Philanthropy will never replace<a href="https://nepalitimes.com/news/uk-aid-for-nepal-s-covid-affected-mp4ab6lw"> public aid</a>, but it can be a powerhouse if we use it right. With global development funding under strain, <a href="https://nepalitimes.com/news/e75-million-eu-aid-to-nepal-for-covid-19-ckmyfbkq">European aid</a> budgets being redirected toward defence and rearmament, and the <a href="https://nepalitimes.com/news/how-usaid-cut-affects-nepal">United States rethinking foreign assistance</a> altogether, the aid community has been left scrambling.
The reactions so far have been of two kinds: calls for <a href="https://nepalitimes.com/here-now/philanthropy-in-the-time-of-pandemic">philanthropy</a> to fill the gap, and moralising statements shaming governments for stepping back. Unfortunately, the first is unrealistic, and the second is ineffective.&nbsp;
Private donors cannot solve systemic <a href="https://nepalitimes.com/opinion/12-full-opinion/our-uncommon-future">global challenges</a> alone, and telling politicians that they are morally bankrupt generally does not bring them around to your side. Instead, we need to meet policymakers where they are, sharpen our arguments, and focus on what actually works. The hard truth is that most <a href="https://archive.nepalitimes.com/page/foreign-aid-policy-to-balance-infrastructure-investment-with-social-sector-investment">government aid</a> is not even designed for effectiveness, because it prioritises processes over results. Nor has philanthropy been immune to this impulse.
In early years at the Eleanor Crook Foundation, we funded holistic, multisectoral programs that tried to tackle all causes of malnutrition simultaneously. But the results were underwhelming. The approach looked good on paper, but produced no measurable improvements in <a href="https://nepalitimes.com/here-now/nepal-s-epidemic-of-hunger">malnutrition</a>. So, we learned from that failure and changed course. Now, we direct our funding where the evidence is strongest and the results most immediate.&nbsp;
At the recent Nutrition for Growth (N4G) Summit in Paris, we announced a $50 million commitment, alongside $200 million from other donors, to scale up one of the most cost-effective interventions in global health: prenatal vitamins – known as multiple micronutrient supplements (MMS). This funding will go toward a $1 billion roadmap to ensure access to MMS for pregnant women no matter where they live.
The science on this issue is unequivocal. MMS replaces outdated iron and folic acid (IFA) tablets still given to many pregnant women in low-income countries. With MMS, women receive 15 nutrients, instead of just two, leading to a dramatic reduction in maternal anemia, stillbirth, and low birth weight. The estimated economic returns are $37 for every $1 invested while infant mortality is reduced by nearly one-third.
The global inequities in maternal health are profound. In London, a pregnant woman routinely has access to comprehensive prenatal vitamins. In Lagos, she might receive IFA, or nothing at all. The difference reflects a gap in will, not knowledge. Ending such disparities does not require a scientific breakthrough, just greater investment in already proven solutions.
More than two decades of research, three Lancet studies, and multiple World Bank investment cases have identified roughly ten nutrition interventions that are consistently underfunded despite their proven efficacy. These are not flashy, multisector, utopian initiatives. They are targeted, evidence-based programs that can be implemented immediately to deliver measurable results.
Solutions like breastfeeding support, Vitamin A supplementation, prenatal vitamins, and ready-to-use foods for severely malnourished children belong to a package of interventions that could save at least two million lives over five years if scaled up in nine high-burden countries. Such life-changing results would cost just $887 million per year.
Malnutrition is now the leading driver of <a href="https://archive.nepalitimes.com/news.php?id=16505">child mortality</a> globally, contributing to some three million deaths in 2023 alone. These are not mysterious tragedies. They are predictable and in many cases cost little to prevent. In a world that routinely sends tourists to space, we obviously can afford to ensure that all <a href="https://nepalitimes.com/here-now/saving-one-nepali-mother-at-a-time">pregnant women</a> have access to a $2 bottle of vitamins.
This year’s N4G Summit may be the last of its kind. It was part of a summit series linked to the Olympics, which will next be hosted by the US. With the current <a href="https://nepalitimes.com/editorial/trump-s-second-coming">US administration </a>already signaling that it will not continue the tradition, recent commitments made in Paris have gained new urgency. Vague pledges and political posturing will no longer do.
We are not asking governments to spend like they used to. Rather, we are urging them to look at the evidence and use their remaining budgets for official <a href="https://nepalitimes.com/review/small-is-bountiful?fbclid=IwAR0wRoEdhgYO9qATGiukFQvK2fE6N8rCDZ4CBJBdkTC6_Es-6_mdVHldlic">development assistance</a> to scale up proven, <a href="https://nepalitimes.com/here-now/small-is-still-possible">cost-effective solutions</a>. A modest investment in MMS – representing less than the cost of one week of G7 countries’ defense spending – could save 600,000 lives.
Even with constrained budgets, we have a chance to save millions of lives. But only if we stop trying to do everything, and focus instead on what is the right thing to do.
William Moore is the CEO of the Eleanor Crook Foundation and Chair of Stronger Foundations for Nutrition.

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Philanthropy in an era of declining development aid

James Harris (‘Jim’) Simons, the mathematician and billionaire philanthropist who set up a foundation to improve Nepal’s healthcare system, died in New York on 10 May, aged 86. Jim Simons was an award-winning mathematician who pioneered quantitative investing and gave away much of his billions to support mathematics education, scientific research and various humanitarian causes. But his life was marked by family tragedies. His elder son, Paul, was killed in New York in 1996 in a traffic accident, and his younger son, Nick drowned in Bali in 2003 after a volunteering stint in Nepal.&nbsp; Nick Simons had written letters home from Nepal about his experience in rural health posts, and was determined to become a physician so he could help the underprivileged in poorer parts of the world.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240511120528_08e9e9ec5b9faa6a852fb5a4b5a8586526935cb8a9c8c61fd329fb8e4d7466e4.png" data-media-id="editor_0" data-image-id="20240511120528_08e9e9ec5b9faa6a852fb5a4b5a8586526935cb8a9c8c61fd329fb8e4d7466e4" data-rendition-name="original" width="596" height="812" loading="lazy" alt="Nick Simons"> <figcaption>Nick Simons with a friend in Nepal in 2003. He died soon after while swimming in Bali.</figcaption> </figure>  After Nick’s tragic death, Jim Simons and his economist wife Marilyn travelled to Nepal several times to set up the <a href="https://www.nsi.edu.np/overview" target="_blank">Nick Simons Institute (NSI)</a> to back up government hospitals in rural areas with training, equipment and budgetary support. Since it was established in 2006, NSI has invested more than $100 million in Nepal’s health sector and now supports 45 district hospitals and health facilities. Most of the institute’s work is behind-the-scenes and not visible to the public, like its help with training nurses and anaesthesiologists, maintaining biomedical equipment, and in retaining qualified medical staff in remote rural hospitals by topping up salaries. <a href="https://archive.nepalitimes.com/news.php?id=11436" target="_blank">Jim Simons once told Nepali Times</a>: "Rural health care is not a new problem in Nepal, and there are lots of people addressing the issue. What makes NSI unique is that it will do this job better than it has ever been done with an emphasis on quality and training.”  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240511020552_a9bbf2070d0ace34db48799e7c76f8f18a221750b5f2bcb5fda3a87b2eb97769.jpg" data-media-id="editor_3" data-image-id="20240511020552_a9bbf2070d0ace34db48799e7c76f8f18a221750b5f2bcb5fda3a87b2eb97769" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Jim Simons NT"> <figcaption>Marilyn and Jim Simons in Nepal in 2012. Photo: KUNDA DIXIT</figcaption> </figure>  Indeed, the Simons made several visits to Nepal in 2003 soon after their son died, talking to health experts to see where support would be most catalytic and meaningful. They decided to do this not by running their own hospitals, but by working with the government in developing sustainable solutions in rural healthcare and scaling it up. "With the establishment of the Nick Simon's Institute in 2006, Jim was clearly a game changer for enhancement of rural health in Nepal. &nbsp;Also what is unforgettable about Jim was his amazing sense of humor in telling a story, his sharp intellect, and how he did not suffer fools lightly," says <a href="https://archive.nepalitimes.com/news.php?id=18356" target="_blank">Buddha Basnyat</a>, a physician who is in the executive committee of NSI. The Simons often said they would probably never have been involved in Nepal’s health sector had it not been for their son Nick, who had found fulfilment helping Nepalis and wanted to return to live and work here.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240511020556_761b7ed7926bbf26b24c5e8ab06df077019280451bc1d4efc5bd3c5d44e740bb.jpg" data-media-id="editor_5" data-image-id="20240511020556_761b7ed7926bbf26b24c5e8ab06df077019280451bc1d4efc5bd3c5d44e740bb" data-rendition-name="original" width="904" height="1382" loading="lazy" alt="Jim Simons NT"> <figcaption>Marilyn and Jim Simons in Nepal in 2023 with Patty Weisenfeld of Nick Simons Foundation. Photo: KUNDA DIXIT</figcaption> </figure>  Jim Simons went through three phases in his life: as a mathematician, an investor and a philanthropist. As a maths professor, he found solutions that are still used to solve problems in physics and astronomy. He then set up <a href="https://www.rentec.com/Home.action?about=true" target="_blank">Renaissance Technologies</a> that used his talent in mathematics to analyse complex financial data and forecast global share markets. That is how he made billions, much of which he re-invested in improving STEM education in American schools, in exploring the universe, or trying to find the causes of autism.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240515170536_5ea1f3742ee715ce95ee11a82dfcc6991be56b827f5dff8d6c58824f836763e1.jpg" data-media-id="editor_7" data-image-id="20240515170536_5ea1f3742ee715ce95ee11a82dfcc6991be56b827f5dff8d6c58824f836763e1" data-rendition-name="original" width="1001" height="784" loading="lazy" alt="Jim Simons"> <figcaption>Health expert Aruna Uprety at a school algebra class in western Nepal.</figcaption> </figure>  After the death of his sons, Jim Simons sought solace in solving mathematical puzzles in his head. One morning at the leafy Summit Hotel in Kathmandu, the proof came to him in a flash of a puzzle that had bedevilled him for a long time.&nbsp; ‘Jim was an exceptional leader who did transformative work in mathematics and developed a world-leading investment company,’ the <a href="https://www.simonsfoundation.org/2024/05/10/simons-foundation-co-founder-mathematician-and-investor-jim-simons-dies-at-86/" target="_blank">Simons Foundation</a> said in a statement announcing his death on Friday.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240515170536_e4c458bcc5f9daf7d8833bb0bffc98304224be100b88cde3ade7c7ae41067cd5.jpg" data-media-id="editor_9" data-image-id="20240515170536_e4c458bcc5f9daf7d8833bb0bffc98304224be100b88cde3ade7c7ae41067cd5" data-rendition-name="original" width="2008" height="1396" loading="lazy" alt="Jim Simons"> </figure>  Besides NSI, the <a href="https://www.nicksimonsfoundation.org/" target="_blank">Nick Simons Foundation</a> was involved in other health-related activities in Nepal, including building the new <a href="https://archive.nepalitimes.com/news.php?id=15138" target="_blank">maternity wing at Patan Hospital</a> and supporting <a href="https://www.nyayahealthnepal.org/" target="_blank">Nyaya Health Nepal (NHN)</a> that runs <a href="https://nepalitimes.com/here-now/nepal-s-rural-lifeline" target="_blank">Bayalpata Hospital in Achham District.</a>&nbsp; Jim Simons once said: “Nick opened up a whole new world to us. We have met so many wonderful people who otherwise we never would have known. Nepal is a gift that Nick gave us.”

Kunda Dixit

Jim Simons' gift to Nepal

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121116/636b8c2d9c7e80680e06b2e5jpeg.jpg" alt="" width="2048" height="1536"/><figcaption>Geshe Sonam Wangchen in a scooter helmet distributing meals this week in Boudhanath. Photos: LISA CHOEGYAL</figcaption></figure>The web of wrinkles are etched deep into the soft bronzed face, a lifetime of gritty wind and harsh realities on the Tibetan plateau, smiling out of the phone screen. Brightly painted furniture frame her long plaited hair in a dimly lit room in Kham, a distant eastern province of Tibet on the far side of the Himalaya.Her son, Geshe Sonam Wangchen, beams back with delight, adjusts his dusty maroon monk’s robes and waves the phone in excitement, returning joyous Losar messages as he bears his mother aloft on the small monitor through the sprawling family home on the northern rim of the Kathmandu Valley.“Hey guys, say hello to your aunt in Tibet!” My sons Sangjay and Rinchen, dressed in festive brocade-trimmed raw-silk shirts, are bent over the low sitting room table behind towers of chips playing poker with their uncles and cousins – cards are dispensed with a flourish, intense conspiratorial concentration and whispers erupt into laughter as the tension releases at the end of each round.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121116/636b8c329c7e80680e06b2e6jpeg.jpg" alt="" width="640" height="480"><figcaption> </figcaption></figure>Their grey-haired father and uncles are dressed more plainly in warm adventure gear and down waistcoats. Through the sliding glass doors, the light is fading pink. Engraved silver bowls laden with meat, nuts and dried fruit glow at their elbows. ‘Tashi delek and Happy New Year,’ they call to their cousin’s phone.Although only a couple of months ago, that afternoon seems like another era, BC (Before Corona). We have always regarded our nephew Sonam Wangchen as something of an unlikely hero, with flashes of saintliness. Ever since he returned in robes as Geshe after years of study for his advanced Buddhism degree at the transplanted Sera monastery on the steaming plains of Mysore, his life has been devoted to helping others in Nepal.No fuss, he just sees the need, hops on his battered scooter, and gets on with alleviating suffering in this imperfect world. The fourth son of my husband’s elder sister, he lived in the Tibet Children’s Village in Dharmasala before running away to become a monk. Serving as a translator for Sera’s leaders, Sonam Wangchen was known as Gelung for his selfless vows and aura of focussed compassion, attracting the admiration of donors who followed him and his tireless work to Kathmandu.For expediency on the job, Sonam Wangchen rearranges his robes with a utilitarian claret tee-shirt and red quilted jacket, topped with a bike helmet. Just like he used to hitch up his skirts to play a mean game of football with my boys in the garden during family gatherings.As a kid Sangjay collected money from college friends to assist the heroin detox centre in a modest Budhanilkantha house, and Rinchen saved pocket money to educate young children who had found shelter with him. After one visit I was haunted by an old man with a suppurating leg in a brace who had found refuge there, abandoned by his family.The scope of Sonam Wangchen’s work received a boost after the 2015 earthquakes when the quiet heroism of his Hope and Challenge NGO attracted ongoing support from donors inspired to make a difference though his hands-on achievements – mainly philanthropic individuals from around Asia, India and Nepal. His resolve never faltered, his grave, unflinching grin never far behind the sorrow.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121116/636b8c369c7e80680e06b2e7jpeg.jpg" alt="" width="640" height="480"><figcaption> </figcaption></figure><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121116/636b8c399c7e80680e06b2e8jpeg.jpg" alt="" width="640" height="480"><figcaption> </figcaption></figure>Today, several expanded rehab centres offer drug and alcohol addiction treatment and counselling for inmates. From a humble rented room in Boudhanath, Geshe Sonam Wangchen and his NGO team provide drug prevention guidance in the Valley’s schools, medical advice and spiritual therapy. They run shelters for vulnerable aged people, and homes for children in need of protection and schooling.For many years one of their most effective and appreciated activities has been feeding the homeless and disabled, every day, around Boudhanath and Swayambhunath. Soon after lockdown last month, I called Geshe-la to see what was needed in these troubled times  – I imagine him impatiently fumbling amidst his dishevelled robes for the phone.“Hello Auntie” I wish he wouldn’t call me that, but his cheerful voice always makes me smile. “More food for the people who can’t find work,” was his immediate reply.The meal distribution stations operating on the streets of Boudhanath and Swayambhunath are overwhelmed with growing numbers of men, women and children turning up every day. They are not only handing out cooked meals, never turning anyone away, but also trying to provide care packages to sustain families – rice, dal and cooking oil.<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/here-now/philanthropy-in-the-time-of-pandemic/" target="_blank" rel="noopener">Philanthropy in the time of pandemic,</a> Shristi KarkiAn email to Nepal-centric friends produced heart-warming results from both home and abroad – many relieved to contribute tangible assistance and to overcome our collective helplessness under these current constraints. Last night Sonam Wangchen called to thank me and the boys for generating extra funds, and sent a load of photos and videos of the suitably masked, socially-distanced, and hand-washing food lines. At dusk, our local hero was still busy.“Whoever wants to come they can come. It used to be homeless people for lunch, but now so many daily workers are hungry as they have no job  – it is very difficult. Many people are coming - we have to keep cooking from early morning to late evening. We are feeding over 1,000 people every day.”<a href="https://www.facebook.com/hopechallengeNepal" data-saferedirecturl="https://www.google.com/url?q=https://www.facebook.com/hopechallengeNepal&amp;source=gmail&amp;ust=1587474191180000&amp;usg=AFQjCNGb56H1RZ6ZYHQwGIhJZbLoA6fMbg">Hope and Challenge</a>Nepal Investment Bank Ltd, Boudha, Kathmandu, NepalAccount name: Hope and Challenge, NCRs account number: 02401030255974, Swift code: NIBLNPKT

Lisa Choegyal

Feeding 1,000 a day in Kathmandu

<figure><img width="1800" height="1472" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110912118/636b8afd9c7e80680e06b273jpeg.jpg" alt=""/><figcaption>Photo: RSS</figcaption></figure>At <a href="https://www.google.com/url?client=internal-element-cse&amp;cx=011870630917993763279:opm7uqsat-4&amp;q=https://www.nepalitimes.com/here-now/home-health-care-during-a-lockdown/&amp;sa=U&amp;ved=2ahUKEwid6dLzsd3oAhUQ8HMBHRP-BbUQFjAAegQIABAC&amp;usg=AOvVaw2O5915jE54QrAp88TUQt17" target="_blank" rel="noopener">Health at Home</a>  the phone lines open at 7am ever day. Within minutes the calls start coming in. Five volunteer doctors are online to take the average 500 calls a day from people all over the country concerned about coronavirus symptoms.<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://dalle.com.np/" target="_blank" rel="noopener">Dalle Momo</a>, the dumpling company, prepares 250 meals a day at its central kitchen at Ratopul and distributes them to security personnel <a href="https://www.nepalitimes.com/here-now/confusion-persists-about-lockdown-rules/" target="_blank" rel="noopener">enforcing the lockdown</a> at intersections across Kathmandu, to frontline health workers at the Sukraraj Tropical and Infectious Disease Hospital in Teku, and homeless people in the Valley.<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.zonta.org/Local-Action/Local-Service-Advocacy/Detail/zonta-club-of-kathmandu-hosts-event-to-honor-local-women-on-rose-day-2018" target="_blank" rel="noopener">Zonta Club of Kathmandu</a> also prepares food packages and has partnered with several NGOs to distribute daily 1,000 meals to daily-wage earners who are out of jobs. Each packet includes basic food items like rice, lentil, salt, sugar, tea, and oil.<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/editorial/back-to-the-future-of-farming/" target="_blank" rel="noopener">Back to the future of farming</a>, Editorial<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/opinion/work-for-food/" target="_blank" rel="noopener">Work for food</a>, Anil ChitrakarThe private sector and non-profit organisations have all been stepping up their activities to help security forces, health workers and daily-wage workers since the nation-wide lockdown began on 24 March.Bishal Dhakal, founder of <a href="https://www.nepalitimes.com/business/caring-for-those-who-cared/" target="_blank" rel="noopener">Health at Home</a>,  says he started the call-in service since people across the country -- especially those in rural areas with no direct access to doctors, decided to set up a telephone triage service so that people can get a free counseling from medical professionals about their symptoms. Health at Home partnered with Ncell so that the incoming calls can be free.At a time when <a href="https://www.nepalitimes.com/latest/awareness-high-among-nepalis-about-virus/" target="_blank" rel="noopener">public concern about the pandemic is high</a>  the service has not only been a way for people to talk to doctors about their symptoms, but also a source of reassurance.“It has become like a counselling platform,” Dhakal says of the telephone triage. “This has been a support network for people in that it has helped with people dealing with the anxiety and stress that they might be feeling during this time.”<a href="https://www.nepalitimes.com/latest/awareness-high-among-nepalis-about-virus/" target="_blank" rel="noopener">Awareness high among Nepalis about virus</a>The call-in service helps screen <a href="https://www.nepalitimes.com/here-now/returnees-may-be-taking-coronavirus-to-rural-nepal/" target="_blank" rel="noopener">potential COVID-19 patients</a> for testing and take the pressure off of hospitals as they tend to get overcrowded with patients suspecting they have the coronavirus, which in turn increases the risk of infections spreading more widely. <figure><img width="640" height="489" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121112/636b8b009c7e80680e06b274jpeg.jpg" alt=""><figcaption> </figcaption></figure><figure><img width="640" height="486" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121112/636b8b039c7e80680e06b275jpeg.jpg" alt=""><figcaption> </figcaption></figure>Subhash Gauchan, co-founder of Dalle Momo, says his company began providing meals with the intention of using its remaining stock of raw material to feed whomever they could instead of letting it go to waste. But then it evolved into something bigger.“A lot of people have come forward and asked how they could help,” Gauchan told Nepali Times over the phone. “They have been stepping up to provide fresh vegetables, which is what we need the most. So, we decided that we would continue doing this for as long as we are able.”Although Nepal seems to have been <a href="https://www.nepalitimes.com/latest/could-an-anti-tb-vaccine-be-protecting-nepalis/" target="_blank" rel="noopener">spared from a more aggressive spread of the coronavirus so far</a>,  Nepalis are set to be significantly affected financially by the pandemic, with daily-wage workers bearing the brunt of <a href="https://www.nepalitimes.com/latest/nepal-covid-19-relief-package/" target="_blank" rel="noopener">the economic fallout</a>. Non-profits like the Zonta Club of Kathmandu have been reaching out to daily wage workers affected by the lockdown.Zonta’s Kamal Kesari Tuladhar says people have constantly been reaching out to offer help and that they were able to raise Rs1.5 million in 2 days. “My initial target was 300 food packages, but the response has been so overwhelming that we are distributing 1,000. As long as the help keeps coming, we will continue this, because people need it.” <a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/opinion/common-sense-is-uncommon-in-fighting-covid-19/" target="_blank" rel="noopener">Common sense is uncommon in fighting COVID-19</a>, Anil Chitrakar <figure><img width="640" height="480" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121112/636b8b069c7e80680e06b276jpeg.jpg" alt=""><figcaption> </figcaption></figure>Siddhant Pandey, CEO of the private equity company <a href="https://bo2.com.np/" target="_blank" rel="noopener">Business Oxygen</a>,  says private sector philanthropy is more important than ever in these unprecedented times. But some companies that have tried to gain widespread publicity from their ‘corporate social responsibility’ have been trolled in social media for seeking promotion mileage rather than genuinely helping.But Pandey says that while some companies might be stepping up their philanthropic efforts  for publicity, it does encourage others to come forward and to provide help as well.“At this point, we need to think rationally,” says Pandey. “Providing urgent food, services, information, and medical equipment is the need of the hour right now.”

Shristi Karki

Philanthropy in the time of pandemic

https://youtu.be/TjoXT_Pu2koWith its new highway to the north, Surkhet has become the gateway to the Karnali and is morphing into a boomtown. But 10 minutes out of the dusty, bustling city nestled amidst a terraced landscape, the Kopila Valley School (KVS) is a functioning model for the rest of Nepal on how schools should be built and administered.At a time when progress is marked by the rise of glass and concrete structures, the school employs rammed-earth technology with an ecofriendly philosophy that uses local materials for construction, harnesses the sun and sewage for energy, harvests rainwater and minimises waste.But even founder Maggie Doyne at first needed convincing by architect Prabal Thapa to accept a mud design for the buildings. Her vision of an environment-friendly school was one made of bamboo, like the Green School she had seen in Bali.“Look, we’re not in Bali,” Thapa told her. “We are in Nepal, and Nepal is known for mountains. With rammed earth, you’re making mountains.”Read also:<a href="https://www.nepalitimes.com/here-now/quake-was-a-learning-experience-for-nepals-schools/" target="_blank" rel="noopener">Quake was a learning experience for Nepal’s schools</a>, Prakriti Kandel<a href="https://www.nepalitimes.com/editorial/lowest-common-denominator/" target="_blank" rel="noopener">Lowest common denominator</a>, Editorial<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108121144/636a41ae9c7e80680e04a68cjpeg.jpg" alt="" width="1400" height="1049"/><figcaption>All photos: SHEILIN TEO</figcaption></figure>Rammed earth provides excellent thermal mass to keep temperature stable indoors, it uses local material and labour, the structure is durable and easy to maintain. The walls are nearly 0.5m thick, and reinforced with steel and concrete banding for seismic resistance.“We wanted the school to feel Nepali through and through, to stay true to local architecture that is so stunningly beautiful,” explains Doyne, showing us around the campus.The two-storey school blocks are simple and rectangular, with gabled roofs, breezy stairwells, and are connected by corridors on one side, much like traditional farmhouses in Nepal. The buildings are designed as modular blocks that can be arranged in various ways to suit the landscape and functions required by the school. The simplicity and repeatability of the modules were important considerations to allow ease of building by unskilled local labourers, many of them women trained on the job.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108121144/636a41b19c7e80680e04a68djpeg.jpg" alt="" width="5000" height="1784"><figcaption> </figcaption></figure>Standing within the grounds, it becomes clear why buildings were sited as they were: they form a protective coterie around a central sports court and create ancillary terraces where children play. The topography creates opportunities for passive surveillance from the administrative block that sits towards the top of the sloping site, and plenty of gathering and resting places along stone-lined steps that double as bleachers overlooking play areas and gardens. When children pour out of their classrooms, they tumble across the sports court and down the stairs, bobbing along ramps that slice across the school’s terrace walls brightly coloured in house colours of reds, blues, yellows and greens.Read also:<a href="http://archive.nepalitimes.com/news.php?id=19495#.XOah1BYzbIU" target="_blank" rel="noopener">Bhaktapur</a>, Lukas Grimm<a href="http://archive.nepalitimes.com/news.php?id=12450#.XOahzhYzbIU" target="_blank" rel="noopener">Mud, glorious mud</a>, Nripal Adhikari“Construction was so difficult, and the only thing that got us through the really hard moments was knowing that one day there would be kids in these classrooms,” Doyne says, explaining that complications in scheduling, budgets and differences of opinion about expectations and work values of intercultural and international teams proved to be challenges.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108121144/636a41b49c7e80680e04a68ejpeg.jpg" alt="" width="2500" height="2174"><figcaption> </figcaption></figure>The project is not just a simple school. Strengthened with steel, stabilised with cement and concrete, fitted with high performance, durable windows, the school buildings called for experience and skills beyond those required by a traditional project. More advanced, outside-the-box technology gives the campus an edge of self-sufficiency, ease of maintenance and durability.Green technology comes at a cost, with lengthy payback periods that are possibly out of reach of most other schools in Nepal, but are easily adaptable to the local context: filtration systems, biogas, rainwater harvesting by Smart Paani, and solar systems by Sun Farmer. At Kopila, all these design elements are integrated in the school’s new buildings, their functions and terrain, giving the school its green edge.“I feel that this campus has so much integrity. Every step of the way, we made decisions that were sometimes hard, or that had cost implications, or we had to forgo certain things in order to have others, but there’s nothing I would change,” says Doyne.Read also:<a href="https://www.nepalitimes.com/banner/learning-from-nepals-past-to-rebuild-its-future/" target="_blank" rel="noopener">Learning from Nepal’s past to rebuild its future</a>, Prakriti Kandel<a href="https://www.nepalitimes.com/banner/lost-in-reconstruction/" target="_blank" rel="noopener">Lost in reconstruction</a>, Shiva UpretyThis approach is not limited to the physical design of the school; its curriculum is also grounded in place-based learning that adapts Nepal’s national curriculum to the school’s philosophy. Principal Naim Chaudhari explains: “It is about trying to integrate what we find in the community, what we can learn from and what we can give back to it. After all, when the children graduate they go into the community and they will live there. That is where they will grow further.”<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108121144/636a41b89c7e80680e04a68fjpeg.jpg" alt="" width="1400" height="1050">The school has a farm and a vocational focus, and the students learn at least one skill each year from among cooking, washing, cleaning, driving, farming, agro-forestry, animal husbandry, horticulture, welding, woodwork, machine work and electrical skills.“When our children graduate from here, they should either go for further studies or be able to find a job,” says Chaudhari.The school includes Grades 1-10 and an Early Childhood Village that focuses on self-learning through play and exploration. The older ‘plus-two’ students are still in an old bamboo school by the highway, but there are plans to bring them into the new buildings.The school’s design allows the new classrooms to blend into the greenery, preserving the productive fruiting trees on site. Just as village life still clings to the fringes of Surkhet, the school’s program extends to the students’ families, farms and the community.“We are a full service community school,” Doyne explains. “It is not just for the kids who study here — we want to bring the community in. This buildings belong to them, and I hope it makes them think about what they ultimately build someday. Just like Bali inspired Kopila, I hope that there will be other schools like this in Nepal, because this one existed.”Read also:<a href="https://www.nepalitimes.com/banner/class-struggle/" target="_blank" rel="noopener">Class struggle</a>, Prakriti Kandel<a href="https://www.nepalitimes.com/banner/building-back-cheaper-and-stronger/" target="_blank" rel="noopener">Building back cheaper and stronger</a>, Sapana Shakya and Aman Raj KhatakhoMaggie's missionIn 2005 when she was 19, Maggie Doyne was trekking in Nepal when she met Hima, a child worker. That started Doyne's Nepal journey, and her efforts to help children go to school eventually expanded to setting up Kopila Valley School and its sister initiatives in Surkhet.Doyne was named the 2014 Unsung Hero of Compassion, awarded by the Dalai Lama, and won the 2015 CNN Hero of the Year Award. Kopila is funded by The BlinkNow Foundation, a non-profit Doyne founded in 2007 as part of a network of initiatives comprising a children’s home, housing for at-risk girls, a training centre for women and a health clinic. KVS admits primarily children from disadvantaged backgrounds, providing for their education and welfare needs. It also runs a Futures Program to teach life skills, and provides vocational and academic support for senior students.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108121144/636a41bb9c7e80680e04a690jpeg.jpg" alt="" width="400" height="400"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108121144/636a41bc9c7e80680e04a691jpeg.jpg" alt="" width="2000" height="1602"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108121144/636a41c09c7e80680e04a692jpeg.jpg" alt="" width="640" height="961">Sun roofConcentrated solar panels on the roof of the canteen, by Sunworks Nepal, power cookers in the kitchen and replace Rs60,000 worth of LPG per year. Gas is still used as backup, but it is methane from a digester hidden under the artificial turf of a sports court, fed by effluent from the toilets. Irrigation for the school’s vegetable garden and landscaping comes from black and grey-water filtration beds. Rainwater from the roofs is harvested into a 300,000l water storage tank under the school canteen, designed to fill all water needs for a year. Arrays of solar photovoltaics power the school, backed up by a diesel generator. Compost from black-water waste is used to grow the KVS’s organic produce.

Starting Nepal’s green school movement

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

New year revolutions

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

What is invisible is more dangerous

82 in २०८२

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

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