<figure><img width="1500" height="1125" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111016114/636d13ad9c7e80680e0a9935jpeg.jpg" alt=""/><figcaption>Newly constructed public toilet in Patan Dhoka is being inagurated on 19 November, World Toilet Day. Photo: KUNDA DIXIT</figcaption></figure>The tactile pavement leads into a reception area inside a cylinder-shaped red brick building. The user pays Rs10, and the staff hands out a token for turnstiles that lead into the male and female lavatories. Visitors do a double take. This looks more like the entrance to the London Underground than <a href="https://www.aerosantoilets.ca/" target="_blank" rel="noopener noreferrer">a public toilet in Kathmandu</a>. The shiny new facility has motion-detector flushes, taps with sensors, a diaper-changing station, turbo-fan ventilation and a menstrual hygiene dispenser for tampons. The effluent goes into a biogas digester, rainwater from the roof is harvested in this new toilet plan that is being built across the Valley. The design was selected among top five projects at the Sarphati Sanitation Challenge during World Water Week this year. <figure><img width="721" height="960" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111016114/636d13b19c7e80680e0a9936jpeg.jpg" alt=""><figcaption>Photo: PRAKASH AMATYA</figcaption></figure>“Our priority is to operate public toilets sustainably and hygienically, and making latrines comfortable, especially for women and people with disabilities,” says Prakash Amatya of Aerosan Sustainable Sanitation that has built six model public toilets ‘hubs’ in Baneswor, Mangal Bazar, Buddha Park, Tripureswor, Ratna Park. In 1980, only 2% of Nepali homes had toilets. By 2018, 97% of Nepalis had <a href="https://www.nepalitimes.com/banner/toilet-trained/" target="_blank" rel="noopener noreferrer">latrine facilities</a>, and this improved hygiene and sanitation leading to a dramatic decrease in gastric infections, typhoid and other diseases, especially among children.Last year, amidst much fanfare, Nepal was declared ‘Open Defecation Free’, but the <a href="http://archive.nepalitimes.com/article/nation/Toilets-for,250" target="_blank" rel="noopener noreferrer">problem of sanitation and water-borne diseases</a> persist.<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/opinion/do-not-fail-students-in-wash/" target="_blank" rel="noopener noreferrer">Many schools</a>, for example, have toilets but no water for hand-washing. The facilities are poorly maintained, and so dirty that students prefer the outdoors.Functioning <a href="https://www.nepalitimes.com/opinion/where-to-take-a-dump/" target="_blank" rel="noopener noreferrer">faecal sludge treatment</a> plants are limited and with overflowing septic tanks and mismanaged household sewage systems, the waste often ends up in rivers.Across villages in Nepal, latrines built by local governments have been turned into storage space for neighbourhoods. Many in the Tarai still prefer to <a href="https://www.nepalitimes.com/banner/nepals-epidemic-of-hunger/" target="_blank" rel="noopener noreferrer">defecate in nearby fields</a>. The problem is even more pronounced in the case of public toilets. Only a third of the 84 public toilets in Kathmandu are operational and even those remain <a href="https://www.nepalitimes.com/here-now/nature-calls/" target="_blank" rel="noopener noreferrer">unhygienic and poorly maintained</a>. Most of the waste is left untreated and is often overflowing from septic tanks. <figure><img width="1500" height="1125" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111016114/636d13b39c7e80680e0a9937jpeg.jpg" alt=""><figcaption>A menstrual hygiene dispenser for sanitary pads at the Patan Dhoka 'hub'.</figcaption></figure>Now, the municipalities in the Valley are out to change that with the new model toilets. Aerosan’s designs incorporate an underground anaerobic bio-digester tank which turns the effluent into methane. The biofuel generated by the public toilet in Swayambhu, for example, is used by a nearby tea stand. The interior design is made as touch-free and hygienic as possible, and <a href="https://www.aerosantoilets.ca/copy-of-nepal" target="_blank" rel="noopener noreferrer">Aerosan</a> has installed flushes that use minimal water. The facilities are also women and disability-friendly, conforming to international safety and cleanliness standards. The ‘hubs’ now sees 500 customers a day, of which 59% are women compared to 13% in other public toilets. Amatya is aware that maintenance and sustainability are key for any public facility in Nepal, which is why the toilets pay for themselves, and are managed with strict protocols for operations and hygiene.“The major reason public toilets are not maintained or are dirty in Nepal is because cleaning and sanitation jobs are frowned upon and are reserved for those from the so-called lower castes. We are trying to change that outlook by dignifying the job,” adds Amatya.  <figure><img width="960" height="720" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111016114/636d13b79c7e80680e0a9938jpeg.jpg" alt=""><figcaption>Budhha chok</figcaption></figure><figure><img width="1600" height="1200" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111016114/636d13b99c7e80680e0a9939jpeg.jpg" alt=""><figcaption>Mangal bazar</figcaption></figure>The company employs 20 people at its six ‘hubs’, with each facility assigned three cleaners who are provided with gloves, personal protection equipment, work shoes, and other necessary equipment. Trained in <a href="https://www.nepalitimes.com/banner/covid-19-revives-nepals-wash-drive/" target="_blank" rel="noopener noreferrer">sanitation</a>, each staff member is also ensured paid leave, medical insurance, a smartphone, and a monthly salary starting from Rs15,000. Aerosan has also established the Sanitation Workers’ Cooperative to help staff and marginalised communities through work placement programs. The government provides the land for the hubs, and the construction is financed through local municipal taxes. For now, Aerosan relies on grants to pay for the toilet fittings staff salaries. Aerosan is now working to mobilise more public finance to build the model hubs outside Kathmandu, and is looking at locations in Pokhara, Biratnagar, and on highway waypoints which are notorious for the lack of proper latrines.Says Amatya: “We need legal frameworks to maintain standards and norms in all public toilets, incentivise their use, and monitor management. Only then will we achieve sanitation and health for all in Nepal.”

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Toilet-trained in Nepal

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141136/636cfe469c7e80680e0a0c2ejpeg.jpg" alt="" width="2529" height="1427"/><figcaption>Photo: HIMALMEDIA</figcaption></figure>A white-coated nurse holding a blue and white, half-litre bag of milk stands in front of a small group of mothers seated near the entrance of the Nutrition Rehabilitation Home in Kathmandu.She is explaining the importance of feeding milk to their children, who are lolling on their mothers’ laps. On a table behind the nurse are containers of pulses and legumes and leaning against the wall, charts displaying leafy vegetables.But later, listening to the women’s stories, it is apparent that solving their children’s problems will require more than a healthy diet. Through tears, Chandra, 24, says she brought her son Raju, 21 months, to the Home after a routine hospital check-up found that he was malnourished.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141136/636cfe499c7e80680e0a0c2fjpeg.jpg" alt="" width="3706" height="2170">His father, who Chandra was forced to marry, bought barely enough food for them to survive, says the woman. That deprivation, plus physical beatings and “mental torture” caused Chandra to flee their village home for Kathmandu.Mother and son arrived in January at the 24-bed facility perched on a hill on the outskirts of the city, where housing colonies sprout on former farm fields. In the month since then, Raju has gained 1kg in weight and is much stronger.The boy will stay at the Home for a few more weeks, says Sunita Rimal, coordinator of the Malnutrition Prevention and Treatment Program at the Nepal Youth Foundation, which runs the Home. By then she hopes to have found some work in Kathmandu for Chandra via her informal channels, so that the mother-son pair don’t have to go back.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141136/636cfe4d9c7e80680e0a0c30jpeg.jpg" alt="" width="901" height="786">Epidemic of hungerNina Parajuli, 45, brought her daughter Anushka, 7, to the Home weeks later on the advice of staff at a local non-governmental organisation. Nina had gone there for skills training after losing her house-cleaning job in Kathmandu.She was forced to find work unexpectedly after Anushka was born, when her husband deserted them. The family that hired her ate their first meal of the day only in the afternoon, which meant the girl left for school in the morning having eaten only snacks, while her mother worked. Eventually, Anushka grew dangerously thin and was considered severely malnourished when she arrived.Nina “was too concerned with her own problems to notice,” Rimal explains. Like her husband, she is HIV positive. She also has a heart condition and is on a waiting list for a uterus operation.Though unique, the stories of Nina and Chandra share a common thread — the causes of their children’s malnutrition are multifaceted. Rimal says that is the norm: “Most of the people who come here have other socioeconomic problems.”Past achievements Nepal is celebrated globally for its success in fighting malnutrition from the 1990s until recent years. Most notably, rates of stunting (low height for age) fell from the world’s highest, 68% in 1995, to 36% in 2016.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141136/636cfe509c7e80680e0a0c31jpeg.jpg" alt="" width="2410" height="1064"><figcaption> </figcaption></figure>New research has teased out exactly which development efforts had what impact on stunting. Indirect (also known as ‘nutrition-sensitive’) approaches were surprisingly effective. For example, better educated parents accounted for 25% of the improvement, <a href="https://www.nepalitimes.com/banner/toilet-trained/" target="_blank" rel="noopener noreferrer">environmental factors</a> like building more toilets contributed 12% and economic growth made up 9%.Direct (‘nutrition-specific’) efforts included: improved nutrition of mothers (accounting for 19% of the gain), and maternal and newborn health care (12%), according to the research, published on the website <a href="https://www.exemplars.health/topics/stunting/nepal">Exemplars in Global Health</a>.“The exemplars that we picked were countries that did (development) much faster than others. Nepal is not necessarily the best example but it is an important example,” says Zulfiqar A Bhutta of the Centre for Global Child Health at The Hospital for Sick Children in Toronto, one of the leaders of the research.“One thing is very clear, no one country has done it alone by only investing in health and nutrition sectors,” explained Bhutta via Zoom from Toronto. “And no one country has done it alone by only investing in poverty alleviation strategies. So the truth is that you have to do both in combination.”Nepal has continued that broad approach, investing in health both directly and indirectly, <a href="https://www.nepalitimes.com/banner/nearly-half-of-nepali-children-still-malnourished/" target="_blank" rel="noopener noreferrer">yet the progress has plateaued</a>.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141136/636cfe549c7e80680e0a0c32jpeg.jpg" alt="" width="1628" height="1255">While stunting continues to fall, the 36% rate is greater than the developing country average of 25% and the Asia average of 21.8%. In fact, the country is on target to hit only one of its nutrition goals for 2025 set by the World Health Assembly — for underweight children under 5 — says the <a href="https://globalnutritionreport.org/resources/nutrition-profiles/asia/southern-asia/nepal/">Global Nutrition Report 2020</a>.So what happened?“The one thing that I was surprised by is that inequity has increased,” says Bhutta, “and I have a feeling some of that may have had to do with the urban poor or rural to urban migration.”Nepal, he adds, should work to pinpoint the who’s and why’s of poverty, but otherwise, it should maintain its balanced approach.Investment on nutrition A recent analysis from UNICEF found, however, that spending on indirect approaches to fight malnutrition was rising while declining for direct interventions. This goes against the direction given in the government’s <a href="http://nnfsp.gov.np/PortalContent.aspx?Doctype=Resources&amp;ID=330">Multi-sector Nutrition Plan</a> (MSNP), the blueprint for tackling malnutrition.<a href="https://www.nepalitimes.com/editorial/hunger-for-governance/">Hunger for governance</a>, EditorialThe first phase of the MSNP ran from 2013 to 2017, and the current plan ends next year. The analysis in UNICEF’s <a href="https://www.unicef.org/nepal/media/13296/file/Nutrition%20-%20Budget%20brief.pdf">Nutrition Sector Budget Brief</a> also pointed out that the cost of programs in phase two (Rs48.9 billion) of the multisector plan is just 54% of phase one (Rs88.5 billion). In addition, the gap between budget numbers and actual spending has been growing.Kiran Rupakhetee of the Good Governance and Social Development Division at the National Planning Commission secretariat, helped shape MSNP-II. In an online interview he suggests that rather than the current plan’s budget being too low, the budget for MSNP-I might have been “over calculated at the time”.As to the growing gap between allocations and real spending — it results from many factors, including “rigidities and structural barriers” in the system, he explains.Another major challenge for MSNP-II is federalism, which introduced three levels of government after elections in 2017. “It’s a Herculean task… because at the moment it’s not only one government—we have 761 governments… There are some difficulties in ensuring coordination among them,” adds Rupakhetee.The pandemic challenge The Covid-19 pandemic <a href="https://www.nepalitimes.com/latest/covid-19-leaves-millions-of-south-asian-children-hungry/" target="_blank" rel="noopener noreferrer">has added to the challenge</a>. “It definitely has hampered our activities,” says Rupakhetee, “but we tried our level best to keep the programme going.”For example, parents were trained to measure the arm circumference of infants to detect signs of malnutrition, a task usually done by female community health volunteers, who have been unable to do so due to frequent lockdowns.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141136/636cfe579c7e80680e0a0c33jpeg.jpg" alt="" width="960" height="640"><figcaption> </figcaption></figure>Nepal’s school feeding programme was also modified because of the pandemic, with food rerouted to students’ homes, says World Food Programme (WFP) Country Director Jane Pearce, in an online interview.“Whereas most of the world stopped all of their school meals programmes, Nepal has continued, which has meant that we’re maintaining the nutrition that we’re providing through our locally-managed school meals programmes by giving households take-home rations,” she said.WFP has also teamed up with UNICEF and other UN agencies to press the government to expand its malnutrition treatment to include not only children who are severely wasted (low weight for age) but moderately wasted, says WFP’s Head of Nutrition Anteneh Girma.“With the impact of Covid and others, if they’re not treated they will become severely malnourished, then chronically malnourished, or stunted,” he adds.In June <a href="https://www.nepalitimes.com/banner/nepals-epidemic-of-hunger/">this paper reported</a> on how severe malnutrition was killing children in the poorest communities in Nepal’s eastern plains. It told the story of Raju Devi Sada, whose first daughter died at 3, after being malnourished. A second daughter died soon after birth, a year later.A third daughter is underweight and local health workers have recommended feeding her nutritious food. But Raju Devi cannot afford vegetables, eggs, milk and meat, and what she earns as a daily wage labourer is barely enough to feed the rest of the family.“We have found that up to 70% of children who die every year in Province 2 do so due to malnutrition, and the main reason for that is extreme poverty,” said Kedar Parajuli at Nepal’s Family Welfare Division. “Without alleviating poverty, we can’t solve malnutrition.”WFP is doing mapping, using mobile data, to create what it calls a vulnerability index. It documents people’s access to water and sanitation services, health and other factors, in addition to nutrition, says Girma.He adds, “Our nutrition response, food security response, is informed by that index… it indicates those who are vulnerable for not having access on time, for being exposed to various inequalities.”The private sectorGirma points out that WFP, both in Nepal and globally, supports the multisector approach. In that vein, the UN agency is working closely with the government to establish the <a href="https://sunbusinessnetwork.org/">Scaling Up Nutrition (SUN) Business Network</a> in Nepal. To date, 10 companies, all working in the food industry, have become members.Ending malnutrition and other food-related diseases “will happen only if the private sector is responsible for what they are producing, and producing something safe …  so their engagement, bringing them to the table, is very important,” says Girma.Leading collaboration with the private sector on the ground is <a href="https://www.baliyonepal.com/en/">Baliyo Nepal</a>, a non-profit company that generated headlines when it launched in 2019. The initiative was funded by the Bill &amp; Melinda Gates Foundation through the Chaudhary Foundation, the charity arm of the Chaudhary Group, makers of Wai Wai instant noodles, which are widely considered junk food.<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/banner/junk-food-is-making-nepali-children-shorter/" target="_blank" rel="noopener noreferrer">Junk food is making Nepali children shorter</a>, Marty LoganToday Baliyo Nepal is set to expand a pilot project that has been running in Lumbini Province since 2020 — raising awareness about nutritious food among school children, including via a cricket program, and educating shopkeepers to sell the nutritious foods in the first phase of its ‘Baliyo Basket’: eggs and a single-portion Rs10 sachet of fortified porridge for infants.“Seventy percent of the sachets in the market were sold, according to the sales report,” says Baliyo Nepal CEO Atul Upadhyay, a nutritionist, in an interview in his Kathmandu office. “The feedback we’re getting from mothers is ‘Now we want it in a bigger package. We can’t go to the shop every day and buy the Rs10 package’.”Upadhyay says manufacturers will start making the larger packs by year end. That is just one of many plans he is cooking up — besides expanding pilot activities to Bagmati and Gandaki provinces, the company will soon be adding to its Baliyo Basket a fortified drink for pregnant and lactating women and fortified porridge for 2-5-year-olds, once they are approved by the government.Upadhyay notes that both the government and private sector are gradually embracing his innovative approach but stresses that new ways to fight malnutrition, like this public-private partnership model, are essential if Nepal is to reach its nutrition targets.“It’s not important who works for nutrition. It’s important that someone works for nutrition, whether it be WFP, Baliyo Nepal, company A, company C — I don’t mind,” he adds.Target StuntingStunting, low height for age, is a sign of chronic undernutrition. It can hinder brain development resulting in reduced mental ability and learning capacity, poor school performance in childhood and lower earnings and higher risks of nutrition-related chronic diseases, such as diabetes, hypertension and obesity, in adulthood.Nepal cut its stunting rate dramatically in recent decades, and it is one form of malnutrition that the country might be on track to reduce in line with coming targets: MSNP-II (2022), World Health Assembly (2025) and SDGs (2030).The UNICEF Nutrition Sector Budget Brief says that the average yearly rate of stunting reduction since 2001 (3.25%) must increase to 3.8% to meet the MSNP-II and WHA targets, and rise to 6.5% to meet the SDG target.According to Kiran Rupakhetee at the National Planning Commission: “The Nepal Multiple Indicator Cluster Survey has brought some encouraging results, but it may still be difficult to make the WHA target... but since the SDGs deadline is quite far away I’m very much optimistic and hopeful that we can meet it.”Stunting rates and targets 2016: Nepal Demographic and Health Survey – 36%2019: Nepal Multiple Indicator Cluster Survey – 31.5%2022:  Target: Multi-sector Nutrition Plan-II – 28%2025:  Target: World Health Assembly – 25%2030:  Target: SDGs – 15%

Marty Logan

A tall order

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121144/636b92f49c7e80680e06f17bjpeg.jpg" alt="" width="2550" height="1429"/><figcaption></figcaption></figure>Nepal has had one emergency heaped on top of another for more than a year now. The Covid-19 emergency, <a href="https://www.nepalitimes.com/banner/nepal-is-going-up-in-smoke/" target="_blank" rel="noopener noreferrer">wildfires</a>, and <a href="https://www.nepalitimes.com/latest/monsoon-hits-nepal-with-a-bang/" target="_blank" rel="noopener noreferrer">now floods</a>.Political flux in Kathmandu continues to undermine the state’s ability to respond adequately. But this is nothing new. The most glaring governance failure of Nepal’s rulers for the past decades has been their incompetence in being able to ensure nutrition for its youngest citizens.Be it during the absolute and constitutional monarchy days, the post-democracy period or now, in the new federal system, the state has failed abjectly in its primary responsibility to fulfil the most basic of all human rights – access to adequate food.Nepal did reduce childhood stunting from 57% to 36% in the two decades after 1990. <a href="https://www.nepalitimes.com/banner/nearly-half-of-nepali-children-still-malnourished/" target="_blank" rel="noopener noreferrer">But progress stalled</a> because of the conflict and political upheavals. Nearly a third of Nepali children are still stunted due to lack of adequate food, 12% are wasted, and 24% low weight.The statistics are shocking. Nepal’s hunger hotspots are Far Western Province where 41% of children are stunted, and in Province 2 where 34% of children have low height due to lack of food. A survey in May by Sharecast Initiative and UNICEF shows that one in five families across Nepal <a href="https://www.nepalitimes.com/latest/nepalis-eating-less-due-to-lockdown-hardships/" target="_blank" rel="noopener noreferrer">reduced the quantity of meals</a> their children ate during the lockdown.Children have so far been largely spared by the SARS-CoV-2 virus and its variants, but they have become <a href="https://www.nepalitimes.com/banner/children-are-collateral-damage-in-nepal-lockdown/" target="_blank" rel="noopener noreferrer">collateral damage in the pandemic</a>. Schools have been closed for most of the past year, and half the students had no access to distance learning. Immunisation drives against pre-existing killer diseases have been disrupted.<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/latest/half-of-nepalis-lost-jobs-in-past-month/" target="_blank" rel="noopener noreferrer">More than half of Nepalis lost their jobs</a> in the past month amidst the second wave, and loss of household income has led directly to insufficient food for children.Hunger is Nepal’s real national epidemic and rampant malnutrition pre-dated the Covid-19 outbreak. The pandemic has undermined the country’s past gains in battling childhood malnutrition.To meet its UN sustainable Development Goals (SDG) targets, Nepal has to reduce stunting well below 15% and wasting and low weight to less than 5% in the next nine years. At the present rate, we will not meet those goals.Horrific as the statistics are, zooming down to <a href="https://www.nepalitimes.com/banner/nepals-epidemic-of-hunger/" target="_blank" rel="noopener noreferrer">ground level in Dhanusha and Mahottari districts</a> of Province 2, our Saglo Samajtv magazine report this week shows how much worse things have got during the lockdowns.Despite Nepal being declared open-defecation free amidst much fanfare, Dalit and other marginalised communities in Dhanusha and Mahottari do not have toilets. If they do have one, there is no running water or soap. They use the same village pond for both humans and cattle, for cleaning and drinking. Things are not much better in pockets in the western mountains. Gastric infections compound malnutrition.The least the government could do is equitably distribute the ‘nutrition allowance’ allocated for the Dalit families and educate the communities on the basics of <a href="https://www.nepalitimes.com/banner/toilet-trained/" target="_blank" rel="noopener noreferrer">sanitation and hygiene</a>.Nutrition Rehabilitation Centres for severely malnourished children must be set up closer to the communities so that the neediest can access the service. The annual budget on nutrition should be increased so that local health posts have sufficient supplements and micronutrients for new mothers and their children.The government’s Multi-Sector Nutrition Plan has not delivered as expected, tangled up over jurisdiction under the new federal structure. But it could just as easily deploy Female Community Health Volunteers, and local representatives to discourage <a href="https://www.nepalitimes.com/banner/child-marriage-in-nepal-eloped-at-13-mother-by-17/" target="_blank" rel="noopener noreferrer">child marriage</a> that feeds the vicious cycle of malnutrition and high maternal and child deaths.Malnutrition is <a href="https://www.nepalitimes.com/banner/junk-food-is-making-nepali-children-shorter/" target="_blank" rel="noopener noreferrer">more than the availability of food</a> and access to clean water, it is also confronting patriarchy, casteism and gender discrimination. It is a result of poor governance, lack of accountability and corruption.But nothing is stopping newly-empowered local governments with technical and financial backing from the centre to now achieve results that Kathmandu’s past centralised governments could not. Training of farmers on climate-smart agriculture, and leasing land to the landless is a good place to start.<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://archive.nepalitimes.com/article/nation/the-face-of-hunger-debt-malnutrition,3604" target="_blank" rel="noopener noreferrer">Children are hungry</a> because of poverty. Their families are poor because of state neglect. We must draw that causal link between lack of food and failure to deliver it by elected representatives. That is the real scandal the evening news bulletins should be highlighting.

Hunger for governance

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110915110/636bb2789c7e80680e07bae4jpeg.jpg" alt="" width="930" height="620"/><figcaption></figcaption></figure>Period stigma has long blighted the lives of young women and girls in Nepal, but the <a href="https://www.nepalitimes.com/here-now/ensuring-menstrual-hygiene-during-nepal-lockdown/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/ensuring-menstrual-hygiene-during-nepal-lockdown/&amp;source=gmail&amp;ust=1599021346631000&amp;usg=AFQjCNFRijVaIWllHBMsdGej-K1GWY9sUw">pandemic is making things worse</a>. If action isn’t taken to help girls menstruate safely, hygienically, and with dignity, Nepal’s <a href="https://www.nepalitimes.com/here-now/nepals-superwomen-beat-superstition/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/nepals-superwomen-beat-superstition/&amp;source=gmail&amp;ust=1599021346631000&amp;usg=AFQjCNGthfvaonsA70ekl3khwSP5i87ZrA">gradual progress in tackling taboos</a> and stigma around menstruation risks being undone.Families are spending long days, weeks, months indoors, and the continued lockdown is reinforcing harmful practices and stigma around menstruation. We have all come to realise the importance of routine hand-washing, but hygiene does not stop there. Menstruation does not stop during a pandemic, nor does the intense stigma associated with it in Nepal.Even without the pressures of the lockdown, many girls and women in poor, rural parts of Nepal simply do not have access to clean running water and soap. They also do not have menstruation pads, and even when they do many find themselves <a href="https://www.nepalitimes.com/editorial/that-time-of-the-month/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/editorial/that-time-of-the-month/&amp;source=gmail&amp;ust=1599021346631000&amp;usg=AFQjCNGkUXe1S5cwSBXCUsDHIGPMJFT67w">facing stigma in the household</a>, making their day-to-day lives all the more difficult.In communities where our Voluntary Service Overseas (VSO) works, <a href="https://www.nepalitimes.com/opinion/tipping-point-on-menstrual-banishment-in-nepal/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/opinion/tipping-point-on-menstrual-banishment-in-nepal/&amp;source=gmail&amp;ust=1599021346631000&amp;usg=AFQjCNFwh8i-WtKzK-Z0JIQog2-ixKuTOw">chhaupadi</a> still persists despite the government’s ban on so-called <a href="https://www.nepalitimes.com/banner/their-songs-from-the-forest/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/banner/their-songs-from-the-forest/&amp;source=gmail&amp;ust=1599021346631000&amp;usg=AFQjCNEa0nTiimV03Cl0KYM5qIyPLMx5Vw">‘period huts’</a>, and a three-month prison sentence and fine for  forcing girls to menstruate in huts. But some are still sent to caves and other locations which put them at risk.To remain ‘clean’, girls are forbidden to touch communal objects in the household. Menstruation untouchability is still practiced and promoted, and even the Nepali word <a href="https://www.nepalitimes.com/here-now/menstruation-is-not-private-business-it-is-everyones-business/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/menstruation-is-not-private-business-it-is-everyones-business/&amp;source=gmail&amp;ust=1599021346631000&amp;usg=AFQjCNE4ZcZ-SxFHOZnulUF2iMVhGjGCLA">nachhuni</a> literally means ‘untouchable’.Women and girls are separated and not allowed to touch and enter kitchen and prayer room. They cannot touch male members of the household, and there is much mental pressure by the family and community members to maintain untouchability norms and practices. Failure to abide by them sometimes leads to ostracisation.At the individual level, it is a painful experience and there are long-term psychological effects of period stigma on girls’ self-esteem, especially among trans and disabled women and girls who face double marginalisation. Some of these women make up our frontline healthcare workers during the time of Covid-19, leading to increased anxiety during the lockdown.Added to all this, the economic crisis is leaving young women and girls unable to afford menstruation products, particularly as prices for sanitary pads have spiked.Last year, the government committed to providing every girl with sanitary pads to help them  continue to go to school in a dignified way and succeed in studies. This year, we reached many girls with the products, helping them stay in school and realise their dreams.This year the government has also allocated funding to provide sanitary pad distribution to schoolgirls. But with schools closed across Nepal for nearly six months now, the goal of reaching every schoolgirl with sanitary pads has been badly interrupted. We are now hearing that girls are resorting to makeshift solutions, risking infection and complications.The pandemic has disrupted every facet of life, but the fight to realise women’s rights to menstruate safely and with dignity must continue. Under the lockdown, VSO is providing hygiene kits to some 4,000 girls across rural Nepal, especially in areas where menstruation taboos and stigma persist.The kits include soap, chlorine wash, underwear and a hygiene kit bag. Prior to the lockdown, VSO also trained over 2,000 young women and girls across four districts to make reusable sanitary pads, a skill which many have put to good use under lockdown.The <a href="https://www.wsscc.org/media/resources/government-nepal-calls-dignified-menstrual-hygiene-management" data-saferedirecturl="https://www.google.com/url?q=https://www.wsscc.org/media/resources/government-nepal-calls-dignified-menstrual-hygiene-management&amp;source=gmail&amp;ust=1599021346631000&amp;usg=AFQjCNHLw7xJvPvYa4obERECweTvlx_SxA">Menstrual Hygiene Management (MHMPA) Alliance Nepal</a> is a national network supporting over 80 initiatives to tackle period stigma in the country which works to shape policy and campaign for change. Its activities are constrained under the lockdown, but the mission to end period stigma across Nepal will not stop.The Nepal government has shown its commitment to end period stigma and other forms of gender inequality. While we fight Covid-19 together, we must also use this moment to ensure the promises we have made to young girls are kept throughout the pandemic and beyond.With the virus continuing to spread in Nepal and schools not opening any time soon, we are calling on national and local governments to honour their original commitment and ensure girls receive free menstrual products even when they are not in school.We have come a long way in improving the rights of women and girls in Nepal, legislating for increased participation of women in politics, while improving their rights in the home. Tackling period stigma is a fundamental part of moving towards a more equal society, and overcoming the barriers women face in public life.We can be <a href="https://www.nepalitimes.com/here-now/nepals-superwomen-beat-superstition/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/nepals-superwomen-beat-superstition/&amp;source=gmail&amp;ust=1599021346631000&amp;usg=AFQjCNGthfvaonsA70ekl3khwSP5i87ZrA">proud of the progress we have made</a> in challenging harmful practices like chhaupadi – and by working together as communities, civil society and government we can make sure that the pandemic does not hinder, or even reverse, our progress.We must use this moment to leverage the partnerships we have built in recent years between civil society and government to ensure that <a href="https://www.nepalitimes.com/banner/communicating-to-remove-menstrual-taboo/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/banner/communicating-to-remove-menstrual-taboo/&amp;source=gmail&amp;ust=1599021346631000&amp;usg=AFQjCNGZh3CqDbtQwCnrdB1XdP0dbuVDag">women and girls are not left behind</a> today, and can thrive when the pandemic eventually ends.Geeta Pradhan is the global lead gender adviser at Voluntary Service Overseas (VSO). She has worked in the Asia-Pacific and Africa.

Pandemic deepens period poverty

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121116/636b8c4d9c7e80680e06b2efjpeg.jpg" alt="" width="4096" height="2730"/><figcaption>Photo: BIKRAM RAI</figcaption></figure>With no proven <a href="https://www.nepalitimes.com/opinion/what-is-novel-about-the-novel-coronavirus/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/opinion/what-is-novel-about-the-novel-coronavirus/&amp;source=gmail&amp;ust=1587612692665000&amp;usg=AFQjCNFhARSUb8HMQP_ZJgsaTmPoQDLWvA">cure or vaccine available yet for COVID-19</a>, various treatments with no proven benefits and potential deadly side-effects are being tried out on patients.One example of a desperate treatment measure is a New York City doctor carelessly declaring on primetime tv recently that COVID-19 pneumonia was similar to <a href="https://www.nepalitimes.com/latest/high-alert/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/high-alert/&amp;source=gmail&amp;ust=1587612692665000&amp;usg=AFQjCNGuDq-Ti_uWGlw-rY-q1PpyQQO54g">high altitude pulmonary edema (HAPE)</a>, and he recommended high altitude drugs like Diamox for the treatment of Covid-19.Trekkers in Nepal are familiar with <a href="http://archive.nepalitimes.com/news.php?id=19693#.Xp-oJy8w0Wo" data-saferedirecturl="https://www.google.com/url?q=http://archive.nepalitimes.com/news.php?id%3D19693%23.Xp-oJy8w0Wo&amp;source=gmail&amp;ust=1587612692665000&amp;usg=AFQjCNGSLnJg3LMR2gIcZz9LMdKOvruqJA">Diamox</a>, a pill they take to acclimatise better when hiking at higher altitudes. There is no scientific basis that the drug will work, but this idea of very low oxygen (hypoxia) and pneumonia in both afflictions was appealing.To counter this some of us in Nepal and other countries have a forthcoming Opinion in the British Medical Journalcautioning against this rash treatment strategy using high altitude medicines. In medicine, doctors have to remember the maxim, Primum non nocere (‘above all do no harm’).But there are some silver linings <a href="https://www.nepalitimes.com/latest/nepal-must-hope-for-the-best-prepare-for-the-worst/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/nepal-must-hope-for-the-best-prepare-for-the-worst/&amp;source=gmail&amp;ust=1587612692665000&amp;usg=AFQjCNGtTkAInA3D5xIkzd65kTSfDvYESg">if Nepal escapes the worst of COVID-19</a>. <a href="https://www.nepalitimes.com/banner/tb/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/banner/tb/&amp;source=gmail&amp;ust=1587612692665000&amp;usg=AFQjCNGbOqrkOzN3uP_va7u0F-uhlxipaQ">Tuberculosis</a> rates, which are very high in South Asia (more than 400 per 100,000) could go down if people continue to use the masks since it will also mean that a tuberculosis patient will not spread the bacteria, not to mention other respiratory infections.Similarly, as more people get into the habit of washing hands with soap and water where available, the rates of diseases like typhoid and hepatitis A and E, caused by fecal oral transmission, will certainly be reduced.An average of <a href="https://www.nepalitimes.com/banner/nepals-deadly-roads-take-their-toll/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/banner/nepals-deadly-roads-take-their-toll/&amp;source=gmail&amp;ust=1587612692665000&amp;usg=AFQjCNHn0HGje-Tq3pDeekYbQAbhZxJOwg">230 people used to be killed every month</a> on Nepal’s highways and streets. The lockdown has now lasted a month, and that is approximately the number of lives saved due to vehicles being off the roads.The importance of public health for both the rich and poor countries has been highlighted by the pandemic. Industrialised countries had thought they had been done with infectious diseases, except perhaps the odd HIV patient. This pandemic has given great pause to that argument. Developing countries which having tried to come to grips with pre-existing epidemics have used lessons learnt in dealing with coronavirus in prevention.The Indian state of Kerala for example, has done relatively better in dealing with COVID-19 partly because it utilised prior lessons from the Nipah outbreak a year ago. Other South Asian countries with robust public health infrastructure like Sri Lanka also have a better handle on the disease.They strengthened their public health system, and it has paid rich dividends. South Korea too had an outbreak of MERS Coronavirus in 2015 which was brought by a South Korean returning from Kuwait, but they were able to effectively control the spread, and have been dealing successfully (so far) with the novel coronavirus. Singapore had been doing well, but discovered last week that it had a blind spot in the migrant workers’ dormitories. It has now announced a ‘circuit breaker’ lockdown till 1 June.South Asian countries have had more time in preparing for the contagion, while they wait for a vaccine or drugs to treat COVID-19. Treatment trials are happening all over the world even as the patients and doctors await with bated breath (pardon the pun). In all likelihood, we will soon know if chloroquin works or not before we have a vaccine.Vaccines will be a game-changer against Covid-19, and competition is heating up because whoever makes this vaccine first will be the knight-in-shining armour. China, USA, UK are probably a few of the countries engaged in developing a vaccine, and among them are researchers at Oxford University Clinical Research Unit who <a href="https://www.nepalitimes.com/banner/a-shot-in-the-arm-for-vaccines-in-nepal/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/banner/a-shot-in-the-arm-for-vaccines-in-nepal/&amp;source=gmail&amp;ust=1587612692665000&amp;usg=AFQjCNHKJgZ_d-vQIhZ5sdehQmMT7iWvHQ">collaborated closely with Patan Academy of Health Science</a> in a recent successful typhoid vaccine study.This Oxford University group lead by Professors Sarah Gilbert and Andrew Pollard are optimistic about producing a million doses of the vaccine by autumn. The vaccine will be eventually required not in the millions, but in billions of dosages. It also has to be affordable for countries like ours.For making vaccines promptly for neglected tropical illnesses, it is hard to beat the Chinese. When <a href="http://archive.nepalitimes.com/news.php?id=19220#.Xp-nMS8w0Wo" data-saferedirecturl="https://www.google.com/url?q=http://archive.nepalitimes.com/news.php?id%3D19220%23.Xp-nMS8w0Wo&amp;source=gmail&amp;ust=1587612692665000&amp;usg=AFQjCNEw-YGKhD3XomMEP736r5ileoWJ3g">Japanese Encephalitis (JE)</a> was raging in China and South Asia, it was the Chinese who tested, developed and made available the ‘Chengdu vaccine’ that revolutionised the prevention of the mosquito-borne disease. The earlier vaccine was expensive and only tourists in Nepal could afford it.Similarly, when <a href="http://archive.nepalitimes.com/news.php?id=18079#.Xp-m3S8w0Wo" data-saferedirecturl="https://www.google.com/url?q=http://archive.nepalitimes.com/news.php?id%3D18079%23.Xp-m3S8w0Wo&amp;source=gmail&amp;ust=1587612692665000&amp;usg=AFQjCNEndZvjwlu6D0uMBXFMGO9OgvSoXg">hepatitis E</a> was a scourge in China, the Xiamen Innovax Biotech came up with a vaccine in 2012 to protect vulnerable populations. Because there is no other commercial vaccine available against hepatitis E, it will be valuable in South Asia if the virus is rampant again and affect pregnant women with a fatal outcome.Nepal clearly needs to have a strong public health infrastructure in collaboration with a prestigious institute abroad to be able to tackle COVID-19 and other infections. Just like earthquakes, there will be more pandemics in future. Humanity needs to up its game in the control of emergent infectious diseases, and Nepal can make a small contribution by helping itself, especially by strengthening public health.Buddha Basnyat is a clinical researcher at Patan Academy of Health Sciences and a <a href="https://www.nepalitimes.com/opinion/what-is-novel-about-the-novel-coronavirus/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/opinion/what-is-novel-about-the-novel-coronavirus/&amp;source=gmail&amp;ust=1587612692665000&amp;usg=AFQjCNFhARSUb8HMQP_ZJgsaTmPoQDLWvA">frequent health columnist</a> for Nepali Times.Prevention while searching for a cur

Buddha Basnyat

Prevention while searching for a cure

<figure><img width="400" height="267" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110912118/636b8acb9c7e80680e06b25fjpeg.jpg" alt=""/><figcaption>Four Mahottari prison inmates watch television in the room also used for worship. Photo: KIRAN PANDAY/Nepali Times Archive</figcaption></figure>Even before the current coronavirus scare, Nepal’s overcrowded prisons were hotbeds for infectious diseases like tuberculosis, typhoid and influenza. But public health experts fear that the ease of spread of COVID-19 through breathing and touch could make Nepal’s jails incubators for the virus.There have been many studies of <a href="https://www.unafei.or.jp/publications/pdf/RS_No80/No80_13PA_Upadhyaya.pdf" data-saferedirecturl="https://www.google.com/url?q=https://www.unafei.or.jp/publications/pdf/RS_No80/No80_13PA_Upadhyaya.pdf&amp;source=gmail&amp;ust=1586411848269000&amp;usg=AFQjCNEOGN3iUvhfW-wCzLrlZoihLVDcTg">crowded living conditions</a>, hygiene and violence in Nepal’s prisons, and a coronavirus outbreak there could affect the health of detainees, security staff and through them spread to the general population.<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/latest/prisons-can-be-incubators-for-covid-19/" target="_blank" rel="noopener">Prisons can be incubators for COVID-19,</a> Nepali Times“Our prison infrastructure is not properly managed, as a result inmates have to be kept in crammed up places,” admits Sharmila Kumari Sharma, Senior Auxiliary Health Worker at Dilli Bazar prison. “We have regular awareness programs on washing hands and maintaining physical separation, but implementation is difficult. It is so crowded here that even maintaining 1.5m distance is not possible.” The World Health Organization (WHO) has published <a href="http://www.euro.who.int/en/health-topics/health-determinants/prisons-and-health/news/news/2020/3/preventing-covid-19-outbreak-in-prisons-a-challenging-but-essential-task-for-authorities" data-saferedirecturl="https://www.google.com/url?q=http://www.euro.who.int/en/health-topics/health-determinants/prisons-and-health/news/news/2020/3/preventing-covid-19-outbreak-in-prisons-a-challenging-but-essential-task-for-authorities&amp;source=gmail&amp;ust=1586411848269000&amp;usg=AFQjCNHyHYu6ntPVhmYSxWdNZc-GfiTgAA">guidelines</a> for preventing and managing the cases of COVID-19 in prisons and detention centres. According to the latest <a href="https://www.dopm.gov.np/uploads/files/falgunmaskebari076%20(version%201)%20-org2.pdf" data-saferedirecturl="https://www.google.com/url?q=https://www.dopm.gov.np/uploads/files/falgunmaskebari076%2520(version%25201)%2520-org2.pdf&amp;source=gmail&amp;ust=1586411848269000&amp;usg=AFQjCNEMlXqE9s0CBDU_uFJ4Il2wQh_KAw">report</a> of the Department of Prison Management (DOPM), there are 24,512 prisoners in Nepal’s jails -- 1,528 of them women, 1,281 foreigners and 91 are dependents. There are 8 juvenile correction centers in Nepal with 847 boys and 23 girls.<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/latest/charles-shobraj-out-of-lockup-during-lockdown/" target="_blank" rel="noopener">Charles Shobraj out of lockup during lockdown?</a>, Deepak Kharel“Given that COVID-19 thrives on social contact, having crowded jails with people coming in and out is likely to promote transmission into jails, transmission within jails and  'spillover' of infections out of the jails into the community,” says Columbia University epidemiology professor <a href="https://www.nepalitimes.com/latest/prisons-can-be-incubators-for-covid-19/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/prisons-can-be-incubators-for-covid-19/&amp;source=gmail&amp;ust=1586411848269000&amp;usg=AFQjCNEzapjwrlthuL-q32XJAonGxqAgjA">Barun Mathema in an email interview with Nepali Times</a> this week. Even within jails and detention centers it is important to identify the medically vulnerable people, those with chronic conditions like <a href="http://archive.nepalitimes.com/news.php?id=13002" data-saferedirecturl="https://www.google.com/url?q=http://archive.nepalitimes.com/news.php?id%3D13002&amp;source=gmail&amp;ust=1586411848269000&amp;usg=AFQjCNGrsWVNSjsVyxrcHwF05diXURaoaQ">HIV</a>/AIDS respiratory illnesses and cancer. Individuals with these co-morbid conditions may be predisposed to poor COVID-19 clinical outcomes. Studies have shown that reducing the number of inmates would lessen the pressure on prisons. Releasing medically vulnerable, nonviolent offenders and people towards the end of their sentence could free up some space in the prisons, and would help in general mitigation goal of slowing the spread of the disease if there is an outbreak. In addition, use of bail, speedy trials, early release and community service could aid in resolving the issue of overcrowding in the prisons and unsanitary conditions – problem that predate who COVID-19. <figure><img width="640" height="320" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110912118/636b8acd9c7e80680e06b260jpeg.jpg" alt=""><figcaption> </figcaption></figure>In fact, the DOPM wrote a <a href="https://www.dopm.gov.np/uploads/files/covid-19%20nirdesan%20076-12-09.jpeg" data-saferedirecturl="https://www.google.com/url?q=https://www.dopm.gov.np/uploads/files/covid-19%2520nirdesan%2520076-12-09.jpeg&amp;source=gmail&amp;ust=1586411848269000&amp;usg=AFQjCNGoq27Ml8euVobHPkrgT8p7qimfmA">letter</a> to the Ministry of Home Affairs stating the need for personal protective equipment (PPE), thermal gun, mask, glove, sanitiser and testing kit in prisons and juvenile correction centers. Hospitals in Nepal are in <a href="https://www.nepalitimes.com/here-now/protecting-those-who-protect-us-from-the-epidemic/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/protecting-those-who-protect-us-from-the-epidemic/&amp;source=gmail&amp;ust=1586411848269000&amp;usg=AFQjCNF3z5GZG-8DUsul-vzoutJuUQ2c-g">shortage</a> of PPEs and other protective gear, and it seems that for the overstretched government the prison system has the last priority. Unsanitary living conditions in the prisons make the facilities even more vulnerable. The Office of Attorney General (OAG) worked on the provisions to reduce the number of prisoners and inmates in juvenile detention centers. Depending on the gravitas of the crime, the concerned authority and the police may release a person from custody. Legally, if the police or adjudicating authority decide it is not necessary to keep a person in detention during the course of an investigation, they may release them on guarantee or bail or recognisance to appear on the given date. Says advocate Rabindra Bhattarai: “It is possible to reduce the reduce the number of prisoners in Nepal by one-third from 22,000 to about 7,000, this would make prisoner management and budget easier, as well as reduce the risk of a coronavirus spread.”The Supreme Court responded positively to a move by Attorney General Agni Kharel to release 13 elderly prisoners in Nepal’s jails and sent the file to the Home Ministry, among them the French-Vietnamese serial killer Charles Shobraj. The Court also decided to exercise the power of case diversion in accordance with the Act Relating to Children-2018 so that juvenile delinquents can be released on recognisance to appear when called by the court on the guarantee of their parent/guardian. The decision to pardon or suspend the jail sentence by the OAG is a win-win situation, legal experts say. It would reduce the load on prison management which would, in turn, minimise the risk of COVID-19. However, many inmates are in the prison because they do not have money to pay for bail, and some are not able to pay the fine. “It is up to the Home Ministry to make the final decision, but we are sending the list to them,” said the director general of the Jail Administration Department, Pradip Raj Kandel. However, there are a lot of questions before the elderly, juveniles or those jailed for non-violent crime are released on bail. How will the inmates or their families get the jail money, how with the district court hearing take place in a lockdown?

Nepal’s prisons need to be depopulated

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101156/636b79739c7e80680e064704jpeg.jpg" alt="" width="1152" height="864"/><figcaption>Historical sites like Kathmandu Darbar Square looked deserted as Nepalis chose to stay indoors amidst COVID-19 pandemic scare. Photo: ALISHA SIJAPATI</figcaption></figure>“It just doesn’t make sense!” You might have heard this phrase more than once lately in the context of Nepal and COVID-19: next to the epicentre in Wuhan and host to a large number of Chinese tourists and residents, this country has still only recorded one case of the coronavirus, and the person recovered. How can that be?You might also have heard, and scoffed, at the rumour that Nepalis have superior immune systems. ‘Nepali people have a stronger immunity power’ was one reason given <a href="https://english.khabarhub.com/2020/13/81620/" data-saferedirecturl="https://www.google.com/url?q=https://english.khabarhub.com/2020/13/81620/&amp;source=gmail&amp;ust=1584943003593000&amp;usg=AFQjCNFc1KpV0IZPmrgxEFmxs8qmB0EFIQ">in this article</a> for why COVID-19 has not hit the country yet. As time goes on and the number of cases remains at just one, could there actually be something to the claim?<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101156/636b79769c7e80680e064705jpeg.jpg" alt="" width="1280" height="960">“The whole world is raising the question of Nepal because of the lack of COVID-19 cases and especially after the country recorded only three deaths from two previous virus outbreaks originating in China — SARS in 2002 and the 2009 H1N1,” says Baburam Marasini, former director of the Epidemiology and Disease Control Division of the Department of Health Services.“I believe that more cases of COVID-19 would have been detected by now if there was an active surveillance system in place,” added Marasini who says he has advised health officials to test people already hospitalised for pneumonia or with major breathing difficulties. “If you compare the number of those people with the number from last year you will see they have increased and have indirect proof that the virus is here.”<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101156/636b797a9c7e80680e064706jpeg.jpg" alt="" width="1280" height="960">Meanwhile, <a href="https://www.nepalitimes.com/banner/why-nepal-must-watch-about-coronavirus-but-not-panic/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/banner/why-nepal-must-watch-about-coronavirus-but-not-panic/&amp;source=gmail&amp;ust=1584943003593000&amp;usg=AFQjCNGvsYFUHfFB29Dfd_gj9XfxzoCYYg">Sameer Dixit of the Centre for Molecular Dynamics</a> says he has done that comparison and in the past four months there has been no increase in reports of flu-like illnesses to the Epidemiology and Disease Control Division compared to previous years. Across the country 20-25 government, private and community hospitals report to the division via the Early Warning and Response System.Yet based on experiences in other countries to date, 10-15% of those infected with COVID-19 should become seriously ill. Asks Dixit: “The limited testing to date could be a major factor, but don’t you think that there should be huge spikes everywhere of severe illness among the elderly population? It’s not happening. At night I lie in bed wondering why, and it’s bothering the hell out of me.”Dixit, who has postgraduate degrees in immunology and biotechnology, believes that people are not getting seriously ill because Nepal is experiencing a less severe strain of the virus, and/or Nepalis do have stronger immune systems."While lack of testing is also a big cause for missing cases, I believe that immunity may be a major player in developing countries. I know this sounds far-fetched, and people will laugh when they hear it, but there is a ‘hygiene hypothesis’." The theory suggests that people who grow up in less hygienic surroundings develop strong immunity to external health threats. Dixit notes that the hypothesis has not been tested for virus outbreaks. But to support the hygiene hypothesis he notes figures from previous outbreaks:  2009 Influenza A H1N1 pandemic: Global infected 700 million -1.4 billion, Global deaths 150,000-600,000, Nepal: Infected 173, Deaths 3.2003 SARS Corona outbreak: Global infected ~8,000, Global deaths ~770, Nepal: Infected 0, Deaths 0.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101156/636b797d9c7e80680e064707jpeg.jpg" alt="" width="1280" height="960"><a href="https://www.nepalitimes.com/opinion/what-is-novel-about-the-novel-coronavirus/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/opinion/what-is-novel-about-the-novel-coronavirus/&amp;source=gmail&amp;ust=1584943003593000&amp;usg=AFQjCNEHbM3RH59Ci_1YI8koW6JWamgnKw">Buddha Basnyat, a physician at Patan Hospital,</a> downright rejects the notion of ‘Nepali immunity’. He says: “I think it is foolhardy to think that we are somehow immune – there is no scientific basis for this. I think it is a silly, wild conjecture.”He adds: “I hope it does not happen here, I hope all of these theories about immunity are true, but this is not a one-off virus, I think. Our health system is in a shambles, I think we should just make plans for a disaster.”Dixit, however, is not convinced that wider testing is necessary. “Developing countries like Nepal have a limited number of tests. It is very hard to justify testing among the 80-85% of people who could develop mild symptoms — how would we find them anyway? You’d basically have to go door-to-door and how practical is that … we basically need to save lives. Screw the detective work.”Instead, Dixit counsels trying to identify the 10-15% of the population most at risk, suggesting that people might have been hospitalised and mistakenly diagnosed with Influenza A when they actually have COVID-19.

Covid-19, Nepal and the hygiene hypothesis

<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101156/636b796c9c7e80680e064700jpeg.jpg" alt="" width="335" height="490"/>Nepal has had three months of lead time to study the <a href="https://www.nepalitimes.com/latest/wait-and-watch/" target="_blank" rel="noopener">coronavirus pandemic</a> and behaviours that have been associated with flattening the curve of the COVID-19 infection. Every cultural circumstance has the potential to contribute a different solution, and we should attempt to link our own common practices with the pandemic to come up with <a href="https://www.nepalitimes.com/latest/all-nepal-flights-cancelled-22-31-march/" target="_blank" rel="noopener">novel ways of dealing</a> with it.One such behaviour could the Nepali habit of blowing the nose hard (seee-seee!) and the deep, loud, clearing the throat (haak-thoo!).The <a href="https://www.nepalitimes.com/opinion/global-thinking-and-local-action-on-coronavirus/" target="_blank" rel="noopener">COVID-19</a> spreads through droplets transmitted though the air from sneezing and coughing. If two people have not maintained social distancing, virus particles from an infected person may land on an uninfected companion and enter the latter’s body through her eyes, nose, or mouth. The particles then travel to the back of the nasal passages and to the mucus membrane at the back of the throat.The spiked protein of the <a href="https://www.nepalitimes.com/editorial/this-is-a-test/" target="_blank" rel="noopener">coronavirus</a> particles hook on to cell membranes at the back of the throat, and it is here that the virus’s genetic material enters the cells of the human body, resulting in infection. The symptoms of dry cough and sore throat start with this. The genetic material of the virus then uses the cells as the virus’s carriers and multipliers and starts to move down the bronchial tubes towards the lungs, where it does the most damage.If <a href="https://www.nepalitimes.com/opinion/what-is-novel-about-the-novel-coronavirus/" target="_blank" rel="noopener">coronavirus</a> particles travel to the back of the nasal passage and the back of the throat to infect the individual in question, could it be that the loud Nepali habit of blowing the nose hard and clearing the throat can contribute to reducing the numbers of infected?If this is indeed the case, all that blowing and spitting must be done in an appropriate place. Doing it in public and where others are present risks spreading the virus even more widely.Given that the coronavirus resides at the back of the nose and throat before making its way to the lungs, could it be that our first line of defense – if we should get the virus – would be to wash our faces, including our eyes, and to blow our noses and clear our throats?We should <a href="https://www.nepalitimes.com/banner/covid-19-revives-nepals-wash-drive/" target="_blank" rel="noopener">wash our hands several times a day</a>  as we have been instructed. Our hands can transfer the virus from one place to another. They can infect us if they bring the virus in contact with our own eyes, nose, or mouth, and if we are infected, they can pass the virus on by bringing the virus into contact with things that others will touch.But if the virus has in fact already found its way on to our bodies, then we will want to get it off of our bodies, and perhaps washing our faces and ejecting it from our noses and mouths – as so many Nepalis do – is the way.Once again, it is critical that we never spit or blow our noses in public places. Avoiding this restricts the spread not only of coronavirus but of major killers that have been around for much longer, such as <a href="https://www.nepalitimes.com/banner/tb/" target="_blank" rel="noopener">TB</a>  If we must blow our noses or clear our throats in public, we should blow our noses into a handkerchief which we later wash, and we must swallow our saliva. If swallowed, the virus particles would be killed by the juices in the digestive tract.Perhaps, in addition to frequent hand-washing, we should wash our faces, blow our noses and cough out several times a day as part of an anti-coronavirus regimen.Shanta Basnet has a PhD in public health from Columbia University.

Keeping nose and throat clean

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101148/636b779f9c7e80680e064648jpeg.jpg" alt="" width="1500" height="997"/><figcaption>Eco Soap Bank Nepal's Nicky Lama teaching a student about hand hygiene. Photo: ECO SOAP BANK NEPAL</figcaption></figure>Many Nepalis woke up on Wednesday to an early-morning SMS from the Ministry of Health and Population: ‘Let’s wash our hands with soap and water regularly and if possible refrain from going to crowded places to be safe from coronavirus disease. Cover your mouth and nose while coughing or sneezing.’The public service announcement was aimed at stopping the spread of <a href="https://www.nepalitimes.com/banner/why-nepal-must-watch-about-coronavirus-but-not-panic/" target="_blank" rel="noopener">COVID-19</a>, but will revive Nepal’s hand-washing drive to control other infections like diarrohea and typhoid that kill mainly children.COVID-19 has now hit 78 countries. New infections and fatalities are tapering off in China, but the outbreak is spreading in Iran, Europe and the United States. Visit Nepal Year 2020 has been shelved, the Sagarmatha Sambaad postponed, and the US Embassy has put off its Independence Day celebration at Phora Darbar.Read also: <a href="https://www.nepalitimes.com/editorial/when-panic-goes-viral/" target="_blank" rel="noopener">When panic goes viral</a>, Editorial“There is still widespread lack of awareness about hand-washing, even right here in Kathmandu among marginalised communities,” says Diwakar Acharya, principal of Pulchoki School in Godavari. “Schools play an important role in educating children, their families and the community as a whole. This becomes especially important with the rise of new emerging diseases like coronavirus.”Nicky Lama of <a href="https://ecosoapbank.org/" target="_blank" rel="noopener">Eco Soap Bank</a> Nepal, which supplies recycled hotel soap to schools, has been visiting government schools in Kathmandu to train children in hand hygiene. “We have been training students and teachers so parents are also sensitised. It is a protective measure against not only coronavirus but already existing seasonal flus and common infections like typhoid,” says Lama.<a href="https://www.nepalitimes.com/here-now/nature-calls/" target="_blank" rel="noopener">Nepal was declared free of open defecation last year</a>, and is a model for the region. While this is dramatic progress from 1990 when only 6% of households had toilets, public health experts have raised questions about poorly maintained toilets and lack of water supply.In a 2018 study, the Global Sanitation Fund Programme found that 3% of households in communities declared ‘open defecation free’ did not in fact have toilets, and that in 5% of families who had a toilet at home, at least one member continued to defecate outdoors.“Despite declaring open defecation free, toilet infrastructure is not always optimum, septic tanks are now filling up and availability and quality of water is questionable, particularly in urban slums,” says Sandhya Chaulagain, Hygiene officer at WaterAid Nepal. “But most  health workers are focused on curative measures and often wait for the outbreaks to happen instead of preventing them.”Read also: <a href="https://www.nepalitimes.com/opinion/do-not-fail-students-in-wash/" target="_blank" rel="noopener">Do not fail students in WASH</a>, Marty LoganThe additional challenge for the WASH (Water, Sanitation and Hygiene) campaign in Nepal comes from the lack of clarity about  jurisdiction and roles of each tier of government in the new federal structure. A new bill on WASH is undergoing review at the parliament.Good news is that some municipalities have started collecting household-level sanitation, hygiene and water data using the GIS-based app NWASH. Says Govind Shrestha, policy specialist at the NGO WaterAid Nepal, “Moving ahead we need to find and then reach all the areas that do not have proper water and sanitation facilities yet. The challenge is to reach all 753 local bodies and as soon as possible.”<h2>Recycling soap</h2><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101148/636b77a29c7e80680e064649jpeg.jpg" alt="" width="1500" height="1068">Nicky Lama was volunteering at a hospital in Cambodia when she met Samir Lakhani, of Eco Soap Bank fame and Top Ten CNN Hero of 2017. She was so moved by his commitment to improve child health that she decided to return to Nepal and bring with her the campaign of collecting used soap from fancy hotels and recycling it to improve hygiene in schools.Thousands of children die unnecessarily or fall sick due to diarrhoeal dehydration and <a href="http://archive.nepalitimes.com/news.php?id=17306#.XmGoynIzbIU" target="_blank" rel="noopener">typhoid</a>. These illnesses have faecal-oral transmission, which can be easily prevented through regular handwashing.Lakhani founded Eco Soap Bank in 2014 with the aim of saving, sanitising, and supplying recycled hotel soap for the developing world. The soap bank is currently operating in ten countries: Cambodia, Laos, Bangladesh, Lebanon, Rwanda, South Africa, Tanzinia, Ghana, Sierra Leone, and now Nepal.Read also: <a href="https://www.nepalitimes.com/banner/virtuous-cycle/" target="_blank" rel="noopener">Virtuous cycle</a>, Yuvaraj ShresthaThe Nepal branch works independently from the network and was set up three years ago. It networks with 23 hotels in Kathmandu including the Hyatt Regency, Hotel Annapurna, Soaltee Crowne Plaza and Kathmandu Guest House. Women in its Swayambhu workshop process the soaps to produce 7,000 bars of recycled soap per year, most of which are distributed in government schools in parts of Kathmandu Valley.“At the moment we are a small set-up, but we plan to expand to hotels in Chitwan and Pokhara, set up workshops there, employ many more disadvantaged women and help spread hand-hygiene awareness in schools,” says Lama, who is now country director of Eco Soap Bank Nepal.After finishing high school in Kalimpong, Lama went to the UK to study International Development. She then worked in Zambia, introducing tablet computers in community schools. Later, in Cambodia, she volunteered at a children’s hospital.Read also: <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/Alcohol,276" target="_blank" rel="noopener">Alcohol to the rescue</a>, Buddha Basnyat Eco Soap Bank Nepal is looking to collaborate with agencies working on the WASH (Water, Sanitation and Hygiene) campaign. “We want to not only promote eco soap banks but also create employment and spread the message about handwashing with a focus on the prevention side of healthcare,” says Niall Kavanagh, an adviser to the Nepal operation.The added benefit of the Eco Soap Bank concept is that it promotes a cost-effective hygiene product that also reduces waste generated by the hotel industry. Says project coordinator Narendra Lamichhane: “There is a misconception that recycled goods cannot be used. We need to change that, while at the same time creating jobs for women.”

Sonia Awale

COVID-19 revives Nepal’s WASH drive

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110813110/636a450d9c7e80680e04d364jpeg.jpg" alt="" width="1500" height="1002"/><figcaption>No Privacy Photo taken by Sushma, 15, from Sindhuli, in a WaterAid UK participatory project She said: “This is the girls’ toilet at our school. It doesn’t lock properly. If someone is inside, someone else has to wait outside, pushing the door. This is why we need more girl-friendly toilets.”</figcaption></figure>By the numbers, Nepal’s progress in water, sanitation and health (WASH) is encouraging. More than <a href="https://www.nepalitimes.com/here-now/survey-is-wakeup-call-for-nepal-government/" target="_blank" rel="noopener">90% of people now have access to toilets and 74% enjoy safe drinking water</a>, a recent survey found.But as usual, facts and figures alone don’t tell the full story. <a href="https://www.unicef.org/nepal/media/1026/file/A%20CONCEPTUAL%20FRAMEWORK%20FOR%20RESOURCE%20MOBILIZATION.pdf" target="_blank" rel="noopener">According to Unicef</a>, just 25% of water supply systems in the country work properly, 36% require minor repairs and 39% need either major repairs, rehabilitation or reconstruction.<a href="https://www.unicef.org/nepal/media/1026/file/A%20CONCEPTUAL%20FRAMEWORK%20FOR%20RESOURCE%20MOBILIZATION.pdf" target="_blank" rel="noopener">Schools are also reporting progress</a> — 82% now have toilets and close to 80% can boast an improved water source — but in only 47% of schools was water supply available during a recent survey.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110813110/636a45119c7e80680e04d365jpeg.jpg" alt="" width="1500" height="844"><figcaption> </figcaption></figure>Nationally, two-thirds of schools have separate toilets for girls. That is supported by <a href="https://www.unicef.org/nepal/media/336/file/ANALYSIS%20OF%20MENSTRUAL%20HYGIENE%20PRACTICES%20IN%20NEPAL.pdf" target="_blank" rel="noopener">research done in 12 schools</a> in Achham, Bajura and Parsa in 2016. It found that all schools had toilets, with 10 having separate ones for girls. Yet only 3 toilets in all 12 schools had a water tap that children could reach and just 1 toilet in all the schools was disabled-friendly. Nineteen toilets had a door that locked while 33 lacked a door; no toilets had soap and water nearby for hand-washing.Girl students especially are sensitive to the availability of toilets, and if they have to share facilities with boys, or if there are no locking doors or if no water is available, some girls will choose to stay home instead.Given that enrolment of girls in schools is already lower than boys because of traditional beliefs that educating females is simply not a smart investment, effort is needed to ensure they remain in class. When girls are menstruating equipped private toilets are even more important.The number of examples is growing country-wide of <a href="https://thehimalayantimes.com/nepal/sanitary-pads-bring-down-girl-students-absenteeism/" target="_blank" rel="noopener">schools where the administration and students are overcoming traditional barriers</a> to together manage girl students’ menstruation so that they don’t miss classes. There was good news in the recent budget too, the government promising to supply all community schools with sanitary pads and also allocating Rs43 billion for water supply and sanitation projects.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110813110/636a45149c7e80680e04d366jpeg.jpg" alt="" width="640" height="366">While implementation will be key, such initiatives should be praised. WASH is not a luxury or an add-on like a science lab or a football pitch; it is a necessity. Having working toilets does not equate to equipping schools with fancy facilities but of taking pains to create healthy environments, and habits, for Nepali children.Advances in water supply will undoubtedly be challenged by growing shortages as the climate crisis deepens. Water quality also remains a priority concern in this country. <a href="https://www.unicef.org/nepal/media/1026/file/A%20CONCEPTUAL%20FRAMEWORK%20FOR%20RESOURCE%20MOBILIZATION.pdf">Surveys have found</a> that 71% of households in Nepal are at risk from E. coli contamination of source water, and 82% from E.coli at the household level. <a href="https://www.wateraid.org/uk/where-we-work/nepal" target="_blank" rel="noopener">700 children die from diarrhoea yearly</a>.If we want our girls to have the same opportunities as boys, and if we want all children to be healthy enough to attend school every day, it’s time that we took building — and maintaining — toilets as seriously as we do building roads.To mark World Environment Day (5 June) a WASH Mela is being held 8-9 June, 8AM-5PM, Basantapur, Kathmandu

Do not fail students in WASH

Born in Khandbari in eastern Nepal, Parashuram Pathak helped his family around the farm, sold what they grew in the market and lent a hand in the kitchen.&nbsp; After working as a chef in Dubai, San Francisco, Denmark, Australia, and on cruise ships, Pathak has now brought back what he has learnt to the Tusa Restaurant in Bhaktapur that opened on Nepali New Year on 13 April. Tusa uses fresh indigenous ingredients from various parts of Nepal, and fuses them with international methods to produce unique dishes. Pathak is a global Nepali, and is introducing global Nepali cuisine to his homeland. Pathak left an executive chef job to intern at three-Michelin-starred Noma in Denmark, named the best restaurant in the world five times. Noma runs on a philosophy of foraging to rediscover wild local ingredients, and Tusa’s mission is similarly noble: preparing dishes with Nepali ingredients using modern techniques and equipment. “We are taking Nepali food beyond dal-bhat and momo, we are taking it international,” Pathak said on the phone from Sydney. Read also: <a href="https://nepalitimes.com/here-now/nepali-baker-rises-to-the-top-in-denmark">Denmark’s best baker is a Nepali</a>, Vishad Onta  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240419180424_1312bc016cbb2fe59c6d4a78d1f8b463af4a10b3f79559a2405fd54ea5b3197a.jpg" data-media-id="editor_1" data-image-id="20240419180424_1312bc016cbb2fe59c6d4a78d1f8b463af4a10b3f79559a2405fd54ea5b3197a" data-rendition-name="original" width="801" height="802" loading="lazy" alt="The return of the natives Page 12 NT #1208"> <figcaption>Photo: PARASHURAM PATHAK/FACEBOOK</figcaption> </figure>  Pathak’s team in Nepal includes chefs Rupesh Bohara and Sagar Shrestha who have also worked extensively in Dubai and Australia, and share his vision. The three realised they shared the same dream, and over the past five years have travelled across Nepal to research their menu, collecting ingredients and ideas from homestays, food carts, and nature. The team then scouted for Nepal’s best architect, and zeroed in on Bhaktapur-based heritage conservationist Rabindra Puri who designed the Malla-era house for Tusa in the Nag Pokhari neighbourhood. Bohara and Shrestha have moved back to Nepal for good, and Pathak arrives in September. “I made dishes from all over the world, but when someone asked what Nepali food was like, I had no answer,” says Bohara, “I came back to find out.” &nbsp;“You can get citizenship, a green card, big houses and cars, but where is the self-satisfaction?” asks Shrestha, who has a red-and-blue chef’s knife with the sun and moon of the Nepali flag tattooed on his right forearm.&nbsp; Read also:<a href="https://nepalitimes.com/diaspora-diaries/the-return-of-a-master-baker"> The return of a master baker</a>, Raju Pakhrin  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240419180424_c601264463e5a28d4e71a46781f340a53619a08d00949a7aaebfef84e75a319d.jpg" data-media-id="editor_3" data-image-id="20240419180424_c601264463e5a28d4e71a46781f340a53619a08d00949a7aaebfef84e75a319d" data-rendition-name="original" width="6000" height="4000" loading="lazy" alt="The return of the natives Page 12 NT #1208"> <figcaption>Photos: TUSA</figcaption> </figure>  Bohara and Shrestha passionately recount stories of their trips across Nepal, speaking of generous lodge owners who introduced them to local ingredients. Tusa can seat 28, and dining here is a sensory experience with a live kitchen. The chefs cook and place dishes on a large granite countertop with induction sections built in. Behind the counter is a grill on an indoor fire with pulley control to adjust the fire. Everything that can be made in Nepal — chairs and tables, ceramic dishes, the grill — is locally sourced. The executive kitchen/laboratory is downstairs. It is spacious, spotless, and contains appliances rarely seen in restaurants here: a sous vide machine that cooks vacuum-sealed packets at consistent temperatures, and a dehydrator for sisnu nettles. A fresh batch of deep purple kimbu (mulberry) muffins has just come out of the oven. Fridges have dry-aged fish and marigold kombucha. Fermentation seems to be the theme at Tusa, and Pathak explained: “Fermentation takes away the natural sugars in food, leaving behind a true, umami taste.”&nbsp; Read also: <a href="https://nepalitimes.com/here-now/vikings-khukri-passion">Viking's khukri passion</a>, Alisha Sijapati  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240419180424_c59e2b4230864f646bc36108adb951e95ec85da6156740294b1ec715b86acf89.jpg" data-media-id="editor_5" data-image-id="20240419180424_c59e2b4230864f646bc36108adb951e95ec85da6156740294b1ec715b86acf89" data-rendition-name="original" width="5895" height="3930" loading="lazy" alt="The return of the natives Page 12 NT #1208"> </figure>  Tusa itself means ‘shoot’ in Nepali, and can be a dish of fermented bamboo shoots. The restaurant serves a tasting menu with six courses, plus surprises. It starts with a fermented potato and millet roti with charred green garlic and tomato chutney. The bread tastes like a mix of alu paratha and kodoko roti with a satisfying, mild flavour. The chefs do not show off, and overdo it. Dishes are tastefully simple and faithful, a theme that runs through the meal. The second course is a filet of fish charred on one side and placed in a broth. It is delicate and smokey, and does not mask the character of the fish.&nbsp; The next is Batuk Chukauni, a Magar dish with a lentil snack and a yoghurt-based potato achar. The batuk, made of lentil batter, is light and the chukauni has potatoes and peas. Read also: <a href="https://nepalitimes.com/here-now/money-is-not-everything-but-you-need-money-for-everything">"Money is not everything, but you need money for everything"</a>, Rohit Shrestha  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240419180424_e3f51228ff792e8d4297f81f8e67d138584e922ae035d131977494219e5e85c5.jpg" data-media-id="editor_7" data-image-id="20240419180424_e3f51228ff792e8d4297f81f8e67d138584e922ae035d131977494219e5e85c5" data-rendition-name="original" width="1333" height="1000" loading="lazy" alt="The return of the natives Page 12 NT #1208"> <figcaption>Batuk Chukauni. Photo: VISHAD ONTA</figcaption> </figure>  Next is a skewer of jackfruit with a tamarind and mustard glaze that has the texture of a slice of sausage and melts in the mouth. Then comes the first off-menu item: a steak of watermelon, glazed and grilled, tasting sweet, sour and smokey. After that a palate cleanser sorbet made with laligurans syrup adorned with a frozen candied rhododendron petal. Finally the main course: barbeque chicken and chyakla coarse corn grits. The chicken has been brined, marinated, cooked sous-vide and seared on the grill. The delicate consistency of the chicken stands out. Desert is a smooth, creamy cheesecake that uses the local juju-dhau yoghurt. And the last course is a moist, moss-green sisnu cake laced with mulberry jam and cream.&nbsp; There is nothing gimmicky about Tusa. It is the coming together of skilled Nepalis with international exposure who have mixed what they have learnt abroad with the flavours of home.&nbsp; The tasting menu is Rs3,500, and it may take some time before Nepalis develop a predilection for some of its items. The chefs are excited, vindicated, and relieved. Coming back to Nepal, uprooting successful careers abroad to take a chance on Nepal must not have been easy.&nbsp; Tusa had a soft launch on New Year’s day with Kathmandu-based diplomats. Australian Ambassador Felicity Volk was one of them, and wrote on a Facebook post: ‘Chefs who honed their skills in Australia and returned to Nepal to give back. We call it fine dining, they call it #cominghome.’ Read also: <a href="https://nepalitimes.com/multimedia/the-baker-of-barpak">The baker of Barpak</a>, Tara Aryal Pandey

The return of the natives

For a year or two after the 25 April 2015 earthquake, the residents of Kathmandu were too terrified to return to their high-rise apartments. None of them collapsed in the 7.8 disaster, but many sustained serious structural damage. &nbsp;
Fast forward nine years, and they have all but forgotten that frightful day. Kathmandu is back to building substandard structures, even as land prices drive developers to build taller.&nbsp;
With no more space to spread horizontally, Kathmandu is going vertical. But structural engineers say most of the high rises do not take into account seismicity, soil condition, construction methods, quality of raw materials, fire hazard, and search and rescue in collapsed concrete structures.
“Much of our focus since the 2015 earthquake has been on building and construction, but not as much on where we are building,” warns Sangeeta Singh, Professor of Urban Planning and Deputy Director of Centre for Disaster Studies at the Institute of Engineering.
Read also: <a href="https://nepalitimes.com/banner/in-a-disastrous-state">In a disastrous state</a>, Sonia Awale
She adds: “Kathmandu is not really suited for high-rises. We have to first test the condition of the soil, but building permits are being issued without this fundamental step.”
Kathmandu Valley is a former lakebed with soft topsoil prone to liquefaction and excessive shaking, as seen during the 1934 megaquake. Many ruptures tore up the surface in 2015. &nbsp;
During an earthquake, the rock layers below Kathmandu ring like a bell and the vibrations on the surface take between 0.5 to 2 seconds for one oscillation. Buildings also vibrate, but at different frequencies depending on their height, construction material, and arrangement of their structural components.
At five floors, the vibration period of a building is 0.5 seconds, which is the same as that for Kathmandu Valley, and this could cause more damage, says structural engineer Surya Narayan Shrestha at the National Society for Earthquake Technology - Nepal (NSET).
“Building anything that is five storeys or higher in Kathmandu needs special design and structural considerations,” says Shrestha.
Read also: <a href="https://nepalitimes.com/editorial/shaking-things-up">Shaking things up</a>, Editorial
Technologies exist to reduce seismic risk in high-rises, and these are used in earthquake-prone cities like Tokyo, Los Angeles, Jakarta or Mexico City.&nbsp;
Base isolation, for example, separates the vibration of the land and the building, reducing damage from soil-building resonance. Base isolators move and stretch under pressure, absorbing much of an earthquake's impact by reducing swaying and shaking. &nbsp;
Seismic dampers change the pattern of vibration altogether, dissipating energy as vibrations move across a structure. But these are all expensive technologies, and none of the high-rises in Kathmandu use them.
However, Nepali engineers who can help with technology transfer are working in the field in Nepal and overseas. Kathmandu’s high-rises are already very expensive, and making them seismic-resistant would be an incremental cost.
Read also: <a href="https://nepalitimes.com/opinion/comment/learning-from-jajarkot-what-we-didnt-after-2015-695vpzle">Learning from Jajarkot what we didn't after 2015</a>, Sushil Gyewali
The shape of high-rises also matters. Reinforced concrete buildings with asymmetric designs of the kind that are seen in newer structures in Kathmandu experience more torsion and shear during quakes. High-rises with regular geometry are stronger. &nbsp;&nbsp;
An even bigger concern is that of emergency evacuation and rescue in case of fire or earthquake. Kathmandu fire services do not have ladders that reach the higher floors of most new structures.
“High-rises mean more people and potentially higher casualties,” explains Shrestha. “We need immediate evacuation routes, fire escapes, emergency ladders, and fire trucks that can reach higher. Right now, safety features are voluntary and not mandatory.”
The street access, shelters, open spaces, and evacuation routes are integral to disaster preparedness and the safety of neighbourhoods and not just buildings. Most new high-rises in Kathmandu have narrow access roads.
Read also: <a href="https://nepalitimes.com/opinion/rebuilding-resilience-7-years-later">Rebuilding resilience 7 years later</a>, Anil Pokhrel
Since most of the buildings that survived the 2015 disaster were reinforced concrete structures, it fed the misconception that they are safer. But Himalayan seismologists say that if the intensity and duration of the shaking had been just a little higher, many substandard concrete structures would have collapsed.&nbsp;
And that is the final gap: Nepal’s limited expertise and equipment for search and rescue inside collapsed concrete structures. Kathmandu’s high-rises need to be better prepared for the next Big One.
“Structural safety and design were at the front and the centre after the 2015 earthquake, we also revised some building codes but we are back to square one with contractor-driven construction, especially in peri-urban areas,” says Sangeeta Singh, who is also with the National Planning Commission. “We need to monitor construction as much as design.”&nbsp;
Shrestha at NSET agrees there have been improvements in building practices in the past nine years, but adds, “We have both learnt and unlearnt lessons from 2015. The awareness hasn’t yet translated into action on safety.”
Read also: <a href="https://nepalitimes.com/here-now/lessons-not-learned-from-2015-o2etq6zu">Lessons not learned from 2015</a>, Sonia Awale

The rise of high-rises

Midway along the stretch of the ancient trade route between Tibet and India lies the Kel Tol neighbourhood. The name is derived from the original Koligrām, and it is believed the Koli people, who were originally from Rāmagrām in present-day southern Nepal near the Indian border, settled here. The Koli were the maternal ancestors of none other than the Buddha. Kel Tol is famous for the Buddhist monastic complex of Kanak Chaitya Mahāvihar, featuring the majestic two-tiered gilded temple of the white god Karunāmaya.&nbsp; This elaborately decorated courtyard is a bustling centre of the Vajrayāna sect of Buddhism, practised widely by the indigenous Newā people of Kathmandu Valley. Karunāmaya, also known as Ārya Avalokiteshwor, is defined in great detail in the 1st century CE Buddhist text Sadharmapundarikā where he liberates all sentient beings from suffering. He helps rid the eight external fears metaphorically equated with their equivalent internal states of mind: lions (pride), wild elephants (ignorance), fire (anger), snakes (jealousy), floods (attachment), imprisonment (miserliness), thieves (wrong views) and cannibals (doubt).  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240418130432_fe370cbee75003cd3eb5dccc7c3b2671630da193b0744db2aeac1bab3ff4a85c.jpg" data-media-id="editor_0" data-image-id="20240418130432_fe370cbee75003cd3eb5dccc7c3b2671630da193b0744db2aeac1bab3ff4a85c" data-rendition-name="original" width="1338" height="2000" loading="lazy" alt="Seto Machhindranath"> </figure>  In the Pancha Rakshyā Sutra, a Buddhist scripture from 200 CE, Ārya Avalokiteshwor was counted among the eight major deities. Followers of the Brāhminical god Shiva worship Ārya Avalokiteshwor as Seto Machhindranāth. For Shaivites, Machhindranāth is the Indian saint who founded the Nāth cult in the 10th century CE. He is the guru of saint Gorakhnāth. During the reign of Yakshya Malla (1428–1482 CE), a beautiful image of Ārya Avalokiteshwor was dug up by a farmer in present-day Jamal, which was then a cultivated area outside the city. The farmer, known as a Jamami (meaning the one from Jamal) took the image home for safekeeping. That night, Ārya Avalokiteshwor appeared in the farmer’s dream and told him that the proper place for him to reside is at the confluence of two rivers. The nearest confluence was at present-day Wongha (Indrachok) and the image was installed in the Kanak Chaitya Mahāvihar complex in Kel Tol near Wongha. This made it easier for city residents to pay homage to Ārya Avalokiteshwor and spread compassion. Soon, the deity came to be revered highly as Jamaleshwor, the one found in Jamal. Eventually, the name got corrupted, as happens often in Nepāl Bhāsā, to Janabahā Dyo. The courtyard where his temple is located is now popularly known as Janabahā.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240418130432_5c9b219530e400445ef4e7f64856b43e7cdb756be26d9ed4565c84044c178a7e.jpg" data-media-id="editor_1" data-image-id="20240418130432_5c9b219530e400445ef4e7f64856b43e7cdb756be26d9ed4565c84044c178a7e" data-rendition-name="original" width="2500" height="1668" loading="lazy" alt="Seto Machhindranath"> </figure>  The gilded temple of Janabahā Dyo, first built in the early 16th century CE, is adorned with wooden and metal artefacts that symbolise 108 forms of Ārya Avalokiteshwor. It stands out as the most decorated temple of its kind in Kathmandu. Today, Janabahā is a living heritage site where many ancient customs and rituals are widely practised as per Vajrayāna Buddhist tradition. Devotees throng the Janabahā Dyo shrine for daily worship and to receive Karunāmaya’s blessings. Being the compassionate one, Ārya Avalokiteshwor goes around town every year in his tall wooden chariot to allow sick and physically disabled devotees to pay homage to him from the comfort of their homes. One could say it is a door-to-door visit by the Compassionate One.&nbsp; For the pragmatic minded, the chariot festival is an annual renewal of communal harmony, validation of our ancient mathematical supremacy and demonstration of the need to keep practical skills alive, including the craft of building earthquake resilient houses.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240418130432_fc8b234ceca87dee4b99e897a485cef121fb953857fb61492a413fbfcc48360c.jpg" data-media-id="editor_2" data-image-id="20240418130432_fc8b234ceca87dee4b99e897a485cef121fb953857fb61492a413fbfcc48360c" data-rendition-name="original" width="2500" height="1667" loading="lazy" alt="Seto Machhindranath"> </figure>  The Janabahā Dyo chariot is pulled from Jamal, where his image was found by the farmer, through the historic heart of Kathmandu in a gala parade every year. The procession, accompanied by folk music ensembles and revellers, starts on the eighth day of the bright half of the month of Chaitra, and lasts up to a week (ending on Saturday this year). Hundreds of devotees pull the chariot along the streets as a way of expressing their gratitude to lord Karunāmaya for blessing them with compassion and well-being. Purna Ratna Vajrāchārya is an ordained priest who belongs to the clan responsible for taking care of Janabahā Dyo. He has been studying the design and architecture of the chariot for the past 40 years, and overseeing its construction for the past 15. He has learnt that the engineering principles of building the chariot are based on the mathematical system in which Buddhism is taught. For example, 365 pieces of wood are used in the chariot, each representing a day of the year. Each of the four wheels consist of 25 pieces of wood, totalling 100, representing completeness or fulfilment. The chariot is vertically divided into 13 sections, a parallel to the Buddhist concept of Trayodashi Bhuvana that describes the 13 steps that one must take to achieve the state of Nirvana.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240418130432_36d9964c9845f6d9a074786361fc5ab7d49138503ad162086998b731349b0ec0.jpg" data-media-id="editor_3" data-image-id="20240418130432_36d9964c9845f6d9a074786361fc5ab7d49138503ad162086998b731349b0ec0" data-rendition-name="original" width="2500" height="1668" loading="lazy" alt="Seto Machhindranath"> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240418130432_2662753a9514a682ccdfd17bf05e2be3771183a68dc86b717ab67d9aad894563.jpg" data-media-id="editor_4" data-image-id="20240418130432_2662753a9514a682ccdfd17bf05e2be3771183a68dc86b717ab67d9aad894563" data-rendition-name="original" width="1668" height="2500" loading="lazy" alt="Seto Machhindranath"> </figure>  &nbsp;Exactly nine types of wood are used, which is the sum of the four base elements that make up the universe (earth, water, fire and air) and the five human senses. The height and length of the chariot is 32 arm’s length (hāt in Sanskrit), 14.8m. The number 32 represents the maximum number of auspicious and physical qualities one could possess to be considered an outstanding human being.&nbsp; Says Vajrācharya, “Observing how the chariot is built helps one learn the fundamental pillars of the Buddha’s teachings, and find an easier path to Nirvana.” The structural design of the nearly 15m wooden chariot is not only awe-inspiring but also gravity-defying. It leverages the pliancy of the materials used in its construction -- flexible joints tied with cane soaked in water for several days. The precise proportions of the chariot ensure great manoeuverability in the narrow streets along the route of the chariot procession that include some 90° bends, without colliding into houses.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240418130432_9f5c2943f5d6b3f0010d3d5213697549945e87a6f7d3d8cbadd69f0dea6c6e2c.jpg" data-media-id="editor_5" data-image-id="20240418130432_9f5c2943f5d6b3f0010d3d5213697549945e87a6f7d3d8cbadd69f0dea6c6e2c" data-rendition-name="original" width="2500" height="3750" loading="lazy" alt="Seto Machhindranath"> </figure>  Driving and steering the chariot with brute muscle power of the mirthful crowd is a seemingly impossible task. But this has been achieved year after year, despite the fact that the devotees who tug wildly at the ropes lassoed to the two front wheels, are most likely in high-spirits (pun intended). Sanjay Manandhar, a US-based technology entrepreneur, recounts how his high school physics teacher from Canada asked his students to go observe the locals build the chariots of Karunāmaya if they were interested in becoming engineers in the future.&nbsp; “That made no sense to me then, but, after all these decades, I now see clearly how the structural design of the chariot, adopted early on by our ancestors is full of earthquake-resilient properties that need to be applied in building houses in an earthquake-prone zone like Nepal,” says Manandhar. A highlight of the chariot festival is that human goddess Kumari makes an appearance at the final destination in Lagan, usually on the third day. This is only one of the 13 times that people get to see the Kumari outside her temple abode.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240418130432_08aa39f3f004a212b33c60a2840d6013110de15dd34a0288f699dd5fda8957ab.jpg" data-media-id="editor_6" data-image-id="20240418130432_08aa39f3f004a212b33c60a2840d6013110de15dd34a0288f699dd5fda8957ab" data-rendition-name="original" width="2500" height="1667" loading="lazy" alt="Seto Machhindranath"> </figure>  On the last day of the festival (Saturday), the image of lord Karunāmaya is carried on a palanquin by priests from Janabahā in a gala procession and brought back to his permanent residence at the temple in Kel Tol.&nbsp; The chariot festival is thought to have started during the reign of King Pratap Malla of Kantipur in the 17th century CE. For close to four centuries, the construction of the chariot and its operation has proven to be a phenomenal engineering feat, and the people’s faith in divinity means the tradition is alive.&nbsp; The essence of the colourful rituals and the religious beliefs of this ancient chariot festival is now all but lost. The logic, technology and practicality must be brought back to light, as they reflect the high civilisation and wisdom of our ancestors that we can leverage in modern times and into the future. &nbsp; Alok Tuladhar is a culture and heritage documentarian.

Kathmandu’s gravity-defying chariot festival

In the run-up to the third Nepal Investment Summit this weekend, there have been seminars, conferences and workshops where the discourse has revolved around the economy and the investment climate.
The consensus that Nepal needs foreign direct investments (FDI) to grow was repeated, and the familiar litany of reasons about why it has not been able to was discussed.&nbsp;
Policy advocates and regulators have understood that the lack of urgency is compounded by procedural inconsistencies, on top of the already deficient investment environment in the country.
It is a welcome change from what used to be flippantly accepting matters as given. There now seems to be a sense of urgency, with procedural inconsistencies and lack of harmonisation between various Acts and regulations openly discussed.&nbsp;
Government stakeholders also appear more willing to learn and attempt to be part of the solution. Whatever policy changes have been introduced in the past have been piecemeal and address the few rather than the entire industry. This left dual regulatory approaches aimed at similar players.&nbsp;
Read also: <a href="https://nepalitimes.com/opinion/killing-investment-in-nepal-in-10-easy-steps">Killing investment in Nepal in 10 easy steps</a>, Dibesh Karmacharya
This time, unlike in the past two Summits, the government seems to be committed to amending 9 Acts, a positive step towards showing commitment to change. However, the deadline to do so during the winter session of Parliament is over. The option mooted has been to have it passed through ordinance, a lesser appealing step; albeit, a positive one moving forward.&nbsp;
To attract FDI in a competitive global market means that Nepal has to demonstrate that it is serious about bringing in investments with a more consultative and collaborative approach with investors. A departure from procedural to a result-oriented focus is needed.&nbsp;
To put issues in perspective, Nepal needs US$20 billion in investments to meet the UN’s Sustainable Development Goals (SDG) targets by 2030. If net-zero decarbonisation targets are to be met by 2045, another US$7 billion will be required annually.&nbsp;
Looking at our investment history and poor government capital expenditure, the gap is long and wide. In fiscal year 2022-23 Nepal booked a lamentable ~$59 million in FDI (equity). Nepal is in fact the lowest market in South Asia for FDI with 0.3% of the regional average.&nbsp;
What is it that we can do to fill the gap?&nbsp;
First, we need to move away from the notion that Nepal only needs large investments. This has proven to be a mistake, and time series data have proven that smaller investments, in aggregate, make a larger impact on economies.&nbsp;
Read also: <a href="https://nepalitimes.com/news/poor-cash-rich-nepal">Poor cash-rich Nepal</a>, Sonia Awale
We talk about an ‘enabling environment’ but without the right tools. We place restrictions on interest on debt ceiling (SOFR +5.5), without risk premium adjustments, we do not have an active secondary market for bond trading, nor do we have a yield curve, an integral part of the bond market, which is inhibiting us from tapping into the trillion dollar green bond market.&nbsp;
In order to attract green financing, Nepal needs to develop its bond market. Sovereign risk rating has been mooted and was expected to be operationalised before the Investment Summit.&nbsp;
However, to be rated in an adverse economic environment could further deteriorate investment potential due to a lesser-than-expected rating.&nbsp;
Hedging is another instrument that needs further research on. A commercial bank last year showcased the first risk-hedging mechanism for an investment of $8 million. This can be the beginning to expand on its modality. &nbsp;
Subordinated debt instruments have been introduced, but on a special nod basis, this now needs to be institutionalised as it is the most applicable form of investment after equity in a market that has volatile forex reserves.&nbsp;
Read also: <a href="https://nepalitimes.com/editorial/invest-in-investment">Invest in investment</a>, Nepali Times
Viability Gap Funding has been introduced by multilateral development agencies implemented in solar installations. It is a tool to incentivise the private sector to invest in projects that are not financially lucrative initially, but have potential for profitability in the long run. This needs to be scaled up and replicated in sectors like infrastructure, where returns may not be immediate.
Moving forward, to attract FDI, Nepal needs to tap into the funds that are available for the growth of small and medium enterprises (SMEs) and climate change. Alternative investments such as Private Equity Venture Capital (PEVC) have been around in a structured manner in Nepal for nearly a decade now.
These funds have blended finance components and have attracted climate funding as well. PEVC is a new asset class and can address the issues of penetrating into SME financing by incorporating environment, social and governance issues into their investment process.&nbsp;
SMEs are the backbone of any economy, PEVC comes with the ability not only to scale up the enterprise with risk capital, but with the ability to bring technical knowhow to enhance not only the enterprise but also the entrepreneur.&nbsp;
Read also: <a href="https://nepalitimes.com/opinion/success-in-nepal-means-not-having-to-work">Success in Nepal means not having to work</a>, Anil Chitrakar
A differentiator from all other forms of financing available till date in Nepal. Blended finance is a way of de-risking investments, especially in frontier markets. Business Oxygen (BO2) is an example of blended finance with subordinated debt investments of IFC (World Bank Group) taking the lead and Climate Investment Funds along with FCDO as co-investors.&nbsp;
On a larger scale, the 216MW Upper Trisuli 1 is another example of blended finance with IFC, a Korean consortium and local investments. So far, we see that development finance Institutions have been taking the lead in Nepal as their risk appetite is greater than commercial investors and they are eager to help develop the financial markets.&nbsp;
In order to be sustainable, we need to step on this and attract commercial capital from all over the world. To do this there has to be political will to make that pivot.&nbsp;
Instead of being a means to an end, the two previous Investment Summits turned out to be intermittent and cosmetic, providing hardly any results. The third one’s success will depend on how the event will be implemented as a platform for continuous marketing for the country and facilitation for investors in future.&nbsp;
Nepal has outdone many countries in its macro-economic indicators, with sound forex reserves and a stellar history of debt payments to its creditors. This story needs to be propagated along with the drive for change to attract potential investors.
Read also: <a href="https://nepalitimes.com/opinion/comment/alternative-investments-to-attract-fdi">Alternative investments to attract FDI</a>, Siddhant Raj Pandey

hygiene