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>

After a week of violent and destructive protests, Nepal’s President Ram Chandra Poudel on Friday appointed <a href="https://archive.nepalitimes.com/regular-columns/Legalese/justice-in-chief,804">former Chief Justice Sushila Karki</a> as a caretaker Prime Minister to lead an interim citizens' government.&nbsp; Poudel had been in <a href="https://nepalitimes.com/news/what-next-nepal">closed-door discussions since Thursday</a> with youth members who spearheaded the protests, constitutional experts, the House Speaker, and the Army Chief. There was a consensus on the choice of Karki as candidate for interim prime minister, but her swearing-in was stalled due to a disagreement about Constitutional processes for her appointment.&nbsp; Youth delegates and Karki demanded that Parliament be dissolved before the appointment of the caretaker prime minister, while President Poudel had been arguing that Parliament would be automatically dissolved once the new council of ministers announced elections. Representing the GenZ movement, <a href="https://nepalitimes.com/here-now/who-or-what-is-hami-nepal">Sudan Gurung</a> (pictured, below) is said to have insisted that dissolution of Parliament first was non-negotiable because he did not trust the political parties. He is said to have added that he would call his supporters out into the streets, and the President relented. The military’s warning earlier that an emergency would be declared if there was no agreement tonight clinched it.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025091216098_cdd409c5824b578a04f05a43280e3f475d92bf7123d3a4565b4d720768fcc1b3.jpg" data-media-id="editor_3" data-image-id="2025091216098_cdd409c5824b578a04f05a43280e3f475d92bf7123d3a4565b4d720768fcc1b3" data-rendition-name="original" width="1080" height="600" loading="lazy" alt="Sudan Gurung"> <figcaption>Sudan Gurung of Hami Nepali during negotiations.</figcaption> </figure>  With this, Karki becomes Nepal’s first female prime minister, exactly a decade after she became the <a href="https://archive.nepalitimes.com/article/interview/a-woman-is-as-capable-sushila-karki,3375">country’s first female chief justice in 2016</a>.&nbsp; Nepalis, still shocked by the <a href="https://nepalitimes.com/news/nepal-s-8-september-massacre">death and destruction of the past week</a>, heaved a sigh of relief at the announcement, which was greeted as a victory of youth power for political reform led by the GenZ movement. Its initial anti-corruption protest on 8-9 September <a href="https://nepalitimes.com/news/kathmandu-burns-despite-pm-resignation">spiralled out of control into violence and arson</a> nationwide that claimed at least 51 lives. Several other candidates were floated for the caretaker prime minister’s post. Kathmandu Mayor Balen Shah and former head of the electricity utility Kulman Ghising were being considered, but both declined possibly because they want to contest the next national elections. Given her experience in the judiciary and zero tolerance for corruption, Karki was the favourite of various groups within the GenZ campaign.&nbsp; The site of the negotiations moved to the official residence of the president in Shital Niwas from the Nepal Army Headquarters on Thursday. The Army had come under criticism on social media and from civil society for detaining the President and not letting him speak or be a part of the negotiation.&nbsp; This fuelled public perception that the military had a soft spot for a return of the monarchy. There were widespread rumours on Thursday that king Gyanendra, who was ousted after the abolition of the monarchy in 2008, was trying to stage a comeback by piggybacking on the agitation. Writing on X, senior journalist Kishore Nepal revealed that the Chief of Army Staff Ashokraj Sigdel had allegedly asked Poudel to step aside and pave the way for the military to negotiate, to which the President is said to have replied: “I will not resign. Kill me instead and blame it on the protesters. Then you can do whatever you like.” Live broadcast of swearing in of Sushila Karki:&nbsp; <div class="embed-block"><iframe width="560" height="315" src="https://www.youtube.com/embed/53go4OxuOa0?si=Zd89QGIAX8-7Bm75" title="YouTube video player" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share" referrerpolicy="strict-origin-when-cross-origin" allowfullscreen></iframe></div>  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025091219094_41b0f97a5925ab6969e1413636bf073ae43262893a55d9c177cb1312dea52f0d.jpg" data-media-id="editor_8" data-image-id="2025091219094_41b0f97a5925ab6969e1413636bf073ae43262893a55d9c177cb1312dea52f0d" data-rendition-name="original" width="1280" height="851" loading="lazy" alt="Sushila Karki swearing in"> <figcaption>President ram Chandra Poudel swearing in Sushila Karki as the 42nd Prime Minister of Nepal.</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025091303098_8f2b6f98898c4cd73c271caa51b8e29d679a7385c249380aeb96d7cc2c3f6dba.png" data-media-id="editor_9" data-image-id="2025091303098_8f2b6f98898c4cd73c271caa51b8e29d679a7385c249380aeb96d7cc2c3f6dba" data-rendition-name="original" width="1480" height="924" loading="lazy" alt="Sushila Karki PM"> <figcaption>GenZ representatives with new Prime Minister Sushila Karki after her swearing in.</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025091301098_470dbca4f4d34ca4533ce4d160045ffe8e525e98380f6f1e20eb24a6236c6029.jpg" data-media-id="editor_10" data-image-id="2025091301098_470dbca4f4d34ca4533ce4d160045ffe8e525e98380f6f1e20eb24a6236c6029" data-rendition-name="original" width="2048" height="1365" loading="lazy" alt="Sushila Karki PM"> <figcaption>Sushila Karki with supporters including Genz representative Sudan Gurung of Hami Nepal and Sumana Shrestha of Rastriya Swatantra Party.</figcaption> </figure>  COURAGE AND INTEGRITY Sushila Karki served as the chief justice between 11 July 2016 to 6 June 2017, and has been known for her frugal ways. She was a firebrand judge unafraid to ruffle powerful feathers, and as chief justice was behind ruling to impeach for abuse of office a powerful head of Nepal’s anti-graft body in 2016. She wrote that he had ‘<a href="https://archive.nepalitimes.com/regular-columns/Legalese/the-end-of-karkistocracy,827">neither the moral character nor qualifications for the post</a>’. Even before she became Chief Justice, Karki was one of the two judges on the bench that convicted the sitting Minister for Information and Communication, Jaya Prakash Gupta, of corruption in 2012. Then in 2016, a bench including Karki ruled against granting amnesty to former Maoist lawmaker and convicted murderer Bal Krishna Dhungel. Karki was born on 7 June 1952 in Biratnagar. She completed her undergraduate studies at Mahendra Morang College in 1972 before obtaining a postgraduate degree in political science from Banaras Hindu University in India three years later. This was followed by a Bachelor's in Law in 1978 from Tribhuvan University, and she started her law career as an advocate a year later. In 1985, Karki worked as a teacher at Mahendra Multiple Campus in Dharan, and was jailed for participating in the 1990 People’s Movement to overthrow the Panchayat absolute monarchy. She became a senior Advocate at the Nepal Bar Association in 2008 and was appointed an Ad-Hoc Justice at the Supreme Court in January 2009.&nbsp; On Thursday, there were supporters for other candidates for the post sloganeering against Karki’s nomination outside the Army Headquarters. Some on social media were also skeptical of her connection to the Nepali Congress (NC) party. Growing up in Biratnagar Karki was close to the family of B P Koirala, Nepal’s first elected prime minister in 1960. Her husband Durga Subedi was part of a group of underground Congress activists who hijacked a Royal Nepal Airlines plane in 1973, flying it to India to snatch cash belonging to Nepal Rastra Bank in the cargo hold.&nbsp; The money was used for the party’s pro-democracy campaign. Karki has no love lost for the political establishment. In April 2017, the governing coalition under Maoist Prime Minister Pushpa Kamal Dahal <a href="https://archive.nepalitimes.com/article/editorial/lady-justice-sushila-karki,3693">submitted an impeachment motion against her</a> after the Supreme Court overturned his decision to install a favoured police chief, violating succession based on seniority. It was a political move backed by Dahal’s coalition partner Sher Bahadur Deuba of the NC who was waiting to become prime minister for the 4th time. CHALLENGES AHEAD With Karki now in charge of the interim government, she has the daunting task of forming a council of ministers made up of amorphous and disparate groups from the GenZ, technocrats, and current politicians. Karki has said she will not prevent members of her cabinet from contesting elections, which means those with electoral aspirations like Kulman Ghising, Balen Shah and Sumana Shrestha could be asked to join. Karki has her work cut out as she has to get her team members to pull in the same direction to hold free and fair elections. She also has to make sure she has the support of the military without giving the generals too much say, while also smartly maneuvering Nepal’s precarious geopolitical ties with its giant neighbours, China and India. But most of all, the new prime minister must lay the foundations to not just physically rebuild the judiciary, executive and legislature but also ensure that elections will produce a more accountable and efficient government. Read also: <a href="https://nepalitimes.com/editorial/trial-by-fire">Trial By Fire</a>, Editorial

Madam Prime Minister of Nepal

Many had never heard of <a href="https://www.haminepal.org/">Hami Nepal</a>, the organisation that is part of the GenZ movement that did not just topple the government this week, but <a href="https://nepalitimes.com/news/what-next-nepal">pushed Nepal’s political system into new, uncharted territory</a>. It was part of an organic coming together of various youth groups fed up with Nepal’s corruption, mismanagement and lack of accountability. Hami Nepal and its GenZ comrades are now part of the negotiations with the Army to form an interim government. Hami Nepal is a non-profit dedicated to supporting communities and individuals in need, guided by its motto ‘For the People, By the People’. Its core mission is to assist individuals and communities in need, particularly during emergencies and crises, with a focus on directly connecting donors with recipients, and delivering aid efficiently and transparently. It was set up after the 2015 earthquake, but was formally registered and gained recognition in 2020 during the Covid-19 pandemic. Hami Nepal is led by 36-year-old civic activist Sudan Gurung who started the organisation after he lost his own son in the 2015 earthquake.&nbsp; Leading up to the events this week, it played a central role in guiding the demonstrations, using its Instagram and Discord platforms to circulate protest information and share guidelines. Other GenZ groups used their own WhatsApp groups and other fora.&nbsp; Among the 20 or so volunteers is Ronesh Pradhan, who spoke to <a href="https://nepalitimes.com/news/nepal-s-gen-z-protest-turns-deadly">Nepali Times on 8 September </a>morning during the GenZ rally, before the violence escalated.&nbsp; “The voices of young people matter. We can’t keep being ruled by the same old men,” Pradhan said. “Our generation is the future and if there are older leaders in government, they need to be competent and accountable. We are ready to lead this country forward.” Hami Nepal’s earliest visible campaigns include donating more than 400 blankets to Bir Hospital’s Covid unit in 2022, creating a plasma and oxygen bank during the pandemic, and distributing school jackets to children in rural districts. More recently, it mounted a relief effort in response to the 2023 Jajarkot earthquake, reaching over 13,000 families with shelter, food, and medical support. The organisation was also associated with the two-month ‘Save Ghopa’ campaign, demanding effective and smooth administration of the BPKIHS (B P Koirala Institute of Health Sciences) in Dharan. The organisation was also actively engaged in providing rescue and relief during the Kagbeni and Sindhupalchok floods this year. It even sent aid to Turkey after its 2023 earthquake. After the Kavre floods last year, Hami Nepal donated solar lights. Funding for Hami Nepal comes directly from public donations, with a policy of channeling 100% of received funds for aid distribution. Volunteers self-finance administrative costs, and the group publishes detailed expenditure figures, regularly sharing updates and transparency reports through their social media and website which it launched at its Annual General Meeting in Bhaktapur last year.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250911090920_cd40c472bd7e06cc038a2d77a431cba777b6f53e4374a0216c9af2c4feb56c88.jpg" data-media-id="editor_3" data-image-id="20250911090920_cd40c472bd7e06cc038a2d77a431cba777b6f53e4374a0216c9af2c4feb56c88" data-rendition-name="original" width="1080" height="719" loading="lazy" alt="Who, or what, is Hami Nepal?"> </figure>  Following the death of Nepali student Prakriti Lamsal at KIIT University in India earlier this year, Hami Nepal advocated for justice using its Instagram account, raising concern about the safety of Nepali students. Its advocacy platform started with rescue and relief, and Hami Nepal managed to develop a track record for efficient campaigns and transparency in Nepal’s humanitarian landscape. But its work pushed the group to realise that there was a deeper malaise in Nepali society. Its #youthsagainstcorruption campaign on social media platforms gained rapid momentum, and that led to the rally on 8 September. Read also: <a href="https://nepalitimes.com/news/nepal-s-8-september-massacre">Nepal’s 8 September massacre</a>, Shristi Karki The international #Nepobaby trend on TikTok propelled the rally even more, and young Nepalis used it to expose the scions of powerful politicians and politically-connected influencers who were exhibiting their flashy lifestyles on social media while citizens struggled with joblessness, corruption and poor service delivery. Public anger reached a tipping point when the UML-NC coalition led by Prime Minister K P Oli announced a sweeping ban on major social media platforms citing tax revenue, cyber security, and lack of content moderation. Netizens, civil society and media, however, saw it as the latest authoritarian attempt by the government to clamp down on free speech, increase surveillance of citizens and constrict Nepal’s open society. Susmita Khadka, 22, told us at the rally: “Politics is everywhere. Gen Z has the most platforms, and we want a revolution.” Leading up to 8 September, the GenZ movement disseminated information and reassured participants with volunteers readily available for help, medical support, and assistance. It put up a protest support helpline so that students needing assistance could get help. As the protests intensified, leaving at least 20 dead outside Parliament, and forcing Prime Minister K P Oli to resign, Hami Nepal shifted into a mediator role, engaging in talks with officials and seeking GenZ’s views on future leadership.&nbsp; Influencers like TikToker Nimesh Shrestha publicly backed the group, amplifying their voice in ongoing negotiations with the Nepal Army alongside other GenZ representatives. However, as the protests escalated on 9 September, <a href="https://nepalitimes.com/news/kathmandu-burns-despite-pm-resignation">resulting in massive arson and vandalism of public and private property</a>, many GenZ activists disavowed association with the attackers, saying their movement had been infiltrated. The group backtracked, with Gurung saying he was not the leader of the protests.&nbsp; Meanwhile, others accused Hami Nepal for singlehandedly speaking with the Army chief, and said that they did not represent GenZ’s collective voice. Most GenZ supporters backed <a href="https://archive.nepalitimes.com/regular-columns/Legalese/justice-in-chief,804">Former Chief Justice Sushila Karki</a> as their candidate for interim prime minister in an online group. Not everyone in the GenZ movement agrees with that choice, with support for Kathmandu Mayor Balen Shah, even though he has endorsed Karki’s appointment. Dharan Mayor Harka Sampang rushed to Kathmandu on Wednesday to push his own candidacy. Hami Nepal has supported Balen Shah to lead the country for the next five years, not just during the interim period, and have called on the public to share their posts supporting Shah to amplify the message. With the old guard gone, there is a power vacuum with multiple actors with competing interests to fill it. GenZ’s youth-led activism has brought new energy for political reform, but its real test begins now — whether it can unite Hami Nepal and other sections to negotiate with the Nepal Army.&nbsp;

Who, or what, is Hami Nepal?

As this story is being uploaded on Wednesday evening, sloganeering is going on outside the gates of the Nepal Army headquarters in Kathmandu between various GenZ groups about who should be the caretaker prime minister.&nbsp; The GenZ campaign includes Hami Nepal and several other groups that spearheaded the anti-government rally this week against corruption and neoptism. Thirty people died as the protests in Kathmandu turned violent on Monday and Tuesday. After Prime Minister K P Oli stepped down on Tuesday, Nepal has existed in a power vacuum, with no one really in charge. The Nepal Army took over security management from Monday night, and President Ram Chandra Poudel appealed to Nepali youth to come to the negotiating table.&nbsp; Thousands of GenZ youth held hours long discussions on Discord and other online fora on Wednesday, and voted to endorse former Chief Justice Sushila Karki to lead the transitional government. The group informed Chief of Army Staff Ashokraj Sigdel about their choice, but he has also been meeting leaders of at least 12 other groups claiming to be the genuine GenZs. Among them are royalist and other groups that many saw as having infiltrated the GenZ rally on Monday in which 20 people were killed while trying to storm Parliament.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250910170936_4efefa67f54228154d316ca692838c3d0c078f5f9ec96ea68cfc4ca740f4df4d.jpg" data-media-id="editor_0" data-image-id="20250910170936_4efefa67f54228154d316ca692838c3d0c078f5f9ec96ea68cfc4ca740f4df4d" data-rendition-name="original" width="640" height="387" loading="lazy" alt="Sushila Karki"> <figcaption>Photo: SHAHIDUL ALAM</figcaption> </figure>  On Tuesday, disparate groups joined the arson and looting that ended up gutting Singha Darbar, the Parliament and Supreme Court buildings and attacks on party offices, media, schools and private residences across the country. The original GenZ disavowed involvement.&nbsp; 'Nepal's 2015 Constitution does not envision any transitional or emergency provisions to address a state of political and constitutional vacuum. For now, the President, per Article 273 of the Constitution, can exercise emergency powers in light of the current situation,’ wrote former National Human Rights Commissioner Mohna Ansari on social media on Wednesday evening. The President can declare a state of emergency per Article 273 of the Constitution, but that must be endorsed by a two-third majority of Parliament within a month, after which it will be in effect for three months. ‘Former Chief Justice Sushila Karki is the best option to address the adverse circumstances prevailing in the nation. The President must heed the Constitution and take the next steps in a manner that is transparent, keeps the public informed, and is in the national interest,’ Ansari added.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250910140912_019d62de4b62a366299a27d1276e931a7dadefcc674441e7fb3acd503970efaf.jpg" data-media-id="editor_1" data-image-id="20250910140912_019d62de4b62a366299a27d1276e931a7dadefcc674441e7fb3acd503970efaf" data-rendition-name="original" width="8000" height="5760" loading="lazy" alt="Nepal in ashes"> <figcaption>Photos: KAMAL PRASAI</figcaption> </figure>  The Gen Z movement itself appears fragmented and without distinct leadership, both before the anti-corruption protests on 8 September and in the aftermath of the two-day protests.&nbsp; Various groups are said to have met or waited to meet the Gen Sigdel on Wednesday. The Army told others claiming to be GenZ and raising slogans against Karki’s candidacy to appear at the army headquarters on Thursday.&nbsp; Nepalis had floated the names of some of Nepal’s more acceptable public figures to lead a caretaker government, including Kathmandu mayor Balen Shah. But Shah told the Army chief he endorsed Sushila Karki’s nomination. <div class="embed-block"><iframe src="https://www.facebook.com/plugins/post.php?href=https%3A%2F%2Fwww.facebook.com%2FbalenOfficial%2Fposts%2Fpfbid02M9CBZiWETz4qocKaYUG6ZSZ4ARNcq231V8edJJVGQhPLmpSRMdv1mTWM2q7mJijjl&show_text=true&width=500" width="500" height="256" style="border:none;overflow:hidden" scrolling="no" frameborder="0" allowfullscreen="true" allow="autoplay; clipboard-write; encrypted-media; picture-in-picture; web-share"></iframe></div> The names of former NEA chief Kulman Ghising and ex-education minister Sumana Shrestha of the RSP had also been proposed.&nbsp; Polls conducted on social media to gauge public sentiment show a significant number are open to Sushila Karki taking charge of a transitional government. Both Shah and Shrestha are not so keen, and are probably waiting to contest elections.&nbsp; Meanwhile, Nepal’s young reform campaigners largely seem to reject the idea of handing leadership to RSP chair Rabi Lamichhane who was retrieved by supporters on Tuesday from Nakhhu jail after eight months of incarceration for embezzling depositers of cooperatives. But even as GenZ held discussions with the Army chief to decide on the interim government, other interest groups have continued to engage as well. Erstwhile royalist businessman Durga Prasai, posted a photo of himself with Sigdel on social media and professed that he has 'no interest' in leadership and would accept whomever GenZ youth chose. The job of the caretaker government, whoever leads it, will primarily be to hold free and fair elections for a new leadership which will then face the challenge of reestablishing Nepal’s democratic institutions.&nbsp; “The course of events showed that the movement has gone beyond Constitutional remedy,” political analyst Krishna Khanal told BBC Nepali following erstwhile Prime Minister Oli’s resignation on Tuesday. “There needs to be a middle-ground solution that will be acceptable to the people who took to the streets while upholding the existing constitutional process.” Various GenZ collectives have issued demands that include the dissolution of Parliament and the formation of a new civilian government, which analysts say are antithetical. Constitutional experts have suggested that the youth opt for a solution that allows for new leadership to move forward under the current Constitution.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250910140912_e6bf05bfe95f519e05ab8d9016587211b241340fd23a0f9ae728e74747fc5f29.jpg" data-media-id="editor_3" data-image-id="20250910140912_e6bf05bfe95f519e05ab8d9016587211b241340fd23a0f9ae728e74747fc5f29" data-rendition-name="original" width="8064" height="6048" loading="lazy" alt="Nepal in ashes"> </figure>  One option, they say, is for the President to appoint any prime minister from the existing Parliament under Article 76(5) if all other measures fail, who would then have the authority to appoint up to 25 non-elected ministers for six months. This can be a way for that temporary leadership to hold elections within the mandated time frame. The existing Constitution can then be amended to accommodate the aspirations of the Nepali youth after the election.&nbsp; But any conditions put forward by GenZ youth that requires a new Constitution might set Nepal back years, warn some experts. The 2015 Constitution was the result of nearly 10 years of negotiations and strife, and the formation of another charter will mean that Nepal will head into decades more of rotating governments and political instability. For now, Nepali youth need to unite to decide by Thursday who leads the country into the next phase.&nbsp;

What next, Nepal?

Edited: The paragraph about K P Oli's whereabouts has been deleted. On Wednesday morning, orange flames are still leaping out of the windows of Singha Darbar. Fire trucks which could finally make their way in, were trying to douse the fires. Most of the ministries inside Singha Darbar, including the Prime Minister’s Office, are charred hulks. Singha Darbar’s imposing west facade built by Chandra Shumsher Rana 117 years ago and the hall where he met visiting foreign envoys was destroyed in the 2015 earthquake. It was restored last year to its original splendour with stained glass windows and an ornate ceiling. After demonstrators entered the central government secretariat on 9 September they set the entire complex on fire. Dozens of SUVs and cars that were smashed and burnt litter the parking lot.&nbsp; Across to the south at the Supreme Court, a fire truck belonging to Kathmandu Metropolitan City is trying to put out the flames. The building is still smoking, and hundreds of case files have gone up in flames. There is now also a threat from escaped prisoners from jails all over the country.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250910100936_fd21ff82606c8ab6ec729b3758edb70e7f4498004d71ba7a857a86c9fb75f786.jpg" data-media-id="editor_0" data-image-id="20250910100936_fd21ff82606c8ab6ec729b3758edb70e7f4498004d71ba7a857a86c9fb75f786" data-rendition-name="original" width="1600" height="1066" loading="lazy" alt="Raising Nepal from the ashes"> <figcaption>Supreme Court sustained heavy damages following Tuesday's arson.</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250910100932_6c36bde0847f90934f6a40086a92573c1eec8f2967a4ddc59d79a56c08495628.jpg" data-media-id="editor_1" data-image-id="20250910100932_6c36bde0847f90934f6a40086a92573c1eec8f2967a4ddc59d79a56c08495628" data-rendition-name="original" width="7008" height="4672" loading="lazy" alt="Raising Nepal from the ashes"> <figcaption>Nepal Army cleaning up the debris outside the main gate of Singha Darbar.</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025091010098_f4c7d857ae1111968223d20ad02bda6ac0127a3fe4caaa779b35d0e8f07b3529.jpg" data-media-id="editor_2" data-image-id="2025091010098_f4c7d857ae1111968223d20ad02bda6ac0127a3fe4caaa779b35d0e8f07b3529" data-rendition-name="original" width="7008" height="4672" loading="lazy" alt="Raising Nepal from the ashes"> <figcaption>The grand staircase leading to the upper balcony of the Parliament building.</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250910100916_39154c14faa25b5a8838f75c9cb4aa7505f228bd344e19c8e29209cebfb25d46.jpg" data-media-id="editor_3" data-image-id="20250910100916_39154c14faa25b5a8838f75c9cb4aa7505f228bd344e19c8e29209cebfb25d46" data-rendition-name="original" width="6526" height="4350" loading="lazy" alt="Raising Nepal from the ashes"> <figcaption>Nepal Army armoured car guarding the Baneswor intersection outside Parliament.</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250910100916_1dabfef07b909c916aa462b7c0bb62a1db96ebe4f0b52d61f71140edffd429f4.jpg" data-media-id="editor_4" data-image-id="20250910100916_1dabfef07b909c916aa462b7c0bb62a1db96ebe4f0b52d61f71140edffd429f4" data-rendition-name="original" width="6677" height="4451" loading="lazy" alt="Raising Nepal from the ashes"> <figcaption>The row of electric vehicle showrooms in Thapathali were all torched with the cars inside.</figcaption> </figure>  Interestingly, the under construction Supreme Court, and the newly-built Parliament Complex are untouched. The current Parliament is housed in the Birendra International Convention Centre (BICC) built by the Chinese in 1993, and was the first target of protesters on 8 September. Outside its gates was where 20 students were shot and killed as they tried to storm the gates. After Tuesday’s mayhem, Kathmandu’s streets are now under control of the Nepal Army which has imposed a nationwide curfew. K P Oli was whisked out of his official residence in Baluwatar on Tuesday.&nbsp; Tuesday and Wednesday saw additional 8 casualties, including policemen who were lynched in Tinkune and Budanilkantha.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250910100916_1e93335333741ec809cff95e27e7b714bfea6af527c94c6f74f7cbd311562bbf.jpg" data-media-id="editor_5" data-image-id="20250910100916_1e93335333741ec809cff95e27e7b714bfea6af527c94c6f74f7cbd311562bbf" data-rendition-name="original" width="6539" height="4360" loading="lazy" alt="Raising Nepal from the ashes"> <figcaption>The parking area of the Department of Roads with a row of charred cars (also below).</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250910100920_a3e5a54cf11411c8b81a7b2a01c0f43bff451f343b7b2ce35de70d5719f35d30.jpg" data-media-id="editor_6" data-image-id="20250910100920_a3e5a54cf11411c8b81a7b2a01c0f43bff451f343b7b2ce35de70d5719f35d30" data-rendition-name="original" width="7008" height="4672" loading="lazy" alt="Raising Nepal from the ashes"> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250910100920_e75830d7d0e87dc8c451be3caccf1f00ef858b8299a20fe8c7dc8805d83a82aa.jpg" data-media-id="editor_7" data-image-id="20250910100920_e75830d7d0e87dc8c451be3caccf1f00ef858b8299a20fe8c7dc8805d83a82aa" data-rendition-name="original" width="6726" height="4484" loading="lazy" alt="Raising Nepal from the ashes"> <figcaption>A police vehicle set on fire by demonstrators at Patan Darbar Square on Tuesday.</figcaption> </figure>  The Army is negotiating with the president and representatives of the GenZ campaign that includes Hami Nepal group that organised the protests to form a new government. Kathmandu Mayor Balen Shah and former Supreme Court Chief Justice Sushila Karki have been named as potential candidates to lead the new government The Civil Aviation Authority of Nepal has decided to keep Kathmandu airport closed for all domestic and international flights ‘until further notice’. Update: The video of a flight attendant speakling on social media has now been found to be fake. The error is regretted.&nbsp;