As a nurse, Anju Chaudhary has to often test the limits of her skills when dealing with <a href="https://www.nepalitimes.com/here-now/another-babys-life-is-saved-in-rural-nepal">complicated pregnancies</a> that arrive at the government hospital here in Katari.&nbsp; She is also the leader of a team of nurses who are on duty for 24 hours a day, seven days a week, caring for patients. Chaudhary has helped deliver over 1,000 babies and <a href="https://www.nepalitimes.com/banner/saving-nepali-mothers-and-babies-district-by-district">prevented the deaths of many mothers and newborns</a>. But no case was as challenging as that of Sharmila Surkheti. One morning in March, the 30-year-old Dalit woman arrived at the hospital, weak and bleeding profusely.&nbsp; “We had never seen a mother in such a near-death situation, but we were prepared, and we got into action immediately to save her life,” recalls Chaudhary. Surkheti had already been pregnant 13 times in her young life. All six of her newborns were delivered at home, and she had undergone seven abortions. Barely a year ago, she had another baby who died at childbirth. Read also: <a href="https://www.nepalitimes.com/here-now/who-will-save-nepal-s-poor-new-mothers">Who will save Nepal's poor new mothers?</a>, Rojita Adhikari This year, she decided to try to risk her own life to try for another son but there was post partum haemorrhage after the baby was born. Her husband helped get her to Katari Hospital while leaving behind the newborn. It was a two hour walk from home. There was no General Physician at the hospital that day so it was up to Chaudhary and her nurse team to save her life. A quick decision had to be made. They used the bundle approach in postpartum haemorrhage (PPH) management to control the bleeding. As a chronic anaemic patient, the mother had a low haemoglobin of only 6.1, which was alarming. To save her life, the nurses planned to take Surkheti to a better-equipped hospital in Gaighat but the family could not even afford transportation. Read also: <a href="https://www.nepalitimes.com/here-now/nepal-s-rural-lifeline">Nepal's rural lifeline</a>, Sonia Awale Her blood pressure dropped alarmingly low, and the nurses immediately created an emergency fund to pay for the private ambulance to reach Gaighat. She also needed blood transfusion, but Surkheti’s husband was malnourished and there were concerns about his health. The nurses then found a male colleague at the hospital who agreed to donate his blood. They closely monitored the mother, and her haemoglobin improved to 8.8. The hospital’s Acting Medical Superintendent, Dr. Gaurab Shah, an MD Pathologist, also put a lot of effort into managing a blood donor.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20230902040916_6d4eb5e618d116e1cbcc72776152080ad55f53e026f67be55044f350d2849c2e.png" data-media-id="editor_4" data-image-id="20230902040916_6d4eb5e618d116e1cbcc72776152080ad55f53e026f67be55044f350d2849c2e" data-rendition-name="original" width="2100" height="1500" loading="lazy" alt="Nurses in rural Nepal"> </figure>  The next day, the nurses gave her iron tablets, B complex, and vitamins and she was sent home. But during a post-natal home visit, the nurses were dismayed to see the utter poverty of the Surkheti’s family, including her husband and six children. Read also: <a href="https://www.nepalitimes.com/banner/this-is-how-to-upgrade-nepals-rural-health">This is how to upgrade Nepal's rural health</a>, Sewa Bhattarai Given her anaemic state and being very weak, Surkheti was unable to produce milk and had been feeding biscuits to her baby which worried the nurses. The family had no money to buy formula milk.&nbsp; So the nurses started collecting cash from their own pockets and started a fundraiser through online requests and on the phone. But there was very little response, and the six nurses put in their own money to save the mother and baby.&nbsp; “The greatest gift for me was to hear the words of gratitude from the mother who survived the ordeal,” says Chaudhary modestly. Despite her training as a <a href="https://www.nepalitimes.com/multimedia/saving-nepali-mothers-on-mother-s-day">Skilled Birth Attendant</a> that she had done many years ago, Chaudhary had no knowledge of uterine balloon tamponade, which can help in the treatment of PPH.&nbsp; After graduating from her nursing education, she was transferred to Bir Hospital where she never got the chance to work with mothers and babies, as she was too busy handling injuries and accidents in the emergency department. It was only after she moved back to Katari Hospital in Udaypur that her career path changed with the help of the non-profit <a href="https://www.nepalitimes.com/banner/what-can-be-more-fulfilling-than-saving-lives">One Heart Worldwide</a> (OHW). She received an invitation from OHW to attend its Simulation-based Mentorship Program in 2017 which allowed her to learn new skills. “I feel fortunate that my team was there to help Surkheti, and today, both she and her baby are healthy,” she says.&nbsp; Indeed, at a time when many Nepali nurses aim to migrate abroad the nation should be thankful for the dedication and passion of nurses like Anju Chaudhary.&nbsp;

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Saving one Nepali mother at a time

Nepali nurses gone and going to the UK

<img width="800" height="438" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20230228150236/63fe119b9c7e80680e0da4eajpeg.jpg" alt=""/>Nurse Sabita Gyawali goes to school bright and early as the first rays of the sun hit Mt Dhaulagiri to the north, and she gets to work right away. Shen the students start arriving, she checks that they follow cleanliness routines, and teaches them how to wash hands properly. She provides first-aid to those who need it, and is responsible for the students’ physical and mental health. But her main priority is to make sure that no student has brought junk food for lunch. In fact, she has prohibited packaged chips and noodles from the school grounds.   Gyawali has been a nurse for nine years, much of it at Kathmandu’s Sahid Gangalal National Heart Center. In 2019, she came to Baglung to work at Bidya Mandir Secondary school under the Health Ministry’s new 'One School, One Nurse' program.  Once there, Gywali designed the school’s lunch menu and already there has been a positive change in the eating habits of students – even teachers.  “Initially, students from elementary to high school would eat packaged store-bought lunch, she explains. “It was very difficult to wean the children off their junk food habit, but it is now under control.”The World Food Programme (WFP) has been managing school meals across Nepal for 45 years, and the government has been gradually assuming responsibility and expanding the project. Now, thanks to the initiative, students don’t go home for lunch anymore and attendance rates have increased, resulting in fewer dropouts.However, there are challenges. The Rs15 per student charge for lunch is beyond the means of some students who have working parents, or are in single parent households, and there is not enough time to bring a tiffin box.  For some students, this means coming to school on empty stomachs. For others, it was cheaper and more convenient to buy quick-and-easy junk food.  <img width="1350" height="2400" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20230228150236/63fe119e9c7e80680e0da4ebjpeg.jpg" alt="">“The budget provided by the government was low enough that only little snacks or small meals used to be served," notes Gyawali, who then came up with a lunch menu that would fit the budget.And while the school lunch menus made by the government might be applicable to rural schools, they do not work for public schools in urban areas with the same budget.The other problem is not having enough nurses. There are 82 public schools within Baglung Municipality, out of which only five secondary schools have nurses. <img width="1232" height="693" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20230228150236/63fe11a19c7e80680e0da4ecjpeg.jpg" alt="">Ram Prasad Khanal, the head of the municipality's health department, says that the municipality has asked the state government to appoint nurses to all the schools. “Every school that has a nurse has shown positive growth,” notes Khanal.At Bageshwari Secondary School in Bhaktapur’s Chyamasing, students have stopped consuming junk food for lunch due to the efforts of nurse Sajina Manandhar. “It is very difficult to take students off instant noodles, but we have managed to do it.”The ‘One School, One Nurse’ program is run by the Nursing and Social Security Division under Nepal’s Department of Health Services (DoHS) and aims to  encourage children to have a balanced diet and improved hygiene. The program also supports adolescent sexual and reproductive health, as well as mental health.“The school nurse program has brought about a noticeable improvement in nutrition-related problems, mental health, menstrual health, and even school dropout issues,” says Bala Rai, a senior hospital nursing administrator at the Nursing and Social Security Division.But there is a long way to go. So far, only about 1,000 schools out of 10,644 public secondary schools nationwide have appointed school nurses.The DoHS measures nutrition impact through 'anthropometry' — measuring the heights and weights of children to determine whether or not they are malnourished. A recent Demographic Health Survey (DHS) revealed that 25% of children under five have stunted growth while 8% are underweight as compared to 36% and 10% respectively in 2016.There is improvement, but more can be done, and the government has set a target to reduce the growth stunt down to 15% by 2030.   <img width="800" height="450" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20230228150236/63fe11a59c7e80680e0da4edjpeg.jpg" alt="">The survey also revealed the program, which involves nurses also making home visits, has been instrumental in identifying children who have learning disorders, mental health issues, or those who have been victims of domestic violence. Illnesses have been identified and reported to hospitals, and it has also become easier to educate adolescents about sexual and reproductive health."We have appointed health-in-charges to each class so that students feel comfortable speaking to and about themselves,” explains Sajina Manandhar. “We continuously meet with those in charge, and provide them information related to reproductive health and family planning.”Nurse Anamika Sharma says that the number of girls who miss school while having their period has gone down by 90% since she began working as a school nurse, largely because it is easier for female students to ask for pads at school. Menstrual health counseling is also more readily available.Binu Kakshapati is the School Nurse Focal Person of Bagmati Province, and says the attendance of female students has gone up since the province began distributing pads in public schools. “Students have started to become more open to using pads since the government started distributing them in Bagmati,” she adds.In some schools, nurses even fill in when a math or science teacher is absent. Bala Rai says she had to send a circular to the local units to ask them to stop forcing nurses to do jobs that they are not there to do.Translated from the Himal Khabar <a href="https://www.himalkhabar.com/news/133436" data-saferedirecturl="https://www.google.com/url?q=https://www.himalkhabar.com/news/133436&amp;source=gmail&amp;ust=1676366852671000&amp;usg=AOvVaw2z3rWSO2Xmif-YMO_MB9wL">original</a> by Shristi Karki.

Nurses ensure nutrition for Nepal’s children

<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111414114/63723d469c7e80680e0c9667jpeg.jpg" alt="" width="1882" height="1248"/>Nepal’s agreement in August to supply an initial 100 nurses to Britain with an option for several thousand more in future was followed by <a href="https://www.theguardian.com/politics/2022/sep/25/plan-to-recruit-nepal-nurses-for-nhs-puts-them-at-risk-of-exploitation" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.theguardian.com/politics/2022/sep/25/plan-to-recruit-nepal-nurses-for-nhs-puts-them-at-risk-of-exploitation&amp;source=gmail&amp;ust=1667191551913000&amp;usg=AOvVaw0jEsiELAF23WOoR1iMe-Q0">debate in both countries</a> about the pros and cons of the deal.Nursing workforce managers and researchers in Nepal, Britain and in international agencies have drawn attention to the fact that the nurses are being diverted from greater need back home to fulfil the UK's shortfall. But there is support for Britain's international recruitment of healthcare professionals from nursing colleges in Nepal and the <a href="https://www.nepalitimes.com/here-now/new-uk-options-for-nepali-chefs-and-nurses/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/new-uk-options-for-nepali-chefs-and-nurses/&amp;source=gmail&amp;ust=1667191551913000&amp;usg=AOvVaw00lunMQfm5PaWjBAuKTKwL">global aspirations of nurses themselves</a>.Presently, the UK faces a considerable shortfall in the hiring and retention of student nurses. Scotland has <a href="https://www.bbc.com/news/uk-scotland-62985343" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.bbc.com/news/uk-scotland-62985343&amp;source=gmail&amp;ust=1667191551913000&amp;usg=AOvVaw2uoO5Ht7E0kSxSASuPVAS7">not been able to meet its student nurse recruitment targets</a>, with a gap this year of over 700 student candidates. This means Scotland alone will be short of 700 nurses in three years’ time, when the current intake of students graduates. Furthermore, the student dropout rate is currently around 25%.Across Britain, by the time the current cohort graduates there will already not be enough nurses in the UK labour market even without the previous shortfall. And there are said to be vacancies for up to 50,000 health professionals in the NHS with the post-Brexit departure of East European staffers.Britain therefore has very little choice but to recruit nurses from other countries. In the past nurses have been hired from English-speaking countries with weaker economies like the Philippines or India (see graph).<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111414114/63723d499c7e80680e0c9668jpeg.jpg" alt="" width="2044" height="1310">British nurse recruitment policy now displays little concern for source countries’ workforce situations, and of World Health Organization’s ethical recruitment guidelines which bars hiring medical workforce from ‘red list’ countries that do not have sufficient nurses and doctors for their own populations. But the staffing gap is so serious that countries like the UK, Japan, the <a href="https://www.nepalitimes.com/here-now/overseas-nepalis-on-the-covid-19-frontlines/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/overseas-nepalis-on-the-covid-19-frontlines/&amp;source=gmail&amp;ust=1667191551913000&amp;usg=AOvVaw1BVT7aW5dfuYKp8X5LHeH_">United States,</a> Canada, <a href="https://www.nepalitimes.com/here-now/demand-grows-for-nepali-caregivers-in-israel/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/demand-grows-for-nepali-caregivers-in-israel/&amp;source=gmail&amp;ust=1667191551913000&amp;usg=AOvVaw2OzwZhw_Mum2Z_ml8roKHV">Israel</a> and other European countries are competing to attract health professionals, disregarding the WHO guideline.For Nepal, the situation is just the opposite. There is no shortage of nursing students considering a professional education. And as a result of increased nursing education capacity, there are more students successfully graduating than Nepal’s hospitals can employ. Unlike the UK, there is no major concern about student dropout rates in Nepal, and most nursing students complete their education and graduate.Then there is also the push-factor of low starting salaries back home that makes overseas work attractive. Many nursing graduates struggle to find suitable employment within Nepal. For them international jobs are the best option. In fact, a majority of nursing students in Nepal are pursuing their studies with the sole focus on emigration.Given the lack of a clear and appropriate migration pathways to the international labour market, Nepali nurses are going abroad as students to further their education. The number of nurses taking this route is much higher than those going abroad directly as employees.Because of the lack of safe and effective avenues for Nepali nurses to get jobs abroad, including in the UK, recruitment agencies in Kathmandu have found this a lucrative option. They are known to collude with international nurse recruiters to exploit nurses whose desperation to earn more makes them vulnerable.The laws of supply and demand mean that this happens not only in Nepal and the UK, but globally. Migrant nurses seeking employment, or further education abroad, often fall victim to recruiters who charge exorbitant fees from nurses yearning to leave their home country.To break this vicious cycle, there is an urgent need to create transparent and fair employment options for Nepali nurses for the UK's NHS.The UK for its part should improve the working terms and conditions for all of its nurses, including retention of its own nursing students.Nepal must also have a proper workforce plan in place, and create gainful employment for its own graduate nurses at home.  Indeed, improving the recruitment and retention of nursing workforces should be a top priority for all developing countries supplying health professionals to well-off ones.Countries like Nepal need to improve  investment in the health sector if they are to provide Universal Health Coverage by 2030, which is a Sustainable Development Goal of the United Nations of which Nepal is a signatory.Radha Adhikari is a Lecturer in School of Health and Life Sciences, at the University of the West of Scotland, and has published extensively on international nurse migration and global health workforce challenges. Her latest research monograph, Migrant health professionals and the global labour market: the dreams and traps of Nepali nurses, was published in 2019, by <a href="https://www.taylorfrancis.com/books/9780429325731">Routledge</a>.Read more: <a href="https://nepalitimes.com/here-now/new-uk-options-for-nepali-chefs-and-nurses/">New UK job options for Nepalis</a>,  Upasana Khadka

Radha Adhikari

Nepali nurses now Britain-bound

<figure><img width="957" height="638" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111152/636b866b9c7e80680e067852jpeg.jpg" alt=""/><figcaption>Photo: BIKRAM RAI</figcaption></figure>On 20 May, the Health Ministry released a condolence message for doctors including Ishwor Lal Acharya, Mukesh Chaudhary and Pujya Shree Karki who lost their lives to Covid-19.Nepal doesn't yet have an exact figure on the total number of <a href="https://www.nepalitimes.com/here-now/protecting-those-who-protect-us-from-the-epidemic/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/protecting-those-who-protect-us-from-the-epidemic/&amp;source=gmail&amp;ust=1622085873678000&amp;usg=AFQjCNE67Zklb3ITwY-EN9ZPs4LRP2MFtQ">medical staff</a> infected by the SARS-CoV-2 but the Nepal Health Research Council (NHRC) is currently conducting a study to find out. “Majority of our frontline health care provides have been fully vaccinated, so even if they are being infected, they are only mild to moderately sick,” says cardiologist and chair of the Nepal Medical Council (NMC) <a href="https://www.facebook.com/bhagawan.koirala" data-saferedirecturl="https://www.google.com/url?q=https://www.facebook.com/bhagawan.koirala&amp;source=gmail&amp;ust=1622085873678000&amp;usg=AFQjCNEOs-qwziT36jBSTwwrTvDCe4MA1A">Bhagawan Koirala.</a> “This combined with a better understanding of Covid-19, they are now more confident and have a better sense of responsibility this time around.”At the National Trauma Centre in Kathmandu, nursing staff Suman Chaudhary is back to work after recovering from the coronavirus herself and draws motivation from health workers who are battling the pandemic in major hotspots like Birganj.“This is our chance to make a real contribution and having been infected myself has given me a new perspective on how patients feel,” says Chaudhary who was pursuing Masters in Nursing at Bir Hospital during the first wave. “It is difficult to work in a PPE all day without water or bathroom breaks. I still feel weak and have shortness of breath, but watching people recover keeps us going.”Both Koirala and Chaudhary, however, agree that there is a <a href="https://www.nepalitimes.com/here-now/nepals-frontline-workers-brave-it-out/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/nepals-frontline-workers-brave-it-out/&amp;source=gmail&amp;ust=1622085873678000&amp;usg=AFQjCNG1eSnzgkQ-VmoauOQrzkj_c0eUzA">chronic shortage of medical staff</a> across the country. Hospitals outside Kathmandu and even Covid dedicated institutions are overstretched, and now doctors and nurses are themselves falling sick. In some hospitals, since patients and staff are all positive, nurses and doctors with mild symptoms have just kept working, since there is no one else to take care of the sick.Last week, more than 47 of Dhading District Hospital’s emergency and ward staff were infected with Covid-19, with many of them in isolation and some requiring ICU treatment even as the facility was finding it difficult to source enough <a href="https://www.nepalitimes.com/latest/why-is-there-still-an-oxygen-shortage/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/why-is-there-still-an-oxygen-shortage/&amp;source=gmail&amp;ust=1622085873678000&amp;usg=AFQjCNGkShQk2X-gpsUuQceFplgqsL0bSg">oxygen for existing patients</a>.“We are a hospital of only 8 doctors, 5 paramedics and 23 nurses and with no backup, we were very close to collapsing,” says Medical Superintendent at Dhading District Hospital Tribhuvan Jha, adding that everyone had to be called back to work after 10 days of isolation. “We are in this position due to a lack of preparedness, shortage of staff and limited infrastructure.”At Charikot Hospital in Dolakha, which is also a Covid-dedicated hospital, the majority of coronavirus patients are critical and there is at least one fatality every day. The 17 nurses work three shifts a day, and are unable to handle patient inflow, so the hospital has brought in community nurses from outlying villages. The hospital is consistently reporting a 45% test positivity rate among those tested.“If a majority of our health workers get infected and are in isolation, we have no Plan B and this is especially worrying because we are the sole care provider for Covid here,” says Binod Dangal of Charikot Hospital. “Medical staff are all  overworked, and they do not have any insurance or allowances.”As dire as the situation is in Nepal’s big cities and district hospitals, the <a href="https://www.nepalitimes.com/editorial/nepals-humanitarian-emergency/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/editorial/nepals-humanitarian-emergency/&amp;source=gmail&amp;ust=1622085873678000&amp;usg=AFQjCNE3z3JV_9xnJ0reDy2ABkI8VuY16A">pandemic has now infiltrated rural Nepal</a> where there is just one doctor for every 15,000 people. Kathmandu’s doctor-to-patient ratio is 1:850.In her village of Phediguth of Okhaldhunga district, <a href="https://www.nepalitimes.com/banner/saving-nepali-mothers-on-mothers-day/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/banner/saving-nepali-mothers-on-mothers-day/&amp;source=gmail&amp;ust=1622085873678000&amp;usg=AFQjCNErggt96LmoW-c38IzduDUsayQwIg">Rita Khatri</a> is the only skilled birth attendant. Despite the growing risk of the second wave, she is still performing deliveries and ante-natal check-ups wearing a mask and her single PPE suit. There are no tests of health workers and the public.“We are working despite fears of transmission, I wish we had more PPEs, masks and gloves so that we could conduct more regular check-ups and make home visits,” adds Khatri. “At the moment many people in the community have high fever and are staying at home, but there is no way to test them.” This time last year while in the grip of the first wave of a new pandemic, there was stigma associated with Covid-19 and people who were infected were ostracised in the community. There were many instances where <a href="https://www.nepalitimes.com/here-now/nepal-health-workers-battle-covid-19-but-also-stigma/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/nepal-health-workers-battle-covid-19-but-also-stigma/&amp;source=gmail&amp;ust=1622085873678000&amp;usg=AFQjCNECgLl_SyeWRy6kuDEPnEbsSFoCyQ">healthcare providers were mistreated</a>.Doctors and nurses interviewed for this report say that is still the case, but there is also more praise for frontline medical workers risking their own health to save lives. However, there is growing concern about the worry and over-work affecting the mental health of nurses and doctors.“Among other things we need psychological support and counselling. I have seniors who have children infected with the new variant, and they are having a hard time coping,” says Suman Chaudhary, nursing staff at the Trauma Centre in Kathmandu.As most of Nepal enters the fourth week of lockdown, nationwide daily Covid-19 infections, positivity rate as well as fatalities are going down slightly. The number of recoveries have also risen to nearly equal new confirmed cases on some days.Bayalpata Hospital in remote Accham District had to turn its Emergency Room into a Covid-19 ward last month to cope with a flood of patients. It had 33 patients, 18 of them needing high flow oxygen support. On Wednesday, it had only 12 Covid-19 patients with only two on oxygen. Four of those infected are medical staff. “The situation is easing somewhat here, in Mangalsen, Doti and Dadeldhura. There are beds available, and oxygen is coming in. But we are desperately short of medical staff,” says Mandeep Pathak, a physician at Bayalpata which is also caring for trauma and maternity patients from surrounding districts.However, the cases and the test positivity rate <a href="https://www.nepalitimes.com/here-now/its-an-emergency/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/its-an-emergency/&amp;source=gmail&amp;ust=1622085873678000&amp;usg=AFQjCNHx4NfPYsEDb5xqY31L966E2avOdg">have not gone down as expected</a> and fatalities nationwide have stayed above 160 for nearly two weeks now as the highly contagious and more lethal B.1.617.2 variant spreads rapidly through communities.Health Minister Hridayesh Tripathi sounded optimistic at a virtual press meet on Monday, predicting that there would be a decline in the infection rate in the next four weeks. As Nepal receives large shipments of oxygen cylinders, liquid oxygen, test kits, PPEs and masks, doctors say the emphasis now needs to shift to more testing, mass vaccination, and replenishing exhausted and over-stretched medical staff at hospitals, both in the cities and the districts. A non-profit One Heart Worldwide that works primarily in maternal care in Nepal’s 21 districts has been helping district hospitals by mobilising oxygen cylinders and medical kits it procured from China.<a href="https://www.nepalitimes.com/banner/what-can-be-more-fulfilling-than-saving-lives/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/banner/what-can-be-more-fulfilling-than-saving-lives/&amp;source=gmail&amp;ust=1622085873678000&amp;usg=AFQjCNFzGOK8F0-jy4gwuRmK8iyNBD7AIA">Executive director Surya Bhatta</a> gives three reasons why despite the lockdown the infection rate is still high. “There is virtually no contact tracing, people are still not following health protocols and patients isolating at homes are not doing it right, resulting in a gross underestimation of total cases and fatalities.”		
			<h2>Weddings into hotspots</h2>		
		Gopal Dahal in DhankutaOn 30 April, when a young man in Okhre village in Dhankuta district got married, the whole . The whole community was invited for the feast.But a few days later, the groom suddenly fell sick. When he showed coronavirus symptoms, a test at the primary health care centre confirmed he was <a href="https://www.nepalitimes.com/here-now/its-an-emergency/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/its-an-emergency/&amp;source=gmail&amp;ust=1622085873678000&amp;usg=AFQjCNHx4NfPYsEDb5xqY31L966E2avOdg">Covid-19</a> positive.Now, every household in Okhre village has members showing similar symptoms. Most of them had attended the wedding. Of the 51 people tested, 25 tested positive. “This is a crisis, the pandemic has spread to the whole village now,” says Ward Chair Palak Basnet.One of the guests at the wedding was a man who had returned recently from the Tarai with mild symptoms. He was hired to wash dishes at the wedding, and had died a few days after the feast. No one tried to find the cause of death, and there was no PCR test done. Dhankuta MP Jitendra Rumdali Rai says there are probably many more cases than the ones who have tested positive so far. “The pandemic is spreading out of control here because the municipality wasn’t able to manage it on time,” he adds.Okhre village has now been sealed off till 8 June. Some of those infected are in critical condition, and six who were more serious were taken to hospital in Dharan. It is difficult for the others because the municipality does not have an ambulance, and some who had taken sick relatives to Dharan returned because there were no beds, or it was too expensive. “Initially they were charging Rs10,000 per day for the bed and we paid Rs4,000 daily for the doctor. But then they hiked it to Rs14,700 and I couldn’t pay it any more,” says one patient’s family who returned recently from Dharan’s Bijayapur Hospital.Another <a href="https://www.nepalitimes.com/latest/rural-nepal-fights-back-covid-19/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/rural-nepal-fights-back-covid-19/&amp;source=gmail&amp;ust=1622085873679000&amp;usg=AFQjCNHu0t7Yl9XzW-TA064jBcggx4L-TA">coronavirus</a> patient says ambulances are also expensive, making it hard to get patients to hospitals. Buses refuse to take passengers who are sick.The municipality called an emergency all-party meeting and decided to set up a 10-bed isolation centre with two staff nurses, and a doctor. Talks are underway to get at least a pickup from Dhankuta Red Cross to use as an ambulance.

Sonia Awale

Protecting those who protect us from Covid

<figure><img width="957" height="638" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131128/636cee759c7e80680e09ae2fjpeg.jpg" alt=""/><figcaption>Photo: BIKRAM RAI</figcaption></figure>On 20 May, the Health Ministry released a condolence message for doctors including Ishwor Lal Acharya, Mukesh Chaudhary and Pujya Shree Karki who lost their lives to Covid-19.Nepal doesn't yet have an exact figure on the total number of <a href="https://www.nepalitimes.com/here-now/protecting-those-who-protect-us-from-the-epidemic/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/protecting-those-who-protect-us-from-the-epidemic/&amp;source=gmail&amp;ust=1622085873678000&amp;usg=AFQjCNE67Zklb3ITwY-EN9ZPs4LRP2MFtQ">medical staff</a> infected by the SARS-CoV-2 but the Nepal Health Research Council (NHRC) is currently conducting a study to find out. “Majority of our frontline health care provides have been fully vaccinated, so even if they are being infected, they are only mild to moderately sick,” says cardiologist and chair of the Nepal Medical Council (NMC) <a href="https://www.facebook.com/bhagawan.koirala" data-saferedirecturl="https://www.google.com/url?q=https://www.facebook.com/bhagawan.koirala&amp;source=gmail&amp;ust=1622085873678000&amp;usg=AFQjCNEOs-qwziT36jBSTwwrTvDCe4MA1A">Bhagawan Koirala.</a> “This combined with a better understanding of Covid-19, they are now more confident and have a better sense of responsibility this time around.”At the National Trauma Centre in Kathmandu, nursing staff Suman Chaudhary is back to work after recovering from the coronavirus herself and draws motivation from health workers who are battling the pandemic in major hotspots like Birganj.“This is our chance to make a real contribution and having been infected myself has given me a new perspective on how patients feel,” says Chaudhary who was pursuing Masters in Nursing at Bir Hospital during the first wave. “It is difficult to work in a PPE all day without water or bathroom breaks. I still feel weak and have shortness of breath, but watching people recover keeps us going.”Both Koirala and Chaudhary, however, agree that there is a <a href="https://www.nepalitimes.com/here-now/nepals-frontline-workers-brave-it-out/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/nepals-frontline-workers-brave-it-out/&amp;source=gmail&amp;ust=1622085873678000&amp;usg=AFQjCNG1eSnzgkQ-VmoauOQrzkj_c0eUzA">chronic shortage of medical staff</a> across the country. Hospitals outside Kathmandu and even Covid dedicated institutions are overstretched, and now doctors and nurses are themselves falling sick. In some hospitals, since patients and staff are all positive, nurses and doctors with mild symptoms have just kept working, since there is no one else to take care of the sick.Last week, more than 47 of Dhading District Hospital’s emergency and ward staff were infected with Covid-19, with many of them in isolation and some requiring ICU treatment even as the facility was finding it difficult to source enough <a href="https://www.nepalitimes.com/latest/why-is-there-still-an-oxygen-shortage/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/why-is-there-still-an-oxygen-shortage/&amp;source=gmail&amp;ust=1622085873678000&amp;usg=AFQjCNGkShQk2X-gpsUuQceFplgqsL0bSg">oxygen for existing patients</a>.“We are a hospital of only 8 doctors, 5 paramedics and 23 nurses and with no backup, we were very close to collapsing,” says Medical Superintendent at Dhading District Hospital Tribhuvan Jha, adding that everyone had to be called back to work after 10 days of isolation. “We are in this position due to a lack of preparedness, shortage of staff and limited infrastructure.”At Charikot Hospital in Dolakha, which is also a Covid-dedicated hospital, the majority of coronavirus patients are critical and there is at least one fatality every day. The 17 nurses work three shifts a day, and are unable to handle patient inflow, so the hospital has brought in community nurses from outlying villages. The hospital is consistently reporting a 45% test positivity rate among those tested.“If a majority of our health workers get infected and are in isolation, we have no Plan B and this is especially worrying because we are the sole care provider for Covid here,” says Binod Dangal of Charikot Hospital. “Medical staff are all  overworked, and they do not have any insurance or allowances.”As dire as the situation is in Nepal’s big cities and district hospitals, the <a href="https://www.nepalitimes.com/editorial/nepals-humanitarian-emergency/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/editorial/nepals-humanitarian-emergency/&amp;source=gmail&amp;ust=1622085873678000&amp;usg=AFQjCNE3z3JV_9xnJ0reDy2ABkI8VuY16A">pandemic has now infiltrated rural Nepal</a> where there is just one doctor for every 15,000 people. Kathmandu’s doctor-to-patient ratio is 1:850.In her village of Phediguth of Okhaldhunga district, <a href="https://www.nepalitimes.com/banner/saving-nepali-mothers-on-mothers-day/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/banner/saving-nepali-mothers-on-mothers-day/&amp;source=gmail&amp;ust=1622085873678000&amp;usg=AFQjCNErggt96LmoW-c38IzduDUsayQwIg">Rita Khatri</a> is the only skilled birth attendant. Despite the growing risk of the second wave, she is still performing deliveries and ante-natal check-ups wearing a mask and her single PPE suit. There are no tests of health workers and the public.“We are working despite fears of transmission, I wish we had more PPEs, masks and gloves so that we could conduct more regular check-ups and make home visits,” adds Khatri. “At the moment many people in the community have high fever and are staying at home, but there is no way to test them.” This time last year while in the grip of the first wave of a new pandemic, there was stigma associated with Covid-19 and people who were infected were ostracised in the community. There were many instances where <a href="https://www.nepalitimes.com/here-now/nepal-health-workers-battle-covid-19-but-also-stigma/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/nepal-health-workers-battle-covid-19-but-also-stigma/&amp;source=gmail&amp;ust=1622085873678000&amp;usg=AFQjCNECgLl_SyeWRy6kuDEPnEbsSFoCyQ">healthcare providers were mistreated</a>.Doctors and nurses interviewed for this report say that is still the case, but there is also more praise for frontline medical workers risking their own health to save lives. However, there is growing concern about the worry and over-work affecting the mental health of nurses and doctors.“Among other things we need psychological support and counselling. I have seniors who have children infected with the new variant, and they are having a hard time coping,” says Suman Chaudhary, nursing staff at the Trauma Centre in Kathmandu.As most of Nepal enters the fourth week of lockdown, nationwide daily Covid-19 infections, positivity rate as well as fatalities are going down slightly. The number of recoveries have also risen to nearly equal new confirmed cases on some days.Bayalpata Hospital in remote Accham District had to turn its Emergency Room into a Covid-19 ward last month to cope with a flood of patients. It had 33 patients, 18 of them needing high flow oxygen support. On Wednesday, it had only 12 Covid-19 patients with only two on oxygen. Four of those infected are medical staff. “The situation is easing somewhat here, in Mangalsen, Doti and Dadeldhura. There are beds available, and oxygen is coming in. But we are desperately short of medical staff,” says Mandeep Pathak, a physician at Bayalpata which is also caring for trauma and maternity patients from surrounding districts.However, the cases and the test positivity rate <a href="https://www.nepalitimes.com/here-now/its-an-emergency/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/its-an-emergency/&amp;source=gmail&amp;ust=1622085873678000&amp;usg=AFQjCNHx4NfPYsEDb5xqY31L966E2avOdg">have not gone down as expected</a> and fatalities nationwide have stayed above 160 for nearly two weeks now as the highly contagious and more lethal B.1.617.2 variant spreads rapidly through communities.Health Minister Hridayesh Tripathi sounded optimistic at a virtual press meet on Monday, predicting that there would be a decline in the infection rate in the next four weeks. As Nepal receives large shipments of oxygen cylinders, liquid oxygen, test kits, PPEs and masks, doctors say the emphasis now needs to shift to more testing, mass vaccination, and replenishing exhausted and over-stretched medical staff at hospitals, both in the cities and the districts. A non-profit One Heart Worldwide that works primarily in maternal care in Nepal’s 21 districts has been helping district hospitals by mobilising oxygen cylinders and medical kits it procured from China.<a href="https://www.nepalitimes.com/banner/what-can-be-more-fulfilling-than-saving-lives/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/banner/what-can-be-more-fulfilling-than-saving-lives/&amp;source=gmail&amp;ust=1622085873678000&amp;usg=AFQjCNFzGOK8F0-jy4gwuRmK8iyNBD7AIA">Executive director Surya Bhatta</a> gives three reasons why despite the lockdown the infection rate is still high. “There is virtually no contact tracing, people are still not following health protocols and patients isolating at homes are not doing it right, resulting in a gross underestimation of total cases and fatalities.”		
			<h2>Weddings into hotspots</h2>		
		Gopal Dahal in DhankutaOn 30 April, when a young man in Okhre village in Dhankuta district got married, the whole . The whole community was invited for the feast.But a few days later, the groom suddenly fell sick. When he showed coronavirus symptoms, a test at the primary health care centre confirmed he was <a href="https://www.nepalitimes.com/here-now/its-an-emergency/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/its-an-emergency/&amp;source=gmail&amp;ust=1622085873678000&amp;usg=AFQjCNHx4NfPYsEDb5xqY31L966E2avOdg">Covid-19</a> positive.Now, every household in Okhre village has members showing similar symptoms. Most of them had attended the wedding. Of the 51 people tested, 25 tested positive. “This is a crisis, the pandemic has spread to the whole village now,” says Ward Chair Palak Basnet.One of the guests at the wedding was a man who had returned recently from the Tarai with mild symptoms. He was hired to wash dishes at the wedding, and had died a few days after the feast. No one tried to find the cause of death, and there was no PCR test done. Dhankuta MP Jitendra Rumdali Rai says there are probably many more cases than the ones who have tested positive so far. “The pandemic is spreading out of control here because the municipality wasn’t able to manage it on time,” he adds.Okhre village has now been sealed off till 8 June. Some of those infected are in critical condition, and six who were more serious were taken to hospital in Dharan. It is difficult for the others because the municipality does not have an ambulance, and some who had taken sick relatives to Dharan returned because there were no beds, or it was too expensive. “Initially they were charging Rs10,000 per day for the bed and we paid Rs4,000 daily for the doctor. But then they hiked it to Rs14,700 and I couldn’t pay it any more,” says one patient’s family who returned recently from Dharan’s Bijayapur Hospital.Another <a href="https://www.nepalitimes.com/latest/rural-nepal-fights-back-covid-19/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/rural-nepal-fights-back-covid-19/&amp;source=gmail&amp;ust=1622085873679000&amp;usg=AFQjCNHu0t7Yl9XzW-TA064jBcggx4L-TA">coronavirus</a> patient says ambulances are also expensive, making it hard to get patients to hospitals. Buses refuse to take passengers who are sick.The municipality called an emergency all-party meeting and decided to set up a 10-bed isolation centre with two staff nurses, and a doctor. Talks are underway to get at least a pickup from Dhankuta Red Cross to use as an ambulance.

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109191120/636bef674b0ad905ca02efa6jpeg.jpg" alt="" width="1200" height="708"/><figcaption>105-year-old Chandra Kumari Joshi after beating the coronavirus. All photos: JOSHI FAMILY</figcaption></figure>Six weeks ago, the live-in nurse who takes care of my<a href="https://www.nepalitimes.com/here-now/who-runs-the-world-girls/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/who-runs-the-world-girls/&amp;source=gmail&amp;ust=1608281673384000&amp;usg=AFQjCNEXylkJd6i9QhI2aGHlWa-nof2rmA"> 105-year-old grandmother-in-law (Muwa)</a> fell ill. She had developed cold-like symptoms and a headache, but not a fever. After she went back home for Tihar, Muwa developed a dry cough, but no fever.She began to take cough medicine, but we also applied every home remedy, steam treatments, turmeric water, honey, ginger, what have you. The fact that this could be indicative of Covid did not even cross my mind because I still somehow believed that having the coronavirus meant high fever. On the third day, Muwa’s cough got better.But then I developed a fever the day before भाइ टिका on 16 November and isolated immediately. I could only  get tested the day after Tihar, and the next day my husband developed a fever as well. My report came back positive 24 hours later, and all other seven members in our house -- including my grandmother-in-law--tested positive.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109191120/636bef6a4b0ad905ca02efa7jpeg.jpg" alt="" width="440" height="681"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109191120/636bef6b4b0ad905ca02efa8jpeg.jpg" alt="" width="418" height="681">The news of Muwa at her age testing positive was chilling. We had taken every possible precaution, ensured every measure to keep her safe. So the coming days were filled with worry.However, if we could look for a silver lining during this ordeal, it was that we did not need to follow strict measures of isolation, since everyone in our household had tested positive. We had been worrying about making different sleeping, cooking, and bathroom arrangements while we were waiting for all our results to come back, but that was not necessary anymore.So we shut the front gate, and sealed ourselves from the world. No one was allowed in or out. Our daughter and my sister-in-law had left enough essentials on our doorstep to last the duration of our isolation.Of the eight people in our home, my husband and I were the only ones who developed a fever, the others all had only mild symptoms. But while my fever peaked at 100°F, my husband, who is diabetic, had a high fever right from the start. When his oxygen level began to drop, he had to be admitted to hospital where he stayed for two weeks, completing a course of steroid and antibiotic treatments for secondary lung infection.It was an extremely stressful time back at home. On one hand, I worried about my husband alone in the hospital. On the other, I worried over what to tell his grandmother whenever she asked about her grandson.One day, Muwa said, “It’s so lonely here with just you and me.” Maybe she realised that it would just be the two of us in that family from now onwards. So when her grandson returned home after two weeks in hospital, she exclaimed in relief, “Finally, I can see you like this.”<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109191120/636bef6d4b0ad905ca02efa9jpeg.jpg" alt="" width="640" height="952"><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109191120/636bef704b0ad905ca02efaajpeg.jpg" alt="" width="900" height="544"><figcaption>Chandra Kumari Joshi sees her grandson, who recovered from Covid-19 after a hospital stay.</figcaption></figure>Muwa likes to watch the tv news every day, and when she asks, “What happened today?”. She wants us to know how many people died of Covid-19 that day, and we give her the figure.Muwa often asks when her great-grandchildren, who live abroad, are going to come back home. We told her that planes were not flying because the pandemic was spreading all over the world. But since the lockdown was lifted and flights resumed, she sits on the terrace and keenly watches the planes fly by.Some days she notices that there were very few planes. Other days, she muses, “Quite a lot of flights today.” The planes in the sky have become symbols of hope for her to be reunited with her family one day.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109191120/636bef734b0ad905ca02efabjpeg.jpg" alt="" width="900" height="438"><figcaption>Chandra Kumari Joshi meets her great-great granddaughter a month after testing positive for the coronavirus.</figcaption></figure>Muwa lost her only daughter-in-law, <a href="https://www.nepalitimes.com/here-now/who-runs-the-world-girls/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/who-runs-the-world-girls/&amp;source=gmail&amp;ust=1608281673384000&amp;usg=AFQjCNEXylkJd6i9QhI2aGHlWa-nof2rmA">Angurbaba Joshi, </a>during the pandemic. A month after her passing, she lost her sister Binda Shakya with whom she was very close. We broke the news of her passing two months later when Muwa began to ask why her sister had not been visiting.One day, as she was expressing her annoyance over Binda Didi’s continued absence, without thinking I said, “She can’t come anymore.” She immediately asked, “Why? Is she dead?” I answered, “Yes.”<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109191120/636bef754b0ad905ca02efacjpeg.jpg" alt="" width="1500" height="1094">Muwa was inconsolable over the next three weeks. She has begun to forget a lot of things, but she has not forgotten that her sister has passed. In her grief, she has started to reconcile with her own mortality. “My time has come, this is it,” she said one day.The grief of her having outlived  all of her younger siblings, a son, a daughter-in-law, and other loved ones shows clearly on her face. Sometimes, she sees her own longevity as a  curse. “Why hasn’t god taken me away yet?” she asks.Muwa overcame ‘Karuna’ (what she calls the coronavirus, and a Sanskrit word that means ‘compassion’) better than any of us. The doctors have always told us that her lungs and her heart are as healthy as a young woman’s. Her immune system is strong, perhaps from the clean and fresh surroundings and food she grew up with. She has hardened, enduring  a great deal in life, as a child widow, and as an old woman who has seen many loved ones pass on.Muwa’s mental fortitude is a testament to the fact that she is still here with us. Her memories may be blurred, but she is not inactive and silent, and will never be.

How a 105-year-old beat the virus

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181148/636be8749c7e80680e08785djpeg.jpg" alt="" width="1200" height="708"/><figcaption>105-year-old Chandra Kumari Joshi after beating the coronavirus. All photos: JOSHI FAMILY</figcaption></figure>Six weeks ago, the live-in nurse who takes care of my<a href="https://www.nepalitimes.com/here-now/who-runs-the-world-girls/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/who-runs-the-world-girls/&amp;source=gmail&amp;ust=1608281673384000&amp;usg=AFQjCNEXylkJd6i9QhI2aGHlWa-nof2rmA"> 105-year-old grandmother-in-law (Muwa)</a> fell ill. She had developed cold-like symptoms and a headache, but not a fever. After she went back home for Tihar, Muwa developed a dry cough, but no fever.She began to take cough medicine, but we also applied every home remedy, steam treatments, turmeric water, honey, ginger, what have you. The fact that this could be indicative of Covid did not even cross my mind because I still somehow believed that having the coronavirus meant high fever. On the third day, Muwa’s cough got better.But then I developed a fever the day before भाइ टिका on 16 November and isolated immediately. I could only  get tested the day after Tihar, and the next day my husband developed a fever as well. My report came back positive 24 hours later, and all other seven members in our house -- including my grandmother-in-law--tested positive.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181148/636be8779c7e80680e08785ejpeg.jpg" alt="" width="440" height="681"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181148/636be8789c7e80680e08785fjpeg.jpg" alt="" width="418" height="681">The news of Muwa at her age testing positive was chilling. We had taken every possible precaution, ensured every measure to keep her safe. So the coming days were filled with worry.However, if we could look for a silver lining during this ordeal, it was that we did not need to follow strict measures of isolation, since everyone in our household had tested positive. We had been worrying about making different sleeping, cooking, and bathroom arrangements while we were waiting for all our results to come back, but that was not necessary anymore.So we shut the front gate, and sealed ourselves from the world. No one was allowed in or out. Our daughter and my sister-in-law had left enough essentials on our doorstep to last the duration of our isolation.Of the eight people in our home, my husband and I were the only ones who developed a fever, the others all had only mild symptoms. But while my fever peaked at 100°F, my husband, who is diabetic, had a high fever right from the start. When his oxygen level began to drop, he had to be admitted to hospital where he stayed for two weeks, completing a course of steroid and antibiotic treatments for secondary lung infection.It was an extremely stressful time back at home. On one hand, I worried about my husband alone in the hospital. On the other, I worried over what to tell his grandmother whenever she asked about her grandson.One day, Muwa said, “It’s so lonely here with just you and me.” Maybe she realised that it would just be the two of us in that family from now onwards. So when her grandson returned home after two weeks in hospital, she exclaimed in relief, “Finally, I can see you like this.”<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181148/636be87a9c7e80680e087860jpeg.jpg" alt="" width="640" height="952"><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181148/636be87d9c7e80680e087861jpeg.jpg" alt="" width="900" height="544"><figcaption> </figcaption></figure>Muwa likes to watch the tv news every day, and when she asks, “What happened today?”. She wants us to know how many people died of Covid-19 that day, and we give her the figure.Muwa often asks when her great-grandchildren, who live abroad, are going to come back home. We told her that planes were not flying because the pandemic was spreading all over the world. But since the lockdown was lifted and flights resumed, she sits on the terrace and keenly watches the planes fly by.Some days she notices that there were very few planes. Other days, she muses, “Quite a lot of flights today.” The planes in the sky have become symbols of hope for her to be reunited with her family one day.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181148/636be87f9c7e80680e087862jpeg.jpg" alt="" width="900" height="438"><figcaption> </figcaption></figure>Muwa lost her only daughter-in-law, <a href="https://www.nepalitimes.com/here-now/who-runs-the-world-girls/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/who-runs-the-world-girls/&amp;source=gmail&amp;ust=1608281673384000&amp;usg=AFQjCNEXylkJd6i9QhI2aGHlWa-nof2rmA">Angurbaba Joshi, </a>during the pandemic. A month after her passing, she lost her sister Binda Shakya with whom she was very close. We broke the news of her passing two months later when Muwa began to ask why her sister had not been visiting.One day, as she was expressing her annoyance over Binda Didi’s continued absence, without thinking I said, “She can’t come anymore.” She immediately asked, “Why? Is she dead?” I answered, “Yes.”<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181148/636be8829c7e80680e087863jpeg.jpg" alt="" width="1500" height="1094">Muwa was inconsolable over the next three weeks. She has begun to forget a lot of things, but she has not forgotten that her sister has passed. In her grief, she has started to reconcile with her own mortality. “My time has come, this is it,” she said one day.The grief of her having outlived  all of her younger siblings, a son, a daughter-in-law, and other loved ones shows clearly on her face. Sometimes, she sees her own longevity as a  curse. “Why hasn’t god taken me away yet?” she asks.Muwa overcame ‘Karuna’ (what she calls the coronavirus, and a Sanskrit word that means ‘compassion’) better than any of us. The doctors have always told us that her lungs and her heart are as healthy as a young woman’s. Her immune system is strong, perhaps from the clean and fresh surroundings and food she grew up with. She has hardened, enduring  a great deal in life, as a child widow, and as an old woman who has seen many loved ones pass on.Muwa’s mental fortitude is a testament to the fact that she is still here with us. Her memories may be blurred, but she is not inactive and silent, and will never be.

<figure><img width="768" height="1024" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109191116/636beeed4b0ad905ca02ef77jpeg.jpg" alt=""/><figcaption> There are nearly 2,000 Nepali nurses registered with the NHS in the UK, and the country needs more health workers.</figcaption></figure>Santosh Shah, the now famous Nepali who is a finalist in <a href="https://www.bbc.co.uk/programmes/b007mtf0" data-saferedirecturl="https://www.google.com/url?q=https://www.bbc.co.uk/programmes/b007mtf0&amp;source=gmail&amp;ust=1607952191831000&amp;usg=AFQjCNF7TXOI_L9k-3AhvbmN7_60pyCDtQ">Masterchef: The Professionals 2020</a>, knows how the right combination of effort and luck helped him to come such a long way from a village in Siraha to Britain and onto the world stage.This is an immigrant success story that proves talent is everywhere, opportunities are not, and migration can be an equaliser of sorts. Hard work, determination, and passion for his chosen profession made Shah one of the finalists in the coveted cookery competition.“If I can do it, so can others if they are given an opportunity – there is no shortage of talent in Nepal and I am no exception,” Shah told <a href="https://www.nepalitimes.com/here-now/you-inspire-others-by-learning-not-teaching-santosh-shah/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/you-inspire-others-by-learning-not-teaching-santosh-shah/&amp;source=gmail&amp;ust=1607952191831000&amp;usg=AFQjCNFpFsH-oYcei2EC9sjnh6rebJblHw">Nepali Times in an interview.</a>However, the less discussed, and perhaps less glamorous part of this globalisation of Nepali cuisine, is that the ‘chef’ occupation is one of the hard-to-fill occupations in the UK. The shortage of chefs in Asian restaurants across Britain led hundreds of them to close shop even before the Covid-19 crisis.South Asian restaurants in the UK prefer to hire migrants from the Subcontinent who are familiar with the cuisine, the flavour and the spices. But British immigration rules have made it difficult to hire chefs from non-EU countries. The minimum threshold salary and other recruitment expenses are too high for an employer to be able to sponsor South Asian migrants, says Ravi Thapaliya at City Cleaning, a placement agency.But all this is set to change from 11pm on 31 December, 2020 when the Brexit transition period expires, and the free movement of EU citizens to the UK will come to an end. <figure><img width="666" height="837" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109191116/636beeef4b0ad905ca02ef78jpeg.jpg" alt=""><figcaption> </figcaption></figure>“Non-EU and EU citizens will now be treated equally and be subject to the same set of rules,” explains UK-based solicitor Deepak Bhattarai. A point-based immigration system favouring skilled workers will require both EU and non-EU applicants to obtain at least 70 points, which depends on different criteria including job offers that meets salary threshold, English proficiency, education background, minimum salary and whether or not the occupation is in the Shortage Occupational List (SOL), which lists jobs facing a shortage and where it is ‘sensible’ to fill those with migrant workers. Now, the threshold salaries for skilled workers, including chefs, has been slightly reduced, and the point-based system has been made more flexible so the UK government can revise the criteria based on labour market requirements. Chefs have been included in the SOL which rewards additional points to the applicant, but many restaurants find the salary threshold is too high, especially with the pandemic crisis. “The incentive in the near future will be to mobilise workers who are already in the UK,” says Thapaliya.Easier immigration rules to recruit non-EU staff was one of the reasons why many in the South Asian Britons voted for the Leave option. But the inaction post-referendum has left the ‘curry industry’ that employs over 100,000 people, feeling misled by pro-Leave politicians. Hiring both EU and non-EU staff is now more difficult.“Businesses will continue to lobby with the government to further reduce the salary threshold. But there is a lot of uncertainty regarding immigration at present both because of Brexit and Covid,” Thapaliya addsThings are different in the medical sector, where there is an acute shortage of health workers and there are opportunities for nurses, including from Nepal. Both Covid-19 and the end of free movement have further amplified the demand for health workers, including from outside the EU. Britain has introduced a fast-track entry system with certain waivers including reduced fees for doctors and nurses, while visas for current healthcare workers was automatically extended for one year.  Nirmala Simkhada has been working in the UK for the last 12 years and has seen a demographic shift among her colleagues. She says, “Many of my friends from Eastern European countries like Romania and Bulgaria are returning to their countries because of the Brexit uncertainty, added paperwork, lack of access to the same benefits as British nationals.”Rising wages in their own countries and the fall in the value of the British pound after Brexit also mean that staying on in Britain is no longer as attractive as it used to be. Simkhada thinks newcomers from EU countries will also drop because of added complications like the new requirement to take IELTS language tests just as non-EU migrants have to.As a result, the proportion of health workers in Britain from the Philippines and India are on the rise. The share of European joiners to the National Health Service (NHS) since 2015/16 has decreased from 10.9% to 7.2% while non-EU/EEA nationals have increased from 8.7% to 14.5%. Some 22,000 EU nationals have reportedly quit the NHS since 2016, of which 8,800 were nurses.This could be an opportunity for Nepal, which can offer skilled migration in the global labour market, especially in the health sector.  “We have many unemployed nurses in Nepal as the health sector has not been able to absorb all graduates, so emigration is a financially safe alternate,” says Bikash Simkhada of the Nepali Nursing Association in the UK.He says English proficiency is a major obstacle, and Nepal’s nursing curriculum could be further strengthened to address geriatric care and other issues, and Nepal must prepare with better policies and partnerships with destination countries.But there are concerns about the impact of an exodus of health-workers on the health systems of developing countries. There are currently 1,988 Nepali nurses registered with the NHS in the UK. With the added demand for healthcare workers from the UK and elsewhere, Nepal will see a <a href="https://www.nepalitimes.com/here-now/home-health-care-during-a-lockdown/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/home-health-care-during-a-lockdown/&amp;source=gmail&amp;ust=1607952191831000&amp;usg=AFQjCNF1CV67RG_SAPgCreT6du_H3g4oJg">depletion of its own nursing workforce</a>. <img width="1398" height="892" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109191116/636beef14b0ad905ca02ef79jpeg.jpg" alt="">Already, an increasing number of students are joining nursing schools in Nepal because it is a <a href="https://www.nepalitimes.com/here-now/overseas-nepalis-on-the-covid-19-frontlines/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/overseas-nepalis-on-the-covid-19-frontlines/&amp;source=gmail&amp;ust=1607952191831000&amp;usg=AFQjCNEV0ec6CHuU-P1qi8dA9eTmmjHgig">path to migration.</a> But even those who stay <a href="https://www.nepalitimes.com/business/caring-for-those-who-cared/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/business/caring-for-those-who-cared/&amp;source=gmail&amp;ust=1607952191831000&amp;usg=AFQjCNHL0uHvqHH5HIC32y1vxbRKop8h1g">become frustrated with the low salaries</a> and lack of respect, and end up emigrating, explains Tara Pokhrel, former president of the Nursing Association of Nepal. After spending at least Rs2.3 million for a nursing degree, they earn just Rs10,000 a month in private sector hospitals, she adds.“The government must strictly monitor the nurse-to-patient ratio in private hospitals in Nepal, and make proper salaries to health workers a criteria during license renewals. Our talent is recognised and absorbed abroad while our own hospitals especially outside the capital suffer from staff shortage. We lack health workers because we fail to reward them adequately,” Pokhrel adds.Skilled workers from Nepal are seeing an increased demand in non-traditional destination countries. Last year, <a href="https://www.nepalitimes.com/opinion/the-future-is-older/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/opinion/the-future-is-older/&amp;source=gmail&amp;ust=1607952191831000&amp;usg=AFQjCNF8ikowcr343XFrSW03L9ii5LLt7g">Nepal signed an agreement with Japan</a> for 16 job categories including nurses and chefs and the nursing exams took place in November in Kathmandu.This year, in the midst of the pandemic <a href="https://www.nepalitimes.com/here-now/demand-grows-for-nepali-caregivers-in-israel/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/demand-grows-for-nepali-caregivers-in-israel/&amp;source=gmail&amp;ust=1607952191831000&amp;usg=AFQjCNE1zqyPCK3IFP6ApGGu9YirmI8udg">Nepal and Israel also signed an agreement</a> to source caregivers with backgrounds in nursing. The UAE and Oman have repeatedly expressed interest in hiring nurses from Nepal via bilateral cooperation.  There is no bilateral labour agreement between Nepal and countries like UK and Australia. In fact, due to the Code of Practice for International Recruitment, Britain’s NHS refrains from actively recruiting from countries including Nepal to prevent them from having a shortage of health workers. But the NHS has over 50,000 unfilled vacancies, and this is further complicated by the impending end of free movement of EU nationals on 31 December. Even without actively sourcing health workers from Nepal, therefore, Nepali nurses will be following the money, convenience and new opportunities abroad. Just as Santosh Shah of MasterChef has become a hero in Nepal, so has the Filipno-British nurse May Parsons who administered the first Covid-19 vaccine in the UK last week. Earlier this year, the Philippine government banned the migration of health workers because of the domestic demand during Covid-19, but the move backfired because few nurses agreed to take domestic jobs. The ban was lifted, but there is a cap of 5,000 nurses a year going abroad. Nepali Seema Pokhrel arrived in the UK two years ago and works as a nurse in Harrow. While most of her nursing friends opted for Australia, she chose UK because of the faster track to become a registered nurse.“The employer sponsored my second UK qualification exam and we could work alongside as health assistants and earn throughout,” she says. “While better salary was the primary motive for my decision to move, there is also better upward career mobility here unlike in Nepal where it was based on connections and not competence.”

Upasana Khadka

New UK job options for Nepalis

<figure><img width="768" height="1024" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181148/636be7ee9c7e80680e08782ejpeg.jpg" alt=""/><figcaption> There are nearly 2,000 Nepali nurses registered with the NHS in the UK, and the country needs more health workers.</figcaption></figure>Santosh Shah, the now famous Nepali who is a finalist in <a href="https://www.bbc.co.uk/programmes/b007mtf0" data-saferedirecturl="https://www.google.com/url?q=https://www.bbc.co.uk/programmes/b007mtf0&amp;source=gmail&amp;ust=1607952191831000&amp;usg=AFQjCNF7TXOI_L9k-3AhvbmN7_60pyCDtQ">Masterchef: The Professionals 2020</a>, knows how the right combination of effort and luck helped him to come such a long way from a village in Siraha to Britain and onto the world stage.This is an immigrant success story that proves talent is everywhere, opportunities are not, and migration can be an equaliser of sorts. Hard work, determination, and passion for his chosen profession made Shah one of the finalists in the coveted cookery competition.“If I can do it, so can others if they are given an opportunity – there is no shortage of talent in Nepal and I am no exception,” Shah told <a href="https://www.nepalitimes.com/here-now/you-inspire-others-by-learning-not-teaching-santosh-shah/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/you-inspire-others-by-learning-not-teaching-santosh-shah/&amp;source=gmail&amp;ust=1607952191831000&amp;usg=AFQjCNFpFsH-oYcei2EC9sjnh6rebJblHw">Nepali Times in an interview.</a>However, the less discussed, and perhaps less glamorous part of this globalisation of Nepali cuisine, is that the ‘chef’ occupation is one of the hard-to-fill occupations in the UK. The shortage of chefs in Asian restaurants across Britain led hundreds of them to close shop even before the Covid-19 crisis.South Asian restaurants in the UK prefer to hire migrants from the Subcontinent who are familiar with the cuisine, the flavour and the spices. But British immigration rules have made it difficult to hire chefs from non-EU countries. The minimum threshold salary and other recruitment expenses are too high for an employer to be able to sponsor South Asian migrants, says Ravi Thapaliya at City Cleaning, a placement agency.But all this is set to change from 11pm on 31 December, 2020 when the Brexit transition period expires, and the free movement of EU citizens to the UK will come to an end. <figure><img width="666" height="837" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181148/636be7f19c7e80680e08782fjpeg.jpg" alt=""><figcaption> </figcaption></figure>“Non-EU and EU citizens will now be treated equally and be subject to the same set of rules,” explains UK-based solicitor Deepak Bhattarai. A point-based immigration system favouring skilled workers will require both EU and non-EU applicants to obtain at least 70 points, which depends on different criteria including job offers that meets salary threshold, English proficiency, education background, minimum salary and whether or not the occupation is in the Shortage Occupational List (SOL), which lists jobs facing a shortage and where it is ‘sensible’ to fill those with migrant workers. Now, the threshold salaries for skilled workers, including chefs, has been slightly reduced, and the point-based system has been made more flexible so the UK government can revise the criteria based on labour market requirements. Chefs have been included in the SOL which rewards additional points to the applicant, but many restaurants find the salary threshold is too high, especially with the pandemic crisis. “The incentive in the near future will be to mobilise workers who are already in the UK,” says Thapaliya.Easier immigration rules to recruit non-EU staff was one of the reasons why many in the South Asian Britons voted for the Leave option. But the inaction post-referendum has left the ‘curry industry’ that employs over 100,000 people, feeling misled by pro-Leave politicians. Hiring both EU and non-EU staff is now more difficult.“Businesses will continue to lobby with the government to further reduce the salary threshold. But there is a lot of uncertainty regarding immigration at present both because of Brexit and Covid,” Thapaliya addsThings are different in the medical sector, where there is an acute shortage of health workers and there are opportunities for nurses, including from Nepal. Both Covid-19 and the end of free movement have further amplified the demand for health workers, including from outside the EU. Britain has introduced a fast-track entry system with certain waivers including reduced fees for doctors and nurses, while visas for current healthcare workers was automatically extended for one year.  Nirmala Simkhada has been working in the UK for the last 12 years and has seen a demographic shift among her colleagues. She says, “Many of my friends from Eastern European countries like Romania and Bulgaria are returning to their countries because of the Brexit uncertainty, added paperwork, lack of access to the same benefits as British nationals.”Rising wages in their own countries and the fall in the value of the British pound after Brexit also mean that staying on in Britain is no longer as attractive as it used to be. Simkhada thinks newcomers from EU countries will also drop because of added complications like the new requirement to take IELTS language tests just as non-EU migrants have to.As a result, the proportion of health workers in Britain from the Philippines and India are on the rise. The share of European joiners to the National Health Service (NHS) since 2015/16 has decreased from 10.9% to 7.2% while non-EU/EEA nationals have increased from 8.7% to 14.5%. Some 22,000 EU nationals have reportedly quit the NHS since 2016, of which 8,800 were nurses.This could be an opportunity for Nepal, which can offer skilled migration in the global labour market, especially in the health sector.  “We have many unemployed nurses in Nepal as the health sector has not been able to absorb all graduates, so emigration is a financially safe alternate,” says Bikash Simkhada of the Nepali Nursing Association in the UK.He says English proficiency is a major obstacle, and Nepal’s nursing curriculum could be further strengthened to address geriatric care and other issues, and Nepal must prepare with better policies and partnerships with destination countries.But there are concerns about the impact of an exodus of health-workers on the health systems of developing countries. There are currently 1,988 Nepali nurses registered with the NHS in the UK. With the added demand for healthcare workers from the UK and elsewhere, Nepal will see a <a href="https://www.nepalitimes.com/here-now/home-health-care-during-a-lockdown/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/home-health-care-during-a-lockdown/&amp;source=gmail&amp;ust=1607952191831000&amp;usg=AFQjCNF1CV67RG_SAPgCreT6du_H3g4oJg">depletion of its own nursing workforce</a>. <img width="1398" height="892" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181148/636be7f39c7e80680e087830jpeg.jpg" alt="">Already, an increasing number of students are joining nursing schools in Nepal because it is a <a href="https://www.nepalitimes.com/here-now/overseas-nepalis-on-the-covid-19-frontlines/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/overseas-nepalis-on-the-covid-19-frontlines/&amp;source=gmail&amp;ust=1607952191831000&amp;usg=AFQjCNEV0ec6CHuU-P1qi8dA9eTmmjHgig">path to migration.</a> But even those who stay <a href="https://www.nepalitimes.com/business/caring-for-those-who-cared/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/business/caring-for-those-who-cared/&amp;source=gmail&amp;ust=1607952191831000&amp;usg=AFQjCNHL0uHvqHH5HIC32y1vxbRKop8h1g">become frustrated with the low salaries</a> and lack of respect, and end up emigrating, explains Tara Pokhrel, former president of the Nursing Association of Nepal. After spending at least Rs2.3 million for a nursing degree, they earn just Rs10,000 a month in private sector hospitals, she adds.“The government must strictly monitor the nurse-to-patient ratio in private hospitals in Nepal, and make proper salaries to health workers a criteria during license renewals. Our talent is recognised and absorbed abroad while our own hospitals especially outside the capital suffer from staff shortage. We lack health workers because we fail to reward them adequately,” Pokhrel adds.Skilled workers from Nepal are seeing an increased demand in non-traditional destination countries. Last year, <a href="https://www.nepalitimes.com/opinion/the-future-is-older/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/opinion/the-future-is-older/&amp;source=gmail&amp;ust=1607952191831000&amp;usg=AFQjCNF8ikowcr343XFrSW03L9ii5LLt7g">Nepal signed an agreement with Japan</a> for 16 job categories including nurses and chefs and the nursing exams took place in November in Kathmandu.This year, in the midst of the pandemic <a href="https://www.nepalitimes.com/here-now/demand-grows-for-nepali-caregivers-in-israel/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/demand-grows-for-nepali-caregivers-in-israel/&amp;source=gmail&amp;ust=1607952191831000&amp;usg=AFQjCNE1zqyPCK3IFP6ApGGu9YirmI8udg">Nepal and Israel also signed an agreement</a> to source caregivers with backgrounds in nursing. The UAE and Oman have repeatedly expressed interest in hiring nurses from Nepal via bilateral cooperation.  There is no bilateral labour agreement between Nepal and countries like UK and Australia. In fact, due to the Code of Practice for International Recruitment, Britain’s NHS refrains from actively recruiting from countries including Nepal to prevent them from having a shortage of health workers. But the NHS has over 50,000 unfilled vacancies, and this is further complicated by the impending end of free movement of EU nationals on 31 December. Even without actively sourcing health workers from Nepal, therefore, Nepali nurses will be following the money, convenience and new opportunities abroad. Just as Santosh Shah of MasterChef has become a hero in Nepal, so has the Filipno-British nurse May Parsons who administered the first Covid-19 vaccine in the UK last week. Earlier this year, the Philippine government banned the migration of health workers because of the domestic demand during Covid-19, but the move backfired because few nurses agreed to take domestic jobs. The ban was lifted, but there is a cap of 5,000 nurses a year going abroad. Nepali Seema Pokhrel arrived in the UK two years ago and works as a nurse in Harrow. While most of her nursing friends opted for Australia, she chose UK because of the faster track to become a registered nurse.“The employer sponsored my second UK qualification exam and we could work alongside as health assistants and earn throughout,” she says. “While better salary was the primary motive for my decision to move, there is also better upward career mobility here unlike in Nepal where it was based on connections and not competence.”