It's the middle of winter, and the wards of Tribhuvan University Teaching Hospital in downtown Kathmandu, Nepal, are full of people who can't breathe.
On the third-floor pediatrics ward, Basanta K.C. balances his baby daughter, Bursa, in his right arm and deftly threads a narrow plastic tube into her nostrils. As she struggles for air, her eyes bulge slightly, and her skin pulls tautly against tiny neck muscles.
"Sometimes she plays a lot, but within minutes she has problems breathing," says Bursa's mother, Dipa, surveying the pair. Bursa curls against her father with a look of preternatural calm; Dipa's forehead is knitted in concern. At 24, Dipa retains a measure of good humor, but faint worry lines run from the edges of her lips. Both she and Basanta, 29, have small, dark rings beneath their eyes.
The trio traveled to Nepal's capital city from their native Dang district—a 287-mile drive that takes 16 hours on the country's notoriously rough roads. When she was three months old, Bursa was diagnosed with recurrent pneumonia. The condition required regular check-ups, and, during the last one, the doctors at their local hospital flagged a problem they weren't capable of treating. After trying—and failing—to get care at an Indian hospital just across the border, the family headed to Kathmandu. When I met them, they had already been at Tribhuvan University for two months. Sixty-two days to be precise, according to Dipa.
Bursa had spent a month in the intensive care unit and another month in primary care. Doctors in Kathmandu diagnosed the 15-month-old with asthma—the type of highly treatable illness that can easily become a death sentence in the developing world.
Like many families of patients here and at other government hospitals, Basanta and Dipa have no money to spare for accommodation. At night, they sleep on thin, rubberized patient mattresses; when the ward is full, they sleep in plastic chairs.
The doctors asked the couple to buy an asthma inhaler attached to a small mask and gave them a crash course in using it. Then, they offered the couple some practical advice.
"Don't go into a crowded area, or a place with dust, or where people are smoking," Dipa says, rattling the impossible list off.
While Basanta tidies the baby's medications, Dipa drops her voice to a whisper and looks at my translator conspiratorially. "Tell him not to smoke," she says, hoping Basanta will heed an outsider's advice. "It's not good for her health." Later, Basanta would protest that he had stopped. But he admitted that his mother—with whom they shared a small home—smoked regularly.
Whatever happens, dust will remain an omnipresent part of the family's life.
Because there is not enough electricity to meet the demands of Nepal's rapidly growing cities, blackouts have been rampant. Each time the electricity powers off, thousands of diesel generators rumble to life, spewing noxious particulate matter, or PM2.5. The particles are less than 2.5 microns in diameter and sit suspended in the air, waiting to be inhaled. Though Nepal has almost no industry, it faces some of the worst air pollution in the world.
"The doctor says it's a prolonged chronic disease, but as she grows up and gains weight, it will get better," Dipa says. She repeats these words like a mantra during our conversation.
One floor below, a doctor scrawls a diagram of lungs on the back of an envelope, pointing to the spot where Ajit Tamang's infection has taken hold. Ajit squints to get a better look.
"The government is doing nothing, but air pollution is a big problem," the doctor tells Ajit, without looking up from his sketch. "But your infection isn't that complicated—you'll be discharged tomorrow."
Ajit is 36. His black hair is closely shorn. Dressed in jeans, a motorcycle jacket, and scarf, he sits on the mattress like he has just materialized there—like he was heading toward a nightclub and somehow wound up in a hospital.
When the doctor walks away, Tek Bahadur Tamang begins complaining to his brother under his breath.
"I'm not happy about this," he tells Ajit. Getting discharged means you can no longer stay in the hospital, and the brothers have nowhere to go while they wait four more days for the test results. They have already spent a significant sum on medicine, the hospital care, and travel.
Ajit has had "blood in his cough," as he describes it, for six months now, but was compelled to seek medical attention only when the bleeding became excessive for five days in a row. He works on construction sites in eastern Nepal. He supposes that, somewhere along the way, enough dust wended its way into his lungs to cause an infection.
"I want to use a mask regularly now," Ajit says.
Masks are everywhere. In the wards, the doctors and patients mostly don't bother, but nearly everyone coming in off the street has one hooked neatly behind their ears. A paper mask costs about five cents, a cheery patterned-cloth one costs 20, and heavy-duty black fabric models cost a dollar or two. When people come to TU Teaching Hospital from other districts, they are often startled at how bad the air is in their nation's capital. Then they buy a mask.
At a crowded shop near the hospital's entrance, Gita Subedi fingers a red floral one. She pushes her white hair from her face and flashes a broad smile. It's only a mask, but Gita is making the most of the shopping expedition.
"I was planning to get a white one, but I think it will get dirty too quickly," she murmurs, half to herself.
She picks up one, then the other, mulling her options.
A day earlier, the 49-year-old arrived in Kathmandu for heart treatment.
"There's a lot of dust here, and it's harmful to health. I'm already suffering from problems with dust and cold—this could worsen it," she says. "It's difficult to walk in the street with the dust and all."
Masked men and women stream past Gita. The shop is one of perhaps a dozen selling masks in the immediate vicinity of the hospital, and, each day, it sells 50 to 100 of the paper ones.
Outside the building a lanky traffic cop, wearing a fabric mask provided by his department, directs an endless flow of cars. When the cars move quickly, their wheels kick up the fine layer of dust coating many of Kathmandu's streets. More often, they are stalled in traffic, belching fumes.
Nine hours a day, seven days a week, Dambar Bahadur Dhamshe, the traffic policeman, stands there in the middle of the street. When his mask is off, the particulate matter snakes its way into his lungs and bloodstream. Even though the hospital behind him is full of people with pneumonia, chronic obstructive pulmonary disease, and respiratory infections, Dambar prefers not to worry. He's only been at the job for two months, he says, and he has his mask.
"For now, I don't have any health problems," he says. "Let's see in the future."
A version of this story, which was sponsored by the International Reporting Project and to which Pragati Shahi contributed translation and reporting, originally appeared in the August/September 2017 issue of Pacific Standard.