Nepal’s Integrity Idol


At a time when Nepal’s political leaders are throwing chairs and vandalising parliament property, and people disregard civil servants, one man has won the reputation as the country’s first Integrity Idol.

Gyan Mani Nepal, a district education official from the eastern district of Panchthar, didn’t have to woo people by singing or dancing to win public votes. But his honesty and commitment to reform his district’s education sector made him a winner.

“I haven’t done anything different, I’ve just done things differently,” Nepal said in a speech after he was declared the winner.

Nepal gained the maximum number of votes and was chosen among 303 nominees.

Here’s my story. 

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In Antwerp, coming close to art and culture

The afternoon drizzle had deserted the square in front of the Cathedral of Our Lady in Antwerp. For a moment I was the lone tourist gazing at the magnificent 14th Century church, struck by its intricate art and architectural details, inside and out. But then a group of middle-aged Japanese tourists came with their colourful umbrellas and compact digital cameras. They huddled over an area in front of the gigantic structure and started taking photos – not of the Roman Catholic church listed in the World Heritage Site but of a small plank in front it.

I later find that the dramatic climax of the book A Dog of Flanders by British-French writer Marie-Louise de la Ramée, hugely popular in Japan, is set in this premise. The tale of Nello and his dog Patrasche draws hundreds of fans to this city, an Antwerp native told me.

While the pathos of a bestselling book’s plotline attracts many visitors, this Flanders city, also Belgium’s second largest, still lags behind the Belgian capital Brussels by miles considering that it is only about 45 minute train ride from the capital. But I would have never visited this port town too if it weren’t for my friend, Ian, who told me that his city will not disappoint, and in less than 36 hours that I had, I would like the city, if not fall in love with it.

It was already dark when my bus reached its destination in Plantinkai— it was a seven-hour comfortable bus ride from London— and it was freezing. But my friend insisted that I should see what he called “the heart and soul” of the city.

I shivered staring at the long stretch of the Scheldt River with lights reflecting on Europe’s second busiest port after Rotterdam, Netherlands. This port holds significant economic value for the city and also the region, which prompted French Emperor Napoleon Bonaparte to build Antwerp’s first dock.

The next day, I returned to the dock – it reminded me of a seaside pier in the US but without the Ferris wheel and a noisy amusement park. I liked the calmness. There I sat munching on frites, or Belgian fries with some spicy sauce, listening to the ship horns at a distant and admiring the crimson sunset from a wooden bench overlooking the river. On the other side was a stunning view of Antwerp’s old quarter, including the towering Cathedral.

The previous evening, Ian had whizzed me on a whirlwind tour though the town centre. In less than an hour, through narrow cobbled streets and some dark alleys, he guided me though his city’s churches, squares and streets narrating bits and pieces of their history. The next day I would be on my own.

I had a rough sketch of the city from that quick, guided tour along with some mental notes. My task, as it seemed, was to find all these places of interest in the daytime. Without a map, venturing into the unknown, following Dutch signs that sounded vaguely familiar, I explored the city. I found myself astray in the alleyways while bumping into beautiful courtyards and buildings that line up the streets.

The starting point to my sightseeing was the magnificent Antwerp Central train station, aptly known as the Railway Cathedral. Built between 1895 and 1905, the architectural design and details are awe-inspiring; it’s a classic mix between the traditional stone exterior with a dome— it could be mistaken for a church— and a futuristic iron and glass panel in the waiting area inside the main terminal. Compared to the other historic stations I’ve visited, including the ones in London, New York, Moscow and Mumbai, I was glad to pause and ponder the grandeur of Antwerp Central without being rammed by a sea of commuters.

Just out of the station and without realising I was at Diamantkwartier, the city’s Diamond District, navigating through Pelikaanstraat to Hovenierstraat. Though the streets aren’t dazzled as Dubai’s Gold Souk, don’t get undermined by this 550-year-old marketplace with an estimated $54 billion annual turnover. As I peeked
through the glass windows and admired the sparkling diamonds and their “cuts” — though I have no knowledge of that whatsoever — I smirked with the thought that I don’t have to invest in one of those shiny stones anytime soon, not for now at least.

About 45 minutes from here, meandering the bike-friendly city, I walked down a narrow cobbled street that opened to the courtyard of St. Charles Borromeo. This grand architectural masterpiece is modelled after the Jesuit’s’ church in Rome festooned with the works of Antwerp’s much-revered painter Pieter Paul Rubens.

Rubens’s self-designed house and studio from the 17th Century is now the Rubenshuis Museum at the Wapper Square, and his statue stands tall minutes away at the Groenplaats, a square with a cluster of outdoor cafes and restaurants in proximity to the Cathedral of Our Lady.

Another popular square nearby, and one of my favourites, is the Grote Markt. In the centre of this Square is the fountain with the 1887 statue of Brabo, hurling a piece of a cut hand; he is a heroic figure and locals talk passionately about his story.

According to folklore, a giant named Antigoon collected money from people crossing the bridge over the Scheldt and cut their hands when they failed to pay. So when Brabo killed the demon, he did the same – he cut his hand and threw it away. This is how the city’s name was derived: Antwerp, meaning throwing of the hand. A stone replica of the hand is on The Meir, Antwerp’s fashion and shopping conclave, akin to Oxford Circus in London but less crowded.

Standing in the Grote Markt amid the centuries old elaborate gildenhuis, or guild houses, and the Renaissance Town Hall, the place could easily be characterised as a set from a classic period movie. It is however an immaculate slice of the bygone era that has been well preserved for countless generations to see.

On that limited time frame, I had crammed in everything that I could possibly see, at least Antwerp’s major attractions, all by foot though there are trams and buses that run frequently. And in between, I didn’t miss out on stuffing myself with Belgian waffles and chocolates. And sometime during the day, I also managed to take a stroll around Antwerp’s Chinatown, a short stretch of street with restaurants, supermarkets and nail salons; it is apparently the only one in Belgium. With a large number of multi-ethnic population – Jewish, Indians and Moroccans – the city is also considered as a melting pot of cultures and cuisines.

When the daylight diminished, which is quite early this time of the year (around 4:30pm), it was certainly time to taste some of the best Belgian beers. The menus at the bars are elaborate and it was impossible to try a lot of them looking at the alcohol content – some were as high as 18 percent. So I settled over a glass of Winterbok, a strong dark beer, as I detailed my day to Ian.

“You’ve seen more than what I had expected,” he told me. “I hope you liked it.”

And in that short period, I not only liked the city, as he had claimed, but also started to fall in love. However, it was time for another city. But I know that my love affair with Antwerp is to be continued, preferably some time summertime.

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City lights

There are countless hours of power cuts throughout the year. Evenings are usually dark and dismal. But then there is one night, the darkest of them all, when the city lights up. In that moment, we forget the darkness of the past and the numerable hours of load-shedding to follow in the coming days. We light the lamps, lit up the city and cherish the moment.

Let us enjoy the festival of lights. Let the lights reign over darkness. Happy Tihar.


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Ani Choying Drolma: The superstar nun


I first heard Ani Choying Drolma in 2004 — her song “Phool Ko Ankhama” had become viral of some sort. It was everywhere — on TV, radio and playing across the CD stores in New Road. It seemed like almost everyone was addicted to that song. Its simple lyric and haunting melody soothingly introduced us to a Buddhist nun, an unlikely music star among the likes of Nabin K. Bhattarai, Girish-Pranil and Kunti Moktan whose songs lingered on the music charts.

In 2005, I was leaving for the United States for higher education. I packed a lot of things which I thought would remind me of Nepal in a foreign country. And I also packed Ani Choying Drolma’s super-hit album Moments of Bliss. I’m not sure why I thought her music would remind me of home — maybe I packed it because I liked her songs.

But in that lonely two-bedroom apartment in the US when I played her songs, they really reminded me, in a very strange way, of being somewhere close to home. I cannot say exactly how, but it did: maybe it was just listening to those words or the music and chants that often echoed along the streets of Thamel and Boudha.

Exactly 10 years later since I first heard her, thanks to my profession, I had a chance of interviewing her. There she was in her apartment, profusely apologising to me for being late as soon as she entered. She said she was taking guitar lessons and that kept her occupied in the mornings.


As she made herself comfortable, we started chatting. Since we weren’t under a time constraint, I was at ease while talking to her. I have to admit, I was a bit nervous initially but as we chatted, there were bursts of laughter and moments of silence. In the two-hour timeframe, we covered a lot of topics — from her tormented childhood to music to her admiration for music, movies and food. And becoming a star, being branded as a ‘rock star nun.’

But then and there, she didn’t behave like one. Even in that formal setting, we chatted casually.

“You’re just like anyone,” I said when we were discussing about how people perceive about her and the notions of being a super star nun.

“Oh, thank you,” she laughed. “Thank god you think I’m a normal person – I am just like you and everyone else.”

Here’s my profile on Ani Choying Drolma for the South China Morning Post’s Post Magazine

VIDEO: Ani Choying Drolma on how she became a singer

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The street that leads to Pashupati

Pashupatinath temple

This piece was published in the Nepali Times as a part of Galli Salliharuma project.

“Galli Salliharuma is a public writing project that archives personal stories to build a walking-breathing map of Kathmandu as marked and narrated by its inhabitants and visitors. The project is an exercise at encountering and engaging with ideas of place, memory and belonging.”

Here I sketch, through words, and try to navigate and narrate the street that once led to Pashupatinath temple:

THERE WAS A TIME when the temple bells from Pashupati pierced through the windows of our old Newari house. Every morning, during winter recess, this sound was a call to go for a walk with my grandfather. Through the thick fog, all bundled up, I grabbed Baa’s wrinkled hand and followed him briskly through the stone-paved alleyways of Deopatan to the Pashupatinath temple.

Every day, my eyes met with the same string of ancestral Newari houses, familiar faces peeking through windows, and even more familiar smiles greeting us from the doors. Then there were small shops with wooden shutters; the busiest in the lot was Ganga Ram’s halwai pasal, distinctly famous for its halwa-swari combo.

When we reached Ganga Ram’s shop, we took the right instead of going through the packed street that led to the main temple. There were two reasons why I always dragged my old man that way. My favorite stationery shop was at the end of this lane, and I secretly took joy in shoplifting the smallest of things, like those fifty paisa filmy postcards. The second reason was to follow the road past the flower shops to the banks of the Bagmati to sail my paper boats. My little brain found both these activities adventurous. Especially the thrill of seeing my paper boats sail successfully, and then disappear into the river through the morning mist.

Times have changed and the hand that led me through these alleyways is not here anymore. The chain of old houses has now crumbled, and the shops have moved. This old place has a new character but little charm, including the river where I once sailed my paper boats. It now smells of sewage.

But I’ve kept these streets intact in my mind, the routes are mapped out in my memory. And today, in all its unfamiliarity, I can still see those shops, smell those sweets and sense the thrill in those boats sailing away. But when I open my eyes in the mornings, it’s usually to the punctuating sounds of vehicles and not the temple bells.

Photos: Training to become a Gurkha

Last June, while I was in Pokhara, I met some passionate young men who were training to prepare for the British Gurkha recruitment camp. Thousands of young hopefuls apply for the British Gurkha Army every year but a selected few are chosen after a rigourous recruitment process. I spent two days with these men who were giving their 100 percent to become the chosen ones. These photos are from an assignment in 2013. [Story link]

In Nepal, hundreds of young hopefuls have started to join pre-recruitment training institutions for the British Gurkha recruitment process. The training academies are like a mock-up of the actual recruitment camp, says Rahul Pandey, founder of Salute Gorkha, one such academy.

In Nepal, hundreds of young hopefuls have started to join pre-recruitment training institutions for the British Gurkha recruitment process. The training academies are like a mock-up of the actual recruitment camp, says Rahul Pandey, founder of Salute Gorkha, one such academy.

Rain or shine, these men believe in discipline and a strict training regiment, which they say will bring them a step closer to achieving their ultimate goal.

Rain or shine, these men believe in discipline and a strict training regiment, which they say will bring them a step closer to achieving their ultimate goal.

The British Gurkha selection process involves a number of physical activities that includes heaving, push-ups and the doko race among others.

The British Gurkha selection process involves a number of physical activities that includes heaving, push-ups and the doko race among others.

Hundreds of young Nepali men apply to join the British Gurkha every year.  In 2012, 6,134 men applied for 126 positions.

Hundreds of young Nepali men apply to join the British Gurkha every year. In 2012, 6,134 men applied for 126 positions.

Himal Shrees Magar from Rupandehi says he wants to be a Gurkha for the opportunities and benefits that comes with the position.

Himal Shrees Magar from Rupandehi says he wants to be a Gurkha for the opportunities and benefits that comes with the position.


At Salute Gorkha, about 150 men are undergoing a six-month training session. These men are applying for the British Army, as well as the Indian Army and Singapore Police.

At Salute Gorkha, about 150 men are undergoing a six-month training session. These men are applying for the British Army, as well as the Indian Army and Singapore Police.

They start their day from 5am and includes a rigorous, all-day training session.

They start their day from 5am and includes a rigorous, all-day training session.

As a part of the training, the men who are contesting for this year’s recruitment process do long and short distance run as well as cross country and speed distance running.

As a part of the training, the men who are contesting for this year’s recruitment process do long and short distance run as well as cross country and speed distance running.

Many young men say they are attracted toward the British Gurkha because of the good pay scale, prestige and the long-term benefits that comes with the position.

Many young men say they are attracted toward the British Gurkha because of the good pay scale, prestige and the long-term benefits that comes with the position.

The trainings are intense but these young men say they are ready to give their 100 percent and do whatever it takes to become a Gurkha.

The trainings are intense but these young men say they are ready to give their 100 percent and do whatever it takes to become a Gurkha.

This year [2013] will be the fourth and final attempt for Deepak Gurung from Tanahu. He says his hard work will pay off this recruiting season.

This year [2013] will be the fourth and final attempt for Deepak Gurung from Tanahu. He says his hard work will pay off this recruiting season.

Hundreds of young Nepali men apply to join the British Gurkha every year.  In 2012, 6,134 men applied for 126 positions.

Hundreds of young Nepali men apply to join the British Gurkha every year. In 2012, 6,134 men applied for 126 positions.

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Meeting the Living Goddess

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Kathmandu is supposedly where the gods and goddesses once frequently visited. Locals say their presence is still strong in this city crowded with temples and shrines — the deities that once toured the valley now dwell in these temples. And to be precise, this modern metropolis that once was a fabled bed of civilization, is still home to the Living Goddess, Kumari.

A few months ago, my friend from London called me to know more about this tradition. She was interested in knowing about the relationship between goddesses and girls, and if worshipping these divine female forces empowered them.

Through another friend I managed to get the number of one of the former living goddesses, Chanira Bajracharya. I called her up. I wasn’t expecting a prompt or a positive response, but she agreed to meet.

A few days later, I walked through the busy inner street of Patan leading to the Durbar Square, trying to find Chanira’s house, which also used to be her temple. I called her four times maybe – I was a bit worried that I was already annoying her. But she was helpful in providing me with the directions. I later find out from Chanira that it’s difficult for her to give directions considering she didn’t step out of the house as a goddess until the age of 15.

Her younger brother greeted me at the door and led me through the dark staircase to the living room. It was dimly lit but the collage of photographs from Chanira’s Kumari days were strikingly visible on the wall.

As I was scanning the room, Chanira entered the room and smiled. She sat, kneeling on the floor. I explained her about my visit and soon we started talking. My friend from London was on the phone – she asked a series of questions and I added my own set of curiosities.

We talked about her days as a Kumari: how she felt as a goddess, did she feel some sort of power, if she had a connection with the goddess Taleju, who she is considered to be a manifestation of.

Sometimes she was quick in answering. At times she paused. She spoke softly and mostly fidgeted with the tip of her shawl or her fingers as she answered.

We then talked about her life after she retired as a living goddess: the transformation, the challenges, and most importantly how it was to be a mortal, like almost every one of us.

As we continued to talk, she eased herself. Then we chatted about school, her classes, friends, and her future. Currently, she is pursuing her undergraduate in business studies. She wants to become a banker.

Chanira told me that she was preparing for her exam the next day. I just thought it was the right time to wrap up the interview. I wished her luck with her studies and asked what would be the best way to contact her.

“You can call me or email,” she said giving her her email address.

And then she said: “You can also find me on Facebook.”


Here’s a short profile on Chanira I wrote for the South China Morning Post. 

Also, Isbabella Tree’s new book, The Living Goddess, is an insightful read. It not only details the history and culture of the Living Goddess in Nepal but also provides a good context to the subject starting right from the formation of the Kathmandu Valley to the future of Kumaris in the modern Nepal and everything in between. 

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Happy faces

I took this photo while on an assignment at the Buddha Secondary School in Lele, about 45 minutes outside Kathmandu.

Entering the school was like traveling back in time — a memory lane of those primary school days. When I peeked into this third grade, the students started to laugh and giggle. After seeing a camera in my hand, they started posing.

But a bunch of girls in the front row kept laughing non stop. I asked them why they were laughing but then they started laughing even more. I couldn’t stop but capture this moment.


Nepal’s Health Innovations

Despite political turmoil and power struggle in the center, surprisingly Nepal has been progressive in reforming parts of  its health sector. The country is on track for achieving the targets for the United Nations Millennium Development Goals – reduce under-five mortality by two-thirds and maternal mortality ratio by three-quarters between 1990 and 2015. While improved government policies have helped to materialize these goals, the community’s role should also be underscored. For them, these targets are much more than reducing the numbers and getting a “pass/fail” remark on the global report card – every mother and newborn saved, like for everyone else, is a story of joy and celebration, a memory that will live with their generations to come.

During the past two weeks, I have had a chance to learn about some of the researches that have helped save thousands of lives and the programs followed thereafter, which have been a basis for formulating national health policies. The policies that led to national programs have massively helped reducing neonatal, child and maternal mortality in Nepal.  Meanwhile, it was also interesting to see how the ongoing researches are incorporating innovative and easy solutions that could further help save more mothers and newborns.

The following innovations and success stories listed below were highlighted in an event during the visit of Dr. Rajiv Shah, Administrator of the United States Agency for International Development (USAID). The first high-level US official to visit Nepal since 2002, Shah was in the country to award the Government of Nepal, Ministry of Health and Population, for its Chlorhexidine Program.

Chlorhexidine Cord Care Program

In 2011, Nepal’s Ministry of Health and Population became a global pioneer to scale up the use of Chlorhexidine for newborn cord care at national level through the Chlorhexidine Navi Care Program and other partners. For this significant march toward improved neonatal health care, the program has been awarded one of the Grand Prizes of USAID’s 2013 Science and Technology Pioneers Prize that commemorates the use of science, technology and innovation to solve development challenges.

A majority of Nepal’s population, especially in remote parts of the nation, still prefer traditional remedies for cord care to modern-day medicines. The latest Demographic and Health Survey estimates more than 41 percent of babies had materials such as mustard oil, turmeric, ash etc. used in their umbilical cord.

Such practices may contribute to Nepal’s neonatal mortality rate of 33 deaths per 1,000 live births. With about two-third of deliveries conducted at home, mostly in unhygienic conditions, newborns are vulnerable to neonatal infections, which is a leading cause of neonatal deaths in Nepal.

But Chlorhexidine, locally known as Navi Malam, is an antiseptic gel that reduces bacterial colonization on the skin and umbilical stump of newborns.

A pooled analysis of three randomized controlled trials of use of Chlorhexidine immediately after cord cutting done in Nepal, Bangladesh and Pakistan shows that the application of  Chlorhexidine reduces neonatal mortality by 23 percent and reduces serious infections by 68 percent.

The intervention that has reached 41 of the 75 districts started as a pilot project in 2009 using the antiseptic manufactured by a Nepali company, Lomus Pharmaceuticals, along with technical support through USAID and Nepal Family Health Program/JSI. Female Community Health Volunteers, the backbone of Nepal’s public health system, are the main channel to counsel pregnant women and distribute Chlorhexidine tube during the eighth month of pregnancy.

When the program is scaled up and implemented nationally through the public health system, Lomus estimates Nepal would require about 800,000 tubes annually – one for each birth. Currently, the pharmaceutical company produces around 20,000 tubes per day, which cost Rs. 18 (approximately $0.18) apiece.

Since 2009 Lomus has delivered more than 775,000 tubes within Nepal. The company has also exported 240,000 tubes to countries like Nigeria, Madagascar and Liberia within the last two years.

One-cent test for pre-eclampsia/eclampsia

At a time when most public health facilities are lacking standardized testing tools for pre-eclampsia and eclampsia, Jhpiego is in a developing phase to innovate and improve the screening of the disease, which is the leading cause of maternal mortality in Nepal. Though it can be detected early during antenatal visits to a health facility, about 50 percent of women do not fulfil this routine.

This new technique to test pre-eclampsia and eclampsia involves a device (currently a dropper) to dispense a color-changing reagent on paper. Similar to a pregnancy test kit, a pregnant woman urinates on the paper and finds out the result instantaneously. While yellow signifies a negative result, green is a warning that they should visit the health facility.

In this developmental phase, Jhpiego, an affiliate of John Hopkins University in the US, is also training the Female Community Health Volunteers who take this testing to the would-be mothers.

The Maternal Mortality and Morbidity Study 2009 suggests that 21 percent of deaths are attributed to eclampsia.

In course of time, with results from the research that would meet the Gold Standard, Jhpiego plans to develop a standardized design for manufacturing, get a regulatory approval and conduct nationwide pilot studies.

The cost of this innovation would drastically bring down the testing cost. The current retail price for manufacturing and distribution is estimated between $4 to $5 per device for 500 tests; high quality dipsticks cost between  25 cents to 40 cents per test.

GIS Mapping System

A work-in-progress digital mapping of Nepal’s health system is said to be the most advanced in South Asia.

The highly interactive map will also provide scientific data on roads, locations of health services and workers in relationship with population and health service centers.

According to the Ministry of Health and Population, GIS has been incepted and is in the process of institutionalization in the health system. This adoption is also reinforced by e-health, Health GIS and need for integration of information systems.

The Health Facility Mapping Survey has been carried out in 57 districts with technical and financial support from World Health Organization and further processing for remaining 18 districts started in 2013 with the assistance of SAIPAL with support from USAID.

Once compiled the entire database can be linked and accessed according to the user requirement, without the need of studying data table or reports, making GIS the ultimate tool for decision makers in analyzing data by visual means. It would help in answering key questions related to the health sector that would further improve and enhance the country’s health system.

Regarded as Nepal’s “Health Atlas,” the project, once completed, will have the most cutting-edge, geo-enabled data on infrastructure, location and equipment of all health facilities in the region to improve data for decision-making.

Nepal Nutrition Intervention Project – Sarlahi (NNIPS)

For the past 25 years, NNIPS, which is being carried out by Johns Hopkins University (JHU) Bloomberg School of Public Health in collaboration with the Nepal Netra Jyoti Sangh, has been a leader in researching life-saving innovations.

The years of collaborative work, conducting large community trials in the Sarlahi district of Nepal, have contributed significantly to the establishment of programs responsible for reducing maternal, child, and neonatal deaths.

From the vitamin A revolution to umbilical cord cleansing with Chlorhexidine, NNIPS has produced noteworthy health discoveries that have become the basis for establishment of new national health policies and the launching of programs both nationally and globally.

In Nepal, during the 1990s, 2 to 8 percent of preschool-aged Nepali children experienced severe vitamin A deficiency, with a much larger percentage experiencing moderate and sub-clinical deficiencies and the concomitant health and mortality risks associated with them.

During NNIPS’ first large study conducted from 1989 through 1991, it was demonstrated that with periodic high-dose vitamin A supplementation a 30 percent reduction in child mortality in children between six months to five years of age can be achieved. Encouraged by this and similar results from large trials in India and Africa, the Government of Nepal initiated the Nepal National Vitamin A Program in 1993.

The vitamin A campaign now reaches nearly 1 billion children in over 50 countries around the world.

The results of NNIPS’ randomized controlled community trial of umbilical cord cleansing with Chlorhexidine on neonatal mortality and infection in Sarlahi have showed that if applied within 24 hours of birth, chlorhexidine can produce a 34 percent reduction in neonatal mortality.

This research result encouraged the government to implement the Nepal National Chlorhexidine Navi Care Program in 2011.  This program, that has the potential to save thousands of lives in Nepal, has now been expanded to 41 districts, with all 75 districts to be eventually included.  Many African and Asian countries have either already started or are interested in starting their own national Chlorhexidine cord care programs as well.

Female Community Health Volunteers

Dressed in their blue saree uniform patterned with concentric circles, a striking uniform that makes them stand out, Nepal’s cadre of 52,000 Female Community Health Volunteers have been an instrumental force in promoting safer motherhood and institutional deliveries, encouraging contraceptive use among women and men and administering various government-led health campaigns to effectively using a timer to diagnose respiratory illness in children.

The Government of Nepal started the program in 1988 with support from USAID, UNICEF, UNFPA and local non-governmental organizations. In its 25 years now, these women have been play a key role in helping in strengthen the country’s health system from a grassroots level on a voluntary basis. – what started as a community-based project is a public health sector’s national pride now.

During these years, the FCHVs have also played an integral role in scaling up innovations that have put Nepal in the global spotlight. They are at the forefront of promoting the use of Chlorhexidine to prevent umbilical cord infection in newborn, one of the major causes of neonatal deaths in Nepal.

They are also responsible for promoting community-based health interventions, which include distribution of Oral Rehydration Salt for diarrhoea, Vitamin A and pneumonia treatment, have helped to reduce under-fiver mortality by more than 50 percent in the last 15 years.

Along with the responsibilities, being an FCHV also comes with a reputation – they’re the trusted members who are well recognized in their communities, which motivates most of them to continue doing what they’re doing best.

(The following write-up is partially extracted  from a special USAID publication for Dr. Rajiv Shah’s visit to Nepal. With inputs from Alok Thapa for GIS and NNIPS, editing by Jane Silcock, and design by Swapnil Acharya.)


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In Accham


“We have to cross several hills like these,” said my driver Ranjit as we drove from Dadeldhura to Accham in far-west Nepal. “It will take us about six hours.”

Those mighty green hills, overlapping one another, with the snow-capped Appi Saipal range towering above them, would suit perfectly for an artist’s canvas; flying over them, if no turbulence, is always a joyride; but driving through the narrow, serpentine strips literally carved cutting those hills, is dizzying.

“This is where a bus plunged recently,” Ranjit said. I rolled down the window and looked – I couldn’t see anything but a steep hill rising from hundreds of feet below.

Just getting to that point had been exhausting. I had started my journey the previous day. The flight from Kathmandu to Dhangadi — the longest domestic flight — was delayed, and so I landed in the far-west plains as the sun was ready to settle down.

Ranjit was there to pick me, and he recommended we drive to Dadeldhura, a hilly town that would be our stopover for the night. During the four-hour drive, the vehicle broke down three times – the first time, it was closer to Dhangadi and we managed to get a mechanic. The other two times, it was in the middle of the highway – thanks to the friendly truck drivers who helped us out.

Driving through sections of the snow-covered Bhim Dutta Highway in pitch dark, we finally reached the destination for that night. I checked into a hotel and tried to make myself cosy in a cold room – I put on three layers of clothing plus my socks and hat and covered myself with three blankets for the night. I went to sleep with no expectation of what this cold town would look like.

In the morning, when I opened the curtain, it was a magnificent view. With only an hour to spare, I went to have a close look at the Himalayas. Walking through the bazaar, I made my way to Toofan Danda (Windy Hill) and captured the sight in my camera before starting that long drive to Accham.


During the six-hour journey, we passed through Doti district – small settlements scattered throughout the highway where cattle grazed freely and children played fearless of the speeding vehicles. Life in these settlements reflects rural Nepal, a stark contrast to the progressive pockets that tends to define modern Nepal.

As you enter Accham district, a typical big concrete gate welcomes you. One of the first boards I noticed was about safer practises to prevent HIV. The pictorial illustrations highlighted safer sex, discouraged sharing needles and also encouraged people to get tested.

Accham is one of the districts with the highest prevalence of HIV/AIDS in the country. With a majority of Acchami men leaving to India for employment, they have unknowingly brought home the virus that has largely been transmitted to the women, and also children, in the district.

During my stay, I talked to some men who said they got the virus from India, but had “no idea how they got it.” I also talked to women who told me they got the virus from their husbands. But amid a crisis, which they term as the “Bombay Disease”— because most of the men go to Bombay for work and bring the disease— people have started to come out and speak about it. I met a woman who was infected by her husband and now passionately advocates about HIV/AIDS – she thinks it’s important to spread the message and encourage people to get tested. Early detection and being on medication, she said, will help them live “an easy life.”


For most Acchamis, everyday life is not easy. With an average household income of Rs 6,125, limited employment opportunities and infrastructural development, challenges are apparent. As soon as you reach Sanfebagar, one of the emerging marketplaces in the district, you get the sense. A stretch of rickety tin-built shops cluster the area serving as a transit point for buses departing to Dhangadi, Kathmandu and the neighboring district of Bajura. Apart from that, there is nothing much to this area until you reach Airport Bazaar, where a thriving marketplace exists, even better than the market in Mangalsen [pic below].


Twelve years ago, after a Maoist attack, this place was one of the casualties of war. A friend who had visited the place during the conflict time told me about the devastation. But now, though the airport remains dysfunctional, this small marketplace is on a slow road to recovery. People are making investments, taking a risk and starting small-scale businesses.

Here I met people like Lalit Kunwar and Shankar Bhul who have taken loans from the cooperatives and microfinance institutions that they’re members of. With limited banking services in the district, a majority of Acchamis have turned into cooperatives and microfinance institutions that have allowed them to save and also borrow money at lower interest rates. With 202 cooperatives and three microfinance institutions, locals said they have a better access to finance – people have been prompted to make small investments and in this process, women are also coming forward, taking control of their financial ownership.

But while women are actively taking a lead, it’s hard to ignore the issues that are plaguing them – the tradition of Chaupadi is largely prevalent, pushing women into a time machine forcing them to follow the rules of the past.

In the district headquarter of Mangalsen, I met some women who still practise Chapudai, where they spend five to seven days of their menstrual period in a shed, isolated from the main household. Most of them were young, going to school, but said they couldn’t question their traditional beliefs and speak against them. These women still see themselves as “impure” during menstruation, a belief that has been ingrained and passed on from generations.

The district headquarter of Mangalsen, though it serves as a center of commerce and the seat of government offices, looks primeval compared to the other remote places I’ve visited: A majority of houses are built from mud, stone or tin, electricity is scarce and the slushy streets is an inconvenience for someone from the city, though Kathmandu’s streets are pretty similar at the moment. However, there is a black-topped road that links Mangalsen to the rest of Nepal, which locals said have played an instrumental role in the district’s development.


Also, one of the notable progresses in Accham is the resurgence of its public hospital in Bayalpata, a small settlement in between Sanfebagar and Mangalsen. In a public-private partnership with the Government of Nepal, Nyaya Health, a local NGO, has revived the once dilapidated hospital. The hospital that serves about 52,000 patients yearly looks like a miniature of a private hospital in Kathmandu with first-class, free service to the people of Accham. No wonder, the medical facility is a darling of many Acchamis today and has been declared Nepal’s best hospital for 2013.

During my four days in Accham, it was difficult not to think how this place and the people have actually moved past the death and destruction during the decade-long conflict that stalled any development. During a short span of time, a mere seven years since the war ended in 2006, the peace dividend has seemed to paid off quite well for places like Accham, which were literally cut off from rest of the country.

In these seven years, Nepal has been politically unstable, and quickly scanning from what we’ve achieved, it looks like the country hasn’t really gained a lot. But if we dig into Nepal’s rural pockets that were ravaged by the conflict, it really gives a little bit of hope and optimism. The progress being made on a community level and the people’s enthusiasm to drive their district’s development is hard to ignore – just like that drive up to Mangalsen.


When the dense fog that blocked the view up to Mangalsen suddenly vanished, the mist of uncertainty cleared into a sunny spell. Standing up the hill, I looked down – the hills below looked beautiful despite the fact they were covered in a thick blanket of clouds. In the next hour, as I stood still, admiring the beauty, the clouds cleared, giving a picture-perfect view of the valley.

In these seven years, this place where I was then standing, I thought, has been cleared of the fog. However the clouds still linger, but I’m sure they’ll pass, giving a way for the sun to shine.

STORIES FROM ACCHAM [Will post stories as they’re published]

Bridging the financial gap [Republica The Week]

Crowdfunding platform Nyaya helps raises cash for health care for Nepal’s poor [South China Morning Post]

Q&A: Mark Arnoldy, Executive Director, Nyaya Health [Republica The Week]

Nepali women still plagued by archaic practice of imprisonment during menstruation [South China Morning Post]

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