Nepal’s health sector continues to suffer from an equity gap: even when families have access to medical care, it is either unaffordable or of poor quality. &nbsp;&nbsp;&nbsp; Enter: a combination of artificial intelligence and telemedicine that could allow the country to leapfrog technology and reach people so far deprived of medical treatment.&nbsp; Over a tenth of Nepalis are forced to live with disease and disability because they cannot afford medical services. In government hospitals where treatment is supposed to be free, quality of care is poor. Many lose their lives simply because they do not get the right treatment in time. “Creating and using AI models may not sound like top priority for a country where even the most basic healthcare is still inaccessible,” admits Bishesh Khanal, co-founder of the NepAl Applied Mathematics and Informatics Institute (NAAMII). “But those that can benefit from AI are precisely countries like ours.” NAAMII’s research integrates AI, computing and robotics in healthcare and agriculture. By creating computational models, &nbsp;researchers use machine learning to devise tools to address medical &nbsp;conditions. With support from IISH (Institute for Implementation of Science and Health) NAAMII is working on an AI-guided screening tool for cervical cancer, which uses smartphone-captured images of the cervix to visually inspect and detect the condition even remotely. “With visual inspection, gynecology experts can diagnose patients of cervical cancer within minutes,” Khanal explains. “The problem is that Nepal’s socioeconomic and geological conditions make it difficult for such medical expertise to get to places."&nbsp; With AI tools and telemedicine, caregivers in remote regions can &nbsp;identify disease in consultation with specialists in the city. Another project NAAMII is working on is an AI-assisted tool that allows a smartphone to act as a microscope to detect diarrhoea parasites in contaminated vegetables, stool, and water. Read also: <a href="https://www.nepalitimes.com/news/healthcare-moving-from-hospitals-to-homes">Healthcare moving from hospitals to homes</a>, Sonia Awale  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20230709120748_b06b42866f77704ff6a7540df744be4c03bb6460e62960d8c28d23ce9cd1e936.jpg" data-media-id="editor_1" data-image-id="20230709120748_b06b42866f77704ff6a7540df744be4c03bb6460e62960d8c28d23ce9cd1e936" data-rendition-name="original" width="1600" height="900" loading="lazy" alt="AI healthcare NT"> <figcaption>Researchers at NAAMII discuss options for using AI for medical diagnosis. Photo: NAMMII</figcaption> </figure>  AI models that can also detect defects in the intestinal tract, and an algorithm for patients with a muscle disorder called dystonia that can classify what type of the disease a patient has, are some of the other technology NAAMII boasts. NAAMII’s work in the health sector aims to add to existing care providers so that even in remote regions, advanced medical procedures can be carried out by personnel with less expertise. AI models are also deployed at the Hospital for Children, Eye, ENT and Rehabilitation Services (CHEERS) in Bhaktapur, under the aegis of the non-governmental BP Eye Foundation. The centre developed a learning-based model integrating telemedicine with AI that allows non-skilled health workers to predict if patients have certain eye, ear, nose, and throat diseases. Two AI models to predict diabetic retinopathy and glaucoma, both of which are common causes of vision loss, were developed by feeding thousands of photographs to the AI system. These diseases are often overlooked or missed by doctors at clinics, but with both of these models diagnosis was more than 90% accurate. This disease prediction support is now provided at the Foundation’s outreach clinics across the valley, and also at the health camps organised by CHEERS. A 52-year-old patient from Lele came to a mobile clinic recently and although diabetic, was not on medication. She thought glasses would correct her vision loss. An image of her eye, analysed by the AI model at the camp, revealed that she had proliferative diabetic retinopathy. She was referred to a virtual consultation from an ophthalmologist at the CHEERS Hospital in Bhaktapur. Her eyesight was saved. &nbsp; “Telehealth and AI prediction is a model that can reach specialised diagnosis and treatment more easily to people who do not have to make an expensive trip to a hospital,” says Pranita Upadhyaya an IT professional at CHEERS. She adds: “Patients in remote villages can now receive virtual consultation with specialists. The AI models further ensure they are treated correctly for the exact condition they have.” AI also helps community health workers to build capacity and skill, as they can compare and confirm their own diagnosis with ones made by AI and at city hospitals. But there are also technological hurdles in implementation because of the scarcity of data in rural settings. Upadhyaya explains: “AI models rely on sizeable, varied datasets. These models lack the ability to contextualise like humans, and so when deployed in rural areas where medical records are sparse and datasets are biased, it affects the precision and dependability of AI forecasts.” To bridge this data gap the 2019 Digital Nepal Framework has provisions for a national digital health mobile application, a centralised telemedicine center, a comprehensive electronic health record, mobile health units, and the provision of e-maternal care. Read also: <a href="https://www.nepalitimes.com/here-now/an-eye-for-two-eyes">An eye for two eyes</a>, Yugottam Koirala  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20230709120752_04df4f35b8b41ac1c45600f6d6df030c7027309c8e98231f81c334f0c9ed2802.png" data-media-id="editor_3" data-image-id="20230709120752_04df4f35b8b41ac1c45600f6d6df030c7027309c8e98231f81c334f0c9ed2802" data-rendition-name="original" width="1926" height="958" loading="lazy" alt="AI healthcare NT"> </figure>  Like with everything else in Nepal, although this blueprint looks impressive on paper, implementation is almost non-existent, even after the government allocated Rs22 billion for it over the past four years. “Ultimately, how AI enters healthcare is through individualised, specific services,” says Khanal. “There will have to be separate AI tools and products for each niche within healthcare. We will always have to rely on the private sector to keep spurring the development of new AI products. The government’s role should be in formulating and regulating.” As of now, clear regulatory frameworks governing the use of AI or automated systems in Nepal’s healthcare are practically non-existent. The National Ethical Guidelines for Health Research 2022 sets the standards for research practices in health, but omits any implications of digital technology. The National Science, Technology and Innovation Policy 2019 mentions AI only in passing. “AI in and of itself cannot be operated without concrete ethical guidelines in place,” cautions Upadhyaya. “When coupled with healthcare, especially in unique contexts like rural Nepal, a whole new array of special ethical considerations arise. Regulations should strike a balance between facilitating innovation and ensuring responsible use of AI technologies.” Thanks partly to the pandemic, Nepal’s healthcare is shifting into the digital sphere, and this will make deployment of AI in the health system easier. This shift has been accelerated by public-private partnerships such as Nyaya Health Nepal in Achham, which works with the Ministry of Health and Population to set up Electronic Health Records (EHRs) to remotely coordinate care between doctors and patients. Says Upadhyaya: “We should move forward by involving government agencies, private sector, academia, and healthcare professionals to drive AI innovation in healthcare while safeguarding patient rights and societal well-being.” &nbsp;&nbsp; Read also: <a href="https://www.nepalitimes.com/here-now/the-karnali-s-hunger-emergency">The Karnali’s hunger emergency</a>, Anita Bhetwal

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Artificially intelligent medicine

<figure><img width="640" height="427" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114101128/63720a5e9c7e80680e0b559bjpeg.jpg" alt=""/><figcaption>Photo: SONIA AWALE</figcaption></figure>The spread of <a href="https://archive.nepalitimes.com/article/nation/long-distance-medicine-in-nepal,3521" target="_blank" rel="noopener noreferrer">telemedicine</a> is one of the most remarkable spillover effects of the <a href="https://www.nepalitimes.com/here-now/3rd-wave-in-2-years/" target="_blank" rel="noopener noreferrer">Covid-19 pandemic</a> worldwide, and could also transform healthcare in Nepal.In the US, the Center for Disease Prevention and Control (CDC) specifically recommended that health care facilities and providers offer clinical services through virtual means as a result of which growth in telehealth usage is 38 times higher than before the pandemic.The US was amongst the first adopters of telehealth and has also been a mature user of tele-ICU services, with an estimated 11% of American ICU beds under telemonitoring. Adoption of telemedicine was <a href="http://archive.nepalitimes.com/news.php?id=14607#.YhzApy8w3u1" target="_blank" rel="noopener noreferrer">slow to catch on </a>in the developing world due to insufficient communication infrastructure and status quo biases plus regulation deficiencies. But it witnessed a breakthrough during the pandemic, thus making the virtues of telemedicine apparent. Argentina had passed legislation to validate electronic prescriptions and launched TeleCovid, a public telemedicine provider.In Australia, Singapore, Indonesia, and the Philippines, governments have been making consistent efforts to advance the use of telehealth through subsidies, funding, and loosening certain health regulations during the pandemic.In developed countries, this was enabled by three factors: increased consumer willingness to use telehealth, greater provider willingness to use telehealth, and regulatory changes enabling greater access and reimbursements.While it is evident that government intervention and public sector support have been the key to creating favourable business environments for telehealth in those regions, Nepal seems to stand out.Read also: <a href="https://www.nepalitimes.com/latest/covid-crisis-can-spur-digitisation/" target="_blank" rel="noopener noreferrer">Covid crisis can spur digitisation</a>, Ashutosh M DixitDuring the pandemic, many startups and corporates in the country launched telemedicine and digital health services to meet the growing need. But, will the surge in telemedicine services be sustainable post the pandemic or will it retreat? In Nepal, the majority of dispensaries, hospitals, and doctors are located in urban areas where only 21% of the population resides. Even then, they are concentrated in better off urban centres.Which means rural, peri-urban, and urban slums lack adequate access to quality primary healthcare. Much of the care delivered in underserved areas is through public sector primary or community health centers.Health tech startups and firms have made a successful market entry at the height of the pandemic, the result of which led to an exponential boom in online consultations via apps, medicine delivery, and even health service at the patients' door.These gains should not detract from the need to enable to specialist and super-specialist care to the untapped population of Nepal.The government's telemedicine strategy in 25 remote districts in Nepal is defunct due to financial and operational constraints. How strategic choices and the manner of those choices cascade to the bottom of pyramid markets will determine the sustainability of health tech startups.During the Covid-19 pandemic, telehealth companies recorded an average growth of 70% in basic telemedicine demand as compared to 2020. As promising as it sounds, online consultations on their own may not be enough for it to thrive post-pandemic.It has to be integrated into other services like home healthcare where the physicians go to the patients' home to provide medical services including routine checkups, administering medication and collection of medical samples for diagnostic purposes. Read also: <a href="https://www.nepalitimes.com/banner/drones-to-the-rescue/" target="_blank" rel="noopener noreferrer">Drones to the rescue</a>, Lucia de VriesFully integrated patient record allows clinicians to serve the people best, no matter whether they are present physically or remotely. Home delivery of prescribed medications adds to the safety and convenience of patients. Another emerging trend in the industry is modern healthcare subscriptions which may help expand the service offerings through the app and make services financially accessible to patients.Built on proprietary technology, telehealth apps are seen to be the core products. Through the app, patients or their dependents can avail services of online video consultations, book hospital appointments, or even order medicines online.However, acquiring and retaining customers may be challenging due to changing customer needs and preferences in the long run. It is for this reason that companies have to offer more than the basics, with better user engagement and experience.This means business analysis and planning exercises, phase-wise implementation, regular updates, and zero errors leading to faster processing of information and lower latency.Globally, telemedicine has the potential to revolutionise healthcare by bringing down provider and patient costs as well as improving the accessibility to quality medical professionals.In Nepal, telemedine should not just be an off shoot of the pandemic lockdowns but a deliberate strategy to improve the state of public health infrastructure and services with digital connectivity options.But the private sectors' efforts to bring innovation and improvements towards digitalisation in the health care ecosystem in Nepal can be a precursor for the country's healthcare transformation. Due to this the sustainability of telehealth companies must be reviewed time and time again.Read also: <a href="https://www.nepalitimes.com/here-now/digitial-path-to-social-buffers-in-nepal/">Digital path to social buffers in Nepal</a>, Ashraya DixitBishal Raj Paudyal is a Chartered Accountant and an MBA from Asian Institute of Technology in Bangkok.

Sonia Awale

Healthcare moving from hospitals to homes

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141124/636cfc2c9c7e80680e0a0b73jpeg.jpg" alt="" width="1500" height="1000"/><figcaption>Photo: MONIKA DEUPALA</figcaption></figure><ul><li>Two years ago after going through a bad relationship, a 36-year-old Kathmandu-based doctor started getting suicidal thoughts. During the long months of lockdown, he would be on the rooftop and imagine jumping off to end it all. But before long he realised that he was causing self-harm, and sought help. He was diagnosed with depression, eight months into treatment he is rid of suicidal thoughts and is back to his outgoing ways.</li> <li>The bubbly young woman used to be the life of every party, but few of her friends and relatives realised what was going on inside her mind. As the pandemic hit, she started having violent thoughts about harming others and herself. The 22-year-old tried to deal with it herself, but two months ago she sought help from a mental health doctor. She was diagnosed with Obsessive Compulsive Disorder (OCD) and started treatment. Looking back, she advises others to also seek professional help in time.</li> <li>The young woman felt worthless, lacked confidence, avoided crowds and had self-inflicted cuts on her arm. Her inability to come in terms with her sexuality aggravated her sense of insecurity. When the pandemic foiled her plans, she blamed everything on herself, she felt irritated and uncertain, stopped attending virtual classes and her eating habits changed. She finally sought help for her depression and she is now under regular psychiatric counselling and medications. Grounding exercises in particular have helped her overcome self-harm and feelings of inadequacy. “I am okay now,” she says.</li></ul>As the pandemic turns lives upside down, there has also been a global <a href="https://www.nepalitimes.com/here-now/post-pandemic-mental-health-epidemic/" target="_blank" rel="noopener noreferrer">outbreak of mental health disorders</a>, and Nepal has reported a rise in suicides. However, as these cases show, professional counselling and medication can save lives.Recoveries rarely make news, only suicides do.“Most of my patients who attempted suicide have gone on to lead normal lives after they get treatment, and oftentimes they look back to their mental health crisis as nothing more than a lapse of judgment,” says psychiatrist and researcher Rishav Koirala.There has been a sharp rise in <a href="https://www.nepalitimes.com/latest/have-suicides-increased-during-nepal-lockdown/" target="_blank" rel="noopener noreferrer">suicides in Nepal</a> since the Covid-19 pandemic in March 2020 and subsequent lockdowns. Nepal Police data shows that in the last 12 months, there have been 7,141 reported deaths due to suicides nationwide, up from 6,252 the year before.Do not shy away from seeking help. If you, or anyone you know, would like to speak to a trained mental health professional, please contact:TUTH Suicide Hotline: 9840021600Transcultural Psychosocial Organisation-Nepal Crisis Hotline: 1660 0102005Mental Health Helpline Nepal: 1660 0133666Centre for Mental Health and Counselling Nepal Toll-free: 16600185080, Hotline: 1145Koshish Toll-free helpline: 166001-22322 (Bagmati Province)Patan Hospital Helpline: 9813476123National Suicide Prevention helpline operated by Mental Hospital Lagankhel and TPO: 1166<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141124/636cfc2e9c7e80680e0a0b74jpeg.jpg" alt="" width="640" height="475"><figcaption> </figcaption></figure>In a survey last year, <a href="http://www.tponepal.org" target="_blank" rel="noopener noreferrer">Transcultural Psychosocial Organisation (TPO) Nepal</a> which works with mental health compared five years of suicide data for March-July to see if there was any change during the lockdowns in 2020 and 2021.The results are revealing: suicides have been increasing steadily at an average rate of 8.5% every year, but it spurted to 19.4% in the first four months of the lockdown. Researchers also conducted key informant interviews across Nepal, who reported witnessing an increase in <a href="https://www.nepalitimes.com/latest/suicide-watch/" target="_blank" rel="noopener noreferrer">suicidal behaviours</a> in the community as well as health facilities.“We now have both quantitative and qualitative evidence that mental health problems have increased following the pandemic,” says TPO Nepal’s executive director Kamal Gautam. “And given that the majority of suicides are caused by psychological problems, we can say that Covid-19 has significantly contributed to its increase.”Mental health professionals have long been warning of an epidemic of psychological disorders following the Covid-19 crisis. They have reported an increase in anxiety, depression, post-traumatic stress disorder (PTSD), hypochondria, obsessive disorders and psychotic symptoms among the general population in the last two years.Economic collapse, job loss and slashed income due to the pandemic as well as <a href="https://www.nepalitimes.com/latest/in-nepal-lockdown-a-domestic-violence-spike/" target="_blank" rel="noopener noreferrer">increased domestic and sexual violence</a> and added workload during the lockdowns have all acted as contributing factors. In addition, those afflicted do not have normal social interactions that used to be a safety valve during more normal times.Moreover, many patients on treatment and medication have relapsed due to the limited access to health services, counselling and psychotropic drugs during the pandemic, and in many cases because of Covid phobia.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141124/636cfc319c7e80680e0a0b75jpeg.jpg" alt="" width="1052" height="690"><figcaption> </figcaption></figure>Up to 80% of suicides have mental health disorders as an underlying cause. A significant portion of cases are also a result of impulsive behaviour.Experts agree that the official <a href="https://www.nepalitimes.com/here-now/nepals-suicide-rate-vastly-underestimated/" target="_blank" rel="noopener noreferrer">numbers on suicides are vastly underestimated</a> due to a lack of suicide registry. Official figures are based solely on police data and post-mortems, and because of stigma associated with mental health, many families also often refrain from revealing the actual cause of death.Official records also do not take into account <a href="https://www.nepalitimes.com/here-now/in-the-minds-of-nepals-migrant-workers/" target="_blank" rel="noopener noreferrer">suicides of Nepali migrant workers overseas</a>, mainly Malaysia and South Korea. Similarly, suicides among those in the LGBTIQ community who have lost their limited sources of livelihood during the pandemic have been largely neglected.“Reported cases alone are not conclusive, but given that we now have a year and a half long trend and data, we have seen a significant increase in mental health disorders, and can assume that pandemic has played a crucial part in the rise in the number of suicides,” adds Rishav Koirala.<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.who.int/news-room/fact-sheets/detail/suicide" target="_blank" rel="noopener noreferrer">More than 700,000 people die by suicide</a> every year around the world, that is one in every 100 deaths -- more than HIV, malaria, breast cancer, or war and homicide. And for every suicide, there are many more who make attempts to end their lives.Nepal is among the countries with the highest suicide rates in the world and consistently ranks within the WHO’s top 10 list. The Nepal Health Research Council (NHRC)’s <a href="http://nhrc.gov.np/wp-content/uploads/2020/09/Factsheet-Adults-1.pdf" target="_blank" rel="noopener noreferrer">National Mental Health Survey</a> published earlier this year found the prevalence of suicidality (current suicidal thoughts, lifetime suicidal attempt and future likelihood of suicidal thoughts) to be high at 7.2% among Nepalis.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141124/636cfc339c7e80680e0a0b76jpeg.jpg" alt="" width="1464" height="752"><figcaption> </figcaption></figure>The first of its kind survey in Nepal interviewed 15,088 participants and was carried out before <a href="https://www.nepalitimes.com/opinion/coping-with-anxiety-in-new-lockdown/" target="_blank" rel="noopener noreferrer">the pandemic</a> from January 2019 to January 2020. The study revealed that 10% of Nepal’s adult population had mental health problems in their lifetime with 4.3% experiencing some disorders at present.Mood disorders and neurotic and stress-related disorders were among the most common <a href="https://www.nepalitimes.com/latest/tackling-nepals-mental-health-pandemic/" target="_blank" rel="noopener noreferrer">psychological problems among Nepalis</a>. The prevalence of lifetime disorders was found the highest in Province 1 (13.9%), in the age group 40-49 years (13.3%) and among males (12.4%). As for current disorders, Bagmati scored the highest (5.9%) as well as those in the age group 40-49 years (6.3%) and females (5.1%).These figures correlate with Nepal’s suicide data of the past five years. Despite fewer attempts, men accounted for 57% of total suicides, against 43% of women. Among minors, however, more girls died by suicide, which experts ascribe to possible victimisation and a higher prevalence of borderline personality disorder among younger females.Suicide deaths are also disproportionately distributed across Nepal with Province 1 recording 65 deaths per 100,000 populations. Lumbini and Gandaki follow closely with 58 and 52 per 100,000 respectively. Traditionally neglected by the state and economically disadvantaged Karnali, Far West and Province 2 regions have lower suicide rates.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141124/636cfc369c7e80680e0a0b77jpeg.jpg" alt="" width="2287" height="1816"><figcaption> </figcaption></figure>More people are dying of suicides in urban centres such as Kathmandu Valley and Ilam district, which reported 32 and 38 suicide deaths respectively per 100,000 populations last year against Rautahat’s 18 and Humla’s 6.This is in direct contrast with the global trends where 77% of suicides occur in low and middle-income countries. Unemployment and poor economic condition have long been associated with a high risk of suicides, but only up to a certain point, as proven by recent data. Japan, <a href="https://www.nepalitimes.com/here-now/dead-end-of-the-korean-dream/" target="_blank" rel="noopener noreferrer">South Korea</a> and Hungary with their higher per capita GDPs have some of the highest suicide rates in the world.“Poorer nations have weaker education and health systems, which translates into delayed or even lack of diagnosis but poverty is not a sole factor for suicides,” says Kamal Gautam. “Suicide is complex and there are multiple factors at play which means a linear approach to prevention would be incomplete, it needs an integrated approach.”Addressing underlying mental health disorders is the most effective way to prevent suicides. This means increased awareness and education about psychological disorders, which in turn can help <a href="https://www.nepalitimes.com/here-now/all-in-the-family/" target="_blank" rel="noopener noreferrer">reduce societal stigma</a>. An introduction to and discussion on mental health in the school curriculum can further sensitise the public.In addition to medication and counselling, societal structure and family dynamics is an important support system for individuals suffering from psychosis, trauma and depression. Telemedicine in particular has been essential in preventing self-harm during the pandemic-induced restrictions but mental health services need to be scaled up across the country.On the other hand, a strict regulation must be implemented on the <a href="https://www.nepalitimes.com/here-now/suicide-by-pesticide-in-nepal/" target="_blank" rel="noopener noreferrer">availability of pesticides</a>, an easy means of suicide for many. Access to alcoholic products must also be supervised with Nepalis known to self-medicate to cope with stress and trauma, in turn increasing the risk of self-harm and suicide.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141124/636cfc399c7e80680e0a0b78jpeg.jpg" alt="" width="1280" height="853"><figcaption> </figcaption></figure>But most of all, analysing suicide attempts can be a powerful tool for prevention. On average, there are six attempts behind every suicide. Up to 80% of people with suicidal ideation reveal their intention to either a family member, friends or their doctors within a month before their attempt.“We forget that even before the pandemic suicide rates were very high in Nepal and while the pandemic might have added to the problem, the figures alone don’t mean anything if we fail to also study suicide attempts to find a stronger link between the prevalence and the contributing factors,” says Rabi Shakya, psychiatrist and director of Patan Academy of Health Sciences.He adds: “Historically, there have been more suicides after than during the crisis due to the long-term socioeconomic impacts. So we must start preparing for the pandemic of mental health problems including suicides post-Covid. Our health care workers must be trained and fanned out across the country.”Nepalis are not new to mental health problems induced by a crisis. The 10-year-long Maoist insurgency killed 17,000 people but many more continue to suffer from <a href="https://www.nepalitimes.com/here-now/the-mental-scars-of-violence/" target="_blank" rel="noopener noreferrer">PTSD, depression, anxiety and distress</a>. A 2017 report published in the journal Lancet found as high as <a href="https://archive.nepalitimes.com/article/nation/stigma-and-silence-mental-health-nepal,3486" target="_blank" rel="noopener noreferrer">37.5% of the general public</a> had some form of psychological disorder.The <a href="https://www.nepalitimes.com/here-now/its-all-in-the-mind/" target="_blank" rel="noopener noreferrer">2015 earthquake</a> further added to Nepal’s epidemic of mental disorders. Survivors who had narrow escapes or lost family members reported increased panic attacks, anxiety and trauma.But <a href="https://archive.nepalitimes.com/article/editorial/the-republic-of-insomnia,3311" target="_blank" rel="noopener noreferrer">conflicts, disasters</a> and pandemics have shined a light on mental health with an increased national and foreign investment in prevention and management. With larger chunks of the population impacted, there is now more acceptance and the field is starting to get the priority it warrants.Says Rishav Koirala, WHO focal person for mental health post-2015 earthquake: “The best way to prevent suicides is to address underlying psychological disorders and crises, despite adding to the burden has helped normalise them because many more people can now relate and understand that they are treatable.”

Nepal sees spike in suicides during pandemic

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121140/636b91ab9c7e80680e06f104jpeg.jpg" alt="" width="960" height="640"/><figcaption>Photo: BIKRAM RAI/NEPALI TIMES ARCHIVES</figcaption></figure>Prashuma Malla had never felt so helpless as a physician. Her patient, a man in his 40s, was suffocating, incapable of drawing in breath.But the hospital ventilators were all occupied, and the central supply of oxygen was very low. She pronated her patient while his wife sobbed near him.“With no oxygen, we can do nothing,” said the 28-year-old second year medical resident specialising in anaesthesia at Bir Hospital in Kathmandu. “It is scary. It is non-stop. I try to tell myself everything is OK. But what can we do? Eight people have already died on my watch.”Malla and her colleagues are on the <a href="https://www.nepalitimes.com/here-now/protecting-those-who-protect-us-from-covid/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/protecting-those-who-protect-us-from-covid/&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNEZnm1Wh-lIyg9tsnCRr9-mgD_R4Q">Covid frontlines in Nepal</a>. Her world is a haze of 36-hour intense, and often terrifying shifts, at Nepal’s oldest and best-known public hospital.As in many <a href="https://www.nepalitimes.com/here-now/protecting-those-who-protect-us-from-the-epidemic/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/protecting-those-who-protect-us-from-the-epidemic/&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNELCBtyZv7D1U8LDXT-i7HJPRZbeQ">government hospitals in Nepal</a>, relatives follow patients in the wards, providing food and running to pharmacies to purchase medicine. <a href="https://www.nepalitimes.com/here-now/nepals-frontline-workers-brave-it-out/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/nepals-frontline-workers-brave-it-out/&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNGmvFGTkOC_M_eTcOYyHWYTMLFBJw">Bir Hospital is overwhelmed</a>. People are sleeping in hallways, stairways, curled up on patients’ beds, pacing from room to room.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121140/636b91ad9c7e80680e06f105jpeg.jpg" alt="" width="1500" height="850"><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121140/636b91b09c7e80680e06f106jpeg.jpg" alt="" width="768" height="513"><figcaption>Crowded Covid ward at Teku Hospital. Photo: AMIT MACHAMASI</figcaption></figure>Doctors believe many relatives are sick as well, but the hospital does not have enough PPEs for them, and there is a serious shortage of oxygen.“We are exposed to the virus all the time,” Malla said of her shifts with the sickest of patients. “Everywhere you go is a Covid ward.”Malla and her colleagues have also become counsellors. But with every patient, her job gets harder because most are in their 30s and 40s, and increasingly some in their 20s are being brought in.In the chaos, it calms her to explain every detail to relatives. What does it mean to be intubated? Why once intubated it is hard to take patients off, and they usually die if they are taken out. No, they cannot take the body to be cremated: only police or soldiers can remove it from the hospital.“They are confused, they have never seen someone come off an intubator. I remind them: there is no guarantee,” Malla said.Every move Malla makes, every decision she takes, she reports to her superior. And every day at the shift handover, she has to be careful with the safety precautions.At the end of her shift that lasts more than 24 hours, Malla heads home on her scooter through light traffic because of the lockdown. She lives in a tiny two-room apartment with her two brothers, and is terrified of infecting them.She washes immediately, including her mask and face shield. Masks are always on, they cook together. Briefly unmasked, she eats alone on a miniature terrace. She talks on Viber with her parents in central Nepal.Every day, sometimes every hour, they remind each other to stay safe. She tries to focus on her online medical classes. She doesn’t want to fall behind. But always that nagging fear. Death is lurking. Near her. Floating and invisible.Although Nepal’s second wave appears to have peaked, and the official number of Covid-19 cases and mortality is down, there are <a href="https://www.nepalitimes.com/latest/nepal-covid-19-impact-worse-than-official-figures/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/nepal-covid-19-impact-worse-than-official-figures/&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNGD_zw--sdgKNcbkUD2EUdjZg82Lw">doubts about how accurate the figures are</a>.The number of daily recoveries is now higher than new infections, and the official death toll is hovering around 100 every day, which is half what it was three weeks ago. The number of active cases fell below 100,000 for the first time in more than one month on Saturday. But there are still more than 1,500 <a href="https://www.nepalitimes.com/latest/nepal-designates-more-hospitals-for-covid-19-treatment/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/nepal-designates-more-hospitals-for-covid-19-treatment/&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNHxZUs6NeKiFHYbFIJkkSZzx7D9vg">patients in ICUs</a> nationwide, with 450 of them needing ventilator support.More and more cases in city and <a href="https://www.nepalitimes.com/here-now/at-the-covid-19-frontlines-in-rural-nepal/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/at-the-covid-19-frontlines-in-rural-nepal/&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNFpAtg51hSoSi41jBs4YjPKQ9MsVA">district hospitals</a> now are from the hinterland, and there are indications that the <a href="https://www.nepalitimes.com/editorial/nepals-humanitarian-emergency/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/editorial/nepals-humanitarian-emergency/&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNGRytlb8jAYJB_hKJQNVCuwiFBmEQ">virus has spread to the remotest communities </a>in the mountains where there is no hospital care. And no <a href="https://www.nepalitimes.com/latest/life-hangs-by-an-oxygen-tube-in-nepal/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/life-hangs-by-an-oxygen-tube-in-nepal/&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNF2Eis06JvGsCzy_McEPymUP-h5sw">supplemental oxygen</a>.<a href="https://www.nepalitimes.com/latest/in-nepal-virus-climbs-from-plains-to-mountains/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/in-nepal-virus-climbs-from-plains-to-mountains/&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNEsKzdZRZejQF0SGnV4lSHoAk0EHQ">In rural Nepal</a>, there is now hope from ground-breaking tele-health that is transforming medical care.Hari Neupane is fighting Covid-19 with his cell phone. He is simultaneously a doctor, nurse and mental health expert, and works with <a href="https://www.healthfoundationnepal.org/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.healthfoundationnepal.org&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNGdGiTiG90TCoPVsSwtrWug2LqVYA">Health Foundation Nepal</a>, a Kathmandu-based volunteer-staffed telemedicine service that reaches out to patients across 35 districts in Nepal via its Kathmandu hotline.Neupane leads a team of seven doctors in Dang Valley in mid-western Nepal. Because of the large numbers of workers returning from India and its rudimentary medical facilities, Dang bore the brunt of the pandemic in both the first and second waves.As the monsoon approaches, it is soon rice planting season but a national lockdown has left fields, streets and roads empty, void of the everyday crowds and cacophony of passing trucks.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121140/636b91b39c7e80680e06f107jpeg.jpg" alt="" width="1500" height="1000"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121140/636b91b69c7e80680e06f108jpeg.jpg" alt="" width="1500" height="1000">In Dang in western Nepal, the highways are empty because of the lockdown, while farmers are busy preparing for rice-planting. Photos: HARI NEUPANE<a href="https://archive.nepalitimes.com/article/nation/long-distance-medicine-in-nepal,3521" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://archive.nepalitimes.com/article/nation/long-distance-medicine-in-nepal,3521&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNGKSSvGC8yUXhCQ9FP5G-0uZmJjng">Telemedicine is new in Nepal</a>, and medical teams in the field in Nepal are supervised by Ashok Devkota, a doctor of internal medicine in Providence, Rhode Island, in the United States The organisation’s seven full-time workers and 50 part-time physicians are all volunteers.Most of Neupane’s patients across Nepal have Covid symptoms, but most have not been tested. Working closely with local health posts, Neupane’s team identifies symptoms, using cell phones – voice, photos and videos – as medical communicators.They connect patients via cell phone with pharmacies and if necessary source portable oxygen. The very sick are referred to the hospital.“We focus on people in home isolation and counsel them on the medicines they need and how to get them. We prescribe steroids and do follow-ups and notify local government officials,” Neupane explained.In Dang, cell phones have become transformative lifelines at many levels. They are a critical means of money transfers from relatives working abroad, so that families can pay school fees, medical bills and food.This year’s lockdown has made day-long walks to access medical care virtually impossible. Even if patients can get to a hospital, chances of a bed are slim. In Dang, there are only 155 intensive care beds and 15 ventilators, most of them occupied.Health Foundation Nepal advertises its telemedicine counselling through social media and newspapers. It cannot take blood tests, but with the help of local health workers can monitor oxygen saturation, blood pressure and temperature and can gauge the condition of the patients to recommend a solution.“Telemedicine existed in Nepal before but before Covid people did not accept it much, but now it is helping save lives,” said Ashok Devkota, the Nepali doctor in the US who supervises medical staff like Neupane half-way around the world Nepal. And as long as Neupane’s cell phone stays charged, he is on duty.The pandemic and political crisis in Nepal have increased the risk of Nepal becoming an imploding catastrophe. The country was just beginning to recover from the 2015 earthquake, and was struggling with pre-existing health challenges, and earlier this year was beginning to think the worst was over when the second Covid-19 wave struck.The health and economic crises <a href="https://www.nepalitimes.com/latest/covid-19-to-reverse-child-survival-gains/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/covid-19-to-reverse-child-survival-gains/&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNHA2oJKTj8wDzac2WJdbkvphDJODQ">threaten the gains Nepal has made</a> in the past years in fighting malnutrition, immunisation against other infectious diseases, child labour, early marriage and women’s rights.But if Nepal is a petri dish of disasters, it is also one of innovation and individual dedication. This pandemic once again is a place where despair is often met by individual and community fortitude by medical workers like Prashuma Malla and Hari Neupane.Donatella Lorch is a former New York Times foreign correspondent who lived three years in Nepal. She blogs at: <a href="https://tangledjourneys.com/about/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://tangledjourneys.com/about/&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNEHm4HaaRyE_KrqKL6VlN7zbgNjlQ">tangledjourneys</a>

Nepal’s doctors are like soldiers fighting a war

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131144/636cf2839c7e80680e09d913jpeg.jpg" alt="" width="960" height="640"/><figcaption>Photo: BIKRAM RAI/NEPALI TIMES ARCHIVES</figcaption></figure>Prashuma Malla had never felt so helpless as a physician. Her patient, a man in his 40s, was suffocating, incapable of drawing in breath.But the hospital ventilators were all occupied, and the central supply of oxygen was very low. She pronated her patient while his wife sobbed near him.“With no oxygen, we can do nothing,” said the 28-year-old second year medical resident specialising in anaesthesia at Bir Hospital in Kathmandu. “It is scary. It is non-stop. I try to tell myself everything is OK. But what can we do? Eight people have already died on my watch.”Malla and her colleagues are on the <a href="https://www.nepalitimes.com/here-now/protecting-those-who-protect-us-from-covid/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/protecting-those-who-protect-us-from-covid/&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNEZnm1Wh-lIyg9tsnCRr9-mgD_R4Q">Covid frontlines in Nepal</a>. Her world is a haze of 36-hour intense, and often terrifying shifts, at Nepal’s oldest and best-known public hospital.As in many <a href="https://www.nepalitimes.com/here-now/protecting-those-who-protect-us-from-the-epidemic/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/protecting-those-who-protect-us-from-the-epidemic/&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNELCBtyZv7D1U8LDXT-i7HJPRZbeQ">government hospitals in Nepal</a>, relatives follow patients in the wards, providing food and running to pharmacies to purchase medicine. <a href="https://www.nepalitimes.com/here-now/nepals-frontline-workers-brave-it-out/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/nepals-frontline-workers-brave-it-out/&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNGmvFGTkOC_M_eTcOYyHWYTMLFBJw">Bir Hospital is overwhelmed</a>. People are sleeping in hallways, stairways, curled up on patients’ beds, pacing from room to room.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131144/636cf2869c7e80680e09d914jpeg.jpg" alt="" width="1500" height="850"><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131144/636cf2899c7e80680e09d915jpeg.jpg" alt="" width="768" height="513"><figcaption> </figcaption></figure>Doctors believe many relatives are sick as well, but the hospital does not have enough PPEs for them, and there is a serious shortage of oxygen.“We are exposed to the virus all the time,” Malla said of her shifts with the sickest of patients. “Everywhere you go is a Covid ward.”Malla and her colleagues have also become counsellors. But with every patient, her job gets harder because most are in their 30s and 40s, and increasingly some in their 20s are being brought in.In the chaos, it calms her to explain every detail to relatives. What does it mean to be intubated? Why once intubated it is hard to take patients off, and they usually die if they are taken out. No, they cannot take the body to be cremated: only police or soldiers can remove it from the hospital.“They are confused, they have never seen someone come off an intubator. I remind them: there is no guarantee,” Malla said.Every move Malla makes, every decision she takes, she reports to her superior. And every day at the shift handover, she has to be careful with the safety precautions.At the end of her shift that lasts more than 24 hours, Malla heads home on her scooter through light traffic because of the lockdown. She lives in a tiny two-room apartment with her two brothers, and is terrified of infecting them.She washes immediately, including her mask and face shield. Masks are always on, they cook together. Briefly unmasked, she eats alone on a miniature terrace. She talks on Viber with her parents in central Nepal.Every day, sometimes every hour, they remind each other to stay safe. She tries to focus on her online medical classes. She doesn’t want to fall behind. But always that nagging fear. Death is lurking. Near her. Floating and invisible.Although Nepal’s second wave appears to have peaked, and the official number of Covid-19 cases and mortality is down, there are <a href="https://www.nepalitimes.com/latest/nepal-covid-19-impact-worse-than-official-figures/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/nepal-covid-19-impact-worse-than-official-figures/&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNGD_zw--sdgKNcbkUD2EUdjZg82Lw">doubts about how accurate the figures are</a>.The number of daily recoveries is now higher than new infections, and the official death toll is hovering around 100 every day, which is half what it was three weeks ago. The number of active cases fell below 100,000 for the first time in more than one month on Saturday. But there are still more than 1,500 <a href="https://www.nepalitimes.com/latest/nepal-designates-more-hospitals-for-covid-19-treatment/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/nepal-designates-more-hospitals-for-covid-19-treatment/&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNHxZUs6NeKiFHYbFIJkkSZzx7D9vg">patients in ICUs</a> nationwide, with 450 of them needing ventilator support.More and more cases in city and <a href="https://www.nepalitimes.com/here-now/at-the-covid-19-frontlines-in-rural-nepal/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/at-the-covid-19-frontlines-in-rural-nepal/&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNFpAtg51hSoSi41jBs4YjPKQ9MsVA">district hospitals</a> now are from the hinterland, and there are indications that the <a href="https://www.nepalitimes.com/editorial/nepals-humanitarian-emergency/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/editorial/nepals-humanitarian-emergency/&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNGRytlb8jAYJB_hKJQNVCuwiFBmEQ">virus has spread to the remotest communities </a>in the mountains where there is no hospital care. And no <a href="https://www.nepalitimes.com/latest/life-hangs-by-an-oxygen-tube-in-nepal/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/life-hangs-by-an-oxygen-tube-in-nepal/&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNF2Eis06JvGsCzy_McEPymUP-h5sw">supplemental oxygen</a>.<a href="https://www.nepalitimes.com/latest/in-nepal-virus-climbs-from-plains-to-mountains/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/in-nepal-virus-climbs-from-plains-to-mountains/&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNEsKzdZRZejQF0SGnV4lSHoAk0EHQ">In rural Nepal</a>, there is now hope from ground-breaking tele-health that is transforming medical care.Hari Neupane is fighting Covid-19 with his cell phone. He is simultaneously a doctor, nurse and mental health expert, and works with <a href="https://www.healthfoundationnepal.org/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.healthfoundationnepal.org&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNGdGiTiG90TCoPVsSwtrWug2LqVYA">Health Foundation Nepal</a>, a Kathmandu-based volunteer-staffed telemedicine service that reaches out to patients across 35 districts in Nepal via its Kathmandu hotline.Neupane leads a team of seven doctors in Dang Valley in mid-western Nepal. Because of the large numbers of workers returning from India and its rudimentary medical facilities, Dang bore the brunt of the pandemic in both the first and second waves.As the monsoon approaches, it is soon rice planting season but a national lockdown has left fields, streets and roads empty, void of the everyday crowds and cacophony of passing trucks.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131144/636cf28c9c7e80680e09d916jpeg.jpg" alt="" width="1500" height="1000"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131144/636cf28f9c7e80680e09d917jpeg.jpg" alt="" width="1500" height="1000">In Dang in western Nepal, the highways are empty because of the lockdown, while farmers are busy preparing for rice-planting. Photos: HARI NEUPANE<a href="https://archive.nepalitimes.com/article/nation/long-distance-medicine-in-nepal,3521" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://archive.nepalitimes.com/article/nation/long-distance-medicine-in-nepal,3521&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNGKSSvGC8yUXhCQ9FP5G-0uZmJjng">Telemedicine is new in Nepal</a>, and medical teams in the field in Nepal are supervised by Ashok Devkota, a doctor of internal medicine in Providence, Rhode Island, in the United States The organisation’s seven full-time workers and 50 part-time physicians are all volunteers.Most of Neupane’s patients across Nepal have Covid symptoms, but most have not been tested. Working closely with local health posts, Neupane’s team identifies symptoms, using cell phones – voice, photos and videos – as medical communicators.They connect patients via cell phone with pharmacies and if necessary source portable oxygen. The very sick are referred to the hospital.“We focus on people in home isolation and counsel them on the medicines they need and how to get them. We prescribe steroids and do follow-ups and notify local government officials,” Neupane explained.In Dang, cell phones have become transformative lifelines at many levels. They are a critical means of money transfers from relatives working abroad, so that families can pay school fees, medical bills and food.This year’s lockdown has made day-long walks to access medical care virtually impossible. Even if patients can get to a hospital, chances of a bed are slim. In Dang, there are only 155 intensive care beds and 15 ventilators, most of them occupied.Health Foundation Nepal advertises its telemedicine counselling through social media and newspapers. It cannot take blood tests, but with the help of local health workers can monitor oxygen saturation, blood pressure and temperature and can gauge the condition of the patients to recommend a solution.“Telemedicine existed in Nepal before but before Covid people did not accept it much, but now it is helping save lives,” said Ashok Devkota, the Nepali doctor in the US who supervises medical staff like Neupane half-way around the world Nepal. And as long as Neupane’s cell phone stays charged, he is on duty.The pandemic and political crisis in Nepal have increased the risk of Nepal becoming an imploding catastrophe. The country was just beginning to recover from the 2015 earthquake, and was struggling with pre-existing health challenges, and earlier this year was beginning to think the worst was over when the second Covid-19 wave struck.The health and economic crises <a href="https://www.nepalitimes.com/latest/covid-19-to-reverse-child-survival-gains/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/covid-19-to-reverse-child-survival-gains/&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNHA2oJKTj8wDzac2WJdbkvphDJODQ">threaten the gains Nepal has made</a> in the past years in fighting malnutrition, immunisation against other infectious diseases, child labour, early marriage and women’s rights.But if Nepal is a petri dish of disasters, it is also one of innovation and individual dedication. This pandemic once again is a place where despair is often met by individual and community fortitude by medical workers like Prashuma Malla and Hari Neupane.Donatella Lorch is a former New York Times foreign correspondent who lived three years in Nepal. She blogs at: <a href="https://tangledjourneys.com/about/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://tangledjourneys.com/about/&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNEHm4HaaRyE_KrqKL6VlN7zbgNjlQ">tangledjourneys</a>

Recent outrage in Sikkim over an Indian Army expedition climbing <a href="https://nepalitimes.com/here-now/saving-kangchenjunga">Kangchenjunga</a>, the world’s third-highest peak, has spiked attention to the need to balance mountaineering jobs with indigenous reverence for sacred landmarks. Kangchenjunga (8,586m) is not a peak as much as it is a mountain range with 16 peaks above 7,000m on the border between India and Nepal -- the word itself means ‘five treasures of the snows’ in Tibetan. Some of the highest prominences like Kangchenjunga West and Kangbachen are in Nepal, while the Main, Central and South Peaks are on the border. Climbing the peak from the Indian side has been banned since 2001 because the indigenous Lepcha community there regard the mountain as the abode of Dzoe-nga, the patron deity of Sikkim, which was an independent Himalayan Kingdom until it was annexed by India in 1975.&nbsp; Buddhists in Sikkim say their saint, Padmasambhava, recognised the mountain as a protective spirit. The state has declared the base of the mountain Kangchenjunga National Park, which covers an area one-third of Sikkim. ‘The act of scaling this sacred peak is not only a matter of serious concern but also a violation of both the prevailing legal provisions and the deeply held religious beliefs of the people of Sikkim,’ read a letter from Chief Minister Prem Singh Tamang (Golay) to Amit Shah, India’s Minister of Home Affairs and Cooperation.&nbsp; Tamang continued: ‘We further request Your Honour to take up the issue with the Government of Nepal to ensure that no future expeditions are permitted on the sacred mountain, in deference to the deeply held beliefs and cultural values of the people of Sikkim.’ Kangchenjunga was climbed for the first time exactly 70 years ago by a British team who told King Tashi Namgyal, the Choegyal of Sikkim, that they would not set foot on the summit. Since then, there have been about 532 successful climbs of the peaks and 52 have died while trying.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250628060616_5c268e08cf49f36b79ef9b31933fc2d9bf9a6f65414e7ca06dd028bf04e7ccc1.png" data-media-id="editor_1" data-image-id="20250628060616_5c268e08cf49f36b79ef9b31933fc2d9bf9a6f65414e7ca06dd028bf04e7ccc1" data-rendition-name="original" width="1782" height="1178" loading="lazy" alt="Kangchenjunga: too sacred to climb NT"> <figcaption>Indigenous communities in Sikkim held purification ceremonies following the Indian expedition to Kangchenjunga. Photo: THE VOICE OF SIKKIM / FACEBOOK</figcaption> </figure>  <a href="https://nepalitimes.com/here-now/peak-climbing-season-2025-s4abrxny">This spring climbing season</a> alone, there were 70 climbing permits for foreigners issued for Kangchenjunga by the Nepal government, and made it to the top while one French climber died.&nbsp; One of the expeditions this year was an Indian Army team led by Col Ranveer Jamwal, who has summited the highest peaks on all seven continents, and Mt Everest thrice. Jamwal’s team was on the final leg of a ‘<a href="https://economictimes.indiatimes.com/news/india/nimas-summits-mt-kangchenjunga-concludes-historic-har-shikhar-tiranga-mission-successfully/articleshow/121341315.cms?from=mdr">Har Shikhar Tiranga</a>’ (The Tricolour on Every Peak) mission to plant the Indian flag at the highest points of each of India’s 28 states. Kanchenjunga was the last peak they had left, and the hardest, but the expedition put five climbers on the summit. What seems to have incensed the Sikkimese is that while it has banned climbing the mountain from its side, it was an Indian military expedition that went to Nepal to climb the mountain. After news broke of the climb in May, the Sikkim Indigenous Lepcha Tribal Association asked people to observe purification ceremonies in temples across the state. Mayalmit Lepcha of the association acknowledged that the Sikkim government was also partly at fault: “I don’t think such an expedition could have gone forward without the state government being informed, so it could have done something to intervene. It shows weakness. What’s done is done, all we can do is carry out these sanctification ceremonies.”&nbsp; In 2000, one year before Sikkim’s ban, the state allowed an Austrian team to attempt Kanchenjunga’s northeast face for a fee of $20,000, on agreement that they would stop 10m before the summit. Despite this, there was outrage over the expedition on the grounds that it violated Indian laws regarding the defiling of religious sites and Sikkim’s rights to maintain its culture after merging with India. The Indian Army expedition was also seen to have circumvented Sikkim’s law and violated religious sensibilities by going through Nepal. While the team may have thought they were respecting Sikkim’s beliefs by finding a way to complete the mission, the people of Sikkim saw it as defilement.&nbsp; The somber mood of the Sikkim people at the ritual contrasts sharply with Jamwal’s sense of accomplishment. “Without a doubt, the most difficult summit of my life,” he told reporters after the climb. “It tested every ounce of our will.”&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250628060616_ccfe079c78dab788d19fe2080ee8a5d5dcb11de4157316f6d94e5964da097157.jpg" data-media-id="editor_4" data-image-id="20250628060616_ccfe079c78dab788d19fe2080ee8a5d5dcb11de4157316f6d94e5964da097157" data-rendition-name="original" width="787" height="377" loading="lazy" alt="Kangchenjunga: too sacred to climb NT"> <figcaption>Prayer flags along the Sikkim-Kangchenjunga trekking route. Photo: TREKKINGININDIA.COM</figcaption> </figure>  The <a href="https://nepalitimes.com/news/the-rise-and-fall-of-nims-purja">controversial Nepali-British mountaineer Nirmal Purja</a> was also on Kangchenjunga this spring the mountain, on a mission to summit all 14 8,000m peaks for a third time. He echoed Jamwal about the tough conditions: “The conditions above camp were extremely tough, with deep snow and challenging terrain—more crevasses than usual.” Nepal’s government has not said anything publicly, but it is unlikely that it will ban climbing on Kangchenjunga, since it is becoming popular with expeditions because of its technical challenges, and overcrowding on Mt Everest. Nepal does have bans in place for some of its mountains out of respect for local beliefs. <a href="https://nepalitimes.com/banner/to-open-machapuchre-for-mountaineering-or-not">Mt Machapuchre</a> (6,990m) the imposing pyramid that looms over Pokhara, for example, is seen as an icon of purity by the Gurung people and a symbol of Vishnu by the Hindu communities who live at its base. A strict climbing ban has been in place since 1957, when a British expedition led by Col Jimmy Roberts stopped 45m short of the summit – either because the last bit was too difficult or out of deference to local sentiments.&nbsp; Khumbila that stands above Namche Bazar is only 5,761m high, but like Kanchenjunga is considered the protector deity of the Sherpa people. Gauri Shankar on the Nepal-China border, called Chomo Tseringma by the local community, was off-limits between 1965 and 1979 due to its association with Lord Shiva and Gauri, his consort. Although expeditions are now allowed, there are not too many takers. In Tibet, climbing Mount Kailash is prohibited by the Chinese government because it revered by the Hindus, Buddhists and followers of the Bon faith. Even Mt Everest is regarded as sacred, and its Sherpa name is Chomolungma, Goddess Mother of the Earth.&nbsp; Economically, climbs on Kanchenjunga bring in decent revenue. This climbing season, the 41 permits, at $1,800 each, brought in $73,800. This is somewhat comparable to Makalu, Lhotse, and Annapurna I, but these numbers are dwarfed by the $4 million in <a href="https://nepalitimes.com/news/the-everest-industry">Everest permits</a>. Revenue from Kanchenjunga climbing permits is something Nepal could potentially forgo if necessary, but the expeditions also provide jobs to hundreds of high altitude guides, porters, base camp support staff and other logistical costs.&nbsp; As the third highest mountain in the world and the tallest in India, there will always be significant motivation to climb it from the Nepal side, especially as climbers are drawn by the technical climbing at high altitude.

Kangchenjunga: too sacred to climb?

The debate about who is less accountable to the public: politicians or bureaucrats is as old as Nepal’s democracy itself.
Some blame politicians for being beholden to the businessmen who finance their electoral campaigns, and are forced to return the favour with contracts and kickbacks when in power.&nbsp;
Others say it is civil servants who are neither civil nor servants, and know the inner workings of the system to exploit loopholes – they then teach ministers, MPs, mayors, or ward chairs which juicy projects can be squeezed. And everyone gets their share.
In reality, it is probably not a case of either, or. Both have their hands deep in the honey pot. Corruption is now such a given that yet another exposé in the mainstream press, like the latest visit-visa scam, does not raise eyebrows anymore.
We may have to edit Lord Acton’s famous quote to say that in Nepal we do not even need absolute power to corrupt absolutely. The ruling cartel has divvied up the spoils, so that no one ever faces charges. The three parties all know about the skeletons rattling in each other’s closets, and they cancel each other out.
Politicians and bureaucrats get all the blame for taking bribes, but what of the givers of bribes? In this crony capitalism, businesses invariably need political patrons in an elaborate <a href="https://nepalitimes.com/here-now/nepals-only-growth-industry-private-sector-corruption" target="_blank">national network of give-and-take</a>.
<a href="https://nepalitimes.com/here-now/nepals-only-growth-industry-private-sector-corruption" target="_blank">Politicians and businesses work hand-in-glove</a> so that conflict of interest in contracts, insider trading, cartelling, and non-performing assets of banks become the norm. Our survey after the 2017 local election showed that out of the 753 newly-elected local government chairs, <a href="https://nepalitimes.com/news/elected-contractors" target="_blank">nearly 300 were contractors</a> involved in sand-mining, quarrying, or transportation syndicates.
Nepal’s tycoons have discovered that instead of donating to election war chests of politicians, it is a much surer return on investment to spend the money to <a href="https://nepalitimes.com/news/the-business-of-politics-in-nepal" target="_blank">become legislators and politicians themselves</a>.
In democracies, there are checks and balances to control corruption when it becomes endemic. The Nepal Police and Central Bureau of Investigation (CBI) are supposed to do the detective work without political interference. The courts are required to be independent in dispensing justice and punishing crooks.
But the less said about the judiciary the better. A writ petition in the Supreme Court last week accused our sister magazine <a href="https://www.himalkhabar.com/" target="_blank">HimalKhabar</a> of contempt of court for two stories: one about how high courts have been overturning a majority of verdicts of district courts in cases of rape, and another about the Biratnagar High Court clearing a self-proclaimed holy man, Krishna Bahadur Giri, of rape despite police presenting physical evidence.
The doctrine of the separation of powers stipulates that it is when the other three pillars in a democracy are compromised that the role of the free press becomes even more vital. The world over, as soon as populist autocrats are elected to the executive, their first order of business is to co-opt the legislature and the judiciary. Then they buy off, intimidate, or neutralise the media with Strategic Lawsuits Against Public Participation (SLAPP).
Nepal’s officialdom seems to be taking midnight Zoom lessons from other despots on how to gag the media. Last month, popular talk show host Dil Bhushan Pathak was served an arrest warrant by the Kathmandu District Court for <a href="https://www.youtube.com/watch?v=-CntsnTrtG8" target="_blank">a YouTube explainer</a> about the alleged involvement of the son of Foreign Minister Arzu Deuba Rana in a reported purchase of Kathmandu’s Hilton Hotel.
The Lalitpur District Court ruled that Pathak could not be arrested without fair trial, but this week the Kathmandu District Court filed another case against the journalist based on a complaint by the Cyber Bureau, and put him on a fugitive list.&nbsp;
Without going into the veracity of Pathak’s explainer, it is deeply problematic that the Electronic Transaction Act has been invoked – proof that politicians are getting the courts and investigating agencies to make an example of a high profile journalist.&nbsp;
The intention is to silence media investigations into the fake refugee scandal in which the main partner in the ruling coalition is implicated, and in which one of its former home ministers was jailed last year.
The Kathmandu High Court has been mysteriously active in targeting journalists these days. <a href="https://bizmandu.com/" target="_blank">Bizmandu</a> and <a href="https://nepalkhabar.com/" target="_blank">Nepalkhabar</a> were served a notice last month <a href="https://nepalitimes.com/news/no-freedom-after-expression-y4inku06" target="_blank">to withdraw a story they did</a> on the Chair of the <a href="https://www.sebon.gov.np/" target="_blank">Security and Exchange Board of Nepal (SEBON</a>) Santosh Narayan Shrestha allegedly demanding kickbacks from hydropower investors.&nbsp;
Incredibly, the court even asked the two portals not to report on the subject anymore – a ruling so absurd that the Patan High Court overturned it a week later.&nbsp;
The allegations against Shrestha were made in a public meeting of the <a href="https://www.ippan.org.np/members/3060/bungal-hydro-ltd" target="_blank">Independent Power Producers Association of Nepal (IPPAN)</a>, and MPs demanded a <a href="https://myrepublica.nagariknetwork.com/news/parliament-demands-probe-into-sebon-chairman-over-alleged-commission-demand-40-32.html" target="_blank">Parliament inquiry</a> into the regulator. <a href="https://www.himalkhabar.com/144523/santosh-narayan-shrestha" target="_blank">HimalKhabar</a> reported this week that while Shrestha was reportedly demanding commissions from private investors for IPOs, he cleared primary share sales in Bajhang’s 10.75MW <a href="https://www.ippan.org.np/members/3060/bungal-hydro-ltd" target="_blank">Bungal Hydro</a> in which his family members have investments, company records show.
And then just on Monday, bureaucrats hoodwinked MPs by deleting references in a bill requiring a two-year ‘cooling off’ period under which retiring civil servants could be barred from holding constitutional positions for two years.
The contest for who is more corrupt: bureauacrats, politicians, or the private sector is on.
Kunda Dixit

SLAPPing Democracy

The monsoon this year arrived on time, and brought life-giving rain — irrigating paddy terraces, recharging groundwater, reviving springs, and increasing electricity generation.
But Nepal has to deal with either too much water or too little. On a clear April day before the monsoon, the hills of Sindhuli district were parched, and there were wildfires burning out of control. There had been no rain for the past six months.
And that has been the perennial crisis for Nepal’s farmers: that 85% of the rainfall occurs during just four months of the monsoon with little rain for the other eight months.&nbsp;
The water crisis is related to the powerful changes sweeping the mid-hill region of Nepal. With better roads, higher incomes and more exposure, many residents now aspire to have the kind of water supply seen in urban homes. They want hot or cold water at the turn of a tap, showers and flush tank toilets.&nbsp;
To meet this rising demand, many local and provincial governments are investing in large water supply projects often by lifting water from rivers hundreds of metres down the mountain. But these new systems may not be sustainable in the long run.
Many villages in Sindhuli are switching from local springs to piped systems, and even in rural homes, overhead tanks are becoming common.
But this new convenience comes with big challenges. Lifting water from rivers far below requires long pipes, electric pumps, and constant maintenance. These systems are costly, and the streams themselves often shrink to a trickle in the dry months. Big water-lifting schemes look impressive, but there is doubt if they can meet growing water demand.
A much more sustainable solution would be what some communities are doing: restoring old ponds or build new recharge systems. But those villages are exceptions, in most places traditional ponds and wallows are being filled up to be turned into sports fields, or make way for buildings.
Where there are new ponds, they are sometimes in the wrong places or without proper design. Roads and drains are not engineered properly and have increased landslides and erosion. Water management in hilly areas is not just about building things, it is about building in the right way, in the right place.
Traditional water systems were based on nature. They were not perfect, but they used the land wisely. Ponds used to hold rainwater and slowly refill springs which supported families, farms, and forests.&nbsp;
Not everything worked well in the past, but we can learn from traditional water management practices. Across Nepal, some rural municipalities have launched campaigns to store monsoon runoff — either in tanks, ponds or by recharging the aquifers.
But not all efforts have been successful. Some ponds are built without any hydrological study. Some are rushed to meet deadlines rather than real needs.&nbsp;
Now, the Muhan initiative hopes to revive springs to make households more resilient and help farmings. With the financial support of the Australian Centre for International Agricultural Research, research is being done to understand how springs work and how they are affected by changes in rainfall, land use, and development.&nbsp;
Instead of just building pipes and tanks, the project maps the entire springshed so we can understand the root cause of water shortage. In Sindhuli, the problem is not the amount of rain, but the loss of natural systems that store it and the social systems that manage water.&nbsp;
Nepal’s towns and villages now face a major challenge: how to manage water all year round as demand rises with people’s living standards. Depending only on river-lift systems is not a sustainable solution.&nbsp;
We need a mix of approaches that help store water from the rainy season to make it available for the rest of the year, whether by directly harvesting rainwater, restoring ponds, managing springsheds, or smart management of demand.
Rural Nepal is also seeing dramatic depopulation. Much of the outmigration can be stemmed if there is easier water supply for agriculture and household use. Across the mid hills, villages are emptying because springs are going dry. Government policy needs to catch up with the reality on the ground, and support solutions that work for people and nature. Every water supply plan should include recharge structures. Every road or building project should consider water flow and erosion. Local governments need more than budgets: they need training, tools, and data.
Ngamindra Dahal is with the Nepal Water Conservation Foundation, Kathmandu. Hemant Ojha collaborated in this piece and is associated with the Australian National University.

Water for Life

<a href="https://nepalitimes.com/multimedia/the-last-of-the-kusunda">The Kusunda</a> are among the last remaining hunter-gatherer communities left in Nepal, and it has only one fluent speaker left of a language that is not related to any other language group in South Asia.&nbsp; The Kusunda call themselves the King of the Forests ((गेम्येहाक़ in Kusunda,वन राजा in Nepali) and used to have a nomadic lifestyle till recently. But decades of exclusion from mainstream society and modernity have forced the Kusunda to assimilate. &nbsp; Today, most Kusunda live across Nepal’s mid-hills and western plains, choosing to identify themselves as Thakuri and adopting names like Sen, Shahi, and Khan to avoid ostracisation. Over time, inter-ethnic marriages between the Kusunda and other communities became increasingly common.&nbsp; However, the assimilation with other communities also meant that almost no one from the Kusunda community can speak their mother tongue – considered by linguists to be a ‘language isolate’ not related to any other language group in the world, and lacking set rules of grammar that are foundational to other languages. There are no words for ‘Yes’ or ‘No’ in Kusunda, nor are there words to signify direction. There are 23 languages with less than 1,000 speakers listed in Nepal's 2021 census, with Kusunda being the language with the least number of speakers. The number of people who identified as Kusunda has decreased with each subsequent census. Only 253 individuals identified themselves as Kusunda in the last National Census of 2021, down from 273 in 2011.&nbsp; <div class="embed-block"><iframe src="https://creators.spotify.com/pod/show/raithane-bhakha/embed/episodes/Kusundas---the-last-of-the-forest-kings-e23ge6p/a-a9peei1" height="102px" width="400px" frameborder="0" scrolling="no"></iframe></div> The government’s decision to provide a social security stipend to the community for the past few years has prompted many from the Kusunda community to reclaim their identity and in the process, explore their culture and language. Kamala Sen Kusunda, who lives in Dang, is the only fluent native Kusunda speaker alive, although there are now other Kusunda and non-Kusunda people learning how to speak the language. By the time Kamala Sen Kusunda was born in 1975, her family had settled in a village in Rolpa. Although she did not experience the nomadic life of her forebears, she still roamed the forests freely as a child and many of the values and socio-cultural practices of her community were instilled in her and her siblings.&nbsp; This meant that Kamala grew up speaking Kusunda with her family. But by then, the Kusunda had increasingly begun to interact with people beyond their community, and inter-ethnic marriages had become a norm.&nbsp; Kamala herself married at 18 to a 52-year-old man from the Chhetri community. She would go on to have four children, but they were brought up with her husband’s culture and community rather than her own, and teaching them her mother tongue seemed impractical.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250628030648_afaa298bf8ea3b7086e2ed086b11eab463ef2b20a82a4aad74df3dd2e922a4c3.jpg" data-media-id="editor_2" data-image-id="20250628030648_afaa298bf8ea3b7086e2ed086b11eab463ef2b20a82a4aad74df3dd2e922a4c3" data-rendition-name="original" width="855" height="641" loading="lazy" alt="Kusunda NT"> <figcaption>Gyani Maiya Kusunda with Kusunda youth in 2015.</figcaption> </figure>  “If I had spoken my language to them when they were children, they would have learned,” she tells us ruefully. “But they were growing up in a different community, so I never pushed, and they never expressed interest.” At the time, she had other things to worry about, such as earning a livelihood and sustaining her family. To find work, Kamala and her family moved to Shimla in India, where she worked at an apple orchard for six years.&nbsp; Over the next years, Kamala and her family moved back and forth between India and Nepal for work, and Kamala was not actively conversing in the language of her people or being able to connect with members of her community now scattered across Nepal.&nbsp; Had she not forgotten her language after all those years? “How could I forget the language of my ancestors?” she replies. “Not speaking it did not mean that it ceased to be a part of me.”&nbsp; Kamala had been working at a brick kiln in Thimi seven years ago when the National Language Commission tracked her down, offered her a paid position as a Kusunda language consultant and source person for basic language training in Dang.&nbsp; It was there that Kamala met her cousin Gyani Maiya Sen Kusunda, the only other person able to speak Kusunda fluently, who had been working with the Commission to conserve Kusunda language and culture. It was also where Kamala met language researcher and lexicographer Uday Raj Ale. Ale had been in the middle of his research into the Tharu language and community 15 years ago when he met Gyani Maiya Kusunda’s son, who told him that his mother was one of the few people who spoke Kusunda, but that no one had shown an interest in studying and preserving the language and culture. Ale met Gyani Maiya, spending time with her learning and researching Kusunda. By 2017, Ale had collected enough words to put together a Kusunda dictionary. The Kusunda vocabulary currently comprises 2,000 words. His research into the Kusunda language and culture has taken him to every known Kusunda household in Nepal. Although the census puts the number of Kusunda at 253, Ale reckons there are only 158.&nbsp; “Kusunda language is endangered due to its lack of use in everyday life, literature, and religious and socio-cultural practices, as well as the prevalence of inter-ethnic marriages,” explains Ale. In 2019 the Language Commission began its language transfer programs for youth from indigenous communities. Since then, the Commission has completed multiple phases of Kusunda language classes in Dang facilitated by Uday Raj Ale. The classes have 20 students, not just from the Kusunda community, but also interested non-native students.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250626120632_c6c378bc00af450f2b7f0cf17af1c3b2b6f7b7226927c458c3e01ec389869d33.jpg" data-media-id="editor_3" data-image-id="20250626120632_c6c378bc00af450f2b7f0cf17af1c3b2b6f7b7226927c458c3e01ec389869d33" data-rendition-name="original" width="1485" height="1535" loading="lazy" alt="Kusunda NT"> <figcaption>Students learning Kusunda with instructor Uday Raj Ale (second row, left)</figcaption> </figure>  Khamba Rokaya, who worked as a caretaker for young Kusunda children in Dang, became interested in learning the language as she sat in with the children during their lessons, and for the last few years has been among the few non-native Kusunda language learners in Dang. “I am not from the Kusunda community, but now that I have learned the language, I hope to do my part to carry on the work and share my knowledge with as many people as possible,” she says. “One way to ensure that we preserve this language is to extend its speaker base, both within the Kusunda and non-native communities.” Ale and Kamala have continued to work together since Gyani Maya’s passing in 2020, expanding the Kusunda vocabulary and creating appropriate curricula to fit the needs of the students as their knowledge of Kusunda expands.&nbsp; But without any documentation of Kusunda history, the community’s traditions, stories, values and language were at risk of being lost to time. “The loss of an ethnicity, language or culture in a country is akin to losing a vital organ, and a unique perspective of looking at the world,” says Ale. Which is why Archive Nepal in collaboration with the British Council’s Cultural Protection Fund and the UK’s Department of Culture, Media, and Sport in February launched a book of creative writings in the Kusunda language titled पिन्डा (meaning ‘The First’ in Kusunda): A Compilation of Kusunda Literature. The book is a collection of informative essays about the Kusunda language and culture, short stories that explore themes from nomadic life to universal Nepali experiences of poverty and migration, letters to loved ones, as well as conversational pieces by five Kusunda students ranging from ages 16 to 30. The works in the Kusunda language are also translated into Nepali and English.&nbsp; “Language is an important part of ethnic identity, and our indigenous languages cannot evolve or be conserved unless they are spoken or taught,” said Ale during the launch of the book earlier this year. “But most importantly, language exists as long as there exists literature in that language.” Kamala was in Kathmandu for the launch of the book, and smiled proudly as she looked at the young writers who had contributed to the collection. She said: “I’m glad the young people have chosen to learn and preserve Kusunda. Otherwise, our language would have died with me.” &nbsp;

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Water for Life

Saving the Kusunda language from extinction