Sagar Tamang first met Laxmi Tamang in video calls between Malaysia and Pokhara. He was working as a security guard in Malaysia, and had sent her a <a href="https://nepalitimes.com/banner/facebook-nation">Facebook </a>request. Before long, between messages and calls, they were in love and planning a future together. Laxmi could see it clearly: after six years Sagar would <a href="https://nepalitimes.com/diaspora-diaries/migrant-worker-returns-to-create-work-at-home">return home</a> to Sankuwasabha, they would get married and have children, live in the home that Sagar had built, and she would open up her tailoring shop with Sagar’s savings from abroad. But Sagar revealed that he was experiencing shortness of breath and his legs had begun to swell. She pleaded with him to come back, but he would only return after his roadside property back home was built. Sagar’s parents had already built a new house with his income and were planning another nearby. The symptoms worsened over time, prompting Sagar to eventually consult a doctor. Both his <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/A-mysterious-rash-of-kidney-failures,3639">kidneys had completely failed</a>. A seemingly healthy, energetic 28-year-old suddenly turned into a dialysis patient. Sagar lived with his mother, father, five sisters and four brothers in Sankuwasabha, and the family depended entirely on a piece of land they farmed. An older brother left home to seek work elsewhere but that was not enough. So, after just finishing Grade 10 Sagar decided on an <a href="https://nepalitimes.com/here-now/overseas-job-seeker-now-creates-jobs-in-nepal">overseas job</a>. He arrived <a href="https://nepalitimes.com/here-now/the-malaysia-nepal-migrant-scam-nexus">in Malaysia</a> at just 20, saddled with loans, and an immense pressure to raise the economic status of his family. But upon arrival, he found that he would be working in agriculture, not as a security guard as per his contract. Toiling for 11 hours in the sun every day, he felt worn down and disillusioned with the<a href="https://nepalitimes.com/news/push-factors-driving-nepalis-out?fbclid=IwAR0Og_Lv1SMmn69MAkgqu1Ywu8IoLuB_v9KpnjG2F8PR-OAOCDvL6kLoKlk_aem_AX_Vm0Bo8vLUzR_RAr8GpJ8dDX53u8v0zPMP1GzR590UiMfz5jHkg7k14WF5cAQOHwY"> promise of life abroad</a>. His living situation, made up of a tightly regulated, crowded compound with other migrant workers, was no better. Only when he heard the distorted voice of his mother through his flip phone did Sagar find a sense of solace. Over the next two years, Sagar developed friendships with other Nepalis working with him, and eventually accepted that his life abroad was nearly permanent. He planned to stay aboard at least 10 years. And after writing a letter to his company, he was able to successfully switch to security guard work. Although the hours were longer, it beat the difficult manual labour Sagar was previously forced to complete for a meagre salary. Sagar fell into a routine he thought he would follow for the next eight years: get ready, go to work, return to the compound, and call Laxmi before going to sleep. But two years ago, his health reached a breaking point, and he had to return to Nepal for dialysis. Upon his arrival, he was rushed to Bir Hospital for immediate treatment. To this day, Sagar has never stepped foot inside the houses his family built with his overseas earnings. Read also:<a href="https://nepalitimes.com/multimedia/dirty-dangerous-difficult-and-dehydrating"> Dirty, Dangerous, Difficult ... and Dehydrating</a>, Pinki Sris Rana <h2>Dialectics of dialysis</h2>  <figure><img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025051509054_5b8972cf42e1d1ae531b7d32c0492380964f065432a8dd0a7e41674b7160b266.jpg" data-media-id="editor_7" data-image-id="2025051509054_5b8972cf42e1d1ae531b7d32c0492380964f065432a8dd0a7e41674b7160b266" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Dying to work overseas NT"><figcaption>HARD LABOUR: Sagar Tamang in a dialysis session at the National Kidney Centre in Kathmandu (right) after both his kidneys failed while working abroad in harsh conditions.</figcaption></figure>  It is estimated that <a href="https://nepalitimes.com/multimedia/dirty-dangerous-difficult-and-dehydrating" target="_blank">one in four </a>Nepali kidney patients is a returnee migrant. <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/A-mysterious-rash-of-kidney-failures,3639" target="_blank">Factors </a>such as excessive heat, dehydration, and unhealthy diets can lead to chronic kidney disease, including kidney failure. Many returnees head straight to a dialysis bed in Kathmandu instead of taking the first bus home. In dialysis wards across the country, scores of young men under 40 sit in hospital beds, unable to work or earn for their families anymore. Many remain in debt for treatment, or have had to relocate to seek care. For patients with no source of reliable income, even finding a willing landlord to rent out a room in the capital can be almost impossible without the right connections. However, Sagar’s cousin, who had also developed chronic kidney disease while working abroad and had moved to Kathmandu from Sankhuwasaba for dialysis, took him in. Laxmi finally met Sagar two months later. She found it hard to hold back tears whenever she saw his face. She was able to stay with her brother in Bhaktapur for some time, but eventually the couple decided to marry. Laxmi’s mother and sisters urged her to put off the marriage until Sagar had completed a kidney transplant. The couple eloped. Two days after their marriage, Laxmi’s family called them to come to their home in Nagarkot to celebrate. Now, the couple lives in a rented house near the National Kidney Centre with other dialysis patients and their families. Sagar walks to his dialysis session three times a week. In this house, there is a sense of solidarity among patients, and Laxmi especially feels a comfort knowing that her neighbours understand her position as the wife and caretaker of a dialysis patient. Members of the house cook for each other, help with transport to the hospital, and sometimes even <a href="https://nepalitimes.com/here-now/when-disaster-strikes-home">lend money</a>. So far, Sagar has used his savings from abroad to pay for the direct and indirect costs of his treatment. However, the money is running out as the couple grapples with the city’s <a href="https://nepalitimes.com/opinion/is-free-health-care-possible-in-nepal?fb_comment_id=3363039693768713_5667191770020149">cost of living and medical bills</a>. The government offers free lifetime haemodialysis for patients, but the Rs5,000 monthly allowance does not come consistently, in full, or just never comes at all despite repeated requests to the patient’s municipal office. Those receiving treatment in the Kathmandu Valley also access medicine through Bhaktapur’s Shahid Dharmabhakta National Transplant Centre (SDNTC), but under the hospital’s insurance are required to pay for 10% of the cost.  <figure><img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025051509058_2001d2b6d07ca8406575bd1c89f714b5b224d64bf25437b55bda0e21475fdbc4.jpg" data-media-id="editor_12" data-image-id="2025051509058_2001d2b6d07ca8406575bd1c89f714b5b224d64bf25437b55bda0e21475fdbc4" data-rendition-name="original" width="2773" height="4160" loading="lazy" alt="Dying to work overseas"><figcaption>Sagar with his wife Laxmi in Pokhara.</figcaption></figure>  Once his family’s primary earner, Sagar can no longer make or send money due to his condition. His family runs a goat and <a href="https://nepalitimes.com/banner/are-you-sick-of-chicken">poultry farm</a>, but has been forced to take loans to stay afloat and cannot send money for Sagar’s treatment. Until recently, Laxmi worked 12 hours a day as a tailor and house cleaner. Sagar, his mother and Laxmi, have been making trips to SDNTC in preparation for his transplant. In Nepal, only relatives or the spouse of the patient are allowed to be donors for their <a href="https://nepalitimes.com/opinion/comment/saving-kidneys-to-save-nepal">kidney transplant</a>. This can be debilitating for patients whose families are unwilling or unable to donate due to pre-existing health issues such as hypertension or diabetes. Wives and mothers are the most likely demographic to donate to a male patient. Due to Sagar’s inability to come home and officiate his marriage it is yet to be recognised by the municipality, making Laxmi an ineligible donor. After finding out his father’s blood type did not match and refusing his younger sister’s offer to give her kidney, he and his mother decided that they could start the transplant process together. Even Nepal’s prime minister K P Oli has had a double kidney transplant, but for those who cannot find a donor within the family, the remaining years of life is measured by the humming and erratic beeps of a dialysis machine three times a week. It is going to be a lengthy and expensive process, but it is the only hope for Sagar. And what are his immediate plans after a successful transplant? To return home, to finally see his siblings, father, neighbours and friends, he tells us. He has seen his father once since his <a href="https://nepalitimes.com/here-now/searching-for-a-homeland-away-from-home">return to Nepal</a>, but has not seen his siblings since he left for Malaysia. They have not visited him in Kathmandu yet, but he hopes that they will before his transplant. The couple believes that after his transplant, anything is possible: finally getting their marriage recognised, opening up a tailoring shop, having children, building a life in Sankuwashaba. Laxmi strongly objects to Sagar ever leaving Nepal again, but he remains open to the idea.

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Dying to work overseas

At the National Kidney Centre in Kathmandu, a substantial number of the staggering 800 patients who come for regular kidney dialysis are migrant returnees from the Gulf and Malaysia.&nbsp;
Last month alone, 90% of the 90,000 Nepalis who went abroad were migrant workers. Most of them went to West Asia. They are healthy when they leave, but are <a href="https://nepalitimes.com/editorial/too-hot-to-work">exposed to extreme temperatures</a>, and many return with ruined kidneys.
Nepal is suffering an epidemic of renal failure due to the workers’ continuous exposure to excessive heat, chronic dehydration, harsh work environment, and the tendency to go for energy drinks immediately after returning from work. The problem will get worse in coming decades with nonsurvivable wet-bulb summer temperatures in the countries where Nepali migrants work.&nbsp;
Truth be told, renal failure is not confined to migrant workers. Increasingly high numbers of young Nepalis are suffering from lifestyle-related ailments. Individuals as young as 25 are living with high blood pressure, fatty liver, and diabetes, among others.
In the past 40 years, Nepal has seen a dramatic transformation from a country with mortality mostly from infectious diseases to one where people are living longer but are dying due to lifestyle-related ailments. A <a href="https://nhrc.gov.np/wp-content/uploads/2022/02/BoD-Report-Book-includ-Cover-mail-6_compressed.pdf">2019 study by the Nepal Health Research Council</a> found that non-communicable diseases accounted for 71% of deaths in the country.&nbsp;
Diabetes, high blood pressure, and the irrational use of painkillers are some of the main reasons behind this figure. Kidney failure can be prevented if diabetes and hypertension are controlled in the initial stages.
Renal health is very much linked to the quality of life and economy. Patients do not suffer alone, often they are the sole breadwinners and their condition will greatly impact their families.
As per the World Health Organization, 10% percent of Nepal’s total population (300,000 people) suffer from kidney issues, 30,000 of them are in the final stage, and 3,000 need dialysis or transplant every year.
The increasing burden of non-communicable diseases is a global phenomenon but developing countries like Nepal face a double whammy as we continue to battle preventable infections too.
The chances of survival for people suffering from renal failure are slim, but the good news is that the government provides dialysis and transplantation services free of cost.&nbsp;
Currently, over 90 health facilities throughout the country provide free dialysis services to over 6,000 patients with renal failure. Over 3,000 patients have undergone kidney transplants since the service started about a decade ago, including a former prime minister and other senior government officials.&nbsp;
Every year Nepal spends Rs2.11 billion on the treatment of patients with renal failure. Local governments also provide monthly livelihood allowances to those with kidney failure or undergoing transplants. This is the highest amount the government has been spending for any single disease.&nbsp;
Even so, the focus is on the treatment of the 3,000 people living with kidney failure and scant attention has been paid to 270,000 others who suffer from some sort of kidney disease, and another 270,000 who are at risk of kidney disease.
Providing free dialysis service is not a sustainable solution. Authorities concerned should promote prevention, and encourage renal failure patients to opt for transplants. Despite the legal provision that allows any immediate family to donate a kidney, many with renal failure cannot find one.&nbsp;
Road traffic accidents are one of the biggest causes of deaths today and a kidney from brain-dead donors is a viable option. But this requires increased awareness about organ donation.
Preventing kidney disease is the best way, and the first step is to launch awareness campaigns, the cost of which is minimal compared to the treatment cost of renal patients.
The public should be told about the dangers of obesity, excessive consumption of alcohol, tobacco, salt, and junk food as well as insufficient intake of vegetables and fruits. Regular exercise, drinking plenty of water, and cutting on sugar should be promoted.
Screening is crucial to early diagnosis and a lot of lives can be saved if testing for non-communicable diseases is made free once a year for all age groups. Even then, most Nepalis do not undergo tests unless it is an emergency.&nbsp;
The government has established laboratories at the health post level to carry out the test, but very few make use of the service. People can monitor protein levels in urine and do a creatinine test, a measure that shows how well one’s kidneys are performing or filtering waste from blood. The tests cost just Rs100.
Above all, these awareness campaigns should be launched at the school and community levels so that we have an early chance to save every kidney from severe damage. Before things get worse, we Nepalis and Nepal can bring down the burden of non-communicable diseases, cut medical costs, and save lives.
Rishi Kumar Kafle is a senior Nephrologist and is the founding President of the National Kidney Center in Kathmandu.

Saving kidneys to save Nepal

Between mid-June and mid-October alone, almost 37,500 Nepalis left for the UAE for jobs, placing it among the top destination countries. Many of these workers will likely be engaged in the delivery of the COP28 Climate Summit that will ironically be held in the UAE, the world’s fifth <a href="https://nepalitimes.com/news/nepal-s-greenwashing-in-glasgow">biggest</a> exporter of refined petroleum, with the head of the Abu Dhabi National Oil Company (ADNOC) service as conference president. Prime Minister Pushpa Kamal Dahal will lead the Nepali delegation.Migrant workers form <a href="https://worldmigrationreport.iom.int/wmr-2022-interactive/">88% of the UAE population</a>, so one cannot talk about COP28 or the UAE by ignoring migration. For Nepal, too, the climate crisis and the migration economy are linked.<a href="https://www.hrw.org/news/2023/11/21/uae-migrant-worker-abuses-linked-broader-climate-harms">New research</a> by Human Rights Watch (HRW) states that the COP28 host’s role in climate injustice goes beyond it being one of the largest fossil fuel producers and among the highest per capita emitters. It also relates to its treatment of migrant workers. HRW interviewed 151 current and former migrant workers and their families from Bangladesh, Pakistan and Nepal. Despite negligible per capita greenhouse gas emissions, the three countries are among the most climate vulnerable and have suffered extreme weather and slow-onset events linked to climate change.&nbsp; The climate impact countries like Nepal face should also be considered from the perspective of their mobile populations in the UAE and other countries. Migrant workers are exposed to extreme heat with inadequate protection, and because widespread abuse like wage theft and exorbitant recruitment fees limit the ability of workers to send home remittances, including during climate-linked emergencies. Dubai’s maximum temperature on some days <a href="https://www.khaleejtimes.com/uae/weather/uae-temperatures-cross-50oc-for-first-time-this-summer">exceeded</a> 50 Celsius this summer, and the UAE itself is vulnerable to heat stress due to atmospheric warming.The Intergovernmental Panel on Climate Change (IPCC) has said that the Gulf <a href="https://www.ipcc.ch/report/ar6/wg2/downloads/report/IPCC_AR6_WGII_Chapter10.pdf">states’</a> wet bulb globe temperature (WBGT) is ‘expected to approach, and possibly exceed, the physiological threshold for human adaptability (35°C) by the end of the century’. Migrant workers, including Nepalis, are disproportionately exposed.The most common heat mitigation strategy used in the Gulf including the UAE are ‘summer midday bans’ that stop outdoor work in the afternoons for a few hours. But a <a href="https://oem.bmj.com/content/80/6/347">study</a> in <a href="https://oem.bmj.com/content/80/6/347">Kuwait</a> found that despite the ban there was a substantial increase in the risk of occupational injuries associated with extremely hot temperatures. Another <a href="https://www.researchgate.net/publication/333293731_Assessment_of_Heat_Stress_Exposure_among_Construction_Workers_in_the_Hot_Desert_Climate_of_Saudi_Arabia">study </a>found that the highest heat intensity for workers in Saudi Arabia was from 9 am to noon, while the ban is in effect between noon and 3 pm. HRW’s research recommends that the UAE move away from arbitrary, calendar-based midday bans towards risk-based measures such as the WBGT.&nbsp; Heat is a health hazard. It can exacerbate pre-existing conditions, impair cognitive function, and increase the risk of workplace injuries and long-term illnesses like end-stage renal failures. Dialysis rooms across Nepal that are filled with Gulf returnees. &nbsp; HRW’s <a href="https://www.hrw.org/video-photos/interactive/2023/11/21/migrant-workers-bear-the-brunt-of-uae-extreme-heat">research</a> follows three dialysis patients who are all UAE returnees describing how they did not get support from the UAE. The Nepal government provides dialysis for free, but the cost of medicines, injections, and transportation add up. Chitrakala, the wife of a dialysis patient, Til, who accompanies him to the hospital multiple times a week for his dialysis says, “In some ways, I find it comforting to be at the hospital because in the waiting room, I realise I am not alone. It is not just my family that is facing this.”&nbsp; Another UAE returnee, Purna, says it is after he frequented the dialysis centre that he realised that kidney failure is common among migrant worker returnees. The situation will worsen in a changing climate. “The UAE is externalising their own climate risks onto migrant workers who are labouring under woefully inadequate protections. These workers often experience chronic health harms linked to extreme heat, and then return home without any compensation from the UAE and instead let countries like Nepal bear all the serious health costs like dialysis treatment,” says Michael Page of HRW.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20231124031152_7daf43db2cba93c6e81c6607aa61d07d3f3fbd4e2b338aadd2aaa4720828cb76.jpg" data-media-id="editor_9" data-image-id="20231124031152_7daf43db2cba93c6e81c6607aa61d07d3f3fbd4e2b338aadd2aaa4720828cb76" data-rendition-name="original" width="4032" height="2268" loading="lazy" alt="COP28 and migtants NT"> </figure>  There are other labour abuses like wage theft and exorbitant recruitment fees that also contribute to climate injustice, the HRW report argues. Climate emergencies back home exacerbate the mental stress of wage theft and recruitment debt as families in Nepal are in increasingly dire and even life-threatening situations.&nbsp; Workers HRW spoke to who were unable to send remittances because of labour abuses spoke of the dilemma they face: their families lose both critical financial support and the help they could have provided for urgent tasks like rebuilding damaged property had they stayed home. But for many, even exiting the UAE with outstanding recruitment debts or unpaid wages during such climate emergencies posed a challenge. Workers had to pay fees to retrieve their passports including by obtaining ‘reverse remittances’ on loan from families back home already reeling from life-threatening climate emergencies. Good migration can be transformative, but bad migration can be devastating for families. To be sure, remittances have been critical for economies of Nepal and other South Asian countries, but they do not substitute their responsibility. Historical and major greenhouse gas emitters also have a duty to support communities heavily impacted by the climate crisis. <a href="https://www.knomad.org/sites/default/files/publication-doc/migration_development_brief_38_june_2023_0.pdf">Remittances</a> are equivalent to a quarter of Nepal’s GDP, while Pakistan and Bangladesh are among the top 10 remittance recipients globally. Remittances have also been a lifeline including post-earthquake and during Covid. But these numbers mask the individual experiences of migrant workers and their families who face abuses and many of whom end up in financially worse situations than they did pre-migration. Virtually all migrant workers pay hefty fees for jobs which itself creates a huge dent on the returns to migration while excluding some of the poorest communities from even attempting to migrate. But even that does not guarantee a good job. The July 2021 <a href="https://www.icimod.org/article/the-melamchi-flood-disaster/">Melamchi flood</a> was a climate-induced disaster in Nepal, and one of its victims told HRW researchers: “During the flood, all we wanted was to save our lives. We survived, but we lost everything. The flood finished us.”His wife is headed to the UAE for a waitressing job which cost her Rs &nbsp;200,000, and borrowed at 24% annual interest. If all goes well, her first year’s salary of a mere $262 a month will just go to repay the loan. Another Sindhupalchok returnee from the UAE said, “Whether climate change or not, we have to migrate. We used to be self-sufficient but now have to buy food. Yields are lower. Insects and diseases are more common.” Climate change can be a compounding factor for longstanding emigration such as from Nepal to the Gulf, and adds to the burden of past, present and future migrant workers. The UAE is also being criticized for its restrictions on civil society and free expression during COP28. The HRW research states these affect migrant workers by limiting their ability to raise workplace concerns and seek structural, worker-centered reforms. The government’s opacity around <a href="https://pomeps.org/climate-the-environment-and-health-of-migrant-workers-lessons-from-kuwait">health data</a> hampers research for <a href="https://vitalsignsproject.org/wp-content/uploads/2023/06/Vital_signs_3_online.pdf">evidence-based</a> policymaking including for better outdoor protections, while academics and journalists tend to <a href="https://www.hrw.org/news/2021/10/01/uae-tolerance-narrative-sham-0">self-censor</a> to avoid reprisals. At the COP 28 in Dubai, Prime Minister Dahal would do well to dwell on the links between the host country and increasing climate vulnerability that Nepalis face both at home from weather extremes and heat stress at their workplaces in the UAE.

Too hot to work

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110151112/636d06f59c7e80680e0a5f92jpeg.jpg" alt="" width="1500" height="1000"/><figcaption>Photo: MONIKA DEUPALA</figcaption></figure>The past year-and-half since the Covid-19 outbreak, Nepal’s limited health resources all had a singular focus. But now that the second wave is waning and the lockdown has been eased, hospitals are once again flooded with patients with <a href="https://archive.nepalitimes.com/article/nation/diabetes-in-south-asia,3018" target="_blank" rel="noopener noreferrer">diabetes</a>, cardiovascular diseases and kidney ailments.Many of these patients had left these conditions untreated, and doctors say nursing them back to health will be more complicated. One of the most common disorders is hypertension or high blood pressure, which has become an epidemic.Hypertension is a silent killer and one of the most common causes of chronic conditions like <a href="http://archive.nepalitimes.com/article/Nepali-Times-Buzz/A-mysterious-rash-of-kidney-failures,3639" target="_blank" rel="noopener noreferrer">kidney damage</a> that are often too costly to treat for the majority of Nepalis. Now, mental stress due to Covid has also added to the problem.“Hypertension makes up for the majority of patients in hospitals these days now that the lockdown has been relaxed,” says cardiologist Prakash Regmi. “Also worrying is that many of these are new patients coming in due to Covid-related stress, a large number of people who had their blood pressure under control previously after treatment are also relapsing.”To be sure, Nepal has been seeing a dramatic rise in hypertension patients even before the pandemic – some of them in their teens and 20s. <a href="https://www.hindawi.com/journals/ijhy/2021/6610649/" target="_blank" rel="noopener noreferrer">A paper published in March</a> in the International Journal of Hypertension, shows that since 2000, the hypertension rate in Nepal has been increasing at 3.5% per decade, and 44.7% of Nepali men will be suffering from hypertension by 2025.The study also found that high blood pressure is disproportionately affecting men, the elderly, those without formal education, and those who reside in urban areas, and seems to be most common in Gandaki Province.Worldwide, an estimated 1.13 billion people have hypertension, and it is responsible for 9.4 million deaths globally every year. In 2015, 1 in 4 men and 1 in 5 women had elevated blood pressure.In Nepal, close to one-third of the adult population has some form of hypertension, but in urban centres the figure is as high as 40%, with 25% in rural areas suffering from it.There is no specific cause of hypertension, but its biggest risk factor is high sodium intake. A survey in 2020 revealed that on average, the mean dietary <a href="https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.13813#:~:text=Overall%2C%20estimated%20mean%20salt%20intake,d%20(SD%20%C2%B1%204.7)." target="_blank" rel="noopener noreferrer">salt intake of a Nepali</a> per day is 13.3 mg. Most of the world consumes double the WHO recommended 5g of daily salt intake, increasing the risk of heart disease and strokes, which kills some 3 million people annually worldwide.“Traditionally Nepalis have a preference for salty food, but now with higher consumption of processed and <a href="https://www.nepalitimes.com/banner/nepalis-binge-on-junk-foods-the-west-rejected/" target="_blank" rel="noopener noreferrer">junk food</a>, our salt intake has grown,” says public health expert Aruna Uprety, adding that the sodium content in packaged foods is often much higher than what companies claim.In May WHO (World Health Organisation) released a new set of <a href="https://www.who.int/news-room/events/detail/2021/05/05/default-calendar/launch-event-who-global-sodium-benchmarks-for-different-food-categories" target="_blank" rel="noopener noreferrer">global benchmarks for sodium levels</a> that will act as a guide for countries and industry to reduce sodium content in more than 60 categories of processed foods, in line with the global target of reducing salt intake by 30% and hypertension by 25%, both by 2025.Another prominent risk factor is mental stress and lack of physical exercise, both of which have been exacerbated with people staying at home for months and under the uncertainty of the pandemic. Family history of hypertension also plays a significant role in an individual developing high blood pressure, as does smoking and drinking alcohol.Undetected hypertension, and non-medication to control it, can lead to other disorders like stroke, heart disease, kidney failure, etc.Despite the huge burden of the disease on public health and the economy, treatment of hypertension is ill-managed. Patients are never diagnosed because often times there are no prior symptoms.And of the 50% who are diagnosed with high blood pressure, half ignore their condition and get no treatment. Of the remaining, 25% do get some kind of treatment but half of them again do not follow-up or take the correct dose of medication.“All in all only about 10% of hypertension patients get proper treatment in Nepal. Lack of proper health monitoring system, as well as misconceptions about life-long medications, hasn’t helped,” says cardiologist Prakash Regmi. “This often leads to a point where treatment is either too expensive, or even unmanageable.”Hypertension is first and foremost a lifestyle disease with strong ties to a possible failure of crucial organs in the human body. Its prevention and control are heavily dependent on an <a href="https://www.nepalitimes.com/banner/junk-food-is-making-nepali-children-shorter/" target="_blank" rel="noopener noreferrer">individual’s choice of diet</a>.A state-sponsored robust awareness campaign to focus on preventive measures and a strong healthcare system are urgently needed to reduce the epidemic of hypertension.Says public health expert Aruna Uprety: “Mandatory blood pressure check-ups for certain age groups at fixed intervals is a good place to start. It goes a long way in reducing the cost of the disease and human lives.”Stages of hypertension<ul style="font-weight: 400;"><li>Normal: Less than 120/80 mm Hg</li> 	<li>Prehypertension (Elevated): Systolic between 120-129 and diastolic less than 80</li> 	<li>Stage 1 (Moderate): Systolic between 130-139 or diastolic between 80-89</li> 	<li>Stage 2 (Severe): Systolic at least 140 or diastolic at least 90 mm Hg</li> 	<li>Hypertensive crisis: Systolic over 180 and/or diastolic over 120</li></ul>Types of hypertension<ul style="font-weight: 400;"><li>Primary or essential: Most common high blood pressure among adults. No specific cause but risk factors include diet, age, physical activity and genetics.</li> 	<li>Secondary: Up to 10% of hypertension is secondary. Most often caused by another medical condition or the use of certain medicines.</li></ul>Risk factors<ul style="font-weight: 400;"><li>High salt/sodium intake</li></ul>WHO recommendation: 5gm/day<ul style="font-weight: 400;"><li>Mental stress</li> 	<li>Lack of physical exercise</li></ul>WHO recommendation: at least 150–300 minutes of moderate-intensity aerobic physical activity<ul style="font-weight: 400;"><li>Family history of high blood pressure</li></ul>

Sonia Awale

Why do so many Nepalis have high blood pressure?

Fenerbahçe Beko won the Turkish Airlines EuroLeague finals in Abu Dhabi, held 23-25 May, defeating Monaco 81-70 in the final. Olympiacos, who defeated Panathinaikos 97-93, finished the series in third place. The Most Valuable Player (MVP) of the final match, Nigel Hayes-Davis from Fenerbahçe Beko, received a prize of 1,000,000 Miles&amp;Smiles from Turkish Airlines’ Chief Commercial Officer Ahmet Olmuştur. The carrier has been the title sponsor of the Turkish Airlines EuroLeague, a top tier tournament, since 2010.

Turkish Basketball

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

The Last Days of the Khampa

Starting 17 September Turkish Airlines will fly daily to Seville, one of Spain’s major tourist draws. This is Turkish’s sixth destination in Spain after Madrid, Barcelona, Valencia, Malaga, and Bilbao. Seville is in the Andalusia region on Spain’s south coast with a rich Moor history. There are approximately 30,000 Nepalis living in Spain.&nbsp;

Turkish to Seville

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

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