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

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Doctor who does not just treat symptoms

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

Sonia Awale

Protecting those who protect us from Covid

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

This week at the National Population Policy launch Prime Minister K P Oli exhorted Nepalis to get married by age 20 and have three babies by the time they are 30. This was the first indication that the highest office in the land has understood the need to address Nepal’s dramatically <a href="https://nepalitimes.com/news/nepals-demographic-window-is-closing">falling birth rate</a>, but Oli’s statement was greeted with ridicule on<a href="https://nepalitimes.com/banner/avoiding-the-quicksand-of-social-media"> social media</a> — especially by women. Most urban young are already grappling with economic pressures and shifting life priorities. Even with a university degree,<a href="https://nepalitimes.com/here-now/workers-return-to-jobless-nepal?%2F"> many cannot find jobs</a>, and are taking the first flight out for overseas employment. Having a child is now a fraught decision shaped by income, individual autonomy, and family pressure. The <a href="https://www.unfpa.org/swp2025">UNFPA’s State of the World Population report </a>released last month, highlighted a significant <a href="https://nepalitimes.com/here-now/migrating-males-and-population-decline">decline in fertility rates </a>around the world. The global average fertility rate is 2.25 children per woman, and 18% of the reproductive adults said they will not be able to have the number of children they desire. The total fertility rate in Nepal has plummeted to 2.1 births per woman — down from 5 just 30 years ago. This is considered replacement level, meaning the newborns will replace their parents.&nbsp; However, birth rates are not declining as rapidly everywhere. The Tarai in has a total fertility rate of 2.20, and northwestern mountains is still 2.24.&nbsp; There are multiple factors in play, and the report broadly divides them into four categories: health issues, economic concerns, fears about the future, and lack of a supportive partner or their absence. More than half of the respondents said finance, which includes unemployment and increased cost of housing, as well as parenthood, was a barrier to having children. “More and more people prefer one or two children at maximum. Many women also decide to have children at a much later age,” says Kamala Devi Lamichhane of Tribhuvan University. “The opportunity cost is far higher for women.” But there is also a cost for the country, as the National Population Policy notes. At the rate the total fertility rate is falling it will soon be below replacement level — meaning that in the next three decades Nepal will be confronted with an <a href="https://nepalitimes.com/opinion/the-future-is-older">ageing population</a>.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250714140740_bac3e5a284b69a77d97b3b99daf2e7fd3019bc48f1a399fb2771381c751d8291.png" data-media-id="editor_6" data-image-id="20250714140740_bac3e5a284b69a77d97b3b99daf2e7fd3019bc48f1a399fb2771381c751d8291" data-rendition-name="original" width="1302" height="501" loading="lazy" alt="Nepalis having fewer babies. Why?"> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250714140740_251115b0a88d4e82be70245c43cb74477f3be18042ef1aa3b904c597d815f13b.png" data-media-id="editor_7" data-image-id="20250714140740_251115b0a88d4e82be70245c43cb74477f3be18042ef1aa3b904c597d815f13b" data-rendition-name="original" width="1125" height="500" loading="lazy" alt="Nepalis having fewer babies. Why?"> </figure>  Besides income, there are also cultural factors at play in women having fewer babies — they are expected to do all the childcare duties, even putting their careers on hold. In general, there is little help from spouses, and with more nuclear families there is less support from relatives. “Women today are well educated, career-oriented, and economically independent, allowing them to delay marriage as well as being conscious about their body and <a href="https://nepalitimes.com/multimedia/nepal-far-from-hitting-contraceptive-target?%2F">reproductive rights</a>,” says Laxmi Tamang of the International Confederation of Midwives (ICM). Also present at the policy launch was demographer Yagya Bahadur Karki, who said that women are more educated and hence, empowered to take their own informed decisions regarding having children.&nbsp; He adds, “But the fertility rates have reached replacement rate, and that stands as a warning for the future.”&nbsp; Fertility rates have fallen in inverse proportion to the rise in female literacy. The regions of Nepal where couples have more babies is where women are less educated. Couples in Madhes and Sudur Paschim provinces, where child marriage, gender-based discrimination, menstrual huts and dowry are still widespread are where the fertility rate is still high.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250717120740_ababfd31ed5ff79ded427e1f1adfff02e6af2384bd541e51dfe05e52fbbccb39.jpg" data-media-id="editor_9" data-image-id="20250717120740_ababfd31ed5ff79ded427e1f1adfff02e6af2384bd541e51dfe05e52fbbccb39" data-rendition-name="original" width="994" height="682" loading="lazy" alt="TFR Map"> </figure>  And because female literacy also has a direct correlation with <a href="https://nepalitimes.com/news/fatal-discrimination">infant and child mortality</a>, couples in those regions tend to have more babies so some of them survive.&nbsp; But it is Nepal’s urban centres among the educated where the increased choices in reproductive health, including alternative methods of conception like IVF and treatment for infertility, as well as <a href="https://nepalitimes.com/banner/implant-service-providers-take-contraception-to-nepals-poor">contraceptives</a> offer more options for family planning. “There are more choices regarding reproductive health, and there is more awareness as well, which is why people decide carefully on whether or not to bear a child,” says population expert Yogendra Gurung. <a href="https://nepalitimes.com/here-now/migrants-returning-from-the-gulf-with-infertility">Migration is another factor</a> adding to the decline in fertility rates. Many young Nepalis of reproductive age leave every day in pursuit of better jobs overseas. Spousal separation means fewer children.&nbsp; “Once away, even if not educated, they realise that child-rearing costs are high, and try to have fewer and even no children in some cases,” Gurung adds. Recent studies have also shown that men returning after their stint in the Gulf and Malaysia, where they are <a href="https://nepalitimes.com/news/gulf-workers-need-protection-from-heat">exposed to extreme heat </a>for extended periods as well as various chemicals and toxins in their work environment &nbsp;have a range of health problems, including infertility. To increase the birth rate, Nepal will have to reverse its family planning strategy of the past 40 years. Complicating this is that some regions of Nepal will need measures to control the birth rate, while urban areas will need a strategy to help parents have more babies. One way to help families have more children is to develop more <a href="https://nepalitimes.com/here-now/future-proofing-nepal-s-population-strategy?s=04&amp;fbclid=IwY2xjawFQf-NleHRuA2FlbQIxMQABHRxSwwGPfm7_2cBhDVAowPxEmFXP0Os-KRs1DXqIW_84wDhciExtZuNi1g_aem_jzRqN2cEVAppfwr5qedxRg">family-friendly policies</a> that favour women and youth as the Nordic countries, which also have falling birth rates, have done. They have introduced flexible parental leaves for both parents, including financial and health incentives. China, also concerned about its declining birth rate and an ageing population, now has a three-child policy as well as tax deductions, expanded childcare services, and leave policies to encourage couples to have more children. “We must work towards childbirth and childcare policies and plans that are suitable for Nepal, so that couples planning for children do not have to think twice about it because of finances or other reasons,” adds Gurung. Tamang of the International Confederation of Midwives says a gender transformative approach is needed to address the issues of the gender gap which is adding to the decline in childbirth. Husbands need to play a more important role in child-rearing. Instead of increasing fertility for the sake of it, the objective should be to assist young people to start the families they desire, at a point and time of their choice. Respect for everyone’s rights and dignity lays a foundation for a more balanced demographic trend. Lamichhane sums it up: “If fertility rates are to be sustained, it requires changes in the gender roles and behaviour, keeping the youth’s aspirations in mind.”

Nepalis are having fewer babies. Why?

Does anyone know that 2023-33 was declared the <a href="https://nepalitimes.com/banner/visit-nepal-again">Visit Nepal</a> Decade? Or that Pokhara announced that 2025 is a Special Tourism Year? The fuselage of Nepal Airlines jets still carry the Visit Nepal Year 2020 logos. Such ad hoc and unnoticed promotion is emblematic of the way Nepal has tried to increase visitor arrivals <a href="https://nepalitimes.com/news/nepal-hopes-for-tourism-rebound-in-2021-rk4dlo9t">post-Covid</a> — and of the country’s wider political disarray. Deepak Raj Joshi of the Nepal Tourism Board (NTB) has his work cut out to coordinate various agencies of the government to boost arrivals.&nbsp; He says, “We have been working on marketing strategies to revive the tourism sector, and are hopeful that this year will mark a 8-10% increase in arrivals compared to the pre-pandemic times.” On paper, tourist numbers have rebounded to pre-Covid numbers with over 1 million last year, but official figures do not give a true picture of duration of stay, average spending, and the fact every visitor is counted as a ‘tourist’, even repeat visitors who come on business. The few bright spots are largely a result of private sector promotion of niche tourism products, individual social media posts of <a href="https://archive.nepalitimes.com/page/top-10-treks">adventurous treks in Nepal</a>, or the fact that Indians are allowed to enter China again to visit Lake Mansarovar and Mt Kailash via Nepal. Indeed, Simkot airport has up to 15 flights a day from Nepalganj bringing in <a href="https://nepalitimes.com/opinion/borderlines/nepal-india-trans-boundary-bonds">Indian pilgrims</a> who are then ferried by helicopter to the border in Hilsa, or Lapcha Pass from where the holy sites in Tibet are visible. The rudimentary hotels and rest houses along the route in Humla have been bursting at the seams for the past month, to the point that some establishments are no longer able to provide patrons basic amenities.&nbsp; Last year, 1.14 million tourists visited Nepal, and the government has projected up to 10% increase in tourist arrivals this year. International tourist arrivals to Nepal have been steadily increasing, especially from the US, Europe, and India. Domestic and regional travel has also increased after the <a href="https://nepalitimes.com/news/lockdown-5-utlzqtvs">Covid lockdowns</a>.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250717120756_e1c8f08e7e26496d2b2394e0be776e147fb46c415347b781ed9e5c64d9c9e505.jpg" data-media-id="editor_5" data-image-id="20250717120756_e1c8f08e7e26496d2b2394e0be776e147fb46c415347b781ed9e5c64d9c9e505" data-rendition-name="original" width="1145" height="668" loading="lazy" alt="Tourist numbers"> </figure>  The tourism industry employs at least 1 million people, trekking injects money directly into the <a href="https://nepalitimes.com/editorial/not-rising-nepal">rural economy </a>and sustains ancillary sectors like handicrafts and domestic aviation. In the last fiscal year, tourism brought in Rs82.33 billion, according to Nepal Rastra Bank. But the industry has been affected by negative publicity about poor infrastructure, air pollution in Kathmandu, travel safety and news of disasters like the <a href="https://nepalitimes.com/news/rasuwa-flood-likely-a-glof">China-Nepal flood last week</a> that made international headlines. Growing worries about the climate crisis is also affecting youth travel, especially from Europe. Read also: <a href="https://nepalitimes.com/news/missing-out-on-nepal-s-tourism-potential">Missing out on Nepal’s tourism potential</a> “The limitations of airport and road infrastructure has hindered the development of the tourism sector,” admits Joshi. “And many are put off by the appalling state of our road network, especially during <a href="https://nepalitimes.com/opinion/managing-the-monsoon">the monsoon season</a>.” Nepal is home to 20 protected areas, 10 heritage sites, and eight out of the world’s 10 highest mountains, and despite all the obstacles it is still the perfect destination for the modern social media savvy traveller, who are experience-driven and inclined to look for itineraries that emphasise wellness and cultural immersion.&nbsp; Some hotels around Kathmandu, Pokhara, Jomsom and the Khumbu have strived to adapt to this new tourism landscape, expanding facilities with significant international investment. <a href="https://nepalitimes.com/business/a-thamel-within-thamel">Luxury hotels like Aloft Kathmandu</a> in Thamel were inaugurated just before the pandemic lockdowns, survived the crisis and thrived as it. Says General Manager Vikram Singh (pictured, below): “Our prime location in Thamel enhances the guest experience, especially for those seeking convenience and immersion in the local scene and travellers who want to be in the centre of it all.”  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025071805070_8d29803e8b52bcd4439422e7b7a0bc25aa68ef3d227b9130bd0e079af626677d.jpg" data-media-id="editor_11" data-image-id="2025071805070_8d29803e8b52bcd4439422e7b7a0bc25aa68ef3d227b9130bd0e079af626677d" data-rendition-name="original" width="1066" height="1600" loading="lazy" alt="Aloft GM"> </figure>  <a href="https://nepalitimes.com/here-now/what-sustainable-tourism-means-in-practice">Sustainability </a>and environmental consciousness has also become an integral part of the hospitality industry. ISO certifications as well as sustainability initiatives like the Travelife sustainability certification for eco-friendly resorts validate credibility of hotels. Aloft is the first five-star hotel in Nepal to have earned the Waste Smart Certificate, and it has also been awarded the ISO 14001:2015 certification, which is the internationally recognised standard for environmental management systems (EMS). But such investments will not amount to much unless Nepal makes serious efforts to promote itself as a<a href="https://nepalitimes.com/here-now/peak-tourism-in-2023-9ukoi8iz?utm="> tourism destination</a>, especially to its two giant neighbours. More importantly, the country needs to increase activities in which tourists can spend the money they want to. “While <a href="https://nepalitimes.com/here-now/nepal-pushes-mountain-bike-tourism?fbclid=IwAR1MNH0iFGv1vRz5G9uZ4AzUlKxB6nY7JKq0qT6je_FV4_SuxPZqviwKGn0">mountaineering and adventure tourism</a> are extensively promoted, we have fallen short of marketing other elements such as wildlife, pilgrimage and cultural heritage,” says Joshi. “There is a need to diversify promotion to increase income from the tourism sector.” Meanwhile, making Nepal more accessible to international and domestic visitors, must also be a priority. Kathmandu remains the sole aerial gateway despite new airports in Pokhara and Bhairawa. “International airlines have shown interest, and if access and flights are increased these airports can be fully functional,” says Joshi. But Sichuan Airlines has stopped flying to Pokhara, and there does not seem to be much interest from Thai, Vietnamese and Cambodian carriers to fly directly to Lumbini. Says Singh: “There’s tremendous opportunity to strengthen Nepal’s destination marketing by telling richer, more compelling stories that <a href="https://nepalitimes.com/opinion/comment/culture-cannot-be-an-afterthought">connect travellers with our culture</a>, nature, and people.”

Tourism needs a new push

Local residents of Mustang, including a sitting MP and several politicians, submitted a petition to Prime Minister KP Oli in Kathmandu this week urging the government to lift the region’s ‘restricted’ status. This is not the first time such a demand has been raised, and as infrastructure the region’s accessibility improved over the years, calls to remove the long-standing restriction have grown louder.&nbsp; Upper Mustang is no longer weeks away <a href="https://nepalitimes.com/here-now/postcards-from-kathmandu">from Kathmandu.</a> Nearly 85% of the road from Beni to Kagbeni has been blacktopped, and one can drive from Kathmandu to Lo Manthang with an overnight stop in Pokhara. Between April 2024 and April 2025, Lower Mustang received 144,745 international tourists, a near 50% increase compared to the previous year. Most of these were <a href="https://nepalitimes.com/opinion/borderlines/nepal-india-trans-boundary-bonds">Indian pilgrims </a>travelling to Muktinath. <a href="https://nepalitimes.com/here-now/comings-and-goings-in-mustang">Mustang</a> is also gaining popularity among Nepali visitors, with 700,000 visiting the region in 2024. A hotel operator in Kagbeni estimated that about 20% of Nepali visitors to Muktinath also travel to Korala, the trade and transit checkpoint on the <a href="https://nepalitimes.com/latest/north-of-the-border">China border</a>. That would mean that nearly 100,000 domestic tourists visit Upper Mustang annually. In stark contrast, international tourist numbers to Upper Mustang (north of Kagbeni) have remained stagnant, hovering around 4,000 visitors per year. The primary reason is the continued enforcement of the region’s restricted status. Foreign visitors must pay a steep permit fee: a minimum of $500 for 10 days, with an additional $50 per day thereafter. Tourism some entrepreneurs, politicians, and residents want these fees to be abolished so Upper Mustang can attract a broader range of international travellers. The success of Lower Mustang, where relaxed restrictions have led to a<a href="https://nepalitimes.com/here-now/boom-time-in-central-tarai"> tourism boom</a>, is often cited as proof of what lifting restrictions could achieve. Upper Mustang is not the only region in Nepal with a restricted status. Several northern areas prefixed with ‘Upper’ (Upper Manaslu, Upper Dolpo, Upper Kanchenjunga, and Upper Arun) also need similar permits and fees. Although no clear official explanation exists, these areas were primarily restricted due to historical inaccessibility, ecological and cultural fragility and security concerns. Read also: <a href="https://nepalitimes.com/news/upper-mustang-opposes-prohibited-areas">Call to scrap Upper Mustang tourist fee</a> In the 1960s and 1970s, these remote regions served as shelters for Khampa guerrilla fighters who launched cross border ambushes on the <a href="https://nepalitimes.com/here-now/the-last-days-of-the-khampa">Chinese military </a>across the border.&nbsp; Though the Khampa have long gone, security concerns rooted in that era seem to persist. The government in Kathmandu is seemingly unaware of the changed political and security landscape. If concerns do remain, they are not made public. One of the main reasons for maintaining the restricted designation is to limit visitor numbers. But with <a href="https://nepalitimes.com/opinion/the-road-out-of-nepal">improved road access and services</a>, as Upper Mustang has seen, this justification no longer holds. When Upper Mustang first opened to international tourists in 1992, it had no formal lodges or hotels, and it took four to five days of trekking from Jomsom to Lo Manthang.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250716120744_4e4405cf10e6f127f90a1cd40feda0b9d8d69efd13093a2563530ca31489ba9f.jpg" data-media-id="editor_8" data-image-id="20250716120744_4e4405cf10e6f127f90a1cd40feda0b9d8d69efd13093a2563530ca31489ba9f" data-rendition-name="original" width="2000" height="509" loading="lazy" alt="Lift restrictions on Upper Mustang"> <figcaption>Photo: SHRIJAN PANDEY / NT ARCHIVE</figcaption> </figure>  Without a nechyang (a household with traditional friendship), it was difficult to find a place to stay or get a proper meal. Only a few elite households offered accommodation. Today, there are now more than 80 lodges and hotels above Kagbeni, spread across nearly every village. Several upmarket hotels now struggle to stay afloat during the off-season, relying on low-spending domestic visitors to survive. Lo Manthang, once a remote destination, is now just a few hours’ drive from Jomsom, easily reachable by lunchtime for early starters. Once the remaining road sections are blacktopped, travel time will be further reduced. Yet, the government still charges a flat $500 fee for a 10-day permit based on outdated &nbsp;assumptions from a bygone era. There has been no serious review of the permit structure to align with current realities, nor any response to local aspirations to attract more international tourists and <a href="https://nepalitimes.com/here-now/peak-tourism-in-2023-9ukoi8iz">harness tourism for economic development</a>. Concerns about over tourism are valid. There is a risk that increasing visitor numbers could erode Upper Mustang’s <a href="https://nepalitimes.com/here-now/a-million-mantras-in-mustang">cultural heritage</a>, social fabric, and fragile natural environment, precisely the features that make it special. However, the region’s 33 years of tourism experience have been largely positive.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250716120744_5c7e5e05097cd0e5a1027b51c7e3db3be0bd67e0f7cbaea6d2c447b1dacafc8a.jpg" data-media-id="editor_11" data-image-id="20250716120744_5c7e5e05097cd0e5a1027b51c7e3db3be0bd67e0f7cbaea6d2c447b1dacafc8a" data-rendition-name="original" width="1400" height="1050" loading="lazy" alt="Lift restrictions on Upper Mustang"> <figcaption>Photo: MUKESH POKHREL / NT ARCHIVE</figcaption> </figure>  Tourism has contributed significantly to the restoration and <a href="https://nepalitimes.com/here-now/the-history-of-heritage?%2F">preservation of religious and historical sites</a> like the Thubchen and Jampa monasteries in Lo Manthang, the ongoing conversion of the old palace in Ghami into a premium hotel, and the rehabilitation of many monasteries and chortens.&nbsp; These efforts, supported by international donors and heritage experts, demonstrate that tourism—when well managed—can be a powerful driver of <a href="https://nepalitimes.com/here-now/shrinking-tourism-s-ecological-footprint">conservation</a>. The high permit fees have been somewhat effective in limiting international visitors, but they have no influence on the growing number of domestic tourists, particularly during the Dasain and Tihar holidays. The most pressing need now is for all levels of government—federal, provincial, and local—to<a href="https://nepalitimes.com/news/why-invest-in-nepal"> invest in </a>managing tourist flows and maintaining tourist sites. These efforts are essential not only to enhance visitor experience but also to build long-term resilience and sustainability for the destination. Read also: <a href="https://nepalitimes.com/news/greening-nepal-s-tourism">Greening Nepal’s tourism</a>, Hanna Wells Visitor numbers are central to any tourism development strategy that aims to balance economic, social, and environmental goals. Clinging to obsolete policies and concerns to justify Upper Mustang’s restricted status is not only unfair, it also suggests an undemocratic and discriminatory attitude toward a remote district.&nbsp; Shailendra Thakali, PhD, is from Jomsom and is a freelance consultant on protected areas, tourism, conservation, and sustainable livelihoods.

Lift restrictions on Upper Mustang

Many of us former Nepal Peace Corps volunteers (PCVs) would agree that our time in Nepal changed in significant but very different ways our perspectives on life if not the future paths we chose to follow. Of no one was this truer than Dorothy Mierow. Dorothy was born in 1920, in Colorado Springs. Her father Charles C Mierow was a classics scholar and Latin professor, who served for ten years as president of Colorado College.&nbsp; Dorothy developed an interest in animals as a child, graduated with a BA degree in natural history from Carlton College in 1942, a Master’s in biology from the University of Pittsburgh, and another Master’s in geography from the University of Minnesota.&nbsp; As a young woman, Dorothy traveled with her father throughout Europe, including a visit to ancient Greek ruins, and took a Magellan Tour by cruise ship around the world in 1958.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025071901074_0bad133ab22aada319e74bbad95d563e191371db291c08f373839fbd15440262.jpg" data-media-id="editor_0" data-image-id="2025071901074_0bad133ab22aada319e74bbad95d563e191371db291c08f373839fbd15440262" data-rendition-name="original" width="903" height="1178" loading="lazy" alt="How the Peace Corps changed a volunteer's life"> <figcaption>HOME AWAY FROM HOME: Dorothy Mierow as a college student in her native Colorado.</figcaption> </figure>  She was a college teacher during much of the 1940s, also teaching at a girls’ school in Hawaii. Then back to her native Colorado in 1953, where she became a curator and later director of the Colorado College Natural History Museum. She taught geography classes, and in her free time, Dorothy climbed 22 of Colorado’s 14,000-foot peaks. Traveling in India in 1960, Dorothy decided to spend two weeks in Nepal. In late 1961, she filled out an application to join the Peace Corps and specified that she wanted to go to Nepal, ‘because I admired the people so much when my father and I were there on our trip’.&nbsp; Dorothy reached Kathmandu in September 1962 as the first group of American Peace Corps volunteers in Nepal. She stood out from the others: one of the few women in that group, surely the oldest at age 41, a world traveler, and a woman who already had established a professional career.&nbsp; One doubts if Dorothy had had a husband and children whether she would ever have gone to work and spend much of the rest of her life in Nepal.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025071901078_68e84ade1ffb0f6c83c7f8fa5c1e7315b5f6c543217f96cde012e4d86f171515.jpg" data-media-id="editor_1" data-image-id="2025071901078_68e84ade1ffb0f6c83c7f8fa5c1e7315b5f6c543217f96cde012e4d86f171515" data-rendition-name="original" width="1259" height="910" loading="lazy" alt="How th Peace Corps changed a volunteer's life NT"> <figcaption>Pokhara Bazar in 1962.</figcaption> </figure>  The Peace Corps assigned Dorothy to teach geography at Tri-Chandra College. After the school closed in the winter due to lack of heating, USAID and the College of Education asked Dorothy to help train general science teachers.&nbsp; She taught for two months and became involved in a textbook-writing project, commenting: ‘I would like the children to know something about public health, conservation (the trees are going fast and so is the soil), and learn the names of some of their common birds, trees, and flowers. They are more impressed with electricity, airplanes, and cell structure.’ When a new college opened in Pokhara in 1963, Dorothy was transferred there and lived with a Nepali family. The college boasted 30 students and no permanent buildings.&nbsp; In October 1963, Dorothy wrote: ‘Pokhara is a town of almost 5,000 people … We are in a fertile valley surrounded by foothills … There is a small Mission Hospital … a Leper Hospital and Tibetan Refugee Camp started by the Red Cross and now run by the Swiss. With winter approaching, more Tibetans are appearing in town, often with pack horses or donkeys. Some have been carrying large boxes of powdered milk,donated (by USAID) to the camp from the airport … There is no electricity, and the transportation problems make many items scarce and expensive. I am really a sort of a museum. The landlord brings all kinds of people in to see how I live and count my shoes and dresses. They express amazement at my books, pictures, tin oven, Nepali dolls from Kathmandu, screened food shelves and curtained closet.’ The standard term for Peace Corps volunteers was two years, but Dorothy extended her term and was still at Prithvi Narayan College at the end of 1965, when she wrote that she had 20 Geography students in the first-year class and 6 in the second year preparing for the IA Examination. The college enrollment was 125 students, and the foundation for a new science building was being excavated.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025071901074_c6a80e5e0db0c705b2f8733c6d30dc0386fe3abbd2238ea9d947b7d746f94a29.jpg" data-media-id="editor_2" data-image-id="2025071901074_c6a80e5e0db0c705b2f8733c6d30dc0386fe3abbd2238ea9d947b7d746f94a29" data-rendition-name="original" width="902" height="605" loading="lazy" alt="How the Peace Corps changed a volunteer's life"> <figcaption>Mierow and friends at Phewa Lake.</figcaption> </figure>  Dorothy noted that she ate one meal a day at the (Shining Mission) Hospital but otherwise lived on dal-bhat, momo, and potato curry at local shops. However, she had developed a new passion: to build what she initially called the Pokhara Museum of the Himalaya. In commendable Peace Corps fashion, Dorothy always worked with Nepalis and respected the culture. ‘The greatest joy and satisfaction I have had has been from the building of a Museum-Library in memory of my parents … It has been possible to feel like a wealthy benefactor with the money saved by father for the family’s education and now available for the education of others… (Father) would have loved to be in on the founding of a new college and be able to plan a library. Several hundred of the books to be in the museum-library came from his collection and were carefully selected to be of use for students in Nepal…’&nbsp; ‘The museum part is to satisfy my own inclinations and was thought of when I found how little diversion there was for the people of Pokhara… It is part of the University requirements for the college that it should have a geography and biology museum. The museum building is small but adequate.&nbsp; I have tried to design it in harmony with Nepalese architecture and decorate it with some of the art of the best artists or woodcarvers… Posts holding up the porch roof are carved by Cottage Industries to represent different peoples of Nepal in typical costumes. The door was carved by a local wood carver and has typical birds of Nepal around it. Inside are 10 roof-support carvings designed by the retired Director of the National Museum in Kathmandu, Mr. C.M. Maskey.&nbsp; They were carved by the best wood carvers in Patan very skilfully. The building has three rooms: the library, the exhibition room, and a smaller workroom which can be used by our newly formed Woman’s Club as well as other groups or classes.’  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025071901074_03d3359c65389d30a0134e9a4862778994121e7e833b7d28b18e06e36fc76ff8.jpg" data-media-id="editor_3" data-image-id="2025071901074_03d3359c65389d30a0134e9a4862778994121e7e833b7d28b18e06e36fc76ff8" data-rendition-name="original" width="629" height="599" loading="lazy" alt="How the Peace Corps changed a volunteer's life"> <figcaption>Mierow with local women in Pokhara in 1969.</figcaption> </figure>  Dorothy promoted her project to influential Nepalis connected with organisations whose support she solicited: The Department of Archaeology, the Department of Agriculture, the Godavari Botanical Gardens; Tribhuvan University’s Science and Education Department, Nature Conservation Society.&nbsp; The museum was opened officially in early 1967. The Annapurna Natural History Museum, the building Dorothy designed and had constructed, is still open and features some exhibits which she created many years ago.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025071901074_54326a8a0685e980e782378076de2f5cd02d2426e9b0d94eed972d3dbe83af26.jpg" data-media-id="editor_4" data-image-id="2025071901074_54326a8a0685e980e782378076de2f5cd02d2426e9b0d94eed972d3dbe83af26" data-rendition-name="original" width="1333" height="1000" loading="lazy" alt="How the Peace Corps changed a volunteer's life"> <figcaption>The Annapurna Natural History Museum.</figcaption> </figure>  Dorothy returned to America in 1967, but she longed for Nepal. In the spring of 1969, she again tried to enroll as a Peace Corps volunteer but was told that as she had spent more than four years, she would not be eligible for another assignment. Undeterred, she persuaded the college in Pokhara to invite her to return as a teacher.&nbsp; UNICEF and the Forestry Department sponsored Dorothy to prepare charts on trees, birds, animals and flowers in colour for distribution to the schools of Nepal. Dorothy, back in the Peace Corps, returned to Pokhara and the Museum in 1972. She formed a friendship with her former geography student from Sikles, Chandra Prasad Gurung, and in 1974, she brought Chandra to America, where he enrolled in Colorado College and studied cultural anthropology.&nbsp; Chandra subsequently earned his PhD in geography from the University of Hawaii and returned to Pokhara to become director of the Annapurna Conservation Area Project. Gurung actively promoted ecotourism, landscape conservation, and biodiversity conservation in Nepal. His life was cut short along with those of 23 other Nepalis and foreigners who perished in a helicopter crash near Taplejung in September 2006.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025071901074_322d3c3ac6f1b08ffa07c44a19998b937a7db9eb43527f7539cf6481e1546314.jpg" data-media-id="editor_5" data-image-id="2025071901074_322d3c3ac6f1b08ffa07c44a19998b937a7db9eb43527f7539cf6481e1546314" data-rendition-name="original" width="2500" height="1000" loading="lazy" alt="How the Peace Corps changed a volunteer's life"> <figcaption>Mierow's four books on Nepal and its biodiversity. </figcaption> </figure>  Dorothy worked with several well-known Nepalis to publish her paintings and photos in beautifully illustrated books. She and Hemanta Mishra of the National Parks and Wildlife Service wrote Wild Animals of Nepal (Ratna Pustak Bhandar, 1976). More than 400 photos Dorothy took on treks to the Everest region, Gosaikunda, Muktinath, Jumla and Rara Lake, as well as travels in the Tarai, appeared in Himalayan Flowers and Trees (Sahayogi Prakashan, 1978).&nbsp; The botanist Tirtha Bahadur Shrestha identified the species. Dorothy and Kesar Lall published This Beautiful Nepal (Sahayogi Press, 1981). Birds of the Central Himalayas (1988) contained Dorothy’s paintings of 250 species of birds found along the areas of the Kali Gandaki River, Pokhara, Chitwan and the central Tarai. Dorothy summed up her life and work in Nepal in Thirty Years in Pokhara (Pilgrims Book House, 1997). Dorothy returned to Pokhara and her adopted Gurung family several times during the 1980s and 1990s to celebrate festivals and meet old friends. Her final years were spent at her mountain cottage in Green Mountain Falls north of Colorado Springs. She died at the age of 79 in August, 2000. Nepal gave new meaning and purpose to Dorothy Mierow’s life. Daniel W Edwards was a Peace Corps volunteer in 1966 and is the author of several books on Nepal. The author thanks Special Collections, Tutt Library, Colorado College.

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