This year, the UN has declared ‘Island Biodiversity’ as the theme for celebrating International Day for Biological Diversity. The world’s islands are home to about 600 million people – 10 per cent of the world’s population. These islands are also home to some unique species of plants and animals that are found nowhere else in the world. For example, the kangaroo is found only in Australia, the flightless kiwi bird is found only in New Zealand, and the now extinct dodo – another flightless bird – was found only in Mauritius. Australia, New Zealand and Mauritius are all island countries.
‘Islands’ – the word generally conjures images of areas of land surrounded by water. For conservationists, islands take on another meaning when pockets of pristine land areas rich in biodiversity exist amidst intensive areas of human settlements, agriculture or industrialization. These ‘islands’ are generally home to numerous species of plants, birds, insects and animals. At a larger scale, many of these ecologically significant islands have been set aside as areas to protect plants and wildlife.
Animals, particularly large animals, must move, and thus require large areas of habitat for their survival. Often, when animals travel outside their ‘islands’ of protected areas, they enter human settlements and destroy crops, livestock, and even human life, resulting in what conservationists term ‘human-wildlife conflicts’. Humans generally respond to such wildlife intrusions by exterminating them through various means – a process termed as ‘retaliatory killing.’
One of the methods by which the habitat of large animals can be increased is by connecting protected areas through wildlife ‘corridors’. These corridors can be instrumental in connecting fragmented habitat islands and thereby facilitating wildlife movement. Corridors also promote interbreeding, which results in genetic diversity within the wildlife population.
The Kanchenjunga Landscape is one of seven landscape initiatives in the Hindu Kush Himalayas where the ecosystem approach is being used with a focus on connecting islands of protected areas through conservation corridors. This initiative is a trans-boundary program involving the governments of Bhutan, India, and Nepal. The program aims to develop connectivity between the 20 isolated protected areas in the landscape through a network of conservation corridors extending from eastern Nepal, through the states of Sikkim and northern West Bengal in India, to western Bhutan. These corridors will facilitate the movement of species, such as the endangered snow leopard at the higher elevations, and Bengal tiger and Asian elephant at the lower elevations.
The Kanchenjunga Landscape is part of the Eastern Himalaya ‘Biodiversity Hotspot’ where there is high level of biodiversity, much of which is facing severe threats from humans. The landscape hosts a significantly high number of plants and is home to at least six species of endangered animals including the snow leopard, Himalayan musk deer, Bengal tiger, Asian elephant, and one-horned rhino, among others. The trademark plant species of the landscape is the rhododendron – at least 45 species of which are found in the landscape. The landscape is also home to approximately seven million women and men, some of whom belong to distinct ethnic groups, such as the Lepchas and the Walungs.
Despite the ecological significance of the Kanchenjunga Landscape, there is much we need to know about the biodiversity and socio-economy of the region. During a recent review process for understanding the state of knowledge on biodiversity in the landscape, about 850 published and unpublished documents were recorded. The first recorded study in the landscape was conducted more than 170 years ago on the Lepchas of Sikkim by Archibald Campbell, the British political agent to Sikkim and Darjeeling in the East India Company. This was followed by the work of the notable British naturalist Joseph Dalton Hooker, who published an account of his botanical expedition in the Kanchenjunga region in two volumes of The Himalayan Journals in 1854. Subsequently, research interest in the Kanchenjunga landscape increased significantly only three decades later in the 1980s. Much of the information gathered in the area was focused on animals and plants, with the red panda being the most researched animal species in the landscape. Over 80 per cent of the research has been conducted in the Indian portion of the Kanchenjunga Landscape, only 9 per cent has been conducted in Nepal and just 4 per cent took place in the Bhutan portion of the landscape.
Why is it important to know about the biodiversity in the Kanchenjunga Landscape? There are an estimated 8.7 million species of organisms in the world. Among these, only 1.2 million species have been identified till date – representing only 14 per cent of the total biodiversity in the world. Accordingly, we have probably identified only a third of the total number of species in the Kanchenjunga Landscape. Much of the gaps in our knowledge exist in relation to species other than plants and animals, i.e. on fish, amphibians, insects, fungi, and bacteria. Not much has been done to know the status of these relatively neglected life forms.
Knowledge about biodiversity is crucial to understanding their roles in the ecosystem and therefore for their effective management. Biodiversity is a natural capital that provides a number of ecosystem services in the Kanchenjunga Landscape, including providing food, timber, fiber and medicines – all things we depend on. It is also an important source of income for many local people living in the landscape. Therefore, gaining in-depth knowledge on biodiversity and associated ecosystem functions is extremely important for the well-being of the communities within the Kanchenjunga Landscape, as well as for the global community.
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The Demise of Judiciary
Five weeks ago the Judicial Council (JC) recommended eight names for positions in the Supreme Court. It had taken three years to arrive at this point, and immediately a huge row erupted over its choice.
Its recommendations for justices’ posts in the Supreme Court were highly controversial and raised great concern among legal professionals, the Nepal Bar Association (NBA) and others associated with the justice sector over the future independence of the judiciary. The recommendations were instantly criticized because they included some justices with 'tainted' reputations of corruption, immorality and bad conduct in their professional history.
Despite such huge controversy over the recommendations and seemingly weeks of wrangling among the political parties and others, the Parliamentary Hearing Special Committee (PHSC) went ahead just a few days ago and endorsed all eight nominees for Supreme Court service. Today everybody is demanding to know what the point is of having a Parliamentary Hearing if it simply goes ahead and endorses individuals for public service even though they are known to be incompetent, immoral and lacking in professional ethics?
The JC has, of course, been heavily criticized for, in the first place, by making recommendations for judges´ appointments that were not based on the competence of the individuals but rather on political exchanges (len-den), money, muscles, favoritism and nepotism. The controversial appointments give rise to a fresh debate about whether such an institution as the JC and the constitutional provision of the Parliamentary Hearing have any relevance or pragmatic outcome in our context. The appointment of controversial judges brings into question the accountability of the JC itself and the relevance of a mandatory constitutional provision called a ‘Parliamentary Hearing’.
Judges’ appointments in Nepal have always been controversial. There has been an absence of transparency, and appointments have often been based on personal preference and political connection. Over the course of its 60 years’ history, the country’s judiciary appears somewhat as a politicized organ, but never before has it been so politically and socially controversial. The JC’s recent recommendations for judicial appointment and the PHSC’s subsequent endorsement amount to perhaps the most controversial episode in our country’s judicial history. How can such an unholy, unconstitutional and immoral practice do other than to jeopardize the system of justice in our country? How can such controversial judges, appointed not on the basis of merit but of political allotment (bhagbanda), dispense fair justice? Whose interest are they going to serve throughout their tenure?
It is not as though this matter is happening for the first time. It has happened many times, and it has affected the appointment of judges at every court of law. The time has arrived for us all to think seriously about the following questions. Why are there no rules or, if they exist, why does no one wish to follow them? Why do we see the same thing repeated again and again in this country? Where are the professional ethics of all concerned? Is it not time to undertake a critical assessment of all stakeholders, including the judges, the JC and the PHSC, the system for their appointment and their moral conduct in post? Should the judiciary not be independent of politics and of any outside interference? How can we establish fair and impartial justice if the Apex Court itself is headed by individuals who, in the eyes of the public, are already recognized as being controversial, immoral, corrupt and incompetent? The recent gross failure of the PHSC to respect the expectations of the wider public gives off a number of very negative messages, as follows:
Firstly, an independent judiciary is the backbone of any democratic state, but in our context the pillar of independence would seem to have been destroyed. Powerful stakeholders in the country have hijacked the judiciary, and the norms and values of this vital dispenser of justice are seriously under threat. The judiciary has been forced into a very vulnerable situation, subject now to an external power. How judges are appointed - their capability, professional ethics, merit and integrity - is crucial for ensuring judicial independence. Can our judiciary still maintain its autonomy? And can it still dispense justice fairly?
Secondly, this recent unfortunate episode must be viewed as a great tragedy for our justice system. It reveals only too clearly excessive political and external interference with the judiciary and with our system of justice. Consequently public trust in the nation’s justice system is greatly diminished, and all citizens must ask what kind of justice they can expect in the future?
Thirdly, this appointment of judges in the Apex Court has raised very serious questions about the effectiveness of the ‘Parliamentary Hearing’. This process is supposed to 'increase public trust in the authorities and the institutions that they represent, and citizens are given an opportunity to evaluate the willingness, effectiveness and ability of their representatives to accommodate public voices. Conducting a Hearing is an effective means of potentially earning the trust of a public often wary of politicians' credibility’. Did the PHSC on this occasion serve its purpose? The answer clearly has to be a big ‘No’: the purpose served would appear to be that of the leaders of the so-called political parties and of those hidden powers that wish to use the judiciary to serve their sick desire to legalize and legitimize their own vested interests. It is argued that the PHSC attracted an unrepresentative sample of society, mainly powerful stakeholders with an economic or political interest in the outcome. Many are therefore asking today: Why do we need such a 'karmakandi natak' (ceremonial) hearing if it does not have any effect - especially if it fails to serve the interest of the people? Someone out there must answer this to the people.
Finally, the JC, established under Article 113 of the Interim Constitution of 2007, is a body responsible for making recommendations for the appointment and transfer of judges as well as for any disciplinary action needed against them and for their dismissal. Has this constitutional body ever fulfilled its constitutional duty? The answer is again a huge No! By recommending so many controversial individuals for appointment as judges in the Apex Court, it has made a mockery of the institution itself, its purpose and its mandate. The JC has misused its constitutional authority. Is this not the time to restructure, rethink and redefine its function, its roles and its responsibilities? Shouldn’t this institution be made more accountable to the people? Isn’t it a time, in fact, for a reform of every justice sector institution?
The time is certainly ripe for a wider debate around the following questions. What is the meaning of judicial independence, and what are its proper limits? How is judicial independence best protected, and by whom? What are the roles of lawyers, politicians, civil society and the media in maintaining the autonomy of the judiciary? Why do we keep repeating the same old mistakes again and again? Firstly, if we wish the judiciary to become a vibrant institution for the prompt and impartial delivery of justice, those who are appointed as judges must be seen to be fully competent, moral and clean for the role. The JC, which makes the appointments, must be headed and staffed by clean, qualified and non-political individuals. Clearing up the mess within the JC itself would be the first essential step towards reforming our justice system. Secondly, the JC and all courts of law must be free from political lobbying and allotment (bhagbanda). Thirdly, both judges and lawyers must maintain their integrity and morality and comply with their professional ethics.
Our country is again facing constitutional upheaval, political crisis and even greater uncertainty. It is imperative that we rapidly re-establish the supremacy of the constitution, the rule of law, the separation of powers and the full impartiality of our judicial system. Democratic principles require that all government actions are open to scrutiny by the courts of law. Those courts in turn must redefine their functions, attitudes and operating procedures to re-establish their credibility and to win back public confidence. Let us hope that the principles and values of justice will not perish in this part of the world.
4 World Environment Day Special: The Himalayas - Upstream but Downwind
The Hindu Kush Himalayan (HKH) region has received much attention as the source of rivers that supply water to 1.3 billion people downstream. It has received far less attention for its role as the recipient of the air pollution originating in the plains.
Across northern South Asia during the dry season, individual plumes from hundreds of millions of cooking fires, tens of millions of diesel vehicles, generators and pump sets, as well as tens of thousands of brick kilns merge together into one thick brown haze layer that extends across international borders from Pakistani Punjab to Bangladesh, penetrating deep into Himalayan valleys. A major constituent of this haze is black carbon.
Black carbon is a carcinogen and has major impacts on people’s health. It is also a ‘short-lived climate pollutant’ (SLCP) – an air pollutant that has significant impacts on local and regional climate. Unlike the greenhouse gas carbon dioxide (CO2), which, once emitted, stays in the atmosphere for centuries impacting global climate, SLCPs have atmospheric lifetimes of days to months.
The good news is that shutting down the sources of SLCPs reduces their climate impact within days to months. Their short lifetime also means that they do not have time to mix uniformly around the globe, and that their greatest impact is near their sources. The bad news is that the HKH region is near a major source region for black carbon: the Indo-Gangetic Plains, where more than half a billion people live along the Indus, Ganges, and Brahmaputra rivers and their tributaries. While globally black carbon has the second biggest impact on climate after CO2, its impact in northern South Asia is much bigger than its global average.
Black carbon contributes to the melting of Himalayan glaciers and snowfields, warms the atmosphere at higher elevations and cools it at lower elevations, affecting atmospheric circulation patterns. It also reduces visibility to the point where snowy peaks are no longer visible from places whose livelihoods depend on selling mountain views to tourists. In addition, it contributes to changes in monsoon clouds and in the timing and intensity of rainfall, with potentially significant impacts on droughts, floods, landslides, hydropower, agriculture and drinking water availability.
While air pollution is severe in some of the larger cities in the plains, such as Delhi, Agra, and Dhaka, it can be as bad or worse in smaller cities within the HKH region, such as Kathmandu, Nepal. The mountains surrounding the Kathmandu Valley, and the airflow they create, confine its local emissions within the valley from early evening until late morning. Field studies during the first half of 2013 found concentrations of air pollutants several times above WHO’s and Nepal’s own air quality standards for extended periods of time.
Emissions within the Kathmandu Valley are not the only source of its air pollution problem. There are also inputs from cooking fires, agricultural fires, and forest fires in the surrounding valleys and mountains, and more importantly, an inflow of air pollution up the Bagmati Valley from the south. While sewage from mountain cities flows down the rivers into the plains and across borders, a reverse flow of air pollution comes back up the mountain valleys. There are around 120 brick kilns within the Kathmandu Valley, less than 800 in all of Nepal, mostly in southern Nepal, but almost 23,000 in the two neighbouring Indian states of Uttar Pradesh and Bihar alone.
Air pollution crosses borders daily. Shutting down all of Nepal’s brick kilns will not stop the pollution arriving from the ones south of the border. Bhutan has no brick kilns. It imports its bricks as well as black carbon from brick kilns.
Creating effective air pollution policies to reduce people’s exposure to high levels of air pollution and to reduce its impacts on climate requires detailed scientific understanding of the links between sources and impacts, as well as regionally coordinated science-based policies. What fraction of the black carbon arriving on Yala Glacier in Langtang is from nearby households, from Kathmandu, from the Nepali Terai, or from India or beyond?
Effective policy making at the local and national levels requires detailed maps of emissions sources, atmospheric modeling systems that simulate the fate of emitted pollutants, connecting sources to impacts, as well as a network of measurement stations that provide real-time data to the public and policy makers and inputs to atmospheric models. It also requires free flow of data across borders, and regionally coordinated responses to high air pollution episodes. Ultimately, cleaning up air pollution in northern South Asia and reducing its impacts on the HKH region requires a strong push towards cleaner, less polluting technologies, including clean cooking, clean brick production and clean transportation.
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Understanding health care and hospital system in Kathmandu
In December 2013, I decided to undertake a three-week medical elective at two very different hospitals in Kathmandu. The first hospital I volunteered at was the Civil Service Hospital at New Baneshwor. This is a government-financed hospital built by the Chinese government as a gift to the government of Nepal. It is well regarded for its speciality in the haematology field. Importantly, government officials including existing government service workers, pensioners and retirees receive 50 per cent concession for hospital charges. The second hospital I volunteered at was the Tribhuvan University Teaching Hospital (TUTH) at Maharajganj. The TUTH is regarded as the best and biggest hospital in Nepal for many reasons. First, being the largest capacity hospital in the country, all kinds of disease patterns present and when people have a diagnostic dilemma, they come to this hospital because it focuses on rare diagnoses. Second, it places a big focus on academia and research and third, it also has provisions for the very poor (living below US$1 a day).
As I set out on my medical elective, the main goal was to gain an appreciation and understanding of the health care and hospital system in Nepal and contrast it to Australia. This article discusses some of the major differences I observed and experienced within the health care and hospital system and other related areas.
Lack of a strong primary health care system
I found the absence of a strong primary health care (PHC) provision in Nepal. Primary preventative care and self-management are not considered as important and therefore, do not have a strong influence in Nepal. The concept of general practice does not contribute to a large proportion of outpatient care. Instead, the system is structured on Outpatient Departments (OPD) within hospitals where patients can have short consults with doctors according to the medical speciality such as respiratory OPD, OBGYN OPD etc. and if further medical care is required, they self admit to the hospital. The process for OPD consults is one of a ticketing system whereby patients purchase a Rs 25 ticket before consultation with the doctor. The nature of the consults are incredibly short, lasting between 5-10mins and done in the presence of 2-3 other doctors who are consulting different patients at the same time. Therefore, there is a lack of consideration for privacy and confidentiality in these circumstances. The consulting process is hectic and overcrowded as up to 1500 patients are consulted every day (TUTH). Given the time frame and ratio of patients to consult, the provision of patient focus, holistic care and efficiency are most likely overlooked.
Medical care provision
The second major difference noted was the provision of medical care according to affordability. As there is no health system in Nepal that provides universal coverage for medical care, the patients health is based mainly on out of pocket expenses; therefore, the type of care received by patients in hospitals is based on fee they can afford. For example, the TUTH has up to 7,000 beds available. For those who can afford to pay Rs 600 a night are placed in a different ward and those who cannot are placed in a central area with 10 beds, open to public access. Amongst these poorer group of patients, some cannot even afford hospital care and are therefore placed in a separate area beneath a sign that reads too poor to pay for medical care (direct translation) so that the staff understand their financial situation before providing them with economically appropriate medical care. Furthermore, diagnostic tests ordered by doctors are also based on patients income. If a patient can afford high-level medical care, expensive tests with definitive diagnosis outcomes are recommended, however, for those that cannot, only small-scale tests are ordered and ultimately pose a diagnostic problem for the medical team.
The very poor cannot afford even the most basic tests, and so appropriate parameters are put in place by the hospital to separate these patients into a scheme that receives free care by the hospital. Interestingly, the parameters to decipher these situations are very subjective and judgemental i.e. if a patient can afford a mobile phone, they can afford medical care, or judging by the clothes they wear.
Patient education and management
The third major difference noted was less focus on patient education and self-management. The Nepali population has a very different perspective and attitude about health and wellbeing in general compared to Australians and this is the prime reason for this discrepancy, which needs to be addressed. Nepali people often endure ill health until they reach severe circumstances and require hospital assistance. Their general attitude is that illness may be temporary and will get resolved in time without medical assistance. Alongside this attitudinal difference, a lot of patients cannot afford medical care or find it a nuisance to visit the doctor or the hospital, particularly if it interferes with their ability to make a living or responsibility to care for family. An example of this is a 38-week pregnant woman who refused to be admitted to the obstetrics ward despite being told by the doctor that she would give birth that day after a physical examination. Her main concern was that she had not been in pain and she needed to be home to look after her husband and family. The doctor proceeded to call her husband to explain the situation because many women dont tell their husbands about the consult and if pregnancy complications ensue, the husband makes complaints to the hospital. The focus of the patient education should not only be for patient awareness but also for medico-legal purposes to overcome social and societal issues.
In contrast, people in Australia deem it a right to have access to health care and place it as a priority to get general check-ups and medical care when they are ill. Although this is still an issue in the rural areas of Australia, this problem is minimal relative to the general Nepali population. Therefore, Nepali people require better patient education about what constitutes ill health, when it is important to visit a doctor and why its important to have frequent general check-ups to better manage their health and avoid acute illness in the future.
Priorities
Nepals health care and hospital system would benefit from a stronger primary health care system, which focuses on health education, awareness and preventative care alongside self-management of patients. This will help people manage their health within the community and reduce the pressure placed in secondary care within a hospital setting when patients are admitted severely ill and at the end spectrum of their disease state. It will also reduce hospital costs for patients and save the health cost for the countrys economy. Furthermore, family and friends of patients also need to be better educated alongside the patient about how to self manage their health at home and how to prevent illness to encourage them to seek health assistance in a timely manner.
Other areas of improvement that may be beneficial to improve the patients journey in the health care system includes strengthening doctor patient relationships, emphasis on holistic medical care and focus on mental health. Doctors are highly revered people in the community and patients respect them to the point that they will do anything a doctor advises even if it is beyond their wishes. This is because patients have an inherent belief that the doctor always knows best and often leave the most important decisions about their own health in the hands of someone else. Therefore, better communication between the doctor and patient regarding patient values, finances, personal, cultural and religious beliefs are important to include in the decision making process for their health. Additionally, the focus of medicine in Nepal is one of a diagnostic or quick fix rather than a holistic model of care. This model focuses on the patients medical problem and aims to fix it rather than looking at the disease in the context of the persons life. This is where the doctor-patient relationship is important to understand the barriers for providing the best medical care and quality of life for that particular patient. Finally, there is little emphasis on mental health problems in Nepal. Most hospitals dont have a separate mental health ward, but a joint ward with around 10 beds. Interestingly, the most common causes of mental illness in Nepal include cases of Schizophrenia and depression; mainly post traumatic stress disorder. Although there is low prevalence of mental health conditions in Australia and there is a proper system to look after, on the contrary in Nepal, a large majority of the population goes undiagnosed because there is no screening system, little provision within the health care system and even less support for them within the community once diagnosed.
Summary
Overall, despite the need to improve parts of Nepals health care and hospital system, there are so many positives I observed during my elective. I was mainly impressed by the efficiency of a hospital system in a developing country. The hospital system is able to cater for so many patients without an abundance of resources or financial support. The hospital operational system was very efficient and there was a good working relationship between the medical officers, doctors, nurses and other staff. I was inspired by the ability of doctors to cater to a wide variety of patients in Nepal from different social, cultural, religious and economical backgrounds. The calibre of the staff was also very impressive in their level of expertise, knowledge and teaching. Furthermore, the staff were incredibly friendly and taught me like I was a student of their own.
Having had the opportunity to undertake my medical elective in Kathmandu, I have benefited in understanding the differences between hospital system structure and function between developing and developed countries. These experiences and perspectives I gained will help me enormously in my clinical studies in Australia.
‘Islands’ – the word generally conjures images of areas of land surrounded by water. For conservationists, islands take on another meaning when pockets of pristine land areas rich in biodiversity exist amidst intensive areas of human settlements, agriculture or industrialization. These ‘islands’ are generally home to numerous species of plants, birds, insects and animals. At a larger scale, many of these ecologically significant islands have been set aside as areas to protect plants and wildlife.
Animals, particularly large animals, must move, and thus require large areas of habitat for their survival. Often, when animals travel outside their ‘islands’ of protected areas, they enter human settlements and destroy crops, livestock, and even human life, resulting in what conservationists term ‘human-wildlife conflicts’. Humans generally respond to such wildlife intrusions by exterminating them through various means – a process termed as ‘retaliatory killing.’
One of the methods by which the habitat of large animals can be increased is by connecting protected areas through wildlife ‘corridors’. These corridors can be instrumental in connecting fragmented habitat islands and thereby facilitating wildlife movement. Corridors also promote interbreeding, which results in genetic diversity within the wildlife population.
The Kanchenjunga Landscape is one of seven landscape initiatives in the Hindu Kush Himalayas where the ecosystem approach is being used with a focus on connecting islands of protected areas through conservation corridors. This initiative is a trans-boundary program involving the governments of Bhutan, India, and Nepal. The program aims to develop connectivity between the 20 isolated protected areas in the landscape through a network of conservation corridors extending from eastern Nepal, through the states of Sikkim and northern West Bengal in India, to western Bhutan. These corridors will facilitate the movement of species, such as the endangered snow leopard at the higher elevations, and Bengal tiger and Asian elephant at the lower elevations.
The Kanchenjunga Landscape is part of the Eastern Himalaya ‘Biodiversity Hotspot’ where there is high level of biodiversity, much of which is facing severe threats from humans. The landscape hosts a significantly high number of plants and is home to at least six species of endangered animals including the snow leopard, Himalayan musk deer, Bengal tiger, Asian elephant, and one-horned rhino, among others. The trademark plant species of the landscape is the rhododendron – at least 45 species of which are found in the landscape. The landscape is also home to approximately seven million women and men, some of whom belong to distinct ethnic groups, such as the Lepchas and the Walungs.
Despite the ecological significance of the Kanchenjunga Landscape, there is much we need to know about the biodiversity and socio-economy of the region. During a recent review process for understanding the state of knowledge on biodiversity in the landscape, about 850 published and unpublished documents were recorded. The first recorded study in the landscape was conducted more than 170 years ago on the Lepchas of Sikkim by Archibald Campbell, the British political agent to Sikkim and Darjeeling in the East India Company. This was followed by the work of the notable British naturalist Joseph Dalton Hooker, who published an account of his botanical expedition in the Kanchenjunga region in two volumes of The Himalayan Journals in 1854. Subsequently, research interest in the Kanchenjunga landscape increased significantly only three decades later in the 1980s. Much of the information gathered in the area was focused on animals and plants, with the red panda being the most researched animal species in the landscape. Over 80 per cent of the research has been conducted in the Indian portion of the Kanchenjunga Landscape, only 9 per cent has been conducted in Nepal and just 4 per cent took place in the Bhutan portion of the landscape.
Why is it important to know about the biodiversity in the Kanchenjunga Landscape? There are an estimated 8.7 million species of organisms in the world. Among these, only 1.2 million species have been identified till date – representing only 14 per cent of the total biodiversity in the world. Accordingly, we have probably identified only a third of the total number of species in the Kanchenjunga Landscape. Much of the gaps in our knowledge exist in relation to species other than plants and animals, i.e. on fish, amphibians, insects, fungi, and bacteria. Not much has been done to know the status of these relatively neglected life forms.
Knowledge about biodiversity is crucial to understanding their roles in the ecosystem and therefore for their effective management. Biodiversity is a natural capital that provides a number of ecosystem services in the Kanchenjunga Landscape, including providing food, timber, fiber and medicines – all things we depend on. It is also an important source of income for many local people living in the landscape. Therefore, gaining in-depth knowledge on biodiversity and associated ecosystem functions is extremely important for the well-being of the communities within the Kanchenjunga Landscape, as well as for the global community.
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The Demise of Judiciary
Five weeks ago the Judicial Council (JC) recommended eight names for positions in the Supreme Court. It had taken three years to arrive at this point, and immediately a huge row erupted over its choice.
Its recommendations for justices’ posts in the Supreme Court were highly controversial and raised great concern among legal professionals, the Nepal Bar Association (NBA) and others associated with the justice sector over the future independence of the judiciary. The recommendations were instantly criticized because they included some justices with 'tainted' reputations of corruption, immorality and bad conduct in their professional history.
Despite such huge controversy over the recommendations and seemingly weeks of wrangling among the political parties and others, the Parliamentary Hearing Special Committee (PHSC) went ahead just a few days ago and endorsed all eight nominees for Supreme Court service. Today everybody is demanding to know what the point is of having a Parliamentary Hearing if it simply goes ahead and endorses individuals for public service even though they are known to be incompetent, immoral and lacking in professional ethics?
The JC has, of course, been heavily criticized for, in the first place, by making recommendations for judges´ appointments that were not based on the competence of the individuals but rather on political exchanges (len-den), money, muscles, favoritism and nepotism. The controversial appointments give rise to a fresh debate about whether such an institution as the JC and the constitutional provision of the Parliamentary Hearing have any relevance or pragmatic outcome in our context. The appointment of controversial judges brings into question the accountability of the JC itself and the relevance of a mandatory constitutional provision called a ‘Parliamentary Hearing’.
Judges’ appointments in Nepal have always been controversial. There has been an absence of transparency, and appointments have often been based on personal preference and political connection. Over the course of its 60 years’ history, the country’s judiciary appears somewhat as a politicized organ, but never before has it been so politically and socially controversial. The JC’s recent recommendations for judicial appointment and the PHSC’s subsequent endorsement amount to perhaps the most controversial episode in our country’s judicial history. How can such an unholy, unconstitutional and immoral practice do other than to jeopardize the system of justice in our country? How can such controversial judges, appointed not on the basis of merit but of political allotment (bhagbanda), dispense fair justice? Whose interest are they going to serve throughout their tenure?
It is not as though this matter is happening for the first time. It has happened many times, and it has affected the appointment of judges at every court of law. The time has arrived for us all to think seriously about the following questions. Why are there no rules or, if they exist, why does no one wish to follow them? Why do we see the same thing repeated again and again in this country? Where are the professional ethics of all concerned? Is it not time to undertake a critical assessment of all stakeholders, including the judges, the JC and the PHSC, the system for their appointment and their moral conduct in post? Should the judiciary not be independent of politics and of any outside interference? How can we establish fair and impartial justice if the Apex Court itself is headed by individuals who, in the eyes of the public, are already recognized as being controversial, immoral, corrupt and incompetent? The recent gross failure of the PHSC to respect the expectations of the wider public gives off a number of very negative messages, as follows:
Firstly, an independent judiciary is the backbone of any democratic state, but in our context the pillar of independence would seem to have been destroyed. Powerful stakeholders in the country have hijacked the judiciary, and the norms and values of this vital dispenser of justice are seriously under threat. The judiciary has been forced into a very vulnerable situation, subject now to an external power. How judges are appointed - their capability, professional ethics, merit and integrity - is crucial for ensuring judicial independence. Can our judiciary still maintain its autonomy? And can it still dispense justice fairly?
Secondly, this recent unfortunate episode must be viewed as a great tragedy for our justice system. It reveals only too clearly excessive political and external interference with the judiciary and with our system of justice. Consequently public trust in the nation’s justice system is greatly diminished, and all citizens must ask what kind of justice they can expect in the future?
Thirdly, this appointment of judges in the Apex Court has raised very serious questions about the effectiveness of the ‘Parliamentary Hearing’. This process is supposed to 'increase public trust in the authorities and the institutions that they represent, and citizens are given an opportunity to evaluate the willingness, effectiveness and ability of their representatives to accommodate public voices. Conducting a Hearing is an effective means of potentially earning the trust of a public often wary of politicians' credibility’. Did the PHSC on this occasion serve its purpose? The answer clearly has to be a big ‘No’: the purpose served would appear to be that of the leaders of the so-called political parties and of those hidden powers that wish to use the judiciary to serve their sick desire to legalize and legitimize their own vested interests. It is argued that the PHSC attracted an unrepresentative sample of society, mainly powerful stakeholders with an economic or political interest in the outcome. Many are therefore asking today: Why do we need such a 'karmakandi natak' (ceremonial) hearing if it does not have any effect - especially if it fails to serve the interest of the people? Someone out there must answer this to the people.
Finally, the JC, established under Article 113 of the Interim Constitution of 2007, is a body responsible for making recommendations for the appointment and transfer of judges as well as for any disciplinary action needed against them and for their dismissal. Has this constitutional body ever fulfilled its constitutional duty? The answer is again a huge No! By recommending so many controversial individuals for appointment as judges in the Apex Court, it has made a mockery of the institution itself, its purpose and its mandate. The JC has misused its constitutional authority. Is this not the time to restructure, rethink and redefine its function, its roles and its responsibilities? Shouldn’t this institution be made more accountable to the people? Isn’t it a time, in fact, for a reform of every justice sector institution?
The time is certainly ripe for a wider debate around the following questions. What is the meaning of judicial independence, and what are its proper limits? How is judicial independence best protected, and by whom? What are the roles of lawyers, politicians, civil society and the media in maintaining the autonomy of the judiciary? Why do we keep repeating the same old mistakes again and again? Firstly, if we wish the judiciary to become a vibrant institution for the prompt and impartial delivery of justice, those who are appointed as judges must be seen to be fully competent, moral and clean for the role. The JC, which makes the appointments, must be headed and staffed by clean, qualified and non-political individuals. Clearing up the mess within the JC itself would be the first essential step towards reforming our justice system. Secondly, the JC and all courts of law must be free from political lobbying and allotment (bhagbanda). Thirdly, both judges and lawyers must maintain their integrity and morality and comply with their professional ethics.
Our country is again facing constitutional upheaval, political crisis and even greater uncertainty. It is imperative that we rapidly re-establish the supremacy of the constitution, the rule of law, the separation of powers and the full impartiality of our judicial system. Democratic principles require that all government actions are open to scrutiny by the courts of law. Those courts in turn must redefine their functions, attitudes and operating procedures to re-establish their credibility and to win back public confidence. Let us hope that the principles and values of justice will not perish in this part of the world.
4 World Environment Day Special: The Himalayas - Upstream but Downwind
The Hindu Kush Himalayan (HKH) region has received much attention as the source of rivers that supply water to 1.3 billion people downstream. It has received far less attention for its role as the recipient of the air pollution originating in the plains.
Across northern South Asia during the dry season, individual plumes from hundreds of millions of cooking fires, tens of millions of diesel vehicles, generators and pump sets, as well as tens of thousands of brick kilns merge together into one thick brown haze layer that extends across international borders from Pakistani Punjab to Bangladesh, penetrating deep into Himalayan valleys. A major constituent of this haze is black carbon.
Black carbon is a carcinogen and has major impacts on people’s health. It is also a ‘short-lived climate pollutant’ (SLCP) – an air pollutant that has significant impacts on local and regional climate. Unlike the greenhouse gas carbon dioxide (CO2), which, once emitted, stays in the atmosphere for centuries impacting global climate, SLCPs have atmospheric lifetimes of days to months.
The good news is that shutting down the sources of SLCPs reduces their climate impact within days to months. Their short lifetime also means that they do not have time to mix uniformly around the globe, and that their greatest impact is near their sources. The bad news is that the HKH region is near a major source region for black carbon: the Indo-Gangetic Plains, where more than half a billion people live along the Indus, Ganges, and Brahmaputra rivers and their tributaries. While globally black carbon has the second biggest impact on climate after CO2, its impact in northern South Asia is much bigger than its global average.
Black carbon contributes to the melting of Himalayan glaciers and snowfields, warms the atmosphere at higher elevations and cools it at lower elevations, affecting atmospheric circulation patterns. It also reduces visibility to the point where snowy peaks are no longer visible from places whose livelihoods depend on selling mountain views to tourists. In addition, it contributes to changes in monsoon clouds and in the timing and intensity of rainfall, with potentially significant impacts on droughts, floods, landslides, hydropower, agriculture and drinking water availability.
While air pollution is severe in some of the larger cities in the plains, such as Delhi, Agra, and Dhaka, it can be as bad or worse in smaller cities within the HKH region, such as Kathmandu, Nepal. The mountains surrounding the Kathmandu Valley, and the airflow they create, confine its local emissions within the valley from early evening until late morning. Field studies during the first half of 2013 found concentrations of air pollutants several times above WHO’s and Nepal’s own air quality standards for extended periods of time.
Emissions within the Kathmandu Valley are not the only source of its air pollution problem. There are also inputs from cooking fires, agricultural fires, and forest fires in the surrounding valleys and mountains, and more importantly, an inflow of air pollution up the Bagmati Valley from the south. While sewage from mountain cities flows down the rivers into the plains and across borders, a reverse flow of air pollution comes back up the mountain valleys. There are around 120 brick kilns within the Kathmandu Valley, less than 800 in all of Nepal, mostly in southern Nepal, but almost 23,000 in the two neighbouring Indian states of Uttar Pradesh and Bihar alone.
Air pollution crosses borders daily. Shutting down all of Nepal’s brick kilns will not stop the pollution arriving from the ones south of the border. Bhutan has no brick kilns. It imports its bricks as well as black carbon from brick kilns.
Creating effective air pollution policies to reduce people’s exposure to high levels of air pollution and to reduce its impacts on climate requires detailed scientific understanding of the links between sources and impacts, as well as regionally coordinated science-based policies. What fraction of the black carbon arriving on Yala Glacier in Langtang is from nearby households, from Kathmandu, from the Nepali Terai, or from India or beyond?
Effective policy making at the local and national levels requires detailed maps of emissions sources, atmospheric modeling systems that simulate the fate of emitted pollutants, connecting sources to impacts, as well as a network of measurement stations that provide real-time data to the public and policy makers and inputs to atmospheric models. It also requires free flow of data across borders, and regionally coordinated responses to high air pollution episodes. Ultimately, cleaning up air pollution in northern South Asia and reducing its impacts on the HKH region requires a strong push towards cleaner, less polluting technologies, including clean cooking, clean brick production and clean transportation.
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Understanding health care and hospital system in Kathmandu
In December 2013, I decided to undertake a three-week medical elective at two very different hospitals in Kathmandu. The first hospital I volunteered at was the Civil Service Hospital at New Baneshwor. This is a government-financed hospital built by the Chinese government as a gift to the government of Nepal. It is well regarded for its speciality in the haematology field. Importantly, government officials including existing government service workers, pensioners and retirees receive 50 per cent concession for hospital charges. The second hospital I volunteered at was the Tribhuvan University Teaching Hospital (TUTH) at Maharajganj. The TUTH is regarded as the best and biggest hospital in Nepal for many reasons. First, being the largest capacity hospital in the country, all kinds of disease patterns present and when people have a diagnostic dilemma, they come to this hospital because it focuses on rare diagnoses. Second, it places a big focus on academia and research and third, it also has provisions for the very poor (living below US$1 a day).
As I set out on my medical elective, the main goal was to gain an appreciation and understanding of the health care and hospital system in Nepal and contrast it to Australia. This article discusses some of the major differences I observed and experienced within the health care and hospital system and other related areas.
Lack of a strong primary health care system
I found the absence of a strong primary health care (PHC) provision in Nepal. Primary preventative care and self-management are not considered as important and therefore, do not have a strong influence in Nepal. The concept of general practice does not contribute to a large proportion of outpatient care. Instead, the system is structured on Outpatient Departments (OPD) within hospitals where patients can have short consults with doctors according to the medical speciality such as respiratory OPD, OBGYN OPD etc. and if further medical care is required, they self admit to the hospital. The process for OPD consults is one of a ticketing system whereby patients purchase a Rs 25 ticket before consultation with the doctor. The nature of the consults are incredibly short, lasting between 5-10mins and done in the presence of 2-3 other doctors who are consulting different patients at the same time. Therefore, there is a lack of consideration for privacy and confidentiality in these circumstances. The consulting process is hectic and overcrowded as up to 1500 patients are consulted every day (TUTH). Given the time frame and ratio of patients to consult, the provision of patient focus, holistic care and efficiency are most likely overlooked.
Medical care provision
The second major difference noted was the provision of medical care according to affordability. As there is no health system in Nepal that provides universal coverage for medical care, the patients health is based mainly on out of pocket expenses; therefore, the type of care received by patients in hospitals is based on fee they can afford. For example, the TUTH has up to 7,000 beds available. For those who can afford to pay Rs 600 a night are placed in a different ward and those who cannot are placed in a central area with 10 beds, open to public access. Amongst these poorer group of patients, some cannot even afford hospital care and are therefore placed in a separate area beneath a sign that reads too poor to pay for medical care (direct translation) so that the staff understand their financial situation before providing them with economically appropriate medical care. Furthermore, diagnostic tests ordered by doctors are also based on patients income. If a patient can afford high-level medical care, expensive tests with definitive diagnosis outcomes are recommended, however, for those that cannot, only small-scale tests are ordered and ultimately pose a diagnostic problem for the medical team.
The very poor cannot afford even the most basic tests, and so appropriate parameters are put in place by the hospital to separate these patients into a scheme that receives free care by the hospital. Interestingly, the parameters to decipher these situations are very subjective and judgemental i.e. if a patient can afford a mobile phone, they can afford medical care, or judging by the clothes they wear.
Patient education and management
The third major difference noted was less focus on patient education and self-management. The Nepali population has a very different perspective and attitude about health and wellbeing in general compared to Australians and this is the prime reason for this discrepancy, which needs to be addressed. Nepali people often endure ill health until they reach severe circumstances and require hospital assistance. Their general attitude is that illness may be temporary and will get resolved in time without medical assistance. Alongside this attitudinal difference, a lot of patients cannot afford medical care or find it a nuisance to visit the doctor or the hospital, particularly if it interferes with their ability to make a living or responsibility to care for family. An example of this is a 38-week pregnant woman who refused to be admitted to the obstetrics ward despite being told by the doctor that she would give birth that day after a physical examination. Her main concern was that she had not been in pain and she needed to be home to look after her husband and family. The doctor proceeded to call her husband to explain the situation because many women dont tell their husbands about the consult and if pregnancy complications ensue, the husband makes complaints to the hospital. The focus of the patient education should not only be for patient awareness but also for medico-legal purposes to overcome social and societal issues.
In contrast, people in Australia deem it a right to have access to health care and place it as a priority to get general check-ups and medical care when they are ill. Although this is still an issue in the rural areas of Australia, this problem is minimal relative to the general Nepali population. Therefore, Nepali people require better patient education about what constitutes ill health, when it is important to visit a doctor and why its important to have frequent general check-ups to better manage their health and avoid acute illness in the future.
Priorities
Nepals health care and hospital system would benefit from a stronger primary health care system, which focuses on health education, awareness and preventative care alongside self-management of patients. This will help people manage their health within the community and reduce the pressure placed in secondary care within a hospital setting when patients are admitted severely ill and at the end spectrum of their disease state. It will also reduce hospital costs for patients and save the health cost for the countrys economy. Furthermore, family and friends of patients also need to be better educated alongside the patient about how to self manage their health at home and how to prevent illness to encourage them to seek health assistance in a timely manner.
Other areas of improvement that may be beneficial to improve the patients journey in the health care system includes strengthening doctor patient relationships, emphasis on holistic medical care and focus on mental health. Doctors are highly revered people in the community and patients respect them to the point that they will do anything a doctor advises even if it is beyond their wishes. This is because patients have an inherent belief that the doctor always knows best and often leave the most important decisions about their own health in the hands of someone else. Therefore, better communication between the doctor and patient regarding patient values, finances, personal, cultural and religious beliefs are important to include in the decision making process for their health. Additionally, the focus of medicine in Nepal is one of a diagnostic or quick fix rather than a holistic model of care. This model focuses on the patients medical problem and aims to fix it rather than looking at the disease in the context of the persons life. This is where the doctor-patient relationship is important to understand the barriers for providing the best medical care and quality of life for that particular patient. Finally, there is little emphasis on mental health problems in Nepal. Most hospitals dont have a separate mental health ward, but a joint ward with around 10 beds. Interestingly, the most common causes of mental illness in Nepal include cases of Schizophrenia and depression; mainly post traumatic stress disorder. Although there is low prevalence of mental health conditions in Australia and there is a proper system to look after, on the contrary in Nepal, a large majority of the population goes undiagnosed because there is no screening system, little provision within the health care system and even less support for them within the community once diagnosed.
Summary
Overall, despite the need to improve parts of Nepals health care and hospital system, there are so many positives I observed during my elective. I was mainly impressed by the efficiency of a hospital system in a developing country. The hospital system is able to cater for so many patients without an abundance of resources or financial support. The hospital operational system was very efficient and there was a good working relationship between the medical officers, doctors, nurses and other staff. I was inspired by the ability of doctors to cater to a wide variety of patients in Nepal from different social, cultural, religious and economical backgrounds. The calibre of the staff was also very impressive in their level of expertise, knowledge and teaching. Furthermore, the staff were incredibly friendly and taught me like I was a student of their own.
Having had the opportunity to undertake my medical elective in Kathmandu, I have benefited in understanding the differences between hospital system structure and function between developing and developed countries. These experiences and perspectives I gained will help me enormously in my clinical studies in Australia.