The Overall Schedule for CCNEPal summer 2016 is taking shape


The Theme of Summer 2016

In past years, I don’t worry too much about what the schedule will be when I get to Nepal. As long as the first few days are scheduled, I know I will get many eager requests to go here or there. The only small city on the 2016 list is Jumla.

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.

Generally, the eleven weeks this time will be divided into two week blocks. As of today, the first eight weeks are spoken for, and I’ll confirm weeks nine & ten soon.  The work week in Nepal is six days. I take Saturday off each week. Less travel time = more teaching time.

I plan to post a photo album for each session, on the CCNEPal FaceBook page.

Pokhara ( 1 & 2)

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;

About the town: Pokhara is neck and neck with Biratnagar for the title of Nepal’s second-largest city, with about 353,000 people. It is the jumping off point for many treks, and is situated on one of Nepal’s few lakes. I have taught there twice before, for a total of a hundred nurses. There are two medical colleges in Pokhara. The host is Paschimanchal Community Hospital, Buspark, Prithvichowk, Pokhara. The contact persons are: Dr Umid Shrestha, and Sushila Neupane who now is at Charak Memorial Hospital.  (please note that is a correction- I originally gave the incorrect hospital). I will be staying in the city, above and away from “lakeside” while there.

Pokhara_Montage_2

On June 2nd, CCNEPal will travel to the next location.

Bharatpur (3 & 4) – College of Medical Sciences  (CMS)

teaching a 3-day class to nurses and/or nursing students on
Sunday-Monday-Tues June 5th,6th and 7th.
then a 2-day session for MBBS June 9th and 10th;
Then another 3-day class for nurses June 12th, 13th and 14th;
and finally a 2-day session for MBBS/interns June 16th and 17th.

About Bharatpur. This city is located where the road from Kathmandu intersects the east-west highway across the Terai. I first taught here in 2011. The city has two medical colleges, the old (“Purano,” also known as CMS) and the new (“Naiyyan,” also known as CMC). I did not know their official names for quite some time.  CMS has several distinctions. First, they have the single busiest Emergency Room in Nepal, with a breathtaking level of activity. Next, they serve a population that comes down from Makwanpur, the nearby hill district. Bharatpur is the city closest to Chitwan National Park. Contact person there is Mrs. Sita Parajuli, Matron of CMS Teaching Hospital. Also, Dr Biswas Gurung will know where to find me.

Janakpur ( weeks 5 & 6)

2-day version of class for  MBBS, June 19th  and 20th (30 seats)
2-day version for MBBS June 21st and 22nd (30 seats)
2-day version for MBBS 23rd and 24th (30 seats)
3-day version for nurses, 26th, 27th and 28th (30 seats)
3-day version 29th, 30th and July 1st (30 seats)
I will leave Janakpur the morning of July 2nd.

About Janakpur.  I have not taught here before, but they too have a medical college. Janakpur is the site of the Janaki Mandir, a legendary pilgrimage site for Hindus dedicated to the Goddess Sita. Janakpur is also the site where they filmed this documentary about trains.  The primary local language here is Maithili, not Nepali or Hindi.

Biratnagar ( weeks 7 & 8)

2-day version for MBBS July 3rd and 4th (30 seats)
2-day version for MBBS July 5th and 6th (30 seats)
2-day version for MBBS July 7th and 8th (30 seats)
then 3-day version for nurses July 10,11th and 12th (30 seats)
then 3-day version for nurses July 13th, 14th and 15th (30 seats).

IMG_20140717_130423

I was in Biratnagar summer 2014. That time of year, women apply mehendi. These are nurses who took my class. I worked with “CNEplanet” and enjoyed my time there, despite an auto accident on the way. I returned in 2015.

About Biratnagar. I taught here in 2014 and 2015. It is in the eastern Terai, the largest “industrial city” of Nepal. There is a sizeable Muslim population – the Muezzins start up at about 0430 every day. In 2014 they were having a hepatitis E epidemic, and The New York Times featured Biratnagar in this news video. I believe that this is the city where Lonely Planet wrote: “…there is no reason for any western tourist to ever visit this place.”

So – despite the above statement, I can truly attest to how nice the people are in Biratnagar. They were really super. The host agency is Nobel Medical College with Dr. Bandana Paudel.

I don’t drink the water when I am there. My contact person is Mrs. Dipty Subba.

IMG_20150410_114443

This is not Dipty’s usual head gear.

Jumla (weeks 9 & 10)

specific dates TBA.

About Jumla. I have a long story about Jumla, but then again, I have long stories about each of these places. Jumla is home to Karnali Academy of Health Sciences (KAHS), in far-western Nepal. I will go there for two weeks, and most likely using the shuttle as opposed to flying. How exactly to rendezvous with the KAHS shuttle, will be one of the loose ends of the summer. It’s on the opposite end of the country from Biratnagar. Biratnagar is twelve hours from Kathmandu by bus, and Jumla is two days by bus or shuttle.

KAHS is new, and the teaching hospital there has 30 beds. They had a fire in one building this past winter,  after which patients were treated on pallets on the ground in open air for a few days. They wanted me to go there last year to upgrade skills of emergency and especially pre- and post-op nurses, but this was cancelled after the earthquake. Contact person is Dr. Mangal Rawal.  I met him when he was completing his orthopedic residency at Bir Hospital in Kathmandu.

KAHS Jumla nurses 2016

from the KAHS FaceBook Page. The teaching hospital is small and so is the nursing staff.

Jumla has had low rain and crop failure so far in 2016. There are predictions of famine in the district.

After Jumla I will go to Kathmandu. I’ve been asked to do some teaching for an NGO that specializes in “health camps” in the mountains, and other groups. I think by that time, I will need to simply “chill” and enjoy the city.

The above plan is subject to change. It will minimize the bus travel. My 2015 bus accident took three weeks to recover from. Since then I want to avoid the out-and-back trips, designing a circuit instead.

IMG_20150108_112956

I travel light. Here is my collection of “props” for the class.

I will bring my own supply of “organic coffee.” The locals drink tea here as a rule.

The person who met me at the airport in May 2007 is Mr. Ram Maharjun, manager of Shalom Guest House. He will always know where I happen to be. I will also register with the  US Embassy, as in the past.

The best way to follow me is to “like” the CCNEPal FaceBook page.

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


UPDATED with more specific info Wednesday May 4th and 12th

ACLS training registration can be done at:
Registration desk Paschimanchal Community Hospital Buspark, Prithvichowk, Pokhara – 9, Kaski, Nepal. Phone no. 061 530722 Email: pchospital2071@gmail.com

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: http://wp.me/p1pDBL-yy

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: https://youtu.be/XqBjcYSzU_k

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: https://youtu.be/8uQ9sYSP_vY

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: https://joeniemczura.wordpress.com/2015/02/05/schedule-for-2-day-course-in-advanced-life-support-for-mbbs-docs-feb-5th-2015/

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: https://youtu.be/zIdBjw4VBaU

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.

Certificate?

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. https://www.facebook.com/2013KtmCriticalCareNursingCourse/

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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

IMG_20150420_141846

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.

IMG_20150423_102834

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.

IMG_20150510_102114

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

Jumla

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.

Terai

I plan to do a road trip through the Terai.

Bhairawaha,

Butwal,

Bharatpur (x2),

Birgunj,

Biratnagar.

Nepalganj

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:  joeniemczura@gmail.com

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.

Impressions

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.

Paranda

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.

DSC03032a

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: 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.

 

 

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