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?

The monsoon has got bad press because Nepal’s tourism operators actively told visitors to avoid <a href="https://nepalitimes.com/opinion/managing-the-monsoon?%2F">the rainy season</a>. It is time to change that. The reason can be found right here in the vast alpine meadows of Central Nepal where this time of year you can walk on velvet grass of pastures abloom with delicate pink, red and yellow flowers as the mist rolls up the valley. There is no sound except the hum of bumble bees. &nbsp;&nbsp; There are dozens of places across high Nepal called Chaurikharka, which means yak pasture. But this particular Chaurikharka in Rukum East located at an altitude of 4,000m stands out for its serene beauty, rustic charm and bucolic setting. There is just the occasional chime of <a href="https://nepalitimes.com/here-now/when-yaks-go-so-does-culture">yak bells</a> in the distance, and the sharp whistle of herders corralling sheep. &nbsp;&nbsp; The grass shoots are so fragile that one hesitates to step on them, the rounded ridges appear and quickly vanish in waves of mist. With the<a href="https://nepalitimes.com/here-now/before-the-next-monsoon"> arrival of monsoon</a>, these meadows are a soothing shade of green dotted with millions of <a href="https://nepalitimes.com/review/the-anatomy-of-a-flower?%2F=">multi-coloured flowers</a>. Until very recently, it took a week or so to hike up to places like Chaurikharka, but with the expansion of the road network even to these far-flung mountains in the lap of Dhaulagiri, they are much more accessible. It is just a three-hour uphill from the Mid-Hill Highway on the border between Baglung and Rukum East.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250802130828_a0b06b494d751b2144ffbbf10894ea64b29e8aed844bc8c66171783abfaf4e16.jpg" data-media-id="editor_4" data-image-id="20250802130828_a0b06b494d751b2144ffbbf10894ea64b29e8aed844bc8c66171783abfaf4e16" data-rendition-name="original" width="2048" height="1365" loading="lazy" alt="Visit Nepal in the monsoon"> </figure>  Purists would say that such easy access devalues the sanctity of these remote high meadows, but it also means more people will be moved to treasure the experience, appreciate <a href="https://nepalitimes.com/banner/natures-fragile-gift-to-nepal">the value of nature </a>so they can take steps to protect it.&nbsp; To be sure, the <a href="https://nepalitimes.com/here-now/deadly-monsoon-in-nepal-turns-deadlier">monsoon season can be challenging for road travel</a>. The roads are rough even at the best of times, and in the monsoon they become muddy and treacherous, often blocked by<a href="https://nepalitimes.com/news/monsoon-deluge-in-nepal"> landslides</a>. But that could be precisely the kind of adventure that the more intrepid visitors crave. Improved road connectivity has already made Chaurikharka and places like Badimallika &nbsp;and other sacred lakes in the mountains of western Nepal popular with domestic tourists. What is driving this traffic is the urge to go to exotic new places and share videos and selfies on social media. Several of Nepal’s travel vloggers have visited Chaurikharka and popularised the place, enticing followers on TikTok or YouTube to retrace their footsteps. But even as they become more popular, these fragile and once-remote places should be protected from over-tourism.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250731110736_f97110b7cdc3e7f80d5877690948fc9f4c95a09c583deb23b07355491e6c5446.jpg" data-media-id="editor_8" data-image-id="20250731110736_f97110b7cdc3e7f80d5877690948fc9f4c95a09c583deb23b07355491e6c5446" data-rendition-name="original" width="1083" height="699" loading="lazy" alt="Visit Nepal in the monsoon NT"> </figure>  <h2>INCREASING FOOTFALL</h2> Chaurikharka is located in Bhume Rural Municipality of East Rukum, near the scenic valley of Dhorpatan in Baglung district. Even in the <a href="https://nepalitimes.com/banner/monsoon-culture">middle of the monsoon</a>, there is a steady stream of Nepali hikers trooping to these high pastures – especially during festival days like Saune Sankranti which this year was on 17 July and actually marks the auspicious beginning of the monsoon here. “This year the rains have not been as heavy and there have been some clear mornings when we could see everything from Dhaulagiri to Machapuchre,” says Khageswar Bhandari, who trekked up here from the road. “The flowers, the greenery and the snowy mountain views make this an incredibly unique place.”&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250802130824_1b9e26f2e9853fdfe69154bb42a7c9ea6da4bf4940efc1da99b304dcfbd7d3d9.jpg" data-media-id="editor_10" data-image-id="20250802130824_1b9e26f2e9853fdfe69154bb42a7c9ea6da4bf4940efc1da99b304dcfbd7d3d9" data-rendition-name="original" width="2048" height="1152" loading="lazy" alt="Visit Nepal in the monsoon"> </figure>  Chaurikharka is worthwhile to get to in any season, but it has a different charm during the monsoon. Word has spread and because it is now easy to get to from Baglung or even Pokhara, people have been flocking here.&nbsp; “Holidays and Saturdays see the largest crowds, with up to 500 visitors every day,” says ward chair Mankaji Pun of Bhume.&nbsp; There was a time not too long ago when local herders brought sheep, goats, cows, buffaloes, horses, and mules to graze here during the monsoon. Although there are still livestock around, animals have been replaced by visitors taking selfies. Read also: <a href="https://nepalitimes.com/here-now/the-monsoon-and-nature-s-arithmetic">The monsoon, and nature’s arithmetic</a>, Tom Robertson Ward Chair Pun says infrastructure development is his main priority. A foot trail to Chaurikharka was built last year by the Tourism Division Office in Kohalpur, but access via the Raniwas-Koipa road section still remains challenging.&nbsp; “If we get more budget, we can improve the road and facilities to make Chaurikharka the main tourist attraction of this region,” says Bhume Municipality Chair Hom Prakash Shrestha. “After that, we hope to promote Chaurikharka as a top tourist spot.”&nbsp; Economic activity is also picking up with the arrival of visitors, but there seems to be a need to manage the makeshift sheds made of corrugated sheets that spoil the beauty of the place. Tea shops and lodges are also available but facilities are basic. Kuldeep Neupane took a three-day trip from Ghorahi in Dang to visit Chaurikharka recently, and says: “This is an ideal trip to make a quick getaway and let nature recharge your mind and body. And it is much more fun with a tent, to watch the sunrise over the Himalaya or the mist blowing in.”

Visit Nepal in the monsoon

Two weeks ago, Prime Minister KP Sharma Oli announced jubilantly on social media that Nepal had achieved a historic annual growth of 81.8% in exports. He was right. Nepal’s trade did take a great leap forward compared to last year. But the dramatic rise was mainly due to processed soya bean oil.&nbsp; However, Nepal does not produce the edible oil it exports. In fact, the soya and palm oil that make up 44% of total exports are imported from Southeast Asia and South America, and simply re-exported, mostly to India.&nbsp; Under the SAFTA (South Asian Free Trade Area) Agreement, Nepal can export products to India duty-free if it has at least 30% value-added. Nepal’s traders have taken advantage of SAFTA even though the edible oils they export do not reach that value addition threshold. “The 30% value addition requirement is often only on paper,” says former commerce secretary Purushottam Ojha. “It is clear that simply packaging edible oils in Nepal does not fulfil the terms of the trade agreement.” Prime Minister Oli is aware of this, and even called Nepal’s export figures “fake” at an earlier event. The government is relying on other iffy figures to suggest that Nepal’s economy is strong and getting stronger. For example, the value of imports rose by 13.25% in 2024-25 compared to the previous fiscal year.&nbsp; Some of it was due to a jump in electric vehicle imports worth Rs 31.76 billion, but mostly it was because more wholesale soya oil was imported to be re-packaged and sold in India. The very fact that the government boasts about increased imports is an indication of how much it relies on taxing them for revenue. Touting such trade figures cannot be the basis to claim an economic rebound.&nbsp; “A jump in the value of imports can be interpreted as an increase in purchasing power, but it is not evidence of a stronger economy,” says economist Keshav Acharya. “Even though imports have increased, Nepal's domestic production and productive capacity have not improved.” Nepal Rastra Bank's semi-annual economic activity study report shows that industrial production was down in the first six months of the last fiscal year. This despite an increase in the number of new industries registered and investment commitments. Out of the Rs70.2 billion proposed foreign investment, Nepal received only Rs17.9 billion last year.&nbsp; Meanwhile, the rate of capital formation was limited to 24% last year, which is lower than the year before, suggesting that new investment, job creation and economic expansion all declined. If domestic production does not improve in relation to this year’s inflated trade figures, the outflow will put pressure on foreign exchange reserves like it did three years ago. At that time, Nepal borrowed from the IMF under its Extended Credit Facility Program to kickstart the economy.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025080710084_2cdaaa5795828c4a7de93a0604ba884ef0a8b8f24cccd939f6c24e279ab6058f.jpg" data-media-id="editor_0" data-image-id="2025080710084_2cdaaa5795828c4a7de93a0604ba884ef0a8b8f24cccd939f6c24e279ab6058f" data-rendition-name="original" width="1633" height="723" loading="lazy" alt="Nepal's bubble economy NT"> <figcaption>Source: NEPAL RASTRA BANK</figcaption> </figure>  The macroeconomy is on firm footing with foreign exchange reserves at a comfortable Rs2,520 billion in May, up 23% from last year. This was largely due to remittances, and partly due to a falling NPR exchange rate. Real estate transactions and the stock market index have also been climbing as a result of government policies to revive the sector.&nbsp; However, former executive director of Nepal Rastra Bank Nar Bahadur Thapa cautions: “This is not organic growth, it is the result of deliberate policy decisions to relax rules on real estate and stock markets transactions.” In reality, the sharp rise in land prices have increased the cost of production, and excessive monetisation of the real estate has become the main source of Nepal’s economic woes. The central bank has announced a slew of new policies, shifting the terms of loan repayment for industrialists and entrepreneurs, reducing interest rates, and injecting more working capital — all designed to inject adrenaline into the real estate and stock market sectors.&nbsp; When he was governor, Mahaprasad Adhikari made several financial reforms during the latter half of his tenure to stimulate the economy, including tightening credit flow.&nbsp; By the last fiscal year, additional financial reforms had resulted in a credit expansion rate of around 8%. As the pace of credit expansion slows, real estate prices have started to fall. This is actually beneficial to the economy, because it lays the foundation for improvements in land-related entrepreneurship, production, and the construction sector. Just because real estate and the stock market transactions increase, it does not indicate an economic turnaround — especially when manufacturing and productive sector continues to languish.&nbsp; “It is foolish to believe that real estate and the stock market have magically revived our economy. Agriculture employs more than half of the population, but it is in decline. Investment in the productive sector has not increased, and job creation has not increased.” Two years ago, Nepal’s industrialists, business leaders, and political leadership predicted a recession amidst a sluggish business, declining market demand, large-scale job loss, and a shrinking real estate and share market.&nbsp; Still, the economy grew by 3.36% in fiscal year 2023/24. In fact, Nepal’s economy has grown nominally over the last two decades even when all sectors of the economy are in decline.&nbsp; Says Keshav Acharya: “The growth in trade, real estate, and the stock market are bubbles. The real economy remains stagnant.”

Nepal’s bubble economy

The final investigation report on the crash of a Saurya Airlines jet on 24 July 2024 at Kathmandu airport has revealed flaws in the carrier’s technical operation procedures, poor monitoring by the Civil Aviation Authority of Nepal (CAAN) and gaps in the airport’s emergency response. Eighteen people including a child were killed, and only the captain survived as the plane plunged seconds after takeoff, crashing within the airport perimeter. This was the latest in a series of aircraft accidents in previous years, and further tarnished Nepal’s already poor aviation safety record and contributed to the country being retained in the EU’s air safety list. &nbsp;&nbsp;&nbsp; The circumstances in the Saurya crash were different from the Yeti Airlines crash in Pokhara in January 2022 that killed all 72 on board, and two Tara Air crashes in February 2016 and May 2022 on approach to Jomsom that together claimed 45 lives. However, all four tragedies were a result of negligence of carriers and crew, failure to follow procedures, regulatory slackness, and overconfidence. The Saurya crash, especially, was a glaring example of how an ailing airline broke its own rules to allow passengers, including non-employees, a joy ride to Pokhara on a maintenance ferry flight. CRASH REPORT The Final Investigation Report prepared by the Aircraft Accident Investigation Commission and released on the first anniversary of the crash last week carried a long list of rules that were ignored or broken, and of regulatory failure. The first mistake was to cram spares, tools and inflammable chemicals needed for the aircraft’s C-Check in Pokhara into the cargo hold flouting its own ground handling procedures.&nbsp; There was no check-in of passengers, some of whom were not even employees – even though regulations say only flight and maintenance crew should be on board a maintenance positioning flight. Many brought their own luggage into the plane and stored it unsecured in the cabin. There was no flight attendant to give a safety briefing to passengers. The load and trim charts given to the flight crew were rough estimates, and the total takeoff weight of the plane was 18,300kg plus or minus 200 kg. That would still have been all right, but there was a glaring mistake in the speedchart Saurya pilots were using to calculate the minimum takeoff speed (known as VR), and it had been wrong ever since the 21-year-old aircraft entered service with the airline in 2017. FAULTY DATA&nbsp; The Commission probed Flight Data Recorder inputs from previous takeoffs of the Canadian-built CRJ200-LR in 2023-2024 and found that the undetected error in the speedchart had caused the plane to pitch up at an abnormal rotation rate at least 18 times on previous takeoffs.&nbsp; Any rotation rate more than 3°/sec is regarded as unusual. But on at least two occasions, this aircraft with tail number 9N-AME had rotation rates of 5.8°/sec and 5.5°/sec, the second one was when the pilot who survived was flying in March 2024.&nbsp; On this particular day, the plane’s rotation rate was 6.5°/sec, causing it to go into a deep stall soon after takeoff, the Commission report said. Essentially, the plane was not flying fast enough down the runway to take off safely.&nbsp; It is not yet clear whether excess weight, unsecured luggage, wrong centre of gravity were also factors, but relying on a faulty speedchart for the given takeoff weight, the captain flying pulled back on the yoke before the plane had reached takeoff speed and at a pitch angle that was too steep. The investigation report says the plane then went into a deep stall and started banking right with the stick shaking. At this point, the flight officer on the right hand seat is heard on the cockpit voice recorder saying: “Whoa, whoa, whoa. Sir, Sir, Sir…” It then banked left before the pilot flying turned the plane sharply to the right again in an evasive action to avoid the parking aprons of the international and domestic terminals. Had he not done so, there would have been a disaster of a much greater magnitude at Kathmandu airport that day. The plane scraped the runway with its right wingtip, collided with a container having helicopter spare parts, and plunged into a gully east of the runway, exploding in a fireball. The investigation also noted that the impact forces seemed to be survivable for some occupants. The fire trucks took unnecessarily long to reach the site even though it was inside the airport perimeter. The absence of an ICAO-standard runway strip, inadequate rescue drills, lack of training, and a blocked emergency service gate leading to the crash site were cited as other factors. &nbsp;&nbsp; <h2>Timestamp of a Disaster</h2>  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250731110724_39cdd04693994ce6e55a5b302905c0fa4884fe85bed21ff0779bb1439f3a5725.jpg" data-media-id="editor_0" data-image-id="20250731110724_39cdd04693994ce6e55a5b302905c0fa4884fe85bed21ff0779bb1439f3a5725" data-rendition-name="original" width="778" height="826" loading="lazy" alt="Flouting rules caused Saurya tragedy NT"> </figure>  11:10:34 - The Saurya Airlines CRJ200 on the takeoff roll from runway 02. It had a takeoff weight of about 18,300kg, but the pilot’s speedcard had a previously undetected mistake about the minimum takeoff speed. 11:10:55 -The plane with tail number 9N-AME goes into deep stall soon after takeoff because it does not have enough speed to lift its weight. The plane also has an abnormally steep nose-up attitude.&nbsp; 11:11:03 - Without enough speed to generate lift, the plane banks right, then left and right again in CCTV photos taken from the domestic apron (below). If it had not banked right, it could have hit the aprons and terminal buildings. Seen parked is Saurya’s other CRJ200 with tail number 9N-ANM.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250731110732_608132f7225c649125cca2691dd6a6bf930984c5b359e888d7ad9e5eacce3afd.jpg" data-media-id="editor_1" data-image-id="20250731110732_608132f7225c649125cca2691dd6a6bf930984c5b359e888d7ad9e5eacce3afd" data-rendition-name="original" width="770" height="555" loading="lazy" alt="Flouting rules caused Saurya tragedy NT"> </figure>  11:11:08 - The plane scrapes the runway with its right wingtip, and falls into the gully. The captain is thrown off the left side of the cockpit and survives. 11:11:15: Plane explodes in a fireball inside the airport perimeter. Firefighters take time to reach the site because of lack of access road and a blocked gate. Read the full investigation report <a href="https://www.tourism.gov.np/files/9N-AME%20AIC%20Final%20Report.pdf">here</a>.

Flouting rules caused Saurya tragedy

French citizen Louis arrived in Nepal for the first time earlier this year, planning to <a href="https://nepalitimes.com/banner/the-abcs-of-a-winter-trek-in-nepal">trek the Annapurna Circuit </a>before heading down to Bardia to hopefully catch a glimpse of some<a href="https://nepalitimes.com/news/nepal-counting-its-tigers"> tigers</a>. Before he began his journey from Besisahar, Louis (who only revealed his first name) had imagined breathing crisp mountain air, and following the melodious gurgle of the Marsyangdi.&nbsp; Instead, he had to breathe fumes and dust all the way to Chame. Louis says he masked his face with a handkerchief: “It was not what I expected, this is not right.”  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025080304080_f03fce1527cf8a63178e4e82589a1a7096c8cfa28893ca4a5f7fe82d91a6e38a.jpg" data-media-id="editor_2" data-image-id="2025080304080_f03fce1527cf8a63178e4e82589a1a7096c8cfa28893ca4a5f7fe82d91a6e38a" data-rendition-name="original" width="2419" height="1814" loading="lazy" alt="Manang trails NT 1"> </figure>  Many other trekkers are similarly disappointed as roads have been built along what used to be <a href="https://nepalitimes.com/banner/a-walk-back-in-time-chandragiri-hatiban">walking trails</a>. Manang and Humla are the last remote regions in the Himalaya to be connected to the national road network. &nbsp;Construction of the 87km Besisahar-Manang road began in 1994, but was stalled during <a href="https://nepalitimes.com/news/14-years-after-conflict-no-closure-in-nepal">the Maoist conflic</a>t, and finally finished in 2012.&nbsp; Most of it has not yet been blacktopped, and sections have been carved out of vertical cliff faces, making them treacherous. But it has allowed road access to Manang, a journey that previously took a week on foot.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025080304084_32b3ca875a0df9f1dd42dbe915e6f6a2cd4f2e53f1cf2d3ee5cbdb3435905000.jpg" data-media-id="editor_5" data-image-id="2025080304084_32b3ca875a0df9f1dd42dbe915e6f6a2cd4f2e53f1cf2d3ee5cbdb3435905000" data-rendition-name="original" width="2400" height="1505" loading="lazy" alt="Manang trails NT 1"> </figure>  While the <a href="https://nepalitimes.com/opinion/the-road-out-of-nepal">road has improved access</a>, it has impacted on<a href="https://nepalitimes.com/here-now/trekking-in-the-time-of-climate-change"> trekking tourism </a>— the mainstay of Manang’s economy. The number of tourists visiting the scenic valley behind the Annapurnas grew from 21,245 in 2023 to 30,866 in 2024. The Annapurna Circuit is known for unique sights like <a href="https://archive.nepalitimes.com/news.php?id=9194">Tilicho</a>, one of the highest lakes in the world, the Thorong La pass that connects Manang to Mustang, and the valley’s own rich cultural heritage. Thorong La at 5,416m is the highest hiking pass in the world, and was used by locals for trade with Mustang before it became a <a href="https://nepalitimes.com/opinion/comment/lift-restrictions-on-upper-mustang">popular trekking route</a>. &nbsp; “For guests, the excitement of reaching Thorong La is now overshadowed by their disappointment of having to journey through dusty roads to get there,” says Manang lodge-owner Ongma Gurung. “That is the complaint we get the most.” <a href="https://nepalitimes.com/banner/tourism-that-treads-lightly-on-the-land">Local tourism </a>operators are trying to get the government to build alternative foot trails. But there have been delays due to a lack of budget.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025080304084_c5f76e398182785bb17846a148e3ca89de5687b4623580f8e2d725a7a287edfa.jpg" data-media-id="editor_11" data-image-id="2025080304084_c5f76e398182785bb17846a148e3ca89de5687b4623580f8e2d725a7a287edfa" data-rendition-name="original" width="2419" height="1762" loading="lazy" alt="Manang trails"> </figure>  The Naso Rural Municipality has identified other routes along the Annapurna Circuit in Chyamche, Tal, and Khotro so trekkers can bypass heavy vehicles involved in the construction of the Manang-Marsyangdi Hydropower Project. “But the local government cannot do everything,” admits the chair Dhan Bahadur Gurung. “And for leaders in Kathmandu, Manang is out of sight and out of mind.” Munindra Jung Gurung represents Manang in the Gandaki Provincial Assembly, and says he has raised the issue in <a href="https://nepalitimes.com/news/pokhara-s-tourism-woes">Pokhara</a>. He is hopeful there will be a hearing. To be sure, the road is not all bad news. Locals benefit, the number of visitors has grown, and trekkers can now also save time and use it to explore <a href="https://archive.nepalitimes.com/news.php?id=5960">side valleys in Manang</a>, visiting the villages like Nar and Phu. Annapurna Conservation Area (ACA) chief Rabin Kadariya concedes that the road to Upper Manang was crucial to connect the remote region with the rest of Nepal, but adds: “We have built an alternative trail connecting Talgaun, and we will consult local communities about their priorities on other hiking trails.”&nbsp;

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