<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114121112/637222d29c7e80680e0c0318jpeg.jpg" alt="" width="1400" height="905"/><figcaption>Photo: NEPALI TIMES ARCHIVE</figcaption></figure>Every year, half a million Nepalis fall below the poverty line paying for expensive medical care. Another three million face financial burden, unable to pay hospital bills even after selling their assets. This is over 10% of Nepal’s population.Nepal might have taken dramatic strides in reducing maternal mortality and childhood malnutrition in the last decades, but it is lagging behind in assuring accessible and affordable healthcare for its people.This is a crime, it goes against the Constitution which guarantees basic health care for all Nepalis. Like other social sectors including education, healthcare is either over-commercialised or offers substandard service.Public health is just not the priority of the government, especially when it comes to the poorest and most neglected sections of society. The state’s investment in healthcare is inadequate, and the budget allocation for the health sector is considerably lower than the global average of 10% of GDP, and is less than most developing countries.Read more: <a href="https://www.nepalitimes.com/here-now/grassroots-democracy-promotes-good-health/">Grassroots democracy promotes good health</a>, Sagar BudhathokiEven the budget that is set aside for healthcare is mostly spent on shoddy infrastructure, or procuring unnecessary and expensive equipment that is never used. There is little left for trained medical personnel and retaining them in remote area hospitals.Nepalis are sick because they are poor, and they are getting poorer because they are sicker. Most families that cannot afford treatment in private institutions have to sell property or borrow from loan sharks to pay medical bills.Private hospitals and clinics operate on free market principles, and need a return on investment. The most lucrative business in Nepal today is medical education, and the sky high fees in those colleges perpetuate the cycle of over-priced medical treatment.Read more: <a href="https://archive.nepalitimes.com/news.php?id=18362#.YrLw3-xBzDI">Do hospitals have to be so expensive?</a> Elipha PradhanangaHealthcare should not be guided by the free market, and as long as the state does not take responsibility for the wellbeing of its citizens we will never achieve equity.Medical care cannot be a commodity, patients are not customers.Primary health care (PCH) is free in government hospitals in Nepal, and is paid for through taxes. Specialised medical care is best covered by insurance so the cost is not passed on to patients and their families. But in Nepal, primary health care is too basic, government hospitals are crowded and understaffed, and private hospitals are out of reach of most.A welfare state with a social safety net pays for free healthcare through taxes, or insurance. Tax revenue goes for other sectors besides health, but medical insurance is targeted for specifically for health.Countries like Bhutan, Cuba and Sri Lanka show that it is indeed possible to achieve free universal healthcare. Nepal itself has public-private partnership models like Bayalpata Hospital. Replicating these examples requires political will, and a national vision.Read more: <a href="https://www.nepalitimes.com/banner/this-is-how-to-upgrade-nepals-rural-health/">This is how to upgrade Nepal’s rural health</a>, Sewa BhattaraiOur salvation may lie in national health insurance that is mandatory and where the premium is based on a family’s capacity to pay. Nepal introduced its national insurance scheme in 2017, and the premium is now Rs3,500 per year per family for a benefit package of Rs100,000. But this does not even pay for an ambulance to a city hospital.Late reimbursement to care providers is chronic, and hospitals now want to pull out from the national insurance program. Patients are cannot access timely treatment, and  are dropping out.To correct this mistake, the government is making another blunder: hand over management of health insurance programs to the private sector.The state is giving up on health insurance without even trying, abandoning citizens and leaving them at the mercy of profiteers.Letting the private sector manage health insurance defeats its very purpose: providing equitable and affordable medical care for those most in need and to prevent them from falling into the poverty trap.A better alternative is to work within the existing health insurance program by upgrading its features including the revaluation of the premium and benefits, bringing in private institutions for research and technical know-how, and digitisation of reimbursement for care providers.There are ways the Nepali state can fulfil its constitutional obligation to ensure healthcare for all, and deliver on promises not kept. It just has not tried hard enough.Read more: <a href="https://www.nepalitimes.com/opinion/is-free-health-care-possible-in-nepal/">Is free health care possible in Nepal?</a> S P KalauneeSonia Awale

Sonia Awale

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In a healthy state

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221104141144/6365179b9c7e80680e02c286jpeg.jpg" alt="" width="1400" height="905"/><figcaption>IN GOOD HANDS: Community Health Worker Bhajan Kunwar checks patient Namsara Tamrakar at her home in Chandika village of Achham. Pics: Marty Logan and Srawan Shrestha</figcaption></figure>Rounding a steep curve on the road to the district capital of Mangalsen a startling set of modular structures comes into view. The modern buildings look out of place in this scenic, but underserved, region of western Nepal.The construction is part of a $4 million expansion of <a href="http://archive.nepalitimes.com/news.php?id=17650#.WreWXNRua70">Bayalpata Hospital</a>, a unique medical facility that is a model for public-private partnership to improve medical care in Nepal’s remote interior.Inside the ward, orthopaedic surgeon Mandeep Pathak is examining an elderly man with a swollen knee. Clearly visible on an x-ray monitor is a short pin inserted by a general practitioner a few weeks ago, after the patient fell and broke his kneecap.https://www.youtube.com/watch?v=SuWvlDGasEAIn the same room with the surgeon today is Community Medical Assistant (CMA) Khagendra Pant, who is wrapping plaster around the arm of a small boy. Thanks to training at the hospital, Pant was able to diagnose the boy’s injury as a clean fracture that did not require an operation.Such training means Bayalpata now has to refer just 10-20% of orthopaedic cases to hospitals in Dhangadi and Nepalganj, compared to nearly 70% two years ago.“I am proud to say that all the basic trauma care can now be done by general practitioners. Plus they can diagnose cases and decide which need to be referred to outside centres,” says Pathak.Training is integral to Bayalpata’s mission, says Director of Medical Education <a href="http://archive.nepalitimes.com/regular-columns/GUEST-COLUMN/Saving-one-mother-at-a-time,816">Bikash Gauchan</a>: his hospital has continuing medical education for clinicians, and on the job training for future nurses and other staff. General practitioners from various centres learn rural surgery at Bayalpata while mid-level staff come to improve their clinical knowledge.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221104141144/6365179e9c7e80680e02c287jpeg.jpg" alt="" width="1400" height="650"><figcaption> </figcaption></figure>For some <a href="http://archive.nepalitimes.com/article/nation/aim-for-fewer-patients-in-achham-possible-hospital,2022">patients who travel many days</a> to reach Bayalpata, access to basic surgery here means avoiding an expensive trip to the city. People whose limbs were fractured as long as three years ago delayed treatment until surgery was available at the hospital because they couldn’t afford the trip to a city hospital.Treatment at Bayalpata and at another hospital in Dolakha run by the non-profit Possible, is <a href="http://archive.nepalitimes.com/article/nation/Nation-free-for-all-healthcare,491#.UbrA4ueLA1s">free</a>. The group believes healthcare is a fundamental human right protected by Nepal’s Constitution, and should have no cost at point of delivery.Possible is funded by donations and Nepal government grants, which will grow as its hospitals attain clinical targets, such as the percentage of women who give birth in a facility with a trained clinician. Operating expenses last year were $4.8 million, of which 9% came from the government.Arrivals are registered in the hospital’s Electronic Health Record (EHR), which puts patients’ information at the fingertips of clinicians throughout the hospital, and eliminates bulky paper records.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221104141144/636517a19c7e80680e02c288jpeg.jpg" alt="" width="1400" height="823"><figcaption> </figcaption></figure>One patient already on the EHR is Namsara Tamrakar. Sitting cross-legged on a raised, wooden platform outside her home in Chandika village (left), the elderly woman shows visiting hospital staff that she knows how to use her inhaler, but it is empty.Three years ago, a doctor at Bayalpata diagnosed her with chronic obstructive pulmonary disease and prescribed medicine via inhaler. Now Community Health Worker Bhajan Kunwar (see box, left) visits regularly to follow up. Like others, Tamrakar’s house has a small blue metal tag on an outside wall with a unique household ID. The houses are also geo-tagged.Kunwar’s visit is guided by CommCare, a software developed by Dimagi and customised by Possible that includes counselling information and checklists for each patient. Plans are to integrate CommCare with the EHR so that field followups are immediately reflected in the hospital’s system. Eventually, Bayalpata’s EHR will be linked to a national data system.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221104141144/636517a49c7e80680e02c289jpeg.jpg" alt="" width="1400" height="1024"><figcaption> </figcaption></figure>Kunwar takes Tamrakar’s blood pressure: 120 by 80. The woman is happy to hear the news and to see Kunwar again: “She comes, does a check-up, and tells me what sickness I have, and if it is getting better or worse. She insists I go to Bayalpata for a follow-up.”The hospital's <a href="http://archive.nepalitimes.com/article/nation/Nation-Crowdfund-globally-act-locally,490">community health program</a> focuses on maternal and child health as well as non-communicable diseases such as hypertension, diabetes and respiratory ailments. Possible employs 56 community health workers looking after more than 80,000 people in Achham and Dolakha. It is planning to more than quadruple that number next year.Bayalpata Hospital started in 2009, when the group <a href="http://archive.nepalitimes.com/article/nation/Crowding-it-out,1003">Nyaya Health</a> (now Possible) took over an abandoned government facility. Then it had five beds and treated up to 12,000 patients a year. Last year, Possible saw 86,000 patients at Bayalpata: the goal is to treat 150,000 people annually after the new wards, emergency room, administration building, a dormitory and remaining small houses for on-call staff are added.“Our integrated, hospital-to-home approach will be a model for Nepal, and beyond,” explains Gauchan, “and we will be proving that in a resource-limited setting, health care expansion, providing universal health coverage to people is possible.”But is the Bayalpata model really replicable? Skeptics say that two hospitals could have been built for the cost of the new buildings, which feature rammed earth technology, solar energy and rainwater collection, and that only substantial donor support made the expansion possible.Gauchan admits that the initial investment may seem high but says it will be more cost-effective in the long run.He adds: “The existing infrastructure for rural health care is way less than the minimum needed to address the emerging burden of non-communicable diseases and road accidents as well as infectious diseases. That is why we are investing in a very robust infrastructure.”<h2>Community spirit</h2>In 2011, Bhajan Kunwar (pictured above) was living an “Ok” life with her husband Purna and children in Bhageswor village of Achham when her sister-in-law Shavitra asked for a favour.Shavitra had been hearing rumours that her husband, who was working in India, was having an affair or had even remarried. Would Purna take her to India to find out? Purna agreed, and brother and sister set off with a friend. En route, Purna received a phone call from Shavitra’s husband warning them not to come, or there would be trouble.They continued anyway, and after crossing the border got on a train. That night, a group of men, perhaps including police, boarded the train and took Purna away. He later called Shavitra’s husband to say he had been kidnapped and would be killed unless help came quickly.Police found Purna’s body the next morning, on the roadside in Ahmednagar, east of Mumbai. It looked like he had been run over, but Bhajan believes he was murdered.Widowed at 25 and with two small children, Bhajan spent the mourning period worrying about how she would afford to send the children to school, and if her mother-in-law and community would accept her becoming the breadwinner for her husband’s four younger brothers and sisters and their families. (Her father-in-law had died earlier).That month, Bayalpata Hospital had a vacancy for a community health worker for the area. Bhajan was hired and six years later, still visits on foot the more than 700 households in her catchment area, checking that patients are taking their medicines, and much more (see main article).“This hospital made me strong,” she tells us. "Before I didn’t know anyone in my village and I didn’t know so many things.” Now with a college certificate, Bhajan advises young women to get educated before they get married. “I tell them ‘if I can do it, you can do it too’. I believe in myself and don’t care what others say about me. If you are true and honest, no harm will come to you.”Bhajan says she will never forget her husband. “But I have to live for my children, and control my mind and my heart. If I am strong, they can have a regular life. The hospital is now my husband, I cannot imagine leaving it.”Marty Logan in Achham<h2>Operating remotely</h2>When nine-year-old Samir Tamang was bitten by a dog on his way to school in Rayale village of Kavre last week, he had to take a two-and-a-half hour long bus ride to Kathmandu with his grandfather Suk Bahadur Tamang, for a rabies vaccination at Teku Hospital.Samir missed school and his grandfather, who works as a driver in Kathmandu, had to ask for leave from his employers.“We are relatively close to the capital, but imagine what it must be like for people living in remote parts of Nepal where there are no roads,” says Suk Bahadur.Indeed, despite the spread of basic health care in Nepal, emergency treatment and procedures like mending broken bones or caesarean sections are not yet available in rural areas. This means families have to sell property or borrow from moneylenders to be able to afford treatment in the cities. Studies have shown that many Nepali families are driven to poverty if relatives are referred to private hospitals.Unmet surgical needs in remote districts remain a major public health issue in Nepal, according to a recent study in 39 remote area hospitals commissioned by the Nick Simons Institute (NSI).One day this week, an informal survey of patients at the government-run Bir and Teaching Hospitals in Kathmandu showed that a majority of the patients were from remote districts, some as far away as Piuthan and Jajarkot.The NSI study shows that except for caesarean sections in Dolakha, Lamjung and Panchthar, very few government hospitals elsewhere were able to do simple operations of the abdominal cavity, or even mend broken bones.Nepal’s surgery rate falls well below the Lancet Commission target of 5,000 operations per 100,000 population. If the goal is to have a surgical facility within two-hour travel distance for patients, at present only a third of the population can reach an orthopaedic surgeon, and only 22% have access to abdominal surgery.However, the survey reaffirms that the presence of a medical general practitioner (MDGPs who can perform caesarean sections and other relatively simple surgical procedures) can change this. District hospitals with resident MDGPs can eliminate the need for patients to make expensive and extended trips to the cities for treatment.The minimum personnel at a district hospital should include an MDGP, obstretrics doctor, anaesthesia assistant, staff nurse and biomedical technician. However, Nepal’s density of hospitals with such staffing is very low (0.4-3.1 per 100,000) as against the Lancet Commission target of 20 per 100,000 population.“In the long run we need specialists but placing three of them in each district hospital will take a long time. For the next 5-10 years, MDGPs will be the answer to solve surgical problems throughout the country,” explains Anil Shrestha, NSI’s Executive Director.The study recommends an MDGP-led generalist surgical team with proper staff, drugs and equipment to upgrade emergency surgical care in all district hospitals.Adds Shrestha: “The government has to strengthen strategically located district hospitals and make them functional to take care of surgical needs throughout the year. It is entirely possible to do.”Sonia Awale in KavreRead also:<a href="https://www.nepalitimes.com/editorial/poor-health/">Poor health</a>, Editorial <a href="http://archive.nepalitimes.com/news.php?id=17650#.Wrydky5ubIV">Resurrection Accham</a>,  Paavan Mathema<a href="http://archive.nepalitimes.com/article/nation/aim-for-fewer-patients-in-achham-possible-hospital,2022">Boy walked eight days to treat broken arm</a>,  Tsering Dolker Gurung<a href="http://archive.nepalitimes.com/article/nation/Nation-free-for-all-healthcare,491#.UbrA4ueLA1s">Free-for-all health</a>,  Duncan Maru and Roshan Bista

Marty Logan

State of the art rural hospital

Sometimes, we need to take a step back to realise what a tectonic movement Nepali politics witnessed this month.
In a region and world ruled by elected authoritarians, Nepalis &nbsp;went to the ballot box freely to express a collective will for change.
These faces in this group photo of the RSP’s 180 freshly-minted MPs at the ballroom of the Royal Tulip Hotel on Wednesday is symbolic of what Nepal has come through.&nbsp;
The ship of state righted itself after the September Storm, installing an interim government that held an election within six months in which voters banished obsolete politicians and their parties into oblivion.
Nepalis, fed up with the inept kakistocracy of the past three decades, took the country into a post-ideological phase — replacing Marxists, Maoists and monarchists &nbsp;with a belief in a new governing culture that rewards delivery and accountability. And they have trusted the RSP to carry it through.
Nepal’s history has never been linear, it jerks ahead in lurches. The polity also tends to take one step forward and two steps back, so the public’s great expectations is tempered by a sense of cautious optimism and guarded pessimism.
This could be the great leap forward that Nepalis have waited for and deserve, but it could also be a Gramscian interregnum in which the old is dead and the new is not yet born. We will have to wait to see whether this transitional period will also see ‘morbid symptoms’.
As disruptor-in-chief, it was the Balendra Shah ‘wave’ or ‘craze’ that propelled the RSP to power. The former Kathmandu mayor needed a party platform, and the RSP’s tainted leader Rabi Lamichhane required a booster. Nepal's voters were looking for a saviour.
Personality-wise Shah and Lamichhane are poles apart: one is Type B and the other Type A. One is enigmatic, the other phlegmatic. But yin and yang do also tend to complement each other.&nbsp;
Kathmandu’s chattering class is already making self-fulfilling prophecies about the two falling out, and are fishing for hints that they already have. Shah’s absence from the RSP’s orientation this week was taken as a clue.&nbsp;
Closing the two-day tutorial on Wednesday, Lamichhane delivered a fiery 30-minute speech that laid out the RSP’s main agenda: to function differently from the old parties, serve the people, avoid middlemen, become true lawmakers without taking the law into their own hands.&nbsp;
“The old political parties contributed to history, we will build the future with a new political contract with citizens,” he said, trying to rise over past controversies and his abrasive rhetoric to sound statesmanlike.&nbsp;
GIVE AND TAKE
Lamichhane is said to be in touch with the reclusive Shah to announce a compact cabinet next week. Its composition will be an indication of how much give-and-take there was, and whether the criteria for selecting ministers is competence or loyalty.
Will RSP ministers behave like rulers or service providers? The new government will dive right into the economic fallout of the West Asia war with soaring fuel &nbsp;prices, inflation and uncertainty about remittance inflows.
On Thursday, Gagan Thapa resigned as NC chair, taking moral responsibility for the party’s election loss. The UML’s unrepentant K P Oli does not share the same sentiment about who is responsible for his own party’s historic downfall.&nbsp;
NCP chair Pushpa Kamal Dahal, who was luckier than his cross-party cohort, is now a comparative relic in a Parliament largely comprised of freshmen and sophomore lawmakers.
But the NC, UML and NCP still control provincial and most municipal governments. The old parties could try to make things difficult for the RSP at the centre, but it is also an opportunity for them to clean up their act ahead of local elections next year.&nbsp;
Another test for the RSP will be dealing with a heavily-politicised klepto-bureaucracy which has to frontend its policy decisions. &nbsp;

People’s power

This week, the RSP held a two-day closed orientation camp for its newly elected members of Parliament. The party has also decided to assign parliamentary and Cabinet roles to leaders only after the new MPs are sworn in on 28 March.&nbsp;
This means the new prime minister and his cabinet of 15 ministers are likely to be installed closer to the Nepali New Year, and the expectation is that it will also usher in a new era of governance and politics in Nepal.&nbsp;
Between now and then, there is much speculation regarding who will become new ministers and from which camp—Balendra Shah's or Rabi Lamichanne’s. Meanwhile, the final argument in the petition against the Rabi Lamichanne case revision is set for Thursday, with a verdict expected on the same day.
“In the past, parties did anything to form coalitions and to keep them from splitting ministries and appointing anyone they wanted to, even going against the spirit of the Constitution, but the RSP doesn’t need to partake in any such activities,” says political analyst Indra Adhikari.
Adhikari notes that governance failures in the past was often the result of coalition governments formed through political bargaining that meant the primary party often had to compromise on their agenda.&nbsp;
“But nothing is stopping the party from fulfilling its election manifesto,” she says. “And if they aren’t able to deliver, we know Nepalis are prone to protests, so another revolt is also a possibility.”
Journalist and author Mohan Mainali agrees that the everyday Parliamentary proceedings should go smoothly for new government because of their majority.&nbsp;
But there are questions as to what a near two-thirds majority allows the RSP to achieve in Parliament. Its 182 seats in the Lower House allows the party to enact and amend laws without hurdles and bypass Upper House’s request for Bill revisions. But the RSP has no presence in the National Assembly, and that means that its majority in the Lower House is not enough to amend the Constitution.&nbsp;
“The Constitution poses no obstacles for the RSP to work on improving governance, development and delivery,” says Mainali. &nbsp;“If they do show some performance, it will be easier for them to go into the next election and ask for a two-thirds majority to also amend the constitution,” he adds.
The last coalition government of the UML and Nepali Congress before the GenZ protests had been built upon a primary agreement to make amendments to the Constitution. So, depending on the nature of amendments, the RSP might find some support within the National Assembly at a time when some of the older parties, such as the Nepali Congress, have committed to supporting the new government as well as internal party reforms.
“What we need is a structural overhaul, from our laws and foreign policy to economy and security apparatus, and for this the RSP needs to champion collaboration and consultation for the sake of nation building,” says Indra Adhikari. “So it all comes down to the understanding and judgment of the RSP’s leadership. If they try to go at it alone, it will lead nowhere.”
To be sure, the provincial government could also clean up their act before the next local and provincial elections, which would help the older parties to regain some of their lost footing and rebuild trust.
As it stands, RSP lawmakers will also have to learn to work with each other. Mainali notes that the RSP not being bound by one clear ideology might lead to future problems, including the rumoured animosity between party president Rabi Lamichhane and prime minister-in-waiting Balendra Shah.
“Parties that came before the RSP had an ideology, whether they followed them or not, but the RSP is made of different kinds of people,” says Mainali. “If they are not motivated by a common goal of achieving something tangible in the next five years, it might be difficult for them to stay together.”
Adds Adhikari: “Balendra and Rabi don’t seem to be compatible. Rabi has already failed when it comes to the matters of governance, and Balendra won’t carry that burden. Additionally, there is a struggle between the two in terms of party hierarchy.”
Speaking at the closing of the two-day orientation, from which Balendra Shah was noticably absent, Rabi Lamichanne said that the RSP’s image as intolerant needs to be changed, and that the country is not heading towards totalitarianism but is in the hands of good, new people.
Regardless of the assurance, the general public has seen Balendra Shah and Lamichanne’s disposition in the last several years, and analysts are worried that their personalities and ambition might lead to an environment of increased intolerance.&nbsp;
As it stands in absence of a strong opposition, the responsibility falls on the media and the civil society to be the watchdog and play an effective check and balance role.&nbsp;
“Seeing how Balendra has ignored the media so far and Rabi has made inflammatory remarks in the past, they are probably more intolerant than the likes of Trump and Modi,” says Mainali. He notes that the party does not just have technical human resource and cyber army but a large number of dedicated supporters.&nbsp;
The media must thus continue to build trust by highlighting good work, educating the public on the importance of impartial journalism in democracy and debate any Bill purposed in Parliament, Mainali adds.&nbsp;
Says Adhikari: “The media should praise the government when they do well, motivate them, but it should also point out wrongdoings without fear, and provide recommendations to do better. Otherwise, absolute power corrupts absolutely, which we have seen happen happen in America with Trump and in India with Modi, where extremism has taken over and democracy has been curtailed.”

Balancing act

The sense of sight is front, centre, and everywhere else as hundreds of eyes follow visitors while they move from one painting to the next at Nikhil Bahadur Shakya’s ongoing exhibition at Siddhartha Art Gallery. Shakya has used blank canvases as well as partially-done thangka and paintings as a base for more than 50 works on display. The exhibit takes visitors beyond the physical world into a surreal spiritual realm. Shakya strips the human body down to muscle, tendon, networks of nerves, and skeleton. But all the while, eyes are a constant presence.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026031708034_dddbfedc57433dc528fbf032642abea4ee67e63875091b06a7804cecdc7716cf.jpg" data-media-id="editor_0" data-image-id="2026031708034_dddbfedc57433dc528fbf032642abea4ee67e63875091b06a7804cecdc7716cf" data-rendition-name="original" width="1080" height="720" loading="lazy" alt="Nikhil Bahadur Shakya"> <figcaption>Artist Nikhil Bahadur Shakya with a visitor.</figcaption> </figure>  The central theme is self-reflection and the journey from one’s outward to inward self, and the works offer a glimpse into the artist’s world of mindfulness.&nbsp; Shakya grew up watching his artisan grandfather design jewellery, which he says cultivated in him an interest for art. During the Covid-19 pandemic, confronted by the fragility of life and the stark reality of death, his art took an introspective turn. The paintings have splashes of neon yellow, pink, red, orange, green, and gold, and Shakya combines them with black and white to create the human body, sunflowers, geometrical shapes, and the cosmos — turning these motifs into elements of devotion and spirituality. In Wheel of Life, Shakya adds to an incomplete thangka, contrasting traditional Buddhist devotional imagery with contemporary mosaic art to create a demon holding on to a wheel with a yin and yang symbol.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026031708034_f2a8e10c73aa83a67e5de06a3f0acff9aa35c1cda278b36fed76ed03e71a7014.jpg" data-media-id="editor_1" data-image-id="2026031708034_f2a8e10c73aa83a67e5de06a3f0acff9aa35c1cda278b36fed76ed03e71a7014" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Nikhil Bahadur Shakya"> <figcaption>Wheel of Life (centre)</figcaption> </figure>  “I wanted to reflect the elements of life and the balance of good and bad in this painting,” explains Shakya. “I took a lot of time to complete this particular piece, but it felt as though my vision flowed out of the brush onto the canvas.” The neon colours used means that visitors can see his artwork under blue light as well, giving viewers a chance to look at a single artwork from two different perspectives. His Sunflower series draws from a field of blossoms, and the eyes stare back at visitors in an almost-hypnotic gaze. In An Ancestral Visit, Shakya goes transcendental to depict the connection of living beings to their forebears.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026031708038_0fbe465b3af872d04f699030ba093d97aad182221730aef535dbf7d059fb57cf.jpg" data-media-id="editor_2" data-image-id="2026031708038_0fbe465b3af872d04f699030ba093d97aad182221730aef535dbf7d059fb57cf" data-rendition-name="original" width="1500" height="1431" loading="lazy" alt="sunflower painting"> </figure>  “In my father’s last days, he was unwell and often unable to eat, it left his body very frail,” explains Shakya. “An Ancestral Visit was inspired by a dream in which I saw my father as his former healthy self. That dream made me feel deeply connected to my ancestors.” In another one of his works titled Devotion, a woman prays to a Shivalinga against a background of red-and-white stripes, which was inspired by the tradition of women being at the forefront during religious and spiritual ceremonies.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026031708038_75e30a4fd339257fbc108e3a326f732fd33d25af0428add0d305b8b7824c558c.jpg" data-media-id="editor_3" data-image-id="2026031708038_75e30a4fd339257fbc108e3a326f732fd33d25af0428add0d305b8b7824c558c" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="devotion"> <figcaption>Devotion</figcaption> </figure>  In Sunyata, which shows a skeletal figure meditating as they are surrounded by flames, Shakya captures the chaos of the outside world with peace of the inner self. Shakya was compelled to create Sunyata when he saw a monk, his body thin and face gaunt, meditating peacefully. “Many viewers might find the painting frightening, but when they take it home, I think it will give them strength whenever they feel like they need it,” says Shakya. The exhibit also includes a gigantic painting of Masan Bhairav spread across two canvases, capturing the majesty of the original work housed at Banepa’s Chandeswori Temple. Shakya met the artist who painted it, and asked to reproduce it.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026031708034_0216eac587827b02982f5addbd67c6f852fd7f9f47b477267ea7430d5f862a9b.jpg" data-media-id="editor_4" data-image-id="2026031708034_0216eac587827b02982f5addbd67c6f852fd7f9f47b477267ea7430d5f862a9b" data-rendition-name="original" width="1500" height="1030" loading="lazy" alt="art review"> </figure>  Geometric figures are another recurring motif on Shakya’s creations, which he says were inspired by mathematics textbooks from his school days. He says, “Art channels the strength of our minds and brings about change in our lives. My paintings reflect the fact that we are all made up of some madness, magic, and love.” Journey to a Visionary Artworld by Nikhil Bahadur Shakya Siddhartha Art Gallery, Baber Mahal Till 6 April 11AM-5PM

In the mind's eye

Deadly floods two years ago along the southern fringes of Kathmandu Valley killed 200 people. Climate change was blamed, but the destruction was magnified by quarries and sand mining owned by local politicians and crony contractors. Disaster mitigation and environmental risk was not a priority for any of the political parties that ran and won Nepal’s election last week. Although the RSP has a supermajority, rural municipalities that grant mining contracts are still ruled by the established parties that supply aggregates and sand to feed &nbsp;Kathmandu’s construction boom. Here in Lele Valley, residents are worried about another monsoon season that will start in June and fear more floods bringing unmanaged gravel from quarries down the Nallu River.&nbsp; The house of Sanumaya Nagarkoti, 65, and ten neighbours were washed away by the flood on the night of 28 September 2024. She and her husband petitioned the ward and municipal council to remove the crushers but no one listened. The slopes above are scarred by landslides from two years ago, and the banks of the river are strewn with bounders the size of cars that were brought down. “We live in constant fear of landslides,” says Chakra Nagarkoti, “the heavy crusher machinery and tipper trucks also constantly shake the house.”&nbsp; Google Earth images show that 24.6 hectares of mountain flanks have been excavated since 2010, and despite the disaster no lessons have been learnt.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260319090348_bdce7f17500eadac0ce0814c32c2b4190d01325976fd4d29db9985148459c0bc.jpg" data-media-id="editor_0" data-image-id="20260319090348_bdce7f17500eadac0ce0814c32c2b4190d01325976fd4d29db9985148459c0bc" data-rendition-name="original" width="1500" height="907" loading="lazy" alt="Lele"> <figcaption>Photo: GOOGLE EARTH</figcaption> </figure>  The RSP might have got a near two-thirds majority in Parliament but decision-making at the community level is controlled by politicians in cahoots with contractors.&nbsp; Along the Mahadev Khola, the Department of Mines cancelled excavation permits for crushers citing flood and landslide risk. Yet there are still 21 contractors mining stones and sand.&nbsp; Nearby Godavari Municipality also instructed operators who had not renewed permits to close down. No action was taken. One of them is Vinayak Multipurpose which delivers aggregate and stones for United Cement. Local ward chair Milan Silwal, has a stake in Vinayak and locals accuse him of taking the side of industry.&nbsp; Another slope is being gouged out near Mahadev Khola, and comparing satellite imagery from 2010 shows that the scar on the mountain is now five times bigger.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260319090348_21a8f7f7f9d6cc784c35719da737b20283f934bbe16c9de971d91bf01012499a.jpg" data-media-id="editor_1" data-image-id="20260319090348_21a8f7f7f9d6cc784c35719da737b20283f934bbe16c9de971d91bf01012499a" data-rendition-name="original" width="1500" height="1125" loading="lazy" alt="Lele"> <figcaption>United Cement operating near Mahadev Khola. Photo: ARCHANA DARJI</figcaption> </figure>  Nearby stands the lone house of 55-year-old Sabina Tamang, who lives with her husband and daughter. Due to the sound of the stone-breakers, they cannot hear each other speak. “Last year, a landslide destroyed our cowshed and latrine,” she says. “Next it is going to be our home.”&nbsp; DRY SPRINGS Lele gets its water from several perennial springs which have gone dry in recent years. One of them is near where the cement factory quarries limestone. “We hardly get any water, and the little that does flow is murky and red,” says local resident Rajesh Shrestha. A parliamentary committee directive ordered excavation to stop 15 years ago after a similar flood to the one in 2024.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260319090352_af7da754299116578cc1dd91d5318ec337b69e74b0676599260b7c57c6ec6fd7.png" data-media-id="editor_2" data-image-id="20260319090352_af7da754299116578cc1dd91d5318ec337b69e74b0676599260b7c57c6ec6fd7" data-rendition-name="original" width="1440" height="494" loading="lazy" alt="Lele"> <figcaption>Lele over the years. Photo: GOOGLE EARTH</figcaption> </figure>  United Cement’s manager Hari Upreti says his company has fulfilled all requirements and has permission to mine 15 hectares of its own property and 4 hectares of government land. “We have the Department of Mines permit which is valid till 2036 and extract 1,600 tons of limestone every day,” says Upreti. “The local community knew about the mining and if there is a problem with springs going dry it is not because of us.” Environmental researcher Uttambabu Shrestha, however, says there is a direct correlation between the quarry operation and floods, landslides and dry springs.&nbsp; “Extraction should not be allowed without an environmental impact assessment, and companies must stick to set limits,” he says. Investigation of permits show that there is collusion between local officials and contractors. Godavari-6 Chair Bishnuman Maharjan has investment in two quarries and crusher companies operating along Nallu Khola. A paper trail links Maharjan also to Sagarmatha Stone Crusher and Mankamana Aggregate Industries. IMPUNITY&nbsp; Godavari Municipality published a notice in June 2024, instructing crusher companies to submit environmental reports within two weeks, covering initial examination and impact assessment. It also told them to pay local development fees and clear outstanding dues. The municipality even wrote to the Department of Mines clarifying that it had issued permits to only five out of 27 contractors. Within a month, the Department wrote to the District Administration Office (DAO) and District Police Office instructing them to stop illegal excavation, and sent a copy to the Lalitpur Division Forest Office. The DAO then wrote to Lalitpur Police naming Machindranath Multipurpose as operating illegally and should be shut down. There was no followup. The municipality then issued fines worth Rs 60 million to it and one other company for non-compliance. The companies stalled, disputing the calculations.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260319090356_6e96403d3c5be4aef4d030974d6d92029a0eb396deafd19c511978dae30dd3d2.jpg" data-media-id="editor_3" data-image-id="20260319090356_6e96403d3c5be4aef4d030974d6d92029a0eb396deafd19c511978dae30dd3d2" data-rendition-name="original" width="4000" height="2250" loading="lazy" alt="Lele"> <figcaption>Another site of extraction near Mahadev Khola in Godavari. </figcaption> </figure>  Machhindranath Multipurpose operator Kedar Timalsina Shashi denies doing anything wrong, and says the landslides were collateral damage because of the steep terrain. When contacted Godavari Municipality Deputy Mayor Muna Adhikari declined to comment. It has been 10 years since Rajesh Shrestha, Nikesh Shrestha, and others raised their voices against the environmental destruction caused by the construction mafia. An agreement was finally reached two years ago between locals and mining and transport businessmen, stipulating that stone mines must close permanently by mid-2025. The agreement also stated that check dams must be built to manage mining debris, and damaged structures must be restored to their original state. Trees were to be planted at sites where stone mines had operated. But the mines in the catchment are still in operation with 500 tipper trucks working on the site every day, transporting stones and aggregate. Local youth have continued holding sit-in street protests and at Lalitpur DAO.&nbsp; After one sit-in, the mines closed for about a month but they started back up a month later.&nbsp; Birendra Maharjan owns one of the crusher units, and says he follows all environmental protocols. He told us: “You need stones to build, and we must dig to extract stones. Some trees have to be cut, people get employment, and besides, floods and landslides happen across Nepal.” &nbsp;&nbsp; Centre for Investigative Journalism – Nepal.

rural-health

In a healthy state

State of the art rural hospital

People’s power

Balancing act

In the mind's eye

Loot in Lele