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Language politics in Nepal: A socio-historical overview

This paper aims to outline the language politics in Nepal by focusing on the influences and expansions shifted from Global North to the Global South. Based on a small-scale case study of interviews and various political movements and legislative documents, this paper discusses linguistic diversity and multilingualism, globalization, and their impacts on Nepal’s linguistic landscapes. It finds that the language politics in Nepal has been shifted and changed throughout history because of different governmental and political changes. Different ideas have emerged because of globalization and neoliberal impacts which are responsible for language contact, shift, and change in Nepalese society. It concludes that the diversified politics and multilingualism in Nepal have been functioning as a double-edged sword, which on the one hand promotes and preserves linguistic and cultural diversity and on the other hand squeezes the size of diversity by vitalizing the Nepali and English languages through contact and globalization.

1 Introduction

Nepal is a multilingual, multicultural, multiracial, and multi-religious country. Despite its small size, Nepal is a country of linguistic diversity with four major language families, namely, Indo-Aryan, Tibeto-Burman, Dravidian (Munda), and Austro-Asiatic, and one language isolate, Kusunda ( Poudel and Baral 2021 ). The National Population and Household Census 2011 ( Central Bureau of Statistics 2012 ) records the number of speakers for 123 languages and some other includes an additional category of ‘other unknown languages’ with close to half a million speakers. The state intervention to preserve and promote these languages remained inconsistent throughout history, as some governments intentionally discouraged the planned promotion compared to others which designed some measures to promote them. Both monolingual and multilingual ideologies remained as points of debate in political and social spaces.

Language politics is the way language is used in the political arena in which people can observe the treatment of language by various governmental and non-governmental agencies. Research related to language politics focuses on identifying and critiquing any sets of beliefs about language articulated by users as a rationalization or justification of perceived language structure and use ( Dunmre 2012 : 742; Silverstein 1979 : 193). In this context, every political movement is the outcome of different conflicting ideas between language users and linguistic differences running through any society ( Pelinka 2018 ). The politics of language choice becomes particularly difficult when institutional choices have to be made in what language(s) the government will conduct its business and communicate its citizens, and, above all, what the language(s) of education will be ( Joseph 2006 : 10). Nepal’s language politics and democratic movements question whether democracy can promote linguistic diversity, or narrow down diversity by marginalizing ethnic/minority languages. In Nepal, linguistic diversity and democracy have been challenged by the contradiction between the normative assumption of existing demos and the reality of a society that is too complex to be defined by one orientation only by nation, culture, and religion ( Pelinka 2018 : 624). Nepal’s language politics has not been explained from such a perspective where we can see several factors influencing the issues related to language, culture, and society. Hence, this paper tries to overview the language politics in Nepal which has been influenced by various external and internal factors.

2 Brief history of language politics in Nepal

Following the Gorkha [1] conquest, Gorkhali or Khas (now known as Nepali), the language of ruling elites and mother tongue of many people in the Hills, was uplifted as the national official language in Nepal. After unification, [2] a hegemonic policy in terms of language and culture was formulated which promoted the code (linguistic and dress) of the Hill Brahmins, Chhetries, and Thakuris to the ideal national code (i.e. Nepali language and Daura Suruwal Topi-dress [3] ). This has been interpreted as one of the attempts to promote assimilatory national policy (in terms of language and culture) that contributed to curbing both linguistic and cultural diversity. However, for the rulers then, it was an attempt to establish a stronger national identity and integrity. The Rana regime further prolonged this ‘one nation-one language’ policy by uplifting the Nepali language in education and public communication. The Rana, during their rule, suppressed various language movements (Newar, Hindi, Maithili, etc.), which serves as evidence of their deliberate plan to eliminate all but one language, viz. Nepali. In this sense, we can understand that Nepal’s diversity and multilingual identity were suppressed historically in the name of nation-building and promoting national integration among people with diverse ethnic and cultural orientations.

Following the end of the Rana oligarchy in 1950, with the establishment of democracy, some changes were noticed concerning the recognition and mainstreaming of the other ethnic/indigenous languages. This instigated the policy change in terms of language use in education as well. However, the status quo of the Nepali language further strengthened as it was made the prominent language of governance and education. The Education in Nepal: Report of the Nepal Education Planning Commission ( Sardar et al. 1956 ), the first national report on education, basically reflected the ideology of monolingualism with the influence of Hugh. B. Wood. It stated, “If the younger generation is taught to use Nepali as the basic language then other languages will gradually disappear” ( Sardar et al. 1956 : 72). Though this report formed the backbone of Nepal’s education system, it also paved the way for minimizing the potential for empowering the languages of the nation. Pradhan (2019 : 169) also writes that this commission attempted to “coalesce the ideas of Nepali nationalism around the “triumvirate of Nepali language, monarchy, and Hindu religion”. The same idea was reinforced by K. I. Singh’s government in 1957 by prescribing Nepali as the medium of instruction in school education.

The Panchayat regime also promoted the use of Nepali as the only language of administration, education, and media in compliance with the Panchayat slogan ‘one language, one dress, one country’ ( eutaa bhasha, eutaa bhesh, eutaa desh ), again providing a supportive environment for strengthening the monolingual nationalistic ideology (i.e. the assimilatory policy). Not only in education but also in governance, English or Nepali language was made mandatory in recording all documents of companies through the Nepal Companies Act 1964 ( Government of Nepal 1964 ). Following the Panchayat system, with the restoration of democracy in 1990, the Constitution of the Kingdom of Nepal 1990 ( Government of Nepal 1990 ) provisioned the Nepali language written in Devanagari script [4] as the national language, and also recognized all the mother tongues as the languages of the nation with their official eligibility as the medium of instruction in primary education. The Interim Constitution of Nepal 2063 ( Government of Nepal 2007 ), which came as a collective outcome of the various political movements and Andolan II continued to strengthen the Nepali language, but ensured (in Part 1, Article 5.2) that each community’s right to have education in their mother tongue and right to preserve and promote their languages, script, and culture as well.

The recognition of all the mother tongues as the languages of the nation was a progressive step ahead provisioned by the Interim Constitution of Nepal 2063. Apart from further confirming the right of each community to preserve and promote its language, script, culture, cultural civility, and heritage, the Interim Constitution of Nepal 2063 (Part 3, Article 17) clearly explained the right to each community to acquire basic education in their mother tongue as provided for in the law. The same was well articulated in the Constitution of Nepal 2072 ( Government of Nepal 2015 ) as well, and each state was given the authority to provide one or many languages spoken by the majority population as the official languages. Along with this, the language commission was established in 2016 to study and recommend other issues related to language and multilingualism (Part 1, Article 7 of the Constitution of Nepal 2072 ). However, it can be realized that these policy provisions that embrace diversity will have less effect if the concerned communities or agencies do not translate them into practice.

3 Research method

This study, following a qualitative approach, is based on a small-scale case study with primary and secondary data sets.

The author has obtained the primary data from semi-structured interviews with two selected individuals who have spent their lives in politics and especially language movements and advocacy for language preservation and promotion in Nepal. They were observed and interviewed informally on many occasions from 2019 to 2020 related to language issues like constitutions, language movements, language diversities and democracy, and so on. The interviews (altogether 3 h each) were recorded, transcribed, and translated into English, and were checked for accuracy and reliability.

Mr. Yonjan and Dr. Thakur [5] have been selected from two different political and linguistic backgrounds. Mr. Yonjan is a liberal democratic fellow who has been working as a freelance language activist for more than 40 years, involving himself in many governmental and non-governmental policies and programs related to language issues. Dr. Thakur worked as a politician (left-wing) and teacher educator who later joined Radio Nepal, engaged in various cultural advocacy forums of the ruling Communist Party of Nepal, and again moved to politics at the later part of his life. He was a member of the parliament in the Constituent Assembly. Mr. Yonjan is the native speaker of Tamang (a major Tibeto-Burman language) and Dr. Thakur is a native speaker of Bhojpuri (a major Indo-Aryan language), and both of them learn Nepali as a second language. In that, both of the individuals have active engagement in language politics and planning, however, are from different cultural, linguistic, and geopolitical backgrounds. It is assumed that their ideas would make the understanding of language politics in Nepal more enriched.

The secondary data is obtained from a detailed reading of available literature about language politics. Nepal’s language and educational history, various political movements, constitutions and legislative documents, policy documents, and other published research papers and documents have been carefully utilized.

4 Findings and discussion

Language politics in Nepal has a very long history since the beginning of modern Nepal. After the victory of Prithvi Narayan Shah, a Gurkha King whose mother tongue was Khas (Nepali), in Kathmandu valley (1769), Nepali became the language of law and administration ( Gautam 2012 ) where the vernacular language was Newar spoken by the majority of people. Since then, language politics has become the center of democratic and political movements in Nepal.

Nepali language was highlighted and became the language for all public and private activities after the Unification Movement (1736–1769) in Nepal. Janga Bahadur Rana’s visit to the United Kingdom and his relation to British India made it possible for the Nepalese rulers to start English Education formally in Durbar High school in 1854. After Rana Regime, Nepal experienced an unstable political scenario for 10 years before the establishment of the Panchayat Regime in 1961 which employed assimilatory language policy until 1990. The country was converted into a multiparty democratic system and eventually, most of the ethnic and minority linguistic groups flourished for the preservation and documentation of their ethnic and cultural heritages. At present, Nepalese politics has been influenced by ethnic, cultural, and language issues at the center.

4.1 Legal and constitutional provisions

Nepalese constitutions are the main sources of language politics in Nepal. Before the construction of the constitution in the country, some government policies played a vital role in creating language issues debatable all the time. The first legal court Muluki Ain [6] (1854) enforced Hinduisation and Nepalization in Nepal by ignoring most of the other ethnic languages. The establishment of the Nepal National Education Planning Commission (NNEPC) by the recommendation of the National Education Board of the Government of Nepal emphasized the Nepali language by implementing it as a medium of instruction in all levels of education.

The medium of instruction should be the national language (Nepali) in primary, middle, and higher educational institutions because any language which cannot be made lingua franca and which does not serve legal proceedings in court should not find a place. The use of national language can bring about equality among all classes of people. ( Sardar et al. 1956 : 56)

This excerpt indicates the emphasis given to the Nepali language by the government then. The use of Nepali in education was further reinforced by the K. I. Singh government in 1957 by prescribing Nepali as the medium of instruction. The case of Nepali was again strengthened during the Panchayat regime. In 1961, the National System of Education was introduced to promote the use of only Nepali in administration, education, and media in compliance with the Panchayat’s popular slogan of ‘one language, one dress, and one country’. In addition, the Nepal Companies Act was passed in 1964 directing all companies to keep their records in English or Nepali. The Panchayat constitution followed a nationalist assimilation policy to promote the Nepali language in different ways.

The Constitution of the Kingdom of Nepal 1990 ( Government of Nepal 1990 : 4) framed after the restoration of democracy recognized languages other than Nepali and made the following provisions about the non-Nepali languages:

(1) The Nepali language in the Devanagari script is the language of the nation of Nepal. The Nepali language shall be the official language. (Part 1, Article 6.1) (2) All the languages spoken as the mother tongue in the various parts of Nepal are the national languages of Nepal. (Part 1, Article 6.2)

In addition, the constitution also made a provision for the use of mother tongues in primary education (Part 1, Article 18.2). It also guaranteed a fundamental right to the people to preserve their culture, scripts, and their languages (Part 1, Article 26.2).

Similarly, the Maoist movement that started in 1996 brought new changes and dynamics among all the ethnic minorities of Nepal. This political campaign motivated them to preserve and promote their languages and cultures which has been documented in the Interim Constitution of Nepal 2063 . The Interim Constitution of Nepal 2063 ( Government of Nepal 2007 : 2), an outcome of the people’s revolution (Andolan II), made the following provisions for languages:

(1) All the languages spoken as the mother tongue in Nepal are the national languages of Nepal. (2) The Nepali Language in Devanagari script shall be the official language. (3) Notwithstanding anything contained in clause (2), it shall not be deemed to have hindered to use the mother language in local bodies and offices. State shall translate the languages when they are used for official purpose. (Part 1, Article 5)

Regarding education and cultural rights, the Interim Constitution of Nepal 2063 ( Government of Nepal 2007 : 8) enshrined the following provisions:

(1) Each community shall have the right to receive basic education in their mother tongue as provided for in the law. (2) Every citizen shall have the right to receive free education from the State up to secondary level as provided for in the law (3) Each community residing in Nepal has the right to preserve and promote its language, script, culture, cultural civilization and heritage. (Part 3 Article 17)

The Interim Constitution of Nepal 2063 was more progressive and liberal than the constitution of 1991. For the first time, this constitution recognized all the languages spoken in Nepal as the national languages. Apart from further confirming the right of each community to preserve and promote its language, script, culture, cultural civility, and heritage, this constitution (Part 3, Article 17) discussed the right to each community to acquire basic education in their mother tongue as provided for in the law. However, the role of the government was to facilitate the speech communities to materialize these rights which still are not effective.

Likewise, the latest Constitution of Nepal 2072 ( Government of Nepal 2015 : 4) has clearly stated the following provisions:

Languages of the nation: All languages spoken as the mother tongues in Nepal are the languages of the nation. (Part 1, Article 6)

Official language: (1) The Nepali language in the Devanagari script shall be the official language of Nepal. (2) A State may, by a State law, determine one or more than one languages of the nation spoken by a majority of people within the State as its official language(s), in addition to the Nepali language. (3) Other matters relating to language shall be as decided by the Government of Nepal, on recommendation of the Language Commission. (Part 1 Article 7)

The Constitution of Nepal 2072 ( Government of Nepal 2015 ) conferred the right to basic education in mother tongue (Article 31.1), the right to use mother language (Article 32.1), and preservation and promotion of language (Article 32.3). This constitution states that each community shall have the right to preserve and promote its language, script, culture, cultural civility, and heritage. Unless the constitution articulates the responsibility of the government to preserve and promote the endangered languages, the efforts of the communities will be useless. Observing and analyzing the legal provisions, Nepal has manifested significant progress and gradual development in the use of languages along with historical events. The key measure of a language’s viability is not the number of people who speak it, but the extent to which children are still learning the language as their native tongue. The Constitution of Nepal 2072 ( Government of Nepal 2015 ) also made the provision of establishing a language commission in article 287 which was a landmark in Nepalese history.

4.2 Democracy and political movements

Nepal’s language politics is guided by various democratic and political movements in different periods. The Universal Declaration of Human Rights ( United Nations 1948 ) asserts that democracy assures the basic human rights for self-determination and full participation of people in the aspects of their living such as decision-making about their language and culture (Article 27). Nepal’s political parties and the ruling governments never understand the seriousness of political movements and democratic practices. Human rights also provide them with ways of assuring social benefits such as equal opportunities and social justice. In Nepal, diversity was promoted by democracy through the policy provisions, especially after the promulgation of the Constitution of the Kingdom of Nepal 1990 . The basic rights for the use of indigenous languages were assured in the constitution as well as other educational acts formed as outcomes of democratic political turns. The changes in the policy provisions provided opportunities for linguists, language rights activists, and advocacy groups or individuals to explore more about their languages and cultures. Due to their attempts, also supported by the democratic political system, new languages were identified, and some others were streamlined through the preparation of educational materials such as textbooks for primary level education. However, pragmatic actions remained fragile for education in the schools to support the aspiration for promoting diversity, which ultimately resulted in squeezing multilingualism. The statistical data shows that the number of languages spoken as mother tongues in Nepal is 129, [7] some scholars still doubt whether these languages functionally exist in reality ( Gautam 2019a ), or if they are there, then the practice may be fragile. In having such a very weak practice in the field, it can be noted that various factors played key roles, including lack of community participation, hegemonic attitude, and agency of the individuals who could have purposive actions.

For instance, the recognition of linguistic diversity in Nepal can be observed clearly after the establishment of multiparty democracy in 1990. Sonntag (2007 : 205) stated that “the Nepali-only policy was discarded in favor of an official language policy that recognized Nepal’s linguistic diversity”. This shows that the democratic political system that remained open to the neoliberal economy embraced linguistic diversity as a resource, due to which the multilingual identity of Nepalese society was officially recognized. However, at the same time, this political system could not preserve the minority/indigenous languages as expected, which prompted us to question the co-existence of diversity and democracy. Also, “[i]t is very much a matter of democracy that everyone has the right to language and that society has a common language that everyone can understand and use” ( Rosén and Bagga-Gupta 2013 : 59). As democratic states (e.g. Nepal, India, and Sweden) which address the contradictory discourses of language rights and develop equal access for everyone to a common language (e.g. Nepali in Nepal) are struggling to settle the language issues. However, the fundamental question still not well-answered, at least in the case of Nepal, is whether democracy can, in a real sense, promote linguistic diversity, or it narrows down the diversity by marginalizing the ethnic/minority languages. While responding to this unanswered concern, this article finds that diversity as a resource and diversity as a problem are the two distinct discourses that emerged during the evolutionary process of democracy in Nepal, which is also emphasized by the two participants.

4.3 Linguistic diversity and politics

Linguistic, cultural, and geographical diversities are the essences of Nepalese democratic practices in different periods in history. Nepal’s modern history starts with the unification campaign of Prithvi Narayan Shah, the first Shah King of Nepal. Prithvi Narayan Shah’s unification modality worked indirectly to promote the politics of assimilation in nation-building, national integration, and identity. Roughly, all other systems of governance following the unification adopted similar ideological orientations, which (in) directly contributed to the marginalization of other mother tongues. Mr. Yonjan expressed his view as, “Historically, even before the unification movement of Nepal, there were several territories in which the state Kings used to speak their own languages, and the linguistic diversity was preserved and strengthened”. He further claimed, “The geopolitical, historical, socio-political, and anthropological history recognized the multilingual social dynamics, however, the national policies after the unification too could not embrace such diversity”. By saying so, Mr. Yonjan expressed that the current political systems and the ideologies of Nepali nationalism were guided by the notion of ultra-nationalism. Dr. Thakur also emphasized that the government’s multilingual policies would not operate as the practice had largely shaped people’s orientation towards Nepali and English, side-lining the regional and local languages. The same perception was reported by Mr. Yonjan as, “Though careful efforts were made in the policy level to promote the regional/local languages through status planning, there still existed the attitudinal problem which undermined the potential of bringing local and minority languages into practice”. Their claims also adhered to the statements made in the documents which reflect the hidden language politics of Nepal.

Both informants in this study argued that diversity has two different outcomes viz. as a resource and as a problem. Mr. Yonjan claims, “If any language of a community dies, the culture and lifestyle of that community disappears and it reduces biodiversity, and that ultimately will be a great threat to humanity”. He understands linguistic diversity as a part of the ecology and strongly argues that it should be protected. Agnihotri (2017 : 185) also echoes a similar belief as “Just as biodiversity enriches the life of a forest, linguistic diversity enhances the intellectual well-being of individuals and groups, both small and large”. But Dr. Thakur views that “In Nepal, along with the history, there remains an ideological problem that diversity is understood as a construct for division, rather than understanding it as a potential tool for nation-building”. He further clears that this community-level ideology and practice has led to the fragmentation of values associated with their languages, most probably harming the socio-historical harmony among languages. Mr. Yonjan further added, “No language should die or move towards the edge of extinction in the name of developing our own existence and condition”. Both Mr. Yonjan and Dr. Thakur pointed out that the discourse on diversity and multilingualism in Nepal had been strengthened and institutionalized after 1990 when the country entered a multiparty democratic system.

However, Mr. Yonjan thinks that the current legislative provisions have partially addressed the diversity needs to fit Nepal’s super diverse context. Dr. Thakur again indicates that the rulers for long “undermined the potential of the linguistic diversity and wished to impose a monolingual national system that marginalized the use of these languages”. Mr. Yonjan also provided a similar view as “in Nepal, throughout the history, there remained a political problem that diversity was understood as a construct for division, rather than a potential tool for nation-building”. His understanding also reflects what was discussed in the western countries as Nettle (2000 : 335) clarifies “the linguistic and ethnic fragmentation relates to low levels of economic development since it is associated with societal divisions and conflicts, low mobility, limited trade, imperfect markets, and poor communications in general”. Therefore, the direct economic benefits from learning a language were a great motivation for the people in the communities. In other words, they have preserved the sentimental functions of the minority languages while they have embraced the dominant languages associating them with educational and economic potential gains. This community-level politics and practices have led to the fragmentation of values associated with their languages, most probably harming the socio-historical harmony among languages. Gautam (2018) has pointed out this concern as a cause of intergenerational shifts in languages among the youths of indigenous languages (such as Newar, Sherpa, and Maithili in Kathmandu Valley). Consequently, this trend has influenced the participation of the relevant communities in campaigns for the revitalization of their languages that points to the influence of the Global North in bringing ultranationalist values in Nepal’s language politics and diversity.

4.4 Impact of globalization

The international political-economic structure seems stacked against a substantial or near future diminishment of “the North-South gap” ( Thompson and Reuveny 2009 : 66). The neoliberal trends that emerged from the Global North have traveled to the Global South, influencing these countries through the language and culture of the countries in the Global North. The unprecedented expansion of English as a global phenomenon ( Dearden 2014 ) can be a good example of such an effect. It involved various combinations of developmental states recalling domestic markets from foreign exporters (import substitution) and the recapture of domestic business (nationalization). The outcome, aided by investments in education, was a new elite of technical managers and professionals who could build on historical experiences and opportunities in the post-war environment to manufacture and market commodities involving increasing product complexity and scale. Migration and demographic changes have had variable impacts on the North-South gap. Nepali youths’ labor migration and their English preference have also influenced the generational shifts in languages ( Gautam 2020 : 140). The youths’ migration to the countries in the Middle East, and their participation in the global marketplaces in the Global North countries have contributed to the reshaping of their ideologies towards the home languages and English. Mr. Yonjan states, “We have made lots of choices in our society and education systems (e.g. choice of language for education, western culture, and lifestyles) attracted by the politics and ideologies created even by our immigrant Nepali population usually in the western world”. Among many, this expression can be understood as one of the causes for stressed deviating tendencies in language shifts, usually from mother tongues or heritage languages and dominant national languages to English. In the context of Nepal, either English or Nepali has been highlighted even though there have been lots of attempts of implementing mother tongue-based multilingual education.

4.4.1 English and globalization

English has become the global language because of its use, function, and popularity in most of the social, cultural, and academic areas. A sizeable body of scholarship has addressed the topic of globalization and its impact on the modern world ( Giddens 1991 ; Levitt 1983 ). Among several definitions, globalization refers to the multifarious transformations in time and place that influence human activities through the creation of linkages and connections across geographical borders and national differences ( Giddens 1991 ; Held et al. 1999 ). In the context of Nepal, these linkages and connections are often facilitated through various globalized activities, such as marketing, transportation, shipping, telecommunications, and banking. Similarly, sociolinguists and language planners have examined the phenomenon of global English and its impact on the linguistic landscape around the world. Crystal (2012) maintains that a language attains a global status once it has gained a distinctive role in every nation-state around the globe. This special role is manifested in three ways: functioning as the mother tongue of the majority of citizens, being assigned the official status, and/or playing the role of the major foreign language. Many observers view English as the global language par excellence of the Internet, science and education, entertainment, popular culture, music, and sports. The emergence of global English is also attributable to some factors, notably the economy, military, and politics.

Historical records show that English was used in Nepal as early as the seventeenth century ( Giri 2015 ). However, English language education started formally after Janga Bahadur visited the UK during British rule in India. He knew the importance of English and started English Education in Durbar School for selected Ranas. It was the first government-run English medium school in Nepal. It was only established for the Rana family as the Ranas saw an educated person as a threat to their control ( Caddell 2007 ). The first post-secondary (higher) educational institution in Nepal was Trichandra College (1918) where the language of instruction was English. The main purpose was to shelter students of Durbar School and to stop them from going abroad (India) for further education. The underlying purpose was to prevent Nepalese from getting radical ideas that could be dangerous for them and the entire Rana regime. Tri-Chandra College was affiliated with Patna University, India. It borrowed the syllabus and assessment system from there; therefore, there was a direct influence of the British Indian Education System in the Nepalese system. Another very important reason for the spread of English was the recruitment and the retirement of the Nepalese British army. As English was mandatory for their recruitment in the British army, the youngsters willing to join the British army learned English. After their retirement, these armies returned to their homeland and inspired their younger generations to learn English. In South Asian countries, English is viewed as a language of power and as a means of economic uplift and upward social mobility ( Kachru et al. 2006 : 90). It led to the establishment of many private schools and colleges and made English indispensable to the Nepalese curriculum. Later, it became the language of attraction for all academic activities. The spread of global English as an international lingua franca intensifies socio-economic disparities both within and between speech communities. Tollefson (1995) and Pennycook (1995) explain that the promotion of English as an international language is driven by social, economic, and political forces, thereby giving rise to economic inequalities. In the same way, Canagarajah (1999) noted that generally, native speakers of English are presented with better compensation and benefits packages compared to non-natives, regardless of their academic qualifications. In Nepal, the state’s neoliberal ideology in the post-1990 era, however, has valorized the commodity value of English as a global language, creating a hierarchy of languages in which minoritized languages like Newar, Sherpa, Maithili, Tharu, Limbu, etc. remain at the bottom ( Gautam 2021 ). Following the state’s neoliberal structural reforms, a large number of private schools popularly known as ‘English medium’ and ‘boarding’ schools have been established with private investments in many parts of the country ( Sharma and Phyak 2017 : 5). The establishment of various international non-governmental organizations like the United Nations Organization (UNO), the World Health Organization (WHO), the United National Education, the Scientific and Cultural Organization (UNESCO), and regional organizations like the South Asian Association for Regional Cooperation (SAARC) have spread the use and demand of English. After the restoration of democracy in 1990, Nepal’s active participation in such organizations made English vital in Nepalese society. Although it has a sort of colonial liability, it is now accepted as an asset in the form of a national and international language representing educational and economic processes ( Kachru et al. 2006 : 90). As Kachru (2005) opines that Nepalese learners do not learn English to communicate in their homeland but they learn to talk in their work abroad. Now, this view is partially true since mostly Nepalese learn English to talk in their workplace either it can be at home or abroad. Therefore, from the time of commencement of English education, English has been learned and taught for professional development, scientific and technological knowledge, international communication, mass media, travel, and tourism. Globalization and its impact on the flourishing of English in Nepal have been very productive in recent days when the country was converted into a Federal republic state after the 2006/2007 political change. Learning English is deeply rooted among Nepalese people across the country, although the government seems reluctant to force the users to use English as a medium of instruction formally and officially ( Gautam 2021 ).

4.4.2 Language contact and shift

The present world is diversified and multilingual by nature and practice. Language contact is the common phenomenon of multilingualism where people choose their codes in their conversations and discourses. Social, historical, political, and economic power relations are major forces that influence the linguistic outcome of language contact ( Thomason and Kaufman 1992 ) as they may shape ideologies and attitudes that social actors hold toward such languages. Consequently, there is always a change in the linguistic behavior of language communities in contact which may even result in language loss due to displacement ( Sankoff 2001 ). In the context of Nepal, language contact has been the common phenomenon in Nepalese discourse of all aspects of society which is moving slowly towards code-mixing, switching, translanguaging, and the shifting from the heritage languages to the dominant and global languages.

In multilingual countries like Nepal, speakers tend to switch back and forth between two languages (or more) in different situations, formal and informal contexts, and even within the same conversation. People may code switch for various reasons. They sometimes shift within the same domain or social situation depending on the audience. A speaker might code switch to indicate group membership and similar ethnicity with the addressee. The linguistic situation of Nepal is very complex since people in their daily lives often use their respective mother tongues, Nepali, Hindi, and English within the same conversation ( Milroy and Muysken 1995 ). Language practices are inherently political in so far as they are among the ways individuals have at their disposal of gaining access to the production, distribution, and consumption of symbolic and material resources, that is, in so far as language forms part of the process of power ( Heller 1995 : 161) which we can easily observe and experience in Nepal. Code-switching in Nepal is shifting towards Nepali and English among the minority and other language communities ( Gautam 2019b ) as a mark of modernization, high socioeconomic position, and identity with a certain type of elite group; and in stylistic terms, it marks what may be termed as “deliberate” style. A marker of “modernization” or civilization is the impact of western music and culture in Nepal ( Gautam 2021 : 20). Dr. Thakur says “Our political leaders speak multiple languages in different places to collect the emotional feelings of the speakers attached with their mother tongues. Many Madhesi politicians speak Hindi, Maithili, and Bhojpuri in Terai and Nepali in Kathmandu”. This indicates that language contact and shift have also been the center of Nepalese politics for collecting votes to win the election.

4.4.3 Christianity and neoliberal impact

Christianity started when Father Juan Craybrawl (Portuguese) entered Nepal in 1628, during the reign of Laxmi Narsingha Malla in Kantipuri Nagari. [8] He had permission from the King to preach Christianity in Kathmandu valley. But basically, the gospel was brought to Nepal by Nepalese who were outside Nepal, as they come in and go. Slowly, missionaries started to enter Nepal during the 1950s but were not directly involved in preaching the gospel. They focused on social services like hospitals, education, and development works. Two major missionary organizations to serve Nepal, the United Mission to Nepal (UMN) and the International Nepal Fellowship (INF), came into existence in the early 1950s ( Kirchheiner 2016 ). The Nepal Christian Fellowship (NCF), now the National Churches Fellowship of Nepal (NCFN), played a significant role during the first 30 years from the 1960s to the 1990s. From just a single secret Christian residing in Nepal in 1951, the number of Nepali Christians grew to about 40,000 baptized believers by 1990 and has increased more rapidly since then. Groups of International Christian agency made United Mission to Nepal and founded Saint Xavier School in Godawari, Patan Hospital, and Tansen Hospital which provided grade one services to the people of Nepal. It was possible only after Nepal became a democratic country and many people accepted Jesus Christ as their personal Lord and savior. Christians in Nepal were overjoyed when Nepal has declared a secular state in 2008. The Christian population in Nepal outgrew to triple in 2011 from 2001, but this record is not accurate. Now, according to the World Christian Database, which tracks global trends in Christianity, Nepal has seen the fastest-growing Christian population. Times are changing in Nepal, not only because of democracy but also because of globalization. The influx of media, computers, and new types of secular education is guiding young generations into fields where Nepalese habits, customs, and traditional ways of approaching matters are challenged.

Christianity has developed cross-cultural practices in the country developing various neoliberal activities in the Global South. The new generation has become more concerned about the use of foreign goods, music, and activities in the name of religion or westernization. Many ethnic language communities (e.g. Tamang, Limbu, Newar, Magar, Gurung, etc.) are motivated towards English and Nepali by following Christianity through Bible translation. As a result, their cultural festivals have been converted into birthday, anniversary ceremonies in the churches with lots of western music and songs. Neoliberal ideology has influenced the construction of institutional language policies and the corporatized individual subject in the socio-historical context of Nepal ( Sharma and Phyak 2017 : 4). Migrated urban areas are very important sites in imposing language dominance, particularly capital cities and trade and commercial centers; towns tend to dominate the surrounding rural areas and their influence radiates out those areas ( Gautam 2021 : 127). People’s motivation and migration for economic benefit have also been noted as keys to encouraging people to adopt languages that deploy more instrumental functions in their job market ( Gautam 2021 : 151).

4.4.4 Ideological impacts on Global South

Nepal’s growing engagement with the international community (through its membership in UN, WTO, IMF, etc.) and its political systems have largely influenced the attitudinal patterns in Nepalese society. From a geopolitical perspective, as Nepal is sandwiched between two giant countries, India and China, the changes in the neighborhood would influence it on a larger scale. In addition, the development of the Global North would always have a chain effect on the countries of the Global South. For instance, the British colonial government of India then promoted English amidst other languages, and a similar trend emerged in Nepal with the effect of a similar environment in the neighborhood. Such geopolitical conditions and the waves gravely influenced the closely related communities to the development of nationalism and the creation of nation-states, including a new Europe perceived as superior to other parts of the world ( Bagga-Gupta 2010 ; Gal and Irvine 1995 ; Rosén and Bagga-Gupta 2013 ; Shohamy 2006 ). The ideologies of the countries of the Global North have influenced the countries of the Global South in many ways, including ideologies of language planning and policy ( Gautam and Poudel 2021 ). This has generated a perception and a social space that differentiates “us” and “the other” through the formation of linguistic-cultural ideologies ( Gynne et al. 2016 ) in the communities that have multiple languages in place. This made some languages valued more than others in the domains of governance and educational spaces ( Poudel 2019 ; Poudel and Choi 2021 ). In the case of Nepal, the first educational commission ( Sardar et al. 1956 ) was influenced by Hugh B. Wood’s ideologies and politics. He formed out of his involvement in the Indian and the western world, and the committee under the huge influence in collaboration with academia and Nepalese politicians, and then recommended for streamlining the education systems through monolingual ideology. The same politico-ideological structure continued for a long. And even today Nepali is the national language to be used in governance and education, while at the same time the constitution allows other regional or ethnic languages for such purposes as an outcome of democratic political development. It can, in a sense, be understood as an ideological link with the Englishization efforts of many developing countries in the world.

5 Conclusion

This paper discusses the way Nepal has undergone a process of democratizing its macro-policies for the promotion and preservation of its linguistic diversity and provides evidence that such practices have minimal impact on the substantial results due to the processes of glocalization ( Choi 2017 ). The identification of new languages and recognition of multilingualism have been the visible results of democratic governance. However, largely monolingual and bilingual practices in governance, education, and public communication remain rooted in every community throughout the country. Nepal’s language politics has been largely influenced by various political movements and changes in the governments over history. The interviews and the secondary data indicate that Nepal’s language politics has been influenced by globalization and neoliberal impacts which indicate massive language shift and change from minority to the major and dominant languages. It can be concluded that democracy in Nepal functioned as a double-edged sword ( Gautam and Poudel 2021 ), which on the one hand promoted efforts of preservation and promotion of cultural and linguistic diversity, while on the other hand, contributed to clutching the size of diversity by vitalizing Nepali and English relegating the prospective of indigenous languages as pointed out by the informants above in various contexts and the reality of Nepal’s language politics.

The democratic ideology fundamentally borrowed from the Global North had done more justice at the policy level while creating inequalities in the practice, and that consequently made the investments and attempts in promoting linguistic diversity futile. Democracy also promoted monolingual/bilingual ways of thinking about multilingualism, which became counterproductive to the mission of protecting linguistic diversity in Nepal ( Gautam and Poudel 2021 ). Piller’s (2016 : 32) critical understanding of the monolingual ways of seeing multilingualism entails a focus on the product of the monolingual academic texts which was equally applicable in the case of Nepal. The democracy in Nepal did not practically contribute to promoting linguistic diversity though it developed awareness of the linguistic rights of the individuals and communities of minority languages. The state’s intervention to preserve and promote these languages remained inconsistent throughout history, as some governments intentionally discouraged the planned promotion compared to others which designed some measures to promote them. Both monolingual and multilingual ideologies remained as points of debate in political and social spaces in the context of Nepalese society where we can see the conflict among the languages, language users, and policymakers.

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A Survey of Nepali Literature in English: Translated and Original

One of the basic motifs of writing in English from Nepal is to internationalize Nepali literature. Two types of attempts have been apparently made in this direction so far, both of which have their bearing with writing in English. First, there has been a boom of writers writing in English, and second, there have been translations from original Nepali source. The cumulative outputs of the two have been staggering, and the number is on the rise every day. However, the collective dream of the practices to internationalize Nepal through literature has always been thwarted. One of the probable solutions for this might come, if conscious efforts are made to root Nepali literature in unique Nepali experiences and knowledge so that beside delighting as all literatures do, they might open a gateway into a new epistemological territory, which might draw the attention of the world.

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Diversity, Multilingualism and Democratic Practices in Nepal

This paper presents the relationship among Nepal’s linguistic diversity, multilingualism, and democratic practices by bringing into ideas from the global north and global south. The guiding question for exploring this relationship is, “why is Nepal’s linguistic diversity being squeezed despite the formulation of democratic and inclusive language policies that intended to promote multilingualism?”. To investigate this concern, qualitative data were obtained from semi-structured interviews with two purposively selected high-profile people working in the capacity of language policymaking in the state agencies. In Nepal, although democracy promoted awareness towards the issue of language rights and the need of preservation and promotion of minority languages, the narrowing of multilingual diversity continued in practice. This study concluded that democracy allowed neoliberal ideologies to penetrate sociolinguistic spaces and put greater emphasis on English and Nepali. While there is an intertwined relationship between linguistic diversity, democracy, and multilingualism, the ongoing democratic practices have become counterproductive in maintaining the linguistic diversity leading to the marginalization of minority and lesser-known languages. Also, despite ample literature documenting linguistic diversity as a resource and opportunity, the notions of ‘linguistic diversity’ and ‘multilingualism’ were utilized merely as political agendas and issues of critical discourses which have left negligible impact on changing the conventionalized practices of linguistic domination of Nepali and English. Therefore, we question the co-existence of diversity and democracy and claim that democracy alone does not necessarily contribute to the protection of linguistic diversity. In line with this concept, democratic practices could even be counterproductive in the promotion and protection of linguistic diversity. Our findings suggest future interventions about essentializing the use of minority languages in education and governance, alongside democracy providing the fertile grounds for policy pitches to address micro problems in maintaining multilingualism within a democracy.

Introduction

Nepal is a multilingual, multicultural, multiracial, and multi-religious country (Constitution of Nepal 2007 ; 2015 ) situated in the Greater Himalayan Region, the mega center of biodiversity, and home to more than one-sixth of world languages ( Turin 2007 ). The tremendous linguistic diversity, with four major language families namely Indo-Aryan, Tibeto-Burman, Dravidian (Munda), and Austro-Asiatic and one language isolate i.e., Kusunda, is one of the aspects of its national identity. The National Population and Housing Census (Central Bureau of Statistics [ cbs ] 2012 ) records more than 123 languages spoken as mother tongues, with an additional category of “other unknown languages” – with close to half million speakers while as many as 129 languages have also been recorded recently ( Language Commission 2019 ). Despite this huge linguistic and cultural diversity, it has been found that the speakers of traditionally unwritten and increasingly endangered vernacular languages have been shifting towards the regional, national and even international languages that carry relatively better economic benefits, access to education, trade, and participation in mainstream politics. This is understood as an impact of the forces of neoliberal ideologies ( Sharma and Phyak 2017 ). The instance of adoption of Nepali and English as media for education, business, and communication is also reported among ethnic communities instead of using the local languages, especially in urban contexts such as the Kathmandu Valley ( Gautam 2020a ). This trend has contributed to the weakening of the functional status and strength of many ethnic/indigenous languages, igniting several movements initiated by indigenous communities. At the same time, there are mounting challenges for the preservation and promotion of those languages due to both policy and practice lapses at micro levels ( Poudel and Choi 2020 ). Though there are several instances of attempts by national governments and related communities for the promotion and preservation of these languages, these efforts have been found to be inconsistent across history. In that, at various times, some governments have promoted monolingual policies whereas, at other times, some other governments have adopted multilingual policies.

Amidst these attempts, both monolingual and multilingual ideologies emerged to the forefront of the debate concerning whether and how to preserve languages, and how they are negotiated in everyday life as well ( Gynne, Bagga-Gupta and Lainio 2016 ). These ideologies emerged as agendas of political discourse perhaps due to the political parties’ attempts to please as well as empower the communities that have their indigenous and ethnolinguistic identities for political reasons. In this paper, we have explored such issues that have emerged around the values of diversity, democracy, and multilingualism while shaping policymaking processes. In doing so, we assess recent trends on linguistic diversity relating to Nepal’s democratic practices with special reference to its historical dimension drawing on instances from the changing status of languages and diversity, and the linguistic practices therein. We also present our critical evaluation of the current policy based on the analysis of legal and policy documents, and practices based on the analysis of interview data.

Supported by our in-depth exploration of the policies and practices, a study of the relevant literature from the countries in the global south, in-depth interviews with participants, we have identified several issues within the democratic polity that have impacted Nepal’s linguistic diversity in various ways. Finally, some implications have been drawn for future planning directions to enrich and maintain multilingualism within the democratic system in Nepal.

Diversity and Language Vitality in Nepal

Diversity emerges and exists when people from different identity orientations such as races, nationalities, ethnicities, religions, or even philosophies come together to form a community that recognizes and celebrates the values of all backgrounds (also, see Bagga-Gupta and Messina Dahlberg 2018 ). As stated earlier, linguistic, cultural, and ethnic diversity are the essences of Nepalese society, and such diversity characteristics have been existing since the early history of Nepal. All these diversities make up Nepal’s collective multilingual and multicultural identity. The domains of geographical, linguistic, and cultural diversities hold a mutually reinforcing connection among the people in constituting Nepal’s collective identity. Comprising an area of 147,516 square kilometers, 1 with a length of 885 kilometers from east to west and a breadth of 193 kilometers from north to south, Nepal embraces the demographic, cultural and linguistic diversities influenced by people-to-people connection with India on the south and China on the north. Along the three ecological zones, 2 a total of 125 officially recognized ethnic and caste groups reside ( Yadava 2014 ), making this country ethnically and socio-culturally diverse, not only geographically, but also with varied demographic characteristics of the people.

Similarly, Nepal is a “home of 5,400 plus species of higher plants and more than 850 species of birds measuring about 2.2% and 9.4% of the world’s level of biodiversity per unit area matched by a similar rate of linguistic and cultural variation” ( Turin 2007 , 14). This biodiversity, which also links with the social and cultural systems of the communities, contributes to the enrichment of relevant cultural patterns, and enriches the country’s linguistic repertoire. All these species exist through the network of interrelationships in an ecosystem, which also matters for language preservation ( Crystal 2000 ). The diversity of cultural patterns and values also highlight the role of language within. For instance, Crystal (2000, 34) argues that “If the development of multiple cultures is so important then the role of languages becomes critical, for cultures are chiefly transmitted through spoken and written languages”. Although the cultural aspect of diversity is beyond the focus of this paper, it is sensible enough to note that there is an explicit link between language and culture for the very survival of the both, and the ethnic and cultural identity emerge therein. Embracing situated diversity in the national systems is important for Nepal as we see the very identity of this country lies in the same premises. For this, policy provisions in celebrating, preserving, and accommodating diversity and multilingualism have been well articulated in the macro national policies that came out in recent decades ( The Constitution of Nepal 2015 ; National Planning Commission 2013 ). The brief historical account hereafter exemplifies and elaborates on the evolutionary development of such policies in Nepal.

Diversity and Multilingualism in Nepal: A Glimpse of Language Policy

Despite being multicultural and multilingual, Nepal preserved ‘ethnic’, instead of ‘civic’, nationalism in its task of nation-building which has been reflected in various policies from unification movement (1736 ad ) to present time. Following the Gorkha conquest 3 Gorkhali or Khas (now known as Nepali spoken by 44.6% of national population- cbs 2012 ), the language of ruling elites and mother tongue of many people in the Hills, was uplifted as the national official language. After unification, a hegemonic policy in terms of language and culture was formulated which promoted the code (linguistic and dress) of the Hill Brahmins, Chhetries and Thakuris to the ideal national code (i.e., ‘Nepali’ as the national language and ‘Daura Suruwal Topi’ 4 as national dress). This has been interpreted as one of the attempts to promote assimilatory national policy (in terms of language and culture) that contributed to curbing both linguistic and cultural diversity. However, for the rulers then, it was an attempt to establish stronger national identity and integrity. The Rana regime 5 further prolonged this nationalist (i.e., ‘one nation-one language’) policy by uplifting the Nepali language in education and public communication (as the language of wider communication within the territory of Nepal). The Rana, during their rule, suppressed the Newar and Hindi language movements, which served as evidence of their deliberate plan to eliminate all but one language, viz. Nepali. In this sense, we can understand that Nepal’s diversity and multilingual identity were suppressed historically in the name of nation-building and promoting national integration among people with diverse ethnic and cultural orientations.

Following the end of Rana oligarchy in 1950, with the establishment of democracy, some changes were noticed concerning the recognition and mainstreaming of the other ethnic/indigenous languages. This instigated policy changes in terms of language use in education as well. However, the status quo of the Nepali language further strengthened as it was made the prominent language of governance and education. The National Education Planning Commission [ nnepc ] (1956), the first national report on education, basically reflected the ideology of monolingualism with the influence of Hugh. B. Wood (one of the prominent scholars and educationists from the US who worked in India was invited by the Government of Nepal to advise the education policy and planning process). The nnepc recommended the following concerning language stating, “If the younger generation is taught to use Nepali as the basic language then other languages will gradually disappear, the greater the national strength and unity” (Ministry of Education [ moe ] 1956 , 97). Although this report formed the backbone of Nepal’s education system, it also paved the way for minimizing the potential for empowering the languages of the nation. Pradhan (2019, 169) also writes that this commission attempted to “coalesce the ideas of Nepali nationalism around the triumvirate of Nepali language, monarchy and Hindu religion as uniquely Nepali”. The same was reinforced by the K. I. Singh government in 1957 by prescribing Nepali as a medium of instruction in school education.

The Panchayat regime 6 also promoted the use of Nepali as the only language of administration, education, and media in compliance with the Panchayat slogan ‘one language, one dress, one country’ ( eutaa bhasha, eutaa bhesh, eutaa desh ), again providing a favor for the strengthening of the monolingual nationalistic ideology (in other words, the assimilatory policy). Such an ideology can be seen in the report of the All-Round National Education Commission (1961) as well. Not only in education but also in governance, English, or Nepali were made mandatory in recording all documents of companies through the Company Act (1964). Following the Panchayat system, with the restoration of democracy in 1990, the Constitution of Nepal ( 1991 , part 1, article 6.1 and 6.2) provisioned the Nepali language written in Devnagari 7 script as the national language, while also recognizing all the mother tongues as the languages of the nation with their official eligibility as a medium of instruction up to primary education. 8 Similarly, the Interim Constitution of Nepal (2007) , which came as a collective outcome of the Maoist insurgency 9 and Andolan ii (Public movement - ii ) continued to strengthen the Nepali language but ensured (in its part 1, article 5[2]) that each community has the right to get education in their mother tongue and the right to preserve and promote their languages, script, and culture as well.

The recognition of all the mother tongues as the languages of the nation was a progressive step ahead provisioned by the Interim Constitution of Nepal (2007) . Apart from further confirming the right of each community residing in Nepal to preserve and promote its language, script, cultural civility, and heritage, this constitution (Part 3, Article 17) enshrined the right to each community to obtain basic education in their mother tongue as provided for in the law. The same was well-articulated in the Constitution of Nepal (2015) as well, and each state was given the authority to provide one or many languages spoken by the majority population as the official language(s). Along with this provision, the Language Commission was established to study and recommend other matters relating to language (part 1, article 7 of the constitution). However, it can be concluded that these policy provisions that embrace diversity will have less effect if the concerned communities or agencies do not translate them into practice.

This small-scale case study is based on both primary and secondary data sets. The primary data were collected from semi-structured interviews with two purposively selected participants who we identified through our professional networks. The secondary data were obtained from detailed reading of available literature about language policy and planning such as legislative documents, policy papers, and research papers. The two interviewees, Mr Anjan and Mr Akela (pseudonyms used) have extensive work experience in the field of education, governance, constitution-making, and advocacy for language preservation and promotion in Nepal. Anjan and Akela emerge from two different backgrounds. Anjan worked at the Ministry of Education for more than 25 years, studied about multilingual education from a university in Europe as a part of his higher education. While at the ministry, he worked in the capacity of director at central offices such as the Office of the Controller of Examination, Department of Education, Curriculum Development Center, and served in the most influencing decision-making positions in the areas of language and education policy planning in Nepal. On the other hand, Akela worked as a politician and journalist, teacher educator who later joined Radio Nepal, engaged in various cultural advocacy forums of the Communist Party of Nepal, and again moved to politics at the later part of his life. He was an elected member of the parliament in the Constituent Assembly. While Anjan is the native speaker of Nepali, Akela is a native speaker of Bhojpuri and learned Nepali as a second language among other languages such as Hindi, Maithili, English, etc. In that, both individuals are still active in language politics, policy, and planning, however, they are from different socio-cultural, linguistic, and geopolitical backgrounds. We claim that their ideas have made our understanding of linguistic diversity and democracy more enriched and reliable since both have experienced the major political transitions in Nepal and were involved in key policymaking positions. Also, both have been actively engaged in the language policy processes and advocacy. Therefore, our trust in the data obtained from the interviews with them lies in their history, professional background, and engagement.

They were interviewed online, using the Zoom interactive videoconferencing platform. The semi-structured interviews lasted for approximately one hour each. The questions asked were primarily related to the overarching concern “Why is Nepal’s linguistic diversity being squeezed despite the formulation of democratic and inclusive language policies that intended to promote multilingualism? However, several new concerns (e.g., ultranationalism, pragmatic gaps in policy implementation) emerged during the interviews (cf. the findings and discussion below). The interviews were video recorded, they were transcribed verbatim, and the relevant extracts were translated into English (by the authors) and were double-checked for accuracy and reliability. We have analyzed the data without being stuck to any specific theory, but rather with inductively generated themes ( Miles, Huberman, and Saldana 2014 ), and have positioned ourselves on the critical perspectives that challenge the historical and structural practices contributing to the understanding of inequalities and marginalization of the ethnic/indigenous languages. In other words, we looked at the data in reference to our major concern that questions the co-existence of democracy and linguistic diversity in multilingual contexts. We examined the relationship between historically shifting democratic practices and the situated linguistic diversity of Nepal, questioning whether democracy promotes diversity or subdues it. The empirical data have been integrated with the policy information, which facilitated us to generate relevant themes that relate to the focus of the study. Hence, the trichotomy of diversity, democracy, and multilingualism constitutes the backbone of the analytical framework in this paper.

We have taken our positions on the critical theories that challenge the historical and structural practices contributing to the understanding of inequalities and marginalization of the languages. Such practices have been promoted by democracies of various types (usually in the global North and the South) instead of facilitating the promotion of linguistic diversities. Hence the discussion moves around the trichotomy of diversity, democracy, and multilingualism as an analytical framework.

Findings and Discussion

This section presents the findings of the data organized around inductively generated themes presented in subthemes that deal with historicity of language policy, democracy and its impact on diversity, conceptualization of linguistic diversity (e.g., diversity as resources vs diversity as problem), community engagement in promotion and protection of languages, instances of language contact, and impact of global North ideologies on the language policy and practice processes of global South. The findings are also discussed integrating empirical data and the available literature as appropriate.

‘One Nation’ Ideology and Linguistic Diversity

Historically, even before the unification of Nepal, there were several principalities in which the Kings used to speak their languages, and the linguistic diversity was preserved and strengthened”. In a follow-up response to the same query, he claimed, “The geopolitical, historical, socio-political and anthropological history recognized the multilingual social dynamics, however, the national policies after the unification could not embrace such diversity”.

He relates his claim with the inability to embrace diversity as expected within the current political systems and the ideologies of Nepali nationalism and adds that practices of promoting only Nepali language constitute instances of growing ultranationalism. Ultra-nationalism refers to the ideology and the practice of promoting the interest of one state or people in the name of extreme nationalism, with very little or no attention to consolidating democratic institutions ( Irvine 1997 ). Akela emphasizes that the government’s plurilingual policies will not operate as the practice has largely shaped people’s orientation towards Nepali and English, sidelining the regional and local languages. Anjan also expressed a similar perception as, “Though deliberate efforts are made in the policy level to promote the regional/local languages through status planning, there still lies the attitudinal problem which undermines the potential of bringing local languages into practice. Their claims echo discontents expressed by the Language Commission (2019) in its report regarding the failure in translating the national policies that value minority languages into practice, including language use for official as well as educational purposes.

Diversity and Democracy

The Universal Declaration of Human Rights (1948) asserts that democracy assures the basic human right for self-determination and full participation of people in various aspects of their living such as decision-making concerning their language and culture. It also provides them with ways of assuring social benefits such as equal opportunities and social justice (Pillar, 2016). In Nepal, diversity was promoted by democracy through policy provisions, especially after the promulgation of the Constitution of Nepal in 1990 following the Nepali-only monolingual policy of the absolute monarchy (alternatively the Panchayat regime). The basic rights for the use of indigenous languages were assured in the constitution as well as other educational acts formed as outcomes of democratic political turns. The changes in the policy provisions provided opportunities for linguists, language rights activists, and advocacy groups/individuals to explore more about their languages and cultures. Due to their attempts, also supported by the democratic political system, new languages (e.g., Santhali, Bote, Dhimal, etc.) were identified and recognized. For instance, a total of 31 languages were recorded by the National Census in 1991, whereas after the establishment of democracy, the successive censuses in 2001 and 2011 identified a total of 92 and 123 languages respectively ( Yadava 2014 ). Accordingly, to streamline the mother tongue education, as a form of campaign for preservation and promotion of the languages, teaching and learning materials (for up to grade 3) were prepared in more than 22 languages by cdc . However, pragmatic actions remained fragile for mother tongue education up to grade 3 to support the aspiration for promoting diversity. The ineffective implementation (or perhaps a failure) of the state policies to run mother tongue education up to primary level ultimately resulted in constraining multilingualism instead of promoting it. Although the statistical data shows that the number of languages spoken as mother tongues in Nepal is 129 ( Language Commission 2019 ), some scholars still doubt whether these languages functionally exist in reality ( Gautam 2019 ), or if they are there, then the practice may be fragile. This fragile practice in the field can be noted to be influenced by a multitude of factors including lack of community participation, hegemonic attitude of people with power of the dominant languages (e.g., Nepali, Maithili, etc.), and their agency against the minority languages.

Nepal’s participation in the UN organizations and endorsement of most of its declarations compelled Nepal Government to form its domestic policies in line with the commitments made in the international communities to ensure the fundamental concerns of democracy, and that further contributed to creating pressure for right-based policies in Nepal.

Anjan echoed a similar belief saying, “ The recognition of linguistic diversity in the macro policies is the result of democracy” . From the observation of their claims and, also with support from the available literature (e.g., Sonntag 1995 , 2007 ; Pradhan 2019 ; Poudel and Choi 2020 ), it can be strongly claimed that the establishment of multiparty democracy in 1990 in Nepal contributed to the wider recognition of linguistic diversity. Also, “The Nepali-only policy was discarded in favor of an official language policy that recognized Nepal’s linguistic diversity” ( Sonntag 2007 , 205). This informs that the democratic political system that remained open to the neoliberal economy embraced the linguistic diversity as a resource, due to which the multilingual identity of Nepalese society was officially recognized. However, at the same time, this political system could not preserve the minority/indigenous languages as expected, which prompted us to question the co-existence of diversity and democracy. Also, “It is very much a matter of democracy that everyone has the right to language and that society has a common language that everyone can understand and use” (Rosén and Bagga-Gupta 2015, 59). This implies that democratic states (e.g., Nepal, India, Sweden) must address the contradictory discourses of language rights and equity concerns pertaining to language(s) (e.g., Nepali and other indigenous languages). However, the fundamental question still not well-answered, at least in the case of Nepal, is whether democracy can, in a real sense, promote linguistic diversity, or if it narrows down diversity by marginalizing ethnic/minority languages. While responding to this unanswered concern, we have observed that diversity as a resource and diversity as a problem are the two distinct discourses that emerged during the evolutionary process of democracy in Nepal, which was also emphasized by the two participants. Their arguments (see elaboration in 5.3 and 5.4 below) revealed that the two mutually exclusive concerns (diversity as resource vs diversity as problem) parallelly existed in Nepal’s language policy and planning discourse, and they have formed the core of the debate.

Diversity as a Resource

Both informants in this study argued that diversity must be absolutely understood as a resource, very significant for human beings at the global level. Akela claims, If any language of a community dies, the culture and lifestyle of that community disappears, reduces biodiversity, and that ultimately will be a threat to humanity . He understands linguistic diversity as a part of the ecology, and strongly argues that it should be protected. Agnihotri (2017, 185) also echoes a similar belief as Just as biodiversity enriches the life of a forest, linguistic diversity enhances the intellectual well-being of individuals and groups, both small and large . Akela adds, No language should die for our existence as well . Both Akela and Anjan pointed out that the discourse on diversity and multilingualism in Nepal has been strengthened and institutionalized after 1990 when the country entered a multiparty democratic system.

However, Akela thinks that the current legislative provisions have only partially addressed the diversity needs to fit Nepal’s super diverse context. He also points to the influence of the global North in bringing ultranationalist values in Nepal’s policymaking. He does not think that the identity issues raised and addressed through policy processes would make significant differences as they were just brought into the field as agendas of political bargains. He stated, The agendas of identity are just the forked tongues’, translated from [pahichanko sabal ta dekhaune daant matra ho] . He meant that the identity issues have been largely used by the political leaders to deceive the concerned communities for their political benefits. This perception of a political leader, who is also an activist and scholar from the concerned ethnic community is very much meaningful for this study, as it indicates that Nepal’s democratic path initiated a comprehensive discourse for the protection of diversity. However, such discourse has been mostly used for political goals, rather than changing the grass-root practice and engagement of the concerned communities to bring indigenous knowledge and skills into the education systems. However, it has been well-agreed that multilingualism, and variability are constitutive of human existence. We usually engage in the dynamic dialogic interaction to construct our identity within the diversity we have ( Agnihotri 2017 ). Agnihotri (ibid) thinks that the potentiality for multilingualism is innately programmed in human beings, so that linguistic and cultural harmony in our communities can be developed, for which the democratic political system facilitates.

Diversity as a Problem

There is a strong motivation of people towards educating their children in Nepali and English, however they stick to their ethnic languages for communicative purposes. And when there comes the issue of language of the provincial or regional communication, there is a conflict between two of the major regional languages (i.e., Maithili and Bhojpuri).

He sees that such conflicts are due to ideological divides among people themselves. It can, therefore, be observed that this community-level ideology and practice has led to the fragmentation of values associated with their languages, most probably harming the socio-historical harmony among languages.

Nettle (2000, 335) claimed, “Linguistic and ethnic fragmentation relates to low levels of economic development since it is associated with societal divisions and conflict, low mobility, limited trade, imperfect markets, and poor communications in general”. The low levels of societal values and economic development linked with the indigenous languages might have led to intergenerational shifts among the youths of these communities ( Gautam 2019 ). Consequently, this trend has impacted the participation of the relevant communities in campaigns for revitalization of their languages. In addition to this, on the educational dimension of language use, the “schools are often not always aware of the linguistic and cultural wealth they own and could reveal as an important part of their school identities” ( Finkbeiner 2011 , 86). Despite the availability of rich multilingual diversity, the rapid expansion of English medium instruction, irrespective of the local as well as national language, in private and public schools in Nepal is a lively example of how the mother tongues are undervalued. This trend has indirectly contributed to the devaluation of the potential of indigenous language use in education systems in multilingual communities globally.

The Role of Community Participation in Language Preservation and Promotion

In principle, the participatory democracy and the consequential reconciliation often appear to be the only suitable approach ( Agnihotri 2017 ), but in reality, the community participation in the promotion and protection of the indigenous languages is negligible if we take the case of multilingual countries such as Nepal and India. With the utilization of democratic ideals, some communities (e.g., Tamang, Newar, Maithili, Rajbansi, etc.) have made several initiatives but largely in many communities the motivation towards educating their children in their ethnic/indigenous languages is negligible, especially conditioned by the local level policymakers’ inaction (see, Poudel and Choi 2020 ), and their demotivation are influenced by the pedagogical and ideological debates around the discourses on empowering local languages ( Poudel 2019 ). This practice has served the interest of the elites who, with influences from various sectors, would like to homogenize the societies linguistically and culturally, which creates inequalities of various types.

A sense of ownership in the community about keeping their language(s) lively is very significant for the preservation and promotion of both the language and culture. For instance, in Nepal, some languages (e.g., Kusunda, Raute) are endangered as the number of native speakers is declining, and there is a lack of community participation in preserving them. Akala says, “ Unless the community owns it, initiates it, no outsider can feel the language as the native-speakers do. The emic feeling is far stronger than the etic one ”. However, he believes that the cause for diminishing participation of the community in language preservation initiatives is due to the structural constraints that shape people’s mindset towards the preference of either Nepali or English. Rosén and Bagga-Gupta (2013, 70) stated that “It is through participation and interaction that the social structure that forms the practice is (trans)formed and (re)produced”. Both Anjan and Akela believe that the widespread use or practice of Nepali and English in academia, governance and education has contributed to the (re)production of the hegemonic power structure of these languages over the other ethnic/indigenous ones, and this structure has (trans)formed the public understanding that learning in indigenous languages is inferior to the dominant ones (Kansakar, 1996). For them, this trend is a counterproductive outcome of democracy that promoted neoliberal ideas ( Siegel 2006 ) and led the languages into the competitive edge in the societies, which ultimately led to the promotion of the promoted, and suppression of the suppressed in which the “ideological and affective mismatches that arise out of encounters between people with different language socialization experiences” ( Fujita 2010 , 38) were observed. The data also pointed to the impacts of global North ideologies (for instance, the inclusive democratic ideas) on the discourses of multilingualism of the global South.

Ideological Construction of the Global North and Impacts on Global South

Nepal’s growing engagement with the international community (through its membership in the UN, wto , imf , etc.), and its political systems have largely influenced attitudinal patterns in Nepalese society. From a geopolitical perspective, Nepal is sandwiched between two giant countries India and China, and the changes in the neighborhood would influence it on a larger scale. Besides, the development in the global North would always have a chain effect in the countries of the global South. For instance, the British colonial government of India then promoted English amidst other languages, and a similar trend emerged in Nepal with the effect of the environment in the neighborhood. Such geopolitical conditions and the waves gravely influenced the closely related communities to the development of nationalism and the creation of nation-states, including a new Europe perceived as superior to other parts of the world ( Bagga-Gupta 2010 ; Gal and Irvine 1995 ; Rosen and Bagga-Gupta 2013 ; Shohamy 2006 ). The ideologies of the countries of the global North have influenced the countries of the global South in many ways, including ideologies of language planning and policy. This has generated a perception and a social space that differentiates ‘us and the other’ through the formation of linguistic-cultural ideologies ( Gynne, Bagga-Gupta and Lainio 2016 ) or creating linguistic imageries constitutive of cultural tools ( Bagga-Gupta and Rao 2018 ) in the communities that have multiple languages in place that ultimately impact relevant social actions. This made some languages valued more than others in the domains of governance and educational spaces ( Poudel and Choi 2020 ; Poudel 2010 ). In the case of Nepal, the first educational commission was influenced by Huge. B. Wood’s ideologies formed out of his involvement in Indian and the western world, and the committee under his leadership had huge influence in collaboration with academia and politicians then recommended for streamlining the education systems through a monolingual ideology. Awasthi (2008) also noted that the ideologies constructed by the Macaulay Minutes (1835) in India had an invisible effect in Nepal’s language policymaking, especially reflected in the nnepc report prepared with the contribution of Mr. Wood. The same ideological structure continued for long, and even today with maintaining Nepali as the national language to be used in governance and education ( Sharma 1986 ), while at the same time allowing other regional or ethnic languages for such purposes as an outcome of democratic political development. It can be understood as having an ideological link with the “Englishization” efforts of many countries in the global North, reflected in nnepc and the reports afterward. In this way, it is not unfair to claim that the ideologies of the global North impacted the linguistic, cultural, and economic systems of countries in the global South (e.g., India, Nepal, etc.).

In addition to that, “the international political-economic structure seems stacked against a substantial or near future diminishment of the north-south gap” (Thompson and Reuveny 2010: 66). The neoliberal trends that emerged from the global North have travelled to the global South, impacting the global-south countries through the language and culture of the former. The unprecedented expansion of English as a global phenomenon ( Dearden 2014 ) can be a living example of such an effect. The advancement in technology and the increasing use of English as the dominant language of that domain further brought the global North and South together, influencing each other. As a result, the language also became one of the aspects of the north-south political economy. It involved various combinations of developmental states recapturing domestic markets from foreign exporters (import substitution) and the recapture of domestic business (nationalization). The outcome, aided by investments in education, was a new elite of technical managers and professionals who could build on historical experience and opportunities through the commodification of the English language.

Besides, the technology sharing, migration and demographic changes have had variable impacts on the north-south gap. For instance, Nepali youths’ labor migration and their English preference have also impacted the “generational shifts in languages” ( Gautam 2020a , 140). The youths’ migration to the countries in the Middle East and their participation in the global marketplaces in the global North countries have contributed to reshaping of their ideologies towards the home languages and English. Anjan’s statement, “ We have made whimsical choices in our social and education systems, (e.g., choice of language for education) and are even lured by the ideologies formed even by our immigrant population usually in the western world” . Among many, this can be understood as one of the causes for accentuated divergent tendencies in language shifts, usually from the indigenous and national languages to English. Similar cases were reported in the countries of globalized economies as well. For instance, in Singapore, Lakshmi (2016, 229) concluded “Despite governmental and community efforts to support Tamil maintenance in Singapore, census and school data show a decrease in the number of Indian families using Tamil as the predominant home language”, and perhaps this is an instance of a generalizable scenario of squeezing multilingualism in the micro level.

Multilingualism and Language Contact as an Outcome of Democracy

Multilingualism is a defining feature of intricate social and cultural practices ( Lafkioui 2013 ), and it is influenced gravely by the dynamic social, cultural, and political processes such as migration, social movements, and mobility in any society. For instance, the global impact of migration entailed language contact in multilingual countries ( Gautam 2020a , 2021 ), and this was evidenced in various communities across Nepal. Multilingual diversity has also been threatened by such processes, as the language choices have been more constrained due to limited linguistic competencies and interactive skills among the migrants as members of the community. It is also possible that the more intense the migration, the more homogeneity in language use emerges. Highly migrant communities (usually in the urban spaces) attempt to develop a shared linguistic and cultural identity through increasingly engaging in the construction of new normal patterns of shared beliefs and values.

Languages are a treasure trove of literature, philosophy, and worldviews, and the loss of languages will have a huge intellectual catastrophe ( Abbi 2017 ). The protection of 6000 plus languages in the world has been a big challenge as estimates have shown a language dies every fortnight on this planet (ibid). This global problem has affected Nepal’s linguistic diversity as well in an unprecedented way. Regmi (2017) writes that nearly 44% of languages are safe, and the rest of the 56% languages are broadly labelled as threatened and shifting, and this trend has been growing. Also, most of the Nepalese minority language speaking communities have been influenced by the impact of cross-border links through media, marriage, migration (M3s) in the city areas ( Gautam 2018 , 2020a ), and these trends have intensified the trend of language contacts among the dominant ones further reducing the functional values of the minority languages. Due to this, the multilingual arenas turned to be more complex zones for incidences of contacts across local, national, and international languages reproducing the dominance of the dominating languages. The strongest impact of language contact on multilingualism in Nepal can be observed after the 1990s that increased people’s participation in social spaces in inclusive democratic processes. The “Nepali-only policy of the absolute monarchy was discarded in favor of an official language policy that recognized Nepal’s linguistic diversity” ( Sonntag 2007 , 205). On top of that, the impact of the Maoist revolution (1996–2006) brought lots of social and cultural changes in Nepalese multilingualism. Many ethnic communities were displaced from their original homelands to the capital city, and other urban contexts because of political pressure from the agitating parties then. Hence, the urban contexts such as Kathmandu (largely Newar speaking area), Pokhara (Gurung and Magar speaking area), Nepalgunj (Tharu speaking area), Kapilvastu (Awadhi speaking area), etc. were established as zones for the increasing trend of language contacts as people from various remote villages hurled to these cities for opportunities of education, employment, and business. Nowadays, people have gradually well-assimilated with the dominant language and cultural values developing complex social zones for language contact activities.

The consequences of such contacts which are further triggered by democratic political processes, are multifaceted. One of the major effects is the shift of such minority languages and their cultures towards assimilation into the dominant ones. Such assimilation has led to erasing of the indigenous languages and cultures, not even leaving linguistic marks of some dead languages for the future generations. This, as one of the reasons for the inter-generational shift, was reported by our participants as well. Gautam (2020b, 204) claims, “The young generations are not very much interested about the role of language in community rather they are more concerned about globalization and the economic activities” Similarly, Anjan says, “ The contemporary generation of parents and their children do not value their ethnic language on the economic grounds, and that has impacted the way they make language choices at home and in schools ”. Indirectly, he pointed towards the increasing trend of educating in English medium. This shift has impacted the policymaking process regarding language use in education as well ( Poudel and Choi 2020 ), because the relevant policymaking bodies did not end up with strong resolutions to use the already minoritized local languages in education and governance.

Conclusion and Implications

In this paper, we discussed the way that a democratic country (here, Nepal) has undergone through a process of democratizing its macro policies for the promotion and preservation of its linguistic diversity, which provided shreds of evidence that such practices have minimal impact on the substantial results due to the processes of glocalization ( Choi 2017 ). The identification of new languages and recognition of multilingualism through scheduling of these languages in the constitution have been the visible results of democratic governance. However, largely mono and/or bilingual practices in governance, education, and public communication show that the promises of the constitution have not materialized as yet. Based on the analysis of the data, we conclude that democracy in Nepal functioned as a “double-edged sword”, which on the one hand promoted efforts of preservation and promotion of linguistic diversity, while on the other hand, contributed to constraining the size of diversity by vitalizing mainly Nepali and English, sidelining the potential of indigenous languages. Such a role of democracy promoted the ethnic and indigenous communities’ active engagement in reacting against the macro policies pertaining to languages. This issue was also used as an agenda of political gains but with very little or nil impact on the ongoing practices within their own linguistic and cultural communities. The democratic ideology fundamentally borrowed from the global North had done more justice at the macro policy level but created inequalities and injustices in practices at the micro level, and that consequently turned the investments and attempts in promoting linguistic diversity futile.

Our conclusion implies that in Nepal democracy promoted monolingual/bilingual ways of thinking about multilingualism, which became counterproductive to the mission of protecting linguistic diversity. Here, our understanding adheres to Pillar’s (2016, 32) critical claim that “The monolingual ways of seeing multilingualism entails a focus on the product of the monolingual academic texts”. In other words, democracy did not practically contribute to promoting linguistic diversity though it developed awareness of the linguistic rights of the individuals and communities of minority languages. During the democratic evolutions, the state intervention to preserve and promote these languages remained inconsistent, as some governments intentionally discouraged the planned promotion compared to others. Although monolingual and multilingual ideologies were debated in political and social spaces, the substantial effects of such debates in transforming current practices are yet to be materialized. We also claim that, owing to the uniquely complex nature of Nepal’s linguistic and demographic diversity, the ideal policies, especially those related to linguistic diversity and multilingualism, developed outside of Nepal are likely to be ineffective or perhaps will have counterproductive effects. This rightly informs of the fact that the governmental systems need to develop all-inclusive policies that adhere to Nepal’s unique situation and translate into observable practices to fundamentally change the current situation of diminishing linguistic diversity.

The conclusion of this paper also implies that democratic political system alone will not be sufficient to promote diversity, unless the relevant communities proactively engage in localized policymaking, valuing their own cultures and languages, and link them with the peripheral world. Despite the increasing awareness of the indigenous identity and rights among people including those from the concerned communities, the streamlined long-term visions in changing the practice are essential to utilize the democratic political systems in protecting and promoting multilingual diversity. We also appeal to the reassessment of the investments (or probably the wasteful investments) in the name of promoting multilingualism in the case of Nepal, as all the efforts made for this, or with this agenda, have proved to be less effective to materialize the very mission of protecting and promoting diversity and multilingualism. Hence, we suggest for a planned intervention in changing the practice at the local governmental level to build collective strength to promote ethnic/indigenous languages in wider use, including their socio-cultural and economic values so that the current and the future generation can feel assured that they can survive out of the learning of local/ethnic languages. Although in this paper, we explored the case of Nepal, our conclusions are informative to the other similar contexts globally where minority languages are endangered due to less supportive political systems where the ethnic minority communities are struggling hard to revive them back.

Acknowledgments

We express our deep sense of gratitude to the informants of this study for their trust in us, and the great sharing based on our queries, despite their very busy schedule at the time of crisis due to Covid-19 lockdown in Nepal. At the same time, we acknowledge all the scholars whose works have been cited in the paper.

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Agnihotri , Rama Kant. 2017 . “ Identity and Multilinguality: The Case of India ”. In: Language Policy, Culture, and Identity in Asian Contexts ”, edited by A. M. Tsui and J. W. Tollefson , (Pp. 185 – 204 ). London : Routledge .

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A typical Nepali dress promoted as the identity of Nepalese people, and so is established as the formal dress code for official functions.

The Rana Oligarchy, in which Ranas ruled the country for 103 years in Nepal between 1846 and 1951.

The Panchayat regime ruled Nepal since 1961 to 1990.

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Esikai Portal Nepal

Download here, कार्यमूलक अनुसन्धान : नमुना एक.

1. Background - During my past two years of teaching, there have been many challenges that I have encountered, from learning a new school system, materials, and strategies for learning the structure and regimentation through my own personal experience. The one thing that I have found to be the most challenging though is finding my own individual teaching style and structure for making classroom more interactive in a trial and error process. Most Nepalese students especially from the government aided schools are usually found to be quiet in the English classroom, as they have a little experience in classroom interaction with the teacher. Traditionally Nepalese classrooms are dominated by the lecture method that does not encourage students to participate in the classroom activities. The other reason behind the students’ inactivity is the poor English background and lack of exposure in English in the lower level. So, teaching English with students interaction is quite challenging. This paper, employing action research, attempts to explore this problem and suggests some possible ways to create a more interactive classroom.

2. Class Description - The class observed was a group of 42 students of class-9 section (B) at Saraswoti Higher Secondary School , G.M.N-7, Ahale ,Gorkha. The level of the students in the class was beginners or under-intermediate. The students were from the heterogeneous backgrounds in regard of their social, economic, cultural as well as cognitive aspects. Out of 42 students, the teacher was a student-teacher with several years teaching experience at secondary level. The goal of this required class is to teach the students reading and writing skills aloud including listening when the teacher reads the passage.

3. Problems Identification and Investigation - The students, as a class, don't respond voluntarily to the teacher's questions and do not participate in class discussions. Students never ask the questions to the teacher outside one-on-one situations. Thus, the teacher receives little oral feedback. According to the teacher “Most of the class members sit looking straight ahead using minimal facial expressions, gestures and verbal utterances. What I want is for the students to be more demonstrative and more overtly communicative in their feedback. I want these behaviors: I want the students to ask questions, make comments and to respond with nods and shakes of the head, with sounds of agreement or sounds of understanding. Also, I want them to be both reactive and proactive.” Despite the teacher's several attempts, the students don't seem responsive and interested in the teaching as well. Few of them try to respond in Nepali in submissive manner. Very few of them seem attentive but cannot respond to the teacher's questions; neither they ask any questions to the teacher about anything nor answer properly. The teacher's class was first observed in the third week of the first term. In the first 25 minutes, the class went through reading passage.

The students first listened to the teacher read and explain the text to the students with their books in their hands, then the students read the text silently themselves. Then the teacher asked them whether they understood anything or not, but nobody responded. Next 15 minutes, the teacher went through the text explaining the new word meanings to the students so that they could understand better and respond to him. He asked the following questions to them based on the text: T: Any questions? Do you understand everything? Ss: Š(no one responds)T: Okay, how many people were quarrelling? Ss: Š(no response)T: How many people were quarrelling? Ss: Š(no response)T: There were three. Three people. Were they friends or strangers? Ss: Š(no response)Š The teacher asked a few other questions which also drew no response or reaction from the students. The students, then, had to write the answers of some questions about the text in their book according to the teacher's instruction. Most of the students seemed to have much trouble doing this, and if there were any questions, they readily seemed to ask few things the friends sitting next to them but didn't drew any meaningful result.

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Abstract: This work introduces an efficient method to scale Transformer-based Large Language Models (LLMs) to infinitely long inputs with bounded memory and computation. A key component in our proposed approach is a new attention technique dubbed Infini-attention. The Infini-attention incorporates a compressive memory into the vanilla attention mechanism and builds in both masked local attention and long-term linear attention mechanisms in a single Transformer block. We demonstrate the effectiveness of our approach on long-context language modeling benchmarks, 1M sequence length passkey context block retrieval and 500K length book summarization tasks with 1B and 8B LLMs. Our approach introduces minimal bounded memory parameters and enables fast streaming inference for LLMs.

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Recent Developments in Machine Learning and Data Analytics pp 229–247 Cite as

Parsing in Nepali Language Using Linear Programming Problem

Archit Yajnik 18 ,
Furkim Bhutia 18 &
Samarjeet Borah 18
Conference paper
First Online: 12 September 2018

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Part of the book series: Advances in Intelligent Systems and Computing ((AISC,volume 740))

Linear Programming Problem (LPP) is one of the powerful techniques for parsing in terms of NLP. Various works are available in the literature using optimization and soft computing techniques. In this paper, the emphasis is given on the fundamental technique of optimization, i.e., simplex method by which the parsing evolves. First, the input is tested with the Big M Method (Penalty approach). Second, the same input is fed to the two-phase simplex method. The concept is tested theoretically using integer programing problem yielding desired results. The test is conducted for ten annotated sentences in Nepali language and observed that two-phase simplex method is found to be the better one.

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Acknowledgements

This work is a part of DST-CSRI, Ministry of Science & Technology, Government of India funded project on Study and Develop A Natural Language Parser for Nepali Language (vide sanction order SR/CSRI/28/2015 dated 28-Nov-2015).

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Yajnik, A., Bhutia, F., Borah, S. (2019). Parsing in Nepali Language Using Linear Programming Problem. In: Kalita, J., Balas, V., Borah, S., Pradhan, R. (eds) Recent Developments in Machine Learning and Data Analytics. Advances in Intelligent Systems and Computing, vol 740. Springer, Singapore. https://doi.org/10.1007/978-981-13-1280-9_23

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Published on 17.4.2024 in Vol 26 (2024)

Service Quality and Residents’ Preferences for Facilitated Self-Service Fundus Disease Screening: Cross-Sectional Study

Authors of this article:

Original Paper

Senlin Lin 1, 2, 3 * , MSc ;
Yingyan Ma 1, 2, 3, 4 * , PhD ;
Yanwei Jiang 5 * , MPH ;
Wenwen Li 6 , PhD ;
Yajun Peng 1, 2, 3 , BA ;
Tao Yu 1, 2, 3 , BA ;
Yi Xu 1, 2, 3 , MD ;
Jianfeng Zhu 1, 2, 3 , MD ;
Lina Lu 1, 2, 3 , MPH ;
Haidong Zou 1, 2, 3, 4 , MD

1 Shanghai Eye Diseases Prevention &Treatment Center/ Shanghai Eye Hospital, School of Medicine, Tongji University, Shanghai, China

2 National Clinical Research Center for Eye Diseases, Shanghai, China

3 Shanghai Engineering Research Center of Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China

4 Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

5 Shanghai Hongkou Center for Disease Control and Prevention, Shanghai, China

6 School of Management, Fudan University, Shanghai, China

*these authors contributed equally

Corresponding Author:

Haidong Zou, MD

Shanghai Eye Diseases Prevention &Treatment Center/ Shanghai Eye Hospital

School of Medicine

Tongji University

No 1440, Hongqqiao Road

Shanghai, 200336

Phone: 86 02162539696

Email: [email protected]

Background: Fundus photography is the most important examination in eye disease screening. A facilitated self-service eye screening pattern based on the fully automatic fundus camera was developed in 2022 in Shanghai, China; it may help solve the problem of insufficient human resources in primary health care institutions. However, the service quality and residents’ preference for this new pattern are unclear.

Objective: This study aimed to compare the service quality and residents’ preferences between facilitated self-service eye screening and traditional manual screening and to explore the relationships between the screening service’s quality and residents’ preferences.

Methods: We conducted a cross-sectional study in Shanghai, China. Residents who underwent facilitated self-service fundus disease screening at one of the screening sites were assigned to the exposure group; those who were screened with a traditional fundus camera operated by an optometrist at an adjacent site comprised the control group. The primary outcome was the screening service quality, including effectiveness (image quality and screening efficiency), physiological discomfort, safety, convenience, and trustworthiness. The secondary outcome was the participants’ preferences. Differences in service quality and the participants’ preferences between the 2 groups were compared using chi-square tests separately. Subgroup analyses for exploring the relationships between the screening service’s quality and residents’ preference were conducted using generalized logit models.

Results: A total of 358 residents enrolled; among them, 176 (49.16%) were included in the exposure group and the remaining 182 (50.84%) in the control group. Residents’ basic characteristics were balanced between the 2 groups. There was no significant difference in service quality between the 2 groups (image quality pass rate: P =.79; average screening time: P =.57; no physiological discomfort rate: P =.92; safety rate: P =.78; convenience rate: P =.95; trustworthiness rate: P =.20). However, the proportion of participants who were willing to use the same technology for their next screening was significantly lower in the exposure group than in the control group ( P <.001). Subgroup analyses suggest that distrust in the facilitated self-service eye screening might increase the probability of refusal to undergo screening ( P =.02).

Conclusions: This study confirms that the facilitated self-service fundus disease screening pattern could achieve good service quality. However, it was difficult to reverse residents’ preferences for manual screening in a short period, especially when the original manual service was already excellent. Therefore, the digital transformation of health care must be cautious. We suggest that attention be paid to the residents’ individual needs. More efficient man-machine collaboration and personalized health management solutions based on large language models are both needed.

Introduction

Vision impairment and blindness are caused by a variety of eye diseases, including cataracts, glaucoma, uncorrected refractive error, age-related macular degeneration, diabetic retinopathy, and other eye diseases [ 1 ]. They not only reduce economic productivity but also harm the quality of life and increase mortality [ 2 - 6 ]. In 2020, an estimated 43.3 million individuals were blind, and 1.06 billion individuals aged 50 years and older had distance or near vision impairment [ 7 ]. With an increase in the aging population, the number of individuals affected by vision loss has increased substantially [ 1 ].

High-quality public health care for eye disease prevention, such as effective screening, can assist in eliminating approximately 57% of all blindness cases [ 8 ]. Digital technologies, such as telemedicine, 5G telecommunications, the Internet of Things, and artificial intelligence (AI), have provided the potential to improve the accessibility, availability, and productivity of existing resources and the overall efficiency of eye care services [ 9 , 10 ]. The use of digital technology not only reduces the cost of eye disease screening and improves its efficiency, but also assists residents living in remote areas to gain access to eye disease screening [ 11 - 13 ]. Therefore, an increasing number of countries (or regions) are attempting to establish eye screening systems based on digital technology [ 9 ].

Fundus photography is the most important examination in eye disease screening because the vast majority of diagnoses of blinding retinal diseases are based on fundus photographs. Diagnoses can be made by human experts or AI software. However, traditional fundus cameras must be operated by optometrists, who are usually in short supply in primary health care institutions when faced with the large demand for screening services.

Fortunately, the fully automatic fundus camera has been developed on the basis of digital technologies including AI, industrial automation, sensors, and voice navigation. It can automatically identify the person’s left and right eyes, search for pupils, adjust the lens position and shooting focus, and provide real-time voice feedback during the process, helping the residents to understand the current inspection steps clearly and cooperatively complete the inspection. Therefore, a facilitated self-service eye screening pattern has been newly established in 2022 in Shanghai, China.

However, evidence is inadequate about whether this new screening pattern performs well and whether the residents prefer it. Therefore, this cross-sectional study aims to compare the service quality and residents’ preferences of this new screening pattern with that of the traditional screening pattern. We aimed to (1) investigate whether the facilitated self-service eye screening can achieve service quality similar to that of traditional manual screening, (2) compare residents’ preferences between the facilitated self-service eye screening and traditional manual screening, and (3) explore the relationship between the screening service quality and residents’ preferences.

Study Setting

This study was conducted in Shanghai, China, in 2022. Since 2010, Shanghai has conducted an active community-based fundus disease telemedicine screening program. After 2018, an AI model was adopted ( Figure 1 ). At the end of 2021, the fully automatic fundus camera was adopted, and the facilitated self-service fundus disease screening pattern was established ( Figure 1 ). Within this new pattern, residents could perform fundus photography by themselves without professionals’ assistance ( Multimedia Appendix 1 ). The fundus images were sent to the cloud server center of the AI model, and the screening results were fed back immediately.

Study Design

We conducted a cross-sectional study at 2 adjacent screening sites. These 2 sites were expected to be very similar in terms of their socioeconomic and educational aspects since they were located next to each other. One site provided facilitated self-service fundus disease screening, and the residents who participated therein comprised the exposure group; the other site provided screening with a traditional fundus camera operated by an optometrist, and the residents who participated therein comprised the control group. All the adult residents could participant in our screening program, but their data were used for analysis only if they signed the informed consent form. Residents could opt out of the study at any time during the screening.

In the exposure group, the residents were assessed using an updated version of the nonmydriatic fundus camera Kestrel 3100m (Shanghai Top View Industrial Co Ltd) with a self-service module. In the process of fundus photography, the residents pressed the “Start” button by themselves. All checking steps (including focusing, shooting, and image quality review) were undertaken automatically by the fundus camera ( Figure 2 ). Screening data were transmitted to the AI algorithm on a cloud-based server center through the telemedicine platform, and the screening results were fed back immediately. Residents were fully informed that the assessment was fully automated and not performed by the optometrist.

In the control group, the residents were assessed using the basic version of the same nonmydriatic fundus camera. The optical components were identical to those in the exposure group but without the self-service module. In the process of fundus photography, all steps were carried out by the optometrist (including focusing, shooting, and image quality review). Screening data were transmitted to the AI algorithm on a cloud-based server center through the telemedicine platform, and the screening results were fed back immediately. Residents were also fully informed.

Measures and Outcomes

The primary outcome was the screening service’s quality. Based on the World Health Organization’s recommendations for the evaluation of AI-based medical devices [ 14 ] and the European Union’s Assessment List for Trustworthy Artificial Intelligence [ 15 ], 5 dimensions were selected to reflect the service quality of eye disease screening: effectiveness, physiological discomfort, safety, convenience, and trustworthiness.

Furthermore, effectiveness was based on 2 indicators: image quality and screening efficiency. A staff member recorded the time required for each resident to take fundus photographs (excluding the time taken for diagnosis) at the screening site. Then, a professional ophthalmologist evaluated the quality of each fundus photograph after the on-site experiment. The ophthalmologist was blinded to the grouping of participants. Image quality was assessed on the basis of the image quality pass rate, expressed as the number of eyes with high-quality fundus images per 100 eyes. Screening efficiency was assessed on the basis of the average screening time, expressed as the mean of the time required for each resident to take fundus photographs.

To assess physiological discomfort, safety, convenience, and trustworthiness of screening services, residents were asked to finish a questionnaire just after they received the screening results. A 5-point Likert scale was adopted for each dimension, from the best to the worst, except for the physiological discomfort ( Multimedia Appendix 2 ). A no physiological discomfort rate was expressed as the number of residents who chose the “There is no physiological discomfort during the screening” per 100 individuals in each group. Safety rate is expressed as the number of residents who chose “The screening is very safe” or “The screening is safe” per 100 individuals in each group. Convenience rate is expressed as the number of residents who chose “The screening is very convenient” or “The screening is convenient” per 100 individuals in each group. The trustworthiness rate is expressed as the number of residents who chose “The screening result is very trustworthy” or “The screening result is trustworthy” per 100 individuals in each group.

The secondary outcome was the preference rate, expressed as the number of residents who were willing to use the same technology for their next screening per 100 individuals. In detail, in the exposure group, the preference rate was expressed as the number of the residents who preferred facilitated self-service eye screening per 100 individuals, while in the control group, it was expressed as the number of residents who preferred traditional manual screening per 100 individuals.

To understand the residents’ preference, a video displaying the processes of both facilitated self-service eye screening and traditional manual screening was shown to the residents. Then, the following question was asked: “At your next eye disease screening, you can choose either facilitated self-service eye screening or traditional manual screening. Which one do you prefer?” A total of 4 alternatives were set: “Prefer traditional manual screening,” “Prefer facilitated self-service eye screening,” “Both are acceptable,” and “Neither is acceptable (Refusal of screening).” Each resident could choose only 1 option, which best reflected their preference.

Sample Size

The rule of events per variable was used for sample size estimation. In this study, 2 logit models were established for the 2 groups separately, each containing 8 independent variables. We set 10 events per variable in general. According to a previous study [ 16 ], when the decision-making process had high uncertainty, the proportion of individuals who preferred the algorithms was about 50%. This led us to arrive at a sample size of 160 (8 variables multiplied by 10 events each, with 50% of individuals potentially preferring facilitated screening [ie, 50% of 8×10]) for each group.

Every dimension of the screening service quality and the preference rate were calculated separately. Chi-square and t tests were used to test whether the service quality or the residents’ preferences differed between the 2 groups. A total of 7 hypotheses were tested, as shown in Textbox 1 .

H1: image quality pass rate exposure group ≠ image quality pass rate control group H0: image quality pass rate exposure group =image quality pass rate control group
H1: screening time exposure group ≠screening time control group H0: screening time exposure group =screening time control group
H1: no discomfort rate exposure group ≠no discomfort rate control group H0: no discomfort rate exposure group = no discomfort rate control group
H1: safety rate exposure group ≠safety rate control group H0: safety rate exposure group = safety rate control group
H1: convenience rate exposure group ≠convenience rate control group H0: convenience rate exposure group = convenience rate control group
H1: trustworthiness rate exposure group ≠trustworthiness rate control group H0: trustworthiness rate exposure group = trustworthiness rate control group
H1: preference rate exposure group ≠preference rate control group H0: preference rate exposure group = preference rate control group

If any of the hypotheses among hypotheses 1-6 ( Textbox 1 ) were significant, it indicated that the service quality was different between facilitated self-service eye screening and traditional manual screening. If hypothesis 7 was significant, it meant that the residents’ preference for facilitated self-service eye screening was different from that for traditional manual screening.

Additionally, subgroup analyses in the exposure and control groups were conducted to explore the relationships between the screening service quality and the residents’ preferences, using generalized logit models. The option “Prefer facilitated self-service eye screening” was used as the reference level for the dependent variable in the models. The independent variables included age, sex, image quality, screening efficiency, physiological discomfort, safety, convenience, and trustworthiness. All statistics were performed using SAS (version 9.4; SAS Institute).

Ethical Considerations

The study adhered to the ethical principles of the Declaration of Helsinki and was approved by the Shanghai General Hospital Ethics Committee (2022SQ272). All participants provided written informed consent before participating in this study. The study data were anonymous, and no identification of individual participants in any images of the manuscript or supplementary material is possible.

Participants’ Characteristics

A total of 358 residents enrolled; among them, 176 (49.16%) were in the exposure group and the remaining 182 (50.84%) were in the control group. Residents’ basic characteristics were balanced between the 2 groups. The mean age was 65.05 (SD 12.28) years for the exposure group and 63.96 (SD 13.06) years for the control group; however, this difference was nonsignificant ( P =.42). The proportion of women was 67.05% (n=118) for the exposure group and 62.09% (n=113) for the control group; this difference was also nonsignificant between the 2 groups ( P =.33).

Screening Service Quality

In the exposure group, high-quality fundus images were obtained for 268 out of 352 eyes (image quality pass rate=76.14%; Figure 3 ). The average screening time was 81.03 (SD 36.98) seconds ( Figure 3 ). In the control group, high-quality fundus images were obtained for 274 out of 364 eyes (image quality pass rate=75.27%; Figure 3 ). The average screening time was 78.22 (SD 54.01) seconds ( Figure 3 ). There was no significant difference in the image quality pass rate ( χ 2 1 =0.07, P =.79) and average screening time ( t 321.01 =–0.58 [Welch–Satterthwaite–adjusted df ], P =.56) between the 2 groups ( Figure 3 ).

For the other dimensions, detailed information is shown in Figure 3 . There were no significant differences between any of these rates between the 2 groups (no physiological discomfort rate: χ 2 1 =0.01, P =.92; safety rate: χ 2 1 =0.08, P =.78; convenience rate: χ 2 1 =0.004, P =.95; trustworthiness rate: χ 2 1 =1.63, P =.20).

Residents’ Preferences

In the exposure group, 120 (68.18%) residents preferred traditional manual screening, 19 (10.80%) preferred facilitated self-service eye screening, 19 (10.80%) preferred both, and the remaining 18 (10.23%) preferred neither. In the control group, 123 (67.58%) residents preferred traditional manual screening, 14 (7.69%) preferred facilitated self-service eye screening, 20 (10.99%) preferred both, and the remaining 25 (13.74%) preferred neither.

The proportion of residents who chose the category “Prefer facilitated self-service eye screening” in the exposure group was significantly lower than that of residents who chose the category “Prefer traditional manual screening” in the control group ( χ 2 1 =120.57, P <.001; Figure 3 ).

Subgroup Analyses

In the exposure group, 4 generalized logit models were generated ( Table 1 ). Regarding the effectiveness of facilitated self-service eye screening, neither the image quality nor the screening time had an impact on the residents’ preferences. Regarding the other dimensions for facilitated self-service eye screening service quality, models 3 and 4 demonstrated that distrust in the results of facilitated self-service eye screening might decrease the probability of preferring this screening service and increase the probability of preferring neither of the 2 screening services.

a Age and gender were adjusted in model 1. Age, gender, image quality, and screening efficiency were adjusted in model 2. Age, gender, physiological discomfort, safety, convenience, and trustworthiness were adjusted in model 3. Age, gender, image quality, screening efficiency, physiological discomfort, safety, convenience, and trustworthiness were adjusted in model 4.

b In the exposure group, distrust in the results of facilitated self-service eye screening might decrease the probability of preferring this screening service and increase the probability of preferring neither the traditional nor the facilitated self-service screening services.

c Not available.

In the control group, another 4 generalized logit models were generated ( Table 2 ). Men were more likely to choose a preference both screening services. The probability of preferring manual screening might increase with age, as long as the probability of preferring facilitated self-service eye screening decreased. Regarding the effectiveness of traditional manual screening, neither the image quality pass rate nor the screening time had an impact on the residents’ preferences. For the other dimensions of the quality of traditional manual screening, models 7 and 8 showed that if the residents feel unsafe about traditional manual screening, their preference for traditional manual screening might decrease, and they might turn to facilitated self-service eye screening.

a Age and gender were adjusted in model 5. Age, gender, image quality, and screening efficiency were adjusted in model 6. Age, gender, physiological discomfort, safety, convenience, and trustworthiness were adjusted in model 7. Age, gender, image quality, screening efficiency, physiological discomfort, safety, convenience, and trustworthiness were adjusted in model 8.

b In the control group, if the residents feel unsafe about traditional manual screening, their preference for traditional manual screening might decrease, and they might turn to facilitated self-service eye screening.

A new fundus disease screening pattern was established using the fully automatic fundus camera without any manual intervention. Our findings suggest that facilitated self-service eye screening can achieve a service quality similar to that of traditional manual screening. The study further evaluated the residents’ preferences and associated factors for the newly established self-service fundus disease screening. Our study found that the residents’ preference for facilitated self-service eye screening is significantly less than that for traditional manual screening. This implies that the association between the service quality of the screening technology and residents’ preferences was weak, suggesting that aversion to the algorithm might exist. In addition, the subgroup analyses suggest that even the high quality of facilitated self-service eye screening cannot increase the residents’ preference for this new screening pattern. Worse still, distrust in the results of this new pattern may lead to lower usage of eye disease screening services as a whole. To the best of our knowledge, this study is one of the first to evaluate service quality and residents’ preferences for facilitated self-service fundus disease screening.

Previous studies have suggested that people significantly prefer manual services to algorithms in the field of medicine [ 16 - 18 ]. Individuals have an aversion to algorithms underlying digital technology, especially when they see errors in the algorithm’s functioning [ 18 ]. The preference for algorithms does not increase even if the residents are told that the algorithm outperforms human doctors [ 19 , 20 ]. Our results confirm that fundus image quality in the exposure group is similar to that in the control group in our study, and both are similar to or even better than those reported in previous studies [ 21 , 22 ]. However, the preference for facilitated self-service fundus disease screening is significantly less than that for traditional manual screening. One possible explanation is that uniqueness neglect—a concern that algorithm providers are less able than human providers to account for residents’ (or patients’) unique characteristics and circumstances—drives consumer resistance to digital medical technology [ 23 ]. Therefore, personalized health management solutions based on large language models should be developed urgently [ 24 ] to meet the residents’ individual demands. In addition, a survey of population preferences for medical AI indicated that the most important factor for the public is that physicians are ultimately responsible for diagnosis and treatment planning [ 25 ]. As a result, man-machine collaboration, such as human supervision, is still necessary [ 26 ], especially in the early stages of digital transformation to help residents understand and accept the digital technologies.

Furthermore, our study suggests that distrust in the results of facilitated self-service fundus disease screening may cause residents to abandon eye disease screening, irrespective of whether it is provided using this new screening pattern or via the traditional manual screening pattern. This is critical to digital transformation in medicine. This implies that if the digital technology does not perform well, residents will not only be averse to the digital technology itself but also be more likely to abandon health care services as a whole. Digital transformation is a fundamental change to the health care delivery system. This implies that it can self-disrupt its ability to question the practices and production models of existing health care services. As a result, it may become incompatible with the existing models, processes, activities, and even cultures [ 27 ]. Therefore, it is important to assess whether the adoption of digital technologies contributes to health system objectives in an optimal manner, and this assessment should be carried out at the level of health services but not at the level of digital transformation [ 28 ].

The most prominent limitation of our study is that it was conducted only in Shanghai, China. Because of the sound health care system in Shanghai, residents have already received high-quality eye disease screening services before the adoption of the facilitated self-service eye screening pattern. Consequently, residents are bound to demand more from this new pattern. This situation is quite different from that in lower-income regions. Digital technology was adapted in poverty-stricken areas to build an eye care system, but it did not replace the original system that is based on manually delivered services [ 13 ]. Therefore, the framing effect may be weak [ 29 ], and there is little practical value in comparing digital technology and manual services in these regions. Second, our study is an observational study and blind grouping was not practical due to the special characteristics of fundus examination. However, we have attempted to use blind processing whenever possible. For instance, ophthalmologists’ evaluation of image quality was conducted in a blinded manner. Third, the manner in which we inquired about residents’ preferences might affect the results. For example, participants in the exposure group generally have experience with manual screening, but those in the control group may not have had enough experience with facilitated screening despite having been shown a video. This might make the participants in the control group more likely to choose manual screening because the new technology was unfamiliar. Finally, individual-level socioeconomic factors or educational level were not recorded, so we cannot rule out the influence of these factors on residents’ preferences.

In summary, this study confirms that the facilitated self-service fundus disease screening pattern could achieve high service quality. The preference of the residents for this new mode, however, was not ideal. It was difficult to reverse residents’ preference for manual screening in a short period, especially when the original manual service was already excellent. Therefore, the digital transformation of health care must proceed with caution. We suggest that attention be paid to the residents’ individual needs. Although more efficient man-machine collaboration is necessary to help the public understand and accept new technologies, personalized health management solutions based on large language models are required.

Acknowledgments

This study was funded by the Shanghai Public Health Three-Year Action Plan (GWVI-11.1-30, GWVI-11.1-22), Science and Technology Commission of Shanghai Municipality (20DZ1100200 and 23ZR1481000), Shanghai Municipal Health Commission (2022HP61, 2022YQ051, and 20234Y0062), Shanghai First People's Hospital featured research projects (CCTR-2022C08) and Medical Research Program of Hongkou District Health Commission (Hongwei2202-07).

Data Availability

Data are available from the corresponding author upon reasonable request.

Authors' Contributions

SL, YM, and YJ contributed to the conceptualization and design of the study. SL, YM, YJ, YP, TY, and YX collected the data. SL and YM analyzed the data. SL, YM, and YJ drafted the manuscript. WL, YX, JZ, LL, and HZ extensively revised the manuscript. All authors read and approved the final manuscript submitted.

Conflicts of Interest

None declared.

Video of the non-mydriatic fundus camera Kestrel-3100m with the self-service module.

Questions for screening service quality.

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Abbreviations

Edited by A Mavragani; submitted 06.01.23; peer-reviewed by B Li, A Bate, CW Pan; comments to author 13.09.23; revised version received 15.10.23; accepted 12.03.24; published 17.04.24.

©Senlin Lin, Yingyan Ma, Yanwei Jiang, Wenwen Li, Yajun Peng, Tao Yu, Yi Xu, Jianfeng Zhu, Lina Lu, Haidong Zou. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 17.04.2024.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on https://www.jmir.org/, as well as this copyright and license information must be included.

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Background: Fundus photography is the most important examination in eye disease screening. A facilitated self-service eye screening pattern based on the fully automatic fundus camera was developed in 2022 in Shanghai, China; it may help solve the problem of insufficient human resources in primary health care institutions. However, the service quality and residents' preference for this new ...
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In this paper, a survey is done on various natural language processing works that have been done for the Nepali language, different resources, and work available. Discover the world's research 25 ...