Marty Logan

original

674x448

610x380

500x500

400x266

400x240

400x203

301x200

1250x600

1084x550

Growing appetite for school lunches

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410114/637204f29c7e80680e0b288djpeg.jpg" alt="" width="1500" height="1000"/><figcaption>Photos: UNICEF NEPAL</figcaption></figure>Despite periods of political and economic instability, Nepal achieved dramatic progress in maternal and child health in the early 2000s becoming an international model.It took great strides in reducing childhood malnutrition, in particular, reducing stunting from 57% in 1996 to 33% in 2016. Maternal and Infant mortality rates also similarly declined, only for much of these successes <a href="https://www.nepalitimes.com/banner/nearly-half-of-nepali-children-still-malnourished/" target="_blank" rel="noopener noreferrer">to stall in the recent years</a>. And this trend has been made worse by the Covid-19 pandemic, states a new UNICEF report.Titled “<a href="https://onlinelibrary.wiley.com/toc/17408709/2022/18/S1" data-saferedirecturl="https://www.google.com/url?q=https://onlinelibrary.wiley.com/toc/17408709/2022/18/S1&amp;source=gmail&amp;ust=1642768390008000&amp;usg=AOvVaw2Qo1HoClES2POc3Qyp2i-7">Nutrition in Nepal: Three decades of progress for children and women</a>”, the report brings together a set of nine original articles that examine the drivers of success and identify where greater policy and programmatic action is needed to achieve the Sustainable Development Goal (SDG) nutrition targets.“Optimal maternal and child nutrition is the basis for developing a resilient society,” says EU Ambassador to Nepal, H.E. Nona Deprez. “The decline in the number of malnourished children, improvements in health facilities and services, and the multisectoral approach used in Nepal over the past three decades are a testament to the Government of Nepal’s commitment to reducing all forms of malnutrition.”A <a href="https://onlinelibrary.wiley.com/toc/17408709/2022/18/S1" data-saferedirecturl="https://www.google.com/url?q=https://onlinelibrary.wiley.com/toc/17408709/2022/18/S1&amp;source=gmail&amp;ust=1642768390008000&amp;usg=AOvVaw2Qo1HoClES2POc3Qyp2i-7">special supplement of the Maternal and Child Nutrition Journal</a> published on Thursday lists some of Nepal’s biggest nutritional achievements. Between 1996-2016, the early initiation of breastfeeding saw an increase from 18% to 56%, and complementary feeding increased from 54% to 77%.During the same period, women taking sufficient iron and folic acid supplements during their pregnancy rose from 6% to 71%. This was combined with earlier and more frequent antenatal care visits.Consistent administering of Vitamin A has saved the lives of an estimated 45,000 Nepali children under the age of five, between 2002 and 2015. Similarly, households using adequately iodised salt doubled from 35% to 77% from 1998 to 2016.Much of this progress can be credited to improvements in household wealth, parental education, and <a href="https://www.nepalitimes.com/banner/toilet-trained/" target="_blank" rel="noopener noreferrer">sanitation</a>. But equally important was increased coverage of health and nutrition services undertaken by successive governments.Nepal Government utilised ground-breaking research to test interventions and overcome challenges, it is also committed to enforcing mandatory legislation such as salt iodisation, writes the journal supplement.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410114/637204f69c7e80680e0b288ejpeg.jpg" alt="" width="1500" height="1001"><figcaption></figcaption></figure>Mobilisation of <a href="https://www.nepalitimes.com/latest/enlisting-female-health-volunteers-to-fight-covid-19/" target="_blank" rel="noopener noreferrer">Female Community Health Volunteers</a> (FCHVs) across Nepal villages and towns have improved the health of mother and children, so has an investment in sectoral programs including education and sanitation.But there are now new challenges to achieving national and global targets on nutrition, which also threatens to undermine past gains.“The learning from the past 25 years that are incorporated in the supplement will inform and contribute to future improvements. However, we must act now, given the impact that the pandemic has had on the nutritional health of mothers and their children,” says Elke Wisch, UNICEF Representative to Nepal.During the pandemic, most households experienced job losses or reduced income. With the <a href="https://www.nepalitimes.com/here-now/3rd-wave-in-2-years/" target="_blank" rel="noopener noreferrer">Omicron-led third wave</a> spreading across Nepal, the pandemic’s ensuing socioeconomic crisis is long from over.This means reduced dietary intake among children and mothers. School closures will deprive many children of getting one decent meal a day. All this will add to <a href="https://www.nepalitimes.com/banner/nepals-epidemic-of-hunger/" target="_blank" rel="noopener noreferrer">childhood malnutrition</a> which continues to be a major cause of death and retarded mental and physical development among younger populationsAs such, UNICEF has recommended the government to improve the general public’s access to nutritious, safe, affordable, and sustainable diets. It also suggests integrating essential nutrition services into the existing service delivery platforms like family planning, antenatal, delivery and post-natal care and well-child and sick-child care and continuing to mobilise FCHVs to reach more women and children.To disseminate factual information, advice and counselling on infant and young child feeding, <a href="https://www.nepalitimes.com/here-now/3rd-covid-wave-infects-nepals-frontliners/" target="_blank" rel="noopener noreferrer">healthcare workers</a> can also use multiple communication channels such as radio, TV or social media.But perhaps equally if not more important is strengthening local levels so that they can plan, implement and monitor nutrition programs and services, and maintain Nepal's commitment to generating data, information, and evidence to assess progress and inform decisions.

Covid undermines Nepal's mother-child gains

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114091156/637203229c7e80680e0b27f0jpeg.jpg" alt="" width="1944" height="1098"/><figcaption></figcaption></figure>In the heart of Edinburgh near the Church of St John the Evangelist is <a href="https://www.oneworldshop.co.uk/" data-saferedirecturl="https://www.google.com/url?q=https://www.oneworldshop.co.uk/&amp;source=gmail&amp;ust=1641433168882000&amp;usg=AOvVaw2DlDyvp0funtWsI3daY8Bf">One World Shop</a>, a modest-looking store that sells goods from all over the world.Among the products are ‘<a href="https://www.nepalitimes.com/banner/made-in-nepal/" target="_blank" rel="noopener noreferrer">Made in Nepal</a>’ sweaters, mufflers, felted slippers, and beanies which are flying off the shelves this winter. There are also Nepali handicraft items, lokta paper products, herbal bath soaps and <a href="https://www.nepalitimes.com/banner/clothed-in-cannabis/" target="_blank" rel="noopener noreferrer">hemp products</a> for sale.But the items are not as much for profit as they are for the international promotion of fair trade handmade goods made by women in poorer communities to improve their livelihood with added income. The store, a fair trade organisation set up in 1983, sources most of its Nepali products from the Association for Craft Producers and Get Paper Industry in Kathmandu."Our goal is to empower women and alleviate poverty through diversification of livelihood options," explains Rachel Farey, business manager of the One World Shop which also sponsors Nepali women to be trained at institutes in the UK. “We buy goods only when we confirm that they were made by women in need, or if they are somehow involved in manufacturing.”Farey comes from a family with a long-standing connection with Nepal. Her uncle was former Gurkha officer <a href="http://archive.nepalitimes.com/news.php?id=9296#.YdRS8C8RqLd" data-saferedirecturl="https://www.google.com/url?q=http://archive.nepalitimes.com/news.php?id%3D9296%23.YdRS8C8RqLd&amp;source=gmail&amp;ust=1641433168882000&amp;usg=AOvVaw2zTu5ZxUmpVaWi0pbRP35h">Mike Cheney</a>, a pioneer figure in <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/trekking-in-Nepal-turns-50,2658" target="_blank" rel="noopener noreferrer">Nepal’s trekking</a> and mountaineering scene during the 1970s, who set up Sherpa Cooperative to ensure that porters had proper working conditions.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114091156/637203259c7e80680e0b27f1jpeg.jpg" alt="" width="640" height="971"><figcaption>Mike Cheney</figcaption></figure>Cheney had served in the British Army from 1946 to 1957 in the Royal Armoured Corps and the 10th Gurkha Rifles. After retiring from active service, he became a tea-estate manager in Darjeeling, and came to Kathmandu in 1965 for the first time and continued working in a tea estate in Ilam.He then turned to Nepal’s fledgling trekking industry, and in 1966 joined forces with <a href="https://www.nepalitimes.com/opinion/hiking-with-jimmy/" target="_blank" rel="noopener noreferrer">Jimmy Roberts</a> who had set up <a href="https://www.nepalitimes.com/here-now/the-himalayan-odyssey/" target="_blank" rel="noopener noreferrer">Mountain Travel Nepal</a>, the first registered trekking company in the world. In his later years, Cheney concentrated his efforts on promoting the country as a household name in the climbing and mountaineering industry.“Mike Cheney showed Nepal the way ahead, connecting the country to the rest of the world at a time when it was not easy to market a new destination, while at the same time making sure that porters got a good deal,” says tourism entrepreneur Karma Sherpa Lama in Kathmandu.Cheney was vocal about <a href="http://archive.nepalitimes.com/news.php?id=4747#.YdT8di2B2b8" target="_blank" rel="noopener noreferrer">low-paid porters</a> carrying heavy leads during mountaineering and trekking expeditions and worked to raise living standards by setting an example with his Sherpa Cooperative. He made sure that porters were paid higher wages, had proper gear for high altitudes, and were taken care of if they fell sick.Cheney’s other major contribution was in scouting new trekking routes across Nepal, away from already <a href="https://www.nepalitimes.com/here-now/managing-everests-waste-problem/" target="_blank" rel="noopener noreferrer">crowded Everest</a> and Annapurna areas, and improving the trails. Cheney was also a correspondent for several alpine journals and mountaineering magazines in Europe and the United States.Cheney was an active member of the Himalayan Rescue Association with its clinic in Pheriche, and the Trekking Agents’ Association of Nepal. He was the Local Hon Secretary of the Bombay-based Himalayan Club, a fellow of the Royal Geographical Society and a member of the Alpine Club.Now, his niece Farey is following in his footsteps and is committed to helping Nepali women and children through her store One World Shop in Edinburgh which sells a wide range of handmade crafts, jewelry, textiles, interior furnishings, furniture, toys, clothing, ceramics, handmade paper products, cards, books and foods.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114091156/637203289c7e80680e0b27f2jpeg.jpg" alt="" width="1700" height="802"><figcaption></figcaption></figure>“Our mission is to reduce poverty by sourcing and selling fair trade goods from all around the world,” says Farey. “It is not just the individual artisans who make the goods that benefit from our work, but also their families and the communities in which they live.”Like her uncle, Farey is also a passionate trekker herself and has visited Nepal often. She says that in a way she is carrying on Mike Cheney’s mission: to uplift Nepali families by removing middlemen and guaranteeing them a just income.For Farey ‘fair trade’ is not just a concept, she is actually practicing it in her business through One World Shop which sources and sells sustainably produced products from around the world by ensuring a decent price which is ploughed back into their communities.During the pandemic, One World Shop was selling its products online even though supplies from Nepal were disrupted because of flight cancellations.

Edinburgh store comes full circle to Nepal

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110161152/636d1e8b9c7e80680e0af416jpeg.jpg" alt="" width="960" height="640"/><figcaption>Photo: SAGLO SAMAJ/HIMALMEDIA</figcaption></figure>The Covid-19 worsened the disparities in young children’s development and learning in Nepal. One out of five Nepali children between the ages of 2-4 years are not developing on track amidst the pandemic with noted impact on their health, <a href="https://www.nepalitimes.com/latest/covid-19-cancels-regions-gains-in-education/">learning</a> and psychological well-being, a new UNICEF study has revealed.The Early Childhood Development Index (ECDI) survey conducted in August among 2,853 households via phone conversation showed that children from lower income families, living in rural areas, with caregivers with no or low levels of education, and not attending early childhood education (ECE) programs were at higher risk.Even among children who attended ECE, those who attended government ECE were at higher risk of being developmentally off track compared to those who attended private programs.Early stimulation activities like <a href="https://www.nepalitimes.com/here-now/the-power-of-reading-aloud/">reading books</a>, telling stories, singing songs, going outside, naming objects, counting, or drawing things were found instrumental for young children’s development and learning. However, the data revealed an alarming plunge in parental engagement compared to pre-pandemic conditions.As the country opened up with the decline in Covid cases in August 2021 and parents pursued livelihood options, only 31% of children received early stimulation at home by family members compared to 73% in 2019.A follow up survey in October found that mothers’ engagement improved over the time after she got over the initial hectic schedule right of the pandemic. The same can’t be said for the fathers, whose parental engagement remained low at 6%, maintaining a social norm of men’s reduced role in raising children.This is just the latest in the series of impacts that young children have been subjected to following the pandemic. Early in the coronavirus crisis, repeated lockdowns and travel restrictions meant that parents were unable to take their children for routine immunisation, also resulting in an outbreak of measles in the Dhading district. Similarly, the dramatic <a href="https://www.nepalitimes.com/banner/children-are-collateral-damage-in-nepal-lockdown/">decline in institutional delivery</a> led to increased infant mortality.Reduced family income due to job losses during the pandemic also added to the problem of childhood malnutrition in Nepal. School closures also deprived many children of getting <a href="https://www.nepalitimes.com/latest/nepals-out-of-school-children-get-food-at-home/">one decent meal a day</a> while they also missed their lessons with over 80% of government school children not having attended classes – online or otherwise in the past two years.Among children in the age group 2-4 years, half of those surveyed were found to have been enrolled in <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/Prepping-for-preschool,253">pre-primary level</a> but 34% of them didn’t participate in learning through alternative learning modalities at all, most of the children only accessed home tuition. While low-tech solutions like educational radio and TV and tele-teaching were almost unused, high-tech solutions like online classes were used almost exclusively among children who attended private ECE.Underused low-tech solutions and unequal access to high-tech solutions might have further contributed to the developmental gap observed between children who attended private ECE and other children and is the proof of the <a href="https://www.nepalitimes.com/here-now/digital-divide-exposes-class-divide-in-nepal-schools/">growing digital divide</a> between private and public institutions.Following the survey results, UNICEF has recommended remedial learning to target children at a higher risk. The government and aid agencies should also develop a system to support teachers and parents to understand their children and figure out their learning levels through user-friendly assessments.In many ways, Covid-19 was a learning lesson for future disasters and being forced to adapt to online educational tools has helped teachers, students and parents prepare for school closures. But the alternative methods of learning remain largely underused, mostly in lack of infrastructure. School across Nepal <a href="https://www.nepalitimes.com/here-now/lessons-not-learned-from-the-pandemic/">has to be trained and well-equipped</a> with Internet facilities and electronic devices.Having said that, parenting education, in particular, involvement of fathers and learning at home is of utmost importance and should be communicated as much in the communities.

Covid derails child development in Nepal

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110161132/636d19729c7e80680e0ac81djpeg.jpg" alt="" width="800" height="533"/><figcaption>The art festival was inagurated by noted Nepali actor Rajesh Hamal (second from right). Also pictured, general manager of Turkish Airlines Abdullah Tuncer Kececi (first from left). Photos: MONA</figcaption></figure>More than 1,500 children in Nepal are diagnosed every year with some form of cancer. Many of them are treatable, but because of the lack of timely diagnosis and proper treatment, many young lives are tragically lost.Help from them has come from an unexpected quarter: Nepali artists who have been representing the country’s social issues on canvas, sculpture or digital art.Earlier this month, 33 of Nepal’s most prominent artists from all genres took part in a live painting performance at <a href="https://www.nepalitimes.com/banner/nepals-first-private-art-museum/" target="_blank" rel="noopener noreferrer">the Museum of Nepali Art</a> in the Kathmandu Guest House premises in Thamel. Part of the proceeds generated from the sale went to the oncology ward of the Kanti Children’s Hospital.Less than 30% of Nepali children have their cancers diagnosed on time, but many of even those are unable to afford expensive treatment.The art festival was inaugurated by noted Nepali actor Rajesh Hamal, who kick-started the event by painting his own contemporary piece ‘No smoking’ under the guidance of noted artists Kiran Manandhar and Lok Chitrakar.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110161132/636d19759c7e80680e0ac81ejpeg.jpg" alt="" width="800" height="533"><figcaption>Renowned contemporary artist Kiran Manandhar with participating artist Sangee Shrestha.</figcaption></figure>As the artists warmed up to the performance, it was evident that they were producing a diverse body of art with differing techniques. It ranged from traditional pauba and <a href="https://www.nepalitimes.com/banner/vibrant-mithila-art-thrives-in-nepal/" target="_blank" rel="noopener noreferrer">Mithila art</a> to abstracts embodying cubism and conceptual art forms.But they were all sharing the space and participating in an exercise that aimed to help underprivileged children with hope. Access to diagnosis and treatment is literally a matter of life or death for many young patients.The art festival coincided with the inauguration of the Kathmandu Guest House (KGH) by renowned <a href="https://www.nepalitimes.com/banner/nepals-far-sighted-eye-care/" target="_blank" rel="noopener noreferrer">ophthalmologist Sanduk Ruit</a> with founder/director of the Museum of Nepali Art (MoNA) <a href="https://www.nepalitimes.com/opinion/i-m-a-g-i-n-a-t-i-o-n-by-uttam-nepali/" target="_blank" rel="noopener noreferrer">Rajan Sakya</a>.“We are committed to conducting similar events annually to promote art for a cause so that it serves those in need,” Sakya said.Following the main event on 7 October, the paintings were exhibited at MoNA in the presence of Bishnu Rath Giri, head of the oncology unit at Kanti Children’s Hospital.Lately, <a href="https://www.nepalitimes.com/banner/nepali-art-going-places/" target="_blank" rel="noopener noreferrer">Nepali art has been getting the recognition</a> it deserves with many of them being exhibited at famous museums, art galleries and private collections worldwide. These pieces fetch hundreds of thousands of dollars in the international art market, and yet it is rare for contemporary Nepali art to shine at home.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110161132/636d19779c7e80680e0ac81fjpeg.jpg" alt="" width="800" height="533"><figcaption></figcaption></figure><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110161132/636d197c9c7e80680e0ac820jpeg.jpg" alt="" width="800" height="533"><figcaption></figcaption></figure>MoNA aims to be a crucible for Nepali art, so that the gallery is an ‘art hub’ in Kathmandu’s bustling Thamel neighbourhood. Such art hubs are common in developed countries including France, Italy, China, and Japan.Established in 2020, MoNA is Nepal’s first museum dedicated to preserving and promoting <a href="https://www.nepalitimes.com/opinion/jeevan-rajopadhyays-untitled/" target="_blank" rel="noopener noreferrer">Nepali art</a>, especially those of living artists. And this is the first time that a live art festival has been held to support a cause.“This event is the start of the crucial process of bridging this social and intellectual gap between artists and the general public,” says Sakya. “One need not be an art historian or critique to recognise creativity and beauty, and artists do not differentiate between ethnicities. Art is tangible culture and a living expression of us Nepalis.”Sworup Kant AdhikariPaintings can be viewed online <a href="https://www.mona.com.np/art/art-fest-2021">here</a>.

Art for a cause

<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110161124/636d17e79c7e80680e0ac791jpeg.jpg" alt="" width="4096" height="2730"/>Children and young people across the world could feel the <a href="https://www.nepalitimes.com/here-now/post-pandemic-mental-health-epidemic/" target="_blank" rel="noopener noreferrer">impact of Covid-19 on their mental health</a> for many years even after the worst effects of the pandemic are gone, a new UNICEF report warns.The annual <a href="https://www.unicef.org/reports/state-worlds-children-2021" target="_blank" rel="noopener noreferrer">State of the World’s Children 2021: On My Mind </a>this year focuses on promoting, protecting and caring for children's mental health and is a comprehensive look at how children, adolescents and caregivers will be affected for many years into the future.Early findings from UNICEF and Gallup’s survey Changing Childhood Project previewed in the report show that one in five respondents aged 15–24 admitted to feeling depressed and losing interest in things. The survey interviewed approximately 20,000 children and adolescents from 21 countries as well as 40 and older.One-third of respondents of a Chinese online survey last year cited in the report reported feeling scared or anxious.“With nationwide lockdowns and pandemic-related movement restrictions, children have spent indelible years of their lives away from family, friends, classrooms, play – key elements of childhood itself,” said UNICEF Executive Director Henrietta Fore. “The impact is significant, and it is just the tip of the iceberg.”According to the Institute of Health Metrics and Evaluation (IHME)’s 2019 Global Burden of Disease Study, more than one in seven adolescents aged 10–19 globally is estimated to live with a <a href="https://www.nepalitimes.com/opinion/coping-with-anxiety-in-new-lockdown/" target="_blank" rel="noopener noreferrer">diagnosed mental disorder</a>, some of which include depression, anxiety, schizophrenia, ADHD, autism, and eating disorders.WHO’s 2019 Global Health Estimates show that almost 46,000 adolescents die from suicide each year.Here in Nepal, community respondents say that <a href="https://www.nepalitimes.com/latest/tackling-nepals-mental-health-pandemic/" target="_blank" rel="noopener noreferrer">mental health is among the primary concerns</a> of children and adolescents. Nepal Police data shows that 8% of those who died by suicide nationwide in the last five years were minors. Some 20% of suicide ideation and calls to psychological helplines across Nepal are associated with violence, and 25% with economic deprivation.Statistics show a <a href="https://www.nepalitimes.com/latest/in-nepal-lockdown-a-domestic-violence-spike/" target="_blank" rel="noopener noreferrer">direct correlation</a> between the lockdown and incidents of gender-based violence, sexual violence, and violence against children in Nepal. There have been 7,141 reported deaths due to <a href="https://www.nepalitimes.com/banner/nepal-sees-spike-in-suicides-during-pandemic/" target="_blank" rel="noopener noreferrer">suicides nationwide in the last 12 months</a>, up from 6,252 the year before.Additionally, recent surveys reveal that a significant number of households with children <a href="https://www.nepalitimes.com/latest/1-in-5-nepal-families-lack-food/" target="_blank" rel="noopener noreferrer">experienced economic and livelihood losses</a> during the 2020 lockdown, and the economic fallout continued into the 2021 lockdown as households experienced<a href="https://www.nepalitimes.com/latest/half-of-nepalis-lost-jobs-in-past-month/" target="_blank" rel="noopener noreferrer"> job losses</a>, with little to no support from the government.At least one in every seven children globally has been directly affected by lockdowns. More than 1.6 billion children have <a href="https://www.nepalitimes.com/latest/covid-19-cancels-regions-gains-in-education/" target="_blank" rel="noopener noreferrer">lost access to education </a>during the pandemic, and the disruption to routines, recreation, as well as impact on family income and health has left young people with exacerbated mental health issues.Mental health issues cause long-term harm to children and young people’s education, life outcomes, and earning capacity. Indeed, a new analysis by the London School of Economics indicates that mental disorders leading to disability or death among young people cost economies nearly $390 billion annually.Despite the epidemic of mental health crisis among young people who are dealing with unaddressed psychological disorders, it doesn’t attract the investment from governments it deserves, and there were significant gaps between mental health needs and funding even before the pandemic.Indeed, the UNICEF report found that only about 2% of government health budgets are allocated to mental health spending globally.The report also notes that genetics, environmental factors including parenting, schooling and relationships, exposure to violence or abuse, discrimination, poverty, as well as humanitarian and health crises have an impact on children’s mental health.And while caregivers, safe school environments, and positive peer relationships can help reduce the risk of mental disorders, the stigma surrounding mental health and lack of funding prevent children from accessing required mental health resources.The report has called on world governments as well as the public and private sector to commit to addressing the <a href="https://archive.nepalitimes.com/article/nation/stigma-and-silence-mental-health-nepal,3486" target="_blank" rel="noopener noreferrer">stigma surrounding mental health</a>; promoting mental health for children, adolescents and caregivers; taking experiences of children and young people seriously, and identifying and caring for vulnerable groups with psychological conditions.Said Fore: “Mental health is a part of physical health, we cannot afford to continue to view it as otherwise. For far too long, in rich and poor countries alike, we have seen too little understanding and too little investment in a critical element of maximising every child’s potential. This needs to change.

The other pandemic: mental health

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110161124/636d17b19c7e80680e0ac780jpeg.jpg" alt="" width="856" height="571"/><figcaption>Kathmandu's Dasain shopping crowd this week. Photo: AMIT MACHAMASI</figcaption></figure>Nearly half of Kathmandu Valley’s population is fully vaccinated against Covid-19, but the national average is only a little over 20%. In essence, this is a microcosm of <a href="https://www.nepalitimes.com/opinion/hope-hyperbole-and-hypocrisy-of-covax/" target="_blank" rel="noopener noreferrer">vaccine inequity seen globally</a> – but it also reflects Nepal’s in-built socioeconomic inequalities.In Asia and Africa, a majority of the population including health workers and the elderly are yet to receive even their first dose. But the US, France, Germany, and Israel are already <a href="https://www.nepalitimes.com/opinion/to-boost-or-not-to-boost/" target="_blank" rel="noopener noreferrer">providing booster shots</a> to their vulnerable populations.On one hand, this is a stark reminder that Nepal is not on the priority of wealthy nations. Just as it was not during the <a href="https://www.nepalitimes.com/banner/the-real-cost-of-nepals-second-wave/" target="_blank" rel="noopener noreferrer">devastating second wave in May</a> when, despite the prime minister and the president calling on foreign governments for vaccine shipments, <a href="https://www.nepalitimes.com/here-now/aid-pours-into-nepal-but-where-be-vaccines/" target="_blank" rel="noopener noreferrer">the response was tepid</a>.On the other hand, the imbalance in vaccine distribution within Nepal is a reflection of long-standing inequities in healthcare services, education, drinking water, and food that predate Covid-19.Despite a federal Constitution that has devolved decisions and delivery of basic services to local governments, it is still Kathmandu that holds the purse strings and power. Isolated and beyond the state’s reach even at the best of times, Nepal’s hinterland this year has been cut off by <a href="https://www.nepalitimes.com/banner/still-chasing-the-melamchi-mirage/" target="_blank" rel="noopener noreferrer">destructive floods blamed on the climate crisis</a>.A village in Kailali with 200 Tharu and Dalit families has been marooned by floods for the past month, where the submerged roads block access to even the rudimentary healthcare available.It is not surprising, therefore, that very few in this village are inoculated. In fact, those who need to be vaccinated the most now face a triple whammy: historical state neglect, international apathy, and now <a href="https://www.nepalitimes.com/opinion/mountainous-regions-face-catastrophic-impacts-without-urgent-climate-action/" target="_blank" rel="noopener noreferrer">climate-induced extreme weather</a>.This in turn has set off a vicious cycle, and the poor are getting poorer. The official death toll from Covid-19 in Nepal is nearly 12,000, but the ‘excess deaths’ that were not counted in remote villages across the country is probably several times higher.An estimated <a href="https://www.nepalitimes.com/banner/helping-nepals-covid-orphans/" target="_blank" rel="noopener noreferrer">1,200 children have become orphans</a> because of the death of one or both parents due to Covid-19. Many of them do not have support for food, healthcare, and education – setting a stage for intergenerational inequity.In Kathmandu and urban centres, on the other hand, there is complacency and false sense of security as <a href="https://www.nepalitimes.com/latest/too-early-for-nepal-to-let-its-guard-down/" target="_blank" rel="noopener noreferrer">the festive season approaches</a>. Unvaccinated children have also started <a href="https://www.nepalitimes.com/editorial/two-schools-of-thought/" target="_blank" rel="noopener noreferrer">attending in-person schools</a>. The Health Ministry’s recent seroprevalence study has revealed that 67% of people have SARS-CoV-2 antibodies, and therefore have natural immunity against the virus. This, combined with half of the valley’s targeted demography being vaccinated on paper, makes a case for a fully immune population.But that is not the case. There is now growing proof that antibodies provided by vaccines wane over time, which means many of us who were vaccinated earlier this year have weaker protection than we think. Only those newly infected with the virus might have sufficient antibodies to fight off the next infection.It is not as important to know what portion of the population has antibodies as to how much of it they have. Vaccinated individuals are less susceptible to hospitalisation, severe symptoms, and death, but they can still be contagious, especially as the <a href="https://www.nepalitimes.com/here-now/delta-variants-wake-up-call-for-nepal/" target="_blank" rel="noopener noreferrer">more virulent Delta variant</a> continues to circulate in the region.The Dasain shopping spree has started, and there are throngs of <a href="https://www.nepalitimes.com/latest/dasain-crowd-unmasked/" target="_blank" rel="noopener noreferrer">shoppers in Asan and other bazar streets</a>. Many have stopped wearing masks, or use them inappropriately. The situation will be worse when Kathmandu residents travel to their hometowns this week. They will be visiting elderly parents and grandparents, exposing vulnerable elderly relatives with lower immunity to the virus.The government is bringing in 100,000 doses of Pfizer vaccines after the festivals, with plans for 10 million more by March. But provincial and district hospitals must have deep refrigeration equipment in place, and make necessary collaboration with private hospitals.To make sure that each Nepali child, even those in remote Karnali, gets <a href="https://www.nepalitimes.com/banner/once-nepal-gets-vaccines-they-need-to-be-fairly-distributed/" target="_blank" rel="noopener noreferrer">a shot at the Covid-19 vaccine</a>, our expansive network of community healthcare workers must be mobilised and, where required, administer vaccines at the household level.Lhamo Yangchen Sherpa is an epidemiologist and a senior research monitoring and evaluation advisor at IPAS Nepal.

Giving all Nepalis a shot at the Covid vaccine

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141156/636d032c9c7e80680e0a36bajpeg.jpg" alt="" width="1500" height="1000"/><figcaption>Bhuvan Kharel and his father Yadav Kharel were inseparable but earlier this year the young boy lost his father to Covid-19. All photos: MONIKA DEUPALA</figcaption></figure>Eight-year-old Bhuvan Kharel used to start his day with a glass of milk in bed brought to him by his father. Yadav Kharel would then prepare a lunch box for his son, drop him off at school and in the afternoon bring him back home.Born to the Kharel couple in Panchkhal of Kavre<a name="m_-7349375543753954955__GoBack"></a> district after 12 years of marriage, Yadav raised his son with care and affection. He used to carry the boy on his back to and from school every day. Bhuvan was equally attached to his Dad, they were inseparable. But on 2 June 2020, Bhuvan lost his father to Covid-19. Since then, the boy has withdrawn from friends and stopped going outdoors. He has lost his appetite and rarely speaks. The fourth-grader at a school in Panchkhal was a class topper, but has now lost his  enthusiasm for studies. <figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141156/636d032f9c7e80680e0a36bbjpeg.jpg" alt="" width="1500" height="1000"><figcaption> </figcaption></figure>“He used to revise his lessons every morning and evening with his dad. But without him, he has lost interest in everything,” says his mother Laxmi, who is yet to pay Rs250,000 in hospital bills and another Rs50,000 she borrowed for the last rites of her husband.Yadav wanted to see his son grow up with a good education but Laxmi is now struggling with schooling Bhuvan with <a href="https://www.nepalitimes.com/banner/nepals-epidemic-of-hunger/" target="_blank" rel="noopener noreferrer">limited income</a>. She says, “How can a single mother without an income give her son a better future?”--<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141156/636d03329c7e80680e0a36bcjpeg.jpg" alt="" width="1500" height="1000"><figcaption> </figcaption></figure>Bishnu Tamang <a href="https://www.nepalitimes.com/latest/the-story-of-nepals-first-covid-19-fatality/" target="_blank" rel="noopener noreferrer">died of Covid-19 at Dhulikhel Hospital</a> in July, 18 days after giving birth to a son. Her husband Min Bahadur Tamang was then infected and in isolation. The couple’s daughters Anju, 12, and Aarti, 10, have now taken it upon themselves to raise their newborn brother.  “My eldest gets up at 5 in the morning to feed and clothe her brother, washes his diapers and looks after him until he sleeps at night,” says Min Bahadur. “Since getting Covid, I haven’t been able to regain my health, and my own parents are old. These two daughters do everything to  take care of the family.”Anju, who is in 6th grade, has not been able to touch her books for months. When her mother was alive, she and her sister helped their mother. Now they have to do everything themselves, and there is no time for <a href="https://www.nepalitimes.com/here-now/lessons-not-learned-from-the-pandemic/" target="_blank" rel="noopener noreferrer">online classes</a>. Min Bahadur knows he has to send his daughters back to school, but he has lost his job as a driver. He says: “It will probably take over a year for me to pay off my Covid treatment costs, how will I educate my children?” --<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141156/636d03359c7e80680e0a36bdjpeg.jpg" alt="" width="1500" height="1000"><figcaption> </figcaption></figure>At 20, Rajkumar BK is already the sole guardian of three younger siblings. First, he lost his mother to Covid in August 2020, then his father earlier this year. “My father was depressed after my mother passed away. One day when no one was at home, he set himself on fire,” recalls Rajkumar.Unable to raise them all, Rajkumar left two older siblings in the care of a relative and got married at 20 to support his family. He exchanged his dreams of higher studies for cheap labour and now works at a handicraft shop in Lalitpur’s Gwarko earning Rs12,000 a month. His 16-years-old brother Shyam is undergoing training to repair mobile phones. Rajkumar is already deep in debt building the house after the fire from his father’s suicide and his mother’s hospital bills.Adds Rajkumar: “I couldn’t continue my studies, but I thought at least my siblings could go to school. But after losing also my father, I don’t think I can do it anymore.” --<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141156/636d03389c7e80680e0a36bejpeg.jpg" alt="" width="1500" height="1000"><figcaption> </figcaption></figure>Divindra Tamang died of Covid at Kathmandu Medical College in May. His two-and-a-half-year-old daughter Rubina still does not know that her father is gone. Every time she hears a car pass by, she rushes out of the house, looking for her father who was a driver. "He always honked when he came back from work, so whenever she heard a horn, she thought he might have returned," says Rubina's mother Rupa, who had married Divindra only three years ago.After their daughter was born, Divindra had bought insurance for Rs900,000 for Rubina’s higher studies, and wanted her to become a nurse. “It is time to pay the Rs25,000 annual premium, but after buying food and paying rent there is no money,” says Rupa.--Siblings Rupa, Susmita, Usha and Rupak Sunar range in age from 3 to 15. They first lost their father to asthma and then mother to Covid in the last three years. With no one to take care of them, the children are now at the SOS Children’s Village in Kavre. --Nearly 11,000 <a href="https://www.nepalitimes.com/banner/nepals-uneven-covid-19-deaths/" target="_blank" rel="noopener noreferrer">Nepalis have lost their lives to Covid-19</a> since the outbreak began in January 2020, most of them in the age group 20-50, but there are also children under 18. Hundreds of children have become orphans in the wake of the pandemic.There are no reliable statistics since the country does not have a proper child protection system at local government level.  So far, data from only 32 out of 753 local municipalities have been recorded, where 224 children have lost their parents, seven of them lost both fathers and mothers.“The rescue, assistance and protection of <a href="https://www.nepalitimes.com/banner/children-are-collateral-damage-in-nepal-lockdown/" target="_blank" rel="noopener noreferrer">children</a> without parents cannot be done on time because of the lack of data,” says Milan Raj Dharel, executive director of the National Child Rights Council (NCRC). “We estimate that we are missing more than a thousand children who have lost their parents.”The NCRC says it is paying for the support of orphaned children at the recommendation of the local levels. But local wards and village councils have not come forward with records of children despite written letters to do so, adds Dharel.Losing parents at a young age has left the children mentally vulnerable and at <a href="https://www.nepalitimes.com/here-now/post-pandemic-mental-health-epidemic/" target="_blank" rel="noopener noreferrer">heightened risk of psychological illnesses</a>. Bhuvan Kharel, 8, has taken to locking himself in his room and inflicting self-harm.“He has four cuts on his hand,” says his worried mother, Laxmi. She is too busy taking care of the family’s needs to attend to her son.https://www.youtube.com/watch?v=i7iEEYDpoCY“Children are often most affected by conflicts, epidemics, accidents, and their young minds are highly vulnerable, which in turn affects their personality development,” says psychiatrist Prasad Ojha. “The uneasiness they show in their behaviour when a family loses a member is called a neurotic disorder. ”Orphaned children feel alone, insecure, are scared and angry, and often unable to sleep and have panic attacks. Depending on their personality, some like to be alone while others become restless.“The family should keep the children busy, play together, develop a routine and make them follow it,” says Arun Kunwar, a psychiatrist at Kanti Children’s Hospital in Kathmandu.Child experts also recommend not telling children about financial stress in the family, or hiding the death of the parent. “If you lie to children, they will continue to wait for them causing further confusion and stress, which in turn can increase the risk of depression, running away, <a href="https://www.nepalitimes.com/banner/nepal-sees-spike-in-suicides-during-pandemic/" target="_blank" rel="noopener noreferrer">suicide attempts</a>, and addiction," adds Ojha.The Children's Act 2019/20 has a provision of a child rights committee at every province and local level in addition to a child welfare officer. It also stipulates establishing a child fund for immediate rescue, relief, rehabilitation of and compensation for children.But less than 10% of local governments have abided by the Act, which means there are no reliable records about the condition and the number of orphans, homeless and needy children who need rescue and protection.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141156/636d033b9c7e80680e0a36bfjpeg.jpg" alt="" width="1500" height="1000"><figcaption> </figcaption></figure>Last year, NCRC formulated an action plan to protect and manage the children who have lost their parents to <a href="https://www.nepalitimes.com/banner/the-real-cost-of-nepals-second-wave/" target="_blank" rel="noopener noreferrer">Covid-19</a> and came up with two strategies: for the 800-900 of children with relatives to provide a social security allowance of Rs30,000, and to place children who have no one to care for them in shelters.For this, the Council is re-examining and verifying the recorded 224 orphaned children from 32 local municipalities and is planning to construct 10 alternative care centres for them.But despite the plan, the budget has not been allocated by the Ministry of Women, Children and Senior Citizens because it does not have a minister since Prime Minister Sher Bahadur Deuba is <a href="https://www.nepalitimes.com/latest/government-in-installments/" target="_blank" rel="noopener noreferrer">yet to expand his Cabinet</a> more than two months after taking office.However, spokesperson Umesh Dhugana at the ministry says: “The program hasn’t stalled in lack of a minister. The cabinet will decide on the programs to ensure the protection and management of the children.”(Translated by Sonia Awale from the the Nepali original in the September-October issue of Himal Khabarpatrika.)

Helping Nepal’s Covid orphans

<figure><img width="1496" height="1000" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141136/636cfe809c7e80680e0a0c40jpeg.jpg" alt=""/><figcaption>Photo: T P Mishra</figcaption></figure>Dear छोरी, Congratulations on starting a long and exciting journey by beginning kindergarten today. It was lovely to see you so excited when we dropped you off at school this morning.  My own excitement is a bit subdued due to my concern about the <a href="https://www.cdc.gov/coronavirus/2019-ncov/index.html" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.cdc.gov/coronavirus/2019-ncov/index.html&amp;source=gmail&amp;ust=1630465642874000&amp;usg=AFQjCNGMzZWmvE980EZTI4OmEgKzYj2Lxw">Covid-19 pandemic</a> surge in America. I know you will feel uncomfortable wearing that mask all day, but it is necessary to help reduce the risk for yourself and those around you. The environment and circumstances of my school days back in Bhutan were so different from your first day at school today. I was only six in 1990 when I and one of my six siblings were enrolled in the Dokap Primary School near our remote village of Indrachok in Bhutan.  My eldest brother, who never had the chance to go to school himself, carried me on his shoulders during the monsoon when the trails were slippery — 30 minutes downhill and 45 minutes uphill.  I would hold on tight with my hands wrapped around his head as he pushed his way through shrubs and bushes. I would arrive in class bleeding with leeches on my head. I had to pluck them off by sprinkling salt on them. During the monsoon, we always carried pouches of salt in our school backpacks.  At home, we did not have a table, and sat on the floor to eat. I was the youngest, and my job was to feed the family dog, टिके. Thankfully, you have an air-conditioned school bus that pulls up outside our home, ready to take you to your school, which is within easy walking distance here in North Carolina <a href="http://archive.nepalitimes.com/blogs/thebrief/2011/08/17/over-50000-butanese-refugees-resettled/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=http://archive.nepalitimes.com/blogs/thebrief/2011/08/17/over-50000-butanese-refugees-resettled/&amp;source=gmail&amp;ust=1630465642874000&amp;usg=AFQjCNHMt0z8b27M2Z1ug7TSEf8x_LJFAQ">where we are now settled.</a> In elementary school, some of the Bhutanese teachers treated me harshly. They used to beat me with sticks because I struggled to learn Dzongkha, the national language. Sometimes they made me stand on one foot with the other foot crossed over the knee.  Classmates were encouraged to laugh at me. I am glad you will be studying in a supportive environment without any such childhood trauma. In 1991, when the <a href="https://www.nepalitimes.com/opinion/who-stands-with-bhutanese-refugees-in-nepal/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/opinion/who-stands-with-bhutanese-refugees-in-nepal/&amp;source=gmail&amp;ust=1630465642874000&amp;usg=AFQjCNFwujDTI2sbF39yVH4le1KSHDgOrA">Bhutanese regime evicted the Lhjotsampa</a>, my family along with thousands of others were taken by trucks across India and forced into Nepal.  Our refugee camp was on the banks of the holy Kankai River in Jhapa where we spent the next 20 years. Many Bhutanese refugees lost their lives over the years to malaria and other diseases. Two members of our own family died, and I will tell you about them when you grow older. Later, we were moved to the <a href="https://www.nepalitimes.com/here-now/home-away-from-home-for-bhutan-refugees/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/home-away-from-home-for-bhutan-refugees/&amp;source=gmail&amp;ust=1630465642874000&amp;usg=AFQjCNEkuK3F_5c0lAvmbn_XEib0ZK-nvQ">Beldangi-II refugee camp</a> and we could attend school again. The classes were out in the open, in the shade of a large tree. Once, during a storm, a branch fell on my head and I had to rush to the health post for treatment. Corporal punishment was a part of everyday life in the classroom. The intention of the teachers towards students was not bad, it was just the way schools functioned in those days in Bhutan and in the <a href="https://www.amnestyusa.org/countries/bhutan/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.amnestyusa.org/countries/bhutan/&amp;source=gmail&amp;ust=1630465642874000&amp;usg=AFQjCNFFLz8IUijatuHD4noHwATnxLrYYA">refugee camp in Nepal</a>. Our large family lived in a bamboo hut, the roof leaked, and did not have electricity in the refugee camp. We did our homework on the floor next to kerosene lamps.  We used to have lots of homework. We had to memorise long paragraphs at home and then recite them when we were in the classroom the following day.  As a refugee child, I did not have shoes. My parents could not afford them, so I wore flip-flops to school.  Always remember that it is not what you wear on your feet that allows you to take steps in life, it is your inner determination. As a new American, you have a place to call home. You should always be grateful to this country where you were born. The United States gave your parents a chance to <a href="https://www.nytimes.com/2009/09/25/nyregion/25bhutan.html" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nytimes.com/2009/09/25/nyregion/25bhutan.html&amp;source=gmail&amp;ust=1630465642874000&amp;usg=AFQjCNHbGYOU59ClcTzQu1BBVTD4I_QUbw">build new lives</a> so that you, too, can enjoy the freedom and citizenship that was denied to us, and to many other peoples around the world today.  Freedom does not mean that you are free from obligations and responsibilities. Never take your freedom for granted. Unlike your parents when they were your age, you will have a roof over your head, you will always have enough food, health care and a sense of belonging. There may be classmates who may be having a hard time, who cannot afford lunch, or who are from refugee families trying to heal from the trauma of war. Your compassion and love will help them as they struggle to make a life in a new place. Share what you have, but do not humiliate others with pity.  Now that you are outside the home, you will probably see things from a different perspective. That is completely normal. I hope you will soon learn to take a stand if you or your friends face bullies. Be kind and generous to others.  Never discriminate against those around you because of the colour of their skin, ethnicity, creed, or any physical difference that sets them apart.  You are starting school even as the people of Afghanistan, especially women there, fear for their lives and are under threat of losing their fundamental rights. I hope you will grow up learning to become the voice of those who cannot speak up for themselves. Culturally, we in Bhutan treat teachers as our second parents. I hope you will carry on that tradition here in the US. We will continue to abide by the language rule: Nepali at home and English at school. As you grow older, I hope the situation will change in our <a href="https://archive.nepalitimes.com/article/nation/Bhutanese-refugees-resettlement-program-ending-in-2018,4121" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://archive.nepalitimes.com/article/nation/Bhutanese-refugees-resettlement-program-ending-in-2018,4121&amp;source=gmail&amp;ust=1630465642874000&amp;usg=AFQjCNFEbjEGZ5Dy0FSpiip7OVuAKH1cXA">motherland Bhutan</a>, so we can go back to trace our ancestral history in the forested mountains of Dagana. When we fled, I hid a plastic bag with my school supplies inside our house because my mother promised we would return home soon. Thirty years have passed, and while we were in the refugee camp in Nepal we learnt that the regime had burnt down our home in Bhutan. That plastic bag with my books must have turned into ashes.  I am sharing these stories from our past for one reason alone — I want you to know where you come from, so that you will make the best of the opportunity that has come your way.  "I will be fine," you assured us right before we dropped you off at your school today. Keep rolling, girl. We cannot wait for you to come home and tell us all about your first day at school.  With unconditional love,  Your बाबा <a href="https://www.bhutannewsservice.org/author/tpmishra/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.bhutannewsservice.org/author/tpmishra/&amp;source=gmail&amp;ust=1630465642874000&amp;usg=AFQjCNFYa5h2v_Lg2Seh4UEFLFfQnXbMWA">T P Mishra</a> is the Executive Editor at the <a href="http://www.bhutannewsservice.org/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=http://www.bhutannewsservice.org/&amp;source=gmail&amp;ust=1630465642874000&amp;usg=AFQjCNH2qDv01UkeJzPUlTt_GNgWLC-Iyg">Bhutan News Service</a> and is one of the 90,000 Bhutanese refugees resettled in the United States. This article first appeared in <a href="https://letsrethinkthis.com/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://letsrethinkthis.com&amp;source=gmail&amp;ust=1630465642874000&amp;usg=AFQjCNGALLJGlN2QKRLwavOKHbqh9gQ-Jw">Let’s Rethink This</a>, and is excerpted with permission. <img width="73" height="109" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141136/636cfe839c7e80680e0a0c41jpeg.jpg" alt="">Read also: <a href="https://www.nepalitimes.com/here-now/elderly-left-in-bhutan-refugee-camp/">Elderly left in Bhutan refugee camp</a>, Mukesh Pokharel

Letter to my kindergarten daughter

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141136/636cfe469c7e80680e0a0c2ejpeg.jpg" alt="" width="2529" height="1427"/><figcaption>Photo: HIMALMEDIA</figcaption></figure>A white-coated nurse holding a blue and white, half-litre bag of milk stands in front of a small group of mothers seated near the entrance of the Nutrition Rehabilitation Home in Kathmandu.She is explaining the importance of feeding milk to their children, who are lolling on their mothers’ laps. On a table behind the nurse are containers of pulses and legumes and leaning against the wall, charts displaying leafy vegetables.But later, listening to the women’s stories, it is apparent that solving their children’s problems will require more than a healthy diet. Through tears, Chandra, 24, says she brought her son Raju, 21 months, to the Home after a routine hospital check-up found that he was malnourished.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141136/636cfe499c7e80680e0a0c2fjpeg.jpg" alt="" width="3706" height="2170">His father, who Chandra was forced to marry, bought barely enough food for them to survive, says the woman. That deprivation, plus physical beatings and “mental torture” caused Chandra to flee their village home for Kathmandu.Mother and son arrived in January at the 24-bed facility perched on a hill on the outskirts of the city, where housing colonies sprout on former farm fields. In the month since then, Raju has gained 1kg in weight and is much stronger.The boy will stay at the Home for a few more weeks, says Sunita Rimal, coordinator of the Malnutrition Prevention and Treatment Program at the Nepal Youth Foundation, which runs the Home. By then she hopes to have found some work in Kathmandu for Chandra via her informal channels, so that the mother-son pair don’t have to go back.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141136/636cfe4d9c7e80680e0a0c30jpeg.jpg" alt="" width="901" height="786">Epidemic of hungerNina Parajuli, 45, brought her daughter Anushka, 7, to the Home weeks later on the advice of staff at a local non-governmental organisation. Nina had gone there for skills training after losing her house-cleaning job in Kathmandu.She was forced to find work unexpectedly after Anushka was born, when her husband deserted them. The family that hired her ate their first meal of the day only in the afternoon, which meant the girl left for school in the morning having eaten only snacks, while her mother worked. Eventually, Anushka grew dangerously thin and was considered severely malnourished when she arrived.Nina “was too concerned with her own problems to notice,” Rimal explains. Like her husband, she is HIV positive. She also has a heart condition and is on a waiting list for a uterus operation.Though unique, the stories of Nina and Chandra share a common thread — the causes of their children’s malnutrition are multifaceted. Rimal says that is the norm: “Most of the people who come here have other socioeconomic problems.”Past achievements Nepal is celebrated globally for its success in fighting malnutrition from the 1990s until recent years. Most notably, rates of stunting (low height for age) fell from the world’s highest, 68% in 1995, to 36% in 2016.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141136/636cfe509c7e80680e0a0c31jpeg.jpg" alt="" width="2410" height="1064"><figcaption> </figcaption></figure>New research has teased out exactly which development efforts had what impact on stunting. Indirect (also known as ‘nutrition-sensitive’) approaches were surprisingly effective. For example, better educated parents accounted for 25% of the improvement, <a href="https://www.nepalitimes.com/banner/toilet-trained/" target="_blank" rel="noopener noreferrer">environmental factors</a> like building more toilets contributed 12% and economic growth made up 9%.Direct (‘nutrition-specific’) efforts included: improved nutrition of mothers (accounting for 19% of the gain), and maternal and newborn health care (12%), according to the research, published on the website <a href="https://www.exemplars.health/topics/stunting/nepal">Exemplars in Global Health</a>.“The exemplars that we picked were countries that did (development) much faster than others. Nepal is not necessarily the best example but it is an important example,” says Zulfiqar A Bhutta of the Centre for Global Child Health at The Hospital for Sick Children in Toronto, one of the leaders of the research.“One thing is very clear, no one country has done it alone by only investing in health and nutrition sectors,” explained Bhutta via Zoom from Toronto. “And no one country has done it alone by only investing in poverty alleviation strategies. So the truth is that you have to do both in combination.”Nepal has continued that broad approach, investing in health both directly and indirectly, <a href="https://www.nepalitimes.com/banner/nearly-half-of-nepali-children-still-malnourished/" target="_blank" rel="noopener noreferrer">yet the progress has plateaued</a>.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141136/636cfe549c7e80680e0a0c32jpeg.jpg" alt="" width="1628" height="1255">While stunting continues to fall, the 36% rate is greater than the developing country average of 25% and the Asia average of 21.8%. In fact, the country is on target to hit only one of its nutrition goals for 2025 set by the World Health Assembly — for underweight children under 5 — says the <a href="https://globalnutritionreport.org/resources/nutrition-profiles/asia/southern-asia/nepal/">Global Nutrition Report 2020</a>.So what happened?“The one thing that I was surprised by is that inequity has increased,” says Bhutta, “and I have a feeling some of that may have had to do with the urban poor or rural to urban migration.”Nepal, he adds, should work to pinpoint the who’s and why’s of poverty, but otherwise, it should maintain its balanced approach.Investment on nutrition A recent analysis from UNICEF found, however, that spending on indirect approaches to fight malnutrition was rising while declining for direct interventions. This goes against the direction given in the government’s <a href="http://nnfsp.gov.np/PortalContent.aspx?Doctype=Resources&amp;ID=330">Multi-sector Nutrition Plan</a> (MSNP), the blueprint for tackling malnutrition.<a href="https://www.nepalitimes.com/editorial/hunger-for-governance/">Hunger for governance</a>, EditorialThe first phase of the MSNP ran from 2013 to 2017, and the current plan ends next year. The analysis in UNICEF’s <a href="https://www.unicef.org/nepal/media/13296/file/Nutrition%20-%20Budget%20brief.pdf">Nutrition Sector Budget Brief</a> also pointed out that the cost of programs in phase two (Rs48.9 billion) of the multisector plan is just 54% of phase one (Rs88.5 billion). In addition, the gap between budget numbers and actual spending has been growing.Kiran Rupakhetee of the Good Governance and Social Development Division at the National Planning Commission secretariat, helped shape MSNP-II. In an online interview he suggests that rather than the current plan’s budget being too low, the budget for MSNP-I might have been “over calculated at the time”.As to the growing gap between allocations and real spending — it results from many factors, including “rigidities and structural barriers” in the system, he explains.Another major challenge for MSNP-II is federalism, which introduced three levels of government after elections in 2017. “It’s a Herculean task… because at the moment it’s not only one government—we have 761 governments… There are some difficulties in ensuring coordination among them,” adds Rupakhetee.The pandemic challenge The Covid-19 pandemic <a href="https://www.nepalitimes.com/latest/covid-19-leaves-millions-of-south-asian-children-hungry/" target="_blank" rel="noopener noreferrer">has added to the challenge</a>. “It definitely has hampered our activities,” says Rupakhetee, “but we tried our level best to keep the programme going.”For example, parents were trained to measure the arm circumference of infants to detect signs of malnutrition, a task usually done by female community health volunteers, who have been unable to do so due to frequent lockdowns.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141136/636cfe579c7e80680e0a0c33jpeg.jpg" alt="" width="960" height="640"><figcaption> </figcaption></figure>Nepal’s school feeding programme was also modified because of the pandemic, with food rerouted to students’ homes, says World Food Programme (WFP) Country Director Jane Pearce, in an online interview.“Whereas most of the world stopped all of their school meals programmes, Nepal has continued, which has meant that we’re maintaining the nutrition that we’re providing through our locally-managed school meals programmes by giving households take-home rations,” she said.WFP has also teamed up with UNICEF and other UN agencies to press the government to expand its malnutrition treatment to include not only children who are severely wasted (low weight for age) but moderately wasted, says WFP’s Head of Nutrition Anteneh Girma.“With the impact of Covid and others, if they’re not treated they will become severely malnourished, then chronically malnourished, or stunted,” he adds.In June <a href="https://www.nepalitimes.com/banner/nepals-epidemic-of-hunger/">this paper reported</a> on how severe malnutrition was killing children in the poorest communities in Nepal’s eastern plains. It told the story of Raju Devi Sada, whose first daughter died at 3, after being malnourished. A second daughter died soon after birth, a year later.A third daughter is underweight and local health workers have recommended feeding her nutritious food. But Raju Devi cannot afford vegetables, eggs, milk and meat, and what she earns as a daily wage labourer is barely enough to feed the rest of the family.“We have found that up to 70% of children who die every year in Province 2 do so due to malnutrition, and the main reason for that is extreme poverty,” said Kedar Parajuli at Nepal’s Family Welfare Division. “Without alleviating poverty, we can’t solve malnutrition.”WFP is doing mapping, using mobile data, to create what it calls a vulnerability index. It documents people’s access to water and sanitation services, health and other factors, in addition to nutrition, says Girma.He adds, “Our nutrition response, food security response, is informed by that index… it indicates those who are vulnerable for not having access on time, for being exposed to various inequalities.”The private sectorGirma points out that WFP, both in Nepal and globally, supports the multisector approach. In that vein, the UN agency is working closely with the government to establish the <a href="https://sunbusinessnetwork.org/">Scaling Up Nutrition (SUN) Business Network</a> in Nepal. To date, 10 companies, all working in the food industry, have become members.Ending malnutrition and other food-related diseases “will happen only if the private sector is responsible for what they are producing, and producing something safe …  so their engagement, bringing them to the table, is very important,” says Girma.Leading collaboration with the private sector on the ground is <a href="https://www.baliyonepal.com/en/">Baliyo Nepal</a>, a non-profit company that generated headlines when it launched in 2019. The initiative was funded by the Bill &amp; Melinda Gates Foundation through the Chaudhary Foundation, the charity arm of the Chaudhary Group, makers of Wai Wai instant noodles, which are widely considered junk food.<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/banner/junk-food-is-making-nepali-children-shorter/" target="_blank" rel="noopener noreferrer">Junk food is making Nepali children shorter</a>, Marty LoganToday Baliyo Nepal is set to expand a pilot project that has been running in Lumbini Province since 2020 — raising awareness about nutritious food among school children, including via a cricket program, and educating shopkeepers to sell the nutritious foods in the first phase of its ‘Baliyo Basket’: eggs and a single-portion Rs10 sachet of fortified porridge for infants.“Seventy percent of the sachets in the market were sold, according to the sales report,” says Baliyo Nepal CEO Atul Upadhyay, a nutritionist, in an interview in his Kathmandu office. “The feedback we’re getting from mothers is ‘Now we want it in a bigger package. We can’t go to the shop every day and buy the Rs10 package’.”Upadhyay says manufacturers will start making the larger packs by year end. That is just one of many plans he is cooking up — besides expanding pilot activities to Bagmati and Gandaki provinces, the company will soon be adding to its Baliyo Basket a fortified drink for pregnant and lactating women and fortified porridge for 2-5-year-olds, once they are approved by the government.Upadhyay notes that both the government and private sector are gradually embracing his innovative approach but stresses that new ways to fight malnutrition, like this public-private partnership model, are essential if Nepal is to reach its nutrition targets.“It’s not important who works for nutrition. It’s important that someone works for nutrition, whether it be WFP, Baliyo Nepal, company A, company C — I don’t mind,” he adds.Target StuntingStunting, low height for age, is a sign of chronic undernutrition. It can hinder brain development resulting in reduced mental ability and learning capacity, poor school performance in childhood and lower earnings and higher risks of nutrition-related chronic diseases, such as diabetes, hypertension and obesity, in adulthood.Nepal cut its stunting rate dramatically in recent decades, and it is one form of malnutrition that the country might be on track to reduce in line with coming targets: MSNP-II (2022), World Health Assembly (2025) and SDGs (2030).The UNICEF Nutrition Sector Budget Brief says that the average yearly rate of stunting reduction since 2001 (3.25%) must increase to 3.8% to meet the MSNP-II and WHA targets, and rise to 6.5% to meet the SDG target.According to Kiran Rupakhetee at the National Planning Commission: “The Nepal Multiple Indicator Cluster Survey has brought some encouraging results, but it may still be difficult to make the WHA target... but since the SDGs deadline is quite far away I’m very much optimistic and hopeful that we can meet it.”Stunting rates and targets 2016: Nepal Demographic and Health Survey – 36%2019: Nepal Multiple Indicator Cluster Survey – 31.5%2022:  Target: Multi-sector Nutrition Plan-II – 28%2025:  Target: World Health Assembly – 25%2030:  Target: SDGs – 15%

children