Early on Monday morning, a bus from Pokhara to Kathmandu plunged off the highway in Dhading killing 19 passengers. Two weeks ago, another bus fell into the Tama Kosi in Manthali, killing 12. A few days before that a bus crash in Baitadi killed 13 people.&nbsp; In just the month before Nepal's election, more than 50 people have been killed in road traffic accidents. Most of these cannot be called 'accidents'. They are a direct result of poorly maintained highways and lack of enforcement of traffic discipline. Political parties in Nepal have rolled out their election manifestos, and voters are once again presented with a flood of promises. Page after page, these documents list megawatts and microcredit, highways and airports, jobs and investment. In these manifestos, growth is quantified, projects itemised, revenue forecast — and there are even threats to beat up contractors who do not finish their jobs. But when everything is declared a priority the stale promises are empty. The voter is left confused as to where the party’s loyalties really lie. Will any of these plans and pledges actually ever materialise and help Nepalis live longer, safer, healthier lives? The main job of any accountable government is to protect its citizens, not so much from foreign enemies but from domestic mismanagement. And this means the most basic test the new government should be made to pass is whether it can ensure basic well-being and protection for all its people. The problems of safety, health, and survival remain unresolved for most Nepalis, and are quietly eroding their lives. In the past year alone, the country’s <a href="https://nepalitimes.com/news/roadkill">roads and highways claimed more than 2,300</a> lives. An estimated 41,000 Nepalis die each year directly because of <a href="https://nepalitimes.com/here-now/what-is-invisible-is-more-dangerous">air pollution</a>, and their <a href="https://nepalitimes.com/news/air-pollution-killing-season-starts-early">lifespans are lessened by 3.4 years</a>.&nbsp; <a href="https://nepalitimes.com/editorial/poor-health">Non-communicable diseases</a> now account for well over half of total deaths in the country. And even where survival has improved, deprivation remains. Chronic malnutrition continues to haunt communities in <a href="https://nepalitimes.com/here-now/mass-migration-from-muktikot">Nepal’s western mountains</a> despite progress in maternal and child health.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260223130240_4f4ef83a31c3c4ae36ecdffb33a355e2fa3de9e98244b840a895af2d95c35ac0.jpg" data-media-id="editor_5" data-image-id="20260223130240_4f4ef83a31c3c4ae36ecdffb33a355e2fa3de9e98244b840a895af2d95c35ac0" data-rendition-name="original" width="1024" height="683" loading="lazy" alt="A life-first manifesto for Nepal NT"> </figure>  These are the lived realities of most Nepalis, and it is here that development can deliver its most immediate returns. A rising GDP, in and of itself, does not make roads safer, clean polluted air, or provide enough nutrition to children. Such outcomes demand intentional, granular policies that confront the specific, everyday problems shaping people’s lives.&nbsp; Macroeconomic growth, trade and investment are important, but these alone cannot guarantee improvements health and safety. The word ‘growth’, after all, is also synonymous with malignancy. Economic progress and human protection are correlated only when governance deliberately links them. Impact on life is the unit in which ordinary Nepalis calculate progress. What is needed, then, is a governing philosophy measurable in these same terms: a ‘life-first’ standard where every policy, budget, and reform can be understood and judged by its impact on protecting and extending human life. Such a ‘life-first’ approach would scrutinise three aspects of every policy. First, whether the policy prevents loss of life. A death is termed preventable if better, more coordinated response systems and regulations could have avoided it (vaccines, drugs, road safety, clean drinking water). A newly built six-lane highway <a href="https://nepalitimes.com/here-now/highway-accidents-are-no-accident-in-nepal">can be a death trap</a> due to poor design or lax enforcement of safety rules. If neonatal deaths continue in a district despite hospitals being present, or if malnutrition claims lives in predominantly agricultural regions, they too are failures. Preventable deaths also cluster where accountability is less direct. Just last year, <a href="https://nepalitimes.com/news/suicides-a-pandemic-within-a-pandemic">Nepal recorded 6,866 suicides</a>, with nearly 20 lives lost every day, yet these deaths fail to prompt any serious examination of governance. The same holds for fatalities linked to domestic or communal violence, alcohol and substance misuse, or ‘natural’ disasters, which register as ‘tragedies without remedy’ rather than as outcomes policy can influence. But when avoidable loss of life recurs at scale, isolated incidents become patterns, and patterns reveal systemic neglect. Saving lives, however, is only the first step, and what matters just as much is the quality of years lived. Nepal’s life expectancy now stands at 71 years, yet many citizens spend years in avoidable disability, untreated chronic illness, or mental distress. A life- first government must ask not only whether people live, but whether they thrive. Are citizens able to pursue education, work, and family life without fear of preventable harm? Do communities have access to clean air and water, nutritious food, and basic healthcare? Can a teenager anywhere in Nepal imagine a future not foreclosed by premature marriage, or untreated depression?  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260223130240_157d72b80b82a07699b6bffbb30036b86f0f767a5674cc3db3d5c20343442940.jpg" data-media-id="editor_8" data-image-id="20260223130240_157d72b80b82a07699b6bffbb30036b86f0f767a5674cc3db3d5c20343442940" data-rendition-name="original" width="2529" height="1427" loading="lazy" alt="A life-first manifesto for Nepal NT"> </figure>  Thriving requires policies that prevent suffering and promote well-being in addition to ensuring survival.&nbsp; Finally, governance must consider graceful aging. Elderly Nepalis should not be left to navigate disease, poverty, or isolation alone. Social systems, healthcare, and community support must enable their continued participation and dignified well-being. Adopting this three-layered standard would gradually reorient how success of any new government is defined. Transportation would be judged by fatalities reduced on the roads. Electricity generation would be measured by whether households can switch from firewood dependence to smoke-free electric stoves.&nbsp; Increase in annual rice harvest must translate into better nutrition, reducing the prevalence of chronic diseases like diabetes. Accountability must follow problems rather than stop at Singha Darbar. Only then will politicians and bureaucrats eventually recognise that their work converges on the same human endpoint. Critics will argue that economies are complex, trade-offs are inevitable, and that governance cannot be reduced to a single metric.But, as Acemoglu and Robinson show in their book <a href="https://ia801506.us.archive.org/27/items/WhyNationsFailTheOriginsODaronAcemoglu/Why-Nations-Fail_-The-Origins-o-Daron-Acemoglu.pdf">Why Nations Fail</a>, the key difference between prosperity and poverty lies in inclusive institutions that empower citizens and create broad incentives for well-being.&nbsp; Extractive institutions concentrate power and wealth in the hands of a few while keeping the majority trapped in neglect. Nepal’s governance has remained a striking example of extraction. If lawmakers in the new Parliament continue to resist changes that would save and improve the lives of ordinary citizens, the same systemic rot will persist for generations to come. A life-first mentality can cut through this inertia by clarifying the moral centre of governance and reminding policymakers that behind every policy failure lies human cost. <a href="https://nepalitimes.com/here-now/epicentre-of-hunger">Every mother in Bajura</a> with a child going hungry at night, every farmer in the Madhes unable to afford medical care, and every family that has lost <a href="https://nepalitimes.com/opinion/comment/saving-kidneys-to-save-nepal">a migrant son to kidney failure</a> understands the true <a href="https://nepalitimes.com/multimedia/dirty-dangerous-difficult-and-dehydrating">value of a life saved</a>. Life is the one metric that transcends ideology, ethnicity, and region. Centering governance on this single, focused metric, can shift an election from a contest of rhetoric to a contest of evidence. Which party ensured access to safe water and basic healthcare? Which made work at home and abroad safer and less exploitative. Which measurably extended healthy years of life for ordinary citizens? Health is wealth. By improving the healthy lifespan of citizens economic prosperity would follow naturally. A ‘life-first’ governance model would therefore compel Nepal to address the underlying structural failures across all sectors, rather than merely alleviating their symptoms. The GenZ protest that toppled the government last September was, at its core, a demand for accountability and a rejection of politics as usual. But as the country edges closer to the polls, that clarity has started to dissipate. Parties are now echoing the language of reform, but the public discourse remains dominated by promises that feel disconnected from Nepal’s most immediate and basic priorities. Every preventable death, every hungry child, and every neglected elder becomes a direct failure of governance and a moral debt the state must answer for. It is how we can make sure we keep the next government in check. The writers are Nepali GenZ students of biomedical engineering at the Hong Kong Polytechnic University.

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Nepal’s life or death election

Here in the mountains of far-western Nepal, the biggest threat to life and limb is gravity. Women collecting fodder fall from trees, boys grazing goats fall off cliffs, heavily loaded tractors plunge from dirt roads carved out of steep slopes. There is nothing to be done about those who die on the spot. But for the severely wounded there is only one hospital: Bayalpata. And it is there that <a href="https://www.youtube.com/watch?v=CJzWlnYd0ZM&amp;t=8s" target="_blank">orthopaedic surgeon Mandeep Pathak</a> is the last hope for many wounded people. Pathak, 42, is too modest to tell us how many lives he has saved over the past 10 years he has worked at Bayalpata. But hospital records show he has performed more than 4,000 operations in the past decade, many of them so patients did not suffer permanent physical disabilities. Pathak also did 800 major life-saving surgeries in that time. “I treat patients with injuries, but I wish I could also treat poverty,” Pathak says, emerging from Bayalpata’s surgical theatre one recent afternoon. <div class="embed-block"><iframe width="700" height="415" src="https://www.youtube.com/embed/CJzWlnYd0ZM?si=s_rkbU4YDaw87gqH" title="YouTube video player" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share" referrerpolicy="strict-origin-when-cross-origin" allowfullscreen></iframe></div> Sudurpaschim Province in Nepal’s far-west is far away from everything: from Kathmandu, from adequate medical care, from food security, and far from the reach of government services. It has suffered state neglect for centuries, its men mainly migrating to India for seasonal work to families who depend on subsistence agriculture. Pathak remembers the searing sadness he felt when a patient once told him, “Doctor, I sold the last of my rice to pay to come here, please give me a medicine that I can take on an empty stomach.” Pathak was born in Kathmandu, and after getting his MBBS from Kathmandu University, he got an MD from The Philippines. At a time when many Nepali doctors and staff nurses were emigrating, Pathak did not just return to Kathmandu but decided to go to one of the remotest districts in Nepal to serve those most in need. The hospital was established in 2009 in the village of Bayalpata, and has been managed by the non-profit <a href="https://www.nyayahealthnepal.org/" target="_blank">Nyaya Health Nepal (NHN)</a> as a public-private partnership treating 100,000 patients a year for no fees at all. NHN is now preparing to hand over the running of the hospital to the Sudurpaschim provincial government so its <a href="https://nepalitimes.com/banner/this-is-how-to-upgrade-nepals-rural-health" target="_blank">model of hospital management</a> can be replicated.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250414130456_b59dabd4604a24426a55fe91c0e5866b5029858bdb4c4028c331557aeb5408ae.jpg" data-media-id="editor_4" data-image-id="20250414130456_b59dabd4604a24426a55fe91c0e5866b5029858bdb4c4028c331557aeb5408ae" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Bayalpata hospital"> <figcaption>Bayalpata hospital in Achham.</figcaption> </figure>  People from not just Achham but surrounding districts, and from as far away as Humla, bring patients to Bayalpata, sometimes walking for days. Some with complicated pregnancies are brought in stretchers, young children with broken arms walk into the emergency, and sometimes there are mass casualties when a tractor or bus falls off a road. And Pathak is always there with his team performing triage, and doing orthopaedic surgeries that would be difficult even in Kathmandu. Recently, his team did a hip replacement at <a href="https://nepalitimes.com/banner/state-of-the-art-rural-hospital" target="_blank">Bayalpata Hospital</a>. Mild mannered, modest, soft-spoken, hard-working, professional are the words families of patients who have been treated at <a href="https://nepalitimes.com/here-now/nepal-s-rural-lifeline" target="_blank">Bayalpata Hospital </a>use to describe Mandeep Pathak. But the surgeon is too busy to let all this get to this head.&nbsp; Asked why he does not emigrate like his peers or get a lucrative position at a private hospital in Kathmandu, Pathak answers simply, without a trace of self-importance, “I do not think I could get the satisfaction or sense of fulfilment anywhere else.” When travelling to attend medical congresses overseas or visit family in Kathmandu, Bayalpata has other doctors to take care of patients, but many wait patiently till Pathak returns for their consultation or surgery.&nbsp; When he returns from seminars abroad after learning the latest skills, Pathak’s suitcases are not full of clothes or presents, but titanium bone implants, external fixation rods, or intramedullary nails to be used in <a href="https://nepalitimes.com/news/altruistic-healthcare-models-in-nepal" target="_blank">surgeries at Bayalpata</a>.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025041414040_5356278472c1eb2b9e4af1d593d6234cc8dc5e5161a8c614197c01abefadbd80.jpg" data-media-id="editor_8" data-image-id="2025041414040_5356278472c1eb2b9e4af1d593d6234cc8dc5e5161a8c614197c01abefadbd80" data-rendition-name="original" width="2048" height="1368" loading="lazy" alt="surgery"> </figure>  Before Bayalpata Hospital was established, most people suffering broken bones had to travel down to Dhangadi or Nepalganj for treatment. No more. Although Pathak’s specialisation is orthopaedic oncology, he is mostly treating fractures and rejoining broken bones.&nbsp; Now as Bayalpata’s Hospital Director, Pathak also has administrative and fundraising duties. He has to take the 10-hour ride down to Dhangadi often to meet various Sudurpaschim ministries to release the hospital’s budget — that is sometimes more difficult than the most complicated surgery. Recently, he had to cancel an appointment with the Chief Minister to rush back to Bayalpata because there was a patient who needed emergency surgery. “I told myself, let me save this patient first, then I will try to save the hospital,” he recalls.&nbsp; Once, when he had to be away for a month on emergency surgery training in the US, the family of a 90-year-old woman who had dislocated her hip after falling from a staircase was waiting for him to return. Her son told Pathak: “Doctor, either put her out of her suffering, or cure her.” Pathak told him it was too dangerous to operate at her age, but the son said his mother was in so much pain it was worth the risk. The operation was touch-and-go, but it was successful. The woman who had been brought in on a stretcher, walked out of the hospital three days after the operation.&nbsp; A few months later, a 27-year-old woman was brought into the ER bleeding profusely from an arm mangled by a thresher machine. Even in that state, she was breastfeeding her baby. Pathak welled up seeing this display of selfless motherhood, as he wheeled her into surgery. She needed three operations, but now has full use of her hand. <div class="embed-block"><iframe width="700" height="415" src="https://www.youtube.com/embed/xJdxLD0hBqo?si=mOpM2R_DsYL88Lfg" title="YouTube video player" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share" referrerpolicy="strict-origin-when-cross-origin" allowfullscreen></iframe></div> It is the sense of achievement from such recovery that keeps Mandeep Pathak here in this isolated village in the middle of nowhere. Bayalpata Hospital has not just saved lives, it also saves families from poverty because they do not have to take sick relatives to expensive city hospitals.&nbsp; In January, a woman was brought to Bayalpata with both hands broken. She said she had taken a fall, but Pathak did not believe her. When alone in the surgery, she finally admitted that her husband had beaten her.&nbsp; It was her husband who had brought her to hospital for treatment, but she refused to file a police report. Pathak quietly put both her arms in casts, thinking about the poverty, patriarchy and injustice in society that he is unable to treat.

The healer of far-western Nepal

For the longest time, most <a href="https://nepalitimes.com/editorial/hunger-for-governance">Nepalis lacked adequate food</a> and were <a href="https://nepalitimes.com/opinion/guest-editorial/we-are-what-we-eat">undernourished</a>. Fast forward three decades, and the country is starting to grapple with obesity. At the pace with which the proportion of <a href="https://archive.nepalitimes.com/article/nation/diabetes-in-south-asia,3018">overweight people</a> is growing, half of Nepal’s adult population will be obese by 2050, according to a forecast study published this week in the health journal The Lancet. This is much higher than next-door India where about one-third of its vast population is projected to be obese. Alarm bells should be ringing because the study shows a rise in obesity over the last 35 years. Nearly 12% of men were obese in 1990, and this had risen to about 30% by 2021, and is expected to rise to 52.5% by 2050. As for women, about 14% were obese in 1990, and this more than doubled to 28% in 2021, and will reach 48% in the next 25 years (graph).  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250314030340_5a381f60225e865970832c7e7dd3595be624cafe51f784183038a5f9a5d8f7e4.jpg" data-media-id="editor_3" data-image-id="20250314030340_5a381f60225e865970832c7e7dd3595be624cafe51f784183038a5f9a5d8f7e4" data-rendition-name="original" width="1221" height="494" loading="lazy" alt="Obesity graph"> <figcaption>Data: THE LANCET</figcaption> </figure>  As for obesity in children, the collective figure for South Asia in 1991 was 0.9% which is expected to increase to 8.3% by 2050. Similarly, the figure for overweight children in the region was 3.3% in 1991 and is projected to reach 9.3%. “Obesity is the mother of all diseases, it is the biggest <a href="https://nepalitimes.com/editorial/poor-health-makes-nepalis-poorer">public health concern </a>draining our already<a href="https://nepalitimes.com/news/local-governments-lack-resources-to-tackle-covid-19-rup2466w"> limited resources</a>,” says public health expert Aruna Uprety. “Changing eating habits including the<a href="https://nepalitimes.com/here-now/junk-food-is-making-nepali-children-shorter"> intake of junk food</a> and a sedentary lifestyle is making more and more Nepalis overweight.” Obesity has been associated with diabetes, high blood pressure, stroke, heart, kidney and liver diseases, visual impairment, dementia, infertility, and certain cancers. Increasing obesity means dietary plans and fitness have become big business, even though many people cannot lose weight fast enough. Read also: <a href="https://nepalitimes.com/here-now/a-deadly-sugar-rush">A deadly sugar rush</a>, Yugottam Koirala In 2017, in came a new drug that has become a game changer: the <a href="https://archive.nepalitimes.com/news.php?id=18656">anti-diabetic medication </a>Ozempic developed by the Danish pharmaceutical company Novo Nordisk. By chance, it was also found to be effective for weight loss, and Ozempic export and licenses gave the company a market value of $570 billion, making it larger than the Danish economy.&nbsp; “Ozempic is a classic case of a serendipitous discovery,” explains Buddha Basnyat of the Oxford University Clinical Research Unit. “It was supposed to be a drug for diabetes, and not intended for weight loss. But it was so effective, it threatened to put weight loss regimens in danger of going out of business.” An active ingredient in Ozempic is the compound semaglutide, which belongs to a class of molecules known as glucagon-like peptide-1 (GLP-1) that delays gastric emptying, causing a feeling of fullness. It also seems to influence areas of the brain that controls<a href="https://nepalitimes.com/here-now/growing-appetite-for-school-lunches"> appetite</a>, making people feel sated. It also reduces<a href="https://nepalitimes.com/banner/the-heat-is-killing-us"> cardiovascular disease</a> as well as the risk of dementia, and in stroke prevention and fighting alcoholism. Says Basnyat: “In many ways, Ozempic is that one <a href="about:blank">modern medicine</a> that can treat a lot of conditions. It is a blockbuster drug.” Ozempic is not available in Nepal yet but as a Least Developed Country (LDC), the country is exempt from patent protection for pharmaceuticals until 1 January 2033, and can manufacture generic medicines without compensating or informing the innovators. Novo Nordisk is set to enter the Indian market despite quickly approaching patent expiry in January 2026. Its patent in China is also set to expire in 2026. “<a href="https://nepalitimes.com/news/nepal-must-allow-foreign-investment-in-pharmaceuticals">Manufacturing a new drug</a> in Nepal isn’t simple as approval doesn’t come easy unlike in our neighbouring countries but we are trying,” says Shankar Ghimire of Asian Pharmaceuticals about Ozempic, adding that it did start working on semaglutide three years ago. “If we have approval, we can bring the molecule and formulate it here in three months.” Ozempic is usually given as an injection once a week but is also available in a pill form called Rybelsus which has to be taken daily. The drug can cost about Rs10,000 per month. Nausea, vomiting, diarrhoea, abdominal pain and bloating are some of the side effects to the drug. Because it can cause rapid muscle loss, users may experience sagging and develop a gaunt appearance. Stopping the medication could again lead to weight gain. Aruna Uprety also cautions against following certain weight loss trends too quickly, and to take into considerations specific health needs and conditions before taking new medication. She says: “We don’t yet know long term effects of these drugs for obesity, elsewhere people are also opting for bariatric stomach surgery but nothing quite beats a healthy diet and natural methods to keep fit.” &nbsp; Read also: <a href="https://nepalitimes.com/here-now/the-karnali-s-hunger-emergency">The Karnali’s hunger emergency</a>, Anita Bhetwal

Sonia Awale

Undernourished to overweight

The Embassy of Japan in Kathmandu is providing Bayalpata Hospital in Achham district to install up-to-date medical equipment as part of its effort to improve healthcare in remote parts of Nepal. The contract for the assistance was signed on Friday between the new Japanese Ambassador Maeda Toru and Kunda Dixit, the Chair of Nyaya Health Nepal which runs the hospital at Bayalpata.&nbsp; Nyaya Health Nepal was set up in 2008 to improve rural healthcare, and has since provided free world class treatment with specialised care free of cost to 1.3 million patients in the far west region of the country.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250131100116_0c4fea12fa18ebd1952dde7abe53e9de7a6371b8364b6a7ad00ec72267935eb8.jpg" data-media-id="editor_0" data-image-id="20250131100116_0c4fea12fa18ebd1952dde7abe53e9de7a6371b8364b6a7ad00ec72267935eb8" data-rendition-name="original" width="1000" height="667" loading="lazy" alt="Japanese aid for Bayalpata Hospital NT"> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250131100116_898086105d50414e81d5a78bf4b436f8ee1005b876fa7deb28988a9bbf625948.jpg" data-media-id="editor_1" data-image-id="20250131100116_898086105d50414e81d5a78bf4b436f8ee1005b876fa7deb28988a9bbf625948" data-rendition-name="original" width="1000" height="667" loading="lazy" alt="Japanese aid for Bayalpata Hospital NT"> </figure>  In that time, the medical need of the region has changed from mainly infectious diseases to lifestyle-related chronic ailments as well as an increase in trauma patients.&nbsp; "I have learnt that Nyaya Health Nepal is improving access to healthcare for underserved communities in rural Nepal, including providing free medical services at Bayalpata Hospital in one of the most remote areas of the country,” Ambassador Toru said at the signing ceremony. “The hospital is the core medical institution in the Achham district and surrounding areas, especially for critical surgeries."  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250131140128_6307d1200c5eecb01964be3a6d6428719d8eee30b801a48c201ad9efe8ae875d.jpg" data-media-id="editor_2" data-image-id="20250131140128_6307d1200c5eecb01964be3a6d6428719d8eee30b801a48c201ad9efe8ae875d" data-rendition-name="original" width="1179" height="1159" loading="lazy" alt="Japanese aid to Bayalpata Hospital NT"> <figcaption>Photo: EMBASSY OF JAPAN</figcaption> </figure>  The $66,263 contract is under the Grant Assistance for Grassroots Human Security Project (GGP) of the Japanese government, and will finance the purchase of a Digital X-ray flat panel unit, USG Machine, &nbsp;and C-arm imaging device that produces high resolution x-ray images of patients in real time.&nbsp; “The grant will help our surgeons and doctors at Bayalpata provide more timely diagnosis, more reliable surgeries and treatment,” Dixit said. "In the last 15 years, the need of the people of Sudurpaschim Province has changed from infectious diseases to chronic ailments and trauma, and the hospital has tried to adapt accordingly in these underserved parts where access and affordability of quality healthcare is a big challenge." &nbsp;&nbsp; Nyaya Health Nepal runs Bayalpata under its Integrated Municipal Healthcare model where community nurses go house-to-house to monitor the status of family members and record it all under its Electronic Health Record (EHR) system. Patients then have to spend money to go to hospital only if it is really needed.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250131100112_bddac95af4869c0cfe696e2f1d804466f956cfe4f8afe8f6da73d444d638b8e4.jpg" data-media-id="editor_3" data-image-id="20250131100112_bddac95af4869c0cfe696e2f1d804466f956cfe4f8afe8f6da73d444d638b8e4" data-rendition-name="original" width="1000" height="667" loading="lazy" alt="Japanese aid for Bayalpata Hospital NT"> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250131100112_ec263a04c02ee334986bda08910632e8f1795f7bbfc4cfe5a0b74c6df672696c.jpg" data-media-id="editor_4" data-image-id="20250131100112_ec263a04c02ee334986bda08910632e8f1795f7bbfc4cfe5a0b74c6df672696c" data-rendition-name="original" width="1000" height="667" loading="lazy" alt="Japanese aid for Bayalpata Hospital NT"> </figure>  Nyaya Health Nepal has deployed its EHR in district hospitals in Karnali Province as well, and handed over Charikot Hospital in Dolakha after the 2015 earthquake before handing it over to the Bagmati Province in 2019.&nbsp; Toru, who has been in Nepal for only three weeks, said that the project will provide better medical services to the people of Sudurpaschim and Karnali provinces through trauma care and orthopedic surgeries at Bayalpata hospital.&nbsp; Added Dixit: "This support will go a long way in strengthening our hospital care. Medical equipment are extremely important, especially digital x-ray, as more and more patients come in for trauma care and emergencies."

Japanese aid for Bayalpata Hospital

Orthopedic surgeon Anil Shrestha’s journey to medicine was laid down well before he was born. His father, noted industrialist Juddha Bahadur Shrestha, had aspired to become a doctor but was turned away from a medical school in India.&nbsp; "It became his mission that one of us, his sons, nephews, or nieces, would don that white coat," recalls Shrestha. That dream fell upon him, the youngest son, and he enrolled at Calcutta Medical College.&nbsp; Freshly graduated he returned to Nepal, where he hoped for a comfortable post at a hospital in Kathmandu. Instead, he was assigned to Jumla, a district which was even remoter and underserved than it is now. But that journey 40 years ago would prove transformative.&nbsp; "It was an eye-opener. I had no idea what rural Nepal was really like. When I reached Jumla, I asked myself why do we become doctors? It is because we have to make a difference," he recalls.&nbsp; The moment that would forever shape his approach to medicine happened at a government-run medical camp. An injured man had travelled from a remote village all the way to Kathmandu for surgery, selling his land to pay for it. He needed to remove his implants but faced a grim reality of having to sell more of his land to afford the procedure.&nbsp; "I thought to myself that we treat the x-rays, but we don’t treat the patients," &nbsp;Shrestha told us in an interview. &nbsp;"What good is a perfectly functioning hand if this man could no longer have a land to plough?" The encounter made the physician realise that healthcare in Nepal should look beyond symptoms and &nbsp;diagnoses, and consider the socio-economic realities of patients. He made it his mission to provide care that didn’t just fix bodies but addressed the underlying factors affecting people’s lives.&nbsp; He co-founded the <a href="https://noh.com.np">Nepal Orthopaedic Hospital</a> in 1998 to provide high-quality surgery at affordable prices. But when he arrived at the site near Gokarna, it was anything but promising.&nbsp; Read also:<a href="https://nepalitimes.com/here-now/nepali-surgeon-with-a-vision-for-the-world"> Nepali surgeon with a vision for the world</a>, Kunda Dixit  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2024101613108_1a9d74aa1c1b550ff9db42dd8092f214de353ffbb2eb48549db110201424cafd.jpg" data-media-id="editor_2" data-image-id="2024101613108_1a9d74aa1c1b550ff9db42dd8092f214de353ffbb2eb48549db110201424cafd" data-rendition-name="original" width="813" height="520" loading="lazy" alt="Nepal Orthopaedic Hospital"> <figcaption>Photo courtesy: NEPAL ORTHOPAEDIC HOSPITAL</figcaption> </figure>  "It was just two blocks of a one-story building," he recalls. "They said: Here’s the hospital. Run it. But buildings don’t make hospitals. You need doctors, you need equipment, you need patients."&nbsp; With a bold plan and support of friends and international donors, Shrestha started with 15 beds, providing care to anyone in need, regardless of their ability to pay. Initially, 93% of their operating expenses were covered by international donors but in less than 10 years, it had reversed the figures so that most of the cost was covered by internal resources. The hospital is self-sufficient today and does not turn away any patient that cannot afford the cost. Over the past 25 years, it has given more than $1 million in charity care.&nbsp; But Shrestha’s job was far from over. Realising the chronic lack of proper spinal care in Nepal, he got involved with the <a href="https://sisn.org.np/sirc/">Spinal Injury Rehabilitation Center in Sanga</a> in 2001, offering holistic treatment to paraplegic and quadriplegic patients. It was a leap of faith-started with a few friends, a handful of nurses, and no specialised doctors.&nbsp; "We just knew the need. People, especially women were falling off trees and cliffs, injuring their backs," Shrestha says, “They needed rehabilitation and physiotherapy, and we thought, why wait? You start small, and if you’re doing well, others will help you."&nbsp; Shrestha had long believed that healthcare in Nepal needed to reach the farthest corner, and after working with Nick Simons Institute (NSI) he realised that <a href="https://nepalitimes.com/news/jim-simon-s-gift-to-nepal">partnering with government hospitals</a> can better strengthen the overall health system. Shrestha’s journey took another turn when he was asked to join the board of OneHeart Worldwide, whose mission, to reduce maternal and neonatal mortality in Nepal’s most underserved areas, deeply resonated with him.&nbsp; Read also: <a href="https://nepalitimes.com/here-now/nepal-s-flying-doctor">Nepal's flying doctor</a>, Kunda Dixit  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241016131020_15d6c1483ea69455b998ba6fd6ecc0ac5eafe3af6effc2214f48f148bee0b540.jpg" data-media-id="editor_6" data-image-id="20241016131020_15d6c1483ea69455b998ba6fd6ecc0ac5eafe3af6effc2214f48f148bee0b540" data-rendition-name="original" width="2048" height="1365" loading="lazy" alt="Spinal Injury Rehabilitation Center"> <figcaption>A caretaker with a patient at the Spinal Injury Rehabilitation Center.</figcaption> </figure>  Shrestha’s approach to leadership is as grounded as his approach to medicine, it was never about control but rather always about enabler-ship. He explains: "Humility is key, and treating staff equally fosters a sense of unity and trust that is essential in difficult times.”&nbsp; He recalls a time at the Orthopaedic Hospital when funds were so tight that salaries could not be paid. The trust was so great that staff worked without pay for three months.&nbsp; Shrestha has a vision to open centres for spinal rehabilitation across all seven provinces of Nepal to provide specialised care – since the number of spinally injured patients rises dramatically because of highway accidents. He wants a health system where each district's hospital is properly equipped and functional, thereby discouraging referral of critical patients to Kathmandu over long and bumpy roads. &nbsp; His message to the next generation of Nepali doctors and social entrepreneurs: "You don't have to wait until everything is perfect to get started. All you need is an idea, and if you see a need, jump into it. Start small and you will always have people to help if you’re passionate and clear about your goals."&nbsp; Shrestha avoids the limelight, and had to be convinced to agree to this profile interview. He says, "When you build an institution, don’t think it’s yours. It belongs to everyone who helped along the way." Read also: <a href="https://nepalitimes.com/here-now/the-barefoot-doctor-of-rolpa">The barefoot doctor of Rolpa</a>, Pinki Sris Rana

Doctor who does not just treat symptoms

The 14th <a href="https://www.apthc2024.org/">Asia-Pacific Travel Health Conference</a> is set to take place in Kathmandu from 18-21 September, bringing together 200 delegates from 27 countries to explore advances in <a href="https://archive.nepalitimes.com/news.php?id=19282">travel medicine</a> which have relevance for Nepal’s own tourism industry.
The biannual conference is the first in four years after its 13th iteration in New Zealand in 2020 was cancelled due to the Covid-19 pandemic. Previous conferences have been held in Bangkok and in Kathmandu in 2016.
Lessons for the travel industry from the <a href="https://nepalitimes.com/news/nepal-covid-19-impact-worse-than-official-figures">Covid-19 pandemic</a> will be prominent in the agenda of the conference in which experts from the <a href="https://www.istm.org/">International Society of Travel Medicine</a> will also be taking part. Nearly 60 of the 200 participants are from Nepal.
"The careful practice of travel medicine can be an important sentinel for diseases,” says <a href="https://nepalitimes.com/opinion/more-porters-sick-on-everest-trail">Buddha Basnyat, MD</a>, Chair of the Oxford University Clinical Research Unit-Nepal, who is part of the Nepali delegation.
The 3-day event will kick off with a day-long Pre-Conference Seminar on Adventure and Wilderness Travel, as well as separate sessions on mental health strategies and military medicine before the main events next week.
“Travel medicine is very relevant to Nepal because it has always been a desirable tourism destination,” says Pratibha Pandey, MD, of <a href="https://ciwechospital.com/">CIWEC Hospital and Travel Medicine Center</a>, which is a partner to the <a href="https://www.apths.org/">Asia-Pacific Travel Health Society</a>.
She adds: “Outbreaks of diseases like <a href="https://nepalitimes.com/banner/mosquitoes-move-up-mountains-as-the-earth-warms">dengue</a>, issues of <a href="https://nepalitimes.com/news/fatalism-and-fatalities">road and aviation safety</a>, and economic hardships have had an impact on the number of travellers coming to Nepal, which will be reflected at the conference.”
Read also: <a href="https://nepalitimes.com/news/poor-safety-to-hit-nepal-tourism">Poor safety to hit Nepal tourism</a>, Sonia Awale 
Each day of the conference will include three plenary panels, followed by parallel symposia, communication sessions, and interactive workshops. The conference will highlight special groups, including the elderly, pregnant, and otherwise immuno-compromised travellers. 
An ‘ABC’ workshop which will provide participants with the basics of setting up a clinic and explain pre-travel consultations. Other sessions include discussion about vaccines, including a plenary on the changing immunisation landscape, newer vaccine technologies, as well as a seminar on the <a href="https://www.reuters.com/business/healthcare-pharmaceuticals/japans-takeda-partners-with-indias-biological-e-boost-dengue-vaccine-production-2024-02-27/">Japanese Qdenga vaccine</a> against dengue that has not yet been licensed for use in Nepal.
Travel medicine is not just important for tourists coming to Nepal, but also for Nepalis since non-endemic infections like <a href="https://www.nature.com/articles/d41586-024-02912-6#:~:text=Mpox%20is%20caused%20by%20variants,materials%20contaminated%20with%20the%20virus.">Mpox and other diseases</a> can be brought here by visiting carriers.
“We were diagnosing dengue and typhus fever in travellers to Kathmandu who came via Rajasthan or Bangkok in the 1990s, long before these diseases became well-established in the local population,” explains Buddha Basnet, who is delivering a lecture on the <a href="https://nepalitimes.com/banner/a-shot-in-the-arm-for-vaccines-in-nepal">Typhoid Conjugate vaccine</a> and its roll-out in Nepal in one of the symposia.
The conference will also discuss airlift and emergency evacuation and a workshop on the role of the military in disaster and outbreak relief operations — both especially relevant to trekking and mountaineering in Nepal. <a href="https://nepalitimes.com/news/climate-breakdown-linked-to-thame-flood">Climate breakdown</a> has increased the need for better preparedness and rescue.
 Read also: <a href="https://nepalitimes.com/here-now/kathmandu-loses-its-open-spaces">Kathmandu loses its open spaces</a>, Tom Robertson and Nilima Thapa Shrestha
Other sessions include a plenary on sustainable travel in the age of no-jet set and <a href="https://www.nytimes.com/2023/02/06/travel/travel-climate-no-fly-pledge.html">climate guilt</a>, as 4% of greenhouse emissions are from air travel. Workshops will also look into other infectious diseases and the use of AI and Large Language Models like ChatGPT on travel medicine.
Because travel medicine specialises in diseases and health conditions that are acquired during international travel, it involves pre-travel, during travel, and post-travel consultations. Apart from the relevance of travel medicine to provide medical care to visitors to Nepal, there is also the opportunity to advance pre-travel and post-travel medicine for Nepalis.
Says CIWEC’s Prativa Pandey: “Heartbreaking as it is, migrant workers and students are leaving in droves, and many migrants are <a href="https://nepalitimes.com/opinion/comment/saving-kidneys-to-save-nepal">coming back with kidney failure</a>, about which there is very little data or research, so there is an urgent need to address those areas as well in Nepal.”
Read also: <a href="https://nepalitimes.com/news/brain-gain-into-brain-drain">Brain gain into brain drain</a>, Sonia Awale
Some of the participants include the ‘father of travel medicine’ Robert Steffan from Switzerland, Tomas Jelinek of the Berlin Centre for Travel and Tropical Medicine, editor of the Journal of Travel Medicine Annelies Wilder Smith, David Shlim who was Medical Director of CIWEC in Kathmandu 1983-1998, and <a href="https://www.ox.ac.uk/news-and-events/find-an-expert/professor-david-warrell">Sir David Warrell</a> a world expert on snake bite, rabies and infectious disease.

Shristi Karki

Medicine on the move

Ritu got her nursing licence in 2017 and started working at a hospital in Bansbari for a monthly salary of Rs15,000. She had a heavy workload, had no overtime pay and could not always get a day off. &nbsp; Two years into her job, Ritu’s brother fell ill and she took two days’ leave to go to Pokhara to care for him. Nursing her sibling back to health took her two additional days, and when her hospital demanded clarification Ritu was so outraged she quit. &nbsp; Ritu then approached another clinic, where she had to work two weeks as a trainee without pay. After that she was offered a salary even less than her previous job. She was so overworked, she left that job after three months even though she had got only a month’s pay check.&nbsp; Ritu went back home to Pokhara and has been out of work for six years. Her mental health has deteriorated during this time. She told Nepali Times: “Experiencing the exploitation and abuse makes me want to tear up my nursing certificate.” Puja is another Proficiency Certificate Level (PCL) nurse from Nepalganj who got a job through a recruitment office that paid only R12,000 a month. Her middle-income family is in debt after spending Rs1.2 million on her nursing education. Puja reluctantly accepted the job, which was harrowing.&nbsp; There were only seven nurses in the 50-bed hospital, and Puja had 18-hour shifts with no overtime. She quit after a year, and has been without a job at home in Nepalganj for the last six months. “Becoming a nurse was a dream that turned into a nightmare,” she told us by phone. Read Also: <a href="https://nepalitimes.com/here-now/nepali-nurses-gone-and-going-to-the-uk">Nepali nurses gone and going to the UK</a> Anjali Pokharel from Dang got the same nurse job in the same hospital as Puja, but she was offered only Rs11,000. Her monthly hostel rent in Kathmandu alone was Rs12,000.&nbsp; “There is no earning, respect, or professional satisfaction in nursing,” says Anjali. “I never &nbsp;imagined that the nursing sector in Nepal was so bleak.”&nbsp; Another nurse with a decade of nursing experience is working at Ihsan Children’s Hospital in Kathmandu for Rs18,000, and says she was threatened with dismissal when she spoke out about low pay and overwork. She told us confidentially: “Despite great dissatisfaction, nurses are forced to keep working because there is no other choice.” All 20 nurses Nepali Times spoke to for this story said they were subjected to exploitation at their workplaces. Says a nurse currently at Norvic Hospital in Kathmandu: “Most nurses fall ill due to the workload, and many speak of wanting to go abroad for more respect and money.”&nbsp; For Nepal’s aspiring nurses, exploitation begins in the classroom. While the government has set a fee of Rs475,000 for the post-SEE three year PCL diploma course, many nurses spend up to Rs1.5 million to complete the course. The four-year BSc nursing fee is capped at Rs750,000, but nursing colleges set fees as high as Rs2.2 million, tacking expenses for food, accommodation, educational tours, etc.&nbsp; Read Also: <a href="https://nepalitimes.com/opinion/comment/nepal-health-workers-at-risk-of-workplace-hazards">Nepal health workers at risk of workplace hazards</a>, Ramita Marasini Female students are also subject to harassment and disciplinary practices that put restrictions on how they can dress, as well as how they do their hair and make-up. Nurse training itself is book-based with outdated curricula, and many nurses will not have interacted with actual patients throughout their academic career. Seema KC, who works at the Civil Hospital in Bhaktapur, says that the lack of practical knowledge means nursing graduates are incapable of the real-world working environment.&nbsp; This is one reason why even the country’s largest, international-level hospitals keep new nurses on probation at very low wages. The government also does not have a fixed minimum wage for nurses, a loophole private hospitals have taken full advantage of.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240317100332_10a449da404b46c671bc9baef588c76762ef41f787de5cd018a87a7eafe3a24e.jpg" data-media-id="editor_2" data-image-id="20240317100332_10a449da404b46c671bc9baef588c76762ef41f787de5cd018a87a7eafe3a24e" data-rendition-name="original" width="768" height="1024" loading="lazy" alt="Nepali Nurses in UK"> <figcaption>Nepali nurses working in the UK. Nurses have started leaving Nepal in search of better professional and academic opportunities abroad. </figcaption> </figure>  A nurse interviewed for this story said she had been offered merely Rs4,000 at Megha Hospital despite having had previous work experience, while Norvic pays PCL nurses up to Rs16,000 and nurses who have a Bachelor’s in Nursing Science (BNS) Rs25,000. Although working hours for nurses at private hospitals are supposed to be only six hours, many work for twice as long daily. The Nepal Health Service Regulations stipulate that health workers should only work 40 hours per week, and are entitled to compensation and additional service leave if their working hours are extended beyond the set hours. &nbsp; Salaries at government hospitals are better compared to private hospitals, but nurses are reluctant to work there because of lack of opportunities for career progression, and are forced to tolerate lower pay at private hospitals. Exploitation, low pay, high nursing college fees, lack of academic or professional growth are driving Nepal’s nurses overseas in droves.&nbsp; “Most nurses at Teaching Hospital have decided to go abroad because there are more academic and professional opportunities outside Nepal,” says Sarita Poudel, a nurse there. Government hospital directors say three to five nurses resign every week, some to pursue nursing abroad, and some to leave the sector entirely.&nbsp; Read Also: <a href="https://nepalitimes.com/latest/nepali-nurses-now-britain-bound">Nepali nurses now Britain-bound</a>, Radha Adhikari Nepal’s Department of Labour granted work permits to 40 nurses to go abroad in 2013. This number increased to 160 in 2019, 109 in 2020, 287 in 2021 and 582 in 2022. In 2023, 607 nurses received permits to go overseas. However, many nurses who go abroad do not appear in these official statistics. Some have gone abroad on student visas to study other subjects. A nurse working at Vayodha Hospital says she is going to Canada on a non-nursing student visa, adding that she will need nothing more than her Nepali nursing license to sit for the nursing license exam there. Data from the Ministry of Health and Population states that there are 14,099 vacancies for nurses across the country, while there are only 9,951 nurses currently employed. The shortage of nurses is affecting medical care across Nepal. In government hospitals, the nurse-patient ratio is 1:40. The Health Institution Operating Standards stipulates one nurse for four to six beds in the general ward, one nurse per two beds in emergency and postoperative rooms, and one nurse per bed in ICUs and CCUs. Meanwhile, there must be two Skilled Birth Attendants (SBA), trained nurses or midwives per patient in delivery rooms. None of Nepal’s hospitals – private or government – meet this requirement. Bir Hospital alone requires at least 938 nurses for its 550 beds, but only 400 are currently employed. The 350-bed Kanti Children’s Hospital requires 600 nurses but has only 169. It is even worse at the Prasuti Griha maternity hospital which needs at least 735 nurses but only has 154.&nbsp; The minimum service standards of the Health Ministry means Nepal’s government hospitals alone need 32,000 nurses, but have only half that number. The irony is that while the nursing posts remain vacant, many nurses are unemployed. The Ministry of Health’s Nepal Health Workforce Projection, (2022-2030), states that Nepal had produced 72,550 staff nurses until 2021. Excluding those who went abroad or had retired, 50,785 staff nurses were available against an estimated requirement of 39,249 professionals. This means that Nepal should theoretically have an excess of 11,536 staff nurses. According to the report, Nepal will need 43,056 nurses by 2031, including 22,255 who have completed the Auxiliary Nurse Midwife (ANM) diploma course as well as 240 graduate nurses and midwives. There are currently 115,793 registered staff nurses and ANM professionals in Nepal. Meanwhile, new nursing colleges are mushrooming with little regard to meeting accepted standards. They produce 7,000 nurses every year, but few get jobs overseas because they are not deemed qualified enough. The Ministry of Health in 2012 gave medical colleges a deadline until 2016 to build their hospitals of up to 100 beds to employ graduating nurses, but most never followed this directive even after multiple deadline extensions. In response, the Medical Education Commission stopped admissions to institutions that did not have 100-bed facilities, but colleges have been lobbying to be allowed to teach students without meeting those standards. The Nursing Association of Nepal has forced the government to agree to reforms in the sector, but few of those agreements were ever implemented. Nurses who spoke with Nepali Times said that many of their problems would be solved if the Nursing Association of Nepal and the Nepal Nursing Council took more initiative.&nbsp; Mana Kumari Rai, president of the Nursing Association blames the Health Ministry for failing to meet past commitments. Last week’s government change has again brought in Upendra Yadav of the JSP as health minister, but few nurses have hope that things will change for the better any time soon. &nbsp; Some names have been changed.

Nursing grievances against the state

The United States Medical Licensing Examination (USMLE) is a test that those who want to practice medicine in America have to pass. A growing number of Nepalis have been taking the test to emigrate to the US.&nbsp;
Last week, USMLE invalidated test results of some 800 Nepali doctors because of ‘unusual score patterns or variations’.
‘The USMLE program has identified a pattern of anomalous exam performance associated with Nepal, which challenges the validity of test results for a group of examinees,’ its statement said.&nbsp;
Essentially, USMLE was accusing Nepali doctors of having prior knowledge of questions. This sparked outrage among Nepalis in the United States who say it tainted the country's image, and besides there is no way the test questions can be ‘leaked’.&nbsp;
<a href="https://nepalitimes.com/here-now/nepali-doctors-love-for-urdu-poetry">Ramu Kharel</a> is an emergency medicine physician and assistant professor at Brown University. He told us, "We care for the integrity of the program, and do not condone cheating in any form but the decision is not backed by strong evidence and creates biases when there is already a lot of brewing anti-immigrant sentiment.”
Kharel reached out to the USMLE director who told him it was ‘an ongoing investigation’.
“And yet they put out a blanket statement that has tarnished an entire country’s image as well as the credibility of practicing Nepali doctors who have done a lot of good work in the US.”
Several international doctors in the United States back this up, saying irregularities should have been addressed individually instead of singling out a whole country.
‘Some folks are using incidents of what they call “unusual USMLE Scores" to vilify the whole immigrant community who are resilient, hardworking, and knowledgeable as local doctors are. Let's not generalize the acts of a few to whole country and to emigrants,” X'ed Sadiq Naveed, psychiatrist in Hartford, Connecticut.
<div class="embed-block"><blockquote class="twitter-tweet">Some folks are using incidents of &quot;unusual USMLE Scores&quot; to vilify whole IMG community. IMGs are as resilient, hardworking, and knowledgable as AMGs are. Let&#39;s not generalize the acts of a few to whole country and the IMG community.&mdash; Sadiq Naveed (@SadiqNaveed) <a href="https://twitter.com/SadiqNaveed/status/1753917839289753714?ref_src=twsrc%5Etfw">February 3, 2024</a></blockquote> <script async src="https://platform.twitter.com/widgets.js" charset="utf-8"></script></div>
<div class="embed-block"><blockquote class="twitter-tweet">USMLE Score Invalidation: In my opinion mistakes of some mustn&#39;t lead to singling out of an entire country🇳🇵. ECFMG &amp; USMLE could have handled the situation better by a making a more generalized statement rather than naming a particular country. &quot;Culprits should be punished… <a href="https://t.co/h7AnANubE6">pic.twitter.com/h7AnANubE6</a>&mdash; Dr Ahmad Rehan Khan (@AhmadRehanKhan) <a href="https://twitter.com/AhmadRehanKhan/status/1754145466608955585?ref_src=twsrc%5Etfw">February 4, 2024</a></blockquote> <script async src="https://platform.twitter.com/widgets.js" charset="utf-8"></script></div>
&nbsp;Ahmad Rehan Khan, psychiatrist based in Virginia also tweeted: ‘In my opinion mistakes of some mustn't lead to singling out of an entire country. ECFMG &amp; USMLE could have handled the situation better by a making a more generalized statement rather than naming a particular country.’
Kharel started a <a href="https://www.change.org/p/call-for-usmle-to-redact-and-change-the-statement-regarding-applicants-from-nepal?recruiter=1329972259&amp;recruited_by_id=12774da0-c307-11ee-8897-7bad97cd7eca&amp;utm_source=share_petition&amp;utm_campaign=share_for_starters_page&amp;utm_medium=copylink">petition calling on USMLE to redact or change the statement</a>, and has over 2,500 signatories already. He has approached the Nepali physicians' group in the US as well as the America Nepal Medical Foundation seeking legal counsel.
“The damage is already done, but USMLE at the very least needs to immediately revise its statement and issue a formal apology,” says Kharel. “The truth is that Nepalis are generally well-liked here."&nbsp;
A week before the USMLE statement, <a href="https://nepalitimes.com/here-now/grass-is-greener-overseas-for-nepals-doctors">Nepali Times published a report about doctors emigrating</a> to the US, UK, Canada, Australia and the Gulf, leading to a shortage of specialists in Nepal and weakening an already fragile medical system.
Nepal has an annual turnover of nearly 2,500 MBBS graduates, yet the country faces a severe shortage of doctors. The Nepal Medical Council says 36% of doctors have emigrated, but that seems to be an undercount. &nbsp;
Between April-December 2023, 1,025 physicians left Nepal. Since 2020, 1,578 doctors have emigrated to the UK, and 888 to the US.&nbsp;
There are many push factors, but the lack of professional fulfilment in Nepal is the biggest. Equally strong is the pull of the American dream, with even unskilled Nepalis paying up to Rs6 million to human traffickers to take the illegal backdoor to the US.
<a href="https://archive.nepalitimes.com/news.php?id=19560">Emigrating doctors</a> may earn more than in Nepal, but international medical graduates in the US often do not get to practice specialised medicine of their choice, and are relegated to long hours as general physicians.&nbsp;
“Nepali doctors are emigrating essentially for thankless, blue-collar jobs,” says Bishal Dhakal, cardiac surgeon and founder of Health At Home in Kathmandu. “They do not make a lot of money by American standards and are doing jobs that American doctors do not want to do. Which is why Nepalis being accused of cheating is so tragic.”
Even so, the <a href="https://www.medscape.com">Medscape medical news website</a> on 1 February states that selling and buying USMLE questions online have become rampant with test questions selling for anywhere from $300 to $2,000.
An Indian doctor Ahmad Ozair at Johns Hopkins says his suspicions were aroused when he saw several students from one medical school in Nepal, posting on social media about scoring up to 280-plus.
‘The statistical probability that you would have three or more candidates in the same year, scoring in the 99th percentile worldwide, from a small geographical area is extremely low,’ Ozair <a href="https://www.medscape.com/viewarticle/us-board-discloses-cheating-grads-say-problem-rampant-2024a10002aj">said to Medscape</a>.&nbsp;
Others say the USMLE recall of Nepali test takers was not an ordinary one, and there is photographic evidence of questions leaked at exam centres.&nbsp;
The fact that Nepal’s university exams have regular scandals of ‘question outs’ gave credence to accusations of Nepali cheaters.&nbsp;
J. Bryan Carmody, nephrologist based in Virginia, also took to Twitter to write: ‘This isn’t the usual low-quality “USMLE recalls” - and instead involves screenshots/photos of real questions, taken at test centers by proctors (or after the proctors were paid to look away).’
<div class="embed-block"><blockquote class="twitter-tweet">The cheating in this case involved “prior unauthorized access to secure exam content.” This isn’t the usual low-quality “USMLE recalls” - and instead involves screenshots/photos of real questions, taken at test centers by proctors (or after the proctors were paid to look away).&mdash; Bryan Carmody (@jbcarmody) <a href="https://twitter.com/jbcarmody/status/1752891546553213219?ref_src=twsrc%5Etfw">February 1, 2024</a></blockquote> <script async src="https://platform.twitter.com/widgets.js" charset="utf-8"></script></div>
Medical educator Conrad Fisher of MedQuest Test Prep questioned in an X post the high performance of Nepalis: ‘Of 138 with &gt;275 applying to my program, 86% are Nepali. Of the top 100 applicant scores 92% are Nepali.’
But Bishal Dhakal says Nepalis are used to practicing for exams based on past tests, and it is unfair for USMLE to call it cheating just because of high scores. “If there is an issue with exam centres, that should be dealt with separately without dragging the whole country into it," he adds.
An increasing number of Nepali doctors passing USMLE tests with high marks seems to be making some international graduates in America insecure. He adds, "We are sending our smartest doctors to America, and that didn’t sit well with those benefiting from the Subcontinent quota. A small country is being singled out." &nbsp;

Cheated out of the American Dream

Like any mother, Sharmila Chadara just wanted to get home to see her child. It was this primal urge, and other unrelated factors, that directly resulted in her death on the night of 24 November. It was easy for journalists to assume that she had died from ‘the cold’ following the <a href="https://nepalitimes.com/news/deadly-earthquake-hits-w-nepal">earthquake on the night of 3 November</a> that killed 150 people outright in Jajarkot and Rukum West. Many of Sharmila’s neighbours in Ward 4 of Nalgad Rural Municipality and the surrounding mountains were forced to sleep outdoors after their houses collapsed.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240102150116_b6edcb6e1b6f52540dfdbc84bdbc23a1701dc9b1f113b7d5da30cf7f8e277898.png" data-media-id="editor_1" data-image-id="20240102150116_b6edcb6e1b6f52540dfdbc84bdbc23a1701dc9b1f113b7d5da30cf7f8e277898" data-rendition-name="original" width="1500" height="1125" loading="lazy" alt="Jajrkot earthquake"> <figcaption>Damaged homes in Nalgad, Ward 1. Many locals are living in tents, below. All photos: MARTY LOGAN</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240102150116_d992b10f8725c5d0415191b0606b33f23c2cff8941e495199a2cea5528542da6.png" data-media-id="editor_2" data-image-id="20240102150116_d992b10f8725c5d0415191b0606b33f23c2cff8941e495199a2cea5528542da6" data-rendition-name="original" width="2000" height="1500" loading="lazy" alt="Jajarkot earthquake"> <figcaption>Tents in Nalgad Municipality, Ward 1, Jajarkot. Occupants had their houses destroyed or damaged in the November 3 earthquake.</figcaption> </figure>  A local politician was quoted saying that Sharmila had become the latest post-earthquake victim because she was sleeping under a flimsy plastic sheet as night temperatures dropped. The <a href="https://annapurnapost.com/story/447108/">news was picked up by the media</a>, and there was outrage across the country. Read also: <a href="https://nepalitimes.com/here-now/jajarkot-one-month-after-the-earthquake">Jajarkot: One month after the earthquake</a>, Ramu Kharel and Maggie Doyne Had she survived, Sharmila Chadara would probably be sleeping inside the tiny home of her husband Dinesh in Nalgad located down a dusty path, a 15-minute walk from a narrow road. It was damaged but is habitable.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240102150116_1e7562050e0b55135f28e96726d6a003c699dbf02214b3849c38e64540b7cfd8.png" data-media-id="editor_5" data-image-id="20240102150116_1e7562050e0b55135f28e96726d6a003c699dbf02214b3849c38e64540b7cfd8" data-rendition-name="original" width="2000" height="1500" loading="lazy" alt="Jajarkot earthquake"> <figcaption>The home where Sharmila Chadara lived in Nalgad Municipality. It was damaged in the earthquake but is still habitable.</figcaption> </figure>  Dinesh, 26, sheltered from the sun against the house as he told us about Sharmila’s final trip home. It was on Dasain Tika day in early November when Sharmila felt labour pains and they took a vehicle down to the local hospital.&nbsp; There were no doctors and the couple was advised to go to the hospital in Khalanga, where doctors in turn referred them to Surkhet. Sharmila had twins and it would be a risky delivery.&nbsp; In Surkhet, she delivered the first baby, a girl. The boy was born lifeless. The doctors advised them to keep the girl in the hospital so she would gain weight. After five days, staff noticed that Sharmila, who till then seemed healthy, developed a cough. They diagnosed severe pneumonia and put her in the ICU. But fluid built up in Sharmila’s lungs and she underwent dialysis, recalled Sakuntala Sapkota, the matron at the Surkhet hospital. “She had many ups and downs,” Sapkota told me. Sharmila had five dialysis treatments as she was shuttled back and forth between ICU and the general ward. At one point a doctor told Dinesh and relatives they might not be able to save Sharmila because her body was “completely infected”. After nearly three weeks, Sharmila had enough. She was missing her son and wanted to return to Jajarkot. But staff urged her to stay two more weeks until she was fully recovered. In Ladakh Three years earlier, Sharmila had travelled to Ladakh where Dinesh was working, as were her own parents. It is normal for at least one member of each household in Jajarkot and surrounding districts to migrate for work in India and beyond. Increasingly, many are taking illegal routes destined for the US. In Athbiskot Municipality we met one woman whose brother had been gone a year, and had only made it to Turkey after paying traffickers Rs10 million.&nbsp; Sharmila stayed and worked alongside her husband at a cement factory in Ladakh, returning for the first time this past Dasain. Dinesh remembers her falling ill in India and coughing up blood. A local doctor diagnosed it as ‘weakness’ and gave her medicine.&nbsp; “But she didn’t finish it,” her husband told us. “She never finished medicine, even vitamins. I don’t know why she was like that.” A neighbour remembers Sharmila as being honest and friendly. She did not like working in Ladakh, she added, but the pressure to earn money must have been strong. At the hospital in Surkhet, Sharmila threatened to pull out her IV drip, remove her oxygen mask, and die in her hospital bed if she was not taken home. Dinesh relented and booked an ambulance for the family’s return trip to Nalgad. The oxygen ran out on the way. “I was not even sure if she was breathing,” he recalled. When they reached the hospital emergency in Radi Bazar at 2AM her vital signs were nil, staff told him. Sharmila had died. Dinesh wanted to take her home. He hired a vehicle to carry her to the foot of the hill and rounded up people in the dead of night to carry her on a stretcher, reaching home at 4AM. Sharmila was finally reunited with her son.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240102150120_2713c13b4d2ba22fe28bc1bf96cfbcfd87a7ede9cc67678b67d69efbe4a4d851.png" data-media-id="editor_6" data-image-id="20240102150120_2713c13b4d2ba22fe28bc1bf96cfbcfd87a7ede9cc67678b67d69efbe4a4d851" data-rendition-name="original" width="1125" height="1500" loading="lazy" alt="Jajarkot earthquake"> <figcaption>Dinesh Chadara with his son Ganesh at home in Nalgad Municipality recently.</figcaption> </figure>  Dinesh told us he has not made up his mind about returning to work in India. His in-laws have given him Rs150,000 to pay medical bills and he has borrowed more, but was still in debt. Sharmila’s baby has been released from hospital, and continues to gain weight and get routine vaccinations.&nbsp; Left out in the cold When we visited Jajarkot and Rukum West nearly two months after the earthquake, survivors were still living in tents and plastic shelters.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240102150124_1efe377bce5e1b8b264308d2378871aba0fc34c13046cabc6fffbdb940c7bb86.png" data-media-id="editor_7" data-image-id="20240102150124_1efe377bce5e1b8b264308d2378871aba0fc34c13046cabc6fffbdb940c7bb86" data-rendition-name="original" width="1500" height="1125" loading="lazy" alt="Jajarkot earthquake"> <figcaption>A health post destroyed in Chinabagar, Ward 1, Rukum West.</figcaption> </figure>  A female community health volunteer (FCHV) in Athbiskot told us she was having trouble finding a good tent for a mother just discharged from a health facility with her newborn. Up the mountain, we reached the house of Seema Chand Malla, 28, who was eight months pregnant. Her brother-in-law was hammering together a door for a wooden shelter while waiting for the government’s Rs 50,000 temporary shelter allowance. Sitting on a windy ridge, Seema said: “It’s very cold, but so far we're OK – let’s see what happens.” Read also: <a href="https://nepalitimes.com/news/below-zero-at-ground-zero">Below zero at ground zero</a>, Durga Rana Magar Like many women we spoke to, Seema seemed to be receiving some, but not all, routine health services. She had gone for six pre-birth (ANC) visits, was taking calcium and iron supplements regularly and had been given medicine to prevent worms. As one of her three children, a son, played on her lap, she said her health was good. The local FCHV used to visit to provide vitamins or information about the children’s health, but Seema had not seen her since the earthquake. The family had received one blanket, a small tent, 25kg of rice and some buckets from the government and various agencies. When we returned from Seema Chand’s house four tractors arrived towing carts piled high with sleeping mats, rice and other goods. We saw such relief deliveries mixed with various stages of reconstruction work across the affected areas.&nbsp; Read also: <a href="https://nepalitimes.com/news/demographics-of-disaster-in-nepal-quake">Demographics of disaster in Nepal quake</a>  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240102150116_7f6c045a4fccc3bb87f6746e702f4db8362b2cfd1d960c55e6ed326fe2bca183.png" data-media-id="editor_10" data-image-id="20240102150116_7f6c045a4fccc3bb87f6746e702f4db8362b2cfd1d960c55e6ed326fe2bca183" data-rendition-name="original" width="1125" height="1500" loading="lazy" alt="Jajarkot earthquake"> <figcaption>Seema Chand Malla, with her son, in Aathbiskot, Ward 14.</figcaption> </figure>  In Radi Bazar a crowd had gathered to get the forms needed to apply for government cash for shelters.&nbsp; <a href="https://nepalitimes.com/news/mass-cremations-for-nepal-quake-victims">The damage</a> seemed mostly random, with single houses on village roads reduced to rubble, but there were also whole clusters of homes that had fallen. On a slope overlooking the scenic, glacier-fed aquamarine Bheri River, there was a line of orange and blue tents. New mother Samjhana Bitalu, 19, crawled out from one of them to tell us that her house nearby was <a href="https://nepalitimes.com/here-now/grief-stricken-survivors-are-cold-and-hungry">damaged in the earthquake</a> and uninhabitable.&nbsp; She and her 55-days-old baby Monika were staying here with her husband, who did not want to leave them alone to return to his job in Khalanga. Samjhana said she gave birth at a nearby health post, but no staff visited her afterwards. The only help the family had received was a tent and 25kg of rice from the Ward office.&nbsp; “When it rains it’s hard to keep the baby dry because the water comes inside the tent, and she has diarrhoea,” the mother said. Following local custom, she did not think the baby should receive any treatment before she was two months old. But a health worker urged Samjhana to get medical care for the baby. “It’s more difficult because I have to manage everything alone,” Samjhana said stoically. “Otherwise, everyone would have been together at home.” Nearby, Amrita Gharti, 22, was still living in her in-laws’ house with her husband. She was almost two months pregnant.&nbsp; Amrita previously had a miscarriage, despite being told by ANCs that she was healthy. This time, arriving at her local birthing facility for her first checkup, she was told to return when she was exactly two months pregnant. “They didn’t do my checkup. They were too busy,” she said.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240102150120_e6d6fd29a04a5c3fa20fc6bd50c2236287fce0b7ddce0e508fefb329644ecf91.png" data-media-id="editor_13" data-image-id="20240102150120_e6d6fd29a04a5c3fa20fc6bd50c2236287fce0b7ddce0e508fefb329644ecf91" data-rendition-name="original" width="1125" height="1500" loading="lazy" alt="Jajarkot earthquake"> <figcaption>Amrita Gharti is pregnant and living in her in-laws' house in Nalgad, Ward 1.</figcaption> </figure>  Aruna Chaudhary of the Radha Paudel Foundation spent two weeks in Nalgad providing menstrual kits to 450 women and adolescent girls.&nbsp; Demand for her support was great and the cold was especially hard on children, she told us.&nbsp; “Many children have pneumonia and cholera and have to take medicine,” she added. “There was lots of diarrhoea and many had injuries from the earthquake itself.”&nbsp; Pneumonia and other cold-related illnesses were also growing in Chinabagar where lack of water and sanitation was worsening the situation, especially for <a href="https://nepalitimes.com/news/remove-barriers-to-life-saving-drug-to-prevent-maternal-deaths">women and adolescent girls</a>. Dhani Kumar Giri from the group WOREC was assisting arrivals at a tent while the group also provided care door-to-door. In a nearby tent an organization was providing psychological counselling to those troubled by the disaster. Some good news Around noon on 6 December, Man Kumari Singh arrived with labour pains at the health post in Athbiskot-4 of Jajarkot. She was pregnant with twins, but had been declared healthy during previous visits to the facility. But by 4PM her labour had not progressed and Man Kumari was starting to shake in distress. Staff decided to request a helicopter rescue, but by the time permission was granted from Kathmandu it was too late in the day.&nbsp; Health post staff decided to send her to the municipal hospital in Dali, but doctors there referred her to the mission hospital in Chaurjahari instead. They sent an ambulance carrying two nurses to accompany her. At 1AM that night Man Kumari’s twins were delivered normally. By noon she had been transferred to the ICU at the provincial hospital in Surkhet. Soon after she was moved to the general ward and by 19 December she had recovered and been discharged. The twins were also reported to be in good health. Author thanks One Heart Worldwide for arranging logistics for reporting on this story.&nbsp;

Poverty killed a mother, not the quake

A rapid assessment of the epicentre of the earthquake that hit just before midnight on 3 November shows that lack of accurate information about the status of survivors and their needs continues to be a challenge. Our trip to the hardest hit areas from Khalanga to Nalgad in this remote district in the mountains of western Nepal involved the rescue of a month-old infant whose mother was reported to have died from the cold.&nbsp; There has been inaccurate and sensationalised reporting in the media after people died from the cold. While it is true that winter has set in the mountains and the long term illnesses can be exacerbated by the cold, stress or unhygienic conditions, many of the deaths have been due to acute illnesses and existing preconditions. There have also been reports of relief items being stuck in bureaucratic bottlenecks and piling up in municipal offices instead of being distributed to those in need. While that may have happened in the early days of the earthquake, on this week’s trip that was not what we saw.&nbsp; In any natural disaster, it is important to recognise that the scenario for relief can rapidly change from day to day, thus making a rapid response and clear communication channels vitally important.&nbsp; We are concerned that inaccurate journalism based on hearsay without fact checking can foster an environment of cynicism and criticism, discouraging collaborative efforts. It can also affect the morale amongst first responders, spreading distrust.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20231201131252_0b36cd97d9d54136ebbc601ca2170c1402ec22944d1f8c5d837ba1e3dfc8ef13.png" data-media-id="editor_0" data-image-id="20231201131252_0b36cd97d9d54136ebbc601ca2170c1402ec22944d1f8c5d837ba1e3dfc8ef13" data-rendition-name="original" width="1368" height="1058" loading="lazy" alt="Jajarkot earthquake NT"> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20231201131252_9f96af647fb9e343ef22159c2191e7aaac8574f6cce70891237a91d24747fcc2.png" data-media-id="editor_1" data-image-id="20231201131252_9f96af647fb9e343ef22159c2191e7aaac8574f6cce70891237a91d24747fcc2" data-rendition-name="original" width="748" height="1142" loading="lazy" alt="Jajarkot earthquake NT"> </figure>  Read also: <a href="https://nepalitimes.com/opinion/comment/learning-from-jajarkot-what-we-didnt-after-2015-695vpzle">Learning from Jajarkot what we didn't after 2015</a>, Sushil Gyewali Relief must be survivor-centred and not be sensationalised or politicised with fake news. A centralised database that can foster collaboration is being put up with accurate and up to date information on the <a href="https://jajarkot.himalayandisaster.org/">Jajarkot Earthquake Response website</a>. Partners on the ground can also fact-check and debunk false reports, and we urge reporters to seek out these primary sources instead of relying on sensationalised clickbait. Rubble and destruction&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2023120112124_66e5ce77ae433644dabf10e3391e39021e92857248896af39bf19ad128e05e8b.jpg" data-media-id="editor_4" data-image-id="2023120112124_66e5ce77ae433644dabf10e3391e39021e92857248896af39bf19ad128e05e8b" data-rendition-name="original" width="1333" height="1000" loading="lazy" alt="2023 Jajarkot after earthquake NT"> </figure>  As we approached the epicentre with three vehicles filled with jackets, sanitation kits, blankets, the destruction was shocking. Even in the relatively accessible areas like the district headquarter of Khalanga the houses are still in ruins. A month after the earthquake the rubble still has not been cleared. Things get worse the deeper we go into the mountains. On the way to Nalgad, there are rows upon rows of destroyed houses. Most people are living under tarp and bamboo tents, in one of them there were seven members of a family huddled inside. One man in Kalanga had broken his arm, and was sifting through the rubble of his home with his other hand. He was sheltering in a nearby school with many other neighbours.&nbsp; A school in Nalgad was still functioning, and students were attending classes in tents. Their school was damaged and there was fear of aftershocks.&nbsp; Multiple political groups and nonprofits are helping clear the rubble in places, but no active rebuilding has started yet.&nbsp; Read also: <a href="https://nepalitimes.com/here-now/grief-stricken-survivors-are-cold-and-hungry">Grief-stricken survivors are cold and hungry</a>, Sagar Budathoki CGI-based temporary homes might be better than tents for this winter. But rapid, affordable, earthquake resistant and sustainable rebuilding must start as soon as possible using the experience and plans developed after the 2015 earthquake. Rural municipalities must be key partners in all rebuilding efforts. Relief organisations can divide up their efforts to avoid duplication. There are prototypes for <a href="https://www.dezeen.com/2015/07/11/prototype-bamboo-shelter-nepal-earthquake-victims-built-by-unskilledworkers-three-days/amp/">winterised temporary shelters</a> and <a href="https://habitatnepal.org/wp-content/uploads/2019/10/Bamboo-Temp-Shelter-Nepali-web.pdf">long term solutions</a> for reconstruction: Immediate Relief and Humanitarian Aid&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2023120112124_fa55e5f5c7e0c08e34679ea94f7eee9d393899fe41c45d32ca0d8b3b52d00ee6.jpg" data-media-id="editor_8" data-image-id="2023120112124_fa55e5f5c7e0c08e34679ea94f7eee9d393899fe41c45d32ca0d8b3b52d00ee6" data-rendition-name="original" width="1333" height="1000" loading="lazy" alt="2023 Jajarkot after earthquake NT"> </figure>  Nepal has a one-door policy currently to manage aid coming into disaster zones. Each district’s disaster relief committee is led by the Chief District Officer (CDO), who is in charge of relief items coming to the region. Jajarkot district has received tons of relief material, and local distribution was initially the bottleneck. There are still reports of items not getting to those that live in remote and roadless areas.&nbsp; We saw this week that the distribution management appeared to have improved. Items lying in municipality offices and district offices were in the process of being delivered. The municipal system makes it easy to coordinate with local ward chairs to find the areas of acute need.&nbsp; Our trucks had to be registered with the CDO with an itemised list and approved for further transport deeper into the district. The process seemed seamless. In Nalgad municipality, where few relief organisations are present, the mayor’s office and the Nepal Army have coordinated with NGOs to distribute blankets, clothes to more remote regions.&nbsp; Read also:<a href="https://nepalitimes.com/news/earthquake-vacates-villages-in-nepal"> Earthquake vacates villages in Nepal</a>, Anita Bhetwal The municipalities are coordinating better, and working closely with relief aid partners. But there is still a need for logistics management and strategic distribution of relief material to difficult to reach villages. Special care must be given to villages at higher altitudes where it will soon start snowing. Relief organisations must respect the one-door policy, and not bypass this effort to coordinate relief and avoid waste and overlap. The Ward chairs have their feet on the ground and are the best source for exact need. They should be made partners in all aid distribution locally.&nbsp; Healthcare&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2023120112124_b094ac6d0dfcdc924f571e1308307ebaa4b6b1d2b7d5c0ebcfe290466cd3abf0.jpg" data-media-id="editor_10" data-image-id="2023120112124_b094ac6d0dfcdc924f571e1308307ebaa4b6b1d2b7d5c0ebcfe290466cd3abf0" data-rendition-name="original" width="1333" height="1000" loading="lazy" alt="2023 Jajarkot after earthquake NT"> </figure>  Jajarkot has a well-equipped district hospital, and each municipality has a &nbsp;health centre. There are smaller health posts in wards within the municipality. The nearest high level facility with ICU capacity is in Surkhet.&nbsp; Jajarkot district hospital had a large number of traumas during the first weeks after the earthquake. The hospital has five medical officers, and one MDGP (consultant) physician, and can provide basic emergency care, maternal and child care including caesarean section and vaginal delivery, and has a robust pharmacy. The hospital’s patient census was not impressive during our visit.&nbsp; The Nalgad municipality health centre was busy with only one medical officer available. Large tents from UNICEF had been erected outside for additional inpatient ward and emergency space. There seems to be a gap from the district to support the local municipality's needs.&nbsp; We came across many groups coming to Jajarkot to conduct health camps. Though increased engagement has benefits, it is not so useful to have camps near the health centres or the district hospital as there are already facilities there. &nbsp;Doctors told us that they had extreme excess of certain supplies and not enough of others.&nbsp; Read also: <a href="https://nepalitimes.com/banner/in-a-disastrous-state">In a disastrous state</a>, Sonia Awale Groups organising health camps should focus on two areas: 1) bring specialist care that otherwise does not exist in this region, 2) reaching areas away from local health infrastructure. They must also coordinate with the district hospital and municipality health centre to assess their utility. Funds used for health camps could instead help strengthen local health facilities. The districts should divert some of their resources (doctors, nurses, etc) to some of these busy health centres in local municipalities like Nalgad. It does not make sense for one doctor to see a large number of patients in Nalgad, while the district hospital is not busy.&nbsp; Safeguarding Women and Children  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2023120112124_2e48aaab35412bd26e577239a96e036781290ce1391da4a9b5d90d44410d9a63.jpg" data-media-id="editor_12" data-image-id="2023120112124_2e48aaab35412bd26e577239a96e036781290ce1391da4a9b5d90d44410d9a63" data-rendition-name="original" width="1800" height="1000" loading="lazy" alt="2023 Jajarkot after earthquake NT"> <figcaption>Ramu Kharel (left) and Maggie Doyne with locals in Jajarkot. The infant whose mother died was brought down and is recovering in ICU in Surkhet.</figcaption> </figure>  There are a large number of pregnant and postpartum women in the most affected areas in Nalgad, Rukum and Kuse. Recent news items have used false narratives to gain viewership, but there is a real need for access to appropriate ante-natal and postnatal care, which was an issue that existed before the earthquake in underserved areas of western Nepal. Jajarkot hospital, the municipal health centres are both equipped to care for most of these women. Various groups are providing warm clothes for the most vulnerable and prioritising these women for safe winterised shelters is a must.&nbsp; There are child protection units and National Child Rights Council (NCRC) offices at each municipal office. When a child, adolescent, pregnant or postpartum woman is in potential or imminent danger, it is critically important that officers be notified immediately.&nbsp; The NCRC works directly with government bodies, police, licensed shelters, and relief agencies to ensure that the woman or child is taken out of danger. NCRC and Kopila Valley are able to work together directly to safeguard the children in distress. The involvement of NCRC also prevents child smuggling and safeguards against family separation, exploitation, and human trafficking. The use of trained trauma informed social workers and child protection officers is critically important when discerning information and keeps the child’s rights and protection at the centre.&nbsp; Available health centres must be equipped with in-facility and outreach programs to identify and care for the most vulnerable in the region. This disaster could be used as an opportunity to equip and build a system around the municipal health centre and district hospitals to create innovative models like <a href="https://www.nyayahealthnepal.org/">Nyaya Health Nepal’s</a> community health care model in Achham, where community health workers are trained and equipped to provide care at home. Read also: <a href="https://nepalitimes.com/opinion/rebuilding-resilience-7-years-later">Rebuilding resilience 7 years later</a>, Anil Pokharel When someone is really ill, taking the patient to Surkhet might be the only way but the road is long and hard. A streamlined approach to access government services like helicopter rescue must be available in this post-disaster setting.&nbsp; A robust ambulance and EMS service from either the municipal health centre and/or Jajarkot district hospital must be made.&nbsp; Water and Sanitation&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2023120112124_186d4e99aa2c91f173de7e0e430b03a24c1099075fdbfeae8ead9b770cee9ca6.jpg" data-media-id="editor_15" data-image-id="2023120112124_186d4e99aa2c91f173de7e0e430b03a24c1099075fdbfeae8ead9b770cee9ca6" data-rendition-name="original" width="1333" height="1000" loading="lazy" alt="2023 Jajarkot after earthquake NT"> </figure>  Even before the earthquake, Jajarkot and surrounding districts were hit by a cholera epidemic in 2009 that killed over 300 people, many of them children. Running water and sanitation has always been a major concern and this danger has been exacerbated with the earthquake aftermath in the dry season.&nbsp; None of the temporary tents and shelters we saw had appropriate water access and hand washing stations. Donor agency temporary toilets were dirty with no hand washing. Water and hygiene must be a priority for development groups going forward. Relief groups must put WASH in their priority.&nbsp; After meeting survivors, relief workers and local elected officials we saw a resilience and a determination to bounce back. The items we took to Nalgad are being strategically distributed in coordination with municipality offices to reach those in most need.&nbsp; We were able to locate the one-month-old infant in Nalgad municipality’s Ward 8. The infant is now getting safe ICU level care now in Surkhet, and is doing better.&nbsp; Read also: <a href="https://nepalitimes.com/editorial/shaking-things-up">Shaking things up</a>, Editorial Resources for aid information and reporting can be found <a href="https://aidpulse.org/aidboard">here</a>. Important phone numbers:&nbsp; National Child Rights Council: 01-5550121&nbsp; Chief Minister Karnali: 985804444&nbsp; Chief District Officer Jajarkot: 9858047777&nbsp; Mayor Nalgad: 9842236335&nbsp; Mayor Kuse: 9858937755&nbsp; District Hospital Khalanga: 089-430188&nbsp; Ambulance: 102&nbsp; AIN (Federation for NGOs): 01-4468128&nbsp; Poison information center: 01-450-2011&nbsp; Suicide Hotline: 1166&nbsp; Police: 100 Ramu Kharel (ramu_kharel@brown.edu) is an emergency medicine physician with global health and public health expertise, and decade long experience in disaster response within Nepal. He is an assistant professor at Brown University, and is founder of <a href="http://www.hapsaglobe.org/">HAPSA Nepal</a>. Maggie Doyne is the co-founder of the <a href="https://blinknow.org/">BlinkNow Foundation</a> and, and has worked for 18 years in the Karnali region caring for at-risk children through community development efforts. She is a CNN Hero and author based in Surkhet.

Jajarkot: One month after the earthquake

At 6 feet and one inch, Hira Bahadur Ghalan was exceptionally tall for a Nepali. In 1936, when people came to his Tamang village near Tistung looking for porters, they recruited him on the spot. This was no ordinary job, Hira Bahadur would lead gangs of 30 or more porters to carry cars bought by Rana rulers from Bhimphedi to Kathmandu.&nbsp; Those were the days when the only motorable roads in Nepal were in Kathmandu, but the capital was not connected to anywhere else by road. So, before cars could carry people, people had to carry cars. More Nepalis had carried cars than ridden in one. The porters were paid Rs5 for the job, and sometimes the Rana owners gave Hira Bahadur a Rs25 baksheesh. One of the cars his community helped carry was a 1939 Daimler Benz gifted by Adolf Hitler to King Tribhuvan to woo Nepal away from the British. The rusted dusty vehicle is now in the Narayanhiti Palace Museum.&nbsp; Hira Bahadur hauled cars for 25 years until his knees gave way, he died at age 90 eight years ago — the last surviving car porters of Nepal from Chitlang Valley.&nbsp; Hira Bahadur Ghalan had three sons and three daughters, one of them is Maila Kaji Lama, who at age 68, is a chauffeur in Kathmandu. His son, Manjil Lama is a pilot with Summit Air, flying to remote Himalayan airstrips. Three generations of one family worked in professions that followed a century of transportation history in Nepal. &nbsp; After the <a href="https://nepalitimes.com/multimedia/the-long-and-winding-road-to-india">Tribhuvan Rajpath was finished in 1957</a> and the ropeway upgraded, Hira Bahadur was out of a job. He tilled the family farm, watching trucks and buses headed to and from Kathmandu on the hairpins.&nbsp; As a child, Maila Kaji was fascinated by cars and wished one day to be able to drive one. After he failed Grade 8, he came to Kathmandu in 1975 and got a Rs20/month job at a petrol station in Maiti Devi. “I watched King Birendra’s coronation and was impressed by the glamour of Kathmandu, and decided to stay here,” Maila Kaji says.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026041816040_a1a41e47dec8500727702f700e43af625f059043cbcd283f13b247344b3a20aa.png" data-media-id="editor_1" data-image-id="2026041816040_a1a41e47dec8500727702f700e43af625f059043cbcd283f13b247344b3a20aa" data-rendition-name="original" width="1974" height="1608" loading="lazy" alt="car carriers"> <figcaption>Maila Kaji</figcaption> </figure>  Former minister Ramesh Nath Pandey used to bring his Volkswagen Beetle to the station, and Maila Kaji started taking care of his car. Later, he drove a Russian Jeep for former minister and geographer Harka Gurung. Along the way, he fell in love with the daughter of a Brahmin colleague, and married her. “My father back in Tistung did not approve of our inter-ethnic marriage, and not speak to me for five years,” Maila Kaji recalls. Manjil Lama grew up in Kathmandu, and did well in science in school. He had wanted to go the US to become a pilot like his friends, but was denied a visa.&nbsp; “The visa officer told him I did not earn enough,” says Maila Kaji, “so I sold some property and sent Manjil to flying school in the Philippines.”  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026041816040_e9091162840baa6d182de2d7cc6f09e43ec9cfd9a9b6e71e7e7b14bc72da3537.png" data-media-id="editor_2" data-image-id="2026041816040_e9091162840baa6d182de2d7cc6f09e43ec9cfd9a9b6e71e7e7b14bc72da3537" data-rendition-name="original" width="1434" height="1754" loading="lazy" alt="car carriers"> <figcaption>Manjil Lama</figcaption> </figure>  After returning to Nepal, Manjil Lama now flies Let 410s of Summit Air to difficult air strips like Lukla and Simkot, and has logged over 2,000 hours. He has to go to the Czech Republic regularly for simulator training. Says Maila Kaji Lama: “My father worked hard carrying cars to raise us, I started from scratch to become a driver to support my family, and my son is now a pilot with experience in flying in the world’s toughest terrain.” &nbsp; Watch <a href="https://www.youtube.com/watch?v=lvT3iTi8yw4" target="_blank">video clip from S Dillon Ripley here</a>.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260419020448_40f8b1bdaace08106ca5c24819b6e7a34fb2109a9a3ec5c6ac179b3309e686ed.png" data-media-id="editor_4" data-image-id="20260419020448_40f8b1bdaace08106ca5c24819b6e7a34fb2109a9a3ec5c6ac179b3309e686ed" data-rendition-name="original" width="900" height="1582" loading="lazy" alt="car carriers"> </figure>

Grandfather carried cars, son drives cars, grandson flies planes

Sudan Gurung is dancing. It is 2009. He has an emo fringe falling over one eye and is spinning on a polished floor. His dance shows dedication — moves that take years of bruised elbows to land. The clip is 16 years old, and had been sitting in the dead archives of YouTube and old Facebook pages, watched by almost nobody. This month <a href="https://www.tiktok.com/@4gr4j/video/7621892206902725909">it has 1.9 million views</a>. Because Gurung is now Home Minister, and is embroiled in a scandal barely two months into office. Within days of becoming an RSP candidate, his pre-political life became public and was put back into circulation. The b-boying, the DJ sets, and the YouTube video of him dancing in a music clip. The youth of Nepal, well-versed in snappy TikTok edits and aura compilations, immediately turned to making <a href="https://www.tiktok.com/@aayvik/video/7626069452177542408">videos of Sudan Gurung's swag</a>.  <figure><img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026042202040_71df4d531423e7c941abde95fb8106346c70ab0afb71bbeb520cc570f14ba178.jpg" data-media-id="editor_2" data-image-id="2026042202040_71df4d531423e7c941abde95fb8106346c70ab0afb71bbeb520cc570f14ba178" data-rendition-name="original" width="2300" height="1000" loading="lazy" alt="When aura meets audit"></figure>  TikTok remixed the footage to trap beats. The comments settled on a nickname that has now crossed into everyday speech: ‘Homie Minister’. <div class="embed-block"><blockquote class="tiktok-embed" cite="https://www.tiktok.com/@yalexthwreal/video/7622325255792512276" data-video-id="7622325255792512276" style="max-width: 605px;min-width: 325px;"> <section><a target="_blank" title="@yalexthwreal" href="https://www.tiktok.com/@yalexthwreal?refer=embed">@yalexthwreal</a> <a title="sudangurung" target="_blank" href="https://www.tiktok.com/tag/sudangurung?refer=embed">#sudangurung</a> new home minister of Nepal😎 <a title="fyppppppppppppppppppppppp" target="_blank" href="https://www.tiktok.com/tag/fyppppppppppppppppppppppp?refer=embed">#fyppppppppppppppppppppppp</a> <a title="sudangrg" target="_blank" href="https://www.tiktok.com/tag/sudangrg?refer=embed">#sudangrg</a> <a title="home" target="_blank" href="https://www.tiktok.com/tag/home?refer=embed">#home</a> <a title="minister" target="_blank" href="https://www.tiktok.com/tag/minister?refer=embed">#minister</a> <a target="_blank" title="♬ original sound - •⪨н є α я т ❤н α ¢ к є я ⪩• - Music Universe 🎧" href="https://www.tiktok.com/music/original-sound-%E2%80%A2%E2%AA%A8%D0%BD-%D1%94-%CE%B1-%D1%8F-%D1%82-%E2%9D%A4%D0%BD-%CE%B1-%C2%A2-%D0%BA-%D1%94-%D1%8F-%E2%AA%A9%E2%80%A2-7308733170064231170?refer=embed">♬ original sound - •⪨н є α я т ❤н α ¢ к є я ⪩• - Music Universe 🎧</a> </section></blockquote> <script async src="https://www.tiktok.com/embed.js"></script></div> Home Minister Gurung is in charge of the Nepal Police, Armed Police Force, Department of Immigration, and the country's internal security apparatus. Calling him ‘homie’ collapses the distance between that office and the Discord server where the movement that brought him into power organised itself. What is harder to explain is why these nostalgic clips are doing the narrative work for Gurung's political standing. A teenager on a dance floor in a Thamel club, filmed before smartphones had decent cameras, is now functioning as political currency for a powerful, but embattled, home minister. The footage is not an argument. Gurung is not doing anything in it that relates to home affairs. He is just dancing. The comments compare him to <a href="https://www.tiktok.com/@4gr4j/video/7621892206902725909">Korean film heroes</a>. A separate <a href="https://www.tiktok.com/@tandavyt7/video/7622151050128018708">48,000-like edit</a> is captioned ‘Our New Home Minister Aura’. The replies are full of people saying they get chills listening to him speak. Political legitimacy in Nepal has been built out of many things over the last 70 years, but it has never been built out of this. The question is: what happens when the job starts demanding things his style, boldness, and swag cannot provide. Because political aura in Nepal used to be a slow harvest, now it isn’t. BP Koirala spent eight years in prison under the Panchayat. He wrote fiction at Sundari Jal. The writing survived, the prison sentences survived, and that experience became the template for what a serious Nepali politician looked like: someone the state had tried to break and failed. Legitimacy was accumulated by having their lives taken away, and refusing to bend the knee. The old mechanics of legitimacy produced politicians who could be audited. The record was made of words, dates, votes, and years behind bars. A voter who wanted to know what a leader stood for could read his writings. A journalist digging for inconsistency had somewhere to look. The system was slow, often corrupt, and frequently boring. In fact, boring used to come with the job. A minister was supposed to be slightly dull — evidence that the person was doing the unglamorous work of reading files and sitting through committee meetings. Today, boring is a disqualification. The attention economy rewards velocity and visual charge, a politician who cannot generate either does not exist in the feed, and that means does not exist at all. The legacy parties are still issuing press statements criticising the new guard in the grammar of paper trails and procedural failure. But the audience has stopped reading, they scroll for their next viral bite. Sudan Gurung, unlike the old parties, understands exactly which grammar the feed rewards. Just look at what he has been up to. On his first evening as Home Minister, he posted a photo of himself sleeping on a sofa inside the ministry. Caption: creation cannot be greater than the creator, government is not above the people. The image travelled further in 12 hours than any ministerial press release has ever done. A minister napping on a sofa, phone-shot, zero production, read by the public as evidence of a minister who had skipped the motorcade and got straight to work. Gurung used Facebook to announce, the names of former ministers and businessmen he intended to arrest. Each name was posted before the arrest, not after. The feed became the announcement venue for state security action.  <figure><img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260422010456_2fa1918e1dd031d01f38b4001ee306d9414073cec0b795fa43a75cb5a8deb8c7.png" data-media-id="editor_6" data-image-id="20260422010456_2fa1918e1dd031d01f38b4001ee306d9414073cec0b795fa43a75cb5a8deb8c7" data-rendition-name="original" width="926" height="868" loading="lazy" alt="When aura meets audit"></figure>  This is not how the Ministry of Home Affairs has ever been operated. It is how a YouTuber releases a series. Sudan Gurung is a political content creator. As home minister, he is an influential influencer constantly, kinetically doing something in the visual medium. Much like Prime Minister Balendra Shah's sunglasses, Gurung's aura, authenticity and swag are a brand asset, instantly recognisable at thumbnail size. Balen's rap career supplies a pre-political archive that authenticates him the same way Gurung's DJ sets and b-boying clips authenticate him. The aesthetic is doing the work a manifesto used to do. The work is authenticity, and the strategy is auramaxxing. The emo fringe predates the ministry. The DJ sets predate Hami Nepal. The b-boying predates the earthquake, the NGO, the September uprising, the interim cabinet, all of it. Whatever Gurung is now, he was already that person before the office existed. This is the real spectacle of the Homie Minister: authenticity. Nepal’s youth have grown up watching heavily-polished, talking-point ministers speak in a language aimed at nobody in particular, But this grainy archival clip of the current Home Minister from 2009 is honest.  <figure><img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260422010456_5d6dff3a09e8b7e77dc60c3aa567c9e02b6bd5f90f94e20737ec05cc9a09023b.jpg" data-media-id="editor_7" data-image-id="20260422010456_5d6dff3a09e8b7e77dc60c3aa567c9e02b6bd5f90f94e20737ec05cc9a09023b" data-rendition-name="original" width="1800" height="1000" loading="lazy" alt="When aura meets audit NT"></figure>  The effect has transcended the GenZ. <a href="https://www.tiktok.com/@ektapokharel/video/7623242573481561365">A TikTok trend </a>captioned NOT ONLY OUR HOME MINISTER, WE ARE ALSO FROM THAT ERA now has <a href="https://www.tiktok.com/@sonykhadka/video/7624106790266948872">millennials posting their own</a> archive photos from the same period, aligning themselves with Gurung's pre-political aesthetic. The aura is doing <a href="https://www.tiktok.com/@_thakuri/video/7623397397556645141">cross-generational work</a>. It is a shared legibility, spanning at least 15 years of Nepali youth culture, and the current Home Minister is standing at its centre. The traditional politician’s entire adult life is a performance of identity. Every photograph is lit for the media, every statement is vetted. The persona is the product, and the product has been in development for 30 years. This makes the old guard legible but, suspect in the attention economy. A generation raised on authenticity-as-currency reads the decades of careful performance as evidence of something to hide. The polish is the problem. The nostalgic Sudan Gurung party clips invert this. The polish is absent. The footage cannot be performance aimed at the viewer, because the viewer did not exist in 2009 and neither did the political stakes. The clip is therefore read as real, in a way a press conference can never be. It is just a kid dancing, and he happened to grow up to be the Home Minister. But Sudan Gurung's job is not to go viral. The Ministry of Home Affairs requires the person running it to file a complete asset declaration and to avoid holding financial interests in entities that might come before the state. None of this work is content. A correctly filed asset declaration does not get remixed into a trap beat. A functioning immigration database is not a TikTok. The paperwork that constitutes actual governance is structurally boring in exactly the way the old parties are structurally boring, and for the same reason. It is the slow, procedural, checkable apparatus that the old system was built to produce and that the new system has not yet learned to replace. And it is ironic that it is painstaking follow-the-money paper trail investigative journalists in the legacy media who have uncovered the evidence. You cannot auramaxx your way out of a share registry. You cannot post your way past a conflict-of-interest statute. No amount of fire outfits and wild DJ transitions does anything for you when a journalist pulls the initial shareholder list of a micro insurance company and finds your name at number 49. <a href="https://www.tiktok.com/@blox.drop/video/7622173520981658900">Auramaxxing was engineered</a> for the mechanics of reaching office. It is the reason Sudan Gurung is Home Minister and Gagan Thapa is not. The question that has not yet been tested, and is now being put to public test, is whether the same weapon works when the terrain changes. The terrain does change when you assume power. TWO CLOCKS Two clocks are running, and they do not sync. The first clock was built for auramaxxing. A clip posted at eight in the morning peaks by noon. A sofa photo is already remixed before the minister has left the building. The feedback loop is fast and legible, and a politician playing this clock gets real-time data on what to post next. The old guard never learned to read it, which is a large part of why they lost the election. The second clock is the one the ministry actually runs on. It measures in quarters, court calendars, and the slow grind of investigation files moving between offices. A share registry takes weeks to pull. A money-laundering case moves at the speed of the prosecutor's office, which is to say, it often does not appear to move at all, until one morning it does. The second clock does not care whether the minister is currently trending. These two clocks have collided. The first one made Sudan Gurung home minister in weeks. The second is pulling out documents that may take months to fully surface and years to adjudicate. The mechanics that won the office are not the same that determine whether the office holds. This is the asymmetry. A politician whose legitimacy is built on <a href="https://www.tiktok.com/@s.u.m.e.e/video/7622165783254158613">high velocity videos</a> is structurally exposed to a process that runs slower than the news cycle, because the archive of aesthetic proof was not engineered to answer documentary evidence. It was engineered to displace the demand for documentary evidence in the first place. When that demand returns, as it always does once a politician takes office, the digital archive keeps performing, but the documents keep getting uncovered. And the two tracks do not communicate. The old guard knew this clock because they had no other clock to know. What they lost in charisma they gained in durability: a politician built over 20 years of parliamentary record is harder to dislodge with a single document because they have already survived thousands of documents. The new guard has not been stress-tested against its own paper trail. Sudan Gurung is now being tested. If he survives this, and he might, a new template will have been proven. A politician can enter office on the strength of a dance clip, face a paper trail that would have ended the career of a politician in a previous era of Nepali politics, and continue to govern because the public has decided that an old dance clip is more persuasive than the hard copy document of the company registrar. The clip is still in circulation, the sofa photo still reads as sincerity. The arrest of a former prime minister that the courts reversed has faded from the feed, which runs faster than judicial reversal, and that is the whole point. If Sudan Gurung does not survive it, a different lesson gets written. Auramaxxing turns out to be a weapon that works in one direction only: it gets you the job, and then it leaves you exposed. The movement that installed Gurung in the name of ending elite capture will have to decide whether its own hero is subject to the same audit it demanded of everyone else. If the answer is yes, the movement retains its moral coherence. If the answer is no, the movement becomes the thing it replaced, only faster. Both outcomes are live. If Gurung walks through this, the technique gets copied. If he does not, the technique gets revised. Whether the gap closes on him, or he rewrites the gap, is the thing to watch.

When Aura meets Audit

Only 70 years ago, Kathmandu was the isolated capital of a country that had no modern surface transport link with the rest of the world.&nbsp; The idea of building a road to connect Nepal with India actually first came up during the last years of the Rana regime, after the British had left India. Construction actually began in 1952, and the serpentine route took five years to complete.&nbsp; Named Tribhuvan Rajpath, after the reigning king who initiated it, the alignment was from Thankot (1,301 m) at the western edge of the Kathmandu Valley to Nagdunga, Naubise, Tistung, Palung, Daman, Sim Bhanjyang (2,504m), Lamidanda, and Bhainse.&nbsp; At Bhainse, the highway joined the existing road to Bhimphedi and it was another 31km to Hetauda and Amlekhganj. There was a railway line between Amlekhganj and Birganj.&nbsp; After regular bus and truck service from Raxaul to Kathmandu began in 1961, the entire road popularly became known as the Tribhuvan Rajpath.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026041610044_a11b48a75c7877a0f68634f8be07d26a3f354e78ebd9adddc7d17252fddf1d1b.jpg" data-media-id="editor_0" data-image-id="2026041610044_a11b48a75c7877a0f68634f8be07d26a3f354e78ebd9adddc7d17252fddf1d1b" data-rendition-name="original" width="4608" height="3072" loading="lazy" alt="Highways NT"> <figcaption>The village of Chitlang on the main route to Kathmandu before the Rajpath was built. In the distance is the Chandragiri ridge above Thankot. Photo: DAN EDWARDS</figcaption> </figure>  <h2>Chronology&nbsp;</h2> (Based on US State Department cables and media reports) November 1945: Gen Bahadur SJB Rana asked an American official if a road could be constructed from the Indian border to Kathmandu. Nepal wanted such a road built across the mountains after first constructing an East-West artery road in the Tarai, and the government was interested in purchasing US surplus war equipment. Gen Rana inquired if there were US firms who could conduct a survey. April 1947: The Nepal government told a US official it was important to upgrade the 20-mile trail from Bhimphedi over the mountains to the Kathmandu Valley into an all-weather road and sought an estimate from the US for doing so. May 1948: Bijaya SJB Rana informed a US official that a survey for a one-lane motor road between Kathmandu and the Tarai had been completed. The road was to follow the Bagmati River to Makwanpur, then connect at Bhimphedi with the road to Amlekhgunj. The road from Tripureswor to Bhainse along the Bagmati River and via Bhimphedi would have been about 60km. (The distance from Kathmandu on the Tribhuvan Rajpath is 122 km.)  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026041610044_bb531baf5d73e00d2032814ac8abb86979a87d781abc066fcb984997aad930e6.jpg" data-media-id="editor_1" data-image-id="2026041610044_bb531baf5d73e00d2032814ac8abb86979a87d781abc066fcb984997aad930e6" data-rendition-name="original" width="4608" height="3072" loading="lazy" alt="Highways NT"> <figcaption>The road climbing the hills toward its destination of Kathmandu. Photo: DAN EDWARDS</figcaption> </figure>  July 1948: The government decided to go ahead and build a motorable road from Amlekhganj to Thankot and complete it in two years. December 1948: Construction of the motor road from Kathmandu to Amlekhgunj via the Bagmati River corridor was started. April 1949: Gen Singha SJB Rana told a US official that the motor road from Kathmandu to the Tarai and the Indo-Nepal border would be completed by the spring of 1950. February 1950: Nepal sanctioned Rs300,000 to make the 6-foot-wide road from Kathmandu along the Bagmati River to Hetauda. Of this, Rs100,000 was allocated for road-building material and machinery. Subsequently, the road would be developed into a broader motorable road at a cost of Rs7.5 million. February 1952: Nepal’s budget speech noted that a plan was underway for a road between Bhainse and Kathmandu. PM Matrika Prasad Koirala laid a foundation stone near Teku for construction of the ‘Kathmandu Hetauda Roadway’.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026041610044_e66d3b81848ec19da48be8b41cacfa8b8e2bad093719b39eda27755c9616ea9a.jpg" data-media-id="editor_2" data-image-id="2026041610044_e66d3b81848ec19da48be8b41cacfa8b8e2bad093719b39eda27755c9616ea9a" data-rendition-name="original" width="4608" height="3072" loading="lazy" alt="Highways NT"> <figcaption>Rajpath winding its way north of Bhainse. Photo: DAN EDWARDS</figcaption> </figure>  February 1952: A party of Indian engineers came to Nepal to determine the best route for a road from Raxaul to Kathmandu. March 1952: Prime Minister Jawaharlal Nehru told Parliament: “So far as India’s security is concerned, we consider the Himalayan mountains as our border.” Ministry of External Affairs official (S.N. Hakar) told a US official that the Indian government was willing to proceed with constructing the Raxaul-Kathmandu road and had sent a survey party to determine the most suitable mountain route. May 1952: Swiss experts had made surveys for a proposed new road between Bhimphedi and Thankot. Nepal government requested financial help to build the road, and India was considering the project.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026041610044_35e390c1a4812f45af7892d681230e04c63727d9006b6614ed79aaa7c22c1ece.jpg" data-media-id="editor_3" data-image-id="2026041610044_35e390c1a4812f45af7892d681230e04c63727d9006b6614ed79aaa7c22c1ece" data-rendition-name="original" width="4608" height="3072" loading="lazy" alt="Highways NT"> <figcaption>With a constant stream of trucks, buses and jeeps, the narrow Rajpath once was Nepal's busiest highway. Photo: DAN EDWARDS</figcaption> </figure>  Summer 1952: Work on a new road was at a standstill, so Nepal asked India for assistance. Indian engineers surveyed two routes: one following the Bagmati River, the other road through Daman that was later adopted. July 1952: Nepal’s Ministry of Planning decided to construct a road between Kathmandu and Raxaul, awaiting Cabinet approval soon. Prime Minister Matrika Koirala said the proposed road was longer than necessary, but it was a better route ‘for strategic reasons’, because it did not require many bridges. August 1952: King Tribhuvan said road construction from Kathmandu to Bhimphedi would “begin soon”. September 1952: An Indian Military Team began construction of the Kathmandu-Bhainse road without a formal agreement being signed with the Nepal government.&nbsp; February 1953: The Indian Ambassador said the road would be hard surfaced within a year. September 1953: Prime Minister Matrika Koirala inspected the completion of a ‘jeepable track’. December 1953: The road was named ‘Tribhuvan Rajpath’. April 1954: Reports circulated that Swiss engineers criticised the alignment, arguing it would have been easier, faster, and cheaper to build over the existing foot trail between Bhimphedi and Thankot through Kulekhani. July 1954: Heavy monsoon rain damaged much of the roadway that had been built.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026041610044_b5b2a1833f1366e532f1629f47c124d877df7b6f8a34b6c83f6c21ec3e4415dd.jpg" data-media-id="editor_4" data-image-id="2026041610044_b5b2a1833f1366e532f1629f47c124d877df7b6f8a34b6c83f6c21ec3e4415dd" data-rendition-name="original" width="855" height="1123" loading="lazy" alt="Highways NT"> <figcaption>Crown Prince Mahendra inspecting construction progress on the Tribhuvan Rajpath in October 1954. Photo: ROYAL PALACE</figcaption> </figure>  November 1954: The Indian ambassador said flood damage was so great that the road would be delayed by two years. May 1955: Twenty military trucks brought rice from Amlekhganj to Kathmandu on the Tribhuvan Rajpath. King Tribhuvan died in Zurich. December 1956: A gravel road was completed, with trucks and buses plying between Amlekhganj and Kathmandu. December 1956: Nepal government abolished regulations that required Nepali nationals to carry permits for travel within Nepal, except for women below the age of 45. 1957: Reduction in price of goods carried to Kathmandu by truck: Sugar, Rs0.13 per kg. Wheat flour Rs0.13 per kg. Kerosene Rs0.25 per litre. February 1957: An article in The Motherland newspaper in Kathmandu noted urgent action was needed to avoid Kathmandu being cut off from the Tarai during the monsoon. The correspondent wrote, ‘In a recent journey from Amlekhganj I found that almost all the bridges are in a very bad state…Now, because of the dry rivers the scores of vehicles that ply the road cross the rivers on the water level. But during monsoons… these rivers will be impossible to cross without bridges. On the road itself, landslides and big holes have made the journey a great undertaking.” April 1957: The first regular passenger bus left Amlekhganj at 12:30PM and arrived in Kathmandu completing a journey of 14 hours.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026041610044_60807e067f2d0b80bdc5e59860e9bc240b495ef606efc9301ef54ea5731d42df.jpg" data-media-id="editor_5" data-image-id="2026041610044_60807e067f2d0b80bdc5e59860e9bc240b495ef606efc9301ef54ea5731d42df" data-rendition-name="original" width="5211" height="4000" loading="lazy" alt="Highways NT"> <figcaption>Daman, one of the highest points on the Rajpath, often saw snow in winter. Photo: DAN EDWARDS</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026041610044_baac4747267c751ab7b0e5ef24697fb5001c4c55e04a82d92c89282bd01a325c.jpg" data-media-id="editor_6" data-image-id="2026041610044_baac4747267c751ab7b0e5ef24697fb5001c4c55e04a82d92c89282bd01a325c" data-rendition-name="original" width="648" height="960" loading="lazy" alt="Highways NT"> <figcaption>Travelers could view the Himalayas from a view tower at Daman. Photo: DAN EDWARDS</figcaption> </figure>  June 1957: Eight thousand Nepali workers and about 500 Indian Army personnel were at work on the road.&nbsp; 30 June 1957: India officially handed the road over to Nepal. India had spent INR32.5 million on the project.&nbsp; January 1958: The road from Amlekhganj to Bhainse was upgraded. July 1961: The gravel road from Raxaul to Birganj was blacktopped. Trucks began transporting goods from Raxaul directly to Kathmandu, avoiding the need for transshipment from train to truck in Amlekhganj, or use the ropeway from Bhimphedi. 1961: Passengers could travel from Raxaul to Kathmandu in a day, whereas it took a week by train to Amlekhganj, bus to Bhimphedi and then on foot. September 1962: Nepal’s 3-Year Plan aimed at broadening and black-topping the road between Bhainse and Raxaul, bypassing the Chure tunnel, and constructing several bridges along the route. 1963: Travelers going to Kathmandu by land: Road, 158,000, Nepal Government Railway, 66,500. Railway passenger service ended in June 1965.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026041610044_2a95eb144dad74271a0fa3a27fab6b45bbab0a1c4be59d21120ad14c08e258fd.jpg" data-media-id="editor_7" data-image-id="2026041610044_2a95eb144dad74271a0fa3a27fab6b45bbab0a1c4be59d21120ad14c08e258fd" data-rendition-name="original" width="2048" height="1344" loading="lazy" alt="Highways NT"> <figcaption>A bus providing ‘deluxe service’ in 1963 is ready to leave Amlekhganj for Kathmandu. Note the railway tracks of the Nepal Government Railway. Photo: RON ELLIOTT</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026041610044_d02013692e84d6add7a6e0ce66c2b552cd53bb084db2aa8df0593bbcf84c2c04.jpg" data-media-id="editor_8" data-image-id="2026041610044_d02013692e84d6add7a6e0ce66c2b552cd53bb084db2aa8df0593bbcf84c2c04" data-rendition-name="original" width="2048" height="1352" loading="lazy" alt="Highways NT"> <figcaption>Vehicles found it difficult to pass on many parts of the Rajpath in 1963. Photo: RON ELLIOTT</figcaption> </figure>  1965: Tribhuvan Highway was considered a useful addition to Nepal’s economic infrastructure, but it could not act as a prime mover in the nation’s economic development. It did play a major role in the 1960s in transporting material and equipment needed to implement development projects in the Kathmandu Valley. September 1966: Nepal took over maintenance of the Tribhuvan Rajpath from the Indian Aid Mission.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026041610044_5488ba1e92f6395ff882392ccbaef2270622632682eccb412d8de7b128f6f397.jpg" data-media-id="editor_9" data-image-id="2026041610044_5488ba1e92f6395ff882392ccbaef2270622632682eccb412d8de7b128f6f397" data-rendition-name="original" width="1764" height="1184" loading="lazy" alt="Highways NT"> <figcaption>Trees still lined the Rajpath near Thankot in 1967. Photo: DAN EDWARDS</figcaption> </figure>  1971: A UN-Nepal study said the best alignment for an alternative road was from Kathmandu, Pharping, Kulekhani, Bhimphedi to Bhainse. 1975: Nepal's Department of Roads’ engineer concluded: ‘The Tribhuvan Rajpath has been built without design speed consideration… The pavement was not constructed to any designed standard… irrespective of quality of material, and later the road was black topped without consideration of traffic intensity and load-bearing capacity of sub-base… utilisation of low-quality material in the Bhainse-Thankot section… Quality control was neither maintained in Bhainse-Thankot nor the Bhainse-Raxaul section. Local materials were used irrespective of their quality to complete the work in the earliest possible time and in the cheapest possible manner. Brick work was done in negligible quantity. Cement used was ordinary portland cement…’ &nbsp;&nbsp;&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026041610044_26c74f45991efb3dc29d616e8acafb3163661ae6573c5314538e59c54d5ca0a5.jpg" data-media-id="editor_10" data-image-id="2026041610044_26c74f45991efb3dc29d616e8acafb3163661ae6573c5314538e59c54d5ca0a5" data-rendition-name="original" width="2368" height="1365" loading="lazy" alt="Highways NT"> <figcaption>Bhainse in 2017. The road divided here, one going to Bhimphedi on the right, the main road proceeding to Kathmandu on the left. Photo: DAN EDWARDS</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260416100416_4d9321abf4d912796842fe963a493501e1aceff462300ecdd9bd5e0b8ba7f294.jpg" data-media-id="editor_11" data-image-id="20260416100416_4d9321abf4d912796842fe963a493501e1aceff462300ecdd9bd5e0b8ba7f294" data-rendition-name="original" width="649" height="1667" loading="lazy" alt="Highway info NT"> </figure>  Even 70 years after it was built, there is still speculation about India's security concerns vis-a-vis China, and how Indian Army engineers purposely made the road longer than it needed to be over the 2,500 Sim Bhanjyang pass instead of following the river route.&nbsp; There is also some evidence that although the Rana regime had first requested the US for help with the highway, Nehru did not want the Americans involved in Nepal. Which is why the Tribhuvan Highway became an Indian military project.&nbsp; There was similar concern from India about the Kodari Highway linking Kathmandu to China, and King Mahednra is famously supposed to have said: "Communism will not come here in a taxi."&nbsp; Geopolitics still affects Nepal's strategic highways. After decades, links to China are still rough and often blocked. Kathmandu-Tarai Fast Track is delayed by years, and not expected to be completed during this decade. Trucks and buses still bypass the Tribuvan Highway with a 200km detour via Mugling because the other alternative routes like the Tika Bhairav or Chhaimale routes are not suitable for heavy vehicles.&nbsp; The shortcut through Chitlang that the Swiss proposed in the 1950s is still too difficult. And a 25km section of the Japanese-built BP Highway to the eastern Tarai has been knocked out by the 202 flood. Dan Edwards was a Peace Corps volunteer in 1966 and is the author of several books on Nepal. This is the fourth instalment in a new limited series in Nepali Times on the historic transportation infrastructures of Nepal.

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