Category Archives: Nepal

Blood on our hands

During her menstrual days,Swomen spend four days in a shed, outcast from the main household

On Thursday, 19-year-old Tulasi Shahi died of snake bites. Almost seven months earlier, 15-year-old Roshani Tiruwa suffocated to death. And just a month before that, it was 26-year-old Dambara Upadhyay. All of them died under the same circumstance — they succumbed to the so-called Hindu tradition in Nepal that banishes women during menstruation.  

In Hinduism, avatars of some goddesses are seen as manifestation of power. And every time when a woman is mistreated, the conflicted views of mythology versus reality becomes a part of public discourse — while they are worshiped as divine figures, since the ancient times its believers have however relegated women from that pedestal, positioning them as “impure” when nature takes it course every month. And generation after generation, the self-proclaimed custodians of the religion have been using fear as a medium to impose these “traditions” at the cost of women’s lives.

“Our elders think the gods will be angry,” Sunita BK told me while reporting on the issue that plagues hundreds of women in different pockets of Nepal. “The family will have to bear the consequences if we stay in the house during menstruation. We can’t speak against them.”

While many families feared the wrath of the divine deity, which may or may not exist, for many women in villages like Mangalsen, it’s the power of the family patriarchs and such practices that govern their existence.

On a balmy January afternoon in the far-western district of Accham, the 19-year-old spoke of frigid winter nights she had spent in the mud shed since her early teens, adhering to the practice locally known as chaupadi. The tin-thatched structure had paper cardboard that carpeted the dusty floor, no windows for ventilation, and a wooden door without proper locks. It wasn’t even big enough for a five-feet woman to stretch.

The shed is a crammed space with no ventilation or windows. Reports of deaths due to suffocation during chaupadi have surfaced over the past years

Sunita said her mother and mother-in-law followed the same tradition, and the latter said her mother told that it was a part of every woman’s monthly routine, with the elderly from the family ensuring that the religious sanctimony is not broken. And in order to protect something that their dead ancestors passed, people tend to entirely ignore the living, leaving women to die under inhumane conditions — in any religion, it would constitute sinful.

When I visited Accham, almost a full-day drive from the closest airport in Dhangadi, in 2014,  death of 15-year-old Sharmila Bhul from the previous year still lingered in people’s memories. She lived 30 minutes away from Sunita’s village, and had mysteriously died in the shed. She was expelled from the house during her period. It wasn’t a shocking news for many. It was a sorrowful story, but not shocking. It was more or less an ill fate that could have happened to anyone.

It is noteworthy that blinded by faith, people tend to normalize such events, selectively ignoring the injustices faced by women in their community, becoming equally complicit in a criminal behavior disguised in the form of tradition.

It’s been 12 years since Nepal’s Supreme Court outlawed chaupadi. During the past decade, the country has witnessed seasons of political and social changes. Women’s empowerment, along with other catch phrases that are used as yardsticks to measure social progress, have become a part of the local lexicon, even in villages of districts as far as Accham. Nepal is hailed for reducing maternal mortality, improving women’s access to finance, and securing political representation, as female leaders hold the positions that once were held by key male players only. They have been elected as the chief justice, speaker of the house, and also the country’s first female president.

And while these developments paint a rosy picture of a poor but progressive country, the society still hasn’t forgotten to deem women “impure” during menstruation. However, it should be noted that this is not only rural Nepal’s problem. Archaic traditions as such are silently practiced in urban pockets like the capital, Kathmandu. In my neighborhood, men from the so-called upper caste Brahmin family still don’t touch women while they bleed, and even in my Newari household, women don’t enter the kitchen or the worship room during menstruation. The only difference is that women die in villages, but in cities we kill their dignity by giving them an “untouchable” status.

While the problem exists, it is important that we look forward seeking solutions. Yes, there have been policy interventions, but that doesn’t guarantee a social transformation. And this is where the members of the community should step forward. In villages like Mangalsen, I met men like Kamal Rawal, a 22-year-old journalist who has taken a stand against the practise, starting from his household. In Ridikot, the village where Sharmila died, locals are challenging this culture, destroying one shed at a time. Rights organizations have also been vocal in raising awareness.

But when I asked Sunita about all of this — the political representation, the progressive attitude, including her neighboring village — she smiled at first, and then shrugged. The teenager, and a mother of a child, said all of that is so distant from her everyday life. They mean little to her as long as she has to brave the weather, wild animals and worry about perverted men barging in the sheds at night, and spend five days in the shed every month during her menstrual cycle.

“I hope the situation will change soon,” she said.

But the underlying question is: How soon will it change?

One after another, women are dying in similar situations. And from where Nepal stands today, even one death is too many. Every death is equally shocking because it’s untimely, unnatural — it can be passed as murder — and something that is undoubtedly preventable. And let’s not wait until another death, or series of stories splashed across international media outlets to enrage us about what’s happening in our backyards.

It’s now beyond time for family patriarchs, community crusaders, and political leaders to shun this practice and shatter the sheds in every corner of the country. For centuries, society has banished women for bleeding, but its members should now collectively accept that they are to blame for each death — they are the ones with blood on their hands.

 

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Hong Kong denied my visa because of my nationality, and I just can’t let it go

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                                                                          Photo: Andrew Colin/Flickr (Creative Commons) 

My name is Bibek Bhandari and I’m a Nepali national – and for that very reason Hong Kong rejected my work visa application.

I have been reporting for the South China Morning Post for almost three years as a freelancer. So when I saw an opening for a suitable position, I applied and secured a full-time job at the newspaper’s headquarters in Hong Kong after two interviews. I was ecstatic and looked forward to a new milestone in my journalism career.

But that abruptly ended when Hong Kong immigration denied my employment visa.

Hong Kong categorically bars certain nationalities — Afghanistan, Cambodia, Cuba, Laos, North Korea, Nepal and Vietnam — from entering China’s Special Administrative Region for training and employment purposes. Regardless of my years of professional experience, credibility as a journalist and an employment offer from the city’s leading newspaper, my application was overlooked based on my passport cover.

In a bold letter highlighting Nepal, the immigration department asserted that Hong Kong’s General Employment Policy was “not applicable to the applicant.”

And I’m not the only one.

In 2014, I met Shanta Nepali, a young woman who paid thousands of rupees to a middleman to go work as a housemaid in the Middle East, just as Hong Kong implemented the visa ban.

She ended up in Lebanon. Hong Kong, with its stringent regulations and supervised labour laws, she believed, would have been a better place to work.

Hong Kong introduced the ban on Nepali students and workers in 2005 — though the ban on students has been relaxed — without an official explanation. However, it is believed that the policy was aimed to discourage Nepalis fleeing the Maoist conflict at home to seek asylum in Hong Kong.

Annie Lin of the Society for Community Organization then told the Post that singling out Nepalis and targeting them is “racial discrimination.”

A 2009 UN Women report also slams Hong Kong’s policy “as not only discriminatory but also imposed excessively beyond reason.”

It has been 11 years since the ban and a lot has changed meanwhile: the war has ended in Nepal; Hong Kong is no longer a leading destination for Nepali migrant workers; and a new generation of Nepalis are now exploring opportunities across the globe.

“It’s high time for Hong Kong government to review and reconsider their policy towards Nepalis,” said Indra Wanem, a legal counsellor from Nepal who has lived in Hong Kong for more than 20 years. “Hong Kong’s view on Nepal as a weak and underdeveloped country in political turmoil must change now.”

He said if Hong Kong were to implement proper screening methods while stamping work visas for white-collar and blue-collar workers, it could benefit both parties, as thousands of Nepalis leave abroad for work and study every day.

I also left Nepal in 2005 and since then have lived and worked in many countries. Having a green-colored passport from Nepal— it’s one of the least powerful passports in the world— has prepped me for visa hiccups, and though the probability of  “rejection” is always imminent, the applications have never been snubbed due to my nationality, until now.

For the first time, even before landing in a city, I felt unwelcomed. Hong Kong made me question my nationality momentarily — I even despised having a Nepali passport for a second — because my future was at stake, barricading the career move that I deserved. Like Nepali, and many others, I was losing an opportunity to a policy that openly perpetuates prejudice towards certain nationalities.

This is unfair. This is wrong.

By arbitrarily banning citizens from a list of handpicked countries regardless of their skills, talents and potentials, Hong Kong is harbouring an archaic policy that undermines its so-called cosmopolitan values.

I am writing this today because I do not want to be just another silent applicant. I cannot ignore this and let go as a policy issue. For the immigration department to dump my application only because I am from Nepal doesn’t suit a city that brands itself as progressive.

So when I look at Hong Kong today, I no longer consider it as “Asia’s world city.” Instead, I see it as a selectively unaccommodating city that has crushed the prospects of many people, exclusively based on where they come from, even before arrival.

A day after the decision, one of my editors wrote to me and said he “hope[d] that out of all this, you get the job you truly deserve in a city that is prepared to welcome you.”

And Hong Kong is not that city.

 

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After the earthquake

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(Two year update: People still living in temporary shelters, delays in rebuilding, concerns over heritage reconstruction

A year is a long time, and in Nepal, the length of the year since the April 25, 2015, earthquake is relative: it depends who you ask.

For the government, it’s been quite a short year: it hasn’t been able to accomplish much of the reconstruction work.

But for the earthquake survivors, it’s been one of the longest years. The quake swallowed their houses, shattered their livelihoods, and a year later, they’re still struggling to pick up the pieces.

It’s been 366 days since the 7.8-magnitude earthquake shattered parts of Nepal, including the capital Kathmandu. It was 11:56 a.m. when the ground shook – it was first a thud and then a thunderous roar that echoed from beneath.

It was violent and lasted almost a minute. It was so violent that I couldn’t reach for the door. My heart pounded, legs trembled, and my thoughts froze. And when it stopped, my surroundings had changed in a matter of seconds.

The street outside my house had cracked, and though many of our houses survived the tremor, just a few meters away, a neighbor’s two-story house had collapsed entirely.

And just an hour later, as I clutched my notebook and ran uncomfortably in my flip-flops while still in shock, in Kathmandu Durbar Square, the city’s century-old palatial courtyard, I witnessed history was erased, almost. Several historic monuments and temples were levelled – and people were buried inside.

The chaos and the commotion in my hometown that day — and the powerful aftershock on May 12 — seemed as if a doomsday prediction had finally come true.

While Kathmandu and its surrounding areas, including Bhaktapur, Sankhu, Bungmati and Harisiddhi, suffered incomprehensible damage, tiny hamlets outside the city were entirely hammered.

In Sindhupalchowk, the district with the highest casualties, I witnessed death, destruction and despair. The scale of the seismic shift was devastating.

“There are no houses left in my village,” Sujan, one of the waiters who worked at my friend’s restaurant, told me hours after the earthquake, as he was making desperate phone calls to his family members in Sindhupalchowk.

Upon visiting the district five days later, I could see what Sujan meant: settlements in Sindhupalchowk were obliterated.  Schools, hospitals, and houses were smashed by the quake.

This is where I met Uddhav. The 28-year-old was trying to see a doctor in a makeshift medical camp in the district headquarters of Chautara on a sweltering May afternoon.

The drive to his small village through a snaking dirt road was striking – it was a stark paradox between nature’s beauty versus the power of its devastation.

The view of the snow-capped Himalayas, rolling hills and gushing rivers was eclipsed by flattened villages and collapsed homes. Uddhav’s village was one of them.

Sitting on his hard bed with no mattress, under a temporary tent house, he told his story without  any visible emotions.

“I’ve lost everything,” he said, his eyes fixated on the ground.

The earthquake not only injured him but also killed his wife and two children. His two-story house was now nothing but a mountain of rubble.

“I need to be strong – I can’t show my tears to my mother,” he said, as his grieving mother sat beside him and wept profusely.

It had been more than a week after the quake when I visited Sindhupalchowk, and survivors like Uddhav were desperately looking for help – water, food, tarpaulin sheets, tents. Anything.

And while local and international non-profits, and most importantly, volunteers from communities across Nepal mobilized to deliver assistance, the government was slow to react. The red tape made humanitarian assistance entangled in bureaucratic web with little sense of urgency.

“It seems like we are invisible,” Laxmi Gole told me last year. She was infuriated and were among the locals blocking part of the road in Sindhupalchowk that led to the district headquarters in Chautara.

It’s been a year and many earthquake survivors still haven’t received much from the state.  Thousands of people like Uddhav have given up hope that the government or the representatives they elected and sent to Kathmandu would act on their behalf.

Most survivors still live in temporary shelters where they braved the monsoon rains, frigid winter and the stormy spring early this year. They feel ignored by the government.

A US$4.1 billion pledge by the international community has more or less turned into a fairytale fantasy. The country’s National Reconstruction Authority, responsible to lead the reconstruction efforts, was buried in a bureaucratic dillydally and was dormant until a few months ago. The Prime Minister Disaster Fund Relief, along with local and international aid organizations, raised millions of dollars in the aftermath of the quake, but the ones who need it the most seem to be entirely out of the equation. Alhough the survivors whose houses were destroyed were to receive Rs. 200,000 from the state, it was not until last week that they received Rs. 50,000 as the first installment – that too, only 641 of the thousands of survivors.

The promulgation of the new constitution in September was seen as an answer to many of Nepal’s problems but it further plunged the country into crisis. And as much as the government hailed the controversial constitution as inclusive, many ethnic groups and women felt alienated. As a result, the southern plains burned, unsatisfied India imposed an economic blockade — it denies the accusations though — and the country’s ailing economy slumped further while the government watched from a distance, indulging in inconclusive talks with the agitating parties and failing to address the issue.

At least 55 people, including civilians and security personnel, died between August and September – it was believed to be the most violent protests since the end of the bloody Maoist conflict a decade ago.

Up in the hills, as winter approached, people were dying, too. By late December, at least 22 people had died. They were able to survive the seismic shake but succumbed to the state’s apathy.

Come spring, the situation has not changed much.

Far from home, as I sit to read an avalanche of articles, many reporters have picked up stories where they left a year ago. And even amid the most encouraging stories, there was agony.

Al Jazeera’s 101 East team — I was a part of last year’s film — also revisited Uddhav and his village. And though there were signs of early progress, life was perilous for many.

Hundreds of men like Uddhav, who already had debt since before the quake days, have taken out additional loans and are now drowned in debt. Many are considering going to the Middle East or Malaysia for foreign employment despite the risks. Almost 1,500 Nepalis leave for foreign employment every day to feed their families back home, and while many return with considerable sum of money and stories of hardship in a foreign land, the unfortunate ones come back in coffins.

And yet, they are determined to leave – just like Uddhav, who told me while visiting Kathmandu months after the quake, that given a chance, he would leave despite his injuries.

Uddhav’s story is indicative of the government’s lethargic reaction to cope with the country’s biggest natural disaster since the 1934 earthquake.

“There’s nothing left,” Uddhav told me.

After what seemed to be the longest year for many survivors, they still have nothing left but hollow promises from the state.

And as leaders release balloons and light candles in Kathmandu to remember the dead at the first year anniversary of the quake that killed nearly 9,000 people, they seem to be less concerned about the living.

Those balloons will deflate and the candles burn out, and no one will remember what the leaders did to mark the earthquake anniversary. But people will never forget that they were forgotten when they needed their government the most.

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Nepal’s Integrity Idol

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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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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

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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.

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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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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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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

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“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.

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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.”

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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].

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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.

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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.

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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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