<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221107171136/6369343e9c7e80680e03dfe5jpeg.jpg" alt="" width="2000" height="1373"/><figcaption>Photo: HRA</figcaption></figure>Kathmandu is hosting the XII World Congress on Mountain Medicine 21-24 November, and the location is indeed appropriate considering that it was in the Nepal Himalaya that modern mountain medicine made great advances in altitude illness.Acute altitude illness requires two things in order to happen: 1) a person not adjusted to high altitude, and 2) going high quickly, faster than the body has time to adjust. Before the advent of modern transportation, no one could travel high enough fast enough to get into much trouble. Altitude illness is therefore mainly a problem of modern times. The largest experience with altitude illness prior to the advent of trekking in Nepal was when the Indian Army, in the Sino-Indian war of 1962, was airlifted rapidly to over 5,000 m.Read also:<a href="https://www.nepalitimes.com/latest/high-alert/" target="_blank" rel="noopener">High alert</a><a href="https://www.nepalitimes.com/opinion/trekkers-with-the-trots/" target="_blank" rel="noopener">Trekkers with the trots</a>, David R ShlimAlthough foreigners started walking around Nepal in the early 1950’s, larger scale trekking only began in the late 1960’s. Trekkers, unaware of the risks of ascending rapidly, began to die on their treks. The number of evacuations and deaths became alarming to the fledgling trekking industry and the few agencies in operation at that time banded together to start the Himalayan Rescue Association (HRA) in 1973, organised by a former Peace Corps Volunteer named John Skow.John Dickinson, who began work at the old Shanta Bhawan Hospital in Patan in 1969, became the receiving physician for severe cases of altitude illness. He and Dr Bond, the pathologist, published the first series of autopsy findings in trekkers dying from altitude illness. This work brought the world’s attention to the problem of altitude illness in Nepal, a rather mysterious condition that stuck down perfectly healthy young people venturing into thin air. Dickinson became the first medical advisor to the HRA.Under the leadership of Tek Chandra Pokharel, Mike Cheney, Dawa Norbu Sherpa and Robert Reiffel in the early 1970’s, the HRA staffed an aid post in the village of Pheriche, at 4,300 m on the path to Everest. When I first passed through Pheriche in 1974, the post was staffed by an American nurse and a famous climbing Sherpa, Tashi. Wanting to stay in Nepal, I volunteered for the next season, and many seasons after that. I became the medical director of the HRA until 1983 when David Shlim (see his contribution alongside) became the medical director after he moved to Nepal to run the CIWEC Clinic.In Pheriche, I conducted the first studies of altitude illness in trekkers. We ended up suggesting a schedule that included rest days on the ascent to Kala Pattar. This new schedule cut the incidence of altitude illness in half but did not completely eliminate it. We demonstrated the value of Diamox (acetazolamide) in preventing altitude illness. A 1977 paper in the Lancet was the first large study of altitude illness in a civilian population, and put Pheriche on the world map as a center for altitude illness research.The HRA now operates the clinic in Pheriche and a clinic in Manang, on the Annapurna trek. These clinics have been, and still remain, the best clinical experience a doctor can get in diagnosing and treating altitude illness. The HRA is currently operated by an all-Nepali board of directors with Buddha Basnyat, a former student of Dickinson’s, as medical director.Nepalis are not immune to the effects of altitude illness. Trekking guides, porters, and climbers have all suffered, and all too frequently, died of altitude illness in the course of their jobs. Basnyat was the first to study the risk of altitude illness in Hindu pilgrims to high altitude sites in Nepal. Just because they are Nepali and have the Himalaya in their backyard does not offer immunity to the effects of low oxygen at altitude.Pilgrims to events such as the Janai Purnima Festival are generally low-altitude people who ascend far too rapidly, such as from Dhunche at 1,960m to Gosainkund Lake at 4,380m, in only 48 hours instead of a safe 4 days. The HRA provides a temporary health camp at the lake for pilgrims and treats many cases of severe altitude illness, preventing deaths and difficult evacuations.The most auspicious development in mountain medicine in Nepal is the large cadre of young Nepali physicians who are now intensely interested in high-altitude medicine. Mentored by Basnyat, these young doctors are carrying on the tradition of quality care of victims of altitude illness, research on causes and treatments, and developing systems of administering care to diverse populations. The Nepal Himalaya, and the HRA, is still a backbone of modern mountain medicine.Peter Hackett is a world renowned high altitude expert and a leading authority on altitude illness, high altitude climbing, and the effects of altitude on people living and working in the mountains.

original

674x448

610x380

500x500

400x266

400x240

400x203

301x200

1250x600

1084x550

Going to great heights to prevent altitude illness

The 12th Mountain Medicine World Congress is being held in Kathmandu 21-24 November, with more than 400 delegates from over 30 countries taking part.The biennial conference is being organised by the International Society for Mountain Medicine (<a href="http://ismm.org/congress/">ISMM</a>) together with the Himalayan Rescue Association (<a href="http://himalayanrescue.org.np/">HRA</a>) and the <a href="https://mmsn.org.np/">Mountain Medicine Society of Nepal</a>. <img width="156" height="250" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221107171136/636934369c7e80680e03dfe1jpeg.jpg" alt=""/>The Congress will continue to focus on science and research and offer a comprehensive overview of ongoing topics of interest in mountain medicine, including emergency mountain medicine.Read also: <a href="https://www.nepalitimes.com/banner/going-to-great-heights-to-prevent-altitude-illness/" target="_blank" rel="noopener">Going to great heights to prevent altitude illness</a>, Peter Hackett<a href="https://www.nepalitimes.com/opinion/trekkers-with-the-trots/" target="_blank" rel="noopener">Trekkers with the trots</a>, David R ShlimLocated in the Central Himalaya with some of the highest terrain in the world, and a popular destination for mountaineers and trekkers from all over the world, Nepal is an ideal venue for the Congress.Nepali climbers have accompanied expeditions for many decades to the world’s highest mountains not just in Nepal, but all over the world. In addition, and increasing number of young Nepalis are discovering their own country, and can be found in large numbers on trekking trails that used to be frequented by foreigners. <figure><img width="1338" height="787" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221107171136/636934389c7e80680e03dfe2jpeg.jpg" alt=""><figcaption>ON A HIGH: The inaugural session of the 12th Mountain Medicine World Congress in Kathmandu on Wednesday. More than 200 delegates from 30 countries are taking part. Photo: NAVIN BHATT</figcaption></figure>Nepal also has a long history of research in mountain medicine starting with the Silver Hut  studies in the early 1960s, one of the first to look at the effect of high altitude on the human physiology. The <a href="http://archive.nepalitimes.com/article/review/The,448">Sherpa people</a> are probably the most studied, breath-analysed and blood-taken community in the world, as scientists try to find out how their bodies have evolved to high altitude.Even today, many Himalayan expeditions have medical research components, like the study of two mountaineers who were on Mt Everest this spring, while their twins stayed at sea level. The goal was to study possible changes in their gene expression.  Local organisers of the Kathmandu conference this week are mostly young Nepali doctors of the Mountain Medicine Society of Nepal (MMSN) which is dedicated to keeping the Himalaya safe by researching and increasing awareness of mountain medicine. They will be presenting findings on <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/Altitude-illness-awareness,1381">altitude illness</a>, cold, avalanche hazards, search and rescue, exposure to ultraviolet radiation, etc. The conference has offered 80 scholarships for young Nepali doctors to attend the meeting with support from Maniraj Neupane, an internal medicine intern in Pittsburgh.The Himalayan Rescue Association has been a pioneer in mountain medicine in the Himalaya for almost 40 years, with its clinics in Pheriche and other popular trekking and mountaineering routes.Among the speakers at the conference are Peter Hackett who has done pioneering research into mountain medicine as medical director at the HRA, and David Shlim who has studied traveller’s diarrhoea. <h2>At Altitude</h2> <img width="640" height="360" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221107171136/6369343b9c7e80680e03dfe3jpeg.jpg" alt="">As trekkers, mountaineers and other visitors to the high mountains climb higher, they can be affected by altitude sickness especially in its life-threatening forms like <a href="http://en.wikipedia.org/wiki/High-altitude_cerebral_edema">high altitude cerebral edema (HACE)</a> and <a href="http://en.wikipedia.org/wiki/High-altitude_pulmonary_edema">high altitude pulmonary edema (HAPE</a>).The initial symptoms of acute mountain sickness (headache and nausea) are warning signs that need to be heeded by descending immediately. Not heeding the signs means the lungs start filling up with water, and excessive brain swelling at altitude or HACE may lead to psychosis, violent behaviour, and eventual death.The Himalayan range, which includes 14 peaks above 8,000m, and begins where the European Alps reach the highest point. Hypoxia (lack of oxygen) stress that climbers feel in the Himalaya is much greater and therefore much more medically significant than in the Alps or perhaps even any other mountain range in the world.In his inaugural keynote to the Congress in Kathmandu on Wednesday, Peter Hackett reminded the audience that the best antidote to altitude illness is still to take the patient down while administering bottled oxygen. <img width="312" height="850" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221107171136/6369343d9c7e80680e03dfe4jpeg.jpg" alt="">

High Alert

It was pure drama: the political transition in Madhes unfolded by the dawn’s early light. At around 4AM on Monday, Province Head Sumitra Subedi Bhandari quietly departed Janakpur saying she was headed to Kathmandu for health reasons.&nbsp;
Outgoing Chief Minister Jitendra Sonal, whose coalition had begun to unravel, even saw her off, asking supporters to clear the road for her motorcade.
But an hour later, instead of continuing on to the capital, Bhandari stopped in Bardibas on the East-West Highway. There, as the sun started rising over the misty plains, she administered the oath of office to Saroj Kumar Yadav of the CPN-UML, invoking Article 168(3) of the Constitution.&nbsp;
Bhandari is also a member of the CPN-UML. The provision she invoked is typically used only after coalitions fail under Article 168(2), and the timing and location of the swearing-in have since drawn scrutiny.
Bhandari was subsequently relieved of her duties, and former National Planning Commission member Surendra Labh Karna was sworn in as the new Madhes province head on Tuesday.
Sonal had formed his government barely a month ago, with the backing of 56 provincial lawmakers but it became evident he would not secure the 54 votes needed to survive a confidence motion.&nbsp;
Several lawmakers in his coalition publicly signalled they would abstain. Still, the seven-party alliance that opposed Yadav’s appointment argues that the Province Head, who is the highest constitutional rank in the provincial structure, acted prematurely and under pressure from central UML party command.&nbsp;
A coalition of seven parties, including the Nepali Congress (NC), had been urging the Province Head to invite them to form a new government under Article 168(2). At the same time, the UML, which had been holding demonstrations outside the Province Head’s office in Janakpur, was calling for the formation of a minority government under Article 168(3).
The alliance of the seven parties that included the NC and Maoist Centre took to the streets. By mid-morning, protests had escalated outside Madhes Bhawan with cadre vandalising both the Chief Minister’s office and the Province Head’s office.
This was the third government in Madhes to fall since the 2022 provincial elections, and it follows a similar pattern. The previous Chief Minister Satish Kumar Singh of the Janamat Party, resigned before a scheduled confidence vote after losing the support of his own party and others including NC and LSP.&nbsp;
His resignation unfolded amid nationwide GenZ protests against corruption, demanding accountability and reform. The recurring instability points to a structural tension in Nepal’s federalism.&nbsp;
Provincial politics remain closely tied to alliances shaped in Kathmandu. The withdrawal of support by parties like the NC and Maoist Centre in provinces often reflects national-level calculations rather than provincial priorities.
As a result, the Provincial Assembly is repeatedly consumed by survival of the coalition instead of governance. Development work stalls. Budget execution slows. Public frustration grows. In a province that was at the forefront of the movement for federalism to counter what is seen as neglect, apathy and discrimination by Kathmandu, the sense that the system may not delivering on its promise is becoming increasingly pronounced.
If federalism is to be strengthened, provincial governments must be able to function with a degree of autonomy that currently exists more in principle than in practice. Otherwise, the perception that federalism is costly, unstable, and ineffective will continue to expand, providing fertile ground for anti-federal sentiment that is already gaining traction.
Earlier examples such as the NC General Secretary Bishwo Prakash Sharma in January calling for a new government in Madhes led by his party demonstrates how the central party leadership deliberately intervenes in provincial affairs. His remarks came during campaigns for bi-elections in Madhes when former CM Singh had been in office for six months only.&nbsp;
Likewise, in early June 2024, the federal coalition in Kathmandu shifted from a Maoist Centre and NC to form a new alliance between the NC &nbsp;and the UML. Within a day, coalition negotiations in Madhes changed to mirror this.
UML leaders publicly stated: “The issues at the federal and provincial levels will be resolved together.” This indicated that the realignment in Madhes followed national party decisions rather than provincial deliberation.
The events that unfolded in Madhes are a reminder that federalism in Nepal is still in transition, and that its success depends on political actors honouring the constitutional framework.

Chronic instability in the Madhes

You do not have to be a climate expert or atmospheric pandit to claim that Nepal is not pulling its weight on the grand narratives of the Anthropocene. As a heavily populated ‘country-on-an-incline’ from the Tarai to the Himalaya, Nepal is a thermometer of global warming.&nbsp; Its people are human witnesses to environmental and climate breakdown, but remain mute observers to the unfolding crises. Nepal should be leading the pack at the COP30 climate conference in Belém, backed by science and lived experience. But it is doubtful that two of the most crucial climate-related subjects central to the culture, economies and human wellbeing in the Himalaya and South Asia will be discussed at the summit that started this week in Brazil.&nbsp; The first topic that should be raised at COP is Black Carbon or the South Asian Brown Cloud, made up of tiny suspended particles in the air. This is not just a transboundary health hazard, there is now enough science to make the case that Himalayan snowmelt is accelerated significantly by the albedo effect that makes ice melt faster because of reduced reflectivity. But Kathmandu has not been able to make governments near and far listen. In 2014, I wrote a short piece published in Outlook magazine explaining why India’s Prime Minister Modi looking northward from a SAARC Summit retreat in Dhulikhel was unable to see the Jugal Himal range barely 30km away. His view was obscured by the pollution layer arriving from as far away as Lahore with substantial contribution from the Delhi region. That summit itself was an opportunity for Nepal to inform the Indian and Pakistani prime ministers that much of the haze, smog, dust and soot that settles on our slopes was generated in Sindh, Punjab, Punjab, Haryana, Western UP and Delhi NCR, carried by prevailing westerly winds up to the Himalaya. The forest fires within Nepal as well as Kathmandu Valley’s pollution contribute to the haze, but the shroud that suffocates the region through autumn, winter and spring is mostly transnational. Last year, these anthropogenic fine aerosols actually curled over the Bay of Bengal and invaded the airspace of Sri Lanka and Maldives.&nbsp; Even as the soot particles accelerate glacial melt and impact everything from infrastructure to public health, the most visible effect is on tourism. Nepal’s economic future is based on tourism, and much of this relies on being able to see the snow mountains. Why should travellers go to Pokhara if they cannot see the Annapurnas?&nbsp; Hoteliers in Nagarkot have started a campaign: ‘Visit Nagarkot 2025: More than Sunrise and Sunset’. While clever, the slogan is a response to the acclaimed Himalayan vista from Everest to the Annapurnas from the hill station, now obscured by the brown curtain of haze for most of the year. As the bellwether country of South Asia when it comes to the climate crisis, Nepal must build diplomatic confidence to reach out to the governments of Pakistan and India even in their present state of antagonism. Kathmandu must launch ‘haze diplomacy’ for its own sake and for the region.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251113001132_16c9941da7b31c1d4683c06dc0f8a572803240701270606848851f915140329c.jpg" data-media-id="editor_0" data-image-id="20251113001132_16c9941da7b31c1d4683c06dc0f8a572803240701270606848851f915140329c" data-rendition-name="original" width="1005" height="695" loading="lazy" alt="permafrost"> </figure>  IMPERMANENT FROST&nbsp; Permafrost is understood mostly as a phenomenon of the Arctic, Antarctica, Siberia and Alaska. Mountains elsewhere did not figure, though it was natural for the ground to freeze all year round at high altitudes.&nbsp; In the Himalaya, besides the snowfields and glaciers, frozen moisture binds rocks and stabilises slopes. But global warming is melting the permafrost that used to cement mountain flanks, including boulders, sand and scree slopes. Some of the debris (गेग्रान) did tumble down, but much of it remained entombed on high, thanks to permafrost. Pokhara Valley and the Seti River reaching all the way up to the base of the Annapurnas, is the best place to observe this dance of geology between gravity and the mountain range. Rubble from the collapse about <a href="https://nepalitimes.com/here-now/remembering-the-seti-disaster">700 years ago of paleo-Annapurna IV </a>created the sediment field on which Pokhara is situated today. However, much of the debris from the crumbled mountain is still lodged up on and around Annapurna IV, but the binding is loosening with the warming earth. A <a href="https://www.icimod.org/event/analysing-permafrost-in-the-hindu-kush-himalaya-using-open-access-tools/">2024 report by the International Centre for Integrated Mountain Development (ICIMOD)</a> indicates that global warming is thawing the permafrost across High Asia. Among the unintended consequences of climate breakdown is that mountains and moraines are collapsing, with <a href="https://www.icimod.org/press-release/everest-region-a-hotspot-of-cryosphere-linked-hazards-icimods-new-study-on-nepals-2024-thame-flood-confirms/">cascading impact</a> that includes glacial lake outburst floods, reduced groundwater recharge as well as winter flow in the Ganga, Indus and Brahmaputra. No one has calculated the total volume of rubble locked in by permafrost across the Himalaya. Despite the increased risk, there is accelerated construction of highways, hydropower projects, housing and tourism infrastructure across the Himalaya. While the COP conferences discuss rising oceans and receding glaciers (without doing much about it), Himalayan permafrost has been melting unremarked. In their path-breaking September 2024 <a href="https://nepalitimes.com/multimedia/the-not-so-permanent-frost">article in Nepali Times</a>, Wilfried Haeberli and Alton C Byers argued that the extreme events of the past few years that led to mountain and moraine collapses, unleashing destructive debris flows downstream, were the result of melting permafrost. Haeberli and Byers suggest that the avalanches and floods including those of <a href="https://archive.nepalitimes.com/article/nation/Anatom-of-a-Himalayan-tsunami,1330">Seti (2012)</a>, <a href="https://www.icimod.org/article/understanding-the-chamoli-flood-cause-process-impacts-and-context-of-rapid-infrastructure-development/">Chamoli (2021)</a>, Birendra Tal (2023), <a href="https://www.sciencedirect.com/science/article/pii/S2772883825000251">Sikkim (2023)</a>, <a href="https://nepalitimes.com/news/climate-breakdown-linked-to-thame-flood">Thame (2024)</a>, <a href="https://himat.org/publication/byers-rockfall-induced-2019/">Barun (2017)</a> and <a href="https://nepalitimes.com/banner/drones-to-the-rescue-in-melamchi">Melamchi (2021)</a> were the result of the thawing of frozen ground. They say that the collapse of the lateral moraine on the <a href="https://nepalitimes.com/news/sikkim-flood-is-warning-to-nepal">South Lhonak glacial lake</a> in Sikkim on 4 October 2023 that swept away more than 100 people, destroyed the $1 billion Chungthang Dam as well as houses, roads and farms far downstream, was also caused by cloudburst on a lateral moraine that had lost its permafrost adhesive. There will be permafrost sceptics, as there have been climate change deniers. But it is time to wake up to the reality that the Himalayan peaks are no longer the immutable sentinels as regarded by humanity since prehistoric times.&nbsp; Modern society has pumped so much greenhouse gas into the atmosphere that now even the mountains are giving up. And we have not even begun to think about the bacteria and viruses locked away in the permafrost up the slope.&nbsp; Loss of permafrost adds to the cumulative impact of climate breakdown, including extreme weather events, drought and cloudbursts, heat waves in the plains affecting lives and livelihoods, creating mass migration, social unrest, and upending politics and geopolitics. The government and polity of Nepal have a duty to themselves and the larger humanity to wake up to the climate breakdown. The Sagarmatha Sambaad conclave organised by the Government in May failed to emerge as a pulpit for global warming and associated ills. Our political class, bureaucracy and academia should make up for lost opportunities to rise to the occasion and take the lead.&nbsp; Kanak Mani Dixit is writer, commentator and founding editor of Himal Southasian.

Climate of tragedy and apathy

This is the 73rd episode of Diaspora Diaries, a Nepali Times series in collaboration with Migration Lab providing a platform to share experiences of living, working and studying abroad. I don’t remember playing with dolls as a little girl. There is not much to remember from my childhood.&nbsp; My responsibilities began at a very young age, as I had two younger brothers to take care of. I was born in Sarlahi, but we moved around quite a bit as my father was in the government and got transferred frequently.&nbsp; From Rasuwa to Dang, from Nepalgunj to Kathmandu. I struggled to adjust in Kathmandu because I joined Grade 9 in the middle of the term. The education was different and fellow students also did not support me initially. But over time, I adjusted and made friends. I did not dream of becoming a nurse. It was by accident. I wanted to pursue medicine, but failed the entrance exam by a few marks. I did not want to lose a year, so decided to take up microbiology instead.&nbsp; I got married after my undergraduate, and my husband encouraged me to take up something more technical like nursing or engineering instead of Masters in Microbiology. As my quantitative background was weak, I chose nursing. I felt like I was born to be a nurse. Juggling my married life and studies was difficult. My teachers would often ask me why I am falling behind. It was not easy, but I managed and took up a full-time job as a nurse. There are challenges being a nurse in Nepal. You are overworked, underpaid, there is lack of appreciation. Superiors can be overbearing. These problems persist. But the bright spot is that you get to serve fellow Nepalis, and be close to your family.&nbsp; Just like I had no intention initially of becoming a nurse, I had no intention of migrating overseas. But life had different plans for me. After my baby boy was born, I noticed that something was off. Even at nine months he had not started crawling or sitting. As a nurse I knew something was wrong, and I took him for check-ups. He tested negative for down syndrome, but he had a heart defect.&nbsp; The cardiologist recommended that I take him to India where he was diagnosed with Williams Syndrome, a rare genetic condition that affects 1 in 10,000 people. It delayed his development. I looked for therapy. It was either not effective, or too expensive. Some schools also refused to admit him, and it drove me to tears.&nbsp; My family members overseas in the UK, US told me to emigrate as there were better facilities for differently abled children. So I decided to apply to the UK. Luckily just then there were calls for candidates under the Nepal-UK government-to-government pilot scheme for 100 nurses. Only 40 met the criteria, and I was one of them.&nbsp; I still remember the day I received the news on the day of my puja. There were people around me, and they told me that it was the result of my fasting and devotion on that auspicious day. Perhaps it was. Life was taking a new turn, and I was happy. I made it to the UK in February 2024 without paying a single paisa to any broker. The G2G scheme was unique as we were treated with dignity and valued for our skills: they covered costs for the ticket and visa, reimbursed us for exams we had taken and costs involved in the preparation and testing of the Objective Structured Clinical Examination were also covered.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251106071148_dc5a0d0ea3024b34a4f2735754f8eb67a650bc7f61b98c75d589676c65b02a0c.jpg" data-media-id="editor_0" data-image-id="20251106071148_dc5a0d0ea3024b34a4f2735754f8eb67a650bc7f61b98c75d589676c65b02a0c" data-rendition-name="original" width="1200" height="1600" loading="lazy" alt="Nurses NT"> </figure>  It was of course difficult to leave my son behind. But I was doing it for his future. I had the option of taking him from the start, but it was a new place and I wanted to be well-settled and knowledgeable about the options available for him before bringing him along. As I packed, he would ask me to take him with me in my suitcase. It did not seem like he was affected by my departure, and it was only later that his teachers said that he would express his feelings more openly at school. He just did not know how to tell me he missed me, and he would tell teachers he was worried I had forgotten him if we did not speak for a day.&nbsp; He missed me, and that realisation made me emotional. But I had to carry on. Life in the UK was difficult in the beginning. Even so, I wanted to prove to myself that I could do it. Fortunately I had cooperative staff who patiently answered my questions. I think I would have been irritated if I were in their place. But they did not seem to mind, and their support and guidance made it easy for me to adjust to the new work environment. APPRECIATION I still struggle to understand the accent of my English patients, and have ask the matron for help. They compliment me on my English, but I can speak better than I understand. The good thing about working in the UK is that you are appreciated for your work, which can be motivating. Sometimes, after a long day’s work you get a message from your supervisor acknowledging your work with a thank you. That’s enough to erase your tiredness.&nbsp; So far I have received 32 WOW nominations which are acknowledgements from patients for a job well done. It can be motivating, especially in the beginning. The main difference between the Alpana who first left Kathmandu for the UK and the Alpana now is that I am a much more confident person. What makes a good nurse? Skills, knowledge and qualifications are of course a given. But mostly, you need humanity. A smiling face. The way you communicate. Your empathy. These attributes can already solve many problems that patients are facing. This is my second time back home in the last 20 months. And this time, I have arranged for my son’s visa. I will go back after Tihar with my son and husband.&nbsp; I am happy, but also a little nervous about what awaits us. What kind of school will I put him in? Will it really be different from schools here? Will his needs be addressed? Will it be like here, or will he be able to adjust?&nbsp; But I am determined to make it work. Success for me would be if he adjusted well and there is a change in his condition. He still cannot recognise alphabets and read words like kids in his age group. Hopefully he will get learning support in the UK. He also has a knack for music, and this is common among individuals with Williams Syndrome. His ears perk up when he hears music, and he takes part in musical events at school. He still does not recognise letters &nbsp;but he uses voice commands to search for guitar videos on YouTube. I will enrol him in music classes, and help him develop this gift. For now, I worry how he will behave on his long flight. He has a short attention span and gets restless. He is also very social and will want to speak with everyone around him, and might irritate fellow passengers.&nbsp; I have already started trying to make him understand that he will need to behave on the flight. He nods in agreement. Let’s see how it goes. &nbsp;

“I felt like I was born to be a nurse”

A month after September’s GenZ movement in Nepal, nurses working in private hospitals took to the streets demanding better work conditions, and salaries equal to what government nurses are paid.&nbsp;
The strike started at Pokhara’s Manipal Teaching Hospital before spreading nationwide, and nurses working at government hospitals joined in.&nbsp;
Nurses at private hospitals are forced to work for far less than Nepal’s minimum monthly wage of Rs19,550 — without overtime, breaks, and other benefits and under physically and mentally taxing conditions. This is driving many qualified nurses to emigrate.
For newly-appointed Health Minister Sudha Sharma Gautam in the interim government, the strike became her first order of business. She met representatives of the Nursing Association of Nepal (NAN), the protesting nurses, and others from the health sector.&nbsp;
An agreement was reached under which private hospitals and medical colleges will pay nurses a minimum monthly salary of Rs34,730. &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
“It is a shame that nurses have been working under such exploitative conditions all this time” says Radha Adhikari, at the School of Health and Life Sciences of the University of the West of Scotland. “The agreement is basic, and there is a long way to go to improve their working conditions. But it is a start.”
NAN chair Chandrakala Sharma has said the ministry’s task force to look into working conditions will also look into facilities for nurses in government hospitals.&nbsp;
“We are committed to solidifying the wage agreement by amending relevant laws within this month,” Sharma said in a video posted by NAN on Facebook. “Our movement is not over, we are still protesting and &nbsp;following up with the Ministry.”
NAN issued an ultimatum to the government to implement the agreements within 48 hours. That deadline has now lapsed and the nurses are back on strike. Many of those protesting now accuse NAN of betraying them.
Jyoti Ranabhat of the Nurses Struggle Committee was present in the meeting, but refused to sign the agreement. “It did not address what we were demanding, we will now go it alone into Plan B,” she tells Nepali Times.&nbsp;
Previous grievances of the nurses did result in similar agreements, but private hospitals failed to comply with government’s past directives — most recently the minimum salary and benefit determined by the state in December 2024.&nbsp;
The Nepal Nursing Council says there are 126,580 registered nurses, specialists, midwives, and Auxiliary Nurse Midwife (ANM) professionals in Nepal. Yet, nursing positions at hospitals remain vacant.&nbsp;
The reason for understaffing is a mass emigration of medical professionals, including nurses. Nursing student enrollment is also declining and there is disinterest in a profession that does not afford health workers quality of life, respect, or dignity.
“Our fight is not with the private sector, it is by definition profit-oriented, our grievance is with the state,” says Ranabhat. “The government is responsible to provide us dignity, respect, and fair pay.”&nbsp;
GREENER PASTURES
Poor pay and working conditions are driving doctors and nurses abroad in large numbers in recent years. Many have simply quit the profession, leading to a shortfall in medical professionals. 

The shortage of nurses is a global phenomenon, and countries like the US, UK and Australia have compensated for their own shortage by offering jobs from countries like the Philippines, India and Nepal.&nbsp;
Nepal Nursing Council data shows that outmigration of nurses rose sharply after 2002, and an estimated &nbsp;20,000-45,000 nurses have left since.
“The state’s denial, derision, and disregard of nurses has caused resentment and disillusionment in the community, driving nurses out,” says Ranabhat. “Ultimately, Nepalis will pay the price when there are no nurses left here.”
Many Nepali nurses who have gone abroad are happy with the respect and quality of life in their jobs abroad. But many others face exploitative recruiters in Nepal and employers abroad. Nursing consultancies have mushroomed as nursing colleges struggle to meet demand.&nbsp;
Adhikari herself worked at United Mission Hospital Tansen before moving to the UK 30 years ago, and remembers that working conditions then were much better for nurses.&nbsp;
“Nepal’s health sector has gone downhill since privatisation,” she states. “Medical colleges are only concerned with supplying doctors and nurses internationally, because that is what makes money.”
But once Nepal’s nurses are abroad, there is no guarantee that they will have jobs in the nursing sector. Many find themselves working outside their field of expertise, in hospitality or sales.&nbsp;
“Nepal has become a production hub for nurses, and Nepali nurses have become products for export,” adds Ranabhat. &nbsp;“People might think this will add to remittances, but no one is thinking about what will happen to Nepal’s health sector.”&nbsp;
For many, nursing has become a way out of Nepal rather than a vocation. In 2022, the government signed an agreement with the UK to send Nepali nurses to work there at zero cost, with benefits and protection equal to UK nurses.&nbsp;
The pilot phase was expected to recruit 100 nurses, and applications opened in July 2023, with 45 nurses said to be selected by Britain’s NHF representatives by the end of 2023. Forty-one of them obtained labour permits.&nbsp;
They may be treated well, but the reality of working in the international health sector is not as straightforward.
Radha Adhikari told us from Scotland: “Market saturation, exploitation, discrimination based on race, gender, and foreignness prevent nurses from finding the right, respectful jobs even here. Ultimately, migration cannot be sustainable for Nepal’s nurses.”

high-altitude

Going to great heights to prevent altitude illness

High Alert

Chronic instability in the Madhes

Climate of tragedy and apathy

“I felt like I was born to be a nurse”

Nepal haemorrhaging nurses