When he was a teenager years ago during the war, the Maoists who held sway over the Dalit village of Muktikot in western Nepal promised Man Bahadur Bishwakarma liberation and prosperity. Many like Man Bahadur believed in that utopia, and took up arms like others from the downtrodden Dalit community here. They even renamed the village Muktikot (Fort Freedom) from its original Dumkot. ‘Dum’ is a derogatory term used to address the Dalit community. Muktikot is spread across a steep mountainside with unirrigated terrace farms. Most of the men migrate to India for seasonal work, others never come back. The women left behind had to walk hours for water, and since there were no roads then, travelling to town for government subsidised rice took at least a week. “The Maoists told us that we would find jobs right here in the village, that every household would have tap water, they promised an end to caste discrimination,” recalls Man Bahadur. “That is why I joined the revolution in Grade 10.” He is talking while walking up a steep trail three hours from Muktikot, where his family has been living in a cattle shed after a landslide damaged his house in 2021.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2024051804058_bc4d26d047714332fcdd2242229a1227d207a972439e02e3c822aaa118066b3f.jpg" data-media-id="editor_0" data-image-id="2024051804058_bc4d26d047714332fcdd2242229a1227d207a972439e02e3c822aaa118066b3f" data-rendition-name="original" width="1600" height="1200" loading="lazy" alt="Muktikot"> <figcaption>Th remote village of Muktikot in Bajura district in far west Nepal.</figcaption> </figure>  Most of Muktikot’s young population joined the Maoists, convinced that changing the name of the village was proof this was going to be a real revolution. Eighteen years after the end of the conflict, the only thing that has changed for the nearly 2,300 Dalits in Muktikot is the name of their village. Not that there has not been some progress. There are now motorable roads and residents do not have to walk as far as Kalikot or Dailekh to get a sack of rice. More essentials are available in local shops for those with cash. Man Bahadur himself migrates to India to earn money, and had just returned for a break when we talked to him. “I fought for the Maoists in the hope that I would not have to go to India for work, but there are still no jobs here,” he says. “The Maoists promised a mirage.”  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2024051804058_fcd64c34f689e7a4d44f285bb6a7b6b28329941e2766440ab208c9039a855d31.jpg" data-media-id="editor_1" data-image-id="2024051804058_fcd64c34f689e7a4d44f285bb6a7b6b28329941e2766440ab208c9039a855d31" data-rendition-name="original" width="1600" height="1200" loading="lazy" alt="Muktikot"> <figcaption>Men in Muktikot preparing to migrate to India for work.</figcaption> </figure>  Birth and death Manbuja Bishwakarma has just turned 20, the minimum legal age of marriage in Nepal. But she has been married since age 13, giving birth to five children, three of whom died. “The babies just died one after the other,” recalls Manbuja, who just had to have more babies in the hope that some would survive. Read also: <a href="https://nepalitimes.com/banner/how-the-climate-crisis-adds-to-child-marriage-in-nepal">How climate crisis adds to child marriage in Nepal</a>, Sonam Lama Her neighbour, 30-year-old Lalkala Bishwakarma has given birth eight times, and only four babies survived. There are women in Muktikot who gave birth to as many as 14 children, and there is not a single mother in Muktikot who has not lost a baby.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2024051804058_dd4d62e65cc4ac88cd46a91a62b9c60bcb2d43bbc5cb5455dc7efe4a7d2ff1b2.jpg" data-media-id="editor_3" data-image-id="2024051804058_dd4d62e65cc4ac88cd46a91a62b9c60bcb2d43bbc5cb5455dc7efe4a7d2ff1b2" data-rendition-name="original" width="1600" height="1200" loading="lazy" alt="Muktikot"> <figcaption>Lalkala Bishwakarma</figcaption> </figure>  Tilakhuni Bishwakarma, 40, had 10 children, and eight of them survived. Sitting outside her home, she is now surrounded by her grandchildren. Despite Nepal’s total fertility rate now dropping to near replacement level, here in Muktikot infant mortality is still high and this means women have more babies in the hope that some will survive. Child marriage and low female literacy contribute to the high rate of maternal and infant mortality. Community health records show that even in 2021, eight out of 45 infants born in Muktikot died. While Nepal’s average infant mortality rate dropped to 33 for every 1,000 babies born in 2022, &nbsp;the rate was 178 in Muktikot. “The most prominent among the many reasons for the high maternal deaths are early marriage and frequent pregnancy,” says Janaki Neupane, a community nurse in Muktikot. &nbsp; Four years ago, Bachchi Bishwakarma died of a hemorrhage while giving birth to her second child at home. Her husband Gorkha says she had barely survived giving birth to their first child. “I was home alone that day, and I took care of her,” Gorkha recounts. “Our child was born, but my wife bled to death.”  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240518040512_4718183318c77de8bb9b719346b9b19c96bef0984055585b00884f741f905c2e.jpg" data-media-id="editor_4" data-image-id="20240518040512_4718183318c77de8bb9b719346b9b19c96bef0984055585b00884f741f905c2e" data-rendition-name="original" width="1600" height="1200" loading="lazy" alt="Muktikot"> <figcaption>Tilakhuni Bishwakarma</figcaption> </figure>  Birthing centres were opened in Muktikot last year to address high infant and maternal deaths, but Nurse Neupane says it still lacks basic equipment and budget. Nirmala Bishwakarma got married when she was 13 and was &nbsp;pregnant soon after. She had her first baby, but soon got pregnant again. “Birth brings death here,” Nirmala, now 20, says simply. Nirmala and her children all look emaciated and she weighs only 33kg. Bajura’s district headquarters in Martadi provides nutritional allowance, but Nirmala cannot afford to travel that far to get it. &nbsp; Nepal’s development indicators, including lifespan (page 1) and poverty rate have shown dramatic improvements over the past three decades. But here in Muktikot, hunger stalks the land. In fact, a recent survey showed that 95% of women, children and young adults in Muktikot are undernourished. Most men, on the other hand, look well fed because they are mostly away in India for work. &nbsp; Only 12% of the land in Bajura is arable, but even then there is lack of irrigation, frequent droughts, and now climate breakdown contributing to the lack of food. “The harvests are just not enough to sustain the families,” says Bharat Bahadur Rokaya, chair of Swamikartik Khapar Rural Municipality where Muktikot is located. Here in the rugged mountains of northern Bajura bordering Humla and Mugu, the families grow millet, maize, and wheat, but Nirmala Bishwakarma says the harvests hardly last a month. “If it was not for the subsidised rice we would have empty stomachs,” she says. Hindrances to hygiene Down the mountain from Muktikot, the green waters of the Karnali River are visible. But the 400 Dalit households here have to share just three community taps for drinking water. Half the households do not have toilets, and defecation in the open is common. Donor agencies have helped build toilets, but these are mostly used to store fodder because there is no water. “How can we use water for the toilets where there isn’t enough for drinking?” asks Ward chair Ajay Bishwakarma. &nbsp; Families have to walk for four hours to bathe and do washing. “We do not wash our clothes for months on end,” says Kushi Bishwakarma, 40.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240518040516_e234d5b4fac4fa24e62e65a35f2eafbfb044a32a5f8ef8172932eca96eeaa17b.jpg" data-media-id="editor_5" data-image-id="20240518040516_e234d5b4fac4fa24e62e65a35f2eafbfb044a32a5f8ef8172932eca96eeaa17b" data-rendition-name="original" width="960" height="733" loading="lazy" alt="Muktikot hygiene"> </figure>  The lack of water has compromised hygiene and sanitation in the village, resulting in diseases like diarrhoea, allergies, and other health issues, especially among children. Lack of water in the village has also led to uterine prolapse among the women in Muktikot since they primarily face the task of ferrying heavy jars of water from the communal taps to their houses The ‘One house, one tap, one toilet’ campaign introduced by the rural municipality this year hopes to solve water-related issues for Muktikot residents. But that is yet another election promise. Testing times This underserved village is not just affected by structural inequality and state neglect. In 2021, a landslide swept away 54 houses in Muktikot, and most families lost homes and what little arable land they had. “Earlier, we at least had a house to live in, now we don’t even have that,” says Muktikot resident Asal Bishwakarma. “We have been living with relatives since. How will we survive?” More than two years after the landslide, not a single house in the village has been rebuilt. Each family was allocated Rs500,000 in relief on an instalment basis, with aid from all three tiers of government.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240518040516_26ebf9b2f52722180b1b403b1410f19ea5c7d0321047b099a574a35519706914.jpg" data-media-id="editor_6" data-image-id="20240518040516_26ebf9b2f52722180b1b403b1410f19ea5c7d0321047b099a574a35519706914" data-rendition-name="original" width="1200" height="1433" loading="lazy" alt="Muktikot landslide"> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240518040516_bbe50221dca556ac0e798843d672f1190abafacb82fa792bfec289eeb31ad013.jpg" data-media-id="editor_7" data-image-id="20240518040516_bbe50221dca556ac0e798843d672f1190abafacb82fa792bfec289eeb31ad013" data-rendition-name="original" width="1600" height="1200" loading="lazy" alt="Muktikot landslide"> </figure>  Asal has only received Rs35,000 so far, and has spent it all on buying food. No one knows where the promised money went. Muktikot residents now want their entire village relocated somewhere safer. &nbsp;The local government agrees that resettlement is necessary, but it was unable to find a suitable alternative. “It is not possible to resettle such a large number of people at one go,” says Bajura MP Badri Pandey. “We also cannot create jobs for all of the population at once.” Muktikot might have been declared liberated on paper during a war fought in the name of Nepal’s downtrodden, but this Dalit village is emblematic of promises not kept. Looking around the landslide scarred village he has spent half a century of his life in, Muktikot’s Dhanajay Bishwakarma laments, “We are not even considered humans by the state.”

original

674x448

610x380

500x500

400x266

400x240

400x203

301x200

1250x600

1084x550

thumbnail

viewImage

Muktikot still waiting for liberation

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.

Saving more mothers and babies

Like any mother, Sharmila Chadara just wanted to get home to see her child. It was this primal urge, and other unrelated factors, that directly resulted in her death on the night of 24 November. It was easy for journalists to assume that she had died from ‘the cold’ following the <a href="https://nepalitimes.com/news/deadly-earthquake-hits-w-nepal">earthquake on the night of 3 November</a> that killed 150 people outright in Jajarkot and Rukum West. Many of Sharmila’s neighbours in Ward 4 of Nalgad Rural Municipality and the surrounding mountains were forced to sleep outdoors after their houses collapsed.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240102150116_b6edcb6e1b6f52540dfdbc84bdbc23a1701dc9b1f113b7d5da30cf7f8e277898.png" data-media-id="editor_1" data-image-id="20240102150116_b6edcb6e1b6f52540dfdbc84bdbc23a1701dc9b1f113b7d5da30cf7f8e277898" data-rendition-name="original" width="1500" height="1125" loading="lazy" alt="Jajrkot earthquake"> <figcaption>Damaged homes in Nalgad, Ward 1. Many locals are living in tents, below. All photos: MARTY LOGAN</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240102150116_d992b10f8725c5d0415191b0606b33f23c2cff8941e495199a2cea5528542da6.png" data-media-id="editor_2" data-image-id="20240102150116_d992b10f8725c5d0415191b0606b33f23c2cff8941e495199a2cea5528542da6" data-rendition-name="original" width="2000" height="1500" loading="lazy" alt="Jajarkot earthquake"> <figcaption>Tents in Nalgad Municipality, Ward 1, Jajarkot. Occupants had their houses destroyed or damaged in the November 3 earthquake.</figcaption> </figure>  A local politician was quoted saying that Sharmila had become the latest post-earthquake victim because she was sleeping under a flimsy plastic sheet as night temperatures dropped. The <a href="https://annapurnapost.com/story/447108/">news was picked up by the media</a>, and there was outrage across the country. Read also: <a href="https://nepalitimes.com/here-now/jajarkot-one-month-after-the-earthquake">Jajarkot: One month after the earthquake</a>, Ramu Kharel and Maggie Doyne Had she survived, Sharmila Chadara would probably be sleeping inside the tiny home of her husband Dinesh in Nalgad located down a dusty path, a 15-minute walk from a narrow road. It was damaged but is habitable.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240102150116_1e7562050e0b55135f28e96726d6a003c699dbf02214b3849c38e64540b7cfd8.png" data-media-id="editor_5" data-image-id="20240102150116_1e7562050e0b55135f28e96726d6a003c699dbf02214b3849c38e64540b7cfd8" data-rendition-name="original" width="2000" height="1500" loading="lazy" alt="Jajarkot earthquake"> <figcaption>The home where Sharmila Chadara lived in Nalgad Municipality. It was damaged in the earthquake but is still habitable.</figcaption> </figure>  Dinesh, 26, sheltered from the sun against the house as he told us about Sharmila’s final trip home. It was on Dasain Tika day in early November when Sharmila felt labour pains and they took a vehicle down to the local hospital.&nbsp; There were no doctors and the couple was advised to go to the hospital in Khalanga, where doctors in turn referred them to Surkhet. Sharmila had twins and it would be a risky delivery.&nbsp; In Surkhet, she delivered the first baby, a girl. The boy was born lifeless. The doctors advised them to keep the girl in the hospital so she would gain weight. After five days, staff noticed that Sharmila, who till then seemed healthy, developed a cough. They diagnosed severe pneumonia and put her in the ICU. But fluid built up in Sharmila’s lungs and she underwent dialysis, recalled Sakuntala Sapkota, the matron at the Surkhet hospital. “She had many ups and downs,” Sapkota told me. Sharmila had five dialysis treatments as she was shuttled back and forth between ICU and the general ward. At one point a doctor told Dinesh and relatives they might not be able to save Sharmila because her body was “completely infected”. After nearly three weeks, Sharmila had enough. She was missing her son and wanted to return to Jajarkot. But staff urged her to stay two more weeks until she was fully recovered. In Ladakh Three years earlier, Sharmila had travelled to Ladakh where Dinesh was working, as were her own parents. It is normal for at least one member of each household in Jajarkot and surrounding districts to migrate for work in India and beyond. Increasingly, many are taking illegal routes destined for the US. In Athbiskot Municipality we met one woman whose brother had been gone a year, and had only made it to Turkey after paying traffickers Rs10 million.&nbsp; Sharmila stayed and worked alongside her husband at a cement factory in Ladakh, returning for the first time this past Dasain. Dinesh remembers her falling ill in India and coughing up blood. A local doctor diagnosed it as ‘weakness’ and gave her medicine.&nbsp; “But she didn’t finish it,” her husband told us. “She never finished medicine, even vitamins. I don’t know why she was like that.” A neighbour remembers Sharmila as being honest and friendly. She did not like working in Ladakh, she added, but the pressure to earn money must have been strong. At the hospital in Surkhet, Sharmila threatened to pull out her IV drip, remove her oxygen mask, and die in her hospital bed if she was not taken home. Dinesh relented and booked an ambulance for the family’s return trip to Nalgad. The oxygen ran out on the way. “I was not even sure if she was breathing,” he recalled. When they reached the hospital emergency in Radi Bazar at 2AM her vital signs were nil, staff told him. Sharmila had died. Dinesh wanted to take her home. He hired a vehicle to carry her to the foot of the hill and rounded up people in the dead of night to carry her on a stretcher, reaching home at 4AM. Sharmila was finally reunited with her son.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240102150120_2713c13b4d2ba22fe28bc1bf96cfbcfd87a7ede9cc67678b67d69efbe4a4d851.png" data-media-id="editor_6" data-image-id="20240102150120_2713c13b4d2ba22fe28bc1bf96cfbcfd87a7ede9cc67678b67d69efbe4a4d851" data-rendition-name="original" width="1125" height="1500" loading="lazy" alt="Jajarkot earthquake"> <figcaption>Dinesh Chadara with his son Ganesh at home in Nalgad Municipality recently.</figcaption> </figure>  Dinesh told us he has not made up his mind about returning to work in India. His in-laws have given him Rs150,000 to pay medical bills and he has borrowed more, but was still in debt. Sharmila’s baby has been released from hospital, and continues to gain weight and get routine vaccinations.&nbsp; Left out in the cold When we visited Jajarkot and Rukum West nearly two months after the earthquake, survivors were still living in tents and plastic shelters.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240102150124_1efe377bce5e1b8b264308d2378871aba0fc34c13046cabc6fffbdb940c7bb86.png" data-media-id="editor_7" data-image-id="20240102150124_1efe377bce5e1b8b264308d2378871aba0fc34c13046cabc6fffbdb940c7bb86" data-rendition-name="original" width="1500" height="1125" loading="lazy" alt="Jajarkot earthquake"> <figcaption>A health post destroyed in Chinabagar, Ward 1, Rukum West.</figcaption> </figure>  A female community health volunteer (FCHV) in Athbiskot told us she was having trouble finding a good tent for a mother just discharged from a health facility with her newborn. Up the mountain, we reached the house of Seema Chand Malla, 28, who was eight months pregnant. Her brother-in-law was hammering together a door for a wooden shelter while waiting for the government’s Rs 50,000 temporary shelter allowance. Sitting on a windy ridge, Seema said: “It’s very cold, but so far we're OK – let’s see what happens.” Read also: <a href="https://nepalitimes.com/news/below-zero-at-ground-zero">Below zero at ground zero</a>, Durga Rana Magar Like many women we spoke to, Seema seemed to be receiving some, but not all, routine health services. She had gone for six pre-birth (ANC) visits, was taking calcium and iron supplements regularly and had been given medicine to prevent worms. As one of her three children, a son, played on her lap, she said her health was good. The local FCHV used to visit to provide vitamins or information about the children’s health, but Seema had not seen her since the earthquake. The family had received one blanket, a small tent, 25kg of rice and some buckets from the government and various agencies. When we returned from Seema Chand’s house four tractors arrived towing carts piled high with sleeping mats, rice and other goods. We saw such relief deliveries mixed with various stages of reconstruction work across the affected areas.&nbsp; Read also: <a href="https://nepalitimes.com/news/demographics-of-disaster-in-nepal-quake">Demographics of disaster in Nepal quake</a>  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240102150116_7f6c045a4fccc3bb87f6746e702f4db8362b2cfd1d960c55e6ed326fe2bca183.png" data-media-id="editor_10" data-image-id="20240102150116_7f6c045a4fccc3bb87f6746e702f4db8362b2cfd1d960c55e6ed326fe2bca183" data-rendition-name="original" width="1125" height="1500" loading="lazy" alt="Jajarkot earthquake"> <figcaption>Seema Chand Malla, with her son, in Aathbiskot, Ward 14.</figcaption> </figure>  In Radi Bazar a crowd had gathered to get the forms needed to apply for government cash for shelters.&nbsp; <a href="https://nepalitimes.com/news/mass-cremations-for-nepal-quake-victims">The damage</a> seemed mostly random, with single houses on village roads reduced to rubble, but there were also whole clusters of homes that had fallen. On a slope overlooking the scenic, glacier-fed aquamarine Bheri River, there was a line of orange and blue tents. New mother Samjhana Bitalu, 19, crawled out from one of them to tell us that her house nearby was <a href="https://nepalitimes.com/here-now/grief-stricken-survivors-are-cold-and-hungry">damaged in the earthquake</a> and uninhabitable.&nbsp; She and her 55-days-old baby Monika were staying here with her husband, who did not want to leave them alone to return to his job in Khalanga. Samjhana said she gave birth at a nearby health post, but no staff visited her afterwards. The only help the family had received was a tent and 25kg of rice from the Ward office.&nbsp; “When it rains it’s hard to keep the baby dry because the water comes inside the tent, and she has diarrhoea,” the mother said. Following local custom, she did not think the baby should receive any treatment before she was two months old. But a health worker urged Samjhana to get medical care for the baby. “It’s more difficult because I have to manage everything alone,” Samjhana said stoically. “Otherwise, everyone would have been together at home.” Nearby, Amrita Gharti, 22, was still living in her in-laws’ house with her husband. She was almost two months pregnant.&nbsp; Amrita previously had a miscarriage, despite being told by ANCs that she was healthy. This time, arriving at her local birthing facility for her first checkup, she was told to return when she was exactly two months pregnant. “They didn’t do my checkup. They were too busy,” she said.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240102150120_e6d6fd29a04a5c3fa20fc6bd50c2236287fce0b7ddce0e508fefb329644ecf91.png" data-media-id="editor_13" data-image-id="20240102150120_e6d6fd29a04a5c3fa20fc6bd50c2236287fce0b7ddce0e508fefb329644ecf91" data-rendition-name="original" width="1125" height="1500" loading="lazy" alt="Jajarkot earthquake"> <figcaption>Amrita Gharti is pregnant and living in her in-laws' house in Nalgad, Ward 1.</figcaption> </figure>  Aruna Chaudhary of the Radha Paudel Foundation spent two weeks in Nalgad providing menstrual kits to 450 women and adolescent girls.&nbsp; Demand for her support was great and the cold was especially hard on children, she told us.&nbsp; “Many children have pneumonia and cholera and have to take medicine,” she added. “There was lots of diarrhoea and many had injuries from the earthquake itself.”&nbsp; Pneumonia and other cold-related illnesses were also growing in Chinabagar where lack of water and sanitation was worsening the situation, especially for <a href="https://nepalitimes.com/news/remove-barriers-to-life-saving-drug-to-prevent-maternal-deaths">women and adolescent girls</a>. Dhani Kumar Giri from the group WOREC was assisting arrivals at a tent while the group also provided care door-to-door. In a nearby tent an organization was providing psychological counselling to those troubled by the disaster. Some good news Around noon on 6 December, Man Kumari Singh arrived with labour pains at the health post in Athbiskot-4 of Jajarkot. She was pregnant with twins, but had been declared healthy during previous visits to the facility. But by 4PM her labour had not progressed and Man Kumari was starting to shake in distress. Staff decided to request a helicopter rescue, but by the time permission was granted from Kathmandu it was too late in the day.&nbsp; Health post staff decided to send her to the municipal hospital in Dali, but doctors there referred her to the mission hospital in Chaurjahari instead. They sent an ambulance carrying two nurses to accompany her. At 1AM that night Man Kumari’s twins were delivered normally. By noon she had been transferred to the ICU at the provincial hospital in Surkhet. Soon after she was moved to the general ward and by 19 December she had recovered and been discharged. The twins were also reported to be in good health. Author thanks One Heart Worldwide for arranging logistics for reporting on this story.&nbsp;

Poverty killed a mother, not the quake

Remove barriers to life-saving drug to prevent maternal deaths

As a nurse, Anju Chaudhary has to often test the limits of her skills when dealing with <a href="https://www.nepalitimes.com/here-now/another-babys-life-is-saved-in-rural-nepal">complicated pregnancies</a> that arrive at the government hospital here in Katari.&nbsp; She is also the leader of a team of nurses who are on duty for 24 hours a day, seven days a week, caring for patients. Chaudhary has helped deliver over 1,000 babies and <a href="https://www.nepalitimes.com/banner/saving-nepali-mothers-and-babies-district-by-district">prevented the deaths of many mothers and newborns</a>. But no case was as challenging as that of Sharmila Surkheti. One morning in March, the 30-year-old Dalit woman arrived at the hospital, weak and bleeding profusely.&nbsp; “We had never seen a mother in such a near-death situation, but we were prepared, and we got into action immediately to save her life,” recalls Chaudhary. Surkheti had already been pregnant 13 times in her young life. All six of her newborns were delivered at home, and she had undergone seven abortions. Barely a year ago, she had another baby who died at childbirth. Read also: <a href="https://www.nepalitimes.com/here-now/who-will-save-nepal-s-poor-new-mothers">Who will save Nepal's poor new mothers?</a>, Rojita Adhikari This year, she decided to try to risk her own life to try for another son but there was post partum haemorrhage after the baby was born. Her husband helped get her to Katari Hospital while leaving behind the newborn. It was a two hour walk from home. There was no General Physician at the hospital that day so it was up to Chaudhary and her nurse team to save her life. A quick decision had to be made. They used the bundle approach in postpartum haemorrhage (PPH) management to control the bleeding. As a chronic anaemic patient, the mother had a low haemoglobin of only 6.1, which was alarming. To save her life, the nurses planned to take Surkheti to a better-equipped hospital in Gaighat but the family could not even afford transportation. Read also: <a href="https://www.nepalitimes.com/here-now/nepal-s-rural-lifeline">Nepal's rural lifeline</a>, Sonia Awale Her blood pressure dropped alarmingly low, and the nurses immediately created an emergency fund to pay for the private ambulance to reach Gaighat. She also needed blood transfusion, but Surkheti’s husband was malnourished and there were concerns about his health. The nurses then found a male colleague at the hospital who agreed to donate his blood. They closely monitored the mother, and her haemoglobin improved to 8.8. The hospital’s Acting Medical Superintendent, Dr. Gaurab Shah, an MD Pathologist, also put a lot of effort into managing a blood donor.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20230902040916_6d4eb5e618d116e1cbcc72776152080ad55f53e026f67be55044f350d2849c2e.png" data-media-id="editor_4" data-image-id="20230902040916_6d4eb5e618d116e1cbcc72776152080ad55f53e026f67be55044f350d2849c2e" data-rendition-name="original" width="2100" height="1500" loading="lazy" alt="Nurses in rural Nepal"> </figure>  The next day, the nurses gave her iron tablets, B complex, and vitamins and she was sent home. But during a post-natal home visit, the nurses were dismayed to see the utter poverty of the Surkheti’s family, including her husband and six children. Read also: <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 Bhattarai Given her anaemic state and being very weak, Surkheti was unable to produce milk and had been feeding biscuits to her baby which worried the nurses. The family had no money to buy formula milk.&nbsp; So the nurses started collecting cash from their own pockets and started a fundraiser through online requests and on the phone. But there was very little response, and the six nurses put in their own money to save the mother and baby.&nbsp; “The greatest gift for me was to hear the words of gratitude from the mother who survived the ordeal,” says Chaudhary modestly. Despite her training as a <a href="https://www.nepalitimes.com/multimedia/saving-nepali-mothers-on-mother-s-day">Skilled Birth Attendant</a> that she had done many years ago, Chaudhary had no knowledge of uterine balloon tamponade, which can help in the treatment of PPH.&nbsp; After graduating from her nursing education, she was transferred to Bir Hospital where she never got the chance to work with mothers and babies, as she was too busy handling injuries and accidents in the emergency department. It was only after she moved back to Katari Hospital in Udaypur that her career path changed with the help of the non-profit <a href="https://www.nepalitimes.com/banner/what-can-be-more-fulfilling-than-saving-lives">One Heart Worldwide</a> (OHW). She received an invitation from OHW to attend its Simulation-based Mentorship Program in 2017 which allowed her to learn new skills. “I feel fortunate that my team was there to help Surkheti, and today, both she and her baby are healthy,” she says.&nbsp; Indeed, at a time when many Nepali nurses aim to migrate abroad the nation should be thankful for the dedication and passion of nurses like Anju Chaudhary.&nbsp;

Saving one Nepali mother at a time

When Sajadi Khatun felt the familiar pain, she knew what to do: she, her husband, her mother and a neighbour quickly left their house in Laxmipur village and started the 20-minute walk to nearby Sundarpur Health Post. They did not get far. Ten minutes later, Sajadi delivered a baby boy on the roadside.&nbsp; After delivery, the tired new mother returned to her home on the outskirts of Sarlahi’s district headquarters Malangwa while the rest took the newborn — the family’s fifth child, and third boy — to the health post for a check-up. A nurse visited and found both mother and child health.&nbsp; “I wasn’t worried about giving birth on the roadside," says Sajadi, stoically, although she and her husband had wanted to deliver the new baby in the health post, like her previous three children. The first was delivered at home as there was no health post in the community at the time.&nbsp; Ahead of the last birth, Sajadi had gone to the health post for check-ups (known as ante-natal care, ANC, visits) eight times before her due date. Recently, Nepal increased the recommended number of ANC visits from four to eight, but in 2022 just 68.4% of women in Madhes Province did four or more ANCs.&nbsp; The local Female Community Health Volunteer (FCHV) had also visited her house many times. On the advice of those health workers, Sajadi was eating as healthy as possible to keep up her own weight and that of the baby.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20230623080636_18c6ee1ef9c231899017a764b9a89ff1ab5d9d3cd4eb417cf91e4868d2041f1f.png" data-media-id="editor_0" data-image-id="20230623080636_18c6ee1ef9c231899017a764b9a89ff1ab5d9d3cd4eb417cf91e4868d2041f1f" data-rendition-name="original" width="1496" height="828" loading="lazy" alt="Map Sarlahi"> </figure>  At the health post, Sajadi, who is not sure of her age but is probably about 30 according to the FCHV sitting nearby during our interview, also started taking calcium and iron supplements and got a tetanus/diphtheria vaccination. Because the facility did not have an ultrasound machine, she and her husband, who do not own a vehicle, paid to go to a nearby private clinic and get the examination. It revealed no problems but staff there estimated her due date 20 days later than the actual delivery day.&nbsp; We do not know what would have happened if the ultrasound had been done at the health post, and produced a more accurate delivery date, but the roadside birth highlights again how lack of resources plays a role in maternal and child health in Nepal, despite the best intentions of health personnel and, of course, families. There was no ultrasound machine at the health post, and no ambulance to call when Sajadi’s labour started.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20230623080612_a44aa91ec02c4b2996c3b0bbdfc17847b279fefd6720b65fb5d2cf0fa5d40e78.jpg" data-media-id="editor_1" data-image-id="20230623080612_a44aa91ec02c4b2996c3b0bbdfc17847b279fefd6720b65fb5d2cf0fa5d40e78" data-rendition-name="original" width="3007" height="2619" loading="lazy" alt="Sajadi Khatun"> <figcaption>New mother Sajadi Khatun, holding her fifth child, talks to nurse Sunita Rai in front of her home near Malangwa in Sarlahi district. </figcaption> </figure>  “The problem is that we don’t have an ambulance in the municipality,” says Auxiliary Nurse Midwife Sunita Rai, who accompanies us to Sajadi’s house. “If we had an ambulance when a woman has a problem like a roadside delivery, we could send it right away and reduce the number of home deliveries.” Sarlahi district, and Madhes Province overall, still have a high number of home deliveries. Statistics from the district health office show that 53.5% of births happened in health facilities in 2021-22. That leaves 46.5% occurring at home or en route to facilities. The Nepal Demographic Health Survey (NDHS) 2022 found that 66.6% of births in Madhes Province occur in a facility versus 79.3% for Nepal overall.&nbsp; “The health situation in Madhes Province is a little worrisome to us, despite all the facilities there,” said the secretary of the Ministry of Health, Roshan Pokhrel. “We’re thinking about giving different targets to different provinces, rather than having a central target,” he added.&nbsp; Nepal is aiming to reach the global Sustainable Development Goals (SDG) target of 70 maternal deaths per 100,000 births. The 2022 rate was 151, according to the NDHS.&nbsp; Read Also:<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 Bhattarai In Sarlahi, health infrastructure is a key factor affecting maternal health. Medical Superintendent of Malangwa Hospital, Nawal Kishore Jha, told us that the facility has burst its seams. For example, when the Covid-19 pandemic displaced the emergency and in-patient departments, they moved to what was the waiting area, where they remain when we visit in April.&nbsp; Also, two years ago the hospital delivered one or two babies daily, but today it is closer to 20, including a growing number of Caesarean sections, yet the facility lacks a gynaecologist, meaning that non-specialists perform the 3-5 ‘C-sections’ done daily.&nbsp; Reached again on budget day, 16 June, Jha has good news: his hospital will be upgraded to a 100-bed facility. That could mean more buildings, more trained staff and equipment, including a CT scan machine.&nbsp; In case of a maternal emergency, accessing the district hospital — the best-resourced health facility in Sarlahi — should not be an issue as it is only a one-hour drive away from anywhere in the district, unless there is monsoon flooding, adds Jha. Yet as Sajadi’s example shows, lack of resources — like ambulances — can still be a barrier.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20230623080636_749b8cb16b39c940e487ba9770a57df181a69ce80f9878240eb273c16e5d4096.png" data-media-id="editor_3" data-image-id="20230623080636_749b8cb16b39c940e487ba9770a57df181a69ce80f9878240eb273c16e5d4096" data-rendition-name="original" width="2880" height="1800" loading="lazy" alt="Mothers of Sarlahi 2"> <figcaption>Women harbest wheat during the pre-monsoon Tarai heat wave recently in Malangwa.</figcaption> </figure>  While Jha and the nurses at health posts all say people’s awareness of maternal health and its potential complications could be higher overall, in the diverse communities near Malangwa, most women and their families are motivated to use health facilities, both to get as healthy as possible before giving birth and for the actual delivery.&nbsp; Besides awareness, living conditions are a major factor, says nurse Kanchen Rai at Laxmipur Khodra Health Post: “We can provide education, but the biggest problem is people’s lack of money. There has been some improvement but the poorest people still don’t have clean water and toilets.”&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20230623080620_b68ff8cb3b3aa01e13dd5ae964c1a4b71296a0ac601a42d47eaa2ce4698db618.jpg" data-media-id="editor_4" data-image-id="20230623080620_b68ff8cb3b3aa01e13dd5ae964c1a4b71296a0ac601a42d47eaa2ce4698db618" data-rendition-name="original" width="4032" height="3024" loading="lazy" alt="Rabena Khatun"> <figcaption>First time mother Rabena Khatun with her baby in front og her house near Malangwa in Sarlahi district. ALL PHOTOS: MARTY LOGAN</figcaption> </figure>  “Pockets” that are away from urban areas and further marginalised by diverse factors are where home births still happen, and must be targeted for improvement, says Jha.&nbsp; First-time mother Rabena Khatun, 22, told us she felt “very happy” when she knew she was pregnant. Within three months she had visited the health post for her first ANC, following it up “3 or 4” more times before delivery, accompanied by her mother-in-law.&nbsp; Read Also: <a href="https://www.nepalitimes.com/opinion/midwives-to-the-rescue-in-nepal">Midwives to the rescue</a>, Laxmi Tamang “The nurses told me I should eat more nutritious food so that I gain weight,” she tells us, crouching on the ground outside of her small thatch-roofed bamboo home, cradling her son Ehsan, now 37 days old, on her lap.&nbsp; When Rabena’s labour pains began, she went to the health post with her mother-in-law and two other relatives. After 10-12 hours the baby was born, without complications. Instructed by a nurse, the first-time mother started breastfeeding within 30 minutes.&nbsp; She tells us that no one in her family or community suggested during her pregnancy that she deliver at home, adding, “All the facilities are there (in the health post) so I felt confident.”&nbsp; <h2>Promise of a healthier district</h2>  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2023062308068_9211b4979e6bafea6f5138663b56b17c33b42294bb53e81c7d3280b5a34fe400.png" data-media-id="editor_6" data-image-id="2023062308068_9211b4979e6bafea6f5138663b56b17c33b42294bb53e81c7d3280b5a34fe400" data-rendition-name="original" width="1297" height="664" loading="lazy" alt="saving lives"> </figure>  The Medical Superintendent of Sarlahi District Hospital in Malangwa, Nawal Kishore Jha, sounded upbeat after hearing in the Madhes Province government budget on 16 June that the facility will be upgraded to a 100-bed hospital.&nbsp; “I’m very happy with the decision, it responds to all our demands,” Jha said on a call from Malangwa. The larger facility will receive more trained staff, more space, including to provide maternal healthcare services, and more equipment such as a machine for CT scans.&nbsp; The government also announced it would build two 50-bed hospitals elsewhere in the district, and that all other municipalities would have 15-bed facilities.&nbsp; The budget revealed that Sarlahi will become a 'completely safe motherhood district'. Among other things, that means all births will be in health facilities, accompanied by skilled health workers, and all pregnant women will have the required number of pre and post-natal checkups.&nbsp; “It is possible,” says Jha, “but it will take some time.” <h2>Bumpy ride triggers birth</h2>  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20230623070656_11438bd7c592e3d356ed26bfcb7de4ae014f8b23549bcafe2f383d6083c61224.png" data-media-id="editor_7" data-image-id="20230623070656_11438bd7c592e3d356ed26bfcb7de4ae014f8b23549bcafe2f383d6083c61224" data-rendition-name="original" width="2794" height="1608" loading="lazy" alt="Mother of sarlahi 1"> <figcaption>Anita Kumari Yadav with her baby and husband. </figcaption> </figure>  Anita Kumari Yadav had felt a pain for three days that she thought meant she was going into labour for her first baby. She walked to nearby Sisautiya Health Post, but was always told it hadn’t started.&nbsp; On the third day, nursing staff referred her to the district hospital because of the delay. When she arrived with her in-laws after a bumpy ambulance ride, she was told she would need a Caesarean section.&nbsp; “I was scared to have an operation,” says Anita, 20. She called her husband, a bus driver who was en route from Kathmandu. He told the family to wait until he arrived. But they didn’t have to. The baby was born half an hour later, one positive outcome of the bone-jarring ambulance ride, speculates Auxiliary Nurse Midwife Ringku Kumari Raut.&nbsp; Like the other women interviewed in the Malangwa area, Anita diligently did her ANC check-ups, once also visiting the district hospital to have a test confirmed. She took iron and calcium supplements (when in stock) and added fortified flour to her diet to gain weight.&nbsp; Nurse Raut says she is happy with how she and her colleagues managed Anita’s delivery, despite the health post’s limited resources: “Everything is fine now but if something had happened, the hospital had resources and facilities to deal with it.” <h2>Maternal deaths deliver lessons</h2> A day before the central government budget was released on 29 May, officials in the Family Welfare Division (FWD) of the Department of Health were resigned to the fact that the status quo was the most they could achieve in programming for the 2023-24 fiscal year.&nbsp; But Section Chief Gauri Pradhan had her fingers crossed that a verbal promise of more funding would allow the section to expand at least one program — for <a href="https://www.nepalitimes.com/news/3-nepali-mothers-still-die-daily-at-childbirth">maternal and perinatal death</a> surveillance and response (MPDSR).&nbsp; Started in Nepal at the Maternity Hospital in Thapathali in 1992, guidelines were created for the program in 2015 and revised in 2021. Today, MPDSR takes place in 42 districts, both in hospitals and where there are maternal and newborn deaths in communities.&nbsp; The promised funding, from an external partner, will permit the program to expand to more hospitals and communities. Pradhan displays the WhatsApp app on her mobile, which shows a group for reporting of mother and newborn deaths in hospitals and another for community deaths.&nbsp; Asked why this one program is likely to be the only maternal and newborn health initiative in the FWD to expand next year, Pradhan says: “It is the basic thing to take action to learn the cause of death. Without knowing the causes, how can we develop activities to make childbirth safer?”&nbsp; Expenses for this trip were paid by One Heart Worldwide.

Mothers of Sarlahi

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114101136/63720cbc9c7e80680e0b7884jpeg.jpg" alt="" width="720" height="540"/><figcaption>Nurses Puspa Pandhak and Sumnima Khapung delivering the baby inside a jeep late at night on 3 March, after concluding that they could not reach the Tehrathum district hospital in time because of the bad road. Photo: DINESH BHATTARAI</figcaption></figure>Puspa Pandhak was just finishing her duty at a rural hospital in Tehrathum district last week when a 19-year-old woman was brought in on a stretcher, writhing in pain.As a birth attendant nurse, Pandhak had performed more than 100 safe deliveries in the past five years, but this maternity case was the first breech she was having to deal with.“As soon as I saw the position of the baby, we decided not to take the risk and take her to Tehrathum Hospital,” Pandhak says.Read also: <a href="https://www.nepalitimes.com/here-now/birth-and-death-during-a-pandemic/" target="_blank" rel="noopener noreferrer">Birth and death during a pandemic</a>, Nunuta RaiBut, as is often the case in rural Nepal, they could not get an ambulance. The condition of the mother and baby was deteriorating, and every second counted.Luckily, a four-wheel drive jeep just happened to pass by and gave them a lift. Pandhak and fellow nurse Sumnima Khapung got on with their patient, taking along their delivery kits.The road was bumpy and dangerous, made worse by the previous day’s heavy rain and the pitch black night. It was already 9:30PM, and they were nowhere near their destination.“It was a rough ride, and we were being thrown about inside the car, but I tried to reassure the young expecting mother since this would be her first baby,” Pandhak recalls.Read also: <a href="https://www.nepalitimes.com/here-now/who-will-save-nepals-poor-new-mothers/" target="_blank" rel="noopener noreferrer">Who will save Nepal's poor new mothers</a>, Rojita AdhikariIn the front seat, the patient’s mother and husband were panicking, and that was not helping at all. Then driver Dinesh Bhattarai also started getting unnerved, and that was not a good sign.It was now nearly 11PM, and it did not look like they would get to the district hospital in time. Pandhak made the tough decision to stop the journey in the small bazar of Tukre.“The trip was becoming too long due to the poor road condition and I knew we would never reach the hospital where an emergency doctor and midwife team were on standby to receive us,” Pandhak recounts. “I was very nervous, but knew that the mother was in bad shape and I needed to help somehow.”<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114101136/63720cbe9c7e80680e0b7885jpeg.jpg" alt="" width="1070" height="1600"><figcaption> </figcaption></figure>The two nurses then decided the safest course was to deliver the baby inside the car. In a breech case, the baby’s body is upside down, which means the head is stuck. Pandhak and Khapung tried to help the mother push the baby, while aware that this could injure her.Finally, the nurses managed to carefully pull the baby out, without the mother suffering a serious tear.Read also: <a href="https://www.nepalitimes.com/here-now/saving-one-nepali-mother-at-a-time/" target="_blank" rel="noopener noreferrer">Saving one Nepali mother at a time</a>, Aruna Uprety“I cannot describe the elation and relief that we felt, and I am sure the mother and her relatives were much happier than us, we had delivered a healthy baby inside a cramped car, and mother was also fine,” Pandhak told us on the phone from Tehrathum.After the enroute delivery, the jeep with one extra person on board, continued the journey to Tehrathum District Hospital. When they got there just past midnight, the emergency team could not believe what they saw.Says Pandhak, “They were so proud of us as they took charge of mother and baby at the birthing facility. It was a nerve-wracking experience, but it all ended well.”<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114101136/63720cc19c7e80680e0b7886jpeg.jpg" alt="" width="794" height="854"><figcaption> </figcaption></figure>Pandhak and Khapung are on the frontlines of Nepal’s efforts to <a href="https://www.nepalitimes.com/latest/3-nepali-mothers-still-die-daily-at-childbirth/" target="_blank" rel="noopener noreferrer">reduce maternal and infant mortality</a>. Thirty years ago, 10 in 10,000 women in Nepal used to die in childbirth. That number has come down to 2 in 10,000. But progress has now flat-lined, and 1,500 mothers still die during delivery every year in the country.Even though such individual acts of heroism never make it to the news, it is the work of Female Community Health Volunteers, dedicated Skilled Birth Attendants (SBAs) like Puspa Pandhak and Sumnima Khapung, and local governments that are helping save lives every day across Nepal.In this case, it was also the support for renovating and equipping the birthing centre and midwife training provided by the organisation One Heart Worldwide (OHW) to Menchhhyayem Rural Municipality that helped raise the capacity of the two nurses.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114101136/63720cc39c7e80680e0b7887jpeg.jpg" alt="" width="640" height="853"><figcaption> </figcaption></figure><a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/banner/what-can-be-more-fulfilling-than-saving-lives/" target="_blank" rel="noopener noreferrer">OHW uses a partnership approach</a> with rural municipalities to upgrade birthing centres through cost-sharing to encourage local ownership. When the work is complete it moves on to other districts.“I still feel so relieved and excited that we saved the lives of the mother and baby, and it was also a life-changing moment for me,” Pandhak says. “I feel so happy to see the family so thrilled. This is the greatest reward that a nurse can ever have.”Pandhak says it was the OHW training that gave her the confidence to make the right decision to deliver in the car and not wait to get to hospital. She adds, “The successful outcome has also given us new confidence to deal with complicated cases in future.”

Another baby's life is saved in rural Nepal

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410114/637204f29c7e80680e0b288djpeg.jpg" alt="" width="1500" height="1000"/><figcaption>Photos: UNICEF NEPAL</figcaption></figure>Despite periods of political and economic instability, Nepal achieved dramatic progress in maternal and child health in the early 2000s becoming an international model.It took great strides in reducing childhood malnutrition, in particular, reducing stunting from 57% in 1996 to 33% in 2016. Maternal and Infant mortality rates also similarly declined, only for much of these successes <a href="https://www.nepalitimes.com/banner/nearly-half-of-nepali-children-still-malnourished/" target="_blank" rel="noopener noreferrer">to stall in the recent years</a>. And this trend has been made worse by the Covid-19 pandemic, states a new UNICEF report.Titled “<a href="https://onlinelibrary.wiley.com/toc/17408709/2022/18/S1" data-saferedirecturl="https://www.google.com/url?q=https://onlinelibrary.wiley.com/toc/17408709/2022/18/S1&amp;source=gmail&amp;ust=1642768390008000&amp;usg=AOvVaw2Qo1HoClES2POc3Qyp2i-7">Nutrition in Nepal: Three decades of progress for children and women</a>”, the report brings together a set of nine original articles that examine the drivers of success and identify where greater policy and programmatic action is needed to achieve the Sustainable Development Goal (SDG) nutrition targets.“Optimal maternal and child nutrition is the basis for developing a resilient society,” says EU Ambassador to Nepal, H.E. Nona Deprez. “The decline in the number of malnourished children, improvements in health facilities and services, and the multisectoral approach used in Nepal over the past three decades are a testament to the Government of Nepal’s commitment to reducing all forms of malnutrition.”A <a href="https://onlinelibrary.wiley.com/toc/17408709/2022/18/S1" data-saferedirecturl="https://www.google.com/url?q=https://onlinelibrary.wiley.com/toc/17408709/2022/18/S1&amp;source=gmail&amp;ust=1642768390008000&amp;usg=AOvVaw2Qo1HoClES2POc3Qyp2i-7">special supplement of the Maternal and Child Nutrition Journal</a> published on Thursday lists some of Nepal’s biggest nutritional achievements. Between 1996-2016, the early initiation of breastfeeding saw an increase from 18% to 56%, and complementary feeding increased from 54% to 77%.During the same period, women taking sufficient iron and folic acid supplements during their pregnancy rose from 6% to 71%. This was combined with earlier and more frequent antenatal care visits.Consistent administering of Vitamin A has saved the lives of an estimated 45,000 Nepali children under the age of five, between 2002 and 2015. Similarly, households using adequately iodised salt doubled from 35% to 77% from 1998 to 2016.Much of this progress can be credited to improvements in household wealth, parental education, and <a href="https://www.nepalitimes.com/banner/toilet-trained/" target="_blank" rel="noopener noreferrer">sanitation</a>. But equally important was increased coverage of health and nutrition services undertaken by successive governments.Nepal Government utilised ground-breaking research to test interventions and overcome challenges, it is also committed to enforcing mandatory legislation such as salt iodisation, writes the journal supplement.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410114/637204f69c7e80680e0b288ejpeg.jpg" alt="" width="1500" height="1001"><figcaption></figcaption></figure>Mobilisation of <a href="https://www.nepalitimes.com/latest/enlisting-female-health-volunteers-to-fight-covid-19/" target="_blank" rel="noopener noreferrer">Female Community Health Volunteers</a> (FCHVs) across Nepal villages and towns have improved the health of mother and children, so has an investment in sectoral programs including education and sanitation.But there are now new challenges to achieving national and global targets on nutrition, which also threatens to undermine past gains.“The learning from the past 25 years that are incorporated in the supplement will inform and contribute to future improvements. However, we must act now, given the impact that the pandemic has had on the nutritional health of mothers and their children,” says Elke Wisch, UNICEF Representative to Nepal.During the pandemic, most households experienced job losses or reduced income. With the <a href="https://www.nepalitimes.com/here-now/3rd-wave-in-2-years/" target="_blank" rel="noopener noreferrer">Omicron-led third wave</a> spreading across Nepal, the pandemic’s ensuing socioeconomic crisis is long from over.This means reduced dietary intake among children and mothers. School closures will deprive many children of getting one decent meal a day. All this will add to <a href="https://www.nepalitimes.com/banner/nepals-epidemic-of-hunger/" target="_blank" rel="noopener noreferrer">childhood malnutrition</a> which continues to be a major cause of death and retarded mental and physical development among younger populationsAs such, UNICEF has recommended the government to improve the general public’s access to nutritious, safe, affordable, and sustainable diets. It also suggests integrating essential nutrition services into the existing service delivery platforms like family planning, antenatal, delivery and post-natal care and well-child and sick-child care and continuing to mobilise FCHVs to reach more women and children.To disseminate factual information, advice and counselling on infant and young child feeding, <a href="https://www.nepalitimes.com/here-now/3rd-covid-wave-infects-nepals-frontliners/" target="_blank" rel="noopener noreferrer">healthcare workers</a> can also use multiple communication channels such as radio, TV or social media.But perhaps equally if not more important is strengthening local levels so that they can plan, implement and monitor nutrition programs and services, and maintain Nepal's commitment to generating data, information, and evidence to assess progress and inform decisions.

Covid undermines Nepal's mother-child gains

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141136/636cfe469c7e80680e0a0c2ejpeg.jpg" alt="" width="2529" height="1427"/><figcaption>Photo: HIMALMEDIA</figcaption></figure>A white-coated nurse holding a blue and white, half-litre bag of milk stands in front of a small group of mothers seated near the entrance of the Nutrition Rehabilitation Home in Kathmandu.She is explaining the importance of feeding milk to their children, who are lolling on their mothers’ laps. On a table behind the nurse are containers of pulses and legumes and leaning against the wall, charts displaying leafy vegetables.But later, listening to the women’s stories, it is apparent that solving their children’s problems will require more than a healthy diet. Through tears, Chandra, 24, says she brought her son Raju, 21 months, to the Home after a routine hospital check-up found that he was malnourished.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141136/636cfe499c7e80680e0a0c2fjpeg.jpg" alt="" width="3706" height="2170">His father, who Chandra was forced to marry, bought barely enough food for them to survive, says the woman. That deprivation, plus physical beatings and “mental torture” caused Chandra to flee their village home for Kathmandu.Mother and son arrived in January at the 24-bed facility perched on a hill on the outskirts of the city, where housing colonies sprout on former farm fields. In the month since then, Raju has gained 1kg in weight and is much stronger.The boy will stay at the Home for a few more weeks, says Sunita Rimal, coordinator of the Malnutrition Prevention and Treatment Program at the Nepal Youth Foundation, which runs the Home. By then she hopes to have found some work in Kathmandu for Chandra via her informal channels, so that the mother-son pair don’t have to go back.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141136/636cfe4d9c7e80680e0a0c30jpeg.jpg" alt="" width="901" height="786">Epidemic of hungerNina Parajuli, 45, brought her daughter Anushka, 7, to the Home weeks later on the advice of staff at a local non-governmental organisation. Nina had gone there for skills training after losing her house-cleaning job in Kathmandu.She was forced to find work unexpectedly after Anushka was born, when her husband deserted them. The family that hired her ate their first meal of the day only in the afternoon, which meant the girl left for school in the morning having eaten only snacks, while her mother worked. Eventually, Anushka grew dangerously thin and was considered severely malnourished when she arrived.Nina “was too concerned with her own problems to notice,” Rimal explains. Like her husband, she is HIV positive. She also has a heart condition and is on a waiting list for a uterus operation.Though unique, the stories of Nina and Chandra share a common thread — the causes of their children’s malnutrition are multifaceted. Rimal says that is the norm: “Most of the people who come here have other socioeconomic problems.”Past achievements Nepal is celebrated globally for its success in fighting malnutrition from the 1990s until recent years. Most notably, rates of stunting (low height for age) fell from the world’s highest, 68% in 1995, to 36% in 2016.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141136/636cfe509c7e80680e0a0c31jpeg.jpg" alt="" width="2410" height="1064"><figcaption> </figcaption></figure>New research has teased out exactly which development efforts had what impact on stunting. Indirect (also known as ‘nutrition-sensitive’) approaches were surprisingly effective. For example, better educated parents accounted for 25% of the improvement, <a href="https://www.nepalitimes.com/banner/toilet-trained/" target="_blank" rel="noopener noreferrer">environmental factors</a> like building more toilets contributed 12% and economic growth made up 9%.Direct (‘nutrition-specific’) efforts included: improved nutrition of mothers (accounting for 19% of the gain), and maternal and newborn health care (12%), according to the research, published on the website <a href="https://www.exemplars.health/topics/stunting/nepal">Exemplars in Global Health</a>.“The exemplars that we picked were countries that did (development) much faster than others. Nepal is not necessarily the best example but it is an important example,” says Zulfiqar A Bhutta of the Centre for Global Child Health at The Hospital for Sick Children in Toronto, one of the leaders of the research.“One thing is very clear, no one country has done it alone by only investing in health and nutrition sectors,” explained Bhutta via Zoom from Toronto. “And no one country has done it alone by only investing in poverty alleviation strategies. So the truth is that you have to do both in combination.”Nepal has continued that broad approach, investing in health both directly and indirectly, <a href="https://www.nepalitimes.com/banner/nearly-half-of-nepali-children-still-malnourished/" target="_blank" rel="noopener noreferrer">yet the progress has plateaued</a>.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141136/636cfe549c7e80680e0a0c32jpeg.jpg" alt="" width="1628" height="1255">While stunting continues to fall, the 36% rate is greater than the developing country average of 25% and the Asia average of 21.8%. In fact, the country is on target to hit only one of its nutrition goals for 2025 set by the World Health Assembly — for underweight children under 5 — says the <a href="https://globalnutritionreport.org/resources/nutrition-profiles/asia/southern-asia/nepal/">Global Nutrition Report 2020</a>.So what happened?“The one thing that I was surprised by is that inequity has increased,” says Bhutta, “and I have a feeling some of that may have had to do with the urban poor or rural to urban migration.”Nepal, he adds, should work to pinpoint the who’s and why’s of poverty, but otherwise, it should maintain its balanced approach.Investment on nutrition A recent analysis from UNICEF found, however, that spending on indirect approaches to fight malnutrition was rising while declining for direct interventions. This goes against the direction given in the government’s <a href="http://nnfsp.gov.np/PortalContent.aspx?Doctype=Resources&amp;ID=330">Multi-sector Nutrition Plan</a> (MSNP), the blueprint for tackling malnutrition.<a href="https://www.nepalitimes.com/editorial/hunger-for-governance/">Hunger for governance</a>, EditorialThe first phase of the MSNP ran from 2013 to 2017, and the current plan ends next year. The analysis in UNICEF’s <a href="https://www.unicef.org/nepal/media/13296/file/Nutrition%20-%20Budget%20brief.pdf">Nutrition Sector Budget Brief</a> also pointed out that the cost of programs in phase two (Rs48.9 billion) of the multisector plan is just 54% of phase one (Rs88.5 billion). In addition, the gap between budget numbers and actual spending has been growing.Kiran Rupakhetee of the Good Governance and Social Development Division at the National Planning Commission secretariat, helped shape MSNP-II. In an online interview he suggests that rather than the current plan’s budget being too low, the budget for MSNP-I might have been “over calculated at the time”.As to the growing gap between allocations and real spending — it results from many factors, including “rigidities and structural barriers” in the system, he explains.Another major challenge for MSNP-II is federalism, which introduced three levels of government after elections in 2017. “It’s a Herculean task… because at the moment it’s not only one government—we have 761 governments… There are some difficulties in ensuring coordination among them,” adds Rupakhetee.The pandemic challenge The Covid-19 pandemic <a href="https://www.nepalitimes.com/latest/covid-19-leaves-millions-of-south-asian-children-hungry/" target="_blank" rel="noopener noreferrer">has added to the challenge</a>. “It definitely has hampered our activities,” says Rupakhetee, “but we tried our level best to keep the programme going.”For example, parents were trained to measure the arm circumference of infants to detect signs of malnutrition, a task usually done by female community health volunteers, who have been unable to do so due to frequent lockdowns.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141136/636cfe579c7e80680e0a0c33jpeg.jpg" alt="" width="960" height="640"><figcaption> </figcaption></figure>Nepal’s school feeding programme was also modified because of the pandemic, with food rerouted to students’ homes, says World Food Programme (WFP) Country Director Jane Pearce, in an online interview.“Whereas most of the world stopped all of their school meals programmes, Nepal has continued, which has meant that we’re maintaining the nutrition that we’re providing through our locally-managed school meals programmes by giving households take-home rations,” she said.WFP has also teamed up with UNICEF and other UN agencies to press the government to expand its malnutrition treatment to include not only children who are severely wasted (low weight for age) but moderately wasted, says WFP’s Head of Nutrition Anteneh Girma.“With the impact of Covid and others, if they’re not treated they will become severely malnourished, then chronically malnourished, or stunted,” he adds.In June <a href="https://www.nepalitimes.com/banner/nepals-epidemic-of-hunger/">this paper reported</a> on how severe malnutrition was killing children in the poorest communities in Nepal’s eastern plains. It told the story of Raju Devi Sada, whose first daughter died at 3, after being malnourished. A second daughter died soon after birth, a year later.A third daughter is underweight and local health workers have recommended feeding her nutritious food. But Raju Devi cannot afford vegetables, eggs, milk and meat, and what she earns as a daily wage labourer is barely enough to feed the rest of the family.“We have found that up to 70% of children who die every year in Province 2 do so due to malnutrition, and the main reason for that is extreme poverty,” said Kedar Parajuli at Nepal’s Family Welfare Division. “Without alleviating poverty, we can’t solve malnutrition.”WFP is doing mapping, using mobile data, to create what it calls a vulnerability index. It documents people’s access to water and sanitation services, health and other factors, in addition to nutrition, says Girma.He adds, “Our nutrition response, food security response, is informed by that index… it indicates those who are vulnerable for not having access on time, for being exposed to various inequalities.”The private sectorGirma points out that WFP, both in Nepal and globally, supports the multisector approach. In that vein, the UN agency is working closely with the government to establish the <a href="https://sunbusinessnetwork.org/">Scaling Up Nutrition (SUN) Business Network</a> in Nepal. To date, 10 companies, all working in the food industry, have become members.Ending malnutrition and other food-related diseases “will happen only if the private sector is responsible for what they are producing, and producing something safe …  so their engagement, bringing them to the table, is very important,” says Girma.Leading collaboration with the private sector on the ground is <a href="https://www.baliyonepal.com/en/">Baliyo Nepal</a>, a non-profit company that generated headlines when it launched in 2019. The initiative was funded by the Bill &amp; Melinda Gates Foundation through the Chaudhary Foundation, the charity arm of the Chaudhary Group, makers of Wai Wai instant noodles, which are widely considered junk food.<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/banner/junk-food-is-making-nepali-children-shorter/" target="_blank" rel="noopener noreferrer">Junk food is making Nepali children shorter</a>, Marty LoganToday Baliyo Nepal is set to expand a pilot project that has been running in Lumbini Province since 2020 — raising awareness about nutritious food among school children, including via a cricket program, and educating shopkeepers to sell the nutritious foods in the first phase of its ‘Baliyo Basket’: eggs and a single-portion Rs10 sachet of fortified porridge for infants.“Seventy percent of the sachets in the market were sold, according to the sales report,” says Baliyo Nepal CEO Atul Upadhyay, a nutritionist, in an interview in his Kathmandu office. “The feedback we’re getting from mothers is ‘Now we want it in a bigger package. We can’t go to the shop every day and buy the Rs10 package’.”Upadhyay says manufacturers will start making the larger packs by year end. That is just one of many plans he is cooking up — besides expanding pilot activities to Bagmati and Gandaki provinces, the company will soon be adding to its Baliyo Basket a fortified drink for pregnant and lactating women and fortified porridge for 2-5-year-olds, once they are approved by the government.Upadhyay notes that both the government and private sector are gradually embracing his innovative approach but stresses that new ways to fight malnutrition, like this public-private partnership model, are essential if Nepal is to reach its nutrition targets.“It’s not important who works for nutrition. It’s important that someone works for nutrition, whether it be WFP, Baliyo Nepal, company A, company C — I don’t mind,” he adds.Target StuntingStunting, low height for age, is a sign of chronic undernutrition. It can hinder brain development resulting in reduced mental ability and learning capacity, poor school performance in childhood and lower earnings and higher risks of nutrition-related chronic diseases, such as diabetes, hypertension and obesity, in adulthood.Nepal cut its stunting rate dramatically in recent decades, and it is one form of malnutrition that the country might be on track to reduce in line with coming targets: MSNP-II (2022), World Health Assembly (2025) and SDGs (2030).The UNICEF Nutrition Sector Budget Brief says that the average yearly rate of stunting reduction since 2001 (3.25%) must increase to 3.8% to meet the MSNP-II and WHA targets, and rise to 6.5% to meet the SDG target.According to Kiran Rupakhetee at the National Planning Commission: “The Nepal Multiple Indicator Cluster Survey has brought some encouraging results, but it may still be difficult to make the WHA target... but since the SDGs deadline is quite far away I’m very much optimistic and hopeful that we can meet it.”Stunting rates and targets 2016: Nepal Demographic and Health Survey – 36%2019: Nepal Multiple Indicator Cluster Survey – 31.5%2022:  Target: Multi-sector Nutrition Plan-II – 28%2025:  Target: World Health Assembly – 25%2030:  Target: SDGs – 15%

Marty Logan

A tall order

<img width="1169" height="747" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110151120/636d08ca9c7e80680e0a603ajpeg.jpg" alt=""/>The Human Rights Watch (HRW) on Tuesday wrote a letter to Prime Minister Sher Bahadur Deuba, urging him to uphold the rights of Nepali citizens and strengthen the rule of law.
Recent <a href="https://www.thelancet.com/action/showPdf?pii=S2214-109X(20)30345-4">reports</a> have revealed that the pandemic has decreased institutional delivery by half, increasing risks of premature birth, stillborn deliveries and newborn deaths, setting back Nepal’s past gains in maternal and child care.
Additionally, reduced family income coupled with prolonged school closures has pushed many Nepali children into labour, with projections that half of the girl students may not rejoin schools once they <a href="https://www.nepalitimes.com/latest/half-of-nepals-girls-may-drop-out-of-school/">reopen</a>. Child marriages are on the rise.
“The new government should take measures to safeguard and continue progress on health and education, including through assistance for households whose livelihoods have been devastated by the pandemic,” says Meenakshi Ganguly, South Asia director at Human Rights Watch. “Safety nets are critical for ensuring that crises do not prevent children from continuing their education or harm progress on reducing child marriage and child labour.” 
The letter paid special attention to pressing human rights issues pertaining to Nepal’s failures in addressing war crime and transitional justice.
In 2015, Nepal formed the Truth and Reconciliation Commission and the Commission of Investigation on Enforced Disappeared Persons. A year before that in 2014, the Supreme Court scrapped provisions in the transitional justice law that allows amnesty for offences including torture, murder, and enforced disappearance during Nepal’s armed conflict. The law has not been revised.
Successive governments have stopped conflict-era cases from being heard in regular courts citing the supposed transitional justice process, even as victim groups and Nepali human rights organisations have long questioned its credibility. 
But their protests seem to have fallen on deaf ears, one of Deuba’s first acts in office was to extend the terms of transitional justice commissioners by another year.
“Successive governments have stalled on delivering justice to victims for the many grave cases of abuse, preferring to protect the abusers instead,” adds Ganguly. “As a result, abuses continue while principles of accountability, the rule of law, and the independence of institutions have been eroded, with negative consequences for everyone in society.”
Nepal has made little progress in investigations of human rights violations at home despite being re-elected as a member of the United Nations Human Rights Council. This has had a corrosive impact on wider principles of accountability and the integrity of institutions.
Of late, Nepal has seen a marked increase in alleged extra-judicial killings, custodial deaths allegedly from torture, and the excessive use of lethal force against protesters. In fact, the NHRC in October 2020 published a list of 286 suspects of serious crimes that included law enforcement officials, military personnel, and former Maoist insurgents that police had refused to investigate.
A culture of impunity has undermined the rule of law, there is no accountability for abuses of power. Instead, they continue to climb up the bureaucratic ladder, like the promotion of a police officer alleged to be involved in the extra-judicial killing of two men in August 2018. 
Justice and relief for survivors of sexual violence during the conflict is even more difficult to come by. On the other hand, families of six young Dalit men murdered in Rukum in May 2020 —among the deadliest instances of caste-based killings in Nepal, still await justice. Those linked to the death of a 12-year-old girl forced to marry her rapist in May 2020 have yet to be held accountable.
The HRW has also called on the Deuba government to reverse appointments made to independent institutions like NHRC and the Election Commission after the Oli government pushed an ordinance amending the law in December 2020 to allow only three members of the Council to make appointments.
There are numerous other pending challenges such as the 2006 Citizenship Act, provisions in the 2015 Constitution, and a draft citizenship bill that limits women’s ability to transmit citizenship through marriage. The bill is similarly discriminatory against Nepal’s transgender people.
The HRW also opposed restrictions on the freedom of religion, rights to peaceful assembly, expression, and association of Tibetan refugees in Nepal who have fled Chinese persecution.
Says Ganguly: “Prime Minister Deuba faces many pressing problems, but he also has an opportunity to craft a positive legacy. Meanwhile, Nepal’s international development partners should press the government for measurable action on accountability if they hope to achieve change.”

Nepal must work on human rights

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.

maternal-health