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The population of the Dalit community in Madhes Province is larger than in any other province, making up about 18 percent of the total provincial population. Yet, despite systemic changes aimed at addressing the plight of Dalits—who remain socially, economically, politically, educationally, and culturally marginalized—their situation has barely improved.

In 2019, the Madhes Province government introduced the Dalit Empowerment Act to uplift the community. The law, brought forward under then Chief Minister Lalbabu Raut, was designed to formulate and implement programs safeguarding Dalit rights and advancing their interests. As part of the Act, the provincial government established a Dalit Development Committee tasked with creating and implementing empowerment plans across the province.

The committee was structured with the Minister for Social Development (now Sports and Social Welfare) as chairperson and a vice-chairperson selected from among Dalit community members with at least a bachelor’s degree and a record of contributing to Dalit upliftment. It also included four members—two of them women—appointed for a four-year term. However, the tenure of the last committee expired in Feb 2025, and since then, the provincial government has failed to appoint new office bearers.

Under the Act, the Council of Ministers is empowered to form the committee, drawing members from the Policy Commission, the Ministry of Economic Affairs and Planning, the Office of the Chief Minister and Council of Ministers, and the Ministry of Social Development. The vice-chairperson’s position carries the same facilities as an 11th-level officer of the provincial government. Appointments are to be made by the Council of Ministers on the recommendation of the Minister of Sports and Social Welfare.

Despite Minister Pramod Kumar Jayaswal recommending candidates to the Chief Minister’s Office two months ago, the process has stalled. Political wrangling and lack of priority accorded to Dalit issues have prevented new appointments.

“Until recently, we had only forwarded the recommendation for the vice-chairperson, but now we are preparing to send the names of all office bearers at once and finalize them in the upcoming cabinet meeting,” Minister Jayaswal said. “It has been delayed, but once new office bearers are appointed, work will move forward smoothly in the new fiscal year.”

Provincial Assembly member Lalita Tatma, however, accuses the government of neglecting Dalit issues.

The Dalit Development Committee was mandated to be consulted on all Dalit-related programs at the provincial level. It was also tasked with running income-generating and skill-development programs and carrying out research and publications on Dalit issues. But due to weak structure, poor implementation, and absence of leadership, it has achieved little.

Dalit leader Rajkumar Paswan of Saptari argues that the state’s indifference is evident in the vacant posts across commissions and institutions, including the Dalit Development Committee. “Dalits are subjected to violence, discrimination, and social oppression in Madhes Province. The committee was supposed to monitor, document, advocate, and resolve these problems, but it has been without office bearers for a long time. This reflects the government’s prejudice and political apathy,” Paswan said. “The government, which talks of inclusion, justice, and equality, has left the Dalit Development Committee headless and ineffective.”

Two years after the Dalit Empowerment Act was passed, Madhes Province formed its first Dalit Development Committee. Ram Pravesh Baitha was appointed vice-chairperson, with members including Rajkumar Das from Rautahat, Shyam Sardar from Parsa, Devi Das from Shewa, and Sunita Marik Dom. However, the committee faced criticism throughout its four-year term for failing to achieve much.

Outgoing vice-chairperson Baitha blames the government for undermining the body. “We were left stranded for a year after our appointment. In the second year, a budget of Rs 20m was provided, from which we managed to set up an office, purchase a vehicle, and conduct small-scale awareness programs. Beyond that, there was little support,” Baitha said.

The preamble of the Dalit Empowerment Act declares its aim to ensure Dalit participation in the social, cultural, political, civil, economic, and educational spheres while eliminating caste-based discrimination and untouchability. Yet in practice, the law remains largely unimplemented. The Act envisioned four monitoring committees to oversee issues of caste-based discrimination. Among them, the Caste Discrimination and Untouchability Monitoring Committee was to function at the provincial level under the Chief Minister, with responsibilities to study incidents, monitor laws, and ensure enforcement. Members included the Ministers of Internal Affairs and Law, Social Development, Dalit Assembly representatives, the Chief Justice, and others.

But according to activist Bhola Paswan, the committee has been inactive since Chief Minister Satish Singh assumed office. “The provincial committee led by the Chief Minister has not met even once. He has no interest in Dalit issues,” Paswan said. “The government treats Dalits as nothing more than a vote bank, without taking real steps for their upliftment.” The Act also required each rural municipality and municipality to establish a local monitoring committee under the mayor to tackle discrimination at the grassroots level. Yet, only 35 of Madhes’s 136 municipalities have formed such bodies.

Dalit leaders say that the hopes raised by the 2019 Act have been dashed. “When this Act was passed, Dalits in Madhes felt hopeful. We believed federalism had finally delivered for us. We thought committees would reach all eight districts, listen to our problems, and design proper programs,” said Manoj Ram, a Dalit leader. “But the reality is the opposite. Officials appointed to the committee cared more about salaries and allowances. During their four-year term, they did little for Dalits. They blame lack of government support, but the community gained nothing from leaders occupying positions just for the sake of it. Even now, I see no commitment from the government to act in favor of Dalits.”

According to the National Census 2021, Nepal’s total population is 29.1m, of which Dalits make up 13.4 percent. Madhes Province, with a population of 6.1m, has around 1.06m Dalits—about 18 percent of its residents. Data from the National Dalit Commission show a literacy rate of 77.9 percent for Dalits in Madhes, while 91 percent are considered economically active.

The Act promised a future where Dalits in Madhes Province could meaningfully participate in society and benefit from targeted programs. Instead, weak institutions, lack of political will, and half-hearted implementation have left the community frustrated. For many Dalits, the Dalit Empowerment Act of 2019 remains little more than words on paper—its committees underfunded, underrepresented, and largely inactive. Leaders and activists alike argue that without urgent government action and sincere prioritization, Madhes’s Dalit community will continue to face discrimination, exclusion, and neglect, despite making up nearly a fifth of the province’s population.

According to the Birgunj Metropolitan City’s Health Division, at least 71 cases of cholera have been confirmed since Friday, with over 200 patients currently receiving treatment for diarrhea and suspected cholera in various hospitals across the city. Two deaths have been reported among patients suffering from severe diarrhea, though cholera infection has not been confirmed in those cases.

Medical experts suspect the outbreak is linked to contamination of drinking water pipelines with sewage. Samples from 11 affected locations have been collected and sent to the National Public Health Laboratory in Teku, Kathmandu, with test results expected soon.

Hospitals in Birgunj, particularly Narayani Hospital, are struggling to cope with the rising patient load. “Due to a shortage of hospital beds, we have been forced to treat patients on the floors and verandas,” said Dr Uday Narayan Singh, spokesperson for Narayani Hospital. 

The outbreak has particularly affected Birgunj Metropolitan City-11, 12, 13, and 16. With community-level spread confirmed, the municipality has ordered all schools in the city to remain closed for two days (Sunday and Monday) as a precautionary measure.

Minister for Water Supply Pradeep Yadav, who visited Narayani Hospital and other affected areas, acknowledged that sewage contamination in water pipelines may have triggered the outbreak. “Water samples from affected areas have been sent to Kathmandu for testing. Only after the results arrive can we confirm the exact cause,” Yadav said. He assured that the government is fully sensitive to the crisis and that teams with water purification materials, including chlorine solutions such as Piyush, have already been dispatched to Birgunj.

Mayor of Birgunj metropolitan city, Rajesh Man Singh, said the city office has also mobilized local health teams for door-to-door awareness campaigns, water sampling, and immediate intervention since Friday night when the first cluster of cases emerged in Murlitol of ward 12. “Strict monitoring is underway at marketplaces to ensure hygiene in the transport and sale of fish, meat, sekuwa and other animal products.” As part of the campaign, authorities have begun inspecting vendors, who display food items openly, sell products in unhygienic conditions or neglect sanitation standards, with actions being taken against violators.

Officials confirmed that this is the first major cholera outbreak in Parsa district in the past decade. Cholera, caused by the bacterium Vibrio cholerae, spreads through contaminated food and water. Symptoms include acute diarrhea, vomiting, abdominal pain, sunken eyes, dehydration, muscle cramps, and in severe cases, fever.

With patient numbers still rising, health authorities warn that the situation could worsen unless water sources are secured and mass preventive measures are enforced immediately.

The Madhes Provincial Government has supplied medicines and health materials to Narayani Hospital in Birgunj for the treatment of cholera patients. On Sunday, Dr Bipan Kumar Jha, Chief of the Health Division at the Ministry of Health and Population, Madhes Province, and Public Health Officer Santosh Thakur handed over the medicines and supplies to Dr Chumanlal Das, Medical Superintendent of Narayani Hospital. The provincial government has provided 17 types of medicines and materials needed for the treatment of diarrhea and cholera patients through the Parsa District Health Office, Thakur said. He added that the provincial government is committed to controlling the cholera outbreak in Birgunj and is prepared to provide additional medicines and supplies if required.

Meanwhile, Home Minister Ramesh Lekhak has directed security agencies to remain on high alert to support efforts in containing a cholera outbreak that has spread across Birgunj. During a meeting of the Central Security Committee on Sunday, Minister Lekhak instructed the Nepali Army, Nepal Police and the Armed Police Force to remain ready for mobilization if required. “The minister has also instructed preparations to deploy medical teams, including doctors, should the situation worsen,” said Ministry spokesperson and Joint-secretary Anand Kafle after the meeting. 

Environmentalist Ujjwal Upadhyay says the cholera outbreak in Birgunj is a direct impact of climate change. Taking to Facebook, he explained that reduced monsoon rainfall and recurring droughts have dried up water sources, creating an acute shortage of drinking water. As a result, local residents have become dependent on unsafe alternatives, such as jar water that is often not quality-tested. When water quantity declines at the source, the concentration of pathogens increases, making the water more contaminated and heightening the risk of infectious diseases.

According to the World Health Organization (WHO), every individual requires at least 100 liters of safe water per day. When supply falls below this level, the likelihood of waterborne diseases rises sharply.

As tube wells began to dry up one after another, the municipality started supplying water through new PVC pipelines, many of which run alongside sewerage canals. During times of acute shortage, people broke open these pipelines to access water but never repaired them afterward, leaving the system highly vulnerable to contamination.

While open defecation has nearly ended in the city, the lack of safe water has compounded the problem. “The bigger question,” Upadhyay stresses, “is who should bear responsibility and provide compensation for such climate-induced losses and damages caused by the excessive carbon emissions of major powers?”

In recent years, words like “sugar” and “pressure” have become part of our everyday conversation. These terms refer to two chronic conditions: diabetes and high blood pressure (hypertension). Once considered the problems of the elderly or the wealthy, they have now become common across all age groups and social classes, posing a serious threat to the health and well-being of millions.

According to the WHO STEPS Survey (2019/20), about one in four Nepalis aged 15 to 69 has high blood pressure, while nearly six percent live with diabetes. Experts believe these numbers are likely higher today due to changes in lifestyle, diet, and increasing urbanization. Perhaps even more worrying is the fact that many individuals remain unaware of their condition until it leads to severe complications such as heart attacks, strokes, or kidney failure.

The changing face of health in Nepal

Nepal has experienced rapid social and economic transformation in recent decades. While infectious diseases and maternal health once dominated public health priorities, a new challenge is emerging: non-communicable diseases (NCDs). Diabetes and hypertension now account for a significant portion of the disease burden. This shift is largely driven by lifestyle changes. Traditional Nepali life involved walking long distances, manual labor, and eating simple, fresh food prepared at home. Today, many people spend most of their time sitting at desks, in vehicles, or glued to digital screens. Physical activity has decreased, and diets have shifted toward high-calorie, processed foods laden with salt, sugar, and unhealthy fats.

Urbanization has brought many conveniences but also new risks. Fast food outlets, sugary drinks, and packaged snacks have become common even in smaller towns. Stress levels have increased as people juggle work, family, and economic challenges. All of these factors contribute to rising rates of obesity, diabetes, and hypertension often affecting people at younger ages than before.

Why are diabetes and high blood pressure dangerous?

Both diabetes and high blood pressure are often called “silent killers” because they typically cause no obvious symptoms in their early stages. Many people feel perfectly fine while the disease silently damages their organs. Diabetes, characterized by high blood sugar levels, can damage blood vessels, nerves, kidneys, eyes, and the heart. Uncontrolled diabetes increases the risk of heart disease, kidney failure, blindness, and amputations.

High blood pressure strains the heart and arteries, increasing the risk of stroke, heart attack, kidney disease, and cognitive decline. Alarmingly, these two conditions often occur together -about two-thirds of people with Type 2 diabetes also have hypertension. The combination of these diseases significantly raises the chance of severe health events and premature death. This dual burden places a heavy strain on individuals, families, and the health system.

The human and economic cost

Living with diabetes or high blood pressure requires lifelong management. Patients need regular doctor visits, medications, blood tests, and lifestyle adjustments. For many Nepali families, especially those in rural areas or with low incomes, the costs of treatment and travel to health facilities are substantial. Moreover, when these diseases lead to complications—such as strokes, heart failure, or kidney failure patients often need hospital stays and expensive procedures. Many lose their ability to work, and their families face income loss and increased care responsibilities. This creates a vicious cycle where illness leads to poverty, which in turn worsens health outcomes.

Early detection: The key to saving lives

Because these conditions develop silently, early detection is critical. Regular screening for blood pressure and blood sugar should be part of routine health care for adults, especially after the age of 35. Unfortunately, many Nepalis do not have easy access to these tests, and awareness remains low. Community health workers and local health posts can play a vital role in educating people and providing screening services. Schools and workplaces are also ideal settings for awareness campaigns and health checks.

Simple steps to prevention and control

The good news is that diabetes and hypertension are mostly preventable and manageable with simple lifestyle choices. Everyone can take steps to protect their health:

• Eat fresh, homemade meals: Limit salt, sugar, and processed foods. Increase fruits, vegetables, and whole grains.
• Stay physically active: Aim for at least 30 minutes of moderate exercise daily. Walking, cycling, yoga, or household work all count.
• Avoid tobacco and limit alcohol: Both increase the risk of these diseases and worsen complications.
• Maintain a healthy weight: Even modest weight loss can improve blood pressure and blood sugar.
• Manage stress: Practices like meditation, spending time with family, or enjoying hobbies can help.
• Regular health checks: Don’t wait for symptoms-check your blood pressure and blood sugar regularly.

What must the government do?

Individual effort alone is not enough. To address the growing NCD burden, Nepal’s health system needs strengthening:

• Expand screening and treatment services in all health facilities, including rural clinics.
• Ensure affordable access to essential medicines for diabetes and hypertension.
• Train health workers to detect and counsel patients effectively.
• Run nationwide awareness campaigns in multiple languages and formats.
• Regulate unhealthy food marketing and consider taxing sugary drinks and junk food.
• Promote physical activity programs in schools, workplaces, and communities.

Nepal has demonstrated remarkable success in tackling infectious diseases and improving maternal health. Similar political will and community engagement can help turn the tide on diabetes and hypertension.

Real stories, real impact

Consider the story of Ramesh, a 52-year-old businessman in Kathmandu. He never thought much about his health until he experienced sudden chest pain and was diagnosed with a heart attack. Tests revealed he had uncontrolled diabetes and hypertension both undiagnosed until then. After months of treatment and lifestyle changes, Ramesh now actively manages his health and advocates for others to get regular checkups. Stories like his are increasingly common. They highlight the urgent need for early detection and prevention across Nepal.

Our collective responsibility

Diabetes and high blood pressure may not cause sudden outbreaks or emergency situations, but their effects are just as devastating. These diseases steal lives slowly and silently, causing suffering for individuals and hardship for families. The good news is that with awareness, commitment, and coordinated action, we can prevent many cases and manage existing ones better. Everyone—individuals, families, healthcare workers, and policymakers—must come together to build a healthier Nepal. We have the knowledge and tools; now is the time to act. Let’s take control of our health before these silent killers take control of our lives.

On a long flight to Kathmandu, the man next to me said, “So, you are a professor—what do you teach?” I smiled. If only academic life were that simple. Teaching is only one part of what I do. Many imagine professors spending most of their time in classrooms. The truth is far broader: we supervise students, review research papers, write proposals, organize conferences, design new courses, serve on committees and sometimes travel across continents to share ideas. Being an academic is not just a job. It is a way of living and learning. Teaching, research and service are woven together, each influencing the others. A student’s question might spark a research idea. Writing a paper might change how I teach. Organizing a conference might lead to collaborations that last years. The philosopher Martin Heidegger called this “worldhood.” 

Our actions don’t exist as isolated tasks, but as parts of a larger, meaningful whole. Reviewing a paper, mentoring a student, preparing a lecture or attending a conference are all connected threads in the same fabric of academic life. Each gains significance from its connection to the others. Our work flows together in a daily rhythm that shapes our identity as academics. Some days are smooth; others are a blur of deadlines, meetings and rejections. But the rewards are real: a student finally grasping a difficult idea, a paper being accepted, a collaboration taking root. Guiding students is among the most satisfying parts of my job.

Watching them grow, thinking critically and discovering new things is deeply rewarding. Every discussion, assignment and piece of feedback is an investment in the next generation—not just in their knowledge, but in their ability to question, explore and contribute to the world. Research is another core pillar. Writing papers, reading others’ work and debating ideas with colleagues all feed into a global conversation. When I attend a conference—whether in Asia, Europe or Africa—I’m not just presenting my work; I’m listening, exchanging perspectives and finding new questions to explore. 

Often, the most important moments happen outside formal sessions: a conversation over coffee, a hallway debate, a chance meeting that sparks an unexpected project. Travel is not just about sightseeing, but also about connecting ideas and people. Each trip adds new threads to the academic fabric—perspectives from different cultures, insights from other disciplines and friendships that outlast any single project.

Academic life is always forward-looking: the next paper to write, the next course to design, the next student to mentor. Our work builds on the knowledge of those before us, and future scholars will build on ours. A lecture is never just a lecture; it’s part of a long chain of learning. A research paper is part of an ongoing conversation. Mentoring a student helps shape the future of our academic community.

Yes, there are challenges—funding struggles, heavy workloads, administrative tangles—but the rewards outweigh them. The freedom to explore ideas, the joy of learning continuously and the chance to inspire others make this life fulfilling. Back in Norway, I still think about my recent guest lecture at Madan Bhandari University of Science and Technology (MBUST) in Nepal.

I noticed how eager students were to explore ways to relate their research to their own community’s challenges. Seeing them connect academic concepts to real-world problems reminded me of the true purpose of teaching: helping students think critically, apply knowledge, and make a difference in the communities they care about. So, when people ask what I do, I find it hard to give a short answer. Being a professor is not a list of duties. 

It is curiosity, dedication and connection. It is the privilege of being part of a community of thinkers and learners. Each lecture, paper, and conversation add to a larger journey. Academia is not just a career. It is a calling—one that shapes how we live, think and relate to the world. For those of us who have chosen it, the journey is filled with challenges, discoveries and every so often, moments that make it all worthwhile.