<figure><img width="800" height="600" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114101124/63720a059c7e80680e0b5579jpeg.jpg" alt=""/><figcaption>Photo: NEURO HOSPITAL</figcaption></figure>* A 32-year-old female patient was suddenly unable to move one side of her body. She was rushed to Upendra Devkota Memorial National Institute of Neurological and Allied Sciences (Neuro Hospital) where doctors used a new non-invasive treatment to remove a clot that was obstructing the artery supplying blood to her brain. The patient’s mobility was immediately restored and she walked out of the hospital.* A man in his mid-fifties arrived at Neuro hospital five hours after suffering a stroke. He underwent the 15-minute procedure after which he could move all of his limbs freely.The strokes could have been fatal for both patients if they had not been rushed to hospital, and if the new state-of-the-art mechanical thrombectomy procedure was not available.The prevalence of strokes in Nepal has increased 40% in the past decade, and more and more younger people are suffering the condition that could paralyse or kill them. Strokes are the third leading cause of premature deaths in Nepal, and ranks first for disabilities. A person somewhere in Nepal suffers a stroke every 20 seconds. Doctors say a changing lifestyle and <a href="https://www.nepalitimes.com/banner/nepalis-binge-on-junk-foods-the-west-rejected/">dietary habits</a>, including heavier drinking and smoking has led to an increase in <a href="https://www.nepalitimes.com/latest/why-do-so-many-nepalis-have-high-blood-pressure/">hypertension</a>, <a href="https://archive.nepalitimes.com/article/nation/diabetes-in-south-asia,3018">diabetes</a>, high cholesterol — all precursors to strokes. <figure><img width="1201" height="660" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114101124/63720a089c7e80680e0b557ajpeg.jpg" alt=""><figcaption> </figcaption></figure>Recent studies have also reported that people infected with Covid-19 have an elevated risk of ischemic stroke, adding to the burden of disease. Other risk factors include aging, congenital heart diseases, hormonal changes and pregnancy. Women are comparatively more prone to suffering strokes.Ischemic strokes account for 85% of all cases, where an artery supplying blood to the brain is blocked damaging it. Haemorrhagic stroke, on the other hand, occurs when blood from a ruptured artery collects in the brain.“A stroke is a medical emergency, especially ischemic stroke which can lead to permanent disabilities and even death if it is not treated immediately,” says Subash Phuyal, Nepal’s first interventional neuro-radiologist at the Neuro Hospital in Bansbari.In fact, speed is of the essence to save the life or prevent life-long paralysis of a patient. But patients in Nepal often are not aware of symptoms and get to hospitals too late, where the right treatment may not be available. <figure><img width="4032" height="3024" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114101124/63720a0b9c7e80680e0b557bjpeg.jpg" alt=""><figcaption> </figcaption></figure>Unlike a heart attack, stroke patients do not feel any pain, making it difficult to identify it. Which is why doctors have come up with the acronym BE FAST (Balance, Eyes, Face drooping, Arm weakness, Slurred speech, and Time) to identify signs of stroke in time.Patients usually experience a sudden problem with their sense of balance, have blurred vision, double vision or loss of sight in one or both eyes. There could be facial drooping, weakness or paralysis on one side of the body, and slurred speech.If a patient gets to hospital within four hours of a stroke, they are immediately given a medicine to dissolve the blood clot obstructing the artery, restoring blood flow to the brain. This treatment is effective in only 10% of patients. Read also: <a href="https://www.nepalitimes.com/banner/new-treatment-offers-hope-for-nepals-leprosy-patients/">New treatment offers hope for Nepal’s leprosy patients</a>, Sonia AwaleHowever, with mechanical thrombectomy, 90% of patients who get to hospital in time can be cured. A small incision is made in the thigh and catheters inserted using an imaging machine in the cath lab. The catheter travels along the major arteries until it retrieves the clot to allow the blood to flow again.In the case of haemorrhagic stroke, surgery to clip the blood vessel is now replaced with a method called endovascular coiling in which the catheter inserts platinum coils to block the aneurysm.This non-invasive mechanical thrombectomy was first devised in 2015, and it was already available at the Neuro Hospital in Kathmandu four years later. Its biplane cath lab has been treating up to 25 patients a month.The hospital’s founder <a href="https://www.nepalitimes.com/here-now/upendra-devkotas-lives/">Upendra </a>Devkota (see box) was determined to introduce the newly-developed endovascular treatment technology in Nepal, but did not live to see it save lives. He died of cancer in 2018. His wife Madhu Devkota completed the dream, and set up an interdisciplinary team for stroke patients. Neuro Hospital is also building a rehabilitation centre for recovering patients who often need physiotherapy.But despite having the most advanced stroke treatment in Nepal, most people are not aware of the danger signs of a stroke. They also do not know that such non-surgical treatment is available in Kathmandu. It is also not widely known that such care is available in the country, and up to half the stroke patients at Neuro Hospital are brought too late for treatment.Nepal’s topography adds to the problem of getting patients to hospital in time. Madhu Devkota suggests the government could provide an air ambulance facility, as it does for complicated maternity cases.Says Subhash Phuyal: “People must know that strokes are preventable, and that advanced treatment is available right here in Nepal. But the most important thing is to get the patient to hospital as quickly as possible.”  <img width="630" height="882" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114101124/63720a0f9c7e80680e0b557cjpeg.jpg" alt="">Visionary doctorA young and talented doctor at Bir Hospital, Upendra Devkota, was sent on a scholarship to the Glasgow Neuroscience Institute in 1983 to train in neurosurgery. Under the guidance of the renowned Professor Graham Teasdale, Devkota proved himself among the best neurosurgeons in the world and had a bright career ahead of him in the UK.But the Gurkha-native left all that behind to return to Nepal in 1989 to set up the country’s first Neurological Trauma Unit at Bir Hospital. He worked day and night, while also training young neurosurgeons with limited resources.Devkota briefly served as the Health Minister under King Gyanendra in 2005, and a year later started setting up the National Institute of Neurological and Allied Sciences.“Many tried to dissuade us, but despite challenges we were determined to set up an institution dedicated to preventing paralysis and disabilities in Nepal,” says Madhu Devkota. “My husband had foreseen the need for an advanced neurological centre in Nepal. So we thought, if not us, who would? So, we ran with it.”Read also: <a href="https://www.nepalitimes.com/latest/why-do-so-many-nepalis-have-high-blood-pressure/">Why do so many Nepalis have high blood pressure?</a> Sonia Awale

Sonia Awale

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New cure for stroke, but prevention is key

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110151112/636d06f59c7e80680e0a5f92jpeg.jpg" alt="" width="1500" height="1000"/><figcaption>Photo: MONIKA DEUPALA</figcaption></figure>The past year-and-half since the Covid-19 outbreak, Nepal’s limited health resources all had a singular focus. But now that the second wave is waning and the lockdown has been eased, hospitals are once again flooded with patients with <a href="https://archive.nepalitimes.com/article/nation/diabetes-in-south-asia,3018" target="_blank" rel="noopener noreferrer">diabetes</a>, cardiovascular diseases and kidney ailments.Many of these patients had left these conditions untreated, and doctors say nursing them back to health will be more complicated. One of the most common disorders is hypertension or high blood pressure, which has become an epidemic.Hypertension is a silent killer and one of the most common causes of chronic conditions like <a href="http://archive.nepalitimes.com/article/Nepali-Times-Buzz/A-mysterious-rash-of-kidney-failures,3639" target="_blank" rel="noopener noreferrer">kidney damage</a> that are often too costly to treat for the majority of Nepalis. Now, mental stress due to Covid has also added to the problem.“Hypertension makes up for the majority of patients in hospitals these days now that the lockdown has been relaxed,” says cardiologist Prakash Regmi. “Also worrying is that many of these are new patients coming in due to Covid-related stress, a large number of people who had their blood pressure under control previously after treatment are also relapsing.”To be sure, Nepal has been seeing a dramatic rise in hypertension patients even before the pandemic – some of them in their teens and 20s. <a href="https://www.hindawi.com/journals/ijhy/2021/6610649/" target="_blank" rel="noopener noreferrer">A paper published in March</a> in the International Journal of Hypertension, shows that since 2000, the hypertension rate in Nepal has been increasing at 3.5% per decade, and 44.7% of Nepali men will be suffering from hypertension by 2025.The study also found that high blood pressure is disproportionately affecting men, the elderly, those without formal education, and those who reside in urban areas, and seems to be most common in Gandaki Province.Worldwide, an estimated 1.13 billion people have hypertension, and it is responsible for 9.4 million deaths globally every year. In 2015, 1 in 4 men and 1 in 5 women had elevated blood pressure.In Nepal, close to one-third of the adult population has some form of hypertension, but in urban centres the figure is as high as 40%, with 25% in rural areas suffering from it.There is no specific cause of hypertension, but its biggest risk factor is high sodium intake. A survey in 2020 revealed that on average, the mean dietary <a href="https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.13813#:~:text=Overall%2C%20estimated%20mean%20salt%20intake,d%20(SD%20%C2%B1%204.7)." target="_blank" rel="noopener noreferrer">salt intake of a Nepali</a> per day is 13.3 mg. Most of the world consumes double the WHO recommended 5g of daily salt intake, increasing the risk of heart disease and strokes, which kills some 3 million people annually worldwide.“Traditionally Nepalis have a preference for salty food, but now with higher consumption of processed and <a href="https://www.nepalitimes.com/banner/nepalis-binge-on-junk-foods-the-west-rejected/" target="_blank" rel="noopener noreferrer">junk food</a>, our salt intake has grown,” says public health expert Aruna Uprety, adding that the sodium content in packaged foods is often much higher than what companies claim.In May WHO (World Health Organisation) released a new set of <a href="https://www.who.int/news-room/events/detail/2021/05/05/default-calendar/launch-event-who-global-sodium-benchmarks-for-different-food-categories" target="_blank" rel="noopener noreferrer">global benchmarks for sodium levels</a> that will act as a guide for countries and industry to reduce sodium content in more than 60 categories of processed foods, in line with the global target of reducing salt intake by 30% and hypertension by 25%, both by 2025.Another prominent risk factor is mental stress and lack of physical exercise, both of which have been exacerbated with people staying at home for months and under the uncertainty of the pandemic. Family history of hypertension also plays a significant role in an individual developing high blood pressure, as does smoking and drinking alcohol.Undetected hypertension, and non-medication to control it, can lead to other disorders like stroke, heart disease, kidney failure, etc.Despite the huge burden of the disease on public health and the economy, treatment of hypertension is ill-managed. Patients are never diagnosed because often times there are no prior symptoms.And of the 50% who are diagnosed with high blood pressure, half ignore their condition and get no treatment. Of the remaining, 25% do get some kind of treatment but half of them again do not follow-up or take the correct dose of medication.“All in all only about 10% of hypertension patients get proper treatment in Nepal. Lack of proper health monitoring system, as well as misconceptions about life-long medications, hasn’t helped,” says cardiologist Prakash Regmi. “This often leads to a point where treatment is either too expensive, or even unmanageable.”Hypertension is first and foremost a lifestyle disease with strong ties to a possible failure of crucial organs in the human body. Its prevention and control are heavily dependent on an <a href="https://www.nepalitimes.com/banner/junk-food-is-making-nepali-children-shorter/" target="_blank" rel="noopener noreferrer">individual’s choice of diet</a>.A state-sponsored robust awareness campaign to focus on preventive measures and a strong healthcare system are urgently needed to reduce the epidemic of hypertension.Says public health expert Aruna Uprety: “Mandatory blood pressure check-ups for certain age groups at fixed intervals is a good place to start. It goes a long way in reducing the cost of the disease and human lives.”Stages of hypertension<ul style="font-weight: 400;"><li>Normal: Less than 120/80 mm Hg</li> 	<li>Prehypertension (Elevated): Systolic between 120-129 and diastolic less than 80</li> 	<li>Stage 1 (Moderate): Systolic between 130-139 or diastolic between 80-89</li> 	<li>Stage 2 (Severe): Systolic at least 140 or diastolic at least 90 mm Hg</li> 	<li>Hypertensive crisis: Systolic over 180 and/or diastolic over 120</li></ul>Types of hypertension<ul style="font-weight: 400;"><li>Primary or essential: Most common high blood pressure among adults. No specific cause but risk factors include diet, age, physical activity and genetics.</li> 	<li>Secondary: Up to 10% of hypertension is secondary. Most often caused by another medical condition or the use of certain medicines.</li></ul>Risk factors<ul style="font-weight: 400;"><li>High salt/sodium intake</li></ul>WHO recommendation: 5gm/day<ul style="font-weight: 400;"><li>Mental stress</li> 	<li>Lack of physical exercise</li></ul>WHO recommendation: at least 150–300 minutes of moderate-intensity aerobic physical activity<ul style="font-weight: 400;"><li>Family history of high blood pressure</li></ul>

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Why do so many Nepalis have high blood pressure?

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101132/636b73f19c7e80680e062367jpeg.jpg" alt="" width="1500" height="1016"/><figcaption>Photo : MONIKA DEUPALA</figcaption></figure>Last November, a speeding bus in Argakanchi lost control and tumbled down a mountain, killing 19 and injuring 18 passengers. Three weeks later, another bus careened off a serpentine road in Sindhupalchok, killing 16 and wounding 18.Seven Nepalis die every day in <a href="https://www.nepalitimes.com/banner/nepals-deadly-roads-take-their-toll/" target="_blank" rel="noopener">road and highway accidents</a>. Shocking though that statistic might be, the number of injured is much higher. On average, 40 people are injured on roads across the country each day. Last year, there were nearly 13,000 road accidents in which 2,736 people lost their lives and 10,731 were seriously injured.Read also: <a href="https://www.nepalitimes.com/?p=40237&amp;preview_nonce=7ab9966f81&amp;preview=true" target="_blank" rel="noopener">It’s an emergency: Nepal needs to improve trauma care</a>, Sanghamitra Subba<a href="http://archive.nepalitimes.com/article/Nepali-Times-Buzz/accident-prone-Mugling-Narayangadi-highway,3828" target="_blank" rel="noopener">Highway accidents</a> are now the biggest killer of young men and women in the country. The causes are usually carelessness and speeding, and poorly-maintained roads and vehicles. The number of accidents are rising faster than the increase in the number of vehicles.Those who survive often have traumatic brain and <a href="http://archive.nepalitimes.com/news.php?id=6946" target="_blank" rel="noopener">spinal cord injuries</a>, requiring long-term or life-long rehabilitative care. But the state of rehabilitation in Nepal is nearly non-existent. There is no government rehabilitation centre, and while some private hospitals do offer inpatient physiotherapy, none have dedicated acute rehabilitation units and none employ physical medicine and rehabilitation consultants.“Forget about prioritising it, rehabilitative medicine is not even included in the healthcare system of Nepal,” laments Raju Dhakal, the only physical medicine and rehabilitative doctor registered in Nepal. “Every hospital has a cardiology unit, intensive care unit and even physiotherapy but no rehabilitation unit. This should be integrated in the healthcare system rather than treated as a separate entity.”The <a href="https://www.facebook.com/SpinalNepal/" target="_blank" rel="noopener">Spinal Injury Rehabilitation Centre</a> (SIRC) in Sanga, founded in 2002, is Nepal’s largest inpatient rehabilitation centre and the only one specialised in spinal cord injury. The 51-bed hospital treats patients from all 77 districts and provides inpatient rehab for 300 individuals a year.It also conducts outpatient care, home follow-up visits, community outreach programs, and a residential vocational rehabilitation program to help people with disabilities integrate back into society and to better equip thier families to deal with their special needs.The only other facilities with dedicated inpatient rehabilitation beds are <a href="https://gphospital.org/" target="_blank" rel="noopener">Green Pastures Hospital</a> in Pokhara and the <a href="https://www.hrdcnepal.org/" target="_blank" rel="noopener">Hospital for Rehabilitation and Disabled Children</a> in Kavre.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101132/636b73f49c7e80680e062368jpeg.jpg" alt="" width="1500" height="1065"><figcaption> </figcaption></figure>“Usually two physical medicine and rehabilitation specialists are needed for every 100,000 people. This means we need 500 specialists in Nepal, and instead we have one,” says Manoj Sivan, associate professor of rehabilitative medicine at Leeds University in the UK, who says the gap in rehabilitative care can be bridged with telemedicine.“Tele-rehabilitation can link the people in the community with specialists to provide necessary interventions remotely, allowing them to the save time and money spent travelling to the centre,” adds Sivan, who was in Nepal last month with a team of researchers to launch a six-month pilot project called Tele-rehabilitation Nepal (TERN) in collaboration with SIRC (above).Unlike <a href="https://archive.nepalitimes.com/article/nation/long-distance-medicine-in-nepal,3521" target="_blank" rel="noopener">other telemedicine consultations</a> where a patient has to visit a health post to connect with doctors based in cities, in tele-rehab a social worker from SIRC visits patients, finds out their needs and then connects them with a specialist team that consists of a physician, physiotherapist, occupational therapist, nurse and  psychologist.Patients with long-term disabilities and their families learn about better management of bladder, bowel and pain, as well as exercise techniques to help mobility.The idea for e-rehab first came to Dhakal when a paraplegic patient from Surkhet visited SIRC and was unable to pay a minimal consultation fee. She had spent Rs45,000 to hire a jeep and had to pay for extended hotel stay for herself and two relatives. “It hit me hard,” Dhakal recalls. “This country’s topography makes accessing healthcare stressful for most Nepalis.”Besides those with <a href="http://archive.nepalitimes.com/article/Nepali-Times-Buzz/paraplegic-ram-bahadur-tamang-travels-from-namo-buddha-to-lumbini,1303" target="_blank" rel="noopener">spinal injuries</a> caused by highway accidents, tele-rehabilitation is useful for those recovering from other medical emergencies like strokes and also for general medicine.The Nepal Government’s 2016 Policy, Strategy, and Ten Year Action Plan on Disability Management plans for every province to have at least one fully equipped rehabilitation centre and established orthotics/prosthetics workshop in the next ten years. SIRC is also working with the Ministry of Health to develop another 100-bed hospital to provide specialised rehabilitation care.Added Dhakal: “Sooner or later the government has to take responsibility and decentralise rehabilitative care. This will allow us to train more people and supervise other centres to decentralise rehab.”<h2>Wheelchair doctor treats patients in wheelchairs</h2>As the only physical medicine and rehabilitation doctor in Nepal, Raju Dhakal (left) has a lot on his plate. His days are packed with back-to-back consultations with rehabilitation patients. The 37-year-old does this with ease as he moves about in his wheelchair greeting patients at Spinal Injury Rehabilitation Centre (SIRC) at Sanga, Kavre.Dhakal himself was diagnosed with poliomyelitis when he was two-and-half years old. Originally from Gorkha, he came to Kathmandu and lived in SOS Children’s Village while undergoing treatment. He started school at age seven, and learned to read and write at the same time as he learned to use crutches.Read also: <a href="https://www.nepalitimes.com/review/new-life-for-khagendra-b-basnyat/" target="_blank" rel="noopener">New life for Khagendra B Basnyat</a>, Sewa BhattaraiWith an MBBS from Kathmandu Medical College, Dhakal went on to receive an MD in Physical Medicine and Rehabilitation in Dhaka.“At daily rotations during my internship, there was one patient that every doctor skipped. He was undergoing rehabilitation after treatment for a spinal injury. No one could do anything for him so he remained there in a corner of that ward,” recalls Dhakal. “This opened my eyes to a gaping hole in medical care in Nepal.”Dhakal went on to become honorary clinical fellow at the Department of Rehabilitative Medicine at the <a href="https://medicine.unimelb.edu.au/research-groups/medicine-and-radiology-research/royal-melbourne-hospital" target="_blank" rel="noopener">Royal Melbourne Hospital</a> in Australia. He trained in Spinal Cord Medicine and Rehabilitation in Ireland, Canada and Switzerland.“In Nepal we are still very focussed on diagnosis and acute treatment. But what about residual paralysis in case of trauma, traumatic brain injuries and spinal injuries?” asks Dhakal. “Long-term rehabilitative care for patients with disabilities is severely lacking. We need more facilities for specialised rehabilitation care.”

Injured use Internet to get rehab care

In 2003, the death by police firing of a student protesting a rise in fuel prices pushed Nepal’s student activists to join the प्रतिगमन विरोधी आन्दोलन (Movement Against Regression), which political parties had begun after king Gyanendra’s sacking an elected government a year before. The students’ participation elevated the movement and prompted more Nepalis to join in, leading to the People’s Movement that first sidelined the monarchy and then abolished it in 2008.&nbsp; That took five years to happen. But 12 years later, this month, a youth-led protest forced the prime minister to resign within 30 hours.&nbsp; Police massacred GenZ activists, many of them students, outside Parliament on 8 September. This intensified public anger, leading to targeted attacks, looting, and burning of the homes of political leaders, private businesses, and public buildings.&nbsp; Amid the smouldering ruins of state institutions, young Nepalis chose a new prime minister to lead an interim government and deliver a fresh mandate. All of this happened in five days.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250910140912_019d62de4b62a366299a27d1276e931a7dadefcc674441e7fb3acd503970efaf.jpg" data-media-id="editor_0" data-image-id="20250910140912_019d62de4b62a366299a27d1276e931a7dadefcc674441e7fb3acd503970efaf" data-rendition-name="original" width="8000" height="5760" loading="lazy" alt="Nepal in ashes"> <figcaption>Parliament building up in flames during the GenZ protest on 9 September. Photo: KAMAL PRASAI</figcaption> </figure>  Students have been central to Nepal’s democratic and political process since the mid 20th century. In her 2018 book Making New Nepal, researcher Amanda Thérèse Snellinger traces the history of student activism and politics against a background of &nbsp;Nepal’s socio-political history and party politics.&nbsp; Snellinger examines the interplay of ideology and identity, explores how student activists fit into a political landscape continually occupied by the traditional elite, and details how student leaders have established themselves through relationships with influential actors on local, national, regional, and transnational levels. The Rana regime’s repression caused students to be politically aware. In 1947, students held the first organised protest against the Rana autocracy demanding educational reforms. The breadth of student activism expanded during the Panchayat era after king Mahendra banned political parties, which drove mainstream politicians and parties underground. &nbsp;Student activists then became proxies for multiparty democracy because they were still able to organise.&nbsp; Student politics was institutionalised, and unions emerged as vanguard sister organisations of political parties. Student activism, more so than mainstream political parties, played key roles during &nbsp;both major movements in 1990 and the 2000s, as they mobilised the citizenry to join the democratic process.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250924130940_f94cf97fb7ed98b90b48736e1aa8a76466f50337dffc36ec78e9cd5e6927deea.jpg" data-media-id="editor_1" data-image-id="20250924130940_f94cf97fb7ed98b90b48736e1aa8a76466f50337dffc36ec78e9cd5e6927deea" data-rendition-name="original" width="1952" height="2928" loading="lazy" alt="1990 people's movement Nepal"> <figcaption>The iconic image of the 1990 People's Movement agaist the autocratic Panchyat regime of the king. Photo: MIN RATNA BAJRACHARYA</figcaption> </figure>  Through extensive ethnographic research between 2003 and 2015, Snellinger investigates the political coming of age of student activists during the final years of the armed insurgency and their role in and beyond the movement that ultimately abolished the monarchy. Her research revolves around the political journeys of five student activists: Akash and Rishi from the Nepali Congress (NC) student wing Nepal Student Union (NSU), Salini from the UML’s All Nepal National Free Students’ Union (ANNFSU-Akhil), Gyanu from ANNISU-Revolutionary of the Maoists, and Lagan, who began his political journey from Nepal Majdoor Kisan Party’s student wing Nepal Krantikari Bidyarthi Sangathan. The ‘movement against regression’ in 2003 served as the entry point &nbsp;for activists into national party politics. Indeed, it was their &nbsp;participation in the movement that elevated the profile of the main subjects of Snellinger’s research. In the years that followed, the paths of the five activists diverged. Some made it into mainstream politics, even becoming lawmakers. In doing so, they have had to trade idealism for pragmatism, and their attempts realise their previous vision for Nepal’s democracy have been overshadowed by their political opportunism and position. And even decades after they began their journey as student activists, the generation that the book focuses on are still considered &nbsp;‘youth’ leaders. Snellinger quotes a former student leader who joined mainstream politics as saying: “I am still a youth because &nbsp;my aspirations remain unfulfilled.”  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250924130944_7cca095d79fb5ce45cf92c61b77d72c31c5e0931aa744c73e264b6f91efdd29b.jpg" data-media-id="editor_2" data-image-id="20250924130944_7cca095d79fb5ce45cf92c61b77d72c31c5e0931aa744c73e264b6f91efdd29b" data-rendition-name="original" width="1500" height="1004" loading="lazy" alt="2006 People's Movement of Nepal"> <figcaption>A student protester wearing a paper crown and ridiculing Gyanendra with an impersonation, a day after king stepped down and left his palace. Photo: AJAY JOSHI / A PEOPLE WAR</figcaption> </figure>  Meanwhile, the refusal of Nepal’s octogenarian leaders to retire (even after The upheaval this month) has created a surplus of younger adults waiting in the wings, making the word ‘youth’ relative in Nepal’s political trajectory. Other subjects of Snellinger's research have retreated from student and mainstream activism, either in disappointment over their mother party’s retreat from some of their more radical positions, or to &nbsp;continue their work at the community level through education and journalism. One of them has leveraged her political connections to further women-led initiatives after unsuccessful election bids. Nearing the end of her research in 2015, Snellinger observes the disappointment of Madhesi communities whose movement to demand more inclusive provisions of the draft Constitution had gone in vain, even after 45 lives were lost.&nbsp; As the Constitution was promulgated in 2015, TVs were switched off in the Tarai, and there were sighs of resignation. In Kathmandu, Snelllinger noted that the student leaders that entered mainstream politics protesting for inclusive democracy had little empathy for the struggles and similar demands of groups in the Madhes. Despite the students’ role in ending the monarchy, Nepal’s political status quo has remained. The institutions and people that replaced the &nbsp;monarchy have allowed one set of Kathmandu elites to be replaced with another.&nbsp; The socio-political benefits promised during the movement two &nbsp;decades ago have remained tightly controlled by leaders who refuse to give up their hold on power. The political system was overhauled, but without concrete reform. It was only a matter of time before public frustration would boil over. Indeed, Snellinger concludes her book by predicting the inevitability of future movements in Nepal.&nbsp; She writes: ‘Leaders emerge through the andolan … a new generation will emerge shaped by Nepal’s accumulated socio-political heritage, which they will mediate to shape a liveable present and future for themselves in their country, perhaps by continuing the movement.’&nbsp; And that is exactly what happened on 8-9 September. Students marched in the streets demanding an end to corruption and impunity, but this time not as proxies of political parties.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250908120948_8a9acceede487651487c2f15b65e40f900ee6cd390bbf98394eade6b95d05b28.jpg" data-media-id="editor_3" data-image-id="20250908120948_8a9acceede487651487c2f15b65e40f900ee6cd390bbf98394eade6b95d05b28" data-rendition-name="original" width="1600" height="1200" loading="lazy" alt="Gen Z protest"> <figcaption>A student during the GenZ protest against acorruption on 8 September. Photo: SUDIKSHA TULADHAR</figcaption> </figure>  Their desire for socio-political reform was apolitical at a time in Nepal’s history when the nation’s student organisations have weakened and lost credibility, mirroring the erosion of trust in their parent parties. Along with party-based student unions, the Free Student Union (FSU)— the umbrella body all student unions—has lost its reputation due to corruption and embezzlement. That is not to say there are no similarities in movements past and present. Whether political or apolitical, protests have been overshadowed by a lack of unity within the groups that spearhead movements. They have led to destruction of public and private institutions.&nbsp; Leaders of youth and student movements have also had to bear the brunt of the frustration of the people they represent when there is no delivery on their demands. The academics of students have suffered because of frequent lockouts of university and college administration. Youth andolan, whether political or apolitical, has been a rite of passage into Nepali democratic politics — dissensus is an integral part of political regeneration. It remains to be see how the fall &nbsp;from grace of political parties after the GenZ movement will affect their affiliated student unions. As elections approach, student unions and youth collectives will find their own footing in Nepal’s &nbsp;newly emerging socio-political landscape. The youth who took to the streets are asking for a complete overhaul for political parties. Establishmentarian leaders still have not seen the writing on the wall.&nbsp; NextGen leaders in their parties have been waiting for years for their turn &nbsp;to break through the glass ceiling. These established political actors will not go down without a fight in the run-up to March elections.&nbsp; Amanda Thérèse Snellinger perhaps needs a post-script or even a sequel to her book to see how a new generation of leaders, forged by their student activism, will compete in Nepal's new political arena.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250923190928_98d53dd49d56c92950bc34642eaee51dea458fd64312d945a358ad70e5e994bb.jpg" data-media-id="editor_4" data-image-id="20250923190928_98d53dd49d56c92950bc34642eaee51dea458fd64312d945a358ad70e5e994bb" data-rendition-name="original" width="1136" height="702" loading="lazy" alt="Making new Nepal book details NT"> </figure>

Nepal’s historic youth dissensus

What does a journalist do when young protesters are shot in front of her? Does she do her job and stay neutral? Can you stay neutral?&nbsp; As protests engulfed Kathmandu, Nepal's journalists found themselves reporting a story that was personal. While doing their job, some of them were even targeted by mobs.&nbsp; Dart Asia Pacific Fellow <a href="https://www.linkedin.com/in/arunkarki/" target="_blank">Arun Karki</a> visited their newsrooms and spoke with his colleagues on their experience of reporting the GenZ protests that erupted on 8 September. These are the first-hand accounts of journalists who witnessed the turmoil in the city they call home. Sunita Karki was at a workshop in a hotel on 8 September. She saw the first waves of protests through hotel windows. Curfew alerts flooded her phone, a vehicle belonging to a human rights group sat burning across the road, young boys were taking their wounded friends on motorbikes to the Everest Hospital, and police were beating a teenager with hands raised up.&nbsp; “I cried a lot,” she said, but the tears were not out of fear -- they were because she felt guilt. “I couldn’t write the news. We were witnessing these scenes from a five-star hotel.” By evening, the death toll had reached 19. On 9 September at about 3:35 p.m. &nbsp;her outlet, the Annapurna Post's office in Tinkune, Kathmandu, was set on fire. Staff had to leave the building as parts of the newsroom burnt down.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250924040948_e1cc49c9e4fcc4bd4cd3c0163c782fc4e9956bf633cff7b53a63cf8e2dd74cff.jpg" data-media-id="editor_1" data-image-id="20250924040948_e1cc49c9e4fcc4bd4cd3c0163c782fc4e9956bf633cff7b53a63cf8e2dd74cff" data-rendition-name="original" width="1333" height="1000" loading="lazy" alt="Dart Centre Asia Pacific"> </figure>  When she knew her office was burning, she anxiously told her husband that she would resign from the job: "If we have to hide our identification cards in every protest, what kind of journalist am I?" she asked herself. She filed a story the next day, but her emotions kept bouncing between that of a journalist’s duty and shock. She said that in moments like this, it’s hard to feel truly neutral. After watching the police beat people, she felt a strong urge to step in, not just stand back and report. The first real calm came later, when people came to the street and lit small candles together. “This was a sort of victory procession. I felt some relief after brutal days,” she said. <a href="https://www.linkedin.com/in/angaddhakal/" target="_blank">Angad Dhakal</a> a photojournalist who works at Kantipur National Daily, was standing outside his office building when protesters stormed in and set parts of it on fire. He had already been informed that protesters were planning to torch his office building and &nbsp;rushed to his office hoping to save his hard drives containing ten years of photography work. He failed. He raised his camera and "forcefully" pressed the shutter - more to document the scene than out of "professional enthusiasm or duty".&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250924040948_ebafaacb85c4ea045c41f2c63f1eff06fee9a4ddb5fbf419724e1a5d533781fa.jpg" data-media-id="editor_3" data-image-id="20250924040948_ebafaacb85c4ea045c41f2c63f1eff06fee9a4ddb5fbf419724e1a5d533781fa" data-rendition-name="original" width="1333" height="1000" loading="lazy" alt="It is hard to feel neutral NT"> <figcaption>Photo: GAURAV POKHAREL</figcaption> </figure>  “My office was burning. What should I photograph?” he recalled. A few moments later, a protester noticed the “PHOTO” label on his yellow Press jacket. Dhakal deflected it by saying he was an early career freelancer and YouTuber. So that protesters wouldn't find out, he went to one corner and took his jacket off. When it comes to covering street protests, &nbsp;Angad usually stands near the police because it feels safer. But on 8 September, fire and gunshots made even that area unsafe. A rubber bullet hit his friend Dipendra Dhungana that badly injured him.&nbsp; He thought, “Where do we go now? If we stay here, we’ll be hit.” After witnessing two days of protests, violence, and killings, and seeing his own office burning, he couldn't sleep for days. The same afternoon that government buildings burned and Kantipur was attacked, a message in a protest Discord forum talked openly of 'attacking Kantipur'.&nbsp; Rumours spread to other outlets. Outside OnlineKhabar's office, where <a href="https://www.linkedin.com/article/edit/7376157229248528384/?author=urn%3Ali%3Afsd_company%3A79132377#" target="_blank">Gaurav Pokharel</a> works, the newsroom manager saw “very suspicious people were walking around”. They lowered blinds, avoided windows, locked the front gate and dispersed staff to other places across the city. The outlet was threatened and effectively locked down, but not torched. Pokharel hid his press ID. “ I never showed the ID card. Sometimes I had to enter the crowd shouting slogans, just to blend in among the protesters,” he said. He watched people fall under gunfire, he helped pull one surrounded journalist out of a hostile crowd.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250924040948_3b335eee57280373cb51f460534ca4476df23f89c787ba9e4a66d116a537b1a3.jpg" data-media-id="editor_5" data-image-id="20250924040948_3b335eee57280373cb51f460534ca4476df23f89c787ba9e4a66d116a537b1a3" data-rendition-name="original" width="1333" height="1000" loading="lazy" alt="It is hard to feel neutral NT"> <figcaption>Photo: GAURAV POKHAREL</figcaption> </figure>  As a freelancer, Gaurav also contributed articles for international outlets. Later, while transcribing an interview of a young protest organiser, he wrote to his editor at an international outlet : “This was very hard to write. I cried many times while doing it.” He had been working at a stretch for days battling bouts of exhaustion and low blood pressure.&nbsp; Protesters vandalised and set fire within the Singha Darbar complex housing Nepal Television and Radio Nepal. They tried to disrupt public broadcasting.&nbsp; Surendra Paudyal began the day with his press ID hanging on his neck, thinking it would let him move freely. But when he reached Singha Darbar around 3:30PM, the situation felt dangerous.&nbsp; He put the ID in his pocket. When asked what mattered most, he answered without pause: life comes first. In that moment, he felt real fear and a strong duty to protect his team.&nbsp; His focus narrowed to basic things: stay calm, find exits, get everyone out safely. Later, they were able to keep the 8 pm news on air through a regional link. He felt mixed emotions and a sense of relief that the broadcast continued, but also sadness and anger that their own studio had come under attack. Reprinted with permission from the Dart Centre Asia Pacific, a regional hub that provides trauma-informed support and advice to journalists.

"It is hard to feel neutral"

Harry Jackson was on an epic adventure ‘from Thailand to the UK on 2 wheels’ when he ran into the ultimate sidequest. Having just visited Zangla in Ladakh, Jackson had only landed in Kathmandu when he found himself in the middle of GenZ protests earlier this month. ‘<a href="https://www.youtube.com/watch?v=Slq6zWu9o9w">Arriving in Nepal - Chaos, Protest &amp; Curfews</a>’ is the title of his first video (<a href="https://www.youtube.com/@wehatethecold/videos">wehatethecold on YouTube</a>) about the protest. He shoots police as they shoot at protesters outside Parliament. Jackson is riding a Honda CT125, a retro lightweight motorbike with off-road capabilities. Strapped to the bike is his sparse luggage, flute, and a faded Union Jack. People are rioting on the streets and there is a heavy armed police presence as he makes his way to his hostel in Thamel. His vlog the day after on 9 September has 29 million views. In ‘<a href="https://www.youtube.com/watch?v=IyxSqeFrlp0">The side of Nepal the media won’t show you</a>’, Jackson rides his bike straight at the crowd just past the Parliament building into Old Baneswar.&nbsp; He parks it and walks among the protestors, documenting it all: from the police firing capsules of tear gas into the crowd to the burning Parliament building as well as the jubilant, victorious crowd in the premises as they destroy police vehicles and dance. “I’m shocked at the scenes I’ve witnessed here today. I have truly witnessed history on a stupid trip from Thailand to England on a f***ing moped!” exclaims Jackson as he leaves the scene for the day, heading back to his hostel to edit the footage. The hostel is in direct contrast to the raucous scenes of the protest, as tourists and Nepalis sit and lounge at tables. ‘KUIRE VLOGGER’ Nepalis quickly called him the ‘kuire vlogger’, and attribute his skin colour to his popularity. Objectively, the videos are well made. Jackson goes full gonzo journalist, putting himself right in the heart of the action, talking directly to the people, all while narrating the events as they unfold. Despite being cut together in an entertaining way, the footage retains a raw, unpolished quality that outdoes what most professional journalists with a heavy duty camera crew could do. At a time when legacy media has been seen to be pushing biased narratives, Jackson wants to see for himself what happened, and make up his own mind.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250925120956_f7141e06c72655502fc4b2e56120d084b0f5ae111078d66df4fd0415adf8d376.jpg" data-media-id="editor_3" data-image-id="20250925120956_f7141e06c72655502fc4b2e56120d084b0f5ae111078d66df4fd0415adf8d376" data-rendition-name="original" width="2880" height="1604" loading="lazy" alt="WehateTheCold"> </figure>  This kind of video journalism takes a lot of skill and a certain personality. Many people, almost everybody, had their phones out at the protests, but only a handful were like Jackson. He interviewed people firsthand, edited the clips and uploaded them the same day. Jackson continued his vlogging over the next few days as the curfew was first put in place and then lifted. He explores the city as the Valley rebounds. By this time, Nepalis recognise him everywhere he goes. Jackson had achieved moderate fame as a 23-year old DJ in Birmingham, but what he has done in Nepal is something else. Almost everyone he talks to has already seen his vlog, and they are all eager to interact. He has been on multiple podcasts in Nepal too, and most videos online on the protests reference his vlogs. Before his Nepal blogs, Jackson had a modest 16k subcribers on YouTube, but after Nepal figure is now almost 700k, gaining over 100k each through 11-13 September. Most of them are Nepali viewers. “I’m just a regular dude who just did what he wanted to do,” says Jackson on a podcast. “I wanted to go on an adventure, learn about history, and learn languages. And I wanted to film it, document it, and have a wicked film for my life to show future generations.” &nbsp;

The accidental journalist

Although instability is endemic to South and Southeast Asia, it is becoming increasingly dangerous both for India’s neighbors and India itself. This was reflected most recently in the violent unrest in Nepal. But that crisis is hardly an isolated case. In Bangladesh, directly to India’s east, the same tensions that led to the overthrow of the government in 2024 remain unresolved. And to the southeast, Thailand is reeling from the court-ordered removal of its prime minister and a series of recent border clashes with Cambodia. 
According to the Armed Conflict Location &amp; Event Data project, Myanmar’s civil war has claimed at least <a href="https://acleddata.com/report/war-sky-how-drone-warfare-shaping-conflict-myanmar" target="_blank">80,000 lives</a>, both civilians and combatants, since 2021, following the military coup that ended Aung San Suu Kyi’s democratic government. To India’s west, a perpetually volatile Pakistan wrestles with the zombies of its history: Islamist extremist groups and poor economic and governmental performance. 
To the south, Sri Lanka may have settled down following the ouster of its president three years ago, but its economy shows few signs of mounting a sustained recovery. And to the north, China’s quest for regional hegemony is another source of instability. 
For India, these crises are not distant concerns. Refugee flows from Bangladesh are causing social unease and disruptions in India’s eastern states; the never-ending threat of cross-border terror from Pakistan nearly incited a war in Kashmir this summer; and now, Nepal’s volatile politics have given China another opportunity for meddling. Since this arc of fragility is too large to ignore, the question for India’s leadership is how to absorb and minimize the shockwaves, and how to steady the region.
One can start with Nepal, which has struggled to live by the ambitious constitution that was forged to end a long Maoist rebellion two decades ago. Nepali state institutions remain fragile and contested, and hopes of stability have been repeatedly dashed by factionalism, corruption, and political leaders’ inability to consolidate a system that everyone can trust. The recent spasm of shockingly brutal violence is a symptom of these deeper fault lines. 
India cannot be indifferent to such instability. Our long, open border with Nepal makes us vulnerable to refugee flows and cross-border crime, and our deep cultural, ethnic, religious, and economic ties mean that the government in Kathmandu will always look over its shoulder at the government in New Delhi. Moreover, China’s increasing influence in Nepal’s domestic politics has, as a matter of necessity, made the country a major strategic concern for India. 
In Bangladesh, the interim government that has ruled since <a href="https://www.project-syndicate.org/columnist/sheikh-hasina">Sheikh Hasina</a>’s ouster is failing in its efforts to restore law and order or safeguard human rights. The economy, a bright spot for decades, is under pressure from domestic political jitters and US President Donald Trump’s punishing tariffs. The febrile political environment has left the country’s minorities feeling increasingly insecure. The stakes for India are high, because its own efforts to manage the border, migration, and counterterrorism depend on the regime in Dhaka maintaining order. 
At first glance, Thailand’s turmoil and the border clashes with Cambodia may seem less urgent. But India, under its Act East policy, has been pursuing deeper economic and strategic ties with the Association of Southeast Asian Nations’ ten member states and their 600 million-plus people. Any instability within that bloc will complicate this outreach. 
Moreover, Thailand has long served as a bridge between South and Southeast Asia. If its institutions falter, or if disputes with Cambodia escalate despite Malaysian Prime Minister <a href="https://www.project-syndicate.org/columnist/anwar-ibrahim">Anwar Ibrahim</a>’s best efforts to broker a resolution, India’s vision of a connected, secure Indo-Pacific corridor could become untenable. 
To describe Pakistan as chronically troubled may sound dismissive, but it is an unfortunate truth. The country’s civilian authorities have been consistently undermined, as when <a href="https://www.project-syndicate.org/columnist/imran-khan-1">Imran Khan</a>’s elected government was ousted in 2022 at the military’s behest. Extremist groups thrive when politics becomes a blood sport, and Pakistan’s fragile economy only exacerbates this dynamic. 
From India’s perspective, Pakistan’s troubles are more than a domestic issue, because they regularly threaten to spill across the Line of Control in Kashmir, fueling terrorism, destroying any prospect for regional peace, and even introducing the specter of a nuclear catastrophe. This continuous instability chains India to the sub-continental chessboard, even when it wants to look outward. The Pakistan-China axis further complicates the status quo, which is unlikely to change in the foreseeable future. 
All these stories point to a larger worrying trend: democracy in India’s neighborhood is in retreat. Constitutions are being rewritten, and courts politicized. Sensing weakness, too many army generals see themselves as free to intervene, including by jailing or exiling political leaders.
For India – the world’s largest democracy – responding to this trend demands a more assertive regional strategy. Of course, for most of South Asia, barring Pakistan, India is the first responder when crises hit. But during periods when India’s neighbors do not think they need its help, they tend to shrug off its security concerns. 
And as if India’s neighborhood were not dangerous enough, the wider world adds its own layers of uncertainty. Trump’s policy toward the region has been arbitrary in the extreme, leading smaller states to hedge their bets. In Japan and South Korea, debates are underway about the wisdom of acquiring nuclear weapons, now that China is flexing its muscles and the US security umbrella has been called into question. 
Although India has stood its ground in the face of the storm, the regional and Trump-induced volatility is making it harder to maintain the country’s treasured strategic autonomy. The task now is no longer to deepen ties with America, but to maintain the strategic, technological, and economic core of the partnership while building resistance against sudden shifts in US policy. 
India is not seeking dominance in South Asia. Its goal is to build an inclusive, rules-based, and connected region – and thus transform a history of recurring crises into a future of enduring stability. © <a href="https://www.project-syndicate.org/">Project Syndicate</a>
Nirupama Rao is a former foreign secretary of India and former Indian ambassador to China and the United States.