<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111016110/636d12069c7e80680e0a98b4jpeg.jpg" alt="" width="844" height="570"/><figcaption></figcaption></figure>I knew I wanted to get vaccinated as soon as the Covid-19 jabs were made available to the general public in the US, and that when it was my turn I would have access to it.It was not the same for people in Nepal, and I remember family and friends back home telling me how hard it was to get a vaccine earlier this year. And a lot of it depended on whether you had the right connections.People in Nepal were <a href="https://www.nepalitimes.com/banner/anger-grows-in-nepal-over-covid-vaccine-delays/">struggling to find their first doses</a>, whereas in the US people did not want to get vaccinated against Covid-19 despite a raging pandemic. Those without access to jabs were confused with those who did not want to get vaccinated.All international students studying in the US must provide proof of immunisations against <a href="https://www.nepalitimes.com/banner/a-shot-in-the-arm-for-vaccines-in-nepal/">MMR (Measles, Mumps and Rubella)</a>, Varicella Tdap (Tetanus, Diphtheria, Pertussis) and Meningitis.I completely understand the reasoning behind requiring those vaccinations, it is to keep people safe, and it never entered my mind to argue the logic.Did I ever feel like my freedoms were being curtailed because I needed to show proof of those inoculations? No. Did I feel like someone was infringing on my choice? No. Did I have a problem getting the necessary vaccine for the greater good? No.So why is it different with the Covid vaccine? The main reason to be vaccinated was so that I do not spread the infection further, as well as protect myself. The sooner we all got vaccinated, the sooner we would be post-pandemic.Which is why it surprised me that unlike <a href="https://www.nepalitimes.com/latest/too-early-for-nepal-to-let-its-guard-down/">Nepal</a>, where the vaccine acceptance rate is 97%, many in the US were choosing to not to get the jab because it curtailed their freedom of choice. The anti-vaxxers were also anti-maskers — and the puzzling thing was that they would however not protest against wearing seat belts to abide by laws against drinking and driving.They say Pfizer and Moderna have side effects. Of course they do, every modern medicine has some side effect. Even junk food has horrible side effects, but that hasn't stopped people from eating fries and burgers.And while anti-vaxxers are worried about their health, they have not taken the time to consider the health of millions of others they directly or indirectly interact with.I had spent most of my life in the US in liberal and progressive cities, so when I was met with the comparatively conservative crowd, I felt it was pointless to argue the subject because they had made up their minds and were not open to other opinions.Nothing has brought out the gap between haves and have nots than the Covid-19 pandemic. The global gap between the jabbed and jabbed nots is growing, increasing the chances of mutant strains evolving.In Nepal, we are not privileged enough to choose whether or not we will get a vaccine for a disease that has killed millions. We cannot even choose which vaccine we want: <a href="https://www.nepalitimes.com/banner/despite-doubts-nepal-sticks-with-astrazeneca-jabs/">AZ-Covishield</a>, VeroCell, J&amp;J. We take whatever is available.For most Nepalis, if there is a disease and there is a way to protect yourself from it, you just do it. There are no what-ifs.The fact that you even have the option to decide if you want to get inoculated against the virus in a country which has the highest national total of fatalities from Covid-19 shows how privileged people are in the US.When you are a <a href="https://www.nepalitimes.com/banner/the-real-cost-of-nepals-second-wave/">daily wage worker</a>responsible for feeding and clothing your family, and when your government doesn’t give you a weekly unemployment allowance for staying at home unable to go to work, you want to return to your job as soon as possible. The only way to do that at the moment is to vaccinate and make it safe for everyone to be out again.I would respect the choice of the anti-vaxers not to get vaccinated if they stayed home and did not interact with the public. But they are out and about (and without masks) claiming that it is their right to do so.Being a citizen means having a sense of responsibility towards oneself and others and not using selfish excuses in the name of freedom to do whatever you want.It is a sensitive topic, and those who are most vocal and against the vaccine seem to be also the least informed about masks, <a href="https://www.nepalitimes.com/banner/climate-change-is-a-disaster-in-the-nepal-himalaya/">the climate emergency</a>, guns, abortion and politics. They live in social media echo-chambers where algorithms expose them to ever more radical posts.Recently, I asked a friend in the US if he had been vaccinated. Later, I was told that it is impolite to ask such questions. But if someone is out in public, mingling and exhaling, they need to be responsible about the health of those around them.The boundary of an individual’s freedom is when it infringes on someone else’s freedom.The decision not to be vaccinated is a matter of life or death for those not fortunate enough to have access to doses. While Americans are refusing to take <a href="https://www.nepalitimes.com/opinion/to-boost-or-not-to-boost/">booster third shots</a>, 70% of Nepalis have not even got their first doses.The next time I see a person drinking a beer while smoking a cigarette trying to rationalise their choice to not vaccinate, you know how that conversation will go.I can already tell you that my Thanksgiving and Christmas in the Land of the Free and the Home of the Brave will be a lot of fun.Anjana Rajbhandary writes this fortnightly Nepali Times column Life Time about mental health, physical health and socio-cultural issues.

Anjana Rajbhandary

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To vax or not to vax

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141152/636d02a39c7e80680e0a368fjpeg.jpg" alt="" width="1360" height="680"/><figcaption>Photo via PROJECT SYNDICATE</figcaption></figure>The upsurge of Covid-19 cases, hospitalisations, and deaths in the United States serves as a bitter reminder that the pandemic is not over. The global economy will not return to normal until the disease is under control everywhere.But the US case is a true tragedy, because what’s currently happening here is so unnecessary. While those in emerging markets and developing countries are longing to get the vaccine (with many dying because they cannot get it), the US supply is ample enough to provide a double dose – and <a href="https://www.nepalitimes.com/opinion/to-boost-or-not-to-boost/" target="_blank" rel="noopener noreferrer">now a booster shot</a> – to everyone in the country. And if almost everyone got vaccinated, Covid-19 would almost surely just “fade away,” as former President Donald Trump memorably put it.And yet not nearly enough people in the US have been vaccinated to prevent the highly contagious <a href="https://www.nepalitimes.com/here-now/delta-variants-wake-up-call-for-nepal/" target="_blank" rel="noopener noreferrer">Delta variant</a> from driving case numbers in many areas to new highs. How do so many in a country with seemingly well-educated people act so irrationally, against their own interest, against science, and against the lessons of history?Part of the answer is that the country, for all of its wealth, is not as well-educated as one might expect – which is reflected in the country’s comparative international performance on standardised assessments. In many parts of the country – including some with the highest rates of resistance to vaccination – science education is particularly poor, owing to politicisation of fundamental issues like evolution and <a href="https://www.nepalitimes.com/banner/un-climate-report-declares-planetary-emergency/" target="_blank" rel="noopener noreferrer">climate change</a>, which in many cases have been excluded from school curricula.In this environment, misinformation can gain traction with many people. And social-media platforms, insulated from liability for what they transmit, have made a business model of maximising “user engagement” by spreading misinformation, including about Covid-19 and the vaccines.But a key part of the answer is a deep misinterpretation, especially among the right, of individual liberty. Those who refuse to <a href="https://www.nepalitimes.com/here-now/3-pronged-strategy-to-save-nepal-from-covid-19/" target="_blank" rel="noopener noreferrer">wear masks</a> or socially distance often argue that requirements to do so infringe on their freedom. But one person’s freedom is another person’s “unfreedom.” If their refusal to wear a mask or get vaccinated results in others getting Covid-19, their behaviour is denying others the more fundamental right to life itself.The essence of the matter is that there are large externalities: In a pandemic, one person’s actions affect the well-being of others. And whenever there are such externalities, the well-being of society requires collective action: regulations to restrict socially harmful behaviour and to promote socially beneficial behaviour.Any ordered society entails restrictions. But while prohibitions against killing, stealing, and so on restrict an individual’s freedom, we all understand that society could not function without them. In our post-Covid world, we might interpret the Ten Commandments to include: “Thou shall not kill, including by spreading infectious diseases when thou can avoid doing so.”Similarly, “Thou shall get vaccinated.” Any infringement of an individual’s liberty by requiring safe and highly effective <a href="https://www.nepalitimes.com/opinion/why-vaccination-should-be-compulsory/" target="_blank" rel="noopener noreferrer">Covid-19 vaccination</a> pales in comparison to the social benefits – and consequent economic benefits – of public health. It is a no-brainer to require all individuals, with only limited medical exemptions, to be vaccinated. While many governments appear to be too timid to impose this requirement, employers, schools, and social organisations – any organised activity that brings individuals into contact with others – should do so.As we have been learning for the last 18 months, global health is a global public good. As long as the disease rages in some parts of the world, <a href="https://www.nepalitimes.com/latest/too-early-for-nepal-to-let-its-guard-down/" target="_blank" rel="noopener noreferrer">the risk of a deadlier</a>, more contagious, more vaccine-resistant mutation grows.In most of the world, however, the problem is not resistance to vaccination but a <a href="https://www.nepalitimes.com/opinion/hope-hyperbole-and-hypocrisy-of-covax/" target="_blank" rel="noopener noreferrer">severe shortage of vaccines</a>. Evidently, the private sector is unable to scale up production to ensure an adequate supply. Is that because vaccine producers lack capital? Is there a shortage of glass vials or syringes? Or is it because they hope that fewer doses will lead to higher prices and even bigger profits? Among the key barriers to greater supply is access to the requisite intellectual property, which is why the IP waiver being discussed at the World Trade Organisation is so important.Given the urgency and scale of the challenge, more is needed: Among the steps US President Joe Biden’s administration could take is to invoke the Defense Production Act and leverage the federal government’s ownership of key patents. The US has been allowing the pharmaceutical companies to use this public IP freely, while they reap billions of dollars in profits. The US must use every instrument at its disposal to increase production at home and abroad.This, too, is a no brainer. Even if the costs of global vaccination totaled tens of billions of dollars, the amount would pale in comparison to the costs of <a href="https://www.nepalitimes.com/banner/how-nepal-must-prepare-for-3rd-covid-wave/" target="_blank" rel="noopener noreferrer">persistent Covid-19 outbreaks</a> to lives, livelihoods, and the world economy.By arrangement with © <a href="https://www.project-syndicate.org/" data-saferedirecturl="https://www.google.com/url?q=https://www.project-syndicate.org/&amp;source=gmail&amp;ust=1607178503443000&amp;usg=AFQjCNHSbaaYvdpDj2FQzkDgwL7xNFnkWg">Project Syndicate</a>Joseph E. Stiglitz, a Nobel laureate in economics and University Professor at Columbia University, is a former chief economist of the World Bank (1997-2000), chair of the US President’s Council of Economic Advisers, and co-chair of the High-Level Commission on Carbon Prices. He is a member of the Independent Commission for the Reform of International Corporate Taxation and was lead author of the 1995 IPCC Climate Assessment.

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Covid-19 and Human Freedom

<figure><img width="1594" height="986" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111015114/636d05889c7e80680e0a5f11jpeg.jpg" alt=""/><figcaption>Photo: AMIT MACHAMASI</figcaption></figure>Much has been said about ‘vaccine apartheid’ and how instead of levelling out rich and poor, it has widened inequities. Nepal today is living proof of this. 
As the government lurches rudderless from one failure to another — nowhere does SARS-CoV-2 have such fertile ground to spread as in Nepal.
The government declared a <a href="https://www.nepalitimes.com/banner/kathmandu-covid-19-lockdown-relaxed/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/banner/kathmandu-covid-19-lockdown-relaxed/&amp;source=gmail&amp;ust=1625191485755000&amp;usg=AFQjCNH7xitObX_aJhpMCkps_jMvT6YgLA">‘smart lockdown’</a> after infection rates dropped, but with only 2.6% of the population vaccinated, the virus is getting ready to pounce back. In 2020, the first wave actually started only after the lockdown was eased and lifted. It can happen again.
The Delta variant is three times more virulent than the original virus, it rides unvaccinated hosts in crowded places, who do not wear masks, and do not have access to adequate healthcare. It has mutated into an even more dangerous Delta+ strain.
Prime Minister K P Oli and four health ministers who have served under him in the past year have cried wolf with sweeping promises of “full vaccination in a few months”. 
We have also heard <a href="https://www.nepalitimes.com/latest/vaccines-are-the-only-solution/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/vaccines-are-the-only-solution/&amp;source=gmail&amp;ust=1625191485755000&amp;usg=AFQjCNEA8CBMu7v8LiyErgNnzw9NMkzWwg">promises from the US President</a>, G-7 and Team Europe of a billion of doses, but there is no sign of surplus vaccines being shipped out. The Danes, Norwegians and Czechs want to send Nepal unused Oxford AstraZeneca doses, but Brussels is <a href="https://www.nepalitimes.com/opinion/hope-hyperbole-and-hypocrisy-of-covax/">forcing them to go through COVAX.</a>
A laudable initiative, COVAX has been undermined by its own funders. Its Japan-hosted pledging summit in early June was proof of how quickly a global mechanism with an equity plan can fall apart when <a href="https://www.nepalitimes.com/here-now/nepal-needs-urgent-american-vaccine-support/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/nepal-needs-urgent-american-vaccine-support/&amp;source=gmail&amp;ust=1625191485755000&amp;usg=AFQjCNGelKWa2vhYATH_AZOtcqkw-g8WVA">national narrow-mindedness</a> prevails over enlightened self-interest. No country is safe from future mutants until everyone is vaccinated. 
We will not even bring up moral and ethical considerations here. <a href="https://www.nepalitimes.com/banner/anger-grows-in-nepal-over-covid-vaccine-delays/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/banner/anger-grows-in-nepal-over-covid-vaccine-delays/&amp;source=gmail&amp;ust=1625191485755000&amp;usg=AFQjCNFfqMeD8wLHk4i9fwxnhcCtYX5Utw">Commentators have drawn attention</a> to veterans from the Indian and British militaries who have died of Covid-19 complications in Nepal’s second wave because India did not send vaccines that had been paid for, and Britain sent us loads of PPEs. 
Please <a href="https://www.nepalitimes.com/here-now/aid-pours-into-nepal-but-where-be-vaccines/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/aid-pours-into-nepal-but-where-be-vaccines/&amp;source=gmail&amp;ust=1625191485755000&amp;usg=AFQjCNEEAA9_pE28k01bucV-_40hsl7myQ">spare us more selfies</a> by diplomats at Kathmandu airport posing with yet another ‘relief’ flight full of latex gloves. We know they know that what Nepal urgently needs right now is vaccines that they themselves promised, or are willing to buy. 
Even if, by some miracle, <a href="https://www.nepalitimes.com/banner/anger-grows-in-nepal-over-covid-vaccine-delays/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/banner/anger-grows-in-nepal-over-covid-vaccine-delays/&amp;source=gmail&amp;ust=1625191485755000&amp;usg=AFQjCNFfqMeD8wLHk4i9fwxnhcCtYX5Utw">1.4 million elderly Nepalis</a> get their second doses of Covishield, it looks impossible that we can procure the 40 million doses needed to inoculate 70% of our eligible population even by the end of 2022 at the earliest.
Our government has failed us, the international community has let us down. We better start looking after ourselves in a vaccine-less future.
As if the Covid-19 crisis was happening on a distant planet, the Supreme Court is consumed by hearings on the future of the government. It will decide by next week the <a href="https://www.nepalitimes.com/banner/court-debates-nepal-pm-olis-future/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/banner/court-debates-nepal-pm-olis-future/&amp;source=gmail&amp;ust=1625191485755000&amp;usg=AFQjCNGethsg3p9twp9kU49cPc4TjdjMmA">fate of Parliament </a>and there isn’t much of a choice: either the current prime minister will get to swear himself in once more, or we will get one who has been prime minister four times in the past 20 years already. 
We cannot expect effective vaccine diplomacy, or needed policy interventions to contain the virus from this inept lot. The daily death toll when the lockdown was announced on 29 April was ten, this week we averaged 35 fatalities a day. Total active cases are higher as restrictions lifted, than they were two months ago. 
And all this is happening even while public health experts warn of a third wave, as the virus mutates in an unvaccinated world. We also know that the official infection and death rates in India and Nepal are underestimated. <a href="https://www.nepalitimes.com/latest/nepal-covid-19-impact-worse-than-official-figures/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/nepal-covid-19-impact-worse-than-official-figures/&amp;source=gmail&amp;ust=1625191485755000&amp;usg=AFQjCNGRjVWVJtLoZDB85E9MRNVTuOQugA">Excess mortality in the population</a> caused by Covid-19 is said to be much higher than official figures.
Projections by the <a href="https://covid19.healthdata.org/nepal?view=cumulative-deaths&amp;tab=trend" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://covid19.healthdata.org/nepal?view%3Dcumulative-deaths%26tab%3Dtrend&amp;source=gmail&amp;ust=1625191485755000&amp;usg=AFQjCNFOSUIRAHJP3kcd8ORL-tNXOKKeFg">University of Washington School of Medicine in Seattle</a> show that on 29 June, when the official fatality tally nationwide was 20, the real death toll from Covid-19 in Nepal was probably closer to 95. 
This week, the official count for the number of people who have died in the pandemic crossed 9,000 — overtaking the total death toll in the 2015 earthquake. But the models suggest that the actual fatalities could be more than 31,000.
At present only 72% of Nepalis wear masks, if that can be raised to 95% as the country opens up, the models show, nearly 1,500 additional deaths due to Covid-19 could be prevented by 1 September.
We have to plan as if there will be no vaccines, and behave <a href="https://www.nepalitimes.com/latest/learning-to-live-with-covid/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/learning-to-live-with-covid/&amp;source=gmail&amp;ust=1625191485755000&amp;usg=AFQjCNHqUkg3c9x8Swh1bHMT1S9RssPOBQ">as if we are still in isolation</a>. The mantra is: mask up and avoid crowds.

No vax? Ask for Mask.

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121144/636b92f69c7e80680e06f17cjpeg.jpg" alt="" width="1500" height="1000"/><figcaption>Photo: MONIKA DEUPALA</figcaption></figure>This op-ed is being simultaneously published in the Indian Express (India), The Daily Star (Bangladesh), Nepali Times (Nepal) and DAWN (Pakistan).In February 2021, Covid-19 numbers started increasing again in South Asia with official daily case counts rising beyond 400,000 in India, 6,000 in Pakistan and 7,500 in Bangladesh, straining health systems.The massive surge in India soon <a href="https://www.nepalitimes.com/banner/we-knew-the-tsunami-was-approaching/" target="_blank" rel="noopener noreferrer">spilled over across the border into Nepal</a>, leading to ‘apocalyptic’ scenes of overwhelmed hospitals.This virus knows no borders. Containing it has necessitated global cooperation among scientists, policy makers and society. Despite a wide variation in how nations have responded to the pandemic, the most successful strategies adhere to science, and attention to local context.The <a href="https://www.nepalitimes.com/editorial/this-is-war/" target="_blank" rel="noopener noreferrer">deadly surge in 2021</a> makes a regionally-coordinated, evidence-driven strategy even more critical. The virus continues to challenge us with its mutations and new lines of attack. If we are to move at the speed of the virus, it is necessary to construct multi-stakeholder regional coalitions to devise new solutions and frugal innovations that can be applied across South Asia.Given our shared and mostly similar social, economic and cultural contexts, local successes must find means to be amplified across the region.Is that even possible, given the troubled history South Asian countries share? The mutual mistrust appears to have hit a new low, as <a href="https://www.nepalitimes.com/editorial/shared-futures/" target="_blank" rel="noopener noreferrer">SAARC</a> has not even managed to hold its summit since 2014.But today we write a positive, hopeful story about a new consortium we are involved in, with core team members from India, Pakistan, Nepal, and Bangladesh jointly developing Covid prevention strategies. The emerging consortium provides an example of how neighbours can work together for mutual benefit, despite political differences.Every country in South Asia has struggled to ensure consistent <a href="https://www.nepalitimes.com/opinion/the-economics-of-masks/" target="_blank" rel="noopener noreferrer">mask-wearing</a> to stem the spread of Covid. Beliefs, priorities, traditions, and aversions to behaviour change are more similar across South Asia than we care to admit. These commonalities mean that interventions that are successful in changing behaviour in one place are likely applicable in other parts of the Subcontinent.We have experienced this with Community-Led Total Sanitation (CLTS) campaigns to solve the <a href="https://www.nepalitimes.com/here-now/nature-calls/" target="_blank" rel="noopener noreferrer">problem of open defecation</a> -- originally developed by Bangladeshi NGOs in partnership with an Indian consultant --- and now broadly applied across South Asia and beyond.The Grameen Bank microcredit model was an indigenous South Asian innovation that spread rapidly. BRAC’s recent ‘Graduation’ program targeting the ultra-poor in Bangladesh was replicated with success in India and Pakistan. India’s digitised social protection ecosystem with Aadhar IDs and Jan Dhan accounts serves as a model (albeit with cautionary notes) for other countries in the region. E-governance programs in Pakistan, like eVaccs and Citizen Feedback Model have been replicated and provide strong models ready to be deployed regionally and globally.The new pan-South Asian consortium in response to Covid-19 evolved out of an experiment conducted in Bangladesh, that successfully changes social norms around mask-wearing in rural communities. We observed that a combination of No-cost distribution, Offering information, Reinforcing the message in markets, mosques and other public spaces, and Modelling and endorsement by community leaders (NORM) leads to large, sustained increases in mask usage that persisted beyond the period of active intervention.This <a href="https://www.nepalitimes.com/here-now/3-pronged-strategy-to-save-nepal-from-covid-19/" target="_blank" rel="noopener noreferrer">four-part NORM intervention</a> was originally examined in a cohort of 350,000 individuals across 600 villages. BRAC is implementing the model to reach 81 million people across Bangladesh.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121144/636b92f99c7e80680e06f17djpeg.jpg" alt="" width="1600" height="876">The team is now partnering with several organisations across Pakistan, India, Nepal, and Bangladesh to start adapting the model to fit each country’s context, and set up partnerships to pilot, implement, tinker, and learn.The Self Employed Women’s Association (SEWA) quickly implemented the model to reach over one million members in Gujarat. An additional 1.5 million masks were shipped from Bangladesh to support SEWA’s outreach to other states. Lahore’s Commissioner worked with our research team to adapt the NORM model to an urban setting, and devised new creative ideas to improve effectiveness.For example, it has prepared to deliver <a href="https://www.nepalitimes.com/opinion/masks-and-vaccines-to-stop-nepals-2nd-wave/" target="_blank" rel="noopener noreferrer">masks</a> at doorsteps using Pakistan’s postal service, and is targeting beneficiaries on the basis of billing information from utility companies. Philanthropists and private corporations are sponsoring the masks. We are re-importing some of these innovations back to Dhaka, inspiring further scale-ups in Dhaka, Chittagong, Rajshahi and Kathmandu.Effective mask promotion requires visits to thousands of remote villages, and those same visits can be used to prepare for more effective community-based healthcare responses. To that end, a host of physicians, scientists and community based organisations created the Swasth Community Science Alliance, committing to pragmatic, science-based protocols to manage mild and moderate cases of Covid-19 in rural India, where institutional health care access is limited.These guidelines (available at https://science.swasth.app) were translated to training tools for healthcare workers by digital health innovators like Noora Health, making them widely available across the region.NORM implementation teams based in Lahore, Ahmedabad, Peshawar, Hyderabad, Dhaka, Kathmandu, and Delhi are learning from each other’s successes and failures. The process usually starts with the original research team sharing evidence-based insights with implementing agencies, as the implementers adapt the design, co-create localised implementation protocols, and are threaded together in a collaborative environment across countries where each implementing team iterates while learning from others’ prior iterations, and all our sub-teams are connected in an active learning system that allows us to course-correct in real time. This coalition is poised to change mask-wearing norms amongst hundreds of millions of people across all of South Asia.The CSA is working with partners across rural, tribal belts around India. A team of physicians from India and the Indian diaspora work with local implementing partners to support design, implementation and monitoring of home-based programs and Covid-19 centres providing rigorously protocolised treatment for moderate cases, with oxygen, proning and steroids.Combining the NORM and CSA interventions, our Masking-Treatment-Vaccine Preparation (MTV) approach offers a sensible strategy to mitigate the pandemic until universal vaccination is achieved. These are regional solutions that thoughtfully apply scientifically sound interventions to the local context.The <a href="https://www.nepalitimes.com/editorial/nepals-humanitarian-emergency/" target="_blank" rel="noopener noreferrer">Covid-19 crisis</a> has increased policymakers’ appetite for evidence-informed policy measures that can be quickly implemented to stem transmission. This drive for quick action has created some unprecedented opportunities for enhanced cross-country collaborations that are normally hampered by politics and mistrust.We hope that the consortium that first formed around <a href="https://www.nepalitimes.com/opinion/how-nepal-can-survive-2nd-covid-wave/" target="_blank" rel="noopener noreferrer">mask-promotion</a>, and now around science-based treatment approaches, and that developed quickly and organically without regard to national boundaries, can serve as a model for a broader and deeper collaborative ecosystem that endures.We need to come together to solve problems that affect us all. Let the lasting legacy of this pandemic be a new era of partnership in social innovations that can benefit all South Asians.https://www.youtube.com/watch?v=d0hpuXRByic&amp;t=9sMushfiq Mobarak is Professor of Economics, Yale University, and Director of the Yale Research Initiative on Innovation and Scale. Twitter: @mushfiq_econ Maha Rehman is director of policy at the Mahbub-ul-Haq Research Centre at the Lahore University of Management Sciences. Twitter @MahaRehman1Satchit Balsari is assistant professor of emergency medicine, and of global health and population, at Harvard University. Twitter: @satchit_balsari

What can we do till vaccines arrive?

<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131144/636cf29e9c7e80680e09d91cjpeg.jpg" alt="" width="1500" height="1000"/>Nepal will open its 2021 lockdown long before the country <a href="https://www.nepalitimes.com/here-now/aid-pours-into-nepal-but-where-be-vaccines/">has enough vaccines</a> to protect its citizens -- our aunts, uncles, and neighbours. We will not have substantial vaccine coverage for many months, if not longer.We will <a href="https://www.nepalitimes.com/here-now/its-an-emergency/">need more oxygen,</a> more testing, and better tracking and isolation procedures. Crucially, we will also have to maintain and strengthen our only effective tools: physical distancing and masks.Unfortunately, too many Nepalis are wearing low-quality masks, taking them off too often, touching them, and not washing them or replacing them often enough. More people should be wearing three-layer surgical masks, which, for only a few more rupees, offer greater protective power.The key problem Nepal faces has not changed: infected people do not know they have the virus and spread it around. And new variants make the virus even more easily transmissible. We need to behave not as if only a small number of people could have the virus, but as if everyone we encounter already has it. That includes the friendly neighbourhood fruit seller. That includes family members. That includes you.“Vaccinations will take a long time to arrive in South Asia to create a wall of immunity. Till then, masks are most essential,” says <a href="https://www.nepalitimes.com/here-now/3-pronged-strategy-to-save-nepal-from-covid-19/">Mushfiq Mobarak</a>, a Yale university professor who recently led a huge study of<a href="https://docs.google.com/forms/d/e/1FAIpQLSfMJkyBBtK74lqSsHZnx_8qb0_sJ0WaR7A7XA8IQHAobrBEQA/viewform"> mask-wearing in Bangladesh.</a>Many Nepalis wear cloth masks or one-layer surgical masks. These help, no question. But the 3-layer surgical masks and N95s offer more filtration efficiency and more protection, although they cost just a few rupees more. That is an investment well worth it to protect individuals, institutions, and governments.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131144/636cf2a19c7e80680e09d91djpeg.jpg" alt="" width="2370" height="950"><figcaption> </figcaption></figure>I asked Biraj Vajracharya, an epidemiologist at Dhulikhel hospital, what kind of mask people should be buying and wearing. "Surgical mask, or if possible, N95 mask," he replied.The Yale researchers recommend high quality 3-layer masks because they filter more efficiently. They can be washed and reused without losing much efficiency. For more on the study's recommendations about masks, see this excellent <a href="https://www.youtube.com/watch?v=ifiR_5DuyfA">video</a>."We need to change mask-wearing norms amongst hundreds of millions of South Asians to mitigate the spread of COVID," Mushfiq Mobarak told me via email. "High-quality washable, reusable surgical masks are much more cost-effective, and offer a feasible path to scalability across the region."The <a href="https://www.business-standard.com/article/current-affairs/covid-19-crisis-india-draws-lessons-from-bangladesh-s-mask-study-121051401341_1.html">Yale study in Bangladesh</a>, involving over 300,000 people in 600 villages, identified simple policies that led to much greater mask wearing. They found that when <a href="https://docs.google.com/document/d/1EUhdri6CST9uzw_myffNmyUVPt8_UMsM75NOt5Q-54o/edit">authorities do four things together</a>, mask wearing more than tripled:<ol><li>Offer free masks</li> <li>Provide clear information about mask wearing in videos and brochures</li> <li>Find community leaders to speak in support of mask wearing</li> <li>Reinforce the message with gentle questioning for those not wearing</li></ol>The fourth policy was the most important: special monitors to verbally poke people who were not wearing masks. Those monitors, the Yale study explains, ‘walk around and if somebody is not wearing a mask, they intercept them and politely say, “We distributed masks here—why aren’t you wearing one?” If the person didn’t have a mask or couldn’t get one, the monitor gives them one.’What this combo of four actions does is establish a community expectation, a clear norm or standard for the community to follow. The norm shows everybody that the community expects them to wear the masks, that it takes masks seriously. That makes a big difference.The researchers call their recommended program NORM:No-Cost masksOffering InformationReinforcement in public places by intercepting non-mask wearersModelling and endorsement by trusted leadersHere's some useful mask info:<ol><li>All masks help, but 3-layer surgical masks and N95 masks offer greater protection.</li> <li>Double masking is good, especially with low-quality surgical or cloth masks.</li> <li>Masks should cover the mouth and nose. A tight fit on all four sides is good.</li> <li>If you touch the mask, you should wash your hands.</li> <li>Masks should be washed and replaced regularly.</li> <li>In general, you should wash your hands with soap several times a day.</li></ol>A historical reminder might be relevant here: when we think about the Covid-19 vaccine, we often recall the <a href="https://www.nepalitimes.com/opinion/how-nepal-eradicated-the-smallpox-virus/">big health breakthroughs of the past</a>, such as the discovery of the polio vaccine in the 1950s, and penicillin in the 1940s.But long before these headline-stealing medical heroes arrived to save the day, death rates had already dropped dramatically in Western Europe and North America. This health revolution came because of much less glamorous innovations: clean drinking water, efficient waste disposal, increased bathing, and expanded soap use.These basic sanitary measures saved millions and millions of lives. In Nepal in 2021, basic preventative measures such as physical<a href="https://www.nepalitimes.com/latest/nepal-covid-19-impact-worse-than-official-figures/">l distancing and careful mask wearing </a>can save lives as well.One other reminder: last year, after we were released from Lockdown I in July, Covid-19 <a href="https://www.nepalitimes.com/latest/nepal-its-no-time-to-let-your-guard-down/">infections spiked</a>. After Lockdown II was lifted in September, infections spiked again, reaching their highest level yet. The end of Lockdown III will <a href="https://www.nepalitimes.com/latest/learning-to-live-with-covid/">likely bring new risks.</a><a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/how-chitwan-was-opened,4159">Tom Robertson</a>, PhD, is researching the environmental history of the Kathmandu Valley.

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After lockdown, we will need masks more than ever

<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121140/636b91c69c7e80680e06f10djpeg.jpg" alt="" width="1500" height="1000"/>Nepal will open its 2021 lockdown long before the country <a href="https://www.nepalitimes.com/here-now/aid-pours-into-nepal-but-where-be-vaccines/">has enough vaccines</a> to protect its citizens -- our aunts, uncles, and neighbours. We will not have substantial vaccine coverage for many months, if not longer.We will <a href="https://www.nepalitimes.com/here-now/its-an-emergency/">need more oxygen,</a> more testing, and better tracking and isolation procedures. Crucially, we will also have to maintain and strengthen our only effective tools: physical distancing and masks.Unfortunately, too many Nepalis are wearing low-quality masks, taking them off too often, touching them, and not washing them or replacing them often enough. More people should be wearing three-layer surgical masks, which, for only a few more rupees, offer greater protective power.The key problem Nepal faces has not changed: infected people do not know they have the virus and spread it around. And new variants make the virus even more easily transmissible. We need to behave not as if only a small number of people could have the virus, but as if everyone we encounter already has it. That includes the friendly neighbourhood fruit seller. That includes family members. That includes you.“Vaccinations will take a long time to arrive in South Asia to create a wall of immunity. Till then, masks are most essential,” says <a href="https://www.nepalitimes.com/here-now/3-pronged-strategy-to-save-nepal-from-covid-19/">Mushfiq Mobarak</a>, a Yale university professor who recently led a huge study of<a href="https://docs.google.com/forms/d/e/1FAIpQLSfMJkyBBtK74lqSsHZnx_8qb0_sJ0WaR7A7XA8IQHAobrBEQA/viewform"> mask-wearing in Bangladesh.</a>Many Nepalis wear cloth masks or one-layer surgical masks. These help, no question. But the 3-layer surgical masks and N95s offer more filtration efficiency and more protection, although they cost just a few rupees more. That is an investment well worth it to protect individuals, institutions, and governments.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121140/636b91c99c7e80680e06f10ejpeg.jpg" alt="" width="2370" height="950"><figcaption> </figcaption></figure>I asked Biraj Vajracharya, an epidemiologist at Dhulikhel hospital, what kind of mask people should be buying and wearing. "Surgical mask, or if possible, N95 mask," he replied.The Yale researchers recommend high quality 3-layer masks because they filter more efficiently. They can be washed and reused without losing much efficiency. For more on the study's recommendations about masks, see this excellent <a href="https://www.youtube.com/watch?v=ifiR_5DuyfA">video</a>."We need to change mask-wearing norms amongst hundreds of millions of South Asians to mitigate the spread of COVID," Mushfiq Mobarak told me via email. "High-quality washable, reusable surgical masks are much more cost-effective, and offer a feasible path to scalability across the region."The <a href="https://www.business-standard.com/article/current-affairs/covid-19-crisis-india-draws-lessons-from-bangladesh-s-mask-study-121051401341_1.html">Yale study in Bangladesh</a>, involving over 300,000 people in 600 villages, identified simple policies that led to much greater mask wearing. They found that when <a href="https://docs.google.com/document/d/1EUhdri6CST9uzw_myffNmyUVPt8_UMsM75NOt5Q-54o/edit">authorities do four things together</a>, mask wearing more than tripled:<ol><li>Offer free masks</li> <li>Provide clear information about mask wearing in videos and brochures</li> <li>Find community leaders to speak in support of mask wearing</li> <li>Reinforce the message with gentle questioning for those not wearing</li></ol>The fourth policy was the most important: special monitors to verbally poke people who were not wearing masks. Those monitors, the Yale study explains, ‘walk around and if somebody is not wearing a mask, they intercept them and politely say, “We distributed masks here—why aren’t you wearing one?” If the person didn’t have a mask or couldn’t get one, the monitor gives them one.’What this combo of four actions does is establish a community expectation, a clear norm or standard for the community to follow. The norm shows everybody that the community expects them to wear the masks, that it takes masks seriously. That makes a big difference.The researchers call their recommended program NORM:No-Cost masksOffering InformationReinforcement in public places by intercepting non-mask wearersModelling and endorsement by trusted leadersHere's some useful mask info:<ol><li>All masks help, but 3-layer surgical masks and N95 masks offer greater protection.</li> <li>Double masking is good, especially with low-quality surgical or cloth masks.</li> <li>Masks should cover the mouth and nose. A tight fit on all four sides is good.</li> <li>If you touch the mask, you should wash your hands.</li> <li>Masks should be washed and replaced regularly.</li> <li>In general, you should wash your hands with soap several times a day.</li></ol>A historical reminder might be relevant here: when we think about the Covid-19 vaccine, we often recall the <a href="https://www.nepalitimes.com/opinion/how-nepal-eradicated-the-smallpox-virus/">big health breakthroughs of the past</a>, such as the discovery of the polio vaccine in the 1950s, and penicillin in the 1940s.But long before these headline-stealing medical heroes arrived to save the day, death rates had already dropped dramatically in Western Europe and North America. This health revolution came because of much less glamorous innovations: clean drinking water, efficient waste disposal, increased bathing, and expanded soap use.These basic sanitary measures saved millions and millions of lives. In Nepal in 2021, basic preventative measures such as physical<a href="https://www.nepalitimes.com/latest/nepal-covid-19-impact-worse-than-official-figures/">l distancing and careful mask wearing </a>can save lives as well.One other reminder: last year, after we were released from Lockdown I in July, Covid-19 <a href="https://www.nepalitimes.com/latest/nepal-its-no-time-to-let-your-guard-down/">infections spiked</a>. After Lockdown II was lifted in September, infections spiked again, reaching their highest level yet. The end of Lockdown III will <a href="https://www.nepalitimes.com/latest/learning-to-live-with-covid/">likely bring new risks.</a><a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/how-chitwan-was-opened,4159">Tom Robertson</a>, PhD, is researching the environmental history of the Kathmandu Valley.

<figure><img width="2038" height="1356" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131128/636ceedd9c7e80680e09ae54jpeg.jpg" alt=""/><figcaption>Universal mask wearing could save 2,211 lives in Nepal in the next three months, according to a new study. Photo: AMIT Machamasi</figcaption></figure>In its daily briefing on Saturday, the Ministry of Health announced that 4,311 people had tested positive for Covid-19, and 116 more people had died in 24 hours from the pandemic.Experts were encouraged by these figures, and took it as a sign that the<a href="https://www.nepalitimes.com/opinion/how-nepal-can-survive-2nd-covid-wave/"> second wave</a> had peaked. Indeed, the daily confirmed cases had dropped to half the level a week ago, and so had the positivity rate. Fatalities were also down from nearly 200 a day earlier this month.However, a new study shows that pandemic statistics the world over are fraught with inaccuracies, and the <a href="https://www.nepalitimes.com/editorial/the-covid-tsunami/">Nepal figures</a> are also a gross underestimation. The calculations show that new daily infections were probably closer to 120,000 on Saturday, and there were more than 700 deaths from Covid-19 nationwide—more than 30 times higher than official figures. The study by the Institute for Health Metrics and Evaluation (IHME) of the University of Washington School of Medicine in Seattle goes beyond official confirmed figures to calculate <a href="http://www.healthdata.org/special-analysis/estimation-excess-mortality-due-covid-19-and-scalars-reported-covid-19-deaths" data-saferedirecturl="https://www.google.com/url?q=http://www.healthdata.org/special-analysis/estimation-excess-mortality-due-covid-19-and-scalars-reported-covid-19-deaths&amp;source=gmail&amp;ust=1622442215950000&amp;usg=AFQjCNGW9ufUy8M70_z6NyotWDzInxyG1A">‘excess mortality’</a> and undetected Covid-19 infections.  ‘As terrible as the COVID-19 pandemic appears, this analysis shows that the actual toll is significantly worse,” said <a href="http://www.healthdata.org/covid/video/insights-ihmes-latest-covid-19-model-run" data-saferedirecturl="https://www.google.com/url?q=http://www.healthdata.org/covid/video/insights-ihmes-latest-covid-19-model-run&amp;source=gmail&amp;ust=1622442215950000&amp;usg=AFQjCNE9LwJOecLypPgPl4neBePOrEG0gw">IHME Director Chris Murray</a>, revealing the results of the analysis this month. ‘Understanding the true number of Covid-19 deaths not only helps us appreciate the magnitude of this global crisis, but also provides valuable information to policymakers developing response and recovery plans.’The official figures for Nepal are frightening enough. The country has the world’s second-highest bi-weekly increase in deaths at 291%, and the highest national test positivity rate of 40%. Yet, Nepal conducts only 713 tests per million people, contact tracing is virtually non-existent, less than 2% of the 30 million population is fully vaccinated, and <a href="https://www.nepalitimes.com/opinion/masks-and-vaccines-to-stop-nepals-2nd-wave/">mask-wearing</a> is at less than 65%. IHME’s graphs for Nepal show that during the early May peak when new confirmed cases were above 9,000 every day, the actual daily number was probably closer to 350,000. Nepal’s Ministry of Health’s total tally of fatalities is now 7,163, but the modelling shows that the actually total is 28,256. <figure><img width="2370" height="1010" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131128/636ceee09c7e80680e09ae55jpeg.jpg" alt=""><figcaption>Cumulative deaths in Nepal by 1 September under pre-Covid mobility scenario, scaled top vaccination drive by then, and if 95% of people wore masks while outdoors. Source of all graphs: IHME University of Washington / Nepal Ministry of Health and Population</figcaption></figure>Epidemiologists warn that if the official figures are so wrong, then the planning to meet the requirements for everything from test kits, hospital beds, ICU, <a href="https://www.nepalitimes.com/here-now/its-an-emergency/">oxygen requirement,</a> ventilators, and even funerary planning would need to be re-evaluated and up-scaled.“We have known that under-reporting is widespread. The figures are underestimates, but the impact cannot be underestimated,” says virologist Sher Bahadur Pun at Teku Hospital. “For example, although we are just beginning to see a <a href="https://www.nepalitimes.com/latest/covid-19-numbers-slightly-down-in-nepal/">plateauing</a> of the second wave, the increase in new cases is constant and the strain on the health system remains the same.”The IHME uses the <a href="http://www.healthdata.org/special-analysis/estimation-excess-mortality-due-covid-19-and-scalars-reported-covid-19-deaths" data-saferedirecturl="https://www.google.com/url?q=http://www.healthdata.org/special-analysis/estimation-excess-mortality-due-covid-19-and-scalars-reported-covid-19-deaths&amp;source=gmail&amp;ust=1622442215950000&amp;usg=AFQjCNGW9ufUy8M70_z6NyotWDzInxyG1A">‘excess mortality’ model</a> to calculate a more accurate figure for the infection and death rate from Covid-19 by using data for previous years, and factoring in new variables to calculate how many more people are actually dying during the pandemic compared to pre-pandemic years.There are many factors affecting mortality during the pandemic: deaths directly due to Covid-19, increase in mortality because patients with pre-existing conditions are not getting the hospital care they need, or deaths due to mental disorders. However, there is also a reduction during the pandemic of deaths caused by high air pollution, fatalities from other air-borne infections like tuberculosis, measles or influenza, and even a drop in highway-traffic accidents. So, IHME modellers collected available data on excess mortality from Covid-19,  added an estimate the additional deaths that were not registered to came up with the total deaths from coronavirus. The results are shocking. The actual global death toll from Covid-19 is more than double the 3.5 million official figure. In India, the government’s figure for total fatalities till Saturday stood at 325,998, but the projections show that the actual deaths probably at more than 1 million. Although the death rate is going down, IHME says India’s cumulative deaths from Covid-19 could be 1.2 million by 1 September. In Nepal, even official data shows a steep spike during the whole of May as Nepali workers started arriving from India with the fast-spreading B.1.617 variant. But on 1 May when the confirmed daily Covid-19 deaths was showing only 32, the model shows that 117 people were already dying every day nationwide from the disease. Within two weeks, even when the official total had soared to 205, the graphs show that the excess daily mortality was already 742. The reason for the discrepancy was that mostly hospital deaths were being counted, and the death registration system is inaccurate and late.  <figure><img width="2350" height="1014" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131128/636ceee39c7e80680e09ae56jpeg.jpg" alt=""><figcaption>Daily deaths is the best indicator of the progression of the pandemic. This graph shows the discrepancy between official figures and total Covid-19 daily fatalities factoring in 'excess mortality'. There is usually a 3-week lag between infection and death.</figcaption></figure>Epidemiologist Lhamo Yangchen Sherpa says the graphs just prove what everyone knew all along: testing is inadequate and even the distribution of testing facilitates is lop-sided. For example, 29 of 42 labs with RT PCR testing capacity in Bagmati Province are clustered within Kathmandu Valley. The whole of Gandaki province is reliant on three labs in Pokhara.She adds: “People in<a href="https://www.nepalitimes.com/latest/in-nepal-virus-climbs-from-plains-to-mountains/"> remote parts of Nepal like Solukhumbu</a> have to walk for days to give their swab sample, which is then sent to a lab in Biratnagar. By the time result is back, a week has passed by and many of them are already sick.” Most of the returnees from India were never tested, and went straight home without quarantine, becoming data blind spots and skewing transmission numbers beyond Nepal’s limited testing capacity. Even though the national case numbers have gone down, experts say it is raging across rural Nepal—but there is no way to quantify it because of the lack of testing.Epidemiologist Sherpa recommends rapid turnaround of antigen tests to reduce time lost waiting for PCR results in <a href="https://www.nepalitimes.com/latest/rural-nepal-fights-back-covid-19/">rural Nepal</a>. She says, “Patients show symptoms in five days but are contagious from the third day onwards. To avoid further spread in that crucial 48 hours, we must increase access to tests but also bring down the time it takes to get the result.”But targeted testing of symptomatic patients in remote districts like Rolpa and Humla have shown a staggering 90% positivity rate. Because of the lack of hospital care and the absence of medical oxygen, many die at home and the numbers never feed into the daily count announced in Kathmandu every evening.Virologist Pun at the Teku Hospital says effective contact tracing would provide the most accurate situation report, but that is not happening. He says, “The 70-80 daily new cases during the first wave were mostly asymptomatic travellers needing mandatory checks and their traced contacts. But in the more severe second wave, there is no contact tracing at all.”  <figure><img width="2350" height="952" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131128/636ceee69c7e80680e09ae57jpeg.jpg" alt=""><figcaption>Estimated infections in Nepal, showing the first and second waves, and the impact of mask-wearing.</figcaption></figure>Experts like Moshfiq Mobarak of Yale University say that the most effective strategy for countries with fragile health systems like Nepal to reduce fatalities is a three-pronged approach that aggressively promotes mask-wearing, responds to localised surges, as well as last-mile vaccine delivery.Mask-wearing alone has been proven in a trial in Bangladesh to show that a vigorous campaign for no-cost mask distribution, aggressive awareness drive, and punishment for non-wearers tripled the number of people using masks properly.‘This is an extremely cost-effective way to reduce transmission risk and save lives,’ Mobarak said in an op-<a href="https://www.nepalitimes.com/here-now/3-pronged-strategy-to-save-nepal-from-covid-19/">ed he co-wrote for Nepali Times last week. </a>Indeed, the IHME model also proves that direct impact of mask wearing in Nepal. The modelling shows that the total coronavirus death toll in Nepal by 1 September will be at 44,711 if mobility went up to pre-Covid levels. However, if 95% of Nepalis wore masks in public at all times, the number of deaths would be reduced to 42,500. This means 2,211 lives would be saved just by universal mask-wearing in the next three months.Even though Nepal’s second wave may be susbsiding, experts say the country will take longer to come out of it than neighbours India or Bangladesh despite the lockdown. This is because of the lack of vaccines, mask-wearing at less than 65%, as well as lack of mass testing. Nepal’s seven-day decrease in new caseloads post-peak is estimated to be around 7.45% compared to India's 12.8%.

Nepal Covid-19 impact worse than official figures

<figure><img width="2038" height="1356" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111152/636b86d59c7e80680e067877jpeg.jpg" alt=""/><figcaption>Universal mask wearing could save 2,211 lives in Nepal in the next three months, according to a new study. Photo: AMIT Machamasi</figcaption></figure>In its daily briefing on Saturday, the Ministry of Health announced that 4,311 people had tested positive for Covid-19, and 116 more people had died in 24 hours from the pandemic.Experts were encouraged by these figures, and took it as a sign that the<a href="https://www.nepalitimes.com/opinion/how-nepal-can-survive-2nd-covid-wave/"> second wave</a> had peaked. Indeed, the daily confirmed cases had dropped to half the level a week ago, and so had the positivity rate. Fatalities were also down from nearly 200 a day earlier this month.However, a new study shows that pandemic statistics the world over are fraught with inaccuracies, and the <a href="https://www.nepalitimes.com/editorial/the-covid-tsunami/">Nepal figures</a> are also a gross underestimation. The calculations show that new daily infections were probably closer to 120,000 on Saturday, and there were more than 700 deaths from Covid-19 nationwide—more than 30 times higher than official figures. The study by the Institute for Health Metrics and Evaluation (IHME) of the University of Washington School of Medicine in Seattle goes beyond official confirmed figures to calculate <a href="http://www.healthdata.org/special-analysis/estimation-excess-mortality-due-covid-19-and-scalars-reported-covid-19-deaths" data-saferedirecturl="https://www.google.com/url?q=http://www.healthdata.org/special-analysis/estimation-excess-mortality-due-covid-19-and-scalars-reported-covid-19-deaths&amp;source=gmail&amp;ust=1622442215950000&amp;usg=AFQjCNGW9ufUy8M70_z6NyotWDzInxyG1A">‘excess mortality’</a> and undetected Covid-19 infections.  ‘As terrible as the COVID-19 pandemic appears, this analysis shows that the actual toll is significantly worse,” said <a href="http://www.healthdata.org/covid/video/insights-ihmes-latest-covid-19-model-run" data-saferedirecturl="https://www.google.com/url?q=http://www.healthdata.org/covid/video/insights-ihmes-latest-covid-19-model-run&amp;source=gmail&amp;ust=1622442215950000&amp;usg=AFQjCNE9LwJOecLypPgPl4neBePOrEG0gw">IHME Director Chris Murray</a>, revealing the results of the analysis this month. ‘Understanding the true number of Covid-19 deaths not only helps us appreciate the magnitude of this global crisis, but also provides valuable information to policymakers developing response and recovery plans.’The official figures for Nepal are frightening enough. The country has the world’s second-highest bi-weekly increase in deaths at 291%, and the highest national test positivity rate of 40%. Yet, Nepal conducts only 713 tests per million people, contact tracing is virtually non-existent, less than 2% of the 30 million population is fully vaccinated, and <a href="https://www.nepalitimes.com/opinion/masks-and-vaccines-to-stop-nepals-2nd-wave/">mask-wearing</a> is at less than 65%. IHME’s graphs for Nepal show that during the early May peak when new confirmed cases were above 9,000 every day, the actual daily number was probably closer to 350,000. Nepal’s Ministry of Health’s total tally of fatalities is now 7,163, but the modelling shows that the actually total is 28,256. <figure><img width="2370" height="1010" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111152/636b86da9c7e80680e067878jpeg.jpg" alt=""><figcaption> </figcaption></figure>Epidemiologists warn that if the official figures are so wrong, then the planning to meet the requirements for everything from test kits, hospital beds, ICU, <a href="https://www.nepalitimes.com/here-now/its-an-emergency/">oxygen requirement,</a> ventilators, and even funerary planning would need to be re-evaluated and up-scaled.“We have known that under-reporting is widespread. The figures are underestimates, but the impact cannot be underestimated,” says virologist Sher Bahadur Pun at Teku Hospital. “For example, although we are just beginning to see a <a href="https://www.nepalitimes.com/latest/covid-19-numbers-slightly-down-in-nepal/">plateauing</a> of the second wave, the increase in new cases is constant and the strain on the health system remains the same.”The IHME uses the <a href="http://www.healthdata.org/special-analysis/estimation-excess-mortality-due-covid-19-and-scalars-reported-covid-19-deaths" data-saferedirecturl="https://www.google.com/url?q=http://www.healthdata.org/special-analysis/estimation-excess-mortality-due-covid-19-and-scalars-reported-covid-19-deaths&amp;source=gmail&amp;ust=1622442215950000&amp;usg=AFQjCNGW9ufUy8M70_z6NyotWDzInxyG1A">‘excess mortality’ model</a> to calculate a more accurate figure for the infection and death rate from Covid-19 by using data for previous years, and factoring in new variables to calculate how many more people are actually dying during the pandemic compared to pre-pandemic years.There are many factors affecting mortality during the pandemic: deaths directly due to Covid-19, increase in mortality because patients with pre-existing conditions are not getting the hospital care they need, or deaths due to mental disorders. However, there is also a reduction during the pandemic of deaths caused by high air pollution, fatalities from other air-borne infections like tuberculosis, measles or influenza, and even a drop in highway-traffic accidents. So, IHME modellers collected available data on excess mortality from Covid-19,  added an estimate the additional deaths that were not registered to came up with the total deaths from coronavirus. The results are shocking. The actual global death toll from Covid-19 is more than double the 3.5 million official figure. In India, the government’s figure for total fatalities till Saturday stood at 325,998, but the projections show that the actual deaths probably at more than 1 million. Although the death rate is going down, IHME says India’s cumulative deaths from Covid-19 could be 1.2 million by 1 September. In Nepal, even official data shows a steep spike during the whole of May as Nepali workers started arriving from India with the fast-spreading B.1.617 variant. But on 1 May when the confirmed daily Covid-19 deaths was showing only 32, the model shows that 117 people were already dying every day nationwide from the disease. Within two weeks, even when the official total had soared to 205, the graphs show that the excess daily mortality was already 742. The reason for the discrepancy was that mostly hospital deaths were being counted, and the death registration system is inaccurate and late.  <figure><img width="2350" height="1014" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111152/636b86dc9c7e80680e067879jpeg.jpg" alt=""><figcaption> </figcaption></figure>Epidemiologist Lhamo Yangchen Sherpa says the graphs just prove what everyone knew all along: testing is inadequate and even the distribution of testing facilitates is lop-sided. For example, 29 of 42 labs with RT PCR testing capacity in Bagmati Province are clustered within Kathmandu Valley. The whole of Gandaki province is reliant on three labs in Pokhara.She adds: “People in<a href="https://www.nepalitimes.com/latest/in-nepal-virus-climbs-from-plains-to-mountains/"> remote parts of Nepal like Solukhumbu</a> have to walk for days to give their swab sample, which is then sent to a lab in Biratnagar. By the time result is back, a week has passed by and many of them are already sick.” Most of the returnees from India were never tested, and went straight home without quarantine, becoming data blind spots and skewing transmission numbers beyond Nepal’s limited testing capacity. Even though the national case numbers have gone down, experts say it is raging across rural Nepal—but there is no way to quantify it because of the lack of testing.Epidemiologist Sherpa recommends rapid turnaround of antigen tests to reduce time lost waiting for PCR results in <a href="https://www.nepalitimes.com/latest/rural-nepal-fights-back-covid-19/">rural Nepal</a>. She says, “Patients show symptoms in five days but are contagious from the third day onwards. To avoid further spread in that crucial 48 hours, we must increase access to tests but also bring down the time it takes to get the result.”But targeted testing of symptomatic patients in remote districts like Rolpa and Humla have shown a staggering 90% positivity rate. Because of the lack of hospital care and the absence of medical oxygen, many die at home and the numbers never feed into the daily count announced in Kathmandu every evening.Virologist Pun at the Teku Hospital says effective contact tracing would provide the most accurate situation report, but that is not happening. He says, “The 70-80 daily new cases during the first wave were mostly asymptomatic travellers needing mandatory checks and their traced contacts. But in the more severe second wave, there is no contact tracing at all.”  <figure><img width="2350" height="952" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111152/636b86df9c7e80680e06787ajpeg.jpg" alt=""><figcaption> </figcaption></figure>Experts like Moshfiq Mobarak of Yale University say that the most effective strategy for countries with fragile health systems like Nepal to reduce fatalities is a three-pronged approach that aggressively promotes mask-wearing, responds to localised surges, as well as last-mile vaccine delivery.Mask-wearing alone has been proven in a trial in Bangladesh to show that a vigorous campaign for no-cost mask distribution, aggressive awareness drive, and punishment for non-wearers tripled the number of people using masks properly.‘This is an extremely cost-effective way to reduce transmission risk and save lives,’ Mobarak said in an op-<a href="https://www.nepalitimes.com/here-now/3-pronged-strategy-to-save-nepal-from-covid-19/">ed he co-wrote for Nepali Times last week. </a>Indeed, the IHME model also proves that direct impact of mask wearing in Nepal. The modelling shows that the total coronavirus death toll in Nepal by 1 September will be at 44,711 if mobility went up to pre-Covid levels. However, if 95% of Nepalis wore masks in public at all times, the number of deaths would be reduced to 42,500. This means 2,211 lives would be saved just by universal mask-wearing in the next three months.Even though Nepal’s second wave may be susbsiding, experts say the country will take longer to come out of it than neighbours India or Bangladesh despite the lockdown. This is because of the lack of vaccines, mask-wearing at less than 65%, as well as lack of mass testing. Nepal’s seven-day decrease in new caseloads post-peak is estimated to be around 7.45% compared to India's 12.8%.

<figure><img width="933" height="622" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85d19c7e80680e067815jpeg.jpg" alt=""/><figcaption>Photo: AMIT MACHAMASI</figcaption></figure>The deadly COVID-19 surge that has engulfed neighbouring India appears to be spilling over into Nepal. <a href="https://covid19.healthdata.org/nepal?view=daily-deaths&amp;tab=trend" data-saferedirecturl="https://www.google.com/url?q=https://covid19.healthdata.org/nepal?view%3Ddaily-deaths%26tab%3Dtrend&amp;source=gmail&amp;ust=1621659959142000&amp;usg=AFQjCNGfuMEKH4nbyw3hcxqFK7i15jQZ4w">Daily deaths have been exploding</a>. The experience from India shows that fragile health systems can get overwhelmed quickly leading to needless suffering: <a href="https://www.nytimes.com/2021/04/23/world/asia/india-covid-oxygen-hospitals.html" data-saferedirecturl="https://www.google.com/url?q=https://www.nytimes.com/2021/04/23/world/asia/india-covid-oxygen-hospitals.html&amp;source=gmail&amp;ust=1621659959142000&amp;usg=AFQjCNENS9eia0jqVilkrcyyhhNE-jxYyw">citizens’ pleas for oxygen</a>, lack of ICU beds and medicines. Tackling this threat requires Nepal to adopt a three-pronged approach immediately: <ol><li>Promote consistent mask-wearing to contain the spread of disease, especially in rural areas where the healthcare infrastructure is even more deficient.</li><li>Prepare a healthcare response in the event of localised surges</li><li>Prepare for quick last-mile vaccination delivery, in anticipation of vaccine arrival. </li></ol>There are rigorous evidence-based strategies to implement such a response, as Nepal’s other South Asian neighbours are doing.  On mask-wearing, researchers at Yale University and Stanford University, together with the non-profits Innovations for Poverty Action and GreenVoice ran a large-scale (350,000 adults) randomised controlled trial to identify <a href="http://tinyurl.com/maskpromotion" data-saferedirecturl="https://www.google.com/url?q=http://tinyurl.com/maskpromotion&amp;source=gmail&amp;ust=1621659959142000&amp;usg=AFQjCNE53xG48uOd3u-buWDHQbA4AgkJ1Q">a precise combination of strategies</a> that are successful in changing <a href="http://tinyurl.com/maskpromotion" data-saferedirecturl="https://www.google.com/url?q=http://tinyurl.com/maskpromotion&amp;source=gmail&amp;ust=1621659959142000&amp;usg=AFQjCNE53xG48uOd3u-buWDHQbA4AgkJ1Q">mask-wearing norms</a>. Randomised controlled trials are the same techniques used to test vaccine efficacy. When the strategies were jointly implemented, they tripled mask-wearing in rural Bangladesh, and this effect was persistent over 10 weeks of observation, including after the intervention activities ended. These four strategies form the NORM model: No-Cost masks distributed at scaleOffering Information on mask-wearingReinforcement in public places by intercepting non-mask wearersModelling and endorsement by trusted leaders   <img width="1540" height="918" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85d49c7e80680e067816jpeg.jpg" alt="">The researchers tested a dozen other strategies like verbal commitments, text message reminders, social signaling, involving the village police in reinforcement, and even village-level monetary rewards, but none of these were successful in increasing mask-wearing rates any further. The basic NORM model without these unnecessary add-ons is an extremely cost-effective way to reduce transmission risk and save lives. Why do these strategies work?  Door-to-door distribution with messaging makes it public knowledge that everyone in the community was given a mask, and neighbors are aware of the public health threat of not wearing one. Public, in-person reinforcement creates some social shame from being confronted by a stranger and creates incentives for people to carry the mask to avoid the awkward confrontation. The endorsement from community leaders makes the program personal and credible. The Stanford engineers on the research team produced high-quality reusable, washable masks that can be procured very quickly and cheaply in South Asia. The research team also provides <a href="https://docs.google.com/document/u/0/d/1EUhdri6CST9uzw_myffNmyUVPt8_UMsM75NOt5Q-54o/edit" data-saferedirecturl="https://www.google.com/url?q=https://docs.google.com/document/u/0/d/1EUhdri6CST9uzw_myffNmyUVPt8_UMsM75NOt5Q-54o/edit&amp;source=gmail&amp;ust=1621659959142000&amp;usg=AFQjCNHmPxf6BzdhtcBRIRgO3QCt-_dj8g">detailed implementation protocols</a> for all project activities, to make each step <a href="http://tinyurl.com/maskprotocol" data-saferedirecturl="https://www.google.com/url?q=http://tinyurl.com/maskprotocol&amp;source=gmail&amp;ust=1621659959142000&amp;usg=AFQjCNFdN78xGI1kCVezL4844eoi9DjiIA">easily and quickly implementable</a> for governments.    The results of this study  were so compelling that state governments and groups in India, Pakistan and Bangladesh have quickly moved to implement the NORM model, and it has drawn headlines such as ‘<a href="https://www.business-standard.com/article/current-affairs/covid-19-crisis-india-draws-lessons-from-bangladesh-s-mask-study-121051401341_1.html" data-saferedirecturl="https://www.google.com/url?q=https://www.business-standard.com/article/current-affairs/covid-19-crisis-india-draws-lessons-from-bangladesh-s-mask-study-121051401341_1.html&amp;source=gmail&amp;ust=1621659959142000&amp;usg=AFQjCNFF_oND2c2C6cn24lnj8UqJQK1crQ">India draws lessons from Bangladesh’s mask study</a>’, in a leading newspaper in India. In India, SEWA (Self-Employed Women’s Association) is distributing 3-5 million masks and has implemented the model for 1 million people in Gujarat. The Mayor of Dhaka North quickly mobilised a consortium of partners within 48 hours to implement in crowded shopping malls and at transit hubs before the Eid travel rush.   <img width="640" height="634" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85d79c7e80680e067817jpeg.jpg" alt="">The commissioner of Lahore and the health minister of Khyber-Pakhtunkhwa Province in Pakistan have mobilised staff and resources to implement after Ramadan. BRAC, the world’s largest non-governmental organisation, is poised to reach 77 million people in Bangladesh with the NORM masking interventions, along with associated healthcare responses and vaccine preparation strategies. This model of community-level mask distribution, promotion, and reinforcement can serve as the anchor to cost-effectively deliver the other necessary components of an effective COVID response strategy: empowering community health workers to provide more accurate treatment options to those who fall ill, and undertaking the activities required to overcome vaccine hesitancy and facilitate vaccine registration.  In both India and Bangladesh, SEWA and BRAC are taking advantage of the economies of scale in mask delivery to also set up Covid care centres to take pressure off hospitals. Distinguishing effective from inaccurate treatment strategies requires medical expertise and clinical experience. We have partnered with the <a href="https://science.swasth.app/" data-saferedirecturl="https://www.google.com/url?q=https://science.swasth.app/&amp;source=gmail&amp;ust=1621659959142000&amp;usg=AFQjCNH_Trj1oFBrdZZoMibJpLTZTEhGVA">Swasth </a><a href="https://science.swasth.app/" data-saferedirecturl="https://www.google.com/url?q=https://science.swasth.app/&amp;source=gmail&amp;ust=1621659959142000&amp;usg=AFQjCNH_Trj1oFBrdZZoMibJpLTZTEhGVA">Alliance</a> convened by a professor at Harvard Medical School to create training manuals on effective Covid treatment plans for community health workers. We have also collected large-sample data to <a href="https://www.medrxiv.org/content/10.1101/2021.03.11.21253419v1" data-saferedirecturl="https://www.google.com/url?q=https://www.medrxiv.org/content/10.1101/2021.03.11.21253419v1&amp;source=gmail&amp;ust=1621659959142000&amp;usg=AFQjCNF7p-2nFnzjsaUPM_uK7qO3Db08rg">systematically understand the nature of vaccine hesitancy</a> in Nepal, and other low and middle-income countries, to inform the design of vaccine campaigns.   Quick implementation of the NORM model in Nepal is feasible with decisive leadership and political will, as other South Asian neighbours are doing. Our international research team stands ready to provide any necessary technical support to adapt the model, share all implementation protocols, and monitor results to aid further tinkering and any necessary course-correction, as we have done for our other partners in India, Pakistan, and Bangladesh. The team is not looking for any monetary or research rewards. The evidence is convincing that this is a cost-effective way to stem Covid transmission and save lives, and we would therefore like to facilitate implementation by the Nepali government or other local non-government actors.    Mushfiq Mobarak is Professor of Economics, Yale University, and Neela Saldanha has a PhD in marketing from the Wharton School of the University of Pennsylvania and an MBA from the Indian Institute of Management, Calcutta. To support:<a target="_blank" href="https://docs.google.com/forms/d/e/1FAIpQLSfMJkyBBtK74lqSsHZnx_8qb0_sJ0WaR7A7XA8IQHAobrBEQA/viewform" style="letter-spacing: normal; margin: 0px; padding: 0px; border: 0px; outline: 0px; font-size: 14px; font-family: Arial, Helvetica, sans-serif; vertical-align: baseline;" rel="noopener noreferrer">https://docs.google.com/forms/d/e/1FAIpQLSfMJkyBBtK74lqSsHZnx_8qb0_sJ0WaR7A7XA8IQHAobrBEQA/viewform</a> <table style="letter-spacing: normal; margin-bottom: 0px; padding: 0px; border-top-width: 0px; border-left-width: 0px; outline: 0px; font-size: 14px; font-family: Arial, Helvetica, sans-serif; vertical-align: baseline;"><tbody style="margin: 0px; padding: 0px; border: 0px; outline: 0px; font-style: inherit; font-size: 1em; font-family: inherit; vertical-align: baseline;"><tr style="margin: 0px; padding: 0px; border: 0px; outline: 0px; font-style: inherit; font-size: 1em; font-family: inherit; vertical-align: baseline;"><td style="margin: 0px; padding: 0px; border-right-width: 0px; border-bottom-width: 0px; outline: 0px; font-style: inherit; font-size: 1em; font-family: inherit; vertical-align: baseline;"> </td> </tr></tbody></table><img width="84" height="109" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85da9c7e80680e067818jpeg.jpg" alt=""><img width="82" height="109" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85db9c7e80680e067819jpeg.jpg" alt="">

3-pronged strategy to save Nepal from Covid-19

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111136/636b836a9c7e80680e067734jpeg.jpg" alt="" width="1050" height="1400"/><figcaption></figcaption></figure><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111136/636b836d9c7e80680e067735jpeg.jpg" alt="" width="1125" height="1500"><figcaption> </figcaption></figure>Nani pulls the elastic band tucked behind her ear and tugs off the mask from her face. It is pink. The mask. It is modelled after a surgical mask—the same flexile lining on one end with a bunch of pleats gathering at the centre, allowing the material to unfold over the face.But it isn’t a surgical mask. It is a copy. Nani squats by the public tap, reaches for the small piece of abandoned soap. The soap has degenerated from constantly lying by the tap and from being repeatedly grabbed by several pairs of hands. Now, Nani holds it too.The soap suds as she rubs it on her mask. The froth leaves a creamy feel on Nani’s palms, otherwise dry from all the washing and cleaning she does, day in and day out. Nani rinses the mask in running water, wrings it and then hangs it next to her kurta on the clothesline.This a daily ritual after she returns home from work. She washes the mask, first thing and leaves it to dry—it has to see her through another day.Read also: <a href="https://www.nepalitimes.com/opinion/how-nepal-can-survive-2nd-covid-wave/" target="_blank" rel="noopener noreferrer">How Nepal can survive 2nd wave</a>, Buddha BasnyatRita Didi, whose house Nani visits every day to clean and wash, had told her: “Nani, here is the money for you to buy masks. Buy a box of surgical masks from the pharmacist’s. Wear a new one every day when you come to work.”“Surgical,” Rita Didi had repeated and had placed a five hundred rupee note in her palm. And as Nani closed her fist to hold the money in, in her mind she immediately saw note books and pencils and a new water bottle that little Reshma had been asking for. So, on her way back home, Nani stopped at the local store.She spent two hundred rupees on a water bottle that had the image of a mouse with massive black ears, looking happy in a red frock with white dots. She spent another two hundred on a note book, pencils and a bunch of coloured chart papers.That was when she had spotted the pink mask, staring at her from a bunch of green, grey, blue masks stacked against a pail of daal. So, fifteen rupees was spent on a pink mask and the change, she thrust into her bag.Nani had finally acquired a mask! She unfurled the pleats of the mask like she were opening an umbrella before an impending storm and pressed it against her face, sliding the elastic bands behind her ears. She had felt safe.A week since, the little pink thing hung on the clothesline, frayed from daily washing. Thin sprays of material like the remnants of a broken spider’s web formed a bush over the front of the mask—the part that chaffed her nose.Tomorrow, Rita Didi would once again ask her why she wasn’t <a href="https://www.nepalitimes.com/opinion/masks-and-vaccines-to-stop-nepals-2nd-wave/" target="_blank" rel="noopener noreferrer">wearing a surgical mask</a>. Again, Nani would tell her that she had not spotted an open pharmacy yet. And Rita Didi would go into a rant about safety, all of it shouted through her white mask that looked like the snout of some animal.Rita Didi would say, “I’m only asking you to come to work because I know you need a salary. I’m trying to help you through this difficult time.” And Nani would nod and begin to do the math in her head, breaking her salary of seven thousand rupees into house rent, a bag of rice, Reshma’s school fees, a new pair of chappals, medicines for Ama, and an umbrella and, and……S walks up to an elderly man who’s pushing a bicycle, loaded down with big baskets carrying fruits.“Dai,” she interrupts him, as he turns around and smiles at her. “Tapai le mask kina nalagauna bhako?” Why aren’t you wearing a mask?The man laughs and pulls out a blue, crushed surgical mask from his front pocket and spreads it over his face. He explains that he had been sucking on some tobacco a while ago and had removed the mask so he could spit and that he had forgotten to wear it back on.S requests him to keep it on at all times and he laughs and say Huss, Huss.“See?” S turns to me. “We keep berating people for not <a href="https://www.nepalitimes.com/opinion/prevention-while-searching-for-a-cure/" target="_blank" rel="noopener noreferrer">wearing masks</a>, but we aren’t thinking of why they aren’t wearing them.” And as though to prove her point, a man walks past us, briefly stopping to spit a streak of paan into the gutter. His mask is dangling by his ear.“We need to think of individual needs, cultures and all kinds of things when talking about masks. It’s no use blaming people without trying to understand why. We need to set up mask banks across the country, so that people have access to masks!” S says excitedly.Past the narrow alleyway, we enter a store that sells branded clothing. There are sets of <a href="https://www.nepalitimes.com/banner/masks-unmasked/" target="_blank" rel="noopener noreferrer">colourful cloth masks</a> arranged in rows on the shelf. The masks have double layers—made from soft cotton that comes with the promise of not leaving marks on the ridge of your nose. They come with the promise of sitting snugly against your face. They come with the promise of colours that match your outfit.“I switched to cloth masks because I don’t want to be throwing surgical masks out everyday and add to the waste,” explains A. “Do they work?” we ask the guy at the counter. “Yes, yes,” he averts our eyes, quickly shoves the masks into tony pouches and pushes them at us across the counter.Suburban Tales is a monthly column in Nepali Times based on real people (with some names changed) in the author’s life.Photos: PRATIBHA TULADHAR

Pratibha Tuladhar

The economics of masks

One smoggy winter morning in February 2019, Ekta regretted coming to her sculpture class. It was the first day of her period, and the 19-year-old wished she was home, curled up in bed with a hot water bag to soothe her cramps.
Her class was at Kalapremi Ceramic Studio, a dark room on the ground floor of a house in Maharajganj, and Ekta’s teacher was the artist Gopal Das Shrestha ‘Kalapremi’, a noted sculptor.
Two other students were already there, using all their muscle strength to knead the sculpting clay. Ekta, now 24, recalls how Kalapremi asked her if she was feeling all right. She avoided him, as she did not want everyone to know she was menstruating.
Kalapremi repeatedly asked Ekta what was wrong. She finally muttered that she was having her period, after which he grabbed her hand and led her to a partitioned corner of the studio and sat her on a chair. Before she could stop him, he slid his hand under her dress, and started massaging her abdomen.
“I was horrified,” Ekta recalls. “I told him to stop, but he didn’t listen, asking me not to be shy, saying he knew how to relieve my pain. He stopped only after I protested furiously.”&nbsp;
The art tutor then said, “You’re like my daughter. I’m doing it out of love to make you feel better, but you’re so stubborn.”&nbsp;
“Instead of saying sorry he acted like I was the one having crazy thoughts,” remembers Ekta, adding that from April 2016 to August 2020 beginning the time she was 16, the artist sexually abused and harassed her on several occasions. &nbsp;
Now, Ekta and the artist’s other former students are finally sharing their experiences and some are pressing legal charges against him, hoping that others do not have to endure what they did.&nbsp;
Award-winning artist and teacher Gopal Das Shrestha ‘Kalapremi’ (the name means ‘Art Lover’) is known for his ceramic art, sculpture, and contemporary pottery. He was <a href="https://nepalitimes.com/review/the-house-of-kalapremi">profiled in Nepali Times after a collaborative exhibition</a>, ‘Where the Wild Things Are’ at the Siddhartha Art Gallery three years ago.&nbsp;
His pieces, titled Gaalis, featured sculpted female figures with the heads of dogs, sheep, and donkeys (pictured) to depict derogatory terms for women. Some critics said the collection was a satire on feminists.
Kalapremi started his artistic and teaching career in 1983 and over the years taught at Bhanubhakta School, Kathmandu University School of Arts, Lalitkala Campus and at his private Kalapremi Ceramic Studio. He has also lectured at Jeonju University in South Korea and recently at Tabor Academy in the United States.
Seven of Kalapremi’s former students were interviewed for this story. Five female students said he touched them inappropriately in his studio or at Kathmandu University. Two male students said they witnessed him abuse and harass the women. In all cases, the students struggled to recognise the abuse when it occurred, and the lack of reporting systems left them to cope on their own for years.&nbsp;
Earlier this year, students shared a social media post hinting at Kalapremi’s history of abusive behaviour following which more students of the artist reached out sharing similar experiences. Some students spoke of abuse that happened as long as 20 years ago.
Kalapremi, 60, has denied the allegations. He told Nepali Times: “Some years ago, there was a movement encouraging people to hug and kiss. I used to do it purely out of friendship and love. But after seeing posts on social media last year calling out my behaviour, I realised my actions may have hurt some people. I understand now that I should have been more mindful.”
He added: “I am also an auxiliary health worker, so I know the exact points to massage to relieve menstrual pain. It’s not just menstruation, I take anyone who is ill to the hospital.”
Sexual abuse is much more rampant than reported given how difficult it is to prove it in court. The law defines sexual abuse as occuring when someone touches another’s private parts, coerces them into touching theirs, uses vulgar language, shows degrading images, or behaves indecently towards them without consent.&nbsp;
Ekta and her fellow students are consulting lawyer Suneeta Regmi Pokhrel, who says they know that even if the court decides in their favour, it is difficult to survive after speaking up, and influential men defend themselves saying they are being framed.&nbsp;
“They are in a lot of pain and weep when recalling how he abused them,” Regmi Pokhrel told us. “They are angry and have filed a case against him, but they are also terrified. They know he is a powerful man and they have seen how our society treats women who speak up against abusers. Unless people speak up, perpetrators will be emboldened.”
Art and academia in Nepal simply reflect the power imbalances in society where people with intersecting identities experience worse forms of abuse. Theatre actors Raj Kumar Pudasaini, Rajan Khatiwada, and Sunil Pokhrel were called out during the #MeToo movement in the Nepali theatre scene in 2019. Even after the allegations Pokhrel went on to receive national awards, while others continued to work without repercussions.
“If you speak up against abusers, you gradually get sidelined from projects,” explained a theatre artist who wished anonymity fearing professional setbacks. “The theatre scene in Nepal is quite small, you just have to make peace with the perpetrators and work with them if you want to sustain yourself.”&nbsp;
In academia there is a history of faculty members sexually harassing students and getting away with it. After Tribhuvan University (TU) lecturer Krishna Bhattachan was accused of harassing women students, the university said it would follow Nepal’s sexual harassment law and set up a reporting mechanism. But nothing happened to the professor, who had already retired. Instead, he counter-accused the students of 'attacking the indigenous people’s movement with baseless allegations' as <a href="https://kathmandupost.com/letters/2019/01/29/bhattachan-responds">he told the Kathmandu Post in 2019</a>. He continues to be featured as a prominent speaker including at TU.
Other faculty members previously accused of sexual harassment include Jagadish Murti Koirala from TU, Bishnu Prasad Acharya from Ratna Rajya Campus, and Bodha Raj Tripathee from Lalitpur Madhyamik Vidhyalaya. A woman staff member from TU also filed a sexual abuse complaint against Dambar Chemjong from TU.
Prominent figures like <a href="https://nepalitimes.com/news/the-rise-and-fall-of-nims-purja">mountaineer Nims Purja</a> have been <a href="https://www.nytimes.com/2024/05/31/sports/mountaineering-sexual-harassment-abuse-nims-purja.html">accused of sexual assault</a>, and cricketer Sandeep Lamichhane, actor <a href="https://nepalitimes.com/news/celebrity-rape-case-spotlights-nepal-laws">Paul Shah</a>, and former speaker of Parliament <a href="https://nepalitimes.com/news/mahara-arrested">Krishna Bahadur Mahara</a> have been accused of rape, but society-at-large has let off the alleged perpetrators amdist a larger debate about justice for survivors and punishment of perpetrators.&nbsp;
‘Gaushala-26’ is the court name given to the 18-year-old who accused Sandeep Lamichhane, former captain of Nepal’s national cricket team and skipper of Biratnagar Kings in the <a href="https://nepalitimes.com/here-now/here-comes-the-nepal-premier-league">ongoing Nepal Premier League</a>, of rape. She left the country citing society questioning her character affecting her mental health while Lamichhane got an outpouring of support. In May, the Patan High Court overturned a prior verdict that found Lamichhane guilty of rape and had sentenced him to eight years in prison. During the 23-month legal battle to pursue justice, Gaushala-26 faced threats of gang rape and acid attacks.&nbsp;
Exhausted by the struggle, Gaushala-26 sought to “move to a new world” where she could live free without hiding her identity.
Actress Samragyee Rajya Laxmi Shah in an Instagram video now deleted detailed the harassment she faced from a filmmaker during a movie shoot. She did not name any name but veteran actor Bhuwan KC filed a defamation case against Rana, but the court ruled that the charge lacked sufficient evidence.&nbsp;
Former Kathmandu mayor <a href="https://nepalitimes.com/opinion/theytoo">Keshav Sthapit also mocked the #MeToo movement</a>, calling accusations against him by journalists Rashmila Prajapati and Ujjwala Maharjan “a rape of men’s rights”.
Serial Abuse
Back at the Kalapremi Ceramics studio, another former student, 24-year-old Rajiv, says he felt the need to speak out after seeing his female classmates being abused.&nbsp;
“He frequently kissed them on their cheeks,” he told Nepali Times. “Whenever they walked into the studio he flailed his arms like a child asking for a hug. They awkwardly hugged him from the side, but he pulled them closer, held their chin, and kissed their cheeks.”&nbsp;
Rajiv says he also saw Kalapremi pull the women’s bra straps, touch their breasts, and slap their buttocks. The young students would freeze, not knowing how to react, and if they protested, he would say it was “normal in art”. Rajiv, 19 at the time like his classmates, remembers thinking perhaps the well-respected artist was right after all.
Another student, Luna, who took lessons at Kalapremi’s studio from 2020 to 2022 did try to confront the tutor after he made an obscene proposal to her. She recalls: “One day when the other students had left the studio and it was just the two of us, he told me that God had given him special artistic talent and he could transfer those powers to me. But to do that both of us will have to be naked, inside a dark room, and have sex.”
Luna, who was 18 then, was livid and told him she did not want any of his powers, but she says he laughed at her as if he was joking. She did not tell her family about the incident because she thought no one would believe her.&nbsp;
“They were all in awe of this famous artist and felt I should be grateful that to be learning sculpting from him,” she says. “I was scared to be alone with him in case he talked about sex again. My coping mechanism was to be rude so he wouldn’t try to come close to me.”
Seeing how some classmates were standing up to Kalapremi, Ekta too tried to push back against his advances, but she said he found ways to coerce her. Since Ekta, Rajiv, and Luna could not afford Kalapremi’s Rs30,000 monthly fee for lessons, he had offered them all a stipend to assist him in the studio.
“He had spondylosis and took me to his therapy sessions to learn massage techniques, then he often made me and other students massage him,” says Ekta. Whenever she refused, he would feign pain to make her feel sorry for him. “He would insist that I put my hands under his shirt so that I could massage him better,” she adds.
The art tutor often tried to “seduce sympathy” from Ekta by sharing how he had never been loved as a child and was “sexually frustrated” as an adult.&nbsp;
“At 7PM, he would pour himself Signature whiskey and immediately go off again about how he was sex-starved. I didn’t know how to respond. It took me time to realise alcohol was just an excuse to talk about sex,” Ekta says.
If convicted, Kalapremi could face financial penalty and/or a prison sentence of up to three years according to Section 224 of National Penal (Code) Act 2017.&nbsp;
Data suggests that victims of child sexual abuse on average take nearly 24 years to tell someone about their trauma, and some may never disclose it at all.&nbsp;
“In our culture, children are rarely taught about boundaries. They often react, show anger when adults pinch their cheeks. But adults insist they did it out of love, and force the children to accept it,” says Sita Lama, a psychotherapist at Manka Kura. “And even when someone touches them inappropriately they struggle to identify and verbalise it.”
When perpetrators claim to be “acting out of love”, Lama says survivors are likely to perceive it as something safe, rather than recognising it as abuse.&nbsp;
“It may take years for them to realise they were abused,” she explains. "And even when they become aware, the power imbalance with the abuser and the associated shame often prevents survivors from speaking up."
Other former students from the School of Art at Kathmandu University have also come forward years later, saying Kalapremi sexually abused them. As young adults, they felt his behaviour was off but were uncertain if it was inappropriate, illegal, or they did not know how to respond. After having understood that it was indeed abuse, they say they are speaking out now to protect others.&nbsp;
Amina Singh, a visiting faculty member at Kathmandu University, says there is no clause against sexual abuse in contracts of teachers, and there is no formal grievance handling mechanism for the students.&nbsp;
“So the only way students can to deal with sexual abuse is approach someone they trust,” she says.
Eight other former art students of Lalit Kala Campus and Srijana College of Fine Arts of Tribhuvan University and other private art studios in Kathmandu say they were also sexually abused by their art teachers. Three faculty members interviewed from these institutions said they saw the abuse, but felt it was futile to report it given how powerful the teachers were.
In the absence of a formal system, some longtime women artists warned each other about “problematic” artists. They shared &nbsp;a “heads-up” to be more cautious when collaborating with them, and avoided responding to their calls and texts after work hours.
To ensure art institutions are safe for all, galleries, museums, artist studios, and smaller art spaces need to develop policies on sexual harassment. This would include a code of conduct or studio policies that hold the leadership accountable and outline the principles of professional ethics.&nbsp;
Students and employees should inquire about accountability mechanisms for raising concerns, both formally and informally, advocates say.
Three years after Ekta left the ceramics studio, she learnt that Kalapremi had harassed many other women. Still trying to get a footing in the art industry, she attended a workshop in Kathmandu where women artists discussed ways to stay safe in the art sector.&nbsp;
Since it was a close-knit group Ekta opened up about how she felt violated and realised she was not alone, he had been abusing underprivileged students for years, and this was common knowledge among artists in Nepal.
Ekta says that even after she quit, Kalapremi continued sending her text messages like ‘I am thinking of you’, ‘Why have you stopped speaking with me’, or ‘I am waiting for your call’.&nbsp;
But what really forced her to act was when Ekta found out that he was sending similar texts to her younger sister.&nbsp;
“I’ve had enough,” she told us. “He abused me all these years but I won’t let him abuse my sister.” &nbsp;
Ekta, Rajiv and Luna are not the real names of the students.&nbsp;

‘Art Lover’ accused of sexual abuse

It was 8:15 in the evening of 25 March 1968 when everyone in the village of Batulechaur near Pokhara heard a deafening sound like thunder as a bright flashing object hurtled down to land in a field.&nbsp; That field belonged to Kul Timilsina, and the next morning he retrieved a sheet of metal about 2m by 1m and carried it home with the help of a few others, thinking it would be useful for his buffalo shed.&nbsp; Before he died at age 83 three years ago, Timilsina had told photo archivist Sunil Ulak that the black metal sheet was not rectangular and had rounded corners. There are a few witnesses still alive who have a clear recollection of the object that fell from the sky that night.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2024120707128_75cc85aac56b9cc4a77366471f058d7b3eb6868776811b0923845c2d0a61f014.jpg" data-media-id="editor_0" data-image-id="2024120707128_75cc85aac56b9cc4a77366471f058d7b3eb6868776811b0923845c2d0a61f014" data-rendition-name="original" width="1170" height="601" loading="lazy" alt="UFO over Pokhara"> <figcaption>The field in Batulechaur belonging to Kul Timilsina where fragments of a flying object fell from the sky in 1968.</figcaption> </figure>  One of them is Timilsina’s wife Gyanu, who was 22 at the time. She had been at home, and remembers hearing the big bang and the sky becoming very bright. “We saw the thing in the field in the morning,” she told us. “It looked like a lid, a covering of some sort. The way it was stuck in the ground, it must have fallen from the sky. We thought we could use it to dry clothes on, and took it home.”&nbsp; Another witness is Kul Narayan Paudel. “I was only eight then. We ran to the field to see what had fallen. It was a four-sided metal sheet. The elders took it away, and I don't know what happened to it.” &nbsp; Ram Bahadur Baniya, a teacher at the local school, says he had heard the sheet had been brought to the school, and later handed over to the Zonal Commissioner at the time, Nanda Prasad Malla. “But that is all hearsay,” he says.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2024120707128_0bf207a12063fb8155b3c8d9a00a94887b126380c9e0627527c84cf5e1101f54.jpg" data-media-id="editor_1" data-image-id="2024120707128_0bf207a12063fb8155b3c8d9a00a94887b126380c9e0627527c84cf5e1101f54" data-rendition-name="original" width="1170" height="610" loading="lazy" alt="UFO over Pokhara"> <figcaption>Gyanu Timilsina, wife of Kul Timilsina.</figcaption> </figure>  There are two versions of what happened to Kul Timilsina’s metal sheet. One is that an American Peace Corp Volunteer teaching at the nearby Bindyabasini School took it, and another is that it was handed over to the government. Recently declassified Central Intelligence Agency (CIA) and US State Department documents from the time say that the US Embassy in Kathmandu tracked down the object two years later and had it shipped back to the US. A telegram from the Department of State and Department of Defense tagged as ‘MOON DUST / Space Fragments’ dated 1 March 1972 stated: ‘1. Restored space fragment will be on board Embassy support flight 115 arriving Kathmandu on or about March 10. Fragment is packed in shipping crate (cargo no. 72-33365) marked in care of DAO.&nbsp; 2. State and Defense representatives examined fragments prior to shipment finding restoration acceptable.’  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241207071212_929d903ee06d41baa4f6040e981cd7c7d7bd75cc9c37c9b617d307fc8538d2df.png" data-media-id="editor_2" data-image-id="20241207071212_929d903ee06d41baa4f6040e981cd7c7d7bd75cc9c37c9b617d307fc8538d2df" data-rendition-name="original" width="856" height="568" loading="lazy" alt="UFO over Pokhara"> <figcaption>Declassified CIA documents about the investigation into the object sighted in Pokhara. </figcaption> </figure>  The documents show that the US government, military and intelligence agencies investigated this incident thoroughly when it occurred, and have continued to revisit it ever since, as recently as five years ago. What is even more intriguing is that the object that fell in Pokhara was not the only unidentified space object that fell to earth that year. There were similar sightings of objects falling from the sky in Ladakh, Sikkim and Bhutan between 19 February and 25 March 1968.&nbsp; These mysteries were the subject of a CIA investigation in 1968 titled ‘<a href="https://www.cia.gov/readingroom/docs/CIA-RDP81R00560R000100070007-8.pdf">Sighting of Unidentified Flying Objects in Ladakh, Nepal, Sikkim and Bhutan</a>’, and the report is part of the recent online declassification of 800,000 top-secret documents from the period.&nbsp; &nbsp;Although unidentified flying objects (UFOs) have a connotation now of being alien craft, it could be pieces of satellite, missile, rocket or even aircraft. The CIA report documents six sightings in 1968 and quotes local sources as describing all of them having similar characteristics: bright blue or red streaks in the sky accompanied by loud sounds like lightning and thunder and objects falling to the ground. Aside from the metallic object that was found in Batlechaur, there were other items also found nearby in Tallakot, Tureypasal, Armalakot and Maidan. Whatever the object was, it seems to have disintegrated even before it hit the ground.&nbsp; The CIA report records the first sighting on 19 February 1968 in various parts of Sikkim and Olangchung Gola and Ghunsa in eastern Nepal. The light was said to be ‘long and thin’ and giving out ‘green and red light’. &nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241207071212_c3c825027d966a2aedc846970390eebe063957503c7eacc8e01e0517843f9bbb.png" data-media-id="editor_4" data-image-id="20241207071212_c3c825027d966a2aedc846970390eebe063957503c7eacc8e01e0517843f9bbb" data-rendition-name="original" width="892" height="596" loading="lazy" alt="UFO over Pokhara "> </figure>  Two days later on 21 February, a soundless blue object was seen traveling fast across the sky above Thimphu in Bhutan. Then on 4 March there were multiple daytime sightings or white streaks in the sky at Chang La Pass, Fukche and Koyul in Ladakh. There were more sightings in Ladakh on the very day fragments fell near Pokhara on 25 March 1968.&nbsp; After the sightings in Pokhara, rumours started flying in Kathmandu that these were aliens trying to land on Earth, it could be Russian or Chinese spy planes or satellites, and some even say it as a sign from heaven that the end of the world was near. This was at the height of the Cold War. The Russians and Americans were testing their thermonuclear devices as well as intercontinental ballistic missile delivery systems. The Washington-Beijing rapprochement had not yet happened, and China was making quick progress testing atomic bombs. Within two years after its first atomic test, in 1966 China exploded its first hydrogen bomb at the Lop Nur site in Xinjiang, 3,000km to the north from Nepal. After neary six decades, what is still intriguing is that all the sightings within a few months of each other in 1968 were along the Himalayan arc bordering Tibet: from Bhutan, Sikkim Nepal, to Ladakh. The US military intelligence seems to have concluded that this was not a coincidence and there were frequent research trips to the site in Pokhara by American officials in the months after the incident. With the help of the Royal Nepal Army, the region north of Pokhara was thoroughly searched.&nbsp; A confidential memo dated 25 June 1968 by Jerry C Trippy to a ‘Mr Farley’ mentions that the US Air Force’s Foreign Technology Division had decided that the debris could be important because it may be related to a Chinese missile test or a Soviet ‘Vehicle Venik’ rocket.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241207071216_feb5425692dc36b20187de4e4fcc2ce9fd12b6d9e1b8724398e50bcdbf9032fe.jpg" data-media-id="editor_5" data-image-id="20241207071216_feb5425692dc36b20187de4e4fcc2ce9fd12b6d9e1b8724398e50bcdbf9032fe" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="UFO over Pokhara"> </figure>  On 28 August 1968 the US Embassy in Kathmandu sent a letter to Washington DC saying that the object could be of Soviet origin, possibly from when the rocket carrying the ‘Kosmos 208’ satellite re-entered the atmosphere. But why were the fragments falling to earth several weeks apart, and in the same region? No one knows where the metal sheet that Kul Timilsina recovered is now. It was definitely packed in a crate and taken to the US, and although it is rumoured that it was returned that is not very likely. Archivist Sunil Ulak heard from the Timilsina family that CIA officials had returned to the site five years ago. &nbsp; Interest in UFOs peaked in the US in the 1950s, with the Cold War space race and tests of atomic weapons and delivery rockets. CIA and scientists were being sent to investigate sightings, both publicly and privately. Could the Pokhara fragments as well as the sightings in Ladakh and Bhutan actually be alien craft falling to earth? The renewal in interest in space travel in large part due to Elon Musk’s SpaceX, UFOs and sightings are again subjects of public interest.&nbsp; Even 57 years later, even if there was definitive proof about whether the Batlechaur fragment was from a Chinese missile or a soviet rocket, it has not been made public in documents declassified so far. We may never know.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241207071216_b6938795f40731e7657fd6dcbb3cf460a326186a15eb11d4f832f602201ff598.jpg" data-media-id="editor_6" data-image-id="20241207071216_b6938795f40731e7657fd6dcbb3cf460a326186a15eb11d4f832f602201ff598" data-rendition-name="original" width="642" height="320" loading="lazy" alt="UFO over Pokhara"> </figure>  Sunil Ulak speculates if the debris actually came from an American aircraft, perhaps on an intel mission upon China. “Which could explain why they were so thorough in collecting the fragments in Pokhara,” he says. But that still does not explain the multiple sightings weeks apart in 1968.&nbsp; Indeed, US military aircraft were at that time flying frequent night-time missions from air force bases in India to supply weapons to Khampa guerrilla camps in Nepal located north of Pokhara in Mustang. It could very well be that the Chinese shot down one such aircraft. The other sightings could have been contrails of US spy planes, or Chinese anti-aircraft missiles.&nbsp; There were quite a few developments regarding UFOs in 2024. In a US congressional hearing in July, former intelligence officer David Grusch claimed that the government had long been involved in a program to investigate and retrieve non-human craft crashes, and then try to reverse engineer them. However Grusch did not show any evidence.&nbsp; The UAP Disclosure Act of 2024 was signed into law by Joe Biden in December 2023. It plans to oversee the public disclosure of UFO information. However, there is a clause in it that prevents disclosure if it would cause threats to military defense, intelligence operations or foreign relations.&nbsp; It is unlikely that the declassified documents about sightings in the Himalayan will cause any real surprise about definite evidence of alien life even if it was found. It seems humanity will continue, at least for now, to wonder about curious lights in the sky and whether there is anybody out there.&nbsp;

UFO over Pokhara

When Rastriya Swatantra Party (RSP) president Rabi Lamichhane was arrested in October on charges of defrauding depositors of cooperatives, the party’s vice president Swarnim Wagle gifted him Fareed Zakaria’s book, Age of Revolutions.
Since then, Lamichhane has been shunted around from Kathmandu to Pokhara to Chitwan and back to Pokhara to attend police investigations and court proceedings. He was being flown to Birganj via Kathmandu on Buddha Air on Monday. There is another pending case in Janakpur.
Human rights groups and civil society have criticised the government for hounding Lamichhane with inhumane treatment that borders on physical torture. The two parties in the coalition, Nepali Congress (NC) and the UML, see Lamichhane’s RSP as a potentially formidable challenge to their power.
Even if the fraud charges against Lamichhane are true, the Nepali public is increasingly looking at the government’s actions through the police and courts as political vendetta.
Despite all the travelling, sometimes by plane and often by road at night, Lamichhane appears to be in high spirits, waving to supporters who often gather if they know he is going to be driven around. A social media video shows him giving high fives to fellow passengers on a recent flight to Pokhara.&nbsp;
In the past weeks, streets in Pokhara have erupted with parallel protests by Lamichhane’s supporters as well as depositors of cooperatives who lost their savings to the scam.&nbsp;
Although family visits are allowed, prison officials in Pokhara told Nepali Times that not many people visit Lamichhane these days. He added, “When he does get visitors, he asks them to bring him books.”
Lamichhane is currently Nepal’s most high-profile public figure in custody, and highlights the stark difference between how influential prisoners are treated compared to ordinary inmates.
There are six prison cells at Kaski District Police Office’s two-story detention centre, three on each floor. And while authorities pack prisoners into already overcrowded cells, Lamichhane has an entire room on the second floor to himself.&nbsp;
He has also been allowed to call his family every few days. Other prisoners are not permitted phone calls except for emergencies.
Meanwhile, Lamichhane’s former business partner Chhabilal Joshi, an ex-Deputy Inspector General of Police with whom he established his Gorkha Media Network, is in custody under the same charges in the prison cell next to him.
Lamichhane is accused of siphoning off depositors' money to the tv network in which he was part-owner and anchor. &nbsp;
Both Lamichhane and Joshi are able to buy food from the police canteen instead of being served the regular meal like other prisoners. Joshi has also given his statement to authorities in Rupandehi and Kathmandu for his alleged role in the scam. Lamichhane is yet to be presented in Kathmandu for questioning.
While he was in custody at the Kathmandu District Police Complex, Joshi expressed his desire to sleep in a police officer’s office, reportedly assuring authorities that he would not run away and he was entitled to certain facilities as a former officer of the law.
“He seemed to be under the impression that he is still a police officer,” says a source at the Kathmandu District Police. “We made it clear to him that as someone accused of a crime, he was not entitled to special treatment.”
Former ministers Balkrishna Khand and Top Bahadur Rayamajhi, and ex-home secretary Tek Narayan Pandey, who were arrested in connection with the fake refugee scam last year, were similarly housed in the offices of law enforcement officials instead of prison cells. Khand has since been released after six months in jail.
While there is no legal provision to keep high-ranking officials in separate detention centres when they are arrested, authorities granting them special facilities is not uncommon. Law enforcement officials say VIP detainees expect preferential treatment while in police custody.
Among those is former Kosi Province minister Lila Ballav Adhikari, who was arrested from Biratnagar on 10 November over his alleged involvement in human trafficking and brought to Kathmandu. Adhikari had flown to Japan without government approval with three individuals on 29 October to attend a cultural conference, but had been sent back to Nepal from Narita.&nbsp;
His three companions were arrested at Kathmandu airport upon their arrival, but Adhikari was able to exit unscathed from the VIP lounge. Adhikari had resigned as the Kosi Province Minister for Internal Affairs and Law when it became public that his companions had been taken into custody, and was himself arrested shortly after. He has since been cleared by the courts.
Throughout his detention, Adhikari was kept separately from other inmates. Senior Superintendent of Police (SSP) Basant Rajouri, head of the Bhadrakali complex, says that while there is no separate detention area for VIPs, some detainees are kept separately depending on the nature of their crime.
However, sources say that arrangements were made for retired judges and others to visit Adhikari frequently worked at the office of a Deputy Superintendent of Police (DSP) during his time in custody.&nbsp;
“He used to constantly pester the authorities to let him sit outside in the sun, and to be able to use the police officer’s shower area,” added an officer.
Adhikari was released on 25 November after the government prosecutor’s office decided not to charge him in a move that was seen to expose the government’s double standards.
Over at Kathmandu’s Dilli Bazar Prison, former Kist Bank CEO Kamal Gyawali emerges from his prison cell into the courtyard of the prison’s ‘Ka (क)’ block every morning with a thick book in his hands, ready to give his daily sermon.
With his long beard, Gyawali, who is serving a prison sentence for banking fraud, looks the part of a religious guru as he implores his rapt listeners to “walk the right path, abandon bad thoughts and turn to scripture and spirituality”.&nbsp;
Afterward, the attendees gather to discuss politics and current affairs. Inmates at his daily sermons at the prison include other high-profile detainees, including former MP Ichchha Raj Tamang, who is in jail for money laundering and cooperatives fraud, former joint secretary Chudamani Sharma, who was convicted of corruption, as well as NC leader Chandra Bahadur Lama and Krishna Bahadur Upreti of the UML both of whom are on trial for embezzling billions of rupees.
Victims of the cooperatives scam that former lawmaker Tamang was involved in have made trips to the prison and requested visits, but he has refused to meet with any of them.
“Tamang often complains that the state has prevented him from returning the money to the victims by locking him up,” says a police officer at the Dili Bazar jail.
“All you hear every day from the VIP prisoners is that they have been framed,” adds the officer. “No one admits that they were involved in misdeeds.”
But while most high-profile prisoners complain about prison conditions, one exception is former provincial lawmaker Deepak Manange, who is serving a sentence at Dilli Bazar Jail for attempted murder.
“He is the happiest prisoner here,” says a warden. “Unlike the others, he doesn’t claim to have been framed, in fact he doesn’t seem to care that he is in prison.”
Manange is detained in the ‘Kha (ख)’ block of the prison complex, which he renovated at his own expense. The block previously housed female prisoners, but Manange used his influence to transfer them elsewhere. He faces no shortage of visitors, who range from political leaders to people from the underworld.
Along with Manange, other well-known prisoners in this block include Nepal Telecom Managing Director Sunil Poudel, and former executive director of the Surakshan Printing Centre Bikal Poudel, who are serving time for corruption.
Former prisoners at Dilli Bazar prison include ex-ministers Khum Bahadur Khadka and Shyam Sundar Gupta, NC leader Ganesh Lama, Maoist MP Balkrishna Dhungel, Nagarik Unmukti Party leader Resham Chaudhary, as well as former IGs Ramesh Chand Thakuri, Om Bikram Rana, and Hem Bahadur Gurung.
Section 54 of Nepal’s Prison Act assigns each prison’s internal administration the
responsibility of governing its prisoners, which means the more favourable the jail management is, the more comfortable it is for prisoners.
Dilli Bazar prison has been the prison of choice for many high-ranking prisoners, especially those convicted of white collar crimes, due to its more accommodating administrators. The prison, which has the capacity to house 700 inmates, is also less crowded than other jails.
Anuj Bhattarai, spokesperson of the Department of Prison Management, says that there is no legal classification in Nepal for felons to be assigned prisons based on the nature of their crimes.
“That Dilli Bazar Jail has a higher number of prisoners convicted of crimes like corruption is most likely a coincidence,” says Bhattarai. “There is no provision for influential people to be able to choose where they will be incarcerated.”&nbsp;
Translated by Shristi Karki from the Nepali original published in himalkhabar.com

What Nepal’s VIP prisoners do in jail

If you were raised in Nepal, you must have picked up its unique set of vocabulary: आन्दोलन, चक्का जाम, बन्द, राँके जुलुस, आफ्नो मान्छे, हाम्रो दल, कर्फु and many more words connoting political protest.
We became familiar with the acrid smell of burning tyres, and eyes smarting from tear gas. And yet, everyone speaks of another revolution in the making. Not by desire, but by suffocation.
We heard speeches about नयाँ नेपाल, but the New Nepal never arrived. The governance system changed, but it did not reflect on people’s lives — except for those close to centres of power. The state is still unreachable and is not bothered about <a href="https://nepalitimes.com/here-now/matter-of-life-and-debt">victims of loan sharks</a>, cooperative scams and other injustices.
Politicians continue to speak in sound bites, but fail to deliver. They have mastered the game of pointing fingers towards an external enemy and convincing people that they are never at fault. The political narrative is so disconnected from the actual analysis of the problem that suffocation doesn’t go away after every revolution.
No genuine effort has been made to deliver at all, which is why there is a palpable sense of disillusionment in the air forcing us to seek another revolution, even if Nepal may not be able to afford it.
How has the current system successfully held power, even if the public is deeply frustrated? How is it that for three decades we continue to be led by the same faces, who have time and again, proved to us that they may be great politicians but not national leaders?
<a href="https://nepalitimes.com/opinion/improving-internet-governance-in-nepal">My experience at the epicentre of politics</a> has led me to identify three cultures that have enabled political parties to keep a tight hold on power: acceptance, silence and dependency.
We accept things the way they are. We use fatalistic phrases like “नेपालमा यस्तै हो” or “नेपालको कानुन दैब जानुन”. While this resilience enables us to rise back up from devastating calamities, it is also a reason for our compliance with the status quo.
Despite so many ‘revolutions’ that have led to significant reforms, these phrases keep getting reinforced, to the point that the upcoming generations have made it their lingo.&nbsp;
This acceptance is not a symbol of law-abiding citizens, but citizens living in fear of those in power, unable to ask the whys and why-nots.
Innovation suffocates in this culture of acceptance of the status quo. This is manifested in remarks like “but we don’t have any laws for this,” or “we don’t have the capacity to implement this”. An innovator or entrepreneur therefore has to spend that energy to become a political lobbyist, often educating and convincing the bureaucracy.&nbsp;
Remember when locally assembled <a href="https://nepalitimes.com/banner/designed-and-made-in-nepal">Yatri motorbikes</a>, despite having willing customers, had to suffer to secure license numbers because of a lack of regulations? Instead of creating new laws, the government kept chanting the “We will promote Nepal-made goods” mantra, leaving entrepreneurs in a labyrinth of bureaucracy. The weight of acceptance of the law lies heavily on innovators. Fatalism is a tactic used by those in power to generate mass fear in society.
When we accept, we become silent. This is a pervasive phenomenon. We are trained to keep quiet, lest we ruffle feathers, burn bridges, or not get the help we need in future. We know, yet we don’t speak.
Read also: <a href="https://nepalitimes.com/here-now/bureaucratic-hurdles-in-researching-nepals-bureaucracy">Bureaucratic hurdles in researching Nepal's bureaucracy</a>, Daniel W Edwards
Here is one example: the 2021 census shows that the number of baby boys born for every 100 baby girls is 112. This is a clear indication of female foeticide because of boy preference in society.
Despite such horrifying realities, there is finger-pointing within the government between the Ministry of Health and Population with the Ministry of Home Affairs. At the citizen level, we know those who are involved in killing girls. Yet, we don’t speak up. The Nepal Medical Council reports state that despite this gender imbalance at birth, there is no indication of any action.
But why would anyone speak against one's own fraternity, no matter how vile the act is?
When we accept and keep quiet, we become dependent on those who yield power. From getting our government procedure completed on time to getting transfers, to accessing any of our legally protected rights as well, we are forced to depend on our networks of चिनेको मान्छे people we know by blood, village, relations, political affiliation.
The culture of dependency has been the established way in Nepal. If you drive a two-wheeler or four-wheeler, and you get into a small accident, you will be asked to sort it yourself, dialing up the most powerful person you know. It becomes a competition of who knows who.
Recently I was told that there were calls from the Ministry of Health and Population and another from the Prime Minister's Office for just one medical position in a private hospital. Each was pushing its own candidate. Guess which candidate got the position.&nbsp;
The dependency of people is not on the laws or the state, it is with people in power, a reliance on the network of somebody who knows somebody, including those not officially in power.
These cultures are deeply ingrained in our heads, and in society. Collectively they form a vicious circle that helps those in power to retain power. This is not the society we want to live in.
Then, what do we do as a collective to break away from this? How do we break away from the cultures of acceptance and silence that have created this dependency? What can we do to ensure that our children do not have to learn the jargon of आन्दोलन before they learn about the state?
These are the cultures political parties need to shed rather than use them to perpetuate their power. This is what <a href="https://nepalitimes.com/opinion/comment/an-alternative-to-alternative-politics-in-nepal">alternative politics</a> needs to be about.
Sumana Shrestha is a member of Parliament’s Education, Health and Information Technology parliamentary committee and represents the Rastriya Swatantara Party.

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