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.

original

674x448

610x380

500x500

400x266

400x240

400x203

301x200

1250x600

1084x550

thumbnail

viewImage

The healer of far-western Nepal

<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022120710124/639057b99c7e80680e0ce16djpeg.jpg" alt="" width="4509" height="4147"/>When people who have gone on to devote their lives to public service are asked who has been their greatest inspiration while growing up, many cite parents, teachers or spiritual gurus.For Nepal’s noted paediatric orthopaedic surgeon Ashok Banskota, the inspiration was an author few today have heard of, and a book even fewer have read: Adventures in Two Worlds the 1952 biography of Scottish doctor and novelist <a href="https://en.wikipedia.org/wiki/A._J._Cronin">A J Cronin</a> and his dual career in a Welsh coalmine.“The story of a medical doctor rushing about in a motorcycle to treat miners somehow left a powerful imprint in my mind,” says Banskota, recalling days spent in the library of St Xavier’s School in Godavari in the 1960s where Jesuit teachers also inculcated values of service, integrity and perseverance.Those ideals have been the guiding principles of the Nepali surgeon who was awarded the <a href="https://www.sicot.org/">SICOT</a> TKS Gold Medal for Outstanding Work by an Orthopaedic Surgeon in a Developing Country at a ceremony in Kuala Lumpur. The prize is given by the Brussels based SICOT (Société Internationale de Chirurgie Orthopédique et de Traumatologie) and named after the veteran Indian surgeon T K Shanmugasunderam.This is just the latest of many awards Banskota has been conferred over a career lasting nearly 50 years. After getting his MBBS from the All India Institute of Medical Sciences (AIMS) in Delhi, Banskota went to the United States where he did his specialisation in various hospitals including Johns Hopkins.He came back to Nepal in 1977, where he had to pull powerful strings to get appointed as a ‘medical officer’ at Bir Hospital because officials would not recognise his American degree. After being discouraged and given the run-around, Banskota recalls tearing up his appointment letter in disgust.“Come hell or high water, I made up my mind never to work for an outfit that was so unmotivated in a place where the need was so great,” he says.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022120710124/639057bf9c7e80680e0ce16ejpeg.jpg" alt="" width="4200" height="2800"><figcaption>HRDC children.</figcaption></figure>Banskota then volunteered at Shanta Bhawan as a paediatric surgeon under Archie Fletcher, and felt that he had finally found his calling in life – helping children from underprivileged families who could not afford treatment. After Shanta Bhawan merged with Patan Hospital in 1982, Banskota turned down an offer to join Fletcher in Seattle, and continued volunteering at Anandaban leprosy hospital doing hand reconstruction, and at the Scheer Memorial Hospital in Banepa.It took another seven years of fund-raising and painstaking preparation for Banskota to finally set up his dream project: the Hospital and Rehabilitation Center for Disabled Children (HRDC) in Banepa in 1992.“As a young surgeon looking for challenges, I couldn’t have asked for more,” Banskota recalls. “The plight of the children was heart-breaking, and the personal sense of fulfilment of having the privilege to make them better was the greatest reward I could have. Yet, there was so much more to do and so little to do it with.”The hilltop facility in Banepa was also a great escape from the grime and congestion of Kathmandu for Banskota, who was working on a parallel project to set up the private B&amp;B Hospital with fellow-physician Jagdish Lal Baidya.Juggling two jobs was not easy, when not supervising construction and overseeing administrative work, he was operating nearly non-stop in the surgery from early morning till late at night. “I did not have much of a family life,” he admits.HDRC offers free medical care for children with congenital and <a href="https://www.nepalitimes.com/here-now/its-an-emergency-nepal-needs-to-improve-trauma-care/">trauma-related disabilities</a>, infections in its six operating theatres, and offers <a href="https://www.nepalitimes.com/here-now/injured-use-internet-to-reach-physiotherapists/">physiotherapy and rehabilitation</a>. Since the children are away from home for so long, the hospital also runs a school so they do not miss out on studies.This is a unique model, where a private city hospital supports a <a href="https://www.nepalitimes.com/latest/step-by-step-for-rural-health-care-in-nepal/">rural charity facility</a>. Besides Banepa, HRDC also runs a Community Based Rehabilitaiton program with four satellite centres and mobile clinics all over Nepal. In the past nearly 40 years, HRDC has changed for the better the lives of 105,000 children, nearly half of them female.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022120710124/639057c29c7e80680e0ce16fjpeg.jpg" alt="" width="1200" height="1600">More than in Nepal, it appears that Banskota’s contribution is recognised internationally. Besides the recent SICOT TKS Award from the World Orthopaedic Concern, Banskota has received the <a href="https://worldofchildren.org/honoree/ashok-banskota/">World of Children Health Award in 2011</a>, the Stars Impact Award in 2014 and a citation in 2016 from the World of Children Hero Award.HRDC even employs former patients like Juddha Nepali on whom Banskota performed hip surgery when he was 13 years old in 1992. Today Nepali is a technician in the prosthetic department. He says, “There is a place in Nepal where children with physical disability can receive world-class treatment irrespective of their caste, ethnicity or economic status. I am a living example of that.”Sumitra was born in remote western Nepal with scoliosis, a deformity on her back and was often stigmatised by peers. A visiting HRDC mobile clinic came to her village, and took her to Banepa for spine surgery. Sumitra’s life has been transformed: she finished college, passed her civil service exam and now has a government job.HRDC’s Community Based Rehabilitation has conducted more than 30 camps in 22 districts all over Nepal, operating and offering post-operative physiotherapy to nearly 30,000 patients just in 2021.Ashok Banskota is not one of those flashy, flamboyant surgeons who craves celebrityhood. Even at age 74, he is more at home in his clinic or operating theatre, but is now devoting more time mentoring a new crop of surgeons and health workers, and trying to inculcate in them the same sense of commitment to public service that motivated him all his life.And when he needed spine surgery himself recently, he got the doctors he trained to operate on him in his own hospital. He says, “Whatever is good enough for my patients is good enough for me.”Read more: <a href="https://www.nepalitimes.com/banner/taking-wealth-out-of-health/">Taking wealth out of health</a>, Anita Shrestha

A life devoted to healing

<figure><img width="640" height="495" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221107161120/636922529c7e80680e03a120jpeg.jpg" alt=""/><figcaption>Goma Dulal participates in a rally marking International Wheelchair day.</figcaption></figure>If you can find time, do go to Jorpati to visit <a href="http://archive.nepalitimes.com/news.php?id=6946#.W5-Qc84zaUk" target="_blank" rel="noopener">Goma Dulal</a> who has just got an electric trolley to help her move about.I first met Goma 16 years ago, when the <a href="https://www.sirc.org.np/" target="_blank" rel="noopener">Spinal Injury Rehabilitation Centre</a> was being established at the Khagendra Nabajiban Kendra precincts in Jorpati. Capable of speaking but motionless other than the ability to move her hands, Goma was resident of the next-door facility known as the Ryder Cheshire Homes, which housed <a href="http://archive.nepalitimes.com/news.php?id=4956#.W5-QqM4zaUk" target="_blank" rel="noopener">differently-abled people</a>.Goma was always there to provide encouragement and good cheer to our fledgling organisation, which she and others began referring to simply as ‘Spinal’. After about five years, ‘Spinal’ moved to Kavre, but Goma has always followed our progress keenly.She was born in 1968, the second of five siblings, the eldest being a brother. When she was about 10, Goma began experiencing difficulty standing or walking. Her mobility worsened progressively, but the hospital only gave palliative care. The elbow and knee joints started swelling, and before long Goma was confined to bed.It was only in 1990 of orthopedic surgeon <a href="http://archive.nepalitimes.com/news.php?id=18607#.W5-SyM4zaUk" target="_blank" rel="noopener">Ashok Banskota</a> diagnosed Goma’s condition as Multiple Rheumatoid Arthritis, where there is no prevention, nor cure, only ‘management’.Banskota lobbied and found Goma residency at the Ryder Cheshire Homes, where she has lived for two decades. As the disease progressed relentlessly, Goma was moved from wheelchair to ‘wheel-bed’, a kind of trolley meant for those who cannot move, only lie supine. All these years, she relies on others for bodily care, to be wheeled in and out, and to be fed. <figure><img width="640" height="390" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221107161120/636922549c7e80680e03a121jpeg.jpg" alt=""><figcaption> </figcaption></figure><img width="640" height="471" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221107161120/636922579c7e80680e03a122jpeg.jpg" alt="">Goma’s mother has been gone now for a decade, her father died five years ago. Since then contact with her brother and sisters have been sporadic, and limited to phone conversations which requires a friend to secure her cellphone on the pillow to Goma’s ear.Her body is hard as rock, the limbs little more than bone and skin. And yet in Goma’s eyes there is a shine and a sweetness in her tongue. Her refuge is music on the radio.One of Goma’s most prized moments was the concert by <a href="http://archive.nepalitimes.com/news.php?id=19310#.W5-SBM4zaUk" target="_blank" rel="noopener">Amrit Gurung</a> and his folk-rock band <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/Nepali-times-buzz-nepathya,581" target="_blank" rel="noopener">Nepathya</a> at the Khagendra Nabajiban Kendra compound. Goma looks forward to Fridays to hear the singer and lyricist Kumar Poudel, who volunteers his time to entertain the residents. “I would die if I did not have music in my life,” she says.The last four decades have weakened Goma considerably, and the one-size-fits-all treatment of residents does not do justice to her growing needs, including a specialised diet. But what has bothered her most is her decreasing mobility even in her manual trolley: “I have to shout for someone to move me, and it is frustrating that help is not always available.”A year go, Goma asked her friends from ‘Spinal’ in Kavre to get her a bijuli trolley with a joystick control. “I am tired of asking help to be moved in and out,” she told them. They ordered an electrical trolley, with battery, motor and steering from India, and it has now cleared customs, undergoing tests, and will soon be in Goma’s hands.Goma prizes her moments with visitors and she likes making new friends, learning new things. Her spirits are high, even as her body gets weaker. Do visit Goma Dulal in Jorpati. She will be wheeling herself out in her newly acquired bijuli gadi to greet you.Read also:<a href="http://archive.nepalitimes.com/news.php?id=6946#.W5-Qc84zaUk" target="_blank" rel="noopener">Standing up to spinal injuries</a>, Hemlata Rai<a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/the-wheel-of-life,4157" target="_blank" rel="noopener">The wheel of life</a>, Sanjeev Sharma

An electric trolley for Goma

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

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

Every earthquake, even a minor one, shakes <a href="https://nepalitimes.com/banner/clash-of-cultures-in-bhaktapur">Bhaktapur</a> more severely than other parts of <a href="https://nepalitimes.com/banner/time-capsule-of-kathmandu">Kathmandu Valley</a>, and <a href="https://nepalitimes.com/here-now/nepal-s-traditional-seismic-resistant-designs">seismologists</a> attribute this to its soil structure. It was no different<a href="https://nepalitimes.com/here-now/lessons-not-learned-from-2015-o2etq6zu"> in 2015 when a 7.8M earthquake rocked central Nepal</a>. Brown dust from collapsed buildings blanketed the town like a sand storm. Even 10 years later, the scars of that disaster are all around, even though most of the monuments have been rebuilt.&nbsp; At the entrance to <a href="https://nepalitimes.com/banner/clash-of-cultures-in-bhaktapur">Bhaktapur Darbar Square</a> is the Rameswar temple, where workers are lifting bricks to repair the damage. The Vatsala Durga temple inside the palace complex collapsed, but the all-stone structure has been masterfully restored.&nbsp; The Yaksheswar Mahadev temple is encased in a bamboo scaffold. Piles of bricks and tiles &nbsp;are stacked below it. Some workers are on top of the temple, while others work on the ground mixing mortar. To the north of the Darbar Square is the Fasi Dega temple which has been rebuilt. The 55-window palace and the art museum which were damaged have also been repaired.&nbsp; The <a href="https://nepalitimes.com/news/nyatapola-alight">five-storey Nyatapola</a>, which survived both the 1934 and 2015 earthquakes, just underwent a $6.3 million renovation. In Taumadhi Square below, the Biska Jatra chariot is under construction for upcoming festivities. Some tourists are on it, posing for pictures.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250407090432_8da447f3cf32a67ba22eedda74af74a6636cd001b544a303eb8e5f8adf3115e3.jpg" data-media-id="editor_6" data-image-id="20250407090432_8da447f3cf32a67ba22eedda74af74a6636cd001b544a303eb8e5f8adf3115e3" data-rendition-name="original" width="2000" height="1284" loading="lazy" alt="Bhaktabur rebuilt 10 years after Nepal earthquake NT 1"> <figcaption>All photos: AJAY HAKAJU</figcaption> </figure>  Read also: <a href="https://archive.nepalitimes.com/article/nation/Monumental-loss,2215">Monumental loss</a> At Pottery Square, three workers sit atop an under-construction structure whittling away with chisels. Nearby houses are still supported by wooden beams. Dattatreya Square was also damaged during the earthquake, but has been renovated.&nbsp; <a href="https://nepalitimes.com/here-now/born-again-after-the-earthquake">After the earthquake</a>, the international community rushed in with offers of help. Kathmandu’s Hanuman Dhoka was restored by the Chinese, Gaddi Baithak by the Americans and various countries ‘adopted’ other monuments. But Bhaktapur declined assistance. UNESCO wanted to be involved since Bhaktapur had been a World Heritage Site since 1979. Germany wanted to help with a €10 million grant, since it had spearheaded the Bhaktapur Development Project 40 years ago.&nbsp; “We believed that we should be able to reconstruct our monuments ourselves,” says Ram Govinda Shrestha, an architect with the municipality. Indeed, Kathmandu Valley has historically rebuilt after every major earthquake with its own resources. Architect and conservationist Rabindra Puri says, “It is shameful to let someone else come in and do the reconstruction for us, especially since the manpower and material would be ours anyway. Why use money from elsewhere?”  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250407090436_7f19bc8a185c9f71404db44fba086438d6c29a3acb63a63d027cbdd4053e1b4f.jpg" data-media-id="editor_9" data-image-id="20250407090436_7f19bc8a185c9f71404db44fba086438d6c29a3acb63a63d027cbdd4053e1b4f" data-rendition-name="original" width="2000" height="1123" loading="lazy" alt="Bhaktabur rebuilt 10 years after Nepal earthquake NT 1"> </figure>  The budget for reconstruction came from the government, town entry fees, taxes, and donations. That was the easy part. But this was followed by multiple discussions between the municipality, the National Reconstruction Authority (NRA), the Department of Archaeology, and multiple stages of proposals, designs, estimations, and building. New committees had to be formed at every step. “Part of the reason why there were so many steps is because we have to let the government know that we were working as frugally as possible,” recalls Shrestha. It cost more than $200 million to rebuild the 116 heritage structures that were destroyed and damaged.&nbsp; Nevertheless, Bhaktapur stands as a model of locally sourced reconstruction in every way. Community people themselves got their hands dirty along with domestic workers and learned various aspects of reconstruction. “We showed what is possible when locals feel a strong sense of responsibility,” adds Shrestha. Read also: <a href="https://archive.nepalitimes.com/page/tourists-trickle-back-to-Bhaktapur">Bhaktapur is waiting for you</a>, Peregrine Frissell But while the monuments were rebuilt, it was not the same with residential buildings. Many of them still have cracks running down their brick façades, and some neighbourhoods are still in ruins with small trees and bushes growing from the rubble.&nbsp; More than 300 people were killed and over 2,000 wounded in house collapses in Bhaktapur. There were some dramatic rescues, including of a baby Sonish Awal who was rescued by an APF team 24 hours after being buried under the rubble.&nbsp; Sonish is now 10 years old, and his house has been rebuilt. The government vowed to ‘Build Back Better’ as fast as possible, by removing bureaucratic hurdles and grant Rs300,000 in three instalments, as well as access to loans at low interest. But things did not go smoothly.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250407090436_d503e5c966f33978abf99a0fa8307369d81bcc6a6e5d768cf88b7dee273cb6cf.jpg" data-media-id="editor_11" data-image-id="20250407090436_d503e5c966f33978abf99a0fa8307369d81bcc6a6e5d768cf88b7dee273cb6cf" data-rendition-name="original" width="2000" height="1123" loading="lazy" alt="Bhaktabur rebuilt 10 years after Nepal earthquake NT 1"> </figure>  “Bhaktapur is very dense, so there was a lot of confusion about where property lines ended, and where walls were,” says Biswanath Sujakhu, a municipality engineer. There were also disputes in families with multiple sons who had stakes in the house, as the act treated them as a single household.&nbsp; Many of the disputes have not been resolved yet, which is why there are so many ruins. &nbsp;Homeowners who chose to remake their houses to look traditional were promised further subsidies of up to Rs300,000, but even that was not enough to pay for the Rs5 million or so needed to build a multi-storey cement structure.&nbsp; Banks weren’t giving loans easily, and multiple changes to the NRA chief meant the grants were not easy to access. Many residents took high-interest loans from local cooperatives. Or they were forced to undersell their land plots. “Bhaktapur also had restrictions about the styles and height of buildings, but many houses didn’t comply as people could only work with the money they had at the time,” adds Sujakhu. Nepal Vocational Academy, established by Rabindra Puri two years before the earthquake in 2013, played a crucial role. The academy produced enough masons, woodcarvers, and stone carvers so that there wasn’t a shortage. The students were also involved in <a href="https://archive.nepalitimes.com/regular-columns/guest-editorial/guest-editorial-better-late-than-never,891">reconstruction efforts</a> across the country. Puri has just one gripe: “A lot of old houses that were perfectly fine were torn down for no reason. Those houses are 200-300 years old and could have been restored instead of being reconstructed.” &nbsp; Read also: <a href="https://nepalitimes.com/here-now/in-with-the-old-in-nepal">In with the old in Nepal</a>, Shriluna Shrestha

orthopedics

The healer of far-western Nepal

A life devoted to healing

An electric trolley for Goma

What is invisible is more dangerous

New year revolutions

Bhaktapur 2.0

82 in २०८२