<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110161148/636d1db19c7e80680e0af3d0jpeg.jpg" alt="" width="767" height="575"/><figcaption>Security personnel and relatives of the deceased attend a mourning at the premise of infectious disease hospital in Pokhara. Photos: BARSHA KAFLE</figcaption></figure>A 79-year-old woman lay on the emergency bed, diagnosed with pneumonia due to Covid-19. Even as she was gasping for breath she had a smile on her face, handing over an invitation card to the attending doctor who was also her relative.Her grandson’s wedding was four days later. Family members from across the world had flown into Pokhara for the ceremony. She died of severe acute respiratory distress syndrome with multiple organ failure a day before the wedding, and it had to be cancelled.As her physician, I had sleepless nights when her condition worsened. We <a href="https://www.nepalitimes.com/here-now/nepal-health-workers-battle-covid-19-but-also-stigma/" target="_blank" rel="noopener noreferrer">health-care workers are also human beings</a>. When we lose near and dear ones it takes a toll on our physical and mental health, we grieve when our patients die. We may hide our emotions but we suffer all the same.The woman was just one of many relatives I have lost during this pandemic. As I grieved with family members gathered at the hospital, we were once again reminded of the Buddhist teachings about impermanence. Yet none of us is ever ready.“But it must be easier for you to face death as a doctor,” one of the mourners said to me. No, it is just as difficult. If not more, because as a physician I had the added responsibility of saving her life.Army men dressed in PPE from head to toe had arrived to take her body for safe disposal. Relatives from across the world who had come to celebrate a wedding ended up attending a funeral.The Gandaki Province government established Nepal’s first provincial infectious disease hospital in July 2020. Since then, it has managed nearly 1,300 Covid-19 cases at a cost of Rs500 million.Tha Gandaki Province government established Nepal's first provincial infectious disease hospital in July 2020. Since then, it has managed nearly 1, 300 Covid-19 cases saving Rs500 million out of pocket expenditure of common people.We have lost 52 people to the coronavirus in the same period. The Covid-19 mortality rate in this provincial hospital is 4.1%, relatively high compared to the total number of people who were hospitalised.The global death rate now stands at 1.97% with a total of 5,318,277 fatalities. This figure is exceptionally high given it has only been two years. Even then, this figure does not include <a href="https://www.nepalitimes.com/banner/the-real-cost-of-nepals-second-wave/" target="_blank" rel="noopener noreferrer">the social, mental and economic consequences</a> to family and friends of the deceased.But each Covid death is also a lesson for us to learn from. Most of these deaths could have been prevented if only Nepal had a robust primary health care system, and if preventive measures were more strictly enforced.With the <a href="https://www.nepalitimes.com/here-now/omicron-may-not-be-as-risky-but-take-care/" target="_blank" rel="noopener noreferrer">rise of new variants like Omicron</a>, it is also advisable to up our vaccination drive and we should also start administering boosters to vulnerable populations given our stock of doses and those that are on the pipeline.A man in his late thirties was isolating at home in Pokhara after getting infected. He just had a common cold but I requested him to undergo hospital-based isolation as he was symptomatic. But just a few days after getting admitted, his symptoms worsened and his condition deteriorated. He was then transferred to another hospital, and died soon after.This was not a case that should have been fatal. Even after 12 years of clinical experience, some of the Covid-19 outcomes I have encountered in the past year have been unexpected and shocking. It must have been devastating for the young man’s family and friends.Earier this year, when a 86-year-old mukhiya from Mustang died at our hospital of Covid complications, hundreds of Thakalis travelled to Pokhara to show their respect to the deceased despite the coronavirus surge at the time. Young or old, the virus was indiscriminate.In November 2020, I myself had to self-isolate with an upper respiratory infection due to a coronavirus infection. I thought I would not survive the excruciating body ache, sleepless nights and high anxiety level. During those horrific 10 days at <a href="https://www.nepalitimes.com/here-now/at-the-covid-19-frontlines-in-rural-nepal/" target="_blank" rel="noopener noreferrer">Bayalpata Hospital in Achham</a> I was battling an infection that I was treating my patients for.An elderly couple had been admitted to our hospital with Covid, both of them had severe symptoms. The husband died within a few hours of admission, but his wife was not aware of his passing until she became critically ill herself, and the family decided to tell her the truth. She passed away a week after her spouse. Medical staff usually have seen it all, but so moved with sorrow they mourned too.Holistic <a href="https://www.nepalitimes.com/banner/this-is-how-to-upgrade-nepals-rural-health/" target="_blank" rel="noopener noreferrer">health care</a> is the central core of modern medicine. But the caregivers can provide only acute biomedical care to alleviate the suffering of Covid patients. Their psycho-social wellbeing and that of their family members are often ignored. And we have not even begun to think about the mental health and trauma of the frontline workers.Over 800,000 Nepalis have been infected with the coronavirus and 12,852 have died of the disease. It is time we study this data, in particular the common causes of Covid-19 deaths in Nepal. Is it heart attack, blockage of vessels in the lungs, multiple organ failure or acute respiratory distress syndrome?We must reshape our health policies based on these facts and evidence. We must ensure adequate preparation with ICU beds, oxygen supply, <a href="https://www.nepalitimes.com/latest/donated-ventilators-gather-dust-in-nepal/" target="_blank" rel="noopener noreferrer">ventilators</a> and other equipment that were in short supply earlier this year.Only then can we design a robust and customised care system to protect our population from future surges.Bikash Gauchan is the Executive Director of the Infectious and Communicable Disease Hospital in Gandaki Province.

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Diary of a Covid frontline worker in Nepal

<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

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When panic goes viral

https://www.youtube.com/watch?v=FQ0-JH097iA&amp;feature=youtu.beDeukali Shahi, 26, looks relieved after delivering a healthy baby girl, but her calmness belies her traumatic childbirth. Her eyes fill with tears as she speaks haltingly of the previous baby she lost and the desperation she felt this time to reach the hospital fast enough so this one would live.Soon, Shahi is overcome with grief and cannot say more. Her sister-in-law Tulaja fills in the rest of the story. The baby was in breech position, but the family did not know this until Deukali was already in labour. They took her to a nearby healthpost, where the nurse said there was nothing they could do. They went on to the district hospital in Mangalsen, which did not have a surgeon to perform a caesarean.“We drove another four hours and arrived here at two in the night, and the doctors operated on her,” Tulaja said. “Now we have a healthy baby girl.”Deukali lost her first child due to the same complication, but the family did not know why the baby would not come out. In these remote mountains of Achham, home delivery is the norm and the district has one of the highest maternal mortality rates in Nepal.Read also: <a href="https://www.nepalitimes.com/banner/state-of-the-art-rural-hospital/" target="_blank" rel="noopener">State of the art rural hospital</a>, Marty Logan<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110814114/636a54559c7e80680e0523a4jpeg.jpg" alt="" width="2000" height="1333"/><figcaption>Photos: MONIKA DEUPALA</figcaption></figure>All that is changing with Bayalpata Hospital, which serves as the informal referral hospital for <a href="http://archive.nepalitimes.com/news.php?id=17650#.XWY3DeMzbIV" target="_blank" rel="noopener">Achham </a>and six surrounding districts. The government hospital is managed by the non-profit Possible Health (formerly <a href="http://archive.nepalitimes.com/news.php?id=17650#.XWY-WeMzaUk" target="_blank" rel="noopener">Nyaya Health</a>) as a private-public-partnership, and now serves 100,000 patients per year.Bayalpata’s safe <a href="https://archive.nepalitimes.com/regular-columns/Comment/mothers-in-Nepal-still-dying-at-childbirth,1007" target="_blank" rel="noopener">motherhood</a> program is accessible at any hour of the day. In the severely understaffed Far West region, Possible is practising an experimental model of healthcare that has become a lifeline for thousands of people in nearby districts. Province 7, which includes Achham, has 13 public hospitals, 16 primary health care centres and 376 health posts, but most of these are under-equipped, under-staffed and under-funded. Aside from government neglect, geography is a further <a href="https://www.nepalitimes.com/here-now/environmental-destruction-is-a-medical-emergency/" target="_blank" rel="noopener">challenge in these mountains</a>. Patients like Deukali have to walk or travel for days to reach a proper hospital like Bayalpata.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110814114/636a54589c7e80680e0523a5jpeg.jpg" alt="" width="2000" height="855">The World Health Organiaation recommends a doctor-patient ratio of 1:1,000, and while it is 1:850 in Kathmandu Valley, the rate is 1:150,000 in rural areas. A recent report by the Nepal Government shows that 20% of staff positions in the healthcare system are not filled.When Nyaya Health took up an abandoned government hospital in Bayalpata 10 years ago, there were no doctors for the people living in the area. The unmet need was so great that the newly-opened hospital could not cope with demand, and soon expanded its facilities. (See box below)“Nepal’s per capita income is very low, and more than 70% of Nepalis <a href="https://archive.nepalitimes.com/article/nation/national-health-insurance-not-as-easy,4028" target="_blank" rel="noopener">cannot afford private healthcare</a>. So a model like this, which makes healthcare free and accessible, is very necessary in Nepal today,” says Bikash Gauchan, medical director of Bayalpata Hospital.With grants from the government and donations from philanthropic individuals and organisations, the hospital provides free medical care to up to 500 patients a day, covering a catchment of 230,000 people in Achham’s neighbouring districts.“The perception in Nepal is that a PPP model is meant to bring in investment for large-scale infrastructure projects like <a href="https://www.nepalitimes.com/opinion/climate-risk-to-hydropower-investment/" target="_blank" rel="noopener">hydropower</a>. When we proposed a model where hospitals would utilise the government funding they deserve, it went against the grain and people found it hard to understand,” says SP Kalaunee, executive director of Nyaya Health Nepal. “But we want to get the best of both worlds: use government funding and resources, but enhance them with our knowledge, skills and management expertise.”Among many things that make Bayalpata different from the average government hospital is its Integrated Healthcare System, <a href="https://archive.nepalitimes.com/article/nation/long-distance-medicine-in-nepal,3521" target="_blank" rel="noopener">digitising patient records</a>. The software is unique in Nepal and allows the facility to track the health of patients including pregnant women, children under two and those with chronic diseases. Community health workers reach out to these patients door-to-door instead of waiting for them to get so sick that they have to travel to hospital.“Each of us meets patients in our village once in 1-3 months, as per the need,” says community health worker Dwarika Rawal. “I meet women of <a href="https://www.nepalitimes.com/banner/implant-service-providers-take-contraception-to-nepals-poor/" target="_blank" rel="noopener">reproductive age and talk to them about family planning</a>, tell them about the different methods available. I also check the weight and health of children below 5, and counsel their parents about child health and hygiene.”<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110814114/636a545c9c7e80680e0523a6jpeg.jpg" alt="" width="3000" height="2000">Rawal also follows up with patients living with chronic diseases such as <a href="https://archive.nepalitimes.com/article/nation/diabetes-in-south-asia,3018" target="_blank" rel="noopener">diabetes</a>, <a href="https://archive.nepalitimes.com/article/nation/ending-AIDS-in-Nepal,2707" target="_blank" rel="noopener">HIV</a>, <a href="https://www.nepalitimes.com/banner/nepal-tb-cases-grossly-underestimated/" target="_blank" rel="noopener">TB</a>, high blood pressure and <a href="https://archive.nepalitimes.com/article/nation/stigma-and-silence-mental-health-nepal,3486" target="_blank" rel="noopener">mental disorders</a>, including to see if they are taking their medicines.In the past decade, health indicators in this region have shown a marked improvement because of Bayalpata Hospital, even surpassing targets in Nepal’s National Health Strategy (NHSS) for 2020 and the UN’s Sustainable Development Goals (SDGs) 2030. In the Sanfebagar area, institutional deliveries have gone up to 96%, compared to the NHSS target of 70% and the SDGs’ 90%. Neonatal mortality has fallen to 6 per 1,000 live births, a third of the NHSS target (18), and half of the SDGs target (12).Eventually, Possible hopes to not just improve service to its patients, but push through its Integrated Healthcare System, which would make local governments more responsible for providing overall healthcare rather than just operating a particular medical facility.“What makes our model successful is more accountability, and that is what is needed in our public healthcare system. We do not necessarily need more health facilities, we need to make them functional: make sure that the staff are always available, the medicines are stocked and the equipment functions as it is supposed to,” says Kalaunee. “Public healthcare needs to incorporate the use of technology and outreach to become comprehensive.”<h2>Building a rural hospital from scratch</h2><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110814114/636a545f9c7e80680e0523a7jpeg.jpg" alt="" width="3456" height="2592">When a group of Nepali and American public health students set up Nyaya Health and took over an abandoned district hospital in remote Achham district in 2009, there was not a single doctor for over 250,000 people.Ravaged by government neglect and endemic<a href="https://www.nepalitimes.com/banner/nepal-tests-and-treats-tb-with-a-flying-pharmacy/" target="_blank" rel="noopener"> TB</a> and <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/stigma-ostracisation-for-HIV-patients-remain-in-western-nepal,1724" target="_blank" rel="noopener">HIV/AIDS</a>, the region had some of the worst child and maternal mortality rates in Nepal, and the shortest lifespan. Subsistence farmers moved to India to work most of the year so they could support families back home.Soon, <a href="https://archive.nepalitimes.com/regular-columns/GUEST-COLUMN/upgrading-health-care-through-public-private-partnership-model,582" target="_blank" rel="noopener">Bayalpata</a> was treating 12,000 people a year out of two rooms, and today it sees 100,000 patients from Achham and six surrounding districts. Renamed Possible, the organisation needed to expand to cater to the huge unmet healthcare demand of Far West Nepal.Paid for mostly by crowd-funding the $4 million three-phase expansion of Bayalpata Hospital is now complete. Coming round the bend on the highway from Surkhet, the modern facility with its <a href="https://www.nepalitimes.com/banner/starting-nepals-green-school-movement/" target="_blank" rel="noopener">state-of-the-art architecture</a> seems like a mirage in the middle of nowhere.Today, Bayalpata Regional Hospital is not just unique for its successful model of a private-public-partnership for rural medical care, but also for its distinctive design using rammed earth technology.An obsolete government facility is now one of the most modern and eco-friendly hospitals in Nepal, providing accessible and affordable health care to the most underserved part of the country.“Our specs were to use local materials as much as possible, keep energy costs low, and respect the local context,” explains Arun Rimal, a Nepali architect with the US-based Office of Structural Design (OSD). “The rammed earth uses local clay and sand from the river. The thick walls give thermal mass for insulation, and the skylights optimise sunlight and ventilation.”<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110814114/636a54639c7e80680e0523a8jpeg.jpg" alt="" width="2550" height="3300">The reliance on local material turned out to be a huge advantage because the project faced unforeseen logistical problems due to the 2015 earthquake and Blockade. However, the four-year construction was delayed by just six months because it did not rely too much on bricks, steel and other imported material.The facility has a <a href="http://archive.nepalitimes.com/news.php?id=5877#.XWZGkOMzaUk" target="_blank" rel="noopener">rainwater harvesting system</a>, treats its wastewater and has a network of greywater-irrigated terraces and bioswales to control erosion and recharge the acquifer. A 100kw solar array on the roof meets most of the hospital’s electricity needs, even powering the facility’s only air conditioning unit in the surgical ward.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110814114/636a54679c7e80680e0523a9jpeg.jpg" alt="" width="4416" height="3312">“It was a deliberate design decision to work with the natural environment as much as possible and also to address the cultural context,” says Tyler Survant from Sharon Davis Design in New York, which also conceptualised the unique Women's Opportunity Centre in Rwanda. “We had to plan for a different kind of hospital from the West: here you have patients and relatives who have travelled for days on foot to get here.”Bayalpata has public outdoor spaces and canopied courtyards to serve as comfortable waiting areas, while the operating theatres and wards are recessed. Unlike in the US, staff housing also had to be integrated into the facility since it has fulltime resident doctors, who live with their families.Bayalpata has been shortlisted for the World Architecture Festival 2019, and besides providing vital medical care for much of the Far West, it is sure to become a landmark for sustainability in Nepal’s architectural landscape.

This is how to upgrade Nepal's rural health

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221107171136/636934889c7e80680e03dfffjpeg.jpg" alt="" width="1400" height="700"/><figcaption>Photo: UNICEF</figcaption></figure>Polio eradication is one of the most ambitious public health initiatives undertaken in human history. Launched in 1988 by the World Health Organization (WHO) the campaign aimed to rid the world of the virus by 2000. But 30 years on and $15 billion later, even though polio cases worldwide have been reduced by 99%, there are still isolated pockets of the disease. And unless every last case is removed, there will always a chance that the infection will come back.Encouraged by the eradication of small pox, WHO launched the campaign in 1988. The organisation debated the wisdom of spending so much time and money to exterminate a disease when there were many other more pressing health concerns like <a href="http://malaria https://www.nepalitimes.com/here-now/the-mosquito-that-changed-nepals-history/" target="_blank" rel="noopener">malaria</a>, <a href="https://www.nepalitimes.com/banner/tb/ or diarrhoea" target="_blank" rel="noopener">TB</a> or diarrhoea that kill many more people.https://www.youtube.com/watch?v=KQd_-6W_9Gg&amp;feature=youtu.beThomas Abraham, a journalist who taught health reporting at the University of Hong Kong, has tried to answer this and other questions in his new book <a href="https://www.amazon.co.uk/Polio-Odyssey-Eradication-Thomas-Abraham/dp/1849049564" target="_blank" rel="noopener">Polio: The Odyssey of Eradication</a>. He says polio was held hostage by geopolitics, and traces the reason why countries opted for a weak vaccine against a strong virus. The author concludes that future global campaigns that zero in on just one disease must be weighed against the necessity of upgrading public health, especially in poorer countries.In Nepal, indigenous <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/Bouncing-back-higher-wheelchair-basketball,3802" target="_blank" rel="noopener">polio</a> was eliminated in 2000 after the country responded to WHO’s eradication goal by adding polio to its successful campaign of vaccination against other diseases. However, there were still polio cases in Nepal brought over the border from India. The last case of polio was detected in Rautahat district in 2010, and <a href="http://archive.nepalitimes.com/blogs/thebrief/2014/03/28/polio-free-nepal/" target="_blank" rel="noopener">Nepal was finally declared polio free</a> four years later.In response to a query from Nepali Times this week, however, Abraham said Nepal is not out of the woods yet. “If polio re-emerges in India, particularly UP and Bihar, this would be a major challenge to Nepal,” he said. “Also, if levels of routine childhood immunisation fall in Nepal there is a danger of outbreaks of vaccine derived polio, as we are seeing in a number of countries.”Even though polio has been largely removed, there are still cases in Pakistan, Afghanistan and Nigeria where vaccination campaigns have been thwarted by religious extremists. Ironically, enmity between India and Pakistan and the heavily guarded border between the two countries has minimised the risk of polio spreading via India to Nepal.Polio derived from oral vaccines has emerged as a new threat to the eradication campaign. By 2016, WHO deployed a combination of Inactivated Polio Virus (Salk vaccine) and bivalent oral vaccine to prevent further outbreaks.“Routine immunisation levels need to remain high in order to maintain Nepal’s polio-free status. Luckily, we have a strong disease surveillance system to detect any new polio cases,” said Jhalak Sharma Gautam of the Department of Health Services.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221107171136/6369348b9c7e80680e03e000jpeg.jpg" alt="" width="640" height="869"><figcaption> </figcaption></figure><a style="background-color: #ffffff; font-size: 15px; letter-spacing: 0.01em;" href="http://archive.nepalitimes.com/news.php?id=16116#.W_aWJTgzaUk" target="_blank" rel="noopener">Polio</a> is one of the oldest diseases to afflict humans, but it wasn’t until the beginning of 20thcentury that there were outbreaks in Europe, North America and Australia. US President Franklin D Roosevelt was paralysed by poliomyelitis, and because of this the US threw considerable political influence and funds to back polio vaccine research.The first was the Salk vaccine that used inactivated poliovirus, and protected individuals injected with right dose, but it did not stop the transfer of the disease. The Sabin vaccine in 1961 employed a weakened poliovirus to be administered orally. It was cheaper and easier to use and protected individuals from paralysis as well as stopped polio transmission, which eventually led to it being chosen as a tool of eradication.Despite its success, the Global Polio Eradication campaign has been criticised for its huge cost and for widening the gap between local health needs and global health programs. In his book, Abraham puts his experience as a foreign correspondent to good use by visiting the frontlines of the battle against polio in Pakistan, India and Nigeria. He writes about the <a href="https://www.nytimes.com/2018/01/22/health/polio-pakistan-killing.html" target="_blank" rel="noopener">assassinations of polio vaccinators in Pakistan</a> and Afghanistan by the Taliban.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221107171136/6369348e9c7e80680e03e001jpeg.jpg" alt="" width="1250" height="441">A considerable portion of the book deals with a long-standing debate about whether targeting a single disease for eradication should take precedence over strengthening national health systems. This resonates with WHO’s own reluctance to endorse polio eradication for a long time in favour of a strong primary health care system.This book is a recommended read for public health professionals, but it has lessons for anyone who wants to better understand the inner workings of health systems, donor agency priorities, and what goes on behind the scenes in Geneva.Abraham is neither an epidemiologist nor a medical practitioner, he is a journalist with over 25 years of experience covering conflict, politics and health. Maybe that is why the book reads more like a thriller with an engaging real-life account of what goes right (and what can go wrong) in the fight against a disease-causing pathogen.Read also:<a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/Bouncing-back-higher-wheelchair-basketball,3802" target="_blank" rel="noopener">Bouncing back</a>, Shreejana Shrestha<a href="http://archive.nepalitimes.com/news.php?id=16116#.W_aWJTgzaUk" target="_blank" rel="noopener">Laxmi dreams of flying</a>, Rupa Joshi

Polio hunt

Violations of Nepal’s airspace during WWII

The American military action in Venezuela and the abduction of President Nicolás Maduro Moros may redefine Nepal’s geopolitics as it juggles between three world powers, India, China and the United States.&nbsp;
Nepal’s interim government is busy preparing for elections on 5 March, and it was late issuing a statement on the American intervention in Venezuela, but the country may have to re-evaluate how it deals with its immediate neighbours and the global power.
“How does Nepal avoid being the next Ukraine or Venezuela? Small countries shouldn’t go around irritating big neighbours. And when big neighbours really get upset, they usually put up a moral fig leaf justifying their miltary action,” says energy economist Dipak Gyawali. “What we see with Venezuela today is bereft of such moral content, essentially banditry which in today’s day and age is unacceptable. Neither the rising new powers nor much of the Global South will take this lying down.”
International relations experts have said that there is now a new world order in which rules-based diplomacy has been thrown out of the window, and the world has been carved into America leading the western hemisphere, Russia is allowed to do what it wants in Ukraine and Europe, and China’s sphere of influence is now the Indo-Pacific.
Foreign affairs expert Nischal Pandey says there is a lesson for smaller nations like Nepal: “We have to be aware of the sensitivities of the major powers in the vicinity.”
There is also a lesson for smaller resource-rich countries not to give an excuse for intervention with poor governance and political instability due to inequity. In Venezuela’s case it was throttling democracy and not using its immense oil-wealth to uplift its people.
Nevertheless, the Trump administration’s abduction of a sitting president of a foreign government regardless of the dictatorial nature of his regime and Venezuela’s volatile internal politics, is illegal and breaches the international order that has been in place since after World War II and its devastation on humanity.
While Trump’s intervention in Venezuela, and threats against Colombia, Cuba and Greenland have brought international condemnation, here in Nepal it has not been taken as seriously as it should.
Says Amish Mulmi, author of the book All Roads Lead North: Nepal's Turn to China: “Some of the reaction on social media has been that of glee over the fall of a dictatorial Communist government on the other side of the world. However, the government statement about fully respecting the principles of sovereignty and the Charter of the United Nations is a strong statement that makes clear Nepal's position on the matter.”
“The abduction of Maduro is a clear sign of Trump's America ensuring its sphere of influence through might and a warning to toe the line,” Mulmi adds. “It also infringes on the sanctity of borders and the preservation of sovereignty. Trump's actions reek strongly of a bygone era of imperialistic control and resource capture.”
Venezuela has 17% of the world’s reserves of crude oil, even though refining this heavy tar-like oil will be costly, and is possible in only a few places including Texas.
“This has to do with a larger political economy of oil, the unravelling of pax Americana and the post-World war II order. This is USA’s heavy-handed response to remain on the top as well as to partly solve its debt of $39 trillion,” explains Gyawali. “But this is not going to help: China is far ahead, Russia has recovered from its 1990s low point, and manufacturing capital has moved away from America. So controlling only financial capital - and using military power so brazenly - is not going to work.”
The might also be specific lessons for Nepal as a smaller country with vast water resources. While water, unlike oil, is renewable, India’s interest in Nepal’s hydro resources cannot be ignored. Ironically, America’s capture of Venezuelan oil reserves could exacerbate climate breakdown and the melting of Himalayan glaciers, which will put Nepal’s water resources in jeopardy in the coming decades.
The only way to deal with this for Nepal and downstream India will be to build reservoirs on rivers to store monsoon precipitation, and that makes water a strategic commodity for the future.&nbsp;
“If we continue in the current mode of hydropower-biased water resources development ignoring irrigation, flood control, navigation, fisheries, tourism and other benefits, India will get the free benefit of regulated water while we pay the upstream environmental and social costs. History will blame our elected leaders for having undersold our resources,” adds Gyawali, who served as water resource minister in the early 2000s.
As for a larger geopolitical lesson: “We in Nepal are fortunate in having not one threatening hegemon but two superpowers India and China: they don’t agree with each other, but do agree on a peaceful Nepal for their own security. However, our current political leaders are irritating both the neighbours, unlike since the centuries past when our rulers looked solely after Nepal’s core interests and our neighbours knew that.”
American intervention in Venezuela also calls for strengthening of our institutions and diplomatic outreach. Nepal has been a non-aligned state, and for all its history has tried to follow a policy of equidistance between India and China. The difference with Venezuela is that Nepal has to deal with two giant neighbours, and not just one.
Says Mulmi: “It is no more only about balancing great power relations but also about benefiting from them. But that will be increasingly difficult as international law and the principles of sovereignty are encroached upon.”

Might might be right, after all

At Budhanilkantha School Ujwal Thapa was a few years my senior. He was a quiet person who kept to himself; I didn’t know him very well despite being related to him because of that introversion and natural shyness. What we did have in common, coming of age in the 1990s, is our generation, GenX, which became weary, inured for the most part, to Nepal’s famously unstable politics.&nbsp; Counting the events of this past September, GenX has, astonishingly, lived through three people’s revolutions, one armed conflict, a flawed but hard won constitution, and a major earthquake. Ujwal Thapa, one of Nepal’s most cherished Gen Xers, despite his previous, youthful reticence, did not long remain a complaisant bystander against the backdrop of these extreme upheavals.&nbsp; By the mid 2000s he had become deeply political, but without the equivocation that so often accompanies politics. Thanks to his lived experience, he came to believe that the youth of Nepal are the key to our future. He believed in discerning wisdom (bibeksheelta), innovation, and nurture. He inspired entire generations, young and old, including GenZ, before his untimely death due to Covid in 2021. He was only 44.&nbsp; By the time of his passing he had started a tech company, and employed and mentored scores of youth. It is important to note that only after he had made a significant contribution to civil society did he turn towards politics, founding and then stepping back from the Bibeksheel Nepali party, which has now, after several complicated mergers and splits, been integrated into the Rastriya Swatantra Party (RSP). When the Ujwal Thapa Foundation set out to make a documentary on his life three years ago, no one could have known that it would premiere at such a crucial point in Nepal’s social and political history.&nbsp; Everything that Ujwal Thapa believed in still holds true. I think he would have been proud to see the youth of our country, GenZ, stand up for themselves, peacefully. He would have been grieved at the state condoned bloodshed, and, believing in non-violent protest himself, been deeply shocked by the savage revolution that followed.&nbsp; Most of all, I wonder how he would have reacted to the publishing of the blatantly elitist RSP proportional representation list - the party that many had pinned their hopes on, and that Bibeksheel Nepali has ultimately been absorbed into. That party now seems like it may be a chip off the rotten old block, ruled by men endorsing rampant nepotism, and outnumbered by people without scruples.&nbsp; Many of the names on the list and the rankings, in particular, disrespect the very spirit of a provision that was created for those competent individuals who would not otherwise be able to contest elections, due to lack of monetary and social capital, but whose marginalised voices are vital for inclusive policy making. There is still time for real inclusion, to embrace a more bibeksheel path, before the March elections.&nbsp; Ujwal Thapa’s own, firm, ethical stances are clear in the The Man Who Shook Our Minds, translated loosely from the Nepali title Dimaag Ghhochne Manchhe. While long, at almost two hours, it is filled with thought-provoking and sage counsel. The film also offers very real insight into how Ujwal Thapa evolved into the icon he is today.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026011111018_eb596eb063dcaf0f67840bfa4ffa39eb27df2bf9ec1a3f9a1f531824c1b7a569.jpg" data-media-id="editor_0" data-image-id="2026011111018_eb596eb063dcaf0f67840bfa4ffa39eb27df2bf9ec1a3f9a1f531824c1b7a569" data-rendition-name="original" width="1600" height="670" loading="lazy" alt="Ujwal Thapa"> <figcaption>Stills from the documentary.</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026011111018_65d9625d3a4865ca228425b7ce7b7b186ae5009313bbfab0ee65eada276aebd6.jpg" data-media-id="editor_1" data-image-id="2026011111018_65d9625d3a4865ca228425b7ce7b7b186ae5009313bbfab0ee65eada276aebd6" data-rendition-name="original" width="1600" height="670" loading="lazy" alt="Ujwal Thapa"> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026011111018_2ff455c55722d153cafbd2d650e19584e38d7c098b109271bd106a55201f4fa0.jpg" data-media-id="editor_2" data-image-id="2026011111018_2ff455c55722d153cafbd2d650e19584e38d7c098b109271bd106a55201f4fa0" data-rendition-name="original" width="1600" height="670" loading="lazy" alt="Ujwal Thapa"> </figure>  It isn’t easy making a documentary after the passing of the primary subject. While there are many talking heads, the people featured, friends, family, fellow activists and senior politicians are all eloquent in their descriptions of Ujwal Thapa and his transformation from an engaged, civic minded entrepreneur into a committed political leader who among many other commendable things, believed in putting women first, and understood the crucial necessity for a welfare state that would serve its people. The main man is not deified, he is humanised.&nbsp; The feature is punctuated, and leavened, with moments of real humour as his infamous bluntness and occasional domestic haplessness are gently exposed. Another strength of the film is the profound love story between Ujwal Thapa and his brave, brilliant, incredibly resilient wife, Erica Adhikary, the heroine to a real life hero, and a major force behind the making of this film, alongside many of his stalwart wellwishers and friends, old and new.&nbsp; Sushila Karki, the Prime Minister, was present at the premiere of the film with members of her Cabinet. Candid and sincere in her opening remarks, she said she had wanted to attend the moment she heard about the film. She had known Ujwal Thapa, and she had mourned his loss, praying for him during his illness. She wished that leaders like him were here today to show us the way forward in a time of need. The film opened in theatres on the 9th of January, and is an essential viewing experience for anyone who cares about Nepal’s future and wants some insight into how they might make a difference.&nbsp; Ujwal Thapa was not perfect, but he was remarkable. He realised that being a civic minded citizen just isn’t enough. To make a real difference, one also needs to be principled, insightful, entrepreneurial, creative, self motivated, able to speak truth to power, uncorruptible, practical, well prepared, and, perhaps, most importantly, able to step back from holding power even after attaining it.&nbsp; The saying by Plato that goes “He who does not desire power is fit to hold it” was surely meant for people like Ujwal Thapa. One can only hope that in the near future more people embodying this description will, however reluctantly, come forward to lead Nepal. Ujwal Thapa worked hard to enable this, they must be out there. <div class="embed-block"><iframe width="560" height="315" src="https://www.youtube.com/embed/veO1yVM4pS4?si=f0Lcbs1wasyqfnK1" title="YouTube video player" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share" referrerpolicy="strict-origin-when-cross-origin" allowfullscreen></iframe></div> The Man Who Shook Our Minds is being screened at QFX cinemas across town. Sophia L Pandé is on the Ujwal Thapa Foundation Advisory Board. She is a writer, art-historian and filmmaker, advising on the economic and social potential of the Cultural and Creative Industries. She is Director of Development at the Kathmandu Valley Preservation Trust, and Founding Director of The Kalā Salon, a non-profit space for the arts.

The Man Who Shook Our Minds

Did <a href="https://nepalitimes.com/banner/1921-rendezvous-mallory-pumori-and-everest">George Mallory</a> and Andrew Irvine of the 1924 British Expedition reach the top of the highest mountain in the world? It has been more than a century after the two climbers were last seen just 300m below the summit. And 26 years ago Mallory’s remains were found on the North Face of Everest, while Irvine’s boot was located at its base.&nbsp; Some doubt that the two could have reached the top with the level of equipment and clothing of the time, but others are convinced that at least one of them made it but had an accident on the way down.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260108110148_26b4f6883ce3362c6f0c312d35422a57384c04aeb673f578d3ddb660761747fc.jpg" data-media-id="editor_1" data-image-id="20260108110148_26b4f6883ce3362c6f0c312d35422a57384c04aeb673f578d3ddb660761747fc" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="George Mallory and Everest"> <figcaption>Panuru Sherpa on the top of Mt Everest with a client in 2002. He has climbed the peak 16 times.</figcaption> </figure>  Among those who believe Mallory and Irvine were the first to climb Mt Everest, and not <a href="https://nepalitimes.com/here-now/everest-70-years-on">Hillary and Tenzing in 1953</a>, are the Nepali guides who took part in the research expeditions in 1999, 2001 and 2004 to find clues about Mallory and Irvine. Mallory’s body was found 8,125m on the North Face in 1999, and Irvine’s detached foot and sock with his initials inside a leather hob-nailed boot was found in 2024 in the Rongbuk Glacier below the North Face. Various expeditions have recovered a mitten, an oxygen cylinder, and ice axe from that expedition. “I believe they reached the summit, and fell on the way down in the dark and bad weather,” says <a href="https://nepalitimes.com/here-now/sherpaland-co-usa">Panuru Sherpa</a>, who has climbed Mt Everest 16 times, including on the northern route taken by four British expeditions in 1921, 1922, 1924 and 1933. “They were making good progress past the Second Step from where it is a much easier hour-and-half to the summit. A climber who reaches that point below the final pyramid does not turn back.”  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260108110148_bdbdd01c5c12cb5bb022857f7ca871cc4ff95e02c2305f6bbf1a63d1d15de8e4.jpg" data-media-id="editor_4" data-image-id="20260108110148_bdbdd01c5c12cb5bb022857f7ca871cc4ff95e02c2305f6bbf1a63d1d15de8e4" data-rendition-name="original" width="1300" height="864" loading="lazy" alt="George Mallory and Everest"> <figcaption>Mt Everest North Face in China which early expeditions took because Nepal was closed till 1950. The red line is the classic route to the peak, the dotted line is probably what George Mallory and Sandy Irvine took in 1924 to avoid the formidable obstacle of the Second Step.</figcaption> </figure>  Panuru is convinced that the location of Mallory’s body and Irvine’s ice axe shows that the two had not lost their way on their descent. He told Nepali Times in Denver, where he now lives: “Mallory’s body was not decomposed even after 75 years, and his exposed back was white like marble. One of legs was broken, and there was an altimeter and letters written to his wife Ruth in his pocket.” He remembers the search team was happy to locate <a href="https://nepalitimes.com/review/mountains-of-books">Mallory</a>, but it was unable to find one of the three cameras believed to be with the duo that could have held the proof that the two, or at least one of them, had indeed been the first to climb Everest.&nbsp; There was a deep wound around Mallory’s waist, which could have been caused during the fall by the rope which was still found tied around his body. Mallory’s remains were covered in stone slabs at the site after a brief ritual, Panuru recalls. A 1975 Chinese expedition reported seeing the body of a Western climber, which was probably Mallory, near their Camp VI. There are rumours in climbing circles that the Chinese also found a camera, but that the negative could not be developed. Everest summiteers have said the Second Step’s 45m overhanging cliff at 8,610m would have been “essentially insurmountable”, and it is only possible today because the Chinese fixed aluminium ladders to the rock face in 1975.&nbsp; But Panuru agrees with other mountaineering historians who believe Mallory could have decided to take a route below the northeast ridge and bypass the Second Step, following the advice of fellow team member Ed Norton who set the then world record by reaching 8,572m. The other finding that could indicate that Mallory reached the top was that a photograph of his wife Ruth which he intended to place at the summit was not in his pocket.&nbsp; EVEREST CONNECTION Panuru is the son of Nima Tsering Sherpa, who was a part of the 1953 expedition to Mt Everest that made Edmund Hillary and Tenzing Norgay the first climbers on the world’s highest peak. Nima carried loads for that expedition up to the South Col. Nima had eight sons and a daughter, Panuru is the sixth, and<a href="https://nepalitimes.com/here-now/nepal-s-most-prolific-mountaineering-clan"> most of his siblings are also climbers</a>. After the successful 1953 expedition, Nima spent time grazing yaks, growing potatoes and raising his family in Phortse. He joined expeditions to support the family. The young Panuru would meet mountaineers who stopped by at the family’s tea house in Phortse. He has walked the Jiri route to Kathmandu many times, and his eldest brother who worked for Mountain Travel Nepal got him a job as a trekking guide. Panuru ended up joining expeditions, climbing Everest from both sides multiple times. Panuru Sherpa’s brother Danuru was the youngest member of the 1999 expedition, and a year earlier had first climbed Everest from the Nepal side when he was only 18. The siblings are now chefs at the Sherpa House in Colorado.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260108110152_9275f617585d33f7324d087455de7c61fd3759fe4d44a7ebe604fa2eefc047df.jpg" data-media-id="editor_7" data-image-id="20260108110152_9275f617585d33f7324d087455de7c61fd3759fe4d44a7ebe604fa2eefc047df" data-rendition-name="original" width="1500" height="523" loading="lazy" alt="George Mallory and Everest"> <figcaption>Brothers Panuru and Danuru Sherpa are now working in Golden, Colorado, and lead occasional climbing trips in the Rockies and Alaska.</figcaption> </figure>  In 2001, both brothers were members of another expedition composed of 20 foreign and 21 Nepali climbers led by David Hahn that tried to find Irvine in the same area of the North Face, guided by the discovery of Irvine’s ice axe in a 1933 expedition as well as sightings of what was believed to be his body near the ridge above. No more clues were found then, or in 2004 when Danuru returned for another search expedition. Remnants of Irvine and Mallory’s Camp VI were found at 8,600m during the 2001 expedition, only about 300m from where Mallory’s body was located.&nbsp; “It was probably dark when Mallory fell because his snow goggles were in his pocket,” says Danuru, who has taken part in the three search expeditions on the north side and is also convinced the two fell on their way down after reaching the summit. Altogether 13 people died on Everest during the three expeditions that Mallory was involved in, of which nine were Nepali porters, cooks and guides who were hired in Darjeeling before the march-in. “Chomolungma and Sherpa are synonymous,” says Danuru. “It was Chomolungma that made the Sherpa people famous globally, and it was Sherpas who made it possible to climb Everest.” Konrad Anker, who led the 1999 team that found Mallory’s body, doubts that one or both the climbers reached the summit in 1924, mainly because of the difficulty of climbing a cliff at 8,600m with the kind of gear they had.&nbsp; “It is possible, but unlikely they climbed the Second Step with 1920s equipment, but even getting to that altitude back then was an incredible accomplishment,” he has said. After the expedition, Anker and Panuru worked together to set up the Khumbu Climbing Center to upgrade the technical skills of Nepali guides. Panuru has also trained hundreds of fellow Nepali guides, and many of them regard him as a mentor. Panuru knew the need for better training because he himself had been badly wounded during a fall into a crevasse in the Khumbu Icefall in one of his early expeditions in 1992 and had to be evacuated by helicopter to Kathmandu.&nbsp; But the very next year, he was back on the mountain. He climbed Everest from the north with a Korean team in 1994, and a year later got to the top again from the north side with an American expedition. He summited again from the Nepal side in 1996, and nearly died in an avalanche on the north side that killed a fellow Sherpa in 1997.&nbsp; So far, Panuru has climbed Everest 16 times, Cho Oyu 14 times from both sides, Xixapangma four times, five other eight-thousanders in Nepal, and Ama Dablam six times. He was the first Nepali to ascend Gurla Mandhata in Tibet. After emigrating to the United States, he has climbed Mt Denali (6,190m) in Alaska three times while also being a part of a volunteer rescue team.&nbsp; Irvine’s boot was found by an expedition led by American climber Jimmy Chin in the Rongbuk Glacier, probably transported there from the base of the face by the movement of ice in the past 100 years. Asked why he climbed Everest 16 times, Panuru echoes George Mallory: “Because I was there.” &nbsp;&nbsp;&nbsp;

primary-health-care