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

Sonia Awale

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Injured use Internet to get rehab care

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101132/636b73eb9c7e80680e062365jpeg.jpg" alt="" width="1500" height="911"/><figcaption>Photo: NATIONAL TRAUMA CENTRE</figcaption></figure>Speeding along a narrow winding mountain road in Dhading, a heavily intoxicated truck driver lost control of the <a href="https://www.nepalitimes.com/banner/nepals-deadly-roads-take-their-toll/" target="_blank" rel="noopener">vehicle</a> and it overturned, killing seven and severely injuring 34 passengers hitching a ride.This was a mass trauma incident that required immediate attention, but <a href="http://nationaltraumacenter.gov.np/" target="_blank" rel="noopener">Nepal’s only trauma care centre</a> was located in Kathmandu, 90km away via bumpy roads jammed with traffic.Read also: <a href="https://www.nepalitimes.com/?p=40249&amp;preview_nonce=aefd82ecbe&amp;preview=true" target="_blank" rel="noopener">injured use Internet to reach physiotherapists in Nepal</a>, Sonia AwaleMost passengers from the truck accident were taken to nearby hospitals in Dhading, but the 21 most critical patients were airlifted or driven in ambulances to the National Trauma Centre in Kathmandu.“It had already taken a while to bring the patients to the Trauma Centre, so we had to act quickly once they were here,’’ recalls Pramod Yadav, acting medical superintendent at the facility.The standard protocol for trauma care is the triage system -- determining the priority of treatment based on the severity of injury. Doctors at the National Trauma Centre quickly designated yellow, green and red codes to patients to ensure that those in critical condition were taken care of first, and fast.Read also: <a href="https://archive.nepalitimes.com/article/nation/accident-prone-Mugling-Narayangadi-highway,3828" target="_blank" rel="noopener">Unblocking an artery</a>, Sanjeev SharmaOn-call doctors were contacted and began assessing the patient’s injuries. But without a functioning MRI and a faulty CT machine, some had to be sent to private clinics and later returned to the hospital.This is a recurring event for patients seeking immediate care at the government-run Trauma Centre where patients in critical condition have to be moved about from one facility to another for tests.“We cannot afford an MRI machine, it is very expensive to repair our CT machines, we have limited trolley beds and only 11 ICU beds when we need more than 50,” says Yadav. “We are requesting the government for Rs420 million to become a real trauma centre, especially since we are the only one in the country.”There were 60,000 severe trauma injuries in Nepal in the last year, a 3,000 increase from the previous year, and a whopping 27,000 over the year before that. Like with all government-run medical centres, the Trauma Centre lacks resources, is under-staffed, and is incapable of handling this exponential increase.“In the last two, three years, falls, physical assault, <a href="https://www.nepalitimes.com/banner/nepals-deadly-roads-take-their-toll/" target="_blank" rel="noopener">road traffic accidents</a>, sports injuries and <a href="https://archive.nepalitimes.com/article/nation/burning-in-the-aftermath,3757" target="_blank" rel="noopener">burns</a> have been the leading causes of trauma,” lists  Siddhartha Dhungana, the Medical Record Officer at the National Trauma Centre. “Head injuries and multi-organ failures have been the highest causes of death in these cases.”Most hospitals in Nepal, like the National Trauma Centre, follow the World Health Organisation’s trauma protocol. During a trauma case, medical personnel are contacted as soon as possible, patients are screened, their needs are identified and necessary care is given.Although the government has not developed a standard care protocol for trauma like it has for cancer patients, private hospitals have implemented and refined their own systems based on WHO guidelines.<a href="http://archive.nepalitimes.com/article/nation/politics-behind-epidemic-of-hospital-vandalism,3578" target="_blank" rel="noopener">Om Hospital</a>’s Continuing Medical Education Program is at the forefront of teaching trauma care to new doctors and providing courses on improved techniques to existing doctors.“We make sure that the ABCs of trauma care are followed strictly and that blood is readily available be it from our blood bank or staff-chain blood donors,” says Binod Adhikari of Om, which handles dozens of cases every day and has systems in place to coordinate between doctors, nurses and critical care anesthesiologists to provide emergency care to patients.<h2>Ambulance chasers</h2><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101132/636b73ee9c7e80680e062366jpeg.jpg" alt="" width="1500" height="1125"><figcaption> </figcaption></figure>Most of Nepal's ambulances are just jeeps with stretchers, with no life-support systems or medical attendants. It was only in 2011 that Nepal’s first emergency medical service was established. Supported by the Patan Academy of Health Sciences and the Stanford University School of Medicine, Nepal Ambulance Service (NAS) has since trained more than 100 emergency medical technicians (EMTs) and ambulance drivers and operates the <a href="http://archive.nepalitimes.com/news.php?id=18888#.XjvhpTIzaUk" target="_blank" rel="noopener">'Dial 102' service</a>. NAS operates mainly in Kathmandu Valley, Pokhara, Chitwan, Butwal and Bhairawa.“Before this, only few private hospitals had ambulances and they were used mainly for patient transfer rather than pre-hospital care,” says Hari Khadka, a paramedic at <a href="https://www.grandehospital.com/" target="_blank" rel="noopener">Grande International Hospital</a> and a member of the first EMT batch of NAS. “Ten years ago, there was simply no concept of pre-hospital care or paramedics in Nepal.”Now, many hospitals have their own EMS systems with mostly Type 3 ambulances that have first aid kits and basic medical supplies. <a href="https://www.nrcs.org/" target="_blank" rel="noopener">Nepal Red Cross Society</a> (NRCS) operates 283 ambulances nationwide. Although not every ambulance carries a paramedic, every driver has received first aid training.“We have five Type 2 ambulances and a paramedic in each vehicle,” says Bipul Neupane of NRCS. “We send these ambulances to patients who need basic life support systems.”But for patients needing critical care in remote areas, there is no recourse but expensive helicopter medical evacuation.Like Type 1 ambulances, some of these helicopters can have doctors, ventilators, advanced life support, and EMTs.“EMS has helped save many lives in Nepal but it isn’t always the best option considering the geography of Nepal and the condition of the roads,” says Sanjaya Karki, Head of the Emergency Department at <a href="https://www.nepalmediciti.com/" target="_blank" rel="noopener">Nepal Mediciti Hospital</a>. “Helicopter Emergency Medical Services ensure that we can get to critical patients as quickly as possible and provide the best pre-hospital care.”

It’s an emergency: Nepal needs to improve trauma care

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110714118/636903cc9c7e80680e037ce4jpeg.jpg" alt="" width="1400" height="932"/><figcaption>File Photo: Shreejana Shrestha</figcaption></figure>When 44 girls were rescued from sexual abuse and torture in a children’s home in <a href="http://archive.nepalitimes.com/article/nation/Nepali-children-rescued-from-India,3618" target="_blank" rel="noopener">Muzaffarpur</a> in Bihar in May, it made headlines in India. What went unnoticed was that seven of children were Nepali.The shelter run by Seva Sankalp Evam Vikas Samiti was raided after reports of abuse, and its head Brajesh Thakur arrested. After trying several times, <a href="http://archive.nepalitimes.com/article/nation/Nepali-children-rescued-from-India,3618" target="_blank" rel="noopener">Shailaja CM</a> of the child charity <a href="https://www.chorachori.org.uk/" target="_blank" rel="noopener">Chora Chori</a> was finally able to bring home to Nepal the three girls and four boys.Now, safe in the Chora Chori shelter in Kathmandu the children are being treated for psychological trauma. They have difficulty in communicating because of their mental scars, are fearful of strangers, and the staff are still working to build trust with them.“Some of the children were quite sullen, and their silence made communication difficult,” says Anila Dangol, counsellor at Chora Chori, which has been rescuing many Nepali children trafficked to India.Dongol and Shailu Rajbhandari have been trying out a new way of rehabilitating the children with <a href="https://www.theraplay.org/" target="_blank" rel="noopener">theraplay</a>, after being trained by British therapist Debbie Mintz.Theraplay imitates the earliest intimate interactions between mother and child, trying to re-build emotional bonds with affection.Says Mintz: “Many children who are traumatised will have missed this nurture, which is an important part of growing up. Without it, they have no history of a trustful and loving relationship with an adult.That makes them unwilling to form social bonds, and they become emotionally insecure.”This method involves treating older children as though they were much younger, and giving them complete attention and affection in guided, hour-long sessions. It usually involves a lot of games with massages, a non-threatening way of encouraging healthy physical contact. The sessions usually involve fun games and storytelling where the therapist begins a story and the child ends it.Many of the <a href="http://archive.nepalitimes.com/news.php?id=2876#.W3VbK84zbIU" target="_blank" rel="noopener">abused children</a> feel threatened by any kind of physical contact. In such cases, the therapist invites the child to touch them first, and maybe use objects like feathers instead of direct contact. At Chora Chori, the theraplay method was applied to 15 children, including children rescued from Muzaffarpur and <a href="http://archive.nepalitimes.com/article/nation/bal-mandir-rape-allegations,1495" target="_blank" rel="noopener">other victims of sexual abuse</a>.The goal is for the children to be able to establish healthy, nurturing relationships with people. Though this therapy is often used for children with trauma, especially in case of adoption, it is now increasingly used on the elderly.“A child who has been denied healthy relationships, bonds with the therapist. They need love, care, and trust, without which they cannot function as healthy adults,” Mintz explains.Since privacy is critical in theraplay, its intimate nature also raises concerns about higher risk of child abuse. But Mintz believes it is no different from any other therapy session where you leave the therapist and child alone in a room, and trust is key.It is too early to say whether this approach will help the rescued children grow up to be emotionally secure adults, but for now Shailu Rajbhandari says it has worked wonders with children at Chora Chori.She adds: “Many of the children came up with stories about their own past after a single session, some talked of abuses while some recalled being forced to work. After the therapy, it was much easier to communicate with children who had been defensive or excessively introverted before.”Some 300 cases of human trafficking are reported to the police every year, but child welfare workers believe the number is much higher. An estimate by the National Human Rights Commission (NHRC) estimates that every year 23,000 <a href="http://archive.nepalitimes.com/article/nation/epicentre-trafficking-migration,3256" target="_blank" rel="noopener">Nepalis become victims of trafficking</a>, and half of them are children. Some end up being taken across the border to India where <a href="http://archive.nepalitimes.com/article/nation/runaway-boys-brought-home-to-%20Nepal,2950" target="_blank" rel="noopener">police regularly round up unaccompanied children from railway stations and the streets and hand them over to shelters</a> like the one in Muzzafurpur that was raided.Says Shailaja CM: “Conditions of many children’s homes in India are deplorable. Not only are many of them lacking in basic facilities, abuse is also rampant.”

Nurturing rescued children with nature

<figure><img width="1400" height="932" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110714114/636902db9c7e80680e037c8bjpeg.jpg" alt=""/><figcaption>Source: The Lancet</figcaption></figure>The debilitating effects of mental health diseases and the <a href="http://archive.nepalitimes.com/news.php?id=14138#.W2MFj9Uza70" target="_blank" rel="noopener">social stigma associated with them</a> are not limited to patients: the lives of family members also change irrevocably. Family support can also be an important source of strength and even help in the healing process, say psychiatrists, patients and their relatives.Reshma Magar from Sindhuli, brought her 35-year-old son to a mental health clinic in Kathmandu after he displayed symptoms like severe headaches, mouth fizzing, and haphazard running around. As a mother, she was constantly worried he might hurt himself.“We have the Sun Kosi River nearby and I would think: what if he jumped?” says Magar, who has to tie him up in the hospital bed to contain his violent behavior. “I would be crying and the nurses here would console me.”Read also: <a href="https://www.nepalitimes.com/?p=10647&amp;preview=true" target="_blank" rel="noopener">Raising children can be therapy</a>, Ketan DulalNabina and Samira Pradhan shared similar hardships. Their brother, 40, started showing erratic behaviour after his wife left him, taking their daughter with her. He throws things around, does not eat, and their 71—year-old mother has to look after him.“It is very hard,” Nabina says, “mother herself has health issues and because of our brother’s state, violence in the home remains a constant danger.”Sufferers of psychotic mental illnesses are generally unaware they have a problem. In <a href="http://archive.nepalitimes.com/article/nation/stigma-and-silence-mental-health-nepal,3486" target="_blank" rel="noopener">schizophrenia</a>, a severe psychotic disease, patients have a distorted sense of reality − hallucinations, extreme paranoia, hearing voices − that their mind infers as truth. They resist help, and family members have a difficult job coaxing them to seek and continue medical treatment.Beyond this, the emotional trauma of having a suffering relative is a constant feature of life for the Magar and Pradhan families, which makes each day frightening and unpredictable.Read also: <a href="https://www.nepalitimes.com/?p=10641&amp;preview=true" target="_blank" rel="noopener">Addicted to the joystick</a> , Suprasanna AryalResearch has shown that patients suffering from psychosis have various structural and functional abnormalities in the brain. Schizophrenia patients have dysfunctions in their neurotransmitter systems, metabolic pathways and certain structures in the brain regulating motor activity.Traditionally Nepali society, which did not have coping mechanisms, regarded mental disorder as a curse, and there is strong social stigma and ostracisation of both the patients and their families. Derogatory labels for <a href="http://archive.nepalitimes.com/article/Nepali-Times-Buzz/overcoming-depression,2164" target="_blank" rel="noopener">‘crazy’ people like ‘dimag khuskeko’ or ‘pagal’</a> are still widely used.However, now that science has shown that the causes are mostly chemical imbalances, there is treatment says Basudev Karki of Lagankhel Mental Hospital: “Medicine now has treatment for mental diseases, just like for physical ailments. Problems of the mind also need medical care and treatment and there is nothing wrong in that. Instilling this understanding will help address stigma for patients.”Read also: <a href="https://www.nepalitimes.com/?p=10601&amp;preview=true" target="_blank" rel="noopener">Ashna comes out of black</a>, Sewa Bhattarai <img width="670" height="585" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110714114/636902de9c7e80680e037c8cjpeg.jpg" alt="">However, Karki cautions that medical interventions alone sometimes do not suffice because the triggers may be a combination of biological, psychological and social factors. For example, there was a <a href="http://archive.nepalitimes.com/article/editorial/the-republic-of-insomnia,3311" target="_blank" rel="noopener">surge in mental disorders in Nepali society</a> during <a href="http://archive.nepalitimes.com/article/nation/psychological-scars-of-maoist-conflict-on-young-survivors-take-longer-to-heal,1519" target="_blank" rel="noopener">the conflict</a> and after <a href="https://www.nepalitimes.com/here-now/its-all-in-the-mind/" target="_blank" rel="noopener">the earthquake</a> and Blockade. Out-migration and family separation pushes people into another class of mental illness, like neuroses, such as <a href="http://archive.nepalitimes.com/regular-columns/all-in-mind/the-silent-scream-depression-is-common-but-only-few-get-treatment,588" target="_blank" rel="noopener">depression</a> and anxieties in which, unlike psychosis, the patients preserve a sense of reality.Following hospital treatment it is up to family to provide psychological support for patients, to think positively and maintain a healthy lifestyle. They must protect patients from extreme stress due to social factors, such as unemployment or financial trouble.Muna Tamang shows extraordinary determination this week as she sits beside the hospital bed of her 24-year-old daughter who is suffering from psychosis. “As long as she can live and heal, I have decided that we will do anything for her treatment, even if we have to take loans,” Tamang told us.Read also: <a href="https://www.nepalitimes.com/here-now/its-all-in-the-mind/" target="_blank" rel="noopener">It's all in the mind</a>, Sonia AwaleNepal’s mental health facilities are mostly based in cities, but even here there aren’t enough trained specialists to deal with what is a national mental health epidemic. Up to one-third of Nepal’s population suffers from some form of mental illness, according to one study. (See chart)One group, The Transcultural Psychosocial Organistaiton (TPO) is working to remedy the urban-rural mental health gap, by training doctors and health workers at the local level with Female Community Health Workers.“We do not just want to make these services available, but to also ensure people reach out to them, and refer patients to seek help in facilities,” says Kamal Gautam at the TPO.Such efforts have helped remove stigma, and empowered patients and families to receive treatment and care. But Nepal still has a long way to go. With greater state investment, access to mental health services and proper therapy, family members can be even more involved in helping patients and reducing their stigma.Some names have been changed.

All in the family

<img width="1078" height="516" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221107121148/6368f1379c7e80680e035a1cjpeg.jpg" alt=""/>A chhuchi girl Muna (<a href="https://www.imdb.com/name/nm8619216/?ref_=nv_sr_1" target="_blank" rel="noopener">Shristi Shrestha</a>) in Dharan meets a pulpuleko dude Ved (<a href="https://www.imdb.com/name/nm4641795/?ref_=nv_sr_1" target="_blank" rel="noopener">Vinay Shrestha</a>) from America. He has all the money to host luxurious pool parties and she has no money for milk in her morning tea. Will they ever click?It seems unlikely: he tears her kurta as he shoves past her and she splashes paint at him. But the director <a href="https://www.imdb.com/name/nm4531129/" target="_blank" rel="noopener">Naresh KC</a>  manages to bring the two together to create sizzling, sparkling chemistry. The transition from spitfire to flames (from sandwich me to sketch me to sandwich chhaina? back again) is entirely believable. Along the way we also learn why the girl is so stubborn, and why the guy so callous. Vinay is a convincing insensitive brat, Shristi credibly essays a struggling small-town girl in flowery kurtas and plaited hairdos, but it's her sister who brings the eastern flavor with her on-point accent.Not that the movie is not without flaws. The editing, especially in the first half, is not that great, it jumps abruptly from a girl doing the shradha funeral ritual to a bikini party to a dream sequence with a monster. And the shock value of that gimmicky bikini party song on Nepali screen is a whole another story (was it really necessary to imitate wannabe South Asian rap videos? Kathale magekai ho?).There are some tropes that could have worked until the 90s, but not today. For example, when Ved loses access to his money and is forced to do Muna's bidding, the audience comes up with a thousand reasonable things he could have done to solve it. Some plot twists are reminiscent of Korean melodramas. Sushma Karki's gold-digger character is not just over the top, but the entire subplot is annoying.What is refreshing, however, is movie’s approach to real world issues instead of taking the masala Bollywood route that most of Kollywood is fond of. In his first film <a href="https://www.imdb.com/title/tt3552320/?ref_=fn_al_tt_1" target="_blank" rel="noopener">Dying Candle</a>, the director had explored complicated family dynamics with an absent, benevolent father and a problematic mother. This time he reverses it with a romanticised, absent mother and a difficult father. This movie calls itself a tribute to Van Gogh, and Van Gogh's strong bond with his supportive brother finds itself reflected in Jukhuri and Thupri, that was also at the centre of Dying Candle.Animation plays a refreshingly large role, perhaps for the first time in Nepali cinema. A CGI-rendered monster haunts Muna in her dreams and spills over into her paintings. It is a symbol of issues that we cannot run away from how we must slay our own demons. The attempt to tackle deep seated emotional trauma is laudable, but not entirely satisfactory -- and this is the movie's biggest flaw. One wishes the writer had worked harder to make the reconciliation more plausible.Still, Van Gogh is a rare treat to movie-going eyes. Starry Night swirls everywhere: from the title credits to Vinay's shirt to songs. A blue train chugs behind Shristi in a red dress and parasol, bringing Bridges across the Seine at Asnieres to life. A field of post-impressionist sunflowers wave in the wind. A couple takes a mid day Siesta after Millet on a haystack to Sukmit Gurung's Pal Pal Timrai Samjhana Ma. Giving new meaning to old songs is something of a favourite for KC. Having used the classic Kehi Mitho Baat Gara to great effect in Dying Candle, he does it again with the mushy favourite Gahiro Gahiro Sagar Jastai. The movie's original songs are also delightful, especially the soulful Sanjh Paryo.Though this movie is wanting in a lot of ways, it is watchable for venturing into new territories. It captures Nepali filmdom at a time it is just beginning to flex its wings, so this is not yet time to compare the fledgling industry with the world cinema. But there are some things this movie does as well as any other: deliver an emotional punch, especially on its central theme--the redemptive power of love.https://www.youtube.com/watch?v=YpcXJBdB4xo

Romeo & Muna

<h2>The conflict and earthquake added to Nepal’s hidden epidemic of mental disorder</h2><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110710114/6368ca479c7e80680e02f2fejpeg.jpg" alt="" width="1400" height="1050"/><figcaption>MEMORIES: Nani Maiya Prajapati was serving lunch to her husband, daughter, son-in law and two grandchildren when the earthquake struck three years ago. She survived, but the rest of her family did not. The 2015 tragedy left mental scars on thousands of survivors like her that will take time to heal. ROJITA ADHIKARI</figcaption></figure><a href="http://archive.nepalitimes.com/article/nation/stigma-and-silence-mental-health-nepal,3486">One-third of Nepalis</a> were already suffering some form of psychiatric disorder, but mental health experts say the numbers <a href="http://archive.nepalitimes.com/article/nation/psychological-scars-of-maoist-conflict-on-young-survivors-take-longer-to-heal,1519">went up significantly during the Maoist conflict</a> and rose again after the <a href="http://archive.nepalitimes.com/blogs/kundadixit/2015/05/27/a-month-that-felt-like-a-year/">2015 earthquake</a>.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110710114/6368ca4a9c7e80680e02f2ffjpeg.jpg" alt="" width="130" height="101">Besides existing psychological disorders in the general population, there are now torture victims, child soldiers, combatants with post-traumatic stress disorders (PTSD), <a href="http://archive.nepalitimes.com/article/nation/Mental-cost-of-migration,3159">mistreated migrant workers</a>, and lately earthquake survivors who had narrow escapes or lost family members.Read Also: <a href="https://www.nepalitimes.com/?p=4261&amp;preview=true">Time heals</a>, Prabin DhungelArun Bhattarai was lying down for a nap that Saturday three years ago when a deep underground rumble followed by a big jolt woke him up. His house in Dhading collapsed, and his family became earthquake refugees in Kathmandu. Bhattarai, now 46, suffered from insomnia and anxiety attacks for months afterwards. The trauma drove him to drink, but today after treatment he has beaten his alcoholism.“A lot of people suffered from anxiety, <a href="http://archive.nepalitimes.com/article/editorial/the-republic-of-insomnia,3311">post-traumatic stress disorder</a> and depression following trauma and bereavement during the earthquake, some even attempted suicide,” says mental health specialist Kapil Dev Upadhyay. “The disaster aggravated the psychosocial condition of many patients who were already recovering.”<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110710114/6368ca4b9c7e80680e02f300jpeg.jpg" alt="" width="500" height="715"><figcaption> </figcaption></figure><a href="https://reliefweb.int/sites/reliefweb.int/files/resources/Hidden-Aftershocks_Summary-Report.pdf">A survey</a> of earthquake-affected districts of Rasuwa, Nuwakot and Makwanpur for the Nepal Red Cross Society, conducted by the group Transcultural Psychosocial Organisation (TPO),  showed that nearly 40% of respondents suffered from <a href="http://archive.nepalitimes.com/regular-columns/all-in-mind/the-silent-scream-depression-is-common-but-only-few-get-treatment,588">depression</a> and anxiety for a year-and-half after the earthquake. Another 22% said they had suicidal thoughts, and a quarter had taken to drinking heavily. More women than men were affected by the symptoms (see chart).Sunita KC was out for a Saturday walk with her husband at Kathmandu Darbar Square when nearby <a href="http://archive.nepalitimes.com/article/nation/Monumental-loss,2215">monuments swayed and collapsed</a> in clouds of dust. The 23-year-old was plagued with nightmares and lost the will to live. She got better after medication, but three years later her symptoms have returned. This week KC was in a clinic in Kathmandu with her family for consultation where she was diagnosed with severe depression.At the Psychiatric Department of Teaching Hospital, Rishav Koirala estimates that every family has at least one member afflicted with some form of mental illness after the earthquake.“In a way, the earthquake was a blessing in disguise because it raised public awareness about mental health and partially removed the <a href="http://archive.nepalitimes.com/news.php?id=14138#.WthaP26FPIU">stigma</a>. The government was also forced to address mental healthcare.”Indeed, the government trained MBBS doctors to provide psychiatric help to survivors in the primary health care systems and district hospitals. Nepal’s Mental Health Policy, adopted in 1997 but rarely implemented, is finally being revised.At an <a href="http://mentalhealthconferencenepal.com/programme/">international conference on mental health in Kathmandu</a> in February, the government pledged to prioritise mental health, increase investment for a mental health focal unit in each provincial health ministry, and to recognise alcohol and substance abuse as mental health problems.“School level psychological education can help change societal attitudes towards mental disorders, and since Nepalis are resilient and family-oriented there is a support system,” says psychiatrist Namrata Pradhan at Model Hospital.Nepal has one of the lowest patients to psychiatrists ratios in the world. In addition, society has entrenched stigma about ‘mad’ people who are often ostracised, often by family members. Even before the earthquake, patients were left to fend for themselves.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110710114/6368ca4d9c7e80680e02f301jpeg.jpg" alt="" width="878" height="516"><figcaption> </figcaption></figure>Rabi Shakya, professor of psychiatry at the Patan Academy of Health Sciences agrees that the public is more aware of mental disorders after the earthquake. “There has been a visible change in terms of awareness and general acceptance level regarding mental health, and as a result patients are coming out and seeking treatment,” he told Nepali Times this week.Post-earthquake studies have shown higher rates of psychiatric disorders, but the major limitation is the lack of a baseline study. The Nepal Health Research Council is now preparing a nationwide mental health survey later this year to help develop a longterm plan to upgrade psychiatric care.Says mental health activist and former patient Jagannath Lamichanne: “We need public awareness and acceptance so that people are comfortable with sharing their experiences, and that can be the most powerful tool for prevention.”Name of patients have been changed.Read also:<a href="http://archive.nepalitimes.com/article/nation/stigma-and-silence-mental-health-nepal,3486">Stigma and silence</a>,  Ketan Dulal<a href="http://archive.nepalitimes.com/article/editorial/the-republic-of-insomnia,3311">The republic of insomnia</a>,  Editorial<a href="http://archive.nepalitimes.com/article/nation/psychological-scars-of-maoist-conflict-on-young-survivors-take-longer-to-heal,1519">Post-conflict stress syndrome</a>,  Taylor Caldwell<a href="http://archive.nepalitimes.com/article/nation/down-and-out,3158">Down and Out</a>,  Smriti Basnet

It’s all in the mind

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110710114/6368ca509c7e80680e02f302jpeg.jpg" alt="" width="1500" height="844"/><figcaption>Pic: Gopen Rai</figcaption></figure>Immediately after <a href="http://archive.nepalitimes.com/blogs/kundadixit/2015/05/27/a-month-that-felt-like-a-year/">the earthquake</a>, there was a <a href="http://archive.nepalitimes.com/article/editorial/the-republic-of-insomnia,3311">sudden surge of patients with mental disorders</a> in Kathmandu’s psychiatric clinics.But since 2016, records at the Nepal Mental Hospital and Bir Hospital show a sharp decrease in the number of patients with post-traumatic stress disorders. Doctors say the reason is that most patients with earthquake-related psychosocial issues received medication, counselling and support from families in the last three years.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110710114/6368ca539c7e80680e02f303jpeg.jpg" alt="" width="130" height="101">Even so, some survivors still have anxiety attacks during an aftershock or when they hear loud noises. Pukar Gautam was a college student who found himself in the narrow alleys of Patan when the earthquake struck.Read Also: <a href="https://www.nepalitimes.com/?p=4260&amp;preview=true">All in the mind</a>, Sonia Awale“I was terrified and took cover below a sturdy beam,” Gautam remembers. He was traumatised for months afterwards, and even today feels claustrophobic in narrow, crowded alleys.Many traumatised children had to be counselled when schools reopened two months after the earthquake in 2015. They could not concentrate on their studies, had difficulty sleeping and looked distracted.Niroj Mali is a teacher at Chantal Mauduit Academy in Taukhel, and remembers students were still in shock when they came back to school. Instead of regular classes he had the children sing, dance and watch cartoons. “They are doing well now, the earthquake seems like a bad dream,” Mali says.Sandeep Bista, 32, works for the Red Cross and was trapped in a room in Bhaisepati with a visiting aunt when the earthquake struck. He was treated for persistent anxiety, and feels much better now. But his aunt suffers relapses and has to regularly visit the district hospital in Ramechhap.Chief Psychiatrist Lata Shrestha at the Nepal Mental Hospital confirms that the number of patients with psychological trauma has declined to levels before the earthquake. “I have seen more people now seeking psychological help and counselling for trauma and this is a positive side-effect of the earthquake,” she says.Nawal Jha was posted to hospitals in earthquake affected districts and remembers treating many survivors with <a href="http://archive.nepalitimes.com/article/nation/down-and-out,3158">mental disorders</a>. Younger patients who had seen much death and destruction were even <a href="http://archive.nepalitimes.com/regular-columns/all-in-mind/suicide-after-earthquake,496">suicidal</a>, he remembers.Purnima Lama was in a building in Bungamati and suffered a fracture when the house she was in collapsed. She needed medical treatment, but was reluctant to seek psychological counselling. “I was scared <a href="http://archive.nepalitimes.com/article/nation/stigma-and-silence-mental-health-nepal,3486">others would think I was mad</a>,” she says, recalling how a relative was ostracised from her village in Dhading after she was mentally traumatised after a brother was killed during the conflict.Psychiatrist Basu Dev Karki also says societal attitudes towards mental disorders are changing: “People now look at mental health at par with other medical conditions. That is a positive step in ensuring the mental wellbeing of the people.”Some names have been altered.  Read also:<a href="http://archive.nepalitimes.com/article/nation/stigma-and-silence-mental-health-nepal,3486">Stigma and silence</a>,  Ketan Dulal<a href="http://archive.nepalitimes.com/article/editorial/the-republic-of-insomnia,3311">The republic of insomnia</a>,  Editorial<a href="http://archive.nepalitimes.com/article/nation/psychological-scars-of-maoist-conflict-on-young-survivors-take-longer-to-heal,1519">Post-conflict stress syndrome</a>,  Taylor Caldwell<a href="http://archive.nepalitimes.com/article/nation/down-and-out,3158">Down and Out</a>,  Smriti Basnet