South of Janakpur near the Indian border is the village of Phulgama. Out of its population of 4,500, nearly every household here has at least one son who is a migrant worker abroad.&nbsp; Some 40% of Nepali men between the ages of 20-35 are <a href="https://nepalitimes.com/news/die-first-get-paid-later">migrant workers abroad</a>, mainly in India, the Gulf states or Malaysia. In the last nine months alone, 741,297 people travelled overseas: mostly to the UAE, Saudi Arabia, Qatar, Malaysia and Kuwait. This does not include those who left on student visas, and there are no records of how many went to India. Most end up working in ‘3D jobs’ — &nbsp;dirty, dangerous and difficult. There is also a fourth D: dehydrating work.&nbsp; Risky outdoor as manual workers, <a href="https://nepalitimes.com/editorial/too-hot-to-work">excessive heat of the desert in the Gulf</a> or humidity of the tropical jungles of Malaysia, poor diet, dehydration and unhealthy lifestyles all contribute to a <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/A-mysterious-rash-of-kidney-failures,3639">higher risk of kidney failure among Nepali migrant workers</a>. Dhanusha district has one of the highest proportions of workers migrating for work to India and abroad. Nephrologists call kidney disease ‘the silent killer’ because patients do not show symptoms until it is too late, and migrant workers are especially susceptible to Chronic Kidney Disease (CKD) or End-Stage Renal Disease (ESRD).&nbsp; Increasing demand for cheap labour and minimum pre-departure health awareness training makes migration more risky than it should be. From a survey of hospitals and dialysis centres in Dhanusha and Kathmandu, the risk of kidney failure<a href="https://nepalitimes.com/opinion/comment/saving-kidneys-to-save-nepal"> appears higher among male migrant workers</a> than in Nepali men of the same age group.&nbsp; “This disease is idiopathic, meaning it is not caused by one specific factor,” explains Rishi Kafle of the National Kidney Center Nepal. “But after screening migrant workers going to the Gulf and developing End-Stage Renal Disease in 3-4 years, we can say that migration increases the likelihood of kidney failure.” Kafle adds: “Because of the need to maximise earnings, working in extreme heat for long hours dehydrates them. And many opt for Coca-Cola and meat instead of healthier water and vegetables.”  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250118070128_b86cd132e88fecad9cde6d6faa648f76b40979660e6d28e846b25469668df9d8.jpg" data-media-id="editor_4" data-image-id="20250118070128_b86cd132e88fecad9cde6d6faa648f76b40979660e6d28e846b25469668df9d8" data-rendition-name="original" width="4032" height="3024" loading="lazy" alt="Dirty, dangerous, difficult, and dehydrating NT"> <figcaption>All photos: PINKI SRIS RANA</figcaption> </figure>  While the risk of kidney failure is higher in returnee migrant workers in Nepal, the disease is on the rise globally due to <a href="https://nepalitimes.com/banner/sick-of-it">lifestyle changes,</a> diabetes or undiagnosed hypertension. Currently, there are 28,266 kidney patients enrolled in the <a href="https://dohs.gov.np/">Department of Health Services</a> for free treatment under the government’s <a href="https://mohp.gov.np/program/medical-treatment-of-deprived-citizens/np">Bipanna Nagarik Kosh</a>, of which 17,044 are male and 11,222 female. Just in the past year, 9,176 more patients were added to the fund. Most hospitalised kidney patients are from age 15-65. In a healthy person, toxins and waste in the blood are filtered by the kidneys. But patients with kidney failure need to circulate their blood regularly through a haemodialysis machine. The whole process takes about 3-4 hours and causes blood vessels in the arms to swell over time. Nearly 2 million Nepalis suffer from chronic kidney disease (CKD), which is about 8% of the population. The rise in diabetes and hypertension is contributing to an increase in the disease. Everyone from migrant workers to many of Nepal’s top politicians suffer from kidney failure. Prime Minister Oli himself has had two kidney transplants. Even with dialysis twice a week, some patients develop nausea, swelling and other problems when they eat or drink. The extra dialysis sessions cost money, and the livelihood allowance given to patients is never enough or timely. Not every migrant working in hot climates returns with kidney disease, but a recent yet-to-be-published study led by nephrologist Sailendra Sharma states that one-fourth of all kidney patients in Nepal are migrant returnees. It points to recurrent heat stress as a primary risk factor. The<a href="https://mihs.edu.np/"> Madhesh Institution of Health Sciences</a> in Janakpur has 103 regular patients who come for dialysis. Of them, 30 are returnee migrants not just from Dhanusha, but also Sarlahi, Siraha, Mahottari and Sindhuli. “Not by the nature of the disease, but the way kidney disease is growing, I would call it an epidemic,” adds Kafle. &nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250118070128_43731248e116cfdc42bfc08b8f7d71e5ff3d44b938065a5ad9e9a337e666b9c7.jpg" data-media-id="editor_9" data-image-id="20250118070128_43731248e116cfdc42bfc08b8f7d71e5ff3d44b938065a5ad9e9a337e666b9c7" data-rendition-name="original" width="1463" height="798" loading="lazy" alt="Dirty, dangerous, difficult, and dehydrating NT"> <figcaption>HARD LABOUR: Jagdish Sah shows a picture from his time in Malaysia.</figcaption> </figure>  Jagdish Sah left for Malaysia ten years ago. He had taken a loan for his sister’s marriage and he had to pay it back. As the eldest son, he was also expected to get married next, but he faced multiple rejections. “Women have expectations too. They want to get married to well-to-do families. They didn’t want to get married to a family that lived in a mud house like ours,” says Sah, now 35. Foreign employment was a one-stop solution to his problems. Or so he thought. Sah was 24 when he left for a tailoring job at a garment factory in Malaysia. He often worked overtime, sometimes up to 12 hours a day in the hopes of earning extra ringgits. Even so, his highest monthly income would only be Rs35,000.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250118070128_7dd5030951c805302adec46afdef623bbdbb6fe1c0f12b7a77fd612531865af1.jpg" data-media-id="editor_10" data-image-id="20250118070128_7dd5030951c805302adec46afdef623bbdbb6fe1c0f12b7a77fd612531865af1" data-rendition-name="original" width="2048" height="1536" loading="lazy" alt="Dirty, dangerous, difficult, and dehydrating NT"> <figcaption>Sah at a garment factory in Malaysia where he worked, often dehydrated, and not taking toilet breaks to earn more.</figcaption> </figure>  Workers got a 30-minute break for lunch, and there were limited toilet breaks. So, Sah just worked straight out. Back in Nepal for a break in 2017, Sah had blurred vision and fainted. He thought it was high blood pressure, but a few months later at age 28, he was diagnosed with double kidney failure. “Whatever he saved in Malaysia went for his treatment in Kathmandu. We even sold a plot of our land,” recalled Sah’s mother, Mantoriya Devi.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250118070128_dc353dd6ce449c05bda6d562907dd961d8900c1b747dc4afec1680bb65b805b7.jpg" data-media-id="editor_11" data-image-id="20250118070128_dc353dd6ce449c05bda6d562907dd961d8900c1b747dc4afec1680bb65b805b7" data-rendition-name="original" width="3995" height="2871" loading="lazy" alt="Dirty, dangerous, difficult, and dehydrating NT"> <figcaption>Sah is now gaunt and frail in this picture taken duing his biweekly dialysis at Madhesh Institute of Health Sciences in Janakpur recently.</figcaption> </figure>  Sah drives his motorcycle twice a week from his village to the Madhesh Institute of Health Sciences in Janakpur for free dialysis. His family says it is as if the Jagdish who went to Malaysia and the one who came back are two different people. &nbsp; “This disease has already doomed my life. Why ruin someone else’s?” says Sah of his lack of marriage prospects. “It is because of dialysis that I have survived so far.” His parents are too old and occupied with their chores to accompany him. Since Jagdish cannot work, his father, Ram Dev sells popcorn by the sidewalk from a wheeled cart. Mithu Kumar went to Saudi Arabia to work as an electrical supervisor two years ago. He was 25. Recently when he started vomiting, he was taken to a local hospital. He was diagnosed with chronic kidney disease and was sent back to Nepal. As Kumar lays down for his dialysis treatment at Save Lives Hospital in Janakpur, he says, “My only wish is that I am healthy enough to work again.”&nbsp; Umesh Kumar Yadav also worked in Saudi Arabia as a guard. He returned with chronic kidney disease, but he says he is the only one to contract the ailment among all the returnees from his village. “Only the ill-fated people have this disease,” says Yadav. “Otherwise, it would have been the same for every other person from the village who is abroad working.” Ambar Bahadur Sarki, 46, travels from Sindhuli for three hours every Monday and Thursday to Janakpur for his free dialysis at the Madesh Institute of Health Sciences. Sarki worked in a palm oil plantation in Malaysia, where heat stress often exceeded the wet-bulb threshold for heat and humidity. “It was extremely hot at all times,” he remembers. He first got hypertension, which made both his kidneys fail. Ram Udgar Mandal from Dhanusha started working in Saudi Arabia in his late twenties. He spent the next 17 years in the desert working as a driver. Now in his late forties, he was diagnosed with End-Stage Renal Disease (ESRD) four years ago.&nbsp; But this is an intergenerational cycle. Mandal’s son has now also gone to Malaysia to supplement the family income. He fears his son will meet the same fate as him. “We do not have a choice, do we?” he says. Lalit Balampaki, 28, from Dhanusa was diagnosed with ESRD a year earlier in Dubai. He stays in Kathmandu along with his older brother’s family on a rented floor. Balampaki worked in extreme heat conditions in a smelting factory in Dubai. He had to work night shifts twice or thrice a week. Sleep deprivation and extended periods without food were part of his daily routine. The pay was good, but his savings have all gone now towards hospital fees. “More than the money, I earned the disease,” says Balampaki. &nbsp; Suraj Thapa Magar, 30, was the sole breadwinner of his family. He installed aluminum windows and doors in Kuwait “It was the hottest in summer and coldest in winter,” says Magar, who worked for 10 hours a day even in 50°C. He also often neglected hydration, and one night he vomited blood. At 26, he was diagnosed with ESRD and has been in Nepal ever since. Thapa has no other choice than to rely on the Rs5,000 allowance, but even that is not timely and not enough. He has to take loans to travel for his dialysis. The government hospitals are supposed to provide some medicines for free, but they are often out of stock. Thapa has looked for jobs, but kidney disease is a stigma and no one wants to hire him. &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;*** In 2016, Nepal started providing free hemodialysis treatment for the poorest patients. Two years later, a monthly livelihood allowance of Rs5,000 was to be distributed to patients suffering from chronic diseases like dual-kidney failure and cancer. Free dialysis is provided in 107 hospitals across the country, but that is only in theory. Many facilities do not have nephrologists because the government does not provide salaries. The machines also often are not working because they need constant maintenance. Among the 11 hospitals that provide free dialysis in Madhes Province, three are in Janakpur. Nepali Times visited the enlisted hospitals but there were no nephrologists to supervise the treatment, and they were run by general physicians or senior nurses.&nbsp; “The government does not provide adequate salaries for the nephrologists,” says Kafle. “That is why nephrologists are mainly affiliated with the private hospitals.” Bagmati Province has 44 hospitals with free dialysis, which is why many dual-kidney failure patients have opted to live in Kathmandu. The hospitals service over 8,000 kidney patients.&nbsp; Since most of them are migrant workers, the end result is that Nepal’s poorly-resourced health system ends up bearing the cost of treating kidneys that failed while working as labourers in hot, rich countries. &nbsp;

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Dirty, Dangerous, Difficult ... and Dehydrating

In a corner seat on the first floor of Bir Hospital, a middle-aged kidney patient winces in pain. Next door, a lady has nerve damage, and is unable to feel the growing wound on her sole. Two floors up, a crowd of desperate patients wait for an appointment with an endocrinologist. This week, the hospital in Kathmandu was filled with different medical complications. But many of them were related to a single disease: diabetes. “On any given day, we see up to 200 patients in our department, and more than half have to do with diabetes mellitus,” says consultant endocrinologist Manil Bajracharya at Bir. Diabetes mellitus is a condition where the body either does not produce enough insulin, or does not use it effectively, resulting in dangerously high blood sugar levels. Untreated, it can lead to life-threatening complications, including disorders of the cardiovascular system, eyes, kidneys, and nerves. In Nepal, the incidence of diabetes is on the rise, with an estimated 8.7% of adults between 20-79 living with the condition in 2021. This number was 3.6% in 2011, and is expected to reach 9.4% by 2045. “This rise most likely has to do with rapid changes in lifestyle and diet,” explains Bajracharya. “We have seen a shift from traditional cereal and vegetable-based diets to ones rich in animal products and processed foods high in fat and sugar content. This nutritional transition, combined with reduced physical activity, has significantly increased the risk of diabetes.” Bagmati Province has a five times higher prevalence of diabetes than the Karnali. Other provinces with urban centres like Gandaki and Lumbini also have a high burden of the disease. Read also: <a href="https://nepalitimes.com/opinion/comment/saving-kidneys-to-save-nepal">Saving kidneys to save Nepal,</a> Rishi Kumar Kafle  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240607150624_2deb3cabd4a1367ea0656a84e817aa0c8bcc920bb4b33bda30037272931024b0.jpg" data-media-id="editor_1" data-image-id="20240607150624_2deb3cabd4a1367ea0656a84e817aa0c8bcc920bb4b33bda30037272931024b0" data-rendition-name="original" width="3952" height="3021" loading="lazy" alt="Diabetes in Nepalis NT"> </figure>  “Nepalis who migrate to cities often have reduced physical activity and transition to high-calorie diets, which contribute to obesity and elevate the risk of diabetes,” says Bajracharya. City dwellers are twice as likely to develop diabetes compared to rural Nepalis. Diabetes mellitus has no cure, but it can be managed through careful monitoring, lifestyle changes, and improving medications. Many people diagnosed with diabetes live for years without experiencing serious symptoms. But Nepal has a huge gap: 43.5% of adults living with diabetes do not know that they have the disease. This means two out of every five cases go undiagnosed, and therefore untreated.&nbsp; “If diabetes isn’t detected on time, it can become life-altering, and may even be fatal,” adds Bajracharya. Raman Tamang did not know he had diabetes until a wound started growing on his foot. “I first thought it was just a normal cut. But it grew and started stinking. It got so bad that my family started avoiding me,” says Tamang. When he was brought to Helping Hands Community Hospital in Chabahil, his wound had turned chronic. A patient with long term diabetes suffers nerve damage. This results in the loss of sensation in the feet. Elevation in blood glucose also reduces the body’s ability to heal wounds. “Minor cuts, scrapes, or wounds often go unnoticed until the body can no longer heal them on its own,” explains orthopaedic surgeon Hem Limbu at Helping Hands.&nbsp; Read also: <a href="https://nepalitimes.com/here-now/junk-food-is-making-nepali-children-shorter">Junk food is making Nepali children shorter</a>, Marty Logan  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240607150624_4e61c5cb980f287da4393eaf277d0c7418dbe95ffb717bb761ffa6f25d8418de.jpg" data-media-id="editor_3" data-image-id="20240607150624_4e61c5cb980f287da4393eaf277d0c7418dbe95ffb717bb761ffa6f25d8418de" data-rendition-name="original" width="1281" height="841" loading="lazy" alt="Diabetes in Nepalis NT"> </figure>  Called diabetic foot ulcers, such wounds often persist and in the worst cases may get infected and have to be amputated. Across the globe, 85% of all amputations happen due to diabetic foot ulcers. “We have to amputate almost half of all cases of diabetic foot because many patients come too late,” adds Limbu. Not amputating the leg can lead to infections spreading to the bloodstream. Studies have shown that 19-47% of diabetic patients in Nepal also have diabetic retinopathy, where high-glucose blood damages blood vessels in the retina of the eye, impairing vision. However, less than 30% of Nepalis who have diabetes know about this risk of blindness. And an additional 50% never get their eyes checked despite living with diabetes. Diabetes also elevates the risk of kidney failure, heart disease, and stroke.&nbsp; An estimated 9,000 Nepalis under 60 died due to some form of complication attributable to diabetes in 2021. Then there are 9.2% of Nepali adults who are prediabetic with elevated blood glucose levels that could reach diabetic levels if their lifestyle does not change. “But because most don’t know they have the condition, proper screening and awareness are essential,” says Hem Limbu. Read also: <a href="https://nepalitimes.com/here-now/myopia">MYOPIA</a>, Yugeshwor Koirala  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240607150624_fcdcf19b68a2f40d6b17f9753cc6d6fa13d511dae2a4b649a665db07c9c23a72.jpg" data-media-id="editor_5" data-image-id="20240607150624_fcdcf19b68a2f40d6b17f9753cc6d6fa13d511dae2a4b649a665db07c9c23a72" data-rendition-name="original" width="1262" height="849" loading="lazy" alt="Diabetes in Nepalis NT"> </figure>  Screening involves a blood test, and to manage high blood sugar, patients require insulin replacement therapy through injections or an insulin pump. But insulin resistance can often be managed with dietary modifications and exercise. “Prediabetes is gaining increasing recognition as a significant health concern, and a growing number of adults are seeking assistance even for mild symptoms,” notes Bajracharya. While this trend reflects improved awareness, it is equally vital to identify prediabetes in younger adults. Developing diabetes at a young age prolongs the duration of the condition and escalates the risk of complications. Timely diagnosis and effective management can mitigate complications: reducing the risk of diabetic retinopathy by up to 95%, foot ulcers and amputations by 85%, kidney disease by 70%, and both cardiovascular disease and stroke by 50%. “Prevention is better than cure for most diseases, but for diabetes, prevention and early detection are the only cures. Once the disease advances, reversing its effects becomes exceedingly challenging, necessitating lifelong symptom management,” adds Bajracharya. “So Nepal’s challenge isn’t just about forming an action plan for diabetes awareness, screening and treatment, but about implementing it in areas where essential drugs and equipment are out of reach.” In urban cities, the challenge is different. Drugs, diagnostic services and self-monitoring equipment are accessible, but so are processed foods and sugary drinks. “After essential healthcare services are in place, preventing and managing diabetes comes down to personal choices and attitudes. Whether or not diabetes continues to surge in Nepal, therefore, depends on each individual more than anything else,” says Bajracharya. &nbsp; Read also:<a href="https://archive.nepalitimes.com/news.php?id=18379"> Diabetic dilemma</a>, Buddha Basnyat

A deadly sugar rush

<a href="https://nepalitimes.com/news/ball-in-balen-s-court">Nepal’s newly-installed Prime Minister Balendra Shah</a> unveiled his Council of Ministers after taking the oath of office on Friday in Kathmandu.&nbsp; Besides Nepal's pre-existing problems, his team will immediately have to deal with the fallout of the West Asia conflict to satisfy an electorate impatient for change. The Rastriya Swatantra Party (RSP) won a majority in the 5 March election and capped the Cabinet size at 15. Shah, a structural engineer and musician, himself has taken charge of the Defence and Industry Ministries. There has been an attempt to make the Cabinet inclusive with women in five of the new portfolios.&nbsp; After much negotiation, the powerful Home Ministry, a bone of contention between Shah and RSP Chair Rabi Lamichhane, has gone to Sudan Gurung, a hitherto little-known figure who <a href="https://nepalitimes.com/here-now/who-or-what-is-hami-nepal">rose to prominence after the September GenZ protest</a> and won the election from Gorkha-2.&nbsp; Gurung will be in charge of Nepal’s internal security apparatus and maintaining law and order. And with Gurung, a close ally of the Prime Minister, in charge, some note the Home Ministry will be a hook for Shah if Lamichhane, with his share of controversies, steps out line.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260327090324_c7725ea5fb9ffbf96df25a7b3122520b7ae3ee10548aed3f37781a7e5440e51a.jpg" data-media-id="editor_2" data-image-id="20260327090324_c7725ea5fb9ffbf96df25a7b3122520b7ae3ee10548aed3f37781a7e5440e51a" data-rendition-name="original" width="1440" height="960" loading="lazy" alt="Balen Shah swearing in NT"> </figure>  Notable RSP leaders, including vice-chair DP Aryal, were said to have been vying for the portfolio.&nbsp; Gurung is the founder of the non-profit Hami Nepal, which worked primarily in earthquake relief in 2015, and emerged onto the national stage during negotiations to appoint Sushila Karki as interim PM after the unrest. He was also involved in key negotiations that cemented Balendra Shah and Rabi Lamichhane’s political partnership in the runup to the election.&nbsp; Most new Cabinet members are not just first-time ministers, but are also freshmen lawmakers. Many are experts in their fields. Finance Minister Swarnim Wagle is an <a href="https://nepalitimes.com/here-now/nepal-needs-to-rebrand-itself">economist </a>with degrees from the London School of Economics and Harvard, and was previously Chief Economic Advisor at the UNDP Regional Bureau for Asia and the Pacific, and also served in Nepal’s National Planning Commission.&nbsp; Previously a member of Nepali Congress, Wagle exited the party in 2023 following differences with top leadership, and joined the RSP. Wagle won a by-election from Tanahu-1 in 2023 and won again from the same constituency in this month’s election.&nbsp; Shishir Khanal, who heads RSP’s foreign affairs department, has been appointed Minister of Foreign Affairs. &nbsp;Khanal is co-founder of Teach For Nepal, was briefly Education Minister when the RSP was part of the the Pushpa Kamal Dahal-led coalition government in 2023.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260327090324_b1a670bac12e2bf4df955134f58c8de7718d48f6be4e1f2df7c7c52f82e36e42.jpg" data-media-id="editor_4" data-image-id="20260327090324_b1a670bac12e2bf4df955134f58c8de7718d48f6be4e1f2df7c7c52f82e36e42" data-rendition-name="original" width="1440" height="960" loading="lazy" alt="Balen Shah swearing in NT"> </figure>  Law Minister Sobita Gautam is a lawyer by profession and worked in governance and public policy before she was elected as the youngest MP in the 2022 election.&nbsp; Health Minister Nisha Mehta is a nurse and became a lawmaker under the Proportional Representation system in this election which swept the RSP to power with a near two-third majority.&nbsp; Education Minister Sasmit Pokharel, a first-time MP elected from Kathmandu-5, served as an aide to Balendra Shah when he was mayor of Kathmandu and a was member of the KMC City Planning Commission.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260327090324_5ed794d7bf0cac2844277521810225c4355746b9c3f7369f70cacc878c94641f.jpg" data-media-id="editor_5" data-image-id="20260327090324_5ed794d7bf0cac2844277521810225c4355746b9c3f7369f70cacc878c94641f" data-rendition-name="original" width="1440" height="960" loading="lazy" alt="Balen Shah swearing in NT"> </figure>  Biraj Bhakta Shrestha is Energy Minister, and also served as the Minister for Youth and Sports in the Dahal-led coalition government in 2024. Before joining RSP, Shrestha was elected to the Bagmati Provincial Assembly in the 2017 elections representing the r<a href="https://nepalitimes.com/here-now/rsp-s-activist-dna">eformist Bibeksheel Sajha Party</a>. He will immediately face the challenge of addressing the <a href="https://nepalitimes.com/news/rough-road-ahead-for-new-nepal-rulers">impact of the West Asia war,</a> including rising petroleum prices and a shortage of cooking gas. Sita Badi, who was elected through the PR system, is Minister for Women, Children and Senior Citizens. She was born and brought up in the underserved and marginalised Badi community in Surkhet and has been advocating for the rights and welfare of women, children, and minority communities. Other ministers include RSP spokesperson Pratibha Rawal as Minister for Federal Affairs and General Administration as well as Land Management, and Gita Chaudhary as Minister for Agriculture, Sunil Lamsal is Physical Infrastrucutre, Transport, and Urban Development Minister, Khadka Raj (Ganesh) Paudel as Tourism and Civil Aviation Minister. Dipak Sah is the Labour and Employment Minister, and Bikram Timilsina is Communication Minister.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260327090324_b67c2d199d4897031583a5b7ec7ce43e88771167696e6161665eeb5fca25d3ed.jpg" data-media-id="editor_8" data-image-id="20260327090324_b67c2d199d4897031583a5b7ec7ce43e88771167696e6161665eeb5fca25d3ed" data-rendition-name="original" width="1440" height="960" loading="lazy" alt="Balen Shah swearing in NT"> </figure>  Meanwhile, RSP vice-chair DP Aryal, who many thought would be home minister because of his proximity with Rabi Lamichhane has been proposed as Speaker of the House.&nbsp; Aryal previously served two brief stints as the Minister of Labour when RSP was part of the RSP’s coalition governments in 2023 and 2024. As minister Aryal came <a href="https://nepalitimes.com/editorial/skeletons-in-the-cabinet-k5x6py1v">under scrutiny </a>for his involvement in an employment agency that was investigated for illegal acquisition of wealth in 2020. If appointed House Speaker, Aryal will be expected to play a neutral and non-partisan role in Parliamentary affairs. &nbsp; With the full Cabinet announced on Friday, Prime Minister Shah and his team now have their work cut out for them. &nbsp;The government’s first priority will be ensuring the safety and long-term security of the almost two million <a href="https://nepalitimes.com/here-now/migrant-workers-in-wartime">Nepalis living and working in the Gulf</a> amid the ongoing conflict in the region, and taking steps to cushion Nepal’s economy from the Israel-US war on Iran. The new leaders will also be tasked with implementing the findings of the Karki Commission report on the September violence that paved the way for the election and the rise of the RSP. &nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260327090324_69b36bc62737e44ade4080be36688f9c2f92201356e1df2072cef8ecc6a9be5d.jpg" data-media-id="editor_11" data-image-id="20260327090324_69b36bc62737e44ade4080be36688f9c2f92201356e1df2072cef8ecc6a9be5d" data-rendition-name="original" width="1440" height="960" loading="lazy" alt="Balen Shah swearing in NT"> <figcaption>Snapshots from PM Balen Shah's swearing-in ceremony</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260327090324_69b36bc62737e44ade4080be36688f9c2f92201356e1df2072cef8ecc6a9be5d.jpg" data-media-id="editor_12" data-image-id="20260327090324_69b36bc62737e44ade4080be36688f9c2f92201356e1df2072cef8ecc6a9be5d" data-rendition-name="original" width="1440" height="960" loading="lazy" alt="Balen Shah swearing in NT"> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260327090324_8646d490883154f696bcdc6e2375084419f2eefaaf0ef0c7e2710aa6e2d94a8a.jpg" data-media-id="editor_13" data-image-id="20260327090324_8646d490883154f696bcdc6e2375084419f2eefaaf0ef0c7e2710aa6e2d94a8a" data-rendition-name="original" width="1440" height="960" loading="lazy" alt="Balen Shah swearing in NT"> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260327090324_89d17d6584593be1eb23eb1d4872c3b7c600e1620f3aca48dbff4838364a1e3c.jpg" data-media-id="editor_14" data-image-id="20260327090324_89d17d6584593be1eb23eb1d4872c3b7c600e1620f3aca48dbff4838364a1e3c" data-rendition-name="original" width="1440" height="960" loading="lazy" alt="Balen Shah swearing in NT"> </figure>  &nbsp;Full list of ministers: Prime Minsiter: Balendra Shah Home Minister: Sudan Gurung Finance Minister: Swarnim Wagle Foreign Affairs Minister: Shishir Khanal Law, Justice and Parliamentary Affairs Ministry: Sobita Gautam Energy, Water and Irrigation Minister: Biraj Bhakta Shrestha Education Minister: Sasmit Pokharel Physical Infrastrucutre, Transport, and Urban Development Minister: Sunil Lamsal Communication and Information Ministry: Bikram Timilsina General Administration Minister: Pratibha Rawal Women, Children and Senior Citizens Minister: Sita Badi Health and Population Minister: Nisha Mehta Agriculture Minister: Gita Chaudhary Culture, Tourism and Civil Aviation Minister: Khadka Raj (Ganesh) Paudel&nbsp; Labour Minister: Dipak Sah

Nepal swears in new Cabinet

Rivers have been the lifelines of civilisations with their dynamic ecosystems providing vital services for human survival and ecological balance through the ages.&nbsp; But accelerating anthropocentric footprints are causing severe, and often irreversible, damage to river systems across the world, including those across High Asia, a region that sustains nearly a fourth of the global population downstream. An example is the <a href="https://nepalitimes.com/here-now/how-the-bagmati-civilisation-is-becoming-uncivilised" target="_blank">Bagmati River</a> that courses through Kathmandu, crosses the Himalayan foothills to join the Ganga in India. A river that once shaped the <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/when-it-comes-to-water-pollution,3196" target="_blank">Kathmandu Valley Civilisation </a>is now a polluted and biologically dead water body constricted by urban sprawl, choked by construction debris, chemical waste and untreated sewage.&nbsp; The loss of a sacred river is tragic enough, but its hazards related to health, life and livelihoods are not limited to the Valley, nor is its enormity fully gauged by the metrics of fatality, income loss, flood return periods, runoffs, embankment failure.&nbsp; It is a systemic collapse of ecological integrity, socio-economic stability and cultural heritage, affecting its downstream users as well. The death of Bagmati is a peril for a population size way bigger than circa 5 million residents of Kathmandu Valley. The degradation started in the 1980s and has accelerated. Why has not enough been done to save this iconic river that runs through Nepal’s capital?&nbsp; The Bagmati River Basin Improvement Project (BRBIP) was designed to make headway in restoring the river with a sewage treatment plant, dams for storing water to support dry-season runoff, recharge groundwater, creation of <a href="https://archive.nepalitimes.com/page/resurrecting-bagmati-the-river" target="_blank">green biodiversity corridors</a> along the river bank to also serve as recreation areas, reduce the urban heat island effect, and also provide cultural continuity. The project also envisages collection of hydrological data for managing Bagmati multipurposewater systems and providing flood forecasts and early warnings aimed at protecting lives and property, among other things. Most importantly, the project takes the integrated water resource management approach, which, in principle, is a holistic and collaborative way of managing all elements of the water cycle to ensure water security, public and environmental health and amenity.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260329040336_9605240fa8c7d649ce49fbe43565130e3187e979338ccf959c4e9b8c581b7a4c.jpg" data-media-id="editor_3" data-image-id="20260329040336_9605240fa8c7d649ce49fbe43565130e3187e979338ccf959c4e9b8c581b7a4c" data-rendition-name="original" width="2126" height="1577" loading="lazy" alt="Bagmati NT"> </figure>  This should pave the way for managing a river as a connected ecological, social, and economic system by enabling coordination across agencies and disciplines, stimulating technological innovation and financial investment. The success of this approach depends on long-term political will and commitment that transcend political cycles, but also needs strong community and civil society in defining issues and proposing solutions, creating and sharing knowledge, taking independent action to inform practice, monitoring and evaluating policies, and participating in public decision-making. Civil society, especially, in making the <a href="https://archive.nepalitimes.com/page/encounter-with-bagmati-river" target="_blank">revival of the Bagmati River</a> a pressing governance issue. The Bagmati Action Plan 2009, a precursor to the BRBIP, was designed in response to lawsuits filed in 2000 and 2004 by an independent legal practitioner of Kathmandu against waste dumping in the river.&nbsp; It took him almost two decades of legal battle for Nepal’s Supreme Court to pass orders for mandatory septic tanks in all homes in Kathmandu Valley, relocation of squatters from Bagmati river banks to government-built houses, and embargo on dumping and burying garbage on the banks of the river and its tributaries. Despite court orders, however, actual results have been unsatisfactory. Restoration of Bagmati barely made it to any political debate or electoral manifesto this time. Treatment plants have not been operational for years, yet no one is held accountable. The population ignores waste segregation or single-use plastic rules to check littering.&nbsp; The current condition of the river therefore seems to have more to do with the lack of public awareness and behaviour change than the failure of various master plans. Why does the deep danger of a dead river fail to arouse widespread civil society concern, let alone action? The apathy is perhaps underlined by an innately anthropocentric understanding of the river as a mere resource to be exploited, rather than the backbone of existence.&nbsp; Such a paradigm shift is possible when river or river systems are understood to be necessary for &nbsp;a harmonious coexistence with human populations. The more pertinent question is not whether a dead river can be restored because there are many examples from around the world where that has been successfully achieved. It is whether we choose to restore our rivers for intergenerational equity. This would require a holistic perspective and political will to revive reverence for a river system so that its symbiotic relationship with human settlements can be restored. Roshni Gurung is Research Assistant, River Basins at the International Centre for Integrated Mountain Development (ICIMOD).

A lifeline becomes liability

Nepal’s new government hit the ground running with the arrests of former Prime Minister K P Oli and home Minister Ramesh Lekhak early Saturday morning.&nbsp;
Their dramatic detentions followed an inquiry commission report recommending that Lekhak, Oli, and former Police chief Chandra Kuber Khapung be investigated and prosecuted for negligence in failing to stop the killing of 19 young protesters by security forces during the protests on 8 September.&nbsp;
Interim PM Sushila Karki’s government faced considerable criticism from GenZ activists at the end of her 7-month tenure for failing to release the report and hold the previous UML-NC coalition to account.&nbsp;
Karki had left any decision on the report’s findings to new RSP government, but her government released it after the content was leaked earlier this week, a day before Nepal’s newly elected lawmakers took their oath of office.
By making the arrests of Oli and Lekhak as its first order of business, the new government, and especially Home Minister Sudan Gurung and Prime Minister Balendra Shah, have tried to show that they are decisive and mean business.&nbsp;
It has been hailed by many as signalling that Nepal’s new and young leadership will back up its pledges with action. However, others including the UML and some constitutional experts, say that the arrests have not followed legal procedures. The UML has mobilised its affiliated groups to start nationwide street protests.&nbsp;
The main divide seems to be over the perception that the new government is only interested in justice for the perpetrators of the 8 September Parliament massacre, and not against those who organised arson and vandalism of government buildings, homes of politicians, businesses and the media the next day.&nbsp;
While some celebrate what they see as the beginning of justice for the victims and survivors of the September violence, political analysts and legal experts express alarm over a lack of adherence to the rule of law.&nbsp;
K P Oli has a lot of experience being behind bars. He was jailed a dozen times in 1970s by the Panchayat regime for his extreme left activism and then spent 14 years in prison between 1974-1988.
Critics argue that the former leaders were denied due process and label their arrest a “political vendetta."
RSP supporters had made similar arguments in October 2024 and April 2025 that the arrest of party chair Rabi Lamichhane over misappropriation of funds from numerous cooperatives were &nbsp;politically motivated.
‘What is happening is unacceptable,’ wrote former minister and diplomat Nilamber Acharya wrote on Saturday morning. ‘Such acts of revenge and crackdowns do not bode well.’
In response to accusations of the arrests being partisan and politically-motivated, Home Minister Sudan Gurung took to social media, saying that the new government is fulfilling its promises: ‘No one is above the law,’ he wrote. ‘This is not revenge, it is the beginning of justice. I believe now that the nation will now take a new direction.’
There is also concern the new leadership has jumped the gun to implement the findings of the inquiry commission, which has itself been criticised in some quarters for concentrating on the events of 8 September rather than investigating the perpetrators of the anarchy on 9 September.&nbsp;
The first meeting of the Council of Ministers made the immediate implementation of the GenZ Movement Inquiry Report its first priority.
But there are questions as to whether the execution of the report will be impartial. Home Minister Gurung will now dictate how the recommendations &nbsp;will be conducted, since he is himself referenced in the report in connection with the unrest on 9 September.&nbsp;
In fact, the report also outlines how supporters stormed Nakhu Prison on 9 September to organise Rabi Lamichhane’s jailbreak. Will Minister Gurung also go after his own party's leadership? &nbsp;
With the UML already calling for nationwide protests against the detention of its leaders, there is concern that Nepal is plunging straight into turmoil instead of stability.
The UML leadership has been unrepentant about the 8 September events. Oli has defiantly blamed infiltration and outside forces for the killings, and unlike the Nepali Congress the UML has not managed its own leadership changeover.&nbsp;
The NC under Gagan Thapa as well as the Nepali Communist Party of Maoist leader Pushpa Kamal Dahal have so far been silent about the detentions even though former Home Minister Ramesh Lekhak is from the NC.
Oli and Lekhak’s arrests will now be challenged in the courts. But their detention also signals to Nepal’s political old guard that the tables have turned: legacy leaders cannot be complacent and assume they will disappear from national consciousness for past deeds without being held accountable for what happened during their watch.
The RSP government under Prime Minister Balendra Shah seems determined not to let bygones be bygones. But while that is all and well, it remains to be see whether the party can deliver on the need of the electorate for tangible governance reform.
The danger is that the new rulers may be defined by the same tactics of political revenge as its predecessors in the name of meting out justice.

New Nepal government signals action

On Friday, Balendra Shah is taking his oath of office as Nepal's prime minister in a capital city of which he was a mayor till six months ago.
At 35, he will be among Nepal’s youngest prime ministers. His reticence and reclusiveness have reinforced his brand as a doer rather than a talker. This was a persona he cultivated as mayor of someone who cleaned up the city by managing garbage. But he also chased off sidewalk vendors in an effort to ‘beautify’ the city.&nbsp;
After being elected, Shah did not attend RSP events in official capacity, and he was absent at an MP orientation last week.&nbsp;
His refusal to engage with the press, and even stopping to post on social media, have added to the air of reclusiveness. But as prime minister, he may have to communicate more even if it just to stop conspiracy theories and intrigue.&nbsp;
The people he will now represent would like to know, and have a right to know, what he is up to. Otherwise the feeling will grow that Nepal is entering uncharted territory. Governance, the economy and investment do not like uncertainty.
Political scientist Pyakuryal notes that calling Balen a 'man of few words' may serve as a useful epithet if he governs with quiet efficiency rather than fanfare. "But as Prime Minister, he must engage the nation’s will, not simply manage from above," she says.
She adds: "The real test lies in his choice of style: will he lead exclusively, keeping decisions close, or inclusively, opening space for dialogue and shared ownership of governance?"
Nepal's newly-elected lawmakers were sworn in on Thursday. And once sworn in as PM on Friday, Balendra Shah is set to appoint a ‘minimalist’ Cabinet. Although the Constitution caps the size of the Council of Ministers at 25, the party has decided to stick to maximum 18 and not split ministries to accommodate loyalists as was done in the past.&nbsp;
&nbsp;"The Cabinet must support the leadership of the Prime Minister while ensuring accountability to the Parliament,” notes political scientist Sucheta Pyakuryal. “But the questions that come to mind are: will the RSP MPs readily submit to Balen’s leadership and is Balen’s absence from the party’s official events an unwillingness or hesitation to submit to the party?”
Prime Minister Sushila Karki and her ministers ended their interim tenures this week, and she was lauded for upholding her commitment to hold a free, fair and peaceful election. But her image was tarnished for her reluctance to release the investigation report on the September violence, as well as recommending her Home Minister Om Prakash Aryal for a National Assembly seat, and her personal secretary to the National Trust for Nature Conservation. President Ram Chandra Poudel has put Aryal’s nomination on hold. &nbsp;
The Investigation Commission report leaked on Wednesday said the state failed to stop the firing on protestors by Police on 8 September and blamed the Army for not preventing the arson next day. It recommended the prosecution of prime minister KP Oli, home minister Ramesh Lekhak, and Police chief Chandra Kuber Khapung.
Notable names said to be in consideration for the Cabinet include many who are experts in their fields, and RSP wants a young lawmaker as Speaker. The new government will plunge headlong into the economic fallout of the West Asia war.
RSP, with its near two-third majority, does not have to placate any coalition partner, so Nepal is at long last expected to have a stable government after 35 years. Despite hopes that there will not be the usual horse-trading this time, there is tension between supporters of RSP chair Rabi Lamichhane and Balendra Shah. The two have been negotiating in hotel rooms for Cabinet posts for loyalists.&nbsp;
Shah’s larger-than-life online persona and nationwide appeal delivered the RSP its overwhelming electoral victory this month, and this makes the party’s core leadership beholden to him. To what extent is Shah willing to meet Lamichhane’s demands is the critical question, and we will know the answer by this weekend.
Says Pyakuryal: “Because this election showcased personality politics rather than the regular party politics, the dangers of ego-clashes, power-tussles and intraparty realpolitik become very real and this kind of equation can greatly hamper the spirit of democracy, representation and collective good."

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 <figcaption>Animation: ANUP TAMU</figcaption>
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Nepal swears in new Cabinet

A lifeline becomes liability

New Nepal government signals action

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