For Nepali MBBS docs who wish to do internship in USA


Going to USA?

This will be brief. A Nepali friend of mine got his MBBS degree last year, has completed his internship, and is working as a Medical Officer. This particular person is one of the brightest and most personable docs I have met in Nepal. (and there are many such).

He told me he wishes to go to USA to take an internship. he’s been to the website of a medical school that has a program he would like to enter. But he asked for help as to how to proceed, because he knew he needed to get USA license. “I know I have to take TOEFL and USMLE but what else do I do?” he asked.

I know there are many other Nepali MBBS graduates studying for USMLE. I don’t consider myself expert on USMLE, or on medical credentials for that matter, but – it looks the rules are very clear: you can’t take USMLE until you have passed the ECFMG process.

I did a websearch and found the site for the Educational Commission for Foreign Medical Graduates. The “about” statement says:

International medical graduates (IMGs) comprise one-quarter of the U.S. physician workforce. Certification by ECFMG is the standard for evaluating the qualifications of these physicians before they enter U.S. graduate medical education (GME), where they provide supervised patient care. ECFMG Certification also is a requirement for IMGs to take Step 3 of the three-step United States Medical Licensing Examination (USMLE) and to obtain an unrestricted license to practice medicine in the United States.

Among other things, you can sign up  for a free electronic newsletter, delivered by email, if you go to their site.

Also, you can start the application process, online.

The Fee?

It’s not free.  the initial application costs 6500 nrs. Before you are finished, if you do the whole process involving USMLE, you pay about $3000 USD, not including the cost of a trip to USA to take USMLE step 2 CS.

Do You know any medical school administrators here in Nepal?

ECMFG has newsletters specifically for medical school administrators. These cover a variety of things, such as how to participate in the international system of hosting USA medical students in Nepal. Please ask your medical school faculty to join this site.

Finally, read my book…….

Posted in medical volunteer in Nepal | Tagged , , , | Leave a comment

April 18, 2015 #Criticalcare Road Trip through #Nepal


CCNEPal is a small #NGO with one mission: teach Advanced Cardiac Life Support  in #Nepal.

For months, we planned a “road trip” outside the Kathmandu Valley with twelve sessions. We made 500 sets of handouts, printed 500 certificates, pre-positioned our teaching supplies, and at each location there was a contact person to alert the future participants as to where and when to appear.

How is it going?

I thought you would never ask!

We now have completed four of the twelve, at P.U. in Biratnagar and CMC in Bharatpur.

The group in Biratnagar was 47, more than my "usual" but I had the help of Dipty Subba and fine support of P.U. administration. We talked about ways to collaborate with the entire P.U. system next year. that would be bindass!

The group in Biratnagar was 47, more than my “usual” but I had the help of Dipty Subba and fine support of P.U. administration. We talked about ways to collaborate with the entire P.U. system next year. that would be bindass!

We teach two similar versions of our class. The 3-day version is for nurses. They have not had as much science as the docs have had, and we spend more time going over ecg when we teach them. The usual curriculum of nursing school has not covered ecg, though more and more B Sc schools are including ecg in their senior year work ( due in part to our promotion of this subject and providing them with teaching materials).

CMC batch #1 of senior MBBS students. Seated are my four assistants for the session - without them the teaching would not have been so good. At each location, the goal is to develop local expertise and experience in running these kind of courses, and I have told CMC administration that I thought CMC was amply ready for this leadership role.

CMC batch #1 of senior MBBS students. Seated are my four assistants for the session – without them the teaching would not have been so good. At each location, the goal is to develop local expertise and experience in running these kind of courses, and I have told CMC administration that I thought CMC was amply ready for this leadership role.

The 2-day version goes straight to the protocols and skills needed to perform and lead a team. We use the protocols of the American Heart Association, with specific adaptations to reflect the current medical practice. For example, certain pieces of equipment are not widely available here and for some of the drugs a less expensive substitute is used.

Note: CCNEPal uses the AHA protocols but we are NOT part of AHA, nor does this course award the participants with the official AHA course completion card for ACLS. Our course is based on the needs of Nepal, and our certificate has little Nepal flags on it. :-)

batch #2. Until 2014, CCNEPal focused mainly on nurse training, and we had trained hundreds of critical care nurses throughout the country in our 3-day course. For MBBS we compress it to two days, and it's go-go-go from the moment we start. the growth they show, in skill and confidence, is rewarding.

batch #2. Until 2014, CCNEPal focused mainly on nurse training, and we had trained hundreds of critical care nurses throughout the country in our 3-day course. For MBBS we compress it to two days, and it’s go-go-go from the moment we start. the growth they show, in skill and confidence, is rewarding.

CCNEPal has taught 62 sessions of this training since it’s inception in 2011. Like in the USA, this is not a lecture class. Consistently, the students are surprised by how practical it is. Much of the class consists of simulated patient situations. The team of instructors guides the student in role play and gives feedback on performance.  There are prop we use to make it more realistic, but we keep these inexpensive and low-tech. For  example, we use a set of child’s playground balls instead of  CPR manikins. These can be deflated for travel.

Batch #3 was also good. there is one more group to come, and I'll add them later. CMC has a high standard for the stduents and I loved the team "vibe" they displayed - the spirit of learning and consulting was excellent.

Batch #3 was also good. there is one more group to come, and I’ll add them later. CMC has a high standard for the stduents and I loved the team “vibe” they displayed – the spirit of learning and consulting was excellent

Right now, the best time for new doctors to take this training is during the final months of  MBBS  program, before beginning their internship year. We have collected feedback as to their training, and we hope to share it with you in a future blog.

In Summary

with eight sessions to go, the Road Trip is turning out very well. The students have been great, and in particular, the support from CMC has been wonderful. In my opinion, CMC needs to develop more as the regional resource for this kind of medical training – they are more accessible for the Terai region than Kathmandu will ever be, and the expertise is excellent.

Want more photos?

In the meantime, you can see a lot more pictures if you go to the FaceBook page for CCNEPal.

The Sacrament of the Goddess – a novel set in a hospital in Nepal

If you wish to learn more about the specific challenges of Nepal health care, you can read one of my two books that described boots-on-the-ground bedside care and decision-making. The second is a novel titled “The Sacrament of the Goddess” – I chose that format to keep it readable.  Click here for a review in Nepali language. You can get this novel in Thamel at Vajra Books, and it has a cult following among young docs and nurses in Nepal. Oh, and it is available in USA too!

Posted in medical volunteer in Nepal | Tagged , , , , , , , , , , | Leave a comment

April 6 2015 New Critical Care Book at LNC Library in Sanepa #Nepal


Every nurse in #Nepal is invited to learn about this new resource. It’s perfect if you are doing a research project on ICU care. Or if you wish to learn about mechanical ventilators, for example.

IMG_20150406_064800

This book costs $125 USD (12,500 nrs) and it is considered to be the most comprehensive and authoritative evidence-based procedure manual for ICU in print. The Library at Lalitpur Nursing Campus in Sanepa now has it in the reference section (not for checkout!). It is available to any nurse who wishes to learn from it. You do not need to be a student at LNC to use this resource. If you are going there, call 975 112 1005 to confirm that the library is open.

This book will join the set of American Heart Association books related to BLS, ACLS, PALS, STEMI, and airway now also at LNC.

Here are the books that LNC now owns. Most are from the American Heart Association.  I will also give them the complete set of materials form the pen drive I usually share at sessions of the CCNEPal class

Here are the books that LNC now owns. Most are from the American Heart Association. I will also give them the complete set of materials form the pen drive I usually share at sessions of the CCNEPal class

Here is more information below, taken from the book’s webpage.

Description

AACN Procedure Manual for Critical Care, 6th Ed.

The AACN Procedure Manual for Critical Care, 6th Edition presents procedures for the critical care environment in an illustrated, consistent, and step-by-step format. The Procedures and Patient Monitoring sections are presented in a tabular format that includes special considerations and rationales for each intervention. References have been meticulously reviewed to ensure that the most authoritative and timely standards of practice are used. Additionally, the references supporting care recommendations are identified according to the latest AACN Evidence Leveling System to ensure that you have a complete understanding of the strength of the evidence base.

“The most important aspect of this procedure manual – that sets it apart from ALL the procedure manuals on the market – (is) each procedure is based on the latest evidence and provides a complete EBP (evidence-based practice) resource of critical care procedures. Each step of each procedure has the level of evidence which supports the step.  

Hospitals are struggling with how to insure that their nursing practice is based on the latest evidence – adoption of this procedure manual for a hospital’s critical care units would provide a pain free way to document and verify that critical care nursing practice is evidence-based!”     – Marianne Chulay, RN, PhD, FAAN

Table of Contents:

UNIT I Pulmonary System

Section Editor: Michael W. Day

Section One:

Airway Management

  1. Combitube Insertion and Removal AP
  2. Endotracheal Intubation (Perform) AP
  3. Endotracheal Intubation (Assist)
  4. Endotracheal Tube and Oral Care
  5. Extubation/Decannulation (Perform) AP
  6. Extubation/Decannulation (Assist)
  7. Laryngeal Mask Airway AP
  8. Emergency Cricothyroidotomy (Perform)
  9. Emergency Cricothyroidotomy (Assist)
  10. Nasopharyngeal Airway Insertion
  11. Oropharyngeal Airway Insertion
  12. Suctioning: Endotracheal or Tracheostomy Tube
  13. Tracheal Tube Cuff Care
  14. Tracheostomy Tube Care

Section Two

Special Pulmonary Procedures:

  1. Continuous End-Tidal Carbon Dioxide Monitoring
  2. Continuous Venous Oxygen Saturation Monitoring
  3. Oxygen Saturation Monitoring by Pulse Oximetry
  4. Pronation Therapy

Section Three

Thoracic Cavity Management

  1. Autotransfusion
  2. Chest Tube Placement (Perform) AP
  3. Chest Tube Placement (Assist)
  4. Chest Tube Removal (Perform) AP
  5. Chest Tube Removal (Assist)
  6. Closed Chest Drainage System
  7. Needle Thoracostomy (Perform) AP
  8. Thoracentesis (Perform) AP
  9. Thoracentesis (Assist)

Section Four

Ventilatory Management

  1. Noninvasive Ventilation (CPAP and BiPAP Masks)
  2. Arterial-Venous Oxygen Content Difference (a-v DO2) and Oxygen Transport (Delivery) and Consumption Calculations
  3. Auto-PEEP Calculation
  4. Compliance and Resistance Measurement
  5. Manual Self-Inflating Resuscitation Bag
  6. Indices of Oxygenation
  7. Shunt Calculation
  8. Invasive Mechanical Ventilation (Through an Artificial Airway)—Volume and Pressure Modes
  9. Standard Weaning Criteria –Negative Inspiratory Pressure, Positive End-Expiratory Pressure, Spontaneous Tidal Volume, Vital Capacity, and Rapid Shallow Breathing Index
  10. Weaning Process
  11. Peripheral Nerve Stimulators

UNIT II Cardiovascular System

Section Editor: Debra Wiegand

Section Five

Cardiac Emergencies

  1. Automated External Defibrillation
  2. Cardioversion
  3. Defibrillation (External)
  4. Defibrillation (Internal) AP
  5. Emergent Open Sternotomy (Perform) AP
  6. Emergent Open Sternotomy (Assist)
  7. Pericardiocentesis (Perform) AP
  8. Pericardiocentesis (Assist)

Section Six

Cardiac Pacemakers

  1. Atrial Electrogram
  2. Atrial Overdrive Pacing (Perform) AP
  3. Epicardial Pacing Wire Removal AP
  4. Implantable Cardioverter-Defibrillator
  5. Permanent Pacemaker (Assessing Function)
  6. Temporary Transcutaneous (External) Pacing
  7. Temporary Transvenous Pacemaker Insertion (Perform) AP
  8. Temporary Transvenous and Epicardial Pacing

Section Seven

Circulatory Assist Devices

  1. Intraaortic Balloon Pump Management
  2. Ventricular Assist Devices

Section Eight

Electrocardiographic Leads and Cardiac Monitoring

  1. Electrophysiologic Leads and Cardiac Monitoring
  2. Extra Electrocardiographic Leads: Right Precordial and Left Posterior Leads
  3. Continuous ST-Segment Monitoring
  4. Twelve-Lead Electrocardiogram

Section Nine

Hemodynamic Monitoring

  1. Arterial Catheter Insertion (Perform) AP
  2. Arterial Catheter Insertion (Assist), Care and Removal
  3. Arterial Pressure-Based Cardiac Output Monitoring
  4. Blood Sampling From an Arterial Catheter
  5. Blood Sampling from a Central Venous Catheter
  6. Blood Sampling From a Pulmonary Artery Catheter
  7. Cardiac Output Measurement Techniques (Invasive)
  8. Central Venous Catheter Removal
  9. Central Venous Catheter Site Care
  10. Central Venous/Right Atrial Pressure Monitoring
  11. Left Atrial Catheter: Care and Assisting With Removal
  12. Pulmonary Artery Catheter Insertion (Perform) AP
  13. Pulmonary Artery Catheter Insertion (Assist) and Pressure Monitoring
  14. Pulmonary Artery Catheter Removal
  15. Pulmonary Artery Catheter and Pressure Lines, Troubleshooting
  16. Single- and Multiple-Pressure Transducer Systems

Section Ten

Special Cardiac Procedures

  1. Arterial and Venous Sheath Removal AP
  2. Pericardial Catheter Management
  3. Transesophageal Echocardiography (Assist)

Section Eleven

Vascular Access

  1. Arterial Puncture AP
  2. Central Venous Catheter Insertion (Perform) AP
  3. Central Venous Catheter Insertion (Assist)
  4. Implantable Venous Access Device: Access, Deaccess, and Care AP
  5. Intraosseous Devices
  6. Peripherally Inserted Central Catheter AP

UNIT III Neurologic System

Section Editors: Mary Beth Makic, Teresa Preuss & Debra Wiegand

Section Twelve

Neurologic Monitoring

  1. Bispectral Index Monitoring
  2. Brain Tissue Oxygenation Monitoring: Insertion (Assist), Care, and Troubleshooting
  3. Intracranial Bolt and Fiberoptic Catheter Insertion (Assist), Intracranial Pressure Monitoring, Care, Troubleshooting, and Removal
  4. Combination Intraventricular/Fiberoptic Catheter Insertion (Assist) and Monitoring
  5. Jugular Venous Oxygen Saturation Monitoring: Insertion (Assist), Care, Troubleshooting, and Removal
  6. Lumbar Subarachnoid Catheter Insertion (Assist) for Cerebral Spinal Fluid Pressure Monitoring and Drainage
  7. Intraventricular Catheter with External Transducer for Cerebrospinal Fluid Drainage and Intracranial Pressure Monitoring
  8. Transcranial Doppler Monitoring AP

Section Thirteen

Special Neurologic Procedures

  1. External and Intravascular Warming/Cooling Devices
  2. Lumbar Puncture (Perform) AP
  3. Lumbar Puncture (Assist)

Section Fourteen

Traction Management

  1. Application of Tongs or Halo Ring for Use in Cervical Traction
  2. Halo Ring and Vest Care
  3. Pin Site Care: Cervical Tongs and Halo Pins
  4. Cervical Traction Maintenance

Section Fifteen

Pain Management

  1. Epidural Catheters: Assisting with Insertion and Pain Management
  2. Patient-Controlled Analgesia
  3. Peripheral Nerve Blocks: Assisting with Insertion and Pain Management

UNIT IV Gastrointestinal System

Section Editor: Eleanor Fitzpatrick

Section Sixteen

Special Gastrointestinal Procedures

  1. Esophagogastric Tamponade Tube
  2. Gastric Lavage in Hemorrhage and Overdose
  3. Intraabdominal Pressure Monitoring
  4. Paracentesis (Perform) AP
  5. Paracentesis (Assist)
  6. Peritoneal Lavage (Perform) AP
  7. Peritoneal Lavage (Assist)
  8. Endoscopic Therapy

UNIT V Renal System

Section Editor: Teresa Preuss

Section Seventeen

  1. Continuous Renal Replacement Therapies
  2. Hemodialysis
  3. Peritoneal Dialysis

UNIT VI Hematologic System

Section Eighteen

Fluid Management

  1. Use of a Massive Transfusion Device and a Pressure Infusor Bag

Section Nineteen

Special Hematologic Procedures

  1. Apheresis and Therapeutic Plasma Exchange (Assist)
  2. Bone Marrow Biopsy and Aspiration (Perform) AP
  3. Bone Marrow Biopsy and Aspiration (Assist)

UNIT VII Integumentary System

Section Editor: Mary Beth Makic

Section Twenty

Burn Wound Management

  1. Donor Site Care
  2. Burn Wound Care
  3. Skin Graft Care

Section Twenty-One

Special Integumentary Procedures

  1. Intracompartmental Pressure Monitoring AP
  2. Pressure Redistribution Surfaces: Continual Lateral Rotation Therapy and RotoRest Lateral Rotation Surface
  3. Wound Closure AP
  4. Suture and Staple Removal

Section Twenty-Two

Wound Management

  1. Cleaning, Irrigating, Culturing, and Dressing an Open Wound
  2. Debridement: Pressure Ulcers, Burns, and Wounds AP
  3. Wound Management with Excessive Drainage
  4. Drain Removal
  5. Fecal Containment Devices and Bowel Management System
  6. Negative-Pressure Wound Therapy

UNIT VIII Nutrition

Section Editor: Eleanor Fitzpatrick

  1. Small-Bore Feeding Tube Insertion Using an Electromagnetic Guidance System (CORTRAK )
  2. Percutaneous Endoscopic Gastrostomy (PEG), Gastrostomy, or Jejunostomy Tube Care
  3. Small-Bore Feeding Tube Insertion and Care

UNIT IX End of Life

Section Editor: Debra Wiegand

  1. Determination of Death in Adult Patients AP
  2. Organ Donation: Identification of Potential Organ Donors, Request for Organ Donation, and Care of the Organ Donor
  3. Cardiac Donation
  4. Withholding and Withdrawing Life-Sustaining Therapy

UNIT X Calculating Medication Doses

Section Editor Eleanor Fitzpatrick

  1. Calculating Doses, Flow Rates, and Administration of Continuous Intravenous Infusions
Posted in medical volunteer in Nepal | Tagged , , , | 1 Comment

CCNEPal “Road Trip” starts April 8th – dates and locations announced


Schedule of #ACLS training in #Nepal announced

CCNEPal has always made our training available outside Kathmandu Valley. The next “Road trip” starts in just a few days.

Here is the plan:

April 8th – travel day, from KTM to Biratnagar. by plane.

April 9th and 10th – 2-day session of our critical care course in Biratnagar. I confess I am not certain of the venue, but the contact person is Dipty Subba, of Purbanchal University. She was the contact person for our trip there last year. We expect to have a large batch for this course; for that reason, we would like to invite the nurses who were the “assistants” to help us. Also, this session will be open to both doctors and nurses. If there are docs in Biratnagar who wish to see what the course is about, be advised, I will do what I can to share my materials with you!

April 11th – travel day from Biratnagar to Bharatpur. by bus.

April 12th 7 13th; 14th & 15th; 16th & 17th; 19th & 20th. Four two-day sessions  of the course to train 140 MBBS students and firstyear interns at Chitwan Medical College in Bharatpur. Many of the readers may not know that CMC has begun the initial steps to perform cardiac surgery.  I will lead these sessions, but CMC has designated specific persons to be my “assistants” for the courses, and the idea is for me to mentor them in doing their own teaching. I have enjoyed my previous trips to CMC and they have some wonderful people!

April 21st – travel day from Bharatpur to Bhairawaha. by bus. I will pass the scene of my bus accident. I wonder if the carcass of the bus will be laying there?

April 22nd, 23rd and 24th – three-day session of the Critical Care Course, for nurses at Universal College of Medical Sciences (UCMS) in Bhairawaha. I was there in 2011 and they were wonderful to me.

April 26th & 27th; 28th & 29th; April 30th/May 1st – At UCMS. three two-day sessions of the course, with a focus on medical officers, MBBS students, and interns. The interns will be finishing their time at UCMS, and this course will help them be ready for possible assignment  to smaller health posts.

May 3rd, 4th & 5th – three-day session for UCMS nursing students.

May 6th & 7th  – travel from Bhairawaha to Jumla. By shuttle vehicle. Jumla is in Western Nepal.

May 8th, 9th & 10th; then again 11th, 12th  and 13th – two threeday sessions in Jumla at Karnali Academy of Health Sciences, for hospital nurses, doctors, medical students – everyone. I will be working with the anesthesia department to help them learn how to teach this course.

May 14th & 15th -travel from Jumla to Butwal. Overland. Then a day off May 16th in Butwal, enjoying one of Nepal’s  underappreciated wonders!

May 17th, 18th & 19th – Mayadevi Technical College in Butwal.

May 20th – travel.

May 21st to May 29th –  tentative. I have been invited to College of Medical Sciences (CMS) in Bharatpur but we have not worked out the details.

May 30th – Tribhuwan International Airport. When I get on the plane, I will  look back on a wonderful year in Nepal and India.

Posted in medical volunteer in Nepal | Tagged , , , , , | Leave a comment

part 4) De-Escalation skills for Critical Care nurses and doctors in #Nepal March 31st 2015


Every nurse and doctor in #Nepal needs to be protected against the possibility that an angry family member will harm them.

This is a major fear. It prevents people from wanting to get involved in emergency care. So, CCNEPal teaches skills that will raise awareness of the problem. The first step is to develop “street smarts” – predicting a problem and taking  steps to prevent it.

Note: the words in blue are hyperlinks – click on one and see what happens!

Fourth in  a series

I already wrote three blogs on this topic. The first was about some beginning techniques in dealing with a person who is enraged and not able to be reasoned with. Another one expanded on this, sharing the concepts of  “de-escalation techniques” that are useful. A third blog was about the design of a secure building. In the future I will  write one about  debriefing after an incident, and also about doing drills with the security guards.

Sometimes the only thing that will prevent a problem is to put the hospital on “lockdown”.

If unruly visitors have a weapon and/or make threats to use it, the first duty of staff is to get away, even if it means abandoning the patient.

Not all hospitals are designed in a way that makes it easy to lock down, but many are. It’s important to limit access.

And now I’ll tell you a secret.

The secret is, ever since 2011 CCNEPal has included a role-play of family counseling during cardiac arrest, as part of the course. I never made a big deal about publicity for the role play, because I wished to preserve an element of surprise.   I decided to do it serendipitously in June 2011 with my very first session. Usually it involved asking some members of the class to role play the distraught relatives of a young victim. The role play created a space where people could share their concerns, and I have included role play of family counseling in every subsequent session, more than fifty times since the beginning.

Role play is not new for nurses in Nepal. Most schools of nursing, B Sc or Bn or PCL, do it as part of training in interpersonal skills, and for that reason, we have had excellent portrayal of this scenario.

Not all medical schools in Nepal use role play. My impression is that role play is very new for medical schools in Nepal,  and that few MBBS programs use it as a teaching tool. Here is an area where the medical education authorities in Nepal could profitably spend some time, if you ask me. There are many applications of role play. In the USA, the USMLE step 2 CS exam consists of role play, and every medical student in USA is evaluated according to their ability to do role play. Why not Nepal?

How we do the role play for dealing with families under severe stress

It’s live improv  theater and there is an element of immediacy. The key actresses are usually given a day in advance to plan out their role, and to bring a costume to wear during the event. We plan it out, and make sure every one understands the objectives. Then we do it.

Debriefing =reframing

The role play is theatrical and “fun” and also intense. The most important aspect of the exercise is the discussion and debriefing afterwards. At the debriefing, we accomplish several tasks.  We go over specific strategies to prevent a situation; we talk about ways to de-escalate; we talk about how to assess the family in advance when that is possible; and we share stories of episodes from among the class participants. But some of the most important parts of the debriefing are when the senior nurses talk about overcoming their own fear, or how to address the existential threat posed when the victim needing resuscitation is the same age and from a similar background. This kind of exercise can be an important step in building resilience in critical care nurses.

The benefits of role play in exploring cultural context

We are able to do this because CCNEPal does not run a “sterile” course.  These days, the course from AHA is DVD-based, and an American ACLS course would not be allowed to add a scenario that was not on the script.  It’s my opinion that any course which fails to address the issue of family counseling  does not meet the needs of Nepali nurses and doctors.

Here is a present for those who read this far.

I have allowed people to video the way that CCNEPal uses role play, usually it’s been the scenarios involving resuscitation. But for the scenario involving counseling, I previously asked participants never to post to Youtube or to FaceBook. Why? Because I have been worried about the way it might be misinterpreted. For example, sometimes during the role play, the participants or onlookers laugh.  On the one hand, laughter in the face of a critical situation involving death despite efforts to save a person’s life, could be construed as not taking it seriously – being disrespectful.  On the other hand, laughter in this context is actually a sign that the person is anxious about the topic.

It is important to me that  people know we are serious in using this technique to pursue excellence in family counseling during this kind of crisis, and I do not want to get flamed on this by a non-professional person who stumbles across it not knowing the context.

Here they are

The first video shows a step in the role-play, during which the team is being instructed as to how to prepare.  http://youtu.be/ExhRDE1c6l8

The next one shows the rest of the group, preparing the various roles and explaining how it will go. http://youtu.be/TpTdeq7P8lk

I think these are a good start. I am not ready to post the next one, where we actually do the role play, yet. I will post that one, as well one which shows the debriefing, soon.

I should note, this issue is partly what prompted me to write my second book about hospital care in Nepal, and the book explores the way that Nepali people act as a group. You can get my book at Vajra books on Jyatha in Thamel, or if you are not in Nepal, on Amazon.

In the meantime, I am eager to hear from the readers as to their impressions of this…… please feel free to reply below….

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

About the Dr. GKC hunger strike in #Nepal March 28th, 2015


UPDATE April 3rd, 2015 – here is a link to Nepali newspaper that describes the agreement to end the hunger strike and accede to the demands of Dr. GKC.

I occasionally blog on DailyKos in USA, a web page for political issues. I haven’t been active there lately, but today I wrote about the hunger strike here. I wanted to get some international solidarity with the NMC, NMSS, Dr GKC – and – everybody.

I know I am an expat, but I think some international pressure would help.

Click here to read the DailyKos blog.

Posted in medical volunteer in Nepal | Tagged , , | Leave a comment

donating ACLS books to LNC Library in #Nepal, March 2015


CCNEPal always follows a certain rule: If you bring something to Nepal to share, leave it in Nepal when you return to USA.

Here are the books that LNC now owns. Most are from the American Heart Association.  I will also give them the complete set of materials form the pen drive I usually share at sessions of the CCNEPal class

Here are the books that LNC now owns. Most are from the American Heart Association. I will also give them the complete set of materials form the pen drive I usually share at sessions of the CCNEPal class

I brought with me a set of the most recent up-to-date books from the American Heart Association. I have donated them to the library of Lalitpur Nursing Campus.  Here is more info about donating.

Here is a video tour of LNC library I recorded a few years back.

LNC allows nursing students from other schools, as well as nurses from the community, to use this resource.

The LNC Librarian was happy to get these books.

The LNC Librarian was happy to get these books.

Here is the list of books. Click on each one and you can read about  contents and reviews of these books from Amazon if you like.

Textbook of Advanced Cardiac Life Support – ACLS

Textbook of Pediatric Advanced Life Support (PALS)

STEMI

Airway Management

Facilitator’s Manual for AHA Airway management course

Basic Life Support

EKG/Pharmacology 

Rapid Interpretation of EKGs ( Dale Dubin)

If you are doing a school report, or if you are a critical care nurse, or if you want to be a critical care nurse, you need to take a look at these.

I am also leaving the LNC library a complete set of all the teaching tools I use in my classes, the ones on Pen Drive. They will be available for download on the computers in the library.

What if every videshi nurse or doctor did this?

Here is something we can all do to help keep Nepal nursing education up-to-date. If you know of anybody in USA who will be coming here, ask them to bring just one textbook in their luggage.  Where to get the textbook? they don’t need to buy it – they can go to the nearest nursing school and ask for the faculty to donate a “desk copy” on a current topic. ( a desk copy is one the faculty gets free, to decide whether they will adopt for a course). It doesn’t even need to be the most recent edition!)

Posted in medical volunteer in Nepal | Tagged , , , , , , , , | Leave a comment