<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111412118/6372219c9c7e80680e0c02c6jpeg.jpg" alt="" width="1000" height="662"/>This year’s health budget kept the contribution to health insurance of the previous year's allocation of Rs7.5 billion. However, the plan to hand over the institutional management of health insurance programs to the private sector through the Ministry of Finance defeats the fundamental goal of the health security.This is not entirely surprising, of course, because the Health Ministry had passed a <a href="https://archive.nepalitimes.com/article/nation/national-health-insurance-not-as-easy,4028">narrow and poorly thought model of health security</a> for Nepal, and there were already concerns that it would eventually be handed over to the private sector and traded as a commodity.A private company can contribute to a health insurance program. But can they really contribute to national public health security, understand equity, expand <a href="https://www.nepalitimes.com/editorial/poor-health-makes-nepalis-poorer/">access to the poorest and the most marginalised</a> population, and negotiate with the government providers for quality services? Are they fundamentally designed to serve the poor?Read also: <a href="https://archive.nepalitimes.com/article/nation/national-health-insurance-not-as-easy,4028">National health insurance not as easy</a>, Sonia AwaleThe private sector has a role in contributing to achieving Universal Health Coverage by mainly serving the affluent. The poor neither can afford private health insurance nor access expensive private hospitals. Even if they are admitted to hospitals, they have to bear <a href="https://www.nepalitimes.com/opinion/is-free-health-care-possible-in-nepal/">catastrophic expenses</a> pushing them into the vicious cycle of poverty.The private insurance companies only pool the resource, they do not share the risk for those who cannot afford to pay the premium. It will be naïve to assume that such companies could be easily maneuvered to deliver services as a fair-price approach. There are around 20 registered private health insurance companies and 366 private hospitals in Nepal, and some are <a href="https://www.nepalitimes.com/latest/nepal-tries-to-ensure-covid-19-insurance/">selling health insurance at exorbitant premiums</a> many times higher than the current premium cap.There are six national health security indexes: prevent, detect, response, health, norms, and risk. During the pandemic, insurance companies got richer by <a href="https://www.nepalitimes.com/latest/nepal-tries-to-ensure-covid-19-insurance/">selling fake insurance schemes</a> while the hospital profits bulged through expensive Covid treatment. Very few hospitals treated Covid patients with a humanitarian approach. None of their technical advancements helped effectively prevent, detect, and respond to the pandemic.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111412118/6372219f9c7e80680e0c02c7jpeg.jpg" alt="" width="1641" height="1000"><figcaption> </figcaption></figure>The current health insurance program has identified the elderly, completely disabled, leprosy, Multi-Drug Resistant TB patients, people living with HIV, and ultra-poor as target populations to waive their premium. Though not adequate, this is an equity approach.But none of these target populations are <a href="https://archive.nepalitimes.com/article/nation/national-health-insurance-not-as-easy,4028">eligible for private health insurance</a>, or they will have to pay a much higher premium. It will be unwise to assume that these companies will change overnight and be equitable. They are powerful enough to influence government policy and have the power to bend them to suit their commercial interests.Read also: <a href="https://www.nepalitimes.com/editorial/poor-health-makes-nepalis-poorer/">Poor health makes Nepalis poorer</a>, EditorialInstead, the government should <a href="https://archive.nepalitimes.com/article/editorial/health-tip-editorial,4032">strengthen the Health Insurance Board</a> and explore ways to integrate health security with the broader social security scheme. In the short term, there are urgent but straightforward reforms like recruiting adequate and skilled human resources, strengthening the organisational systems, revising the design of service purchase strategy and equity, and gradually, having effective providers/purchasers split for better implementation.Ultimately, the program will benefit by forming a broader and more robust social security structure, co-incidentally introduced at the same time by the government. It would be able to absorb costs by pooling tax-based health care contributions and merging subsidies given to the treatment of cancer, renal failure, and other chorionic diseases under one integrated umbrella.But the current government does not appear serious about <a href="https://www.nepalitimes.com/opinion/health-insurance-must-be-an-election-agenda/">reforming health insurance</a>, and simply does not understand the fundamental principles of health security. Health insurance is not just limited to providing health care, but is a part of broader health security.Read also:  <a href="https://archive.nepalitimes.com/article/editorial/health-tip-editorial,4032">Health tip</a>, EditorialThe idea that health security can be strengthened by passing the buck to the private sector amounts to abandoning the constitutional commitment to provide health care, not as a service but as a citizen's fundamental right. The Nepal government is a signatory to achieving the health targets of the Sustainable Development Goals.As argued by Nepali Congress leader Gagan Thapa, who is one of the pioneers who <a href="https://archive.nepalitimes.com/article/editorial/health-tip-editorial,4032">pushed health insurance</a> in Nepal, they contribute to strengthening the health system, strive for healthy populations, cushion the poor and provide them access to health services. It is a vehicle for mobilising adequate health resources, enhancing health security, and ultimately achieving Universal Health Coverage.These goals cannot be met by trading the people's health as mere commodities.Gaj Gurung has a PhD in public health from Chulalongkorn University and Sushil Koirala is a public health expert. Both are based in Bangkok.Read more: <a href="https://www.nepalitimes.com/opinion/is-free-health-care-possible-in-nepal/">Is free health care possible in Nepal?</a> S P Kalaunee

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Dangers of privatising health insurance in Nepal

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114111124/6372175d9c7e80680e0ba9e2jpeg.jpg" alt="" width="1500" height="1000"/><figcaption>Photo: BIKRAM RAI/NEPALI TIMES ARCHIVE</figcaption></figure>If Nepalis are to vote on issues rather than personalities in this year’s elections, they should pay attention to the manifesto of the Nepali Congress (NC) which has put an emphasis on the 2017 National Health Insurance Act.It was the NC’s firebrand leader <a href="http://archive.nepalitimes.com/article/from-nepali-press/Reviving,3589" target="_blank" rel="noopener noreferrer">Gagan Thapa</a> who pushed that legislation when he served as Health Minister. He is now the party’s general secretary, and sees <a href="https://archive.nepalitimes.com/article/nation/national-health-insurance-not-as-easy,4028" target="_blank" rel="noopener noreferrer">health insurance</a> as a way to improve the access and affordability of quality health care in Nepal.Even for a country like Nepal, universal health coverage is not a distant dream if there is the necessary political will. The Covid-19 pandemic has already made it evident that investing in health care and prevention is central to the well-being of the society with added economic benefits.Many countries in the region have health insurance for their citizens. An example is <a href="https://www.social-protection.org/gimi/gess/RessourcePDF.action?ressource.ressourceId=54059" target="_blank" rel="noopener noreferrer">Thailand's Universal Health Coverage Scheme</a>, lauded as the best model for a developing country.The Nepal Health Insurance program was initiated to achieve universal health coverage and was one of the key agendas in the 2015 election with widespread political support. The program actually started in 2016 and the Health Insurance Act was enacted in 2017.With Ministry of Finance (MoF) funding, it offers monetary protection to people by paying directly to the service providers’ on-behalf of insured members.In a few years, Nepal’s health insurance program has had a scalable impact. Our 2020 study in the Kaski district showed that in patient expenses of insured families was less than that of non-insured ones, and were also better protected against catastrophic expenses than the non-insured.Broadly, the program aimed to improve the health quality through provider and purchaser split, and by employing a strategic purchasing approach. For instance, in Thailand, the National Health Security Office purchases services for 43 million people independently which has played a large role in improving health care services.Health insurance generates an additional health budget, as it is a pooling mechanism. The MoF has allocated the insurance budget without curtailing the current national health budget.Unfortunately, the insurance scheme design and implementation have been drowned out by political rhetoric resulting in operational ambiguity and erratic implementation. Without a serious political will to strengthen the program, it is likely to come to grief before long.Insured people are dissatisfied with service providers for their historically low-quality services. In fact, the quality of care has worsened in places after the insurance scheme was introduced, resulting in a high drop-out rate.In turn, service providers are frustrated over the Health Insurance Board (HIB)’s sluggish reimbursement process and some have even stopped their facilities. The HIB does not have adequate skilled human resources to speed up the reimbursement, nor has it formulated an efficient service purchase mechanism.The Board has not been able to function as a prudent insurance manager because of the lack of basic organisational policies on human resources, finance, monitoring and evaluation, communication etc. There are also crucial design errors in the insurance program, such as reimbursement strategy, un-equitable premiums, and provider/purchaser split, to name a few.The current program primarily employs fee-for-service (FES) which is a traditional, retrospective and input-based approach with a cumbersome process to review, validation of cost, and payment. The FES was selected despite other programs including <a href="https://www.nepalitimes.com/opinion/is-free-health-care-possible-in-nepal/" target="_blank" rel="noopener noreferrer">free health service</a> and safer motherhood implementing relatively efficient, output-based and prospective approaches such as capitation.There are also traditional and cultural problems within the MoH, and HIB as a semi-autonomous body does not have the influence or muscle to monitor and negotiate with service providersThe premium amount and benefit package was fixed through very limited study which was a modest Rs2,500 and Rs 50,000 respectively in the beginning, later increased to Rs 3,500 and Rs100,000 but with no scientific basis.This benefit package is quite small for a family of five. The amount gets smaller with increased cost for the high prevalence of non-communicable and chronic diseases in the general population.Apart from the targeted groups (with premium subsidy), the flat premium amount of Rs3,500 for the rest is largely unbalanced. The richest 10% of Nepal's population has more than 26 times the wealth of the poorest 40%. What this means is that while Rs3,500 is peanuts for some households, it could be a monthly household food expense for others.Despite this, the HIB claims that there is no clear provider and purchaser split between MoH and HIB, the former has a high influence on the latter’s organisational structure, as such, many staffing decisions are still pending the ministry’s approval years later.The majority of the HIB staff are seconded from the Ministry of Health,  none of them are health economists or have financial background. Learning by doing is a costly, ineffective and inefficient approach for a high-priority national program.Similarly, the Health Insurance Board is incapable of coordinating with line ministries for the program's effective implementation. For example, the Act has delegated the NIB’s members to standardise service providers' quality control. However, its board is dominated by MoH members.This results in poor service quality, leading to dissatisfaction amongst insured populations and in the high dropout rate and under-utilisation of the services.Nepal’s health insurance program must undergo a serious and urgent reform to prevent it from becoming obsolete:Short to medium term recommendations:<ol><li>HIB needs to develop organisational guidelines to streamline reimbursement. The focus must be on demand generation to enrol rich, healthy and poorest groups equitably.</li> 	<li>The health service purchasing strategy must be reviewed, and this should also guide the structure and human resources needed.</li> 	<li>Private health service providers will inevitably be integrated into the program given the access gaps created by the limited number of public providers. But private providers are often more politically placed and vested interest can put HIB in a weaker negotiating position.</li> 	<li>HIB should develop standards for hospital/PHCC preparedness, provide additional training and incentives for the health workers and develop monitoring tools.</li> 	<li>Integration with other social security funds and health programs will improve efficiency and reduce duplication and wastage. Coordination with these funds will help access data on informal, and formal sector populations and cross-share promising practices particularly on investment.</li> 	<li>HIB should partner with existing research agencies and health economists to conduct studies and use ground-up feedback to reform.</li></ol>Long term recommendations:<ol><li>Premium-based pricing won't be fair or sustainable because of poverty and amidst high informal sector employees. So HIB should look into the possibility of fully tax-funded schemes for the informal sector populations.</li> 	<li>Provider and purchaser split: The provider and purchase split might go through lengthy technical and political discussion after HIB fulfils the majority of short and medium plans eventually. It requires having clear roles and responsibilities between MoH and HIB, understanding of the scope of work and mutual trust.</li></ol>Gaj Gurung is a public health practitioner currently based in Bangkok, Thailand. He has PhD in public health from College of Public Health and Sciences, Chulalongkorn University. His PhD evaluated the Nepal Health Insurance Program implementation fidelity and its effectiveness in reducing the out-of-pocket health expenses amongst insured populations.

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Health insurance must be an election agenda

India and Pakistan are twins separated at birth. Tensions between them have been at a hair trigger ever since independence and has erupted into full scale conflict at least four times in the past 80 years.
The 22 April terrorist attack in Kashmir that killed 25 Indian tourists and a Nepali citizen, threatens to escalate tension between the two nuclear-armed nations. India has squarely blamed Pakistan for the attacks, and Prime Minister Narendra Modi has given his military “operational freedom” to respond. Pakistan has said it has credible intelligence of an Indian military strike and its officials have promised a “full spectrum” response — a code for a <a href="https://nepalitimes.com/editorial/thinking-the-thinkable">nuclear retaliation</a>.
For Nepal, the killing of its national in the Pahalgam attack comes as another stark reminder that in conflicts from Afghanistan to Iraq, from <a href="https://nepalitimes.com/opinion/how-to-agree-an-armistice-in-ukraine">Ukraine</a> to Israel, <a href="https://nepalitimes.com/news/10-nepalis-from-one-town-fighting-in-ukraine">Nepalis are getting caught in the crossfire</a>. The last time full-scale fighting broke out between <a href="https://nepalitimes.com/opinion/peacemongers-at-india-pakistan-border">India and Pakistan</a> on Kargil in 1999, at least 22<a href="https://nepalitimes.com/here-now/india-s-trial-by-fire-for-soldiers-from-nepal?%27%5C%22="> Nepalis fighting for the Indian Army</a> were killed in action.
Three of Nepal’s immediate neighbours (China, India, Pakistan) have nuclear weapons, and they do not have good relations. With China supplying weapons, <a href="https://nepalitimes.com/editorial/war-and-warming">missile technology</a> and other support to Pakistan, this triangular friction could set off a regional conflagration.&nbsp;
<a href="https://www.nature.com/articles/s43016-022-00573-0" target="_blank">Research at Rutgers University</a> has calculated that even a week-long tactical nuclear exchange between India and Pakistan would throw up so much smoke and debris into the atmosphere that it would block out the sun for years, and lead to a collapse of the <a href="https://nepalitimes.com/news/grow-nourish-sustain-together-world-food-day">global food system</a>. This does not take into account the radioactive fallout that prevailing winds would blow up to <a href="https://nepalitimes.com/here-now/lives-on-the-line-in-the-himalaya">the Himalaya</a>, contaminating glaciers that are the sources of <a href="https://nepalitimes.com/here-now/saving-what-is-left-of-himalayan-rivers">Asia’s main rivers</a>.
The impact of <a href="https://nepalitimes.com/news/climate-breakdown-linked-to-thame-flood">climate breakdown </a>on High Asia was already ringing alarm bells about its <a href="https://nepalitimes.com/news/himalayan-icecap-melting-faster-than-thought">shrinking ice cap</a> reducing the dry season flow of water downstream. Water was going to be the next strategic commodity, geopolitical experts warned, and the next wars in Asia would be over water.
That water war is already happening. India retaliated to the Kashmir attack by suspending the <a href="https://www.nytimes.com/2025/04/24/world/asia/india-pakistan-indus-waters-treaty.html" target="_blank">Indus Waters Treaty</a> of 1960 mediated by the World Bank that has withstood at least three wars between India and Pakistan. The treaty gives India control over the three eastern tributaries of the Indus (<a href="https://en.wikipedia.org/wiki/Beas_River" target="_blank">Beas</a>, <a href="https://en.wikipedia.org/wiki/Ravi_River" target="_blank">Ravi</a> and <a href="https://en.wikipedia.org/wiki/Sutlej" target="_blank">Sutlej</a>), while Pakistan got water from the Indus and two of its western tributaries (<a href="https://en.wikipedia.org/wiki/Indus_River" target="_blank">Indus</a>, <a href="https://en.wikipedia.org/wiki/Chenab_River" target="_blank">Chenab</a> and <a href="https://en.wikipedia.org/wiki/Jhelum_River" target="_blank">Jhelum</a>.
Pakistan was assured of 70% of the annual flow, and India could use a reasonable amount of water for<a href="https://archive.nepalitimes.com/news.php?id=15231"> irrigation and hydropower</a>. &nbsp;Within days of its threat, India stopped water flowing down to Pakistan from the Chenab river and is reportedly preparing to do the same on the Jhelum.
The sabre-rattling has reached a crescendo. Besides threats and counter-threats there are also symbolic drills, with the Indian Air Force practicing landing on an expressway in Uttar Pradesh by its Rafale, Su-30 and Jaguar fighter jets to demonstrate ‘operational readiness’. In response Pakistan test-fired its Abdali ballistic missile that can carry a nuclear warhead and has a range of 450km.&nbsp;
The danger is that with ultra-nationalist rhetoric and the beating the war drums by both sides, India’s government and Pakistan’s military may have to ‘do something’ to appease domestic public opinion. But any tactical strike, an artillery exchange, or territorial incursion could quickly escalate out of control.
Expecting an Indian retaliation for the Pahalgam killings, Pakistan is using<a href="https://nepalitimes.com/opinion/interfaith-collaboration-for-nuclear-disarmament"> nuclear deterrence </a>and warning of “catastrophic consequences”. The two neighbours came close to a nuclear exchange in 2019 after an attack on the Indian military in Kashmir, and prompt international intervention led by the United States cooled tensions.&nbsp;
This time, the <a href="https://nepalitimes.com/news/trump-shock-wave-hits-nepal">Trump administration</a> is too distracted and not as engaged. Pakistan has denied it was responsible for the terrorist attack and called on Washington to stop a possible Indian retaliation. India and Pakistan have stopped overflights by each other’s airlines, and some international carriers have even stopped flying over Pakistan fearing an air war.
Washington, Beijing, the UN and the EU have all urged restraint. Iran, which has good relations with both India and Pakistan has sent its foreign minister to urge both countries not to go into a tit-for-tat war. Iran has its own nuclear flashpoint to worry about with tensions in Israel, &nbsp;Yemen and Syria.
India and Pakistan both share similar problems of joblessness, <a href="https://nepalitimes.com/here-now/why-nepal-s-poverty-rate-is-stuck">poverty </a>and <a href="https://nepalitimes.com/here-now/climate-change-new-threat-to-nepal-s-rhinos">environmental threats</a>. Neither side needs the threat of a senseless war, and we in the neighbourhood do not need it either.&nbsp;
Kunda Dixit
This Editorial is brought to you by <a href="https://nepalitimes.com/" target="_blank">Nepali Times</a>, in collaboration with <a href="https://inpsjapan.com/en/" target="_blank">INPS Japan</a> and <a href="https://sgi-peace.org/" target="_blank">Soka Gakkai International</a>, in consultative status with UN ECOSOC.

Nukes in the neighbourhood

The streets of Patan are alive this month with lavender jacaranda trees under rain-washed skies as <a href="https://nepalitimes.com/banner/the-red-god-rises-again-in-patan">the chariot of Rato Matsyendranath</a> is pulled across town. This is the festival of the rain god, and inevitably the heavens opened up and pre-monsoon showers pelted the chariot as it started being pulled in Pulchok last week. Thousands of devotees, onlookers and the chariot procession organisers thronged the streets on the first day last week. The rhythmic cymbals and drums exuded a vibrant energy as the enormous four wheels turned and the chariot lurched.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025051007050_81df97744db16f732a419dc1f1579d235ce3df37642b078f50b83bd4bd026688.jpg" data-media-id="editor_1" data-image-id="2025051007050_81df97744db16f732a419dc1f1579d235ce3df37642b078f50b83bd4bd026688" data-rendition-name="original" width="1000" height="1503" loading="lazy" alt="Divine chariot"> </figure>  The<a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/Red-rain-god,3141"> red rain god</a> has Hindu and Buddhist antecedents, alternatively called Bungadya and<a href="https://nepalitimes.com/here-now/kathmandu-s-gravity-defying-chariot-festival"> Karunamaya</a> — reflecting Kathmandu Valley’s syncretic mixture of the two religions.&nbsp; “Bungadya is a profoundly <a href="https://nepalitimes.com/opinion/12-full-opinion/marketing-the-intangible">intangible form of heritage</a>,” explains heritage expert Monalisa Maharjan. “It embodies traditional knowledge,<a href="https://nepalitimes.com/multimedia/reviving-nepal-s-craft"> artisanal skills passed down through generations</a>. Local communities and specific families have specified roles in being custodians of the heritage, ensuring their survival over the centuries.” There are many legends and stories about this annual tradition. Lichhavi king Narendra Dev is supposed to have brought Rato Matsyendranath from Assam to Kathmandu Valley to convince Guru Gorakhnath to lift a spell that created a two-year drought in Kathmandu.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250510050520_347a9a398f8a9abc4a7fb4e2774fde8264cccbdce8bdab23851ab3f0e73c3e8a.jpg" data-media-id="editor_6" data-image-id="20250510050520_347a9a398f8a9abc4a7fb4e2774fde8264cccbdce8bdab23851ab3f0e73c3e8a" data-rendition-name="original" width="1503" height="1000" loading="lazy" alt="Divine chariot"> </figure>  Matsyendranath was Gorakhnath’s mentor, and upon seeing him, the serpents were released, unleashing the rains. The chariot festival honours the return of this life-giving rain. The deity is seen as an icon for thriving agriculture, t<a href="https://nepalitimes.com/here-now/before-the-next-monsoon">he arrival of monsoon</a> showers, and the welfare of the community. Read also: <a href="https://nepalitimes.com/opinion/the-reign-of-the-god-of-rain">The reign of the god of rain</a>, Vidhu Prakash Kayastha Till this day, the Rato Matsyendranath festival is no ordinary celebration. Patan does not sleep for a month as the chariot is pulled through various neighbourhoods. It unfolds at a state level with the president (formerly the king) attending the climax of the Bhoto Jatra in Jawalakhel later this month.&nbsp; The intergenerational transmission of tradition is unique in the world, and the reason the festival is one of the most vibrant cultural expressions that thrives despite inroads of modernity. The other unique aspect is that it is a transnational festival, binding Patan with Guwahati in the Indian state of Assam.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025051005058_8bc685ada13045d863b28e3eed91c931da2b510714586af6fd7eb5d1e298a24a.jpg" data-media-id="editor_9" data-image-id="2025051005058_8bc685ada13045d863b28e3eed91c931da2b510714586af6fd7eb5d1e298a24a" data-rendition-name="original" width="1000" height="1503" loading="lazy" alt="Divine chariot"> </figure>  “Unlike Nepal, where the deity commands grandeur and devotion, many in Assam are unaware of Rato Matsyendranath,” says Khagen Sharma of Gauhati University, which convened <a href="https://nepalitimes.com/news/nepal-assam-connection-revived">a symposium in February in Guwahati on the rain god</a>. Attending was a delegation led by Lalitpur Mayor Chiribabu Maharjan, organisers of the festival, and builders of the chariot. After the symposium, a committee was formed to explore and revive the tradition in Assam as well. Although the team had planned to visit Nepal this month, logistical challenges delayed the trip. Still, there are plans to build a Guru Matsyendranath statue in Assam to reestablish regular worship practices in the Guwahati shrine.&nbsp; The vines used to build the chariot in Patan are sourced from the jungles of Assam. But Sharma notes that in recent years unclear regulations have blocked the official import of the vines, although they are still brought to Nepal informally. The <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/makers-of-machhindranath,2204">chariot making</a> has also had a taste of modernisation in recent times. In the past, even a single nail or piece of steel was avoided. But over time, the wooden structure, particularly the shaft between the wheels, has been replaced with bronze. When that too proved unstable, metal clamps were introduced, which have become a pragmatic compromise.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250510050524_b2a819a5791612f14c81d30fc393dbd3f99f0c64b90a9110e8b0855d944bfa93.jpg" data-media-id="editor_12" data-image-id="20250510050524_b2a819a5791612f14c81d30fc393dbd3f99f0c64b90a9110e8b0855d944bfa93" data-rendition-name="original" width="1500" height="998" loading="lazy" alt="Divine chariot"> </figure>  Another welcome change is the focus on safety. Builders climbing the chariot’s tower now wear harnesses and there are efforts in crowd control. The most visible change in recent years has been the involvement of Patan’s enthusiastic youth in the festival — the tradition is now passing to a new generation. Says Matsyendranath expert Vidhu Kayastha: “There is more energy, the young people in red t-shirts this year were very organised, these modern touches aren’t diluting our culture, they’re keeping it alive in new forms.” He adds, “We are <a href="https://nepalitimes.com/here-now/searching-for-a-homeland-away-from-home">reconnecting with our roots</a>, we have more resources, more awareness than ever before. We must not be swept away by western values that may not serve us, and in some ways, cause more harm than good. We must revive our own culture.”&nbsp;

Divine chariot

Most Nepalis thought they had seen the last of it after <a href="https://nepalitimes.com/news/11-56-25-april-2015-wkc9q2an">the 25 April 7.8 magnitude </a>earthquake ten years ago. But the Himalaya had more surprises in store. On 12 May, another 7.3 magnitude tremor that some said was an aftershock, but was strong enough to itself be a major earthquake, struck Dolakha.&nbsp; Not many people had heard of Singati till then — a cluster of houses by the Tama Kosi River along a narrow gorge that is the roadhead to Rolwaling Valley.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250508110520_57b6e316656851f71eca56ca6f98d9bbcc820c1a00d62af3c990725b4361244d.jpg" data-media-id="editor_1" data-image-id="20250508110520_57b6e316656851f71eca56ca6f98d9bbcc820c1a00d62af3c990725b4361244d" data-rendition-name="original" width="1000" height="1500" loading="lazy" alt="Climate magnifies earthquake risk in Nepal village NT"> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250508110520_016534fb2b6a79957402281cda768efb83a146786377e39e11df3e251d37159e.jpg" data-media-id="editor_2" data-image-id="20250508110520_016534fb2b6a79957402281cda768efb83a146786377e39e11df3e251d37159e" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Climate magnifies earthquake risk in Nepal village NT"> </figure>  It was here that dozens were killed on 25 April in the first earthquake. Hundreds of <a href="https://archive.nepalitimes.com/article/nation/Singati-rising-from-rubble-rebuilding,3703">Singati survivors</a> had lined up for food and relief supplies in the morning of 12 May when the second earthquake triggered a rock slide that buried a nearby camp. At least 50 people were killed. &nbsp; Three hours later, a US Marine Corps UH-1Y Venom helicopter landed in a nearby cornfield to pick up the wounded, and flew off. The aircraft lost contact with air traffic control in Kathmandu and its wreckage was located high on Kalinchok four days later. Six American servicemen, two Nepal Army soldiers, and five wounded civilians from Singati were killed. Today, Singati bears little physical scar of the multiple tragedies that struck the town ten years ago. Most <a href="https://nepalitimes.com/multimedia/bungamati-builds-back">houses have been rebuilt</a> as urban-style concrete structures, and Singati has become an economic hub on the road leading up to several hydropower plants and a<a href="https://nepalitimes.com/banner/off-the-beaten-trek-in-nepal"> popular trekking destination</a>.&nbsp; The town looks less like a village and more like a suburb of the Dolakha district headquarter of Charikot, 47km away.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250508110520_196f341d1df1403ba133e5dfeb837eec20d7cbcb4c8c56b17cc5598810de5df2.jpg" data-media-id="editor_6" data-image-id="20250508110520_196f341d1df1403ba133e5dfeb837eec20d7cbcb4c8c56b17cc5598810de5df2" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Climate magnifies earthquake risk in Nepal village NT"> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250508110524_ae66c4a92430f67db51b5e11e017059eedfbac4cb18c8e073f2a50cca1fe904e.jpg" data-media-id="editor_7" data-image-id="20250508110524_ae66c4a92430f67db51b5e11e017059eedfbac4cb18c8e073f2a50cca1fe904e" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Climate magnifies earthquake risk in Nepal village NT"> </figure>  “The demand for construction material, cement, iron rods and bricks peaked after the earthquakes,” says Suresh Khadka, who owns a hardware business here and now supplies material to the 456MW Upper Tama Kosi hydropower project that is undergoing repairs after it was damaged by a landslide last year. The demand for cement boomed since most residents believe, not necessarily correctly, that <a href="https://nepalitimes.com/banner/in-a-disastrous-state">cement houses are safer</a>. Although Khadka did well selling construction material after the earthquake, he worries that most new structures do not follow seismic-resistant building codes.&nbsp; The construction boom financed by bank loans has in turn forced many from Singati to <a href="https://nepalitimes.com/banner/making-overseas-migration-better">migrate overseas for work</a> so they can service their debt.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250508110524_50caa4530bd5ff9120cf7ab70a62173846d337ef448ff8bac339f3faa375a9e2.jpg" data-media-id="editor_10" data-image-id="20250508110524_50caa4530bd5ff9120cf7ab70a62173846d337ef448ff8bac339f3faa375a9e2" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Climate magnifies earthquake risk in Nepal village NT"> <figcaption>Suresh Khadka</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250508110520_ef8b7d3993fc3b5df852bbf952feb3fbabc96d6883b0d5eb74ee5c60f4123b83.jpg" data-media-id="editor_11" data-image-id="20250508110520_ef8b7d3993fc3b5df852bbf952feb3fbabc96d6883b0d5eb74ee5c60f4123b83" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Climate magnifies earthquake risk in Nepal village NT"> <figcaption>Phu Doma Sherpa (right)</figcaption> </figure>  “My family had no choice but to borrow money to rebuild our home since the government compensation was not enough, and ten years later we are still paying off the loan,” says Phu Doma Sherpa, 60. Because of the shortage of qualified masons and proper seismic engineering, <a href="https://nepalitimes.com/here-now/structural-problems">many of the buildings are of questionable building standards </a>and the traditional architecture has been abandoned, admits Kul Bahadur Budathoki, deputy chair of the municipality. “But these buildings were more expensive than what the government grants could cover, many people here are heavily in debt and the men have <a href="https://nepalitimes.com/here-now/every-day-is-closer-to-pay-day">migrated to the Gulf to pay their loans</a>,” Budathoki says.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250508110520_32f89e97b7e757fc9286c0bbb671f48ea8d4468e9634fa646d7247c650ad8480.jpg" data-media-id="editor_14" data-image-id="20250508110520_32f89e97b7e757fc9286c0bbb671f48ea8d4468e9634fa646d7247c650ad8480" data-rendition-name="original" width="1501" height="1079" loading="lazy" alt="Climate magnifies earthquake risk in Nepal village NT"> <figcaption>Kul Bahadur Budathoki</figcaption> </figure>  Singati is in a multi-hazard zone. The <a href="https://archive.nepalitimes.com/article/nation/Singati,3091">12 May 2015 earthquake </a>could have led to the collapse of Nepal’s largest glacial lake, <a href="https://nepalitimes.com/here-now/stairway-to-heaven">Tso Rolpa</a>, upstream. Due to global warming, the glacier has turned into an expanding lake 3.5km long, and its collapse would have unleashed a catastrophic Himalayan tsunami down the Tama Kosi Valley, with Singati directly in its path. Singati has literally risen from the ashes of 2015, with its residents beginning to recover from the trauma and financial toll. But it is not out of danger as <a href="https://nepalitimes.com/news/climate-breakdown-linked-to-thame-flood">climate breakdown </a>magnifies the risk from future earthquakes.

Climate magnifies earthquake risk in Nepal village

This is the 67th episode of Diaspora Diaries, a Nepali Times series in collaboration with Migration Lab providing a platform to share experiences of living, working, and studying abroad. <h2>Alpana Adhikari, UK</h2> Back in Nepal, I had worked as a nurse for a decade, but I had my heart set to go overseas. My reason for <a href="https://nepalitimes.com/banner/migration-not-a-wish-but-necessity-for-nepalis">wanting to migrate</a>, however, was a bit different as it was for my son. He has a disability, and considering his situation from multiple perspectives—including <a href="https://nepalitimes.com/here-now/it-s-all-in-the-mind">societal attitudes</a>, the preparedness of schools, and the availability of facilities for individuals with his condition—Nepal did not feel safe for my baby.&nbsp; I had to migrate, no matter what, for his sake. The facilities here in the UK for children with his condition are significantly better, and I am glad he and my husband will join me in a few months.&nbsp; I was applying via private routes like everyone else when the Government to Government pilot program between Britain and Nepal was announced. Even though the initial program targeted 100 nurses, only 40 of us were able to meet the criteria.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250511160536_46f6a3c05fd2d9bdac06a9a478f49079c2c69c783fcf0cc58b75da6128319745.jpg" data-media-id="editor_2" data-image-id="20250511160536_46f6a3c05fd2d9bdac06a9a478f49079c2c69c783fcf0cc58b75da6128319745" data-rendition-name="original" width="720" height="1280" loading="lazy" alt="DD 67"> <figcaption>Alpana Adhikari started working as a nurse in a hospital in the UK in March.</figcaption> </figure>  I made it to the UK &nbsp;in February 2024 without paying a single paisa to any broker. The G2G scheme was unique as we were treated with dignity and valued for our skills: they covered costs for the <a href="https://nepalitimes.com/opinion/free-visa-free-ticket-policy-in-limbo">ticket and visa</a>, reimbursed us for exams we had taken and costs involved in the preparation and testing of the Objective Structured Clinical Examination were also covered.&nbsp; I started work in March last year, and currently am based in the respiratory ward of a hospital. I am enjoying my work a lot. In one year, I have received 26 WOW nominations which are notes of<a href="https://nepalitimes.com/here-now/the-healer-of-far-western-nepal"> appreciation from patients </a>we have served. ‘Alpana is one of the kindest nurses I have seen. Awesome and talented … always smiling, never appears tired and helps everyone,’ one patient testimonial said. Another: ‘You can see clearly that she cares about her patients…She was cool amidst great stress and ALWAYS with a smile which gave me confidence.’ I am also the International Educated Nurses Advocate which means I can raise issues with management about issues facing <a href="https://nepalitimes.com/opinion/comment/nepali-nurses-now-britain-bound">international nurses</a> here.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250511160536_87b959c7550bbd1272ebf840d9f24735db008307ad825e4aa15e66c1662a7fd4.jpg" data-media-id="editor_6" data-image-id="20250511160536_87b959c7550bbd1272ebf840d9f24735db008307ad825e4aa15e66c1662a7fd4" data-rendition-name="original" width="1590" height="1600" loading="lazy" alt="DD 67"> <figcaption>One reason Alpana Adhikari migrated to the UK was so there would be better facilities for her son, who has a disability. </figcaption> </figure>  Recruitment from NHS linked hospitals is free but when we <a href="https://nepalitimes.com/editorial/safer-migration-for-women">migrate through private routes</a>, agencies either charge upfront costs or in some cases, there is wage deduction once the nurses start earning.&nbsp; I have met Nepalis who have paid up to Rs 1 million for the same job. These costs can go even as high as Rs3 million for work in caregiving or nursing homes. I am lucky not to have to pay anyone for my posting.&nbsp; But beyond costs, I think there is also a reputational advantage of coming through the government selection process at the hospital. Such programs need to be expanded more because <a href="https://nepalitimes.com/editorial/nepal-s-nurse-flight">nurses are migrating </a>anyway and it would save people a lot of unnecessary costs and hassles. I will always be protective about Nepal and am grateful for the experience I gained, but it is true that nurses lack dignity in the workplace back home. Nursing is laborious work and completing the education takes a fortune but the <a href="https://nepalitimes.com/here-now/nursing-grievances-against-the-state">pay for nurses in Nepal</a>, other than at a handful of hospitals, is unfairly low.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250511160540_2a483361070e6e65413cf3bcf3be7af0581044f85c3e6da25a66dc87042af9d9.jpg" data-media-id="editor_10" data-image-id="20250511160540_2a483361070e6e65413cf3bcf3be7af0581044f85c3e6da25a66dc87042af9d9" data-rendition-name="original" width="2048" height="1536" loading="lazy" alt="DD 67"> <figcaption>Alpana Adhikari while working as a nurse in Nepal.</figcaption> </figure>  It naturally makes nurses want to migrate. People often ask me what the difference in the UK and Nepal is. Work is similar but in terms of technology, there is less paperwork here as everything is digitised. Treatment is also more nurse-led and we have more say while making recommendations about medicine and discharging decisions which can be empowering. Read also: <a href="https://nepalitimes.com/here-now/nepali-nurses-gone-and-going-to-the-uk">Nepali nurses gone and going to the UK</a> I am not sure what it is about nursing but I am always in high spirits and energetic about showing up to work every day. To be a good nurse, you have to have the passion for <a href="https://nepalitimes.com/news/step-by-step-for-rural-health-care-in-nepal">patient care</a>.&nbsp; Sometimes people tell me it is because my family has not yet joined me which has freed up my time to singularly focus on work, but I do not believe that is true. Back home, too, I used to be as passionate about my job.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250511160540_47851c2c850c936b7bfb23da0f0e8a07620ea213ad929c229b6cca8711adc5d4.jpg" data-media-id="editor_13" data-image-id="20250511160540_47851c2c850c936b7bfb23da0f0e8a07620ea213ad929c229b6cca8711adc5d4" data-rendition-name="original" width="1024" height="768" loading="lazy" alt="DD 67"> <figcaption>Alpana Adhikari (left) during an International Nurses Day rally in Kathmandu.</figcaption> </figure>  What fuels my passion here is the appreciation we get. It is not just about the income. Sometimes after <a href="https://nepalitimes.com/here-now/you-must-be-having-so-much-fun-there?fbclid=IwZXh0bgNhZW0CMTEAAR0OsTusz4rvYDQLvB0bnwhlDvkS3zCQ-UvuoO5manWHC0LGI2c3XY7e6ZY_aem_hR-tZOp4xg1mINPJvwD7Nw">long hours at work</a> when it has been a particularly busy day, a phone message from my manager and colleagues appreciating me for a job well done can go a long way.&nbsp; Likewise, the WOW recommendations from my patients have boosted my confidence. One of my elderly patients who had a <a href="https://archive.nepalitimes.com/article/nation/stigma-and-silence-mental-health-nepal,3486">mental illness </a>and I bonded, and she felt comfortable enough to open up with me. She would then refer to me as her friend with everyone.&nbsp; It is little things like this that can make a big difference. Perhaps that is why my flat mate and colleagues often question why I don’t look tired even after a long shift. <h2>Binu Gurung, Japan</h2> It has been five-and-half years since I came to Japan under the Specified Skilled Workers (SSW) visa in the nursing category. I had previously come to Japan as a language student as well.&nbsp; I grew up in Ghandruk and had just started my Bachelor’s course when a friend suggested we try<a href="https://nepalitimes.com/business/nepalis-in-japan"> to go to Japan </a>so I just followed the trend and stayed here for three years as a student.&nbsp; Two years after returning to Nepal, I re-migrated to Japan under the SSW scheme which was at its early stages and only open to nursing initially.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250511160536_305bb5cb5095da6148911dae8b07356ece5b292148e6c8e57a39fd31d811624b.jpg" data-media-id="editor_17" data-image-id="20250511160536_305bb5cb5095da6148911dae8b07356ece5b292148e6c8e57a39fd31d811624b" data-rendition-name="original" width="720" height="960" loading="lazy" alt="DD 67"> <figcaption>Binu Gurung on arrival in Japan to work as a nurse three years ago.</figcaption> </figure>  I take care of the elderly Japanese who are mostly above 80 years of age, a few even above 100. I try not to get too attached to patients but it is of course not always easy because of the nature of the job and patients we serve.&nbsp; Patients dying of age is common as it is not a care facility where patients recover to return to their homes. Just recently, an elderly lady who had been here from the day I joined 5.5 years ago passed.&nbsp; These leave you a bit खिन्न and emotionally drained. Most are <a href="https://archive.nepalitimes.com/article/nation/dementia-brings-new-problem-that-families-have-little%20knowledge-of,2151">dementia patients</a> who do not &nbsp;even recognise their family members. Some elderly patients are reserved and do not feel comfortable as the work entails helping with personal care tasks like using the toilet or bathing and they can be irritable.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250511160536_c840a0b12c20c3d52d9eceec06a0bc8c90208f13e402c50f319583b1c1a93b87.jpg" data-media-id="editor_19" data-image-id="20250511160536_c840a0b12c20c3d52d9eceec06a0bc8c90208f13e402c50f319583b1c1a93b87" data-rendition-name="original" width="694" height="960" loading="lazy" alt="DD 67"> <figcaption>Binu Gurung's work involves taking care of elderly Japanese.</figcaption> </figure>  Building trust and rapport takes time, patience and familiarity. I do not think there is a way to explain how happy I feel when they are happy with the care we provide and thank us in smiles like we are their own family members.&nbsp; My own grandmother back in Nepal was in a similar situation requiring care before she passed and I am able to extend that kind of care to many patients.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250511160536_0f41ad57ae1ac5bd2f406d86cdc5f542b613cef6961d8fdf20c883ee38404b5e.jpg" data-media-id="editor_20" data-image-id="20250511160536_0f41ad57ae1ac5bd2f406d86cdc5f542b613cef6961d8fdf20c883ee38404b5e" data-rendition-name="original" width="1600" height="1067" loading="lazy" alt="DD 67"> <figcaption>Binu Gurung in Yokohama.</figcaption> </figure>  I know that this job is not for everyone. That is why some nurses who come to Japan because they want to just<a href="https://nepalitimes.com/banner/making-overseas-migration-better"> migrate overseas </a>at any cost without considering the kind of employment realise that caregiving might not be for them.&nbsp; You have to be mentally, physically and emotionally prepared for it. If you are short-tempered by nature, for example, it may not be the best fit. However, for those who are genuinely interested in care work like I am, there are many growth opportunities in nursing which are also financially rewarding.&nbsp; While working under the SSW visa, I was able to take training classes on the side and passed the national exam for nursing. I was then able to change my visa from SSW to nursing caregiver visa. My son joined my husband and I recently in Japan and has started school.

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