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In a major boost to India-Maldives relations under the ‘neighborhood first’ policy, India hosted Maldivian President Ibrahim Mohamed Solih in the first week of August. President Solih led a high-level business and political delegation to discuss a range of bilateral and global issues with India. This was President Solih’s third visit to India after assuming office in October 2018 and the first post-pandemic.

The visit happened amid an internal crisis in the Solih-led Maldivian Democratic Party (MDP) coalition government and difficulties for the island country in grappling with development projects, with low volumes of foreign direct investment and tourists. Since the assassination attempt on Mohamed Nasheed (May 2021), his supporters, and Nasheed himself, have been speaking openly against Solih. He is also opposed to Solih’s candidature in the 2023 presidential elections and has accused him of pandering to Islamist hardliners. Interestingly, in the 2022 MDP party chairmanship elections, Solih’s candidate won over Nasheed.

Given the comprehensive partnership with the Maldives, India gave the visit high priority. The two sides discussed a wide range of bilateral and regional issues including investment, trade, human-resource development, infrastructure, cooperation in multilateral forums, defense, security, and strategic cooperation. As this was the first high-level visit after a two-year gap, the MEA felt it could “advance the exemplary ties of friendship” between the two countries. President Solih met Indian President Droupadi Murmu and had one-on-one as well as delegation level talks with PM Modi. He had a separate meeting with External Affairs Minister Dr. S. Jaishankar.

Ever since the establishment of diplomatic relations between the two countries in 1965, the ties have been characterized by mutual trust, understanding and maturity.  The relationship is free from any major controversy. The one-time claim of the Maldives to Minicoy Island was resolved by the Maritime Boundary Treaty of 1976. Despite many asymmetries, the two countries depend on each other and acknowledge each other as equal partners in their collective endeavor for economic growth, consolidation of democracy, and regional peace. 

The two sets of leaders feel that India’s ‘neighborhood first’ and Maldives’ ‘India first’ policies are complementary. This was reiterated during this visit too. Moreover, the importance of India’s strategic role in that part of the Indian Ocean has been well-recognized by the Maldives given India’s geographical advantage in the region. India is seen as a net security provider to the Maldives both in conventional and non-conventional senses. India was the first to assist the Maldives during the 2004 Tsunami as well as during Male’s water crisis in December 2014.

There are several institutional arrangements between the two countries in areas like hydrographic survey, trade, economic, defense, development cooperation, tourism, disaster management, education, and capacity-building. India was a key trading partner of the Maldives with over $300 in trade in 2021. India was also the fifth largest source of tourists in the Maldives with around 6.1 percent (90,474) market-share before the Covid-19 restrictions. Apart from annual aid and technical assistance, in December 2018, India announced a $1.4 billion financial package in the form of budgetary support, currency swap, and a concessional line of credit to manage the rising external debt created during the presidency of Abdulla Yameen Abdul Gayoom (November 2013- 2018).

Defense and security cooperation is an important aspect of bilateral relationship. India has a wide range of security arrangements with the Maldives including joint maritime security cooperation, SAAGAR, counter-terrorism and capacity building of the Maldivian defence forces.  During this visit, the two PMs acknowledged that the ‘security of India and the Maldives are interlinked’, further strengthening mutual trust and cooperation on security.

This reassurance was both timely and essential. The island country has been witnessing multiple challenges like political instability, Islamic radicalism, extra-regional powers’ interests, and climate change-induced disasters. These challenges are difficult for a small country like the Maldives to address alone. Moreover, given its strategic location and increasing presence of global powers in the Indian Ocean region, these challenges have been a concern for India too. Only a stable, progressive, and democratic government in Male can manage these risks.

Despite being committed to multiparty democracy and a new constitution in 2008, the Maldives has witnessed several autocratic regimes, including, most recently, Yameen’s. India has always pushed for strengthening of multiparty democracy in the Maldives. It played a crucial role in restoring multiparty democracy by supporting the MDP in 2018. India believes autocratic regimes in the Maldives often engage with elements inimical to India. Yameen was the best example of that. The current crisis in the MDP could still affect the continuation of democracy there.

The Maldives is scheduled to have presidential elections in 2023. Current speaker Nasheed and President Solih have shown an interest. If the Solih government continues to be obstructed by Nasheed, then the Progressive Congress, a coalition of the opposition Progressive Party of Maldives (PPM) and the People’s National Congress (PNC)—which has been spearheading an “India Out” campaign—could have an advantage in the elections. The Yameen-led Progressive Congress is known for serving Chinese interests. 

Back to Solih’s visit, it appears to have been successful given the release of the 30-point joint statement on 02 August and the signing of six MoUs in areas of mutual interests. India’s commitment to a new LoC of $100 million to finance infrastructure in the Maldives would support several large projects and boost the fragile Maldivian economy.

Politically, the MDP currently enjoys the majority in parliament. If the tussle between Nasheed and Solih continues, the MDP might lose the same in the upcoming elections. India would wish for the continuation of the current inclusive combination of radical, conservative, and liberal democratic forces to tackle critical issues like religious extremism and Yameen-led ‘India Out’ campaign.

As India treats emerging security issues of Maldives as a challenge to its own national security, it would prefer to further strengthen democracy there and protect its sphere of influence.

Technological advances and growing digitization have forever changed many industries, the trend only accelerating in the post-pandemic world. Of all these, healthcare, arguably, has benefited the most. The sector has changed in unique ways to improve the level of service it provides. Due to substantial advancements in technology and methods required to serve the increased demand for access to healthcare, expanding digitalization with protected health information is the way forward. 

The rapid evolution of technologies like artificial intelligence, extended reality, and bioprinting have led to some ground-breaking innovations in healthcare. This article discusses various trends in healthcare technology and its future in Nepal. 

Artificial intelligence (AI) has generated a lot of buzz as a practical technology across several sectors, particularly in healthcare. AI is a potent tool for effectively processing available data to improve efficiency in decision-making. For instance, AI is helping detect pneumonia through an analysis of CT scans. Natural Language Processing is an AI domain being used in Chatbots, which has the potential to improve telehealth efficiency. 

We thus see that data is the most significant element in the success of Artificial Intelligence in healthcare. An AI model performs better with higher quality and a broader range of information. 

Another trend has been the incorporation of extended reality in healthcare settings. The sector offers a lot of promise for extended reality, a broad phrase that encompasses Augmented Reality (AR), Virtual Reality (VR), and Mixed Reality (MR). Extended reality assists in the planning of surgeries, patient care, and the explanation of difficult medical procedures to patients and their loved ones. Along with providing heads-up information to the surgeons, it is also helpful for training purposes. 

AR has been used to develop various assistive devices as well. For instance, AccuVein, a US-based startup, has developed an AR-based device to assist nurses in finding the vein in patients, which has traditionally been an arduous task, especially in children and the elderly, with data suggesting a 40 percent of IVs (intravenous injections) miss the vein on the first stick. 

A prominent innovation that has been a boon for healthcare is integration of technology in wearables. Patients carrying devices to access their healthcare information and receive treatment have been standard for a long time. Diabetes patients wear glucose monitors. Instead of a gadget that sits on a table and needs to be linked, implanted devices like pacemakers and defibrillators offer a life-saving, close connection with patients. 

Wearables like smartwatches are becoming an integral part of our day-to-day life. They can regularly monitor an individual’s health parameters like heart rate and blood oxygen saturation without an additional device. Smartwatches can also be equipped with other micro-sensors in the future to avoid life-threatening conditions.

Bio-printing is another field disrupting healthcare with artificial organ development. Bio 3D printers are similar to traditional 3D printers. Here the digital model of the organ to be printed is first designed on a computer. Then it is sliced and exported to a 3D printer, which creates the 3D object layer. These printers use bioinks as the material; great attention is needed to retain the desired resolution and structure. Different organs have been developed using bioprinting and are under clinical testing. 

In Nepal, it is crucial to keep an eye on the current trends influencing healthcare technology as we move forward. Modern hospitals and care facilities rely heavily on legacy infrastructure and software. But time has now come to think about how those systems might be integrated with newer technologies or eventually replaced by more dependable ones. 

A technology incubation center to develop and test these technologies is of utmost importance—we need to be abreast of the rest of the world in this digital technological revolution, enhancing the quality and efficiency of our present healthcare system. Most notably, along with technological incubation, the healthcare sector should, with greater use of new technologies, prioritize improvements in performance, productivity, efficiency, and security without compromising dependability and accessibility.

Close to 15 years ago, my wife, Radhika, fancied buying a treadmill for home. I went along; it sounded better and more convenient than going to a gym—a handful then. We bought one.                                      

We began our workout regimen, walking and jogging without further ado. In our eagerness, we sometimes got carried away and pushed ourselves to the limit—only to end up with sore muscles and aching legs. After a layoff of a day or two, we resumed with a vengeance. Radhika lost tidy weight, too. 

With each passing year, the earlier enthusiasm waned, followed by frequent time-outs. But we did not quit and kept wearing thin our trainers on the treadmill belt. As age caught up, we settled on walking alone.  

Then, some eight years later, my wife developed lower back pain. Her work-out on the treadmill came to a grinding halt. The doctor prescribed some pills, recommended some stretches, and suggested cutting down on her weight as her BMI (body mass index) was high.  

Then, to my great surprise, she quit using the treadmill. She said a friend told her it was ‘terrible’ for the lower back and the knees. She further said she heard the same story from someone else and suchlike. That baffled me. 

I was sure she was misled. I tried to convince her the other way round, bringing up some study I’d done—but she stood her ground, and the matter was dropped.  

Our treadmill took a longish respite as I’d developed a passion for cycling and spent more time on it. Then, one day, Radhika raised the issue of disposing of the machine. Begrudgingly, I gave a yes to it; I’d my cycling to cheer me up. There were no buyers.  

I never gave up using my trusted old machine; it worked wonders during the monsoon as my cycling rides got cut down. Radhika never took kindly to the treadmill, however. Her knee problem and back pain stayed on. Her outdoor walks became erratic, and she put on weight.  

I thought it was high time that I convinced her to make a comeback. I buried myself in the Internet to learn more, especially the downsides of it—if any. 

The benefits of walking, whether the traditional way outdoors or on a mechanical treadmill, are a mile long. Following my research, I found some disadvantages of walking on a treadmill. Hang on! Those drawbacks came in the way only if done improperly, though. Here are some tips I gleaned from my research:  

1. Maybe you are overdoing it—always stick to moderation. Start at a slow, easy speed to gradually work your way up to a moderate pace without the support of the handrails. 

2. Proper trainers are a must; use closed-toe athletic shoes for comfort, grip, and better cushioning for those with back or knee problems—no high-impact exercises like running to avoid jarring and pounding.  

3. Treadmill walking, by and large, is better than walking on the asphalted surface like roads as the belt offers extra cushioning.

4. Are you maintaining a natural gait on the machine as you walk outside, including arm movement? A sine qua non. Keep the machine's incline flat while recovering from back pain. Go for a trusted brand with the minimum belt rebound. 

5. Poor walking posture can lead to lower back pain. Leaning on the treadmill bars or walking with your body hunched forward causes lower back muscles to work harder.

6. Avoid taking long strides; walk on the center of the belt, strike the belt first with your heel, roll through the step from heel to toe and push off with the toes. Look straight ahead.  

As a bonus, the treadmill offers an unparalleled cardio advantage over walking outdoors; it allows retro/reverse or backward walking, enabling your heart to pump faster than moving forwards and a metabolism boost. 

Reverse walking burns 30-40 percent more calories than walking forward and works as a therapy for knee problems and lower back pain; it improves gait and mobility in the lower extremities. And science backs this theory. 

There is an old saying in Nepali: Kasai le, Kag le Kaan lagyo bhanyo bhane, Kag ko pachhi daudane hoina, afno Kaan chamne (If somebody tells you the crow has snatched your ear away, you don't run after the crow but feel your ear. No?)  

That said, it still remains touch-and-go. Convincing Radhika would be like moving mountains. 

Disclaimer: Those with lower back pain or knee problems need to consult a health care provider before starting walking/reverse walking on a treadmill. 

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Every now and then, our political leaders, civil servants, policymakers and planners fly to near and far-off shores with different agendas.

Chances are that if our political leaders are not smearing each other, they are on foreign trips. For one thing, our leaders are always in dire need of medical treatment of all sorts.

Is it the result of having to fight too long and hard for democracy, human rights, secularism, federalism and what not?

Does it not mean that time has come for the old guard to retire instead of burning themselves out? Anyways, what significant gains has their supposed hard work over the decades brought to the country? Are we doing better in facets of national life like the rule of law, national security, good governance, living standards, corruption control and financial health?

Is there more to it than meets the eye when it comes to these engagements?

Who would know? Medical professionals? Political pundits? Astrologers, perhaps?

The VIPs and VVIPs of this country will always get numerous opportunities to go abroad for state-funded medical treatment.

But what about the members of the general public? At private medical facilities, services cost a small fortune. This means the people in general have to rely on a public health system not in the pink of health. Even treatment at public health facilities does not come cheap. An ‘ancient’ joke telling how those lacking money end up exiting Bir Hospital through a labyrinth without getting treatment is but a mild satire on our public health system.

Families going broke in the course of treatment of ailing member/s has become a regular affair.

Appeals for funds for medical treatment of kith and kin along the clogged arteries of our metropolises, through mass and social media have started sounding like a cry in the wilderness.

Even after a series of epoch-making changes over the decades, a reliable public health system for treating hearts, limbs, brains, stiff backs and a myriad other aching/ailing parts is lacking. Isn't it a pity?

Back to the foreign trips of our leaders and others in positions of power.

Medical treatment is but a ruse, members of the public feel, and they start speculating about the hidden agendas of impromptu visits, guessing whether this country will lose more pounds of flesh after such a trip.

This is because important agendas are almost always under wraps in our high-level bilateral, multilateral and international engagements. Details of secretive engagements and the prices attached with them coming to light decades later come as a rude shock for successive generations.

At our bilateral engagements in particular, notetakers are always missing. Occasional pictures of our leaders engaged in important discussions taking notes on loose sheets of paper show that the Nepali state needs to act far more professionally, not like a college student attending a lecture that he is least interested in.

Grabs from such meetings show the other side dictating our representatives. The whole idea of this photo-up, it appears, is to show who is the boss/the gangster in this rough neighbourhood that is at the center of a massive global transformation.

During such engagements, our side does not get that much air-time. Even if it does, its concerns do not get due attention. This again brings to notice the unjust and unequal nature of our adjectives-filled relationship.

On the other side of the table, notetakers are always there to keep record of agendas discussed and  understandings reached, thereby boosting institutional memory of the other party and giving them an upper hand in future negotiations.

Our functionaries hardly bother to inform the people about their upcoming impromptu visits, what takes them to those, who take the entire subcontinent as their own backyard (read: fiefdom), the decisions taken after such exchanges and their possible impact on generations to come. These people never feel the need to apprise the sovereign Parliament of their engagements and what national interest they served.

This lack of transparency during such crucial engagements makes a mockery of ideals like democracy, sovereign equality of nations, human rights and a rules-based international order.

‘Powers that be’ are choosing to remain silent on the agendas discussed and understandings reached may be a stark pointer that they, once again, furthered the interests of a clique by selling the country down the river.

Our functionaries lacking the spine to stand for Nepal has been a chronic problem spanning decades. In this context, facilitating and funding medical treatment of our leaders is like treating the symptoms instead of getting at the root cause of the disease. Therefore, national energies should be channelized to strengthen the spine of our subservient political leadership so as to enable it to stand upright and safeguard national interest.