How to register for critical care training sessions in Pokhara May 2016

UPDATED with more specific info Wednesday May 4th

Please share widely.

CNEPal will return to Nepal for ten weeks in summer 2016. We will be in a variety of cities, mostly outside the Kathmandu Valley. Our goal is to create a widespread knowledge of principles of resuscitation and emergency response, throughout Nepal. In the past we delivered 70 sessions of this course, training 2,170 nurses and doctors. Click here for a report:

We will begin the summer by offering five training sessions in Pokhara Nepal, starting in May.

Here is what one person said after taking the class:

This course covers emergency response and is modeled after the USA “Advanced Cardiac Life Support” course. (It has been adapted to meet the needs of Nepali learners, and is not the official American course).

Here is an example of what you will learn to do when you take this course:

This course has been taught twice before in Pokhara, with the cooperation of Kaski Sewa Hospital. We gratefully acknowledge their support and help. pokhara sign for CCNepal.jpg

Two sessions will be for nurses and three will be for MBBS docs. The nursing sessions will be three days long, and a participant needs to attend all three days. The MBBS sessions are two days in length. Click here for the detailed outline of the two-day course:

How to Register

Class space is limited, and you must register in advance.

Register by going to Paschimanchal Community Hospital, Buspark, Prithvichowk, Pokhara. The contact person is Dr Umid Shrestha.

The sessions will be conducted in the Hall of Paschimanchal Community Hospital, Buspark, Prithvichowk, Pokhara.

Here is a video from one of the previous courses in Pokhara:

In 2013, we did two sessions in Pokhara and trained 95 nurses. There were participants from many hospitals and schools of nursing throughout Pokhara. We hope to have a similar cross section of nurses. Please note: if you took the course before, you are invited to help lead the small groups this time around.

You must attend all days of the session to get the certificate.

UPDATE: Fooding will be included.


Yes, there will be a certificate. It will be beautiful.

This is what the certificate looked like in 2013:butwal acls jombies 2.jpg

There is a final exam and if you don’t pass the final, you get no certificate. 

Hold the date!

2-day session for MBBS docs and interns May 19th -20th

3-day class for nurses May 22nd, 23rd and 24th; then

another 3-day class for nurses on May 25th, 26th and 27th;

then 2-day course for MBBS, May 29th and 30th;

then 2-day class for MBBS, May 31st and June 1st;

On June 2nd, CCNEPal will travel to the next location. We will announce further locations and sessions as they are confirmed.

go to CCNEPal’s FaceBook page and “like” the page.

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CCNEPal planning for summer 2016

CCNEPal is an ongoing educational project since 2011. We have trained 2,170 nurses and doctors in Nepal to use a particular set of critical care skills.

May 1st Update

I bought my ticket and I arrive May 16th to TIA.  I expect to scurry around Kathmandu doing errands for a day or two then get on a bus outside the Valley. First stop I am hoping for is Pokhara for two weeks.

The Big Audacious Goal


MBBS interns at CMC in Bharatpur. These young docs were willing and enthusiastic. A bright spot for Nepal’s future. In the recent exams, the aggregate scores for CMC were among the highest in the country.

CCNEPal’s goal is to promote cardiac critical care training throughout the entire country of Nepal so that it is “owned” by every medical school  and a broad movement of nurses and doctors are comfortable with using and sharing these skills.

Please refer to the report of 2014-2015 activity of CCNEPal to learn my assessment of present capability. The conclusion? Kathmandu Valley has got some good things going, and the best return for the effort will be from work in the Terai.

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.

For those Nepalis thinking about taking the training? It’s easy to find a person who took it before….. ask them if it was worthwhile.

And if you are one of those persons who did take it before… tell your friends. Ask your employer to host the training. I don’t charge a fee, but when it’s outside KTM I do ask for fooding and lodging.

Also – If you took it before – please join me as one of my “assistants” – it’s more fun the second time around.


In May of 2013, CCNEPal started routinely including an anatomy lab in the 3-day session for nurses, to make up for gaps in science preparation ( something I had done in USA for years). For this we obtain en bloc heart-lug assemblies of mutton from local fresh shops. Here’s a shot of the coronary arteries.

Train-the Trainer takes more than just two weeks

We are trying to develop Nepali nurses and doctors to teach these skills and use them in daily practice throughout Nepal, so that it will be “owned” by a wide cross-section of Nepalis. What we do goes beyond the usual “train the trainer” program. The leaders of this course need to be persons who are using the skills in daily practice, but also able to effectively debrief according to what just happened.  When we model these skills in class, the participants begin to use them to critique their skills in the clinical setting.

Read past blog entries to get the course objectives, outlines, etc.


CCNEPal uses role play to teach nurses and doctors about situational awareness. These are the actors from the first session at Crimson Hospital in BTWL, May 2015

I will be returning to Nepal for summer 2016. I have not bought my ticket yet, but it will be roughly May 20th to August 10th. As in the past, I don’t schedule sessions of my courses until I get there. I am humbled at the positive word-of-mouth references people give to the training.

General plan


I will spend a few weeks at Karnali Academy of Health Sciences in Jumla. This is to fulfill a promise I made to a person who is now passed; but – also a separate promise I made prior to the earthquake in 2015.


I plan to do a road trip through the Terai.



Bharatpur (x2),




I will go to BPKIHS in Dharan; and LMC in Palpa. I wanna go to Janakpur. I will return to Pokhara as well.

Traveling to widely dispersed cities becomes “my other life.”  I have friends in all these cities – in some cases they know each other but mostly not – and, people in Kathmandu don’t necessarily know my friends elsewhere…… something amazing always happens on these road trips…. I just don’t know what it will be.

I know it will be hot.

Unlike all the previous places,  I know nobody in Janakpur.  Anybody out there able to introduce me to Janakpur?

Pokhara? why not! I was there twice before and trained about a hundred nurses.

And yes, somewhere on the way I will teach in Kathmandu.

How to schedule?

So if there are nursing schools, medical schools, or hospitals that wish to host me, please contact me and we will set up some dates. I am especially eager to go outside Kathmandu Valley and to areas I have not been before. send email to:

Maybe this is finally the year I will take a trek……

PS – For those persons in USA – If you are an ACLS-I or PALS-I  and you want to help out in Nepal, please contact me. What I do is not part of the American Heart Association, but I know the folks who run the one-and-only AHA ITC in Kathmandu, and they would love to have you affiliate with them.

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CCNEPal goes to CUGH 2016 in San Francisco, April 8th to 11th

CCNEPal will be at the meeting of the Consortium of Universities for Global Health 2016 Annual Meeting in San Francisco, CA April 8th through 11th.

Click here for the conference program.

Poster Presentation

Final Poster Number on Poster Board: 2.037_HRW
Abstract Title: Use of Simulation to Support Role Development for Nurses and MBBS Doctors in Nepal
Presentation Date: Sunday, April 10, 16
Presentation Time: 12.45pm – 2.15pm
Category/Session name:
Poster Presentations: Human Resources and Workforce II
Room: Golden Gate Ballroom (Lobby Level)

We hope to see you there.


I am blown away by the breadth and quality of the speakers, the tracks,the breakouts, the location, and of course, the other poster presentations. There are at least a dozen other posters about ongoing projects in Nepal.


CCNEPal will be giving away trinkets, starting on day one. The specific trinket is a “Paranda” – a hair tassel. (best for people with long hair.)

A paranda looks like this:
paranda 6.jpg

It’s braided into a person’s hair. In Nepal it’s very traditional, but these days not worn as often as before. A paranda is “fun.”

Here is a YouTube video showing what this is like. Fast Forward to about 4:24 to see the trick of braiding it on.

I will be giving these away to anybody that talks to me about Nepal. You will be able to find me because I will be wearing a topi, a traditional Nepali cap.


My main goal is to network with people. I don’t take myself too seriously!!

And of course, to read about the CCNEPal project, browse the other blog entries on this site.

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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:

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:

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.


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!


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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:  

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



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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:

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.


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

[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:

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.

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