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

One aspect of colonial cartography of South Asia leaps out in this must-see exhibition – while the coastline of India, Ceylon, Burma are extraordinarily accurate in maps made more than 200 years ago, the Himalayan hinterland is wholly approximate and inexact. The accuracy improves as modern survey techniques are introduced by atlas-makers, but even then formidable terrain and forbidden lands thwart precision. Map aficionados will be fascinated by the 40 antique maps from The Rajbhandari Collection on display at the exhibition ‘Imaging South Asia: Nepal in the Making at Kathmandu Art Gallery’ at Baber Mahal Revisited from 13 February - 17 March.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260211090252_0cbeb88674a97c6292e2b43b2135df219257ca641cbd4723e9aabf5541c2b258.jpg" data-media-id="editor_0" data-image-id="20260211090252_0cbeb88674a97c6292e2b43b2135df219257ca641cbd4723e9aabf5541c2b258" data-rendition-name="original" width="4160" height="3485" loading="lazy" alt="Map Land NT"> </figure>  The first maps were made on clay tablets and cave paintings, but maps improved with Chinese maritime charts of Southeast Asia and beyond. Nautical maps created during the European Age of Exploration used geometry, latitude and longitude. Competition for colonial riches rested on the accuracy of these maps. The Portuguese had the lead in the 15th century, but were soon overtaken by the Spanish with Columbus voyaging to India but landing up in the Americas.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260211090252_1fb21d20cf29b408119f5279ce666e73dee089356e52277d753a27e3440364eb.jpg" data-media-id="editor_1" data-image-id="20260211090252_1fb21d20cf29b408119f5279ce666e73dee089356e52277d753a27e3440364eb" data-rendition-name="original" width="4030" height="3407" loading="lazy" alt="Map Land NT"> </figure>  European mapping of the coastline of peninsular India &nbsp;began after Vasco de Gama sailed around the Horn of Africa to arrive at what is now Kerala in 1498. The British and French struggled for control of India, and the Carnatic Wars of the 19th century were extensions of their rivalry in Europe.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260211090252_0fb0969dc3e07c5a77123b4aa5eb0f11d2ffea73c108077f7e4d1892d6bd4bb6.jpg" data-media-id="editor_2" data-image-id="20260211090252_0fb0969dc3e07c5a77123b4aa5eb0f11d2ffea73c108077f7e4d1892d6bd4bb6" data-rendition-name="original" width="2842" height="4160" loading="lazy" alt="Map Land NT"> </figure>  While most of the maps at this exhibition were commissioned by the East India Company and the Survey of India, there are quite a few made by Parisian cartographers and feature Pondicherry and the Danish trading outpost at Tranquebar. Followed chronologically, the maps show improvements in cartographic techniques. The earliest French map L’Inde of J D Barbié du Bocage from 1760 is a copper engraving with hand painted colours demarcating boundaries. ‘Napaul’, ‘Gorka’ and ‘Catmando’ are depicted. The rivers of India are precisely drawn, as is the Brahmaputra (Yarou Tsanpou) even though locations across the rest of Tibet are rough estimates.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260211090252_486dc1b12f391550516be164f27170d4702a69b5125c1b8c4b10f76fdae4c0b1.jpg" data-media-id="editor_3" data-image-id="20260211090252_486dc1b12f391550516be164f27170d4702a69b5125c1b8c4b10f76fdae4c0b1" data-rendition-name="original" width="1675" height="604" loading="lazy" alt="Map Land NT"> </figure>  The 1781 map Carte des Indes en deçà et au-delà du Gange of Rigobert Bonne has slightly more detail about Nepal with even ‘Pattan’ and ‘Bagmally’ river marked. William Darton’s 1802 map has ‘Nogarcot’ and ‘Mocaumpour’ wrongly placed to the east of the valley of ‘Napaul’. Samuel Arrowsmith’s 1828 map ‘India and the Birman Empire’ has Nepal’s rough boundaries demarcated for the first time within a hand-coloured green border, with the mountain ‘Dholagiri’ and ‘Dhunchi’ appearing for the first time. The 1835 map by Boston-based American cartographer Thomas Bradford has a more precise ‘Burrampooter’ river with ‘Sgigatoe’, ‘Lassa’ and ‘Bootan’ marked. In Nepal, ‘Batgan’, ‘Macwampour’ and ‘Lelit Pattan’ appear near ‘Catmandu’.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260211090252_5509c8e043a74b3e34e399c0684ca8eef7fc79953ee0dd18aedc738e8189d552.jpg" data-media-id="editor_4" data-image-id="20260211090252_5509c8e043a74b3e34e399c0684ca8eef7fc79953ee0dd18aedc738e8189d552" data-rendition-name="original" width="4094" height="3646" loading="lazy" alt="Map Land NT"> </figure>  One striking landmark appears consistently through a century of map-making from 1760 onwards, and that is the sacred Yamdrok Tso near Lhasa. It is precisely located, although it is drawn as a circular lake called ‘Jamdro or Palto Lake’ till J Bartholomew’s lithographic map in 1893 Constable’s Hand Atlas of India. Bartholomew’s map is also where ‘Mt Everest’ appears for the first time with its altitude ’29,002ft’ after Peak XV was calculated to be the highest mountain in the world by the Survey of India. Meanwhile, ‘Kinchinjunga’ appears in some of the earlier maps from the mid-1800s, north of ‘Dorjeloo’. The maps did not only have locations of towns, rivers and mountains but also other interesting facts about places. History buffs will find much to pore over in these maps.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260211090252_8280c979b175946a2ac29e22b7a2b2427f7f36f22093c3456524f1f529311498.jpg" data-media-id="editor_5" data-image-id="20260211090252_8280c979b175946a2ac29e22b7a2b2427f7f36f22093c3456524f1f529311498" data-rendition-name="original" width="4160" height="2762" loading="lazy" alt="Map Land NT"> </figure>  Many have sites of major British battles while conquering India. The ‘British India’ map by J Rapkin has dates and times of the ‘Principle Massacres’ during the Indian Mutiny of 1857. The map also shows India’s growing railway network with completed lines and those ‘in progress’. Narrow gauge lines can be seen in successive maps snaking up to the Nepal border to haul sal logs for sleepers for India’s expanding railway network. Many maps were drawn by British military intelligence. One even has the Kuti route of the Nepal Army while invading Tibet in 1791, and the Chinese Army’s advance in hot pursuit through Kerung to Nuwakot.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260211090252_a41ff6a7453f95d1e83c12ed3f831911d65ebd4d2389e0e3b774252dfa037132.jpg" data-media-id="editor_6" data-image-id="20260211090252_a41ff6a7453f95d1e83c12ed3f831911d65ebd4d2389e0e3b774252dfa037132" data-rendition-name="original" width="1173" height="679" loading="lazy" alt="Map Land NT"> </figure>  Pre-1857 maps show the western Tarai as a part of British India, but in later ones the Naya Muluk districts of Banke, Bardia, Kailali and Kanchanpur have reverted back to Nepal. The maps clearly mark Nepal as an independent nation, and represent it differently from Indian princely states. The Atlas of India of 1846 shows the ‘Dominion of the King of Nepal’.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260211090252_52132146d9ee8b922560b98e90d866149715d7f53ced408b5f3af8f3b142a07b.jpg" data-media-id="editor_7" data-image-id="20260211090252_52132146d9ee8b922560b98e90d866149715d7f53ced408b5f3af8f3b142a07b" data-rendition-name="original" width="4149" height="3682" loading="lazy" alt="Map Land NT"> </figure>  Visitors will be curious about Nepal's claim to Limpiyadhura and Lipu Lek. A map by Mason &amp; Payne from 1846 clearly shows the ‘Kallee River’ as being the border between Nepal and British India, with Kalapni within Nepal. The Lipu Gad tributary (which India claims is the border) is not marked. Some other maps, however, seem to show the border not following the Kali river to Limpiyadhura but the tributary up to Lipu Lek.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026021112024_9a1b6055a9fbecca7b64c3882c205efb336aac03e64ecf43a2044cb079cd699f.jpg" data-media-id="editor_8" data-image-id="2026021112024_9a1b6055a9fbecca7b64c3882c205efb336aac03e64ecf43a2044cb079cd699f" data-rendition-name="original" width="875" height="1215" loading="lazy" alt="Map Land NT"> </figure>  Imaging South Asia: Nepal in the Making&nbsp; Kathmandu Art Gallery, Baber Mahal Revisited&nbsp; 13 February – 17 March For guided walk-throughs and curatorial tours: +977 1-5318048 Panel discussions: -Cartographic Practices from the &nbsp;Gorkha Polity to the Present with Buddhi Narayan Shrestha and Kanak Mani Dixit&nbsp; Friday, 13 February, 4pm -Mapping Beyond Borders with Akhilesh Upadhyay and Amish Raj Mulmi Wednesday, 25 February, 4pm&nbsp;

Map land

The recent Nepali Times Substack post titled ‘Unresident Nepalis’ made me realise I also belong to the category of Nepalis who are technically Non-resident Nepali (NRN), but want to ‘permanently reside inside Nepal’.&nbsp;
Although this was meant as a joke, it is ironic that many of those who go abroad long to come back home, and those who have not emigrated cannot think of a good enough reason to stay back in Nepal.&nbsp;
As soon as the NRN Citizenship was officially introduced in late 2023, I had tried to apply for one but was shut down before even submitting my documents as the district administration office firmly told my then lawyer that I needed to prove “तिन पुस्ता” proof of three generations of Nepalis from my father’s side.&nbsp;
My late father was from Japan and relinquished his citizenship to become a Naturalised Nepali citizen in 2006. Three years ago, I dismissed the rejection with the thought that I will try again later when government officials would gain more experience with such applications.&nbsp;
Now, with an ailing mother and an energetic toddler, I felt the need to act soon and reached out to a law firm that specialises in NRN citizenship applications. To my surprise, they were positive after reviewing my documents, although they did warn me that we may need to overcome some obstacles.&nbsp;
In 2023, I had applied in the district office where my father had received his naturalised citizenship, but now the suggestion was to try from the district where my mother had received her Nepali ancestral origin “बंसागज” citizenship.&nbsp;
The lawyers pointed to the NRN citizenship mandate which clearly states that it can be acquired via a Nepali origin father, mother, grandfather or grandmother. The firm helped arrange the necessary documents required and the first step was to get a “सिफारिस” &nbsp;recommendation letter from my mother’s ward office.&nbsp;
This was the first hurdle as the ward office was unsure if they could issue such a letter, so they checked in with their head office, and luckily we received the go ahead. After persistent follow up from the law associates, they were able to provide us with a recommendation letter and we filled out the application forms.&nbsp;
The law firm wisely suggested that I take the paperwork myself to my mother’s district office while they stayed in the background in case I needed help explaining my situation.&nbsp;
With a big smile and cheerful tone, I dutifully followed the process and to my surprise, I found most of the officials ready to help without creating unnecessary hurdles. The application has to be signed off by the Chief District Officer (CDO) or Assistant CDO and just when I thought wow, I am going to breeze through this, one officer noticed that my father’s naturalised citizenship was from a different district and told me that I should apply for my NRN from there.&nbsp;
I explained that my father has already passed away and as he was not originally a Nepali, therefore it is not possible for me to get my NRN from his documents, as the requirement is ancestral “बंसागज” citizenship. The officer then went to check with their seniors and later told me that I would need police verification as an extra precaution.&nbsp;
Off I went to the police headquarters where they issued a sealed letter to be given to the police station that was in the same vicinity as my mother’s ward office. At the station I was told to get four people who are not my relatives to testify our documents are true.&nbsp;
This process happened to be more stressful than dealing with the government offices. At first, it turned out that most of my mother’s old neighbours had already passed away or had citizenship papers from another area. Others confirmed their availability, but later had conflicting schedules. Luckily, one very helpful old neighbour was able to arrange for enough people to verify the documents.&nbsp;
Encouraged that the end of the tunnel was in sight, I went back to the district office with all the requested documents, and after some initial pushback, I was finally referred to meet the official who signs off the documents before it goes to the CDO.&nbsp;
As luck would have it, the officials were in a meeting that lasted more than two hours, and I had to give my mother her insulin shot and noodles from the cafeteria in the waiting area.&nbsp;
When we were finally able to meet the officer, he didn’t even look at my papers properly and started questioning my lawyers whether they had even read the law, how could I apply for Nepali citizenship when I already had a Japanese passport, etc. He somehow assumed that I was looking to get a normal Nepali citizenship from my mother’s side, and we informed him that I was only looking to get an NRN citizenship, after which his tone became more apologetic and said that he would need to look into the law more closely.&nbsp;
It had already been three full days of working through each step of the process, and I had no problem waiting another day for the conclusion.&nbsp;
Perhaps because this NRN citizenship is a fairly new law and perhaps a lot of NRNs apply from the Nepal’s embassies in their country of domicile, throughout my experience, officials kept on telling me that a case such as mine has not been processed before.&nbsp;
My case being that I have never had a Nepali citizenship, my father having a naturalised Nepali citizenship and my mother being the only 100% Nepali in the family. I kept on saying that just because it has never been done before does not mean that it cannot be done, and sure enough, the next day the officer signed off on my documents, even kindly saying that they should have highly respected my application upon learning about my late father and his contributions to Nepal.&nbsp;
Although the intricacies of the NRN citizenship law have not been fully hacked out such as the transfer of land ownership, it is definitely a positive step in securing the rights and aspirations of fellow NRNs as many would agree that no matter where we go, “यो मन त मेरो नेपाली हो!”&nbsp;
Sonia Miyahara, Managing Director of Hotel Everest View, Trans Himalayan Tours &amp; Trekking Pvt Ltd &amp; Himalaya Kanko Kaihatsu Co. Ltd.

How I got my NRN Citizenship in Nepal

The arrest on 25 January of six people on charges of insurance fraud has brought the scandal of fake helicopter rescue of trekkers in Nepal to the fore once more, denting the image of the tourism industry. Trekking companies, helicopter operators and hospitals were said to be in cahoots to carry out medical evacuations that were not necessary. In some cases, even the rescues were said to be fake with false names of ‘patients’ and their ailments. The six who were arrested were charged by the Central Bureau of Investigation (CIB) with <a href="https://asia.nikkei.com/business/travel-leisure/nepal-s-rescue-helicopter-scam-casts-doubt-on-tourism-credibility2" target="_blank">cheating insurance companies</a>of millions of dollars in the past four years with more than 300 <a href="https://nepalitimes.com/multimedia/heli-rescue-fraud-tarnishes-nepal-s-image" target="_blank">fake chopper medevacs</a> from the base of Himalayan peaks to hospitals in Kathmandu. Nepali personnel of three companies, Nepal Charter Service, Everest Experience and Mountain Rescue were accused of heavily overcharging &nbsp;for fraudulent rescues, faking or inflating medical bills, and claiming payment of over $18 million over the years, the CIB said.&nbsp; In some cases, trekkers themselves who do not want to walk back along the same trail to Everest Base Camp or other routes, and pretend to be sick, are also said to be involved in the scam. “Tourism will attract opportunists, that is true everywhere,” explains Raj Gyawali of <a href="https://socialtours.com/" target="_blank">socialtours</a> and a partner of <a href="https://ethicaltravelportal.com/" target="_blank">Ethical Travel Portal</a>. “Our responsibility as an industry is to weed them out, protect what matters, and keep tourism rooted in passion, integrity, and long-term value.” The scam got <a href="https://www.nytimes.com/2026/02/03/world/asia/mount-everest-helicopter-insurance-fraud.html" target="_blank">wide international attention</a>, and tainted the reputation of Nepal’s mountain tourism sector that employs up to 1 million people. International media headlined allegations that trekker food was spiked to cause diarrhoea to force evacuations. Despite the bad publicity, tourism operators see a silver lining. It shows that Nepal is cleaning up its act and the system is working. Besides, the cheaters are in a minority in an industry that provides some of the best organised and most experienced mountain tourism service in the world.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260210040232_141217f8e5dc8a584642f7cb8d130de1a05cdcf149467334f9ab4e392f7d67aa.jpg" data-media-id="editor_5" data-image-id="20260210040232_141217f8e5dc8a584642f7cb8d130de1a05cdcf149467334f9ab4e392f7d67aa" data-rendition-name="original" width="1584" height="1500" loading="lazy" alt="Helicopter medevac scam NT"> </figure>  “After years of talk and investigation, we are now seeing arrests and it’s encouraging to finally see action. This didn’t happen overnight,” Gyawali says. “The post GenZ interim government works with much less politics, we are seeing a functional system for the first time in decades in Nepal.”&nbsp; This is not a new story. <a href="https://archive.nepalitimes.com/article/nation/Insurance,361" target="_blank">Nepali Times first covered </a>trekking insurance scams in 2013, following up on an investigation by the British Mountaineering Council in <a href="https://www.thebmc.co.uk/" target="_blank">Summit magazine</a> about insurance fraud involving fake helicopter rescues. In <a href="https://nepalitimes.com/multimedia/heli-rescue-fraud-tarnishes-nepal-s-image" target="_blank">another news item</a> published in this paper in 2018 cited an investigation by insurance watchdog <a href="https://www.travellerassist.co/" target="_blank">Traveller Assist</a> which showed that a third of the 1,600 helicopter rescues in Nepal that year were fraudulent, costing up to $4 million. Insurance companies gave the Nepal government <a href="https://nepalitimes.com/banner/nepal-trekking-industry-in-damage-control-mode" target="_blank">an ultimatum</a> to clean up its act, and an investigation committee was formed and 13 companies said to be involved were named. It now looks like although insurance fraud declined, it was still continuing to some extent till 2025. In the cut-throat competition in Nepal’s mountain tourism industry, companies undercut each other, and there are some trying to make a quick buck. These rotten apples spoil the whole barrel. Given Nepal’s remote terrain and extreme weather along Himalayan trekking routes, helicopter rescues are vital in saving hundreds of lives every year, rescuing trekkers and mountaineers suffering from acute mountain sickness, stomach or lung infections. “Nepal has a unique advantage over other Himalayan countries like India, Pakistan, or China because it allows private helicopter companies to conduct rescues,” Gyawali says. “This makes rescues faster and more accessible, often life-saving.” The real problem is that sometimes rescues take too long because of &nbsp;permission needed from multiple government agencies to conduct rescues near the Chinese border, which is considered sensitive. Last year, a mountaineer died on Himlung Himal because a helicopter company could not get clearance in time for a rescue.

Fake rescues hurt Himalayan tourism

This is the 83rd episode of Diaspora Diaries, a Nepali Times series in collaboration with Migration Lab providing a platform to share experiences of living, working and studying abroad. Spain is regularising over 500,000 undocumented workers, and Nepalis come to me inquiring about the program. Those who benefit from it will be very lucky, as it is a life-changing opportunity. I know because I too benefited from the last large scaled regularisation program back in 2005. I left Nepal in 2000 and went to Germany, Belgium, France before landing in Spain. Things were pretty bad in Nepal back then with the Maoist conflict and strikes.&nbsp; Our business was impacted. There was not much hope. When you leave Nepal, you want to make something of yourself and support your family back home. But you have to dream in phases.&nbsp; The first dream is to get ‘kagaj’ or a temporary residence card (TRC). Only then can you focus on your actual dreams. Whether it was because the countries I traveled were not a good fit or because the chances of getting the document was low, I kept country hopping until I reached Spain in 2004. I have not left since.&nbsp; In Spain, I felt at home. The European dream had brought me here, salaries were higher than Gulf which I thought was too strict. Then there was the possibility of traveling to seven European countries back then with the Schengen visa.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260210150228_b57c873801361755cf25048f294b2d1d0574796ef70a0e270531ced2508f64ed.jpg" data-media-id="editor_0" data-image-id="20260210150228_b57c873801361755cf25048f294b2d1d0574796ef70a0e270531ced2508f64ed" data-rendition-name="original" width="2048" height="1536" loading="lazy" alt="Nepalis in Spain"> </figure>  But mostly, I just wanted a secure life for me and my family. What I valued the most about Europe was free healthcare and education. This is very important because in other parts of the world including Nepal, people from our background are just one small disease away from losing half our capital and we spend a significant amount of money on educational expenses. Nepali dais back then told me it would be best to go to either Italy, Spain or Portugal if we wanted to establish ourselves as paper work was relatively easier there than in other European countries. My initial days in Spain without the paper work were difficult. Not concerns about being raided or deported because if we had our apartment, even police let us be.&nbsp; But it was because of unfair pay. You could not go home. It made you tense and irritable. It affects your mental well-being. Some are smart enough to invest time in skills as they wait that will prove useful. Others get depressed. The main reason we migrate is to support our family and when you cannot do it properly and are uncertain about when things will get better, it bothers you. This happened to me too, sometimes I would be staring at the TV and would flinch when other Nepalis asked me what is wrong, and why I look so lost.&nbsp; The newspaper Canarias also interviewed us about our conditions (pictured). I had not gone home since five years, and there was no way to. There was no social media like now to talk to family. Calling home from booths was expensive, just once every three weeks. You did not talk. It was just to hear voices, pass the phone around to say a quick hello.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260210150232_8af8b6f6acb1252e0d67a43556e21ff8074543acfcc318c985816479c6146fd9.jpg" data-media-id="editor_1" data-image-id="20260210150232_8af8b6f6acb1252e0d67a43556e21ff8074543acfcc318c985816479c6146fd9" data-rendition-name="original" width="2048" height="1536" loading="lazy" alt="Nepalis in Spain"> </figure>  When you are undocumented, you don’t get fair wages. But you make that sacrifice because my bigger goal was to establish myself and in the meantime, to support family with whatever I could earn with my wages. All we could do was wait for a regularisation program to open. When Spain initiated such a program in 2005, we were so relieved. We were relatively new so did not understand the language. Other Nepalis guided us and were well-versed in the latest updates via news and consultation with immigration lawyers which they would pass on to us. This time, the regularisation program will come through within 30 days, but back then it took time. I had to wait for nine months. Those nine months felt like nine years. I would keep visiting the cyber café to check my online status. When friends got their notification, I would get even more anxious and wonder if I would get rejected. Maybe today? Maybe tomorrow? It was a long wait. I wanted to know what it felt like to hold the card in my hand. Then I could hold my five-year-old baby back in Nepal in my hand. She was born after I left for Europe. When I finally got it after nine months, I could not be happier. I informed my family. I thanked God. Even when I was having food, I would put the card right in front of me on my table. Food never tasted better, I would eat twice the amount with happiness. It was a different kind of elation — it opened the doors for me to think about my dreams, my targets and how to realise them.&nbsp; There was no stopping me now, I was going to go far. But mostly, I could go home. In that flight back to Nepal after six years my heart swelled and I knelt on the tarmac to pay respect to my motherland. The minute I saw my parents, I touched their feet for blessings. My wife and I cried. My daughter was scared of me and would run away - it took some time for her to get comfortable with my presence. I still break down when I think about it.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260210150232_beba1745d845e219eaeaaf1bc33e0a02c07748ebd80bcc74a467c933cc5602e3.jpg" data-media-id="editor_2" data-image-id="20260210150232_beba1745d845e219eaeaaf1bc33e0a02c07748ebd80bcc74a467c933cc5602e3" data-rendition-name="original" width="2048" height="1536" loading="lazy" alt="Nepalis in Spain"> </figure>  A few trips to Nepal later, I brought my family to Spain after I had fulfilled various rules for family migration. As expenses rise for a migrant, the choice is to either work extra hours or start your own business. Since I got the TRC, I have done it all: various jobs, businesses from selling handicraft from India to a cyber cafe, and the restaurant business.&nbsp; As an entrepreneur, I have seen highs when I could open a second restaurant branch or earn enough to buy an apartment. I have seen lows where I closed down businesses and sold apartment. I have gone from an entrepreneur to a wage job to recoup the losses I made by working extra hours. When I felt comfortable enough, I have gone back to starting a new business.&nbsp; I have met wonderful people who have supported me when I started my business either by providing me financial help or as business partners. I have been duped by my own business partner or worked with colleagues who did not want me to prosper. I now run a handicraft shop, an Indian restaurant and a café. The struggle never ends. There are many Nepalis like me who are running businesses here and have bought property. Back in 2004, Nepalis were mostly working in jobs and for a slight salary bump, we would keep switching jobs. Now, they run their own businesses and have bought property. The power of honesty and hard work that Nepalis are known for helps in businesses. Malaga is incredibly beautiful and reminds me of Thamel. The brilliant weather and beautiful beaches attracts tourists. The houses are kept small to preserve the culture and civilisation.&nbsp; I miss Nepal. I especially miss my father who passed in 2020. He was my biggest cheerleader as I struggled thousands of miles away, and always reminded me that he was here for back support. My mother reminds me to keep at it without worrying.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260210150232_2cea4b66ad47c15859980c696446362603b10981a1b471ab5e076a22a58727b1.jpg" data-media-id="editor_3" data-image-id="20260210150232_2cea4b66ad47c15859980c696446362603b10981a1b471ab5e076a22a58727b1" data-rendition-name="original" width="2077" height="1433" loading="lazy" alt="Nepalis in Spain"> </figure>  Sometimes I ask myself, what did I leave behind to earn money and provide a good life to my family? I regret not getting to spend more time with my father before he died. I am not sure what would have happened if I had not left Nepal, but I would have figured something out. Whatever determination I have shown in Spain to navigate my life here, I would have used it back home, too.&nbsp; I have missed important milestones like weddings, births, deaths and festivals. I have missed it all. Of my three daughters I missed the births of the first two in Nepal. I was only there for my youngest’s birth, in Spain.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260210150232_a6295e4f58d73e5b340235caf916b98eba785e3559341ea4622629c262e7b1a4.jpg" data-media-id="editor_4" data-image-id="20260210150232_a6295e4f58d73e5b340235caf916b98eba785e3559341ea4622629c262e7b1a4" data-rendition-name="original" width="1630" height="1125" loading="lazy" alt="Nepalis in Spain"> </figure>  The regularisation program from 2005 that allowed me to raise the living standards of a number of living around me and reunite with my family. This platform was life changing for me, and my loved ones. There are many Nepalis who will be applying for the 2026 regularisation program if they meet the criteria like presence in the country for at least five months before December 31, 2025. Other European countries have tightened their policies so many Nepalis are in Spain. This is a great opportunity for Nepalis. There are many more undocumented workers than the available quota, a majority from Latin America in Spain who want to benefit. The Nepali diaspora is helping raise awareness and provide accurate information about the processes so they can benefit and no one is left out. I do whatever I can to support young Nepalis because I was in the same position 20 years ago.

renal-failure

Dirty, Dangerous, Difficult ... and Dehydrating

Saving kidneys to save Nepal

Map land

How I got my NRN Citizenship in Nepal

Fake rescues hurt Himalayan tourism

Dreaming in phases