Ritu got her nursing licence in 2017 and started working at a hospital in Bansbari for a monthly salary of Rs15,000. She had a heavy workload, had no overtime pay and could not always get a day off. &nbsp; Two years into her job, Ritu’s brother fell ill and she took two days’ leave to go to Pokhara to care for him. Nursing her sibling back to health took her two additional days, and when her hospital demanded clarification Ritu was so outraged she quit. &nbsp; Ritu then approached another clinic, where she had to work two weeks as a trainee without pay. After that she was offered a salary even less than her previous job. She was so overworked, she left that job after three months even though she had got only a month’s pay check.&nbsp; Ritu went back home to Pokhara and has been out of work for six years. Her mental health has deteriorated during this time. She told Nepali Times: “Experiencing the exploitation and abuse makes me want to tear up my nursing certificate.” Puja is another Proficiency Certificate Level (PCL) nurse from Nepalganj who got a job through a recruitment office that paid only R12,000 a month. Her middle-income family is in debt after spending Rs1.2 million on her nursing education. Puja reluctantly accepted the job, which was harrowing.&nbsp; There were only seven nurses in the 50-bed hospital, and Puja had 18-hour shifts with no overtime. She quit after a year, and has been without a job at home in Nepalganj for the last six months. “Becoming a nurse was a dream that turned into a nightmare,” she told us by phone. Read Also: <a href="https://nepalitimes.com/here-now/nepali-nurses-gone-and-going-to-the-uk">Nepali nurses gone and going to the UK</a> Anjali Pokharel from Dang got the same nurse job in the same hospital as Puja, but she was offered only Rs11,000. Her monthly hostel rent in Kathmandu alone was Rs12,000.&nbsp; “There is no earning, respect, or professional satisfaction in nursing,” says Anjali. “I never &nbsp;imagined that the nursing sector in Nepal was so bleak.”&nbsp; Another nurse with a decade of nursing experience is working at Ihsan Children’s Hospital in Kathmandu for Rs18,000, and says she was threatened with dismissal when she spoke out about low pay and overwork. She told us confidentially: “Despite great dissatisfaction, nurses are forced to keep working because there is no other choice.” All 20 nurses Nepali Times spoke to for this story said they were subjected to exploitation at their workplaces. Says a nurse currently at Norvic Hospital in Kathmandu: “Most nurses fall ill due to the workload, and many speak of wanting to go abroad for more respect and money.”&nbsp; For Nepal’s aspiring nurses, exploitation begins in the classroom. While the government has set a fee of Rs475,000 for the post-SEE three year PCL diploma course, many nurses spend up to Rs1.5 million to complete the course. The four-year BSc nursing fee is capped at Rs750,000, but nursing colleges set fees as high as Rs2.2 million, tacking expenses for food, accommodation, educational tours, etc.&nbsp; Read Also: <a href="https://nepalitimes.com/opinion/comment/nepal-health-workers-at-risk-of-workplace-hazards">Nepal health workers at risk of workplace hazards</a>, Ramita Marasini Female students are also subject to harassment and disciplinary practices that put restrictions on how they can dress, as well as how they do their hair and make-up. Nurse training itself is book-based with outdated curricula, and many nurses will not have interacted with actual patients throughout their academic career. Seema KC, who works at the Civil Hospital in Bhaktapur, says that the lack of practical knowledge means nursing graduates are incapable of the real-world working environment.&nbsp; This is one reason why even the country’s largest, international-level hospitals keep new nurses on probation at very low wages. The government also does not have a fixed minimum wage for nurses, a loophole private hospitals have taken full advantage of.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240317100332_10a449da404b46c671bc9baef588c76762ef41f787de5cd018a87a7eafe3a24e.jpg" data-media-id="editor_2" data-image-id="20240317100332_10a449da404b46c671bc9baef588c76762ef41f787de5cd018a87a7eafe3a24e" data-rendition-name="original" width="768" height="1024" loading="lazy" alt="Nepali Nurses in UK"> <figcaption>Nepali nurses working in the UK. Nurses have started leaving Nepal in search of better professional and academic opportunities abroad. </figcaption> </figure>  A nurse interviewed for this story said she had been offered merely Rs4,000 at Megha Hospital despite having had previous work experience, while Norvic pays PCL nurses up to Rs16,000 and nurses who have a Bachelor’s in Nursing Science (BNS) Rs25,000. Although working hours for nurses at private hospitals are supposed to be only six hours, many work for twice as long daily. The Nepal Health Service Regulations stipulate that health workers should only work 40 hours per week, and are entitled to compensation and additional service leave if their working hours are extended beyond the set hours. &nbsp; Salaries at government hospitals are better compared to private hospitals, but nurses are reluctant to work there because of lack of opportunities for career progression, and are forced to tolerate lower pay at private hospitals. Exploitation, low pay, high nursing college fees, lack of academic or professional growth are driving Nepal’s nurses overseas in droves.&nbsp; “Most nurses at Teaching Hospital have decided to go abroad because there are more academic and professional opportunities outside Nepal,” says Sarita Poudel, a nurse there. Government hospital directors say three to five nurses resign every week, some to pursue nursing abroad, and some to leave the sector entirely.&nbsp; Read Also: <a href="https://nepalitimes.com/latest/nepali-nurses-now-britain-bound">Nepali nurses now Britain-bound</a>, Radha Adhikari Nepal’s Department of Labour granted work permits to 40 nurses to go abroad in 2013. This number increased to 160 in 2019, 109 in 2020, 287 in 2021 and 582 in 2022. In 2023, 607 nurses received permits to go overseas. However, many nurses who go abroad do not appear in these official statistics. Some have gone abroad on student visas to study other subjects. A nurse working at Vayodha Hospital says she is going to Canada on a non-nursing student visa, adding that she will need nothing more than her Nepali nursing license to sit for the nursing license exam there. Data from the Ministry of Health and Population states that there are 14,099 vacancies for nurses across the country, while there are only 9,951 nurses currently employed. The shortage of nurses is affecting medical care across Nepal. In government hospitals, the nurse-patient ratio is 1:40. The Health Institution Operating Standards stipulates one nurse for four to six beds in the general ward, one nurse per two beds in emergency and postoperative rooms, and one nurse per bed in ICUs and CCUs. Meanwhile, there must be two Skilled Birth Attendants (SBA), trained nurses or midwives per patient in delivery rooms. None of Nepal’s hospitals – private or government – meet this requirement. Bir Hospital alone requires at least 938 nurses for its 550 beds, but only 400 are currently employed. The 350-bed Kanti Children’s Hospital requires 600 nurses but has only 169. It is even worse at the Prasuti Griha maternity hospital which needs at least 735 nurses but only has 154.&nbsp; The minimum service standards of the Health Ministry means Nepal’s government hospitals alone need 32,000 nurses, but have only half that number. The irony is that while the nursing posts remain vacant, many nurses are unemployed. The Ministry of Health’s Nepal Health Workforce Projection, (2022-2030), states that Nepal had produced 72,550 staff nurses until 2021. Excluding those who went abroad or had retired, 50,785 staff nurses were available against an estimated requirement of 39,249 professionals. This means that Nepal should theoretically have an excess of 11,536 staff nurses. According to the report, Nepal will need 43,056 nurses by 2031, including 22,255 who have completed the Auxiliary Nurse Midwife (ANM) diploma course as well as 240 graduate nurses and midwives. There are currently 115,793 registered staff nurses and ANM professionals in Nepal. Meanwhile, new nursing colleges are mushrooming with little regard to meeting accepted standards. They produce 7,000 nurses every year, but few get jobs overseas because they are not deemed qualified enough. The Ministry of Health in 2012 gave medical colleges a deadline until 2016 to build their hospitals of up to 100 beds to employ graduating nurses, but most never followed this directive even after multiple deadline extensions. In response, the Medical Education Commission stopped admissions to institutions that did not have 100-bed facilities, but colleges have been lobbying to be allowed to teach students without meeting those standards. The Nursing Association of Nepal has forced the government to agree to reforms in the sector, but few of those agreements were ever implemented. Nurses who spoke with Nepali Times said that many of their problems would be solved if the Nursing Association of Nepal and the Nepal Nursing Council took more initiative.&nbsp; Mana Kumari Rai, president of the Nursing Association blames the Health Ministry for failing to meet past commitments. Last week’s government change has again brought in Upendra Yadav of the JSP as health minister, but few nurses have hope that things will change for the better any time soon. &nbsp; Some names have been changed.

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Nursing grievances against the state

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;

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/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.

Protecting those who protect us from Covid

<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

<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.

How a 105-year-old beat the virus

<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.

<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

On Tuesday, leader of the monarchist RPP once again gathered on Kathmandu’s streets to deliver fiery speeches, but this time there was no arson and looting and no need for riot police to fire live rounds or tear gas.
RPP leaders demanded the release of their members including vice-president Rabindra Mishra and MP Dhawal Shamsher Rana were arrested during the violent <a href="https://nepalitimes.com/news/republicans-and-royalists-on-nepal-s-streets">28 March protests at Tinkune </a>which left two dead. 
They denounced the current leadership of the main parties, demanding the <a href="https://nepalitimes.com/editorial/nepal-party-reincarnating-hindu-monarchy">restitution of Nepal as a Hindu kingdom</a>. They also said the government was responsible for the fatalities on 28 March because it provoked its rally with a tear gas attack even before it started.
It has now been revealed that the police fired at least 100 live rounds from high powered assault rifles at the crowd. Twenty-one of the 120 injured received bullet wounds, and most of them were bystanders and people trying to reach home. 
Tuesday protest on the Ring Road in Balkhu was much more subdued, and comparatively fewer RPP supporters showed up. The arson and vandalism in the previous protest appears to have cost some support for <a href="https://nepalitimes.com/news/the-ghost-of-monarchy-returns-to-haunt-nepal">former king Gyanendra </a>especially for the anointment of medical tycoon and bank defaulter <a href="https://nepalitimes.com/news/street-politics">Durga Prasai </a>as ‘commander’ of the Tinkune rally.
Some monarchists acknowledge Gyanendra’s mistakes when was king 2001-2008, but say he has had a lot of time to reflect on his shortcomings and seems more disciplined and committed. His supporters have tried to build on nostalgia among some Nepalis for<a href="https://nepalitimes.com/news/why-invest-in-nepal"> domestic stability </a>and international respect that <a href="https://nepalitimes.com/here-now/if-birendra-was-alive-nepal-could-still-be-a-monarchy">the monarchy</a> commanded. 
“Nepalis were promised better service delivery, opportunities for the underserved, as well as better, more honest use of state resources, but the <a href="https://archive.nepalitimes.com/news.php?id=16992">people in leadership </a>have not been able to deliver on their commitments,” says RPP leader Prakash Chandra Lohani. “The gap between their rhetoric and reality has widened, the people feel betrayed, and the respect Nepali people had previously had for them has changed to revulsion.” 
Indeed, many commentators have warned the three main parties and their <a href="https://nepalitimes.com/editorial/politics-as-usual">serial prime ministers</a> who have ruled Nepal for much of the past 30 years should address rising public anger with them, and see the writing on the wall.
‘<a href="https://nepalitimes.com/news/nepal-government-changes-again">The UML, NC and Maoists</a> must introspect about their conduct,” warns Gunaraj Luitel, editor of Nagarik, in an op-ed this week. ‘These leaders for life may save themselves from simmering public anger, but they will not be able to save the system. The monarchist wave can only be dispelled when citizens are assured of <a href="https://nepalitimes.com/here-now/nepal-s-local-election-gives-power-back-to-people">better governance</a> through <a href="https://nepalitimes.com/latest/real-world-training-for-youth-leaders">younger leaders</a>, and reforms.’ 
Rifts between radical royals who are gunning for a return to <a href="https://nepalitimes.com/here-now/mob-movement-and-mayhem">Panchayat-style absolutism </a>and moderate monarchists who favour a constitutional king have also weakened the movement somewhat. The split between the RPP and RPP-Nepal cost the royalists numbers in Parliament in 2022, and both parties denounced the violence last month, albeit shifting the blame on the government.
The irony is that the same royalists who want to scrap the republican Constitution had formed electoral alliances with the UML during the 2022 elections. RPP-Nepal chair Kamal Thapa contested the 2022 election with the UML. Thapa has not taken part in the last two rallies, saying he will only be a part of a movement under a national flag, and not a RPP party banner.
For his part, the RPP’s Rajendra Lingden is said to be hesitant to censure some of his party’s more radical royalists for fear of fissure within his ranks, despite his aversion to Durga Prasai’s role. 
Analysts have questioned why <a href="https://nepalitimes.com/news/old-is-still-gold-in-nepali-politics">supporters of the monarchy </a>have decided to reestablish an institution that would not ultimately have executive decision-making power. There are doubts about whether authoritarian-minded Gyanendra will be satisfied being a <a href="https://archive.nepalitimes.com/news.php?id=13957">ceremonial king</a>. 
Read also: <a href="https://nepalitimes.com/news/nepal-s-deja-vu-on-black-friday">Nepal’s déjà vu on Black Friday</a>, Sonia Awale
"The Nepali people will not accept <a href="https://nepalitimes.com/here-now/forgotten-woman-who-sheltered-communist-activists">an absolute monarchy </a>at this point of time, and both the public as well as <a href="https://archive.nepalitimes.com/news.php?id=8371">king Gyanendra</a> are fully aware that there is no other possibility beyond a constitutional monarchy," asserts the RPP’s Lohani. “The traditional monarchy’s institutional capacity might have been enough to meet the needs of feudal Nepal, but an absolute monarchy is impossible both in concept and practice in the context of <a href="https://archive.nepalitimes.com/regular-columns/Economic-Class/waiting-for-an-industrial-revolution,784">modern day Nepal</a>.”

New year revolutions

Besides multiple <a href="https://nepalitimes.com/news/republicans-and-royalists-on-nepal-s-streets">street demonstrations </a>that gridlocked Kathmandu’s traffic for the past weeks, public discourse in Nepal has also been dominated by dangerously <a href="https://nepalitimes.com/here-now/air-pollution-is-more-dangerous-than-smoking">high air pollution levels</a>. Caused mostly by hundreds of <a href="https://nepalitimes.com/news/wildfire-season-starts-early-in-nepal">forest fires </a>raging across the country, the smoke contains suspended soot particles that harms <a href="https://nepalitimes.com/opinion/playing-with-poison">human health</a>. Thursday’s rain have cleared the air somewhat, and many people will soon forget how bad the air quality was. But the time to address the roots of next summer’s fire season is now.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250411060440_d1a119716a9031aadfdd611d299348d436842d376a03e664b8d773957a237524.jpg" data-media-id="editor_4" data-image-id="20250411060440_d1a119716a9031aadfdd611d299348d436842d376a03e664b8d773957a237524" data-rendition-name="original" width="502" height="540" loading="lazy" alt="Wildfires"> <figcaption>EXTINGUISHED: Forest fires raging all over Nepal in the week after 3 March (above) reduced air quality, creating a public health hazard in Kathmandu and across the country. Each red dot is a fire detected by infrared sensors on the NASA Fire Information for Resource Management System (FIRMS) satellite. But the rain on Thursday doused most of the fires (below) with more rain forecast over the weekend.</figcaption> </figure>  The reason everyone was talking about air pollution was because the<a href="https://nepalitimes.com/banner/nepal-is-going-up-in-smoke"> smoke from wildfires</a> was visible. But much more toxic are the invisible and odourless <a href="https://nepalitimes.com/news/nepal-doubles-its-carbon-footprint">gases from vehicular and industrial emissions </a>which have always been there. The theme of World Health Day on 7 April this week was ‘Healthy Beginnings, Hopeful Futures’ dedicated to <a href="https://nepalitimes.com/opinion/comment/saving-more-mothers-and-babies">preventing maternal and newborn deaths</a>. It is estimated that in Nepal, 30% of neonatal mortality can be blamed on air pollution. But that is only part of the story. Harmful as fine particulate matter is to human health, carbon monoxide, nitrogen dioxide, ground-level ozone and other gases in vehicular emissions are more hazardous to health. While the concentration of suspended particulate matter tinier than 1.5 microns (PM2.5) is closely monitored, these toxic gases are invisible, not measured much, and the public is not aware about the dangers they pose. Surface ozone is produced by the interaction of various gases found when <a href="https://nepalitimes.com/news/fossil-fuels-poison-air">burning fossil fuels</a>. Besides being poisonous, ground level ozone contributes up to 0.23°C to <a href="https://nepalitimes.com/here-now/nepal-s-mountains-are-melting">global warming</a> because it is also a greenhouse gas. A new policy brief by the Clean Air Fund titled The Case for Action on Tropospheric Ozone blames surface ozone for a half a million premature deaths every year, 54.8% of which are in South Asia. Ozone also stunts plant growth and reduces crop yields by 26% globally, and 11% loss in <a href="https://nepalitimes.com/news/economic-benefits-of-saving-the-ecology">forest productivity</a>, the report adds.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250411060456_aa02a923f8b27544ae54d0220162678f5bbb5eeb8fc3c466173c22c49b3e9a85.jpg" data-media-id="editor_11" data-image-id="20250411060456_aa02a923f8b27544ae54d0220162678f5bbb5eeb8fc3c466173c22c49b3e9a85" data-rendition-name="original" width="998" height="724" loading="lazy" alt="Gas Chambers"> </figure>  Read also: <a href="https://nepalitimes.com/here-now/bad-air-and-polluted-politics">Bad air and polluted politics</a>, Sonia Awale Ground-level ozone is not emitted directly into the air like other gases, but is formed when oxides of nitrogen (NOx), carbon monoxide (CO) and volatile organic compounds (VOCs) released from automobile tailpipes or industry smokestacks react chemically with each other in the presence of sunlight. The main source of carbon monoxide in Kathmandu Valley are its 1.2 million two-wheelers. “Usually the concentration of carbon monoxide is 200-500 parts per billion (ppb), this has increased up to 3,000 in Kathmandu. Meanwhile, ground-level ozone has gone from 70-80 ppb to 150 ppb,” says Ravi Sahu, regional air quality specialist with the Kathmandu-based International Centre for Integrated Mountain Development (ICIMOD).&nbsp; Sahu says <a href="https://nepalitimes.com/news/no-smoke-without-fire-p7vb9dcj">rampant forest fires of the past weeks</a> have also added to carbon monoxide and ozone in the air, not just the fine particles that make up the visible smoke. He adds, “There isn’t much awareness about <a href="https://nepalitimes.com/banner/poisoning-the-air-we-breathe">ground-level ozone and carbon monoxide</a>, we need to urgently look into it.” A distinction must be made between good and bad ozone. Stratospheric ozone protects living beings from harmful ultraviolet (UV) radiation from the sun.&nbsp; Tropospheric ozone can again be separated into two types: ozone in the free atmosphere which is a greenhouse gas much more potent than carbon dioxide, and ground-level ozone which has adverse impacts on health and agriculture. ‘Cutting tropospheric ozone presents a unique challenge as it requires smart and fast action across multiple greenhouse gases and air pollutants, as well as multiple economic sectors,’ notes the Clean Air Fund's policy briefing. ‘It is a growing and neglected problem that needs an integrated approach on both a local and global level to tackle climate change and air pollution together.’ Dying young There was a time when Nepal made it to international news bulletins only if there were fatalities on Mt Everest. Now, Kathmandu’s bad air frequently makes headlines all over the world. This past week, the concentration of PM2.5 that harms human health was up to 40 times the WHO recommended guideline — adding to the poisonous gases already present from vehicle emissions. The Department of Environment says 40% of the pollution in the past weeks was from wildfires sparked by nearly 6 months without substantial rain over central Nepal. Most of the rest is from vehicular and industrial emissions from Kathmandu itself and across the southern border. NASA’s Fire Information and Resource Management System (FIRMS) which issues daily maps of fires, showed hundreds of blazes raging across Nepal on Wednesday, mainly in Chitwan, Parsa and along the East-West Highway.&nbsp; “If we look at the figures for the last few years, it is clear that wildfires have become the biggest source of air pollution, they are seasonal but have overtaken vehicular emissions,” says urban planner and environmentalist Bhushan Tuladhar. “Forest fires, stubble burning, and open burning of garbage are the bigger problems now. Nepal, India, Bangladesh, and Pakistan are at risk every year, we shouldn’t further delay in finding solutions,” warned air quality expert Bhupendra Das during an event on air pollution organised on 7 March by the Nepal Forum of Environmental Journalists (NEFEJ).&nbsp; Indeed, studies have shown that in winter 60% of the air pollution over Kathmandu is transboundary from the south, and in November it is compounded by smoke from crop residue burning by farmers in India and Pakistan blown in by prevailing winds. Forest fires are a regular pre-monsoon occurrence in Nepal, often intentionally set by farmers and herders to stimulate new grass growth for livestock. Winter rains have failed for eight of the past ten years, and this means the fires often spread out of control. The other reason for the increase in wildfires is the doubling of forest fires to 46% of the country’s area in the past 25 years. But this has happened simultaneously with outmigration, with some mountain districts losing 30% of their population between 2011-2021. With less pressure on forests for fodder and firewood, the undergrowth of community forests is loaded with dry fuel just waiting for a spark. The bowl-shaped topography of Kathmandu, Pokhara and other valleys further concentrates pollutants as they are trapped by surrounding mountains. But a year with a high number of wildfires is usually followed by a year or two with fewer incidents. For example: there were 6,537 fires in 2021 but the following year the number was down to 1,528. There were 5,216 fires last year, this year the number has already reached 1,800, and the trend is likely to be broken. Heavy rains forecast for the coming days are expected to douse some of the fires and clean up the air. But the damage has been done: Kathmandu residents of all age groups this week crowded clinics and hospitals with burning eyes, itchy throats, difficulty breathing, headaches, and dizziness. But in the longer term, soot particles that are tiny enough to jump the blood-air divide in lung capillaries do not just cause Chronic Obstructive Pulmonary Disease (COPD), asthma, but also cancers, heart attacks, strokes, birth defects and other chronic diseases. The latest Air Quality Life Index (AQLI) report by the University of Chicago shows that the annual concentration of PM2.5 in Kathmandu’s air rose from 17.87µg/m3 in 1998 to 31.33µg/m3 in 2022. Air pollution has got worse by 75% in Kathmandu in 25 years. During this time, air pollution has reduced the average life expectancy of Kathmandu’s residents by 3.5 years. According to the Health Effects Institute in Boston, dirty air is among the biggest public health concerns in Nepal killing over 42,100 a year. The adverse impact of high levels of air pollution is not limited to public health, it is seriously affecting tourism. Operators in Pokhara this week said that there were many negative online posts by visitors unable to see the famous panorama of Machapuchre and the Annapurnas even from Sarangkot. Aviation is also affected, as planes have to circle sometimes for hours burning a lot of fuel because of runway visibility being below minima at Kathmandu airport. The higher fuel cost is just passed down to customers, making air tickets in and out of Kathmandu some of the highest in the world. Kathmandu, with a population of four million, has not implemented a concrete policy to curb toxic air despite having formulated various action plans and repeated commitments by the government to protect the environment and control air pollution. The Department of Environment’s 2017 Air Quality Management Action Plan for Kathmandu put forward a policy to reduce air pollution caused by vehicles which was approved by the Cabinet, but has yet to be put to practice. The action included the immediate implementation of the Euro 5 emission standard to reduce pollution emitted by vehicles. However, Nepal has not even been able to implement Euro 4 standards so far. India, meanwhile, has already moved forward with the implementation of the Euro 6 standards. Says Ravi Sahu: “Air pollution in Nepal is not just about air pollution, it has ties to tourism, aviation, the economy so we must be prepared for annual conditions like forest fires, and this requires urgent interdisciplinary collaboration.” &nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250411050452_821d09e283d8a590f1369bfb71b9b7fc6d950726e0651ea86c6488d04deb1742.jpg" data-media-id="editor_15" data-image-id="20250411050452_821d09e283d8a590f1369bfb71b9b7fc6d950726e0651ea86c6488d04deb1742" data-rendition-name="original" width="839" height="784" loading="lazy" alt="Silent Killers"> </figure>  &nbsp;

What is invisible is more dangerous

82 in २०८२

Here in the mountains of far-western Nepal, the biggest threat to life and limb is gravity. Women collecting fodder fall from trees, boys grazing goats fall off cliffs, heavily loaded tractors plunge from dirt roads carved out of steep slopes. There is nothing to be done about those who die on the spot. But for the severely wounded there is only one hospital: Bayalpata. And it is there that <a href="https://www.youtube.com/watch?v=CJzWlnYd0ZM&amp;t=8s" target="_blank">orthopaedic surgeon Mandeep Pathak</a> is the last hope for many wounded people. Pathak, 42, is too modest to tell us how many lives he has saved over the past 10 years he has worked at Bayalpata. But hospital records show he has performed more than 4,000 operations in the past decade, many of them so patients did not suffer permanent physical disabilities. Pathak also did 800 major life-saving surgeries in that time. “I treat patients with injuries, but I wish I could also treat poverty,” Pathak says, emerging from Bayalpata’s surgical theatre one recent afternoon. <div class="embed-block"><iframe width="700" height="415" src="https://www.youtube.com/embed/CJzWlnYd0ZM?si=s_rkbU4YDaw87gqH" title="YouTube video player" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share" referrerpolicy="strict-origin-when-cross-origin" allowfullscreen></iframe></div> Sudurpaschim Province in Nepal’s far-west is far away from everything: from Kathmandu, from adequate medical care, from food security, and far from the reach of government services. It has suffered state neglect for centuries, its men mainly migrating to India for seasonal work to families who depend on subsistence agriculture. Pathak remembers the searing sadness he felt when a patient once told him, “Doctor, I sold the last of my rice to pay to come here, please give me a medicine that I can take on an empty stomach.” Pathak was born in Kathmandu, and after getting his MBBS from Kathmandu University, he got an MD from The Philippines. At a time when many Nepali doctors and staff nurses were emigrating, Pathak did not just return to Kathmandu but decided to go to one of the remotest districts in Nepal to serve those most in need. The hospital was established in 2009 in the village of Bayalpata, and has been managed by the non-profit <a href="https://www.nyayahealthnepal.org/" target="_blank">Nyaya Health Nepal (NHN)</a> as a public-private partnership treating 100,000 patients a year for no fees at all. NHN is now preparing to hand over the running of the hospital to the Sudurpaschim provincial government so its <a href="https://nepalitimes.com/banner/this-is-how-to-upgrade-nepals-rural-health" target="_blank">model of hospital management</a> can be replicated.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250414130456_b59dabd4604a24426a55fe91c0e5866b5029858bdb4c4028c331557aeb5408ae.jpg" data-media-id="editor_4" data-image-id="20250414130456_b59dabd4604a24426a55fe91c0e5866b5029858bdb4c4028c331557aeb5408ae" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Bayalpata hospital"> <figcaption>Bayalpata hospital in Achham.</figcaption> </figure>  People from not just Achham but surrounding districts, and from as far away as Humla, bring patients to Bayalpata, sometimes walking for days. Some with complicated pregnancies are brought in stretchers, young children with broken arms walk into the emergency, and sometimes there are mass casualties when a tractor or bus falls off a road. And Pathak is always there with his team performing triage, and doing orthopaedic surgeries that would be difficult even in Kathmandu. Recently, his team did a hip replacement at <a href="https://nepalitimes.com/banner/state-of-the-art-rural-hospital" target="_blank">Bayalpata Hospital</a>. Mild mannered, modest, soft-spoken, hard-working, professional are the words families of patients who have been treated at <a href="https://nepalitimes.com/here-now/nepal-s-rural-lifeline" target="_blank">Bayalpata Hospital </a>use to describe Mandeep Pathak. But the surgeon is too busy to let all this get to this head.&nbsp; Asked why he does not emigrate like his peers or get a lucrative position at a private hospital in Kathmandu, Pathak answers simply, without a trace of self-importance, “I do not think I could get the satisfaction or sense of fulfilment anywhere else.” When travelling to attend medical congresses overseas or visit family in Kathmandu, Bayalpata has other doctors to take care of patients, but many wait patiently till Pathak returns for their consultation or surgery.&nbsp; When he returns from seminars abroad after learning the latest skills, Pathak’s suitcases are not full of clothes or presents, but titanium bone implants, external fixation rods, or intramedullary nails to be used in <a href="https://nepalitimes.com/news/altruistic-healthcare-models-in-nepal" target="_blank">surgeries at Bayalpata</a>.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025041414040_5356278472c1eb2b9e4af1d593d6234cc8dc5e5161a8c614197c01abefadbd80.jpg" data-media-id="editor_8" data-image-id="2025041414040_5356278472c1eb2b9e4af1d593d6234cc8dc5e5161a8c614197c01abefadbd80" data-rendition-name="original" width="2048" height="1368" loading="lazy" alt="surgery"> </figure>  Before Bayalpata Hospital was established, most people suffering broken bones had to travel down to Dhangadi or Nepalganj for treatment. No more. Although Pathak’s specialisation is orthopaedic oncology, he is mostly treating fractures and rejoining broken bones.&nbsp; Now as Bayalpata’s Hospital Director, Pathak also has administrative and fundraising duties. He has to take the 10-hour ride down to Dhangadi often to meet various Sudurpaschim ministries to release the hospital’s budget — that is sometimes more difficult than the most complicated surgery. Recently, he had to cancel an appointment with the Chief Minister to rush back to Bayalpata because there was a patient who needed emergency surgery. “I told myself, let me save this patient first, then I will try to save the hospital,” he recalls.&nbsp; Once, when he had to be away for a month on emergency surgery training in the US, the family of a 90-year-old woman who had dislocated her hip after falling from a staircase was waiting for him to return. Her son told Pathak: “Doctor, either put her out of her suffering, or cure her.” Pathak told him it was too dangerous to operate at her age, but the son said his mother was in so much pain it was worth the risk. The operation was touch-and-go, but it was successful. The woman who had been brought in on a stretcher, walked out of the hospital three days after the operation.&nbsp; A few months later, a 27-year-old woman was brought into the ER bleeding profusely from an arm mangled by a thresher machine. Even in that state, she was breastfeeding her baby. Pathak welled up seeing this display of selfless motherhood, as he wheeled her into surgery. She needed three operations, but now has full use of her hand. <div class="embed-block"><iframe width="700" height="415" src="https://www.youtube.com/embed/xJdxLD0hBqo?si=mOpM2R_DsYL88Lfg" title="YouTube video player" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share" referrerpolicy="strict-origin-when-cross-origin" allowfullscreen></iframe></div> It is the sense of achievement from such recovery that keeps Mandeep Pathak here in this isolated village in the middle of nowhere. Bayalpata Hospital has not just saved lives, it also saves families from poverty because they do not have to take sick relatives to expensive city hospitals.&nbsp; In January, a woman was brought to Bayalpata with both hands broken. She said she had taken a fall, but Pathak did not believe her. When alone in the surgery, she finally admitted that her husband had beaten her.&nbsp; It was her husband who had brought her to hospital for treatment, but she refused to file a police report. Pathak quietly put both her arms in casts, thinking about the poverty, patriarchy and injustice in society that he is unable to treat.

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New year revolutions

What is invisible is more dangerous

82 in २०८२

The healer of far-western Nepal