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.

Imagine a high-end fair trade tea brand from Nepal that has done everything right, with ethical sourcing practices and international certifications. It has built a loyal base of socially conscious, premium customers in an export market and focuses on quality over quantity. Then one day, a government in the export market introduces a new ‘listing criteria’ that requires exporting a certain amount of tea to at least three countries in the past five years. But this was never a numbers game, it was about a niche market of socially responsible tea lovers. Suddenly, fair trade tea companies are restricted from exporting tea to that country. Pretty unfair for the company, for consumers, for the tea sector. More importantly, for tea farmers and families benefiting from fair standards. The overseas labour industry is facing a similar risk as recruiters, including those that have adopted ethical standards, may soon be barred from finding workers for Malaysia. On 27 October, the Malaysian Ministry of Foreign Affairs sent letters to five countries including Nepal, Bangladesh, Burma, Pakistan and India to ‘rationalise the number of licensed private recruitment agencies permitted to facilitate recruitment and placement of workers to Malaysia’.  <figure><img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251030141040_050274dddc6cf10224b0ad9283eec7b3bc3c0acd650543a808a8ea473ecf40db.jpg" data-media-id="editor_0" data-image-id="20251030141040_050274dddc6cf10224b0ad9283eec7b3bc3c0acd650543a808a8ea473ecf40db" data-rendition-name="original" width="961" height="1135" loading="lazy" alt="Malaysia recruitment"></figure>  The letter includes 10 criteria for private recruiting agencies including at least five years of operating experience, deployment of 3,000 workers in the past three years of operation, experience sending workers to at least three countries, a 10,000 sq m office maintained for three years, valid licenses and good conduct certificates, five employer testimonials, and operating their own training and accommodation centres. Two conditions stand out as potentially harmful to Nepal’s ethical recruitment movement. First, although the letter cites a minimum of 3,000 workers, it says three years in the heading and five in the body text. A big enough difference to affect a significant number of recruiters from making the cut, but problematic regardless. Second, the requirement to send workers to at least three countries disproportionately impacts responsible recruiters in Nepal and elsewhere. Turning the selection of workers into a numbers game is dehumanising. Responsible recruiters deprioritise volume, focus on quality of jobs even when business sustainability comes under threat as ethical opportunities that do not require workers to pay any feed and ensure greater transparency are difficult to come by. Sending workers is further impacted by a series of external shocks. For example, in the Malaysian context Nepal banned emigration to Malaysia for two years followed by the Covid pandemic, and then Malaysia’s decision to stop the intake of foreign workers for the last two years.  <figure><img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251030141040_b1b88b3ae2e94c6bc077529ac6f2a4e380a385ee9a22219edfed25067c9d25a1.jpg" data-media-id="editor_1" data-image-id="20251030141040_b1b88b3ae2e94c6bc077529ac6f2a4e380a385ee9a22219edfed25067c9d25a1" data-rendition-name="original" width="595" height="841" loading="lazy" alt="Malaysia recruitment"></figure>   <figure><img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251030141040_2cf252908d18aaf09c875002eef2d92ab45897a56b560addd2dc02311725c8a7.jpg" data-media-id="editor_2" data-image-id="20251030141040_2cf252908d18aaf09c875002eef2d92ab45897a56b560addd2dc02311725c8a7" data-rendition-name="original" width="590" height="238" loading="lazy" alt="Malaysia recruitment"></figure>  Many ethical recruiters have focused on Malaysia because it is a more common labour market for responsible recruitment than other destinations like the Gulf. There is no credible justification to why responsible recruiters well regarded by scores of Malaysia-based multinational companies and with decades of experience should be ‘disqualified’ for not diversifying. Finding jobs for Nepalis in new markets is difficult given fierce competition, challenges identifying companies which follow the employer-pays principle, lack of networks and shortcomings in marketing strategies. These factors hit responsible recruiters harder because profit-motivated employers are often unwilling to cover the costs and fees associated with workers’ recruitment. “The volume of deployment does not determine a recruiter’s capability or the quality of services provided,” says Sujit Shrestha of the Nepal Association of Foreign Employment Agencies (NAFEA). Nepal recently scrapped the licensing renewal requirement that mandated sending at least 100 workers a year as it was impractical. The new Malaysian criteria is similar in nature, he added. The ball is now in Nepal’s court at a time when the interim government does not even have designated heads in the Foreign Ministry and the Ministry of Labour, Employment Employment and Social Security. When rumours about the Malaysian action started circulating, NAFEA had raised the issue, but was assured that this was not an attempt to set up a syndicate.  <figure><img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251030141044_83c8a174ef116603f747d1cd254c4d353e8b855a41fb99feec54e701f5fc4c3f.jpg" data-media-id="editor_3" data-image-id="20251030141044_83c8a174ef116603f747d1cd254c4d353e8b855a41fb99feec54e701f5fc4c3f" data-rendition-name="original" width="3456" height="5184" loading="lazy" alt="Malaysia recruitment"></figure>  How will governments and recruiters in other origin countries now respond? There is precedence from Bangladesh. Dhaka-based journalist at the Daily Star, Porimol Palma who says, “Earlier, the Malaysian authorities had selected 101 Bangladeshi recruiters unilaterally, despite Bangladesh’s call for a syndicate-free recruitment mechanism.” Between 2022-2024, 450,000 Bangladeshis were recruited under this system with workers paying between $4,500 and $6,000, even though the legal limit was $750. Palma attributes part of the high fees workers had to pay were for commissions or bribes to recruitment syndicates. Adrian Pereira heads the North South Initiative in Malaysia says: “The criteria seems a bit fishy, as they do not appear to address the actual problems in the the recruitment of foreign workers. Some of the criteria seem to encourage a system of monopoly or syndicate rather than a rights-based approach. Every government has the right to set criteria for recruiters, but conventions and ILO (International Labour Organization) standards on recruitment exist. It looks like we’re back to square one.” Whether migrant origin countries including Bangladesh and Nepal accept the terms sent without reservations or push back in good faith remains to be seen. In an ideal world, a collective stance should put workers’ needs and welfare at the centre. How rational is the proposed ‘rationalising strategy’? What aspects of it are promising to curb recruitment abuse and what merits serious reconsideration? Even if the move from the Malaysian side is well-intentioned to address rampant malpractices migrant workers face, Nepal should deliberate on the conditions set, the collateral damage especially on the responsible actors and small but capable recruiters. Alternate options that might serve everyone better before rushing to respond with a chosen list by 15 November. If the proposal is accepted, how would it be done in a transparent and accountable way? It is noteworthy that Indonesia was not listed even though it has the most workers in Malaysia among the 16 countries that send migrants to Malaysia. The Responsible Business Alliance (RBA), the ILO, the International Organization for Migration (IOM), and certification programs like On the Level (OTL) also need to use their leverage to ensure that recruiters, including those they have trained or certified on ethical recruitment principles, are not penalised. This is more than just about protecting the ethical recruitment movement, but raising even more basic questions: Who can legally be a recruiter in Nepal? There are already obligations like hefty security deposit and minimum office requirements. But requirements to have building facilities with ‘accommodations’ or ‘testing centres’ are not among them. There are 1,150 plus players in Nepal’s recruitment sector, with a few hundred engaged in the Malaysian market. A unilateral selection criteria could risk foul play, or lead to unintended, unfavourable consequences. To be sure, overseas recruitment in Nepal is known for ‘settings’, corruption, dog-eat-dog competition, and collusion. The profiteering is out of control, often at the expense of workers. But the solution does not lie in stifling the industry with criteria like deployment volume, building worker accommodations or expanding office floors. The focus should instead be on enforcing rules and laws in both countries that govern the industry, and the Malaysian labour agreement that has not been renewed since October 2023. Meddling in the industry in ways that harms fair competition and ethical actors means workers suffer. The only issue that should be taking precedence is: how will Malaysia’s 10-point criteria and planned arrangement affect migrant workers? We have seen how for identical Malaysia-based jobs, one worker might pay zero while another pays up to Rs400,000, depending on the employer and recruiter. It is unclear if the 10-point selection criteria rewards the employer. As a longstanding host country for Nepali migrants, Malaysia deserves credit for nurturing the small but growing ethical recruitment industry here. Export-oriented companies in Malaysia need responsible recruitment partners and have mentored recruiters to strengthen their practices and move away from worker-paid models. The business case for ethical recruitment standards has led many recruiters in Nepal to pivot with many now in various stages of transition from traditional to hybrid or purely ethical practices. This progress needs to be acknowledged and built upon. Large, well-networked recruiters with large physical assets and high volume of workers seem to be the winners of Malaysia’s 10-point criteria after two years of waiting for the Malaysian market to reopen. Responsible recruiters endure long periods of minimal or no deployments that threatens their survival. The letter now sitting on the desk of the interim government in Nepal deepens the concern: rather than just failing to recognise or reward responsible recruiters, does the international recruitment market actually punish them? Upasana Khadka heads Migration Lab, a social enterprise aimed at making migration outcomes better for workers and their families. Labour Mobility is a regular column in Nepali Times.

Who gets to recruit for Malaysia?

Public anxiety about immigration has become a powerful political currency across many liberal democracies. In Australia, as elsewhere, legitimate concerns about housing and economic fairness can be, and increasingly are exploited by anti-democratic actors who frame migration not as a policy issue but as a cultural threat.&nbsp;
When these narratives move from online spaces to public rallies, they do more than divide opinion; they erode the social trust and pluralism on which democracy depends. Understanding how populist and far-right movements weaponise migration debates is crucial to recognising the early challenging signs of liberal democracy.
Immigration has become one of the most politically charged issues in Australia, not only because of the numbers but because of its entanglement with cost-of-living pressures, housing shortages, and rent spikes.&nbsp;
The latest Household, Income and Labour Dynamics in Australia (HILDA) <a href="https://www.unimelb.edu.au/newsroom/news/2025/september/how-we-live-latest-hilda-data-gives-insight-into-a-changing-australia">data</a> shows rising household financial stress as Australian households spending more on rent and income tax. These changes likely reflect a mix of economic and policy factors but create a lot of room for people to hold inaccurate and occasionally contradictory attitudes on these issues.&nbsp;
While net overseas migration has started to decline from its post-pandemic peak, public concern remains high, amplified by populist rhetoric. Some surveys have <a href="https://www.theguardian.com/australia-news/2025/feb/04/australians-want-less-migration-but-oppose-cutting-international-student-numbers-study-finds">revealed</a> a nuanced picture: most Australians want lower migration overall but oppose cutting international student numbers, and support targeted skilled migration to address workforce gaps.&nbsp;
As former Home Affairs Minister Clare O’Neil <a href="https://minister.homeaffairs.gov.au/ClareONeil/Pages/how-australia-broke-its-migration-system.aspx">argued</a> in 2023, Australia’s migration system is “broken and un-strategic”, not delivering for business, for migrants, or for the larger population. This is a situation that frustrates both sides of the debate and makes immigration an easy political flashpoint.
The recent <a href="https://marchforaustralia.org/">March for Australia</a> rallies turned these anxieties into street-level mobilisation. Tens of thousands <a href="https://www.bbc.com/news/articles/czjmre371l1o">protested</a> at what they called ‘mass immigration’, while far-right groups seized the opportunity to inject xenophobic slogans and calls for ‘remigration’ into the public space. These demonstrations were not only about visa caps or housing and jobs; they became performances of who is entitled to belong.&nbsp;
When immigration is framed not as a policy question but as a cultural test of Australianness, it risks shrinking the demos, the very community that democracy is meant to represent.
What made the March for Australia so striking was not only its size but its composition. Recent investigative reporting <a href="https://www.theage.com.au/politics/victoria/don-t-mention-hitler-and-you-re-sweet-the-great-march-for-australia-deception-20250909-p5mtlc.html">revealed</a> that neo-Nazi groups were not merely present at the March for Australia rallies but played a role in covertly organising them. They amplified messaging online, coordinated attendance, and sought to mask their involvement to broaden appeal.&nbsp;
This highlights that democratic erosion is rarely spontaneous; it requires actors who deliberately exploit social grievances, mistrust, and polarisation to mobilise anger for their anti-democratic ends. The banners reading ‘<a href="https://www.theguardian.com/commentisfree/2025/sep/01/how-do-i-feel-safe-after-march-for-australia-anti-immigration-protest-ntwnfb">Stop Immigration</a>’ revealed that public hostility towards migrants, <a href="https://www.afr.com/politics/federal/pressure-mounts-for-price-to-apologise-to-indian-australians-20250908-p5mt7x">particularly</a> from the Indo-Pacific, is growing.
For many migrants, these displays are more than conceptual debates about white national identity. They are experienced emotionally. Writing shortly after the rallies, Melbourne-based writer Jafrin Kabir <a href="https://www.theguardian.com/commentisfree/2025/sep/01/how-do-i-feel-safe-after-march-for-australia-anti-immigration-protest-ntwnfb">reflected</a> that she had never felt so foreign on Australian soil. She pays taxes and inflated rents, contributes skills in the national interest, cheers for the Tillies and calls Melbourne “home”, yet suddenly felt unsafe because of the origin and colour of her skin.&nbsp;
Similarly, Chinese national interviewed by media outlet <a href="https://www.scmp.com/news/china/diplomacy/article/3325127/i-feel-insecure-chinese-nationals-australia-blindsided-anti-immigration-marches">reported</a> cancelling weekend plans and feeling “blindsided” by the scale of the marches.
Scapegoating migrants especially in times of economic stress is an age-old phenomenon and is not just limited to Australia. Across the democratic world, from the United States to the UK and parts of Europe, hostility toward migrants and minorities has become a route for anti-democratic forces. Populist actors often <a href="https://www.theguardian.com/australia-news/2025/mar/27/peter-dutton-keeps-blaming-migration-for-the-housing-crisis-but-can-it-really-be-that-simple">use</a> cultural anxiety and demographic change to justify illiberal and undemocratic measures, claiming to restore order while actually dismantling checks and balances.
By analysing democratic decay, scholars like Lydia Khalil at the Lowy Institute, <a href="https://interactives.lowyinstitute.org/features/democratic-erosion/">argue</a> that democracies rarely break down at once. Instead, they incrementally weaken through vicious cycles: declining trust in institutions, entrenched division based on hate, the normalisation of political violence, and the bit by bit removal of norms and guardrails.&nbsp;
Though some of the conditions are present in Australia to be exploited by anti-democratic actors, for example, almost two-thirds of Australians believe their leaders intentionally mislead them, according to the <a href="https://www.edelman.com/au/trust/2025/trust-barometer">2025 Edelman Trust Barometer</a>, &nbsp;but their presence is not determinative.
Australia’s democratic guardrails remain strong: independent courts, transparent elections run by the AEC, and a free press continue to hold power to account. Federalism and active civil society further diffuse power and create space for contestation.&nbsp;
But if public trust continues to erode and social divisions deepen, these safeguards will come under strain. Early recognition and action are crucial to ensure that today’s street-level hostilities do not translate into institutional regression.
Preventing such outcome requires a socially embedded understanding of migration, an understanding that goes beyond simplistic optimistic and pessimistic views. Policy makers should go beyond Push-Pull models, functionalist and neoclassical and historical-structural theories.&nbsp;
Consulting the work done by <a href="https://www.guilford.com/books/The-Age-of-Migration/Haas-Castles-Miller/9781462542895#:~:text=International%20Population%20Movements%20in%20the%20Modern%20World,-Hein%20de%20Haas">Hein de Haas</a> et-el, migration should be conceptualised as an intrinsic part of broader processes of development, social transformation and globalisation rather than a 'problem to be solved'. We need more nuanced views that have an eye for the complexity of migration processes and the diversity of its causes and impacts.
Sohail Akhtar is a Melbourne- based researcher focusing on governance, public policy, and migration. He contributes to Lowy Institute Sydney.
This article was issued by the Toda Peace Institute and is being republished from <a href="https://toda.org/global-outlook/2025/is-street-level-hostility-a-challenge-to-liberal-democracy-reflections-from-australia.html">the original</a> with their permission.

Is street-level hostility a challenge to liberal democracy?

Intricately painted Buddha, Aryatara, Krishna, and Parvati gaze serenely at visitors at the Kathmandu Art Gallery under muted amber lights. Moving from one artful devotion to the next, a quiet, profound connection to the divine envelopes the visitor. This transcends art to the realm of the spiritual. &nbsp; The gallery’s latest exhibition, Masters of Devotion, features art by 22 artists all from Bhaktapur. They also include Ajay Karmacharya, Purna Prasad Hyoju, Nhuche Kaji Bajracharya, Rajani Sinkhwal, Shashi Dhar Sainju, Surya Bahadur Chitrakar and Sundar Sinkhwal from the Khowpa Paubha Chowmi Pucha. Paubha are religious and devotional art depicting deities and mandala that date back to the 7th century, when Newa artists began to paint images of the gods on cloth. For the artists who practice this craft, the art form is as meditative as it is meticulous.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251025041028_de34b51d48bcee50ae391301e2ff1890be7ecba3df7e563537c273818825aad5.jpg" data-media-id="editor_0" data-image-id="20251025041028_de34b51d48bcee50ae391301e2ff1890be7ecba3df7e563537c273818825aad5" data-rendition-name="original" width="1280" height="960" loading="lazy" alt="art review "> </figure>  The exhibition at the newly-opened space Kathmandu Art Gallery coincides with the festival season and is a collection of extravagant works done in mineral and stone colour, sakura and gouache. The vintage art space is located at Babar Mahal Revisited and is a fitting accompaniment to the paubha featured in the exhibit.&nbsp; Sundar Sinkhwal’s vividly painted Harihara is among the more eye-catching works. “Half of the painting is Shiva and half is Vishnu, hence the name Harihar,”explains Sinkhwal. “Together with their consorts Parvati and Laxmi, I have painted Uma-Maheswor and Laxmi-Narayan.” Nandi and Garuda, the vehicles of the two gods, complete the vibrant painting.&nbsp; In contrast, for his piece titled Lakshmi, Sinkhwal shrouds his canvas in dark colours to paint Kuber, the deity revered as the custodian to the wealth in the Hindu pantheon, accompanied by two khyak apparitions —one black, the other white— both mythical creatures in Newari folklore.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251025041032_1bde6de442b742c300bb8c9278ea8886445aa8df47076fd9aa362ce1f8bef903.jpg" data-media-id="editor_1" data-image-id="20251025041032_1bde6de442b742c300bb8c9278ea8886445aa8df47076fd9aa362ce1f8bef903" data-rendition-name="original" width="1280" height="960" loading="lazy" alt="art exhibition"> </figure>  “The black khyak is considered inauspicious, while white ones are a symbol of good luck,” explains Sinkhwal. Purna Prasad Hyoju has used mineral paint on canvas for a powerful depiction of Ardhanareswar, the composite form of Shiva and his consort Parvati.&nbsp; “I drew inspiration from the Newari Swasthani story about the separation of Shiva and Satidevi,” says Hyoju. Legend has it that Shiva, unwilling to part from his consort, reincarnated as a unified dual gender form of himself and Parvati. Hyoju has painted goddess Parvati in bright yellow, in homage to one of her other manifestations, Gauri, which means radiant.&nbsp; Meanwhile, Ratna Gopal Sinkhwal’s Kurkula Devi, done in stone pigment, is radiant on the cotton canvas. “Kurkula Devi is a tantric goddess whose traces are found in the Sadhana Mala,” says Sinkhwal. “The stone pigment is what makes the goddess look like she is gleaming.” One of Sinkhwal’s other works draws from stories in the Mahabharat to depict Bhimsen, Draupadi, Dushasan and Akash Bhairav in confrontation, expressions fierce.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251025041028_72eea52c8504eccb8b3be7cd4cef616dfb8efd821e8b1e1ae8f440f10782be11.jpg" data-media-id="editor_2" data-image-id="20251025041028_72eea52c8504eccb8b3be7cd4cef616dfb8efd821e8b1e1ae8f440f10782be11" data-rendition-name="original" width="1280" height="854" loading="lazy" alt="art exhibition"> </figure>  The opening of the exhibition last week also featured a music session, during which some of the artists sang traditional songs. Their voices joined the rhythm of the madal and melody of the harmonium, adding warmth to the crisp autumn evening.&nbsp; Each painstakingly detailed paubha reflects the artists’ devotion to divinity and mythology, as well as their heritage. Masters of Devotion showcases the work of veritable masters of their craft, and is a must-visit for art connoisseurs and devotees alike. Says the gallery’s Sangeeta Rana Thapa: “It is our honour to celebrate the artists’ work—to stand among pieces that embody both devotion and mastery, and to witness a tradition that continues to inspire us.” Masters of Devotion Kathmandu Art Gallery Baber Mahal Revisited Until 22 November

Artful devotion

<a href="https://myrepublica.nagariknetwork.com/news/dhm-forecasts-above-average-rainfall-and-temperatures-for-2025-monsoon-28-10.html">This year, </a>Madhes Province received less rainfall than was forecast by the &nbsp;Department of Hydrology and Meteorology (DHM), reducing groundwater recharge of shallow aquifers which are the lifeline for domestic use and irrigation.&nbsp; The crisis was serious enough for the government to officially declare a drought emergency during the monsoon, with the province declared a '<a href="https://kathmandupost.com/national/2025/07/23/cabinet-declares-madhesh-province-a-disaster-crisis-zone?">disaster-hit zone</a>' in July.&nbsp; The monsoon scarcity hit farmers hardest, a majority of whom depend on rainfall for agriculture. Data from Dhanusa’s <a href="https://add.madhesh.gov.np/noticefiles/%E0%A4%A7%E0%A4%BE%E0%A4%A8-%E0%A4%B0%E0%A5%8B%E0%A4%AA%E0%A4%BE%E0%A4%87%E0%A4%95%E0%A5%8B-%E0%A4%B5%E0%A4%BF%E0%A4%B5%E0%A4%B0%E0%A4%A3-%E0%A5%A4-1752227917.pdf">Agriculture Development Directorate</a> shows that only 33% paddy plantation was completed by mid July, in comparison to <a href="https://kathmandupost.com/money/2024/07/31/fastest-transplantation-rate-sows-hope-for-bumper-paddy-harvest?">92% planting the same time last year</a>. Only 49% of agricultural land in Nepal is irrigated — farmers in the rest of the arable land rely on rainfall, private wells and groundwater extraction. During the dry seasons and droughts, water insufficient groundwater recharge worsens the water crisis.&nbsp; Nearly 88% of households depend on groundwater in Madhes Province which has about 100,780 shallow tube wells and 60,660 deep tube wells. But in recent times, the tube wells and hand pumps have dried up every year.&nbsp; This shortage disproportionately impacts low income families and small-scale farmers, who have no other alternative to irrigate their land. And because paddy accounts for up to 7% of Nepal’s economy, Madhes’ water crisis is not confined to within the province, but has serious implications on the national economy.&nbsp; Underground water Groundwater extraction for irrigation began in the <a href="https://jvs-nwp.org.np/wp-content/uploads/2018/09/Water-Nepal-A-historical-Perspective.pdf">1970s, </a>shallow and deep tube wells for irrigation were introduced with support from development partners. By the 2021 agriculture census, <a href="https://agricensusnepal.gov.np/upload_file/files/post/1731650149_1221316497_Agriculture%20Census%202021_District%20Summary%20Report_by%20Province.pdf">groundwater irrigated land had increased </a>to 41.7%, up from &nbsp;<a href="https://agricensusnepal.gov.np/upload_file/files/post/1694250757_1312300734_National%20Sample%20Census%20of%20Agriculture%202021_22%20(National%20Report).indd.pdf">29.8% in 2011.</a>&nbsp; A lack of strong policies and regulation to monitor unchecked extraction has meant that with the exception of some parts of Kathmandu Valley, domestic users, subsistence and commercial farmers, restaurants, hotels and industries across Nepal can draw any quantity of groundwater from desired depths and location. While the dependence on drilling for water has risen due to limited expansion of surface water infrastructure, there has been little attention to groundwater recharge. This competing use of groundwater threatens the fundamental right to drinking water.&nbsp; The ecologically sensitive Chure and Bhawar watershed play a crucial role in groundwater recharge. However, deforestation and indiscriminate riverbed mining has severely reduced its recharge potential over the years. In addition, widespread monoculture plantation of fast-growing non-native eucalyptus trees, replacing native sissoo and sal trees has compounded the crisis. Eucalyptus, a water intensive species indigenous to Australia, was introduced in the Bhawar region in 1978 for supplying wood. The Tarai’s recurring water crisis is not only climatic. Years of fragmented planning, inadequate budget allocation for groundwater management, as well as limited intra- and inter-government policies and coordination have contributed to the disaster just as much as droughts and floods caused by changing weather patterns. The United Nations said decades ago disasters are not natural, and they occur when we fail to prepare.&nbsp; Groundwater management is <a href="https://www.opmcm.gov.np/download/%e0%a4%86%e0%a4%af%e0%a5%8b%e0%a4%9c%e0%a4%a8%e0%a4%be-%e0%a4%b5%e0%a4%b0%e0%a5%8d%e0%a4%97%e0%a5%80%e0%a4%95%e0%a4%b0%e0%a4%a3%e0%a4%95%e0%a5%8b-%e0%a4%86%e0%a4%a7%e0%a4%be%e0%a4%b0-%e0%a4%a4/?wpdmdl=8990&amp;refresh=683b8df54ffef1748733429">the shared responsibility of federal, provincial and local</a> governments, but there is a lack of <a href="https://www.iwmi.org/blogs/stakeholders-in-nepal-work-together-to-enhance-collective-action-for-municipal-groundwater-management/">integrated planning, &nbsp;budgeting, data sharing</a>, and collective action for groundwater extraction and recharge.&nbsp; Sustainable groundwater use in the plains requires inclusive and equitable practices that combine water science-informed interventions with a long-term cross-disciplinary approach.&nbsp; Groundwater is mainly available either in shallow unconfined aquifers that are close to the surface and directly linked to rainfall and rivers, and deep confined aquifers between semi permeable or impermeable ground layers. Locating and mapping such aquifers would help us find what depth they lie at, how much water they hold, what we can do to recharge them and how much time recharging would take—enabling sustainable use of groundwater. Construction of surface water projects such as the Sun Kosi Marine Diversion Multipurpose Project, which serves a dual purpose of expanding irrigation and recharging groundwater, must be expedited.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251027071020_a9442084bc412998d3e7417cf0d057cae8a2b98f5e47ac1a8cc0630612ff2a55.jpg" data-media-id="editor_9" data-image-id="20251027071020_a9442084bc412998d3e7417cf0d057cae8a2b98f5e47ac1a8cc0630612ff2a55" data-rendition-name="original" width="1778" height="1000" loading="lazy" alt="Mitigating the Madhes water crisis NT"> <figcaption>Photo: ONION FILMS / IWMI</figcaption> </figure>  Such infrastructure have a conjunctive use recognised by the National Irrigation Master Plan 2019 and the National Irrigation Policy 2023, wherein farmers can rely on canals for irrigation during monsoon and groundwater during dry seasons.&nbsp; Nature-based solutions such as rainwater harvesting, managed aquifer recharge techniques, restoration of wetlands and retention ponds, and floodwater reservoirs, particularly in ecologically sensitive regions like the Chure Bhaban, should be explored. &nbsp; The management of green water — the water stored in soil and vegetation — is equally as critical as that of blue water (rivers, canals, and groundwater). Green water is lost through evapotranspiration, which contributes to nearly half of the rainfall on land. Deforestation, soil degradation, poor land use practices, and loss of wetlands contribute to the disruption of the evapotranspiration cycle, affecting rainfall patterns and groundwater recharge. Solutions Rising temperatures compound this situation by increasing evapotranspiration. Soil water conservation, vegetation cover, wetland restoration, and nature friendly land use practices must therefore be prioritised. Water-efficient technologies and practices including drip irrigation use of sprinklers, mulching, and soil fertility improvement should be scaled up.&nbsp; At the same time, we must promote irrigation techniques and technologies along with crop choices and cropping patterns that give more yield per drop of water so that food production and water conservation go hand in hand. &nbsp; The government provides subsidised electricity for irrigation starting at Rs2.3/unit, some local governments are even supplying power for free. While such subsidies support farmers and increase productivity, &nbsp;it also poses serious risk of over extraction of groundwater.&nbsp; Flat subsidies in electricity or solar irrigation must be replaced by targeted subsidies in order to balance domestic and agricultural needs with ecological conservation. The 2015 <a href="https://kvwsmb.gov.np/public/uploads/board_act_&amp;_rules/rule-1.pdf">directive for groundwater licensing</a> developed per the Drinking Water Management Board Act 2006 for Kathmandu valley prohibits groundwater extraction from shallow aquifers for commercial and industrial uses. The directive also has provisions for licensing, and renewals, and mandates for license holders to contribute to groundwater recharge. The Madhes needs similar context-specific policies to address its groundwater crisis and safeguard water rights. Shallow aquifers in the region should be prioritised for domestic use while <a href="https://link.springer.com/chapter/10.1007/978-981-10-3889-1_11">deep aquifers, which are still underutilised, should be tapped</a> in a sustainable manner for commercial, industrial and large scale irrigation and drinking water projects.&nbsp; While <a href="https://www.frontiersin.org/journals/human-dynamics/articles/10.3389/fhumd.2023.1181734/full">technical solutions</a> are important, they are not enough to solve Madhes’ water crisis. Nepal’s Constitution and the Local Governance Operation Act 2017 empower local governments for water management in their constituencies. But beyond the letter of the law, local units require community tailored groundwater policies, regular groundwater monitoring and up-to-date data, and investment in local recharge initiatives such as retention ponds, restoration of wetlands, and rainwater harvesting. Coordination between all three tiers of government is crucial, particularly among agencies that pertain to drinking water, water resources, irrigation, agriculture, land use, environment, climate change, and urban development. &nbsp; Heeding indigenous knowledge will be crucial to understanding the water crisis in Madhes and initiating solutions that will fit the context and needs of the region. Local engagement in groundwater monitoring can help to create self -aware, accountable, cost effective and participatory groundwater management practices.&nbsp; To ensure water security in Madhes, we thus need inclusive governance, coherent policies, active engagement of citizens, integration of local and indigenous knowledge and a principle of equity that puts people at the centre. &nbsp; Sumitra KC, a policy and governance researcher in natural resources management, is the National Researcher at the International Water Management Institute (IWMI), Nepal. Manohara Khadka, PhD, an expert in natural resources management, gender equality, and social inclusion, is the Country Representative of IWMI, Nepal.

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Artful devotion

Mitigating the Madhes water crisis