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The ruling Nepal Communist Party (NCP) and the main opposition Nepali Congress are on a collision course. The NCP leaders accuse their Congress counterparts of rank opportunism—Congress did precious little on medical education reform when it was leading the government, the accusation goes, but has overnight morphed into an ardent advocate of the fasting Dr Govinda KC. The other accusation is that Congress is trying to subvert the authority of a demo­cratically-elected government by obstructing parliament and protesting in banned areas. They argue that five months are nearly not enough to judge this government.Congress leaders contend that they cannot be mute spectators even when the government has put the country on a slippery slope to full-blown authoritarianism, by for instance declaring popular protest places as ‘no go’ areas and by empowering the ‘medial mafia’ by watering down the medical education ordinance brought by the previous Con­gress government. There are other bones of contention too. The constitution requires that speaker and deputy speaker of the federal parliament and well as the seven provincial parliaments be from different parties, but in six of the seven provinces NCP holds both the positions. The appointments to constitutional bodies made by the previous Congress gov­ernment have been cancelled and social security measures it introduced rolled back—and hence the current standoff.

But what will these protests by opposition parties led by Congress—with Baburam Bhattarai’s Naya Shakti even asking for Prime Minister KP Oli’s resignation—amount to?

“It is true that the performance of this government has been disappointing thus far,” says political analyst and former chief election commissioner Bhojraj Pokharel. “But I also don’t think there are enough legitimate grounds for resignation.”

Pokharel credits Oli for trying to bring a “semblance of order” in governance, something that has been missing in Nepal since the 1990 change, “but the way the government has gone about achieving this order is wrong.”

But does he see enough reasons to fear autocracy? “The tendency is there. The biggest cause for concern right now is that the executive has become extremely powerful while the two other organs of the state are weak. This in turn has desta­bilized the principle of check and balance,” Pokharel replies.

Ominously, with the ruling communist party all-powerful and the main opposition in Nepali Congress at its weakest historically, they have no incentive to listen to one another.

The number of Afghan civilians killed in the country's long-running conflict hit a record high in the first six months of 2018, UN figures showed Sunday, with militant attacks and suicide bombs the leading causes of death. 

The toll of 1,692 fatalities was one percent more than a year earlier and the highest for the period since the United Nations Assistance Mission in Afghanistan (UNAMA) began keeping records in 2009. 
Another 3,430 people were wounded in the war, down five percent from the same period last year, the report said. 

Overall civilian casualties -- 5,122 - fell three percent year on year. The record high death toll came despite an unprecedented ceasefire by Afghan security forces and the Taliban last month that was largely respected by both sides, UNAMA said. 

The ceasefire for the first three days of Eid was marked by scenes of jubilation as security forces and Taliban fighters celebrated the Islamic holiday, raising hopes that peace was possible after nearly 17 years of conflict. 

But the suspension of hostilities was marred by two suicide attacks in the eastern province of Nangarhar that killed dozens of people and were claimed by the Islamic State group, which was not part of the ceasefire. 

The Taliban refused a government request to extend the truce, returning to the battlefield and ignoring calls to enter talks with Kabul to end the war. "The brief ceasefire demonstrated that the fighting can be stopped and that Afghan civilians no longer need to bear the brunt of the war," Tadamichi Yamamoto, the UN secretary general's special representative for Afghanistan, said. "We urge parties to seize all opportunities to find a peaceful settlement -- this is the best way that they can protect all civilians." 

 Air strike casualties up 
Suicide bombs and "complex" attacks that involve several militants accounted for 1,413 casualties -- 427 deaths and 986 injuries -- up 22 percent from a year earlier. If that trend continues, the figure will top the 2017 full-year record of nearly 2,300 casualties. 

UNAMA attributed 52 percent of suicide and complex attacks to IS, mainly in Kabul and Nangarhar where the group established a stronghold after emerging in Afghanistan in 2014. 

The Taliban was responsible for 40 percent of such attacks. While the Taliban is Afghanistan's largest militant group and holds or contests more territory than any other, IS has repeatedly demonstrated its ability to carry out devastating attacks in urban areas. 

The latest report comes almost a year after US President Donald Trump announced his new South Asia strategy that involved ramping up American air strikes against militants. 

Civilians have paid a heavy toll for the intensified aerial bombing campaign, with 353 casualties recorded in the first half of the year, up 52 percent on last year, UNAMA said. 

More than half of the civilian casualties were caused by the Afghan Air Force. One of the worst incidents was in the northern province of Kunduz in April when an Afghan air strike on an outdoor religious gathering killed or wounded 107 people, mostly children, a previous UNAMA report found. 
The government and military said it had targeted a Taliban base where senior members of the group were planning attacks. 

UNAMA also recorded 341 civilian casualties in election-related violence -- a trend that is expected to worsen as the October 20 legislative ballot draws closer. AFP

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 Another 450 migrants on board two Frontex vessels were stranded at sea on Saturday as Italy and Malta locked horns over whose responsibility it was to offer them safe harbour. 

The migrants had initially set sail from Libya in a single wooden vessel which was identified early Friday while passing through waters under Malta's jurisdiction. But Italy's far-right Interior Minister Matteo Salvini, who has authority over the country's ports, on Friday refused to let them dock in his latest show of intransigence over migrants stranded at sea. 

And on Saturday, as those on board were transferred to two vessels belonging to the EU border agency Frontex, he insisted they be instructed to "head south, to Libya or Malta". "We need an act of justice, of respect and of courage to fight against these human traffickers and generate a European intervention," he said in talks with Prime Minister Giuseppe Conte, his remarks carried by Italian news agencies.

 
Cited by the Italian media, cabinet sources said Conte was going to push for them to be immediately transferred to other European countries, otherwise they would not be allowed to land. In an exchange of messages, emails and phone calls on Friday, Rome had tried to push Valetta to take responsibility for those on board the wooden boat. 

But Malta said the ship was much closer to the Italian island of Lampedusa, and on Saturday, insisted it had respected "all of its obligations under international conventions" concerning those rescued at sea. 

 Jumping overboard 

On Saturday morning, as the two Frontex vessels approached the wooden boat, several migrants threw themselves overboard, prompting immediate efforts to rescue them from the water, Italian sources said. 
Eight women and children were taken to Lampedusa for medical treatment. 

The new standoff kicked in just hours after 67 migrants were allowed to disembark from an Italian coast guard ship in Sicily late on Thursday. 

Salvini, who took office when Italy's new populist government came to power on June 1, wants to block any further migrant arrivals by boat and has banned charity rescue ships from docking in Italian ports, accusing them of aiding human traffickers. 

Last month, the French rescue ship Aquarius and the German boat Lifeline, who between them were carrying hundreds of migrants, were forced to divert to Spain and Malta respectively after Italy turned them away. 

Italy, Greece and Spain have been on the front line of the migrant crisis, with Europe deeply divided over how to share the burden of the massive influx of people seeking to create a new life in Europe. AFP

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When we hear the word “nurse”, we think of a wom­an with an apron, mainly because the nursing profession in Nepal has been the exclusive preserve of females. But then the country does have a history of male nurses. The Institute of Medicine (IOM) under Tribhuvan University trained four batches of male nurs­es between 1986 and 1993, during which time almost 80 male nurses were produced.The enrolment of male nurses was terminated for two main rea­sons. One, it was a new profession for males and people were uncom­fortable. “The patients would not accept male nurses. They start­ed complaining about not getting proper as they would from female nurses,” says Tara Pokhrel, Presi­dent of the Nursing Association of Nepal (NAN), the umbrella body for nurses in Nepal.

“This made our jobs tough,” says Ratna Guragain, a male nurse from the first batch at the IOM. Guragain would serve as a professional nurse for 20 years before his retirement.

The other reason for the termi­nation of male enrolment was that the trained male nurses refused to serve in rural areas as they were expected to do.

So male nursing is not a com­pletely new concept in Nepal. And on June 19, Nepal Nursing Council (NNC), the main nurs­ing regulatory body in the country, once again decided to enroll male students in nursing courses starting this year in all 125 nursing colleges in Nepal. Fifteen percent seats have been reserved for male students and they will be allowed to enroll in two courses—‘Staff Nurse’ and ‘Bachelor of Science in Nursing’. If all goes according to the plan, every year 1,155 male nurses will be produced.

But what explains the NNC’s deci­sion to enroll males again, after over two- decade hiatus?

Second life

“The society has changed. Peo­ple are now more literate and understand that nursing is not an exclusive women profession. So we thought we would give it anoth­er shot,” says Goma Devi Niraula, President of NNC. “The demand is high and frankly, male nurses have become a necessity today.” The NAN played the lead role in implement­ing the decision, after almost three years of homework.

“We started to hear from Nepalis abroad that there was a huge demand for male nurses in other countries. This also made us con­sider if male nurses had become a necessity in Nepal as well,” says Pokhrel of the NAN.

There are many instances of peo­ple who have completed their Bach­elors and Masters in other streams opting to take up nursing cours­es when they went abroad. “For instance, I personally know of a doctor with an MD who left his job in Nepal to study nursing in America,” says Pokhrel.

Even though the initial enrolment for males had to be terminated par­ty because male nurses refused to serve in remote areas, Pokhrel is more hopeful this time. “The pay at remote government hospitals is good these days,” she says. She also pointed out the desperate need for male nurses during emergencies like the 2015 earthquakes.

The subtle pressure from the International Council of Nurses, a federation of over 130 nurses asso­ciation around the world including the NAN, also played a part. In fact, Nepal was the only country associ­ated with the council that did not have male nurses, and the council pressed for more gender equality.

Says Khusbu Sapkota, a profes­sional female nurse, “The inclu­sion of male nurses will make a big difference in our field. In my time in India, patients and doctors used to prefer male nurses partic­ularly in Operation Theatres and Intensive Care Units. This is because they are strongly built and can shift patients with ease during difficult medical procedures.”

According to Sapkota, many Nepali male patients also find it eas­ier to deal with male medical stuff, for instance during insertion of Foley’s catheter in the male urethra.

Challenges, old and new

Nonetheless there are many chal­lenges to male enrolment. It is pos­sible, says Pokhrel, the NAN presi­dent, the 15 percent male quota will be difficult to fill, at least initially, mainly because of lack of awareness among prospective students of the scope for male nurses. This is why the association plans many aware­ness-raising activities.

When APEX approached 50 SEE graduates this year, we found just one student who was willing to enroll in nursing. The rest said they would be embarrassed to study what was still a ‘girl’s profession’. Even Anil Thapa, the sole SEE grad­uate who intends to take up the course, says he is doing so at the instigation of his father, a medical doctor. But given a choice he would opt out. Why? “I fear being ridiculed by my friends.”

The IOM staff are, however, con­vinced that many male students will enroll as it is a job that is both financially rewarding and emotion­ally satisfying.

Other than that, there are con­cerns that male students might take this course only as a stepping stone to another health profession. “In the past, over 50 percent male nurses changed their profession, to lat­er study Bachelor Public Health or Master of Public Health,” says Pokhrel. “They wanted to serve in top positions of certain government health institutes instead of working in hospitals.”

She says she is not confident that the same thing won’t happen again and if that is the case, “there is no point in teaching nursing to male students.” Also, even though the society has progressed, Pokhrel doubts male nurses will be accepted by female patients easily as “there is a lot of physical contact in this profession, even in sen­sitive areas of the body.”

More than 81,000 nurses are currently reg­istered with the NNC, and there is an over-pro­duction of nurses every year. Income-wise, gov­ernmental hospitals offer lucrative salaries but the offerings in private hospitals are comparably low. This is why there is always the risk that the new male nurses would rather choose to go abroad rather than serve in low-paying private hospitals, or even in well-paying government ones. Just as is happen­ing with female nurses, greener pas­tures could also lure them abroad.