<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410118/637205c69c7e80680e0b28d5jpeg.jpg" alt="" width="1400" height="933"/><figcaption>Photo: SONIA AWALE</figcaption></figure>The last Sunday in January is World Leprosy Day. Since 2006, I have issued an annual Global Appeal to End Stigma and Discrimination against Persons Affected by Leprosy, supported by influential individuals and organisations around the world.Amid the coronavirus pandemic, which has shown how easily fear and anxiety about a disease can fuel prejudice, I believe this call to eliminate <a href="http://archive.nepalitimes.com/news.php?id=711#.YfYlNi2B3ow" target="_blank" rel="noopener noreferrer">stigma and discrimination</a> is more important than ever.Leprosy, also known as Hansen’s Disease, is a chronic infectious disease caused by the bacillus Mycobacterium leprae. It mainly affects the skin and peripheral nerves and is one of the oldest diseases in human history. Yet each year, around 200,000 new cases are reported globally.In Nepal, 2,304 new cases were reported in 2020 and it is one of 23 countries on the WHO’s priority list for leprosy. Most cases are found in Madhes Province bordering India.Today an effective treatment exists in the form of multidrug therapy (MDT) and with early detection and treatment, the disease can be cured without complications. But if treatment is delayed, <a href="http://archive.nepalitimes.com/news.php?id=39#.YfYl-S2B2b8" target="_blank" rel="noopener noreferrer">leprosy can cause progressive impairment</a> and lead to permanent disability.There are an estimated 3-4 million people living with some form of disability due to leprosy. This fact, together with deep-seated fears and misperceptions about this age-old disease, has subjected persons affected by leprosy and even their family members to severe discrimination, which continues to this day.Since becoming WHO Goodwill Ambassador for Leprosy Elimination in 2001, I have visited some 120 countries to see the situation for myself. This has led me to think of leprosy in terms of a motorcycle: the front wheel symbolises curing the disease, and the back wheel represents eliminating discrimination. Unless both wheels are turning together, we will not reach our ultimate goal of zero leprosy.As regards to the front wheel, efforts against the disease, including new case detection, have been badly disrupted by the spread of the novel coronavirus and efforts to prevent transmission. In 2020, the number of new cases reported was down to 37% year on year, according to the WHO, largely due to the impact of Covid-19.Concerning the rear wheel, I have worked hard to have leprosy recognised internationally as a human rights issue since the early 2000s, when I first approached the Office of the UN High Commissioner for Human Rights. One result has been the adoption in 2010 of a UN General Assembly on elimination of discrimination against <a href="http://archive.nepalitimes.com/news.php?id=15213#.YfYl_y2B2b8" target="_blank" rel="noopener noreferrer">persons affected by leprosy</a> and their family members.But the real measure of success will be when principles and guidelines accompanying the resolution are fully implemented. Because of the pandemic, however, awareness-raising efforts in many areas have stalled, and some people have found that Covid-19 is exacerbating the discrimination they already experience as persons affected by leprosy.This is why last August I launched a <a href="https://www.shf.or.jp/en/dont-forget-leprosy-campaign/" target="_blank" rel="noopener noreferrer">campaign called ‘Don't Forget Leprosy’</a> to ensure that leprosy and the needs of those affected by the disease are not overlooked, even amid the pandemic. The campaign stresses the importance of early detection and treatment, as well as the need to eliminate stigma and discrimination.The term 'don't forget' covers many things: that leprosy still exists, that people affected by leprosy and their families still face social prejudice, and that there are healthcare professionals doing their best in difficult circumstances to provide needed services.In Nepal, a country I have visited many times over the years, what has impressed me has been the strong cooperation I have found between the <a href="http://mohp.gov.np/eng/program/communicable-disease/leprosy-control-program" target="_blank" rel="noopener noreferrer">Ministry of Health and Population</a> and leprosy NGOs. They make the most of their respective strengths and complement each other’s efforts, and in this way have helped to advance measures against leprosy throughout the country.Working in partnership with the ministry’s leprosy control program, <a href="https://tlmnepal.org/blog/anandaban-hospital/" target="_blank" rel="noopener noreferrer">Anandaban Hospital</a> near Kathmandu, Lalgadh Leprosy Hospital &amp; Services Center in Janakpur and the Green Pastures Hospital in Pohkara provide both medical and social support. They provide treatment and rehabilitation, and assist with reintegration into the community.I would also like to give a mention to the leprosy center established in Surkhet with the support of the Sasakawa Health Foundation, operated with the dedicated effort of local people and contributing to community medical care.Nepal has also pioneered a <a href="https://www.nepalitimes.com/banner/new-treatment-offers-hope-for-nepals-leprosy-patients/" target="_blank" rel="noopener noreferrer">revolutionary treatment for leprosy wounds</a> saving money and prolonged pain for the patients. The technique called Leukocyte Platelet Rich Fibrin (LPRF) originally devised for dental surgery accelerates the healing of tissue and is now being used widely in the country to treat hard-to-heal skin lesions of diabetes and leprosy patients.Over the past 50 years we have come a long way toward our goal of a world free from leprosy and the discrimination it causes. We must not allow the progress we have made to be undone by the impact of <a href="https://www.nepalitimes.com/here-now/omnipresent-omicron-starts-to-lose-its-edge/" target="_blank" rel="noopener noreferrer">the Covid-19 pandemic</a>.Together with my annual Global Appeal and the activities that partner organisations will be carrying out for World Leprosy Day this year, I hope it will put the disease back in the spotlight and show that our work to end the medical and social problems related to leprosy is not yet done.Please add your voice to the campaign and make this a collective effort. Together we can be heard loud and clear: “Don’t Forget Leprosy.”Yohei Sasakawa is WHO Goodwill Ambassador for Leprosy Elimination as well as the Japanese Government Goodwill Ambassador for the Human Rights of Persons Affected by Leprosy. He is the chair of The Nippon Foundation.

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During the pandemic, don’t forget leprosy

https://www.youtube.com/watch?v=kJLBI7sim0M&amp;feature=youtu.beA revolutionary treatment for open wounds has dramatically reduced the healing period of <a href="http://archive.nepalitimes.com/news.php?id=711#.XSckw-szaUk" target="_blank" rel="noopener">leprosy patients in Nepal</a>, saving them money and prolonged pain. The new procedure has huge implications internationally, as it reduces the medical cost for treating patients with chronic open wounds.The technique, called Leukocyte Platelet Rich Fibrin (LPRF), was <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6089057/" target="_blank" rel="noopener">devised for dental surgery</a> by Nelson Pinto of Chile and has proven to accelerate the healing of tissue. Now, it is also being used to treat hard-to-heal skin lesions of <a href="https://archive.nepalitimes.com/article/nation/diabetes-in-south-asia,3018" target="_blank" rel="noopener">diabetes</a> and leprosy patients.“LPRF has shown miraculous results in the treatment of chronic wounds in Nepal,” says dental surgeon Sushil Koirala who is pushing the new treatment in government hospitals. “It does not need special equipment, is cheap and, so simple even paramedics and nurses can perform it.”<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108131140/636a4f009c7e80680e04fce5jpeg.jpg" alt="" width="1400" height="1050"/><figcaption>SECOND CHANCE: Surgeon Indra Bahadur Napit guides a paramedic during a session of LPRF on a patient with leprosy at Anandaban Hospital. Pic: KUNDA DIXIT</figcaption></figure>There are three specialised leprosy hospitals in Nepal: Ananadaban in Lele, Green Pastures in Pokhara, and Lalgadh in Dhanusa. Anandaban Leprosy Hospital 16 km south of Kathmandu has been trying out LPRF on patients with excellent results.Leprosy is a biblical disease in which bacteria called Mycobacterium leprae damages the patient’s nerves and causes the fingers, toes and limbs to go numb, leading to further injuries. Leprosy is treated with antibiotics, but some patients suffer antigen reaction and need long-term rehabilitation.One of the patients at Anandaban is Phelit Sahi, who was ostracised by her community in Jumla because she had leprosy and had been living in a cave for 25 years. Reporters who had gone to cover a local event in a helicopter found out about her, and flew her to Kathmandu for treatment.Every week, doctors draw 80cc of blood from her and place it in a special centrifuge for 12 minutes. The clear plasma separates from the red corpuscles and is compressed to form a high-density fibrin clot which is applied to her wound.“She is among more than 100 patients that we have treated with LPRF, and we have gained enough experience in this technique to lead the way for the world,” says surgeon Indra Bahadur Napit at Anandaban, who presented his results at WHO in Geneva.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108131140/636a4f039c7e80680e04fce6jpeg.jpg" alt="" width="1400" height="933"><figcaption> </figcaption></figure>Raju Lama was 27 when he was diagnosed with leprosy, but because of late diagnosis, his fingers and toes were deformed, and he had to abandon his job. Doctors recommended amputating his right leg, but became the first patient to get LPRF treatment. He is happy with his “ragat upachar” (blood treatment) and says after several LPRF procedures his wounds are healing much faster.Ram Kumari Sah and her husband from Janakpur have been living with leprosy for decades. She does not feel pain in her hands and legs and often hurts herself. Her lesions become infected and never healed. This week, she was waiting for her turn at the LPRF ward in Anandaban.The hospital’s LPRF pilot study has shown that 97% of the cases healed completely within seven weeks. The results are so encouraging that news of this revolutionary treatment has spread through word of mouth. A dozen patients, currently at Anandaban were referred by hospitals in India. A team of Nepali doctors is also training doctors in Burma, Bangladesh and Nigeria.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108131140/636a4f069c7e80680e04fce7jpeg.jpg" alt="" width="1400" height="1003"><figcaption> </figcaption></figure>The new treatment is expected to add to Nepal’s success in reducing the prevalence of leprosy from 21 cases per 10,000 in the 1980s to less than 1 today. Nepal was officially declared leprosy-free in 2010 when the prevalence rate came down to 0.79%.However, in recent years, the prevalence rate is creeping up again, and was 0.94% in 2018. More than 3,000 new patients are diagnosed with leprosy every year, with most of the cases found in Province 2. Experts say this could be a result of active case finding and may not mean that the prevalence is increasing.Leprosy is curable with multidrug therapy but many do not get treatment on time. The incubation period is five years on average and symptoms may occur within a year, but can also take as long as 30 years to become visible, making the disease difficult to diagnose, and the delay leads to nerve damage and deformities. Leprosy is transmitted through the air during close and frequent contact with untreated cases.“Leprosy can afflict anyone but there is a correlation between the disease and poverty,” explains dermatologist Mahesh Shah. “If one’s immune system is strong, the bugs do not do any damage. But poor hygiene and nutrition increases susceptibiltity. Neglected people from neglected countries suffer from leprosy the most.”<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108131140/636a4f0a9c7e80680e04fce8jpeg.jpg" alt="" width="1400" height="1169"><figcaption> </figcaption></figure>Up to 40% of patients undergoing multidrug treatment develop a reaction, and need long-term hospitalisation. Since the patients are poor, most private hospitals are not interested in treating them. At Anandaban, treatment is free as it is supported by government grants and charities.Since 1% of cases suffer from relapse in Nepal, active door-to-door case finding is important to meet the WHO target of zero leprosy transmission by 2030.Even more daunting is to counter societal stigma and ostracisation of leprosy patients. Family members regard the disease as punishment from the gods, and even some medical interns and nurses refuse to touch patients despite patients being on antibiotics and unable to spread the disease. Nepal’s laws still allow husbands to divorce their wives if they have leprosy.“It is a complicated disease made even more so by stigma and ignorance,” says Napit, “but with LPRF, we now have a powerful weapon in our arsenal. A vaccine would be the final solution, but no one cares about leprosy. All the funding goes for diseases like HIV.”   <h2>Miraculous healing</h2>When Nelson Pinto’s favourite horse broke its leg, he had two options: either put it down or amputate its leg. The Chilean dentist decided on a third option.He drew some blood from the horse, spun it in a centrifuge to separate the autologous fibrin matrix which is rich in platelets, and applied the plasma to the horse’s wound. After a few weeks, the horse was cantering again.Pinto knew about the technique because Leukocyte Platelet Rich Fibrin (LPRF) was developed for dental implant treatment. The surgeon was so convinced that the new process would be useful in treating chronic open wounds that he embarked on a global crusade to spread its use.Pinto convinced fellow-dentist from Nepal, Sushil Koirala, whom he met at an international conference, to adopt the technique. Since then, Koirala has been trying to convince the government and private hospitals to adopt the procedure, but without much success. However, Anandaban Leprosy Hospital in Lalitpur has seen phenomenal improvements in the healing time of lesions among its patients. (See adjoining report above)LPRF is now used to treat diabetic wounds, lesions caused by leprosy, localised <a href="http://archive.nepalitimes.com/article/nation/burning-in-the-aftermath,3757" target="_blank" rel="noopener">burns</a> and surgical wounds, and with this, healing time is often cut in half. It is also being used in cosmetic surgery to remove wrinkles and rejuvenate the skin. The reason why it is so effective, Pinto explained during a trip to Nepal last month, is because it is completely natural and autologous, which means a patient is not receiving any foreign tissues or chemicals.And the treatment is cheap. A similar treatment used in Europe, which involves a kit manufactured by a multinational pharmaceutical company, costs $3,000 per patient. LPRF costs only $30. But it seems as though private hospitals are not interested in this treatment as patients heal so quickly. Many doctors are also not enthusiastic because LPRF can be administered by a paramedic or a nurse.Says Sushil Koirala: “The reason they don’t like it is because there is no money in it. LPRF only uses the patient’s blood and there are no chemicals or equipment involved for multinational companies to make money out of.”Koirala’s Punyaarjan Foundation has donated centrifuge machines to a few hospitals in Nepal including the Sushma Koirala Memorial in Sankhu, Anandaban Leprosy Hospital, Bir Hospital in Kathmandu and to three hospitals in Burma with varying degrees of acceptance.The Bible relates how Jesus Christ miraculously and instantaneously cured ten lepers at the gates of Jerusalem. LPRF may not cure leprosy lesions as quickly, but the procedure is nearly as miraculous.<h2>Life after leprosy</h2><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108131140/636a4f0d9c7e80680e04fce9jpeg.jpg" alt="" width="1400" height="1050"><figcaption> </figcaption></figure>Kumar Tamang, 47, is putting the final touches on his painting of an elephant with a bejewelled crown and a howdah. He dips his paintbrush on a palate and paints the border bright red. His fingers are numb and deformed by leprosy, yet he has been painting for 25 years. His love for Mithila art is on full display on the walls, pillars and ceiling of Shanti Sewa Griha, a leprosy clinic set up by the German charity, Leprahilfe, in 1992.Nearby, in a dark corner, is 50-year-old Nathuni Barai from Nawalparasi, who also has deformed fingers which he uses deftly to draw intricate patterns on a letter pad. Both Tamang and Barai are former patients at <a href="http://archive.nepalitimes.com/news.php?id=15213#.XSckyeszaUk" target="_blank" rel="noopener">Shanti Sewa Griha,</a> making a livelihood from products that Leprahilfe buys from fundraising. Their families live nearby, and their children attend a school set up by the charity.Now, nearly three decades after the clinic was set up, Shanti Sewa Griha runs a school and orphanage in Budhanilkantha, an organic farm in Sundarijal and a rehabilitation centre near Pashupati.As the number of patients grew, they were trained in painting, tailoring, quilt making, carpentry and jewellery making as a form of livelihood. Bags, uniforms, paintings, stationery and decorative items are sold as souvenirs to raise money for the upkeep of the shelters and to pay former patients.“This is a form of operational therapy which tries to break the vicious circle this disease has formed,” said Marianne Grosspietsch, one of the founders of Leprahilfe. “Our goal is to create hope in Nepal.”In 1974, Grosspietsch adopted a young boy named Puskar Limbu who had leprosy like the rest of his family. She took the boy to her home in Germany, treated his leprosy and sent him to school. Limbu went on to pursue a successful career in graphic design in Germany and is a grandfather himself today.Children of former leprosy patients have also gone on to become nurses and doctors.Kalpana Pariyar (pictured above) was 14 when she was diagnosed with leprosy before there was serious nerve damage to her fingers. She grew up in the shelter and married fellow-patient Krishna Majhi, whom she took care of until he died eight years ago. She now has a college going daughter and an eight-year-old son.“I have spent my entire life here. This is my home, this is where I made my life and found peace,” says Pariyar, looking up from her sewing machine on which she was weaving dhaka fabric.Sonia Awale

Sonia Awale

New treatment offers hope for Nepal’s leprosy patients

One aspect of colonial cartography of South Asia leaps out in this must-see exhibition – while the coastline of India, Ceylon, Burma are extraordinarily accurate in maps made more than 200 years ago, the Himalayan hinterland is wholly approximate and inexact. The accuracy improves as modern survey techniques are introduced by atlas-makers, but even then formidable terrain and forbidden lands thwart precision. Map aficionados will be fascinated by the 40 antique maps from The Rajbhandari Collection on display at the exhibition ‘Imaging South Asia: Nepal in the Making at Kathmandu Art Gallery’ at Baber Mahal Revisited from 13 February - 17 March.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260211090252_0cbeb88674a97c6292e2b43b2135df219257ca641cbd4723e9aabf5541c2b258.jpg" data-media-id="editor_0" data-image-id="20260211090252_0cbeb88674a97c6292e2b43b2135df219257ca641cbd4723e9aabf5541c2b258" data-rendition-name="original" width="4160" height="3485" loading="lazy" alt="Map Land NT"> </figure>  The first maps were made on clay tablets and cave paintings, but maps improved with Chinese maritime charts of Southeast Asia and beyond. Nautical maps created during the European Age of Exploration used geometry, latitude and longitude. Competition for colonial riches rested on the accuracy of these maps. The Portuguese had the lead in the 15th century, but were soon overtaken by the Spanish with Columbus voyaging to India but landing up in the Americas.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260211090252_1fb21d20cf29b408119f5279ce666e73dee089356e52277d753a27e3440364eb.jpg" data-media-id="editor_1" data-image-id="20260211090252_1fb21d20cf29b408119f5279ce666e73dee089356e52277d753a27e3440364eb" data-rendition-name="original" width="4030" height="3407" loading="lazy" alt="Map Land NT"> </figure>  European mapping of the coastline of peninsular India &nbsp;began after Vasco de Gama sailed around the Horn of Africa to arrive at what is now Kerala in 1498. The British and French struggled for control of India, and the Carnatic Wars of the 19th century were extensions of their rivalry in Europe.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260211090252_0fb0969dc3e07c5a77123b4aa5eb0f11d2ffea73c108077f7e4d1892d6bd4bb6.jpg" data-media-id="editor_2" data-image-id="20260211090252_0fb0969dc3e07c5a77123b4aa5eb0f11d2ffea73c108077f7e4d1892d6bd4bb6" data-rendition-name="original" width="2842" height="4160" loading="lazy" alt="Map Land NT"> </figure>  While most of the maps at this exhibition were commissioned by the East India Company and the Survey of India, there are quite a few made by Parisian cartographers and feature Pondicherry and the Danish trading outpost at Tranquebar. Followed chronologically, the maps show improvements in cartographic techniques. The earliest French map L’Inde of J D Barbié du Bocage from 1760 is a copper engraving with hand painted colours demarcating boundaries. ‘Napaul’, ‘Gorka’ and ‘Catmando’ are depicted. The rivers of India are precisely drawn, as is the Brahmaputra (Yarou Tsanpou) even though locations across the rest of Tibet are rough estimates.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260211090252_486dc1b12f391550516be164f27170d4702a69b5125c1b8c4b10f76fdae4c0b1.jpg" data-media-id="editor_3" data-image-id="20260211090252_486dc1b12f391550516be164f27170d4702a69b5125c1b8c4b10f76fdae4c0b1" data-rendition-name="original" width="1675" height="604" loading="lazy" alt="Map Land NT"> </figure>  The 1781 map Carte des Indes en deçà et au-delà du Gange of Rigobert Bonne has slightly more detail about Nepal with even ‘Pattan’ and ‘Bagmally’ river marked. William Darton’s 1802 map has ‘Nogarcot’ and ‘Mocaumpour’ wrongly placed to the east of the valley of ‘Napaul’. Samuel Arrowsmith’s 1828 map ‘India and the Birman Empire’ has Nepal’s rough boundaries demarcated for the first time within a hand-coloured green border, with the mountain ‘Dholagiri’ and ‘Dhunchi’ appearing for the first time. The 1835 map by Boston-based American cartographer Thomas Bradford has a more precise ‘Burrampooter’ river with ‘Sgigatoe’, ‘Lassa’ and ‘Bootan’ marked. In Nepal, ‘Batgan’, ‘Macwampour’ and ‘Lelit Pattan’ appear near ‘Catmandu’.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260211090252_5509c8e043a74b3e34e399c0684ca8eef7fc79953ee0dd18aedc738e8189d552.jpg" data-media-id="editor_4" data-image-id="20260211090252_5509c8e043a74b3e34e399c0684ca8eef7fc79953ee0dd18aedc738e8189d552" data-rendition-name="original" width="4094" height="3646" loading="lazy" alt="Map Land NT"> </figure>  One striking landmark appears consistently through a century of map-making from 1760 onwards, and that is the sacred Yamdrok Tso near Lhasa. It is precisely located, although it is drawn as a circular lake called ‘Jamdro or Palto Lake’ till J Bartholomew’s lithographic map in 1893 Constable’s Hand Atlas of India. Bartholomew’s map is also where ‘Mt Everest’ appears for the first time with its altitude ’29,002ft’ after Peak XV was calculated to be the highest mountain in the world by the Survey of India. Meanwhile, ‘Kinchinjunga’ appears in some of the earlier maps from the mid-1800s, north of ‘Dorjeloo’. The maps did not only have locations of towns, rivers and mountains but also other interesting facts about places. History buffs will find much to pore over in these maps.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260211090252_8280c979b175946a2ac29e22b7a2b2427f7f36f22093c3456524f1f529311498.jpg" data-media-id="editor_5" data-image-id="20260211090252_8280c979b175946a2ac29e22b7a2b2427f7f36f22093c3456524f1f529311498" data-rendition-name="original" width="4160" height="2762" loading="lazy" alt="Map Land NT"> </figure>  Many have sites of major British battles while conquering India. The ‘British India’ map by J Rapkin has dates and times of the ‘Principle Massacres’ during the Indian Mutiny of 1857. The map also shows India’s growing railway network with completed lines and those ‘in progress’. Narrow gauge lines can be seen in successive maps snaking up to the Nepal border to haul sal logs for sleepers for India’s expanding railway network. Many maps were drawn by British military intelligence. One even has the Kuti route of the Nepal Army while invading Tibet in 1791, and the Chinese Army’s advance in hot pursuit through Kerung to Nuwakot.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260211090252_a41ff6a7453f95d1e83c12ed3f831911d65ebd4d2389e0e3b774252dfa037132.jpg" data-media-id="editor_6" data-image-id="20260211090252_a41ff6a7453f95d1e83c12ed3f831911d65ebd4d2389e0e3b774252dfa037132" data-rendition-name="original" width="1173" height="679" loading="lazy" alt="Map Land NT"> </figure>  Pre-1857 maps show the western Tarai as a part of British India, but in later ones the Naya Muluk districts of Banke, Bardia, Kailali and Kanchanpur have reverted back to Nepal. The maps clearly mark Nepal as an independent nation, and represent it differently from Indian princely states. The Atlas of India of 1846 shows the ‘Dominion of the King of Nepal’.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260211090252_52132146d9ee8b922560b98e90d866149715d7f53ced408b5f3af8f3b142a07b.jpg" data-media-id="editor_7" data-image-id="20260211090252_52132146d9ee8b922560b98e90d866149715d7f53ced408b5f3af8f3b142a07b" data-rendition-name="original" width="4149" height="3682" loading="lazy" alt="Map Land NT"> </figure>  Visitors will be curious about Nepal's claim to Limpiyadhura and Lipu Lek. A map by Mason &amp; Payne from 1846 clearly shows the ‘Kallee River’ as being the border between Nepal and British India, with Kalapni within Nepal. The Lipu Gad tributary (which India claims is the border) is not marked. Some other maps, however, seem to show the border not following the Kali river to Limpiyadhura but the tributary up to Lipu Lek.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026021112024_9a1b6055a9fbecca7b64c3882c205efb336aac03e64ecf43a2044cb079cd699f.jpg" data-media-id="editor_8" data-image-id="2026021112024_9a1b6055a9fbecca7b64c3882c205efb336aac03e64ecf43a2044cb079cd699f" data-rendition-name="original" width="875" height="1215" loading="lazy" alt="Map Land NT"> </figure>  Imaging South Asia: Nepal in the Making&nbsp; Kathmandu Art Gallery, Baber Mahal Revisited&nbsp; 13 February – 17 March For guided walk-throughs and curatorial tours: +977 1-5318048 Panel discussions: -Cartographic Practices from the &nbsp;Gorkha Polity to the Present with Buddhi Narayan Shrestha and Kanak Mani Dixit&nbsp; Friday, 13 February, 4pm -Mapping Beyond Borders with Akhilesh Upadhyay and Amish Raj Mulmi Wednesday, 25 February, 4pm&nbsp;

Map land

The arrest on 25 January of six people on charges of insurance fraud has brought the scandal of fake helicopter rescue of trekkers in Nepal to the fore once more, denting the image of the tourism industry. Trekking companies, helicopter operators and hospitals were said to be in cahoots to carry out medical evacuations that were not necessary. In some cases, even the rescues were said to be fake with false names of ‘patients’ and their ailments. The six who were arrested were charged by the Central Bureau of Investigation (CIB) with <a href="https://asia.nikkei.com/business/travel-leisure/nepal-s-rescue-helicopter-scam-casts-doubt-on-tourism-credibility2" target="_blank">cheating insurance companies</a>of millions of dollars in the past four years with more than 300 <a href="https://nepalitimes.com/multimedia/heli-rescue-fraud-tarnishes-nepal-s-image" target="_blank">fake chopper medevacs</a> from the base of Himalayan peaks to hospitals in Kathmandu. Nepali personnel of three companies, Nepal Charter Service, Everest Experience and Mountain Rescue were accused of heavily overcharging &nbsp;for fraudulent rescues, faking or inflating medical bills, and claiming payment of over $18 million over the years, the CIB said.&nbsp; In some cases, trekkers themselves who do not want to walk back along the same trail to Everest Base Camp or other routes, and pretend to be sick, are also said to be involved in the scam. “Tourism will attract opportunists, that is true everywhere,” explains Raj Gyawali of <a href="https://socialtours.com/" target="_blank">socialtours</a> and a partner of <a href="https://ethicaltravelportal.com/" target="_blank">Ethical Travel Portal</a>. “Our responsibility as an industry is to weed them out, protect what matters, and keep tourism rooted in passion, integrity, and long-term value.” The scam got <a href="https://www.nytimes.com/2026/02/03/world/asia/mount-everest-helicopter-insurance-fraud.html" target="_blank">wide international attention</a>, and tainted the reputation of Nepal’s mountain tourism sector that employs up to 1 million people. International media headlined allegations that trekker food was spiked to cause diarrhoea to force evacuations. Despite the bad publicity, tourism operators see a silver lining. It shows that Nepal is cleaning up its act and the system is working. Besides, the cheaters are in a minority in an industry that provides some of the best organised and most experienced mountain tourism service in the world.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260210040232_141217f8e5dc8a584642f7cb8d130de1a05cdcf149467334f9ab4e392f7d67aa.jpg" data-media-id="editor_5" data-image-id="20260210040232_141217f8e5dc8a584642f7cb8d130de1a05cdcf149467334f9ab4e392f7d67aa" data-rendition-name="original" width="1584" height="1500" loading="lazy" alt="Helicopter medevac scam NT"> </figure>  “After years of talk and investigation, we are now seeing arrests and it’s encouraging to finally see action. This didn’t happen overnight,” Gyawali says. “The post GenZ interim government works with much less politics, we are seeing a functional system for the first time in decades in Nepal.”&nbsp; This is not a new story. <a href="https://archive.nepalitimes.com/article/nation/Insurance,361" target="_blank">Nepali Times first covered </a>trekking insurance scams in 2013, following up on an investigation by the British Mountaineering Council in <a href="https://www.thebmc.co.uk/" target="_blank">Summit magazine</a> about insurance fraud involving fake helicopter rescues. In <a href="https://nepalitimes.com/multimedia/heli-rescue-fraud-tarnishes-nepal-s-image" target="_blank">another news item</a> published in this paper in 2018 cited an investigation by insurance watchdog <a href="https://www.travellerassist.co/" target="_blank">Traveller Assist</a> which showed that a third of the 1,600 helicopter rescues in Nepal that year were fraudulent, costing up to $4 million. Insurance companies gave the Nepal government <a href="https://nepalitimes.com/banner/nepal-trekking-industry-in-damage-control-mode" target="_blank">an ultimatum</a> to clean up its act, and an investigation committee was formed and 13 companies said to be involved were named. It now looks like although insurance fraud declined, it was still continuing to some extent till 2025. In the cut-throat competition in Nepal’s mountain tourism industry, companies undercut each other, and there are some trying to make a quick buck. These rotten apples spoil the whole barrel. Given Nepal’s remote terrain and extreme weather along Himalayan trekking routes, helicopter rescues are vital in saving hundreds of lives every year, rescuing trekkers and mountaineers suffering from acute mountain sickness, stomach or lung infections. “Nepal has a unique advantage over other Himalayan countries like India, Pakistan, or China because it allows private helicopter companies to conduct rescues,” Gyawali says. “This makes rescues faster and more accessible, often life-saving.” The real problem is that sometimes rescues take too long because of &nbsp;permission needed from multiple government agencies to conduct rescues near the Chinese border, which is considered sensitive. Last year, a mountaineer died on Himlung Himal because a helicopter company could not get clearance in time for a rescue.

Fake rescues hurt Himalayan tourism

The recent Nepali Times Substack post titled ‘Unresident Nepalis’ made me realise I also belong to the category of Nepalis who are technically Non-resident Nepali (NRN), but want to ‘permanently reside inside Nepal’.&nbsp;
Although this was meant as a joke, it is ironic that many of those who go abroad long to come back home, and those who have not emigrated cannot think of a good enough reason to stay back in Nepal.&nbsp;
As soon as the NRN Citizenship was officially introduced in late 2023, I had tried to apply for one but was shut down before even submitting my documents as the district administration office firmly told my then lawyer that I needed to prove “तिन पुस्ता” proof of three generations of Nepalis from my father’s side.&nbsp;
My late father was from Japan and relinquished his citizenship to become a Naturalised Nepali citizen in 2006. Three years ago, I dismissed the rejection with the thought that I will try again later when government officials would gain more experience with such applications.&nbsp;
Now, with an ailing mother and an energetic toddler, I felt the need to act soon and reached out to a law firm that specialises in NRN citizenship applications. To my surprise, they were positive after reviewing my documents, although they did warn me that we may need to overcome some obstacles.&nbsp;
In 2023, I had applied in the district office where my father had received his naturalised citizenship, but now the suggestion was to try from the district where my mother had received her Nepali ancestral origin “बंसागज” citizenship.&nbsp;
The lawyers pointed to the NRN citizenship mandate which clearly states that it can be acquired via a Nepali origin father, mother, grandfather or grandmother. The firm helped arrange the necessary documents required and the first step was to get a “सिफारिस” &nbsp;recommendation letter from my mother’s ward office.&nbsp;
This was the first hurdle as the ward office was unsure if they could issue such a letter, so they checked in with their head office, and luckily we received the go ahead. After persistent follow up from the law associates, they were able to provide us with a recommendation letter and we filled out the application forms.&nbsp;
The law firm wisely suggested that I take the paperwork myself to my mother’s district office while they stayed in the background in case I needed help explaining my situation.&nbsp;
With a big smile and cheerful tone, I dutifully followed the process and to my surprise, I found most of the officials ready to help without creating unnecessary hurdles. The application has to be signed off by the Chief District Officer (CDO) or Assistant CDO and just when I thought wow, I am going to breeze through this, one officer noticed that my father’s naturalised citizenship was from a different district and told me that I should apply for my NRN from there.&nbsp;
I explained that my father has already passed away and as he was not originally a Nepali, therefore it is not possible for me to get my NRN from his documents, as the requirement is ancestral “बंसागज” citizenship. The officer then went to check with their seniors and later told me that I would need police verification as an extra precaution.&nbsp;
Off I went to the police headquarters where they issued a sealed letter to be given to the police station that was in the same vicinity as my mother’s ward office. At the station I was told to get four people who are not my relatives to testify our documents are true.&nbsp;
This process happened to be more stressful than dealing with the government offices. At first, it turned out that most of my mother’s old neighbours had already passed away or had citizenship papers from another area. Others confirmed their availability, but later had conflicting schedules. Luckily, one very helpful old neighbour was able to arrange for enough people to verify the documents.&nbsp;
Encouraged that the end of the tunnel was in sight, I went back to the district office with all the requested documents, and after some initial pushback, I was finally referred to meet the official who signs off the documents before it goes to the CDO.&nbsp;
As luck would have it, the officials were in a meeting that lasted more than two hours, and I had to give my mother her insulin shot and noodles from the cafeteria in the waiting area.&nbsp;
When we were finally able to meet the officer, he didn’t even look at my papers properly and started questioning my lawyers whether they had even read the law, how could I apply for Nepali citizenship when I already had a Japanese passport, etc. He somehow assumed that I was looking to get a normal Nepali citizenship from my mother’s side, and we informed him that I was only looking to get an NRN citizenship, after which his tone became more apologetic and said that he would need to look into the law more closely.&nbsp;
It had already been three full days of working through each step of the process, and I had no problem waiting another day for the conclusion.&nbsp;
Perhaps because this NRN citizenship is a fairly new law and perhaps a lot of NRNs apply from the Nepal’s embassies in their country of domicile, throughout my experience, officials kept on telling me that a case such as mine has not been processed before.&nbsp;
My case being that I have never had a Nepali citizenship, my father having a naturalised Nepali citizenship and my mother being the only 100% Nepali in the family. I kept on saying that just because it has never been done before does not mean that it cannot be done, and sure enough, the next day the officer signed off on my documents, even kindly saying that they should have highly respected my application upon learning about my late father and his contributions to Nepal.&nbsp;
Although the intricacies of the NRN citizenship law have not been fully hacked out such as the transfer of land ownership, it is definitely a positive step in securing the rights and aspirations of fellow NRNs as many would agree that no matter where we go, “यो मन त मेरो नेपाली हो!”&nbsp;
Sonia Miyahara, Managing Director of Hotel Everest View, Trans Himalayan Tours &amp; Trekking Pvt Ltd &amp; Himalaya Kanko Kaihatsu Co. Ltd.

How I got my NRN Citizenship in Nepal

This is the 83rd episode of Diaspora Diaries, a Nepali Times series in collaboration with Migration Lab providing a platform to share experiences of living, working and studying abroad. Spain is regularising over 500,000 undocumented workers, and Nepalis come to me inquiring about the program. Those who benefit from it will be very lucky, as it is a life-changing opportunity. I know because I too benefited from the last large scaled regularisation program back in 2005. I left Nepal in 2000 and went to Germany, Belgium, France before landing in Spain. Things were pretty bad in Nepal back then with the Maoist conflict and strikes.&nbsp; Our business was impacted. There was not much hope. When you leave Nepal, you want to make something of yourself and support your family back home. But you have to dream in phases.&nbsp; The first dream is to get ‘kagaj’ or a temporary residence card (TRC). Only then can you focus on your actual dreams. Whether it was because the countries I traveled were not a good fit or because the chances of getting the document was low, I kept country hopping until I reached Spain in 2004. I have not left since.&nbsp; In Spain, I felt at home. The European dream had brought me here, salaries were higher than Gulf which I thought was too strict. Then there was the possibility of traveling to seven European countries back then with the Schengen visa.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260210150228_b57c873801361755cf25048f294b2d1d0574796ef70a0e270531ced2508f64ed.jpg" data-media-id="editor_0" data-image-id="20260210150228_b57c873801361755cf25048f294b2d1d0574796ef70a0e270531ced2508f64ed" data-rendition-name="original" width="2048" height="1536" loading="lazy" alt="Nepalis in Spain"> </figure>  But mostly, I just wanted a secure life for me and my family. What I valued the most about Europe was free healthcare and education. This is very important because in other parts of the world including Nepal, people from our background are just one small disease away from losing half our capital and we spend a significant amount of money on educational expenses. Nepali dais back then told me it would be best to go to either Italy, Spain or Portugal if we wanted to establish ourselves as paper work was relatively easier there than in other European countries. My initial days in Spain without the paper work were difficult. Not concerns about being raided or deported because if we had our apartment, even police let us be.&nbsp; But it was because of unfair pay. You could not go home. It made you tense and irritable. It affects your mental well-being. Some are smart enough to invest time in skills as they wait that will prove useful. Others get depressed. The main reason we migrate is to support our family and when you cannot do it properly and are uncertain about when things will get better, it bothers you. This happened to me too, sometimes I would be staring at the TV and would flinch when other Nepalis asked me what is wrong, and why I look so lost.&nbsp; The newspaper Canarias also interviewed us about our conditions (pictured). I had not gone home since five years, and there was no way to. There was no social media like now to talk to family. Calling home from booths was expensive, just once every three weeks. You did not talk. It was just to hear voices, pass the phone around to say a quick hello.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260210150232_8af8b6f6acb1252e0d67a43556e21ff8074543acfcc318c985816479c6146fd9.jpg" data-media-id="editor_1" data-image-id="20260210150232_8af8b6f6acb1252e0d67a43556e21ff8074543acfcc318c985816479c6146fd9" data-rendition-name="original" width="2048" height="1536" loading="lazy" alt="Nepalis in Spain"> </figure>  When you are undocumented, you don’t get fair wages. But you make that sacrifice because my bigger goal was to establish myself and in the meantime, to support family with whatever I could earn with my wages. All we could do was wait for a regularisation program to open. When Spain initiated such a program in 2005, we were so relieved. We were relatively new so did not understand the language. Other Nepalis guided us and were well-versed in the latest updates via news and consultation with immigration lawyers which they would pass on to us. This time, the regularisation program will come through within 30 days, but back then it took time. I had to wait for nine months. Those nine months felt like nine years. I would keep visiting the cyber café to check my online status. When friends got their notification, I would get even more anxious and wonder if I would get rejected. Maybe today? Maybe tomorrow? It was a long wait. I wanted to know what it felt like to hold the card in my hand. Then I could hold my five-year-old baby back in Nepal in my hand. She was born after I left for Europe. When I finally got it after nine months, I could not be happier. I informed my family. I thanked God. Even when I was having food, I would put the card right in front of me on my table. Food never tasted better, I would eat twice the amount with happiness. It was a different kind of elation — it opened the doors for me to think about my dreams, my targets and how to realise them.&nbsp; There was no stopping me now, I was going to go far. But mostly, I could go home. In that flight back to Nepal after six years my heart swelled and I knelt on the tarmac to pay respect to my motherland. The minute I saw my parents, I touched their feet for blessings. My wife and I cried. My daughter was scared of me and would run away - it took some time for her to get comfortable with my presence. I still break down when I think about it.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260210150232_beba1745d845e219eaeaaf1bc33e0a02c07748ebd80bcc74a467c933cc5602e3.jpg" data-media-id="editor_2" data-image-id="20260210150232_beba1745d845e219eaeaaf1bc33e0a02c07748ebd80bcc74a467c933cc5602e3" data-rendition-name="original" width="2048" height="1536" loading="lazy" alt="Nepalis in Spain"> </figure>  A few trips to Nepal later, I brought my family to Spain after I had fulfilled various rules for family migration. As expenses rise for a migrant, the choice is to either work extra hours or start your own business. Since I got the TRC, I have done it all: various jobs, businesses from selling handicraft from India to a cyber cafe, and the restaurant business.&nbsp; As an entrepreneur, I have seen highs when I could open a second restaurant branch or earn enough to buy an apartment. I have seen lows where I closed down businesses and sold apartment. I have gone from an entrepreneur to a wage job to recoup the losses I made by working extra hours. When I felt comfortable enough, I have gone back to starting a new business.&nbsp; I have met wonderful people who have supported me when I started my business either by providing me financial help or as business partners. I have been duped by my own business partner or worked with colleagues who did not want me to prosper. I now run a handicraft shop, an Indian restaurant and a café. The struggle never ends. There are many Nepalis like me who are running businesses here and have bought property. Back in 2004, Nepalis were mostly working in jobs and for a slight salary bump, we would keep switching jobs. Now, they run their own businesses and have bought property. The power of honesty and hard work that Nepalis are known for helps in businesses. Malaga is incredibly beautiful and reminds me of Thamel. The brilliant weather and beautiful beaches attracts tourists. The houses are kept small to preserve the culture and civilisation.&nbsp; I miss Nepal. I especially miss my father who passed in 2020. He was my biggest cheerleader as I struggled thousands of miles away, and always reminded me that he was here for back support. My mother reminds me to keep at it without worrying.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260210150232_2cea4b66ad47c15859980c696446362603b10981a1b471ab5e076a22a58727b1.jpg" data-media-id="editor_3" data-image-id="20260210150232_2cea4b66ad47c15859980c696446362603b10981a1b471ab5e076a22a58727b1" data-rendition-name="original" width="2077" height="1433" loading="lazy" alt="Nepalis in Spain"> </figure>  Sometimes I ask myself, what did I leave behind to earn money and provide a good life to my family? I regret not getting to spend more time with my father before he died. I am not sure what would have happened if I had not left Nepal, but I would have figured something out. Whatever determination I have shown in Spain to navigate my life here, I would have used it back home, too.&nbsp; I have missed important milestones like weddings, births, deaths and festivals. I have missed it all. Of my three daughters I missed the births of the first two in Nepal. I was only there for my youngest’s birth, in Spain.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260210150232_a6295e4f58d73e5b340235caf916b98eba785e3559341ea4622629c262e7b1a4.jpg" data-media-id="editor_4" data-image-id="20260210150232_a6295e4f58d73e5b340235caf916b98eba785e3559341ea4622629c262e7b1a4" data-rendition-name="original" width="1630" height="1125" loading="lazy" alt="Nepalis in Spain"> </figure>  The regularisation program from 2005 that allowed me to raise the living standards of a number of living around me and reunite with my family. This platform was life changing for me, and my loved ones. There are many Nepalis who will be applying for the 2026 regularisation program if they meet the criteria like presence in the country for at least five months before December 31, 2025. Other European countries have tightened their policies so many Nepalis are in Spain. This is a great opportunity for Nepalis. There are many more undocumented workers than the available quota, a majority from Latin America in Spain who want to benefit. The Nepali diaspora is helping raise awareness and provide accurate information about the processes so they can benefit and no one is left out. I do whatever I can to support young Nepalis because I was in the same position 20 years ago.

leprosy

During the pandemic, don’t forget leprosy

New treatment offers hope for Nepal’s leprosy patients

Map land

Fake rescues hurt Himalayan tourism

How I got my NRN Citizenship in Nepal

Dreaming in phases