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

Nepal’s cricket team first beat powerhouse West Indies in two out of three matches in September, the first time it won a match and then a series against a test-playing nation.&nbsp; Then the Rhinos played six qualifiers in Oman for the 2026 T20 World Cup which is being held in India and Sri Lanka from 7 February to 8 March next year. The national team qualified comfortably with two games to spare, and won all six matches anyway. In the three months before the World Cup, cricketers will play the second season of the Nepal Premier League from 17 November to 13 December.&nbsp; After a hugely successful first season, steady upgrades have been made. The flood-lit Tribhuvan University Cricket Ground has been fitted with 15,000 seats, even though this takes away from the festival-like atmosphere of fans on their feet on the grassy slope.&nbsp; Last season, matches began at noon and three in the afternoon. Late-evening matches in winter under flood lights will increase attendance and viewership.&nbsp; There is also now technology that will display how far a six was hit and how fast a ball was bowled. Foreign players who will play in the league include Chris Lynn, D’arcy Short, Ravi Bopara, and Sohail Tanvir, all good ex-international players that people have heard of.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251101031128_9db0830fb65d0743e3d36cc4b4473e61d750789028a130f5dff8a619307b0215.jpg" data-media-id="editor_0" data-image-id="20251101031128_9db0830fb65d0743e3d36cc4b4473e61d750789028a130f5dff8a619307b0215" data-rendition-name="original" width="1365" height="1803" loading="lazy" alt="Nepal cricket"> <figcaption>Aasif Sheikh drives through the covers on his way to 69 off 41 vs Samoa.</figcaption> </figure>  But the most important point of the Nepal Premier League will be to prepare and experiment for the World Cup, which starts less than two months after the NPL ends. Team Nepal will be extra eager to play well, given that the matches are happening in South Asia and Nepali fans can make the trip.&nbsp; Head coach Stuart Law will be watching each NPL match keenly, to gain more insight into how to best use his current starters.&nbsp; As each of the eight teams are only allowed a maximum of four foreign players in their starting eleven, Law and Nepali fans will also be scouting new talent who will be hungry to emerge and prove themselves to earn a place in the World Cup Squad.&nbsp; ALL-ROUNDERS One of the most unusual features of the current Nepali squad is how many all-rounders there are. Kushal Bhurtel, Rohit Paudel, Kushal Malla, Gulshan Jha, and Dipendra Singh Airee are all regular starters, and they all bat and bowl. Opener Aasif Sheikh is also the wicketkeeper.&nbsp; Airee, of course, is also an excellent fielder. In the first five games of the qualifiers, he got a record five runouts with direct hits, and was on a roll with a run in every single game. This depth means that almost always seven players bowl for Nepal, and the wealth of options keeps the opponent batting order guessing, but it may create hesitancy within the team in tough situations against stronger teams.&nbsp; Countries at the top level of the sport tend to have more specialists. Perhaps Stuart Law might want to tell Bhurtel to really focus on his batting, or Airee to hone his bowling, which seems to be their strengths. The team would be better off with them performing one aspect consistently well than being hit or miss with both. &nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251101031128_c30fdbab65736ea728f2f94fa121d2169e4d3627194ce1fe9de26eebdb3fc5b3.jpg" data-media-id="editor_1" data-image-id="20251101031128_c30fdbab65736ea728f2f94fa121d2169e4d3627194ce1fe9de26eebdb3fc5b3" data-rendition-name="original" width="957" height="1269" loading="lazy" alt="Nepal cricket"> <figcaption>Lalit Rajbhansi with tricky left arm spin, 3/13 vs Samoa.</figcaption> </figure>  POWERPLAYS The Nepali team likes batting first. It chased only against Japan, but they struggle to put up really competitive scores of say, above 170 unless two batsmen do really well.&nbsp; In the second match against the West Indies, Aasif Sheikh’s 68 and Sundeep Jora’s 63 set up Nepal at 173/6. Against Samoa, Aasif Sheikh had 69 and Airee had 53, before Lokesh Bam’s fierce 39 off 12 featuring 4 sixes set up 211/4.&nbsp; Besides these games, Nepal tends to score up to 150 batting first. To the experienced teams that Nepal will face at the world cup, this is not at all an intimidating score. One reason is that Nepal just cannot seem to get going in the first six powerplay overs, when there are limited fielders on the boundaries.&nbsp; A solution to this might be to promote Gulshan Jha up the order. Although Jha has also been an excellent batter in the end overs, using him at three or four might help set up a more productive powerplay and bigger scores. He should try it out with the Karnali Yaks.&nbsp; Despite all the controversy that comes with Sandip Lamichhane, and his strange decision to sit out the West Indies series minutes before the first match started, his output with the ball is undeniable.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251101031128_453d54ce627367c537d459c38d260d8aca1d56949c49c8023de582f3e72bb678.jpg" data-media-id="editor_2" data-image-id="20251101031128_453d54ce627367c537d459c38d260d8aca1d56949c49c8023de582f3e72bb678" data-rendition-name="original" width="1499" height="1000" loading="lazy" alt="Nepal cricket"> <figcaption>Nepalis turn out to support the team vs Samoa at Al Ameret Stadium in Oman.</figcaption> </figure>  He took wickets in each of the six qualifiers, most notably five vital ones in the match against Qatar that Nepal won by five runs. Lamichhane also gives away very few runs, which cuts some of the more part-time bowlers some slack.&nbsp; Airee is also economical, and his 3/22 was vital in the one-run win against the UAE. Together with Lamichhane the duo constricted the opposition in the middle overs. Veteran Sompal Kami has not been as productive with the ball, and gave away a lot of runs in the series against the West Indies.&nbsp; This is a weakness, because Kami does not contribute with the bat much. While his experience is valuable to ground the young Nepali team, Stuart Law should look out for fast bowlers during the NPL to help balance out quality spinners.&nbsp; One of the most impressive and professional parts of Nepal’s winning streak has been the attention to detail. The players have been generally excellent in the field, giving away very few runs due to wides or no balls. They had three run outs against the UAE and two against Qatar and Japan and in the first game against the West Indies.&nbsp; The fielders seem much calmer and focused when executing difficult catches, a welcome change from past complacency. This attention to detail makes the difference in narrow games and keeps morale high.&nbsp; The Nepali team has performed well, but besides the narrowly-beaten UAE, all the matches were against teams ranked lower in the world T20 rankings. And the series against the West Indies was against a weakened team. In the world cup, Nepal will be facing much stronger teams and will lack the element of surprise it had in the 2024 World Cup.&nbsp; If Nepal wants to keep improving, it now has to be able to dominate teams like Kuwait and Oman. It also should set up more series with associate nations like Scotland, Ireland, Namibia and The Netherlands. This will help accurately gauge the team’s progress and expose its weaknesses.

Nepal’s prospects at World Cup 2026

With the holidays over and elections only four months away, Nepal’s interim government led by Prime Minister Sushila Karki is trying to get down to brass tacks. But it is not easy.
On Wednesday, Karki held the first three-way meeting between GenZ representatives, political parties and the government. Despite some acrimony, there was near unanimity about creating the environment for elections on 5 March. 
Only the UML is holding out, still not taking responsibility for the 8 September massacre, and calling for the reinstatement of Parliament. GenZ delegates poured their wrath on the unrepentant UML, but were themselves talking at cross purposes on the demand for a directly-elected executive. 
Karki was on the defensive, her exasperation spilling over: “How do we undo the damage done by corruption, exploitation, and discrimination over the last 35 years in a single month?” 
She is reported to have added, “There is a tendency to not allow this government to work, and then turn around to criticise it for not achieving anything. We are trying our best, and will fulfil our goal of elections no matter what.” 
The Wednesday meeting does seem to have turned the attention of old parties towards elections, and spurred the GenZ and others with political ambition to form parties.
With the deadline for party registration looming, several like-minded individuals and collectives are coalescing, or trying to. The Election Commission is already reviewing applications from more than a dozen new political parties. 
Kathmandu Mayor Balen Shah has held talks with RSP members, but his popularity on social media is not matched by public visibility and accessibility. Intriguingly, Shah and his supporters on social media have been publicly asking for the resignation of Home Minister Om Aryal for not arresting members of the UML-NC government for the 8 September killings. Aryal used to be Mayor Shah’s legal adviser.
Sudan Gurung of GenZ, ex-RSP Sumana Shrestha, and Energy Minister Kulman Ghising are all shopping for existing or new political parties to join. 
The RSP with its alternative anti-corruption agenda would be the logical choice, but there is a question mark over the role of its head Rabi Lamichhane, who is back in jail on charges of embezzlement.
LARGER CABINET
This week, Karki expanded her Cabinet for the third time by inducting Sudha Sharma Gautam as Minister for Health and activist Bablu Gupta as the Minister for Youth and Sports. 
Recommended by GenZ members, Gupta, 28, is the youngest Minister in Karki’s team. But, as has become the norm with this electoral government, two other controversial nominations fell through. Khagendra Sunar was dropped as Minister for Labour because of several ongoing criminal charges, including for assault and inflammatory speech. And Ganapati Lal Shrestha for Minister of Land Management declined at the last moment after he was not given the Tourism and Culture portfolio as preferred. 
Critics say there is a lack of due diligence on the part of Karki’s advisers in selecting candidates. Last month, Sangeeta Mishra who was nominated for Health Minister was dropped after it turned out that she was under investigation at the CIAA. However, Kulman Ghising also had complaints filed at the anti-corruption body, but was still given three portfolios. 
Then the nomination of Tashi Lhazom was withdrawn after an online controversy over her citizenship. There was also outrage on social media about Mishra and Lhazom being singled out for their ethnicity and gender.
Internal leaks making her choices prematurely public has made Karki’s team overcautious about Cabinet expansion. It is also distracting her from her main goal — to hold credible elections by striking a balance between the political parties and GenZ groups.
After a preliminary hearing on 16 writ petitions against the House dissolution and appointment of new government, the Supreme Court on Wednesday refused to issue an interim order.
“The formation of the government is unconstitutional, and a government formed unconstitutionally is not allowed to make any decisions, until the final hearing,” stated advocate Surendra Bhandari. 
The UML, still smarting from the September protests, is trying to put a spanner in the works of the election government. The GenZ, meanwhile, still do not have a consensus over fundamental demands prior to elections. Combined, these two factors portend a precarious future.

Future imperfect

A little more than one month into its six-month term, Nepal's interim government recalled ambassadors from 11 countries: China, Japan, Malaysia, Qatar, Saudi Arabia, Israel, Russia, Spain, Germany, the UK, the US, and Japan.&nbsp;
Mostly appointed by previous governments, they have to return to Kathmandu by 6 November. The envoys who were retained, even if they were political appointees, tended to be women or from various ethnic minorities.
The recall has met with criticism back home. Prime Minister Sushila Karki is blamed for borrowing a page out of its predecessors’ playbook. Although it was a symbolically inclusive move in a diplomatic corps dominated by established groups, the government may have got its timing wrong.
On Sunday, however, the Supreme Court issued an interim order against government decision to recall the 11 ambassadors. The court questioned the neccesssity and justification of such a move, concerned that it could affect Nepal's relations with the host countries.&nbsp;
Karki has said <a href="https://nepalitimes.com/news/future-imperfect">her priority is to hold elections in March</a>, and by recalling Nepal’s emissaries from important capitals like Washington, London, Bonn, Tokyo, Abu Dhabi and Kuala Lumpur her government has cut channels of communication and support from development partners and with the international community.&nbsp;
Nepal’s anti-corruption GenZ protest and the devolution of the youth movement into <a href="https://nepalitimes.com/here-now/relocate-reallocate-recover">arson, looting, and violence</a> after the targeted killing of protestors in September put the nation in the international spotlight. And the interest was especially keen in neighbouring New Delhi and Beijing.&nbsp;
The Nepal unrest has sparked similar protests across the world from <a href="https://nepalitimes.com/here-now/nepal-genzs-inspired-filipinos">the Philippines</a> to East Timor, Madagascar and Peru. But there is also worry in India where exposure of #nepokids on social media as well as corruption in high places could instigate copycat youth unrest.
And in China, there is still a lingering memory of the deadly protests in 1989 Tiananmen Square. But the Chinese also suspect that some in the GenZ movement have links to free-Tibet. &nbsp;
Foreign policy experts in Nepal reject conspiracy theories about foreign backing for the GenZ, characterising it as mostly triggered by home-grown outrage over chronic corruption of the governing elite.&nbsp;
Throughout its history Nepal has always had to balance the geo-strategic interests of its neighbours: the British in India and the Chinese Empire, and more recently independent India and Communist China.
When former PM K P Oli resigned, he had <a href="https://nepalitimes.com/opinion/comment/when-xi-meets-modi-and-oli">just returned from a visit to Beijing</a> and was a week away from making an official visit to India. A new Nepali prime minister typically makes the first visit to India, but Oli broke that tradition last year by going to China to sign the Belt and Road Initiative (BRI) framework agreement.
"Oli was China's trusted partner supporting <a href="https://nepalitimes.com/news/china-syndrome">Nepal’s participation in BRI</a> and SCO (Shanghai Cooperation Organization)," says geopolitical analyst Sanjay Upadhya. "Now, some in Beijing are apprehensive that there is external support for the youth protests that contributed to Oli’s sudden departure. It is perceived as a strategic setback for China."
Despite an ongoing dispute with India over a 364 sq km border territory, Nepal is heavily dependent economically on India with which it has an open border.&nbsp;
Rulers in Kathmandu have usually leaned over backwards to be closer to China to counterbalance India’s gravitational pull following a strategy of ‘equidistance’ between the two giant neighbours.&nbsp;
Growing American and Western disinterest in the region is making India and China more assertive towards smaller nations. Educator Dovan Rai says, “China is also becoming more aggressive and trying to show its presence in and around South Asia.”
She adds, “Nepal is an important neighbour for China, especially considering issues it regards as sensitive, like the Dalai Lama and Tibet.”
Indeed, the Chinese are said to be suspicious about the links that the <a href="https://nepalitimes.com/here-now/nepal-s-historic-youth-dissensus">GenZ movement</a> was infiltrated by elements linked with Free Tibet or with US-based interests.&nbsp;
What must have especially raised eyebrows at the Chinese Embassy in Kathmandu was that the Dalai Lama’s office in exile in India congratulated Sushila Karki — the first time in history it has sent such a greeting to a new prime minister of Nepal.&nbsp;
Although Nepal’s two neighbours do not see eye-to-eye, both agree and are worried about instability in Nepal, and if it might trigger a refugee crisis, empower extremist factions, or attract Western interference.&nbsp;
Nepal’s September protests were preceded and succeeded by similar movements in the region and around the world. In light of this global eruption of youth frustration, and desire to lead from the front, the hardline governments of Nepal’s two neighbours are undoubtedly wary of the possibility of similar unrest within their own borders.&nbsp;
‘India advocates democratic legitimacy, while China prioritises control and predictability. Recent upheavals demonstrate that neither democracy nor stability alone suffices for sustainable nationhood,’ Upadhya wrote in a recent blog.
With early elections scheduled for 5 March, <a href="https://nepalitimes.com/news/one-month-later">the main challenge for Karki’s transition government</a> is to maintain dialogue and establish consensus between youth groups, political parties, and other agitating forces to participate in polls — all while ensuring there is no covert external influence.&nbsp;
Indeed, with <a href="https://nepalitimes.com/here-now/nepals-democracy-keeps-doubting-itself">Nepal’s democracy</a> at stake as well as new political forces with competing interests set to battle it out in a new political landscape, experts warn that there could be powers that will want to fish in troubled waters.&nbsp;
Explains Dovan Rai: “Along with soft power, foreign countries including our neighbours could intervene in the online information space to promote their interests in Nepal. Fake narratives and disinformation could be spread &nbsp;through digital platforms. We must be careful and vigilant about our digital space.”

Neighbourhood watch on Nepal

The autumn mountaineering season is not over yet, and already there have been 12 fatalities on Himalayan peaks in Nepal.
Of the 1,450 climbing permits issued, 436 were for Mt Ama Dablam (6,812m), 374 for Mt Manaslu (8,163m) and 186 for Himlung Himal (7,126m). There were deaths on all three mountains.
The death of two French climbers on Ama Dablam happened before unseasonal blizzards hit the mountains. But Cyclone Montha from the Bay of Bengal brought on high winds and up to 1m of snow in the peak trekking and mountaineering season.
This increased avalanche conditions, and made helicopter evacuation of stranded and injured climbers difficult. Lower down the mountains, more than 1,000 trekkers from Nepal and around the world were stuck in the Annapurnas, Manaslu circuit and the Khumbu.
However, there have also been allegations that it was not just the weather that delayed rescues. Multiple levels of bureaucracy and the need for flight permits to restricted areas like Manang and Manaslu critically delayed evacuation flights.
Italian climbers Farronato Stefano and Caputo Alessandro were found dead in their tent at Panbari Himal Camp I (6,887m) in the Manaslu area. They had been trapped by heavy snowfall since 28 October, and their bodies were found on 4 November by a team from the expedition organisers, Sherpa Alpine Trekking Service. The team was made up of high level mountain guides and expedition leader Valter Perlino.
The team had been climbing to Camp 3 but decided to descend to base camp because of thrombosis in Perlino’s left foot. The two climbers who would eventually get trapped decided to break at Camp I, a decision that would prove fatal after the projected six-day snowfall arrived two days early.
“They were sleeping in a tent and were buried under 2.5 metres of compacted snow. It happened during the night between Thursday and Friday. While they were sleeping, absurd,” said Perlino.
A deadly incident took place the morning of 3 November, when five foreigners and two Nepalis died in an avalanche on Yalung Ri at 5,630m in the Rolwaling. They were part of a larger group of 15 that were acclimatising for an attempt on the nearby Dolma Khang (6,332m).
Local authorities in Gauri Shankar Conservation Area say calls were immediately made to helicopter companies as well as various ministries in Kathmandu that have to issue permits to fly to the region bordering China.
But the permits for rescue flights to Rolwaling Valley were delayed by eight hours. Rescue flights in these areas require permission from the Ministry of Tourism, the Ministry of Defence, the Home Ministry, and the Civil Aviation Authority of Nepal (CAAN).
Experts say this should be exempted in times of emergency when time is of the essence. CAAN spokesperson Pratap Babu Tiwari claimed to not know of the avalanche on Yalung Ri and deflected questions to the permission department.&nbsp;
There was a similar tragedy on Himlung Himal in Manang as well. Australian Chin-Tark Chan, 49, was climbing with 8K Expeditions and fell ill on 27 October at about 6,800m, developing snow blindness and loss of mobility. The guides immediately called the US insurance company Global Rescue for authorisation of a longline rescue.
Global Rescue refused, saying a rescue at that height would violate Nepal’s aviation rules and put the pilot at unacceptable risk. They asked the guides to transport Chan to Camp 3 at 6,400m to a permitted altitude. Seeing it was a life-or-death situation for its client, 8K called in an aerial rescue anyway, but the helicopter could not land due to bad weather. Chan died slightly below Camp 3 on 29 October.
Global Rescue said in a statement that it was ready to send in a helicopter after Chan had been transported to Camp 3, but several hours were lost for that attempt, and the weather did not get better in the next few days.
To underscore just how dangerous helicopter rescues in the Himalaya can be in bad weather, a chopper from Altitude Air skidded off the helipad at Lobuche below Mt Everest while trying to rescue trekkers in whiteout conditions.&nbsp;
CAAN announced a ban on flights during blizzards or dense fog. While rescue missions are often heroic and courageous, they should not be foolhardy if conditions are unsafe and the risk to pilots and rescuers too high. This autumn was a lesson for future expeditions and for the Nepal government.&nbsp;
The Italian duo on Panbari were caught out by snow that arrived two days ahead of schedule, but the group on Yalung Ri should have postponed their ascent after multiple warnings from the Department of Hydrology and Meteorology to avoid high altitudes.

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