The United States Medical Licensing Examination (USMLE) is a test that those who want to practice medicine in America have to pass. A growing number of Nepalis have been taking the test to emigrate to the US.&nbsp;
Last week, USMLE invalidated test results of some 800 Nepali doctors because of ‘unusual score patterns or variations’.
‘The USMLE program has identified a pattern of anomalous exam performance associated with Nepal, which challenges the validity of test results for a group of examinees,’ its statement said.&nbsp;
Essentially, USMLE was accusing Nepali doctors of having prior knowledge of questions. This sparked outrage among Nepalis in the United States who say it tainted the country's image, and besides there is no way the test questions can be ‘leaked’.&nbsp;
<a href="https://nepalitimes.com/here-now/nepali-doctors-love-for-urdu-poetry">Ramu Kharel</a> is an emergency medicine physician and assistant professor at Brown University. He told us, "We care for the integrity of the program, and do not condone cheating in any form but the decision is not backed by strong evidence and creates biases when there is already a lot of brewing anti-immigrant sentiment.”
Kharel reached out to the USMLE director who told him it was ‘an ongoing investigation’.
“And yet they put out a blanket statement that has tarnished an entire country’s image as well as the credibility of practicing Nepali doctors who have done a lot of good work in the US.”
Several international doctors in the United States back this up, saying irregularities should have been addressed individually instead of singling out a whole country.
‘Some folks are using incidents of what they call “unusual USMLE Scores" to vilify the whole immigrant community who are resilient, hardworking, and knowledgeable as local doctors are. Let's not generalize the acts of a few to whole country and to emigrants,” X'ed Sadiq Naveed, psychiatrist in Hartford, Connecticut.
<div class="embed-block"><blockquote class="twitter-tweet">Some folks are using incidents of &quot;unusual USMLE Scores&quot; to vilify whole IMG community. IMGs are as resilient, hardworking, and knowledgable as AMGs are. Let&#39;s not generalize the acts of a few to whole country and the IMG community.&mdash; Sadiq Naveed (@SadiqNaveed) <a href="https://twitter.com/SadiqNaveed/status/1753917839289753714?ref_src=twsrc%5Etfw">February 3, 2024</a></blockquote> <script async src="https://platform.twitter.com/widgets.js" charset="utf-8"></script></div>
<div class="embed-block"><blockquote class="twitter-tweet">USMLE Score Invalidation: In my opinion mistakes of some mustn&#39;t lead to singling out of an entire country🇳🇵. ECFMG &amp; USMLE could have handled the situation better by a making a more generalized statement rather than naming a particular country. &quot;Culprits should be punished… <a href="https://t.co/h7AnANubE6">pic.twitter.com/h7AnANubE6</a>&mdash; Dr Ahmad Rehan Khan (@AhmadRehanKhan) <a href="https://twitter.com/AhmadRehanKhan/status/1754145466608955585?ref_src=twsrc%5Etfw">February 4, 2024</a></blockquote> <script async src="https://platform.twitter.com/widgets.js" charset="utf-8"></script></div>
&nbsp;Ahmad Rehan Khan, psychiatrist based in Virginia also tweeted: ‘In my opinion mistakes of some mustn't lead to singling out of an entire country. ECFMG &amp; USMLE could have handled the situation better by a making a more generalized statement rather than naming a particular country.’
Kharel started a <a href="https://www.change.org/p/call-for-usmle-to-redact-and-change-the-statement-regarding-applicants-from-nepal?recruiter=1329972259&amp;recruited_by_id=12774da0-c307-11ee-8897-7bad97cd7eca&amp;utm_source=share_petition&amp;utm_campaign=share_for_starters_page&amp;utm_medium=copylink">petition calling on USMLE to redact or change the statement</a>, and has over 2,500 signatories already. He has approached the Nepali physicians' group in the US as well as the America Nepal Medical Foundation seeking legal counsel.
“The damage is already done, but USMLE at the very least needs to immediately revise its statement and issue a formal apology,” says Kharel. “The truth is that Nepalis are generally well-liked here."&nbsp;
A week before the USMLE statement, <a href="https://nepalitimes.com/here-now/grass-is-greener-overseas-for-nepals-doctors">Nepali Times published a report about doctors emigrating</a> to the US, UK, Canada, Australia and the Gulf, leading to a shortage of specialists in Nepal and weakening an already fragile medical system.
Nepal has an annual turnover of nearly 2,500 MBBS graduates, yet the country faces a severe shortage of doctors. The Nepal Medical Council says 36% of doctors have emigrated, but that seems to be an undercount. &nbsp;
Between April-December 2023, 1,025 physicians left Nepal. Since 2020, 1,578 doctors have emigrated to the UK, and 888 to the US.&nbsp;
There are many push factors, but the lack of professional fulfilment in Nepal is the biggest. Equally strong is the pull of the American dream, with even unskilled Nepalis paying up to Rs6 million to human traffickers to take the illegal backdoor to the US.
<a href="https://archive.nepalitimes.com/news.php?id=19560">Emigrating doctors</a> may earn more than in Nepal, but international medical graduates in the US often do not get to practice specialised medicine of their choice, and are relegated to long hours as general physicians.&nbsp;
“Nepali doctors are emigrating essentially for thankless, blue-collar jobs,” says Bishal Dhakal, cardiac surgeon and founder of Health At Home in Kathmandu. “They do not make a lot of money by American standards and are doing jobs that American doctors do not want to do. Which is why Nepalis being accused of cheating is so tragic.”
Even so, the <a href="https://www.medscape.com">Medscape medical news website</a> on 1 February states that selling and buying USMLE questions online have become rampant with test questions selling for anywhere from $300 to $2,000.
An Indian doctor Ahmad Ozair at Johns Hopkins says his suspicions were aroused when he saw several students from one medical school in Nepal, posting on social media about scoring up to 280-plus.
‘The statistical probability that you would have three or more candidates in the same year, scoring in the 99th percentile worldwide, from a small geographical area is extremely low,’ Ozair <a href="https://www.medscape.com/viewarticle/us-board-discloses-cheating-grads-say-problem-rampant-2024a10002aj">said to Medscape</a>.&nbsp;
Others say the USMLE recall of Nepali test takers was not an ordinary one, and there is photographic evidence of questions leaked at exam centres.&nbsp;
The fact that Nepal’s university exams have regular scandals of ‘question outs’ gave credence to accusations of Nepali cheaters.&nbsp;
J. Bryan Carmody, nephrologist based in Virginia, also took to Twitter to write: ‘This isn’t the usual low-quality “USMLE recalls” - and instead involves screenshots/photos of real questions, taken at test centers by proctors (or after the proctors were paid to look away).’
<div class="embed-block"><blockquote class="twitter-tweet">The cheating in this case involved “prior unauthorized access to secure exam content.” This isn’t the usual low-quality “USMLE recalls” - and instead involves screenshots/photos of real questions, taken at test centers by proctors (or after the proctors were paid to look away).&mdash; Bryan Carmody (@jbcarmody) <a href="https://twitter.com/jbcarmody/status/1752891546553213219?ref_src=twsrc%5Etfw">February 1, 2024</a></blockquote> <script async src="https://platform.twitter.com/widgets.js" charset="utf-8"></script></div>
Medical educator Conrad Fisher of MedQuest Test Prep questioned in an X post the high performance of Nepalis: ‘Of 138 with &gt;275 applying to my program, 86% are Nepali. Of the top 100 applicant scores 92% are Nepali.’
But Bishal Dhakal says Nepalis are used to practicing for exams based on past tests, and it is unfair for USMLE to call it cheating just because of high scores. “If there is an issue with exam centres, that should be dealt with separately without dragging the whole country into it," he adds.
An increasing number of Nepali doctors passing USMLE tests with high marks seems to be making some international graduates in America insecure. He adds, "We are sending our smartest doctors to America, and that didn’t sit well with those benefiting from the Subcontinent quota. A small country is being singled out." &nbsp;

Sonia Awale

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Cheated out of the American Dream

In 2009, Samir Lama completed his MBBS and then passed all three stages of the United States Medical Licensing Examination (USMLE), making him eligible to practice in the US. However, he returned to Nepal in a year, opting to serve his own people instead. Lama pursued a three-year residency in General Medical Practice at the Teaching Hospital in Kathmandu sponsored by the Nick Simons Institute and was later placed at the District Hospital in Piuthan under a three-year contract. Eventually, at a medical college in Chitwan, Lama’s monthly salary was Rs80,000, a relatively meagre sum for someone with three years of post-MD work experience. Dissatisfied, he established his own polyclinic in Chitwan. But today, he is based in Britain, working as a resident physician in general practice. “There are difficulties living and working in Nepal,” Lama tells us by phone. “Becoming a doctor through civil service is difficult, and a physician’s life is financially challenging even in private practice.” In 2017, Murari Barakoti completed a one-year fellowship in Interventional Cardiology, and preferred to work in Singapore and the Maldives rather than stay in Nepal. He blames the lack of expertise-based remuneration in Nepal for his decision.&nbsp; “In the Maldives, doctors get ten to twenty times the pay they would normally get in Nepal,” says Barakoti, who is among 1,100 Nepali doctors working in the Maldives today. Ironically, many students from Maldives come to Nepal’s medical colleges for their education. Sandesh Parajuli, a government scholarship recipient for MBBS in Pakistan, worked for two years at Gandaki Provincial Hospital after he returned. In 2020, he took the medical officer exam at Lumbini Provincial Hospital, and the results are still pending. Tired of waiting, Parajuli completed his USMLE online and is now in the US. He says, “There is a sense of fulfilment serving patients in my own country, but the working environment in Nepal for doctors is not conducive. Of my 20 closest friends, only one is still working in Nepal.” It is generally known that young Nepalis are leaving the country by the tens of thousands every year for undergraduate studies in Australia, Canada or Japan. Less well known is this haemorrhage of doctors and nurses. <div class="embed-block"><iframe title="Specialists" aria-label="Grouped Bars" id="datawrapper-chart-3jT6V" src="https://datawrapper.dwcdn.net/3jT6V/1/" scrolling="no" frameborder="0" style="border: none;" width="600" height="492" data-external="1"></iframe></div> The depletion of medical personnel has further weakened the country’s already fragile healthcare system, and added to the shortage of specialists. Despite an annual turnover of 2,000 to 2,500 MBBS graduates, Nepal faces a severe shortage of doctors, especially in remote parts of the country. The Nepal Medical Council (NMC) has nearly 35,000 registered doctors, including 10,588 specialists. But there is no exact figure for working professionals. A 2015 study by the Council reported that approximately 36% of doctors are working abroad, but the actual proportion is estimated to be much higher.&nbsp; Doctors planning to leave are mandatorily required to present a Good Standing Certificate (GSC), and the Medical Education Commission issued 1,025 GSCs just between April to December 2023. Commission sources say the demand for GSCs has surged in the past four years.&nbsp; The majority of Nepali doctors have chosen to migrate to the UK, with 1,578 physicians acquiring certificates since 2020. The US is the second most popular destination, with 888 Nepali doctors moving there to practice in the same period. Opportunities in Australia, UAE, Canada, and Qatar are also on the rise. Sanjeev Sapkota, president of the Non-Resident Nepali Association (NRNA), estimates that of its total membership, 5,000 are doctors and medical specialists. Many others who have migrated have not bothered to become NRNA members. Worryingly, government scholarship recipients make up a rising number of migrant physicians — depriving state-run hospitals in the country of specialists. Some doctors seek improved working conditions, while others, frustrated with unemployment or exploitation in Nepal’s private hospitals, choose to start anew. They are attracted by the promise of higher earnings, and a better future for their families. 1:150,000 Completing an MBBS degree generally takes six years, and those studying on government scholarships are obligated to work in a rural hospital for an additional two years. During this period, they have no time for further study or to sit for civil service exams. However, once the commitment is fulfilled, they are left without a paying job. “Despite some incentives for further studies after MBBS, many graduates struggle because of low salaries and uncertain future prospects,” says Shambu Khanal of the Lumbini Provincial Hospital.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240128110120_63d9c40da537cbdad3dc2307a31623607227185a5768b1999359f53cc6c17b88.jpg" data-media-id="editor_1" data-image-id="20240128110120_63d9c40da537cbdad3dc2307a31623607227185a5768b1999359f53cc6c17b88" data-rendition-name="original" width="2500" height="1667" loading="lazy" alt="Nepali healthcare NT"> </figure>  Postgraduate study opportunities are also hard to get due to limited annual seats of around 2,000. Additionally, a small number of subject-specific seats further complicates matters, particularly for those candidates below the top 500, barring them from pursuing preferred medical disciplines. Without government support, individuals must bear all expenses themselves, discouraging many more aspiring Nepali doctors from pursuing MD/MS degrees. This in turn is leading to a chronic shortage of specialists in Nepal. The 'Human Resources for Health (HRH) Projection in Nepal, 2079-2087' reveals a deficit of 5,779 specialists, with the annual production growth rate falling short at 6.41%, thus widening the gap in the doctor-to-population ratio. At present, there is only 1 doctor for every 850 people in the Kathmandu Valley which is better than the WHO-recommended 1 per 1,000. But this ratio goes down to 1 per 150,000 in remote districts. &nbsp;Despite depopulation of the mountain districts, there is a dire need to retain qualified medical staff in rural Nepal. The absence of diverse medical expertise, coupled with government oversight of emerging disciplines, leaves returning professionals with no acknowledgment or motivation. The country therefore faces a critical shortage of specialised doctors, particularly in cardiology, surgery, gynaecology, and neurology. A recent study by the Medical Education Commission showed a shortfall in surgeons: there are only 660 when the country needs a minimum of 808. Medical generalists face a similar deficit, with just 349 working actively against the 1,115 required. The study also foresees a demand for 1,223 medical generalists in 7 years, factoring in population growth. Doctors in specialised services in new fields face challenges due to inadequate infrastructure and equipment. Even those willing to work in government hospitals struggle to secure positions.&nbsp; Dharmagat Bhattarai, who is specialising in paediatric clinical immunology and rheumatology, says there is an urgent need for specialised doctors, especially for diagnosing and treating rare diseases in children. “After MBBS, graduates work as interns in hospitals for a year. Although hospital administrators assign them duties, they do not get adequate compensation,” says Bijay Parajuli, who specialises in pediatric critical care, rheumatology, congenital heart diseases, and neurosurgery. He adds: “In Pakistan, I received a monthly stipend of Rs44,000 after MBBS while interns in Nepal are getting only Rs9,000.” <div class="embed-block"> <iframe title="Total ‘Good Standing’ certificated from NMC" aria-label="Interactive line chart" id="datawrapper-chart-N0vyK" src="https://datawrapper.dwcdn.net/N0vyK/1/" scrolling="no" frameborder="0" style="border: none;" width="600" height="400" data-external="1"></iframe></div> Resident doctors pursuing MD/MS face a similar fate. Overworked doing hospital health check-ups, filling prescriptions, and handling ward responsibilities, their studies are often hampered—and all this for poor pay. While countries like the USA, UK, and Canada waive tuition fees for MD/MS programs, resident doctors in Nepal have to struggle for better remuneration. A government hospital resident earns an average of Rs48,000 monthly. However, those working in private medical colleges are compelled to work for less than Rs20,000. Some doctors say residents in private hospitals often have to work for 36 hours straight, multiple times a month. Vishad Dahal, an internal medicine student at Kathmandu Medical College, faced suspension for questioning a 20 extra-curricular health camp. His suspension has now been revoked. NMC’s &nbsp;'Regulations for Postgraduate Medical Education (MD-MS Programs) 2017' states that postgraduate residents should not be assigned duty for more than 24 hours per week. Typically, it takes an average of 12 years to complete MD, even after graduation. This means most doctors would not have finished their studies even in their early 30s. Moreover, the cost of private medical education is expensive and often exceeds Rs10 million. And after all that, there is still no job security, not to mention the years it takes to recover the investment. This prompts many to consider working or studying abroad. “The rise in Nepali doctors moving abroad demands urgent attention. While it may seem routine at first glance, the trend can potentially cause a scarcity of experts,” admits Shri Krishna Giri, past president of the Medical Education Commission. He adds: “Restricting doctors from seeking opportunities overseas may not be a practical solution. The challenge lies in finding a nuanced approach that recognises and addresses the multifaceted factors contributing to this exodus.” &nbsp; With additional reporting by Yugottam Koirala.

Grass is greener overseas for Nepal's doctors

Nepal’s only international aviation gateway, at Kathmandu airport, will cut night-time operation hours to allow construction of taxiways, and airlines have been told to curtail flights. This is expected to lead to more than normal chaos during the height of peak autumn and spring tourist seasons at an airport that is congested even at the best of times. The airport will close from 10PM to 8AM from 8 November-31 March 2025. The taxiways will now connect to the thresholds at both ends of the runway, making the airport more efficient in handling higher frequencies of landings and takeoffs. The parallel taxiway extension will allow international flights to land every 4 minutes instead of the current every 7 minutes. At present planes have to wait to land until a plane taking off backtracks along the runway.&nbsp; Kathmandu is Nepal’s only airport with international operations, and it has only one runway that is only one way in from the south over the mountains. With the taxiway improvement, the airport will be able to handle 42 aircraft landings and takeoffs per hour — double the current capacity.&nbsp; The Civil Aviation Authority of Nepal (CAAN) has been trying to entice international airlines to also start flying to and from the other two international airports at Pokhara and Bhairawa (Lumbini) by slashing landing and handling charges. But so far only Nepal Airlines operates a weekly flight to Bhairawa from Kuala Lumpur.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241018161016_046569e53d1d66cd445cc66c697c0ef724810aec9f54bdf827481e3cd6b80c32.jpg" data-media-id="editor_0" data-image-id="20241018161016_046569e53d1d66cd445cc66c697c0ef724810aec9f54bdf827481e3cd6b80c32" data-rendition-name="original" width="2356" height="1134" loading="lazy" alt="Kathmandu airport expansion"> <figcaption>Kathmandu Airport Expansion plan with extension of taxiways to the thresholds of runways 02 and 20 that will limit airport operations from 8 November 2024 - 31 March 2025. Areas in blue are existing structures, including the international terminal which in future will be the domestic airport, and the new international terminal near the north end of the runway,</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241018121028_6e17cc2ee87c1b02d78cb54905825b7aa15299b7a00f5eddb01a59579ab85c1a.jpg" data-media-id="editor_1" data-image-id="20241018121028_6e17cc2ee87c1b02d78cb54905825b7aa15299b7a00f5eddb01a59579ab85c1a" data-rendition-name="original" width="1353" height="1328" loading="lazy" alt="Kathmandu airport NT"> </figure>  CAAN has reportedly told international airlines to cut their flight frequency to Kathmandu citing the shorter operation hours and has told budget airlines to shift some of their flights to Pokhara or Bhairawa, or face cuts. Many airlines currently operate regular flights to and from Kathmandu between 10PM and 8AM: Air Arabia to Sharjah, Fly Dubai to Dubai, Jazeera Airways to Kuwait, Cathay Pacific to Hong Kong, Singapore Airlines, several Nepal Airlines flights, and one of four daily flights by Qatar Airways to Doha. Jazeera Airways, FlyDubai, and Thai AirAsia have applied and got permission from CAAN to begin regular flights to Bhairawa’s Gautam Buddha International Airport. Starting 9 November, FlyDubai will start making a stopover in Bhairawa before flying on to Kathmandu. Immigration, customs and security are all fully functional in Bhairawa. In Kathmandu, the next phase of the airport upgrade includes converting the current international terminal for domestic operations, the construction of a new international terminal where the domestic departure area is now, as well as moving the hangars and the Nepal Army Air Wing to the eastern side of the runway. The apron area will also double its parking space for widebody jets. This is part of a Airport Capacity Enhancement Project that was initially funded through a $80 million loan from the Asian Development Bank (ADB), and the entire masterplan is expected to cost $800 million. This project is the latest upgrade to Nepal’s only international airport since it saw its first flight in 1949. The current international and domestic terminals are too small to handle the current annual traffic volume of 8.5 million passengers a year that is growing at 20% a year.

Kathmandu airport to cut flight hours

As Kathmandu becomes more congested and polluted, and with remote online work becoming the norm, many professional Nepalis are planning to retire in Pokhara, or move there.&nbsp; With its stunning mountain panorama, balmy winters and proximity to a profusion of wilderness areas, builders are responding to this demand with new townhouses, housing development and apartments. One such block of flats is the 10-storey <a href="https://sungavaapartment.com/">Sungava Apartment</a> located at Phulbari above the Seti River, near the point where it flows into and under Pokhara. The imposing structure near Manipal Hospital is almost complete, and on a recent visit the site was strewn with huge boulders unearthed while digging the foundation.&nbsp; The Seti brought down these boulders during a gigantic flood that geologists estimate happened 800 years ago when a chunk of Annapurna IV broke off and ploughed into the glacier below. Today, Sungava (means ‘orchid’) sits safely on a high terrace, 100m above the blue-green Seti and commands a view of Dhaulagiri, Annapurna South, Machapuchre, Annapurna III and IV.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2024102411104_5f8fc736c86ea3c08d7bef43bb727081d3cc1a2caa55ae2b441717e6044de7e9.jpg" data-media-id="editor_1" data-image-id="2024102411104_5f8fc736c86ea3c08d7bef43bb727081d3cc1a2caa55ae2b441717e6044de7e9" data-rendition-name="original" width="2016" height="1512" loading="lazy" alt="High living below the Himalaya NT"> </figure>  The soil here is conglomerate that has solidified like concrete, and the boulders were extracted by heavy earthmovers. It is intriguing to think that these metamorphic rocks as big as cars, rounded by glacial grinding, were once a part of a much higher Annapurna IV. Even for those with little interest in geology, Sungava is an ideal place to contemplate the tectonic forces that pushed these peaks into the sky to be sculpted into delicate shapes by wind, snow, earthquake and avalanche over millions of years. The view of the Himalayan panorama from Sungava’s many balconies are breathtaking when not obscured by clouds, or the haze that drifts in from across the southern border. On most days, just watching the towering pyramid of Machapuchre (Tamu name: कतासुँ क्लिको) play hide and seek with the clouds is mesmerising. There are rocks aplenty at Phulbari, and it is probably the flowers that grew along the flat terraces e that gave the place its flowery name. The boulders will hopefully be turned into a rock garden while landscaping. An nearby restaurant complex is making the best use of the stones in its design, using flat rocks as outdoor benches and tables. Sungava was designed by the husband-wife architect team of Deepak Sherchan and Jyoti Joshi of <a href="https://thedarkmermaidamarbshrestha.blogspot.com/2013/12/creative-builders-collaborative-cbc.html">Creative Builders Collaborative (CBC)</a>, which also built Heritage Plaza, Indreni Apartment and numerous other projects in Nepal. Sadbhavana retains CBC’s trademark Newari-style masonry and here it borrows from the orange brickwork of the old town of Pokhara, integrating it with modern design elements. A few of those heritage houses are still standing in Ganesh Tole and Ram Krishna Tole in Pokhara’s old quarter.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2024102411108_5eb64a4885961b6d30781cefeb1e8a313da313ac5227c7a66b60f0c7d48d6fab.jpg" data-media-id="editor_3" data-image-id="2024102411108_5eb64a4885961b6d30781cefeb1e8a313da313ac5227c7a66b60f0c7d48d6fab" data-rendition-name="original" width="1362" height="595" loading="lazy" alt="High living below the Himalaya NT"> </figure>  About 400m from the apartment past a bend on the river, and down below three tiers of terraces in the canyon is a suspension bridge. Below it, the Seti is still swollen with post-monsoon flow as it tumbles away in a hurry to head down south.&nbsp; Back at the apartment, it is quiet, far away from the hubbub of Lakeside a 15 minute drive away, and in the lap of greenery. There are 52 units at Sungava and it already has a close-knit prospective community of professionals, including doctors, publishers, engineers, and businesspeople from the renewable energy and IT sectors.&nbsp; Some residents say they opted for a second home in Pokhara to make it a ‘base camp’ to explore the Annapurnas with its many hiking trails made newly accessible with new roads. With the NRN citizenship law, overseas Nepalis can now also buy the flats. &nbsp; The floor plans include options for north and south-facing 3-bedroom apartments with verandas, and the facility has underground parking has EV charging, heated pool, sauna and gym. There are still some unsold apartments with panoramic views of the mountains and one can imagine oneself at the kitchen with its huge window, humming a ditty while preparing breakfast: “खाना पकाउँ हिमाल हेरेर...”

High living below the Himalaya

When the United Nations held its Summit of the Future at its headquarters in New York in September, many world leaders, including Nepal’s Prime Minister K P Oli, highlighted the effect of climate breakdown in increasing the frequency and intensity of natural disasters. What did not get as much attention was the long term impact of the climate crisis on food production. In fact, heat stress, weather extremes and the consequences on rain-fed agriculture is already being felt worldwide, undermining the chances of the <a href="https://unstats.un.org/sdgs/">UN’s Sustainable Development Goals (SDGs)</a> being met by 2030.&nbsp; The SDG’s 17 targets commit countries like Nepal to reduce poverty and inequality, end malnutrition, protect the natural environment, and ensure that citizens all enjoy health, justice and prosperity without leaving anyone behind.&nbsp; However, besides the impact of climate breakdown on agricultural production, in Nepal the area under cultivation is impacted by urban expansion, falling productivity and the need for expensive inputs like fertiliser and pesticides.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241019041052_626413c5baf4dae407ac9579231b41daeb51510aa636b75aeb7489d94cca6a62.jpg" data-media-id="editor_1" data-image-id="20241019041052_626413c5baf4dae407ac9579231b41daeb51510aa636b75aeb7489d94cca6a62" data-rendition-name="original" width="999" height="1500" loading="lazy" alt="urban agriculture in Kathmandu"> <figcaption>Kathmandu's urban sprawl is eating into its fertile cultivable lands. Photo: TAYLOR MASON</figcaption> </figure>  Now, a new study led by Nepali researcher Prajal Pradhan at the University of Groningen in The Netherlands looks at how urban agriculture may offer a solution to falling food production and meeting SDG targets. The researchers evaluated 1,450 publications exploring the contributions of urban agriculture with both positive and negative effects, and published their findings in the journal Cells Report Sustainability. Urban agriculture can help achieve 17 SDGs, positively influencing 81 targets. However, it could also undermine 51 goals.&nbsp; Read also: <a href="https://nepalitimes.com/here-now/the-vanishing-land">The vanishing land</a>, Taylor Mason “Urban agriculture offers immense potential for sustainable development, but realising this potential depends crucially on adopting practices that minimise its adverse effects while maximising its benefits,” Pradhan explains. Urban agriculture can substantially enhance urban food security, provide employment to the urban poor, serve as ground water recharge in built-up areas, and preserve open spaces that can serve as safe havens during disasters like earthquakes. However, it also presents problems like the potential health risks from contamination and the need for expensive inputs. &nbsp; “Urban agriculture plays a definitive role in advancing the SDGs, but achieving this requires tailored, context-specific solutions that address the unique challenges of different regions,” says Yuanchao Hu of Wuhan University in China and who is a researcher at the Potsdam Institute for Climate Impact Research. “But it needs equitable access and rigorous management of environmental risks.”&nbsp; Rapid urbanisation is eating into Nepal’s most fertile agricultural land, which means farming in remaining open spaces inside cities can be a viable alternative, especially as food prices rise.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241019041052_7b7c9413086226fbdc630d45acf772cfa1ced77a8970b9056ec5ec7e5226fdf8.jpg" data-media-id="editor_3" data-image-id="20241019041052_7b7c9413086226fbdc630d45acf772cfa1ced77a8970b9056ec5ec7e5226fdf8" data-rendition-name="original" width="1500" height="999" loading="lazy" alt="urban agriculture in Kathmandu"> <figcaption>A vegetable patch in between new houses in Thimi. Photo: TAYLOR MASON</figcaption> </figure>  “The conversion of Nepal’s most fertile land into cities is a severe problem,” Pradhan told Nepali Times. “Crop cultivation, horticulture, agroforestry, beekeeping, livestock rearing, or aquaculture can all be farming activities within and around cities.”&nbsp; The study makes recommendations for sustainable practices that build on the positive aspects of urban agriculture while mitigating the downsides, thereby promoting more resilient cities in future. Research shows that urban agriculture has been helping many countries attain SDG targets by enhancing food security and biodiversity while helping education and preservation of open spaces.&nbsp; Indeed, many farmers from the hinterland who have settled in Kathmandu Valley or other urban areas of the country have been practicing urban agriculture, leasing neighbourhood patches or cultivating roof gardens both out of necessity because of inflation and falling income to grow their own food, and also as a fulfilling hobby. Saurav Dhakal, a sustainability advocate with Story Cycle and now research fellow at the Asian Institute of Technology in Thailand, says there are socio-economic and environmental benefits of urban agriculture. “It provides benefits to all urban dwellers, regardless of their income status,” says Dhakal, “families get fresh food, and there are many other benefits like water retention, heat regulation and biodiversity. These are all public goods, so special government incentives may be needed.” It is not unusual to see vegetable patches and even paddy fields within inner city Kathmandu where an older generation of farmers are using available fertile land and <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/rooftop-gardens-kathmandu,1415">roof gardens to produce fresh, nutritious food </a>to reduce their dependence on food items that have to be bought after being trucked in from large distances.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2024101905100_1291ce98dbbb8caed8702ac4b1d469b3e13016d7ecaaf3bfd5f91c974d3c0c77.jpg" data-media-id="editor_5" data-image-id="2024101905100_1291ce98dbbb8caed8702ac4b1d469b3e13016d7ecaaf3bfd5f91c974d3c0c77" data-rendition-name="original" width="1500" height="999" loading="lazy" alt="urban agriculture in Kathmandu"> <figcaption>An older generation of farmers are using any available fertile land to continue farming but it is getting more and more difficult. Photo: TAYLOR MASON </figcaption> </figure>  Nepal’s urban population grew rapidly from only 3.6% in 1991 to 25% today. There is large outmigration from the mountains to peri-urban areas of the Tarai, to Kathmandu Valley and Pokhara, with many young men then moving abroad for work. Kathmandu Valley’s population has swelled to nearly 3 million, and is growing at 6.5% a year. Dilip Shrestha, 71, used to work for Nepal Food Corporation, so he knew firsthand about inflation, shortages and vegetables with pesticide residue. So, when he designed his new house in Kathmandu, he built a spacious roof where he grows cucumber, ginger, garlic, coriander, onions, tomatoes, chili, beans, okra, pumpkin and lettuce. His family eats healthier, and he has reduced dependence on the market.&nbsp; The co-author of the Cell Reports Sustainability journal article, Daya Raj Subedi who is a PhD candidate at Beijing Forestry University, says urban agriculture also promotes inclusion and psycho-social wellbeing.&nbsp; He says, “A crucial finding of the study is the identification of opportunities and challenges associated with urban agriculture, it can promote sustainable transformation of society.” In Banepa, 55-year-old Bijaya Manandhar in her lifetime has watched the fertile farms of her neighbourhood that used to supply vegetables to Kathmandu, now completely built up with no open space left. The pandemic lockdown prompted her to turn to the family’s <a href="https://nepalitimes.com/banner/rooftop-agriculture-on-the-roof-of-the-world">ancestral livelihood by growing food</a> not on terrace farms, but on the roof terrace. Manandhar is now a part of <a href="https://nepalitimes.com/banner/rooftop-agriculture-on-the-roof-of-the-world%5C%5C">कौसी खेती र करेसाबारी क्रान्ती</a> (Rooftop Farming and Garden Revolution) which has an online membership of 52,000, and awards annual prizes to women who excel in urban agriculture.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241019041052_7257f5def8f823f35a799fa6f6825e153f2ffa406ac11325d4fe74049b79e96d.jpg" data-media-id="editor_8" data-image-id="20241019041052_7257f5def8f823f35a799fa6f6825e153f2ffa406ac11325d4fe74049b79e96d" data-rendition-name="original" width="1600" height="736" loading="lazy" alt="urban agriculture in Kathmandu"> <figcaption>Rooftop farming is gaining popularity as a form of urban agriculture. </figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241019041052_beff1a4494ce896dd8fd383ee1f518e5448bcf7ea8bb138255391c7bcb9769ed.jpg" data-media-id="editor_9" data-image-id="20241019041052_beff1a4494ce896dd8fd383ee1f518e5448bcf7ea8bb138255391c7bcb9769ed" data-rendition-name="original" width="4000" height="3000" loading="lazy" alt="urban agriculture in Kathmandu"> </figure>  Pradhan says the challenge now is to upscale such examples of successful urban agricultural practices so they support Neal’s efforts to meet SDG targets. He adds, “Crop cultivation around cities can be protected by land use plans and regulations. Promoting community-based agriculture, including rooftop gardens, requires community engagement and public-private partnerships across the food value chain.”&nbsp; Such support would accelerate the popularity of existing rooftop farming and community gardens in Kathmandu Valley, or kitchen garden initiatives in Pokhara, and building on traditional farming practices that are preserved and integrated into urban settings like in Bhaktapur and Banepa. In Lalitpur, the Women Entrepreneurship Facilitation Center promotes urban farming enhancing both sustainability and empowerment.&nbsp; Another co-author of the report, Yuanchao Hu from China says followup research of the team will aim to identify good practices in local urban agriculture practices. He adds, “There are examples of urban agriculture that optimise sustainability, ensuring that it remains a viable solution for cities globally while countries try to meet SDG targets.” Prajal Pradhan, Daya Raj Subedi, Kshitij Dahal, Yuanchao Hu, Prakriti Gurung, Sijal Pokharel, Sagar Kafle, Biplav Khatri, Sudeeksha Basyal, Monika Gurung, and Aruna Joshi. Urban Agriculture matters for sustainable development. Cell Reports Sustainability, 1:100217, 2024. [DOI: 10.1016/j.crsus.2024.100217] Prajal Pradhan (<a href="mailto:p.pradhan@rug.nl">p.pradhan@rug.nl</a>) This article 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.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240630110640_30c3782f9c09219bf1c249b51483a3cfb7a53a06d117d2aebd23ca7080d12758.jpg" data-media-id="editor_14" data-image-id="20240630110640_30c3782f9c09219bf1c249b51483a3cfb7a53a06d117d2aebd23ca7080d12758" data-rendition-name="original" width="680" height="103" loading="lazy" alt="SDG logo"> </figure>

Back to the land in the cities

The 700-year-old Lakshmi Narasingha temple in Bhaktapur houses a rare half-lion and half-human incarnation of Lord Vishnu carrying the Goddess Lakshmi. The temple was destroyed in the 1934 mega earthquake that killed 10,000 people and destroyed many monuments in Kathmandu Valley. It was rebuilt by a German project in the 1980s, but as a single-storey structure instead of its original two-tier pagoda design.&nbsp; With new findings from in-depth research, Bhaktapur municipality began re-restoring the temple in 2021, preserving its original architecture.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241017131016_2fae38cce543ad7b1f6de632feb3e212e08ed1acedd747830e949d7b8e878f18.jpg" data-media-id="editor_0" data-image-id="20241017131016_2fae38cce543ad7b1f6de632feb3e212e08ed1acedd747830e949d7b8e878f18" data-rendition-name="original" width="2048" height="1365" loading="lazy" alt="In with the old in Nepal NT"> </figure>  “Our temples and heritage sites hold deep meaning. It is disheartening to witness how often they lose their original elements, whether by design or accident,” explains Kumar Chawal of the Consumer Committee of Bhaktapur. “There is a need to preserve our architecture and protect its historical value for future generations. Otherwise, we risk losing a vital part of our identity.” The Laksmi Narsingha restoration is similar to the Bhai Dega temple in Patan Darbar Square which also collapsed in 1934, but was rebuilt with a Moghul-style dome by the Rana government at the time. Only two months before the 2015 earthquake, heritage conservationists had started to rebuild Bhai Dega as the original three-tier based on early photographs. But priorities shifted when four other temples in the square were brought down by the 7.8M earthquake on 25 April 2015.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241017131016_697ea707d9ad163be5de5f2efbf5b70d3cab771adcc22f0fae6bf937c6cb0130.jpg" data-media-id="editor_1" data-image-id="20241017131016_697ea707d9ad163be5de5f2efbf5b70d3cab771adcc22f0fae6bf937c6cb0130" data-rendition-name="original" width="2048" height="1365" loading="lazy" alt="In with the old in Nepal NT"> </figure>  This showed how damage to monuments in Kathmandu Valley spanned from one earthquake to the next. Bhai Dega restoration remains half-complete to this day because money for its restoration ran out.&nbsp; Whereas Bhai Dega restoration was done by the Kathmandu Valley Preservation Trust with grants from western embassies and international foundations, in Bhaktapur it is the municipality itself that allocated the Rs30.7 million needed to restore the Lakshmi Narasingha temple. The expected date of completion is early 2025. The municipality and local communities are focusing on two main aspects: preserving the past and promoting localisation. The restoration team has designed a blueprint for the temple by using historical photographs and insights from older generations.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241017131016_182882fdc393c99e70d1d0490319e415229563666c4934e3a582426ebf00ca30.jpg" data-media-id="editor_2" data-image-id="20241017131016_182882fdc393c99e70d1d0490319e415229563666c4934e3a582426ebf00ca30" data-rendition-name="original" width="1200" height="560" loading="lazy" alt="In with the old in Nepal NT"> </figure>  “At first, the Lakshmi Narasingha temple had only one entrance, but during the demolition process, we uncovered the foundations of four doors. Now, we are restoring all of them. This is an example of how our ancient structures have changed over time, often without our knowledge,” says Chawal. “Constructing temples is not like building houses. They carry historical and spiritual values, which is why they hold a special place in our hearts,” he adds. By replicating ancient design elements and rebuilding the temple as accurately as possible to its original form, the team has stayed true to Bhaktapur’s soul. But the restoration also revived ancient techniques that were in danger of being forgotten, generating employment for woodcarvers, masons, and contractors. The community of Bhaktapur’s Gahiti neighbourhood near the famous Nyatapola Temple has also set aside specific days for locals to volunteer in the reconstruction work. This has encouraged young people to take pride in ownership of their heritage. Families have also supported the effort by donating funds for bells, the temple pinnacle, and other structural features to the temple.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241017131016_db850ec0c084cdbe54f65bee92dad2ad8122d20fd60ec87ec086fbb9d2f72bd6.jpg" data-media-id="editor_3" data-image-id="20241017131016_db850ec0c084cdbe54f65bee92dad2ad8122d20fd60ec87ec086fbb9d2f72bd6" data-rendition-name="original" width="2048" height="1365" loading="lazy" alt="In with the old in Nepal NT"> </figure>  “I feel at peace knowing I have contributed my sweat to restoring this temple,” said one volunteer. “It is our duty to preserve our temples and heritage. The Nyatapola area will look magical once this temple is completed.” Community mobilisation is a long-standing tradition in Bhaktapur. In the past, locals have actively participated in the restoration of other temples in the city, such as Bhairav and Nyatapola fostering a strong sense of ownership. This collective engagement has not only been crucial in preserving the city's historical monuments but also in strengthening the bond between local communities and their heritage, says officials at the municipality. While securing funding is essential, and the municipality showed it values heritage conservation, the Lakshmi Narasingha restoration is proof that active involvement and sense of responsibility of the local community is as important, if not more. Local involvement also means that the monuments will be cared for into the future, When locals take ownership of these efforts, the restored monuments are not only protected in the present but are also cared for in the future.