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For many years to come, the June 12 summit between the American President Donald Trump and the North Korean Supreme Leader Kim Jung-un will be studied by the students of international relations. Scholars will keep presenting us with new facts that led to the historic summit in Singapore. But if what transpired in China between Richard Nixon and Chairman Mao in1972 is any guide (since many analysts are comparing Trump and Kim, to Nixon and Mao) we can draw three conclusions from the nice surprise. 

First, the North Korean regime is in dire need of cash, as many analysts have argued, after years of sanctions and heavy expenses on the part of the state to develop hydrogen bomb and ICBMs. Maybe the economic problems led the North Korean government to the talks so that the sanctions would be eased, which, in turn, would not only help get the economy on track but also avoid any popular protests that could signal an end to the Kim regime.

One of the reasons Mao was open to talks with the Americans was that the Cultural Revolution (1966-1976) had devastated the Chinese economy. Unable to control the mayhem he unleashed, by 1971 Mao knew that China needed various reforms, including economic, for the CCP’s survival. 

Second, the North Korean regime feared it could be overturned by rebel factions supported by either the American, Russian, Japanese, South Korean or the Chinese (at this point there's no way to know which faction is powerful in North Korea). Perhaps to counter such threats and avoid a Syria-like situation, Kim took a proactive measure and decided that direct talks with America would ensure his survival and would result in little or no bad foreign press when he removes the factions he deems dangerous to his regime.

Another reason Mao was open to talks with the Americans was that he feared he could be overthrown by the pro-Soviet faction in the CCP. Lin Biao, who allegedly plotted a coup against Mao in 1971, was of the opinion that China needed to maintain good relations with the Soviet Union and emulate its development model. Just as Kim got rid of his uncle and other officials he thought could threaten his rule, Mao had Peng Dehuai and Liu Shaoqi brutually tortured, among other prominent communist party members who opposed him. Mao suspected them of being sympathetic or close to the Soviets.

And the third factor, Kim feared a possible joint attack by South Korea and America and maybe even by Japan if he were to continue with the nuclear program and bellicose rhetoric. Shinzo Abe, unlike his predecessors, has made it clear that Japan too would not shy away from proactive measures if its’ or its allies’ interests are threatened.  

Mao was afraid that border skirmishes with the Soviet Union could lead to a full-blown war. Hence he was open to dealing with the Americans, or better yet, to forging a “strategic partnership” to counter the Soviet expansionism. 

Besides these, other factors that could have led to the Kim-Trump historic summit could be:

North Korea feared that Japan would also develop nuclear weapons, which would render its arsenal useless.

Maybe, as many have speculated, Kim felt he already has the weapons needed for his regime’s survival, and it was about time he joined the world community. Because of the hydrogen bomb and ICBM, he could talk with the US president from a position of strength. 

Perhaps Kim realized that if he has to keep relying on China and Russia by antagonizing the rest, soon, the two countries would be calling the shots in North Korea. He probably felt he could be used by them in their dealings with the US, thereby giving North Korea no say in its own affairs. Or he could be the victim in the event of a proxy war between the two countries.

And Trump could have calculated that if he can get this issue resolved, he will have no need to cajole the Chinese and will thus be able to take a tougher stand against China on trade and South China Sea and other issues. He also didn't want any interlocutors so that he himself could take all the credit for resolving the crisis.

Or maybe the Chinese themselves encouraged the North Koreans to hold talks with the US to avoid taking a side in any untoward situation. China realized that it would be in a very difficult position if a war broke out between the US and North Korea. 

Or the summit is a gift from Russia to the Trump, who has shown eagerness to mend ties with it and make it an active member of the international community/organizations including the G7, or to give some positive media to Trump in light of ongoing Mueller investigation into Russia’s role in the US presidential election. 

Perhaps a combination of all these factors were responsible for the June 12 historic summit. For now all we can do is speculate.

Whatever the reasons, both Trump and Kim deserve credit for beginning the talks to achieve lasting peace in the Korean Peninsula. The people who worked behind the scenes, both in North Korea in the US, some visibly and some covertly, deserve some credit too.

“Every day I lie to comfort my wife that everything is going to be fine but in reality things are falling apart,” says Babu Raja Rajthala. Rajthala had to spent nearly all his wealth when his wife, Kesari, 42, had to undergo renal dialysis for around two years before she could get a new kidney. In the two years, Rajthala had already sold all his properties back home in Hetauda for his wife’s treatment. The long stay in the expensive capital city compounded his financial woes. By the time of the transplant, Rajthala was penniless and he could not even buy post-transplant medicines.

The couple’s children are suffering too. “They can’t contin­ue their college education because I can no longer pay their fees,” Rajthala laments.

It could have been a different sto­ry if the Rajthala family had access to the government grant for kidney failure patients right at the start. His wife received the government grant only after seven months of the operation, by which time even her new kidney was damaged. To make the kidney fully functional again, she has to undertake another round of expensive treatment, and Rajthala family simply does not have the money.

The Rajthalas are far from the only sufferers. According to the Health Ministry, around three million Nepalis suffer from kidney-related diseases, and there are currently more than 30,000 patients whose kidneys have failed. That number increases by 3,000 every year.

Renal disease is considered dan­gerous in Nepal, as the patients can live only if they can afford the expensive treatment.

Limited options

Those diagnosed with kid­ney failure have only two options—to undergo dialysis for the rest of their lives or get another kidney. Both processes are costly. Dial­ysis—in which an exter­nal machine temporarily replicates the functions of healthy kidneys—doesn’t cure the underlying dis­ease. A patient has to undergo dialysis 2 or 3 times a week, depending on the severity of the problem. The procedure costs Rs 6,000-9,000 a week; whereas it costs around Rs 400,000-500,000 to transplant a kidney.

The government made dialysis and kidney transplant services free from 2016-2017 and the services are now being provided in over 50 private and government hos­pitals across Nepal. For a single patient, the government bears almost Rs 550,000 on kidney trans­plant and Rs 2,500 per dialysis. The total yearly subsidy comes to over Rs 1 billion a year.

“There have been no recent studies but I believe the government initiative has encouraged more people to seek treat­ment, which has saved many lives,” says Dr Pukar Chandra Shres­tha, Executive Direc­tor of Human Organ Transplant Center (HOTC) at Bhaktapur.

Many patients, few machines

But according to data from the Department of Health Services (DOHS), until May 14, 2018, there were only 410 dialysis machines pro­viding completely free services. The patients outnumber the machines by a huge margin.

“Every day, the number of patients is increasing whereas the number of machines remains con­stant,” says Dr Rajani Hada, Head of Kidney Department at the gov­ernment-run Bir Hospital. “Also, the existing machines are occupied by old patients who need continuous treatment, sometimes preventing the new patients from enrolling.” According to Hada, a dialysis session lasts around four hours and even if the hospital manages to work in three shifts on a single machine, only three people can receive the treatment per day.

Jung Bahadur Thapa Magar, a patient who recently got a kidney transplant at HOTC, chose to ignore the free service and opted to pay out of his own pocket so he could receive timely treatment.

“It takes around 1-2 months to complete the formalities for free services,” says Magar. “Even after that, there is no guarantee of timely service.”

Government officials corroborate his claim. “It takes a minimum of four months to pro­vide the money to the victim,” says Prakash Ghimire, an officer at the DOHS. “The decision-making is dismally slow in our health bureaucracy.”

There are currently more than 450 patients registered for free dialysis at HOTM, many of them on the waiting list. New enrollments have been can­celled as there are not enough dial­ysis machines to meet the demand. Many of the existing machines are not functional or only partly so. In Bir Hospital, 19 dialysis machines lie unused because there aren’t enough trained human resources.

The medi­cines are expensive too. The government provides almost Rs 150,000 to every kidney patient to buy medicines after a transplant. But often that is not enough. In order to protect the newly transplanted kidney, a patient has to rely heavi­ly on medicines. The monthly bill for medicines comes to around Rs 20,000-25,000 for a couple of years after the transplant. Gradually, the cost decreases to Rs 10,000-12,000 a month, which is still expensive considering that the patients have to consume medicines all their lives.

Bimala Basnet’s 14-year-old daughter Binisha has been under­going dialysis for two years. Basnet, who sells fruits inside the HOTC premises, has an unpleasant impres­sion of transplant. “I’ve only seen transplant end people’s lives. I don’t recommend it unless the patient’s family has at least Rs 500,000 in reserve,” she says.

Ghimire of DOHS feels providing medicines to hospitals would be more effective than giving cash to the victims, and says that a review of the existing mechanism is already underway.

Prevention is cure

Nephrologists are pushing the idea of kidney transplant as a per­manent cure, but lack of human resources and infrastructure and unclear rules are major hurdles. As per government rules, only relatives can donate a kidney to a patient.

“This limits the availability of healthy kidneys. Moreover, kidneys may not match even among rela­tives, and older people’s kidneys are not healthy enough,” says Dr Dibya Singh Shah, Professor and Head of Department of Nephrol­ogy at the Tribhuvan University Teaching Hospital in Maharajgunj. According to a DOHS report (July 16, 2016-May 14, 2018), only 203 could get new kidneys in the period.

Health prac­titioners in the field blame the government for introducing the free services without proper homework. Renal diseases can be easily cured if diag­nosed early, they say, and yet there is no initiative in early diagnosis and prevention.

The average cost for a kidney test is only Rs 300. Health practitioners believe that establishing health clinics across the country and pro­moting regular check-ups is the right way to go about it. Also, there is a need to decentralize dial­ysis services away from major cities.

“Those with dysfunctional kidneys need lifelong dialysis. How can a poor person afford it?” Shah asks rhetorically. “If only the focus shifted to prevention, things would be much better. Until then, it’s a vicious circle of medications and surgeries.”

With the number of kidney patients steadily rising in what is still a poor country, how long the government will continue to support kidney patients is also an open question.

Anil Chaudhari, the 23-year-old son of Gita Devi Chaudhari and Shyam Kishor Chaudhari, has been sentenced to death in Qatar. “Please save our son. We’ve heard he’s being executed. He’s our only son,” Gita Devi and Shyam Kishor beseech anyone who visits their home in Aurahi Municipality-1 in Mahottari, a district in the central plains. They frequently break down and weep, or make a plea to God. Besides Anil, Gita Devi and Shyam Kishor have two daughters, both of whom are married. The Chaudhari family is in profound anxi­ety ever since Anil, who went to Qatar three years ago as a migrant worker, was sentenced to death by firing squad on the charge of murdering and robbing a Qatari national Umair Mohammed Umair Al Ramzani Al-Nauimi. Anil used to work as a general laborer in a car wash company.

Just before his arrest 14 months ago, Anil was planning on returning home within a year. Before the death verdict, his family was under the impression that he had committed a misdemeanor. He had told his family that he hadn’t done anything wrong and that he had been held for investigation. Anil’s parents were therefore hopeful that he would be eventually be released.

He still talks to them on the phone. “I won’t live. I won’t be able to come home,” Anil tells his parents. “We don’t cry on the phone, because if we do, he will too. So we maintain poise and talk cheerfully with him to boost his confidence,” says Shyam Kishor. “He is our only hope for old age; we haven’t been able to think straight.”

“We pray to God day and night and implore the Nepal government to get our son free. In return, we are willing to give all our property to the government,” says a grief-stricken Shyam Kishor.

Shyam Kishor and Gita Devi had taken a loan of Rs 150,000 to send Anil to Qatar. The couple live in a rented room after their house was damaged. They have some land and run a small shop in a pushcart. But ever since Anil’s conviction, they have can neither focus on their business nor take good care of their health. The worry has made them emaciated.

They had dreams of building a new house after Anil’s return. They were also looking for a bride for him. Such dreams have been dashed. Shyam Kishor has already spent around Rs 60,000 on his trips to Kathmandu to knock on the government’s doors and beg for his son’s life. He is not ready to give up yet, even if that means he has to take more loans.

The Nepali embassy in Qatar is coordinating with the Ministry of Foreign Affairs to make an appeal on Anil’s behalf. The embassy has filed a case in Qatar’s appellate court.

The recent India-China rapprochement has been intrigu­ing to observe from here in India. Open a random news­paper or flip through the TV news channels, and there is bound to be a news story on how India and China have decided to ‘cooperate’ rather than ‘compete’. Most recently, Indian Prime Minister Narendra Modi, while speaking at the Shangri-La Dialogue forum in Singapore, made it clear that India pursues an independent foreign pol­icy and does not believe in joining any (read: pro-US) bloc. But in the next breath, he added that India is firmly in favor of unhindered and open navigation in South China Sea. This was in reference to what India and the West see as China’s ‘militarization’ of this vital global trade route.

Interestingly, the very next day, He Lei, a top Chinese general who was heading the Chinese delegation at the forum, termed Modi’s rather blunt statement on South China Sea ‘positive’. There clearly are renewed efforts to defuse old Indo-China tensions, even if the leaders of the two countries sometimes have to say provocative things to please their domestic constituencies. These efforts stem largely from the realization that only if the two Asian powers work together can they effectively counter Donald Trump’s protectionist tendencies.

As Prime Minister KP Sharma Oli is set to embark on his official trip to the northern neighbor, what does this thaw­ing of Indo-China ties entail for Nepal? If there is a level of understanding between Modi and Chinese President Xi Jinping on how to deal with other smaller countries in the neighborhood, it could mean India would have fewer qualms about Nepal reaching out to China.

But therein lies the danger. As happened with the 2015 Indo-China bilateral agreement on the Lipulekh tri-junction, vital issues of Nepal’s interest may increasingly be decided in Beijing and New Delhi. In the dealings between big powers, the interests of smaller players can often be ignored. This is why the Nepali foreign policy apparatus as well as PM Oli will have to be proactive in maintaining open and extensive channels of communication with both India and China.

In his second term as prime minister, Oli has been largely successful in performing the delicate balancing act between India and China. But unless our foreign ministry apparatus is also strengthened to quickly respond to emerging foreign policy challenges, and to come up with long-term strategies to back the prime minister’s international outlook, his efforts alone may prove inadequate o