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Nepal relaxing lockdown afterall

Finance and Information Minister Yubaraj Khatiwada told a media briefing on Wednesday evening that the Cabinet extended the COVID-19 lockdown till 18 May, but it had also decided to relax rules on manufacturing, industries and banking sectors. 

These would be partially opened with certain restrictions on distancing and health monitoring of workers, and that the decision about opening up would be done in coordination with local governments. 

The industries included in the list are: food production and processing, dairies, pharmaceuticals and medical equipment manufacturers, water supply, brick kilns, livestock and fisheries, feed industries, sugar, tea and LPG. Also to be opened will be noodles industries, bakeries, poultry, dairy, and processing of other agricultural products.

Among the non-food industries to be relaxed are cement, paint, plywood, plastic pipes, sand and crushers, steel and electrical equipment.

However, the following rules apply: factories cannot have more than ten workers in one place at a time, and workers get health check-ups daily. For the time being, workers also need to stay in dorms, and eat in canteens at their workplaces, without coming in contact with local people or family members.

Fly-by-Night Airlines

Ladies and gentlemen and dear customers, we will now take you away from our regular programming to some breaking news being streamed live on FB from the office of the Ministry of Aviation, Vermiculture and Marxism where Minister Ale has Managing Director Adhikari of Nepal Airlines in a firm jack-knife hold. The managing director tries to wriggle out by executing a reversal, and come to the top position. But can he do it, or can he not? The Minister is carrying out a below-the-belt move called the crotch-lift, and the World Wrestling Federation manual says this position can be employed by either contestant to execute holds with arms and legs, leading to front head-locks with amplitude. But just as he had Ale in an airplane spin before a double underhook half-nelson mat slam, the umpire disqualified Adhikari on a technicality. The crowd roars its disapproval, but the deed is done.

Read Also: First, the good news, Backside

As you can see, to describe Nepal as having a vibrant and lively aviation sector would be a gross understatement. Even before last week’s entertainment courtesy the minister and airline chief, the Civil Aviation Authority of Nepal (CAN’T) had been at the forefront of trying to make things even more thrilling by ordering Fly-by-Night Airlines to serve airports without landing lights, ordering helicopters to have two pilots if they are carrying Very Very Important Politicians (VVIP), and make it mandatory for arriving international flights to overfly Nepal for one hour on a scenic aerial tour of the Himalaya before landing at Tribhuvan Intergalactic Airport.

The good thing is that compared to chaotic airports all across Europe and the US today, our own domestic terminal in Kathmandu now meets international standards. Passengers can develop close interpersonal bonds with fellow human beings at the departure area in a spirit of sharing and accommodation, and even sit on each other’s laps for greater comfort. The single baggage conveyor in the arrival hall is so designed for passengers to manhandle each other as well as their luggage.

Following the international trend, Nepal’s airlines are now also called ‘Budget’ carriers because after this year’s budget, taxes have gone up. This means further cuts in in-flight service. Elsewhere, airlines slash fares to attract more customers, in Nepal we believe in keeping fares high and slash seat covers.

Nepal’s no-budget airlines did away with meals long ago, then post-Covid they stopped serving water, got rid of barf bags, and now hungry passengers have resorted to eating the cotton wool meant to serve as ear plugs.

At the rate aviation fuel keeps going up, airlines will soon get rid of seats to make planes lighter, and we will all have to strap hang on the 15 min Simara shuttle. Toilets will be converted to Royal Uneconomic Class where VVIP passengers can sit on the throne in their own private Q-bicle.

By next fiscal year, Hawa Airlines plans to switch to gliders to eliminate fuel cost altogether, lessen cabin noise, and help Nepal attain its net-zero carbon target.

Read Also: Domestic frights, Backside

A tale of three cities

Bhaktapur Darbar Square. Photo: AMIT MACHAMASI

Restoration of monuments damaged in the 2015 earthquake have been carried out differently in Kathmandu, Lalitpur and Bhaktapur, and this has depended a lot on the political will and community involvement to adhere to traditional building methods and materials.

The cohesiveness of the community living in the historic core of the three cities has also determined the pace and accuracy of reconstruction after the 2015 earthquake.

Since Bhaktapur and Lalitpur have retained much of the historic sense of community and have elected more accountable mayors, restoration there has gone much better than in Kathmandu.

The Trailokya-Mohan Narayan temple in Kathmandu was originally built in the late 17th century by Parthivendra Malla, Pratap Malla’s son – which makes the white walls uncharacteristic. Photo: ASHISH DHAKAL.

For example, restoration work on the Trailokya-Mohan Narayan temple in Kathmandu is now complete. The plastered walls, wooden colonnade, cornices and tile roofs of the three-storey shrine on a five-stage brick plinth at Hanuman Dhoka have returned to their pre-2015 state.

However, for specialists like German architect Wolfgang Korn, the restoration is not quite what it should be. He was surprised to see that the temple had been rebuilt with unpainted plaster that is Rana-style, and not Malla-era as it should be.

“The struts in Malla-era temples are always carved, with the red dachi appa used as veneer bricks,” says historian Dinesh Raj Panta, according to whom the temple was originally built in the late 17th century by Parthivendra Malla, Pratap Malla’s son. This makes the white walls uncharacteristic.

Restoration of the nearby Maju Dega is not yet complete, and scaffolds and green net cover the construction. Korn, who made detailed measurements of the temple in the 1970s (see accompanying piece, below) fears that Maju Dega will also repeat the mistakes on the Trailokya-Mohan Narayan.

“The Department of Archaeology requires only traditional materials and methods be used in rebuilding these sites,” says Korn. “So, I ask myself why this Rana-style on a Malla-era temple? Where are the carved struts?”

Read Also: The history of heritage, Ashish Dhakal

Sanjeev Man Shrestha, who is a retired engineer with the Department of Archaeology (DoA) and was involved in the reconstruction of the Trailokya-Mohan temple, says that the verification of the rebuilt structure is in fact based on photographic evidence. And photos taken before 2015 show both temples with white plaster walls and, in the case of the Narayan temple, with some uncarved struts on the second and third tiers.

“We do not know if it was indeed renovated previously,” Shrestha adds, “but we have used all original materials in the rebuilding wherever possible, even renovating the broken and cracked timber, and replacing with replicas where necessary.”

Architect Amit Bajracharya at the Hanuman Dhoka Darbar Square Conservation Program says that 80% of the wooden windows, doors, pillars and struts were recovered after the earthquake and they have been used in the restoration.

It could be that some of the temples in Kathmandu have been restored to their pre-2015 form, but this is not necessarily what they looked like before the 1934 earthquake. This has thrown up questions of how far back we should go when restoring a monument.

Kathmandu has also seen geopolitical competition in restoration, with the Chinese helping rebuild the Hanuman Dhoka Palace, the Americans involved in the restoration of Gaddi Baithak, and the Japanese of other temples in the palace complex.

Read Also: Kathmandu’s temple restoration after 1934 earthquake, Sahina Shrestha

Rebuilding and restoration work in Bhaktapur Darbar Square. In the right is the Vatsala Temple. Photo: AMIT MACHAMASI.

Over in Bhaktapur, the town’s main gate was plastered white during the Rana-era. It was damaged again in 2015, but architects there have retired it to its Malla-era state with exposed bricks.

“We wanted it to look traditional, keeping with how it must have appeared when it was built,” explains architect Ram Govinda Shrestha of Bhaktapur Municipality.

Nearly all of Bhaktapur’s monuments damaged in 2015 have been restored because of active cooperation between the local communities and the municipality.

Shrestha says the municipality used three approaches for renovation: by the community, by the municipality and through DoA contractors: “In all three approaches, the community was involved in supervision. Woodworkers, masons and craftspeople were also selected by the people, and the municipality helped with finding funds.”

The 350-years-old Bhai Dega in Patan Darbar Square was rebuilt in stucco Mughal-style after the 1934 earthquake. In early 2015 work began to restore it to its original Malla-era structure. Photo: AMIT MACHAMASI.

In Lalitpur, most renovation and rebuilding projects were undertaken through the Kathmandu Valley Preservation Trust (KVPT) with active community participation.

Says KVPT’s Rohit Ranjitkar: “There was minimal bureaucracy, and the work was completed through coordination of the local government and the community. KVPT has also been working in Patan since 2008, which means that the locals trust us.”

It is different in Kathmandu because it does not have the level of expertise that the other two cities of the Valley have, and community participation is also not at the same level.

“Kathmandu lacks the skilled artisans, and therefore is dependent upon Bhaktapur,” admits Amit Bajracharya. “There is also less public participation or interest, as many locals in and around the old town have moved away.”

Ranjitkar says this has meant that the people around the heritage sites in Kathmandu are not original residents but people who rent rooms or shops. “As fewer and fewer locals remain, there is also less and less ownership and engagement,” he adds.

This has also meant that much of the rebuilding in Kathmandu is being done through the DoA’s bidding process, adding to the inaccuracy in restoration.

For instance, the medieval Chilancho Chaitya in Kirtipur which was damaged in 2015 was quickly renovated by the DoA. But just a year later, a crack appeared from the finial to the dome.

Read Also: Rebuilding Kathmandu after the 1934 quake, Alina Bajracharya

Each rebuilding and renovation is particular to the monument, as there is not one such treatment for every building: but a contractor may not be aware of this. Indeed, the lowest bidder with experience in working mostly with concrete, and building modern houses and roads are involved in Kathmandu’s heritage restoration.

“On top of lack of expertise and resources, this is also a result of a lack of forethought and patience,” explains Bharat Maharjan of Nepal Heritage Documentation Project. “Brick walls are different from concrete, sometimes it may take days between one layer and another, work may be paused because a decoration needs to be set. Each step is sensitive and significant. But when people don’t know much about heritage conservation, they don’t consider the quality of work, but only deadlines.”

Further, there are also traditional dimensions to consider in a temple, and processes that are no longer practiced in residential buildings, but integral to heritage restoration.

“With tender, it becomes overly bureaucratic, with a lot of interference,” says Bajracharya. “And the lowest bidder with no expertise in heritage conservation leads to inferior work and compromises to the structure and design.” However, he adds that workers and artisans involved in Hanuman Dhoka have been trained: “Even though it is the lowest bidder who gets the contract, we have tried to make the restoration as authentic as possible.”

Sanjeev Man Shrestha agrees, saying that the DoA has its criteria when selecting the contractor, which takes into account their experience in working with wood, bricks and other traditional materials.

But it may not always be possible to use traditional materials and practices. Korn believes that if the Malla architects had known of ways to make buildings even more structurally sound, they would have used them.

While traditional practices, designs and methods should be preserved and utilised, Rohit Ranjitkar says that architects should also be pragmatic. In a few cases, modern elements, such as steel beams, have been used in Patan just to make the structures stronger.

“We also have to think about our place in an earthquake-prone region and it is not prudent to blindly remake a structurally unsound temple or monument,” Ranjitkar adds. “We should also think about how we may improve a previously collapsed building so that more lives may be saved in time of the next disaster.”

Measuring up to Kathmandu’s heritage

Restoration of monuments is made easier because of scale drawings by a German architect done 50 years ago

Wolfgang Korn leads the way up to the top floor of Lalit Heritage Hotel in Patan. Through the glass doors, the terrace opens almost like a stage for a view of Patan Darbar.

Under the grey sky, the oblique roofs, red bricks and stone temples look restful, against rows of people on benches. Among the scaffolds, spires and baked tiles, the two-tiered Char Narayan Temple stands out.

This is one of many monuments of Kathmandu Valley that Korn surveyed in 1970, producing detailed drawings.

Born in Dessau in what was then East Germany, Korn first arrived in Nepal when he was 25 in 1968. Having studied architecture, he had applied for a German Development Service project in West Africa. They asked him if he would like to go to Nepal instead.

He was fascinated by his first walk around Kathmandu past gods and goddesses, quaint brick houses along narrow streets, wood carvings and stone monuments. 

Korn worked for the Physical Planning Section of the government designing the office buildings. There, he met architect Carl Pruscha who was then mapping out two Ring Roads to give Kathmandu an urban plan for future growth, and started surveying sacred sites.

“It is important to know where the heritage sites are when one plans a town,” explains Korn. “Very often, I went alone with the driver, as people in the government did not want to leave their office.”

This work brought him closer to the ancient Newa architecture of Kathmandu Valley that used wood and bricks to create a highly structured network of urban buildings and open spaces.

“I am not a historian or a researcher but a curious craftsman,” says Korn, recalling how he climbed into the shrines to measure, collect and draw cross-sections.

Wolfgang Korn. Behind stand the red temples of Patan Darbar, including the shrine to goddess Taleju. Photo: AMIT MACHAMASI.

Once in Panauti, he had to convert to Hinduism for 17 minutes to study the damage to the Indresvar Temple.

“I was staring up at the carvings when the pujari came over and asked what I was doing,” recounts Korn. “When I explained to him my profession, he asked me my opinion regarding the topmost, third tier of the temple that was leaning to one side.”

When Korn said that he would not be able to say much from the ground, the priest brought out a copper plate with flowers, vermilion and rice grain. He then started chanting a prayer, sprinkled water and put a red tika on Korn’s forehead, declaring him a temporary Hindu so he could enter the sanctorum to study it.

Keeping to the walls, Korn climbed up to the topmost tier, made some quick pencil sketches, and came down covered in dust and pigeon muck. He briefed the priest about the kind of repairs needed, after which he performed the ceremony in reverse, wiping the tika off his forehead, and restored Korn back to Christianity.

The experience at Indresvar also confirmed to Korn that the Valley’s temples were historically two-tiered, and the third roof was often a later addition.

Between 1970 and 1977, Korn prepared scaled drawings of many structures, including the Indra Sattal in Bhaktapur, Kasthamandap, Lakshmi-Narayan Sattal, Chusya Baha in Kathmandu, and Char Narayan Temple in Patan.

After an extensive survey of Pujari Math in Bhaktapur in 1971 and 1972, Korn embarked solo on the Temple Catalogue Project to prepare an inventory of all tiered temples of the Valley with a photographic catalogue and typologies.

His later work with the Hanuman Dhoka Renovation Project in 1973 and private documentation of temples, monasteries, falcha, private houses, carved windows, led to the publication of the first book on Newa architecture, Traditional Architecture of the Kathmandu Valley, in 1976.

After the 2015 earthquake destroyed many historical monuments in the Valley, Korn’s detailed scale drawings of the Maju Dega, Kasthamandap, Char Narayan and Vatsala Temple have been instrumental in their accurate restoration.

Despite this, Korn is not happy about the haphazard urbanisation of Kathmandu Valley, especially post-2015. He was surprised by the restoration of the Malla-era Trailokya Mohan Narayan Temple in Kathmandu where the walls have been plastered and painted white in the Rana-era style. The same methods are being used in rebuilding Maju Dega, another Malla-era temple dating back to 1692, of which Korn had also taken detailed measurements 50 years ago.

“It looks like the contractor wanted to save money and got away with it,” Korn says, shaking his head.

He believes rebuilding heritage sites should never be given to the lowest bidder, especially when they know nothing about struts, carvings and dimensions.

“To rebuild heritage, you need architects who understand the specific materials traditionally used, such as dachi appa in Newa buildings,” he says.

These rejections of standard building practices are perhaps the reason why the Valley’s towns look the way they do today: residences, offices blocks and view towers rising in a babble of concrete and steel.

Fortunately, the dramatic transformation of the Valley has not deterred Korn’s caring and curious spirit. He has been visiting Nepal several weeks a year to work with the Kathmandu Valley Preservation Trust (KVPT) on renovations at Patan Darbar Square.

He also lectures to Nepali architecture students, inspiring a new generation to care about heritage. “Because,” he adds, “you kill the past by not caring.” 

Ensuring health insurance for all Nepalis

Photo: POSSIBLE HEALTH

Ever since Finance Minister Janardan Sharma in his budget speech last month announced a plan to hand over management of Nepal’s national health insurance program to the private sector, experts are concerned that it will make medical treatment unaffordable for most people. 

Indeed, privatising health insurance is like the government abandoning its people, experts say, and it defeats the very purpose of the program — to provide affordable care for the most underserved communities who can neither access private plans nor expensive hospitals.

“Health insurance delivers the right of citizens to proper healthcare. As soon as it is implemented through a for-profit company, the social security aspect will be forgotten and serve purely as a business,” warns public health expert Sharad Onta.

Private companies already provide health insurance schemes to those who can afford its expensive premium. The private sector therefore mainly serves the affluent, as public health experts Gaj B Gurung and Sushil Koirala argue in their op-ed for Nepali Times:

‘But can they really contribute to national public health security, understand equity, expand access to the poorest and the most marginalised population, and negotiate with the government providers for quality services? Are they fundamentally designed to serve the poor?’

Read also: Sick of it, Sagar Budathoki

In 2017, then health minister Gagan Thapa introduced a national insurance scheme with a premium of Rs2,500 a year for a benefit package of Rs50,000 for a family of five. This was later increased to Rs3,500 premium and Rs100,000 payout. But this is still too low, and needs to be revised.

Hospitals also complain of late reimbursement, and some are considering pulling out of the program. Dhulikhel Hospital alone is owed Rs250 million in reimbursements. Patients are not happy about the service either, and are dropping out. 

But it is too early to give up, says SP Kalaunee, former director of Nyaya Health Nepal which implements the national insurance scheme at its Bayalpata Hospital in Achham.

“Nepal’s health insurance policy is fairly new and such challenges are to be expected,” he says, “But they can be and should be addressed within the existing structure.”

He adds: “The goal of the program was to make healthcare accessible, affordable and equitable to all. The fact that we have an additional feature to the program to strengthen service providers means it was never just a financial mechanism.”

Read also: Taking wealth out of health, Anita Bhetwal

A mandatory health insurance scheme where people pay the premium based on their per capita income could eventually include benefits that include treatment of chronic illnesses, say experts.

Hiring competent staff with expertise in the field at the Health Insurance Board (HIB) might be a good start to improving the existing program. HIB should also be an autonomous body capable of making its own decisions without interference from the Health or Finance Ministry.

Digitising reimbursement will also address some of the grievances, especially as the program should also look into signing up as many hospitals and care providers including the private establishments for the scheme. The private sector can be involved, but only in carrying out research on the sustainability of the program and for technical expertise.

Nepal’s healthcare is divided into three levels: 

  1. Primary health care (PHC) which is free in government hospitals
  2. Secondary care which is paid for by national health insurance and has waived premiums of the elderly, completely disabled, leprosy and Multi-Drug Resistant TB patients, people living with HIV, and the ultra-poor.
  3. Tertiary care that needs specialised treatment of chronic illnesses like cancers for which the government provides up to Rs100,000.

Read more: In a healthy state, Editorial

All three aim to eliminate user fees at the point of care, but there are implementation challenges — the main one being the lack of government investment in the health sector and the limited understanding of what constitutes good health.

“Health is more than just treatment and hospitals. A large part of it is prevention, from preventive measures against infection to building safer roads so that there are fewer road traffic accidents,” explains Sangeeta Kaushal Mishra of the Ministry of Health and Population. 

But health is not the priority of the government and there is not much investment in training medical personnel, making it incapable of meeting public demand. This gap is now being filled by the private sector.

The government’s lack of capacity can be addressed to some measure by working with non-profits much like Nyaya Health Nepal and Nick Simons Institute which work with government hospitals to upgrade service.

Read also: Is free health care possible in Nepal? S P Kalaunee

Community outreach is another crucial aspect in building a people-centric health system, and Nepal has a head start with its thousands of female community health volunteers across the country. They are primarily responsible for high childhood immunisation rates and reducing maternal mortality.  This now needs to expand to also include healthcare professionals at the grassroots, and retaining them.

In the meantime, Nepal’s national health insurance policy also needs to address emerging problems like non-communicable diseases which with injuries make up two-thirds of death and disabilities in Nepal. The program must also include provisions for geriatric care and mental health conditions, all the while making sure the interests of the most vulnerable in the society are addressed.

“Private entrepreneurs will not fulfil the responsibility of the state. The access to the health care of the poor will be further weakened as soon as health insurance is privatised,” warns Damodar Basaula of the Health Insurance Board.

Ensuring accessible and affordable health care for the people is the prerequisite of any government. Passing the buck to the private sector or any other group will further impoverish families unable to pay the medical cost of treating relatives.

Says SP Kalaunee: “If you do not invest in the lives of people now it will cost much more tomorrow. The national health insurance program is set to become our biggest investment soon, and we must prepare the groundwork for it.”

Read more: A national health insurance scheme is not as easy as it looks, Sonia Awale

Sick of it

  • Belamati Nepali of West Rukum was diagnosed with intestinal cancer and underwent surgery in Lalitpur. Her husband Khadke sold the family livestock to pay for his wife’s chemotherapy. He mortgaged his house to a local lender for Rs500,000, which he will lose if he doesn’t pay it back by October. But the money has run out. He says, “I am worried about losing my home, but I am now even more afraid of losing my wife.” 
  • Aman Dhamala’s 23-year-old son was seriously injured in a landslide last year in Kalikot. A local hospital could not treat him, and he borrowed Rs250,000 to hire a helicopter which came seven hours later. His son died in the helicopter before reaching Kathmandu. “If we had a better equipped hospital in Kalikot, my son would be alive today. Now I am left with nothing but a huge debt.”  
  • Suman Lamichhane broke his right leg in a fall 12 years ago in Gorkha, but because of improper treatment there, the National Trauma Centre in Kathmandu had to amputate it. Suman does not have a family. He had to sell everything he owned for treatment, but could not save his leg.
  • Punsiram Tharu’s son was diagnosed with retinoblastoma at Kanti Children’s Hospital this month. Treatment would have cost Rs300,000, and there was a 95% chance of recovery. But the Rs100,000 the government provides for cancer treatment was not enough, Punisram does not own any property, and no one back home will lend him money. The daily wage earner cannot afford his son’s treatment. 
  • Six-year-old Roshan Tamang was taken home to Kavre by his parents midway through his cancer treatment in February because they could no longer afford his treatment. “I had to sell all my property for my son’s chemotherapy, but we were not sure he would get better, and we ran out of money. It broke my heart to take him back home,” Roshan’s father said. Roshan died at home three months ago.

Read more: In a healthy state, Editorial

Nepalis are losing their lives and homes paying for expensive medical care. Others are living with life-long disabilities because they cannot afford treatment. 

Every year, the WHO estimates that 500,000 people across the country are pushed below the poverty line, and another three million face financial burden because of expensive medical care, and lack of insurance. That is over 10% of Nepal’s entire population. 

The cities have modern private hospitals which have made it possible for many Nepalis not to have to go abroad anymore for treatment. But these hospitals are out of reach of most Nepalis. The WHO recommends more than 10% of a nation’s total budget to be invested in health. This year’s budget allocates only 6.87%, which is even lower than other developing nations.  

Most of that money is allocated for construction and unnecessary equipment, there is not enough to train new doctors and nurses or retain them in rural hospitals. 

There was some hope with the introduction of the national health insurance policy, but the benefit amount of Rs100,000 per household is not enough for critical care. 

Instead of streamlining a national insurance scheme so healthcare is more equitable, the finance minister announced plans in his budget speech last month to privatise it. 

Read also: Taking wealth out of health, Anita Bhetwal

Fix what is broken in Nepal’s health system

Decentralised healthcare and a national insurance program can achieve equitable medical treatment for all Nepalis 

Photo: POSSIBLE HEALTH

Ujjwal Thapa, the founding chair of Bibeksheel Sajha Party, died on 1 June last year due to complications from Covid-19.

Thapa’s treatment, which cost Rs2.5 million, was crowdsourced after he was unable to put together enough money to pay mounting hospital bills. His family raised Rs6.8 million for the treatment of a young politician known for his integrity and vision for the country. 

Thapa needed financial support despite belonging to an upper middle class family with a house and business in Kathmandu.

Covid-19 exposed the pre-existing failure of Nepal’s public health system and high cost of treatment at private facilities have forced many families into a vicious cycle of poverty, as well as countless preventable and premature deaths. 

Nepal’s healthcare mechanism is at odds with the constitutionally guaranteed fundamental rights of Nepalis, and needs a complete overhaul. Government hospitals cost less, but treatment is sub-standard and private care is too expensive.  

Read also: Dangers of privatising health insurance in Nepal, Gaj B Gurung and Sushil Koirala

Nepalis have had to sell property and livestock to pay hospital bills, and fall prey to loan sharks. Others have had to abandon treatment midway or entirely knowing that doing so would mean certain death. 

The government subsidises treatment for diseases including cancer, Alzheimer’s and kidney failure, as well as for families of those who were killed or injured during the conflict. However, the amount does not even cover transportation for treatment in most cases. Bureaucratic red tape means not all patients receive the benefits.

Arun Shahi, an oncologist at Patan Hospital says that cancer treatments might take up to five years, and cost as much as Rs20 million: “How much is the Rs100,000 government subsidy going to cover?” 

Particularly tragic are the stories of children whose parents have had to discontinue treatment for lack of money. Doctors at Kanti Children’s Hospital say they have seen at least five such cases from Achham, Sindhuli and Sarlahi districts in the last six months.

“It is heart-breaking to be forced to send young children home, and we are very much aware that the lack of treatment will mean they will not live,” says Bishnurath Giri, a paediatric oncologist at Kanti.

Read more: Grassroots democracy promotes good health, Sagar Budhathoki

In Nepal, medicine for chronic diseases like diabetes and high blood pressure cost about Rs1,000 per month. Kidney dialysis, required to be done thrice weekly, costs Rs2,500 per session. Cancer treatment cost a minimum of Rs300,000, while bone marrow transplants at private facilities cost up to Rs3 million. A brain surgery, which is not available at government hospitals, costs around Rs2 million at the Neuro Hospital in Bansbari. 

Meanwhile, the overall costs of a liver transplant could be as high as Rs3 million. Sagar Poudel, who sees up to 30 patients with liver disease at the Chitwan Medical College every day, says that at least five of those patients require liver transplants, but cannot afford it. 

For families in remote areas, even a fall from a tree or injury in a highway accident can sink them deeper into poverty. Many of Nepal’s migrant workers admit they seek overseas employment to pay debts incurred for medical treatment of family members.

The average cost of treatment for an accident and surgery in private hospitals is Rs200,000. Just an ICU bed in a private institution in Kathmandu costs Rs20,000 per day, while the daily cost for patients needing ventilators is Rs100,000. Critical care at government hospitals is only about Rs15,000 cheaper.

Additionally, the absence of a medical audit for treatment in Nepal, unlike in foreign countries, has led Nepali service providers to charge money arbitrarily by directing patients into unnecessary tests and treatments.

Read also: Health insurance must be an election agenda, Gaj B Gurung

And since patients do not have technical knowledge of medical treatment, it is difficult for them to decide on the choice of service. “It is up to the patient to decide, but healthcare providers have taken the decision out of their hands,” says Poudel, the liver transplant surgeon.

And when families cannot afford treatment fees, hospitals are known to hold new mothers and babies, mentally ill patients, as well as bodies of deceased family members hostage.

The over-saturation of private health institutions in Kathmandu has also led to unhealthy competition between private hospitals which have been known to pay ambulance drivers commissions for bringing patients to them. Tests performed in one hospital are not recognised by another, and a patient needs to take them all over again. 

Patients were already bearing the brunt of expensive medicines and over-prescription of unnecessary medications. Big pharma pays commissions to hospitals and doctors for prescribing drugs. Indeed, up to 75% of the total expenditure or medical treatment is spent on pharmaceuticals.

“While there is a big managerial weakness in the government health institutions, the private sector is engaged in unethical profiteering, and ordinary Nepalis are squeezed between those two problems,” explains physician Kiran Raj Pandey, author of Up is the Curve: A Genealogy of Healthcare in the Developing World.

Read more: Is free health care possible in Nepal? S P Kalaunee

According to the National Health Accounts Report 2018, Nepalis spend 80% of their out-of-pocket expenses on private medical treatment. Nepal’s healthcare mechanism is not only causing people to spend a significant portion of their income on treatment, but also increasing indebtedness.  

Experts have time and again called for the elimination of out-of-pocket healthcare payments due to continued investment into an unregulated private medical sector. 

“The state has let hospitals and clinics charging arbitrary fees off the hook, this needs urgent fixing,” says public health expert Kedar Baral.

The answer is a citizen-centric national health insurance program to reduce the burden of medical costs. Public health expert Sharad Onta says: “Healthcare cannot be a commodity, and patients are not customers.”

Meanwhile, Baburam Marasini, former director at the Epidemiology and Disease Control Division says that the treatment cost of 90% of patients will be reduced if health services are decentralised to primary health centres as well as local and provincial hospitals.

Introducing a national health insurance scheme would then also mean sustainability for district hospitals and local primary health care centres. 

Read more: This is how to upgrade Nepal’s rural health, Sewa Bhattarai

20 YEARS AGO THIS WEEK

Issue #99 21-27 June 2002

Equity in Education 

The Covid-19 pandemic exposed the digital divide in Nepal’s education system, and the widening disparity between the private and public schools. But this problem existed long before the coronavirus crisis. 

The government has historically neglected public schools where 80% of Nepali children are enrolled. This is evident in the performance of students at the national exams. 

Two decades later, not much has changed, the education sector is still politicised and the government is unwilling to address the quality of instruction as well as that of teachers in community schools.

Excerpts from a report in #99 21-27 June 2002, 20 years ago this week:

Every year, six in every ten young Nepalis fail their high school exams. This year, 152,300 students appeared for their tenth grade tests three months ago. Only 47,565 passed. 

Hidden behind these shocking figures are the disparities between government schools and private ones. Only 17 percent of the students from government schools this year passed their School Leaving Certificates (SLC), with some government schools having a zero pass rate. Eighty-three percent of the students who passed the SLC exams this year were from private schools-even though only one-third of all schools in the country are privately run. 

“The SLC results have spread hopelessness in public schools,” says Chakra Bahadur Maharjan of Saraswoti Secondary School in Dhading. “This is a mass inferiority complex dragging society down.” 

The inequality exposed by SLC results is what the Maoists have been using to pressure the government and private schools to reform. Even those who do not agree with the Maoists’ murders of teachers, agree that there is a serious unevenness in the quality of education. 

Private sector involvement in education has met a part of the need, but the higher fees have exacerbated class differences. Since 2000, the Maoists have forced 500 private schools to close, affecting 100,000 students and 9,000 teachers. 

From archive material of Nepali Times of the past 20 years, site search: www.nepalitimes.com

Taking wealth out of health

Charikot Hospital. Photo: NYAYA HEALTH NEPAL

Nepal’s medical industrial complex has modernised healthcare in the country, but it has also pushed treatment out of reach of most citizens.

Collusion between politicians and medical magnates has made it so expensive to become a doctor that it has set off a chain reaction to make hospital treatment unaffordable.

Meanwhile, government hospitals are under-funded, under-staffed and under-motivated. Most medical personnel in district hospitals and health posts moonlight in private clinics, and patient treatment is substandard.

Desperate families have to sell property, jewelry and other assets to afford private treatment, pushing even some middle-class families below the poverty line.  

Read more: In a healthy state, Nepali Times

But there are notable examples of government hospitals that are running well because of various models of partnership with non-profits, foundations and charities. They prove that affordable high quality healthcare is possible, and those hospitals need not be so expensive to run.

There is Dhulikhel Hospital which has a tiny registration fee, treatment is low cost, an insurance scheme pays for most treatment, and patients are charged according to their capacity to pay. Despite being a government hospital, Dhulikhel has upheld a consistently high standard of care and treatment.

United Mission to Nepal has run a hospital in Tansen for over 60 years, a community hospital in Okhaldhunga, and was till recently managing Patan Hospital, providing high quality care at low cost to patients. 

Other public-private partnership institutions that could be models to be replicated across Nepal include:

Bayalpata Hospital. Photo: KUNDA DIXIT

Bayalpata Hospital

After Bayalpata Hospital was established in Achham 20 years ago, for many years it did not have a single doctor. Treatment was so poor that even emergency cases had to be taken on a grueling 12 hour drive down to Dhangadi.

In those days HIV tagged along with the migrant workers returning from India, and there was a full-blown AIDS and TB epidemic in Achham and other district in Far Western Nepal. The mortality rate, already very high among women and children, soared.

In 2009, Nepali and American medical students inspired by the community health model of Paul Farmer set up Nyaya Health Nepal (formerly Possible) taking over  Bayalpata under a public-private partnership with the government. 

Since then, Bayalpata Hospital has upgraded its facilities (left) and treated nearly 1.5 million patients for free, some of them for complicated caesarian and orthopedic surgeries.

Read also: Is free health care possible in Nepal? S P Kalaunee

Up to 100,000 patients from Achham and surrounding districts come to Bayalpata because they get free treatment there, and many families have saved themselves from sinking into poverty.  

Bayalpata also runs a network of community health centres with an Electronic Health Record (EHR) system that digitally keeps track of all patients in the catchment area. The presence of just this one hospital has improved the health parameters of surrounding districts, bringing down the maternal and child mortality rates. Achham once had the highest maternal mortality rate in Nepal, today institutional deliveries make up 90% of total deliveries, and very few women die at childbirth.  

“We have a simple objective: to show that providing free and high quality treatment to the most underserved area of the country is possible at a very low cost,” explains Srijana Devkota of Nyaya Health Nepal.

Once fully funded by international foundations to run hospitals in Bayalpata and Charikot, NHN now provides free medical treatment in Achham for just Rs200 million a year, of which half now comes from the Sudurpaschim Province and local municipality.

+977 – 4100517

https://www.nyayahealthnepal.org/

Spinal Injury Rehabilitation Centre. Photo: BIKRAM RAI/NEPALI TIMES ARCHIVE

Spinal Injury Rehabilitation Centre

The Spinal Injury Rehabilitation Centre (SIRC) in Banepa is a public-private partnership  providing treatment and rehabilitation to people with spinal injuries. It was started by journalist and civil rights activist Kanak Mani Dixit after his miraculous survival and recovery in a trekking accident in 2000 along the Annapurna Circuit that damaged his spinal cord.

SIRC now helps rehabilitate up to 100 spinally injured patients a year, and the numbers are going up every year due to injuries sustained in highway accidents and falls from trees and cliffs. The facility was located in Banepa because of its proximity to highways and nearby trauma centres. The hospital has also been providing community treatment and tele-rehabilitation services for follow-ups.

Read also: POOR HEALTH MAKES NEPALIS POORER, Editorial

The hospital has medical officers, urologists, physiotherapists, occupational therapists, nursing care, prosthetics, orthotics, psychologists and consultants. Those who cannot afford to pay are still treated for free, others are charged the same rate as Bir Hospital.  

“Because patients often have to stay for more than five months, it may be difficult for them to afford the cost, so we charge them according to their capacity to pay,” says SIRC’s Raju Dhakal.

SIRC’s annual running cost is Rs50 million, of which most comes from grants by non-profits and other fund-raising activities. The government also chips in with a budget for the physical construction and equipment as well as occasional allocations to cover budget shortfalls.

[email protected][email protected]

https://www.sirc.org.np/

Charikot Primary Health Centre

The 2015 earthquake damaged Charikot Primary Health Centre along with 98% of the medical facilities in Dolakha district. But the disaster was a blessing in disguise for the Charikot centre. It was rebuilt and upgraded to a full-scale 50-bed hospital and managed first by Médecins Sans Frontières and then by the non-profit Nyaya Health Nepal (NHN). Residents of Dolakha did not have to make expensive journeys to Kathmandu because medical treatment was available for free at Charikot.

Read also: Dangers of privatising health insurance in Nepal, Gaj B Gurung and Sushil Koirala

In 2020, NHN handed over management of the hospital to Bagmati Province and Bhimeshwor Municipality which now run the facility with low cost treatment for up to 300 patients a day. The Charikot experiment has been hailed as a model for successful transfer by a private non-profit to the local government, and it has been running well despite the presence of two private hospitals in Charikot.

“It has been a seamless handover from Nyaya Health to the government, and the level of care and treatment is the same,” says chief physician Binod Dangal. “We perform caesarean sections, orthopedics, telemedicine, free check-ups for the elderly, children and pregnant women, mental health counselling, and chronic illness monitoring.”

+977 49 421125

Sagarmatha Chaudhary Eye Hospital. Photo: NEPALI TIMES ARCHIVE

Sagarmatha Chaudhary Eye Hospital

For the past 30 years, the Sagarmatha Chaudhary Eye Hospital in Lahan of Siraha district has been providing the cheapest cataract surgery in the world for just Rs1,200 per operation.

Thirty years ago when the hospital started, it had only 12 beds. It now treats 470,000 people every year with patients coming in from as far away as southern India and Bangladesh, and they pay the same amount as Nepalis. Just in the last three years, the eye hospital has treated 321,000 foreign nationals.

“It is possible to provide the services at an affordable cost because we are a non-profit, and have an economy of scale,” explains Abhishek Roshan of Sagarmatha Chaudhary Eye Hospital.

Read also: Health tip, Editorial

The hospital has also set up 15 eye care centres throughout the district, and takes treatment directly to the people so they do not have to make the journey to Lahan. It has a separate department for paediatric services, care for newborn babies with vision problems. In 2021 alone, it performed 1,170 eye surgeries on children.

Apart from providing treatment of retina, cornea, glaucoma, oculoplasty, the hospital also serves as an international research centre, collaborating with institutions like The London School of Hygiene and Tropical Medicine.

The hospital subsidises its eye treatment for patients with revenue from its agribusiness ventures. A part of the hospital’s land is dedicated to fish farming, and an orchard for litchi and mangoes, as well as a bamboo grove.

“Income from those ventures help us keep the cost of treatment down,” says Roshan. The hospital is also supported by Christian Blind Mission (CBM), the European Commission and Arvis.

+977-33- 560080

https://www.erec-p.org/sagarmatha

Read more: A national health insurance scheme is not as easy as it looks, Sonia Awale

In a healthy state

Photo: NEPALI TIMES ARCHIVE

Every year, half a million Nepalis fall below the poverty line paying for expensive medical care. Another three million face financial burden, unable to pay hospital bills even after selling their assets. This is over 10% of Nepal’s population. 

Nepal might have taken dramatic strides in reducing maternal mortality and childhood malnutrition in the last decades, but it is lagging behind in assuring accessible and affordable healthcare for its people. 

This is a crime, it goes against the Constitution which guarantees basic health care for all Nepalis. Like other social sectors including education, healthcare is either over-commercialised or offers substandard service. 

Public health is just not the priority of the government, especially when it comes to the poorest and most neglected sections of society. The state’s investment in healthcare is inadequate, and the budget allocation for the health sector is considerably lower than the global average of 10% of GDP, and is less than most developing countries. 

Read more: Grassroots democracy promotes good health, Sagar Budhathoki

Even the budget that is set aside for healthcare is mostly spent on shoddy infrastructure, or procuring unnecessary and expensive equipment that is never used. There is little left for trained medical personnel and retaining them in remote area hospitals.

Nepalis are sick because they are poor, and they are getting poorer because they are sicker. Most families that cannot afford treatment in private institutions have to sell property or borrow from loan sharks to pay medical bills. 

Private hospitals and clinics operate on free market principles, and need a return on investment. The most lucrative business in Nepal today is medical education, and the sky high fees in those colleges perpetuate the cycle of over-priced medical treatment. 

Read more: Do hospitals have to be so expensive? Elipha Pradhananga

Healthcare should not be guided by the free market, and as long as the state does not take responsibility for the wellbeing of its citizens we will never achieve equity. 

Medical care cannot be a commodity, patients are not customers. 

Primary health care (PCH) is free in government hospitals in Nepal, and is paid for through taxes. Specialised medical care is best covered by insurance so the cost is not passed on to patients and their families. But in Nepal, primary health care is too basic, government hospitals are crowded and understaffed, and private hospitals are out of reach of most.

A welfare state with a social safety net pays for free healthcare through taxes, or insurance. Tax revenue goes for other sectors besides health, but medical insurance is targeted for specifically for health. 

Countries like Bhutan, Cuba and Sri Lanka show that it is indeed possible to achieve free universal healthcare. Nepal itself has public-private partnership models like Bayalpata Hospital. Replicating these examples requires political will, and a national vision.

Read more: This is how to upgrade Nepal’s rural health, Sewa Bhattarai

Our salvation may lie in national health insurance that is mandatory and where the premium is based on a family’s capacity to pay. Nepal introduced its national insurance scheme in 2017, and the premium is now Rs3,500 per year per family for a benefit package of Rs100,000. But this does not even pay for an ambulance to a city hospital. 

Late reimbursement to care providers is chronic, and hospitals now want to pull out from the national insurance program. Patients are cannot access timely treatment, and  are dropping out.   

To correct this mistake, the government is making another blunder: hand over management of health insurance programs to the private sector. 

The state is giving up on health insurance without even trying, abandoning citizens and leaving them at the mercy of profiteers.  

Letting the private sector manage health insurance defeats its very purpose: providing equitable and affordable medical care for those most in need and to prevent them from falling into the poverty trap. 

A better alternative is to work within the existing health insurance program by upgrading its features including the revaluation of the premium and benefits, bringing in private institutions for research and technical know-how, and digitisation of reimbursement for care providers. 

There are ways the Nepali state can fulfil its constitutional obligation to ensure healthcare for all, and deliver on promises not kept. It just has not tried hard enough.

Read more: Is free health care possible in Nepal? S P Kalaunee

Thai cuisine returns to Kathmandu

Photo: BISHISHTA RAI

In another sign that things might be returning to normal after the long pandemic closure, Kathmandu is hosting a Thai food festival.

Before the pandemic, Bangkok was among the most popular tourism destinations for Nepalis holidaying abroad. It was Thai International that started the first regular jet service to Kathmandu, and many Burmese of Nepali descent live and work in Thailand.

Although Thai International has not resumed its Kathmandu-Bangkok flights after the pandemic, Nepal Airlines has. And there is talk of the Thai Smile budget airline starting flights to Kathmandu and Bhairawa.

In a another sign of revival, Soaltee Hotel has invited Chef Pairaj Polgeng to Nepal to lead a 16-day food festival at the Bao Xuan restaurant, and he brings back the authentic taste of Thailand to Nepal. 

“Thai food is aromatic, spicy and tasty,” explains Polgeng. “In one bite you can taste everything – the galangal, lemongrass, coconut, chilies, and it is a burst of taste.” 

Photo: BISHISHTA RAI

Polgeng has also brought with him the genuine ingredients including Kaffir lime, Thai chilies, galangal and pandan leaves some of which he uses to make several dishes including the highlight of the demonstration night, Gaeng Keow Wan Kai which is green Thai chicken curry. 

Photos: Soaltee Hotel
Photo: BISHISHTA RAI
Photo: BISHISHTA RAI

The curry presented on a ceramic bowl is shiny green, steaming, creamy accompanied with aroma, taste and fragrance of spices and coconut milk. The meat is coarsely chopped and strewn in a sauce that mixes hot and sweet flavors. Neither taste is overlapping, every bite is a burst of flavour: the lime, the aftertaste of palm sugar, and enough chili to gulp down more water. Yet leaving everyone wanting for more.

The fact that many of the ingredients cannot be found in Nepal and that the real stuff is used, as well as the addition of Nepali touches to the presentation also give the dishes a unique selling point.

Green Curry. Photo: BISHISHTA RAI

Chef Polgeng who has over three decades of experience working with reputed international hotels in Muscat and Dubai was in his element preparing and sharing over 35 full-flavoured dishes bringing Kathmandu closer to the expansive gastronomic culture of Thailand. 

The Thai Food Festival has returned to Soaltee after a two year long hiatus following the pandemic during which the organisers found that more people were eager to try this Southeast Asian cuisine than ever before. 

“We realised many people wanted to try Thai food but we are not bringing just any Thai food but authentic dishes prepared by a Thai chef,” says Pratiksha Basnet at Soaltee.

Some of the dishes participants got to try include the Tom Yum Goong, Som Tum which is the famed raw papaya salad, Prawn Cake, Chicken Pandan Leaf, Pad Thai and everyone’s favourite dessert mango sticky rice and banana coconut milk, to name a few. 

The all-time favourite Tom Yum Goong is another popular show stealer, made from scratch with original ingredients that complement each other. The hot and sour soup was red, vibrant and flavourful. 

 For those who cannot handle their spice, there was an option of Kaeng Lueang, a yellow Thai curry which exudes a creamy richness, and is mild and soothing to the tongue. The curry made with lemongrass, yellow chili, coriander and other ingredients goes well with the fried rice. But the best part of the meal is the gentle coconut flavor infused in the dishes. 

One could happily pack a meal entirely made of snacks too – spicy chicken Thai salad, chicken pandan leaf, stir-fried chicken, Pad Thai and fried rice. 

 The popular papaya salad isrefreshing, sweet and tangy. The chicken, tender and fried lightly in oyster sauce, tastes of white pepper and mild garlic. The pad Thai noodles have sprouts and hence a slight crunch. The noodles and fried rice, not as loaded with fresh hot chilies as other dishes, go well with the curry.

 From Tom Yum to Gaeng Keow Wan Kai, it is the honesty and love in this lavish feast that makes Chef Polgeng’s visit such a gastronomic delight. 

Till 2 July, 7pm-10.45pm, Bao Xuan Restaurant, Soaltee Hotel, Kathmandu

Read more: Kathmandu’s own ‘Eataly’, Sonia Awale

Does the age of an aircraft matter?

Buddha Air’s founder Birendra Bahadur Basnet at the airline’s state-of-the-art hangar in Kathmandu.

Just like a car’s condition is not determined by when it was manufactured but how well it is maintained, it is the same with aircraft.

There are many planes flying in Nepal that are decades old. For example an ATR-42 twin turboprop is designed for a stipulated lifetime through research and tests. Its equipment, wings and fuselage and landing gears have strict guidelines for spare parts replacement and maintenance. 

In addition, airlines that operate the planes have their own protocols for checks and certification which further have to conform to regulatory requirements of the civil aviation safety agency within the country. If a carrier is found to be in violation of any of these rules, the airline is penalised and aircraft grounded.

A Nepal Airlines Airbus 330 dwarfs a Twin Otter at the carrier’s hangar at Kathmandu airport.

The age of an ATR series aircraft like the -42 or -72 is determined not by the year it was manufactured, but how many ‘cycles’ it has logged. One cycle is defined as one takeoff and one landing. For example, an aircraft is considered ‘old’ if it has performed many cycles, and necessarily because of its chronological age.

An older aircraft may not have performed too many cycles, and can keep flying as long as it is maintained as per the requirement of the manufacturer. A typical ATR-72 has tens of thousands of parts, each with its own lifespan measured in cycles. For a plane to be considered airworthy, each one of these parts must be maintained or replaced as per the manuals. Just repairing a particular part is not adequate.

It is not just the moving flight control systems of a plane, or the cockpit instrumentation that need to be checked. An aircraft’s wings, fuselage, flaps, ailerons, tail assembly, all need to be thoroughly checked after a certain number of cycles, every rivet and joint must be carefully inspected.

Photo: BUDDHA AIR

An airline with a fleet of ATRs needs a hangar where the maintenance work can be carried out. That is why Buddha Air invested in a state-of-the-art Rs25o million hangar 10 years ago to perform regular checks on its fleet in Nepal itself, without having to send them abroad. Buddha’s hangar has Rs1.12 billion worth of spare parts in its inventory.

Human Resources are as important as the hangar and equipment. Buddha, for example, employs nearly 200 aeronautical and mechanical engineers who have received specialised training from the ATR company itself.

Besides Buddha Air, Nepal Airlines also has a hangar with trained maintenance personnel for its airframe and engines to look after its Airbus 320s and 330s. The planes have to go for their C and D checks abroad, but most of the regular checks can be done in Kathmandu itself.

Dipendra Karna is the Communication Manager at Buddha Air.

Close encounter with death

Nepali migrant workers bring home the body of a coworker who died on the job in destination country. Photo: GOPEN RAI/NEPALI TIMES ARCHIVE

I came to Malaysia four years ago to work as a security guard. I guard condominiums and sometimes have to accompany visitors to their floors on the elevator. But I do not step out of the elevator. We are not allowed to.

I paid for my tickets to come to Malaysia, and my employer deducted 1,000 Ringgit over the course of two months from my salary. It may not sound as bad as what other migrants pay for these jobs but it was the deal I had struck with my agent.

He had previously sent me to Qatar as an electrician and after five months of not being paid, I returned. He deemed it cheaper to send me to Malaysia as a security guard than to repay the Rs95,000 I had paid for the job in Qatar. It took me 10 months to haggle with him, but it worked out eventually.

Every day for the past four years, I have worked for 12 hours, 30 days a month. I can send home over Rs40,000 a month, which for my family is a lot.

Read also: The high life, Nepali Times

But I realised the fragility of our lives when my roommate, also a security guard, died a few months back.

Let’s call him Shiva dai.

We had been roommates for over two and a half months. We shared a room but we only saw each other for an hour or two every morning given our duty hours.

From the onset it was obvious that Shiva dai came to Malaysia to grind. He had a singular purpose of earning as much as he could while here. Perhaps we all come to the Gulf or Malaysia with the same aim, but Shiva dai was a different breed. He worked two jobs, which meant he worked 20 hours a day, every day.

“We are here to work, to earn money, so I will do whatever it takes to earn as much as I can,” he used to say. And he did. “Why don’t you take up another job or extra shifts?” he used to ask me. I didn’t think it was physically possible for me, 12 hours was more than enough.

Read also: A father’s sacrifice for his son’s dream, Nepali Times

Shiva dai was nice to me. We cooked separately but when we made good food, we used to share it with each other. I had gotten used to our mornings when we cooked and chatted as we ate. I used to ask him not to work so hard, to take care of his health. He used to say he got to sleep at work, on his chair during the night shift when everything was quiet and there wasn’t much to “guard”. In fact, he used to be annoyed at me for not taking advantage of such easy opportunities but I resisted. By his standards, I might have looked idle to him.

One morning, Shiva dai was cooking: boiled eggs for breakfast and chicken soup for his lunch and dinner. He asked me if I could stir the chicken while he took a shower. I agreed. The soup was looking good that morning, especially as I had just come back from a 12 hour night shift.

When Shiva dai came out of the shower, he complained of a backache and that his legs felt stiff. He asked me if I could help apply Vicks on his back. He looked like he was in grave pain. As I helped him, I asked him if this has happened before, he said twice. Next, he was unable to move his leg. I got scared and called my boss. By the time paramedics arrived, Shiva dai had passed after having what looked like three rounds of seizure. The police came, took him away.

When his wife called, I was the one who broke the news. It was not easy. She initially thought I was joking but when she finally realised the truth, she started wailing. I spoke to a few more family members. Each time I had to relive the scenario, each time I had to hear them cry. It broke me.

Read also: Fate joins, then separates, siblings, Anil Shrestha

I had never before witnessed a death so closely. I was scared and too stunned to sleep, even though I had just worked a 12 hours night shift.

I could not stay in the room either. It was eerily quiet but there were too many thoughts racing in my mind. Everything had happened so quickly that it was difficult to process it all. We were laughing and talking one minute, and he was dead the next moment. 

After much restlessness, at 5PM I went to work and took a nap in the rest post, a small room where guards like myself eat and rest. I resumed my duty at 7. I was disturbed for a long time. 

It took 29 days for his body to be repatriated. It was during the pandemic so there were restrictions on flights and much backlog of bodies to be taken back home. He left with over two dozen others, four were just ashes.

Read also: Between home and the deep blue sea, Prakash Gurung

Malaysia is one of the most popular destination for Nepali migrant workers. Photo: KUNDA DIXIT

He did not have much belonging, just some clothes including two security guard uniforms. What stood out was a guitar. He never played. I think he was meaning to take it to his son back home. It was given to him by a family in a condominium where he had previously worked as a security guard.

His suitcase could not be taken back so it was thrown away. He did not have much anyway, but perhaps his family could have found some consolation in receiving them. I don’t know.

Since Covid-19, there has been a shortage of workers in Malaysia as they have stopped recruiting. It is only now that they are slowly starting the recruitment of overseas workers. But throughout these last couple of years, because my boss was unable to hire from overseas and it was too expensive to get local workers, he often wanted me to take extra shifts as there was always work. But for someone who works 12 hours every day, an extra shift means a 36-hour shift.

You finish your regular shift at 7PM after working from 7AM and take up a night shift from 7PM to 7AM, only to continue your regular shift the next morning. Even if you manage to shut your eyes on your duty chair like Shiva dai did, it does not compensate for a full night’s sleep. But many Nepalis continue to work like this. 

Read Also: The Qatar job mirage, Nepali Times

Money is important and that is why I am here. But it is not everything.

I have valued things beyond money throughout my life. I did not accept a dowry during my marriage even though it would have helped my family immensely. I do not want to kill myself for money here in Malaysia either. And especially after what I witnessed with Shiva dai, I have strong reasons not to overdo it. 

Translated from a conversation in Nepali.

Diaspora Diaries is a regular column in Nepali Times providing a platform for Nepalis to share their experiences of living, working, studying abroad. Authentic and original entries can be sent to [email protected] with ‘Diaspora Diaries’ in the subject line.

Read also: Power of workers working together, Madhusudhan Ojha