<figure><img width="1165" height="600" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109141116/636ba8469c7e80680e0737cejpeg.jpg" alt=""/><figcaption>All photos: HEALTHY SMILES</figcaption></figure>Health care facilities are in much demand during the Covid-19 pandemic, but one branch of medicine that is not seeing any patients is dentistry. The patient cannot wear a mask, it is impossible for the dental surgeon to maintain physical distance during treatment, and patients, dentists and their nurses all face extended exposure to virus-carrying aerosols.The World Health Organization (WHO) has advised patients to delay visiting their dentists during the pandemic, and the Nepal Ministry of Health has told dental surgeries to close during the lockdown period.However, dentists interviewed for this overview told Nepali Times if there is one field of medicine that is most prepared to stop the spread of infections, and who were already following strict protocols, it is oral care.“Long before Covid-19 dental clinics already had strict protocols to prevent the spread of airborne infections, so if any doctors already had  preventive measures in place it would be dentists,” says dental surgeon Sushil Koirala of the <a href="http://www.punyaarjanfoundation.org.np/main/" data-saferedirecturl="https://www.google.com/url?q=http://www.punyaarjanfoundation.org.np/main/&amp;source=gmail&amp;ust=1598755551072000&amp;usg=AFQjCNG60e9232rmC_ehPE51HjcNhCR4iw">Punyaarjan Foundation.</a>Koirala says most dentists in the region were already following the WHO protocol from the SARS epidemic in 2003, and even before that dental clinic staff in Nepal have been taking precautions against tuberculosis, seasonal influenza, and other airborne pathogens.<a href="https://www.nepalitimes.com/here-now/protecting-those-who-protect-us-from-the-epidemic/">Protecting those who protect us from the epidemic</a>, Ramu SapkotaFor the first four months of lockdown after March, the government ordered all dental clinics closed, and had allowed oral care departments in two hospitals to remain open for dental emergencies. However, they soon closed after staff tested positive for the novel coronavirus. From March to mid-July most dentists spoke to their patients on the phone about symptoms, and depending on the case, the patients were given advice, prescribed painkillers or antibiotics.Over 90% of the cases were gum infections or tooth decay due to excessive snacking during the lockdown. Most could be treated with analgesics and mouthwash. “With the more serious cases, we practiced a crude form of telemedicine where we asked the patient to take a live video of their oral cavities so we could advise on a course of action,” Koirala says. “Some of my patients learnt to take really good selfies.”Even when the restrictions were partially lifted on 21 July, clinics were still largely empty because the patients were too scared to visit, and the staff stayed away. Dental clinics then followed their standard protocols, adding new guidelines on pre-appointment interviews, disinfection of surgery after every patient, personal protective equipment, and procedures like limiting the number of patients and minimising contact.<a href="https://www.nepalitimes.com/latest/tb-patients-in-limbo-due-to-covid-19/">TB patients in limbo due to COVID-19</a>, Devika Agarwal <img width="1138" height="600" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109141116/636ba8499c7e80680e0737cfjpeg.jpg" alt="">Some innovative clinics like Healthy Smiles in Kathmandu developed their own protocols a based on guidelines issued by the US Centre for Disease Control (CDC) and have <a href="https://youtu.be/MV048n6EuPE" data-saferedirecturl="https://www.google.com/url?q=https://youtu.be/MV048n6EuPE&amp;source=gmail&amp;ust=1598755551072000&amp;usg=AFQjCNEeNub-ibeeEVrwxo8E6Oz-ul--QQ">made videos</a> to illustrate the process to patients.“As this is a droplet infection with aerosol transmission, our attempt is to minimise it with online screening of limited patients, social distance and masks, well ventilated rooms with negative pressure along with high vacuum dental suctions and a floor level exhaust at floor level,” explains dental surgeon Neil Pande of Healthy Smiles.After every patient, the entire outer wear is changed by all to ensure no cross contamination between patients. The donning and doffing of PPE is carried out in a strict sequence and disinfected before cleaning. All the surfaces are decontaminated with 70% alcohol three times, once immediately after and other twice after, with an interval of one hour. Healthy Smiles actually got Nepali engineers to design and build its new ventilation system that sucks air out of the surgery and passes it through HEPA filters to decontaminate it.<a href="https://www.nepalitimes.com/latest/govinda-kc-treats-patients-in-remote-nepal/">Govinda KC treats patients in remote Nepal</a>, Achyutraj Bhandari“We believe infection control to be one of the main pillars of the healthcare system, and it is even more important during this pandemic,” Pande says. “It has completely changed the face of dentistry.”Elsewhere in developed countries, many dentists have defied the WHO’s recommendations saying they are already used to taking necessary precautions to prevent infections. In fact, they argue that patients may suffer other health complications if they cannot see their doctors in time, and that oral infections can worsen the outcome of patients with Covid-19.  In Singapore, where a very strict testing and tracing regimen is in place, dental clinics have remained open and the flow of patients is at 80% of pre-pandemic level. In Australia, except in the state of Victoria, most dentists are seeing patients.In Nepal, Punyaarjan Foundation has <a href="http://www.punyaarjanfoundation.org.np/main/" data-saferedirecturl="https://www.google.com/url?q=http://www.punyaarjanfoundation.org.np/main/&amp;source=gmail&amp;ust=1598755551072000&amp;usg=AFQjCNG60e9232rmC_ehPE51HjcNhCR4iw">published a booklet</a> and posters in Nepali that allow individuals and families to self-evaluate their own risk levels with various activities. Says Sushil Koirala: “Dentists are taught to be extra-cautious about infections, and with this publicity material we want to share that knowledge with the Nepali public -- that the only way to fight infectious disease transmission is through individual responsibility and discipline.Read also: <a href="https://www.nepalitimes.com/here-now/kidney-patients-dying-due-to-covid-19-lockdown/">Kidney patients dying due to COVID-19 lockdown</a>, S Dhiren

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Need to see a dentist during the pandemic?

The series Nepal Made profiles Nepali products and the people who make them possible While premium beauty product outlets were closing during the Covid-19 pandemic, two young women gambled on setting up a new skin and haircare brand with natural ingredients mostly sourced from Nepal and suited for the Nepali complexion. Arushree Sharma Khatiwada and Megha Agarwal were batchmates in school before they left for studies abroad, returning to set up Avani Nepal after year-long rigorous research into ayurveda-based cosmetic products. Avani in Sanskrit means ‘earth’, and as the name suggests it is committed to bringing all natural, pure and authentic range of beauty solutions.&nbsp; “We found a gap in the Nepali market demand for cosmetics, which is why we decided on a brand sourced from all-natural Himalayan herbs that are not used or explored properly,” says co-founder Khatiwada.&nbsp; Nepal is a treasure trove for medicinal plants and those with therapeutic properties. After all, legend has it that Hanuman flew right across the subcontinent from Sri Lanka to the Himalaya to find a rare medicinal plant to save the life of Lord Ram, who was wounded in battle. When he could not find the specific plant, he tore off a whole mountain and brought it down. Read also: <a href="https://nepalitimes.com/multimedia/looking-good-by-doing-good">Looking good by doing good</a>, Sudiksha Tuladhar  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260314120356_32323fd084540236fe4edb3b98286c131d67c73310279c8038510da1e1ae1bc0.jpg" data-media-id="editor_1" data-image-id="20260314120356_32323fd084540236fe4edb3b98286c131d67c73310279c8038510da1e1ae1bc0" data-rendition-name="original" width="3024" height="2012" loading="lazy" alt="Avani"> </figure>  Medicinal plants in Nepal range from yarsagumba to jatamasi and 500 other species traditionally used in the Ayurveda as well as now in the wellness industry. Avani is also trying to experiment hibiscus, Himalayan honey and other plants to eventually launch an export drive. Running a business in Nepal is no easy task, especially for small scale locally crafted products but in a few years, Avani has ammased loyal customer base and have many repeat customers. “While it was tricky initially, we were determined to launch our products with the best quality ingredients and in an affordable price range,” says Khatiwada. Following a worldwide trend and emulating the method used by Korean cosmetic brands, Avani has deployed celebrities and influencers to increase its outreach through tikTok , Facebook and YouTube. &nbsp;Actresses Barsha Shiwakoti and Shilpa Maskey and makeup artists like Lemi have reviewed their products favourably. Sutainability is a big part of the brand, and Avani uses glass bottles, cardboard boxes, paper bags for all its products. Plastic use is cut to a minimum, and where used is recycled.&nbsp; “Many people think that sustainable brands are expensive, we want to bust that myth,” Khatiwada told us. “We focus on being eco-friendly using ethically sourced materials that are paraben, silicon, and cruelty free.”&nbsp; Read also: <a href="https://nepalitimes.com/here-now/proud-to-wear-dolpo">Proud to wear DOLPO</a>, Vishad Raj Onta  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260314120356_da0d7d4082a9aa51c96ecbcb8a2e7a5bc60e27de202fb339a522036aa3f50b49.jpg" data-media-id="editor_3" data-image-id="20260314120356_da0d7d4082a9aa51c96ecbcb8a2e7a5bc60e27de202fb339a522036aa3f50b49" data-rendition-name="original" width="1048" height="1280" loading="lazy" alt="Avani"> </figure>  Avani has expanded its business to get a toehold in Nepal’s tourism and wellness industry, and the products are carried by spas in leading hotels and resorts in Kathmandu and Pokhara such as the Terraces, Marriott, and Kavya resort, and is in talk with the Hideaway Resort in Pokhara.&nbsp; The skin and haircare brand that initially started with 10 products has since expanded its line to 60 with goods placed in more than 100 stores across Kathmandu. Plans are in the works to expand to India, China and in Japan partnering with Okada. Avani Nepal’s founders say that they support empowerment through employment and training opportunities for women at the company. Khatiwada herself has been engaged with organisations such as Nepal Women Chamber of Commerce, and Nepal Youth Entrepreneur Forum. Additional support from the government such as the provision of lower excise duties has helped but guidance for export and other business regulations is as crucial. Such an environment would also foster opportunities for the youth who are otherwise moving away for jobs or study abroad. “While everyone is trying to go abroad, opportunities can be created here in Nepal itself, with adequate support from the government,” says Khatiwada. “In the meantime, we are eyeing for long term benefits. We are trying to create a legacy for cosmetic brands in Nepal.” Read also: <a href="https://nepalitimes.com/here-now/java-in-the-himalaya-y1ilc21h">Java in the Himalaya</a>, Vishad Raj Onta

Redefining the criteria for beauty

- High Court employee Amrita KC fulfilled her duties as a polling officer in Nepalganj on election day, with her six-month-old daughter held in her arms.&nbsp; - The same morning in Kathmandu-1, RSP candidate Ranju Neupane appeared at the polling station to cast her vote with her 10-day-old baby. The next day, she became the first candidate declared a winner by the Election Commission. Her party won a supermajority and will now be tasked with reforms in governance, development, the economy, and service delivery. At least four of the winning RSP candidates are doctors, and the party must fulfil its campaign promise of improving healthcare access across Nepal. Among the lowest-ranking region for healthcare indicators in Nepal is Madhes Province. Across the districts of Madhes and Karnali, where maternal and neonatal health outcomes remain poorer than in the rest of the nation, local governments in collaboration with non-profits, have financed and facilitated the operation of birthing centres where <a href="https://nepalitimes.com/here-now/nepal-haemorrhaging-nurses">nurses are lifelines</a> for pregnant women, new mothers, and newborn babies.&nbsp; At the Inarwari birthing centre in Rautahat district, nurse midwife Manisha Kushwaha gently applies ultrasound gel on the abdomen of 28-year-old Robina Khatun who is having a sonogram in the first trimester.&nbsp; Kushwaha glides the transducer over Khatun’s belly before pronouncing her baby healthy. She will later send the ultrasound machine for the municipality’s monthly mobile sonogram program in a neighbouring village.&nbsp; Ministry of Health and Population guidelines recommend that pregnant people make eight antenatal care (ANC) visits to health posts before their delivery date. Expecting mothers are also provided Rs800 for the eight visits and travel costs according to geographical region. In Baudhimai, the local government provides more incentives: 10 eggs for non-vegetarian and protein powder for vegetarian mothers-to-be per visit. The municipality also provides free ambulance service for pregnant women, and conducts a monthly mobile sonogram program across all communities.&nbsp; The initiatives of local governments, health officials, non-profits, and volunteers have meant that institutional deliveries here have increased drastically. In Rautahat, institutional deliveries have increased from 50% to 68% in four years, according to figures from the non-profit One Heart Worldwide that works to improve <a href="https://nepalitimes.com/here-now/nepal-lagging-in-safe-motherhood">maternal and neonatal health</a> outcomes arcoss Nepal.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260314020352_a3f66142aa6a0333b78d82cd5520b1818633a580885232c10625572e014b1b15.png" data-media-id="editor_2" data-image-id="20260314020352_a3f66142aa6a0333b78d82cd5520b1818633a580885232c10625572e014b1b15" data-rendition-name="original" width="1034" height="650" loading="lazy" alt="Motherhood in Madhes"> </figure>  “Home deliveries have completely stopped in Inarwari, and women are increasingly accessing ante-natal and post-natal care, as well as family planning measures,” says Manisha Kushwaha. “Women and families here are now more aware of maternal and neonatal healthcare.” One of them is Noor Jahan Khatun, who had her first baby at home and gave birth to her second child at the local birthing centre despite wanting another home birth. When the due date for her third child came around, she walked to the health post herself.&nbsp; “I realised it is much better to give birth at the hospital,” Noor, who is pregnant with her fourth child, told us. “They have everything we need in case of complications.” The nursing staff at the birthing centre, as well as other centres in the municipality also periodically review their training in the birthing simulation room set up on the premises of the Inarwari birthing centre so that they retain their training and continue to hone their skills. Over in Sarlahi’s Sundarpur in Chakraghatta Rural Municipality, a state-of-the-art birthing centre now stands adjacent to the derelict old structure from which nurses previously had to provide services.&nbsp; The new and improved maternity ward was built last year with Rs2.4 million from the municipality and a Rs2 million from <a href="https://nepalitimes.com/banner/what-can-be-more-fulfilling-than-saving-lives">One Heart Worldwide</a> under a cost-sharing public-private partnership formula.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260312120328_4e7f71b535541d56d267baa6f2656faf008b7e98cc16da0042253f4c0db3eeb7.jpg" data-media-id="editor_4" data-image-id="20260312120328_4e7f71b535541d56d267baa6f2656faf008b7e98cc16da0042253f4c0db3eeb7" data-rendition-name="original" width="3000" height="2000" loading="lazy" alt="maternal health"> <figcaption>Sundarpur birthing centre in Sarlahi built through the collaboration of the local government and One Heart Worldwide.</figcaption> </figure>  Chief nurse Sunita Rai has been stationed here for the last six years, and looks at the old building. “I remember when we had to deliver babies while ankle-deep in flood water during monsoon,” recalls Rai. “This new facility and the equipment have improved service.”&nbsp; Since the start of the fiscal year, the six-nurse team at Sundarpur has delivered more than 140 babies. One day last month, a national holiday, the centre was quieter than usual, with just two women waiting for delivery.&nbsp; But fewer-than-usual patients does not mean there is no work to be done. In the afternoon, nurses make the rounds of the community to conduct post-natal care visits, and to keep track of how the new mothers and babies in the village are doing. This is important because neonatal mortality of babies within the first month of birth is still high. “For the people in this village we are both the doctor and the nurse,” Rai says matter-of-factly as she walks towards the village to see a new mother.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260314020352_24b9e04295150a8a64ff56f457e3faebd84eaa22a3e3521499ac17c23ec48027.jpg" data-media-id="editor_5" data-image-id="20260314020352_24b9e04295150a8a64ff56f457e3faebd84eaa22a3e3521499ac17c23ec48027" data-rendition-name="original" width="790" height="542" loading="lazy" alt="Motherhood in Madhes"> </figure>  In Sarlahi's Laxmipur Kodraha, Kanchan Rai makes her own rounds, calling out to several young children playing in the pale afternoon sun. Rai has been stationed in Laxmipur for 10 years and delivered most of those children playing outside herself. A beloved member of the community, Rai is greeted by several women and invited in for tea and snacks as she walks by. The Laxmipur birthing centre has seen major renovations to make it more spacious, better equipped, and hygienic. Mothers now have more privacy, especially from men who in the past would simply barge in wanting to know which woman from the village was about to give birth.&nbsp; “We deliver 400 babies on average every year,” Rai says. “There have been zero home births in this village for the last five years, and women are increasingly accessing maternal healthcare and family planning services.” Institutional deliveries in Sarlahi have gone up from 37% to 71% over the past five years.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260314020348_983e3b652b38cee4a1d977742e0211dd85c1ab8085f961876dde1ada78c7c2ac.jpg" data-media-id="editor_6" data-image-id="20260314020348_983e3b652b38cee4a1d977742e0211dd85c1ab8085f961876dde1ada78c7c2ac" data-rendition-name="original" width="359" height="329" loading="lazy" alt="Motherhood in Madhes"> </figure>  Pregnant women who require C-sections, or those who experience complications during pregnancies, are referred to the nearest provincial hospitals in Gaur or Malangwa. “Community-based awareness programs about going for hospital visits have helped reduce home deliveries, and counselling sessions provided to new mothers at provincial hospitals have contributed to better maternal and neonatal health outcomes,” says Sachin Yadav, obstetrician-gynaecologist at Malangwa Provincial Hospital. SAFE MOTHERHOOD Newborns with birth asphyxia, tachycardia, meconium aspiration syndrome and other complications are admitted to the special newborn care unit at the Gaur Provincial Hospital. But Apsana Khatun, chief nurse at the hospital’s maternal and neonatal unit says: “We have not been able to provide neo-natal care as effectively because we do not have an NICU.”&nbsp; Provincial hospitals provide life-saving services, but remain underfunded and in need of life-saving equipment. At the Gaur Hospital, Rukmini Kumari Shah gently rocks her three-day-old son, who was admitted to the special newborn care unit due to birth asphyxia and dehydration.&nbsp; “I have not even been able to think of a name for him,” says the 25-year-old. “My other two children were born normal but I worry for this one.”  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260312120328_2736dbc7660fdb60d928df22b387d084a244607126567e5cbf37235177d1ac3c.jpg" data-media-id="editor_7" data-image-id="20260312120328_2736dbc7660fdb60d928df22b387d084a244607126567e5cbf37235177d1ac3c" data-rendition-name="original" width="3000" height="2000" loading="lazy" alt="maternal health"> <figcaption>Gaur Provincial Hospital.</figcaption> </figure>  This is where the election pledge of the RSP will be tested. Will the new government cut through the bureaucracy, corruption and resource constraints to provide life-saving services to mothers and babies in places like Rautahat and Sarlahi? There has been no maternal mortality at the Malangwa Provincial Hospital for the last two years, but the hospital has had neonatal deaths. “We need more spacious waiting areas and training for maternal and neonatal healthcare workers,” says Sachin Yadav. “Without that we are unable to serve our patients and have to send them to Kathmandu or Birganj.” In Baudhimai village, patient numbers have increased by 140% in the last three years, but the federal government slashed the health budget by 60%. The government across three levels is supposed to provide 98 types of essential medicine free of cost at primary healthcare centres, but the federal and provincial governments often fail to make their share of the drugs available.&nbsp; “Federal and especially provincial governments have been irresponsible when it comes to investing in local healthcare,” says Baudhimai mayor Pradeep Kumar Yadav. Health workers and institutions continue to work without being paid or funded when the budget remains frozen for months at a time. “It does not matter to a patient when the fiscal year begins,” says Sachin Yadav at the Malangwa Provincial Hospital. “Maternal deaths do not wait for the budget to be released.” And despite budget constraints, political posturing still continues. At local levels, officials build multiple birthing centres in each ward when one would suffice, and these buildings remain empty.&nbsp; Politics also plays a significant role in whether or not local officials are willing to agree when health officials try to refer pregnancy-related complications to better-equipped facilities. And while services have improved due to the efforts of dedicated healthcare officials, they are transferred from one place to another at the whim of governments that come and go, which means staff turnover in these institutions is very high, affecting consistent service delivery. &nbsp; Yadav has been at Malangwa for three years— during which yearly institutional deliveries have gone from 2,000 to 3,200 and C-section births have gone from 150 to 700. He had just begun to hit his stride at the hospital when he received transfer letters to another hospital.&nbsp; So far, he has managed to hold on to his position in Malangwa, but he does not know how long he will be able to delay the transfer. &nbsp;&nbsp; <h2>Tackling patriarchy</h2>  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260312120328_7df47f32c19a10cd59efbd7e2639a1b719bd4f6ca50bfa24189c8ecc65f21d09.jpg" data-media-id="editor_8" data-image-id="20260312120328_7df47f32c19a10cd59efbd7e2639a1b719bd4f6ca50bfa24189c8ecc65f21d09" data-rendition-name="original" width="1850" height="3000" loading="lazy" alt="maternal health"> </figure>  Nepal has made dramatic progress in reducing the maternal mortality rate (MMR) from 539 per 100,000 births to 142 over the past 30 years. But that is the national average. MMR is still high in parts of Nepal where access to healthcare and adoption of health services are not as extensive. One reason is that despite birthing centres and awareness of pre- and post-natal healthcare, s<a href="https://nepalitimes.com/here-now/the-slaughter-of-our-daughters">ocio-cultural norms in a patriarchal society</a> also mean that female literacy remains low, and the rate of underage marriage is high.&nbsp; Rautahat has the lowest literacy rate in Nepal, and the lowest female literacy rate. This has a direct correlation with its its fertility and maternal mortality rates. Gaur Hospital continues to see maternal and intrauterine fetal death (IUFD) deaths due to a lack of ANC visits by patients. In the absence of education and information, socio-cultural misconceptions still persist. Women refuse to take essential pre-natal medication like folic acid because they think it will affect their babies’ complexion, and do not eat enough fruits because they believe it will cause fetal pneumonia.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260314020348_2ce41f5b625cb005b9477861d0c208e806601ce7eaa804d525030282675e3856.jpg" data-media-id="editor_10" data-image-id="20260314020348_2ce41f5b625cb005b9477861d0c208e806601ce7eaa804d525030282675e3856" data-rendition-name="original" width="377" height="367" loading="lazy" alt="Motherhood in Madhes"> </figure>  Women are also expected to get through their pregnancies without going for health check ups in keeping with the tradition of their mothers and mothers-in-law enduring pregnancy and childbirth at home without access to healthcare. Maternal and neonatal health outcomes are also affected by child marriage, as well as the patriarchy-enforced preference of a male child in the family.&nbsp; At Gaur Provincial Hospital, 25-year-old Asha Kumari stands with her hands braced against the hospital bed as she is gripped by a contraction. Her eldest child is already 12, and she is at the hospital to have her fifth baby.&nbsp; “She had already had two children by the time she was 18,” explains her mother, who is here with Asha’s mother-in-law. &nbsp; Officials worry that reporting instances of child marriage might mean that women no longer trust health workers and hospitals, and stop accessing healthcare altogether. They insist that investment in maternal health needs to be accompanied by socio-cultural interventions. <div class="embed-block"><div><div style="left: 0; width: 100%; height: 0; position: relative; padding-bottom: 56.25%;"><iframe src="https://cdn.iframe.ly/api/iframe?url=https%3A%2F%2Fwww.youtube.com%2Fembed%2FtVA--CRk3nM%3Fsi%3DJtFs6cwqOhJua9NI&key=87ca3314a9fa775b5c3a7726100694b0" style="top: 0; left: 0; width: 100%; height: 100%; position: absolute; border: 0;" allowfullscreen scrolling="no" allow="accelerometer *; clipboard-write *; encrypted-media *; gyroscope *; picture-in-picture *; web-share *;"></iframe></div></div></div>

Motherhood in the Madhes

Nepal’s new political wave has been described in many ways: a generational shift, a technocratic shift, a shift in ideas, and a shift in political behaviour. Young leaders now sit in Parliament, many with international education and policy experience.
But amid this excitement, a quieter truth risks getting lost: this political transformation is also the ascent of people who, until recently, were the grassroots themselves.
For the first time, many of the people now sitting in government are not distant elites. They are people I have marched with, argued with, worked with, and been inspired by for more than a decade.
They are people who once stood ankle‑deep in floodwaters, not in front of press conferences. As optimism rises around the new government, we must not forget that the climate crisis has not slowed down. 
The monsoon is at our doorstep again. And if the disasters from previous years taught us anything, it is that climate impacts do not wait for political transitions. And our mountains and rivers do not care who sits in Singha Darbar.
What is different this time is who holds power.
During the <a href="https://nepalitimes.com/opinion/flood-of-despair" target="_blank">September 2024 floods in Kathmandu</a>, the first responders were not the state or development machinery. It was ordinary young people. A loosely formed WhatsApp network coordinated everything from dispatching mountain bikers to landslide‑stranded areas, to pooling relief supplies, to delivering materials to army bases for airlifting. These were citizens acting out of necessity, not mandate.
Many from that very network are now part of the government. As I have argued before in Nepali Times, top‑down climate responses in Nepal have always been too little, too late, and too disconnected from lived experience. The only proven path is bottom‑up, community-led adaptation where those who face the risks daily shape the solutions. 
International research backs this: community-based adaptation has been central to success stories from Bangladesh’s cyclone shelters to Vietnam’s mangrove restoration to the Philippines’ barangay disaster committees. The world has repeatedly learned that resilience grows from the ground up, not the top down.
RARE MOMENT
Nepal now has a rare political moment where people with lived experience of crisis sit in positions of authority. The real test is whether this lived experience becomes policy and immediate action.
The expectation should not be that these new leaders deliver because of their degrees. It should be because they remember where they come from and use their privilege to strengthen and fund local institutions, networks and people who kept this country functioning long before governments did.
The monsoon that starts in June will test the government’s commitment to governing from the bottom up. Will these new leaders govern the way they once volunteered — listening first, acting fast, improvising where needed, and involving those closest to the danger? Or will the weight of the state push them back toward the familiar comfort of top‑down plans and consultant reports?
The challenges are complex. <a href="https://nepalitimes.com/opinion/comment/a-pre-monsoon-deja-vu" target="_blank">Climate change is driving displacement</a>, deepening poverty, and exacerbating gendered vulnerabilities. Climate adaptation, therefore, needs cross-sectoral solutions that understand how these issues intersect.
Long-term transformation is essential. Our major cities like Kathmandu desperately need a future where rivers are protected instead of mined, where an urban forest cools our heat‑trapping city, and where mobility focuses on sustainability, not just shiny EVs. Our mountain villages and terai lowlands deserve a community resilient to climate impacts, with livelihoods protected.
These require years of work. But immediate, life-saving measures cannot wait.
Will the government finally rein in the sand mining and quarrying upstream of the Rosi and Nakkhu Khola? Will someone sit down with the communities on the riverbanks and listen to the early warning signs they’ve learned through pain? Will climate adaptation be prioritised amidst political noise and competing crises?
Or will we find ourselves, yet again, mourning damage that could have been prevented? I have been inspired by many of the individuals now in government — they questioned old hierarchies, challenged worn‑out norms, and believed that things could be done differently. 
But while the faces in Parliament have changed, the bureaucracy has not. Development organisations and civil society groups have not. And those systems are slow: too slow for the speed at which our climate is changing.
So something has to give. And that shift must begin with remembering where this political movement came from: the grassroots. Those now in power must not forget the urgency they once carried in their bones. They cannot forget the feeling of wading into murky floodwater, holding a bag of rice over their heads. 
And it is our responsibility — mine <a href="https://nepalitimes.com/news/turning-green-policies-into-greenbacks" target="_blank">as a writer</a>, yours as a reader, and ours as citizens — to remind them. The real spark for <a href="https://nepalitimes.com/opinion/measuring-climate-impact-on-culture-and-heritage" target="_blank">climate action</a> comes from personal stories of loss, fear, survival, and solidarity. And suddenly, those stories are no longer outside the halls of government. They are inside.
The question is no longer whether our leaders understand the stakes. They do. They lived it. The real question, as the skies grow heavier again, is this: What will we do with this moment?
<a href="https://nepalitimes.com/opinion/comment/a-pre-monsoon-deja-vu">Rastra Raj Bhandari</a> is a co-founder and fellow at the Himalayan Water Project, where he leads the research on climate finance opportunities for the Himalaya. He contributes regularly to Nepali Times on climate change.

Soon, the monsoon

The sense of sight is front, centre, and everywhere else as hundreds of eyes follow visitors while they move from one painting to the next at Nikhil Bahadur Shakya’s ongoing exhibition at Siddhartha Art Gallery. Shakya has used blank canvases as well as partially-done thangka and paintings as a base for more than 50 works on display. The exhibit takes visitors beyond the physical world into a surreal spiritual realm. Shakya strips the human body down to muscle, tendon, networks of nerves, and skeleton. But all the while, eyes are a constant presence.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026031708034_dddbfedc57433dc528fbf032642abea4ee67e63875091b06a7804cecdc7716cf.jpg" data-media-id="editor_0" data-image-id="2026031708034_dddbfedc57433dc528fbf032642abea4ee67e63875091b06a7804cecdc7716cf" data-rendition-name="original" width="1080" height="720" loading="lazy" alt="Nikhil Bahadur Shakya"> <figcaption>Artist Nikhil Bahadur Shakya with a visitor.</figcaption> </figure>  The central theme is self-reflection and the journey from one’s outward to inward self, and the works offer a glimpse into the artist’s world of mindfulness.&nbsp; Shakya grew up watching his artisan grandfather design jewellery, which he says cultivated in him an interest for art. During the Covid-19 pandemic, confronted by the fragility of life and the stark reality of death, his art took an introspective turn. The paintings have splashes of neon yellow, pink, red, orange, green, and gold, and Shakya combines them with black and white to create the human body, sunflowers, geometrical shapes, and the cosmos — turning these motifs into elements of devotion and spirituality. In Wheel of Life, Shakya adds to an incomplete thangka, contrasting traditional Buddhist devotional imagery with contemporary mosaic art to create a demon holding on to a wheel with a yin and yang symbol.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026031708034_f2a8e10c73aa83a67e5de06a3f0acff9aa35c1cda278b36fed76ed03e71a7014.jpg" data-media-id="editor_1" data-image-id="2026031708034_f2a8e10c73aa83a67e5de06a3f0acff9aa35c1cda278b36fed76ed03e71a7014" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Nikhil Bahadur Shakya"> <figcaption>Wheel of Life (centre)</figcaption> </figure>  “I wanted to reflect the elements of life and the balance of good and bad in this painting,” explains Shakya. “I took a lot of time to complete this particular piece, but it felt as though my vision flowed out of the brush onto the canvas.” The neon colours used means that visitors can see his artwork under blue light as well, giving viewers a chance to look at a single artwork from two different perspectives. His Sunflower series draws from a field of blossoms, and the eyes stare back at visitors in an almost-hypnotic gaze. In An Ancestral Visit, Shakya goes transcendental to depict the connection of living beings to their forebears.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026031708038_0fbe465b3af872d04f699030ba093d97aad182221730aef535dbf7d059fb57cf.jpg" data-media-id="editor_2" data-image-id="2026031708038_0fbe465b3af872d04f699030ba093d97aad182221730aef535dbf7d059fb57cf" data-rendition-name="original" width="1500" height="1431" loading="lazy" alt="sunflower painting"> </figure>  “In my father’s last days, he was unwell and often unable to eat, it left his body very frail,” explains Shakya. “An Ancestral Visit was inspired by a dream in which I saw my father as his former healthy self. That dream made me feel deeply connected to my ancestors.” In another one of his works titled Devotion, a woman prays to a Shivalinga against a background of red-and-white stripes, which was inspired by the tradition of women being at the forefront during religious and spiritual ceremonies.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026031708038_75e30a4fd339257fbc108e3a326f732fd33d25af0428add0d305b8b7824c558c.jpg" data-media-id="editor_3" data-image-id="2026031708038_75e30a4fd339257fbc108e3a326f732fd33d25af0428add0d305b8b7824c558c" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="devotion"> <figcaption>Devotion</figcaption> </figure>  In Sunyata, which shows a skeletal figure meditating as they are surrounded by flames, Shakya captures the chaos of the outside world with peace of the inner self. Shakya was compelled to create Sunyata when he saw a monk, his body thin and face gaunt, meditating peacefully. “Many viewers might find the painting frightening, but when they take it home, I think it will give them strength whenever they feel like they need it,” says Shakya. The exhibit also includes a gigantic painting of Masan Bhairav spread across two canvases, capturing the majesty of the original work housed at Banepa’s Chandeswori Temple. Shakya met the artist who painted it, and asked to reproduce it.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026031708034_0216eac587827b02982f5addbd67c6f852fd7f9f47b477267ea7430d5f862a9b.jpg" data-media-id="editor_4" data-image-id="2026031708034_0216eac587827b02982f5addbd67c6f852fd7f9f47b477267ea7430d5f862a9b" data-rendition-name="original" width="1500" height="1030" loading="lazy" alt="art review"> </figure>  Geometric figures are another recurring motif on Shakya’s creations, which he says were inspired by mathematics textbooks from his school days. He says, “Art channels the strength of our minds and brings about change in our lives. My paintings reflect the fact that we are all made up of some madness, magic, and love.” Journey to a Visionary Artworld by Nikhil Bahadur Shakya Siddhartha Art Gallery, Baber Mahal Till 6 April 11AM-5PM

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