In a corner seat on the first floor of Bir Hospital, a middle-aged kidney patient winces in pain. Next door, a lady has nerve damage, and is unable to feel the growing wound on her sole. Two floors up, a crowd of desperate patients wait for an appointment with an endocrinologist. This week, the hospital in Kathmandu was filled with different medical complications. But many of them were related to a single disease: diabetes. “On any given day, we see up to 200 patients in our department, and more than half have to do with diabetes mellitus,” says consultant endocrinologist Manil Bajracharya at Bir. Diabetes mellitus is a condition where the body either does not produce enough insulin, or does not use it effectively, resulting in dangerously high blood sugar levels. Untreated, it can lead to life-threatening complications, including disorders of the cardiovascular system, eyes, kidneys, and nerves. In Nepal, the incidence of diabetes is on the rise, with an estimated 8.7% of adults between 20-79 living with the condition in 2021. This number was 3.6% in 2011, and is expected to reach 9.4% by 2045. “This rise most likely has to do with rapid changes in lifestyle and diet,” explains Bajracharya. “We have seen a shift from traditional cereal and vegetable-based diets to ones rich in animal products and processed foods high in fat and sugar content. This nutritional transition, combined with reduced physical activity, has significantly increased the risk of diabetes.” Bagmati Province has a five times higher prevalence of diabetes than the Karnali. Other provinces with urban centres like Gandaki and Lumbini also have a high burden of the disease. Read also: <a href="https://nepalitimes.com/opinion/comment/saving-kidneys-to-save-nepal">Saving kidneys to save Nepal,</a> Rishi Kumar Kafle  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240607150624_2deb3cabd4a1367ea0656a84e817aa0c8bcc920bb4b33bda30037272931024b0.jpg" data-media-id="editor_1" data-image-id="20240607150624_2deb3cabd4a1367ea0656a84e817aa0c8bcc920bb4b33bda30037272931024b0" data-rendition-name="original" width="3952" height="3021" loading="lazy" alt="Diabetes in Nepalis NT"> </figure>  “Nepalis who migrate to cities often have reduced physical activity and transition to high-calorie diets, which contribute to obesity and elevate the risk of diabetes,” says Bajracharya. City dwellers are twice as likely to develop diabetes compared to rural Nepalis. Diabetes mellitus has no cure, but it can be managed through careful monitoring, lifestyle changes, and improving medications. Many people diagnosed with diabetes live for years without experiencing serious symptoms. But Nepal has a huge gap: 43.5% of adults living with diabetes do not know that they have the disease. This means two out of every five cases go undiagnosed, and therefore untreated.&nbsp; “If diabetes isn’t detected on time, it can become life-altering, and may even be fatal,” adds Bajracharya. Raman Tamang did not know he had diabetes until a wound started growing on his foot. “I first thought it was just a normal cut. But it grew and started stinking. It got so bad that my family started avoiding me,” says Tamang. When he was brought to Helping Hands Community Hospital in Chabahil, his wound had turned chronic. A patient with long term diabetes suffers nerve damage. This results in the loss of sensation in the feet. Elevation in blood glucose also reduces the body’s ability to heal wounds. “Minor cuts, scrapes, or wounds often go unnoticed until the body can no longer heal them on its own,” explains orthopaedic surgeon Hem Limbu at Helping Hands.&nbsp; Read also: <a href="https://nepalitimes.com/here-now/junk-food-is-making-nepali-children-shorter">Junk food is making Nepali children shorter</a>, Marty Logan  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240607150624_4e61c5cb980f287da4393eaf277d0c7418dbe95ffb717bb761ffa6f25d8418de.jpg" data-media-id="editor_3" data-image-id="20240607150624_4e61c5cb980f287da4393eaf277d0c7418dbe95ffb717bb761ffa6f25d8418de" data-rendition-name="original" width="1281" height="841" loading="lazy" alt="Diabetes in Nepalis NT"> </figure>  Called diabetic foot ulcers, such wounds often persist and in the worst cases may get infected and have to be amputated. Across the globe, 85% of all amputations happen due to diabetic foot ulcers. “We have to amputate almost half of all cases of diabetic foot because many patients come too late,” adds Limbu. Not amputating the leg can lead to infections spreading to the bloodstream. Studies have shown that 19-47% of diabetic patients in Nepal also have diabetic retinopathy, where high-glucose blood damages blood vessels in the retina of the eye, impairing vision. However, less than 30% of Nepalis who have diabetes know about this risk of blindness. And an additional 50% never get their eyes checked despite living with diabetes. Diabetes also elevates the risk of kidney failure, heart disease, and stroke.&nbsp; An estimated 9,000 Nepalis under 60 died due to some form of complication attributable to diabetes in 2021. Then there are 9.2% of Nepali adults who are prediabetic with elevated blood glucose levels that could reach diabetic levels if their lifestyle does not change. “But because most don’t know they have the condition, proper screening and awareness are essential,” says Hem Limbu. Read also: <a href="https://nepalitimes.com/here-now/myopia">MYOPIA</a>, Yugeshwor Koirala  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240607150624_fcdcf19b68a2f40d6b17f9753cc6d6fa13d511dae2a4b649a665db07c9c23a72.jpg" data-media-id="editor_5" data-image-id="20240607150624_fcdcf19b68a2f40d6b17f9753cc6d6fa13d511dae2a4b649a665db07c9c23a72" data-rendition-name="original" width="1262" height="849" loading="lazy" alt="Diabetes in Nepalis NT"> </figure>  Screening involves a blood test, and to manage high blood sugar, patients require insulin replacement therapy through injections or an insulin pump. But insulin resistance can often be managed with dietary modifications and exercise. “Prediabetes is gaining increasing recognition as a significant health concern, and a growing number of adults are seeking assistance even for mild symptoms,” notes Bajracharya. While this trend reflects improved awareness, it is equally vital to identify prediabetes in younger adults. Developing diabetes at a young age prolongs the duration of the condition and escalates the risk of complications. Timely diagnosis and effective management can mitigate complications: reducing the risk of diabetic retinopathy by up to 95%, foot ulcers and amputations by 85%, kidney disease by 70%, and both cardiovascular disease and stroke by 50%. “Prevention is better than cure for most diseases, but for diabetes, prevention and early detection are the only cures. Once the disease advances, reversing its effects becomes exceedingly challenging, necessitating lifelong symptom management,” adds Bajracharya. “So Nepal’s challenge isn’t just about forming an action plan for diabetes awareness, screening and treatment, but about implementing it in areas where essential drugs and equipment are out of reach.” In urban cities, the challenge is different. Drugs, diagnostic services and self-monitoring equipment are accessible, but so are processed foods and sugary drinks. “After essential healthcare services are in place, preventing and managing diabetes comes down to personal choices and attitudes. Whether or not diabetes continues to surge in Nepal, therefore, depends on each individual more than anything else,” says Bajracharya. &nbsp; Read also:<a href="https://archive.nepalitimes.com/news.php?id=18379"> Diabetic dilemma</a>, Buddha Basnyat

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A deadly sugar rush

<figure><img width="1920" height="1280" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111016114/636d13aa9c7e80680e0a9934jpeg.jpg" alt=""/><figcaption></figcaption></figure>South-East Asia has achieved the fastest rate of decline in <a href="https://archive.nepalitimes.com/regular-columns/Comment/fired-up-over-tobacco,920" target="_blank" rel="noopener noreferrer">tobacco use</a> among any other region in the world in 20 years, sustaining tobacco control measures during the Covid pandemic, according to a <a href="https://www.who.int/publications/i/item/who-global-report-on-trends-in-prevalence-of-tobacco-use-2000-2025-third-edition" target="_blank" rel="noopener noreferrer">new WHO Global Report</a>.
The region was estimated to have the highest average rate of tobacco use compared to all other WHO regions, with around 432 million users, or 29% of the total population.
However, the average prevalence of smoking among men in South-East Asia went down from 50% in 2000 to 25% in 2020, while tobacco smoking among women saw a sharp decline from 8.9% to 1.6% during the same timeframe, reports the 4th WHO Global Report on Trends in Prevalence of Tobacco Use 2000-2025.
South-East Asia at present has the highest proportion of the population covered by tobacco surveillance to monitor tobacco use prevalence and tobacco control policies. With continued efforts, smoking rates in the region could reach as low as 11% by 2025. 
“Sustained political commitment and relentless efforts by countries to strengthen surveillance, expand tobacco control measures including cessation services to help users quit tobacco are some of the key reasons for success,” said Poonam Khetrapal Singh, Regional Director of WHO South-East Asia.
In Nepal, <a href="http://archive.nepalitimes.com/article/Nepali-Times-Buzz/in-a-puff-of-a-smoke,3739" target="_blank" rel="noopener noreferrer">overall tobacco use went down</a> from 56% of the population in 2000 to 26% in 2020. Meanwhile, 2020 figures put 15% of the Nepali population over 15 years old as smokers.
However, the report lists Nepal among the only two countries in the region, along with India, that are likely to achieve the targeted 30% relative reduction in tobacco use by 2025. 
Nepal introduced its Tobacco Control and Regulation Act in 2011 and has some of the strictest smoking laws. The country is far ahead of other nations in the region with its anti-tobacco campaigns and is among few in the region to have scaled-up tobacco cessation services.
However, Nepal, which has imposed a 27% tax on the retail price of <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/Kicking-butts,329" target="_blank" rel="noopener noreferrer">tobacco</a>, has the lowest rates of taxation on tobacco products in the region. The WHO recommends a minimum 75% tax share of the retail price of tobacco.
For packaging, Nepal has implemented large-sized graphic health warnings on tobacco packs, requiring that they cover 90% of the front and back of packages. Pictorial, or graphic, warnings are one measure contained in the global blueprint for fighting tobacco use: the WHO Framework Convention on Tobacco Control (FCTC). Nepal joined the treaty in 2007. 
The FCTC and MPOWER package, a set of six cost-effective and high impact measures to help countries reduce demand and supply of tobacco, contributed significantly to the implementation and effectiveness of tobacco control measures across the country.
Singh also reaffirmed WHO support to member countries towards tackling non-communicable diseases (NCDs) and <a href="http://archive.nepalitimes.com/news.php?id=18267#.YZYlumBByUk" target="_blank" rel="noopener noreferrer">controlling tobacco</a>, emphasising the importance of WHO’s ‘best buys’— a set of cost-effective interventions for the prevention and control of NCDs.
“The best buys…continue to be at the core of the Regional response, recognising the need for countries to identify &amp; implement the most effective, feasible, and affordable interventions whatever their resource setting,” said Singh.
With sustained and accelerated efforts, and using the power of innovation, countries in the region can fulfill their commitment to FCTC and to the 2030 Sustainable Development agenda, leaving no one behind, read a statement by WHO South-East Asia.
Globally, there are now 1.30 billion tobacco users compared to 1.32 billion in 2015. This number is expected to drop to 1.27 billion by 2025.  Sixty countries are on track to achieving the voluntary global target of a 30% reduction in tobacco use between 2010 and 2025, two years ago only 32 countries were on track.

Tobacco use in South-East Asia declines

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108151120/636a66739c7e80680e059980jpeg.jpg" alt="" width="1500" height="1000"/><figcaption>Photo : BIKRAM RAI</figcaption></figure>There used to be a time when the main public health threat in Nepal was from infectious diseases like <a href="https://www.nepalitimes.com/here-now/the-mosquito-that-changed-nepals-history/" target="_blank" rel="noopener">malaria</a>, encephalitis, <a href="https://www.nepalitimes.com/banner/tb/" target="_blank" rel="noopener">TB</a> and typhoid. Whether vector-borne or transmitted through contaminated air or water, the most cost-effective way to address them was through prevention. Communication was the first line of defence against communicable diseases.Things have changed. Awareness has grown because literacy rates are up. Most Nepalis now suffer from non-communicable ailments like cardiovascular diseases, <a href="https://archive.nepalitimes.com/article/nation/diabetes-in-south-asia,3018">diabetes</a>, <a href="http://archive.nepalitimes.com/article/Nepali-Times-Buzz/A-mysterious-rash-of-kidney-failures,3639" target="_blank" rel="noopener">renal failure</a> and malignancies. These need treatment in medical facilities at a time when the over-commercialisation of hospitals has made healthcare unaffordable for a majority of the population. In fact, <a href="https://www.nepalitimes.com/editorial/poor-health/" target="_blank" rel="noopener">poor health</a> is making Nepalis poorer.Read also:<a href="https://www.nepalitimes.com/opinion/is-free-health-care-possible-in-nepal/" target="_blank" rel="noopener">Is free health care possible in Nepal?</a>, S P Kalaunee<a style="background-color: #ffffff; font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/?p=37821&amp;preview_nonce=9ce6a7c55d&amp;preview=true" target="_blank" rel="noopener">Federalism leaves Nepal’s medical sector ailing,</a> Sewa BhattaraiAlso, communicable diseases have not been completely overcome. Diarrhoeal dehydration and other water-carried infections are still major killers. One of the reasons Nepal’s progress in reducing child mortality has stalled is because of the state’s failure to ensure adequate and safe drinking water in remote regions. In this paper we have also reported on <a href="https://www.nepalitimes.com/banner/nearly-half-of-nepali-children-still-malnourished/" target="_blank" rel="noopener">stunting and wasting among children</a> due to malnutrition.In addition, <a href="https://www.nepalitimes.com/here-now/air-pollution-is-more-dangerous-than-smoking/" target="_blank" rel="noopener">worsening air pollution</a> has caused an epidemic of chronic obstructive pulmonary disease (COPD), which has led to lung infections in all age brackets and causing terminal pneumonia and other complications in the elderly. At current levels of PM2.5 concentration in the air, studies show, the average lifespan of city dwellers in Nepal could be reduced by up to four years.Read also:<a href="https://www.nepalitimes.com/here-now/nepal-is-a-microcosm-of-all-of-the-changes-in-world-health/" target="_blank" rel="noopener">"Nepal is a microcosm of all of the change in world health"</a><a href="https://www.nepalitimes.com/editorial/poor-health/" target="_blank" rel="noopener">Poor health</a>, EditorialNepal’s burden of non-communicable diseases and injuries has doubled in the last 25 years, with nearly 15% caused by <a href="https://www.nepalitimes.com/banner/nepals-deadly-roads-take-their-toll/" target="_blank" rel="noopener">road traffic accidents</a> or natural disasters. Traffic accidents are now the second biggest killer of young Nepalis. Just in the past three weeks, 90 people have been killed on highways due to poor road condition or carelessness.A vivid indication of the threat of non-communicable diseases is today’s prevalence of diabetes. South Asians are genetically more susceptible to cardiovascular diseases and diabetes, but there are now new risk factors caused by increasing rural to urban migration. While the world prevalence average for both types of diabetes is 8%, research has shown that 14% of people in Dharan suffer from the disease. Taplejung, from where many have migrated to Dharan, has a rate of only 1%. The reason is clear: increased intake of carbohydrates and a more sedentary lifestyle when people move to cities.To meet these challenges, Nepal desperately needs <a href="https://www.nepalitimes.com/opinion/is-free-health-care-possible-in-nepal/" target="_blank" rel="noopener">affordable and accessible medical care</a>. At the moment, hospital treatment is neither. The poor in remote, underserved areas of the country are disproportionately vulnerable. As our report from Bajura shows, the problem is further complicated because confusion over federalism, budget and jurisdiction has left most rural government hospitals underfunded and underserved. It is imperative that the government act quickly to resolve the retention crisis caused by medical staff getting themselves transferred out of their jobs in remote areas.Read also: <a href="https://archive.nepalitimes.com/article/nation/national-health-insurance-not-as-easy,4028" target="_blank" rel="noopener">A national health insurance is not as easy as it looks</a>, Sonia Awale<a href="https://www.nepalitimes.com/banner/this-is-how-to-upgrade-nepals-rural-health/" target="_blank" rel="noopener">This is how to upgrade Nepal's rural health</a>, Sewa BhattaraiA survey last year showed that half of all <a href="https://archive.nepalitimes.com/article/nation/national-health-insurance-not-as-easy,4028" target="_blank" rel="noopener">medical expenditure of Nepalis families</a> is out-of-pocket, and 60% of that is for treatment of non-communicable diseases and injuries. The federal government allocates only about 10% of its budget to health care, and the focus is still on communicable diseases. Donor priority is also not on non-communicable diseases and injuries. A study of government hospitals by the Nick Simons Institute shows a huge unmet need in remote areas for basic surgery like caesarean sections and orthopaedics.One bright spot ahead is the success of pilot insurance schemes being tried out in various parts of the country. In a <a href="https://www.nepalitimes.com/opinion/is-free-health-care-possible-in-nepal/" target="_blank" rel="noopener">commentary this week</a>, S P Kalaunee of Nyaya Health, an NGO that helps the government manage hospitals in Achham and Dolakha, presents a proven 60:25:15 formula of health insurance. In this arrangement, non-profits, the private sector and all three levels of government can make medical care affordable to all Nepalis, if upscaled. Under the scheme, 60% of the cost of care comes from insurance, provincial governments pay 25% and municipalities take care of the remaining 15%.Parts of the scheme are being tried out in <a href="https://www.nepalitimes.com/banner/this-is-how-to-upgrade-nepals-rural-health/" target="_blank" rel="noopener">Bayalpata Hospital in Achham</a> (which last week <a href="https://www.nepalitimes.com/banner/bayalpata-hospital-in-nepal-wins-global-design-award/" target="_blank" rel="noopener">won the Global Architecture Festival award</a> in Amsterdam for its design). Insurance reimbursement covers the cost of insurance-covered care, the local government allocates funds required for basic and emergency healthcare, and the provincial government pays for managing the cost of referrals beyond insurance coverage. Internationally, this has become an issue with 12 December marked as Universal Health Coverage Day.Nepal’s constitution now guarantees basic and emergency healthcare as fundamental rights of citizens, and puts the responsibility on to the state. The government  can no longer keep passing the buck on providing universal insurance for its citizens.<h2>10 years ago this week</h2>Nepali Times <a href="http://archive.nepalitimes.com/issue/480" target="_blank" rel="noopener">issue #480 of 11-17 December 2009</a> carried an <a href="http://archive.nepalitimes.com/news.php?id=16572#.XfId7ZMzaUk" target="_blank" rel="noopener">interview on page 1 with Baburam Bhattarai</a>, who was then vice-chair of the Maoist party.  Excerpts:‘From the very beginning, we have said that the basis of the federal system should be nationality. In Marxist terms, nationality means a common language, geography, economy and psychological make-up. A group of people that shares these qualities is called a nationality.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108151120/636a66769c7e80680e059981jpeg.jpg" alt="" width="392" height="600">On this basis we have proposed to constitute federal autonomous units in Nepal and we also practised this during the People’s War. Since the very beginning we have been consistent that federalism should be along the lines of nationality.’

POOR HEALTH MAKES NEPALIS POORER

For many decades it was an accepted truth that Nepal’s main public health threat was from infectious diseases, and the most cost-effective way to address that was through prevention. In other words, the first line of defence against communicable diseases was communication.Whether it was gastric infections caused by contaminated water, respiratory ailments due to cold and pollution, or diseases spread by insect vectors like malaria – the goal was to spread public awareness about prevention. Radio jingles about oral rehydration salts or acute respiratory infections in children indirectly helped save millions of lives over the years.Many of these challenges remain. Despite dramatic progress, many Nepalis still lack safe drinking water – not just in the roadless hinterland but right here in the heart of the capital. There are frequent <a href="http://archive.nepalitimes.com/article/nation/%20jajarkot-open-defecation-free,2023">cholera</a> epidemics. Children’s lungs are still affected by indoor smoke from wood fires. Malaria is on the comeback due to resistance and there is an annual epidemic of dengue and encephalitis.Yet, compounding these endemic infections, there is now an <a href="http://archive.nepalitimes.com/article/nation/Communicati-about-non-communicable-diseases,1153">increasing burden of non-communicable diseases and injuries</a> (NCDI). New lifestyle-related cardio-vascular afflictions, chronic obstructive pulmonary disease (COPD) caused by <a href="http://archive.nepalitimes.com/article/Nepali-Times-Buzz/every-breath-we-take-air%20pollution,3536">pollution</a>, or <a href="http://archive.nepalitimes.com/article/nation/stigma-and-silence-mental-health-nepal,3486">mental health disorders</a> have added to the burden of disease and disability. <a href="http://archive.nepalitimes.com/article/nation/diabetes-in-south-asia,3018">South Asians are already genetically susceptible to diabetes</a>, and now there are new risk factors due to migration to urban centres. While the world average for prevalence of both types of diabetes is 8%, more than 14% of people in urban centres like Dharan have diabetes – even though the prevalence for rural Taplejung, for instance, is only 1%.A study by The Nepal NCDI Poverty Commission released this week shows that the burden of NCDIs has doubled in the last 25 years. More than half of all death and disability today are caused by NCDIs, with nearly 15% caused by injuries in conflict, natural disasters or highway accidents. <img width="900" height="802" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221104141144/636517699c7e80680e02c275jpeg.jpg" alt=""/>Being afflicted with an NCDI (or chronic disease) is more fatal in Nepal than in developed countries because of affordability and restricted accessibility to adequate medical treatment. The poor are disproportionately vulnerable. The NCDI burden in Nepal is also different than in other parts of the world – there is a higher incidence of ischemic cardiac conditions, asthma, neurological disorders, cancers caused by untreated infections and injuries, for instance.For us, the report’s main finding, and most damning inference, is about how <a href="http://archive.nepalitimes.com/article/nation/national-health-insurance-not-as-easy,4028">treatment of NCDIs is driving Nepalis into indebetedness and penury</a>. The survey shows that half of all medical expenditure of families is out-of-pocket, and 60% of that is for treatment of NCDIs. This is because the government spends only 11% of its budget on health care, and only 6.4% of that is for treatment of non-communicable diseases.Despite the proven link between chronic ailments and poverty, donors still allocate only 1% of their development assistance for NCDIs.Treatment of injuries, gastro-intestinal infections, heart diseases, cancers, kidney and liver diseases are the most impoverishing NCDs for households. The report’s main conclusions are corroborated by our <a href="https://www.nepalitimes.com/banner/state-of-the-art-rural-hospital/">field report</a> from Achham and Kavre this week  about how the lack of even basic surgical facilities in district hospitals and health posts is forcing Nepalis to undertake expensive and extended trips to private hospitals in the cities.Another recent study of 39 government hospitals commissioned by the Nick Simons Institute (NSI) showed a huge unmet need in remote areas for basic surgery like caesarians, orthopaedics, and abdominal operations. Nepal’s surgery rate is well below the Lancet Commission’s target of 5,000 operations per 100,000 population. Only one-third of patients currently can reach an orthopedic surgeon within two hours of travel. <img width="640" height="456" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221104141144/6365176b9c7e80680e02c276jpeg.jpg" alt="">The public-private partnership models that NSI and Possible are carrying out in remote government hospitals are ways to plug this gap: ensuring minimum staffing of a MDGP physician, anaesthesia assistant, staff nurse and biomedical technician in each hospital can offer basic treatment and surgery in remote areas, reduce the need for referrals, and save household income. At present Nepal’s density of hospitals with such staffing and equipment is at 0.4 per 100,000 population, as against the Lancet Commission’s recommendation of 20/100,000.The Nepal NCDI Poverty Commission report suggests additional measures: national health care delivery should respond to the increasing burden of NCDIs by decentralising.Impoverishment of households due to the high cost of treatment should be addressed through disease-specific policies for high-cost conditions and expansion of insurance coverage.It is often said that health is wealth, but in Nepal wealth is health. That can only be changed by making treatment of chronic conditions and injuries accessible, affordable, inclusive and equitable.Read also:<a href="https://www.nepalitimes.com/banner/state-of-the-art-rural-hospital/">State of the art rural hospital</a>, Marty logan <a href="http://archive.nepalitimes.com/article/nation/national-health-insurance-not-as-easy,4028">A national health insurance scheme is not as easy as it looks</a>,  Sonia Awale<a href="http://archive.nepalitimes.com/article/nation/Communicati-about-non-communicable-diseases,1153">Communicating about non-communicable diseases</a>,  Elina Pradhan and Bigyan R Bista

Poor  health

New and old, businessmen and former diplomats, engineers and academics — they have all been trooping to the Election Commission to register political parties ahead of the Sunday deadline.
Till press time Thursday, five new parties had been registered and 21 new parties were in the process of applying. Behind the scenes, new parties are head-hunting, well-known figures are shopping for parties to join, while older parties are splitting or uniting to form new united parties.
“It is reason for optimism that people are enthused to form new parties,” notes political analyst Indra Adhikari. But, she adds, this does not mean that despite the celebrity status they will win votes and succeed in politics.
The outlier in all this are the Nepali Congress (NC) and the UML, which are still licking the wounds after being swept out of power by the GenZ protests in September. Neither are too keen on elections because of the prospect of losing badly.
Former prime minister K P Oli is the most recalcitrant, and seems to want to scuttle elections so Parliament will be reinstated. After announcing that he was stepping down, the NC’s Sher Bahadur Deuba has had a change of heart in Singapore and is gunning to restore Parliament.
Neither party and their leaders have shown any remorse for the 8 September massacre, or understood the outrage on the streets against their decades-long incompetence and corruption. &nbsp;
Among those registering parties are various GenZ youth groups and family members of those killed during the September protests. Notable among the new parties certified this week was Gatishil Loktantrik Party (गतिलो) backed by Buddha Air founder Birendra Basnet and led by sociologist Dinesh Prasai. Dharan Mayor Harka Sampang’s Shram Sanskriti Party is also registered.
Energy and Infrastructure Minister in the interim government Kulman Ghising has backed the Ujyalo Nepal with former secretary Anup Kumar Upadhyaya as its chair. Ghising has been playing coy about his political ambitions, and is planning to resign from his cabinet post before elections.&nbsp;
Ghising had been talking to Rabi Lamichhane’s RSP about joining, but that negotiation failed. Former RSP lawmaker Sumana Shrestha was supposed to join Ghising, but pulled out following Ghising’s reluctance to resign from government.
Ghising has much public support because he is credited with ending power cuts as head of the Nepal Electricity Authority, but is now getting flak for being unwilling to give up his ministerial portfolios while still wanting to contest elections. &nbsp;
Ujyalo has hit other snags. GenZ activist Tashi Lhazom, who was considered for a Cabinet position last month but was dropped by Prime Minister Sushila Karki, has said she is not in Ujyalo despite being listed as a Central Committee member. Another member has said that he will not be a part of Ujyalo due its “a lack of political culture”.
Even though Nepalis from across backgrounds and professions are eager to participate in the country’s new political landscape, there are doubts about the structure of their parties, ideology and electoral platforms.&nbsp;
Hurriedly set up parties without a shared philosophy have less chance of political influence and longevity. For example, the RSP was formed just months before the 2022 polls to become the fourth-largest party in Parliament, has lost its momentum, and its leader is in jail.
“Parties like the RSP, which did some positive work after being elected, have still not been able to establish a clear ideological roadmap or organisational structure,” Adhikari says. &nbsp;“It is easy to form parties, the real work goes into building an institution, which is the hard part”
Meanwhile, despite expectations of increased and inclusive youth participation not just at the polling booths but also on the ballot, only a few GenZ-led parties are applying at the Election Commission. They include the Rastriya Pariwartan Party and the Rastriya GenZ Party Nepal. Most other parties are led by men in their 40s, even in their 70s.&nbsp;
Analysts note that despite hopes of young blood in politics, Nepalis are still inclined to trust those with experience, as evidenced by GenZ’s choice of Sushila Karki to succeed KP Oli as Prime Minister after the September protests.&nbsp;
“So it will be difficult for young Nepalis without prior political experience to lead parties and it will be even more difficult for them to cultivate enough public trust to get votes,” says Adhikari.&nbsp;
Then there are the old political players, who have been breaking up and making up new alliances. Resham Chaudhary quit his Nagarik Unmukti Party and registered a new one.
Last week, Puspha Kamal Dahal’s Maoist Centre, and Madhav Kumar Nepal’s Unified Socialists merged along with smaller leftist parties to form the Nepali Communist Party (NCP). Disgruntled former UML members like Bhim Rawal have also joined the NCP. On the other hand, Janardan Sharma has fallen out with Dahal and is going his own way.&nbsp;
Even though the NC, UML and NCP show little sign that they have learnt their lesson and will be turning a new leaf, they still have the party organisation and vote banks to fall back on at election time in the runup to 5 March. &nbsp;
Says Adhikari: “At the end of the day, Nepali society remains hyper-partisan. And although the newly-formed parties and their popular candidates may give older leaders a run for their money, established parties will still benefit from their solid vote base.”

Party Time

The very first frame in The Lama’s Son starts with a vision of Shangrila and the quest of a mythical utopia in the Himalaya when the rest of the world is crumbling away. It is also the personal search of filmmaker Kesang Tseten, but what he finds there are adherents of the Bon Po faith clinging to the last remnants of a culture as it erodes away like the sandstone cliffs of Mustang. “It was while editing the documentary that the story became distilled: how does what we see in the high Himalaya relate to the notion of the Shangrila idyll that especially the West ascribed to them,” asked Tseten during a recent trip to Kathmandu from Berne where he now lives. He continued: “Often and perhaps rightly criticised as an orientalist construct, I wondered if there was any basis at all to the Shangrila notion, and I hung the film on that idea.”&nbsp; Tseten takes us to the vast vistas of Mustang and Dolpo, a landscape of his Tibetan ancestors. This is as much an intimate documentation of families on Nepal’s Himalayan rimland torn between remoteness and globalness as it is about Tseten’s own quest for rootedness.&nbsp; We start from Lubra, a 3,000m village in Mustang the 15 households of which follow the Bon faith. Lama Tsultrim is from a 900-year-old lineage of the animist faith and an exponent of the tradition that is slowly being subsumed first by Buddhism and now modernism. For Tseten, the material is familiar, and not at all exotic as it is for non-Nepalis and indeed for many urban Nepalis. Bon, founded in Tibet, predates Buddhism, but over time, the two religions have come to resemble each other.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251113111156_ecf8148fbaa17b93c81ddfa3ed244bed266e3ef6af0cd5e6ca7b64c181b97d45.jpg" data-media-id="editor_0" data-image-id="20251113111156_ecf8148fbaa17b93c81ddfa3ed244bed266e3ef6af0cd5e6ca7b64c181b97d45" data-rendition-name="original" width="1920" height="1080" loading="lazy" alt="The periphery cannot hold NT"> </figure>  ‘Both believe in karma, rebirth, and that humans can become enlightened. Nature and spirits are predominant in Bon, and rituals are what keep them benign and alight,’ says Tseten, who rarely narrates in his documentaries. “This is not really a personal film as such, but it has a point of view,” Tseten said. “I decided to have a voice-over on this one and cast my presence in the film.”&nbsp; Lubra's Lama Tsultrim is called upon to perform rituals from Kagbeni and other villages, but there is no one to continue the tradition after him, which is passed from father to son. Lama Tsultrim’s son (hence the title of the film) is a sushi chef in New York and has been gone for 20 years. “The Lama is like a setting sun, his son should come back and take over his father’s responsibilities,” says a local youngster chatting with friends. “If he dies tomorrow, where do we go? We can’t just light butter lamps ourselves to the gods.” It is not only the Lama’s son who has left. The village is nearly empty, and more are planning to leave. One of them is Chimi, a teacher who will be joining her fiancé who is an Uber driver in New York. Her brother is already in Hong Kong. In Lo Manthang a local is back home for a three-month vacation after being in New York for 12 years. A shopkeeper was in Japan for several years, and has returned. “Everything has changed, our language, our tsampa, our religion. We used to work and live together, now the children live separately,” says a middle-aged woman. “There are roads now, and vehicles stop right outside our house, but what’s the point? No one stays home.”  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251113111156_47b4c4984fa33e42791b16dba1f078aaa7f9d8bd51ca3bfd5415b436c3a0bf2c.jpg" data-media-id="editor_1" data-image-id="20251113111156_47b4c4984fa33e42791b16dba1f078aaa7f9d8bd51ca3bfd5415b436c3a0bf2c" data-rendition-name="original" width="1920" height="1080" loading="lazy" alt="The periphery cannot hold NT"> </figure>  Like most of Tseten’s films, The Lama’s Son is an honest documentation of a place and people whose lifestyle, culture and heritage cling precariously to the past. In Dri village we come across local women filling their buckets with water. Tseten asks them why the village is so empty: “Where is everyone?” The women reply that they are “here, there and everywhere”. Then it is their turn to ask Tseten about where he lives and what he is doing in their village. Migration is a recurring theme in Tseten’s documentaries from We Corner People, In Search of the Riyal, or Saving Dolma. His previous film Diversity Plaza documented the lives of Nepali and Tibetan emigrants in Jackson Heights in the borough of Queens in New York.&nbsp; Diversity Plaza was shown at DOC NYC in 2023, and The Lama’s Son will be one of only two Asian films shown next week at one of the biggest documentary film festivals in the world.&nbsp; “The Lama’s Son is not loud, not attention grabbing but intimate, so I was surprised they chose a quiet film for a big, flashy event,” Tseten told us. In Lama’s Son, we also see how climate breakdown is impacting Nepal’s trans-Himalayan regions. Lama Tsultrim shows us the aftermath of a recent glacial flood that swept away houses and fields. The debris-covered farms are as hard as cement.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251113111156_c82126a3c2dc4577b99beb9bef20aafa16f532a3f41e59caea17c93914c59fff.jpg" data-media-id="editor_2" data-image-id="20251113111156_c82126a3c2dc4577b99beb9bef20aafa16f532a3f41e59caea17c93914c59fff" data-rendition-name="original" width="1920" height="1080" loading="lazy" alt="The periphery cannot hold NT"> </figure>  The nearby village of Dhey at 3,900m is a high and dry cold desert. Farmers get one crop in a year, but the springs have gone dry and there is no snow in winter. So they are relocating to New Dhey, closer to the road. We follow Kesang Tseten to Samling in Dolpo, which at 4,200m is another Bon village. Locals are preparing for the Walchu festival in which Lama Sherrab carries out elaborate rituals to appease spirits that can turn malevolent. But unlike Lama Tsultrim in Lubra, Lama Sherrab has a community of lamas to help him, including two sons, one of whom will eventually take on his role. We move on to the adjacent village of Bicher and listen in as locals talk about how despite being dirt poor, they thrive in scarcity and are resilient. “We wear sheepskin, eat stew and yak meat, and drink wine. But we are very poor, we have nothing. Look at how dirty our clothes are. We may be dirty, but we have few illnesses,” says one. But even here in Upper Dolpo, a week’s walk from the nearest road, things are changing. There are mobile phones, readymade clothes and instant noodles.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251113111156_d1472165cfa9ffa6edbf72de59167e8cbddcc2bf4a7928f7830e099966259a78.jpg" data-media-id="editor_3" data-image-id="20251113111156_d1472165cfa9ffa6edbf72de59167e8cbddcc2bf4a7928f7830e099966259a78" data-rendition-name="original" width="1920" height="1080" loading="lazy" alt="The periphery cannot hold NT"> </figure>  At the Walchu ritual, Tseten watches men and women with hand-woven blankets and down jackets sing and dance after the main ceremony. He narrates: “Bon is sustained by a way of life that fosters a fine but fragile balance between nature and people, where humans come before gods. This is what lies at the heart of Shangrila if there is such a thing.” The film then takes us half-way around the world to a Bon centre in New York, but (spoiler alert) the eponymous Lama’s son never appears. He did not want to be filmed, but it makes for a more powerful portrayal of the life of emigrants forever trapped between two worlds. “Bon villages may be in danger, but the Bon has spread widely across the world,” narrates Tseten, a director who likes to call his storytelling ethnographic, and avoids coming to an apt conclusion. Lama Sherrab’s words after the Walchu ritual is a perfect segue:&nbsp; “Whether you say om mani padme hum (in Buddhism) or matri mi yu (in Bon) they are the same. When you go up, it’s the same heavenly realm. If you go down, it’s still the lord of death who awaits. There isn’t a separate heaven and hell for Buddhists and Bon, it has to be the same for both.” &nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025111312110_82817ef48840bb6baa1732d5b0b90c90ead2f9bd9eb0c289940fa61d8058de8d.jpg" data-media-id="editor_4" data-image-id="2025111312110_82817ef48840bb6baa1732d5b0b90c90ead2f9bd9eb0c289940fa61d8058de8d" data-rendition-name="original" width="7087" height="10004" loading="lazy" alt="The Lama's Son NT"> </figure>  The Lama’s Son by Kesang Tseten, 2025 Shunyata Films To be screened at DOC NYC 16 November at 2:05PM local time, Online: 17-30 November Details <a href="https://www.docnyc.net/film/the-lamas-son/">here</a>.

The periphery cannot hold

It was pure drama: the political transition in Madhes unfolded by the dawn’s early light. At around 4AM on Monday, Province Head Sumitra Subedi Bhandari quietly departed Janakpur saying she was headed to Kathmandu for health reasons.&nbsp;
Outgoing Chief Minister Jitendra Sonal, whose coalition had begun to unravel, even saw her off, asking supporters to clear the road for her motorcade.
But an hour later, instead of continuing on to the capital, Bhandari stopped in Bardibas on the East-West Highway. There, as the sun started rising over the misty plains, she administered the oath of office to Saroj Kumar Yadav of the CPN-UML, invoking Article 168(3) of the Constitution.&nbsp;
Bhandari is also a member of the CPN-UML. The provision she invoked is typically used only after coalitions fail under Article 168(2), and the timing and location of the swearing-in have since drawn scrutiny.
Bhandari was subsequently relieved of her duties, and former National Planning Commission member Surendra Labh Karna was sworn in as the new Madhes province head on Tuesday.
Sonal had formed his government barely a month ago, with the backing of 56 provincial lawmakers but it became evident he would not secure the 54 votes needed to survive a confidence motion.&nbsp;
Several lawmakers in his coalition publicly signalled they would abstain. Still, the seven-party alliance that opposed Yadav’s appointment argues that the Province Head, who is the highest constitutional rank in the provincial structure, acted prematurely and under pressure from central UML party command.&nbsp;
A coalition of seven parties, including the Nepali Congress (NC), had been urging the Province Head to invite them to form a new government under Article 168(2). At the same time, the UML, which had been holding demonstrations outside the Province Head’s office in Janakpur, was calling for the formation of a minority government under Article 168(3).
The alliance of the seven parties that included the NC and Maoist Centre took to the streets. By mid-morning, protests had escalated outside Madhes Bhawan with cadre vandalising both the Chief Minister’s office and the Province Head’s office.
This was the third government in Madhes to fall since the 2022 provincial elections, and it follows a similar pattern. The previous Chief Minister Satish Kumar Singh of the Janamat Party, resigned before a scheduled confidence vote after losing the support of his own party and others including NC and LSP.&nbsp;
His resignation unfolded amid nationwide GenZ protests against corruption, demanding accountability and reform. The recurring instability points to a structural tension in Nepal’s federalism.&nbsp;
Provincial politics remain closely tied to alliances shaped in Kathmandu. The withdrawal of support by parties like the NC and Maoist Centre in provinces often reflects national-level calculations rather than provincial priorities.
As a result, the Provincial Assembly is repeatedly consumed by survival of the coalition instead of governance. Development work stalls. Budget execution slows. Public frustration grows. In a province that was at the forefront of the movement for federalism to counter what is seen as neglect, apathy and discrimination by Kathmandu, the sense that the system may not delivering on its promise is becoming increasingly pronounced.
If federalism is to be strengthened, provincial governments must be able to function with a degree of autonomy that currently exists more in principle than in practice. Otherwise, the perception that federalism is costly, unstable, and ineffective will continue to expand, providing fertile ground for anti-federal sentiment that is already gaining traction.
Earlier examples such as the NC General Secretary Bishwo Prakash Sharma in January calling for a new government in Madhes led by his party demonstrates how the central party leadership deliberately intervenes in provincial affairs. His remarks came during campaigns for bi-elections in Madhes when former CM Singh had been in office for six months only.&nbsp;
Likewise, in early June 2024, the federal coalition in Kathmandu shifted from a Maoist Centre and NC to form a new alliance between the NC &nbsp;and the UML. Within a day, coalition negotiations in Madhes changed to mirror this.
UML leaders publicly stated: “The issues at the federal and provincial levels will be resolved together.” This indicated that the realignment in Madhes followed national party decisions rather than provincial deliberation.
The events that unfolded in Madhes are a reminder that federalism in Nepal is still in transition, and that its success depends on political actors honouring the constitutional framework.

Chronic instability in the Madhes

The sixth edition of PhotoKTM will mark a decade of visual storytelling and continue its role as a vital platform for photographers and visual artists to explore the politics of photographs and their role in shaping our histories and futures.&nbsp; The month-long festival across Kathmandu Valley features 18 exhibitions, slideshows, workshops, artist talks, panel discussions, portfolio reviews, and film screenings. While Nepal Art Council will be the anchor venue, the festival will go on the road in Mangahiti and Chyasal in Patan, Nigu Pukhu in Madhyapur Thimi, Nandi Keshar Bagaincha in Naxal and Tribhuvan University. The curatorial themes of PhotoKTM 6 Global South Solidarities draws inspiration from the historic 1955 Bandung Conference in Indonesia, which marks its 70th anniversary this year.&nbsp; The festival explores the political and cultural legacy of the Third World Project, exploring the history of global resistance and solidarity, and how they have shaped contemporary processes to reclaim sovereignty of regions battered by centuries of colonialism, exploitation, and violence.&nbsp; The festival spotlights the work and curatorial voices of artists from over 40 artists based in the Global South, from Santiago to Lubumbashi and Quito to Dakar, alongside Nepali photographers and filmmakers. “We hope this year’s coming together will deepen cultural understanding among artists and cultural communities across the Third World, strengthen reciprocal transnational solidarities through the sharing of our histories, stories, struggles and hopes, and open up pathways for more south-south collaboration and exchange across geographies,” says NayanTara Gurung Kakshapati, co-founder and festival director.&nbsp; Also featured are eight Nepali artists from the 2025 photo.circle fellowship cohort, whose works explore questions, challenges, and contradictions surrounding the notions of ‘development’ and ‘progress’ in contemporary Nepal.&nbsp; The festival comes two months after the GenZ protests, at a pivotal moment when Nepal is navigating significant political transitions. Says curator Diwas Raja KC: “From anti-colonial struggles to the Bandung Conference, to the non-alignment movement and revolutionary cultural exchanges, these histories continue to shape how countries like Nepal imagine their place in the world.”&nbsp; PhotoKTM6 is supported by the Shikshya Foundation Nepal, the Embassy of Switzerland in Nepal, as well as independent non-profit organisations FreeMuse and Cultural Workers Solidarity Front. “I think it is particularly relevant that these spaces are created and maintained because it is only if people meet and continue to do this important work, in which they think collectively, they work collectively, and they hold up certain values, that they will be capable of contributing to what I would call a ‘free world’,” says yasmine eid-sabbagh, who is the invited interlocutor to this year’s festival. &nbsp;&nbsp; <h2>Ji ta Newa Bhyaa Mawa (I don’t know Nepal Bhasa)&nbsp;</h2> Jyoti Shrestha  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251113121124_0fbeb8abf122867f5d5294c6e4c7ef2a4e3785e2d4083fb663ebe543e9b8396d.jpg" data-media-id="editor_0" data-image-id="20251113121124_0fbeb8abf122867f5d5294c6e4c7ef2a4e3785e2d4083fb663ebe543e9b8396d" data-rendition-name="original" width="1000" height="667" loading="lazy" alt="The politics behind photographs NT"> <figcaption>Photo: JYOTI SHRESTHA</figcaption> </figure>  Jyoti Shrestha was born to Newar parents in Kathmandu but grew up without learning the mother tongue, Nepal Bhasa. ‘My parents, with the best of intentions, taught us English and Nepali—languages of success and survival in a world that had set ours aside... A Newar without language, I felt alien in the very culture that was meant to be mine,’ writes Shrestha in her testimony. Nepal Bhasa is in UNESCO’s ‘definitely endangered’ list. Shrestha has begun to learn her language with help from her parents, and in doing so, their relationship has shifted for the better. She adds: “No census counts the intimacy of a shared memory, the tenderness of language passed between generations, or the weight of an inherited silence.” <h2>The Land Remembers Our Name&nbsp;</h2> Rejin Purja  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251113121128_14b44a9e7a9d27c9ac5e893e59930d049d1be05401a42217c304a7d08c2e47e2.jpg" data-media-id="editor_1" data-image-id="20251113121128_14b44a9e7a9d27c9ac5e893e59930d049d1be05401a42217c304a7d08c2e47e2" data-rendition-name="original" width="1200" height="800" loading="lazy" alt="The politics behind photographs NT"> <figcaption>Photo: RENJIN PURJA</figcaption> </figure>  The Department of Mines and Geology has confirmed the presence of iron ore in Jhumlawang in East Rukum. Iron mining has not started yet but a Kathmandu-based private company is said to have won the bid at Rs40.3 million. If the project indeed takes off, most of the families will have to be evacuated. “Not only will they lose their houses, land, and forests, but their roots, culture, and autonomy are also at stake. How can this project be considered of national benefit when it forces the very people it should serve to live in fear of their future?,” Rejin Purja writes in his testimony. Economic development exploits the natural resources of native and indigenous communities. Such projects may boost GDP and corporate profits, but they rarely improve the lives of the people whose land is being extracted from. This work reflects the uncertainty felt by the local people about their village’s future. <h2>Fragmented Land and Me</h2> Sujata Khadka  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251113121128_f28f960361f822792d8e4442f61deaea71bdf6022b9906509b7e9258939fdbcb.jpg" data-media-id="editor_2" data-image-id="20251113121128_f28f960361f822792d8e4442f61deaea71bdf6022b9906509b7e9258939fdbcb" data-rendition-name="original" width="1200" height="800" loading="lazy" alt="The politics behind photographs NT"> <figcaption>Photo: SUJATA KHADKA</figcaption> </figure>  Sujata Khadka’s ancestral home in Godavari’s Jharuwarasi was destroyed in the 2015 earthquake, after which her family built a new house on a small plot of land nearby. In the decade since the earthquake, rapid land trade has turned the farmland surrounding her home into a housing development. For the past 10 years, Khadka has been watching natural and man-made events unfold on the plots from her window on the second floor of her house. The land has been witness to playing children, negotiating brokers, bulldozers, and prowling wildlife. But despite relentless hemming and hawing by buyers and sellers over the past decade, no houses have been built on the land. &nbsp;“This misshapen land feels like a stage where a cast of characters performs an ongoing act,” says Khadka. “Perhaps this land and I are spectators to this drama.” <h2>Why doesn’t home feel like home?</h2> Karma Tshering Gurung  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251113121128_c568cdf076247f8904b289e9108ed4e7b5187d86694913751123a6b5df663142.jpg" data-media-id="editor_3" data-image-id="20251113121128_c568cdf076247f8904b289e9108ed4e7b5187d86694913751123a6b5df663142" data-rendition-name="original" width="1200" height="800" loading="lazy" alt="The politics behind photographs NT"> <figcaption>Photo: KARMA TSHERING GURUNG</figcaption> </figure>  Karma Tshering Gurung was born in Manang to a Manangi family, where he was raised with his siblings. But in recent times, whenever he has visited his family in Manang, he has felt a sense of unease, like the place sees him as an occasional visitor, an outsider who no longer understands the aspirations of his people. As Manang becomes a tourist spot, Gurung’s brother thinks it is a good idea to tear down their ancestral house and build a snooker house in its place. But Gurung thinks the house is their Appa’s legacy, and worth preserving. The brothers’ ideas of home have diverged. &nbsp; &nbsp;“With a camera in hand, I am trying to rediscover my relationship with this place, with my past, navigating ideas of home and belonging tied to Manang,” he says. “Maybe home for me is no longer just a place, but this search for identity, memory and connection.” <h2>Life and Struggle of Garment Workers&nbsp;</h2> Taslima Akhter (Bangladesh)  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251113121128_9447434bde6d70048768c33dda8001e4e3f8da0718c8fff8f96970c4d69139ef.jpg" data-media-id="editor_4" data-image-id="20251113121128_9447434bde6d70048768c33dda8001e4e3f8da0718c8fff8f96970c4d69139ef" data-rendition-name="original" width="1200" height="800" loading="lazy" alt="The politics behind photographs NT"> <figcaption>Photo: TASLIMA AKHTER@Taslima Akhter</figcaption> </figure>  This project focuses on the millions of workers who leave their villages and move into crowded worker barracks in the cities of Bangladesh, in search of a better life. <h2>Between Us, a Thread&nbsp;</h2> Ahmed Alaqra (Ramallah)  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251113121128_805845728d6e1fd13539d5c0af35f202f72ffbfb8e7dd502cc3c44067e2b574f.jpg" data-media-id="editor_5" data-image-id="20251113121128_805845728d6e1fd13539d5c0af35f202f72ffbfb8e7dd502cc3c44067e2b574f" data-rendition-name="original" width="1200" height="800" loading="lazy" alt="The politics behind photographs NT"> <figcaption>Photo: RUBA ALFARAOUNA</figcaption> </figure>  A quiet gesture between photographers, image-makers, and those who hold memory like a fragile light. Palestinian, Arab, scattered — yet orbiting the same wound.&nbsp; <h2>Possible and Imaginary Lives&nbsp;</h2> yasmine eid-sabbagh / Rozenn Quéré  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251113121128_a30877e2c30764d5d29c0b0457e2722685138e968549dedd8803dee1299bc45c.jpg" data-media-id="editor_6" data-image-id="20251113121128_a30877e2c30764d5d29c0b0457e2722685138e968549dedd8803dee1299bc45c" data-rendition-name="original" width="1200" height="800" loading="lazy" alt="The politics behind photographs NT"> <figcaption>Photo Courtesy: YASMINE EID-SABBAGH AND ROZENN QUÉRÉ(Photo: ) </figcaption> </figure>  An exhibition, based on family photographs and taped interviews, tells the story of four strong and feisty Palestinian-Lebanese sisters, exiled to the four corners of the globe. <h2>Martyrs, Saints &amp; Sellouts&nbsp;</h2> Siona O’Connel (South Africa)  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251113121128_7b84f695bdd27353af1f35ff5f739283d739b4fa7594e4965ca1230d4d60940b.jpg" data-media-id="editor_7" data-image-id="20251113121128_7b84f695bdd27353af1f35ff5f739283d739b4fa7594e4965ca1230d4d60940b" data-rendition-name="original" width="1200" height="800" loading="lazy" alt="The politics behind photographs NT"> <figcaption>Photo: BENNY GOOL</figcaption> </figure>  Comprised of photographs by Benny Gool, Zubeida Vallie and Adil Bradlow, documenting apartheid South Africa, this exhibition presents a vivid narrative of violence, loss and injuries that continue to reverberate under the rhetoric of the post apartheid landscape. <h2>Humo, Semilla, Raíz</h2> Isadora Romero (Ecuador)  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251113121132_b01b94f340265fd42dcdffd98f39f58d3b1b3385718cb055d2b35e04fb1eda58.jpg" data-media-id="editor_8" data-image-id="20251113121132_b01b94f340265fd42dcdffd98f39f58d3b1b3385718cb055d2b35e04fb1eda58" data-rendition-name="original" width="1200" height="798" loading="lazy" alt="The politics behind photographs NT"> <figcaption>Photo: ISADORA ROMERO</figcaption> </figure>  An alternate look into environmental issues through the prism of possibility, instead of catastrophic consequence is what this exhibition brings. Romero’s visual research engages with how the loss of ancestral memory and Indigenous knowledge resulting from colonisation, forced displacement, and racism is causing seeds to disappear at an alarming rate. <h2>First week schedule (selected)</h2> Friday, 14 November Bhandarkhal Garden, Patan Museum, 5:30pm -7:30pm Festival Opening + Award of Excellence Saturday, 15 November Yala Maya Kendra, Patan Dhoka 3pm-4pm Demounting Louis Agassiz – Artistic Renegotiation of Archive, Memory &amp; Place. Talk by Sasha Huber (moderated by Diwas Raja Khatri) 4:30pm-6pm Witness or Accomplice: Photography, Human Rights and the Question of Freedom. Talk by Prof. Siona O’ Connell (moderated by NayanTara Gurung Kakshapati) Sunday, 16 November Yala Maya Kendra July, Unfinished. Jaheen Faruque Amin in conversation with Sabnam Lama, 3pm- 4pm When The World is Blind – Images by Palestinians. Ahmed Alaqra in conversation with yasmine eid-sabbagh, 4- 6pm Manga Hiti, 7pm-8pm Slideshow – Who Does The River Belong To? Monday, 17 November Yala Maya Kendra, 3pm - 4pm Memory is an Inaccurate Place: Dialogues Across Time, Territories, and Histories. Isadora Romero in conversation with Tanvi Mishra 4:30pm-6pm Third Camera – a Film Series: Ernest Cole: Lost and Found Dir. Raoul Peck 2024 | 1h 46m | English Tuesday, 18 November Yala Maya Kendra Sustaining Art Ecosystems That Resist and Nurture – Part 1 Paola Farran in conversation with Jessica Lim, 3pm- 4pm Sustaining Art Ecosystems That Resist and Nurture – Part 2 Chelsea Chua in conversation with Tif Ng, 4pm:30-6pm Khapinchhen, Patan A Photographer’s Fifty-Year Journey in Nepal. A Slideshow and Talk with Kevin Bubriski, 7-7:30pm PhotoKTM Bhoé, 7:30pm-9:30pm Rs1,800 (early bird), Rs2,000 (door sale) Wednesday, 19 November Yala Maya Kendra 3pm- 4pm Sustaining Art Ecosystems That Resist and Nurture – Part 3 Andrea Thal in conversation with Diwas Raja Khatri 4:30pm-6pm We must refuse silence! Samir Eskanda, Shahidul Alam, and Tabara Korka Ndiaye in conversation with yasmine eid-sabbagh Thursday, 20 November Nepal Art Council, 4pm- 6pm Walk-thru at NAC with Enuma Rai, Jyoti Shrestha, Karma Tshering Gurung, Manoj Bohara, Manjit Lama, Rejin Purja, Sujata Khadka, Sushila Bishwakarma More details <a href="https://photoktm.com/photoktm6-schedule/">here</a>. PHOTOKTM6 14 November-14 December Kathmandu Valley All events free and open