James Harris (‘Jim’) Simons, the mathematician and billionaire philanthropist who set up a foundation to improve Nepal’s healthcare system, died in New York on 10 May, aged 86. Jim Simons was an award-winning mathematician who pioneered quantitative investing and gave away much of his billions to support mathematics education, scientific research and various humanitarian causes. But his life was marked by family tragedies. His elder son, Paul, was killed in New York in 1996 in a traffic accident, and his younger son, Nick drowned in Bali in 2003 after a volunteering stint in Nepal.&nbsp; Nick Simons had written letters home from Nepal about his experience in rural health posts, and was determined to become a physician so he could help the underprivileged in poorer parts of the world.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240511120528_08e9e9ec5b9faa6a852fb5a4b5a8586526935cb8a9c8c61fd329fb8e4d7466e4.png" data-media-id="editor_0" data-image-id="20240511120528_08e9e9ec5b9faa6a852fb5a4b5a8586526935cb8a9c8c61fd329fb8e4d7466e4" data-rendition-name="original" width="596" height="812" loading="lazy" alt="Nick Simons"> <figcaption>Nick Simons with a friend in Nepal in 2003. He died soon after while swimming in Bali.</figcaption> </figure>  After Nick’s tragic death, Jim Simons and his economist wife Marilyn travelled to Nepal several times to set up the <a href="https://www.nsi.edu.np/overview" target="_blank">Nick Simons Institute (NSI)</a> to back up government hospitals in rural areas with training, equipment and budgetary support. Since it was established in 2006, NSI has invested more than $100 million in Nepal’s health sector and now supports 45 district hospitals and health facilities. Most of the institute’s work is behind-the-scenes and not visible to the public, like its help with training nurses and anaesthesiologists, maintaining biomedical equipment, and in retaining qualified medical staff in remote rural hospitals by topping up salaries. <a href="https://archive.nepalitimes.com/news.php?id=11436" target="_blank">Jim Simons once told Nepali Times</a>: "Rural health care is not a new problem in Nepal, and there are lots of people addressing the issue. What makes NSI unique is that it will do this job better than it has ever been done with an emphasis on quality and training.”  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240511020552_a9bbf2070d0ace34db48799e7c76f8f18a221750b5f2bcb5fda3a87b2eb97769.jpg" data-media-id="editor_3" data-image-id="20240511020552_a9bbf2070d0ace34db48799e7c76f8f18a221750b5f2bcb5fda3a87b2eb97769" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Jim Simons NT"> <figcaption>Marilyn and Jim Simons in Nepal in 2012. Photo: KUNDA DIXIT</figcaption> </figure>  Indeed, the Simons made several visits to Nepal in 2003 soon after their son died, talking to health experts to see where support would be most catalytic and meaningful. They decided to do this not by running their own hospitals, but by working with the government in developing sustainable solutions in rural healthcare and scaling it up. "With the establishment of the Nick Simon's Institute in 2006, Jim was clearly a game changer for enhancement of rural health in Nepal. &nbsp;Also what is unforgettable about Jim was his amazing sense of humor in telling a story, his sharp intellect, and how he did not suffer fools lightly," says <a href="https://archive.nepalitimes.com/news.php?id=18356" target="_blank">Buddha Basnyat</a>, a physician who is in the executive committee of NSI. The Simons often said they would probably never have been involved in Nepal’s health sector had it not been for their son Nick, who had found fulfilment helping Nepalis and wanted to return to live and work here.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240511020556_761b7ed7926bbf26b24c5e8ab06df077019280451bc1d4efc5bd3c5d44e740bb.jpg" data-media-id="editor_5" data-image-id="20240511020556_761b7ed7926bbf26b24c5e8ab06df077019280451bc1d4efc5bd3c5d44e740bb" data-rendition-name="original" width="904" height="1382" loading="lazy" alt="Jim Simons NT"> <figcaption>Marilyn and Jim Simons in Nepal in 2023 with Patty Weisenfeld of Nick Simons Foundation. Photo: KUNDA DIXIT</figcaption> </figure>  Jim Simons went through three phases in his life: as a mathematician, an investor and a philanthropist. As a maths professor, he found solutions that are still used to solve problems in physics and astronomy. He then set up <a href="https://www.rentec.com/Home.action?about=true" target="_blank">Renaissance Technologies</a> that used his talent in mathematics to analyse complex financial data and forecast global share markets. That is how he made billions, much of which he re-invested in improving STEM education in American schools, in exploring the universe, or trying to find the causes of autism.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240515170536_5ea1f3742ee715ce95ee11a82dfcc6991be56b827f5dff8d6c58824f836763e1.jpg" data-media-id="editor_7" data-image-id="20240515170536_5ea1f3742ee715ce95ee11a82dfcc6991be56b827f5dff8d6c58824f836763e1" data-rendition-name="original" width="1001" height="784" loading="lazy" alt="Jim Simons"> <figcaption>Health expert Aruna Uprety at a school algebra class in western Nepal.</figcaption> </figure>  After the death of his sons, Jim Simons sought solace in solving mathematical puzzles in his head. One morning at the leafy Summit Hotel in Kathmandu, the proof came to him in a flash of a puzzle that had bedevilled him for a long time.&nbsp; ‘Jim was an exceptional leader who did transformative work in mathematics and developed a world-leading investment company,’ the <a href="https://www.simonsfoundation.org/2024/05/10/simons-foundation-co-founder-mathematician-and-investor-jim-simons-dies-at-86/" target="_blank">Simons Foundation</a> said in a statement announcing his death on Friday.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240515170536_e4c458bcc5f9daf7d8833bb0bffc98304224be100b88cde3ade7c7ae41067cd5.jpg" data-media-id="editor_9" data-image-id="20240515170536_e4c458bcc5f9daf7d8833bb0bffc98304224be100b88cde3ade7c7ae41067cd5" data-rendition-name="original" width="2008" height="1396" loading="lazy" alt="Jim Simons"> </figure>  Besides NSI, the <a href="https://www.nicksimonsfoundation.org/" target="_blank">Nick Simons Foundation</a> was involved in other health-related activities in Nepal, including building the new <a href="https://archive.nepalitimes.com/news.php?id=15138" target="_blank">maternity wing at Patan Hospital</a> and supporting <a href="https://www.nyayahealthnepal.org/" target="_blank">Nyaya Health Nepal (NHN)</a> that runs <a href="https://nepalitimes.com/here-now/nepal-s-rural-lifeline" target="_blank">Bayalpata Hospital in Achham District.</a>&nbsp; Jim Simons once said: “Nick opened up a whole new world to us. We have met so many wonderful people who otherwise we never would have known. Nepal is a gift that Nick gave us.”

Kunda Dixit

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Jim Simons' gift to Nepal

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

Pratikshya Roka Magar was a sickly baby ever since she was born in a faraway village in Rukum district. As years went by, the girl’s spine started to bend. Her mother Namrata Roka had given up hope that her daughter would ever get better when she heard about a Japanese doctor who was conducting a mobile health camp in the village.&nbsp; Partikshya was seven years old in 2013 when Japanese physician Ryukichi Ishida examined her, and diagnosed a rare case of spinal scoliosis that ultimately affects the lungs and heart.&nbsp; Now 17, Pratikshya has undergone six major operations in which two rods were inserted to her spine to straighten it. The Japanese benefactor has since been supporting her financially, and checks up on Pratikshya routinely.&nbsp; Read also: <a href="https://www.nepalitimes.com/here-now/nepali-doctors-love-for-urdu-poetry">Nepali doctor's love for Urdu poetry</a>, Abdullah Zahid  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20230817070836_da4e6800792c2aba1c4f41e664f24db51fbc25142c2e41e46b77e2da9d602f29.jpg" data-media-id="editor_1" data-image-id="20230817070836_da4e6800792c2aba1c4f41e664f24db51fbc25142c2e41e46b77e2da9d602f29" data-rendition-name="original" width="1504" height="1000" loading="lazy" alt="Ryukichi Ishida NT"> <figcaption>Photo: SUMAN NEPALI</figcaption> </figure>  “He is like god for us,” says a grateful Namrata. &nbsp; Pratikshya is not the only one who has received Ishida’s healing touch in these mountains where the health system is still rudimentary, and the ravages of the Maoist conflict still linger. During voluntary work with tuberculosis control while walking through Nepal’s remotest districts in 1968 as a 21-year-old medical student, Ryukichi Ishida made a promise that he would return one day to serve the people of this country. Back in Japan, while heading the orthopaedic department at Osaka's Ueda-Shimotanabe Hospital, he constantly felt the tug of Nepal. In 2006, he left his family and a satisfying job to fulfil his pledge to return to Nepal. A question that had nagged him all those years was why medical care around the world, including in Japan and Nepal, was not more equitable. Read also: <a href="https://www.nepalitimes.com/news/paul-farmer-on-my-mind">Paul Farmer on my mind</a>, Bibhav Acharya  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20230817070836_6a2d16dbb69aaaf7f900a41835ca9e091d427f2de37a1411b5df7199749fcf6c.jpg" data-media-id="editor_3" data-image-id="20230817070836_6a2d16dbb69aaaf7f900a41835ca9e091d427f2de37a1411b5df7199749fcf6c" data-rendition-name="original" width="1494" height="1000" loading="lazy" alt="Ryukichi Ishida NT"> <figcaption>Photo: JHUMLAWANG VILLAGE FOUNDATION NEPAL</figcaption> </figure>  Ishida was inspired by his physician father who also ran a clinic in the most underserved part of Japan. He has travelled through Dolakha, Jumla, Jajarkot, Rukum and Rolpa, conducting free medical camps carrying just a backpack — just like when he trekked through Nepal as an idealistic student all those years ago. He has been working at Rolpa's Jaljala Health Post since 2011, a place so remote that even Nepali health workers are reluctant to be posted there. The facility has since been turned into a hospital and research centre and is in the process of becoming a 15 bedded municipality hospital.&nbsp; The hospital has Nepali staff, but none of them stay more than a year. “The only thing constant here is Dr Ishida and his commitment to serve the people,” says Ajay Magar of the Jhumluwang Village Foundation, a non-profit that conducts health camps in collaboration with Ishida.&nbsp; Read also: <a href="https://www.nepalitimes.com/review/the-good-doctor-0pqhzm7t">The good doctor</a>, Lisa Choegyal  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20230817070836_909cd240e9e4ea3b0da86e6038a2a163f6d5e9e94df5117008cbdbf0cf8946f6.jpg" data-media-id="editor_5" data-image-id="20230817070836_909cd240e9e4ea3b0da86e6038a2a163f6d5e9e94df5117008cbdbf0cf8946f6" data-rendition-name="original" width="1531" height="1000" loading="lazy" alt="Ryukichi Ishida NT"> <figcaption>Photo: JHUMLAWANG VILLAGE FOUNDATION NEPAL</figcaption> </figure>  Besides treating patients, Ishida has also supported locals like Sahanshila Buda Magar who is the first female MBBS graduate from Thawang thanks to a scholarship he provided.&nbsp; Sahanshila, 27, got her degree from Changsha Medical University in China, and is undergoing a three-month training at Patan Hospital. She plans to go back home and work at the Jaljala Hospital. &nbsp; Ishida says the staffing challenges of remote area facilities in places like Rolpa can only be met by producing their own crop of young doctors with a commitment to the place they belong.&nbsp; Despite his years of experience as an orthopaedic surgeon, Ishida believes in integrating modern medical practices with traditional healing, especially for bone-setting and birthing. Read also: <a href="https://www.nepalitimes.com/banner/nepals-far-sighted-eye-care">Nepal's far-sighted eye care</a>, Sonia Awale  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20230817070836_03aa6692c46a7850cb8d05acb0e89f7928a5dab973fcfa466ab9417fcd85c165.jpg" data-media-id="editor_7" data-image-id="20230817070836_03aa6692c46a7850cb8d05acb0e89f7928a5dab973fcfa466ab9417fcd85c165" data-rendition-name="original" width="3711" height="2770" loading="lazy" alt="Ryukichi Ishida NT"> <figcaption>Photo courtesy: RYUKICHI ISHIDA</figcaption> </figure>  The only reward Ishida has for his work is the respect and affection of Thawang's people. Villagers refer to him simply as “हाम्रो डाक्टर” (our doctor) — indicating they have ownership over a surgeon who they consider to be rightfully theirs. That same recognition is not reflected in the way the Nepali state regards Ishida. Now 76, and increasingly frail, Ishida has applied unsuccessfully for honorary Nepali citizenship. His visa requires Ishida to make frequent expensive trips back to Japan, and says he no longer wants to go back and forth.&nbsp; When he is away on his visa run, Rolpa’s villagers count the days for Ishida’s return so they can be treated. The surgeon does not take a salary, lives frugally and depends on the Jaljala Hospital for food and lodging.&nbsp; “I was born in Kobe, but I want to die here in Thawang,” says the soft-spoken Ishida. “This is my home now.” Read also: <a href="https://www.nepalitimes.com/here-now/an-eye-for-two-eyes">An eye for two eyes</a>, Yugottam Koirala

Pinki Sris Rana

The barefoot doctor of Rolpa

The winter air pollution season started early this year with emissions, Diwali firecrackers and crop residue burning making the air unbreathable across north India. Much of the pollution was transboundary, with prevailing winds carrying the suspended particulates from Pakistan, across India to Nepal and beyond. All this pollution and domestic emissions killed 41,300 in Nepal in 2023, and 85% of all deaths were because of noncommunicable diseases such as heart and lung disease, lung cancer, diabetes, and dementia, according to the State of Global Air (SoGA) 2025 report released Thursday. With the onset of winter, Kathmandu Valley’s own emissions are trapped in a surface inversion layer and as in previous years will have some of the worst air quality in the world.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251023131016_7c42a4e8b0dce01dfeeaaf89dbb10dbfa036b41163f3ebada88c7ce17dbded49.png" data-media-id="editor_0" data-image-id="20251023131016_7c42a4e8b0dce01dfeeaaf89dbb10dbfa036b41163f3ebada88c7ce17dbded49" data-rendition-name="original" width="921" height="850" loading="lazy" alt="Air pollution killing season starts early NT"> </figure>  The SoGa report says air pollution has now become the leading risk factor for deaths in Nepal, ahead of tobacco and high blood pressure. Interestingly, while the health impacts due to environmental risk factors such as unsafe water and sanitation have reduced significantly since 2000, the opposite is true for ambient PM2.5 (particles smaller than 2.5 microns). Globally, 7.9 million deaths were attributable to air pollution– about 1 in 8 deaths – in 2023. Of this total, 4.9 million deaths were attributable to PM2.5 exposure, 2.8 million were from household air pollution, and 470,000 were from ozone. Similarly, dementia attributable to air pollution resulted in 626,000 deaths and 40 million healthy years of life lost. And 95% of air pollution attributable deaths in adults over the age of 60 are due to noncommunicable diseases. The burden of noncommunicable diseases in relation to air pollution is rising worldwide and in Nepal. The SoGA report shows that nearly nine of ten global air pollution deaths are from chronic ailments, and half of all respiratory disease deaths are attributable to air pollution.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251023131020_8577f464b4a73007de5dd018b8ac91dae3a9c732dbb81a44b6aa5a0ced7df3df.png" data-media-id="editor_1" data-image-id="20251023131020_8577f464b4a73007de5dd018b8ac91dae3a9c732dbb81a44b6aa5a0ced7df3df" data-rendition-name="original" width="1080" height="1080" loading="lazy" alt="Air pollution killing season starts early NT"> </figure>  In Nepal, air pollution is responsible for three out of four COPD deaths, one out of three heart deaths and one out of five diabetes deaths. More than one third of lower respiratory infection deaths were due to air pollution. “The data presented in the State of Global Air report highlight the significant impacts of poor air quality on the health and well-being of billions of people around the world, especially those living in Asia and Africa,” says Pallavi Pant of the Boston-based Health Effects Institute (HEI) that released the report in collaboration with the Institute for Health Metrics and Evaluation and the NCD Alliance. She adds: “Growing momentum on air quality management across those hard-hit locations, including expansion of air quality monitoring, adoption of air quality regulations, and sector-specific interventions are yielding improvements for those most impacted.” Low- and middle-income countries stand to gain most by reducing air pollution, with particularly strong impacts on children, older populations, and people with pre-existing health conditions. Indeed, of the 41,300 air pollution deaths in 2023 in Nepal, 31,600 were in adults over the age of 60 years and 3,500 in children below five years. Death rate for air pollution in Nepal, which is 178 per 100,000, is more than 10 times higher than high-income countries, which is at 17 per 100,000.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251023131020_604e852aed4ffde0dc7d1df72fcd3e73d904136dfb1bb2407e53b7445f3ef72c.png" data-media-id="editor_2" data-image-id="20251023131020_604e852aed4ffde0dc7d1df72fcd3e73d904136dfb1bb2407e53b7445f3ef72c" data-rendition-name="original" width="1078" height="423" loading="lazy" alt="Air pollution killing season starts early NT"> </figure>  “Win-win solutions for air pollution and NCDs exist, with added benefits for climate, physical activity, nutrition, and many other global development priorities,” says Alison Cox, Policy and Advocacy Director at the Geneva-based NCD Alliance. “These policies are effective and deliver a strong return on investment - for the sake of our people and the planet we need to implement them faster.” Fine particle pollution (ambient PM2.5) is the largest driver of air pollution’s burden of disease worldwide as kit attributed to 4.9 million deaths and 124 million healthy years of life lost in 2023. Vehicles, power plants, factories, and homes, as well as agricultural and industrial activities, waste burning and wildfires are some of the biggest sources of pollutants. South Asia is among the regions of the world with the highest exposures to ambient PM2.5 , while more than 36% of people around the world live in areas where PM2.5 levels do not meet even the least stringent interim target. As per the report, 78% of Nepal’s 30 million population lives in areas where annual PM2.5 exposure exceeds the least stringent WHO Air Quality Interim Target of 35 µg/m3. Meanwhile, exposure to household air pollution due to the use of solid fuels for cooking remains an important driver for the disease burden in the country. “Ongoing efforts to meet global development goals are not achievable without directly addressing air pollution,” says Maria Neira, Commissioner of Our Common Air. “Countries and cities must focus their efforts toward reducing air pollution emissions, including household air pollution, which has particularly severe impacts on young children and older people across Asia and Africa.”

Air pollution killing season starts early

This year, the <a href="https://nepalitimes.com/opinion/quo-vadis-un-80-9vthn7mg">United Nations is marking its 80th anniversary</a> and it is being celebrated with special events across the world to commemorate its establishment on 24 October 1945. It has also been 75 years since the first UN adviser, the Swiss geologist Toni Hagen, was sent to Nepal to explore development opportunities. In 1950, there were no roads and Hagen walked on foot across the length and breadth of Nepal’s mountains, valleys and plains. This year also marks the 60th anniversary of the United Nations Development Program (UNDP) in Nepal, and much of Hagen’s work laid the basis for the UN’s involvement in education, health, and connectivity in Nepal’s future development. Despite frequent changes in government and political system, Nepal has made remarkable progress. The poverty rate has gone down by half in the past 30 years to 20.27% of the population. Much of it has to do with remittances from Nepalis working overseas, but it is also a result of the Nepal government’s investment in education, health care and social welfare.&nbsp; There have been special initiatives like the Prime Minister’s Employment Program that have provided jobs to nearly 800,000 people in the country’s 743 municipalities — especially in those areas with lower Human Development Index (HDI) like the far-west and the Tarai.&nbsp; This year’s HDI report by UNDP shows that Nepal’s score had risen to 0.622, whereas it was only 0.404 in 1990. In the past 33 years, the average lifespan of Nepalis has risen by 15.6 years to 70.4 years, whereas it was only 54.8 in 1990. However, the country’s HDI ranking is still 145 among the world’s 193 countries. “Yes, there has been significant improvement in living standards in the past 60 years, road connectivity has improved, the maternal mortality rate has gone down dramatically, almost everyone has phones, there are schools,” says Saru Joshi of the thinktank Nepal Policy Institute. But, she adds: “It is still difficult to get citizenship papers, especially in the name of the mother, and this has excluded many women from banking services, inheritance. After all our progress in physical infrastructure, Nepal now needs to prioritise inclusive social development.”&nbsp; Some of this is also happening. Eighteen years ago, Nabaraj Subedi, 49, of a village in Baglung decided not to join his peers &nbsp;fleeing the Maoist conflict to find work overseas. He invested Rs500,000 to buy a diesel generator and start a small furniture business.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251024071044_eeef308e19a73de507a425b2c6afc47269884549cf4c8fac07ca9a4898c8e031.jpg" data-media-id="editor_1" data-image-id="20251024071044_eeef308e19a73de507a425b2c6afc47269884549cf4c8fac07ca9a4898c8e031" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Nawaraj Subedi"> <figcaption>Nawaraj Subedi, 49, proprietor of Tarakhola Furniture Factory. </figcaption> </figure>  Today, with the installation of the 380 kilowatt small hydroelectric plant, he does not need to depend on his unreliable generator to power his equipment anymore. There is now a road connecting his village, and Subedi has generated local jobs, opened a sales branch in the city, and gets orders from as far away as Pokhara and Chitwan. “My costs have gone down drastically because of the electricity, and sales have gone up because of the road connecting my furniture to markets. My business has expanded,” Subedi says. Back in 1960 in a report he prepared for the Nepal government on behalf of the United Nations, Toni Hagen had emphasised just this: investing in electricity generation and connectivity to uplift the remote rural areas of Nepal.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251024081024_188ab121dc3cf2816ee71a72cb3687493eda37ab99ecc04802d647c8c9b4cd2d.jpg" data-media-id="editor_2" data-image-id="20251024081024_188ab121dc3cf2816ee71a72cb3687493eda37ab99ecc04802d647c8c9b4cd2d" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Tarakhola Furniture Factory"> <figcaption>Subedi's staff at the Tarakhola Furniture Factory.</figcaption> </figure>  Subedi’s furniture factory gets its electricity from the nearby Tarakhola Hydropower, a company set up eight years ago with financial and technical support from UNDP’s Renewable Energy for Rural Livelihood (RERL) project. &nbsp; “The project completely transformed living standards in this village,” says municipality chair Dhan Bahadur BK. “It has helped create jobs locally, there is now money to invest in education and healthcare. Households can pay their electricity fees electronically through smart billing.”&nbsp; After working with the government on rural electrification, UNDP is focussed on using that power for local employment creation. A women’s group, for example, has bought an electric-powered potato processing machine that can produce chips.&nbsp; “We are 12 of us mothers, daughters, daughters-in-law who process, package and market the potato that we grow ourselves, and it has raised our income,” says Sukmaya Roka, 57, who chairs the group.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251024071044_70b22418699178bcdd0abb0aa308796980ecd29634bcda6ff113a7624e709751.jpg" data-media-id="editor_3" data-image-id="20251024071044_70b22418699178bcdd0abb0aa308796980ecd29634bcda6ff113a7624e709751" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Sukamaya Roka"> <figcaption>Sukamaya Roka, 57, chair of Sipa Aalu Chips Utpadan Samuha from Tarakhola Rural Municipality, Baglung. </figcaption> </figure>  Today, 6.1 million households in Nepal (92.2% of total) have electricity in their homes, up from 17.9% 30 years ago. Access to electricity has not just brought lights to homes, but improved everything from productivity, quality of education, healthcare and phone connectivity.&nbsp; “To see what electricity and roads can do, just look at our municipality,” says chair Dhan Bahadur BK, “citizens have become more self-reliant, more aware of the outside world.”&nbsp; NETTLES INTO CASH&nbsp; Just a little bit of training, resource backup and local empowerment can uplift the living standards of Nepalis. The progress made in harvesting abundantly-available allo (nettles) and turning it into household products is an example. When a landslide swept away his home and farm in a flood 40 years ago, Buddhi Purja of Parbat became destitute. But he took part in a government training program supported by UNDP and Australia to harvest the wild nettles that grew on mountain slopes and turn the fabric into bags.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251024071048_56c440c478dffbc13911369b6f4133baf658cc3667773cdb44b7c40e006463ce.jpg" data-media-id="editor_4" data-image-id="20251024071048_56c440c478dffbc13911369b6f4133baf658cc3667773cdb44b7c40e006463ce" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Rhitu Saugat Handicraft"> <figcaption>A worker at Rhitu Saugat Handicraft making a bag out of nettles.</figcaption> </figure>  “After the landslide, we had to go hungry if we did not get a day job,” Purja recalls, “but after this training we have found that we can turn nettles into cash.” His allo bags are now hanging in tourist shops in Pokhara Lakeside and Thamel.&nbsp; The idea that nettles can be processed into useful fabric has not spread across the country, and new ecologically conscious consumers in Europe and elsewhere now import Made in Nepal nettle products.&nbsp; Purja started out with an investment of Rs500,000, and had a Rs20 million business that employed 25 workers. The Covid crisis in 2020 affected the sales, but Purja has recovered from it, sent his daughter off to study abroad, and is thinking of diversifying his product range.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251024071044_ab6d15abcbb9a643e12a384f4bc488b7e210a8c95303fbe1b2f77716d26eede9.jpg" data-media-id="editor_5" data-image-id="20251024071044_ab6d15abcbb9a643e12a384f4bc488b7e210a8c95303fbe1b2f77716d26eede9" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Buddi Purja"> <figcaption>Buddi Purja, proprietor of Rhitu Saugat Handicraft in Pokhara.</figcaption> </figure>  While UNDP’s project has made successful businessmen out of people like Purja, nationwide it has created 187,000 jobs in rural medium-scale industries. Much of what has worked in Nepal has been at the community level with decentralised projects like these that use the entrepreneurship of people like Buddhi Purja, Navaraj Subedi, and Sukmaya Roka. It is tantalising to imagine how much more progress Nepal would have made if their work could be replicated nationside and upscaled to the state-level.

Think locally, invest locally

Nepal needs to enact and enforce animal law

Public anxiety about immigration has become a powerful political currency across many liberal democracies. In Australia, as elsewhere, legitimate concerns about housing and economic fairness can be, and increasingly are exploited by anti-democratic actors who frame migration not as a policy issue but as a cultural threat.&nbsp;
When these narratives move from online spaces to public rallies, they do more than divide opinion; they erode the social trust and pluralism on which democracy depends. Understanding how populist and far-right movements weaponise migration debates is crucial to recognising the early challenging signs of liberal democracy.
Immigration has become one of the most politically charged issues in Australia, not only because of the numbers but because of its entanglement with cost-of-living pressures, housing shortages, and rent spikes.&nbsp;
The latest Household, Income and Labour Dynamics in Australia (HILDA) <a href="https://www.unimelb.edu.au/newsroom/news/2025/september/how-we-live-latest-hilda-data-gives-insight-into-a-changing-australia">data</a> shows rising household financial stress as Australian households spending more on rent and income tax. These changes likely reflect a mix of economic and policy factors but create a lot of room for people to hold inaccurate and occasionally contradictory attitudes on these issues.&nbsp;
While net overseas migration has started to decline from its post-pandemic peak, public concern remains high, amplified by populist rhetoric. Some surveys have <a href="https://www.theguardian.com/australia-news/2025/feb/04/australians-want-less-migration-but-oppose-cutting-international-student-numbers-study-finds">revealed</a> a nuanced picture: most Australians want lower migration overall but oppose cutting international student numbers, and support targeted skilled migration to address workforce gaps.&nbsp;
As former Home Affairs Minister Clare O’Neil <a href="https://minister.homeaffairs.gov.au/ClareONeil/Pages/how-australia-broke-its-migration-system.aspx">argued</a> in 2023, Australia’s migration system is “broken and un-strategic”, not delivering for business, for migrants, or for the larger population. This is a situation that frustrates both sides of the debate and makes immigration an easy political flashpoint.
The recent <a href="https://marchforaustralia.org/">March for Australia</a> rallies turned these anxieties into street-level mobilisation. Tens of thousands <a href="https://www.bbc.com/news/articles/czjmre371l1o">protested</a> at what they called ‘mass immigration’, while far-right groups seized the opportunity to inject xenophobic slogans and calls for ‘remigration’ into the public space. These demonstrations were not only about visa caps or housing and jobs; they became performances of who is entitled to belong.&nbsp;
When immigration is framed not as a policy question but as a cultural test of Australianness, it risks shrinking the demos, the very community that democracy is meant to represent.
What made the March for Australia so striking was not only its size but its composition. Recent investigative reporting <a href="https://www.theage.com.au/politics/victoria/don-t-mention-hitler-and-you-re-sweet-the-great-march-for-australia-deception-20250909-p5mtlc.html">revealed</a> that neo-Nazi groups were not merely present at the March for Australia rallies but played a role in covertly organising them. They amplified messaging online, coordinated attendance, and sought to mask their involvement to broaden appeal.&nbsp;
This highlights that democratic erosion is rarely spontaneous; it requires actors who deliberately exploit social grievances, mistrust, and polarisation to mobilise anger for their anti-democratic ends. The banners reading ‘<a href="https://www.theguardian.com/commentisfree/2025/sep/01/how-do-i-feel-safe-after-march-for-australia-anti-immigration-protest-ntwnfb">Stop Immigration</a>’ revealed that public hostility towards migrants, <a href="https://www.afr.com/politics/federal/pressure-mounts-for-price-to-apologise-to-indian-australians-20250908-p5mt7x">particularly</a> from the Indo-Pacific, is growing.
For many migrants, these displays are more than conceptual debates about white national identity. They are experienced emotionally. Writing shortly after the rallies, Melbourne-based writer Jafrin Kabir <a href="https://www.theguardian.com/commentisfree/2025/sep/01/how-do-i-feel-safe-after-march-for-australia-anti-immigration-protest-ntwnfb">reflected</a> that she had never felt so foreign on Australian soil. She pays taxes and inflated rents, contributes skills in the national interest, cheers for the Tillies and calls Melbourne “home”, yet suddenly felt unsafe because of the origin and colour of her skin.&nbsp;
Similarly, Chinese national interviewed by media outlet <a href="https://www.scmp.com/news/china/diplomacy/article/3325127/i-feel-insecure-chinese-nationals-australia-blindsided-anti-immigration-marches">reported</a> cancelling weekend plans and feeling “blindsided” by the scale of the marches.
Scapegoating migrants especially in times of economic stress is an age-old phenomenon and is not just limited to Australia. Across the democratic world, from the United States to the UK and parts of Europe, hostility toward migrants and minorities has become a route for anti-democratic forces. Populist actors often <a href="https://www.theguardian.com/australia-news/2025/mar/27/peter-dutton-keeps-blaming-migration-for-the-housing-crisis-but-can-it-really-be-that-simple">use</a> cultural anxiety and demographic change to justify illiberal and undemocratic measures, claiming to restore order while actually dismantling checks and balances.
By analysing democratic decay, scholars like Lydia Khalil at the Lowy Institute, <a href="https://interactives.lowyinstitute.org/features/democratic-erosion/">argue</a> that democracies rarely break down at once. Instead, they incrementally weaken through vicious cycles: declining trust in institutions, entrenched division based on hate, the normalisation of political violence, and the bit by bit removal of norms and guardrails.&nbsp;
Though some of the conditions are present in Australia to be exploited by anti-democratic actors, for example, almost two-thirds of Australians believe their leaders intentionally mislead them, according to the <a href="https://www.edelman.com/au/trust/2025/trust-barometer">2025 Edelman Trust Barometer</a>, &nbsp;but their presence is not determinative.
Australia’s democratic guardrails remain strong: independent courts, transparent elections run by the AEC, and a free press continue to hold power to account. Federalism and active civil society further diffuse power and create space for contestation.&nbsp;
But if public trust continues to erode and social divisions deepen, these safeguards will come under strain. Early recognition and action are crucial to ensure that today’s street-level hostilities do not translate into institutional regression.
Preventing such outcome requires a socially embedded understanding of migration, an understanding that goes beyond simplistic optimistic and pessimistic views. Policy makers should go beyond Push-Pull models, functionalist and neoclassical and historical-structural theories.&nbsp;
Consulting the work done by <a href="https://www.guilford.com/books/The-Age-of-Migration/Haas-Castles-Miller/9781462542895#:~:text=International%20Population%20Movements%20in%20the%20Modern%20World,-Hein%20de%20Haas">Hein de Haas</a> et-el, migration should be conceptualised as an intrinsic part of broader processes of development, social transformation and globalisation rather than a 'problem to be solved'. We need more nuanced views that have an eye for the complexity of migration processes and the diversity of its causes and impacts.
Sohail Akhtar is a Melbourne- based researcher focusing on governance, public policy, and migration. He contributes to Lowy Institute Sydney.
This article was issued by the Toda Peace Institute and is being republished from <a href="https://toda.org/global-outlook/2025/is-street-level-hostility-a-challenge-to-liberal-democracy-reflections-from-australia.html">the original</a> with their permission.