<figure><img width="640" height="427" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121140/636b91e29c7e80680e06f117jpeg.jpg" alt=""/><figcaption>Photo: AMIT MACHAMASI</figcaption></figure>Nepal’s oxygen emergency <a href="https://www.nepalitimes.com/latest/why-is-there-still-an-oxygen-shortage/">has eased somewhat as the Covid-19 second wave crests,</a> but the crisis exposed serious gaps in the supply and distribution of medical oxygen with major implications for the future.At the peak of the second wave, many Covid-19 patients died as hospitals ran out of oxygen, but with an<a href="https://www.nepalitimes.com/latest/leading-public-figures-call-on-uk-government-for-oxygen-for-nepal/"> overwhelming international response </a>to rush cylinders, concentrators and generators, there is now the risk of over-capacity of medical oxygen post-pandemic. Nepal’s demand for oxygen cylinders shot up to 50,000 per day during the peak of the second wave in May, with the country’s oxygen factories and hospitals <a href="https://www.nepalitimes.com/here-now/its-an-emergency/">only able to fill 19,000 cylinders every day</a>. In contrast, pre-wave calculations had suggested that peak daily demand would only be about 6,000 cylinders.  <img width="640" height="338" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121140/636b91e49c7e80680e06f118jpeg.jpg" alt=""><img width="640" height="319" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121140/636b91e79c7e80680e06f119jpeg.jpg" alt="">Most of the 29 oxygen factories in Nepal were working at only half capacity pre-pandemic because of low demand. In fact, three of them had closed down. As the second wave hit, the plants went into full-scale production, but a shortage of cylinders meant that the excess production could not be sent to hospitals.Meanwhile, factories relying on liquid oxygen tankers were affected by an Indian ban on export. Empty cylinders from China, Oman and other countries alleviated the shortage somewhat, while oxygen plants grappled with increasing generation capacity. <figure><img width="640" height="361" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121140/636b91ea9c7e80680e06f11ajpeg.jpg" alt=""><figcaption> </figcaption></figure>Too little too lateWhen the inter-ministerial Covid-19 Crisis Management Center (CCMC) finally reacted, it was too late. Its arbitrary quota system for every hospital proved disastrous.“The quota resulted in hard-hit hospitals being undersupplied and safer hospitals being unnecessarily saturated with cylinders,” explains Roop Jyoti, former chairman of Grande City Hospital, suggesting the problems lay in supply chain management rather than oxygen production. Faced with mounting criticism for bungling the oxygen quotas, the Health Ministry resorted to micromanaging, and ordered suppliers to only send filled cylinders to hospitals that had its recommendation letter. The result was catastrophic, many<a href="https://www.nepalitimes.com/here-now/helping-nepalis-breathe-again/"> hospitals were either forced to refuse service</a> or they asked families of patients to bring their own full cylinders.In a notice posted in mid-May, Kathmandu’s Om Hospital said: ‘Under the capping made by the government on oxygen supply, we are unable to take admissions despite our willingness to provide service. We have enough manpower such as doctors and nurses to take care of patients but not enough oxygen supply.’ Families with Covid-19 patients hoarded full cylinders at home, and desperate ones rushed to the gates of oxygen factories to buy the life-saving gas. Municipalities, especially in areas with spare capacity, prevented the transport of oxygen beyond district borders.Most of Nepal’s oxygen plants are in central and eastern Nepal. The Morang-Sunsari industrial corridor alone had five large oxygen factories with surplus capacity, but these were prevented from sending supplies to hospitals in Kathmandu and other areas with shortages. Lack of training in oxygen flow management and ventilator use did not help matters. Makeshift local isolation centres with non-medical staff were using full flow to treat patients with mild symptoms. Hoarding and black marketing was rampant, and while large hospitals ran out of oxygen supply, local isolation centres had one cylinder per patient.In Grande International Hospital, there was a 30% drop in oxygen demand when doctors were more judicious in oxygen use. Still, the shortage was serious enough for some doctors to ration oxygen even for their most serious patients. Others had to make the difficult choice between continuing to put patients who had little chance of survival on oxygen, or to give it to those who would immediately recover with oxygen. Even before the pandemic, government oversight on cylinders was non-existent with no standardisation or regulation in place regarding colour coding, pressure, price rates and deposits on oxygen cylinders.  “I used to get desperate calls at 3am from families of patients desperate for oxygen. We were able to call up spare capacity during the second wave, especially in the east of the country, but the shortage of cylinders for refilling did create a temporary shortage,” says Gaurav Sharda of the Nepal Oxygen Industries Association (NOIA). <figure><img width="640" height="427" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121140/636b91ed9c7e80680e06f11bjpeg.jpg" alt=""><figcaption> </figcaption></figure>After the peak With the first week of June, Nepal’s Covid-19 curve started flattening with hospitals in Kathmandu and major cities seeing fewer patients who needed to be on oxygen or in ICU. “Compared to the devastating shortages in April and May, oxygen availability is relatively stable,” says Anup Bastola, a physician at Teku Hospital. The Ministry of Health also seems to have learnt from its mistakes, and is ensuring a more equitable supply of cylinders. Donated oxygen concentrators are now being flown to district hospitals where they are needed. However, even as demand for oxygen goes down, <a href="https://www.nepalitimes.com/here-now/nepals-diaspora-comes-to-the-rescue/">overseas Nepalis and international donors</a> are still rushing empty cylinders, concentrators, generators and liquid oxygen tanks on relief flights to Kathmandu. There are more oxygen generator plants arriving from France, the US and China this week. Ventilators from <a href="https://www.nepalitimes.com/latest/international-help-for-nepal-picks-up/">international donors</a> are sitting idle at some district hospitals in western Nepal because no one knows how to operate them. Domestic oxygen production itself is now reaching 100% capacity. Even though there is a challenge of logistics, equitable distribution, and cost, Nepal will soon have more oxygen than it needs. What the government needs to focus on is getting much-needed <a href="https://www.nepalitimes.com/latest/life-hangs-by-an-oxygen-tube-in-nepal/">oxygen to rural areas</a> where the virus is spreading house-to-house.  The flood of donated oxygen generators now means that there will be domestic over-capacity just as there was before the second wave. Nepal’s oxygen sector therefore needs to balance supply to meet demand surges and periods of low consumption.Explains Jyoti: “Ironically, many new donated oxygen plants are being set up in hospitals in response to the second wave, so when this passes, there will be tremendous over-capacity. Regular factories would probably have to function at less than 25% capacity and will be destroyed financially.”At Teku Hospital, Bastola says <a href="https://www.nepalitimes.com/banner/two-nepals-in-the-death-zone/">repurposing oxygen equipment</a> could help Nepal prepare for future spikes. If there is a third wave this autumn, for example, demand would go up again. Besides Covid-19, there is also the pre-existing need for oxygen to treat the rise in respiratory ailments such as COPD and heart disease caused by worsening air pollution. Says Sharda at NOIA: “One of two scenarios can now play out. The government could either continue its reliance on donated oxygen generation equipment, thereby driving Nepali producers out of existence, or it could encourage sustained domestic production to meet a spike in demand during future outbreaks.” Last month, reports of Pressure Swing Adsorption (PSA) oxygen plants failing in hospitals, and a CCMC finding of 70% oxygen leakage in many hospitals were overlooked. These issues are structural and if resolved can help alleviate future shortages.“The government’s approach to oxygen distribution was myopic,” says Sharda. “Oxygen is a basic product and can easily be bottled here. But they failed to consult with us producers, and now all this oversupply from abroad will jeopardise our ability to respond to future outbreaks. Plant staff should also be <a href="https://www.nepalitimes.com/banner/nepals-life-or-death-o2-quest/">treated as frontline workers</a> and have vaccinations.” The government and CCMC failed to acknowledge that assistance was needed in the oxygen supply chain rather than production, and by allowing import of production equipment but bungling on supply management, they failed to take into account domestic generation capacity, thus increasing vulnerability in the future.  The only solution to prevent another oxygen crisis is to stop the problem at the source, by <a href="https://www.nepalitimes.com/here-now/aid-pours-into-nepal-but-where-be-vaccines/">stemming the spread of Covid-19.</a> But the lesson from the second wave is that Nepal’s government, hospitals and oxygen plants need to have standby capacity at hand for future waves.

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Pandemic and the political-economy of oxygen supply

<figure><img width="722" height="482" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111152/636b86609c7e80680e06784ejpeg.jpg" alt=""/><figcaption>Photo: AMIT MACHAMASI</figcaption></figure>The flood of social media posts of <a href="https://www.nepalitimes.com/here-now/aid-pours-into-nepal-but-where-be-vaccines/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/aid-pours-into-nepal-but-where-be-vaccines/&amp;source=gmail&amp;ust=1622019280162000&amp;usg=AFQjCNFw4HGIaJzWsPjE6KDbOCN9BO71nA">donated medical supplies</a> being unloaded at Kathmandu airport every day, gives the impression that the outside world cares more about the humanitarian emergency in Nepal than the country’s own leaders.
This week proved that the <a href="https://www.nepalitimes.com/latest/nepal-sets-elections-in-middle-of-pandemic/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/nepal-sets-elections-in-middle-of-pandemic/&amp;source=gmail&amp;ust=1622019280162000&amp;usg=AFQjCNGnYd3WYcqcWZhTuAO1fDLmr6DWrw">Nepali politicians still do not get it</a>. Except for the chatting classes locked up at home, not many Nepalis follow, or care, about a dissolved Parliament, elections in November, or writs at the Supreme Court. They are preoccupied with trying to prevent relatives from <a href="https://www.nepalitimes.com/here-now/helping-nepalis-breathe-again/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/helping-nepalis-breathe-again/&amp;source=gmail&amp;ust=1622019280162000&amp;usg=AFQjCNG0TkkaP2byuZ7gTldxbjVgjSti9w">breathing their last</a>.
Prime Minister K P Oli has proven that he is not just a shrewd manipulator, but also has elastic ethics. In the past year, he has shown that he will stop at nothing: split the NCP that he himself united, dismantle his own UML, dissolve a Parliament in which he had a two-thirds majority. All is fair, it seems, in love and politics. 
Nepalis might have followed the political games in Kathmandu more closely if the alternatives to Oli inspired more confidence. But they are all tried, tested and failed ex-prime ministers themselves. The main contender Sher Bahadur Deuba of the Nepali Congress lined himself up to be PM for the fifth time, and has still not given up.
The crises due to the pandemic would have been the opportunity to form a national unity government, and work together to fight the virus. This would be the time for all the parties to skip a generation and bring up some young do-ers. That is what they may have done if this was a war. But <a href="https://www.nepalitimes.com/editorial/this-is-war/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/editorial/this-is-war/&amp;source=gmail&amp;ust=1622019280162000&amp;usg=AFQjCNEWgT9G992ZUlwbDLKjh5yVL3iW-A">this is a war</a>.
The needs are great: ensuring <a href="https://www.nepalitimes.com/here-now/its-an-emergency/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/its-an-emergency/&amp;source=gmail&amp;ust=1622019280162000&amp;usg=AFQjCNEbjbLTsFcBFUFjyD0KkohRt6dD0w">adequate oxygen supply</a>, rushing relief for the millions who have lost their income during the lockdowns, ensuring that ICU care is available and affordable to the general public, and negotiating a reliable vaccine pipeline. Preoccupied with politicking, the leaders had little time for any of this. 
Most of Nepal’s politically-appointed ambassadors overseas are more beholden to their patrons back home than to the people. With the exceptions of our female envoys in <a href="https://www.nepalitimes.com/here-now/nepals-diaspora-comes-to-the-rescue/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/nepals-diaspora-comes-to-the-rescue/&amp;source=gmail&amp;ust=1622019280162000&amp;usg=AFQjCNHqcfVevxxV6taMreBzCHkR2W-pNw">Oman and Spain</a>, other missions have not stepped up to the task of conveying the emergency like we did after the 2015 earthquake.
The oxygen cylinders and medical equipment that have arrived are mostly through donations from the <a href="https://www.nepalitimes.com/here-now/nepals-diaspora-comes-to-the-rescue/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/nepals-diaspora-comes-to-the-rescue/&amp;source=gmail&amp;ust=1622019280162000&amp;usg=AFQjCNHqcfVevxxV6taMreBzCHkR2W-pNw">Nepali diaspora</a>, citizens groups that have mobilised through social media, and friends of Nepal. 
No wonder the rest of the world does not take us seriously. When a state does not demonstrate accountability towards its own citizens, there is little trust even from governments that genuinely want to help, to provide urgently needed material. 
And there is not much the outside world can do when the malaise is within. Nepal has to resolve its own governance crisis that has messed up its Covid-19 response. 
Having said that, the international community could show more concern for the urgent need for vaccines. There are many flights bearing ventilators, concentrators, PPEs and test kits, but much vacillation on vaccines. 
Nepal is not getting the urgent help it needs to immediately vaccinate 1.4 million people whose default date for the second dose is now. On Monday, the government extended the dose gap to 16 weeks in the hope that someone somewhere will quickly send the <a href="https://www.nepalitimes.com/banner/despite-doubts-nepal-sticks-with-astrazeneca-jabs/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/banner/despite-doubts-nepal-sticks-with-astrazeneca-jabs/&amp;source=gmail&amp;ust=1622019280162000&amp;usg=AFQjCNG_KLW5M52MZ3Y7ijjHYNDTM3xYdQ">AstraZeneca (AZ)</a> vaccines we paid the Serum Institute of India for, but which were never delivered.
This is a major <a href="https://www.nepalitimes.com/here-now/nepal-is-a-priority-for-vaccine-shipments/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/nepal-is-a-priority-for-vaccine-shipments/&amp;source=gmail&amp;ust=1622019280162000&amp;usg=AFQjCNGmt0XUUHhxlq6n1BtsGFdw3YfM_w">failure of Nepal’s vaccine diplomacy</a>, but it is also India, Britain, the EU, US, the WHO that have let us down in this hour of need. We get it that vaccines are now a geo-strategic item, and countries are stockpiling it for the third wave. But some countries have enough doses to vaccinate their populations several times over, at a time when their own citizens are refusing to take AZ because of the panic over clots. 
Across France, AZ vaccines are being dumped because they are nearing expiry, the <a href="https://www.nepalitimes.com/here-now/nepal-needs-urgent-american-vaccine-support/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/nepal-needs-urgent-american-vaccine-support/&amp;source=gmail&amp;ust=1622019280162000&amp;usg=AFQjCNHGyEJVpvRxkfBu00MFW-UbFzLJxQ">United States has a cache</a> of 80 million Covid-19 vaccines, and nearly half its population refuses to be vaccinated. <a href="https://www.nepalitimes.com/latest/vaccines-are-the-only-solution/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/vaccines-are-the-only-solution/&amp;source=gmail&amp;ust=1622019280162000&amp;usg=AFQjCNF0Zuj2D_3iMclB9cP3qSBYR8nxPQ">Ship the shots </a>to people who want and need the vaccines.
We would like to see fewer Tweets of donated items that Nepal can afford to buy, and more timetables for vaccine deliveries.

Vacillating on vaccines

<figure><img width="1236" height="856" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85a09c7e80680e067804jpeg.jpg" alt=""/><figcaption>Photo: AMIT MACHAMASI</figcaption></figure><h2>1. Oxygen</h2> To save lives, Nepal’s most urgent need now is oxygen. Not just cylinders, but oxygen generators, concentrators and liquid oxygen. Most infected people are not succumbing to Covid-19, they are <a href="https://www.nepalitimes.com/here-now/helping-nepalis-breathe-again/" target="_blank" rel="noopener noreferrer">dying because of low oxygen saturation</a> in the blood, and lack of hospital beds -- patients who need not have died of coronavirus. Dire as the situation is in the cities, Nepal’s pandemic has now <a href="https://www.nepalitimes.com/editorial/nepals-humanitarian-emergency/" target="_blank" rel="noopener noreferrer">infiltrated the remotest villages</a> where there is no hospital care and no oxygen. The virus is preying on people already suffering malnutrition, previous ailments, and decades of structural state neglect. In Rolpa, Humla and other remote districts, between 80-90% of PCR tests are coming back positive, and it takes a week to get results. Patients are either not isolating, or not following precautions.Kathmandu's doctor-to-patient ratio is 1:850, but in rural Nepal it is one doctor for every 15,000 people, and hospitals and medical staff there <a href="https://www.nepalitimes.com/here-now/at-the-covid-19-frontlines-in-rural-nepal/" target="_blank" rel="noopener noreferrer">are already overstretched</a>.Close to 60% of all swabs collected nationwide are from Bagmati Province, with nearly half of them in Kathmandu Valley, says epidemiologist Lhamu Yangchen Sherpa. She adds: “There just aren’t enough tests and contact tracing is minimal, official total cases and fatalities are grossly underestimated.” <figure><img width="1497" height="746" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85a39c7e80680e067805jpeg.jpg" alt=""><figcaption> </figcaption></figure><figure><img width="984" height="519" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85a69c7e80680e067806jpeg.jpg" alt=""><figcaption> </figcaption></figure>Hospitals in Kathmandu Valley with roof helipads have multiple daily rescue flights, but even these facilities are <a href="https://www.nepalitimes.com/banner/we-knew-the-tsunami-was-approaching/" target="_blank" rel="noopener noreferrer">at breaking point</a> with patients being turned away. Understaffed and under-equipped hospitals in the districts do not stand a chance. Even where hospitals exist, many families avoid them for fear of being infected and take wrong medication from pharmacies.Case in point are recent deaths due to misdiagnosis across the country. <a href="https://www.nepalitimes.com/banner/a-shot-in-the-arm-for-vaccines-in-nepal/" target="_blank" rel="noopener noreferrer">Typhoid disease</a> simulates Covid-19 with similar symptoms, and the widespread Widal test is known to give false positives.“Covid patients are being prescribed antibiotics to fight typhoid, only to turn critically ill in a few days’ time,” says Buddha Basnyat of Patan Academy of Health Sciences. “This is the reason behind some of the latest Covid fatalities.” <figure><img width="1280" height="720" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85a89c7e80680e067807jpeg.jpg" alt=""><figcaption> </figcaption></figure>As in India, Nepal is beginning to see a slight bending of the curve for new infections, but health experts expect the fatality rate to remain high for some more time.  There were 190 Covid deaths in the past 24 hours and 6,543 recoveries. Of the total 8,305 new cases on Thursday, Kathmandu Valley accounts for 3,232 infections. 7,814 people are undergoing treatment in hospitals with 1,748 in ICU and 492 in ventilator support. “After the relentless patient pressure of the past month, we have seen a decline in those requiring admissions,” says virologist at Teku hospital Sher Bahadur Pun. “The virus has now infected a majority of people in the cities, and this combined with the lockdown means we may be getting to the halfway mark of the second wave.” <h2>2. Vaccines</h2> A prolonged lockdown is not the answer. If it was, the <a href="https://www.nepalitimes.com/latest/covid-19-numbers-slightly-down-in-nepal/" target="_blank" rel="noopener noreferrer">reduction in the number of cases and the positivity rate</a> this week would have been steeper. Even while the government tries to increase oxygen supply to hospitals, the only long-term strategy is to vaccinate at least 70% of Nepal’s eligible population.Doctors report a marked difference between the recovery of people who are vaccinated against those who are not. Says virologist Pun at Teku Hospital: “Except for a few rare cases, all patients in critical condition and those dying are the ones who for one reason or another had not been vaccinated.”But Nepal has run out of its vaccine stock, leaving 1.4 million people still waiting for their second dose of AstraZeneca Covishield in a lurch, after India banned its export, and the COVAX Facility could not supply its remaining 1.8 million vaccines to Nepal because of the global supply bottleneck.  <figure><img width="1440" height="1080" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85ac9c7e80680e067808jpeg.jpg" alt=""><figcaption> </figcaption></figure>The Nepal government and pressure groups in Nepal and the United States <a href="https://www.nepalitimes.com/here-now/nepal-needs-urgent-american-vaccine-support/" target="_blank" rel="noopener noreferrer">have strongly urged the Biden administration</a> to immediately rush some of its AstraZeneca doses to Nepal.Meanwhile, the UK, the US and Canada have authorised vaccines for use in children and adolescents, sparking outrage in the global public health community for prioritising an age group that is rarely critically affected by Covid-19. The World Health Organisation’s director-general Tedros Adhanom Ghebreyesus has urged rich countries to instead donate doses to the <a href="https://www.nepalitimes.com/latest/unicef-urges-g7-to-dispatch-vaccines/" target="_blank" rel="noopener noreferrer">COVAX Facility</a> for poorer states that have barely covered health workers and the most vulnerable groups. Speaking at the British Parliament last week, noted vaccinologist and the principal researcher of Oxford University’s AstraZeneca vaccine, Andrew Pollard, called the decision to inoculate children in wealthy nations ahead of high-risk groups in poorer countries “morally wrong.” Pollard has worked extensively in the region, leading research into the burden and transmission of typhoid in Nepal, Bangladesh and Malawi, and the impact of typhoid vaccine in these areas. He also runs surveillance for invasive bacterial diseases, and studies the impact of pneumococcal vaccines in children in Nepal.In Nepal, vaccination will grind to a halt this week after the current campaign to inoculate 300,000 people in the 18-59 age group with their second dose of the Chinese VeroCell ends.  <figure><img width="960" height="640" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85af9c7e80680e067809jpeg.jpg" alt=""><figcaption> </figcaption></figure><img width="960" height="640" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85b29c7e80680e06780ajpeg.jpg" alt=""><img width="960" height="639" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85b49c7e80680e06780bjpeg.jpg" alt="">Although <a href="https://www.nepalitimes.com/here-now/nepal-is-a-priority-for-vaccine-shipments/" target="_blank" rel="noopener noreferrer">Foreign Minister Pradeep Gyawali says</a> the government is in “final negotiations” for 2 million doses of Sinopharm VeroCell vaccines by June, there is no movement at the Ministry of Health. Ongoing talks to procure 8 million doses of <a href="https://www.nepalitimes.com/opinion/vaccine-geo-politics-and-sputnik-v/" target="_blank" rel="noopener noreferrer">the Sputnik V</a> have hit a production capacity snag in Russia. “We can implement lockdowns only for so long, the only exit strategy is vaccines. Science delivered, now our politicians must do the same,” says Buddha Basnyat, a physical at the Patan Academy of Health Sciences. “The Nepal government must procure vaccines using every diplomatic channel possible, and rich countries must realise that they are not safe until countries like Nepal are also vaccinated.” Activists have been trying to convince <a href="https://www.nepalitimes.com/latest/leading-public-figures-call-on-uk-government-for-oxygen-for-nepal/" target="_blank" rel="noopener noreferrer">the US government and Europeans</a> that Nepal has a lot of experience in successful vaccination campaigns against polio, smallpox, measles. It has over 50,000 female community health volunteers (FCHVs) reaching children with vaccines every year.  <figure><img width="1024" height="768" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85b79c7e80680e06780cjpeg.jpg" alt=""><figcaption> </figcaption></figure><img width="2048" height="943" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85ba9c7e80680e06780djpeg.jpg" alt=""><img width="1920" height="864" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85bd9c7e80680e06780ejpeg.jpg" alt="">Similarly, Nepal’s health system has amassed vast experience in maintaining the vaccine cold chain even in the remote mountains. It also has trained human resource overseeing DOTS (Directly Observed Therapy, Short-course) for tuberculosis management all over the country who can lend a hand in equitable distribution of vaccines in <a href="https://www.nepalitimes.com/latest/rural-nepal-fights-back-covid-19/" target="_blank" rel="noopener noreferrer">rural Nepal</a>.Says epidemiologist Lhamo Yangchen Sherpa: “It’s not too late, we can still use existing resources like FCHVs to better mobilise vaccination, conduct contact tracing, dispel any remaining vaccine hesitancy, and use public health professionals in prevention.”

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It’s an Emergency

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131124/636cedad9c7e80680e09adddjpeg.jpg" alt="" width="768" height="512"/><figcaption>Photo: AMIT MACHAMASI</figcaption></figure>Leading figures including Joanna Lumley, Sir Michael Palin and Sir Chris Bonington today called upon the British government to urgently send lifesaving oxygen equipment and medical supplies to Nepal. The Nepali health system has collapsed due to a massive surge in Covid-19 infections. For over a week hospitals have been turning away patients due to lack of beds, and people have died for lack of oxygen.Sir Chris Bonington said, “I have seen for myself how much the hill people from Nepal have done to help Britain over the years and how much we owe them. I do hope that our government can help them in their desperate plight.”Among those signing the open letter to the foreign secretary Dominic Raab are leading British public health specialists and vaccine researchers including Sir Jeremy Farrar, Sarah Gilbert, Andrew Pollard, Nicholas White, Adrian Hill, Peter Horby, Philippe Guérin, Alain Townsend, and Sandy Douglas.<a href="https://reliefweb.int/sites/reliefweb.int/files/resources/05142021%20Nepal%20SitRep%20C19.pdf" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://reliefweb.int/sites/reliefweb.int/files/resources/05142021%2520Nepal%2520SitRep%2520C19.pdf&amp;source=gmail&amp;ust=1621443857422000&amp;usg=AFQjCNHGoTVKycRtzWTcsv6xd8s0ntxOZQ">According to the United Nations</a> this week, “COVID-19 infections are surging at an unprecedented rate in Nepal. The country of roughly 29 million people . . . has the highest effective rate of reproduction in the world . . . With a much weaker health system than neighbouring India’s, Nepal is now at a critical juncture. Hospitals in major cities are at capacity and have had to turn patients away. . .  [there are] also by critical shortages in human resources and essential commodities such as oxygen.”Captain Ram Bahadur Limbu, one of only five living recipients of the Victoria Cross, signed the letter from his home in Kathmandu. He was awarded Britain’s highest military decoration while serving with the 10th Gurkha Rifles in Indonesia in 1965.General The Lord Richards of Herstmonceux, a former Chief of Defence Staff,  joined the appeal. General Sir Sam Cowan, former Colonel Commandant of the Brigade of Gurkhas and Chairman of the Gurkha Welfare Trust, said, “The people of Nepal are suffering badly, and the poorest the most. Our historic links with the country through Gurkha recruitment go back over 200 years.  It’s time for the UK to step up to the mark to make a major contribution to ease the suffering. We cannot do less. Time is of the essence and we need significant action now. We are already behind what other countries with less historic ties are doing.”Fifty-six leading UK figures including writers, actors, mountaineers and soldiers signed the open letter calling on the British government to act now. The letter, which is open for public signatures on <a href="https://www.change.org/p/the-rt-hon-dominic-raab-mp-uk-send-oxygen-to-nepal-now?recruiter=1205004619&amp;recruited_by_id=14e94300-b7bf-11eb-b788-f53b463e0386&amp;utm_source=share_petition&amp;utm_medium=copylink&amp;utm_campaign=petition_dashboard" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.change.org/p/the-rt-hon-dominic-raab-mp-uk-send-oxygen-to-nepal-now?recruiter%3D1205004619%26recruited_by_id%3D14e94300-b7bf-11eb-b788-f53b463e0386%26utm_source%3Dshare_petition%26utm_medium%3Dcopylink%26utm_campaign%3Dpetition_dashboard&amp;source=gmail&amp;ust=1621443857422000&amp;usg=AFQjCNFvFd1fau2SkCn3BMxm7up7V0_dNQ">Change.org</a>, calls upon “the UK government to urgently respond to the Covid-19 crisis in Nepal by airlifting critical medical supplies including oxygen plants and equipment.”“Acting now will make the difference of life or death for thousands of people. Nepal is one of Britain’s oldest friends in the world, a friendship represented by generations of Gurkha soldiers and mountaineers,” the letter reads. “We must come to Nepal’s aid now.”Sir Michael Palin wrote, “I am very happy to lend my support for the letter. They are very special people facing, once again, an extreme test of survival, and I hope we can do our best for them.”People who want to lend their support to the campaign can do so by signing the <a href="http://change.org/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=http://change.org/&amp;source=gmail&amp;ust=1621443857422000&amp;usg=AFQjCNGj60AEY7yPdJulF3DOI6UPbLBfaw">Change.org</a> petition letter and by contacting their MP to call for medical aid to Nepal.Rory Bremmer, the impressionist and comedian, said, “Whilst the devastating crisis in India has rightly caught the attention of the world, its neighbour Nepal is similarly overwhelmed, its healthcare system unable to cope on its own. Britain should stand by its long standing friend and ally in its hour of need and provide urgent support.”The Nepali government and health officials say physical supplies including oxygen plants, cylinders, oxygen concentrators and related equipment, as well as life saving vaccines and therapeutic drugs, are desperately needed. Due to the Covid emergency in neighbouring India, Nepal has not been able to buy and import equipment, medicines and vaccines needed to combat Covid-19 as it did earlier in the pandemic. The government of Nepal has shared details of the most urgent priorities with other governments, including Britain.The open letter reads: “The Nepali Health Ministry predicts that by 15 July the number of active cases will reach 800,000, resulting in ten critically ill patients for every ICU bed. Only 7% of Nepal’s population has received a dose of vaccine. The potential loss of life and economic devastation over the coming months is staggering, and preventable.”Other signatories include the actor Nickolas Grace, production designer James Acheson, and Joanna Lumley, who successfully campaigned for ex-Gurkhas to settle in the UK. The Everest summiteer and TV personality Ben Fogle, said, “I am deeply saddened and worried about the worsening health crisis in Nepal, a country and people I know and love. A special, kind people who need our help.”Rebecca Stevens, the first British woman to climb Mt. Everest, said, "In a very long relationship between Nepal and Britain, Gurkhas and British army, Sherpas and mountaineers, the Nepalese have alway given with full heart, often with their lives. It is absolutely our turn and our duty to do what we can to help in their hour of need . . . We must act decisively, immediately.”Kenton Cool, a mountaineer and Everest guide who was participating in the current climbing season, said, "Being in Nepal myself at the present time I have seen first hand the extent of this second wave. People are desperate. Any and all help would make an impact. Having experienced the generosity of the Nepali people over many decades it pains me to see this nation struggle once again."Other signatories include the DJ Paul Oakenfold, who was recently at Everest base camp, and the chefs Asma Khan and Santosh Shah - the recent Master Chef finalist. Jeremy Jack Thomas, producer of The Last Emperor, said “Nepal is reeling from a second wave. This magical landlocked country needs all the support it can get from our government, as it has been a friend to Britain not only in our armies but culturally.”Numerous UK-based scholars joined the campaign, including Michael Hutt, emeritus professor of Himalayan studies at SOAS, David Gellner, professor of social anthropology at Oxford University, Mike Searle, professor of earth sciences at Oxford University, and Diwakar Acharya, professor of Eastern religions and ethics at Oxford University.Surya Subedi QC, professor of international law at the University of Leeds, said, “"Nepal is a traditional ally of the UK. I hope the UK Government will provide every assistance possible for the people of Nepal in this hour of need."David Lascelles, the film producer and 8th Earl of Harwood, said, “I’m distressed to hear of the devastation being caused by the second deadly wave of Covid-19 in Nepal. Nepal is home to some of the toughest and most resilient people in the world but this will test even their endurance to the limit. We must do everything we can to help our many friends there in their time of need.”The mountaineers, broadcasters, film makers, soldiers  and authors who have signed the open letter, are now joined by many others at <a href="http://change.org/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=http://change.org/&amp;source=gmail&amp;ust=1621443857422000&amp;usg=AFQjCNGj60AEY7yPdJulF3DOI6UPbLBfaw">change.org</a>. They are united in calling upon the British government to send urgently needed oxygen equipment and other supplies to Nepal. “The UK and Nepal have a unique, centuries-old relationship. We must stand by one of our oldest friends,” the letter reads. “Time is of the essence.”LINK TO <a href="http://change.org/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=http://change.org/&amp;source=gmail&amp;ust=1621443857422000&amp;usg=AFQjCNGj60AEY7yPdJulF3DOI6UPbLBfaw">CHANGE.ORG</a>: <a href="https://www.change.org/p/the-rt-hon-dominic-raab-mp-uk-send-oxygen-to-nepal-now?recruiter=1205004619&amp;recruited_by_id=14e94300-b7bf-11eb-b788-f53b463e0386&amp;utm_source=share_petition&amp;utm_medium=copylink&amp;utm_campaign=petition_dashboard" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.change.org/p/the-rt-hon-dominic-raab-mp-uk-send-oxygen-to-nepal-now?recruiter%3D1205004619%26recruited_by_id%3D14e94300-b7bf-11eb-b788-f53b463e0386%26utm_source%3Dshare_petition%26utm_medium%3Dcopylink%26utm_campaign%3Dpetition_dashboard&amp;source=gmail&amp;ust=1621443857422000&amp;usg=AFQjCNFvFd1fau2SkCn3BMxm7up7V0_dNQ">https://www.change.org/p/the-rt-hon-dominic-raab-mp-uk-send-oxygen-to-nepal-now?recruiter=1205004619&amp;recruited_by_id=14e94300-b7bf-11eb-b788-f53b463e0386&amp;utm_source=share_petition&amp;utm_medium=copylink&amp;utm_campaign=petition_dashboard</a>Social media:Twitter <a href="https://twitter.com/alliance4nepuk" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://twitter.com/alliance4nepuk&amp;source=gmail&amp;ust=1621443857422000&amp;usg=AFQjCNESynB_A9T1PItHuIa8W1ytl9ZfAQ">@alliance4nepuk</a>

Leading Public Figures Call on UK Government for Oxygen for Nepal

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85979c7e80680e067800jpeg.jpg" alt="" width="768" height="512"/><figcaption>Photo: AMIT MACHAMASI</figcaption></figure>Leading figures including Joanna Lumley, Sir Michael Palin and Sir Chris Bonington today called upon the British government to urgently send lifesaving oxygen equipment and medical supplies to Nepal. The Nepali health system has collapsed due to a massive surge in Covid-19 infections. For over a week hospitals have been turning away patients due to lack of beds, and people have died for lack of oxygen.Sir Chris Bonington said, “I have seen for myself how much the hill people from Nepal have done to help Britain over the years and how much we owe them. I do hope that our government can help them in their desperate plight.”Among those signing the open letter to the foreign secretary Dominic Raab are leading British public health specialists and vaccine researchers including Sir Jeremy Farrar, Sarah Gilbert, Andrew Pollard, Nicholas White, Adrian Hill, Peter Horby, Philippe Guérin, Alain Townsend, and Sandy Douglas.<a href="https://reliefweb.int/sites/reliefweb.int/files/resources/05142021%20Nepal%20SitRep%20C19.pdf" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://reliefweb.int/sites/reliefweb.int/files/resources/05142021%2520Nepal%2520SitRep%2520C19.pdf&amp;source=gmail&amp;ust=1621443857422000&amp;usg=AFQjCNHGoTVKycRtzWTcsv6xd8s0ntxOZQ">According to the United Nations</a> this week, “COVID-19 infections are surging at an unprecedented rate in Nepal. The country of roughly 29 million people . . . has the highest effective rate of reproduction in the world . . . With a much weaker health system than neighbouring India’s, Nepal is now at a critical juncture. Hospitals in major cities are at capacity and have had to turn patients away. . .  [there are] also by critical shortages in human resources and essential commodities such as oxygen.”Captain Ram Bahadur Limbu, one of only five living recipients of the Victoria Cross, signed the letter from his home in Kathmandu. He was awarded Britain’s highest military decoration while serving with the 10th Gurkha Rifles in Indonesia in 1965.General The Lord Richards of Herstmonceux, a former Chief of Defence Staff,  joined the appeal. General Sir Sam Cowan, former Colonel Commandant of the Brigade of Gurkhas and Chairman of the Gurkha Welfare Trust, said, “The people of Nepal are suffering badly, and the poorest the most. Our historic links with the country through Gurkha recruitment go back over 200 years.  It’s time for the UK to step up to the mark to make a major contribution to ease the suffering. We cannot do less. Time is of the essence and we need significant action now. We are already behind what other countries with less historic ties are doing.”Fifty-six leading UK figures including writers, actors, mountaineers and soldiers signed the open letter calling on the British government to act now. The letter, which is open for public signatures on <a href="https://www.change.org/p/the-rt-hon-dominic-raab-mp-uk-send-oxygen-to-nepal-now?recruiter=1205004619&amp;recruited_by_id=14e94300-b7bf-11eb-b788-f53b463e0386&amp;utm_source=share_petition&amp;utm_medium=copylink&amp;utm_campaign=petition_dashboard" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.change.org/p/the-rt-hon-dominic-raab-mp-uk-send-oxygen-to-nepal-now?recruiter%3D1205004619%26recruited_by_id%3D14e94300-b7bf-11eb-b788-f53b463e0386%26utm_source%3Dshare_petition%26utm_medium%3Dcopylink%26utm_campaign%3Dpetition_dashboard&amp;source=gmail&amp;ust=1621443857422000&amp;usg=AFQjCNFvFd1fau2SkCn3BMxm7up7V0_dNQ">Change.org</a>, calls upon “the UK government to urgently respond to the Covid-19 crisis in Nepal by airlifting critical medical supplies including oxygen plants and equipment.”“Acting now will make the difference of life or death for thousands of people. Nepal is one of Britain’s oldest friends in the world, a friendship represented by generations of Gurkha soldiers and mountaineers,” the letter reads. “We must come to Nepal’s aid now.”Sir Michael Palin wrote, “I am very happy to lend my support for the letter. They are very special people facing, once again, an extreme test of survival, and I hope we can do our best for them.”People who want to lend their support to the campaign can do so by signing the <a href="http://change.org/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=http://change.org/&amp;source=gmail&amp;ust=1621443857422000&amp;usg=AFQjCNGj60AEY7yPdJulF3DOI6UPbLBfaw">Change.org</a> petition letter and by contacting their MP to call for medical aid to Nepal.Rory Bremmer, the impressionist and comedian, said, “Whilst the devastating crisis in India has rightly caught the attention of the world, its neighbour Nepal is similarly overwhelmed, its healthcare system unable to cope on its own. Britain should stand by its long standing friend and ally in its hour of need and provide urgent support.”The Nepali government and health officials say physical supplies including oxygen plants, cylinders, oxygen concentrators and related equipment, as well as life saving vaccines and therapeutic drugs, are desperately needed. Due to the Covid emergency in neighbouring India, Nepal has not been able to buy and import equipment, medicines and vaccines needed to combat Covid-19 as it did earlier in the pandemic. The government of Nepal has shared details of the most urgent priorities with other governments, including Britain.The open letter reads: “The Nepali Health Ministry predicts that by 15 July the number of active cases will reach 800,000, resulting in ten critically ill patients for every ICU bed. Only 7% of Nepal’s population has received a dose of vaccine. The potential loss of life and economic devastation over the coming months is staggering, and preventable.”Other signatories include the actor Nickolas Grace, production designer James Acheson, and Joanna Lumley, who successfully campaigned for ex-Gurkhas to settle in the UK. The Everest summiteer and TV personality Ben Fogle, said, “I am deeply saddened and worried about the worsening health crisis in Nepal, a country and people I know and love. A special, kind people who need our help.”Rebecca Stevens, the first British woman to climb Mt. Everest, said, "In a very long relationship between Nepal and Britain, Gurkhas and British army, Sherpas and mountaineers, the Nepalese have alway given with full heart, often with their lives. It is absolutely our turn and our duty to do what we can to help in their hour of need . . . We must act decisively, immediately.”Kenton Cool, a mountaineer and Everest guide who was participating in the current climbing season, said, "Being in Nepal myself at the present time I have seen first hand the extent of this second wave. People are desperate. Any and all help would make an impact. Having experienced the generosity of the Nepali people over many decades it pains me to see this nation struggle once again."Other signatories include the DJ Paul Oakenfold, who was recently at Everest base camp, and the chefs Asma Khan and Santosh Shah - the recent Master Chef finalist. Jeremy Jack Thomas, producer of The Last Emperor, said “Nepal is reeling from a second wave. This magical landlocked country needs all the support it can get from our government, as it has been a friend to Britain not only in our armies but culturally.”Numerous UK-based scholars joined the campaign, including Michael Hutt, emeritus professor of Himalayan studies at SOAS, David Gellner, professor of social anthropology at Oxford University, Mike Searle, professor of earth sciences at Oxford University, and Diwakar Acharya, professor of Eastern religions and ethics at Oxford University.Surya Subedi QC, professor of international law at the University of Leeds, said, “"Nepal is a traditional ally of the UK. I hope the UK Government will provide every assistance possible for the people of Nepal in this hour of need."David Lascelles, the film producer and 8th Earl of Harwood, said, “I’m distressed to hear of the devastation being caused by the second deadly wave of Covid-19 in Nepal. Nepal is home to some of the toughest and most resilient people in the world but this will test even their endurance to the limit. We must do everything we can to help our many friends there in their time of need.”The mountaineers, broadcasters, film makers, soldiers  and authors who have signed the open letter, are now joined by many others at <a href="http://change.org/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=http://change.org/&amp;source=gmail&amp;ust=1621443857422000&amp;usg=AFQjCNGj60AEY7yPdJulF3DOI6UPbLBfaw">change.org</a>. They are united in calling upon the British government to send urgently needed oxygen equipment and other supplies to Nepal. “The UK and Nepal have a unique, centuries-old relationship. We must stand by one of our oldest friends,” the letter reads. “Time is of the essence.”LINK TO <a href="http://change.org/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=http://change.org/&amp;source=gmail&amp;ust=1621443857422000&amp;usg=AFQjCNGj60AEY7yPdJulF3DOI6UPbLBfaw">CHANGE.ORG</a>: <a href="https://www.change.org/p/the-rt-hon-dominic-raab-mp-uk-send-oxygen-to-nepal-now?recruiter=1205004619&amp;recruited_by_id=14e94300-b7bf-11eb-b788-f53b463e0386&amp;utm_source=share_petition&amp;utm_medium=copylink&amp;utm_campaign=petition_dashboard" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.change.org/p/the-rt-hon-dominic-raab-mp-uk-send-oxygen-to-nepal-now?recruiter%3D1205004619%26recruited_by_id%3D14e94300-b7bf-11eb-b788-f53b463e0386%26utm_source%3Dshare_petition%26utm_medium%3Dcopylink%26utm_campaign%3Dpetition_dashboard&amp;source=gmail&amp;ust=1621443857422000&amp;usg=AFQjCNFvFd1fau2SkCn3BMxm7up7V0_dNQ">https://www.change.org/p/the-rt-hon-dominic-raab-mp-uk-send-oxygen-to-nepal-now?recruiter=1205004619&amp;recruited_by_id=14e94300-b7bf-11eb-b788-f53b463e0386&amp;utm_source=share_petition&amp;utm_medium=copylink&amp;utm_campaign=petition_dashboard</a>Social media:Twitter <a href="https://twitter.com/alliance4nepuk" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://twitter.com/alliance4nepuk&amp;source=gmail&amp;ust=1621443857422000&amp;usg=AFQjCNESynB_A9T1PItHuIa8W1ytl9ZfAQ">@alliance4nepuk</a>

India and Pakistan are twins separated at birth. Tensions between them have been at a hair trigger ever since independence and has erupted into full scale conflict at least four times in the past 80 years.
The 22 April terrorist attack in Kashmir that killed 25 Indian tourists and a Nepali citizen, threatens to escalate tension between the two nuclear-armed nations. India has squarely blamed Pakistan for the attacks, and Prime Minister Narendra Modi has given his military “operational freedom” to respond. Pakistan has said it has credible intelligence of an Indian military strike and its officials have promised a “full spectrum” response — a code for a <a href="https://nepalitimes.com/editorial/thinking-the-thinkable">nuclear retaliation</a>.
For Nepal, the killing of its national in the Pahalgam attack comes as another stark reminder that in conflicts from Afghanistan to Iraq, from <a href="https://nepalitimes.com/opinion/how-to-agree-an-armistice-in-ukraine">Ukraine</a> to Israel, <a href="https://nepalitimes.com/news/10-nepalis-from-one-town-fighting-in-ukraine">Nepalis are getting caught in the crossfire</a>. The last time full-scale fighting broke out between <a href="https://nepalitimes.com/opinion/peacemongers-at-india-pakistan-border">India and Pakistan</a> on Kargil in 1999, at least 22<a href="https://nepalitimes.com/here-now/india-s-trial-by-fire-for-soldiers-from-nepal?%27%5C%22="> Nepalis fighting for the Indian Army</a> were killed in action.
Three of Nepal’s immediate neighbours (China, India, Pakistan) have nuclear weapons, and they do not have good relations. With China supplying weapons, <a href="https://nepalitimes.com/editorial/war-and-warming">missile technology</a> and other support to Pakistan, this triangular friction could set off a regional conflagration.&nbsp;
<a href="https://www.nature.com/articles/s43016-022-00573-0" target="_blank">Research at Rutgers University</a> has calculated that even a week-long tactical nuclear exchange between India and Pakistan would throw up so much smoke and debris into the atmosphere that it would block out the sun for years, and lead to a collapse of the <a href="https://nepalitimes.com/news/grow-nourish-sustain-together-world-food-day">global food system</a>. This does not take into account the radioactive fallout that prevailing winds would blow up to <a href="https://nepalitimes.com/here-now/lives-on-the-line-in-the-himalaya">the Himalaya</a>, contaminating glaciers that are the sources of <a href="https://nepalitimes.com/here-now/saving-what-is-left-of-himalayan-rivers">Asia’s main rivers</a>.
The impact of <a href="https://nepalitimes.com/news/climate-breakdown-linked-to-thame-flood">climate breakdown </a>on High Asia was already ringing alarm bells about its <a href="https://nepalitimes.com/news/himalayan-icecap-melting-faster-than-thought">shrinking ice cap</a> reducing the dry season flow of water downstream. Water was going to be the next strategic commodity, geopolitical experts warned, and the next wars in Asia would be over water.
That water war is already happening. India retaliated to the Kashmir attack by suspending the <a href="https://www.nytimes.com/2025/04/24/world/asia/india-pakistan-indus-waters-treaty.html" target="_blank">Indus Waters Treaty</a> of 1960 mediated by the World Bank that has withstood at least three wars between India and Pakistan. The treaty gives India control over the three eastern tributaries of the Indus (<a href="https://en.wikipedia.org/wiki/Beas_River" target="_blank">Beas</a>, <a href="https://en.wikipedia.org/wiki/Ravi_River" target="_blank">Ravi</a> and <a href="https://en.wikipedia.org/wiki/Sutlej" target="_blank">Sutlej</a>), while Pakistan got water from the Indus and two of its western tributaries (<a href="https://en.wikipedia.org/wiki/Indus_River" target="_blank">Indus</a>, <a href="https://en.wikipedia.org/wiki/Chenab_River" target="_blank">Chenab</a> and <a href="https://en.wikipedia.org/wiki/Jhelum_River" target="_blank">Jhelum</a>.
Pakistan was assured of 70% of the annual flow, and India could use a reasonable amount of water for<a href="https://archive.nepalitimes.com/news.php?id=15231"> irrigation and hydropower</a>. &nbsp;Within days of its threat, India stopped water flowing down to Pakistan from the Chenab river and is reportedly preparing to do the same on the Jhelum.
The sabre-rattling has reached a crescendo. Besides threats and counter-threats there are also symbolic drills, with the Indian Air Force practicing landing on an expressway in Uttar Pradesh by its Rafale, Su-30 and Jaguar fighter jets to demonstrate ‘operational readiness’. In response Pakistan test-fired its Abdali ballistic missile that can carry a nuclear warhead and has a range of 450km.&nbsp;
The danger is that with ultra-nationalist rhetoric and the beating the war drums by both sides, India’s government and Pakistan’s military may have to ‘do something’ to appease domestic public opinion. But any tactical strike, an artillery exchange, or territorial incursion could quickly escalate out of control.
Expecting an Indian retaliation for the Pahalgam killings, Pakistan is using<a href="https://nepalitimes.com/opinion/interfaith-collaboration-for-nuclear-disarmament"> nuclear deterrence </a>and warning of “catastrophic consequences”. The two neighbours came close to a nuclear exchange in 2019 after an attack on the Indian military in Kashmir, and prompt international intervention led by the United States cooled tensions.&nbsp;
This time, the <a href="https://nepalitimes.com/news/trump-shock-wave-hits-nepal">Trump administration</a> is too distracted and not as engaged. Pakistan has denied it was responsible for the terrorist attack and called on Washington to stop a possible Indian retaliation. India and Pakistan have stopped overflights by each other’s airlines, and some international carriers have even stopped flying over Pakistan fearing an air war.
Washington, Beijing, the UN and the EU have all urged restraint. Iran, which has good relations with both India and Pakistan has sent its foreign minister to urge both countries not to go into a tit-for-tat war. Iran has its own nuclear flashpoint to worry about with tensions in Israel, &nbsp;Yemen and Syria.
India and Pakistan both share similar problems of joblessness, <a href="https://nepalitimes.com/here-now/why-nepal-s-poverty-rate-is-stuck">poverty </a>and <a href="https://nepalitimes.com/here-now/climate-change-new-threat-to-nepal-s-rhinos">environmental threats</a>. Neither side needs the threat of a senseless war, and we in the neighbourhood do not need it either.&nbsp;
Kunda Dixit
This Editorial is brought to you by <a href="https://nepalitimes.com/" target="_blank">Nepali Times</a>, in collaboration with <a href="https://inpsjapan.com/en/" target="_blank">INPS Japan</a> and <a href="https://sgi-peace.org/" target="_blank">Soka Gakkai International</a>, in consultative status with UN ECOSOC.

Nukes in the neighbourhood

The streets of Patan are alive this month with lavender jacaranda trees under rain-washed skies as <a href="https://nepalitimes.com/banner/the-red-god-rises-again-in-patan">the chariot of Rato Matsyendranath</a> is pulled across town. This is the festival of the rain god, and inevitably the heavens opened up and pre-monsoon showers pelted the chariot as it started being pulled in Pulchok last week. Thousands of devotees, onlookers and the chariot procession organisers thronged the streets on the first day last week. The rhythmic cymbals and drums exuded a vibrant energy as the enormous four wheels turned and the chariot lurched.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025051007050_81df97744db16f732a419dc1f1579d235ce3df37642b078f50b83bd4bd026688.jpg" data-media-id="editor_1" data-image-id="2025051007050_81df97744db16f732a419dc1f1579d235ce3df37642b078f50b83bd4bd026688" data-rendition-name="original" width="1000" height="1503" loading="lazy" alt="Divine chariot"> </figure>  The<a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/Red-rain-god,3141"> red rain god</a> has Hindu and Buddhist antecedents, alternatively called Bungadya and<a href="https://nepalitimes.com/here-now/kathmandu-s-gravity-defying-chariot-festival"> Karunamaya</a> — reflecting Kathmandu Valley’s syncretic mixture of the two religions.&nbsp; “Bungadya is a profoundly <a href="https://nepalitimes.com/opinion/12-full-opinion/marketing-the-intangible">intangible form of heritage</a>,” explains heritage expert Monalisa Maharjan. “It embodies traditional knowledge,<a href="https://nepalitimes.com/multimedia/reviving-nepal-s-craft"> artisanal skills passed down through generations</a>. Local communities and specific families have specified roles in being custodians of the heritage, ensuring their survival over the centuries.” There are many legends and stories about this annual tradition. Lichhavi king Narendra Dev is supposed to have brought Rato Matsyendranath from Assam to Kathmandu Valley to convince Guru Gorakhnath to lift a spell that created a two-year drought in Kathmandu.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250510050520_347a9a398f8a9abc4a7fb4e2774fde8264cccbdce8bdab23851ab3f0e73c3e8a.jpg" data-media-id="editor_6" data-image-id="20250510050520_347a9a398f8a9abc4a7fb4e2774fde8264cccbdce8bdab23851ab3f0e73c3e8a" data-rendition-name="original" width="1503" height="1000" loading="lazy" alt="Divine chariot"> </figure>  Matsyendranath was Gorakhnath’s mentor, and upon seeing him, the serpents were released, unleashing the rains. The chariot festival honours the return of this life-giving rain. The deity is seen as an icon for thriving agriculture, t<a href="https://nepalitimes.com/here-now/before-the-next-monsoon">he arrival of monsoon</a> showers, and the welfare of the community. Read also: <a href="https://nepalitimes.com/opinion/the-reign-of-the-god-of-rain">The reign of the god of rain</a>, Vidhu Prakash Kayastha Till this day, the Rato Matsyendranath festival is no ordinary celebration. Patan does not sleep for a month as the chariot is pulled through various neighbourhoods. It unfolds at a state level with the president (formerly the king) attending the climax of the Bhoto Jatra in Jawalakhel later this month.&nbsp; The intergenerational transmission of tradition is unique in the world, and the reason the festival is one of the most vibrant cultural expressions that thrives despite inroads of modernity. The other unique aspect is that it is a transnational festival, binding Patan with Guwahati in the Indian state of Assam.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025051005058_8bc685ada13045d863b28e3eed91c931da2b510714586af6fd7eb5d1e298a24a.jpg" data-media-id="editor_9" data-image-id="2025051005058_8bc685ada13045d863b28e3eed91c931da2b510714586af6fd7eb5d1e298a24a" data-rendition-name="original" width="1000" height="1503" loading="lazy" alt="Divine chariot"> </figure>  “Unlike Nepal, where the deity commands grandeur and devotion, many in Assam are unaware of Rato Matsyendranath,” says Khagen Sharma of Gauhati University, which convened <a href="https://nepalitimes.com/news/nepal-assam-connection-revived">a symposium in February in Guwahati on the rain god</a>. Attending was a delegation led by Lalitpur Mayor Chiribabu Maharjan, organisers of the festival, and builders of the chariot. After the symposium, a committee was formed to explore and revive the tradition in Assam as well. Although the team had planned to visit Nepal this month, logistical challenges delayed the trip. Still, there are plans to build a Guru Matsyendranath statue in Assam to reestablish regular worship practices in the Guwahati shrine.&nbsp; The vines used to build the chariot in Patan are sourced from the jungles of Assam. But Sharma notes that in recent years unclear regulations have blocked the official import of the vines, although they are still brought to Nepal informally. The <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/makers-of-machhindranath,2204">chariot making</a> has also had a taste of modernisation in recent times. In the past, even a single nail or piece of steel was avoided. But over time, the wooden structure, particularly the shaft between the wheels, has been replaced with bronze. When that too proved unstable, metal clamps were introduced, which have become a pragmatic compromise.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250510050524_b2a819a5791612f14c81d30fc393dbd3f99f0c64b90a9110e8b0855d944bfa93.jpg" data-media-id="editor_12" data-image-id="20250510050524_b2a819a5791612f14c81d30fc393dbd3f99f0c64b90a9110e8b0855d944bfa93" data-rendition-name="original" width="1500" height="998" loading="lazy" alt="Divine chariot"> </figure>  Another welcome change is the focus on safety. Builders climbing the chariot’s tower now wear harnesses and there are efforts in crowd control. The most visible change in recent years has been the involvement of Patan’s enthusiastic youth in the festival — the tradition is now passing to a new generation. Says Matsyendranath expert Vidhu Kayastha: “There is more energy, the young people in red t-shirts this year were very organised, these modern touches aren’t diluting our culture, they’re keeping it alive in new forms.” He adds, “We are <a href="https://nepalitimes.com/here-now/searching-for-a-homeland-away-from-home">reconnecting with our roots</a>, we have more resources, more awareness than ever before. We must not be swept away by western values that may not serve us, and in some ways, cause more harm than good. We must revive our own culture.”&nbsp;

Divine chariot

Most Nepalis thought they had seen the last of it after <a href="https://nepalitimes.com/news/11-56-25-april-2015-wkc9q2an">the 25 April 7.8 magnitude </a>earthquake ten years ago. But the Himalaya had more surprises in store. On 12 May, another 7.3 magnitude tremor that some said was an aftershock, but was strong enough to itself be a major earthquake, struck Dolakha.&nbsp; Not many people had heard of Singati till then — a cluster of houses by the Tama Kosi River along a narrow gorge that is the roadhead to Rolwaling Valley.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250508110520_57b6e316656851f71eca56ca6f98d9bbcc820c1a00d62af3c990725b4361244d.jpg" data-media-id="editor_1" data-image-id="20250508110520_57b6e316656851f71eca56ca6f98d9bbcc820c1a00d62af3c990725b4361244d" data-rendition-name="original" width="1000" height="1500" loading="lazy" alt="Climate magnifies earthquake risk in Nepal village NT"> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250508110520_016534fb2b6a79957402281cda768efb83a146786377e39e11df3e251d37159e.jpg" data-media-id="editor_2" data-image-id="20250508110520_016534fb2b6a79957402281cda768efb83a146786377e39e11df3e251d37159e" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Climate magnifies earthquake risk in Nepal village NT"> </figure>  It was here that dozens were killed on 25 April in the first earthquake. Hundreds of <a href="https://archive.nepalitimes.com/article/nation/Singati-rising-from-rubble-rebuilding,3703">Singati survivors</a> had lined up for food and relief supplies in the morning of 12 May when the second earthquake triggered a rock slide that buried a nearby camp. At least 50 people were killed. &nbsp; Three hours later, a US Marine Corps UH-1Y Venom helicopter landed in a nearby cornfield to pick up the wounded, and flew off. The aircraft lost contact with air traffic control in Kathmandu and its wreckage was located high on Kalinchok four days later. Six American servicemen, two Nepal Army soldiers, and five wounded civilians from Singati were killed. Today, Singati bears little physical scar of the multiple tragedies that struck the town ten years ago. Most <a href="https://nepalitimes.com/multimedia/bungamati-builds-back">houses have been rebuilt</a> as urban-style concrete structures, and Singati has become an economic hub on the road leading up to several hydropower plants and a<a href="https://nepalitimes.com/banner/off-the-beaten-trek-in-nepal"> popular trekking destination</a>.&nbsp; The town looks less like a village and more like a suburb of the Dolakha district headquarter of Charikot, 47km away.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250508110520_196f341d1df1403ba133e5dfeb837eec20d7cbcb4c8c56b17cc5598810de5df2.jpg" data-media-id="editor_6" data-image-id="20250508110520_196f341d1df1403ba133e5dfeb837eec20d7cbcb4c8c56b17cc5598810de5df2" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Climate magnifies earthquake risk in Nepal village NT"> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250508110524_ae66c4a92430f67db51b5e11e017059eedfbac4cb18c8e073f2a50cca1fe904e.jpg" data-media-id="editor_7" data-image-id="20250508110524_ae66c4a92430f67db51b5e11e017059eedfbac4cb18c8e073f2a50cca1fe904e" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Climate magnifies earthquake risk in Nepal village NT"> </figure>  “The demand for construction material, cement, iron rods and bricks peaked after the earthquakes,” says Suresh Khadka, who owns a hardware business here and now supplies material to the 456MW Upper Tama Kosi hydropower project that is undergoing repairs after it was damaged by a landslide last year. The demand for cement boomed since most residents believe, not necessarily correctly, that <a href="https://nepalitimes.com/banner/in-a-disastrous-state">cement houses are safer</a>. Although Khadka did well selling construction material after the earthquake, he worries that most new structures do not follow seismic-resistant building codes.&nbsp; The construction boom financed by bank loans has in turn forced many from Singati to <a href="https://nepalitimes.com/banner/making-overseas-migration-better">migrate overseas for work</a> so they can service their debt.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250508110524_50caa4530bd5ff9120cf7ab70a62173846d337ef448ff8bac339f3faa375a9e2.jpg" data-media-id="editor_10" data-image-id="20250508110524_50caa4530bd5ff9120cf7ab70a62173846d337ef448ff8bac339f3faa375a9e2" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Climate magnifies earthquake risk in Nepal village NT"> <figcaption>Suresh Khadka</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250508110520_ef8b7d3993fc3b5df852bbf952feb3fbabc96d6883b0d5eb74ee5c60f4123b83.jpg" data-media-id="editor_11" data-image-id="20250508110520_ef8b7d3993fc3b5df852bbf952feb3fbabc96d6883b0d5eb74ee5c60f4123b83" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Climate magnifies earthquake risk in Nepal village NT"> <figcaption>Phu Doma Sherpa (right)</figcaption> </figure>  “My family had no choice but to borrow money to rebuild our home since the government compensation was not enough, and ten years later we are still paying off the loan,” says Phu Doma Sherpa, 60. Because of the shortage of qualified masons and proper seismic engineering, <a href="https://nepalitimes.com/here-now/structural-problems">many of the buildings are of questionable building standards </a>and the traditional architecture has been abandoned, admits Kul Bahadur Budathoki, deputy chair of the municipality. “But these buildings were more expensive than what the government grants could cover, many people here are heavily in debt and the men have <a href="https://nepalitimes.com/here-now/every-day-is-closer-to-pay-day">migrated to the Gulf to pay their loans</a>,” Budathoki says.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250508110520_32f89e97b7e757fc9286c0bbb671f48ea8d4468e9634fa646d7247c650ad8480.jpg" data-media-id="editor_14" data-image-id="20250508110520_32f89e97b7e757fc9286c0bbb671f48ea8d4468e9634fa646d7247c650ad8480" data-rendition-name="original" width="1501" height="1079" loading="lazy" alt="Climate magnifies earthquake risk in Nepal village NT"> <figcaption>Kul Bahadur Budathoki</figcaption> </figure>  Singati is in a multi-hazard zone. The <a href="https://archive.nepalitimes.com/article/nation/Singati,3091">12 May 2015 earthquake </a>could have led to the collapse of Nepal’s largest glacial lake, <a href="https://nepalitimes.com/here-now/stairway-to-heaven">Tso Rolpa</a>, upstream. Due to global warming, the glacier has turned into an expanding lake 3.5km long, and its collapse would have unleashed a catastrophic Himalayan tsunami down the Tama Kosi Valley, with Singati directly in its path. Singati has literally risen from the ashes of 2015, with its residents beginning to recover from the trauma and financial toll. But it is not out of danger as <a href="https://nepalitimes.com/news/climate-breakdown-linked-to-thame-flood">climate breakdown </a>magnifies the risk from future earthquakes.

Climate magnifies earthquake risk in Nepal village

This is the 67th episode of Diaspora Diaries, a Nepali Times series in collaboration with Migration Lab providing a platform to share experiences of living, working, and studying abroad. <h2>Alpana Adhikari, UK</h2> Back in Nepal, I had worked as a nurse for a decade, but I had my heart set to go overseas. My reason for <a href="https://nepalitimes.com/banner/migration-not-a-wish-but-necessity-for-nepalis">wanting to migrate</a>, however, was a bit different as it was for my son. He has a disability, and considering his situation from multiple perspectives—including <a href="https://nepalitimes.com/here-now/it-s-all-in-the-mind">societal attitudes</a>, the preparedness of schools, and the availability of facilities for individuals with his condition—Nepal did not feel safe for my baby.&nbsp; I had to migrate, no matter what, for his sake. The facilities here in the UK for children with his condition are significantly better, and I am glad he and my husband will join me in a few months.&nbsp; I was applying via private routes like everyone else when the Government to Government pilot program between Britain and Nepal was announced. Even though the initial program targeted 100 nurses, only 40 of us were able to meet the criteria.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250511160536_46f6a3c05fd2d9bdac06a9a478f49079c2c69c783fcf0cc58b75da6128319745.jpg" data-media-id="editor_2" data-image-id="20250511160536_46f6a3c05fd2d9bdac06a9a478f49079c2c69c783fcf0cc58b75da6128319745" data-rendition-name="original" width="720" height="1280" loading="lazy" alt="DD 67"> <figcaption>Alpana Adhikari started working as a nurse in a hospital in the UK in March.</figcaption> </figure>  I made it to the UK &nbsp;in February 2024 without paying a single paisa to any broker. The G2G scheme was unique as we were treated with dignity and valued for our skills: they covered costs for the <a href="https://nepalitimes.com/opinion/free-visa-free-ticket-policy-in-limbo">ticket and visa</a>, reimbursed us for exams we had taken and costs involved in the preparation and testing of the Objective Structured Clinical Examination were also covered.&nbsp; I started work in March last year, and currently am based in the respiratory ward of a hospital. I am enjoying my work a lot. In one year, I have received 26 WOW nominations which are notes of<a href="https://nepalitimes.com/here-now/the-healer-of-far-western-nepal"> appreciation from patients </a>we have served. ‘Alpana is one of the kindest nurses I have seen. Awesome and talented … always smiling, never appears tired and helps everyone,’ one patient testimonial said. Another: ‘You can see clearly that she cares about her patients…She was cool amidst great stress and ALWAYS with a smile which gave me confidence.’ I am also the International Educated Nurses Advocate which means I can raise issues with management about issues facing <a href="https://nepalitimes.com/opinion/comment/nepali-nurses-now-britain-bound">international nurses</a> here.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250511160536_87b959c7550bbd1272ebf840d9f24735db008307ad825e4aa15e66c1662a7fd4.jpg" data-media-id="editor_6" data-image-id="20250511160536_87b959c7550bbd1272ebf840d9f24735db008307ad825e4aa15e66c1662a7fd4" data-rendition-name="original" width="1590" height="1600" loading="lazy" alt="DD 67"> <figcaption>One reason Alpana Adhikari migrated to the UK was so there would be better facilities for her son, who has a disability. </figcaption> </figure>  Recruitment from NHS linked hospitals is free but when we <a href="https://nepalitimes.com/editorial/safer-migration-for-women">migrate through private routes</a>, agencies either charge upfront costs or in some cases, there is wage deduction once the nurses start earning.&nbsp; I have met Nepalis who have paid up to Rs 1 million for the same job. These costs can go even as high as Rs3 million for work in caregiving or nursing homes. I am lucky not to have to pay anyone for my posting.&nbsp; But beyond costs, I think there is also a reputational advantage of coming through the government selection process at the hospital. Such programs need to be expanded more because <a href="https://nepalitimes.com/editorial/nepal-s-nurse-flight">nurses are migrating </a>anyway and it would save people a lot of unnecessary costs and hassles. I will always be protective about Nepal and am grateful for the experience I gained, but it is true that nurses lack dignity in the workplace back home. Nursing is laborious work and completing the education takes a fortune but the <a href="https://nepalitimes.com/here-now/nursing-grievances-against-the-state">pay for nurses in Nepal</a>, other than at a handful of hospitals, is unfairly low.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250511160540_2a483361070e6e65413cf3bcf3be7af0581044f85c3e6da25a66dc87042af9d9.jpg" data-media-id="editor_10" data-image-id="20250511160540_2a483361070e6e65413cf3bcf3be7af0581044f85c3e6da25a66dc87042af9d9" data-rendition-name="original" width="2048" height="1536" loading="lazy" alt="DD 67"> <figcaption>Alpana Adhikari while working as a nurse in Nepal.</figcaption> </figure>  It naturally makes nurses want to migrate. People often ask me what the difference in the UK and Nepal is. Work is similar but in terms of technology, there is less paperwork here as everything is digitised. Treatment is also more nurse-led and we have more say while making recommendations about medicine and discharging decisions which can be empowering. 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> I am not sure what it is about nursing but I am always in high spirits and energetic about showing up to work every day. To be a good nurse, you have to have the passion for <a href="https://nepalitimes.com/news/step-by-step-for-rural-health-care-in-nepal">patient care</a>.&nbsp; Sometimes people tell me it is because my family has not yet joined me which has freed up my time to singularly focus on work, but I do not believe that is true. Back home, too, I used to be as passionate about my job.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250511160540_47851c2c850c936b7bfb23da0f0e8a07620ea213ad929c229b6cca8711adc5d4.jpg" data-media-id="editor_13" data-image-id="20250511160540_47851c2c850c936b7bfb23da0f0e8a07620ea213ad929c229b6cca8711adc5d4" data-rendition-name="original" width="1024" height="768" loading="lazy" alt="DD 67"> <figcaption>Alpana Adhikari (left) during an International Nurses Day rally in Kathmandu.</figcaption> </figure>  What fuels my passion here is the appreciation we get. It is not just about the income. Sometimes after <a href="https://nepalitimes.com/here-now/you-must-be-having-so-much-fun-there?fbclid=IwZXh0bgNhZW0CMTEAAR0OsTusz4rvYDQLvB0bnwhlDvkS3zCQ-UvuoO5manWHC0LGI2c3XY7e6ZY_aem_hR-tZOp4xg1mINPJvwD7Nw">long hours at work</a> when it has been a particularly busy day, a phone message from my manager and colleagues appreciating me for a job well done can go a long way.&nbsp; Likewise, the WOW recommendations from my patients have boosted my confidence. One of my elderly patients who had a <a href="https://archive.nepalitimes.com/article/nation/stigma-and-silence-mental-health-nepal,3486">mental illness </a>and I bonded, and she felt comfortable enough to open up with me. She would then refer to me as her friend with everyone.&nbsp; It is little things like this that can make a big difference. Perhaps that is why my flat mate and colleagues often question why I don’t look tired even after a long shift. <h2>Binu Gurung, Japan</h2> It has been five-and-half years since I came to Japan under the Specified Skilled Workers (SSW) visa in the nursing category. I had previously come to Japan as a language student as well.&nbsp; I grew up in Ghandruk and had just started my Bachelor’s course when a friend suggested we try<a href="https://nepalitimes.com/business/nepalis-in-japan"> to go to Japan </a>so I just followed the trend and stayed here for three years as a student.&nbsp; Two years after returning to Nepal, I re-migrated to Japan under the SSW scheme which was at its early stages and only open to nursing initially.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250511160536_305bb5cb5095da6148911dae8b07356ece5b292148e6c8e57a39fd31d811624b.jpg" data-media-id="editor_17" data-image-id="20250511160536_305bb5cb5095da6148911dae8b07356ece5b292148e6c8e57a39fd31d811624b" data-rendition-name="original" width="720" height="960" loading="lazy" alt="DD 67"> <figcaption>Binu Gurung on arrival in Japan to work as a nurse three years ago.</figcaption> </figure>  I take care of the elderly Japanese who are mostly above 80 years of age, a few even above 100. I try not to get too attached to patients but it is of course not always easy because of the nature of the job and patients we serve.&nbsp; Patients dying of age is common as it is not a care facility where patients recover to return to their homes. Just recently, an elderly lady who had been here from the day I joined 5.5 years ago passed.&nbsp; These leave you a bit खिन्न and emotionally drained. Most are <a href="https://archive.nepalitimes.com/article/nation/dementia-brings-new-problem-that-families-have-little%20knowledge-of,2151">dementia patients</a> who do not &nbsp;even recognise their family members. Some elderly patients are reserved and do not feel comfortable as the work entails helping with personal care tasks like using the toilet or bathing and they can be irritable.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250511160536_c840a0b12c20c3d52d9eceec06a0bc8c90208f13e402c50f319583b1c1a93b87.jpg" data-media-id="editor_19" data-image-id="20250511160536_c840a0b12c20c3d52d9eceec06a0bc8c90208f13e402c50f319583b1c1a93b87" data-rendition-name="original" width="694" height="960" loading="lazy" alt="DD 67"> <figcaption>Binu Gurung's work involves taking care of elderly Japanese.</figcaption> </figure>  Building trust and rapport takes time, patience and familiarity. I do not think there is a way to explain how happy I feel when they are happy with the care we provide and thank us in smiles like we are their own family members.&nbsp; My own grandmother back in Nepal was in a similar situation requiring care before she passed and I am able to extend that kind of care to many patients.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250511160536_0f41ad57ae1ac5bd2f406d86cdc5f542b613cef6961d8fdf20c883ee38404b5e.jpg" data-media-id="editor_20" data-image-id="20250511160536_0f41ad57ae1ac5bd2f406d86cdc5f542b613cef6961d8fdf20c883ee38404b5e" data-rendition-name="original" width="1600" height="1067" loading="lazy" alt="DD 67"> <figcaption>Binu Gurung in Yokohama.</figcaption> </figure>  I know that this job is not for everyone. That is why some nurses who come to Japan because they want to just<a href="https://nepalitimes.com/banner/making-overseas-migration-better"> migrate overseas </a>at any cost without considering the kind of employment realise that caregiving might not be for them.&nbsp; You have to be mentally, physically and emotionally prepared for it. If you are short-tempered by nature, for example, it may not be the best fit. However, for those who are genuinely interested in care work like I am, there are many growth opportunities in nursing which are also financially rewarding.&nbsp; While working under the SSW visa, I was able to take training classes on the side and passed the national exam for nursing. I was then able to change my visa from SSW to nursing caregiver visa. My son joined my husband and I recently in Japan and has started school.

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