Teachers: Having a Voice and Being Heard? Evidence from Two Private Schools in Nepal

Profit-oriented private schools in Nepal are usually owned and managed by those people who put money into schools. In such private schools, owners are usually the principals, and schools’ administration is run according to the decisions of owners instead the kinds of rules and regulations applicable to state schools. These private schools exclude most of the stakeholders (parents, teachers and other non-owner staff) from the decision making process. However, with political changes in the country overthrowing an absolute monarchy for a constitutional monarchy in 1990, and then to a republic in 2008, scenarios within these schools seem to have changed. This research is an attempt to explore the realities of private school life from the viewpoint of teachers, administrators (middle level managers) and principals in the changed political context of Nepal. It has used semi-structured interviews from two schools selected as the prime source of data for the case study. In addition to semi-structured interviews, field notes and documentary sources form supplementary sources of data. This study suggests that the non-separation of management and ownership in both private schools created a concentration of power in the schools’ owners. However, with the political change in the country and subsequent unionisation of private schoolteachers and other non-owner staff, they have now started perceiving themselves as having a voice, even when their voice is not being heard. School owners have developed different strategies to deal with the changing context within and outside the schools, in order to maintain power, control and profits. The schools’ owners, operating a hierarchy of power similar to monarchs, exercised power over the non-owner staff, including teachers working in different levels of the school, to extract their time and labour. However, since the advent of the republic and subsequent unionisation of private schoolteachers, power relations within schools began to shift. Non-owner staff (including teachers) of the two private schools in my study, by deriving power through networks and alliances, started collective bargaining on their rights and privileges. This brought about a scenario of continuous tension between the schools’ owners and non-owner staff. Arising from the study, I detected differences in the modes of power relations existing between primary level teachers and schools’ owners, and secondary level teachers and schools’ owners. One of the reasons behind such differences is linked to the market orientation of private schools. It is apparent that such schools focus on their students’ performance in the standardised national level tests, the School Leaving Certificate (SLC) examination, using these results to compete with other schools. Since the secondary level students are the ones sitting in the SLC examination, school owner attitudes towards secondary level teachers was found to be quite different from their attitudes to primary level teachers. This study adds to the sparse literature on the perceptions and experiences of teachers, administrators and owner/principals of private schools in Nepal in the altered political context of the country, even though the sample size is small. It also has enhanced our understanding of school organisations within the private school contexts and teachers’ professionalism in the changed political context. It furthers our understanding of how the wider political environment of the country is reflected within these schools’ organisation and distribution of power. Finally, I am expecting that my study will support academic debates about teachers’ professionalism in private schools of Nepal

Histopathological findings of renal biopsy in systemic lupus erythematousus

Introductions: Classifying morphological pattern of renal involvement is important in systemic lupus erythematosus (SLE) for definitive treatment and prognosis. This study aim to analyse the histopathological pattern of glomerular in SLE patients.Methods: This was a retrospective chart review of patients diagnosed with SLE who had renal biopsy during October 2013 to September 2015 at Patan Hospital.Results: There were 38 patients of SLE.  Antinuclear antibody (ANA) was positive in all patients 38 (100 %), Anti-dsDNA seen in 18 (47.4%). Active urinary sediment & proteinuria was seen 25 (65.8%) patients and proteinuria in 13 (34.2%) patients. Histopathological patterns were of glomerular involvement was, ISN Class II in 2 (5.3%), Class III in 2 (5.3%), class IV 20 (52.5%), class V in 6 (15.8%) and mixed IV –V in 8 (21.1%).Conclusions: The diffuse proliferative lupus nephritis (ISN Class IV) was the most com­mon pattern of lupus nephritis encountered in our study followed by mixed pattern (ISN class IV&V) and membranous lupus nephritis (ISN class IV). Keywords: histopathology, lupus nephritis, renal biopsy, systemic lupus erythematosu

Kidney biopsy in glomerular disease: a hospital based study

Introductions: Kidney biopsy is the standard tool to diagnose glomerular disease (GD). There is lack of national registry of kidney biopsy for the type, incidence and prevalence of GD. We aim to review kidney biopsy at Patan Hospital for profile of GD in local scenario. Methods: This was a chart review of patients who underwent kidney biopsy at Patan Hospital, Nepal, from October 2013 to September 2015. We analyzed the data for indication of kidney biopsy, types of GD and complication of biopsy. Results: There were 117 patients who had kidney biopsies. Immunoglobulin A Nephropathy was seen in 42 (35.8%) and Lupus Nephritis in 38 (32.5%). Sub nephrotic range proteinuria with or without active urinary sediments was found in 75 (64%). Blood transfusion was required in 3 (2.5%) patients after biopsy. There was no surgical intervention or mortality related to biopsy. Conclusions: IgA Nephropathy was the commonest glomerular disease. Kidney biopsy was a safe and effective procedure. Keywords: glomerular disease, kidney biopsy, nephropath

Pain Experiences among Postoperative Patients Admitted in Surgical Ward of Teaching Hospital, Chitwan

 Patients experience moderate to severe pain during the first 24 hours after surgery. The purpose of this study was to assess pain experience among postoperative patients admitted in surgical ward of teaching hospital, Chiwan, Nepal.A descriptive cross-sectional study was conducted among 171 purposively selected postoperative patients who had undergone surgery. Data was collected through interview method using modified pre-tested Revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R) and patients’ charts were reviewed for the clinical information. Data were analyzed using descriptive statistics, χ2 test and Spearman correlation test.The results indicated that about 95.4% of patients reported postoperative pain during the first 24 hour after surgery with the mean pain intensity score 4.13± 2.23. Of these patients, 46.2% had moderate and 13.5% had severe pain. It was positively associated with the interference in daily physical activities and anxious feeling. More than two third (67.3%) were very satisfied with their pain management. Both pain intensity and satisfaction with pain management were significantly associated with the type of surgery. However, there was no significant relationship between pain intensity score and patients’ satisfaction with overall pain management (Spearman correlation -0.085, 95% CI: -0.233 to 0.063).Moderate to severe pain experience is common among the post-operative patients despite of using pharmacological pain management strategy. Hence, additional efforts are required to reduce post-operative pain which will ultimately increase the patients’ physical and emotional conditions. 

An uneven playing field: regulatory barriers to communities making a living from the timber from their forests–examples from Cambodia, Nepal and Vietnam

Community forestry (CF) is widely viewed as the solution to many of the challenges facing forest management and governance in the Asia-Pacific region. However, it is often felt that CF is not delivering on its potential. This paper focuses on one possible limitation: the role of regulations in curbing communities’ ability to make a living from their timber resources. The work covers Cambodia, Nepal and Vietnam, using policy analyses, national level experts’ workshops, and focus group discussions in two CF sites in each country. The results highlight the fact that there are numerous, often prohibitive, regulations in place. One challenge is the regulations’ complexity, often requiring a level of capacity far beyond the ability of community members and local government staff. The paper puts forward various recommendations including simplifying regulations and making them more outcome-based, and facilitating key stakeholders, including government and community based organizations, working together on the design and piloting of forest monitoring based on mutually agreed forest management outcomes. The recommendations reflect the belief that for CF to succeed, communities must be allowed to make a meaningful living from their forests, a result of which would be increased investment in sustainable forest management

Prevalence and risk factors associated with chronic kidney disease in Nepal: evidence from a nationally representative population-based cross-sectional study.

OBJECTIVE: This study aimed to determine population-based prevalence of chronic kidney disease (CKD) and its associated factors in Nepal. STUDY DESIGN: The study was a nationwide population-based cross-sectional study. SETTING AND PARTICIPANTS: Cross-sectional survey conducted in a nationally representative sample of 12 109 Nepalese adult from 2016 to 2018 on selected chronic non-communicable diseases was examined. Multistage cluster sampling with a mix of probability proportionate to size and systematic random sampling was used for the selection of individuals aged 20 years and above. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome in this study was population-based prevalence of CKD in Nepal. A participant was considered to have CKD if the urine albumin-to-creatinine ratio was greater than or equal to 30 mg/g and/or estimated glomerular filtration rate is less than 60 mL/min/1.73 m2 at baseline and in follow-up using modification of diet in renal disease study equations. The secondary outcome measure was factors associated with CKD in Nepal. The covariate adjusted association of risk factors and CKD was calculated using multivariable binary logistic regression. RESULTS: The overall prevalence of CKD in Nepal was 6.0% (95% CI 5.5 to 6.6). Factors independently associated with CKD included older age (adjusted OR (AOR) 2.6, 95% CI 1.9 to 3.6), Dalit caste (AOR 1.6, 95% CI 1.1 to 2.3), hypertension (AOR 2.4, 95% CI 2.0 to 3.0), diabetes mellitus (AOR 3.2, 95% CI 2.5 to 4.1), raised total cholesterol (AOR 1.3, 95% CI 1.0 to 1.6) and increased waist-to-hip ratio (AOR 1.6, 95% CI 1.2 to 2.3). CONCLUSION: This nationally representative study shows that the prevalence of CKD in the adult population of Nepal is substantial, and it is independently associated with several cardiometabolic traits. These findings warrant longitudinal studies to identify the causes of CKD in Nepal and effective strategies to prevent it

Rebuilding local seed system and safeguarding conservation of agrobiodiversity in the aftermath of Nepal 2015 earthquake

A study was conducted from July 2015 to December 2017 to rebuild local seed system and safeguard conservation of agrobiodiversity in the aftermath of earthquake through rescue collection, conservation and repatriation of endangered crop landraces from 10 earthquake affected districts. The process employed several methods, approaches and processes combining rescue missions with qualitative and quantitative assessments techniques and tools. The process helped to assess status of diversity of traditional crops, identify endangered, extinct and rare crop landraces, document and characterize their unique agronomic traits and develop and validate methodology for conservation of native crops by linking on-farm and ex-situ approaches. A total of 921 accessions of 61 crops were collected from 35 VDCs of 10 severally earthquake affected districts. The process has identified 104 lost crop landraces and rescued 284 rare and endangered ones and conserved them in national Genebank. Some of the farmer demanded crop landraces are repatriated back to local communities and also conserved in community seed banks in affected districts.The process therefore helped to restore lost diversity, revive and strengthen the local seed system and safeguard biodiversity of native crops to adapt to more extreme and changing climatic conditio

Health System Capacity and Access Barriers to Diagnosis and Treatment of CVD and Diabetes in Nepal

Background: Universal access to essential medicines and routine diagnostics is required to combat the growing burden of cardiovascular disease (CVD) and diabetes. Evaluating health systems and various access dimensions – availability, affordability, accessibility, acceptability, and quality – is crucial yet rarely performed, especially in low- and middle-income countries. Objective: To evaluate health system capacity and barriers in accessing diagnostics and essential medicines for CVD and diabetes in Nepal. Methods: We conducted a WHO/HAI nationally-representative survey in 45 health-facilities (public sector: 11; private sector: 34) in Nepal to collect availability and price data for 21 essential medicines for treating CVD and diabetes, during May–July 2017. Data for 13 routine diagnostics were obtained in 12 health facilities. Medicines were considered unaffordable if the lowest paid worker spends >1 day’s wage to purchase a monthly supply. To evaluate accessibility, we conducted facility exit interviews among 636 CVD patients. Accessibility (e.g., private-public health facility mix, travel to hospital/pharmacy) and acceptability (i.e. Nepal’s adoption of WHO Essential Medicine List, and patient medication adherence) were summarized using descriptive statistics, and we conducted a systematic review of relevant literature. We did not evaluate medicine quality. Results: We found that mean availability of generic medicines is low (<50%) in both public and private sectors, and less than one-third medicines met WHO’s availability target (80%). Mean (SD) availability of diagnostics was 73.1% (26.8%). Essential medicines appear locally unaffordable. On average, the lowest-paid worker would spend 1.03 (public sector) and 1.26 (private sector) days’ wages to purchase a monthly medicine supply. For a person undergoing CVD secondary-prevention interventions in the private sector, the associated expenditure would be 7.5–11.2% of monthly household income. Exit interviews suggest that a long/expensive commute to health facilities and poor medicine affordability constrain access. Conclusions: This study highlights critical gaps in Nepal’s health system capacity to offer basic health services to CVD and diabetes patients, owing to low availability and poor affordability and accessibility. Research and policy initiatives are needed to ensure uninterrupted supply of affordable essential medicines and diagnostics

A multi-targeted approach to suppress tumor-promoting inflammation

Cancers harbor significant genetic heterogeneity and patterns of relapse following many therapies are due to evolved resistance to treatment. While efforts have been made to combine targeted therapies, significant levels of toxicity have stymied efforts to effectively treat cancer with multi-drug combinations using currently approved therapeutics. We discuss the relationship between tumor-promoting inflammation and cancer as part of a larger effort to develop a broad-spectrum therapeutic approach aimed at a wide range of targets to address this heterogeneity. Specifically, macrophage migration inhibitory factor, cyclooxygenase-2, transcription factor nuclear factor-κB, tumor necrosis factor alpha, inducible nitric oxide synthase, protein kinase B, and CXC chemokines are reviewed as important antiinflammatory targets while curcumin, resveratrol, epigallocatechin gallate, genistein, lycopene, and anthocyanins are reviewed as low-cost, low toxicity means by which these targets might all be reached simultaneously. Future translational work will need to assess the resulting synergies of rationally designed antiinflammatory mixtures (employing low-toxicity constituents), and then combine this with similar approaches targeting the most important pathways across the range of cancer hallmark phenotypes

Long-Baseline Neutrino Facility (LBNF) and Deep Underground Neutrino Experiment (DUNE) Conceptual Design Report Volume 2: The Physics Program for DUNE at LBNF

The Physics Program for the Deep Underground Neutrino Experiment (DUNE) at the Fermilab Long-Baseline Neutrino Facility (LBNF) is described