<figure><img width="1200" height="800" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410110/637204749c7e80680e0b2862jpeg.jpg" alt=""/><figcaption>Picture of Astaman Maharjan in Ananda Niketan</figcaption></figure>Ten years ago, Patan’s Astaman Maharjan donated a plot of land in a prime location and Rs5 million to build an old age home. Even though the devout Astaman did not live long enough to see his project completed, the facility now cares for the elderly who have been foresaken by the state and have no family. As a devotee of Shiva, Astaman used to visit Pashupatinath every Monday. There, he would see the condition of older people in the premises of the temple and would be disheartened by their <a href="http://archive.nepalitimes.com/news.php?id=19664#.YeQRvi2B3-Y">miserable living conditions</a>. Astaman made it his life’s goal to build a proper home for the elderly, where they would have friends, proper meals and comfortable rooms. But he did not know where to start. <img width="1920" height="1046" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410110/637204779c7e80680e0b2863jpeg.jpg" alt="">It was at a community picnic in 2012, that Astaman Maharjan suddenly and without consulting anyone, announced that he would donate land and money to the Jyapu Samaj Yala to build a home for the elderly. In February 2013, the foundation stone was laid and construction began for the ‘Jyapu Samaj Senior Citizen Ananda Niketan’.  Read also: <a href="http://archive.nepalitimes.com/news.php?id=19664#.YeQg9VIzbjA">Giving up on grannies</a>, Dambar Krishna Shrestha“It was his one big wish, and he would visit the construction site very day to supervise,” says Maharjan’s son Kiran. “Wherever he is, he will be happy that his project is finished.”Such was Astaman’s dedication that he was closely involved with every aspect of the structure and facilities, trying to make sure that the elderly who would one day live there would be comfortable.  <img width="1913" height="1065" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410110/6372047a9c7e80680e0b2864jpeg.jpg" alt="">The construction faced many delays, with <a href="https://www.nepalitimes.com/editorial/lessons-still-not-learnt/">the earthquake</a>, Blockade in 2015 and then the <a href="https://www.nepalitimes.com/here-now/3rd-wave-in-2-years/">Covid-19 pandemic</a>, during which Astaman himself succumbed to double kidney failure at the age of 77. However, with the money he left behind, the Jyapu Samaj of Patan completed the project.The Ananda Niketan building will start operating from next month and provide shelter for at least 110 senior citizens. “It is sad that Astaman couldn’t see the completion of the building, but he has set an example and we hope his generosity will motivate others to bring real change in the society,” says Bal Krishna Maharjan of the Jyapu Samaj. <img width="1920" height="1080" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410110/6372047d9c7e80680e0b2865jpeg.jpg" alt="">Despite the donation from the Maharjan family including the land in Bagdol which would be worth Rs80 million today, the project needed more financial support for completion. Several organisations and individuals stepped up after learning about Astaman’s generosity. The Indian Embassy donated Rs100 million, Bagmati provincial government provided another Rs30 million and Lalitpur Metropolitan Office chipped in Rs10 million. Members of Jyapu Samaj Yala, which has membership in 40 neighbourhoods in Lalitpur also made significant contributions.  <img width="1920" height="1080" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410114/637204819c7e80680e0b2866jpeg.jpg" alt="">The building itself is seismic resistant and can accommodate at least 110 elderly people. It has a hall for morning hymns, yoga and meditation, there is a library, guest rooms and a specialised canteen. The five-storey building made with traditional dachi appa bricks is surrounded by the garden, has elevators and is disabled friendly. Senior citizens can live here free of cost and there are different arrangements also for those willing to pay. It also has a clinic with an around-the-clock medical team as well as its own ambulance.Ananda Niketan also has a daycare facility such that throughout the day when their children are working, the elderly can enjoy the amenities at the facility and participate in interactive activities. The home also provides transportation services.“He is an inspiration for all of us,” says Kiran of his late father. “We don’t get to take anything with us when we die, so we should leave our possessions for the betterment of society.”  <img width="1920" height="1080" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410114/637204849c7e80680e0b2867jpeg.jpg" alt="">The average lifespan of Nepalis has increased from just 40 in 1970 to 72 today, and this demographic shift is leading to <a href="http://archive.nepalitimes.com/article/Nepali-Times-Buzz/need-to-prepare-for-ageing-society,3624">greater population of elderly</a>. About 12 working-age Nepalis support one senior citizen, and this ratio is set to drop to 5.6 by 2050. As early as 2028, Nepal will be an ‘aging society’ where 7% of its population will be above 65.Read also: <a href="http://archive.nepalitimes.com/article/Nepali-Times-Buzz/need-to-prepare-for-ageing-society,3624">A much older tomorrow</a>, Sonia AwaleThe Nepali state and society therefore needs to be better prepared to support and engage senior citizens. This means younger people and children today should be more productive, and the government must be prepared to outlay more for <a href="https://archive.nepalitimes.com/regular-columns/guest-editorial/guest-editorial-old-is-gold,876">geriatric care</a>.This has led to a proliferation in the number of old age homes across Nepal. This has become more widespread also because of younger people living abroad either for work or study, leaving parents without the support in their old age. <img width="1919" height="1065" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410114/637204879c7e80680e0b2868jpeg.jpg" alt="">This is where initiatives like Ananda Niketan make a big difference, and the management of the home is getting queries from older Nepalis living abroad who want to be provided with better care in their advanced age instead of living alone. Says Bal Krishna Maharjan of Jyapu Samaj: “The elderly can live here in peace with minimal discomfort in the latter part of their lives. This is the legacy Astaman Maharjan left behind and what he will be remembered for.” Read also: <a href="https://archive.nepalitimes.com/news.php?id=19055#.YeQg9lIzbjA">Orphaned at old age</a>, Paavan Mathema

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Home sweet home for older Nepalis

<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110161144/636d1d209c7e80680e0af396jpeg.jpg" alt="" width="1080" height="810"/>Jyoti Bikash Bank this week distributed warm clothing for the elderly at the Matatirtha Old-Age Home. Assistant General Manager of the Bank Ram Hari Acharya, Kathmandu Valley Regional Office Chief Dilip Raj Baral and Branch Manager of Balambu Prakash Shrestha were present.

Jyoti for the elderly

<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 width="2048" height="1364" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111015118/636d05fb9c7e80680e0a5f3ajpeg.jpg" alt=""/><figcaption>Photo: MONIKA DEUPALA</figcaption></figure>There is breaking news every other day: the United States donates 2 million Moderna shots to Bangladesh and Pakistan. Denmark announces 250,000 AstraZeneca doses to Bhutan. Japan pledges surplus AZ vaccines to Sri Lanka and the Pacific Islands.Nepal is never in the news, even though <a href="https://www.nepalitimes.com/here-now/lonely-wait-of-nepals-elderly-for-2nd-doses/" target="_blank" rel="noopener noreferrer">1.4 million people still wait for their second doses</a> of Covishield AZ vaccines and another 20 million people need to be inoculated before a possible third wave this year. So far, Nepal has only been gifted or bought vaccines from India, China or the COVAX initiative. It has not even got 1 million vaccines from Serum Institute India that it paid for, and <a href="https://www.nepalitimes.com/editorial/no-vax-ask-for-mask/" target="_blank" rel="noopener noreferrer">all other promises from western countries were never kept</a>.  Nepal’s vaccine diplomacy has failed miserably. And the only silver lining is that there are four million doses of the Chinese Sinopharm VeroCell starting next week to immediately inoculate its above 55 population.Nepal is still recording an excess of 2,000 new cases a day and is seeing a slight daily increase following the <a href="https://www.nepalitimes.com/banner/kathmandu-covid-19-lockdown-relaxed/" target="_blank" rel="noopener noreferrer">relaxation in travel restrictions</a>. Everyone, the public and the government, seem to have forgotten that the real peak during the first wave last year took place only after the lockdown was eased.“The third wave is already on its way, our figures are going up and we must assume we will be hit by new variants,” says Buddha Basnyat, a physician at Patan Academy of Health Sciences (PAHS). “We must vaccinate as many people as quickly as possible, if not we will get more difficult variants that are potentially resistant to the vaccines.”In other news, the Oxford Vaccine Group which developed the AstraZeneca (AZ) vaccine has found that administering two doses 44-45 weeks produced the highest antibody boost. This news, announced by <a href="https://www.nepalitimes.com/opinion/im-sad-vaccines-are-delayed-in-nepal/" target="_blank" rel="noopener noreferrer">Andrew Pollard</a>, one of the developers of the AZ, is glad tidings for countries like Nepal where people above 65 are waiting for their second doses.Pollard said antibody levels remained elevated for close to a year with <a href="https://www.thehindu.com/sci-tech/health/ten-month-gap-between-astrazeneca-doses-sees-highest-antibody-boost-oxford-study/article35019890.ece" target="_blank" rel="noopener noreferrer">a ten-month gap between AZ doses</a>, as well as antibody levels twice that after the second dose among volunteers who were administered a third booster dose, pointing to a long-term, possibly life long immunity, also against variants.“This is great news for the elderly, many of whom are panicking, unable to get their second dose in the recommended time frame. The additional time the study has afforded us shouldn’t lead to complacency in our effort to procure vaccines,” says Sher Bahadur Pun, an epidemiologist at Sukraraj Tropical and Infectious Disease Hospital. <figure><img width="950" height="633" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111015118/636d05fe9c7e80680e0a5f3bjpeg.jpg" alt=""><figcaption> </figcaption></figure>Norway, Czech Republic and Denmark have unused AZ shots they want to donate to Nepal, but have been forced to go through <a href="https://www.nepalitimes.com/opinion/hope-hyperbole-and-hypocrisy-of-covax/" target="_blank" rel="noopener noreferrer">COVAX, which is unlikely to deliver</a> the doses before the end of 2021.On 1 July, Denmark announced that it would donate 250,000 vaccines to Bhutan. However, it is understood that these grants still need to be facilitated by the EU. Also in the news this week is the result of a new modelling study published in the European Centre for Disease Prevention and Control’s medical journal Eurosurveillance that further strengthens the link between <a href="https://www.nepalitimes.com/banner/despite-doubts-nepal-sticks-with-astrazeneca-jabs/" target="_blank" rel="noopener noreferrer">AZ vaccines and a rare blood clot</a>.The study models four months of a vaccine distribution strategy in France from May 2021 and concludes that using AZ on the entire adult population would avert 10 deaths from Covid among 18-39-year-olds. However, it would be associated with 21 deaths from blood clots in the same age group over the same time period. In other words, <a href="https://www.irishexaminer.com/news/arid-40328123.html?type=amp" target="_blank" rel="noopener noreferrer">clot risk to younger people from the AZ vaccine</a> is twice as high as Covid death risk. But public health experts in Nepal maintain that the benefit of mass vaccination still far outweighs the risk. “Similar studies in the context of the South Asian population are needed but as it is, transmission risk of Covid is much higher than the individual risk of blood clots here,” says epidemiologist Lhamo Yangchen Sherpa.Buddha Basnyat of PAHS concurs: “The UK with over half of its population fully vaccinated is now being hit by the <a href="https://www.nepalitimes.com/latest/covids-regional-threat-needs-regional-response/" target="_blank" rel="noopener noreferrer">delta variant</a>, although it has been largely spared from severity due to the mass inoculation. Nepal being mostly unvaccinated is unprotected both from transmission and severity. This should show us where our priority should lie.”The European Centre for Disease Prevention and Control finding about clot risk therefore could indirectly be a blessing in disguise for countries like Nepal by further freeing up AZ stockpiles in Europe, as well as Korea and Japan.Even so, blood clot risk has prompted leaders including Germany’s Angela Markel to opt for Moderna as a booster shot to her first dose of AZ jab.Several EU nations including Germany have said mix-and-match doses are safe for Covid prevention, which according to new findings also point to <a href="https://www.bbc.com/news/health-57636356" target="_blank" rel="noopener noreferrer">a better immune response</a>. This could also offer much-needed flexibility when vaccine supplies are uneven or limited.“We need to introduce mixing and matching also in Nepal in the face of more virulent delta variants, particularly for the elderly who are at the higher risk of developing severity from an infection, instead of waiting endlessly for Covishield,” says Basnyat.At a time when Nepal is yet to recover from a <a href="https://www.nepalitimes.com/banner/the-real-cost-of-nepals-second-wave/" target="_blank" rel="noopener noreferrer">devastating second surge</a>, only an equitable vaccination strategy will prevent an even more deadly third wave. But a mere 2.6% of Nepal’s population has been fully vaccinated, and less than 9% has received a single dose of either Covishield or VeroCell shots.  <figure><img width="1594" height="898" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111015118/636d06009c7e80680e0a5f3cjpeg.jpg" alt=""><figcaption> </figcaption></figure>And even the doses are unevenly distributed within the country. More than half the first dose of VeroCell was distributed in Bagmati province, according to the government’s own figures. Moreover, 97% of the booster jabs of VeroCell were used only in Bagmati Province. “We are seeing a similar kind of disparity in vaccination that we saw in testing, concentrated in urban centres and in particular Kathmandu,” notes epidemiologist Lhamo Yanghen Sherpa. “The excuse for using most of the doses in Kathmandu is that people elsewhere refused to inoculate. If that’s the case what is the government and others doing to dispel vaccine myths?” Virologist Sher Bahadur Pun says the government should immediately deploy its 60,000 or so <a href="https://www.nepalitimes.com/latest/enlisting-female-health-volunteers-to-fight-covid-19/" target="_blank" rel="noopener noreferrer">female community volunteers</a> and healthcare workers who have historically done such effective work in non-Covid childhood vaccination drives.He adds, “They are spread across the country and are best placed to communicate the significance of vaccines and increase vaccination uptakes at  local levels.”

Sonia Awale

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Vaccines too little, too late for Nepal?

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111011110/636ccc3c9c7e80680e08bc10jpeg.jpg" alt="" width="2048" height="1550"/><figcaption>Photo: MONIKA DEUPALA</figcaption></figure>Even as Nepal completes the first phase of its Covid vaccine drive to inoculate <a href="https://www.nepalitimes.com/here-now/nepal-health-workers-battle-covid-19-but-also-stigma/" target="_blank" rel="noopener noreferrer">frontline health workers</a> and other high-risk groups, new hyper-spreading variants of the coronavirus as well as vaccine denial have raised concerns about the efficacy of the campaign.Public health experts, however, say the government must continue its vaccination to reach as many vulnerable people as possible with a better communication strategy and more aggressive promotion.Nepal is one of the first countries in the region to start a mass Covid-19 vaccination drive. But the first phase <a href="https://www.nepalitimes.com/banner/why-is-there-vaccine-hesitancy-in-nepal/" target="_blank" rel="noopener noreferrer">saw a moderate turnout</a> with only half of the doctors, nurses, FCHVs, security personnel and cleaners prioritised by the government inoculating themselves because of the safety concerns and inaccessibility.This forced the Health Ministry to expand the first phase to also include civil servants, diplomats, bankers and journalists so that it could used up the <a href="https://www.nepalitimes.com/latest/jabs-and-jab-nots/" target="_blank" rel="noopener noreferrer">1 million doses of Covishield vaccines donated by India</a> last month.With additional 2.25 million Covishield doses under the WHO’s COVAX initiative arriving in Nepal by early March and another 2 million that the government is in talks to purchase from the Serum Institute of India, officials are gearing up for the <a href="https://www.nepalitimes.com/banner/next-up-for-vaccines-elderly-nepalis/" target="_blank" rel="noopener noreferrer">second phase of the vaccination</a> for people above 55 years and those with co-morbidities starting from 7 March.This will be followed by the age group 40-54 and then those below 40 years of age.“The campaign will now be community-based, unlike the first phase that was facility-based, we will take the vaccine to the people and ensure higher coverage,” assured Shyam Raj Uprety, head of government’s Covid Vaccine Strategy. “And as per the WHO recommendation, our advisory groups will soon finalise their decision to provide the second dose between 8-12 weeks.”Public health experts say that the emergence of new variants should not dissuade the government from discontinuing or scaling back its vaccine drive.“An RNA virus will have variants, it is a given, we have to live with them. In fact, we might have our own variant in South Asia, but we should keep on vaccinating and saving lives,” says Sameer Dixit of the Centre for Molecular Dynamics Nepal.Of the multiple variants circulating globally, the one first identified in the UK called B.1.1.7 is more widespread, and some have been detected in Nepal in travellers arriving from Britain. The good news is that AstraZeneca Covishield vaccine has been found to be effective against the strain.However, a trial involving 2,000 people in South Africa claimed that Oxford jabs offered only <a href="https://thewire.in/health/south-africa-asks-serum-institute-to-take-back-1-million-covid-19-vaccine-doses" target="_blank" rel="noopener noreferrer">minimal protection against mild and moderate cases</a> (of their variant B.1.351). Experts caution that it may be too soon to declare the vaccine ineffective because the study was conducted in a small population of young people.In Brazil, a variant called P.1 has been found to contain contains a set of additional mutations that may affect its ability to be recognised by antibodies, adding to the challenge.“What’s important in this debate is that even if one were to contract Covid, the vaccine will prevent people from getting severely ill and dying,” says Buddha Basnyat of the Patan Academy of Health Sciences. “Trials and emergency use so far has strongly addressed safety concerns regarding Covishield, so we can’t let news of variants put a damper on the vaccination campaign.”<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111011110/636ccc3f9c7e80680e08bc11jpeg.jpg" alt="" width="1500" height="1125"><figcaption> </figcaption></figure>The <a href="https://www.nepalitimes.com/banner/nepal-begins-covid-19-vaccination-drive/" target="_blank" rel="noopener noreferrer">nationwide vaccination campaign</a> is taking place at a time when Nepal and the rest of the South Asia are reporting much fewer cases and fatalities, much of which has been credited to limited contact tracing and herd immunity in major cities after large chunks of the population developed resistance against SARS-CoV-2 after contracting it.But the lack of surveillance, seroprevalence studies and antibody tests means that researchers have not been able to confirm localised immunity.“The government is unwilling to conduct a study despite interest from aid agencies. Results from these studies would have helped us better prepare vaccination strategy at a time when we face great resource constraint,” says Dixit.Nepal also needs to continue with <a href="https://www.nepalitimes.com/here-now/when-will-nepals-covid-vaccine-turn-come/" target="_blank" rel="noopener noreferrer">vaccine diplomacy</a> and look into other shots, in particular, Chinese Sinovac and Bharat Biotech’s Covaxin. Both the vaccines use the whole inactivated (dead) virus, because of which they are unable to infect people or cause pathological effects but deploy the immune system to mount a defensive reaction against the virus.<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nytimes.com/2021/02/05/opinion/covid-vaccines-china-russia.html" target="_blank" rel="noopener noreferrer">Sinovac made global headlines</a> when it was found to be only 50.4% effective in a trial in Brazil whereas it performed better in Turkey (91% efficacy). <a href="https://www.newindianexpress.com/cities/thiruvananthapuram/2021/feb/16/the-covaxin-conundrum-2264436.html" target="_blank" rel="noopener noreferrer">Covaxin</a> is also controversial because of its emergency use among the frontline health workers in India despite not completing its phase three trials.It will do well for Nepal to keep track of their trials with the government aiming to vaccinate 72% of its eligible population above 18 years. People aged 55 and above make up 11% of Nepal’s population whereas the 40-54 age group account for 13%. People aged 18-39 made up nearly half of Nepal’s 28.8 million population in the 2011 census.In the meantime, the government needs to enforce the equitable distribution of the vaccine to the remotest parts of the country with the most at-risk groups high in priority. Public health experts say that with cases rising again in India, Nepal could also see a spike as people become complacent and mingle more.Says Sher Bahadur Pun of the Infectious Disease Hospital in Teku: “We have been given this reprieve with fewer cases and fatalities, we need to utilise this time to vaccinate the elderly so that the most vulnerable in our communities are protected if and when the next wave hits us.”

Nepal braces for new wave with vaccine drive

<figure><img width="873" height="655" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110111132/636cd3779c7e80680e08f96bjpeg.jpg" alt=""/><figcaption>Prakash Parajuli at the Tribhuvan International Airport, before boarding his flight to Japan. PHOTO: PRAKASH PARAJULI</figcaption></figure>On 21 December 2020, Prakash Parajuli was waiting at the Tribhuvan International Airport to board his flight to Japan. He had secured necessary paperwork for his job there as a caregiver, and was in high spirits at the prospect of starting anew despite the pandemic.Parajuli is employed under the <a href="https://www.nepalitimes.com/opinion/the-future-is-older/" target="_blank" rel="noopener noreferrer">Japan Government’s Specified Skilled Worker</a> (SSW) residence status. “This is a result of a lot of hard work and patience. For many months, I focused entirely on studying for the Japanese language test,” Parajuli told Nepali Times before he boarded his plane.After working in Qatar for two years as a cashier with a monthly income of around Rs40,000, he had come home and started looking for fresh migration opportunities. Now, he is set to earn around Rs145,000, excluding overtime and bonuses. “I plan to work very hard and hope to stay long-term in Japan,” he says.In March 2019, the governments of Nepal and Japan signed a memorandum of cooperation for the SSW residence program. The SSW1 category of the program allows workers to remain in Japan for a maximum of five years, with workers ensured equality of treatment as well as the ability to change employers within the same sector. There is also a longer-term SSW2 category that allows unlimited visa renewals and dependents. In the next five years, a total of 345,000 workers were to be hired from all SSW partner countries. <img width="200" height="174" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110111132/636cd3799c7e80680e08f96cjpeg.jpg" alt="">In addition to the win-win situation that such labour programs afford, by helping 14 sectors address severe worker shortages in super-aging Japan (see figure), it also allows Nepali youth to be gainfully employed at higher earnings in a secure labor market. Nepal had one more reason to be jubilant— it was the second country to sign the agreement with Japan after the Philippines. <figure><img width="1768" height="996" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110111132/636cd37a9c7e80680e08f96djpeg.jpg" alt=""><figcaption> </figcaption></figure>But little did we know that almost two years down the road, Parajuli would be just one of the handful of Nepalis who would benefit from this agreement despite the head start.The agreement was a hybrid of the existing agreements Nepal has with other countries: it was neither a purely government-to-government model like that with South Korea or <a href="https://www.nepalitimes.com/here-now/demand-grows-for-nepali-caregivers-in-israel/" target="_blank" rel="noopener noreferrer">Israel</a>, nor did it allow recruiters to play a role like the agreements with Malaysia and select Gulf countries. It was signed under a government-to-business model in which the Nepal Government proposed setting up a Japan Unit at the <a href="https://www.nepalitimes.com/here-now/labour-recruiter-netted-in-sting-raid/" target="_blank" rel="noopener noreferrer">Department of Foreign Employment</a> (DOFE) to oversee all aspects of the SSW implementation.On the Japan side, the government played a more hands-off role and allowed the private sector to participate including employers, recruiters and support organisations. “This mixed modality is creating widespread confusion as there is a misconception that this is a government-to-government modality, while it isn’t,” says Yuzo Yoshioka, Charge d'Affaires, Embassy of Japan in Nepal.This government-to-business model envisioned a proactive government that would take on added responsibilities in lieu of the recruiters via the Japan Unit. It was an attempt to ensure that the flawed technical implementation experiences related to the past programs would not be further exacerbated in this model, forcing workers to pay hefty amounts to land in the destination job market. Especially, noting that the Japanese Government did not want to be involved in the cost issue but trusted the involved employer-worker to mutually agree on such details. This was viewed as risky for Nepal, given the trend of rampant malpractices that worsen with the attractiveness of destination countries.The success of this hybrid model, however, rested on a proactive Japan Unit that imitated the private sector’s strengths in marketing, matching, information sharing and employer engagement. Most recruiters are very good at following up on these details, but these comparative advantages are obscured by the malpractices in the industry, often at the cost of the most vulnerable workers.To be fair, the overall SSW program itself has had a rough start. The number of countries that Japan has signed agreements with has increased over the last two years with the addition of Bangladesh, Sri Lanka, Pakistan, and most recently, India. But deployment has been poor across the board.Started in April 2019, SSW1 visas have only been issued to 8,769 workers (see figure) as of September 2020, which is less than a tenth of the target. Over 60% are from Vietnam, followed by Indonesia and the Philippines. Many of them were already based in Japan under other statuses, who simply changed their residence status to SSW1. For a program that has had a bumpy start, the onset of Covid-19 further derailed progress. <figure><img width="1150" height="784" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110111132/636cd37d9c7e80680e08f96ejpeg.jpg" alt=""><figcaption> </figcaption></figure>Tests have been ongoing for a while now, in various countries including Nepal. While the SSW program covers 14 sectors facing worker shortages, so far, tests have been arranged only for the caregiving sector in Nepal. <a href="http://ac.prometric-jp.com/testlist/ssw/index.html" data-saferedirecturl="https://www.google.com/url?q=http://ac.prometric-jp.com/testlist/ssw/index.html&amp;source=gmail&amp;ust=1611462015510000&amp;usg=AFQjCNEEt1pnPBFBFCtd7JTrgi40Yzql3g">Tests</a> in other sectors like the food industry and agriculture are scheduled for February and March. Japan-based Nepalis have also been taking advantage of the tests administered in Japan to enable them to switch to SSW1status.Hari Sangroula from Universal Training Center shares, “The performance of Nepali students in the exams has improved over time. Initially, there was confusion about the content and exam modality so the learning curve was steep. Performance in care worker skills exams has significantly increased, but students are still struggling with the language exams in which pass rates are relatively lower.”  Unlike in the language exam for <a href="https://www.nepalitimes.com/here-now/dead-end-of-the-korean-dream/" target="_blank" rel="noopener noreferrer">South Korea</a>'s Employment Permit Scheme program where all eligible candidates are allowed to appear for the language exams, the number of test-takers in Japan is limited and conducted multiple times a year. “Earlier, the selection of test-takers was based on a lottery system. Now students are selected on a first-come-first-serve basis online, and it takes just a minute or two for all the available seats to fill-up which can be stressful for aspiring test-takers,” says Sangroula.According to Yoshioka from the Japan Embassy, in the last two fiscal years, 234 Nepalis have passed the technical examination for care workers whereas 207 have passed the language exam. “So, over 200 aspirants are eligible to work as caregivers in Japan and they will have to make the effort to find suitable employment opportunities,” he says.  <figure><img width="1458" height="758" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110111132/636cd3809c7e80680e08f96fjpeg.jpg" alt=""><figcaption> </figcaption></figure>And therein lies the confusion, as the Japan Unit at Department of Foreign Employment (DOFE) is still not functional, whereas private sector intermediaries are barred from participating. Both employers and migrants are unfamiliar with the recruitment and employment system in the other country.“There is a Japan Unit at DOFE, but it is not fully functional yet. The directive that will detail the mandate of the Japan Unit, including information dissemination to aspirants, coordination with employers, selection and visa processing support is being finalised at the Labor Ministry,” explains Tika Neupane, Spokesperson at DOFE.There are students who have reached out to DOFE after completing the exams successfully, questioning what to do next and DOFE allowed them to take individual labour approvals. “However, the full implementation of the SSW as per the agreement with Japan Unit taking on a large, more hands-on role has yet to begin. The directive that is being finalised will clarify the implementation details,” Neupane adds.“Only 69 Nepalis are currently under the SSW residential status so far in Japan. But a good majority of <a href="https://archive.nepalitimes.com/article/nation/nepalis-from-chitwan-to-chidoya,4110" target="_blank" rel="noopener noreferrer">Nepalis who were already in Japan</a>, simply switched to the SSW1 residence status from other statuses like technical intern. They are mostly involved in the food industry,” Yoshioko says.In 2019, the Nepal Embassy issued 7 visas for SSW although it is not clear how many among them passed the exams in Nepal versus Japan. More visas have been issued in 2020, but the data has not been made public yet. <figure><img width="1768" height="996" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110111132/636cd3849c7e80680e08f970jpeg.jpg" alt=""><figcaption> </figcaption></figure>While individual labour approvals are being issued by DOFE, which means a migrant can independently arrange his contract with the employer and would be provided the labor approval by DOFE, it is easier said than done. The employment system is complex to navigate: from job search to obtaining the visa related paperwork, confusion related to language differences, distance and unfamiliarity of contexts and practices prevail.Sujit Shrestha, General Secretary of the Nepal Association of Foreign Employment Agencies (NAFEA), attributes the ongoing delay to finalise the directive to heavy political interference and vested interests. A leaked version of the Directive includes a provision of a ‘third party’ that is registered in Japan and recommended by the Nepal Embassy to facilitate the recruitment of SSW workers, including the evaluation of employers in Japan and demand collection from employers. This has been heavily contested by recruiters in Nepal who are excluded from the agreement and want part of this lucrative corridor.“The leaked directive contradicts the original spirit of the agreement that barred the private sector from participating in the implementation of the SSW program. The Government barred the involvement of recruiters while the Japan Unit hasn’t been able to deliver and even if it is functional, it won’t be able to mobilise at scale. They should have let us do it under defined criteria and monitor our activities closely like other countries. The government should be dealing with the government counterparts of destination countries, and not the private sector,” he says.However, Neupane from DOFE insists that the SSW directive will be as envisaged in the original agreement with a fully functional Japan unit.Pre-pandemic, a survey in 2019 showed that over 61 percent Japanese companies reported not receiving applications to jobs offered (see figure). The Nepal Government dragged its feet in the initial two years after the signing of the agreement. As employers in Japan figure out the nuts and bolts of recruiting under the SSW status and further intensify their cross-border efforts to address their human resource challenges, making the process unnecessarily confusing will work against Nepali aspirants, especially as there are other 12 countries to choose from. Nepalis are already investing time, effort and money to prepare for the exams, with many, as seen in the case of over 200 successful test-takers, who are looking for guidance on being matched with employers in the <a href="http://archive.nepalitimes.com/article/Nepali-Times-Buzz/nepali-caregivers-in-israel,3809" target="_blank" rel="noopener noreferrer">caregiving sector</a>. <figure><img width="1768" height="996" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110111132/636cd3879c7e80680e08f971jpeg.jpg" alt=""><figcaption> </figcaption></figure>Amid the confusions and delays, a few language institutes like Universal and Reiwa have stepped in to intermediate and garnered recognition among aspirants for helping them connect to employers. They explain that they have facilitated the interviews with care centers in <a href="https://www.nepalitimes.com/banner/why-nepalis-are-flocking-to-okinawa/" target="_blank" rel="noopener noreferrer">Japan</a> free of cost to the migrants because but are being compensated by their Japan-based partners. Four SSW workers at various stages of the recruitment and deployment process have confirmed this to Nepali Times. This is encouraging, with the caveat that workers seldom reveal details of service fees paid, in fear of retribution. Data obtained by Universal Training Center from the Japan Foundation shows that, of the couple hundred that have passed both exams, around 96 have gone further with the process and passed interviews, completed paperwork, and received their Certificate of Eligibility (COE), the last step required before they can apply for visas. But there are delays and uncertainty in obtaining visas due to the pandemic. Santosh Neupane who is part of the management of Reiwa Nepal, a language institute that cooperates with Japan based recruiter Dogwood Group, emphasises on a strong partnership between the private sector and the Nepal Government to ensure the SSW implementation. “It is far-fetched to expect employers to carry out all recruitment activities on their own by coordinating with Japan Unit that will not be as involved as the private intermediaries are for nitty-gritty details even if it were to be functional. The added burden may dissuade employers, who will source workers from Philippines or Vietnam, instead,” says Neupane. <figure><img width="720" height="960" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110111132/636cd38a9c7e80680e08f972jpeg.jpg" alt=""><figcaption> </figcaption></figure>While confusion abounds and there is a pressing need for a functional Japan Unit or another alternate to the woeful inaction, the lucky few Nepalis who manage to overcome the odds are thankful for the opportunity.  Binu Gurung, was one of the first and few SSW workers from Nepal who arrived in Japan in November 2020. “I am now in my training period but am getting paid my regular wages. Most of the Japanese I take care of are in their 80s and 90s,” she said over the phone.A pioneer SSW Nepali, she has become a mentor for other Nepalis who want to work in Japan. She is pleased with the support she has been receiving as a financially secure future looms in the horizon. Her husband, too, has taken Japanese language classes and is waiting for his opportunity to take the exam so he can join her.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110111132/636cd38d9c7e80680e08f973jpeg.jpg" alt="" width="694" height="960">Binu Gurung working in Japan as a caregiver. PHOTO: BINU GURUNG Things do not always fall into place for everyone, like it did for Binu. Despite successfully completing his language and skills exams, Phanindra Sedai, has failed the interviews with prospective employers. “I have taken the interview three times already. I won’t stop reapplying because I have already invested an enormous amount of time and effort and passed the tests,” says Sedai, who worked in Malaysia for eight years as a security guard now runs a small shop in Nepal, brushing up on Japanese vocabulary when he has time.Sangroula from Universal says employers are looking for more than communication skills. “The way they conduct themselves, their demeanor—all matter during online video interviews. To help frail, aging patients with everyday tasks and be their sole companion in their twilight years is a demanding job requiring an enormous amount of compassion and patience.”

Upasana Khadka

Nepal-Japan jobs deal still stuck

<figure><img width="920" height="2000" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181116/636be10c9c7e80680e083e28jpeg.jpg" alt=""/><figcaption>A girl worships in a locked up Ganesh temple in Kuleshwor in Kathmandu this week. All photos: Rajani Maharjan</figcaption></figure>For decades, Dhanamaya Singh concluded each day at Aakash Bhairab Temple in Indrachok in Kathmandu’s historic heart, to sing bhajan hymns.As an unmarried elder, these evening prayers were her way of engaging with her community and were the centre of her social and ritual life. But, at the end of March, with the first government-mandated lockdown to prevent the spread of Covid-19, her daily practice was stopped abruptly. Dhanamaya has not seen a single one of her relatives since the lockdown began, and even after it was lifted has to be careful. While she previously visited them frequently for feasts and rituals days, her family is strictly adhering to social distancing practices, so she now spends most of her time alone at home. She says the isolation, though protective of her physical health, has been detrimental to her mental wellbeing.  <a href="https://www.nami.org/Blogs/NAMI-Blog/December-2016/The-Mental-Health-Benefits-of-Religion-Spiritual" data-saferedirecturl="https://www.google.com/url?q=https://www.nami.org/Blogs/NAMI-Blog/December-2016/The-Mental-Health-Benefits-of-Religion-Spiritual&amp;source=gmail&amp;ust=1605372826448000&amp;usg=AFQjCNGy1PM7H-LAzL9nOponn9G9rrlPhg">Numerous studies</a> have shown the connection between religious practice and mental health benefits. The system of beliefs, the structure, and the sense of community inherent in most religions have a largely positive impact on mental wellbeing. Regardless of the belief system, including Hinduism, Christianity, Islam, all involve rituals that help people cope with difficult life events such as the death of a loved one, lessons that arise from challenging situations, as well as regularity and predictability, all of which are highly beneficial during the uncertainty of a pandemic. Additionally, religion and spirituality create a group of people who connect over shared beliefs. The benefits of feeling a sense of belonging, a place for trusting public engagement, and social connection have been shown to reduce anxiety, depression, and other forms of mental distress. <figure><img width="640" height="853" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181116/636be10f9c7e80680e083e29jpeg.jpg" alt=""><figcaption> </figcaption></figure>While the Covid-19 pandemic has affected all aspects of religious practice in Nepal, most people, regardless of their age, gender, or social position, say that it is the change in community engagement that has had the most significant impact on their lives. While many report that they are visiting temples less frequently and have reduced the scale of their rituals, people say they are still finding a way to worship and to regain the sense of community that their typical religious practice brings. To do so, more and more residents of Kathmandu are turning to technology, some for the very first time. But can tools like Facebook, messenger apps, and even virtual reality really replace the real experience?Dhanamaya’s struggle with loneliness and the way in which the Covid-19 pandemic has impacted her mental health is not uncommon in Kathmandu Valley, across Nepal, or around the world. Since the first case of Covid-19 was <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30067-0/fulltext" data-saferedirecturl="https://www.google.com/url?q=https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30067-0/fulltext&amp;source=gmail&amp;ust=1605372826448000&amp;usg=AFQjCNGg55WQDhgR0lx9yQqWW4gYDhRhRg">recorded in Nepal</a> on 23 January, the valley has been in and out of lockdowns with varying degrees of restrictions.Although restaurants and public offices have been allowed to reopen periodically, most of the city’s temples, particularly the major ones that draw the largest crowds, have remained shuttered for over seven months.Almost every country in the world has grappled with how to manage the disease burden without causing devastating impacts to the economy, and Nepal is no different in the way it has been forced to bear this struggle. However, because Nepal’s healthcare capacity is already limited, the government of Nepal instituted even more stringent lockdown actions, particularly in Kathmandu Valley, than have been seen in many other countries, including measures such as even/odd days for vehicles, grounding domestic flights, and the complete and long-term closure of businesses. The impacts of these extend far beyond purely the economic.      For example, when Maya Dangol’s mother died a couple of months ago, she and her family struggled to conduct the death rituals due to the lockdown measures. Market closures, supply shortages, and the even/odd license plate restrictions on vehicles posed a challenge when trying to obtain all the necessary material to conduct the funeral rituals. She says her family visited the temples at four in the morning to burn wick lamps in their mother’s name to enable them to return home by six to avoid vehicle restrictions and contact with other people. <figure><img width="960" height="720" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181116/636be1119c7e80680e083e2ajpeg.jpg" alt=""><figcaption> </figcaption></figure>Despite these limitations, coronavirus cases continue to increase daily and hospitals in Kathmandu are reaching capacity, some having to turn away even serious cases due to a lack of beds and other resources. The total confirmed cases in Nepal surpassed 200,000 this week, with nearly half of them just in Kathmandu Valley. The total deaths crossed 1,202 on 13 November, with 456 of them in Kathmandu. For the past weeks, the Valley is recording an average of 60% of the daily cases detected nationwide.Public health experts say the government has failed to effectively respond to the pandemic because there was little planning or work to improve healthcare facilities before they became overwhelmed. Now some, especially underprivileged families, feel they have few options if they contract the virus. There is also concern about how the government’s response to the pandemic has impacted the way religious and cultural events have been carried out. Dhiraj, a Newa environmental scientist is worried about the impact of the lockdown on some of the major festivals and rituals, including Rato Machindranath and Bisket Jatra. “The government has prevented these festivals from taking place, but other functions are allowed to continue. Major temples like Pashupati, have been closed since the beginning of the lockdown period, while other activities remain open, like markets and shops,” he explained.“Previously, the Newa community of Kathmandu Valley was especially strong in its religious beliefs, these days this is breaking down. For the first time in a very long time, people are not observing the rituals,” said Dhiraj, adding that this was partly due to fears about disease transmission, but also partially due to government regulation.  While most of the major religious events have been canceled or carried out with highly reduced numbers, residents of Kathmandu and people across Nepal have found ways to adapt and maintain spiritual and social connections despite the difficulty the pandemic poses. Dhanamaya, the bhajan singer, exemplifies this. Although she could no longer play bhajan at the temple, Dhanamaya realised she had another outlet to share her songs and worship with the community: through social media platforms such as Facebook. It was difficult for her to embrace the technology at first, she admits, and she needed help from her young nieces and nephews to navigate the platform. But Dhanamaya says: “Now, when I have leisure time, I get dressed up as if I am going out. I then position my mobile to record myself singing and if the video is nice, I post it.” When her friends and family give positive feedback, she feels less disconnected, and inspired to continue learning and sharing.  <figure><img width="600" height="872" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181116/636be1139c7e80680e083e2bjpeg.jpg" alt=""><figcaption> </figcaption></figure>Similarly, Gyani Maharjan says she spends a most of her days on video calls and other social media platforms. Because she has high blood pressure and is therefore at a greater risk for a more serious infection if she contracts the virus, she too is limiting physical contact with others, including family. To stay healthy physically as well as mentally, she participates in a yoga class through a messenger application on her mobile. Like Dhanamaya, she says this has helped her regain a sense of community when she would otherwise be almost completely isolated. Gyani and her nine siblings changed the way they celebrated the festival season this year, but she says, this did not make them feel any less connected as a family. During recent festivals, each sibling would participate in group video calls where they would show what they had prepared for that particular day and joke with each other and laugh. Gyani said she feels less anxious and stressed when she gets to connect using these platforms and watch videos of her grandchildren. In <a href="https://restofworld.org/2020/hey-bhagwan/" data-saferedirecturl="https://www.google.com/url?q=https://restofworld.org/2020/hey-bhagwan/&amp;source=gmail&amp;ust=1605372826448000&amp;usg=AFQjCNE_XGUoyhE7Wod0TspJ2h-j-QFa-Q">India</a>, virtual reality (VR) platforms are being marketed as a way to enable people to do darshan even when they cannot physically get to the temples. This began even before the beginning of the pandemic for people who have moved out of their home state or to a foreign country, because they are elderly or ill, and for those who the major traffic jams of the Indian metropolises prevented them from visiting the temples regularly. Smartphone application downloads for VR temple experiences have increased exponentially since temples were closed in response to the spread of Covid-19. VR apps enable priests to continue to perform the rituals and maintain their livelihoods while devotees can continue to engage, though from afar.Likewise, many Americans have adopted the habit of attending virtual church from their laptops every Sunday. Even after the virus is managed and in-person worship can resume, many churches report that they will continue live streaming weekly services to accommodate those who are unable to attend the service or who prefer to worship from home.However, not everyone has embraced these changing forms of worshiping and socialising though. Baburaja Bajracharya, a priest, says he has heard that some of the Brahmin priests  are instructing people to perform puja through video calls, however, he and other Newa priests that he knows have not adopted this practice. For Baburaja and many others who are hesitant to involve technology in religious practice or who reject it outright, the experience and perceived benefits of being at a temple or in the presence of a priest during puja cannot be replicated virtually. The sense of community afforded through religious practice is not felt to the same degree when those experiences are happening on a mobile phone. <figure><img width="492" height="1024" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181116/636be1159c7e80680e083e2cjpeg.jpg" alt=""><figcaption> </figcaption></figure><figure><img width="492" height="1024" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181116/636be1179c7e80680e083e2djpeg.jpg" alt=""><figcaption> </figcaption></figure> <a href="https://journals.sagepub.com/doi/abs/10.1177/1745691617713052?journalCode=ppsa" data-saferedirecturl="https://www.google.com/url?q=https://journals.sagepub.com/doi/abs/10.1177/1745691617713052?journalCode%3Dppsa&amp;source=gmail&amp;ust=1605372826448000&amp;usg=AFQjCNHQIKJRX8DVUxp5GgqxtnVybWftvw">Research</a> has shown that social media can be effective in addressing loneliness when it is used to enhance existing relationships, like in the case of Dhanamaya and Gyani, but is counterproductive when it is relied upon to replace in-person interaction. Therefore, the benefits of this technology are largely dependent on the way they are integrated into daily lives.However, during a pandemic, many feel as though there are few other options for socialisation other than to engage on virtual platforms. This suggests that for some, the perceived benefits may end up being short-lived or unsustainable if social distancing remains necessary far into the future.  For some, though, the use of technology to conduct and share ritual, religious, and community experiences has been essential. Alok Siddhi Tuladhar, a cultural activist, says his birthday would have been a lonely and isolating day for both him and his parents if not for platforms that enable virtual connection. Because he tested Covid-19 positive, though asymptomatic, he chose to celebrate his birthday at home with only his wife and son. His elderly parents watched his wife perform the birthday puja from their house across the city over video chat. Tuladhar says he thinks “technology helped us to fill the gap that comes with social distancing when we are unable to visit each other physically.”  Although technology has helped fill that gap for some, its impact in a post-pandemic world is yet to be seen. Rajani Maharjan is an environmental anthropologist affiliated with the Small Earth Nepal (SEN), an environmental research group.Madison Wrobley is a 2019-2020 Fulbright-National Geographic Storytelling Fellow who studies water insecurity, primarily in Kathmandu Valley, and is now based in Colorado.

With temples locked up, Nepalis improvise

<figure><img width="640" height="464" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181112/636bdfd49c7e80680e083dbfjpeg.jpg" alt=""/><figcaption>Photo: BIKRAM RAI</figcaption></figure>Up until two months ago, health experts were perplexed as to why <a href="https://www.nepalitimes.com/latest/why-are-younger-people-in-poor-countries-dying-of-covid-19/" target="_blank" rel="noopener noreferrer">mostly younger people were dying of Covid-19</a> in Nepal and other South Asian countries. In Europe and North America, it was mainly the elderly who were victims. In fact, age-wise breakdown of coronavirus mortality by Health Ministry in August showed that most deaths recorded were of people in the 41-50 years category. This was explained by the fact that younger people were moving about more, and were <a href="https://www.nepalitimes.com/here-now/returnees-may-be-taking-coronavirus-to-rural-nepal/" target="_blank" rel="noopener noreferrer">bringing the virus back from India or from hotspots</a> within Nepal.But since then, the virus is spreading within the community and families, younger asymptomatic people who have not been tested are infecting elderly family members at home.September-October saw a sharp rise in the fatality of people in their seventies and above from Covid-19, even though infection rate is much higher in the 21-50 age group. On 31 October when Nepal registered 23 deaths a day, 13 of the fatalities were above 70, and 20 of them were aged between 60-70. <img width="640" height="428" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181112/636bdfd69c7e80680e083dc0jpeg.jpg" alt="">Health experts say this is striking proof that younger people are now taking home SARS-CoV-2 and making their parents and grandparents seriously sick. This trend may have been exacerbated by <a href="https://www.nepalitimes.com/banner/heat-map-of-nepals-covid-19-hotspots/" target="_blank" rel="noopener noreferrer">families travelleing to far corners of the country for get togethers over Dasain</a>, and a new spike in infections is expected in the coming week. Despite being <a href="https://www.nepalitimes.com/banner/protecting-nepals-elderly-from-covid-19/" target="_blank" rel="noopener noreferrer">the most susceptible to coronavirus</a>, the elderly were already getting the least priority from the state, society and increasingly even within families. Physically fragile, <a href="http://archive.nepalitimes.com/article/nation/dementia-brings-new-problem-that-families-have-little%20knowledge-of,2151" target="_blank" rel="noopener noreferrer">suffering memory loss</a>, or lonely seniors are politically ignored and socially ostracised.  <img width="640" height="555" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181112/636bdfd99c7e80680e083dc1jpeg.jpg" alt="">“We know senior citizens are at the most risk, focus should have been on saving them during this crisis, but they are literally on the bottom of the ladder in terms of society’s priorities,” says <a href="https://archive.nepalitimes.com/regular-columns/guest-editorial/guest-editorial-old-is-gold,876" target="_blank" rel="noopener noreferrer">Krishna Murari Gautam</a> (pictured left), social scientist and founder of Ageing Nepal that helps old age homes manage the coronavirus. “Most households are misinformed: people think old people cause and spread Covid-19 but it is the younger people who are exposing them to the virus, so they have to be mindful of their behaviour,” Gautam adds.To be sure, <a href="http://archive.nepalitimes.com/article/Nepali-Times-Buzz/need-to-prepare-for-ageing-society,3624" target="_blank" rel="noopener noreferrer">the elderly were already the most vulnerable</a>, but now the pandemic has added to all the pre-existing problems they faced: collapse of joint families, children and grandchildren abroad for studies or work, economic hardships and expensive health care. <figure><img width="640" height="427" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181112/636bdfdc9c7e80680e083dc2jpeg.jpg" alt=""><figcaption> </figcaption></figure><a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/business/caring-for-those-who-cared/" target="_blank" rel="noopener noreferrer">Older people</a> are now more isolated than ever within their homes and communities: they cannot go out and mingle within a limited circle of friends and relatives, visit temples or take part in community bhajans and other religious activities.To make matters worse, they have been terrorised by the daily television headlines that highlight the death toll. Many are now showing psychosomatic symptoms of coronavirus without actually being infected out of sheer anxiety.In others, <a href="https://www.nepalitimes.com/here-now/post-pandemic-mental-health-epidemic/" target="_blank" rel="noopener noreferrer">mental health illnesses</a> has become an increasing problem. Those on medication for depression and dementia are suffering relapse due to additional stress, say health experts.Gautam, who was recently awarded the UNESCO Literacy Prize for his activism on behalf of Nepal’s elderly, says: “Most seniors are either illiterate or at least digitally illiterate. A much more effective option would have been to <a href="https://www.nepalitimes.com/latest/enlisting-female-health-volunteers-to-fight-covid-19/" target="_blank" rel="noopener noreferrer">utilise our great network of female community health volunteers</a> spread across the country or even cooperatives to spread awareness about Covid-19 among the elderly.”Lockdowns in the initial phase of the crisis to contain coronavirus added to the problem. Old age homes soon ran out of daily essential supplies and donations they relied on. <a href="http://archive.nepalitimes.com/article/editorial/editorial-reaping-demographic-dividend,3621" target="_blank" rel="noopener noreferrer">The elderly</a> at these care institutes also need regular health check-ups as well as stock of medicines for various conditions.Rosha Shrestha of Harmony Care Home in Bansbari worked early on to prepare for the oncoming crisis. In January, as the country was recording the first case of Covid-19, Shrestha started looking for an alternative should an outbreak occur and worked meticulously to develop her own protocols to keep the virus at bay. <img width="585" height="827" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181112/636bdfde9c7e80680e083dc3jpeg.jpg" alt="">Harmony is now segregated into red, yellow and green zones for all people and materials entering inside or going out of the home, everything has to be disinfected. Shrestha who is a nurse by profession also equally focused on uplifting the moral of her family of senior citizens as well as in enriching their diet, using traditional home recipes. As a result, none of the occupants have symptoms and have not had to visit a hospital in the last nine months, unlike in the past when they needed to be hospitalised every once in a while for their different ailments.  Shrestha has also trained other nursing homes and regularly consults older people over the phone, trying to dispel the notion that Covid-19 is catastrophic, that it is like any other epidemics of the past, not without casualties but also not something we can’t overcome with safety measures. “Despite these positive steps I know that I have to save my <a href="https://www.nepalitimes.com/here-now/home-health-care-during-a-lockdown/" target="_blank" rel="noopener noreferrer">older people</a> for at least another year or two so that they won’t have to visit hospital for any reason, which is now unsafe and also unavailable,” says Shrestha. “It was a grave mistake on the government’s part to allow all hospitals to admit Covid-19 patients instead of segregating a dedicated facility. Where do I take my ba and ma if they fall sick now?” <figure><img width="1473" height="1000" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181112/636bdfe09c7e80680e083dc4jpeg.jpg" alt=""><figcaption> </figcaption></figure>With increasingly more youth migrating abroad for jobs and further studies, there is now a dire need of geriatric caregivers in Nepal. In fact, even as <a href="https://www.nepalitimes.com/opinion/the-future-is-older/" target="_blank" rel="noopener noreferrer">Nepalis take up elderly care jobs in Israel and Japan,</a> they might be needed more at home in near future.Since the 1950s, Nepal have added over 40 years of life expectancy, a dramatic public health achievement. But how well have we planned those added years or realised its potential?Says Gautam: “It’s ironic that on the face of Covid-19 crisis, we have more or less abandoned the elderly when this was what we strived to achieve for so long. The good news is it is still not too late to care for them and their needs, especially this winter when the risks go up.”

Spared at first, elderly hit hard by Covid-19

The long journey back to Nepal

<figure><img width="1440" height="1080" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110912114/636b89d69c7e80680e06b20bjpeg.jpg" alt=""/><figcaption>Photo: ALISHA SIJAPATI</figcaption></figure>Even before the two-week lockdown, more and more Nepali families with elderly relatives hired nursing care at home. Several companies had started up as demand from the Nepali diaspora added to the need for home caregivers. The COVID-19 lockdown had accelerated this trend.  Srijana Paudel (pictured above), 21, a certified nurse has been looking after a bed-ridden elderly woman in Lalitpur for more than six months. But on 23 March, when Prime Minister K P Oli went on television to announce a nationwide lockdown from 6 AM the next morning, she was in a fix.While hospital workers and ambulances are allowed on the roads, many nurses taking care of elderly or sick family members could not commute to and from their own homes anymore. So, Paudel has been forced to stay over at her patient’s home for the past ten days, without being able to take care of her own family.<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/banner/protecting-nepals-elderly-from-covid-19/" target="_blank" rel="noopener">Protecting Nepal's elderly from COVID-19</a>, Alisha Sijapati<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/here-now/protecting-those-who-protect-us-from-the-epidemic/" target="_blank" rel="noopener">Protecting those who protect us from the epidemic</a>, Ramu Sapkota“I feel bad not being able to return to my home and be with my family, but looking after someone more vulnerable is my duty as a nurse and I will make my best effort to protect them,” Poudel says. “It would make me feel more guilty if I stayed home. I have become close with my patient’s family, so that helps.” There are over 200 nurses and caregivers like Srijana Paudel from various home care services in Kathmandu working in private residences of elderly patients. Seniors and patients with pre-existing medical conditions such as asthma, diabetes, or heart disease are more vulnerable to becoming severely ill with the novel coronavirus, making the need for the home caregivers even more critical.  <figure><img width="1000" height="662" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110912114/636b89d99c7e80680e06b20cjpeg.jpg" alt=""><figcaption> </figcaption></figure>Rupa Joshi of Bag Bazar has two elderly relatives to look after in her household: a 105-year-old grandmother-in-law and a mother-in-law who is 90. Both require special assistance. “We had been on self-quarantine even before the lockdown to protect elderly family-members and reduce the risk of contamination,” says Joshi who has asked her mother-in-law’s caregiver to stay with her own family until the lockdown is lifted to avoid contamination. Another caregiver has been asked to live-in so she does not catch the virus during her commute. “Our caregivers are like family members now, and in this difficult situation we have to help them, and accommodate their needs too,” Joshi adds.  While some <a href="https://www.nepalitimes.com/business/caring-for-those-who-cared/" target="_blank" rel="noopener">home care services</a> had drawn up a contingency plan two weeks before the lockdown, other health providers have had to change their schedules overnight to cater to patients since the shutdown.  <a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/here-now/8-ways-to-keep-well-during-a-lockdown/" target="_blank" rel="noopener">8 ways to keep well during a lockdown</a>, Marcia ChenAt Patan based health care service Medilink, Sushmita Khanal has been working non-stop from her home to cater to her clients and also address the needs of her caregivers who look after older patients. “We knew COVID-19 and the lockdown was inevitable, but I wish we had more time to buy equipment and medicines and plan effectively,” Khanal said over the phone. <a style="font-size: 15px; letter-spacing: 0.01em;" href="http://archive.nepalitimes.com/article/Nepali-Times-Buzz/need-to-prepare-for-ageing-society,3624" target="_blank" rel="noopener">Home care</a> had already become a trend in Nepal even before the pandemic scare as family members worked fulltime, and there was no one to take care of elderly relatives. The job has become even more challenging and necessary during the lockdown.  <a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/opinion/home-work-during-the-lockdown/" target="_blank" rel="noopener">Work from home during the lockdown</a>, Saniaa ShahBishal Dhakal was a resident surgeon in Pakistan, and returned to Kathmandu in 2009 to start a health service provider, Health at Home. Although his clients need services now more than ever, he says the economic downturn may affect the ability of families to hire services like his.  “We have clients from all backgrounds, but since most of them work on monthly salaries we can foresee many clients cancelling their contracts in the next couple of months,” says Dhakal. Fearing a slump, Dhakal’s Health at Home, Sushmita Khanal’s Medilink have put off expansion plans in their businesses. However, their central focus continues to be in giving best possible service to existing patients during the lockdown, and communicating virtually with caregivers and nurses on preventing the virus from infecting the elderly. While most caregivers and nurses are trapped in the homes where they work, the service providers have managed to get limited transport permits to pick and drop some staff who have families to take care in their own homes. Like Rupa Rai, 22, a nurse at Medilink Health Care who finally got back to her own family after being trapped in her patient’s house for nine days. She says: “I didn’t bring spare clothes, but now I am more prepared mentally for an extended lockdown.”

elderly