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

<a href="https://nepalitimes.com/news/ball-in-balen-s-court">Nepal’s newly-installed Prime Minister Balendra Shah</a> unveiled his Council of Ministers after taking the oath of office on Friday in Kathmandu.&nbsp; Besides Nepal's pre-existing problems, his team will immediately have to deal with the fallout of the West Asia conflict to satisfy an electorate impatient for change. The Rastriya Swatantra Party (RSP) won a majority in the 5 March election and capped the Cabinet size at 15. Shah, a structural engineer and musician, himself has taken charge of the Defence and Industry Ministries. There has been an attempt to make the Cabinet inclusive with women in five of the new portfolios.&nbsp; After much negotiation, the powerful Home Ministry, a bone of contention between Shah and RSP Chair Rabi Lamichhane, has gone to Sudan Gurung, a hitherto little-known figure who <a href="https://nepalitimes.com/here-now/who-or-what-is-hami-nepal">rose to prominence after the September GenZ protest</a> and won the election from Gorkha-2.&nbsp; Gurung will be in charge of Nepal’s internal security apparatus and maintaining law and order. And with Gurung, a close ally of the Prime Minister, in charge, some note the Home Ministry will be a hook for Shah if Lamichhane, with his share of controversies, steps out line.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260327090324_c7725ea5fb9ffbf96df25a7b3122520b7ae3ee10548aed3f37781a7e5440e51a.jpg" data-media-id="editor_2" data-image-id="20260327090324_c7725ea5fb9ffbf96df25a7b3122520b7ae3ee10548aed3f37781a7e5440e51a" data-rendition-name="original" width="1440" height="960" loading="lazy" alt="Balen Shah swearing in NT"> </figure>  Notable RSP leaders, including vice-chair DP Aryal, were said to have been vying for the portfolio.&nbsp; Gurung is the founder of the non-profit Hami Nepal, which worked primarily in earthquake relief in 2015, and emerged onto the national stage during negotiations to appoint Sushila Karki as interim PM after the unrest. He was also involved in key negotiations that cemented Balendra Shah and Rabi Lamichhane’s political partnership in the runup to the election.&nbsp; Most new Cabinet members are not just first-time ministers, but are also freshmen lawmakers. Many are experts in their fields. Finance Minister Swarnim Wagle is an <a href="https://nepalitimes.com/here-now/nepal-needs-to-rebrand-itself">economist </a>with degrees from the London School of Economics and Harvard, and was previously Chief Economic Advisor at the UNDP Regional Bureau for Asia and the Pacific, and also served in Nepal’s National Planning Commission.&nbsp; Previously a member of Nepali Congress, Wagle exited the party in 2023 following differences with top leadership, and joined the RSP. Wagle won a by-election from Tanahu-1 in 2023 and won again from the same constituency in this month’s election.&nbsp; Shishir Khanal, who heads RSP’s foreign affairs department, has been appointed Minister of Foreign Affairs. &nbsp;Khanal is co-founder of Teach For Nepal, was briefly Education Minister when the RSP was part of the the Pushpa Kamal Dahal-led coalition government in 2023.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260327090324_b1a670bac12e2bf4df955134f58c8de7718d48f6be4e1f2df7c7c52f82e36e42.jpg" data-media-id="editor_4" data-image-id="20260327090324_b1a670bac12e2bf4df955134f58c8de7718d48f6be4e1f2df7c7c52f82e36e42" data-rendition-name="original" width="1440" height="960" loading="lazy" alt="Balen Shah swearing in NT"> </figure>  Law Minister Sobita Gautam is a lawyer by profession and worked in governance and public policy before she was elected as the youngest MP in the 2022 election.&nbsp; Health Minister Nisha Mehta is a nurse and became a lawmaker under the Proportional Representation system in this election which swept the RSP to power with a near two-third majority.&nbsp; Education Minister Sasmit Pokharel, a first-time MP elected from Kathmandu-5, served as an aide to Balendra Shah when he was mayor of Kathmandu and a was member of the KMC City Planning Commission.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260327090324_5ed794d7bf0cac2844277521810225c4355746b9c3f7369f70cacc878c94641f.jpg" data-media-id="editor_5" data-image-id="20260327090324_5ed794d7bf0cac2844277521810225c4355746b9c3f7369f70cacc878c94641f" data-rendition-name="original" width="1440" height="960" loading="lazy" alt="Balen Shah swearing in NT"> </figure>  Biraj Bhakta Shrestha is Energy Minister, and also served as the Minister for Youth and Sports in the Dahal-led coalition government in 2024. Before joining RSP, Shrestha was elected to the Bagmati Provincial Assembly in the 2017 elections representing the r<a href="https://nepalitimes.com/here-now/rsp-s-activist-dna">eformist Bibeksheel Sajha Party</a>. He will immediately face the challenge of addressing the <a href="https://nepalitimes.com/news/rough-road-ahead-for-new-nepal-rulers">impact of the West Asia war,</a> including rising petroleum prices and a shortage of cooking gas. Sita Badi, who was elected through the PR system, is Minister for Women, Children and Senior Citizens. She was born and brought up in the underserved and marginalised Badi community in Surkhet and has been advocating for the rights and welfare of women, children, and minority communities. Other ministers include RSP spokesperson Pratibha Rawal as Minister for Federal Affairs and General Administration as well as Land Management, and Gita Chaudhary as Minister for Agriculture, Sunil Lamsal is Physical Infrastrucutre, Transport, and Urban Development Minister, Khadka Raj (Ganesh) Paudel as Tourism and Civil Aviation Minister. Dipak Sah is the Labour and Employment Minister, and Bikram Timilsina is Communication Minister.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260327090324_b67c2d199d4897031583a5b7ec7ce43e88771167696e6161665eeb5fca25d3ed.jpg" data-media-id="editor_8" data-image-id="20260327090324_b67c2d199d4897031583a5b7ec7ce43e88771167696e6161665eeb5fca25d3ed" data-rendition-name="original" width="1440" height="960" loading="lazy" alt="Balen Shah swearing in NT"> </figure>  Meanwhile, RSP vice-chair DP Aryal, who many thought would be home minister because of his proximity with Rabi Lamichhane has been proposed as Speaker of the House.&nbsp; Aryal previously served two brief stints as the Minister of Labour when RSP was part of the RSP’s coalition governments in 2023 and 2024. As minister Aryal came <a href="https://nepalitimes.com/editorial/skeletons-in-the-cabinet-k5x6py1v">under scrutiny </a>for his involvement in an employment agency that was investigated for illegal acquisition of wealth in 2020. If appointed House Speaker, Aryal will be expected to play a neutral and non-partisan role in Parliamentary affairs. &nbsp; With the full Cabinet announced on Friday, Prime Minister Shah and his team now have their work cut out for them. &nbsp;The government’s first priority will be ensuring the safety and long-term security of the almost two million <a href="https://nepalitimes.com/here-now/migrant-workers-in-wartime">Nepalis living and working in the Gulf</a> amid the ongoing conflict in the region, and taking steps to cushion Nepal’s economy from the Israel-US war on Iran. The new leaders will also be tasked with implementing the findings of the Karki Commission report on the September violence that paved the way for the election and the rise of the RSP. &nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260327090324_69b36bc62737e44ade4080be36688f9c2f92201356e1df2072cef8ecc6a9be5d.jpg" data-media-id="editor_11" data-image-id="20260327090324_69b36bc62737e44ade4080be36688f9c2f92201356e1df2072cef8ecc6a9be5d" data-rendition-name="original" width="1440" height="960" loading="lazy" alt="Balen Shah swearing in NT"> <figcaption>Snapshots from PM Balen Shah's swearing-in ceremony</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260327090324_69b36bc62737e44ade4080be36688f9c2f92201356e1df2072cef8ecc6a9be5d.jpg" data-media-id="editor_12" data-image-id="20260327090324_69b36bc62737e44ade4080be36688f9c2f92201356e1df2072cef8ecc6a9be5d" data-rendition-name="original" width="1440" height="960" loading="lazy" alt="Balen Shah swearing in NT"> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260327090324_8646d490883154f696bcdc6e2375084419f2eefaaf0ef0c7e2710aa6e2d94a8a.jpg" data-media-id="editor_13" data-image-id="20260327090324_8646d490883154f696bcdc6e2375084419f2eefaaf0ef0c7e2710aa6e2d94a8a" data-rendition-name="original" width="1440" height="960" loading="lazy" alt="Balen Shah swearing in NT"> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260327090324_89d17d6584593be1eb23eb1d4872c3b7c600e1620f3aca48dbff4838364a1e3c.jpg" data-media-id="editor_14" data-image-id="20260327090324_89d17d6584593be1eb23eb1d4872c3b7c600e1620f3aca48dbff4838364a1e3c" data-rendition-name="original" width="1440" height="960" loading="lazy" alt="Balen Shah swearing in NT"> </figure>  &nbsp;Full list of ministers: Prime Minsiter: Balendra Shah Home Minister: Sudan Gurung Finance Minister: Swarnim Wagle Foreign Affairs Minister: Shishir Khanal Law, Justice and Parliamentary Affairs Ministry: Sobita Gautam Energy, Water and Irrigation Minister: Biraj Bhakta Shrestha Education Minister: Sasmit Pokharel Physical Infrastrucutre, Transport, and Urban Development Minister: Sunil Lamsal Communication and Information Ministry: Bikram Timilsina General Administration Minister: Pratibha Rawal Women, Children and Senior Citizens Minister: Sita Badi Health and Population Minister: Nisha Mehta Agriculture Minister: Gita Chaudhary Culture, Tourism and Civil Aviation Minister: Khadka Raj (Ganesh) Paudel&nbsp; Labour Minister: Dipak Sah

Nepal swears in new Cabinet

Next to my home in Bhainsepati stood a dead Uttis tree next to a public tap. A nearby water tank built a year earlier had killed its roots.
If the tree collapsed, people living nearby and those queuing up to fetch water at the tap would be hurt. With the storm season approaching, the risk was obvious. The tree could also fall on my own house, so I volunteered to find a way to remove this threat.
Little did I know how difficult it would be. A forest officer acquaintance told me there is a special procedure for cutting risky trees. I contacted the Lalitpur District Forest Office (DFO).&nbsp;
He said a technical report from a field officer was needed, and passed on her number. When I called, she asked for the location, photos, and a video. I send them all.
The ward office also suggested I use Lalitpur Metropolitan City’s mobile app, Lalitpur Alert, to report the problem. I uploaded photos, and submitted the complaint. This seemed to be very easy and efficient.
Indeed, the next day the municipality called me back and I explained the situation. They said they could not act without permission from the DFO. I asked why the app existed if the city could not act on such complaints. The officer said he did not know. My happiness was short-lived.
A couple of days later, the app notified me that my problem had been solved, and the complaint was removed. But the dead tree still stood there defiantly.&nbsp;
A week later, two forest technicians arrived on a scooter to inspect the tree. They looked up at the tree and asked if I had a measuring tape so they could measure its diameter.
“You are the technicians,” I told them. “You came to inspect the tree, and you came without a measuring tape?”
I rummaged at home and found a tape measure. They got the diameter and said they would prepare a technical report, but I would have to obtain a recommendation letter from the ward office and submit it to the DFO.
“This tree is dead,” I told them. “It is on public land. You have seen it with your own eyes. You know it's dangerous, so write a report and arrange for it to be cut. Why do I have to run from office to office to apply for recommendation letters?”
Their answer was simple, yet expected: “Those are the rules.”
They left, and I gave up. Two technicians spent half a day visiting the site. The metropolis runs a complaint system with a mobile app funded with public money. The ward office has staff to solve problems. Yet none of these institutions took the responsibility to remove a dangerous tree.
Everyone is busy citing rules and regulations and passing the buck. Weeks passed. Everyone reacted to the problem, but no one took any responsibility to resolving it.
Then, one bright December morning under a deep blue sky, a few neighbourhood boys were swinging their axes on the trunk. They had no proper equipment, no safety gear, and no professional experience.
I gave the boys some money and so did a neighbour. It took an hour or so for the tree to come crashing down safely. We had paid to have the tree cut illegally, and the matter ended there.
Multiple government offices, technicians, procedures, and mobile apps could not remove a dangerous tree, and we had to break the law to cut it. The tree is gone now, but the real problem remains: an inefficient bureaucracy.&nbsp;
It is perhaps symbolic that the tree is the election sign of the Nepali Congress, which was part of Nepal's governance and bureaucracy for decades and did not perform well in this month's election.&nbsp;
That is the bureaucracy that the new RSP government now has to get to work. But it will not be easy.
I posted on Facebook: ‘When people feel leaders have grown arrogant or corrupt with power, they change their minds and their votes. If those who replace them follow the same path, voters will again change their minds and votes.’
I continued: ‘The strength of democracy lies in this simple principle: the more citizens act as independent voters, the stronger democracy becomes. The more they behave as party loyalists, the weaker it grows. If we want a better system, we must demand deep reform of the state bureaucracy and hold institutions accountable.’&nbsp;
The first responses came from two senior government officials. They told me privately that they agreed by 200% but could not say so publicly.
It is quite normal for a Nepali to get the run around in government offices, it is almost a given to be asked for a bribe. As an environmental reporter and citizen, I have numerous such examples.
It is not just one sector that has been suffering. It is everywhere, and this is just an example of how complicated our bureaucracy is. As a 40 something person, I am old enough to remember the 1990 pro-democracy movement, &nbsp;the Maoist insurgency. Many promises made then by the politicians were broken.
We fought for rights, we fought for regime change. The country has changed political systems several times, from monarchy to multiparty democracy and finally a republic.
Yet one thing that remains largely untouched or reformed is our inefficient and corrupt bureaucracy. The new government, to be led by the youngest prime minister in our history must start this reform if it wants to deliver.&nbsp;
Otherwise, we may have to keep changing governments every few years, and still find ourselves unable to legally cut down even one dead tree.

A dead tree tests Nepal's bureaucracy

Rivers have been the lifelines of civilisations with their dynamic ecosystems providing vital services for human survival and ecological balance through the ages.&nbsp; But accelerating anthropocentric footprints are causing severe, and often irreversible, damage to river systems across the world, including those across High Asia, a region that sustains nearly a fourth of the global population downstream. An example is the <a href="https://nepalitimes.com/here-now/how-the-bagmati-civilisation-is-becoming-uncivilised" target="_blank">Bagmati River</a> that courses through Kathmandu, crosses the Himalayan foothills to join the Ganga in India. A river that once shaped the <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/when-it-comes-to-water-pollution,3196" target="_blank">Kathmandu Valley Civilisation </a>is now a polluted and biologically dead water body constricted by urban sprawl, choked by construction debris, chemical waste and untreated sewage.&nbsp; The loss of a sacred river is tragic enough, but its hazards related to health, life and livelihoods are not limited to the Valley, nor is its enormity fully gauged by the metrics of fatality, income loss, flood return periods, runoffs, embankment failure.&nbsp; It is a systemic collapse of ecological integrity, socio-economic stability and cultural heritage, affecting its downstream users as well. The death of Bagmati is a peril for a population size way bigger than circa 5 million residents of Kathmandu Valley. The degradation started in the 1980s and has accelerated. Why has not enough been done to save this iconic river that runs through Nepal’s capital?&nbsp; The Bagmati River Basin Improvement Project (BRBIP) was designed to make headway in restoring the river with a sewage treatment plant, dams for storing water to support dry-season runoff, recharge groundwater, creation of <a href="https://archive.nepalitimes.com/page/resurrecting-bagmati-the-river" target="_blank">green biodiversity corridors</a> along the river bank to also serve as recreation areas, reduce the urban heat island effect, and also provide cultural continuity. The project also envisages collection of hydrological data for managing Bagmati multipurposewater systems and providing flood forecasts and early warnings aimed at protecting lives and property, among other things. Most importantly, the project takes the integrated water resource management approach, which, in principle, is a holistic and collaborative way of managing all elements of the water cycle to ensure water security, public and environmental health and amenity.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260329040336_9605240fa8c7d649ce49fbe43565130e3187e979338ccf959c4e9b8c581b7a4c.jpg" data-media-id="editor_3" data-image-id="20260329040336_9605240fa8c7d649ce49fbe43565130e3187e979338ccf959c4e9b8c581b7a4c" data-rendition-name="original" width="2126" height="1577" loading="lazy" alt="Bagmati NT"> </figure>  This should pave the way for managing a river as a connected ecological, social, and economic system by enabling coordination across agencies and disciplines, stimulating technological innovation and financial investment. The success of this approach depends on long-term political will and commitment that transcend political cycles, but also needs strong community and civil society in defining issues and proposing solutions, creating and sharing knowledge, taking independent action to inform practice, monitoring and evaluating policies, and participating in public decision-making. Civil society, especially, in making the <a href="https://archive.nepalitimes.com/page/encounter-with-bagmati-river" target="_blank">revival of the Bagmati River</a> a pressing governance issue. The Bagmati Action Plan 2009, a precursor to the BRBIP, was designed in response to lawsuits filed in 2000 and 2004 by an independent legal practitioner of Kathmandu against waste dumping in the river.&nbsp; It took him almost two decades of legal battle for Nepal’s Supreme Court to pass orders for mandatory septic tanks in all homes in Kathmandu Valley, relocation of squatters from Bagmati river banks to government-built houses, and embargo on dumping and burying garbage on the banks of the river and its tributaries. Despite court orders, however, actual results have been unsatisfactory. Restoration of Bagmati barely made it to any political debate or electoral manifesto this time. Treatment plants have not been operational for years, yet no one is held accountable. The population ignores waste segregation or single-use plastic rules to check littering.&nbsp; The current condition of the river therefore seems to have more to do with the lack of public awareness and behaviour change than the failure of various master plans. Why does the deep danger of a dead river fail to arouse widespread civil society concern, let alone action? The apathy is perhaps underlined by an innately anthropocentric understanding of the river as a mere resource to be exploited, rather than the backbone of existence.&nbsp; Such a paradigm shift is possible when river or river systems are understood to be necessary for &nbsp;a harmonious coexistence with human populations. The more pertinent question is not whether a dead river can be restored because there are many examples from around the world where that has been successfully achieved. It is whether we choose to restore our rivers for intergenerational equity. This would require a holistic perspective and political will to revive reverence for a river system so that its symbiotic relationship with human settlements can be restored. Roshni Gurung is Research Assistant, River Basins at the International Centre for Integrated Mountain Development (ICIMOD).

A lifeline becomes liability

On Friday, Balendra Shah is taking his oath of office as Nepal's prime minister in a capital city of which he was a mayor till six months ago.
At 35, he will be among Nepal’s youngest prime ministers. His reticence and reclusiveness have reinforced his brand as a doer rather than a talker. This was a persona he cultivated as mayor of someone who cleaned up the city by managing garbage. But he also chased off sidewalk vendors in an effort to ‘beautify’ the city.&nbsp;
After being elected, Shah did not attend RSP events in official capacity, and he was absent at an MP orientation last week.&nbsp;
His refusal to engage with the press, and even stopping to post on social media, have added to the air of reclusiveness. But as prime minister, he may have to communicate more even if it just to stop conspiracy theories and intrigue.&nbsp;
The people he will now represent would like to know, and have a right to know, what he is up to. Otherwise the feeling will grow that Nepal is entering uncharted territory. Governance, the economy and investment do not like uncertainty.
Political scientist Pyakuryal notes that calling Balen a 'man of few words' may serve as a useful epithet if he governs with quiet efficiency rather than fanfare. "But as Prime Minister, he must engage the nation’s will, not simply manage from above," she says.
She adds: "The real test lies in his choice of style: will he lead exclusively, keeping decisions close, or inclusively, opening space for dialogue and shared ownership of governance?"
Nepal's newly-elected lawmakers were sworn in on Thursday. And once sworn in as PM on Friday, Balendra Shah is set to appoint a ‘minimalist’ Cabinet. Although the Constitution caps the size of the Council of Ministers at 25, the party has decided to stick to maximum 18 and not split ministries to accommodate loyalists as was done in the past.&nbsp;
&nbsp;"The Cabinet must support the leadership of the Prime Minister while ensuring accountability to the Parliament,” notes political scientist Sucheta Pyakuryal. “But the questions that come to mind are: will the RSP MPs readily submit to Balen’s leadership and is Balen’s absence from the party’s official events an unwillingness or hesitation to submit to the party?”
Prime Minister Sushila Karki and her ministers ended their interim tenures this week, and she was lauded for upholding her commitment to hold a free, fair and peaceful election. But her image was tarnished for her reluctance to release the investigation report on the September violence, as well as recommending her Home Minister Om Prakash Aryal for a National Assembly seat, and her personal secretary to the National Trust for Nature Conservation. President Ram Chandra Poudel has put Aryal’s nomination on hold. &nbsp;
The Investigation Commission report leaked on Wednesday said the state failed to stop the firing on protestors by Police on 8 September and blamed the Army for not preventing the arson next day. It recommended the prosecution of prime minister KP Oli, home minister Ramesh Lekhak, and Police chief Chandra Kuber Khapung.
Notable names said to be in consideration for the Cabinet include many who are experts in their fields, and RSP wants a young lawmaker as Speaker. The new government will plunge headlong into the economic fallout of the West Asia war.
RSP, with its near two-third majority, does not have to placate any coalition partner, so Nepal is at long last expected to have a stable government after 35 years. Despite hopes that there will not be the usual horse-trading this time, there is tension between supporters of RSP chair Rabi Lamichhane and Balendra Shah. The two have been negotiating in hotel rooms for Cabinet posts for loyalists.&nbsp;
Shah’s larger-than-life online persona and nationwide appeal delivered the RSP its overwhelming electoral victory this month, and this makes the party’s core leadership beholden to him. To what extent is Shah willing to meet Lamichhane’s demands is the critical question, and we will know the answer by this weekend.
Says Pyakuryal: “Because this election showcased personality politics rather than the regular party politics, the dangers of ego-clashes, power-tussles and intraparty realpolitik become very real and this kind of equation can greatly hamper the spirit of democracy, representation and collective good."

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