CYCLE CITY
Kathmandu Valley would benefit most from a combination and choice of non-fossil fuelled mobility options: biofuel-powered private motor vehicles and both bus and rail transit, bicycles and walking. ('Cycle city', #406) Effective mobility requires maintaining the compact, diverse and accessible urban planning and building that traditionally made cities economically and environmentally sustainable.

Stephen Coyle,
email

• I accept that the United Nations is necessary for Nepal's peace process and development. But looking at the obscene salaries it pays its staff and the wastage of resources in driving around in huge gas-guzzling SUVs, one wonders if it couldn't do more if it spent less on itself.

At a time when the whole world is reeling under a fuel crisis, the UN should set an example by reducing travel, using staff buses, bicycles, electric vehicles for delivery and generally cutting down on its carbon footprint.

C Rajendra,
email

HEALTH HEROES
The reason doctors only serve in Kathmandu and not in remote areas ('Nepal's unsung health heros', #406) is because the doctors have no choice. Stop blaming the doctors. Everything in Nepal is centralised so they have no choice. Think of those few doctors serving in remote areas. Is their service rewarded appropriately by the government? Are they given incentives? Is their work even noticed by the health ministry?

Puspa Pant,
Aberdeen

• Nepal has a multi-tier health system. Rich patients go to Bangkok or India. The middle-class go to expensive clinics and nursing homes in Kathmandu. The underprivileged queue up at government and teaching hospitals in Kathmandu and other cities. The poor go to local health centres in villages and district hospitals. And finally, there are the many who do not have access to any kind of healthcare system whatsoever.

As Mark Zimmerman says ('Not just any doctor', #405) MDGPs can play a major leadership role at the district level, to improve health care. However, let us not forget that embedded within the vision of a 21st century healthcare delivery is the ever-growing need for specialists. Primary care at the health post level, complicated cases to MDGPs at district level, selected cases to zonal hospitals for specialist care and Kathmandu, Dharan, Bharatpur for highly specialised care, eg neurosurgery, cardiothoracic surgery, transplant surgery, interventional radiology, etc. For conditions needing long-term or life-long follow up, the continuity-of-care chain goes backward following the referral chain. For smooth referral, good telecommunication and information infrastructures-including air ambulances-are essential. I know I am dreaming, but we will get there one day.

MDGPs is one place to start.

J Jaspure,
Edinburgh

• Doctors can be stimulated to work in the remote areas by giving them attractive salaries. I remember that a Scottish organisation had to spend money to bring a Scottish GP to work in the far west as Nepali doctors refused to work there for the low salary. Paisa always matters.

Glen Mitrasingh,
Amsterdam

PRESIDENT
Madhab Kumar Nepal is the best choice for president. He is a simple man, his wife still works for a government bank and he has already had experience as deputy prime minister and foreign and defence minister of the country. Besides, he was the General Secretary of the second largest party of the nation during the time of the people's movement. Sahana Pradhan and Subash Nembang are cadre of the same party where he was the General Secretary.

Rajesh Gautam,
Putali Sadak