<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”

The daily 10-hour curfew at Tribhuvan International Airport from 8 November that will last five months has affected tourism during Nepal’s peak season, with some hotels and trekking agencies here reporting cancellations into spring next year. The reduced hours at Nepal’s main aviation gateway till 31 March means that a third of all flights have been cut. This has also caused ticket prices to surge by up to eight times of normal fares. For example a Kathmandu-Delhi ticket that used to cost Rs12,000 is now listed at Rs50,000, and even then seats are not available.&nbsp; “Especially if they are here to trek, change in flight dates can cause tourists to miss their connections,” says Jagan Timilsina, who runs a trail running and outdoor education business. &nbsp; Pokhara is feeling the brunt as hotels report last-minute cancellations for November because of flight disorders. Some hoteliers also say although there have been some cancelled trips, most itineraries have been rescheduled.&nbsp; Hari Prasad Sharma Gaire of the local chapter of the Hotel Association of Nepal says the Kathmandu airport closure should have been timed for the off-season. He told us: “Starting construction during the peak tourist season was a mistake and will cause the tourism industry to lose a lot of business. The upgrade could have been spread out over a longer time but closed for fewer hours at night so that disruption was minimal.”&nbsp; Nearly a third of the 1.2 million tourists who visit Nepal annually come to Pokhara, which is also the gateway to Mustang, the Annapurna treks and pilgrimage tourism to Muktinath. Located by scenic lakes with a range of adventure sports like hot air ballooning, paragliding, canyoning, bungee and ziplines, Pokhara is also popular among diaspora Nepalis. “Besides its own attractions, Pokhara is really the hub for central Nepal, and we have been trying to get visitors to extend their stay here,” says Timilsina, who started out as a trekking porter and rose up the ranks to be an expedition guide and entrepreneur. &nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2024111603114_0e071ce63ea9b0a9a7ee76f8c3cea0ff08c6767c41dd09f6bc4413d2db067a60.jpg" data-media-id="editor_0" data-image-id="2024111603114_0e071ce63ea9b0a9a7ee76f8c3cea0ff08c6767c41dd09f6bc4413d2db067a60" data-rendition-name="original" width="3500" height="2333" loading="lazy" alt="Pokhara's tourism woes NT"> <figcaption>Tourist arrivals in Pokhara have slumped since the disruptions at Kathmandu airport due to upgrading work. Photo: KRISHNA MANI BARAL/NEPALI TIMES ARCHIVE</figcaption> </figure>  Even without the Kathmandu airport closure affecting tourist arrivals, Pokhara was already suffering from a decline due to many factors like the poor state of the Prithvi Highway, the shortage of luxury accommodation for high-end tourists, and the reluctance of international airlines to start direct flights to Pokhara despite an expensive new airport that was inaugurated two years ago.&nbsp; “There was a lot of initial excitement on the construction of the international airport,” says Timilsina, “but it hasn’t delivered as expected due to politics. People have invested in nearby businesses, and have faced losses.” India has blocked direct flights from its cities to Pokhara because the facility was built by a Chinese company. Although tourists and pilgrims from India hit record levels this year, the poor state of the highways and the Indian bus accident on the highway to Kathmandu in July that killed 27 pilgrims from Maharashtra state dampened arrival figures. Gaire says, “While tourist arrivals to Pokhara are now approaching pre-Covid levels, we haven’t seen the improvement we were expecting. We need a better marketing strategy. What are our embassies abroad doing?”&nbsp; Indeed, Pokhara used to be a favourite destination for Chinese tourists. There was a boom in arrivals from China before Covid, especially after a popular Chinese tv serial was shot on location here. But arrivals from China have not really recovered since the pandemic because of the economic slowdown there. Promoting Pokhara airport to handle direct flights from Chengdu or Kunming could revive Chinese arrivals.&nbsp; Nepal’s Civil Aviation Authority (CAAN) has used the Kathmandu airport closure as an excuse to arm-twist international airlines to start flying to Bhairawa, which has barely been in operation for two years since it was inaugurated. So far, Fly Dubai, Thai AirAsia, Jazeera and Qatar are flying to Bhairawa, but most use it as a hop before flying on to Kathmandu, which does not reduce congestion at Kathmandu.&nbsp; An ideal situation could have been to get Pokhara to run to full capacity while Kathmandu is partially out of action. Pokhara entrepreneurs are puzzled why the CAAN and the national government have not taken more interest in promoting Pokhara as an alternative to reduce the congestion in Kathmandu. Nepal’s football team that was flying to Dushanbe this week couldn’t get tickets via Delhi, and took a domestic flight to Bhadrapur, crossed over to Bagdogra and flew on to Delhi to catch their flight to Tajikistan.

Pokhara’s tourism woes

An excerpt of a conversation between an anthropologist and linguist Mark Turin, PhD and Lava Deo Awasthi, PhD, the first Chairperson of the Language Commission of Nepal. Nepali Times: What is the role of Nepal’s Language Commission and when was it formed? Lava Deo Awasthi: The Constitution of Nepal (2015) created a Language Commission (LC) with the following four core mandates: (a) to develop eligibility criteria for gaining status as an official language and offer recommendations to the Government of Nepal about the official language(s) in each province; (b) to offer recommendations to the Government about measures to be taken for the conservation, promotion, and development of languages; (c) to suggest possible ways of using mother tongues in education by assessing their stage of development; and, (d) to conduct studies, carry out research and perform monitoring functions about the response to the constitutional provisions for the federalisation of languages in Nepal. The Commission was founded in 2016 and I was appointed as the Chairperson of the Commission in September of the same year by the Cabinet of Ministers. What in your own professional and educational background helped to prepare you for the role? I have worked with the Government of Nepal for about 30 years, alongside holding teaching appointments at universities in Nepal. Prior to assuming the role of the Chairperson of the Commission, I served as permanent Secretary to the Government of Nepal and worked as the Chief Administrator of the Central Development Region. I was appointed as Director General of the Department of Education and completed my assignments as Joint Secretary at the Planning, Monitoring and Educational Administration Divisions of the Ministry of Education.&nbsp; In addition, I have taught courses as a visiting professor at Tribhuvan University and Kathmandu University for more than three decades. Later, I also started supervising MPhil and PhD students at the Far Western University in Mahendranagar, Kanchanpur. My PhD project from the Danish University of Education was dedicated to making sense of Nepal’s social construct and commitment to multilingualism, exploring the persistence of monolingual school practices in the face of constitutional promises and state commitments to multilingualism. I conducted a survey of Nepal’s languages and carried out a qualitative study of the Tharu language in the district of Bardia. I analysed language policy statements and explored classroom pedagogies in schools. I documented how teachers showed a tendency to resist change and maintain the status quo because they were not consulted when new educational language policies were introduced. Teachers also exhibited a deeply-held adherence to the Gurukul education system which appears to have been harnessed as a way to resist newer pedagogical ideologies imported from the West. Recognising how engrained these rich traditions of knowledge transmission are, I wanted to know how students’ engagement in the learning process appeared to have dwindled, creating a gap between children’s home languages and the language(s) of the school. Whilst statutory provisions for education in the mother tongue were oriented towards promotion, classroom pedagogies remained resolutely monolingual and exclusionary. The result was that multilingual education policies that had been introduced in Nepal did not result in meaningful changes in classroom practices. My research was also a reflection of childhood traumas I had experienced at the earliest stage of formal education. My home language, Baitadeli, has a strong oral tradition and no written literature. English is my fifth language in terms of exposure and competence, and my home district of Baitadi is well-known for its loyalty to the local language. I had to drop out of school after completing my sixth grade. Staying at home, I received much attention from my family and had much greater exposure to my native language, culture and environment. My overall impression is that dropping out of school had a surprisingly positive impact on my life. The opportunity offered a surprising dividend for me as I gained mastery in my mother tongue and received extensive exposure to folk literature and Indigenous knowledge and survival skills, cultivating my interest in language, culture, literature and local cosmologies.&nbsp; Now that I reflect on it, I appreciate how language has always played a key role in my life. I grew up in a multilingual environment: brought up with Baitadeli, Hindi, Sanskrit, Nepali and English. Language played a major part in my decision to leave school and my later success is closely linked to my competence in several languages. It was rewarding to be at home with my family as I deepened my understanding of native language and culture, which in turn helped me to harness and refine my art of living. Languages matter so much to me because they are both software and hardware. Later, when I was in secondary school, I realised that my command of my home language contributed significantly to enhancing my Nepali and English. I used my mother tongue as a form of linguistic capital to strengthen my competence in both English and Nepali.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2024111811110_5400ba54792bf9e4854e1c1effde8bf09804e99647f23513700b450cc49adc4a.jpg" data-media-id="editor_0" data-image-id="2024111811110_5400ba54792bf9e4854e1c1effde8bf09804e99647f23513700b450cc49adc4a" data-rendition-name="original" width="1000" height="1500" loading="lazy" alt="Dr Lava Deo Awasthi"> </figure>  In your term as the Commission’s first Chairperson, what were your strategic goals and objectives? My first strategic goal was to create an environment conducive to implementing the provisions of the Constitution of Nepal in relation to language. My priority was to prepare a detailed action plan for my six-year tenure in consultation with language stakeholders, including language experts, professionals, activists, Indigenous community members and representatives of relevant national and local-level institutions. The Commission formed a body of high-level advisors to ensure that the Chairperson’s work was well-informed and credible. The advisors to the committee had highly visible professional and social reputations in Nepal and had much experience in the field of language conservation, promotion, research and development. Another strategy we adopted was to establish close institutional linkages with federal, provincial, and local level governments for collecting opinions and disseminating information widely.&nbsp; What critical issues did you have to consider while discharging your duty? When Nepal’s new Constitution was drafted, a number of concerns could not be adequately addressed. These related to the conservation of languages, the recognition of official languages at the provincial level, and the use of mother tongues at federal, provincial, and local levels. These unresolved issues and matters pertaining to the federalizsation of Nepal’s languages were passed on to the Language Commission to address and resolve.&nbsp; Regarding the recommendations for official languages, a five-year timeline had been set by the Constitution. With great effort, we succeeded in having all provinces agree to recognise their official languages as per the recommendations of the Commission.&nbsp; What were your greatest achievements during your term? One of the greatest achievements was that we succeeded in setting a language agenda at all levels. Nepal’s language communities and other stakeholders expressed the view that this was the first time their languages were recognised and their voices heard by the state. People participated in debates and discussed issues relating to language that in all likelihood had never before happened in their lifetimes, at least not in ways that were supported by the state. We encouraged people to speak in their own language(s) and provided translators during plenary sessions and group discussions. Another major achievement was developing criteria for the status planning of languages at federal, provincial, and local levels, and to recommend 11 province-level official languages, in addition to the Nepali language. Similarly, a notable achievement was recognising Indigenous languages spoken by smaller communities, all of whom faced ongoing marginalisation and high levels of endangerment. The Commission identified 9 new languages that had not been reported in the 2011 census, and provided a framework for recognising official languages within a municipality. The commission emphasised the need for documentation and digitisation of languages for developing corpora and archives at national and sub-national levels.&nbsp; Languages of historical importance as well as classical languages were given recognition for their protection, growth, and development. Recommendations were made for the conservation, promotion and development of Nepal’s marginalised languages that are threatened by majority languages and for those languages that hold particular power at local and global levels. Recommendations were also made for how best to safeguard Nepal’s languages from the ever-growing spread of English and other powerful, globalising languages.&nbsp; A further important aspect of the Commission’s work was to emphasise mother tongue medium instruction in schools across the nation. Recognising the role of language in children’s cognitive, socio-emotional and academic development, the Commission suggested strategies for linking schools with ward-level language clusters for use in the classroom. The importance of nurturing and respecting a child’s first language was reiterated in the Commission’s recommendations for children’s learning and all-round development. By the end of my term, a remarkable change could be observed in terms of building trust within and across Nepal’s diverse language communities. A network of language groups and stakeholders across the country proved to be a powerful way of bringing all language communities under one roof for a collective review of and response to the process of federalising language policy. The many language stakeholders across Nepal appreciated the opportunity to work within a coordinated framework, and—feeling empowered by this—seemed genuinely enthusiastic about the initiatives taken by the Commission.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2024111811114_b45297fdd2fedf17bdb6313e495a1062c0d87f1a19fa5349f871f220b75f93ab.jpg" data-media-id="editor_1" data-image-id="2024111811114_b45297fdd2fedf17bdb6313e495a1062c0d87f1a19fa5349f871f220b75f93ab" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Dr Lava Deo Awasthi NT"> </figure>  What were the most significant challenges for you as Chairperson? One of the major challenges was winning people’s trust in advocating for the mission of the Language Commission. I faced considerable resistance as I sought to emphasise the use of native languages in families and communities. While the Commission advocated for multilingualism and promoted linguistic diversity, the prevailing policy circles and central level institutions had been deeply influenced by a one-language discourse and ideology of Nepali only. The spread of English also poses a huge threat to Nepal’s languages. However, people in power do not seem to see this as a problem. They tend to abandon their own languages in preference for English. The way that Nepal’s municipalities are increasingly introducing English as a medium of instruction at the earliest stage of a child’s school-based education has proven to be detrimental to their cognitive development, socio-emotional wellbeing and academic success. Most of Nepal’s elites have been heavily influenced by the spread of English and remain unaware about its impact on their home languages as well as on the inter-generational transmission of Indigenous languages in the country. I wish that we could have produced more compelling evidence to show the consequences of making poor policy choices for our children’s education. Demystification calls for a collective response. To make change happen across this entire, complex and federalising country was daunting work and left like a race against time. I feel that I could have done more to offer concrete examples in favour of using the mother tongue as a medium of children’s education at the earliest stages of a child’s education. What do you see the Language Commission achieving in the next 5-10 years? The Language Commission will have to ensure that all of its key recommendations are implemented at all levels of government. In 10 years’ time, all seven of Nepal’s provinces will have their official languages in place. These languages will also be recognised as languages of federal business, alongside Nepali. I anticipate that all official languages in the federal and provincial systems will have a national portal for inter-language corpora using machine translation to fulfil their federal, provincial and local level language functions, and that all languages spoken in Nepal will be represented through a digital database in the national archive. The Office of Statistics will monitor the status of Nepal’s languages over time. By the end of the next decade, each municipality in the country will have recognised one or two official languages at the local level, based on speech populations. Other local languages will have received community-level legal recognition and official status to fulfil their functional roles. Languages that are highly endangered or at risk will be entitled to receive state grants for enhancing local level capabilities to encourage families and young learners to speak the language. Incentive schemes will be introduced in municipalities that promote language within the family and at home. Inter-generational transmission of languages will have received welcome and timely attention across Nepal. It is my hope that all schools—public and private—will have introduced mother tongue medium instruction at the earliest stage of school education, at least up to class five. Nepali, English and other national as well as classical and foreign languages will be taught as subjects. The existing policy of English medium education at the early stage of education will be abolished. The Government of Nepal will be held accountable if the number of speakers of any language decreases or if local communities face language loss and greater endangerment. Under the aegis of the Language Commission, a Centre for Language Research and Innovation will be created with world-class facilities for language documentation and archiving in collaboration with Tribhuvan University’s Central Department of Linguistics and other relevant institutions. Harnessing the vastness of Nepal’s linguistic diversity, the Language Commission will morph into a centre of excellence for national and international communities to engage in collaborative language research, to share experiences and document best practices at in service of global linguistic diversity and Nepal’s many Indigenous languages.

Languages are both software and hardware

Earlier this month, Nepal received Rs1.6 billion from the World Bank as part of its <a href="https://nepalitimes.com/news/will-nepal-ever-be-paid-for-saving-trees">Forest Carbon Partnership Facility (FCPF)</a>, rewarding the country for increasing its carbon sink capacity. Nepal is the first in South Asia to benefit from this facility, and it is specifically to recompense the country for increasing forest cover in 13 Tarai districts between 2018-2024. “We are also trying to get another Rs13 billion from the facility while also preparing for free market-based carbon trading in the international market,” says Nabaraj Pudasaini of the REDD (Reducing Emissions from Deforestation and Forest Degradation in Developing Countries) Implementation Centre. Big emitters of greenhouse gases are under pressure to reduce their carbon emissions, and many have signed agreements to do so by investing in decarbonisation projects in developing countries. Countries that emit more than a specified amount of carbon would be able to buy emission rights from countries that emit less. Nepal is internationally known for its community forestry program which has been largely credited for <a href="https://nepalitimes.com/banner/tree-mendous">increasing tree cover to over 45%</a> in less than three decades. But this achievement had not been adequately recognised or rewarded internationally before. Forests, especially in the tropics, absorb and store large amounts of carbon while releasing oxygen in a process known as photosynthesis. <a href="https://www.fao.org/forest-resources-assessment/en/">Preventing deforestation</a> and increasing canopy cover is considered a much more achievable goal than reducing emission in the scale necessary to limit global average temperature to 1.5°C above pre-industrial levels. COP11 in Montreal in 2005 first proposed reducing carbon emissions by improving forest quality by halting degradation. By 2015, a new mechanism of financial assistance was created to help less developed countries with sustainable management of forests <a href="https://www.un-redd.org/">(called REDD+)</a>. Under this new mechanism, countries receive aid based on their efforts to prevent forest degradation and increase carbon sink, and in 2021 the World Bank was entrusted with implementing it. Nepal’s FCPF receipt this month was calculated on the basis of 2.4 million tons of carbon stored at a rate of $5 per ton. In the second phase, Nepal will receive more than Rs4 billion within the next year for storing an additional 7 million tons of carbon. Eighty per cent of this amount obtained from carbon trading needs to be spent on local beneficiaries and indigenous communities.&nbsp; But carbon trading is not easy, Nepal needs to prove that protected forests will not be destroyed in future.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241121091132_c8a381c9a95aa86fec558951650d97bb87914741f01766982ba2b086af001f16.jpg" data-media-id="editor_4" data-image-id="20241121091132_c8a381c9a95aa86fec558951650d97bb87914741f01766982ba2b086af001f16" data-rendition-name="original" width="1500" height="999" loading="lazy" alt="Greenbacks for greenery NT "> <figcaption>Photo: KUNDA DIXIT</figcaption> </figure>  Explains carbon trading expert Yugan Manandhar. “Forests should be handed over to the community and shown that they are managed sustainably. Proving this will be particularly challenging; forest encroachment and degradation is rife in the Tarai.” <a href="https://nepalitimes.com/multimedia/nepal-is-going-up-in-smoke">Deliberate forest fires</a> have also added to the challenge because they increase carbon emissions and reduce the sink capacity of forests. The basis for the amount that Nepal received was set five years ago by calculating the carbon reserves of forests in the 13 Tarai districts. In the meantime, sustainable forest management, tree plantation, forest destruction and erosion control were prioritised to increase carbon reserves in those forests. Nepal is signing another carbon trading agreement during the ongoing Baku climate conference. The <a href="https://www.leafcoalition.org/">Lowering Emissions by Accelerating Forest finance (LEAF Coalition) </a>proposes to sell the carbon stored in the forests of Bagmati, Gandaki and Lumbini provinces. For this, Nepal signed the letter of intent three years ago at COP26 in Glasgow. The target is to store 70 million tons of carbon in 32 million hectares of forest in the three provinces per which Nepal will receive Rs13 billion in four years at $10 per ton with provisions to increase the rate if various conditions are met. However, the agreement in itself doesn’t guarantee the amount. According to the targets set by Nepal, forest degradation should be stopped and carbon reserves increased by protecting tree cover. Preparations are also underway for clean air carbon trade because it has offset fossil fuel use by introducing 30,000 electric vehicles. Nepal has been selected for the first round to receive $40 million within one and a half years through the Clean Air System of the World Bank. Given that most of Nepal’s energy mix is from biomass, replacing them with electric stoves can significantly improve health by reducing indoor pollution as well as strengthen the country’s capacity for carbon trade. “Nepal's goal now is to sell carbon in the free market where carbon credits are bought and sold based on supply and demand in an open and transparent manner,” adds Pudasaini of the REDD Implementation Centre. “Nepal can now set its own price and bargain with interested buyer countries and organisations.” Lately, India has been discussing setting up a carbon market. Nepal has exported Rs12.72 billion worth of electricity to India so far this fiscal year, which can be traded under Nepal’s carbon market. “Carbon trading can create significant economic benefits for Nepal, which will help reinvest in development and environmental protection projects,” says Manandhar. “But we must prioritise sustainable management of forests, cutting older trees and allowing regrowth as well as promoting electric stoves and electric vehicles.”

Greenbacks for greenery

Turkish Airlines has introduced a new amenity kit collection designed in collaboration with French fashion house Lanvin for international business class passengers on flights more than five hours. It consists of five pieces designed for sustainability and elegance. Bags are reusable and will consist of Lanvin cosmetic products like hand and body lotions and lip balm. Eye masks and socks are made from recycled materials, earplugs are packaged in paper and the toothbrush is bamboo.

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Languages are both software and hardware

Greenbacks for greenery

Turkish amenity kit