South of Janakpur near the Indian border is the village of Phulgama. Out of its population of 4,500, nearly every household here has at least one son who is a migrant worker abroad.&nbsp; Some 40% of Nepali men between the ages of 20-35 are <a href="https://nepalitimes.com/news/die-first-get-paid-later">migrant workers abroad</a>, mainly in India, the Gulf states or Malaysia. In the last nine months alone, 741,297 people travelled overseas: mostly to the UAE, Saudi Arabia, Qatar, Malaysia and Kuwait. This does not include those who left on student visas, and there are no records of how many went to India. Most end up working in ‘3D jobs’ — &nbsp;dirty, dangerous and difficult. There is also a fourth D: dehydrating work.&nbsp; Risky outdoor as manual workers, <a href="https://nepalitimes.com/editorial/too-hot-to-work">excessive heat of the desert in the Gulf</a> or humidity of the tropical jungles of Malaysia, poor diet, dehydration and unhealthy lifestyles all contribute to a <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/A-mysterious-rash-of-kidney-failures,3639">higher risk of kidney failure among Nepali migrant workers</a>. Dhanusha district has one of the highest proportions of workers migrating for work to India and abroad. Nephrologists call kidney disease ‘the silent killer’ because patients do not show symptoms until it is too late, and migrant workers are especially susceptible to Chronic Kidney Disease (CKD) or End-Stage Renal Disease (ESRD).&nbsp; Increasing demand for cheap labour and minimum pre-departure health awareness training makes migration more risky than it should be. From a survey of hospitals and dialysis centres in Dhanusha and Kathmandu, the risk of kidney failure<a href="https://nepalitimes.com/opinion/comment/saving-kidneys-to-save-nepal"> appears higher among male migrant workers</a> than in Nepali men of the same age group.&nbsp; “This disease is idiopathic, meaning it is not caused by one specific factor,” explains Rishi Kafle of the National Kidney Center Nepal. “But after screening migrant workers going to the Gulf and developing End-Stage Renal Disease in 3-4 years, we can say that migration increases the likelihood of kidney failure.” Kafle adds: “Because of the need to maximise earnings, working in extreme heat for long hours dehydrates them. And many opt for Coca-Cola and meat instead of healthier water and vegetables.”  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250118070128_b86cd132e88fecad9cde6d6faa648f76b40979660e6d28e846b25469668df9d8.jpg" data-media-id="editor_4" data-image-id="20250118070128_b86cd132e88fecad9cde6d6faa648f76b40979660e6d28e846b25469668df9d8" data-rendition-name="original" width="4032" height="3024" loading="lazy" alt="Dirty, dangerous, difficult, and dehydrating NT"> <figcaption>All photos: PINKI SRIS RANA</figcaption> </figure>  While the risk of kidney failure is higher in returnee migrant workers in Nepal, the disease is on the rise globally due to <a href="https://nepalitimes.com/banner/sick-of-it">lifestyle changes,</a> diabetes or undiagnosed hypertension. Currently, there are 28,266 kidney patients enrolled in the <a href="https://dohs.gov.np/">Department of Health Services</a> for free treatment under the government’s <a href="https://mohp.gov.np/program/medical-treatment-of-deprived-citizens/np">Bipanna Nagarik Kosh</a>, of which 17,044 are male and 11,222 female. Just in the past year, 9,176 more patients were added to the fund. Most hospitalised kidney patients are from age 15-65. In a healthy person, toxins and waste in the blood are filtered by the kidneys. But patients with kidney failure need to circulate their blood regularly through a haemodialysis machine. The whole process takes about 3-4 hours and causes blood vessels in the arms to swell over time. Nearly 2 million Nepalis suffer from chronic kidney disease (CKD), which is about 8% of the population. The rise in diabetes and hypertension is contributing to an increase in the disease. Everyone from migrant workers to many of Nepal’s top politicians suffer from kidney failure. Prime Minister Oli himself has had two kidney transplants. Even with dialysis twice a week, some patients develop nausea, swelling and other problems when they eat or drink. The extra dialysis sessions cost money, and the livelihood allowance given to patients is never enough or timely. Not every migrant working in hot climates returns with kidney disease, but a recent yet-to-be-published study led by nephrologist Sailendra Sharma states that one-fourth of all kidney patients in Nepal are migrant returnees. It points to recurrent heat stress as a primary risk factor. The<a href="https://mihs.edu.np/"> Madhesh Institution of Health Sciences</a> in Janakpur has 103 regular patients who come for dialysis. Of them, 30 are returnee migrants not just from Dhanusha, but also Sarlahi, Siraha, Mahottari and Sindhuli. “Not by the nature of the disease, but the way kidney disease is growing, I would call it an epidemic,” adds Kafle. &nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250118070128_43731248e116cfdc42bfc08b8f7d71e5ff3d44b938065a5ad9e9a337e666b9c7.jpg" data-media-id="editor_9" data-image-id="20250118070128_43731248e116cfdc42bfc08b8f7d71e5ff3d44b938065a5ad9e9a337e666b9c7" data-rendition-name="original" width="1463" height="798" loading="lazy" alt="Dirty, dangerous, difficult, and dehydrating NT"> <figcaption>HARD LABOUR: Jagdish Sah shows a picture from his time in Malaysia.</figcaption> </figure>  Jagdish Sah left for Malaysia ten years ago. He had taken a loan for his sister’s marriage and he had to pay it back. As the eldest son, he was also expected to get married next, but he faced multiple rejections. “Women have expectations too. They want to get married to well-to-do families. They didn’t want to get married to a family that lived in a mud house like ours,” says Sah, now 35. Foreign employment was a one-stop solution to his problems. Or so he thought. Sah was 24 when he left for a tailoring job at a garment factory in Malaysia. He often worked overtime, sometimes up to 12 hours a day in the hopes of earning extra ringgits. Even so, his highest monthly income would only be Rs35,000.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250118070128_7dd5030951c805302adec46afdef623bbdbb6fe1c0f12b7a77fd612531865af1.jpg" data-media-id="editor_10" data-image-id="20250118070128_7dd5030951c805302adec46afdef623bbdbb6fe1c0f12b7a77fd612531865af1" data-rendition-name="original" width="2048" height="1536" loading="lazy" alt="Dirty, dangerous, difficult, and dehydrating NT"> <figcaption>Sah at a garment factory in Malaysia where he worked, often dehydrated, and not taking toilet breaks to earn more.</figcaption> </figure>  Workers got a 30-minute break for lunch, and there were limited toilet breaks. So, Sah just worked straight out. Back in Nepal for a break in 2017, Sah had blurred vision and fainted. He thought it was high blood pressure, but a few months later at age 28, he was diagnosed with double kidney failure. “Whatever he saved in Malaysia went for his treatment in Kathmandu. We even sold a plot of our land,” recalled Sah’s mother, Mantoriya Devi.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250118070128_dc353dd6ce449c05bda6d562907dd961d8900c1b747dc4afec1680bb65b805b7.jpg" data-media-id="editor_11" data-image-id="20250118070128_dc353dd6ce449c05bda6d562907dd961d8900c1b747dc4afec1680bb65b805b7" data-rendition-name="original" width="3995" height="2871" loading="lazy" alt="Dirty, dangerous, difficult, and dehydrating NT"> <figcaption>Sah is now gaunt and frail in this picture taken duing his biweekly dialysis at Madhesh Institute of Health Sciences in Janakpur recently.</figcaption> </figure>  Sah drives his motorcycle twice a week from his village to the Madhesh Institute of Health Sciences in Janakpur for free dialysis. His family says it is as if the Jagdish who went to Malaysia and the one who came back are two different people. &nbsp; “This disease has already doomed my life. Why ruin someone else’s?” says Sah of his lack of marriage prospects. “It is because of dialysis that I have survived so far.” His parents are too old and occupied with their chores to accompany him. Since Jagdish cannot work, his father, Ram Dev sells popcorn by the sidewalk from a wheeled cart. Mithu Kumar went to Saudi Arabia to work as an electrical supervisor two years ago. He was 25. Recently when he started vomiting, he was taken to a local hospital. He was diagnosed with chronic kidney disease and was sent back to Nepal. As Kumar lays down for his dialysis treatment at Save Lives Hospital in Janakpur, he says, “My only wish is that I am healthy enough to work again.”&nbsp; Umesh Kumar Yadav also worked in Saudi Arabia as a guard. He returned with chronic kidney disease, but he says he is the only one to contract the ailment among all the returnees from his village. “Only the ill-fated people have this disease,” says Yadav. “Otherwise, it would have been the same for every other person from the village who is abroad working.” Ambar Bahadur Sarki, 46, travels from Sindhuli for three hours every Monday and Thursday to Janakpur for his free dialysis at the Madesh Institute of Health Sciences. Sarki worked in a palm oil plantation in Malaysia, where heat stress often exceeded the wet-bulb threshold for heat and humidity. “It was extremely hot at all times,” he remembers. He first got hypertension, which made both his kidneys fail. Ram Udgar Mandal from Dhanusha started working in Saudi Arabia in his late twenties. He spent the next 17 years in the desert working as a driver. Now in his late forties, he was diagnosed with End-Stage Renal Disease (ESRD) four years ago.&nbsp; But this is an intergenerational cycle. Mandal’s son has now also gone to Malaysia to supplement the family income. He fears his son will meet the same fate as him. “We do not have a choice, do we?” he says. Lalit Balampaki, 28, from Dhanusa was diagnosed with ESRD a year earlier in Dubai. He stays in Kathmandu along with his older brother’s family on a rented floor. Balampaki worked in extreme heat conditions in a smelting factory in Dubai. He had to work night shifts twice or thrice a week. Sleep deprivation and extended periods without food were part of his daily routine. The pay was good, but his savings have all gone now towards hospital fees. “More than the money, I earned the disease,” says Balampaki. &nbsp; Suraj Thapa Magar, 30, was the sole breadwinner of his family. He installed aluminum windows and doors in Kuwait “It was the hottest in summer and coldest in winter,” says Magar, who worked for 10 hours a day even in 50°C. He also often neglected hydration, and one night he vomited blood. At 26, he was diagnosed with ESRD and has been in Nepal ever since. Thapa has no other choice than to rely on the Rs5,000 allowance, but even that is not timely and not enough. He has to take loans to travel for his dialysis. The government hospitals are supposed to provide some medicines for free, but they are often out of stock. Thapa has looked for jobs, but kidney disease is a stigma and no one wants to hire him. &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;*** In 2016, Nepal started providing free hemodialysis treatment for the poorest patients. Two years later, a monthly livelihood allowance of Rs5,000 was to be distributed to patients suffering from chronic diseases like dual-kidney failure and cancer. Free dialysis is provided in 107 hospitals across the country, but that is only in theory. Many facilities do not have nephrologists because the government does not provide salaries. The machines also often are not working because they need constant maintenance. Among the 11 hospitals that provide free dialysis in Madhes Province, three are in Janakpur. Nepali Times visited the enlisted hospitals but there were no nephrologists to supervise the treatment, and they were run by general physicians or senior nurses.&nbsp; “The government does not provide adequate salaries for the nephrologists,” says Kafle. “That is why nephrologists are mainly affiliated with the private hospitals.” Bagmati Province has 44 hospitals with free dialysis, which is why many dual-kidney failure patients have opted to live in Kathmandu. The hospitals service over 8,000 kidney patients.&nbsp; Since most of them are migrant workers, the end result is that Nepal’s poorly-resourced health system ends up bearing the cost of treating kidneys that failed while working as labourers in hot, rich countries. &nbsp;

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Dirty, Dangerous, Difficult ... and Dehydrating

At the National Kidney Centre in Kathmandu, a substantial number of the staggering 800 patients who come for regular kidney dialysis are migrant returnees from the Gulf and Malaysia.&nbsp;
Last month alone, 90% of the 90,000 Nepalis who went abroad were migrant workers. Most of them went to West Asia. They are healthy when they leave, but are <a href="https://nepalitimes.com/editorial/too-hot-to-work">exposed to extreme temperatures</a>, and many return with ruined kidneys.
Nepal is suffering an epidemic of renal failure due to the workers’ continuous exposure to excessive heat, chronic dehydration, harsh work environment, and the tendency to go for energy drinks immediately after returning from work. The problem will get worse in coming decades with nonsurvivable wet-bulb summer temperatures in the countries where Nepali migrants work.&nbsp;
Truth be told, renal failure is not confined to migrant workers. Increasingly high numbers of young Nepalis are suffering from lifestyle-related ailments. Individuals as young as 25 are living with high blood pressure, fatty liver, and diabetes, among others.
In the past 40 years, Nepal has seen a dramatic transformation from a country with mortality mostly from infectious diseases to one where people are living longer but are dying due to lifestyle-related ailments. A <a href="https://nhrc.gov.np/wp-content/uploads/2022/02/BoD-Report-Book-includ-Cover-mail-6_compressed.pdf">2019 study by the Nepal Health Research Council</a> found that non-communicable diseases accounted for 71% of deaths in the country.&nbsp;
Diabetes, high blood pressure, and the irrational use of painkillers are some of the main reasons behind this figure. Kidney failure can be prevented if diabetes and hypertension are controlled in the initial stages.
Renal health is very much linked to the quality of life and economy. Patients do not suffer alone, often they are the sole breadwinners and their condition will greatly impact their families.
As per the World Health Organization, 10% percent of Nepal’s total population (300,000 people) suffer from kidney issues, 30,000 of them are in the final stage, and 3,000 need dialysis or transplant every year.
The increasing burden of non-communicable diseases is a global phenomenon but developing countries like Nepal face a double whammy as we continue to battle preventable infections too.
The chances of survival for people suffering from renal failure are slim, but the good news is that the government provides dialysis and transplantation services free of cost.&nbsp;
Currently, over 90 health facilities throughout the country provide free dialysis services to over 6,000 patients with renal failure. Over 3,000 patients have undergone kidney transplants since the service started about a decade ago, including a former prime minister and other senior government officials.&nbsp;
Every year Nepal spends Rs2.11 billion on the treatment of patients with renal failure. Local governments also provide monthly livelihood allowances to those with kidney failure or undergoing transplants. This is the highest amount the government has been spending for any single disease.&nbsp;
Even so, the focus is on the treatment of the 3,000 people living with kidney failure and scant attention has been paid to 270,000 others who suffer from some sort of kidney disease, and another 270,000 who are at risk of kidney disease.
Providing free dialysis service is not a sustainable solution. Authorities concerned should promote prevention, and encourage renal failure patients to opt for transplants. Despite the legal provision that allows any immediate family to donate a kidney, many with renal failure cannot find one.&nbsp;
Road traffic accidents are one of the biggest causes of deaths today and a kidney from brain-dead donors is a viable option. But this requires increased awareness about organ donation.
Preventing kidney disease is the best way, and the first step is to launch awareness campaigns, the cost of which is minimal compared to the treatment cost of renal patients.
The public should be told about the dangers of obesity, excessive consumption of alcohol, tobacco, salt, and junk food as well as insufficient intake of vegetables and fruits. Regular exercise, drinking plenty of water, and cutting on sugar should be promoted.
Screening is crucial to early diagnosis and a lot of lives can be saved if testing for non-communicable diseases is made free once a year for all age groups. Even then, most Nepalis do not undergo tests unless it is an emergency.&nbsp;
The government has established laboratories at the health post level to carry out the test, but very few make use of the service. People can monitor protein levels in urine and do a creatinine test, a measure that shows how well one’s kidneys are performing or filtering waste from blood. The tests cost just Rs100.
Above all, these awareness campaigns should be launched at the school and community levels so that we have an early chance to save every kidney from severe damage. Before things get worse, we Nepalis and Nepal can bring down the burden of non-communicable diseases, cut medical costs, and save lives.
Rishi Kumar Kafle is a senior Nephrologist and is the founding President of the National Kidney Center in Kathmandu.

Saving kidneys to save Nepal

Everyone in the world is running some kind of race. Some chase recognition. Some chase money. Others run simply to stay ahead of others. But there are some who run for others. They are not trying to overtake anyone, they do not do it for fame, they are not getting paid to do it. But they run to pay for the upliftment of those less privileged. Bal Joshi, 41, is originally from Surkhet. His father was involved in the democratic movement during the days of absolute monarchy and he remembers frequent police searches of the house. And with his father in hiding, the young Joshi had to take care of the family. When the family’s small shop failed, his mother took the young Bal and his brother back to the village, and that is where he completed his education, walking four hours roundtrip every day between home and school. He ran most of the way, and without realising it he has been running ever since. Life was hard. Rent, food, education. His mother struggled constantly. There were days when there was no money even to buy kerosene for the stove. At one point, he sold his calculator, worth Rs 300, for just Rs 80 to get by.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251229031252_edb16b64a3d362a8dc86870bfa5deaad03a84e67d47f37cfd0bb5a8e584691fe.jpg" data-media-id="editor_0" data-image-id="20251229031252_edb16b64a3d362a8dc86870bfa5deaad03a84e67d47f37cfd0bb5a8e584691fe" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Running for dear life NT"> </figure>  At 15, Joshi moved to Nepalganj to continue his education. He initially stayed with his uncles, but eventually began living on his own. The transition to city life was difficult, and he experienced significant economic hardship while trying to pursue his studies. There were times when he struggled to meet basic needs, and at one point he sold his calculator just to get by. When he was 17, after hearing that his father was seriously ill, Joshi travelled to Gujarat to bring him back home. His father died soon after, and Joshi took on responsibility for supporting his family. It was his mother who taught him that despite scarcity, life had to be lived with dignity. Joshi started working at a newspaper at the age of 16 as a proofreader, and later became a journalist. During the Maoist war when children were being orphaned as a result of violence by both sides, he became active in the Sahara Group, and at 19, he began managing an orphanage that took in conflict-affected children. In Bajhang, after the army killed a man on suspicion of being a Maoist, his wife jumped into the Seti River and ended her life. Their two children were taken into army custody. During the rescue process, Joshi met Sunaina Adhikari of the ICRC and back in Nepalganj they decided to get married. The conflict was still raging in western Nepal in 2005, when Joshi went to the United States. In Maryland, he initially worked at a Bengali-owned Subway outlet, spending long hours on his feet behind the counter. He changed jobs frequently, financing his education along the way, and ultimately graduated with a degree in finance in 2008. He joined Hancock Whitney Bank in Texas, and has risen up the ranks to be Senior Vice President. A colleague inspired him to run as a way to stay healthy. But it soon turned into something more meaningful — running more than a dozen 50km marathons for charity.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251229031252_165a6d935860cf6707178aa2ac7395733883158f425bbe0ebed125529d601f61.jpg" data-media-id="editor_1" data-image-id="20251229031252_165a6d935860cf6707178aa2ac7395733883158f425bbe0ebed125529d601f61" data-rendition-name="original" width="999" height="1500" loading="lazy" alt="Running for dear life NT"> </figure>  Last year, Joshi returned to Nepal to run the Everest Marathon, and raised $42,000 which he donated to <a href="https://onestepfoundation.org/" target="_blank">One Step Foundation</a> which works on health care, child welfare and cultural preservation in Nepal and around the world. In June this year, Joshi and his family climbed Kilimanjaro, raising $19,000 for 80 HIV-affected orphaned children in Tanzania. During the Diwali festival he ran 220km in Nevada’s Red Canyon and raised $25,000 for cataract surgeries through the the <a href="https://www.theruitfoundation.org/" target="_blank">Ruit Foundation</a> in Nepal for cataract surgeries.&nbsp; Joshi does not run competitions, and is not trying to break any records. His motto is: “My race, my pace.”&nbsp; Turning his childhood scarcity into helping others, he says: “We all share sunlight, rain, air, and soil, nothing is truly just your own. I grew up without shoes, and I am fortunate to be able to distribute shoes to those who walk barefoot.” We ask Bal Joshi what (and where) next? His answer: the <a href="https://www.worldmarathonchallenge.com/" target="_blank">World Marathon Challenge</a> that will go around the world to run seven marathons in seven continents in seven days beginning in Antarctica at end-January.&nbsp; Joshi aims to run wearing the daura suruwal and Nepal’s flag as to show where he comes from, and how far in life he has come.

Running for dear life

A day after Rabi Lamichhane and Balen Shah <a href="https://nepalitimes.com/news/old-vs-new-in-nepal-in-2026-z6l4fgrd">came together to form an electoral alliance</a>, Kulman Ghising has also joined forces with the two leaders, merging his Ujyalo Nepal Party with the RSP.&nbsp; Following last-minute negotiations before Monday’s midnight deadline for parties to file their list of candidates for the Proportional Representation (PR) seats, Lamichhane and Ujyalo Nepal chair Anup Kumar Upadhyay signed a seven-point agreement to unify the two parties, with Balen Shah as witness.&nbsp; Per the deal, Ghising will be the vice-chair of the RSP, joining DP Aryal and Swarnim Wagle as the party’s seconds-in-command. The earlier agreement between Lamichhane and Shah retained Lamichhane as RSP chief, and promised Shah prime ministership if the party wins a majority in Parliament in March.&nbsp; Ghising’s team reportedly has a 17% share on the list of PR candidates filed by the RSP at the Election Commission. Balen has also fielded his own picks, and together the party has the likes of cricketer Gyandenra Malla, actress Reema Biswokarma, rights activist Mohna Ansari, climate activist Tashi Lhazom, and singer Prakash Saput as PR candidates. Ghising had held multiple rounds of talks with the RSP chair and the Kathmandu Mayor to discuss possible collaborations, but had failed to reach a power-sharing agreement. On Monday, Ghising had met with Lamichhane heeding a last-ditch effort from GenZ leaders, in particular Sudan Gurung, as they tried for the final time to get the interim Minister on board with Lamichhane and Shah before the PR list submission deadline.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025123004128_99e23ae7b6a042e71d271e3e74f7527086a7bb55779e6781bc9e7b711c8303e7.jpg" data-media-id="editor_1" data-image-id="2025123004128_99e23ae7b6a042e71d271e3e74f7527086a7bb55779e6781bc9e7b711c8303e7" data-rendition-name="original" width="1595" height="1087" loading="lazy" alt="Sudan Kulman Balen"> <figcaption>Photo: SUDAN GURUNG / FACEBOOK</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025123004128_d9f530704ab4c6e27eebf51f8e9fb55fed1d4281c99d089d06455cc7448bfda7.jpg" data-media-id="editor_2" data-image-id="2025123004128_d9f530704ab4c6e27eebf51f8e9fb55fed1d4281c99d089d06455cc7448bfda7" data-rendition-name="original" width="1026" height="1084" loading="lazy" alt="Balen and Sudan NT"> <figcaption>Photo: BALEN SHAH / FACEBOOK</figcaption> </figure>  The three are now set to make a formidable team to challenge mainstream parties at the polls. News of this alliance has been welcome to Nepalis who are looking for any alternatives to break the stronghold of the Oli-Deuba-Dahal trio over Nepali politics in recent history.&nbsp; But they will also carry each other’s baggage.&nbsp; Lamichhane, who was jailed for defrauding cooperatives depositors last year, was welcomed back as RSP party chair with open arms after he was released on bail last week. And while he has maintained his base of loyal supporters, he was subject to widespread criticism after he walked out of detention amid the jailbreak during the September protests, prompting his eventual voluntary return to prison.&nbsp; His party’s silencing and expulsion of critics within the RSP has also drawn direct comparison with the leadership structure of Nepal’s mainstream parties. Prominent leaders like Sumana Shrestha have left the party over disagreements with leadership.&nbsp; Meanwhile, Balen’s impassioned campaign resonated with Nepalis disillusioned with establishment leaders during the 2022 election and made him mayor of Kathmandu. The mayor’s direct, no-holds-barred style of communication and commentary has attained him much support beyond his constituency.&nbsp; But his unyielding, often unempathetic leadership style and policies— like his dismissal of street vendors and informal businesses during his drive to free up Kathmandu’s footpaths— have also earned him detractors. His recent outburst on social media in November that included expletives against both of Nepal’s neighbours and the US, as well as Nepal’s three main parties and the RSP was also widely criticised.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251230041212_fc2088daf32bac93541ebf25ca07725d75a721ae83440749ac8fa09d8fe308f2.jpg" data-media-id="editor_3" data-image-id="20251230041212_fc2088daf32bac93541ebf25ca07725d75a721ae83440749ac8fa09d8fe308f2" data-rendition-name="original" width="890" height="1255" loading="lazy" alt="Agreement NT"> <figcaption>The seven-point agreement between RSP and Ujyalo Nepal Party.</figcaption> </figure>  Ghising, credited with ending Nepal’s prolonged load-shedding during his tenure as the chief of Nepal Electricity Authority, has a reputation of getting the job done. His public goodwill earned him a seat on Prime Minister Sushila Karki’s interim Cabinet following the youth protest.&nbsp; But he has also been under scrutiny for funds misappropriation as well as controversial power purchase agreements during his tenure as NEA chief. Ghising had foregone the leadership position at his Ujyalo party, preferring to play the role of patron until closer to the election date, but was nonetheless criticised for his political and electoral aspirations while being a member of the transitional government. It now remains to be seen if and when Ghising will step away from his position in the interim Cabinet and begin campaigning with his new partners.&nbsp; As it stands, the involvement of prominent GenZ figures in bringing together Ghising, Shah, and Lamichhane has established youth leaders as major players in Nepal’s post-September political landscape. These leaders will have significant pull with young and first-time voters. But not all young leaders are impressed with this new triumvirate. Some have pointed out that the unity between these three leaders is no different from the political opportunism and quid-pro-quo power-sharing culture established and followed by Nepal’s mainstream leadership for the last three decades which culminated into the GenZ movement of September.

Kulman follows Balen to RSP

Koreana Coffee Guff begins with a scene where Narayan Wagle, the editor-turned-farmer, appears in reverse cameo, as a character in a novel. He has just landed at Incheon in the dead of winter.&nbsp; The opening premise reminds one of Tolstoy’s saying about how stories begin either when someone goes on a journey, or when a stranger comes to town. ‘The winds of each city are its original inheritance, shaped by its local language, its specific topography and the buffets of the airborne wings of birds and airplanes,’ Wagle writes.&nbsp; The author is both on a journey and a stranger to the town. The word ‘stranger’ might need to be redefined here, as he has visited Korea several times before. But if every journey is new, then he is a stranger of sorts — stranger to the people he meets for the first time in the book, stranger to the reader who will encounter him for the first time like I did in high school reading the English translation of his 2005 Madan Puraskar winning novel Palpasa Cafe.&nbsp; Koreana is non-fiction, and was first published in 2017 in Nepali, and recently rendered into English by Prawin Adhikari, who specialises in translating Nepali works into English in such a way that they do not read like translations at all.&nbsp; Even so, I turned to a few chapters from the original text, curious to see how ideas have morphed. Take Wagle’s journey to Ansan Mountain. It is the same mountain, but something different happens in the two languages. The inexplicable feeling is that the translation has to conquer the mountain itself. At its best, the book gives the reader a peek into Wagle’s mind, his internal monologues, his writing ideas, his thoughts on the people around him, his deep yearning and respect for nature, his exploration of Seoul and Korea, where he is attending the Asian Literary Creative Writing Workshop in 2017.&nbsp; BACK TO THE LAND ‘All cities appear the same everywhere,’ he writes of Seoul, speaking of how ‘development’ has masked the original charm of a city rebuilt after war. In recent years, Wagle has moved on from being the editor of Kantipur, to activism, and has now returned to his ancestral land in Tanahu to farm.&nbsp; Clues to this metamorphosis can be detected in this book, which was written nearly ten years ago and before his transition. Wagle used to write a column called Coffee Guff, and the book carries that conversational style.&nbsp; But not all monologues land. Thoughts rooted in a specific time and space like the hike to Ansan where the author reflects on buildings, birds, and trees feel connected with a context and background. Then there are those that bring in a new metaphor, a new reflection, a new connection in almost each new sentence which make it difficult to follow the author’s stream of consciousness.&nbsp; Halfway into the book, we finally meet the writers who have come from different parts of Asia for the workshop. Not speaking a common language, the writers have to rely on interpreters and Google, which turns their exchanges into quirky moments of laughter.&nbsp; Writers are an important part of the book, the lens through which Wagle invites us to see the world. Poets Manjul from Nepal and Shiva Ryu from Korea make guest appearances. Through two Korean writers who share the surname Kim, we get a glimpse into Korean history and society, and how writing is intertwined with politics.&nbsp; This Korea is different from the Kpop idols and skincare routine that has dominated recent imagination of the divided peninsular nation. Wagle writes, ‘Literature attempts to unite, politics impedes it. They are being continuously thwarted by the conflicts ongoing in the nation’s politics.’&nbsp; One of the Kims is Kim Min-jung (김민정), author of The World’s Most Expensive Novel, that explores what it means to be a writer in Korea.&nbsp; Reading Koreana feels like a hike through a jungle. If one is able to move past the tangled and stretched monologues, the book can hold moments of awe and wonder. But there is always a desire for a clearer trail to follow. &nbsp;&nbsp; Narayan Wagle’s characteristic witticism is there aplenty, his observations are astute. Writers exploring their craft and readers curious of what is churning inside Wagle’s mind will find treats -- sometimes well-crafted, other times to be searched between the lines. &nbsp; Alfa M Shakya is a writer, researcher, and podcaster. She runs and hosts ‘How’d You Create That?’, an art podcast about the creative process.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251230071252_5503c9fb08d62adb328d8f817b353604429559d3d9c6542edf3663c3f8c554e5.jpg" data-media-id="editor_0" data-image-id="20251230071252_5503c9fb08d62adb328d8f817b353604429559d3d9c6542edf3663c3f8c554e5" data-rendition-name="original" width="1136" height="702" loading="lazy" alt="Korean coffee guff English translation review"> </figure>

Coffee guff from Korea

From stone spouts to cast-iron mains, Nepal’s water system and its struggle to provide safe water tells a larger story of power, disease, dependency — and lessons for the future. From 1823 to 1891, the Nepali state made just two notable interventions in Kathmandu’s drinking water system. The first was when Prime Minister Bhimsen Thapa commissioned a stone pout (hiti) to tap groundwater within the valley’s traditional supply system. The second came nearly 70 years later with Nepal’s first industrial-era water system, the Bir Water Works in 1891 under Prime Minister Bir Shumsher Rana. Linking these two milestones was the spectre of cholera. From the 19th century on there were seven global cholera pandemics. <a href="https://www.sciencedirect.com/science/article/pii/S0264410X19309995#bb0325" target="_blank">Originating in Asia</a>, the disease reached Europe and the Americas, the Vibrio cholera bacillus breeding in poor sanitation wherever it found it. The first wave erupted in 1817, followed by others in 1829, 1852, 1863, 1881, 1889 and, finally, in 1961, the seventh pandemic which still lingers on. London, the epicentre of the Industrial Revolution, was repeatedly stricken. In Britain ‘miasma’ foul air was blamed. &nbsp;In Nepal, cholera was seen as divine damnation. By the late 19th century, as Nepal’s relationship with Britain deepened, the Bir Water Works was inaugurated in 1891 as a defence against cholera. Whether cholera also shaped Bhimsen Thapa’s decision in 1823 is less clear. Contemporary records note the commissioning of Sundhara, but do not refer to the cholera epidemic raging at the time. The silence itself is telling: Nepal’s elites were ruling in the shadow of the disease. Bhimsen Thapa first resided in Thapathali Palace, which was built in 1802 by Nain Singh Thapa, father of Mathabarsingh Thapa, who would briefly become prime minister in the 1840s. In 1806, Bhimsen Thapa moved to Bagh Durbar, a new complex on the western edge of Tundikhel. Historians are vague about the water supply in the residences of the nobility, but wells and water hauled from rivers, ponds, canals, and other sources were likely the primary sources. A small hiti north of Bagh Durbar, near today’s Sun Dhara, may have supplied the palace. In 1823, Bhimsen Thapa had it enlarged, making it the last and largest state-built hiti in Kathmandu. Even as Bhimsen Thapa was involved in palace intrigues and border conflicts, Britain was engineering pipelines. By the late 18th century, Sir Thomas Simpson had invented the bell-and-spigot joint, making long-distance pipes viable. Fluid dynamics, dealing with pumps, pipes, and filters, was becoming a foundational discipline. In Kathmandu, the scourge continued. Cholera struck Kathmandu repeatedly, in 1862, 1867, 1872, 1874 and 1875. The 1872 epidemic, <a href="https://nepalitimes.com/news/kathmandu-in-the-time-of-cholera" target="_blank">according to historian Tom Robertson</a>, claimed between 200 and 250 lives a day. On average, cholera killed between 1,200 and 1,500 people annually in Kathmandu Valley, an enormous toll for its small population. The summer of 1885 was especially calamitous: a cholera epidemic ravaged Kathmandu and its periphery from the beginning of June until late August. The disease even breached the royal palace, reportedly killing 23 people, mostly young girls. Records show that 909 people received treatment at the British Residency dispensary, and estimates suggest that as many as 10,000 people perished in a city of 50,000. In November that year, Bir Shumsher seized power in a coup. He inherited not only a premiership but a Valley ridden with disease. Cholera was endemic, and it was accompanied by typhoid, smallpox, goitre, syphilis, and chronic dyspepsia. The The British Residency dispensary at Lainchaur was inadequate. “In a poor country like ours, wealth means health,” Bir Shumsher remarked, an unusually pragmatic admission that epidemics were not divine punishment but structural afflictions of urban life. He soon pledged to expand health care. In 1889, he opened Bir Hospital and staffed it with Indian doctors to treat cholera, typhoid, smallpox, and other prevalent illnesses. PIPED WATER Bir Shumsher also recognised the need for safe drinking water. Between 1866 and 1872, he had served as Nepal’s ambassador in Calcutta, and he must have seen water mains already in operation there, and a filtration plant inaugurated in 1870. Madras had installed such a system as early as 1800, Bombay constructed the Vihar and Tulsi reservoirs in the mid-19th century. In Kathmandu British Residency personalities such as George Gimlette must have urged Bir’s government to quicken the construction of the hospital and water system, yet the archival traces of such exchanges still await historical scrutiny. By the late 19th century, the British had developed a technological ecosystem for water supply, intakes, pipes, fittings, reservoirs, and trained engineers. Bir Shumsher appealed to the British Government in India for engineering assistance. A British engineer named Mr Feigneur surveyed Kathmandu to prepare maps, and estimated the volume of water that could be brought from the Rudramati River. In 1889, a more experienced engineer, Lockhart Matthew Sinclair arrived. He was a Scotsman educated at Wellington College and the Royal Indian Engineering College, with prior experience in constructing waterworks in Jubbulpore and the Viceregal Palace in Shimla. Appointed State Engineer of Nepal (1889–1892), Sinclair reviewed Feigneur’s plans, updated them, and chose the Bishnumati River as the source of the city’s drinking water. Sinclair’s design included a reservoir at Panipokhari, at 1,330m elevation and 30m above &nbsp;Tundikhel, thereby enabling gravity-fed distribution in pipes. With a capacity of 7,327 cubic metres, the reservoir could store nine days of supply.&nbsp; The system was designed to serve about 70,000 residents through both private connections and public standpipes. The reservoir was a single-compartment tank with an arched brick roof covered in earth and turf. Its brick walls were bonded with lime mortar and aggregate, and its floor was dressed with fly stone. Work on the valley’s water supply began in 1888, three years after Bir Shumsher seized power. The following year, Bir Hospital and the Bir Water Works took shape. The project involved some 40km of imported cast-iron pipes, weighing 1.866 million kg and inscribed with the marks of Scottish foundries ‘Ally and McLean’ and ‘Glasgow’. Construction required 620,000 man-days of labour and cost over Rs600,000. Transport costs inflated prices: <a href="https://commons-nepal.com/the-first-kaldhara-in-the-four-cities-of-the-valley/" target="_blank">a load of cement</a> costing Rs10 in Calcutta was worth Rs33 by the time it reached Kathmandu. Bir Water Works was inaugurated in September 1891, six years after the cholera epidemic. Water flowed out of 131 taps, including eight in Lainchaur, six in the royal palace, eleven in the prime minister’s palace, sixteen around Tundikhel, thirteen in Thapathali, seven in Thamel, and two in Naxal. The system’s designation, the term ‘works’ , echoes the Chelsea, Calcutta, and Glasgow Water Works, underlining its industrial pedigree. Water was also supplied to Phora Durbar, Bir Shumsher’s palace of music and dance whose fountains sprayed rose-scented water in a display of opulence. The <a href="https://commons-nepal.com/the-first-kaldhara-in-" target="_blank">Bir Dhara Works</a> was more than an engineering scheme: it was Nepal’s first modern public-health intervention. Safer drinking water curbed waterborne disease, and the number of cholera outbreaks declined, but were not eliminated.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260103020144_d5c22de54c0eaab680a166c5a7482839fdc09b60679109021d0504252a810254.png" data-media-id="editor_4" data-image-id="20260103020144_d5c22de54c0eaab680a166c5a7482839fdc09b60679109021d0504252a810254" data-rendition-name="original" width="865" height="535" loading="lazy" alt="Cholera and drinking water in Kathmandu"> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260103020144_a46075b6d759585df56a2bb8e5a07d85de7d9a69406165c32784fe30012c9971.jpg" data-media-id="editor_5" data-image-id="20260103020144_a46075b6d759585df56a2bb8e5a07d85de7d9a69406165c32784fe30012c9971" data-rendition-name="original" width="2791" height="3859" loading="lazy" alt="Cholera and drinking water in Kathmandu"> </figure>  “Now we have water to fight cholera, and I believe cholera will no longer prevail. After four years of piped water, the benefits have been greater than expected,” Bir Shumsher said in a proclamation. Despite this, the prevalence of poor sanitation, open defecation, cramped housing, and malnutrition meant that typhoid, smallpox, and dyspepsia remained endemic. The Bir Dhara system marked Kathmandu’s transition from reliance on wells, rivers, springs, and hiti to piped water, operating for several decades and laying the foundation for the expansion of drinking water services across the country in the late twentieth century. <a href="https://commons-nepal.com/the-first-kaldhara-in-the-four-cities-of-the-valley/" target="_blank">Extensions followed in Patan</a> under Chandra Shumsher, and Bhim Shumsher later added the Tri Bhim Dhara. Piped water systems were subsequently constructed in towns such as Kirtipur, Bhaktapur, Dhankuta, Pokhara, Dhulikhel, and Jajarkot which itself saw a deadly cholera outbreak in 2009.&nbsp; CHOLERA METAPHOR In 1933, Nepal’s first water bureaucracy, the Pani Goswara, was established, formalising state involvement in urban water supply. Yet even till the late 20th century, households continue to rely on a mix of sources, including public water networks, private vendors, rooftop storage tanks, borewells, wells, hiti, and household filtration. The lack of reliable water supply places disproportionate financial, physical, and psychological burdens on low-income households, underscoring how decades of infrastructure expansion have not translated into universal, reliable service. during challenges in governance, investment priorities, and regulation. Bir Shumsher also attempted to introduce <a href="https://www.ukaalo.com/news/cholera-in-kathmandu-1958/" target="_blank">basic hygiene measures</a>, such as pit latrines with squatting slabs. However, there is no record of these facilities being built in his palaces, later built palaces, or elsewhere. Sanitation conditions remained poor for both the elite and the general population. Open defecation or the use of crude pit latrines without proper waste disposal was common. With no drainage or sewer systems, human waste accumulated near homes, contributing to the spread of waterborne diseases. In 2019, Nepal declared itself ‘open defecation free’, a policy milestone, but this achievement masks the persistence of deeper problems. Urban areas generate some 867 million litres of wastewater daily, yet only 7% of it is treated before being discharged. Sewage flows untreated into rivers and streams, spreading cholera, typhoid, dysentery, and other diseases, particularly among children and vulnerable communities. Safe disposal of faecal sludge continues to be a major struggle for many communities and local governments. Besides Jajarkot, Godavari in Kathmandu Valley had a localised outbreak in 2024. This year, Birganj was struck by a cholera outbreak caused by a lethal combination of unreliable water supply, groundwater overpumping, poor drainage and hygiene, and unsafe waste disposal. And Nepal’s peacekeepers deployed after the earthquake in Haiti in 2010 were blamed for spreading cholera that ultimately killed 30,000 people in the Caribbean nation. The Bir Water Works was more than a reservoir and pipes. It was Nepal’s first brush with modernity, mediated through engineering and haunted by cholera. More than 134 years on, cholera remains a threat and a reminder of Nepal’s challenges in water and sanitation governance. The issue is not merely ensuring access to safe water but also building public trust that quality essential services can be delivered equitably, sustainably, and with resilience. Ajaya Dixit is a Kathmandu-based researcher exploring Nepal’s water history since the mid-eighteenth century to inform ethical water and river management in a changing climate.

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