review of The Sacrament of the Goddess by a Nepali person Oct 2014


warning: spoiler alert.

If you don’t want to read one of the twists and turns of the book, don’t continue!

 THE SACRAMENT OF GODDESS

”Today, I felt my heart inundated with an elegant blend of emotion, feelings of love overshadowing the sadness, rays of respect enlightening the hatred. You know! I am not the one that I was yesterday. I have a vigor mounted to that summit from where I can fathom the depth of life, explore me and my ethnicity, the Humanity. Yes! today I have ‘The sacrament of goddess’ between my thumb and the index finger with my eyes acquainted with its every pages and my heart drenched in its every scenarios.”, I thought quietly, and made a mental note to gratify the king of that creativity, Joe Niemczura.

Suddenly, I looked next to me in my room and quickly turned around the window as soon as I noticed that I was not there alone. A feeling of shame and fear mingled through my veins, I wished my sister didnot see me as the drops of tear rolled down my cheeks and two of them ended up making the 1/100th of the page of book wet. Helplessly, I was witnessing the inhumane scenario of (spoiler of dramatic plot twist edited out from this spot…)  I felt it, I saw it, not through my eyes but through the writer’s. Can you imagine it??

This is why, I call writing is a magic!

Yes! I have their photographs in the gallery of my mind. I know the way they look, the way they talk and behave. Though they donot know me, I can say how Matt looks like, I can exactly picture the smile of Sushila, I have a clear idea about the behave of Dr. Ranjit in operation theatre..I have obvious pictures of Sara, Arjun, Captain Gurung, Sushila’s mother and Matt’s parents. I have kept the record of every details of them being completely invisible to them. Can you believe it???

Oh! Thats why, I call writing is a magic!!

I have no idea, How can I pay my debts to this guy who arranged my travel upto Beni, Uk and USA, who arranged the visits with so many wonderful people, who displayed the numerous stories of life.. just within a single day. Have you heard anyone completing all of these stuffs in such a short period? You may be thinking.. no… never…

But see, I am here who did it some days back. I know you would surely love to.

The respect of the Nepali culture, religion and appreciation of the different dimension of life in the countries like Nepal are there in the novel that mount your feeling of patrotism, love and the unbound grace of humanity.

To realise a true sense of the dynamic relation between the writer, the characters and the reader, with the ascended sensation of love for the people, country and life in the universe you must go through ”THE SACRAMENT OF GODDESS” once.

Regards,

Asmita Panthi

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looking for nurses and docs in Nepal to become Official Instructors of BLS or ACLS


Updated due to fee clarification, 5 PM Oct 13 -see below.

Health-Care Technology Upgrade in Nepal

Throughout the country of Nepal, the hospitals are upgrading the investment in critical care services, and the health care professionals are catching up to the skills needed. Also, more and more nurses and doctors are trying for abroad career, where specialized credentials are required before a person can be considered for advancement. Both home and abroad, there is tremendous desire for skills upgrade.

CCNEPal has been working to raise awareness of the skills needed, and we have trained 1,100 nurses and doctors since 2011. The policy makers and professional bodies are now turning attention to this area of need in a way that did not seem likely four years ago.

Disclosure: I am not employed by the Center for Medical Simulation. I have consulted with them on a voluntary basis since their goals are close to those of CCNEPal. The opinions expressed here are my own, and I am not authorized by CMS to make any offer of employment or offer any service on their behalf. Any statements made here are subject to revision or revocation by C.M.S.

We are pleased to report that Prudent Meditech, pvt., ltd a major medical supply company in Nepal, has made significant investment in training equipment and classroom space to move this forward with this vision. They have formed a subsidiary named The Center for Medical Simulation which will be Nepal’s first International Training Center certified by the American Heart Association. (The application has been submitted to AHA International as of Oct 2014).

The Heart Association produces the curriculum and standards for their official courses on Basic Life Support, using an AED, and Advanced Cardiac Life Support.

The goal of The Center for Medical Simulation is to offer a full menu of courses, including the ones above, as well an non-AHA courses to address specific topics such as ecg, STEMI M.I., airway management, infection control, and the like.

And Now the Announcement

This is a big and bold goal. In order to meet this, CMS  needs to expand the number of Official Instructors for all of these programs, and this email is to encourage qualified persons persons to apply.  CMS wants a mix of nurses and doctors to become instructors. Please apply before Nov 10th, 2014.

For MBBS doctors, you do not need to be a cardiologist! The best instructors are ones working as Internists or Medical Officers in a “front line” role, able to apply these skills and share real-world day-to-day experiences.

For nurses, CMS prefers that you have prior teaching experience or critical care nursing experience, but CMS will consider a person with less experience who is enthusiastic and dedicated.

Training

CMS will train the successful applicants. The training will involve:

- studying the Official manual for a month beforehand, and taking some prep sessions to be sure of the skills, during the period between Nov 15th and Dec 20th. These can be tailored to the background of the individual.

-taking a five-day sequence of course work supervised by an official Heart Association Regional Faculty from Hyderabad, India, in late December 2014.

- becoming familiar with the policies and procedures of an Official International Training Center.

5 PM clarification of course fee for instructor training: The Official Certification as an ACLS-Instructor at the end, is recognized worldwide as part of the worldwide network. Successful trainees will be expected to teach several courses per year for CMS, for which a per diem pay rate will be given (specific amount is not yet established).

IMPORTANT NOTE regarding training deposit

NOTE: at the time of registration for the training, participants will pay a deposit, and when the requirement for teaching is fulfilled, they will be eligible for reimbursement of the training deposit. This policy is necessary to prevent “no-shows’ and to ensure that Instructors fulfill their teaching obligation.

How to Apply

To apply you must send an email to Srijana Kansakar, RN, BSN, who is the Training Center Coordinator. Her email is srijana.cms@gmail.com

All the application materials are available in a Word document, and they are attached to the end of this blog. If you want the attachment, send email to joeniemczura@gmail.com Prospective Instructors must sign the detailed agreement to follow the specific policies, procedures and standards of the Training Center. (see below).

The forms

From here below, are the forms you will need to complete in order to be considered for this opportunity. Applying is not a guarantee of acceptance. See below.

One last note, Oct 14th. This job involves teaching and due to the stringent requirements of the American Heart Association for documentation, also involves meticulous recordkeeping, as you can see from below. One person already said “The application is too hard. Can’t I just give you my name?” I can sympathize, but my reply was “Perhaps if you can’t do the application, you won’t be able to fill out the course documentation. are you sure this right for you?”

*****

Last name: ________________________

The Center for Medical Simulation

Kathmandu Nepal

ACLS and/or BLS Instructor profile

policy number: __________________date of policy______________ approved by __________________

Policy: The AHA requires each International Training Center (ITC) to keep a file on every Instructor aligned with the ITC. Please complete the following information:

Name_______________________________________________ title: _________________________

Address: ____________________________________________

Phone number: ______________________________________

Mobile: _____________________________________________

Email: ______________________________________________

Courses to be taught: ______________________________

Attach   ⃝ BLS   ⃝ACLS card

***************************************************************

For administrative use only:

⃝ CV attached _____

⃝ cards attached _____

⃝ course record attached.____

⃝ user agreement parts for ITC alignment attached, part one_____ part two _______

⃝ conflict of interest statement agreed to and signed____

⃝ code of ethics agreed to and signed _____

Last name: ________________________

The Center for Medical Simulation

Kathmandu Nepal

policy number: __________________date of policy______________ approved by __________________

date of this agreement _____________________________

User Request for ITC alignment, part one

I, _________________________ request to align with an International Training Center (ITC) known as the Center for Medical Simulation as an Instructor of  ⃝ ACLS  ⃝ BLS (check all which apply).

The ITC may require a meeting or monitoring before acceptance, and the Center makes the sole decision. The decision is final and there is no appeal.

I understand that my performance will be monitored and that the ITC may revoke alignment based on performance issues, as described in part two of this agreement. I agree to act in accordance with AHA course policies, Instructor policies, the Code of Ethics, the Conflict of Interest, and any other policies of the ITC. I recognize that the ITC has the sole right to determine which instructors to keep on the roster.

This agreement does not preclude serving with another International Training Center.

I understand that I must remain aligned with an ITC in order to retain Instructor status, and that the ITC will comply with AHA rules on revocation as outlined in the ITC Manual page 30. I will surrender my Instructor card if requested to do so.

I understand that the following activities will lead to revocation of Instructor status, and that this list is not all-inclusive of reasons that can result in revocation:

  • Falsification of class records
  • Non-adherence to AHA guidelines and curricula
  • Producing or issuing non-AHA course completion cards
  • Continued instruction that is inconsistent with AHA standards for the course/program after    remediation by the TCC, TCF, ECC staff, or RF
  • Using non-AHA examinations or breaching security of AHA exams
  • Inappropriate activities, language, harassment, or conduct during courses or directed toward other instructors, students, ECC staff, or volunteers

signed: ___________________________________ date: ____________________________-__

ITC administrator signature: ___________________ date: ______________________________

Last name: ________________________

The Center for Medical Simulation

Kathmandu Nepal

policy number: __________________date of policy______________ approved by __________________

date of this agreement _____________________________

Instructor Agreement for ITC alignment, part two

To be signed by Instructor when Alignment is authorized by the Training Center.

The Center for Medical Simulation’s name is on all of the cards that you will issue and we require all instructors to adhere to the following policies.

 

As an Aligned Instructor with the Center for Medical Simulation, Pvt., Ltd., I agree to:

 

  1. Use AHA materials and content as core curriculum when teaching AHA ECC courses.
  2. ONLY use the current versions of all forms found on the NEMSA Training Center website. Use of older versions of all

forms may require resubmission.

  1. Purchase Provider and Instructor manuals for each AHA discipline I teach within 30 days of new updates being

released.

  1. Evaluate all students based on the established AHA guidelines.
  2. Arrange for or coordinate AHA ECC courses as requested to further the AHA’s ECC mission and chain of survival

initiatives.

  1. Disseminate appropriate information concerning new materials, changes in policies, procedures and techniques to

ensure quality control.

  1. Sign up for the AHA Instructor Network and align with The Center for Medical Simulation, to ensure I receive all updates as soon as they are released.
  2. Attend Instructor Update meetings as requested.
  3. Teach 4 courses every 2 years and arrange to be monitored by a TCF or RF every 2 years, as required by AHA

guidelines.

  1. Maintain current Provider status.
  2. (BLS and Heartsaver Instructors) Provide documentation of a successful completion of the BLS Instructor Exam (score

84% or higher).

  1. Refrain from engaging in activities that are in conflict with the goals of the AHA and represent the AHA in a professional

manner at all times.

  1. Notify the Center for Medical Simulation of any changes in my address, telephone number, email address or employment immediately.
  2. Submit a copy of all required paperwork for each course taught, including course rosters, monitoring forms, individual

course evaluations (or a summary) and grievance procedures within 2 weeks of the course date.

I understand The Center for Medical Simulation has the right to revoke my Instructor alignment if AHA guidelines are not followed or for any Instructor who fails to honor any part of the Agreement. I understand The Center for Medical Simulation, Pvt., Ltd reserves the right to monitor my teaching at any time as a quality assurance protocol.

 

I agree to the above terms required to align with The Center for Medical Simulation International Training Center as an AHA Instructor.

_____________________________________________________ _________________________

Signature Date

_____________________________________________________

Print name

Address

City, State, ZIP

Telephone

Email address


 

Last name: ________________________

The Center for Medical Simulation

Kathmandu Nepal

conflict of interest statement

policy number: __________________date of policy______________ approved by __________________

from AHA ITC Manual page 54

The AHA, its affiliates and components, and all officers, directors, delegates, council and committee members scrupulously shall avoid any conflict between their own respective personal, professional, or business interests and the interests of the Association in any and all actions taken by them on behalf of the Association in their respective capacities. In the event that any officer, director, delegate, council, or committee member of the Association shall have any direct or indirect interest in, or

relationship with, any individual or organization which proposes to enter into any transaction with the Association, including but not limited to transactions involving:

  1. The sale, purchase, lease, or rental of any property or other asset
  2. Employment, or rendition of services, personal or otherwise
  3. The award of any grant, contract, or subcontract
  4. The investment or deposit of any funds of the Association

Such person shall give notice of such interest or relationship and shall thereafter refrain from discussing or voting on the particular transaction in which he or she has an interest, or otherwise attempting to exert any influence on the Association or its components to affect a decision to participate or not participate in such a transaction.

I have read the above statement and will comply with it.

Signed,

______________________________________ date ____________________________

Last name: ________________________

The Center for Medical Simulation

Kathmandu Nepal

policy number: __________________date of policy______________ approved by __________________

Code on Conduct

All persons in AHA ECC leadership are expected to conduct themselves with honesty, integrity, and a commitment to the goals of the AHA and the ECC Programs. This code is intended to provide standards of professional conduct.

The scope of the standards implied in this code includes activities directly related to the discharge of ECC leadership functions, such as committee activities and assignments, as well as actions performed with other AHA programs or activities, such as ECC classes and activities related to AHA affiliate programs.

Competence

ECC leaders must demonstrate a competent knowledge relative to their assigned specific area of responsibility. Leaders must maintain all prerequisites for the position and participate in required educational or informational sessions.

Respect for others

ECC leaders must respect and treat others fairly, regardless of race, ancestry, place of origin, color, ethnic origin, citizenship, religion, gender, sexual orientation, socioeconomic status, age, disability, or any other basis protected by law. Additionally, there is no tolerance for sexual harassment, including sexual solicitation, physical advances, or verbal or nonverbal conduct that is sexual in nature and that is unwelcome, offensive, or creates a hostile work or classroom environment.

Integrity

ECC leaders must conduct themselves with honesty, fairness, and trustworthiness and must not make statements that are false, misleading, or deceptive. ECC leaders must adhere to all applicable AHA rules and regulations governing the ECC Programs, course, and ITC operations as well as all federal, state, and local laws and regulations in the discharge of their AHA duties.

Neutrality

AHA volunteers should maintain neutrality in terms of specific proprietary products or brand names (eg, drugs, devices, and publications) and in terms of descriptions of other professional individuals and organizations. Specifically, whenever possible, generic names for drugs and devices should be used. While in their volunteer roles, instructors and Faculty will not be advocates for specific brand names or proprietary products outside of AHA recommendations. Furthermore, instructors and Faculty, while in their volunteer roles, will use caution when referring to others, particularly when referring to differences or negative descriptions of other professional individuals or organizations.

I have read the above and will comply, Signed ________________________________ date: ______________

Last name: ________________________

The Center for Medical Simulation

Kathmandu Nepal

policy number: __________________date of policy______________ approved by __________________

courses taught by ________________________________________

Title of course date role Course evaluations
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for Nepali Nurses thinking of Canada PR status


note: if you found the link on Facebook – please do not send me a FB friend request. I don’t accept requests for people I do not know.

also, why not buy my book? The Sacrament of the Goddess will be released in Nepal soon.

Permanent Residency

A friend of mine asked me to help her figure out how to apply for P.R. status in – Canada.

I know how to ice skate on a frozen pond. I am a Boston Bruins  hockey fan. I have been to Canada. My daughters read the Anne of Green Gables books when they were little. But – until now I never gave much thought to Canadian Immigration. Why should I?

The first thing was, she told me that she checked out a consultancy on Putali Sadak, and it was going to cost “three lahks and fifty thousand rupees” which she did not have. Could I possibly help her? And how can I resist the entreaties of a damsel in distress! A Lahk is a hundred thousand. so – using a currency converter, I figured that this was $3510 in American money. I had no idea as to what they charge. On the scale of things, $3510 is not too too much for an American, but when the nurse is being paid $240 per month in Nepal, it is a lot of money.

Online Assessment

She said everyone told her that there was an online assessment she could take, but she and her friends were not able to find it. She sent me the link to the one she was going to complete. It was obvious right away that this was a commercial site, and mostly interested to collect her personal information so that they could give her a sales pitch.

Hmmmmm, I said, with furrowed brow. She showed me the links on her laptop, and there was a problem. there is one named canadianimmigration dot org and another named www.canadianimmigration dot com and another named canadianpr dot net .  It was easy to see that not one of these was an official government website. To make matters worse, there was a spot on the official site for advertising, and the ad showed a Canadian flag with a link to a self-assessment quiz that looked official, but was not.

Lesson #1

So, the first lesson of Canadian immigration is, be sure the site you are visiting is the one run by the government, especially if you are trying to go to the source and not a consultancy.

Here is the link to the site run by the Canadian Government.

Here is the link to check your eligibility> this is the actual link.

http://www.cic.gc.ca/ctc-vac/getting-started.asp

(link updated since the first one was wrong…..)

Lesson #2

There seem to be multiple pathways to get to Canada. This advice is independent of applying to go to graduate school there. And also, this applies only to the Canadian Federal Government, not to the Provinces.

Lesson #3

The system is evidently changing in January 2015, but the length of the process will stay the same: It takes six months to get approved. Also, if you have a job offer in hand, the process is faster. So – somehow you need to get the job offer. I presume that is where the consultancy adds value to this particular process. Without the consultancy, an individual nurse has a limited chance of getting such an offer. The nurse would need to compose a resume, fill out the job applications, and send it online, then do a Skype interview with the potential employer. Somewhere on the site it said if you go there with no job you need to prove that you have enough money to support yourself, which for an unmarried nurse is $11,600 dollars in cash.

Lesson #4

Oh, and did I say that you need to take the license exam? and also have a good IELTS score? They speak English, sort of. But you get extra points if you speak French, because that is the major language of Quebec.

Lesson #5

I have this idea that if the government matches you with a nursing job, it has a higher-than-average chance of being in a geographical area that is less-desired by the Canadian nurses. If they have a shortage in a particular spot, there may be a reason why…..

It’s a whole nother maze of governmental rules to learn…..

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What is A.C.L.S. and why should every MBBS doc enroll in A.C.L.S. course?


“Critical Care is not a geographic location like the ICU of a hospital. Critical care is a set of knowledge and skills that a doctor carries with them. And nurses too!”

_Joe Niemczura, CCNEPal

A.C.L.S. (or just plain ACLS) is Advanced Cardiac Life Support.  The abbreviation denotes a two-day course in critical care skills in USA, leading to a certificate. ACLS is only just now becoming more widely known in Nepal.  Note: be sure to click on the hyperlinks, in blue.

A Mandatory requirement in USA

ACLS  was developed decades ago by the American Heart Association (AHA) and in USA it is a required course for any doctor or nurse who works in O.T., Casualty, post-op, or critical care. In a USA hospital, no doctor or nurse is allowed to administer midazolam unless they have had this course, because this drug produces “conscious sedation.” In USA, most medical students take an ACLS course during their senior year, and it is required before starting any residency program.

ACLS is a two-day course, but most people who take it for the first time will prepare by taking an ecg course, an airway course, a Basic Life Support (BLS) course, and a pharmacology course. ACLS is not simply a sit-down-and-take-notes class; it involves simulated patient situations that teach you how to react and save a life. ACLS  gives assessment skills and teamwork skills that apply to a wide variety of situations.

High Standards

Because of the reliance on high standards of instruction, the AHA has a stringent set of requirements for anybody who proposes to teach the course leading to the “official” certification. These are laid out in a 60-page Program Administration Manual. Until very recently, the only way a person from Nepal could take this course was a) travel to Delhi and enroll there; b) enroll in a course brought into Nepal by various groups of videshi doctors who bring the equipment with them; or c) take an unofficial version of the course.

The difficulty and expense of enrolling in a course has led to a sort of secrecy about the training, in which it becomes mysterious and limited to a few persons. The problem is, the need for the skills is universal here, just as it is in USA. In Nepal, ACLS training is needed by everyone who works in an Emergency Room or any kind of critical situation. Not just doctors either, but nurses too. Right now, a coordinated effort needs to be made to share this set of skills as widely as possible in Nepal.

USMLE?

If you are thinking of someday taking USMLE you will find that ACLS is indispensable. The items tested in ACLS are considered to be among the core knowledge for any doctor in USA. There are rumors that Nepal MBBS graduates are not ranked as highly as they could be, because they don’t have this training when they apply for residencies in India or abroad countries. They are unfairly penalized.

There are two resources of which you should be aware.

First, CCNEPal is a group that teaches a version of the ACLS class which does not lead to the official certificate. CCNEPal has trained 1,100 nurses and doctors since 2011. CCNEPal will be scheduling more courses in the near future. CCNEPal is also looking for docs who wish to help lead the training.  You do not need to be a cardiologist!

Next, The Center for Medical Simulation (CMS) will soon be opening in Kathmandu. CMS will have a state-of-the-art Simulation learning center, including a “3G Sim Man” used for this type of training. Most importantly, CMS has applied to be designated an International Training Center via the American Heart Association, and will soon be offering high-quality training in ACLS that follows every standard of the Heart Association just as if you were taking an ACLS class in New York City. CMS will offer the full series of pre-course prep classes as well.

To find CMS, go to their FaceBook fan page. https://www.facebook.com/PrudentMeditechSimulationCenter

ACLS, and the skills it encompasses, needs to be taught in every medical school and nursing school in Nepal. ACLS is not simply a sit-down-and-take-notes class; it involves simulated patient situations that teach you how to react and save a life. ACLS  gives assessment skills and teamwork skills that apply to a wide variety of situations.

for more information, or to volunteer in the effort to make ACLS more widely available to MBBS docs in Nepal, send an email to joeniemczura@gmail.com

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CCNEPal report as of Oct 2nd, 2014


Summary: every public thing stops in Nepal during Dasain. I decided not to go trekking, so I am just hanging out in Kathmandu. It’s a good time to reflect on progress.

to begin with, here is a list of the sessions I have conducted since arriving in late May:

Session dates and locations Contact person
June 8, 9 and 10, CMC Bharatpur Mrs Laxmi Rajbandari, Matron
June 11,12,12 CMC Bharatpur Mrs Laxmi Rajbandari, Matron
June 18, 19 20; 22,23, 24 KU Dhulikhel Rajendra Khoju, MD and Mrs. Regina Singh.
June 26, 27, Tamakoshi Sewa Hospital, Manthali Suman Karmacharya, MD medical director
July 7,8; 9,10; CMC MBBS Bharatpur Rano Mal Piryani, MD, CMC medical school
July 13, 14 CMS MBBS Bharatpur Manohar Pradhan, MD Director of Casualty.
July 16, 18 ,18 CNE Planet, Biratnagar (double sessions) Dipty Subba and Raj Mehta (now at CMC)
July 31, Aug 1, CMS MBBS Bharatpur Manohar Pradhan, MD, Director of Casualty.
Aug 3,4,5; 10,11,12; 17,18, 19; 24,25,26. Four sessions at Lalitpur Nursing Campus, Sanepa Mrs. Radha Bangdel, Campus Chief
Aug 6,7,; 13,14, 15 doctors and nurses at Sayeed Memorial Hospital in Kalanki Dr Ankit Rai, Medical Director
Sept 3,4,5; 7,8,9; 19,11,12th; 14,15, 16;   CMS in Bharatpur. Nurses, BN and B Sc students, and MBBS. Mrs. Sita Parajuli, matron of CMS
Sept 19,20,21; TUTH Man Mohan CVTVTC Mrs. Bimila Cansakaar, matron
Sept 25,26; LMC, Palpa Raju Shakya, MD Deputy Hospital Director

Certificates

The total number of certificates given to participants is 608 as of today. I missed a couple groups somehow, but on the FB page is a group shot of each batch, and when I view them as a slide show it’s amazing to me how many. I am not able to remember all the names. I adopted an approach of delegating the role of “assistant” within each session, in an effort to develop more leadership skill in this method of teaching, and I now tend to interface with the four or five such persons in the class, more personally.

This exceeds the number awarded in 2013 (534).  I have conducted about 23 sessions of the course, half of them outside the Kathmandu Valley. I continued my past practice of four first-come first-served courses using Lalitpur Nursing Campus space, but the rest of the courses were all sponsored by one clinical agency or another.  I was not able to fulfill all requests for collaboration, there are about ten hospitals/schools that are on  a waiting list.

2-day version

I added a 2-day version of the course, for MBBS docs, to go along with the 3-day version for nurses. Far and away, the largest number of participants for the MBBS version were in Bharatpur, both CMC and CMS. The classroom dynamics and course focus makes a shift when this is the audience. My experience with this group has given me valuable insight into the learning needs of young docs in Nepal. I plan to work with this group more.

Prudent Meditech, and the Center for Medical Simulation (CMS)

I have interfaced with Mr Rajesh Agrawal since 2011 when I investigated the idea of buying a CPR manikin, and when I got in touch with him this year, there was exciting news. He is a business man in the medical supply field, here since 1993. He has been taking many affirmative steps needed to develop a Simulation Center here in Kathmandu, to the point of renovating a suite of offices into classroom space, ordering a state-of-the-art “3G SimMan” and launching the steps to have an official “International Training Center (ITC)” fully certified by the American Heart Association (AHA), for the purpose of teaching ACLS and BLS and PALS according to every standard of the AHA.  I was delighted to hear this, because this center will be something that promotes my exact goal: advancing the standard of ACLS in Nepal.

And so when in town I have voluntarily consulted with him on the steps. The ITC coordinator will be Srijana Kansakar, who has a BSN from Alabama, USA, and a team of nurses.  I reviewed with them the Program Administration Manual (PAM) and drafted some Policies and Procedures. I am still independent of the Center for Medical Simulation but we have discussed ways I can help. To begin with, I think the application process laid out in the PAM is baffling to any person not steeped in USA health care middle management. The idea of this kind of NGO certification is very new in Nepal. For CCNEPal I had looked into doing something like this a year ago, and concluded that I could not bankroll it or afford to buy the mandatory equipment to run an “official” ACLS course. CMS is well capitalized and able to afford to do it right.

Instructor Bottleneck

We identified the biggest problem CMS will have, which is to develop a cadre of BLS-I and ACLS-I instructors and meet the required ratio of instructors for each class. So far, there are very few ACLS-Is in town, and they are all doctors who have active practices. In order to get the certification they have needed to got Delhi, since there is no place to get certified as an ACLS-I in Nepal.  CMS is fortunate that the medical leaders of hospitals have the vision to support this, but also faces a dilemma: how can they offer enough courses when they are competing for the time of some of the most talented doctors in Kathmandu?

National Policy on critical care and ACLS

as an aside, the Ministry of Health, and also the Cardiology Society of Nepal, have begun to put ACLS on their agenda. I like to think that my efforts have helped bring this pressing need to the attention of policymakers sooner than might have otherwise been the case.

back to the Instructor bottleneck, and the “Monarchy of Gambia.”

At this time, CMS has proposed a plan to AHA about how to expand the instructor pool.  I briefly explored the idea of reactivating my Regional Faculty status within AHA (lapsed since 2000), to do this, but it would have taken time, cost money, and distracted me from my core teaching of critical care using the format I now have. I come back to the same conclusion I reached a year ago: I am having better impact by doing what I do without the need for a set of “certification cards” to make me feel official.

I call this the “King of Gambia” theorem. The knowledge that I have is free, and up-to-date. I am a master of classroom management techniques that meld South Asian learning styles to the content. I have had excellent feedback about the course. Would this be enhanced if I were to announce that I was now crowned the King of Gambia? or some such other foreign title? At this point in my life, I can offer what I need to offer without needing another line on my resume.  Flirting with the idea of becoming Regional Faculty of AHA for Nepal is equivalent to being High Potentate of Gambia. I’m too old to be motivated by this anymore.

Having a “Crew”

Having said all that, I am helping them as much as I can, right now, without waiting for any particular certification as a go-ahead. I have shared with them my ACLS-I materials. This is a package of stuff I bought for $200 USD last year. CMS has four nurses now on the payroll who will be the backbone of the cadre in administering the courses, and I am orienting them to the AHA culture, values and standards.

Migrating my course toward an AHA format, sort of

The core of our collaboration is that they are  now my semi-permanent “assistants” for each session, since early August. An AHA ACLS course is set up with short periods of video, then discussion by the Course Leader, then work in small groups. Each small group does a role play scenario, and then gets debriefing. Up to now, I improvise this when I go form place to place, using assistants I recruit one day one of each session. From here on while in Kathmandu, I have the same crew of Assistants each time. We are refining the skills, and giving them practical experience that allows them to develop. I have revisited the ACLS-I materials including the layout of their official ACLS-I class, and I am using that to as a resource to develop their skills consistent to what the AHA expects. In the next month or two, I will be adapting my course format to incorporate more of the ACLS debriefing tools, so they will each become more able to use the AHA format. I’m happy to have the help of Srijana, Manika, Lochan and Binda for these courses, and these activities are ones I can do right now, without waiting for benediction from somebody halfway across the world.

We hope to add to the pool of Instructor candidates. If there are any people out there, especially MBBS and MDs, who want to help do this teaching, please contact me.

Future direction

I am needing to reapply for my visa. Every office in Kathmandu is closed during Dasain. If this is not approved, I will be taking a two month break and returning to Nepal January 2nd. I expect it to be approved. When that happens I will be travelling more to western Nepal, especially to Lumbini Medical College where I have been appointed as a volunteer Visiting Faculty.

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Mandatory reading for those afraid of Ebola in the USA


“Oh My God Ebola has made it to the USA!”

If you do nothing else about Ebola, read this specific article, which came my way from the twitter feed of Atul Gawande: http://www.vox.com/2014/9/30/6875459/calm-down-youre-not-going-to-get-ebola

From here in Kathmandu, it’s not always easy to learn what “the man in the street” of the USA is thinking when it comes to the news. My attention perks up when USA media starts talking about bedside conditions in hospitals in Low Income Countries, because that is what I work on every day, and it’s why I am here in Nepal with an NGO.

Living as an expat

I don’t watch TV when here. Oh, I caught the World Cup, on tape delay. But not much else. I get a whiff of the news from Twitter, FaceBook, and the web. But in the interest of full disclosure, I am a follower of dailykos, and though I expect the left-leaning news to be truthful, I know enough to realize that they put their own spin on events.

Ebola and the first rule of public health

But the hysteria in the USA news media about Ebola is difficult to ignore, and it reinforces something known as the first rule of public health: “don’t do or say anything to alarm the general public”

The main thing that keeps these diseases under control is a sense of “we’re all in this together,” and if we adopt an “every man for himself” mentality, we leave the women and children behind when we scramble to whichever symbolic life boat serves as an escape route. Or even worse, we find a scapegoat to kill. It’s simple really. Oh, and wash your hands.

the real problem? problem number one is –

The real problem is the lack of investment in health infrastructure, especially public health infrastructure, in the low income countries of the world. Here in Nepal, cholera is endemic ( meaning that it is always here at a low level) as opposed to epidemic. We can’t get rid of it, but we can control it. How? when a person gets admitted to the hospital, we are careful to clean every flat surface that might get contaminated. it’s only when we stop cleaning things that these diseases get out of control, in a hospital setting. That was true in Africa – reports indicated that when there was diarrhea everywhere, is when the staff refused to go to work. they fixed it by massive cleaning. It’s not rocket science. Oh, and don’t go around kissing any dead persons on the lips.

problem number two is -

I’ve written two books on the subject of day-to-day bedside care in hospitals in Nepal – The Hospital at the End of the World (nonfiction) and The Sacrament of the Goddess (fiction).  Each has given me a sort of cult following among other nurses and doctors (nurses especially) who are thinking of doing similar things. But neither has been a best seller. Now it’s entirely possible that they could be better-written than they are, but I have concluded that one main factor preventing my appearance on Oprah has been the search for a happy ending among the American public. Nobody wants to read another children-are-dying book, and if you mention Sally Struthers who used to appear in all those dismal commercials appealing for money, they are tapped out. There is a deep mindset that there has got to be an ending in which the problems are solved, because that’s the only way we can all get up again in the morning. This is true of every book written by Christian missionaries I think, but also for those written by secular New York Times columnists (Nicholas Kristof comes to mind). Americans never want to read about a problem unless an easy solution is presented right alongside. We live in a fantasy world, existing just beyond our borders, inhabited by Boogie men and evil characters. Or else Albert Schweitzer. The more black-and-white it can be, the better.

The truth is, we need to work on these things every day, methodically and carefully, throughout the world, even when there is no epidemic occurring.

So – wash your hands. and kiss your children good night when you tuck them into bed…..

 

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Nepal Nurse going to USA – steps needed Sept 18th 2014


“I want to go to USA and work. How can I do it?”

or,

“I will have arranged marriage with Nepali guy who is living in Texas, USA. what do I do?”

or:

“I want to get M Sc  in nursing in USA. (“and are there are any scholarships?””)

(note: I originally had trouble getting USA web links, I added them after about 300 people had seen)

I get asked about this all the time. “How can I go to USA and work?” My first answer is – we need you in Nepal! But if you must go, plan carefully.

disclaimer:

I am not an immigration lawyer. I do not work for a consultancy. I have a recommendation as to a specific consultancy, but I am not employed by them in any way nor did they ask me to write about this.  I’m writing this because I don’t want you to make a mistake.

Here is a story:

I live in Hawaii and one day I got an email from a Nepali nurse who just moved to New York City. “Please help. My husband and I just moved to New York. I need a nursing job. Can you help me get a license and nursing job?”

My reply was ” Sorry. New York is 8,000 km away from Honolulu Hawaii and I don’t know anybody there. did you already take NCLEX?”

her answer. “No”

I told that I don’t know anybody in New York and she did not plan properly. They lived there for five months until they ran out of money and moved back to Nepal. She never worked as a nurse in USA.  she may have gotten a job as a “nurse’s aide” – performing personal care tasks which in Nepal are given to the family to do, such as cleaning incontinence and feeding and bathing. such jobs pay minimum wage and are often not enough to support a family.

It didn’t need to be that way.

From what I have seen, it takes more than a year of planning to get all the documents lined up.

you need:

all educational transcripts; IELTS or TOEFL; CGFNS; and NCLEX; then you need a work visa or a student visa that allows work; then you need a social security card. This is not the final list. You will need to pay for attorney to help you.

Let’s go one by one.

educational transcripts: if you have PCL with just SLC you probably will get your transcript rejected. So if you have just a PCL, stop right there. I have never yet heard of a PCL nurse whose transcript was sufficient unless they had SLC plus 2.  For all those PCL schools in  Nepal, they need to stop promising that PCL with only SLC is good enough. it is not true. In my opinion, CTEVT needs to begin mandating that all PCL nurses have SLC plus two.

Hate to tell you this, but if your intention was to go to USA, you should have gotten B Sc, not PCL. it’s probably too late, but – that is the case.

Note: there is no place anywhere where this is written down. If there is somebody who can prove that I am wrong by giving me the actual name of a person now working in USA as an RN with just a PCL, please email me at joeniemczura@gmail.com and give me their contact info.

KEY POINT:

DO AS MANY OF THESE STEPS AS POSSIBLE, BEFORE YOU MOVE THERE unless you have somebody to support you financially, because you will wait around and work until you do them.  I can’t stress this enough. IT MIGHT TAKE A YEAR to get all this completed.  Can you afford to pass the time with no income?  It will take money.

IELTS or TOEFL: you need a score of 7 (seven) or better in all areas, -speaking, reading, writing, comprehension. take the language test first. www.ielts.org

CGFNS stands for Commission on Graduates of Foreign Nursing Schools. Click here to go to cgfns. USA has fifty states and you apply to a state, not the federal government. Most states ask for documents from CGFNS before you can take NCLEX exam. CGFNS application costs about $300 US Dollars. You begin the process by creating an online account.

CGFNS also administers “VisaScreen” in addition to credentials evaluation. click here to learn about Visa screen.

at that site, it says:

For nurses educated outside the United States, all U.S. State Boards of Nursing require credentials evaluation, certification, or verification as a first-step in the application process. Specific requirements differ by state.

NCLEX: only after you have done the above,  can you take NCLEX.  Click here for link to NCLEX. you can take NCLEX in Delhi, but you must choose one of the fifty states to apply. click here for list of all fifty state agencies for nursing. NCLEX costs about $300 USD. There is NO guarantee that you will pass. In USA, the first-time taker’s pass rate is 80% to 90%.

According to this document from NCSBN, https://www.ncsbn.org/Table_of_Pass_Rates_2014.pdf the pass rate for first-tme takers who are internationoally educated is 30% in 2014 so far. do not underestimate this exam.

M Sc program: you need to do all  of the above before you can apply for USA M Sc program. You must be a USA RN to enroll in RN-to-BSN program or in M Sc program.

WORK VISA: here is where you need a lawyer. I am told that USA Immigration Service will reject application for spelling errors, but won’t tell you where they found the error and what to fix. This will drive you crazy.

social Security number: nobody is allowed to give a job unless they can show record that you have this. The US government will fine the employer if they do not supply this. Every employer is strict for that reason.

I wrote about this two years ago!

link to my previous blog on free resources. click on it to find another link to a free document. http://joesar.wordpress.com/2012/04/21/resources-to-help-foreign-nurses-get-a-usa-rn-license/

My recommendation: my friend Shirley Evans, RN, BSN, is part of SLI Group, in Chaubahil, and she has been doing NCLEX review in Kathmandu for ten years. click here for SLI Group link. She has a proven track record. She will meet with you and give personal evaluation about chances of success. Yes, her group charges money. Here is link to their FaceBook page.

If a consultancy says they have a USA nurse working with them, don’t pay any money until you ask for the name and to meet that person. Shirley’s photo is on the FaceBook page. She is a native English speaker. She has a good sense of humor.

IMPORTANT NOTE AT 7:30 PM

Shirley tells me that there are some inaccurate things here. I will fix them when I learn what they are. In the meantime, the most important point is the same: make a plan make a plan make a plan

FINALLY,  I almost forgot.

If you are in USA, I invite you to go to Amazon and buy my book about Nepal health care. It’s a novel. and yes there is a love story.  http://www.amazon.com/Sacrament-Goddess-Joe-Niemczura/dp/1632100029/

The Sacrament of the Goddess

The Sacrament of the Goddess. IN USA its available on Amazon. The Special South Asian edition will be published in Nepal soon.

If you are in Nepal, be advised that The Sacrament of the Goddess will be available here soon. go to the Facebook page,  https://www.facebook.com/thesacramentofthegoddess

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