<figure><img width="1920" height="1152" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108141120/636a57ce9c7e80680e054800jpeg.jpg" alt=""/><figcaption>Illustration: SONNY ROSS</figcaption></figure>The climate crisis is making people sicker – worsening illnesses ranging from seasonal allergies to heart and lung disease.Children, pregnant people and the elderly are the most at risk from extreme weather and rising heat. But the impact of the <a href="https://www.nepalitimes.com/banner/weather-warning-for-climate-meeting/" target="_blank" rel="noopener">climate crisis</a> – for patients, doctors and researchers – is already being felt across every specialty of medicine, with worse feared to come.<figure data-interactive="https://interactive.guim.co.uk/embed/iframe-wrapper/0.1/boot.js" data-canonical-url="https://interactive.guim.co.uk/uploader/embed/2019/09/archive-5-zip/giv-3902d8jdxgN0Ltya/index.html" data-alt="series linker"></figure>“There’s research suggesting that our prescription medications may be causing harm because of changing heat patterns,” said Aaron Bernstein, a pediatric hospitalist who is the co-director of the Center for Climate, Health and the Global Environment at Harvard University.Read also: <a href="https://www.nepalitimes.com/banner/mosquitoes-move-up-mountains-as-the-earth-warms/" target="_blank" rel="noopener">Mosquitoes move up the mountains as the earth warms</a>, Sonia Awale“There’s evidence that <a href="https://www.nepalitimes.com/opinion/turning-on-the-heat/" target="_blank" rel="noopener">extreme weather events</a> are affecting critical medical supplies so we can’t do things as we normally would do because IV fluids aren’t available.“And there’s evidence that extreme weather events are knocking out power more and more, and that is a huge issue for providing care in healthcare facilities.”In a recent example, a study in the Journal of the American Medical Association found that lung cancer patients undergoing radiation were less likely to survive when hurricane disasters disrupted their treatments.An August <a href="https://www.nejm.org/doi/full/10.1056/NEJMp1906035" data-link-name="in body link">article</a> in the New England Journal of Medicine lays out dozens of similar studies to show how the climate crisis affects each practice of medicine. Renee Salas, a co-author of the report, who teaches emergency medicine at Harvard Medical Schoolsaid: “The climate crisis is impacting not only health for our patients but the way we deliver care and our ability to do our jobs. And that’s happening today.”Read also: <a href="https://www.theguardian.com/environment/2019/sep/16/climate-crisis-health-risks-extreme-weather" target="_blank" rel="noopener">'Like a sunburn on your lungs': how does the climate crisis impact health?</a>, The Guardian<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108141120/636a57d19c7e80680e054801jpeg.jpg" alt="" width="200" height="200"><h2>Allergies</h2>Climate change makes <a href="https://archive.nepalitimes.com/article/nation/what-are-you-allergic-to,4151" target="_blank" rel="noopener">allergies</a> worse.As temperatures increase, plants produce more pollen for longer periods of time, intensifying the allergy seasons. Increased concentrations of carbon dioxide in the atmosphere can make plants grow more and <a href="https://www.ncbi.nlm.nih.gov/pubmed/25372614?dopt=Abstract" data-link-name="in body link">cause more grass pollen</a>, which causes allergies in about 20% of people. Carbon dioxide can also <a href="http://www.publish.csiro.au/fp/FP05039" data-link-name="in body link">increase the allergy-causing effects</a> of pollen.Neelu Tummala, an ear, nose and throat specialist at the George Washington Medical Faculty Associates in Washington DC, said she sees many patients with allergic rhinitis, or inflammation of the nasal cavity, congestion and post-nasal drip.“It used to be that tree pollens were only in spring, grasses were just in summer, ragweed was just in fall,” Tummala said. “But the timing of those is starting to overlap more.”One of Tummala’s patients, Kelly Kenney, had minor seasonal allergies as a child but now suffers from year-round from sinus pains, ear pressure and congestion.“The last four years, my symptoms have gotten increasingly worse,” Kenney said.<h2>Pregnancy and newborn complications</h2>Pregnant people are more vulnerable to heat and the <a href="https://www.nepalitimes.com/here-now/air-pollution-is-more-dangerous-than-smoking/" target="_blank" rel="noopener">air pollution</a> that is being made worse by climate change.Bruce Bekkar, a San Diego-based obstetrician gynecologist who stopped practicing six years ago to spend more time as a climate activist, has compiled 68 studies from the continental US on the association between heat, smog and the tiny particles of pollution that come from <a href="https://www.nepalitimes.com/banner/from-a-fossil-past-to-an-electric-future/" target="_blank" rel="noopener">fossil fuels</a> and how they are connected with premature birth, low birth weight and stillbirth.More smog forms when it is hot, and some research suggests particulate matter also increases with the <a href="https://www.nepalitimes.com/editorial/climate-damage/" target="_blank" rel="noopener">climate crisis</a>, although the data is less robust.Bekkar said he and his co-authors found a significant association in 58 of the 68 studies. The body of research covers 30m births in the US.Bekkar said doctors should talk to their patients about how heat waves could lead to premature births and how staying away from <a href="https://www.nepalitimes.com/opinion/toxic-bubble/" target="_blank" rel="noopener">air pollution</a> can help them keep their children healthy.“We’re finding that we have increasing numbers of children born already in a weakened state from heat and air pollution. That’s a totally different story than thinking about climate change as the cause of hurricanes over Florida … It’s a much more pervasive and ongoing impact.”In the developing world pregnant people can also suffer from food and water scarcity. <a href="https://www.nepalitimes.com/banner/mosquitoes-move-up-mountains-as-the-earth-warms/" target="_blank" rel="noopener">Insect-borne illnesses</a> – such as the Zika virus, which was spread by mosquitoes – are also a hazard to developing fetuses.<h2>Heart and lung disease</h2><aside data-component="rich-link-tag" data-link-name="rich-link-tag"> Air pollution gets worse as temperatures rise, stressing both the heart and lungs. The fossil fuel pollution that causes the climate crisis also is linked with increased hospitalizations and deaths from cardiovascular disease, and it is connected with more asthma attacks and other breathing problems. </aside>More intense <a href="https://www.nepalitimes.com/opinion/its-a-jungle-out-there-2/" target="_blank" rel="noopener">wildfires</a> spew dangerous smoke into the air, as documented in the western US this year. And hotter days make more smog, which the American Lung Association describes as acting “like a sunburn on your lungs which may trigger an asthma attack”.<h2>Risks for children</h2>Children under the age of five experience the majority of the <a href="https://www.nepalitimes.com/here-now/climate-health-emergency/" target="_blank" rel="noopener">health burden from climate change</a>, according to Salas’ report.Samantha Ahdoot, a pediatrician in Alexandria, Virginia, treated an 11-year-old and a 13-year-old who moved from Florida after a hurricane destroyed their community and their medical records at their doctor’s office.One needed surgery for a heart condition and had to start from scratch with a new cardiologist. Both had attention-deficit/hyperactivity disorder (ADHD) that was harder to treat amid the major life disruption and without records on adjustments to medication dosages. Ahdoot, who also founded the group Virginia Clinicians for Climate Action, said she has seen an influx of families moving because of weather disasters.<h2>Dehydration and kidney problems</h2>Much hotter days make it harder to stay hydrated. They are linked with electrolyte imbalances, kidney stones and <a href="http://archive.nepalitimes.com/article/Nepali-Times-Buzz/A-mysterious-rash-of-kidney-failures,3639" target="_blank" rel="noopener">kidney failure</a>. Patients who need dialysis as their kidneys fail can have trouble getting treatment during extreme weather events.<h2>Skin disease</h2>Higher temperatures and the depletion of the ozone layer increase the risk of skin cancer. The same refrigerants and gases that damage the ozone layer contribute to climate change.<h2>Digestive illnesses</h2>Heat is linked with higher risks for salmonella and campylobacter outbreaks. Extreme rains can contaminate drinking water. Harmful algae blooms that thrive in higher temperatures can cause gastrointestinal problems, too.<h2>Infectious disease</h2>Changing temperature and rainfall patterns allow some insects spread farther and transmit malaria, <a href="https://www.nepalitimes.com/banner/mosquitoes-move-up-mountains-as-the-earth-warms/" target="_blank" rel="noopener">dengue</a>, Lyme disease and West Nile virus. Waterborne cholera and cryptosporidiosis increase with drought and flooding.<h2>Mental health conditions</h2>The American Psychological Association created a 69-page guide on how climate change can induce stress, depression and anxiety. The group says “the connections with <a href="https://archive.nepalitimes.com/article/nation/stigma-and-silence-mental-health-nepal,3486" target="_blank" rel="noopener">mental health</a> are often not part” of the climate-health discussion.People exposed to or displaced by extreme weather or violent conflict are at higher risk for mental health challenges. Extreme heat can also make some mental illnesses worse.The University of Maryland’s Howard Center for Investigative Journalism found emergency calls relating to psychiatric conditions increased about 40% in Baltimore in summer 2018, when the heat index surged above 103F, as reported on <a href="https://www.npr.org/2019/09/04/757034136/how-high-heat-can-impact-mental-health" data-link-name="in body link">NPR</a>.And some psychotropic medications interfere with the body’s ability to regulate temperature – increasing vulnerability to heat.<h2>Neurologic disease</h2>Fossil fuel pollution can increase the risk of stroke. Coal combustion also produces mercury – a neurotoxin for fetuses. Diseases spread by mosquitoes and ticks increase the chance of neurological problems. Extreme heat is also linked with cerebrovascular disease, a disorder that affects blood supply to the brain.<h2>Nutrition</h2>Carbon dioxide emissions are lowering the nutritional density of <a href="https://www.nepalitimes.com/latest/ipcc-report-and-nepals-food-security/" target="_blank" rel="noopener">food crops</a>, reducing plant levels of protein, zinc and iron and leading to more <a href="https://www.nepalitimes.com/banner/junk-food-is-making-nepali-children-shorter/" target="_blank" rel="noopener">nutritional deficiencies</a>. Food supplies are also disrupted by drought, societal instability and inequity <a href="https://www.sciencedirect.com/science/article/abs/pii/S2211912418300063" data-link-name="in body link">linked with climate change</a>.<h2>Trauma</h2>Extreme weather events, including hurricanes, floods and wildfires, often cause physical injuries. Doctors see minor fractures, crush injuries and smoke inhalation. Extreme heat is also linked with aggression and violence, and the climate crisis globally is connected with violent conflict and forced migration.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108141120/636a57d29c7e80680e054802jpeg.jpg" alt="" width="360" height="180">This story originally appeared in <a href="https://www.theguardian.com/international">The Guardian</a>. It is republished here as part of Nepali Times' partnership with Covering Climate Now, a global collaboration of more than 250 news outlets to strengthen coverage of the climate story.

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'Like a sunburn on your lungs': how does the climate crisis impact health?

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108131148/636a50749c7e80680e04fd5ejpeg.jpg" alt="" width="1500" height="1125"/><figcaption>Photo: KUNDA DIXIT</figcaption></figure>“Can we tell the story so people get it?” US tv journalist Bill Moyers said at the launch of <a href="https://www.cjr.org/covering_climate_now/covering-climate-partnerships.php">Covering Climate Now</a>, a project aimed at breaking the climate silence that has long prevailed within too much of the news media.Co-founded by The Nation and the Columbia Journalism Review, in partnership with The Guardian, Covering Climate Now aims to convene and inform a conversation among journalists about how all news outlets—big and small, digital and print, TV and radio, US-based and abroad—can do justice to the defining story of our time.Covering Climate Now has among its members tv networks (CBS News), major newspapers in the US (The Philadelphia Inquirer, Minneapolis Star Tribune, San Francisco Chronicle, Seattle Times) and Asahi Shimbun and la Repubblica in Japan and Italy. Nepali Times is also a member.Other participating media include specialist publications (Nature, Scientific American, InsideClimate News, Harvard Business Review), distinguished digital publications (HuffPost, Vox, The Intercept, Slate) leading individual and institutional voices (author Bill McKibben; the radio and TV program Democracy Now!; Channel 4 UK correspondent Alex Thomson; veteran TV meteorologists Dan Satterfield, Mike Nelson, and Paul Gross); and many more.Each of these outlets has committed to running one week of focused climate coverage, to begin September 16 and culminating on September 23, the day of the landmark international <a href="https://www.un.org/en/climatechange/">Climate Action Summit</a> hosted by UN Secretary General Antonio Guterres in New York.“We’re not here to tell people what to write or broadcast. All that’s required is for each outlet to make a good faith effort to increase the amount and the visibility of its climate coverage—to make it clear to their audiences that climate change is not just one more story but the overriding story of our time,” said <a href="https://www.cjr.org/author/mark-hertsgaard-and-kyle-pope">Mark Hertsgaard the environment correspondent of The Nation and Kyle Pope</a>, editor of CJR.The point is to give the climate story the attention and prominence that scientists have long said it demands so that the public and policymakers can make wise choices, they said.Covering Climate Now seeks to fulfill journalism’s most sacred responsibilities: to inform people and foster constructive debate about common challenges and opportunities. Arguably, no problem in today’s world is more challenging, or offers brighter opportunities.In a report last October, scientists with the UN’s Intergovernmental Panel on Climate Change warned that humanity had just 12 years to slash heat-trapping emissions in half or else face catastrophic temperature rise and the record-breaking extreme weather it unleashes. Meanwhile, spectacular advances in solar, wind and energy efficiency illustrate how doing right by the climate can make our societies better, not worse, if we’re smart about it.To elevate climate coverage is no more of a value judgment than it is to sideline such coverage. For many years now, most of the news media, at least in the US, has done the latter. The major TV networks devoted more air time in a week this spring to a new royal baby in Britain than they did in the entire year to the climate story. When last October’s IPCC report was released, 28 of the 50 biggest newspapers in the US didn’t bother to tell their readers about it.The Covering Climate Now initiative includes:Print &amp; Online Newspapers and Magazines:<ol><li>The Columbia Journalism Review</li> 	<li>The Nation</li> 	<li>The Guardian</li> 	<li>The Philadelphia Inquirer/<a href="http://philly.com/">com</a></li> 	<li>HuffPost</li> 	<li>The Minneapolis Star Tribune</li> 	<li>Nature(UK)</li> 	<li>Scientific American</li> 	<li>The Conversation (UK)</li> 	<li>Asahi Shimbun(Japan)</li> 	<li>la Repubblica(Italy)</li> 	<li>Newsweek Japan(Japan)</li> 	<li>The Seattle Times</li> 	<li>Vox</li> 	<li>Slate</li> 	<li>The Intercept</li> 	<li>The Texas Observer</li> 	<li>The Coast(Canada)</li> 	<li>Harvard Business Review</li> 	<li>The (Colorado Springs) Gazette</li> 	<li>The Nepali Times(Nepal)</li> 	<li>CQ &amp; Roll Call</li> 	<li>Mongabay</li> 	<li>Maclean’s(Canada)</li> 	<li>National Catholic Reporter</li> 	<li>Yale Climate Connections</li> 	<li>Clean Energy Wire (Germany)</li> 	<li>IEEE Spectrum</li> 	<li>Talking Points Memo</li> 	<li>The Alpinist</li> 	<li>Rock and Ice</li> 	<li>La Tercera(Chile)</li> 	<li>Stuff (New Zealand)</li> 	<li>Newsroom (New Zealand)</li> 	<li>The Spinoff (New Zealand)</li> 	<li>Literary Hub</li> 	<li>Ecosystem Marketplace</li> 	<li>Renewable Energy World</li> 	<li>Ensia</li> 	<li>Jolon Indian Media</li> 	<li>Croakey Health Media (Australia)</li> 	<li>Planet Friendly News (Canada)</li> 	<li>San Francisco Chronicle</li> 	<li>Bay Nature</li> 	<li>Sludge</li> 	<li>The Shoestring</li> 	<li>The Junction (Australia)</li> 	<li>The Tyee</li> 	<li>InsideClimateNews</li> 	<li>Nexus Media</li></ol>TV &amp; Radio:<ol><li>CBS News (national)</li> 	<li>WNYC (public radio station for New York City area)</li> 	<li>WHYY (public radio station for Philadelphia area)</li> 	<li>WAMU (public radio station for Washington, DC, area)</li> 	<li>WBEZ (public radio station for Chicago area)</li> 	<li>WBUR (public radio station for Boston area)</li> 	<li>WFPL (public radio station for Louisville, KY area)</li> 	<li>WWNO (public radio station for New Orleans area)</li> 	<li>KQED (public radio station for San Francisco Bay area)</li> 	<li>Marketplace, daily business show of American Public Media</li> 	<li>The World, daily global news show of PRI and BBC</li> 	<li>Science Friday, public radio news program distributed by WNYC Studios</li> 	<li>Dan Satterfield, chief meteorologist, WBOC-TV, CBS affiliate in Salisbury, Maryland</li> 	<li>Mike Nelson, chief meteorologist, Channel 7 Denver, ABC affiliate in Denver</li> 	<li>Paul Gross, chief meteorologist, WDIV, NBC affiliate in Detroit</li> 	<li>The Years Project/Years Of Living Dangerously</li> 	<li>Politically Aweh, TV news show (South Africa)</li> 	<li>Elemental: Covering Sustainability(regional collaborative of PBS and NPR stations in Denver, Phoenix and Los Angeles)</li> 	<li>Democracy Now!(national radio and TV show)</li> 	<li>The Global GoalsCast</li></ol>Independent Journalists (outlets listed for identification purposes only):<ol><li>Bill McKibben, writer</li> 	<li>David Biello, TED Talks</li> 	<li>Alex Thomson, chief correspondent, Channel 4 News (UK)</li> 	<li>Yereth Rosen, formerly Anchorage Daily News</li> 	<li>Rex Dalton, formerly Nature</li> 	<li>Isabel Seta (Brazil)</li> 	<li>Michael Tatarski (Vietnam)</li> 	<li>Sean Holman (Canada)</li> 	<li>Nivedita Khandekar (India)</li> 	<li>Preti Jha (Singapore)</li> 	<li>Don Paul, contributing meteorologist, The Buffalo News</li> 	<li>Peter Schwartzstein, freelance Middle East environment correspondent</li></ol>Institutions:<ol><li>Climate Matters (Climate Central, George Mason University Center for Climate Communications, and Climate Communications)</li> 	<li>Solutions Journalism Network</li> 	<li>Boston University</li> 	<li>The Lancet Countdown On Climate Change and Health</li></ol>coveringclimatenow@cjr.org

World media joins to cover climate

<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108101136/636a239d9c7e80680e0417f8jpeg.jpg" alt="" width="1500" height="1125"/>Responding to a slew of reports in the international media about <a href="https://www.nepalitimes.com/banner/heli-rescue-fraud-tarnishes-nepals-image/" target="_blank" rel="noopener">insurance fraud in the trekking industry</a>, the Nepal government says it is cracking down on perpetrators, while planning action against an insurance investigator said to be behind the sustained negative coverage.Reports this week in <a href="https://www.nytimes.com/2019/01/25/world/asia/nepal-everest-insurers-fraud.html" target="_blank" rel="noopener">The New York Times</a> and <a href="https://www.independent.co.uk/travel/news-and-advice/nepal-everest-helicopter-scams-evacuation-rescue-travel-insurance-a8745601.html" target="_blank" rel="noopener">The Independent</a> quote a letter written to Minister of Tourism Rabindra Adhikari by Jonathan Bancroft, Managing Director of <a href="https://www.travellerassist.co/" target="_blank" rel="noopener">Traveller Assist</a>, in which he has threatened to get his clients to cut coverage if Nepal does not press charges against 17 trekking agencies, helicopter companies and hospitals it says are involved in claiming insurance for fake rescues.Read also:<a href="https://www.nepalitimes.com/banner/heli-rescue-fraud-tarnishes-nepals-image/">Heli rescue fraud tarnishes Nepal's image</a>, Robert SkinnerBoth stories quote Danny Kaine of Traveller Assist, who is said to have personally delivered the letter to the ministry in which Bancroft bluntly writes: ‘To be clear, this is an ultimatum! If our clients stop issuing travel insurance policies in Nepal … (it) will have a devastating effect on the tourism industry in Nepal, and your country’s reputation.’ (See box below.)<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108101136/636a23a19c7e80680e0417f9jpeg.jpg" alt="" width="181" height="172">The government appears to be taking the damaging media coverage seriously, and called an emergency meeting in Singha Darbar on Tuesday with Tourism Minister Rabindra Adhikari, representatives of the Ministry of Finance, the Central Bureau of Investigation and others.Read also:<a href="https://www.nepalitimes.com/latest/choppers-to-abc-banned/">Choppers to ABC banned</a>, Yuvaraj ShresthaAdhikari told Nepali Times: “We are committed to cracking down on insurance fraud, and set up a Committee last year to investigate. After that, the number of cases of helicopter rescues, especially unnecessary ones, had actually started to drop. Which is why we are concerned by the continued leaks to the international press, and the threatening tone of this letter.”The Ministry of Tourism says its statistics show that there were only 186 helicopter rescues in the autumn trekking season last year, a sharp drop from the 1,532 between March and May of 2018. (See graph below.)In the letter to the minister, Bancroft says his company had issued the 15 February deadline since ‘not a single charge has been laid’ on the companies named in the ministry’s report, which it said were still in business.<a style="color: #989898!important; text-decoration: none!important;" href="https://infogram.com/f3a5c6ea-cddc-4183-b708-ea4f7e14ab05" target="_blank" rel="noopener">Helicopter rescues</a><a style="color: #989898!important; text-decoration: none!important;" href="https://infogram.com" target="_blank" rel="nofollow noopener">Infogram</a>The incidence of fraudulent rescues claiming insurance has risen in the past four years, <a href="https://www.nepalitimes.com/banner/heli-rescue-fraud-tarnishes-nepals-image/">as reported by this newspaper</a> and others. Some trekking companies, in collusion with helicopter charters and hospitals, entice trekkers to opt for medical evacuation at an inflated fee, and share the profits. There have even been rumours of guides deliberately spiking the food of trekkers so they fall sick.Stung by the flurry of reports, the Tourism Ministry set up an investigation committee which issued its report in August. The Ministry then drafted new rules governing search, <a href="http://archive.nepalitimes.com/news.php?id=19077#.XFOgGM8zYnU" target="_blank" rel="noopener">rescue</a>, and <a href="https://www.nepalitimes.com/banner/going-to-great-heights-to-prevent-altitude-illness/">treatment of trekkers</a> to check fraud.However, Tourism Ministry officials themselves admit that the rules have not been enforced because of a lack of manpower. Says Secretary Krishna Devkota: “We are committed to investigate and take action against the guilty. These scams are having a negative impact on the industry ahead of Visit Nepal 2020.”A source at the Tourism Ministry disclosed that last August, after the investigation committee presented its report, a delegation led by Nabaraj Dahal of <a href="http://www.taan.org.np/" target="_blank" rel="noopener">Trekking Agents Association of Nepal</a> met the co-Chair of the ruling NCP Pushpa Kamal Dahal who then put pressure on Minister Adhikari to let those named off the hook.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108101136/636a23a29c7e80680e0417fajpeg.jpg" alt="" width="640" height="480">Some of the unscrupulous companies involved in the scam enjoy high-level political protection because they are party donors, offer free helicopter rides during elections, or provide complimentary hospital treatment.Prakash C Lohani of <a href="http://www.alpine-rescue.com/" target="_blank" rel="noopener">Alpine Rescue Service</a> which represents half the foreign insurers says: “The rescue business needs to be better regulated. We need to punish the guilty, and stop maligning the whole trekking industry.”Those involved in fake rescues play on the grey zone in which even physicians are not able to tell if a patient suffering from <a href="https://www.nepalitimes.com/banner/going-to-great-heights-to-prevent-altitude-illness/">altitude sickness</a> or <a href="https://www.nepalitimes.com/opinion/trekkers-with-the-trots/">severe diarrhoea</a>  needs immediate evacuation or will get better by simply descending and taking medicine. Many trekkers themselves agree to be evacuated at the slightest sign of trouble.Read also:<a href="https://www.nepalitimes.com/banner/going-to-great-heights-to-prevent-altitude-illness/">Going to great heights to prevent altitude sickness</a>, Peter Hackett <a href="https://www.nepalitimes.com/opinion/trekkers-with-the-trots/">Trekkers with the trots</a>, David R ShlimRam Sapkota of <a href="https://www.hsj.com.np/" target="_blank" rel="noopener">Himalayan Social Journeys</a> says the real problem is unnecessary rescues rather than fake rescues. “Some trekkers get seriously sick, others pretend to be more ill than they are. <a href="http://archive.nepalitimes.com/news.php?id=2912#.XFOhDc8zYnV" target="_blank" rel="noopener">Up in the mountains no one wants to take a risk</a>,” he adds.After the investigation and new rules, the Tourism Ministry says the number of unnecessary rescues have gone down. Strict enforcement of the guidelines, setting an upper limit for <a href="https://archive.nepalitimes.com/article/nation/Insurance,361">helicopter rescues</a>, a fixed price for hospital treatment, and monitoring compliance would prevent price gouging.“All they have to do to control fraud rescues is to enforce existing rules,” says Rajendra Bahadur Singh of <a href="http://mtnhelicopters.com/" target="_blank" rel="noopener">Mountain Helicopters</a>, who knows of rescues in which charter companies evacuate more than one trekker, but bill them separately. There is also conflict of interest: some travel and trekking agencies represent insurance companies, and approve final compensation payments to themselves.Says mountaineer Kaji Sherpa: “This scandal has tarnished Nepal’s image, and that of the many upright companies here. There should not be a cover-up, we should correct ourselves and book the guilty.”<h2>What is Traveller Assist?</h2>This Ireland-based company works on behalf of international insurance underwriters in Nepal and other ‘difficult countries’ on medical assistance, insurance processing and ‘cost containment’ – a euphemism for investigating and reducing false claims.All stories in the international media in the past year exposing insurance fraud in Nepal’s trekking industry quote <a href="https://www.travellerassist.co/" target="_blank" rel="noopener">Traveller Assist</a>’s Danny Kaine, an ex-soldier and a frequent Nepal visitor. This week, Kaine is said to have delivered a letter from Traveller Assist Managing Director Jonathan Bancroft addressed to the Minister of Tourism Rabindra Adhikari in which he has threatened to get his clients to stop issuing coverage for Nepal after 15 February unless those guilty of fraudulent rescues are charged. The letter was leaked to international media and got wide coverage.Ministry officials say they are now strictly monitoring unnecessary rescue flights, and claim that the numbers have come down. “We are surprised by these damaging leaks to the international press at a time when we were cleaning up the industry,” said a Ministry official. “We have taken note of the threatening tone of the letter. Who are they to be giving an ultimatum to the Government of Nepal on behalf of their clients?”Indeed, reputable agencies and hospitals in Nepal, while admitting there are dodgy companies involved in insurance scams, accuse Kaine of writing them emails soliciting all insurance business for himself. Ministry officials also refuted Kaine’s claim that he has an agreement with the government to uncover rescue fraud. The Police Central Investigation Bureau is reportedly probing Kaine’s activities in Nepal, and confirmed that he flew out this week.Many media reports quote Traveller Assist’s statistics on the fraudulent rate for the 3,200 helicopter rescues in 2018. Doctors specialising in high altitude medicine interviewed by Nepali Times say that even if a company had access to so many medical records of rescues, it would still be difficult to determine the exact condition of the patient, and whether a rescue was necessary or not in cases of Acute Mountain Sickness.In an interview in Kathmandu last week, Kaine denied writing emails to trekking agencies and hospitals, and demanded to see them. He added: “I don’t have any personal interest in this, but Nepali companies are cheating American, British and Australian insurance firms as reported in the international media. If the guilty are not charged, we will increase international attention on this issue.”In a separate note to Nepali Times on 29 January, Kaine said the emails about him were ‘fabricated … by one of the companies named in the fraudulent investigation’. He went on to accuse this paper of ‘acting on behalf of the companies accused of fraud … a very dangerous precedent to set for a journalist from a respected news agency in Nepal’.Earlier, in answer to a simple email query about whether Kaine really worked for Traveller Assist, Jonathan Bancroft was needlessly abrasive, and accused this reporter of trying to play him off against Kaine. Bancroft went on to add: ‘Mr Sharad, after asking some questions in the industry in Nepal about you … (it) _gives me the inclination to no longer communicate with you or your organization…’.

Nepal trekking industry in damage control mode

From stone spouts to cast-iron mains, Nepal’s water system and its struggle to provide safe water tells a larger story of power, disease, dependency — and lessons for the future. From 1823 to 1891, the Nepali state made just two notable interventions in Kathmandu’s drinking water system. The first was when Prime Minister Bhimsen Thapa commissioned a stone pout (hiti) to tap groundwater within the valley’s traditional supply system. The second came nearly 70 years later with Nepal’s first industrial-era water system, the Bir Water Works in 1891 under Prime Minister Bir Shumsher Rana. Linking these two milestones was the spectre of cholera. From the 19th century on there were seven global cholera pandemics. <a href="https://www.sciencedirect.com/science/article/pii/S0264410X19309995#bb0325" target="_blank">Originating in Asia</a>, the disease reached Europe and the Americas, the Vibrio cholera bacillus breeding in poor sanitation wherever it found it. The first wave erupted in 1817, followed by others in 1829, 1852, 1863, 1881, 1889 and, finally, in 1961, the seventh pandemic which still lingers on. London, the epicentre of the Industrial Revolution, was repeatedly stricken. In Britain ‘miasma’ foul air was blamed. &nbsp;In Nepal, cholera was seen as divine damnation. By the late 19th century, as Nepal’s relationship with Britain deepened, the Bir Water Works was inaugurated in 1891 as a defence against cholera. Whether cholera also shaped Bhimsen Thapa’s decision in 1823 is less clear. Contemporary records note the commissioning of Sundhara, but do not refer to the cholera epidemic raging at the time. The silence itself is telling: Nepal’s elites were ruling in the shadow of the disease. Bhimsen Thapa first resided in Thapathali Palace, which was built in 1802 by Nain Singh Thapa, father of Mathabarsingh Thapa, who would briefly become prime minister in the 1840s. In 1806, Bhimsen Thapa moved to Bagh Durbar, a new complex on the western edge of Tundikhel. Historians are vague about the water supply in the residences of the nobility, but wells and water hauled from rivers, ponds, canals, and other sources were likely the primary sources. A small hiti north of Bagh Durbar, near today’s Sun Dhara, may have supplied the palace. In 1823, Bhimsen Thapa had it enlarged, making it the last and largest state-built hiti in Kathmandu. Even as Bhimsen Thapa was involved in palace intrigues and border conflicts, Britain was engineering pipelines. By the late 18th century, Sir Thomas Simpson had invented the bell-and-spigot joint, making long-distance pipes viable. Fluid dynamics, dealing with pumps, pipes, and filters, was becoming a foundational discipline. In Kathmandu, the scourge continued. Cholera struck Kathmandu repeatedly, in 1862, 1867, 1872, 1874 and 1875. The 1872 epidemic, <a href="https://nepalitimes.com/news/kathmandu-in-the-time-of-cholera" target="_blank">according to historian Tom Robertson</a>, claimed between 200 and 250 lives a day. On average, cholera killed between 1,200 and 1,500 people annually in Kathmandu Valley, an enormous toll for its small population. The summer of 1885 was especially calamitous: a cholera epidemic ravaged Kathmandu and its periphery from the beginning of June until late August. The disease even breached the royal palace, reportedly killing 23 people, mostly young girls. Records show that 909 people received treatment at the British Residency dispensary, and estimates suggest that as many as 10,000 people perished in a city of 50,000. In November that year, Bir Shumsher seized power in a coup. He inherited not only a premiership but a Valley ridden with disease. Cholera was endemic, and it was accompanied by typhoid, smallpox, goitre, syphilis, and chronic dyspepsia. The The British Residency dispensary at Lainchaur was inadequate. “In a poor country like ours, wealth means health,” Bir Shumsher remarked, an unusually pragmatic admission that epidemics were not divine punishment but structural afflictions of urban life. He soon pledged to expand health care. In 1889, he opened Bir Hospital and staffed it with Indian doctors to treat cholera, typhoid, smallpox, and other prevalent illnesses. PIPED WATER Bir Shumsher also recognised the need for safe drinking water. Between 1866 and 1872, he had served as Nepal’s ambassador in Calcutta, and he must have seen water mains already in operation there, and a filtration plant inaugurated in 1870. Madras had installed such a system as early as 1800, Bombay constructed the Vihar and Tulsi reservoirs in the mid-19th century. In Kathmandu British Residency personalities such as George Gimlette must have urged Bir’s government to quicken the construction of the hospital and water system, yet the archival traces of such exchanges still await historical scrutiny. By the late 19th century, the British had developed a technological ecosystem for water supply, intakes, pipes, fittings, reservoirs, and trained engineers. Bir Shumsher appealed to the British Government in India for engineering assistance. A British engineer named Mr Feigneur surveyed Kathmandu to prepare maps, and estimated the volume of water that could be brought from the Rudramati River. In 1889, a more experienced engineer, Lockhart Matthew Sinclair arrived. He was a Scotsman educated at Wellington College and the Royal Indian Engineering College, with prior experience in constructing waterworks in Jubbulpore and the Viceregal Palace in Shimla. Appointed State Engineer of Nepal (1889–1892), Sinclair reviewed Feigneur’s plans, updated them, and chose the Bishnumati River as the source of the city’s drinking water. Sinclair’s design included a reservoir at Panipokhari, at 1,330m elevation and 30m above &nbsp;Tundikhel, thereby enabling gravity-fed distribution in pipes. With a capacity of 7,327 cubic metres, the reservoir could store nine days of supply.&nbsp; The system was designed to serve about 70,000 residents through both private connections and public standpipes. The reservoir was a single-compartment tank with an arched brick roof covered in earth and turf. Its brick walls were bonded with lime mortar and aggregate, and its floor was dressed with fly stone. Work on the valley’s water supply began in 1888, three years after Bir Shumsher seized power. The following year, Bir Hospital and the Bir Water Works took shape. The project involved some 40km of imported cast-iron pipes, weighing 1.866 million kg and inscribed with the marks of Scottish foundries ‘Ally and McLean’ and ‘Glasgow’. Construction required 620,000 man-days of labour and cost over Rs600,000. Transport costs inflated prices: <a href="https://commons-nepal.com/the-first-kaldhara-in-the-four-cities-of-the-valley/" target="_blank">a load of cement</a> costing Rs10 in Calcutta was worth Rs33 by the time it reached Kathmandu. Bir Water Works was inaugurated in September 1891, six years after the cholera epidemic. Water flowed out of 131 taps, including eight in Lainchaur, six in the royal palace, eleven in the prime minister’s palace, sixteen around Tundikhel, thirteen in Thapathali, seven in Thamel, and two in Naxal. The system’s designation, the term ‘works’ , echoes the Chelsea, Calcutta, and Glasgow Water Works, underlining its industrial pedigree. Water was also supplied to Phora Durbar, Bir Shumsher’s palace of music and dance whose fountains sprayed rose-scented water in a display of opulence. The <a href="https://commons-nepal.com/the-first-kaldhara-in-" target="_blank">Bir Dhara Works</a> was more than an engineering scheme: it was Nepal’s first modern public-health intervention. Safer drinking water curbed waterborne disease, and the number of cholera outbreaks declined, but were not eliminated.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260103020144_d5c22de54c0eaab680a166c5a7482839fdc09b60679109021d0504252a810254.png" data-media-id="editor_4" data-image-id="20260103020144_d5c22de54c0eaab680a166c5a7482839fdc09b60679109021d0504252a810254" data-rendition-name="original" width="865" height="535" loading="lazy" alt="Cholera and drinking water in Kathmandu"> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260103020144_a46075b6d759585df56a2bb8e5a07d85de7d9a69406165c32784fe30012c9971.jpg" data-media-id="editor_5" data-image-id="20260103020144_a46075b6d759585df56a2bb8e5a07d85de7d9a69406165c32784fe30012c9971" data-rendition-name="original" width="2791" height="3859" loading="lazy" alt="Cholera and drinking water in Kathmandu"> </figure>  “Now we have water to fight cholera, and I believe cholera will no longer prevail. After four years of piped water, the benefits have been greater than expected,” Bir Shumsher said in a proclamation. Despite this, the prevalence of poor sanitation, open defecation, cramped housing, and malnutrition meant that typhoid, smallpox, and dyspepsia remained endemic. The Bir Dhara system marked Kathmandu’s transition from reliance on wells, rivers, springs, and hiti to piped water, operating for several decades and laying the foundation for the expansion of drinking water services across the country in the late twentieth century. <a href="https://commons-nepal.com/the-first-kaldhara-in-the-four-cities-of-the-valley/" target="_blank">Extensions followed in Patan</a> under Chandra Shumsher, and Bhim Shumsher later added the Tri Bhim Dhara. Piped water systems were subsequently constructed in towns such as Kirtipur, Bhaktapur, Dhankuta, Pokhara, Dhulikhel, and Jajarkot which itself saw a deadly cholera outbreak in 2009.&nbsp; CHOLERA METAPHOR In 1933, Nepal’s first water bureaucracy, the Pani Goswara, was established, formalising state involvement in urban water supply. Yet even till the late 20th century, households continue to rely on a mix of sources, including public water networks, private vendors, rooftop storage tanks, borewells, wells, hiti, and household filtration. The lack of reliable water supply places disproportionate financial, physical, and psychological burdens on low-income households, underscoring how decades of infrastructure expansion have not translated into universal, reliable service. during challenges in governance, investment priorities, and regulation. Bir Shumsher also attempted to introduce <a href="https://www.ukaalo.com/news/cholera-in-kathmandu-1958/" target="_blank">basic hygiene measures</a>, such as pit latrines with squatting slabs. However, there is no record of these facilities being built in his palaces, later built palaces, or elsewhere. Sanitation conditions remained poor for both the elite and the general population. Open defecation or the use of crude pit latrines without proper waste disposal was common. With no drainage or sewer systems, human waste accumulated near homes, contributing to the spread of waterborne diseases. In 2019, Nepal declared itself ‘open defecation free’, a policy milestone, but this achievement masks the persistence of deeper problems. Urban areas generate some 867 million litres of wastewater daily, yet only 7% of it is treated before being discharged. Sewage flows untreated into rivers and streams, spreading cholera, typhoid, dysentery, and other diseases, particularly among children and vulnerable communities. Safe disposal of faecal sludge continues to be a major struggle for many communities and local governments. Besides Jajarkot, Godavari in Kathmandu Valley had a localised outbreak in 2024. This year, Birganj was struck by a cholera outbreak caused by a lethal combination of unreliable water supply, groundwater overpumping, poor drainage and hygiene, and unsafe waste disposal. And Nepal’s peacekeepers deployed after the earthquake in Haiti in 2010 were blamed for spreading cholera that ultimately killed 30,000 people in the Caribbean nation. The Bir Water Works was more than a reservoir and pipes. It was Nepal’s first brush with modernity, mediated through engineering and haunted by cholera. More than 134 years on, cholera remains a threat and a reminder of Nepal’s challenges in water and sanitation governance. The issue is not merely ensuring access to safe water but also building public trust that quality essential services can be delivered equitably, sustainably, and with resilience. Ajaya Dixit is a Kathmandu-based researcher exploring Nepal’s water history since the mid-eighteenth century to inform ethical water and river management in a changing climate.

Life in a time of cholera

As someone born and raised in Patan, I knew that the city was rich in art, architecture and intangible heritage. But I never realised just how rich, and how little I knew about its hidden treasures until this book. Yala Mhasika/Exploring Lalitpur/Lalitpurko Chinari is published by the Lalitpur Chamber of Commerce &amp; Industry and introduces the city to the world, as well as to its own inhabitants. Lalitpur is popularly known as Patan, probably because of the pastures for livestock in its outskirts. Its original name in Nepal Bhasa is Yala, and is a blend of urban and rural, old and new.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260101120152_700fb4c7b27d78813f69347846403c492cd1d54e2f62e4ec097013714c4a2022.jpg" data-media-id="editor_0" data-image-id="20260101120152_700fb4c7b27d78813f69347846403c492cd1d54e2f62e4ec097013714c4a2022" data-rendition-name="original" width="2000" height="1333" loading="lazy" alt="Exploring Lalitpur book review"> <figcaption>Patan Dhoka</figcaption> </figure>  Like other kingdoms in the valley of Swoniga, the dense urban cluster of houses, temples, monasteries were situated along the higher ground, while the farmlands were on the slopes leading to the rivers below. This unique townscape combined an urban lifestyle within a distinctly agriculture-based rural setting. The fertile soil, replenished by organic nutrients washed down from the streets above, as well as Kathmandu’s location on the ancient trade route between India and Tibet, provided the Valley’s kingdoms with prosperity – and thus the flourishing of art and culture over centuries. Most of Yala’s residents were farmers, traders, or artisans. Chinese visitors who came to Nepal in the 6th century saw that there were more traders than farmers, and more temples than houses. An entire street is inhabited by the descendants of Lhasa traders. Arniko is supposed to have been born in Yala.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260101120152_0fb490355fac9b8252c9abfbf5ef1bbac844b29103744a421eb6ef6dbc77dff7.jpg" data-media-id="editor_1" data-image-id="20260101120152_0fb490355fac9b8252c9abfbf5ef1bbac844b29103744a421eb6ef6dbc77dff7" data-rendition-name="original" width="2000" height="1332" loading="lazy" alt="Exploring Lalitpur book review"> <figcaption>Kwonti area which houses five-storey Kumbeshwar temple dedicated to Shiva and Baglamukhi temple dedicated to Dasa Mahavidya shakti peeth.</figcaption> </figure>  Nepal exported goods and even minted coins for Tibet, and had a virtual monopoly of the major trans-Himalayan trade routes. This prosperity was reflected in monuments and shrines like the Kwa Baha Golden Temple. More so than the other three kingdoms of Swoniga, architecture flourished in Yala making it the centre for metal, stone and wood craft. The name Lalitpur means ‘city of fine art’ but with its sense of community, it might as well be a city of fine living. Legend also has it that the name Lalitpur comes from a farmer called Lalit who helped bring the rain god Karunamaya from Assam when the Valley was suffering a prolonged drought. Lalit’s shoulder beam stands to this day in Jhatapol. Disasters, invasion and <a href="https://nepalitimes.com/here-now/life-in-a-time-of-cholera">epidemics</a> were a recurring theme in Patan.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260101120152_b33b1024cb7a46f49fea35ecc9afa2740895907059d7a43c8bd6c463b1be05e7.jpg" data-media-id="editor_3" data-image-id="20260101120152_b33b1024cb7a46f49fea35ecc9afa2740895907059d7a43c8bd6c463b1be05e7" data-rendition-name="original" width="2000" height="1333" loading="lazy" alt="Exploring Lalitpur book review"> <figcaption>Ajima of Haugal Tole which is the oldest stone scripture in Nepal with the Gaja Laxmi in Chyasal.</figcaption> </figure>  The book was put together by the heritage expert team of Rosha Bajracharya, Sunil Pandey and Anil Chitrakar and provides a socio-economic and political history of Patan – how it was always food surplus, thanks to sustainable farming until recently. Ground and drone images by Photo Venture Nepal in the book give us a rare new perspective on Patan. There is an entire chapter on the chariot festival of Karunamaya (Machhindranath), a community-managed festival with Barahi carpenters assembling the woodwork, vine engineers Yamva weaving rope and rattan for the 25m tall chariot, and Ghaku drivers controlling the speed and brakes as the structure rolls through narrow streets in the annual festival.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260101120152_d27b23aeb4548b0b64ab8ed20f40baa331060498c6b5443e2cb999b876c670af.jpg" data-media-id="editor_4" data-image-id="20260101120152_d27b23aeb4548b0b64ab8ed20f40baa331060498c6b5443e2cb999b876c670af" data-rendition-name="original" width="2000" height="1333" loading="lazy" alt="Exploring Lalitpur book review"> <figcaption>Te Bahal in Patan which houses Karunamaya six months a year.</figcaption> </figure>  WALKING, WORSHIPPING The book can help in exploring Patan along five routes starting in Patan Dhoka, Pulchok, Shankhamul, Mahaboudha and Lagankhel with maps and details of the baha and bahil, shrines, ponds, open spaces, dhyochenn, courtyards and phalcha along the way. Because of its coffee-table size and heft, however, the guidebook is not practical to carry around. And despite detailed descriptions of the past and present of each site, readers are left wanting to know more about those places. It is proof of Patan’s vast treasures that even this book barely scratches the surface.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260101120152_31a597b7dc1bcc9f67b4f6a66b8c1c0e0a9406727389699e6aed9ac6c3c50901.jpg" data-media-id="editor_5" data-image-id="20260101120152_31a597b7dc1bcc9f67b4f6a66b8c1c0e0a9406727389699e6aed9ac6c3c50901" data-rendition-name="original" width="2000" height="1332" loading="lazy" alt="Exploring Lalitpur book review"> <figcaption>Patukodom where visitors can view what remains of the ancient Kirant palace.</figcaption> </figure>  Some of the lesser-known must-visit sites include Patukodom which is all that remains of a palace of the original Kirat inhabitants of Patan. An archaeological dig here would surely unearth hitherto unknown facets of pre-Newa Patan. Then there are the slightly out of the way shrines like Mahabouha, a replica of a temple in Bodhgaya which houses 3,341 terracotta Buddhas with 90 big statues and which took 35 years and four generations to complete.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260101120152_ffb657dc254f707dc1755f6f13b1ef67bb7183b6573da9678c54482129fb3878.jpg" data-media-id="editor_6" data-image-id="20260101120152_ffb657dc254f707dc1755f6f13b1ef67bb7183b6573da9678c54482129fb3878" data-rendition-name="original" width="2000" height="1333" loading="lazy" alt="Exploring Lalitpur book review"> <figcaption>Mahaboudha is a replica of a temple in Bodhgaya.</figcaption> </figure>  In a recent Patan by Night heritage walk, we learnt that Pim Bahal was the labour of love of a lakhe demon (now popularised as masked dancer) who had fallen for a local girl, and he dug the pond so she would not have to walk to a faraway spout to collect water. Nearby is the Charumati Chaitya, built by the daughter of Emperor Ashoka when she visited the Valley in the 3rd century BCE to spread Buddhism in Nepal. Interestingly, if Kathmandu is a city of temples, Patan is the centre of monasteries which represent a unique Tantric melding of Buddhist and Hindu forms. Examples are: the Tadham Cuka with relocated Licchavi-era chaityas symbolic of the four major events in Buddha’s life, Ajima of Haugal Tole which is the oldest stone scripture in Nepal with the Gaja Laxmi in Chyasal, and Bignantak Ganesa temple which is a manifestation of Shiva mingled with Vajrayana Buddhism.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260101120152_17a500e77f06b9881f684329e41d3482f6f6a639ffb929d8bb44e5af7934c61c.jpg" data-media-id="editor_7" data-image-id="20260101120152_17a500e77f06b9881f684329e41d3482f6f6a639ffb929d8bb44e5af7934c61c" data-rendition-name="original" width="2000" height="1333" loading="lazy" alt="Exploring Lalitpur book review"> <figcaption>Bignantak Ganesa temple.</figcaption> </figure>  &nbsp;Besides spatial descriptions, the book also explains the temporal by curating a detailed cultural calendar of Lalitpur with dates and places of jatra, rituals, devotional dances and festivals that weave the agricultural cycle with the zodiac.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260101120152_b8e1cc03653fea85dec84a7abee4fd594c35c6ad553769f37905eb5b38774e08.jpg" data-media-id="editor_8" data-image-id="20260101120152_b8e1cc03653fea85dec84a7abee4fd594c35c6ad553769f37905eb5b38774e08" data-rendition-name="original" width="2000" height="1125" loading="lazy" alt="Exploring Lalitpur book review"> <figcaption>Mipwa Lakhe of Patan which create fire in mid aid during performance.</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260101120152_442e10bff842214e8c7522ebf6e63663599768db73bb57d999deff9de1b59375.jpg" data-media-id="editor_9" data-image-id="20260101120152_442e10bff842214e8c7522ebf6e63663599768db73bb57d999deff9de1b59375" data-rendition-name="original" width="2000" height="1333" loading="lazy" alt="Exploring Lalitpur book review"> <figcaption>Gan pyakhan or Astamatrika dance which is performed in Patan Darbar Squre during Dasain. </figcaption> </figure>  The very last chapter is dedicated to water and nature, what sustains lives and civilisations, and how Lalitpur continues to be the city it is because of the water supply system our ancestors left behind which function still, despite encroachment and pollution. ‘In the history of the world cities have been built, they thrived for some time and then became archaeological sites because they were not able to maintain the quality of air, water, and its soil,’ the authors write. ‘This led these cities to depopulate and ultimately die and are only referred to in history books. Lalitpur is not going to make the same mistake.’ &nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260104080132_3f403388d57da82b499d6c489a8f095002bf69f11e515e92fa96fb5ca3af69e9.jpg" data-media-id="editor_10" data-image-id="20260104080132_3f403388d57da82b499d6c489a8f095002bf69f11e515e92fa96fb5ca3af69e9" data-rendition-name="original" width="1136" height="702" loading="lazy" alt="Exploring Lalitpur"> </figure>

YALA

Nepal has made dramatic progress in expanding health services, yet millions of people still do not fully benefit from their Constitution-ensured right to basic medical service. Many of those deprived of accessible and affordable healthcare are in remote far-flung areas of the country, but increasingly they are also among the urban poor who have migrated to the cities and live in the margins. In both areas there are gaps in service quality, health workforce availability, and governance capacity. Out of pocket expenses for medical treatment of a family member can push families into absolute poverty and debt. The 2025 WHO–World Bank Global Monitoring Report on Universal Health Coverage underlines this challenge -- financial hardship from health spending remains a major barrier to equity, even where medical coverage has improved. In Nepal, rising demand for better and more affordable healthcare and workforce shortages due to outmigration of medical personnel and other factors mean that the government is unable to bridge these gaps through public provision alone. Well-governed and accountable public-private partnerships (PPPs) aligned with national priorities offer <a href="https://archive.nepalitimes.com/article/nation/Crowding-it-out,1003" target="_blank">a practical pathway from policy commitment to real-world impact</a>. The experience of the non-profit Nyaya Health Nepal (NHN) in partnership with the Sudurpaschim Province is an example of where this has worked well. Through <a href="https://nepalitimes.com/banner/altruistic-healthcare-models-in-nepal" target="_blank">public ownership and non-profit management</a>, <a href="https://www.youtube.com/watch?v=CJzWlnYd0ZM&amp;t=17s" target="_blank">Bayalpata Hospital</a> in Achham and <a href="https://nepalitimes.com/news/unique-hospital-handover-in-dolakha" target="_blank">Charikot Hospital in Dolakha</a> strengthened service delivery, supply chains, health workforce management, and digital health systems, while keeping all services free at the point of care.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251231101244_b59dabd4604a24426a55fe91c0e5866b5029858bdb4c4028c331557aeb5408ae.jpg" data-media-id="editor_4" data-image-id="20251231101244_b59dabd4604a24426a55fe91c0e5866b5029858bdb4c4028c331557aeb5408ae" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Bayalpata"> <figcaption>Bayalpata hospital in Achham.</figcaption> </figure>  NHN managed Charikot from 2016-2020 and handed it over to Bagmati Province, and Bayalpata was handed over to Sudurpachim after 17 years in August 2025. These partnerships reduced out-of-pocket spending, improved trust in public facilities, and directly addressed financial concerns of citizens. The WHO–World Bank Global Monitoring Report emphasised that universal health coverage requires strengthening primary health care, providing free services at the point of care, and protecting families from financial hardship. Public–nonprofit partnerships like NHN and others in Nepal provide a model to directly address these challenges. By improving access to quality care, supporting local health workers, and keeping services free, these partnerships help reduce health costs for families, build trust in local health facilities, and narrow the gap between rural and urban health services, <a href="https://www.youtube.com/watch?v=xJdxLD0hBqo&amp;t=3s" target="_blank">turning </a><a href="https://www.youtube.com/watch?v=xJdxLD0hBqo&amp;t=3s" target="_blank">policy commitments into real improvements for communities.</a> The experience of <a href="https://nepalitimes.com/banner/state-of-the-art-rural-hospital" target="_blank">Bayalpata and Charikot hospitals</a> show that effective PPPs are governance-driven, not market-led. Clear agreements, transparent data sharing, performance-based management, and strong government oversight guaranteed that public institutions were strengthened rather than sidelined. Bayalpata and Charikot successfully transitioned leadership and full management to Sudurpaschim and Bagmati provincial governments, proving that public-private partnerships can build lasting government capacity, not dependency.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251231101244_a8821faa2059498bbd3318386a1bea25b7cfe7a36600c2e2ce250e97caed51e8.jpg" data-media-id="editor_8" data-image-id="20251231101244_a8821faa2059498bbd3318386a1bea25b7cfe7a36600c2e2ce250e97caed51e8" data-rendition-name="original" width="1570" height="940" loading="lazy" alt="Charikot hospital"> <figcaption>Charikot hospital in Dolakha.</figcaption> </figure>  This model combined facility-level operational flexibility with public stewardship, and tackled long-standing weaknesses in Nepal’s health system, from workforce retention to evidence-based decision-making. Scaling such models through a national, gap-focused partnership framework is now an urgent opportunity. Replicating Bayalpata model partnerships in selected hospitals and primary health care centers could rapidly advance the three pillars of universal healthcare: equitable access, quality services, and financial risk protection. Institutionalising public-private partnerships within the Ministry of Health and Population and &nbsp;linking it to national health insurance reforms could help fulfil the promise of Article 35 of the Constitution guaranteeing basic healthcare to all citizens. For development partners and donors, this could represent a high-impact, evidence-informed investment aligned with the WHO–World Bank call to reduce financial hardship while strengthening healthcare systems. If Nepal is serious about leaving no one behind, strategic public–non-profit partnerships must move from the margins to the mainstream of health system reform. By <a href="https://nepalitimes.com/opinion/is-free-health-care-possible-in-nepal" target="_blank">scaling the NHN model</a> at Bayalpata and Charikot nationwide, Nepal can build a resilient, equitable health system where every community regardless of location or income has access to quality care, financial protection, and the opportunity to succeed. Investing in well-governed PPP models is not only essential to protect the health of the Nepali people but also to safeguard the country’s economic stability and long-term resilience. &nbsp; Srijana Devkota is Director of Program and Partnerships at <a href="https://nyayahealthnepal.org/" target="_blank">Nyaya Health Nepal</a> (NHN). <a href="https://www.youtube.com/watch?v=xJdxLD0hBqo&amp;t=3s" target="_blank">Watch a video of Bayalpata Hospital.</a> <div class="embed-block"><iframe width="560" height="315" src="https://www.youtube.com/embed/xJdxLD0hBqo?si=_gSoClqwmI-ecSxh" 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>

A healthier, wealthier Nepal

For daring to demand democracy, the Rana regime hanged activist Shukra Raj Shastri at midnight on 24 January 1941 by the side of the road at Teku. Across town in Siphal, Dharma Bhakta Mathema was also hanged. Four days later, Dasrath Chand and Gangalal Shrestha were executed by firing squad. These four young revolutionaries were members of the underground Nepal Praja Parishad that led the anti-Rana revolution with plans to assassinate key figures of the dynasty. The four martyrs sacrificed their lives for an unfulfilled cause. Monuments were put up in their honour (Shahid Gate) and their names glorified by the Shah monarchy that itself went on to ban political parties and persecute democracy activists. In 1950, the newly-formed Nepal National Congress launched an armed uprising against Rana rule after King Tribhuvan sought refuge at the Indian embassy to flee from the Rana regime. In 1951, the Ranas, Nepali Congress and King Tribhuvan signed a tripartite agreement that brought an end to 104 years of Rana rule.&nbsp; Thus began contemporary Nepal’s cycles of unfinished revolutions. Some 75 years later, on a sunny September morning, Nepal’s young and hopeful took to the streets demanding an end to the nation’s corrupt polity, envisioning a better democracy. They organised through digital platforms, played songs, danced, and chanted slogans. A few hours later, commandos fired on the protesters, massacring dozens. Over 8 and 9 September 2025, the government was overthrown, constitutional bodies were literally reduced to ashes, and 74 Nepalis were martyred.&nbsp; Nepal’s periodic revolutions have been ignited by anger against rulers, they have begun with great promise, spread with enthusiastic popular support despite rulers trying to crush them — but ultimately they have always fallen short of the expectations of citizens demanding reform. Through decades of dissent, Nepal’s periodic revolutions have remained incomplete, with the nation caught up in a cyclical search for stability.&nbsp; In 1960, king Mahendra staged a coup and overthrew an elected government led by prime minister B P Koirala -- a royal revolution against democracy. Mahendra is reported to have famously said to Koirala: “Nepal is not big enough for the two of us.” For the next 30 years Nepal resembled a one-party state under the absolute monarchy of the Panchayat. Elected leaders languished in jail or exile, political parties were banned, and the press controlled. This was the most frigid period of the Cold War, with Nepal’s neighbours India and China at war. Geopolitics was bound to have an impact. “After the 1816 Sugauli Treaty with British India, external forces magnified internal power struggles as outsiders played divide and rule,” explains editor and political analyst Rajendra Dahal. “Movements did not reach a logical conclusion because domestic politicians were forced to compromise.” Indeed, the departure of the British from India in 1947 meant that the days of the Anglophile Rana regime were numbered. Successive prime ministers sought patronage in Delhi, and the monarchy tried to counterbalance it with a policy of equidistance with China. The neighbours showed a keen strategic interest in Nepal’s domestic politics. “The Panchayat system did not deliver what it promised,” says Santosh Sharma Poudel of Nepal Institute of Policy and Research. “Nepalis suffered administrative and governance failure, politics was centralised in Kathmandu, leaving out the rest of Nepal.” With mainstream political parties and leaders were &nbsp;underground between 1961 till 1990, student activists became proxies for political parties. As pressure for change grew, a student-led pro-democracy movement spread across Nepal in 1979. In response, King Birendra announced a referendum to allow Nepalis to choose between the status quo and a ‘reformed’ Panchayat &nbsp;system.&nbsp; The Panchayat won by a slim margin with questions about the legitimacy of the plebiscite. The reforms never materialised and it would be another decade before street anger boiled over again. As the People’s Movement for democracy spread, king Birendra again relented, unbanning political parties and Nepal became a constitutional monarchy. Inspired by Mao Zedong, a faction of Nepal’s Communists felt that western-style parliamentary democracy was too slow to end a feudalist monarchy. They launched an armed struggle in 1996, and the war lasted ten years (editorial, page 2). “If the democratic government post-1990 had performed better, and brought real reform, the Maoists would not have a reason to launch a revolution,” says Poudel. After nearly a decade of bloodshed that left 17,000 dead and thousands still missing, the Maoists joined forces with the democratic parties that they had been fighting, to pressure king Gyanendra through street protests in 2006 to restore democracy. In 2008, an elected Constituent Assembly abolished the monarchy. &nbsp;Recalls Rajendra Dahal: “The second people’s movement did not aim to abolish the monarchy. In fact, the reinstated parliament even granted equal rights for royal daughters to be crowned queen. But eventually, the monarchy no longer fit the political framework that the parties envisioned.” It took two elections over the next eight years to draft a new Constitution that reflected Nepal’s socio-cultural and geographic diversity and met the demands of the Maoists. The new federal Constitution was finally promulgated in 2015, but failed to satisfy India and the aspirations of the Madhes communities for autonomy. The state’s effort to crush the Madhes movement cost 45 lives. The promise of the new Constitution was squandered over the next decade with rotating leadership of the NC, UML and the Maoists — all of whom had forgotten the sacrifices made in the name of revolution. Cronyism and corruption was the order of the day. And it was this never-ending cycle of political opportunism and malgovernance that brought Nepal’s youth to the streets on 8 September.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260101120128_bc50f6370ff80a6758199ea7ba9f4c214656a9322a8d2ba1c97e6cdfb88f7f62.jpg" data-media-id="editor_0" data-image-id="20260101120128_bc50f6370ff80a6758199ea7ba9f4c214656a9322a8d2ba1c97e6cdfb88f7f62" data-rendition-name="original" width="3372" height="1371" loading="lazy" alt="timeline"> </figure>  1951 Revolution against the &nbsp;Rana regime 1960 King Mahendra's coup, jails B P Koirala and launches the partyless Panchayat system 1979 Student protests for democracy, King Birendra announces referendum&nbsp; 1980 Continuation of the partyless Panchayat system narrowly wins plebiscite&nbsp; 1990 People’s Movement I 1996 Maoists launch armed struggle&nbsp; 2000 Royal Massacre 2005 King Gyanendra's military-backed coup&nbsp; 2006 Comprehensive Peace Accord and Parliament restored 2008 Monarchy is abolished 2015 Madhes Movement, New Constitution promulgated 2017 First 3-tier election under federal system 2022 Second elections under federal Constitution&nbsp; 2025 GenZ protests BRK ALLIANCE “The socio-political change sought in all these movements never matched the people’s expectations, because the central issue of clean and efficient government never materialised,” says Poudel. The post-September political landscape has injected new personalities and alliances still relatively new to politics, as evidenced by the new electoral partnership of the BRK — Balen Shah, Rabi Lamichhane, and Kulman Ghising (page 1).&nbsp; These leaders are not without flaws, but they have become the effective flag-bearers of the GenZ movement, hoping to represent Nepalis disillusioned by decades of democratic decay. The March election will pit them against the legacy parties. There is already criticism that BRK is behaving just like male-dominated opportunists of old parties. The troika is resembling the triumvirate of Oli, Deuba and Dahal and its culture of patronage and quid-pro-quo power-sharing between alpha males. Will this also be another unfinished revolution? Says political scientist Sucheta Pyakuryal: &nbsp;“The kind of destruction that happened after the revolution should have been followed by a ground-breaking shift in Nepal’s political ecosystem, but that did not happen. Today the situation is a lot grimmer because we have players who have learned how to use the democratic facade to sound ‘equitable’ and ‘accountable’. But look closely and you see how the same political chauvinism, cronyism and nepotism still continue.”&nbsp;