Impact of Facebook. Meeting my Students

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Used to be: You’d have an overseas experience and return home. When you were home, you’d develop your photos, which the people in your host country would never see; You’d tell your stories, which the people on your host country would not hear and to which they could not rebut; and their names and identities, so real at the time, would fade into the stereotypes of “otherness”.

Used to be, if you did this as a sense of Christian mission, that it was only about your relationship with God; not about a relationship with humanity. You had the luxury of being smug, you had the luxury to validate your own superiority.

Used to be, if you still were in touch with the locals after that chapter was written, you were an oddity. It was in fact, frowned upon. Many NGO’s had a rule against such contact. Lots of reasons why.

Used to be that while you were away, you disappeared in to a black hole, being a traveller was to be on the dark side of the moon. Not until you returned, would anyone hear the story. That was not entirely a bad thing….

But…. All these things have changed with the internet, and especially with FaceBook (FB). You don’t need to own your own computer in order to have a FB profile. You don’t need an ISP to establish a FB identity. Just a local cyber cafe and a yahoo ID. Perfect set-up for Low Income Countries to get citizens online.

No wonder FB is being used in places like Egypt and Syria. Here, in this instance, is what I have done and how this has impacted *me*

 First, many many of the people who are actually in my book, even as minor “characters”, are now on FB. They can see the Fan Page for the book, and their own photos there. This includes the students from my 2007 clinical group on pedi, one of the best groups of nursing students of my career regardless of which country…

Next, In 2007 I had a digital camera but did not print photos to give to the people who allowed me to photograph them. In 2008 I took the lead from Brad Wong, (a more cosmopolitan traveller than I ) printing the next day and sharing immediately. A simple act to acknowledge a common bond. One more reason why Brad is so wicked-ass cool. I want to be like Brad!

 Third, I used FB prior to this trip to announce my plans in Kathmandu. I knew that to reach an audience of potential students I would need to advertise or to find a means to gather those who wished to learn what it was I wished to teach. I created an event page, and took out a FB ad, just for Nepal. I got 500 replies, and it created a database of local Nepali fans. BTW it’s a very inexpensive market in which to advertise.

FB worked to create community and shared action in Egypt and Morocco – why not here? Why not this? So today came the test. Here in Patan there was load shedding so I heated the coffee water on the stove instead of using the electric teapot with the french press. (We are not as rustic as Tansen, though the Tansen Guest House is still the Last Homely House….probably TGH is one of the most exclusive boutique hotels in all of South Asia. Not just anyone can stay there.) Shaved and showered, and wandered over to LNC, it’s only a ten minute walk. No bandh today.

And set up to register students under the awning in the front yard of the school, which was once a palace of the Rana dynasty. Now, Wednesday is always a day for classroom work, not clinical. Nepali nursing students wear their sari-uniform on these days, color coded by school. So I immediately realized that in addition to the nurses who came to register, we had six different nursing schools waiting. For what? To use the library. Reinforcing for me, my assessment: that the books I shipped/brought/sent by ‘mule’ are valued.

The BN students from Bir Hospital were there and in chorus they begged me to offer my course at Bir on Saturdays. (Nope). Gave them my business card to give to their Campus Chief. I have a soft spot for Bir, it serves Old Kathmandu and is the Trauma Center. Nurses there have that same take-no-shit toughness I recall from Boston City Hospital, my first RN job.

One person who now registered had attended a seminar I gave in 2009 at Bir, and said she wanted this course because she learned a lot that day and liked my style. She teaches at Bir. Says she will get me over there this summer.

Another works for the UN and says maybe I can tag along when the UN maternal-child health team visits Jumla and Dolpo. So I spoke with each person as they registered, and learned their story. I got the email and cell number of each, and also their photograph. I will be setting up a closed FB page to accompany the class, and these pics will be uploaded there.

About forty five people registered. Friday morning we will again conduct registration session. The max I can take is one hundred. Obviously this will force me to adjust the way the material is taught.

I have about six nursing teachers in the course, who basically all said “we want to teach this better than we do now”. I have one bright young person who said “I work at Gangalal” (the heart center that does CABGs, very specialized) “and though I think I already know all this, I want to see how you teach it and I’m not afraid of you. I’ve got a lot of questions!”

Direct eye contact. That one is going to give me a run for my money. Alpha dominance at stake. Little red mark next to her name.

Some said “Our English is not so good we need to learn this but what can we do?” So I will enlist a better English-speaker to sit near them and translate. And so on.

The best story, though, is below. I already sent it out and am retelling here for the blog.


In the meantime, I also queried them, and as I suspected, there is nobody presently doing “mega-code” or anything like it here. It’s been my plan from the beginning to develop an awareness of “mega-code” here, it’s something needed desperately. If you aren’t a nurse, or if ACLS is not a requirement of your job, find a nurse-friend who works in ER, ICU or telemetry and ask their opinion.

In ten words or less, mega-code is a set of simulation games in which the students drill on how to respond to an arrest or near-arrest situation. It includes defibrillation, CPR, drugs, intubation, team skills – the Full Monty. And it is a big chunk of what I bring with me. In the TV show “ER”, most of the action scenes in the trauma room were enactments of mega-code.

A wooden defibrillator?

 Now, one little item. LNC does not own a CPR mannikin, or a monitor, or a defibrillator. We won’t be able to borrow a defibrillator to bring to campus, and to actually show them one, I need to take students to a hospital. In the meantime, I have asked around to find a broken one. Barring that, I will get a local artisan to build me a fake monitor/defib unit out of wood and rope; duct tape and bungee cord; and bondo. Just the idea of doing megacode this way, makes me chortle. Safer to have that type when beginners are involved. Stay tuned.

And the best student story is…

Now for those of you who are teachers – had another one of those things happen to me, which does happen. If you have not has this happen, my wish for you is that it would. Maybe it’s because of who I teach and what I teach ….. You decide.

But: if you have read my book you know that about a third of it ( pages 121 to 205) was devoted to pediatrics and my pediatric clinical group of 2007. Pedi was busy and overflowing that year. After the snakebite incident, “Sanjita” and I shared a group of about ten secondyears. About a dozen pedi patients died during our month long time; we did burn care on some wrenching cases; I was bummed and I cried a lot; as a force-multiplier I did everything I could to push that group of seventeen-year-old girls. The end of my time (as described in the book on page 203) with them was emotional – wouldn’t you have bonded with somebody when together you worked hard to save the life of a pediatric patient only to be there at death? Or did daily burn care on the wounds of Kusmati? For a month?

Anyway, I realized at the time it was my best group of my entire teaching career. They stepped up to the plate and grew and worked and learned and “got it.” Then I saw them again briefly in 2008 but taught a different class-year that summer and they were all in the community.

Dinner with my UH Clinical Group

At my end-of-semester dinner three weeks ago with my two UH clinical groups, a UH student asked me “what’s the hardest semester of nursing school?” And my answer was “the one where you figure out that this is not a game or a joke and that people’s lives are on the table. It’s usually the personal experience of finding that one patient who destroys the myth of your personal invulnerability. For some that’s a patient your own age with similar family background who has a boyfriend that looks like yours. If you are a mom it’s when the dying child in front of you is the same age as your kid.” Naturally this killed the conviviality for a bit…. It was actually a fine dinner and the UH kids parodied me so well that I had a good belly laugh.

Well – what made the 2007 pedi group stand out for me, was the manner in which they went about learning that life lesson for a nurse from the patients we shared.

Today one of the members of that group walked through the door to enroll in this class. I recognized her immediately, and she in turn had that sort of shining-eyed smile. We “namaste’d” and gave each other a deep bow.

Silence for a moment. People of opposite sex do not hug in public in South Asia. Not even if they are married to each other. Even in Hawaii I don’t hug students.

Then a delightful conversation in which she said she was now at Patan Hospital in L and D, but had worked pedi for two years and that every day she tried to do things as “Sangita” and I had taught. We laughed about some of the lighter-hearted antics of 2007, such as them teaching me how to drink water. (Yes it’s a skill that must be learned by foreigners) For all my teaching colleagues: I sincerely hope your former students come back to see you in this way. This is one more reason I teach. There are critical care nurses I worked with twenty years ago with whom I still have a similar bond.

Evening in “Jhamel”

Did some admin work to get the database into the computer to generate course rosters, etc. This evening I joined my friend Bibin with some of his old college buddies at an open-air restaurant about a block from here -“Tamarind.” This neighborhood has sprouted about a dozen such places, they are like Waikiki (but with no nearby ocean). A sort of “Euro-Bar” with a mix of well-heeled Nepalis and Westerners.  Getting to be a scene, Bibin says the slang term is “Jhamel”, because is like Thamel only in Jawalekhel. Trendy – the new peace dividend. The guy who sat across from me does international import/export and was happy to discuss the merits of ways to get books here. I got his business card.

Peace out.

Joe Sar


About Joe Niemczura, RN, MS

These blogs, and my books, and videos are written on the principle that any person embarking on something similar to what I do will gain more preparation than I first had, by reading them. I have fifteen years of USA nursing faculty background. Add to it fifteen more devoted to adult critical care. In Nepal, I started teaching critical care skills in 2011. I figure out what they need to know in a Nepali practice setting. Then I teach it in a culturally appropriate way so that the boots-on-the-ground people will use it. One theme of my work has been collective culture and how it manifests itself in anger. Because this was a problem I incorporated elements of "situational awareness" training from the beginning, in 2011.
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