<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 the aftermath of the GenZ protests last month, as new PM Sushila Karki chose the first members of her Council of Ministers, youth collectives urged that it reflect the country’s diversity by including women, youth and people from various ethnic and socio-cultural backgrounds.&nbsp;
It took another couple of weeks for Karki to include &nbsp;bureaucrat and public health expert Sangeeta Mishra as &nbsp;Health Minister in her next tranche of ministers. Almost immediately, people dug up a video of Mishra calling herself “Nepali, but a native Indian”.
She was telling it like it was: Mishra is a naturalised Nepali citizen. But there was outrage in the ultra-nationalistic cybersphere. Mishra’s name was withdrawn from the list of ministers, with government officials citing an ongoing investigation at the CIAA.&nbsp;
With her Cabinet still incomplete a month after taking office, Prime Minister Karki was preparing to induct GenZ as ministers. A leak in the media floated the names, one of which was of Tashi Lhazom, a climate activist and filmmaker from Humla’s Limi Valley.&nbsp;
Almost immediately, social media erupted with discriminatory, xenophobic and misogynistic epithets against her: that she supported a separatist movement, that she was a foreign agent, that her citizenship was disputed, that she did not ‘look’ or ‘speak’ like a Nepali.&nbsp;
Political figures like Gyanendra Shahi, a prominent voice calling for the restoration of a Hindu monarchy, added fuel to the fire by making bigoted and false remarks about her heritage.
The former Commissioner of the National Human Rights Commission, Mohna Ansari, wrote on social media that it was shameful to question Lhazom’s identity: ‘Ms Tashi Lhazom is as Nepali as you are. Our society’s ugliest face and biggest flaw is doubting our own. Real patriotism embraces diversity — fake nationalism must end.’
Ansari, a human rights lawyer and activist, has also often been subject to Islamophobic and derogatory comments on digital platforms. &nbsp;
In response, the Indigenous GenZ Collective released Lhazom’s Nepali citizenship certificate to debunk the mistruths spreading on digital as well as mainstream media.
What makes a Nepali? What does a Nepali look or sound like? Who is a Nepali?
‘Had my name been Tashi Poudel, Thapa, Bhattarai or Ghimire, this would not have happened,’ Lhazom said in an interview with Kantipur following an avalanche of bigotry against her. ‘They questioned me because I do not look Nepali, or speak Nepali like a Khas. Because it is not my mother tongue.’
It is an indictment of Nepali society that indigenous Nepalis have to present proof, at the slightest inconvenience of mostly the dominant groups, of being a citizen of this nation simply because they might not fit into an imagined idea of Nepali nationhood by virtue of physical appearance, speech, geography, or faith.
And while we celebrate the successes of Nepal-born naturalised foreign citizens (some now hold elected office in the US) we refuse to afford the same respect to naturalised Nepali citizens, and those born in Nepal to excluded groups, nor do we expect them to work in the national interest if they are given responsibility to govern. And women are singled out twice as much for scrutiny.
Then cyber Nepal went into a tizzy when videos appeared of a biker’s group clad in black t-shirts emblazoned with the acronym ‘TOB’ which was interpreted to stand for ‘Tibetan Original Blood’ and linked to the Free Tibet movement.
The accusations snowballed into disinformation, xenophobia, and even calls for violence against Nepalis of Tibetan heritage and the Tibetan community in Nepal.&nbsp;
In the aftermath of the September protest, the hope was that politics and the bureaucracy would finally be rid of orthodox political actors. But first, we as a nation need to collectively examine the biases and bigotry that exist in Nepal’s socio-cultural space.&nbsp;
Otherwise, Nepal’s multiculturalism will be limited to just words in the Constitution and political tokenism.
No one who is in government now or in future can be expected to be completely free of subjective opinions, ideology, affiliation to a cause, or prior activism. And such criticism falls disproportionately on activists, advocates, and members from underserved and underrepresented communities.&nbsp;
One cannot be apolitical and hope to participate in politics, and as we move forward to rebuild the system it must not just reflect diverse communities, but also celebrate diversity of thought and beliefs.&nbsp;
Resorting to ethnocentrism, racism and chauvinism with conspiracy theories and discriminatory dog-whistling about fellow citizens is a disservice to Nepali nationhood. It is Nepal’s diversity that makes us strong.&nbsp;
Shristi Karki

What makes a Nepali?

In the very first page of the first chapter of Nepal 2043: The Road to Prosperity are two maps. The first places Nepal right at the epicentre of Asia, and in the second the Kathmandu is at exactly the midpoint between Mumbai and Beijing. With his trademark optimism, author Sujeev Shakya says Nepal is not land-locked but land-linked to three billion people in China and India. We just need those two economic engines to pull us in the same direction. ‘With China and India becoming the two largest economies in the world in the next two decades … Nepal is the most valuable piece of real estate in the world,’ Shakya writes. For one thing, Nepal does not look beyond India and China for tourism — with the right policies it can attract millions of tourists just from those two countries. Nepal is set to graduate from a low- to a middle-income country by 2026 and to a high-income country in 2043 — hence the name of the book. The year 2043 in the Bikram Sambat calendar is also 2100 — a new Nepali century. The book delves into the past, present and future of Nepal and analyses enablers including hydropower, a fundamental transformation of which will drive the 2043 goal. The commoditisation of electricity will be the biggest transformation. Nepal can deploy ‘Cyber Gurkhas’ to attract foreign investors with the management of data centres with climate friendly renewable energy. Access to technology such as precision agriculture, a data-driven approach to farming to improve food production, reduce environmental impact and enhance profitability could be Nepal’s strategy into 2043 and beyond. ‘Earlier, we needed ploughs and strong hands in agriculture. Now, you need a computer and strong fingers,” Shakya writes, citing a neighbour’s son who inspects his crops from drone cameras. A farmer in an Ilam teashop tells the author he asks AI questions in Nepali, and it answers promptly. The biggest enabler of all is Nepal’s young demography with 62% of the population in the active 15-60 age bracket, while 28% are younger than 14. Nepal’s dependency ratio has dropped to the lowest in history with 100 Nepalis having to support 62 dependents. But this demographic dividend window is closing. Nepal’s total fertility rate declined from 2.62% in 1981 to 0.92% in 2021 — below replacement level. We have less than 30 years left to make the best use of the youth, many of whom are currently studying and working abroad. Nepal’s biggest resource, therefore, is its diaspora spread across the world who send home $20 billion a year. Migration is not just a necessity but an aspiration for many Nepalis, and they are an important source of contacts, investment and soft power. This young and educated group has taken advantage of connectivity and digitisation in all arenas of national life. TikTok and Instagram have become e-commerce platforms, or mobile app-riven digital services. Nepal’s software companies exported over $1 billion worth of IT products last year. Next we need a change in the bureaucratic mindset to eliminate paper and manual processes, which would also contribute to reducing corruption. Shakya comes up with many revelations: 81% of Nepalis live in houses they own, much higher than most other South Asian countries which means higher disposable income. Nepal has the highest tax-to-GDP ratio in South Asia. The banking sector is twice the size of Bangladesh despite Nepal having just one-fifth of its population. In 2021, 12.62% of the population had demat accounts in Nepal, while India had only 5.32%. For every five male investors, there are four women in Nepal while it is 10:1 in India. With such figures and prospects, how come Nepal just went through a violent uprising that took the shortest time to topple a democratically-elected government in modern history? One early chapter of 2043 is actually dedicated to how Nepalis have always thrived on chaos. When people faced up to 20 hours of power cuts a day, people worked around the load-shedding schedule, woke up at ungodly hours to cook and stock up on inverters. They did not put up a fight, or even protest. ''Generally, Nepalis are used to taking things lying down, and perhaps this also needs to change,' says Shakya, writing that line before last month’s uprising. ‘On the one hand, some of these issues speak volumes about the average Nepali’s patience and perhaps optimism that things will change in the long run. On the other hand, one is also forced to wonder how much longer they will be able to put up with unfavourable conditions if things don’t change.’ It does seem Nepali had enough with corruption, governance failure and political apathy to the concerns of ordinary people. The final chapter lists the non-negotiables to realise the 2043 Nepal Roadmap: democratic values and freedom of speech, a capitalist welfare state and socio-political transformation to tackle corruption and impunity. The book notes, ‘Countries transitioning to democratic rule experienced a 20% increase in GDP over a 25 year period compared to what they would have achieved under authoritarian regimes. After the end of the Shah rule in 2006, Nepal’s GDP rose from US$10 billion to US$44 billion by 2024.’ The government’s Vision 2030 document projects Nepal’s GDP at US$100 billion, and the Vision 2043 estimates that it will be a US$423 billion economy with a per capita of US$12,100. However, it will need more than optimism and practical action to make these projections real. China and India loom large throughout the book with examples of small city states like Singapore which have taken advantage of their strategic location. Despite the tension between India and China, the two will have to collaborate given the inherent advantages. China has replaced the United States as India’s biggest trading partner. Sujeev Shakya is a great admirer of former Singaporean diplomat and author Kishore Mahbubani, and he has written a blurb for the book. He quotes Mahbubani saying that for the past 2,000 years, apart from the last two hundred, Asian countries have dominated the world, and it is quite natural that the world’s economic centre is returning to Asia. And Nepal is strategically placed to make the most of it because of its location between two of the world’s fastest growing economies. We just have to get our politics right, and have a strategy for equitable growth in the new Nepali century.  <figure><img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251016091052_78b2d1495d59cd492a17693e0e770b65230c7cb749393ac6643f4676b73832ef.jpg" data-media-id="editor_0" data-image-id="20251016091052_78b2d1495d59cd492a17693e0e770b65230c7cb749393ac6643f4676b73832ef" data-rendition-name="original" width="1136" height="702" loading="lazy" alt="Sujeev Shakya book details NT"></figure>

Retrofitting Nepal for future shocks

We were used to getting stuck in Kathmandu’s notorious traffic with gas fumes and horns blaring. We are still stuck in traffic, but now it is mostly the quiet hum of EVs, and street-level air is noticeably cleaner. Alongside Norway, Nepal has the highest combustion-to-EV conversion rates in the world. And we are not even a middle-income country yet. How did we get here?&nbsp; For the first time in Nepal’s history, 2025 saw an unprecedented turn of events: two back-to-back auto shows a week apart in August, independent of each other. This was timed for the warm up to the Dasain season. &nbsp;&nbsp; The first auto show 6-11 August was the <a href="https://naimanepal.org/mobility-expo" target="_blank">NAIMA Mobility Expo 2025 </a>by the newly established Nepal Automobile Importers and Manufacturers Association which saw 35 new models, many of them EVs with 50 participating brands like Toyota, BYD, Hyundai, Kia, MG, Mahindra, Omoda &amp; Jaecoo, Proton and Leapmotor.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025101711108_d8c03f5141f0086814d866543af4d95310f340a7191363e4705aedda8e4b73d0.jpg" data-media-id="editor_1" data-image-id="2025101711108_d8c03f5141f0086814d866543af4d95310f340a7191363e4705aedda8e4b73d0" data-rendition-name="original" width="1770" height="1097" loading="lazy" alt="Electric cars in Nepal NT"> </figure>  The exhibition had a strong focus on two-wheelers aimed at affordable and easy mobility in a town now known for long traffic jams (see report). NAIMA attracted a record 100,000 visitors in six days.&nbsp; The second one was the Nepal Automobile Dealer’s Association Auto Show 2025 (<a href="https://youtu.be/emSd0mUuMjU" target="_blank">NADA</a>) to address the growing demands for cars and two-wheelers. It was a natural expression of new market forces at work, on one hand, and popular taste, on the other — one influencing the other.&nbsp; This year’s NADA Auto Show was its 17th iteration, and carried a hefty legacy: exhibiting a contemporary lineup from manufacturers such as Tata, Suzuki, Xpeng and Nammi, but also classics for vintage car lovers like the 1928 Ford Model A and a rare 1955 Austin Princess Dm4 sedan.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025101711108_dda7d264ddb12448cc10d9b1cb699632eee975741fc4c56055e4df904579c34f.jpg" data-media-id="editor_3" data-image-id="2025101711108_dda7d264ddb12448cc10d9b1cb699632eee975741fc4c56055e4df904579c34f" data-rendition-name="original" width="1381" height="848" loading="lazy" alt="Electric cars in Nepal NT"> </figure>  It also showcased the Deepal eVTOL (a 2-seater drone), and a humanoid robot with dog. Curious onlookers at Bhrikuti Mandap thronged the show with footfall crossing 170,000.&nbsp; Earlier this year, I had traveled to attend India's largest auto show, the <a href="https://youtu.be/OgIIvXx6yOM?si=zNmMgklzCJpagTye" target="_blank">Bharat Mobility Global expo</a> in January in New Delhi. It was part of a <a href="https://youtu.be/GT6LBKiJvyg?si=r7YaxahjSAnsIfBY" target="_blank">roadtrip</a> from one capital to another with BYD Nepal on a Dolphin. The journey took three days through Bhairawa and then the Lucknow-Agra Expressway, covering a distance of 1200km one way.&nbsp; The drive through the horrid Narayanghat-Butwal corridor alone was testimony that EVs are no longer fragile and could handle a beating. And while both Nepal's economy pales in comparison to India, it was evident that the private passenger segment is well on its way to electrification. More than 70% of all vehicles sold in Nepal last year were electric. Sales representatives are unanimous: inquiries for EVs are at an all-time high and overshadow demand for ICE (Internal Combustion Engine) vehicles. Besides four-wheelers, a fast-growing proportion of scooters were also electric.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251017111016_e4cd988ca915ddd283a86d48fac332f22f98ff776b3d22391e10156ad56d7a1a.jpg" data-media-id="editor_6" data-image-id="20251017111016_e4cd988ca915ddd283a86d48fac332f22f98ff776b3d22391e10156ad56d7a1a" data-rendition-name="original" width="1389" height="863" loading="lazy" alt="Electric cars in Nepal"> </figure>  I have spent the last two years <a href="https://youtu.be/256YQa37Ol8?si=Sv1wQ8EdvgMCiTM_" target="_blank">reviewing</a> many of these EVs. The days of batter-powered cars being small toy cars, with sub-par build quality and the range of golf carts have long gone.&nbsp; Fit and finishing in both Chinese and Indian EVs are comparable to established brand names even in Japanese and European markets. But most significantly for us in Nepal, battery technology and range have made inter-city travel on our highways imaginable. The media sometimes portrays Nepal as a prime testing/dumping ground for EVs due to lack of regulation and the proximity to the world’s largest EV exporter (China) and our tough geographical conditions. That is just a part of the story. What actually stands out is the incredible appetite for risk among Nepali buyers.&nbsp; Since the Covid pandemic charging infrastructure has spread across the country. My early trips between Kathmandu and Pokhara saw the possibility of topping up with just one charging gun at the <a href="https://rsr.com.np/" target="_blank">Riverside Springs Resort in Kurintar</a> – and I would have to wait in line, or the charger simply would not be working.&nbsp; These days, by the time I cross Kurintar from Koteswor in my Kona, I will have passed at least 10 charging stations with multiple guns. &nbsp; On my <a href="https://www.youtube.com/@casuallyannoyeddriver" target="_blank">YouTube reviews</a>, people from across the globe ask about range and handling EVs on poor road conditions like ours. The occasional skeptics also leave comments like: ‘If this works in the higher altitudes and mountainous roads of Nepal, then it should be a breeze down here in the flats of Australia and/or hills around Auckland!’  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251017111016_8b4fbe59884538849be6428eb2ce9249627a8970ed9ef4cd3c792682bf26dbed.jpg" data-media-id="editor_10" data-image-id="20251017111016_8b4fbe59884538849be6428eb2ce9249627a8970ed9ef4cd3c792682bf26dbed" data-rendition-name="original" width="1139" height="787" loading="lazy" alt="Electric cars in Nepal"> </figure>  SATURATION? However, both the NAIMA and NADA auto show also confirmed that we could be hitting a peak EV. From having just one car in one budget segment, there are now multiple alternatives stretching from the entry of below Rs3 million to the premium and high-end Rs 10 million price point.&nbsp; Furthermore, the price wars on EVs that started in China a year ago have also trickled across to Nepal. Models such as the <a href="https://youtu.be/3wFN2I81Tq0?si=T6L4SAfRpoyNNvYC" target="_blank">MG S5</a>, Nammi Vigo, BYD Atto 2 (and 1) and <a href="https://youtu.be/y214kWbWTc4?si=bIevanDZEPQdkEs4" target="_blank">Deepal S05</a> saw aggressive pricing schemes and discounts that disrupted pre-existing quotas. Consumers can suddenly afford a lot more cars, and travel a lot further for a considerably smaller price tag.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025101711108_276afec1bdbd37497572939a4eada4bef74c9d075cd5851892c4dd1985edb9c5.jpg" data-media-id="editor_13" data-image-id="2025101711108_276afec1bdbd37497572939a4eada4bef74c9d075cd5851892c4dd1985edb9c5" data-rendition-name="original" width="1953" height="1107" loading="lazy" alt="Electric cars in Nepal NT"> </figure>  However, booking numbers at both auto shows did not necessarily translate into actual deliveries. The fact remains that almost 80% of registered vehicles in Nepal are still two-wheelers, and GDP per capita stands at just $1500 — among the lowest in the world.&nbsp; This means that early first-adopters are first-time buyers, and the remaining customers in the market are more skeptical and less willing. But there are also those that are unlikely to consider the EV suitable to travel to off-road rural areas. For the average Nepali family, upgrading or purchasing a new car is no small decision. It happens in five years or more with resale values being a big determinant. The EV boom may be reaching saturation.&nbsp; Both NADA and NAIMA shows drove home the message that Nepal’s transport sector is on an electric fast-track, but the road ahead will be bumpy.&nbsp; Soon after the shows, the glacial debris flow on the Bhote Kosi knocked out the Rasuwa-Kerung border with China, and earlier landslides had already blocked the Koradi checkpoint. Manufacturers are now using the less convenient Korala border in Mustang. BYD, Leapmotor and Omoda &amp; Jaecoo have begun rerouting their vehicles to make up for delivery deadlines.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025101711108_62fd70a476656062005959c247b38178d8efabf8570c73929295c0a103ff4013.jpg" data-media-id="editor_14" data-image-id="2025101711108_62fd70a476656062005959c247b38178d8efabf8570c73929295c0a103ff4013" data-rendition-name="original" width="1438" height="1031" loading="lazy" alt="Electric cars in Nepal NT"> </figure>  Although the distance from the capital to the Korala border (470km) is four times longer than from Rasuwa (128km) &nbsp;and Tatopani (112km), it is still considered faster and more cost effective than shipping via India using sea routes.&nbsp; And then Nepal was engulfed in turmoil after the youth-led protests of 8-9 September and its aftermath. Many automobile showrooms around Thapathali including Tata, Hyundai and CG were vandalised and torched.&nbsp; Sushila Karki leads a caretaker government till elections are held in March, and the unsettled situation will affect the economy and investment climate as well as the automobile sector. Arnav Upadhyay reviews automobiles and promotes road safety under the handle Casually Annoyed Driver on <a href="https://www.youtube.com/@casuallyannoyeddriver" target="_blank">Youtube</a>, <a href="https://www.tiktok.com/@casuallyannoyeddriver" target="_blank">Tiktok</a> and <a href="https://www.instagram.com/casuallyannoyeddriver/" target="_blank">IG</a>, and this monthly column Drive Line in Nepali Times.

Is Nepal reaching peak EV?

Nepali Times: You just climbed Mt Everest without oxygen and then skied down the mountain. How does one even train for something like that?&nbsp; Andrzej Bargiel: What made skiing down Everest possible was all the years of experience I’ve gained in high-altitude mountains. Spending a lot of time in the high mountains helps me read the snow, the conditions, and potential hazards. I need to ski often, especially in steep and exposed terrain, so that it becomes a place where I feel completely at home.&nbsp; I also climb regularly, I am an IFMGA mountain guide. I also run, ride a bike, and work out in the gym. Like in any endurance sport, I have to prepare my body for the demands of an expedition.&nbsp; What motivated you to do Everest? This was actually my third attempt on Everest. After many years of ski mountaineering and racing, I felt it would be great to use that experience to take on a meaningful project in the Himalaya. It’s about exploring what’s really possible, testing my limits, and seeing how far I can go. I was inspired by people like Davo Karničar, Fredrik Ericsson, and Hans Kammerlander, who showed that skiing in the high mountains can truly be done.&nbsp; What do you have to be most careful about when skiing at such high altitude? You really have to manage your energy well, because you need to be ready to spend many hours at very high altitude — even above 8,000 meters. Risk management is essential. You have to read the signals nature gives you and make the right decisions, choosing safe moments to move. The dangers are always there: avalanches, crevasses, extreme fatigue, and exposed terrain, so you have to stay fully aware and focused. Safety comes first, always. You also need to stay open to changing your plans, because in the mountains, things don’t always go the way you expect.&nbsp; Why did you choose autumn and not spring?&nbsp; Autumn is really the only season when you can think about making a full ski descent from the summit all the way to base camp. In the spring there’s much more ice left after winter, and the snow cover is broken. A full descent simply isn’t possible then, because too much rock and ice are exposed. Of course, in spring it’s easier to climb the mountain. The conditions are more stable, the snow is firmer, there’s less avalanche risk, and you don’t have to wade through deep snow. The autumn ascent is very complex and demanding, which is why so few expeditions attempt it. But in autumn, skiing becomes possible. Several meters of fresh snow fall on Everest’s slopes, covering the rocks and ice, and that transforms the mountain into something wild, beautiful, and most importantly skiable. What was your favourite part this time? The moment I remember most fondly was reaching the summit — and that first stretch just below the top, when I clicked into my skis and started moving down through surprisingly nice snow. It felt smooth and natural, a kind of free, easy glide down toward the Hillary Step. I could feel the movement, the flow, and at the same time this awareness that I was skiing from the highest point on Earth. It was just a really good feeling. The Icefall was another special moment. I felt from a skier’s point of view that it really worked. I could make my turns, and the descent itself was fun, technical, but a beautiful one too — full of variety, weaving through ice towers and seracs that looked incredible in the sunlight. It was challenging, but also just pure joy.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251015141012_e9e671e07b089a7d59e4b9ba34df993180ae2dfcae3786113a4d48c515427b3d.jpg" data-media-id="editor_0" data-image-id="20251015141012_e9e671e07b089a7d59e4b9ba34df993180ae2dfcae3786113a4d48c515427b3d" data-rendition-name="original" width="1365" height="2048" loading="lazy" alt="Andrzej Bargiel NT"> </figure>  And what was most challenging? The hardest moment came on 14 September, during our first summit push attempt. We were breaking trail in deep snow and reached the South Col in the evening. I already knew we wouldn’t be going higher that night, so I decided to stay there, to use the climb to acclimatise.&nbsp; But after that attempt failed, the team completely lost faith that the project could still succeed. Almost everyone started packing up, convinced it was over, nobody thought that the snow would stabilise enough.&nbsp; I skied down from the Col early the next morning in really good conditions, while the rest of the team descended on foot. Rebuilding belief within the team that it could still be done was the toughest part, mentally. It took me several days to bring that energy and motivation back, to make everyone believe again that we could try once more. What was your support crew like?&nbsp; I want to thank the whole team — all team members from Poland, all those who contributed to the project, all the sponsors, and the Seven Summit Treks crew, especially Dawa Sherpa, who had the courage to go to the top with me.&nbsp; In the end, his courage made it possible. Doing it alone would have been almost impossible. With him there, I felt safe, and that made all the difference. What potential for skiing do you see in the Himalaya?&nbsp; Huge. There’s massive potential here both for ski touring and for a more recreational form of skiing. In the Himalaya, there are so many mountains you can ski from, and they don’t have to be eight-thousanders.&nbsp; There is an incredible amount of snow even in the lower valleys during the winter, which makes it a really interesting place for skiing. You can find great powder and enjoy long, wide runs.&nbsp; The key, I think, is to keep developing local guiding structures. There should be more certified guides in Nepal, Sherpas gaining guiding qualifications, and a proper professional rescue service. That would definitely increase the sense of safety for both skiers and tourists coming to the mountains. I’d love to come back to the Himalayas one winter just to ski in those lower parts — in deep snow, on much longer and wider skis – that would be pure pleasure. At those lower altitudes, the fun can be so much greater, with a more relaxed, freeride kind of feeling.