<figure><img width="2000" height="1333" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110161148/636d1dca9c7e80680e0af3d8jpeg.jpg" alt=""/><figcaption>Photo: MONIKA DEUPALA</figcaption></figure>After watching the Netflix drama<a href="https://www.netflix.com/title/81004536"> </a><a href="https://www.netflix.com/title/81004536">Bombay Begums</a> recently, I was encouraged to see that mainstream cinema has started giving space to a female character going through menopause and experiencing hot flashes. This is probably a first in the Subcontinent's cinema.The series did not captivate me as much as this rare portrayal of a woman during menopausal transition in a s<a href="https://www.nepalitimes.com/here-now/saving-one-nepali-mother-at-a-time/" target="_blank" rel="noopener noreferrer">ociety that is so steeped in </a>patriarchy, and an issue that even women in Nepal do not want to address. The same kind of <a href="https://www.nepalitimes.com/opinion/tipping-point-on-menstrual-banishment-in-nepal/">taboos that dictate menstruation</a> also affect menopause, the two biological events that bookend the life of women.The general assumption is that this is not something that should be talked about openly, and the prevailing misconception is that women’s health consists only of <a href="https://www.nepalitimes.com/here-now/nepal-far-from-hitting-contraceptive-target/">pregnancies and contraception</a>. Health after menopause is either ignored or dismissed. This is prevalent not only in the public, but also among us health workers who have limited knowledge on the matter. We need a fundamental change in how we view women’s health to understand menopause better.Women today are living much longer than their mothers and grandmothers. Assuming most women have menopause between 45-50 years, they still have a considerable number of years left to live, which makes understanding menopause even more essential. Menopause is a natural biological process, and not a ‘disease’ or ‘sickness’ that some health workers and drug companies try to make it out to be. It is much like <a href="https://www.nepalitimes.com/here-now/menstruation-is-not-private-business-it-is-everyones-business/">menstruation or menarche</a> where girls experience pain only to disappear with time, with only a few needing medical treatment. <a style="background-color: #ffffff; font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/editorial/that-time-of-the-month/" target="_blank" rel="noopener noreferrer">Much of this</a> is managed with a few simple home remedies. I used to carry a hot water bag and my mother used to make me soup with garlic and fenugreek to relieve the pain. Once in a while, I also needed a painkiller but not often. When I was 48, I started getting irregular menstruation and within a year, my periods stopped completely. I did not have other health problems like palpitation, dizziness, night sweats, hot flashes headaches and irritability, often described by many pre-menopausal or menopausal women. There is no way to predict who will and who will not experience such symptoms. But this can be avoided or reduced by adopting <a href="https://www.nepalitimes.com/opinion/living-to-eat/" target="_blank" rel="noopener noreferrer">healthy eating habits</a> and exercises while still in our prime.This is explained in detail in Our Bodies, Ourselves: Menopause, a book I was gifted some time back. Given that it dealt with a matter largely untouched in this part of the world, the book's message was a pleasant surprise.It was eye-opening in a lot of ways. I learned about various mental and physical health issues associated with menopause, and how detrimental it is not talking opening about it.Menopause can be highly stressful for those going through it. In addition to physical discomfort, women get skin spots, gain weight and develop wrinkles. But one must accept these changes, be prepared and still strive to lead a healthy life without giving too much importance to appearances.  <img width="400" height="497" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110161148/636d1dcd9c7e80680e0af3d9jpeg.jpg" alt="">Our body transforms with age, and everyone starts losing bone mass after the age of 35. Bone loss in women increases after menopause. This book has important tips on how to slow down this process: consume foods high in calcium and vitamin D, sunbathe and exercise daily. Whole grain, green leafy vegetables, lentils and fruits should make up a large chunk of the daily diet. Say <a href="https://www.nepalitimes.com/opinion/we-are-what-we-eat/" target="_blank" rel="noopener noreferrer">no to junk and processed foods</a>, carbonated drinks, extra sugar and fatty items which may give her osteoporosis later in life.For optimum health during menopause and after, a woman should also avoid smoking which interferes with the way bones absorb calcium and weaken our bones.Every woman has to go through menopause, but it is largely up to us to be prepared and make the experience as less painful as possible, physically as well as mentally. This book succeeds in sending the message across. Although written by a medical doctor, <a href="https://www.ourbodiesourselves.org/publications/menopause/" target="_blank" rel="noopener noreferrer">Our Bodies, Ourselves: Menopause </a>is an easy read. The author has interviewed many women to document the myriad of experiences they have had and hence is very relatable. Some health workers consider menopause as a disease and have developed ways to treat it. Here in Nepal too, there is now hormone therapy for women who have undergone menopause. The book argues that it is unnecessary, and instead has negative impacts on women’s bodies. By emphasising that menopause is a natural process and that most women have a relatively easy time with the transition, this book tells you that the hormonal changes of menopause affect each woman differently, they just need to work out how best to manage those changes. And while every woman is unique, <a href="http://archive.nepalitimes.com/article/nation/we-are-what-we-eat-aruna-uprety,3954" target="_blank" rel="noopener noreferrer">attention to diet and lifestyle</a> can do wonders in relieving discomfort as well as help with estrogen deficiency. The author combines trustworthy medical information based on the best available evidence with thoughtful analysis of the social, cultural, and political forces affecting our health. Inspired by this read, I have decided to write a book on menopause in Nepali so that all women, young and old across the country (as well as men) are educated about this transition and are prepared with the necessary tools to tackle it. Aruna Uprety is a public health expert and the author of the book Khana Khanu Bho?

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Talking about life after menopause

<figure><img width="640" height="494" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141128/636cfc959c7e80680e0a0b98jpeg.jpg" alt=""/><figcaption>All photos and infographics courtesy of: MERCY CORPS</figcaption></figure>The news of Covid infections in Karnali do not readily reach the capital. But remote districts in this far-flung region have some of the highest coronavirus fatality rates in the country.There are multiple factors involved: <a href="https://www.nepalitimes.com/editorial/pandemic-of-poverty/">poverty,</a> limited health and transport infrastructure, shortage of medical staff, lack of testing, and family members returning from India. People in the remote mountains of this historically neglected region now also have to survive on limited food.A recent survey in outback communities of Karnali province shows that the most serious socio-economic impact of the pandemic has been on <a href="https://www.nepalitimes.com/latest/quarter-of-nepalis-still-hungry-during-pandemic/">access to food</a> – a full one-third of households surveyed reported <a href="https://www.nepalitimes.com/latest/1-in-5-nepal-families-lack-food/">not having enough food.</a> Another 19% said they were even heavier in debt, and 14% lost their livelihood.To be sure, the Karnali has suffered <a href="https://www.nepalitimes.com/latest/the-pandemic-of-hunger/">chronic food insecurity</a> even before the pandemic, and almost every household has at least one member working in cities or in India. But the Covid crisis has made it worse. The survey was conducted among 395 people across 21 Karnali municipalities by USAID BHAKARI program implemented by the global humanitarian aid group Mercy Corps with an aim to improve food security in the region. Ten per cent of those polled were people with disabilities. <img width="640" height="283" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141128/636cfc989c7e80680e0a0b99jpeg.jpg" alt="">Some 78% of those surveyed said they had to change their diet and as high as 90% reported not having money to buy food, 38% switched to cheaper food items while 16% of the households resorted to prioritising children over adults with limited meals. Another 14% said they reduced the size of meal portions, 13% reduced the number of meals per day.  These figures may lead to a long-term impact on the physical and mental growth of children. The coronavirus crisis and subsequent lockdowns have pushed millions of Nepalis back below the poverty line leading to an <a href="https://www.nepalitimes.com/editorial/hunger-for-governance/">epidemic of childhood malnutrition.</a> “The impact of drought and the second wave are significant in the vulnerable communities in Karnali province, further increasing the food crisis in the region. We have reached a critical point,” says Yugdeep Thapa of Mercy Corps.  Women and people with disabilities in particular have faced added challenges in the past 18 months since the outbreak of Covid-19. Of the total women surveyed, 67% are not getting access to <a href="https://www.nepalitimes.com/here-now/ensuring-menstrual-hygiene-during-nepal-lockdown/">hygiene</a> products ranging from soap and sanitisers to menstrual pads.<a href="https://www.nepalitimes.com/latest/a-little-help-goes-a-long-way-in-home-isolation/"> Limited access to health services</a> due to lockdown-induced restrictions meant that 45% of the women couldn’t visit a health post or hospitals for reproductive health services. There have been a slew of reports about an <a href="https://www.nepalitimes.com/latest/in-nepal-lockdown-a-domestic-violence-spike/">increase in domestic and sexual violence</a> across the country during the pandemic, with women and children in closer contact with their abusers for a longer period. The Mercy Corps study confirms this, with one-third of the women reporting an unsafe environment at home due to domestic violence. Another 28% said they had faced increased violence and abuse in the household. While telemedicine has been an effective tool to receive medical consultation regarding coronavirus and other health problems, here in the mountains of Karnali Province, a majority of families have had no knowledge of such services with 24% of women unaware of the general Covid related helpline.Last winter’s drought added to the food insecurity. A quarter of those polled said they lost their entire year's harvest, and 89% said they were looking for work to sustain their livelihoods. Some 44% of respondents said they were farmers, 17% were daily wage earners and 21% had family members working abroad. <img width="550" height="980" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141128/636cfc9b9c7e80680e0a0b9ajpeg.jpg" alt="">The contribution of <a href="https://www.nepalitimes.com/latest/more-remittance-more-than-remittance/">remittance to household income is likely to increase</a> as job losses have pushed a further 15% of people to migrate to India, many of them after returning home due to the Covid lockdowns there in 2020 and this year. Those who couldn’t afford <a href="https://www.nepalitimes.com/business/remittances-from-nepali-workers-rise/">foreign employment</a> sold their livestock or property to feed their children during the pandemic. In fact, 57% of the respondents in the study said they had to sell livestock or borrow money. Less than 1% of those surveyed had a year's worth of food stock, 42% had enough food to last only three months at most. <img width="640" height="272" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141128/636cfc9d9c7e80680e0a0b9bjpeg.jpg" alt="">Half of the participants in the survey have not received any social security allowance to tide them over the long months of the coronavirus crisis. Those who did spent it mostly on food, health care and education.On the disaster front, 62% of the respondents had little to no information on preparedness even as the <a href="https://www.nepalitimes.com/latest/monsoon-hits-nepal-with-a-bang/">annual monsoon flooding season</a> was approaching at the time of the survey. But among those who accessed some news, did it mostly via radio and mobile phones which local governments could use to disseminate essential information in the future. <img width="640" height="530" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141128/636cfca09c7e80680e0a0b9cjpeg.jpg" alt="">Read Also:<a href="https://www.nepalitimes.com/latest/covid-19-affecting-food-security-in-nepal-wfp/"> Covid-19 affecting food security in Nepal</a>

Karnali’s Covid blues

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109141112/636ba77e9c7e80680e073787jpeg.jpg" alt="" width="1728" height="1296"/><figcaption>A woman gets Sayana Press suring the lockdown. Photo: IPAS NEPAL</figcaption></figure>For the past two decades, Basanti Paudel, 41, of Nawalpur had always used Depo-Provera to <a href="https://www.nepalitimes.com/banner/no-conceivable-reason-for-unwanted-pregnancies/" target="_blank" rel="noopener noreferrer">prevent unwanted pregnancies</a>  Then last year, she was given a new choice: Sayana Press.<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/here-now/nepal-far-from-hitting-contraceptive-target/" target="_blank" rel="noopener noreferrer">Sayana Press</a>, a successor to Depo-Provera, was introduced last year in  Nawalparasi and Sindhuli and is a better option because it has a smaller dosage, comes with a small needle, can be stored at room temperature and is injected sub-cutaneously just under the skin rather than in the muscles, making it less painful. Sayana can also be self-injected at home and lasts for three months just like Depo-Provera.Basanti Paudel immediately took to the new contraceptive. “It is a much better, but I worry about its availability during the lockdown, and that I may have to go back to using Depo-Provera,” she says.Pabitra Acharya, 42, of the same neighbourhood also started using Sayana Press after her husband who was working in India came back home following Covid-19 pandemic. She would also like to continue using the injection but is also worried about its availability.“Once we decide on the contraceptive best for us, we should be able to access it each time. Using different methods affects our health,” Acharya says.Both women were at the Rajahar Health Post in Nawalpur this week to express their concern about availability. At the health post, Dev Bahadur Dahal  Nawalpur assured them that they would not have to go back to using Depo Provera.“The drug used in Sayana Press and Depo-Provera is the same, the only difference is the dose, which is 30% lower. We thought why not go for an option that has lower drug but is just as effective and not as painful,” says Lhamo Y Sherpa of Ipas Nepal, adding that depending on the results in the two districts, the new contraceptive would be scaled up to the rest of the country.<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/banner/implant-service-providers-take-contraception-to-nepals-poor/" target="_blank" rel="noopener noreferrer">Nepal’s contraceptive prevalence</a> rate at 53% is a dramatic improvement from 20 years ago, but it is still a long way from the government’s target of 75% contraceptive prevalence by 2030.Furthermore, the use of modern family planning methods has plateaued since 2006 <a href="https://www.nepalitimes.com/here-now/migrating-males-and-population-decline/" target="_blank" rel="noopener noreferrer">due to labour migration</a>. But the <a href="https://www.nepalitimes.com/here-now/workers-return-to-jobless-nepal/" target="_blank" rel="noopener noreferrer">return of hundreds of thousands of migrant workers from India</a> and the Gulf following the Covid-19 pandemic is leading to an increase in the demand of contraceptives. Which is why there is a <a href="https://www.nepalitimes.com/here-now/baby-boom-expected-after-lockdown/" target="_blank" rel="noopener noreferrer">fear of shortages</a>  and also a break in the supply chain because of the lockdowns.According to the Nepal Demographic and Health Survey (NDHS) 2016, there is a 24% unmet need for family planning in Nepal — a quarter of women who need contraceptives are not using them.Sayana Press offers a new and easy to use contraceptive that can help meet the country’s unmet needs for family planning. It also gives women agency, especially because their husbands often refuse to use condoms.The new birth control device is already popular with women in Nawalparasi and Sindhuli districts and very few users have complained of side effects normally associated with contraceptives. In fact, users have reported fewer reproductive health complications.“For 20 years, I never got my periods regularly, once I did not have them for two years, and had to resort to medications to force my period,” says Basanti Paudel. “Since using Sayana, it has become more regular. It evevn seems to have brought down my blood pressure, and I don’t have nausea anymore.”Dilmaya Pariyar, 29, has been using contraceptives for 12 years and once every three months she needed to go to a health post to get a Depo-Provera injection, which was always followed by a week of pain in her arms, preventing her from working.“With Sayana Press, I haven’t had any pains. In fact, this has been the most suitable contraceptive for me so far,” she says. The other advantage is that Sayana Press can be injected at home with some basic training.There are some women who have complained of excessive bleeding for up to seven days after switching to Sayana Press, but according to a survey, the new contraceptive appears to have been well accepted in the trials which are conducted by the reproductive health agency Ipas Nepal and the Ministry of Health and Population (MoH) with financial support from the UK’s Department for International Development (DFID). Sayana Press is already used in 40 European countries.Of 1,112 women from 17-49 years of age who participated in the Ipas Nepal comparative study, 12% said they preferred Sayana Press to Depo-Provera. Participants also found the fact that it was self-injectible quite appealing.Says Bhim Singha Tinkaro, head of Family Welfare Division in the Health Ministry: “Given the positive results so far, Sayana Press can now be expanded to other parts of the country, and the ministry is expected to make a decision soon.”

New contraceptive for increased lockdown demand

<figure><img width="931" height="620" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110914118/636ba68f9c7e80680e07372djpeg.jpg" alt=""/><figcaption>All photos: VSO</figcaption></figure>Despite <a href="https://www.nepalitimes.com/banner/kathmandu-valley-back-to-lockdown/" target="_blank" rel="noopener noreferrer">restrictions on gatherings</a>,  women across Nepal mark Tij this week, the festival of women, on Friday. Increasingly, Tij songs are less about lamenting gender justice and more about striving for equality.One manifestation of entrenched patriarchy in Nepal is menstrual taboo, an extreme form of which is chhaupadi, the practice in parts of Nepal of the <a href="http://archive.nepalitimes.com/article/nation/women-speaking-out-against-chaupadi,3518" target="_blank" rel="noopener noreferrer">monthly banishment</a> of women to an outhouse during their periods.In a country where period stigma is still prevalent young women, adolescent girls are facing extra barriers under lockdown to maintain their period in a safe and dignified way.During the pandemic girls are mostly confined to the household, and during their periods are forbidden to touch communal objects in the household. Added to this, the economic crisis hitting these communities is leaving young women and girls unable to afford period products.Under a unique <a href="https://www.vsointernational.org/our-work/inclusive-education/system-strengthening/sisters-for-sisters" data-saferedirecturl="https://www.google.com/url?q=https://www.vsointernational.org/our-work/inclusive-education/system-strengthening/sisters-for-sisters&amp;source=gmail&amp;ust=1597908281944000&amp;usg=AFQjCNE0R0d69AjenpkQ1LnCoIEncENunQ">Sisters for Sisters' Education</a> started by the UK-based VSO (Volunteer Service Overseas), big girls in rural Nepal who were already mentoring younger ones have stepped in during the lockdown to guide them about using and accessing period products.<a href="https://www.nepalitimes.com/?p=21465&amp;preview=true" target="_blank" rel="noopener noreferrer">Nepal’s superwomen beat superstition</a>, Aruna Upreti <figure><img width="932" height="620" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110914118/636ba6919c7e80680e07372ejpeg.jpg" alt=""><figcaption>Muni Kumari Gupta is a ‘Big Sister’ who has been mentoring 11 little sisters in her community in a village in Parsa, the district in Nepal hardest hit by the Covid-19 pandemic. “These days we are all living in a fear of the coronavirus,” Muni Kumari says, “ever since the first case was found in our village, there has been more fear.”</figcaption></figure>Muni Kumari Gupta is a ‘Big Sister’ who has been mentoring 11 little sisters in her community in a village in Parsa, the district in Nepal hardest hit by the Covid-19 pandemic.“These days we are all living in a fear of the coronavirus,” Muni Kumari says, “ever since the first case was found in our village, there has been more fear.”Because the lockdown has been re-imposed in Parsa, Muni Kumari keeps in touch with her little ‘sisters’ through the mobile phone telling them to wear masks, maintain distance and keep elderly relatives safe.<a href="https://www.nepalitimes.com/banner/communicating-to-remove-menstrual-taboo/" target="_blank" rel="noopener noreferrer">Communicating to remote menstrual taboo</a>, Sewa BhattaraiWhen the lockdown eased for a few weeks in July, she visited the homes of her ‘sisters’ to coach them in school lessons. Most schools in Parsa had been converted into quarantine centres for returnees from abroad, and had been closed.Muni Kumari herself takes classes through the radio and joins her ‘sisters’ to learn English through the remote radio classes.“It has been very difficult to communicate properly with girls and their families. I was allowed to visit a few families near my home so that I could teach them how to wash hands and use a face mask properly,” says Muni Kumari, who had been trained in making reusable sanitary pads, and she shares this skill with family members and girls in the community.“During the lockdown, we were unable to buy sanitary pads at the shops. Therefore, the skills helped us to make our pads at home,” she adds.<a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/pad-power-nepal,4147">Pad Power</a>, Ziyu LinAnjali Patel is now in Grade 10, and is thankful that she has her ‘Big Sister’, Muni Kumari Gupta to help her navigate the dangers of the pandemic, the shortages of everything during the lockdown, and setbacks to education because of the closure of schools.“My Big Sister is the closest person I can share my problems with,” says Anjali, “she lives nearby and is always available to guide us and the other small sisters. She helps me with my studies, and tells me how to stay safe during the pandemic.”When Anjali was 10, her parents made her do household chores so she missed school a lot. Her parents also did not find school to be that important for a girl child. It was Muni Kumari who convinced her parents that Anjali should get an education.<a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/removing-menstrual-shame,4148" target="_blank" rel="noopener noreferrer">Removing menstrual shame</a>, Clara Hare-Grogg <img width="933" height="620" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110914118/636ba6949c7e80680e07372fjpeg.jpg" alt=""><img width="931" height="619" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110914118/636ba6969c7e80680e073730jpeg.jpg" alt="">Anjali Patel is at home listening to a remote classroom on the radio, and helping her nephews with school lessons.After the lockdown started in March, Anjali found it difficult because she could not meet her mentor face-to-face. But Muni Kumari called her on the phone and gave her confidence, instructing her how to protect herself and the family against the virus.The Sister for Sisters program is supported by UK Aid through VSO and has distributed sanitary hygiene packs to nearly 1,200 families in Surkhet, Lamjung, Dhading and Parsa districts of Nepal. The kits include soap, towel, toothbrush, reusable sanitary pad, underwear, nail cutter, hygiene kit bag and liquid chlorine. The project is implemented by Global Action Nepal and Aasaman Nepal. Nitu Gupta is also a ‘Big Sister’ for 13 smaller girls in an adjoining village in Parsa district. As elsewhere in Nepal, the young girls cannot go to school, their families are in a precarious economic situation, and there is the need to protect themselves from the spread of the coronavirus.<a href="https://www.nepalitimes.com/editorial/that-time-of-the-month/" target="_blank" rel="noopener noreferrer">That time of the month</a>, EditorialNitu was already helping to educate her 13 ‘sisters’ before the lockdown, and she has been carrying on that work to make up for the closure of schools.  “During the lockdown, our economic situation became much more difficult, and the girls were mentally affected because there have been suicides in the community,” Nitu says.Sisters for Sisters helped girls like Nitu with remote training through radio to stay safe during the pandemic. She kept in touch with the girls under her care, teaching them to wash hands frequently. <a href="https://www.nepalitimes.com/here-now/menstruation-is-not-private-business-it-is-everyones-business/" target="_blank" rel="noopener noreferrer">“Menstruation is not a private business, it’s everyone’s business”</a>, Reeti KC <figure><img width="932" height="620" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110914118/636ba6999c7e80680e073731jpeg.jpg" alt=""><figcaption>Nitu Gupta is another mentor in the Sister for Sisters project, raising awareness about Covid-19 and supporting the education of girls who are out of school in Bahubari of Parsa district. Here she is handing over a hygiene kit to the mother of one of her little 'sisters'.</figcaption></figure>She adds, “The most challenging has been the lack of access to reading materials and menstrual products during the lockdown. But we have been able to provide the families with hygiene kits. This has helped the girls stay clean and comfortable.” Joya Parvin,18, is also a ‘Big Sister’ with 13 younger girls under her charge, but during the lockdown she has only been able to keep in touch with four of them who live nearby. She says the biggest challenge for the girls in her group is accessing menstrual products, soap and sanitser and masks.When she first became a ‘Big Sister’ her main role was to convince parents from her Muslim community to send their daughters to school. But now that schools are closed, he mentoring is different – to make sure the girls keep up with their studies through radio, and have the necessary support to maintain hygience and stay safe.<a href="https://archive.nepalitimes.com/regular-columns/GUEST-COLUMN/blood-sisters-menstruation,839" target="_blank" rel="noopener noreferrer">Blood sisters</a>, Sangita Thebe-Limbu <figure><img width="930" height="620" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110914118/636ba69b9c7e80680e073732jpeg.jpg" alt=""><figcaption>Joya Pravin showing the little 'sisters' under the charge how to make their own sanitary napkins.</figcaption></figure>One of the little ‘sisters’ in the group that Joya mentors is Rami Khatun, and she says she was seized with panic when Parsa became a coronavirus hotspot in July. “But she gave us tips on how to stay safe, and when the shops ran out of sanitary pads, Joya taught us how to make our own,” says Rami.Rami spends her lockdown days at home helping with chores, and taking care of her nephews. Even though the schools are closed, Joya used to visit when the lockdown was eased. But now that are restrictions of movement, she calls frequently and Rami listens to the radio program to improve her English.Read also: <a href="https://www.nepalitimes.com/opinion/tipping-point-on-menstrual-banishment-in-nepal/">Tipping point on menstrual banishment in Nepal</a>, Marty Logan

Ensuring menstrual hygiene during Nepal lockdown

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108141124/636a58c19c7e80680e054852jpeg.jpg" alt="" width="1400" height="933"/><figcaption>WELCOME TO THE WORLD: A child sleeps in a hammock while its parents work in a workshop making idols for the Dasain festival in Kupondol. Photo: GOPEN RAI</figcaption></figure>Giving birth is a life or death issue in Nepal. Even though the maternal mortality rate dropped from 1,000 per 100,000 live births 40 years ago to 239 today, inadequate birthing facilities is still a problem. But attention is now also shifting to preventing pregnancies.There is a big <a href="https://www.nepalitimes.com/banner/implant-service-providers-take-contraception-to-nepals-poor/">unmet need for contraceptives</a>: nearly a quarter of women surveyed nationwide in 2016 said they were not using birth control, even if they need it. Social stigma, patriarchy, ignorance and lack of access were reasons.Nepal’s contraceptive prevalence rate is 52%, but in remote Bajura it is only 34%. Although progress is being made, we are still a long way from the government’s target of raising the rate to 75% by 2030.Read also: <a href="https://www.nepalitimes.com/?p=33714&amp;preview_nonce=033aa12640&amp;preview=true" target="_blank" rel="noopener">Nepal far from hitting contraceptive target,</a> Sewa BhattaraiAs our reports in this edition from Bajura and Chitwan show, there are cultural hurdles. With <a style="background-color: #ffffff; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/here-now/migrating-males-and-population-decline/" target="_blank" rel="noopener">husbands away working for long periods</a>, their wives are reluctant to use contraceptives because of what others will say. The result: women suffer unwanted pregnancies, <a style="background-color: #ffffff; letter-spacing: 0.01em;" href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/globe-rallies-to-aid-nepals-women,3841" target="_blank" rel="noopener">unsafe abortions</a> and ultimately struggle to take care of large families.Almost every woman who visited a hospital in Bajura on a busy day last month had the same story: their husbands were away and they did not use birth control. Some were suffering from botched abortions.More than 800 abortion cases were registered in Bajura last year. Just one hospital in Achham terminated more than 600 pregnancies in one year. Meanwhile, Nepal’s total fertility rate has dropped from 6 in 1960 to near-replacement level at 2.05 today, and the country’s population growth rate is also down from 2.5% in 1990 to 1.1% today. Surveys in Province 2 and Far-western Province have shown a clear correlation between unwanted pregnancies, child marriage and fertility in regions with entrenched patriarchy.Among Nepalis, 21% use injectable contraceptives, 10% are on pills, 10% use condoms, 8% have IUDs and only 3% have implants. Depo-Provera was among the most used injectables, but it was difficult to administer and painful. Now, the government, with donor support, is field-testing in Nawalpur and Sindhuli a lower-dose injectable called Sayana Press, which could make contraceptives more accessible to women.Interventions like these, the government hopes, will reduce unwanted pregnancies, thus preventing unsafe abortions and reducing the number of women who have to take care of larger families.<a href="https://archive.nepalitimes.com/regular-columns/Comment/mothers-in-Nepal-still-dying-at-childbirth,1007" target="_blank" rel="noopener">Complications during pregnancy or at childbirth</a> are the leading causes of death among girls aged 15-19 in low-income countries like Nepal. Unwanted pregnancies also hamper women’s education and economic independence, and impact their family life, fuelling an intergenerational cycle of poverty and poor health.Read also: <a style="background-color: #ffffff; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/banner/implant-service-providers-take-contraception-to-nepals-poor/" target="_blank" rel="noopener">Implant service providers take contraception to Nepal's poor</a>, Rojita Adhikari

Born in Nepal

https://youtu.be/VaSUaALct0oParvati Thapa, 39, looks lost as she wanders into the district hospital in this isolated northwestern corner of Nepal. She and her husband have walked a whole day to get here, and they just found out she is 19 weeks pregnant.Thapa already has three children, and after they were born she lost four sons one after another. After her menstruation stopped, she suspected menopause but now knows she is pregnant for the eighth time.“My husband is away for months at a time, tending cattle in the mountains. Why should I use <a href="https://www.nepalitimes.com/banner/implant-service-providers-take-contraception-to-nepals-poor/" target="_blank" rel="noopener">family planning</a> when we meet so rarely?” asks Thapa, who looks much older than her age.Read also: <a href="https://www.nepalitimes.com/?p=33648&amp;preview_nonce=5c7e9df60a&amp;preview=true" target="_blank" rel="noopener">Born in Nepal</a>, Sewa Bhattarai<a href="https://www.nepalitimes.com/?p=33648&amp;preview_nonce=5c7e9df60a&amp;preview=true" target="_blank" rel="noopener"> </a>Like most women in the remote mountains, Thapa has never used contraceptives. <a style="background-color: #ffffff; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/here-now/migrating-males-and-population-decline/" target="_blank" rel="noopener">Doing so carries a stigma for married women with migrant husbands</a>, and there are misconceptions about the different methods available. The result is that women suffer unwanted pregnancies, <a style="background-color: #ffffff; letter-spacing: 0.01em;" href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/globe-rallies-to-aid-nepals-women,3841" target="_blank" rel="noopener">unsafe abortions</a> and end up with large families they are  unable to take care of.Nepal’s contraceptive prevalence rate is 53%, but in Bajura it is only 34%. Although this is a dramatic improvement from 20 years ago, it is still a long way from the government’s target of 75% contraceptive prevalence by 2030. The fact that the use of modern family planning methods has plateaued since 2006 points to futher deterrences.“The family planning rate is really low in Bajura because a lot of the men migrate to India for work,” says nurse Dhankala Khadka at Bajura District Hospital. “If the husband is away and the wife wants to use birth control, she is often questioned about fidelity and may be ostracised by her community. Even husbands do not support them.”<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108141124/636a58de9c7e80680e054862jpeg.jpg" alt="" width="1400" height="970"/><figcaption>Parvati Thapa went to Bajura district hospital suspecting menopause, but found out it was her eighth pregnancy. Photo: MONIKA DEUPALA</figcaption></figure>Almost every woman who visited nurse Khadka on a busy day last month had the same story: their husbands were away and they did not use birth control.There were 804 abortions in Bajura in the past year, which Rohit Giri of Bajura District Hospital says is very high: “Most who come to us are married women with children, and the abortions are due to the lack of birth control, which leads to unwanted pregnancies.”<a style="background-color: #ffffff; letter-spacing: 0.15px;" href="https://www.nepalitimes.com/banner/this-is-how-to-upgrade-nepals-rural-health/" target="_blank" rel="noopener">In Bayalpata Hospital</a> in neighbouring Achham district, the story is much the same — it performed 660 abortions in the past year. Bhawana Rawal, 33, has had two abortions at the hospital in the past five years and admits she does not used birth control.Read also: <a href="https://www.nepalitimes.com/here-now/migrating-males-and-population-decline/" target="_blank" rel="noopener">Migrating males and population decline</a>, Om Astha Rai“I already have two children, and do not need any more, but I got pregnant twice by accident,” she says. “I still do not want to use contraceptives in future.” Rawal did try a Depo-Provera injection once but says it made her bleed too much. Other women have the same complaint. For those who do not want to use a permanent contraception, many felt pills were a hassle to acquire and take every day, and IUDs hurt.“Unwanted pregnancies often lead to anaemia because women lose so much blood,” says Kalawati Setthi, a nurse at Bayalpata Hospital. Nearly 40% of women in Far-western Nepal were found in a survey to be anaemic — most of them pregnant and <a href="https://www.nepalitimes.com/banner/back-to-the-nipple-in-nepal/" target="_blank" rel="noopener">breastfeeding</a>.The government has put up posters in rural hospitals to encourage contraceptive use but at this rate, it is unlikely that the target of 75% contraceptive use will be reached.<h2>Demand, but no supply</h2>According to the Nepal Demographic and Health Survey (NDHS) 2016, there is a 24% unmet need for family planning in Nepal — a quarter of women who need contraceptives are not using them. A report by Population Services international (PSI) Nepal found that unmarried youth aged 15-24 and married women aged 20-24 are the groups that use contraceptives the least.Married women like Parvati Thapa at a clinic in Bajura last month (left), normally tended to use contraceptives after their first child, and exposure to information about family planning through health workers and current users of family planning, as well as talking about it with husbands or relatives.Unmarried youth were likely to discuss family planning only with their sexual partners and most used condoms over other methods, which were bought and kept by the male partner. In contrast, married women visited health facilities themselves and chose the type of method they wanted.Unmarried youth, especially adolescents, had a higher unmet need and were more vulnerable to stigma associated with family planning. The report argues that the term ‘family planning’ only applies to married women and their plan to have children, whereas there are many contraceptive users who have no intention of having children, or use contraceptives to prevent sexually-transmitted diseases (STDs).Read also: <a href="https://www.nepalitimes.com/banner/child-marriage-in-nepal-eloped-at-13-mother-by-17/" target="_blank" rel="noopener">Child marriage in Nepal, eloped at 13, mother by 17</a>, Sewa BhattaraiWhen a woman goes to a public health facility for contraceptives, a register is filled out, which includes a column for ‘husband’s name’, which is another deterrent for unmarried women. Though the husband’s name is optional, there is no column for the wife’s name when it comes to male contraceptives like condoms or a vasectomy.A report by the UN Population Fund (UNFPA) about sexual and reproductive health says complications in pregnancy and childbirth are the leading cause of death among girls aged 15-19 in low-income countries like Nepal. Unwanted pregnancies also hamper women’s education and economic independence, and impact their family life, fuelling an intergenerational cycle of poverty and poor health.<h2>More choice for family planning</h2><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108141124/636a58e19c7e80680e054863jpeg.jpg" alt="" width="1400" height="1029"><figcaption> </figcaption></figure>Although Nepal’s contraceptive prevalence rate has increased dramatically, from 7% in 1981 to nearly 60% today, social taboos, patriarchy and unavailability mean that many women still do not have access to birth control.It usually falls on women to take the initiative, since many men refuse to use condoms or get a vasectomy. Popular contraceptives used to be the pill or Depo-Provera, an injectable that needs refrigeration and must be taken at a clinic, but the dosage is high and the injection painful.Now, women like Shanti Adhikari, 43, in Chitwan, (pictured, right) who have always used Depo-provera for short-term contraception, have a new choice: Sayana Press.Read also: <a style="background-color: #ffffff; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/banner/implant-service-providers-take-contraception-to-nepals-poor/" target="_blank" rel="noopener">Implant service providers take contraception to Nepal's poor</a>, Rojita Adhikari<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108141124/636a58e49c7e80680e054864jpeg.jpg" alt="" width="524" height="531">Adhikari’s husband, who works as a security guard in India, will be coming home for Dasain, so she is at the health post in Nawalpur for her Depo-Provera progesterone hormone injection, which prevents pregnancy for three months.But auxiliary nurse midwife Sharada Rimal (pictured, left) tells her about Sayana Press. Its advantages over Depo-Provera are that it comes with its own small needle, the dosage is much smaller, it is less painful and can be self-injected.“Everyone in my neighbourhood comes to this health post for contraceptives, but no one told me about this new injection. The needle looks much smaller, I think I will go with this one,” says Adhikari, 43, as Rimal proceeded to inject her in the thigh.Sayana Press, a successor to Depo-Provera, is being launched in Nepal in two districts: Nawalpur and Sindhuli, by the reproductive health agency Ipas Nepal in coordination with the UK’s Department for International Development (DFID) and the Ministry of Health and Population (MoH). The drug has already been tried and approved, and is available for use in 40 European countries.What sets Sayana apart from Depo-Provera is the smaller dosage (104 mg compared to 150), it comes with its own needle, it can be stored at room temperature and is injected sub-cutaneously (just under the skin), rather than in the muscles like <a href="https://archive.nepalitimes.com/article/from-nepali-press/Ftnp-the-curse-of-the-contraceptive,493" target="_blank" rel="noopener">Depo-Provera</a>.Injectable contraceptives are the most popular reversible contraceptive among women, for a variety of reasons. Adhikari says she does not like pills because she has to remember to take them every day, and, because of her age, she wants to be discreet about using them.While most other methods, like IUCDs, implants, condoms and pills, are visible and can be discovered by others, an injection leaves no traces. 52% married couples use contraceptives in Nepal: 8.9% use injectables, 4.6% are on pills, 4.2% use condoms, 1.4% use IUDs and only 3.3% use implants. 9.8% use other traditional methods. Some have gone for permanent contraception, with 14.7% preferring female Sterilization and 5.5% male Sterilization.“Depo-Provera has been in use for 50 years, but it was so popular and effective not much further research was done on it,” explains Lhamo Yangchen Sherpa of Ipas. “But WHO studies found that a much lower dosage was enough.”<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108141124/636a58e69c7e80680e054865jpeg.jpg" alt="" width="478" height="531">Health workers like Rimal confirm that Sayana Press is much easier to inject, more portable and less painful. Though it is self-injectable in some countries, in Nepal, where it has been undergoing trials in 14 health facilities of Nawalpur and Sindhuli since 5 September, it will only be administered by health professionals.Bhim Singh Tinkari of the MoH Family Welfare Division says that since 7% of pregnant women still die from unsafe abortions, making contraceptives easily accessible can save lives. Binod Bindu Sharma of the MoH links contraceptives to women’s choice and empowerment. “The availability of contraceptives is important for women’s rights, since it lets women choose when and how many children to have,” says Sharma, adding that the ministry is making Sayana Press available for free in health facilities.Lisa Honan, head of DFID Nepal, links contraceptives with women’s economic potential, adding that the country can make better use of women in the workforce if they have better choices of contraceptives. “DFID is committed to providing Sayana in any volume in Nepal until 2022 through UNFPA (the UN Population Fund), and would help Nepal scale it up all over the country if the results of the feasibility study are positive.”

Nepal far from hitting contraceptive target

Architecture can be a powerful agent of change, shaping not just spaces but the way people live, connect, and experience the world.&nbsp; For Nepal, which is <a href="https://nepalitimes.com/banner/natures-fragile-gift-to-nepal">gifted by nature</a> and rich in <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/ambassador-fund-cultural-preservation-nepal,2092">cultural heritage</a>, &nbsp;reviving rural architecture with modern amenities could hold the key to more <a href="https://nepalitimes.com/here-now/what-sustainable-tourism-means-in-practice">sustainable tourism </a>that benefits local people more. “<a href="https://nepalitimes.com/banner/bayalpata-hospital-in-nepal-wins-global-design-award">Design and architecture</a> are amazing tools to create a unique experience for visitors,” says Spanish architect Tomeu Esteva of Esteva i Esteva Architecture Studio. “Difficult destinations have beautiful hotels with design and comfort.” Esteva was in Kathmandu with his colleagues at an event organised by the Spanish Honorary Consulate at Dwarika’s Hotel last week to showcase buildings which Nepali architects can adapt with local material and design inputs.&nbsp; Rural architecture holds a unique significance: it is more than a shelter and must reflect <a href="https://nepalitimes.com/here-now/inking-an-idenity">local identity, culture</a> and <a href="https://nepalitimes.com/here-now/saving-humla-from-heritage-loss">heritage</a>. An area’s natural and cultural harmony can be upset by <a href="https://nepalitimes.com/here-now/protecting-protected-areas-from-infrastructure?fbclid=IwAR1wK0MDFlFST_2EYb3f54LS4-fPt6rYfLG1DJ1JaQsU3w8-ezyXIxGOqzk">poorly planned development</a>, speakers at the event said, but the environment can be improved and revitalised by well-integrated structures.&nbsp; Another Spanish architect, Belen Moneo, has designed hotels at elevations of 3,700m in her home country Spain that supply natural spring water spas. “<a href="https://nepalitimes.com/banner/lost-in-reconstruction">Creativity in construction</a> must be encouraged. Rural architecture always shows possibilities of what we can do better,” Moneo explains, adding that designs must enhance <a href="https://nepalitimes.com/opinion/the-healing-power-of-nature">the beauty of nature</a> and give a natural feel at a time when steel, glass and cement dominate <a href="https://nepalitimes.com/here-now/rebuilding-kathmandu-after-the-1934-quake">urban design</a>.&nbsp; This is why the <a href="https://nepalitimes.com/here-now/weaving-nature-into-craft">use of natural products</a> such as bamboo, local timber, straw and rammed earth are in demand from customers who want a fresh eco-friendly look encouraged in construction of rural architectural structures. The demand for boutique hotels has increased world over, with &nbsp;more and more tourists favouring aesthetics, experience and comfort over price. While creativity is an important part of <a href="https://nepalitimes.com/here-now/architecture-for-mountains">construction and architecture</a>, incentives to build and use <a href="https://archive.nepalitimes.com/article/nation/Building,370">rural construction materials</a> still remain minimal, and Moneo emphasises the significance of design and execution.&nbsp; Esteva helped design the Vana Retreat in Dehradun that kept the natural environment in focus, with the structure giving an elaborate aesthetic experience to visitors. Another example is Hotel Las Mercedes in the Dominican Republic which was designed and constructed by Moneo and the company she co-founded Moneo Brock, respecting and revaluing the traditional architecture of the area. Hotels providing such experience could attract tourists and revenue. The Spanish ambassador to Nepal Juan Antonio March Pujol said, “The role of architecture and architects in developing tourism is crucial, not only in urban areas but rural settings as well.”&nbsp; The concept of rural boutique hotels gained traction in Spain during the 1990s, particularly in regions like Majorca with economic and environmental sustainability as the main focus. In Nepal <a href="https://nepalitimes.com/opinion/12-full-opinion/guiding-nepal-s-tourism-industry">the tourism industry</a> directly employs about 1 million people, and makes up about 8% of the country’s GDP. In Nepal, the stone homes of <a href="https://nepalitimes.com/news/reviving-himalayan-vulture-and-culture">Mustang and Manang</a>, bamboo and mud structures of <a href="https://nepalitimes.com/here-now/the-tarai-s-shrinking-forests">the Tarai</a>, and the Kathmandu Valley’s terra cotta tile skylines, graceful temples, and tranquil bahal courtyards are all examples of <a href="https://nepalitimes.com/here-now/nepal-s-traditional-seismic-resistant-designs">Nepal’s traditional architecture</a>.&nbsp; Nepali architect Sarosh Pradhan has been working for the past eight years on the Brakka Village project in Manang Valley north of <a href="https://nepalitimes.com/banner/municipalities-want-to-manage-annapurna">the Annapurnas</a>. Other examples of this kind of rural architecture for high-end tourism are the Shinta Mani Hotel in Mustang and Khumbu Lodge below <a href="https://nepalitimes.com/news/mt-everest-pvt-ltd">Mt Everest</a>. Says Pradhan, “There are places in Nepal that radiate purity and embrace simplicity. Creating projects in such settings require deep reflection and thoughtful planning.”  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250421030444_a07a23f6b60fa89c0f35b9dc1aaf19937da4881e6bfb2e1858f3c27dff91729f.jpg" data-media-id="editor_19" data-image-id="20250421030444_a07a23f6b60fa89c0f35b9dc1aaf19937da4881e6bfb2e1858f3c27dff91729f" data-rendition-name="original" width="4608" height="2184" loading="lazy" alt="A new architecture for Nepal's tourism"> </figure>  Rural architecture is not easy, and sometimes more expensive. Inflation, energy efficiency, <a href="https://nepalitimes.com/here-now/those-who-stay">the climate crisis</a>, and <a href="https://nepalitimes.com/banner/cost-of-living-in-a-big-city">increased costs of living</a> pose obstacles to sustainable rural architecture. Read also: <a href="https://nepalitimes.com/here-now/forgotten-international-starchitects-in-nepal">Forgotten international starchitects in Nepal</a>, Anne Feenstra and Varun S Bapu Esteva says faith and trust between client and architect is necessary for any project to be successful. He adds that architects must practice being humble, the process of designing always involves learning and not imposing their ideas on clients. Nepal is uniquely positioned for the growth of <a href="https://nepalitimes.com/banner/hiking-up-the-benefits-of-tourism">rural tourism</a> because of its stunning countryside as well as its internationally renowned traditions in holistic wellness. Creating infrastructure that is small, thoughtfully planned and that respects both tradition and contemporary hospitality standards is crucial. “Projects in Nepal can be made cost effective by using materials from houses that have been brought down,” says Esteva. “Pilot projects involving <a href="https://nepalitimes.com/banner/local-government-by-the-people-for-the-people-of-the-people">local people </a>and simple designing also helps the process.” <a href="https://nepalitimes.com/banner/vacant-homes-become-homestays-in-nepal">The growth of homestays in Nepal</a> is a step in the right direction, but they are still a bit too rustic for the international traveller who also wants comfort and is willing to pay extra for it. Upgrading the facilities in homestays and ensuring that the <a href="https://nepalitimes.com/here-now/an-archive-of-nepali-heritage">architectural heritage</a> of the locality is preserved using locally sourced building material could allow owners to charge more. Says Sangita Shrestha of Dwarika’s Hotel, “Our effort is to build upon rural architecture by empowering local communities and using what is available locally. We can fine tune and encourage indigenous design and training.” The vision goes beyond just boosting the economy, it is about building a future where tourism helps villages grow in a healthy and lasting way. Instead of using up resources, it gives back to the land and the people. It supports local communities by<a href="https://nepalitimes.com/opinion/staying-in-nepal-to-create-jobs"> creating jobs</a>, improving infrastructure, and protecting natural beauty. When done right, tourism can be a tool for <a href="https://nepalitimes.com/editorial/progress-and-or-preservation">preserving culture and nature</a>, not harming them. Architects must therefore see their work as more than just designing buildings, they also need to care deeply about people and places, especially in rural areas that can benefit the most.&nbsp; With global interest in sustainable and off-the-beaten-path travel increasing, Nepal stands at the cusp of a <a href="https://nepalitimes.com/news/missing-out-on-nepal-s-tourism-potential">tourism transformation</a> that values community-driven, eco-conscious hospitality. A mix of modern ideas and traditional knowledge could transform rural tourism in Nepal. Says Shrestha, “Young architects should spend time with <a href="https://nepalitimes.com/latest/the-unsung-heroes-of-conservation">local and indigenous communities</a>, listen to their stories, and learn from their <a href="https://nepalitimes.com/banner/life-and-livelihood-in-remote-nepal">ways of living</a>. These communities have deep knowledge about the land, materials, and climate. If this wisdom is used in new designs, it can help create tourism spaces that truly benefit everyone.” &nbsp;

A new architecture for Nepal's tourism

Extract from an addendum to Nepal's Two Wars, Chapter 2 in the updated edition of Essays on Nepal: Past and Present by Sam Cowan, a retired British Army general with a long association with the Gurkhas. The book was first published in 2018, and republished earlier this month by FinePrint exclusively on Amazon. The addendum details a one-to-one conversation the author had in the <a href="https://archive.nepalitimes.com/news.php?id=8884">Royal Palace </a>with the <a href="https://archive.nepalitimes.com/news.php?id=8371">King Gyanendra</a> in November 2002 just after he had taken his initial steps on the road that ultimately led to <a href="https://archive.nepalitimes.com/news.php?id=14681">the abolition of the monarchy</a> in Nepal in 2008. In the early evening of September 16, 2002, in my role as Colonel Commandant of the Brigade of Gurkhas, I had my second and last official audience with King Gyanendra to give him an update on the Brigade’s activities over the previous 12 months. I had some 6 or 7 such audiences with <a href="https://nepalitimes.com/here-now/preserving-king-birendra-s-family-home">King Birendra</a>.&nbsp; These were official affairs with the British ambassador of the day present, along with key <a href="https://archive.nepalitimes.com/news.php?id=12233">palace officials</a> and a representative from Nepal's Foreign Ministry. The two monarchs were very different in character and temperament, but both treated me with the utmost civility and made the audiences as relaxed and easy for me as possible.&nbsp; It is, however, worth recording that when the official business had been covered, King Birendra, with a twinkle in his eye, often ended by asking, “Now General, what’s the gossip in London?” The second audience with <a href="https://archive.nepalitimes.com/news.php?id=8026">King Gyanendra </a>was my last official act in uniform. We came back to Kathmandu in the first week of November (after treks) to stay for a few nights with our Defence Attaché before heading back to the UK. Waiting for me was a message from the Palace saying that King Gyanendra would like to meet me informally: <a href="https://archive.nepalitimes.com/news.php?id=6933">no uniform</a> and no ambassador.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250421080420_f9046f9882d4481781d14f2b64f18c7fbbea62562e1d74e3465de6d01fb43750.jpg" data-media-id="editor_7" data-image-id="20250421080420_f9046f9882d4481781d14f2b64f18c7fbbea62562e1d74e3465de6d01fb43750" data-rendition-name="original" width="1750" height="2406" loading="lazy" alt="Gyanendra crowned page 1"> <figcaption>Nepali Times Special Edition of 6-14 June 2001 with enthronement of Gyanendra. </figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250421080424_21333d6ae21828eb47fe3f849438d215fe2804460d47bb2896ef4aee4e895ad2.jpg" data-media-id="editor_8" data-image-id="20250421080424_21333d6ae21828eb47fe3f849438d215fe2804460d47bb2896ef4aee4e895ad2" data-rendition-name="original" width="1500" height="1857" loading="lazy" alt="Royal massacre"> <figcaption>Nepali Times 22-29 June 2001 covering the royal massacre after which Gyanendra became king. </figcaption> </figure>  Although I had no idea what the purpose of the meeting might be, events in Kathmandu since I last saw the king put me on edge. On October 4, 2002, Gyanendra had dismissed Prime Minister Sher Bahadur Deuba, allegedly for failing to hold <a href="https://nepalitimes.com/news/what-goes-on-in-nepal-s-elections">elections</a>. He had put in place a new prime minister and a cabinet personally selected by him. When I heard the news on my travels, the people I met were generally supportive of the king’s actions. There was a general view that something had to be done, the country was going nowhere, and the king deserved his chance, not least to solve<a href="https://nepalitimes.com/latest/14-years-after-conflict-no-closure-in-nepal"> the Maoist </a>problem. Back in Kathmandu, views were not so sanguine. The chosen prime minister, Lokendra Bahadur Chand, was a relic from <a href="https://nepalitimes.com/here-now/mob-movement-and-mayhem">the Panchayat period</a> whose party had failed to win a single seat in the last elections held in 1999. Some of the chosen cabinet ministers had, to put it mildly, dubious reputations, and others had no record of proven competence in any field. There was a fear that the king’s real motive in dismissing <a href="https://nepalitimes.com/editorial/deubas-denouement">Deuba</a> was to start to reverse the democratic gains made since 1990. I informed <a href="https://nepalitimes.com/news/nepal-britain-mark-centenary-of-1923-treaty">the British ambassador</a> about the invitation. He was strongly against accepting it, which was probably the clinching reason for my decision to do the polite thing and accept it. On the evening of November 7, 2002, I presented myself at the royal palace, alone and in civilian attire.&nbsp; As in the past, the Military Secretary, Major General Vivek Shah, met and escorted me into the presence of the monarch. This time, however, he was politely asked to leave the room and shut the door behind him. King Gyanendra greeted me warmly and invited me to sit down.&nbsp; Read also:<a href="https://nepalitimes.com/news/the-ghost-of-monarchy-returns-to-haunt-nepal"> The ghost of monarchy returns to haunt Nepal</a>, Shristi Karki  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250421080424_e382af945d0ad2a04ae41fabe5393f793dd10f54cb1220f111c7c9e7423eb558.jpg" data-media-id="editor_15" data-image-id="20250421080424_e382af945d0ad2a04ae41fabe5393f793dd10f54cb1220f111c7c9e7423eb558" data-rendition-name="original" width="1000" height="993" loading="lazy" alt="Gyanendra coup"> <figcaption>Nepali Times 4-10 February 2005 after king Gyanendra's coup imposed media censorship. anendra became king. </figcaption> </figure>  I had wondered, and to be truthful, had worried, not just about the purpose of the meeting, but about how the conversation might start and develop. I reduced my resolve to two points: be polite but speak candidly. The latter resolve was quickly put to the test with the king’s opening words: “Sam, [in previous meetings it had been ‘General’, you walk the highways and byways of this land more than most, tell me what the common man is thinking?” &nbsp;“Your Majesty, I have no idea what they are thinking, but they are waiting.” “Waiting?” “Yes, Your Majesty, they are waiting to see whether what you did some weeks ago in appointing your own prime minister and cabinet ministers is going to make any difference to their lives or whether it is just going to be more Kathmandu hot air.” “Everything is going to be difficult and is going to take time, a lot of time.” “Your Majesty, time is the one thing you don’t have. You must act quickly and decisively to take advantage of the opportunity you have created. Everyone knows that you have appointed these new ministers. Why don’t you get them in here one by one and tell them that they have three months to deliver a programme in their area of responsibility that is going to make a difference to people’s lives? Most will fail to do so. Sack them! It will be a powerful signal of your strong intent to deliver real change.” I can express the opening of our conversation in this way because just about every word is still etched in my mind. The king’s response to my last quoted words was to challenge me to give an example of something that could be delivered quickly. I can give a verbatim record of what I said in response to this unexpected challenge: “Health posts, Your Majesty, there is no shortage of them throughout the country as building them has been one of the sources of local corruption, but very few have any medicine to issue at present or have skilled people to assess and meet medical needs. Your Majesty, children are dying for lack of a few pills. Given the right priority, over a period, say of six months, every health post could be fully stocked with medicine and manned with trained people. This is something I could help to lead for you as I know it would have strong international backing. At last, people would know that you mean business.” As I warmed to the theme, I could see no sign of the king having any enthusiasm for the idea, and I quickly disengaged as it dawned on me, as it had clearly dawned on the king, that the reason for the deficiencies in health posts was to prevent any Maoist combatant from gaining access to any <a href="https://nepalitimes.com/opinion/tech-away/nepal-s-health-tech-industry-is-here-to-stay">medical support</a>, and if this meant people suffering, so be it. The subject of the Maoist insurgency inevitably came up, and I took the opportunity to elaborate on what is written in the final four paragraphs of the article above. I advised King Gyanendra that, self-evidently, since there were three parties in the conflict—him, the Maoists, and the political parties—it was imperative that he form an alliance with one of them, preferably the political parties; otherwise, he would find himself isolated, as the other two parties would inevitably, at some stage, form their own alliance. However, it quickly became apparent that the king’s mind was on a totally different track. On the Maoists, he told me that he had channels open to them, but he was scathing about the political party leaders. He made it clear that they would be waiting for a very long time before he gave any power back to them, and that is a polite way of expressing the actual words he used, but “crawling through the door” is a phrase which has stuck in my mind.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250421080424_5403455ff6168f0d202a96cb53edea69136d74d59b989cfcc7cc4a1d57672cb5.jpg" data-media-id="editor_17" data-image-id="20250421080424_5403455ff6168f0d202a96cb53edea69136d74d59b989cfcc7cc4a1d57672cb5" data-rendition-name="original" width="2000" height="1317" loading="lazy" alt="fall of monarchy"> <figcaption>Nepali Times 28 April-3 May 2005 with cover image by Ajay Joshi of jubilant protesters after street demonstrations sidelined king Gyanendra, paving the way for a ceasfire and restoration of democracy. </figcaption> </figure>  As the conversation developed, it became ever clearer that King Gyanendra had decided to go in alone, relying on the misleading assurances he was constantly receiving from <a href="https://archive.nepalitimes.com/news.php?id=14954">the army</a>, and no doubt his close advisers, that the Maoists could and would be quickly defeated militarily, and taken out of the equation. This would obviate the need for him to do any deal with the political parties.&nbsp; Thus, the way would be clear for him to establish a version of his father’s Panchayat system, under a constitution that would be granted to the people by him, their sovereign, as his father and brother had done in 1962 and 1990. As in those constitutions, ultimate power would have remained in the sovereign’s hands. This proposed direction of travel was very clear from what the king said to me. In sum, King Gyanendra was motivated by a desire to emulate his immediate predecessors by granting his people a constitution that would restore his father’s Panchayat system in a modern form and give him a central role in decision-making. What was particularly dispiriting was that beyond this single objective he had no plan worthy of the name, nor demonstrably did he have the people with the skills to implement an appropriate plan even if one had existed. Crucially and depressingly, there was little or no indication from the king that he realised that such a course of action could put Nepal’s monarchy into serious jeopardy, as indeed proved to be the case. <h2>King Twice</h2>  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250420110436_315d519fe3d68d2406ebe1480fed54720fbf21b8907a4da5cde751fdc623d445.jpg" data-media-id="editor_19" data-image-id="20250420110436_315d519fe3d68d2406ebe1480fed54720fbf21b8907a4da5cde751fdc623d445" data-rendition-name="original" width="1302" height="632" loading="lazy" alt="“Tell me what the common man is thinking!”"> </figure>  <a href="https://archive.nepalitimes.com/news.php?id=8371">Gyanendra Bir Bikram Shah has been king twice</a>. In 1950 he was enthroned briefly as a child king (left, above) by the Rana Prime Minister Mohan Shumsher when his grandfather, King Tribhuvan, fled to exile in India. In 2001 he was crowned king again after the massacre in the royal palace in which his brother King Birendra and nine other members of his family were killed by Crown Prince Dipendra.&nbsp; During his second reign, Gyanendra gradually asserted power by sacking Prime Minister Sher Bahadur Deuba in 2002, and then taking full control after the 1 February 2005 coup. He was sidelined after the ceasefire in April 2006, and became a commoner after the Constituent Assembly finally <a href="https://archive.nepalitimes.com/article/from-nepali-press/Ftnp-abolishing,624">abolished the monarchy in 2008</a>. In the past year, Gyanendra has tried to exploit public dissatisfaction with the political parties to restore the monarchy.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250421080432_26ef4a4b0e3cee9fdc6794446702efe16550d293904b4f6dd46fe35d4d10c788.jpg" data-media-id="editor_22" data-image-id="20250421080432_26ef4a4b0e3cee9fdc6794446702efe16550d293904b4f6dd46fe35d4d10c788" data-rendition-name="original" width="1136" height="702" loading="lazy" alt="Essays on Nepal by Sam Cowen"> </figure>

“Tell me what the common man is thinking!”

He had just sat down for lunch after tending the garden at his house in Lagan Tole on 25 April 2015 when the ground began to shake violently. &nbsp; Gautam Nepal, 56 at the time, realised it was an earthquake. He panicked at the thought of his neighbours' multi-storied buildings toppling on top of his modest one-storey house. He rushed out as the high-rises swayed and groaned. “We were used to earthquakes, moderate ones are a regular occurrence in Kathmandu, but I had never felt fear like I felt on that day,” recalls Gautam. “My house proved strong, it did not collapse.”  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250419040440_82a74881218223df70e30eb1759cd3a7c9edbb7728acef83c3f8b397d6e6dfe9.jpg" data-media-id="editor_0" data-image-id="20250419040440_82a74881218223df70e30eb1759cd3a7c9edbb7728acef83c3f8b397d6e6dfe9" data-rendition-name="original" width="1737" height="1000" loading="lazy" alt="Loss of soul and soil NT"> <figcaption>LAGAN TOLE'S TOLL: Lagan Tole photographed by tour guide Neil S Rawlins during his travel to Kathmandu in February 1970.</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250419040448_90914720a75b7d31a12bc27f0c0af9484a5e5efc7dd797dc6bcd190fc28ecdcb.jpg" data-media-id="editor_1" data-image-id="20250419040448_90914720a75b7d31a12bc27f0c0af9484a5e5efc7dd797dc6bcd190fc28ecdcb" data-rendition-name="original" width="1500" height="1004" loading="lazy" alt="Loss of soul and soil NT"> <figcaption>Lagan Tole photographed by Neils Gutschow in 1992.</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250419040440_9a4dd35b070949949bfe275eff8216dd29f88f74a30b063dc614845226f68f03.jpg" data-media-id="editor_2" data-image-id="20250419040440_9a4dd35b070949949bfe275eff8216dd29f88f74a30b063dc614845226f68f03" data-rendition-name="original" width="1501" height="1000" loading="lazy" alt="Loss of soul and soil NT"> <figcaption>Lagan Tole in 2025.</figcaption> </figure>  Other residents of Lagan who also live in traditional low rise houses had the same fear. Tara Nepali, then 48, was doing the washing that Saturday.&nbsp; She recalls, “When my house began to shake, I could only think about the bigger buildings falling on top of me. I was sure my house would collapse, but to my surprise, it survived, and so did we.”  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250419040440_2b4b1ec427d9aec5980021b97b25ca3164d5f79337f113ba02b1d802f71b7cad.jpg" data-media-id="editor_3" data-image-id="20250419040440_2b4b1ec427d9aec5980021b97b25ca3164d5f79337f113ba02b1d802f71b7cad" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Loss of soul and soil NT"> <figcaption>Gautam Nepali in front of his one-storey Lagan home, where he had been having lunch just before the earthquake struck 10 years ago.</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250419040436_6f8a7057bbd269214712076e13117b665165e03a0351db0e3666aee05e91f63c.jpg" data-media-id="editor_4" data-image-id="20250419040436_6f8a7057bbd269214712076e13117b665165e03a0351db0e3666aee05e91f63c" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Loss of soul and soil NT"> <figcaption>Tara Nepali in front of her house in Lagan. She was doing the washing during the earthquake in 2015.</figcaption> </figure>  But Buddha Khadgi, 68, was not so lucky. His was one of the few houses in the neighbourhood to be reduced to rubble. His lifelong collection of photographic prints were buried, and so were the traditional Newari musical instruments passed down through generations of his family that he used to give music lessons.&nbsp; “I lost the things that connected me to my roots and my heritage. That was infinitely more heartbreaking than the fact that my house was gone,” says Khadgi, now living in a new cement structure.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250419040436_58f4a8ee4eb740536c69096a4d8c0cd2007fdbcc4ef56551ff460d2ef0ef6f2b.jpg" data-media-id="editor_5" data-image-id="20250419040436_58f4a8ee4eb740536c69096a4d8c0cd2007fdbcc4ef56551ff460d2ef0ef6f2b" data-rendition-name="original" width="2496" height="1671" loading="lazy" alt="Loss of soul and soil NT"> <figcaption>Lagan's Maka Galli some decades ago. Photo: SHREE RAM NEPALI</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250419040440_6b2bacaf0a1e93b441aff8093b343836d6de0b44d7b29f9b758209845f675bff.jpg" data-media-id="editor_6" data-image-id="20250419040440_6b2bacaf0a1e93b441aff8093b343836d6de0b44d7b29f9b758209845f675bff" data-rendition-name="original" width="1000" height="1500" loading="lazy" alt="Loss of soul and soil NT"> <figcaption>Lagan's Maka Galli in 2025. The neighbourhood's old Newari houses have been replaced by concrete structures, although the falcha has been rebuilt in traditional style.</figcaption> </figure>  Lagan Tole in Kathmandu's historic heart emerged relatively unscathed from the earthquake in large part because, like in nearby Asan, the buildings are densely packed and lean on each other. But in the years after the earthquake, urban pressure and fear of future quakes have made families tear down their traditional houses with sloping tile roofs and replace them with concrete structures.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250419040440_25983e79dc88388cb370b16f7f631e4c276cfc997ffa1f9ce3701e40c876b355.jpg" data-media-id="editor_7" data-image-id="20250419040440_25983e79dc88388cb370b16f7f631e4c276cfc997ffa1f9ce3701e40c876b355" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Loss of soul and soil NT"> <figcaption>Glimpses of present-day Lagan.</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250419040440_9a6a88df8815352a452895c43840a898d4b6c080b79562383306c0cfe8bcd952.jpg" data-media-id="editor_8" data-image-id="20250419040440_9a6a88df8815352a452895c43840a898d4b6c080b79562383306c0cfe8bcd952" data-rendition-name="original" width="1000" height="1500" loading="lazy" alt="Loss of soul and soil NT"> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250419040440_a348b974bd3a5e76d0bf9b309f98813556d43dd6c361856c67e79c03d4283e69.jpg" data-media-id="editor_9" data-image-id="20250419040440_a348b974bd3a5e76d0bf9b309f98813556d43dd6c361856c67e79c03d4283e69" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Loss of soul and soil NT"> </figure>  Lagan’s longtime residents, especially the elderly whose families have lived here for generations, say that the neighbourhood with its characterless new tall cement boxes is no longer familiar to them. “We used to say that our houses are not supposed to be taller than temples, the houses of our gods,” says Gautam. “Now, the houses here dwarf the temples and even the chariot of Seto Machindranath.”  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250419040440_88d18ce580abaf9e62fd807403f2e3c9a5bd8972d3b32bdacb97d8991c7fec35.jpg" data-media-id="editor_10" data-image-id="20250419040440_88d18ce580abaf9e62fd807403f2e3c9a5bd8972d3b32bdacb97d8991c7fec35" data-rendition-name="original" width="1041" height="1441" loading="lazy" alt="Loss of soul and soil NT"> <figcaption>The Seto Machindranath procession at Lagan on 10 April 1998, during which the chariot caught fire. Photo: SOCIAL MEDIA</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250419040440_c403f91f9a48c14eaaeed2d38a2cb97714416765730b6d12f29487f9b0f47e83.jpg" data-media-id="editor_11" data-image-id="20250419040440_c403f91f9a48c14eaaeed2d38a2cb97714416765730b6d12f29487f9b0f47e83" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Loss of soul and soil NT"> <figcaption>The Seto Machindranath procession at Lagan earlier this month.</figcaption> </figure>  &nbsp;The old baha courtyards, falcha resting places, and open spaces where Lagan’s residents used to grow vegetables and gather as a community are nearly all gone. And the taller the houses get, residents say they feel less anchored to the soil. Lagan has also lost its soul -- the community spirit is eroding as elderly neighbours rarely venture down to meet each other in the evenings. &nbsp; “This no longer feels like the tole I grew up in,” says a resident. “We are beginning to lose the relationships we had with each other as a community, and with it, the spirit of Lagan.”&nbsp;

Loss of soul and soil

Dealer Cimex has extended warranties on BYD EVs sold in Nepal for 10yrs/200,000km, up from 8yrs/160,000km. Lights, tyre pressure monitors, suspension and ball joints now have 5yr/125,000km warranties, and all other parts now have 7.5yr/187,500km warranties.&nbsp;

womens-health