part 1 of 3: #IamwithDrGKC revives after New Constitution, January 2016


Executive Summary

Start here with a video by Subina Shrestha. It’s titled “Nepal doctors Back Hunger-Striking Colleague”

Doctor Govinda KC is an orthopedic surgeon from Kathmandu who has been a champion of reform for medical education in Nepal.  He is a professor at TU IOM.

Dr KC has made treks to bring medical services to remote areas of Nepal.

Dr KC has made treks to bring medical services to remote areas of Nepal.

He has been willing to dramatize this issue by going on hunger strikes, five times in the past. He’s been able to mobilize medical students at TU IOM. His effort  have led to  investigational journalism to expose the “medical mafia” of Kathmandu, and also led to the government-appointed Mathema Commission” which produced the “Mathema Report” named after the Chairperson.  The journalists have pointed to the involvement of political figures in “buying” the license to run these colleges.

From a previous effort in support of hunger strike of Dr KC. - As of Sept 15th, with all that has happened, it seems so "tame."

From a previous effort in support of hunger strike of Dr KC. – As of Sept 15th, with all that has happened, it seems so “tame.”

Dr GKC’s most recent hunger strike was September 2015, and he suspended it when the government agreed to an eleven-point list of demands.

Here, as reported in the Kathmandu Post, are the eleven points:

The agreement
1)    Form Health Profession Education Commission in the next Cabinet meeting. This Commission will
(a) Formulate Health Profession Policy; (b) Will not renew LoI of Medical Nursing and Dental colleges inside Kathmandu Valley;
(c) Gradually decrease the MBBS seats to 135 then 115 and 100 in next three years; (d) Set Rs 3.5 million fee ceiling for MBBS course; (e) Foreigners should also sit for common entrance examination. For Nepali students they should mandatorily sit for the common entrance before obtaining No Objection Letter and Eligibility Certificate from Ministry of Education and Nepal Medical Council
2)    Form a legal commission to probe abuse of authority in KU and TU
3)    Form a ‘search’ committee without political representation to appoint office bearers in universities and other health councils.
4)    Make the Post-Graduate education free and implement it from this session
5)    Take action against owners of Janaki Medical College and properly manage students
6)    Government medical college should have 50 percent free seats that should be eventually increased up to 75 percent
7)    The government should probe into the extended programme of Dev Daha and Birat Medical College and take action against KU officials.
8)    Halt the process of establishing Medical University
9)    The ratio of government to private medical colleges should be at least at 1:3
10)    Dispatch a letter to KU stating the representation of professors in KU senate.
11)    All the above mentioned agreements will remain accordingly, while the rest will be implemented from the action plan endorsed by the Cabinet from: http://kathmandupost.ekantipur.com/news/2015-09-05/drkc-signs-an-11-point-agreement-with-the-government.html

Response by Private Medical Colleges

In September 2015, there was a surprising twist. Within a day, “The Association of Private Medical and Dental Colleges of Nepal” held a press conference, and presented a five-point plan of their own, saying that many medical colleges in Nepal would go bankrupt if the eleven-point plan was implemented. This has been hinted at in the past,  but now has been stated more forcefully.

infographic of medical education in Nepal 5

Half the population of Nepal lives in Terai. All the medical schools in Terai are non-governmental, i.e., “private” – and I should add, in this region of Nepal there is a higher per centage of Hindi speakers.

The only  list of the five points is in Nepali. Here is a summary from Aug 8th:

Aug 9, 2015-An organisation of private medical colleges has expressed concerns over some of the points in Mathema-committee report, arguing that it would weaken the existing medical colleges and might be detrimental if it is implemented in haste.

The Association of Private Medical and Dental College of Nepal on Saturday asked the government to review the Health Profession Education Policy in such a manner that the ‘fate of private medical colleges are also secured’.

In a statement, association President Dr Bhola Rijal, a senior gynaecologist, has objected to the panel’s recommendations to limit the number of medical seats to 100;  MBBS course fee to Rs3.5million; entrance examination for foreign students and to set minimum requirement of 60 percent in common entrance examination to secure an admission……

–    The Association of Private Medical and Dental College of Nepal demands a policy review to secure ‘fate of private medical colleges’

–    Objects the panel’s recommendations to limit the number of medical seats to 100;  MBBS course fee to Rs3.5million; entrance examination for foreign students and to set minimum requirement of 60 percent in common entrance examination to secure an admission

–    It will automatically put curbs on students going abroad for medical education. From:http://kathmandupost.ekantipur.com/news/2015-08-09/private-med-colleges-call-for-policy-review.html

For me, this caused a re-evaluation. Problems in Kathmandu are one thing. There is a distinctly different set of problems faced by medical schools in the Terai.

infographic of medical education in Nepal 6

From Nepali Times. There twenty one medical colleges in Nepal, one third are in the Kathmandu Valley. This map does not include Karnali Academy of Health Sciences in Jumla.

How can the proposals be decided so as to promote medical education around the entire country? The petrol crisis has highlighted the needs of Terai.

Suspended

All of this was put on hold during the Petrol Crisis. But in January 2016 a bill was put up for discussion in the new Parliament that would authorize “Man Mohan Medical College” in Kathmandu to begin construction of a teaching hospital in Kathmandu. This was exactly against the prior agreement with Dr GKC and his supporters and the Mathema Commission.

Doctor GKC has now met with the Prime Minister, and will begin a new hunger strike in two weeks (January 20th) if progress is not made.

This is the first of a three-part series of diaries. The next part will review the current status medical education, and the third part will address some other concerns specific to the Terai.

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2015 annual report for CCNEPal blog


One of the things I like about WordPress is the ease of access to statistics.

They sent me a summary of activity for this blog.

152 countries

That’s how many locations my readers live. wow!

https://joeniemczura.wordpress.com/2015/annual-report/

 

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“The Dream Trap” is required reading for Nepali nurses thinking of going to the UK


I usually share information about the process of getting a nurse’s license in USA, and I don’t pretend to know about the UK system. The other day somebody shared a link with me that brings you to a paper written by a Nepali nurse in UK who has done research on this subject. Her name is Radha Adhikari. She has done some other writing about nursing in Nepal as well.

it’s titled “The “dream-trap”: Brokering, “study abroad” and nurse. It’s excellent. It’s  a bit long, and the best parts are near the end, but if you are serious about the UK, it’s very worthwhile. It  goes into the history of nursing in Nepal, and especially the history of nurses who go abroad. Then it covers the whole idea of working with consultancies. And it is very honest about the problems that nurses face once they get to UK.

Ms. Adhikari did her PhD work on this subject. Here is the abstract for her doctoral dissertation:

The migration of nurses is stimulating international debate around globalisation, ethics, and the effects on health systems. This thesis examines this phenomenon through nurses trained in Nepal who migrate to the UK. Since 2000, increasing numbers of Nepali nurses have started crossing national borders to participate in the global healthcare market, particularly in the affluent west. By using qualitative multisited research and in-depth interviews with key stakeholders in both Nepal and the UK, this thesis explores why nurses aspire to migrate, how they fulfil these aspirations, and their experience of living and working in the UK. The thesis begins by examining the historical development of nurse training in Nepal, particularly from the mid 1950s. This period saw profound socio-political transformations, including in the position of women in Nepali society and in the perception of nursing in Nepal. Previously, many families were very reluctant to send their daughters into nursing. By the late 1990s, middle-class women and their families were increasingly attracted to nursing, both as a vocation and as a means to migrate. The thesis explores the rise of private training colleges to meet the increased demand for nurse training, and the new businesses that have grown up around the profession to facilitate nurse recruitment and migration. Around one thousand nurses have migrated to the UK since 2000, and the second part of the thesis presents their experiences of the migration process and of working and settling in the UK. Nurses have faced complex bureaucratic and professional hurdles, particularly after UK nurse registration and work-permit policies changed in 2006. The thesis also highlights how highly qualified nurses with many years of work experience in Nepal have become increasingly deskilled in UK. Frequently sent to rural nursing-homes by recruiting agencies, they create and join new diasporic support networks. Further, many have left their loved ones behind, and experience homesickness and the pain of family separation. Often, they plan for their husbands and children to join them after several years, and the research explores this and the issues faced by their families, as they relocate and adapt to life in the UK. Finally, the thesis makes some important policy recommendations. For Nepal, these relate to greater regulation of nurse training and the brokering of nurses abroad. In the UK, they relate to increasing the flexibility of registration and visa regulations to assist in supporting Nepali nurses’ work choices, and to value and utilise their professional skills in the UK better. to find the entire PhD work, go to: https://www.era.lib.ed.ac.uk/handle/1842/6199  

This has been in print for awhile, obviously but I only just found it. Dr Adhikari’s email is in the profile linked above.

 

 

Posted in medical volunteer in Nepal, nursing education | Tagged , , , | 1 Comment

India Nursing Council takes 30,000 Nepali women hostage Nov 9th 2015


link to news article in Nepali language

काठमाडौं– भारतमा नर्सिङ पढेका नेपाली नर्सहरु आन्दोलित भएका छन् । इन्डियन नर्सिङ काउन्सिलले त्यहाँ पढेका नेपाली नर्सलाई दर्ता नगर्ने नीति लिएपछि उनीहरु आन्दोलनमा उत्रिएका हुन् । – See more at: http://swasthyakhabar.com/2015/11/35866.html#sthash.Ie9Edl0j.2owCsNgz.dpuf

http://swasthyakhabar.com/2015/11/35866.html

Please help me improve this blog entry. I know it’s not perfect but it’s a news item many Nepali nurses are interested in.

preparing the banner for the march.

preparing the banner for the march.

Nepali Nursing Students need to read this before enrolling in nursing education in India

If your plan is to study nursing in India, then work in India or go to a third country such as Oz, watch this video. Click here. Or click here for another one. Please share these.

It is especially important to share this with young people thinking of going to India, before they spend any money.

Because I go back and forth from USA to Nepal, nurses ask me about working “abroad.” (to see what I have written, click here). Turns out that many young women study nursing because they hope to get out of Nepal, and go to India, UK, EU, Oz, or – anywhere. I have noticed that since the blockade these are getting more hits. I will write about this in some future blog.

At this time there are said to be 10,000 Nepali women per year graduating from nursing in various Universities in India. Since each program takes at least three years, this adds up to 30,000 people affected. I recently learned about a new problem. See the letter below.

Here is the letter from the India Nursing Council. This issue extends back in time well before the blockade.

Here is the letter from the India Nursing Council. This issue extends back in time well before the blockade.

I learned that a group of Nepali nurses were meeting with the Nepal Nursing Council, and planning a protest. I queried the person who informed me about it. Here is her reply:

We are deeply concerned with the reports that Nepalese nursing students graduated from Indian Nursing colleges are denied registration by Indian Nursing Council. This is clearly a breach of “1950 India-Nepal Treaty of Peace and Friendship” that grants the Nepalese and Indian citizens to live and work in either of the country. Thus, by denying the registration, Indian Nursing Council has barred Nepalese nursing students from pursing Nursing career in India which is totally against the aspiration of the treaty. Also, without registration from parent council, Nepalese nursing students who have graduated via Indian nursing colleges are unable to apply nursing jobs abroad and thereby are restricted from pursuing career abroad despite of meeting all the other parameters.

A protest by Nepali nursing students in Bangalore, India.

A protest by Nepali nursing students in Bangalore, India.

She continued:

India has been a lucrative country for Nepalese students to pursue their study and nursing, top the list. This has not only given an opportunity for Nepalese students to acquire best education but also has opened up business opportunities for many Indian institutes, and the new provision, barring Nepalese nursing students from getting registration will surely jeopardize the business opportunities that nursing colleges from India are enjoying so far, as such discriminatory provision will discourage Nepalese students to prefer India for nursing hereby. Nepal-India relationship has been very special in every aspects and are two very reliable partners from the region, who have strong potentials of working together in making the region a better place. The growing demand of healthcare workers in both countries can only be fulfilled by respecting and acknowledging the value of these healthcare-related students and discovering the ways to assimilate them, which anyway Nepal-India treaty of peace and friendship guarantees. So, this is our humble request to concerned authorities and departments to respect the century-old Nepal-India relationship, diligently adhere with the provision of 1950 India-Nepal treaty that guarantees equal job opportunities for both nationalities, willfully acknowledge the importance of Nepalese nursing students and value their skills and potentials, and weigh this sensitive issue wisely and pragmatically and do the needful.

placards used in the protests.

placards used in the protests.

Finally,

Reportedly, there has never been an issue in this regard in the past and there shall be no issue restoring the earlier provision, that is, registration opportunity for Nepalese nursing students graduated from India. We believe the grievance will be heard and dealt by in earliest possible. #source kagmandu magazine

The nursing students wrote letters to the Nepal Nursing Council and the Nurses Association of Nepal. Click here to read it.
There was an article in a Bangalore newspapers

http://onlinepatrika.com/62684/

[अशोक महर्जन]
काठमाडौँ, २३ कात्तिक । ‘भारतमा नर्सिङ विषय नपढौं’ भन्दै भारतमा नर्सिङ विषय अध्ययन पुरा गरेर फर्किएका नेपाली विद्यार्थीहरु सोमबारदेखि आन्दोलनमा उत्रेका छन् । आन्दोलनको क्रममा विद्यार्थीहरुले सोमबार भारतीय दूतावास अगाडि धर्ना दिएका छन् । धर्नास्थल पुग्नुअघि नेपाली विद्यार्थीहरुले भद्रकालीदेखि ¥याली निकालेका थिए । – See more at: http://onlinepatrika.com/62684/#sthash.i3fOAUbu.otIDopgS.dpuf

Will the Nepal Nursing Council help?

I was previously aware that the Nepal Nursing Council was not enthusiastic about granting Nepal nursing registration to newly-graduated Nepali women who wished to work here. One person from NNC told me “Those schools in India are not as good as Nepal nursing schools. Not enough practical.” The NNC has not made it easy. Historically, there are many nurses in Nepal who attended nursing school in India – and who are in fact, Indian citizens. (more of these work in Terai. Nurses from most parts of Nepal speak at least a little bit of Hindi).

Will the educational consultancies in Nepal help?

This is a good question. One person in the discussion said she thought the consultancies on Putalisadak, where many people go for career advice, do not wish for this to become widely known, since it will affect their profits.

Will the Nepal Government help?

The Nepal government presently has other more pressing diplomatic problems to discuss with the India government. Somehow I worry that they are not in a position to advocate for Nepali citizens working or studying there as effectively as in the past. It occurs to me that no Nepali journo has explored what’s happening to Nepali people in India these days.

I was reminded not too long ago that 600,000 Nepali citizens live and work in India. As we all know, Nepali is one of the twentythree official languages of India. In the 2001 consus, there were 2,871,749 Nepali speakers in India

In November 2014 on my epic India trip, I was invited to teach at a school of nursing in Bangalore.  At this place they were not so rigid about identical uniforms. I enjoyed the colorful Punjabi outfits. The students were smart and enthusiastic and reminded me of USA students.

In November 2014 on my epic India trip, I was invited to teach at a school of nursing in Bangalore. At this place they were not so rigid about identical uniforms. I enjoyed the colorful Punjabi outfits. The students were smart and enthusiastic and reminded me of USA students.

.

Please share widely. I am likely to edit this and improve it with feedback from people who have personal experiences or who are involved in addressing this problem.

Posted in medical volunteer in Nepal, nursing education, south Asia | Tagged , , , , , | 2 Comments

Critique of the Human Rights Watch report on Nepal Oct 16th, 2015 and suggestions


“Like We are Not Nepali”

The Human Rights Watch published a 44-page report investigating the killings in Nepal during the Terai Andolan of August-September 2015. The report was accompanied by a press release and a New York Times article to draw the attention of the international community.

Now that I am back in USA, I have been blogging on DailyKOS, a website with a million subscribers, to which I occasionally contribute since 2008.  I’ve been blogging there every day since the petrol crisis began a few weeks back. Here is my reaction to the Human Rights Watch report.

At the end of the Human Rights Watch report, is a list of recommendations. Keep reading to the bottom, because  I will add some items at the end, that I think were overlooked.

Here are the recommendations from HRW:

IV. Recommendations

To the Government and Security Forces

  • Ensure that all security forces abide by the UN Basic Principles on the Use of Force and Firearms by Law Enforcement Officials.
  • Immediately end the indiscriminate and excessive use of force, and ensure the intentional use of lethal force only occurs where strictly necessary to protect life.
  • Immediately establish an independent commission of inquiry to investigate the unlawful killings of protesters and police.
  • Ensure that these findings are forwarded to the Attorney General’s office for prosecution.
  • Ensure that those accused of violence and other crimes during the protests are accorded full due process rights, including a fair trial, freedom from torture, and access to lawyers and family. Ensure that any statements given by the accused under duress are not introduced as evidence in court.
  • Immediately end the harassment and intimidation of members of the public belonging to the Tharu and Madhesi communities, including beatings, threats, and the use of racial slurs by members of the security forces.
  • Ensure full protection of political rights, including freedom of assembly, association, and speech.
  • Undertake a broad consultation with all aggrieved communities and stakeholders to redress rights violations.
  • Take immediate steps to address any systematic discrimination suffered by minority communities, including providing effective judicial remedies to afford redress and accountability for rights violations.
  • Issue clear instructions that anyone holding public office at any level who engages in hateful speech or incitement of serious crimes will face significant consequences, including investigations and dismissal from public office, and possible criminal prosecution if found to have incited crimes.
  • Ensure all security forces comply with the Ministry of Education’s 2011 “Schools as Zones of Peace National Framework and Implementation Guideline.”

To the Protesters and Protest Leaders

  • Publicly call on all protesters to desist from violence and other crimes.
  • Fully cooperate with the police and others in any criminal investigation into serious crimes.

To the International Community

  • Urgently press the Nepali government to abide by its international obligations not to use excessive force in policing demonstrations and to abide by the UN Basic Principles on the Use of Force and Firearms by Law Enforcement Officials.

  • Press the Nepali government for timely and credible investigations of alleged human rights abuses, and for perpetrators among both the security forces and agitating groups to be prosecuted.

  • Strengthen the capacity of international human rights monitoring inside Nepal, including by pressing for access by the Office of the High Commissioner for Human Rights (OHCHR).

  • Be alert to activities or rhetoric which may contribute to human rights abuses, and strenuously dissuade any actor from taking this course.

My critique

I certainly agree with the recommendations above. HRW seems to be clearly supporting the idea that the government needs to negotiate and compromise with the protesters. The other day a rally in Birgunj attracted 100,000 supporters. If the government plans to use riot police again, it will find that it takes a very large number of riot police to dominate a crowd that size. This has grown well beyond what can be controlled by force.

My perspective is informed by the work I have done in the Terai to teach situational awareness to Nepali doctors and nurses. In the course of that work I have learned about the Health Care in Danger initiative of the International Committee of the Red Cross.(ICRC). The Health Care in Danger initiative posts booklets and guidelines on their page.

The ICRC publication I think people in Nepal need to study is:

Ensuring the preparedness and security of health-care facilities in armed conflict and other emergencies

Date of release: Jul 27, 2015  Languages: English
This publication is intended as a practical manual for governments, hospital managers and others concerned, with a view to helping them prepare for and manage situations that could jeopardize their objective of assisting the wounded and sick and maintaining the health of people affected by armed conflict and other emergencies. Built on the recommendations that emerged from two Health Care in Danger experts’ workshops on ensuring the safety of health-care facilities, which took place in Ottawa, Canada, in 2013 and Pretoria, South Africa, in 2014; this publication has also benefited from contributions by the Canadian Red Cross Society, the Egyptian Red Crescent Society, the Harvard Humanitarian Initiative, the International Federation of Hospital Engineering, the International Hospital Federation, Médecins Sans Fontières, the Pan American Health Organization and the World Health Organization.
It can be downloaded for free as a pdf.  Here is a chapter-by-chapter summary of contents:

Chapter 1 gives an overview of the impact that violence may have on the delivery of health care, highlights the importance of enhancing the security of health-care facilities and discusses the protection afforded by international law.

Chapter 2 focuses on contingency planning for health-care facilities, measures to enhance coordination and cooperation between facilities, and advocacy for the safe delivery of health care.

yy Chapter 3 covers issues relating to the security and well-being of health-care personnel and patients, and methods for preparing for and dealing with stressful situations caused by an emergency.

yy Chapter 4 discusses a number of generally recognized architectural principles and engineering considerations relating to the design of health-care facilities and proposes measures that could increase the security level of infrastructure.

yy Chapter 5 outlines potential risks of disruption in the supply of health-care equipment and goods, and proposes measures to enhance the preparedness and resilience of health-care services.

yy Chapter 6 considers the implications of temporarily relocating health-care services to a safer place when security for staff and patients reaches a higher risk level

My additional items:

For the riot police:
1) arrange for the presence of an ambulance at or near the scene of riot control actions so as to minimize the transit time to medical care for any injured persons.
2) issue first aid kits to each unit in a riot control action and train members of each squad in their use especially to control hemorrhage.
3) ‎retrain police members in proper aim of baton rounds
For hospitals
1) improve security by obtaining the recommendations from iCRC in their “health care in danger” initiative and implementing‎ them.
2) train staff in situational awareness, mass casualty triage and tear gas decontamination.
For protest groups
1) use smartphone video cameras to document all encounters‎.
2) train as many protesters as possible in first aid techniques, especially control of hemorrhage.
 
For all sides
 
1) respect the neutrality of hospitals, medical personnel, ambulances and first aid providers.
2) medical schools and hospitals in the Terai and elsewhere need to ramp up courses of elementary first aid to police and to potential protesters or protest groups.
I would note that on YouTube, there are videos of many of the incidents described in the report, as well as others dating back months or years prior to the current round of protests. It’s clear to me that some of the wounded  in the videos died of hemorrhage, and it is equally clear that the fellow protesters and police had no idea whatsoever, how to use elementary first aid techniques to control bleeding. Some of the deaths were easily preventable after the initial wound. Of course, all of the death were preventable if they protests had not taken place; but if protests are planned,  some attention to treatment of casualties needs to be considered.

I will add to this in coming days. If the readers wish to add something, feel free.

Posted in medical volunteer in Nepal | Tagged , , , | 1 Comment

Welcome Nurse Eye Roll fans!


Welcome Nurses of USA!

I have more than one blog, and this is the one that describes, in professional terms, “CCNEPal” the critical care education project in Nepal that I started in 2011. Please feel free to browse the site.

Nurses need to learn how to do this. (don't try this at home. these are trained professionals under expert supervision)

Nurses need to learn how to do this. (don’t try this at home. these are trained professionals under expert supervision)

There’s a list of blog entries to the right, as well as helpful links to nursing in Nepal. In Nepal I explain USA to the Nepali people I work with. In USA, I explain Nepal to Americans.

Yes, I was in Nepal for the earthquake.

Sangkhu Nepal. Yes, I was in Nepal for the April earthquake but I travel a lot and I was nowhere near the epicenter.

Sangkhu Nepal. Yes, I was in Nepal for the April earthquake but I travel a lot and I was nowhere near the epicenter.

I knew that Kati Kleber, RN, the author of “Becoming Nursey” was going to print a review of my book, and I was pleased to read it today. She was so enthusiastic she made me want to read the thing myself ( and, I already know how it ends!)

Required reading for every medical person who thinks he understands what goes on in Nepal...... available on Amazon at http://www.amazon.com/dp/1632100029

Required reading for every medical person who thinks he understands what goes on in Nepal…… available on Amazon at
http://www.amazon.com/dp/1632100029

I realize that the most recent entry prior to this one was on the care of patients with injury due to “Rubber Bullets” used in riot control actions by police in Nepal. They are having political turmoil, a sad echo of the drama described in my book, The Sacrament of the Goddess. I needed a better entrée page – here it is!

I have never met Kati or spoke with her, but I got acquainted with her writing because she wrote a blog entry on the topic of nurses with Obsessive-Compulsive Disorder. I thought the two entries complemented each other.

Also, I thought her advice for new RNs in Becoming Nursey was right on. It’s been great to follow her blog, and you should do so if you haven’t already.

Brad Wong photo, 2008. women's inpatient ward. eleven women, one bathroom.

Brad Wong photo, 2008. women’s inpatient ward. eleven women, one bathroom.

The novel has it’s own actual blog, as we all as a FaceBook page. I invite you to look at those. In particular, there’s a page titled “Glossary of Terms used in the book” that will help once you finally read the novel.

thanks!

Posted in medical volunteer in Nepal | Tagged , , , | 2 Comments

What you need to know about “Rubber Bullet” in Nepal used by riot police kill 4 year old boy.


note: be sure to click on the colored words. they are hyperlinks.

News from Bhairawaha

In USA we have ample access to firearms, and there are many nurses and doctors  (including me) with experience with ballistic wounds of all kinds. Starting in 1977 when I worked at Boston City Hospital (where the police took every gunshot wound victim), I have dealt with this. In Nepal, not so much. Nobody here owns a firearm. (which is a very good thing!)

Tutorial needed

As the violence continues in Terai, I am thinking that every nurse and doctor needs a tutorial on treatment of wounds from bullets – both the “usual kind” made of lead and steel, and the “Rubber Bullet.”

The tragic news on September 15th 2015 is about a child killed by a “rubber bullet” at a confrontation in Bhairawaha. Here is the News Report video in Nepali: https://youtu.be/XR9vC4jK3RE

What is a “rubber bullet?”

https://en.wikipedia.org/wiki/Rubber_bullet

Rubber bullets (also called rubber baton rounds) are rubber or rubber-coated projectiles that can be fired from either standard firearms or dedicated riot guns. They are intended to be a non-lethal alternative to metal projectiles. Like other similar projectiles made from plastic, wax, and wood, rubber bullets may be used for short range practice and animal control, but are most commonly associated with use in riot control and to disperse protests.[1][2][3] These types of projectiles are sometimes called baton rounds.[4] Rubber projectiles have largely been replaced by other materials as rubber tends to bounce uncontrollably.[5]

Such “kinetic impact munitions” are meant to cause pain but not serious injury. They are expected to produce contusions, abrasions, and hematomas.[6] However, they may cause bone fractures, injuries to internal organs, or death. In a study of injuries in 90 patients injured by rubber bullets, one died, 17 suffered permanent disabilities or deformities and 41 required hospital treatment after being fired upon with rubber bullets https://en.wikipedia.org/wiki/Rubber_bullet

  • There are different styles of  “rubber bullet”
  • A properly trained policeman is supposed to fire the rubber bullet at the ground in front of the protester, so it only hits the protester in the legs.
  • If it hits you in the eye, you will lose your eye.
  • If it hits a child, it can kill – we already knew this. Everybody already knew this.

In the U.K., police are forbidden to use them, (until recently) not even for riot control.

They ARE used in USA, and here is a graphic but short video showing their effect.

If you see a policeman with a gun that has a wide mouth like one of these, it means they are ready to use rubber bullets:

pix paul lewis/http://www.dailymail.co.uk/debate/article-2059053/The-decision-authorise-use-plastic-bullets-bad-wrong.html I don't for sure this is the style that is being employed

pix paul lewis/http://www.dailymail.co.uk/debate/article-2059053/The-decision-authorise-use-plastic-bullets-bad-wrong.html I don’t for sure this is the style that is being employed

Trauma doctors conduct research on this kind of thing. Click here for a report of a medical study of injuries caused by rubber bullets, conducted in Kashmir, where communal violence is a problem.  Among other things, the rubber bullet can pierce the skin and lodge inside the victim.

This is from the Kashmir study. If the wound looks like this, it's an ENTRY WOUND and the projectile is inside the body.

This is from the Kashmir study. If the wound looks like this, it’s an ENTRY WOUND and the projectile is inside the body.

I looked for a specific video on medical treatment of wounds from rubber bullets. Here is a video of what it is like to get hit with one: https://youtu.be/djtnh5vonz8

Doctors and Nurses in Terai need to watch this next video and learn more about projectile injuries

I did find a six-minute video on assessment and treatment of bullet wounds. In USA we have ample access to firearms, and so many people (including me) have experience with these. In Nepal, not so much. The size of the external wound has no relation to the amount of internal bleeding the victim is having.

I would be remiss if I only focused on the medical treatment and made no other comment.

Lessons

The protesters should not be bringing children to these events, or allowing them outside. Would you allow your child outside if a tiger was in the neighborhood?

The police need proper training in use of these weapons.

Escalating violence by throwing stones, invites a police response. The police and the Army, can be counted on to escalate until they dominate. It is foolish to expect them to do otherwise.  They only way they will go away is when people stop provoking them. Express your anger in  a different way, such as by voting.

When you see the police like this, go away from there. It's simple, really.

When you see the police like this, go away from there. It’s simple, really.

Everyone needs to be able to identify “escalation” and “de-escalation” and learn how to de-escalate.

This whole cycle got out of control when the people in Tikapur made a conscious, cold-blooded decision to murder Nepali police that were trying to keep things peaceful. Violence only begets more violence.

Take the lessons of the people in Dang who organized a rally for social harmony.

“This is not just the issue of Dang, people in other parts of country presently fear loss of existing social and communal harmony,” Shanta said. “There is a dire need to voice for restoring and maintaining communal and social harmony in all parts of the nation.”Baharu Tharu, another participant in the rally, expressed worries on the probability of conflict between the Tharus community members and the hill people community. “People from all caste, religion, ethnicity and region should live in harmony. We have helped each other in hard times and must continue doing so in future also,” he said. “As social beings it’s not possible to live in society without helping each other.” – See more at: http://myrepublica.com/society/story/28150/tharu-organize-rally-in-dang-for-social-harmony.html#sthash.TYUG5dX0.dpuf

from Republica. Dang, in western Nepal. These are the women of the town. It seems like the young boys are the violent ones. let's pray for all the cooler heads to prevail. The world will not end Spet 21st just because the new constitution will be announced Sept 20th

from Republica. Dang, in western Nepal. These are the women of the town. It seems like the young boys are the violent ones. let’s pray for all the cooler heads to prevail. The world will not end Spet 21st just because the new constitution will be announced Sept 20th

The new constitution will be announced Sept 20th, and nothing will change that. On Sept 21st, everyone will arise in the morning and look out the window. The world will still be there and it will look the same.

If you are thinking of violence, watch this video.

Finally, the factors that go into “communal violence” (e.g., “a riot”) are complicated. In Nepal, I work in this issue because it is prevalent – long before the widespread protests in Terai region. My second book addresses the question as to why and how this happens, and how nurses and doctors get mixed up in it.

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