<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410114/637204ac9c7e80680e0b2875jpeg.jpg" alt="" width="960" height="641"/><figcaption>Crowd of people lining up for Covid vaccination outside Teku Hospital on Tuesday. Photos: AMIT MACHAMASI</figcaption></figure>During the devastating second wave last year, hundreds of people were dying every day. Hospitals had <a href="https://www.nepalitimes.com/here-now/helping-nepalis-breathe-again/" target="_blank" rel="noopener noreferrer">run out of ICU beds and oxygen cylinders</a>.This time, hospitals are running out of medical staff.As elsewhere, <a href="https://www.nepalitimes.com/here-now/3rd-wave-in-2-years/" target="_blank" rel="noopener noreferrer">the third wave</a> in Nepal is infecting healthcare workers, endangering not only patients with Covid pneumonia, but also those suffering from pre-existing conditions like kidney failure, diabetes, cancers or cardio-vascular diseases.This acute shortage in medical staff across Nepal due to the rapid spread of Omicron has prompted the Ministry of Health to consider shortening the isolation period for doctors, nurses and paramedics to five days. The US and India have already done so.Hundreds of <a href="https://www.nepalitimes.com/here-now/nepal-health-workers-battle-covid-19-but-also-stigma/" target="_blank" rel="noopener noreferrer">health workers</a> are testing positive daily in hospitals all over the country, turning health facilities themselves into a hotbed of the virus.On Tuesday, there were 10,258 new cases out of 22,828 tested, bringing the positivity rate up to 45%. This is the highest ever daily new cases for Nepal and also the highest positivity rate.International airlines flying out of Kathmandu are reporting a sharp increase in the number of passengers who cannot fly because of the PCR positive test results. So far passengers on domestic flights are not required PCR tests, only vaccine cards from next week.“Omicron is spreading like wildfire through all hospitals, in ours alone we have 35 staff testing positive,” says <a href="https://www.nepalitimes.com/banner/nepals-far-sighted-eye-care/" target="_blank" rel="noopener noreferrer">Sanduk Ruit</a> of Tilganga Eye Hospital in Kathmandu.One of the bigger facilities in Kathmandu, HAMS Hospital, has 16 of its clinical staff in isolation after testing positive. On 17 January, 52 staff of the Trauma Centre Hospital tested positive in one day, affecting emergency care of accident victims.Teaching Hospital and Bir Hospital in the Valley also have a similarly high number of doctors and nurses infected and isolating.“Health workers in every ward are infected, Covid has now spread from the emergency to the general ward, the blood bank, physiotherapy, ICU and even the administration,” director of the Trauma Centre Pramod Joshi told Nepali Times.The hospital is now primarily treating patients that need emergency care and surgery. “The hospital is full of patients and the ICU is packed as it always is,” he said.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410114/637204ae9c7e80680e0b2876jpeg.jpg" alt="" width="1641" height="1000"><figcaption> </figcaption></figure>The third wave has now even affected hospitals outside Kathmandu, which are struggling to cope due to a shortage of staff.<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/banner/state-of-the-art-rural-hospital/" target="_blank" rel="noopener noreferrer">Bayalpata Hospital</a> in remote Achham district has curtailed some critical services like C-sections because of sick staff. Charikot hospital in Dolakha district which had finally stopped reporting new Covid infections only last month is back to caring for an increasing number of coronavirus patients but with fewer staff.“Some of us have mild but manageable symptoms but we are still working, we had a shortage of healthcare workers even before this third wave,” Binod Dangal of Charikot Hospital said. “In fact, we have fewer people than we had during the second wave, we have equipment but no trained staff. We are no better prepared than we were before.”The only respite during the third wave is that the new strain is much milder. Because Omicron’s impact is largely confined to the upper respiratory tract, physicians say their patients do not need as much oxygen or ventilator support as was the case with the Delta variant which primarily affected the lungs.Most doctors in and <a href="https://www.nepalitimes.com/here-now/at-the-covid-19-frontlines-in-rural-nepal/" target="_blank" rel="noopener noreferrer">outside Kathmandu</a> say they expect infected staff to be back at work in a week after another test. Even so, given Nepal’s largely unprepared and limited healthcare infrastructure which works on a shift basis, medical staff having to isolate just a few days can seriously disrupt medical care, especially in rural areas where hospitals and doctors were always few and far between.Indeed, this latest crisis reflects on a pre-existing chronic shortage of doctors, nurses and trained medical staff, says <a href="https://www.nepalitimes.com/opinion/diary-of-a-covid-frontline-worker-in-nepal/" target="_blank" rel="noopener noreferrer">Bikash Gauchan</a> of the Gandaki Province Infectious and Communicable Disease Hospital in Pokhara.“What we are experiencing now is both an acute and chronic shortage of healthcare workers, and this carries a lesson for our government, to strengthen and prepare its medical resources for future pandemics,” he adds.<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/here-now/boosting-booster-jabs-against-omicron/" target="_blank" rel="noopener noreferrer">Booster shots for frontliners</a> including healthcare workers in Nepal  started this week, and the additional dose will provide much needed protection to doctors and nurses who work in close contact with possibly infected patients.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410114/637204b29c7e80680e0b2877jpeg.jpg" alt="" width="960" height="641"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410114/637204b49c7e80680e0b2878jpeg.jpg" alt="" width="960" height="641"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410114/637204b79c7e80680e0b2879jpeg.jpg" alt="" width="960" height="641"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410114/637204ba9c7e80680e0b287ajpeg.jpg" alt="" width="960" height="641">But crowded vaccination centres (pictured above) themselves risk being breeding grounds for infection. This time the queues are not just of the unvaccinated getting their first jabs, but also those waiting for boosters. Even if vaccinated, doctors say masks and physical distancing are mandatory.They warn the public <a href="https://www.nepalitimes.com/here-now/omicron-may-not-be-as-risky-but-take-care/" target="_blank" rel="noopener noreferrer">not to be complacent</a> because they are vaccinated and that Omicron is milder. Binod Dangal of Charikot Hospital says: “Most people are treating Omicron as a normal cold but it is very important for us to monitor the progress of the disease in the next few weeks, and prepare for adequate critical care.”At Nepal’s biggest infectious disease centre Teku Hospital, virologist Sher Bahadur Pun cites scientific studies to say that the shortage of healthcare workers will not persist, and the isolation period can be reduced. Nepal has likely passed the most infectious stage of <a href="https://www.nepalitimes.com/here-now/living-with-covid-in-2022/" target="_blank" rel="noopener noreferrer">Omicron spread</a> and it is now time to keep a close watch on people isolating at homes and in hospitals.Pun adds: “We must also investigate which strain is causing Covid deaths in Nepal because if Omicron had indeed replaced Delta, our figures for mortality should not be as consistent as it was before the third wave.”

Sonia Awale

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3rd Covid wave infects Nepal’s frontliners

When the <a href="https://www.nepalitimes.com/banner/we-knew-the-tsunami-was-approaching/">second wave of the Delta variant ravaged Nepal</a> in April-May this year, <a href="https://www.nepalitimes.com/banner/nepals-life-or-death-o2-quest/" target="_blank" rel="noopener noreferrer">hospitals ran out of oxygen and ICU beds</a>. The <a href="https://www.nepalitimes.com/here-now/aid-pours-into-nepal-but-where-be-vaccines/" target="_blank" rel="noopener noreferrer">international community rushed</a> oxygen plants and ventilators, but many of the critical life-saving machines are lying idle in government hospitals around the country.  Besides the hundreds of donated ventilators, the government also bought the machines, but <a href="https://www.nepalitimes.com/latest/rural-nepal-fights-back-covid-19/">state-run hospitals</a> do not have the anaesthesiologists <a href="https://www.nepalitimes.com/banner/nepals-doctors-are-like-soldiers-fighting-a-war/" target="_blank" rel="noopener noreferrer">trained</a> to run it nor the critical care wards to put them in.  The district hospital in Sandhikharka of Arghakhanchi bought a ventilator six months ago, it has never been turned on even though there were critically-ill Covid-19 patients who needed respiratory support.  Even though the second wave <a href="https://www.nepalitimes.com/latest/as-covid-19-crests-nepal-eases-restrictions/" target="_blank" rel="noopener noreferrer">appears to have subsided</a>, the positivity rate among those being tested is still hovering at 10%, and there is a weekly rolling average of 320 patients in ICU and 120 in ventilators in government and private hospitals around the country. “Only two days ago, we had a Covid patient who had to be put on a ventilator. But we had to send them to Butwal since we didn’t have anyone who knew how to use it,” says Rajendra GC, medical superintendent of the hospital. The Seti Provincial Hospital in Nepalganj has 11 ventilators, but not all of them can be used at the same time because of the lack of dedicated space and trained personnel.“If the ventilators stop working, we won’t be able to treat the patients until a technician from Kathmandu comes to fix them,” says hospital manager Ved Prakash Joshi. <img width="1978" height="1156" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110161124/636d17eb9c7e80680e0ac792jpeg.jpg" alt=""/><img width="1440" height="905" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110161124/636d17ee9c7e80680e0ac793jpeg.jpg" alt="">In the district hospital in remote Bajhang district, a medical officer was the only person with some level of training in critical care. He was transferred recently, and it is hospital chief Sandip Okheda who has had to handle emergency cases based on only a few days of training to operate ventilators.Ventilators are essential for <a href="https://www.nepalitimes.com/here-now/at-the-covid-19-frontlines-in-rural-nepal/" target="_blank" rel="noopener noreferrer">patients needing critical care</a> and are used for breathing problems that can accompany various health conditions. In severe Covid patients, the virus damages the lungs, causing the oxygen level to drop and making it harder for the person to breathe. Ventilator tubes are intubated to push air into the lungs, and the procedure is regarded as the last resort for many patients.Before the pandemic, government hospitals across the country had only 500 ventilators, which meant there was a critical shortage during the second wave when many of the patients admitted to the ICU needed life support. At the height of the pandemic in April-May, there were 11,000 new confirmed cases daily and up to 240 people were dying every day, <a href="https://www.nepalitimes.com/latest/nepal-nears-10k-daily-cases/" target="_blank" rel="noopener noreferrer">hospitals were overwhelmed</a>.  The public health emergency led national and international aid agencies as well as Nepali migrant workers in the Gulf to <a href="https://www.nepalitimes.com/here-now/nepals-diaspora-comes-to-the-rescue/" target="_blank" rel="noopener noreferrer">rush in with the help</a>. The government reportedly added 1,000 ventilators after the pandemic, and some government hospitals ordered their own, although there is no count of the exact number.  There are currently 329 Covid patients getting treatment in ICUs across the country and an additional 112 in ventilator support, many of them referral patients from outside Kathmandu Valley.  Each patient on a breathing machine requires multiple doctors and nurses to care for them and operate it properly. In many district hospitals, that is not the case and as a result, patients needing ventilator support have lost their lives. <img width="301" height="459" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110161124/636d17f19c7e80680e0ac794jpeg.jpg" alt="">“My own relatives died because the hospitals did not have ventilators and intensive care units,” says epidemiologist Anup Subedi. “Having ventilators alone is not enough, hospitals must be equipped, and the staff trained in intensive care.” <img width="800" height="451" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110161124/636d17f29c7e80680e0ac795jpeg.jpg" alt="">According to critical care specialist Manoj Kumar Yadav, operating a ventilator requires a pulmonologist, anaesthesiologist and intensive care specialist. Professionals with 3-4 years of training through fellowship or a graduate of internal medicine or anaesthesia are considered proficient. Meanwhile, doctors with an MD in anaesthesia and medicine as well as nurses can be trained in critical care to fill the gap.A recent study conducted at Teaching Hospital in Kathmandu has shown that of all the diseases, Covid patients require ventilators the most. It also found that 84% of the 95 Covid-19 patients in the hospital who were on ventilator support have died.“The same study also points out that although the lack of skilled manpower is not directly responsible for the death of patients on ventilators, round-the-clock care is required for those on breathing support or complications may arise,” adds Yadav.Officials at the Health Ministry admit that the inability of the government to recruit permanent doctors and specialists has adversely affected the healthcare services across the country. This is a critical gap, and leaves Nepal at high risk in case there is a third wave.The Ministry of Health spokesperson Krishna Prasad Paudel has the usual vague promise, without mentioning actual actions taken: “We will train our human resource and make sure that at least the ventilators in storage are up and running soon."

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Donated ventilators gather dust in Nepal

Once Nepal gets vaccines, they need to be fairly distributed

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

Protecting those who protect us from Covid

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

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111011110/636ccc3c9c7e80680e08bc10jpeg.jpg" alt="" width="2048" height="1550"/><figcaption>Photo: MONIKA DEUPALA</figcaption></figure>Even as Nepal completes the first phase of its Covid vaccine drive to inoculate <a href="https://www.nepalitimes.com/here-now/nepal-health-workers-battle-covid-19-but-also-stigma/" target="_blank" rel="noopener noreferrer">frontline health workers</a> and other high-risk groups, new hyper-spreading variants of the coronavirus as well as vaccine denial have raised concerns about the efficacy of the campaign.Public health experts, however, say the government must continue its vaccination to reach as many vulnerable people as possible with a better communication strategy and more aggressive promotion.Nepal is one of the first countries in the region to start a mass Covid-19 vaccination drive. But the first phase <a href="https://www.nepalitimes.com/banner/why-is-there-vaccine-hesitancy-in-nepal/" target="_blank" rel="noopener noreferrer">saw a moderate turnout</a> with only half of the doctors, nurses, FCHVs, security personnel and cleaners prioritised by the government inoculating themselves because of the safety concerns and inaccessibility.This forced the Health Ministry to expand the first phase to also include civil servants, diplomats, bankers and journalists so that it could used up the <a href="https://www.nepalitimes.com/latest/jabs-and-jab-nots/" target="_blank" rel="noopener noreferrer">1 million doses of Covishield vaccines donated by India</a> last month.With additional 2.25 million Covishield doses under the WHO’s COVAX initiative arriving in Nepal by early March and another 2 million that the government is in talks to purchase from the Serum Institute of India, officials are gearing up for the <a href="https://www.nepalitimes.com/banner/next-up-for-vaccines-elderly-nepalis/" target="_blank" rel="noopener noreferrer">second phase of the vaccination</a> for people above 55 years and those with co-morbidities starting from 7 March.This will be followed by the age group 40-54 and then those below 40 years of age.“The campaign will now be community-based, unlike the first phase that was facility-based, we will take the vaccine to the people and ensure higher coverage,” assured Shyam Raj Uprety, head of government’s Covid Vaccine Strategy. “And as per the WHO recommendation, our advisory groups will soon finalise their decision to provide the second dose between 8-12 weeks.”Public health experts say that the emergence of new variants should not dissuade the government from discontinuing or scaling back its vaccine drive.“An RNA virus will have variants, it is a given, we have to live with them. In fact, we might have our own variant in South Asia, but we should keep on vaccinating and saving lives,” says Sameer Dixit of the Centre for Molecular Dynamics Nepal.Of the multiple variants circulating globally, the one first identified in the UK called B.1.1.7 is more widespread, and some have been detected in Nepal in travellers arriving from Britain. The good news is that AstraZeneca Covishield vaccine has been found to be effective against the strain.However, a trial involving 2,000 people in South Africa claimed that Oxford jabs offered only <a href="https://thewire.in/health/south-africa-asks-serum-institute-to-take-back-1-million-covid-19-vaccine-doses" target="_blank" rel="noopener noreferrer">minimal protection against mild and moderate cases</a> (of their variant B.1.351). Experts caution that it may be too soon to declare the vaccine ineffective because the study was conducted in a small population of young people.In Brazil, a variant called P.1 has been found to contain contains a set of additional mutations that may affect its ability to be recognised by antibodies, adding to the challenge.“What’s important in this debate is that even if one were to contract Covid, the vaccine will prevent people from getting severely ill and dying,” says Buddha Basnyat of the Patan Academy of Health Sciences. “Trials and emergency use so far has strongly addressed safety concerns regarding Covishield, so we can’t let news of variants put a damper on the vaccination campaign.”<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111011110/636ccc3f9c7e80680e08bc11jpeg.jpg" alt="" width="1500" height="1125"><figcaption> </figcaption></figure>The <a href="https://www.nepalitimes.com/banner/nepal-begins-covid-19-vaccination-drive/" target="_blank" rel="noopener noreferrer">nationwide vaccination campaign</a> is taking place at a time when Nepal and the rest of the South Asia are reporting much fewer cases and fatalities, much of which has been credited to limited contact tracing and herd immunity in major cities after large chunks of the population developed resistance against SARS-CoV-2 after contracting it.But the lack of surveillance, seroprevalence studies and antibody tests means that researchers have not been able to confirm localised immunity.“The government is unwilling to conduct a study despite interest from aid agencies. Results from these studies would have helped us better prepare vaccination strategy at a time when we face great resource constraint,” says Dixit.Nepal also needs to continue with <a href="https://www.nepalitimes.com/here-now/when-will-nepals-covid-vaccine-turn-come/" target="_blank" rel="noopener noreferrer">vaccine diplomacy</a> and look into other shots, in particular, Chinese Sinovac and Bharat Biotech’s Covaxin. Both the vaccines use the whole inactivated (dead) virus, because of which they are unable to infect people or cause pathological effects but deploy the immune system to mount a defensive reaction against the virus.<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nytimes.com/2021/02/05/opinion/covid-vaccines-china-russia.html" target="_blank" rel="noopener noreferrer">Sinovac made global headlines</a> when it was found to be only 50.4% effective in a trial in Brazil whereas it performed better in Turkey (91% efficacy). <a href="https://www.newindianexpress.com/cities/thiruvananthapuram/2021/feb/16/the-covaxin-conundrum-2264436.html" target="_blank" rel="noopener noreferrer">Covaxin</a> is also controversial because of its emergency use among the frontline health workers in India despite not completing its phase three trials.It will do well for Nepal to keep track of their trials with the government aiming to vaccinate 72% of its eligible population above 18 years. People aged 55 and above make up 11% of Nepal’s population whereas the 40-54 age group account for 13%. People aged 18-39 made up nearly half of Nepal’s 28.8 million population in the 2011 census.In the meantime, the government needs to enforce the equitable distribution of the vaccine to the remotest parts of the country with the most at-risk groups high in priority. Public health experts say that with cases rising again in India, Nepal could also see a spike as people become complacent and mingle more.Says Sher Bahadur Pun of the Infectious Disease Hospital in Teku: “We have been given this reprieve with fewer cases and fatalities, we need to utilise this time to vaccinate the elderly so that the most vulnerable in our communities are protected if and when the next wave hits us.”

Nepal braces for new wave with vaccine drive

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110101156/636ccb019c7e80680e08bb9cjpeg.jpg" alt="Nepal Covid vaccine drive" width="1500" height="1000"/><figcaption>Photo: MONIKA DEUPALA</figcaption></figure><a href="https://www.nepalitimes.com/banner/nepal-begins-covid-19-vaccination-drive/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/banner/nepal-begins-covid-19-vaccination-drive/&amp;source=gmail&amp;ust=1613056346323000&amp;usg=AFQjCNGRuyt2OfxCWKaKKLdw2TJG6SdtOw">Nepal was one of the first countries in the region to start</a> a mass Covid-19 vaccination drive two weeks ago, but less than half of the frontline workers and high-risk individuals prioritised by the government have chosen to inoculate themselves.Officials figures show that only 184,000 of the 430,000 people on the government’s list for the first phase opted for the jabs. India had donated 1 million doses of the <a href="https://www.nepalitimes.com/latest/jabs-and-jab-nots/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/jabs-and-jab-nots/&amp;source=gmail&amp;ust=1613056346323000&amp;usg=AFQjCNGbEytIydsDOvvzkqbOT7FXyhs-3Q">Astra Zeneca Covishield</a> vaccine made by Serum Institute of India.This means that the vaccines which were manufactured in October 2020 will expire by April, and the Nepal government is running out of time to use up the doses before another batch of 2.25 million Covishield doses under the WHO’s COVAX initiative arrive in Nepal.“It’s a new vaccine against a new disease, people are naturally concerned about taking it,” says Sher Bahadur Pun of the Sukraraj Tropical and Infectious Disease Hospital. “We should have promptly addressed safety concerns and about its minor side effects to curb any doubts.”Pun said even some of his doctors and nurse colleagues refused to take the vaccines, doubting their efficacy. The first phase of inoculations was being administered through 201 booths across 77 districts.Possibly because there are still so many doses left, the Ministry of Health has decided to ignore its own vaccination strategy and expand the first phase to also include civil servants, diplomats and journalists.“The first phase showed us that the vaccine is safe, there were no major side effects or deaths but our coverage was much lower than targeted,” admits Shyam Raj Upreti, head of government’s Covid Vaccine Strategy. “The vaccination campaign wasn’t as decentralised as we would have liked and weren’t able to reach as many people. We need to take vaccination booths to areas closed to the public, especially as we prepare to jab the elderly and those with morbidities in the second phase.”Quick, successive <a href="https://www.nepalitimes.com/here-now/when-will-nepals-covid-vaccine-turn-come/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/when-will-nepals-covid-vaccine-turn-come/&amp;source=gmail&amp;ust=1613056346323000&amp;usg=AFQjCNFs83cBekg92QnPuzJNNc2EvwI5zQ">vaccine development</a> also made many wary. Others in the priority list such as cleaners and security guards were suspicious of being turned into guinea pigs.“The government was unsuccessful in properly communicating the significance and efficacy of the vaccine and explain why certain groups of people are being prioritised for the vaccination,” says Ramesh Kant Adhikari of the National Immunisation Committee which oversees other vaccination programs in Nepal besides Covid-19.To be sure, vaccine hesitancy is not unique to Nepal. Several countries have deployed methods to increase vaccine acceptance among the masses: national leaders, politicians and celebrities were televised live being inoculated. Many influencers took to social media to share their experience of being vaccinated.India’s donation of 1 million Covishield vaccines to Nepal on 20 January has prompted China to now offer 500,000 doses of its own Sinopharm vaccines to Nepal even though it has not yet been certified by WHO. The Nepal government is reported to be reluctant to accept this gift because there might be even more public scepticism about it.Nepal is receiving 2.25 million more Covishield vaccines with a £550 million UK government support under the World Health Organisation (WHO) and the Global Vaccine Alliance (GAVI) <a href="https://www.nepalitimes.com/opinion/glimmers-of-hope-for-nepal-on-vaccine/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/opinion/glimmers-of-hope-for-nepal-on-vaccine/&amp;source=gmail&amp;ust=1613056346324000&amp;usg=AFQjCNFZN0apBpL_aFBCnwHDKiwmg_Ae-Q">COVAX initiative</a> by early March. Nepal will receive the rest of the vaccine it applied for 20% population later.But excluding people under 18 years of age, Nepal needs vaccines for 72% of its population. So in the meantime, the government is in talks with India to purchase another 2 million doses of Covidshield, which will arrive in a month.China’s promise of 500,000 doses of Sinopharm vaccine in March is up from 300,000 previously promised. India’s Bharat Biotech-manufactured Covaxin and <a href="https://www.nepalitimes.com/latest/sputnik-v-vaccine-mystery-in-nepal/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/sputnik-v-vaccine-mystery-in-nepal/&amp;source=gmail&amp;ust=1613056346324000&amp;usg=AFQjCNHBgDRzkXyVnFgFxxpCBi_0ZFm6Sw">Russian Sputnik V</a> are in a race to supply additional jabs for Nepalis.Earlier doubts about Russian and Chinese vaccines have been quelled with new findings and due to the limited manufacturing capacity of Covidshield, Moderna and Pfizer.A <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00191-4/fulltext" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00191-4/fulltext&amp;source=gmail&amp;ust=1613056346324000&amp;usg=AFQjCNGnOehxFhj9rk3WHLUe7xgfCoKJmQ">recent research paper</a> on the medical journal Lancet called Russian Sputnik V safe and effective (91.6%) based on interim results from its phase three trials. Sinopharm has had efficacy ranging from 86% to 79%.An <a href="https://www.nytimes.com/2021/02/05/opinion/covid-vaccines-china-russia.html" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nytimes.com/2021/02/05/opinion/covid-vaccines-china-russia.html&amp;source=gmail&amp;ust=1613056346324000&amp;usg=AFQjCNEmjmbcQ4Kmfsq2JtR_rbErtuXdGw">op-ed in the New York Times</a> last week explained that another Chinese vaccine Sinovac performed poorly (50.4%) in Brazil compared to Turkey (91%) because it was conducted exclusively among health workers in São Paulo who were at the highest risk, leading to much lower efficacy.But so far Covidsheild is the only Covid-19 vaccine registered at Nepal’s Drug Development Administration, even though South Africa has discontinued its use because it was found not to be effective against a new strain of coronavirus found there.“For us to administer Sinopharm and others, we need a different strategy, get an approval from a health authority in the manufacturing company and a study of its side effects in similar populations,” explains Adhikari.There is also an on-going debate about the use of different vaccines for the same individual. While experts agree on using the same vaccine for both the first and second dose as far as possible, a mix of two different shots is also being advocated given there is a limited stock of vaccines of one kind.Vaccines are here at a time when positivity and fatality rates are going down in Nepal and the region. Multiple factors have been credited to this: fewer tests and contact tracing, large chunks of the population developing immunity against SARS-CoV-2 after contracting it and the natural peak and fall cycle of infectious diseases.But one cannot ignore the possibility of another wave as seen frequently in the US and Europe and continue to <a href="https://www.nepalitimes.com/opinion/staying-safe-in-2021-and-beyond/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/opinion/staying-safe-in-2021-and-beyond/&amp;source=gmail&amp;ust=1613056346324000&amp;usg=AFQjCNF6rm1nNlH54u3FDLQ2odstVqCvkQ">wear masks, maintain physical distance and practice handwashing</a>.Says Sher Bahadur Pun: “This is the right time to vaccinate and be better prepared for possible next wave by strengthening our health infrastructure and human resource while continuing to follow safety measures, we must use this period to the fullest.”

Why is there vaccine hesitancy in Nepal?

<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

Nepalis overseas get first vaccinations

<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.

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109151112/636bb5e89c7e80680e07bc2ejpeg.jpg" alt="" width="2048" height="1536"/><figcaption>Photo: VIJAY LAMA</figcaption></figure>I am a Captain with Nepal Airlines, and had been feeling unusually fatigued in the cockpit during recent trips. After a <a href="https://www.nepalitimes.com/latest/long-and-winding-road-home-to-nepal/" target="_blank" rel="noopener noreferrer">repatriation flight</a> from Riyadh two weeks ago, I was assigned to fly out Nepal Army peacekeeping troops stationed in South Sudan.I was in the cockpit for only half the 24 hour roundtrip to Juba, but on return to Kathmandu my skin started feeling like it was being poked with needles. I had a headache, and soon developed a fever.I gradually lost my sense of taste and smell of food, and used to break out into sweat. I quarantined myself at Soaltee Hotel and got a PCR test. Since it came back positive, and being symptomatic, I was admitted into Star Hospital.My condition got worse. The fever stayed at 102, and I had severe head and joint aches. I tossed and turned in bed, and could not sleep, sometimes I was delirious. Nurses and physicians in masks, visors and PPE would ask me muffled questions, but I could not see their faces, and in my blurred vision, they looked like automatons.I am certain that I am alive now, and can speak these words, because of these <a href="https://www.nepalitimes.com/here-now/nepal-health-workers-battle-covid-19-but-also-stigma/" target="_blank" rel="noopener noreferrer">dedicated healthcare workers</a>. As airline crew during the pandemic, we considered ourselves frontline professionals as we carried out ferry flights to rescue stranded Nepalis abroad. But it is the <a href="https://www.nepalitimes.com/here-now/overseas-nepalis-on-the-covid-19-frontlines/" target="_blank" rel="noopener noreferrer">medical personnel</a> at our hospitals who are the true frontline heroes doing battle to save lives at great personal risk.They work 12 hour shifts at a stretch in full PPEs, they <a href="https://www.nepalitimes.com/here-now/nepals-frontline-workers-brave-it-out/" target="_blank" rel="noopener noreferrer">cannot even take a toilet break</a>. They cannot go home to families, and if they live in rented flats, they face stigmatisation from landlords and neighbours. Many are underpaid and over-worked, do not have insurance, some even had their salaries cut as hospitals struggle to survive. I salute their dedication.https://www.youtube.com/watch?v=4KfwCQZ60XEAfter coming out of the dark corridor of this disease, I beseech everyone to <a href="https://www.nepalitimes.com/latest/dont-take-covid-19-lightly/" target="_blank" rel="noopener noreferrer">take this virus seriously</a>. I only survived because I got the very best care available in Nepal, I had access to the medicines, was in a strong physical and mental state, and I could afford the cost of treatment.Many of us may not be as lucky, which means we have to take even more care – especially if we have underlying conditions, are senior citizens, or have elderly relatives at home. And we have to take extra precautions as we go into <a href="https://www.nepalitimes.com/opinion/a-covid-19-exit-strategy-for-nepal/" target="_blank" rel="noopener noreferrer">the winter flu season</a>, and lockdown restrictions are relaxed further. For example, we have to strictly enforce the PCR negative rule for airline passengers.Just because you are young, bored at home, or miss your friends, please do not let your guard down. If you get sick, you will not just be jeopardising your own health. You never know where you can pick up this airborne virus. Always wear masks when outside the home, avoid crowded places, maintain a safe distance, and wash hands.Even <a href="https://www.nepalitimes.com/opinion/countries-cooperating-to-find-covid-19-cure/" target="_blank" rel="noopener noreferrer">when a vaccine is available</a> next year, it is not a 100% guarantee, and you will need to maintain these precautions.The most distressing thing about Covid-19 is that you are all alone in your hospital. You cannot see your family, the health care workers do not have faces, and it can really bring your spirit down. So, you have to maintain a positive mental attitude, convince yourself that you will beat this virus.You have to keep your brain very active, not worry too much, and make plans for the future. You cannot let the virus win, and keeping yourself mentally alert is as important as maintaining physical strength. After all, it is the mind that enhances your immune system.Even with all my crew training, will power and good physical state, I do not think I would have survived without the hospital treatment I got. Remdesivir boosted my body’s capacity to fight back, as did some of the other drugs.But my advice is not to rely on turmeric, or some of the other traditional remedies, they are not a cure. I am now waiting for my final PCR test, and if it is negative I hope to go home, and after regaining my strength will be back in the cockpit soon.The <a href="https://www.nepalitimes.com/opinion/what-is-novel-about-the-novel-coronavirus/" target="_blank" rel="noopener noreferrer">SARS-CoV-2</a> is a formidable enemy. Do not take it lightly. Do not think you are invincible. It is not a flu. It is a killer, and it will take you down to its dark depths, and you have to fight your way back up to the light.Vijay Lama is a senior Airbus330 captain with Nepal Airlines, and dictated this comment from his hospital bed on Wednesday morning.

“We better take this virus seriously”

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

Four international names in architecture, Shigeru Ban, Rem Koolhaas, Tadao Ando and Louis Isadore Kahn, all left their mark in Nepal. But despite their best intentions, the ambitious designs fizzled out. Ban, Koolhaas and Ando won Pritzkers, the best known international award for architecture, and Kahn could have won it had the prize been given in his lifetime. But their designs fell short of transforming Nepali architecture and did not help inspire local architects.&nbsp; Why were these four ‘starchitects’ unable to pull off their Nepal projects and enrich the country with exemplary contemporary designs? The failure, especially the violation of Kahn’s design, also raises larger questions about how much contemporary architecture is valued in Nepal.&nbsp; Whereas Sri Lanka had Geoffrey Bawa and Bangladesh had Mazharul Islam, the pioneers of contemporary architecture in Nepal have had far less public appreciation. One wonders if Nepali architecture only refers to the monuments and heritage of the past. Nepal does have examples of outstanding modern architecture such as the &nbsp;पाङ्रे घर ‘Wheel House’ and खुट्टे घर &nbsp;‘House on Legs’ by Shankar Nath Rimal in the 1960s. These are the best examples of how some Nepali designers successfully tailored modern architecture to the Nepali context.&nbsp; Ten years ago, Nepal had three architecture magazines, SPACES, praXis and Business Architecture, but none of these survived. This newspaper has prominently covered contemporary architecture, and the built environment, but these are exceptions in Nepal’s media. There have been a few encouraging signs. The 2024 exhibition Modern Encounters in Architecture in Kathmandu Valley (1945-1985) at the Taragaon Museum had many visitors and its accompanying book is a seminal document.&nbsp; In 2023, the Mountain Architecture Dialogue (MAD) that focused on examples of good-practice sustainable contemporary architecture for the mountainous terrains of Nepal was a packed event with over 300 young architects, engineers, environmentalists and architecture students. <h2>Shigeru Ban</h2>  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2024122003128_8bb8dde080c5698c2585966bef27ce4c08e4ee488d3432b2caac98b9de762dfe.png" data-media-id="editor_0" data-image-id="2024122003128_8bb8dde080c5698c2585966bef27ce4c08e4ee488d3432b2caac98b9de762dfe" data-rendition-name="original" width="990" height="1074" loading="lazy" alt="Forgotten international starchitects in Nepal NT"> </figure>  Shigeru Ban had already built a name for himself in post-disaster construction when he came to Nepal following the 2015 earthquakes in which 500,000 people lost their homes. The basic design and its 3D-rendered images were reviewed in upbeat articles on DOMUS, Architectural Review, Dezeen, and Arch Daily.&nbsp; But his signature cardboard tubes could not handle the monsoon and the roof structure had to be re-designed with timber. Only two shelters were completed in Sindupalchok, and only one of them still stands at the Hyatt Regency grounds today, as Ban’s souvenir to Nepal.&nbsp; <h2>Rem Koolhaas</h2>  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2024122003128_58afec9b57accfa38327af0936648c6eb2f2e11ff18f1af8ca27383dc57dc222.png" data-media-id="editor_1" data-image-id="2024122003128_58afec9b57accfa38327af0936648c6eb2f2e11ff18f1af8ca27383dc57dc222" data-rendition-name="original" width="750" height="722" loading="lazy" alt="Forgotten international starchitects in Nepal NT"> </figure>  The designs of Dutch architect Rem Koolhaas have a specific signature: bold shapes and an intriguing architectural typology that challenges standard building blocks. Some designs even seem to defy gravity, like the CCTV headquarters in Beijing: an angular, continuous geometry of glass and steel.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241220031216_a18dc8a8d6b97bc6fa9d590036cf374f9dc3709c699fe5c5787304bbd05cb17d.png" data-media-id="editor_2" data-image-id="20241220031216_a18dc8a8d6b97bc6fa9d590036cf374f9dc3709c699fe5c5787304bbd05cb17d" data-rendition-name="original" width="1812" height="1168" loading="lazy" alt="Forgotten international starchitects in Nepal"> <figcaption>Rem Koolhaas' design for Ullen's School in Khumaltar.</figcaption> </figure>  Koolhaas was commissioned by Belgian billionaire Guy Ullens to design a new building for Ullens School in Khumaltar. The most prominent feature is its vertical glass block staircase. Some interior spaces have lowered windowsills, which provide ample views and daylight. But the school building has gone unremarked in Nepal. <h2>Tadao Ando</h2>  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241220031212_cc16bd6feb8be07a7198285b847a45d2126dc3a479e0cc7370331861fc544675.png" data-media-id="editor_3" data-image-id="20241220031212_cc16bd6feb8be07a7198285b847a45d2126dc3a479e0cc7370331861fc544675" data-rendition-name="original" width="626" height="628" loading="lazy" alt="Forgotten international starchitects in Nepal"> </figure>  Doctors providing aid to victims of the Great Hanshin earthquake in 1995 in Japan requested Tadao Ando, who had donated his Pritzker money to the victims, to also make a design for a hospital in Butwal.&nbsp; Ando’s contribution would be pro-bono and the construction was funded by the Hanshin Earthquake victims and by the popular Japanese newspaper Mainichi, as a tribute to Nepali doctors. The first block that Ando designed for the Siddhartha Children and Women’s Hospital (SCWH) was the out-patient department. He quickly realised that he would not be able to pull off structures with his typical style of smooth-finished, high-quality concrete.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241220031216_73ec0950d52320277ccc81d4a66fa6aa6acb38141e7b7633683e4cf8179dc579.png" data-media-id="editor_4" data-image-id="20241220031216_73ec0950d52320277ccc81d4a66fa6aa6acb38141e7b7633683e4cf8179dc579" data-rendition-name="original" width="1594" height="958" loading="lazy" alt="Forgotten international starchitects in Nepal"> <figcaption>Tadao Ando's Siddhartha Children and Women Hospital in Butwal.</figcaption> </figure>  Ando wrote in the online architectural catalog Architectuul, that the two main problems with the project were costs and the availability of local technology. ‘It became a facility that has a slightly different expression from the buildings I have completed so far,’ he wrote. He designed a colonnade for the west façade that would provide shelter from harsh sunlight, and the exposed brick walls were locally manufactured bricks.&nbsp; The hospital is characterised by modernist cuboidal massing, but the outer brick façades now appear unintentionally badly weathered by monsoons. The interiors lack both sufficient natural light and natural ventilation. <h2>Louis I Kahn</h2>  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2024122003128_612e199d62fb3e72b6b8f6a936b0fa0451d8c0aa3d831c071320bf423ee3d67f.png" data-media-id="editor_5" data-image-id="2024122003128_612e199d62fb3e72b6b8f6a936b0fa0451d8c0aa3d831c071320bf423ee3d67f" data-rendition-name="original" width="694" height="926" loading="lazy" alt="Forgotten international starchitects in Nepal NT"> </figure>  American architect Louis I Kahn had experience of projects in South Asia, and several were under construction when he died suddenly in 1974. Amongst these were the National Assembly complex in Dhaka, the Indian Institute of Management in Ahmedabad and the Family Planning and Maternal Child Welfare Centre in Kathmandu.&nbsp; Kahn had started the USAID funded project in Nepal by developing a master plan for the government institutional zone in Kathmandu, which included a building for the Health Ministry. The building’s façade in exposed brick has deeply recessed vertical windows for shading.&nbsp; The balancing of accentuated horizontal lines in the brickwork with the verticality of the larger composition is the work of a master. The brick walls rise up into punctured parapet walls at the roof level. These square apertures ‘frame the sky’.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241220031216_69c2e4972dbe38773e0a3a3f1129485c9c87033ee84cd454e24ae0dc772d05cf.png" data-media-id="editor_6" data-image-id="20241220031216_69c2e4972dbe38773e0a3a3f1129485c9c87033ee84cd454e24ae0dc772d05cf" data-rendition-name="original" width="1924" height="1242" loading="lazy" alt="Forgotten international starchitects in Nepal"> <figcaption>Louis Kahn's plan for the Ministry of Health.</figcaption> </figure>  When Kahn died, only the eastern half of the building was finished. The Western part was never built and Nepal’s bureaucrats decided that without paint, the exposed brick façade was not finished. Then in 1995, citing roof leakage and a space crunch, the Health Ministry added a floor.&nbsp; The frames-to-the-sky in the roof parapet were converted into windows and topped off with a sloping roof of corrugated steel sheets, whose only virtue was that it was cost-effective.&nbsp; Kahn’s orthogonal composition, which clean horizontal and vertical lines, was desecrated despite a public outcry and legal challenges from architects and cultural organisations. A version of this article was first published in HIMAL Southasian. Illustrations by Varun S Bapu.

Forgotten international starchitects in Nepal

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

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