<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101132/636b73eb9c7e80680e062365jpeg.jpg" alt="" width="1500" height="911"/><figcaption>Photo: NATIONAL TRAUMA CENTRE</figcaption></figure>Speeding along a narrow winding mountain road in Dhading, a heavily intoxicated truck driver lost control of the <a href="https://www.nepalitimes.com/banner/nepals-deadly-roads-take-their-toll/" target="_blank" rel="noopener">vehicle</a> and it overturned, killing seven and severely injuring 34 passengers hitching a ride.This was a mass trauma incident that required immediate attention, but <a href="http://nationaltraumacenter.gov.np/" target="_blank" rel="noopener">Nepal’s only trauma care centre</a> was located in Kathmandu, 90km away via bumpy roads jammed with traffic.Read also: <a href="https://www.nepalitimes.com/?p=40249&amp;preview_nonce=aefd82ecbe&amp;preview=true" target="_blank" rel="noopener">injured use Internet to reach physiotherapists in Nepal</a>, Sonia AwaleMost passengers from the truck accident were taken to nearby hospitals in Dhading, but the 21 most critical patients were airlifted or driven in ambulances to the National Trauma Centre in Kathmandu.“It had already taken a while to bring the patients to the Trauma Centre, so we had to act quickly once they were here,’’ recalls Pramod Yadav, acting medical superintendent at the facility.The standard protocol for trauma care is the triage system -- determining the priority of treatment based on the severity of injury. Doctors at the National Trauma Centre quickly designated yellow, green and red codes to patients to ensure that those in critical condition were taken care of first, and fast.Read also: <a href="https://archive.nepalitimes.com/article/nation/accident-prone-Mugling-Narayangadi-highway,3828" target="_blank" rel="noopener">Unblocking an artery</a>, Sanjeev SharmaOn-call doctors were contacted and began assessing the patient’s injuries. But without a functioning MRI and a faulty CT machine, some had to be sent to private clinics and later returned to the hospital.This is a recurring event for patients seeking immediate care at the government-run Trauma Centre where patients in critical condition have to be moved about from one facility to another for tests.“We cannot afford an MRI machine, it is very expensive to repair our CT machines, we have limited trolley beds and only 11 ICU beds when we need more than 50,” says Yadav. “We are requesting the government for Rs420 million to become a real trauma centre, especially since we are the only one in the country.”There were 60,000 severe trauma injuries in Nepal in the last year, a 3,000 increase from the previous year, and a whopping 27,000 over the year before that. Like with all government-run medical centres, the Trauma Centre lacks resources, is under-staffed, and is incapable of handling this exponential increase.“In the last two, three years, falls, physical assault, <a href="https://www.nepalitimes.com/banner/nepals-deadly-roads-take-their-toll/" target="_blank" rel="noopener">road traffic accidents</a>, sports injuries and <a href="https://archive.nepalitimes.com/article/nation/burning-in-the-aftermath,3757" target="_blank" rel="noopener">burns</a> have been the leading causes of trauma,” lists  Siddhartha Dhungana, the Medical Record Officer at the National Trauma Centre. “Head injuries and multi-organ failures have been the highest causes of death in these cases.”Most hospitals in Nepal, like the National Trauma Centre, follow the World Health Organisation’s trauma protocol. During a trauma case, medical personnel are contacted as soon as possible, patients are screened, their needs are identified and necessary care is given.Although the government has not developed a standard care protocol for trauma like it has for cancer patients, private hospitals have implemented and refined their own systems based on WHO guidelines.<a href="http://archive.nepalitimes.com/article/nation/politics-behind-epidemic-of-hospital-vandalism,3578" target="_blank" rel="noopener">Om Hospital</a>’s Continuing Medical Education Program is at the forefront of teaching trauma care to new doctors and providing courses on improved techniques to existing doctors.“We make sure that the ABCs of trauma care are followed strictly and that blood is readily available be it from our blood bank or staff-chain blood donors,” says Binod Adhikari of Om, which handles dozens of cases every day and has systems in place to coordinate between doctors, nurses and critical care anesthesiologists to provide emergency care to patients.<h2>Ambulance chasers</h2><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101132/636b73ee9c7e80680e062366jpeg.jpg" alt="" width="1500" height="1125"><figcaption> </figcaption></figure>Most of Nepal's ambulances are just jeeps with stretchers, with no life-support systems or medical attendants. It was only in 2011 that Nepal’s first emergency medical service was established. Supported by the Patan Academy of Health Sciences and the Stanford University School of Medicine, Nepal Ambulance Service (NAS) has since trained more than 100 emergency medical technicians (EMTs) and ambulance drivers and operates the <a href="http://archive.nepalitimes.com/news.php?id=18888#.XjvhpTIzaUk" target="_blank" rel="noopener">'Dial 102' service</a>. NAS operates mainly in Kathmandu Valley, Pokhara, Chitwan, Butwal and Bhairawa.“Before this, only few private hospitals had ambulances and they were used mainly for patient transfer rather than pre-hospital care,” says Hari Khadka, a paramedic at <a href="https://www.grandehospital.com/" target="_blank" rel="noopener">Grande International Hospital</a> and a member of the first EMT batch of NAS. “Ten years ago, there was simply no concept of pre-hospital care or paramedics in Nepal.”Now, many hospitals have their own EMS systems with mostly Type 3 ambulances that have first aid kits and basic medical supplies. <a href="https://www.nrcs.org/" target="_blank" rel="noopener">Nepal Red Cross Society</a> (NRCS) operates 283 ambulances nationwide. Although not every ambulance carries a paramedic, every driver has received first aid training.“We have five Type 2 ambulances and a paramedic in each vehicle,” says Bipul Neupane of NRCS. “We send these ambulances to patients who need basic life support systems.”But for patients needing critical care in remote areas, there is no recourse but expensive helicopter medical evacuation.Like Type 1 ambulances, some of these helicopters can have doctors, ventilators, advanced life support, and EMTs.“EMS has helped save many lives in Nepal but it isn’t always the best option considering the geography of Nepal and the condition of the roads,” says Sanjaya Karki, Head of the Emergency Department at <a href="https://www.nepalmediciti.com/" target="_blank" rel="noopener">Nepal Mediciti Hospital</a>. “Helicopter Emergency Medical Services ensure that we can get to critical patients as quickly as possible and provide the best pre-hospital care.”

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It’s an emergency: Nepal needs to improve trauma care

<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108151120/636a664f9c7e80680e059974jpeg.jpg" alt="" width="1200" height="793"/>Around the world, in rich countries and poor, financing healthcare is one of the biggest challenges. In poor countries, it becomes a life-or-death issue.Over 40% of global healthcare expenses are still covered by patients and their families, and more than half the world’s population lacks access to essential health services. Medical bills push 100 million people into extreme poverty every year.Nepal has taken remarkable strides in healthcare in past decades despite internal conflict and instability, but <a href="https://archive.nepalitimes.com/article/nation/national-health-insurance-not-as-easy,4028" target="_blank" rel="noopener">medical care is still unaffordable</a> or inaccessible to most. More than half the healthcare expenditure of Nepalis is still covered out of pocket. Nearly a third of families spend over 10% of their annual income on medical care.Read also: <a style="background-color: #ffffff; font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/banner/this-is-how-to-upgrade-nepals-rural-health/" target="_blank" rel="noopener">This is how to upgrade Nepal's rural health</a>, Sewa Bhattarai <a style="background-color: #ffffff; font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/banner/state-of-the-art-rural-hospital/" target="_blank" rel="noopener">State of the art rural hospital</a>, Marty LoganThursday, 12 December, is Universal Health Coverage Day, an important date to remind ourselves of the next steps we need to take to achieve healthcare for all. The 2015 constitution of Nepal declares basic and emergency healthcare as fundamental rights of citizens, putting the responsibility of financing such care on the state. Following federalism, municipal governments have got the responsibility to manage basic and essential care. A national health insurance bill has been passed and is being implemented.The state guarantees quality healthcare without financial burden on citizens, for which the insurees pay Rs3,500 per year for a family of five, and receive care worth Rs100,000. This is expected to reduce the burden of out of pocket and catastrophic expenses, while the government covers the premium for citizens under the poverty line.Read also: <a href="https://archive.nepalitimes.com/article/nation/national-health-insurance-not-as-easy,4028" target="_blank" rel="noopener">A national health insurance scheme is not as easy as it looks</a>, Sonia Awale<a style="background-color: #ffffff; font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/editorial/poor-health/" target="_blank" rel="noopener">Poor health</a>, EditorialThere is also a provision for free essential drugs and free treatment for patients with cardiovascular disease, cancer, spinal injuries, renal ailments and sickle cell anaemia, through the Disadvantaged Citizens Medical Treatment Fund.None of these initiatives is being implemented fully yet, but with federalism Nepal has a chance to build an accountable and sustainable healthcare system. The country therefore needs to focus on the following areas to manage health financing to meet the targets of the Sustainable Development Goals:<ul><li>Increase public sector healthcare investment to at least 7% of annual national budget. This should also be targeted towards reducing external aid.</li> 	<li>Empower people for self-care and make treatment more strategic and efficient as the burden shifts from communicable to non-communicable diseases.</li> 	<li>Focus on primary health care and improve services at the first point of care with comprehensive, accessible and community based care.</li> 	<li>Coordinate multisectoral policy action involving education, agriculture and social behaviour.</li> 	<li>Launch a priority national campaign to spread insurance coverage. Enrollment can be top-down starting with all government officials and then the public at large.</li></ul>A mixed financing model using tax-based funds through the treasury, and premium-based funds through health insurance can work for public, private, community, and other hospitals that run under the state-non-state partnership. An example of state- non-partnership is Bayalpata Hospital in Achham district, managed through a public-private partnership between the ministry of health and population and the non-profit Nyaya Health Nepal, where insurance reimbursement covered over 60% of the hospital’s operating costs.The hospital provides healthcare with no user fees. The care is extended from hospital to communities using a network of community health workers. How can care delivery with no user fee sustain? Can Nepal afford to provide such care to its entire population?It is possible. The country should effectively implement the national health insurance program, and strategically invest tax based funding. In the mixed financing model, for a ‘district level hospital, insurance can cover 60% of healthcare operating costs, and tax-based funding can take care of the rest. But to ensure effectiveness, the tax-based investment will need to be unrestricted and tied to audited performance indicators. The cost of care should also incorporate the extension of hospital-based services into communities in the catchment area.Bayalpata Hospital serves both as a primary care facility and also as a referral hospital. In this case, the tax-based contribution can be split into the three government tiers, with the federal government providing support for infrastructure, and provincial and local governments covering the cost of basic healthcare, and referral care not covered by the insurance.Insurance reimbursement then covers the cost of insurance-covered care, the local government allocates funds required for basic and emergency healthcare, and the provincial government pays for managing the cost of referrals beyond insurance coverage.<a style="background-color: #ffffff; font-size: 15px; letter-spacing: 0.01em;" href="https://archive.nepalitimes.com/article/nation/Nation-Crowdfund-globally-act-locally,490" target="_blank" rel="noopener">Bayalpata Hospital</a> provides basic and referral care, and its tax-based contribution can be split into the three government tiers, with the federal government providing support for basic infrastructure and provincial and local governments covering the cost of basic and referral care not covered by the insurance.Insurance reimbursement then covers the cost of insurance-covered care, the local government allocates funds required for basic and emergency healthcare, and the provincial government pays for managing the cost of referrals beyond insurance coverage.The proposed model has a 60:25:15 ratio to pay for health care, with 60% from insurance and provincial and local governments paying 25% and 15% of the cost. When the benefit package increases to cover the cost of healthcare without capitation, the share of health insurance coverage percentage will increase significantly, thereby reducing the tax-based direct public sector investment.S P Kalaunee is Executive Director of Nyaya Health Nepal, which manages Bayalpata and other public hospitals in partnership with the ministry of health and population.

Is free health care possible in Nepal?

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110714118/636903869c7e80680e037cc9jpeg.jpg" alt="" width="1000" height="616"/><figcaption>Photo: SHRADDHA SABURI HEALTH SERVICE</figcaption></figure>As a married, working woman with a child, it was impossible for Jasmine Bajracharya to take days off to care for her ailing parents. T<a name="_GoBack"></a>hey needed physiotherapy, but her father refused to visit a hospital. So they had to get the physiotherapist at home. Both are recovering thanks to home treatment.<a href="https://doctorsonkall.com/">Doctors on Call Nepal</a>, which provided the service to Bajracharya’s parents, is one of many new home care services that have come up in Nepal as the population ages, and their offspring are either abroad or busy at work.“My father is very talkative, so I was worried that he might offend the doctor on call,” Bajracharya says, “but the whole experience turned out to be very useful both for my parents and me, because of good communication and coordination. Now I know I have someone to turn to if my parents need care again.”Home health care has also helped provide jobs in Nepal for staff nurses and caregivers who may have otherwise have <a href="https://www.nepalitimes.com/here-now/migrating-males-and-population-decline/">migrated abroad</a>. In turn, as more and more young Nepalis go abroad to study or work, there is a growing demand for care givers who can take care of elderly parents at home, or take them to hospital for treatment.Another service provider is <a href="http://healthathome.com.np/">Health at Home</a> (see box) which was established in 2009 and has now grown into a nationwide network with units in Pokhara, Chitwan and Biratnagar besides Kathmandu.“In the West, every hospital has a home care unit. Its prospects in Nepal indicate that it is the future of medical care, which needs continuous innovation,” says founder Bishal Dhakal.Health at Home and others provide a range of services from nurses, doctors, physiotherapists and lab technicians on call to caretakers, travel support and appointment management. Many provide full doctoral supervision, while a few outsource nurses and caregivers only.The demand for care-givers is new in Nepal, and has grown exponentially to meet growing demand. Their work includes non-professional assistance which nurses do not perform, and some families prefer male health assistants.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110714118/636903889c7e80680e037ccajpeg.jpg" alt="" width="640" height="808"><figcaption> </figcaption></figure><a href="http://healhomecare.com/">Heal Home Care</a> and <a href="http://www.sshealthservices.com/">Shraddha Saburi Health Service</a> outsource female nurses and caregivers, employing more than a hundred trained personnel each, and one-third of them have been hired by Nepalis living abroad who want their parents cared for.Along with an improvements in physical health, many doctors and clients have also felt that such a service has positive effects on the mindset of elderly people, who prefer not go to a hospital. A simple follow up call or a quick visit brightens up the mood of elderly people who are often lonely, anxious or depressed because of health issues and separation from children.While the increasing demand has led to the mushrooming of home care in Kathmandu, health experts are worried that the quality of care may go down and put the health of the elderly at risk.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110714118/6369038b9c7e80680e037ccbjpeg.jpg" alt="" width="640" height="860"><figcaption> </figcaption></figure>Ramesh Kadel, Nepal’s first Geriatric Specialist, expresses concern over nurses trained in specialized care of the elderly. He says, “Service providers should keep hospitals and doctors in the loop. Our society is not fully geriatric friendly yet, and negligence of elderly people’s health is still prevalent, we need to be more aware and careful.”For the first time in world history, <a href="http://archive.nepalitimes.com/article/Nepali-Times-Buzz/need-to-prepare-for-ageing-society,3624">the population of people above 60 has exceeded that of children below 5</a>, and in 30 years more proper and holistic health care will be needed for the aging population.“There has been a lot of research and experiment on child health care, but proper research is lacking in the field of geriatrics. What will the future look like for today’s active population when they grow older?” asks <a href="https://www.google.com/url?q=http://archive.nepalitimes.com/news.php%3Fid%3D6370&amp;sa=U&amp;ved=0ahUKEwiKmsT_-u7cAhXRfCsKHY9xDzsQFggHMAE&amp;client=internal-uds-cse&amp;cx=011870630917993763279:opm7uqsat-4&amp;usg=AOvVaw3bqUqf9aY11y1eBubOwlMC">Krishna Murari Gautam</a> of <a href="http://ageingnepal.org/">Aging Nepal</a>, which has started a week-long specialised training for care givers of elderly patients.Doctors on Call Nepal and Health at Home also have a guided selection procedure and orientation program for nurses and caregivers, and a systematic recording of their patients to maintain quality.<h2>Health care at more homes</h2><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110714118/6369038d9c7e80680e037cccjpeg.jpg" alt="" width="1000" height="662">Home care for the elderly is one of their social enterprises that run as a business, while providing a public service. The company <a href="http://archive.nepalitimes.com/article/Nepali-Times-Buzz/Doctor,344">Health at Home won the Surya Nepal Award in 2012</a> for the concept of a socially responsible business. It hasn’t looked back.Nine years later, Health at Home has grown into a nationwide network of home care service company with centres in Pokhara, Kathmandu, Patan, Chitwan and Biratnagar providing much-needed home care for Nepal’s rapidly-aging population. With young men and women migrating abroad for work and studies and a growing demand from their elderly parents for health care, Health at Home is planning to open four more centres.“When we started, it was a small idea. With innovation, the idea turned into an industry and today we look forward to be an influencer that provides global standard health facility in the comfort of patient’s own home,” explains founder Bishal Dhakal.As it grew, the company has corporatised its structure with four partners, and CEO Amit Shrestha. The idea is to serve people in their community by building care capacity through an accountable, transparent and predictable process.“The concept of home care ten years ago was just to send nurses home to take care of the elderly. We are trying to constantly innovate and meet demands from patients for specialised care,” says Dhakal.Shrestha says Health at Home is poised to be a global player in virtual health care. The company is partnering with Samsung to invent a virtual platform for data management of home care parameters. This means doctors and the health management team do not need to visit homes, and can monitor patients remotely, making visits only if intervention is required.“We want to redefine health care for the new generation with new technology,” says Shrestha.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110714118/636903909c7e80680e037ccdjpeg.jpg" alt="" width="640" height="960"><figcaption> </figcaption></figure>Health at Home customers have requirements from postnatal to elderly care, patients with chronic diseases, the terminally ill, and dependent patients. The company ties up with hospitals like Mediciti, Nidan, Nepal Cancer Hospital, Sumeru and Green City, and insurance companies like MetLife, Reliance and Citizen Life and various diagnostic labs and pathologist.And there are additional services like Japanese massage therapy and nurse placements with home care specialization. So far, Health at Home has built up a reputation for reliable and personalised care that is responsive to the needs to patients.With Nepal’s population expected to reach 33 million by 2030 with nearly 15% of them above  65, there will be an ever-greater need for elderly care. Combined with out-migration of the young, this means the field is wide open for innovation and expansion in home care services.Read also: <a href="https://www.nepalitimes.com/banner/lets-talk-about-it/">Let’s talk about it</a>, Duksangh Sherpa<a href="https://archive.nepalitimes.com/article/nation/national-health-insurance-not-as-easy,4028">A national health insurance scheme is not as easy as it looks</a>, Sonia Awale<a href="http://archive.nepalitimes.com/article/nation/malnutrition-stunting-wasting,3603">Thought for food</a>, Marty Logan

Caring for those who cared

Nepal’s fertility rate is going down even though contraceptive use has not increased<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221104141140/636517189c7e80680e02c252jpeg.jpg" alt="" width="1400" height="933"/><figcaption>THE RIGHT SHOT: Health worker Januka Dhakal injects Depo-Provera on a woman at Rayale Health Post of Kavre district on Tuesday. With their husbands away, fewer women now want to use contraceptives. Sonia Awale</figcaption></figure>Sita Yonjan, 21, has a two-year-old daughter, and recently stopped using <a href="http://archive.nepalitimes.com/article/from-nepali-press/Ftnp-the-curse-of-the-contraceptive,493">contraceptives</a> even though she is not planning to have another child. She says she doesn’t need her birth control implant anymore because her husband went away to work in Qatar two months ago.Yonjan visited a health post in Rayale village of Kavre to remove the birth control implant that she had inserted last year. The tiny device prevents births for five years, and does not need to be removed even when users abstain from intercourse. But many Nepali men want their wives to stop using contraceptives when they leave for overseas work."My husband thinks I could sleep with anyone if I use contraceptives in his absence," Yonjan frankly admits.An estimated four million Nepali men of reproductive age <a href="http://archive.nepalitimes.com/article/nation/The-cycle-of-migration,3230">work abroad</a>, and their wives back home generally see no need for contraceptive implants, preferring to use short-term methods like condoms, pills and injectables when their husbands come home on leave. Like Yonjan, those using IUDs and implants remove them as soon as their husbands go away again.https://www.youtube.com/watch?v=8lXkqrDtUOUDemographers say this explains the riddle about why Nepal's fertility rate has been going down despite contraceptive prevalence rate remaining low.When Nepal conducted its first-ever nationwide health survey in 1996, only 26% women were using modern contraceptives. Within ten years, it had nearly doubled to 44%, but has leveled off since. The contraceptive prevalence rate actually declined to 43% in 2016, when the last National Demographic Health Survey (NDHS) was conducted. Even so, the fertility rate that measures the average number of children per couple has been going down -- from 4.6 in 1996 to 3.1 in 2006 and 2.3 in 2016 (see graphs, overleaf).Demographers were initially puzzled by the drop in the fertility rate despite contraceptive use rate flatlining. But an analysis in 2013 suggested a correlation between male outmigration and contraceptive use. Another analysis is now underway, which will probably confirm the impact out-migration of men may be having on contraceptive use and fertility rate."If we consider only women who are married and living with husbands, we find a high contraceptive prevalence rate," explains Sharad Pathak, a demographer at the government’s Family Health Division. "This rate is low only because lots of women generally do not need contraceptives when their husbands are away."<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221104141140/6365171c9c7e80680e02c253jpeg.jpg" alt="" width="900" height="826">However, experts warn that Nepal’s declining fertility rate may not mean that population growth will reach replacement level -- one in every four married women still have an unmet need for family planning. A third of young married women aged 15-19 do not use contraceptives, making them more vulnerable to unintended pregnancies and unsafe abortion.Kristine Blokhus at the UN Population Fund (UNFPA) says Nepali women are aware of the benefits of having fewer babies, but face barriers in accessing contraceptives: "Health facilities often run out of contraceptive stocks, and there are not enough trained health workers to provide long-term contraceptives like implants and IUD."A 2016 UNFPA assessment showed most health posts provide only condoms, pills and injectables because of the lack of trained staff. Only one third of the facilities provide all five types of modern contraceptives including implants and IUDS. In most villages, women have to choose between oral pills or Depo-Provera, which they cannot use if there are side effects. Male or female sterilisation is available occasionally, and most women complain their husbands do not want to use condoms.With rising female literacy, the number of women opting for traditional family planning like withdrawal and the rhythm method instead of modern contraceptives is also going up. In 1996, only 3% of married women used such natural methods, now it is 10%. However, the NDHS 2016 showed that 62% women using the rhythm method to avoid pregnancy did not have an accurate knowledge about the ovulation cycle.Nepal’s target is to increase its contraceptive prevalence rate to 52% by 2020, but it may not meet that goal because of male migration, the preference for natural methods, and family planning programs being scaled back due to a drop in U.S. funding after the <a href="http://archive.nepalitimes.com/article/Nepali-Times-Buzz/globe-rallies-to-aid-nepals-women,3841">gag rule under President Trump</a>. The United States has traditionally been the main supporter of family planning projects in Nepal, through organisations like Marie Stopes International that provide abortion services.Beth Schlachter, Director of Family Planning 2020, who recently visited Kathmandu to take stock of Nepal's progress, says: "The US gag rule might affect Nepal's family planning programs if organisations delivering safe abortion services here do not find other resources to supply contraceptives."Since Nepal is poised to become an 'aging' <a href="http://archive.nepalitimes.com/article/Nepali-Times-Buzz/need-to-prepare-for-ageing-society,3624">society by 2030 and an 'aged one' by 2050</a>, there is an even greater need to scale up family planning. For the country to reduce its dependency ratio and <a href="http://archive.nepalitimes.com/article/editorial/editorial-reaping-demographic-dividend,3621">reap the demographic dividend</a>, many more women must have easier access to a much wider range of contraceptives.The mix mattersWhen Nepal launched its first population control campaign in the late 1960s, its population was only 13 million, it was growing at 3% per year because the fertility rate was nearly 6 children per couple. The only contraceptive choice women had then was to get their partners to use condoms. Most men did not like using them, and women did not have any control over reproductive health. The pill could have given women freedom to limit or space births, but they were scared of its side effects.Later, injectables like Depo-Provera and IUDs were introduced and today the government provides five types of contraceptives for free, and conducts health camps offering permanent family planning methods like male as well female sterilisation. But many other contraceptives like emergency pills and female condoms are available only in private clinics, and most rural women cannot use them even if they want to.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221104141140/6365171e9c7e80680e02c254jpeg.jpg" alt="" width="900" height="609">Beth Schlachter, Director of Family Planning 2020, says Nepal needs to provide a much wider mix of contraceptives in order to protect women from unintended pregnancies, unsafe abortions and maternal deaths: "What a 15-year-old girl needs might be different from what a 24-year-old mother of two children needs," she says. "If we try to address all of them with just one or two methods, we will not be very successful."Marie Stopes International is preparing a pilot program to test the acceptability of a new type of Depo-Provera called Sayana Press which can be injected at home and would suit women who do not like to visit health posts every three months for their Depo-Provera.Read also:<a href="http://archive.nepalitimes.com/article/Nepali-Times-Buzz/globe-rallies-to-aid-nepals-women,3841">Cutting the lifeline</a>,  Kate Ryan<a href="http://archive.nepalitimes.com/article/editorial/editorial-reaping-demographic-dividend,3621">Reaping the demographic dividend</a>, Editorial

Migrating males and population decline

The monsoon has got bad press because Nepal’s tourism operators actively told visitors to avoid <a href="https://nepalitimes.com/opinion/managing-the-monsoon?%2F">the rainy season</a>. It is time to change that. The reason can be found right here in the vast alpine meadows of Central Nepal where this time of year you can walk on velvet grass of pastures abloom with delicate pink, red and yellow flowers as the mist rolls up the valley. There is no sound except the hum of bumble bees. &nbsp;&nbsp; There are dozens of places across high Nepal called Chaurikharka, which means yak pasture. But this particular Chaurikharka in Rukum East located at an altitude of 4,000m stands out for its serene beauty, rustic charm and bucolic setting. There is just the occasional chime of <a href="https://nepalitimes.com/here-now/when-yaks-go-so-does-culture">yak bells</a> in the distance, and the sharp whistle of herders corralling sheep. &nbsp;&nbsp; The grass shoots are so fragile that one hesitates to step on them, the rounded ridges appear and quickly vanish in waves of mist. With the<a href="https://nepalitimes.com/here-now/before-the-next-monsoon"> arrival of monsoon</a>, these meadows are a soothing shade of green dotted with millions of <a href="https://nepalitimes.com/review/the-anatomy-of-a-flower?%2F=">multi-coloured flowers</a>. Until very recently, it took a week or so to hike up to places like Chaurikharka, but with the expansion of the road network even to these far-flung mountains in the lap of Dhaulagiri, they are much more accessible. It is just a three-hour uphill from the Mid-Hill Highway on the border between Baglung and Rukum East.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250802130828_a0b06b494d751b2144ffbbf10894ea64b29e8aed844bc8c66171783abfaf4e16.jpg" data-media-id="editor_4" data-image-id="20250802130828_a0b06b494d751b2144ffbbf10894ea64b29e8aed844bc8c66171783abfaf4e16" data-rendition-name="original" width="2048" height="1365" loading="lazy" alt="Visit Nepal in the monsoon"> </figure>  Purists would say that such easy access devalues the sanctity of these remote high meadows, but it also means more people will be moved to treasure the experience, appreciate <a href="https://nepalitimes.com/banner/natures-fragile-gift-to-nepal">the value of nature </a>so they can take steps to protect it.&nbsp; To be sure, the <a href="https://nepalitimes.com/here-now/deadly-monsoon-in-nepal-turns-deadlier">monsoon season can be challenging for road travel</a>. The roads are rough even at the best of times, and in the monsoon they become muddy and treacherous, often blocked by<a href="https://nepalitimes.com/news/monsoon-deluge-in-nepal"> landslides</a>. But that could be precisely the kind of adventure that the more intrepid visitors crave. Improved road connectivity has already made Chaurikharka and places like Badimallika &nbsp;and other sacred lakes in the mountains of western Nepal popular with domestic tourists. What is driving this traffic is the urge to go to exotic new places and share videos and selfies on social media. Several of Nepal’s travel vloggers have visited Chaurikharka and popularised the place, enticing followers on TikTok or YouTube to retrace their footsteps. But even as they become more popular, these fragile and once-remote places should be protected from over-tourism.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250731110736_f97110b7cdc3e7f80d5877690948fc9f4c95a09c583deb23b07355491e6c5446.jpg" data-media-id="editor_8" data-image-id="20250731110736_f97110b7cdc3e7f80d5877690948fc9f4c95a09c583deb23b07355491e6c5446" data-rendition-name="original" width="1083" height="699" loading="lazy" alt="Visit Nepal in the monsoon NT"> </figure>  <h2>INCREASING FOOTFALL</h2> Chaurikharka is located in Bhume Rural Municipality of East Rukum, near the scenic valley of Dhorpatan in Baglung district. Even in the <a href="https://nepalitimes.com/banner/monsoon-culture">middle of the monsoon</a>, there is a steady stream of Nepali hikers trooping to these high pastures – especially during festival days like Saune Sankranti which this year was on 17 July and actually marks the auspicious beginning of the monsoon here. “This year the rains have not been as heavy and there have been some clear mornings when we could see everything from Dhaulagiri to Machapuchre,” says Khageswar Bhandari, who trekked up here from the road. “The flowers, the greenery and the snowy mountain views make this an incredibly unique place.”&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250802130824_1b9e26f2e9853fdfe69154bb42a7c9ea6da4bf4940efc1da99b304dcfbd7d3d9.jpg" data-media-id="editor_10" data-image-id="20250802130824_1b9e26f2e9853fdfe69154bb42a7c9ea6da4bf4940efc1da99b304dcfbd7d3d9" data-rendition-name="original" width="2048" height="1152" loading="lazy" alt="Visit Nepal in the monsoon"> </figure>  Chaurikharka is worthwhile to get to in any season, but it has a different charm during the monsoon. Word has spread and because it is now easy to get to from Baglung or even Pokhara, people have been flocking here.&nbsp; “Holidays and Saturdays see the largest crowds, with up to 500 visitors every day,” says ward chair Mankaji Pun of Bhume.&nbsp; There was a time not too long ago when local herders brought sheep, goats, cows, buffaloes, horses, and mules to graze here during the monsoon. Although there are still livestock around, animals have been replaced by visitors taking selfies. Read also: <a href="https://nepalitimes.com/here-now/the-monsoon-and-nature-s-arithmetic">The monsoon, and nature’s arithmetic</a>, Tom Robertson Ward Chair Pun says infrastructure development is his main priority. A foot trail to Chaurikharka was built last year by the Tourism Division Office in Kohalpur, but access via the Raniwas-Koipa road section still remains challenging.&nbsp; “If we get more budget, we can improve the road and facilities to make Chaurikharka the main tourist attraction of this region,” says Bhume Municipality Chair Hom Prakash Shrestha. “After that, we hope to promote Chaurikharka as a top tourist spot.”&nbsp; Economic activity is also picking up with the arrival of visitors, but there seems to be a need to manage the makeshift sheds made of corrugated sheets that spoil the beauty of the place. Tea shops and lodges are also available but facilities are basic. Kuldeep Neupane took a three-day trip from Ghorahi in Dang to visit Chaurikharka recently, and says: “This is an ideal trip to make a quick getaway and let nature recharge your mind and body. And it is much more fun with a tent, to watch the sunrise over the Himalaya or the mist blowing in.”

Visit Nepal in the monsoon

Two weeks ago, Prime Minister KP Sharma Oli announced jubilantly on social media that Nepal had achieved a historic annual growth of 81.8% in exports. He was right. Nepal’s trade did take a great leap forward compared to last year. But the dramatic rise was mainly due to processed soya bean oil.&nbsp; However, Nepal does not produce the edible oil it exports. In fact, the soya and palm oil that make up 44% of total exports are imported from Southeast Asia and South America, and simply re-exported, mostly to India.&nbsp; Under the SAFTA (South Asian Free Trade Area) Agreement, Nepal can export products to India duty-free if it has at least 30% value-added. Nepal’s traders have taken advantage of SAFTA even though the edible oils they export do not reach that value addition threshold. “The 30% value addition requirement is often only on paper,” says former commerce secretary Purushottam Ojha. “It is clear that simply packaging edible oils in Nepal does not fulfil the terms of the trade agreement.” Prime Minister Oli is aware of this, and even called Nepal’s export figures “fake” at an earlier event. The government is relying on other iffy figures to suggest that Nepal’s economy is strong and getting stronger. For example, the value of imports rose by 13.25% in 2024-25 compared to the previous fiscal year.&nbsp; Some of it was due to a jump in electric vehicle imports worth Rs 31.76 billion, but mostly it was because more wholesale soya oil was imported to be re-packaged and sold in India. The very fact that the government boasts about increased imports is an indication of how much it relies on taxing them for revenue. Touting such trade figures cannot be the basis to claim an economic rebound.&nbsp; “A jump in the value of imports can be interpreted as an increase in purchasing power, but it is not evidence of a stronger economy,” says economist Keshav Acharya. “Even though imports have increased, Nepal's domestic production and productive capacity have not improved.” Nepal Rastra Bank's semi-annual economic activity study report shows that industrial production was down in the first six months of the last fiscal year. This despite an increase in the number of new industries registered and investment commitments. Out of the Rs70.2 billion proposed foreign investment, Nepal received only Rs17.9 billion last year.&nbsp; Meanwhile, the rate of capital formation was limited to 24% last year, which is lower than the year before, suggesting that new investment, job creation and economic expansion all declined. If domestic production does not improve in relation to this year’s inflated trade figures, the outflow will put pressure on foreign exchange reserves like it did three years ago. At that time, Nepal borrowed from the IMF under its Extended Credit Facility Program to kickstart the economy.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025080710084_2cdaaa5795828c4a7de93a0604ba884ef0a8b8f24cccd939f6c24e279ab6058f.jpg" data-media-id="editor_0" data-image-id="2025080710084_2cdaaa5795828c4a7de93a0604ba884ef0a8b8f24cccd939f6c24e279ab6058f" data-rendition-name="original" width="1633" height="723" loading="lazy" alt="Nepal's bubble economy NT"> <figcaption>Source: NEPAL RASTRA BANK</figcaption> </figure>  The macroeconomy is on firm footing with foreign exchange reserves at a comfortable Rs2,520 billion in May, up 23% from last year. This was largely due to remittances, and partly due to a falling NPR exchange rate. Real estate transactions and the stock market index have also been climbing as a result of government policies to revive the sector.&nbsp; However, former executive director of Nepal Rastra Bank Nar Bahadur Thapa cautions: “This is not organic growth, it is the result of deliberate policy decisions to relax rules on real estate and stock markets transactions.” In reality, the sharp rise in land prices have increased the cost of production, and excessive monetisation of the real estate has become the main source of Nepal’s economic woes. The central bank has announced a slew of new policies, shifting the terms of loan repayment for industrialists and entrepreneurs, reducing interest rates, and injecting more working capital — all designed to inject adrenaline into the real estate and stock market sectors.&nbsp; When he was governor, Mahaprasad Adhikari made several financial reforms during the latter half of his tenure to stimulate the economy, including tightening credit flow.&nbsp; By the last fiscal year, additional financial reforms had resulted in a credit expansion rate of around 8%. As the pace of credit expansion slows, real estate prices have started to fall. This is actually beneficial to the economy, because it lays the foundation for improvements in land-related entrepreneurship, production, and the construction sector. Just because real estate and the stock market transactions increase, it does not indicate an economic turnaround — especially when manufacturing and productive sector continues to languish.&nbsp; “It is foolish to believe that real estate and the stock market have magically revived our economy. Agriculture employs more than half of the population, but it is in decline. Investment in the productive sector has not increased, and job creation has not increased.” Two years ago, Nepal’s industrialists, business leaders, and political leadership predicted a recession amidst a sluggish business, declining market demand, large-scale job loss, and a shrinking real estate and share market.&nbsp; Still, the economy grew by 3.36% in fiscal year 2023/24. In fact, Nepal’s economy has grown nominally over the last two decades even when all sectors of the economy are in decline.&nbsp; Says Keshav Acharya: “The growth in trade, real estate, and the stock market are bubbles. The real economy remains stagnant.”

Nepal’s bubble economy

The final investigation report on the crash of a Saurya Airlines jet on 24 July 2024 at Kathmandu airport has revealed flaws in the carrier’s technical operation procedures, poor monitoring by the Civil Aviation Authority of Nepal (CAAN) and gaps in the airport’s emergency response. Eighteen people including a child were killed, and only the captain survived as the plane plunged seconds after takeoff, crashing within the airport perimeter. This was the latest in a series of aircraft accidents in previous years, and further tarnished Nepal’s already poor aviation safety record and contributed to the country being retained in the EU’s air safety list. &nbsp;&nbsp;&nbsp; The circumstances in the Saurya crash were different from the Yeti Airlines crash in Pokhara in January 2022 that killed all 72 on board, and two Tara Air crashes in February 2016 and May 2022 on approach to Jomsom that together claimed 45 lives. However, all four tragedies were a result of negligence of carriers and crew, failure to follow procedures, regulatory slackness, and overconfidence. The Saurya crash, especially, was a glaring example of how an ailing airline broke its own rules to allow passengers, including non-employees, a joy ride to Pokhara on a maintenance ferry flight. CRASH REPORT The Final Investigation Report prepared by the Aircraft Accident Investigation Commission and released on the first anniversary of the crash last week carried a long list of rules that were ignored or broken, and of regulatory failure. The first mistake was to cram spares, tools and inflammable chemicals needed for the aircraft’s C-Check in Pokhara into the cargo hold flouting its own ground handling procedures.&nbsp; There was no check-in of passengers, some of whom were not even employees – even though regulations say only flight and maintenance crew should be on board a maintenance positioning flight. Many brought their own luggage into the plane and stored it unsecured in the cabin. There was no flight attendant to give a safety briefing to passengers. The load and trim charts given to the flight crew were rough estimates, and the total takeoff weight of the plane was 18,300kg plus or minus 200 kg. That would still have been all right, but there was a glaring mistake in the speedchart Saurya pilots were using to calculate the minimum takeoff speed (known as VR), and it had been wrong ever since the 21-year-old aircraft entered service with the airline in 2017. FAULTY DATA&nbsp; The Commission probed Flight Data Recorder inputs from previous takeoffs of the Canadian-built CRJ200-LR in 2023-2024 and found that the undetected error in the speedchart had caused the plane to pitch up at an abnormal rotation rate at least 18 times on previous takeoffs.&nbsp; Any rotation rate more than 3°/sec is regarded as unusual. But on at least two occasions, this aircraft with tail number 9N-AME had rotation rates of 5.8°/sec and 5.5°/sec, the second one was when the pilot who survived was flying in March 2024.&nbsp; On this particular day, the plane’s rotation rate was 6.5°/sec, causing it to go into a deep stall soon after takeoff, the Commission report said. Essentially, the plane was not flying fast enough down the runway to take off safely.&nbsp; It is not yet clear whether excess weight, unsecured luggage, wrong centre of gravity were also factors, but relying on a faulty speedchart for the given takeoff weight, the captain flying pulled back on the yoke before the plane had reached takeoff speed and at a pitch angle that was too steep. The investigation report says the plane then went into a deep stall and started banking right with the stick shaking. At this point, the flight officer on the right hand seat is heard on the cockpit voice recorder saying: “Whoa, whoa, whoa. Sir, Sir, Sir…” It then banked left before the pilot flying turned the plane sharply to the right again in an evasive action to avoid the parking aprons of the international and domestic terminals. Had he not done so, there would have been a disaster of a much greater magnitude at Kathmandu airport that day. The plane scraped the runway with its right wingtip, collided with a container having helicopter spare parts, and plunged into a gully east of the runway, exploding in a fireball. The investigation also noted that the impact forces seemed to be survivable for some occupants. The fire trucks took unnecessarily long to reach the site even though it was inside the airport perimeter. The absence of an ICAO-standard runway strip, inadequate rescue drills, lack of training, and a blocked emergency service gate leading to the crash site were cited as other factors. &nbsp;&nbsp; <h2>Timestamp of a Disaster</h2>  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250731110724_39cdd04693994ce6e55a5b302905c0fa4884fe85bed21ff0779bb1439f3a5725.jpg" data-media-id="editor_0" data-image-id="20250731110724_39cdd04693994ce6e55a5b302905c0fa4884fe85bed21ff0779bb1439f3a5725" data-rendition-name="original" width="778" height="826" loading="lazy" alt="Flouting rules caused Saurya tragedy NT"> </figure>  11:10:34 - The Saurya Airlines CRJ200 on the takeoff roll from runway 02. It had a takeoff weight of about 18,300kg, but the pilot’s speedcard had a previously undetected mistake about the minimum takeoff speed. 11:10:55 -The plane with tail number 9N-AME goes into deep stall soon after takeoff because it does not have enough speed to lift its weight. The plane also has an abnormally steep nose-up attitude.&nbsp; 11:11:03 - Without enough speed to generate lift, the plane banks right, then left and right again in CCTV photos taken from the domestic apron (below). If it had not banked right, it could have hit the aprons and terminal buildings. Seen parked is Saurya’s other CRJ200 with tail number 9N-ANM.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250731110732_608132f7225c649125cca2691dd6a6bf930984c5b359e888d7ad9e5eacce3afd.jpg" data-media-id="editor_1" data-image-id="20250731110732_608132f7225c649125cca2691dd6a6bf930984c5b359e888d7ad9e5eacce3afd" data-rendition-name="original" width="770" height="555" loading="lazy" alt="Flouting rules caused Saurya tragedy NT"> </figure>  11:11:08 - The plane scrapes the runway with its right wingtip, and falls into the gully. The captain is thrown off the left side of the cockpit and survives. 11:11:15: Plane explodes in a fireball inside the airport perimeter. Firefighters take time to reach the site because of lack of access road and a blocked gate. Read the full investigation report <a href="https://www.tourism.gov.np/files/9N-AME%20AIC%20Final%20Report.pdf">here</a>.

Flouting rules caused Saurya tragedy

French citizen Louis arrived in Nepal for the first time earlier this year, planning to <a href="https://nepalitimes.com/banner/the-abcs-of-a-winter-trek-in-nepal">trek the Annapurna Circuit </a>before heading down to Bardia to hopefully catch a glimpse of some<a href="https://nepalitimes.com/news/nepal-counting-its-tigers"> tigers</a>. Before he began his journey from Besisahar, Louis (who only revealed his first name) had imagined breathing crisp mountain air, and following the melodious gurgle of the Marsyangdi.&nbsp; Instead, he had to breathe fumes and dust all the way to Chame. Louis says he masked his face with a handkerchief: “It was not what I expected, this is not right.”  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025080304080_f03fce1527cf8a63178e4e82589a1a7096c8cfa28893ca4a5f7fe82d91a6e38a.jpg" data-media-id="editor_2" data-image-id="2025080304080_f03fce1527cf8a63178e4e82589a1a7096c8cfa28893ca4a5f7fe82d91a6e38a" data-rendition-name="original" width="2419" height="1814" loading="lazy" alt="Manang trails NT 1"> </figure>  Many other trekkers are similarly disappointed as roads have been built along what used to be <a href="https://nepalitimes.com/banner/a-walk-back-in-time-chandragiri-hatiban">walking trails</a>. Manang and Humla are the last remote regions in the Himalaya to be connected to the national road network. &nbsp;Construction of the 87km Besisahar-Manang road began in 1994, but was stalled during <a href="https://nepalitimes.com/news/14-years-after-conflict-no-closure-in-nepal">the Maoist conflic</a>t, and finally finished in 2012.&nbsp; Most of it has not yet been blacktopped, and sections have been carved out of vertical cliff faces, making them treacherous. But it has allowed road access to Manang, a journey that previously took a week on foot.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025080304084_32b3ca875a0df9f1dd42dbe915e6f6a2cd4f2e53f1cf2d3ee5cbdb3435905000.jpg" data-media-id="editor_5" data-image-id="2025080304084_32b3ca875a0df9f1dd42dbe915e6f6a2cd4f2e53f1cf2d3ee5cbdb3435905000" data-rendition-name="original" width="2400" height="1505" loading="lazy" alt="Manang trails NT 1"> </figure>  While the <a href="https://nepalitimes.com/opinion/the-road-out-of-nepal">road has improved access</a>, it has impacted on<a href="https://nepalitimes.com/here-now/trekking-in-the-time-of-climate-change"> trekking tourism </a>— the mainstay of Manang’s economy. The number of tourists visiting the scenic valley behind the Annapurnas grew from 21,245 in 2023 to 30,866 in 2024. The Annapurna Circuit is known for unique sights like <a href="https://archive.nepalitimes.com/news.php?id=9194">Tilicho</a>, one of the highest lakes in the world, the Thorong La pass that connects Manang to Mustang, and the valley’s own rich cultural heritage. Thorong La at 5,416m is the highest hiking pass in the world, and was used by locals for trade with Mustang before it became a <a href="https://nepalitimes.com/opinion/comment/lift-restrictions-on-upper-mustang">popular trekking route</a>. &nbsp; “For guests, the excitement of reaching Thorong La is now overshadowed by their disappointment of having to journey through dusty roads to get there,” says Manang lodge-owner Ongma Gurung. “That is the complaint we get the most.” <a href="https://nepalitimes.com/banner/tourism-that-treads-lightly-on-the-land">Local tourism </a>operators are trying to get the government to build alternative foot trails. But there have been delays due to a lack of budget.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025080304084_c5f76e398182785bb17846a148e3ca89de5687b4623580f8e2d725a7a287edfa.jpg" data-media-id="editor_11" data-image-id="2025080304084_c5f76e398182785bb17846a148e3ca89de5687b4623580f8e2d725a7a287edfa" data-rendition-name="original" width="2419" height="1762" loading="lazy" alt="Manang trails"> </figure>  The Naso Rural Municipality has identified other routes along the Annapurna Circuit in Chyamche, Tal, and Khotro so trekkers can bypass heavy vehicles involved in the construction of the Manang-Marsyangdi Hydropower Project. “But the local government cannot do everything,” admits the chair Dhan Bahadur Gurung. “And for leaders in Kathmandu, Manang is out of sight and out of mind.” Munindra Jung Gurung represents Manang in the Gandaki Provincial Assembly, and says he has raised the issue in <a href="https://nepalitimes.com/news/pokhara-s-tourism-woes">Pokhara</a>. He is hopeful there will be a hearing. To be sure, the road is not all bad news. Locals benefit, the number of visitors has grown, and trekkers can now also save time and use it to explore <a href="https://archive.nepalitimes.com/news.php?id=5960">side valleys in Manang</a>, visiting the villages like Nar and Phu. Annapurna Conservation Area (ACA) chief Rabin Kadariya concedes that the road to Upper Manang was crucial to connect the remote region with the rest of Nepal, but adds: “We have built an alternative trail connecting Talgaun, and we will consult local communities about their priorities on other hiking trails.”&nbsp;

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