Nepal’s major hospitals are not prepared for emergency response and care in an event of another earthquake or pandemic, according to a recent new study published in the International Journal of Emergency Medicine. The paper lists a serious lack of preparedness at emergency units of hospitals, and compares the capacity of private, government, and teaching hospitals in Kathmandu.
The study was the first of its kind conducted in Nepal and its investigators aimed to build on the Emergency Care Systems Assessment (ECSA) conducted by Nepal’s Health ministry the WHO in 2019. The ECSA report had identified 39 key items to improve emergency care in the country. <a href="http://archive.nepalitimes.com/news.php?id=17851#.ZA7O-3ZBy3A" target="_blank">Another survey in 2011</a> had shown that only two of the hospitals in Kathmandu Valley at the time had earthquake resistant buildings.
&nbsp;The cross-sectional pilot study looked into seven tertiary hospitals in the Valley out of which three are academic, two are governmental, and two are private institutions. Included in the study are TU Teaching Hospital, Patan Hospital, Dhulikhel Hospital, Bir Hospital, the National Trauma Centre, Grande Hospital and HAMS Hospital.&nbsp;
Researchers used a cross-sectional mixed-method study to gather data on facility characteristics, human resources, clinical services, and signal functions of seven major tertiary-level health facilities in the Kathmandu Valley.&nbsp;
Read also:&nbsp;
<a href="https://www.nepalitimes.com/banner/taking-wealth-out-of-health">Taking wealth out of health</a>
<a href="https://www.nepalitimes.com/banner/in-a-healthy-state/">In a healthy state</a>
Investigators identified three respondents from each of the seven institutions who are directly involved with the emergency department in a clinical care or administrative leadership role. Respondents included physicians, nurses, hospital administrators, and general hospital staff.
Emergency response—which is at the forefront of natural disasters and pandemics—during two major disaster events in the country, the 2015 Gorkha earthquake and the Covid19 Delta wave in 2021, showed that Nepal’s emergency response and care was subpar, write the authors.
“This study was designed and conducted so that we recognise our weaknesses, and start slowly improving them,” said Olita Shilpakar, an emergency physician at TUTH, and one of the authors.
The study concluded that while all the facilities surveyed had general availability of round-the-clock emergency services, there were significant gaps as well as differences in infrastructure, diagnostic, consultant, and human resource availability.
“The WHO estimates nearly 40% of lives can be saved with appropriate emergency care,” said Ramu Kharel, an assistant professor of emergency medicine at Brown University in the USA who led the study. “Improving emergency care is one of the most efficient public health interventions. Our study identified many opportunities for us to improve emergency care at hospital levels.”
Government hospitals were characterised by a lack of a designated triage area, as well as the unavailability of Obstetrics/Gynecology (Ob-Gyn), orthopaedics, paediatrics, or psychiatry consulting services.
Academic hospitals had limited isolation rooms or infectious diseases and were found to not have adequate access to toilet facilities. There was limited availability of social work services and security personnel.&nbsp;
In private hospitals, protocols for time targets in triage, triage for children below five years of age, trauma care, and burn care among other services were found to be missing. Safety protocols for managing hazardous exposures were not there, and there was a lack of protection for staff and patients from violence.&nbsp;
While government hospitals that typically care for low-income populations reported better availability of ancillary services and social care services, private hospitals not supririsngly scored the highest in access to and availability of health infrastructure.
Meanwhile, academic facilities were found to have more written protocols given their increased likelihood for research and teaching compared to governmental and private facilities. However, academic institutions were found to have the highest rating with greater availability of consulting services.
Common barriers across all institutions included a lack of training in key emergency procedures, written protocols, point-of-care testing, and ancillary patient services.&nbsp;
Read also: <a href="https://www.nepalitimes.com/opinion/is-free-health-care-possible-in-nepal/">Is free health care possible in Nepal?</a> S P Kalaunee
Researchers have recommendations regarding the triage system and time metrics, training and education, written protocols for emergency care, and health infrastructure in order for the health facilities included in the study to improve emergency care. Investigators also highlighted a need for specific training, and cross-collaboration between the institutions to strengthen Nepal’s emergency services.
“The findings of this study will allow us to find areas of collaboration between institutions as well. For example, some hospitals have better protocols, others have better triage systems,” said Kamal Thapa, one of the study investigators and an emergency consultant at Grande Hospital. “We need to work together to improve emergency care. Ultimately, our concern is <a href="https://www.nepalitimes.com/editorial/poor-health-makes-nepalis-poorer">good patient care.</a>”
Emergency medicine is a new field globally, and especially so for Nepal but evidence from other countries has shown that even simple interventions— like having a good triage system in hospitals— have a significant impact in saving lives.
Said Kharel: “The next step for these hospitals is to use the findings as a guide to take steps towards addressing gaps identified in this report. Furthermore, we need to conduct larger research around the country to look at gaps in emergency care in rural area facilities.”
Read also: <a href="https://archive.nepalitimes.com/article/editorial/health-tip-editorial,4032">Health tip</a>, Editorial

original

674x448

610x380

500x500

400x266

400x240

400x203

301x200

1250x600

1084x550

Emergencies in Nepal's Emergency Rooms

<figure><img width="800" height="600" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114101124/63720a059c7e80680e0b5579jpeg.jpg" alt=""/><figcaption>Photo: NEURO HOSPITAL</figcaption></figure>* A 32-year-old female patient was suddenly unable to move one side of her body. She was rushed to Upendra Devkota Memorial National Institute of Neurological and Allied Sciences (Neuro Hospital) where doctors used a new non-invasive treatment to remove a clot that was obstructing the artery supplying blood to her brain. The patient’s mobility was immediately restored and she walked out of the hospital.* A man in his mid-fifties arrived at Neuro hospital five hours after suffering a stroke. He underwent the 15-minute procedure after which he could move all of his limbs freely.The strokes could have been fatal for both patients if they had not been rushed to hospital, and if the new state-of-the-art mechanical thrombectomy procedure was not available.The prevalence of strokes in Nepal has increased 40% in the past decade, and more and more younger people are suffering the condition that could paralyse or kill them. Strokes are the third leading cause of premature deaths in Nepal, and ranks first for disabilities. A person somewhere in Nepal suffers a stroke every 20 seconds. Doctors say a changing lifestyle and <a href="https://www.nepalitimes.com/banner/nepalis-binge-on-junk-foods-the-west-rejected/">dietary habits</a>, including heavier drinking and smoking has led to an increase in <a href="https://www.nepalitimes.com/latest/why-do-so-many-nepalis-have-high-blood-pressure/">hypertension</a>, <a href="https://archive.nepalitimes.com/article/nation/diabetes-in-south-asia,3018">diabetes</a>, high cholesterol — all precursors to strokes. <figure><img width="1201" height="660" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114101124/63720a089c7e80680e0b557ajpeg.jpg" alt=""><figcaption> </figcaption></figure>Recent studies have also reported that people infected with Covid-19 have an elevated risk of ischemic stroke, adding to the burden of disease. Other risk factors include aging, congenital heart diseases, hormonal changes and pregnancy. Women are comparatively more prone to suffering strokes.Ischemic strokes account for 85% of all cases, where an artery supplying blood to the brain is blocked damaging it. Haemorrhagic stroke, on the other hand, occurs when blood from a ruptured artery collects in the brain.“A stroke is a medical emergency, especially ischemic stroke which can lead to permanent disabilities and even death if it is not treated immediately,” says Subash Phuyal, Nepal’s first interventional neuro-radiologist at the Neuro Hospital in Bansbari.In fact, speed is of the essence to save the life or prevent life-long paralysis of a patient. But patients in Nepal often are not aware of symptoms and get to hospitals too late, where the right treatment may not be available. <figure><img width="4032" height="3024" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114101124/63720a0b9c7e80680e0b557bjpeg.jpg" alt=""><figcaption> </figcaption></figure>Unlike a heart attack, stroke patients do not feel any pain, making it difficult to identify it. Which is why doctors have come up with the acronym BE FAST (Balance, Eyes, Face drooping, Arm weakness, Slurred speech, and Time) to identify signs of stroke in time.Patients usually experience a sudden problem with their sense of balance, have blurred vision, double vision or loss of sight in one or both eyes. There could be facial drooping, weakness or paralysis on one side of the body, and slurred speech.If a patient gets to hospital within four hours of a stroke, they are immediately given a medicine to dissolve the blood clot obstructing the artery, restoring blood flow to the brain. This treatment is effective in only 10% of patients. Read also: <a href="https://www.nepalitimes.com/banner/new-treatment-offers-hope-for-nepals-leprosy-patients/">New treatment offers hope for Nepal’s leprosy patients</a>, Sonia AwaleHowever, with mechanical thrombectomy, 90% of patients who get to hospital in time can be cured. A small incision is made in the thigh and catheters inserted using an imaging machine in the cath lab. The catheter travels along the major arteries until it retrieves the clot to allow the blood to flow again.In the case of haemorrhagic stroke, surgery to clip the blood vessel is now replaced with a method called endovascular coiling in which the catheter inserts platinum coils to block the aneurysm.This non-invasive mechanical thrombectomy was first devised in 2015, and it was already available at the Neuro Hospital in Kathmandu four years later. Its biplane cath lab has been treating up to 25 patients a month.The hospital’s founder <a href="https://www.nepalitimes.com/here-now/upendra-devkotas-lives/">Upendra </a>Devkota (see box) was determined to introduce the newly-developed endovascular treatment technology in Nepal, but did not live to see it save lives. He died of cancer in 2018. His wife Madhu Devkota completed the dream, and set up an interdisciplinary team for stroke patients. Neuro Hospital is also building a rehabilitation centre for recovering patients who often need physiotherapy.But despite having the most advanced stroke treatment in Nepal, most people are not aware of the danger signs of a stroke. They also do not know that such non-surgical treatment is available in Kathmandu. It is also not widely known that such care is available in the country, and up to half the stroke patients at Neuro Hospital are brought too late for treatment.Nepal’s topography adds to the problem of getting patients to hospital in time. Madhu Devkota suggests the government could provide an air ambulance facility, as it does for complicated maternity cases.Says Subhash Phuyal: “People must know that strokes are preventable, and that advanced treatment is available right here in Nepal. But the most important thing is to get the patient to hospital as quickly as possible.”  <img width="630" height="882" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114101124/63720a0f9c7e80680e0b557cjpeg.jpg" alt="">Visionary doctorA young and talented doctor at Bir Hospital, Upendra Devkota, was sent on a scholarship to the Glasgow Neuroscience Institute in 1983 to train in neurosurgery. Under the guidance of the renowned Professor Graham Teasdale, Devkota proved himself among the best neurosurgeons in the world and had a bright career ahead of him in the UK.But the Gurkha-native left all that behind to return to Nepal in 1989 to set up the country’s first Neurological Trauma Unit at Bir Hospital. He worked day and night, while also training young neurosurgeons with limited resources.Devkota briefly served as the Health Minister under King Gyanendra in 2005, and a year later started setting up the National Institute of Neurological and Allied Sciences.“Many tried to dissuade us, but despite challenges we were determined to set up an institution dedicated to preventing paralysis and disabilities in Nepal,” says Madhu Devkota. “My husband had foreseen the need for an advanced neurological centre in Nepal. So we thought, if not us, who would? So, we ran with it.”Read also: <a href="https://www.nepalitimes.com/latest/why-do-so-many-nepalis-have-high-blood-pressure/">Why do so many Nepalis have high blood pressure?</a> Sonia Awale

Sonia Awale

New cure for stroke, but prevention is key

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110161148/636d1db19c7e80680e0af3d0jpeg.jpg" alt="" width="767" height="575"/><figcaption>Security personnel and relatives of the deceased attend a mourning at the premise of infectious disease hospital in Pokhara. Photos: BARSHA KAFLE</figcaption></figure>A 79-year-old woman lay on the emergency bed, diagnosed with pneumonia due to Covid-19. Even as she was gasping for breath she had a smile on her face, handing over an invitation card to the attending doctor who was also her relative.Her grandson’s wedding was four days later. Family members from across the world had flown into Pokhara for the ceremony. She died of severe acute respiratory distress syndrome with multiple organ failure a day before the wedding, and it had to be cancelled.As her physician, I had sleepless nights when her condition worsened. We <a href="https://www.nepalitimes.com/here-now/nepal-health-workers-battle-covid-19-but-also-stigma/" target="_blank" rel="noopener noreferrer">health-care workers are also human beings</a>. When we lose near and dear ones it takes a toll on our physical and mental health, we grieve when our patients die. We may hide our emotions but we suffer all the same.The woman was just one of many relatives I have lost during this pandemic. As I grieved with family members gathered at the hospital, we were once again reminded of the Buddhist teachings about impermanence. Yet none of us is ever ready.“But it must be easier for you to face death as a doctor,” one of the mourners said to me. No, it is just as difficult. If not more, because as a physician I had the added responsibility of saving her life.Army men dressed in PPE from head to toe had arrived to take her body for safe disposal. Relatives from across the world who had come to celebrate a wedding ended up attending a funeral.The Gandaki Province government established Nepal’s first provincial infectious disease hospital in July 2020. Since then, it has managed nearly 1,300 Covid-19 cases at a cost of Rs500 million.Tha Gandaki Province government established Nepal's first provincial infectious disease hospital in July 2020. Since then, it has managed nearly 1, 300 Covid-19 cases saving Rs500 million out of pocket expenditure of common people.We have lost 52 people to the coronavirus in the same period. The Covid-19 mortality rate in this provincial hospital is 4.1%, relatively high compared to the total number of people who were hospitalised.The global death rate now stands at 1.97% with a total of 5,318,277 fatalities. This figure is exceptionally high given it has only been two years. Even then, this figure does not include <a href="https://www.nepalitimes.com/banner/the-real-cost-of-nepals-second-wave/" target="_blank" rel="noopener noreferrer">the social, mental and economic consequences</a> to family and friends of the deceased.But each Covid death is also a lesson for us to learn from. Most of these deaths could have been prevented if only Nepal had a robust primary health care system, and if preventive measures were more strictly enforced.With the <a href="https://www.nepalitimes.com/here-now/omicron-may-not-be-as-risky-but-take-care/" target="_blank" rel="noopener noreferrer">rise of new variants like Omicron</a>, it is also advisable to up our vaccination drive and we should also start administering boosters to vulnerable populations given our stock of doses and those that are on the pipeline.A man in his late thirties was isolating at home in Pokhara after getting infected. He just had a common cold but I requested him to undergo hospital-based isolation as he was symptomatic. But just a few days after getting admitted, his symptoms worsened and his condition deteriorated. He was then transferred to another hospital, and died soon after.This was not a case that should have been fatal. Even after 12 years of clinical experience, some of the Covid-19 outcomes I have encountered in the past year have been unexpected and shocking. It must have been devastating for the young man’s family and friends.Earier this year, when a 86-year-old mukhiya from Mustang died at our hospital of Covid complications, hundreds of Thakalis travelled to Pokhara to show their respect to the deceased despite the coronavirus surge at the time. Young or old, the virus was indiscriminate.In November 2020, I myself had to self-isolate with an upper respiratory infection due to a coronavirus infection. I thought I would not survive the excruciating body ache, sleepless nights and high anxiety level. During those horrific 10 days at <a href="https://www.nepalitimes.com/here-now/at-the-covid-19-frontlines-in-rural-nepal/" target="_blank" rel="noopener noreferrer">Bayalpata Hospital in Achham</a> I was battling an infection that I was treating my patients for.An elderly couple had been admitted to our hospital with Covid, both of them had severe symptoms. The husband died within a few hours of admission, but his wife was not aware of his passing until she became critically ill herself, and the family decided to tell her the truth. She passed away a week after her spouse. Medical staff usually have seen it all, but so moved with sorrow they mourned too.Holistic <a href="https://www.nepalitimes.com/banner/this-is-how-to-upgrade-nepals-rural-health/" target="_blank" rel="noopener noreferrer">health care</a> is the central core of modern medicine. But the caregivers can provide only acute biomedical care to alleviate the suffering of Covid patients. Their psycho-social wellbeing and that of their family members are often ignored. And we have not even begun to think about the mental health and trauma of the frontline workers.Over 800,000 Nepalis have been infected with the coronavirus and 12,852 have died of the disease. It is time we study this data, in particular the common causes of Covid-19 deaths in Nepal. Is it heart attack, blockage of vessels in the lungs, multiple organ failure or acute respiratory distress syndrome?We must reshape our health policies based on these facts and evidence. We must ensure adequate preparation with ICU beds, oxygen supply, <a href="https://www.nepalitimes.com/latest/donated-ventilators-gather-dust-in-nepal/" target="_blank" rel="noopener noreferrer">ventilators</a> and other equipment that were in short supply earlier this year.Only then can we design a robust and customised care system to protect our population from future surges.Bikash Gauchan is the Executive Director of the Infectious and Communicable Disease Hospital in Gandaki Province.

Diary of a Covid frontline worker in Nepal

<figure><img width="3510" height="1500" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108151116/636a651f9c7e80680e059913jpeg.jpg" alt=""/><figcaption>Photo: MONIKA DEUPALA</figcaption></figure>Nepal’s <a href="https://www.nepalitimes.com/banner/state-of-the-art-rural-hospital/">Bayalpata Hospital</a> has won an international award in the Health Category at the World Architecture Festival held in Amsterdam on Thursday.The hospital in <a href="http://archive.nepalitimes.com/news.php?id=17650#.Xens94Mza72">Nepal’s Achham district</a> is a public-private partnership between the group Nyaya Health and the Nepal government, and is built almost entirely using rammed earth technology using locally available material with an ambitious zero carbon construction.‘This is an example of when architecture provides more than a building. Although modest in scale and architectural expression is delivers a massive leap in healthcare provision in a region with scarce resources,’ jury members of the Global Architecture Festival said in their citation. ‘A great example of an architect listening closely and responding intelligently to site and situation. The building is rooted in its site through its use of onsite materials and has impeccable zero carbon design credentials.’ <img width="1500" height="1125" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108151116/636a65229c7e80680e059914jpeg.jpg" alt="">Bayalpata was <a href="http://archive.nepalitimes.com/news.php?id=17650#.XensoYMza71">started by visionary Nepali and American public health experts in 2009</a>, and took over a defunct government hospital to show that accessible and free medical care was possible in a rural Nepal district that had the highest maternal and child mortality and lowest lifespan.Today, the hospital <a href="https://archive.nepalitimes.com/regular-columns/GUEST-COLUMN/upgrading-health-care-through-public-private-partnership-model,582">treats 100,000 patients a year</a> from Achham and six surrounding mountain districts. Paid for mostly by crowd-funding, the $4 million three-phase expansion of Bayalpata Hospital with its <a href="https://www.nepalitimes.com/banner/starting-nepals-green-school-movement/">state-of-the-art architecture</a> was completed earlier this year.“Our specs were to use local materials as much as possible, keep energy costs low, and respect the local context,” explains Arun Rimal, a Nepali architect with the US-based Office of Structural Design (OSD). “The rammed earth uses local clay and sand from the river. The thick walls give thermal mass for insulation, and the skylights optimise sunlight and ventilation.”  <img width="4416" height="3312" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108151116/636a65279c7e80680e059915jpeg.jpg" alt="">The reliance on local material turned out to be a huge advantage because the project faced unforeseen logistical problems due to the 2015 earthquake and Blockade. However, the four-year construction was delayed by just six months because it did not rely too much on bricks, steel and other imported material. The facility has a <a href="http://archive.nepalitimes.com/news.php?id=5877#.XWZGkOMzaUk">rainwater harvesting system</a>, treats its wastewater and has a network of greywater-irrigated terraces and bioswales to control erosion and recharge the acquifer. A 100kw solar array on the roof meets most of the hospital’s electricity needs, even powering the facility’s only air conditioning unit in the surgical ward. “It was a deliberate design decision to work with the natural environment as much as possible and also to address the cultural context,” says Tyler Survant from Sharon Davis Design in New York, which also conceptualised the unique Women’s Opportunity Centre in Rwanda. “We had to plan for a different kind of hospital from the West: here you have patients and relatives who have travelled for days on foot to get here.” <img width="640" height="828" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108151116/636a652b9c7e80680e059916jpeg.jpg" alt="">Bayalpata has public outdoor spaces and canopied courtyards to serve as comfortable waiting areas, while the operating theatres and wards are recessed. Unlike in the US, staff housing also had to be integrated into the facility since it has fulltime resident doctors, who live with their families.

Bayalpata Hospital in Nepal wins global design award

<figure><img width="1000" height="1500" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108111156/636a35fe9c7e80680e0482dfjpeg.jpg" alt=""/><figcaption>Pic: BIKRAM RAI</figcaption></figure>Suresh Shakya (pictured above) was sitting down for lunch with his family in his house in Itum Bahal four years ago when there was a terrifying, subterranean growl, and his building started shaking.Shakya, 46, knew it was an earthquake, and while he was concerned the house could collapse, he was even more afraid that an adjacent, new 10-floor highrise that a neighbour had built would topple on him.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108111156/636a36019c7e80680e0482e0jpeg.jpg" alt="" width="1000" height="454">Outside, it was difficult to stand as the ground rolled. An hour later, there was a big aftershock and Shakya remembers the tall building swaying like a tree in a storm, creating deep gashes on his house, which remains propped up by timber to this day.Seismologists warn that the quake four years ago this month was just a warning, and that Nepal faces serious risk from even bigger earthquakes in future. This precarious highrise is not likely to survive those ones.Read also: <a href="https://www.nepalitimes.com/?p=25092&amp;preview=true" target="_blank" rel="noopener">Lessons Unlearnt</a>, Editorial<a href="https://www.nepalitimes.com/?p=25110&amp;preview=true" target="_blank" rel="noopener">Shaking up the health sector</a>, Sewa Bhattarai<a style="background-color: #ffffff; font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/?p=25119&amp;preview=true" target="_blank" rel="noopener">Quake was a learning experience for Nepal’s schools</a>, Prakriti KandelOn the fourth anniversary of the 25 April 2015 earthquake, experts warn that attention should now shift to retrofitting and strengthening hospitals and schools across the country. More than 1,000 health facilities and 5,000 schools were completely destroyed in 2015, and tens of thousands of children could have been killed if the disaster had happened on a weekday.  Hospitals and schools flattened in the 2015 earthquake are being rebuilt, but what about the rest of Nepal vulnerable to future quakes? A recent Ministry of Health (MoH) study showed the government hospital in Nepalganj was structurally so weak that it needs to be demolished, and recommends retrofitting four other hospitals in Western Nepal that do not meet the WHO Health Safety Index."The study is a warning. The condition of rural health facilities across Nepal is similar, and we need to quickly retrofit them before the next disaster strikes,” says Chudamani Bhandari of the Health Emergency and Disaster Management Unit at the MoH. "Western Nepal is in greater danger of a big earthquake, so we have decided to focus there."The Disaster Risk Reduction and Management Act of 2018 stipulates that the main responsibility of managing crises now lies at the local level, but the MoH says it first wants to build capacity at the provincial level.Read also:<a href="https://www.nepalitimes.com/here-now/nepals-traditional-seismic-resistant-designs/" target="_blank" rel="noopener"> </a><a href="https://www.nepalitimes.com/here-now/nepals-traditional-seismic-resistant-designs/" target="_blank" rel="noopener">Nepal's traditional seismic resistant designs</a>, Sheilin Teo<a style="background-color: #ffffff; font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/here-now/building-back-cheaper-and-stronger/" target="_blank" rel="noopener">Building back cheaper and stronger</a>, Sapana Shakya and Aman Raj KhatakoHowever, the first step must be to carry out a baseline safety inspection of medical centres all over the country. The National Reconstruction Authority (NRA) plans a survey of schools and hospitals, but only after it is done with reconstruction.The National Society for Earthquake Technology (NSET) is also resuming its retrofitting of schools in Western Nepal that it had started before 2015. Says NSET’s Surya Narayan Shrestha: "We need to concentrate on Western Nepal because the vulnerability of public buildings there is high.” Western Nepal is said to be particularly at risk because it has not had a mega-earthquake for the past 500 years. DFID is supporting NSET with a Safer Schools Project to retrofit classrooms in the region.Schools are important community hubs and strengthening them can raise public awareness about safer construction in areas that are at high risk. In fact, 2015 itself provided a lesson for schools. Deepak Sharma of the Ministry of Education explains: "The few schools that were retrofitted before 2015 suffered no damage, so we are trying to retrofit schools in all districts for future earthquakes."Read also:  <a href="https://www.nepalitimes.com/here-now/nirmala-pariyars-2nd-life/" target="_blank" rel="noopener">Nirmala Pariyar's second life</a>, Ramu Sapkota<a style="background-color: #ffffff; font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/opinion/nepal-is-being-loved-to-death/" target="_blank" rel="noopener"> Nepal is being loved to death</a>, Anil Chitrakar

Tall Order

Nepal’s oldest maternity hospital is still recovering from the April 2015 earthquake: its main building had to be demolished after earning a red sticker because of its structural damage. Soon, it will move into a new seismic-resistant wing, designed to withstand future earthquakes. For now, the hospital is working out of temporary cramped quarters offering only 375 beds out of the normal 415. But when the new building is inaugurated next month, the hospital will have more capacity, lecture rooms, an emergency ward, operating theatres and an ante-natal section. <div class="embed-block"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108111156/636a36329c7e80680e0482f4jpeg.jpg" alt="" width="1000" height="454"></div> Hospital director Jageshwor Gautam looks excited to show &nbsp;visitors around the construction site. “We expect our work to be much easier when the new building is completed and we can use the new space,” he says. Read also: <a href="https://www.nepalitimes.com/?p=25119&amp;preview=true" target="_blank">Quake was a learning experience for Nepal’s schools</a>, Prakriti Kandel <a href="https://www.nepalitimes.com/?p=25092&amp;preview=true" target="_blank">Lessons Unlearnt</a>, Editorial&nbsp; <a href="https://www.nepalitimes.com/here-now/tall-order/" target="_blank">Tall order</a>, Sewa Bhattarai and Prakriti Kandel The project is supported by the Japan International Cooperation Agency (JICA), built by consultant Hazama Ando and is expected to be handed over on 15 May. The 2015 earthquake damaged 1,197 health facilities across Nepal, offering them a chance to rebuild so they can withstand future quakes. A survey done before the 2015 disaster had shown that of the 14 hospitals tested in Kathmandu, only 2 (Teaching Hospital and Patan Hospital, built by the Japanese) were seismic resistant. The situation in other parts of the country was even worse. <div class="embed-block"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108111156/636a36329c7e80680e0482f4jpeg.jpg" alt="" width="1000" height="454"></div> JICA is working to rebuild modern and safe hospital wings at Paropakar Maternity Hospital (pictured, right) and Bir Hospital, both in Kathmandu. They will enjoy advanced technologies like motion-sensor taps in order to reduce infections in washrooms, flush systems that reuse water from handwashing, handicapped-friendly toilets and treatment plants for hospital waste. Elsewhere in the quake-affected areas, however, reconstruction of health facilities is not going as well. Only 55% of the health posts and hospitals that were damaged or destroyed have been repaired, according to the National Reconstruction Authority (NRA). “The construction of hospitals was delayed due to technical reasons, but now they are our top priority,” says Manohar Ghimire of the NRA. “Of the 643 structures built, most are pre-fab structures which have already been handed over to the communities. Now we are focusing on rebuilding the rest.” The reconstruction of health facilities was delayed because the central government could not agree on who should rebuild them. The Ministry of Health and Population had planned to do it, before passing it on to the NRA almost a year after the earthquake, where the plans faced further delays. That cost a total delay of two years, resulting in a reconstruction rate of only 53%, when the target was 65%. Read also:&nbsp; &nbsp;<a href="https://www.nepalitimes.com/here-now/nepals-traditional-seismic-resistant-designs/" target="_blank">Nepal's traditional seismic resistant designs</a>, Sheilin Teo <a href="https://www.nepalitimes.com/here-now/building-back-cheaper-and-stronger/" target="_blank">Building back cheaper and stronger</a>, Sapana Shakya and Aman Raj Khatako <div class="embed-block"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108111156/636a36369c7e80680e0482f6jpeg.jpg" alt="" width="1400" height="786">Nepal's oldest maternity hospital is currently operating out of cramped quarters, forced to put some beds in corridors due to lack of space.</div> Of the 524 medical facilities that need to be rebuilt, 145 are under construction, while the rest seem to be inordinately delayed due to technical reasons. "Many health centres do not have their own land, and there are no guidelines for buying land. We can only build on already available land," says Pranaya Upadhyaya, senior Public Health Administrator at the Ministry of Health. "Before the earthquake, many were operating from schools or other government buildings. But now we have strict standards for medical facilities including size of land, type of soil, etc. The institutes that are having a hard time fulfilling these criteria are the one that are delayed." Upadhyay informs that work has not begun on the 250 health centres that the Indian government committed to, which contributes to the reason more than 500 of them remain to be built. Even if the earthquake had not occurred, Nepal’s health sector needed a structural revamp. A survey two decades ago of 14 hospitals in Kathmandu by the National Society for Earthquake Technology (NSET) showed that only two of the facilities would be fully functional if hit by a high-intensity earthquake, and four would be partially operational. Read also:&nbsp; <a href="https://www.nepalitimes.com/here-now/nirmala-pariyars-2nd-life/" target="_blank">Nirmala Pariyar's second life</a>, Ramu Sapkota <a href="https://www.nepalitimes.com/opinion/nepal-is-being-loved-to-death/" target="_blank">Nepal is being loved to death</a>, Anil Chitrakar Survey leader Ramesh Guragain explains that quake intensity is not just &nbsp;measured in the Richter scale, but by many other factors like depth, type of soil and distance from the epicentre. Which means that the intensity of the 2015 earthquake caused greater damage nearer the epicentre than in districts around Kathmandu. A subsequent NSET survey of five regional hospitals outside Kathmandu also showed that Nepal’s health care centres are structurally unprepared for future large-scale disasters. Although services and facilities in some of the hospitals have improved, the structures within which they are housed are weak and could collapse. Kathmandu’s oldest medical centre, Bir Hospital, in the heart of the city, has no space for expansion. After the 2015 earthquake damaged its mortuary, the hospital is constructing a new building in its place, which will also house its nephrology, cardiology and gastrology departments, but it is still short of space. “Even after we start using our new facilities, we will need more space for the nursing campus, pediatric and maternity departments, organ transplant centre and many other services,” says Bir’s director Kedar Prasad Century, adding that there is no option but to expand to Duwakot in Bhaktapur, outside of Kathmandu. Hospitals with large capacity will be much in demand after the next earthquake, and if they are knocked out of service, the injured will have nowhere to go. In 2015, many hospitals worked in the open or out of tents for months after the earthquake. “In order to avoid such a situation in future, it is imperative that the reconstruction and retrofitting of hospitals be carried out with the utmost priority,” says NSET’s Guragain. If this is the situation in Nepal’s privileged capital, one can only imagine what it is like in district hospitals. Many of the buildings are in advanced stages of disrepair, lack hygiene and are overcrowded, even in normal times. During disasters, hospitals will have to cope with a large influx of patients but the medical centres themselves will have suffered damage. Read also: <a href="https://www.nepalitimes.com/editorial/aint-seen-nothing-yet/" target="_blank">Ain't seen nothing yet</a>, Editorial

Shaking up the health sector

<figure><img width="1000" height="2392" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108111156/636a36059c7e80680e0482e1jpeg.jpg" alt=""/><figcaption>Photo: BIKRAM RAI</figcaption></figure>Four years later, Central Nepal is still being rocked by aftershocks of 2015. That peculiar earthquake shook everything to the east of the epicentre, and inflicted almost no damage at all to its west. The release of tectonic energy appears to have travelled along a rupture zone from Gorkha and ground to a halt somewhere beneath the southern edge of the Kathmandu Valley. The <a href="https://www.nepalitimes.com/editorial/aint-seen-nothing-yet/" target="_blank" rel="noopener">stored tension</a> of the 7.8 magnitude earthquake is only partially spent.Read also: <a href="https://www.nepalitimes.com/?p=25110&amp;preview=true" target="_blank" rel="noopener">Shaking up the health sector</a>, Sewa Bhattarai<a style="background-color: #ffffff; font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/?p=25119&amp;preview=true" target="_blank" rel="noopener">Quake was a learning experience for Nepal’s schools</a>, Prakriti Kandel<a href="https://www.nepalitimes.com/here-now/tall-order/" target="_blank" rel="noopener">Tall order</a>, Sewa Bhattarai and Prakriti Kandel<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108111156/636a36079c7e80680e0482e2jpeg.jpg" alt="" width="1000" height="454">For the first two years after the earthquake, memory was still fresh and we were careful about building back better. There was even talk of strictly enforcing the building code. <a href="http://archive.nepalitimes.com/article/nation/A-concrete-future,2251" target="_blank" rel="noopener">Look at us now</a>. The kinds of structures that are going up in Kathmandu prove that we have all but forgotten what an earthquake can do. There is still <a href="http://archive.nepalitimes.com/page/not-out-of-danger-the-big-one" target="_blank" rel="noopener">the unfinished business</a> of 2015 beneath the Valley, and below western Nepal is <a href="https://www.nepalitimes.com/here-now/past-disasters-foretold/" target="_blank" rel="noopener">the ticking time bomb</a> of tension from the <a href="https://www.unr.edu/nevada-today/news/2016/nepal-earthquake-danger" target="_blank" rel="noopener">subduction</a> of the Indian plate into the Eurasian landmass, which has not been released for nearly 700 years.We still don’t seem to fathom <a href="http://archive.nepalitimes.com/article/from-nepali-press/not-destructive-as-predicted-but-the-loss-is-still-great,2221" target="_blank" rel="noopener">how lucky we were</a> that the 2015 earthquake occurred on a Saturday, did not happen at night, and that it was below 8 magnitude. April 25 was a warning to enforce seismic-resistant designs in private homes, but especially public buildings. <a href="https://www.nepalitimes.com/banner/class-struggle/" target="_blank" rel="noopener">Schools</a> may not be so lucky next time, and classrooms need to be strengthened. Our hospitals have poor construction, as the destruction of a newly-built <a href="http://archive.nepalitimes.com/article/nation/being-prepared-for-monsoon-and-outbreaks,2293" target="_blank" rel="noopener">district hospital in Chautara</a> in 2015 proved. Pre-positioning supplies, digging equipment and designating open spaces for evacuation needs to happen now. Across Nepal, earthquake drills will be more important than singing the national anthem at assembly.https://www.youtube.com/watch?v=hpABIXZIp2k&amp;feature=youtu.beWhile thinking and preparing ourselves for future shocks, there is also all the catching up we have to do to reach the most vulnerable survivors of the 2015 earthquake. It is not just about distributing the insufficient amount earmarked for rebuilding homes, but also rehabilitating families, providing skills training and finding jobs near home for them.The <a href="https://www.nepalitimes.com/banner/disastrous-management-in-nepal/" target="_blank" rel="noopener">National Disaster Management Act</a> has been passed, but where is the <a href="https://nepalitimes.atavist.com/reconstruction-in-ruins" target="_blank" rel="noopener">Authority</a>? The NRA now needs to be phased out (it wasn’t much help anyway) to prepare for the Next Big Ones. It is a feeble hope, but let us not get bogged down in turf battles and allow the Home Ministry to mess it up with political appointments and job distribution to party faithful again.Under the federal structure, we have a new opportunity to decentralise disaster preparedness, planning and management.  Every municipality now has to take responsibility from ward level up, so that there is a search, rescue and relief plan in place. But given that so many mayors and local elected officials are contractors who are awarding construction jobs to themselves, there is not much hope. We wish the incompetence of Kathmandu Municipality in earthquake rehabilitation of monuments was an exception, but it is the rule. The delays in rebuilding <a href="http://archive.nepalitimes.com/blogs/thebrief/2016/08/29/halt-rani-pokhari-reconstruction/" target="_blank" rel="noopener">Rani Pokhari</a> and <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/rebuilding-kasthamandap-nepal,4012" target="_blank" rel="noopener">Kastamandap</a> are national disasters in themselves. It is hard to figure out who is more culpable — Mayor Shakya or the Department of Archaeology. There are lessons to be learnt about how not to organise compensation for rebuilding. While a lot more of the grants have been cleared, there are many families who have found loopholes to build tiny cement sheds just to get their hands on the cash.As our coverage this past month in the run-up to the fourth anniversary of the quake, and in this issue, indicate: it is now time to also turn our attention to the seismic risk in the rest of the country. For the past four years, we have been in rehab mode, picking up the pieces of the damage in Central Nepal’s 14 districts. It bears repeating that the risk is now to the whole country from the massive slip that is bound to occur sooner or later in Western Nepal. There is no other way to put it: the death and destruction from it will be nationwide and catastrophic. Read also: <a href="https://www.nepalitimes.com/editorial/aint-seen-nothing-yet/" target="_blank" rel="noopener">Ain't seen nothing yet</a>, Editorial <h2>10 years ago this week</h2> This Editorial titled ‘Half full’ from issue #447 of 16-23 April 2009 tried to look at the bright side, but could not find much to be cheerful about. Not much has changed in Nepal in 10 years. Excerpt:‘Wonder if Pushpa Kamal Dahal, sitting in Baluwatar and preparing for his China visit, has any clue about the rising frustrations of the people. The Maoists may have got three of the six seats in the by-elections, but that is not the real barometer. Ask people stuck inside buses for 24 hours because the government can’t clear the week-long blockade of the country’s main national highway by flood victims. Ask city-dwellers who have seen no respite from power and water shortages.This coalition has spectacularly failed to deliver. There is no law and order, youth wings of ruling parties roam the streets and the police have no orders to intervene.’<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108111156/636a36089c7e80680e0482e3jpeg.jpg" alt="" width="508" height="811">

Lessons Unlearnt

In the black and white photograph, General Wangdu smiles broadly in front of the dusty cactus garden in Kathmandu’s Annapurna Hotel. With an ill-fitting jacket and shaggy hair he looks benign enough, but this was the last leader of the Tibetan freedom fighters who led the resistance against the Chinese from their remote mountain hideouts in <a href="https://nepalitimes.com/here-now/comings-and-goings-in-mustang">Mustang</a>. Five months later, Wangdu was dead. Snapped in March 1974, I had only recently arrived in Nepal. How did I meet this legendary fighter? Possibly with his devoted camp follower, Lynne Klapecki, and probably in the Om Restaurant near Freak Street which was the preferred <a href="https://nepalitimes.com/banner/hippie-trail-nostalgia-in-kathmandu">hippie hang-out</a>. Om Lobsang and his brother Yeshe were <a href="https://archive.nepalitimes.com/page/earthquake-brings-back-memories-of-camps-for-tibetan-refugees">refugees from East Tibet </a>whose cafe offered a friendly welcome and<a href="https://nepalitimes.com/multimedia/momo-loco"> the best momos</a> - they became my in-laws after I married their eldest brother Tenzin, but that was a decade later.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025052403054_4573b34282b0f5395c007243d6bef12c7ba76bfd520419e994cdcea048d795a1.jpg" data-media-id="editor_4" data-image-id="2025052403054_4573b34282b0f5395c007243d6bef12c7ba76bfd520419e994cdcea048d795a1" data-rendition-name="original" width="1000" height="1583" loading="lazy" alt="The last days of the Khampa NT"> <figcaption>Photo: LISA CHOEGYAL</figcaption> </figure>  Wangdu’s English was enthusiastically rudimentary, but even riding around town with him on the back of an aging <a href="https://nepalitimes.com/here-now/kathmandu-s-new-motorbike-museum">motorbike</a>, he was a commanding presence. Always flanked by armed outriders, impressive scars marked his forearms and a pistol hung from the cord around his neck. A charismatic guerrilla leader, Wangdu was celebrated by his followers for his tough commitment and respected for his measured pragmatism. He seemed so young to have shouldered such a responsibility of command, leading hundreds of hardened <a href="https://archive.nepalitimes.com/article/nation/50-years-after-the%20raid-into-Tibet,1012#google_vignette">Khampa combatants </a>through what had been a particularly <a href="https://nepalitimes.com/news/heavy-snowfall-over-nepal-himalaya">brutal winter in Mustang</a>, the last bastion to hold out against the Chinese invasion of their Tibetan homeland.&nbsp; The freedom fighters of Tibet, known as the Chushi-Gangdruk, had emerged to resist the <a href="https://nepalitimes.com/editorial/territorialism">Chinese takeover</a> of Tibet during the 1950s. Estimated to be 80,000-strong at the time of <a href="https://nepalitimes.com/here-now/what-or-who-after-the-dalai-lama">the Dalai Lama</a>’s final escape to India in 1959, the sheer number of Chinese deployed into Tibet eventually forced the Chushi-Gangdruk to retreat to Mustang, From this high Himalayan stronghold, they continued cross-border raids on the Chinese People’s Liberation Army (PLA) throughout the 1960s.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025052403054_8a4a935ba25ae79dc3a63bb5c14626927020e5ec098093c45ccb9a5982e009fd.jpg" data-media-id="editor_10" data-image-id="2025052403054_8a4a935ba25ae79dc3a63bb5c14626927020e5ec098093c45ccb9a5982e009fd" data-rendition-name="original" width="1114" height="676" loading="lazy" alt="The last days of the Khampa NT"> <figcaption>Guerrillas known as the Chushi-Gangdruk emerged to resist the Chinese annexation of Tibet during the 1950s. Photo courtesy: MIKEL DUNHAM</figcaption> </figure>  Their Kathmandu base was a small discreet lodge in a back lane near Rani Pokhari. Sipping sweet tea from a blue mug with a chipped lid, I sat bemused in a corner of the Mustang Hotel room whilst Wangdu and his cohorts received a battered brown suitcase from their CIA connection, a tousle-haired American in a leather jacket. Heaved onto the dingy bedspread that covered the thin mattress, it was clicked open to reveal piles of neatly stacked dollar bills.&nbsp; I cannot think why Wangdu allowed me to witness this handover but I was clearly no threat, a newly arrived world traveller with no understanding of the stakes nor any Nepali or <a href="https://nepalitimes.com/multimedia/tibetan-music-in-nepals-sacred-valley">Tibetan language</a>. Despite armed guards in the corridor,Wangdu radiated confidence and bravado, and there was a practiced familiarity to the tense transaction. This deadly dance for many years had been funded by the Americans, tolerated by <a href="https://nepalitimes.com/here-now/the-kingdom-within-a-republic">Mustang’s residents</a>, and permitted by King Mahendra and the Nepali authorities who it suited to turn a blind eye.&nbsp; But Mahendra died in 1972, and times were changing. Richard Nixon’s ping-pong diplomacy thawed the cold war and signalled a fresh entente with China. Nepal’s yet-to-be-crowned <a href="https://nepalitimes.com/here-now/if-birendra-was-alive-nepal-could-still-be-a-monarchy">King Birendra </a>was under pressure to curb the irritating incursions against the PLA launched from the Nepali territory of Mustang. Keen to appease his northern neighbour, on several occasions the King summoned Wangdu for peace talks but, despite increasingly overwhelming odds, Wangdu refused to surrender.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025052403054_a8efd5cfb92cd997bd7cb74296a936fef46e2f7428f9cd642b03f1ac4ea11ecb.jpg" data-media-id="editor_14" data-image-id="2025052403054_a8efd5cfb92cd997bd7cb74296a936fef46e2f7428f9cd642b03f1ac4ea11ecb" data-rendition-name="original" width="1055" height="885" loading="lazy" alt="The last days of the Khampa NT"> <figcaption>General Wangdu flanked by two Tibetan resistance fighters in Mustang in the 1970s. Photo courtesy: MIKEL DUNHAM</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025052403054_75969125a745847a2ef82b6fe8b9106c0b21a116d85b8efdf5d2ee89a347bb31.jpg" data-media-id="editor_15" data-image-id="2025052403054_75969125a745847a2ef82b6fe8b9106c0b21a116d85b8efdf5d2ee89a347bb31" data-rendition-name="original" width="1044" height="792" loading="lazy" alt="The last days of the Khampa NT"> <figcaption>King Birendra with General Wangdu (right in dark glasses) taken in 1974 possibly in Mustang after one of their few attempts at negotiation. Photo courtesy: RAJRNDRA KUNWAR</figcaption> </figure>  While I naively rode pillion around Kathmandu in the spring sunshine, Wangdu was in the midst of what turned out to be his final round of negotiations with the Nepal government. Refusing to cease hostilities with the Chinese, Wangdu must have suspected the cost of his decision, making his cheerful smile in the photograph all the more poignant and brave. It was only much later that I appreciated the significance of the moment. Wangdu had been sent to replace the first resistance leader in Mustang, Baba Gen Yeshe, a much derided corrupt character who stole money meant for his troops and exploited fleeing refugees by seizing their treasures. Baba Gen Yeshe never forgave Wangdu,and sought revenge in May 1974 by betraying him and his commanders to the Nepal authorities. Renewed Chinese incursions from the north, active PLA collusion with the Nepali forces under the new King, and treachery from within the Chushi-Gangdrukranks combined to seal their fate.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025052403054_e0987a7c90d76431b0d7d5e6115ebfe3dbda7ab939e5941e079c18d722e884c0.jpg" data-media-id="editor_16" data-image-id="2025052403054_e0987a7c90d76431b0d7d5e6115ebfe3dbda7ab939e5941e079c18d722e884c0" data-rendition-name="original" width="1400" height="769" loading="lazy" alt="The last days of the Khampa NT"> <figcaption>British television journalists George Patterson and Adrian Cowell embedded themselves with Khampa guerrillas and accompanied them from Tsum Valley on a cross border raid on a Chinese Army convoy in 1964. Photo: ESSAYS ON NEPAL / SAM COWAN</figcaption> </figure>  Mikel Dunham, renowned author of Buddha’s Warriors, writes: ‘It is possible that Wangdu was waiting for some cue from the Dalai Lama’s government-in-exile in Dharamsala, India. It is equally possible – during that last, <a href="https://nepalitimes.com/multimedia/the-human-cost-of-nepal-s-yarsa-gold-rush?fbclid=IwZXh0bgNhZW0CMTEAAR31-Cqw8oyIwMPzf_35e4Skr0ululJvLf3_vDkzHn-AYG2h8uPw2rqqErg_aem_tGVn5coY1-jA7fze_xqhew">desolate winter </a>– that he made the decision to go out in glory rather than admit defeat. Over the last fifteen years, Wangdu had experienced Tibet’s organized resistance being squeezed and shoved around by every conceivable outside force.&nbsp; First they had been pushed out of their own country by the PLA; then they had been refused sanction while on <a href="https://nepalitimes.com/opinion/borderlines/nepal-india-trans-boundary-bonds?fbclid=IwAR0PpJ5zUEbwdug3g_U3ar6FUugngRY0S8Tl2v_7wqzrsHmXWcXsKjvL4t4">Indian soil</a>; then they were abandoned by the Americans because, apparently, Nixon wanted to make friends with Wangdu’s mortal enemies, the communists; then they had been betrayed by the vampiric Baba Gen Yeshe – a Tibetan and, even worse, a fellow Khampa; and now, finally Wangdu’s army was being evicted by the Nepalis. One thing was certain: Wangdu was a warrior. To imagine Wangdu simply giving up and settling down in the pacific squalor of a <a href="https://nepalitimes.com/here-now/elderly-left-in-bhutan-refugee-camp">refugee camp </a>was unthinkable.’  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025052403054_8fc1ffef4ae751628b90ae781b66e11e51e4fdde2787207c9042efbee345ce49.jpg" data-media-id="editor_20" data-image-id="2025052403054_8fc1ffef4ae751628b90ae781b66e11e51e4fdde2787207c9042efbee345ce49" data-rendition-name="original" width="500" height="746" loading="lazy" alt="The last days of the Khampa NT"> <figcaption>The much derided Baba Gen Yeshe, the first Tibetan resistance leader in Mustang, who betrayed Wangdu for personal gain. Photo courtesy: MIKEL DUNHAM</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025052403054_b1d833cdb00d3ac4416b844d8730475cd88c238caaaf8da69889a584eea229a3.jpg" data-media-id="editor_21" data-image-id="2025052403054_b1d833cdb00d3ac4416b844d8730475cd88c238caaaf8da69889a584eea229a3" data-rendition-name="original" width="500" height="656" loading="lazy" alt="The last days of the Khampa NT"> <figcaption>Aditya SJB Rana of the Royal Nepal Army whose team ambushed Wangdu and his cohorts at the top of Tinker Pass in Darchula, West Nepal. Photo courtesy: GAUTAM SJB RANA</figcaption> </figure>  By August 1974 the game was up. Wangdu and six of his exhausted party were killed on their horses by <a href="https://archive.nepalitimes.com/news.php?id=7270">the Royal Nepal Army</a> on the brink of escape. The officer in charge, Aditya SJB Rana, cleverly predicted their route into India after they failed to silence a police radio in Yari. A carefully laid ambush trapped them near the summit of the Tinker Pass in Darchula,at 5,000 meters the highest military operation of its time. Wangdu’s body was helicoptered to Kathmandu, and a big show made of the royal Nepal victory.&nbsp; The Tibetan armed insurgency against China had reached its end.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250524030520_3ff9c6fc85a65bc9a2c3afe9736d9f5f9413de752e790a5d9dca0981ea94f9b4.jpg" data-media-id="editor_23" data-image-id="20250524030520_3ff9c6fc85a65bc9a2c3afe9736d9f5f9413de752e790a5d9dca0981ea94f9b4" data-rendition-name="original" width="1136" height="702" loading="lazy" alt="The last days of the Khampa NT"> </figure>

The Last Days of the Khampa

The newly-formed Himalayan Art Council is set to launch Nepal’s National Art Protection Platform that seeks to preserve <a href="https://nepalitimes.com/banner/the-history-of-heritage">Nepal’s unique cultural heritage </a>using<a href="https://nepalitimes.com/here-now/artificial-censorship"> AI-powered tools</a>. The Council seeks to safeguard <a href="https://nepalitimes.com/banner/nepali-art-going-places">Nepali art works</a> from neglect, theft and counterfeiting as well as preserve existing artwork and celebrate living masters by giving them a cultural space to continue the <a href="https://nepalitimes.com/banner/sacred-survival">sacred art traditions</a>. "We are introducing a new digital platform designed to preserve, verify and elevate <a href="https://nepalitimes.com/banner/nepals-new-generation-of-alternative-artists">Nepal’s art for generations to come,</a>” says a statement from the Council, adding that the digital platform will use AI told for authentication and blockchain to keep track of works of art. Artists can now be protected by <a href="https://nepalitimes.com/multimedia/ayo-ai?fbclid=IwAR1uwmTVq4gUB70ljfRezjzukD9ArWXPuMnUikopeQ8PoiZMjicToPSwhKE&amp;=1">AI tools</a> that detect forgeries, identify their work even when unsigned, and ensure they receive proper recognition and credit. The archives will be searchable with translated inscription and interactive guides. Says curator Meena Lama: “AI and blockchains are tools that give us the power to detect fakes and identify unsigned paintings and track every piece. With these tools we can restore trust, secure authorship and give artists the dignity they deserve.”  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250514170544_2ab58f6313c0458f75114a692b0016bd9efb3b59d5f8f07f0da72e1e37b82f53.jpg" data-media-id="editor_6" data-image-id="20250514170544_2ab58f6313c0458f75114a692b0016bd9efb3b59d5f8f07f0da72e1e37b82f53" data-rendition-name="original" width="1300" height="1000" loading="lazy" alt="Artwork at the Traditional Art Exhibition at Patan Museum."> <figcaption>Artwork at the Traditional Art Exhibition at Patan Museum.</figcaption> </figure>  The Council is also holding an exhibition of Nepali cultural masterpieces with 50 historical <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/Buzz-the-art,671">thangka and paubha </a>by past masters and <a href="https://nepalitimes.com/review/between-the-sacred-and-everyday">contemporary works by current artists</a>. This curated collection is a living tribute to <a href="https://nepalitimes.com/here-now/when-yaks-go-so-does-culture">Himalayan culture</a> with economic depictions of deities, mandala and sacred narratives. The exhibition at <a href="https://nepalitimes.com/multimedia/a-portal-into-patan-s-past-and-present">Patan Museum</a> also provides an opportunity to meet painters and custodians of art and culture. Read also: <a href="https://nepalitimes.com/review/golden-deities">Golden deities</a>, Sewa Bhattarai ‘The exhibition is only the first step in a long journey to ensure that Nepali art is no just seen but fully understood, <a href="https://archive.nepalitimes.com/article/nation/Narratives-of-Faith-and-Memory-Remembering-the-Lost-Sculptures-of-Kathmandu-exhibition,987">protected and remembered</a>,’ the Council says. Artist Kailash K Shrestha of Artudio has spent decades promoting thankha and paubha traditions because of their beauty and devotional meaning. But he also says artists are underpaid, exploited and ignored. He adds, “AI and blockchain are not just buzzwords, they are powerful tools that can protect Nepal’s artists from fraud, verify authenticity and build a permanent record of provenance.” Traditional Art Exhibition Till 17 May Patan Museum

Digital protection for Nepal’s art

<a href="https://www.instagram.com/prabalgurung/" target="_blank">Prabal Gurung</a> left Nepal for New York in 1999 to escape years of bullying, sexism and homophobia, and to pursue his dream of becoming a fashion designer. He <a href="https://www.youtube.com/watch?v=KqN0VaoAI5w" target="_blank">realised his dream</a>, but did not escape discrimination and racism in the new world. Propelled by passion for fashion, Gurung overcame everything America threw at him. He has attained <a href="https://www.vanityfair.com/style/story/prabal-gurung-recalls-his-first-met-gala-when-zoe-saldana-was-at-his-side?srsltid=AfmBOooy-H0oGgxMit864FnW_Pmw8mUnV8rYrh-co-f6OyYK6m2ip5hP" target="_blank">fame and recognition</a> for his haute couture dress designs while remaining true to his Nepali roots, and is even more resolute in <a href="https://www.youtube.com/watch?v=dSmNauyzACk" target="_blank">fighting prejudice</a> in all its forms. Prabal Gurung’s newly-released memoir <a href="https://www.amazon.com/Audible-Walk-Like-Girl-Memoir/dp/B0DG11HCDQ?fbclid=IwY2xjawKZfpxleHRuA2FlbQIxMQABHuZcIJO2OXyXcRm1oq1iG6wzeoF7VJFrQ7GXOFI0YxuZZ4id_CNvSZSZZIna_aem_pG_mOKG73RTnYvN8JaC4fA">Walk Like a Girl</a> is a saga of harrowing abuse in boarding schools in Nepal and India, only finding himself facing a different kind of bullying in the US. He prevails over it all to be where he is today: an award-winning American fashion designer with his own label. Walk Like a Girl was launched last week in New York at a time when everything Gurung fought for — tolerance, inclusion and diversity — are in retreat in his adopted country because of a president who has espoused a culture of bullying. The book is a searing, raw exposé of how cruel and abusive people can be even at a young age in school. On the other hand, it also shows that there are generous, compassionate and open-minded souls out there. In his book, <a href="https://www.youtube.com/watch?v=K4le_uWX7YE">Prabal Gurung</a> calls out those who tormented and tried to hold him back (some of their names have been altered). The moral of his story is: resist, never stop believing in yourself, do not let others define you, never lose sight of your dream, and help those who have been kept out. “Walk like a girl” was a slur used by bullies back in school in Nepal and India for Gurung’s effeminate ways. He fought back then, and he is still resisting by turning those words into something to be proud of.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250519170544_4ffc9c3f565dd2cfa754d10b224816897b82bb31ebaee91b6d79d469fc96f14e.jpg" data-media-id="editor_6" data-image-id="20250519170544_4ffc9c3f565dd2cfa754d10b224816897b82bb31ebaee91b6d79d469fc96f14e" data-rendition-name="original" width="1000" height="1253" loading="lazy" alt="Prabal Gurung NT"> <figcaption>Prabal Gurung at home in Kathmandu in the 1990s.</figcaption> </figure>  “Living through it all was one thing, but writing about it is one of the hardest things I have done in my life,” admitted Gurung during the launch. “I broke down constantly during the six-year writing process.” He continues: “I did not want this to be a victim’s book. I did not want to burden my readers with my emotions. I wanted my struggle to be an inspiration for others facing what I faced. I am grateful to those who bullied me in school, they made me a stronger person ready to face the world.” Indeed, this book is a departure from his earlier one titled simply, Prabal Gurung (Abrams, 2019), which was a lush pictorial autobiography of his career in fashion. Walk Like a Girl is not a typical fashion book, it is an intimate tale of <a href="https://archive.nepalitimes.com/news.php?id=16997">Gurung’s travails and triumphs</a>, and how he willed himself to succeed. Prabal pays a lavish tribute to his mother Durga Rana. We find out she is a descendant of the first wife of the eldest son of Jang Bahadur Rana who was banished to Palpa in the late 19th century. Prabal’s father served in the Singapore Police and that is where he was born before the family returned to Nepal when he was four. Gurung relates with brutal honesty about the violence his mother endured from his father. Durga raises three children as a single mother in Nepal, and Prabal credits her for his fierce determination to resist patriarchy and injustice, which in time manifests itself in his hyper-feminine and subversive dress designs. Writing the book has been a cathartic experience for Gurung, who says he is now relieved of the burdens of his past. It no longer haunts him, and he does not have to prove anything to anyone anymore. Walk Like a Girl has life lessons not just for the <a href="https://www.instagram.com/p/DJmOcSgxdWz/" target="_blank">fashion industry</a>, but for every other profession. How can my job serve a greater cause? Gurung tells us his work is <a href="https://asiasociety.org/blog/asia/why-designer-prabal-gurung-doesnt-want-just-stick-fashion" target="_blank">bigger than just making clothes</a>, it is about making the world a better place because it could do with a lot of improvement.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250519170544_d75296ad8bfdc00d88935f40d23543c6fea3d4d6a10e61a99d6cfc6127f2ee5b.png" data-media-id="editor_10" data-image-id="20250519170544_d75296ad8bfdc00d88935f40d23543c6fea3d4d6a10e61a99d6cfc6127f2ee5b" data-rendition-name="original" width="1516" height="1000" loading="lazy" alt="Prabal Gurung"> </figure>  This story of chasing the American dream may sound familiar to many immigrants: knocking on doors for jobs, rejections, trying to survive from day to day on expensive rent, and dealing with subtle racism in white America. Gurung finds racism is rife, and he is often mockingly called ‘gaysian’. He writes: ‘There was a strong hypocrisy — this idea of independence felt like a marketting ruse … and for all the talk of feminism in America, these high society women were trapped by the patriarchy just like in Nepal and India.’ After a trek to the Khumbu region in 2013, Gurung is inspired to use the colours, palette and textures of Nepal for his collection exhibited on Manhattan’s 8th Avenue. A major buyer tells him bluntly: “Stick to making pretty dresses … if I need to see a collection like this, I could buy a copy of National Geographic.” The New York Times was equally dismissive: ‘The designer tries to draw connections between blistered techo-fabric used to construct it and the topography of his homeland, Nepal. But, at the moment, he has lost his map.’ One potential investor tells Gurung he cannot design for Americana because “you do not look American”. Gurung wants to use expletives, but restrains himself. After a fundraiser in New York for the Nepal earthquake in 2015, some belittled his effort, saying: “Here comes the saviour."&nbsp; Read also: <a href="https://nepalitimes.com/review/prabal-gurung-by-prabal-gurung">Prabal Gurung by Prabal Gurung</a>, Kunda Dixit The Gurkha DNA must be dominant in Prabal Gurung’s genes because he does not take such mistreatment lying down. When asked by a fashion publicist why he was designing clothes for fat people, he snaps back: “Because of people like you.” He joins the Black Lives Matter and #MeToo movements, launches the Shikshya Foundation charity in Nepal, and has powerful allies among celebrities who wear clothes he designed: Michelle Obama, Oprah Winfrey, Sara Jessica Parker, Kamala Harris, Deepika Padukone … it is a long list.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250519150556_48a5f4211991a23fa85b64bbd5377575ca7081d97309d7542035591dda5180fe.png" data-media-id="editor_12" data-image-id="20250519150556_48a5f4211991a23fa85b64bbd5377575ca7081d97309d7542035591dda5180fe" data-rendition-name="original" width="1114" height="1534" loading="lazy" alt="Being Prabal Gurung by design"> <figcaption>Nigerian novelist Chimamanda Ngozi Adichie wearing Atelier Prabal Gurung’s design for Met Gala 2025 in which the theme was ‘Superfine: Tailoring Black Style’. </figcaption> </figure>  “I don’t dress women to look beautiful, they already are,” Gurung says. “I try to bring out their innate strength and grace.” <a href="https://www.instagram.com/stories/highlights/17908766880140171/" target="_blank">Admirers</a> tell Gurung he makes it all look so easy, but he used to put up a strong facade to not show his own vulnerabilities in public. “I was closed because of my childhood experiences,” he says. “I was always on guard to defend myself because I never knew where the next punch would come from.” But in <a href="https://www.youtube.com/watch?v=PPVepzPA210" target="_blank">Walk Like a Girl,</a> Gurung comes to terms with his vulnerability, and bares his soul. It has not been easy, it took sustained will power and support from his mother, sister Kumudini and a circle of close friends. “I made unbelonging my power,” he says. “Nepal is where I still have my heart and soul. Nepal grounds you. It is where people go to find themselves. But I escaped.” Recently appointed vice-chair of the <a href="https://cfda.com/about-cfda" target="_blank">Council of American Fashion Designers</a>, Gurung says: “I can’t believe I am here, it feels like it is happening to someone else. Writing this book, the healing has finally begun.” <h2>‘Everything is better in color’</h2> The Met Gala was two weeks later, and my table was an example of everything I’d been fighting for all these years as my guests represented everything I believed in: dynamic, powerful, influential women who were unapologetically original and unabashedly graceful. I was grateful to Anna for inviting me to host and dress a table that reflected my ethos—and for her guidance in doing so. I was also aware of the privilege as one of the first-­ever Asian fashion designers—not just from Nepal, but from the entire continent— to get the opportunity to do so. That fact was not lost on me. I reached out beyond the expected Hollywood celebrities and well-­known socialites to curate a table of exceptional women who inspired me. I invited Deepika Padukone and Alia Bhatt for their first-­ever Met Galas, as well as Michelle Yeoh, Mindy Kaling, Camila Cabello, Ashley Park, Denée Benton, KiKi Layne, Quannah Chasinghorse, and Grace Elizabeth. Together we checked many boxes: Asian, Black, Latinx, and Indigenous, each woman undeniably chic and powerful, a dazzling array of skin tones and experiences that proved my decades‑in‑the-­making hypothesis: everything is better in color. Excerpt from Walk Like a Girl Viking © 2025 by Prabal Gurung  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250519170520_6b91d560e9f072c37d16876901058c073a51ffa05e7ad1b9461d19e1c9c28215.jpg" data-media-id="editor_16" data-image-id="20250519170520_6b91d560e9f072c37d16876901058c073a51ffa05e7ad1b9461d19e1c9c28215" data-rendition-name="original" width="1136" height="702" loading="lazy" alt="Prabal Gurung book details NT"> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250519170520_345240c21be400e2ce2ec629b52bd82bb53890e5bd86fe95b48340d84b5f1748.jpg" data-media-id="editor_17" data-image-id="20250519170520_345240c21be400e2ce2ec629b52bd82bb53890e5bd86fe95b48340d84b5f1748" data-rendition-name="original" width="1136" height="702" loading="lazy" alt="Prabal Gurung book details NT"> </figure>  &nbsp;

Being Prabal Gurung by design

India and Pakistan are twins separated at birth. Tensions between them have been at a hair trigger ever since independence and has erupted into full scale conflict at least four times in the past 80 years.
The 22 April terrorist attack in Kashmir that killed 25 Indian tourists and a Nepali citizen, threatens to escalate tension between the two nuclear-armed nations. India has squarely blamed Pakistan for the attacks, and Prime Minister Narendra Modi has given his military “operational freedom” to respond. Pakistan has said it has credible intelligence of an Indian military strike and its officials have promised a “full spectrum” response — a code for a <a href="https://nepalitimes.com/editorial/thinking-the-thinkable">nuclear retaliation</a>.
For Nepal, the killing of its national in the Pahalgam attack comes as another stark reminder that in conflicts from Afghanistan to Iraq, from <a href="https://nepalitimes.com/opinion/how-to-agree-an-armistice-in-ukraine">Ukraine</a> to Israel, <a href="https://nepalitimes.com/news/10-nepalis-from-one-town-fighting-in-ukraine">Nepalis are getting caught in the crossfire</a>. The last time full-scale fighting broke out between <a href="https://nepalitimes.com/opinion/peacemongers-at-india-pakistan-border">India and Pakistan</a> on Kargil in 1999, at least 22<a href="https://nepalitimes.com/here-now/india-s-trial-by-fire-for-soldiers-from-nepal?%27%5C%22="> Nepalis fighting for the Indian Army</a> were killed in action.
Three of Nepal’s immediate neighbours (China, India, Pakistan) have nuclear weapons, and they do not have good relations. With China supplying weapons, <a href="https://nepalitimes.com/editorial/war-and-warming">missile technology</a> and other support to Pakistan, this triangular friction could set off a regional conflagration.&nbsp;
<a href="https://www.nature.com/articles/s43016-022-00573-0" target="_blank">Research at Rutgers University</a> has calculated that even a week-long tactical nuclear exchange between India and Pakistan would throw up so much smoke and debris into the atmosphere that it would block out the sun for years, and lead to a collapse of the <a href="https://nepalitimes.com/news/grow-nourish-sustain-together-world-food-day">global food system</a>. This does not take into account the radioactive fallout that prevailing winds would blow up to <a href="https://nepalitimes.com/here-now/lives-on-the-line-in-the-himalaya">the Himalaya</a>, contaminating glaciers that are the sources of <a href="https://nepalitimes.com/here-now/saving-what-is-left-of-himalayan-rivers">Asia’s main rivers</a>.
The impact of <a href="https://nepalitimes.com/news/climate-breakdown-linked-to-thame-flood">climate breakdown </a>on High Asia was already ringing alarm bells about its <a href="https://nepalitimes.com/news/himalayan-icecap-melting-faster-than-thought">shrinking ice cap</a> reducing the dry season flow of water downstream. Water was going to be the next strategic commodity, geopolitical experts warned, and the next wars in Asia would be over water.
That water war is already happening. India retaliated to the Kashmir attack by suspending the <a href="https://www.nytimes.com/2025/04/24/world/asia/india-pakistan-indus-waters-treaty.html" target="_blank">Indus Waters Treaty</a> of 1960 mediated by the World Bank that has withstood at least three wars between India and Pakistan. The treaty gives India control over the three eastern tributaries of the Indus (<a href="https://en.wikipedia.org/wiki/Beas_River" target="_blank">Beas</a>, <a href="https://en.wikipedia.org/wiki/Ravi_River" target="_blank">Ravi</a> and <a href="https://en.wikipedia.org/wiki/Sutlej" target="_blank">Sutlej</a>), while Pakistan got water from the Indus and two of its western tributaries (<a href="https://en.wikipedia.org/wiki/Indus_River" target="_blank">Indus</a>, <a href="https://en.wikipedia.org/wiki/Chenab_River" target="_blank">Chenab</a> and <a href="https://en.wikipedia.org/wiki/Jhelum_River" target="_blank">Jhelum</a>.
Pakistan was assured of 70% of the annual flow, and India could use a reasonable amount of water for<a href="https://archive.nepalitimes.com/news.php?id=15231"> irrigation and hydropower</a>. &nbsp;Within days of its threat, India stopped water flowing down to Pakistan from the Chenab river and is reportedly preparing to do the same on the Jhelum.
The sabre-rattling has reached a crescendo. Besides threats and counter-threats there are also symbolic drills, with the Indian Air Force practicing landing on an expressway in Uttar Pradesh by its Rafale, Su-30 and Jaguar fighter jets to demonstrate ‘operational readiness’. In response Pakistan test-fired its Abdali ballistic missile that can carry a nuclear warhead and has a range of 450km.&nbsp;
The danger is that with ultra-nationalist rhetoric and the beating the war drums by both sides, India’s government and Pakistan’s military may have to ‘do something’ to appease domestic public opinion. But any tactical strike, an artillery exchange, or territorial incursion could quickly escalate out of control.
Expecting an Indian retaliation for the Pahalgam killings, Pakistan is using<a href="https://nepalitimes.com/opinion/interfaith-collaboration-for-nuclear-disarmament"> nuclear deterrence </a>and warning of “catastrophic consequences”. The two neighbours came close to a nuclear exchange in 2019 after an attack on the Indian military in Kashmir, and prompt international intervention led by the United States cooled tensions.&nbsp;
This time, the <a href="https://nepalitimes.com/news/trump-shock-wave-hits-nepal">Trump administration</a> is too distracted and not as engaged. Pakistan has denied it was responsible for the terrorist attack and called on Washington to stop a possible Indian retaliation. India and Pakistan have stopped overflights by each other’s airlines, and some international carriers have even stopped flying over Pakistan fearing an air war.
Washington, Beijing, the UN and the EU have all urged restraint. Iran, which has good relations with both India and Pakistan has sent its foreign minister to urge both countries not to go into a tit-for-tat war. Iran has its own nuclear flashpoint to worry about with tensions in Israel, &nbsp;Yemen and Syria.
India and Pakistan both share similar problems of joblessness, <a href="https://nepalitimes.com/here-now/why-nepal-s-poverty-rate-is-stuck">poverty </a>and <a href="https://nepalitimes.com/here-now/climate-change-new-threat-to-nepal-s-rhinos">environmental threats</a>. Neither side needs the threat of a senseless war, and we in the neighbourhood do not need it either.&nbsp;
Kunda Dixit
This Editorial is brought to you by <a href="https://nepalitimes.com/" target="_blank">Nepali Times</a>, in collaboration with <a href="https://inpsjapan.com/en/" target="_blank">INPS Japan</a> and <a href="https://sgi-peace.org/" target="_blank">Soka Gakkai International</a>, in consultative status with UN ECOSOC.

hospital