Nepal’s remote far western districts have always suffered from food insecurity, but this year saw a significant decline in rice harvest which is expected to increase outmigration and <a href="https://nepalitimes.com/here-now/the-karnali-s-hunger-emergency">malnutrition</a>.
The shortages were recorded in just the three months after this year’s harvests hit the market and are attributed to unfavourable rains, people moving away from farming, shortage of fertiliser and other agricultural inputs, low market price for local rice, and lack of irrigation.&nbsp;
This was revealed in the <a href="https://www.facebook.com/USAIDNepal/posts/pfbid0wWMzUk7nbDkqfmMwDNYSMbUfgpXeQEuzULdAXSYwWXiXrHiAMF6ZVAhh7uC9gNcwl">International Rice Conference</a> held by the Nepal government in partnership with Feed the Future and USAID in Kathmandu this week with the theme: 'Achieving self-sufficiency in rice for Nepal's sustainable economic growth'.
The conference highlighted investment in research and development, subsidised loans to farmers for fertiliser, machinery and raising import tariffs. But by far the greatest impact would be to increase the area under irrigation, especially in the more arid western mountains of Nepal which are chronically food-deficit.
Three-fourths of Nepalis depend on agriculture, which makes up a quarter of the GDP. About 20% of that comes from rice. Till 30 years ago, Nepal used to export rice, but the country’s population has doubled in that time, there is also a growth in numbers of people switching to rice in their diet, and a fall in production.
Although productivity has increased, the area of land under cultivation has gone down. Nepal imported rice worth Rs40 billion in 2020-21, up 64% from the previous year.
Productivity could be further increased if there was better irrigation, since 80% of farms depend on rain-fed agriculture. The climate crisis has made those rains more erratic.
Even if all of Nepal’s 30 million people ate rice, the country would theoretically need 6.5 million tonnes of rice per year, but Nepal imports 7.5 million tonnes. The spurt in rice import is also because of the demand from the burgeoning beer industry.
This time last year, industrial warehouses were full of rice. Now, most of them in Dhangadi and other market towns are empty. Karnali Province grows about 150 million kg of rice annually. However, production this year is down by 50%, says agro-businessman Om Prakash Agrawal.
As it stands, the shortage in supply has also meant that prices have increased. The price of short-grain rice has gone up from Rs42 per kg to Rs55, while the cost of long-grain rice has increased from Rs60 three months ago to Rs75.&nbsp;
Hari Shankar Thakur, owner of Thakur Agro Industries, says that the scarcity of rice in the market caused by the decrease in paddy production has exacerbated the supply shortage in the far western hill districts.&nbsp;
Read Also: <a href="https://nepalitimes.com/here-now/the-karnali-s-hunger-emergency">The Karnali’s hunger emergency</a>, Anita Bhetwal
“Current stocks indicate that unless the government intervenes, there will be a severe shortage of food in the Far West in another three months’ time,” adds Thakur. “But it seems like the government is unconcerned about how to meet the people’s demands for rice.”&nbsp;
The Nepal Food Corporation, which purchases paddy from Nepali suppliers every year to avoid food shortages in the country’s hill districts, began buying rice in November of this year as well.
Indeed, the Corporation unit in Dhangadi which last year set a target to purchase 4 million kg of paddy, aimed to buy 6 million kg this season at the government-allocated support price of Rs31.98 per kg. The market price of rice does not affect the support price set by the government.&nbsp;
The corporation established six purchase depots in the district to facilitate transactions. However, farmers stopped showing up to sell their rice in the depots in December because they prefer to sell their product at a higher price elsewhere than at the government-allocated price, corporation officials said.&nbsp;
So far, Dhangadi has bought only 1.87 million kg of paddy out of the targeted 6 million kg, says Angila Basnet, head of the Food Corporation in Dhangadi.&nbsp;
This means the paddy harvested will only produce 1 million kg of rice which will not even be enough to cover one week’s demand.
“It is impossible for our supply to meet the demand for rice in the far west,” says Basnet. “In fact, there is already a shortage of food in the mountains &nbsp;even though the paddy season is not over yet.”
Read Also: <a href="https://nepalitimes.com/banner/nearly-half-of-nepali-children-still-malnourished">Nearly half of Nepali children still malnourished</a>, Sonia Awale

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Paddy production falls in west Nepal

<figure><img width="3000" height="1405" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110161128/636d18f59c7e80680e0ac7f3jpeg.jpg" alt=""/><figcaption>Photos: RSS</figcaption></figure>Still reeling from a <a href="https://www.nepalitimes.com/banner/after-the-deluge-in-nepal/" target="_blank" rel="noopener noreferrer">disastrous monsoon season</a>, Nepal has been hit with unseasonal downpours that have dumped more rain on rice crops that were ready for harvest across the country.. More than 100mm of rain fell in 24 hours in most parts of western Nepal, which has been the worst affected so far as a late-monsoon depression from the Bay of Bengal was swept into the Himalaya by a westerly system.The Indian state of Uttarakhand and Nepal’s Far-Western Province on either side of the Mahakali River have been badly affected by floods, landslides and submerged rice fields.The border Mahakali River reached record-high levels on Tuesday, destroying roads and bridges. More than 24 people are feared dead in a village in Bajhang hit by a landslide. Another andslide killed two children Dharan. <figure><img width="432" height="324" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110161128/636d18f79c7e80680e0ac7f4jpeg.jpg" alt=""><figcaption></figcaption></figure><figure><img width="1800" height="1350" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110161128/636d18fa9c7e80680e0ac7f5jpeg.jpg" alt=""><figcaption></figcaption></figure><figure><img width="1134" height="629" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110161128/636d18fe9c7e80680e0ac7f6jpeg.jpg" alt=""><figcaption></figcaption></figure>Nepal received 15% more rain than average this monsoon, which officially ended two weeks ago, according to the Department of Hydrology and Meteorology. The increased precipitation, including in <a href="https://www.nepalitimes.com/banner/himalayan-floods-a-sign-of-worse-to-come/" target="_blank" rel="noopener noreferrer">Manang valley</a> in Nepal’s rain shadow brought with it flashfloods that caused major damage in seven hydropower plants, and Nepal’s most expensive project for supplying water to Kathmandu <a href="https://www.nepalitimes.com/banner/still-chasing-the-melamchi-mirage/" target="_blank" rel="noopener noreferrer">Melamchi Water Supply</a>.Except in the landslide-hit areas, farmers across Nepal had been encouraged by a healthy monsoon and were looking forward to a bumper rice harvest. Early reports said standing crops were submerged, and harvested rice stalks were destroyed right across Nepal.Many roads in the country have been blocked due to floods from the continuous rain, including the Butwal-Bardaghat section of the East-West Highway. Water levels in the Mahakali, <a href="https://www.nepalitimes.com/banner/the-karnali/" target="_blank" rel="noopener noreferrer">Karnali</a> and Seti rivers in western Nepal have risen to dangerous levels, putting riverside settlements at risk, with many villages on the banks inundated. <figure><img width="3600" height="1667" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110161128/636d19019c7e80680e0ac7f7jpeg.jpg" alt=""><figcaption></figcaption></figure><figure><img width="3092" height="2061" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110161128/636d19069c7e80680e0ac7f8jpeg.jpg" alt=""><figcaption></figcaption></figure>Two hundred houses in the Bhimdatta and Dodhara Chandani municipalities near the Indian border in Far-Western Province are reported to have been flooded.According to the Department of Water and Meteorology, 196 out of 225 rainfall measurement centers in the country have recorded heavy rain in the past few days.Senior meteorologist of the Department, Pratibha Manandhar explains: “The low-pressure systems in central India and the Bay of Bengal moving north and the westerly winds becoming active is the reason we are experiencing such heavy rainfall so late in the season.”Generally, anything more than 100mm of rain within 24 hours is considered to be extreme precipitation. In the Far-western Province, Dadeldhura has already recorded 211mm of rainfall in the past 24 hours, Dipayal received 166mm in a sustained cloudburst, Ghorahi got 133mm, and Bhairawa 112mm. (see map, below) In Nepal, <a href="https://www.nepalitimes.com/opinion/a-disaster-resilient-nepal-is-possible/" target="_blank" rel="noopener noreferrer">monsoon rains</a> usually stop by the end of September, as the prevailing winds switch direction to blow in from the west. Climate experts are surprised by just how erratic this year’s monsoon has been.  <figure><img width="1128" height="578" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110161128/636d190a9c7e80680e0ac7f9jpeg.jpg" alt=""><figcaption>Total rainfall between 8:45 AM 18 October to 8:45AM 19 October in various parts of Nepal. Red areas show highest precipitation in western Nepal. Source: DEPARTMENT OF HYDROLOGY AND METEROLOGY</figcaption></figure>Water expert Madhukar Upadhya writes on his Twitter account: ‘As soon as we were saying that monsoon has ended, I find it surprising to see such high levels of rain, even capable of causing loss of life and property.’However, Manandhar from the Department of Water and Meteorology says that this kind of post-monsoon period is not unprecedented. She says: “There are weather variations from year to year, so it is not surprising to see rains so late into the season. Usually we get post-monsoon rains when the monsoon itself has heavy precipitation.”  The Department predicts more rain till Wednesday evening especially in Lumbini, Karnali, the Far Western Province, and in many places in Province 1, and gradually diminishing by the end of the week as the westerlies hold sway. However, a few places are still expected to see thunderstorms, strong winds, and heavy rainfall.This untimely rain has severely impacted on the <a href="https://www.nepalitimes.com/banner/the-rise-of-rice-in-nepal/" target="_blank" rel="noopener noreferrer">country’s rice harvest</a>. Madhav Prasad Poudel from the Department of Agriculture, says, “Unseasonal rain like this affects both standing crops and also those that have been cut and are left in the fields to dry. The water makes even the straw rot.”   <figure><img width="1500" height="1015" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110161128/636d190d9c7e80680e0ac7fajpeg.jpg" alt=""><figcaption>Satellite radar image taken on Tuesday at noon of heavy precipitation over northern India and Nepal. The westerlies are now pushing the system to the west, and the Department of Hydrology and Meteorology says the rains will taper off by Wednesday afternoon.</figcaption></figure>Although the Met Department forecast rain, the information did not reach farmers. Poudel adds that the rain has affected the paddy harvest adversely, but the exact damage has not yet been determined. Sitaram Chaudhary, a farmer from Dhangadi, said that the floods have severely affected the quality of paddy, rice, and straw and even vegetable farms. The government had been predicting records harvests of rice this year because of the favorable monsoon, but this week’s deluge may affect those hopes. This also puts tens of thousands of farmers at the risk of food insecurity. However, agriculturist <a href="https://www.facebook.com/rajendra.uprety" target="_blank" rel="noopener noreferrer">Rajendra Uprety at the Ministry of Agriculture of Province 1 </a>says the damage from rains may have been exaggerated, and Nepali farmers are used to dealing with heavy rains and high winds affecting ready to harvest rice crops.  "Of course, there has been damage, but there are ways to salvage rice stalks even from submerged fields," he says, "wet stalks need to be kept in a dry place, the paddy fields need to be drained, and the still standing crop should be harvested only after the rains stop. And we should all be helping each other instead of spreading alarmist information." Rice is grown in over 1.4 million hectares in Nepal. Last year, the country produced over 5 million metric tons of paddy, but <a href="https://www.nepalitimes.com/here-now/are-nepalis-really-eating-more-rice/" target="_blank" rel="noopener noreferrer">still imported about Rs51 billion worth of rice</a> to meet growing demand. With this week’s late monsoon floods and unexpected rain, the 2021 harvest is most likely to be below target.

Post-monsoon rain ruins Nepal’s crops

<figure><img width="1641" height="1000" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131116/636cec639c7e80680e09ad61jpeg.jpg" alt=""/><figcaption>Services provided from outside of OPD due to Covid cases. Photos: NYAYA HEALTH NEPAL</figcaption></figure>Nepal’s rural health system, already underfunded, understaffed and overstretched, is struggling with the enormous added burden of the Covid-19 pandemic.  Having barely coped with the first wave last year, hospitals in the remote mountains of Far-Western Province have found that the variants in the second wave are much more lethal, there are many more patients than before, and more of them require hospitalisation.  In Achham district the administration declared a lockdown on 3 May, but by then the virus was already spreading within families and house-to-house. Till the day before the lockdown, people were still arriving by the busloads from India, Kathmandu and other cities. Testing and tracing were lax, and they were mingling in the markets.  On Sunday, Nepal added 8,850 new confirmed infections, bringing total active cases to 88,160. There were 52 fatalities but 26 more died at home. Kathmandu reported 4,198 cases in the last 24 hours. There are 832 people in ICU across the country, and 267 patients on ventilator support. In the village of Jaygad of Achham, for example, an annual fair with large crowds was being held even as 13 out of 15 sample antigen tests came out positive. The virus was spreading into the remotest villages. “We have increased awareness programs and testing, and local governments have become more active in the recent days and taken more ownership of testing and information dissemination,” says Janakraj Dhungana at Achham’s District Health Office.  But many wonder whether it is too late to be disseminating information through loudspeakers on masking and distancing, when patients and families throng ill-equipped hospitals. Dhungana himself admits that there was not enough testing and isolation because of a shortage of kits.  Like other districts of Far-Western Province, the caseload in Achham is increasing, with 2,183 positive cases and 17 deaths so far. Of this, 511 positive cases and 6 deaths are during this second wave.  The vaccination drive was also suspended after 3,000 medical personnel and community health workers were inoculated. But 15,000 senior citizens in Achham alone still have not got their second doses yet.  <figure><img width="1500" height="1000" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131116/636cec669c7e80680e09ad62jpeg.jpg" alt=""><figcaption>Bayalpata Hospital in Achham run by the non-profit Nyaya Health Nepal is treating a flood of Covid-19 cases.</figcaption></figure>The government has now asked all hospitals to also treat Covid-19 patients. Bayalpata Hospital in Achham, which is run by the non-profit Nyaya Health Nepal in partnership with the local government, was not a designated Covid-19 hospital during the first wave. This year, it is treating a flood of Covid-19 cases.“We had set aside an entire wing for coronavirus cases, but there has been such a surge in the past week that we have turned the emergency room into a Covid ward,” says Mandeep Pathak, medical director at Bayalpata Hospital. “We converted five rooms set aside for drug-resistant tuberculosis treatment for Covid patients.”Bayalpata is currently treating 26 patients with Covid-19, all of them with low oxygen saturation levels, but new cases are being admitted every day. The hospital has also had to reassign eight rooms for Covid-19 patients, including for 14 of its own staff who have tested positive. In Dadeldhura Hospital a four-hour drive to the west, all 31 beds are full with Covid-19 patients, and although there are only five ICU beds, 13 patients are receiving intensive care. In the neighbouring district of Doti, it is the same story.“Even if we have beds, we have no oxygen, it is a vicious cycle,” says Jagdish Bista, Medical Superintendent at Dadeldhura District Hospital. “The most urgent need now is oxygen, and we are also running out of PPEs.” But what worries the doctor more is the 50-70% positivity rate of testing, and what this means for the next two weeks.For the time being, the nursing staff shortage has been alleviated with new transfers. But Dadeldhura Hospital’s oxygen plant cannot cope with demand, and there are difficulties to get cylinders refilled in Nepalganj and Dhangadi. Covid-19 has taken precedence over other cases, apart from emergencies and deliveries. Most patients are in the 30-year-old range, and those turned away seek help in Dhangadi’s Seti Hospital, which is also inundated.Patients who can get to hospital and get admitted in this remote region are the lucky ones. Local municipalities have built isolation centres, but most are empty because there is no oxygen and no medical personnel, says Devraj Devkota of Panchadeval Binayak municipality. <figure><img width="1753" height="2409" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131116/636cec699c7e80680e09ad63jpeg.jpg" alt=""><figcaption>Achham District made this urgent plea for equipment last week.</figcaption></figure>“Our people prefer to either isolate at home or try to get to a hospital if their condition deteriorates,” he adds. “We have had no help from Kathmandu.”But Nepal’s cities, including in the capital, are also out of hospital beds and oxygen, so there is little hope for outside help. In fact, a reverse flow is starting: critical Covid-19 patients in Kathmandu are being helicoptered to Jhapa or Kaski where there are still hospital beds with oxygen.The need in every municipality in the far west is the same: oxygen cylinders, pulse oximeters and testing kits, and additional hospital beds for serious cases.Says Achham’s District Health Officer Dhungana: “Oxygen is a problem. We depend on Dhangadi and Nepalganj to refill cylinders. They get used up fast, which has made it a logistical challenge.” There is also a critical shortage of staff. Despite vacancy notices, there were few applicants for specialised medical personnel even pre-pandemic. For example, although the District Hospital in Mangalsen has ventilators, there is no one to run them, and there isn’t enough oxygen.Patient referrals to city hospitals offering critical care, or just beds with oxygen, are also complicated. They are also overwhelmed, and there are few ambulances with oxygen for the 8-12 hour journey across mountain highways. Ambulances are expensive, and helicopter air lifts are even more costly. Despite this, desperate families have taken loans to try to save family members in critical conditions by air lifting them to city hospitals—often too late. Then there are all the other non-Covid trauma patients needing urgent surgery, or maternity cases. With its free treatment, Bayalpata Hospital has served more than 1 million patients from Achham and six surrounding districts of Karnali and Far-West Provinces in the past 12 years. Separating Covid-19 and other cases is a challenge for doctors like Mandeep Pathak (pictured right) who do not like to turn patients away. Even though the height of the pandemic this week, the orthopaedic surgeon has performed 15 operations, including on a 13-year-old boy from Kalikot with a fractured leg. In the past month, Bayalpata Hospital has performed 77 deliveries, of which eight were caesarean sections. “The staff adjust, innovate, accommodate, reallocate, adapt and have kept working right through the pandemic,” Pathak says. <img width="1906" height="1398" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131116/636cec6c9c7e80680e09ad64jpeg.jpg" alt="">New health protocols have been adapted to minimise disruptions, and Bayalpata is seeking resources to help with the crisis. There is fear that regular services will be increasingly impacted as the pandemic peaks.  The lockdown also means that families may wait till the very last moment to take patients to hospitals, by when it is usually too late. Bayalpata Hospital has therefore modified some of its regular services to remote care via phone calls. Bayalpata Hospital’s community health program, for example, that provides regular group antenatal care to pregnant women has been severely impacted. While the program was offered throughout the first wave, it has been interrupted during the second wave, and staff have had to resort to phone-based counselling and follow-up unless in case of emergencies.  The fear is that far-flung and traditionally neglected districts like Achham will be the last to get test kits, PPEs, oxygen, hospital beds and eventually vaccines. The progress Nepal has made over decades in rural healthcare is being undone by the pandemic.  For offers of assistance to hospitals in Far-Western Nepal, contact: Bayalpata Hospital: <a target="_blank" rel="noopener noreferrer">srijana.devkota@nyayahealthnepal.org</a> +977 9851093920   Dadeldhura Hospital: +977 9858753201 (Dr Jagadish Bista) <a href="https://give2asia.org/covid-19-pandemic-response-nepal/" target="_blank" rel="noopener noreferrer">https://give2asia.org/covid-19-pandemic-response-nepal/</a>

At the Covid-19 frontlines in rural Nepal

<figure><img width="1641" height="1000" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111140/636b84419c7e80680e067784jpeg.jpg" alt=""/><figcaption>Services provided from outside of OPD due to Covid cases. Photos: NYAYA HEALTH NEPAL</figcaption></figure>Nepal’s rural health system, already underfunded, understaffed and overstretched, is struggling with the enormous added burden of the Covid-19 pandemic.  Having barely coped with the first wave last year, hospitals in the remote mountains of Far-Western Province have found that the variants in the second wave are much more lethal, there are many more patients than before, and more of them require hospitalisation.  In Achham district the administration declared a lockdown on 3 May, but by then the virus was already spreading within families and house-to-house. Till the day before the lockdown, people were still arriving by the busloads from India, Kathmandu and other cities. Testing and tracing were lax, and they were mingling in the markets.  On Sunday, Nepal added 8,850 new confirmed infections, bringing total active cases to 88,160. There were 52 fatalities but 26 more died at home. Kathmandu reported 4,198 cases in the last 24 hours. There are 832 people in ICU across the country, and 267 patients on ventilator support. In the village of Jaygad of Achham, for example, an annual fair with large crowds was being held even as 13 out of 15 sample antigen tests came out positive. The virus was spreading into the remotest villages. “We have increased awareness programs and testing, and local governments have become more active in the recent days and taken more ownership of testing and information dissemination,” says Janakraj Dhungana at Achham’s District Health Office.  But many wonder whether it is too late to be disseminating information through loudspeakers on masking and distancing, when patients and families throng ill-equipped hospitals. Dhungana himself admits that there was not enough testing and isolation because of a shortage of kits.  Like other districts of Far-Western Province, the caseload in Achham is increasing, with 2,183 positive cases and 17 deaths so far. Of this, 511 positive cases and 6 deaths are during this second wave.  The vaccination drive was also suspended after 3,000 medical personnel and community health workers were inoculated. But 15,000 senior citizens in Achham alone still have not got their second doses yet.  <figure><img width="1500" height="1000" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111140/636b84449c7e80680e067785jpeg.jpg" alt=""><figcaption> </figcaption></figure>The government has now asked all hospitals to also treat Covid-19 patients. Bayalpata Hospital in Achham, which is run by the non-profit Nyaya Health Nepal in partnership with the local government, was not a designated Covid-19 hospital during the first wave. This year, it is treating a flood of Covid-19 cases.“We had set aside an entire wing for coronavirus cases, but there has been such a surge in the past week that we have turned the emergency room into a Covid ward,” says Mandeep Pathak, medical director at Bayalpata Hospital. “We converted five rooms set aside for drug-resistant tuberculosis treatment for Covid patients.”Bayalpata is currently treating 26 patients with Covid-19, all of them with low oxygen saturation levels, but new cases are being admitted every day. The hospital has also had to reassign eight rooms for Covid-19 patients, including for 14 of its own staff who have tested positive. In Dadeldhura Hospital a four-hour drive to the west, all 31 beds are full with Covid-19 patients, and although there are only five ICU beds, 13 patients are receiving intensive care. In the neighbouring district of Doti, it is the same story.“Even if we have beds, we have no oxygen, it is a vicious cycle,” says Jagdish Bista, Medical Superintendent at Dadeldhura District Hospital. “The most urgent need now is oxygen, and we are also running out of PPEs.” But what worries the doctor more is the 50-70% positivity rate of testing, and what this means for the next two weeks.For the time being, the nursing staff shortage has been alleviated with new transfers. But Dadeldhura Hospital’s oxygen plant cannot cope with demand, and there are difficulties to get cylinders refilled in Nepalganj and Dhangadi. Covid-19 has taken precedence over other cases, apart from emergencies and deliveries. Most patients are in the 30-year-old range, and those turned away seek help in Dhangadi’s Seti Hospital, which is also inundated.Patients who can get to hospital and get admitted in this remote region are the lucky ones. Local municipalities have built isolation centres, but most are empty because there is no oxygen and no medical personnel, says Devraj Devkota of Panchadeval Binayak municipality. <figure><img width="1753" height="2409" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111140/636b84479c7e80680e067786jpeg.jpg" alt=""><figcaption> </figcaption></figure>“Our people prefer to either isolate at home or try to get to a hospital if their condition deteriorates,” he adds. “We have had no help from Kathmandu.”But Nepal’s cities, including in the capital, are also out of hospital beds and oxygen, so there is little hope for outside help. In fact, a reverse flow is starting: critical Covid-19 patients in Kathmandu are being helicoptered to Jhapa or Kaski where there are still hospital beds with oxygen.The need in every municipality in the far west is the same: oxygen cylinders, pulse oximeters and testing kits, and additional hospital beds for serious cases.Says Achham’s District Health Officer Dhungana: “Oxygen is a problem. We depend on Dhangadi and Nepalganj to refill cylinders. They get used up fast, which has made it a logistical challenge.” There is also a critical shortage of staff. Despite vacancy notices, there were few applicants for specialised medical personnel even pre-pandemic. For example, although the District Hospital in Mangalsen has ventilators, there is no one to run them, and there isn’t enough oxygen.Patient referrals to city hospitals offering critical care, or just beds with oxygen, are also complicated. They are also overwhelmed, and there are few ambulances with oxygen for the 8-12 hour journey across mountain highways. Ambulances are expensive, and helicopter air lifts are even more costly. Despite this, desperate families have taken loans to try to save family members in critical conditions by air lifting them to city hospitals—often too late. Then there are all the other non-Covid trauma patients needing urgent surgery, or maternity cases. With its free treatment, Bayalpata Hospital has served more than 1 million patients from Achham and six surrounding districts of Karnali and Far-West Provinces in the past 12 years. Separating Covid-19 and other cases is a challenge for doctors like Mandeep Pathak (pictured right) who do not like to turn patients away. Even though the height of the pandemic this week, the orthopaedic surgeon has performed 15 operations, including on a 13-year-old boy from Kalikot with a fractured leg. In the past month, Bayalpata Hospital has performed 77 deliveries, of which eight were caesarean sections. “The staff adjust, innovate, accommodate, reallocate, adapt and have kept working right through the pandemic,” Pathak says. <img width="1906" height="1398" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111140/636b844b9c7e80680e067787jpeg.jpg" alt="">New health protocols have been adapted to minimise disruptions, and Bayalpata is seeking resources to help with the crisis. There is fear that regular services will be increasingly impacted as the pandemic peaks.  The lockdown also means that families may wait till the very last moment to take patients to hospitals, by when it is usually too late. Bayalpata Hospital has therefore modified some of its regular services to remote care via phone calls. Bayalpata Hospital’s community health program, for example, that provides regular group antenatal care to pregnant women has been severely impacted. While the program was offered throughout the first wave, it has been interrupted during the second wave, and staff have had to resort to phone-based counselling and follow-up unless in case of emergencies.  The fear is that far-flung and traditionally neglected districts like Achham will be the last to get test kits, PPEs, oxygen, hospital beds and eventually vaccines. The progress Nepal has made over decades in rural healthcare is being undone by the pandemic.  For offers of assistance to hospitals in Far-Western Nepal, contact: Bayalpata Hospital: <a target="_blank" rel="noopener noreferrer">srijana.devkota@nyayahealthnepal.org</a> +977 9851093920   Dadeldhura Hospital: +977 9858753201 (Dr Jagadish Bista) <a href="https://give2asia.org/covid-19-pandemic-response-nepal/" target="_blank" rel="noopener noreferrer">https://give2asia.org/covid-19-pandemic-response-nepal/</a>

<figure><img width="1500" height="1125" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110912118/636b8ab19c7e80680e06b255jpeg.jpg" alt=""/><figcaption>Sodasha Higher Secondary School in western Nepal is undergoing retrofitting as an earthquake preparedness model for future quakes in the region. Photo: NSET</figcaption></figure>With the <a href="https://www.nepalitimes.com/latest/western-nepal-potential-covid-19-outbreak/" target="_blank" rel="noopener">detection of three new COVID-19 cases</a> in Kailali district on Saturday, one of them the country’s first case of community transmission, western Nepal could be the epicentre for two disasters: a coronavirus hot spot, and a ticking time bomb for a mega-earthquake.This is not scare-mongering. Public health experts say western Nepal’s rudimentary healthcare system will be overwhelmed by a possible COVID-19 outbreak because at least 120,000 Nepali workers have returned from India without screening before both countries went into lockdown.   The government is extending rapid diagnostic testing to hospitals in Nepalganj, Dhangadi, Surkhet and Dadeldhura and there may be a surge in positive cases in the days ahead.<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/here-now/returnees-may-be-taking-coronavirus-to-rural-nepal/" target="_blank" rel="noopener">Returnees maybe taking coronavirus to rural Nepal</a>, Mukesh Pokhrel and Sonia Awale<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/banner/rebuilding-five-years-after-2015-quake/" target="_blank" rel="noopener">Rebuilding five years after 2015 quake</a>, Alisha SijapatiHowever, there is another Damocle’s Sword that has been hanging over the region even before novel coronavirus – the likelihood of a catastrophic mega-earthquake. As Nepal marks the fifth anniversary of its 2015 earthquake, seismologists have warned that an even bigger megaquake is not a question of ‘if’ but ‘when’.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110912118/636b8ab39c7e80680e06b256jpeg.jpg" alt="" width="252" height="128">The region between Pokhara and Nepal’s western border with India has not had a major earthquake since 1505 when an estimated 8.9M temblor killed one third of Kathmandu Valley’s population including the king, devastated north India, and created the debris fan from a cataclysmic flood on which Pokhara city is situated today.Speaking with Nepali Times, seismologist <a href="https://www.nepalitimes.com/editorial/aint-seen-nothing-yet/" target="_blank" rel="noopener">Roger Bilham warned</a> five years ago that the 2015 was not the Big One. He said the seismic gap in western Nepal had accumulated tremendous tectonic energy that had not been released for 500 years, and an earthquake was long overdue.<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/here-now/past-disasters-foretold/" target="_blank" rel="noopener">Past disasters foretold</a>, Om Astha Rai<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/editorial/aint-seen-nothing-yet/" target="_blank" rel="noopener">Ain't seen nothing yet</a>, Editorial“There’s a plenty of stress stored for an earthquake above 8 magnitude in western Nepal, and it could kill at least 100,000 people in Nepal alone,” says Surya Narayan Shrestha of the National Society for Earthquake Technology (NSET). “But despite being the most at risk, western Nepal is less prepared and has relatively low awareness about earthquake safety, and this doubles its vulnerability.”In two weeks, Nepal will mark the <a href="https://www.nepalitimes.com/banner/rebuilding-five-years-after-2015-quake/" target="_blank" rel="noopener">fifth anniversary of the 25 April 2015 earthquake</a> yet neither the government nor the people seem to have learnt the lesson. Western Nepal, in particular, is ill-equipped to handle another major earthquake. <img width="640" height="480" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110912118/636b8ab49c7e80680e06b257jpeg.jpg" alt=""><figure><img width="640" height="360" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110912118/636b8ab79c7e80680e06b258jpeg.jpg" alt=""><figcaption> </figcaption></figure>A major earthquake of greater than An 8M quake in <a href="https://www.nepalitimes.com/here-now/past-disasters-foretold/" target="_blank" rel="noopener">western Nepal</a> would be felt even more strongly in Kathmandu Valley than the 7.8M disaster five years ago. Still, disaster preparedness experts say attention should now turn from the 14 districts in Central Nepal affected in 2015 to western Nepal.Before the COVID-19 lockdown, Nepal had begun to retrofit 2,200 classrooms in around 200 schools in four western districts Bardia, Surkhet, Jumla and Achham to be completed in four years with funding support of DFID UKAID under the Nepal Safer Schools Project (NSSP). NSSP is being implemented by a consortium led by Crown Agents together with NSET, Save the Children and Arup International and is aligned with and contribute to the Government of Nepal’s School Sector Development Plan (2016-2023) which includes a focus on School Safety and Disaster Risk Reduction. Prior to 2015, NSET had similarly retrofitted around 300 schools in Kathmandu Valley and surrounding areas which survived the earthquake and served as emergency shelters. However, <a style="letter-spacing: 0.01em;" href="https://archive.nepalitimes.com/article/nation/earthquake-an-opportunity-to-rebuilt-education-system-not-just-fallen-schools,2336" target="_blank" rel="noopener">nearly 8,000 schools were completely destroyed</a> in 2015, and colossal loss of lives was averted only because the earthquake struck on a Saturday.<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/here-now/quake-was-a-learning-experience-for-nepals-schools/" target="_blank" rel="noopener">Quake was a learning experience for Nepal's schools</a>, Prakriti Kandel“We selected the schools in western based on vulnerability, potential for replication, availability of masons and enthusiasm of the school management committee,” adds Shrestha. “Next step is to scale this up and this means more investment, technical support and massive mobilisation of human resources.”Hospitals in western Nepal at the moment are all on red alert for a possible outbreak of COVID-19 in the region and healthcare workers are keenly aware of shortages of live-saving medical equipment such as test kits, ventilators, ICU beds, oxygen and personal protective gear. In an event of a major earthquake, this situation will be even worse because the hospital buildings themselves may be damaged.Three components within a healthcare facility determine if a hospital will be functional during an earthquake: seismic resistance of the building, state of power supply and medical equipment, and an emergency preparedness system with health workers trained for mass casualties.Dadeldhura hospital has been identified as a disaster management hub in Far West Nepal with satellite facilities in other district hospitals.“For the kind of earthquake projected here, none of us is prepared, western Nepal the least of all. We might have big hospitals in city centres but can the buildings withstand the quake is the real question,” says Bikash Gauchan of Bayalpata hospital in Achham.Few weeks before the earthquake struck in 2015, <a href="https://www.nepalitimes.com/banner/this-is-how-to-upgrade-nepals-rural-health/" target="_blank" rel="noopener">Bayalpata hospital had undergone reconstruction</a> to turn the institution into an eco-friendly, earthquake resistant facility. A disaster management protocol was also drawn up for triage in its emergency, as well as in and out patient buildings.Gauchan says hospitals in the Far West have to be prepared for multiple disasters: “We can’t overhaul our system every time a disaster strikes, be it the coronavirus or an earthquake. We need a standard operating protocol based on concrete national guidelines.”Back in 2003, Nepal government in collaboration with WHO had conduced earthquake vulnerability assessment of 15 major hospitals across the country that recommended they all be retrofitted. More than 15 years later, <a href="https://archive.nepalitimes.com/article/nation/preparedness-saves-lives,2264" target="_blank" rel="noopener">except from minor strengthening of health clinics</a>, nothing has been done.Hope now rests on the newly formed National Risk Reduction and Disaster Management Authority (DMA) which will replace the National Reconstruction Authority set up after 2015. Experts hope the focus will now shift to strengthening infrastructure of public buildings, transmission lines, telecommunication, sewage and water supply.Says Surya Narayan Shrestha at NSET: “We spent the last fives years mostly in the reconstruction of residential building and heritage sites in Central Nepal. Our priority now is on reinforcing infrastructure and ensuring essential services are better equipped to survive the next big one.” <h2>Preparing to be prepared</h2> <img width="1754" height="1146" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110912118/636b8aba9c7e80680e06b259jpeg.jpg" alt="">Nepal was just beginning preparations for risk reduction and management of disasters like earthquakes, floods, landslides and epidemics when the 2015 earthquake struck. This year, the Disaster Management Authority (DMA) has been formed which has listed 22 different kinds of disasters Nepalis are exposed to.The winter of 2017 saw 48 fatalities in a cold wave in the Tarai. Two years later, no one died in a similar cold wave. The Home Ministry’s Disaster Risk Reduction and Management Working Committee is credited with such pre-preparedness for blizzards, cold and heat waves, and monsoon floods.An average of 700 people die every year in Nepal due to disasters, most of these are weather related. The climate crisis is exacerbating extreme rainfall events, and the ministry has drawn up a Monsoon Emergency Workplan to address increased frequency and intensity fo floods.“We have to be prepared, and preparation is most effective when it is at the local level since they are the first responders,” says Anil Pokhrel of the DMA. With the help of the British aid agency DfID and the world Food Programme (WFP) the government is setting up Humanitarian Staging Areas in all seven provinces for stockpiling food and relief material for disasters. The central station was in operation at Kathmandu airport during the 2015 earthquake.New staging areas  in Dhangadi and Nepalganj were inaugurated by British Ambassador Nicola Pollitt and WFP’s Pippa Bradford recently (pictured above). Western Nepal is important because of the special seismic risk there. Each staging area can address the emergency needs of up to 70,000 people at a time. The staging areas house tents,  health and sanitation kits, water purifying equipment, fuel storage, satellite phones, search and rescue equipment and pre-positioned water supply.Proximity to the airport allows the relief material to be helicoptered out to the affected areas, and also to be resupplied from Kathmandu, quickly.Laxmi Basnet in Dhangadi

Sonia Awale

Epicentre of two disasters in West Nepal

Lack of access to and awareness of family planning, the prevalence of unhealthy superstitions and taboos, and the desire to produce a son together explain why Nepal’s average fertility rate has stalled after a steep drop in the last decades.Many families in the far western hills and the central Tarai still believe that contraceptive use is against god’s wishes. These areas also tend to be steeped in patriarchy, with low female literacy rates and a high incidence of child marriage.It is a vicious cycle: women are anemic, malnourished, uneducated, disempowered, physically weak because of annual pregnancies, and poor. And they do not use family planning methods even when they are available at rural health posts.Read also:<a style="background-color: #ffffff; font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/opinion/miracle-drug-to-reduce-maternal-deaths/" target="_blank" rel="noopener">Miracle drug to reduce maternal deaths</a>, Buddha Basnyat<a href="https://www.nepalitimes.com/here-now/who-will-save-nepals-poor-new-mothers/" target="_blank" rel="noopener">Who will save Nepal’s poor pregnant women … a government plan, or God?</a>, Rojita Adhikari<a href="http://archive.nepalitimes.com/blogs/thebrief/2011/09/22/nepals-work-in-maternal-health-noticed/" target="_blank" rel="noopener">Global recognition for Nepal’s maternal health program</a>, Nepali TimesIn these villages in the mountains of Bajura, Achham and Baitadi there are many families where a mother and her daughter are giving birth simultaneously. The region’s medical services are also basic, which means a low incidence of institutional delivery and a maternal mortality rate that remains more than twice the national average.The government offers five types of contraception for free in health posts: condoms, pills, injectables, implants and intrauterine contraceptive devices (IUCDs). However, belief that contraceptives affect health or the unavailability of the desired device means many do not opt for family planning.“Every day an average of five women come to our health post to ask about long-acting contraceptives like IUCDs or implants, but we either do not have the devices or the trained health workers to insert them,” shrugs Sabina Thapa, a nurse at a Bajura health post. “Even women on pills miss the timeline and get pregnant.”Read also: <a href="https://www.nepalitimes.com/here-now/nepal-far-from-hitting-contraceptive-target/" target="_blank" rel="noopener">Nepal far from hitting contraceptive target</a>, Sewa Bhattarai<a href="http://archive.nepalitimes.com/news.php?id=14551#.Xk6ENzIzbIU" target="_blank" rel="noopener">Treating pain and shame</a>, Mallika AryalCurrently, 43% of all married women of reproductive age in Nepal use modern contraceptives, and another 10 % use traditional family planning methods. A 2016 survey showed that there is a 44% unmet need for family planning measures in Nepal.A recent report by the <a href="https://www.guttmacher.org/fact-sheet/adding-it-up-meeting-contraceptive-mnh-needs-nepal" target="_blank" rel="noopener">Guttmacher Institute</a> showed that Nepali women have 1.2 million pregnancies each year, of which 539,000 are unintended. Nearly a quarter of these result in unplanned births and two-thirds are aborted.“Actually, we have achieved a lot with the little money we have invested,” explains Bhim Singh Tinkari of the Family Welfare Division in Kathmandu. “But the money is mainly to buy contraception and family planning products. There is a huge gap in contraceptive supply, public awareness and trained health workers.”“If all unmet need for modern contraception were met, unintended pregnancies would be reduced by 87%, or 469,000 annually, and unplanned births, abortions and miscarriages would decline by the same proportion. Fully meeting women’s need for contraception would reduce maternal deaths,” The Guttmacher Institute report concludes.To address the unmet need would cost only $30million according to a survey, but this is five times more than the government’s current family-planning budget. Without this funding Nepal is unlikely to meet the Sustainable Development Goals (SDG) target of 75% contraceptive prevalence.“The situation has become more complicated than before with the new federal system. Local health needs are now the responsibility of provincial and municipality governments, but work has not started yet,” says Tinkari. “We need the money and we need to act soon if we are to meet the 2030 target.”<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101136/636b75319c7e80680e0623d8jpeg.jpg" alt="" width="1500" height="1000"/><figcaption>Kewara Koli, 34, is already mother to seven daughters and one son. Her eldest daughter, Laxmi, is in Grade 10 at a local school in Baitadi. Laxmi advised her mother to get an implant from a nearby health post. “My mother was giving birth every two years, and she became weaker after every baby,” says Laxmi (standing at back).</figcaption></figure><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101136/636b75349c7e80680e0623d9jpeg.jpg" alt="" width="1500" height="1000"><figcaption> </figcaption></figure><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101136/636b75379c7e80680e0623dajpeg.jpg" alt="" width="1500" height="1000"><figcaption> </figcaption></figure><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101136/636b753b9c7e80680e0623dbjpeg.jpg" alt="" width="1500" height="1000"><figcaption> </figcaption></figure><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101136/636b753e9c7e80680e0623dcjpeg.jpg" alt="" width="1500" height="1000"><figcaption> </figcaption></figure>Read also: <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/globe-rallies-to-aid-nepals-women,3841" target="_blank" rel="noopener">Cutting the lifeline</a>, Kate Ryan<a href="http://archive.nepalitimes.com/article/nation/people-politics-placentas-child-delivery-complications,3922" target="_blank" rel="noopener">People, Politics, and Placentas</a>, Bikash Gauchan

No conceivable reason for unwanted pregnancies

https://youtu.be/1jdbg4DVyecPeer pressure drove Sudip to start drinking at a young age. Soon, he was an addict and lost his job at a travel agency. His personal relationships soured and health deteriorated. He dabbled in various trades, but was often inebriated from early morning. He did sober up. When the <a href="http://archive.nepalitimes.com/blogs/kundadixit/2015/05/27/a-month-that-felt-like-a-year/" target="_blank" rel="noopener">earthquake struck in 2015</a>, he was travelling with his infant son. The shock drove him to drink again. Sudip has been in and out of rehab, but nothing worked until he was tasked with organising <a href="http://www.aanepal.org/" target="_blank" rel="noopener">Alcoholics Anonymous (AA) meetings</a> in Kathmandu. The challenge finally made it possible to overcome his own addiction.Read also: <a href="https://www.nepalitimes.com/editorial/octoberfest/" target="_blank" rel="noopener">Octoberfest</a>, Editorial“I used to find solution in drinking. Now, I know that not drinking is the solution,” says Sudip, now in his mid 40s and 15-months sober. We caught up with Sudip during one of his meeting with AA in Patan this week where 23 men from their 20s to 60s were seated in rows. While the oldest member spoke about how he had not had a drink for 10 years, a newly-sober member talked about how difficult it had been for him. Each was met with applause. <a href="http://www.who.int/news-room/detail/21-09-2018-harmful-use-of-alcohol-kills-more-than-3-million-people-each-year--most-of-them-men" target="_blank" rel="noopener">Alcohol kills more than three million people every year around the world</a>, mostly men. <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31571-X/fulltext" target="_blank" rel="noopener">A recent paper in the journal Lancet</a> reported that no level of alcohol improves health, challenging the notion that moderate drinking is good for the heart.  <figure><img width="1400" height="1050" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221107171116/63692f8b9c7e80680e03c0afjpeg.jpg" alt=""/><figcaption>Binge drinking during Dasain causes many cured alcoholics to suffer relapses. Photo: KUNDA DIXIT</figcaption></figure>Some <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31310-2/fulltext" target="_blank" rel="noopener">21% of men in Nepal are regular drinkers</a>, but only 1.5% of women. The annual per capita alcohol consumption among Nepalis is 2.2 litres, but increases to 28.8 litres among drinkers (36.2 litres in men). Nearly 1% of Nepalis suffer from alcohol dependence, according to WHO, but this seems to be an underestimate as it does not count <a href="http://archive.nepalitimes.com/news.php?id=14913#.W8CRk3szaUl" target="_blank" rel="noopener">homemade alcohol</a>. “There has been an increase in alcohol consumption in Nepal and it is a bigger risk factor than <a href="https://www.nepalitimes.com/here-now/nepali-scientist-returns-to-pinpoint-hazards-of-dirty-air/" target="_blank" rel="noopener">smoking</a>, <a href="https://www.nepalitimes.com/here-now/nepali-scientist-returns-to-pinpoint-hazards-of-dirty-air/" target="_blank" rel="noopener">air pollution</a> or adulterated food. Plus it leads to an increase in crime rate,” says psychiatrist Rabi Shakya at Patan Hospital. Read also: <a href="https://www.nepalitimes.com/banner/festivals-of-sisterhood/" target="_blank" rel="noopener">Festivals of sisterhood</a>, Sewa Bhattarai and Sabina DevkotaThe challenge is that cultural drinking is accepted, people use it as self-medication, and social drinking has become the norm. Sale of alcohol shoots up during festivals like Dasain and Tihar.“Alcohol-related problems are a common cause of hospital admissions, and it is rising with liver cirrhosis and mouth cancer and infectious diseases,” says Buddha Basnyat, a physician at the Patan Academy of Health Sciences. Binge drinking during festivals like Dasain are worrisome because that is when cured alcoholics are most susceptible to suffer relapse. “Dasain is a trigger, a temptation for all the recovering alcoholics like us,” admits Samir Timilisina, Chair of Alcoholics Anonymous in Kathmandu. AA began in Nepal in 1970s and holds meetings six days a week at Patan Hospital, Teaching Hospital and Lazimpat. There are currently 60 regular members. Timilsina himself struggled with addiction for 25 years and has been sober for the past 14 months. “AA meetings are for those who have realised their problem, want to quit but are unable to do so. We share each other’s stories and draw inspiration from that,” he explains. Read also: <a href="https://www.nepalitimes.com/here-now/the-sacrifice-of-animal-sacrifices/" target="_blank" rel="noopener">The sacrifice of animal sacrifices</a>, Aashish MishraSenior cardiologist Prakash Regmi at Bir Hospital is busiest this time of the year. Patients with Holiday Heart Syndrome, a condition with abnormal and high heartbeat due to excessive drinking, crowd his clinic. They need immediate treatment, or may die due to heart failure or stroke.“Our mentality that festivals cannot be celebrated without booze needs to be wiped out,” says Regmi.Mark Zimmerman has been practicing medicine in Nepal for 32 years, and has found alcoholism to be common, but difficult to treat. “<a href="http://archive.nepalitimes.com/news.php?id=4584#.W8CL2HszaUk" target="_blank" rel="noopener">It is a disease</a>, but excessive drinking is considered a habit, a coping mechanism to deal with stress, and therein lies the biggest problem,” explains Zimmerman, who has noticed a rise in female alcoholics among his patients. “At any given time, up to 10% of patients here are alcohol related, and most have damaged 3-4 organs due to excessive drinking. But this is just a tip of the iceberg because those are only who come to hospital,” he adds.Read also: <a href="https://www.nepalitimes.com/banner/no-dasain-in-kalikot/" target="_blank" rel="noopener">No Dasain in Kalikot</a>, Seetashma ThapaAlcoholism is especially prevalent in impoverished western Nepal, where rice sent by the government to tide over food insecurity is often distilled into bootleg alcohol. Until six years ago, Accham was a dry district, but that led to the sale of spurious liquor, leading to a huge disease burden.“Alcohol is a major source of revenue generation. But we have not thought about the much higher price we are paying for treatment,” says Bikash Gauchan of Bayalpata Hospital in Achham.The government adopted a stricter policy for alcohol sales last year, making it mandatory for manufacturers to put pictorial warnings covering at least 75% of the bottle like in cigarette packs, and to ban liquor advertising. People under 21 are not allowed to buy alcoholic products, and retailers cannot sell alcohol from 5AM to 7PM. While some rules have come into effect, the alcohol industry has fought back. Increasing the tax on alcohol has worked in most countries, but here it could force users to turn to unsafe moonshine. A complete ban in Bihar has actually resulted in massive smuggling of Nepal-made beer and spirits across the border. Says psychiatrist Raju Shakya: “Alcoholism should be the number one public health agenda. If we can reduce alcohol consumption, it will remove many health issues.”Read also:<a href="http://archive.nepalitimes.com/news.php?id=4584#.W8CSDXszaUl" target="_blank" rel="noopener">Nepal's anonymous alcoholism</a>, Hemlata Rai<a href="http://archive.nepalitimes.com/news.php?id=14913#.W8CRk3szaUl" target="_blank" rel="noopener">Sobering thought</a>, Tom-Owen Smith <figure><img width="463" height="768" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221107171116/63692f909c7e80680e03c0b0jpeg.jpg" alt=""><figcaption> </figcaption></figure>

Go easy on the booze this holiday season

https://youtu.be/4adGA4P0k54The buses to <a href="http://archive.nepalitimes.com/blogs/thebrief/2013/06/17/distress-call-from-darchula/" target="_blank" rel="noopener">Darchula</a>, <a href="http://archive.nepalitimes.com/news.php?id=10816#.W5EAds4zbIU" target="_blank" rel="noopener">Baitadi</a>, <a href="http://archive.nepalitimes.com/news.php?id=16115#.W5D_Ss4zbIU" target="_blank" rel="noopener">Doti </a>or <a href="http://archive.nepalitimes.com/blogs/kundadixit/2013/03/13/not-so-far-west/" target="_blank" rel="noopener">Dadelhura </a>were all packed last week for the annual Gaura Festival of womanhood, celebrated in Western Nepal, and wherever people from the west of Nepal live.Across the districts of Far Western Nepal, towns are deserted and villages are abuzz with women engaged in weeklong fasting, feasting and revelry. This religious festival has deep agrarian roots, and celebrates the closes ties women have to the land and their crops.Saraswati Bhatta is shaping an image of the Goddess Gaura from rice stalks and decorating it like a bride with a red dress and jewelry. The doll god is then treated like a woman visiting her maternal home for her family’s pampering.Gaura is another name for Gauri, Shiva’s consort. Unlike Tij, which is marked on 14 September in the rest of Nepal, the Gaura Festival is more ritualistic with women soaking grains, fasting and then eating the sprouts. Unlike Tij, on the main day the men fast too until their wives’ puja ends.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221107161116/6369215f9c7e80680e03a0cajpeg.jpg" alt="" width="1500" height="1000"/><figcaption>A woman throws down her walking stick to join hands with other women and sing along. All pics: BIKRAM RAI</figcaption></figure>But like Tij, Gaura is essentially a festival of, by and for women. Gaura songs are performed at predetermined times encapsulating the lifestyle and values of the entire community here in the remote mountains of western Nepal. The songs are about the courtship of Gaura and Maheswor (Siva and Parvati for easterners), a woman’s experience of childbirth, and many other social events.The lyrics outline social customs like the dates of festivals, and behaviour expected from men and women. Some songs describe which food is found in what season, and even where to find water. The festival serves as an elaborate information and communication system set in song long before mass media served that purpose. The songs instill a knowledge of roles, values, and social mores, and help people feel rooted in the community.The Gaura platform still gives women in a society steeped in patriarchy a rare chance to voice their perspective and provide valuable insight into women’s lives and thoughts. On the fourth day of the festival, women dance with the image of Gaura and send her off to her husband’s home, singing songs of bereavement.However, the Gaura Festival, like Tij, while allowing women to let off steam hand serve an emancipating role, also establishes the gender status quo, instructing women them about their place in society.Read also: <a href="http://archive.nepalitimes.com/news.php?id=18795#.W5EfLM4zbIU" target="_blank" rel="noopener">Songs of our past</a>, Amar Gurung<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221107161116/636921629c7e80680e03a0cbjpeg.jpg" alt="" width="640" height="960"><figcaption> </figcaption></figure>The festival is followed by popular mela, and people from all over the region congregate here in Malikarjun of Darchula situated amidst lush mountains above the clouds. Food stalls and shops line the site, damaha players strike drum beats rousing people with deeply devotional music. The strong feeling of community is enhanced by women in traditional clothes and jewelry who do slow walk-dances while singing in circles for hours.“Both men and women sing songs of local histories and epic poems, and express their feelings spontaneously, this might seem like just entertainment, but it is also a way of preserving and passing down our history,” says Mohan Dhami, an expert of local culture.Despite its continuing popularity, the significance of Gaura in communicating the spirit of community is losing out to modern lifestyles with mobility and mass communication. However, it still carries a strong sense of identity for the people of Western Nepal wherever they may live.Read also: <a style="background-color: #ffffff; font-size: 15px; letter-spacing: 0.01em;" href="http://archive.nepalitimes.com/news.php?id=16252#.W5Eeys4zbIU" target="_blank" rel="noopener">Re-inventing Tij</a>, Mallika Aryal<a style="background-color: #ffffff; letter-spacing: 0.01em; font-size: 15px;" href="http://archive.nepalitimes.com/article/Nepali-Times-Buzz/songs-of-rebellion,3249" target="_blank" rel="noopener">Songs of rebellion</a>, Smriti Basnet<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221107161116/636921659c7e80680e03a0ccjpeg.jpg" alt="" width="1500" height="1000"><figcaption> </figcaption></figure><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221107161116/636921689c7e80680e03a0cdjpeg.jpg" alt="" width="1500" height="1000"><figcaption> </figcaption></figure><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221107161116/6369216c9c7e80680e03a0cejpeg.jpg" alt="" width="1500" height="1000"><figcaption> </figcaption></figure><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221107161116/6369216e9c7e80680e03a0cfjpeg.jpg" alt="" width="1500" height="1000"><figcaption> </figcaption></figure><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221107161116/636921729c7e80680e03a0d0jpeg.jpg" alt="" width="1500" height="1010"><figcaption> </figcaption></figure><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221107161116/636921759c7e80680e03a0d1jpeg.jpg" alt="" width="1500" height="1000"><figcaption> </figcaption></figure><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221107161116/636921789c7e80680e03a0d2jpeg.jpg" alt="" width="3000" height="2000"><figcaption> </figcaption></figure><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221107161116/6369217c9c7e80680e03a0d3jpeg.jpg" alt="" width="3000" height="2000"><figcaption> </figcaption></figure>

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