Over the last two decades, Nepal has made notable progress in maternal and neonatal healthcare. The<a href="https://mohp.gov.np/uploads/Resources/Final%20Report-26%20March-%202023-UPDATED.pdf"> maternal mortality ratio (MMR</a>) has declined from 536 per 100,000 live births in 1996 to 151 by 2021.
Driving this process were the country’s <a href="https://mohp.gov.np/program/safe-motherhood-programme/en">Safe Motherhood policy</a>, an increase in skilled healthcare providers, free delivery services for expectant mothers, incentive schemes for antenatal care, as well as postnatal visits.
Other measures, such as birth preparedness packages along with systematic planning for managing potential complications during childbirth, amplified these achievements.&nbsp;
There has been a remarkable rise in institutional deliveries, an increase in antenatal visits, and an impressive 70% of women receiving postpartum care from healthcare providers within the first two days after giving birth.
Quality improvement initiatives such as the Maternal and Perinatal Death Review, minimum health facility assessment standards, routine clinical monitoring, and supportive onsite supervision visits, have been outlined in policy documents and guidelines to elevate the overall quality of care.&nbsp;
However, it is when analysing province-wise MMR. that we still see significant disparities. Maternal deaths are still high in Lumbini Province (207 per 100,000 live births) and Karnali (172). The MMR in Bagmati Province (98) correlates with better figures for higher education, awareness and access to health service and providers.
In contrast, 83% of women in Karnali face challenges in seeking medical care, primarily due to financial constraints and long distance to healthcare facilities.
Half of the maternal deaths in Nepal are of mothers within the age groups of 15-34. Despite the legal marriage age being 20, child marriage is still widespread and contributes to the highest number of pregnancy-related deaths.&nbsp;
Read Also: <a href="https://nepalitimes.com/news/remove-barriers-to-life-saving-drug-to-prevent-maternal-deaths">Remove barriers to life-saving drug to prevent maternal deaths</a>, Marty Logan
The median age of marriage in Nepal is 18.3 years, with the lowest median age in Madhes province at 16.6 years and the highest in Bagmati province at 19.9 years. The Muslim community reports the lowest at 16.5 years, while the Janajati and Brahmin/Chettri communities have generally higher median ages for marriage.
In Madhes and Sudur Paschim Provinces early marriages among girls under 15 contribute to heightened adolescent mortality, mainly due to difficulties accessing timely health facilities. Disparities persist among ethnic groups, particularly among doubly marginalised Madhesi Muslims, who face high mortality rates due to early marriages.
Health facility deliveries have improved from 10% in 2001 to 79% in 2021. But again, progress is uneven and these disparities need to be overcome to<a href="https://nepalitimes.com/editorial/more-equal-than-others"> meet the UN’s Sustainable Development Goals</a> (SDGs) target of 90% institutional delivery rate by 2030.
Wealth inequality and provincial variations, especially in Madhes, pose challenges that need nuanced understanding of women’s reluctance to seek health services.&nbsp;
Despite Nepal’s success in maintaining population growth close to replacement levels, the total fertility rate (TFR) is significantly higher among those without formal education. The proportion of postpartum family planning uptake is also lowest in Madhes and Sudur Paschim at only 0.2%.
Breastfeeding is in decline, with less than three out of five mothers following recommended practices. Regional variations highlight the need for targeted interventions, particularly in provinces like Bagmati, where breastfeeding rates are lower among well-educated city dwellers.&nbsp;
Read Also: <a href="https://nepalitimes.com/here-now/why-has-progress-in-saving-women-s-lives-stalled">Why has progress in saving women’s lives stalled?</a>, Marty Logan
Anemia persists as another risk factor, with Madhes Province again carrying the highest burden.
Comparing Nepal with Bangladesh, India, and Pakistan shows that we are doing better in under-five and infant mortality rates. Nepal’s institutional delivery rate surpasses Bangladesh, but lags slightly behind India.
Even so, alarming disparities persist in neonatal and maternal mortality rates within disadvantaged groups, reflecting inadequate coverage of routine maternal and neonatal health visits and suboptimal care.&nbsp;
This points to both limited access to recommended interventions for disadvantaged women and potential inefficiencies in delivering crucial interventions during routine these visits.
Nepal should prioritise rural pockets of the country and employ a comprehensive strategy that includes delivering antenatal care through primary health care outreach, home visits, distributing essential medicines, vaccinations, and identifying appropriate health facilities for birth preparedness.
Read Also: <a href="https://nepalitimes.com/banner/what-can-be-more-fulfilling-than-saving-lives">“What can be more fulfilling than saving lives?</a>”, Naresh Newar
The quality of antenatal care must be improved by talking about nutrition with pregnant women and families, emphasising awareness of danger signs that necessitate timely health facility visits, and ensuring local governments can efficiently refer complicated cases, with airlifting as a viable option for emergencies.
Adolescent Sexual Reproductive Health with a targeted focus in provinces with early marriages and childbirths combined with education, awareness, and easy access to reproductive health services are imperative.
More effort is needed to meet the SDG target of reducing the MMR to 70 per 100,000 live births. Mitigating disparities among provinces demands political commitment, active local leadership, community engagement, especially leveraging the youth force, and fostering public-private partnerships at all levels.
Surya Bhatta is Executive Director of One Heart Worldwide that works primarily on maternal health in rural Nepal.

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Saving more mothers and babies

Remove barriers to life-saving drug to prevent maternal deaths

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111413114/63722f839c7e80680e0c251djpeg.jpg" alt="" width="1200" height="800"/><figcaption>Photo: PRASANSA BUDHA LAMA</figcaption></figure>From 1991 to 2016, the maternal mortality rate in Nepal declined by a staggering 72% -- from 850 deaths per 100,000 live births to 239 in 25 years.This was a dramatic advance, but since then progress has slowed and almost plateaued off, mainly due to high rates of neonatal deaths.And at the current rate, Nepal will have to further bring down this figure by 71% by 2030 to meet its Sustainable Development Goals (SDGs) on maternal health. This is a considerable challenge given that Nepal has the highest maternal and neonatal mortality rates in South Asia, behind only Afghanistan.A shortage of skilled birth attendants, weak referral systems and difficulty in accessing treatment for complex pregnancies all point to the government’s chronic neglect of women’s health and the subsequent high mother-baby death rate.It is well established that the six pillars of safe motherhood are family planning, HIV/STD control, antenatal care, obstetric care, postnatal care and abortion care. And these can be strengthened through education, gender equality and access to primary health care. However, the Ministry of Health has overlooked these aspects, and this is undermining past gains.The 2015 Right to Safe Motherhood and Reproductive Health Act guarantees women the right to necessary counseling and maternity services from a midwife. But this does not apply to a majority of women in rural areas due to a lack of trained staff.Read also: <a href="https://archive.nepalitimes.com/regular-columns/GUEST-COLUMN/Saving-one-mother-at-a-time,816">Saving one mother at a time</a>, Bikash GauchanThe government needs to produce more than 10,000 midwives with a minimum of a three-year certificate if it is to reduce the maternal mortality rate to 75 for every 100,000 births by 2030, as per the SDGs.Under the previous Millennium Development Goal (MDG), Nepal had committed to reducing maternal mortality by three-quarters by 2015, which included midwifery education and services in the five-year plan. A policy was then formulated in 2006 to produce skilled birth assistants (SBA) with other staff to be given two months of training to develop 27 basic maternity services.The strategy includes basic nursing skills in nursing and medical education such as ANMI certification, BSc Nursing, MBBS and MDGP and aims to produce professional midwives in the long run.At present, Sudeni Maternal and Child Health Workers and Assistant Nurse-Midwife (ANMI) who underwent midwifery training for two months are deployed to communities as maternal health service providers.Since 2006, the program has produced more than 10,000 SBAs and reduced maternal mortality by 15% in the past decade at the cost of Rs1 billion, but we are yet to see the kind of progress we aspired to. The program has significantly increased awareness about maternal healthcare, but has not produced as many professional midwives.Read also: <a href="https://www.nepalitimes.com/editorial/nepali-ama/">Nepali Ama</a>, EditorialIn India, ANMI must have passed high school and undergone two years of training. In Nepal, those who have passed grade 8 and trained for 29 months can become ANMI. Therefore, people at the forefront of providing maternal and child healthcare are already lagging in resources, skills and education levels.In urban centres, mothers have the choice of obstetricians and gynecologists, but in villages, their best bet are ANMIs, many of whom have not even completed remote obstetric training. This negligence has cost the lives of many young mothers.Further, women accessing health facilities face humiliation, and even violence, and are stigmatised. The main reason for this is the lack of midwives, and the shortage of such an important position within the National Health Care System.Read also: <a href="https://www.nepalitimes.com/here-now/another-babys-life-is-saved-in-rural-nepal/">Another baby’s life is saved in rural Nepal</a>, Naresh NewarThere is also a tendency to announce popular programs only to source large budgets from state coffers. The President’s Program for Women’s Upliftment is an initiative to save the lives of mothers at childbirth.Launched in 2018, the program has only spent Rs36.6 million in three years when its budget was Rs50 million a year. In the same period, while it saved 360 women, 789 died without treatment.Expecting women in remote areas are constantly at risk due to the delays: at home while making a decision, on-road in lack of proper transport and at health facilities.Even then we can mitigate the illiteracy, ignorance and financial constraints that cause decision delays at home and on roads with public awareness programs. But the bigger challenge is that of local health facilities take time to transfer women to better-equipped hospitals.According to 2020 Maternal Infant Mortality Monitoring and Response (MPDSR), most maternal deaths were due to preventable causes such as bleeding, high blood pressure, infections and prolonged labour pains. The analysis also showed that 37% of women died on the way from one health facility to another, 30% at home, 23% in private and non-government hospitals and 10% on the way home from health facilities. Most of these deaths were of women under 34.Read also: <a href="https://www.nepalitimes.com/banner/balancing-life-and-death-in-nepal/">Balancing life and death in Nepal</a>, Ashmita Hamal and Naresh NewarBy mobilising skilled midwives at local-level health facilities, we can manage many complications and counsel families if a mother needs to be relocated. And one way to achieve that is by providing the ANMIs with a 3-year certificate level midwifery education.Midwives in essence stand for women's rights. They advocate for all women of reproductive age to receive the quality and dignified services they deserve, especially during pregnancy and childbirth.Midwives have proven their effectiveness in countries like Norway, Finland, Sweden, Denmark and the Netherlands for the past 250 years and have reduced maternal mortality rates to as low as 2 per 100,000 live births.With the maternity knowledge, skill and behaviour they have, only a midwife can determine the true condition of a woman in labour pain when there is no obstetrician and gynecologist present which is often the case across Nepal’s rural villages.If we want to save our mothers, it is of utmost importance that the Nepali state act immediately to produce midwifery practitioners.Laxmi Tamang is the president of the Nepal Midwifery Society.Adapted from the <a href="https://www.himalkhabar.com/news/130974">Nepali original</a> in Himalkhabar monthly magazine by Aria Parasai.Read more: <a href="http://archive.nepalitimes.com/news.php?id=16327#.Ys5GPOxBzAM">Homeward bound</a>, Sabhyata Timsina

Midwives to the rescue in Nepal

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111413114/63722eef9c7e80680e0c24ebjpeg.jpg" alt="" width="768" height="1024"/><figcaption>Bhavana with her young son. Photo: RITA ALE MAGAR</figcaption></figure>It was a night that Rita Ale Magar says she will never forget. Bhavana, 17, from remote Dumre Dara village walked 2.5 hours to reach a birthing centre of Udaypur.The underage mother was already 16 days overdue, her blood pressure was alarmingly high and she was going through prolonged labour. She was having difficulty pushing out the baby and was in severe pain.This was the most complicated case the centre had received, and the nurses were understandably nervous. But Nurse Rita had to lead the team and take the decision to try to save both the mother and her baby who were at high risk.“This was the moment when I had to use all the knowledge that I was taught by my mentors,” recalls Rita, who is a beneficiary of the Simulation-Based Mentorship Program (SBMP) of the group, One Heart Worldwide.After nearly two hours, the baby was born but that was only the beginning of the ordeal. The baby was not breathing and had no heart rate or muscle tone.“All of us thought the baby was dead, but we had to try our hardest to save him. I had less than a minute to give my best,” adds Rita, still shaken as she narrates her experience.It was at that point she remembered the ‘Golden Minute’ session she had learned about at the mentorship program -- the time needed for newborn resuscitation of babies born with asphyxia and deprived of oxygen.Nurse Rita quickly cut off the umbilical cord, put the baby on the resuscitation table and gave him electric suction which allowed it to start breathing. But the baby still looked pale, and was having difficulty crying.At the same time, the mother’s condition was worsening, she was bleeding profusely. The nurse sought help from a paramedic team to ventilate the baby with an Ambu bag while she tended to the mother.The baby's condition started to improve, but since there was no neonatal intensive care unit at the birthing centre, Rita referred the baby to a hospital in Biratnagar. The baby boy has since recovered and is now healthy.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111413114/63722ef19c7e80680e0c24ecjpeg.jpg" alt="" width="389" height="515"><figcaption>Nurse Rita Ale Magar used the ‘Golden Minute’ to save a newborn who was suffering from severe complications. Photo: ONE HEART WORLDWIDE</figcaption></figure>“I was panicking but I benefited from my mentorship, and I will always be grateful to the clinical team from One Heart Worldwide who had trained me,” she adds.One would think that health professionals would not want to work in villages with minimal resources, but the opposite is true for Rita for whom being stationed in the far-off government birthing centre has been a challenge, but fulfilling when she can save lives like this recent case.Nurse Rita has delivered over 200 babies in the last three years. The birthing centre was initially under-equipped and she was the only Skilled Birth Attendants. This is where the One Heart came in to provide hands-on simulation exercises to nurses to get them ready for real-life birthing complications.Two nurses who received that simulated training were instrumental in saving the underage mother and her baby. They also counseled family members.Read also: <a href="https://www.nepalitimes.com/here-now/who-will-save-nepals-poor-new-mothers/">Who will save Nepal’s poor new mothers?</a> Rojita AdhikariThe patient, Bhavana did not know about the risks associated with pregnancies and was adamant about giving birth at home because she herself was born at home. Additionally, she had not seen anyone going to the birthing centre for delivery.Even after she was long past her due date Baavana was still not convinced about institutional delivery. It was only when she realised she was putting herself and her baby at risk did she relent.“Ultimately, she made the right decision but it was almost too late. Luckily, she survived. Saving her was so rewarding also because this could set an example to other villagers,” adds the nurse.But it is not easy for the villagers to get to the birthing centre due to the rugged terrain which further discourages them from accessing institutional delivery. There is no proper transport or ambulance service either. Most people have to walk over four hours to get to the centre which is especially inconvenient for pregnant women and girls.Says Rita Ale Magar: “But no matter how hard the journey, it is worth the effort because us nurses are here at the birthing centre to help mothers like Bhavana and their newborns.”Read more: <a href="https://www.nepalitimes.com/banner/no-conceivable-reason-for-unwanted-pregnancies/">No conceivable reason for unwanted pregnancies</a>, Rojita Adhikari

Balancing life and death in Nepal

<figure><img width="1198" height="679" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114111144/63721c059c7e80680e0bd46djpeg.jpg" alt=""/><figcaption> Locals from Budhinanda in Bajura transporting a woman in labour to a hospital in district headquarters. All photos: PRAKASH SINGH</figcaption></figure><img width="1456" height="589" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114111144/63721c079c7e80680e0bd46ejpeg.jpg" alt="">Nothing could be more symbolic of the misplaced priorities of all three tiers of government in Nepal than the sight of women giving birth by the wayside at a time when politicians are <a href="https://www.nepalitimes.com/latest/nepals-shortsighted-view-tower-craze/">inaugurating yet another view-tower</a> in a lavish function.As a reporter based in Bajura district in Nepal’s rugged northwestern mountains, I have see many mothers with complicated pregnancies being carried on stretchers to hospitals. Usually, they are women who have been in prolonged and agonising labour. Many do not make it, and die along the way. I was working on a story on maternal mortality when I came across a photograph from four years ago of a woman giving birth along a trail. I tweeted it on 26 March, and the image immediately went viral because it coincided with the inauguration by Pushpa Kamal Dahal of a nine-storey view-tower in Rolpa district.<blockquote>बाटोमा यसरी बच्चा जन्माउछन्, दुर्गमका महिला <a href="https://t.co/sZfmFmzv3F">pic.twitter.com/sZfmFmzv3F</a>— Prakash Singh (@prakashbajura) <a href="https://twitter.com/prakashbajura/status/1507590311073230853?ref_src=twsrc%5Etfw">March 26, 2022</a></blockquote> Even though that photograph was from some years ago, the situation with maternal and infant deaths in Bajura has not improved. For Nepal’s netizens, that symbol of neglect was in stark contrast with the view-tower building spree across the country. In fact Bajura has one of the worst socio-economic and health indicators in Nepal. Just in the past three years, eight women with difficult pregnancies have died while being transported to the district’s only hospital in Martadi. These were just ones that were officially recorded, there are surely many more mothers in far-flung villages of this district who did not make it.Read more: <a href="https://www.nepalitimes.com/here-now/grassroots-democracy-promotes-good-health/">Grassroots democracy promotes good health</a>, Sagar BudathokiThe mother and baby in my photograph that went viral in social media were the lucky ones. The mother’s name was Tara Luhar from Budiganga Municipality, and after running into them on a village trail, I took the photo after taking their consent.   Although heavily pregnant, Tara had been doing all household chores herself, including raising her other children and taking care of the livestock and farm. No female community health volunteer had visited her home and she did not know that she needed pre-natal checkups, and the need to deliver in a health post or hospital. Most women in Bajura’s traditional families are <a href="https://www.nepalitimes.com/here-now/the-curse-of-being-new-mothers/">banished to cowsheds during childbirth</a>. It was only when her labour dragged on for four days that neighbours and relatives decided to carry Tara to the health post in a stretcher. During the journey lasting several hours, the baby came out and into the dusty trail. Tara simply carried her baby, and walked back home.  This week, after the photograph made her famous, I called Tara Luhar. She said the baby was now four years old and they were both were healthy. Her husband, who was working in India, had died at about the time her son was born. As single mother, she now struggles to make ends meet.“Most of our births in Bajura are at home, there are very few institutional deliveries,” explains Bimala Pandey of the Bichchyan Health Post in Bajura. “There are many cases of women giving birth while on their way. We have to refer the complicated cases to Achham.”  Nepal has taken dramatic strides in reducing its maternal mortality ratio (MMR). It has come down from 880 per 100,000 live births in 1980 to less than 200 in 2019. But maternal deaths have gone up again in the past two years because of the drop in institutional <a href="https://www.nepalitimes.com/here-now/birth-and-death-during-a-pandemic/">deliveries during the pandemic.</a> Bajura’s maternal mortality ratio in 2014 was much higher than the national average: 380. The district ranks at the bottom among Nepal’s districts in the Human Development Index (HDI), with just 0.364 against a national average of 0.602 in 2019. The infant mortality ratio has improved, but is still at 27 deaths per 1,000, mainly babies who die within a month of being born.Although the photograph of the mother giving birth by the side of the road sparked outrage on Nepal’s cybersphere, for Bajura it was just another tragic reminder of its poor state of healthcare. Three <a href="https://www.nepalitimes.com/latest/3-nepali-mothers-still-die-daily-at-childbirth/">mothers die at childbirth every day</a> in Nepal, and in Bajura there is not a month that goes by without news of yet another mother who does not make it while giving birth by the roadside. <figure><img width="1200" height="681" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114111144/63721c0b9c7e80680e0bd46fjpeg.jpg" alt=""><figcaption>Bajura's Nitikhola resident Parvati Budha, 23, delivering a baby on the way.</figcaption></figure>The <a href="https://www.nepalitimes.com/here-now/who-will-save-nepals-poor-new-mothers/">high cost of ambulance</a> and lack of political connections to get medical evacuation by helicopter under the <a href="https://www.nepalitimes.com/here-now/nepals-air-ambulance-saves-mothers/">President’s Program for Women’s Upliftment</a>, most families have to physically carry pregnant women with complicated pregnancies. Last month, 23-year-old Parbati Buda of Himal Rural Municpality had her baby while being carried for over six hours to the local health post. Buda was lucky to survive. In the past year two women died while being carried to Achham – the travel by stretcher and jeep took too long, and the family had waited till it was too late to save them.Because local health posts are not properly equipped to deal with births in which a caesaerian section may be required, many families try to take them to <a href="http://archive.nepalitimes.com/regular-columns/GUEST-COLUMN/Saving-one-mother-at-a-time,816">Bayalpata Hosptial in adjoining Achham district</a>, which has a dedicated maternity ward and surgery.Read more: <a href="https://www.nepalitimes.com/banner/this-is-how-to-upgrade-nepals-rural-health/">This is how to upgrade Nepal’s rural health</a>, Sewa BhattaraiPrakash Singh is editor in chief of Badimalika Khabar in Bajura.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114111144/63721c0e9c7e80680e0bd470jpeg.jpg" alt="" width="120" height="150">

Born by the roadside in Nepal

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111144/636b84729c7e80680e067796jpeg.jpg" alt="" width="1500" height="1125"/><figcaption>Rita Khatri, 21, is the only skilled birth attendant in her village of Phediguth of Okhaldhunga district, where she has helped to promote institutional birthing despite the challenges posed by the pandemic. All photos: NARESH NEWAR</figcaption></figure>Unlike many of her nursing colleagues who yearn to go abroad or find a job in a city hospital, Rita Khatri returned to her home village in Okhaldhunga after completing her training as a skilled birth attendant in Kathmandu.It was not easy for the 21-year-old to be taken seriously by her own community in Phediguth village of Champadevi Municpality, she had to earn their trust and respect one safe delivery at a time.But just as families in surrounding villages came to depend on her for vital <a href="https://www.nepalitimes.com/latest/3-nepali-mothers-still-die-daily-at-childbirth/" target="_blank" rel="noopener noreferrer">prenatal care and safe deliveries</a>, the Covid-19 pandemic hit. Now, on top of all the other health challenges in rural Nepal, there is the additional danger of being infected with this contagious new strain of the coronavirus that has spread across the country.Because of its remoteness and lack of connectivity, the pandemic has not affected this scenic district of eastern Nepal as seriously as other parts of the country. Still, there are 90 active Covid-19 cases in the district and a dozen people on average test positive every day.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111144/636b84769c7e80680e067797jpeg.jpg" alt="" width="1500" height="1125"><figcaption> </figcaption></figure>Being a trained midwife, Rita Khatri’s main worry is that restrictions on travel and fears about the <a href="https://www.nepalitimes.com/here-now/birth-and-death-during-a-pandemic/" target="_blank" rel="noopener noreferrer">virus will affect maternal and neonatal health services</a> as most villagers are afraid to visit her birthing centre for check-ups and deliveries.“I am scared that the pandemic will set back all the work we have done here to reduce home deliveries and to improve maternal and infant survival,” Khatri says. “We had finally managed to convince families to opt for institutional birthing, but that might now change.”Staff at the centre are also worried about their safety, since this <a href="https://www.nepalitimes.com/editorial/this-is-war/" target="_blank" rel="noopener noreferrer">second wave is much more deadly</a> than the one in 2020. Last year, Khatri had helped mothers even when most government health posts had shut down in the districts, many staff were afraid to come to work, and if they did were afraid to even touch their patients.But Khatri kept the birthing centre open, and carried out 32 deliveries in 2020, some of them complicated ones where the <a href="https://www.nepalitimes.com/here-now/birth-and-death-during-a-pandemic/" target="_blank" rel="noopener noreferrer">mothers’ life would have been in danger</a> if they had given birth at home.“Closing down would have meant risking the lives of many mothers,” says Khatri, who has been trying to convince as many families as possible who are under her care that it was safe to visit the birthing centre.https://www.youtube.com/watch?v=ESmZURVRyN4It is much more difficult this year to convince both mothers and staff. Still, Khatri says, “I am also apprehensive about being infected, but I am the only SBA around here, and I want to ensure as many <a href="https://www.nepalitimes.com/banner/infant-deaths-up-during-nepal-lockdown/" target="_blank" rel="noopener noreferrer">institutional deliveries</a> as possible and save mothers and their babies from risking home births.”Khatri says that for her, nursing is not just a job. It is an occupation through which she wished to serve her community where there is no doctor for miles around. There is a steely determination in her thin voice as she says, “I will keep my doors open no matter how bad the pandemic is, this is what I was trained to do.”The community has a new esteem for Rita Khatri because of the dedication and hard work she displayed last year, and villagers are glad that they have her to go to for <a href="https://www.nepalitimes.com/opinion/newborn-deaths-and-a-vision-for-a-post-pandemic-nepal/" target="_blank" rel="noopener noreferrer">safe motherhood</a>.It has not been easy for Khatri to earn this trust. When she first returned home to Okhaldhunga to join Phediguth Health Post, villagers heard that a new ‘doctor’ had arrived. But when they came to visit, they were visibly disappointed that it was just a girl they knew from the village.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111144/636b847a9c7e80680e067798jpeg.jpg" alt="" width="1500" height="1125"><figcaption> </figcaption></figure>But within a few months, Khatri proved herself through her profesionalism and ability to handle the most complicated maternity cases at the birthing centre which was upgraded with help from the non-profit, <a href="https://www.nepalitimes.com/banner/what-can-be-more-fulfilling-than-saving-lives/" target="_blank" rel="noopener noreferrer">One Heart Worldwide</a> (OHW).Not every delivery goes right, there are some which need specialist treatment or caesarian sections, others suffer post-partum haemorrhage and some mothers are already in a critical condition because they are brought to the centre too late. When the mother or child cannot be saved, Khatri has sometimes been slapped, kicked and verbally abused by angry relatives.“I could understand their frustration, but I did not let anything demoralise me,” says Khatri. “I was trying to the best of my ability to save their lives.”Today, everyone respectfully calls Khatri ‘Sister’, and some even call her ‘Doctor’. Many also have apologised for mistreating her in the past, and come bearing gifts to show their gratitude. “I refuse to take them because I am just doing my duty,” Khatri tells us.Champadevi Health Post has upgraded its maternity room, but there are many others across Nepal that are struggling with <a href="https://www.nepalitimes.com/banner/this-is-how-to-upgrade-nepals-rural-health/" target="_blank" rel="noopener noreferrer">proper buildings, equipment and staff</a>. The biggest challenge is the lack of nurses trained as skilled birth attendants.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111144/636b847d9c7e80680e067799jpeg.jpg" alt="" width="1500" height="1125"><figcaption> </figcaption></figure>When Rita Khatri joined the Phediguth Health Post, its birthing centre did not have proper equipment, not even a maternity bed for deliveries. Most deliveries happened late at night without electricity, and mothers were in prolonged labour sometimes lasting 16 hours. Some of Khatri’s patients preferred lying on the floor to give birth because they found the table that served as a maternity bed so uncomfortable.Without electricity, staff had to stumble in the dark during deliveries, and it was difficult to keep the maternity room warm without heaters. Khatri tried unsuccessfully with the local government to get power supply, but it was One Heart Worldwide that installed solar-powered lights. Little by little, the facility was improved to be the clean and bright birth centre it is today.Khatri is modest about her accomplishment: “This is the least I could do for my birthplace, so giving birth is safe."To donate to Phediguth Health Post: Account name: Phediguth Health PostRastriya Banijya Bank, OkhaldhungaAccount number 207000290101

Saving Nepali mothers on Mother’s Day

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221129151140/638619f69c7e80680e0cccd2jpeg.jpg" alt="" width="1500" height="844"/><figcaption>Photo: MARTY LOGAN</figcaption></figure>It should not be surprising that <a href="https://www.nepalitimes.com/latest/the-story-of-nepals-first-covid-19-fatality/" target="_blank" rel="noopener noreferrer">Nepal’s first COVID-19 death was a new mother</a>. What was surprising was to hear Prime Minister K P Oli admitting in Parliament on Tuesday that Nepal’s coronavirus deaths represented a failure of his government.<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/banner/3rd-month-of-lockdown/" target="_blank" rel="noopener noreferrer">Three Nepalis have died with coronavirus</a> since the pandemic hit Nepal. But that is the number of mothers who died every day across Nepal at childbirth. Despite dramatic strides in reducing the <a href="https://www.nepalitimes.com/here-now/who-will-save-nepals-poor-new-mothers/" target="_blank" rel="noopener noreferrer">maternal mortality</a> rate, 1,200 mothers still die while giving birth every year.Government statistics show that this number has risen dramatically in March and April, as women avoid hospitals because of the COVID-19 scare, as well as because of the lack of transport during the lockdown.The 29-year-old woman from Sindhupalchok, whose name has not been released, died on 16 May of post-partum sepsis and a <a href="https://www.nepalitimes.com/here-now/bhaktapurs-covid-19-heroes/" target="_blank" rel="noopener noreferrer">coronavirus infection</a> 10 days after safely delivering her baby at Teaching Hospital in Kathmandu, then returning home. There were delays in taking her to hospital after complications because the family could not find an ambulance.Even before the COVID-19 crisis, one of the reasons far too many Nepali women still give birth unsafely at home was the <a href="https://archive.nepalitimes.com/regular-columns/Comment/mothers-in-Nepal-still-dying-at-childbirth,1007" data-saferedirecturl="https://www.google.com/url?q=https://archive.nepalitimes.com/regular-columns/Comment/mothers-in-Nepal-still-dying-at-childbirth,1007&amp;source=gmail&amp;ust=1590230096851000&amp;usg=AFQjCNHGPAy4FgQc1EbtnlKIZJMxrFl6XA">high cost of ambulance</a> to take them to health facilities.Nepal has made <a href="http://archive.nepalitimes.com/article/nation/people-politics-placentas-child-delivery-complications,3922" target="_blank" rel="noopener noreferrer">progress in reducing maternal mortality</a> and <a href="https://www.nepalitimes.com/banner/born-in-nepal/" target="_blank" rel="noopener noreferrer">newborn deaths</a> thanks to the Safe Motherhood program, for which it received global recognition. But that improvement was nowhere enough to conclude that the job was done and the country could rest on its laurels.Figures show that in 1990, 901 women died per 100,000 births. That number was slashed to 239 per 100,000 live births in 2015. Yet the target for 2030 under the global Sustainable Development Goals is less than 70.If the health of pregnant women is still a government priority it has not been obvious during the lockdown. Pregnant women have been too fearful to visit clinics for crucial antenatal checkups, but by now arrangements should have been made for them to do so safely — or alternatives put in place — and those plans communicated to women.Of course, post-partum mothers are not the only Nepalis dying because of the broken health system. <a href="https://www.nepalitimes.com/here-now/kidney-patients-dying-due-to-covid-19-lockdown/" target="_blank" rel="noopener noreferrer">Non-communicable diseases </a> NCDs) are now the cause of most deaths in the country, led by heart disease, lung disease and stroke, but an NCD Multisectoral Action Plan spanning 2014-20 has yielded no visible results.The main causes of maternal mortality include post-partum bleeding, unsafe abortions, high blood pressure and post-delivery infection. Abortions aside — because there is still stigma attached to having one and a lack of knowledge about their legality — the other causes are treatable.Some initiatives have been taken. The President’s Women Uplift Program has used helicopters to rescue dozens of pregnant or post-partum mothers in emergency situations and many local governments have started programs to cajole or coerce women to give birth in facilities andto properly care for themselves and their newborns in the crucial days following delivery. But too many health facilities that should be providing services to pregnant women remain <a href="https://www.nepalitimes.com/here-now/who-will-save-nepals-poor-new-mothers/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/who-will-save-nepals-poor-new-mothers/&amp;source=gmail&amp;ust=1590230096851000&amp;usg=AFQjCNEb9E7sQYw1XzmTTnMfGji3UmNybQ">under-staffed, ill-equipped and short of medicines</a>, and there is no visible national action plan, certainly no sense of urgency.Contrast media coverage of deaths of new mothers with those of women and girls practising chhaupadi in far western Nepal. Temporarily exiled from their homes during menstruation or after giving birth, they are at risk of snakebite, asphyxiation in tiny, windowless huts, and rape and physical assault. While outlawed, the practice continues.In recent years chhaupadi has been reported widely in Nepal and garnered numerous headlines in major global media. Yet, while roughly 15 women have died in <a href="https://www.nepalitimes.com/opinion/tipping-point-on-menstrual-banishment-in-nepal/" target="_blank" rel="noopener noreferrer">chhaupadi</a> in Nepal since 2010, there have been 15,000 women who died in that time from causes associated with giving birth. For much of the media, death during pregnancy has become too routine to deserve coverage.The prime minister was right to admit failure over the COVID-19 deaths to date: his government <a href="https://www.nepalitimes.com/latest/has-nepals-lockdown-just-postponed-covid-19/" target="_blank" rel="noopener noreferrer">has had ample time to craft a much more effective response, and has not</a>  The deficits in the health system overall have been evident, and discussed, throughout the decades that the prime minister and his colleagues in all parties have been in power. That deserves an admission of failure, followed by corrective action.

3 Nepali mothers still die daily at childbirth

After a week of violent and destructive protests, Nepal’s President Ram Chandra Poudel on Friday appointed <a href="https://archive.nepalitimes.com/regular-columns/Legalese/justice-in-chief,804">former Chief Justice Sushila Karki</a> as a caretaker Prime Minister to lead an interim citizens' government.&nbsp; Poudel had been in <a href="https://nepalitimes.com/news/what-next-nepal">closed-door discussions since Thursday</a> with youth members who spearheaded the protests, constitutional experts, the House Speaker, and the Army Chief. There was a consensus on the choice of Karki as candidate for interim prime minister, but her swearing-in was stalled due to a disagreement about Constitutional processes for her appointment.&nbsp; Youth delegates and Karki demanded that Parliament be dissolved before the appointment of the caretaker prime minister, while President Poudel had been arguing that Parliament would be automatically dissolved once the new council of ministers announced elections. Representing the GenZ movement, <a href="https://nepalitimes.com/here-now/who-or-what-is-hami-nepal">Sudan Gurung</a> (pictured, below) is said to have insisted that dissolution of Parliament first was non-negotiable because he did not trust the political parties. He is said to have added that he would call his supporters out into the streets, and the President relented. The military’s warning earlier that an emergency would be declared if there was no agreement tonight clinched it.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025091216098_cdd409c5824b578a04f05a43280e3f475d92bf7123d3a4565b4d720768fcc1b3.jpg" data-media-id="editor_3" data-image-id="2025091216098_cdd409c5824b578a04f05a43280e3f475d92bf7123d3a4565b4d720768fcc1b3" data-rendition-name="original" width="1080" height="600" loading="lazy" alt="Sudan Gurung"> <figcaption>Sudan Gurung of Hami Nepali during negotiations.</figcaption> </figure>  With this, Karki becomes Nepal’s first female prime minister, exactly a decade after she became the <a href="https://archive.nepalitimes.com/article/interview/a-woman-is-as-capable-sushila-karki,3375">country’s first female chief justice in 2016</a>.&nbsp; Nepalis, still shocked by the <a href="https://nepalitimes.com/news/nepal-s-8-september-massacre">death and destruction of the past week</a>, heaved a sigh of relief at the announcement, which was greeted as a victory of youth power for political reform led by the GenZ movement. Its initial anti-corruption protest on 8-9 September <a href="https://nepalitimes.com/news/kathmandu-burns-despite-pm-resignation">spiralled out of control into violence and arson</a> nationwide that claimed at least 51 lives. Several other candidates were floated for the caretaker prime minister’s post. Kathmandu Mayor Balen Shah and former head of the electricity utility Kulman Ghising were being considered, but both declined possibly because they want to contest the next national elections. Given her experience in the judiciary and zero tolerance for corruption, Karki was the favourite of various groups within the GenZ campaign.&nbsp; The site of the negotiations moved to the official residence of the president in Shital Niwas from the Nepal Army Headquarters on Thursday. The Army had come under criticism on social media and from civil society for detaining the President and not letting him speak or be a part of the negotiation.&nbsp; This fuelled public perception that the military had a soft spot for a return of the monarchy. There were widespread rumours on Thursday that king Gyanendra, who was ousted after the abolition of the monarchy in 2008, was trying to stage a comeback by piggybacking on the agitation. Writing on X, senior journalist Kishore Nepal revealed that the Chief of Army Staff Ashokraj Sigdel had allegedly asked Poudel to step aside and pave the way for the military to negotiate, to which the President is said to have replied: “I will not resign. Kill me instead and blame it on the protesters. Then you can do whatever you like.” Live broadcast of swearing in of Sushila Karki:&nbsp; <div class="embed-block"><iframe width="560" height="315" src="https://www.youtube.com/embed/53go4OxuOa0?si=Zd89QGIAX8-7Bm75" title="YouTube video player" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share" referrerpolicy="strict-origin-when-cross-origin" allowfullscreen></iframe></div>  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025091219094_41b0f97a5925ab6969e1413636bf073ae43262893a55d9c177cb1312dea52f0d.jpg" data-media-id="editor_8" data-image-id="2025091219094_41b0f97a5925ab6969e1413636bf073ae43262893a55d9c177cb1312dea52f0d" data-rendition-name="original" width="1280" height="851" loading="lazy" alt="Sushila Karki swearing in"> <figcaption>President ram Chandra Poudel swearing in Sushila Karki as the 42nd Prime Minister of Nepal.</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025091303098_8f2b6f98898c4cd73c271caa51b8e29d679a7385c249380aeb96d7cc2c3f6dba.png" data-media-id="editor_9" data-image-id="2025091303098_8f2b6f98898c4cd73c271caa51b8e29d679a7385c249380aeb96d7cc2c3f6dba" data-rendition-name="original" width="1480" height="924" loading="lazy" alt="Sushila Karki PM"> <figcaption>GenZ representatives with new Prime Minister Sushila Karki after her swearing in.</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025091301098_470dbca4f4d34ca4533ce4d160045ffe8e525e98380f6f1e20eb24a6236c6029.jpg" data-media-id="editor_10" data-image-id="2025091301098_470dbca4f4d34ca4533ce4d160045ffe8e525e98380f6f1e20eb24a6236c6029" data-rendition-name="original" width="2048" height="1365" loading="lazy" alt="Sushila Karki PM"> <figcaption>Sushila Karki with supporters including Genz representative Sudan Gurung of Hami Nepal and Sumana Shrestha of Rastriya Swatantra Party.</figcaption> </figure>  COURAGE AND INTEGRITY Sushila Karki served as the chief justice between 11 July 2016 to 6 June 2017, and has been known for her frugal ways. She was a firebrand judge unafraid to ruffle powerful feathers, and as chief justice was behind ruling to impeach for abuse of office a powerful head of Nepal’s anti-graft body in 2016. She wrote that he had ‘<a href="https://archive.nepalitimes.com/regular-columns/Legalese/the-end-of-karkistocracy,827">neither the moral character nor qualifications for the post</a>’. Even before she became Chief Justice, Karki was one of the two judges on the bench that convicted the sitting Minister for Information and Communication, Jaya Prakash Gupta, of corruption in 2012. Then in 2016, a bench including Karki ruled against granting amnesty to former Maoist lawmaker and convicted murderer Bal Krishna Dhungel. Karki was born on 7 June 1952 in Biratnagar. She completed her undergraduate studies at Mahendra Morang College in 1972 before obtaining a postgraduate degree in political science from Banaras Hindu University in India three years later. This was followed by a Bachelor's in Law in 1978 from Tribhuvan University, and she started her law career as an advocate a year later. In 1985, Karki worked as a teacher at Mahendra Multiple Campus in Dharan, and was jailed for participating in the 1990 People’s Movement to overthrow the Panchayat absolute monarchy. She became a senior Advocate at the Nepal Bar Association in 2008 and was appointed an Ad-Hoc Justice at the Supreme Court in January 2009.&nbsp; On Thursday, there were supporters for other candidates for the post sloganeering against Karki’s nomination outside the Army Headquarters. Some on social media were also skeptical of her connection to the Nepali Congress (NC) party. Growing up in Biratnagar Karki was close to the family of B P Koirala, Nepal’s first elected prime minister in 1960. Her husband Durga Subedi was part of a group of underground Congress activists who hijacked a Royal Nepal Airlines plane in 1973, flying it to India to snatch cash belonging to Nepal Rastra Bank in the cargo hold.&nbsp; The money was used for the party’s pro-democracy campaign. Karki has no love lost for the political establishment. In April 2017, the governing coalition under Maoist Prime Minister Pushpa Kamal Dahal <a href="https://archive.nepalitimes.com/article/editorial/lady-justice-sushila-karki,3693">submitted an impeachment motion against her</a> after the Supreme Court overturned his decision to install a favoured police chief, violating succession based on seniority. It was a political move backed by Dahal’s coalition partner Sher Bahadur Deuba of the NC who was waiting to become prime minister for the 4th time. CHALLENGES AHEAD With Karki now in charge of the interim government, she has the daunting task of forming a council of ministers made up of amorphous and disparate groups from the GenZ, technocrats, and current politicians. Karki has said she will not prevent members of her cabinet from contesting elections, which means those with electoral aspirations like Kulman Ghising, Balen Shah and Sumana Shrestha could be asked to join. Karki has her work cut out as she has to get her team members to pull in the same direction to hold free and fair elections. She also has to make sure she has the support of the military without giving the generals too much say, while also smartly maneuvering Nepal’s precarious geopolitical ties with its giant neighbours, China and India. But most of all, the new prime minister must lay the foundations to not just physically rebuild the judiciary, executive and legislature but also ensure that elections will produce a more accountable and efficient government. Read also: <a href="https://nepalitimes.com/editorial/trial-by-fire">Trial By Fire</a>, Editorial

Madam Prime Minister of Nepal

One Friday night last month, we were swapping stories about Vipassana, a rigorous <a href="https://nepalitimes.com/opinion/comment/practicing-mindfulness-in-schools?fbclid=IwAR2X1T9SNG1tWe61UPqMUgHjOWNZ4U1foJyURLJMrjYAsUdr4u_mz1rmC1U">meditation</a> technique of silent observation, over dinner. We spoke of its ten days of noble silence, of respiration, observation, and sensation.&nbsp; I told them about my first retreat in Lumbini last year when my mind kept getting distracted: ‘What is happening in the outside world? Is <a href="https://nepalitimes.com/here-now/those-were-the-days-knea0341">K P Oli still prime minister</a>? When I emerged ten days later, he was still PM. During my second Vipassana in February this year, I reassured my mind that nothing dramatic could unfold in ten days. Still, my gut knew this country was always one headline away from <a href="https://nepalitimes.com/editorial/trial-by-fire">revolution</a>. By my third retreat, I was confident, even cocky.&nbsp; At that dinner, I joked: “What could possibly change? If Oli survived my first two meditation retreats, the world can hold steady for a third.” I should’ve known better. On 1 September, I was back at Shivapuri for the second time, my third retreat, with no expectations — only hope that ten days of noble silence would peel yet another layer from my mind.&nbsp; Vipassana is a paradox: brutally difficult, yet infinitely generous. It is the tool needed to tame and know your unconscious mind, and to know yourself even a little through it is a profound achievement. My room at Z House had the best view of the Kathmandu Valley. I developed a ritual: press my hands against my cheeks and stare down at the city. The city below looks chaotic, but somehow beautiful in its stubbornness, where pollution and pride coexist. From up there, it looked like no one was free, trapped in their egos, pettiness and misery.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250913090920_9e77930ed911289c05a731605157f402c06249347e33964dc59c58d32dc2a6d6.jpg" data-media-id="editor_3" data-image-id="20250913090920_9e77930ed911289c05a731605157f402c06249347e33964dc59c58d32dc2a6d6" data-rendition-name="original" width="3000" height="1300" loading="lazy" alt="Vipassana during Nepal revolution"> <figcaption>Those undergoing Vipassana in Sundarijal had no idea of the chaos and mayhem the country was undergoing. Photos: AARSALA ADHIKARI(Photo: Sonia Awale)</figcaption> </figure>  Then, softer thoughts of Metta and compassion would emerge. If only every single person could sit in silence and know their breath, just once. Blessed with ten days of Dhamma teachings on universal law, I imagined our 334 patriarchal parliamentarians and the <a href="https://nepalitimes.com/editorial/house-of-cards?%2F">Oli, Deuba, Prachanda trinity</a>. UNSEEN CHAOS On the seventh and the eighth days of Vipassana (8–9 September) there was <a href="https://nepalitimes.com/news/kathmandu-burns-despite-pm-resignation">black smoke rising from the Valley </a>below. Why were people burning all that garbage? There was no traffic on the straight road down from Budanilkantha. There were gunshots, and I assumed locals were shooting at marauding monkeys. I mistook the sound of helicopters at night for flights circling after takeoff.&nbsp; On the ninth day and in the morning of the tenth, it rained heavily. I tried to spot Dharara like I did every day, but the city was shrouded in a blanket of thick black smog. Even after two days of heavy rain, the smoke had not been washed down. This did not make sense, but my mind had returned to the safe harbour of my meditation. Nothing to see here. On the morning of 9/11, the tenth day, as we emerged from silence, the hall outside filled with chatter. Many people left, weeping, overwhelmed by the experience of the past ten days. We joked about our hardships and dreamt of delicious food, feeling a wave of accomplishment after a documentary about how Vipassana had transformed Tihar Jail in New Delhi.&nbsp; The hall radiated with inspiration and hope. Then, as the film ended an assistant teacher made an announcement: “There are serious protests going on in the Valley. K P Oli has resigned as prime minister. There are no cabinet ministers. The military has taken over, and a curfew has been imposed.”&nbsp; The news hit like a lightning bolt. Mental tranquility gave way to gasps of “What the f**k?” In the main Dhamma Hall, some women erupted in applause. We had spent ten days cultivating Metta, only to step out and realise the world had erupted into chaos. We huddled, trying to piece together fragments of what was happening. The Valley was <a href="https://nepalitimes.com/here-now/nepal-turmoil-will-hit-tourism">still covered in black smoke</a>, the main road was still quiet. A neighbour turned up the radio, reporting deaths, destruction and curfew.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250913050944_ce09e04207ef5eb72ea55800b76df0c16a9d46a3eea957a4ecb0d67e978c2595.jpg" data-media-id="editor_7" data-image-id="20250913050944_ce09e04207ef5eb72ea55800b76df0c16a9d46a3eea957a4ecb0d67e978c2595" data-rendition-name="original" width="1440" height="1200" loading="lazy" alt="Meme doing the rounds on social media"> <figcaption>Meme doing the rounds on social media. </figcaption> </figure>  A first-time meditator, Shivani Karn, overheard a neighbour from wall cross telling his son that people had been shot and that he should not go to school any more. She had wanted to flee the Centre, but stayed on. Stranded foreigners from Argentina to China were bewildered and terrified. Volunteers debriefed us, recounting the shocking details: buildings burning, ministers’ houses ransacked, Oli fleeing, Deuba and his wife beaten up. The leaders were all in the Shivapuri barracks up the mountain. Over 15,000 inmates had broken out of prison. It was a catastrophe unfolding in real time. The city felt ripped out from a nightmare. In the common space, people complained about <a href="https://nepalitimes.com/news/nepal-s-gen-z-protest-turns-deadly">corruption and the ban on social media</a>. But an understanding emerged: both those in power and those who grant it are bound by the law of cause and effect. Driving down from Shivapuri on the morning of 12 September, my heart sank. The smog I had seen was smoke from still smouldering buildings. It was not garbage burning, but the rage of the people. Those were not people scaring away monkeys, but guns that killed innocent lives. The sound of aircraft were actually helicopters rescuing politicians.&nbsp; We drove past Singha Darbar, a charred ruin. Another Vipassana meditator, Anjali Baidya, shared a chilling memory. She recalled being 12 years old in 1973, watching from her home in Makhan Tole as Singha Durbar first caught fire. History had repeated itself 52 years later.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250910140912_e6bf05bfe95f519e05ab8d9016587211b241340fd23a0f9ae728e74747fc5f29.jpg" data-media-id="editor_9" data-image-id="20250910140912_e6bf05bfe95f519e05ab8d9016587211b241340fd23a0f9ae728e74747fc5f29" data-rendition-name="original" width="8064" height="6048" loading="lazy" alt="Nepal in ashes"> <figcaption>Singha Darba, the seat of the government, set ablaze on 9th September. Photo: KAMAL PRASAI</figcaption> </figure>  One Bhatbhateni supermarket after another were scorched, police stations, government offices, once symbols of everyday life. There were soldiers everywhere, not police. &nbsp;Amidst the devastation, a deeper truth settled in. This, too, was Anicca — impermanence. Anicca teaches us that all things are constantly changing, including our thoughts, emotions, and physical sensations. Political systems, power structures, national crises are all transitory. This understanding is crucial for healing. When we cling to the idea that a leader, political system or ourselves are permanent, we set ourselves up for disappointment and anger when it inevitably changes. The Dhamma teaches that responsibility is shared. The anger and fear on the streets are similar to feelings many carry inside. We Nepalis have intergenerational trauma. What I saw was not an abstraction: the gunshots and chaos echoed the terrifying nights of 1 February 2005 in Panauti, a grim replay of the fear I knew as a child at Malpi school, huddling with friends for safety.&nbsp; Read also: <a href="https://nepalitimes.com/news/what-next-nepal">What next, Nepal?</a>, Shristi Karki Our national history is a series of ruptures that become personal landmarks. I was nine years old at my aunt’s birthday party on 1 June 2001, when the celebration was abruptly called off and we were sent home into the silent shock of a royal massacre.&nbsp; This pattern must be broken, and it starts now. The path to national healing must begin with individual healing. We can learn from the story of Angulimala, a violent figure who was transformed by the Buddha’s compassion. The Buddha walked steadily toward him and said, “I have stopped, Angulimala. You must stop too.” Angulimala realised the truth, renounced violence, and was enlightened. Cycles of anger and conflict can be softened and transformed. Nepal’s long-term well-being depends on our ability to approach the Dhamma as a pragmatic tool. Inner calm can help us process collective trauma. By cultivating forgiveness and compassion, we can create a stability that begins within. True healing begins when we stop externalising our pain or intellectualising our emotions, and start nurturing our own inner peace. As the dust settles, the true noise begins: the roar within. We are left with a stark choice: remain trapped in this endless loop of rage, or we can deliberately choose to stop. The Dhamma is not some philosophy for a meditation centre; it is the raw truth of our applied wisdom. <a href="https://nepalitimes.com/news/madam-prime-minister-of-nepal">Sushila Karki, Nepal’s first female prime minister</a>, may have emerged as a new ‘messiah’ but we must begin to take responsibility and accountability. Change cannot come from chaos, it is a conscious effort we must make precisely when it feels most impossible.&nbsp; The path forward is not through the streets, but inward — into the ruins of our own self-righteousness. The disparity and deep-seated grudges are the quiet kindling that have brought this new revolution. The rage on the streets is about suppressed dignity, and a burning hunger for justice.&nbsp; It is time to check the recesses of our minds and hearts, sit down, breathe, and to ask: “When do we stop running, and when do we start healing?”&nbsp; Alisha Sijapati is a writer specialising in cultural heritage, and a former Nepali Times correspondent.

Vipassana during a revolution

Violent protests on Monday and Tuesday in Nepal got unprecedented worldwide publicity for Nepal — but not of the kind it would have wanted at the peak of the autumn tourism season which sees more than a third of annual arrivals. Videos on tv and online about the death, destruction and mayhem in Kathmandu have led to some cancellations, especially with scenes of burning internationally branded hotel chains. Thousands of passengers have been stranded in Kathmandu and in destination cities with the 24 hour closure of Nepal’s only international airport. The Nepali diaspora coming home early for the Dasain-Tihar holidays were also impacted.&nbsp; However, despite the unprecedented nature of events this week and the continuing political uncertainty, tourism officials are confident that Nepal will make it through like it did after past crises. Even during the height of the Maoist war, tourists and trekkers were not harmed. “The tourism industry has been through a lot in recent years, such as conflict, pandemic and earthquake. We have always managed to recover, and have learned a lot about how to bounce back,” says Deepak Raj Joshi, CEO of the Nepal Tourism Board. “However, having such situations again and again really hurts our credibility as a destination.”  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250912130952_31a707c5bec9f2ce4968bcec95a3a1e9beb25d6f20772cb7d081d0d1fd4d0dd4.jpg" data-media-id="editor_0" data-image-id="20250912130952_31a707c5bec9f2ce4968bcec95a3a1e9beb25d6f20772cb7d081d0d1fd4d0dd4" data-rendition-name="original" width="4160" height="2773" loading="lazy" alt="Nepal turmoil will hit tourism"> </figure>  Nepal was just bouncing back from the slump brought on by a series of upheavals starting with the earthquake and the Covid-19 lockdowns. The number of international visitors had finally reached pre-pandemic levels, recording 736,562 arrivals from January to August 2025. A series of new hotels including international brands such as Hilton, Marriott and Holiday Inns came up across the country. With the Nepal Army stepping in to stabilise the situation starting Tuesday night and through Wednesday and Thursday, the streets are calmer. Kathmandu airport is back in operation, but arriving passengers have to drive past the charred hulks of government buildings and torched cars. At present there are up to 35,000 foreign tourists in Nepal, many already trekking in the Everest and Annapurna regions. Some of them are in Pokhara, Chitwan and Lumbini.&nbsp; “Many are carrying on with what they came to Nepal to do,” says Joshi, adding that since the airport is open their current situation will steadily resolve itself as the backlog of passengers are handled in the coming week. NTB has organised shuttle services between the airport and hotels for tourists, and these buses had passes to ply even during the 10AM-5PM and 7PM-6AM curfew hours on Thursday. Once a more normal state has been reached, NTB plans to work with the private sector to put out the message that Nepal is back in business and has always been safe for tourists. Indeed, no tourists have been harmed during the protests, and they have not been targeted in past conflicts either. At a hotel in Pokhara protestors backed off when they were told that there were foreign guests, and any disturbance would hurt Nepal internationally. The mob left after breaking a few glasses and some vases and torching swimming pool towels. Foreign Investment However, the negative impact of the protests in the short and long term are undeniable. Visuals of a burning Hilton Hotel has been a powerful deterrent, not just for tourism but also for foreign investors thinking of setting up in a country already infamous for corruption and an unfriendly investment climate. “This will likely deter investors who are interested in building an environment for high-end tourists,” cautions Joshi. The last available Doing Business report by the World Bank that included Nepal was in 2020 where Nepal ranked 94th out of 190 countries, a significant jump from its previous position.Pokhara also saw several governmental buildings including a ward office being vandalised and set on fire. Four hotels and establishments linked to politicians -- Mantra Thakali, Hotel Sarowar, Hotel Pokhara Goodwill, and the recently opened Bagaincha Resort were all attacked. According to Mani Raj Lamichhane, NTB’s Gandaki Province head, most of the violence happened around Pokhara’s New Road area, with a few incidents in Lakeside popular with tourists. “Tourists had already been evacuated when the hotels were attacked, and they are now at Lakeside, waiting for buses to ferry them to the airport,” he adds. A Himalaya Airlines flight from Lhasa that could not land in Kathmandu after the airport was closed on Tuesday afternoon was diverted to Pokhara with 65 passengers. The plane flew back to Kathmandu last night. Lamichhane is not so pessimistic about the future. He says, “Nepal has these situations periodically. We lost the tourists that would have come yesterday, and as we were just going into the season we might lose 10-15% of our business. But we are telling tourists to keep their bookings on hold instead of cancelling them.”He adds: “We really have to put the message out there that despite the violence, tourists are safe and they are left alone to enjoy Nepal’s sights.”

Nepal turmoil will hit tourism

After prolonged negotiations over the weekend, Nepal’s new <a href="https://nepalitimes.com/news/madam-prime-minister-of-nepal">Prime Minister Sushila Karki</a> on Monday appointed three members to her Council of Ministers, but the youth group that put her in power does not like her choice. The GenZ group that initiated the movement that toppled Nepal’s government accused Karki of not being consulted about the choice of Om Prakash Aryal, a lawyer who was helping with negotiating with the Army, as the Home and Law Minister.&nbsp; GenZ’s purported leader <a href="https://nepalitimes.com/here-now/who-or-what-is-hami-nepal">Sudan Gurung</a> led a group of his supporters and families of youth killed in <a href="https://nepalitimes.com/news/raising-nepal-from-the-ashes">last week’s demonstration</a> at a midnight protest outside the prime minister’s residence, demanding Karki’s resignation unless she listened to them. Aryal is also a legal adviser to Kathmandu Mayor Balen Shah, who has supported the GenZ movement but refused their offer to lead the interim government.&nbsp; The other two ministers include former Finance Secretary Rameshore Khanal as Finance Minister, and the popular former chief of the Nepal Electricity Authority (NEA) Kulman Ghising as the Energy Minister, Urban Development Minister, and Minister of Physical Infrastructure and Transport. They were sworn in on Monday. While Prime Minister Karki has said she wants competent and honest technocrats in the Council of Ministers, GenZ has been pushing for candidates that do not seem to meet her criteria — including a military officer and Mayor Balen Shah’s candidate.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025091511090_f7db633bbf56c5e2a43b6cd248e522365f56cd34578d65cdeca243c65d807f6d.jpg" data-media-id="editor_3" data-image-id="2025091511090_f7db633bbf56c5e2a43b6cd248e522365f56cd34578d65cdeca243c65d807f6d" data-rendition-name="original" width="2048" height="1365" loading="lazy" alt="new ministers being sworn in"> </figure>  Karki’s list is said to include retired Lt Gen Balananda Sharma, &nbsp;Magsaysay Award winner Mahabir Pun of the National Innovation Centre, former Education Minister Sumana Shrestha who quit RSP on Sunday and Dharan Mayor Harka Sampang. Karki met the government machinery on Sunday at her Singha Darbar office. Speaking without a prepared text, she admitted that there had been a “huge loss” not just to government buildings but also to official and court records during the 9 September arson attacks. “I am ashamed to say that there has been a systematic targeting of sensitive and essential government institutions, we will track down the perpetrators and investigate them,” she said. Karki also assured officials that she had no intention of staying on as prime minister beyond 5 March, the date she has set for early elections. She added: “The destruction by criminal elements has added to our challenges, but we have to choose but to unite and rebuild. This movement was about ending corruption, improving governance and equality. Help me achieve those goals.” <h2>KNOW YOUR MINISTERS</h2> Om Prakash Aryal Home Minister, Minister of Law  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250915110916_6bbaa39c523979ea1a3e85bd496232fa0dcb6152718ede106078bb5f3d069c3c.jpg" data-media-id="editor_4" data-image-id="20250915110916_6bbaa39c523979ea1a3e85bd496232fa0dcb6152718ede106078bb5f3d069c3c" data-rendition-name="original" width="960" height="955" loading="lazy" alt="Om Prakash Aryal"> <figcaption>Om Prakash Aryal</figcaption> </figure>  Back in 2016, <a href="https://archive.nepalitimes.com/article/nation/do-gooders-to-watch-out-for,3435">Om Prakash Aryal</a> filed a writ petition against the appointment of all powerful Lokman Singh Karki to the Commission for the Investigation of Abuse of Authority (CIAA), paving way for the impeachment of the head of the anti-graft body together with Prime Minister Sushila Karki, who was then Chief Justice. An advocate at the Supreme Court, Aryal gained widespread fame for his work in Public Interest Litigation. Most recently, earlier this year he filed a petition against then Prime Minister K P Oli and Minister for Land Management Bala Ram Adhikari, among others, for their alleged role in the non-implementation of Supreme Court order in the Giribandhu tea estate land scam in eastern Nepal. Aryal came from Gulmi to Kathmandu to be a singer, but ended up pursuing a career in law instead. Aryal also served four years in the National Human Rights Commission (NHRC), and was based in Geneva with the International Commission of Jurists (ICJ). Rameshore Khanal Finance Minister  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250915110916_1655aeec3a17a048663b95c0dec3ab302300c51d61f6aed682b17fe5c1532c58.jpg" data-media-id="editor_6" data-image-id="20250915110916_1655aeec3a17a048663b95c0dec3ab302300c51d61f6aed682b17fe5c1532c58" data-rendition-name="original" width="1000" height="666" loading="lazy" alt="Finance Minister"> <figcaption>Rameshore Khanal</figcaption> </figure>  Former Finance Secretary Rameshore Khanal has over 30 years of experience in the civil service, and led reforms in government accounting and reporting, public procurements, tax policy and administration. He also served as Chair of the Board in Agricultural Development Bank and was Board Director in Nepal Rastra Bank, Rastriya Banijya Bank, Nepal Telecom Company, and Nepal Airlines. He also served as an economic adviser to Baburam Bhattarai when he was prime minister in 2013. In October last year, <a href="https://nepalitimes.com/news/nepal-in-the-red">he led the government formed</a> the High Level Economic Reforms Recommendation Commission. The 440-page recommendation released last month included review of the fixed exchange rate with India and the provision for national political parties to receive grants so candidates did not have to depend on business donors at election time. He has announced that he is not going to take a salary, official residence, body guard or official car for himself. Kulman Ghising Energy, Water Resources and Irrigation Minister, Urban Development Minister, and Minister of Physical Infrastructure and Transport  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250915110920_7704ba4dd27f06d423852bc9792610cc89acdbee6ff0b380904479c095d328ab.jpg" data-media-id="editor_8" data-image-id="20250915110920_7704ba4dd27f06d423852bc9792610cc89acdbee6ff0b380904479c095d328ab" data-rendition-name="original" width="1057" height="769" loading="lazy" alt="Kulman Ghising"> <figcaption>Kulman Ghising</figcaption> </figure>  The man credited for ending 18-hour-a-day loadshedding in Nepal was also considered for the post of Prime Minister before Sushila Karki was chosen by the GenZ movement on Friday. Ghising is a two-time CEO of Nepal Electricity Authority (NEA) before <a href="https://nepalitimes.com/news/sacking-of-nea-chief-exposes-cronyism">his tenure was cut short</a> by the Oli-led governing coalition earlier this year and replaced by Hitendra Dev Shakya. Ghising’s removal was seen as being politically motivated, and outraged the public and commentators. Many expected Ghising to open his own party ahead of the 2027 elections two years later, but is seen to be close to the Maoist-Centre party. After being appointed NEA chief in 2016, Ghising cut off the dedicated electricity feeds to industries, and redistributed the saved power to the public — ending long power cuts. But he also imported electricity from India to ensure 24-hour supply during the winter dry season to meet demand. Several new hydropower plants came into operation during his tenure, and today Nepal had an electricity surplus.&nbsp; OTHER APPOINTMENTS Elsewhere, Sabita Bhandari Baral has been appointed Nepal’s first female Attorney General.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250915110920_4d60704a1e69309fdfb49a195f538c32159f27748fd2be88693c609ddb98d380.jpg" data-media-id="editor_10" data-image-id="20250915110920_4d60704a1e69309fdfb49a195f538c32159f27748fd2be88693c609ddb98d380" data-rendition-name="original" width="730" height="506" loading="lazy" alt="Female attorney general"> <figcaption>Sabita Bhandari Baral</figcaption> </figure>  By Sunday, total casualties of the nationwide GenZ protests has reached 72. Prime Minister Karki has declared that bereaved families of those killed in the protests will be compensated while hundreds of those still receiving treatment in hospitals will be treated for free. &nbsp;

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