At the foothills of the Himalayas, two men lift their shirts to reveal wide scars on their bodies.
Both are in their 40s and seem self-conscious, even embarrassed, but eager to share their stories.
The men, known as Kancha and Ramu, were driven by financial desperation to sell their kidneys. Kancha is still in pain and unable to work due to the side effects of the surgery.
“It's impossible to count how many people have done it,” he says. “So many people sold their kidneys in this village, in that village, everywhere.”
Hokuse village Nepal It has a unique and very difficult history. Someone in almost every household has sold a kidney, known as the kidney trough.
Despite being illegal, brokers have been visiting the area for years to persuade people to part with their organs.
Local residents have worked hard in recent years to shed its bad name. They feel cheated and their reputations tarnished. Some claim they were exploited, while others claim they were told their kidneys would regenerate. Some people have died as a result of what was done to their bodies.
And now, tragically, poverty is causing a new health crisis in Nepal, and the kidneys are once again at the center of it.
More and more Nepalis are choosing to work in the Gulf and abroad. Malaysia To earn more money for my family back home. But it comes with risks.
Once healthy young men are returning to Nepal in dire need of kidney transplants. Some scientists say this is the result of exposure to extreme heat and severe dehydration.
A few years ago, 31-year-old Suman was devastated financially and emotionally and considered ending her life. He felt he had “no choice” but to go to India to sell his kidney to a woman pretending to be his sister.
It was a physically painful process that left him scarred. He was paid £3,000.
“I felt weak and lost consciousness,” he says. “When I woke up, it really hurt. I can't work right now, so I'm telling anyone who can to not sell their kidneys.”
Suman wasn't sure if the doctor knew what he was doing, but Indian law is clear: donors must be related and provide relevant documentation. .
Organ trafficking remains a major concern India. It is driven by a large gap between demand and supply.
A shortage of donors has created a black market, and doctors and hospitals have also been busted in investigations into the “cash for kidney” racket.
But it's not limited to India. According to estimates, one in every 10 of his transplanted organs is trafficked around the world.
“The agents produced forged documents in Kathmandu, including Indian identity cards,” said Kancha, who sold his kidney in India.
“My kidney was given to my fake sister. I think the doctors in India knew that I had sold it.”
In Hokse, locals claim that no one sells their kidneys anymore, but some are still willing to take extreme risks to improve their lives.
Jit Bahadur Gurung worked in Saudi Arabia for three years. Just 29 years old, he undergoes dialysis for four hours three times a week at the National Kidney Center in Kathmandu.
He looks tired and withdrawn.
“I had to work in extreme heat, about 50 degrees Celsius,” he says. “I didn't have time to eat lunch, go to the bathroom, or drink water.”
He describes the moment he realized something was wrong. “I had too much fever. Suddenly I felt my legs swell and I couldn't walk. Then they told me my kidneys were failing.”
Symptoms of kidney failure often go unnoticed, and by the time migrant workers return to Nepal, it is often too late.
Jit is in desperate need of a donor. However, the donor must be a relative, and there are not enough positive matches.
Ishwor is 34 years old and still searching for a lifeline. He said he worked 16 hours a day in Dubai for seven years.
“I worked long hours in the heat and couldn't sleep,'' he says. His body swelled up as if he had been hit.
Dr. Pukhar Shreth, a pioneering and renowned surgeon at Nepal's Human Organ Transplant Center, used to only perform transplants on elderly people, but recently he has started seeing young people with damaged and atrophied kidneys.
He noticed a pattern – young men going to work in intense heat with little to no water and coming home with “complete kidney failure.”
“This is very serious because about a third of all transplants are migrant workers from overseas,” he says.
“This places a tremendous burden on our nation's medical facilities, as they account for more than 30% of the total number of transplants in our country.”
This is a disproportionate number, as overseas workers make up about 14% of Nepal's population.
Dr. Shrestha believes that education is key and makes sure young men going abroad know the importance of water, rest and proper diet.
A young doctor working with him collects important data about where the men have been and what conditions they were facing. The men were required to undergo medical examinations before traveling abroad for work, and are therefore believed to have been in good health previously.
In fact, they feel forced to work in the hottest places in the world and have little agency.
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Although some countries like Qatar have reduced the amount of time people can work in the sun, the suffering of Nepalis has not stopped.
Studies have shown that the risk of extreme heat waves in the Gulf has increased in recent years due to climate change.
A recent Human Rights Watch report also said migrant workers are being mistreated and considered “disposable.”
Nepal's hospital is a stark warning of the dangers of a warming world and the high price people in coal-mining regions are paying.
Anyone who is experiencing mental distress or having suicidal thoughts can seek help in the UK by calling Samaritans on 116 123 or by emailing jo@samaritans.org. In the United States, call your local Samaritans branch or call 1 (800) 273-TALK.
Additional reporting by Rachel Thorne, Asia Producer
