Cultural taboos in Nepal ?????

Update Nov 26, 2014

Just want to point you to another excellent, and far more comprehensive, blog on the topic of taboo in Nepal. check it out. click here.

The Kathmandu blog is on hiatus while I am in USA. go to my current blog. when you get there, click the “sign me up” box to the right, and you will be subscribed. it’s like magic

 Who let the dogs out?

For those of you visiting Nepal: bring textbooks , or any book, to donate to LNC library….. And hey, share this blog with friends. And the YouTube channel…..

In this town, you have to get used to dogs that bark all night. A chorus. Little yapping lap dogs (soprano) and low pitched Big Dogs (baritone or bass). I prefer bullfrogs or even a whip-poor-will…… Or perhaps Gavia Immer….. I swear they were woofing out a tune at some point…..

Reality TV show.. sort of….

Spend five out of six days in a ballroom with fifteen BN students from LNC….(Or anywhere). It’s like being on a reality TV show – can’t help but see personalities emerge. There are always some in each class who are verbal, assertive and confident. These students draw your attention from the first day. There is a jokester. Or two. There is the administrative leader who collects the daily lunch money. As each day proceeds I get more of a chance to develop the quieter members of the class. The list of names and photos I put on the BB on day one, is very handy because I call on each by name. Nobody can hide or shrink away.

Group Bonding

I think I have done well at getting the group to bond. They started off pretty tight. The material I teach includes time spent doing play-acting as a team, and bonding results in better team play. This is not a group that grew up playing team sports the way girls in USA do. It takes a while to get them to be comfortable “on stage.”

Thursday I brought the camera to video the mega-code teams. We did a drill on CPR and I got out the camera to film each student as they did the shake-and-shout routine. We have only one CPR manikin, and nobody has had CPR training that remotely resembles an American-style course. So I focus on one-rescuer adult CPR, nothing fancy. Five on a team while the other ten classmates watch.

“Vertically Challenged”

We have two students who are so short they can only do CPR if they use a chair to climb onto the stretcher or bed where the victim is, and by short I mean, less than four feet tall. Walking around town, I always notice members of the subgroup of really short Nepalis, and when it is an older person it makes me think about how their growth might have been stunted by famine at a young age before the country was open to foreigners. But these two kids are in their early twenties.

But I digress. Part of the reason I emphasize the CPR component is because it’s viewed as an area in which nurses here are weak. A problem. Universally, docs here tell me the nurses never seem to initiate CPR during an actual emergency, and are reluctant to do it. I have also experienced this. In Tansen my response was to drill the students on the procedures, which was effective – I will tell that story sometime…. My experience there served to incubate my present ideas of how to approach teaching these skills to wider audience.

It’s not rocket science…….

I don’t always think of short people as being leaders….. How many truly short people do you know anyway? Anyway as the exercise proceeded, one of the more shy members of the class was taking her turn, doing chest compressions. The shortest member of the class called out something in Nepali, that made the whole group burst out laughing, and the one doing CPR, blushed. I didn’t quite catch it…. They all quickly looked over at me as she said it, so I knew it was something. Evidently it was a bit on the crude side, something to the effect of “you’re shaking your hips because you know Joe is going to put you on FaceBook!”. ……..

This caught me off guard. The student finished doing her CPR but as soon as she did she left the room with one of her friends for a bit afterwards. I had the idea she was a bit stung by the comment. We still continued with the rest of the megacode drills for two more hours.

For the record, The students have given permission for all photos and I send them a copy as well. Now, Nepal is somewhat of a conservative society in terms of gender roles, even in Kathmandu. Unwritten rules of propriety are still in play, so it was actually not a surprise to see that the students would single out one of their members who was doing CPR; it was merely surprising to hear one of the Nepali women say this out loud, sort of snapping her colleague back into place. Thwack! My natural instinct was a quick check to ask myself if I was somehow leering at this student – and no, I was not – I was off in the ozone watching whether she had proper hand placement and depth of compression….. Duh…..


So for me, the remark seemed to illustrate one of the cultural barriers to CPR as performed by nurses here in Nepal. When the women’s peer group thinks that doing CPR is the same as “strutting your stuff”, people will be more self-conscious about stepping up and performing the skill – whether it’s CPR or – whatever. A manifestation of collectivistic society, an anthropologist might say. Women here would never make even a remotely suggestive move in public. Does that include CPR?

Request for clarification from Nepali sathiharu….

I am cc’ing this to some women friends in USA who are Nepali… Plz tell me what you think….. Is this true? I purposely exploited the collectivist mindset when I mandated that the group form into three smaller teams….. How do you change a group norm? Engage the group!

Anyway, people enjoyed seeing themselves on video, and could see the areas for improvement more clearly. I tried to upload to YouTube but had a problem; if I use the camera I need to load it to the laptop then go to WiFi place. To upload via WiFi takes hours…. So – I will stick with the BlackBerry for future YouTube videos, I think. Today I finished my six-day stretch – a day off tomorrow – aaaaahhhh – what to do?

Get outta town, that’s what!

The next blog will be about ABGs and mechanical ventilation, the theme of Friday’s class. (today) ….. I was happy with the approach I took…. And we had more silliness….. We ended day five -Sunday and Monday we end this cohort – a sprint to the finish for them…..


PS the fifteen in this group will be the first to complete this training and there are definitely a few I will now enlist to be my helpers for the large group mega codes – and for training the MBBS group…. Heh heh heh……..


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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