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

<a href="https://nepalitimes.com/news/ball-in-balen-s-court">Nepal’s newly-installed Prime Minister Balendra Shah</a> unveiled his Council of Ministers after taking the oath of office on Friday in Kathmandu.&nbsp; Besides Nepal's pre-existing problems, his team will immediately have to deal with the fallout of the West Asia conflict to satisfy an electorate impatient for change. The Rastriya Swatantra Party (RSP) won a majority in the 5 March election and capped the Cabinet size at 15. Shah, a structural engineer and musician, himself has taken charge of the Defence and Industry Ministries. There has been an attempt to make the Cabinet inclusive with women in five of the new portfolios.&nbsp; After much negotiation, the powerful Home Ministry, a bone of contention between Shah and RSP Chair Rabi Lamichhane, has gone to Sudan Gurung, a hitherto little-known figure who <a href="https://nepalitimes.com/here-now/who-or-what-is-hami-nepal">rose to prominence after the September GenZ protest</a> and won the election from Gorkha-2.&nbsp; Gurung will be in charge of Nepal’s internal security apparatus and maintaining law and order. And with Gurung, a close ally of the Prime Minister, in charge, some note the Home Ministry will be a hook for Shah if Lamichhane, with his share of controversies, steps out line.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260327090324_c7725ea5fb9ffbf96df25a7b3122520b7ae3ee10548aed3f37781a7e5440e51a.jpg" data-media-id="editor_2" data-image-id="20260327090324_c7725ea5fb9ffbf96df25a7b3122520b7ae3ee10548aed3f37781a7e5440e51a" data-rendition-name="original" width="1440" height="960" loading="lazy" alt="Balen Shah swearing in NT"> </figure>  Notable RSP leaders, including vice-chair DP Aryal, were said to have been vying for the portfolio.&nbsp; Gurung is the founder of the non-profit Hami Nepal, which worked primarily in earthquake relief in 2015, and emerged onto the national stage during negotiations to appoint Sushila Karki as interim PM after the unrest. He was also involved in key negotiations that cemented Balendra Shah and Rabi Lamichhane’s political partnership in the runup to the election.&nbsp; Most new Cabinet members are not just first-time ministers, but are also freshmen lawmakers. Many are experts in their fields. Finance Minister Swarnim Wagle is an <a href="https://nepalitimes.com/here-now/nepal-needs-to-rebrand-itself">economist </a>with degrees from the London School of Economics and Harvard, and was previously Chief Economic Advisor at the UNDP Regional Bureau for Asia and the Pacific, and also served in Nepal’s National Planning Commission.&nbsp; Previously a member of Nepali Congress, Wagle exited the party in 2023 following differences with top leadership, and joined the RSP. Wagle won a by-election from Tanahu-1 in 2023 and won again from the same constituency in this month’s election.&nbsp; Shishir Khanal, who heads RSP’s foreign affairs department, has been appointed Minister of Foreign Affairs. &nbsp;Khanal is co-founder of Teach For Nepal, was briefly Education Minister when the RSP was part of the the Pushpa Kamal Dahal-led coalition government in 2023.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260327090324_b1a670bac12e2bf4df955134f58c8de7718d48f6be4e1f2df7c7c52f82e36e42.jpg" data-media-id="editor_4" data-image-id="20260327090324_b1a670bac12e2bf4df955134f58c8de7718d48f6be4e1f2df7c7c52f82e36e42" data-rendition-name="original" width="1440" height="960" loading="lazy" alt="Balen Shah swearing in NT"> </figure>  Law Minister Sobita Gautam is a lawyer by profession and worked in governance and public policy before she was elected as the youngest MP in the 2022 election.&nbsp; Health Minister Nisha Mehta is a nurse and became a lawmaker under the Proportional Representation system in this election which swept the RSP to power with a near two-third majority.&nbsp; Education Minister Sasmit Pokharel, a first-time MP elected from Kathmandu-5, served as an aide to Balendra Shah when he was mayor of Kathmandu and a was member of the KMC City Planning Commission.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260327090324_5ed794d7bf0cac2844277521810225c4355746b9c3f7369f70cacc878c94641f.jpg" data-media-id="editor_5" data-image-id="20260327090324_5ed794d7bf0cac2844277521810225c4355746b9c3f7369f70cacc878c94641f" data-rendition-name="original" width="1440" height="960" loading="lazy" alt="Balen Shah swearing in NT"> </figure>  Biraj Bhakta Shrestha is Energy Minister, and also served as the Minister for Youth and Sports in the Dahal-led coalition government in 2024. Before joining RSP, Shrestha was elected to the Bagmati Provincial Assembly in the 2017 elections representing the r<a href="https://nepalitimes.com/here-now/rsp-s-activist-dna">eformist Bibeksheel Sajha Party</a>. He will immediately face the challenge of addressing the <a href="https://nepalitimes.com/news/rough-road-ahead-for-new-nepal-rulers">impact of the West Asia war,</a> including rising petroleum prices and a shortage of cooking gas. Sita Badi, who was elected through the PR system, is Minister for Women, Children and Senior Citizens. She was born and brought up in the underserved and marginalised Badi community in Surkhet and has been advocating for the rights and welfare of women, children, and minority communities. Other ministers include RSP spokesperson Pratibha Rawal as Minister for Federal Affairs and General Administration as well as Land Management, and Gita Chaudhary as Minister for Agriculture, Sunil Lamsal is Physical Infrastrucutre, Transport, and Urban Development Minister, Khadka Raj (Ganesh) Paudel as Tourism and Civil Aviation Minister. Dipak Sah is the Labour and Employment Minister, and Bikram Timilsina is Communication Minister.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260327090324_b67c2d199d4897031583a5b7ec7ce43e88771167696e6161665eeb5fca25d3ed.jpg" data-media-id="editor_8" data-image-id="20260327090324_b67c2d199d4897031583a5b7ec7ce43e88771167696e6161665eeb5fca25d3ed" data-rendition-name="original" width="1440" height="960" loading="lazy" alt="Balen Shah swearing in NT"> </figure>  Meanwhile, RSP vice-chair DP Aryal, who many thought would be home minister because of his proximity with Rabi Lamichhane has been proposed as Speaker of the House.&nbsp; Aryal previously served two brief stints as the Minister of Labour when RSP was part of the RSP’s coalition governments in 2023 and 2024. As minister Aryal came <a href="https://nepalitimes.com/editorial/skeletons-in-the-cabinet-k5x6py1v">under scrutiny </a>for his involvement in an employment agency that was investigated for illegal acquisition of wealth in 2020. If appointed House Speaker, Aryal will be expected to play a neutral and non-partisan role in Parliamentary affairs. &nbsp; With the full Cabinet announced on Friday, Prime Minister Shah and his team now have their work cut out for them. &nbsp;The government’s first priority will be ensuring the safety and long-term security of the almost two million <a href="https://nepalitimes.com/here-now/migrant-workers-in-wartime">Nepalis living and working in the Gulf</a> amid the ongoing conflict in the region, and taking steps to cushion Nepal’s economy from the Israel-US war on Iran. The new leaders will also be tasked with implementing the findings of the Karki Commission report on the September violence that paved the way for the election and the rise of the RSP. &nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260327090324_69b36bc62737e44ade4080be36688f9c2f92201356e1df2072cef8ecc6a9be5d.jpg" data-media-id="editor_11" data-image-id="20260327090324_69b36bc62737e44ade4080be36688f9c2f92201356e1df2072cef8ecc6a9be5d" data-rendition-name="original" width="1440" height="960" loading="lazy" alt="Balen Shah swearing in NT"> <figcaption>Snapshots from PM Balen Shah's swearing-in ceremony</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260327090324_69b36bc62737e44ade4080be36688f9c2f92201356e1df2072cef8ecc6a9be5d.jpg" data-media-id="editor_12" data-image-id="20260327090324_69b36bc62737e44ade4080be36688f9c2f92201356e1df2072cef8ecc6a9be5d" data-rendition-name="original" width="1440" height="960" loading="lazy" alt="Balen Shah swearing in NT"> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260327090324_8646d490883154f696bcdc6e2375084419f2eefaaf0ef0c7e2710aa6e2d94a8a.jpg" data-media-id="editor_13" data-image-id="20260327090324_8646d490883154f696bcdc6e2375084419f2eefaaf0ef0c7e2710aa6e2d94a8a" data-rendition-name="original" width="1440" height="960" loading="lazy" alt="Balen Shah swearing in NT"> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260327090324_89d17d6584593be1eb23eb1d4872c3b7c600e1620f3aca48dbff4838364a1e3c.jpg" data-media-id="editor_14" data-image-id="20260327090324_89d17d6584593be1eb23eb1d4872c3b7c600e1620f3aca48dbff4838364a1e3c" data-rendition-name="original" width="1440" height="960" loading="lazy" alt="Balen Shah swearing in NT"> </figure>  &nbsp;Full list of ministers: Prime Minsiter: Balendra Shah Home Minister: Sudan Gurung Finance Minister: Swarnim Wagle Foreign Affairs Minister: Shishir Khanal Law, Justice and Parliamentary Affairs Ministry: Sobita Gautam Energy, Water and Irrigation Minister: Biraj Bhakta Shrestha Education Minister: Sasmit Pokharel Physical Infrastrucutre, Transport, and Urban Development Minister: Sunil Lamsal Communication and Information Ministry: Bikram Timilsina General Administration Minister: Pratibha Rawal Women, Children and Senior Citizens Minister: Sita Badi Health and Population Minister: Nisha Mehta Agriculture Minister: Gita Chaudhary Culture, Tourism and Civil Aviation Minister: Khadka Raj (Ganesh) Paudel&nbsp; Labour Minister: Dipak Sah

Nepal swears in new Cabinet

Next to my home in Bhainsepati stood a dead Uttis tree next to a public tap. A nearby water tank built a year earlier had killed its roots.
If the tree collapsed, people living nearby and those queuing up to fetch water at the tap would be hurt. With the storm season approaching, the risk was obvious. The tree could also fall on my own house, so I volunteered to find a way to remove this threat.
Little did I know how difficult it would be. A forest officer acquaintance told me there is a special procedure for cutting risky trees. I contacted the Lalitpur District Forest Office (DFO).&nbsp;
He said a technical report from a field officer was needed, and passed on her number. When I called, she asked for the location, photos, and a video. I send them all.
The ward office also suggested I use Lalitpur Metropolitan City’s mobile app, Lalitpur Alert, to report the problem. I uploaded photos, and submitted the complaint. This seemed to be very easy and efficient.
Indeed, the next day the municipality called me back and I explained the situation. They said they could not act without permission from the DFO. I asked why the app existed if the city could not act on such complaints. The officer said he did not know. My happiness was short-lived.
A couple of days later, the app notified me that my problem had been solved, and the complaint was removed. But the dead tree still stood there defiantly.&nbsp;
A week later, two forest technicians arrived on a scooter to inspect the tree. They looked up at the tree and asked if I had a measuring tape so they could measure its diameter.
“You are the technicians,” I told them. “You came to inspect the tree, and you came without a measuring tape?”
I rummaged at home and found a tape measure. They got the diameter and said they would prepare a technical report, but I would have to obtain a recommendation letter from the ward office and submit it to the DFO.
“This tree is dead,” I told them. “It is on public land. You have seen it with your own eyes. You know it's dangerous, so write a report and arrange for it to be cut. Why do I have to run from office to office to apply for recommendation letters?”
Their answer was simple, yet expected: “Those are the rules.”
They left, and I gave up. Two technicians spent half a day visiting the site. The metropolis runs a complaint system with a mobile app funded with public money. The ward office has staff to solve problems. Yet none of these institutions took the responsibility to remove a dangerous tree.
Everyone is busy citing rules and regulations and passing the buck. Weeks passed. Everyone reacted to the problem, but no one took any responsibility to resolving it.
Then, one bright December morning under a deep blue sky, a few neighbourhood boys were swinging their axes on the trunk. They had no proper equipment, no safety gear, and no professional experience.
I gave the boys some money and so did a neighbour. It took an hour or so for the tree to come crashing down safely. We had paid to have the tree cut illegally, and the matter ended there.
Multiple government offices, technicians, procedures, and mobile apps could not remove a dangerous tree, and we had to break the law to cut it. The tree is gone now, but the real problem remains: an inefficient bureaucracy.&nbsp;
It is perhaps symbolic that the tree is the election sign of the Nepali Congress, which was part of Nepal's governance and bureaucracy for decades and did not perform well in this month's election.&nbsp;
That is the bureaucracy that the new RSP government now has to get to work. But it will not be easy.
I posted on Facebook: ‘When people feel leaders have grown arrogant or corrupt with power, they change their minds and their votes. If those who replace them follow the same path, voters will again change their minds and votes.’
I continued: ‘The strength of democracy lies in this simple principle: the more citizens act as independent voters, the stronger democracy becomes. The more they behave as party loyalists, the weaker it grows. If we want a better system, we must demand deep reform of the state bureaucracy and hold institutions accountable.’&nbsp;
The first responses came from two senior government officials. They told me privately that they agreed by 200% but could not say so publicly.
It is quite normal for a Nepali to get the run around in government offices, it is almost a given to be asked for a bribe. As an environmental reporter and citizen, I have numerous such examples.
It is not just one sector that has been suffering. It is everywhere, and this is just an example of how complicated our bureaucracy is. As a 40 something person, I am old enough to remember the 1990 pro-democracy movement, &nbsp;the Maoist insurgency. Many promises made then by the politicians were broken.
We fought for rights, we fought for regime change. The country has changed political systems several times, from monarchy to multiparty democracy and finally a republic.
Yet one thing that remains largely untouched or reformed is our inefficient and corrupt bureaucracy. The new government, to be led by the youngest prime minister in our history must start this reform if it wants to deliver.&nbsp;
Otherwise, we may have to keep changing governments every few years, and still find ourselves unable to legally cut down even one dead tree.

A dead tree tests Nepal's bureaucracy

On Friday, Balendra Shah is taking his oath of office as Nepal's prime minister in a capital city of which he was a mayor till six months ago.
At 35, he will be among Nepal’s youngest prime ministers. His reticence and reclusiveness have reinforced his brand as a doer rather than a talker. This was a persona he cultivated as mayor of someone who cleaned up the city by managing garbage. But he also chased off sidewalk vendors in an effort to ‘beautify’ the city.&nbsp;
After being elected, Shah did not attend RSP events in official capacity, and he was absent at an MP orientation last week.&nbsp;
His refusal to engage with the press, and even stopping to post on social media, have added to the air of reclusiveness. But as prime minister, he may have to communicate more even if it just to stop conspiracy theories and intrigue.&nbsp;
The people he will now represent would like to know, and have a right to know, what he is up to. Otherwise the feeling will grow that Nepal is entering uncharted territory. Governance, the economy and investment do not like uncertainty.
Political scientist Pyakuryal notes that calling Balen a 'man of few words' may serve as a useful epithet if he governs with quiet efficiency rather than fanfare. "But as Prime Minister, he must engage the nation’s will, not simply manage from above," she says.
She adds: "The real test lies in his choice of style: will he lead exclusively, keeping decisions close, or inclusively, opening space for dialogue and shared ownership of governance?"
Nepal's newly-elected lawmakers were sworn in on Thursday. And once sworn in as PM on Friday, Balendra Shah is set to appoint a ‘minimalist’ Cabinet. Although the Constitution caps the size of the Council of Ministers at 25, the party has decided to stick to maximum 18 and not split ministries to accommodate loyalists as was done in the past.&nbsp;
&nbsp;"The Cabinet must support the leadership of the Prime Minister while ensuring accountability to the Parliament,” notes political scientist Sucheta Pyakuryal. “But the questions that come to mind are: will the RSP MPs readily submit to Balen’s leadership and is Balen’s absence from the party’s official events an unwillingness or hesitation to submit to the party?”
Prime Minister Sushila Karki and her ministers ended their interim tenures this week, and she was lauded for upholding her commitment to hold a free, fair and peaceful election. But her image was tarnished for her reluctance to release the investigation report on the September violence, as well as recommending her Home Minister Om Prakash Aryal for a National Assembly seat, and her personal secretary to the National Trust for Nature Conservation. President Ram Chandra Poudel has put Aryal’s nomination on hold. &nbsp;
The Investigation Commission report leaked on Wednesday said the state failed to stop the firing on protestors by Police on 8 September and blamed the Army for not preventing the arson next day. It recommended the prosecution of prime minister KP Oli, home minister Ramesh Lekhak, and Police chief Chandra Kuber Khapung.
Notable names said to be in consideration for the Cabinet include many who are experts in their fields, and RSP wants a young lawmaker as Speaker. The new government will plunge headlong into the economic fallout of the West Asia war.
RSP, with its near two-third majority, does not have to placate any coalition partner, so Nepal is at long last expected to have a stable government after 35 years. Despite hopes that there will not be the usual horse-trading this time, there is tension between supporters of RSP chair Rabi Lamichhane and Balendra Shah. The two have been negotiating in hotel rooms for Cabinet posts for loyalists.&nbsp;
Shah’s larger-than-life online persona and nationwide appeal delivered the RSP its overwhelming electoral victory this month, and this makes the party’s core leadership beholden to him. To what extent is Shah willing to meet Lamichhane’s demands is the critical question, and we will know the answer by this weekend.
Says Pyakuryal: “Because this election showcased personality politics rather than the regular party politics, the dangers of ego-clashes, power-tussles and intraparty realpolitik become very real and this kind of equation can greatly hamper the spirit of democracy, representation and collective good."

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 <video controls src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260327020320_f91bd3e51c1dd198b099a24daac8c52384b408174506e7f5a0ced1db76773824.mp4" alt="" width="100%" height="100%"></video>
 <figcaption>Animation: ANUP TAMU</figcaption>
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Ball in Balen’s court

Rivers have been the lifelines of civilisations with their dynamic ecosystems providing vital services for human survival and ecological balance through the ages.&nbsp; But accelerating anthropocentric footprints are causing severe, and often irreversible, damage to river systems across the world, including those across High Asia, a region that sustains nearly a fourth of the global population downstream. An example is the <a href="https://nepalitimes.com/here-now/how-the-bagmati-civilisation-is-becoming-uncivilised" target="_blank">Bagmati River</a> that courses through Kathmandu, crosses the Himalayan foothills to join the Ganga in India. A river that once shaped the <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/when-it-comes-to-water-pollution,3196" target="_blank">Kathmandu Valley Civilisation </a>is now a polluted and biologically dead water body constricted by urban sprawl, choked by construction debris, chemical waste and untreated sewage.&nbsp; The loss of a sacred river is tragic enough, but its hazards related to health, life and livelihoods are not limited to the Valley, nor is its enormity fully gauged by the metrics of fatality, income loss, flood return periods, runoffs, embankment failure.&nbsp; It is a systemic collapse of ecological integrity, socio-economic stability and cultural heritage, affecting its downstream users as well. The death of Bagmati is a peril for a population size way bigger than circa 5 million residents of Kathmandu Valley. The degradation started in the 1980s and has accelerated. Why has not enough been done to save this iconic river that runs through Nepal’s capital?&nbsp; The Bagmati River Basin Improvement Project (BRBIP) was designed to make headway in restoring the river with a sewage treatment plant, dams for storing water to support dry-season runoff, recharge groundwater, creation of <a href="https://archive.nepalitimes.com/page/resurrecting-bagmati-the-river" target="_blank">green biodiversity corridors</a> along the river bank to also serve as recreation areas, reduce the urban heat island effect, and also provide cultural continuity. The project also envisages collection of hydrological data for managing Bagmati multipurposewater systems and providing flood forecasts and early warnings aimed at protecting lives and property, among other things. Most importantly, the project takes the integrated water resource management approach, which, in principle, is a holistic and collaborative way of managing all elements of the water cycle to ensure water security, public and environmental health and amenity.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260329040336_9605240fa8c7d649ce49fbe43565130e3187e979338ccf959c4e9b8c581b7a4c.jpg" data-media-id="editor_3" data-image-id="20260329040336_9605240fa8c7d649ce49fbe43565130e3187e979338ccf959c4e9b8c581b7a4c" data-rendition-name="original" width="2126" height="1577" loading="lazy" alt="Bagmati NT"> </figure>  This should pave the way for managing a river as a connected ecological, social, and economic system by enabling coordination across agencies and disciplines, stimulating technological innovation and financial investment. The success of this approach depends on long-term political will and commitment that transcend political cycles, but also needs strong community and civil society in defining issues and proposing solutions, creating and sharing knowledge, taking independent action to inform practice, monitoring and evaluating policies, and participating in public decision-making. Civil society, especially, in making the <a href="https://archive.nepalitimes.com/page/encounter-with-bagmati-river" target="_blank">revival of the Bagmati River</a> a pressing governance issue. The Bagmati Action Plan 2009, a precursor to the BRBIP, was designed in response to lawsuits filed in 2000 and 2004 by an independent legal practitioner of Kathmandu against waste dumping in the river.&nbsp; It took him almost two decades of legal battle for Nepal’s Supreme Court to pass orders for mandatory septic tanks in all homes in Kathmandu Valley, relocation of squatters from Bagmati river banks to government-built houses, and embargo on dumping and burying garbage on the banks of the river and its tributaries. Despite court orders, however, actual results have been unsatisfactory. Restoration of Bagmati barely made it to any political debate or electoral manifesto this time. Treatment plants have not been operational for years, yet no one is held accountable. The population ignores waste segregation or single-use plastic rules to check littering.&nbsp; The current condition of the river therefore seems to have more to do with the lack of public awareness and behaviour change than the failure of various master plans. Why does the deep danger of a dead river fail to arouse widespread civil society concern, let alone action? The apathy is perhaps underlined by an innately anthropocentric understanding of the river as a mere resource to be exploited, rather than the backbone of existence.&nbsp; Such a paradigm shift is possible when river or river systems are understood to be necessary for &nbsp;a harmonious coexistence with human populations. The more pertinent question is not whether a dead river can be restored because there are many examples from around the world where that has been successfully achieved. It is whether we choose to restore our rivers for intergenerational equity. This would require a holistic perspective and political will to revive reverence for a river system so that its symbiotic relationship with human settlements can be restored. Roshni Gurung is Research Assistant, River Basins at the International Centre for Integrated Mountain Development (ICIMOD).