Tranexamic acid (TXA) is a game-changer drug in the treatment of post-partum haemorrhage (PPH), the main cause of death in women immediately after giving birth.Unsurprisingly, 99 % of these deaths occur in under-developed countries like Nepal because many patients cannot afford treatment. The good news is that TXA is inexpensive, and is widely available in South Asia.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101136/636b75419c7e80680e0623ddjpeg.jpg" alt="" width="800" height="479"/>Most doctors, especially those who work in emergency room settings, have certainly heard about this drug and probably use it often. The drug’s scope is clearly not limited to PPH: it is very often used in trauma victims to stem bleeding.Read also: <a href="https://www.nepalitimes.com/?p=41024&amp;preview_nonce=ec84b2062a&amp;preview=true" target="_blank" rel="noopener">No conceivable reason for unwanted pregnancies</a> <a href="https://www.nepalitimes.com/here-now/who-will-save-nepals-poor-new-mothers/">Who will save Nepal’s poor pregnant women … a government plan, or God?</a>, Rojita AdhikariHowever, many doctors, <a href="https://www.figo.org/news/save-mothers-stop-PPH" target="_blank" rel="noopener">including those in obstetrics and gynecology</a>, may not know why exactly this well-known and often-used drug has recently shot to prominence in the treatment  of  PPH.It all had to do with the <a href="https://www.lshtm.ac.uk/newsevents/news/2017/every-minute-counts-when-using-lifesaving-drug-treat-bleeding" target="_blank" rel="noopener">WOMAN study</a>. In order to avoid unnecessary bias regarding drug recommendations, Western medicine is generally based on randomised, double-blind, placebo-controlled trials called RCT (randomised controlled trials).These rigorous methods are applied so that the final results will have as little to do with chance as possible. (In fact this year’s Nobel Prize in economy went to a couple, Banerjee and Duflo,who used the RCT method to arrive at their conclusions on alleviating global poverty.)For the <a href="https://sinaiem.org/txa-in-the-hemorrhaging-postpartum-patient/" target="_blank" rel="noopener">TXA study,</a> the investigators recruited women aged 16 years and older with a clinical diagnosis of <a href="https://www.medpagetoday.com/meetingcoverage/smfm/70933" target="_blank" rel="noopener">post-partum hemorrhage after vaginal birth or caesarian section</a> from 193 hospitals in 21 countries, including BPKIHS and Birat Hospital in Dharan and Nepal Medical College in Kathmandu.Read also: <a href="https://www.nepalitimes.com/here-now/nepal-far-from-hitting-contraceptive-target/" target="_blank" rel="noopener">Nepal far from hitting contraceptive target</a>, Sewa BhattaraiBetween March, 2010 and April 2016, 20,060 women were randomly assigned by the international panel of study investigators to receive either 1 gram of intravenous TXA or a matching  placebo (a look-alike sugar pill) in addition to the usual care that included other drugs.The results were ground-breaking. When given within three hours after the onset of PPH, one in three maternal deaths were prevented with TXA. The study was published in the medical journal Lancet in May 2017. The World Health Organization (WHO) took note.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101136/636b75439c7e80680e0623dejpeg.jpg" alt="" width="1000" height="562">In fact the WHO had already recommended the use of TXA in PPH back in 2012, but the recommendation at that time was to use TXA almost as a last resort after the uterotonics failed to control the bleeding. Uterotonics are drugs like oxytocin and prostaglandins that are commonly used to contract the uterus to stop haemorrhage. TXA does not work by tightening the uterus but by inhibiting the breakdown of blood clots (fibrin and fibrinogen), a completely different mechanism of action.Read also: <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/globe-rallies-to-aid-nepals-women,3841" target="_blank" rel="noopener">Cutting the lifeline</a>, Kate RyanIn  2017, based on the WOMAN trial (the World Maternal Antifibrionlytic acronym is in keeping with TXA’s mechanism  of action), the WHO put out new recommendations prioritising the use of TXA in the treatment of PPH: to use it as soon as possible with the uterotonics and not to wait and watch.This updated recommendation may not be known to many health care professionals on the frontline of post-partum haemmorhage treatment in Nepal. The use of TXA for a patient with PPH will only succeed if there is the political will to push it. Otherwise this tremendous advancement in medical care will be relegated to the dustbin.Fortunately, the Nepal government may soon be endorsing  new guidelines for the prompt use of TXA, especially in remote health facilities, to further reduce Nepal’s maternal mortality rate.Read also: <a href="http://archive.nepalitimes.com/article/nation/people-politics-placentas-child-delivery-complications,3922" target="_blank" rel="noopener">People, Politics, and Placentas</a>, Bikash GauchanThe prompt use of TXA can also decrease the financially- devastating helicopter rescues that poor Nepali families in far-away districts have to resort to to save the lives of relatives suffering from PPH. Most cannot afford to hire helicopters and bleed to death.In most cases, TXA has to be given intravenously, and since many Nepali births (and deaths) take place at home, this approach may not be feasible. Who is going to put in the intravenous line even if the drug is available and cheap?Amazingly, the tablet form of the drug is already easily available in Nepal, but more research is needed to find out if giving the drug orally will achieve the same result. If TXA  tablets stop post-birth bleeding as injections do, that would be very welcome news for Nepali mothers-to-be.Buddha Basnyat, MD, is a physician at the Patan Academy of Health Sciences and writes on health issues for Nepali Times.

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Miracle drug to reduce maternal deaths

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101136/636b74e99c7e80680e0623bcjpeg.jpg" alt="" width="3600" height="2400"/><figcaption>Nepali students on their way to the quarantine centre in Bhaktapur after landing in Kathmandu Airport on Sunday morning. Photo: RSS</figcaption></figure>The global public health crisis caused by <a href="https://www.nepalitimes.com/banner/why-nepal-must-watch-about-coronavirus-but-not-panic/">the 2019 novel coronavirus </a>has  hospitalised tens of thousands and killed hundreds of people, wrecked tourism in the Asia-Pacific region, impacted civil aviation and slowed down the world economy.An <a href="https://www.theguardian.com/global-development/2020/feb/07/coronavirus-chinese-rage-death-whistleblower-doctor-li-wenliang">attempt by the Chinese authorities to suppress</a> first reports from Wuhan is blamed for the initial rise in case load, and its dissemination across China and the world. But it is also China’s willingness to quarantine a whole province that is stopping its spread.The epidemic has also exposed the challenges to containment in <a href="v">the age of social media</a>. Rumours and conspiracy theories resulting in stigmatisation and xenophobia have become the norm in a global village interconnected instantaneously by internet-based apps.The media’s habit of magnifying the negative is now exacerbated by the split-second reach of individual posts, click-baits, fake news, and the chain-reaction through shares and likes over web platforms.Till Wednesday, 2,012 people had died from <a href="https://www.nepalitimes.com/latest/a-nepali-in-beijing-during-coronavirus-scare/">the Wuhan virus</a>, and 75,227 are hospitalised. These statistics are constantly updated in the media, with countries where it has spread shaded ominously on a world map – giving the impression that it has spread globally.Yet there are very few mentions anywhere that nearly 15,000 infected people have made full recovery, or that the fatality rate for the virus is a low 2%. Even though no one has yet died in the United States from this virus strain, there is saturation coverage in the media that likens the epidemic to the one in the Hollywood thriller Contagion. Few compare Covid-19 to the common flu that killed nearly 35,000 people in the United States last winter.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101136/636b74eb9c7e80680e0623bdjpeg.jpg" alt="" width="1800" height="1291"><figcaption> </figcaption></figure>The psychology of terror, irrationality of panic, and fear of diseases without cure are not new. What is new this time is mobile communication which allows panic about the virus to go viral.In Nepal, too, the media was obsessed with the plight of 182 students trapped in Hubei province. The issue was politicised by those opposed to Prime Minister Oli’s government – both within his NCP and without. Media gave prominence to tearful parents, highlighted a letter to the prime minister about his callousness and disregard. Under pressure already for non-performance, the government found <a href="https://www.nepalitimes.com/latest/nepalis-from-hubei-quarantined-in-bhaktapur/">the evacuation of the students to a quarantine camp</a> in Bhaktapur a convenient way to show-case action.If only the government reacted with similar efficiency to other, much more serious, national emergencies like Nepal’s unacceptably high maternal mortality rate. Although there has been a steep drop in the number of women who die in childbirth from 900 per 100,000 in 1990 to 239 today, Nepal has <a href="https://www.nepalitimes.com/banner/federalism-leaves-nepals-medical-sector-ailing/">missed the target</a> of reducing that number to 125 this year. It does not look like we will hit the SDG goal of 75 by 2030, either.<a href="https://www.nepalitimes.com/here-now/who-will-save-nepals-poor-new-mothers/">More than 1,200 women die</a> in child birth every year in Nepal, that is three every day. Most of these are easily preventable either by ensuring proper nutrition, enforcing the ban on <a href="https://www.nepalitimes.com/banner/child-marriage-in-nepal-eloped-at-13-mother-by-17/">child marriage</a>, ensuring access to ultrasound machines to detect complications in time, and encouraging institutional delivery.As Buddha Basnyat of the Patan Academy of Health Sciences (PAHS) comments, it is only political will that is stopping Nepal from adopting the game-changer drug Tranexamic acid (TXA) in the treatment of post-partum haemorrhage, (PPH) the most common cause of maternal death. There is a huge 44% <a href="https://www.nepalitimes.com/here-now/nepal-far-from-hitting-contraceptive-target/">unmet need for contraceptives</a>, which is leading to unwanted pregnancies and preventing a further drop in Nepal’s total fertility rate.<a href="https://www.nepalitimes.com/banner/tb/">Tuberculosis</a> kills 6,000 people in Nepal every year, and every other Nepali is a carrier of the bacillus, which means half the population should actually be quarantined. Yet the health system is supremely unconcerned, and the public is not aware of the risk.There were 2,736 fatalities in <a href="https://www.nepalitimes.com/banner/nepals-deadly-roads-take-their-toll/">road traffic accidents</a> in Nepal last year. Yet, even though the coronavirus has not killed anyone and there has been only one suspected case, Nepalis are hoarding supplies of masks and hand sanitisers. Meanwhile, vehicles continued to be driven recklessly over precarious roads. Where is the outrage?<a href="https://www.nepalitimes.com/here-now/air-pollution-is-more-dangerous-than-smoking/">Air pollution</a> in Kathmandu Valley, Chitwan and the Tarai is so bad that it is making many people die prematurely, reducing our lifespans by 3.5 years. Where is the peoples’ anger at having their lives cut short? It is ironic that residents of Kharipati are more worried about Nepali students from Wuhan being quarantined in their neighbourhood, than about the toxic fumes emitted by dozens of brick kilns nearby.To be sure, we cannot afford to be complacent when it comes to new epidemics like <a href="v">Covid-19</a>. However, it is the neglect of easily preventable diseases that kills more people in Nepal -- most often poor people in rural communities. We need a robust health system that prioritises primary health care, trains medical professionals, and builds a well-equipped infrastructure to handle future epidemics.But that does not make it into the news.Sonia Awale

Sonia Awale

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When panic goes viral

This is the 91st 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. I have still not come to terms with the reality that my daughter Ruby Thakur is now the Deputy Speaker of Nepal’s Parliament. Sometimes, when I am walking, the thought hits me, and I cannot believe it.&nbsp; Things changed for my daughter in a very short time. I had dreamt that the best my daughter could achieve was a good engineering job. Fate had bigger plans for her. She is no longer just my daughter, she is the nation’s daughter. Nepal’s daughter.&nbsp; My children’s education was always my foremost priority. That is the main reason I went overseas for employment. I realised the value of education while working in Saudi Arabia. In my office, colleagues with good education earn $8,000 per month working on computers. Those with low education toil outdoors in the heat for much lower wages. A good education or skills can change everything. I am in Nepal on vacation and will soon return to my job. Ruby is all set now. But I still have to take care of my other children's education. As the eldest son, I myself never got a chance to prioritise my own education. I dropped out in Grade 7 because I had to take care of my ageing parents and younger siblings. I have done all kinds of jobs. I worked in a landlord’s field for a share of the harvest. Even now my wife and I farm for the land owner and have to give away half of what we grow.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260413120444_051b61e01a5189af538aa1e011acd3e2b38d5f42825116b2afd325d93d0c519b.jpg" data-media-id="editor_0" data-image-id="20260413120444_051b61e01a5189af538aa1e011acd3e2b38d5f42825116b2afd325d93d0c519b" data-rendition-name="original" width="4032" height="2268" loading="lazy" alt="DD"> <figcaption>Sogarath Thakur during a break in Nepal with wife tending to his farm.</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260413120448_8a1c3ac3fd559026bc6f981cc8dc82cb8ad09a3a4f55fb9f6f7fd5f49c3d5571.jpg" data-media-id="editor_1" data-image-id="20260413120448_8a1c3ac3fd559026bc6f981cc8dc82cb8ad09a3a4f55fb9f6f7fd5f49c3d5571" data-rendition-name="original" width="4032" height="2268" loading="lazy" alt="DD"> </figure>  Then I worked as a barber, my family’s line of occupation. I went door to door cutting people’s hair and later worked in a relative’s saloon. Hairstyles were simple back then, and I got to keep half the fee. I also worked in a brick factory where I was paid weekly. &nbsp; I married when I was 16, and my wife was a year younger. As my family and responsibilities grew, I had to migrate leaving behind my three children including Ruby who was just three months old.&nbsp; I went to Qatar where I continued working as a barber. It was a large saloon and the standards for cleanliness and professionalism were higher. I had to hand over 70% of my daily earnings to the employer. I had to rely on my colleague to translate what the customer wanted. But I slowly became fluent in Arabic. I used to jot down words in Nepali and Arabic and memorise them. In Qatar, customers even came at night for haircuts, and people stayed up late. I would work till 3AM.&nbsp; Communicating with my family was one-way. I would go to Bismillah and ask someone to type out questions to my family about their whereabouts, how the harvest was that season. I would offer very little information about my life in Qatar because it was not easy. What was the point of getting them all worried? What could they do? I never received a letter in return, so throughout my time in Qatar, I never knew how my family was faring. When I appeared in the village after five years without any advance notice, it was a bittersweet reunion, and I had no gifts. I still remember how unfamiliar my village felt when I came home after so many years. I had to ask for directions. When I came home, Ruby was already in school. I had left her in my wife’s arms five years prior. I missed her growing up, and did not even see her pictures. My wife had to introduce her to me as her father. But it took just 15 minutes for her to warm up to me.&nbsp; The Arabic skills I had picked up in Qatar came in handy when I remigrated two years later to Saudi Arabia. I worked as a labourer in the desert heat, but once my company found out I spoke Arabic, I was hired for an indoor job as an office boy. The struggle in Qatar had paid off. I worked in an air conditioned office serving tea or coffee, doing bank runs or getting documents signed and photocopied. I have worked in the same company for the past 20 years, sending money home.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260413120448_f083fa873a6d77b19c8b0bdde623415c643a151fb550c57ff4e52b3c2431355f.jpg" data-media-id="editor_2" data-image-id="20260413120448_f083fa873a6d77b19c8b0bdde623415c643a151fb550c57ff4e52b3c2431355f" data-rendition-name="original" width="5712" height="3213" loading="lazy" alt="DD"> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260413120452_5ccd9a01ee05ce26b71381725108215d0f0d3806508b0cb482aabcfea09bbaef.jpg" data-media-id="editor_3" data-image-id="20260413120452_5ccd9a01ee05ce26b71381725108215d0f0d3806508b0cb482aabcfea09bbaef" data-rendition-name="original" width="4032" height="3024" loading="lazy" alt="DD"> </figure>  My wife is not just my children’s guardian, but also mine throughout the two decades I was away. I trust her with all my earnings, and she manages our household finances well. She makes sure that the children’s school fees and other expenses are paid on time. These days, with video calls, things have become much easier for me to stay in touch with home.&nbsp; When Ruby told me she wanted to do an engineering diploma, I was happy. Later, her friends inspired her to join politics so she started getting involved with Shram Sanskriti Party. I first found out she got the proportional representation nomination through social media while on my work duty in Saudi Arabia. I was so excited, but even more so when she was elected Deputy Speaker. I was back home in Dhanusha on my vacation at the time.&nbsp; We are overjoyed and waiting for her to come back to the village for a visit when she gets a chance so we can celebrate properly with everyone. I plan to go back to Saudi Arabia as originally planned, I have a good job and will work for maybe five more years. Ruby has taken 75% of the load off my back. She can help take care of her siblings.&nbsp; I sleep at 8PM every day and wake up at 5AM to exercise before my day in Saudi Arabia begins – I have stuck to the same routine for the last two decades and it has worked well for me and my health. I have a good rapport with my boss who is an Egyptian. My requests to resign have often been met with counter-offers to stay on. My honesty and hard work have won me the company's trust. I will go back and resume working as I have, despite my daughter’s huge achievements. I am still a farmer’s son, a simple man who has to fulfil his family responsibilities. My colleagues in Saudi Arabia are aware that Ruby is Deputy Speaker in Nepal’s Parliament, they are all happy for me and have congratulated me. This time, when I go back, I have promised them that I will throw a bakhri party to celebrate my daughter’s achievement.

The nation’s daughter

At 6 feet and one inch, Hira Bahadur Ghalan was exceptionally tall for a Nepali. In 1936, when people came to his Tamang village near Tistung looking for porters, they recruited him on the spot. This was no ordinary job, Hira Bahadur would lead gangs of 30 or more porters to carry cars bought by Rana rulers from Bhimphedi to Kathmandu.&nbsp; Those were the days when the only motorable roads in Nepal were in Kathmandu, but the capital was not connected to anywhere else by road. So, before cars could carry people, people had to carry cars. More Nepalis had carried cars than ridden in one. The porters were paid Rs5 for the job, and sometimes the Rana owners gave Hira Bahadur a Rs25 baksheesh. One of the cars his community helped carry was a 1939 Daimler Benz gifted by Adolf Hitler to King Tribhuvan to woo Nepal away from the British. The rusted dusty vehicle is now in the Narayanhiti Palace Museum.&nbsp; Hira Bahadur hauled cars for 25 years until his knees gave way, he died at age 90 eight years ago — the last surviving car porters of Nepal from Chitlang Valley.&nbsp; Hira Bahadur Ghalan had three sons and three daughters, one of them is Maila Kaji Lama, who at age 68, is a chauffeur in Kathmandu. His son, Manjil Lama is a pilot with Summit Air, flying to remote Himalayan airstrips. Three generations of one family worked in professions that followed a century of transportation history in Nepal. &nbsp; After the <a href="https://nepalitimes.com/multimedia/the-long-and-winding-road-to-india">Tribhuvan Rajpath was finished in 1957</a> and the ropeway upgraded, Hira Bahadur was out of a job. He tilled the family farm, watching trucks and buses headed to and from Kathmandu on the hairpins.&nbsp; As a child, Maila Kaji was fascinated by cars and wished one day to be able to drive one. After he failed Grade 8, he came to Kathmandu in 1975 and got a Rs20/month job at a petrol station in Maiti Devi. “I watched King Birendra’s coronation and was impressed by the glamour of Kathmandu, and decided to stay here,” Maila Kaji says.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026041816040_a1a41e47dec8500727702f700e43af625f059043cbcd283f13b247344b3a20aa.png" data-media-id="editor_1" data-image-id="2026041816040_a1a41e47dec8500727702f700e43af625f059043cbcd283f13b247344b3a20aa" data-rendition-name="original" width="1974" height="1608" loading="lazy" alt="car carriers"> <figcaption>Maila Kaji</figcaption> </figure>  Former minister Ramesh Nath Pandey used to bring his Volkswagen Beetle to the station, and Maila Kaji started taking care of his car. Later, he drove a Russian Jeep for former minister and geographer Harka Gurung. Along the way, he fell in love with the daughter of a Brahmin colleague, and married her. “My father back in Tistung did not approve of our inter-ethnic marriage, and not speak to me for five years,” Maila Kaji recalls. Manjil Lama grew up in Kathmandu, and did well in science in school. He had wanted to go the US to become a pilot like his friends, but was denied a visa.&nbsp; “The visa officer told him I did not earn enough,” says Maila Kaji, “so I sold some property and sent Manjil to flying school in the Philippines.”  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026041816040_e9091162840baa6d182de2d7cc6f09e43ec9cfd9a9b6e71e7e7b14bc72da3537.png" data-media-id="editor_2" data-image-id="2026041816040_e9091162840baa6d182de2d7cc6f09e43ec9cfd9a9b6e71e7e7b14bc72da3537" data-rendition-name="original" width="1434" height="1754" loading="lazy" alt="car carriers"> <figcaption>Manjil Lama</figcaption> </figure>  After returning to Nepal, Manjil Lama now flies Let 410s of Summit Air to difficult air strips like Lukla and Simkot, and has logged over 2,000 hours. He has to go to the Czech Republic regularly for simulator training. Says Maila Kaji Lama: “My father worked hard carrying cars to raise us, I started from scratch to become a driver to support my family, and my son is now a pilot with experience in flying in the world’s toughest terrain.” &nbsp; Watch <a href="https://www.youtube.com/watch?v=lvT3iTi8yw4" target="_blank">video clip from S Dillon Ripley here</a>.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260419020448_40f8b1bdaace08106ca5c24819b6e7a34fb2109a9a3ec5c6ac179b3309e686ed.png" data-media-id="editor_4" data-image-id="20260419020448_40f8b1bdaace08106ca5c24819b6e7a34fb2109a9a3ec5c6ac179b3309e686ed" data-rendition-name="original" width="900" height="1582" loading="lazy" alt="car carriers"> </figure>

Grandfather carried cars, son drives cars, grandson flies planes

Nepalis are insured but not covered

Only 70 years ago, Kathmandu was the isolated capital of a country that had no modern surface transport link with the rest of the world.&nbsp; The idea of building a road to connect Nepal with India actually first came up during the last years of the Rana regime, after the British had left India. Construction actually began in 1952, and the serpentine route took five years to complete.&nbsp; Named Tribhuvan Rajpath, after the reigning king who initiated it, the alignment was from Thankot (1,301 m) at the western edge of the Kathmandu Valley to Nagdunga, Naubise, Tistung, Palung, Daman, Sim Bhanjyang (2,504m), Lamidanda, and Bhainse.&nbsp; At Bhainse, the highway joined the existing road to Bhimphedi and it was another 31km to Hetauda and Amlekhganj. There was a railway line between Amlekhganj and Birganj.&nbsp; After regular bus and truck service from Raxaul to Kathmandu began in 1961, the entire road popularly became known as the Tribhuvan Rajpath.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026041610044_a11b48a75c7877a0f68634f8be07d26a3f354e78ebd9adddc7d17252fddf1d1b.jpg" data-media-id="editor_0" data-image-id="2026041610044_a11b48a75c7877a0f68634f8be07d26a3f354e78ebd9adddc7d17252fddf1d1b" data-rendition-name="original" width="4608" height="3072" loading="lazy" alt="Highways NT"> <figcaption>The village of Chitlang on the main route to Kathmandu before the Rajpath was built. In the distance is the Chandragiri ridge above Thankot. Photo: DAN EDWARDS</figcaption> </figure>  <h2>Chronology&nbsp;</h2> (Based on US State Department cables and media reports) November 1945: Gen Bahadur SJB Rana asked an American official if a road could be constructed from the Indian border to Kathmandu. Nepal wanted such a road built across the mountains after first constructing an East-West artery road in the Tarai, and the government was interested in purchasing US surplus war equipment. Gen Rana inquired if there were US firms who could conduct a survey. April 1947: The Nepal government told a US official it was important to upgrade the 20-mile trail from Bhimphedi over the mountains to the Kathmandu Valley into an all-weather road and sought an estimate from the US for doing so. May 1948: Bijaya SJB Rana informed a US official that a survey for a one-lane motor road between Kathmandu and the Tarai had been completed. The road was to follow the Bagmati River to Makwanpur, then connect at Bhimphedi with the road to Amlekhgunj. The road from Tripureswor to Bhainse along the Bagmati River and via Bhimphedi would have been about 60km. (The distance from Kathmandu on the Tribhuvan Rajpath is 122 km.)  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026041610044_bb531baf5d73e00d2032814ac8abb86979a87d781abc066fcb984997aad930e6.jpg" data-media-id="editor_1" data-image-id="2026041610044_bb531baf5d73e00d2032814ac8abb86979a87d781abc066fcb984997aad930e6" data-rendition-name="original" width="4608" height="3072" loading="lazy" alt="Highways NT"> <figcaption>The road climbing the hills toward its destination of Kathmandu. Photo: DAN EDWARDS</figcaption> </figure>  July 1948: The government decided to go ahead and build a motorable road from Amlekhganj to Thankot and complete it in two years. December 1948: Construction of the motor road from Kathmandu to Amlekhgunj via the Bagmati River corridor was started. April 1949: Gen Singha SJB Rana told a US official that the motor road from Kathmandu to the Tarai and the Indo-Nepal border would be completed by the spring of 1950. February 1950: Nepal sanctioned Rs300,000 to make the 6-foot-wide road from Kathmandu along the Bagmati River to Hetauda. Of this, Rs100,000 was allocated for road-building material and machinery. Subsequently, the road would be developed into a broader motorable road at a cost of Rs7.5 million. February 1952: Nepal’s budget speech noted that a plan was underway for a road between Bhainse and Kathmandu. PM Matrika Prasad Koirala laid a foundation stone near Teku for construction of the ‘Kathmandu Hetauda Roadway’.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026041610044_e66d3b81848ec19da48be8b41cacfa8b8e2bad093719b39eda27755c9616ea9a.jpg" data-media-id="editor_2" data-image-id="2026041610044_e66d3b81848ec19da48be8b41cacfa8b8e2bad093719b39eda27755c9616ea9a" data-rendition-name="original" width="4608" height="3072" loading="lazy" alt="Highways NT"> <figcaption>Rajpath winding its way north of Bhainse. Photo: DAN EDWARDS</figcaption> </figure>  February 1952: A party of Indian engineers came to Nepal to determine the best route for a road from Raxaul to Kathmandu. March 1952: Prime Minister Jawaharlal Nehru told Parliament: “So far as India’s security is concerned, we consider the Himalayan mountains as our border.” Ministry of External Affairs official (S.N. Hakar) told a US official that the Indian government was willing to proceed with constructing the Raxaul-Kathmandu road and had sent a survey party to determine the most suitable mountain route. May 1952: Swiss experts had made surveys for a proposed new road between Bhimphedi and Thankot. Nepal government requested financial help to build the road, and India was considering the project.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026041610044_35e390c1a4812f45af7892d681230e04c63727d9006b6614ed79aaa7c22c1ece.jpg" data-media-id="editor_3" data-image-id="2026041610044_35e390c1a4812f45af7892d681230e04c63727d9006b6614ed79aaa7c22c1ece" data-rendition-name="original" width="4608" height="3072" loading="lazy" alt="Highways NT"> <figcaption>With a constant stream of trucks, buses and jeeps, the narrow Rajpath once was Nepal's busiest highway. Photo: DAN EDWARDS</figcaption> </figure>  Summer 1952: Work on a new road was at a standstill, so Nepal asked India for assistance. Indian engineers surveyed two routes: one following the Bagmati River, the other road through Daman that was later adopted. July 1952: Nepal’s Ministry of Planning decided to construct a road between Kathmandu and Raxaul, awaiting Cabinet approval soon. Prime Minister Matrika Koirala said the proposed road was longer than necessary, but it was a better route ‘for strategic reasons’, because it did not require many bridges. August 1952: King Tribhuvan said road construction from Kathmandu to Bhimphedi would “begin soon”. September 1952: An Indian Military Team began construction of the Kathmandu-Bhainse road without a formal agreement being signed with the Nepal government.&nbsp; February 1953: The Indian Ambassador said the road would be hard surfaced within a year. September 1953: Prime Minister Matrika Koirala inspected the completion of a ‘jeepable track’. December 1953: The road was named ‘Tribhuvan Rajpath’. April 1954: Reports circulated that Swiss engineers criticised the alignment, arguing it would have been easier, faster, and cheaper to build over the existing foot trail between Bhimphedi and Thankot through Kulekhani. July 1954: Heavy monsoon rain damaged much of the roadway that had been built.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026041610044_b5b2a1833f1366e532f1629f47c124d877df7b6f8a34b6c83f6c21ec3e4415dd.jpg" data-media-id="editor_4" data-image-id="2026041610044_b5b2a1833f1366e532f1629f47c124d877df7b6f8a34b6c83f6c21ec3e4415dd" data-rendition-name="original" width="855" height="1123" loading="lazy" alt="Highways NT"> <figcaption>Crown Prince Mahendra inspecting construction progress on the Tribhuvan Rajpath in October 1954. Photo: ROYAL PALACE</figcaption> </figure>  November 1954: The Indian ambassador said flood damage was so great that the road would be delayed by two years. May 1955: Twenty military trucks brought rice from Amlekhganj to Kathmandu on the Tribhuvan Rajpath. King Tribhuvan died in Zurich. December 1956: A gravel road was completed, with trucks and buses plying between Amlekhganj and Kathmandu. December 1956: Nepal government abolished regulations that required Nepali nationals to carry permits for travel within Nepal, except for women below the age of 45. 1957: Reduction in price of goods carried to Kathmandu by truck: Sugar, Rs0.13 per kg. Wheat flour Rs0.13 per kg. Kerosene Rs0.25 per litre. February 1957: An article in The Motherland newspaper in Kathmandu noted urgent action was needed to avoid Kathmandu being cut off from the Tarai during the monsoon. The correspondent wrote, ‘In a recent journey from Amlekhganj I found that almost all the bridges are in a very bad state…Now, because of the dry rivers the scores of vehicles that ply the road cross the rivers on the water level. But during monsoons… these rivers will be impossible to cross without bridges. On the road itself, landslides and big holes have made the journey a great undertaking.” April 1957: The first regular passenger bus left Amlekhganj at 12:30PM and arrived in Kathmandu completing a journey of 14 hours.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026041610044_60807e067f2d0b80bdc5e59860e9bc240b495ef606efc9301ef54ea5731d42df.jpg" data-media-id="editor_5" data-image-id="2026041610044_60807e067f2d0b80bdc5e59860e9bc240b495ef606efc9301ef54ea5731d42df" data-rendition-name="original" width="5211" height="4000" loading="lazy" alt="Highways NT"> <figcaption>Daman, one of the highest points on the Rajpath, often saw snow in winter. Photo: DAN EDWARDS</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026041610044_baac4747267c751ab7b0e5ef24697fb5001c4c55e04a82d92c89282bd01a325c.jpg" data-media-id="editor_6" data-image-id="2026041610044_baac4747267c751ab7b0e5ef24697fb5001c4c55e04a82d92c89282bd01a325c" data-rendition-name="original" width="648" height="960" loading="lazy" alt="Highways NT"> <figcaption>Travelers could view the Himalayas from a view tower at Daman. Photo: DAN EDWARDS</figcaption> </figure>  June 1957: Eight thousand Nepali workers and about 500 Indian Army personnel were at work on the road.&nbsp; 30 June 1957: India officially handed the road over to Nepal. India had spent INR32.5 million on the project.&nbsp; January 1958: The road from Amlekhganj to Bhainse was upgraded. July 1961: The gravel road from Raxaul to Birganj was blacktopped. Trucks began transporting goods from Raxaul directly to Kathmandu, avoiding the need for transshipment from train to truck in Amlekhganj, or use the ropeway from Bhimphedi. 1961: Passengers could travel from Raxaul to Kathmandu in a day, whereas it took a week by train to Amlekhganj, bus to Bhimphedi and then on foot. September 1962: Nepal’s 3-Year Plan aimed at broadening and black-topping the road between Bhainse and Raxaul, bypassing the Chure tunnel, and constructing several bridges along the route. 1963: Travelers going to Kathmandu by land: Road, 158,000, Nepal Government Railway, 66,500. Railway passenger service ended in June 1965.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026041610044_2a95eb144dad74271a0fa3a27fab6b45bbab0a1c4be59d21120ad14c08e258fd.jpg" data-media-id="editor_7" data-image-id="2026041610044_2a95eb144dad74271a0fa3a27fab6b45bbab0a1c4be59d21120ad14c08e258fd" data-rendition-name="original" width="2048" height="1344" loading="lazy" alt="Highways NT"> <figcaption>A bus providing ‘deluxe service’ in 1963 is ready to leave Amlekhganj for Kathmandu. Note the railway tracks of the Nepal Government Railway. Photo: RON ELLIOTT</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026041610044_d02013692e84d6add7a6e0ce66c2b552cd53bb084db2aa8df0593bbcf84c2c04.jpg" data-media-id="editor_8" data-image-id="2026041610044_d02013692e84d6add7a6e0ce66c2b552cd53bb084db2aa8df0593bbcf84c2c04" data-rendition-name="original" width="2048" height="1352" loading="lazy" alt="Highways NT"> <figcaption>Vehicles found it difficult to pass on many parts of the Rajpath in 1963. Photo: RON ELLIOTT</figcaption> </figure>  1965: Tribhuvan Highway was considered a useful addition to Nepal’s economic infrastructure, but it could not act as a prime mover in the nation’s economic development. It did play a major role in the 1960s in transporting material and equipment needed to implement development projects in the Kathmandu Valley. September 1966: Nepal took over maintenance of the Tribhuvan Rajpath from the Indian Aid Mission.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026041610044_5488ba1e92f6395ff882392ccbaef2270622632682eccb412d8de7b128f6f397.jpg" data-media-id="editor_9" data-image-id="2026041610044_5488ba1e92f6395ff882392ccbaef2270622632682eccb412d8de7b128f6f397" data-rendition-name="original" width="1764" height="1184" loading="lazy" alt="Highways NT"> <figcaption>Trees still lined the Rajpath near Thankot in 1967. Photo: DAN EDWARDS</figcaption> </figure>  1971: A UN-Nepal study said the best alignment for an alternative road was from Kathmandu, Pharping, Kulekhani, Bhimphedi to Bhainse. 1975: Nepal's Department of Roads’ engineer concluded: ‘The Tribhuvan Rajpath has been built without design speed consideration… The pavement was not constructed to any designed standard… irrespective of quality of material, and later the road was black topped without consideration of traffic intensity and load-bearing capacity of sub-base… utilisation of low-quality material in the Bhainse-Thankot section… Quality control was neither maintained in Bhainse-Thankot nor the Bhainse-Raxaul section. Local materials were used irrespective of their quality to complete the work in the earliest possible time and in the cheapest possible manner. Brick work was done in negligible quantity. Cement used was ordinary portland cement…’ &nbsp;&nbsp;&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026041610044_26c74f45991efb3dc29d616e8acafb3163661ae6573c5314538e59c54d5ca0a5.jpg" data-media-id="editor_10" data-image-id="2026041610044_26c74f45991efb3dc29d616e8acafb3163661ae6573c5314538e59c54d5ca0a5" data-rendition-name="original" width="2368" height="1365" loading="lazy" alt="Highways NT"> <figcaption>Bhainse in 2017. The road divided here, one going to Bhimphedi on the right, the main road proceeding to Kathmandu on the left. Photo: DAN EDWARDS</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260416100416_4d9321abf4d912796842fe963a493501e1aceff462300ecdd9bd5e0b8ba7f294.jpg" data-media-id="editor_11" data-image-id="20260416100416_4d9321abf4d912796842fe963a493501e1aceff462300ecdd9bd5e0b8ba7f294" data-rendition-name="original" width="649" height="1667" loading="lazy" alt="Highway info NT"> </figure>  Even 70 years after it was built, there is still speculation about India's security concerns vis-a-vis China, and how Indian Army engineers purposely made the road longer than it needed to be over the 2,500 Sim Bhanjyang pass instead of following the river route.&nbsp; There is also some evidence that although the Rana regime had first requested the US for help with the highway, Nehru did not want the Americans involved in Nepal. Which is why the Tribhuvan Highway became an Indian military project.&nbsp; There was similar concern from India about the Kodari Highway linking Kathmandu to China, and King Mahednra is famously supposed to have said: "Communism will not come here in a taxi."&nbsp; Geopolitics still affects Nepal's strategic highways. After decades, links to China are still rough and often blocked. Kathmandu-Tarai Fast Track is delayed by years, and not expected to be completed during this decade. Trucks and buses still bypass the Tribuvan Highway with a 200km detour via Mugling because the other alternative routes like the Tika Bhairav or Chhaimale routes are not suitable for heavy vehicles.&nbsp; The shortcut through Chitlang that the Swiss proposed in the 1950s is still too difficult. And a 25km section of the Japanese-built BP Highway to the eastern Tarai has been knocked out by the 202 flood. Dan Edwards was a Peace Corps volunteer in 1966 and is the author of several books on Nepal. This is the fourth instalment in a new limited series in Nepali Times on the historic transportation infrastructures of Nepal.

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