<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108151120/636a66739c7e80680e059980jpeg.jpg" alt="" width="1500" height="1000"/><figcaption>Photo : BIKRAM RAI</figcaption></figure>There used to be a time when the main public health threat in Nepal was from infectious diseases like <a href="https://www.nepalitimes.com/here-now/the-mosquito-that-changed-nepals-history/" target="_blank" rel="noopener">malaria</a>, encephalitis, <a href="https://www.nepalitimes.com/banner/tb/" target="_blank" rel="noopener">TB</a> and typhoid. Whether vector-borne or transmitted through contaminated air or water, the most cost-effective way to address them was through prevention. Communication was the first line of defence against communicable diseases.Things have changed. Awareness has grown because literacy rates are up. Most Nepalis now suffer from non-communicable ailments like cardiovascular diseases, <a href="https://archive.nepalitimes.com/article/nation/diabetes-in-south-asia,3018">diabetes</a>, <a href="http://archive.nepalitimes.com/article/Nepali-Times-Buzz/A-mysterious-rash-of-kidney-failures,3639" target="_blank" rel="noopener">renal failure</a> and malignancies. These need treatment in medical facilities at a time when the over-commercialisation of hospitals has made healthcare unaffordable for a majority of the population. In fact, <a href="https://www.nepalitimes.com/editorial/poor-health/" target="_blank" rel="noopener">poor health</a> is making Nepalis poorer.Read also:<a href="https://www.nepalitimes.com/opinion/is-free-health-care-possible-in-nepal/" target="_blank" rel="noopener">Is free health care possible in Nepal?</a>, S P Kalaunee<a style="background-color: #ffffff; font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/?p=37821&amp;preview_nonce=9ce6a7c55d&amp;preview=true" target="_blank" rel="noopener">Federalism leaves Nepal’s medical sector ailing,</a> Sewa BhattaraiAlso, communicable diseases have not been completely overcome. Diarrhoeal dehydration and other water-carried infections are still major killers. One of the reasons Nepal’s progress in reducing child mortality has stalled is because of the state’s failure to ensure adequate and safe drinking water in remote regions. In this paper we have also reported on <a href="https://www.nepalitimes.com/banner/nearly-half-of-nepali-children-still-malnourished/" target="_blank" rel="noopener">stunting and wasting among children</a> due to malnutrition.In addition, <a href="https://www.nepalitimes.com/here-now/air-pollution-is-more-dangerous-than-smoking/" target="_blank" rel="noopener">worsening air pollution</a> has caused an epidemic of chronic obstructive pulmonary disease (COPD), which has led to lung infections in all age brackets and causing terminal pneumonia and other complications in the elderly. At current levels of PM2.5 concentration in the air, studies show, the average lifespan of city dwellers in Nepal could be reduced by up to four years.Read also:<a href="https://www.nepalitimes.com/here-now/nepal-is-a-microcosm-of-all-of-the-changes-in-world-health/" target="_blank" rel="noopener">"Nepal is a microcosm of all of the change in world health"</a><a href="https://www.nepalitimes.com/editorial/poor-health/" target="_blank" rel="noopener">Poor health</a>, EditorialNepal’s burden of non-communicable diseases and injuries has doubled in the last 25 years, with nearly 15% caused by <a href="https://www.nepalitimes.com/banner/nepals-deadly-roads-take-their-toll/" target="_blank" rel="noopener">road traffic accidents</a> or natural disasters. Traffic accidents are now the second biggest killer of young Nepalis. Just in the past three weeks, 90 people have been killed on highways due to poor road condition or carelessness.A vivid indication of the threat of non-communicable diseases is today’s prevalence of diabetes. South Asians are genetically more susceptible to cardiovascular diseases and diabetes, but there are now new risk factors caused by increasing rural to urban migration. While the world prevalence average for both types of diabetes is 8%, research has shown that 14% of people in Dharan suffer from the disease. Taplejung, from where many have migrated to Dharan, has a rate of only 1%. The reason is clear: increased intake of carbohydrates and a more sedentary lifestyle when people move to cities.To meet these challenges, Nepal desperately needs <a href="https://www.nepalitimes.com/opinion/is-free-health-care-possible-in-nepal/" target="_blank" rel="noopener">affordable and accessible medical care</a>. At the moment, hospital treatment is neither. The poor in remote, underserved areas of the country are disproportionately vulnerable. As our report from Bajura shows, the problem is further complicated because confusion over federalism, budget and jurisdiction has left most rural government hospitals underfunded and underserved. It is imperative that the government act quickly to resolve the retention crisis caused by medical staff getting themselves transferred out of their jobs in remote areas.Read also: <a href="https://archive.nepalitimes.com/article/nation/national-health-insurance-not-as-easy,4028" target="_blank" rel="noopener">A national health insurance is not as easy as it looks</a>, Sonia Awale<a href="https://www.nepalitimes.com/banner/this-is-how-to-upgrade-nepals-rural-health/" target="_blank" rel="noopener">This is how to upgrade Nepal's rural health</a>, Sewa BhattaraiA survey last year showed that half of all <a href="https://archive.nepalitimes.com/article/nation/national-health-insurance-not-as-easy,4028" target="_blank" rel="noopener">medical expenditure of Nepalis families</a> is out-of-pocket, and 60% of that is for treatment of non-communicable diseases and injuries. The federal government allocates only about 10% of its budget to health care, and the focus is still on communicable diseases. Donor priority is also not on non-communicable diseases and injuries. A study of government hospitals by the Nick Simons Institute shows a huge unmet need in remote areas for basic surgery like caesarean sections and orthopaedics.One bright spot ahead is the success of pilot insurance schemes being tried out in various parts of the country. In a <a href="https://www.nepalitimes.com/opinion/is-free-health-care-possible-in-nepal/" target="_blank" rel="noopener">commentary this week</a>, S P Kalaunee of Nyaya Health, an NGO that helps the government manage hospitals in Achham and Dolakha, presents a proven 60:25:15 formula of health insurance. In this arrangement, non-profits, the private sector and all three levels of government can make medical care affordable to all Nepalis, if upscaled. Under the scheme, 60% of the cost of care comes from insurance, provincial governments pay 25% and municipalities take care of the remaining 15%.Parts of the scheme are being tried out in <a href="https://www.nepalitimes.com/banner/this-is-how-to-upgrade-nepals-rural-health/" target="_blank" rel="noopener">Bayalpata Hospital in Achham</a> (which last week <a href="https://www.nepalitimes.com/banner/bayalpata-hospital-in-nepal-wins-global-design-award/" target="_blank" rel="noopener">won the Global Architecture Festival award</a> in Amsterdam for its design). Insurance reimbursement covers the cost of insurance-covered care, the local government allocates funds required for basic and emergency healthcare, and the provincial government pays for managing the cost of referrals beyond insurance coverage. Internationally, this has become an issue with 12 December marked as Universal Health Coverage Day.Nepal’s constitution now guarantees basic and emergency healthcare as fundamental rights of citizens, and puts the responsibility on to the state. The government  can no longer keep passing the buck on providing universal insurance for its citizens.<h2>10 years ago this week</h2>Nepali Times <a href="http://archive.nepalitimes.com/issue/480" target="_blank" rel="noopener">issue #480 of 11-17 December 2009</a> carried an <a href="http://archive.nepalitimes.com/news.php?id=16572#.XfId7ZMzaUk" target="_blank" rel="noopener">interview on page 1 with Baburam Bhattarai</a>, who was then vice-chair of the Maoist party.  Excerpts:‘From the very beginning, we have said that the basis of the federal system should be nationality. In Marxist terms, nationality means a common language, geography, economy and psychological make-up. A group of people that shares these qualities is called a nationality.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108151120/636a66769c7e80680e059981jpeg.jpg" alt="" width="392" height="600">On this basis we have proposed to constitute federal autonomous units in Nepal and we also practised this during the People’s War. Since the very beginning we have been consistent that federalism should be along the lines of nationality.’

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POOR HEALTH MAKES NEPALIS POORER

<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108151120/636a664f9c7e80680e059974jpeg.jpg" alt="" width="1200" height="793"/>Around the world, in rich countries and poor, financing healthcare is one of the biggest challenges. In poor countries, it becomes a life-or-death issue.Over 40% of global healthcare expenses are still covered by patients and their families, and more than half the world’s population lacks access to essential health services. Medical bills push 100 million people into extreme poverty every year.Nepal has taken remarkable strides in healthcare in past decades despite internal conflict and instability, but <a href="https://archive.nepalitimes.com/article/nation/national-health-insurance-not-as-easy,4028" target="_blank" rel="noopener">medical care is still unaffordable</a> or inaccessible to most. More than half the healthcare expenditure of Nepalis is still covered out of pocket. Nearly a third of families spend over 10% of their annual income on medical care.Read also: <a style="background-color: #ffffff; font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/banner/this-is-how-to-upgrade-nepals-rural-health/" target="_blank" rel="noopener">This is how to upgrade Nepal's rural health</a>, Sewa Bhattarai <a style="background-color: #ffffff; font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/banner/state-of-the-art-rural-hospital/" target="_blank" rel="noopener">State of the art rural hospital</a>, Marty LoganThursday, 12 December, is Universal Health Coverage Day, an important date to remind ourselves of the next steps we need to take to achieve healthcare for all. The 2015 constitution of Nepal declares basic and emergency healthcare as fundamental rights of citizens, putting the responsibility of financing such care on the state. Following federalism, municipal governments have got the responsibility to manage basic and essential care. A national health insurance bill has been passed and is being implemented.The state guarantees quality healthcare without financial burden on citizens, for which the insurees pay Rs3,500 per year for a family of five, and receive care worth Rs100,000. This is expected to reduce the burden of out of pocket and catastrophic expenses, while the government covers the premium for citizens under the poverty line.Read also: <a href="https://archive.nepalitimes.com/article/nation/national-health-insurance-not-as-easy,4028" target="_blank" rel="noopener">A national health insurance scheme is not as easy as it looks</a>, Sonia Awale<a style="background-color: #ffffff; font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/editorial/poor-health/" target="_blank" rel="noopener">Poor health</a>, EditorialThere is also a provision for free essential drugs and free treatment for patients with cardiovascular disease, cancer, spinal injuries, renal ailments and sickle cell anaemia, through the Disadvantaged Citizens Medical Treatment Fund.None of these initiatives is being implemented fully yet, but with federalism Nepal has a chance to build an accountable and sustainable healthcare system. The country therefore needs to focus on the following areas to manage health financing to meet the targets of the Sustainable Development Goals:<ul><li>Increase public sector healthcare investment to at least 7% of annual national budget. This should also be targeted towards reducing external aid.</li> 	<li>Empower people for self-care and make treatment more strategic and efficient as the burden shifts from communicable to non-communicable diseases.</li> 	<li>Focus on primary health care and improve services at the first point of care with comprehensive, accessible and community based care.</li> 	<li>Coordinate multisectoral policy action involving education, agriculture and social behaviour.</li> 	<li>Launch a priority national campaign to spread insurance coverage. Enrollment can be top-down starting with all government officials and then the public at large.</li></ul>A mixed financing model using tax-based funds through the treasury, and premium-based funds through health insurance can work for public, private, community, and other hospitals that run under the state-non-state partnership. An example of state- non-partnership is Bayalpata Hospital in Achham district, managed through a public-private partnership between the ministry of health and population and the non-profit Nyaya Health Nepal, where insurance reimbursement covered over 60% of the hospital’s operating costs.The hospital provides healthcare with no user fees. The care is extended from hospital to communities using a network of community health workers. How can care delivery with no user fee sustain? Can Nepal afford to provide such care to its entire population?It is possible. The country should effectively implement the national health insurance program, and strategically invest tax based funding. In the mixed financing model, for a ‘district level hospital, insurance can cover 60% of healthcare operating costs, and tax-based funding can take care of the rest. But to ensure effectiveness, the tax-based investment will need to be unrestricted and tied to audited performance indicators. The cost of care should also incorporate the extension of hospital-based services into communities in the catchment area.Bayalpata Hospital serves both as a primary care facility and also as a referral hospital. In this case, the tax-based contribution can be split into the three government tiers, with the federal government providing support for infrastructure, and provincial and local governments covering the cost of basic healthcare, and referral care not covered by the insurance.Insurance reimbursement then covers the cost of insurance-covered care, the local government allocates funds required for basic and emergency healthcare, and the provincial government pays for managing the cost of referrals beyond insurance coverage.<a style="background-color: #ffffff; font-size: 15px; letter-spacing: 0.01em;" href="https://archive.nepalitimes.com/article/nation/Nation-Crowdfund-globally-act-locally,490" target="_blank" rel="noopener">Bayalpata Hospital</a> provides basic and referral care, and its tax-based contribution can be split into the three government tiers, with the federal government providing support for basic infrastructure and provincial and local governments covering the cost of basic and referral care not covered by the insurance.Insurance reimbursement then covers the cost of insurance-covered care, the local government allocates funds required for basic and emergency healthcare, and the provincial government pays for managing the cost of referrals beyond insurance coverage.The proposed model has a 60:25:15 ratio to pay for health care, with 60% from insurance and provincial and local governments paying 25% and 15% of the cost. When the benefit package increases to cover the cost of healthcare without capitation, the share of health insurance coverage percentage will increase significantly, thereby reducing the tax-based direct public sector investment.S P Kalaunee is Executive Director of Nyaya Health Nepal, which manages Bayalpata and other public hospitals in partnership with the ministry of health and population.

Is free health care possible in Nepal?

Sha Bahadur Gurung was 30 years old when he was arrested for participating in a peaceful protest. He died aged 65 last week in Bhutan’s Chamgang Central Prison. He was among 31 prisoners of conscience in Bhutan, many of whom are serving long sentences for opposing the regime’s forcible expulsion of 100,000 of its Lhotsampa people in the early 1990s. ‘Mr Gurung died on 15 December in his prison cell under circumstances that raise serious concerns about custodial negligence and long-term abuse,” said a statement by the Global Campaign for the Release of Political Prisoners in Bhutan (GCRPPB) based in The Hague which demanded an external probe, justice and release of remaining political prisoners. Gurung was from Chirang and was arrested in 1990 while serving in the Royal Bhutan Army, and accused of having sympathies for the Lhotsampa people. He was mostly held at the notorious Rabuna Prison in Wangdi Phodrang District.&nbsp; Gurung’s relatives in the United States said he had endured prolonged physical and psychological abuse during his imprisonment, and repeatedly subjected to torture and inhumane treatment. They believe the decades of ill-treatment had damaged his health, ultimately leading to his death. Earlier this month, Gurung was transferred from Rabuna to Chamgang Central Prison. On 14 December. He had gone to bed after dinner without any visible sign of distress. He was found unconscious in his cell the next morning.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251224151248_5fc8305ecd320d89b9e343c04a1a897dc1353353da55b6d277f5398034b265ea.jpg" data-media-id="editor_0" data-image-id="20251224151248_5fc8305ecd320d89b9e343c04a1a897dc1353353da55b6d277f5398034b265ea" data-rendition-name="original" width="902" height="1103" loading="lazy" alt="Sha Bahadur Gurung NT"> <figcaption>Sha Bahadur Gurung, who died at age 65 in prison in Bhutan after serving 30 years for expressing political opinion.</figcaption> </figure>  He was referred to a hospital in Thimphu, suggesting that he was still alive during transfer to a local health post. But it appears that he had already died before being taken from prison. Gurung’s death occurred two days before Bhutan’s National Day on 17 December, when families, supporters, and human rights advocates worldwide had hoped for the release of political prisoners through a royal amnesty. Instead, the death of one of the longest-serving political prisoners has caused grief and anger in the Bhutanese diaspora.&nbsp; “We strongly condemn the treatment and death of Gurung, a peaceful and justice-loving Bhutanese citizen,” the V statement said. ‘This tragedy raises serious questions about the treatment of political prisoners in Bhutan and stands in stark contrast to the country’s international image under the principles of Gross National Happiness, compassion, and mindfulness.’ Earlier this year, The <a href="https://www.ohchr.org/en/special-procedures/wg-arbitrary-detention/opinions-adopted-working-group-arbitrary-detention/opinions-adopted-working-group-arbitrary-detention-its-101st-session" target="_blank">United Nations Working Group on Arbitrary Detention</a> said the Bhutan government was detaining citizens without parole for <a href="https://nepalitimes.com/news/detainees-in-dire-straits-in-bhutan-s-prisons" target="_blank">expressing political opinion</a>. The New York-based Human Rights Watch (HRW) said in 2023 that there were least 37 <a href="https://www.hrw.org/news/2023/03/13/bhutan-free-long-term-political-prisoners" target="_blank">political prisoners</a> in Bhutan’s jails. Of them, 32 belong to the Nepali-speaking Lhotshampa community, which has faced <a href="https://www.hrw.org/news/2003/06/18/nepal-bhutanese-refugees-rendered-stateless" target="_blank">decades of discrimination and abuse</a> and eviction. Most of them were convicted because of prohibited political activity between 1990 and 2008. One political prisoner, <a href="https://nepalitimes.com/news/no-country-for-dissent?fbclid=IwAR07lpitMBWAYSkny_3d_smQBlmoxAOQm1OxdNtl-27h8mV0RNO9IxVY2qs" target="_blank">Madhukar Monger</a>, who was released in 2023 after serving 29 years described brutal conditions in <a href="https://www.hrw.org/asia/bhutan" target="_blank">Bhutan</a>'s jails. Political prisoners were not given enough food, and medical care, he said, urging the internaitoonal community to press for the release of prisoners of conscience.&nbsp; In March, <a href="https://www.hrw.org/about/people/meenakshi-ganguly" target="_blank">Meenakshi Ganguly</a>, Deputy Asia director at Human Rights Watch, urged Bhutan’s international partners to call on the Bhutan government to release all remaining political prisoners immediately.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251224161216_9d11a78ed5490091c595341900e4c26f5c0dd0328718f6930ef19c1e9b7f95a6.jpg" data-media-id="editor_8" data-image-id="20251224161216_9d11a78ed5490091c595341900e4c26f5c0dd0328718f6930ef19c1e9b7f95a6" data-rendition-name="original" width="1000" height="1422" loading="lazy" alt="Bhutan political prisoners NT"> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251224161216_176855f3d3df42d24ac7e77372bbf49115695b732a6c094a66267e969111dfca.jpg" data-media-id="editor_9" data-image-id="20251224161216_176855f3d3df42d24ac7e77372bbf49115695b732a6c094a66267e969111dfca" data-rendition-name="original" width="1000" height="1420" loading="lazy" alt="Bhutan political prisoners NT"> </figure>  &nbsp;

Bhutan political prisoner dies in detention

‘Get out of my house.’ ‘All my sickness is because of you.’ ‘You’re a millstone around my neck.’ Arundhati Roy heard these admonitions from her mother over and over throughout her life.&nbsp; This must be a singular, yet universal experience. There must be very few daughters who make it through life unscathed by their mothers. And vice-versa.&nbsp; How many of our mothers look at us and see in us the potential of all of the lives they could have lived? How many resent us for it, or want us to live those lives in their stead? And how many of us look back at our mothers and imagine what they would have achieved had they not been expected and assigned to play the role of wife, daughter-in-law, mother — had we never existed in their lives? How many mothers project their experiences onto their own daughters and continue the cycle? No daughter seems to escape it — no matter how well-behaved, docile, unruly, or rebellious. Certainly not the child who would go on to become a Booker prize-winning author. Arundhati Roy’s memoir Mother Mary Comes To Me chronicles her complex relationship with her mother Mary, or Mrs Roy, as her educator mother had her two children refer to her. In December, Arundhati Roy was in Kathmandu to sign books and briefly interact with readers at two bookshops in the city. She describes a childhood overshadowed by her mother’s volatility towards her and her brother. Mary herself was raised by an abusive father to escape whom she married the first man who proposed — Arundhati’s father who in her mother’s words turned out to be an alcoholic ‘Nothing Man’.&nbsp; Mary left her husband in Assam and eventually wound up with her two children in her town of Aymanam in Kerala, encountering other family members along the way who did not treat her, or her children with respect. The trauma and cruelty her mother endured could not be contained in her body, and spilled out onto her two children, towards whom she was physically, verbally, and emotionally abusive.&nbsp; While she treated her children with disregard, she would build a school in the nearby town of Kottayam from the ground up, educate thousands of children, take up a legal fight that led to the Supreme Court granting Syrian Christian women in India equal inheritance rights, and uplift many orphaned children and women in Kerala.&nbsp; Arundhati lived with both her mother’s brutality and brilliance. And like her daughter, readers must reconcile the indefensible parts of Mary Roy’s personality — the cruelty of calling her nine-year-old daughter a bitch, or shooting the family dog that mated with a stray — with her unyielding drive to educate thousands, fight for equal rights, and challenge the way her world viewed women.&nbsp; Mrs Roy had little kindness for her own children, but plenty for the students, children, and women whose lives she shaped, and made better. And her kindness was not rooted in empathy, but in anger at the hand she had been dealt in life. Eventually, Arundhati decided to temporarily cut all contact with Mrs Roy — not because she did not love her, she writes, but so that she could continue to love her. Her desire to get away from her abusive mother, and her fascination with the ideas inspired by the architect who built her mother’s school, would lead her to the Delhi School of Architecture at age 16. In Delhi, Arundhati became roommates with Hisila Yami before she and her Maoist ideologue husband Baburam Bhattarai went underground to lead Nepal’s decade-long armed struggle. &nbsp; But architecture was not her calling. In Delhi, the heart of India’s statecraft, Arundhati came into young adulthood against a backdrop of the country’s changing socio-politics, which began to take a turn for the hyper-nationalist, Hindu supremacist community that it has now largely become. The winds of those changes have now blown into Nepal. In the city, far from her mother, Arundhati met the man who would become her partner of many years, collaborating with him on several films and screenplays before finding the language (‘I needed to hunt [language] down like prey,’ she writes) she needed to become the writer she is now.&nbsp; She went on to write her Booker prize-winning novel The God of Small Things, but the wealth and status the book brought her did not sit comfortably. So she smashed her newly-built gilded cage, as she describes it, and became more political. Contrary to norm, she published several works of non-fiction, and would only publish her second novel, The Ministry of Utmost Happiness, in 2017, 20 years after The God of Small Things. &nbsp;&nbsp; Her fierce opposition to India’s nuclear policies, to a dam that would displace millions of indigenous people and ecologically damage the Narmada Valley, her championing of Kashmiri self-determination, and her time spent with Maoist rebels in the forests of Chhattisgarh as they took up arms to defend their land and resources against corporate interests made her an enemy of the state.&nbsp; Meanwhile, being raised by a single mother had never sat well within her Syrian Christian community. ‘I wasn't Christian enough. I wasn't Hindu enough. I wasn't communist enough. I wasn't enough,’ Roy writes in her memoir. For all her love for India, the nation did not seem to reciprocate. The circumstances might be different, but it might strike a chord with readers in Nepal, many of whom marched on the streets in September hoping for a better tomorrow, but were gunned down by the very institutions meant to protect them. It might resonate with those who are not seen as citizens of this nation simply because they might not fit into an imagined idea of Nepali nationhood.&nbsp; Arundhati’s relationship with her mother, who was simultaneously proud and disdainful of her daughter’s accomplishments, continued to be tumultuous until the end of Mary Roy’s life.&nbsp; One of Mrs Roy’s last messages to her daughter before she passed was: ‘There is no one in the world whom I have loved more than you.’ Arundhati muses that her lifelong refusal to stop loving her mother must have finally breached her barriers. One wonders if that final declaration of love was solace enough, apology enough, for all the pain caused.&nbsp; But for Arundhati Roy, her love for her mother and her motherland outweighs the cruelty both have shown her. This, too, must be a singular, yet universal experience.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025122208128_32b171acb09df2184495367b74efd91fe2896b0f5ba75b276e1533276268761c.jpg" data-media-id="editor_0" data-image-id="2025122208128_32b171acb09df2184495367b74efd91fe2896b0f5ba75b276e1533276268761c" data-rendition-name="original" width="1136" height="702" loading="lazy" alt="Mother Mary Comes to Me review"> </figure>

The sins of our mothers

Samrat Upadhyay’s newest novel <a href="https://www.nytimes.com/2025/01/10/books/review/darkmotherland-samrat-upadhyay.html" target="_blank">Darkmotherland</a> imagines a Kathmandu in political turmoil after a large earthquake. In the aftermath, Home Minister Giridharilal Bhagirath Kumar stages a ‘koo’, and has convinced people that he is the answer to the crisis.&nbsp; He is now known as ‘PM Papa’, and picks up classic dictatorial ways — propaganda, statue-making, history-revising, and a gang of Shiva-worshipping ‘Fundys’.&nbsp; We are introduced to two complicated protagonists. The first is Kranti, a fetching young woman and ‘Madam Mao’, her Communist professor mother. The chef father loved classic rock and died by gas cylinder suicide. Kranti hates her mother, and the Communist group which congregates at her home to plot against PM Papa, although they seem to take forever to get anything done.&nbsp; Kranti has a complicated relationship with the handsome Bhaskar, the middle son of the Ghimirey family oligarchy that is aligned with the dictator. She loves him, but as Bhaskar gets more and more involved with her mother and the Communist group, finds herself heading out to the ‘Bhurey’ (Bhu-kampa Rey-fugee) tents, to spend time with poet Kabiraj.&nbsp; Kranti is also given to delusions, paranoia, and psychosis, convinced that Bhaskar’s family is spying on her, and that one in the Communist group has supernatural powers of suggestion that led to her father’s suicide. Despite mental issues, she marries Bhaskar and into the Ghimirey clan, and the complex nexus between business and politics.&nbsp; The second is Rozy, initially the genderqueer lover of PM Papa who he discovered in the streets, and is described as a ‘gorgeous homosexual’. She turns heads due to her sexuality and beauty, and gets more and more politically powerful as the story moves along.&nbsp; Upadhyay tells us Nepali writers writing in English often feel a pressure to create an “all-embracing world” (interview), but that is what he seems to be getting at with the monumental plot of his novel. Unlike the realism in his previous novels, this one drifts off into magical realism. His narrative blends the ever-present risk of a big earthquake and the actuality of political tremors. The speed of political upheaval seems a little unrealistic for anyone who lived through the 2015 earthquake, although the GenZ protests showed just how quickly a regime can be reduced to a heap of rubble. The age-old question: oppression can be overcome, but what comes after? The PM Papa character is a Gyanendra-Oli-Deuba-Prachanda-Modi-Trump-Papa Doc composite who is good friends with the not even thinly veiled President Corn Hair.&nbsp; Through the character of Kranti, Upadhyay conveys the dynamic between a parent and a child who is now a full adult, on relationships in Kathmandu as marriage looms, on pervasive corruption which one might denounce but have to take advantage of to get things done.&nbsp; Through Rozy, Upadhyay brings attention to the non-binary identity, one that has existed forever in Nepal, and although is discussed a lot in the West lately but not so much here. Upadhyay explores the origins, the present, and the various advantages and disadvantages of the queer.&nbsp; Storytelling in the early parts of the book oscillates between the real and absurd fantasy amidst the physical and political backdrop that does not have to be Nepal -- it could be Modi's India or Trump's America.&nbsp; The reader sees the world through Kranti’s psychosis, or PM Papa’s displays of power, such as when a ‘Sweej’ wrestler is beaten to death with a mace in a wrestling spectacle.&nbsp; These elements <a href="https://www.publishersweekly.com/pw/by-topic/authors/profiles/article/96329-samrat-upadhyay-wants-you-to-expect-the-unexpected.html" target="_blank">coagulate in the novel</a>, and Upadhyay has all the pages at his disposal to prod and push them against one another to see what happens. The novel is still at its best and most engaging when describing vulnerable scenes, of Kranti and her mister, or of Rozy’s messed-up childhood.&nbsp; Any Nepali reading his weighty novel can recognise the allusions and nudges such as the Tourist Area: Thamel, Open Stage: Khula Manch, Tri-Moon: Tri-Chandra etc. But anyone not from these parts may have a tough time keeping track. Keeping a notebook handy may be useful.&nbsp; Ultimately, the novel does work, it provokes and entertains. For best results, serialise the reading over 30 days, not 3 like this reviewer.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025122005124_88d92d9a2c5718436354d9c1ce6a2576931ef3242a37f6b90d84da15fe96dd8d.jpg" data-media-id="editor_2" data-image-id="2025122005124_88d92d9a2c5718436354d9c1ce6a2576931ef3242a37f6b90d84da15fe96dd8d" data-rendition-name="original" width="1136" height="702" loading="lazy" alt="Darkmotherland NT"> </figure>  <h2>More things change, more they remain the same</h2> First US-published Nepali Samrat Upadhyay is the award-winning author of novels and short story collections like Arresting God in Kathmandu, The City Son, Mad Country, and Buddha’s Orphans. Upadhyay is also the Martha C. Kraft Professor of Humanities at Indiana University, where he teaches Creative Writing.&nbsp; Recently in Kathmandu, he talked to the Nepali Times over coffee in Boudha about his writing, his teaching, and his newest novel, DARKMOTHERLAND.&nbsp; Nepali Times: Darkmotherland is 732 pages long. What was it like writing a much longer book? Samrat Upadhyay: Torturous Ha ha ha. Around 2014 I started a story. I knew it was going to be a novel. It was about this woman who is accused of being a Mangalik. Then the big earthquake happened in 2015. I was in the US but my parents were still here, they were living in tents. Then I started thinking, what would happen if a dictator came to power. That’s how PM Papa was born. I think mostly because of his character the novel exploded. I had never written a character like him before. I don’t do any plot outlines when I write. Let’s see where it goes. I like the process of writing to lead to discoveries. If I knew everything then I’d get bored. Not knowing where the storyline might go is very exciting. All these different threads started coming in, the character of Kranti started taking on a big role. Her mother, a Communist-leaning professor, started taking shape. Kranti also had a love-interest from an oligarchical family. The novel just took off and I just continued writing. A novel is as long as it needs to be. The initial draft was 1,700 pages. I was writing pretty fast. I don’t pause to see if the sentences are pretty. I whittled it down, and by the time I sent it to my agent it was 1,100 pages. He was able to sell it to Soho Press. I worked with an editor who suggested some further cuts and expansions. The editing part was even harder than the initial writing, because by that time I was tired of looking at the novel. There was a bit of a delay because of Covid, then we got back on track. What’s your daily process of getting the words on paper? I am a morning writer. I get up in the morning and start writing. You can have all kinds of theories but there is this saying, Shut Up and Write. The writing is where the meat is. You encounter difficulties in writing that you may not encounter when thinking about it. I see this in my students. I knew this was a big project so I knew that if I wanted to get it out I would need to write a lot per day. I got a couple fellowships in the university that gave me a few semesters off teaching. I would write for about 4 or 5 hours. Sometimes I would give myself a 1,000 word deadline, but I’m flexible with it if I don’t get there. You have to be kind and patient. What is your inspiration behind the gender-queer character, Rozy? I’ve always been a strong supporter of LGBT. I would say that at this point half of my students are non-binary or on the gender spectrum. Some of them are going through transitions. In some ways Nepal has become more accepting, but in other ways not. I did a workshop with Blue Diamond Society, and heard pretty harrowing stories. I didn’t intend to create a gender-queer character, but it seemed like the novel was demanding that. Especially in terms of the tyrannical stronghold that PM Papa has over the entire country, it made sense that there would be a counterpart, I wanted to put these things in motion and see how they interact. As I was writing Rozy, her character became very formidable. How much do you draw from Nepali politics? Do you form characters off people you know? Not in a very concrete sense, but I’m always drawing from them. I grew up in the Panchayat System, and lived in Lainchaur. The palace was there. The monarchy was such an institution. But then I was in the US, so I wasn’t here when the pro-democracy movement happened. In some ways it felt like things had changed, but were the same in other ways. I feel the same way now. I do draw upon people. I think my father makes an appearance in my work in various forms, I disguise him, of course. You’ve taught creative writing for a while now, how is literature changing?&nbsp; My students are also writing non-binary characters, because they want to be reflected in the stories. This is something new that we didn’t have. White authors, characters were the default. People of Color on the margins. African American and then Hispanic, South Asian authors were always pushing back on this status quo. When I was growing up in the classroom we were reading a lot of white male authors, but in my own life I was reading Salman Rushdie, African, South African friends and writers. My students have a lot more interest in fantasy, many are writing dystopian. One student is writing a novel where the characters start playing a game, and then they enter the game, and an entire new world opens up. On the one hand there are complaints that students aren’t reading enough, which is true, but my students are producing smarter work. Writing that is a lot more insightful. The calibre of discussion in my graduate-level novel writing classes is mind-boggling to me, and makes me want to keep on teaching. Do Nepali writers who write in English feel a certain pressure, from the market or self-imposed, to make their stories more Nepali? My experience for a long time was that there was a pressure, I felt it true in my case, I was supposed to be the representative of every Nepali. But Nepali writers writing in Nepali are not asked, how are you representing Nepal. At that time there was a lot of pressure to write a novel that is all-embracing, that is supposed to speak on all aspects of the country. Politics felt like an integral part of it, that these novels had to make big political statements. I always felt like this was wrong. I mean, people have to write what they want to write. &nbsp;You write what you want to write, and if it resonates with readers, that’s great. If it doesn’t, that’s fine too. Art isn’t going to speak to everyone. We do a competition every couple of years called Writing Nepal. We make a call for stories, and we decide the best ones. I find it refreshing now that the writing isn’t all about Nepal. The best stories are quite varied. What are Nepalis writing about?&nbsp; Several of the stories are about the role of women in our society, done with a lot of nuance, about the sort of multitasking they have to do. Some of it was deeply historical, some dystopian, the coming of AI. Some of them have an old-timey type of feel, and some of them are very modern, contemporary. The general level of art in movies, TV shows, and novels seems to have regressed compared to say the 90s.&nbsp; I don’t think that’s entirely true. Publishing has been harder, for sure, but there are a lot of novels being published every year. My writing workshop had always been a good vehicle for short stories, but a lot of my students now—even undergraduates—are working on novels. I haven’t formulated my thoughts on AI, it is so new and has hit us so hard. Many of my students are using AI, especially when writing response papers to works of literature or peers, which I find appalling. That’s going to be a struggle. I tell my students, who are you fooling? If you feel that you want to be an artist, or a writer, then what’s the point of using AI? AI-generated stories are also just not that good. They’re almost too perfect, too well put-together, making moves that are easy to detect. There is something about human-written stories that are messy and exciting. But there are also plenty of students who want to do original work and don’t want anything to do with AI.

A dystopian motherland

From its headwaters near Mansarovar on the Tibetan Plateau to its confluence with the Ganga in India, <a href="https://nepalitimes.com/banner/faith-to-reality">the Karnali</a> remains one of the last great free-flowing rivers in the Himalaya. At a time when most major Asian rivers have been dammed by concrete, the Karnali still surges, migrates, floods and recedes according to its own natural rhythms. This sustains an entire living system -- wildlife, communities and cultures — that cannot be replicated once a river is turned into a staircase of reservoirs. The Karnali is a natural artery for western Nepal. It nourishes fertile floodplains, recharges aquifers, supports fisheries and connects remote communities.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251221101240_213faa0e9da42af63e6c4f8a41e23a96efbd9f29a1d148227d65d2f16bb64b53.jpg" data-media-id="editor_1" data-image-id="20251221101240_213faa0e9da42af63e6c4f8a41e23a96efbd9f29a1d148227d65d2f16bb64b53" data-rendition-name="original" width="2500" height="1875" loading="lazy" alt="Karnali"> <figcaption>Confluence of the Humla and Mugu Karnali.</figcaption> </figure>  Bardia National Park and its rich biodiversity, including the tiger and fresh water dolphins, depend on the river and its seasonal interaction with the floodplain and wetlands. Riverine birds, crocodilians, endemic fish, all depend on the river. Millions of people in Nepal and India rely on the Karnali (called Ghaghara in India) for household use, irrigation and livelihoods. This living river now faces <a href="https://nepalitimes.com/banner/dams-and-dreams-a-journey-down-the-karnali">a cascade of proposed hydropower projects</a>. So far, the Upper Karnali &nbsp;(900MW) and the massive Karnali-Chisapani (10,800MW) have been purposed. Both have been mired in controversy and have been delayed. Construction of smaller projects like the Bheri-Babai Diversion are already underway.&nbsp; The Upper Karnali is a Rs146 billion project first purposed in 2006. It started construction earlier this year with the Indian conglomerate GMR leading the task. Even so it faces a setback as Bangladesh cancelled the power purchase deal of 500MW.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025122109124_80c381c4299dd7e18dbbcacb26e567edc5cfffba76d428e3b325dd194eae8a47.jpg" data-media-id="editor_3" data-image-id="2025122109124_80c381c4299dd7e18dbbcacb26e567edc5cfffba76d428e3b325dd194eae8a47" data-rendition-name="original" width="4284" height="5712" loading="lazy" alt="Karnali"> <figcaption>Free-flowing Upper Karnali.</figcaption> </figure>  The project is located on the stupendous Karnali Bend where the water can be pushed through a 2.5km tunnel over a drop of 130m, creating a huge generation capacity. But Nepal’s move towards big dams comes at a time when scientists warn of more extreme weather events like floods and landslides in the already fragile Himalayan landscape. Nepal now needs investment in storage projects as most hydropower plants are of the run-of-river type, which means power generation drops in the dry season. But a piecemeal dam-by-dam approach risks destroying a unique resource for benefits that could be achieved elsewhere with far less ecological cost. Once a free-flowing river is fragmented, its sediment delivery is choked, fish migrations are cut off, floodplains dry out and local cultures that revolve around seasonal flows begin to unravel. These changes are effectively permanent.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025122109120_4f59b09b6e03889457b9b98d72d6b604d3519895f8825b4b03f486d67ea299af.jpg" data-media-id="editor_4" data-image-id="2025122109120_4f59b09b6e03889457b9b98d72d6b604d3519895f8825b4b03f486d67ea299af" data-rendition-name="original" width="2500" height="1875" loading="lazy" alt="Karnali"> <figcaption>Local children play indigenous musical instrument.</figcaption> </figure>  “The Karnali is the last and most pristine Himalayan River left, most others are already exploited. It should be protected as a wild, scenic, free flowing river as a gift to future generations,” says activist Megh Ale, who wants the river to be developed as an eco-tourism corridor on the pilgrim trail to Mt Kailash and Mansarovar.&nbsp; “We have many big tributaries to the Karnali,” Ale adds. “We can keep the main stream of the river as free flowing, and develop hydro projects on the tributaries. More than 6,000MW can be produced without touching the main river stem.”  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025122109128_223faf7f50c43f3bf008a7745b90131fa91975689109533b71ed7d9dcdb8c53e.jpg" data-media-id="editor_5" data-image-id="2025122109128_223faf7f50c43f3bf008a7745b90131fa91975689109533b71ed7d9dcdb8c53e" data-rendition-name="original" width="1875" height="2500" loading="lazy" alt="Karnali"> <figcaption>Rafters say Karnali is one of the best places for white water rafting in the world.</figcaption> </figure>  Nepal has abundant alternatives to hydropower: solar energy has been hardly tapped, and integrating them with pump storage systems are cheap, quick to build and are low impact. Smarter siting and design, modern transmission links and regional power trading can deliver reliable energy without sacrificing the country’s last pristine river. Preserving the Karnali would also pay dividends in climate resilience: free-flowing rivers buffer <a href="https://nepalitimes.com/banner/climate-denial-in-the-himalaya">extreme floods and droughts</a>, carry sediment that builds deltas and replenishes nutrients on farmland, and provide insurance against glacial and monsoon variability.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025122109124_a5726642ee785b624ee3e6d81a051091c91a8d388dba8c33f4a03bab1fddc97f.jpg" data-media-id="editor_7" data-image-id="2025122109124_a5726642ee785b624ee3e6d81a051091c91a8d388dba8c33f4a03bab1fddc97f" data-rendition-name="original" width="2500" height="1875" loading="lazy" alt="Karnali"> <figcaption>Tharu women repair a channel fed by the Karnali, which is a life line for their farms.</figcaption> </figure>  The Karnali is also a cultural and economic asset in its own right. As a rare, undammed Himalayan river, it underpins nature-based tourism, scientific research, and a way of life for Indigenous and local communities. Kalashtham Tharu, 32, is an elephant mahout in Bardia, and says the Karnali is an important source of water for animals and farming. Diversion for irrigation near Chisapani has meant that a channel going into Bardia National Park has gone dry, affecting biodiversity and nearby farms. &nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025122109120_6d3a45a440263e859d64c427a8543c6ede5a447a411797d25a6a41d713d33e91.jpg" data-media-id="editor_8" data-image-id="2025122109120_6d3a45a440263e859d64c427a8543c6ede5a447a411797d25a6a41d713d33e91" data-rendition-name="original" width="1500" height="2000" loading="lazy" alt="Karnali"> <figcaption>Panning for gold on the banks of the Karnali. She makes Rs200,000 per year. </figcaption> </figure>  Similarly, the Sonahar community in Bardia relies on the river to pan for gold, their sole source of income. Anita, 40, says there is much less water in the Karnali this year. On an average, she makes Rs200,000 from middlemen for the gold she pans during non-monsoon months. &nbsp; WILD RIVERS Around the world, countries are beginning to recognise the value of keeping a few great rivers wild. Protecting the Karnali would place Nepal at the forefront of that movement and strengthen efforts to seek international recognition for the river’s outstanding natural heritage. Any decision should be grounded in a transparent, basin-wide assessment that weighs the full social, ecological and economic costs—not just the megawatts on a project spreadsheet. That means evaluating alternatives, safeguarding critical habitats and migration routes, and recognising the rights and knowledge of the people who live along the river. It also means asking a simple question: If Nepal can meet its energy goals without damming the Karnali’s main stem, why wouldn’t it?  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025122109128_3e357c863de55b397f09cfd666c762de297a8b07ac024a41a8bb5b9e8d3a76cf.jpg" data-media-id="editor_9" data-image-id="2025122109128_3e357c863de55b397f09cfd666c762de297a8b07ac024a41a8bb5b9e8d3a76cf" data-rendition-name="original" width="2000" height="1500" loading="lazy" alt="Karnali"> <figcaption>River mining the Karnali in Kalaili district causing uneven landscape with the river flowing away from Bardia National park.</figcaption> </figure>  Advocates have petitioned Nepal’s Supreme Court to protect the Karnali, with a hearing scheduled in Kathmandu on 22 December. International lenders and investors should take note: Financing high-impact dams on the Karnali would run counter to emerging global standards on biodiversity, <a href="https://nepalitimes.com/banner/dancing-with-the-river">climate resilience</a> and free-flowing river protection. Funding clean energy in Nepal should not require sacrificing the country’s most pristine river. For three decades, I have documented the Karnali from its source in Tibet to its entry into India, capturing the river’s seasons and the lives it sustains. The images I have captured and the voices of people who depend on the river, tell a simple truth: a free-flowing Karnali is irreplaceable. Once the concrete is poured, there is no going back.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025122109128_760ae5218d5f7e961c198da0a6c8696247e34281752a2857de935f9e8aec2c5c.jpg" data-media-id="editor_11" data-image-id="2025122109128_760ae5218d5f7e961c198da0a6c8696247e34281752a2857de935f9e8aec2c5c" data-rendition-name="original" width="1504" height="1502" loading="lazy" alt="Karnali"> <figcaption>Inner sanctum of Mt Kailas in the vicinity of Manasarovar and Rakshas lakes in Tibet.</figcaption> </figure>  Nepal has many options for generating power. <a href="https://nepalitimes.com/here-now/a-karnali-portrait?%2F">It has only one Karnali</a>. Keeping this river wild would be a gift to the living Earth and to future generations — a legacy measured not in megawatts, but in life. Says Megh Ale: “We are very rich in natural resources but manage them very poorly. We want instant solutions but do not have a long-term vision. We are not against development but there needs to be a good balance with nature.” &nbsp;

universal-health-coverage-day

POOR HEALTH MAKES NEPALIS POORER

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Bhutan political prisoner dies in detention

The sins of our mothers

A dystopian motherland

The river of life