928f9e78" data-rendition-name="original" width="1000" height="1270" loading="lazy" alt="The American Ayla NT"> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251216141236_a84ede74c67a61e75af2f0cc1c985b4d04ff2292c6bd0bd0b841f4d2c7b593aa.jpg" data-media-id="editor_2" data-image-id="20251216141236_a84ede74c67a61e75af2f0cc1c985b4d04ff2292c6bd0bd0b841f4d2c7b593aa" data-rendition-name="original" width="1778" height="1000" loading="lazy" alt="The American Ayla NT"> </figure>  &nbsp;“We also believe ayla is a wonderful way to tell Nepal’s story to the world,” says Lilu KC Shrestha, Chief Operating Officer of the company. “We intend to use our platform to promote Nepal in any way we can, and also find ways to give back to the country. It was high time a world-class Nepali spirits brand entered the global market, and we are proud to take the lead.” Aside from the ayla itself, the bottle and packaging was conceived by New York-based designer Sahara Shrestha to reflect a complete Nepaliness. “Each bottle and box is a love letter to Nepal, and every detail is an expression of respect and appreciation of Nepali heritage and our desire to share it with the world,” says Kashish Das Shrestha. “And ayla itself is a sacred part of our culture, so we wanted to make sure the bottle reflects this reverence.”  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251216141244_d2746204c64802ff81453d7a8749f516bf3c62538fe3c98400a9b3978c03b273.jpg" data-media-id="editor_3" data-image-id="20251216141244_d2746204c64802ff81453d7a8749f516bf3c62538fe3c98400a9b3978c03b273" data-rendition-name="original" width="1920" height="1475" loading="lazy" alt="The American Ayla NT"> <figcaption>Aylarita</figcaption> </figure>  The bottom of each bottle has an embossed Mandala representing the universe and its interconnectedness. A glass molding of Himalayan peaks Chomolungma and Nuptse signifies the earth and heaven. The bottle cap is a black and gold rendering of the metal plates that hang from Kathmandu’s temples. The logo of The Nepali Spirit Company is also inspired by the unti, a traditional vessel used to pour ayla. While its top is typically adorned with a peacock, the company’s design replaces it with rice stalks. This motif is also on the label of Annapurna Whiskey named in honour of both the mountain and the goddess, the giver of grain. For a new take, ayla can be paired with a lime wedge lathered in honey, cumin, and salt, or on the glass rim. It can also be mixed into cocktails to make Aylarita, Aylatini, or Aylapolitan. <a href="http://www.thenepalispirit.com/" target="_blank">www.thenepalispirit.com</a>, @TheNepaliSpirit

The American Ayla

When Winston Churchill addressed the Canadian Parliament in December 1941, he recalled that generals of Nazi-occupied France had said that England would “have her neck wrung like a chicken”. Churchill went on to quip: “Some chicken.” As the laughter and applause subsided, he added: “Some neck.” (Even longer laughter and applause) We do not know who first started calling the narrow corridor that joins India to its northeastern states a 'Chicken’s Neck', but there also was the hint of a Churcillian connotation. Akhilesh Upadhayay in his new book In the Margins of the Empires: A History of the Chicken’s Neck, uses this strip as an entry point to explore a region adjoining Nepal, Bhutan, China, Sikkim, Darjeeling, India’s northeast and the tectonics that shaped its geo-strategic terrain.&nbsp; Upadhyay’s Chicken Neck is an organic whole, connected through centuries by transboundary traders, travellers, monks, spies, missionaries, mountaineers, and more. And as infrastructure and connectivity improves, smaller countries like Nepal and Bhutan (and earlier Sikkim) are caught up in the region’s rivalries. The tri-junction of the Chicken’s Neck is a potential flashpoint that has obsessed India’s military strategists ever since Partition in 1947 and the formation of East Pakistan, and the Chinese annexation of Tibet. India found itself squeezed between Chumbi Valley in China to the north and Pakistan to the south. So, when Sikkim started acting too independent for its own good 50 years ago, India engineered its annexation and turned it into its 22nd state. The 1962 Sino-Indian war elevated its strategic importance even more. Alarm bells ring in New Delhi each time there is trouble around the Chicken’s Neck: the Naxalite uprising had to be swiftly crushed, the Indian military moved in to liberate Bangladesh, Gorkhaland and ULFA activities were dangerously nearby, Bhutan had to be appeased. Every once in a while things would flare up between India and China, as in the 2017 Doklam standoff.&nbsp; And last year’s regime change in Bangladesh has rattled New Delhi enough to deploy its Rafael fighters and BrahMos cruise missiles in the Chicken’s Neck. It is now the most densely militarised strip of real estate in this part of the world. &nbsp; As a journalist and former editor of Kathmandu Post, Upadhyay also peers at the Chicken’s Neck through Nepal’s perspective. After all, Jhapa (where the author is originally from) sits right there astride India’s strategic lifeline.&nbsp; Geopolitics is at the front and centre of the book that takes readers back to the time Nepal was a closed Himalayan kingdom.&nbsp; Nepal may be a yam between two boulders, but it may just as well be a thicker Chicken’s Neck as far as New Delhi and Beijing are concerned. Nepal’s rulers have always had to walk the tightrope between China and India. Khampa guerrillas, covertly helped by American and Indian intelligence, raided Chinese military convoys from bases in Nepal, and King Mahendra had to do some intricate diplomatic footwork. India is often described as Nepal’s closest friend, but our relations with China go back as long in terms of the Lhasa trade, Bhrikuti and Arniko, religious exchanges and people-to-people relations. While Nepali researchers are wary of touching on Chinese, Indian or American sensitivities, Upadhyay’s journalistic background means he has no qualms about tackling the subject head-on, and objectively. He spent more than a year researching the book, sniffing around Siliguri, Bagdogra, Naxalbari, Darjeeling and the villages on the Jhapa side. Then he travelled to Olangchung Gola to listen to ordinary people of the Himalayan rimlands. Despite the perception about rigid frontiers between nation states, the book hints at how absurd the notion is. The Chicken’s Neck is also a wild elephant migration corridor, disturbed by the India-Bangladesh border fence, new expressway embankments, airport runways, and expanding cities. Similarly, the people on the Nepal-tibet border used to cross over to graze yaks — this expanded the gene pools of not just the yaks but also the nomadic humans who moved with the herds.&nbsp; Despite the hard borders, trade flourishes. Upadhyay marvels that a shop in Phungling in Taplejung has embroidered saris from Siliguri and fluffy jackets from China. he finds that residents in the northeastern and southeastern tips of Nepal have more in common with kin across the border in Tibet or India than with someone from Kathmandu. Nepal was once one of the biggest trade hubs in ancient times, and our products were treated as equals in Indian border cities. People too, could move freely, especially if they were and are from bordering Tarai cities.&nbsp; Nepal’s rich history and culture was shaped by the proximity to neighbours, and despite borders it is still cemented by marriages and trade — especially in the Nepali-speaking lands to the east. Its geographical positioning makes Nepal not landlocked but land-linked, adjacent to the largest emerging economies of the world. Nepal needs to deploy its soft power with effective diplomacy to take advantage of these two empires, and not be choked by their rivalry. The book was going to press when the GenZ protests ignited in September, but Upadhyay nevertheless managed to insert the current political transition into the pages with deft editing. &nbsp;The final section of the book examines at least three possible scenarios that may unfold as South Asia continues to be shaped by great power rivalries and imperial contests that have weakened the unilateral influence of the west.&nbsp; Akhilesh Upadhyay extrapolates from the Chicken’s Neck, zooming out for a wider perspective on the Subcontinent. &nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025121912124_0ae772e7736a65f53a99599b5724ca133a64fdea0e61c7170ea81f9dd95c7af0.jpg" data-media-id="editor_0" data-image-id="2025121912124_0ae772e7736a65f53a99599b5724ca133a64fdea0e61c7170ea81f9dd95c7af0" data-rendition-name="original" width="1136" height="702" loading="lazy" alt="In the Margins of Empires: A History of the Chicken’s Neck NT"> </figure>

Some chicken, some neck

This is the first instalment of our new series Nepal Made, where we profile world-class Nepali products and the people behind them. The Himalaya is the home to Ayurveda, the preventive and curative medicinal practice that relies on the tremendous diversity of plant life. This is where Hanuman is said to have come to find a specific rare herb when Ram was wounded in battle. When he could not find it, he tore off a whole mountain and hauled it down to Lanka. Since then, herbal medicines and care products have been steadily modernised in India and Nepal. Now, one Kathmandu-based company, Herveda, is going global with an all-natural skincare brand that blends traditional knowledge of medicinal plants with modern technology. Originally a Sanskrit word, Ayurveda literally means ‘the science of life’ and promotes physical and mental wellbeing through a holistic knowledge system that is 4,000 years old. Ayurvedic products have gotten more popular as global demand rises for all-natural, chemical-free cosmetic and wellness products, instead of wasteful fast fashion and beauty trends. Herveda was founded by Prativa Pandey, a scientist-entrepreneur and mother of two. She did her PhD in nanotechnology chemistry from Northwestern University in the United States and returned to Nepal in 2015 after the earthquake, staying back to explore the market and launch her brand.  <figure><img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251218141216_b699e74ee82333951b99b22648705dc916deb8eef3d425c77c1e2f3b1058a64d.jpg" data-media-id="editor_0" data-image-id="20251218141216_b699e74ee82333951b99b22648705dc916deb8eef3d425c77c1e2f3b1058a64d" data-rendition-name="original" width="1000" height="1500" loading="lazy" alt="Looking good by doing good NT"></figure>  “I wanted to do something in Nepal, but didn’t want to be a doctor or engineer,” says Pandey at the elegant Herveda showroom in Jhamsikhel. “Whatever knowledge that I had gathered, I wanted to spread it in my own country.” Nepal is rich in traditional medicinal herbs and Ayurvedic plants, but proper utilisation and mobilisation has always been lagging. Most of the benefits are reaped by large companies and not local farmers. Pandey wanted to change that. To ensure that it gives back to the community, Herveda collaborates with farmers and local traders for fair trade. “I have always been fascinated by the medicinal herbs found in Nepal, and wanted to create high value products with them. It was a way to combine valuable indigenous knowledge with my academic research background,” adds Pandey. “I did not require a huge investment, just a proper marketing strategy.”  <figure><img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251218141216_350f6eb1511523ea54a8aba468f20a7dffcb5def3fade4dcced30324417f83bc.jpg" data-media-id="editor_1" data-image-id="20251218141216_350f6eb1511523ea54a8aba468f20a7dffcb5def3fade4dcced30324417f83bc" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Looking good by doing good NT"></figure>  According to the Trade and Promotion Center under the Ministry of Industry, Nepal’s import of cosmetic products is increasing every year, driven by demand from a younger population. These younger customers are also more conscious about the products they use. For brands like Herveda, it is important that customers engage in wellness and skincare in an ethical and sustainable manner. Apart from being all natural, Herveda’s flagship store in Jhamsikhel has a reuse box where consumers can drop used bottles, which are then recycled. The store also displays products from 35 local businesses. Pandey believes that Nepali brands should cross-promote and complement each other: “Rather than competing, I believe we should support each other. 1+1 can be 11, and not two.” Effectiveness and functionality hold great importance for Herveda. which employs 25 scientists to develop and lab test its products at its research institute. Currently, there are products ranging from Rs400-2,000, which include lip balms, serums, and essential oils. A signature product is the Berry Boost Radiance Mask, which contains Spikenard (Jatamansi), Ashwagandha, Orange Peel, and Rhododendron.  <figure><img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251218141216_7ec1104e0dd63db2fbbfe666034b468fe5b7e6876fde8b5446cb9d9fe27566cf.jpg" data-media-id="editor_2" data-image-id="20251218141216_7ec1104e0dd63db2fbbfe666034b468fe5b7e6876fde8b5446cb9d9fe27566cf" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Looking good by doing good NT"></figure>  Herveda exports to the United States and plans to expand to China and Europe. The products get a 50-100% markup in the international market. The company recently received a grant from UKAid to expand the market as well as build capacity to scale up. It has partnered with Agriplayer software to help to develop QR codes on its products, which consumers will be able to scan to track the product sources and evaluate pricing. Nepal lags behind in rules and regulations, and the lack of monitoring has allowed low quality cosmetic products to penetrate into the market. Herveda has got an international certification from USFTA, which is important for its foray into the export market. “For the cosmetic industry to scale up, there should be a central testing facility that is well equipped and meets international standards. Additionally, export should be made easy,” adds Pandey. “If there are too many barriers to entry, no one will be willing to invest.”

Looking good by doing good

Mithila art has represented Nepal’s indigenous culture, passing down through generations in the Madhes. Now, noted artist S C Suman explores this tradition with a bit of modern touch that gives it added relevance. Each of his paintings at the ‘Mithila Cosmos VII: Journey of a Pilgrim’ exhibition at Siddhartha Art Gallery exudes culture, colours and feminism, but with added improvisations that make it contemporary. “Mithila is an art form that is mostly used by women. Women have been the ones who preserve culture and pass it to other people and upcoming generations. The art form is what it is today because of women,” explains Suman. Inaugurating the exhibition on oMonday, art historian Julia Llyod Williams spoke fondly of Nepal and Mithila art, relating how she once bought a Mithila painting she liked without knowing its historical and cultural importance to the Mithila civilisation.  <figure><img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251216031232_729d03089084a1bc79b0678766a09e13dcd9236ebd628795eb3b8c3aafcf8981.jpg" data-media-id="editor_0" data-image-id="20251216031232_729d03089084a1bc79b0678766a09e13dcd9236ebd628795eb3b8c3aafcf8981" data-rendition-name="original" width="1080" height="720" loading="lazy" alt="Mithala exhibition NT"></figure>  Suman is a self-taught artist, textile designer and a radio host from Biratnagar, and one of the country’s most celebrated artists, with national and international honours. He has held 14 solo exhibitions and numerous group shows in Nepal and all over the world. “With Mithila Cosmos, Suman brings his artistic evolution into a deeper, more traditional realm, where pilgrimage is shaped not only by movement but by cultural memory and sacred stories,” says Sangeeta Thapa of Siddhartha Art Gallery. The seventh edition of the exhibition explores and displays reflections of pilgrimage, sharing the artist’s physical and spiritual experience with viewers. The first of this series was exhibited in 2007. “I am confident that this edition will also win visitors’ hearts. In the past, different dimensions of Mithila art were presented through this series. This time around as well, I have tried to give viewers a new perspective,” says Suman.  <figure><img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251216031232_2626f5a28e0051157af5d7f414128a1893645ddda02c955448103f4e92078385.jpg" data-media-id="editor_1" data-image-id="20251216031232_2626f5a28e0051157af5d7f414128a1893645ddda02c955448103f4e92078385" data-rendition-name="original" width="1191" height="1500" loading="lazy" alt="Mithala exhibition NT"></figure>  The exhibition is displayed on two floors of the gallery and includes paintings of Swayambhu, Pashupati, Lord Ganesh, Krishna, Ram Sita Bibabah among other renderings. Explains Suman: “The Pashupatin painting depicts the evolution of the temple, and since I live near Swayambhu, the mantra chanted there gives me energy, inspiring me to paint the shrine.” Use of colour, especially hues of blue, grab the attention of the viewers creating a sublime experience. ‘Samundra Manthan’ depicts how Lord Shiva drank poison to save the world. All the elements of the episode including Vasuki Nag, Kamdhenu and others are elaborately depicted. This carries on the Mithila tradition of telling stories by showing them through art. ‘Ram Sita Bibah’ shows the story of Ram and Sita in an intricate and intimate manner, and this is followed by the Banbas series, where Lord Ram is expelled from the palace, owing to family politics for power. In ‘Banbas I’, when crossing a river, the person rowing the boat asks to cleanse Lord Ram’s feet and then only allow him to board the boat, and pictorialises the storyline of the Ramayana. Similarly ‘Nava Durga’ is painted over canvas, has mantra painted all over the background and comprises ten avatars of Goddess Durga that is worshipped throughout Dasain.  <figure><img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251216031232_7a24f7f8d264d7bd204b8f475d1e86dc6fe70765487c37ebed85da8117081a80.jpg" data-media-id="editor_2" data-image-id="20251216031232_7a24f7f8d264d7bd204b8f475d1e86dc6fe70765487c37ebed85da8117081a80" data-rendition-name="original" width="1000" height="1570" loading="lazy" alt="Mithala exhibition NT"></figure>  “I finished the Nava Durga painting in the ten days of Dasain. Each day I used to wake up, do my daily puja and then sit for painting. No matter what, I separated time to paint even during festivities,” Suman says, showing how the paintings are a deeply reverential devotional artform. ‘Geeta Saar’ is an equally breathtaking exposition from the Bhagavad Gita, the blues once again giving the show a tranquil ambience. Visitors at the exhibition do not just walk past the works hanging on the walls of Siddhartha Art Gallery, they stand in front of each of them for a minute or two, almost in prayer. The Mithila Cosmos exhibition series started when the Maoist conflict was still taking place, and today it is taking place in the aftermath of recent protests during which government buildings surrounding the gallery were all torched. Suman’s ‘Journey of a Pilgrim’ makes us ponder how it all fits in with Nepal’s history, culture and faith. Says Suman, “My aim is to bring stories of the Valley, Madhes and other cultures into a single canvas. I have tried to find ways to incorporate Nepal’s diversity in every single painting.”  <figure><img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251216031236_89a12ff1908123e079cb08b77e37a4a875544e6baa6c9c1f4bfdba52b99e4287.jpg" data-media-id="editor_3" data-image-id="20251216031236_89a12ff1908123e079cb08b77e37a4a875544e6baa6c9c1f4bfdba52b99e4287" data-rendition-name="original" width="1500" height="1015" loading="lazy" alt="Mithila exhibition NT"></figure>  Mithila Cosmos VII: Journey of a Pilgrim Siddhartha Art Gallery, Baber Mahal Revisited Till 10 January 11:00am – 5:00pm