Submit your Article

The development expenditure of the Sudurpaschim (far-western) provincial government, which was not able to exceed 70 percent in the last two fiscal years, has been low this year as well. Only 20 percent of the development budget has been spent till February of the current fiscal year, according to the Comptroller and Auditor General's Office, Kailali.

“Only 20.73 percent of the budget has been spent on the capital side and 22.85 percent on the current side,” informs Basudev Joshi, province comptroller. “Although there has been some improvement on budget spending compared to last year, it has not been as expected.”

Joshi also informs that as of mid-February last fiscal year, the development budget was 17.26 percent, but this year it reached 20 percent around the same time. “It cannot be said that it has improved much, but it has increased on a percentage basis,” Joshi says. Two ministries in the province have been vacant for two months after the dispute in the ruling communist party over the dissolution of the House of Representatives.

Chief Minister Trilochan Bhatta had dismissed the Minister for Physical Infrastructure Development Pathan Singh Bohara claiming that he was in favor of Prime Minister KP Oli. Shortly afterwards, the state's economic affairs and planning minister, Jhapat Bohara, resigned. Bohara is also a central member of the Oli faction.

“The Ministry of Physical Infrastructure Development is responsible to spend the major part of the capital budget. It has no minister right now,” complains Ran Bahadur Rawal, parliamentary party leader of Nepali Congress. “The chief minister has not been able to appoint a new minister, nor has he been able to run it himself or regulate how the development budget is implemented.”

Rawal further accuses the provincial government of not having a vision for development. “The provincial government has employees and subordinate bases, but why only 20 percent of the expenditure? This government is a failure. It has no mission or vision,” Rawal says.

The Ministry of Physical Infrastructure Development, which is allotted the largest budget, has achieved 25 percent financial progress by mid-February. In the development budget of Rs 11 billion, the ministry has been able to spend only Rs 2.82 billion.

Other large-budget ministries too have not been able to make financial progress in the province. The Ministry of Social Development has a capital budget of Rs 2 billion. But it has been able to spend only Rs 360 million by mid-February, which is only 17 percent of the allotted budget. The Ministry of Social Development covers health, education, women's development, and sports.

“Now the problem is, 83 percent of the budget cannot be spent within the next four months. There is a tendency in Nepal to remain silent for ten months and rush to do everything in June and July, the last two months of the fiscal,” says economist Shivahari Mudbhari. “It seems this trend of budget spending will not change.”

Total 450 million in capital budget has been allotted to the office of the Chief Minister and the Council of Ministers alone. Of that, only Rs 18 million—a mere 3.98 percent—has been spent till February.

In April 2017, Kathmandu Valley was declared a ‘no horn’ zone. Traffic police fined vehicles honking unnecessarily, and even removed pressure horns on buses and trucks. The police also penalized bikers who modified their silencers to create loud sound. Within a few months, traffic noise was reduced significantly and valley streets became quieter and more disciplined.

But four years down the line, traffic noise is increasing again. Although there has been no recent research on the valley’s noise pollution level, the CBS’s Environment Statistics of Nepal 2019 shows that areas with heavy traffic, commercial areas, residential areas, and industrial areas inside Kathmandu valley all exceed their respective WHO noise pollution limits. Most places in the valley exceed the WHO limit of 70 decibels A (dBA) for ‘High Traffic Area’. For instance, the Balaju industrial area records a maximum of 78 dBA at day-time.

The WHO threshold for high noise pollution is 90 (dBA), after which the noise can cause serious harm to human health. But the harm can set in even at lower levels.

Research apart, the general public feels an increase in noise pollution. The ApEx office, at Teenkune, is exposed to deafening sounds of vehicles—specially buses and trucks—all day, every day.  

At Teenkune chowk, Surakshya Shrestha waits for her bus, visibly perplexed by the loud traffic noise. Originally from Dolakha, the recent high school graduate is in Kathmandu to pursue higher studies. “I came here to meet a friend and am waiting to take a bus back to my residence at Sukedhara,” Shrestha says. “As I wait, I see buses and microbuses compete to overtake each other and honking so loudly, and so often. I am not used to this.”

Public health professional Shashi Dev Shah is mainly concerned about the effects of noise pollution on students. “Prolonged noise exposure can have long term effects on our physical and mental health, and in Kathmandu we get exposed to them pretty young,” Shah says. “Most academic institutions here are located in the busiest areas, which might be a problem in the long run.”

Citing a report published in the International Journal of Recent Scientific Research in 2019, Shah says most students in the valley are exposed to noise pollution on a daily basis. The joint report of Raju Chauhan and Sijar Bhatta states that “along with the problems like air pollution, water pollution and solid waste, noise pollution is emerging as a threat to the inhabitants of Kathmandu Valley.”

The research shows over 90 percent educational institutions in Kathmandu Valley are in noisy areas that exceed both national and WHO noise thresholds. Institutions located in high traffic areas have highest noise exposures. The six-hour average noise level for educational institutions located in different zones are as follows: High Traffic (70.1 dBA),  Commercial (66.2 dBA),  Low Traffic (65.7 dBA), and Residential (56.3 dBA).

Mangala Devi Secondary School at Gaushala (101 dBA) was found to have the highest noise level of all education institutions, followed by Pashupati Multiple Campus in Chabahil (100.4 dBA) and Trichandra Campus at Ghantaghar (99.9dBA). The Tribhuvan University central campus at Kirtipur (22.4 dBA) recorded the lowest noise level.

“It is surprising that our academic institutions open and operate mostly in high traffic and commercial areas,” Shah says. “How can students concentrate in studies when they have to listen to loud horns and traffic noise all day?” Easier way to control noise is to restrict horns in the valley, Shah suggests.

Dr Leison Maharjan, ENT specialist at Patan Hospital, warns of the repercussions of prolonged exposure to noise pollution. “The effects of noise pollution, or loud noise, vary according to its intensity and duration,” Maharjan says, “Generally, for the human ear, noise level above 80dBA can be harmful. You can see noise as a toxin, the effects of which are in proportion to the intensity and duration of exposure.”

Giving example of a field visit to a hydropower project where most workers complained of hearing problems, Maharjan adds that noise pollution can cause many such occupational hazards. “The direct health effects are ear-related problems like tinnitus and hearing loss, which can be temporary or permanent,” Maharjan adds. “Noise pollution can also lead to anxiety, irritability, stress, poor concentration, mental fatigue, sleep disturbance, high blood pressure and cardiovascular diseases.”

ApEx contacted the Ministry of Health and Population to inquire about the problem. Its spokesperson, Dr Jageshwar Gautam, gave a nonchalant reply. With the same energy he displayed during the government’s televised coronavirus briefings, Gautam informed that the ministry does consider noise pollution in Kathmandu a problem and also sees vehicle horns as the major culprit. But then he says it is not for the ministry to solve the problem.

When asked why the ‘no-horn’ policy exists on paper but has been poorly implemented, Gautam replies, “You should put someone out on the street and have them report the honking. Sensitize people and other stakeholders. We are not a regulatory body, and this is out of our jurisdiction.”

The Metropolitan Traffic Police Division is more receptive of our queries. Its spokesperson SP Shyam Krishna Adhikari explains that right after the lockdown, there was a series of political protests and gatherings as well as VIP movements. That occupied the limited human resources of the traffic police.

“We understand that vehicle horns are a major source of noise pollution in the national capital,” Adhikari says. “We are already trying to dissuade motorists from blaring horns haphazardly and are starting an operation against honking starting this week. We will also be looking out for modified vehicles that cause loud noise”.

Street smarts

Sushila Dahal, 42, Housewife

We need peace and silence everywhere. And on the roads, we need to be extra careful. Honking disturbs and irritates people, which actually contributes to accidents.

Laxman Ghimire, 44, Teacher

I think reducing noise pollution will help cure many problems. These loud horns are making people short-tempered.

Binayak Bhattarai, 24, Student

I don’t think ‘no-horn’ refers to a total ban on honking. Reducing unnecessary noise should be the prime concern. Does anyone ever think of the traffic police’s mental health?

Kamal Karmacharya, 45, Microbus driver

I don’t get the idea of declaring the valley a ‘no-horn’ zone. You can’t apply it. Instead, restrict the rule to certain areas and make people follow it.

Sujita Koirala, 47, Credit cooperative officer

My office is located right beside a wide, straight road and there is no need to honk there. Traffic lights control the jam. Still, I listen to bellowing horns all the time. The commotion is so loud, we can’t even talk on the phone. People should themselves be aware of the disturbance they are causing.

Rohit Chaudhary, 22, Tootle/Pathao rider

I understand that blowing horns stresses people on the road but sometimes it becomes imperative to avoid accidents.

Sakar Lamsal, 31, Engineer

Nepalis sometimes behave like a herd of sheep. If one starts to bleat (honk), everyone follows, without a reason. It is a matter of common sense.

Kamala Karki, 28, Traffic constable

Blow horn only in emergency. Otherwise, it is illegal and we might penalize you.

Samundra Karki, 26, Engineering student

The extremist policy of ‘no-horn’ is absurd. The goal should be reducing horn-use, not its ban. Vehicles have horns for a reason.

Rabi Shrestha, 42, Taxi driver

People, mainly youth, walk carelessly on the streets, often with headphones on. This usually invites accidents. In these situations, honking can’t be avoided. But the ‘no horn’ policy can be partially applied.

A road being constructed through Nuwakot, formerly known as West No. 1, will be a crucial trilateral road for Nepal, connecting it with China in the north and India in the south.

The Raxaul-Birgunj-Galchi-Trishuli-Rasuwagadhi-Kerung road is being constructed with the aim of connecting China's Kerung, via Nepal’s Rasuwagadhi all the way down to Birgunj, to India’s Raxaul border point. The construction of the road—one of the 15 special priority projects of the government—is in full swing currently with 65 percent of the work completed by now.

According to the Galchi-Trishuli-Malung-Safrubensi-Rasuwagadhi Road Planning Office, Nuwakot, the road is being widened as well as blacktopped with retaining walls wherever required. Currently, work is underway simultaneously on 15 different sections of the road. Chief of the office, Narayan Dutta Bhandari, informs that the work of cutting through the hills of Budhsinghghat and Dhurpure of Devighat has begun while cutting through the Kalchaude Bhir of Galchi-Trishuli section has been completed.

According to Bhandari, the company given the responsibility of upgrading the road from Galchi to Malung— Kovek-Tandi-Rasuwa JV— has expedited the construction work so as to complete the blacktop within the next three months. The width of Galchi-Trishuli-Malung-Syafrubensi-Rasuwagadhi road section will be 30 meters, but only 11 meters are to be blacktopped for now, Bhandari informs, also adding that the most difficult rock cutting of the Galchi-Trishuli section has been completed. The construction company has mobilized nine rock breaker machines, more than 20 technical workers and five trippers daily to cut the 500-meter cliff. Around 200,000 cubic meters of the cliff has been cut off already.

The Galchi-Trishuli-Malung-Safrubensi-Raswagadhi road project is being constructed by dividing it into three sections. The working period of the road has been extended till mid-July due to various reasons. The first section—Bidur-Betrawati-Malung road—is 46 kilometers long.

The planning office informs that more than 25 kilometers of the road has been tarred so far. The construction work of the 19-kilometer Malung-Safrubensi road segment under the second section was signed last July. This section is being widened and walled. So far, only 12 percent of the road has been completed.

Preparations have also been made to upgrading the Syaphru-Rasuwagadhi section; the actual work is set to begin in April. Electricity poles along the road section will be removed by April, immediately after which the upgradation work will begin. The work of moving the electricity poles, which began more than a year ago, is being overseen by Nepal Electricity Authority (NEA) Dhunche Distribution Center which states that there has been a problem in shifting all the electricity poles due to compensation issues which has resulted in obstruction by the locals. Besides some geographical difficulties, the Covid-19 pandemic also caused some delays in completion of the shifting, the NEA claims. The Galchi-Trishuli-Malung-Syafrubensi-Rasuwagadhi road project states that 55 percent of the 325 poles in the road section have been removed. The expansion of this section is estimated to cost Rs 15 billion.

Pop a painkiller and get to work—That’s the busy millennial life. An annual medical check-up or that ultrasound to figure out just what’s causing the recurrent what-feels-like heartburn can wait. Meetings, presentations, and paperwork at the office take precedence over our health because, really, who doesn’t have niggling pains and aches every once in a while?

It’s this mindset that has most people self-medicating themselves. Pharmacists around the valley confessed that on a daily basis they have more people coming to buy medicines without a doctor’s prescription than with one. And they aren’t just buying paracetamol or anti-diarrheal pills. More often than not, it’s antibiotics, blood pressure medications, and even psychiatric drugs.

Pharmacist Krishna Dhakal, who has been running Narayani Pharmacy in Thapathali, Kathmandu, for 22 years, says it’s the easy accessibility to drugs that has people becoming their own doctors. A quick Google search of your symptoms and a trip to the nearest pharmacy is most people’s two-step treatment plan.

“This approach is sure to backfire sooner or later. You are doing your health a great disservice if stopping by a pharmacy and buying random medicines is a regular thing,” says Dhakal, adding many people also tend to look at their friends’ cases as reference for self-diagnosis. If so and so medicine cured a friend’s sore throat then it will surely work for them too, they think.

“But each case is unique or there might be an underlying cause of your problem that could get worse without the right treatment,” he says.

According to Nim Raj Tamang, assistant pharmacist at Nirvan Pharmacy in Pulchowk, Lalitpur, earlier it was mostly people from low-income groups who used to visit pharmacies with their health woes. They were trying to save on doctor’s consultation fees. That money, they felt, could be used to buy a month’s supply of medicines. But as the internet became more pervasive, everyone slowly became experts in treating themselves. 

Zero faith in healthcare

During the Covid-19 pandemic, Tamang says, many people hoarded antibiotics and took them for a day or two at the slightest hint of a runny nose or cough. This happened and continues to happen because of two reasons, he believes: First, people aren’t aware of antibiotics resistance and what overusing them can lead to and second, most people have a couldn’t-care-less approach to health as long as they aren’t ill or in pain as there is always more important work to be done.

But self-medication isn’t a trend only because it’s convenient. Talking to random people out and about their day—catching up with friends at a coffee shop in Battisputali, shopping at a grocery store in Sanepa, and having masala tea at Pulchowk in the evening—ApEx found that majority of people seem to have no faith in the country’s healthcare system, which is curative rather than preventive.

Doctors, they said, don’t give you more than two minutes or listen to your queries properly unless your condition is serious. The unanimous opinion was that there was no point in annual health checkups or consulting doctors unless you thought there was something seriously wrong with you.

Sarah Shrestha, 32, a public relations officer, says her company pays for an annual full checkup but she, in the past two years, hasn’t been to a hospital. Shrestha says she doesn’t want to spend an entire day at a hospital getting tests after tests done and then another day waiting for the doctor to look at her reports and certify she’s in good health and prescribe vitamins.

“I would know if I was sick, wouldn’t I? So, if doctors aren’t going to tell me how I can stay healthy or counsel me about what I should or shouldn’t do in the future, then I will only schedule an appointment when I’m actually unwell,” she says.

Roshan K.C, 24, who is taking a gap year before going to India for his masters later this year, says a pharmacy visit will suffice for minor ailments because there is nothing a pharmacist won’t tell you that a doctor will. 

“Of course, doctors have more knowledge but in Nepal they don’t have the time or the willingness to share that information,” he says.

It seems Nepalis are definitely more inclined than ever to rely on over-the-counter drugs unless they perceive themselves to be in life-threatening situations. Of the 25 people questioned, 24 said hospitals in Nepal were only for emergencies and surgical procedures.

Lasting damages

However, the impact of self-medication is far-reaching. Immediate serious side-effects aside, misuse of drugs can give rise to long-term health problems that are difficult to cure because your body doesn’t respond to treatments. Improper dosage of antibiotics or failure to complete its course could lead to your body becoming resistant to it. You will thus require stronger medicines in the future. Its overuse, on the other hand, could destroy your body’s natural flora making you prone to various infections and diseases.

“Little knowledge is a dangerous thing. As clichéd as that might be, it couldn’t be truer,” says Suman Dawadi, a pharmacist at Sesaang Pharmacy in Thapathali, Kathmandu. He says a lot of times people come to the pharmacy asking for a tablet or two of antibiotics.

“I think in such cases the onus lies on the pharmacists too. We should not sell the medicines, or we should make people aware about the proper dosage and the importance of sticking to the recommended course even when their symptoms go away,” says Dawadi.

The problem is, he says, that is not what happens and one or two pharmacies developing a conscience isn’t going to change much. There isn’t a strict drug regulation and monitoring system in Nepal. Most medicines that shouldn’t be sold over the counter are being bought recklessly without prescriptions.

The Department of Drug Administration under the Ministry of Health and Population has classified drugs into different categories—a, b, and c—with statutory warnings printed in bold red on packages of drugs that shouldn’t be sold without a prescription.

Category ‘a’ consists of narcotic and poisonous drugs. Antibiotics, hormones etc. fall under category ‘b’. These are prescription drugs and can only be sold by a pharmacist or a medical professional. The drugs that fall under category ‘c’ are the only ones that can be sold over the counter, without a prescription.

“Unfortunately, in Nepal, everything is being sold over the counter,” says Dhakal. He says it’s not unusual for people to come with old prescriptions for fresh complaints, claiming the medicine worked in the past and so they will just continue with it. Topping up prescription drugs without going for a follow-up is also quite common. What the doctor intended for you to have for six months, say for high blood pressure, you’ve probably had for a year or more.

“With stricter rules to ensure prescription drugs couldn’t be sold over the counter, people would have to go to see a doctor when they are unwell,” says Sanjit Chaudhary, pharmacist at Alka Hospital Pharmacy in Jawalakhel, Lalitpur.

That alone, however, won’t be effective in curbing the problem, argues his colleague, pharmacist Sajan Chaulagain. The issue here, he points out, is that there are just too many community pharmacies that are often run by people with zero pharmaceutical knowledge. As pharmacies have become business- and not service-oriented, even if a certain pharmacy does not sell prescription drugs without a doctor’s slip, there are bound to be at least ten others that will.

“People need to be cautious where their health is concerned. It’s not something to be taken lightly. We can’t always depend on rules, laws, penalties or on the government,” says Chaulagain.

The way out

Dr Namita Sindan, gynecologist at Paropakar Maternity and Womens’ Hospital in Thapathali, Kathmandu, agrees and says she is appalled by people’s ignorance and carelessness in health matters.

Stringent drug regulation laws wouldn’t hurt but a lot more needs to be done to tackle the problem, says Dr Sindan. There needs to be greater awareness about the long-term repercussions of being negligent with your health. Medical professionals—doctors, nurses, pharmacists—must also strongly dissuade people from self-medicating.

“There was recently a maternal death because the woman had taken random painkillers to manage discomfort. Her child died in the womb and that led to a fatal infection,” she says adding there are also many preventable deaths in the country because women take abortifacient drugs to terminate unwanted pregnancies without medical advice.

There are many contraindications for drug use, especially in case of antibiotics and other prescription medicines. A medical personnel can determine which drug will work in which case and when a certain medicine shouldn’t be administered. This knowledge comes from training and practice. An internet search or even pharmacists can’t give this information to you.

A general consensus among medical experts seemed to be that people could explore telemedicine that enable them to get health-related services and information through video-conferencing apps and tools. Something is better than nothing is the principle that could be applied here, says Dawadi, adding when even simple over-the-counter medications can have rare but severe adverse reactions, it’s best to err on the side of caution.

“There is no substitute for expert advice. A consultation or checkup instead of popping random medicines could save you from many unnecessary health troubles, if not potentially save your life,” concludes Dr Sindan.