<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>

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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="1641" height="1000" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131116/636cec639c7e80680e09ad61jpeg.jpg" alt=""/><figcaption>Services provided from outside of OPD due to Covid cases. Photos: NYAYA HEALTH NEPAL</figcaption></figure>Nepal’s rural health system, already underfunded, understaffed and overstretched, is struggling with the enormous added burden of the Covid-19 pandemic.  Having barely coped with the first wave last year, hospitals in the remote mountains of Far-Western Province have found that the variants in the second wave are much more lethal, there are many more patients than before, and more of them require hospitalisation.  In Achham district the administration declared a lockdown on 3 May, but by then the virus was already spreading within families and house-to-house. Till the day before the lockdown, people were still arriving by the busloads from India, Kathmandu and other cities. Testing and tracing were lax, and they were mingling in the markets.  On Sunday, Nepal added 8,850 new confirmed infections, bringing total active cases to 88,160. There were 52 fatalities but 26 more died at home. Kathmandu reported 4,198 cases in the last 24 hours. There are 832 people in ICU across the country, and 267 patients on ventilator support. In the village of Jaygad of Achham, for example, an annual fair with large crowds was being held even as 13 out of 15 sample antigen tests came out positive. The virus was spreading into the remotest villages. “We have increased awareness programs and testing, and local governments have become more active in the recent days and taken more ownership of testing and information dissemination,” says Janakraj Dhungana at Achham’s District Health Office.  But many wonder whether it is too late to be disseminating information through loudspeakers on masking and distancing, when patients and families throng ill-equipped hospitals. Dhungana himself admits that there was not enough testing and isolation because of a shortage of kits.  Like other districts of Far-Western Province, the caseload in Achham is increasing, with 2,183 positive cases and 17 deaths so far. Of this, 511 positive cases and 6 deaths are during this second wave.  The vaccination drive was also suspended after 3,000 medical personnel and community health workers were inoculated. But 15,000 senior citizens in Achham alone still have not got their second doses yet.  <figure><img width="1500" height="1000" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131116/636cec669c7e80680e09ad62jpeg.jpg" alt=""><figcaption>Bayalpata Hospital in Achham run by the non-profit Nyaya Health Nepal is treating a flood of Covid-19 cases.</figcaption></figure>The government has now asked all hospitals to also treat Covid-19 patients. Bayalpata Hospital in Achham, which is run by the non-profit Nyaya Health Nepal in partnership with the local government, was not a designated Covid-19 hospital during the first wave. This year, it is treating a flood of Covid-19 cases.“We had set aside an entire wing for coronavirus cases, but there has been such a surge in the past week that we have turned the emergency room into a Covid ward,” says Mandeep Pathak, medical director at Bayalpata Hospital. “We converted five rooms set aside for drug-resistant tuberculosis treatment for Covid patients.”Bayalpata is currently treating 26 patients with Covid-19, all of them with low oxygen saturation levels, but new cases are being admitted every day. The hospital has also had to reassign eight rooms for Covid-19 patients, including for 14 of its own staff who have tested positive. In Dadeldhura Hospital a four-hour drive to the west, all 31 beds are full with Covid-19 patients, and although there are only five ICU beds, 13 patients are receiving intensive care. In the neighbouring district of Doti, it is the same story.“Even if we have beds, we have no oxygen, it is a vicious cycle,” says Jagdish Bista, Medical Superintendent at Dadeldhura District Hospital. “The most urgent need now is oxygen, and we are also running out of PPEs.” But what worries the doctor more is the 50-70% positivity rate of testing, and what this means for the next two weeks.For the time being, the nursing staff shortage has been alleviated with new transfers. But Dadeldhura Hospital’s oxygen plant cannot cope with demand, and there are difficulties to get cylinders refilled in Nepalganj and Dhangadi. Covid-19 has taken precedence over other cases, apart from emergencies and deliveries. Most patients are in the 30-year-old range, and those turned away seek help in Dhangadi’s Seti Hospital, which is also inundated.Patients who can get to hospital and get admitted in this remote region are the lucky ones. Local municipalities have built isolation centres, but most are empty because there is no oxygen and no medical personnel, says Devraj Devkota of Panchadeval Binayak municipality. <figure><img width="1753" height="2409" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131116/636cec699c7e80680e09ad63jpeg.jpg" alt=""><figcaption>Achham District made this urgent plea for equipment last week.</figcaption></figure>“Our people prefer to either isolate at home or try to get to a hospital if their condition deteriorates,” he adds. “We have had no help from Kathmandu.”But Nepal’s cities, including in the capital, are also out of hospital beds and oxygen, so there is little hope for outside help. In fact, a reverse flow is starting: critical Covid-19 patients in Kathmandu are being helicoptered to Jhapa or Kaski where there are still hospital beds with oxygen.The need in every municipality in the far west is the same: oxygen cylinders, pulse oximeters and testing kits, and additional hospital beds for serious cases.Says Achham’s District Health Officer Dhungana: “Oxygen is a problem. We depend on Dhangadi and Nepalganj to refill cylinders. They get used up fast, which has made it a logistical challenge.” There is also a critical shortage of staff. Despite vacancy notices, there were few applicants for specialised medical personnel even pre-pandemic. For example, although the District Hospital in Mangalsen has ventilators, there is no one to run them, and there isn’t enough oxygen.Patient referrals to city hospitals offering critical care, or just beds with oxygen, are also complicated. They are also overwhelmed, and there are few ambulances with oxygen for the 8-12 hour journey across mountain highways. Ambulances are expensive, and helicopter air lifts are even more costly. Despite this, desperate families have taken loans to try to save family members in critical conditions by air lifting them to city hospitals—often too late. Then there are all the other non-Covid trauma patients needing urgent surgery, or maternity cases. With its free treatment, Bayalpata Hospital has served more than 1 million patients from Achham and six surrounding districts of Karnali and Far-West Provinces in the past 12 years. Separating Covid-19 and other cases is a challenge for doctors like Mandeep Pathak (pictured right) who do not like to turn patients away. Even though the height of the pandemic this week, the orthopaedic surgeon has performed 15 operations, including on a 13-year-old boy from Kalikot with a fractured leg. In the past month, Bayalpata Hospital has performed 77 deliveries, of which eight were caesarean sections. “The staff adjust, innovate, accommodate, reallocate, adapt and have kept working right through the pandemic,” Pathak says. <img width="1906" height="1398" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131116/636cec6c9c7e80680e09ad64jpeg.jpg" alt="">New health protocols have been adapted to minimise disruptions, and Bayalpata is seeking resources to help with the crisis. There is fear that regular services will be increasingly impacted as the pandemic peaks.  The lockdown also means that families may wait till the very last moment to take patients to hospitals, by when it is usually too late. Bayalpata Hospital has therefore modified some of its regular services to remote care via phone calls. Bayalpata Hospital’s community health program, for example, that provides regular group antenatal care to pregnant women has been severely impacted. While the program was offered throughout the first wave, it has been interrupted during the second wave, and staff have had to resort to phone-based counselling and follow-up unless in case of emergencies.  The fear is that far-flung and traditionally neglected districts like Achham will be the last to get test kits, PPEs, oxygen, hospital beds and eventually vaccines. The progress Nepal has made over decades in rural healthcare is being undone by the pandemic.  For offers of assistance to hospitals in Far-Western Nepal, contact: Bayalpata Hospital: <a target="_blank" rel="noopener noreferrer">srijana.devkota@nyayahealthnepal.org</a> +977 9851093920   Dadeldhura Hospital: +977 9858753201 (Dr Jagadish Bista) <a href="https://give2asia.org/covid-19-pandemic-response-nepal/" target="_blank" rel="noopener noreferrer">https://give2asia.org/covid-19-pandemic-response-nepal/</a>

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At the Covid-19 frontlines in rural Nepal

<figure><img width="1641" height="1000" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111140/636b84419c7e80680e067784jpeg.jpg" alt=""/><figcaption>Services provided from outside of OPD due to Covid cases. Photos: NYAYA HEALTH NEPAL</figcaption></figure>Nepal’s rural health system, already underfunded, understaffed and overstretched, is struggling with the enormous added burden of the Covid-19 pandemic.  Having barely coped with the first wave last year, hospitals in the remote mountains of Far-Western Province have found that the variants in the second wave are much more lethal, there are many more patients than before, and more of them require hospitalisation.  In Achham district the administration declared a lockdown on 3 May, but by then the virus was already spreading within families and house-to-house. Till the day before the lockdown, people were still arriving by the busloads from India, Kathmandu and other cities. Testing and tracing were lax, and they were mingling in the markets.  On Sunday, Nepal added 8,850 new confirmed infections, bringing total active cases to 88,160. There were 52 fatalities but 26 more died at home. Kathmandu reported 4,198 cases in the last 24 hours. There are 832 people in ICU across the country, and 267 patients on ventilator support. In the village of Jaygad of Achham, for example, an annual fair with large crowds was being held even as 13 out of 15 sample antigen tests came out positive. The virus was spreading into the remotest villages. “We have increased awareness programs and testing, and local governments have become more active in the recent days and taken more ownership of testing and information dissemination,” says Janakraj Dhungana at Achham’s District Health Office.  But many wonder whether it is too late to be disseminating information through loudspeakers on masking and distancing, when patients and families throng ill-equipped hospitals. Dhungana himself admits that there was not enough testing and isolation because of a shortage of kits.  Like other districts of Far-Western Province, the caseload in Achham is increasing, with 2,183 positive cases and 17 deaths so far. Of this, 511 positive cases and 6 deaths are during this second wave.  The vaccination drive was also suspended after 3,000 medical personnel and community health workers were inoculated. But 15,000 senior citizens in Achham alone still have not got their second doses yet.  <figure><img width="1500" height="1000" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111140/636b84449c7e80680e067785jpeg.jpg" alt=""><figcaption> </figcaption></figure>The government has now asked all hospitals to also treat Covid-19 patients. Bayalpata Hospital in Achham, which is run by the non-profit Nyaya Health Nepal in partnership with the local government, was not a designated Covid-19 hospital during the first wave. This year, it is treating a flood of Covid-19 cases.“We had set aside an entire wing for coronavirus cases, but there has been such a surge in the past week that we have turned the emergency room into a Covid ward,” says Mandeep Pathak, medical director at Bayalpata Hospital. “We converted five rooms set aside for drug-resistant tuberculosis treatment for Covid patients.”Bayalpata is currently treating 26 patients with Covid-19, all of them with low oxygen saturation levels, but new cases are being admitted every day. The hospital has also had to reassign eight rooms for Covid-19 patients, including for 14 of its own staff who have tested positive. In Dadeldhura Hospital a four-hour drive to the west, all 31 beds are full with Covid-19 patients, and although there are only five ICU beds, 13 patients are receiving intensive care. In the neighbouring district of Doti, it is the same story.“Even if we have beds, we have no oxygen, it is a vicious cycle,” says Jagdish Bista, Medical Superintendent at Dadeldhura District Hospital. “The most urgent need now is oxygen, and we are also running out of PPEs.” But what worries the doctor more is the 50-70% positivity rate of testing, and what this means for the next two weeks.For the time being, the nursing staff shortage has been alleviated with new transfers. But Dadeldhura Hospital’s oxygen plant cannot cope with demand, and there are difficulties to get cylinders refilled in Nepalganj and Dhangadi. Covid-19 has taken precedence over other cases, apart from emergencies and deliveries. Most patients are in the 30-year-old range, and those turned away seek help in Dhangadi’s Seti Hospital, which is also inundated.Patients who can get to hospital and get admitted in this remote region are the lucky ones. Local municipalities have built isolation centres, but most are empty because there is no oxygen and no medical personnel, says Devraj Devkota of Panchadeval Binayak municipality. <figure><img width="1753" height="2409" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111140/636b84479c7e80680e067786jpeg.jpg" alt=""><figcaption> </figcaption></figure>“Our people prefer to either isolate at home or try to get to a hospital if their condition deteriorates,” he adds. “We have had no help from Kathmandu.”But Nepal’s cities, including in the capital, are also out of hospital beds and oxygen, so there is little hope for outside help. In fact, a reverse flow is starting: critical Covid-19 patients in Kathmandu are being helicoptered to Jhapa or Kaski where there are still hospital beds with oxygen.The need in every municipality in the far west is the same: oxygen cylinders, pulse oximeters and testing kits, and additional hospital beds for serious cases.Says Achham’s District Health Officer Dhungana: “Oxygen is a problem. We depend on Dhangadi and Nepalganj to refill cylinders. They get used up fast, which has made it a logistical challenge.” There is also a critical shortage of staff. Despite vacancy notices, there were few applicants for specialised medical personnel even pre-pandemic. For example, although the District Hospital in Mangalsen has ventilators, there is no one to run them, and there isn’t enough oxygen.Patient referrals to city hospitals offering critical care, or just beds with oxygen, are also complicated. They are also overwhelmed, and there are few ambulances with oxygen for the 8-12 hour journey across mountain highways. Ambulances are expensive, and helicopter air lifts are even more costly. Despite this, desperate families have taken loans to try to save family members in critical conditions by air lifting them to city hospitals—often too late. Then there are all the other non-Covid trauma patients needing urgent surgery, or maternity cases. With its free treatment, Bayalpata Hospital has served more than 1 million patients from Achham and six surrounding districts of Karnali and Far-West Provinces in the past 12 years. Separating Covid-19 and other cases is a challenge for doctors like Mandeep Pathak (pictured right) who do not like to turn patients away. Even though the height of the pandemic this week, the orthopaedic surgeon has performed 15 operations, including on a 13-year-old boy from Kalikot with a fractured leg. In the past month, Bayalpata Hospital has performed 77 deliveries, of which eight were caesarean sections. “The staff adjust, innovate, accommodate, reallocate, adapt and have kept working right through the pandemic,” Pathak says. <img width="1906" height="1398" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111140/636b844b9c7e80680e067787jpeg.jpg" alt="">New health protocols have been adapted to minimise disruptions, and Bayalpata is seeking resources to help with the crisis. There is fear that regular services will be increasingly impacted as the pandemic peaks.  The lockdown also means that families may wait till the very last moment to take patients to hospitals, by when it is usually too late. Bayalpata Hospital has therefore modified some of its regular services to remote care via phone calls. Bayalpata Hospital’s community health program, for example, that provides regular group antenatal care to pregnant women has been severely impacted. While the program was offered throughout the first wave, it has been interrupted during the second wave, and staff have had to resort to phone-based counselling and follow-up unless in case of emergencies.  The fear is that far-flung and traditionally neglected districts like Achham will be the last to get test kits, PPEs, oxygen, hospital beds and eventually vaccines. The progress Nepal has made over decades in rural healthcare is being undone by the pandemic.  For offers of assistance to hospitals in Far-Western Nepal, contact: Bayalpata Hospital: <a target="_blank" rel="noopener noreferrer">srijana.devkota@nyayahealthnepal.org</a> +977 9851093920   Dadeldhura Hospital: +977 9858753201 (Dr Jagadish Bista) <a href="https://give2asia.org/covid-19-pandemic-response-nepal/" target="_blank" rel="noopener noreferrer">https://give2asia.org/covid-19-pandemic-response-nepal/</a>

<figure><img width="1500" height="1000" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131116/636cebe19c7e80680e09ad30jpeg.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.

Sahina Shrestha

Medical students deprived of Covid-19 vaccines

<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.

<img width="1366" height="871" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111140/636b83b69c7e80680e067751jpeg.jpg" alt=""/>Nepal’s first wave of the coronavirus last year now looks like a ripple, and what the country is now witnessing is the main eruption. 
A lot of the attention is on Kathmandu Valley because more than half the daily new Covid-19 cases are here. But it is the Tarai districts bordering India that have been ravaged first, <a href="https://www.nepalitimes.com/banner/as-india-peaks-covid-19-spreads-rapidly-in-nepal/" target="_blank" rel="noopener noreferrer">just like last year</a>, but on a much vaster scale. 
Epidemiologists say what happens in India arrives in Nepal four weeks later, and the border cities precede Kathmandu by two weeks. Banke district, for example, which is the gateway to Nepal for most returnees from India, is the second most affected after Kathmandu, with 4,811 <a href="https://covid19.mohp.gov.np/covid/englishSituationReport/6091313e5e4ad_SitRep450_COVID-19_4-05-2021_EN.pdf" target="_blank" rel="noopener noreferrer">active cases</a>. 
Banke’s positivity rate is shocking: <a href="https://covid19.mohp.gov.np/covid/englishSituationReport/6091313e5e4ad_SitRep450_COVID-19_4-05-2021_EN.pdf" target="_blank" rel="noopener noreferrer">210 of the 299 PCR tests</a> at Nepalganj Medical College (NMC) in Kohalpur in 24 hours on Tuesday were positive -- 19 times higher than the rate a month earlier.
The doubling time for the infection at Bheri Hospital in Nepalganj is only eight days. The hospital did 1.6% of all the tests nationwide in the past two months, but had 5.35% of the new cases in that time. 
One would have thought that the first wave would have prepared Banke and indeed Nepal for this one. But what is happening now is a <a href="https://www.nepalitimes.com/editorial/the-covid-tsunami/" target="_blank" rel="noopener noreferrer">tsunami</a>.
Last year, when we caught up with <a href="https://www.nepalitimes.com/latest/quarantine-guidelines-impossible-to-meet-local-governments/" target="_blank" rel="noopener noreferrer">Deputy Mayor Uma Thapa Magar of Nepalganj</a>, she was trying to enforce mandatory quarantine on returnees from India, and trying to make sense of a virus that no one knew much about. The mixed directives or inadequate resources from the federal government did not help. Municipalities were left to fend for themselves. 
“We were learning as we went along, this time we are dealing with a completely different virus," says Deputy Mayor Magar. "Last year the patient numbers were manageable, even with home isolation. This year, a high share of those who test positive need hospital beds with oxygen. If we cannot provide oxygen, we lose them. There is enough oxygen, but not enough cylinders." 
The first wave was a dress rehearsal for the <a href="https://www.nepalitimes.com/banner/unmasking-the-second-wave/" target="_blank" rel="noopener noreferrer">second one</a>. Local leaders have learnt that <a href="https://www.nepalitimes.com/latest/the-india-connection-in-nepals-covid-19-status/" target="_blank" rel="noopener noreferrer">the border is the chokepoint</a>, and 70% of cases initially were among those with travel history. At the Indian border, health personnel are working in three shifts to screen inbound Nepalis with antigen tests. Those testing negative are kept in holding centres, then transported to home districts by local governments. Positive patients are kept in isolation in Nepalganj, or taken to their domiciles with the support of the Red Cross. These pre-established networks from the first wave have made the work smoother, but the sheer numbers have overwhelmed local capacity. 
Bheri Hospital had 140 beds and NMC had 50, which had been expanded to 220 and 300 during the first wave. As our report this week shows, <a href="https://www.nepalitimes.com/latest/nepal-designates-more-hospitals-for-covid-19-treatment/" target="_blank" rel="noopener noreferrer">Nepalganj has also added isolation centres</a>, including with oxygen supply, to reduce the pressure on the hospitals. But even with all this, it is not enough.
“We are operating beyond capacity,” says Prakash Bahadur Thapa, the physician who heads Bheri Hospital, sounding fatigued on the phone. “Of the 277 patients now, 180 need oxygen and 9 are on ventilator support, 77 in ICU beds. We are using up to 400 oxygen cylinders daily, before Covid we needed only 10-20 per day.”
More than 100 staff at Bheri Hospital have tested positive. More support has been added, but even doctors and nurses with mild symptoms are caring for patients in the Covid-19 wards. A bed is available only when a patient recovers or dies. Says Thapa, “There is no comparison between the first and the second wave, and the next two months will be difficult.”  
The number of deaths is also higher during the current spread, and even the Nepal Army is overwhelmed in <a href="https://www.nepalitimes.com/banner/kathmandu-electric-crematorium-running-non-stop/" target="_blank" rel="noopener noreferrer">management of bodies</a>. We asked Thapa what is most urgently needed. His reply: <a href="https://www.nepalitimes.com/latest/nepal-designates-more-hospitals-for-covid-19-treatment/" target="_blank" rel="noopener noreferrer">more hospitals need to be included as Covid-19 facilities</a>. Just two hospitals with limited beds are already inadequate. 
Nepalganj shows that local governments are best placed to react urgently to the ground situation. But Deputy Mayor Thapa Magar says the scale of this crisis means that they need help with medical supplies, oxygen, cylinders, setting up more isolation centres. Voluntary organisations can also help by mobilising awareness about using masks and avoiding crowds. The only way to stay alive in the pandemic is not to fall sick in the first place. 
Physician Thapa at Bheri Hospital puts it bluntly: “In the coming days, it will be the availability of oxygen that will determine how many live and how many die.” 
An exasperated Sunil Singh, chair of Ward 2, says Nepalganj must declare a health emergency. “Imagine if this was an earthquake or a flood disaster, what would our response be? More medical supplies, more health staff, temporary health centres, food rations for the needy. Kathmandu and Karnali Province have not done enough. This is a war. We are hanging by a thread, how much longer before it breaks? 
Read also: <a href="https://www.nepalitimes.com/latest/our-health-system-cant-contain-the-pandemic/">“Our health system can’t contain the pandemic”</a>, Nepali Times

This is war

<img width="1366" height="871" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131116/636cebda9c7e80680e09ad2ejpeg.jpg" alt=""/>Nepal’s first wave of the coronavirus last year now looks like a ripple, and what the country is now witnessing is the main eruption. 
A lot of the attention is on Kathmandu Valley because more than half the daily new Covid-19 cases are here. But it is the Tarai districts bordering India that have been ravaged first, <a href="https://www.nepalitimes.com/banner/as-india-peaks-covid-19-spreads-rapidly-in-nepal/" target="_blank" rel="noopener noreferrer">just like last year</a>, but on a much vaster scale. 
Epidemiologists say what happens in India arrives in Nepal four weeks later, and the border cities precede Kathmandu by two weeks. Banke district, for example, which is the gateway to Nepal for most returnees from India, is the second most affected after Kathmandu, with 4,811 <a href="https://covid19.mohp.gov.np/covid/englishSituationReport/6091313e5e4ad_SitRep450_COVID-19_4-05-2021_EN.pdf" target="_blank" rel="noopener noreferrer">active cases</a>. 
Banke’s positivity rate is shocking: <a href="https://covid19.mohp.gov.np/covid/englishSituationReport/6091313e5e4ad_SitRep450_COVID-19_4-05-2021_EN.pdf" target="_blank" rel="noopener noreferrer">210 of the 299 PCR tests</a> at Nepalganj Medical College (NMC) in Kohalpur in 24 hours on Tuesday were positive -- 19 times higher than the rate a month earlier.
The doubling time for the infection at Bheri Hospital in Nepalganj is only eight days. The hospital did 1.6% of all the tests nationwide in the past two months, but had 5.35% of the new cases in that time. 
One would have thought that the first wave would have prepared Banke and indeed Nepal for this one. But what is happening now is a <a href="https://www.nepalitimes.com/editorial/the-covid-tsunami/" target="_blank" rel="noopener noreferrer">tsunami</a>.
Last year, when we caught up with <a href="https://www.nepalitimes.com/latest/quarantine-guidelines-impossible-to-meet-local-governments/" target="_blank" rel="noopener noreferrer">Deputy Mayor Uma Thapa Magar of Nepalganj</a>, she was trying to enforce mandatory quarantine on returnees from India, and trying to make sense of a virus that no one knew much about. The mixed directives or inadequate resources from the federal government did not help. Municipalities were left to fend for themselves. 
“We were learning as we went along, this time we are dealing with a completely different virus," says Deputy Mayor Magar. "Last year the patient numbers were manageable, even with home isolation. This year, a high share of those who test positive need hospital beds with oxygen. If we cannot provide oxygen, we lose them. There is enough oxygen, but not enough cylinders." 
The first wave was a dress rehearsal for the <a href="https://www.nepalitimes.com/banner/unmasking-the-second-wave/" target="_blank" rel="noopener noreferrer">second one</a>. Local leaders have learnt that <a href="https://www.nepalitimes.com/latest/the-india-connection-in-nepals-covid-19-status/" target="_blank" rel="noopener noreferrer">the border is the chokepoint</a>, and 70% of cases initially were among those with travel history. At the Indian border, health personnel are working in three shifts to screen inbound Nepalis with antigen tests. Those testing negative are kept in holding centres, then transported to home districts by local governments. Positive patients are kept in isolation in Nepalganj, or taken to their domiciles with the support of the Red Cross. These pre-established networks from the first wave have made the work smoother, but the sheer numbers have overwhelmed local capacity. 
Bheri Hospital had 140 beds and NMC had 50, which had been expanded to 220 and 300 during the first wave. As our report this week shows, <a href="https://www.nepalitimes.com/latest/nepal-designates-more-hospitals-for-covid-19-treatment/" target="_blank" rel="noopener noreferrer">Nepalganj has also added isolation centres</a>, including with oxygen supply, to reduce the pressure on the hospitals. But even with all this, it is not enough.
“We are operating beyond capacity,” says Prakash Bahadur Thapa, the physician who heads Bheri Hospital, sounding fatigued on the phone. “Of the 277 patients now, 180 need oxygen and 9 are on ventilator support, 77 in ICU beds. We are using up to 400 oxygen cylinders daily, before Covid we needed only 10-20 per day.”
More than 100 staff at Bheri Hospital have tested positive. More support has been added, but even doctors and nurses with mild symptoms are caring for patients in the Covid-19 wards. A bed is available only when a patient recovers or dies. Says Thapa, “There is no comparison between the first and the second wave, and the next two months will be difficult.”  
The number of deaths is also higher during the current spread, and even the Nepal Army is overwhelmed in <a href="https://www.nepalitimes.com/banner/kathmandu-electric-crematorium-running-non-stop/" target="_blank" rel="noopener noreferrer">management of bodies</a>. We asked Thapa what is most urgently needed. His reply: <a href="https://www.nepalitimes.com/latest/nepal-designates-more-hospitals-for-covid-19-treatment/" target="_blank" rel="noopener noreferrer">more hospitals need to be included as Covid-19 facilities</a>. Just two hospitals with limited beds are already inadequate. 
Nepalganj shows that local governments are best placed to react urgently to the ground situation. But Deputy Mayor Thapa Magar says the scale of this crisis means that they need help with medical supplies, oxygen, cylinders, setting up more isolation centres. Voluntary organisations can also help by mobilising awareness about using masks and avoiding crowds. The only way to stay alive in the pandemic is not to fall sick in the first place. 
Physician Thapa at Bheri Hospital puts it bluntly: “In the coming days, it will be the availability of oxygen that will determine how many live and how many die.” 
An exasperated Sunil Singh, chair of Ward 2, says Nepalganj must declare a health emergency. “Imagine if this was an earthquake or a flood disaster, what would our response be? More medical supplies, more health staff, temporary health centres, food rations for the needy. Kathmandu and Karnali Province have not done enough. This is a war. We are hanging by a thread, how much longer before it breaks? 
Read also: <a href="https://www.nepalitimes.com/latest/our-health-system-cant-contain-the-pandemic/">“Our health system can’t contain the pandemic”</a>, Nepali Times

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181152/636be9aa9c7e80680e0878d2jpeg.jpg" alt="" width="1350" height="1565"/><figcaption>Nischal Shrestha, a caregiver in Israel, getting vaccinated last week.</figcaption></figure>Long before Nepalis in Nepal will be vaccinated against the coronavirus, <a href="https://www.nepalitimes.com/here-now/overseas-nepalis-on-the-covid-19-frontlines/" target="_blank" rel="noopener noreferrer">Nepali frontline workers around the world</a> are already receiving their first jabs.The most optimistic prediction for a vaccine to arrive in Nepal is mid-2021, but with countries around the world prioritising medical workers, many Nepalis who work in the healthcare sector overseas are starting to get vaccinated.The globalisation of the Nepali workforce became even more apparent during the pandemic: a Nepali doctor in the UK could be using medical gloves <a href="https://www.nepalitimes.com/latest/global-glove-makers-compensate-nepali-workers/" target="_blank" rel="noopener noreferrer">made by Nepali workers in a Malaysian glove factory</a> while vaccinating a Nepali nurse.“We always knew healthcare workers would be in the priority group, but the general understanding was it would still be a few months into 2021 that the vaccines would reach us,” said Binaya Raman Dahal, a Nepali hospitalist in North Carolina who got his first injection last week, and said it was like taking any other flu shot.Dahal recalls how his colleagues would fall ill, and hospital staff had to step in even during off days. The first couple of months into the pandemic, <a href="https://www.nepalitimes.com/here-now/protecting-those-who-protect-us-from-the-epidemic/" target="_blank" rel="noopener noreferrer">personal protective equipment</a> ran out, and there was a rush of patients following the July 4 and Labour Day weekends.“There is a big sense of relief that the vaccines are here,” Dahal said over the phone, adding that he will still have to careful because of the risk to family.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181152/636be9ae9c7e80680e0878d3jpeg.jpg" alt="" width="686" height="915"><figcaption>Binaya Raman Dahal, a hospitalist in North Carolina, getting his vaccination. He says it is a “big relief” for health workers like him as the pandemic rages across the US.</figcaption></figure><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181156/636be9b09c7e80680e0878d4jpeg.jpg" alt="" width="686" height="915"><figcaption>Srijana Panta Rokka has been a nurse in the UK for 15 years, and says she is fortunate as a frontline worker to be one of the first in the UK to be vaccinated against Covid-19.</figcaption></figure>Srijana Panta Rokka, has been a nurse in the UK since 2004, and considers herself fortunate for being one of the first recipients of the vaccine. “It was like taking a flu-shot. Others report sore arms, temperature and headache as side effects, but for me I just felt tired and my eyes ached that day,” she recalls.Her General Practice has largely avoided in-contact patients since March, and has moved to tele-medicine, while only taking emergency in-person patients. But from 1 January, she will be serving as a vaccinator, after being trained in administering the Pfizer vaccine.“I was one of the nine nurses in my practice who got vaccinated so we could vaccinate others,” Rokka said in a phone interview. Most patients eligible for vaccination will be above 80 years.There are fears about side-effects and long-term implications of the vaccine, and Rokka has had to counsel fellow Nepalis working in elderly homes in the UK who are eligible for the vaccine, but are reluctant to take it. She thinks information campaigns to assuage people’s fears will have to be a part of vaccination drives.Another Nepali clinician in the United States, Yagya Raj Bhattarai, says the past year has shown that Covid-19 spared no one. “I had a 20-year-old patient who suffered the worst outcomes, including heart failure and anoxic brain injury. Then, I had a 100-year-old who was positive but completely asymptomatic,” said Bhattarai, who self-isolated in a room throughout the period to keep his family safe.Bhattarai’s hospital in North Carolina participated in vaccine trials, and says the efficacy of the first dose is 52%, and it is 95% after the second shot. He experienced mild local pain in his left arm and no other side effects.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181156/636be9b39c7e80680e0878d5jpeg.jpg" alt="" width="859" height="915"><figcaption>Khagendra Dahal, a clinician in Nebraska, was overwhelmed when he got an email regarding his first vaccination dose.</figcaption></figure>Across the United States in Nebraska, cardiologist Khagendra Dahal recalls long periods of self-isolation and the difficulty explaining to his young children why he was staying separately.“Even after being vaccinated, we will still need to continue to wear our protective gear because it is not known whether we are transmitters of the virus even if we ourselves are safe,” Dahal says.Another country with a sizeable <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/nepali-caregivers-in-israel,3809" target="_blank" rel="noopener noreferrer">Nepali caregiver population is Israel</a>, and it has started a massive vaccine campaign for health workers, those over 60 and at high risk. Nepali caregivers are considered frontline workers.Nischal Shrestha (pictured above) has been living in Israel for the last 11 years, and takes care of a 91-year-old woman who she took to the hospital to vaccinate last week.“I was not expecting to be given the shot because we were told that the priority would be health workers and the elderly. But my employer got the hospital to also get me immunised,” says Shrestha, who says her arm and body ached for a day or two, but she is fine now.Deepika Bhusal also works as <a href="https://www.nepalitimes.com/here-now/demand-grows-for-nepali-caregivers-in-israel/">a live-in caregiver</a> for an elderly couple in Israel. Her employers got their first doses of the vaccine on 25 December, and there was much celebration in the house.“I trust the health system here. Even the Prime Minister went on live television to take his first shot publicly,” says Bhusal, who is getting her own shot on new year’s day.“We live in the same house so compared to elderly care institutes or live-out care workers, we were in a much safer position,” Bhusal explains. “But we had to go outdoors often for therapy or exercise, or to shop, so there was always a risk,” she adds.The UAE is another popular destination for Nepali workers, and the first country to approve the Chinese Sinopharm vaccine which is said to be 86% effective after trials around the world. The UAE is providing the vaccines free to residents and citizens.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181156/636be9b69c7e80680e0878d6jpeg.jpg" alt="" width="720" height="960"><figcaption>Notice in a UAE newspaper announcing free Covid-19 vaccinations for citizens and residents.</figcaption></figure><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181156/636be9b89c7e80680e0878d7jpeg.jpg" alt="" width="720" height="960"><figcaption>And a UAE Covid-19 vaccination card.</figcaption></figure>Kisan Magar works in a car showroom whose employer got him and his European and Filipino colleagues vaccinated recently. He says he has been getting lots of congratulatory messages from family in Nepal, while compatriots in the UAE have been querying him about how to enrol for the vaccine.Navaraj Ghimire, another UAE-based Nepali who got his first jab says: “We work in security and are exposed to risk, and 33 people in my company have been infected so far." Some of his colleagues, however, refused to be vaccinated because they did not trust it.Back in Nepal, the <a href="https://www.nepalitimes.com/here-now/when-will-nepals-covid-vaccine-turn-come/" target="_blank" rel="noopener noreferrer">best-case scenario is for the first vaccinations</a> to start in mid-2021. Health experts say Nepal was late in the game to start ‘vaccine diplomacy’, and there is a fear that even when the vaccines do arrive the poor in remote areas will be the last in the queue.The vaccines that Nepal will acquire will have to be the ones that require less sophisticated cold storage systems which are currently in Phase 3 trials in India and China. Till then and even after being vaccinated, Nepalis have to keep wearing masks, avoid crowds and wash hands.According to Ministry of Health and Population, the Government plans to vaccinate 72% of the country's population, as 28% are below 15 and therefore excluded. An estimated 20% are expected to be vaccinated through the <a href="https://www.nepalitimes.com/opinion/glimmers-of-hope-for-nepal-on-vaccine/">WHO-initiated COVAX facility</a>, while the remaining 52% will be through government-to-government mechanisms.

Nepalis overseas get first vaccinations

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109191124/636bf0914b0ad905ca02f01bjpeg.jpg" alt="" width="1350" height="1565"/><figcaption>Nischal Shrestha, a caregiver in Israel, getting vaccinated last week.</figcaption></figure>Long before Nepalis in Nepal will be vaccinated against the coronavirus, <a href="https://www.nepalitimes.com/here-now/overseas-nepalis-on-the-covid-19-frontlines/" target="_blank" rel="noopener noreferrer">Nepali frontline workers around the world</a> are already receiving their first jabs.The most optimistic prediction for a vaccine to arrive in Nepal is mid-2021, but with countries around the world prioritising medical workers, many Nepalis who work in the healthcare sector overseas are starting to get vaccinated.The globalisation of the Nepali workforce became even more apparent during the pandemic: a Nepali doctor in the UK could be using medical gloves <a href="https://www.nepalitimes.com/latest/global-glove-makers-compensate-nepali-workers/" target="_blank" rel="noopener noreferrer">made by Nepali workers in a Malaysian glove factory</a> while vaccinating a Nepali nurse.“We always knew healthcare workers would be in the priority group, but the general understanding was it would still be a few months into 2021 that the vaccines would reach us,” said Binaya Raman Dahal, a Nepali hospitalist in North Carolina who got his first injection last week, and said it was like taking any other flu shot.Dahal recalls how his colleagues would fall ill, and hospital staff had to step in even during off days. The first couple of months into the pandemic, <a href="https://www.nepalitimes.com/here-now/protecting-those-who-protect-us-from-the-epidemic/" target="_blank" rel="noopener noreferrer">personal protective equipment</a> ran out, and there was a rush of patients following the July 4 and Labour Day weekends.“There is a big sense of relief that the vaccines are here,” Dahal said over the phone, adding that he will still have to careful because of the risk to family.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109191124/636bf0944b0ad905ca02f01cjpeg.jpg" alt="" width="686" height="915"><figcaption> </figcaption></figure><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109191124/636bf0964b0ad905ca02f01djpeg.jpg" alt="" width="686" height="915"><figcaption> </figcaption></figure>Srijana Panta Rokka, has been a nurse in the UK since 2004, and considers herself fortunate for being one of the first recipients of the vaccine. “It was like taking a flu-shot. Others report sore arms, temperature and headache as side effects, but for me I just felt tired and my eyes ached that day,” she recalls.Her General Practice has largely avoided in-contact patients since March, and has moved to tele-medicine, while only taking emergency in-person patients. But from 1 January, she will be serving as a vaccinator, after being trained in administering the Pfizer vaccine.“I was one of the nine nurses in my practice who got vaccinated so we could vaccinate others,” Rokka said in a phone interview. Most patients eligible for vaccination will be above 80 years.There are fears about side-effects and long-term implications of the vaccine, and Rokka has had to counsel fellow Nepalis working in elderly homes in the UK who are eligible for the vaccine, but are reluctant to take it. She thinks information campaigns to assuage people’s fears will have to be a part of vaccination drives.Another Nepali clinician in the United States, Yagya Raj Bhattarai, says the past year has shown that Covid-19 spared no one. “I had a 20-year-old patient who suffered the worst outcomes, including heart failure and anoxic brain injury. Then, I had a 100-year-old who was positive but completely asymptomatic,” said Bhattarai, who self-isolated in a room throughout the period to keep his family safe.Bhattarai’s hospital in North Carolina participated in vaccine trials, and says the efficacy of the first dose is 52%, and it is 95% after the second shot. He experienced mild local pain in his left arm and no other side effects.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109191124/636bf0984b0ad905ca02f01ejpeg.jpg" alt="" width="859" height="915"><figcaption> </figcaption></figure>Across the United States in Nebraska, cardiologist Khagendra Dahal recalls long periods of self-isolation and the difficulty explaining to his young children why he was staying separately.“Even after being vaccinated, we will still need to continue to wear our protective gear because it is not known whether we are transmitters of the virus even if we ourselves are safe,” Dahal says.Another country with a sizeable <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/nepali-caregivers-in-israel,3809" target="_blank" rel="noopener noreferrer">Nepali caregiver population is Israel</a>, and it has started a massive vaccine campaign for health workers, those over 60 and at high risk. Nepali caregivers are considered frontline workers.Nischal Shrestha (pictured above) has been living in Israel for the last 11 years, and takes care of a 91-year-old woman who she took to the hospital to vaccinate last week.“I was not expecting to be given the shot because we were told that the priority would be health workers and the elderly. But my employer got the hospital to also get me immunised,” says Shrestha, who says her arm and body ached for a day or two, but she is fine now.Deepika Bhusal also works as <a href="https://www.nepalitimes.com/here-now/demand-grows-for-nepali-caregivers-in-israel/">a live-in caregiver</a> for an elderly couple in Israel. Her employers got their first doses of the vaccine on 25 December, and there was much celebration in the house.“I trust the health system here. Even the Prime Minister went on live television to take his first shot publicly,” says Bhusal, who is getting her own shot on new year’s day.“We live in the same house so compared to elderly care institutes or live-out care workers, we were in a much safer position,” Bhusal explains. “But we had to go outdoors often for therapy or exercise, or to shop, so there was always a risk,” she adds.The UAE is another popular destination for Nepali workers, and the first country to approve the Chinese Sinopharm vaccine which is said to be 86% effective after trials around the world. The UAE is providing the vaccines free to residents and citizens.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109191124/636bf09b4b0ad905ca02f01fjpeg.jpg" alt="" width="720" height="960"><figcaption> </figcaption></figure><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109191124/636bf09e4b0ad905ca02f020jpeg.jpg" alt="" width="720" height="960"><figcaption> </figcaption></figure>Kisan Magar works in a car showroom whose employer got him and his European and Filipino colleagues vaccinated recently. He says he has been getting lots of congratulatory messages from family in Nepal, while compatriots in the UAE have been querying him about how to enrol for the vaccine.Navaraj Ghimire, another UAE-based Nepali who got his first jab says: “We work in security and are exposed to risk, and 33 people in my company have been infected so far." Some of his colleagues, however, refused to be vaccinated because they did not trust it.Back in Nepal, the <a href="https://www.nepalitimes.com/here-now/when-will-nepals-covid-vaccine-turn-come/" target="_blank" rel="noopener noreferrer">best-case scenario is for the first vaccinations</a> to start in mid-2021. Health experts say Nepal was late in the game to start ‘vaccine diplomacy’, and there is a fear that even when the vaccines do arrive the poor in remote areas will be the last in the queue.The vaccines that Nepal will acquire will have to be the ones that require less sophisticated cold storage systems which are currently in Phase 3 trials in India and China. Till then and even after being vaccinated, Nepalis have to keep wearing masks, avoid crowds and wash hands.According to Ministry of Health and Population, the Government plans to vaccinate 72% of the country's population, as 28% are below 15 and therefore excluded. An estimated 20% are expected to be vaccinated through the <a href="https://www.nepalitimes.com/opinion/glimmers-of-hope-for-nepal-on-vaccine/">WHO-initiated COVAX facility</a>, while the remaining 52% will be through government-to-government mechanisms.

Upasana Khadka

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

The Nepal Premier League T20 men’s cricket tournament is a culmination of much progress in the sport in Nepal over the past decade, and a thrilling first step into higher level sports events in the country. Adding to the excitement is the international talent taking part. The tournament features eight teams made up of Nepali and international cricketers, including Shikhar Dhawan, one of India’s greatest ODI batsmen over the 2010s, and an IPL stalwart for the Delhi and Mumbai franchises. Dhawan is playing for the Karnali Yaks at the NPL. Other eminent imports include Kiwi batsman Martin Guptill, Indian-American Unmukt Chand, and Trinidadian fast bowler Anderson Philip. The NPL franchises are named for Nepal’s provinces and cities. Beside the Yaks, there are the Biratnagar Kings, the Chitwan Rhinos, the Janakpur Bolts, the Kathmandu Gurkhas, the Lumbini Lions, the Pokhara Avengers, and the Sudurpaschim Royals. The franchises have a wide variety of backers, including Kantipur Publications behind the Gurkhas, Chitwan Medical College behind the Rhinos, and Himalayan Builders for the Yaks. These entities are paying the international stars salaries rumoured to be in the Rs5 million range ($37,000) for the 21-day contest.&nbsp; The teams will play each other first in a round-robin league, after which the best performers will progress to playoffs. There will be 32 games in total, all to be held at the Tribhuvan University International Cricket Ground in Kirtipur which is being spruced up, including additions of an expanded boundary, digital scoreboard, new sight screens, and practice pitches.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241129041152_9236da646959b888a8635b10bd46b9f9e08f0068ab031a4b8ad736a185288164.jpg" data-media-id="editor_0" data-image-id="20241129041152_9236da646959b888a8635b10bd46b9f9e08f0068ab031a4b8ad736a185288164" data-rendition-name="original" width="1080" height="1080" loading="lazy" alt="NPL"> </figure>  “Holding all the games at the same stadium makes sense logistically for this inaugural season,” says Chhumbi Lama of the Cricket Association of Nepal (CAN). “Future editions will see matches happen across Nepal.”&nbsp; Another benefit of the tournament in future is that it may expedite the completion and upgrades of stadiums across the country, such as Mulpani Cricket Stadium in Kathmandu, the Gautam Buddha International Stadium in Bharatpur, and the Fapla Cricket Ground in Kailali. The main benefit of the tournament is said to be the development of Nepali cricket talent. The rules are also made up to favour this with each 16-player squad having no more than four foreign players. One Nepali ‘marquee’ player was selected by lottery, and others were signed through auctions for as high as Rs1.5 million. “Each team will have the marquee player from the province they represent,” says Lama, although this does not seem to be the case in practice. The 24-year-old leg spinner Sandeep Lamichhane, for example, is captaining the Biratnagar Kings, although he comes from Syangja district in Gandaki Province. “NPL’s goal is to support the development of cricket and our players,” says ex-captain and CAN secretary Paras Khadka. Players who are not usually selected for the national team will have the chance to show their cricketing skills. This has proved very beneficial in similar domestic leagues around the world. The Indian Premier League, for instance, led to the discovery and improvement of players like fast-bowler Jasprit Bumrah and batsman Suryakumar Yadav, who not only have become regular starters for the Indian national team, but also are now some of the top-ranked cricketers in the world, contributing to India being the best team in both T20s and ODIs. Nepal’s excellent run in the T20 World Cup this summer, with stellar performances against The Netherlands, South Africa and Bangladesh showed the world that the country could compete at the highest level in cricket. This has added to the legitimacy of the NPL and also promises longevity through future editions: the titular sponsor of the tournament, Siddhartha Bank, has committed to this role until 2029. Ncell is also involved, as the ‘Powered by’ sponsor, continuing the telecom company’s support for cricket, football, volleyball, golf and paralympic athletes. Another sponsor for the Kathmandu Gurkhas, is Chinese electric vehicle giant BYD. Adding weight to the NPL is that it is being broadcast live on Star Sports, giving it a global audience. Perhaps the eyes on the tournament that will have the added benefit of discouraging match fixing which has been a problem in past attempts to organise cricket leagues in Nepal.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2024112905110_d1817c8e82f476c20081dae3ba820c7f7305b8cfb095a97264915c6af50f3d60.jpg" data-media-id="editor_1" data-image-id="2024112905110_d1817c8e82f476c20081dae3ba820c7f7305b8cfb095a97264915c6af50f3d60" data-rendition-name="original" width="1440" height="1080" loading="lazy" alt="Nepal Premier League NT 3"> </figure>  The 2022-23 Nepal T20 league, sold to Indian sports management company Seven3Sports by CAN, saw individual cricketers approached by sports bettors to ‘spot-fix’ by getting out quickly or conceding a lot of runs when bowling. The large sums of money offered to the athletes by fixers is tempting, especially considering that salaries are not only low but sometimes unpaid. This led to an investigation from officials from the International Cricket Council, and cases filed against cricketers by the District Attorney’s Office in Kathmandu. The much wider coverage of this tournament should do better at discouraging corruption. Ticketing partner Khalti reports that tickets for the opening game are quickly selling out. The winning trophy was revealed at a ceremony at Dharara on Saturday. Marquee Players including Lamichhane, Rohit Paudel, Dipendra Singh Airee and Sompal Kami flanked Prime Minister KP Oli as he presented the cup: a large silver piece with an engraving of Mt Everest, topped by a stone from Kala Pattar (pictured).&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241129041152_f37ca66b9e68f28ad9bf1ab6f7dc74314e71345b8b3a02794c62be9357fb08be.jpg" data-media-id="editor_2" data-image-id="20241129041152_f37ca66b9e68f28ad9bf1ab6f7dc74314e71345b8b3a02794c62be9357fb08be" data-rendition-name="original" width="1080" height="720" loading="lazy" alt="Nepal Premier League NPL NT 1"> </figure>  The tournament kicks off at 12:15PM on Saturday 30 November, with a game between the Biratnagar Kings and the Janakpur Bolts. Two games are scheduled almost every day until 16 December, with the first starting at 9:15AM and the second at 1:15PM. Playoffs start on 18 December with teams that end up third and fourth playing first, with the loser eliminated. The first and second play next, with the winner advancing to the final. The loser then plays the winner of the first match for a place in the final. This format, compared to a straight semifinal-final approach, rewards teams for having done better in the group stages, as teams 1 and 2 have multiple chances at reaching the grand finale on 21 December. A team to look out for is the Sudurpaschim Royals which is well-backed, with the most Facebook followers. Captained by popular national team all-rounder Dipendra Singh Airee, the Royals also have batsman Aarif Sheikh, bowler Abinash Bohara and Scottish all-rounder Brandon McMullen in their ranks.

frontline-health-workers

Nepal’s doctors are like soldiers fighting a war

Nepal’s doctors are like soldiers fighting a war

At the Covid-19 frontlines in rural Nepal

At the Covid-19 frontlines in rural Nepal

Medical students deprived of Covid-19 vaccines

Medical students deprived of Covid-19 vaccines

This is war

This is war

Nepalis overseas get first vaccinations

Nepalis overseas get first vaccinations

‘Art Lover’ accused of sexual abuse

UFO over Pokhara

What Nepal’s VIP prisoners do in jail

Here comes the Nepal Premier League