Updated Schedule for CCNEpal 2014 as of July 21, 2014

Where have I been?

Just got back from two weeks in the Terai. Mostly Bharatpur but also Biratnagar. I loved the people in Biratnagar, though I was so busy teaching I really never left the hotel. I taught “double session” there – one group of thirty from 0800 to 1 PM; then an hour off before teaching the next group of 25 from 2 to 7 PM.

At the end of each day I was tired.

CNE Planet

This is the name for a group that provides Continuing Education for Nurses, located in Biratnagar. They were my hosts. I was excited to learn about their mission.  find them on FaceBook at https://www.facebook.com/groups/309310719106884/

What about the Terai?

I think every foreign medical volunteer needs to go to Terai. For at least part of their trip, and not just to ride an elephant.

Fifty per cent of the population of the country lives in the southern valleys that make up the Terai, and now we have a half-dozen medical schools and teaching hospitals there, all of which are dedicated to improving the health of the population. Some medical schools in Kathmandu talk about sending their graduates to the rural areas; these schools in the Terai are actually doing it.


There have been cancellations and additions to the CCNEPal schedule since I last wrote.

July – session in Butwal is cancelled. I will happily make a Road Trip to Butwal/Bhairawha at some future time but I need a host in each location. I don’t go to any place unless the in-charge people invite me.

July 29th and 30th; then again July 31st and August 1st – two, two-day sessions for MBBS docs in Bharatpur at CMS. I am still experimenting with the best way for the 2-day version for docs. it’s been well-received so far. this time we will have a smaller group.

LNC Sessions in August

August 3, 4 and 5; 10,11 and 12th; these two sessions are fully enrolled.

August 17, 18 and 19th – there are still seats available for this session at LNC campus in Sanepa. to register, go to LNC Library with 1200 nrs fee.

August  24, 25 and 26th -still seats available for this session at LNC campus in Sanepa. to register, go to LNC library with 1200 nrs fee.

August 6,7 and 8th; 13, 14 and 15th – sessions at Said Memorial Hospital in Kalanki. there may be a few seats available, send me an email. joeniemczura@gmail.com  due to small size of classroom we limit the number of enrollees.

open dates in August in KTM – I would be willing to add a session on August 20, 21 and 22 in KTM Valley. I would also possibly add a session on August 27, 28 and 29th. please send email to joeniemczura@gmail.com

Terai again

Sept 3rd through 16th – I will be in the Terai again at CMS in Bharatpur. 3,4 and 5th; 10,11 and 12th; 14, 15 and 16th for 3-day nurses sessions. we will do a 2-day MBBS session at CMS September 7th and 8th.

open dates in September in Terai – I could add a 3-day session the 18th, 19th and 20th in Terai. I figure that once I am there I might as well be there, as opposed to coming back and forth from KTM all the time.

Sept 25th to Oct 10th – is Dasain and Tihar. do you seriously think anybody will take a class at that time? I don’t think so either!

Oct 12,13 and 14th; 19th,20th and 21st; 22nd, 23rd and 24th; a series of 3-day sessions at Lumbini Medical College Teaching Hospital in Palpa district. also, a 2-day session for MBBS docs Oct 16th and 17th (tentative).

Nov 6th in Dulikhel, I have agreed to speak at a conference on evidence-based practice.

Nov 15th – the Nepal Society of Critical Care Medicine is hosting the First Ever national conference on critical care. I plan to go.

Nov 16th – I return to USA for a few weeks holiday with my daughters. I expect to be back in Nepal about January 2nd.



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Shouldn’t we read about the real Nepal?

The Sacrament of the Goddess is about Nepal, but not the Nepal you usually read about. This book is about Nepalis, not Western mountain climbers. Nobody climbs Everest. Everybody here is trying to lead a good life.

Nepal is a fine place to go on a Buddhist retreat, but taking a class is not the only way to learn about Buddhism in this country. There are people here who were born into Buddhist families – how do they live their lives? the story in this book will reveal that mystery…..

When I attempted to win this from First Reads I thought it was a biography of a missionary doctor. I am not quite sure how I got that so mixed up. Okay , so I didn’t do too bad, it wasn’t a biography, but it was about a missionary doctor and the village hospital he chose to serve at. It was very educational. I know more about Buddhism and Hinduism than I learned in my World Cultures class. It was great the way Kali showed Matt (and us) the similarities and differences.. It was also a love story, neatly woven through the years. It is a story about friends, family, and community. An excellent book to read for enjoyment, or even for a world Religions course.

this is the most recent review. to read other reviews and to order the book, click here


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doing ICU care in Bharatpur, Nepal – dispelling the myths

quick advert -

buy my second book about health care in Nepal. It’s a novel that draws upon my experiences here. It is about contemporary Nepal, and nobody in the book climbs Mount Everest or goes through a harrowing accident involving a glacier.

I just finished four days of training the staff of Chitwan Medical College Teaching Hospital in Bharatpur, Nepal. If you include the thirty people from last year, I have now trained about 140 nurses and doctors and medical students in Cardiac Life Support at CMC, the most of any individual hospital in the country.

Bharatpur is a medical nexus for the Terai. People come from long distances to seek medical treatment here. more than fifty per cent of the population of Nepal lives in the Terai.

I think there is a myth or fantasy that somehow, this part of Nepal consists only of thatched roof buildings and that they are only capable of delivering elementary care in a collection of dirt-floor huts made of mud-brick.  If you read the statements of people in Kathmandu, (whom I will not name) they seem to say that nobody outside Kathmandu can possibly know what they are doing.

I have had the opportunity to spend time here, get to know people, watch them in action, and look at their physical plant and equipment.

IN SUMMARY:  they have modern buildings and equipment and they are offering a high standard of critical care services appropriate to the needs of the community. They do know what they are doing, here.

to see up-to-date photos, click here

I decided to take some photos. I love wordpress but this is not the easiest way to post photos, and so I am creating a photo album on the FaceBook page for CCNEPal.





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The Evolution of My Atttitude toward megacode scenarios in Nepal

quick advert: My second book is a novel, but the medical details represent real situations and of course, the intent is to convey the feeling of being in a small medical community in a remote area of Nepal. You can get The Sacrament of the Goddess on Amazon.

“Too far from town to learn baseball” as Robert Frost would say.

“And how many members of your team?”

I just spent two days registering people for the August sessions of the signature course of CCNEPal – the 3-day event. More than one person asked this question.

Right now the answer is “everyone in the class is a member of my team”

In 2011 I started this project, experimenting with teaching nurses Advanced Cardiac Life Support (ACLS) skills in Nepal. Okay, it’s a not the “official” American Heart Association (AHA) course by that name – let me make it clear. The course does not include a written exam, and is tailored to the needs of acute care professionals in Nepal. Significant part of the USA course do not apply to Nepal (very few AEDs here, for example, so why bother teaching about it?)

A big part of each 3-day session is small group scenario work, known in USA as “megacode”

And I was thinking about this. I used to do it a certain way. It has changed, slowly, to become what it is these days.

in 2011

when I started all this, I would call forth a group from the class, or ask for random volunteers. They would respond to a scenario while everyone watched. When I did it this way, it was possible for shy class members to lurk in the background and never volunteer.

There was another American RN in Kathmandu, Shirley Evans who teaches the NCLEX review class. When she came, we would divide the group in half. From within each half, a small group would do the megacode while everyone else watched. so – it was “better.”

By the end of 2011 I got to the point though, where some of the Nepali nurses had caught on, and become familiar enough with the scenarios and the ins and outs, that they would lead the small groups. I realized that it was silly to restrict the group leadership only to myself and one other person.


I started off the summer 2013 project with two other RNs – from Canada and Australia. they would lead the groups. they were great. But they didn’t stay the whole summer. And so, I relied on my Nepali friends to help lead the groups, again. Problem was, in Kathmandu all the best ones – Indu Karki, Usa Rai, Anupama Karnajeet,  and Binu Koirala – had jobs, and could not make it every time. time to improvise. When I went to Pokhara, I met Mario Hughes and Sushila Neupane – they helped me as well. Actually, when I think about it, there was a long list of people I pressganged into service.

At Nepal Medical College I also had MDs as co-teachers – which was something new for me. Dr. Gautam Bajracharya, the chief of anesthesia, was a joy to work with. His enthusiasm and knowledge helped me to relax.


This time around I am making it official that I will use the expertise of people within the class. I view these sessions as if I am teaching two simultaneous classes – one for the 25 or so people in the class, and the other for the five or so who are brave enough to agree to be a scenario group leader. To accomplish this, I spend a bit more time at the beginning explaining to everyone just how it works, and when we break up into small groups, the group leaders know that they need to come and join a small huddle to get the updated instructions.

some of the sessions I have been able to have all of the small groups led by a Nepali person, which frees me to give encouragement to all groups and make sure the whole class is going smoothly. after each round of scenarios, each group leader gives feedback in the front of the class, in Nepali, to make sure that every participant “gets it” – which helps overcome the language challenge that some people bring.

When we are practicing ecg, I also ask the fast-learners of ecg to help point the way for the others, so that nobody is struggling with ecg just because of the artificial barrier of language. Over the course of the three days, the small groups can reinforce each others’ learning in Nepali language.


I think this is worth blogging about because it is a concrete example of the way that a person’s teaching approach will change. The content is the same as it’s been, it’s the classroom management strategies to enhance learning that have evolved. These days, adapting the strategy allows me to give up “control” of every single minute element of the class ( not that my classes are ever under control, LOL). I think I gain something more fun.

For my readers:

especially those who teach in culturally diverse settings. I’m curious as to whether you notice the same kind of evolution in your own teaching…..

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My trip to Manthali, June 2014

short version

several months ago I got contacted out of the blue by an American MD who was planning to go to Manthali Nepal to volunteer her services there. This happens every now and again since I have such a robust presence on the internets. She invited me to spend some days there.

Why not?

It turns out that Tamakoshi Sewa, the hospital at which she was volunteering, was a very interesting place indeed. It is a small place – there are fifteen beds but the inpatient census was three. The main thing was to see how they address the health needs of their region. They serve about 120,000 people in a very mountainous area.

I really only spent two days there. One of the mornings I sat quietly in the corner and observed as one of the doctors was conducting the OPD clinic. This was open to all comers. I simply don’t get involved in primary care much these days so it was very interesting to see who came in next.

Doctor Suman Karmacharya, MD is the main guy at Tamakoshi Sewa. On my last evening there, he gave an overview of the services they provide.

They are involved with a wide range of projects including safe drinking water and toilets.

They partner with World Neighbors for many projects.

Though they mostly do primary care, much of the annual activity is given over to the periodic camps they conduct. A camp typically involves a team of doctors and nurses from other parts of Nepal or even other countries, who set up shop for a limited time to provide a specific purpose. There is a lot of logistics involved. Obviously, the team needs to bring all their equipment and supplies; but also, somebody has to screen the patients and get them to show up on the appointed day. At the village level, there is a “VDC” ( Village Development Committee) in each of the hamlets, and these are enlisted to help.

Uterine Prolapse Camp

Dr Karmacharya told me an amazing story: he was in touch with a German NGO that was willing to do a visit for the specific purpose of surgical repair of uterine prolapse. Okay, that’s good. But – in order to gather the patients for this, a qualified person needed to examine every candidate. which meant – him. So, he embarked on a 45-day walking trip through the roadless part of the district, and at each village he would stop and examine every one ( not just for uterine prolapse, but for other conditions as well). He  found more than fifty cases, and set up a system for every to appear the week that the Germans were in town.

There are some other remarkable things they do at this place, but I thought this was a prime example of the dedication it takes to meet the health needs of the people in a remote area such as this.

One more thing

The hospital has a small Guest House which is clean and inexpensive  (600nrs per night) and at 8 PM every evening they serve dinner under a bamboo awning near the detached kitchen. Evening conversation was very pleasant indeed.


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list of upcoming sessions as of June 16, 2014

UPDATED JULY 1st to register for August sessions at LNC campus, go to the LNC Library. there are still seats available for some of the sessions.

schedule-as-you-go for CCNEPal

I don’t start filling up the calendar until I arrive here. It’s easier to have a face-to-face meeting with each potential host agency to discuss the assessment, the goals and methods. I am very fortunate and grateful that the 3-day course I deliver has received excellent word-of-mouth endorsements, and I thank all the past participants for this support.

I already did two sessions at Chitwan Medical College in Bharatpur.

Here is what is on the books:

Dulikhel Hospital #1 – June 18th, 19th and 20th (finished)

Dulikhel Hospital #2 – June 22nd, 23rd, and 24th ( finished)

July 7th and 8th,  – first 2-day session for MBBS students and new M.O.s at Chitwan Medical College Teaching Hospital, Bharatpur.

July 9th and 10th – second 2-day session for MBBS students and new M.O.s at Chitwan Medical College Teaching Hospital, Bharatpur.

July 11th and 12th – first 2-day session for Medical Officers at College of Medical Science, Bharatpur.

July 13th and 14th – second 2-day session for Medical Officers at College of Medical Science, Bharatpur.

July 16th, 17th and 18th, session for “CNE Planet” in Biratnagar.  Dipty Subba is contact person.

July 27th, 28th and 29th, session at Advanced Institute for Health Science, Butwal.  Jyoti Paudel is contact person.

August 3rd, 4th and 5th – LNC session #1 (now fully enrolled, no more seats available.)

August 6th, 7th and 8th – session #1 at Said Memorial Hospital in Kalanki. ( ? seats available for nurses not employed by SMH)

August 10th, 11th and 12th – LNC session #2 (now fully enrolled, no seats remain)

August 13th, 14th and 15th, session #2 at Said Memorial Hospital in Kalanki ( see above. maybe seats available)

August 17th, 18th and 19th – LNC session #3 (as of July 1st, 21 seats remain.)

August 24th, 25th and 26th – LNC session #4 (as of July 1st, nine seats remain unfilled.)

Pace of activity

I am on the same pace as in 2013.

Flexible to add more sessions.

I do have space for other sessions, for example I could add one in Bhairawha when I am nearby in BTWL.  I only work with host agencies that request me to come there. If you wish to have me come to a place where you practice nursing, tell your matron to contact me. I can give references.

Long term schedule

I will be here in Nepal until Nov 16th at which time I will go to USA for six weeks, then return from January until May 2015. I am aware that voluntary trainings are unlikely to be well-attended during Dasain. I wish to go on a short trek sometime around that time as well.


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How to register for summer sessions of Critical care Nursing 3-day course in Kathmandu, August 2014

UPDATED JULY 21st 2014

We have completed arrangements to offer the 3-day Critical Care Nurses Training session in Kathmandu in August. This is the same session that was offered in 2013, when 534 people took this training. to learn about the course, go back to the FaceBook page and browse there.

We are so pleased to be partnering with Lalitpur Nursing Campus for the third time. LNC is a very forward-thinking school of nursing in Nepal, empowering nurses and advancing the advocacy role since 1959.

Here are the dates, time, locations etc and also here are instructions on how to register for this course.


there will be four sessions of three days each. each is a Sunday-Monday-Tuesday. You must attend all three days to get the certificate.

#1 is August  3rd, 4th and 5th (all seats enrolled)

#2 is August 10th, 11th and 12th; (all seats enrolled)

#3 is August 17th, 18th and 19th; (13 seats available as of July 21st), and

#4 is August 24th, 25th and 26th. (9 seats available as of July 1st, total of 120 seats in all four sessions.)

each days class starts at 0900 and goes to 4 PM or 4:30

Location of class: in the upstairs green ballroom classroom of Lalitpur Nursing Campus, Sanepa.

Fooding: tea breaks and lunch will be provided;

Fee: there is a MANDATORY fee of 1,200 nrs for this course, most of which goes toward fooding ( and handouts, etc). the fee is nonrefundable and must be paid in advance.

Certificate: of course there is a certificate! it is dherai ramro. there is a picture of it on the FB page.

NO PHONE Reservations. the fee must be paid in full at time of registration. it’s okay if you send your money with a friend, but if the fee is not paid, we will not hold a slot for you.


We have completed the off-campus phase of registration. From this date forward, go to the LNC Library to register. bring the fee and a pen drive.

BRING: 1,200 rupees and a pen drive. You will be given course documents to study.

for more info send email to joeniemczura@gmail.com or ask on CCNEPal FaceBook page.


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